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Central East Local Health Integration Network CEO Report to the Board

June 27, 2012

Table of Contents Transformational Leadership .............................................................. 2 Service and System Integration .......................................................... 4 Mental Health and Addictions ............................................................. 6 Integrations ......................................................................................... 7 Aboriginal Services ........................................................................... 10 French Language Services ............................................................... 10 Quality and Safety ............................................................................. 12 IHSP Strategic Aims .......................................................................... 14 Chronic Kidney Disease (CKD) / Renal System Development ......... 22 Enablers – eHealth ............................................................................ 23 Community Engagement ................................................................... 31 Central East LHIN Operations ........................................................... 33 Appendices ....................................................................................... 34

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Central East Local Health Integration Network CEO Report to the Board

June 27, 2012 The following is a compilation of some of the major activities/events undertaken during the month of June in support of the Central East LHIN’s Strategic Directions;

a) Transformational Leadership, b) Quality and Safety, c) Service and System Integration, and d) Fiscal Responsibility.

Transformational Leadership: The LHIN organization will demonstrate accountability and systems-thinking in all decision-making and leadership actions, reward innovation which is aligned with the Integrated Health Service Plan (IHSP) 2010 - 2013 and model fair, transparent, and honest interaction with one another and with Health Service Providers. Service and System Integration/Quality and Safety: The LHIN organization will create an integrated system of care that is easily accessible, sustainable and achieves good outcomes. Healthcare will be people-centred in safe environments of quality care. The Central East LHIN is working towards achievement of the Strategic Aims of the 2010-2013 IHSP; 1. Save a Million Hours of Time Patients Spend in the Emergency Departments by 2013; and 2. Reduce the Impact of Vascular Disease by 10% by 2013 (2010-2013 IHSP).

Transformational Leadership The LHIN organization will demonstrate accountability and systems-thinking in all decision-making and leadership actions, reward innovation which is aligned with the Integrated Health Service Plan (IHSP) 2010 - 2013 and model fair, transparent, and honest interaction with one another and with Health Service Providers. Transitions in Care: The Central East LHIN Transitions in Care Steering Committee is a critical body of a new and evolving structure within the LHIN aimed at improving overall quality of care through better transition management of people and information by their care team. The Steering Committee is envisioned to bring together separate yet linked initiatives that, while targeting different aspects of the system, share similar goals. The intent is to provide improved cohesion of initiatives to promote outcomes for better care for patients/clients/residents and better health of the population as a whole. The Steering Committee is accountable to the Central East LHIN for the strategic guidance and quality improvement for emerging Transition Management priorities, and for providing oversight to selected Transition Management quality improvement initiatives. In addition to patients/clients/residents, key stakeholders include health service provider leaders, initiative-specific provincial stakeholders and frontline healthcare providers. The Central East LHIN Transitions in Care Steering Committee, chaired by the CEO of Rouge Valley Health System (RVHS) and the Senior Director, Client Services of the Central East CCAC, has oversight over the full spectrum of quality improvement and/or business process initiatives designed to directly improve the transitions in the patient/client/resident journey through the healthcare system. Its purpose and work are aligned with provincial level initiatives and Central East LHIN priorities. It provides leadership to system and sector-specific

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committees and projects within the LHIN related to priorities and/or projects intended to improve care transitions. Strategic guidance is provided by the Executive Sponsor, a member of the Central East LHIN Senior Team. The Home First Oversight Committee and the Resource Matching and Referral Oversight Committee report to the Transitions in Care Steering Committee. The Transitions in Care Steering Committee met for the second time on May 16, 2012. The key messages from each Committee included the following:

• LHIN Stocktake Report will be an important document for this Committee and the May Stocktake submission will be reviewed at the June meeting.

Transitions in Care Steering Committee

• Discussions to occur prior to the June meeting concerning how best to establish a Quality Committee within the Transitions in Care structure.

• A Mental Health quality improvement initiative around Assertive Community Treatment Teams, led by Ontario Shores, will also be included as part of the Transitions in Care structure.

• RWS final report that mapped current and future state for rehab/CCC was reviewed. Resource Matching and Referral (RM&R) Oversight Committee

• Working Group will be established to proceed with implementation planning, co-chair by the CCAC and a hospital representative.

• Ross Memorial Hospital and Markham-Stouffville Hospital – Uxbridge site have not had an ALC to LTC designation for three weeks!

Home First Sustainability Oversight Committee

• Trends continue to be monitored by teams at the hospital and LHIN levels. • There is increasing demand for Convalescent Care beds. • Efforts to improve repatriation from hospital to long term care and retirement homes are being undertaken

by this Committee. Central East LHIN Doctor Talks: Central East LHIN’s Primary Care Physician Leads Dr. Robert Drury and Dr. Christopher Jyu are working with the LHIN staff and in partnership with the Ontario Medical Association to plan the first ever Doctor Talks. This Continuing Medical Education (CME) accredited “Doc Talks” series will provide primary care physicians in Central East with an opportunity to share their expertise and inform the development of the Central East LHIN’s next Integrated Health Service Plan (IHSP). Key issues, challenges and opportunities from the perspective of primary care practitioners for five priority primary care topics will be covered:

1) Mental Health and Addictions; 2) Diabetes and Vascular Health; 3) Frail Seniors; 4) Palliative and End of Life Care; and 5) Primary Care Reform & Leadership at LHIN level.

Face to face discussions supported by a range of media to promote broad participation including OTN, teleconference and webinars will be held from July-October 2012. Each session will be moderated by one of the Primary Care Physician Leads, and discussion lead by a panel of two or three physicians representing primary and specialist care in rural and urban communities. Two patient stories - one rural and one urban - will be used to initiate conversations on challenges for patients and their primary care providers. Central East LHIN planning partners will also be invited to observe these discussions as input received will help guide the development of IHSP work plans and strategy.

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Service and System Integration The LHIN organization will create an integrated system of care that is easily accessible, sustainable and achieves good outcomes. Healthcare will be people-centred in safe environments of quality care. Stocktake Report: The Stocktake report is the unified report of all LHIN activities and performance to the Ministry of Health and Long Term Care (Ministry), and is completed collaboratively by representatives of all LHIN portfolios to communicate our strategies and plans clearly. The Stocktake Report includes all indicators related to the following initiatives and agreements:

• Ministry LHIN Performance Agreement (MLPA)

• Pay-for-Results (P4R) • Nurse Practitioner Supporting Teams

Averting Transfer (NPSTAT) • Excellent Care for All Act (ECFAA)

• Community Care Access Centre (CCAC) Wait Times Emergency Department-Performance Improvement Plans (ED-PIP)

• Transitional Care • Mental Health and Addictions

The 2012 Spring Cycle Stocktake report template is scheduled to be published by the Ministry on May 14 and the completed report is due on May 28. Because the 2012-13 MLPA negotiation meetings for all LHINs will take place in June, there will be no Stocktake meetings with the Ministry for this cycle.

Key Highlights: • Time spent in the ER for high acuity patients increased by 54 minutes compared to Q3 11/12 but

decreased by 78 minutes when compared to Q4 11/12. • Time spent in the ER for low acuity patients has increased by 12 minutes over Q3 11/12 but decreased

by 12 minutes when compared to Q4 10/11. • In Q4 11/12, the number of days from ALC designation to discharge to Mental Health has decreased by

373 days in comparison to Q3 11/12. • The MRI wait time was above the LHIN target by four (4) days which is a dramatic decrease from Q3

11/12.

Regional Specialized Geriatric Services (RSGS): The RSGS will be submitting its initial high level content for the LHIN’s next Integrated Health Service Plan (IHSP) by the end of September 2012 to be followed by a more detailed operational plan to be included in the LHIN’s Annual Business Plan in January. On June 13 the Northumberland Hills Hospital, in its role as Host Agency for the RSGS, announced the appointment of Victoria van Hemert as the Executive Director for the Central East RSGS. Victoria will begin in her new role on July 9. Ms. van Hemert joins the entity from the Central LHIN, where she is currently the Senior Director for Planning, Integration and Community Engagement. Upon commencing this role, Victoria will be working with the committee members to develop and implement a model for specialized geriatric services. At its May 22, 2012 the committee members received presentations from existing specialized services including Geriatric Emergency Management (GEM) nurses, Nurse Practitioners Supporting Teams Averting Transfers (NPSTAT) and the Geriatric Assessment and Intervention Network (GAIN). A document to capture an inventory of existing services and how they are linked (or not) is being finalized. Efforts to define the target population continue as more meaningful data is becoming available to the LHIN in this regard. Northumberland Hills Hospital is continuing in their recruitment efforts for an executive director and are hoping to have an

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announcement within the next couple of weeks. Interviews to fill the remaining vacancies (Long-Term Care Home and Primary Care Physician) will be completed by the end of June. A Medical Director position summary has been finalized through various discussions and the recruitment strategy will be initiated in June. Assisted Living Services for High Risk Seniors (ALS-HRS): The Assisted Living program offered by Community Care Durham (CCD) is currently serving 29 clients in the Oshawa Hub and 22 clients in the Whitby Hub. A total of 51 clients are being served by CCD. Based on their current experience CCD has indicated that they may be able to serve more than the target population of 54 clients.

14 clients in Scarborough, 13 clients in North Durham, 25 clients in Peterborough and 2 clients in Lakefield have started service with the VON program. 11 clients in Scarborough, 14 clients in North Durham, 18 clients in Peterborough and 2 clients in Lakefield have been matched for the service and will be transitioned from the CCAC to the VON shortly. The VON program is constantly demonstrating efficiencies gained around cost per caseload due to larger programming. If a decision is made to integrate the Beaverton program into the ALS-HRS program then the process for administration, referral, intake, staff education, management support, reporting and data requirements will be standardized across all the hubs.

Behavioural Supports Ontario (BSO) Program: Behavioural Supports Ontario (BSO) activity continued to focus on rolling out Part 1 of the BSO value stream process to all long-term care homes in the Central East LHIN and in May focused on Scarborough and North East homes. There were a total of nine roll out sessions conducted in May and only a few long-term care homes had not attended at least one session. Follow-up with the remaining few Long-Term Care Homes is ongoing. Also in May, a full-day value stream mapping session was held with over 30 stakeholders from across Central East LHIN representing all partners of the integrated care team - long-term care, Community Care Access Centre, hospital acute and tertiary care, psycho-geriatric consultants and Nurse Practitioners Supporting Teams Averting Transfers (NPSTAT). On May 30, the Design Team held an all-day Strategic planning session to talk about the key priorities and action steps for the Behavioural Supports Program model development, spread and sustainability. Building on the success and lessons learned to date, the Action Plan will be updated to reflect the goals and objectives to be pursued and achieved up to the end of March 2013. From a staffing perspective, the Project Manager and Improvement Facilitator Supervisor positions were transferred to the Central East Community Care Access Centre and hiring processes for “Other Health Professionals” is ongoing. The BSO Design Team, Education and Capacity Building Committee and Measurement and Metrics Committee continued to meet in May. The Therapeutics Working Group met to plan the appropriate medical assessment procedures for people with behaviours in long-term care homes (LTCHs). Once processes and procedures are drafted, a strategy to engage LTCH physicians will be developed and tested. Quality improvement processes will be developed to ensure appropriate testing and spread throughout Central East. The Interim BSO Evaluation Report, March 2012 was distributed to key stakeholders across the province and reviews and analyses by the BSO Design Team and Measurement and Metrics Committee began in May.

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NPSTAT (Nurse Practitioners Supporting Teams Averting Transfers) Program: The NPSTAT program continues to operate effectively and recent “draft” data from the Ministry of Health and Long-Term Care has shown good outcomes for long-term care homes that have engaged the NPSTAT program. An example of this includes the reduced transfer rates to the Emergency Department. Once validated, data from the Ministry will be shared through the Stocktake report. Transitional Care Program: In mid-May the Ministry of Health and Long-Term Care requested the LHIN provide information on programs that have been implemented which support an "assess and restore" model of care “to help inform the Ministry's planning and development of a more consistent approach to assess and restore programs across the province to support government objectives outlined in Ontario's Action Plan for Health Care.” After requesting and receiving further clarification about the parameters of the request, LHIN staff determined that the request related to the following programs in Central East and submitted a completed report to the Ministry on June 11:

• Glenhill Strathaven Lifecare Centre – 15 convalescent care beds; • Northumberland Hills Hospital – 8 restorative care beds; • Rouge Valley Ajax Pickering – 20 transitional restorative care beds; • Peterborough Regional Health Centre – 7 interim long-term care beds; • Ross Memorial Hospital - Functional Enhancement/Restorative Care beds; • Lakeridge Health Whitby – 10 restorative care beds; • Campbellford Memorial Hospital – restorative care unit; and • The Scarborough Hospital – enhanced functional/cognitive/social therapy.

Mental Health and Addictions Ontario Common Assessment of Need: The Central East LHIN Ontario Common Assessment of Need (OCAN) local Steering Group did not meet in May. Implementation of the OCAN is complete across the LHIN. Three Central East LHIN OCAN Steering Committee members attended an OCAN training event in Toronto on May 17. The next Steering Committee will include the determination of a Sustainability Plan for OCAN, as well as membership in the OCAN GTA Implementation Group. This Group will oversee the ongoing implementation of the OCAN across the GTA to ensure consistency across the GTA LHINS. The fact that Ontario Shores has not implemented the OCAN remains a concern for both the LHIN and system partners. Schedule 1 Bed Registry and Common Assessment Tool (CAT) Implementation: The first month of operation for the Schedule 1 Bed Registry and CAT is running successfully. The Steering Committee met again on June 7, 2012 at Ontario Shores. Central East LHIN staff have received several inquiries from other LHINs regarding this project, and have entered information sharing discussions. Discontinuation of OxyContin: As noted in last month’s report, the delisting and discontinuation of the drug OxyContin is an issue of great concern to the Ministry of Health and Long Term Care, and to the LHINs. Several initiatives were introduced in March to address any anticipated crisis situations related to system capacity that could arise as the result of the discontinuation of OxyContin. These initiatives included:

• Provider training via webinars and other electronic formats. • Purchase of OTN equipment to increase system capacity. • Opioid Alerts from the Ministry of Health and Long Term Care

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• Real Time Surveillance of 70 Emergency Departments across Ontario. Each of the four initiatives has been completed. The Fact Sheets have been received by the LHIN, and are posted on the Ministry of Health and Long Term Care website. OTN equipment has been purchased. A Steering Group of LHIN Senior Directors, LHIN staff, MOHLTC staff and OTN staff has been struck to develop the distribution criteria and strategy for the province. The Central East LHIN has been an active participant. The MOHLTC is now negotiating with Health Canada regarding the installation of the equipment on First Nations. As of the end of May, this matter was not resolved. It is our understanding the Minister’s panel has provided their report to the Minister. However, it has not been released beyond the Ministry at this point. Although the weekly teleconferences with the Ministry have been cancelled, the LHIN is continuing to submit weekly reports. Staff have been communicating with Health Service Providers on a regular basis. There has been no substantive change in the situation in this LHIN in May. The Curve Lake First Nation has noted some concerns around OxyContin use related to members of their community and have requested an OTN Unit to assist them in accessing clinical supports. This request has been submitted to the Ministry of Health and Long Term Care as part of the overall Central East LHIN OTN request. Central East LHIN staff continue to carefully monitor this situation. Addictions Supportive Housing (ASH) Beds: The Central East LHIN received the final allotment of Addictions Supportive Housing Beds in April. This will add the last eight beds that were included in the 72 beds provided over the four year period of the project. Homestead in the Scarborough Cluster will receive eight beds, as will the Pinewood/CMHA Durham partnership in Oshawa. The Addictions Supportive Housing providers have been continuing to meet as a Community of Practice since the project began. The next meeting of this group is scheduled for July 18, 2012. Nurses in Schools: Central East LHIN staff will meet with the CECCAC, District School Boards and Central East LHIN Mental Health and Addictions providers on June 26 at the CECCAC to discuss the implementation and ongoing operation of this program. Central East Mental Health and Addictions Network: James Meloche provided an excellent presentation to the Central East Mental Health and Addictions Network on May 16 that was very well received. He has asked the Network to work on a Strategic Aim for Mental Health and Addictions for inclusion in the IHSP 2013-16. This will be submitted no later than September 2012. Central East LHIN staff will support the development of the Aim through several planning meetings to be held throughout the summer. Community Treatment Order (CTO) Reference Committee: Central East LHIN staff participated in the Provincial Community Treatment Order Reference Committee, which reviewed the legislation relevant to Community Treatment Orders in Ontario. The report has been completed and is available online – www.health.gov.on.ca/english/public/pub/ministry_reports/dreezer/dreezer.html.

Integrations Apsley and District Homes for Seniors (ADHS): Although the funding is now being provided to both the Canadian Red Cross and the Peterborough Housing Corporation, the LHIN has not received word that the final property transfer has taken place.

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Community Health Services Integration Strategy: The purpose of the project is to implement a facilitated integration process to achieve the ‘Community First Strategic Aim’ in each of the Durham, Scarborough and Northeast Service Clusters. The project will result in the identification of a preferred community health services integration model for each service cluster.

Design and implement a cluster-based service delivery model for Community Support Services and Community Health Centre agencies by 2015 through integration of front-line services, back office functions, leadership and/or governance to:

Community Health Services (CHS) Strategic Aim

• improve client access to high-quality services, • create readiness for future health system transformation and, • make the best use of the public’s investment.

In April 2012, the Durham Integration Planning Team (IPT) which includes CEO/EDs from the Durham Cluster and the LHIN team began meeting weekly. Each of 10 HSPs has identified one governor to be the identified ‘liaison’ to participate in 3-4 planned governance check-ins – this is in addition to regular updates provided by the organization’s own CEO/ED.

Durham Cluster Process

Accomplishments to date:

• Guiding Principles are the in process of being endorsed by all Health Services Provider Boards; • Terms of Reference has been endorsed and Ground Rules identified; and • Agencies have initiated due diligence information sharing presentations – highlighting client stories,

service delivered, challenges, and opportunities.

Local organizations providing health care to the residents of Haliburton County are working together to improve access and ensure that their organizations are ready to meet the needs of a changing population by becoming part of a Central East LHIN Integration Planning Team (IPT).

Integration Planning Process in Haliburton County

The work being done by the Haliburton County IPT is part of the broader Community Health Services Integration Strategy approved by the Central East LHIN Board in February 2012. It is recognized that Haliburton County is unique to other parts of the Central East LHIN because of its relative geographic isolation, distinct population and socio-economic realities. These differences present an opportunity to continue to improve quality, safety and client/patient outcomes. The Haliburton County Integration Planning Team held its first meeting on May 18th, and includes representatives of LHIN-funded health service providers whose main offices are permanently located in Haliburton County. Unique to the Haliburton County integration process, two critical partners, the Central East Community Care Access Centre and the Haliburton Highlands Family Health Team have been included on the IPT because of their significant contribution in delivering service to local residents. Member organizations of the IPT include: • Community Care Haliburton County • Haliburton Highlands Health Services • SIRCH Community Services

• Central East Community Care Access Centre • Haliburton Highlands Family Health Team

The Guiding Principles and Terms of Reference are currently in the process of being endorsed by all Health Service Provider Boards, the Guiding “Rules of Engagement” have been identified and agencies have initiated

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due diligence information sharing presentations – highlighting client stories, service delivered, challenges, and opportunities as well. The Haliburton County IPT meets every second Friday with a facilitator provided by the LHIN as well as a LHIN Team. CMHA – Northeast Cluster Integration: The CMHA – Joint Executive Governance Committee has been meeting every two weeks. The meetings have been attended by Central East LHIN staff. The Joint Executive Governance Committee, (JEGC) and Management Implementation Team (MIT) are making solid progress toward implementation of the objectives set out in the Integration Plan approved January 2012. Suggestions for the name of the new corporation were solicited. The JEGC plans to make a final decision on the new name at their meeting in Lindsay on June 12. It is also expected that a decision regarding the final structure of the new organization will be made at that time. This will allow Central East LHIN staff to initiate the Ministry processes necessary to complete the integration. The group is making steady progress towards finalizing the integration, the process has been exhaustive in its detail. It is expected that the JEGC will use the approved schedule set out in the Integration plan to evaluate their process to date at the June 12th meeting. Each of the Boards, (CMHA-P and KL) has been continuing to meet separately throughout this process. Decisions made by the JECG have been brought forward to each Board for their approval prior to finalization. The volunteer board members and staff members of each of these organizations should be commended for their dedication in working to complete this project. Central East LHIN Hospice Palliative Care Network (CEHPCN): On April 19, 2012 the CEHPCN held an all day Hospice Palliative Care IHSP Strategic Aims Planning Session. The Network was successful in developing a draft IHSP Strategic Aim: “Increase the number of people who receive hospice palliative care in the community and die at home, by choice, by X% (percentage to be determined) by 2016.” Another planning meeting will be scheduled to discuss next steps i.e. the establishment of strategic aim goals, leveraging of current resources and initiatives etc.

On April 20, 2012, LHIN CEOs, Senior Directors and the Ministry came together to discuss the completion of the palliative care template outlining 14 separate but aligned implementation plans reflecting a common end point for all LHINs over the next three years. A document has been generated and revisions have been solicited and incorporated. A formal poll of all CEOs was undertaken regarding agreement to proceed with discussions with the Ministry based on the document. The Central East LHIN offered its approval pending some provisions concerning how the process would unfold on a provincial basis. On May 1 and 2nd the Provincial End of Life Care Network came together for their second annual face-to- face meeting to discuss the Ministry Palliative Care document, “take stock” of each network’s relationship to the LHIN and review plans to move forward in collaboration with Ministry priorities. Palliative Education: The LHIN is working with the CE CCAC, the Central East Hospice Palliative Care Network (CEHPCN) and Durham Regional Cancer Centre in reshaping and investing in the Palliative Care system, including the delivery of education programs. LHIN-funded palliative education includes, but is not limited to, the following courses: Fundamentals of Hospice Palliative Care, Advanced Palliative Care Education (APCE), Comprehensive Advanced Palliative Care Education (CAPCE), and Learning Essentials for Advanced Practitioners (LEAP).

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The Central East LHIN, in partnership with stakeholders, is considering options to improve the delivery of education services and related programs across the Central East region while providing requisite accountability for outcomes. We are currently seeking ways to more equitably distribute resources across the entire Central East LHIN. As a result, the LHIN will continue to postpone palliative care education until the September 2012 while endeavoring to implement and deliver a new education work plan in the fall of 2012. The LHIN will continue to work with stakeholders in order to identify a clearer understanding of the palliative care needs within our region. Community Palliative Care Nurse Practitioner Program (CPNP): The following CPNP updates were highlighted in this month’s CECCAC Project Status Report:

• Project working groups have been established in both the Durham and North East clusters with final meetings scheduled for last week of June.

• Stakeholder analysis/population needs have been researched and conducted. • The Durham NP will initially focus on the Ajax/Pickering region. The North East NP will operate out of

the Lindsay office. • Stakeholder communications and relationship building is complete although this will be an ongoing

tasks throughout the course of the project. A communications strategy has been developed. • Two successful NPs have been recruited. Candidates started orientation and training on June 4th, 2012.

The CCAC has posted for five (5) additional palliative NP positions following the confirmation of funding from the MOHLTC.

• Training and presentation materials have been developed for the Symptom Response Kit for Palliative Care.

• A broad introduction letter introducing the CPNP program to Durham and North East Physicians has been drafted; physician mailing list complete. Letter to be issued the week of June 11, 2012.

Aboriginal Services First Nations Health Advisory Circle and Métis, Non-Status and Inuit Health Advisory Circles: The Central East LHIN Métis, Non-Status and Inuit Health Advisory Circle, and the First Nations Health Advisory Circle did not meet in May. The Metis, Non-Status Circle met at the LHIN office on June 13, while the First Nations Circle will meet at the Hiawatha First Nations on June 28. The Metis, Non-Status and Inuit Circle were pleased to welcome Liz Stone, the Executive Director of Niijkiwendidaa Anishnaabekwewag Services Circle in Peterborough. Central East LHIN staff are working to establish contact with the Executive Director of the Friendship Centre in Peterborough as well. The Central East LHIN Aboriginal Lead attended the annual LHIN Aboriginal Lead event hosted by the North Simcoe Muskoka LHIN in Victoria Harbour and Orillia on June 16 and 17.

French Language Services French Language Services Third Party Regulations 284/11: The Ministry issued a Directive requiring all agencies to ensure that French language services were being actively offered by all affiliated organizations who are providing a service on behalf of a Crown agency (through an accountability agreement). This means that appropriate measures must be taken (such as signs, notices and information on services) to make it known to the public that services are available in French. These active offers of service are to be put in place immediately if the accountability agreement with the third party was entered after July 1, 2011 and for agreements which took effect prior to July 1, 2011, agencies have until July 1, 2014 to have the active offer regulation in place. Supporting documents have been provided by the Office of

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Francophone Affairs and the French Language Services branch at the ministry, including an implementation guide and a check list Within these deadlines, every government agency must make sure that the French services are provided on an “active offer” basis. A meeting will be scheduled with the French Language Services Coordinators from all 14 LHINs to discuss how this regulation will be monitored to ensure compliance. LHIN Receipt of Entity Annual Report: Since becoming operational in the spring of 2011, the French Language Health Planning Entities have started reaching out to the Francophone community. In December 2011, Entity #4 submitted their first advisory report to the Central East LHIN and have since then completed a 2011-2012 work plan. On June 18, staff from the Central East LHIN attended Entity #4’s Annual General Meeting where the 2012-2015 Strategic Orientations were presented. In the Annual report, the following key accomplishments were noted:

• In collaboration with the LHIN French Language Services Coordinators and health care service providers, Entity 4 has delivered two French language training modules for Peer Leader Training and Self-Management through the Central East Self Management Program run by the Central East Community Care Access Centre. These modules follow the Standford model, which forms the basis of all regional self-management programs.

• The Entity will host a French Peer Leader training course for Self-Management on chronic disease prevention and management. Progress has been made in promoting this training in the Francophone Community and recruiting a very good group of committed volunteers.

French Language Services Coordinator: The French Language Services work plan was updated with the hiring of the new French Language Services Coordinator in early May. Work is underway to develop relationships with the French-speaking stakeholders and Health Service Providers in Central East LHIN catchment area. With the introduction of the Active Offer regulation, staff are working to build the French Language Services capacity with our designated providers, to ensure the fair and equitable delivery of high-quality healthcare services. Future initiatives include Francophone engagement to ensure active participation of Francophones in public consultations and community engagement activities which will inform planning and priority setting for the 2013-2016 Integrated Health Services Plan (IHSP). The French Language Services Coordinator has started to meet with key francophone organization leaders to seek input. Together with the French Language Planning Entity # 4, a francophone table will be created to gather feedback from this group of stakeholders. A joint meeting of French Language Services Coordinators from the GTA took place on May 22, which included staff from the Central, North Simcoe Muskoka and Central East LHINs, as well as staff from Entity #4 to review the joint action plan between the Entity and the LHINs. The LHINs will be deploying a survey to assess francophone needs and provide information regarding the socio-demographic status of the Francophone population of Central East LHIN and other LHINs who are conducting a similar survey. On May 25, staff from the LHIN met with the Entity Planning Officer to review the joint action plan and the funding agreement and discuss the implementation activities. On June 1, staff from the Central East LHIN met with the office of the Minister of Francophone Affairs, the French Language Commissioner’s office, the Entity and other LHINs to discuss the Minister of Francophone Affair’s role, mission and mandate and to discuss their responsibility and the role of the LHINs and the Entity in providing French Language Services.

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Quality and Safety Pharmaceutical Shortage: The Sandoz Canada injectable drug shortage continues to be monitored province-wide and at all LHINs. During the Central East LHIN CEO’s absence in May, the Champlain LHIN CEO acted as the Lead LHIN CEO to work with the Ministry on the system wide response. The Central East team continued to provide support to the Champlain LHIN CEO during this time. Provincially, the Drug Shortage Technical Advisory Committee has ceased regular meetings. The Ethical Framework developed by this group has been published to all stakeholders provincially, and Health Service Providers throughout the province are reviewing the document and determining how to operationalize it. The provincial Health Stakeholder calls led by the Ministry Emergency Operations Centre have stopped as responsibility for managing the provincial response is transferred to the Ontario Drug Program. Within the Central East LHIN, Health Stakeholder calls have been reduced to once every two weeks, but the Pharmacy group continues to meet via teleconference once per week. This group is to be commended for its mutual support, quick action when any member has a concern or query, and its development of a drug-sharing agreement that has now been shared provincially. Additionally, Lakeridge Health has developed a web-enabled Pharmacy Tracking Tool to manage inventory and flag impending shortages that is being shared both LHIN-wide and provincially. Senior Friendly Hospitals: Even though the Senior Friendly Hospital (SFH) LHIN Lead Working Group has been disbanded, we continue to participate on the Senior Friendly Hospitals Indicators Working Group. In May, the Indicator Working Group initiated a voting process to select two hospital-based indicators, one to measure functional decline and the other to measure delirium. Once selected, we will communicate the indicator definitions to hospitals and other key stakeholders. Better Outcomes Registry and Network (BORN): The Better Outcomes Registry and Network (BORN) is a provincial initiative developed to provide the knowledge needed for the best possible beginning for life-long health. The mechanisms for leading the organization to this vision include a number of key supports:

• The leadership team includes the executive, medical, scientific and administrative expertise required to oversee operations and set direction for the organization

• The Ministry of Health and Long Term Care in Ontario is providing the funding required to support BORN in delivering the necessary technology and knowledge required for the initiative

• CHEO

provides the founding support and sponsorship of BORN. They continue to provide the governance structure and administrative supports required to make the organization successful

The BORN Maternal Newborn Outcomes Committee identified six key indicators of quality care that will help improve the health of mothers and newborns in Ontario. These six indicators represent areas where there is good scientific evidence about the practices, where change was felt to be feasible and where by making changes, health of mothers or newborns would be improved. There were two areas of opportunity for our facilities in Central East LHIN namely:

• Rate of repeat cesarean section in low risk women not in labour at term with no medical or obstetrical complications done prior to 39 weeks gestation; and

• Proportion of women induced with an indication of post-dates who are less than 41 weeks gestation at delivery

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Central East LHIN BORN summary for Fiscal Year 2010-11:

Key Performance Indicators RVAP LH-O LH-PP NHH PRHC RMH RVC TSG TSB

Status Range

Target Warning Alert Rate of episiotomy in women having a spontaneous vaginal birth

11.2% 14.1% 5.4% 16.6% 25.4% 22.2% 48.4% 24.3% 12.2%

<13.0% 13.0-17.0%

>17.0%

Rate of formula supplementation in term infants whose mothers intended to breastfeed

6.6% 26.1% 9.2% 22.4% 19.4% 3.6% 23.5% § §

<20.0% 20.0-25.0%

>25.0%

Rate of repeat cesarean section in low risk women not in labour at term with no medical or obstetrical complications done prior to 39 weeks gestation

91.3% 60.8% 50.0% 70.4% 41.5% 59.0% 72.2% 56.7% 72.7%

≤10.0% 11.0-15.0%

>15.0%

Proportion of labouring women delivering at term who had Group B Streptococcus (GBS) screening at 35-37 weeks gestation

93.3% 95.3% 98.3% 93.0% 76.2% 89.9% 95.3% 94.6% 91.0%

≥95% 90.0-94.0%

<90.0

Proportion of women induced with an indication of post-dates who are less than 41 weeks gestation at delivery

67.4% 31.7% 16.7% 21.4% 14.7% 44.4% 65.6% 14.8% 42.2%

<5.0% 5.0-

10.0% >10.0%

Maternal Child Health: In review of the Provincial Council for Maternal and Child Health Maternal and Newborn Level Definitions Recommendations Report, last year, Rouge Valley Health System - Ajax/Pickering (RVHS AP) was asked to take the necessary steps to ensure their maternal-newborn services and programs were aligned with current level of care definitions provided in the report. Specifically: 2b Level of Care Status (Gestational Age- greater than of equal to 32 weeks and 0 days): Maternal

• Uncomplicated twin pregnancies if < 36 weeks and 0 days consider consultation and transfer; Women carrying fetus with anomalies (minor) not likely to need immediate interventions; Low-to-moderate maternal risk experiencing low risk medical/obstetrical complications where SGA is not suspected.

• 24/7 induction and augmentation of labour. • 24/7 availability of continuous EFM. • Labour analgesia should be available. This includes use of systemic narcotics (eg. IM, IV, PCA), nitrous

oxide,based on the availability of Anesthesia staff at that centre. Epidural services should be regularly available via well-defined epidural services and provided according to CAS/ASA guidelines for obstetrical anesthesia.

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• Available assessment within 30 minutes by Obstetrics, Anesthesia, and Pediatrics for emergencies and potential Cesarean sections.

• Uncomplicated dichorionic twin pregnancies if < 34 weeks and 0 days consider consultation and transfer.

Neonatal

• Care for infants with age ≥34 weeks and 0 days gestation and 1800 gms who have mild illness expected to resolve quickly.

• Resuscitation and stabilization of ill infants before transfer to an appropriate care facility. • Nasal oxygen with oxygen saturation monitoring (acute and convalescing). • Ability to initiate and maintain peripheral intravenous. • Gavage feeding. • Care of stable infants who are convalescing after intensive care. • Stable neonatal retrotransfers that are over 32 weeks + 0 days (corrected) gestation and not requiring

assisted ventilation or advanced treatments or investigations. • Care of infants with an age ≥ 32 weeks and 0 days gestation and greater than or equal to and a weight

of 1500g or greater who are moderately ill with problems expected to resolve quickly or who are convalescing after intensive care.

• Mechanical ventilation for brief durations (less than 24 hours) or extended stable continuous positive airway pressure (CPAP).

• Insert and maintain umbilical lines. • Maintenance of PICC lines. • Peripheral intravenous infusions and total parenteral nutrition for a limited duration. • Stable neonatal retrotransfers that are over 29 weeks + 6 days gestation and over 1200 grams not

requiring assisted ventilation or advanced treatments or investigations. Over the last year, hospital staff and physicians worked to ensure appropriate policies and procedures were developed as well as the roll out of education to support Maternal Newborn Levels of Care Definitions. As of June 12th, RVHS AP has transitioned its program to fulfill all of the Provincial Council for Maternal and Child Health requirements to provide level "2b" neonatal and maternal care at Rouge Valley Ajax and Pickering. The hospital is now safely and confidently providing this enhanced level of care to their community.

IHSP Strategic Aims Save a Million Hours of Time Spent in the ER Department ED Pay for Results (P4R) Year III (2010-2011):

MOHLTC communicated a proposed formula for calculating recovery of P4R Year III (FY2010) fixed funds on 08 November 2011. The proposed recovery formula relaxed the performance requirements that had been published in March 2010 for Year III. LHINs were given an opportunity to submit a performance explanation to MOHLTC, including any argument for a further reduction in recovery rates. The Central East LHIN did submit a performance explanation, recommending a further reduction in the recovery at RVAP, because of substantial volume increases at that site, and significant constraints on inpatient capacity.

Fixed Funding

The amounts communicated by MOHLTC and suggested by the Central East LHIN are as follows:

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Site

2010/11 One-Time

Fixed Allocation Initial

Recovery

Proposed Recovery (MOHLTC)

Proposed Recovery (Central

East LHIN)

LHB $740,700 $296,300 $74,100 $74,100

LHO $841,700 $673,400 $420,900 $420,900

NHH $399,000 N/A N/A N/A

PRHC $840,000 N/A N/A N/A

RMH $664,900 N/A N/A N/A

RVAP $417,500 $167,000 $33,400 $6,300

RVC $932,500 $186,500 $28,000 $28,000

TSB $379,500 N/A N/A N/A

TSG $379,500 $151,800 $30,400 $30,400

Totals $5,595,300 $1,475,000 $586,800 $559,700 The timeline published by MOHLTC indicated that follow-up with LHIN’s on the performance explanations would take place in December, and that recovery letters from MOHLTC to hospitals would be initiated in January 2012. As of June 2012, no response to the LHIN performance explanation has been received.

Year III was the first year in which designated Pay-for-Results sites were also required to achieve a 10% reduction in the time to physician initial assessment (PIA) at the 90th percentile. Separate funding was allocated to achieve this reduction, and this funding was described as being subject to recovery, but no proposed formula for recovery of this funding has ever been published by the Ministry. Hospital performance and funding in this category for year III is indicated in the table below:

Physician Initial Assessment (PIA) Funding

Site Baseline Target FY2010 PIA Performance PIA Funding Amount LHB 2.8 2.5 2.7 -4% $100,500 LHO 3.2 2.8 3.0 -4% $255,400 NHH 3.7 3.3 3.6 -2% $113,000 PRHC 4.6 4.1 3.7 -19% $120,000 RMH 3.3 3.0 2.9 -11% $148,000 RVAP 3.6 3.2 2.7 -24% $130,300 RVC 4.1 3.7 3.5 -16% $170,200 TSB 4.2 3.8 3.4 -18% $105,300 TSG 4.6 4.1 4.3 -6% $ 88,000

Legend

YTD performance meeting target

YTD performance improving, but not yet at target

YTD performance longer than previous year’s baseline

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ED Pay for Results Year IV (2011-2012):

Final funding for Year IV of the Pay-for-Results program distributes the Central East LHIN fixed funding allocation as follows:

Fixed Funding

Central East LHIN $6,041,100

Lakeridge Health - Bowmanville site $1,003,500

Lakeridge Health - Oshawa site $586,500

Northumberland Hills Hospital $387,700

Peterborough Regional Health Centre $630,900

Ross Memorial Hospital $531,600

Rouge Valley Health System - Ajax/Pickering site $852,200

Rouge Valley Health System - Centenary site $1,334,700

The Scarborough Hospital - Birchmount Campus $357,000

The Scarborough Hospital - General Campus $357,000 Conditions of fixed Pay-for-Results funding require all designated hospital sites to achieve an aggregate reduction in 90th percentile Emergency Department Length of Stay (EDLOS) across three patient categories. The amount by which each site must reduce this time varies depending on fiscal year 2010/11 baseline performance. Although the MOHLTC Pay-for-Results program does not require patient stream-specific reductions, the Central East LHIN has established each hospital’s H-SAA target as the Pay-for Results target1

. Achievement of the H-SAA targets will result in achievement of the Pay-for-Results aggregate targets for eight of the nine designated sites.

Final 2011-12 performance for the nine designated hospitals against their H-SAA targets is as follows:

Site

Admitted 90th Percentile Time (interim provincial target 25

hours)

Non-Admitted High Acuity 90th Percentile Time

(provincial target 7 hours)

Non-Admitted Low Acuity 90th Percentile Time

(provincial target 4 hours) FY2010

Baseline H-SAA Target

FY2011 Performance

FY2010 Baseline

H-SAA Target

FY2011 Performance

FY2010 Baseline

H-SAA Target

FY2011 Performance

LHB 38.83 34.42 26.32 6.05 6.05 5.18 3.92 3.92 3.38 LHO 80.10 61.45 67.57 6.82 6.60 7.20 4.48 4.00 4.85

NHH* 14.02 14.02 22.95 5.88 5.88 6.33 4.23 4.00 4.68 PRHC 41.52 38.43 46.82 7.80 7.60 7.85 4.40 4.00 4.45 RMH 45.70 37.38 39.08 6.72 6.72 6.53 3.92 3.92 4.08 RVAP 77.60 56.41 71.92 6.05 6.05 5.73 4.17 4.00 3.87 RVC 50.82 42.75 43.57 6.62 6.62 6.42 4.78 4.00 4.27 TSB 30.03 26.78 27.97 8.32 7.49 6.93 4.92 4.00 4.40 TSG 40.53 34.46 27.23 8.28 7.46 7.22 5.20 4.00 4.67

1 Northumberland Hill Hospital (NHH) is the exception to this practice, as its baseline performance in the admitted category was below the interim provincial target of 25 hours. NHH was assigned a P4R target in this category of 10% reduction over baseline, or 12.62 hours.

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Legend:

Baseline above provincial target Baseline below provincial target YTD performance meeting HSAA target YTD performance improving, but not yet at HSAA target YTD performance longer than previous year’s baseline

*Note that NHH performance for patients admitted to an inpatient bed, although increased over last year’s baseline, remains the lowest of the group, and below the interim provincial target of 25 hours, but still above the provincial standard of 8 hours. Final 2011-12 performance for the nine designated hospitals against their Pay-for-Results fixed funding aggregate targets is as follows, where green in the final column indicates that the site has achieved the required aggregate reduction, and red indicates that it has not:

Site Admitted Non-Admitted

I-III Non-Admitted

IV-V Performance

Target Overall

Performance LHB 32% 15% 14% 6.6% 60.2% LHO 14% -5% -7% 8.0% 15.6% NHH -60% -7% -10% 6.6% 0.0% PRHC -10% -1% -2% 10.0% 0.0% RMH 19% 1% -6% 6.6% 17.2% RVAP 7% 6% 8% 8.0% 19.8% RVC 15% 3% 11% 8.0% 28.1% TSB 7% 17% 11% 10.0% 34.0% TSG 33% 13% 11% 10.0% 55.9%

The funding letters from MOHLTC made no indication of what the recovery formula will be for this year for any funding stream. However, it is reasonable to assume that hospitals that have achieved their fixed funding performance targets will have none of that funding recovered. Additionally, for the sites that are participating in ED-PIP this year, $250,000 of allocated funds are protected against recovery. Thus, potential recovery scenarios for fixed funding appear as follows:

Site Final Funding Amount Overall

Performance ED-PIP

Participant Maximum Possible Recovery LHB $1,003,500 60.2% -

LHO $586,500 15.6% -

NHH $387,700 0.0% $387,700 PRHC $630,900 0.0% $630,900 RMH $531,600 17.2% -

RVAP $852,200 19.8% -

RVC $1,334,700 28.1% -

TSB $357,000 34.0% -

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TSG $357,000 55.9% -

Physician Initial Assessment (PIA) Funding: Each designated Pay-for-Results site is also required to achieve a 10% reduction in the time to physician initial assessment (PIA) at the 90th percentile. As for Year III, PIA funding was listed as being subject to recovery in Year IV of the Pay-for-Results program, but with no indication of the recovery formula. Final 2011-12 hospital funding and performance in this measure is as follows:

Site Baseline Target FY2010 PIA Performance PIA Funding Amount LHB 2.7 2.4 2.4 -11% $100,500 LHO 3.1 2.7 3.1 1% $255,400 NHH 3.6 3.3 3.9 6% $100,000 PRHC 3.7 3.3 3.7 1% $170,200 RMH 2.9 2.6 3.0 2% $113,900 RVAP 2.7 2.4 2.5 -9% $141,800 RVC 3.5 3.1 3.0 -13% $148,800 TSB 3.4 3.1 3.1 -9% $ 96,200 TSG 4.3 3.9 4.1 -5% $130,300

Legend

YTD performance meeting target YTD performance improving, but not yet at target

YTD performance longer than previous year’s baseline

Short Stay Unit Funding: On 05 January, a 10-bed Short Stay Unit was implemented at RVAP, using a Pay-for-Results allocation of $571,500 ($320,300 from a specific Short-Stay Unit funding stream, and $251,200 from that site’s Fixed Funding distribution). Performance requirements associated with this funding include: reduction of “Time to Inpatient Bed” to 8 hours, and maintenance of baseline “Time to Disposition.” Final RVAP performance against these requirements for 2011-12 is as follows:

Time to Inpatient Bed (hours)

FY2010 Baseline

Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

69.4 8.0 50.3 62.7 71.9 72.8 55.9 65.5 71.9 43.3 52.3 59.9 64.3 54.7 64.6

Time to Decision to Admit (hours)

FY2010 Baseline

Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

17.8 17.8 16.9 17.5 17.7 18.2 17.4 15.4 17.2 17.5 17.2 17.2 17.3 17.9 17.3 In the table above, green indicates that the hospital has met the requirement, and yellow indicates improvement, but non-achievement of target. Short-Stay Unit funding, as with other up-front Pay-for-Results funding, is described as being subject to recovery, but no formula or methodology has been identified to calculate this recovery. In Year IV of the Pay-for-Results program, designated hospitals are eligible to earn bonus funding each quarter by:

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1. Increasing the volume of admitted patients admitted to an inpatient bed within the provincial target of eight hours;

2. Increasing the volume of non-admitted CTAS IV-V patients discharged within the provincial target of four hours; and

3. Decreasing the volume of admitted patients remaining in the ER over 25 hours. In April, the LHIN received funding letters from the Ministry of Health and Long Term Care indicating bonus funding to be paid to LHIN hospitals for Q3 of fiscal year 2011-12, bringing the total variable funding flowed to date to the following:

Hospital Q1 Bonus Q2 Bonus Q3 Bonus

LH $155,800 $99,300 $320,500

NHH - $32,700 -

PRHC $68,000 $120,200 $23,100

RMH $49,400 $63,000 $4,500

RVHS $102,600 $214,200 $115,100

TSH $222,400 $300,100 $293,300

Central East LHIN $598,200 $829,500 $756,500

In Q3 and Q4, because of the establishment of the Short-Stay Unit, RVAP was not eligible to earn variable funding for either of the admitted categories (numbers 1 and 3 above). Q4 performance indicates that an additional $465,100 has been earned by Central East LHIN hospitals in variable funding. The funding earned by site and the funding that each site could have earned if 100% of patients were treated within the provincial targets is as follows:

Site Q4 Bonus Earned Q4 Bonus Opportunity

LHB $163,850 $303,100

LHO $13,500 $1,173,050

NHH $0 $118,250

PRHC $0 $758,750

RMH $900 $392,250

RVAP 0 $494,500

RVC $35,300 $431,050

TSB $20,250 $575,650

TSG $231,300 $785,550

Central East LHIN $465,100 $5,032,150 Formal notification of these funding amounts has not yet been received from MOHLTC, so these numbers are not yet final. ED Pay for Results Year V (2012-13): A working group consisting of ED LHIN Leads, LHIN Senior Directors, Cancer Care Ontario and MOHLTC representatives has proposed a draft model for the Pay for Results program for Year V (2012-13) that will

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streamline funding and eliminate recovery. This model is going through the approval process at the Ministry, and as of June 2012, has not yet been published. Clinical Decision Units: Clinical Decision Units (CDUs) are established at the following Central East hospital sites: LHB, NHH, PRHC, RMH, RVAP, RVC, TSB, and TSG. CDU’s must meet certain guidelines published by the MOHLTC, and are monitored by Access to Care on a monthly basis for compliance with two indicators:

1. the proportion of CDU patients with a total EDLOS (including CDU time) greater than 24 hours (not to exceed 10%); and

2. the proportion of CDU patients admitted to inpatient beds (not to exceed 30%). The purpose of measuring the two selected compliance indicators is to ensure that the hospital is not using the CDU to lower its ED length of stay for admitted patients artificially, as admission to the CDU stops the length of stay clock. However, analysis of the months during which Central East LHIN hospitals have breached either of the compliance indicators do not show a suspicious corresponding decrease in ED length of stay for admitted patients. Rather, those months reflect a lengthening of ED length of stay, suggesting that CDU performance is worsened during periods when the ER is struggling with all its performance indicators. Additionally, having different thresholds for the two indicators, while theoretically sound, in practice merely means that operating within the compliance threshold for the second indicator can provide a false sense of security for the first. Up to 30% of CDU patients can be admitted to an inpatient bed without triggering a compliance issue, but only 10% of CDU patients can exceed an EDLOS of 24 hours. If the hospital’s flow from the ED is impaired either because all its inpatient beds are occupied or because there is no most responsible physician (MRP) to admit to, all admitted patients, including the up to 30% that are allowed in the CDU, will have an EDLOS that is too long. December performance resulted in the CDU’s at both Peterborough Regional Health Centre (PRHC) and The Scarborough Hospital—Birchmount Campus (TSB) being escalated to Level 1 compliance. The indicator at issue for PRHC is percent of cases with ED Registration to CDU Discharge time greater than 24 hours—the hospital has continued to breach this threshold for January and February. For TSB the issue is percent of CDU cases admitted to inpatient beds—January and February performance dropped below the threshold of 30% once again. Action plans for these hospitals have not yet been submitted to Access to Care, as that organization has developed a new template for their submission. These plans will be submitted in Q1 of the 2012-13 fiscal year, along with communication of the problems with the compliance indicators noted above. Hospital Scorecards: Monthly scorecards have been developed, tracking the following seven Emergency Department/Alternative Level of Care (ED/ALC) indicators for all Central East LHIN hospitals:

• Emergency Medical Services (EMS) Offload Time; • 90th Percentile ED Length of Stay (LOS) for Admitted Patients (MLPA indicator); • 90th Percentile ED Length of Stay (LOS) for Non-Admitted Complex Patients(MLPA indicator); • 90th Percentile ED Length of Stay (LOS) for Non-Admitted Minor/Uncomplicated Patients(MLPA

indicator); • 90th Percentile time to Physician Initial Assessment (PIA) (P4R indicator); • ALC-LTC Volume (HSAA indicator); • % Alternate Level of Care (ALC) Days (MLPA indicator); and • % Hospital Discharges Before 11:00am.

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These monthly scorecards are sent to designated hospital staff accompanied by a LHIN request for a rationale for a given site’s performance or a plan for how to correct underperformance when necessary. Scorecards for the remainder of the 2011-12 fiscal year were sent out in May.

For fiscal year 2012/13, a new scorecard is being developed that will be more closely aligned with the MLPA dashboard and the Stocktake report, and will track additional contributing measures at all hospitals. The new scorecard, when finalized, will be presented to the Board for approval. Emergency Department (ED) LHIN Lead: Dr. Gary Mann, the Central East LHIN ED LHIN Lead, has scheduled site visits to all Central East hospital Emergency Departments. The purpose of the visits is to familiarize the ED LHIN Lead with the various sites, and to allow him to spend some time with the individual Chiefs discussing their particular concerns and suggestions. The ED LHIN Lead works with LHIN staff, Health Force Ontario, the Ministry of Health and Long Term Care, and when necessary, other ED LHIN Leads across the province to monitor ED staffing issues. The LHIN submits a weekly dashboard to the Ministry tracking any Emergency Departments at risk of closure due to physician staffing. Campbellford Memorial Hospital and Northumberland Hills Hospital continue to struggle with ED coverage on a month by month basis. This situation is being monitored closely by the LHIN and the ED Lead. Emergency Department Chiefs The Emergency Department LHIN Lead has, in the past, held a bi-monthly meeting of the LHIN Emergency Department Chiefs, scheduled to correspond with the bi-monthly Pay-for-Results meetings. Poor attendance of ED Chiefs has been a consistent problem at these meetings, compounded by a diffusion of other attendees because of rising interest in overall emergency and related services across the LHIN. The ED LHIN Lead, ER/ALC Performance Lead, and LHIN Senior Team are reviewing the structure and alignment of emergency services representation within the LHIN and this will be discussed as draft at the June 5, 2012 meeting of the Medical Leadership Group. Reducing the Impact of Vascular Disease by 10% (save 10,000 patient hospital days) by 2013 Supporting an Integrated Roll-out of the Ontario Diabetes Strategy:

The Regional Diabetes Coordinating Centre has received approval from the MOHLTC Diabetes team to proceed with planning and implementation of centralized intake for diabetes education programs across the LHIN. Planning will commence as part of the Centre for Complex Diabetes Care project. The Diabetes Regional Coordination Centre is in the process of updating the Diabetes Services Inventory for the Central East Region to support this initiative.

Standardized Referral and Intake Process

The Diabetes Regional Coordination Centre is actively engaged with the Centre for Complex Diabetes Care Collaborative in the early planning for the Central East Centre for Complex Diabetes Care. Integral to the success of this project is the engagement of primary care as part of the team developing the plan of care for these patients with very complex needs. Endocrinologists, Drs. Khan and Sigalis have expressed interest in participating in the planning for the Centre for Complex Diabetes Care to explore this role.

Inter-professional collaboration - Diabetes Specialists supporting Primary Care

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Chronic Kidney Disease (CKD) / Renal System Development In 2010, the province created the Ontario Renal Network (ORN), organized to align to provincial LHIN boundaries. A Central East LHIN Advisory body comprised of medical and administrative leadership from the three (3) Regional Renal Programs: Peterborough and Area (PRHC), Durham (LH) and Scarborough (TSH) were established. The ORN Regional Director is Jay Wilson and the Clinical Lead is Dr. Andrew Steele. New Chronic Kidney Disease Provincial Funding Model: Education sessions for hospitals related to implementation of new Chronic Kidney Disease funding are being held in July at each of the regional renal centres. Through this process the new funding level for hemodialysis has been increased from $263 from $199.50. This is an interim amount and will be revised again in 2013. The costing does not include the allied health costs (Lab and Diagnostic Imaging). In 2012-2013, in-centre and chronic kidney disease clinics will begin receiving funding based on ‘service bundles’. A similar funding approach for home modalities (service bundles) will be rolled out later in 2012-13. Within each dialysis bundle there are number of best practices identified for the patient. Programs should not see a major change in the funding this year unless they engage in more than 6 follow-up clinic visits consistently for each patient. The hospitals are in the process of two large data captures for the CKD patients to support the introduction of this new funding approach. The Scarborough Hospital: The Transition Unit official opening was held on June 7th at the General Campus. The event was a joint partnership between the hospital and the Ontario Renal Network to launch the Ontario Renal Plan. Lakeridge Health: The Lakeridge Health and Peterborough Regional Health Centre team met on May 30th to discuss strategies to improve vascular access for Lakeridge Health and Peterborough Regional Health Centre patients. The team hopes to have a 3rd surgeon in place for July 2013. This supports the commitment from Peterborough Regional Health Centre and the Lakeridge Health Senior Teams to execute a Memorandum of Understanding for vascular surgical services in the Durham and Northeast service clusters of the LHIN. Peterborough Regional Health Centre: The team is currently working with the Ontario Renal Network to review hemodialysis technician roles. Rouge Valley Health System: Discussions continue with specialist physicians from Rouge Valley Health System who are supporting Chronic Kidney Disease patients in their offices to identify opportunities for the Regional Program to provide access for these clients to Chronic Kidney Disease multidisciplinary teams. Vascular Access Task force: The Vascular Access coordinators from each of the three renal programs attend this task force. A current state Value Stream Mapping analysis has been completed for each program. This exercise was well received and provided an opportunity for the sharing of processes. The ORN is hosting a one-day workshop for the Vascular Access/Independent Dialysis coordinators on June 20. Central East Community Care Access Centre: The Ontario Renal Network continues to work with the Central East Community Care Access Centre to increase awareness of Peritoneal Dialysis in the Long-Term Care homes within the Central East LHIN.

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Carefirst Seniors and Community Services: Carefirst submitted an RFP to the Heart and Stroke Foundation to develop and implement an Ontario Needs Assessment for Chinese Ontarians Living with Heart Disease or Stroke. This will be a three month project with the final report delivered on August 27th. Carefirst was successful in the initial round of reviews and was asked to provide a presentation of their proposed work to the Heart and Stroke selection panel on June 5th.

Enablers – eHealth eHealth Strategic Plan: The Central East LHIN has set out to develop an eHealth Strategic Plan by building on the 2007 eHealth Strategic Plan and making revisions to address current and emerging needs and requirements in support of the LHIN IHSP and Provincial eHealth Ontario strategy. Also, the revised plan should inform and enable the development of a GTA LHIN Cluster strategy. The Cluster Chief Information Officer is working with eHealth Ontario to confirm funding for the strategic planning for the cluster and LHINs. Once funding is confirmed, the cluster will proceed to finalizing the contract with the preferred vendor from the Request for Proposal (RFP) process which will inform the development of the Strategic Plan. Resource Matching and Referral: Using a Lean approach, RWS developed a standardized, streamlined Future State through an understanding of the Current State at the site, hospital and LHIN levels. The current state assessment identified a number of challenges in terms of the Patient Experience, People, Standardization, Bottlenecks, and Technology. A number of opportunities were identified in the Rehab and CCC referral process. At the Central East LHIN Resource Matching and Oversight Committee meeting on May 16, 2012 there were detailed discussions on the eligibility criteria and referral process from acute to rehab/CCC. It was discussed that perhaps this needed to be approached in the same way as Home First and representatives from each hospital would work with the CECCAC to develop a plan and roll out by individual hospital/site. Consensus was reached on the “Conceptual Framework for Functional Groups” and this would help the Central East LHIN to categorize the programs. The Central East LHIN engaged RWS Advisory to assist in the development of Current State Value Stream Maps (VSMs) and Future State VSMs and Workflows for the RM&R project – essentially Steps 2 and 3 in the following 7-Step model:

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The key recommendations to move the Central East LHIN Acute to Rehabilitation and CCC referral processes to the desired Future State are:

1) Adopt the provincial Rehabilitation and Complex Continuing Care (RCCC) Expert Panel’s definitions when they become available;

2) Implement a paper version of the Future State Process before selecting and implementing a finalized electronic solution, including the following key changes: a) Obtain patient consent prior to initiating the application. b) Assess the patient as a candidate for post-acute care while they are in acute care. c) Keep the patient informed of their referral status. d) Streamline communications between the sender and receiver. e) Submit referrals prior to deeming the patient as “Rehabilitation Ready/Medically Stable” or

“Medically Appropriate”. f) Have one referral form or point of entry for both Rehabilitation and CCC. g) Have the receiving unit screen the patient for multidrug resistant organisms (MROs).

3) Select and implement an RM&R technology solution that enables the Future State Process, including streamlined information flows, a common waitlist, updated processes, and a corresponding matching algorithm and data set.

cGTA – ConnectingGTA: ConnectingGTA is a project with the five (5) GTA LHINs structured to “integrate electronic patient information from across the care continuum, and make it available at the point-of-care, to improve the patient and clinician experience”. The ConnectingGTA project will allow 700 service providers to securely share patient health information across the five (5) GTA Local Health Integration Networks (LHINs). Currently, electronic health information is contained in silos within the system. Over time, all 700 service providers will be connected under one “electronic roof” – allowing patient information to move from one service provider to another within the system. Program activities will focus on populating the ConnectingGTA solution with clinical data and then providing clinicians, from across the care continuum, with viewing capabilities to use that data to improve patient care. A number of projects contribute to the overall ConnectingGTA solution with many organizations participating in multiple streams of activity. In order to simplify and organize work for health service providers, implementation activities are being refined to allow resources and their time to be better managed at the organizational level. The aim of this work is to deliver an integrated program to help improve the continuity of care in the GTA. Within the program, we have two major buckets of work: data population and data viewing. Early Adopter Data Contributors have made great progress in technical planning and scoping activities over the past six weeks. To share timely updates, an Executive Indicator Report was introduced in early-May. The Executive Indicator Report will be distributed monthly to participating site CEOs, Chief Information Officers and Project Managers and the ConnectingGTA Steering Committee and working group members. The program continues to expand its reach and confirm the additional Early Adopters to obtain view access to ConnectingGTA. The viewing strategy will provide clinicians in the community support, long-term care, mental health and addictions, primary care and rehabilitation/ complex continuing care sectors with view-access to ConnectingGTA data in the initial implementation phase. Over the next few months efforts will start to increase in Clinical Engagement, Operational Sustainability and Expansion Planning.

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Timely Discharge Information Systems (TDIS) – Phase II: The Timely Discharge Information System (TDIS) has been developed to ensure family doctors and other community physicians receive the information concerning a patient’s hospital stay within 72 hours of transcription from the hospital. TDIS continues to add new physicians weekly to receive live transmission of patient discharge summaries and reports directly into their information systems. All four (4) client management system (CMS) vendors (OSCAR, Purkinje, P&P Data Systems, Abelmed) completed their Physician Interface development and user acceptance testing. 14 pilot physicians are now turned over to receive live data via TDIS. There are 150+ physicians currently receiving discharge summaries and other reports into their clinical management systems (CMS) via TDIS. More than 10,000 reports are being accessed on a monthly basis and early feedback supports the fact that clinicians are better able to make timely and informed decisions for patient care. Phase 2, as part of the connecting GTA project, involves an expansion to include additional LHIN hospitals: Ross Memorial, Haliburton Hills and Ontario Shores CECCAC, two CHCs and four additional vendors. The status of the PSS upgrade has been tracked and the status of physicians/clinics in the implementation phase have also been shared with the Central East LHIN Primary Care Leads, Dr. Drury and Dr. Jyu who are currently reaching out to these physicians to encourage them to upgrade the licenses so they may benefit from receiving TDIS reports directly into the PSS Electronic Medical Record. Surgical Utilization Booking Management Integration Tool (SUBMIT): SUBMIT is a web-based project geared to improve patient Wait List management and Wait Times reporting for surgeons and hospitals in the Central East LHIN. The product, Novari Health, is being implemented in seven Hospitals with surgical programs. The project work is almost complete for the SUBMIT surgical project. While there are some components that will be rolled out past March 31, 2012, including complex project work with Cancer Care Ontario for Phase II hospitals, an upgrade of the Pre-Op Module to a full calendar, the completion of testing for the McKesson interface for Ross Memorial Hospital (RMH) and final implementation for Campbelford Memorial Hospital (CMH). In the months of May and June, the Chief Nursing Executives and Chief Financial Officers received a presentation of SUBMIT on May 18th and there was a review of the application use for reporting purposes. Rouge Valley Healthy System led a presentation at eHealth 2012 in Vancouver on May 29 by Surgical Director, titled the following – “Are We There Yet? A Regional Public/Private Collaboration to Implement an Integrated, Real Time Operating Room Booking/Wait List Management & Wait Times Reporting System”. Phase II hospitals (RMH, PRHC, NHH, CMH) continuine testing for Complex Migration to CCO (Cancer Care Ontario). Patient Pre-Op work – “PAC Module” preparation work was completed through data requests from hospitals. A meeting was held with Central LHIN staff and the SUBMIT project manager to discuss reporting requirements to effectively manage wait times on a monthly basis. The LHIN has asked the Project Manager (PM) to conduct data gathering in conjunction with the Diagnostic Imaging Director group, to determine if a Diagnostic Module is viable within Novari. The Chiefs of Radiology from Central East LHIN hospitals received a presentation on the surgical system and the findings on May 28th. There was discussion on potential benefits of a Giagnotics Module was well received.

Lakeridge Health will be the pilot for the other six sights in confirming procedure pre-op triggers and the implementation plan of PSS, meetings are being held with the Lakeridge Health physicians to confirm and build the templates and the plan. Hospitals will be formalizing the payment schedule of annual maintenance and licensing for the Novari system.

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CCIM – Community Care Information Management – Tool Adoption: The CCIM project consists of supporting the implementation of the Human Resources Information System (HRIS) and the various Common Assessment tools (CAT) within the Central East LHIN. Two CCIM tools are being implemented that impact the Hospitals and CCAC sectors, namely the Ontario Common Assessment of Need (OCAN) and Integrated Assessment Record (IAR), which will allow hospitals to view all assessments by patient in a central repository and storage environment for OCAN and Resident Assessment Instrument-Mental Health (RAI-MH). OCAN will be implemented by the outpatient and external mental health clinics of hospitals by March 2012.

Eight out of nineteen health service providers have completed implementation, with a total of seventeen health service providers agreeing to participate and are currently rolling this tool out. Software is being tested for two other organizations with thirteen of the seventeen currently live on OCAN. Reflective practices are being run with one organization and work will continue to ensure that the remaining organizations meet their Integrated Assessment Record milestones.

OCAN/IAR

Community Support Services Common Assessment Project (CSS CAP) provided three options to the Central East LHIN around the vendor strategy for the interRAI CHA software implementation. The Central East LHIN steering committee in conjunction with the Central East LHIN staff chose the Hybrid Model, which is a primarily LHIN-based approach where the majority of HSPs would use the LHIN solution, while other HSPs may choose and manage other vendors independently. After carefully considering the various issues around implementation, timelines, education, support, sustainability and costs the Central East LHIN made a decision to follow the HNHB LHIN strategy and leverage the existing Community Care Access Centre (CCAC) Provincial assessment tool solution that is hosted by eHealth Ontario. This solution has been in use for several years with over 5,000 CCAC users provincially and has the capacity to support the interRAI CHA module/tool for HSPs.

CSS/IAR

13 of the 15 Phase 1 health service providers are now live on the Common Health Assessment (CHA). The remaining health service providers are working towards June 25th as a roll-out date. CAPs and Care planning was scheduled in mid-end of June. Phase II providers have all met their technical training milestones. They are all registered and attending training sessions for coding this month. Additional training is being offered for consent and the Privacy and Security implications of the software. Phase II providers have a go live date of July 9. Fiscal Responsibility: Resource investments in the Central East LHIN will be fiscally responsible and prudent Funding and Allocations: The following funding letters were issued in May to our Health Service Providers –

• 2012/13 Base Funding Increase for Supportive Housing for People with Problematic Substance Abuse (SAP) Program: Lakeridge Health (LH) and The Governing Council of the Salvation Army (GCSA) each received $84,000 in base funding for fiscal year 2012/13. This program will target people with problematic substance abuse who are homeless or at risk of homelessness and who are high-needs for addictions support services, have complex addiction problems and may have a concurrent disorder. The objectives of this program are: to reduce the frequency of re-admissions to addiction program, reduce contact with the criminal justice system, and reduce repeated use of emergency and acute care systems. This funding with all associated expenses and applicable client statistics must be reported by

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LH and GCSA to the Ministry of Health and Long-Term Care (MOHLTC) and the Central East Local Health Integration Network (Central East LHIN) in all data submissions using accounts provided in the Ontario Health Care Reporting Standards (OHRS).

• 2012/13 Reallocation of Protected Physician Funds: Port Hope Community Health Centre (PHCHC) has been authorized by the Central East LHIN and MOHLTC to reallocate $75,000 from unspent dedicated physician salary funding towards hiring one Nurse Practitioner (NP). The performance requirements include the one NP who is to work up to 3 days per week and funds are to be utilized by March 31, 2013. This funding is to support the expansion of evening services to accommodate an average of 10 to 12 new applications per week.

Web Enabled Reporting System (WERS)/Self Reporting Initiative (SRI) Update: The 2011-12 CATLite Q4 reports were due on June 7. WERS access was sporadic due to increased traffic on the site as agencies download previous reports which will no longer be accessible from WERS as of June 30, 2012 as the system transitions to SRI. As a result, many agencies that had completed their reports on time were unable to upload to the system. 83% of agencies uploaded their reports to WERS by the deadline and the remaining agencies were contacted to upload their reports as WERS access has been restored. The 2011-12 Annual Reconciliation Report (ARR) is due on WERS by June 30, 2012. Providers have been encouraged to upload sooner to avoid any complications as WERS access stops on June 30, 2012. Ministry-LHIN Performance Agreement (MLPA) Performance Requirements and Risks: In April the Central East LHIN reported all “green” performance status for all 90th Percentile Diagnostic Imaging and Surgical Wait Times indicators, building on the results achieved in March 2012 and sustaining the gains. A number of Central East interventions carried out in Q4 continued to provide benefits in April 2012. These Q4 2011-12 interventions included the purchase of additional volumes, funding for data quality improvement and clean up, and the introduction of Surgical Utilization Booking Management Integration Tool (SUBMIT) software. The April results are summarized in the attached Central East LHIN MLPA Performance Indicator Dashboard, Appendix A. As a result of new funding rates announced by the Ministry, as part of Quality Based funding, each hospital will review whether or not to continue procedures. Hospitals may choose to specialize in certain procedures as a means to reduce costs. The Central East LHIN has set up a working group to discuss volume adjustments between the hospitals, and to determine “who does what” procedures, beginning with cataract procedures. Hospital Service Accountability Agreement (2012/15 H-SAA): As June 30 approaches, the Central East LHIN has been working very closely with all 10 Hospital corporations to arrive at a 2012/13 H-SAA. A provincial LHIN H-SAA Leads group was formed in April and weekly meetings have commenced to raise issues and discuss the process. To date, it has been confirmed that agreements will be signed with the hospitals as of July 1, 2012. However, the potential for extensions for extenuating circumstances has been identified. The Ministry authorized the LHINs to release Indicative Planning Numbers (IPNs) to the hospitals on April 17th, officially kicking off the Hospital Annual Planning Process (HAPS) on the WERS reporting system. The Central East LHIN Hospitals preferred to wait until the Health System Funding Reform QbP and HBAM allocations were available before proceeding with the planning process. These were officially released on May 29th, at which time, the Central East LHIN extended the WERs submission deadlines to June 15th. In the meantime, the Central East LHIN booked meetings and prepared volume reconciliations, to meet with all hospitals and discuss their 2012/13 plans, particularly the following:

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• Volumes and Wait Times as negotiated as of March 31,2012 unless impacted by HSFR

• Negotiation of new indicators or changes to definitions

• Mitigation strategies to balance any plans for integrations

• Plans for major changes to services • Risks and mitigations • Discussion of impacts of QbP and HBAM

(HSFR Hospitals only)

The provincial working group has not yet released the legal draft of the agreement, although it is anticipated it should be available in time for the LHIN Board meeting on June 27. The schedules have been released with the following changes noted, Percentage ALC Days (closed cases) has been added and a new provincial ALC indicator - % ALC Days has been introduced in addition to:

• Total Acute Inpatient Weighted Cases and Day Surgery Weighted Cases (previously combined); Global Volumes

• Mental Health Inpatient Weighted Patient Days - not previously weighted; and • Rehab Inpatient Weighted Patient Days – not previously weighted.

• Cardiac Surgery broken down into several sub-categories; Wait Time Volumes

• Angioplasty and paediatric surgery added; • Services and Strategies; and • Neurosurgery and Bariatric Surgery added.

• Cases of Ventilator-associated Pneumonia; Five New Quality Indicators

• Central Line Infection Rate; • Hospital Acquired Cases of Clostridium Difficile Infections; • Hospital Acquired Cases of Vancomycin Resistant Enterococcus; and • Hospital Acquired Cases of Methicillin Resistant Staphylococcus Aureus.

• Primary hip New Section for Year 1 Quality Based Procedures:

• Primary knee • Cataract

• Inpatient rehab for primary hip • Inpatient rehab for primary knee • Chronic Kidney Disease (as per Ontario Renal Network

Allocation Schedule) Health System Funding Reform: The Ministry has been travelling to LHINs across the province to provide training and answer questions about HSFR, including HBAM and QbP. On May 28th and 29th, two full day sessions were offered in this LHIN. The first day included senior leadership from the LHIN and the hospitals. The second day was opened up to a broader base of participants. These sessions have brought the system closer to an understanding of how the components of HSFR were calculated. The hospitals have all requested a more detailed breakdown of the opening allocations and what is included and not included (i.e. LHIN funding). This is forthcoming within the next week or two. In addition to the Ministry training session, Gary Mitchell of Lakeridge Health who is also a member of the Ministry HSFR Advisory Committee, at the request of the HCFLG conducted a discussion about HBAM at the HCFLG meeting on May 18th, followed by an afternoon session on June 8th, directed at a more technical audience. It is anticipated that with Gary’s assistance, LHIN hospitals will gain a clearer understanding of how activity and demographics can influence future HBAM results.

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Long-Term Care Service Accountability Agreement (L-SAA): The Central East CCAC has been conducting its quarterly engagement sessions with the long term care sector. The LHIN contributed messaging around the Central East LHIN process for addressing revisions to the LTCH Occupancy Targets Policy and the Behavioural Supports Project updates. Central East Community Care Access Centre (CECCAC) Performance and Risks: As a result of the introduction of the quality-based funding model in 2012-13, it is expected that 90% of rehabilitation services for Hips and Knees will be performed by the CCAC. Central East LHIN staff have estimated the resulting pressure to be between $0.5 M and $0.6 M on the CECCAC in 2012-13. The CECCAC is actively planning for and implementing a number of initiatives, including the new client care model, mental health and addiction nurses in schools, the rapid response nurse program, the nurse practitioner integrated palliative care program and the Behavioural Supports Ontario (BSO) program in the community. The in-home program costs have levelled off since the impact of the revised Home First criteria in April 2012. The CECCAC is focusing its efforts to reduce the weekly in-home costs to offset any potential 2012/13 deficits. The strategies to achieve this will be finalized at an upcoming CECCAC senior team meeting and will then be implemented through Q2. See Appendix B. Hospital Performance, Risks and Capital Issues:

The Q4 2011-12 results are due in June 2012 and will be reported to the Board in August. At the present time, the LHIN is not aware of any hospital ending the year without being balanced or not being able to operate within negotiated corridors.

Hospital Performance

Due to the following factors, the key challenge in 2012/13 is the ability of the hospitals to function within the balanced budget requirement without significant reduction in services:

Hospital Risks

• 0% increase to base budget for inflationary component when hospitals are experiencing approximately 3.5% for negotiated union settlements and other inflation pressures in 2012/13;

• Changes in funding and volume allocation for four Quality Based procedures represent a challenge to the hospitals as they now need to deliver at a new 40th percentile price; and

• Adjustments as a result of the introduction of the Health Based Allocation Methodology (H-BAM). Based on meetings held with Central East LHIN hospitals, our preliminary assessment is that all hospitals will come in balanced without significant reduction in services. The Ministry has reduced the impact of HBAM on hospitals in 2012-13 by applying a mitigation factor. The pre-mitigation impact is much higher; hospitals’ ability to cope will be assessed as part of 2013-14 hospital planning.

Ontario Shores’ facilities are now 16 years old. According to Ontario Shores, while many progressive features were introduced in the design, the inpatient facilities are under-sized. Ontario Shores will be submitting a capital proposal in the summer of 2012 for Central East LHIN and Ministry consideration.

Hospital Capital Issues

Wait Time Strategy Working Group (WTSWG): The WTSWG met in May to discuss the April results. The Working Group was pleased with the performance status indicators under the 90th percentile Diagnostic Imaging and Surgical Wait Times which have remained consistent or better from March 2012. The Working Group noted that stellar performance was due to a number of Central East LHIN interventions in Q4 of 2011/12. These included the purchase of additional volumes, funding for data quality improvement and clean up and the introduction of Surgical Utilization Booking Management Integration Tool (SUBMIT) software.

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The Group was concerned about sustaining the current performance as the effect of one-time funding in Q4 wears off and the likelihood that there may not be one-time funding available in 2012-13. Several hospitals noted that patient choice for a particular physician led to high wait times. Staff from the LHIN will be working with this group to monitor the continued performance and address concerns. Orthopaedic Scorecard: On April 11, 2012, an Orthopaedic Quality session was held in the Central East LHIN. In attendance were physician representatives from Central LHIN hospitals. The purpose of engaging the physicians in this session was to gain their support in the achievement of performance targets. Positive feedback was received from those in attendance. Some of the suggestions made included:

• Taking into consideration that an allied health team would be a benefit; • Ensuring that there is clear messaging to patients which will lead to improved results; and • The need to educate family physicians was raised.

Hospital-Community Care Access Centre Financial Leadership Group (HCFLG): On May 18, the Central East LHIN Hospital/Community Care Access Centre Chief Financial Officer Group engaged the Vice President Clinical Services and Chief Nursing Executives Group to establish a process for applying the LHIN Decision Making Framework to Quality-Based Procedures (QBP). This model will be applied to the second half of the QbP allocations for hips, knees, cataracts and hip and knee rehabilitation to be allocated in 2012/13. Once the model is refined, it will be used to evaluate all remaining QbPs (up to 30) planned for allocation over the next three years. The first steps in this process, included an introduction to the Decision Making Framework, the guiding principles and ground rules such as agreement on a consensus model. This is an iterative process, including several surveys back in forth between meetings to arrive at criteria to evaluate weights to apply to criteria and, performance metrics to compose ranking scores, etc. The group’s meeting on June 15th was used to review and assess how each of the hospitals ranked using pre-defined, weighted criteria and objective data on the cataract procedure. Options around alternative models will then be explored and the decision-making model applied once again. After proposals for models of service delivery are on the table, affected hospitals will submit business cases and further discussion at the group level will proceed to assess system readiness (Step 4), with the goal of arriving at a system-wide proposal to provide to the Central East LHIN Board for discussion in September. Diagnostic Imaging (DI) Working Group: The DI Working Group co-hosted with the LHIN, an engagement session directed towards Diagnostic Imaging (DI) Department Chiefs and/or Medical Directors across the LHIN. The purpose of the session was to educate and update the LHIN, Diagnostic Imaging Working Group and Wait Time Strategy Working Group initiatives and to solicit feedback and input. Paul Barker led the session with an introduction to the Health System Funding Reform, including Quality-Based Procedures and the potential impact on diagnostic imaging in the Central East LHIN. Lydia Antalfy, Chair, DI Group, provided a summary of the CT and MRI performance and the accomplishments of the DI group, the Wait Time Strategy Working Group (WTSWG) and the LHIN in developing strategies to manage DI performance at a system level. Karol Eskedjian, Lakeridge Health (LH), conducted a demonstration of the Surgical Utilization Booking Management Integration Tool (SUBMIT) program and discussed the plans and consultations underway regarding the potential development of a DI Module (DIRECT). There was

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considerable interest in this project and the potential for elimination of unnecessary paperwork, protocol and follow-up with prescribing physicians for missing information. The LHIN will continue to engage with this group through the DI group with a quarterly communiqué and future face-to-face engagements, as required.

Community Engagement Community Engagement is the foundation of all activity at the Central East LHIN. Being more responsive to local needs and opportunities requires ongoing dialogue and planning with those who use and deliver health services. Engagement with a wide range of stakeholders can be conducted at various levels including informing and educating; gathering input; consulting; involving and empowering. To assist us in tracking our Community Engagement activities, an ongoing Calendar of Events is kept up to date and shared weekly with staff. It documents all engagement activities with a wide range of stakeholders. Many of these events are also posted on the Central East LHIN website: www.centraleastlhin.on.ca/showcalender.aspx. Below are listings of recent activities that the Central East LHIN staff have been involved with:

• On May 4th, Central East LHIN staff were invited to participate in an information sharing meeting with the Central East CCAC at Scarborough Agincourt MPP Soo Wong’s office. Ms. Wong was interested in learning more about the role of the CCAC and how they played an integral role in the health care system.

• Staff attended the Concurrent Disorders Training event held in Oshawa by the Concurrent Disorders Network of Durham on May 9.

• Jai Mills attended a meeting of the Student Leadership Initiative held at the Durham District School Board on May 11.

• The Township of Brock Council invited James Meloche to speak at a health care knowledge exchange on May 15th. This event was open to the public. The invitation was a result of the Central East LHIN’s presentation to Durham Region’s Health and Social Services Committee in January. The Township of Brock wanted more information, including information pertaining specifically to their township.

• Wayne Gladstone and James Meloche participated in the 4th Annual Central East Continuing Medical Education (CME) event for primary care physicians, hosted by Dr. Christopher Jyu at Tosca Banquet hall on May 16th.

• Reach for Recovery, formerly SPAN, hosted a one year anniversary celebration in Lindsay on May 25th. Staff from the Central East LHIN attended along with Haliburton-Kawartha Lakes-Brock MPP Laurie Scott. The program appears to be thriving under the leadership of CMHA Peterborough and staff and clients seem to be thrilled with the new, comfortable space.

• On June 13th, James Meloche was the guest speaker at the Retired Teachers of Ontario Association in Lindsay. The focus of James’ presentation was the Value of LHINs. The attendees had some tough questions on access to services, and commented on the need for more information to be shared with the public so they knew how to access services when they needed them.

The Central East LHIN website continues to be a primary vehicle for both communication and engagement with our stakeholders. From May 1 -31, 2012 there were 7,155 visits made by 4,126 visitors. There were 22,404 pages viewed. After the splash page, the page with the biggest number of hits continues to be the Careers page with 1,358 unique views. This was closely followed by the About our LHIN page, which had 739 unique views.

Website

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As noted in previous CEO reports, many LHINs and HSPs have starting using Social Media to communicate with their audiences. Below are the “tweets” posted on the Central East LHIN Twitter account in May:

Social Media

May 7, 2012

@CentralEastLHIN

. May 7, 2012

@CentralEastLHIN Mental Health For All, strategic events happening across the country http://bit.ly/Krkg8S May 8, 2012

@CentralEastLHIN Leads to share latest info with stakeholders

http://bit.ly/IIVXC1 May 16, 2012

@CentralEastLHIN

http://bit.ly/J8gr72 May 17, 2012

@CentralEastLHIN http://bit.ly/Jz0lon

May 17, 2012

@CentralEastLHIN presentation 2 local physicians

http://bit.ly/IIVXC1 May 24, 2012

@CentralEastLHIN hospitals after presentation at yesterday’s board meeting

http://bit.ly/Mu6ZcO May 24, 2012

@CentralEastLHIN Local citizens invited 2 join board 2 fill current vacancies, deadline 2 apply June 1 plz RT, for more info http://bit.ly/JZKBcf Many of our tweets were retweeted by some of our 233 followers and then retweeted again by their followers so that our messages were spread to thousands of stakeholders. We continue to encourage people to subscribe to the website and to follow us on Twitter in order to be alerted to new content and new information as it is posted. This will ensure our communities are informed, educated, can provide input, be involved and consulted on the work being done to create an integrated system of care that provides better care, better health and better value for money.

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Ministry Announcements: Seniors Care Strategy: On May 24, 2012 the Ministry of Health announced the development of its Seniors Care Strategy which is focused on helping seniors to stay healthy and live at home longer. The strategy will include the expansion of physician house calls, increased access to home care for seniors, the establishment of care coordinators to assist seniors in navigating through the system and encouraging healthy eating and active living. Dr. Samir Sinha was appointed as the expert lead for the strategy. Dr. Sinha is the Director of Geriatrics at Mount Sinai and the University Health Network and is Chair of the Health Professionals Advisory Committee with the Toronto Central LHIN. A list of recommendations will be provided to the Ministry of Health in the fall of 2012 addressing how to help more seniors live independently at home and in their community. Other Announcements: Haliburton Highlands Health Services (HHHS) CEO accepts new position: Paul Rosebush, CEO of HHHS will be leaving his position as Chief Executive Officer on September 1, 2012 to pursue new career opportunities. Paul has served as CEO of Haliburton Highlands Health Services from 2008 and his dedication has led the hospital to achieve financial and operational efficiencies as well as eliminate a substantial deficit all while improving patient care. We wish Paul all the best in his new position. CEO of Ontario Community Support Association (OCSA) retires: Susan Thorning will be retiring as CEO of OCSA following the annual conference in October. As an advisor to the organization for the past 19 years, Susan served as CEO from 2006 onwards and is recognized for her leadership through a period of political and fiscal change.

Central East LHIN Operations Finance: The Audited Financial Statements were presented to the Audit Committee on May 15, 2012 and were approved by the Board at the meeting on May 23, 2012. The final bilingual version will be published in the Central East LHIN Annual Report. The Consolidated Report 2011-12 was submitted to the Ministry of Health and Long-Term Care on May 30, this report included the financial statements and schedules regarding assets and transfer payment reconciliations. The transition to the new financial system Microsoft Dynamics GP 2010 is now complete and the business unit continues to process purchase orders, accounts payable invoices and the month-end cycle using the new system. Training for the Human Resources Information System (HRIS) module was offered to LHIN staff in this role during the month of May through the LHINs Shared Services Office. The implementation committee continues to design and configure the system according to the needs specified by all 14 LHINs in preparation for the employee web-based portal, which is scheduled to go live in September 2012. Staffing Announcements: Michelle Lemme will be commencing a contract position with the Project Management office on June 18 as an Integration Facilitator. She has held previous consulting positions with Mount Sinai Hospital, the University Health Network and the Ministry of Health and Long-Term Care. Prior to these assignments, Michelle held senior positions with Eli Lilly Canada. Respectfully Submitted,

Deborah Hammons Chief Executive Officer Central East Local Health Integration Network

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Appendices Appendix A

MLPA April 2012 report.pdf

Appendix B

CECCAC report.pdf OBRAM Monthly Update to CE LHIN.pd

Appendix C

IMS Messenger JUNE 2012.pdf

Appendix D

CCIM update.pdf