3.0 PATIENT STORY 3.1 Patient Story K Gillis Information 1:37-1: APPROVAL of CONSENT AGENDA Approval of Consent Agenda

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1 South West Local Health Integration Network Board of Directors Meeting Tuesday April 17, 2018, 1:30 pm to 5:00 pm Elgin St. Thomas Public Health Elgin Rooms 1-2-3, 1230 Talbot Street, St. Thomas AGENDA Item Agenda Item Lead Expected Outcome 1.0 COVENING THE MEETING 1.0 Call to Order, Recognition of Quorum Chair 1: Approval of Agenda Chair Decision 1:30-1: Declaration of Conflict of Interest 2.0 APPROVAL OF MINUTES 2.1 March 20, 2018 DRAFT Board of Directors Meeting Minutes Chair Decision 1:35-1: PATIENT STORY 3.1 Patient Story K Gillis Information 1:37-1: APPROVAL of CONSENT AGENDA Approval of Consent Agenda Chair 1:55-2: /18 Quarter 4 Broader Public Sector Accountability Act Attestation Decision 4.2 South West LHIN Board-to-Board Reference Group Terms of Reference Decision 4.3 February 8, 2018 DRAFT Board to Board Reference Group Minutes Information 4.4 February 20, 2018 DRAFT Audit Committee Minutes Information 4.5 February 20, 2018 DRAFT Finance Committee Minutes Information 4.6 March 6, 2018 DRAFT Quality Committee Minutes Information /18 Quarter 4 LHIN CEO Delegation of Authority Report Information 4.8 South West LHIN Patient Engagement Plan Update Patient Family Advisory Committee Information 4.9 South West LHIN Musculoskeletal (MSK) Strategy Implementation Update Information 4.10 South West LHIN Report on Performance Information Scorecard /18 Q3 Board Committee Reports Board Director Reports 5.0 DECISION / FOCUSSED DISCUSSION ITEMS South West LHIN Accreditation Canadian Mental Health Association Elgin Branch Investigation Indigenous Engagement Committee Chair M Brintnell K Gillis/ D Ladouceur M Brintnell Information Information Decision Discussion Discussion /19 LHIN Transfer Payment and LHIN- Delivered Services Funding Update Discussion 5.5 Integrated Health Service Plan(IHSP) Strategic Planning Update and Board Advance K Gillis Discussion 5.6 Talent Management Update M Bedek Discussion BREAK 3:00-3:10 Time 2:00-3: CLOSED SESSION 6.1 Closed Session Chair Decision 3:10-5: FUTURE MEETINGS/EVENTS South West LHIN Board of Directors Meeting- Tuesday May 15, 2018, 1:00 pm to 5:00 pm, South West LHIN, 201 Queens Ave, Suite 700, Main Boardroom London 8.0 Adjournment Chair Decision 5:00

2 South West LHIN Board of Directors Meeting Board of Directors Meeting Tuesday March 20, 2018, 1:00 pm to 5:00 pm South West LHIN - Stratford, 65 Lorne Avenue East Room: Avon/Maitland Rooms Minutes Present: Regrets: Staff: Andrew Chunilall, Vice Chair, Acting Board Chair Linda Ballantyne, Vice Chair, Board Director Jean Marc Boisvenue, Board Director Myrna Fisk, Board Director Glenn Forrest, Board Director Jim Sheppard, Board Director Leslie Showers, Board Director Cynthia St. John, Board Director Aniko Varpalotai, Board Director Lori Van Opstal, Board Chair Wilf Riecker, Board Director (attended first portion of meeting by teleconference) Kelly Gillis, Interim Co-CEO/Vice President, Strategy, System Design & Integration Hilary Anderson, Vice President, Corporate Services Dan Brenann, Communications Director Mark Brintnell, Vice President, Quality, Performance & Accountability Dr. Cathy Faulds, Vice President Clinical Donna Ladouceur, Interim Co-CEO/Vice President, Home & Community Care Stacey Griffin, Executive Office Coordinator (Recorder) 1.0 Call to Order Welcome and Introductions The Acting Board Chair called the meeting to order at 1:02 pm. There was quorum and four members of the public, which included health service providers, were in attendance for parts of the meeting Approval of Agenda MOVED BY: SECONDED BY: Myrna Fisk Aniko Varpalotai THAT the Board of Directors meeting agenda for March 20, 2018, be approved as presented. A closed session will be held CARRIED 1.2 Declaration of Conflict of Interest No conflicts were declared

3 March 20, 2018 Board Of Directors Minutes Page Approval of Minutes 2.1 February 20, 2018 South West LHIN Board of Directors Meeting MOVED BY: SECONDED BY: Glenn Forrest Jim Sheppard THAT the February 20, 2018 South West LHIN Board of Directors meeting minutes be approved as presented. CARRIED 3.0 Patient Care Story Dr Cathy Faulds presented a patient story on the case of Connie. The story is an example of missed and quality of care in Home Care delivery in London. Connie was a patient with stenosis, Congestive Heart Failure, A fibrillation, Pulmonary embolus x2, general debility from Osteoarthritis, Chronic Kidney Disease stage III, and Osteoporosis with multiple fractures. An overview was provided on Connie s medical and care delivery and Palliative Care Journey. 4.0 Approval of Consent Agenda MOVED BY: SECONDED BY: Jean-Marc Boisvenue Cynthia St. John THAT the consent agenda items be received and approved as circulated in the agenda package. CARRIED 5.0 Decision Items Board-Governed Agency Attestation MOVED BY: SECONDED BY: Leslie Showers Glenn Forrest THAT the South West Local Health Integration Network Board of Directors authorizes the Board Chair and Chief Executive Officer to sign-off on the Board-Governed Agency Attestation for submission to the Ministry of Health and Long-Term Care. CARRIED Hospital Service Accountability Agreement (HSAA) MOVED BY: SECONDED BY: Jim Sheppard Aniko Varpalotai THAT the South West Local Health Integration Network Board of Directors authorizes the Board Chair and Chief Executive Officer to approve and sign the two year Hospital Service Accountability Agreement covering the period April 1, 2018 to March 31, 2020 with the 16 public hospital corporations and one private hospital in the South West LHIN that have submitted balanced budgets. CARRIED MOVED BY: Jean-Marc Boisvenue SECONDED BY: Myrna Fisk

4 March 20, 2018 Board Of Directors Minutes Page 3 THAT the South West Local Health Integration Network Board of Directors authorizes the Board Chair and Chief Executive Officer to approve and sign the Hospital Service Accountability Agreements and balanced budget waivers covering the period April 1, 2018 to March 31, 2020 with Grey Bruce Health Services, the South Huron Hospital Association, and Tillsonburg District Memorial Hospital. CARRIED /19 Multi-Sector Service Accountability Agreement (MSAA) MOVED BY: SECONDED BY: Aniko Varpalotai Leslie Showers THAT the South West Local Health Integration Network (LHIN) Board of Directors authorizes the Board Chair and Chief Executive Officer to approve and sign the 2018/19 Multi-Sector Service Accountability Agreement effective April 1, 2018 with each of the community support services, community health centres, and community mental health and addictions health service providers in the South West LHIN. CARRIED MOVED BY: SECONDED BY: Linda Ballantyne Glenn Forrest THAT the South West Local Health Integration Network (LHIN) Board of Directors authorizes the Board Chair and Chief Executive Officer to approve and sign the 2018/19 Multi-Sector Service Accountability (Amending Agreement) effective April 1, 2018 with South East Grey Community Health Centre and Canadian Mental Health Association (CMHA) Elgin. CARRIED LHIN staff continue to assess the overall impact associated with the new Bill 148 legislation and will work will HSPs on mitigation strategies as the impact unfolds in the upcoming fiscal year All M-SAA s with the exception of two were sent out to HSPs. The two exceptions are noted below: South East Grey Community Health Centre (CHC) The LHIN was advised by the organization that it would not sign the proposed 2018/19 M-SAA. The SEGCHC has requested a general base funding increase and new funding associated with a pending primary care physician practice change. The LHIN has advised that no new base funding exists and any new base funding will be allocated based on priorities and all community HSPs would be considered in such a process. In terms of the pending primary care situation, the LHIN has extended an offer to meet and further discuss and plan possible changes to the primary care environment in the area. LHIN staff advised the SEGCHC that an extension of the current M-SAA could be recommended but that the SEGCHC would not be entitled any new funding until such a time as a new M-SAA is approved. Canadian Mental Health Association Elgin - LHIN staff has not been able to reach a point of issuing a draft M-SAA for CMHA Elgin. A number of points of clarity remain and form the basis of active discussions taking place between the two organizations. The goal is to wrap up these discussions in Q1 of 2018/19. LHIN staff recommend an extension of the current M-SAA until conclusion on all items currently being discussed is achieved /19 Long-Term Care Home Service Accountability Agreement (L-SAA) MOVED BY: SECONDED BY: Glenn Forrest Leslie Showers

5 March 20, 2018 Board Of Directors Minutes Page 4 THAT the South West Local Health Integration Network (LHIN) Board of Directors authorizes the Board Chair and Chief Executive Officer to approve and sign the 2018/19 Long-Term Care Home Service Accountability Agreement effective April 1, 2018 with each of the 78 Long-Term Care Homes in the South West LHIN. CARRIED Knollcrest Lodge (KL) identified to the South West LHIN and to the Long Term Care Homes Division, Ministry of Health and Long-Term Care their concerns regarding its inability to manage its cash flow. As a result, KL has worked with the South West LHIN and the MOHLTC to obtain a cash advance to help manage its short-term cash pressures while a longer-term solution may be determined. 5.5 South West LHIN 2018/19 Quality Improvement Plan MOVED BY: SECONDED BY: Glenn Forrest Myrna Showers THAT the South West Local Health Integration Network Board of Directors approves the 2018/19 Quality Improvement Plan and submit to Health Quality Ontario. CARRIED 5.6 Residential Hospice Planning Updates MOVED BY: SECONDED BY: Myrna Fisk Cynthia St John THAT the South West Local Health Integration Network (LHIN) Board of Directors approves, in principle, the establishment of an 8 bed Residential Hospice for the Elgin sub-region and THAT pending the allocation of funding from the Ministry of Health and Long-Term Care, operational funding will be provided for the nursing, personal support and other patient related costs in accordance with the provincial Residential Hospice funding policy once the 8 beds are operational. CARRIED The shortage of PSWs in the South West is resulting in a surplus in Home and Community Care and is anticipated this to continue into 2018/19. A request has been submitted to the ministry to utilize Home Care/LHIN Delivered Services funding to support additional Residential Hospice (RH) capacity (4 beds) in the South West LHIN. An additional 4 Residential Hospice beds (2 in Grey Bruce and 2 in Huron Perth) could help to keep palliative patients in a home-like setting and out of hospital. We are still awaiting ministry approval. The board heard in response to questions raised that Jessica s House is close to opening their three bedroom home at the south end of Exeter. **The Board took a short break from 2:45 pm to 2:53 pm

6 March 20, 2018 Board Of Directors Minutes Page Focused Discussion items 6.1 January 2018 Financial Update The board was provided with a January 2018 update, the South West LHIN is currently operating at a $9.09M year to date surplus at January 31, We are forecasting a $2.19M surplus as at March 31, Purchased services is continuing to trend down and a significant portion of this trend is due to the continued shortage of PSW staffing. Approval was obtained in February for the transfer of $4.0M from the Home and Community Care envelope to the HSP transfer payment envelope, Expected compensation expenses were reduced by $2.48M. This is the projected impact of the increased vacancies trend for the year. This is offset by an increase in Purchased Patient Services of $1.10M as a result of Bill Fair Workplaces, Better Jobs Act, which was implemented January 1, Provincial Ministry of Heath funding was increased by $300K due to new funding for Chapman House Hospice in Grey-Bruce. Special Needs Strategy plans are on track for early In scope of this project is movement of physiotherapy, occupational therapy, speech and language pathology services to MCYS. There will be no reduction in service levels and families will continue to experience service continuity throughout the transition. Movement of Geriatric Nursing services to Parkwood Hospital is also on track for fall 2018 The Audit Committee is scheduled for June 14, 2018 to receive and review the 2017/18 annual audit report and letter from Deloitte and approval by the Board at its June 26, 2018 Board of Directors meeting. 6.2 Governance Update and Retreat Focus The Board Governance Chairs reviewed format for the April 23/24 th Governance Retreat. April 23 rd session will focus on the South West LHIN Integrated Health Service Plan and will work with staff and consultant. April 24 th Facilitated discussion with Lyn McDonnell from The Accountability Group (TAG) Board to Board Reference Groups: with the emergence of LHIN sub-regions, there are opportunities for improved health system planning, performance improvement and service integration. Sub-regions are intended to drive local improvement and innovation with the common objective of improving the patient experience. At present, the South West LHIN is establishing groups in each of the sub-regions to help align organizations for more purposeful integration and a more robust system recruiting governors who can champion change. Will reference Collaborative Governance. Follow up to December Board Retreat looking at agenda recommendations, board retreat concept for discussion on long-range, objects, issues, governance monitor, work plans for the Committees and the Board, etc. Setting new goals for the Board for the next period. The Board retreat will be extended to 2:00 pm on April 24 th. Lynn McDonnell will attend the April 17 th Board of Directors to review the Board meeting to assist with preparation for the upcoming Board retreat. 6.3 Communications Protocol The staff and board reviewed items considered under a communication protocol. The board expressed that they appreciate receiving the daily communications clips and would request further information on specific topics as they arise. The South West LHIN Chief Executive Officer (CEO), and Board Chair or their designates will each serve as the South West LHIN s official spokesperson and have the authority to make statements to the media on behalf of the organization.

7 March 20, 2018 Board Of Directors Minutes Page 6 The Board took a short break from 3:30 pm to 3:35 pm 7.0 Closed Session MOVED BY: SECONDED BY: Cynthia St John Glenn Forrest THAT the Board of Directors move into a closed session at 3:35pm pursuant to s. 9(5)(a)(g) of the Local Health System Integration Act, 2006 CARRIED LHIN staff members Donna Ladouceur, Hilary Anderson, Mark Brintnell, Cathy Faulds and Stacey Griffin were permitted to attend for parts of the meeting and left the meeting at 3:55 pm. MOVED BY: SECONDED BY: Leslie Showers Linda Ballantyne THAT the South West LHIN Board of Directors rise from closed session at 5:06 pm and returned to open session. The Acting Board Chair reported that the Chair provided a Board Chair Update, reviewed Board performance and Board monitor report. The Board discussed establishing a working group to move forward with establishing a better relationship with our Indigenous communities. Board Directors Jean- Marc Boisvenue and Glenn Forrest will lead. The Board also discussed the CEO Executive Search and Board Chair Succession planning. CARRIED 8.0 Dates and Location of Next Meeting The next South West LHIN Board of Directors Meeting will be held on Tuesday April 17, 2018, from 1:00 pm to 5:00 pm at Elgin St. Thomas Public Health, Talbot Boardroom, located at 1230 Talbot Street, St. Thomas 9.0 Adjournment MOVED BY: SECONDED BY: Cynthia St John Aniko Varpalotai THAT the South West LHIN Board of Directors meeting adjourn at 5:08pm. APPROVED: Andrew Chunilall, Acting Board Chair Date:

8 Report to the Board of Directors 2017/18 Quarter 4 Broader Public Sector Accountability Act Attestation Meeting Date: April 17, 2018 Agenda item 4.1 Submitted By: Kelly Gillis, Interim Co-Chief Executive Officer Donna Ladouceur, Interim Co-Chief Executive Officer Submitted To: Board of Directors Board Committee Purpose: Information Only Decision ATTESTATION Prepared in accordance with section 14 of the Broader Public Sector Accountability Act, 2010 (BPSAA) TO: South West LHIN Board FROM: Kelly Gillis and Donna Ladouceur, Interim Co-CEO s Date: April 17, 2018 RE: 2017/18, Quarter 4, January 1, 2018 to March 31, 2018 On behalf of the South West 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/Ministry LHIN Performance Agreement in effect, during the Applicable Period. On May 24, 2017, all of the employees, assets, liabilities, rights and obligations of the South West Community Care Access Centre (the CCAC ) were transferred to the South West Local Health Integration Network (the LHIN ) pursuant to an order of the Minister of Health and Long-Term Care under Part V.1 of the Local Health System Integration Act, 2006 ( LHSIA ).

9 Report to the Board of Directors-2017/18 Quarter 4 Broader Public Sector Accountability Act Attestation Page 2 It is my understanding that no non-compliance with: the Ministry LHIN Accountability Agreement; the Memorandum of Understanding with the Ministry of Health and Long-Term Care; any policy or law of the Province of Ontario; or any Management Board of Cabinet directive, has resulted as a consequence of this transfer, or will result as a consequence of the LHIN using any assets, performing any contracts, honouring any liability or otherwise dealing, in the normal course of the LHIN s business, with any of the assets, liabilities, rights and obligations transferred from the CCAC. 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. I further certify that any material exceptions to this attestation are documented in the attached Schedule A. Dated at London, Ontario this April 17, 2018 Kelly Gillis, Interim Co-CEO, South West Local Health Integration Network Donna Ladouceur, Interim Co-CEO, South West Local Health Integration Network I certify that this attestation has been approved by the Board of the South West LHIN on April 17, 2018 Andrew Chunilall, Acting Board Chair, South West Local Health Integration Network

10 Report to the Board of Directors-2017/18 Quarter 4 Broader Public Sector Accountability Act Attestation Page 3 ATTESTATION Prepared in accordance with section 14 of the Broader Public Sector Accountability Act, 2010 (BPSAA) SCHEDULE A South West Local Health Integration Network For the Applicable Period: 2017/18, Quarter 4, January 1, 2018 to March 31, MEMORANDUM OF UNDERSTANDING Non-Compliance. 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 Bill 41, Patients First Act 2016, receiving Royal Assent, which will significantly impact the LHIN s insurance needs, the LHIN is maintaining the status quo and, when appropriate will take such steps as may be agreed among the all fourteen LHINs and the Crown in regard to this matter. 2. MINISTRY LHIN ACCOUNTABILITY AGREEMENT/MINISTRY LHIN PERFORMANCE AGREEMENT No known exceptions 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 No known exceptions 5. COMPLIANCE WITH APPLICABLE DIRECTIVES ISSUED BY MANAGEMENT BOARD OF CABINET No known exceptions a. OPS PROCUREMENT DIRECTIVE b. OPS TRAVEL, MEAL AND HOSPITALITY EXPENSES DIRECTIVE c. OPS PERQUISITES DIRECTIVE

11 Report to the Board of Directors South West LHIN Board-to-Board Reference Group Terms of Reference Agenda item 4.2 Meeting Date: April 17, 2018 Submitted By: Board-to-Board Reference Group Chair Submitted To: Board of Directors Board Committee Purpose: Information Only Decision Suggested Motion: TO amend the Terms of Reference for the South West LHIN Board-to-Board Reference Group as recommended by the South West LHIN Board-to-Board Reference Group. Background: Refer to the draft minutes of the South West LHIN Board-to-Board Reference Group meeting held on February 8, 2018 included in the consent agenda section of this meeting package and the recommended Terms of Reference immediately following.

12 Terms of Reference South West LHIN Board-to-Board Reference Group Approval Date: March 2011 Updated: September 2012 Revised Date: July 17, 2013 by the Board-to-Board Reference Group Approval Date: December 18, 2013 by the South West LHIN Board of Directors Review Date: January 19, 2015 by the Governance & Nominations Committee Approval Date: February 16, 2016 by the South West LHIN Board of Directors Review Date: February 8, 2018 by the Board-to-Board Reference Group Approval Date: pending (April 17) by the South West LHIN Board of Directors South West LHIN Board-to-Board Reference Group Terms of Reference Page 1 of 4

13 1. Background/Context The South West Local Health Integration Network Board of Directors approved the following South West LHIN Mission, Vision, Values at the November 21, 2017 Board of Directors Meeting. Mission Statement: Working with our communities to deliver quality care and transform the health care system. Vision Statement: A healthier tomorrow for everyone. The South West LHIN is devoted to our core set of values and believes that these values are also of importance to all Health Service Providers and health care partners within the South West. South West LHIN Values: Respect: We will treat everyone with dignity and kindness, valuing everyone s opinion and perspective. Integrity: We will be fair, consistent, and transparent in all that we do and will follow through on our commitments. Compassion: We will be empathetic and recognize that our decisions impact people. Courage: We will amplify the patient s voice, challenge the status quo, and make the hard decisions. Innovation: We will be creative and embrace new ideas to respond to the changing needs of our communities. The South West LHIN recognizes the important role of local board members in providing guidance and leadership that ensures the delivery of high quality sustainable care that provides a seamless patient journey for individuals and families relying on our local services. To reach our goal of an integrated system of care, the LHIN believes that a system-level governance view is imperative. The South West LHIN continues to move forward with health system renewal plans as part of the Patients First directions. A key focus of this work is on the development of five subregions across the South West LHIN. Sub-regions are smaller geographic areas that follow recognized care patterns. They have been created as part of a vision for seamless, consistent, high-quality care, and will be a focal point for integrated, population-based service planning and delivery. The South West LHIN has identified five sub-regions: Grey Bruce, Huron Perth, London Middlesex, Oxford, and Elgin. The South West LHIN is establishing 5 Sub-region Board-to-Board Reference Groups to ensure proactive consideration of board-related issues associated with the work of the subregion integration tables and to promote a system view at the governance level within each sub-region. The South West LHIN Sub-region Board-to-Board Reference Groups will be available as needed to provide board perspectives to the sub-region integration tables representing Grey Bruce, London Middlesex, Huron Perth, Elgin, and Oxford. The key responsibility will be to facilitate broader board and community engagement in their respective local sub-region areas to promote South West LHIN Board-to-Board Reference Group Terms of Reference Page 2 of 4

14 patient-centred, inter-organization coordination while honouring member s obligations to their respective health service provider organization. Specific issues that will be considered by the Sub-region Board-to-Board Reference Groups will include but will not be limited to: Strategies to promote a system view amongst health service provider board members Board perspectives on the current and future state of health care within the sub-region and broader South West LHIN and the role and expectations of board members; and Support for focused board and community engagement in the local sub-region areas to advance sub-region objectives related to improved population health, experience of care and value for money. 2. Mandate 2.1. Role of the South West LHIN Board-to-Board Reference Group The South West LHIN Board-to-Board Reference Group provides a forum for the discussion of governance matters of interest to the South West LHIN and local Health Service Provider governing bodies having gathered input through the local Sub-region Board-to-Board Reference Groups. Specific issues that will be considered include: Approaches for engaging health service provider governors and the broader community in LHIN strategic planning and strategy implementation Governance perspectives on the current and future state of health care in the South West and the role and expectations of governors Strategies to support the work of the Sub-region Board-to-Board Reference Groups; and Other matters of relevance to health care governors in the South West LHIN. 3. Membership 3.1. Membership The South West LHIN Board-to-Board Reference Group will include the Board Chair and (2) Board Directors from the South West LHIN and twelve to fourteen Board members from Health Service Provider organizations across the South West including: Community Support Services Mental Health and Addiction Agencies Community Health Centres Hospitals Long-Term Care Homes Primary Care Public Health Residential Hospice At least one member from each Sub-region Group will be appointed to the South West Board-to- Board Reference Group. South West LHIN Board-to-Board Reference Group Page 3 of 4 Terms of Reference

15 The South West LHIN Board-to-Board Reference Group will be chaired by the South West LHIN Board Chair or designate. Additional South West LHIN Board Directors may attend on a rotating basis. Membership will reflect the geographical diversity across the South West LHIN. South West LHIN Board and staff will seek to fill vacant positions by identifying potential organizations and/or candidates based upon geographical representation and/or health sector representation Accountability The South West LHIN Board-to-Board Reference Group is convened by the South West LHIN Board of Directors to provide an opportunity for informed dialogue and discussion with Health Service Provider governors regarding governance matters of interest in the South West LHIN. The Terms of Reference of the Board-to-Board Reference Group will be reviewed annually by the Board-to- Board Reference Group with any recommended changes to be approved by the Board of Directors of the South West LHIN Individual Roles Individual members will: Provide input and advice on LHIN strategic planning and strategy implementation. Participate fully in the exchange of information and identification of issues of relevance. Consider ideas and issues raised and provide guidance and input as appropriate. Consider system level and organizational implications and impacts of issues under consideration. Participate in the development of an annual work plan. 4. Logistics and Processes 4.1. Role of the Chair The Chair will be responsible for coordinating the development of the meeting agenda and leading the meeting in a way that ensures advancement of the agenda within the timelines allocated for specific agenda items. The Chair will ensure that input is solicited from all reference group members when establishing reference group objectives and meeting agendas. The Chair will ensure that an annual work plan is established by the group Delegates It is expected that members will regularly attend meetings, however, it is recognized that on occasion individual members may need to send a delegate to the meeting due to unavoidable scheduling conflicts. If members are sending a delegate, it is important to ensure consistency in terms of the individual selected to attend as a delegate and the use of delegates should be kept to a minimum to ensure continuity. Permission should be sought from the Chair in advance of sending delegates to a meeting. It is the responsibility of members to ensure that delegates are appropriately briefed and debriefed prior to and following any meetings that they attend Frequency of Meetings The Board-to-Board Reference Group will meet a minimum of three (3) times per year (February/March, May/June, September/October) or at the call of the Chair. South West LHIN Board-to-Board Reference Group Page 4 of 4 Terms of Reference

16 South West LHIN Board-to-Board Reference Group Thursday, February 8, to 4 pm Stratford - South West LHIN, 65 Lorne Avenue East - Avon/Maitland Rooms Minutes Draft Present: Staff: Regrets: Leslie Showers, South West LHIN, Group Chair John Haggarty, South Bruce Grey Health Centre Kimberlee Haines, London Health Sciences Centre via teleconference Rosemary Rognvaldson, Listowel Wingham Hospital Alliance via teleconference Cynthia St. John, South West LHIN Ruby Withington, Tillsonburg District Memorial Hospital via teleconference Kelly Gillis, Interim Co-CEO and Vice President Strategy, System Design & Integration Donna Ladouceur, Interim Co-CEO and Vice President Home & Community Care Marilyn Robbins, Executive Office Assistant (Recorder) Andrew Chunilall, South West LHIN Philip McMillan, Alzheimer Society, Huron County Diane Sullivan, Southwest Ontario Aboriginal Health Access Centre 1.0 PREAMBLE Minutes of a meeting of the South West LHIN Board-to-Board Reference Group held on Thursday, February 8, 2018 in Stratford. 2.0 CALL TO ORDER & MEMBERSHIP UPDATE At 2 pm Leslie Showers called the meeting to order. Leslie reported that Graham McEwan, Past Chair, Choices for Change has resigned from the group. Graham s term with Choices for Change will be ending shortly and in the meantime he has a new job that limits his availability to attend day-time meetings. Graham has been thanked for his contributions to the group and to health care in the South West, and he has committed to encouraging another from Choices for Change to consider joining the group.

17 3.0 AGENDA MOVED BY: SECONDED BY: Rosemary Rognvaldson John Haggarty 4.0 MINUTES To approve the agenda of the February 8, 2018 meeting of the South West LHIN Board-to-Board Reference Group as presented. CARRIED MOVED BY: SECONDED BY: John Haggarty Kimberlee Haines To approve the minutes of the October 31, 2017 meeting of the South West LHIN Board-to-Board Reference Group as presented. CARRIED 5.0 MISSION, VISION, VALUES UPDATE Leslie Showers, Group Chair referenced the mission, vision and value statements recently approved by the South West LHIN Board of Directors and thanked the group for their input on the development of these foundational pieces. 6.0 TERMS OF REFERENCE & WORK PLAN Leslie Showers reviewed proposed changes to the South West LHIN Board-to-Board Reference Group Terms of Reference along with a draft work plan for The group discussed how the new Sub-region groups connect to the South West LHIN Board-to- Board Reference Group and some members expressed some confusion about the model. Feedback included A request for a simple outline to describe the Reference Group model for the South West LHIN and the respective sub-regions. A suggestion to extend the deadline for expressions of interest for the sub-region groups. A suggestion to confirm the number of meetings per year required and the objectives of each. Board member fatigue is a barrier. When seeking volunteers for these roles need to make clear what s in it for them and what they ll need to contribute. In response, comments included The sub-region groups will meet to talk about local governance, integration, and issues that are important to them as governors/board members. A member of each sub-region group will be designated to participate at the LHIN-level group in order for information to flow in both directions. It is estimated that sub-region groups will meet a minimum of twice per year likely spring and fall. Barriers to travel and time commitment may be addressed with teleconferencing. 2

18 Participants shared what it is they get out of participating in the South West LHIN Board-to-Board Reference Group. Comments included I get to know others perspectives, and influence the shaping of LHIN messaging. It s an opportunity to meet other governors in the system to understand their challenges and strategies. I m able to bring to my board some high-level information on LHIN activities. It gives me a view to the LHIN s direction that I forward to my board and other area/sector groups. The South West LHIN established the Board-to-Board Reference Group to get the pulse of governors and to provide a governance perspective on LHIN plans. While successful to date, there is a limited number of HSP boards that can participate. The initiative to establish groups in each of the sub-regions is an opportunity for broader participation. The group discussed the responsibility of governors to champion change on behalf of patients and that governors are the glue in aligning organizations for more purposeful integration and a more robust system. The new Board-to-Board Reference Group model aims to create an opportunity for HSP board governors to engage with one another with the goal of addressing local system issues. It was agreed that this work requires governors to have courage as it takes courage to really make a difference and to do something that s never been done before on behalf of patients. It was agreed that the opportunity to participate in the Board-to-Board Reference Group model at both the sub-region and LHIN-wide level is really about championing change in the local health care system. Strong board leadership is needed to drive the required changes on behalf of patients. The invitation to participate in the Board-to-Board Reference Groups needs to be more about the why than about the structure. MOVED BY: SECONDED BY: John Haggarty Rosemary Rognvaldson To recommend amending the Terms of Reference for the South West LHIN Boardto-Board Reference Group as circulated in the meeting materials. CARRIED At this time, no changes were suggested to the draft Work Plan for GOVERNANCE ENGAGEMENT APPROACH Membership Recruitment Update Leslie reported that while expressions of interest continue to be received for participation in the Sub-region Board-to-Board Reference Groups, more applicants are sought for the March 2, 2018 deadline to form more fulsome sector representation in each. The group discussed extending the deadline, membership terms, and their potential to recruit candidates. The group considered launching sub-region groups as ready rather than all at once, and the potential to tie recruitment/engagement activity to future HSP governance education sessions. Some members will be sought to participate at both their sub-region group and the LHIN-wide group in order to facilitate information flow in support of development at the sub-region level. John Haggarty and Rosemary Rognvaldson both indicated their interest in serving in these roles for Grey Bruce and Huron Perth respectively. 3

19 In every case, members are encouraged to promote the Board-to-Board Reference Group opportunity to their board colleagues and contacts in other health system partner organizations. Membership selection process The group reviewed the proposed process for membership selection confirming agreement to review and recommend membership for appointment by the South West LHIN Board of Directors. The group also indicated their support for governors from an HSP situated in a neighbouring LHIN but serving patients from the South West to be welcome to participate. Launch The original proposal called for the Sub-region groups to launch in April/May with a centrallyhosted webinar broadcast to venues in each of the sub-regions where the groups would meet to begin initial planning. In view of the membership status it was agreed to revisit the launch proposal at a later date. 8.0 HSP GOVERNANCE EDUCATION SESSION PLANNING FOR FALL 2018 Leslie Showers, Group Chair reviewed the proposal included in the meeting materials to deliver five governance education sessions (one in each sub-region) during the fall of Typically, 3 sessions have been held every other year in each of the north, south and central parts of the LHIN area. The last sessions were held in November 2016 with approximately 150 governors attending in total. The group briefly discussed the sessions as an opportunity to provide education but also to engage the sub-regions. While generally supportive of these traditionally successful events, members again cautioned about volunteer fatigue and board member overload. 9.0 QUALITY SYMPOSIUM PLANNING UPDATE Kelly Gillis, Interim Co-CEO and Vice President Strategy, System Design & Integration provided a brief review of the preliminary agenda for the 2018 Quality Symposium as included in the meeting materials. Registration is scheduled to open on March ROUND TABLE &ADJOURNMENT Members took the opportunity to announce any news related to their respective organizations. The meeting adjourned at 3:50 pm. APPROVED: Leslie Showers, CHAIR SOUTH WEST LHIN BOARD-TO-BOARD REFERENCE GROUP Date: 4

20 Audit Committee South West LHIN Board Tuesday, February 20, am to noon South West LHIN, Oxford Street Office Trillium East/West, 356 Oxford Street West, London Minutes Draft Present: Guests: Staff: Myrna Fisk, Audit Committee Chair & Board Director Linda Ballantyne, Board Vice Chair Andrew Chunilall, Acting Board Chair Glenn Forrest, Board Director Wilf Riecker, Board Director Chris Dowding, Partner, Deloitte Jim Sheppard, Board Director Aniko Varpalotai, Board Director Steve Stewart, Partner, Deloitte via teleconference Hilary Anderson, Vice President, Corporate Services Marilyn Robbins, Executive Office Assistant (Recorder) 1. Call to Order The Chair called the meeting to order at 11 am. No members of the public were in attendance. 2. Approval of Agenda MOVED BY: SECONDED BY: Linda Ballantyne Wilf Riecker TO approve the agenda for the February 20, 2018 meeting of the South West LHIN Audit Committee. CARRIED

21 3. Approval of Minutes September 15, 2017 MOVED BY: SECONDED BY: Wilf Riecker Andrew Chunilall TO approve the minutes of the meeting of the South West LHIN Audit Committee held September 15, CARRIED 4. Appointment of Auditors for 2017/2018 Hilary Anderson, Vice President, Corporate Services introduced discussion around the requirement to appoint auditors for 2017/2018 acknowledging that as Deloitte has already been contracted provincially to provide audit services for all 14 LHINs it s a rather unusual process in that the South West Board of Directors is still required to motion accordingly and that the Audit Committee will be hearing the Audit Service Plan presentation on the same day as the appointment motion. While this process has been a little out of order for 2017/2018, Hilary reported that Health Shared Services Ontario (HSSO) intends to hold a Request for Proposals (RFP) process next year for the provision of audit services on behalf of all 14 LHINs. It was noted that Deloitte has provided audit services to both the legacy LHIN and legacy CCAC in the South West and are therefore familiar with the new organization. Staff confirmed that the fee quoted for the audit of the 2017/2018 yearend financial statements is $29,600. MOVED BY: SECONDED BY: Andrew Chunilall Linda Ballantyne THAT the South West Local Health Integration Network Audit Committee recommends that Deloitte and Touche be appointed the auditor for the 17/18 audit and that the Board of Directors authorize the LHIN Board Chair and LHIN CEO to execute, on behalf of the LHIN, the Amending Agreement substantially in the form attached to the minutes of this meeting, amending the Auditing Service Agreement between the LHIN and Deloitte and Touche LLP that originally took effect in CARRIED /2018 Audit Service Plan Hilary Anderson, Vice President, Corporate Services introduced Chris Dowding and Steve Stewart of Deloitte. Chris will manage the South West LHIN audit and Steve is the partner for the 14 LHINs across the province. Chris presented Deloitte s 2018 Audit service plan for the year ending March 31, 2018 noting the scope, materiality, significant audit risks, fraud risk strategy, and timelines. The audit service plan was circulated in the meeting materials and posted to the board portal. Steve reported that the financial statements will look quite a bit different this year in order to reflect the new organization and mandate. There is a small group of LHIN staff from across the province working with HSSO to create a standard template for the financial statements that Deloitte expects to review and provide feedback on by early March. Hilary Anderson is a member of this 2

22 working group and noted the challenge of incorporating prior year numbers into the statements for this year. The committee briefly discussed potential disclosure notes to address this while acknowledging that the Ministry of Health and Long-Term Care (MOHLTC) is the primary audience to receive the audited year-end statements. The committee suggested notes regarding dependency on MOHLTC revenue, the stub period, and the overall transition of the legacy LHIN and CCAC organizations to one new LHIN organization and all of the related transactions. Steve and Chris confirmed that a lot of notes are expected and that there will need to be a lot of conversation about the readability of the statements. Hilary reminded the committee that the working group is applying a provincial lens to the template and notes development so that the resulting statements are able to be compared from LHIN to LHIN. It was agreed that an in-camera session was not required and Chris and Steve left the meeting at 11:35 am. Aniko Varpalotai joined the meeting at 11:40 am /2019 Audit Committee Work Plan There was a suggestion to adopt the legacy CCAC format for committee work plans. MOVED BY: SECONDED BY: Linda Ballantyne Glenn Forrest TO adopt the draft 2018/19 Work Plan as circulated in the meeting materials. CARRIED 7. Proof of Liability Insurance Copies of two certificates of insurance were circulated in the meeting materials. Staff confirmed that all 14 LHINs are currently insured by HIROC and that the coverage for the South West LHIN was increased from $10M to $20M at transition. The committee discussed the role of the MOHLTC and HSSO in ensuring the LHINs are appropriately insured. ACTION: Staff to report at the June meeting on how coverage for the South West LHIN compares with other LHINs, if any changes to process or coverage are being considered, and will confirm any responsibilities to or directions from the MOHLTC or LHIN Legal on same. 8. Adjournment The meeting adjourned at 11:45 am. APPROVED: Myrna Fisk, CHAIR AUDIT COMMITTEE Date: 3

23 ATTACHMENT AMENDING AGREEMENT THIS AMENDING AGREEMENT (the Agreement ) is made as of the February 20, 2018 B E T W E E N: AND SOUTH WEST LOCAL HEALTH INTEGRATION NETWORK (the LHIN ) DELOITTE AND TOUCHE LLP (the Auditor ) WHEREAS the LHIN and the Auditor (together the Parties ) entered into an Auditing Services Agreement that took effect in 2012 (the Audit Agreement ); AND WHEREAS pursuant to various amending agreements the term of the Audit Agreement has been extended to March 31, 2018; AND WHEREAS the LHIN and the Auditor have agreed to amend the fees for the fiscal year under the Audit Agreement; NOW THEREFORE in consideration of mutual promises and agreements contained in this Agreement and other good and valuable consideration, the parties agree as follows: 1.0 Definitions. Except as otherwise defined in this Agreement, all terms shall have the meaning ascribed to them in the Audit Agreement. References in this Agreement to the Audit Agreement mean the Audit Agreement as amended and extended. 2.0 Amendments. The section B.1 of Schedule 1 of the Audit Agreement is hereby amended by adding the following: The maximum fee for audit services to be provided in accordance with the Audit Agreement for the year ending March 31, 2018 is $29, If translation of the audit is required by the LHIN, the maximum fee for such translation is $2, Effective Date. The amendment set out in Article 2 shall take effect on February 20, All other terms of the Audit Agreement shall remain in full force and effect. 4.0 Governing Law. This Agreement and the rights, obligations and relations of the Parties will be governed by and construed in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein. 5.0 Counterparts. This Agreement may be executed in any number of counterparts, each of which will be deemed an original, but all of which together will constitute one and the same instrument. 6.0 Entire Agreement. This Agreement constitutes the entire agreement between the Parties with respect to the subject matter contained in this Agreement and 4

24 supersedes all prior oral or written representations and agreements. IN WITNESS WHEREOF the Parties have executed this Agreement on the dates set out below. SOUTH WEST LOCAL HEALTH INTEGRATION NETWORK By: Andrew Chunilall I have authority to bind the LHIN. Title Date By: Donna Ladouceur I have authority to bind the LHIN. Title Date By: Kelly Gillis I have authority to bind the LHIN. Title Date 5

25 DELOITTE AND TOUCHE LLP By: [Name], I have authority to bind Deloitte and Touche LLP. Title Date 6

26 Finance Committee of the Whole South West LHIN Board Tuesday, February 20, 2018 Noon to 1 pm South West LHIN, Trillium East/West, 356 Oxford Street West London Minutes Draft Present: Regrets: Staff: Andrew Chunilall, Acting Board Chair & Treasurer Linda Ballantyne, Board Vice Chair Myrna Fisk, Board Director Glenn Forrest, Board Director Wilf Riecker, Board Director Jim Sheppard, Board Director Leslie Showers, Board Director Cynthia St. John, Board Director Aniko Varpalotai, Board Director Jean-Marc Boisvenue, Board Director Hilary Anderson, Vice President, Corporate Services Maureen Bedek, Vice President, Human Resources Dan Brennan, Director, Communications Cathy Faulds, Vice President, Clinical Kelly Gillis, Interim Co-CEO & Vice President, Strategy, System Design and Integration Stacey Griffin, Executive Office Coordinator Donna Ladouceur, Interim Co-CEO & Vice President, Home and Community Care Marilyn Robbins, Executive Office Assistant (Recorder) 1. Call to Order The Chair called the meeting to order at noon. No members of the public were in attendance. No conflict of interest declared. 2. Approval of Agenda MOVED BY: SECONDED BY: Glenn Forrest Aniko Varpalotai TO approve the agenda for the February 20, 2018 meeting of the South West LHIN Finance Committee of the Whole. CARRIED

27 3. Presentation of 2017/18 Quarter 3/LE09 Financial Statement and Year End Projection Hilary Anderson, Vice President, Corporate Services introduced the discussion stating that the numbers for consideration takes into account approval from the Ministry of Health and Long-Term Care (MOHLTC) to move $4M from the Home and Community Care envelope into the Health Service Provider (HSP) transfer payment envelope. Even after this move, a $932K surplus at yearend is projected due to the trending down of purchased services resulting from the shortage of personal support workers (PSWs) and snow days limiting delivery of the school health program. Concern was expressed about the PSW shortage noting that other LHINs are experiencing the same, and that the on-going staffing issues pertaining to both availability and quality of service need to be addressed. It was suggested that this issue be further discussed during the Board s closed session later today. Hilary provided an overview of the 2017/18 Quarter 3/LE09 Financial Statement and Year End Project report included in the meeting materials. 4. Presentation of 2018/2019 Draft Budget Hilary Anderson, Vice President, Corporate Services introduced her presentation of the South West LHIN 2018/19 Budget report as included in the meeting materials by stating that each of the Vice Presidents was engaged in a zero-based budgeting exercise, and that no increase to revenue was assumed in developing this draft balanced budget for the Board s consideration. In reviewing the report it was noted that starting April 1, as part of the Special Needs Strategy, $4.3M will move with the responsibility for school therapies to the Thames Valley Children s Centre. Staff confirmed that the Children s Centre is equipped to take on this work and is wellpositioned to coordinate service offerings though the transfer date may be delayed as the Ministry of Health and Long-Term Care addresses issues around the transfer of patient files and information. Based on current trends within populations for purchased services a $5.9M increase in spend is projected for 2018/2019 over 2017/2018. The Spending on Patient Care chart contained in the meeting materials shows how the spending on home and community care patients has increased each year until 2017/2018 due to the shortage of PSWs. The 2018/2019 projection is another yearover-year decrease but due to the $4.3M reallocation to the Thames Valley Children s Centre. Regarding compensation expenses it was suggested that there be further discussion on union agreements during the Board s closed session later in the day. Preliminary costing for the impact of Bill 148 on part-time, casual, and non-union staff is estimated at an increase of $260K pending further interpretation of the Bill. The impact of Bill 148 on Service Provider Organizations was also noted. Staff reported that conversations are on-going about efficiencies and anticipated allocations in view of the 8% savings to executive and management office expense as sought by the MOHLTC and resulting from the LHIN/CCAC transition. The overall financial structure and allocations for the new LHIN continue to evolve and will be reflected in the financial management and reporting devices accordingly. Hilary spoke in detail to each of the Risks to budget as listed in the report inviting questions on each. 2

28 Regarding Infrastructure Ontario Expenses, staff confirmed that the Deputy Minister s office is aware of the LHIN CEOs concerns about the proposed agreement with Infrastructure Ontario (IO). It was suggested that the LHIN Chairs should engage the MOHLTC about the same as the agreement will require the LHINs to use IO for both basic and challenging facility work and the cost of using IO is challenging to predict. The committee discussed the province s trending to the centralization of services under the banner of efficiencies citing LHIN Legal, Health Shared Services Ontario, Personal Support Services Ontario as additional examples. The committee expressed concern that the centralization movement is jeopardizing patient care delivery in terms of dollars and staffing resources available, and trending towards a regional or chapter office model. ACTION: Interim Co-CEOs to provide the Acting Board Chair with material on the South West LHINs centralization concerns for further discussion at the LHIN Chairs Council. 5. Recommendation of the of 2017/18 Quarter 3/LE09 Financial Statement and Year End Projection MOVED BY: SECONDED BY: Myrna Fisk Linda Ballantyne THAT the South West LHIN Finance Committee of the Whole approves the 2017/2018 Quarter 3 Financial Statement and Latest Estimate (revised budget) as presented and provides a recommendation to the South West LHIN Board for approval. CARRIED 6. Recommendation of the 2018/2019 Draft Budget MOVED BY: SECONDED BY: Glenn Forrest Jim Sheppard THAT the South West LHIN Finance Committee of the Whole approves the 2018/2019 budget as presented and provides a recommendation to the South West LHIN Board for approval. CARRIED 7. Adjournment The meeting adjourned at 1 pm. APPROVED: Andrew Chunilall, ACTING BOARD CHAIR & TREASURER FINANCE COMMITTEE OF THE WHOLE DATE: 3

29 South West LHIN Board Quality Committee Tuesday, March 6, to 3:50 pm LHIN Office Main Boardroom at 201 Queens Avenue, London Minutes Draft Present: Regrets: Guests: Staff: Aniko Varpalotai, Board Director and Meeting Chair Linda Ballantyne, Board Vice Chair and Quality Committee Chair via teleconference Jean-Marc Boisvenue, Board Director Myrna Fisk, Board Director Andrew Chunilall, Acting Board Chair Glenn Forrest, Board Director Dawna Van Boxmeer, Patient Jeff, Community Nurse Jenna Prouse, Patient Safety Advisor Jim Sheppard, Board Director via teleconference Gwen Vanderheyden, Manager, Patient Safety and Risk Mark Brintnell, Vice President, Quality, Performance and Accountability Dr. Cathy Faulds, Vice President, Clinical Steven Carswell, Director, Quality Marilyn Robbins, Executive Office Assistant (Recorder) 1. Call to Order Aniko Varpalotai called the meeting to order at 2:02 pm. No members of the public were in attendance. 2. Approval of Agenda & Minutes MOVED BY: SECONDED BY: Jean-Marc Boisvenue Myrna Fisk TO approve the agenda for the March 6, 2018 meeting and the minutes of the January 16, 2018 meeting of the South West LHIN Quality Committee. CARRIED

30 3. Patient Story Managing IV in the Community Members of the LHIN s Patient Safety staff team were in attendance and accompanied by a community IV patient and the patient s community nurse. The staff team referred to a presentation included in the meeting materials titled Community Infusion Improvement. The presenters shared how an alternative IV delivery device (Intermate Elastomeric Pump) was piloted in response to this patients request for a more user-friendly solution to the standard alarmed electronic pump. The pilot of the non-electronic medication pump has been successful and the LHIN now has over 100 patients using it as most patients find it to be simple to use, light-weight, mobile, discreet and without the alarms associated with the electronic pumps. Staff report financial and human resource savings with the cost of the Intermate pumps covered by the Ontario Drug Benefit Plan and fewer nursing visits required to administer/monitor treatment and to resolve unplanned alarms. The LHIN is now focusing on introducing the Intermate to long-term care (LTC) home staff for those residents requiring IV antibiotic therapy. The presenters provided materials about the device for the committee s further information and the committee briefly discussed patient education tool design. Once the presenters left the meeting, Mark Brintnell, Vice President, Quality, Performance and Accountability asked the committee to reflect on this patient story and for feedback on how they would prefer to see the patient voice incorporated in their on-going work. Suggestions included Important to hear about both successes and failures. Link patient stories to system-level issues and opportunities today it was good to have the patient, the nurse and the planners all present together to demonstrate the connection. Ask the presenting patient for feedback on the committee s questions and for suggestions on how to best prepare both presenters and the committee for worthwhile story sharing. Brief progress reports on stories presented would be appreciated i.e. Intermate in LTC. The committee was generally pleased with today s patient story and excited about the opportunity to further improve care for other patients in the LHIN. Staff suggest that this improvement project and others to come will be more achievable in the new LHIN organization because of the integration of care coordination, clinical, and system resources and expertise /19 Quality Improvement Plan (QIP) Mark Brintnell, Vice President, Quality, Performance and Accountability introduced the presentation of draft Home and Community Care QIP measures and targets highlighting the focus on identifying goals and challenges most meaningful to the South West LHIN balanced to Health Quality Ontario (HQO) recommended measures. This approach resulted in a total of 10 indicators being proposed for the 2018/19 QIP including 3 HQO priority indicators and 7 local indicators. Steven Carswell, Director, Quality reviewed each of the indicators and the rationale for selection confirming that HQO is supportive of the proposed. 2

31 Staff confirmed that the LHIN will continue to measure and monitor priorities not reflected in the QIP referring to Table 2 - HQO Priority Indicators not selected for QIP included in the meeting materials. The committee considered the indicators proposed and discussed the opportunity for service provider organizations (SPO) to align similarly-aimed plans. The committee was generally supportive of the proposed and very supportive of the focus on local indicators. Staff confirmed their comfort with, and their capacity for the improvement work to be undertaken as identified in the draft QIP cautioning that some of the proposed will yield measureable results more quickly than others. Time and energy will be required for those areas where robust data does not yet exist, and the focus on improvement goals will not be impeded by the pressure of arbitrary calendar dates that some of this work will be multi-year. As the committee considered a motion to recommend to the South West LHIN Board of Directors, the measures as proposed for the 2018/19 QIP, staff confirmed that a complete draft plan would be made available for the Board s consideration with formal reports to the Quality Committee scheduled on a quarterly basis with other updates coming forward as needed. MOVED BY: SECONDED BY: Jean-Marc Boisvenue Myrna Fisk TO recommend that the South West LHIN Board of Directors approve the measures for the 2018/19 Home and Community Care Quality Improvement Plan as presented. CARRIED 5. Accreditation Update Mark Brintnell, Vice President, Quality, Performance and Accountability reported that based on recent discussions, a formal proposal from Accreditation Canada to proceed with a Primer Survey is anticipated. Accreditation Canada has indicated they would aim to undertake the on-site survey sometime between October and December The committee discussed their role and the roles of the Board and the Board s Governance Committee in the accreditation process. It was generally agreed that the Governance Committee would need to engage on the Governance Functioning Tool, that the Quality Committee would drive the accreditation process with staff, and that the Board is responsible for monitoring the overall process and response to the resulting accreditation report. There was further discussion about the Board s role in confirming the Primer Survey approach with staff committing to providing an update to the full Board once the Accreditation Canada proposal is received for contract. There was a brief discussion on how to best keep the Board up to date on the work of the Quality Committee. 6. Engagement with Health Quality Ontario Committee Chair and Board Vice Chair, Linda Ballantyne asked the committee to consider recommending that the Board invite HQO to deliver training on roles and responsibilities for 3

32 quality. This would build on learnings from a recent webinar attended by some LHIN Board Members. As Dr. Cathy Faulds, Vice President, Clinical represents HQO in the South West LHIN and Steven Carswell, Director, Quality Co-Chairs the Clinical Quality Table with Cathy it was suggested that staff develop an education piece for the Board and the Quality Committee on how these lens are applied to LHIN quality work. 7. Emerging Themes & Risks Steven Carswell, Director, Quality announced that there will be a fulsome report to the Board of Directors at their March 20 meeting on PSW and Nursing Capacity and Quality. The committee asked about the role of the LHIN in recent situations reported by the media. One involving a local resident who became critically ill while vacationing in Mexico and unable to access a hospital bed in London, and another about LHSC closing their Cardiac Fitness Institute. The group noted the roles of the hospital(s), the insurance company, and the Ministry and identified a need for some board education on how and what the LHIN communicates and the LHIN s role in these issues. 8. Other Business and Adjournment The next meeting of the Quality Committee is scheduled for Tuesday, April 24 at 2 pm in the Main Boardroom at 201 Queens Avenue. There will not be a meeting on March 27 as previously scheduled. The meeting adjourned at 3:48 pm. APPROVED: Linda Ballantyne, CHAIR QUALITY COMMITTEE Date: 4

33 Agenda item 4.7 Meeting Date: April 17, 2018 Report to the Board of Directors South West LHIN CEO Delegation of Authority Transfer Payments 2017/18 Q4 Report Submitted By: Kelly Gillis, Interim Co-Chief Executive Officer Donna Ladouceur, Interim Co-Chief Executive Officer Submitted To: Board of Directors Board Committee Purpose: Information Decision Purpose The purpose of this report is to provide an update on 2017/18 Q4 (January 1, 2018 to March 31, 2018) approvals triggered by the CEO through the South West LHIN Delegation of Authority for Funding, Accountability Agreements, and Routine Reports policy. The South West LHIN Co-CEO s exercised delegation provisions on the items noted below. Item Funding for Residential Acquired Brain Injury (ABI) Services Ontario Dementia Strategy Dementia Strategy - Community Dementia Program Musculoskeletal (MSK) Models of Care Item Description Implement a new model of care that will provide 1 respite space, 3 transitional spaces, and 3 CSS ABI Assisted Living ABI spaces. The implementation of this model will assist to reduce Alternate Level of Care (ALC) pressures, and successfully support people with ABI to transition between hospital and communitybased services. Ontario Dementia Strategy: implement the new coordinated intake and access model Ontario Dementia Strategy: funding provided for education and training for staff/volunteers who work directly with the Adult Day Program (ADP) and ADP Overnight Respite Beds programs Support the costs for the inception of a Central Intake and Assessment Centre for hip, knee, and spine patients Health Service Provider Dale Brain Injury Services St. Joseph s Health Care Various London Health Sciences Centre Funding B=Base OT=One- Time $495,790 B (2018/19) $60,000 OT $161,300 OT $103,163 B $194,476 OT 2018/19 $63,551 OT

34 Report to the Board of Directors Page 2 Musculoskeletal (MSK) Models of Care Indigenous Cultural Safety Facilitator Provincial Rehabilitative Care Alliance Expansion of Adult Day Program Owen Sound Site Behavioral Supports Ontario (BSO) Provincial coordinating Office Community One-time Minor Infrastructure Program Funding is for 2017/18 unless otherwise indicated above. Support the purchase of annual Novari software licenses, and professional services to enable the South West LHIN Regional MSK Project and Team members hosted by London Health Sciences Centre Support administrative costs of the Southwest Ontario Aboriginal Health Access Centre (SOAHAC) Indigenous Cultural Safety Facilitator for 2017/18 South West LHIN share of funding to support the work of the Provincial Rehabilitative Care Alliance Improve access to Adult Day Programs for clients in Grey Bruce by increasing the number of available spaces up to an additional 500 annually and to offset increased transportation costs associated with the newly created spaces. Contribution of $24,000 to the North East LHIN to support the provincial BSO Coordinating Office One-Time funding for minor infrastructure projects, equipment, training, etc. Funding limited to the community sector St. Thomas Elgin General Hospital Southwest Ontario Aboriginal Health Access Centre St. Joseph s Health Care (hospital to pay the Alliance) Home and Community Support Services of Grey-Bruce North East LHIN 51 community HSPs $269,520 B $57,450 OT $35,000 OT $13,447 B ($40,349 annualized) $24,000 OT $3,918,696 OT

35 Report to the Board of Directors South West LHIN Patient Engagement Plan Update Patient Family Advisory Committee Agenda item 4.8 Meeting Date: April 17, 2018 Submitted By: Kelly Gillis, Interim Co-Chief Executive Officer, Vice President, Strategy, System Design & Integration Submitted To: Board of Directors Board Committee Purpose: Information Decision Purpose To provide the Board of Directors with an update on the South West LHIN Patient Engagement Plan that is being developed by the Patient and Family Advisory Committee (PFAC). Background The South West LHIN understands that engagement efforts must extend beyond establishing a PFAC and must consist of a variety of activities and initiatives to create a patient-centered healthcare system where patients, families and caregivers are partners in their personal healthcare, and are actively engaged in healthcare system design and decision-making. A main focus of PFAC has been codeveloping the South West LHIN patient engagement plan that will guide the South West LHIN s approach to involving patients in healthcare planning and delivery. A Patient Engagement Plan Working Group was formed at the PFAC launch meeting. The purpose of the working group was to lead the co-development of the LHIN Patient Engagement Plan. The working group is composed of a representative from each of the five sub-regions within the South West LHIN geography and includes the following individuals: Barb West-Bartley Grey Bruce representative Matthew Maynard Huron Perth representative Anna Pearson Oxford representative Shirley Biro Elgin representative Nadia Tahir London-Middlesex representative Patient Engagement Plan Update The Patient and Family Advisory Committee has developed the following documents that outline the provincial goal, description of a strong culture of patient engagement, and priority areas of focus for the LHIN patient engagement approach.

36 Report to the Board of Directors Page 2 1. Description of What a Strong Culture of Patient Engagement would look like for the South West LHIN The South West LHIN has adopted the Health Quality Ontario Patient Engagement Framework to guide the LHIN patient engagement work. Committee members reviewed the provincial framework including the provincial strategic goal for patient engagement: A strong culture of patient, caregiver and public engagement to support high quality health care The PFAC members described what a strong culture of patient engagement across the South West LHIN would look like or feel like if we achieved this goal. Please see the link below for the description of what a strong culture of patient engagement would look like for the South West LHIN from the patient, family and caregiver perspective. See Appendix A for the Description of a Strong Culture of Patient Engagement document 2. Internal and External Consultation on Patient Engagement As an input into the LHIN Patient Engagement Plan, Patient, Family and Caregiver Partners and the LHIN Patient Engagement Team met with health service provider organizations Patient and Family Advisory groups. St. Joseph s Hospital Parkwood Institute Kensington Long Term Care Home South Grey Bruce Health Centre Cheshire Oxford County Community Health Centre In addition, the LHIN Patient Engagement Team met internally with the various functional areas within the LHIN organization. These meetings have been very valuable and have highlighted current and future patient engagement opportunities within the organization. 3. Broader Engagement with Patients, Families and Caregivers from the Indigenous and Francophone Communities The PFAC has also identified and recognized the need for broader engagement on the patient engagement plan from patients, families and caregivers from the Indigenous and Francophone communities. The Patient Engagement Lead has met with the Indigenous Health Lead and the French Language Services Planner and they have provided input into the description of a strong culture of patient engagement, driver diagram and high-level tactics. 4. Patient Engagement Driver Diagram The PFAC has co-developed the patient engagement driver diagram. A key input for the driver diagram was developing an inventory of current patient engagement activities occurring in the South West LHIN and identifying the future opportunities to advance patient engagement. The driver diagram will continue to evolve as PFAC socializes these documents with various stakeholders within and across the South West LHIN and learns more about how to achieve its goal. The PFAC will continue to work closely with

37 Report to the Board of Directors Page 3 the Communications Team as we share the information from the driver diagram more broadly. It has been recognized that we will need to summarize and share information within the patient engagement plan in different formats depending on the audience. The driver diagram also highlights where the South West LHIN patient engagement plan is aligned to the Minister s PFAC priority areas of focus. To achieve the provincial goal of embracing a strong culture of patient engagement, PFAC has identified the following three primary drivers: Include and engage patients, families and caregivers as valued partners in care of themselves, the people they love, and the broader, inclusive community Support and engage healthcare providers to leverage the collective experience, knowledge and wisdom of patients, families and caregivers Cultivate leaders that will champion patient engagement See Appendix B for Driver Diagram document Recommended Next Steps: 1. PFAC Co-Chairs present Patient Engagement Plan at May board meeting. 2. Further discussion to occur at Board Quality Committee regarding relationship and alignment with PFAC 3. Further engagement across South West LHIN internal and external to socialize and/or evolve direction and determine implementation details Appendix A: Description of a Strong Culture of Patient Engagement Patient Engagement Plan Vision, Goal and Description of a Strong Culture of Patient Engagement The South West LHIN has adopted the Health Quality Ontario s Patient Engagement Framework to guide its approach to patient engagement in the South West region. The South West LHIN has embraced Health Quality Ontario s strategic goal of building a strong culture of patient, caregiver and public engagement to support high quality health care. In addition, the LHIN PFAC s vision for patient engagement for the South West region is aligned with the Minister Patient and Family Advisory Council s vision for patient engagement in Ontario of creating a patient-centered health care system where patients, families, and caregivers, are partners in their personal health care, and are actively engaged in health care system design and decision-making. To expand on provincial goal and vision, the South West LHIN s Patient and Family Advisory Committee have created the below document that focuses on answering the question, What would a strong culture of patient engagement look like across the various domains, personal care and health decisions, program and service design and policy, strategy and governance? Personal Care and Health Decisions A strong culture of patient engagement, at the personal care and health decisions level, would look like and include: Access to equitable health care that is culturally and linguistically safe Easy access to relevant information that is culturally and linguistically safe Only need to share their story once

38 Report to the Board of Directors Page 4 Engagement is focused on meeting the needs of patients Feel well-informed about their health care options Clear pathways to provide feedback, ask questions, and share concerns Easy access to their health information Examples of what a strong culture of patient engagement would look like at the patient level: Patients receive equitable health care that is culturally safe and in their language of choice When I need health care services, information about how to access care is easy to find and available in multiple ways. The information that I receive is up-to-date, accurate and linguistically and culturally safe. My family, caregiver or I feel listened to by all health care providers or staff and they talk to us in a language that we can understand. Proactively identify what language that I would like to receive services (active offer) Health care provider proactively asking/embedded step in process to look at culture/language of patient There is no limit to how many issues we can discuss at one time or during a visit and my concerns are not dismissed but seen as actual issues. Health care providers focus their care on me and not the disease. They look at me as a whole person and respect my lived experience as well as the knowledge of the patient/family/caregiver. Health care providers are empathetic and listen to patient needs beyond the medical. They take into consideration my possible social determinants of health and other needs such as employment, education and shelter. This is embedded in health care delivery from the beginning and included in the health care provider s education and training. When discussing treatment, I feel well-informed about my options, the risks associated with those options, and am not forced to follow a specific treatment that would be against my wishes or goals. If recommended, I am offered multiple services to achieve best possible health outcome. If I need to be referred to another service, my information is shared with other health care providers so that I don t need to share my story multiple times. I am able to view my health record and the process does not require filling out forms and paying a fee. If I have questions or complaints about my care, there is a clear and easy process to share my concerns and I am not immediately referred to patient relations. A follow up phone call from the health care provider will be completed but if something comes up before then, I have the information of who to contact. Program and Service Design A strong culture of patient engagement, at the program and service design level, would look like and include: Patient engagement and health equity are built into organizational culture Care delivery is open and transparent involving patients in every part of the process

39 Report to the Board of Directors Page 5 Organizational structures and care delivery are co-designed with patients (including francophone and indigenous) Organizations co-build patient feedback into the design of services Patients are informed on all aspects of their care, and empowered to provide feedback Examples of what a strong culture of patient engagement would look like at the programs and services level: Organizations demonstrate the needs of patient, families and caregivers in their process designs. Organizations consciously plan opportunities and protect time to engage with patients, families and caregivers. They let the patient lead the conversation. Through collaboration and based on best practices, organizations continually gather information about patient experience and use this information to make improvements or innovate. Patients, families and caregivers are aware of how they can provide their feedback and insights about their care delivery and the organizations facilitate the process by giving them the necessary information or tools (for instance a suggestion box, an address, etc.) to do so. Patients, families and caregivers participate equally in meetings where decisions are being made about programs and services and offer insights about care delivery design, hours of service, language and cultural considerations, and the outcomes that are important to them and should be measured. Organizations demonstrate the needs of patient, families and caregivers in their process designs Organizational structures are designed with patients, families and caregivers in mind and make it easy for patients, families and caregivers to navigate the buildings and easily find the medical or administrative services they are referred to. Organizations look at all of the needs of the person (including housing, transportation, accessibility) as well as the community needs (coordinated services around the patient) Ex. all appointments booked in same day to alleviate multiple visits ) Embrace the opportunity to work with multiple populations to add value to programs and services and serve all patients (francophone, Indigenous) Patient engagement and health equity is built into the culture of the organization Patient, family and caregiver representatives are embedded in all operational work. Projects are required to demonstrate how they incorporated patient, family and caregiver feedback. Building programs that provide opportunities for patients to learn from each other Policy, Strategy and Governance A strong culture of patient engagement, at the policy, strategy and governance level, would look like and include: Policies are accessible, easily understood, and culturally safe for patients Patients are included in designing, decision-making and policy development of the health care system Patient experience is part of the decision-making process Patients know about and have access to decision makers at all levels

40 Report to the Board of Directors Page 6 Examples of what a strong culture of patient engagement would look like at the system policies, strategies and governance level: Policies are in a format that can be easily read and understood, no jargon is used. Policies are available in both official languages Policy documents are easy to find and access Internal policies/processes are in place for francophone and Indigenous populations Patients, families and caregivers are asked to participate fully at all strategy or governance tables / groups as they are a valued, respected participant and contributor to the discussion System-level decisions are not only guided by the bottom line but would consider the patient experience and prioritize the population health needs There are effective ways, based on best practices, to continually gather information about patient experience at the system-level and use this information to make improvements or innovate Patients, families and caregivers are involved / engaged in the decision making process around strategy and system design. System design improvements tackle challenging issues and not just the low hanging fruit Patients, families and caregivers are actively engaged in policy development. Patient, family and caregivers are consulted before polices are made at the ministry/lhin level Patients, families and caregivers know about and have access to all levels of decision makers. There should be transparency about how patients can provide input to governance at an appropriate level. The Patient and Family Advisory Committee will be using the guiding principles outlined in Health Quality Ontario s Patient Engagement Framework, partnership, responsiveness, empowerment, learning, transparency, and respect to guide their plan. In addition, the guiding principles developed by the South West LHIN Executive Advisory Group, November 2016, will be applied to the LHIN patient engagement work and Patient and Family Advisory Committee s decisions. These guiding principles are aligned to the provincial guiding principles and include: Person and caregiver centered Equitable and aligned to what specific populations need Integrated across sectors and systems Borderless access to care Trust and respect among partners Transparency Sustainability

41 Appendix B Driver Diagram

42 Report to the Board of Directors South West LHIN Musculoskeletal (MSK) Strategy Implementation Update Meeting Date: April 17, 2018 Agenda item 4.9 Submitted By: Kelly Gillis, Interim Co-Chief Executive Officer, Vice President, Strategy, System Design & Integration Shirley Koch, Sub-Region Director Huron Perth Andrea McInerney, Manager of Quality Improvement Submitted To: Board of Directors Board Committee Purpose: Information Decision Overview The South West LHIN continues work with our provincial and local partners on the implementation of the provincial MSK Strategy which involves a new standardized pathway for patients with hip and knee osteoarthritis (OA) and low back pain. New to the South West will be a single central intake office for the Region and inter-professional assessment within 2-4 weeks of referral from Primary Care. Key benefits of the strategy will include: increased supports for primary care, reduced variation in wait times for patients, reduced unnecessary diagnostic imaging, and improved patient experiences. The model below illustrates the provincial model for the two pathways:

43 Report to the Board of Directors Page 2 Funding Over the next three years, the Province will invest $245 million to expand models of care for highly prevalent conditions and improve specialist access, including new digital solutions to streamline consults and e-referrals. In 2017/18, this included: $17M for expanding MSK intake and assessment across all LHINs (Central Intake Assessment Centre and Inter-professional Spine Assessment and Education Clinics) plus $10M for digital solutions (such as ereferral and econsult). In December of 2017, the South West LHIN received local funding details outlining ~$1.6M annual (base dollars) to support this new pathway of care. One-time project initiation resources have also been provided to support project management and clinical sponsorship through to 2018/19 recognizing this work requires a multi-year implementation approach. South West LHIN MSK Strategy Governance Project sponsors are Cathy Vandersluis, VP, Patient Centred Care LHSC and Sue McCutcheon, Director, Planning and Integration and Regional Programs, South West LHIN. Formal committee and working group structures were launched in the fall 2017 to support the strategy, including the Steering Committee, the Clinical Advisory Board, and a working group. These groups meet regularly and include representation from 3 patient advisors, surgical champions for hip, knee and spine, a primary care lead, all South West Ortho sites, medical secretaries, project manager, process improvement advisors, South West Self- Management Program, Partnering for Quality, and LHIN co-leads (Shirley Koch, Sub Region Director Huron Perth, and Andrea McInerney, Manager of Quality Improvement). Progress to Date Steering Committee membership confirmed with representation from all 6 Ortho hospitals across the South West The working group meets every two weeks with a focus on the advancement of the key elements of the service delivery model Clinical Advisory Board (CAB) established and meeting monthly to provide surgical/clinical expertise required for key clinical components of the model Engagement of Primary Care and Allied Health Professionals, Community based Providers, and community partners such as the Arthritis Society to better understand non-surgical management resources available today Communication with Hospital Chief Executive Officer and Hospital Chief Nursing Executive forums via regular updates Core project team members continue to liaise with provincial colleagues via regular webinars to inform and receive updates on standardized tools and resources to be used across the province Novari e-request has been selected as the Central Intake software for this strategy and future coordinated access models in the South West LHIN Regular meetings meeting with Novari and other provincial partners using this technology Next Steps LHIN Board approval for the allocation of MSK base resources to South West LHIN Provider(s) expected May 2018 Recruitment and selection process for two Advanced Practice Leaders to champion the assessment component of the pathway. A staggered recruitment approach will then be used for additional program staff including Assessors and Central Intake Administrative staff. Determination of the location of the Assessment Centres across all sub-regions in the South West LHIN Further engagement with Primary Care and Allied Health professionals to inform program design Support for building new forms into EMRs will be enabled by the Partnering for Quality Team Implementation and central intake go-live in Quarter 2, 2018/19

44 Report to the Board of Directors South West LHIN Report on Performance Scorecard /18 Quarter 3 Meeting Date: April 17, 2018 Agenda Item 4.10 Submitted By: Mark Brintnell, Vice President, Quality, Performance and Accountability Nicole Robinson, Director, Performance Improvement Submitted To: Board of Directors Board Committee Purpose: Information Decision Purpose The purpose of this report is to highlight 2017/18 third quarter results monitored as part of interim performance reporting for the South West LHIN organization. Monitoring and reporting performance is important not only to communicate and demonstrate how the LHIN is delivering on home and community care priorities and achieving an integrated health system for all, but also as a sign of our commitment to accountability and transparency to patients and communities. Background The scorecard in the attached Report on Performance tracks progress on four high-level or Big Dot measures (focused on longer-term improvement), and associated indicators selected to demonstrate how we are doing against our Integrated Health Service Plan (IHSP) objectives, Ministry-LHIN Accountability Agreement (MLAA) performance obligations, and additional priorities and goals. Select one-page Priority Summaries accompany the Report on Performance and, along with an interactive web-based performance e-tool, offer further detail for select system measures. Backgrounder and Technical Specifications documents complement the Report on Performance and are available with the other tools and reports on the South West LHIN website at These latter two documents have been updated to include all home and community care service delivery measures. Highlights of the 2017/18 Q3 Report on Performance: Big Dot 1: Self-Reported Health Status the percentage of South West LHIN respondents to the Canadian Community Health Survey reporting their health as very good or excellent is 60.9%. By the end of FY 2018/19, we aim to reach 63%. This measure will include one more annual update prior to the close of IHSP

45 Report to the Board of Directors Page 2 Big Dot 2: Faster Access to Care in the Community three components that describe access to key community services make up this Big Dot: wait time for mental health case management, receiving a personal support worker (PSW) visit within five days, and timely access to a primary care provider. Two of the three component measures showed improvements from baseline in the most recent quarter and, together, the net result means access to care in the community is almost back up to where were were at baseline. Our goal over three years is to see 20% faster access across these community services. Big Dot 3: Satisfaction with Health Care in the Community the percentage of adults who reported they were very satisfied or somewhat satisfied with health care in their community is 88.8%, a small improvement from baseline. Over three years, we aim to reach 92%. Big Dot 4: Value Realized by Reducing Hospital Visits and Days reducing readmissions to hospital, reducing unnecessary Emergency Department (ED) use for conditions best treated in primary health care settings, and reducing the rate at which people are hospitalized for ambulatory care sensitive conditions (ACSC) that could be managed in the community represent three components that quantify costs that can be avoided or value that can be realized if improvements are made. Over three years, we aim to realize $11.7 million in cost avoidance. To-date, worse-than-targeted rates for readmissions, hospitalizations for ACSC, and unnecessary ED use translate into a cumulative $4.8 million unnecessarily spent supporting these readmissions, hospitalizations, and ED visits over the first half of IHSP Next Steps 1. The interim Report on Performance will continue be updated and communicated quarterly to the Board and to the public via the South West LHIN website, through to the end of fiscal 2017/ Building from the narrowed priority focus outlined in the newly drafted Annual Business Plan (ABP) , the LHIN team has taken an improvement approach, and has developed driver diagrams for each of the priority goals within the ABP. As part of this work, the team is working to develop an approach and structure for the design of cascading scorecards including a focused set of indicators that align to the expanded LHIN role, and to enable prioritization of existing reporting and monitoring needs of the new LHIN organization. Board and leadership engagements are being planned through Spring and Summer 2018 to enable a staged reporting launch in the Fall As a key enabler to the above, the development of a Strategy Management System is underway within the South West LHIN. As part of this work, establishing clear accountability and responsibility for monitoring, reporting, and improvement is key. Mapping of internal team/ committee structures for the new organization is underway to enable focused improvement conversations related to performance. In addition, the LHIN team is working through recommendations regarding a single measurement delivery platform, (a new technology solution to support internal operational, and external reporting and monitoring). 4. A focus on sub-region variations in performance will follow so that opportunities to improve through collaboration and integration may be identified. The LHIN team is working with subregion partners to prioritize opportunities for improvement, and ensure that action plans are established and implemented. Attachment: 2017/18 Q3 Report on Performance

46 REPORT ON PERFORMANCE Quarter 3, 2017/18

47 Report on Performance in the South West LHIN Monitoring and reporting performance is important not only to communicate and demonstrate how the South West LHIN is achieving an integrated health system for all, but also as a sign of our commitment to accountability and transparency to our community. Quality Care, Improved Health, Better Value these are the triple aim goals of the South West LHIN to improve health outcomes, the experience of care, and value for money, as outlined in our Integrated Health Services Plan (IHSP). Report on Performance Scorecard and Big Dots A set of four high-level or Big Dot measures, 25 system level measures, and 20 home and community Care service delivery measures have been selected to track progress and demonstrate how we are doing against our strategy, and stated priorities and goals. While these measures and Big Dots align to the South West LHIN s triple aim system goals, they do not summarize or reflect all of the South West LHIN s initiatives. Report on Performance Summary Reports (Priority Summaries) Performance is measured quarterly against seven priority areas and key objectives identified within the IHSP. Each one-page report summarizes performance and actions underway to impact performance Quarter 3, 2017/18

48 Report on Performance Scorecard Self-Reported Health Status Faster Access to Care in the Community Satisfaction with Health Care in the Community Value Realized by Reducing Hospital Visits and Days PRIMARY HEALTH CARE Baseline Target 16/17 16/17 16/17 16/17 17/18 17/18 17/18 Provincial LHIN Q1 Q2 Q3 Q4 Q1 Q2 Q3 Performance Rank 1 Percentage of Adults Who Were Able to See a Primary Care Provider on the Same Day or Next Day When They Were Sick 38.6% 40.0% 32.4% 29.3% 28.0% 33.3% 35.7% 41.0% % 6 2 Rate of Emergency Visits for Conditions Best Managed Elsewhere % Percentage of Acute Care Patients Who Have Had a Follow-Up With a Physician Within 7 Days of Discharge 41.3% 50.0% 44.5% 42.6% 42.3% 40.8% 42.0% % 10 HOME, LONG-TERM CARE AND COMMUNITY CARE Baseline Target 16/17 16/17 16/17 16/17 17/18 17/18 17/18 Provincial LHIN Q1 Q2 Q3 Q4 Q1 Q2 Q3 Performance Rank Percentage of Home Care Clients With Complex Needs Who Received 4 Their Personal Support Visit Within 5 Days of the Date That They Were 88.8% 95.0% 90.9% 87.9% 85.2% 89.7% 87.4% 90.2% % 8 Authorized for Personal Support Services 5 Percentage of Home Care Clients Who Received Their Nursing Visit Within 5 Days of the Date They Were Authorized for Nursing Services* 93.1% 95.0% 92.2% 92.1% 91.8% 92.3% 94.0% 94.1% % 14 90th Percentile Wait Time From Community for In-Home Services: 6 Application From Community Setting to First Service (Excluding Case 21 days 21 days Management)* Percentage of Home Care Clients With an Unplanned, Less Urgent 7 Emergency Department Visit Within the First 30 Days of Discharge From 8.8% 7.5% 8.0% 8.6% 8.5% 8.0% 8.4% % 11 Hospital* 8 Alternate Level of Care (ALC) Rate 11.1% 12.7% 12.4% 12.7% 11.3% 10.2% 12.0% 11.4% 11.3% 16.1% 2 9 Percentage of Alternate Level of Care (ALC) Days 8.9% 9.5% 8.8% 11.8% 10.7% 10.2% 8.1% 9.4% % 2 PREVENTING AND MANAGING CHRONIC CONDITIONS Baseline Target 16/17 16/17 16/17 16/17 17/18 17/18 17/18 Provincial LHIN Q1 Q2 Q3 Q4 Q1 Q2 Q3 Performance Rank 10 Hospitalization Rate for Ambulatory Care Sensitive Conditions Readmissions Within 30 Days for Selected HBAM Inpatient Grouper (HIG) Conditions 16.6% 15.5% 17.1% 17.6% 16.7% 16.5% 17.2% % 11 MENTAL HEALTH AND ADDICTION SERVICES Baseline Target 16/17 16/17 16/17 16/17 17/18 17/18 17/18 Provincial LHIN Q1 Q2 Q3 Q4 Q1 Q2 Q3 Performance Rank 12 Average Wait Time for Mental Health Case Management 29 days 21 days Repeat Unscheduled Emergency Visits Within 30 Days for Mental Health Conditions 17.6% 16.3% 17.9% 18.9% 18.6% 18.1% 18.3% 18.8% % 6 14 Repeat Unscheduled Emergency Visits Within 30 Days for Substance Abuse Conditions 23.7% 22.4% 26.4% 26.3% 23.2% 22.5% 26.9% 26.5% % 4 15 Mental Health and Substance Abuse Hospitalization Rate HOSPITAL-BASED CARE Baseline Target 16/17 16/17 16/17 16/17 17/18 17/18 17/18 Provincial LHIN Q1 Q2 Q3 Q4 Q1 Q2 Q3 Performance Rank 16 90th Percentile Emergency Department (ED) Length of Stay for Complex Patients 8.0 hours 8.0 hours th Percentile Emergency Department (ED) Length of Stay for Minor/Uncomplicated Patients 3.6 hours 4.0 hours Percentage of Priority 2, 3 and 4 Cases Completed Within Access Target for % 90.0% 80.3% 84.0% 87.0% 87.0% 83.0% 85.0% 84.0% 71.0% 6 CT Scan 19 Percentage of Priority 2, 3 and 4 Cases Completed Within Access Target for MRI Scan 33.0% 90.0% 34.4% 40.3% 54.2% 53.0% 54.0% 44.0% 49.0% 39.0% 2 20 Percentage of Priority 2, 3 and 4 Cases Completed Within Access Target for Hip Replacement 73.0% 90.0% 58.0% 46.0% 57.0% 41.0% 49.5% 44.0% 46.4% 78.0% Percentage of Priority 2, 3 and 4 Cases Completed Within Access Target for Knee Replacement 72.0% 90.0% 59.0% 41.0% 44.0% 46.0% 47.5% 43.0% 38.9% 73.8% Health Based Allocation Model (HBAM) Variance 5.5% 3.3% Hospital Standardized Mortality Ratio (HSMR) REHABILITATIVE SERVICES Baseline Target 16/17 16/17 16/17 16/17 17/18 17/18 17/18 Provincial LHIN Q1 Q2 Q3 Q4 Q1 Q2 Q3 Performance Rank 24 Length of Stay Efficiency for Inpatient Rehabilitation HOSPICE PALLIATIVE CARE Baseline Target 16/17 16/17 16/17 16/17 17/18 17/18 17/18 Provincial LHIN Q1 Q2 Q3 Q4 Q1 Q2 Q3 Performance Rank 25 Percentage of Palliative Care Patients Discharged From Hospital With Home Support 82.3% 95.0% 82.9% 78.3% 83.1% 87.3% 85.2% 80.2% % 10 Italicized items are Big Dot components Bolded items are 2017/18 MLAA indicators * 2017/18 Quality Improvement Plan (QIP) indicators Achieved Target LEGEND Within 10% of Target > 10% From Target Shading reflects evaluation against target during the IHSP time period assessed; current targets may differ from those previously applied Quarter 3, 2017/18

49 HOME, LONG-TERM CARE AND COMMUNITY CARE (Service Delivery Measures) Home and Community Care Report on Performance Scorecard SAFETY Baseline Target 16/17 16/17 16/17 16/17 17/18 17/18 17/18 Provincial LHIN Q1 Q2 Q3 Q4 Q1 Q2 Q3 Performance Rank 26 Falls: Percentage of Adult Long-Stay Home Care Patients Who Record a Fall on Their Follow-Up (RAI-HC) Assessment* 38.8% 34.0% 38.6% 42.3% 41.8% 44.0% 40.1% 43.3% 42.7% 40.9% Percentage of Long-Stay Home Care Patients That Have Had Medication Reconciliation/Management Within the Last 180 Days 69.0% 80.0% 71.0% 68.0% 71.0% 67.0% 69.0% 71.4% 67.6% Missed Care: Overall Percentage of Missed Care Visits From South West LHIN Providers 0.32% 0.05% 0.20% 0.31% 0.39% 0.32% 0.36% 0.91% 0.94% - - EFFECTIVENESS Baseline Target 16/17 16/17 16/17 16/17 17/18 17/18 17/18 Provincial LHIN Q1 Q2 Q3 Q4 Q1 Q2 Q3 Performance Rank 29 Percentage of Home Care Clients With an Unplanned, Less Urgent Emergency Department Visit Within the First 30 Days of Discharge From Hospital* 8.8% 7.5% 8.0% 8.6% 8.5% 8.0% 8.4% % 11 Percentage of Home Care Clients who Experienced an Unplanned Readmission to % 16.5% 16.1% 16.7% 17.3% 16.5% 17.8% % 10 Hospital Within 30 Days of Discharge From Hospital* 31 Number of Care Conferences 3,431 3,500 3, Complex Patients: Patients with MAPLe Scores High/Very High Living in the % 55.0% 56.4% 57.2% 57.3% 57.4% 57.2% 57.2% 57.4% 54.7% 2 Community Supported by LHIN Home and Community Care 33 Home First Impact: Estimated Number of Hospital Days Saved 201, , , Health Links: Total Number of Patients Supported by Coordinated Care Plans (CCP) ACCESSIBLE Baseline Target 16/17 16/17 16/17 16/17 17/18 17/18 17/18 Provincial LHIN Q1 Q2 Q3 Q4 Q1 Q2 Q3 Performance Rank Percentage of Home Care Clients With Complex Needs Who Received Their 35 Personal Support Visit Within 5 Days of the Date That They Were Authorized 88.8% 95.0% 90.9% 87.9% 85.2% 89.7% 87.4% 90.2% % 8 for Personal Support Services* 36 Percentage of Home Care Clients Who Received Their Nursing Visit Within 5 Days of the Date They Were Authorized for Nursing Services* 93.1% 95.0% 92.2% 92.1% 91.8% 92.3% 94.0% 94.1% % Wait Time - Discharge to Initiation: 90th Percentile Wait Time From Hospital Discharge to Service Initiation (Hospital Setting) 8 days 7 days th Percentile Wait Time From Community for In-Home Services: Application From Community Setting to First Service (Excluding Case Management) 21 days 21 days Percent of Palliative /End of Life Patients who Died in their Preferred Place of Death* 64.0% 70.0% 59.9% 64.6% 66.3% 66.8% 65.3% 62.8% 68.1% 64.0% 7 40 Adult Day Program Occupancy 94.0% 90.0% 94.0% 94.0% 95.0% 92.0% 96.0% 95.7% 97.9% - - PATIENT-CENTERED Baseline Target 16/17 16/17 16/17 16/17 17/18 17/18 17/18 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Provincial Performance LHIN Rank 41 Patient and Caregiver Overall Rating of South West LHIN Services* 93.6% 95.0% 93.5% % - 42 Patient and Caregiver Overall Rating of Facilitation of Care by Care Coordinator 93.4% 95.0% 93.1% % - 43 Patient and Caregiver Overall Satisfaction With Connection to Community Services 80.7% 80.0% 79.9% % - 44 Patient and Caregiver Complaints per 1,000 Patients - South West LHIN 0.85 TBD Patient and Caregiver Complaints per 1,000 Patients - Provider 2.44 TBD Italicized items are Big Dot components Bolded items are 2017/18 MLAA indicators * 2017/18 Quality Improvement Plan (QIP) indicators - lagged data/not available Achieved Target LEGEND Within 10%of Target > 10%From Target Shading reflects evaluation against target during the IHSP time period assessed; current targets may differ from those previously applied Quarter 3, 2017/18

50 The Big Dots 2019 Self-Reported Health Status Percentage Reporting Very Good or Excellent Health 2018 Current = 1% Decline in Reported Health 2017 Current = 60.9% Baseline = 61.6% Faster Access to Care in the Community Improvement in Access for Key Community Services (Mental Health, PSW and Primary Care) 3-Year Target = 63.0% 2019 Current = 8% Slower Access Year Target = 19% Faster Access 2019 Wait Time for Mental Health Case Management Current = 35 Days Baseline = 29 Days Target = 21 Days Personal Support Worker (PSW) Within 5 Days Current = % Baseline = 88.9% Target = 95.0% Timely Access to a Primary Care Provider Current = 41.0% Baseline = 38.6% Target = 47.0% Satisfaction with Health Care in the Community Overall Satisfaction With Health Care in the Community % Increase in Satisfaction 2017 Current = 88.8% Baseline = 88.3% Value Realized by Reducing Hospital Visits and Days Savings Realized by Reducing Unnecessary Visits and Admissions to the Hospital LEGEND 3-Year Target = 92.0% 2019 Current = $4.8M Unnecessarily Spent Year Target = $11.7M Realized No Overall Progress or Negative Overall Progress Readmissions Within 30 Days for HIG Conditions Current = $1.4M Unnecessarily Spent Baseline = $151,788 Unnecessarily Spent Target = $1.8M Realized Emergency Visits Best Managed Elsewhere Current = $74,880 Unnecessarily Spent Baseline = $1.7M Unnecessarily Spent Target = $2.5M Realized Hospitalizations for Ambulatory Care Sensitive Conditions Current = $3.3M Unnecessarily Spent Baseline = $5M Unnecessarily Spent Target = $7.4M Realized LEGEND Positive Progress Negative Component Progress Quarter 3, 2017/18

51 Primary Health Care How Will We Know We Have Been Successful? Faster access to primary care when you are sick Fewer visits to the Emergency Department (ED) for conditions that are better managed in primary care More people see their primary care provider following discharge from hospital How Are We Doing? Target: 9.2 Over the past year, 41% of residents across the South West LHIN reported they were able to see a primary provider on the same or next day when they were sick. Performance on this measure has been steadily improving over the past year, moving from 12 th to 6 th amongst the 14 LHINs. Although less than half of respondents reported same/next day access to primary care services, 66% felt that the wait time they did experience for their appointment felt about right (Ontario: 65%). The South West LHIN continues to have the 2 nd highest rate of avoidable ED use in the province despite improvements observed in Q2 17/18. 60% of residents living in the South West LHIN who responded to the Health Care Experience Survey over the past year reported difficulty accessing medical care in the evenings/weekends and on holidays without going to the ED (Ontario: 53%). What Is Impacting Performance? Initiating & Planning: a) Implementation of the Sub-region Primary Care Approach Primary Care Alliances were launched in each subregion in Q3 17/18. Membership represents the broader primary care sector and will work to identify local care issues, needs and interests in order to improve patient access, quality and experience of care. b) Practice Facilitation Partnering for Quality is developing a new program suite for practice facilitation, including assistance with Advanced Access. Executing: a) Improving Access to Team-Based Care - The London Middlesex sub-region became an early adopter of a facilitatedoutreach approach to connect primary care providers and their patients to interdisciplinary health professional resources. b) Targeted Recruitment - The South West LHIN is working with HealthForce Ontario to recruit family physicians in high-needs communities. In Q3 17/18 several vacancies in existing primary care practices were filled in Grey Bruce, Elgin, and Oxford. c) Primary Care Provider Orientation in December, the South West LHIN and HealthForce Ontario launched an orientation program for newly practicing primary care providers. This program will support a shared understanding of resources and services available to support their practices and patients. Monitoring & Closing: None at this time. Potential Future Opportunities and Considerations A business case to expand access to Interdisciplinary Primary Care Teams was submitted to the Ontario Ministry of Health and Long Term Care in Q4 17/18. Announcement of funding is expected in Q1 18/19. Quarter 3, 2017/18

52 Home, Long-Term Care, and Community Care How Will We Know We Have Been Successful? Faster access to care provided by personal support workers and nursing in the community Fewer people waiting in the hospital for care in the community How Are We Doing? In Q2 17/18, the percentage of clients receiving their first nursing visit within the five day wait-time target ranked lowest amongst the 14 LHINs. Performance has steadily improved in the last three quarters and is approaching the provincial target of 95%. The South West LHIN is consistently among the top four top performing LHINs on Alternate Level of Care (ALC) rate. Over the past five quarters, the ALC rate at London Health Sciences Centre has been meeting the provincial/lhin target, accounting for approximately 23% of the total ALC open cases in the South West LHIN. While several small community hospitals have high ALC rates, they collectively contribute to less than 20% of total ALC open cases. At the end of Q3 17/18, 59% of patients deemed ALC in the South West LHIN were waiting for Long-Term Care (LTC) beds and 7% of total ALC days were contributed by patients waiting for Assisted Living spaces. Of those waiting for Assisted Living, 74% of ALC days were contributed by post-acute clients with mental health and behavioural challenges. What Is Impacting Performance? Initiating & Planning: a) Behavioural Support Unit - Additional Behavioural Support Units in LTC Homes will enhance discharge options for patients with mental health and behavioural challenges. b) Transitional Care Program (TCP) - TCP is being implemented to create alternative discharge options for target clients. Executing: a) Coordinated Access - Developing and implementing tools and processes to optimize coordinated access. b) Home First Refresh The South West LHIN hospitals are implementing Home First Refresh. c) Leadership and Oversight for Improving Patient Access and Flow - With leadership provided by the Chief Nursing Executive (CNE) Leadership Forum, four key priorities have been identified to support improvement. Monitoring & Closing: a) Level of Care and Caregiver Respite Funding - Expand respite service provision to Homecare clients with complex care needs and their caregivers. b) Assisted Living - Achieve modest improvements by investing to implement additional Assisted Living supports in selected communities. c) Behavioural Supports Ontario Coordinate prevention, care and educational strategies across sectors. Potential Future Opportunities and Considerations Quantify capacity needs of Home and Community Care and Long-Term Care to support proactive plans to enhance services and supports. Quarter 3, 2017/18

53 Preventing and Managing Chronic Conditions How Will We Know We Have Been Successful? Fewer people need to be hospitalized for chronic conditions Improved transitions of care following a hospital stay How Are We Doing? In Q2 17/18, rates of avoidable admissions for ambulatory care sensitive conditions were 5% above the South West LHIN s target. Readmission rates in Q1 17/18 were above expected for acute myocardial infarction (+51%), pneumonia (+8%) and gastrointestinal disorders (+8%). Excess readmissions were largely attributable to additional readmitted cases at St. Thomas Elgin General Hospital, and a few cases spread across the regions small rural sites. Readmission rates for chronic obstructive pulmonary disease (COPD) remain below the LHIN's expected rate (8%). Declining readmissions for COPD reflect the continued efforts of the London Middlesex and Grey Bruce Health Links, the Connecting Care to Home Project (CC2H), and Telehomecare to improve coordination of care for patients with mild to moderate COPD. What Is Impacting Performance? Initiating & Planning: a) Indigenous-led Care Coordination Pathway - An Indigenous-led early test of change for culturally safe coordinated care planning is currently participating in Cohort 12 of the IDEAS Advanced Learning Program. Executing: a) Health Links - Over 2,250 coordinated care plans had been completed by the end of Q3 17/18, covering 5.1% of the estimated target population across the South West LHIN. Residents supported by Coordinated Care Plans have experienced a 26% reduction in Emergency Department visits, a 35% reduction in unplanned admissions to hospital, and a 49% reduction in days stayed in hospital within six months of their initial care conference. Grey Bruce, Huron Perth and London Middlesex Health Links are all currently engaged in planning for sustainability. b) Connecting Care to Home (CC2H) - Outcomes of the CC2H project in London suggest an estimated 50% of inpatient days and 50% of acute hospital and community care costs could potentially be diverted by supporting patients with mild to moderate COPD and CHF through bundled care. Work is underway to spread the CC2H model to residents of Elgin and Oxford through St. Thomas Elgin General Hospital with enrollment expected in Q1 18/19. c) South West Self-Management The Self West Self-Management program offered 25 patient, one caregiver and 22 provider workshop/courses throughout Q3 17/18. Self-paced elearning courses are now available online. Monitoring & Closing: None at this time. Potential Future Opportunities and Considerations The South West LHIN is dispersing leadership for coordinated care planning, actively onboarding Primary Care and Community Support Service agencies to Health Partner Gateway, and embedding the Health Links Approach to Care into sub-region priorities and planning. Quarter 3, 2017/18

54 Mental Health and Addiction Services How Will We Know We Have Been Successful? Fewer people returning to the Emergency Department (ED) due to better connections to community supports Fewer people needing to be hospitalized for mental health conditions Fast access to mental health care in the community How Are We Doing? The South West LHIN ED revisit rates for mental health and substance abuse conditions have been better than provincial performance for the past four years, although rates did rise throughout the most recent quarter. The total volume of both index visits and revisits for mental health declined in Q2 17/18 with the greatest declines observed at London Health Sciences Centre (LHSC). Several small community hospitals experienced significant increases in the volume of index and revisit cases, resulting in an overall rise to the LHIN s revisit rate. The total volume of index visits for substance use at LHSC increased by 10% from Q1 to Q2 17/18, while revisits increased by 12%. 27% of all revisits indexed at LHSC returned to an ED within 24 hours of their initial visit; half of all revisiting cases returned within 72-hours. What Is Impacting Performance? Initiating & Planning: a) Acute Bed Planning 24 additional mental health beds were funded in Q3 17/18 at London Health Sciences, Victoria Hospital to increase capacity. These beds were operationalized in Q4 17/18. Capacity Planning The South West LHIN released the Mental Health and Addictions Capacity Planning Report along with actionable recommendations in Q3 17/18. Prioritization of recommendations is currently underway. b) Supportive Housing - Planning is underway for investment in supportive housing for people with mental health and addiction conditions; additional housing opportunities are being explored through collaboration with housing service advisors and municipalities. c) Emergency Medical Services (EMS) In Q3 17/18 the South West LHIN Board of Directors approved plans to divert clients utilizing Middlesex London Emergency Medical Services (MLEMS) to the Crisis Centre where appropriate. Executing: a) Peer Support Strategy - Partner integrations will be completed by Q1 18/19. b) Rapid Access Addiction Medicine Clinics Grey Bruce Health Services is working to increase the availability of clinics. Monitoring & Closing: a) Crisis Centre Canadian Mental Health Association (CMHA) Middlesex is pursuing capital funds to co-locate five additional stabilization beds to the Crisis Centre. b) Reach Out Reach Out is currently receiving upwards of 1,000 calls per month. Potential Future Opportunities and Considerations Enhance cross-sector partnerships to provide preventative services and transitional/urgent supports to divert ED visits. Work with cross-sector partners to develop strategies to respond to increasing drug-induced psychoses and opioid crises. Quarter 3, 2017/18

55 Hospital-Based Care How Will We Know We Have Been Successful? Faster access to care in Emergency Departments and to surgical and diagnostic procedures Fewer people dying in hospital Improved cost alignment to provincial standard How Are We Doing? In Q3 17/18, the South West LHIN ranked 2 nd amongst the 14 LHINs for Emergency Department Wait Times for Complex patients. The LHIN has experienced a 4% increase in ED visits volumes in Q3 17/18 in comparison to same time period in FY 16/17. In Q3 17/18, the South West LHIN ranked 4 th amongst the 14 LHINs for Diagnostic Imaging, performing 70% of Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans within the access target. Eight of ten hospital sites are completing more than 90% of CT scans within the access target. None of five sites are completing 90% of MRI scans within the access target, but all sites are performing above their HSAA targets and corridors. What Is Impacting Performance? Initiating & Planning: a) Regional Medical Imaging Integrated Care Project Implementing strategies to standardize quality, appropriateness, and access through integrating medical imaging services. b) Alternate Level of Care (ALC) Avoidance and Patient Flow - Chief Nursing Executive sponsored Home First Refresh is underway to address ALC and discharge planning leveraging provincial best practices and a learning collaborative format, as well as a review of services and supports in place for extraordinary needs patients. c) Development of Regional Access and Flow Memorandum of Understanding - inclusive of year-round surge and escalation plans. Executing: a) Pay for Results and Knowledge Transfer Learning Collaborative Hospital sites are progressing their 2017/18 action plans targeting improvement in patient flow opportunities. Since FY 2012/13, there has been an estimated 7.1% improvement over baseline in wait times for admitted patients. Monitoring & Closing: a) Quarterly ED Learning Collaborative Continue to utilize this group and the Service Accountability Agreement review process to monitor ED performance at the organizational level. b) Regional OneNumber Access and Flow Protocol - Updated by the Chief Nursing Executives to strengthen the language and commitment to ensure timely repatriations/transfers supporting care close to home and regional patient flow. Potential Future Opportunities and Considerations: Regional Medical Imaging Project to identify centralized intake opportunities and provide recommendations for future phases. Quarter 3, 2017/18

56 Rehabilitative Services How Will We Know We Have Been Successful? More people able to access rehabilitative services to maximize recovery How Are We Doing? Target: 1.06 The SW LHIN length of stay efficiency for inpatient rehabilitation has remained steady over the past five quarters, ranking 10 th in the province amongst the 14 LHINs. Clients of inpatient rehabilitation in the South West LHIN experience less improvements in their Functional Independence Measure (FIM) scores per day compared to the provincial average. Among the top three high-volume Rehabilitation Client (RC) Groups, the South West LHIN ranked 11 th for Stroke, 6 th for Medically Complex, and 7 th for Orthopedic Conditions. The LOS efficiency for Stroke is attributed to low FIM score change. What Is Impacting Performance? Initiating & Planning: a) Assess and Restore - Capacity building to develop expertise and skill in the treatment of frail seniors and early identification of patients for direct referral to support improved recovery. b) Evidence-Informed Rehab Capacity Planning - Developing a model of care that will support a patient s rehabilitative journey across the continuum, including recommendations to improve prevention, Acute Care rehabilitation, and community programs. c) Transforming Musculoskeletal Care Developing an intake process so that patients receive more timely assessments and consults. Executing: a) Senior Friendly Hospital - Improvements in services for seniors that will result in a better rehabilitative journey. b) Quality- Based Procedures (QBP) Implementation - Stroke, Hip and Knee best practices are being implemented which positively impact LOS efficiency. c) Coordinated Access - Ensure rehabilitation resources are accessed by patients who benefit from that level of care. d) Stroke Realignment - Realigning stroke care from 28 facilities to seven to improve acute and rehabilitative outcomes for stroke survivors. e) Provincial Bedded Definitions Framework - Standardizing Rehabilitation and Complex Continuing Care (CCC) bed terminology, eligibility criteria and resources to improve access to the right care and support system-level planning. Monitoring & Closing: FIM efficiency has been included in the South West LHIN Rehabilitative Care Committee dashboard for discussion. Potential Future Opportunities and Considerations: FIM efficiency is being used to engage Health Service Providers in quality improvement discussions. Develop and support a rehabilitative approach within Acute Care settings to prevent functional decline and reduce Rehabilitation, CCC, and Long-Term Care referrals. Quarter 3, 2017/18

57 Hospice Palliative Care How Will We Know We Have Been Successful? More people with palliative care needs being supported at home How Are We Doing? Four out of every five palliative care patients identified in the South West LHIN are being discharged from hospital to home-based settings with supportive care in place. Discharges from hospital to home with palliative support declined slightly again in Q2 17/18. This was attributable to a number of palliative patients who were discharged home without documentation that supportive care was in place from London Health Sciences Centre. South West LHIN Home and Community Care Services, Health Links, and Secondary Level Outreach Consultation Teams are continuing to support an increasing number of palliative clients, families and care providers in home and community settings. Over 80% of clients supported by these services are dying in their place of choice, with the majority of deaths occurring in home and residential hospice. Average occupancy in residential hospice exceeded 80% at all three sites in Q3 17/18, confirming that the beds recently added at Chapman House (Grey Bruce) are being utilized. What Is Impacting Performance? Initiating & Planning: a) Expansion of Residential Hospice Expansion of residential hospice capacity for Huron Perth and Grey Bruce was approved by the South West LHIN Board of Directors in Q1 17/18; residential hospice planning and engagement is underway in Elgin b) Palliative Education - Spread of early identification strategies including Advanced Care Planning and Gold Standards Framework. c) Indigenous-led Coordinated Palliative Care Pathway - An Indigenous-led early test of change for culturally safe coordinated palliative care planning is currently participating in Cohort 12 of the IDEAS Advanced Learning Program. Executing: a) Expansion of Residential Hospice (Grey Bruce) - A two-bed expansion to newly constructed Chapman House was completed in Q1 17/18. b) Secondary Level Outreach - Community-based Secondary Level Palliative Care Outreach Consultation Teams are fully operational in Grey Bruce, Huron Perth, Oxford, and Elgin sub-regions. A Palliative Care Outreach model is being developed for Indigenous communities in London Middlesex and Grey Bruce. 70% of patients supported by their care providers and the outreach teams died at home or in residential hospice in Q3 17/18. Monitoring & Closing: None at this time. Potential Future Opportunities and Considerations The Palliative Care Capacity report was refreshed in Q2 17/18. Recommendations included a focus to guide the alignment of palliative care services planning to the Ontario Palliative Care Network s Action Plan 1: , released November Quarter 3, 2017/18

58 Report to the Board of Directors Board Committee Reports Agenda item 4.11 Meeting Date: April 17, 2018 Submitted To: Purpose: Board of Directors Information Only Audit Committee The committee last met on February 20 and the draft minutes are included in the consent section of this meeting package for acceptance. The next meeting of the Audit Committee is scheduled for 3 pm on Thursday, June 14, 2018 to receive and review the 2017/18 annual audit report and letter from Deloitte. Board-to-Board Reference Group The draft minutes from the February 8 meeting of the South West LHIN Board-to-Board Reference Group and the recommendation contained therein to amend the Terms of Reference are included in these meeting materials for the board s consideration their inclusion having been approved by the group via . A second memo with accompanying fact sheet have been developed with input from the group to further solicit governor interest in the Sub-region Board-to-Board Reference Groups to launch this fall, the deadline for expressions of interest having been extended from March 2, Governance & Nominations Committee The Governance Committee is scheduled to meet at 9 am on Friday, April 27 at the Queens Avenue office. The preliminary agenda includes board governance policy harmonization, debrief the April 23/24 board workshop, update on Sub-region Board-to-Board initiative, board and committee work plans, and a committee appointment recommendation. Quality Committee The Quality Committee met on March 6, 2018 and the draft minutes are included in the meeting materials for acceptance by the Board. Also, included in these meeting materials is a decision item pertaining to the approach to the accreditation process for the South West LHIN. The committee is next scheduled to meet on Tuesday, April 24 at 2:30 pm at the Queens Avenue office. The preliminary agenda includes a patient story, quality measures, accreditation readiness, provincial Quality Committee Guidelines, and an education piece about the South West Clinical Quality Table.

59 Report to the Board of Directors Board Director Reports Agenda item 4.12 Meeting Date: April 17, 2018 Submitted To: Purpose: Board of Directors Information Only Board Directors reported attending the following events. Linda Ballantyne March 28, 2018 Meeting of CEO Search Committee credential review April 3, 2018 CEO Search Committee Teleconference April 4, 2018 Meeting of CEO Search Committee candidate interviews Wilf Riecker March 28, 2018 Meeting of CEO Search Committee credential review April 4, 2018 Meeting of CEO Search Committee candidate interviews Cynthia St. John Planning for the board development day on April 24th Lyn has a great day in store for us Board-to-Board Reference Group discussions we are hopeful for some additional nominations Governance Committee meeting planning next Committee meeting is April 27th Aniko Varpalotai CEO selection committee: reviewing applications, and first round of interviews.

60 Report to the Board of Directors South West LHIN Accreditation Agenda item 5.1 Meeting Date: April 17, 2018 Submitted By: Linda Ballantyne, Board Member and Chair of Quality Committee Mark Brintnell, Vice President, Quality, Performance and Accountability Submitted To: Board of Directors Board Committee Purpose: Information Only Decision Recommended Motion THAT the South West Local Health Integration Network Board of Directors approves proceeding with a primer survey for the upcoming accreditation cycle. Purpose This report is meant to update on the organization s discussions with our LHIN Board Quality Committee and Accreditation Canada related to our interest in proceeding with a Primer survey as part of our accreditation commitment. The report also outlines steps and preparations to move forward. Background Accreditation Canada uses a full program called The Qmentum Accreditation Program to asses all aspects of an organization from a quality improvement lens. A pan-lhin effort was undertaken to work with Accreditation Canada to understand options to extend accreditation status. Accreditation Canada put forward 4 options (below) for each LHIN to consider. 1. Interim report submit a report on key safety and risk criteria. Receive one year accreditation award on home and community care, bringing accreditation status to Bridging Survey Visit in six months, have a bridging survey on home and community care (leadership and governance not included). Receive a two year accreditation award bringing status to Sequential Survey Visits sequential surveying begins on home and community care (leadership and governance not included). Receive a two year accreditation aware bringing status to 2020.

61 Report to the Board of Directors Page 2 4. Primer Survey Visit at six months, have a primer survey on home and community care and use instruments (tools) on patient safety, work-life and governance to learn and build organizational strength for the following survey cycle. Receive a two year accreditation award bringing status to Primer Survey is used for a new organization. Given the LHIN is a new organization, LHIN staff felt this option offered the most value for our organization. This approach provides the South West LHIN with an opportunity to extend its current Accreditation with Exemplary Standing, and plan for a small, introductory accreditation survey. This option was chosen because 1) the South West LHIN believes in the value of accreditation as a strong vehicle for quality improvement, 2) the organization believes accreditation will be valuable for the entire organization, not just for the Home and Community Care operations accreditation would have been applied to in the past, and 3) LHIN capacity. Individual LHINs are on different accreditation cycles and have opted for different options. For more information on the Primer Survey, Board members can view the Accreditation Primer Overview E-learning module, found at accreditation.ca or linked here. For the South West LHIN, our accreditation survey would occur in the Fall/Winter Given the organization s history and experience with accreditation, it is believed that this represents an acceptable time to prepare for the survey. Steps for a Primer Survey Pending LHIN Board approval, LHIN staff will work with Accreditation Canada to confirm timing and survey components. The following process and steps would need to be undertaken to prepare for the primer survey. 1. Selection of an internal Accreditation Steering Team The organization should establish a small, cross departmental leadership structure within the South West LHIN to oversee the Accreditation survey. The leadership structure should provide oversight to the planning process, progress against improvement plans, and on broad engagement throughout the organization. The team should be comprised of Senior Leadership and staff across multiple portfolios (clinical and administrative). 2. Selection of internal resources to support planning To support a successful survey, management should identify a small group of dedicated resources across the organization. These resources will be responsible for on-site survey preparation, supporting improvement activities and on reporting on progress against goals. 3. Selection of Primer Survey Team and Schedule In consultation with Accreditation Canada, the South West LHIN must develop an On-Site survey schedule to determine 1) which sites/regions will be visited 2) which areas/parts of the organization will be a focus of the survey 3) how many surveyors will be deployed for the survey? 4. Deployment of the Instruments As a part of the Primer Process, the organization can deploy three distinct surveys to staff, leaders and governors. These tools, known as instruments, would help the organization understand its current progress towards accreditation requirements. a. Patient Safety Culture Tool (LHIN staff recommend to use) b. Work-Life Pulse Survey (LHIN staff recommend to use) c. Governance Functioning Tool (LHIN staff recommend to use)

62 Report to the Board of Directors Page 3 5. Self-Assessment against Primer Standards In addition to the results of the Instruments, the leadership team will conduct a formal self-assessment to determine progress towards standards. 6. Quality Improvement Action Plan With the results of the Instruments and the Self-Assessment, management will create formal action plans for improvement prior to the survey. This may include the introduction of new policy, processes or training. The action plan will also serve as the method of reporting progress to the Board and Senior Leadership. 7. On Site survey Preparations A small dedicated team will prepare for the survey, including preparing the Board of Directors, management and staff with an overview of how the process will unfold, and in scheduling key staff / teams to meet with surveyors. It will also include preparing for a post-survey celebration. 8. Primer Survey On Site Typically, 1 to 3 days in length, the Primer survey will require multiple surveys traveling to various offices and teams, and engaging with patients, partners and stakeholders. 9. Primer Decision Based on the results of the survey, a decision will be rendered by Accreditation Canada. Next Steps The South West LHIN Board Quality Committee was supportive of the primer survey approach. Subject to the full Board s consideration of the motion, LHIN staff would finalize the details with Accreditation Canada and proceed to prepare for the primer survey. The Board Quality Committee would receive progress reports on the status of the process, with updates taken through to the Governance Committee and full Board.

63 Report to the Board of Directors Canadian Mental Health Association Elgin Branch Investigation Meeting Date: April 17, 2018 Agenda item 5.2 Submitted By: Mark Brintnell, Vice President, Quality, Performance and Accountability Submitted To: Board of Directors Board Committee Purpose: Information Decision Purpose The purpose of this report is to update the South West LHIN Board on the status of the investigation at Canadian Mental Health Association Elgin Branch. Background Based on concerns being raised concerning the governance, management and operations at CMHA Elgin, the South West LHIN exercised its authority to appoint an investigator in order to obtain a thirdparty assessment of the organization. On January 16, 2018, the South West LHIN Board passed a motion approving its intention to appoint an investigator to investigate CMHA Elgin related to the concerns with the organization. At its February 20, 2018 meeting, the South West LHIN Board passed the following motion: THAT the South West LHIN Board of Directors approve the appointment of Mr. Ron McRae as the Investigator under authority of Section 21.1 of Local Health System Integration Act (LHSIA) to investigate the Canadian Mental Health Association (CMHA) Elgin Branch related to reported governance, management and operational concerns and produce findings and any recommendations based on the review findings. The cost of the investigation will be paid by the South West LHIN. A terms of reference was established to guide the work of the investigator. LHIN Board Chair and senior staff met with CMHA Elgin Board Chair and Executive Director to review the terms of reference and discuss the overall approach to the work. At that point, the investigator initiated the investigation process. Current Status A draft report was delivered to the LHIN on March 29, 2018 and a copy was issued to CMHA Elgin for review and comment. CMHA Elgin prepared a written response which the LHIN forwarded to the investigator for review and consideration for the final report. A written copy of the investigator s assessment and response to CMHA Elgin s response was provided to CMHA Elgin.

64 Report to the Board of Directors Page 2 The Investigation Final Report was delivered to the LHIN on April 9, 2018 and the LHIN provided CMHA Elgin with a copy the same day. The final report is deemed a public document. The Board Chairs from both organizations held a call on April 9 th to confirm a final report was received and would be discussed at the upcoming April 17 th Board meeting. A copy of the final report can be requested through the LHIN office. The over-riding theme of the findings and recommendations contained in the report is that changes need to be made in all three areas of focus investigated. The findings confirm material limitations in governance, leadership and operations at CMHA Elgin. Next Steps CMHA Elgin was advised that the final report would be considered by the South West LHIN Board at its April 17 th meeting and that the LHIN would be back in touch with CMHA Elgin to discuss next steps.

65 Report to the Board of Directors 2018/19 LHIN Transfer Payment and LHIN Home Care Funding Update Meeting Date: April 17, 2018 Agenda item 5.4 Submitted By: Mark Brintnell, Vice President, Quality, Performance and Accountability Submitted To: Board of Directors Board Committee Purpose: Information Only Decision Purpose The purpose of this report is to update on known information pertaining to new funding allocations in 2018/19. Background New funding provided to the LHIN to support Health Service Providers (HSP) and LHIN-Delivered Home Care services is determined annually as part of the Ontario Budget. This year s Ontario Budget speech was delivered March 28 th and will need to be confirmed by the Ontario Legislature. Following approval of the budget, funding details are confirmed as amendments to the Ministry-LHIN Accountability Agreement MLAA) and communicated to LHINs. This process can take several weeks after the budget release and subsequent approval. The government continues to increase spending in health care. Total health sector budget for 2018/19 is $61.3 billion. Ontario is investing an additional $5 billion in health care over three years. Funding is to provide care across the health care system, including long-term care homes, home and community care, hospitals, primary care and key wait times. LHIN Home Care and Community Sector The South West LHIN has not yet received specific details on LHIN home care funding nor funding targeting our community sector partners. The Ontario Budget 2018 included a number of measures that would support LHIN-funded HSPs and LHIN-delivered community programs including: More integrated, high-quality mental health and addictions services Expanding supportive housing for mental health Expanding and improving Home and Community Care for Clients and Caregivers Investing in Ontario s Personal Support Workers Reducing the wait time for long-term care Improving support in school for children with special needs

66 Report to the Board of Directors Page 2 Hospital Sector In 2018/19, an additional $822 million will be invested in hospital operations, representing a 4.6% increase over last year. The South West LHIN s hospital sector base funding has been increased by $38,318,400 and new one-time funding totals $6,981,935 (subject to appropriation form the Ontario Legislature). Individual hospital base increases over 2017/18 funding levels range from 2% to 4%. Service enhancement highlights: - Over $1M or 398 new quality based procedures like cataracts, hip/knee replacements - Over $2M or 220 new quality based procedures like Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, Stroke - Over $1M or 4,054 one-time MRI hours - Over $250K or 498 one-time cataract procedures When compared to the funding assumptions used for the recent 2018/19 Hospital Service Accountability Agreements (H-SAA), the new confirmed funding is greater in every case but LHIN staff will be working with each hospital corporation to confirm material differences and ensure the new funds support maintain and/or enhancing certain services. Once the LHIN has final funding information, we will be working with our hospital partners to amend the H-SAA funding, service and performance schedules to incorporate the impact of the new funding. Major capital investments include London Health Sciences Centre s expansion of inpatient and outpatient clinics to increase access to the stem cell transplant program. South Bruce Grey Health Centre renovations to expand the emergency department, address aging infrastructure and optimize the use of existing space at the Kincardine site. Grey Bruce Health Services new construction at Markdale site. Long-Term Care Home (LTCH) The South West LHIN has not yet received specific details on South West LTCH funding levels. The Ontario Budget 2018 highlighted an investment of $300 million over three years in new funding, starting with $50 million in to hire a registered nurse for every home, and setting a goal of increasing the provincial average to four hours of daily care per resident by This will provide residents with more direct, one-on-one patient care, including nursing, personal support and therapeutic care. It will also ensure that every home will have staff with specialized training in behavioural supports and in palliative and end-of-life care. Next Steps As the LHIN receives further details on funding impacting LHIN home care and HSP funding allocations, these details will be shared with the LHIN Board.

67 Board of Directors - Talent Management April 17, 2018

68 Talent Management Framework Benefits and Health & Wellness Organization Culture & Image Recognition Leadership, Social Networks Great Organization Great Rewards Salary Base & Incentive Talent Management Proposition Career Development Training & Job Security Work Content Practices, Experiences Great Job 2

69 Talent Management Framework Compensation and Benefit Strategy Great Rewards A competitive salary and benefits program Great Rewards Rewarding performance Internal & Pay Equity AON Market Salary Review completed Job Evaluation is underway; have a few more to assess 3

70 Talent Management Great Rewards For the SW LHIN For the Non-union Employees Talent management Human Resource Strategy provides the framework for other integrated HR programs Reinforces the desired organizational culture and business strategy Manages compensation costs in the most effective manner Provides a structured framework Flexible, easy to administer Manage salaries within defined salary administration policies and procedures Attract and retain talented employees Ensure salaries are competitive with the external market Recognize the value of high performance Encourage pay differentiation based on performance and contribution Fair, consistent and objective approach for the compensation program Compensation and benefits programs are competitive with the market Innovative human resource programs make SWLHIN a great place to work 4

71 Process Overview AON Salary Survey Completed in February 2018 Non-Union Job Evaluation process completed in March 2018 New Salary Ranges for based on Compensation Guidelines approved March Within budget and in keeping with best practices Pay Equity compliant 80% Minimum Job Rate 100% 110% Maximum 5

72 Trend Line Analysis Comparing SWLHIN salaries to the external market SWLHIN vs Market 50th and 75th y = e x R² = th y = e x R² = Internal Trend y = e x R² = th 75th Percentile Actual SWLHIN Trend Line 50th Percentile SWLHIN Actual 50th 75th Expon. (SWLHIN Actual) Expon. (50th) Expon. (75th) 6

73 Merit Based Reviews New for Legacy CCAC Increases based on successful Performance Evaluation Process Grids were in place Merit based process rolled out for next year aligned to Annual Business Plan Clear goals and objectives were not set in spring of 2017 Modified process for 2018 review 7

74 Executive Compensation Framework Vice Presidents are not part of the process to be rolled out. Ministry directed no further discussions with Ministry at this time. Follow Executive Compensation Framework as required when advised by the Ministry to proceed. 8

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