Central LHIN Board of Directors. February 28, Meeting Called to Order. Notice of a Meeting. Approval of Agenda. Board Development and Education

Transcription

1 Central LHIN Board of Directors February 28, Meeting Called to Order Notice of a Meeting Approval of Agenda Board Development and Education Declaration of Conflicts of Interest Approval of Consent Agenda 7 Chairman s Report CEO Report Items for Approval CEO Report Items for Information Other Business Future Meetings Motion Moving into Closed Session/In Camera Materials

2 TAB 2 NOTICE OF A MEETING

3 NOTICE OF BOARD MEETING OPEN TO PUBLIC TUESDAY, February 28, :00-4:00 p.m. Board meeting 4:00-4:30 p.m. Engagement with the Public Central LHIN 60 Renfrew Drive, Suite 360 Markham, ON AGENDA ITEMS TO INCLUDE: Approval of Minutes Chairman and CEO Reports Ministry Funding Allocations LHIN Funding Allocations 60 Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: NOTICE OF CLOSED MEETING TUESDAY, February 28, :30-6:00 p.m. Central LHIN 60 Renfrew Drive, Suite 360 Markham, ON AGENDA ITEMS TO INCLUDE: Review of Minutes Business Arising New Business Items for Information Agenda is subject to approval or amendment at the meeting Meeting notices, agenda and minutes will be posted on the Central LHIN website at: Light Refreshments will be provided

4 TAB 3 APPROVAL AGENDA

5 AGENDA BOARD OF DIRECTORS February 28, :00 pm-4:00 pm Suite 360, 60 Renfrew Drive Markham, ON L3R 0E1 Tab No. Agenda Item Time Presenter 1.0 MEETING CALLED TO ORDER 2:00 Mr. Warren Jestin 2.0 NOTICE/RECOGNITION OF A QUORUM Mr. Warren Jestin 3.0 APPROVAL OF AGENDA Mr. Warren Jestin 3.1 Welcome Members of the Public 3.2 Patient Story 4.0 BOARD DEVELOPMENT AND EDUCATION 4.1 Central CCAC Quality Improvement Plan Overview 2:10 30 min Ms. Lorri Eckler Mr. Joe Figliomeni 5.0 DECLARATION OF CONFLICTS OF INTEREST Mr. Warren Jestin 6.0 APPROVAL OF CONSENT AGENDA 2:40 Mr. Warren Jestin 6.1 APPROVAL OF MINUTES January 31, OTHER ITEMS Multi-Sector Service Accountability Agreements Slate /17 Allocation Process and Priorities for Investment 6.3 REPORTS OF COMMITTEES Audit Committee Report Committee Membership Updates to Board Membership of the Audit Committee and Governance and Community Nominations Committee 7.0 CHAIR S REPORT ITEMS FOR INFORMATION & APPROVAL 7.1 Patients First Transition Planning Task Force (Placeholder) 2:45 Mr. Warren Jestin 8.0 CEO REPORT ITEMS FOR APPROVAL 3:00 Ms. Kim Baker 8.1 North York General Hospital s Pre-Capital Submissions Part A

6 Tab No. Agenda Item Time Presenter 9.0 CEO REPORT ITEMS FOR INFORMATION 9.1 CEO/Senior Director Report 3:10 30 min Ms. Kim Baker Ms. Karin Dschankilic Ms. Chantell Tunney 10.0 OTHER BUSINESS (Additions to the Agenda) 3:40 Mr. Warren Jestin 11.0 FUTURE MEETINGS Tuesday, March 28, :00 pm-4:00 pm Central LHIN, 60 Renfrew Drive, Markham Mr. Warren Jestin 12.0 MOTION MOVING INTO A CLOSED SESSION 4:00 Mr. Warren Jestin 12.3 BUSINESS ARISING 12.4 FOR APPROVAL Patients First Transition Planning Task Force (Placeholder) Audit Committee LHIN/CCAC Banking Arrangements Central LHIN Insurance Policy 13.0 CHAIR S REPORT OF A CLOSED SESSION (IF REQUIRED) Mr. Warren Jestin 14.0 MOTION OF TERMINATION 6:00 Mr. Warren Jestin 2

7 TAB 4 BOARD DEVELOPMENT & EDUCATION

8 60 Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: ITEM 4.1 CENTRAL LHIN BOARD BRIEFING NOTE PRESENTATION ON CENTRAL COMMUNITY CARE ACCESS CENTRE S QUALITY IMPROVEMENT PLAN FEBRUARY 28, 2017 BACKGROUND: All Community Care Access Centres (CCACs) across Ontario have Quality Improvement Plans (QIP) aligned with principles found in the Excellent Care for All Act and as directed by the Ministry of Health and Long-Term Care. The QIP is a formal, documented set of organizational priorities focused on quality and quality improvement objectives. Reviewed annually, it consists of a) narrative document highlighting key priorities for the year, and b) work plan on quality improvement targets and initiatives. The Central CCAC QIP is available on their website and on Health Quality Ontario's website. Per the Central CCAC s website, some of the stated objectives of a QIP include: Support the goals and principles of the Excellent Care for All Act, including accountability, transparency, and high-quality patient care. Organize and prioritize quality improvement projects. Allow patients, community members, providers and health care partners to be engaged in the quality of care provided by the CCACs. PRESENTER BIOGRAPHIES: Co-presenting today to provide an overview of the Central CCAC s QIP is: Lorri Eckler, Central CCAC s Director of Organizational Effectiveness. Lorri has worked in the home and community care sector for over 20 years. Her focus is fostering a culture of quality improvement and adoption of best practices across the Central CCAC, the Central community and health system partners. Lorri has a Masters of Health Science, Honours B.Sc (Human Kinetics) and is a Certified Improvement Advisor. Joe Figliomeni is currently Central CCAC s Senior Manager of Quality and Organizational Development. He will become the Central CCAC s Acting Director, Organizational Effectiveness on March 17, Since joining the Central CCAC nearly six years ago, Joe s focus is effective change management and quality improvement and reporting in support of delivering outstanding patient care. Joe holds a B.A.Sc. specializing in Mechanical Engineering and is a Lean Six Sigma Black Belt.

9 ITEM 4.1 Central CCAC s Quality Improvement Plan An Overview February 28, 2017 Central CCAC Outstanding care every person, every day

10 Today s Agenda Background Excellent Care for All Act (ECFAA) and directive for Community Care Access Centres (CCACs) Quality Improvement Plan (QIP) timelines Purpose of QIPs and how they drive improvement across sectors Developing QIPs: Key Roles The Board s QIP Accountabilities Central CCAC s QIP Quality Indicators for 2017/18 QIPs 2

11 Background on ECFAA The Excellent Care for All Act (ECFAA) received Royal Assent in June 2010 Drives health care reform Patient-centred system focused on accountability and transparency Underlying principles Creating positive patient experiences Delivering high quality care Public accountability and transparency, and Quality care should be everyone s goal 3

12 QIP Milestones Hospitals required to prepare QIPs Aboriginal Health Access Centres, Community Health Centres, Family Health Teams and Nurse Practitioner Led Clinics required to submit QIPs CCACs have a directive to develop and post Continuous Quality Improvement Plans Long-Term Care Homes Initial posting April 2011 Initial posting April 2013 Initial posting April 2014 Initial posting April

13 What is a QIP? Public document that sets out commitments and actions to assist an organization to meet quality objectives 1 Establishes central focus to guide initiatives that improve quality of patient/client services Communicates commitment to accountability and strategic focus on creating a positive experience and delivering high quality care 1 Source: Ministry of Health and Long-Term Care 5

14 Cross-Sector Thinking Source HQO Webinar presentation, January

15 Quality Improvement Plan Our annual Quality Improvement Plan (QIP) is part of our ongoing accountability to our patients, caregivers, community and funders to provide the best quality care in a fiscally responsible manner. 7

16 Relationship between QIPs and Service Accountability Agreements 8

17 9

18 Developing QIPs: Key Roles Lead Ministry of Health Health Quality Ontario Current Role & Function Provides overall vision, strategy and direction on priorities, the Excellent Care for All Act, 2010 and QIPs as a whole QIP policy development, based on consultation and collaboration Prioritizes core metrics for QIP Implements QIP strategy (analysis, reports, support, recommendations, knowledge sharing) Assesses and promotes quality improvement across the system Provides feedback to field on QIP development and implementation Source HQO Webinar presentation, January 15,

19 Developing QIPs: Key Roles Source: HQO QIP Guidance Document for Ontario s Health Care Organizations, November

20 Board QIP Accountabilities Patient Services and Quality Committee of the Board Fully engaged in developing the QIP each year Brings final draft of QIP to the full Board for sign-off Monitors Quarterly Progress Reports Board must approve QIP prior to the end of the fiscal year Posting QIP on HQO website is mandatory April 1 every year 12

21 Priority Issues & Indicators for CCACs Aligned to six characteristics of quality as defined by Institute of Medicine Safe, effective, patient-centred, efficient, timely, equitable Priority aims and indicators for CCAC include: Reducing falls for long stay home care patients Reducing hospital readmissions within 30 days of discharge from hospital Reducing unplanned, less urgent ED visits within 30 days of discharge from hospital Improving the rate of patients who receive their first nursing visit within 5 days of service authorization Improving the rate of complex patients who receive their first personal support visit within 5 days of service authorization Improving overall patient experience with CCAC services 13

22 Quality Issues & Indicators 2017/18 QIPs Source: HQO QIP Guidance Document for Ontario s Health Care Organizations 2017/18 14

23 Questions and Discussion 15

24 TAB 6 APPROVAL OF CONSENT AGENDA

25 CENTRAL LOCAL HEALTH INTEGRATION NETWORK BOARD OF DIRECTORS MEETING January 31, :00pm-4:00pm Central LHIN, 60 Renfrew Drive, Suite 360, Markham, ON L3R 0E1 Item Board Members Present: Mr. Warren Jestin, Chair Mr. Albert Liang, Vice Chair Ms. Aldous Young, Board Member Ms. Brenda Urbanski, Board Member Mr. David Lai, Board Member Mr. Stephen Quinlan, Board Member Ms. Tanya Goldberg, Board Member Dr. Uzo Anucha, Board Member Regrets: Ms. Audrey Wubbenhorst, Board Member MINUTES OF MEETING Staff Participants: Ms. Kim Baker, Chief Executive Officer Ms. Karin Dschankilic, Senior Director, Performance, Contracts and Allocations & Chief Financial Officer Ms. Chantell Tunney, Senior Director, Planning, Integration &Community Engagement Ms. Laurie Rose, Corporate Governance and Board Relations Ms. Rosemary MacGilchrist, Manager, Communications Ms. Robin Gauzas, Executive Assistant, Recording Secretary. Guests: Ms. Polly Stevens, VP Vice President of Risk Management, Healthcare Insurance Reciprocal of Canada 1.0 MEETING CALLED TO ORDER The meeting was called to order at 2:01 pm 2.0 NOTICE/RECOGNITION OF A QUORUM This meeting was formally constituted with Board members receiving adequate notice in accordance with By-Law No. 2. The notice, agenda and materials were distributed to the Board and were posted on the Central LHIN website. Quorum of a Board comprising eight members is 5 directors. A quorum was present at the meeting. In accordance with the By-law, participants and guest speakers were introduced. No public deputations were noted for the meeting.

26 3.0 APPROVAL OF AGENDA ON MOTION made by Ms. Brenda Urbanski and seconded by Mr. Albert Liang, IT WAS RESOLVED THAT, The Agenda be approved as circulated. CARRIED January PATIENT STORY Mr. Jestin introduced Ms. MacGilchrist who shared a patient story about an elderly gentleman in Central LHIN who appears to need more care than he is willing to accept. 4.0 BOARD DEVELOPMENT AND EDUCATION 4.1 Healthcare Insurance Reciprocal of Canada (HIROC): Oversight of Risks in Healthcare Organizations and how HIROC can help Mr. Jestin welcomed Ms. Polly Stevens, Vice President of Risk Management, Healthcare Insurance Reciprocal of Canada (HIROC). Ms. Stevens presentation covered the following items: Risk management concepts Leadership/governance of risk HIROC Risk Register program Medical malpractice risks HIROC Risk Assessment Checklists program 5.0 DECLARATION OF CONFLICT OF INTEREST None at this time. 6.0 APPROVAL OF CONSENT AGENDA ON MOTION made by Mr. Stephen Quinlan and seconded by Dr. Uzo Anucha, IT WAS RESOLVED THAT, The Consent Agenda be approved and all resolutions contained therein be adopted as circulated. CARRIED January

27 6.1.1 November 29, 2016 Board minutes BE IT RESOLVED THAT: The minutes of November 29, 2016 are approved as circulated. 6.2 OTHER ITEMS CARRIED January /18 Multi Sector Accountability Agreement Refresh (Tranche 1) BE IT RESOLVED THAT: The Central LHIN Board of Directors: a) Approves the funding, volume and performance targets for the following twentyseven health service providers: 1. Alzheimer Society of York Region 2. Aphasia Institute 3. Carefirst Seniors and Community Services Association 4. Caritas School of Life 5. Cedar Centre 6. Cerebral Palsy Parent Council of Toronto 7. Chai-Tikvah Foundation 8. CHATS - Community & Home Assistance to Seniors 9. Chippewas of Georgia Island 10. Circle Of Home Care Services (Toronto) 11. City of Toronto 12. Community Head Injury Resource Services of Toronto (CHIRS) 13. Etobicoke Services For Seniors 14. Jane/Finch Community and Family Centre 15. Lumacare Inc. 16. Mackenzie Health 17. Markham Stouffville Hospital 18. New Unionville Home Society 19. North York Seniors Center 20. North Yorkers For Disabled Persons 21. St. Demetrius Supportive Care Service 22. Stevenson Memorial Hospital 23. The Bernard Betel Centre for Creative Living 24. The Canadian Hearing Society - Simcoe Region and York Region 25. The Canadian National Institute for the Blind 26. The Vitanova Foundation

28 4 27. Yee Hong Centre for Geriatric Care b) Approves the funding, volume and performance targets for the Central CCAC, including rolling over the two MSAA Indicators targets (90 th Percentile Wait Time for Community Home Services (Community) and Percentage of Home Care Clients with Complex needs who Receive their Person Support Visit within 5 days of the date they were authorized for Personal Support Services), with the expectation that these will be replaced with a provincial MLAA target directly with the LHIN at a future date; and c) Delegates authority to the Central LHIN Chief Executive Officer to execute the Multi-Sector Service Accountability Agreement amendments for the above health service providers CARRIED January /17 Quarter 3 CEO Compliance Declaration. BE IT RESOLVED THAT: The Central LHIN Board of Directors approve the CEO and Board Chair to execute and submit the Declaration of Compliance to the Ministry for the 2016/17 third quarter. CARRIED January REPORTS OF COMMITTEES None at this time. 7.0 CHAIR S REPORT Mr. Jestin congratulated the Stevenson Memorial Hospital team on receiving Exemplary Standing from Accreditation Canada last month. Mr. Jestin acknowledged the great work on behalf of Board Chair Michael Martin, and CEO Jody Levac along with all of the Board and Staff for being recognized for operations excellence. Mr. Jestin also congratulated Mr. Dan Zanordee past President of St. Demetrius Development Corp. as, for being named an outstanding community contributor by MPP Yvan Baker. Mr. Jestin advised that this recognition was specifically for his volunteerism to seniors services. The Board was provided with an update on LHIN Renewal activity taking place. Mr. Jestin noted that he currently serves on the Provincial LHIN Governance Work Stream along with other LHIN and CCAC Board Chairs. Mr. Jestin noted that the objective of those meetings is to establish a governance and accountability structure that reflects the expanded mandate of the LHINS. Mr. Jestin advised that the group is working on the new LHIN Accountability Documents

29 Memorandum of Understanding and Accountability Agreements and Mandate Letters. Mr. Jestin noted that from a Governance Policy perspective, minor aspects of our ByLaws #1 and #2 will need to be updated and work is underway. Mr. Jestin advised that the legislation calls for three additional Board Members and the Ministry s goal is that all LHIN Boards have a minimum of 10 Members, but ideally 12, by Transition Day. Mr. Jestin noted the he has been in contact with Ministry s Appointments Advisor several times this month, and noted that Progress continues in Central LHIN. It was noted that the provincial Governance Workstream is assessing onboarding and training requirements and as such a Request for Services (RFS) to support Board Training has been issued. At the local level, Central LHIN s Transition Planning Task Force, with CCAC governance representation, has commenced and among materials prepared in support of transition, a plan has been shared to support on-boarding new LHIN Board members. 8.0 CEO REPORT ITEMS FOR APPROVAL 8.1 Southlake Regional Health Centre Pre-Capital Submission-Perioperative Services Redevelopment Ms. Tunney provided the Board with an overview of Southlake Regional Health Centre Pre- Capital Submission-Perioperative Services Redevelopment.. ON MOTION made by Ms. Brenda Urbanski and seconded by Mr. Stephen Quinlan, IT WAS RESOLVED THAT, The Central LHIN Board of Directors endorses Southlake Regional Health Centre s Pre- Capital Submission Part A, in respect of the Perioperative Services Redevelopment. CARRIED January CEO REPORT ITEMS FOR INFORMATION Ms. Baker provided the Board with the following updates: Transition Readiness Organizational Structure Across the province organizational charts of the new LHINs have also been approved by the Ministry and are in the process of being rolled in alignment with consistent guidelines and principles that have been provided to LHINs. In Central LHIN we have retained professional external human resource expertise to assist with the process and also to provide a resource and support to staff both in the LHIN and CCAC. Currently, the new LHIN organizational chart has been shared with both senior teams and confidential conversations are underway. The communication and engagement plan to cascade information and process to all staff is in development and will roll out as expeditiously as possible. Guiding principles in this process continue to be focused on minimizing disruption to service delivery which includes minimizing disruption to people and process to support stabilization moving forward. 5

30 The LHIN and CCAC staff continue to engage, learn and collaborate on transition planning particularly in relation to the four working groups (below) that are supporting the process more formally. Earlier today, materials developed from the work groups, that have governance implications, have been shared and discussed at the Task Force meeting which includes LHIN and CCAC Board representation. - Finance and Administration - HR operations - Patients services - Information technology In relation to work that is pan-lhin in nature the Ministry has struck an operations committee and workgroup structure to address pan LHIN decisions that are required to support the upcoming transfer of CCACs to LHINs. Ms. Baker advised The Ministry of Health and Long Term Care has engaged Deloitte to undertake a readiness and capacity process across the LHINs. The Central LHIN and CCAC participated at both the staff and governance level on January 19 and 20 th. Ms. Baker noted that a status report will be provided to each of the LHINs as part of the process. Health Shared Services Ontario (HSSO) The Minister has signed the transfer order for the transfer of the LHIN Collaborative (LHINC), LHIN Shared Services Organization (LSSO), and the Ontario Association of Community Care Access Centres to the new Health Shared Services Organization (HSSO) for March 1, 2017 System Transformation Sub-Regions Central LHIN s sub-regions have been approved by the Ministry and are posted on the Central LHIN website and shared with Health Service Providers. The team is in the process of developing an engagement plan to go out to the sub-regions later in March and into April. From a governance perspective identifying LHIN Board members in these sub regions who may wish to attend engagements will be brought forward as plans are developed. Holiday System Pressures Hospital Emergency Volumes Ms. Baker advised that Central LHIN hospitals experienced significant volume surges in the emergency department over the holidays, primarily due to respiratory illness complaints. Ms. Baker noted staff worked with our hospitals over the holidays and that several additional meetings have taken place with the Ministry of Health and Long Term Care, GTA LHINs and Hospital stakeholders to better understand the pressures and potential solutions to address these challenges and risks. 6

31 7 Ms. Dschankilic provided the Board with an update on the following items: /17 Quarter 2 Stocktake Scorecard Ms. Dschankilic provided the board with an over view of each of the flagged indicators. Ms. Tunney provided the Board with an update on the following items: - Enhanced Assisted Living Update - Foot Care - Wave Two Syrian Refugee Health Response 10.0 OTHER BUSINESS. None at this time FUTURE MEETINGS Tuesday February 28, :00pm - 4:00pm Central LHIN, 60 Renfrew Drive, Suite 360, Markham, ON L3R 0E MOTION MOVING INTO A CLOSED SESSION ON MOTION by Mr. Albert Liang and seconded Mr. David Lai, IT WAS RESOLVED THAT, The members attending this meeting move into a Closed Session pursuant to the following exceptions of LHINs set out in s.9(5) of the Local Health Systems Integration Act, 2006: Personal or public interest Public security Security of the LHIN and its directors Personal health information Prejudice to legal proceedings Safety Personnel matters Labour relations Matters subject to solicitor client privilege Matters prescribed by regulation Deliberations on whether to move into a closed session and further that the following persons be permitted to attend: Ms. Kim Baker Ms. Karin Dschankilic Ms. Chantell Tunney Ms. Laurie Rose Ms. Robin Gauzas

32 Ms. Rosemary MacGilchrist. CARRIED January CLOSED SESSION CALLED TO ORDER The session was called to order at 3:48 pm APPROVAL OF AGENDA ON MOTION by Mr. David Lai and seconded by Mr. Stephen Quinlan, IT WAS RESOLVED THAT, The Agenda of the Closed Session of January 31, 2017 be approved as circulated APPROVAL OF MINUTES 15.1 Review of Minutes of November 29, 2016 CARRIED January ON MOTION by Mr. David Lai and seconded by Mr. Stephen Quinlan, IT WAS RESOLVED THAT, The minutes of the Closed Session of November 29, 2016 be approved as distributed CFIN-3 Financial Signing Authority A motion was passed CARRIED January CARRIED January Process and Transfer of IT Licence agreements and Leases A motion was passed 18.0 Leasing Arrangements A motion was passed /17 Performance Review for CEO A motion was passed. CARRIED January CARRIED January CARRIED January-31-13

33 20.0 MOTION MOVING OUT OF CLOSED MEETING ON MOTION by Mr. Albert Liang and seconded by Ms. Brenda Urbanski, IT WAS RESOLVED THAT, The Closed Session is terminated (5:30 p.m.) and that closed session minutes are permitted to be shared with all Board members and permitted attendees. CARRIED January MOTION TO TERMINATE SESSION ON MOTION by Ms. Tanya Goldberg and seconded by Dr. Uzo Anucha, IT WAS RESOLVED THAT, The session be terminated (5:30 p.m.). CARRIED January Warren Jestin, Chair Robin Gauzas, Recording Secretary 9

34 60 Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: ITEM CENTRAL LHIN BOARD OF DIRECTORS BRIEFING NOTE MULTI-SECTOR SERVICE ACCOUNTABILITY AGREEMENTS SLATE 2 FEBRUARY 28, 2017 PROPOSED RESOLUTION: WHEREAS the current Multi Sector Service Accountability Agreement (M-SAA) is a threeyear Agreement that expires on March 31, 2017; and WHEREAS the M-SAA Advisory Committee endorsed a one-year extension to the current Agreement with a new expiry date of March 31, 2018 and a provincial refresh process to update information; and WHEREAS on October 25, 2016, the Board approved the principles and process for reviewing the Community Accountability Planning Submissions to inform the volume and performance targets; and WHEREAS the funding targets for fiscal assume no general increase in base funding; and WHEREAS Central LHIN staff has reviewed the Community Accountability Planning Submissions and performance targets have been set according to the Board approved principles; BE IT RESOLVED THAT: The Central LHIN Board of Directors: a) Approves the funding, volume and performance targets for the following ten health service providers: 1. Access Independent Living Services 2. Across Boundaries - An Ethnoracial Mental Health Centre 3. Bayview Community Services Inc. 4. Better Living Health and Community Services 5. COTA Health 6. Hazel Burns Hospice 7. Humber River Hospital 8. March of Dimes Canada 9. Southlake Regional Health Centre 10. The Regional Municipality of York

35 b) Delegates authority to the Central LHIN Chief Executive Officer to execute the Multi-Sector Service Accountability Agreement amendments for the above health service providers ANALYSIS: Community Accountability Planning Submissions Central LHIN has received all fifty Health Service Provider Board approved Community Accountability Planning Submissions (CAPS) and has performed reviews based on the Board approved principles and process. On January 31, 2017, the Central LHIN Board of Directors approved the funding, volume and performance targets for twenty eight health service providers. As of February 7, 2017, an additional ten Health Service Providers met the criteria detailed below, bringing the total brought forward for approval to thirty eight: An Annual Balanced Budget as defined in the M-SAA; and Central LHIN funded administrative expenses not to exceed 15% of Central LHIN funding; and No overall service reductions. Health service providers may propose shifts in services to better meet community demand for services and to align with provincial priorities. All Health Service Providers will have the following performance indicators (as defined in the MSAA technical specifications document): Balanced Budget for fund type 2 (LHIN funding) Administrative expenses less than or equal to 15% of LHIN funding Variance Forecast to Actual Expenditures Total Margin (Balanced Budget for total entity -hospitals and municipalities excluded) Service Activity by Functional Centre Variance Forecast to Actual Units of Service Number of Individuals Served Percentage of Acute Alternate Level of Care (ALC) Days (TBD until MLAA for 17/18 set) Alternate Level of Care (ALC) Rate 1 Funding targets in the MSAAs include closing fiscal funding plus any additional approved initiatives during fiscal There has been no general increase in base funding. 1 If a community HSP delivers service in a single sub region, the target will be the hospital target in the same subregion. If a community HSP delivers service in multiple sub regions, the target will be the composite of hospitals targets in the applicable sub regions. For hospital, the LHIN will align the target in the MSAA with the target in the HSAA. For CCAC, the LHIN will align the target in the MSAA with the MLAA target. 2

36 The following table highlights the 2017/18 funding and key volume targets for the ten health service providers: Health Service Providers 2017/18 Unique Service Activity LHIN Funding Individuals Served Visits 1 Resident Days 2 Attendance Days 3 Meals Delivered Hours of Care 4 Access Independent Living $4,467, , ,924 Services Across Boundaries - An $2,274, ,279-6, Ethnoracial Mental Health Centre Bayview Community Services $747, ,140 5, Inc. Better Living Health and $4,046,896 6,476 48, ,750 68,812 16,600 Community Services COTA Health $6,581,955 1,304 22,391 69,346 2,976-5,670 Hazel Burns Hospice $210, , Humber River Hospital $3,199,107 1,650 11,049 1, March of Dimes Canada $9,614, ,871 11,190-89,272 Southlake Regional Health Centre $6,383,562 2,757 22, The Regional Municipality of $2,442, ,370-13, York Notes: 1. Visits include case management, counseling and treatment, addictions treatment, crisis intervention, diversion and court support, eating disorders, psycho-geriatric, assertive community treatment team, service arrangement and coordination, social and safety, social rehab and recreation, visiting hospices and caregiver support. 2. Resident days include Mental Health supports within housing, short term crisis support beds, assisted living and residential addiction withdrawal management centre. 3. Attendance days include social and congregate dining, day programs, mental health social rehabilitation and recreation program. 4. Hours of care includes respite programs, personal support services, homemaking, personal support and independence training programs. NEXT STEPS: Central LHIN staff is working with the remaining twelve community health service providers to resolve outstanding issues related to the CAPS. The remaining M-SAA funding, volume and performance targets for fiscal 2017/18 will be brought forward for Board approval in March The M-SAA for the ten health service providers approved in this slate will be amended through a funding letter including the amendment schedules and signed by the LHIN CEO. A sign-back by health service providers will be due to the LHIN no later than March 31,

37 60 Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: ITEM CENTRAL LHIN BOARD OF DIRECTORS BRIEFING NOTE 2016/17 ALLOCATION PROCESS AND PRIORITIES FOR INVESTMENT- UPDATE FEBRUARY 28, 2017 PROPOSED RESOLUTION: WHEREAS on May 31, 2016, the Central LHIN Board of Directors approved the process and priorities for investment; and WHEREAS an allocation of up to $32.5 million in community sector and discretionary funds for fiscal year 2016/17 was approved; and WHEREAS due to the confirmation by the Ministry of various funding amounts as well as the timing of some planned initiatives, changes to the allocation for priorities for investment are required; BE IT RESOLVED THAT: The Central LHIN Board of Directors approves the following revised funding allocation for priorities for investment for fiscal year 2016/17: Strategic Priority Funding Amount Up to: (in millions) Change from May 31, 2016 Better Seniors Care $ 8.6 $ 0.6 Better Palliative Care $ 1.9 $ 1.4 Better Community Care $ 14.4 $ 0.4 Better Care for Underserved Communities $ 0.4 $ 0.1 Better Mental Health $ 0.1 $(2.9) Achievement of MLAA $ 3.0 $ 0 Sustainability $ 3.9 $ 0.4 Total $ 32.4 $(0.2)

38 ANALYSIS: Priorities for Investment When the priorities for investment were developed, the ministry had not yet communicated the funding and specific investments to the LHIN. The LHIN planned for $32.5 million in base and one-time investments including $18 million base for the community sector. When the LHIN received the funding letter, the majority of the investments were directed by the ministry, with only $4.2 million discretionary. This resulted in a different allocation by strategic priority than was approved by the Board. Some of the planned initiatives were also implemented later than anticipated resulting in an opportunity for additional one-time funding in sustainability and patient services initiatives. Examples of these include community capital and one-time support for service pressures or for meeting legislated requirements. The recommended revisions to 2016/17 funding amounts, along with updated investment information, is shown in Table 1 below: Table 1: Funded Investments for 2016/17 Strategic Priority Approved (May 2016) Up to: ($millions) February 2017 Updated Forecast Up to: ($millions) One-Time Base Total Key Projects Better Seniors Care $8.0 $1.5 $7.1 $8.6 Assisted Living and Home First spots Better Palliative Care $0.5 $1.4 $0.5 $1.9 CCAC Palliative Services Enhanced services for complex and crisis Better Community Care $14.0 $4.6 $9.8 $14.4 patients, Home for the Holidays program, Caregiver Respite Tele-opthalmology, FLS Navigator, Mental Better Care for Underserved $0.5 $0.1 $0.3 $0.4 Health and Addictions Franophone Outreach Communities Services Better Mental Health $3.0 $0.1 $0.0 Evaluation of Mental Health and Addictions $0.1 Initiatives Achievement of MLAA $3.0 $3.0 $0.0 $3.0 CT and MRI hours, ALC initiatives Sustainability $3.5 $3.6 $0.3 Community capital, legislated and contractual $3.9 obligations, Hospital one-time pressures TOTAL $32.5 $14.3 $18.1 $32.3 BACKGROUND: Source of Funds At the May 31, 2016 Board of Directors meeting, the Board approved strategic priorities and the associated funding to guide Central LHIN staff when allocating discretionary funds. The revised forecast for funds available for discretionary investment is consistent with the forecast presented to the Board in May; however, available one-time funds have increased due to the timing of investments as noted above. This has driven a change in the funding allocation priorities as outlined above. The updated amounts available to the LHIN are shown below in Table 2. 2

39 Table 2: Forecasted Funds Available for Investment in May 2016 Estimate February 2017 Forecast Base Funds New Community Investment 18,000,000 17,881,600 Unallocated Base 2,000,000 1,753,150 Sub-Total: Base Funds 20,000,000 19,634,750 One-Time Funds Urgent Priorities Funds 3,609,369 3,609,369 In-Year Surplus (base programs- no restrictions) 350, ,100 In-Year Surplus (Community Investment- restricted) 1 3,000,000 8,501,561 Sub-Total: One-Time Funds 6,959,369 12,705,030 Total: Funds $26,959,369 $32,339,780 Note 1: The increase in In-Year Surplus -Community Investment is due to unanticipated late start of CCAC new funded programs NEXT STEPS: Upon Board approval of the updated funding allocations, the Central LHIN staff will finalize the remainder of the allocations for fiscal year 2016/17. 3

40 From: Brenda Urbanski, Chair, Audit Committee Date: February 9, 2017 CENTRAL LHIN BOARD OF DIRECTORS AUDIT COMMITTEE REPORT FEBRUARY 28, Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: ITEM The Audit Committee met on Thursday February 9, ITEMS FOR APPROVAL 2016/17 Audit Service Plan from Deloitte The Audit Services Plan for fiscal year 2016/17 was presented by the Audit Partner from Deloitte. There are no new accounting changes, however there is one significant event that will impact the financial statements this year. This event is related to the passing of Bill 41 and the impacts it will have on the March 31, 2017 year end from both an accounting and disclosure perspective. Fieldwork will begin the week of April 24, with the results scheduled to be presented to the Audit Committee in May. Delegation of Authority Q4 Declaration of Compliance The Committee delegated the Chair of the Audit committee to make a recommendation to the Board regarding the Q4 Compliance in the absence of an April Audit Committee meeting. ITEMS FOR INFORMATION 2016/17 Q3 Ministry Submission Operations Forecast Consistent with the Board approved budget, the LHIN forecasted a balanced year end position as at December 31, The LHIN has communicated no change to the budget to the Ministry as part of the 2016/17 Q3 Ministry submission. Proposed note to the 2016/2017 Financial Statements A note to the financial statement for the fiscal year 2016/2017 will be required which discloses the date of the transfer of all assets, liabilities, commitments, and contingencies from the CCAC to the Central LHIN, which is scheduled to occur after the fiscal year end, but may be before the issuance of the final audited statements in late May.

41 PROPOSED RESOLUTION: CENTRAL LHIN BOARD BRIEFING NOTE COMMITTEES OF THE BOARD MEMBERSHIP AUDIT COMMITTEE AND GOVERNANCE & COMMUNITY NOMINATIONS COMMITTEE FEBRUARY 28, Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: WHEREAS, the current Chair of the Central LHIN Audit Committee, Ms Brenda Urbanski, will have served six years on the Central LHIN Board and her Board term is expiring on April 7, 2017; WHEREAS, Central LHIN Board Member, Mr. David Lai, is a current member of the Audit Committee; WHEREAS, Central LHIN Board Member, Ms Aldous Young, has expressed interest in serving on the Governance and Community Nominations Committee; WHEREAS, Michael MacEachern became a Central LHIN Board Director by provincial Order-In- Council dated February 2, 2017, BE IT RESOLVED THAT: The Central LHIN Board of Directors: ITEM Extends appreciation to Ms Urbanski for her service as the Audit Committee Chair; and 2. Approves the following Board Directors be appointed to the following Board Committees: Audit Committee Mr. David Lai as Chair of the Audit Committee Mr. Michael (Mike) MacEachern Governance & Community Nominations Committee Ms Aldous Young NEXT STEPS: Upon approval of this resolution, that staff recognize Mr. Lai as the Chair of the Audit Committee, provide Mr. MacEachern and Ms Young respectively with Audit Committee and Governance and Community Nominations Committee materials, and henceforth engage them into all planning and proceedings for these committees.

42 TAB 8 CEO REPORT-APPROVAL ITEMS

43 60 Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: CENTRAL LHIN BOARD OF DIRECTORS BRIEFING NOTE NORTH YORK GENERAL HOSPITAL PRE-CAPITAL SUBMISSIONS Part A February 28, 2017 ITEM 8.1 PROPOSED RESOLUTION: WHEREAS on November 1, 2016, North York General Hospital (the hospital) submitted two Pre- Capital Submission Forms Part A with respect to Heart Function Clinic Renovations and Chemotherapy and Pharmacy Admixture Room Renovations, with its own funds, for review; and WHEREAS the Heart Function Clinic Renovations is focused on renovating the current Heart Function Clinic in order to improve safety, resolve work flow inefficiencies, and improve privacy for patients and families; and WHEREAS the Chemotherapy and Pharmacy Admixture Room Renovations is focused on renovating the current Chemotherapy Clinic and Pharmacy Admixture Room to meet the regulatory standards for Hazardous Compounding put forward by the Ontario College of Pharmacists, resolve hospital workflow inefficiencies, and improve patient and staff experience; and WHEREAS Central LHIN staff have reviewed the hospital s submissions and determined that they address the requirements outlined in the MOHLTC-LHIN Joint Review Framework for Early Capital Planning Stages with respect to program and service elements of the proposal; BE IT RESOLVED THAT: The Central LHIN Board of Directors endorses the North York General Hospital s Pre-Capital Submissions Part A, with its own funds, in respect of the renovations of: a. Heart Function Clinic; and b. Chemotherapy and Pharmacy Admixture Room.

44 ANALYSIS: The hospital has submitted two own-funds capital projects that are focused on renovating space in its General site to improve patient experience while delivering effective and quality care to the North York General Hospital community. Heart Function Clinic Renovations The Heart Function Clinic is a culmination of a number of cardiology clinics, including: The Rapid Cardiology Assessment Clinic, Arrhythmia Clinic, Pacemaker Clinic, and Heart Failure Clinic. These clinical services have provided follow-up care for post-surgical patients and patients who were deemed safe for discharge from the Emergency Department. This own-funds proposal, estimated to cost $1,721,827, proposes to physically combine the Heart Function Clinic from its current layout of 2 separate rooms (5 exam spaces and administrative spaces) to a consolidated space in order to improve patient safety, increase work flow efficiencies, and improve privacy for patients and families. A redeveloped Heart Function Clinic space would also allow the hospital to further explore innovative practices such as the use of telemedicine with this patient population. The hospital has indicated that the Clinic requires renovations due to a lack of sufficient physical space that is required to accommodate the needs of patients and staff. The majority of patients that visit the Clinic are elderly and often require mobility aids such as walkers or wheelchairs. The tight space is not conducive for these patients. Likewise, the current work space is too small and poorly configured for the Clinic s inter-professional team, which compromises the team s work flow and negatively impacts the team s ability to work efficiently. In addition, the current space size and layout impedes patient privacy and confidentiality. Chemotherapy and Pharmacy Admixture Room Renovations The Chemotherapy Clinic is an outpatient service that provides chemotherapy to the hospital s cancer patients. The Pharmacy Admixture Room is where the hospital s medications are prepared, packaged and dispensed. This own-funds proposal, estimated to cost $3,103,692, will renovate the current space to meet new provincial standards, improve hospital workflow efficiencies, and improve patient and staff experience. The hospital s Pharmacy and Admixture space does not meet the regulatory standards put forward by the Ontario College of Pharmacists on September 20, These standards stipulate that all hospital pharmacies must comply with the new Hazardous Compounding codes by January 1, Hospitals that do not comply with the recommendations will be forced to cease all compounding activities, which will negatively impact the level of service that North York General Hospital can provide to its patients, especially those receiving chemotherapy. The current arrangement of the Chemotherapy Clinic provides limited privacy for patients and families making this renovation important to better accommodate patient privacy and confidentiality. The hospital has indicated that the two projects will not have significant operational implications in terms of operating costs or staffing. LHIN staff has reviewed the submissions and confirms that they have met the threshold for LHIN support outlined in the Joint Review Framework, including alignment between the proposed services and local health system priorities. 2

45 Alignment with IHSP The proposals align with the Central LHIN s IHSP by ensuring that patients have access to care that supports the best patient experiences in the right environment. In particular, the LHIN s strategic priority of better seniors care will be advanced as the hospital renovates its outpatient services. COMMUNITY & STAKEHOLDER CONSULTATION The hospital has received positive feedback from its internal stakeholder engagements regarding both projects. It plans on conducting additional consultations with other Health Service Providers in subsequent planning stages, to explore innovative service delivery models, service realignments, and alternatives redevelopment options to enhance the patient experience. BACKGROUND: The Ministry-LHIN Accountability Agreement sets out the roles and responsibilities of LHINs with respect to capital initiatives proposed by a Health Service Provider related to the a construction, renewal or renovation of a facility or a site. The LHIN is required to review Part A of a Health Service Provider s Pre-Capital submission and provide advice and/or endorsement to the Ministry; The MOHLTC-LHIN Joint Review Framework defines the role of the LHIN in the review of capital submissions. The LHIN focuses on the alignment between the proposed programs and services outlined in the project and the needs of the local health system. The role of the ministry is to review and approve the project including all physical, cost, program and service elements from a provincial perspective. A schematic summarizing the various stages of the capital planning process is as follows: Overview of Capital Planning Process Planning Grants: 3 possible approval milestones: proposal development, functional program, design development Construction Grant Pre-Capital (Part A & B) Stage 1 Proposal (Part A & B) Stage 2 Functional Program (Part A & B) Stage 3 Preliminary Design Or Output Specifications Stage 4 Working Drawings Or Output Specifications Stage 5 Implementation Review and support of Pre-Capital Submission. Proposal Development grant Review and approval Review and approval of Stage 1 Submission. of Stage 2 Functional Program Functional Program. grant. Design Development grant Requires Government approval to plan Review and approval of blocks and sketch plans; approval to proceed to working drawings OR blocks/output specifications Requires Government approval to construct Review and approval to tender & implement/issue RFP OR approval to award construction contract/ Project Agreement. 3

46 The Joint Planning Framework requires a health service provider to address a number of key criteria in the development of a Pre-Capital Submission Part A. These criteria include: A narrative description of the program/service need to be addressed by the project; A statistical description of the program/service need to be addressed by the project; A description of how the program/service need supports local health system integration and a unified system of care; Support from other stakeholders with respect to the project; Any significant operational implications of the project; Alternative program/service solutions. NEXT STEPS: Upon Board endorsement of the Pre-Capital Submissions Part A, the LHIN staff will notify the Ministry and the North York General Hospital with a direction for the hospital to submit the Pre-Capital Submissions Part A & B to the MOHLTC. 4

47 TAB 9 CEO REPORT INFORMATION ITEMS

48 ITEM 9.1 Central LHIN Board of Directors CEO REPORT February 28, 2017

49 Central LHIN CEO Report - Items for Information Better Seniors Care Develop specialized strategies and support systems to help older adults stay healthy and independent at home for as long as possible. Reduce reliance on acute care by exploring and implementing other options that are senior-friendly and costeffective. Better Community Care Create stronger links to integrated community services and to primary care, to help patients recover and receive more of their health care at home, with safety and independence. Better Palliative Care Provide holistic, proactive and continuous care and support for patients with progressive, life-limiting illness and for their families. Support families through the entire spectrum of care before and after death by helping patients to live as they choose, and to die in their preferred location of choice - with quality of life, comfort, dignity and security. Better Care for Underserved Communities Create organized, integrated systems of care to improve early intervention and treatment of disease in neighbourhoods where there are recurring patterns of chronic and acute or episodic health conditions. Develop partnerships that will improve long-term health by addressing the key factors that determine healthy outcomes. Better Care for Kids and Youth Develop new partnerships and innovative models to bring specialized care closer to home, for children and youth. Better Mental Health Integrate a supportive system of programs and services to enhance the wellness of people with mental illness and addictions, and to promote and sustain recovery.

50 Central LHIN CEO Report - Items for Information Contents Contents... 2 CEO Highlights CEO Highlights... 1 Business Arising Business Arising... 2 Performance, Contracts and Allocation /17 Q2 Hospital Sector Performance Appendix A /18 Opening Cash Allocations Appendix B Funding Allocation Delegated Authority February 2017 Appendix C... 6 Planning, Integration and Community Engagement Mackenzie Health Proposal Putting Patients First: A solution to address imminent... 6 patient safety risk in South West York Region Influenza Activity Report & Holiday Planning Update... 7

51 Central LHIN CEO Report - Items for Information CEO Highlights 9.0 CEO Highlights Patients First Transition Planning Collaboration continues across the Central LHIN and Central CCAC teams to support readiness for transition. There is continued focus on completing pan-lhin work along with requirements within Deloitte s readiness checklist (Ministry s consultant to support all LHINs for transition). The specific date for CCAC assets and employees to transition to the LHIN is pending. We will have further clarity in the weeks ahead, possibly by mid-april, on a likely timeframe for transition. The organizational structure continues to roll out through a transparent and open process. The new LHIN management structure has been shared across both organizations. There is also a process underway to cascade confirmation of staff, which is progressing well. Some positions at the senior level and at the Director level to replace vacancies will be required. Human Resources staff from both organizations are involved in the staff confirmation process. Meantime, the Communications staff are continuing to develop and share updates with all staff, as well as with Central LHIN Health Services Providers. In recognition of bringing together the LHIN and CCAC teams, a change management plan to engage all LHIN and CCAC staff is being developed. This work is being led by CCAC organizational effectiveness and communications staff. All staff will be invited to local forums in the weeks ahead to participate in transition conversations to support a smooth, seamless transition. Transformation Planning Previous reports have shared updates on the Central LHIN s six sub-regions which were approved by the Ministry of Health and Long-Term Care in December With the six sub-regions, Central LHIN planners, providers and partners will look at care patterns through a smaller, more local lens, and be better able to identify and respond to community and patient needs. This includes the needs of Francophone Ontarians, Indigenous communities, newcomers and other individuals and groups within the Central LHIN whose health care needs are unique and who often experience challenges accessing and navigating the health care system. With the geographies of our six sub-regions now confirmed, we are rolling out a sub-region engagement plan. We have invited all Central LHIN Health Service Providers (HSPs) to join a webinar in March to discuss sub-region planning current status, engagement plan, how the LHIN is working partnership to co-design a robust patient-centered approach, and timelines. This is our second sub-region planning webinar with local HSPs. Following the webinar, we will host community engagement sessions to share robust dialogue on opportunities to improve the local health care system. We can anticipate that dialogues will include opportunities for elements of consistency across the LHIN, empowering sub-regions to identify their Central LHIN Board of Directors Page 1 CEO Report February 28, 2017

52 Central LHIN CEO Report - Items for Information own priorities to improve system performance, defining a more inter-dependent perspective to strengthen the patient experience, and including the patient voice in planning. Other Stakeholder Engagement Related to engaging with health care stakeholders, the Central LHIN senior management team met with thirteen service provider organizations active in the home and community care sector in February. As well, on February 22, I met with members of the Association of Family Health Teams of Ontario. AFHTO organized this collaborative workshop in Markham to discuss primary care with Executive Directors, Lead Physicians and Board Directors of AFHTO-member organizations within Central LHIN region. I was pleased to participate and share dialogue on initiatives and updates from the LHIN. 9.1 Business Arising Business Arising No business arising items noted in follow up to the January 31, 2017 Board meeting /17 Q2 Hospital Sector Performance Appendix A Summary: As per the reporting requirements outlined in the Hospital Service Accountability Agreement, Central LHIN hospitals have submitted reports with details of performance for the second quarter of fiscal year 2016/17. Central LHIN hospitals generally performed well compared to the targets set out in the Agreements, with the exception of Alternate Level of Care (ALC) and Emergency Department (ED) Length of Stay for Complex Patients. Hospital-specific performance is provided below. A full performance dashboard can be found in Appendix A. Humber River Hospital Year-end Results Total LHIN Funding: $334.4 million Number of Beds: 562 Number of FTEs: 2,826 Performance, Contracts and Allocation Year-End Surplus (H-SAA definition): $(287,500) (-0.07% of revenue) Cash and Investments: $10.8 million Long-term Debt: $159.2 million % of Total Debt: 8.12% Humber River Hospital is generally performing well compared to Hospital Service Accountability Agreement (H-SAA) targets with the exception of those indicators noted below: Day Surgery Weighted Cases: Decreased volumes are primarily a result of lower than expected volumes during the summer months. The hospital expects that that volumes will increase during the second half of the year and approach target by fiscal year-end. Central LHIN Board of Directors Page 2 CEO Report February 28, 2017

53 Central LHIN CEO Report - Items for Information Year-end Total Margin: Forecasted year-end margin was based on information available as of early November With the additional PCOP funding that the hospital received in Q3, the hospital now expects to have a balanced financial position by fiscal year-end. ED Length of Stay for Complex Patients: The decline in performance from the previous quarter was driven by the LOS of its admitted patients. The hospital continues to implement strategies targeting the complex admitted patient population, including the implementation of tools to improve patient flow. In addition, the hospital has made significant revisions to its ED staffing model, including increased physician availability by 20 hours/day, improving shift alignment between nurses and physicians, and recently hired 9 new ED physicians. Notably, the hospital has made significant improvements (nearly 7 hours) from the previous year. The admitted patient LOS decreased from 26.4 hrs. (FY 2015/16) to 19.6 hrs. YTD (Q2). ALC: Performance continues to be driven by the high volume of open ALC cases (89%, as of September 2016) at Humber who are waiting for placement in Long-Term Care. In Q2, 2016/17, 44 long stay ALC patients were discharged, which was the highest volume amongst all Central LHIN hospitals. The hospital continues to actively participate in Central LHIN ALC Collaborative initiatives and has led the development of the escalation and substitute decision maker (SDM) algorithm to support communications with patients and families throughout the transition process. This algorithm will be implemented across all Central LHIN hospitals. CT and MRI: Increased demand for CT and MRI services since the opening of the Wilson site has contributed to longer wait times at Humber. CT and MRI priority 4 requests exceed capacity by 40% and 21%, respectively. This is compounded by higher priority 1 (emergency) referrals which displace lower priority cases on which the performance metric is based. It is expected that the addition of a new CT scanner at Humber in March should result in improved CT wait times by June. North York General Hospital Year-end Results Total LHIN Funding: $ million Number of Beds: 421 Number of FTEs: 2,155 Year-End Surplus (H-SAA definition): $6.6 million (1.76% of revenue) Cash and Investments: $33.8 million Long-term Debt: $14.7 million % of Total Debt: 5.66% North York General Hospital is generally performing well compared to Hospital Service Accountability Agreement (H-SAA) targets with the exception of those indicators noted below: Inpatient Mental Health Weighted Patient Days: Decreased volumes are being driven by lower than expected occupancy rates as well as data quality issues which were corrected as of November The hospital has taken patient transfers from other hospitals when beds are available. ALC: North York General Hospital s performance in ALC is driven by the continued increase in volume of open ALC cases. The majority of these patients are waiting for placement in Long- Term Care (73%) and Rehabilitative Care (13%) (as of September 2016). The hospital continues to actively participate in Central LHIN initiatives to improve ALC. Central LHIN Board of Directors Page 3 CEO Report February 28, 2017

54 Central LHIN CEO Report - Items for Information ED Length of Stay for Complex Patients: The hospital improved in its performance for wait time for admitted patients, from 28.5 hrs. (Q1) to 23.7 hrs. (Q2). The hospital was able to create inpatient capacity by discharging long stay rehab patients, opening an 8-bed short stay unit, and using the surgical beds that normally close over the summer. The hospital continues to refine its ED escalation protocols and work on internal processes that target patient flow and ALC patients. It has also embarked on a number of projects, including ways to reduce physician consult time and improving the use of diagnostic imaging in the ED. CT: Performance was driven by longer wait times for Priority 3 cases which were due to scheduling issues which have been corrected. The hospital has shown an improvement through Q3. Rate of Hospital-Acquired C. Difficile Infections (CDI): The target for the HSAA indicator is set to the Hospital s Quality Improvement Plan target and it is of note that North York General has set a stringent target for this indicator. North York General has consistently achieved good results in this indicator as compared to their benchmark peer group of hospitals. The hospital uses a molecular CDI test that detects 25-30% more CDI cases than tests used at many other centres. In addition, the hospital operates in an older physical facility comprised of mostly multi-bed rooms which increases the risk of infection. Southlake Regional Health Centre Year-end Results Total LHIN Funding: $290.1 million Number of Beds: 391 Number of FTEs: 2,303 Year-End Surplus (H-SAA definition): $8.8 million (2.29% of revenue) Cash and Investments: $18.7 million Long-term Debt: $28.1 million % of Total Debt: 9.28% Southlake Regional Health Centre faced challenges in meeting 2015/16 H-SAA targets for ED Length of Stay, wait times for diagnostic services and certain clinical activity volumes. Specific performance challenges are noted below: ALC: Southlake has seen an increase in ALC Rate from Q1 to Q2 2016/17. The top discharge destination for open ALC cases continues to be Long-Term Care, with 70% of their ALC patients waiting for Long-Term Care, as of September In December 2016, Central LHIN has provided one time funding to the hospital to implement an Outpatient Stroke/Neurological Rehab Program to facilitate earlier discharge of patients with moderate strokes and save acute patient days. Southlake continues to actively participate in other Central LHIN ALC initiatives, including the ALC Working Group and subgroups. ED Length of Stay for Complex Patients: The decline in performance was driven by the wait time for admitted patients. The hospital continues to express challenges related to Mental Health bed capacity, and is working on establishing a surge plan for its mental health patients waiting in the ED. More specifically, the hospital is developing an escalation process that will be triggered by the identification of a specified number of mental health patients presenting in ED. CT: Increased demand for CT services as well as a greater proportion of higher priority cases has contributed to longer CT wait times at Southlake. Demand for emergency and inpatient CT cases increased by 10% in Q2. This increased demand for higher priority cases limits capacity available for lower priority cases and also decreases overall efficiency. The hospital has invested global funds to increase CT operating hours to mitigate impact on wait times. Central LHIN Board of Directors Page 4 CEO Report February 28, 2017

55 Central LHIN CEO Report - Items for Information Mackenzie Health Year-end Results Total LHIN Funding: $178.6 million Number of Beds: 356 Number of FTEs: 1,797 Year-End Surplus (H-SAA definition): $0 (0.00% of revenue) Cash and Investments: $28 million Long-term Debt: $24 million % of Total Debt: 8.99% Mackenzie Health is generally performing well compared to H-SAA targets with the exception of those indicators noted below: ALC: Mackenzie Health has seen an increase in both Percentage ALC Days and ALC Rate. The majority (75%) of open ALC cases are waiting for placement in Long-Term Care (as of September 2016). Mackenzie Health is working with Central LHIN, Humber River Hospital and the Ministry of Health and Long-Term Care in implementing a transition strategy that utilizes existing space at Humber River Hospital s York-Finch site to improve bed capacity at Mackenzie Richmond Hill Hospital. ED Length of Stay for Complex Patients: The decline in performance was driven by the wait time for admitted patients. The hospital continues to work on implementing initiatives targeted at improving patient flow of admitted patients, such as increasing hours of availability of Geriatric Emergency Management nurses in the ED and implementing a corporate discharge planner to improve internal processes. Markham Stouffville Hospital Year-end Results Total LHIN Funding: $173.1 million Number of Beds: 279 Number of FTEs: 1,441 Total Surplus (H-SAA definition): $4.0 million (1.75% of revenue) Cash and Investments: $49.6 million Long-term Debt: $29.2 million % of Total Debt: 6.74% Markham Stouffville is performing well on H-SAA indicators with the exception of those indicators noted below. ALC: Both Percentage ALC Days and ALC Rate has increased at Markham Stouffville Hospital from Q1 to Q2 2016/17 reporting period. As of September 2016, the top discharge destination for open ALC cases is Long-Term Care (78%). Markham Stouffville Hospital continues to participate actively in Central LHIN ALC initiatives, including the ALC Working Group and subgroups. They are a pilot site implementing improved hospital discharge planning in conjuction with CCAC care coordination in hospitals. Rate of Hospital-Acquired C. Difficile Infections (CDI): Performance was mainly driven by multiple room closures at the Uxbridge site which limited space and hence increased risk of infection, and also resulted in a decrease in total patient days which increases the rate for the metric. This issue has been addressed and mitigation strategies put in place to prevent future impact. The hospital has also implemented focused education and orientation regarding hand hygiene as well as monitoring mechanisms to track audits. Central LHIN Board of Directors Page 5 CEO Report February 28, 2017

56 Central LHIN CEO Report - Items for Information Stevenson Memorial Hospital Year-end Results Total LHIN Funding: $20.0 million Number of Beds (average): 38 Number of FTEs (average): 172 Year-End Surplus (H-SAA definition): $39,800 (0.14% of revenue) Cash and Investments: $1.9 million Long-term Debt Year-end: $0 % of Total Debt: 0% Stevenson is performing well compared to H-SAA targets, with the exception of those indicators noted below. ALC: From the Q1 to Q2 reporting period, Stevenson s performance in Percentage ALC Days decreased from 17.0% to 11.8%; while their performance in ALC Rate increased from 13.1% to 18.2%. As a small community hospital with relatively low patient volumes, their performance in both indicators can be easily impacted by the addition or avoidance of 1-2 long stay patients within the quarter. As of September 2016, all of the ALC patients are waiting for placement in Long-Term Care. Central LHIN has recently provided funding to Stevenson to implement foundational elements of the Assess and Restore model, to support development and implementation of a fulsome Restorative Care Project in 2017/ /18 Opening Cash Allocations Appendix B Consistent with previous years, the LHIN has received direction from the Financial Management Branch of the Ministry of Health & Long-Term Care ( the Ministry ) to roll-over prior year base funding to 2017/18. The objective is to continue to provide funding to Health Service Providers at the level of the previous year base funds to enable programs and services to continue to be delivered. The rollover amounts are based on the amounts recorded in the financial systems in the Ministry as at January 31, 2017 and are in Appendix B for information. 9.4 Funding Allocation Delegated Authority February 2017 Appendix C A list of funding delegations approved by Central LHIN staff since the January 31, 2017 Board of Directors meeting is attached in Appendix C. Planning, Integration and Community Engagement 9.5 Mackenzie Health Proposal Putting Patients First: A solution to address imminent patient safety risk in South West York Region On January 30, 2017, the Central LHIN and the Ministry of Health and Long-Term Care (MOHLTC) received a proposal from Mackenzie Health ( the hospital') to transfer up to 90 complex continuing care (CCC) and rehabilitation (rehab) beds to Humber River Hospital s York-Finch site. The hospital has been in discussions with the Humber River Hospital, Central LHIN and the MOHLTC since October 2016 to explore this initiative. The proposal is intended to address the critical overcapacity issues at the hospital s Richmond Hill site, and mitigate the current risk to patient safety, quality, and access to care from now until the opening of the Mackenzie Vaughan Hospital in 2020/21. The Central LHIN sent a letter to the MOHLTC on February 8, 2017 confirming its support for the hospital s proposal. Upon approval by the MOHLTC, the LHIN will work with the hospital to determine next steps and to ensure that all appropriate MOHLTC approvals are received where required. Central LHIN Board of Directors Page 6 CEO Report February 28, 2017

57 Central LHIN CEO Report - Items for Information Mackenzie Health has also indicated that it has submitted a separate multi-hospital proposal in collaboration with Central LHIN partner hospitals that includes a detailed solution for increasing Alternative Level of Care (ALC) capacity at the Humber Regional Hospital York-Finch site. The proposal is currently under review by the MOHLTC and the LHIN. 9.6 Influenza Activity Report & Holiday Planning Update Since January 2017, the Central LHIN has been participating in weekly ministry-led teleconferences to monitor surge activity across the province. Surveillance data from 131 hospitals in Ontario showed a rise in Emergency Department (ED) visits between December 2016 and January 2017, with peak activity over the holiday period. Across the province, ED volumes in December 2016 were 3.5% higher compared to December In Central LHIN, ED visits in December 2016 were 3.9% higher and the admissions from ED increased by 5.7% compared to December Influenza-related activity was at elevated seasonal levels across the province in January 2017, contributing to province-wide surge activities and increased inpatient admissions for patients diagnosed with respiratory conditions. As with previous H3N2-dominant seasons, two distinct periods of elevated influenza activity are expected: a larger peak occurring in January due to increased influenza A activity, and a smaller peak which is usually expected in March/early April due to increased influenza B activity. Based on the weekly Influenza-Like Illness (ILI) Activity Level indicator, influenza activity in Central LHIN was at elevated seasonal levels in January 2017 but has now reduced back to low seasonal levels. The Central LHIN Holiday Planning Working Group has been working with hospitals, Central CCAC, York Public Health and other community partners to develop and implement strategies to ensure a systemic approach to mitigate the overcrowding and surge conditions in hospitals during the winter holiday period. 1. Patient transitions from Acute Care to Long Term Care Central LHIN Hospitals and Long Term Care Homes have continued to use the Acute Care to Long Term Care (LTC) Home Transfer Checklist and Patient Transitions during Outbreak Guidance Document and Process Flow Document to support communications, decision making and repatriation of patients from hospitals to Long Term Care Homes. System partners have indicated that Central LHIN Board of Directors Page 7 CEO Report February 28, 2017

58 Central LHIN CEO Report - Items for Information these tools have been useful in facilitating better communication and patient transitioning between acute care and Long Term Care Homes. 2. Enhanced Communication and Public Awareness Promotion of the Central Healthline Holiday Hours webpage among Central LHIN health service providers (HSPs) and primary care providers drove 1,610 page views, compared to 767 page views in 2015; indicating a 108% increase. Central LHIN also developed and distributed various communication materials to all Central LHIN health service providers (HSPs) and primary care physicians to outline resources available for them to use over the winter holidays. 3. Patient Support in the Community In December 2016, the Central CCAC launched Home for the Holidays, an initiative that enabled select hospital patients to return home for 15 days over the holiday season with enhanced CCAC services. As of January 9, 2017, 60 patients were identified and successfully transferred home; over 80% of these patients remained at home following the 15-day enhanced services. The Central CCAC will continue to evaluate this initiative through patient satisfaction surveys and an internal review to for longer-term sustainability of the program. Furthermore, the eighth CCAC nursing clinic was open in October 2016 in Richmond Hill. The overall utilization of all CCAC clinics was 74% in December The Central CCAC will continue to promote and increase the utilization of the community nursing clinics. The Central LHIN Holiday Planning Working Group will continue to meet and identify mitigation strategies to address surge activities and ensure safe patient access to health services in anticipation of the 2017/18 holiday period and influenza season. Central LHIN Board of Directors Page 8 CEO Report February 28, 2017

59 Central LHIN Public Hospital Performance Summary /17 Q2 Appendix A GLOBAL VOLUMES TORONTO Humber River Regional TORONTO North York General NEWMARKET Southlake Regional RICHMOND HILL Mackenzie Health MARKHAM Stouffville ALLISTON Stevenson Memorial Reporting Period Emergency Department - Weighted Cases 6,320 5,989 5,329 5,561 4,393 1,468 Q2 Forecast Complex Continuing Care - RUG Weighted Patient Days 13,474 33,400 3,830 Q2 Forecast Total Inpatient Acute Activity - Weighted Cases 38,210 30,709 30,684 22,231 18,453 2,022 Q2 Forecast Day Surgery - Weighted Cases 5,236 5,160 9,973 2,986 2, Q2 Forecast Inpatient Mental Health - Weighted Patient Days 20,803 16,592 12,008 9,229 12,960 Q2 Forecast Inpatient Rehabilitation - Weighted Cases Q2 Forecast Ambulatory Care - Visits 250, , , , ,326 31,296 Q2 Forecast ORGANIZATIONAL HEALTH TORONTO Humber River Regional TORONTO North York General NEWMARKET Southlake Regional RICHMOND HILL Mackenzie Health MARKHAM Stouffville ALLISTON Stevenson Memorial Reporting Period Current Ratio Q2 Forecast Year End Total Margin -0.07% 1.76% 2.3% 0.00% 1.8% 0.00% Q2 Forecast SYSTEM PERSPECTIVE TORONTO Humber River Regional TORONTO North York General NEWMARKET Southlake Regional RICHMOND HILL Mackenzie Health MARKHAM Stouffville ALLISTON Stevenson Memorial Central LHIN Actual Reporting Period Percentage ALC Days 14.48% 16.46% 13.46% 17.05% 14.41% 14.62% 14.56% YTD Q1 2016/17 ALC Rate 17.68% 19.11% 13.68% 15.46% 13.01% 18.24% 16.13% Q2 2016/17 PERSON EXPERIENCE TORONTO Humber River Regional TORONTO North York General NEWMARKET Southlake Regional RICHMOND HILL Mackenzie Health MARKHAM Stouffville ALLISTON Stevenson Memorial Central LHIN Actual Reporting Period 90th Percentile ED LOS for Complex Patients YTD Q2 2016/17 90th Percentile ER LOS for Non-Admitted Uncomplicated Patients YTD Q2 2016/17 Priority 2-4 Cases for Diagnostic CT Scan 77% 73% 58% 82% 93% 94% 77% YTD Q2 2016/17 Priority 2-4 Cases for Diagnostic MRI Scan 31% 55% 27% 64% 81% 50% YTD Q2 2016/17 Priority 2-4 Cases for Hip Replacement 97% 100% 100% 100% 95% 99% YTD Q2 2016/17 Priority 2-4 Cases for Knee Replacement 97% 100% 100% 95% 90% 97% YTD Q2 2016/17 PERSON EXPERIENCE TORONTO Humber River Regional TORONTO North York General NEWMARKET Southlake Regional RICHMOND HILL Mackenzie Health MARKHAM Stouffville Main Site Uxbridge Overall ALLISTON Stevenson Memorial Reporting Period Rate of Cases of Clostridium Difficile Infections (CDI) YTD Q2 2016/17 Organization's performance is within HSAA performance corridor Organization's performance is outside the HSAA performance corridor Organization's performance is outside the HSAA performance corridor but meets provincial performance target \\LHINFPS01\LHIN-CH\D. Health Service Providers\PCA Performance\Hospital Sector\ \Q3\Hospital Sector - Q3 Performance Review Summary.xls

60 60 Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: Appendix B Central Local Health Integration Network Opening Cash Allocation Community Care Access Centre Central Community Care Access Centre $316,868,058 Acquired Brain Injury Services COTA Health $689,949 March of Dimes Canada - York 2,816,244 CHIRS 7,181,452 York Central Hospital - Adult Day Program 344,423 Assisted Living Services in Supportive Housing Carefirst Senior and Community Services Association (Central LHIN) $1,917,044 Etobicoke Service for Seniors 1,296,588 Community Home Assistance to Seniors (CHATS) 6,319,661 Circle of Home Care Services (Toronto) 3,475,589 St. Demetrius Supportive Care Services 740,423 Yee Hong Centre - Markham 594,254 Villa Colombo 1,476,603 PACE Independent Living 5,524,307 Lumacare Services 1,696,513 March of Dimes Canada - York 4,198,205 City of Toronto Cummer Lodge 530,319 North Yorkers for Disabled Persons Inc. 853,130 Cerebral Palsy Parent Council of Toronto (Participation House) 2,267,717 Access Independent Living Services 3,496,491 North York Seniors Centre 1,299,108 Attendant Outreach PACE Independent Living $3,408,319 March of Dimes Canada - York 2,600,037 Cerebral Palsy Parent Council of Toronto (Participation House) 1,380 Access Independent Living Services 970,824