2.0 NOTICE/RECOGNITION OF A QUORUM Mr. Michael MacEachern

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1 AGENDA BOARD OF DIRECTORS January 30, :00 pm-4:00 pm Suite 360, 60 Renfrew Drive Markham, ON L3R 0E1 Tab No. Agenda Item Time Presenter 1.0 MEETING CALLED TO ORDER 2:00 Mr. Michael MacEachern 2.0 NOTICE/RECOGNITION OF A QUORUM Mr. Michael MacEachern 3.0 APPROVAL OF AGENDA Mr. Michael MacEachern 3.1 Welcome Members for the Public 3.2 Patient Story 2:10 10min Ms. Tini Le 4.0 BOARD DEVELOPMENT AND EDUCATION 4.1 Caring for Patients: 2017/2018 Winter Surge 2:20 30 min Ms. Lynn Singh Ms. Mary Burello 5.0 DECLARATION OF CONFLICTS OF INTEREST Mr. Michael MacEachern 6.0 APPROVAL OF CONSENT AGENDA 2:50 Mr. Michael MacEachern 6.1 November 28, Multi-Sector Service Accountability Agreements - Tranche Canadian Mental Health Association, York Region Bounce Back Program Funding Recovery 6.4 Delegation of Authority to the Audit Chair for External Auditor 6.5 Governance Policies Consent Agenda- Revised 6.6 Board Committee Reports Governance and Community Nominations Committee Report 7.0 CHAIR S REPORT 3: ITEMS FOR APPROVAL Community Nominations Committee Membership Ms. Tanya Goldberg 8.0 CEO REPORT ITEMS FOR APPROVAL 3:10 Ms. Kim Baker 8.1 Markham Stouffville Hospital Pre-Capital Submission - Uxbridge Site Infrastructure Repair Project

2 Tab No. Agenda Item Time Presenter 9.0 CEO REPORT ITEMS FOR INFORMATION 9.1 CEO/VP Report 3:30 Ms. Kim Baker Ms. Karin Dschankilic Ms. Chantell Tunney Ms. Tini Le Ms. Barb Bell Ms. Karen Adams 10.0 OTHER BUSINESS (Additions to the Agenda) 3:55 Mr. Michael MacEachern 11.0 FUTURE MEETINGS Tuesday, March 27, :00 p.m. 4:00 p.m. Markham Site 60 Renfrew Drive, Suite 360 Central Park Boardroom Markham ON Mr. Michael MacEachern 12.0 MOTION MOVING INTO A CLOSED SESSION 4:00 Mr. Michael MacEachern 13.0 CHAIR S REPORT OF A CLOSED SESSION (IF REQUIRED) Mr. Michael MacEachern 14.0 MOTION OF TERMINATION 6:00 Mr. Michael MacEachern 2

3 ITEM 4.1 Caring for Patients: 2017/18 Winter Surge Central LHIN Board of Directors Meeting January 30, 2018 Lynn Singh, Director Health System Planning, Central LHIN Mary Burello, Director, Home and Community Care Hospitals, Central LHIN

4 Health System Pressures During Winter Season Health System Capacity 2

5 What is the impact on Patients? Increase in Emergency Department Wait times Use of unconventional bed spaces Canceled surgeries Reduced opportunities for transfers to appropriate discharge destinations Patient experience 3

6 Patient Flow and Data trending

7 Current State: Central LHIN System Capacity As of mid-january 2018, >8% of all daily ED visits within Central LHIN are for a respiratory complaint* All hospitals have reported increase in ED, admitted patients, ICU, and ALC volumes Formal Moderate surge was declared by MH on January 4 (115% occupancy in the ICU) As of the 2 nd week in January, 46% of Long-Term Care Homes, and 24% of Retirement Homes are in outbreak situation As of the 2 nd week in January, 182 patients waiting for crisis placement *Source: Influenza-Like Illness (ILI) Mapper, KFL&A Public Health, 5

8 ED Utilization ED Volumes Central LHIN Monthly ED Volumes by Acuity (Apr Nov 2017) Both high (CTAS 1-3) and low acuity (CTAS 4-5) ED volumes throughout the winter months increased over the past 2 years. High acuity ED Volumes has seen an increasing trend over the last 32 months High Acuity (CTAS I-III) Low Acuity (CTAS IV-V) Source: Access to Care Analytics, CCO Central LHIN Hospital Monthly Bed Occupancy Rate (Apr Dec 2017) 120% Bed Occupancy Rate (%) 100% 80% 60% 40% 20% 0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Source: Home and Community Care (Legacy CCAC) ALC Dashboard.

9 Alternative Level of Care (ALC) ALC Days October November December January Source: WTIS, iport, CCO, extracted on Jan 18, 2018 Central LHIN ALC Patient Volumes Winter 2017/ Note: Data as of January 17, 2018 Between October 2017 and January 17, 2018, 48.6% of patients designated ALC in Central LHIN hospitals are awaiting placement in a Long-Term Care Home ALC Days Central LHIN Top Discharge Destinations Winter 2017/18 October November December January Month 2017/18 Home - with CCAC Services Long-Term Care Bed Rehabilitation Bed Source: WTIS, iport, CCO, extracted on Jan 18,

10 Maintaining Patient Flow 8

11 2017/18 Investments To support Central LHIN Hospital Bed Capacity: $4,455,500 in onetime funding to add surge beds and support immediate capacity challenges within the hospitals $14,494,900 in base funding to support services at the Reactivation Care Centre (RCC) $1,169,000 in onetime funding to implement short term transitional care at home pilot project $185,400 in one-time funding to continue the Central LHIN ALC Collaborative initiative $20,304,800 invested to support hospital bed capacity 9

12 Central LHIN Hospital Surge Bed Capacity Hospital Southlake Regional Health Centre Markham Stouffville Hospital Baseline Beds Additional Surge Beds ( ) *Reactivation Care Center Phase 1 Total bed Capacity * Phase Humber River Hospital Mackenzie Health North York General Hospital Stevenson Memorial Hospital Totals 2, ,257 *RCC phase 2 will include transfer of 90 CCC/Rehab beds from MH and ALC beds for MSH 10

13 Reactivation Care Centre- A Central LHIN Hospitals Collaborative Opened on December 10 th 2017 with 105 patients transitioning from four partner hospitals As of January 9 th 2017, a total of 144 patients admitted and 16 have been discharged to various destinations MH and MSH are tentatively scheduled to move patients by April 2018 The RCC provides a unique and innovative model of care delivery focused on enhanced activation programming, to maintain and improve functional ability of Alternative Level of Care (ALC) patients 11

14 Hospital Referral Volumes to Home and Community Care Total: 4,408 Total: 4,738 % Increase = 7.5% 12

15 Central LHIN Long-Term Care Home Outbreaks 250 Central LHIN LTC Home Outbreak Conditions 200 Total Days in Outbreak Apr. May June July Aug. Sept. Oct. Nov. Dec. Month (2017) 13

16 Transitional Care at Home Transitioning patients from hospital to home with activation and restorative care services to support recovery, improve function and promote independence at home 63 patients admitted; 8 discharged* 103 ALC days saved* Launched on October 16, 2017 * Data as of January 18,

17 Looking ahead Influenza activity continues to increase across the country, and expected to peak in the next couple of weeks Preliminary estimates for the vaccine s effectiveness against influenza A in Australia is ~10% Ongoing engagement and collaboration with the MOHLTC and hospitals to monitor/mitigate surge capacity issues Support/work with neighboring LHINs to improve access to care for patients Continue to identify and transition patients home/community with support 15

18 26

19 Appendix A 2017/18 Provincial Investment 17

20 Appendix B Photos of Reactivation Care Centre 18

21 CENTRAL LOCAL HEALTH INTEGRATION NETWORK BOARD OF DIRECTORS MEETING November 28, :00pm-4:00pm Central LHIN, 60 Renfrew Drive, Suite 300, Markham, ON Item 6.1 MINUTES OF MEETING Board Members Present: Mr. Charles Schade, Meeting Chair, Vice Chair Mr. Graham Constantine, Board Member Ms. Tanya Goldberg, Board Member Mr. David Lai, Board Member Mr. Michael MacEachern, Board Member Ms. Heather Martin, Board Member Ms. Elspeth McLean, Board Member Mr. Stephen Smith, Board Member Mr. Mark Solomon, Board Member Mr. Warren Jestin, Board Chair (via teleconference) Regrets: Ms. Audrey Wubbenhorst, Board Member Ms. Aldous Young, Board Member Staff Participants: Ms. Kim Baker, Chief Executive Officer Ms. Karin Dschankilic, VP & Chief Financial Officer Ms. Chantell Tunney, VP, Health System and Engagement Ms. Tini Le, VP, Home and Community Care Ms. Barbara Bell, VP, Quality and Patient Safety Ms. Karen Adams, VP, HR and Organizational Development Ms. Robyn Saccon, Corporate Relations Officer Ms. Katrina Santiago, Governance Associate, Recording Secretary 1.0 MEETING CALLED TO ORDER The meeting was called to order at 2:00 pm 2.0 NOTICE/RECOGNITION OF A QUORUM This meeting was formally constituted with Board members receiving adequate notice in accordance with By-Law No. 2. The notice, agenda and materials were distributed to the Board and were posted on the Central LHIN website. Quorum of a Board comprising 12 members is seven directors. A quorum was present at the meeting.

22 In accordance with the By-law, participants and guest speakers were introduced. No requests for public deputations were received or planned for this meeting, 3.0 APPROVAL OF AGENDA ON MOTION made by Mr. Stephen Smith and seconded by Mr. David Lai, IT WAS RESOLVED THAT: The Agenda be approved as circulated. CARRIED November WELCOME MEMBERS OF THE PUBLIC Mr. Schade welcomed all members of the public attending the board meeting. 3.2 PATIENT STORY Mr. Schade introduced Ms. Tini Le, Vice President, Home and Community Care. Ms. Le presented a patient story about a patient who had end stage congestive heart failure, rapidly deteriorating health and quality of life, and requested Medial Assistance in Dying (MAID). Discussion took place regarding the role of the LHIN with respect to MAID requests. 4.0 BOARD DEVELOPMENT AND EDUCATION 4.1 Strengthening Addiction Services within the Central LHIN Mr. Schade introduced and welcomed Ms. Penny Marrett, Executive Director from Addiction Services for York Region, who presented on the Addictions Strategy and its development and alignment with the Central LHIN strategy. The presentation included the following highlights: Statistics on addiction across Canada Statistics on addiction across the LHIN Priorities for the Three Year Addiction Strategy Opioid Strategy and Investment Central LHIN Opioid Response Following the presentation, there was discussion around the legalization of cannabis, its impact in terms of addiction, and what to expect from a systems perspective. Insights were provided by Ms. Marrett related to possible impacts and suggested action plans to equip for the legalization. 5.0 DECLARATION OF CONFLICT OF INTEREST 2

23 None at this time. 6.0 APPROVAL OF CONSENT AGENDA On the approval of all directors, Item Delegation of Authority to Chair was removed from the consent agenda and moved to 7.1 Items For Approval under Chair s Report. ON MOTION made by Mr. Michael MacEachern and seconded by Mr. David Lai, IT WAS RESOLVED THAT: The Consent Agenda be approved as amended and all resolutions contained therein be adopted as circulated. 6.1 APPROVAL OF MINUTES CARRIED November October 24, 2017 Board Minutes BE IT RESOLVED THAT: The Minutes of October 24, 2017 Board Meeting are approved as circulated. CARRIED November November 1, 2017 Special Board Meeting Minutes BE IT RESOLVED THAT: The Minutes of November 1, 2017 Special Board Meeting are approved as circulated. CARRIED November OTHER ITEMS BE IT RESOLVED THAT: Proposed 2018 Board Meeting Schedule 3

24 The Central LHIN Board of Directors approves the 2018 Schedule of Board Meetings for posting on the Central LHIN website. CARRIED November REPORTS OF COMMITTEES Board of Directors Committees Membership BE IT RESOLVED THAT: The Central LHIN Board of Directors approves: 1. The Audit Committee: Mr. Stephen Smith, Voting Member Ms. Elspeth McLean, Voting Member 2. The Patient Services and Quality Committee: Ms. Tanya Goldberg, Voting Member Ms. Elspeth McLean, Voting Member Mr. Mark Solomon, Voting Member 3. The Governance and Community Nominations Committee: Mr. Mark Solomon, Voting Member as recommended by the Chair of the Governance Committee. BE IT RESOLVED THAT: Board Committee Terms of Reference CARRIED November The Central LHIN Board of Directors approves the terms of reference for the CEO Performance Task Force and the Audit Committee. CARRIED November

25 6.3.3 Board Committee Reports Audit Committee Report Patient Services and Quality Committee Report 7.0 CHAIR S REPORT 7.1 Delegation of Authority to Chair Item Delegation of Authority to the Chair was the consent agenda was noted after discussion amongst Board members. ON MOTION made by Mr. Mark Solomon and seconded by Mr. Graham Constantine, IT WAS RESOLVED THAT: The Central LHIN Board of Directors approves delegation of authority to the Chair on the condition that grounds taken to achieve quorum could not be met by the Board where there is urgency to the decision. CARRIED November Governance Council Fall Forum Mr. Schade remarked on the Fall Forum of the Governance Council earlier in November, which was very well received. Feedback indicated that governors felt the format was engaging, and placed high value on the presentation from Anne Corbett, Partner from Borden, Laudner and Gervais; the dialogue from the breakout sessions, and the opportunity to network. There was interest to collaborate with others within their sub-regions, so staff collected consent from attendees and will be sharing their contact information among their fellow governors. AFHTO Bright Lights Awards - North York Family Health Team Mr. Schade shared with the Board that the Association of Family Health Teams of Ontario hosts their annual Bright Lights Awards, which recognize leadership, outstanding work and significant progress being made to improve the value delivered by interprofessional primary care teams across Ontario. The North York Family Health Team was awarded in the category of Clinical Innovations for Specific Populations for their work with a Multidisciplinary Approach to Deprescribe Sedative Hypnotics in the Elderly. Their initiative introduced a two-stage, interprofessional insomnia reduction program for older adults, resulting in improved mood and sleep quality, reduced anxiety and lower drug use. Mr. Schade congratulated the team on this amazing work. 5

26 8.0 CEO REPORT ITEMS FOR APPROVAL Hospital Accountability Planning Submission Process and Principles ON MOTION made by Ms. Tanya Goldberg and seconded by Mr. Stephen Smith, IT WAS RESOLVED THAT: The Central LHIN Board of Directors: a) Approves the process by which the Central LHIN will execute the 2018/19 Hospital Service Accountability Agreement with its public hospitals as follows: The hospitals will submit a Hospital Accountability Planning Submission to Central LHIN by January 31, 2018; and Central LHIN and hospital staff will work together to finalize planning submissions and negotiate targets during January and February 2018; and Central LHIN staff will bring the 2018/19 Hospital Service Accountability Agreements to the Central LHIN Board of Directors for approval in March 2018; b) Approves the process by which the Central LHIN will execute the 2018/19 Hospital Service Accountability Agreement with its private hospitals and West Park Healthcare Centre whereby funding and volumes will remain consistent with 2017/18; and c) Approves the target and performance standard for the two Patient Experience Performance Indicators: Percent of Priority 2, 3 and 4 cases completed within access targets for MRI and CT Scans, to be set as Not Applicable (N/A) and be replaced with an indicator cascaded from the MLAA; and d) Delegates authority to the LHIN CEO to set LHIN-specific obligations to be included in the Agreements; and e) Approves the following principles and assumptions for setting key performance targets in the Agreements: Item Principles for target setting 1. HBAM: Funding Determined individually by each hospital based on local circumstances. 2. Global: Funding and Volumes No change in global funding from 2017/18 Volumes to be determined individually by hospitals in line with funding assumptions 3. Wait Time Strategy: Volumes, Funding and Wait Times (CT and MRI) No change from 2017/18 funding and volumes; 6

27 4. Quality Based Procedures: Volumes, Funding and Wait Times (Surgical Hip and Knee) th Percentile Emergency Department Length of Stay 6. Quality Indicators (C. Difficile Rate) Performance targets will be set in a manner consistent with local circumstances with unique wait time targets for each hospital that supports performance improvement. No change from 2017/18 funding and volumes; Performance targets set in a manner that enables achievement of the LHIN MLAA wait time targets. Performance targets set in a manner that supports achievement of provincial targets. Hospital-specific negotiated targets based on provincial target setting guidelines. 7. Alternate Level of Care (ALC) Performance targets set in a manner that enables achievement of the LHIN MLAA targets. 8. Readmission Rates Performance targets set in a manner that supports performance improvement and aligns with related MLAA readmission rate target. 9. Current Ratio Set at 0.8, with performance standard (corridor) of , with the exception of Southlake which will be set in line with their working capital plan. 10. Total Margin Set at 0.00% (balanced budget), with performance standard (corridor) up to 2.00% /2018 Allocation Process and Priorities for Investment Update. CARRIED November ON MOTION made by Ms. Tanya Goldberg and seconded by Mr. Michael MacEachern, IT WAS RESOLVED THAT: The Central LHIN Board of Directors approves the following revised funding allocation for priorities for investment for fiscal year 2017/18: Strategic Priority Funding Amount Up to: (in millions) Change from June 27, 2017 Better Seniors Care $ 4.4 $ (2.2) Better Palliative Care $ 0.5 $ 0 7

28 Better Community Care $ 4.6 $ 2.2 Better Care for Kids and Youth $ 0.7 $ 0 Better Care for Underserved Communities $ 0.4 $ 0 Better Mental Health $ 2.9 $ (0.3) Achievement of MLAA $ 1.5 $ 0.3 Sustainability $ 3.0 $ 0 Total $ 18.0 $ 0.0 CARRIED November Opposed: Mr. Graham Constantine 9.0 CEO REPORT ITEMS FOR INFORMATION Tour of Humber River Hospital Command Centre- November 30 Ms. Baker reported on the Humber River Hospital Command Centre opening, referring back to Ms. Barb Collins presentation to the Board in September. Ms. Baker invited board members to let Katrina know if they are interested in taking tours of the Centre on the opening day. Self-Directed Care Organization Ms. Baker reported that the Ministry is launching an agency to provide further choice and self-direction in their personal support services to eligible clients. The agency is expected to improve the satisfaction of the client and contribute to client well-being and health outcomes. The core objective of the agency is to provide personal support services to eligible clients and provide for: Client choice when selecting a personal support worker Client control when determining their care schedule More choice in the services provided within the allowable personal support services. The new agency, which is specific to the provision of personal support services, will act as a centralized employer, taking on employment responsibilities and ensuring quality of services. Clients with a high volume of personal support service needs will be eligible for this program. Currently, high volume is defined as those clients requiring 14 hours or more of personal support services per week. There will be more information about the agency in the Spring. French Language Health Services Forum planning day Ms. Baker and Mr. MacEachern attended the French Language Health Services (FLHS) Forum planning day with LHINs across the province. The Forum served as an opportunity to further discuss the Guide to FLHS and address any questions in relation to FLHS responsibilities and obligations. Entité 4 represented the LHIN well and will present in the new year. 8

29 Release of the 2018/2019 Mandate Letter Ms. Baker informed the Board that the 2018/2019 Mandate letter has been posted on the Board portal for members to access. The letter continues to focus on working in partnership with patients, families, LHINs, and HSPs. In particular for , the Central LHIN is asked to prioritize a reduction in the number of people who are waiting in a hospital bed for the right level of care, expanded access to mental health and addictions services, and initiatives that support seniors. The collective focus includes: Improving the patient experience by partnering with patients in health care planning and by delivering care that reflects the patient voice and is responsive to patients' needs, values and preferences. Addressing the root causes of health inequities and the social determinants of health Reducing the burden of disease and chronic illness and investing in health promotion Seniors Strategy Announcement Ms. Baker updated the Board on the Seniors Strategy. There will be 5,000 new long term care (LTC) beds over the next four years and 15 million more hours of nursing, personal support and therapeutic care annually for residents in LTC homes There is also a 10-year plan to create more than 30,000 new beds over the next decade, working with the long-term care sector An annual high-dose influenza vaccine, targeted to protect seniors, will be available free of charge as part of the Ontario Universal Influenza Immunization Program, starting in the flu season Support for "naturally occurring" retirement communities by investing more than $15 million over two years for apartment buildings or housing developments where many seniors already live close to one another More volunteering opportunities connecting seniors and youth, fostering learning and mentorship while reducing older people's risk of social isolation A one-stop website where seniors -- about 70 per cent of whom go online every day -- can find information about tax credits, drug coverage, powers of attorney, recreation programs and more. Seniors will also be able to get information over the phone in more than 150 languages It is not yet confirmed what the impact will be for Central LHIN. The mid-month report links to the current report that is posted publicly on the Central LHIN website related to LTC wait lists. Mental Health Ms. Baker provided the Board with an update on the work underway at the Mental Health and Addictions Provincial Systems table that she Co-Chairs with a wide variety of champions across the LHINs. Some of the current work includes: The Ministry is now proposing a new Provincial Governance Framework that defines that roles and accountabilities provincially, regionally and at the local level. Multiple tables will guide and support this transformation. Wave 1 includes 7 of the LHINs, to understand psychotherapy programs. 9

30 In January, there will be a roadshow to primary care leads and sub-regional tables to explain the program and the rollout. This is being led by our very own CMHA York Region CEO. Release of Patient Ombudsman Report Ms. Baker informed the Board of the release of 2016/2017 Annual report from the Patient Ombudsman, outlining the first full year of operations. Their goal has been to try to resolve a patient or caregiver s complaint first. Many of the complaints are complex but a common theme is lack of communication. This has been a big opportunity for the Ontario health system. Ms. Elliott will be speaking at Board Development Day on December 14 th to provide some insights related to Central LHIN Integrated Health Services Plan Update; Annual Business Plan 2016/2017 Year End Report Ms. Tunney provided an update on the report card from first year of the 3-year Integrated Health Services Plan as well as current work. Highlights of the presentation included: The LHIN Planning Cycle A Summary of Year 1 and indicators that monitor the IHSP A focus on three indicators: Below target: Alternate Level of Care (ALC) Rate Progressing well: 90th percentile wait time from community for home care services: application from community setting to first home care service (days) Met target: Hospitalization rate for ambulatory care sensitive conditions Six-Month planning horizon 10.0 OTHER BUSINESS None at this time FUTURE MEETINGS Tuesday, January 30, 2017 Board Meeting 2:00 p.m. 4:00 p.m. Central LHIN, 60 Renfrew Drive, Markham Ontario 12.0 MOTION MOVING INTO A CLOSED SESSION ON MOTION by Mr. Michael MacEachern and seconded Mr. Steve Smith, IT WAS RESOLVED THAT: The members attending this meeting move into a Closed Session pursuant to the following exceptions of LHINs set out in s.9(5) of the Local Health Systems Integration Act, 2006: Personal or public interest 10

31 Public security Security of the LHIN and its directors Personal health information Prejudice to legal proceedings Safety Personnel matters Labour relations Matters subject to solicitor client privilege Matters prescribed by regulation Deliberations on whether to move into a closed session and further that the following persons be permitted to attend: Ms. Kim Baker Ms. Karin Dschankilic Ms. Chantell Tunney Ms. Tini Le Ms. Barbara Bell Ms. Karen Adams Mr. Mitchell Toker Mr. Jeff Simser Ms. Katrina Santiago Ms. Robyn Saccon. CARRIED November CLOSED SESSION CALLED TO ORDER The session was called to order at 4:04 p.m APPROVAL OF AGENDA ON MOTION by Ms. Tanya Goldberg and seconded by Ms. Elspeth McLean, it was resolved that: The Agenda of the Closed Session of November 28, 2017, be approved as circulated APPROVAL OF MINUTES 15.1 Review of Board of Directors Minutes of October 24, 2017 CARRIED November ON MOTION by Mr. Michael MacEachern and seconded by Ms. Tanya Goldberg, it was resolved that: 11

32 The Minutes of the Closed Session of October 24, 2017, be approved Review of Minutes of November 1, 2017 CARRIED November ON MOTION by Ms. Tanya Goldberg and seconded by Mr. Mark Solomon, it was resolved that: The Minutes of the Closed Session of November 1, 2017, be approved. CARRIED November MOTION MOVING OUT OF CLOSED MEETING ON MOTION by Ms. Tanya Goldberg and seconded by Mr. Stephen Smith, IT WAS RESOLVED THAT, The Closed Session is terminated at 5:26 p.m. and that closed session minutes are permitted to be shared with all Board members and permitted attendees MOTION TO TERMINATE SESSION CARRIED November ON MOTION by Mr. David Lai and seconded by Mr. Michael MacEachern, IT WAS RESOLVED THAT: The session be terminated (5:27 p.m.). CARRIED November Charles Schade, Meeting Chair, Vice Chair Katrina Santiago, Recording Secretary 12

33 60 Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: ITEM 6.2 CENTRAL LHIN BOARD OF DIRECTORS MULTI-SECTOR SERVICE ACCOUNTABILITY AGREEMENTS TRANCHE 1 JANUARY 30, 2018 PROPOSED RESOLUTION: WHEREAS the current Multi Sector Service Accountability Agreement is a four-year Agreement that expires on March 31, 2018; and WHEREAS the M-SAA Advisory Committee endorsed a one-year extension to the current Agreement with a new expiry date of March 31, 2019 and a provincial refresh process to update information; and WHEREAS on October 24, 2017, the Board approved the principles and process for reviewing the Community Accountability Planning Submissions to inform the volume targets, balanced budget and administrative percentage; and WHEREAS the funding targets for fiscal assume no general increase in base funding; and WHEREAS Central LHIN staff has reviewed the Community Accountability Planning Submissions against the Board approved review principles; BE IT RESOLVED THAT: The Central LHIN Board of Directors: a) Approves the funding, volume and performance targets for the following twenty health service providers: 1. Across Boundaries - An Ethnoracial Mental Health Centre 2. Aphasia Institute 3. Bernard Betel Centre for Creative Living 4. Cedar Centre 5. Cerebral Palsy Parent Council of Toronto (Participation House) 6. Chai-Tikvah Foundation 7. Chippewas of Georgina Island 8. City of Toronto - Long-Term Care Homes & Services 9. Community Head Injury Resource Services of Toronto 10. Hazel Burns Hospice

34 11. Humber River Hospital 12. Jane/Finch Community and Family Centre 13. LumaCare Services 14. New Unionville Home Society 15. North Yorkers for Disabled Persons Inc. 16. St. Demetrius Supportive Care Services Corp. 17. The Canadian National Institute for the Blind 18. The Vitanova Foundation 19. Villa Colombo Homes for the Aged Inc. 20. Yor-Sup-Net Support Service Network b) Delegates authority to the Central LHIN Chief Executive Officer to execute the Multi-Sector Service Accountability Agreement amendments for the above health service providers ANALYSIS: Community Accountability Planning Submissions Central LHIN has received all forty-nine Health Service Provider Board approved Community Accountability Planning Submissions (CAPS) and has performed reviews based on the Board approved principles and process. As of January 8, 2018, the submissions of twenty health service providers met the following criteria: An Annual Balanced Budget as defined in the M-SAA; and Central LHIN funded administrative expenses not to exceed 15% of Central LHIN funding; and No overall service reductions. Health service providers may propose shifts in services to better meet community demand for services and to align with provincial priorities. All Health Service Providers will have the following performance indicators (as defined in the MSAA technical specifications document): Balanced Budget for fund type 2 (LHIN funding) Administrative expenses less than or equal to 15% of LHIN funding Variance Forecast to Actual Expenditures Total Margin (Balanced Budget for total entity -hospitals and municipalities excluded) Service Activity by Functional Centre Variance Forecast to Actual Units of Service Number of Individuals Served 2

35 Alternate Level of Care (ALC) Rate 1 (TBD until MLAA for 18/19 set) Funding targets in the MSAAs include fiscal funding plus any additional approved initiatives during fiscal There has been no general increase in base funding. Community Support Services and Mental Health Agencies The following table highlights the 2018/2019 funding and key volume targets for the twenty health service providers: 2018/2019 Service Activity Health Service Providers Sector LHIN Funding Visits 1 Hours of Care 2 Resident Days 3 Attendance Days 4 Meals Delivered Across Boundaries - An Ethnoracial CMH&A $2,274,124 17, ,000 - Mental Health Centre Aphasia Institute CSS $1,313, ,300 - Bernard Betel Centre for Creative CSS $745,782 90, ,900 42,500 Living Cedar Centre CMH&A $284,455 3, Cerebral Palsy Parent Council of CSS $2,269, , Toronto (Participation House) Chai-Tikvah Foundation CMH&A $413, ,920 5,208 - Chippewas of Georgina Island CMH&A, $267,656 2,370 2,652-3,404 - CSS City of Toronto - Long-Term Care CSS $530, , Homes & Services Community Head Injury Resource CSS $7,297,637 2,750 28,720 9,855 17,139 - Services of Toronto Hazel Burns Hospice CSS $210,768 4, Humber River Hospital CMH&A $3,199,107 11,049-1, Jane/Finch Community and Family CMH&A, $623,241 4, ,600 - Centre CSS New Unionville Home Society CSS $472, ,885 - LumaCare Services CSS $7,780,562 2,094 17, ,945 20,700 25,920 North Yorkers for Disabled Persons CSS $853, , Inc. St. Demetrius Supportive Care Services CSS $740, , Corp. The Canadian National Institute For CSS $512,056 7, The Blind The Vitanova Foundation CMH&A $612, ,975 - Villa Colombo Homes for the Aged CSS $1,779, ,429 15,200 13,000 Inc. Yor-Sup-Net Support Service Network CMH&A $6,255,003 43, If a community HSP delivers service in a single sub-region, the target will be the hospital target in the same sub-region. If a community HSP delivers service in multiple sub-regions, the target will be the composite of hospitals targets in the applicable sub-regions. For hospitals, the LHIN will align the target in the MSAA with the target in the HSAA. 3

36 1. Visits include case management, counseling and treatment, addictions treatment, early intervention, crisis intervention, abuse services, health promotion, visiting hospices, social and safety, social rehab and recreation, vision impaired services, foot care services, caregiver support, transportation, psychology and speech language pathology. 2. Hours of care includes respite programs, personal support and independence training programs. 3. Resident days include assisted living, withdrawal management centre, mental health supports within housing and short-term crisis support beds. 4. Attendance days include social and congregate dining, day programs and addictions treatment programs. Service Substitution Access to community services is an important priority for the government, LHINs and HSPs. As a result, any proposed reduction, transfer or elimination of a service should be consistent with the overall goal of an integrated health system that provides access to high quality health services and coordinated health care in an effective and efficient manner. The LHIN must be provided with lead-time (at least 60 days) to ensure that essential levels of service are maintained. Within this slate, Aphasia Institute, Bernard Betel Centre for Creative Living and LumaCare Services have submitted a service substitution in its respective CAPS. LHIN staff has reviewed and deemed the proposed service substitution for these providers as appropriate. NEXT STEPS: Central LHIN staff is working with the remaining twenty-nine community health service providers to resolve outstanding issues related to the CAPS. The remaining M-SAA funding, volume and performance targets for fiscal 2018/19 will be brought forward for Board approval in March MSAA Amending Agreements populated with the approved funding, volume and performance targets for the above twenty health service providers will be sent by mail for signatures. Upon receipt of the provider Board-approved and signed M-SAAs, the Central LHIN Board Chair and Chief Executive Officer will execute the Amending Agreements by March 31,

37 60 Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: ITEM 6.3 CENTRAL LHIN BOARD OF DIRECTORS CANADIAN MENTAL HEALTH ASSOCIATION, YORK REGION BOUNCE BACK PROGRAM FUNDING RECOVERY JANUARY 30, 2018 PROPOSED RESOLUTION: WHEREAS in Fiscal Year 2014/2015 Central Local Health Integration Network (the LHIN ) funded Canadian Mental Health Association, York Region (the CMHA York ) an annualized funding of $640,000 to support a Joint Bounce Back Program; and WHEREAS in Fiscal Year 2016/2017 the Province has adopted this into their strategy to expand and fund across the Province, hence this program no longer requires the LHIN s original investment; and WHEREAS the Central LHIN s Transfer Payment policy (CFIN-4), requires Board approval for recoveries greater than $500,000 per Health Service Provider; BE IT RESOLVED THAT: The Central LHIN Board of Directors approves the following Multi-Sector Service Accountability Agreement funding and target amendments for Canadian Mental Health Association, York Region related to the Bounce Back Program funding recovery: Functional Centre and Performance Indicator One-Time Funding and Target Adjustments Annualized Funding and Target Adjustments Mental Health Counseling Funding ($263,189) ($640,000) and Treatment Visits (3,002) (7,290) Group Sessions (39) (120) Group Participants (400) (600) Individual Served by Organization (717) (1,870)

38 ANALYSIS: In January 2015, the LHIN provided CMHA York with annualized funding of $640,000 for a Bounce Back Program. The funding is being provided to implement a combined bounce back program with a group psychiatry model for clients with mild to moderate mood disorders. The LHIN supported this initiative by utilizing its community discretionary funding. As part of Ontario's commitment to develop a province wide, publicly funded psychotherapy program, in October 2017 the Ontario government announced an investment for the Bounce Back program, which will help people with mental health conditions such as anxiety and depression. This program will be rolled out across the province over the next three years. People can access these programs and other mental health supports by speaking to their primary care provider, or by visiting their local community mental health and addictions centre. CMHA Ontario has confirmed they will fund CMHA York directly for the Bounce Back Program. Given this latest development, it is the intention of the LHIN to recover the LHIN funds and redirect the discretionary funding towards other community priorities. BACKGROUND: Bounce Back is an evidence-based program designed to help youth and adults overcome symptoms of mild to moderate depression, low mood and anxiety. Based on cognitive behavioural therapy principles, this guided self-help program offers an educational video on self-help strategies and a guided self-help workbook with telephone or online coaching. It is a low-intensity, high-capacity intervention, with a focus on improving and capacity of primary care providers to refer clients to the program. NEXT STEPS: Upon approval, LHIN staff will prepare an amendment letter to inform Canadian Mental Health Association, York Region of the funding and target amendments related to the Bounce Back funding recovery. 2

39 60 Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: ITEM 6.4 CENTRAL LHIN BOARD OF DIRECTORS RESOLUTION TO APPROVE DELEGATION OF AUTHORITY TO THE AUDIT CHAIR FOR EXTERNAL AUDITOR JANUARY 30, 2018 WHEREAS the Central LHIN s Auditing Services Agreement with its Auditor (Deloitte and Touche LLP) expired in March 2017; and WHEREAS under the Terms of Reference of the Audit Committee, the Committee is to recommend to the Board of Directors approval of the Auditing Services Agreement; and WHEREAS Health Shared Services Ontario (HSSO) has undertaken a pan-lhin procurement for auditing services on behalf of the 14 LHINs; and WHEREAS the Audit Committee will be reviewing an extension of the Agreement with Deloitte on February 22, 2018; and WHEREAS work must begin on audit activities as soon as possible; BE IT RESOLVED THAT: The Central LHIN Board of Directors delegates authority to the Audit Chair, to approve and execute the Deloitte and Touche LLP Audit Services contract.

40 60 Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: ITEM PROPOSED RESOLUTION: CENTRAL LHIN BOARD OF DIRECTORS CONSENT AGENDA POLICY JANUARY 30, 2018 WHEREAS the Governance and Community Nominations Committee is responsible for developing, reviewing and recommending governance policies to the Central LHIN Board of Directors WHEREAS the Governance and Community Nominations Committee met on January 24, 2018, per the workplan; and WHEREAS the Governance and Community Nominations Committee reviewed and is recommending the attached updated policy with highlights showing suggested changes to the policy; BE IT RESOLVED THAT: The Central LHIN Board of Directors approves the Consent Agenda (Appendix) as recommended by the Governance and Community Nominations Committee.

41 CENTRAL LHIN GOVERNANCE MANUAL APPENDIX Title: Consent Agenda Policy Number: GP 002 Originated: February 10, 2016 Board Approved: March 29, PURPOSE To streamline the Board meeting process to support the Board of Directors to execute their governance role and allow for more time for discussion of strategic issues and education. 2.0 POLICY The use of the consent agenda will include items that pertain to routine board business and noncontroversial items. Items on the consent agenda may also have been reviewed as part of a Board Committee workplan. 3.0 PROCEDURE A consent agenda groups the routine, procedural, informational and self-explanatory noncontroversial items typically found in an agenda. These items will be presented to the Board in a single motion for vote after allowing any Board member to request that a specific item be moved to the full agenda for individual attention. Other items, particularly those requiring strategic thought, decision-making or action, will be handled as usual. 3.1 The Chair of the Board and the Chief Executive Officer together will determine items to be placed on the consent agenda of each meeting. 3.2 All consent agenda items must be clearly identified and included in the pre-circulated board agenda material. 3.3 Board members will thoroughly review the consent agenda items and other pre-circulated material prior to the meeting and anticipate that no verbal reports will be presented. 3.4 If an item in a committee report does not qualify as a 'consent agenda' item then that item shall be moved to the regular agenda for approval. The rest of the items will remain on the consent agenda and, after a motion by the board chair, will be presented to the board for their vote under the items for approval section.

42 3.5 Matters to be removed from the consent agenda will be inserted into the regular agenda as appropriate. 4.0 PROCESS FOR REMOVING AN ITEM FROM THE CONSENT AGENDA Ideally, Board Directors shall request and seek clarification to remove items from the consent agenda prior to the meeting. Board Directors can make such a request, in writing, to the Chair with a copy to the CEO to remove an item from the consent agenda. During the meeting, Board Directors may also make a request to remove an item from the consent agenda. Items requested to be removed will be moved to the Chair s Report section of the agenda. When there are no more items to be removed from the consent agenda, the Chair will state If there is no objection, these items are adopted to the remaining items noted in the consent agenda. Board Directors are strongly encouraged to reach out to the Chair, copying the CEO, prior to the Board meeting to inquire on items included in the Board package including the consent agenda if they have questions. 5.0 CONTENT OF A CONSENT AGENDA The consent agenda may include but is not limited to the following: 4.1 Approval of board minutes 4.2 Committee reports, that require no discussion 4.3 Confirmation of pro forma items or actions that need no discussion but are required by the by-laws, to be approved by the Board 4.4 Routine LHIN business requiring Board approval 4.5 Dates of future meetings 4.6 Routine policies and procedures 4.7 Items for which the proposed actions do not include a disclosure of conflict or potential conflict 2

43 GOVERNANCE COMMITTEE REPORT TO CENTRAL LHIN BOARD OF DIRECTORS JANUARY 30, Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: ITEM Report of the Governance and Community Nominations Committee, which met on Wednesday, January 24, Mr. Warren Jestin opened the meeting at 9:31am. Per the workplan, the Committee agenda included the following items. APPROVED ITEMS per the Committee workplan Consent Agenda Policy CEO Succession Plan Community Nominations Committee- Membership of Community Members New Board Member Skill Profile Board Development Day Debrief and Evaluation Results- December 2017 It was recommended by the Committee that the Consent Agenda Policy, Community Nominations Committee- Membership of Community Members, be brought forward to the Board for consideration at the January 30, 2018 meeting. ITEMS for next meeting: Memorandum of Understanding Governance Role Revised Whistleblower Policy Board Education and Development- Survey Results Please note the Governance Committee materials are posted on the Central LHIN Board Portal should Board members wish to access the materials.

44 PROPOSED RESOLUTION: CENTRAL LHIN BOARD OF DIRECTORS COMMUNITY NOMINATIONS COMMITTEE MEMBERSHIP JANUARY 30, Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: WHEREAS two vacancies will be created on the Central LHIN Board of Directors as of October 24, 2018; WHEREAS as outlined in regulation 417/06 issued under Local Health System Integration Act, 2006, and By- Law #1, a Community Nominations Committee ( The Committee ) will be struck to identify and recommend potential Board Directors; WHEREAS the Terms of Reference will guide the work of the Committee including the membership of the Committee; WHEREAS the Committee shall consider the Profile of a Director and the Board Skills Matrix to reflect the LHIN s current needs with respect to specific skills, experience and experience among Directors; WHEREAS the Committee will make a recommendation to the Central LHIN Board of Directors for consideration at the May 2018 Board of Directors meeting; and WHEREAS the Board approved candidate(s) will be sent to the Minister s Office for consideration along with a recommendation letter from the Board Chair; BE IT RESOLVED THAT: The Central LHIN Board of Directors approves the Community Nominations Committee Membership: ITEM Mr. Warren Jestin, Chair, Voting Member Mr. Charles Schade, Board Vice Chair, Voting Member Mr. Graham Constantine, Board Director, Voting Member Ms. Tanya Goldberg, Board Director, Voting Member Mr. Mark Solomon, Board Director, Voting Member Ms. Aldous Young, Board Director, Voting Member Mr. Albert Liang, Community Member, Voting Member Ms. Michelle Kungl, Community Member, Voting Member Ms. Kim Baker, CEO, Non-Voting Member.

45 Board Member Completing Terms: Audrey Wubbenhorst, October 22, 2018 Aldous Young, October 22, 2018 CENTRAL LHIN BOARD OF DIRECTORS COMMUNITY NOMINATIONS COMMITTEE 2018 RECRUITMENT PROCESS - TIMELINE 60 Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: APPENDIX TIMELINE JANUARY FEBRUARY MARCH APRIL MAY Approval of skills sought January 30 Board meeting Approval of Community Members Identify prospective Board candidates Advertising/applications (2 weeks) Ministry Process PAU Application review Process, 4-6 weeks January 30 Board meeting Recruitment and Education meetings Posting and advertising- week of February 26- closing March 9 March 9 April 20 Committee to review applications Week of April 30 Committee Interviews Early-mid May Committee Recommendation to Board Recommendation Letter to Minister PAU Conducts Interviews of Recommended Candidates (4 weeks) Orders in Council Process (4-6 weeks) May 22 May 28 Interviews with MO October appointments targeted

46 60 Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: Fax: Toll Free: CENTRAL LHIN BOARD OF DIRECTORS MARKHAM STOUFFVILLE HOSPITAL PRE-CAPITAL SUBMISSION UXBRIDGE SITE INFRASTRUCTURE REPAIR PROJECT JANUARY 30, 2018 ITEM 8.1 PROPOSED RESOLUTION: WHEREAS on November 23, 2017, Markham Stouffville Hospital submitted a Pre-Capital Submission Form Part A with respect to Uxbridge Site Infrastructure Repair Project for review; and WHEREAS the project is focused on addressing immediate infrastructure repairs at Uxbridge Cottage Hospital site due to the facility s condition and multiple infrastructure failures experienced in 2017; and WHEREAS Central LHIN staff have reviewed the hospital submission in collaboration with the Central East LHIN staff as the Uxbridge hospital site is located within the geographic boundaries of the Central East LHIN, and have determined that it addresses the requirements outlined in the MOHLTC-LHIN Joint Review Framework for Early Capital Planning Stages with respect to program and service elements of the proposal; BE IT RESOLVED THAT: The Central LHIN Board of Directors endorses the Markham Stouffville Hospital s Pre-Capital Submission Part A, in respect to the Uxbridge Site Infrastructure Repair Project. ANALYSIS: The Uxbridge Cottage Hospital (UCH) is a hospital site of the Markham Stouffville Hospital (MSH) Corporation and, thus, a Central LHIN health service provider. This small community hospital, is located in the town of Uxbridge and within the geographic boundaries of the Central East LHIN. Staff from the Central and Central East LHIN have worked closely together in its review of the Pre-Capital submission in relation to the potential impacts on services and programs in the surrounding areas. The Central East LHIN has no further questions at this stage. The catchment area of UCH is comprised of approximately 60-70% Uxbridge residents (with a population over 20,000), and 4-5% of patients from surrounding hamlets and townships (total population of approximately 14,000). The nearest small community hospital is the Lakeridge Health, Port Perry site which is located 16 km away, and the nearest large community hospital is the MSH s general site located 33 km away.

47 The UCH opened in 1959 and underwent expansions in 1967 and 1982, however, much of the space within the facility is original from the day of opening, and the existing infrastructure does not meet current standards. The UCH has undergone a facility assessment by an independent provider, who identified that more than $12 Million is required in repairs and renovations over the next 5 years to sustain the existing facility. Due to the hospital s condition and aged infrastructure, MSH submitted a Pre- Capital proposal to the LHIN in November 2016 for redevelopment of the UCH site. The Pre-Capital submission was endorsed by the Central LHIN Board of Directors on June 27, 2017, and is currently under review by the Ministry of Health and Long-Term Care (MOHLTC). Pending MOHLTC review, MSH submitted a Pre-Capital project proposal on November 23, 2017 for infrastructure repairs at the UCH site. In 2017, UCH experienced four infrastructure failures and costs to repair the affected infrastructure has exceeded MSH s annual Health Infrastructure Renewal Fund (HIRF) allocation. To date, repair costs have been funded by the UCH Foundation, which reduces its ability to fundraise for the future redevelopment project. The Uxbridge hospital has experienced a 22% increase in Emergency Department volumes and 38% increase in hospital admission rates due to the fire at Lakeridge Health, Port Perry hospital which has been closed since August Should a debilitating infrastructure failure occur at UCH, there is a high risk of service interruption to patients in the North Durham community. The total estimated capital cost of the Infrastructure Repairs at UCH is $4,763,530. The list of projects in the proposal (see table below) can build a system and infrastructure that can be re-used in a redeveloped facility, which will minimize sunk costs should the Redevelopment Project at UCH be approved. Project Name Estimated Cost Full electrical system replacement $4,206,700 Air exchange for isolation room $138,000 Window Shakers $138,000 Domestic hot water system $50,370 Incoming main domestic water feed $230,460 Total $4,763,530 The proposed set of infrastructure repair projects will not impact operating costs or staffing, and is not intended to address program/service needs, expansion or program redesign. Alignment with IHSP The proposal aligns with the Central LHIN s IHSP and supports best patient experiences as the hospital addresses infrastructure repairs to maintain access to programs and services for patients and families in the community. COMMUNITY & STAKEHOLDER CONSULTATION As this proposal is meant to address infrastructure repair needs only, engagement of community and internal staff has not been applicable. In October 2017, the hospital participated in a teleconference with Central and Central East LHINs, and the MOHLTC to review the infrastructure repair needs at UCH, and was advised by the MOHLTC to submit a Pre-Capital submission. 2

48 BACKGROUND: The Ministry-LHIN Accountability Agreement sets out the roles and responsibilities of LHINs with respect to capital initiatives proposed by a Health Service Provider related to the construction, renewal or renovation of a facility or a site. The LHIN is required to review Part A of a Health Service Provider s Pre-Capital submission and provide advice and/or endorsement to the Ministry. The MOHLTC-LHIN Joint Review Framework defines the role of the LHIN in the review of capital submissions. The LHIN focuses on the alignment between the proposed programs and services outlined in the project and the needs of the local health system. The role of the ministry is to review and approve the project including all physical, cost, program and service elements from a provincial perspective. A schematic summarizing the various stages of the capital planning process is as follows: Overview of Capital Planning Process Planning Grants: 3 possible approval milestones: proposal development, functional program, design development Construction Grant Pre-Capital (Part A & B) Stage 1 Proposal (Part A & B) Stage 2 Functional Program (Part A & B) Stage 3 Preliminary Design Or Output Specifications Stage 4 Working Drawings Or Output Specifications Stage 5 Implementation Review and support of Pre-Capital Submission. Proposal Development grant Review and approval Review and approval of Stage 1 Submission. of Stage 2 Functional Program Functional Program. grant. Design Development grant Requires Government approval to plan Review and approval of blocks and sketch plans; approval to proceed to working drawings OR blocks/output specifications Requires Government approval to construct Review and approval to tender & implement/issue RFP OR approval to award construction contract/ Project Agreement. The Joint Planning Framework requires a health service provider to address a number of key criteria in the development of a Pre-Capital Submission Part A. These criteria include: A narrative description of the program/service need to be addressed by the project; A statistical description of the program/service need to be addressed by the project; A description of how the program/service need supports local health system integration and a unified system of care; Support from other stakeholders with respect to the project; Any significant operational implications of the project; Alternative program/service solutions. 3

49 NEXT STEPS: Upon Board endorsement of the Pre-Capital Submission Part A, the LHIN staff will notify the Ministry and the Markham Stouffville Hospital with a direction for the hospital to submit the Pre-Capital Submission Part A & B to the MOHLTC. 4

50 ITEM 9.1 Central LHIN Board of Directors CEO REPORT January 30, 2018

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

52 Central LHIN CEO Report - Items for Information Contents Contents... 2 CEO Highlights CEO Highlights... 1 Business Arising Business Arising... 1 Performance, Corporate Services and Finance Redevelopment of Cedarvale Lodge Retirement and Care Community Redistibution of Long-Term Care Surplus /18 Q2 Community Sector Performance Report Appendix A /18 Q2 Hospital Sector Performance Report Appendix B /18 Quarter 2 Stocktake Scorecard Appendix C Health Based Allocation Model Preliminary Results Funding Allocation Delegated Authority January 2018 Appendix D Health System Planning and Engagement Assertive Community Treatment Teams Expansion into South Simcoe Enhanced Adult Day Program Central LHIN Opioid Update Hip & Knee Replacement Bundled Care Model Update Hospice Capacity Update Central LHIN Hospital Capacity Reactivation Care Center: A Central LHIN Hospitals Collaborative - Status Update Home and Community Care Central LHIN s Fall Prevention Update Congestive Heart Failure Pilot Central LHIN Capacity Update - Hospital/LTC Placement Holiday Surge Quality Patient and Family Advisory Committee (PFAC) Annual Home and Community Care Quality Improvement Plan (QIP)... 17

53 Central LHIN CEO Report - Items for Information CEO Highlights 9.0 CEO Highlights Verbal report at the meeting will be provided. Deputy Minister webinar (project) governance structure Governance Education Webinars Staff move to 11 Allstate Change Management Training System Transformation focus on sub-regions and primary care strategy Quality Improvement Plan (QIP) inaugural LHIN submission Local System Capacity Client and Caregiver Experience Survey Provincial Mental Health Systems Table 9.1 Business Arising Business Arising No business arising items noted in follow up to the November 28, 2017 Board meeting. Performance, Corporate Services and Finance 9.2 Redevelopment of Cedarvale Lodge Retirement and Care Community On November 24 th, the Central LHIN received a letter from the Ministry s LTC Licencing Unit regarding the proposal of a new LTC Home licence for Cedarvale Lodge Retirement and Care Community in Keswick. The licence proposal includes: the redevelopment of the Home s 60 B beds to new status; the transfer of 88 beds to the new Home from the now-closed Christie Gardens in Toronto previously located within the Toronto Central LHIN; 12 additional LTC beds allocated by the Ministry of Health and Long-Term Care, subject to project approval and meeting all licencing requirements; and the issuance of a new licence for the 160 redeveloped beds on land adjacent to the Home, with a term of up to 30 years following the Home s redevelopment. As part of the review,on December 7 th, 2017 the Central LHIN was provided input relating to the public interest on the need for the beds and the eligibility of the Licensee. On December 12 th, the Central LHIN was informed that in accordance with section 106 of the LTCHA, the Ministry is conducting a public consultation on January 17 th, 2018 and the Central LHIN was invited to send a representative to attend. The Ministry will be taking the feedback they have received into consideration prior to making a final decision regarding the proposal. Central LHIN Board of Directors Page 1 CEO Report January 30, 2018

54 Central LHIN CEO Report - Items for Information 9.3 Redistibution of Long-Term Care Surplus Long-Term Care Homes are funded on a per-diem basis based on a presumed occupancy of 97%. The funds are reconciled in December each year and adjusted based on actual occupancy and resident revenue earned. In a memo dated December 28, 2017, the Ministry informed the Central LHIN that a total in-year savings of $2,563,439 was identified in the Long-Term Care sector for the province. Specifically, projected savings of $235,746 are available for reallocation to the Central LHIN. All of the Central LHIN LTCHs met the occupancy level of 97%. The main reason for the savings was driven by the higher resident revenue per diem that LTCHs are receiving. The one-time funds will be allocated as part of the LHIN s Priorities for Investment process /18 Q2 Community Sector Performance Report Appendix A All 49 Community Health Service Providers within the Central LHIN reported their 2017/18 second quarter financial and activity performance results as required under Article 8.1 (b) of the Multi- Sector Service Accountability Agreement (M-SAA). The three performance criteria are: 1. Balanced budget (Within 2% surplus or deficit on total fund type 2 revenues for Central LHIN programs); 2. All activity (service volume) indicators within corridor; and 3. A maximum of 15% spent on administration expenses. As the 15% administration indicator (criteria #3 above) requires separate reporting, this indicator is reviewed at year-end only. LHIN staff reviewed the year-end forecast information in 2017/18 Q2 reports based on criteria #1 and #2 above. The results are as follows: Criteria # of Providers % of Total Met both critera - Balanced budget and all activity (service volume) indicators within corridor 41 84% Did not achieve criteria #2 All performance activity (service volume) indicators within corridor 6 12% Did not meet both criteria - Balanced budget and all activity (service volume) indicators within corridor 2 4% Total % Primary reasons for providers not meeting criteria were related to staffing challenges and program vacancies. The LHIN continues to work with providers to bring them to compliance. Appendix A contains the 2017/18 Q2 Community Scorecard which details the health service providers in each category as described above /18 Q2 Hospital Sector Performance Report Appendix B As per the reporting requirements outlined in the Hospital Service Accountability Agreement, Central LHIN hospitals have submitted reports with details of performance for the second quarter of Central LHIN Board of Directors Page 2 CEO Report January 30, 2018

55 Central LHIN CEO Report - Items for Information fiscal year 2017/18. Central LHIN hospitals generally performed well compared to the targets set out in the Agreements, with the exception of performance related to Alternate Level of Care (ALC), Emergency Department (ED) Length of Stay for Complex Patients, and Diagnostic Imaging wait time indicators. No Central LHIN hospitals were able to achieve the provincial target of 12.7% for ALC Rate during the first half of fiscal 2017/18. Central LHIN ranked tenth among all LHINs for the ALC Rate indicator in Q2 of 2017/18. Likewise, with the exception of Stevenson Memorial Hospital, most hospitals continued to struggle to meet the provincial target for ED Length of Stay for Complex Patients as Central LHIN performance for this indicator ranked 6 th out of the 14 LHINs. Central LHIN hospitals also performed below expectations during the first half of 2017/18 for Diagnostic Imaging wait times indicators. The Central LHIN provided one-time funding at the end of September 2017 to support additional CT and MRI services and improve wait time performance in 2017/18. However, Central LHIN hospitals continue to experience growing demand for diagnostic services which exceeds available capacity, thus dampening the potential performance improvements anticipated from the additional LHIN funding. A Central LHIN Diagnostic Imaging Leaders Committee has been initiated with representatives from each hospital. The committee will review the compendium of promising practices and is interested in e-referral systems. Hospital-specific performance is provided below. A full performance dashboard can be found in Appendix B. Humber River Hospital Year-end Forecast Total Margin (H-SAA definition): Total LHIN Funding: $345.1 million Year-end forecast $2.86 million (0.62% of revenue); Q2 actual $1.43 million (0.62% of revenue) Number of Beds: 591 Cash and Investments: $25 million Long-term Debt: $149.3 million Number of FTEs: 2,871 % of Total Debt: 7.75% Humber River Hospital is generally performing well compared to Hospital Service Accountability Agreement (H-SAA) targets. Highlights of some of the exception of the indicators are noted below: ED Length of Stay for Complex Patients: Humber s performance in ED length of stay for Complex Patients continues to be driven by the LOS of admitted patients which increased from 19.7 hrs in Q1 to 23.8 hrs in Q2 of 2017/18. The hospital continues to implement strategies to improve patient flow and ED length of stay, including the implementation of the Command Centre (an operational hub that brings people and actionable information together to expedite care and coordinate work flow); electronic tools to monitor and improve patient flow; and collaborating with other health partners to implement process changes to reduce transfers. The recent opening of the Reactivation Care Centre at the Humber Finch Site and the provincial investments in surge beds will also support patient flow by creating system capacity. ALC Rate: Humber demonstrated an improvement in ALC Rate performance between fiscal year 2016/17 (16.3%) and current fiscal 2017/18 Q2 year to date (14.4%). The primary driver of ALC are the volumes of ALC cases and days attributed to patients awaiting placement in Long- Term Care (LTC). The hospital is an active participant in Central LHIN ALC Collaborative initiatives, and has led the development of an electronic Discharge Planning Dashboard that will Central LHIN Board of Directors Page 3 CEO Report January 30, 2018

56 Central LHIN CEO Report - Items for Information be implemented in 5 of 6 Central LHIN hospitals. Humber also collaborated with Central LHIN hospital partners, the Central LHIN, and Ministry of Health and Long Term Care to re-purpose the Hospital s Finch site into the Reactivation Care Centre. This strategy is intended to create capacity for acute care beds and enhance patient flow at the home hospital site. CT Diagnostic Imaging Wait Time: Humber continues to experience growing demand for CT scans and in particular outpatients exams. The CT scanner at the former Finch Urgent Care Centre was closed in December One existing scanner at the Wilson site operated extended hours to compensate for some of the lost hours at the Finch Urgent Care Centre. However, the demand for CT continues to exceed capacity. Recently in June 2017, Humber began operating a new CT scanner giving the hospital a total of 4 scanners. The volume of CT scans delivered by Humber has increased and the hospital continues to use some of its global budget towards increasing CT hours to help mitigate the growing queue of patients. Rate of Hospital Acquired C. Difficile Infections (CDI): It is of note that Humber has the most stringent performance corridor for this indicator in 2017/18 compared to all other Central LHIN hospitals. Humber set this stretch goal based on a 10% improvement from their fiscal year 2016/17 performance. The hospital s Antibiotic Stewardship Committee is currently implementing an action plan to further improve antibiotic drug therapy utilization. North York General Hospital Year-end Forecast Total LHIN Funding: $ million Number of Beds: 422 Number of FTEs: 2,115 Total Margin (H-SAA definition): Year-end forecast $7.04 million (1.87% of revenue); Q2 actual $8.8 million (4.73% of revenue) Cash and Investments: $18 million Long-term Debt: $13.2 million % of Total Debt: 5.15% North York General Hospital is generally performing well compared to H-SAA targets with the exception of the indicators noted below: Current Ratio: North York General reported a current ratio of 1.21 at Q2, and was forecasting a current ratio of 0.71 at year end based on information available as of October The hospital now projects the ratio to be above 0.8 based on more current information which includes the receipt of additional capital grants that will result in a higher cash balance. ALC Rate: The ALC Rate at North York General has increased from 18.5% in fiscal year 2016/17 to 19.8% in current fiscal 2017/18 Q2 year to date. The majority of cases were awaiting placement in LTC or for a Rehabilitation bed. Since 2014/15, the hospital has partnered with Home and Community Care for the Assess and Restore pilot project to provide restorative care services and prevent deconditioning in hospital for at-risk frail seniors. The hospital is also an active participant in Central LHIN ALC collaborative initiatives, and was engaged in planning for the Reactivation Care Centre. In December 2017, the hospital transferred ALC patients to the Reactivation Care Centre to create capacity for acute care beds and enhance patient flow at the home hospital site. ED Length of Stay for Complex Patients: The hospital s performance in ED length of stay for Complex Patients continues to be driven by the length of stay of admitted patients which increased from 21.3 hrs in Q1 to 23.4 hrs in Q2 of the current 2017/18 year. However, this is notable improvement from 28.2 hrs in fiscal year 2016/17. The hospital has put in place a Central LHIN Board of Directors Page 4 CEO Report January 30, 2018

57 Central LHIN CEO Report - Items for Information number of mitigation strategies including parallel discharge planning for complex patients going home with Home and Community Care services versus convalescent care, implementation of electronic tools to allow accurate capture of process turn-around times, and opening of newly designed medical units with increased capacity for isolation beds. The recent opening of the Reactivation Care Centre at the Humber Finch Site and the provincial investments in surge beds will also support patient flow by creating system capacity. CT and MRI Diagnostic Imaging Wait Time: Longer wait times for CT and MRI were seen at North York General due to increased demand for services. The hospital also experienced a delay in implementing a new electronic appointment notification system which has created a backlog in processing requests during the first two quarters of 2017/18. To help with the backlog, the hospital will be increasing staffing to add more time slots for appointments. North York General continues to push forward with the implementation of the new appointment notification system and is also working on an e-referral tool in partnership with Central LHIN and other Central LHIN hospitals that is expected to be in use in fiscal 2018/19. Southlake Regional Health Centre Year-end Forecast Total Margin (H-SAA definition): Total LHIN Funding: $295.8 million Year-end forecast $5.2 million (1.3% of revenue); Q2 actual $6.78 million (3.42%) Number of Beds: 386 Cash and Investments: $11.3 million Long-term Debt: $59.7 million Number of FTEs: 2,376 % of Total Debt: 17.5% Southlake Regional Health Centre is experiencing some challenges in meeting their 2017/18 H-SAA targets, particularly for targets related to ALC, ED Length of Stay, wait times for diagnostic services and global volumes. Specific performance challenges are noted below: Day Surgery Weighted Cases: Southlake s performance is slightly below the corridor due to decreased volumes during the first half of the year. Based on more current information available, the hospital has increased its activity in November and December and now expects performance to be within the performance corridor by year-end. Inpatient Rehabilitation Weighted Cases: Inpatient rehab activity was reduced at Southlake due to acute medical volume pressures. The higher inpatient medical volumes were accommodated in the inpatient rehab beds. It is anticipated that the opening of the Reactivation Care Centre at the former Humber Finch site will help alleviate some of the bed pressures and enable Southlake to place their medical patients in the appropriate bed. The hospital has been working on proactively reducing the length of stay of their rehab patients which subsequently contributes to lower weighted cases. At the same time, Southlake is participating in the new bundled care project for hip and knee replacements which may lead to further opportunities to reduce hospital rehab length of stay as appropriate post-op care may take place in the community or home. Current Ratio: The current ratio for Southlake is below the target of The hospital has been drawing down on cash reserves in order to pay for the implementation of their new Hospital Information System (HIS). This approach was taken by hospital in order to avoid paying higher borrowing costs over the long-term. The hospital will eventually need to borrow funds for the HIS project, however, the lower borrowing amount will reduce future interest costs, while simultaneously reducing the current ratio. The hospital is operating under a working capital improvement plan and is targeted to reach a current ratio of 0.8 in 2019/20. Purchase of an HIS was not included in their plan. ALC Rate: Southlake experienced an increase in ALC Rate between fiscal year 2016/17 (14.8%) and current fiscal 2017/18 Q2 year to date (15.9%). The main driver of ALC is patients awaiting placement in LTC. The hospital is an active participant in Central LHIN ALC Central LHIN Board of Directors Page 5 CEO Report January 30, 2018

58 Central LHIN CEO Report - Items for Information collaborative initiatives, and was engaged in planning for the Reactivation Care Centre and has transferred ALC patients in December 2017 to create capacity for acute care beds and enhance patient flow at the home hospital site. ED Length of Stay for Complex Patients: The ED performance at Southlake improved slightly from 14.2 hrs in Q1 to 14.0 hrs in Q2 of the current fiscal 2017/18 year. Performance of this indicator continues to be driven by the length of stay of admitted patients, which increased from 36.4 hrs in Q1 to 38.6 hrs in Q2 of 2017/18. The hospital continues to express challenges in access to inpatient beds. More specifically in Q2, the hospital implemented a new overnight stay unit (ONSU) to which ED physicians admit patients who they believe will require a shorter LOS. More frequent rounds on the unit allow more timely patient discharges. The recent opening of the Reactivation Care Centre at the Humber Finch Site and the provincial investments in surge beds will also support patient flow by creating system capacity. CT and MRI: Southlake continues to experience longer wait times due to increased demand for services especially from high acuity ER and inpatient cases. Southlake is on track with its diagnostic imaging redevelopment project which will see a new MRI scanner installed in April 2018 to replace the existing mobile MRI scanner. Readmissions to Own Facility within 30 days for selected HBAM Inpatient Grouper (HIG) Conditions: Performance in the readmission rate was driven by a select group of patients. Three patients with Congestive Heart Failure (CHF) were readmitted twice back to Southlake. The hospital is reviewing these cases to identify the causes and determine a course of action to mitigate future readmissions. Mackenzie Health Year-end Forecast Total LHIN Funding: $185.6 million Number of Beds: 365 Number of FTEs: 1,862 Total Margin (H-SAA definition): Year-end forecast $243,850 (0.08% of revenue); Q2 actual ($6.6 million) ( 4.46% of revenue) Cash and Investments: $33.5 million Long-term Debt: $40 million % of Total Debt: 12.1% Mackenzie Health is facing challenges in 2017/18 as it is dealing with the growing demand for their services particularly in the emergency department and acute inpatient care. The pressures from the high patient volumes have impacted both the hospital s clinical and financial performance. Those performance indicators in particular are noted below: Total Margin: Mackenzie Health s total margin as a percentage of revenue at Q2 of 2017/18 was 4.46% compared to the target of 0%. The hospital has forecasted a year-end total margin of 0.08%; however, this is based on the hospital s assumption that it will receive additional funding to balance the budget. The Central LHIN continues to work with the hospital and Ministry to mitigate this funding pressure and it is not anticipated that the total margin will improve significantly from the Q2 performance by the end of this fiscal year. ED Length of Stay for Complex Patients and Non-Admitted Uncomplicated Patients: The ED length of stay increased from Q1 to Q2 of the current 2017/18 year for both complex and non-complex patients. The launch of their new electronic medical records (EMR) system in Q2 had a major temporary impact on patient flow and throughput as staff implemented new workflows. The hospital also faced significant data quality challenges during the new EMR implementation. The hospital continues to redevelop/redesign clinical and electronic work flows to improve efficiency and ensure accurate and timely data submissions. The recent opening of Central LHIN Board of Directors Page 6 CEO Report January 30, 2018

59 Central LHIN CEO Report - Items for Information the Reactivation Care Centre at the Humber Finch Site and the provincial investments in surge beds will also support patient flow by creating system capacity. CT and MRI: Mackenzie Health continues to face increased demand for CT and MRI services, especially for high priority inpatient and emergency cases. The growth in higher priority cases has shifted resources away from lower priority cases. However, Mackenzie Health continues to operate diagnostic services at a level that places them as one of the highest efficiency performers in Central LHIN Readmissions to Own Facility within 30 days for selected HBAM Inpatient Grouper (HIG) Conditions: Mackenzie Health s readmission rate performance was 14.3% compared to their target of 12.7% and upper corridor of 14%. The hospital is refocusing on this indicator within an existing operations committee and will implement action plans to address the key conditions identified as driving the performance of this indicator. Markham Stouffville Hospital Year-end Forecast Total LHIN Funding: $176.6 million Number of Beds: 284 Number of FTEs: 1,429 Total Margin (H-SAA definition): Year-end forecast $7.5 million (3.2% of revenue); Q2 actual $8.56 million (7.18% of revenue) Cash and Investments: $34.7 million Long-term Debt: $0 % of Total Debt: 0% Markham Stouffville is generally performing well on H-SAA indicators with the exception of the indicators noted below: Total Margin: Markham Stouffville s total margin as a percentage of revenue was 7.18% (or $8.57 million) at Q2 of 2017/18 and forecasted to be 3.19% (or $7.5 million) by year end. The higher margin is partly driven by the receipt of one-time funding in 2017/18, including a onetime rebate from the hospital s benefits provider. The Central LHIN will work with the hospital regarding this performance issue. ALC Rate: Markham Stouffville had an increase in ALC Rate between fiscal year 2016/17 and fiscal 2017/18 Q2 year to date. The primary driver of ALC are patients awaiting placement in LTC. The hospital is actively participating in Central LHIN ALC Collaborative initiatives and planning for the implementation of the Integrated Care Coordination pilot project to streamline the hospital s discharge planning and care coordination processes. CT and MRI: Performance has declined since the end of the 2016/17 year due to rising demand for CT and MRI services, thus resulting in growth of the wait list. The hospital was one of the best performers last year, but consequently, the good performance has led to more referrals. With a fixed capacity, the higher demand has caused longer wait times. MRI wait time was negatively impacted in early 2017/18 due to equipment failure resulting in lost capacity of nearly 200 hours. The hospital is planning to add more resources in the evenings and weekends to help address the lost productivity. Rate of Hospital-Acquired C. Difficile Infections (CDI): Markham Stouffville experienced a much higher rate of C. Difficile infections in Q1 of 2017/18 compared to Q2. The hospital is in the process of implementing several new strategies to further reduce infection rates. The strategies include: replacing bar soap with liquid soap in all shower rooms at the Uxbridge site; installing personal protective equipment holders outside all inpatient rooms and outpatient clinic areas; and piloting the protocol of testing patients prior to transfer to another inpatient unit. Readmissions to Own Facility within 30 days for selected HBAM Inpatient Grouper (HIG) Conditions: The hospital has identified CHF as a particular focus as it contributed significantly Central LHIN Board of Directors Page 7 CEO Report January 30, 2018

60 Central LHIN CEO Report - Items for Information to the total readmitted cases. The hospital has implemented a new clinical pathway in Q1 of 2017/18 including the adoption of digital order sets as a mitigation strategy. The hospital is also planning to open a CHF clinic and recruit two cardiologists to enhance care in the outpatient setting. Stevenson Memorial Hospital Year-end Forecast Total Margin (H-SAA definition): Total LHIN Funding: $20.7 million Year-end $114,100 (0.39% of revenue); Q2 actual $337,970 (2.28% of revenue) Number of Beds: 38 Cash and Investments: $1.7 million Long-term Debt Year-end: $4.1 million Number of FTEs: 175 % of Total Debt: 24.5% Stevenson is performing generally well compared to H-SAA targets with the exception of the following areas: ALC Rate: Stevenson demonstrated an increase in ALC Rate between fiscal year 2016/17 (14.3%) and current fiscal 2017/18 Q2 year to date (17.3%). However, as a small community hospital with relatively low patient volumes, ALC performance can be easily impacted by the addition or avoidance of a few stay patients within the reporting period. CT Scans: Wait time performance dropped in Q1 and Q2 of 2017/18 from prior periods as a result of the week long installation of a new CT scanner at Stevenson in April and data quality issues. Diagnostic imaging staff who work in the X-ray department are being cross-trained on CT in order to leverage available staff to perform outpatient CT scans. Readmissions to Own Facility within 30 days for selected HBAM Inpatient Grouper (HIG) Conditions: Stevenson s readmission performance was driven by COPD patients. A new clinical pathway was developed and implemented for COPD patients that encompasses more robust clinical intervention and education of patients. The pathway follows through to the home after discharge and also includes pre-booking follow up visits with the patient s primary care physician within 7 days of discharge and the use of Telehomecare where appropriate /18 Quarter 2 Stocktake Scorecard Appendix C Central LHIN received the 2017/18 quarter 2 Stocktake results from the Ministry in Novmeber The quarter 2 Stocktake Scorecard summarizes Central LHIN s latest quarter performance based on the 13 MLAA (Ministry LHIN Accountability Agreement) indicators, as well as the trending of performance from quarter 1 of 2013/14. The scorecard shows Central LHIN performance compared to other LHINs and provincial results, and highlights LHIN initiatives focused on improving performance, particularly for the indicators where the LHIN did not meet target. Central LHIN met the provincial target for five performance indicators in quarter 2, which was the highest number achieved by any LHIN in the province Health Based Allocation Model Preliminary Results The Ministry of Health and Long-Term Care in collaboration with the Ontario Hospital Association (OHA), released preliminary 2016/17 Health Based Allocation Model (HBAM) results to the LHINs and hospitals to assist the sector with forecasting their funding for 2018/19. The early release of the preliminary data allows hospitals to validate the data and identify any data quality issues before the HBAM results are finalized and used in the Health System Funding Reform (HSFR) calculations for determining 2018/19 funding. HBAM is the funding formula used by the ministry to allocate Central LHIN Board of Directors Page 8 CEO Report January 30, 2018

61 Central LHIN CEO Report - Items for Information available funding for health services. It estimates future expense based on past service levels and efficiency, as well as population and health information. An HSP s share of funding is impacted by their own expected results, including year over-over-year changes in expected results, as well as the expected results of all other HSPs. It is important to note that an HSP s change in HBAM expected results does not have a 1:1 correlation with their change in funding. The 2016/17 results also provide the LHIN with an opportunity to assess the five public hospitals funded through the funding formula at a high level in terms of operational cost efficiency- defined as actual cost of care versus the expected cost - and service volume delivery- defined as actual volumes versus expected volumes. The model is based on patients actually seen at a hospital and provincial averages, not clinical or operational best practices. In general, the majority of Central LHIN hospitals are operating efficiently (as shown by a negative variance- actual costs are less than expected costs) across the acute and emergency patient care types. These two patient care types represent the majority of hospital costs. Humber remains inefficient, primarily due to the fact they had not yet grown into their new facility, however the hospital has noted that due to rapid growth over the past year, their operational efficiency has increased dramatically over the past few years. Hospital Name Actual 2016/17 Unit Costs Acute Inpatient & Day Surgery HBAM Expected variance % variance from Expected Actual Emergency Room HBAM Expected variance % variance from Expected North York General Hospital 5,016 5,244 (229) -4.4% 5,043 5,705 (662) -11.6% Mackenzie Health 5,171 5,188 (17) -0.3% 4,002 5,392 (1,390) -25.8% Southlake Regional Health Centre 5,180 5,350 (170) -3.2% 4,459 5,453 (994) -18.2% Markham Stouffville Hospital 5,254 5,273 (19) -0.4% 5,531 5, % Humber River Hospital 5,439 5, % 5,539 5, % At the same time, the results show that most hospitals are close to meeting the expected HBAM service volumes and are within 1%. This indicates that the hospitals are delivering the expected services and programs to meet the needs of our patients. An exception was Markham Stouffville Hospital which is approximately 1.6% below their expected activity levels. In 2016/17, Markham Stouffville Hospital entered year 4 of its Post Construction Operating Plan (PCOP). The hospital continues to ramp up its services and programs to deliver the additional volumes expected as a result of the redevelopment project Central LHIN Board of Directors Page 9 CEO Report January 30, 2018

62 Central LHIN CEO Report - Items for Information Acute Inpatient and Day Surgery Total Acute Weighted Cases 2016/17 Service Volumes Emergency Room Ontario Modified Weighted Cases Hospital Name Actual Acute Total Weighted Activity 2016/17 Expected Acute Total Weighted Activity 2016/17 variance % variance from Expected Actual Weighted Activity 2016/17 Expected Weighted Activity 2016/17 variance % variance from Expected North York General 36,513 36,606 (93) -0.25% 5,604 5,644 (40) -0.70% Mackenzie Health 25,414 25,513 (99) -0.39% 5,447 5, % Southlake Regional Health Centre 42,050 42, % 5,157 5, % Markham Stouffville 21,516 21,867 (350) -1.60% 4,255 4,327 (72) -1.66% Humber River 45,439 45,616 (177) -0.39% 5,984 5,986 (2) -0.04% 9.8 Funding Allocation Delegated Authority January 2018 Appendix D A list of funding delegations approved by Central LHIN staff since the November 28, 2017 Board of Directors meeting, is attached in Appendix D. Health System Planning and Engagement 9.9 Assertive Community Treatment Teams Expansion into South Simcoe Assertive Community Treatment (ACT) is a client-centred, recovery-focused mental health service delivery model. ACT Teams are designed to serve individuals with serious and persistent mental illness, whose symptoms are escalated and require specialized services, and provide intensive treatment, rehabilitation, and support services. Although case management, peer support and therapy is available, services are not provided 24 hours a day/7 days per week. As a result, those that require more intensive community mental health services often end up in the emergency department. There are currently six ACT Teams in Central LHIN that provide service coverage across the region; however, residents in South Simcoe do not have access to comprehensive medical and/or recovery based support. To support goals of the Central LHIN Integrated Health Service Plan ( ), a request for proposals was issued to community service agencies in South Simcoe and Northern York Region who are currently funded to provide ACT services. The Canadian Mental Health Association, Region of York and Southlake Regional Health Centre submitted a successful collaborative proposal that leverages existing infrastructure and cross-sector relationships that optimize operational and cost efficiencies. The creation of this program is expected to provide equitable access to ACT services across Central LHIN, provide high quality client-centred services for individuals with serious mental health conditions, as well as reduce emergency department utilization. Central LHIN Board of Directors Page 10 CEO Report January 30, 2018

63 Central LHIN CEO Report - Items for Information 9.10 Enhanced Adult Day Program In Summer 2016, Central LHIN developed a Long-Term Care Capacity Plan that modeled alternatives to traditional LTCH bed placement. These alternatives were designed based on level of service required and determined through a combination of MAPLe/RAI HC scores. One of the alternatives was Enhanced Adult Day Programs (ADPs) for Seniors. Expanded or enhanced ADPs would support seniors who require moderate to high care needs and provide much-needed respite for caregivers. Services to be provided include, but are not limited to, assistance with activities of daily living, therapeutic recreation/activation programs, exercise and falls prevention, medication management, access and referral to other programs including foot care and caregiver support. In January 2017, the Central LHIN Enhanced ADP Working Group was established. The mandate of the working group was to provide recommendations for program expansion through the development of a consistent core basket of services for ADPs. Demand for these services is high and, as of September 2017, there were 968 clients on Central LHIN ADP waitlists. The Central LHIN identified ADPs under Priorities for Investment and, on October 3, 2017, a Request for Proposal (RFP) was distributed to Community Support Services (CSS) Agencies that were currently funded to provide ADPs for service expansion. A total of $349,936 in annualized base funding was allocated to three CSS agencies (Alzheimer Society of York, CHATS - Community and Home Assistance to Seniors, and Yee Hong Centre for Geriatric Care) to provide additional 58 spaces for seniors to participate in ADPs, thereby affecting wait lists in high demand LHIN sub-regions (Western York, Eastern York, and Northern York) Central LHIN Opioid Update In October 2017, the Ministry Emergency Operations Centre (MEOC) was activated to provide health system support in managing the ongoing opioid crisis. The MEOC supports mechanisms to monitor and share information to better understand operational system pressures, and to help navigate, problem solve, and coordinate potential responses. Weekly teleconferences have been scheduled among various stakeholders affected by this crisis, specifically public health units, EMS, provincial associations, regulatory colleges and LHINs. Central LHIN has been a participant on these calls, and to date there have been no urgent or emergent local or regional issues identified. Central LHIN HSPs continue to be engaged and kept informed of MEOC Situation Reports as necessary. Central LHIN has received monthly emergency department (ED) data for opioid overdoses, between April and November, During this period, approximately 7% (402 of 5,639) of all opioid overdoses in the ED presented at a Central LHIN hospital. The average median age as of November is Central LHIN Board of Directors Page 11 CEO Report January 30, 2018

64 Central LHIN CEO Report - Items for Information ED Visits for Opioid Overdose: April November, 2017 Erie St. Clair South West Waterloo Wellington HNHB Central West Mississauga Halton Toronto Central Central Central East South East Champlain 6% 4% 10% 7% 5% 5% 2% 4% 18% 7% 5% 6% 4% 17% LHIN Name # ED Visits Erie St. Clair 204 South West 414 Waterloo Wellington 331 HNHB 965 Central West 250 Mississauga Halton 263 Toronto Central 994 Central 402 Central East 536 South East 249 Champlain 365 North Simcoe Muskoka 306 North East 260 North West 100 Ontario 5,639 Since August of 2017, the number of visits has been on a decline from a high of 103 cases to 22 cases in November (figure below). Central LHIN is currently working with all three public health units to understand data as it relates opioid use. Central LHIN ED Visits for Opioid Overdose As part of the Provincial announcement on December 7th, 2017 to expand and respond to the escalating overdose crisis, the MOHLTC has requested an exemption under federal law to create temporary overdose prevention sites. These sites will provide supervised injection, harm reduction supplies (including needle exchange and disposal), and distribute naloxone to help reduce the growing number of overdose deaths. Central LHIN has shared the application process with respective HSPs to help deal with community pressures that may be evident throughout the region. Central LHIN Board of Directors Page 12 CEO Report January 30, 2018

65 Central LHIN CEO Report - Items for Information 9.12 Hip & Knee Replacement Bundled Care Model Update In September 2017, the Ministry of Health and Long-Term Care (MOHLTC) informed LHINs of its commitment and plans to expand bundled care models based on the learnings from the Integrated Funding Model (IFM) pilots implemented in 2015 and advice received from key thought leaders. The Integrated Funding models are intended to integrate funding over a patient s episode of care with a single payment to a team of health care providers to cover care for the patient both in the hospital and at home. Services are coordinated around the patient s needs to minimize readmissions to hospital. The MOHLTC provided opportunity for all LHINs to identify cross-provider teams to participate in a voluntary expansion of the bundled care program for hip and knee replacement procedures. Within the Central LHIN, three hospitals volunteered to participate in the hip and knee bundled care program: Markham Stouffville Hospital (MSH), North York General Hospital (NYGH), and Southlake Regional Health Centre (SRHC). Planning is currently underway at each of these hospitals to identify key partners and develop patient care pathways to support the bundled care model for hip and knee replacement procedures Hospice Capacity Update In October 2016, the Central LHIN was allocated 35 new adult residential hospice beds by the Ministry of Health and Long-Term Care (Ministry) under the Palliative and End of Life Strategy. This investment will strengthen hospice services in our region and will significantly improve access to palliative care support for Central LHIN residents. Prior to the investment, Central LHIN was funded to operate 17 residential hospice beds which are located at: Hill House (3 beds), Matthews House (4 beds) and Margaret Bahen Hospice (10 beds). The total new complement of 52 beds is allocated as follows: Hospice Name Community Existing Beds New Beds Estimated opening date Hill House Hospice Richmond Hill 3 Matthews House Hospice Alliston Margaret Bahen Newmarket 10 Hospice Vaughan Vaughan/Woodbridge Neshama Hospice North York Saint Elizabeth North York Subtotal As we expand our residential hospice capacity in the Central LHIN, a new Hospice Community of Practice group has been initiated. The group includes residential and community hospices and will come together regularly to share knowledge, best practice and enhance patient care Central LHIN Hospital Capacity Surge Update Central LHIN works with the MOHLTC, public health and its hospitals to monitor influenza activity and resulting impact on hospital bed capacity within the LHIN. A number of indicators are being Central LHIN Board of Directors Page 13 CEO Report January 30, 2018

66 Central LHIN CEO Report - Items for Information monitored, including data from syndromic and laboratory surveillance systems, and health system utilization data for situational awareness and to keep track of system level pressures. Central LHIN hospitals have been experiencing surges over the past several weeks in December and January, and continue to manage their capacity pressures locally. Influenza activity has varied across the province with some local hospitals reported elevated surges. Central LHIN Indicator Latest Period* Previous Week* Change Average Inpatient Hospital Utilization Across All Sites Average Critical Care Bed Occupancy Rate 102% (Jan 07) 93.86% (Dec 24-30) ALC Patients 325 (Dec 24-31) ILI Activity Status Moderate (Dec 31 Jan 06) 95% (Dec 31) 91.46% (Dec 17-23) 286 (Dec 17-23) Elevated (Dec 24 30) +7% +2.62% % Decreased Source: Influenza/Influenza-like Illness Activity & System Pressure Dashboard, January 9 th 2018, Ministry of Health and Long-Term Care Emergency Operations Centre. *Please note, date ranges are aligned to availability of data for each specific indicator. Central LHIN received funding from the MOHLTC in December 2017 to support augmenting hospital bed capacity includeing 20 targeted beds and 51 surge capacity flex beds. The enhanced bed capacity continues to support hospitals surge pressures and facilitates bed flow, particularly over the current influenza season Reactivation Care Center: A Central LHIN Hospitals Collaborative - Status Update On December 10, 2017, the former Humber River Hospital Finch site was opened as the Reactivation Care Centre A Central LHIN Hospitals Collaborative (RCC). A total of 105 patients transitioned from Humber River Hospital, Mackenzie Health, North York General Hospital and Southlake Regional Health Centre to the newly renovated Reactivation Care Centre. The RCC provides a unique and innovative care delivery model that offers specialized care focused on enhanced activation programming to maintain and improve functional ability of Alternative Level of Care (ALC) patients. Since opening, a total of 144 patients have transitioned to the RCC and 16 have been discharged to various destinations including rehabilitation units, home with support, convalescent care and long term care (LTC) homes. All partner hospitals have reported a smooth transition and the response from patients and families has been positive. The capacity created at main hospital sites has assisted in patient flow, however outbreaks and isolation requirements during the influenza season have impacted capacity of each hospital. Central LHIN and all partner hospitals have been working to ensure clinical integration and standardization across all RCC units, and will continue to monitor patient flow and process metrics Central LHIN Board of Directors Page 14 CEO Report January 30, 2018

67 Central LHIN CEO Report - Items for Information on an ongoing basis. Regular status updates will be provided to the Central LHIN Board in upcoming meetings Central LHIN s Fall Prevention Update Patient safety is paramount in the delivery of Central LHIN s home and community care services. Falls, which can significantly impact patient safety account for the highest number of reported adverse patient events in the Central LHIN. Falls are the leading cause of injury in seniors aged 65 and older. Each LHIN tracks and reports the rate of falls for long-stay community patients. As of September 30, 2017, Central LHIN had the second lowest rate of falls, at 34.70% compared to the provincial rate of 41.10%. Central LHIN has a robust falls prevention strategy. Fall prevention activities have been developed and sustained through active collaboration with contracted Service Provider Organizations (SPO) and community partners, including York Region Public Health. Central LHIN s fall prevention strategy has been shared by: participating in a multi-sector and LHIN wide Fall Prevention Committee collaborating with SPOs, York Region Public Health and community organizations to deliver comprehensive fall prevention education, group exercise programs and one on one in-home rehabilitation interventions providing annual fall prevention education for our Care Coordinators and Team Assistants as well as SPOs sharing leading practices with partner LHINs delivering national and provincial fall prevention presentations to enhance knowledge and inform practice piloting a falls notification process to enhance communication among our LHIN Care Coordinators, Team Assistants and Service Providers, in alignment with the LHIN s Falls Quality Improvement Plan ongoing education regarding a least restraint approach to care and shifting Care Coordinators and Service Provider practice regarding use of full/partial bed rails to enhance patient safety and independence As noted in Health Quality Ontario s Insights into Quality Improvement Services*, largescale change to reduce falls in long-stay home care clients will require a multi-dimensional approach linking a defined population to appropriate and available falls prevention program through an efficient process. As the complexity of patients continues to increase, it is essential that a multifaceted approach, strong partnerships and data-informed practice be maintained to help reduce the prevalence and impact of falls. (*Reference: Insights into Quality Improvement Services, , Health Quality Ontario, page 16) 9.17 Congestive Heart Failure Pilot Home and Community Care A pilot was initiated with Markham Stouffville Hospital (MSH) to support complex patients with Congestive Heart Failure (CHF) in Q2. The key objectives of the pilot were to improve transitions Central LHIN Board of Directors Page 15 CEO Report January 30, 2018

68 Central LHIN CEO Report - Items for Information from hospital to community, deliver care with an integrated approach, increase communication between health care providers involved in patients care plan and to leverage technology. Key stakeholders included the physician lead and patient navigator at MSH, Central LHIN, York Region Paramedics and primary care. Initial findings of the pilot have demonstrated key outcomes including improved patient experience and reduction of avoidable emergency department (ED) visits and hospital readmission through a more integrated approach to care. Preliminary evaluation has revealed reduction in ED visits and hospital readmissions. To supplement the piloted model of care, MSH will add a clinic to enable further improvement to health outcomes. In early February 2018, MSH will be opening a community medicine clinic to serve inpatient and outpatient complex patients. This clinic will be expanding to service all complex patients and will incorporate funding of the CHF pilot. Central LHIN will work with MSH leveraging current best practices and resources including integration of Health Links to service these complex patients Central LHIN Capacity Update - Hospital/LTC Placement Holiday Surge New capacity for 120 hospital patients in Central LHIN was operationalized with the opening of the Reactivation Care Centre on December 10 th. Approximately 30 patients from each of Humber, North York, Southlake and Mackenzie Health were transitioned successfully. A majority of the patients are waiting for Long Term Care however, with LHIN Care Coordinators on site, applications for Long Term Care were completed as staff met with patients and families to review discharge options. Several patients have started to be transitioned to either LTC or the community with home care supports. When required patients may go home through the LHIN s Home First initiative with enhanced levels of services for a period up to 90 days or the Transitional Care at Home pilot with enhanced therapy and personal support services. To date the LHIN s Transitional Care at Home pilot has enrolled 61 patients and avoided approximately 103 ALC days which is in support of our collective goal to provide the right care at the right time in the right place. For December, Central LHIN hospitals reported a census of 106%, consistent with Dec. 2016/17 however, the LHIN responded to over 4700 discharges for the month of December which is a year over year increase of 7.5% for the same period. During this period the LHIN also received 700 new Long Term Care applications. As expected, seasonal influenza has contributed to the outbreaks experienced in Long Term Care homes however December 2017 tallied 205 days of outbreak compared to 121 for December Outbreaks in LTCHs and retirement homes create a significant challenge for hospital transitions. Quality 9.19 Patient and Family Advisory Committee (PFAC) The Central LHIN successfully recruited 17 members from the regional community for the Patient and Family Advisory Committee (PFAC) and held it its first meeting in late October. The role of the PFAC is to assist in shaping LHIN programs, services and initiatives designed to improve care in the Central LHIN. The PFAC will fulfill this role by: Central LHIN Board of Directors Page 16 CEO Report January 30, 2018

69 Central LHIN CEO Report - Items for Information identifying and advising on opportunities to incorporate the patient s perspective in initiatives to better integrate care across the region and across the health care system; supporting effective patient engagement within the LHIN; providing advice on recommendations about health care access or service delivery improvements from the patient and/or family caregiver perspective; providing input on LHIN policies and standards guiding LHIN initiatives, particularly regarding patient care and patient engagement; recommending strategies and practical ideas for improving patient care, and caregiver recognition and support; and working in partnership and engaging in co-design with the LHIN CEO, LHIN staff, service providers and partners. Several weeks post the first meeting a sub-group of PFAC members provided feedback on the Central LHINs draft Quality Framework. In November the PFAC named two of its members Pat Legris and Robert White as co-chairs. Both co-chairs attended the Board education session which focused on governance collaboration and learning about the Patient Ombudsman s role and experience over the past eighteen months. The PFAC held its second meeting in mid-january and provided input to the Draft Home and Community Care Quality Improvement Plan; the Home and Community Care section of the Annual Business Plan; and the Dementia Care Strategy. The areas that most resonated with the PFAC was the importance of timely service, navigating the system, and the use of digital systems and technology to improve communication and coordination. The Central LHIN is in the process of organizing a visit of Julie Drury, Chair of the Minister s PFAC (MPFAC) and for her to meet with the Central LHIN PFAC in the next several months. This will be an opportunity for our PFAC and the LHIN to learn more about the work of the MPFAC Annual Home and Community Care Quality Improvement Plan (QIP) Health Quality Ontario (HQO) oversees the Annual Quality Improvement Plan Program. Health care organizations in Ontario are required to prepare and submit a Quality Improvement Plan (QIP) to Health Quality Ontario each year. The intent of the QIP program is to cultivate and support the development of a culture of quality within organizations and across the health system. The Central LHIN is obligated to submit a QIP for Home and Community Care. In a QIP, organizations identify the quality issues they wish to address, select the indicators they will use to track their progress toward improvement, set targets for improvement, and describe planned interventions (i.e., change ideas ) to achieve these targets. The quality issues are organized by the six dimensions of quality: experience, timeliness, equity, efficiency, safety, and access. A QIP is a public, documented set of quality commitments that a health care organization makes to its patients, staff, and community on an annual basis to improve quality through focused targets and actions. The documents include a: QIP narrative provides context and sets the stage for the commitments being made in the QIP for the coming year QIP worksheet includes indicators, baseline data, targets, and change ideas QIP Progress report is a tool that assists an organization to gain insight into how effective the change ideas tested were in achieving established targets for the previous year s QIP Central LHIN Board of Directors Page 17 CEO Report January 30, 2018

70 Central LHIN CEO Report - Items for Information The Patient Services and Quality Committee provides oversight to the development of the QIP which will be brought to the Board for consideration at its March meeting. Subsequent to approval, the QIP is submitted to HQO and posted on the LHIN website. Central LHIN Board of Directors Page 18 CEO Report January 30, 2018

71 Appendix A Central LHIN Community Scorecard 2017/18 Q2 Report ACHIEVED BALANCED BUDGET; and ALL ACTIVITY (SERVICE VOLUMES) WITHIN CORRIDOR; Access Independent Living Services Addiction Service for York Region Alzheimer Society Of York Region Aphasia Institute Bayview Community Services Inc. Bernard Betel Centre for Creative Living Better Living Health and Community Black Creek Community Health Centre Canadian Mental Health Association, Metropolitan Toronto Branch Canadian Mental Health Association, York Region Carefirst Seniors Community Services Association Caritas School of Life Cedar Centre Cerebral Palsy Parent Council Of Toronto (Participation House) Chai-Tikvah Foundation Chippewas of Georgina Island City Of Toronto - Long-Term Care Homes & Services (Supportive Housing) Community Head Injury Resource Services Of Toronto COTA Health Etobicoke Services For Seniors Hazel Burns Hospice Humber River Hospital Jane/Finch Community And Family Centre LumaCare Services MacKenzie Health March of Dimes Canada - York Markham-Stouffville Hospital New Unionville Home Society North York General Hospital North York Seniors Centre North Yorkers For Disabled Persons Inc. PACE Independent Living St. Demetrius Supportive Care Services Corp. Stevenson Memorial Hospital The Canadian National Institute for the Blind York Region The Lance Krasman Memorial Centre for Community Mental Health The Vitanova Foundation Vaughan Community Health Centre Villa Colombo Home for the Aged Inc. ACHIEVED BALANCED BUDGET; and ALL ACTIVITY (SERVICE VOLUMES) WITHIN CORRIDOR (Cont d); Yee Hong Centre For Geriatric Care Yor-Sup-Net Support Service Network ACHIEVED BALANCED BUDGET; ACTIVITY (SERVICE VOLUMES) OUTSIDE CORRIDORS Circle Of Home Care Services (Toronto) CHATS Community Home Assistance To Seniors Southlake Regional Health Centre The Canadian Hearing Society - York Region The Regional Municipality of York Toronto North Support Services BOTH DID NOT BALANCE BUDGET & VOLUMES OUTSIDE THE CORRIDOR Across Boundaries - An Ethnoracial Mental Health Centre LOFT Community Services FOLLOW-UP PROCESS: Achieved both criteria : No Follow-up Did not achieve both criteria : LHIN follow up with HSP Senior Staff

72 Central LHIN Public Hospital Performance Summary /18 Q2 GLOBAL VOLUMES TORONTO Humber River Regional TORONTO North York General NEWMARKET Southlake Regional RICHMOND HILL Mackenzie Health MARKHAM Stouffville ALLISTON Stevenson Memorial Reporting Period Emergency Department - Weighted Cases 6,676 5,782 5,564 5,662 4,585 1,488 Q2 Year End Forecast Complex Continuing Care - RUG Weighted Patient Days 11,667 31,950 4,506 Q2 Year End Forecast Total Inpatient Acute Activity - Weighted Cases 38,524 30,656 32,802 23,394 19,055 2,293 Q2 Year End Forecast Day Surgery - Weighted Cases 6,062 5,160 10,071 3,050 2, Q2 Year End Forecast Inpatient Mental Health - Weighted Patient Days 22,409 16,267 10,484 10,705 12,478 Q2 Year End Forecast Inpatient Rehabilitation - Weighted Cases Q2 Year End Forecast Ambulatory Care - Visits 261, , , , ,528 32,742 Q2 Year End Forecast ORGANIZATIONAL HEALTH TORONTO Humber River Regional TORONTO North York General NEWMARKET Southlake Regional RICHMOND HILL Mackenzie Health MARKHAM Stouffville ALLISTON Stevenson Memorial Reporting Period Current Ratio Q2 Year End Forecast Year End Total Margin 0.62% 1.87% 1.3% 0.08% 3.2% 0.39% Q2 Year End Forecast SYSTEM PERSPECTIVE TORONTO Humber River Regional TORONTO North York General NEWMARKET Southlake Regional RICHMOND HILL Mackenzie Health MARKHAM Stouffville ALLISTON Stevenson Memorial Central LHIN Actual Reporting Period ALC Rate 15.30% 22.07% 16.24% 14.74% 19.03% 11.85% 17.02% Q2 2017/18 PERSON EXPERIENCE TORONTO Humber River Regional TORONTO North York General NEWMARKET Southlake Regional RICHMOND HILL Mackenzie Health MARKHAM Stouffville ALLISTON Stevenson Memorial Central LHIN Actual Reporting Period 90th Percentile ED LOS for Complex Patients YTD Q2 2017/18 90th Percentile ER LOS for Non-Admitted Uncomplicated Patients YTD Q2 2017/18 % of Priority 2-4 Cases Completed within Access Targets for CT Scans 78% 68% 64% 59% 83% 75% 72% YTD Q2 2017/18 % of Priority 2-4 Cases Completed within Access Targets for MRI Scans 40% 44% 20% 30% 31% 33% YTD Q2 2017/18 % of Priority 2-4 Cases Completed within Access Targets for Hip replacements 99% 100% 93% 100% 94% 98% YTD Q2 2017/18 % of Priority 2-4 Cases Completed within Access Targets for Knee replacements 95% 100% 98% 90% 93% 96% YTD Q2 2017/18 PERSON EXPERIENCE NEWMARKET Southlake Regional RICHMOND HILL Mackenzie Health Main Site Uxbridge Overall Rate of Hospital Acquired Clostridium Difficile Infections (CDI) YTD Q2 2017/18 Readmissions within 30 days for selected HIGs TORONTO Humber River Regional TORONTO North York General MARKHAM Stouffville TORONTO Humber River Regional TORONTO North York Gen - NEWMARKET RICHMOND HILL MARKHAM Stouffville Finch Site Church Site Keele Site North York Branson site Southlake Mackenzie Health Main Site Uxbridge General Regional Readmissions to Own Facility within 30 days for selected HIGs 14.8% 11.3% 13.5% 14.3% 14.0% 13.3% YTD Q2 2017/18 Organization's performance is within HSAA performance corridor Organization's performance is outside the HSAA performance corridor Organization's performance is outside the HSAA performance corridor but meets provincial performance target ALLISTON Stevenson Memorial Reporting Period ALLISTON Stevenson Memorial Reporting Period

73 Indicator Name Percentage of home care clients with complex needs who received their personal support visit within 5 days of the date that they were authorized for personal support services (2017Q1) Provincial Target Central LHIN Actual Provincial Performance PERFORMANCE INDICATORS Home and Community: Reduce wait time for home care (improve access); More days at home (including end of life care) 95.00% 2017/18 MLAA Quarter 2 Stocktake Scorecard - CLHIN Performance Performance Date Produced: November 14, 2017; Date of Next issue: March, 2018 Rank Better (1 is best, 14 than ON? is worst) Trend over time Overall Improve since 2013/14? 94.28% 89.26% 4 YES Comments & CLHIN Initiatives Focused on Improving Performance Appendix C LEGEND Achieved Target Within 10% of Target >10% from Target Performance improved for this indicatorin this quarter. The enhanced communication process established with service provider organizations continues to support processes for ensuring clients receive service within 5 days. Another factor contributing to the performance improvement is the change in methodology for calculating this indicator which took place in Q1 of 2017/18. The new method now calculates the wait time starting from when the patient is available for service, rather than when the service is authorized. The LHIN has invested in additional assistance living, attendant outreach and adult day programs to further support improvement in this indicator. Central LHIN will continue to work towards meeting the target of 95% at the end of the fiscal 2017/18 year. Percentage of home care clients who received their nursing visit within 5 days of the date they were authorized for nursing services (2017Q1) 95.00% 96.89% 96.34% 5 YES Central LHIN continues to meet the provincial target for this indicator since Q1 of 2016/17. The performance has been sustained through process improvements implemented in earlier periods such as: 1) Monitoring compliance on the standardized service offer process in conjunction with regular reporting and auditing of processes followed with corrective actions if necessary; 2) Enhancing communication with service providers (e.g. mandatory completion of the "service requested by" date field); and 3) A sustainability plan for orientation of care coordinators to ensure new hires are accurately completing documentation of key information (e.g. First Visit Date). The performance improvement this quarter is partly attributed to the change in methodology for calculating this indicator where wait time is now calculated from the Patient Availability date as opposed to the Service Authorization date. Central LHIN expects to continue to meet the provincial target. 90th percentile wait time from community setting to first home care service (excluding case management) (2017Q1) 21 days YES Performance has improved steadily since Q1 of 2016/17. For Q1 of 2017/18, performance improved to 22 days and Central LHIN ranked 3rd in the province, due in part to significant investments in home and community care in FY 2017/18.. Three new strategies were implemented which contributed to the performance improvement: enhancement of a dashboard that enabled staff to proactively coordinate the start of services within 21 days; practice of scheduling initial home visits at the time of intake; and collaboration with rehab service provider organizations to improve the service offer process and in turn reduce response time. Central LHIN continues to focus on the existing strategies and ensure compliance to support sustained performance in working towards meeting the target by the end of fiscal 2017/18. 90th percentile wait time from hospital discharge to service initiation for home and community care (2017Q1) TBD N/A Performance for this indicator has been sustained from the previous quarter and continues to be aligned with the improvements made for the Percentage of Home Care Clients who received Nursing visit within 5 days of service authorization indicator. Better than average wait times for Short Stay Rehab and Long Stay Complex patients have contributed to improved performance. System Integration and Access: Provide care in the most appropriate setting; Improve coordinated care; Reduce wait times (specialists, surgeries) 90th percentile emergency department (ED) length of stay for complex patients (2017Q2) 8 hours YES ED Length of Stay (LOS) performance worsened during last quarter. Central LHIN had the highest ED volume of complex patients among all 14 LHINs in Q2 of 2017/18 with four of Central LHIN hospitals being in the top ten hospitals in the province. Performance continues to be driven by the length of stay for admitted patients. Therefore, Central LHIN hospitals are focusing on initiatives to improve patient flow targeting the length of stay for the complex admitted patients. The Reactivation Care Centre at the former Humber River Finch site was opened in early December 2017, and 71 flex beds were opended across the LHIN. This has created additional capacity for acute inpatient beds that will help improve patient flow at the five Central LHIN large community hospitals. 90th percentile ED length of stay for minor/uncomplicated patients (2017Q2) 4 hours NO Central LHIN continues to meet the target and perform better than the provincial average, however, performance has worsened slightly in Q2 of 2017/18 compared to prior quarters. A number of initiatives are currently in place to sustain this performance, including a focus on patient flow in ED, process improvement for non-complex patients, internal protocols to identify pressures in the ED, and increased access to Diagnostic Imaging services.

74 Indicator Name Percent of priority 2, 3 and 4 cases completed within access target for hip replacement (2017Q2) Percent of priority 2, 3 and 4 cases completed within access target for knee replacement (2017Q2) Provincial Target Central LHIN Actual Performance Provincial Performance Rank Better (1 is best, 14 than ON? is worst) Trend over time Overall Improve since 2013/14? 90.00% P2: 42 days 97.14% 77.98% 1 YES 90.00% P3: 84 days P4: % 73.98% 1 YES Comments & CLHIN Initiatives Focused on Improving Performance Central LHIN continues to meet the Hip and Knee performance targets and is ranked #1 in the province on performance for these indicators. Percentage of alternate level of care (ALC) days (2017Q1) 9.46% 13.01% 13.87% 6 NO ALC rate (2017Q2) 12.70% 17.02% 15.87% 10 NO Percentage of ALC Days improved significantly this quarter as this performance reflected the lowest percentage of ALC days in two fiscal years. The improved performance was driven by the decrease in ALC discharged cases along with a decrease in the number of ALC discharged cases with long lengths of stay (> 100 days). However, the ALC Rate worsened in Q2 of 2017/18 as five of six Central LHIN hospitals experienced an increased ALC rate. The top discharge destinations for ALC patients continue to be LTC, Home with Community Services, and Inpatient Rehab with the majority waiting for LTC. The opening of the Reactivation Care Centre at the former Humber River Finch site in December 2017 will support additional capacity for acute medical inpatient beds combined with enhanced care for patients in the new Reactivation Centre to facilitate improved transitions home. The Central LHIN is also engaged in strategic planning with hospitals to integrate traditional roles of hospital discharge planning and Home and Community Care service coordination. Health and Wellness of Ontarians - Mental Health: Reduce any unnecessary health care provider visits; Improve coordination of care for mental health patients Repeat unscheduled emergency visits within 30 days for mental health conditions (2017Q1) 16.30% 20.13% 20.82% 9 NO Performance worsened in this quarter and has declined over the past several quarters. A strong contributor to this performance is the frequest repeat visits to the ED from a core group of patients, concentrated at three hospitals with the high repeat visits. Central LHIN continues to work with key stakeholders regarding the proposed creation of a Mental Health Hub aimed at providing the appropriate care in the community setting to divert unnecessary ED visits. Investments are also being made in an Assertive Community Treatment (ACT) Team in South Simcoe to address the service gap in the north for those with serious mental health illness and complex needs who often present in the ED. Repeat unscheduled emergency visits within 30 days for substance abuse conditions (2017Q1) 22.40% Sustainability and Quality: Improve patient satisfaction; Reduce unnecessary readmissions 25.31% 33.80% 4 NO Repeat ED visits for substance abuse conditions improved slightly in Q1 of 2017/18 and performed better than the provincial average. Central LHIN ranked 4th this quarter among all LHINs, however, performance remains unfavourable to the provincial target. Performance continues to be impacted by the patients' choice in seeking or receiving treatment and a small number of patients who account for a disproportionately large number of repeat ED visits. Central LHIN has continued an investment in the Rapid Access Addiction Medicine (RAAM) Clinic based at Southlake Regional Health Centre and will be expanding this type of clinic to each of Central LHIN's remaining sub-regions as part of the provincial opioid strategy. In addition, Central LHIN has completed its Three- Year Addictions Strategy in alignment with the provincial opioid strategy which outlines specific opportunities to better address addiction issues within the community. Readmissions within 30 days for selected Health Based Allocation Model (HBAM) Inpatient Group (HIG) conditions (2016Q4) 15.50% 15.32% 16.71% 2 More detail NO Performance in this readmission indicator improved in Q4 of 2016/17 compared to prior quarters and met the provincial target. The improvement this quarter was due to a reduction in the readmission rates for the COPD and CHF patients which have consistently high for the LHIN over the past periods. Central LHIN continues to fund initiatives including the Telehomecare program which is the largest program in the province focusing on COPD and CHF and the implementation of two COPD clinics in Community Health Centres aimed at expanding outreach to primary care. The LHIN also continues to support two Integrated Funding Model pilots for stroke and CHF/COPD through North York General Hospital. Both projects will continue in fiscal 2018/19 with the focus of transitioning from a project status to an established program. The LHIN is monitoring these programs to demonstrate improved adoption and support that will contribute towards improved performance for this readmission indicator.

75 Funding Allocations Delegated Authority January 2018 Appendix D A. New or Unallocated Transfer Payments from the Ministry 1. Assess and Restore Hospital Sector - $531,000 One-Time Funding for North York General Hospital to provide screening and standardized in-patient rehabilitation to North York General Hospital emergency department and admitted patients. 2. Provincial Aphasia Education and Training Community Sector - $400,000 One-Time Funding provided to Aphasia Institute to support the provincial education and training of adults with aphasia, their caregivers and healthcare professionals. 3. Long-Term Care Home Support Long-Term Care Sector - $100,000 One-Time Funding was allocated to River Glen Haven Nursing Home for additional human resources and education to support the home s response to compliance orders. 4. Acquired Brain Injury Community Sector - $199,961 Base Funding provided to the Community sector to support the expansion of Acquired Brain Injury personal support/independence training, case management and crisis intervention services. 5. Provincial Programs Hospital Sector - $372,000 One-Time, $2,063,300 Base Base funding for select cardiac services, including pacemakers and cardiac surgeries, and one-time funding for education and training new and mid-career critical care nurses. 6. Attendant Outreach Services Community Sector - $400,000 Base Funding to Access Independent Living Services for the expansion of Attendant Services both in designated buildings and in independent homes. 7. Recruitment and Retention Hospital and Community Sectors - $409,700 Base Funding provided to the Community sector to support recruitment and retention of qualified primary care staff. 8. Community Funding Various HSPs - $994,455 One-Time Funding provided to the Community sector for capital and non-capital expenditures to address financial and service pressures. Community providers have not received a base increase to offset inflationary increases since 2011/12. These funds are to assist providers in meeting financial obligations, allow for minor equipment refresh and renovations, additional service delivery, and staff education. 9. Reactivation Care Centre Hospital Sector - $14,281,000 Base Funding allocated for additional services, equipment, and facility costs associated with the Reactivation Care Centre. 10. Enhanced Adult Day Program - Community Sector - $334,936 Base Funding the LHIN provides to the Community sector to support the expansion of Enhanced Adult Day Programs for High Risk Seniors. 11. Assertive Community Treatment Services Community Sector - $1,000,000 Base Funding to the Canadian Mental Health Association, York Region for Assertive Community Treatment services in the South Simcoe sub-region. 1

76 Central LHIN 12. Opioid Treatment Program Community Sector - $100,000 Base Funding was allocated to Addiction Services for York Region to support Opioid Treatment Program expansion in response to increasing volumes and cost pressures. B. Recoveries and Reallocations of Funds to/from a Health Service Provider 1. Personal Support Services Community Sector ($135,000) Base Base funding for Personal Support Services was recovered from March of Dimes and PACE Independent Living based on the HSPs projected year-end surpluses. Summary of Approvals Item Health Service Provider Approved (D/M/Y) One-Time Annualized Base Description A1 North York General Hospital 16/10/2017 $531,000 Assess and Restore A2 Aphasia Institute 30/10/2017 $400,000 Provincial Education and Training A3 River Glen Haven Nursing Home 13/11/2017 $100,000 Long Term Care Home compliance A4 Community Head Injury Resource Services of Toronto 14/11/2017 $52,000 Acquired Brain Injury services A4 COTA Health 14/11/2017 $47,996 Acquired Brain Injury services A4 Mackenzie Health 14/11/2017 $99,965 Acquired Brain Injury services A5 Southlake Regional Health Centre 14/11/2017 $2,063,300 Provincial Programs Cardiac Services A5 Southlake Regional Health Centre 14/11/2017 $106,000 Provincial Programs Critical Care Nurse Training A5 Humber River Hospital 14/11/2017 $75,700 Provincial Programs Critical Care Nurse Training A5 Mackenzie Health Hospital 14/11/2017 $99,500 Provincial Programs Critical Care Nurse Training A5 Markham Stouffville Hospital 14/11/2017 $30,300 Provincial Programs Critical Care Nurse Training A5 North York General Hospital 14/11/2017 $60,500 Provincial Programs Critical Care Nurse Training A6 Access Independent Living Services 14/11/2017 $400,000 Attendant Outreach Services A7 Black Creek Community Health Centre 20/11/2017 $255,300 Recruitment and Retention A7 Vaughan Community Health Centre 20/11/2017 $134,300 Recruitment and Retention A7 Stevenson Memorial Hospital 20/11/2017 $20,100 Recruitment and Retention A8 Access Independent Living Services 21/11/2017 $30,000 Lease costs and salary pressures A8 Across Boundaries 21/11/2017 $25,000 Administration cost pressures A8 Addiction Services for York Region 21/11/2017 $27,500 Lease costs A8 Alzheimer Society of York Region 21/11/2017 $29,000 Lease costs A8 Aphasia Institute 21/11/2017 $30,000 Furniture and computer hardware A8 Bayview Community Services Inc. 21/11/2017 $15,500 Equipment, computer hardware and additional services A8 Better Living Health and Community 21/11/2017 Services $30,000 Lease costs and additional services A8 Black Creek Community Health Centre 21/11/2017 $80,000 Additional services A8 Carefirst 21/11/2017 $25,000 Computer equipment and software A8 Caritas School of Life 21/11/2017 $27,250 Equipment and facility renovations A8 Cedar Centre 21/11/2017 $28,680 Computer software and staff training A8 Cerebral Palsy Parent Council of Toronto 21/11/2017 $24,813 Salary pressures and equipment 2

77 Central LHIN Item Health Service Provider Approved (D/M/Y) One-Time Annualized Base Description A8 Chai-Tikah Foundation 21/11/2017 $860 Salary pressures A8 Community & Home Assistance to Seniors 21/11/2017 $27,500 Lease costs A8 Circle of Home Care Services (Toronto) 21/11/2017 $25,000 Staff training A8 CHIRS 21/11/2017 $30,000 Compensation pressures A8 COTA Health 21/11/2017 $29,925 Computer equipment A8 Etobicoke Services for Seniors 21/11/2017 $24,700 Salary pressures A8 Hazel Burns Hospice 21/11/2017 $27,500 Lease costs and additional services A8 Humber River Hospital 21/11/2017 $24,674 Education and salary pressures A8 Jane/Finch Community and Family Centre 21/11/2017 $8,844 Salary pressures A8 LOFT 21/11/2017 $30,000 Computer hardware A8 Mackenzie Health Hospital 21/11/2017 $23,736 Salary pressures and computer hardware A8 North Yorkers for Disabled Persons Inc. 21/11/2017 $30,000 Staff training and additional services A8 North York Seniors Centre 21/11/2017 $27,500 Facility renovations A8 PACE 21/11/2017 $27,500 Salary pressures A8 Southlake Regional Health Centre 21/11/2017 $27,500 Salary pressures A8 St. Demetrius Supportive Care Services 21/11/2017 $24,102 Additional services A8 Stevenson Memorial Hospital 21/11/2017 $22,500 Equipment A8 The Bernard Betel Centre for Creative 21/11/2017 Living $25,000 Equipment A8 Canadian Mental Health Association, 21/11/2017 Toronto $27,500 Salary pressure A8 Lance Krasman Memorial Centre 21/11/2017 $22,500 Equipment and staff training A8 The Regional Municipality of York 21/11/2017 $27,500 Facility renovations A8 Toronto North Support Services 21/11/2017 $30,000 Additional services A8 Vitanova Foundation 21/11/2017 $22,371 Computer hardware, software and upgraded internet service A8 Yee Hong Centre for Geriatric Care 21/11/2017 $25,000 Website enhancement A8 Yor-Sup-Net Support Services Network 21/11/2017 $30,000 Salary pressures A9 Mackenzie Health Hospital 24/11/2017 $2,139,200 Reactivation Care Centre A9 Humber River Hospital 24/11/2017 $7,940,400 Reactivation Care Centre A9 North York General Hospital 24/11/2017 $2,139,200 Reactivation Care Centre A9 Southlake Regional Health Centre 24/11/2017 $2,062,200 Reactivation Care Centre A10 Alzheimer Society of York Region 29/11/2017 $112,937 Enhanced Adult Day Program A10 Community & Home Assistance to Seniors 29/11/2017 $105,000 Enhanced Adult Day Program A10 Yee Hong Centre for Geriatric Care 29/11/2017 $116,999 Enhanced Adult Day Program A11 Canadian Mental Health Association, York Region 4/12/2017 $1,000,000 Assertive Community Treatment Services A12 Addiction Services for York Region 5/12/2017 $100,000 Opioid Treatment Program B1 March of Dimes 5/12/2017 ($30,000) Personal Support Services Recovery B1 PACE Independent Living 5/12/2017 ($105,000) Personal Support Services Recovery 3

78 ITEM 12.0 CENTRAL LHIN BOARD OF DIRECTORS CLOSED SESSION RESOLUTION January 30, 2018 BE IT RESOLVED THAT: The members attending this meeting move into a Closed Session pursuant to the following exceptions of LHINS set out in s.9(5) of the Local Health Systems Integration Act, 2006: Personal or public interest Public security Security of the LHIN and its directors Personal health information Prejudice to legal proceedings Safety Personnel matters Labour relations Matters subject to solicitor client privilege Matters prescribed by regulation Deliberations on whether to move into a closed session and further that the following persons be permitted to attend: Ms. Kim Baker Ms. Karin Dschankilic Ms. Chantell Tunney Ms. Tini Le Ms. Barbara Bell Ms. Karen Adams Mr. Mitchell Toker Ms. Katrina Santiago Ms. Robyn Saccon.