CHIEF EXECUTIVE OFFICER REPORT TO THE BOARD

December 2018

Annual Business Plan Community MOHLTC Updates Accountability Communications Priorities Engagement

The following is a compilation of the major activities/events undertaken during this

period in support of Mississauga Halton Local Health Integration Network (LHIN) Table of Contents strategic directions:

Access ANNUAL BUSINESS PLAN PRIORITIES 3  Bring Care Closer to Home  Integrate and Partner to Improve Access & Services Through Coordinated Access 3 Efforts Capacity 16  Make It Simpler to Navigate the Health Care System & Reduce Barriers to Quality 21 Access

ACCOUNTABILITY 26 Capacity  Quantify Capacity Needs and Expand Supports to Care Providers COMMUNITY ENGAGEMENT 31  Enhance Program Capacity to Support the Right Care in the Right Place  Recognize and Address the Impact Social Determinants Play in Building a COMMUNICATIONS 34 Sustainable, Person-Centred Health Care System Quality  Ensure the Needs and Voice of the Patient and Their Family Shape How Services are Delivered  Coordinate and Integrate Care with the Person at the Heart of the Health Care System  Foster a Culture of Health and Community Wellness

Cover: Trillium Health Partners and SE Health recognized with the 2018 Minister’s Medal Honouring Excellence in Health Quality and Safety during the Health Quality Transformation 2018 conference on October 17, 2018. Left to right: Julie Drury, Ministry of Health and Long-Term Care; Dr. Dante Morra, Trillium Health Partners; Kathryn Hayward-Murray, Trillium Health Partners; Michael Peters, SE Health; Helene Lacroix, SE Health; Robin Martin, Parliamentary Assistant to Minister, Ministry of Health and Long-Term Care; Dr. Joshua Tepper, Health Quality Ontario

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PROGRESS ON ANNUAL BUSINESS PLAN PRIORITIES

 ACCESS

 CAPACITY

 QUALITY

Critical Care Capacity Planning strengthening opportunities within the LHIN. These important The provincial Life or Limb Policy is a “no refusal” policy for patients with life or limb discussions will inform the development of a three-year capacity plan threatening conditions. The guiding principles of the policy are triggered when a patient is life for the Mississauga Halton LHIN which is targeted for completion in or limb threatened and therapeutic options exist, which are needed within four hours. mid-December 2018. On October 18, 2018, Critical Care Services Ontario held their annual Chronic Disease Prevention and Management town hall meeting with the Mississauga Halton and Central West As the population ages the likelihood of developing chronic conditions increases. Chronic LHINs to provide an overview of the Ontario Critical Care Plan Disease Prevention Management in the Mississauga Halton LHIN focuses on health (2018-2021). A highlight of the event was a presentation by Halton promotion and the self-management initiatives that address the risks associated with the Healthcare and Trillium Health Partners on their organizational progression of chronic conditions within the population. The Mississauga Halton LHIN works activities to enhance patient and family engagement to further collaboratively with our health and community partners across the continuum of care to build healthy environments, increase equitable access to self-management programs and inter- improve the patient experience. Attendees also participated in LHIN- professional care for patients with chronic conditions to improve their quality of life and overall wide critical care system planning and identified priorities for capacity well-being.

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Community Paramedicine program deserve a big thank you. I hope this wonderful caring Peel Paramedic Services opened a third community paramedicine program will continue. clinic in East Mississauga. This expansion will ensure seniors living at ~ Lorraine DeGasperis 177 Dundas Street will have access to a community paramedic once a week who will conduct a health assessment, offer patient education and refer participants to the appropriate community and health care Regional Meals in Home supports. To date, the Mississauga Halton LHIN currently supports Mississauga Halton LHIN’s Meals in Home Program goal is to provide equitable access for three community paramedicine programs across eight sites: meals in home to the most vulnerable residents. Eligibility will be determined by income and  Halton community paramedicine clinics (one site in ability to move about in relation to other medical/health needs. Georgetown, one site in Milton, and two sites in Oakville) As part of a new pilot beginning December 1, 2018, the Regional  Peel community paramedicine clinics (three sites in Meals in Home program will begin to introduce fresh produce in its Mississauga) offerings, including both fruits and vegetables, at no cost to the client.  Community Paramedicine-Led Wellness Clinic and Home Clients will have the option to have their orders prepared and Visit Program (one site in South Etobicoke) packaged for immediate consumption, ensuring barrier free access. The following quote is from one of the seniors who benefits from the Work on the pilot is underway with a new partner, FoodforLife South Etobicoke community paramedicine program and shared her Canada, Halton region’s largest food recovery program. Continuous positive experience with www.toronto.com: quality improvement cycles are planned throughout the fourth quarter with active engagement with clients. A fulsome evaluation will be …When I arrived at my new home, which I have been residing in for completed at the beginning of first quarter of 2019-2020, with hopes the past nine years, I felt something missing — lonely, isolated and to expand the pilot to include other services within the Mississauga sick people with no means of support. As of September 2018, Halton LHIN to incorporate meals or snacks into their programming. community paramedics have set up a program for senior residents in our building every Monday from 11 a.m. until 3 p.m., assisting seniors In addition to the pilot, the “Finding Food’ website (www.finding- with health issues, support, doctors and a feeling of safety. The food.com) is currently being upgraded to customize the client user residents are happier and now have people who care and discuss experience to ensure they are only provided options that meet their issues important to them. I commend paramedics for their involvement specific needs (i.e. such as options available on specific days or by with our community and the welfare of our seniors, lending support public transit); providing more detailed descriptions of available wherever needed, giving hope and balance moving forward with their services; and adding geo location to help clients understand what is lives. All parties that helped set up this community paramedics local to them as well as mapping out the best routes for access.

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Telemedicine Health System Funding Innovation and Transformation The Mississauga Halton LHIN is working to champion and support a culture that uses The Ministry of Health and Long-Term Care continues to test and scale innovative funding Telemedicine solutions to improve access and equity to health care services; to enhance and service delivery models to achieve high quality, more consistent and better integrated health system capacity; and to increase knowledge transfer and collaboration between health care. Under the Bundled Care funding model, designated “bundle holders” receive a single care providers in a way that will positively impact the overall patient and health care provider payment for an episode of care across multiple settings. Health service providers, the LHIN’s experience in the Mississauga Halton LHIN. direct service delivery branch, and relevant stakeholders are collectively responsible for creating seamless transitions and improved outcomes including reduced length of stay, Telemedicine enables providers to remotely diagnose, monitor and treat patients – and helps reduced emergency department visits, reduced hospital readmissions, improved patient, patients manage their illnesses through self-care and access to education and support caregiver and provider experience and improved value for money. systems. The Ontario Telemedicine Network provides the platform and tools, programs and services that make this possible. At the 2018 Health Quality Transformation Conference in October, As part of Enhancing Access to Primary Care, we’ve made significant Trillium Health Partners and SE Health were recognized as the Team strides in the implementation of the Novari eVisit solution, software Based Winners of the 2018 Minister’s Medal of Honour for that enables a patient to initiate a virtual visit with their health care Excellence in Health Quality and Safety for Putting Patients at the provider via their mobile and/or desktop devices. Thus far, 63 primary Heart (PPATH): A seamless journey for Cardiac Surgery Patients. care providers have been registered, trained and using the Novari PPATH brings together the hospital and home care as one team to eVisit platform, exceeding the provincial target of 40 by 57 per cent. provide seamless service to cardiac surgery patients. As of October 2018, we have had 315 eVisits, registered 673 patients, Furthermore, Trillium Health Partners and Halton Healthcare continue and invited a total of 1,955 patients. to advance bundled care for residents undergoing hip and knee Within our addiction and mental health sector, BounceBack surgery in the Mississauga Halton LHIN. As both hospitals have experienced two consecutive months where volumes were exceeded achieved approved agency status, a key feature of this new model of monthly projections. In the second quarter report, there were 222 care involves recruiting and partnering with a single community referrals to the program. Big White Wall implementation plans are agency to provide homecare services. progressing well as the Ontario Telemedicine Network’s formal Ontario campaign launched in October 2018. To date, the Mississauga Health Links Halton LHIN ranks in the sixth position amongst the LHINs for total The provincial mandate for Health Links is moving from a project to an approach to care, registrations with “Managing Stress and Anxiety” and “Managing ensuring that individuals with complex needs get the care they need, when they need it irrespective of the most responsible provider. The expectation is that Health Links will fully Depression” being the two top courses signed up for across the evolve into the sub-region planning approach within the next two years. As we work together province. to spread and scale the Health Links collaborative philosophy, like all LHINs across the province we will use the Health Links Maturity Domains ˗ a model to gauge progress/maturity which includes deliverables and outcomes that fall within four domains ˗ as a guide to move 5 | P a g e December 2018 Annual Business Plan Community MOHLTC Updates Accountability Communications Priorities Engagement along the five level process continuum of leading practice reviews set out by Health Quality 4. Neighborhood Rounding: The Mississauga Halton LHIN is Ontario. The Health Links approach will continue to guide our community partnerships at the piloting a "Community/Neighbourhood face-to-face rounding" point of care, even as we integrate and evolve the Health Links governance structure with with community partners. The aim is to continue to optimize care community (sub-region) planning. an integrated neighbourhood care team breaking down silos Health Links Maturity Domains across care sectors to offer a regular touch point for key team Embedding the Health Links approach for patients with complex members to identify new patient issues, provide updates and needs within the Mississauga Halton LHIN has involved working enable shared decision-making, to inform current care closely with our partners to support a consistent method for planning that leads to more timely access to service and/or identifying these patients. Current initiatives under way include: responsiveness to patient needs. 5. Health Link Measures: In November 2018, the newly 1. Coordinated Care Plans: Working closely with patients and enhanced Health Link Measures were implemented within the circle of care, Coordinated Care Plans are developed for all Home and Community Care and will assist in capturing patients with complex needs. specific data for patients with complex needs receiving the 2. Regional Learning Solution: In collaboration with Health Links approach to care. We are currently in the community partners, we developed a core competency planning phase and working with seven early adoption framework and implemented a Regional Learning Solution community partners to implement these measures. that supports clinicians from a broad range of health service providers to identify patients with complex needs requiring the Embedding Care Coordination in Primary Care Health Links approach. The Regional Learning Solution was Strengthening connections between care coordination and primary also developed to support frontline staff in identifying patients care settings is recognized as a priority to better support patients with with complex needs, enhance care coordination practice and complex needs, as well as to improve the ease of transitions and support embedding the Health Links approach to care within quality of care for patients and caregivers between home and community partner agencies. community care and other health and social services. The goal of the 3. Enhanced Collaboration and Service Delivery: The project is to improve patient experience and outcomes. renewed organizational structure into sub-regions facilitated closer working relationships between frontline care Various practice settings in both urban and rural locations have been coordinators and operations leaders across the hospital and identified to roll out tests of change in the third quarter for which home and community care sectors. This has resulted in models will be finalized over the coming weeks. In order to ensure the enhanced collaboration and service delivery for many complex quality of the data being used for decision making and Ministry patients. reporting, improvements in current processes for data collection have

6 | P a g e December 2018 Annual Business Plan Community MOHLTC Updates Accountability Communications Priorities Engagement been identified, developed and are being rolled out across Home and Primary care advisors have expanded their role to include practice Community Care. Tests of change include streamlining the intake facilitation where they support practice change in primary care offices process, correctly identifying the Most Responsible primary care by working both with physicians and their office staff to implement provider across all sub-regions, working with the primary care new workflows and programs. They have been provisioning, training advisors to identify the preferred method of communication for and supporting practice change for the adoption of eVisit. The practice primary care physicians with care coordinators; and identifying a facilitation approach will be expanded to include eConsult next with practice setting with a critical mass of Home and Community Care the primary care advisors gaining the ability to register, onboard, patients within which to embed a care coordinator. orient, and support Electronic Medical Record integration of eConsult The Community of Practice table has met twice to review the into primary care offices. This will be available for both models of provincial reporting template, best practices across the province and eConsult available in Ontario. opportunities for improving engagement with primary care. The final The primary care advisor role has expanded to include delivering Provincial template for reporting was received on October 24 for academic detailing, evidence based educational outreach, for primary submission on November 7. The levels of connection between care care providers. The primary care advisors have worked extensively coordinators and primary care was collected in early October in with the Regional Palliative Care team to develop an educational preparation for the submission. The project team is working with module to support knowledge translation on the palliative approach in Information Management and Technology with respect to technology primary care. Physicians will receive Mainpro+ credits through the options to ease the recording of care connections from care College of Family Physician of Canada for their participation in these coordinators for future Ministry submissions. one-on-one knowledge translation sessions. Using the information gained through this, physicians will be able to assess patients with Primary Care Evolution palliative care needs to determine the appropriate supports and care to Primary Care Evolution, designed to improve access to primary care and increase linkages provide at each point along a terminal disease trajectory. between primary care and other health care providers, is working towards initiatives that will build awareness of health care system resources and capacity within the primary care sector. The partnership with the Centre for Effective Practice continues with the primary care advisors promoting their academic detailing service Primary Care Advisors focused on Opioids and Alternatives for Chronic Non-Cancer Pain to This fall, the primary care advisors focused their engagements on primary care. hospital and community based programs including the new provincial

Central Intake Process and Rapid Access Clinics for hip and knee arthritis and low back pain, and the Assess and Restore program for frail and senior patients. 7 | P a g e December 2018 Annual Business Plan Community MOHLTC Updates Accountability Communications Priorities Engagement

Mississauga Integrated Care Centre identified the requirement for an Electronic Medical Record and has From a governance perspective, recruitment continues to fill the begun to evaluate the options. remaining positions on the Mississauga Integrated Care Centre Board Health Care Connect of Directors, including the role of Clinical Director – Physician. The Health Care Connect, a provincial program to connect Ontarians with Board has established a mission, vision and values for the a primary care provider, has seen an increase in patients requiring a organization and has begun the strategic planning process. physician who will do a home visit due to their physical condition. Site development for the South West Mississauga site has made This is a very challenging task for our Health Care Connect team to significant headway as floor plans have been approved by both the accomplish as few physicians are willing to take on a new patient City of Mississauga and the Ministry of Health. The tendering process requiring a home visit. The LHIN is exploring innovative methods to was completed with construction expected to start before year end. address this barrier to receiving care including leveraging technology The Mississauga Integrated Care Centre expects to open the doors at and partnering with system partners who already visit the home to the South West Mississauga location in spring 2019. Site selection for facilitate primary care visits for house bound patients. the East Mississauga sub-region continues. Research and Innovation Over the fall, significant engagement has been completed both with Rollout of the research framework has begun with several initiatives, patients, physicians and other key partners. This included focus both internally and externally, going through the Research Committee groups with the Patient and Family Advisory Committee, two focus process. We are pleased to report that the Mississauga Halton LHIN groups with primary care physicians, surveys for both patients and now has 24 Research Champions from across the organization, caregivers and primary care providers, two co-design workshops representing each business stream and portfolio. Our Research delivered by Healthcare Human Design Factors and numerous Champion kick off also took place with resounding positive feedback. individual interviews with subject matter experts. This has provided a plethora of insight into the needs and preferences of both patient and We are halfway through our initiative with Rotman Business School providers as it relates to program planning, site design and how as the final presentations by the MBA students took place at the patients and providers will interact. school on December 4, 2018. New partnerships with the Mississauga Academy of Medicine have been undertaken to recruit students for a At an operational level, significant planning is underway for both the quality improvement project within primary care, looking at palliative care and mental health and addiction clinical pathways, as improving digital health workflow in primary care offices to minimize well as the model of care coordination for the Mississauga Integrated burnout, and improve end of life and advance care planning. Care Centre. The initial recruitment of key staff has begun to support further program planning. The Digital Health working group has

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Addiction and Mental Health cultural ambassador in the community to complete screenings at various Halton Multicultural Council offices to increase the chance of one-Link being connected to services. Metrics and evaluation will be embedded Mississauga Halton LHIN’s one-Link enables equitable access and coordinated care to make it possible for people to receive the right addiction and mental health care, at the right time in this work and the initial scope will be with Chinese, Arab and and in the right place. Development and implementation of one-Link is ongoing. South Asians communities using available socio-demographic data presently collected at point of screening. Projected outcomes include: one-Link continues to offer Safe Talk on a monthly basis to anyone who is looking to increase suicide safe talk skills with a capacity of 20 a) Improving Access to one-Link services. participants per session. This is co-facilitated by one of our trained b) one-Link will receive more accurate information which will service coordinators alongside a peer mentor. inform the screening to send the most appropriate service. Service coordinators have been actively offering access to Big White c) one-Link service coordinators will be more satisfied in Wall and BounceBack online mental health services to all clients at providing support. point of screening to be able to offer early service supports. Big White Wall, an online peer support and self-management tool, was d) Ethno-Cultural/Racial Communities will be aware of mental developed in the United Kingdom and adapted for use in Canada. It is health services. made available to all Ontarians through the Ontario Telemedicine e) Cultural Ambassadors will enhance number of referrals to Network. BounceBack, a telephone coaching program with skill- mental health and addiction. building workbooks and online videos, was also developed in the Staff member anecdote on the powerful effect one-Link peer mentor United Kingdom and has been used by the Canadian Mental Health Chelsea Robertson had during a Halton Healthcare training event: Association British Columbia since 2008. BounceBack is available in many languages, and is managed by Canadian Mental Health “I would like to state that I found Chelsea’s share/speech completely moving and informative. Association Ontario. I had no idea of the history of peer support. And sadly and yet thankfully I will admit that Chelsea hit on some misperceptions that I had…I feel they (peer mentors) are an integral cog one-Link staff will be commencing a project with the Halton in our wheel in terms of the healing/recovery process… I can’t even begin to share the Multicultural Council that will train their Cultural Ambassadors to positive feedback I get about those who have worked with peer supports. I just want to reiterate, it was Chelsea’s speech…how she pulled up a chair, looked us in the eye and work with one-Link service coordinators on different terminologies vulnerably yet factually shared her story of her commitment to peer support.” related to mental health, the process intake once a referral has been sent to a service, and increasing cultural knowledge to best be able to obtain information required to connect to services and supports. As part of this work, service coordinators will be placed alongside a

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Pictured from left to right: John Martin, Peer Support Worker, Trillium Health Partners and Ontario Peer Development Initiative Board Member, Richard Adair. Special Honour for John Martin from Trillium Health Partners

Chelsea Robertson (pictured above), a Peer Mentor with one-Link since Spring of 2015, was a guest John Martin was awarded Peer of the Year at the Ontario Peer speaker that a “Back to Basics” training session speaking to the history of peer support to all of the Development Initiative Lighthouse Awards on October 1, 2018. John mental health and addiction program staff at Halton Healthcare. works on the In-patient unit at Trillium Health Partner’s Credit Valley Sustaining Peer Supports in the Mississauga Halton LHIN site. John was also part of a team that developed a presentation on Peer Supports have been demonstrated to play an important role in both addiction and “Implementing and Sustaining Peer Support in Community Hospitals” mental health recovery. In 2015, Mississauga Halton LHIN increased peer support capacity that was recognized with the Best Poster award at the Association of by adding services to 11 mental health and addiction health service providers. The Mississauga Halton LHIN has also invested in supports to maintain the effectiveness of the General Hospital Psychiatry. John’s peer support role as well as other new and existing peer supports in our region through: coordination of services; best practices peer support positions were part of a series of Mississauga Halton support for health service providers hiring peer support workers; and providing ongoing LHIN investments to enhance peer support capacity in our region. training and development of the peer support workers and their supervisors.

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Excellence through Quality Improvement Projects Cohort 2 & the Developing a National Community of Practice Peer Support Centre’s progress with Validated Research Tool (Survey) Evaluation and Research Integrity, Quality & Impact of Peer Support The Centre for Innovation in Peer Support continues its leadership The Centre for Innovation in Peer Support is in the process of rolling role to facilitate the development of a national Peer Support out the Peer Support Integrity, Quality and Impact assessment tool Evaluation and Research Community of Practice. Working with Dr. that was developed based on the work from Excellence through Simon Coulombe at Wilfrid Laurier University, Robyn Priest at Quality Improvement Projects Cohort 1.0 at St. Joseph’s Hospital in Robyn Priest Live Your Truth, Stephanie Rattelade at Stella’s Place, Hamilton. Excellence through Quality Improvement Projects is a Keely Philips at Centre for Excellence in Peer Support partnership between Health Quality Ontario, Addictions and Mental Waterloo/Wellington and previously Shaleen Jones from Peer Support Health Ontario, Canadian Mental Health Association-Ontario. Canada; a survey was developed to identify peer needs, the work in With strong coaching from the Excellence through Quality progress and interest to building capacity for evaluation, research, Improvement Projects 2.0 team, tremendous support from the hospital quality improvement that align with the values and fidelity of peer team, hospital peer staff and LHIN staff the project is on target to support. meet its goals and objectives. Excellence through Quality Canada-Norway Peer Support Research Project Consultation Improvement Projects 2.0 is focused on peer support in hospital The Centre for Innovation in Peer Support has been advising Dr. settings; optimal “patient experience” and impact by exploring ways Gillian Mulvale, Director, Health Services Policy & Management to effectively balance peer philosophy with hospital policy and Specialization/MBA Program with McMaster University who is procedures. When we complete this part of the project we plan to facilitating some international peer work with a Canada-Norway Peer expand use of the assessment tool survey to all 10 LHIN funded Support Research Project focused on operationalizing peer support in organizations. Once baseline data is developed there will be an acute care settings such as hospitals. There were Mississauga Halton application of Quality Improvement strategies and measures to LHIN implementation learnings as well as evaluation framework and improve and sustain the implementation of authentic peer work in tools shared that will inform the project’s final report. order to build the capacity of the peer work force, peer supervisors, the individual agencies and to authentically support peer support Walk in My Shoes Co-Creation Project across the region. The Walk in My Shoes Co-Creation Project is a joint venture between the Mississauga Halton LHIN and Teach, Empower, Advocate for Community Health – Support & Housing Halton. The project is based on co-design methods that engage people with lived experience and families and friends to share their stories and experiences with opioids 11 | P a g e December 2018 Annual Business Plan Community MOHLTC Updates Accountability Communications Priorities Engagement and other illicit drug use, and to talk about what’s working and what’s No Wrong Door Poster Presentation not working in the health care system and other supports. The No Wrong Door initiative was profiled with a poster presentation On October 17, 2018 the project team attended the Health Quality at Health Quality Ontario’s Health Quality Transformation 2018 Transformations Conference in Toronto. A poster was presented as Conference in October. It highlighted how mental health and part of the Patient and Family Engagement stream of the conference. addiction community organizations in the Mississauga Halton LHIN The conference was attended by more than 2,000 people and traffic at are improving quality care in reducing client “Did not attend” rates. A the poster was brisk. The Walk in My Shoes team spoke to dozens of focus of the presentation was the Canadian Mental Health Association people working in health care or attending as persons with lived – Halton Region Branch’s Peer Support Program as part of the experience or family members and received positive feedback. LHIN’s No Wrong Door initiative, which had experienced a high “No Attendees were interested in the co-design process and how it could show” rate for scheduled appointments. Due to concern that the “No be applied to their own projects and priorities. show” rate could potentially be affecting client outcomes, a 72-hour reminder call was noted in the No Wrong Door Best Transfer Protocol. As a result, there was a substantial decrease in the “Did not attend” rate in the Peer Program and the Canadian Mental Health Association – Halton Region Branch is replicating these learnings to improve the “Did not attend” rate in other programs.

Walk in My Shoes team pictured from left to right: Ilyas Khamis, Debbie Jones, Shayne McCarthy & Alyssa Gremmen – Teach, Empower, Advocate for Community Health – Support & Housing Halton “Every Door is the Right Door” Service System Through the No Wrong Door philosophy of care, providers are embracing a shared commitment to work collaboratively to help people with mental health and addiction challenges access the right service at the right time, adopt common values and objectives and provide exceptional customer service. Pictured is the No Wrong Door IDEAS Poster Presentation 12 | P a g e December 2018 Annual Business Plan Community MOHLTC Updates Accountability Communications Priorities Engagement

Opioid Strategy  Halton Alcohol, Drug and Gambling Assessment Prevention Mississauga Halton LHIN’s strategy to prevent opioid addiction and overdose enables an and Treatment and Halton Healthcare system have partnered to urgent response to the opioid crisis by building equitable and accessible service capacity for support the new Integrated Addictions Medication Clinic on addiction treatment and supports across the region. site at Halton Healthcare System. Alcohol, Drug and The Mississauga Halton LHIN Opioid Strategy, as directed by the Gambling Assessment Prevention and Treatment services are Ministry, aims to augment and align opioids projects and initiatives available in real-time on site to create a supportive treatment across multiple stakeholders focusing on a Four Pillar approach – model for clients and families. Clinic is operational and prevention, harm reduction, treatment and enforcement. Key partners accepting referrals from the emergency department at Halton include primary care, community mental health and addiction Healthcare System – performance metrics and outcomes are agencies, public health units, community health centers, justice being collected and will be available at next reporting cycle. services and emergency management for the goal of a more Regional Practical Clinic coordinated system for clients and families with opioid-use. The Mississauga Halton LHIN’s Regional Practical Clinic offers three levels of Activities to date include: psychotherapeutic intervention, matched to patient need, adapted from cognitive behavioural and mindfulness-based approaches to treat symptoms of depression, anxiety and high stress.  Creation of the Opioids Capacity Project Action Table with the Mississauga Halton LHIN co-leading. Our work is focused on The following graphics illustrate metrics shared at Halton gap analysis and collaboration of services through co-design Healthcare’s Grand Rounds on October 11, 2018. Dr. Steven Selchen, and program evaluation. Zoe Dawe, Tricia Nikkari and Erin Stanners-Moroz with Halton  Collaboration with all system partners to ensure effective Healthcare provided an overview and update of the first year since reporting mechanisms for stakeholder communication and role implementation of the Regional Practical Clinic. understanding. A key example of this collaboration is the Naloxone Kit distribution process to Trillium Health Partners The presentation was very well received and the team has been and Halton Healthcare System coordinated with the Regional approached to present at Trillium Health Partners’ Grand Rounds to Health Department and the Mississauga Halton LHIN. increase knowledge and awareness on this regional resource.  Peel Health Department and Halton Health Department meetings occurring to understand the work underway and support system integration and to review surveillance reports.

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The following are four graphics illustrating metrics shared at Halton Healthcare’s Grand Rounds.

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Care Coordination Optimization Project patients being cared for in hospitals is among the top issues that must be urgently addressed. Alternate Level of Care avoidance and management strategies must be Patients with complex needs should get the care they need, when they need it, irrespective of optimized and coordinated from across all hospital and home and community care partners. the organization considered most responsible for their care. Thus, building community capacity for care coordination has been identified as an important goal both provincially and The strategies identified for this project were developed in collaboration between regionally. To build capacity it was important to understand the current state/capacity of care Mississauga Halton LHIN, Trillium Health Partners and Halton Healthcare who are working coordination in the region. Therefore, objectives of the project are: Understand current state closely together for the success of this project. of care coordination through the region, Deliver an enhanced and consistent approach to care coordination for clients, Reduce duplication of work between providers and ensure patients The Alternate Level of Care Prevention Work stream is a pilot that is only tell their story once, Provide access to the learning solution for any organization who is seeking to understand patients at risk of requiring Alternate Level of providing care coordination as a function, Build capacity and system collaboration for care Care and identifying interventions to reduce the likelihood that these coordination and Align with the Ministry of Health and Long-Term Care’s direction on patients being admitted to hospital or reducing unnecessary access to embedding the Health Links approach across the region. acute care. On October 22, 2018, participants from 10 organizations across the The pilot is one component included in the Mississauga Halton LHIN participated in workshops on the core competencies for care LHIN’s Home and Community Care Quality Improvement Plan coordination functions. The classroom and computer-based training intended to improve lagging indicator performance for unplanned program provides a consistent approach to training on care emergency department visits and hospital readmissions. These coordination core competencies, coordinated care planning, and care measures signal the capacity and strength by which the system is conferencing. To ensure fidelity of the training program, all training ensuring the patient is accessing the right care, at the right time, in the for core competency for care coordination functions are delivered right setting. Patients with chronic obstructive pulmonary disease and through the Regional Learning Centre. congestive heath failure within our region represent a high volume of In December 2018, all Home and Community Care coordinators readmissions rates. The Alternate Level of Care Prevention Work completed two of the computer based core competency training as Stream incorporate the following: refresher to previous training received in 2015.  The Detection of Indicators and Vulnerabilities for Emergency We continue to move forward with planning with our seven early Room Trips scale, which is an evidenced-based tool adopter partner organizations to encourage greater use of the (algorithm) developed for use with the Inter-RAI tool. This Coordinated Care Plan, reduce manual processes, ensure accuracy, tool is used to identify patients at risk of emergency and facilitate timely sharing of Coordinated Care Plan information. department visits, and is used to assist in planning appropriate Hospital Overcrowding – Patient Access and Flow care. Capacity is the single most important issue facing our LHIN when it comes to the provision of  This pilot is a patient-centred model of care that educates and hospital and home and community care. Unprecedented numbers of Alternate Level of Care supports patients to self-manage their chronic conditions 15 | P a g e December 2018 Annual Business Plan Community MOHLTC Updates Accountability Communications Priorities Engagement

according to their own goals and preferences with use of As part of the process, admissions to the unit would be staggered as community support and services. This framework is based on beds are available through attrition. the chronic care model, by using self-management principles, As part of the plan, patient reviews are occurring with our hospital enables people to be more proactive in coping with their partners. Collaboration has occurred with our community stakeholders disease by informing on a more responsive care approach. By including: Behavioural Supports Ontario, hospital partners, Nurse taking a more proactive approach, individuals can identify and Practitioners Supporting Teams Averting Transfers, Alzheimer’s use learned strategies in order to prevent a potential hospital Society of Peel and Sheraton Village Special Behaviour Support Unit admission. team. Trillium Health Partners Psycho Geriatrician has agreed to be The pilot went live on November 19, 2018. the consulting physician for this unit and most responsible person will remain with the house physician. Communication has gone out Alternate Level of Care Management Strategy 2018-2020 internally to Mississauga Halton LHIN staff, as well as an external The Access and Flow Steering Committee met to develop the 2018- memo that aligned with the opening date. 2020 Alternate Level of Care management strategy. Work plans for the initiatives are currently in development with established timelines. Mississauga Halton Palliative Care Network Established in July 2015, the Ontario Palliative Care Network is a formalized provincial The Alternate Level Care draft annual report is pending approval by network tasked with implementing the provincial strategy for palliative care outlined in the the Access and Flow Steering Committee prior to distribution. Advancing High Quality, High Value Palliative Care in Ontario A Declaration of Partnership and Commitment to Action. To support the evolution of palliative care in Ontario, and to align The Hospital Home and Community Care Teams at Trillium Health with the Ontario Palliative Care Network’s provincial strategy, the Mississauga Halton Partners are working on the implementation of the discharge planning Palliative Care Network has formed, with executive-level representation from the LHIN, pathway and standardized process for Joint Discharge Operations. residential and community hospices, and hospitals.

Cooksville Transitional Care Unit Stakeholder Engagement As of December 3, 2018, 30 more beds have been made available Over the past four months, the Mississauga Halton Palliative Care within the Mississauga Halton LHIN. The proposal, completed in Network has engaged a broad spectrum of palliative care stakeholders collaboration with Regional Programs, was initially approved for 32 in developing and finalizing a mission and vision statement that aligns beds (10 beds for patients bound for Long-Term Care and 20 beds for with our objectives in moving palliative care forward in our region. enhanced convalescent care). However, the Ministry later approved to The vision and mission statement were incorporated in the new have two beds on abeyance to create some recreational space for the Network Communications Placemat tool that will be presented and patients, which decreased the total bed census to 30. Eligible patients discussed with our partners through the fall and into the new year. must have a primary diagnosis of dementia with responsive behaviors. 16 | P a g e December 2018 Annual Business Plan Community MOHLTC Updates Accountability Communications Priorities Engagement

Education on the Palliative Approach to Care Improving Palliative Approach to Care in Long-Term Care The Mississauga Halton Palliative Care Network offered a broad Homes range of education opportunities this fall including Learning Essential Through the Long-Term Care Improving and Driving Excellence Approaches to Palliative Care Core session at the end of September Across Sectors Project, work has begun to decrease emergency attended by 27 individuals and Learning Essential Approaches Long- department visits from a long-term care home by increasing the Term Care session at the end of November for five long-term care number of discussions around goals of care with residents and their homes. families. Work will continue in the area of improving the palliative The Mississauga Halton Palliative Care Network Primary Care approach to care within long-term care homes through the work of the Working Group recently developed a Palliative Academic Detailing Mississauga Halton LHIN Long-Term Care Steering Committee. To document, “The Palliative Approach to Care in the Mississauga help measure change in this area and others, development of a Halton LHIN” that has been approved for accreditation to the College Mississauga Halton LHIN Palliative Care Network Regional of Family Physicians of Canada. This document was distributed and Scorecard is underway. presented to all of our primary care physicians in the Mississauga Governance to Governance Collaborations Halton LHIN this fall in alignment with a primary care engagement The Mississauga Halton LHIN Board meets on a quarterly basis with the governors and rollout. executive leaders of both our health service providers and service provider organizations for a Governance to Governance session. These sessions provide a collaborative forum for all Innovative Models of Community Palliative Care for Vulnerable partners to engage on governance issues that affect our local health system. and Underserved Populations Project The Mississauga Halton LHIN held a Governance to Governance Work continues on our pilot project that has a Palliative Nurse session on September 24, 2018. Tim Hadwen, Assistant Deputy Practitioner attend one of our local shelters on a weekly basis to Minister – Health System Accountability, Performance and French provide care to the residents as needed. Work-plan development and Language Services shared a high level overview of the Ministry’s implementation planning is underway for several other initiatives that priorities and an update on Ministry initiatives. were identified in our vulnerable populations report including creation The LHIN Board’s Strategic Planning Task Force provided an of a governance structure, establishment of service pathways and overview of the finalized strategic directions, objectives and outcomes standards, development of consent documentation and a and discussed next steps for TOGETHER – Strategy 2025 which was comprehensive list of the individuals being served and increased subsequently approved by the Board on October 4, 2018. knowledge sharing, training, and education on a palliative approach to care for this population.

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The group wrapped up the evening with a generative discussion on the “strategic levers” or critical success factors in achieving the objectives of the Strategic Plan. The next Governance to Governance session will take place in the fourth quarter and will, in part, focus on the Strategic Plan communication and implementation. Regional Rehabilitative Care Strategy The Regional Rehabilitative Care Strategy is working to standardize and streamline rehabilitative care services across the Mississauga Halton LHIN. The Mississauga Halton LHIN is working with the Rehabilitative Care Alliance of Ontario and local stakeholders to implement initiatives across our hospitals, Long-Term Care home, home and community providers to ensure that eligibility, service standards and access to care can be standardized irrespective of where the patient accesses the system. The Mississauga Halton LHIN is currently working with the

Rehabilitative Care Alliance and the healthline.ca team on their Rehabilitative Care Alliance Rehab portal. The Rehab portal will serve as a centralized rehabilitative care online resource that provides rehabilitative care information across the Mississauga Halton LHIN to the general public and health service providers. This portal will help bridge the information gap across our rehab providers by sharing an online inventory of programs and services offered. In addition, the Pictured above are promotional materials to support the Mississauga Halton LHIN fall prevention month Rehab portal gives the public the opportunity to navigate and find campaign. Top to bottom: Photo of Bill MacLeod, Chief Executive Officer, Mississauga Halton LHIN promoting the initiative; campaign collateral material. rehab programs and services based on individual needs. Health service providers and patient representatives have been engaged to help build In November 2018, the Mississauga Halton LHIN launched an navigation tools to access Mississauga Halton LHIN rehab programs. exciting month-long campaign to help raise awareness around The Rehab portal is expected to go live before the end of this year. To preventing falls. Falls are the leading cause of injury among support the launch, the LHIN is working on a marketing strategy to Mississauga Halton residents over 65. In 2017-2018, falls for our promote this online resource to our residents and health service residents resulted in 8,621 emergency department visits and 1,732 providers. hospital admissions. The campaign targeted our primary care

18 | P a g e December 2018 Annual Business Plan Community MOHLTC Updates Accountability Communications Priorities Engagement providers, health service providers, service provider organizations, home, and other pertinent issues impacting caregivers. All participants and LHIN staff through the introduction of weekly themes. The noted that they acquired a key learning that is applicable to their role initiative also featured a large social media component. See as caregivers. Communications on page 34 to learn more. Bookings/utilization of the Regional Learning Centre space by Mississauga Halton LHIN Regional Learning Centre community partners and Home and Community Care continue to The Mississauga Halton LHIN Regional Learning Centre is an innovative community increase, and there are now regularly more than 30 bookings per educational resource for health service providers, inclusive of both staff and management, as month. well as caregivers in the Mississauga Halton LHIN. The Regional Learning Centre’s community educators, in partnership with the Education and Development Collective, inform Behaviours a diverse educational curricula that reflects a broad spectrum of community needs and The purpose of the Regional Continence Program is to enrich, optimize and maintain the supports using flexible learning opportunities to meet the needs of the participants health and wellness of Mississauga Halton LHIN residents through enhanced awareness, access, assessment and support by promoting bladder and bowel management. The Regional Learning Centre is continuing to build on the progress made in 2018 to provide educational offerings that meet the needs of Earlier this year, the Ministry issued an Amendment to the Ministry its stakeholders. In addition to new courses on mental health in the LHIN Accountability Agreement to support the Ontario Dementia workplace, the Regional Learning Centre is in the process of having Strategy, in which the Ministry has provided the LHIN with up to two staff members trained to facilitate sessions on “Compassion $708,356 in base funding for the 2018-2019 funding year to support Fatigue” for healthcare providers and “Powerful Tools for Caregivers” enhancements to Behavioural Supports Ontario in Long-Term Care. for family caregivers. There has been a significant increase in offsite After a thorough review process engaging key health partners to education numbers with 21 offsite sessions being held, and 231 seats determine how to appropriately allocate this additional base funding, filled. In addition, 19 sessions were run onsite, with 144 participants the Ministry approved the Mississauga Halton LHIN’s and funds attending. flowed to the long-term care homes in October 2018. An education day for family caregivers was held at the Regional This new investment has created 11.5 additional full-time employees Learning Centre as part of a highly collaborative effort to enhance the across the 28 long-term care homes and provided stabilization funding skills and knowledge of family caregivers in the region. In partnership to the existing 47.8 Behaviour Supports Ontario full-time employees. with several Mississauga Halton LHIN Adult Day Services, This investment will also provide the homes with funding for Mississauga Halton LHIN Patient and Family Engagement, and the education and development of staff and the opportunity for the first City of Mississauga, more than 35 family caregivers attended. Eight time to use some of the funds for therapeutic supplies and equipment breakout sessions were offered covering topics such as dementia, that support the delivery of Behavioural Supports Ontario non- power of attorney, music therapy, back safety, living safely in your pharmacological interventions.

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Funds have been allocated to provide education and training for one local strategy as well as examining the capacity and most effective key long-term care home that will act as the lead home for education manner to address the priorities. The decision on which targeted and training within the Mississauga Halton LHIN. An Education and interventions and improvement initiatives will be included in our Development Committee, currently in development, will identify and Annual Business Plan 2019-2020, outlining the planned activities to develop some key training and education sessions/packages that will address population needs at the sub-region level. be made available to all 28 long-term care homes throughout our Rapid Access Clinics LHIN. The goal of “pooling” the education funding this way is so that A provincially driven initiative to implement rapid access assessments using a central intake as a LHIN we can develop a minimum standard of education and model for musculoskeletal patients to increase access to specialist care, decrease wait times training for Behavioural Supports Ontario staff. and increase patient satisfaction through a central shared care model linking primary care, specialists, allied health and patients. The funding has also supported further investments to the community Behavioural Supports Ontario team. This brings the total compliment On November 1, 2018, the Hip and Knee Central Intake and Rapid of the Regional Behavioural Supports Ontario Program in the Access Clinics was launched to support patients with moderate to Mississauga Halton LHIN to 70 full-time employees. severe hip or knee arthritis. By November 15, 2018, primary care providers were starting to route referrals through the Mississauga Sub-Region Planning/Care Communities Halton Central Intake program and patients were receiving treatment Sub-regions have been formalized as part of the Patients First Act, 2016 and reflect a smaller at the Hip and Knee Rapid Access Clinics. There are two Hip and geographic planning region within the Mississauga Halton LHIN. By looking at care patterns through a smaller, more local lens, the Mississauga Halton LHIN will be able to better identify Knee Rapid Access Clinics located in the Mississauga Halton LHIN and respond to community needs and ensure that patients across the entire LHIN have with one at Halton Healthcare and another at Trillium Health Partners. access to the care they need, when and where they need it. The end goal of sub-region To support this pathway, an electronic solution, Novari eRequest, is in planning efforts, is the development of integrated care delivery networks inclusive of health the process of being implemented. The e-solution will increase and social service providers and partnerships encompassing prevention, promotion and care process efficiency, streamline communication along the care for best possible population health outcomes, patient experience and optimized resources. continuum, and capture data. Over the last couple of months, Care Communities have engaged in a series of facilitated discussions to gain a better understanding of the Planning continues for the expansion of Low Back Rapid Access influencing factors affecting health status in their respective sub- Clinics. Spine Surgeons in the Mississauga Halton LHIN participated regions and identified priority populations. These priorities underwent in an overview session on the model of care on November 14, 2018. review in November 2018 to determine commonalities and unique There is currently one clinic in operation in Oakville and full characteristics across the sub-regions. Part of this work will be to implementation is planned for early 2019. ensure alignment of priorities with government areas of focus and

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Wound Care Best Practices Implementation partners, to specifically address the critical need for culturally appropriate mental health and trauma supports. The focus of the wound care program is to work collaboratively with system partners to develop and implement a regional wound care strategy across the continuum of care. The LHIN will continue to expand on the concept of “the right care in the right location, with right products/practices, to enhancement the patients’ experience and to provide high quality care to those living with wounds. Implementation of Health Quality Ontario’s three Wound Care standards to enhance capacity and improve health outcomes for patients with wounds continues within the Mississauga Halton LHIN. With the success seen in the implementation of the Total Contact Cast in home and community care, expansion of the offloading initiative for patients with diabetic foot ulcers has extended to the region’s Community Health Centre (LAMP) and the Mississauga Halton LHIN Diabetes Foot Care Program. Both of these health service providers offer foot care services to low income and high needs patient populations. This expansion will promote patient access to the appropriate offloading options for the prevention, treatment and Photo of Immigrant, Refugee Citizenship Canada Planning Day for Halton and Peel Regions at the Living Arts Centre in Mississauga management of their diabetic foot ulcers. Indigenous Services Health Equity The Mississauga Halton LHIN is committed to efficiently work with Indigenous communities, A key focus for Health Equity is on initiatives aimed at collecting sociodemographic data to create opportunities for collaborations and maximize resources. apply an equity lens to better inform program development and organizational outreach to marginalized groups for improved client outcomes. The Mississauga Halton LHIN participated on a Provincial Best Practice Panel at the Provincial Aboriginal Leads Network Annual On September 14, 2018, the Mississauga Halton LHIN participated in Meeting on October 3, 2018. At the Native Canadian Centre of the Immigrant, Refugee Citizenship Canada Planning Day for Halton Toronto, we shared the exciting work Mississauga Halton LHIN is and Peel Regions at the Living Arts Centre in Mississauga. Over 100 doing with partners at Central West LHIN on the Indigenous Holistic settlement stakeholders were in attendance along with cross-sectoral Wellness Project. This two-year project is a collaborative initiative community partners. Conversations focused on newcomer settlement among four partner organizations – Peel Aboriginal Network, Credit and integration in the region which highlighted the need for more River Métis Council, Canadian Mental Health Association – Halton collaborative partnerships among settlement and non-settlement

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Region Branch and Reach Out Centre for Kids. Together the group is centered on building relationships and discussing wise practices, working to improve Indigenous mental health outcomes by offering collective areas of focus for improving Indigenous health outcomes increased access to Indigenous wellness services, traditional and how we can work together to develop skills and knowledge ceremonies and land based programming provided by Traditional related to improving health service quality for Indigenous Peoples. At Elders, Healers and Knowledge Keepers. the end of the day, participants developed concrete action steps to improve quality, access and equity in Indigenous Health. An important first step is the online Indigenous Cultural Safety training that many in the LHIN have already completed. The goal is to offer more spots to staff in the near future. On October 26, 2018 members of the Ontario Indigenous Cultural Safety Program and Traditional Indigenous Elder Cat Criger facilitated an all-day event with the Leadership Executive Teams of the Mississauga Halton and Central West LHINs, and Medical Officers of Health for Peel and Halton Public Health Units. The workshop focused on building relationships among the Public Health Units and the LHIN Leadership Executive Teams to better understand their shared mandate to explore opportunities for ongoing collaboration in health planning for Indigenous Peoples; exploring how these organizations can improve their inclusiveness and accessibility for Indigenous Peoples; and raising awareness of the From Left to Right: Jean-Marc Maheu, Councillor, Credit River Métis Council, Elizabeth Molinaro, Lead, National Truth and Reconciliation Commission’ Calls to Actions to French Language Services, Mississauga Halton LHIN, Dr. Jairus Skye, Executive Director, Peel advance Indigenous Health. Aboriginal Network, Dieufert Bellot, Former French Language Services Coordinator and Indigenous Health Consultant, Central West LHIN French Language Services Meeting participants at the 2018 Provincial Aboriginal Leads Network In improving Francophones’ equitable access to health care in a minority situation, we work Annual Meeting included members of the Ontario Indigenous Cultural with community members, partners and health service providers to break down linguistic and cultural barriers. We explore potential pathways to build capacity by developing Safety Program, Pan-LHIN Indigenous Health Leads, LHIN CEOs implementation strategies for the active offer of French language services). and their delegates, prominent Indigenous community organizations and community members from across the province. The full-day event At the September 2018 French language services Community of Practice meeting, a member of the Réseau franco-santé du sud de 22 | P a g e December 2018 Annual Business Plan Community MOHLTC Updates Accountability Communications Priorities Engagement l’Ontario / French Health Network of Central Southwestern Ontario long-term care services and can live fully in French throughout all presented the “Welcoming Community” initiative, a community phases of their lives, in an environment respectful of their cultural, approach to promoting increased access to bilingual health social and linguistic abilities and values. Specialized long-term care professionals in official language minority communities. The French needs of the Francophone communities were defined and innovative language services Community of Practice will participate in this models adapted to the various needs of the Francophone communities, opportunity to enhance French language services in our region. As we their families and caregivers were explored. work together to develop local collaborative welcoming practices with Mississauga Halton LHIN Regional Quality Table future bilingual professionals, we strive to strengthen relationships The Regional Quality Table is a partnership between the Mississauga Halton LHIN and and collaborations between groups of health service providers that Health Quality Ontario, and provides a mechanism to advance the foundations for clinical support French language services and bilingual healthcare for college quality improvement in support of the LHIN’s Integrated Health Service Plan. The Regional and university students by sharing information and collaborative Quality Table will align the quality agenda across the LHIN to build on existing efforts and opportunities such as student placements, mentorships, volunteer promote a culture of quality to enable improved patient outcomes, experience of care and value for money. positions and training programs. On September 13, the Regional Quality Table held a meeting to Reflet Salvéo, the French Language Health Planning Entity, also refresh its terms of reference and work plan, discuss the work to be presented at the November 2018 Meeting of the Mississauga Halton completed by fiscal year-end and the projects going forward. The Board of Directors. Joyce Irvine, Vice Chair of the Board of Directors terms of reference now includes an additional focus implementing and Gilles Marchildon, Executive Director, Reflet Salvéo, highlighted Health Quality Ontario’s quality standards. The sector update focused the strong working relationship between the Mississauga Halton on primary care and the Regional Quality Table members were given LHIN and Reflet Salvéo. Major achievements for this past year a great overview of the current challenges, priorities and pros/cons include Francophone health promotion services, English language with the Integrated Regional Quality Improvement Plan indicator Leadership Training on Active Offer for health service providers and “acute care patient follow-up by a physician within seven days of record breaking Francophone community engagement participation. discharge”. The working group selected one quality standard On November 23, 2018, the Mississauga Halton LHIN participated in (Behavioural Symptoms of Dementia) to test the approved process a forum on Partnering for Innovative and Collaborative Long-Term and these learnings and results were presented at the November 8, Care Solutions for Francophones at the Alliance Française in Toronto. 2018 meeting. In addition, the Regional Quality Table was engaged in Stakeholders from the public, private and not-for-profit organizations providing feedback on the draft Mississauga Halton LHIN Quality and participated in this full-day event where leading and best practices Risk Framework and viewed the Health Quality Ontario LHIN were shared. Conversations focused on envisioning a future where Quality Improvement Plan snapshot and LHIN spotlights. Francophone adults experiencing loss of autonomy have access to 23 | P a g e December 2018 Annual Business Plan Community MOHLTC Updates Accountability Communications Priorities Engagement

School Based Rehabilitation Services transferring from Digital Health LHINs to Children’s Treatment Centres Electronic Medical Record Implementation The Government of Ontario is taking steps to support children and youth with special needs An Electronic Medical Record is a digital version of the traditional paper-based medical get the services they need at home, at school and in the community, as they transition to record for a patient. The Electronic Medical Record typically represents a medical record adulthood. within a single facility, such as a doctor’s office or a clinic. OntarioMD managed the program put in place to help physicians and specialist fund the implementation of a specification A key initiative of this strategy is the integrated delivery of compliant Electronic Medical Record system. rehabilitation services. As part of this initiative, existing Mississauga Halton LHIN school support services contracts for speech-language As part of the Digital Health Primary Care plan for the Mississauga pathology, occupational therapy and physiotherapy services in Halton LHIN, we will be taking a look at where our Electronic publicly funded schools will be transitioned to our Children’s Medical Record gaps are within each sub-region and building an Treatment Centre, ErinoakKids. The goal is to make it easier for approach to help close those gaps. In addition, we will be establishing families to access services, while ensuring seamless care from birth education and training material to help positively influence the use of through the school years. Electronic Medical Records along with the quality and consistency of data within. High level data gathering has begun through the support After a brief pause, all LHINs received a joint update from the of OntarioMD. Ministry of Health and Long-Term Care and Ministry of Community, Children and Social Services on August 31, 2018, instructing the The process of selecting an Electronic Medical Record for the reinstatement of the direction to the transfer of contract management Mississauga Integrated Care Centre has begun. Evaluation criteria and from LHINs to the Children’s Treatment Centres winter 2018-2019. business requirements are being finalized with a selection target in the The internal project team has been reinitiated and Mississauga Halton third quarter. From a sub-region perspective, we are also looking at LHIN is working with ErinoakKids, LHIN and service provider identifying Electronic Medical Record gaps, and through analysis of partners to meet the timelines set out by the Government to ensure these gaps, preparing recommendations to the LHIN. seamless transition of school-based rehab services. The executed Data The Electronic Medical Record Quality Dashboard initiative by Sharing Agreement has enabled further progression of the work to OntarioMD is a framework of indicators for physician’s Electronic transitioning the services to ErinoakKids and timelines have been Medical Records (OSCAR, Practice Solutions and Med Access) established for the remaining steps in the process. The LHINs which allow high level visual representation of Electronic Medical continue to work in collaboration with Health Shared Services Ontario Record data using widely-recognized, primary care indicators. These and the Ministry on a standardized approach across the province. indicators can be used in the management of various patient populations (i.e. eligible patients who have been screened for colorectal cancer). Within the dashboard the physician can drill down 24 | P a g e December 2018 Annual Business Plan Community MOHLTC Updates Accountability Communications Priorities Engagement into the standardized patient data present in their Electronic Medical Both hospital organizations have completed all phases of the Record. The forecast of 33 physicians has been exceeded by six per ConnectingOntario implementation (data contribution and data cent. We now have 35 deployments and 27 physicians who have viewing). Adoption efforts continue within each organization. completed the associated training. In support of the decision made by the Mississauga Halton LHIN

Executive team, ConnectingOntario is the preferred solution for all Health Report Manager Implementation clinical staff of the LHIN as of November 7, 2018. OntarioMD's Health Report Manager enables physicians using electronic medical records to receive direct electronic hospital reports into their patient's medical record within 30 minutes of transcription. We currently have approximately 581 primary care physicians (up three per cent) and 165 specialists (up two per cent) live on Health Report Manager receiving electronic hospital discharge reports for their patients directly into their OntarioMD certified Electronic Medical Records.

ConnectingOntario (formerly cGTA) ConnectingOntario is a regional solution that supports the delivery of provincial electronic health records by linking and integrating electronic patient information from across the care continuum and making it available at point-of-care to improve the patient and clinician experience. There are currently over 41,000 enrolled users who will gain access to their patient’s records through ConnectingOntario, that’s more than double the original target for enrollment. The delivery team for the eConnect project continues working with our long term care homes to implement the integration component that will allow a contextual launch from PointClickCare to

ConnectingOntario. One long-term care home was successfully implemented in November and 15 went live in November 2018. The remaining 10 long-term care homes will launch in 2019.

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ACCOUNTABILITY Ministry-LHIN Accountability Agreement Targets The purpose of the Ministry-LHIN Accountability Agreement Targets is to establish the performance obligations between the ministry and the LHIN related to key operational and funding expectations not already addressed in the Local Health System Integration Act, 2006. The draft 2015-2018 Ministry-LHIN Accountability Agreement Targets is comprised of 13 performance indicators, eight monitoring indicators and two developmental indicators. All performance targets are established at the provincial level whereby all LHINs will be held to account for the same target.

2018 Q2 Performance Variance by LHIN of2018 all Q2 Ministry Performance-LHIN Variance Accountabil by LHIN of all MLAAity Indicators Agreement (data as of Targets 14 November Indicators 2018) (data as of November 14, 2018)

LHIN Provincial A. Performance Indicators LHIN Target ESC SW WW HNHB CW MH TC C CE SE CH NSM NE NW Performance performance PSW 95.00% 89.66% 87.09% 92.60% 90.21% 94.06% 87.89% 82.59% 89.66% 95.67% 94.53% 86.36% 90.70% 69.79% 86.34% 87.18% 85.71% Nursing 95.00% 96.60% 96.37% 96.46% 94.74% 96.15% 95.63% 97.15% 96.60% 96.74% 96.60% 97.06% 95.72% 95.60% 97.37% 98.86% 96.08% Home & Community In-Home Services HCC: Community 21.00 23.00 27.0 19 25 15 28 27 23 27 23 46.5 20 42 36 29 23 HCC: Hospital TBD 9 7 5 12 6 6 8 9 12 6 11 7 11 7 10 5 Complex 8.00 10.23 10.60 9.78 8.23 9.33 15.43 9.22 10.23 13.77 10.22 10.75 8.62 11.37 10.08 8.35 10.17 EDLOS Minor 4.00 3.87 4.62 4.92 4.00 5.18 5.38 3.90 3.87 4.80 4.15 4.78 4.68 5.57 4.48 4.25 5.05 Surgical & Diagnostic Hip 90.00% 53.04% 78.98% 89.39% 49.88% 65.58% 73.08% 74.68% 53.04% 94.66% 92.69% 89.15% 78.83% 87.86% 74.14% 83.08% 89.66% System Integration & Access Wait Times Knee 90.00% 44.10% 74.88% 73.01% 52.04% 59.41% 68.52% 47.47% 44.10% 96.27% 93.20% 85.79% 73.63% 92.58% 74.21% 67.35% 76.73% % ALC 9.46% 13.74% 15.88% 11.11% 8.95% 14.74% 16.70% 12.26% 13.74% 10.67% 17.71% 20.42% 16.84% 14.14% 21.94% 29.42% 23.88% Wasted Bed Days ALC Rate 12.70% 14.04% 15.54% 12.81% 12.17% 14.15% 14.91% 6.85% 14.04% 11.75% 13.60% 21.89% 19.91% 13.57% 22.37% 24.98% 33.02% Health & Wellness of MH 16.30% 17.16% 21.97% 19.36% 21.71% 17.66% 21.11% 26.83% 17.16% 29.38% 20.91% 21.98% 21.79% 20.52% 17.24% 18.92% 22.05% Repeat ED Visits Ontarians - Mental Health SA 22.40% 31.89% 34.97% 28.36% 30.40% 29.54% 33.86% 40.25% 31.89% 42.71% 27.90% 29.99% 26.54% 27.75% 20.44% 32.76% 46.76% Sustainability & Quality Readmissions 15.50% 15.05% 16.62% 16.68% 17.79% 15.43% 16.46% 16.29% 15.05% 18.40% 15.81% 16.39% 17.30% 15.12% 17.59% 17.15% 16.88%

B. Monitoring Indicators ESC SW WW HNHB CW MH TC C CE SE CH NSM NE NW Cataract 90.00% 68.21% 85.56% 84.51% 83.48% 64.72% 93.87% 96.32% 68.21% 81.84% 99.65% 99.25% 65.40% 84.80% 60.09% 87.09% 95.29% Surgical & Diagnostic MRI 90.00% 83.09% 70.79% 84.95% 64.66% 86.52% 64.70% NA 83.09% 61.02% 82.27% 94.18% 75.02% 70.10% 55.54% 68.67% 58.22% Wait Times CT 90.00% 81.68% 85.73% 95.37% 82.48% 95.83% 76.82% 95.97% 81.68% 76.11% 88.76% 99.17% 83.58% 85.22% 83.84% 84.59% 88.28% Community NA 13 14.0 11 8 12 9 20 13 N/R 24 20 13 22 13 8 44 System Integration & Access LTC Assessment Hospital NA 9.50 7.0 2 3 6 6 15 9.5 N/R 4 9 6 13 33 10 15 ED visits NA 1.00 3.30 3.16 9.01 2.34 3.35 1.27 1.00 0.93 1.20 2.27 7.40 3.79 5.36 11.42 8.08 Primary Care Hospitalization NA 48.40 79.70 99.12 102.10 71.27 104.53 62.54 48.40 63.75 48.61 76.97 125.43 69.95 104.02 152.61 150.56 MD follow-up NA 52.13% 44.65% 45.65% 38.60% 42.92% 45.48% 54.88% 52.13% 47.56% 51.60% 46.54% 38.49% 39.58% 40.59% 35.45% 39.91%

C. Developmental Indicators ESC SW WW HNHB CW MH TC C CE SE CH NSM NE NW Home & Community In-Home Services Palliative NA 87.91% 81.37% 75.63% 76.70% 83.89% 83.70% 89.03% 87.91% 78.07% 82.98% 81.33% 88.54% 79.89% 82.73% 78.15% 72.58% Sustainability & Quality Experience Satisfaction NA 87.60% 85.70% 84.00% 87.30% 85.70% 83.30% 85.20% 87.60% 89.00% 85.40% 85.80% 82.30% 88.50% 84.00% 82.10% 78.20%

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Highlights of Second Quarter Performance The Mississauga Halton LHIN ranked 7th out of 14 for overall performance across 13 indicators. Our LHIN ranked first in the province in three key indicators: emergency department length of stay for uncomplicated patients; repeat emergency department visits for mental health; and readmission rate. Given the ongoing capacity pressures at both hospitals, it is remarkable that the patient’s time to be seen by a physician remained within three hours; thus demonstrating that the pressures remain in the ability to access a bed for the 10 per cent of the populuation who eventually become an inpatient at the hospital, and not those emergency visits that are able to be managed in the emergency department alone (i.e. outpatient). For the same period last year, the hospitals experienced a three percent increase in emergency department visits, resulting in about 300 new admissions. With the LHIN’s first place ranking in emergency department visits for uncomplicated patients, performance is attributable to highly efficient and effective emergency departments, triaging appropriately and only admitting patients who require acute care services most. In the case of revisit rates for mental health in the emergency department, a regional practical clinic has begun operations to try to address one identified service gap to provide care in three levels of psychotherapeutic intervention, matched to patient need, adapted from cognitive behavioural and mindfulness-based approaches to treat symptoms of depression, anxiety and high stress. In the first year, 1,548 new individuals have been assessed within the clinic helping to address depression and anxiety – identified as a significant driver of 30-day unscheduled repeat visits and accounting for 30.1 per cent of visits that present to emergency department. Lastly, the readmission rate indicator provides how the system is functioning, beyond the acute sector, in supporting care for several chronic conditions, including congestive heart failure, chronic obstructive pulmonary disease, diabetes, stroke, cardiac arrest, pneumonia, and gastrointestinal conditions. The top three contributors to the LHIN’s readmission rate are related to congestive heath failure, cardiac arrest, and chronic obstructive pulmonary disease. The best readmission performance occurs in stroke, with a rate of five per cent, attributed to the stroke navigator resource, part of the West GTA Stroke Network, which works with patients up to one year following a stroke, providing navigation, psychosocial and other supports as needed. In some areas where the LHIN’s performance is challenged, such as hip and knee surgery wait times, given existing capacity challenges and interdependencies for bedded capacity, the hospitals worked with LHIN staff to identify incremental surgical capacity to help address this wait time, resulting in a one-time investment of $700,000 in the third quarter. The LHIN invested in 13 initiatives in the third and fourth quarter of fiscal 2018-2019, about $2 million, to help address key areas of the Ministry- LHIN performance indicators where performance improvement opportunities arose, and was within the LHIN’s scope of control to influence. Specifically, to create capacity in the community sector, with themes including: waitlist reduction for seniors to help prevent falls and proactively identify gaps in their care, where possible; enhanced residential support to those with acquired brain injury; incremental spaces or enhanced care for supports for daily living; and addressing health equity with an enhancement to the food security strategy of the LHIN for the most vulnerable population.

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Mississauga Halton LHIN Quality Report The Board Quality Report is illustrated in a scorecard format showing the LHIN’s performance based on indicators grouped by the following quality dimensions: Safe, Effective, Patient-centred, Efficient, Timely and Equitable. LHIN staff in consultation with the Mississauga Halton LHIN Board Quality Committee have worked to redesign the Quality Report incorporating the changes in the LHIN mandate as of the transition date of May 31, 2017. The high level summary page of the Quality Report (Quality Scorecard) reflects how our system and our home care delivery is doing overall. Overall the Mississauga Halton LHIN Quality Scorecard shows that the system and Home and Community Care is doing well in delivering quality of care within highly constrained conditions. Those conditions translate to lower performance in some of the dimensions and within the different areas of scope. We are focusing much of the improvement and innovation work in Home and Community Care and with our system partners on patient flow, such as the sustained focus on Alternate Level of Care improvement and alternatives to long-term care.

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Service Accountability Agreements Ontario's LHINs are required under the Local Health Services Integration Act, 2006 to have in place service accountability agreements with the health service providers they fund. Long-Term Care Home Service Accountability Agreements Term Care Home Accountability Planning Submission are due to the The Mississauga Halton LHIN and long-term care homes entered into Long-Term Care Home Mississauga Halton LHIN by December 12, 2018. Service Accountability Agreements for a three-year period from April 1, 2016 to March 31, 2019. Following legislative changes necessitated by the Patients First Act, 2016, the LHINs Multi-Sector Service Accountability Agreements approved a new one year Long-Term Care Home Service Accountability Agreements The Mississauga Halton LHIN and community based health service providers entered into template for the period April 1, 2018 to March 31, 2019 to replace the 2016-2019 Long-Term Multi-Sector Service Accountability Agreements for a one-year period from April 1, 2018 to Care Home Service Accountability Agreements template. March 31, 2019. The Long-Term Care Home Accountability Planning Submission is a planning document that The Community Accountability Planning Submission is a planning document submitted by provides information about an individual long-term care home and supports the negotiation of health service providers in the Community Health Centre, Mental Health and Addiction and the Long-Term Care Home Service Accountability Agreements. Community Support Services sectors in order to facilitate the negotiation of the Multi-Sector Service Accountability Agreements. The information provided in the Community The Long-Term Care Home Service Accountability Agreements Accountability Planning Submission is used to populate the Multi-Sector Service Advisory Committee is continuing discussions regarding a new 2019- Accountability Agreements Schedules and Quarterly Reports in the Self Reporting Initiative. 22 Long-Term Care Home Service Accountability Agreements The Multi-Sector Service Accountability Agreements Advisory template, including updated schedules and indicators, and a renewed Committee is continuing discussions on the template agreement and Long-Term Care Home Accountability Planning Submission. The working towards a new three-year agreement that will become Committee endorsed all recommendations from the Long-Term Care effective on April 1, 2019. The Committee has also endorsed the Home Service Accountability Agreements Planning and Schedules recommendations of the Indicators and Planning and Schedules Work Work Group and the Indicators Work Group for changes to the Groups. Health service providers will be required to submit a 2019- schedules and indicators for 2019-2020. The Long-Term Care Home 2020 Community Accountability Planning Submission and 2019-2020 Accountability Planning Submission process will be undertaken this Community Accountability Planning Submission Narrative as part of year in preparation for a new Long-Term Care Home Service this year’s Multi-Sector Service Accountability Agreements cycle. Accountability Agreements on April 1, 2019. Local LHIN education Local LHIN education sessions via webinar on the Community sessions via webinar on the 2019-2020 Long-Term Care Home Accountability Planning Submission and Multi-Sector Service Accountability Planning Submission and Long-Term Care Home Accountability Agreements Indicators and Schedules were held in Service Accountability Agreements schedules and indicators were October with all community sector health service providers. The held in October with all Mississauga Halton LHIN long term care Community Accountability Planning Submissions were due on homes. The health service provider’s governing-body-approved Long- November 16, 2018 and the LHIN is in the process of reviewing,

29 | P a g e December 2018 Annual Business Plan Community MOHLTC Updates Accountability Communications Priorities Engagement negotiating and finalizing the Community Accountability Planning Work is still underway on the development of a draft Hospital Submission budgets and targets with health service providers. Board- Integrated Service Accountability Agreement. To date, consultations approved Community Accountability Planning Submission budgets have occurred between LHIN Legal and the LHINs, and the document are due to the LHIN by January 31, 2019 with fully executed has been shared with LHIN Chief Executive Officers and Ontario agreements expected to be in place by April 1, 2019. Hospital Association legal. The Hospital Service Accountability Agreements Steering Committee reviewed the draft Hospital Hospital Service Accountability Agreements The Mississauga Halton LHIN and the hospitals entered into Hospital Service Accountability Integrated Service Accountability Agreement in its September and Agreements for a two-year period from April 1, 2018 to March 31, 2020, with Schedules October meetings and the Committee is continuing its review and refreshed annually. discussions, making good progress on its development. The Hospital Accountability Planning Submission is a working document that is used in the 2019/20 HAPS process to inform hospital planning through linkages in the financial and clinical plan. The HSAA Schedules are informed by the specific plans in the Hospital Accountability Planning Submission and are negotiated between the hospital and the LHIN. The annual Hospital Accountability Planning Submission includes a detailed operating plan, financial and statistical budgets and performance indicators. The Hospital Service Accountability Agreements Steering Committee is continuing its discussion on the current Hospital Service Accountability Agreements template, and agreed that there would not be any material changes to the template for 2019-2020. The Committee endorsed recommendations from the Hospital Service Accountability Agreements Indicators and Planning and Schedules Work Group. The first draft submission of Hospital Accountability Planning Submission is due to the LHIN by November 23, 2018. The LHIN will review and negotiate the Hospital Accountability Planning Submission with its hospitals, with a final board approved Hospital Accountability Planning Submission due to the LHIN by January 31, 2019. The amended Hospital Service Accountability Agreements with updated schedules will become effective on April 1, 2019.

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COMMUNITY ENGAGEMENT The Mississauga Integrated Care Centre Community Engagement (Patient/Family Committee Participation) Though a variety of engagement methods; surveys, focus groups, workshops, and in-person meetings; patients, families, community Community Engagement is an integral part of the LHIN model and central to support LHIN members, health care providers and community organizations decision making. Meaningful engagement enables health system development in the Mississauga Halton LHIN to be informed by the experiences and stories of those who provide participated in providing input on the development of the Mississauga and receive care in our communities. Following principles from our Integrated Health Service Integrated Care Centre. Community Engagement was essential to Plan, the Mississauga Halton LHIN engages the community along our journey to build ensure that the spaces created are inclusive, accessible, inviting and innovative partnerships with health care partners, stakeholders outside of health care, as well meet the needs of the community. Community members provided as patients and their families. input on digital health solutions, patient experience preferences, as The implementation of the Mississauga Halton LHIN Patient, Family well as furniture style, equipment and the overall design and function and Community Engagement Roadmap continues to be a priority for of these primary care centres. the Patient Engagement and Community Outreach Team, and the Education and Training many patient, caregiver and community partners who participated in creating the roadmap. Thirty Patient and Family advisors from across the region participated in a training opportunity developed for the LHINs by Health Quality Most recently, an Engagement Toolkit was developed to support Ontario. The focus of the training was to build capacity and develop greater opportunities for more equitable engagement with patients, skills to be an effective Patient advisor. caregivers, and community members in the Mississauga Halton LHIN. Working with Patient and Family advisors, standardized processes, Care Community Tables including accessible taxi booking, expense reimbursements for travel Community members were recruited to participate on the Care and attendant care, have been established and promoted to decrease Community Tables, working collaboratively to develop the sub-region participation barriers and allow for greater participation and plans for the seven Care Communities in the Mississauga Halton engagement from more members of the communities we serve across LHIN, further fortifying the important role of patients and families as our region partners in health system design. The growing membership in the Patient and Family Advisory Program Children with Complex Health Needs Service Re-design is active and committed to shaping our shared health care system. The following are very recent Mississauga Halton LHIN engagement A facilitated engagement comprised of parents of children with opportunities: complex health needs took part in a focus group discussion to inform a service improvement plan. The goal of the discussion was to better meet the needs and challenges faced by these families. 31 | P a g e December 2018 Annual Business Plan Community MOHLTC Updates Accountability Communications Priorities Engagement

Personal Support Worker Strategy Committee members have participated in opportunities that shape and Patients and Family advisors that are in receipt of Personal Support inform models of primary care delivery, taken part in training to build Worker Services have been recruited and embedded in the working advisor capacity, informed the development of Patient and Family groups dedicated to this initiative. A call for participation for Patients Advisory Program Tools, co-developed educational videos, and Family advisors to engage in a facilitated focus group to discuss, participated in research initiatives, taken part in Care Coordination inform and shape elements of the strategy is planned for the third Week acknowledgement activities, represented the Mississauga Halton LHIN as Patient and Family delegates at the Health Quality quarter. Ontario Leadership Summit, informed Patient and Family survey Quality and Risk Framework designs, contributed to the Annual Report, and shared their patient Involving patients and families at both the patient care level and journeys at forums. The Patient and Family Advisory Committee also system level by utilizing the Quality and Risk Framework in all our supported the development of the Mississauga Halton LHIN six-year work is critical to supporting quality and reducing risk. A call for strategic plan, TOGETHER – Strategy 2025, which will inform two participation is underway to engage Patient and Family advisors successive Integrated Health Service Plans. interested in taking part in a focus group discussion to inform and The impact and reach of the Patient and Family Advisory Committee shaping this initiative. continues to grow as requests for engagement increases with each Patient and Family Advisory Committee passing month. The recognition of and appreciation for the Committee’s contributions extends beyond the organization, we The Mississauga Halton LHIN Patient and Family Advisory Committee is one of the patient continue to receive requests for engagement with various system and caregiver forums that assist the LHIN in shaping its programs, services and initiatives to improve health care for people in our region. Volunteer Patient and Family Advisory partners including Peel Public Health, the Canadian Foundation for Committee members meet at least four to six times per year to provide feedback and input Health Care Improvement, the Ministry of Health and Long-Term that will drive meaningful changes to Mississauga Halton LHIN programs, services and Care, Health Quality Ontario, and other LHIN partners across the initiatives, and will help shape the local health care system. province. The Patient and Family Advisory Committee has met a milestone in Strategic Planning: 2019-2025 completing its inaugural year. Comprised of 14 members, the Advisory Committee is a committed group, volunteering their time The Mississauga Halton LHIN has launched a collaborative planning process to develop a and effort in supporting and providing input on a variety of the six-year strategic plan (2019-2025) that will inform two successive three-year Integrated Health Service Plans. Mississauga Halton LHIN’s organizational initiatives. During this past year, members have been dedicated to making a positive impact on The Mississauga Halton LHIN Board approved the strategic plan on health care delivery in the community. Patient and Family Advisory October 4, 2018. This has been a nine-month long journey.

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TOGETHER – Strategy 2025 and our Integrated Health Service Plan 2019-2022 will take effect April 1, 2019. With the Board approval as a significant milestone behind us, we have since engaged with our system partners on identifying the key levers for the implementation of the strategic plan. The communication plan for the strategic plan is moving forward to the Communicate phase. An ongoing piece of work continues to be how we will measure our progress towards strategic plan goals. Work on measures with our Quality and Performance working group will continue in the coming months. Through this work we will engage health service providers for their feedback and insight on measures, to ensure we maintain the collaborative partnerships that characterized the development of TOGETHER Strategy 2025. TOGETHER Strategy 2025 has informed the development of a draft 2019-2022 Integrated Health Service Plan which was submitted to the Ministry for review and feedback at the end of October 2018. The Annual Business Plan 2019-2020 is under development and will be submitted to the Ministry at the end of December 2018.

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COMMUNICATIONS Media Relations – Mississauga Halton LHIN  Helping to End Hallway Medicine in Mississauga Mississauga Media releases referencing Mississauga Halton LHIN and our health service providers and (November 23, 2018) from September 1, 2018 – December 1, 2018 are listed below.  Credit Valley Hospital Celebrates Completion of 20 year Expansion Plan Mississauga (November 23, 2018) Mississauga Halton LHIN Media Releases  ‘Senior care’ top of mind for Mississauga residents Trillium’s telephone town hall reveals Mississauga (December 3, 2018)  Innovative Cardiac Partnership in the Mississauga Halton LHIN Receives 2018 Minister’s Medal Honouring Excellence in Health News Coverage – Mississauga Halton LHIN Quality and Safety Oakville (Oct. 17, 2018) Media stories referencing Mississauga Halton LHIN from September 1, 2018 – December 1,  Health Care Partnership in Mississauga Wins Prestigious 2018 are listed below.

Provincial Quality Award Mississauga (October 17, 2018)  2018 Minister's Medal Awards Honouring Excellence in Health Mississauga Halton LHIN Health Service Provider Media Quality and Safety news.ontario.ca (October 17, 2018) Releases  2018 Minister's Medal Winners health.gov.on.ca (October 17,  Trillium Health Partners Launches Annual Endowed Lecture 2018) Mississauga (October 2, 2018) From September 1, 2018 – December 1, 2018, there were 19 media stories referencing  Halton Healthcare Hosts Staff Event to Share Emotional, Social Mississauga Halton LHIN health service providers and service provider organizations. and Ethical Challenges Faced by Healthcare Workers Milton (October 23, 2018)  Halton Healthcare Receives Leadership Award for Dementia Care External Website Engagements – Mississauga Halton LHIN and Education Oakville (October 31, 2018) New or updated web pages posted on the Mississauga Halton LHIN external website from  Oakville Trafalgar Memorial Hospital Receives International September 1, 2018 – December 1, 2018 are listed below. Recognition for Surgical Patient Care Oakville, (November 12,  November is Fall Prevention Month 2018)  The Total Contact Cast for Diabetic Foot Ulcers  ITAC Ingenious Awards & Canadian CIO of the Year Awards winners announced: Provides glimpse into power of ICT to change  2018 Minister's Medal the lives of people, communities and businesses Toronto  Transforming Musculoskeletal Care (November 7, 2018)  Coming spring 2019: Mississauga Integrated Care Centre  Superhero IV poles designed to boost spirits of Trillium Health  Medical Assistance in Dying Partners’ paediatric patients Mississauga (November 13, 2018)

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Social Media Engagements – Mississauga Halton LHIN series of Facebook and Twitter updates shared positive patient testimonials and directed users to watch April’s Total Contact Cast November is Fall Prevention Month story. A social media campaign #PreventFalls2018 in support of fall prevention month ran throughout November. The goal of the daily Surveys Twitter tweets and weekly Facebook posts TOGETHER 2025 Strategy Draft Plan Survey was to create awareness In January 2018, the Mississauga Halton LHIN launched a and share evidence based collaborative planning and engagement practices to create a fall process to develop a six-year strategic prevention culture and plan (2019 -2025) that will inform two help our residents remain successive Integrated Health Service healthy and safe at home. Plans. Developed in partnership, this It takes a community to strategic plan provides a transformational prevent a fall! opportunity for providers, partners, and local community to commit to an November Total Contact Cast Campaign innovative and shared vision for our local In recognition of health system that establishes shared November as Diabetes system priorities and places patients, Awareness Month and families, caregivers and residents at the November 14 as World forefront. Diabetes Day, we After months of consultation, stakeholder launched a social media and staff engagement and feedback, the campaign to raise Mississauga Halton LHIN released a draft awareness of the of the strategic plan. During September 11- Mississauga Halton 24, 2018, internal and external audiences had the opportunity to LHIN’s Total Contact review the draft plan and provide feedback and comments. Cast program to heal diabetic foot ulcers. A 35 | P a g e December 2018 Annual Business Plan CommunityCommunity MOHLTC Updates Accountability Communications Priorities EngagementEngagement

Publications Community Engagement; and Palliative Care. Through these and many more initiatives, we continue to move towards a more seamless The LHINsider health system for our communities. In November 2018, the LHINsider – Mississauga Halton LHIN’s monthly 2018 Ontario Economic Outlook and Fiscal Review internal newsletter – celebrated its one On November 15, 2018, Minister of year anniversary. The publication Finance Vic Fedeli released the 2018 continues to help staff connect. Each Ontario Economic Outlook and Fiscal issue features department updates, Review, outlining the government's employee profiles and recognition, plan to help people make ends meet — notes of thanks from patients and their and get ahead — while making families, notices of upcoming events government more efficient. Ontario is and a regular message from Chief now projecting a 2018-19 deficit of Executive Officer Bill MacLeod. Each $14.5 billion. The government plans to LHINsider issue has a different theme that is reflected in the stories take immediate action to reduce the shared that month. province’s deficit, while making Ontario more affordable for Reports individuals, families and businesses, and making Ontario open for business. Report to the Community 2018 Together with our partners, we continue to develop innovative solutions to strengthen health services for the residents and patients in our region. The Report to the Community provides a snapshot of the major work and initiatives undertaken in 2017-2018. This year, the following three initiatives were highlighted: Alternate Level of Care Management; Patient, Family and 36 | P a g e December 2018 Annual Business Plan Community MOHLTC Updates Accountability Communications Priorities Engagement

Measuring Up 2018 Health Quality Ontario 2017-2018 Halton Healthcare Annual Measuring Up 2018, is Report produced by Health Quality The 2017-2018 Annual Report of Ontario and was released on Halton Healthcare was made public on November 16, 2018. The annual September 28, 2018. The Report report looks at the performance outlines the achievements of the organization as it continues to of Ontario’s health system. It is developed with input from implement the strategic initiatives patients, families, doctors, within the Strategic Plan Pathway 2020. nurses, and other health care Throughout the pages of the report, professionals to understand what’s working well and where there is patients and families tell their room for improvement. The key finding of 2018 emphasize the perspective on Halton Healthcare’s backlog seen in different parts of the health system, while also strategic priorities of Innovate, Collaborate and Empower. showing the many bright spots scattered throughout the system.

Access to Palliative Care in Canada The Access to Palliative Care in Canada Report, was published by the Canadian Institute for Health Information on September 19, 2108. The report says that most Canadians (75 per cent) want to die at home, and reveals that people who access palliative home care services in their last year of life are 2.5 times more likely to do so. The publication shows that early palliative care reduced the number of visits to intensive care and emergency department visits for terminally ill Canadians in their last month of life.

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