1.0 CALL TO ORDER/REVIEW OF AGENDA. 2.0 NEW BUSINESS/INFORMATION/APPROVALS 2.1 Chair s Remarks

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1 Item 1.1 LONDON HEALTH SCIENCES CENTRE OPEN MEETING OF THE BOARD OF DIRECTORS Held, Wednesday, March 25, 1500 hours in the Victoria Hospital Board Room C3-401 Board Members Present: B. Bird, V. Burkoski, S. Caplan, R. Conyngham (Chair), S. Elliott, M. Glendining, K. Haines, M. MacLeod, I. Shewan, M. Strong, J. Wright T. Gustafson, F. Siddiqi, R. Sifton, C. Hanycz, T. Gergely, K. Ross, M. Faysal, R. Robinson Board Member Regrets: L. McBride, V. Fantillo, S. Carlyle Guests: G. Kernaghan, P. Griffin=R, H. Rundle Resource: T. Eskildsen 1.0 CALL TO ORDER/REVIEW OF AGENDA Mrs. Conyngham called the meeting to order and welcomed guests. As a reminder, board members were advised that any items within the Consent Agenda would be moved into the regular agenda if anyone had a question or wished to have further discussion before approval. Directors were also reminded and invited to declare any conflicts they may have pertaining to any item on the agenda. The Chair reviewed that the Consent Agenda consists of a number of minutes, reports and documents of which can be found in Appendix 1 starting on page 145. The Board of Directors APPROVED by UNANIMOUS CONSENT, the full Agenda which includes a Consent Agenda starting on page 145 for the March 25, 2015 Board meeting, consisting of the following recommendations and reports: 1.1 Minutes of Regular Meeting 2014/02/ Committee Minutes Finance and Audit Governance Human Resources Committee Medical Advisory Committee Minutes Quality and Performance Monitoring NEW BUSINESS/INFORMATION/APPROVALS 2.1 Chair s Remarks The Chair reviewed her activities attended on the Board s behalf and highlighted the following items:

2 March 25, 2015 OPEN BOARD OF DIRECTORS MEETING Page 2 - Deputy Minister of Health Visit to Stratford on March 6, 2015 on a two day road show with a LHIN governance presentation. An invitation to Toronto was extended by the Deputy Minister to share Southwest learning on the Board to Board governance work. - Quality as a Strategic Priority for the Board: Conference for Board and Quality Committee Members is a conference being offered by the OHA for June 8, Congratulations were extended to the Renal Patient Website Team for being chosen as one of the 20 Faces of Change supported by the Change Foundation. 2.2 President s Report Mr. Glendining submitted his report into record, and indicated that he would be pleased to answer any questions. Mr. Glendining further updated the Board on the following: Minister Matthews was on site earlier this month to announce funding for a new Paediatric Chronic Pain Management program at LHSC's Children's Hospital that will help children suffering from ongoing pain such as migraines, backaches, abdominal pain and tendinitis. The findings from the Stroke study known as ESCAPE were published February 11, 2015 in the New England Journal of Medicine and can be found online was recommended as a good read. The Ministry has issued an Expression of Interest (EOI) to the health system for Integrated Funding Models that will champion the delivery of quality, evidence-based care to patients. Providers (including hospitals, CCACs, direct service home care providers, physicians, and others) will be encouraged to create innovative and solutions-driven approaches within a defined policy framework. This approach will allow providers to test out new payment models that are based on evidence-informed clinical pathways and focus on enhancing coordination of care. Cancer Care Ontario Mr. Neil Johnson provided an overview to assist the Board in building understanding of the past, current and evolving role of CCO as a system builder in Ontario and also shared the CCO s business model which informs the cancer program s work with the CCO and development of processes within LHSC including the recent work undertaken by the Cancer Care team in patient engagement. In response to questions by the Board members, Mr. Johnson reported the following: potential length time to result for physician level performance information work is in the beginning stages and that Cancer Care Ontario would be starting with the areas that have considerable data to utilize (ie Breast Screening). It was estimated that full trending performance information may take as long as two years to be fully developed. Mr. Johnson indicated that he would follow up with CCO and report back with any additional information. Access to radiation has improved. This service however is heavily dependent on the imaging department and work is ongoing to look at potential improvement mechanisms to reduce delays. Strategic X-Matrix 2015/16 Draft Mr. Glendining introduced Carol Walters who reviewed the 2015/16 Strategic X-matrix and changes from previous year with the Board. Highlights include: The goals were recommended to remain unchanged from previous year. Strategic objectives were recommended to be reduced to three and only one remains unchanged:

3 March 25, 2015 OPEN BOARD OF DIRECTORS MEETING Page 3 1) Achieve 95% occupancy while maintaining or improving quality and patient and staff safety 2) Improve shared accountability and staff engagement 3) Achieve Financial Sustainability The feedback the team received included that the objectives needed to be focused in key areas where there is shared accountability, especially the clinical strategy work. In the top level improvement initiatives 13 have been recommended with eight being specifically attributed to the Implementation work of the clinical strategy renewal. Supporting the initiatives are eight tangible and achievable targets to define measures of success for each project and initiative. There was recognition by the Board Directors that the goal of achieving 95% occupancy was a stretch target for the organization and could take longer than a single year to accomplish. The Board was encouraged to contact Mr. Glendining with any additional feedback. The X- matrix will be finalized and will return for approval in April Quality and Performance Monitoring Recommendations /16 Quality Improvement Plan Recommendation The Board of Directors APPROVED by UNANIMOUS CONSENT the 2015/16 Quality Improvement Plan Priority 1 Indicators and targets aligned with an equal weight executive compensation model identified in Appendix A as follows: Medication Reconciliation at Admission (%) with a target of 85% ED Wait Times: 90th%ile ED LOS for Admitted Patients with a target of 25.0 hours Inpatient Satisfaction - Percent Positive (Excellent, Very Good and Good) with a target of 96% The Board of Directors APPROVED by UNANIMOUS CONSENT the additional four quality dimensions, indicators and targets not aligned with executive compensation identified in Appendix B as follows: 30 Day /readmission rate with a target of 18.0 % ALC Days with a target of 7.70% CDI with a target of 0.40 Total Margin with a target of Medical Advisory Committee Recommendations New Appointments to Professional Staff Mar 2.4.2Changes to Professional Staff Appointments Mar 2.4.3Appointments to the Clinical Fellows Mar The Board of Directors APPROVED by UNANIMOUS CONSENT the following recommendations: New Appointments to Professional Staff March Changes to Professional Staff Appointments March Appointments to the Clinical Fellows March 2.5 Governance Committee Recommendations Administrative By-Law Amendment The Board of Directors ENDORSED and RECOMMEND to the Corporation for APPROVAL by UNANIMOUS CONSENT the proposed amended language to the LHSC Administrative Bylaw definition of associate.

4 March 25, 2015 OPEN BOARD OF DIRECTORS MEETING Page Disclosure of Relationships Tool Mr. Elliott provided an overview of development of a tool to assist the Nominating Committee s work. It was noted that conflict of interest is potential factor for everyone considering the size of the operation of LHSC and the diversity of the current Board. The tool is designed to assist in the disclosure of any potential relationships/conflicts in advance of a subject matter being deliberated at the Board or Committee table and will act as an additional mechanism to ensure the Board is transparent to the potential risks to the organization through Conflict of Interest. A concern was raised that the legal language could be difficult to interpret and the Board members provided feedback and suggestions as follows: One on one time with candidate would ease the use of the tool Practical examples be developed to assist in the interpretation from legal to layman terms Board Directors would attest annually any changes in conflict status. A list of affiliates could be developed and provided In this the initial year extra care and time would be available to assist current board members to ensure clarity Mr. Elliott expressed appreciation to the Board for their candid feedback on the continued evolution of the tool. The Chair indicated that this document would move forward for approval at this time so that it could be put to trial during this year s nomination processes and further noting that the above suggestions be considered for inclusion. The Board of Directors APPROVED by UNANIMOUS CONSENT the Disclosure of Relationships Tool Terms of Reference Governance Amendment The Governance Committee approved the consolidation of the Nominating Committee work within the Governance Committee mandate and has requested that the Board approve amendments to the Terms of Reference to recognize this change, and to also consolidate the membership of the current Nominating Committee within the Governance Committee. The Board of Directors APPROVED the recommended amendments to the Terms of Reference of the Governance Committee to reflect the following: Additional two members Remove the references to a specific nominating sub committee Community Member Appointment The Board of Directors APPROVED by UNANIMOUS CONSENT the APPOINTMENT of Ms. Nancy Davies as a community member to the Governance Committee. 2.6 Finance and Audit Committee Recommendations CIBC Credit Facility This amendment makes available Credit G, a demand bridge construction loan to be used for interim construction financing. Upon completion, the interim credit facility will convert to long term financing by way of an increase to the existing Credit F, originally established to provide long term financing for the new parking facility on Wellington and Baseline at VH, as a second tranche The Board of Directors APPROVED by UNANIMOUS CONSENT the proposed CIBC Credit Agreement dated February 24, 2015 for immediate signback Early Psychosis Intervention Amendment of 2014/17 Multi-Sector Services Accountability Agreement

5 March 25, 2015 OPEN BOARD OF DIRECTORS MEETING Page 5 The South West Local Health Integration Network and the Early Psychosis Intervention and Geriatric Mental Health and Urgent Consultation Program entered into a Multi-Sector Service Accountability Agreement for a three-year term effective April 1, The budgeted financial data, service activities and performance indicators for the second and third year of the agreement were replicated based on 2014/15 planning assumptions. The LHIN is updating the M-SAA schedules to include the required financial, service activity and performance expectations for the 2015/16 and 2016/17 fiscal years to Schedules B, C, D and E. The Board of Directors APPROVED by UNANIMOUS CONSENT the amendment of the 2014/17 Multi-Sector Accountability Agreement (MSAA) for 2015/16 effective April 1, /16 Operating and Capital Budget Mr. Shawn Gilhuly provided an overview of the work of the organization in preparing for the 2015/16 Budget. The following highlights were noted: In March, 2015 the SW LHIN indicated that the H-SAA Steering Committee has decided to issue a one-year H-SAA extension while continuing to pursue focused discussions on a multi-year H-SAA. Funding announcements are expected late summer 2015 LHSC continues to witness significant patient demands and cost pressures this fiscal year. Health care inflation continues to out-pace funding and capital infrastructure pressures are significant, both issues recognized province wide. The Hospital enters FY15/16 facing the fourth consecutive year of a funding reduction and given the financial reality in Ontario, it is clear there will be no new funding for hospitals in the foreseeable future. This means that LHSC can expect annual fiscal challenges as experienced in the past two years of approximately $26M To the guide the budget processes the following highlights were noted. Management made reasonable and conservative revenue and inflationary expense assumptions based on various funding and inflationary assumptions were modeled and challenged. 2014/15 corporate x-matrix was utilized to ensure the budgeting remained focused on goals of the organization. LHSC will continue to live within available cashflow (net equipment amortization) for regular capital investments and acceptable reasonable working capital and liquidity. Mr. Gilhuly reported that an organization the size of LHSC would require to maintain a ratio of.8 to 1.2 (minimum $100M) available. Hospital wide savings targets were set which resulted in approximately ½ of the required savings. Other budgeting saving strategies being considered include: o Investments in the Clinical Service Renewal (CSR) plan which fundamentally changes the way the organization would deliver care, improve access and flow and enhance key enabling processes. The extent that the organization can achieve savings through the CSR initiatives will dictate the ability of the organization to reinvest in the longer term strategies. o Benchmarking and a space utilization exercise was conducted to find additional efficiency opportunities o Investment in Toyota Production system produced targeted saving apportioned to three areas the Emergency Department, Mental Health and Admissions/Discharge. The major objective of this strategy is to reduce unnecessary admissions via the ED by 30% and reduce conservable days by 30%. o Revenue adjustments around the sale of utilities estimated to provide savings to the organization

6 March 25, 2015 OPEN BOARD OF DIRECTORS MEETING Page 6 o With approximately 80% of the organization's costs allocated to people, it is expected that a reduction in staff hours and changes to skill mix staffing requirements will be required. The effect of the reduction of hours will not be fully known until later in the spring until all Human Resources processes are finalized. It remains the intention of the senior team to minimize layoffs through normal vacancies, recurring attrition and retirements. The Board of Directors engaged in discussion on the plan presented and the following statements were supported: The recommendation by the Finance and Audit Committee that Management develop a three year rolling budget plan. That the 2015/16 Goal of 95% occupancy have measured goals and targets to meet this target within three years. In response to a question on the amount of cashflow required in the bank to operate The Board of Directors APPROVED by UNANIMOUS CONSENT the Operating and Capital Budget as prepared by management for 2015/16 fiscal period. 2.7 Lawson Health Research Institute Report Dr. Rundle submitted the report into record and drew the group s attention to the Recognition received by Dr. David Palma for his cancer research and Dr. David Hill s recognition for his research in diabetes. 2.8 St. Joseph s Health Care, London Update Dr. Kernaghan provided a brief update on ongoing work and initiatives at St. Joseph s. 2.8 Other Committee Updates Mrs. Robinson provided a brief update on the work of the Human Resources Committee highlighting a written update received providing an overview of the work of LHSC s Volunteer workforce and asked the Board s consideration in having an overview of this work presented at a future Board meeting. The Chair requested that this item be added to the Board workplan. 3.0 ADJOURNMENT The Board of Directors ADJOURNED by UNANIMOUS CONSENT the Open Board of Directors Meeting. Recorded by Tammy L. Eskildsen Ruthe Anne Conyngham, Chair