Target as stated on QIP 2017/18. Current Performance as stated on QIP2017/18

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1 Excellent Care for All Quality Improvement Plans (QIP): Progress Report for QIP The Progress Report is a tool that will help organizations make linkages between change ide and improvement, and gain insight into how their change ide might be refined in the future. The new Progress Report is mostly automated, so very little data entry is required, freeing up time for reflection and quality improvement activities. Health Quality Ontario (HQO) will use the updated Progress Reports to share effective change initiatives, spread successful change ide, and inform robust curriculum for future educational sessions. Meure/Indicator from 1 5 day wait time - Personal Support for Complex Patients: % of complex patients who received their first personal support service within 5 days of the service authorization date. ( %; Home Care Clients; October 2015 September 2016; HSSO CHRIS, HSSO DAD) QIP No planned improvement initiatives (change ide) were included in Mississauga Halton's 2017/ QIP. continues to be better than the provincial average bed on current available data. NOTE: This indicator technical definition h been changed to include patient available date (historically h included service authorization date which is being sunset) and will mean different performance outcomes. Realizing that the QIP is a living document and the change ide may fluctuate you test and implement throughout the year, we want you to reflect on which change ide had an impact and Change e from Lt Years QIP (QIP ) See. W this change idea implemented intended? (Y/N button) Lessons Learned: (Some Questions to Consider) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others?

2 Meure/Indicator from 2 5-day wait time for home care: Nursing Visits % of home care patients who received their first nursing visit within 5 days of the service authorization date. ( %; Home Care Clients; October September 2016; HSSO CHRIS, HSSO DAD) QIP No planned improvement initiatives (change ide) were included in Mississauga Halton's 2017/ QIP. continues to be better than the provincial average bed on current available data. NOTE: This indicator technical definition h been changed to include patient available date (historically h included service authorization date which is being sunset) and will mean different performance outcomes. Realizing that the QIP is a living document and the change ide may fluctuate you test and implement throughout the year, we want you to reflect on which change ide had an impact and Change e from Lt Years QIP (QIP ) See. W this change idea implemented intended? (Y/N button) Lessons Learned: (Some Questions to Consider) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others?

3 Meure/Indicator from 3 Percent of home care clients who responded "Good", "Very Good", or "Excellent" on a five-point scale to any of the client experience survey questions: i) Overall rating of LHIN Home and community care services ii) Overall rating of management/handling of care by Care Coordinator iii) Overall rating of service provided by service provider ( %; Home Care Clients; April March 2016; HSSO CCEE Survey) QIP Mississauga Halton and its contracted service providers remain committed to further improving the overall experience of our patients and caregivers and made this an area of focus in our respective QIPs. Mississauga Halton's performance of 90.9% for the period April 2016 through March 2017 is lower (worse) than the provincial average score of 92.2% for the same time period and falls below (is worse than) our internal QIP of 93.0%. Our performance h been stable in and around 91% for a number of quarters and is slightly better than this time lt year. Realizing that the QIP is a living document and the change ide may fluctuate you test and implement throughout the year, we want you to reflect on which change ide had an impact and Change e from Lt Years QIP (QIP ) W this change idea implemented Lessons Learned: (Some Questions to Consider) What w your experience with this indicator? What were your key

4 Cultural Competence & Diversity Training (CC&D) for staff intended? (Y/N button) Yes learnings? Did the change ide make an impact? What advice would you give to others? 372 employees have attended in person Cultural Competency and Diversity Training with 92% of participants reporting that the information w both relevant and useful. Training continues for Mississauga Halton LHIN staff well contracted service providers who have signed up to receive the training for their respective staff. Continue enhancements to the Neighbourhood Care Delivery Model program of work comprised of three parts by: a) Implementing the outstanding care coordination core competencies part of the Care Coordination Framework; b) To spread flexible care pilot evaluation findings from previous year for patients requiring a more flexible personal support care schedule; c) Meaningful connections with Primary Care; and d) Continuing to leverage Health Links to build capacity for coordinated care planning with an expanded circle of care to meet patient/caregiver goals. Yes a) All outstanding care coordination core competencies part of the Care Coordination Framework have been designed and shared with all home and community care staff. During the lt couple of years through this initiative, a redesign of our care coordination approach w completed to enable the delivery of better integrated, more consistent, patient-centred care at the neighbourhood level. b) Spread of flexible care pilot h not been rolled out to other retirement homes awaiting data to better understand the scope of the rollout before moving forward. The pilot provided either a hub and spoke model of care in the Evergreen retirement home and in patient homes within a maximum 2 km radius surrounding this home; or provided a mobile model of care in a maximum of 2 km radius within a specified Et and Southwest Mississauga neighbourhood with a high density of complex and chronic patients. These models permitted PSWs to do multiple visits up to thirty minutes each for up to a maximum total of four hours a day for each selected patient bed on their care needs. c) Deferred a component pertaining to the alignment of Family Health Team Primary Care Practitioner and Care Coordinator. This may be explored we look to opportunities in primary care delivery models. d) Transitioning from a Health Link project phe into a sustainable approach of care for individuals with complex needs. All patients with complex needs will now get a Health Links approach to care no eligibility determination by care coordinators for Health Link referrals. Meure/Indicator from

5 4 Percent palliative/end of life patients who died in their preferred place of death ( %; Patients deemed palliative or end of life; Oct 2015 Sept 2016; HSSO CHRIS) QIP CB Our beline w determined to be 70.41%. Going forward we will begin to better understand the definition and what factors contribute to the behavior of this meure now that a beline h been determined. Realizing that the QIP is a living document and the change ide may fluctuate you test and implement throughout the year, we want you to reflect on which change ide had an impact and Change e from Lt Years QIP (QIP ) Under Development W this change idea implemented intended? (Y/N button) Lessons Learned: (Some Questions to Consider) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others?

6 Meure/Indicator from 5 Percentage of adult longstay home care clients who have a fall on their follow-up of the international research network s Resident Assessment Instrument (interrai) for home care. ( %; Home Care Clients; October September 2016; HSSO HCD) QIP Mississauga Halton s performance of 36.2% for the period Oct through Sept is favorably better than the Ontario sector average of 38.4% but above (worse than) our QIP target of 35.4%. Realizing that the QIP is a living document and the change ide may fluctuate you test and implement throughout the year, we want you to reflect on which change ide had an impact and Change e from Lt Years QIP (QIP ) Improving Patient Outcomes through Medication Management & Falls Prevention Program of Work by: a) enhancing the NPs, RRNs and MHANs processes; b) providing interactive training opportunities for medication reconciliation program of work; and c) creating a Falls Risk Matrix to sist staff and that is aligned with the Mississauga Halton Local Health Integration Network's Falls Prevention Strategy. W this change idea implemented intended? (Y/N button) Yes Lessons Learned: (Some Questions to Consider) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others? a) Work continues in the development of a Falls Prevention & Injury Reduction process and introduction of new tools to be used by the Access Care Team, Community, RRNs, Palliative, NPs and Short Stay teams well the Service Provider anizations. This should decree the rate of falls it proactively identifies the patients at risk for falling even if there had been no previous fall 90 in the days before they start receiving services. b) Education developed in accordance with the recommendations set forth by Safer Healthcare Now! and provided to staff. c) Work continues in the redesign and introduction of new tools to be used. The Falls Matrix w deemed to be a bit restrictive and a decision w made to create an Intervention Plan bed on patient risk factors to sist staff and will be carried forward into the /19 QIP.

7 Meure/Indicator from 6 Percentage of home care clients who experienced an unplanned readmission to hospital within 30 days of discharge from hospital. ( %; Home care clients discharged from hospital; July 2015 June 2016; HSSO HCD, CIHI DAD, CIHI NACRS) QIP Mississauga Halton's organizational result of 18.54% for the most recently available period (Jul through Jun. 2017) is worse than the provincial average of 17.8% for the same time period. Further, it does not achieve the internal QIP of 14.9% (the lower our result, the better). We focused this year to have a number of ALC Avoidance, Management & Flow initiatives at the "prevention", "early " and "transition" stages to sist our return to better performance levels, with patients receiving the right care at the right time in the right place. Realizing that the QIP is a living document and the change ide may fluctuate you test and implement throughout the year, we want you to reflect on which change ide had an impact and Change e from Lt Years QIP (QIP ) Enhanced transition planning for Complex Adults affiliated with the Wait At Home Model of Care in collaboration with hospital partners. W this change idea implemented intended? (Y/N button) Yes Lessons Learned: (Some Questions to Consider) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others? Developed a hospital transition pathway combining our existing Wait at Home (WAH) and Wait at Home Enhanced (WAHE) programs to offer consistent services for all patients leaving hospital. New program entitled "My Way Home". Evaluation of this program demonstrated that patients who received OT and PT services in the first month post discharge were significantly less likely to return to

8 Spread previous Seamless Transitions work to the remaining two Halton Healthcare Services partners (improving the transition of patients from hospital to home). No the ED within 30 days. Hence OT and PT sessments were added to the pathway. In the My Way Home program, complex patients leaving hospital experience a customized hospital-to-home transition plan, where care is delivered sooner. In this program, patients leaving hospital regardless of their final destination will be eligible to receive pre-hospital discharge occupational therapy (OT) and Rapid Response Nurse (RRN) services, well enhanced in-home personal support, physiotherapy, OT and RRN services for up to 60 days. We have rolled out elements of the seamless process through Unit Affiliation, with dedicated Care Coordination resources attached to high volume units at Oakville Trafalgar and Milton District Hospital sites. However, due to competing priorities within Halton Healthcare, we were unable to spread to other sites. Reintegration care programming Yes (surge bed capacity pilot) estimated 6 month pilot providing access for complex hospital patients with barriers to discharge to supervised beds in retirement communities' setting to continue discharge planning for medically stable patients. Implemented Bridges to Care Program in February This innovative solution to address system capacity sees patients move from hospital to a retirement home in the community where they experience the benefits of living in a safe, comfortable, home-like environment while making important decisions about the next phe of their journey whether that be to home, or to Long Term Care. This restorative, community bed approach enables patients to regain strength and independence in safe environment outside of hospital, which empowers them with confidence to make educated decisions about future care and living arrangements - whatever path patients choose, they are supported along the way.

9 Meure/Indicator from 7 Percentage of home care clients with an unplanned, less-urgent ED visit within the first 30 days of discharge from hospital. ( %; Home care clients discharged from hospital; July 2015 June 2016; HSSO HCD, CIHI DAD, CIHI NACRS) QIP Mississauga Halton's performance continues to be better than the provincial average of 6.7% and close to our target in the QIP of 3.5%. Data in the lt three quarters shows rates slightly increing. Realizing that the QIP is a living document and the change ide may fluctuate you test and implement throughout the year, we want you to reflect on which change ide had an impact and Change e from Lt Years QIP (QIP ) Implement pathways for Chronic Obstructive Pulmonary Disee (COPD) and Chronic Heart Failure (CHF) programming an approach to reduce the number of unplanned Emergency Department visits and improve the quality of life and functional status of patients. W this change idea implemented intended? (Y/N button) No Lessons Learned: (Some Questions to Consider) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others? Not Initiated exploring opportunities to incorporate into primary care delivery models.

10 Meure/Indicator from 8 Percentage of patients identified meeting Health Link criteria who are offered access to Health Links Approach ( %; Patients meeting Health Link criteria; Most recent 3 month period; Local data collection) QIP CB CB NA Additional Indicator that we will not be collecting due to all patients with complex needs receiving a Health Links approach to care no eligibility determination by care coordinators for health link referrals are being done of Oct Realizing that the QIP is a living document and the change ide may fluctuate you test and implement throughout the year, we want you to reflect on which change ide had an impact and Change e from Lt Years QIP (QIP ) Under Development W this change idea implemented intended? (Y/N button) Lessons Learned: (Some Questions to Consider) What w your experience with this indicator? What were your key learnings? Did the change ide make an impact? What advice would you give to others?