2.0 NOTICE/RECOGNITION OF A QUORUM Mr. Warren Jestin

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1 AGENDA BOARD OF DIRECTORS March 27, :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 for the Public 3.2 Patient Story 2:10 10min Ms. Tini Le 4.0 BOARD DEVELOPMENT AND EDUCATION 4.1 Delivering Home and Community Care: Traditional Care and the Family Managed Home Care Program 2:20 30 min Ms. Barb Bell/ Ms. Sue Turcotte 5.0 DECLARATION OF CONFLICTS OF INTEREST Mr. Warren Jestin 6.0 APPROVAL OF CONSENT AGENDA 2:50 Mr. Warren Jestin 6.1 January 30, 2018 Meeting Minutes 6.2 March 7, 2018 Special Meeting Minutes Multi-Sector Accountability Agreements /2018 Quarter 3 CEO Compliance Declaration 6.5 Resolution to Appoint a Vice-Chair of the Board of Directors and Board Secretary 6.6 Audit Committee Report 6.7 Patient Services and Quality Committee Reports January 24, March 8, Resolution of Board Business Conducted from March 31, March 27, CHAIR S REPORT 3: ITEMS FOR APPROVAL Ms. Warren Jestin 8.0 CEO REPORT ITEMS FOR APPROVAL 3:10 Ms. Kim Baker Hospital Service Accountability Agreements Quality Improvement Plan Submission 9.0 CEO REPORT ITEMS FOR INFORMATION 3:30 Ms. Kim Baker

2 Tab No. Agenda Item Time Presenter 9.1 CEO/VP Report Ms. Karin Dschankilic Ms. Chantell Tunney Ms. Tini Le Ms. Barb Bell Ms. Karen Adams 10.0 OTHER BUSINESS (Additions to the Agenda) 3:55 Mr. Warren Jestin 11.0 FUTURE MEETINGS Tuesday, May 29, :00 p.m. 4:00 p.m. Markham Site 60 Renfrew Drive, Suite 360 Central Park Boardroom Markham ON Mr. Warren Jestin 12.0 MOTION MOVING INTO A CLOSED SESSION 4:00 Mr. Warren Jestin 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

3 ITEM 4.1 Delivering Home and Community Care: Direct Care Service Provider Organization Family Managed Home Care Program Personal Support Service Ontario Board of Directors Ms. Barbara Bell, VP, Quality and Safety Tuesday March 27, 2018

4 Objectives: To provide an overview of: How home and community care is evolving in Ontario Related structures and processes Governance implications 1

5 Home and Community Care Delivery Models Needs Assessment Eligibility Determination Care planning / Care Coordination Outcomes Monitoring Jkl Central LHIN Employees Direct Nursing Service Provider Organizations Family Managed Home Care Program PSW-personal support worker Service Provider Organizations Nursing PSW Etc. Family Managed Home Care Program Eligibility Criteria Personal Support Services Ontario 14 hrs./week PSW 2

6 Direct Nursing LHIN employees provide the following: Palliative Care Nurse Practitioners visiting patients in the community Mental Health Addictions Nurses visiting public high schools and on exception elementary schools Rapid Response Nurses visiting patients with chronic disease in their homes within 48 hours after discharge from the emergency department Telehomecare health coaching for patients with congestive heart failure and chronic obstructive pulmonary disease in the community for up to 6 months post hospital discharge 3

7 Service Provider Organizations Provide nursing, physiotherapy, occupational therapy, speech language therapy, and personal support workers 14 agencies are contracted (Appendix A) Constitutes 72% of LHIN budget Care is provided in-home, schools, and congregate settings, in addition to eight Central LHIN nursing clinics 4

8 Service Provider Organizations-Contracts 2008, moratorium on competitive procurement 2012, the ministry issued Contract Management Guidelines that shifted from competitive procurement to performance-based contract management (exceptions) 5

9 Service Provider Organizations-Contracts LHINs follow provincially developed Client Service Contract Performance Framework that includes: Requirement of annual contract renewal Service Provider contracts are evergreen Statutory mechanism that enabled transition day grandfathered the contracts to the LHINs Annual renewal will include administrative amendments to enable alignment of provincial process and improve responsiveness and efficiencies. LHINs use a provincial template to enable such amendments. LHINs are in process of renewing contracts for

10 Client Service Contract Management Performance Framework Measure Monitor Report Manage Provincial Performance Indicators and Standards Routine Contract Monitoring Contract Performance Audits Performance Dashboards Annual Report & QIP Oversight by Patient Services and Quality Committee Provincial Performance Management (Process & Tool Kit) 7

11 Family Managed Home Care Program Eligibility criteria: Patients with exceptional circumstances where usual care is not satisfactory or appropriate (criteria to be clarified) Personal Support Services Ontario Eligibility includes 14 hours of personal support services per week Children with medical complexity Home schooled children Adults with Acquired Brain Injury 8

12 Family Managed Home Care Program Currently, the LHIN has six self-directed care contracts with patient/substitute decision makers. Legislation prohibited LHINs from entering into new self-directed contracts post transition Legislation was amended in December, Ministry of Health and Long- Term Care announced the revised model March 4 th Implications for LHINs: Staffing costs including financial administration, contract management, care coordination No new resources New eligible expenses: book keeping costs, recruitment, termination of service provider costs All processing will be manual by staff Application of eligibility criteria in a transparent and consistent manner will be important 9

13 Personal Support Services Ontario For long-stay patients with a care plans that include 14 hours or more per week of personal support services Personal Support Services Ontario will recruit, train and employ personal support workers and provide care to this select group of home-care clients Patients/substitute decision makers will be able to select personal support workers employed by Personal Support Services Ontario through an interview process Phased approach to launch in spring 2018 with three LHINS Personal Support Services Ontario is a Crown agency, board selected and interim CEO hired Service Provider Organizations have raised concerns. Media reporting agencies have launched legal action 10

14 Appendix A: List of Service Provider Organizations CarePartners 1to1 Rehab Inc. Bayshore Healthcare Ltd. CBI Home Health Toronto Circle of Care Closing the Gap Healthcare Group ParaMed Inc. RNS Health Care Services Inc. Saint Elizabeth Health Care Spectrum Health Care SRT-Med Staff Susan McLean Speech Language Pathologist Professional Corporation Inc. d.b.a. The Speech Clinic VHA Home HealthCare WeCare Health Services 11

15 CENTRAL LOCAL HEALTH INTEGRATION NETWORK BOARD OF DIRECTORS MEETING January 30, :00pm-4:00pm Central LHIN, 60 Renfrew Drive, Suite 300, Markham, ON ITEM 6.1 MINUTES OF MEETING Board Members Present: Mr. Michael MacEachern, Meeting Chair, Board Member Mr. Graham Constantine, Board Member Ms. Tanya Goldberg, Board Member Ms. Elspeth McLean, Board Member Mr. Stephen Smith, Board Member Mr. Mark Solomon, Board Member Ms. Audrey Wubbenhorst, Board Member Ms. Aldous Young, Board Member Mr. Warren Jestin, Board Chair (Teleconference) Regrets: Mr. Charles Schade, Vice Chair Mr. David Lai, Board Member Ms. Heather Martin, Board Member Staff Participants: Ms. Kim Baker, Chief Executive Officer Ms. Karin Dschankilic, VP & Chief Financial Officer Ms. Chantell Tunney, VP, Health System and Engagement Ms. Tini Le, VP, Home and Community Care Ms. Barbara Bell, VP, Quality and Patient Safety Ms. Karen Adams, VP, HR and Organizational Development Ms. Robyn Saccon, Corporate Relations Officer Ms. Katrina Santiago, Governance Associate, Recording Secretary 1.0 MEETING CALLED TO ORDER The meeting was called to order at 2:00 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 12 members is seven directors. A quorum was present at the meeting.

16 In accordance with the By-law, participants and guest speakers were introduced. No requests for public deputations were received or planned for this meeting, 3.0 APPROVAL OF AGENDA Item 8.2 Pre-Capital Submission North York General Hospital Branson Ambulatory Care Centre Transition was added to the agenda for approval. ON MOTION made by Mr. Stephen Smith and seconded by Ms. Tanya Goldberg, IT WAS RESOLVED THAT: The Agenda be approved as amended. CARRIED January WELCOME MEMBERS OF THE PUBLIC Mr. MacEachern welcomed all members of the public attending the board meeting. 3.2 PATIENT STORY Mr. MacEachern introduced Ms. Tini Le, Vice President, Home and Community Care. Ms. Le presented a patient story focused on the amendment to the Long Term Care Homes Act to introduce Reunification Priority Access Beds (RPABs) which was developed to expedite the reunification of spouses/partners in Category 1 (crisis). The story focused on two sisters in their late 80s with high needs of high levels of care in the same long-term care home but reunited under the Spousal/Partner reunification priority. 4.0 BOARD DEVELOPMENT AND EDUCATION 4.1 Caring for Patients: 2017/2018 Winter Surge Mr. MacEachern introduced and welcomed Ms. Lynn Singh, Director, Health System Planning and Design and Ms. Mary Burello, Director, Home and Community Care from the Central LHIN who provided a presentation on the winter surge. The presentation included the following highlights: Pressures during the winter season Impact on patients Patient Flow and Data Trends Maintaining Patient Flow Following the presentation there was discussion regarding the value of educating more broadly on surge capacity in the winter months to prevent hospital capacity issues as well as annual planning. 5.0 DECLARATION OF CONFLICT OF INTEREST None at this time. 6.0 APPROVAL OF CONSENT AGENDA 2

17 ON MOTION made by Mr. Graham Constantine and seconded by Ms. Aldous Young, IT WAS RESOLVED THAT: The Consent Agenda be approved and all resolutions contained therein be adopted as circulated. CARRIED January Approval of November 28, 2017 Board Meeting Minutes The Minutes of November 28, 2017 Board Meeting are approved as circulated. CARRIED January Multi-Sector Service Accountability Agreements Tranche 1 The Central LHIN Board of Directors: a) Approves the funding, volume and performance targets for the following twenty health service providers: 1. Across Boundaries - An Ethnoracial Mental Health Centre 2. Aphasia Institute 3. Bernard Betel Centre for Creative Living 4. Cedar Centre 5. Cerebral Palsy Parent Council of Toronto (Participation House) 6. Chai-Tikvah Foundation 7. Chippewas of Georgina Island 8. City of Toronto - Long-Term Care Homes & Services 9. Community Head Injury Resource Services of Toronto 10. Hazel Burns Hospice 11. Humber River Hospital 12. Jane/Finch Community and Family Centre 13. LumaCare Services 14. New Unionville Home Society 15. North Yorkers for Disabled Persons Inc. 16. St. Demetrius Supportive Care Services Corp. 17. The Canadian National Institute for the Blind 18. The Vitanova Foundation 19. Villa Colombo Homes for the Aged Inc. 3

18 20. Yor-Sup-Net Support Service Network 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 CARRIED January Canadian Mental Health Association, York Region Bounce Back Program Funding Recovery The Central LHIN Board of Directors approves the following Multi-Sector Service Accountability Agreement funding and target amendments for Canadian Mental Health Association, York Region related to the Bounce Back Program funding recovery: Functional Centre and Performance Indicator One-Time Funding and Target Adjustments Annualized Funding and Target Adjustments Mental Health Counseling Funding ($263,189) ($640,000) and Treatment Visits (3,002) (7,290) Group Sessions (39) (120) Group Participants (400) (600) Individual Served by Organization (717) (1,870) CARRIED January Resolution to Approve Delegation of Authority to the Audit Chair for External Auditor The Central LHIN Board of Directors delegates authority to the Audit Chair, to approve and execute the Deloitte and Touche LLP Audit Services contract. 6.5 GOVERNANCE POLICIES Consent Agenda Revised CARRIED January

19 The Central LHIN Board of Directors approves the Consent Agenda (Appendix) as recommended by the Governance and Community Nominations Committee. CARRIED January BOARD COMMITTEE REPORTS Governance and Community Nominations Committee Report 7.0 CHAIR S REPORT Upcoming Engagements Mr. MacEachern indicated that the board will be participating in some political engagement in the coming months, including meeting with several MPs and MPPs across the LHIN, as well as some Municipal Leaders engagement, which will give the LHIN the opportunity to provide updates to York Region s Councillors on Central LHIN s current activities and progress as well as provide a forum to discuss local priorities. Georgina Nurse Practitioner Clinic Mr. MacEachern acknowledged the staff of the Georgina Nurse Practitioner Clinic for their great work in ensuring patient updates, continuity of care and safeguarding minimal disruption to patient care and services in the midst of dealing with damage to the Clinic due to fire earlier this month. 7.1 ITEMS FOR APPROVAL Community Nominations Committee Membership ON MOTION made by Ms. Tanya Goldberg and seconded by Mr. Stephen Smith, IT WAS RESOLVED THAT: The Central LHIN Board of Directors approves the Community Nominations Committee Membership: Mr. Warren Jestin, Chair, Voting Member Mr. Charles Schade, Board Vice Chair, Voting Member Mr. Graham Constantine, Board Director, Voting Member Ms. Tanya Goldberg, Board Director, Voting Member Mr. Mark Solomon, Board Director, Voting Member Ms. Aldous Young, Board Director, Voting Member Mr. Albert Liang, Community Member, Voting Member Ms. Michelle Kungl, Community Member, Voting Member Ms. Kim Baker, CEO, Non-Voting Member. 5

20 CARRIED January CEO REPORT ITEMS FOR APPROVAL 8.1 Markham Stouffville Hospital Pre-Capital Submission Uxbridge Site Infrastructure Repair Project ON MOTION made by Mr. Mark Solomon and seconded by Ms. Aldous Young, IT WAS RESOLVED THAT: The Central LHIN Board of Directors endorses the Markham Stouffville Hospital s Pre-Capital Submission Part A, in respect to the Uxbridge Site Infrastructure Repair Project. CARRIED January Pre-Capital Submission: North York General Hospital Branson Ambulatory Care Centre Transition Ms. Tunney provided background on the basis for and details related to the submission. Ms. Baker called to the Board s attention that the specific addresses of the proposed locations for the relocation of services were not shared by North York General Hospital with any of the associated hospitals and physicians given that lease negotiations are underway. Ms. Baker also shared the LHIN is aware of stakeholder concerns about the engagement process, undertaken by the Hospital, with external stakeholders. Materials provided to the Board reflect the patient utilization data used and associated rationale that supports the proposed location on the shared heat map. ON MOTION made by Ms. Tanya Goldberg and seconded by Mr. Mark Solomon, IT WAS RESOLVED THAT: The Central LHIN Board of Directors endorses the North York General Hospital s Pre-Capital Submission Part A, in respect to the Branson Ambulatory Care Centre Transition; To relocate five Outpatient Services within the Westminster-Branson community o Adult Mental Health and Addiction Services, Diabetes Education Centre, Complex Diabetes Centre, Ontario Breast Screening Program, Bone Mineral Density ; To relocate seven Minor Procedure Services centrally in North York area 6

21 The LHIN s expectation that the host hospital (NYGH) will collaborate with participant hospitals in good faith in order to plan and deliver eye care services through upholding and revising the Regional Eye Care Centres Agreement (2010), as necessary. CARRIED January CEO REPORT ITEMS FOR INFORMATION Ms. Baker provided the following verbal updates to the Board: Deputy Minister Webinar On January 16 th, the Deputy Minister held a webinar for all LHIN Senior Management Teams across the province. A portion of the meeting was focused on the LHIN Renewal Project Partnership Model, previously shared with the Board, that outlines the various working groups and projects and highlights Ministry led vs. LHIN led. Governance Education Webinars On January 25, LHIN Legal hosted a webinar on LHSIA Integrations - Current State, with the presentations available on the Board Portal. Health Quality Ontario (HQO) will be hosting a Quality webinar on February 9 with more details to come, and the materials posted on the Board Portal for board members who are unable to attend. Move to 11 Allstate Staff are preparing for the move to 11 Allstate and the development of an office renewal timeline. Temporary accommodations have been set up and across the organization, move-in dates for the new site have been displayed, including: February 16 closing of the Renfrew site February 26 reopening of the Renfrew site as a new home for Placement and Telehomecare and Hospital Leadership March 5 first move-in date to the new Allstate site; will roll in until March 12 March 30 servery on the 6 th floor at Sheppard complete Early April construction at the Newmarket site begins End of April construction at Newmarket and Sheppard sites to be complete. This has been a large undertaking for all staff involved and Ms. Baker thanked Ms. Dschankilic and Ms. Le as Co- Leads and Executive Sponsors for this initiative for their hard work in keeping us moving forward. Change Management Training- Prosci Prosci is an approach to change management and a guide to individual and organizational management. It is evidence-based and provides easy-to-use frameworks, with tools and templates for planning, 7

22 sponsoring, leading, managing and executing change. As the organizations have come together, management has been looking for a common language and will be investing in Central LHIN Leadership through creating sponsor training and train the trainer approaches for the management team. Following that, the Prosci methodology will be applied and use to targeted projects organization-wide. System Transformation - focus on sub-regions and primary care strategy Currently the Central LHIN has six active Sub-region Collaborative Tables, which include over 80 clinical, health system and community service leaders. They are working together to define and implement opportunities to improve access, continuity in care and patient experience in each of the Central LHIN s six sub-regions. The IPC Expression of Interest is complete for Phase 1. Quality Improvement Plan - Inaugural LHIN submission HQO oversees the annual Quality Improvement Plan (QIP) program. This QIP will be the first submission of the new LHIN. There are no mandatory indicators for home and community care sector this year but staff are looking for indicators that directly impact patients and resident and health care providers. HQO released the templates in December and staff have started engaging, recommending 8 indicators some of which included: Falls for long stay Five day wait time - complex patients Home and Community care in home services wait time - from community setting to first HCC service On January 18 th, the Central LHIN Patient and Family Advisory Committee (PFAC) provided feedback on the proposed indicators. Input from the Patient Services and Quality Committee was obtained on January 24. Next steps include approval in March by the Patient Services and Quality Committee, followed by seeking Board approval at the end of March and in turn publicly posted. Local System Capacity A Capacity Dashboard has been developed with daily bed census calls with teams, advising on outbreaks, capacity in Hospitals and Home first programs as well as Provincial Bed Census Summary calls. Client and Caregiver Experience Survey The Experience Survey Expert Panel, with its Chair, Gail Donner, will lead a review of the current Client and Caregiver Experience Evaluation (CCEE) survey and provide recommendations regarding future experience survey(s) for home and community care. The advisory group will seek approval for key decisions from the LHIN sponsor(s), and when sponsor(s) deem appropriate, LHIN CEO Council. Ms. Baker is one of the Executive Sponsors for this initiative and will work with a panel of crossrepresentation from the sector that will provide advice and recommendations for an updated patient experience survey. This survey is a quality improvement and performance management tool. For service delivery, it is intended to standardize delivery in a consistent manner across the province. Ms. Baker will look to provide further updates on this panel once they are underway. 8

23 Provincial Mental Health Systems Table As a Co- lead of this Provincial System table, the LHINs has been working closely with the Ministry on the development of a Comprehensive Mental Health and Addictions strategy; Core services Access Quality Data funding and Governance Structured Psychotherapy Ontario will be launched province-wide with each of the Canadian Mental Health Association (CMHA) branches working with LHIN partners through a newsletter that will also be launched province-wide, providing access to various psychotherapy services in Ontario. It also being used as a communication tool to provide information on mental health and addictions trends, as well as Overdose Prevention sites in January. Upcoming Political Engagements Ms. Baker noted that Mr. MacEachern and Mr. Solomon will be meeting with Minister Philpott, the current Minister of Indigenous Services provide some key updates on activities related to Indigenous Health in the Central LHIN as well as the York Region Mental Health Hub. The Central LHIN will also be hosting an MPP Breakfast at Queen s Park on March 7. In April, the LHIN will also be hosting a Municipal Leaders Breakfast with York Region Councillors. Further updates were provided by the Vice Presidents which included: Neshama Hospice Funding Update Ontario Palliative Care Network Action Plan Health Quality of Ontario Opioid Report 10.0 OTHER BUSINESS None at this time FUTURE MEETINGS Tuesday, March 27, 2018 Board Meeting 2:00 p.m. 4:00 p.m. Central LHIN, 60 Renfrew Drive, Markham Ontario 12.0 MOTION MOVING INTO A CLOSED SESSION ON MOTION by Mr. Stephen Smith and seconded Ms. Elspeth McLean, 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: 9

24 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. Tini Le Ms. Barbara Bell Ms. Karen Adams Ms. Katrina Santiago Ms. Robyn Saccon. CARRIED January CLOSED SESSION CALLED TO ORDER The session was called to order at 3:49 p.m APPROVAL OF AGENDA ON MOTION by Ms. Tanya Goldberg and seconded by Mr. Graham Constantine, IT WAS RESOLVED THAT: The Agenda of the Closed Session of January 30, 2018, be approved as circulated APPROVAL OF MINUTES 14.1 Review of Board of Directors Minutes of November 28, 2017 CARRIED January ON MOTION by Mr. Mark Solomon and seconded by Mr. Stephen Smith, IT WAS RESOLVED THAT: 10

25 The Minutes of the Closed Session of November 28, 2017, be approved. CARRIED January Draft Annual Business Plan A motion was passed BOARD DEBRIEF CEO Succession Plan A motion was passed New Board Member Skills Profile A motion was passed. CARRIED January CARRIED January CARRIED January MOTION MOVING OUT OF CLOSED MEETING ON MOTION by Mr. Graham Constantine and seconded by Ms. Tanya Goldberg, IT WAS RESOLVED THAT, The Closed Session is terminated at 4:55 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 Mr. Graham Constantine, IT WAS RESOLVED THAT: The session be terminated 4:56 p.m. CARRIED January

26 Michael MacEachern, Meeting Chair, Board Member Katrina Santiago, Recording Secretary 12

27 CENTRAL LOCAL HEALTH INTEGRATION NETWORK BOARD OF DIRECTORS MEETING March 7, :00pm-4:10pm Meeting via Teleconference ITEM 6.2 MINUTES OF MEETING Board Members Present: Mr. Warren Jestin, Board Chair Mr. Charles Schade, Vice Chair Mr. Graham Constantine, Board Member Ms. Tanya Goldberg, Board Member Mr. David Lai, Board Member Mr. Michael MacEachern, Board Member Ms. Elspeth McLean, Board Member Mr. Stephen Smith, Board Member Mr. Mark Solomon, Board Member Ms. Audrey Wubbenhorst, Board Member Ms. Aldous Young, Board Member Regrets: Ms. Heather Martin, Board Member Staff Participants: Ms. Kim Baker, Chief Executive Officer Ms. Robyn Saccon, Corporate Relations Officer Ms. Katrina Santiago, Governance Associate, Recording Secretary 1.0 MEETING CALLED TO ORDER The meeting was called to order at 4:00 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 12 members is seven directors. A quorum was present at the meeting. In accordance with the By-law, participants and guest speakers were introduced. No requests for public deputations were received or planned for this meeting, 3.0 APPROVAL OF AGENDA ON MOTION made by Ms. Tanya Goldberg and seconded by Mr. Stephen Smith, IT WAS

28 RESOLVED THAT: The Agenda be approved as circulated. CARRIED March WELCOME MEMBERS OF THE PUBLIC None in attendance. 3.2 PATIENT STORY None at this time 4.0 BOARD DEVELOPMENT AND EDUCATION None at this time. 5.0 DECLARATION OF CONFLICT OF INTEREST None at this time. 6.0 APPROVAL OF CONSENT AGENDA None at this time. 7.0 CHAIR S REPORT None at this time. 8.0 CEO REPORT ITEMS FOR APPROVAL None at this time. 9.0 CEO REPORT ITEMS FOR INFORMATION None at this time OTHER BUSINESS None at this time FUTURE MEETINGS Tuesday, March 27, 2018 Board Meeting 2:00 p.m. 4:00 p.m. Central LHIN, 60 Renfrew Drive, Markham Ontario 12.0 MOTION MOVING INTO A CLOSED SESSION ON MOTION by Mr. Stephen Smith and seconded by Ms. Tanya Goldberg, IT WAS RESOLVED THAT: 2

29 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. Katrina Santiago Ms. Robyn Saccon. CARRIED March CLOSED SESSION CALLED TO ORDER The session was called to order at 4:03 p.m APPROVAL OF AGENDA ON MOTION by Mr. Graham Constantine and seconded by Ms. Aldous Young, it was resolved that: The Agenda of the Closed Session of March 7, 2018, be approved as circulated APPROVAL OF MINUTES None at this time. CARRIED March Ministry-LHIN Accountability Agreement A motion was passed. CARRIED March

30 15.0 BOARD DEBRIEF None at this time MOTION MOVING OUT OF CLOSED MEETING ON MOTION by Ms. Aldous Young and seconded by Mr. Graham Constantine, IT WAS RESOLVED THAT, The Closed Session is terminated at 4:33 p.m. and that closed session minutes are permitted to be shared with all Board members and permitted attendees. CARRIED March MOTION TO TERMINATE SESSION ON MOTION by Ms. Aldous Young and seconded by Mr. Stephen Smith, IT WAS RESOLVED THAT: The session be terminated 4:34 p.m. CARRIED March Warren Jestin, Board Chair Katrina Santiago, Recording Secretary 4

31 11 Allstate Parkway, Suite 500 Markham, ON L3R 9T8 Tel: Toll Free: Fax: Allstate Parkway, bureau 500 Markham, ON L3R 9T8 Téléphone: Sans frais: Télécopieur: ITEM 6.3 CENTRAL LHIN BOARD OF DIRECTORS MULTI-SECTOR SERVICE ACCOUNTABILITY AGREEMENTS TRANCHE 2 MARCH 27, 2018 PROPOSED RESOLUTION: WHEREAS the current Multi Sector Service Accountability Agreement is a four-year Agreement that expires on March 31, 2018; and WHEREAS the M-SAA Advisory Committee endorsed an amendment to the current MSAA Agreement with a new expiry date of March 31, 2019 and a provincial refresh process to update information; and WHEREAS on October 24, 2017, the Board approved the principles and process for reviewing the Community Accountability Planning Submissions to inform the volume targets, balanced budget and administrative percentage; and WHEREAS the funding targets for fiscal 2018/2019 assume no general increase in base funding; and WHEREAS Central LHIN staff has reviewed the Community Accountability Planning Submissions against the Board approved review principles; BE IT RESOLVED THAT: The Central LHIN Board of Directors: a) Approves the 2018/2019 funding, volume and performance targets for the following twentyseven health service providers without exception to the Board approved principles: 1. Access Independent Living Services 2. Addiction Services For York Region 3. Alzheimer Society Of York Region 4. Better Living Health and Community 5. Black Creek Community Health Centre 6. Canadian Mental Health Association, Metropolitan Toronto Branch 7. Canadian Mental Health Association, York Region 8. Carefirst Seniors Community Services Association 9. Caritas School of Life 10. Circle Of Home Care Services (Toronto)

32 11. Community Home Assistance To Seniors (CHATS) 12. Cota Health 13. Etobicoke Services For Seniors 14. LOFT Community Services 15. MacKenzie Health 16. March of Dimes Canada York 17. Markham-Stouffville Hospital 18. North York General Hospital 19. North York Seniors Centre 20. PACE Independent Living 21. Stevenson Memorial Hospital 22. The Canadian Hearing Society - York Region 23. The Lance Krasman Memorial Centre For Community Mental Health 24. The Regional Municipality of York 25. Toronto North Support Services 26. Vaughan Community Health Centre 27. Yee Hong Centre For Geriatric Care b) Approves the 2018/2019 funding, volume and performance targets Southlake Regional Health Centre including a reduction in Case Management/ Supportive Counselling & Services - Mental Health reported volumes to reflect a new model of care. c) Delegates authority to the Central LHIN CEO to approve the final MSAA resulting from the integration of Bayview Community Services Inc. and Good Sheppard Non-Profit Homes Inc. d) Delegates authority to the Central LHIN CEO and Board Chair to execute the 2018/2019 Multi-Sector Service Accountability Agreement Amendments for the above health service providers ANALYSIS: 2018/2019 Community Accountability Planning Submissions Central LHIN has received all forty nine Health Service Provider Board approved Community Accountability Planning Submissions (CAPS) and has performed reviews based on the Board approved principles and process. On January 30, 2018, the Central LHIN Board of Directors approved the funding, volume and performance targets for twenty health service providers. The submissions were reviewed against the following criteria: 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 2

33 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 Alternate Level of Care (ALC) Rate (TBD until MLAA for 18/19 set) Funding targets in the MSAAs include fiscal funding plus any additional approved initiatives during fiscal There has been no general increase in base funding. A. Community Support Services and Mental Health Agencies i. The following table highlights the 2018/2019 funding and key volume targets for the twenty-six health service providers: Health Service Providers Sector 2018/19 Visits 1 Hours of Resident Attendance Meals Funding Care 2 Days 3 Days 4 Delivered Access Independent Living Services CSS $4,867,315 25,310 19,397 Addiction Services For York Region CMH&A $5,838,738 27,270 1,810 Alzheimer Society Of York Region CSS $1,859,347 11,408 17,800 Better Living Health and Community CSS $4,049,016 47,256 17, ,750 63,325 Canadian Mental Health Association, CMH&A $20,508,332 99,829 4, ,900 25,507 Metropolitan Toronto Branch Canadian Mental Health Association, CMH&A $14,463,121 92,720 14,960 10,625 York Region CSS Carefirst Seniors Community Services CSS $2,914, ,550 42, ,611 Association Caritas School of Life CMH&A $389,168 9,697 Circle Of Home Care Services CSS $8,973, ,600 17, , ,450 26,000 (Toronto) Community Home Assistance To CSS $14,693, ,158 89, ,250 63,835 32,000 Seniors (CHATS) Cota Health CMH&A $6,629,951 22,391 6,448 69,346 2,976 CSS Etobicoke Services For Seniors CSS $3,237,816 8,387 4,595 43,250 12,383 LOFT Community Services CMH&A $8,600,004 77,979 10,220 96,407 3

34 MacKenzie Health CMH&A CSS $1,454,034 4,039 6,589 March of Dimes Canada York CSS $9,584,486 68,467 20,871 11,190 Markham-Stouffville Hospital CMH&A $736, North York General Hospital CMH&A $5,177,450 21, CSS North York Seniors Centre CSS $2,756,190 18,274 13,650 37,390 7,553 PACE Independent Living CSS $8,827,626 2,624 72,669 19,770 Southlake Regional Health Centre CMH&A $5,983,562 22,632 CSS Stevenson Memorial Hospital CMH&A $704,695 8,480 CSS The Canadian Hearing Society - York CSS $573,945 3,787 Region The Lance Krasman Memorial Centre CMH&A $735,973 13,980 For Community Mental Health The Regional Municipality of York CMH&A $2,442,981 5,004 11,908 CSS Toronto North Support Services CMH&A $2,897,255 20,864 Yee Hong Centre For Geriatric Care CSS $2,001, ,815 7, Visits include case management, counseling and addictions treatment, crisis intervention, abuse services, health promotion, visiting hospices, social and safety, social rehab and recreation, vision impaired, hearing care, and foot care services, caregiver support, transportation, diversion and court support, eating disorders, psychogeriatric, assertive community treatment team, forensic, in-home nursing and therapies. 2. Hours of care includes home maintenance, respite programs, personal support services, homemaking, personal support and independence training programs. 3. Resident days include Mental Health supports within housing, assisted living, overnight stay care and addiction withdrawal management centre. 4. Attendance days include social and congregate dining, day programs, addictions treatment programs and consumer survivor initiatives program. ii. Service Adjustments Southlake Regional Health Centre submitted a CAPS with a service adjustment to their volume targets. LHIN staff working with Southlake are recommending approval. Functional Centre Case Management/ Supportive Counselling & Services - Mental Health 2018/ /18 Target Target 1,100 visits 1,410 visits Variance Rationale (310) visits Southlake s 2016/17 and 2017/18 targets were based on a model of care which the hospital has changed. The new model of care focuses on inperson vs. telephone visits which reduced the total number of visits that can be provided for the allocated funding. 4

35 iii. Fund Type Reclassification Health service providers receive funding from sources other than the LHIN. Historically, both funding and activity associated with other revenue were included as part of the some HSP s MSAA deliverables. This subjects the other revenue to ministry reconciliation processes and could result in a recovery of funds not provided by the LHIN. During the 2018/19 MSAA refresh, health service providers have been instructed to reclassify the other revenue to a fund type other than LHIN revenue. Deliverables associated with the other revenue source will not be part of the HSP s MSAA. This impacted the following health service providers: Canadian Mental Health Association, Metropolitan Toronto Branch Canadian Mental Health Association, York Region Caritas School of Life Circle Of Home Care Services (Toronto) Etobicoke Services For Seniors North York Seniors Centre The Lance Krasman Memorial Centre For Community Mental Health The Regional Municipality of York B. Community Health Centres (CHC) The following table highlights the key 2018/19 funding, volume and performance targets for the two CHC health service providers. The sector specific performance targets were set using the historical data and methodologies as defined in the Provincial MSAA technical specifications document: Community Health Centre Funding Percentage spent on Admin Visits Non Unique Client Interactions Group Sessions Group Participant Attendances Service Provider Interactions Interpretation / Translation assignments Black Creek $8,915, ,500 1,395 1,092 17,280 31,173 0 Vaughan $4,907, , ,000 28,863 2,052 Sector Specific Performance Indicators: Cervical Cancer Screening Colorectal Screening Interprofessional Diabetes Care Influenza Vaccination Breast Cancer Screening Access to Primary Care Retention Rate for NPs and Physicians Black Creek 77% 73% 86% 55% 73% 58% 90% Vaughan 87% 84% 90% 68% 87% 85% 96% 5

36 NEXT STEPS: MSAA Amending Agreements populated with the approved 2018/19 funding, volume and performance targets for the above twenty-eight health service providers will be sent by mail for signatures. Staff will finalize and the CEO will approve the final MSAA resulting from the Bayview Community Services integration. Upon receipt of the provider Board-approved and signed M-SAAs, the Central LHIN Board Chair and CEO will execute the Amending Agreements. 6

37 11 Allstate Parkway, Suite 500 Markham, ON L3R 9T8 Tel: Fax: Toll Free: ITEM 6.4 PROPOSED RESOLUTION: CENTRAL LHIN BOARD OF DIRECTORS 2017/2018 QUARTER 3 CEO COMPLIANCE DECLARATION MARCH 27, 2018 WHEREAS under the Broader Public Sector Accountability Act, 2010, LHINs are required to prepare and submit compliance attestations to the Ministry on a quarterly basis: and WHEREAS having received and considered the CEO s Declaration of Compliance as at December 31, 2017 the Central LHIN Patient Safety and Quality Committee recommends that the Central LHIN Board of Directors authorize the CEO and Board Chair to execute and submit the Declaration of Compliance to the Ministry for the 2017/2018 third quarter; 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 2017/2018 third quarter.

38 11 Allstate Parkway, Suite 500 Markham, ON L3R 9T8 Tel: Toll Free: Fax: APPENDIX A ATTESTATION Prepared in accordance with section 14 of the Broader Public Sector Accountability Act, 2010 (BPSAA) TO: FROM: Ministry of Health and Long-Term Care Kim Baker, CEO Central Local Health Integration Network Date: March 27, 2018 RE: Attestation for October 1 December 31, 2018 ( the Applicable Period ) On behalf of the Central Local Health Integration Network (the LHIN) I attest to: the completion and accuracy of reports required of the LHIN, pursuant to section 5 of the BPSAA, on the use of consultants; the LHIN s compliance with the prohibition, in section 4 of the BPSAA, on engaging lobbyist services using public funds; the LHIN s compliance with all of its obligations under applicable directives issued by the Management Board of Cabinet; the LHIN s compliance with its obligations under the Memorandum of Understanding with the Ministry of Health and Long-Term Care; and the LHIN s compliance with its obligations under the Ministry LHIN Accountability Agreement in effect, during the Applicable Period. In making this attestation, I have exercised care and diligence that would reasonably be expected of a Chief Executive Officer in these circumstances, including making due inquiries of LHIN staff that have knowledge of these matters.

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40 1. MEMORANDUM OF UNDERSTANDING See Below SCHEDULE A to Attestation For Central Local Health Integration Network For the Applicable Period: 2. MINISTRY LHIN ACCOUNTABILITY AGREEMENT/MINISTRY LHIN PERFORMANCE AGREEMENT See Below 3. COMPLETION AND ACCURACY OF REPORTS REQUIRED PURSUANT TO SECTION 5 OF THE BPSAA NO KNOWN EXCEPTIONS 4. PROHIBITION ON ENGAGING LOBBYIST SERVICES USING PUBLIC FUNDS PURSUANT TO SECTION 4 OF THE BPSAA NO KNOWN EXCEPTIONS 5. COMPLIANCE WITH APPLICABLE DIRECTIVES ISSUED BY MANAGEMENT BOARD OF CABINET a. OPS PROCUREMENT DIRECTIVE b. OPS TRAVEL, MEAL AND HOSPITALITY EXPENSES DIRECTIVE See Below As a consequence of the Transfer Order, all the laws and Ministry and government directives, policies and guidelines that apply to the LHIN will apply to the CCAC business assumed by the LHIN. The LHIN will work with the Ministry to resolve any non-compliance with the various requirements as may be identified, in a manner agreed with the Crown. The LHIN has determined that the terms and conditions on which all fourteen LHINs acquired insurance breach the LHINs obligations under LHSIA, the Financial Administration Act, the MOU and possibly the MLPA. In the context of the introduction of Bill 41, which impacts the LHIN s insurance needs, the LHIN is maintaining the status quo. When appropriate, the LHIN will take such steps as may be agreed with the Crown in regard to this matter. The LHIN has determined that the terms and conditions of its lease breached the LHIN s obligations under the Financial Administration Act. The LHIN is in the process of investigating this matter and taking the steps necessary to resolve any such accidental breach that may have occurred. 3

41 TO: FROM: The Board of Directors, Central Local Health Integration Networks (the LHIN ) Kim Baker Chief Executive Officer ( CEO ) 11 Allstate Parkway, Suite 500 Markham, ON L3R 9T8 Tel: Fax: Toll Free: APPENDIX B REPORTING PERIOD: October 1 December 31, 2017 RE: CEO Certificate of Compliance I have reviewed, or caused to be reviewed, such files, books, records and accounts of the LHIN and have made, or caused to be made, such enquiries of the financial, accounting and other personnel of the LHIN as I have determined necessary for the purposes of this certificate. In my capacity as CEO of the LHIN, and for the reporting period identified above, I hereby certify that to the best of my knowledge and except as set out on Schedule A: 1. Salaries and Benefits. The LHIN has met all of its obligations in respect of the payment of all employee salaries and wages, vacation pay, holiday pay, termination pay, severance pay, bonuses and benefits. The LHIN is in compliance with the provisions of the Public Sector Compensation Restraint to Protect Public Services Act, Statutory Deductions. The LHIN has met all of its obligations in respect of the deduction, withholding and or remittance as the case may be, of funds under the Income Tax Act, (Canada), the Income Tax Act, (Ontario), the Employer Health Tax Act (Ontario), the Employment Insurance Act (Canada), the Canada Pension Plan Act (Canada); and the Retail Sales Tax Act (Ontario). 3. Financial Statements. The financial statements of the LHIN, as at their respective dates of preparation, were accurate and complete in all material respects. 4. Insurance. All insurance policies remained in full force and effect. The LHIN was not in default with respect to any of the provisions contained in any insurance policy and did not fail to give any notice or present any claim under any insurance policy in a timely manner. 5. Compliance. The LHIN conducted its business in compliance with: (i) all applicable laws of the Province of Ontario and Canada;

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43 Schedule A As a consequence of the Transfer Order, all the laws and Ministry and government directives, policies and guidelines that apply to the LHIN will apply to the CCAC business assumed by the LHIN. The LHIN will work with the Ministry to resolve any non-compliance with the various requirements as may be identified, in a manner agreed with the Crown. The LHIN has determined that the terms and conditions on which all fourteen LHINs acquired insurance breach the LHINs obligations under LHSIA, the Financial Administration Act, the MOU and possibly the MLAA. In the context of the introduction of Bill 41, which impacts the LHIN s insurance needs, the LHIN is maintaining the status quo. When appropriate the LHIN will take such steps as may be agreed with the Crown in regard to this matter. The LHIN has determined that the terms and conditions of its lease breached the LHIN s obligations under the Financial Administration Act. The LHIN is in the process of investigating this matter and taking the steps necessary to resolve any such accidental breach that may have occurred. 3

44 11 Allstate Parkway, Suite 500 Markham, ON L3R 9T8 Tel: Fax: Toll Free: ITEM 6.5 CENTRAL LHIN BOARD OF DIRECTORS RESOLUTION TO APPOINT A VICE-CHAIR OF THE BOARD OF DIRECTORS AND BOARD SECRETARY MARCH 27, 2018 PROPOSED RESOLUTION: WHEREAS sections 6.01, 6.03 and 6.07 of By-Law No.1 of the Central LHIN provide that the Board may appoint, from time to time, a Vice-Chair and Board Secretary, and may specify the powers and duties of any such Vice-Chair and Board Secretary; WHEREAS the Chair of the Board placed a call of interest out to the entire Board of Directors for interest; and; WHEREAS candidates were reviewed by the Governance Committee on December 4, 2017, and approved the motion of the one year appointment for the role of Vice Chair and Board Secretary; BE IT RESOLVED THAT: The Central LHIN Board of Directors appoints Mr. Michael MacEachern as Vice-Chair and Mr. Stephen Smith as Board Secretary of the Central LHIN Board of Directors effective March 27, 2018, for the period of one year.

45 11 Allstate Parkway, Suite 500 Markham, ON L3R 9T8 Tel: Toll Free: Fax: CENTRAL LHIN BOARD OF DIRECTORS AUDIT COMMITTEE REPORT MARCH 27, Allstate Parkway, bureau 500 Markham, ON L3R 9T8 Téléphone: Sans frais: Télécopieur: ITEM 6.6 From: David Lai, Chair, Audit Committee The Audit Committee met on Thursday February 22, ITEMS FOR APPROVAL Appointment of Auditor The Audit Committee, with delegation from the Board, has appointed Deloitte LLP as the Central LHIN Auditor for fiscal year 2017/ /18 Audit Service Plan from Deloitte The Audit Services Plan for fiscal year 2017/18 was presented by the Audit Partner from Deloitte. There are no accounting changes that will impact the financial statements this year. However, there is a change in financial reporting standard from Public Sector Accounting Standards to Public Sector Accounting Standards Not for Profit which will change the format of the financial statements. There will be an Interim Audit this year which will take place on March 19, 20, and 21 and will focus on the transition of the Central Community Care Access Centre to the Central LHIN. Fieldwork for the year-end audit will begin the week of May 14. Audit Committee Work Plan The Committee reviewed and approved the 2017/18 and 2018/19 Work Plans. The Work Plans reflect the required Audit Committee duties under the Audit Committee Terms of Reference. The Committee confirms it met its deliverables under the 2016/17 Work Plan. See Appendix A. ITEMS FOR INFORMATION None.

46 Report on fiscal 2016/17 Activities: Appendix A Topic/Item Aug Oct 2016 Feb 2017 Annual Items Annual Review of Terms of Reference Annual Appointment of Members Work Plan Evaluation Appointment of Auditor Review Audit Plan Report from Auditor and Recommend Audited Financial Statements for Approval Annual Review of Policies Review and Recommend Preliminary Operating Budget for Annual Business Plan Submission Review and Recommend Final Operating Budget Review of Agency Establishment and Accountability Directive Risk Report Standing Items Quarterly Compliance Certificate Operating Results Consulting Report (verbal if nil) Review Board Chair Expenses Report on whistleblowing (verbal) Updates to accounting practices Ministry Reports As Needed Updates to legislation, directives, etc. May 2017

47 Work plan for fiscals 2017/18 and 2018/19 ITEM Aug 2017 Nov 2017 Review of Terms of Reference (bi-annually) Work Plan Review Annual Committee Report to Board Appointment of Auditor and Audit Plan Report from Auditor and Recommend Audited Financial Statements for Approval Report from Auditor and Recommend Audited Financial Statements for Approval Stub Period Feb 2018 May 2018 Review of Policies Aug 2018 Review Operating Budget Assumptions Recommend Operating Budget Use of Consultants Report Annual Review Board Chair Expenses Interim Financial Reports Nov 2018 Feb 2019 May 2019 Report on Internal Controls (TOR III.2) Report on Information Systems (TOR 5.a) Report on Privacy and Security (TOR 5.c)

48 11 Allstate Parkway, Suite 500 Markham, ON L3R 9T8 Tel: Toll Free: Fax: ITEM PATIENT SERVICES AND QUALITY COMMITTEE REPORT TO THE CENTRAL LHIN BOARD OF DIRECTORS MARCH 8, 2018 From: Mr. Charles Schade, Chair, Patient Services and Quality Committee Report of the Patient Services and Quality Committee, which met on Wednesday, January 24, The following information was reviewed during the routine business of the open session : Receipt of the Q3 Quality Improvement Plan (QIP) Results Review Draft QIP The members were given the opportunity to provide feedback on the draft QIP Narrative which will be brought forward to the committee for approval and endorsement of Board approval at the March 8th meeting. ITEMS FOR APPROVAL The Home and Community Care Balanced Scorecard was presented to the Committee for approval. The Scorecard reports on measures and targets from the QIP, provincial reports were established and monitored by the legacy CCAC through transition to the Central LHIN. The scorecard will be reviewed quarterly by the Committee. The next meeting of the Patient Services and Quality Committee has been scheduled for March 8, 2018, 9:30 to 11:30 a.m. Please note the Patient Services and Quality Committee materials are posted on the Central LHIN Board Portal should Board members wish to access the materials.

49 11 Allstate Parkway, Suite 500 Markham, ON L3R 9T8 Tel: Toll Free: Fax: PATIENT SERVICES AND QUALITY COMMITTEE REPORT TO THE CENTRAL LHIN BOARD OF DIRECTORS MARCH 27, 2018 ITEM From: Mr. Charles Schade, Chair, Patient Services and Quality Committee Report of the Patient Services and Quality Committee, which met on Thursday, March 8, The following information was reviewed during the routine business of the open session: Q3 Complaints, Compliments and Appeals Report Q3 Events Trending Report Quality Improvement Plan (QIP) Progress Report Status of the Patient Services and Quality Committee Workplan ITEMS FOR APPROVAL 1. QIP Submission The members were provided with an overview of the criteria and target setting approaches used to inform the finalization of the QIP Narrative and Workplan in preparation for the submission to the Board of Directors. The Committee approved the final QIP Narrative and Workplan, which are recommended for consideration at the Board of Directors meeting on March 27. The members approved the motion for the QIP materials to be recommended at the upcoming Board of Directors meeting, for approval and signature Patient Services and Quality Committee Workplan A revised workplan was tabled for consideration by the committee. The members approved the motion to approve the revised committee workplan for fiscal The next meeting of the Patient Services and Quality Committee has been scheduled for Thursday, May 10, 2018, 9:30 to 11:30 a.m. Please also note that the Patient Services and Quality Committee materials are posted on the Central LHIN Board Portal should Board members wish to access the materials.

50 11 Allstate Parkway, Suite 500 Markham, ON L3R 9T8 Tel: Fax: Toll Free: ITEM 6.8 CENTRAL LHIN BOARD OF DIRECTORS RESOLUTION OF BOARD BUSINESS CONDUCTED FROM MARCH 31, MARCH 27, 2018 MARCH 27, 2018 PROPOSED RESOLUTION: WHEREAS all LHIN business conducted by staff and the board was exercised with an understanding of diligence and within the fiduciary responsibilities outlined with By- Law #1 and By- Law #2 and inclusive of requirements related to the Memorandum of Understanding, the Ministry LHIN Performance Agreement, and LHSIA; BE IT RESOLVED THAT: The Central LHIN Board of Directors approves all LHIN business decisions and the decisions made in the course of business conducted from March 31, 2017 to March 27, 2018 inclusive.

51 11 Allstate Parkway, Suite 500 Markham, ON L3R 9T8 Tel: Fax: Toll Free: CENTRAL LHIN BOARD OF DIRECTORS HOSPITAL SERVICE ACCOUNTABILITY AGREEMENTS MARCH 27, 2018 ITEM 8.1 PROPOSED RESOLUTION: WHEREAS the Hospital Service Accountability Agreements for public and private hospitals expire on March 31, 2018; and WHEREAS on November 28, 2017, the Central LHIN Board of Directors approved the process by which 2018/19 Hospital Service Accountability Agreements would be executed and the principles by which performance targets would be established; and WHEREAS Central LHIN hospitals, with the exception of Mackenzie Health and Stevenson Memorial Hospital, have submitted plans for 2018/19 which include funding assumptions, performance and volume targets that are consistent with Central LHIN Board-approved principles; and WHEREAS more time is required to assess and approve deficit waivers, if required, for Mackenzie Health and Stevenson Memorial Hospital; and WHEREAS on March 1, 2018, a new provincial Hospital Service Accountability Agreement template for public hospitals that covers the two year period from April 1, 2018 to March 31, 2020 was approved and adopted for use by all LHINs, with schedules to be completed for the first year (2018/19) only; and WHEREAS the Central LHIN will use the existing private hospital amending agreement to extend the current private hospital service accountability agreement for one-year to March 31, 2019 while the Ministry works through the transition of private hospitals to alternative legislative frameworks in light of the impending repeal of the Private Hospitals Act under Bill 160; BE IT RESOLVED THAT: The Central LHIN Board of Directors a) Approves the 2018/19 funding, volume and performance targets for Central LHIN s public hospitals, as follows, to be included in the Hospital Service Accountability Agreements:

52 North York General Hospital Southlake Regional Health Center Markham Stouffville Hospital Humber River Hospital Total LHIN Funding (Base) $251,622,984 $307,288,234 $181,987,039 $368,932,757 Total Acute Inpatient Weighted Cases 31,855 34,000 19,996 43,024 Day Surgery Weighted Cases 5,187 10,400 3,146 6,334 Complex Continuing Care Weighted Patient Days na 10,620 6,204 na Mental Health Weighted Patient Days 17,119 10,961 13,812 23,706 Inpatient Rehabilitation Weighted Cases na Emergency Visits Weighted Cases 5,584 5,500 4,862 6,677 Ambulatory Care Visits 163, , , ,921 Current Ratio Year End Total Margin 0.00% 0.00% 0.00% 0.00% Percent of P2, 3 and 4 Cases Completed within Access Target for Hip Replacements Percent of P2, 3 and 4 Cases Completed within Access Target for Knee Replacements Percent of P2, 3 and 4 Cases Completed within Access Target for MRI Scans Percent of P2, 3 and 4 Cases Completed within Access Target for CT Scans 90th Percentile Emergency Department Length of Stay for Non-Admitted High Acuity Patients (CTAS I-III) (hours) 90th Percentile Emergency Department Length of Stay for Non-Admitted Low Acuity Patients (CTAS IV-V) (hours) 90% 90% 90% 90% 90% 90% 90% 90% na na na na na na na na Alternate Level of Care (ALC) Rate 16.8% 13.6% 12.7% 14.6% Readmission Rate to Own Facility within 30 Days for Selected HIG Conditions 13.2% 12.4% 12.1% 15.1% Rate of Hospital-Acquired C. Difficile 0.0 (with standard <= 0.14) 0.0 (with standard <= 0.30) 0.0 (with standard <= 0.26) 0.0 (with standard <= 0.14) b) Approves the following LHIN-specific obligations for the 2018/19 year to be included in the Hospital Service Accountability Agreements for Central LHIN s public hospitals: 2018/19 Targets Percent of P2 and 3 Cases Completed within Access Target for MRI Scans Percent of P2 and 3 Cases Completed within Access Target for CT Scans North York General Hospital Southlake Regional Health Center Markham Stouffville Hospital Humber River Hospital 75% 60% 73% 78% 84% 76% 86% 90% 2 c) Approves the extension of the 2017/18 Hospital Service Accountability Amending Agreements for Mackenzie Health and Stevenson Memorial Hospital for a period of six months, to September 30, 2018, to allow sufficient time for the hospital and LHIN to finalize the requirements for a deficit waiver, if required;

53 d) Approves the 2018/19 funding, volume and performance targets for West Park Healthcare Centre, as follows, to be included in the Hospital Service Accountability Agreement: West Park Healthcare Centre LHIN Funding (Base) $1,150,000 Complex Continuing Care Weighted Patient Days 1,576 Number of Admissions to the Transitional Home Ventilation Program 16 Number of discharges to an alternate setting other than acute care 16 Number of avoided Alternate Level of Care (ALC) Days 3,285 Number of consultations that led to avoided acute care admissions 6 e) Approves the extension of the 2017/18 Private Hospital Service Accountability Agreement agreements for Shouldice Hospital and Don Mills Surgical Unit to March 31, 2019; f) Delegates authority to the Central LHIN Chair and CEO to sign the Hospital Service Accountability Agreements for the following public hospitals: North York General Hospital Southlake Regional Health Centre Markham Stouffville Hospital Humber River Hospital West Park Healthcare Centre g) Delegates authority to the Central LHIN Chair and CEO to sign the 2018/19 Private Hospital Service Accountability Extension Agreements for the following private hospitals: Shouldice Hospital Don Mills Surgical Unit. ANALYSIS: 2018/19 Public Hospital Accountability Planning Submissions On November 28, 2017, the Central LHIN Board of Directors approved the process and principles by which Central LHIN would execute the 2018/19 Hospital Service Accountability Agreements ( HSAAs ) with its public and private hospitals. In February 2018, each Central LHIN public hospital submitted a Hospital Accountability Planning Submission ( planning submission ) to Central LHIN. Central LHIN staff has reviewed the planning submissions in the context of the Board approved principles. The funding and volume information contained within the planning submissions will be used to complete the HSAA Schedules that will form a part of the final HSAA; however, these funding and volume targets will only be for one year (2018/19) even though the new HSAA template covers a two-year term ending March 31,

54 The following table summarizes key information included in Central LHIN hospital planning submissions: Hospital North York General Hospital Southlake Regional Health Centre Markham Stouffville Hospital Comments The hospital began implementing its multi-year Ambulatory Transition Plan in 2017 and expects to complete the implementation by the end of fiscal 2018/19. The plan includes the closure of the Urgent Care Centre and Medical Imaging department at the Branson site, along with the move of the Total Joint Assessment Centre from Branson to the main General site. The hospital also completed its review of their outpatient services and does not anticipate any further significant changes from the transition plan. In order to achieve a balanced budget for 2018/19, the hospital identified several initiatives to improve process efficiencies and control costs. Only $200,000 of the initiatives were assessed as being medium risk while the remainder were of low risk. North York General Hospital continues to address their aging and undersized facility through a Master Facilities Plan refresh and with the opening of the new 30 bed unit at the Central LHIN Reactivation Care Centre located at the former Humber River Hospital Finch site, the added capacity will support the hospital with addressing the challenge of Alternate Level of Care (ALC) and emergency department (ED) volumes. The hospital is progressing towards the completion of phase 1 of their new Health Information System (HIS) in the third quarter of 2018/19 in partnership with Markham Stouffville and Stevenson Memorial Hospitals. The new system will enable seamless patient care and information sharing across the hospital sites through the shared platform. In 2018/19, the hospital plans to use long-term financing in order to support the full implementation the new HIS system in conjunction with their goal of improving their working capital. Central LHIN staff will continue to monitor the hospital s financial health. Growth in admitted patient activity from the ED alongside the ALC population will continue to be a challenge for the hospital in 2018/19 as these pressures have forced the hospital to accommodate many patients in non-conventional bed spaces. The addition of the hospital s new 30 bed unit at the Central LHIN Reactivation Care Centre will assist with mitigating some of this pressure on their inpatient bed capacity in 2018/19. The hospital will begin developing a new five year strategic plan and master capital plan in 2018/19 with a focus on growth to meet the needs of their community. The hospital is entering the sixth and final year of their Post-Construction Operating Plan (PCOP) ramp-up and has exceeded planned volumes in a number of clinical programs. In 2018/19, the hospital will be implementing plans to grow in the surgical, mental health, maternal child and oncology programs alongside the expansion of ambulatory clinics to reduce pressures on the ED. The hospital will also be opening its new 24 bed unit at the Central LHIN Reactivation Care Centre near the start of the 2018/19 year which will increase capacity and help address the ALC patient population. The hospital is partnering with Southlake and Stevenson on implementing a new HIS system. 4

55 The hospital is in the process of developing a new strategic plan that will be launched in late 2018 as the hospital plans for the end of their PCOP funding after 2018/19 in light of ongoing inflationary cost pressures and growing community demands. Humber River Hospital The hospital is entering year 4 of the 6-year Post-Construction Operating Plan (PCOP) ramp-up. The hospital has surpassed forecasted volumes in the first several years of PCOP. The significant growth in activity will create pressure on the hospital to operate within its allotted funding envelope. For 2018/19, the hospital has plans to expand clinical programs in the areas of inpatient surgery, critical care and maternal child, as well as outpatient pediatric ambulatory clinic and child/adolescent mental health clinic. The hospital will be undertaking lean initiatives and continuing to implement new technologies to support improved operational efficiencies and outcomes. A key area will be the deployment of the new upgrade for their Meditech hospital information system. Also, the hospital recently launched the first hospital-based Command Centre in Canada and will continue in 2018/19 to fully implement the system which uses real-time data and advanced predictive analytics to support real-time decision making for patient care. In 2018/19, the hospital does not plan to operate the third MRI that was approved and installed as part of the functional plan for their new hospital because they have not received base operational funding for the MRI. The LHIN will continue to support the hospital as they seek operational funding from the Ministry of Health and Long-Term Care. Financial and Service Volume Targets Central LHIN and hospital management have discussed the planning submissions and have come to agreement on the recommended 2018/19 financial and service volume targets. Historical and HBAM expected volumes and funding, and PCOP were the major drivers taken into account when setting targets. The proposed targets have been set in a manner that is reasonable based on each hospital s individual circumstances. The proposed targets for Current Ratio and Total Margin have been set in accordance with the provincial standard, being 0.80 for Current Ratio and 0.00% for Total Margin. The only exception is for Southlake which will have their Current Ratio target set at 0.72 in alignment with the hospital s Working Capital Improvement Plan. Performance Targets Central LHIN and hospital management have come to agreement on the recommended 2018/19 performance targets as follows: 5 Hip and Knee Replacement Surgery Wait Times: Targets support the achievement of the Central LHIN s anticipated Ministry-LHIN Accountability Agreement (MLAA) target. CT and MRI Wait Times: Targets support improved performance.

56 Emergency Department Length of Stay for Non-Admitted High Acuity and Low Acuity Patients: Targets support achievement of provincial performance targets. Alternate Level of Care (ALC) Rate: Targets support improved performance. Readmissions to Own Facility within 30 days: Targets support improved performance. Rate of Hospital-Acquired Clostridium (C.) Difficile Infections: Targets and performance corridors were set in accordance with the provincial guidelines. Targets are set at 0 and corridors are set for achievable performance based on current and historic performance. A comparison of 2018/19 targets and historical performance for North York General Hospital and Southlake Regional Health Centre is summarized in the following table: Southlake Regional Health North York General Hospital Center Funding and Volume Targets 2 YR 2018/19 2 YR 2018/19 Average Target Average Target Total LHIN Funding (Base) $245,084,390 $251,622,984 $290,865,697 $307,288,234 Total Acute Inpatient Weighted Cases 30,802 31,855 31,222 34,000 Day Surgery Weighted Cases 5,381 5,187 9,656 10,400 Complex Continuing Care Weighted Patient Days na na 12,939 10,620 Mental Health Weighted Patient Days 17,017 17,119 12,107 10,961 Inpatient Rehabilitation Weighted Cases na na Emergency Visits Weighted Cases 5,871 5,584 5,302 5,500 Ambulatory Care Visits 168, , , ,090 Current Ratio Year End Total Margin 1.03% 0.00% 3.72% 0.00% Performance Targets 2 YR Average 2018/19 Target 2 YR Average 2018/19 Target Percent of P2, 3 and 4 Cases Completed within Access Target for Hip Replacements 100% 90% 97% 90% Percent of P2, 3 and 4 Cases Completed within Access Target for Knee Replacements 100% 90% 99% 90% Percent of P2 and 3 Cases Completed within Access Target for MRI Scans 72% 75% 58% 60% Percent of P2 and 3 Cases Completed within Access Target for CT Scans 82% 84% 72% 76% 90th Percentile Emergency Department Length for Non-Admitted High Acuity Patients (CTAS I-III) th Percentile Emergency Department Length for Non-Admitted Low Acuity Patients (CTAS IV-V) Alternate Level of Care (ALC) Rate 19.16% 16.80% 15.31% 13.60% Readmission Rate to Own Facility within 30 Days for Selected HIG Conditions 13.30% 13.17% 12.42% 12.42% Rate of Hospital-Acquired C. Difficile

57 A comparison of 2018/19 targets and historical performance for Markham Stouffville Hospital and Humber River Hospital is summarized in the following table: Funding and Volume Targets Markham Stouffville Hospital Humber River Hospital 2 YR Average 2018/19 Target 2 YR Average 2018/19 Target Total LHIN Funding (Base) $168,807,104 $181,987,039 $342,995,264 $368,932,757 Total Acute Inpatient Weighted Cases 18,049 19,996 37,411 43,024 Day Surgery Weighted Cases 2,673 3,146 5,487 6,334 Complex Continuing Care Weighted Patient Days 3,282 6,204 na na Mental Health Weighted Patient Days 12,482 13,812 20,326 23,706 Inpatient Rehabilitation Weighted Cases Emergency Visits Weighted Cases 4,349 4,862 6,207 6,677 Ambulatory Care Visits 109, , , ,921 Current Ratio Year End Total Margin 4.27% 0.00% 1.43% 0.00% Performance Targets 2 YR 2018/19 2 YR 2018/19 Average Target Average Target Percent of P2, 3 and 4 Cases Completed within Access Target for Hip Replacements 92% 90% 99% 90% Percent of P2, 3 and 4 Cases Completed within Access Target for Knee Replacements 92% 90% 96% 90% Percent of P2 and 3 Cases Completed within Access Target for MRI Scans 69% 73% 78% 78% Percent of P2 and 3 Cases Completed within Access Target for CT Scans 86% 86% 88% 90% 90th Percentile Emergency Department Length for Non-Admitted High Acuity Patients (CTAS I-III) th Percentile Emergency Department Length for Non-Admitted Low Acuity Patients (CTAS IV-V) Alternate Level of Care (ALC) Rate 14.95% 12.70% 15.36% 14.60% Readmission Rate to Own Facility within 30 Days for Selected HIG Conditions 12.26% 12.14% 15.29% 15.14% Rate of Hospital-Acquired C. Difficile Mackenzie Health and Stevenson Memorial Hospital Mackenzie Health and Stevenson Memorial planning submissions include deficit budgets. Public hospitals requesting approval of deficit budgets require LHINs to issue a balanced budget waiver in accordance with Ministry processes. The process includes a risk-based approach to determine the level of Ministry involvement which ranges from notifying the Ministry of a waiver to requiring Ministry review and approval prior to issuing a waiver. Therefore, Central LHIN staff recommends the existing HSAAs with Mackenzie Health and Stevenson Memorial Hospital to be extended to September 30, 2018 to allow the LHIN, hospital and Ministry to work through the process. 7

58 West Park Healthcare Centre Central LHIN funds West Park Healthcare Centre for a Transitional Home Ventilation Program only. The amount of funding is not expected to change for 2018/19. As such, targets for West Park are consistent with 2017/18 with the exception of a decrease in the number of admissions and discharges related to this program. West Park is now caring for a more complex patient population in the Transitional Home Ventilation Program and therefore patients are having longer lengths of stay. The longer stays are required to ensure patients are properly transitioned to the community with appropriate supports in place in the community. However, this causes a reduced ability to turn over the beds as quickly as in the past resulting in fewer admissions over the course of the year. The proposed targets for the volume of admissions and discharges are reasonable based on the current patient population served by the hospital. 2018/19 Private Hospital Accountability Planning Submissions The Ministry of Health and Long-Term Care is working with private hospitals across Ontario to support the transition of the hospitals to alternative legislative frameworks in light of the impending repeal of the Private Hospitals Act under Bill 160. In addition, a new Private Hospital Service Accountability Agreement ( PHSAA ) has not been developed in time for April 1, Therefore, staff are recommending that the existing agreements with the private hospitals be extended to March 31, The following table summarizes the funding and targets for 2017/18 which will be extended into 2018/19: Shouldice Hospital Don Mills Surgical Unit LHIN Funding (Base) $ 6,945,600 $ 1,316,500 Surgical Cases 6,480 na Occupancy % 70% na Acute Patient Days 24,000 na OHIP-Covered Day Surgery Cases na 1,250 Current Ratio The following LHIN-specific obligations in the 2017/18 PHSAA agreement, as required by the ministry, will be extended into 2018/19: Shouldice Hospital: Quality - The Private Hospital shall adhere to best practices related to infection control and patient safety. Funding Surpluses: 1) Any surplus arising from the operations relating to the Private Hospital fulfilling its obligations under this agreement belongs to the Private Hospital as long as the contracted volumes within the agreed to corridors are met. A recovery of funds may arise if these volumes are not completed. 2) The Private Hospital is exempted from clause 5.7 of the Agreement (Contribution to Profit). Don Mills Surgical Unit: Quality - The Private Hospital shall adhere to best practices related to infection control and patient safety. 8

59 BACKGROUND: On November 28, 2017, the Central LHIN Board of Directors approved the process and principles by which Central LHIN would execute the 2018/19 HSAAs with its public and private hospitals. As per this process, all Central LHIN hospitals submitted a planning submission to Central LHIN in February Funding assumptions, performance and volume targets were submitted based on information available at the time when the plans were developed. The hospital plans were reviewed by Central LHIN staff. Central LHIN hospitals with the exception of Mackenzie Health and Stevenson Memorial Hospital, submitted plans in line with the Board approved principles for target setting. During this year s planning cycle for the 2018/19 HSAA, it was assumed that the current HSAA would be extended for another year as negotiations for a new HSAA template agreement were still in process between the LHINs and the Ontario Hospital Association. In late January 2018, all LHINs were notified that a new HSAA template agreement, covering a two-year term from April 1, 2018 to March 31, 2020, was negotiated and endorsed by the Provincial HSAA Steering Committee. Before the new template can be used provincially, it requires approval from more than two-thirds of the 14 LHINs. Notification was received on March 1, 2018 that pan-lhin approval was obtained. NEXT STEPS: Upon Central LHIN Board approval, Central LHIN staff will duly execute the new HSAAs for the applicable public hospitals, the 2018/19 HSAA extensions for Mackenzie Health and Stevenson Memorial Hospital, and the 2018/19 PHSAA extensions for the private hospitals. 9

60 11 Allstate Parkway, Suite 500 Markham, ON L3R 9T8 Tel: Toll Free: Fax: CENTRAL LHIN BOARD OF DIRECTORS QUALITY IMPROVEMENT PLAN SUBMISSION MARCH 27, 2018 ITEM 8.2 PROPOSED RESOLUTION: WHEREAS the Central LHIN has prepared the Quality Improvement Plan Narrative as part of the Heath Quality Ontario submission along with the Quality Improvement Workplan; and WHEREAS the Central LHIN has prepared the Quality Improvement Plan Narrative to provide context and set the stage for the commitments made in the Quality Improvement Workplan; and WHEREAS the Quality Improvement Workplan provides detailed information on indicators, targets, and change ideas for , for submission to Health Quality Ontario; and WHEREAS the Central LHIN Patient Services & Quality Committee, have reviewed, and make recommendation to the Board; BE IT RESOLVED THAT: The Central LHIN Board of Directors approve the Central LHIN s Quality Improvement Plan to be executed by the Chair, CEO, and Committee Chair and staff to upload in the Health Quality Ontario portal and post on the Central LHIN website. PURPOSE: To provide the board with an overview of the criteria and target setting approaches used to inform the development of the Central LHIN s Quality Improvement Plan proposed for submission to Health Quality Ontario. ANALYSIS:

61 The Health Quality Ontario 2018 Quality Improvement Plan Development Guidelines outline best practices for Quality Improvement Plan development as well as criteria for indicator selection and approaches to target setting. In addition to the best practices provided input was incorporated from Central LHIN staff, the Patient and Family Advisory Committee and the Patient Services and Quality Committee of the Board. The Patient Family Advisory Committee expressed support for the inclusion of indicators that focused on experience, timeliness of services, and prevention of falls. The committee also supported striving for the best possible targets. The Patient Service and Quality Committee members supported: A limit of 5-6 indicators/areas of improvement Moving indicators to the balanced scorecard where improvement has reached target or where timely data for monitoring and maintenance of performance A focus on indicators where improvement is recognized as important/significant and where evidence/standards are available for implementation The criteria used for indicator inclusion/selection: Identified as a priority area for improvement considering: o alignment with mandate/integrated Health Services Plan/provincial directions o impacts a significant/large population o existence of quality standards to aid in implementation of evidence informed practice Current performance needs improvement Availability of data collection Internal capacity to support quality improvement work, implement change ideas, and sustain improvements Health Quality Ontario mandatory indicators must be included Target setting approaches considered included: Theoretical best Best Achieved elsewhere 90th Percentile amongst peers Match rate of improvement achieved by others Provincial average Overall development considerations for the Quality Improvement Plan included: Focus on not more than 5-7 indicators/areas for improvement Incorporation of Patient Family Advisory Committee engagement Inclusion of at minimum three of six quality dimensions including patient experience 2

62 CURRENT STATUS: The proposed Home and Community Care Quality Improvement Plan has seven indicators/areas of improvement. Two of the indicators do not have targets and will be focused on standardizing data collection and reporting as well as setting a performance baseline. One of the indicators will also involve implementing Health Quality Ontario quality standards for healing diabetic heal ulcers. Areas of improvement will impact four dimensions of quality including: safety, timeliness, effectiveness, and patient experience. Patient Family Advisory Committee feedback was incorporated in the selection of indicators. BACKGROUND: On April 1 st, the Central LHIN is required to submit its Quality Improvement Plan (Narrative, Appendix A and Workplan, Appendix B) to Health Quality Ontario and post publicly on its external website. The Quality Improvement Plan Narrative provides an overview of the purpose of the QIP, achievements over the past year, patient and staff engagement, collaboration and integration, population health and equity, alternate level of care initiatives, opioid strategy, and work place violence prevention. The Quality Improvement Work Plan is focused on specific areas of improvement/indicators, targets, and change ideas. It provides a road map for the quality improvement work for the year ahead. NEXT STEPS: Following Board approval, the Board Chair and Patient Services and Quality Committee Chair will sign the Quality Improvement Plan Narrative. The Central LHIN staff will submit the Quality Improvement Plan via the Health Quality Ontario portal and post on the Central LHIN s external website for April 1 st,

63 2018/19 Quality Improvement Work Plan for Home and Community Care "Improvement Targets and Initiatives" Central Local Health Integration Network APPENDIX B AIM Measure Change Quality dimension Issue Measure/Indicator Unit / Population Source / Period Current performance Target Target justification Effective Wound care 1. Percentage of % / Home Local data N/A Collecting To establish a patients diagnosed with Care Clients a healable diabetic foot ulcer, whose ulcer closed within 12 weeks. collection / Most recent 12 month period Baseline Data standardized process for data capture and reporting. Planned improvement initiatives (Change Ideas) 1) Develop a tracking mechanism to establish data collection and reporting for patients diagnosed with a healable diabetic foot ulcer. 2) Implement Health Quality Ontario's Diabetic Foot Ulcer Quality Standards. Methods 1) Work with stakeholders to develop an automated system to capture the required information to establish the baseline data. 2) In collaboration with Service Provider Organizations (SPOs), review and implement applicable Diabetic Foot Ulcer Quality Standards. Process measures 1) The percentage of tracking measure implemented. 2) The percentage of recommendations implemented. Target for process measure Comments 1) 100% 2) 100% Patient-centred Person experience 2. Percentage of home care clients who responded "Good", "Very Good", or "Excellent" on a fivepoint 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 3. Percentage of complaints acknowledged to the individual who made a complaint within two business days. % / Home Care Clients % / Home Care Clients HSSO CCEE Survey / April March 2017 Local data collection / most recent 12 month period 90.5% 92.2% To achieve provincial average. The 1) Focused customer service education with service provider staff. approach is incremental improvement taking into account the average rate of improvement across the province is 0.4%. N/A Collecting Baseline Data To establish a standardized process to capture data and reporting. 1) Develop a tracking mechanism to establish data capture and reporting. 1) Implement "Changing the Conversation" program with our Personal Support Worker (PSW) service providers by the end of Q2. 1a) Complete a Value Stream Analysis to understand the current state process and to develop and implement a future state by the end of Q2. 1b) Review data from the implemented future state, identify where gaps exist in process and test one change idea by the end of Q3. 1) Percentage of Personal Support Worker (PSW) SPOs that completed the program. 1a) Percentage of the future state implemented. 1b) The number of change ideas tested. 1) 100% 1a) 100% 1b) 1

64 AIM Measure Change Quality dimension Issue Measure/Indicator Unit / Population Source / Period Current performance Target Target justification Planned improvement initiatives (Change Ideas) Methods Process measures Target for process measure Comments Palliative care 4. Percent palliative/end of life patients who died in their preferred place of death. % / Patients deemed palliative or end of life HSSO CHRIS / October September % 81.07% To achieve the 90th percentile among peers. 1) Enhance the monitoring system to analyze the data and to identify opportunities for improvement. 2) Education of staff regarding importance of measure and how to accurately capture in our health records system. 3) Improve communication across care team focusing on patient s needs. 1) Work in collaboration with stakeholders to refine the process that will enable the timely and accurate analysis of data. This data will then generate change ideas to test. 2) Create a webinar that will be taken by all staff. 3) Launch communication huddles across our sub-regions that will include the dedicated palliative care teams by the end of Q1. 1) The number of change ideas tested. 2) The percentage of staff who completed the webinar. 3) The percentage of huddles launched. 1) 2 2) 95% 3) 100% Safe Safe care 5. Percentage of adult long-stay 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 HSSO HCD / October September % 31.4% To achieve provincial top performance. 1) Enhance communication regarding falls among members of the patients' health care team. 2) Pilot a draft process flow for medication reconciliation related to falls. 1) Develop and pilot tools to enhance communication regarding falls among members of the patients' health care team. 2) Educate all Rapid Response Nurses on tools and processes developed for the medication reconciliation pilot. 1) The number of tools piloted with Care Coordinators and Service Providers (e.g. specific falls section on service providers' reports). 2) Percentage of Rapid Response Nurses participating in the pilot. 1) 2 tools piloted 2) 100% of RRNs participated in the pilot Timely Timely access to care/services 6. 5-day wait time for % / Home home care: Personal Care Clients support for complex patients - % of complex home care patients who received their first personal support service visit within five days of the patient available date (PAD). HSSO CHRIS, HSSO HCD / October 2016 September % 95% To achieve the provincial target. 1)Sustain the improvements from the previous year through continued collaboration with stakeholders. Improvement areas include various data quality enhancements and service offer accuracy. 1) The team will collaborate with stakeholders to sustain positive performance by continuing to refine the standardized monitoring process. 2) Develop change ideas to be tested through PDSAs with SPOs that are not meeting the 5 day Complex PSW wait target. 1a) The percentage of stakeholders meeting the target. 1b) Complete a 100% review of all patients who did not receive service within 5 days and identify the root cause for the miss 2) #The number of change ideas tested. 1a) 90% of Stakeholders are meeting target on quarterly basis 1b) Audit completed for 100% of misses 2) 2

65 AIM Measure Change Quality dimension Issue Measure/Indicator Unit / Population Source / Period Current performance Target Target justification Planned improvement initiatives (Change Ideas) Methods Process measures Target for process measure Comments 7. 90th percentile wait time from community for home care services: application from community setting to first home care service (excluding case management). % / Home Care Clients HSSO CHRIS, HSSO HCD / April 2017 December Days 21 days To achieve the provincial target. 1)Sustain the improvements from the previous year by enhancing collaboration with stakeholders. Improvement areas include the reduction of pending referrals and intake and referral process enhancements. 1a) The team will collaborate with stakeholders to sustain positive performance by refining and operationalizing the standardized monitoring process. 1b) If target not met, develop change ideas to be tested through Plan Do Study and Act cycles (PDSAs) with stakeholders. 1a) Continue to monitor performance on a weekly basis. 1b) Investigate all negative special cause variation to identify root cause. Develop change ideas where root cause identifies improvements are not being sustained. 1a) Performance reviewed 100% of the weeks 1b) Root cause identified for 100% of special cause variation

66 Central LHIN Board of Directors CEO REPORT March 27, 2018

67 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.

68 Central LHIN CEO Report - Items for Information Contents CEO Highlights CEO Highlights... 1 Business Arising Business Arising... 1 Performance, Contracts and Allocation Long-Term Care Home Service Accountability Agreement Amending Agreement and Schedules Refresh Short-Stay Respite Beds LTC Case Mix Index (CMI) Results /19 Opening Cash Allocations Appendix A Funding Allocation Delegated Authority March 2018 Appendix B... 2 Health System Planning & Engagement Roadmap for the Central LHIN Integrated Health Services Plan ( ) French Language Services Update: Markham Designation Interprofessional Primary Care Expansion 2017/18 Funding (Phase 1) Improving Access to Structured Psychotherapy Demonstration Project... 4 Home & Community Care Ontario s Special Needs Strategy for Children - Transition of Rehabilitation Services in Publicly Funded Schools Helping More Seniors Through Assisted Living Investment Sub-region Alignment of Care Coordination Teams Call for Applications of New Long-Term Care Beds... 6

69 Central LHIN CEO Report - Items for Information CEO Highlights 9.0 CEO Highlights A verbal report will be provided on the following: Ministry-LHIN Accountability Agreement Annual Business Plan New Minister of Health and Long-Term Care, Helena Jaczek March 7 MPP Briefing Breakfast Ongoing meetings with MPPs Update on Office Move Taking on Primary Care Role LHIN CEO Co-Lead Business Arising 9.1 Business Arising No business arising items noted in follow up to the January 30, 2018 Board meeting. Performance, Contracts and Allocation Long-Term Care Home Service Accountability Agreement Amending Agreement and Schedules Refresh The LHIN and Long-Term Care Homes will be entering into the third year of the current Long-Term Care Home Service Accountability Agreement (L-SAA) on April 1, Central LHIN staff conducted an education session that was shared on-line with the long-term care home sector to prepare health service providers for the upcoming L-SAA Amendment and Schedule refresh. In December, Health Shared Services Ontario (HSSO) provided the LHINs with the LSAA Amending Agreement and Schedule Template (Amending Template). The Amending Template has been updated to align with the legislative changes arising from the Patients First Act, This template is to be consistent across the LHINs and as such was approved for use by the required majority of LHINs including the Central LHIN CEO, meaning the Amending Template is ready for execution. In the month of April 2018, the L-SAA Amending Agreement and refreshed Schedules will be distributed to each respective long-term care health service provider for their Board approval. No changes have been made to Schedule D- Performance Indicators: total margin and debt service coverage ratio. Other schedules have been updated with new fiscal year dates or any informational changes that have occurred during the year. It is expected that all health service provider Board approved L-SAA Amending Agreements will be received by the LHIN in April for final execution by Central LHIN Board Chair and CEO. Central LHIN Board of Directors Page 1 CEO Report March 27, 2018

70 Central LHIN CEO Report - Items for Information Short-Stay Respite Beds On January 5, 2018 the Central LHIN approved the continued operation of 30 short-stay respite beds allocated across 17 Long-Term Care Homes for the 2018 calendar year. All beds from 2017 will continue to be funded from January 1, 2018 to December 31, 2018, with the exception of 1 bed from Bloomington Cove Care Community as this home is under redevelopment. These beds will be funded from May 1, 2018 to December 31, LTC Case Mix Index (CMI) Results The Ministry released the 2018/19 provincial CMI Results package on January 19, The Long-Term Care Homes funding formula is based on a fixed per-diem rate, adjusted for occupancy and case-mix index, which are indicators of resource intensity. Consistent with prior years, there is a funding floor mechanism in the formula to ensure stability in the sector. Reductions resulting from application of the formula are capped at 5% of the Nursing and Personal Care funding envelope. The range of CMI changes in Central LHIN spanned from an increase of 7.5% to a decrease of 4.9%, with an average change of a 0.5% increase. All Central LHIN Long-Term Care Homes have received their home-specific CMI letters, 2018/19 CMI results, funding calculators and a Frequently Asked Questions (FAQ) document /19 Opening Cash Allocations Appendix A Consistent with previous years, the LHIN has received direction from the Financial Management Branch of the Ministry to roll-over prior year base funding to 2018/19. 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, 2018 and are in Appendix A for information. 9.6 Funding Allocation Delegated Authority March 2018 Appendix B A list of funding delegations approved by Central LHIN staff since the January 30, 2018 Board of Directors meeting, is attached in Appendix B. Health System Planning & Engagement 9.7 Roadmap for the Central LHIN Integrated Health Services Plan ( ) Each LHIN is to develop an Integrated Health Services Plan (IHSP) by the fall of It will be the fifth iteration of this document since the inception of LHINs that details both strategic priorities and actions for improvement in the health care system for the 3-year period starting in April The IHSP builds from the foundational work and plans established in previous IHSPs that have defined local health care needs, identified strategic system integrations and prioritized opportunities to improve care. The plan will build from existing work and align with provincial priorities of the Ministry of Health and Long-Term Care (MOHLTC) as described in Patients First: Action Plan for Health Care (February 2015) and the Minister s mandate letter. Central LHIN Board of Directors Page 2 CEO Report March 27, 2018

71 Central LHIN CEO Report - Items for Information Provincial consistency, efficiency and collaboration among LHINs plays a key role in IHSP development that for example, will include the creation of a refreshed Environmental Scan led by Health Shared Service Ontario (HSSO) in partnership with all 14 LHINs across the province. A slide deck has been appended (Appendix C) indicating preliminary timelines and approach. Each LHIN will target to submit a draft of its IHSP to the MOHLTC on or before October 31, 2018 for comment. The MOHLTC will review the draft IHSP and provide feedback where appropriate, within four (4) weeks. Each LHIN will publicly release its Board approved IHSP in both English and French by February 1, French Language Services Update: Markham Designation On June 30, 2015, the Ontario Government announced the City of Markham s designation under the French Language Services Act (FLSA), effective July 1, At this time, all government ministries and agencies located in Markham including the Central LHIN will be required to offer French-language services equivalent to services provided in English. Central LHIN has been participating in a Provincial Implementation Committee co-led by the Ministry of Francophone Affairs and the Association of Francophones of York Region (AFRY) to support the Markham Designation. In preparation for the Markham Designation, Central LHIN has established a working group responsible for leading the readiness of Central LHIN to be compliant with designation requirements. In addition to internal readiness, the working group, in partnership with the Entité, will also be delivering education sessions to health service providers that focus on the promotion and application of the "Active Offer process for French language services. "Active Offer" is a concept developed by the Ministry of Francophones Affairs to ensure that French language services are clearly visible, readily available, easily accessible, publicized, and that the quality of these services is equivalent to that of services offered in English. 9.9 Interprofessional Primary Care Expansion 2017/18 Funding (Phase 1) The Ontario Budget 2017 includes a base funding commitment of $15.5M in 2017/18 (Phase 1) and an additional $27.8M in 2018/19 (Phase 2), to support the expansion of Inter-professional Care Teams (IPCT). This inter-professional approach to primary care has been shown to result in improvements in patient experience, population based care, timely access to care and chronic disease management. Initial funding consideration ($15.5M) in 2017/18 (Phase 1) targets LHIN sub-regions that currently do not have inter-professional care teams, or have low rates of access to team-based primary care. Central LHIN was one of eight LHINs targeted in Phase 1, with four sub-regions identified as priority: North York West, North York Central, Northern York Region and Western York Region. On November 10 th, the Central LHIN in collaboration with our Community Health Centre (CHC) partners submitted business cases with a strategy aimed at increasing capacity and developing access to their inter-professional teams for solo practitioners based on the Solo-Practitioners in Need (SPiN) or People in Need of Teams (PINOT) model of care. The Ministry has approved funding for IPCT expansion for all four of the identified sub regions: Northern York Region: New IPCT satellite site for Vaughan CHC located in Keswick, Ontario Central LHIN Board of Directors Page 3 CEO Report March 27, 2018

72 Central LHIN CEO Report - Items for Information Western York Region: North York Central: North York West: Expansion of existing IPCT at Vaughan CHC New IPCT satellite site for Black Creek CHC located within Unison Community and Health Services, Bathurst-Finch Hub Expansion of existing IPCT at Black Creek CHC Central LHIN will be working with Black Creek CHC and Vaughan CHC to ensure that IPCT program design and strategies are aligned and standardized across the sub regions Improving Access to Structured Psychotherapy Demonstration Project In November 2014, the province released the second phase of Ontario s Mental Health and Addictions Strategy, which included investments to improve access and reduce wait times for critical services in mental health care. In November 2016, the four provincial Mental Health Specialty Hospitals submitted a discussion paper to the Ministry of Health suggesting the Ontario government take the lead in providing a solution that would increase and standardize access to Cognitive Behavioural Therapy. In the first year (June 2017 March 2018) the focus of the project was to serve adults 18+ with mild and moderate depression and anxiety within the Ontario Shores service areas (Central East LHIN and Central LHIN) for two years. In year one clinicians were embedded in primary care health teams to integrate therapy service with primary health care services (7 clinicians in Central East LHIN and three in Central LHIN). As of January 31, 2018 approximately 133 patients were receiving service, with another 144 waiting. In February 2018, the ministry confirmed Phase Two of the project which included funding for 23 additional clinicians over a two year period. Ontario Shores is working with both Central and Central East LHIN to establish and expand clinical support into community agencies. Central LHIN is anticipated to receive 12 clinicians, with a projected launch date of April/May Central LHIN has decided to engage sub-region tables to identify future sites in alignment with priority needs, service demand and wait lists. Home & Community Care 9.11 Ontario s Special Needs Strategy for Children - Transition of Rehabilitation Services in Publicly Funded Schools A key initiative of Ontario s Special Needs Strategy for Children (SNS) is the integrated delivery of rehabilitation services, including Physiotherapy (PT), Occupational Therapy (OT) and Speech Language Pathology (SLP) services for children and youth from birth to school exit. In September 2017, the Ministry of Health and Long-Term Care (MOHLTC) and the Ministry of Children and Youth Services (MCYS) announced that LHINs contracts or portions thereof, for OT, PT and SLP services in publicly-funded schools will transition to the Children s Treatment Centres (CTCs). In the Central LHIN, these services will transition to the Children s Treatment Network of Simcoe York (CTN). The Central LHIN will continue to provide nursing services for this population as well Central LHIN Board of Directors Page 4 CEO Report March 27, 2018

73 Central LHIN CEO Report - Items for Information as nursing, personal support and rehab services for in-home, private school and home schooled children. In preparation for the transition of services to CTN, the Central LHIN established an internal crossfunctional working group in October 2017 to guide the transition. As well, to ensure consistency across the province, a pan-lhin working group, led by Health Shared Services Ontario (HSSOntario), came together to collaborate on a number of key activities, including: Secure transfer of health records to CTN Standardized provincial templates for Data Sharing Agreement, Non-Disclosure Agreement, etc. Development of Communications Plan, including provincial key messages The MOHLTC has proposed an amendment to Ontario Regulation , the Provision of Community Services, under the Home Care and Community Services Act, 1994 to facilitate this transition. The proposed amendment, which specifies eligibility for services in public, private and home schools, is posted on the government s online Regulatory Registry for public comments until March 19, The transition of rehabilitation services is scheduled to take place between April and August Helping More Seniors Through Assisted Living Investment The Central LHIN-funded Assisted Living (AL) Service for High Risk Seniors delivers personal support services within a supportive housing building or specific geographic boundary through community support service (CSS) agencies, to better meet the needs of seniors and help them remain living safely in their home. In July 2017, the Central LHIN distributed a service expansion Request for Proposal. Total funding of $750,000 for the fiscal year was allocated to Lumacare and Circle of Care. This enabled an additional 35 enhanced spots at each agency, providing up to 14 hours service per week. Fully implemented as of January 31, 2018, this investment reduced the waitlist by 70 patients and enabled the Central LHIN Home and Community Care to reallocate 455 hours per week of personal support services to other patients. Each year, the Ministry of Health and Long Term Care has increased Central LHIN s funding, enabling more patients to access the Assisted Living program and empowering patients and families to continue living in their own homes. This has also helped build the LHIN s capacity to deliver inhome care and delay the need to transition to long-term care, which can be difficult for patients and families Sub-region Alignment of Care Coordination Teams Consistent with the goals of Patients First, to increase timely access to care and enable better care experiences for patients and their families, the Central LHIN continues to leverage its six subregions to support population health based decision making, and planning through the eyes of the patient. In February, via an electronic process called digimapping, the majority of the existing community care coordination teams were aligned with the six Central LHIN sub-regions, allowing for a rebalance and equalization of caseload sizes. The ongoing growth in referral volumes to the Central LHIN, coupled with increased patient complexity, requires more frequent contact and intervention Central LHIN Board of Directors Page 5 CEO Report March 27, 2018

74 Central LHIN CEO Report - Items for Information by community care coordinators. The new caseloads maximize care coordinator availability to patients supporting timely assessment, communication and access to appropriate care. A guiding principle of the digimapping process is to minimize disruption to patients. Through this realignment of caseloads, working with patients, familieis, our primary care and community partners at the local level, Central LHIN care coordinators can now better meet the unique needs of these patients and their families, help them navigate the health care system and ensure they have access to the care they need, when and where they need it Call for Applications of New Long-Term Care Beds Building on the strategies outlined in Aging with Confidence: Ontario s Action Plan for Seniors (2017), the government has issued a Call for Applications for 5,000 new long-term care (LTC) beds to reduce wait times for individuals in crisis and those waiting in hospital for discharge to long-term care homes. The Call for Applications supports the Patients First objective of community driven local health system planning and the Enhanced LTC Home Renewal Strategy Objective of incenting LTC bed redevelopment. The new beds, set to be online by 2022, will prioritize capacity serving culturally specific needs, francophone and Indigenous populations. With demand for LTC beds in Central LHIN region greater than the supply, the Central LHIN is playing an active role in this process. We have engaged with Central LHIN LTC operators to help them better understand existing LTC pressures in the Central region and at the sub-region level and to support them in demonstrating the need for new beds to build much-needed capacity in our LHIN. The Central LHIN has 12% (127,000) of Ontario s seniors 75+ (the highest in province). At the same time, the Central LHIN has the second lowest LTC bed supply per 1,000 population of seniors 75+. This has resulted in a high number of people waiting for a long-term care bed: 4,449 people waiting for one of a total 7,249 beds. At the sub-region level, the highest demand areas in the Central LHIN are Eastern York Region (801 people on the wait list for one of the 1,016 total LTC beds in that sub-region) and Western York Region (969 people on the wait list for one of the 1,348 total LTC beds in that sub-region). Applications deadline to the Ministry of Health and Long-Term Care was March 2. From March 5 to 9, Central LHIN evaluated submissions for our LHIN, prioritizing them based on how well they respond to local needs. Feedback was sent to the Ministry on March 9. Aging with Confidence was developed jointly by the Ministry of Health and Long-Term Care and the new Ministry for Seniors. It builds on previous government strategies and successes to enhance services and supports for Ontario s seniors. Central LHIN Board of Directors Page 6 CEO Report March 27, 2018

75 Appendix A 2018/19 Opening Cash Allocations Acquired Brain Injury Services Organization/Program Name 2018/19 Opening Cash Allocation March of Dimes Canada - York 2,786,244 CHIRS 7,233,452 York Central Hospital - Adult Day Program 444,388 COTA Health 737,945 11,202,029 Assisted Living Services in Supportive Housing Organization/Program Name 2018/19 Opening Cash Allocation Carefirst Senior and Community Services Association (Central LHIN) 1,917,044 Etobicoke Service for Seniors 1,286,159 Community Home Assistance to Seniors (CHATS) 6,314,353 Circle of Home Care Services (Toronto) 4,000,589 St. Demetrius Supportive Care Services 740,423 Yee Hong Centre - Markham 589,251 Villa Colombo 1,472,416 PACE Independent Living 5,434,307 Lumacare Services 2,221,698 March of Dimes Canada - York 4,198,205 City of Toronto Cummer Lodge 530,378 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 1,300,529 36,622,690 Attendant Outreach Organization/Program Name 2018/19 Opening Cash Allocation PACE Independent Living 3,393,319 March of Dimes Canada - York 2,600,037 Cerebral Palsy Parent Council of Toronto (Participation House) 1,380 Access Independent Living Services 1,370,824 7,365,560

76 Community Support Services Organization/Program Name 2018/19 Opening Cash Allocation Carefirst Senior and Community Services Association (Central LHIN) 997,022 Etobicoke Service for Seniors 1,951,657 Community Home Assistance to Seniors (CHATS) 8,268,621 Circle of Home Care Services (Toronto) 4,972,588 Yee Hong Centre - Markham 1,412,635 Aphasia Institute 913,612 Villa Colombo 311,028 CMHA York Region 176,944 Alzheimer Society - York Region 1,859,347 Lumacare Services 5,558,864 Bernard Betel Centre for Creative Living 745,782 The Canadian Hearing Society - York Region 573,945 CNIB York Branch 512,056 Chippewas of Georgina Island First Nations 251,856 Regional Municipality of York 1,830,395 Better Living Health and Community Services 2,840,382 CHIRS 64,185 New Unionville Home Society 472,670 North York Seniors Centre 1,455,661 Jane/Finch Community and Family Centre - CSS 411,641 Mackenzie Health 517,163 North York General Hospital (CSS) 225,951 36,324,005 Palliative Care Organization/Program Name 2018/19 Opening Cash Allocation Hazel Burns Hospice 210,768 Better Living Health and Community Services 1,208,634 Southlake Regional Health Centre - CSS 1,648,398 Stevenson Memorial Hospital (CSS) 45,338 3,113,138

77 Community Health Centre Organization/Program Name 2018/19 Opening Cash Allocation Vaughan Community Health Centre 4,907,117 Black Creek Community Health Centre 8,233,942 13,141,059 Children's Mental Health Organization/Program Name 2018/19 Opening Cash Allocation North York General Hospital 973,518 Community Mental Health Program 973,518 Organization/Program Name 2018/19 Opening Cash Allocation Across Boundaries 2,046,049 Chaitikvan Foundation 413,861 Toronto North Support Services 2,871,334 Canadian Mental Health Association Toronto Branch 20,001,092 Krasman Centre 710,052 Addiction Services Of York Region 205,605 Cota Health 5,849,416 Canadian Mental Health Assoc (CMHA) York Region 14,739,076 Bayview Community Services 0 Chippewas Of Georgina Island 15,800 Humber River Hospital 894,886 Regional Municipality Of York 612,586 Southlake Regional Health Centre 3,507,337 Loft Community Services 8,600,004 Jane/Finch Community & Family Centre 211,600 Cedar Centre 284,455 Stevenson Memorial Hospital 578,897 Markham Stouffville Hospital 99,704 North York General Hospital 2,512,006 Yor-Sup-Net Support Service Network 6,210,723 70,364,483 Psychiatric Outpatient Medical Salaries Organization/Program Name 2018/19 Opening Cash Allocation Humber River Hospital 802,446 Southlake Regional Health Centre 338,583 Mackenzie Health 433,083 Markham Stouffville Hospital 552,964 North York General Hospital 920,167 3,047,243

78 Substance Abuse Program Organization/Program Name 2018/19 Opening Cash Allocation Across Boundaries 152,474 Vitanova Foundation 612,254 Caritas School Of Life 389,168 Addiction Services Of York Region 5,382,286 Canadian Mental Health Assoc (Cmha) York Region 125,000 Humber River Hospital 866,190 Black Creek Community Health 681,120 North York General Hospital 181,845 8,390,337 Problem Gambling Organization/Program Name 2018/19 Opening Cash Allocation Addiction Services Of York Region 224, ,926 Sessional Fee Organization/Program Name 2018/19 Opening Cash Allocation Across Boundaries 75,601 Toronto North Support Services 25,921 Canadian Mental Health Association Toronto Branch 57,240 Krasman Centre 25,921 Addiction Services Of York Region 25,921 Cota Health 42,590 Canadian Mental Health Assoc (CMHA) York Region 62,101 Bayview Community Services 0 Humber River Hospital 635,585 Southlake Regional Health Centre 489,244 Mackenzie Health 59,400 Stevenson Memorial Hospital 80,460 Markham Stouffville Hospital 84,240 North York General Hospital 363,963 Yor-Sup-Net Support Service Network 44,280 2,072,467

79 Long-Term Care Homes Organization/Program Name 2018/19 Opening Cash Allocation Villa Leonardo Gambin 8,012,060 Valleyview Residence 8,414,640 Southlake Residential Care Village (2955) 9,300,673 Langstaff Square Community Ontario Limited 7,677,871 Norfinch Care Community Ontario Limited 8,144,223 Weston Terrace Care Community Ontario Limited 11,043,875 Villa Colombo Seniors Centre (Vaughan) Inc., 8,416,274 Willows Estate Nursing Home (The) - Omni Health Care Limited Partnership 4,098,669 Hawthorne Place Care Centre - Rykka Care Centres LP 11,893,906 Good Samaritan Nursing Home 3,133,399 Downsview Long Term Care Centre 12,453,605 Village of Humber Heights - Schlegel Villages Inc. 9,624,893 Extendicare (Canada) Inc. - Bayview 8,940,146 Bloomington Cove Care Community - Royale Development LP 5,274,081 Bradford Valley Care Community - Royale Development LP 12,544,863 Cedarvale Lodge Retirement and Care Community - Royale Development LP 2,463,473 Kristus Darzs Latvian Home 4,352,255 Ukrainian Canadian Care Centre - St. Demetrius (Ukrainian Catholic) Development 6,788,107 Eagle Terrace - Revera Long Term Care Inc. 3,007,174 Mackenzie Place - Revera Long Term Care Inc. 4,570,040 York Region Newmarket Health Centre 7,302,723 Cheltenham Care Community - Vigour Ltd. Partnership 8,148,977 York Region Maple Health Centre 4,265,046 Elginwood Long Term Care Centre - Revera Long Term Care Inc. 6,057,419 Yee Hong Centre for Geriatric Care - Markham 10,635,137 Bethany Lodge 6,101,617 Better Living at Thompson House 5,726,766 Markhaven Inc 4,743,957 Parkview Home - The Mennonite Home Association of York County Inc. 6,485,189 Simcoe Manor Home for the Aged - The County of Simcoe 5,872,221 Union Villa Home for the Aged - Unionville Home Society 7,680,440 Sherwood Court Long Term Care Centre - Revera Long Term Care Inc. 4,658,626 Chartwell Woodhaven Long Term Care Residence 9,519,879 Mon Sheong Foundation - Richmond Hill 9,337,731 Cummer Lodge - City of Toronto 20,131,841 Chartwell Aurora Long Term Care Residence 12,092,110 Chartwell Gibson Long Term Care Residence 9,287,889 Mackenzie Health Long Term Care Facility 9,689,831 Carefree Lodge - City of Toronto 5,852,951 North Park Nursing Home Limited 3,341,025 River Glen Haven Nursing Home - Kannampuzha Holding Ltd 5,850,043 King City Lodge Nursing Home - Poranganel Holdings Ltd 1,717,188 Mariann Nursing Home and Residence 3,273,637

80 Seniors' Health Centre - North York General Hospital 9,842,181 Harold and Grace Baker Centre 5,411,506 Villa Colombo Home for the Aged Inc. 18,188,798 Hospitals 351,368,953 Organization Name 2018/19 Opening Cash Allocation Humber River Hospital 354,873,385 Southlake Regional Health Centre 295,091,153 Mackenzie Health 185,719,574 Stevenson Memorial Hospital 19,386,716 Markham-Stouffville Hospital 172,691,095 North York General Hospital 247,951,104 Don Mills Surgical Unit Ltd. 1,316,500 Shouldice Hospital Limited 6,945,600 1,283,975,127 Total for all Sectors 1,828,185,535

81 Funding Allocations Delegated Authority March 2018 Appendix B LEGEND Better Seniors Care Better Care for Kids and Youth Better Community Care Better Mental Health Better Palliative Care Achievement of MLAA performance Better Care for Underserved Communities Sustainability A. New or Unallocated Transfer Payments from the Ministry 1. Quality Based Procedures Hospital Sector - $296,500 Base Base funding was provided to Stevenson Memorial Hospital for gastro-intestinal cancer surgeries, or Quality Based Procedures (QBPs). The hospital had previously been funded for these QBPs through Cancer Care Ontario. 2. Mental Health and Addiction Services Community Sector - $1,620,000 Base Funding for Addiction Services for York Region to implement the Rapid Access Addictions Medicine Clinics across the LHIN and for the expansion of community based withdrawal management services as part of the Ministry of Health and Long Term Care s Strategy to Prevent Opioid Addiction and Overdose. 3. Emergency Department Initiative Hospital Sector - $74,440 One-Time Funding to Stevenson Memorial Hospital to assist with Emergency Department volume growth and surge pressures. 4. Community Funding Various HSPs - $95,000 One-Time Funding provided to the Chippewas of Georgina Island and LumaCare Services for capital and non-capital expenditures to address operating and service pressures. 5. Wound Care Quality Standards Hospital and Community Sectors - $1,500 One-Time, $33,189 Base Funding for the provision of specialized casts for the treatment of diabetic foot ulcers was provided to North York General Hospital, Black Creek Community Health Centre and Vaughan Community Health Centre. 6. Hospital Bed Capacity Hospital Sector - $4,455,500 One-Time Central LHIN s hospitals were allocated funds to address immediate inpatient bed capacity challenges and to provide added surge capacity during the flu season. 7. Change Management Support Hospital Sector - $64,909 One-Time Markham Stouffville Hospital was allocated funding to provide change management support for the musculoskeletal central intake program. 1

82 Central LHIN 8. Mental Health and Addictions Services Community Sector - $29,700 One-Time Funding for additional Mental Health sessional fees was provided to Mackenzie Health to compensate their Psychiatrists. 9. Mental Health and Addiction Services Community Sector - $87,615 One-Time Funding to Canadian Mental Health Association, York Region for the evaluation of various mental health and addiction services in alignment with the implementation of the MHA Supports within Housing Action Plan for York Region. 10. Hospital Funding Hospital Sector - $2,000,000 One-Time One-time funding was allocated to Mackenzie Health to address ongoing operational pressures. 11. Behavioural Support Services Community Sector - $65,000 One-Time Funding provided to LOFT Community Services for the enhancement of the Behavioural Support Transitions Resources to support the Reactivation Care Centre and Central LHIN s home hospital sites. 12. Mental Health and Addiction Services Community Sector - $24,500 One-Time Funding to The Canadian Mental Health Association, York Region for a dedicated resource to lead in facilitation, data collection, analysis and recommendations in establishing a York Region Mental Health and Addictions Crisis Hub. 13. Hospital Funding Hospital Sector - $552,900 One-Time $2,211,600 Base Southlake Regional Health Centre was allocated one-time and base funding to support hospital sustainability. B. Recoveries and Reallocations of Funds to/from a Health Service Provider 1. Mental Health and Addictions Services - Community Sector ($238,580) One-Time Funding totalling $238,580 was recovered from four community sector providers based on the projected year-end surpluses from their Community Mental Health and Assisted Living Services funding envelopes. 2. Mental Health and Addictions Services Community Sector ($15,120) One-Time One-time sessional fees funding was recovered from Toronto North Support Services based on the HSP s projected year-end surplus submission. 3. Mental Health and Addictions Services - Community Sector ($132,109) One-Time Funding recovered from The Canadian Mental Health Association, Toronto based on the HSP s projected year-end surplus from its Community Mental Health Program funding envelope. 4. Bounce Back Program Community Sector ($640,000) Base Central LHIN recovered base funding from The Canadian Mental Health Association, York Region. These recoveries were related to the dedicated Bounce Back program funding that has now become a provincially funded program. 2

83 Central LHIN Summary of Approvals Item Health Service Provider Approved (D/M/Y) One-Time Annualized Base Description A1 Stevenson Memorial Hospital 5/12/2017 $296,500 Quality Based Procedures - GI Endoscopy and Cancer Surgeries A2 Addiction Services for York Region 20/12/2017 $1,620,000 Opioid Addictions Treatment Services A3 Stevenson Memorial Hospital 27/12/2017 $74,440 Emergency Department Initiative A4 Chippewas of Georgina Island 2/1/2018 $70,000 Wheelchair Accessible Van A4 LumaCare 2/1/2018 $25,000 Service Pressures A5 North York General Hospital 2/1/2018 $900 $11,544 Centre of Complex Diabetes Care A5 Black Creek Community Health Centre 2/1/2018 $600 $14,430 Diabetes Education Program A5 Vaughan Community Health Centre 2/1/2018 $7,215 Diabetes Education Program A6 Humber River Hospital 3/1/2018 $516,000 Additional Hospital Bed Capacity A6 Mackenzie Health Hospital 3/1/2018 $ Additional Hospital Bed Capacity A6 Markham Stouffville Hospital 3/1/2018 $274,000 Additional Hospital Bed Capacity A6 North York General Hospital 3/1/2018 $758,000 Additional Hospital Bed Capacity A6 Southlake Regional Health Centre 3/1/2018 $2,210,000 Additional Hospital Bed Capacity A6 Stevenson Memorial Hospital 3/1/2018 $121,000 Additional Hospital Bed Capacity A7 Markham Stouffville Hospital 9/1/2018 $64,909 Musculoskeletal Central Intake Program A8 Mackenzie Health 11/1/2018 $29,700 Additional Mental Health and Addictions Sessional Fees A9 Canadian Mental Health Association, Evaluation of Mental Health and Addiction 11/1/2018 $87,615 York Region services A10 Mackenzie Health 25/1/2018 $2,000,000 Operational Pressures A11 LOFT Community Services 26/1/2018 $65,000 Behavioural Support Transitions Resources A12 Canadian Mental Health Association, York Region 5/2/2018 $24,500 York Region Mental Health and Addictions Crisis Hub A13 Southlake Regional Health Centre 9/2/2018 $552,900 $2,211,600 Hospital Sustainability B1 Across Boundaries 15/12/2017 ($14,580) Mental Health and Addictions sessional fees Canadian Mental Health Association, B1 15/12/2017 ($144,000) Community Mental Health Program Toronto B1 Yee Hong Centre for Geriatric Care 15/12/2017 ($70,000) Assisted Living Services Program B1 York Support Services Network 15/12/2017 ($10,000) Community Mental Health Program B2 Toronto North Support Services 19/12/2017 ($15,120) Mental Health and Addictions sessional fees B3 Canadian Mental Health Association, Toronto 29/1/2018 ($132,109) Community Mental Health Program B4 Canadian Mental Health Association, York Region 6/2/2018 ($640,000) Bounce Back Program 3

84 APPENDIX C Central LHIN Integrated Health Service Plan 5 Draft Development Roadmap Central LHIN Board of Directors March 27, 2018

85 Current Status MOH-LHIN - Common Environmental Scan Pan-LHIN - IHSP Roadmap Development LHIN CEOs/MOH Co-designed priorities framework Pan LHIN Consistent approach to develop context & content Central LHIN will be developing the new three-year strategic plan within the context of an expanded mandate. Past IHSP Development has included: ENGAGEMENT External healthcare-related stakeholder engagement (e.g. HSPs, municipalities, community partners), Patients Families & Caregivers, FLS/FNIM, staff, board LEVERS OF CHANGE HHR, funding models, technology, quality improvement, performance, Patients First SYSTEM LEVEL PLANNING Priority development, achievements, challenges GOALS Access, Connect, Protect, Inform IHSP 5 additional considerations: Staff engagement within new organizational structure New stakeholder: SPOs, Increased need for PFAC and resident involvement in the codesign/validation of priorities Stronger and more directed focus on Integration as a core theme Sub-region care delivery priorities Primary care involvement Stronger requirements for FLS & FNIM co-design Demonstrated alignment to Mandate Letter and system impact performance 2

86 Draft IHSP 5 Process & Timelines Central LHIN ADM memo to LHINs Late April 2018 Advertising Black-out: Mar 9 - Jun 7 LHIN public consultations prior to or after blackouts Communications Blackout: May 8 - end date TBC LHINs submit draft IHSPs Late October 2018 Ministry sends feedback Early December, 2018 LHINs publish IHSPs February 1, 2019 Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb CLHIN Staff Engagement SPO Engagement Ext. Stakeholder Engagement CLHIN Board Process Update Engage Update Update Engage Final TBD Engage Engage TBD Engage Engage TBD Update Update Engage Update Break Period Engage Approval 17/ / /20 Annual Business Plan Development ABP 19/20 Begin Staff Involvement & Development Board approval Submit MOH 3 Final

87 IHSP5 Stakeholder Engagement Map Internal Stakeholders External Stakeholders Ministry of Health Health Service Providers (formal) Central LHIN Board of Directors Primary Care & other Community Partners Central LHIN Staff Municipalities Clinical leadership Central LHIN IHSP5 Academic and Other Advisory Groups Service Provider Organizations Public Health Residents, patients and families 4

88 ITEM 12.0 CENTRAL LHIN BOARD OF DIRECTORS CLOSED SESSION RESOLUTION MARCH 27, 2018 BE IT 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. Tini Le Ms. Barbara Bell Ms. Karen Adams Mr. Mitchell Toker Ms. Katrina Santiago Ms. Robyn Saccon.