Central East Local Health Integration Network CEO Report to the Board June 27, 2012 Table of Contents

Transcription

1 Central East Local Health Integration Network CEO Report to the Board June 27, 2012 Table of Contents Transformational Leadership... 2 Service and System Integration... 4 Mental Health and Addictions... 6 Integrations... 7 Aboriginal Services French Language Services Quality and Safety IHSP Strategic Aims Chronic Kidney Disease (CKD) / Renal System Development Enablers ehealth Community Engagement Central East LHIN Operations Appendices

2 Central East Local Health Integration Network CEO Report to the Board June 27, 2012 The following is a compilation of some of the major activities/events undertaken during the month of June in support of the Central East LHIN s Strategic Directions; a) Transformational Leadership, b) Quality and Safety, c) Service and System Integration, and d) Fiscal Responsibility. Transformational Leadership: The LHIN organization will demonstrate accountability and systems-thinking in all decision-making and leadership actions, reward innovation which is aligned with the Integrated Health Service Plan (IHSP) and model fair, transparent, and honest interaction with one another and with Health Service Providers. Service and System Integration/Quality and Safety: The LHIN organization will create an integrated system of care that is easily accessible, sustainable and achieves good outcomes. Healthcare will be people-centred in safe environments of quality care. The Central East LHIN is working towards achievement of the Strategic Aims of the IHSP; 1. Save a Million Hours of Time Patients Spend in the Emergency Departments by 2013; and 2. Reduce the Impact of Vascular Disease by 10% by 2013 ( IHSP). Transformational Leadership The LHIN organization will demonstrate accountability and systems-thinking in all decision-making and leadership actions, reward innovation which is aligned with the Integrated Health Service Plan (IHSP) and model fair, transparent, and honest interaction with one another and with Health Service Providers. Transitions in Care: The Central East LHIN Transitions in Care Steering Committee is a critical body of a new and evolving structure within the LHIN aimed at improving overall quality of care through better transition management of people and information by their care team. The Steering Committee is envisioned to bring together separate yet linked initiatives that, while targeting different aspects of the system, share similar goals. The intent is to provide improved cohesion of initiatives to promote outcomes for better care for patients/clients/residents and better health of the population as a whole. The Steering Committee is accountable to the Central East LHIN for the strategic guidance and quality improvement for emerging Transition Management priorities, and for providing oversight to selected Transition Management quality improvement initiatives. In addition to patients/clients/residents, key stakeholders include health service provider leaders, initiative-specific provincial stakeholders and frontline healthcare providers. The Central East LHIN Transitions in Care Steering Committee, chaired by the CEO of Rouge Valley Health System (RVHS) and the Senior Director, Client Services of the Central East CCAC, has oversight over the full spectrum of quality improvement and/or business process initiatives designed to directly improve the transitions in the patient/client/resident journey through the healthcare system. Its purpose and work are aligned with provincial level initiatives and Central East LHIN priorities. It provides leadership to system and sector-specific 2

3 committees and projects within the LHIN related to priorities and/or projects intended to improve care transitions. Strategic guidance is provided by the Executive Sponsor, a member of the Central East LHIN Senior Team. The Home First Oversight Committee and the Resource Matching and Referral Oversight Committee report to the Transitions in Care Steering Committee. The Transitions in Care Steering Committee met for the second time on May 16, The key messages from each Committee included the following: Transitions in Care Steering Committee LHIN Stocktake Report will be an important document for this Committee and the May Stocktake submission will be reviewed at the June meeting. Discussions to occur prior to the June meeting concerning how best to establish a Quality Committee within the Transitions in Care structure. A Mental Health quality improvement initiative around Assertive Community Treatment Teams, led by Ontario Shores, will also be included as part of the Transitions in Care structure. Resource Matching and Referral (RM&R) Oversight Committee RWS final report that mapped current and future state for rehab/ccc was reviewed. Working Group will be established to proceed with implementation planning, co-chair by the CCAC and a hospital representative. Home First Sustainability Oversight Committee Ross Memorial Hospital and Markham-Stouffville Hospital Uxbridge site have not had an ALC to LTC designation for three weeks! Trends continue to be monitored by teams at the hospital and LHIN levels. There is increasing demand for Convalescent Care beds. Efforts to improve repatriation from hospital to long term care and retirement homes are being undertaken by this Committee. Central East LHIN Doctor Talks: Central East LHIN s Primary Care Physician Leads Dr. Robert Drury and Dr. Christopher Jyu are working with the LHIN staff and in partnership with the Ontario Medical Association to plan the first ever Doctor Talks. This Continuing Medical Education (CME) accredited Doc Talks series will provide primary care physicians in Central East with an opportunity to share their expertise and inform the development of the Central East LHIN s next Integrated Health Service Plan (IHSP). Key issues, challenges and opportunities from the perspective of primary care practitioners for five priority primary care topics will be covered: 1) Mental Health and Addictions; 2) Diabetes and Vascular Health; 3) Frail Seniors; 4) Palliative and End of Life Care; and 5) Primary Care Reform & Leadership at LHIN level. Face to face discussions supported by a range of media to promote broad participation including OTN, teleconference and webinars will be held from July-October Each session will be moderated by one of the Primary Care Physician Leads, and discussion lead by a panel of two or three physicians representing primary and specialist care in rural and urban communities. Two patient stories - one rural and one urban - will be used to initiate conversations on challenges for patients and their primary care providers. Central East LHIN planning partners will also be invited to observe these discussions as input received will help guide the development of IHSP work plans and strategy. 3

4 Service and System Integration The LHIN organization will create an integrated system of care that is easily accessible, sustainable and achieves good outcomes. Healthcare will be people-centred in safe environments of quality care. Stocktake Report: The Stocktake report is the unified report of all LHIN activities and performance to the Ministry of Health and Long Term Care (Ministry), and is completed collaboratively by representatives of all LHIN portfolios to communicate our strategies and plans clearly. The Stocktake Report includes all indicators related to the following initiatives and agreements: Ministry LHIN Performance Agreement (MLPA) Pay-for-Results (P4R) Nurse Practitioner Supporting Teams Averting Transfer (NPSTAT) Excellent Care for All Act (ECFAA) Community Care Access Centre (CCAC) Wait Times Emergency Department- Performance Improvement Plans (ED- PIP) Transitional Care Mental Health and Addictions The 2012 Spring Cycle Stocktake report template is scheduled to be published by the Ministry on May 14 and the completed report is due on May 28. Because the MLPA negotiation meetings for all LHINs will take place in June, there will be no Stocktake meetings with the Ministry for this cycle. Key Highlights: Time spent in the ER for high acuity patients increased by 54 minutes compared to Q3 11/12 but decreased by 78 minutes when compared to Q4 11/12. Time spent in the ER for low acuity patients has increased by 12 minutes over Q3 11/12 but decreased by 12 minutes when compared to Q4 10/11. In Q4 11/12, the number of days from ALC designation to discharge to Mental Health has decreased by 373 days in comparison to Q3 11/12. The MRI wait time was above the LHIN target by four (4) days which is a dramatic decrease from Q3 11/12. Regional Specialized Geriatric Services (RSGS): The RSGS will be submitting its initial high level content for the LHIN s next Integrated Health Service Plan (IHSP) by the end of September 2012 to be followed by a more detailed operational plan to be included in the LHIN s Annual Business Plan in January. On June 13 the Northumberland Hills Hospital, in its role as Host Agency for the RSGS, announced the appointment of Victoria van Hemert as the Executive Director for the Central East RSGS. Victoria will begin in her new role on July 9. Ms. van Hemert joins the entity from the Central LHIN, where she is currently the Senior Director for Planning, Integration and Community Engagement. Upon commencing this role, Victoria will be working with the committee members to develop and implement a model for specialized geriatric services. At its May 22, 2012 the committee members received presentations from existing specialized services including Geriatric Emergency Management (GEM) nurses, Nurse Practitioners Supporting Teams Averting Transfers (NPSTAT) and the Geriatric Assessment and Intervention Network (GAIN). A document to capture an inventory of existing services and how they are linked (or not) is being finalized. Efforts to define the target population continue as more meaningful data is becoming available to the LHIN in this regard. Northumberland Hills Hospital is continuing in their recruitment efforts for an executive director and are hoping to have an 4

5 announcement within the next couple of weeks. Interviews to fill the remaining vacancies (Long-Term Care Home and Primary Care Physician) will be completed by the end of June. A Medical Director position summary has been finalized through various discussions and the recruitment strategy will be initiated in June. Assisted Living Services for High Risk Seniors (ALS-HRS): The Assisted Living program offered by Community Care Durham (CCD) is currently serving 29 clients in the Oshawa Hub and 22 clients in the Whitby Hub. A total of 51 clients are being served by CCD. Based on their current experience CCD has indicated that they may be able to serve more than the target population of 54 clients. 14 clients in Scarborough, 13 clients in North Durham, 25 clients in Peterborough and 2 clients in Lakefield have started service with the VON program. 11 clients in Scarborough, 14 clients in North Durham, 18 clients in Peterborough and 2 clients in Lakefield have been matched for the service and will be transitioned from the CCAC to the VON shortly. The VON program is constantly demonstrating efficiencies gained around cost per caseload due to larger programming. If a decision is made to integrate the Beaverton program into the ALS- HRS program then the process for administration, referral, intake, staff education, management support, reporting and data requirements will be standardized across all the hubs. Behavioural Supports Ontario (BSO) Program: Behavioural Supports Ontario (BSO) activity continued to focus on rolling out Part 1 of the BSO value stream process to all long-term care homes in the Central East LHIN and in May focused on Scarborough and North East homes. There were a total of nine roll out sessions conducted in May and only a few long-term care homes had not attended at least one session. Follow-up with the remaining few Long-Term Care Homes is ongoing. Also in May, a full-day value stream mapping session was held with over 30 stakeholders from across Central East LHIN representing all partners of the integrated care team - long-term care, Community Care Access Centre, hospital acute and tertiary care, psycho-geriatric consultants and Nurse Practitioners Supporting Teams Averting Transfers (NPSTAT). On May 30, the Design Team held an all-day Strategic planning session to talk about the key priorities and action steps for the Behavioural Supports Program model development, spread and sustainability. Building on the success and lessons learned to date, the Action Plan will be updated to reflect the goals and objectives to be pursued and achieved up to the end of March From a staffing perspective, the Project Manager and Improvement Facilitator Supervisor positions were transferred to the Central East Community Care Access Centre and hiring processes for Other Health Professionals is ongoing. The BSO Design Team, Education and Capacity Building Committee and Measurement and Metrics Committee continued to meet in May. The Therapeutics Working Group met to plan the appropriate medical assessment procedures for people with behaviours in long-term care homes (LTCHs). Once processes and procedures are drafted, a strategy to engage LTCH physicians will be developed and tested. Quality improvement processes will be developed to ensure appropriate testing and spread throughout Central East. The Interim BSO Evaluation Report, March 2012 was distributed to key stakeholders across the province and reviews and analyses by the BSO Design Team and Measurement and Metrics Committee began in May. 5

6 NPSTAT (Nurse Practitioners Supporting Teams Averting Transfers) Program: The NPSTAT program continues to operate effectively and recent draft data from the Ministry of Health and Long-Term Care has shown good outcomes for long-term care homes that have engaged the NPSTAT program. An example of this includes the reduced transfer rates to the Emergency Department. Once validated, data from the Ministry will be shared through the Stocktake report. Transitional Care Program: In mid-may the Ministry of Health and Long-Term Care requested the LHIN provide information on programs that have been implemented which support an "assess and restore" model of care to help inform the Ministry's planning and development of a more consistent approach to assess and restore programs across the province to support government objectives outlined in Ontario's Action Plan for Health Care. After requesting and receiving further clarification about the parameters of the request, LHIN staff determined that the request related to the following programs in Central East and submitted a completed report to the Ministry on June 11: Glenhill Strathaven Lifecare Centre 15 convalescent care beds; Northumberland Hills Hospital 8 restorative care beds; Rouge Valley Ajax Pickering 20 transitional restorative care beds; Peterborough Regional Health Centre 7 interim long-term care beds; Ross Memorial Hospital - Functional Enhancement/Restorative Care beds; Lakeridge Health Whitby 10 restorative care beds; Campbellford Memorial Hospital restorative care unit; and The Scarborough Hospital enhanced functional/cognitive/social therapy. Mental Health and Addictions Ontario Common Assessment of Need: The Central East LHIN Ontario Common Assessment of Need (OCAN) local Steering Group did not meet in May. Implementation of the OCAN is complete across the LHIN. Three Central East LHIN OCAN Steering Committee members attended an OCAN training event in Toronto on May 17. The next Steering Committee will include the determination of a Sustainability Plan for OCAN, as well as membership in the OCAN GTA Implementation Group. This Group will oversee the ongoing implementation of the OCAN across the GTA to ensure consistency across the GTA LHINS. The fact that Ontario Shores has not implemented the OCAN remains a concern for both the LHIN and system partners. Schedule 1 Bed Registry and Common Assessment Tool (CAT) Implementation: The first month of operation for the Schedule 1 Bed Registry and CAT is running successfully. The Steering Committee met again on June 7, 2012 at Ontario Shores. Central East LHIN staff have received several inquiries from other LHINs regarding this project, and have entered information sharing discussions. Discontinuation of OxyContin: As noted in last month s report, the delisting and discontinuation of the drug OxyContin is an issue of great concern to the Ministry of Health and Long Term Care, and to the LHINs. Several initiatives were introduced in March to address any anticipated crisis situations related to system capacity that could arise as the result of the discontinuation of OxyContin. These initiatives included: Provider training via webinars and other electronic formats. Purchase of OTN equipment to increase system capacity. Opioid Alerts from the Ministry of Health and Long Term Care 6

7 Real Time Surveillance of 70 Emergency Departments across Ontario. Each of the four initiatives has been completed. The Fact Sheets have been received by the LHIN, and are posted on the Ministry of Health and Long Term Care website. OTN equipment has been purchased. A Steering Group of LHIN Senior Directors, LHIN staff, MOHLTC staff and OTN staff has been struck to develop the distribution criteria and strategy for the province. The Central East LHIN has been an active participant. The MOHLTC is now negotiating with Health Canada regarding the installation of the equipment on First Nations. As of the end of May, this matter was not resolved. It is our understanding the Minister s panel has provided their report to the Minister. However, it has not been released beyond the Ministry at this point. Although the weekly teleconferences with the Ministry have been cancelled, the LHIN is continuing to submit weekly reports. Staff have been communicating with Health Service Providers on a regular basis. There has been no substantive change in the situation in this LHIN in May. The Curve Lake First Nation has noted some concerns around OxyContin use related to members of their community and have requested an OTN Unit to assist them in accessing clinical supports. This request has been submitted to the Ministry of Health and Long Term Care as part of the overall Central East LHIN OTN request. Central East LHIN staff continue to carefully monitor this situation. Addictions Supportive Housing (ASH) Beds: The Central East LHIN received the final allotment of Addictions Supportive Housing Beds in April. This will add the last eight beds that were included in the 72 beds provided over the four year period of the project. Homestead in the Scarborough Cluster will receive eight beds, as will the Pinewood/CMHA Durham partnership in Oshawa. The Addictions Supportive Housing providers have been continuing to meet as a Community of Practice since the project began. The next meeting of this group is scheduled for July 18, Nurses in Schools: Central East LHIN staff will meet with the CECCAC, District School Boards and Central East LHIN Mental Health and Addictions providers on June 26 at the CECCAC to discuss the implementation and ongoing operation of this program. Central East Mental Health and Addictions Network: James Meloche provided an excellent presentation to the Central East Mental Health and Addictions Network on May 16 that was very well received. He has asked the Network to work on a Strategic Aim for Mental Health and Addictions for inclusion in the IHSP This will be submitted no later than September Central East LHIN staff will support the development of the Aim through several planning meetings to be held throughout the summer. Community Treatment Order (CTO) Reference Committee: Central East LHIN staff participated in the Provincial Community Treatment Order Reference Committee, which reviewed the legislation relevant to Community Treatment Orders in Ontario. The report has been completed and is available online Integrations Apsley and District Homes for Seniors (ADHS): Although the funding is now being provided to both the Canadian Red Cross and the Peterborough Housing Corporation, the LHIN has not received word that the final property transfer has taken place. 7

8 Community Health Services Integration Strategy: The purpose of the project is to implement a facilitated integration process to achieve the Community First Strategic Aim in each of the Durham, Scarborough and Northeast Service Clusters. The project will result in the identification of a preferred community health services integration model for each service cluster. Community Health Services (CHS) Strategic Aim Design and implement a cluster-based service delivery model for Community Support Services and Community Health Centre agencies by 2015 through integration of front-line services, back office functions, leadership and/or governance to: improve client access to high-quality services, create readiness for future health system transformation and, make the best use of the public s investment. Durham Cluster Process In April 2012, the Durham Integration Planning Team (IPT) which includes CEO/EDs from the Durham Cluster and the LHIN team began meeting weekly. Each of 10 HSPs has identified one governor to be the identified liaison to participate in 3-4 planned governance check-ins this is in addition to regular updates provided by the organization s own CEO/ED. Accomplishments to date: Guiding Principles are the in process of being endorsed by all Health Services Provider Boards; Terms of Reference has been endorsed and Ground Rules identified; and Agencies have initiated due diligence information sharing presentations highlighting client stories, service delivered, challenges, and opportunities. Integration Planning Process in Haliburton County Local organizations providing health care to the residents of Haliburton County are working together to improve access and ensure that their organizations are ready to meet the needs of a changing population by becoming part of a Central East LHIN Integration Planning Team (IPT). The work being done by the Haliburton County IPT is part of the broader Community Health Services Integration Strategy approved by the Central East LHIN Board in February It is recognized that Haliburton County is unique to other parts of the Central East LHIN because of its relative geographic isolation, distinct population and socio-economic realities. These differences present an opportunity to continue to improve quality, safety and client/patient outcomes. The Haliburton County Integration Planning Team held its first meeting on May 18 th, and includes representatives of LHIN-funded health service providers whose main offices are permanently located in Haliburton County. Unique to the Haliburton County integration process, two critical partners, the Central East Community Care Access Centre and the Haliburton Highlands Family Health Team have been included on the IPT because of their significant contribution in delivering service to local residents. Member organizations of the IPT include: Community Care Haliburton County Haliburton Highlands Health Services SIRCH Community Services Central East Community Care Access Centre Haliburton Highlands Family Health Team The Guiding Principles and Terms of Reference are currently in the process of being endorsed by all Health Service Provider Boards, the Guiding Rules of Engagement have been identified and agencies have initiated 8

9 due diligence information sharing presentations highlighting client stories, service delivered, challenges, and opportunities as well. The Haliburton County IPT meets every second Friday with a facilitator provided by the LHIN as well as a LHIN Team. CMHA Northeast Cluster Integration: The CMHA Joint Executive Governance Committee has been meeting every two weeks. The meetings have been attended by Central East LHIN staff. The Joint Executive Governance Committee, (JEGC) and Management Implementation Team (MIT) are making solid progress toward implementation of the objectives set out in the Integration Plan approved January Suggestions for the name of the new corporation were solicited. The JEGC plans to make a final decision on the new name at their meeting in Lindsay on June 12. It is also expected that a decision regarding the final structure of the new organization will be made at that time. This will allow Central East LHIN staff to initiate the Ministry processes necessary to complete the integration. The group is making steady progress towards finalizing the integration, the process has been exhaustive in its detail. It is expected that the JEGC will use the approved schedule set out in the Integration plan to evaluate their process to date at the June 12 th meeting. Each of the Boards, (CMHA-P and KL) has been continuing to meet separately throughout this process. Decisions made by the JECG have been brought forward to each Board for their approval prior to finalization. The volunteer board members and staff members of each of these organizations should be commended for their dedication in working to complete this project. Central East LHIN Hospice Palliative Care Network (CEHPCN): On April 19, 2012 the CEHPCN held an all day Hospice Palliative Care IHSP Strategic Aims Planning Session. The Network was successful in developing a draft IHSP Strategic Aim: Increase the number of people who (percentage to be determined) receive hospice palliative care in the community and die at home, by choice, by X% by Another planning meeting will be scheduled to discuss next steps i.e. the establishment of strategic aim goals, leveraging of current resources and initiatives etc. On April 20, 2012, LHIN CEOs, Senior Directors and the Ministry came together to discuss the completion of the palliative care template outlining 14 separate but aligned implementation plans reflecting a common end point for all LHINs over the next three years. A document has been generated and revisions have been solicited and incorporated. A formal poll of all CEOs was undertaken regarding agreement to proceed with discussions with the Ministry based on the document. The Central East LHIN offered its approval pending some provisions concerning how the process would unfold on a provincial basis. On May 1 and 2 nd the Provincial End of Life Care Network came together for their second annual face-to- face meeting to discuss the Ministry Palliative Care document, take stock of each network s relationship to the LHIN and review plans to move forward in collaboration with Ministry priorities. Palliative Education: The LHIN is working with the CE CCAC, the Central East Hospice Palliative Care Network (CEHPCN) and Durham Regional Cancer Centre in reshaping and investing in the Palliative Care system, including the delivery of education programs. LHIN-funded palliative education includes, but is not limited to, the following courses: Fundamentals of Hospice Palliative Care, Advanced Palliative Care Education (APCE), Comprehensive Advanced Palliative Care Education (CAPCE), and Learning Essentials for Advanced Practitioners (LEAP). 9

10 The Central East LHIN, in partnership with stakeholders, is considering options to improve the delivery of education services and related programs across the Central East region while providing requisite accountability for outcomes. We are currently seeking ways to more equitably distribute resources across the entire Central East LHIN. As a result, the LHIN will continue to postpone palliative care education until the September 2012 while endeavoring to implement and deliver a new education work plan in the fall of The LHIN will continue to work with stakeholders in order to identify a clearer understanding of the palliative care needs within our region. Community Palliative Care Nurse Practitioner Program (CPNP): The following CPNP updates were highlighted in this month s CECCAC Project Status Report: Project working groups have been established in both the Durham and North East clusters with final meetings scheduled for last week of June. Stakeholder analysis/population needs have been researched and conducted. The Durham NP will initially focus on the Ajax/Pickering region. The North East NP will operate out of the Lindsay office. Stakeholder communications and relationship building is complete although this will be an ongoing tasks throughout the course of the project. A communications strategy has been developed. Two successful NPs have been recruited. Candidates started orientation and training on June 4 th, The CCAC has posted for five (5) additional palliative NP positions following the confirmation of funding from the MOHLTC. Training and presentation materials have been developed for the Symptom Response Kit for Palliative Care. A broad introduction letter introducing the CPNP program to Durham and North East Physicians has been drafted; physician mailing list complete. Letter to be issued the week of June 11, Aboriginal Services First Nations Health Advisory Circle and Métis, Non-Status and Inuit Health Advisory Circles: The Central East LHIN Métis, Non-Status and Inuit Health Advisory Circle, and the First Nations Health Advisory Circle did not meet in May. The Metis, Non-Status Circle met at the LHIN office on June 13, while the First Nations Circle will meet at the Hiawatha First Nations on June 28. The Metis, Non-Status and Inuit Circle were pleased to welcome Liz Stone, the Executive Director of Niijkiwendidaa Anishnaabekwewag Services Circle in Peterborough. Central East LHIN staff are working to establish contact with the Executive Director of the Friendship Centre in Peterborough as well. The Central East LHIN Aboriginal Lead attended the annual LHIN Aboriginal Lead event hosted by the North Simcoe Muskoka LHIN in Victoria Harbour and Orillia on June 16 and 17. French Language Services French Language Services Third Party Regulations 284/11: The Ministry issued a Directive requiring all agencies to ensure that French language services were being actively offered by all affiliated organizations who are providing a service on behalf of a Crown agency (through an accountability agreement). This means that appropriate measures must be taken (such as signs, notices and information on services) to make it known to the public that services are available in French. These active offers of service are to be put in place immediately if the accountability agreement with the third party was entered after July 1, 2011 and for agreements which took effect prior to July 1, 2011, agencies have until July 1, 2014 to have the active offer regulation in place. Supporting documents have been provided by the Office of 10

11 Francophone Affairs and the French Language Services branch at the ministry, including an implementation guide and a check list Within these deadlines, every government agency must make sure that the French services are provided on an active offer basis. A meeting will be scheduled with the French Language Services Coordinators from all 14 LHINs to discuss how this regulation will be monitored to ensure compliance. LHIN Receipt of Entity Annual Report: Since becoming operational in the spring of 2011, the French Language Health Planning Entities have started reaching out to the Francophone community. In December 2011, Entity #4 submitted their first advisory report to the Central East LHIN and have since then completed a work plan. On June 18, staff from the Central East LHIN attended Entity #4 s Annual General Meeting where the Strategic Orientations were presented. In the Annual report, the following key accomplishments were noted: In collaboration with the LHIN French Language Services Coordinators and health care service providers, Entity 4 has delivered two French language training modules for Peer Leader Training and Self-Management through the Central East Self Management Program run by the Central East Community Care Access Centre. These modules follow the Standford model, which forms the basis of all regional self-management programs. The Entity will host a French Peer Leader training course for Self-Management on chronic disease prevention and management. Progress has been made in promoting this training in the Francophone Community and recruiting a very good group of committed volunteers. French Language Services Coordinator: The French Language Services work plan was updated with the hiring of the new French Language Services Coordinator in early May. Work is underway to develop relationships with the French-speaking stakeholders and Health Service Providers in Central East LHIN catchment area. With the introduction of the Active Offer regulation, staff are working to build the French Language Services capacity with our designated providers, to ensure the fair and equitable delivery of high-quality healthcare services. Future initiatives include Francophone engagement to ensure active participation of Francophones in public consultations and community engagement activities which will inform planning and priority setting for the Integrated Health Services Plan (IHSP). The French Language Services Coordinator has started to meet with key francophone organization leaders to seek input. Together with the French Language Planning Entity # 4, a francophone table will be created to gather feedback from this group of stakeholders. A joint meeting of French Language Services Coordinators from the GTA took place on May 22, which included staff from the Central, North Simcoe Muskoka and Central East LHINs, as well as staff from Entity #4 to review the joint action plan between the Entity and the LHINs. The LHINs will be deploying a survey to assess francophone needs and provide information regarding the socio-demographic status of the Francophone population of Central East LHIN and other LHINs who are conducting a similar survey. On May 25, staff from the LHIN met with the Entity Planning Officer to review the joint action plan and the funding agreement and discuss the implementation activities. On June 1, staff from the Central East LHIN met with the office of the Minister of Francophone Affairs, the French Language Commissioner s office, the Entity and other LHINs to discuss the Minister of Francophone Affair s role, mission and mandate and to discuss their responsibility and the role of the LHINs and the Entity in providing French Language Services. 11

12 Quality and Safety Pharmaceutical Shortage: The Sandoz Canada injectable drug shortage continues to be monitored province-wide and at all LHINs. During the Central East LHIN CEO s absence in May, the Champlain LHIN CEO acted as the Lead LHIN CEO to work with the Ministry on the system wide response. The Central East team continued to provide support to the Champlain LHIN CEO during this time. Provincially, the Drug Shortage Technical Advisory Committee has ceased regular meetings. The Ethical Framework developed by this group has been published to all stakeholders provincially, and Health Service Providers throughout the province are reviewing the document and determining how to operationalize it. The provincial Health Stakeholder calls led by the Ministry Emergency Operations Centre have stopped as responsibility for managing the provincial response is transferred to the Ontario Drug Program. Within the Central East LHIN, Health Stakeholder calls have been reduced to once every two weeks, but the Pharmacy group continues to meet via teleconference once per week. This group is to be commended for its mutual support, quick action when any member has a concern or query, and its development of a drug-sharing agreement that has now been shared provincially. Additionally, Lakeridge Health has developed a web-enabled Pharmacy Tracking Tool to manage inventory and flag impending shortages that is being shared both LHINwide and provincially. Senior Friendly Hospitals: Even though the Senior Friendly Hospital (SFH) LHIN Lead Working Group has been disbanded, we continue to participate on the Senior Friendly Hospitals Indicators Working Group. In May, the Indicator Working Group initiated a voting process to select two hospital-based indicators, one to measure functional decline and the other to measure delirium. Once selected, we will communicate the indicator definitions to hospitals and other key stakeholders. Better Outcomes Registry and Network (BORN): The Better Outcomes Registry and Network (BORN) is a provincial initiative developed to provide the knowledge needed for the best possible beginning for life-long health. The mechanisms for leading the organization to this vision include a number of key supports: The leadership team includes the executive, medical, scientific and administrative expertise required to oversee operations and set direction for the organization The Ministry of Health and Long Term Care in Ontario is providing the funding required to support BORN in delivering the necessary technology and knowledge required for the initiative CHEO provides the founding support and sponsorship of BORN. They continue to provide the governance structure and administrative supports required to make the organization successful The BORN Maternal Newborn Outcomes Committee identified six key indicators of quality care that will help improve the health of mothers and newborns in Ontario. These six indicators represent areas where there is good scientific evidence about the practices, where change was felt to be feasible and where by making changes, health of mothers or newborns would be improved. There were two areas of opportunity for our facilities in Central East LHIN namely: Rate of repeat cesarean section in low risk women not in labour at term with no medical or obstetrical complications done prior to 39 weeks gestation; and Proportion of women induced with an indication of post-dates who are less than 41 weeks gestation at delivery 12

13 Central East LHIN BORN summary for Fiscal Year : Key Performance Status Range Indicators RVAP LH-O LH-PP NHH PRHC RMH RVC TSG TSB Target Warning Alert Rate of episiotomy in women having a % 14.1% 5.4% 16.6% 25.4% 22.2% 48.4% 24.3% 12.2% <13.0% spontaneous vaginal birth 17.0% >17.0% Rate of formula supplementation in term infants whose mothers intended to breastfeed 6.6% 26.1% 9.2% 22.4% 19.4% 3.6% 23.5% <20.0% % >25.0% Rate of repeat cesarean section in low risk women not in labour at term with no medical or obstetrical complications done prior to 39 weeks gestation 91.3% 60.8% 50.0% 70.4% 41.5% 59.0% 72.2% 56.7% 72.7% 10.0% % >15.0% Proportion of labouring women delivering at term who had Group B Streptococcus (GBS) screening at weeks gestation 93.3% 95.3% 98.3% 93.0% 76.2% 89.9% 95.3% 94.6% 91.0% 95% % <90.0 Proportion of women induced with an indication of post-dates who are less than 41 weeks gestation at delivery 67.4% 31.7% 16.7% 21.4% 14.7% 44.4% 65.6% 14.8% 42.2% <5.0% % >10.0% Maternal Child Health: In review of the Provincial Council for Maternal and Child Health Maternal and Newborn Level Definitions Recommendations Report, last year, Rouge Valley Health System - Ajax/Pickering (RVHS AP) was asked to take the necessary steps to ensure their maternal-newborn services and programs were aligned with current level of care definitions provided in the report. Specifically: 2b Level of Care Status (Gestational Age- greater than of equal to 32 weeks and 0 days): Maternal Uncomplicated twin pregnancies if < 36 weeks and 0 days consider consultation and transfer; Women carrying fetus with anomalies (minor) not likely to need immediate interventions; Low-to-moderate maternal risk experiencing low risk medical/obstetrical complications where SGA is not suspected. 24/7 induction and augmentation of labour. 24/7 availability of continuous EFM. Labour analgesia should be available. This includes use of systemic narcotics (eg. IM, IV, PCA), nitrous oxide,based on the availability of Anesthesia staff at that centre. Epidural services should be regularly available via well-defined epidural services and provided according to CAS/ASA guidelines for obstetrical anesthesia. 13

14 Available assessment within 30 minutes by Obstetrics, Anesthesia, and Pediatrics for emergencies and potential Cesarean sections. Uncomplicated dichorionic twin pregnancies if < 34 weeks and 0 days consider consultation and transfer. Neonatal Care for infants with age 34 weeks and 0 days gestation and 1800 gms who have mild illness expected to resolve quickly. Resuscitation and stabilization of ill infants before transfer to an appropriate care facility. Nasal oxygen with oxygen saturation monitoring (acute and convalescing). Ability to initiate and maintain peripheral intravenous. Gavage feeding. Care of stable infants who are convalescing after intensive care. Stable neonatal retrotransfers that are over 32 weeks + 0 days (corrected) gestation and not requiring assisted ventilation or advanced treatments or investigations. Care of infants with an age 32 weeks and 0 days gestation and greater than or equal to and a weight of 1500g or greater who are moderately ill with problems expected to resolve quickly or who are convalescing after intensive care. Mechanical ventilation for brief durations (less than 24 hours) or extended stable continuous positive airway pressure (CPAP). Insert and maintain umbilical lines. Maintenance of PICC lines. Peripheral intravenous infusions and total parenteral nutrition for a limited duration. Stable neonatal retrotransfers that are over 29 weeks + 6 days gestation and over 1200 grams not requiring assisted ventilation or advanced treatments or investigations. Over the last year, hospital staff and physicians worked to ensure appropriate policies and procedures were developed as well as the roll out of education to support Maternal Newborn Levels of Care Definitions. As of June 12 th, RVHS AP has transitioned its program to fulfill all of the Provincial Council for Maternal and Child Health requirements to provide level "2b" neonatal and maternal care at Rouge Valley Ajax and Pickering. The hospital is now safely and confidently providing this enhanced level of care to their community. IHSP Strategic Aims Save a Million Hours of Time Spent in the ER Department ED Pay for Results (P4R) Year III ( ): Fixed Funding MOHLTC communicated a proposed formula for calculating recovery of P4R Year III (FY2010) fixed funds on 08 November The proposed recovery formula relaxed the performance requirements that had been published in March 2010 for Year III. LHINs were given an opportunity to submit a performance explanation to MOHLTC, including any argument for a further reduction in recovery rates. The Central East LHIN did submit a performance explanation, recommending a further reduction in the recovery at RVAP, because of substantial volume increases at that site, and significant constraints on inpatient capacity. The amounts communicated by MOHLTC and suggested by the Central East LHIN are as follows: 14

15 Site 2010/11 One-Time Fixed Allocation Initial Recovery Proposed Recovery (MOHLTC) Proposed Recovery (Central East LHIN) LHB $740,700 $296,300 $74,100 $74,100 LHO $841,700 $673,400 $420,900 $420,900 NHH $399,000 N/A N/A N/A PRHC $840,000 N/A N/A N/A RMH $664,900 N/A N/A N/A RVAP $417,500 $167,000 $33,400 $6,300 RVC $932,500 $186,500 $28,000 $28,000 TSB $379,500 N/A N/A N/A TSG $379,500 $151,800 $30,400 $30,400 Totals $5,595,300 $1,475,000 $586,800 $559,700 The timeline published by MOHLTC indicated that follow-up with LHIN s on the performance explanations would take place in December, and that recovery letters from MOHLTC to hospitals would be initiated in January As of June 2012, no response to the LHIN performance explanation has been received. Physician Initial Assessment (PIA) Funding Year III was the first year in which designated Pay-for-Results sites were also required to achieve a 10% reduction in the time to physician initial assessment (PIA) at the 90 th percentile. Separate funding was allocated to achieve this reduction, and this funding was described as being subject to recovery, but no proposed formula for recovery of this funding has ever been published by the Ministry. Hospital performance and funding in this category for year III is indicated in the table below: Site Baseline Target FY2010 PIA Performance PIA Funding Amount LHB % $100,500 LHO % $255,400 NHH % $113,000 PRHC % $120,000 RMH % $148,000 RVAP % $130,300 RVC % $170,200 TSB % $105,300 TSG % $ 88,000 YTD performance meeting target Legend YTD performance improving, but not yet at target YTD performance longer than previous year s baseline 15

16 ED Pay for Results Year IV ( ): Fixed Funding Final funding for Year IV of the Pay-for-Results program distributes the Central East LHIN fixed funding allocation as follows: Central East LHIN $6,041,100 Lakeridge Health - Bowmanville site $1,003,500 Lakeridge Health - Oshawa site $586,500 Northumberland Hills Hospital $387,700 Peterborough Regional Health Centre $630,900 Ross Memorial Hospital $531,600 Rouge Valley Health System - Ajax/Pickering site $852,200 Rouge Valley Health System - Centenary site $1,334,700 The Scarborough Hospital - Birchmount Campus $357,000 The Scarborough Hospital - General Campus $357,000 Conditions of fixed Pay-for-Results funding require all designated hospital sites to achieve an aggregate reduction in 90 th percentile Emergency Department Length of Stay (EDLOS) across three patient categories. The amount by which each site must reduce this time varies depending on fiscal year 2010/11 baseline performance. Although the MOHLTC Pay-for-Results program does not require patient stream-specific reductions, the Central East LHIN has established each hospital s H-SAA target as the Pay-for Results target 1. Achievement of the H-SAA targets will result in achievement of the Pay-for-Results aggregate targets for eight of the nine designated sites. Final performance for the nine designated hospitals against their H-SAA targets is as follows: Site Admitted 90 th Percentile Time (interim provincial target 25 hours) FY2010 H-SAA FY2011 Baseline Target Performance Non-Admitted High Acuity 90 th Percentile Time (provincial target 7 hours) FY2010 H-SAA FY2011 Baseline Target Performance Non-Admitted Low Acuity 90 th Percentile Time (provincial target 4 hours) FY2010 H-SAA FY2011 Baseline Target Performance LHB LHO NHH* PRHC RMH RVAP RVC TSB TSG Northumberland Hill Hospital (NHH) is the exception to this practice, as its baseline performance in the admitted category was below the interim provincial target of 25 hours. NHH was assigned a P4R target in this category of 10% reduction over baseline, or hours. 16

17 Baseline above provincial target Baseline below provincial target Legend: YTD performance meeting HSAA target YTD performance improving, but not yet at HSAA target YTD performance longer than previous year s baseline *Note that NHH performance for patients admitted to an inpatient bed, although increased over last year s baseline, remains the lowest of the group, and below the interim provincial target of 25 hours, but still above the provincial standard of 8 hours. Final performance for the nine designated hospitals against their Pay-for-Results fixed funding aggregate targets is as follows, where green in the final column indicates that the site has achieved the required aggregate reduction, and red indicates that it has not: Site Admitted Non-Admitted I-III Non-Admitted IV-V Performance Target Overall Performance LHB 32% 15% 14% 6.6% 60.2% LHO 14% -5% -7% 8.0% 15.6% NHH -60% -7% -10% 6.6% 0.0% PRHC -10% -1% -2% 10.0% 0.0% RMH 19% 1% -6% 6.6% 17.2% RVAP 7% 6% 8% 8.0% 19.8% RVC 15% 3% 11% 8.0% 28.1% TSB 7% 17% 11% 10.0% 34.0% TSG 33% 13% 11% 10.0% 55.9% The funding letters from MOHLTC made no indication of what the recovery formula will be for this year for any funding stream. However, it is reasonable to assume that hospitals that have achieved their fixed funding performance targets will have none of that funding recovered. Additionally, for the sites that are participating in ED-PIP this year, $250,000 of allocated funds are protected against recovery. Thus, potential recovery scenarios for fixed funding appear as follows: Site Final Funding Amount Overall Performance ED-PIP Participant Maximum Possible Recovery LHB $1,003, % - LHO $586, % - NHH $387, % $387,700 PRHC $630, % $630,900 RMH $531, % - RVAP $852, % - RVC $1,334, % - TSB $357, % - 17

18 TSG $357, % - Physician Initial Assessment (PIA) Funding: Each designated Pay-for-Results site is also required to achieve a 10% reduction in the time to physician initial assessment (PIA) at the 90 th percentile. As for Year III, PIA funding was listed as being subject to recovery in Year IV of the Pay-for-Results program, but with no indication of the recovery formula. Final hospital funding and performance in this measure is as follows: Site Baseline Target FY2010 PIA Performance PIA Funding Amount LHB % $100,500 LHO % $255,400 NHH % $100,000 PRHC % $170,200 RMH % $113,900 RVAP % $141,800 RVC % $148,800 TSB % $ 96,200 TSG % $130,300 YTD performance meeting target Legend YTD performance improving, but not yet at target YTD performance longer than previous year s baseline Short Stay Unit Funding: On 05 January, a 10-bed Short Stay Unit was implemented at RVAP, using a Pay-for-Results allocation of $571,500 ($320,300 from a specific Short-Stay Unit funding stream, and $251,200 from that site s Fixed Funding distribution). Performance requirements associated with this funding include: reduction of Time to Inpatient Bed to 8 hours, and maintenance of baseline Time to Disposition. Final RVAP performance against these requirements for is as follows: Time to Inpatient Bed (hours) FY2010 Baseline Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Time to Decision to Admit (hours) FY2010 Baseline Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD In the table above, green indicates that the hospital has met the requirement, and yellow indicates improvement, but non-achievement of target. Short-Stay Unit funding, as with other up-front Pay-for-Results funding, is described as being subject to recovery, but no formula or methodology has been identified to calculate this recovery. In Year IV of the Pay-for-Results program, designated hospitals are eligible to earn bonus funding each quarter by: 18

19 1. Increasing the volume of admitted patients admitted to an inpatient bed within the provincial target of eight hours; 2. Increasing the volume of non-admitted CTAS IV-V patients discharged within the provincial target of four hours; and 3. Decreasing the volume of admitted patients remaining in the ER over 25 hours. In April, the LHIN received funding letters from the Ministry of Health and Long Term Care indicating bonus funding to be paid to LHIN hospitals for Q3 of fiscal year , bringing the total variable funding flowed to date to the following: Hospital Q1 Bonus Q2 Bonus Q3 Bonus LH $155,800 $99,300 $320,500 NHH - $32,700 - PRHC $68,000 $120,200 $23,100 RMH $49,400 $63,000 $4,500 RVHS $102,600 $214,200 $115,100 TSH $222,400 $300,100 $293,300 Central East LHIN $598,200 $829,500 $756,500 In Q3 and Q4, because of the establishment of the Short-Stay Unit, RVAP was not eligible to earn variable funding for either of the admitted categories (numbers 1 and 3 above). Q4 performance indicates that an additional $465,100 has been earned by Central East LHIN hospitals in variable funding. The funding earned by site and the funding that each site could have earned if 100% of patients were treated within the provincial targets is as follows: Site Q4 Bonus Earned Q4 Bonus Opportunity LHB $163,850 $303,100 LHO $13,500 $1,173,050 NHH $0 $118,250 PRHC $0 $758,750 RMH $900 $392,250 RVAP 0 $494,500 RVC $35,300 $431,050 TSB $20,250 $575,650 TSG $231,300 $785,550 Central East LHIN $465,100 $5,032,150 Formal notification of these funding amounts has not yet been received from MOHLTC, so these numbers are not yet final. ED Pay for Results Year V ( ): A working group consisting of ED LHIN Leads, LHIN Senior Directors, Cancer Care Ontario and MOHLTC representatives has proposed a draft model for the Pay for Results program for Year V ( ) that will 19

20 streamline funding and eliminate recovery. This model is going through the approval process at the Ministry, and as of June 2012, has not yet been published. Clinical Decision Units: Clinical Decision Units (CDUs) are established at the following Central East hospital sites: LHB, NHH, PRHC, RMH, RVAP, RVC, TSB, and TSG. CDU s must meet certain guidelines published by the MOHLTC, and are monitored by Access to Care on a monthly basis for compliance with two indicators: 1. the proportion of CDU patients with a total EDLOS (including CDU time) greater than 24 hours (not to exceed 10%); and 2. the proportion of CDU patients admitted to inpatient beds (not to exceed 30%). The purpose of measuring the two selected compliance indicators is to ensure that the hospital is not using the CDU to lower its ED length of stay for admitted patients artificially, as admission to the CDU stops the length of stay clock. However, analysis of the months during which Central East LHIN hospitals have breached either of the compliance indicators do not show a suspicious corresponding decrease in ED length of stay for admitted patients. Rather, those months reflect a lengthening of ED length of stay, suggesting that CDU performance is worsened during periods when the ER is struggling with all its performance indicators. Additionally, having different thresholds for the two indicators, while theoretically sound, in practice merely means that operating within the compliance threshold for the second indicator can provide a false sense of security for the first. Up to 30% of CDU patients can be admitted to an inpatient bed without triggering a compliance issue, but only 10% of CDU patients can exceed an EDLOS of 24 hours. If the hospital s flow from the ED is impaired either because all its inpatient beds are occupied or because there is no most responsible physician (MRP) to admit to, all admitted patients, including the up to 30% that are allowed in the CDU, will have an EDLOS that is too long. December performance resulted in the CDU s at both Peterborough Regional Health Centre (PRHC) and The Scarborough Hospital Birchmount Campus (TSB) being escalated to Level 1 compliance. The indicator at issue for PRHC is percent of cases with ED Registration to CDU Discharge time greater than 24 hours the hospital has continued to breach this threshold for January and February. For TSB the issue is percent of CDU cases admitted to inpatient beds January and February performance dropped below the threshold of 30% once again. Action plans for these hospitals have not yet been submitted to Access to Care, as that organization has developed a new template for their submission. These plans will be submitted in Q1 of the fiscal year, along with communication of the problems with the compliance indicators noted above. Hospital Scorecards: Monthly scorecards have been developed, tracking the following seven Emergency Department/Alternative Level of Care (ED/ALC) indicators for all Central East LHIN hospitals: Emergency Medical Services (EMS) Offload Time; 90 th Percentile ED Length of Stay (LOS) for Admitted Patients (MLPA indicator); 90 th Percentile ED Length of Stay (LOS) for Non-Admitted Complex Patients(MLPA indicator); 90 th Percentile ED Length of Stay (LOS) for Non-Admitted Minor/Uncomplicated Patients(MLPA indicator); 90 th Percentile time to Physician Initial Assessment (PIA) (P4R indicator); ALC-LTC Volume (HSAA indicator); % Alternate Level of Care (ALC) Days (MLPA indicator); and % Hospital Discharges Before 11:00am. 20

21 These monthly scorecards are sent to designated hospital staff accompanied by a LHIN request for a rationale for a given site s performance or a plan for how to correct underperformance when necessary. Scorecards for the remainder of the fiscal year were sent out in May. For fiscal year 2012/13, a new scorecard is being developed that will be more closely aligned with the MLPA dashboard and the Stocktake report, and will track additional contributing measures at all hospitals. The new scorecard, when finalized, will be presented to the Board for approval. Emergency Department (ED) LHIN Lead: Dr. Gary Mann, the Central East LHIN ED LHIN Lead, has scheduled site visits to all Central East hospital Emergency Departments. The purpose of the visits is to familiarize the ED LHIN Lead with the various sites, and to allow him to spend some time with the individual Chiefs discussing their particular concerns and suggestions. The ED LHIN Lead works with LHIN staff, Health Force Ontario, the Ministry of Health and Long Term Care, and when necessary, other ED LHIN Leads across the province to monitor ED staffing issues. The LHIN submits a weekly dashboard to the Ministry tracking any Emergency Departments at risk of closure due to physician staffing. Campbellford Memorial Hospital and Northumberland Hills Hospital continue to struggle with ED coverage on a month by month basis. This situation is being monitored closely by the LHIN and the ED Lead. Emergency Department Chiefs The Emergency Department LHIN Lead has, in the past, held a bi-monthly meeting of the LHIN Emergency Department Chiefs, scheduled to correspond with the bi-monthly Pay-for-Results meetings. Poor attendance of ED Chiefs has been a consistent problem at these meetings, compounded by a diffusion of other attendees because of rising interest in overall emergency and related services across the LHIN. The ED LHIN Lead, ER/ALC Performance Lead, and LHIN Senior Team are reviewing the structure and alignment of emergency services representation within the LHIN and this will be discussed as draft at the June 5, 2012 meeting of the Medical Leadership Group. Reducing the Impact of Vascular Disease by 10% (save 10,000 patient hospital days) by 2013 Supporting an Integrated Roll-out of the Ontario Diabetes Strategy: Standardized Referral and Intake Process The Regional Diabetes Coordinating Centre has received approval from the MOHLTC Diabetes team to proceed with planning and implementation of centralized intake for diabetes education programs across the LHIN. Planning will commence as part of the Centre for Complex Diabetes Care project. The Diabetes Regional Coordination Centre is in the process of updating the Diabetes Services Inventory for the Central East Region to support this initiative. Inter-professional collaboration - Diabetes Specialists supporting Primary Care The Diabetes Regional Coordination Centre is actively engaged with the Centre for Complex Diabetes Care Collaborative in the early planning for the Central East Centre for Complex Diabetes Care. Integral to the success of this project is the engagement of primary care as part of the team developing the plan of care for these patients with very complex needs. Endocrinologists, Drs. Khan and Sigalis have expressed interest in participating in the planning for the Centre for Complex Diabetes Care to explore this role. 21

22 Chronic Kidney Disease (CKD) / Renal System Development In 2010, the province created the Ontario Renal Network (ORN), organized to align to provincial LHIN boundaries. A Central East LHIN Advisory body comprised of medical and administrative leadership from the three (3) Regional Renal Programs: Peterborough and Area (PRHC), Durham (LH) and Scarborough (TSH) were established. The ORN Regional Director is Jay Wilson and the Clinical Lead is Dr. Andrew Steele. New Chronic Kidney Disease Provincial Funding Model: Education sessions for hospitals related to implementation of new Chronic Kidney Disease funding are being held in July at each of the regional renal centres. Through this process the new funding level for hemodialysis has been increased from $263 from $ This is an interim amount and will be revised again in The costing does not include the allied health costs (Lab and Diagnostic Imaging). In , in-centre and chronic kidney disease clinics will begin receiving funding based on service bundles. A similar funding approach for home modalities (service bundles) will be rolled out later in Within each dialysis bundle there are number of best practices identified for the patient. Programs should not see a major change in the funding this year unless they engage in more than 6 follow-up clinic visits consistently for each patient. The hospitals are in the process of two large data captures for the CKD patients to support the introduction of this new funding approach. The Scarborough Hospital: The Transition Unit official opening was held on June 7 th at the General Campus. The event was a joint partnership between the hospital and the Ontario Renal Network to launch the Ontario Renal Plan. Lakeridge Health: The Lakeridge Health and Peterborough Regional Health Centre team met on May 30 th to discuss strategies to improve vascular access for Lakeridge Health and Peterborough Regional Health Centre patients. The team hopes to have a 3 rd surgeon in place for July This supports the commitment from Peterborough Regional Health Centre and the Lakeridge Health Senior Teams to execute a Memorandum of Understanding for vascular surgical services in the Durham and Northeast service clusters of the LHIN. Peterborough Regional Health Centre: The team is currently working with the Ontario Renal Network to review hemodialysis technician roles. Rouge Valley Health System: Discussions continue with specialist physicians from Rouge Valley Health System who are supporting Chronic Kidney Disease patients in their offices to identify opportunities for the Regional Program to provide access for these clients to Chronic Kidney Disease multidisciplinary teams. Vascular Access Task force: The Vascular Access coordinators from each of the three renal programs attend this task force. A current state Value Stream Mapping analysis has been completed for each program. This exercise was well received and provided an opportunity for the sharing of processes. The ORN is hosting a one-day workshop for the Vascular Access/Independent Dialysis coordinators on June 20. Central East Community Care Access Centre: The Ontario Renal Network continues to work with the Central East Community Care Access Centre to increase awareness of Peritoneal Dialysis in the Long-Term Care homes within the Central East LHIN. 22

23 Carefirst Seniors and Community Services: Carefirst submitted an RFP to the Heart and Stroke Foundation to develop and implement an Ontario Needs Assessment for Chinese Ontarians Living with Heart Disease or Stroke. This will be a three month project with the final report delivered on August 27 th. Carefirst was successful in the initial round of reviews and was asked to provide a presentation of their proposed work to the Heart and Stroke selection panel on June 5 th. Enablers ehealth ehealth Strategic Plan: The Central East LHIN has set out to develop an ehealth Strategic Plan by building on the 2007 ehealth Strategic Plan and making revisions to address current and emerging needs and requirements in support of the LHIN IHSP and Provincial ehealth Ontario strategy. Also, the revised plan should inform and enable the development of a GTA LHIN Cluster strategy. The Cluster Chief Information Officer is working with ehealth Ontario to confirm funding for the strategic planning for the cluster and LHINs. Once funding is confirmed, the cluster will proceed to finalizing the contract with the preferred vendor from the Request for Proposal (RFP) process which will inform the development of the Strategic Plan. Resource Matching and Referral: Using a Lean approach, RWS developed a standardized, streamlined Future State through an understanding of the Current State at the site, hospital and LHIN levels. The current state assessment identified a number of challenges in terms of the Patient Experience, People, Standardization, Bottlenecks, and Technology. A number of opportunities were identified in the Rehab and CCC referral process. At the Central East LHIN Resource Matching and Oversight Committee meeting on May 16, 2012 there were detailed discussions on the eligibility criteria and referral process from acute to rehab/ccc. It was discussed that perhaps this needed to be approached in the same way as Home First and representatives from each hospital would work with the CECCAC to develop a plan and roll out by individual hospital/site. Consensus was reached on the Conceptual Framework for Functional Groups and this would help the Central East LHIN to categorize the programs. The Central East LHIN engaged RWS Advisory to assist in the development of Current State Value Stream Maps (VSMs) and Future State VSMs and Workflows for the RM&R project essentially Steps 2 and 3 in the following 7-Step model: 23