Capital Planning Aligning MOHLTC & LHIN Processes

Advancing Local NeedsApril 20, 2010

Item: 3.5

Presentation Outline• Provincial Capital Planning Process - a transition for Major Capital (over 10M projects)*

– Objectives* (MOH, CE LHIN)– Pre-Capital– Program Planning Stage 1A and 1B– Functional Programming Stage 2A and 2B– Stages 3, 4, 5.* pending MOHLTC roll-out & development of Minor (under $10M)

• Advancing Local Capital Initiatives

– CE LHIN Capital Planning Checklist – Key Components– Brock CHC – Lakeridge Healthcare Corporation (Oshawa and Bowmanville sites)– Ross Memorial Hospital

• Future Steps – Transition to New Capital Processes– Finalization of Capital Planning Checklist– Health Service Provider orientation & communication– Environmental Scan – CE LHIN capital initiatives (status)

• Consideration of Motions for Endorsement

Why Update the Provincial Capital Planning Process?

• A refreshed capital planning process is required to meet the objectives of the Ministry LHIN Accountability Agreement

• Leverage LHIN expertise in identification and implementation of integrated system solutions

• Focus MOHLTC expertise on bricks & mortar and build-related finances

• Ensure alignment of expectations for capital builds between MOHLTC (facilities) and LHIN (programs/services, integration and operations funding)

• Clarity for HSPs – LHIN vs MOH responsibilities; HSP accountability for the quality & success of the capital projects.

• Advance recommendations from the joint MOHLTC and LHIN Capital Working Group

Objectives of Capital Planning Process – All Stages• Process

– Provincial expectations

• Alignment with provincial strategic plan• Consistent with Capital Planning Guidelines (industry standards)

– CE LHIN level expectations

• Integration – patient experience, value for money, population health, IHSP priorities

• Regional Clinical Services Planning and delivery• CE LHIN Capital Checklist – being developed

– Joint Expectations:• Alignment and as necessary negotiations between MOH and LHIN at all Stages of

development

• Timeline: 22-29 months+ for Major Capital Projects

Capital Planning: Pre-Capital• Objective: First point of contact - establish need to proceed with capital process

• Requirements & Submissions:

• Pre-Capital HSIP

• Part A – LHIN

– description of the role of the HSP in the local health system and describes the initiative being proposed, including program rationale and evidence of alignment with local health system priorities.

• Part B – MOHLTC

– The development concept provides a high level description of the physical changes being considered to support the program proposal

• Decision points:

• LHIN endorsement of Part A;

• MOH approval to move to Stage 1

Capital Planning: Stage 1 - Proposal• Objective: Provide the LHIN opportunity to review and provide support for the service

component of the proposed redevelopment prior to any additional planning taking place

• Requirements & Submissions:– Part A – LHIN: Focuses on service and program planning

• Master Program

• Preliminary Operating Cost Estimate• Service Delivery Options Analysis

• Human Resources Plan

– Part B – MOHLTC: Evaluates the condition and potential use of existing buildings and defines long-term development strategies for specific sites.

• Business Case / Options Analysis

• Facility Development Plan

• Master Program/Master Plan

• Decision Point: LHIN endorsement Part A; MOH seeks government approval for the entire Stage 1 Proposal submission. Government approval is required prior to proceeding to Stage 2 Functional Program.

Capital Planning: Stage 2 - Functional Program• Objective: Define details of proposed project and the scope of proposed programs/ services

within the context of the plans developed at the proposal stage

• Requirements & Submissions:• Part A – LHIN: Review of program parameters

– Program Parameter Report– Functional Program (Summary, Program Requirements).

• Part B – MOHLTC: Review of specific spatial requirements and other design objectives – Design and spatial requirements– Phasing Plan– Project budget– Project Schedule– Local Share Plan

• Decision points: • LHIN endorsement of Part A; provision of advice to MOH.

• MOHLTC Part A to ensure alignment with provincial planning and strategies (i.e. capacity planning study).

• MOHLTC support of Part A and Part B - then HSP would advance its project through the design stages (Stages 3 and 4)

Capital Planning: Stages 3, 4, 5

• Stage 3: Preliminary Design or Output Specifications• Stage 4: Working Drawings or Output Specifications

– Objectives Stage 3 & 4: • Review and approval of blocks and sketch plans• Approval to proceed to working drawings or block/output specifications

– Decision Points Stage 3 & 4: Government approval to proceed to construction

• Stage 5: Implementation– Objectives: Review and approval to tender and implement/issue RFP or

approval to award construction contract/Project Agreement

Advancing Local Capital Initiatives

CE LHIN Capital Planning Checklist – Under Development• Key Components

– Aligned to new provincial expectations/process

– Advances CE LHIN IHSP and identified capacity/planning needs

– Advances opportunities for system integration• focus on issues that are in common (i.e. patient experiences) rather than on the

differences between communities.

• Supports a common solution – organizational priorities and/or external partnerships

• Improves how healthcare will be delivered

• Identifies opportunities for cost savings/efficiency (e.g back office partnerships, co- location with other agencies, multi-purpose space)

• Advances health service design and delivery in consideration of known/expected changes in clinical practice, technology, patient choice and demographic changes

• integration of services (health/other) at the community level to improve patient experience of care

– Supports a Triple Aim approach to quality improvement (population health, patient experience and value for money)

Advancing Local Capital Initiatives – a Transition to New Capital Approval Processes for Current Major & Minor Projects

• Brock CHC – new facility (major capital)

• Lakeridge Healthcare Corporation (own funds – minor capital)– LHC Bowmanville - Critical Care Unit

– LHC Oshawa• Breast Assessment Unit • Education/Training Expansion

• Ross Memorial Hospital (major capital - physical plant infrastructure upgrade)

Brock Community Health Centre

Brock Community Health Centre • Objective:

– Construction of permanent facility for new CHC

• Intent of LHIN review:

– endorsement to enable submission of Stage 1 and Stage 2 Capital Request to MOHLTC

• Context:

– CHC announced in 2005

– Pre-capital approval of Program, Services and Staffing Plan by MOHLTC 2006

– Site Selection approval by MOHLTC 2008 (consultation with LHIN)

– MOHLTC approval to purchase new site, demolish current building on the site and to complete soil remediation.

– Combined Stage 1 Master Programming & Stage 2 Functional Programming (as per existing CHC capital approval process)

Brock Community Health Centre • Physical Facility Highlights:

– New facility in Cannington – centrally located in Brock Township

– 28,632 square feet

– Estimated Capital Costs:– Construction costs $ 9,193,800– Furniture & equipment 744,568– Consultants 346,047– Prime Contractor 747,452– Miscellaneous costs 813,864

_________Total cost $11,865,731

Brock Community Health Centre

• Program & Services Highlights:

– Programs:

– Primary Health Care

– Diabetes Education

– Brock Geriatric Assessment Clinic (a partnership with Lakeridge Health, Durham Region and the Regional Geriatric Program of Toronto).

– Community Development and Health Promotion Program

– Integration Partnerships:

– Oral Healthcare – with other CHCs and Durham Health Department

– Community Care Durham – co-location of north Durham services

– Geriatric Assessment – with LHC, Regional Geriatric Program Toronto, Lakeview Manor in Beaverton

Brock Community Health Centre • Operational - Risks

– On-site parking limited – nearby options to be negotiated– Programs:

– Current services to be relocated to mobile units in interim– Oral Health care operational funds to be secured from Low Income

Dental Program– Accommodation Fees – MOHLTC standard rent/annual lease cost

formulae in sufficient

• Operational - Opportunities– Advances cross sector partnerships with Public Health, Community

Support Services, hospital and the RGP of Toronto. – Underserviced rural community: centralized, accessible location for

enhanced healthcare - youth and seniors programming

Lakeridge Healthcare Corporation

Lakeridge Healthcare Corporation – Oshawa & Bowmanville Sites• Objective:

– LH – Oshawa: Completion (Fit-out) of Breast Assessment Centre and Education and Training facilities at LH Oshawa

– LH – Bowmanville: Completion of the Critical Care Unit redevelopment

• Intent of LHIN review: – Endorsement for LHC to proceed with own funds, minor capital projects at

LH Oshawa and Bowmanville sites. • Context:

– 2007, LH developed a capital plan to guide the future development of facilities at the existing Oshawa, Bowmanville and Port Perry Campuses. Included in this capital plan was the proposed completion of the shelled space on the B1 level of the North Wing into an Education/Conference Centre and Breast Assessment Centre and the redevelopment of the CCU in Bowmanville.

Lakeridge Healthcare Corporation (Bowmanville Site Only)

• Physical Facility Highlights:

– Capital Cost: $1.3M

– The Memorial Hospital Foundation – Bowmanville has committed to fund $1,3M of the CCU project costs.

• Programs & Services Highlights:

– A new acute care unit consisting of:

• 6 Critical Care beds

• 9 Telemetry beds

• 10 Medical or Surgical beds

Lakeridge Healthcare Corporation (Bowmanville Site Only)• Operational - Risks

– Recruitment of experienced critical care physicians, nurses, respiratory technologists and other health care practitioners has been difficult at LH Bowmanville as result of a less than ideal work environment and inability to flex up to manage patients. This project has already assisted with these recruitment efforts even though it’s in the planning phase.

• Operational – Opportunities– Resolution of challenges associated with care management practice for

telemetry patients by ensuring the staff caring for these patients are also directly assessing the cardiac rhythm on the physiological monitoring system.

– Moving CCU beds will free up space adjacent to the Emergency Department and relieve some of the current Emergency Department overcrowding issues.

– New unit will be congruent with expected standards of care, with appropriate technology, room size and air flow systems for infection control and isolation practices.

– Larger footprint will resolve issues associated with patient confidentiality.

Lakeridge Healthcare Corporation (Oshawa Site Only)• Physical Facility Highlights:

– Education and Conference Centre and the Breast Assessment Centre, which are immediately adjacent to each other, will cover a space of approximately 2750 square meters or 29,600 square feet.

– Corporate Education and Conference Centre:• Construction $692,533• Project Management $4,247,699• Equipment $201,700• Management Reserve $358,068

Total $5,500,000

– Breast Assessment Centre:• Construction $794,902• Project Management 194,013• Equipment $50,425• Management Reserve $145,996• Total $1,185,336

Grand Total BAC and CEC - Oshawa $ 6,685,335

Lakeridge Healthcare Corporation (Oshawa Site Only)• Program & Services Highlights:

– Programs:• Education Centre design includes:

– pre-function reception areas; – auditorium (reception area, stage, projection room); – 2 conference rooms; 3 classrooms; (catering support area; media services

facilities, library)– 2 simulation training laboratories & a computer training lab– offices and resident support areas for Queen’s University Department of

Family Medicine; – Other: Storage rooms washrooms, change rooms and a coat room.

• The Breast Assessment Centre consists of:– reception area, (patient seating area change area, gowned waiting area);– two examination rooms;– 2 mammography rooms, a biopsy room and 2 ultrasound rooms (image

reading and staff work areas);– a post-biopsy recovery room.

Lakeridge Healthcare Corporation (Oshawa Site Only)

• Program & Services Highlights – continued

– Integration & Partnerships:

• The Department of Family Medicine, Queen’s University has committed $1,000,000 towards the project cost. An agreement to this effect has been executed between Lakeridge Health and Queen’s University.

• The remaining funds $5,685,335 will be funded 100% by the Oshawa Hospital Foundation.

Lakeridge Healthcare Corporation (Oshawa Site Only)• Operational - Risks

– The General Contractor’s bid will expire May 17, 2010. After this date LH will have no choice but to re-tender the project, risking receipt of bids that fall outside the approved budget. Anticipate a 25% increase.

– Education and Conference Centre: Currently, LH has no capacity for group functions and/or meetings, conferences over 20 people at any of the 4 campuses. Rental of off-site spaces for physician, resident, staff education, large functions and management forums is required and less than ideal.

– Breast Assessment Centre: Currently these services are offered within LH at locations that are distinct and separate from each other, causing staffing and efficiency challenges.

Lakeridge Healthcare Corporation (Oshawa Site Only)• Operational - Opportunities

– Partnerships:

• The new Breast Assessment Centre will serve mammography, the Ontario Breast Screening Program and the McLaughlin Durham Regional Cancer Centre.

• Queen’s University Family Medicine Program is contributing towards the Education & Conference Centre. This will support expansion of the LH and Queen’s relationship and enable the training of additional Queen’s residents and medical students. Intention to pursue establishment of a Queen’s satellite program situated at LH.

Ross Memorial Hospital

Ross Memorial Hospital• Objective:

– Replacement of Air Handling Units and associated mechanical and electrical infrastructure upgrades as useful life expectancy of equipment has been exceeded.

• Intent of LHIN review: – Endorsement of Pre-Capital HSIP for infrastructure renewal at RMH for submission to

MOHLTC

• Context:– Ross Memorial Hospital (RMH) in Lindsay has been working with the Ministry of Health and

Long-Term care staff since 2006 on a proposal for the replacement of air handling units (AHUs) and associated mechanical and electrical infrastructure upgrades

– The AHUs in the East Wing are more than 50 years old and provide service to staff offices, a nuclear medicine suite, the kitchen and outpatient services located in the Wing

– The AHUs in the West Wing are more than 35 years old and provide services to the Operating Rooms, the Laboratory, Pharmacy, inpatient wards and the basement of the Wing

– The March 2008 MOHLTC commissioned Facility Condition Assessment Project (FCAP) report at RMH identified the East and West Wing AHUs as priority items that require urgent remedial action

Ross Memorial Hospital• Physical Facility Highlights:

Projects costs by building area:– East Wing Air Handling Units Replacement $3.13 million– East Wing Infrastructure Mechanical & Electrical $5.05 million– O.R. Dept AHU Replacement and ductwork $1.75 million

Total $9.93 millionCapital Cost Summary:

– Construction Cost: $7,626,730– Furniture and Equipment: $0– Project Consulting $1,769,400– Prime Contractor $381,355– Miscellaneous $152,535

Total $ 9.93M• Program & Services Highlights:

– Programs:

This request for Capital Funding is for infrastructure renewal only and does not increase or decrease current programs within Ross Memorial Hospital

Ross Memorial Hospital• Operational - Risks

– Useful life expectancy has been exceeded creating risk for RMH and patients if failure was to occur

• Operational – Opportunities

– The Hospital will utilize/secure $993,000 of its own funds (Ross Memorial Foundation) to pay for 10% share of the total project cost.

Next Steps

• Transition to New Capital Processes– Health Service Provider orientation & communication

– Minor capital review process confirmation

– Cross- LHIN working group

• CE LHIN Capital Initiatives– Environmental Scan – status of CE LHIN capital initiatives

• Hospitals

• Community Health Centres

• LTC Facilities

• Other HSPs

– Develop CE LHIN Capital Checklist

– Augment current HSIP process

Pause for Reflections

Motions for Endorsement

MOTION:

Brock Township Community Health Centre

The Central East LHIN Board authorizes Management to issue a letter of support to enable Stage 1 and Stage 2 of the Brock CHC Capital Project to be submitted to MOHLTC.

MOTIONS:

Lakeridge Healthcare Corporation - Oshawa

The Central East LHIN Board authorizes Lakeridge Healthcare Corporation to proceed to implement the minor capital, own source funding Breast Assessment Centre and Corporate Education and Conference Centre fit out projects.

Lakeridge Healthcare Corporation - Bowmanville

CELHIN authorize Lakeridge Healthcare Corporation to proceed to implement the minor capital, own source funding project to redevelop the Critical Care Unit.

MOTION:

Ross Memorial Hospital

The Central East LHIN Board endorses submission of Pre-Capital HSIP Part A to MOHLTC to support infrastructure renewal.

Further, the Board emphasizes to the MOHLTC the need to expedite approval process as the infrastructure upgrade will take approximately 2years to complete and the useful life of equipment has been exceeded.

Thank You!