CENTRAL LHIN CEO REPORT ITEMS FOR INFORMATION

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1 140 Allstate Parkway Suite 210 Markham, ON L3R 5Y CENTRAL LHIN CEO REPORT ITEMS FOR INFORMATION

2 Central LHIN CEO Report- Items for Information Table of Contents 1.0 BUSINESS ARISING COMMUNITY ENGAGEMENT CEO HIGHLIGHTS COMMUNITY ENGAGEMENT GUIDELINES CENTRAL LHIN QUALITY SYMPOSIUM (APPENDIX 2.2) ANNUAL CENTRAL LHIN MPP BREAKFAST FRENCH LANGUAGE HEALTH PLANNING ENTITIES- FUNDING AND ACCOUNTABILITY AGREEMENT MINISTRY-LHIN ACCOUNTABILITY AGREEMENT STATUS REPORT ( APPENDIX 2.5) EMERGENCY DEPARTMENT/ALTERNATE LEVELS OF CARE QUARTERLY STOCKTAKE RESULTS EXCELLENT CARE OF ALL ACT, 2010 UPDATE (APPENDIX 2.7) MULTI-SECTOR SERVICE ACCOUNTABILITY AGREEMENT ( M-SAA) TEMPLATE HOSPITAL SERVICE ACCOUNTABILITY AGREEMENT PROCESS LONG- TERM CARE HOME TRANSFER OWNERSHIP HIGH DEMAND FOR EMERGENCY ROOM SERVICES FOR INFLUENZA RELATED ILLNESSES AND RESULTING PRESSURES ON INPATIENT CAPACITY YORK CENTRAL HOSPITAL- SERVICE DELIVERY MODEL REPORT CONTINUATION OF BASE FUNDING TO HEALTH SERVICE PROVIDERS IN WAIT TIMES ALLOCATIONS PROCESS /11 IN-YEAR WAIT TIME REALLOCATIONS INTRA-LHIN TRANSFER OF CATARACT SURGERY CASES: SOUTHLAKE TO NORTH YORK SCHOOL HEALTH SERVICES REVIEW COMPLIANCE DECLARATION (APPENDIX 2.18) ON THE HORIZON... 8 Central LHIN Board of Directors Page 1 CEO Report February 22, 2011

3 Central LHIN CEO Report- Items for Information 1.0 BUSINESS ARISING 1.1 Community Engagement In follow up to the January 2011 Board Presentation, Central LHIN Community Engagement: Optimizing Best Practices, staff are planning for Citizen Engagement to be a key element of the Central LHIN Annual Community Engagement Plan, which is currently under development. Further, a new quick poll web-technology is being employed on the Central LHIN website to encourage citizens to share their perspectives and tell their health care stories to assist the LHIN in its local planning activities. 2.0 CEO HIGHLIGHTS 2.1 Community Engagement Guidelines Community Engagement On February 11, 2011, community engagement staff from across the LHINs met to review the now finalized LHIN Community Engagement Guidelines. The adoption of these guidelines is the result of collective efforts of LHINs and the Ministry of Health and Long-Term Care to bring increased consistency, accountability and transparency to community engagement initiatives province wide. The new guidelines give LHINs tools for planning and evaluating community engagement. They outline requirements for LHINs to review their community engagement plans with external partners, demonstrate community engagement results (including to the Board), and post an Annual Community Engagement Plan their websites. The plans, to be posted by April 30, 2011, will provide the public with an understanding of the community engagement activities anticipated in the coming year, goals for engagement, and how the community can expect to participate in these processes. The official launch of the LHIN Community Engagement Guidelines occurred on February 16, 2011 and was supported by key communications, including: LHIN CEO memoranda to staff and Health Service Providers; launch of a dedicated community engagement section on LHIN websites where the new guidelines, annual plans and other community engagement information will be posted; and the release of a standard LHIN news release to media and other stakeholders. Moving forward, all Central LHIN community engagement activities will be conducted per the guidelines and using the recommended planning templates. 2.2 Central LHIN Quality Symposium (Appendix 2.2) Central LHIN has finalized the program and faculty for the March 3, 2011 Quality Symposium Patients First: Creating Quality in the Transitions of Care. The official program invitation was released on February 14, 2011, and included invitations to all Central LHIN Health Service Provider Board Chairs as well as provincial and municipal elected officials. Moderated by former Ontario Deputy Minister of Health, Michael Decter, the symposium includes key note addresses by the Hon. Deb Matthews, Minister of Health and Long-Term Care and Hugh MacLeod, President and CEO of the Canadian Patient Safety Institute. Professor Ross Baker from the Department of Health Policy, Management and Evaluation at the University of Toronto is providing expert advice on the workshop components of the day, which examines opportunities and challenges in establishing quality across complex health care systems. Central LHIN thanks all faculty for dedicating their valuable time to this important event. Full program details are included in Appendix 2.2 of this Report. Central LHIN Board of Directors Page 2 CEO Report February 22, 2011

4 Central LHIN CEO Report- Items for Information 2.3 Annual Central LHIN MPP Breakfast Central LHIN staff are preparing to host our annual MPP Breakfast on February 24th, The break will be cochaired by Honourable MPP Wynne and Ken Morrison. This year the breakfast will be held at the Legislature. System Accountability and Performance 2.4 French Language Health Planning Entities- Funding and Accountability Agreement Ontario Regulation 515/09 "Engagement with the Francophone Community under Section 16 of the Act", made under the Local Health System Integration Act, 2006 (LHSIA) came into effect on January 1, This regulation supports coordinated and effective engagement of local Francophone communities on French language health service issues. This regulation provides criteria for the selection of French Language Health Planning Entity (Entities) and specific direction to LHINs on engagement with these Entities. The regulation is one of many tools used by the Ministry to deliver on the French language services mandate for health. Prior to providing funding to Entities, the LHINS and the Entities must enter into funding and accountability agreements. In order to ensure the more effective implementation of the regulation, a template Accountability Agreement has been developed by representatives of the LHINs, and Entities and with the support of Ministry staff. LHINs are underway working with FLPE to execute these accountability agreements Ministry-LHIN Accountability Agreement Status Report ( Appendix 2.5) The existing Ministry-LHIN Accountability Amending Agreement has been extended pending finalization of the new Ministry-LHIN Performance Agreement. The existing obligations therefore continue. Existing requirements that require MOHLTC confirmation of multiyear budget targets remain red and are identified on the Part One - summary page. Part Two summarizes the mutual obligations of the Ministry and the Central LHIN. 2.6 Emergency Department/Alternate Levels of Care Quarterly Stocktake Results Central LHIN received its latest performance report on February 11, 2011 from Access to Care Cancer Care Ontario. The Stocktake Report (which now incorporates the Ministry-LHIN Performance Agreement indicators) summarizes quarterly results for key emergency department wait time indicators (including those from the Pay for Results Program), bed utilization indicators, repeat visits to the Emergency Department and readmissions for selected clinical conditions, Emergency Department satisfaction ratings, and surgical/diagnostic imaging wait time indicators (31 indicators in total). The reporting periods range from Q1 to Q3 of 2010/11, depending on the indicator. A full review and analysis of the Stocktake indicators is currently underway, and is due to the Ministry at a full-day Peer Review on February 25, Highlights Preliminary review of the results indicates that Central LHIN hospitals have maintained their improvements in the areas of Emergency Department wait times for non-admitted patients (both high and low acuity) and time to physician initial assessment; and have made improvements in the 90 th percentile wait times for cancer surgery, cataract surgery, cardiac by-pass procedures, and MRI scans. Performance declined in several areas including alternate level of care days (which increased from 15.2% to 16.53%), Emergency Department Wait times for admitted patients, and 90 th percentile wait times for hip and knee replacement surgeries. The increase in percent alternate level of care days was expected due to the focus on discharging long-stay ALC patients in the fall. Central LHIN Board of Directors Page 3 CEO Report February 22, 2011

5 Central LHIN CEO Report- Items for Information 2.7 Excellent Care of All Act, 2010 Update (Appendix 2.7) The provincial government continues to move forward with implementing various requirements of this legislation, which received Royal Assent on June 8, Please refer to the slide deck The Role of LHINs in Advancing the Excellent Care for All Act, 2010 for a status update and key next steps related to this work Multi-Sector Service Accountability Agreement ( M-SAA) Template The draft Multi-Sector Service Accountability Agreement Template provided by the M-SAA Steering Committee was provided to the 14 LHIN Boards for approval in January. The Central LHIN Board approved in principle and delegated authority to the Board Chair and CEO to approve the final template. The final template was released on February 9, 2011 which addresses to the two key concerns raised with the draft template. As a result, the final Multi-Sector Service Accountability Agreement has been approved by Central LHIN and has been distributed to the Community Sector health service providers as part of the process Hospital Service Accountability Agreement Process Provincial Process In the absence of funding targets for 2011/12, the Joint LHIN/OHA Hospital Service Accountability Agreement (H- SAA) Steering Committee has developed the Gap-based Accountability Planning Submission (GAPS) process for hospitals and LHINs to facilitate directional system planning. GAPS is a tool to enable discussion on how each hospital will respond to continued operating pressures in 2011/12 at 1% and 2% gaps. The GAPS process is intended to provide a forum for the H-SAA Amending Agreement discussions, but will not produce the data required to complete the H-SAA Amending Agreement schedules. The process for executing the 2011/12 Hospital Service Accountability Amending Agreements (H-SAAs) will be similar to the process followed for the 2010/11 Amending Agreements. In the absence of a funding announcement from the Ministry, the 2008/10 H-SAA will be amended for a second time and be extended for a one-year term to cover 2011/12. With the exception of Global Volumes and Performance Targets, all terms and conditions in the 2011/12 Amending Agreement will remain in effect until such time that the Ministry announces 2011/12 hospital funding. Central LHIN Current Status In advance of the direction received from the OHA/LHIN Steering Committee about the GAPS process, and in order to facilitate a timely and fulsome planning process, Central LHIN management initiated a planning process with hospitals in December. On the direction of hospital CEOs, Central LHIN hospitals developed planning scenarios which are being used by Central LHIN to inform H-SAA discussions Long- Term Care Home Transfer Ownership Two Central LHIN Long-Term Care homes, Yorkview Lifecare Centre and Good Samaritan Nursing Home Limited were subject to transfer of ownership effective January 1, 2011 and January 12, 2011 respectively. Long-Term Care Home Service Accountability Agreements (L-SAA) have been signed between Central LHIN and the new operators of the homes. Yorkview Lifecare Centre is now operating under the name of Hawthorne Place Care Centre and Good Samaritan continues to operate under that name. The number of licensed beds remains the same in both homes. Capacity Building 2.11 High Demand for Emergency Room Services for Influenza related illnesses and resulting pressures on Inpatient Capacity Central LHIN Board of Directors Page 4 CEO Report February 22, 2011

6 Central LHIN CEO Report- Items for Information During December 2010 and continuing through January, emergency departments experienced higher volumes of patients with influenza and/or influenza related complications of chronic diseases (between 4 and 19%, Dec 2009 compared to December 2010). This has resulted in higher admissions to inpatient units within hospitals. At the January Central LHIN Board meeting, the Board approved funding to alleviate the December pressures, and delegated to the Chair and Chief Executive Officer of Central LHIN the approval of further funding should it be required. Based on an analysis of January emergency department volumes and inpatient admissions against a baseline of January 2010, the Chair and Chief Executive Officer of Central LHIN have approved the following allocation. Humber River Regional Hospital $314,476 Markham Stouffville Hospital $250,404 North York General Hospital $264,791 Southlake Regional Health Centre $393,316 Stevenson Memorial Hospital $58,322 York Central Hospital $122,035 The costs approved were based on the average emergency department visit, inpatient day and intensive care unit costs, with each hospital receiving a baseline amount of $100,000, with the exception of Stevenson Memorial Hospital with a baseline of $50,000. The York Central Hospital allocation was adjusted to take into account Post Construction Operation Plan funding York Central Hospital- Service Delivery Model Report In January, 2009, the Ministry of Health and Long-Term Care requested that Central LHIN undertake the development of Part 1 of a Service Delivery Model Report (i.e. the Master Program component of the Stage 1 Proposal/Business Case) for new hospital services in the community of Vaughan. Central LHIN subsequently retained a consultant to lead a collaborative planning process that included community engagement and which resulted in the development and submission of a report entitled, Vision for Hospital Services in Vaughan. This report was submitted to the Ministry following Board review in November, In November, 2009, York Central Hospital received a planning grant from the Ministry of Health and Long-Term Care to support a Stage 1: Proposal/Business Case Capital Submission for the redevelopment of the Richmond Hill hospital site and a new hospital site to be built in Vaughan. In December 2009, the Ministry Management Committee endorsed a new Joint Review Framework for the submission and review of Pre-Capital, Stage 1 and Stage 2 capital submissions that supports the respective roles of LHINs and the Ministry for the review of capital projects as outlined in the Ministry-LHIN Accountability Agreement. Under this Framework, the role of the LHIN is to focus on the alignment between the programs and services outlined in the proposed project and the needs of the local health system; the role of the Ministry is to review and approve the project, including to review all physical and cost elements as well as program and service elements from a provincial perspective. There are several points of alignment required between the LHIN and the Ministry in this process. In October, 2010, the Ministry officially launched the new MOHLTC-LHIN Joint Review Framework for Early Capital Planning Stage Toolkit which applies to the submission and review of York Central Hospital s Stage 1: Proposal/Business Case. Anticipating this release, beginning in the early fall of 2010, representatives from the Hospital (including their planning, architectural and site consultants) have been meeting regularly with Ministry and LHIN staff to review progress on the various elements of the Stage 1 submission. For the LHIN s review, the Stage 1 submission, in its entirety, includes a Service Delivery Model Report which includes: Central LHIN Board of Directors Page 5 CEO Report February 22, 2011

7 Central LHIN CEO Report- Items for Information A Master Program a document that reflects the health care facility s present and future role within the community; current and projected programs, staffing and high-level departmental space requirements A Human Resources Plan A Preliminary Operating Cost Estimate For the Ministry s review, the Stage 1 submission includes a Service Support Infrastructure Report which includes spacial requirements, a Multi-Year Infrastructure Plan, a Technical Building Assessment, a Master Site Plan, a Master Building Plan, a Business Case/Options Analysis, and a Facility Development Plan. The following graphic from the MOHLTC-LHIN Joint Review Framework illustrates the review process. LHIN review and alignment with the Ministry is required during Pre-Capital, Stage 1 and Stage 2. Overview of Capital Planning Process Planning Grants: 3 possible approval milestones: proposal development, functional program, design development Construction Grant Pre-Capital (Part A & B) Stage 1 Proposal (Part A & B) Stage 2 Functional Program (Part A & B) Stage 3 Preliminary Design Or Output Specifications Stage 4 Working Drawings Or Output Specifications Stage 5 Implementation Review and support of Pre-Capital Submission. Proposal Development grant Review and approval Review and approval of Stage 1 Submission. of Stage 2 Functional Program Functional Program. grant. Design Development grant Requires Government approval to plan Review and approval of blocks and sketch plans; approval to proceed to working drawings OR blocks/output specifications Requires Government approval to construct Review and approval to tender & implement/issue RFP OR approval to award construction contract/ Project Agreement. The York Central Hospital team are working towards a Spring, 2011 submission of their Stage 1 report to the LHIN and the Ministry and have been invited to present progress on their project at the March meeting of the Central LHIN Board. According to the new Ministry-LHIN Joint Review Framework, LHIN staff are expected to review the submission and provide a recommendation to the Board to: endorse the program and service elements of the proposal endorse the program and service elements of the proposal, with conditions reject the program and service elements of the proposal. Upon Board endorsement of the programs and services, staff will provide written rationale and advice to the Ministry. Central LHIN staff intend to undertake the review in the context of the Integrated Health Service Plan, the 2008 Health Service Needs and Gaps Analysis (SNAGA), relevant analysis provided by the Ministry, and other relevant provincial health services planning documents. Central LHIN Board of Directors Page 6 CEO Report February 22, 2011

8 Central LHIN CEO Report- Items for Information Funding Updates 2.13 Continuation of Base Funding to Health Service Providers in Consistent with past practice, Central LHIN will continue to cash flow the base allocations to Health Service Providers in Consistent with last year, Central LHIN has received directions from the Financial Management Branch of the M inistry on roll-over of prior year base funding to The objective is to continue to cash flow Health Service Providers at the level of previous year approvals in order for programs and services to continue to be delivered. This process has also been adopted by other LHINs. It is expected that the Ministry of Health and Long-Term Care will provide confirmation of funding for fiscal year after the provincial budget is released. Thereafter, staff will seek Board approval of Health Service Provider budgets for , performance expectations, and distribution of adjustments Wait Times Allocations Process The Ministry is beginning the 2011/12 wait time allocation process for hip and knee, cataract, paediatric and general surgeries, and Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) hours. This process involves hospitals completing surveys to identify their Need and Capacity for incremental wait time volumes in order to maintain or improve wait times for identified procedures. LHINs review the hospital surveys and forward summaries to the Ministry for analysis who then determines allocations to each LHIN. In response to significant feedback from LHINs, and in an attempt to provide greater funding stability to hospitals and LHINs, the Ministry will attempt to provide confirmation of a portion of the LHINs 2012/13 and 2013/14 allocations. The serviceat a later date and may potentially include allocations for specific details of these allocations will be provided surgical service areas beyond those currently funded through the Wait Time Strategy /11 In-Year Wait Time Reallocations As a result of the intra-lhin reallocation process, Central LHIN was able to transfer paediatric and general surgery cases between hospitals to keep funding within our LHIN. As a result of the inter-lhin reallocation process, $783,500 was returned to the province from other LHINs, however, there were $44M in requests. The province focused on funding MRI Hours and Paediatric Surgeries as these have the greatest wait times. Central LHIN did not receive any incremental funding through this process as Central LHIN was a recipient of substantial 2010/11 MRI Priority 4 funding and base funding for two new MRI machines. In addition, Central LHIN has achieved the paediatric provincial wait time target and therefore was not allocated additional paediatric wait time funding Intra-LHIN Transfer of Cataract Surgery Cases: Southlake to North York As part of the Regional Eye Care Centres Agreement, Markham Stouffville Hospital physicians were to perform cataract surgeries at both Southlake Regional Health Centre and North York General Hospital. Over the course of the year, they have performed more cases at North York General Hospital and as a result Southlake Regional Health Centre will be short of their target by 240 cases. Accordingly, a transfer of 240 cataract surgery cases from Southlake Regional Health Centre to North York General Hospital will occur to reflect the final allocation of cases and funding. Central LHIN Board of Directors Page 7 CEO Report February 22, 2011

9 Central LHIN CEO Report- Items for Information 2.17 School Health Services Review Other Updates Over the last year, the Ministries of Health and Long-Term Care, Children and Youth Services, and Education have been working on a review of School Health Support Services program which is funded by the MOHLTC and administered by Community Care Access Centres across the province. Referrals for School Health Support Services originate from school boards and following assessment of the student, services can include nursing, physiotherapy, occupational therapy, speech language pathology, and dietetics. The goal of the program is to assist children who have an array of medical, functional, developmental, behavioural and educational needs to attend school. The review of the School Health Support Services program was recently completed by Deloitte Consulting. Its goals were to review access and equity to services, coordination and quality of services, and strengths and weaknesses of the current mandate, policies, and models of service, with a view to identifying opportunities for improvement (the performance of individual LHINs was not reported as this was a provincial program review). The review involved extensive consultation with key stakeholders across the health, education, and community service sectors, as well as individuals, families and provider organizations. Deloitte identified 15 recommendations which have been posted on the MOHLTC s website for a 60- day public feedback period. The three Ministries plan to review the feedback from the public in order to determine next steps Compliance Declaration (Appendix 2.18) The Compliance Declaration for February 2011 is included in the appendices On the Horizon Service Accountability Agreements Central LHIN will be bringing forward performance volumes for three public hospitals to the February Board meeting for approval. Negotiations are continuing with the remaining four public hospitals and three private hospitals and are expected to be completed by March 31, Community Health Service Providers are required to submit a Board approved Community Accountability Planning Submissions to the LHIN by February 25, LHIN staff will review these submissions based on the principles being brought forward for Board approval in February. Staff reviewed and approved Community Accountability Planning Submissions will be used to populate the Multi Sector Accountability Agreements to be brought forward for approval in March. Central LHIN Office Lease Central LHIN has given notice to the current landlord and is anticipating moving by the end of March Central LHIN Board of Directors Page 8 CEO Report February 22, 2011

10 Central LHIN Patients First: Creating Quality in the Transitions of Care Appendix 2.2 Thursday March 3, :30 a.m. 4:00 p.m. Westin Prince Hotel 900 York Mills Road Toronto, Ontario SYMPOSIUM LEARNING OBJECTIVES: Identify key challenges to successful transitions and implications on measuring quality between care settings Learn foundational components of useful and meaningful performance indicators for quality in the transitions of care Prioritize key elements, challenges and barriers to quality improvement across care settings Identify roles for providers, patients, families and governance bodies in quality improvement Special Participation by: HONOURABLE D E B M AT T H E W S Minister of Health and Long Term Care ROSS BAKER Professor of Health Policy Management and Evaluation University of Toronto MICHAEL B.DECTER Former Ontario Deputy Minister of Health HUGH MACLEOD President and CEO Canadian Patient Safety Institute MAINTENANCE OF CERTIFICATION Attendance at this program entitles certified Canadian College of Health Leaders members (CHE / Fellow) to 2.5 Category II credits toward their maintenance of certification requirement.

11 W H O S H O U L D AT T E N D? Central LHIN health service and primary care providers Board members, senior management (including CEOs and VPs) from hospitals, long-term care homes, community support services, community mental health agencies, Family Health Teams, Community Health Centres, Community Care Access Centres Senior management and/or quality experts from national and provincial health professional associations, provincial agencies, think tanks/policy and research organizations, other LHINs and ministries

12 O P E N I N G R E M A R K S B Y: KEN MORRISON Chair, Central LHIN Board of Directors Ken Morrison is president of R.V. Anderson Associates Limited, a consulting firm engaged in the provision of professional engineering, operations and management services for infrastructure and environmental projects. Prior to joining the Central LHIN Board, Mr. Morrison had a long association with the North York General Hospital. He joined the hospital s foundation board of governors in 1991, serving as chair of the planned giving committee, and then as treasurer and finance committee chair. In 1994, Morrison joined the hospital s board of governors and served as Vice-Chair from 1996 to 2000, before being elected to serve as Chair from 2000 to He was appointed as the Chairman of the Central LHIN Board of Directors in KIM BAKER Chief Executive Officer, Central LHIN Kim Baker joined the Central LHIN in July 2007 to lead the Planning, Integration and Community Engagement portfolio. She brings over fifteen years of healthcare planning and leadership experience to the role from key sectors including hospital, ministry and long-term care. In addition to clinical training as a respiratory therapist and an undergraduate degree in administrative studies, Kim holds a Master of Health Science in Health Administration (MHSc) from the University of Toronto. Kim was officially appointed CEO of the Central LHIN in July Prior to joining the Central LHIN, Kim led a national portfolio for Extendicare s home care and community health service division, ParaMed. Kim brings health system and health service planning experience from key roles at the Ministry of Health including the Strategic Directions Project and through ten years of hospital experience including leading the redevelopment planning directorate at the University Health Network. Kim previously served on the Board of the Central Community Care Access Centre. She is an active member of the Canadian College of Health Service Executives as a Certified Health Executive (CHE). S P E C I A L R E M A R K S B Y: HONOURABLE DEB MATTHEWS Deb Matthews was elected to the Ontario Legislature by the people of London North Centre in 2003, and re-elected in Following her re-election, she was appointed Minister of Children and Youth Services and Minister Responsible for Women s Issues. In October 2009 she was appointed to her current position as Minister of Health and Long-Term Care and is committed to building a more sustainable health care system with shorter wait times and better access to high quality family health care.throughout her life, Deb has been actively involved in community organizations. She served as President of Big Sisters of London, and has volunteered with organizations including the Thames Valley Children s Centre, the Salvation Army, Orchestra London, and the Canadian National Institute for the Blind. Her professional experience includes time spent in the construction industry, fundraising for the Boys and Girls Club of London, and teaching at the University of Western Ontario where she was twice honoured with a place on the University Students Council Teaching Honour Roll while completing her Ph.D. in Social Demography. Deb was born in London, Ontario where she has lived her entire life. Her most important role remains as mother to her three children, and as grandmother to her three grandchildren. FA C U LT Y: ROS S BAKER is a professor in the Department of Health Policy, Management and Evaluation at the University of Toronto. Together with Dr. Peter Norton of the University of Calgary, Ross led the Canadian Adverse Events study which was published in the Canadian Medical Association Journal in Baker and Norton were awarded the Health Services Research Advancement Award for their work on patient safety and quality improvement by the Canadian Health Services Research Foundation in May Ross co-chairs a working group on methods and measures for patient safety for the World Health Organization and chairs the Advisory Committee on Research and Evaluation for the Canadian Patient Safety Institute. In 2009 Ross led a study of effective governance practices in improving quality and patient safety. The results were published in Healthcare Quarterly and served as the basis for the Governance Toolkit (Effective Governance in Quality and Patient Safety) and as a course for trustees developed by the Canadian Patient Safety Institute and Canadian Health Services Research Foundation. Ross Baker is the author of High Performing Healthcare Systems: Quality by Design, is also Associate Editor of Healthcare Quarterly and has edited 5 issues of Patient Safety Papers, a special edition of Healthcare Quarterly. Ross is currently chairing an Advisory Panel on Avoidable Hospitalizations for the Ontario Ministry of Health and Long Term Care and serves as a member of the King s Fund (London, UK) Commission on Leadership and Management in the NHS.

13 MICHAEL B. DECTER is a Harvard trained economist, Senior Portfolio Manager and President & Chief Executive Officer of LDIC Inc. He is also the author of six financial and healthcare books. His health care books include: Four Strong Winds Understanding the Growing Challenges to Health Care (2000) and Navigating Canada s Health Care, co-authored by Francesca Grosso (2006). As the former Deputy Minister of Health for Ontario and Cabinet Secretary in the Government of Manitoba, Mr. Decter is a well-recognized speaker on broader political and economic issues. Michael was the Founding Chair of the Health Council of Canada and former Chair of the Saint Elizabeth Health Care. He also served as the Chair of the Canadian Institute for Health Information, the Ontario Cancer Quality Council and Wait Times Data Certification Council of Ontario. In 2004, Michael was awarded the Order of Canada. MICHAEL GARDAM Dr. Gardam has been medical director of the tuberculosis clinic at the Toronto Western Hospital since 2000, and of the Infection Prevention and Control Unit at the University Health Network since He recently returned from a 2-year secondment as the Director, Infectious Disease Prevention and Control, at the Ontario Agency for Health Protection and Promotion. He is an assistant professor of at the University of Toronto. He is Physician Director of the Community and Hospital Infection Control Association Canada (CHICA) and is the national lead of the New Approach to Controlling Superbugs initiative for Safer Healthcare Now! Dr. Gardam has acted as a consultant on infection control issues such as SARS, tuberculosis, pandemic influenza and C. difficile, at the provincial, national and international level. Within Canada, he has helped a number of hospitals control outbreaks and develop their infection control programs. Dr. Gardam has published over 60 scientific papers and book chapters. His research interests focus on mitigating the spread of infectious diseases in both the hospital and community setting. ROBERT J. HOWARD is the President and CEO of St. Michael s. Dr. Howard brings expert medical knowledge and highly regarded leadership qualities to his new role of President and CEO. He has played a number of key roles at St. Michael s - as a clinician, a researcher and a member of the executive leadership team. Dr. Howard joined the Hospital as staff cardiologist in 1982 and was appointed Director of the University of Toronto training program in Cardiology in In 1998, Dr. Howard was named the Hospital s Chief Medical Officer. In 2002, Dr. Howard was appointed Executive Vice-President, Programs and Education to acknowledge the growing importance of the education and academic partnerships portfolio at the Hospital. Through his thoughtful guidance, St. Michael s Fitzgerald Academy has become the first choice for University of Toronto medical students. Dr. Howard has an undergraduate degree in industrial engineering from the University of Toronto, a medical degree from McMaster University and an executive MBA from the Richard Ivey School of Business. A professor in the Faculty of Medicine at the University of Toronto, Dr. Howard serves on the Boards of HealthForceOntario and the Canadian Cardiovascular Society Academy. Dr. Howard continues to teach echocardiography to residents and fellows of the University of Toronto and until recently practiced clinical cardiology one day a week. NICK KATES is a the Ontario Lead for the Quality Improvement and Innovation Partnership (QIIP), which assists Primary Care Practices in Ontario to implement a quality improvement agenda. He is a Professor in the Department of Psychiatry & Behavioural Neurosciences at McMaster University with a cross appointment in the Department of Family Medicine and is the director of Quality Improvement for the Hamilton Family Health Team. For 12 years he was the director of the Hamilton HSO Mental Health & Nutrition Program. He has participated in many planning initiatives in Ontario for both mental health and primary care reform. He has consulted extensively nationally and internationally on redesigning systems of care and has published over 60 articles and authored two books. HUGH B. MACLEOD is CEO of the Canadian Patient Safety Institute (CPSI). Prior to joining CPSI in February 2010, Hugh held senior positions with the Government of Ontario as Associate Deputy Minister Climate Change Secretariat and Assistant Deputy Minister System Accountability and Performance for the Ontario Ministry of Health and Long Term Care. During his four years with the Ministry he also was the Executive Lead of the Premiers Health Results Team responsible for a provincial surgical wait time strategy, a provincial primary care strategy and the creation of Local Health Integration networks. Prior to coming to Ontario in 2003, Hugh held a number of senior executive positions in the province of British Columbia, including Senior Vice President of Vancouver Coastal Health and Senior Vice President of the Health Employers Association of British Columbia. Hugh has a work record that demonstrates commitment to systems productivity improvement. He has a passion for leadership development and his interest lie in the areas of system/integrative thinking, sustainability and organizational cultures that create high performance.

14 TERRY MCCULLUM is the CEO of LOFT Community Services whose mission is to support people s health and recovery from mental health and addiction challenges, especially for those who are marginalized, homeless, fall into gaps in service or have no services at all. LOFT operates 14 different support programs in both Toronto and York Region serving over 3500 people each year. Its services include a variety of supportive housing options, community support/case management services and street outreach services. Terry has over 25 years experience working with supportive housing and community support programs for youth, adults and seniors. His professional training is in Social Work (BSW, MSW). Presently Terry is the Co-Chair of the Mental Health and Addictions Steering Committee of the Toronto Central LHIN. MARGARET MOTTERSHEAD Since 2007 Margaret has been the CEO of the Ontario Association of Community Care Access Centres, which represents 14 Community Care Access Centres across the Province. Prior to this, Margaret was the President of Mottershead & Associates Inc., a management consulting firm specializing in health care. In this role Margaret has provided executive, management and negotiations expertise to several large health care initiatives. She has been Chief Negotiator for the Ontario Government on contract negotiations with the medical profession on alternate payment plans for all specialists in 2 Academic Health Sciences Centres, and hundreds of specialists in regional programs across the province (including the Regional Geriatric Program, medical and radiation oncologists). She was also the Project Manager for the CCAC Alignment Project that saw Ontario s 42 CCACs transformed to 14 new CCACs in Margaret is a former Deputy Minister of Health, and Senior Assistant Deputy Minister of Health, with many years of experience in public service. LIZ RYKERT is President of Meta Strategies and Senior Advisor of the IDPC Team at the Ontario Agency for Health Protection and Promotion. Liz Rykert began her career as a social worker. Currently she is a positive deviance coach supporting the University Health Network and four other health systems including Bridgepoint. The purpose of the work is to reduce the spread of hospital acquired infections and address other areas of patient safety. Liz a member of the team for the Canadian research project on PD and is the lead coach for the Safer Health Now! Collaborative: New Approaches to Controlling Superbugs. Ms. Rykert founded her own business, Meta Strategies, in She also works part-time at the Ontario Agency for Health Protection and Promotion as a Senior Advisor on the Infectious Diseases Protection and Control Team. Her work combines social process with technology for real change. MARIAN WALSH CEO of Bridgepoint Health, has been identified as a futurist by Health Care Manager Magazine. She is a strong advocate for transforming the health care system to meet evolving needs of patient populations. At Bridgepoint, Marian is leading of one of Canada s largest and most progressive healthcare networks focused on changing the world for people living with complex disease and disability. Under Marian s leadership, Bridgepoint has become Canada s leader in complex care and complex rehabilitation. She believes that the future of healthcare lies not just in saving life but in optimizing the lives of those who are living with chronic and complex diseases and disabilities. Her response is Bridgepoint Health; an organization that delivers an integrated network of programs and services; is advancing knowledge, expertise and care through research, teaching and learning; and engaging our community and health care partners to create a networked system of support, including integrated EHRs for safe continuity of care. At this time, Marian is overseeing redevelopment of the new Bridgepoint Hospital, a state of the art purpose built facility scheduled to open in Prior to Bridgepoint, Marian held a number of leadership and advisory roles that have greatly influenced understanding and the direction of complex chronic care in the Province and across Canada.

15 P R O G R A M M E : PA T I E N T S F I R S T C R E A T I N G Q U A L I T Y I N T H E T R A N S I T I O N S O F C A R E Thursday, March 3rd, : 3 0 R E G I S T R A T I O N & C O N T I N E N T A L B R E A K FA S T 8 : 3 0 W E L C O M E A N D O P E N I N G R E M A R K S Kim Baker Chief Executive Officer, Central LHIN 9 : 0 0 W E L C O M E A N D O P E N I N G R E M A R K S F R O M T H E S Y M P O S I U M M O D E R A T O R Michael B. Decter Former Ontario Deputy Minister of Health Founding Chair Health Council of Canada Former Chair of CIHI and of the Ontario Cancer Quality Council 9 : 1 5 K E Y N O T E A D D D R E S S : Improving the Patient Journey through the Continuum of Care: What is the Patient Experience? Hugh MacLeod President and CEO Canadian Patient Safety Institute 1 0 : 0 0 H E A LT H A N D N E T W O R K I N G B R E A K 1 0 : 1 5 PA N E L D I S C U S S I O N : The Challenges and Opportunities to Create Seamless Care This panel discussion will address challenges and opportunities faced by care settings when patients are transitioned from another part of the health system, what these challenges mean to patient care and the solutions or opportunities to bridge these gaps. Panelists: Bob Howard President and CEO, St. Michael s Hospital Nick Kates Provincial Lead Quality Improvement and Innovation Partnership and Program Director Hamilton Family Health Team Terry McCullum CEO, LOFT Community Services Margaret Mottershead President and CEO, OACCAC Marian Walsh President and CEO, Bridgepoint Health 1 1 : 1 5 E X P E R T S E S S I O N S Improving Care Transitions: Evidence, Interventions and Challenges to Implementation This session identifies the impact of transitions on patients and health systems, reviews the types of interventions that have been identified to improve transitions and outlines some of the system barriers to implementing these interventions. Ross Baker Professor, Health Policy Management and Evaluation University of Toronto

16 1 2 : 0 0 Overcoming Cultural Barriers to Quality Improvement across Transitions of Care Among the greatest challenges to tracking and improving quality in the transitions of care is overcoming the cultural barriers that exist between care settings and organizations. This session will: Discuss how culture can dramatically impact upon quality improvement initiatives Provide an approach to overcoming cultural barriers in complex systems Michael Gardam National Lead Superbug Intervention Safer Healthcare Now Director, Infection Prevention and Control Assistant Professor, Faculty of Medicine, University Health Network 1 2 : 3 0 L U N C H E O N 1 : 1 5 W O R K S H O P Identifying and Prioritizing Key Barriers to Quality in Complex Systems of Care Delegates will be introduced to an innovative, interactive and entertaining approach to identifying barriers and challenges in establishing quality across complex systems. Lead facilitators will also introduce participants to problem solving methods including: the Theory of Inventive Problem Solving (TRIZ), the Wise Crowds and the 5 Whys. Using these methods delegates will then work in groups to identify and prioritize challenges and opportunities to improve care between care settings. Each group will work through key questions and provide short answers that will be integrated into a post Symposium report by the Central LHIN, which can help inform the development of meaningful quality performance indicators across the transitions of care. Professor Baker will provide support and help participants understand how these techniques can be used to inform quality improvement and quality indicators. Lead Facilitators: Michael Gardam National Lead Superbug Intervention Safer Healthcare Now Director, Infection Prevention and Control Assistant Professor, Faculty of Medicine, University Health Network Liz Rykert President, Meta Strategies Inc, Toronto Faculty and Coach, a New Approach to Controlling Superbugs Safer Healthcare Now! Facilitator: Ross Baker Professor, Health Policy, Management and Evaluation University of Toronto 2 : 4 5 H E A LT H A N D N E T W O R K I N G B R E A K 3 : 0 0 S E L E C T E D R E P O R T B A C K P R E S E N T A T I O N S : Selected groups will present the highlights of their group s work. 3 : 3 0 C L O S I N G K E Y N O T E A D D R E S S Honourable Deb Matthews Ontario Minister of Health and Long Term Care 3 : 4 5 R E M A R K S F R O M T H E M O D E R A T O R 4 : 0 0 C L O S I N G R E M A R K S Ken Morrison Chair, Central LHIN Board of Directors Go to to register on-line!

17 C E N T R A L L H I N Q U A L I T Y S Y M P O S I U M A D V I S O R Y G R O U P Thomas O Shaughnessy, Chair Director, Strategic Communications, Stakeholder Engagement & Integration Central LHIN Barbara Kendrick Director, Quality and Planning Southlake Regional Health Centre Carolyn Acton Chief Operating Officer Circle of Care Leigh Scott Sr. Director, Organizational Health & Performance Improvement Central Community Care Access Centre Debra Cooper Burger President and CEO Union Villa Home for the Aged Dr. David Kaplan Associate Family Physician In Chief, North York General Hosptial Central LHIN Regional Diabetes Lead Co-Chair, Central LHIN Primary Care Action Group Dr. Peter Nord Vice President and Chief Medical Officer Providence Health Care Paula Blackstein-Hirsch Executive Director Centre for Health Care Quality Improvement Terry McCullum CEO LOFT Community Services Isabel Araya Executive Director Vaughan Community Health Centre Trish Maxwell Senior Planner Central LHIN Creating Caring Communities, Healthier People... Together

18 Part One: MLAA Status Update This section provides a summary of MLAA obligations that have not been fully met by Central LHIN or MOHLTC. Updates for on track deliverables and initiatives will continue to be provided through the CEO Report. # Central LHIN MLAA Obligation 1.1 Negotiate and sign 2010/11 Ministry LHIN Performance Agreement (MLPA) 4.1 Require health service providers to submit data and information (including financial) to the MOHLTC, Canadian Institute of Health Information, or other third party. 5.1 Develop an Annual Service Plan within the multi-year targets that outlines a three-year spending plan for each of its Operating and Transfer Payment Budgets. 5.2 Advise each public hospital of its multi-year funding targets for Hospital Accountability Agreements. Issues Impact Status Planned Actions Central LHIN awaits the final version to be signed from the MOHLTC. Central LHIN has one provider who has not submitted a number of financial reports required by the Ministry and the LHIN. The MOHLTC has not provided multi-year funding targets The MOHLTC has not provided multi-year funding targets for health service providers Agreement contents and performance targets are known but not official. Delayed reporting could impact the Community Annual Planning Submission for this provider. LHIN and HSPs cannot develop multi-year plans LHIN and HSPs cannot develop multi-year plans Currently operating status quo under current MLAA. New MLPA indicators are tracked and monitored. A letter requiring all outstanding reports to be submitted has been sent to the provider. Staff will continue to work with the agency to facilitate submission. N/A N/A 5.4 Jointly develop policies and plans with the MOHLTC to introduce and ensure compliance with annual balanced budget provisions. The framework for LHIN intervention on issues arising at health service providers has not yet been finalized. There may be inconsistent LHIN-wide approaches in intervention. N/A Slightly off-plan Significantly off-plan

19 Part Two: Summary of MLAA Obligations This section summarizes the mutual obligations of the Ministry and the Central LHIN that are subject to period/ongoing action. Schedule 1: General # MOHLTC Obligation CLHIN Requirement Frequency 1.1 Develop provisions to address and add to the Schedules in the following areas: (a) Schedule 5: Financial Management, related to capital. (b) Schedule 7: Local Health System Compliance Protocols; (c) Schedule 9: Allocations (d) Schedule 10: Local Health System Performance, performance benchmarks, baselines, LHIN targets and performance corridors for the performance indicators as set out in Tables A, B and C of the Schedule. 1.2 Review within 120 days of 2010/11 budget announcement by the Government of Ontario: Schedule 3: Local Health System Management Schedule 9: Allocations; and Schedule 10: Local Health System Performance Schedule 2: Community Engagement, Planning & Integration # MOHLTC Obligation CLHIN Requirement Frequency 2.1 N/A Regularly review community engagement strategy and Quarterly plan. 2.2 N/A Report on community engagement activities in the Annual Report. 2.3 Develop and update, as necessary, an Integrated Health System Planning Guide to support the development of the Provincial Strategic Plan and the IHSP. As Needed 2.4 Released by the Ministry the Provincial Strategic Plan in Spring New 3 year IHSP (2009/ /13) developed Every three years 2.5 Develop a process to review the functions of health systems planning Organizations, other than LHINs. Provide to the MOHLTC: (i) Advice on the functions of health system planning organizations, other than LHINs; and (ii) Information on any significant proposed changes to its IHSP. As Needed Page 2

20 2.6 N/A Reflect the IHSP in the Annual Service Plan required under Schedule N/A Demonstrate progress on the implementation of IHSP priorities, and report in the LHINs Annual Report. 2.8 Consult with the MOHLTC prior to issuing a decision to integrate or to stop the integration under sections 26 or 27 of the Act and include a report on its integration activities in its Annual Report. As Needed and Schedule 3: Local Health System Management # MOHLTC Obligation CLHIN Requirement Frequency 3.1 Assign agreements the the LHIN beginning April 2007 and set a termination date for those agreements Make decisions about which services will be provided including service volumes, performance requirements, and funding. h li bl 3.2 Provide the LHIN with, and develop as appropriate, those provincial standards (such as operational or service standards and policies, and program eligibility) directives and guidelines that apply to health service providers, including providing the LHIN with relevant program manuals. 3.3 Assign agreements to the LHIN beginning April 2007 and set a termination date for those agreements where applicable. 3.4 For Hospital Programs Funded through Base Budgets and Provincial Resources: Notify LHIN of a)provincial/regional service delivery models and b) designated service coordination functions that must be maintained. 3.5 For Hospital Programs Funded through Base Budgets and Provincial Resources: Determine, in consultation with the Central LHIN, the hospital-specific volumes for those hospitals providing Specialized Hospital Services until April 1, Require health service providers to provide services funded by the LHIN in accordance with applicable legislation, provincial policies, standards, operating manuals; directives and guidelines. Develop a plan to negotiate new service accountability agreements as required. Maintain funding and service coordination and require hospitals that provide these services to maintain the volume or activity levels and scope of service delivery. Consult the the MOHLTC on any proposed service changes to Specialized Hospital Services which include the following: Trauma, Sexual Assault and Domestic Violence Treatment Centres, Provincial Regional Genetic Services, HIV Outpatient Clinics, Hemophiliac Ambulatory Clinics, Regional/District Stroke Centres, Cardiac Rehab Services, and Permanent Cardiac Pacemaker Services. As Needed Page 3

21 3.6 Acute Sector Provincial Strategies: Determine strategic and operational program policy (funding model and accountability framework) and work with LHINs to identify hospitals to deliver the Provincial Strategies. 3.7 Acute Sector Cardiac Services: Determine the provincial service delivery requirements and standards and the dedicated funding envelope for Cardiac services. 3.8 Acute Sector Cardiac Services: Provide approval for LHIN requests. 3.9 Acute Sector: Chronic Kidney Disease: Determine the provincial service delivery requirements and standards and the dedicated funding envelope for Cardiac services. Provide advice to the MOHLTC. Incorporate into Hospital Service Accountability Agreements. Use the Dedicated Funding Envelope and require hospitals delivering these services to meet service delivery requirements. Seek approval from the Ministry: a) Fund a cardiac service at a hospital that did not perform that type of service as of April 1, 2009; and b) Discontinue a hospital s performance of a cardiac service. Use the Dedicated Funding Envelope and require hospitals delivering these services to meet service delivery requirements Support service delivery of cancer programs in hospitals in CLHIN. As Needed 3.11 For Wait Time Strategy funded emergency department services determine specifications, including providers, volumes, funding levels Determine Wait Time Strategy specifications, including funding levels for cataracts, hip and knee and MRI/CT services, and paediatric and general surgery but will not determine providers or allocations to providers Convalescent Care Beds: Consult with Central LHIN to determine which Long Term Care Home operators will provide the service and the number of beds to be funded. Incorporate service requirements into accountability agreements with providers. Determine the providers for these services and allocations to providers as set out in the MOHLTC specifications. Incorporate service requirements into accountability agreements with providers. Fund and incorporate into service agreements. Determine whether to fund operators outside of funding envelope using Central LHIN allocation. Page 4

22 3.14 Determine per Diem rate. Project unused funding as of September 30 each fiscal year by LTC home operators and reallocate a share of this funding to the Central LHIN in proportion to the number of LTC beds Determine the Construction Cost Funding per Diem and which Long Term Care Homes will receive it Determine number of interim beds to be funded as of March 31, 2010 and consult with Central LHIN to determine operators of these beds. Fund per MOHLTC per Diem and require compliance with per Diem envelope spending. Provide Construction Cost Funding per Diem to selected Long Term Care Homes and make recommendations re new Construction Cost Funding applications. Fund operators and incorporate conditions of funding into service agreements. Determine whether to fund operators outside of funding envelope using Central LHIN allocation. As Needed 3.17 Approve beds in Abeyance applications. Manage applications, make recommendations to MOHLTC, monitor need to re-open beds and as necessary restore them to operation Review and approve LHIN request to temporarily use funding available from Beds in Abeyance for new Interim Beds and Convalescent Care Beds. Determine the process and conditions for approval. LHIN may request approval from MOHLTC to temporarily use funding available as a result of any approved Beds in Abeyance for creation of new Interim or Convalescent Care beds. As Needed As Needed 3.19 Determine the minimum threshold for occupancy for short stay beds Determine funding for services by CHCs to uninsured persons. Monitor short stay bed utilization of each Long Term Care Homes home operator. Take action as appropriate to improve the utilization of these beds. Have the ability to set threshold for occupancy higher than the minimum set by MOHLTC. Use Dedicated Funding Envelope for services to uninsured persons for CHCs Community Mental Health: Determine and advise the LHIN of the health service providers and the Dedicated Funding Envelope for specified programs and services. Use the Dedicated Funding Envelopes as advised by the Ministry, to fund health service providers who provide identified services Determine the Dedicated Funding Envelope for Problem Gambling Treatment and for pregnant women with addictions funding through the Early Childhood Development Initiative. Use the Dedicated Funding Envelopes of which it is advised for specified services. Fund the provision by health service providers of withdrawal management and counselling and support Page 5

23 services Determine the Dedicated Funding Envelopes for children/youth in Private & Home Schools for Professional Health Services, Personal Support Services and Related Medical/Personal Equip; And The volumes & dedicated funding envelope for Acute Hospital Replacement Clients and End of Life Strategy 3.24 Determine the Dedicated funding Envelope for compensation and benefits under specific initiatives or agreements for persons paid directly by health service providers. Use the Dedicated Funding Envelopes of which it is advised for specified services. Require the CCAC to achieve volumes determined by the MOHLTC for Acute Hospital Replacement Clients and End of Life Strategy. Require health service providers to use the Dedicated Funding Envelope as determined by the MOHLTC. Schedule 4: Information Management Supports # MOHLTC Obligation CLHIN Requirement Frequency 4.1 Develop data standards, data quality definitions and reporting timelines and Develop a repository of data and info to support health system needs and provide access to that repository to the LHIN Require health service providers to submit data and information (including financial) to the MOHLTC, Canadian Institute of Health Information, or other third party. Improve data quality and timelines as necessary. Quarterly Schedule 5: Financial Management # MOHLTC Obligation CLHIN Requirement Frequency 5.1 Provide multi-year funding targets Develop an Annual Service Plan within the multi-year targets that outlines a three-year spending plan for each of its Operating and Transfer Payment Budgets. 5.2 Provide multi-year funding targets for health service providers Advise each public hospital of its multi-year funding targets for Hospital Accountability Agreements. 5.3 Provide multi-year funding targets Prepare a plan to implement multi-year funding targets for community health service providers. 5.4 Jointly develop policies and plans to introduce and ensure compliance with annual balanced budget provisions. Ongoing Page 6

24 5.5 N/A Plan and achieve an annual balanced budget for its Operating and Transfer Payment Budgets and submit annual balanced budget forecasts to the MOHLTC as part of Annual Service Plan and include annual balanced budget provision in agreements with Health Service Providers. 5.6 N/A Provide Quarterly Reports the last day of each quarter. Report on the: LHIN Quarterly Forecast by Sector, including forecast of year-end position, planned in-year reallocations, and actual in-year reallocations; Risk Summary and related mitigation strategies. Quarterly 5.7 N/A 5.8 Develop LHIN Risk Management Tools and Policies in accordance with Ontario Public Service Risk Management Framework (2001) and Risk Management Policy (2002). Submit Annual Report including: Community Engagement and Integration Activities; LHIN s Audited Financial Statements; LHIN s engagement with planning entities. Using MOHLTC Tools and Policies, report on identified risks and related mitigation strategies in Annual Service Plan and quarterly regular reports. Quarterly 5.10 Carry out capital planning in alignment with the Provincial Strategic Plan. Ongoing 5.11 Work together to enable the LHIN to provide advice about the consistency of a health service provider s Capital Initiative review and approval processes, including pre-proposal, business case or functional program stages. As Needed 5.12 Enable the LHIN to provide advice about the consistency of a public hospital s Own-Funds Capital Ongoing Project and devolve the review and approval process for Own-Funds Capital Projects from the MOHLTC to the LHIN, as appropriate Work together to enable the LHIN to begin approving Health Infrastructure Renewal Fund projects. Ongoing Schedule 6: Financial Processing Protocols # MOHLTC Obligation CLHIN Requirement Frequency 6.1 Manage payment process for LHINs. Request payments to be made and adjustments to Ongoing payments to health service providers. Page 7

25 6.2 Review and Approve potential reallocations from LHINs. 6.3 Collect and provide forecast information to LHINs. Monitor the financial information of health service providers, and direct the MOHLTC on potential reallocations and adjustments. Provide expenditure forecasts in quarterly and year end reports. Ongoing Quarterly Schedule 7: Local Health System Compliance Protocols # MOHLTC Obligation CLHIN Requirement Frequency 7.1 Work together to proactively assess and mitigate risks to the local health system that arise or may arise from the MOHLTC s activities. Jointly develop guidelines for the LHIN on conducting audits, inspections, and reviews of health service providers. Jointly develop protocols for the consultations and information exchanges between the LHIN and the MOHLTC. Ongoing (See Item 5.4). 7.2 Inform the LHIN as soon as reasonably possible of any non-compliance (either legislative or otherwise) by a long-term care home operator. Inform the MOHLTC of any non-compliance by a health service provider with an assigned agreement, a service accountability agreement, or legislation, including program standards. Provide the results of any audit or review of a health service provider. As Needed 7.4 Beginning in 2008/09 both parties will develop protocols for consultations and information exchanges between the LHIN and the MOHLTC. As Needed Schedule 8: Integrated Reporting # MOHLTC Obligation CLHIN Requirement 8.1 Provide forms for quarterly Regular and Consolidation Reports by April 30 of each fiscal year. As required, develop and notify LHIN of reporting requirements relating to government priorities. 8.2 Collect and provide information for Advertising Review Board annual fiscal report. 8.3 Provide data on performance indicators (Schedule 10) Submit to the MOHLTC Quarterly Reports using forms provided, Provide expenditure details each year reporting Communications contracts Submit to the MOHLTC reports on performance indicators using forms provided. Reporting Frequency Quarterly Quarterly Report on mitigation strategies and performance improvement plans for all performance indicators, where variance has been identified until variance resolved. Page 8

26 8.4 Provide report containing year-to-date expenditures. Provide a form for the Reallocation Report. 8.5 Provide for each fiscal year the form for the financial content of the Annual Report by March 31 and the form for the Year-end Consolidation Report by April Provide Annual Report requirements (nonfinancial content) and forms for Annual Report (financial content) 8.7 Provide the forms and information requirements for the Annual Business plan component of the Annual Service Plan. 8.8 Provide the forms and information requirements for Multi-year Consolidation Report Schedule 11: e-health Submit quarterly reports to the MOHLTC Submit to the MOHLTC the year-end consolidation report, for each fiscal year to which this Agreement applies. Submit to the MOHLTC an Annual Report for the previous fiscal year in accordance with MOHLTC requirements, which includes: i) The effectiveness of the LHIN S community engagement strategy using the common assessment tool. ii) Engagement with planning entities prescribed under the Act. iii) A report on the LHIN s integration activities. iv) A report on the performance of the local health system on all performance indicators. Submit to the MOHLTC a draft Annual Business Plan Submit to the MOHLTC the multi-year Consolidation Report using the forms provided by the MOHLTC. Quarterly # MOHLTC Obligation CLHIN Requirement Frequency 11.1 Inform one another of significant issues or initiatives that contribute to or impact on provincial or local e-health issues, strategies or work plans. As Needed 11.2 Provide the LHIN with provincial e-health priorities and strategic directions and provide any updates. Implement the approved LHIN e-health strategy through its LHIN e-health Work Plan and service accountability agreements with health service providers. Ongoing Page 9

27 Appendix 2.7 The Role of LHINs in Advancing the Excellent Care for All Act, 2010 Status Update Central LHIN Board Presentation February 22,

28 ECFAA Implementation Status The Excellent Care for All Act, 2010 (ECFAA) received Royal Assent on June 8th, 2010 ECFAA requires health care organizations, beginning with hospitals to: Develop and post annual quality improvement plans (QIPs) and submit them to LHINs - see Appendices I and II Create quality committees to report to each hospital board on quality related issues Link executive compensation to achievement of quality plan performance improvement targets Implement patient and employee satisfaction survey and a patient complaints process The Act also expands the mandate of the Ontario Health Quality Council (OHQC) to recommend evidence-based clinical practice guidelines and provide advice around health care services funding. An OHQC Expansion Plan is underway to transition the current agency to its new and broader mandate Additionally Hospitals will be required to move towards a patient-based payment system of funding where funding is allocated on the types and volumes of patients treated 2

29 ECFAA Implementation Status Cont d ECFAA requirements are currently at various levels of development and implementation. Local Health Integration Network CEOs are collaborating with the Ministry of Health and Long-Term Care and the OHQC in support of ECFAA implementation and the provincial quality agenda, including to: Support implementation of ECFAA in its first phase (Year 1) Ready other sectors for ECFAA through an integrative approach that focuses on the transitions of patients in the system Engage, strengthen and consolidate local health service provider quality improvement capacity LHINs (CEOs and senior staff) are key participants on numerous provincial working groups and committees, including: ECFAA Implementation Working- Group, LHIN CEO Quality Working Group, Patient Based Payment Working Group, etc. 3

30 Leveraging LHIN Construct to Support Implementation Consistency and Standardization o Implement ECFAA in an integrated way within and across LHINs o o Align service accountability agreements and quality improvement plans to the extent possible, including to address compliance Develop a core suite of indicators to support provincial priorities (e.g. ALC) Quality Improvement Capacity o o o Champion provincial quality improvement efforts at the local level Lead community engagement activities on quality initiatives KEY LHIN ROLE Enable readiness for implementation in other sectors (capacity building) Provincial Structure for Dialogue/Alignment o Establish a regular table with LHINs, OHQC and Ministry to support implementation of ECFAA o o Focus on system priorities including Integrated Health Service Plans and quality results/reporting assessment Replicate this framework at the local level between LHINs and health service providers Quality in the Transitions of Care o Focus on care delivery transitions between providers (a key barrier to achieving quality improvement) as a strategy to bring other sectors into ECFAA compliance o Develop quality improvement transitions of care indicators to support this effort 4

31 Key Next Steps Continued LHIN CEO engagement with Ministry and OHQC leadership to support implementation Hospital development of QIPs underway due to OHQC by March 31, 2011 for review (with a copy to LHINs) LHIN wide engagement with hospitals on QIPs by June 30, Key goals are to better understand: Local common improvement initiatives across hospitals Implications for performance improvement (based on MLPA) Opportunities to advance organizational collaboration/alignment with these initiatives LHINs to provide feedback to all hospitals, Ministry and OHQC to advance local system quality planning 5

32 Appendix I Core QIP Indicators (Consistent with HSAA) Safety CDI, VAP, Hand Hygiene, CLI, Pressure Ulcers, Falls Effectiveness HSMR, Readmission, ALC Access ER Wait Times Patient Satisfaction Patients Satisfied 6

33 Appendix II Example of Completed Row in QIP EXAMPLE AIM MEASURE CHANGE Objective Outcome Measure/Indicator Current performance Performance goal 2011/12 Priority High level improvement plan Methods and results tracking Target for 2011/12 Target justification Comments Improve provider hand hygiene compliance Hand hygiene compliance before patient contact: The number of times that hand hygiene was performed before initial patient contact divided by the number of observed hand hygiene indications for before initial patient contact multiplied by /10, consistent with publicly reportable patient safety data 65% 80% 1 monthly education and training sessions by program Complete installation of ABHR outside all remaining patient rooms and treatment areas Positive deviance training for HH champions Encourage patients to ask providers if they ve washed hands using pamphlets, posters. audit to show 80% of staff trained environmental review to confirm installation 100% attendance at training. 75% self report using a positive deviance technique. Survey patients to ask if they were comfortable doing so; aim for 50% 80% of hand hygiene champions trained internal targeting exercise decided to aim for getting halfway towards long term goal this year and attaining long term goal in the following year 7

34 140 Allstate Parkway, Suite 210 Markham, ON L3R 5Y8 Tel: Fax: Toll Free: TO: FROM: The Board of Directors, Central Local Health Integration Networks (the LHIN ) Kim Baker Chief Executive Officer ( CEO ) REPORTING PERIOD: February 2011 RE: CEO Certificate of Compliance ====================================================================== I have reviewed, or caused to be reviewed, such files, books, records and accounts of the LHIN and have made, or caused to be made, such enquiries of the financial, accounting and other personnel of the LHIN as I have determined necessary for the purposes of this certificate. In my capacity as CEO of the LHIN, and for the reporting period identified above, I hereby certify that to the best of my knowledge and except as set out on Schedule A: 1. Salaries and Benefits. The LHIN has met all of its obligations in respect of the payment of all employee salaries and wages, vacation pay, holiday pay, termination pay, severance pay, bonuses and benefits. The LHIN is in compliance with the provisions of the Public Sector Compensation Restraint to Protect Public Services Act, Statutory Deductions. The LHIN has met all of its obligations in respect of the deduction, withholding and or remittance as the case may be, of funds under the Income Tax Act, (Canada), the Income Tax Act, (Ontario), the Employer Health Tax Act (Ontario), the Employment Insurance Act (Canada), the Canada Pension Plan Act (Canada); and the Retail Sales Tax Act (Ontario). 3. Financial Statements. The financial statements of the LHIN, as at their respective dates of preparation, were accurate and complete in all material respects. 4. Insurance. All insurance policies remained in full force and effect. The LHIN was not in default with respect to any of the provisions contained in any insurance policy and did not fail to give any notice or present any claim under any insurance policy in a timely manner. 5. Compliance. The LHIN conducted its business in compliance with: (i) all applicable laws of the Province of Ontario and Canada; (ii) the terms of the memorandum of understanding and the accountability agreement currently in effect (iii) between the LHIN and the Ministry of Health and Long Term Care; and all intra LHIN agreements, including the Shared Services Agreement and the LHIN Collaborative agreement. 6. Ibid. Without limiting the foregoing, the LHIN did not breach the terms of the Local Health System Integration Act, the Financial Administration Act, the Travel and Expense Directive, or the Procurement Directive. Dated this 16th day of February 2011 Kim Baker, Chief Executive Officer