MINISTRY/LHIN ACCOUNTABILITY AGREEMENT (MLAA) MLAA Performance Assessment Dashboard /10 Q3

Transcription

1 MINISTRY/LHIN ACCOUNTABILITY AGREEMENT (MLAA) MLAA Performance Assessment Dashboard - 29/1 Q3

2 README The 29/1 MLAA Dashboard has been designed to reflect various reporting fiscal periods as well as the Ministry's focus of a performance management approach that is outcome oriented (aligned with current Provincial and Local Health System priorities strategies). The primary objective is for to enable and facilitate more effective changes in current health care practices and processes, to ensure that targeted objectives and goals are achieved successfully which is in the "delineation of performance management responsibilities between the Ministry and the LHINs. The purpose of the MLAA Dashobard is to enable System Effectiveness, Enablers Delivery Assessments with the following processes: 1 To ensure that Central East Local Health Integration Network is fulfilling their performance expectations and obligations as per the signed Ministry/LHIN Accountability Agreement Performance Schedules. 2 The MLAA Dashboard reflects the current status of each performance indicator for a given reporting period. 3 How each MLAA indicator is trending from the the prior fiscal year to current reporting period. 4 Quick identification of high level performance outcomes and drivers (positive/negative) in relation to the provision and wait time of service delivery. 5 Recommendations for next steps to optimize our local health system. Excerpt from Central East MLAA 27 21: "Further to the Local Health System Integration Act, 26 (the "Act") this Agreement supports the collaborative relationship between the MOHLTC and the LHIN to carry out the made in Ontario solution to improve the health of Ontarians through better access to high quality health services, to co ordinate health care in local health systems and to manage the health system at the local level effectively and efficiently. 1.2 The purpose of this Agreement is to set out the mutual understandings between the MOHLTC and the LHIN of their respective performance obligations in the period from April 1, 27 to March 31, 21 covering the 27 28, and fiscal years. This is an accountability agreement for the purposes of section 18 of the Act. The Agreement applies to each party's funding and performance obligations for the period April 1, 27 and ending March 31, 21 as they are determined for each fiscal year." List of MLAA 29/1 Indicators: 1. 9th Percentile Wait Times for Cancer Surgery 2. 9th Percentile Wait Times for Cataract Surgery 3. 9th Percentile Wait Times for Hip Replacement 4. 9th Percentile Wait Times for Knee Replacement 5. 9th Percentile Wait Times for Diagnostic MRI Scan 6. 9th Percentile Wait Times for Diagnostic CT Scan 7. Median Wait Time to Long Term Care Home Placement All Placements 8. Percentage of Alternate Level of Care (ALC) Days By LHIN of Institution 9. Proportion of Admitted patients treated within the LOS target of <= 8 hours 1. Proportion of Non admitted high acuity (CTAS I III) patients treated within their respective targets of <= 8 hours for CTAS I II and <= 6 hours for CTAS III 11. Proportion of Non admitted low acuity (CTAS IV V) patients treated within the LOS target of <= 4 hours Legend: MLAA Indicator Definitions 1. 9th Percentile Wait Times for Cancer Surgery 2. 9th Percentile Wait Times for Cataract Surgery 3. 9th Percentile Wait Times for Hip Replacement 4. 9th Percentile Wait Times for Knee Replacement 5. 9th Percentile Wait Times for Diagnostic MRI Scan 6. 9th Percentile Wait Times for Diagnostic CT Scan 7. Median Wait Time to Long Term Care Home Placement All Placements 8. Percentage of Alternate Level of Care (ALC) Days By LHIN of Institution 9. Proportion of Admitted patients treated within the LOS target of <= 8 hours 1. Proportion of Non admitted high acuity (CTAS I III) patients treated within their respective targets of <= 8 hours for CTAS I II and <= 6 hours for CTAS III 11. Proportion of Non admitted low acuity (CTAS IV V) patients treated within the LOS target of <= 4 hours 9 out of 1 patients are able to receive their treatment (cancer surgery) within a given time frame with 1 out of 1 patients waiting for treatment longer (9% vs 1%). CE LHIN has a negotiated target of 48 days with an overa provincial target = 84 days. Pertaining to surgical cancer procedures, wait time is calculated starting with when both the patient and surgeon make a decision to proceed to surgery to the time the actual procedure/surgery is completed. When 9 out of 1 patients or 9% receive treatment/services for Cataract surgery/procedures in a given time period (1 out of 1 or 1% patients waiting longer). Cataract Surgery is required when the "lens of the eye becomes clouded making it difficult for a person to see" and is usually reversible (due to aging). A procedure that is cost effective and normally successful (improvement in approximately 95% of cases). 9 out of 1 patients are able to receive their treatment (Hip Replacement Surgery) within a given time frame with 1 out of 1 patients waiting for treatment longer (9% vs 1%). For patients who require a replacement of a hip join (degeneration of cartilage and/or bones where non surgical treatments are not sufficient for the reduction of a patient's pain/disability). An effective treatment for the reduction of pain (in terms of quality and cost) to enable patients to become more functional and mobile. 9 out of 1 patients are able to receive their treatment (Knee Replacement Surgery) within a given time frame with 1 out of 1 patients waiting for treatment longer (9% vs 1%). For patients who require a replacement of a Knee joint (degeneration of cartilage and/or bones where non surgical treatments are not sufficient for the reduction of a patient's pain/disability). An effective treatment for the reduction of pain (in terms of quality and cost) to enable patients to become more functional and mobile. When 9 out of 1 patients or 9% receive treatment/services for an ordered MRI scan in a given time period (1 out of 1 or 1% patients waiting longer). Magnetic Resonance Imaging (MRI) is a tool which assists in the diagnosis, treatment (subsequent follow ups) of reported illnesses and is a one of two preferred methods for imaging procedures. Concerning Magnetic Resonance Imaging, the wait time calculated involves when a "diagnostic scan is ordered, until the time the actual exam is completed." ("decision to treat to treatment"). When 9 out of 1 patients or 9% receive treatment/services for an ordered Computed Tomography scan in a given time period (1 out of 1 or 1% patients waiting longer). Computed Tomography (CT) is a tool which assists in the diagnosis, treatment (subsequent follow ups) of reported illnesses and is a one of two preferred methods for imaging procedures. Concerning CT, the wait time calculated involves when a "diagnostic scan is ordered, until the time the actual exam is completed." ("decision to treat to treatment"). "Median wait time is the point at which half the patients have had their treatment, and the other half are still waiting." In essence, this measures the median time waited for an Ontario client to be placed within a Long Term Care Home and is calculated using the time from a client's LTC Home Application (or Consent Date) to the actual Date of Placement, by group/geography reported. Number of actual alternate levels of care (ALC) days of total Patient's Length of Stay. A patient resides within a hospital and is occupying an acute care bed but who does not require acute care services. ALC cases are determined via a clinical decision and noted on the patient's chart by their attending physician. Patient should be receiving health care services in a more appropriate care setting but is awaiting placement to another stream of care (e.g Rehab, Complex Continuing Care, Long Term Care, etc.) which wil be less costly than acute care. Defined as a ratio of the number of admitted patients with total time spent in ER less than or equal to 8 hours over the total number of admitted patients. Interpreted as the the ratio of the number of non admitted patients at the Canadian Triage Acuity Scale (CTAS) I, II and III, with total time spent in ER less than or equal to 8 hours for Canadian Triage Acuity Scale (CTAS) I and II and les than or equal to 6 hours for Canadian Triage Acuity Scale (CTAS) III over the total number of non admitted patients Canadian Triage Acuity Scale (CTAS) I, II and III. CTAS I: severely ill, requires resuscitation CTAS II: requires emergent care and rapid medical intervention CTAS III: requires urgent care Indicates the ratio of the number of non admitted patients assessed at the Canadian Triage Acuity Scale (CTAS) IV and V (less urgent, non urgent), where total time spent in ER is less than or equal to 4. CTAS IV: requires less urgent care CTAS V: requires non urgent care

3 README Legend: Ministry/LHIN Accountability Agreement Reporting Periods 29/1 Fiscal Quarter 1 Fiscal Quarter 2 Fiscal Quarter 3 Fiscal Quarter 4 Indicators year to year) Year End (YE) 9th Percentile Wait Times for Cancer Surgery 2 : 9th Percentile Wait Times for Cataract Surgery 2 : 9th Percentile Wait Times for Hip Replacement 1 : 9th Percentile Wait Times for Knee Replacement 1 : 9th Percentile Wait Times for Diagnostic MRI Scan 1 : July 31st, 29 Median Wait Time to Long Term Care Home Placement All Placements 3 : Percentage of Alternate Level of Care (ALC) Days By LHIN of Institution 5 : Proportion of Admitted patients treated within the LOS target of <= 8 hours 4 : Proportion of Non admitted high acuity (CTAS I III) patients treated within their respective targets of <= 8 hours for CTAS I II and <= 6 hours for CTAS III 4 October 1st, 29 : 28/9Q4 (Jan, Feb, Mar. 29) 29/1Q1 (Apr, May, Jun. 29) 29/1Q1 (Apr, May, Jun. 29) October 31st, 29 January 1st, 29 29/1Q1 (Apr, May, Jun. 29) 29/1Q2 (Jul, Aug, Sept. 29) 29/1Q2 (Jul, Aug, Sept. 29) February 15th, 29 April 1st, 29 29/1Q2 (Jul, Aug, Sept. 29) 29/1Q3 (Oct, Nov, Dec. 29) 29/1Q3 (Oct, Nov, Dec. 29) May 15th, 29 July 1st, 29 29/1Q3 (Oct, Nov, Dec. 29) 29/1Q4 (Jan, Feb, Mar. 21) 29/1Q4 (Jan, Feb, Mar. 21) May 8th, 29 July 1st, 29 29/1YE (April 29 to March 21) 29/1YE (Apr 29 to Dec 29) 29/1YE (April 29 to March 21) 29/1YE (April 29 to March 21) Proportion of Non admitted low acuity (CTAS IV V) patients treated within the LOS target of <= 4 hours 4 : Note 1: At Year End, Central East LHIN will be evaluated on 29/1Q4 (Jan, Feb, Mar 21) Actual Performance instead of Year End (12 months year to date) due to the Starting Point (baseline) being greater than the Provincial Target Note 2: Central East LHIN will be evaluated on 29/1 Year End Actual Performance (Apr 29 to Mar 21) due to the Starting Point (baseline) being less than the Provincial Target Note 3: LHIN Year End performance will be evaluated using fiscal year 29/1 Actual Annual Performance Value (interim data that is estimated using Q1 to Q3 data) Note 4: Quarterly information is utilized in MLAA Performance although for monthly reports for the StockTake report (via Cancer Care Ontario), there is a 4 month time lag in ER data submission i.e. ER data pertaining to February 29 is available in July 29. Note 5: Quarterly information is utilized in MLAA Performance although for monthly reports for the StockTake report (via Cancer Care Ontario), there is a 6 month time lag in ALC data submission i.e. ALC data pertaining to February 29 is available in September 29 ***Caution: Access to Care Informatics (Cancer Care Ontario) LHIN specific monthly ALC data April May 29 still not available as of Dec 29, postponed indefinitely until further notice;

4 CENTRAL EAST LOCAL HEALTH INTEGRATION NETWORK MLAA SYSTEM LEVEL STATUS REPORT 29/1 Q3 Wait Times [WT] 9th Percentile, Median Rates 2% 1% % % of ALC Days by Institution Median WT to LTC Home th Percentile WT for MRI Scan 5 9th Percentile WT for CT Scan 29/1 Q3 29/1 Q2 29/1 Q3 29/1 Q3 2% 15% 1% 5% % Trend of % of ALC Days by Institution 8/9 Q3 8/9 Q4 9/1 Q1 9/1 Q2 9/1 Q Trend of Median WT to LTC Home 8/9 Q2 8/9 Q3 8/9 Q4 9/1 Q1 9/1 Q Trend of 9th Percentile WT for MRI Scan 8/9 Q3 8/9 Q4 9/1 Q1 9/1 Q2 9/1 Q Trend of 9th Percentile WT for CT Scan 8/9 Q3 8/9 Q4 9/1 Q1 9/1 Q2 9/1 Q3 CE LHIN's major driver in the % of ALC Days continues to be wait time to be placed into a LTC Home. In accordance with the CE LHIN ALC weekly survey, 6 CE LHIN hospitals have seen improvements, including CMH, HHHS, NHH, LHC Port Perry, RVHS Centenary TSH Birchmount in 29/1Q3. Exception is RMH where there have been slight increases (3% Nov to 32.5% Dec). CE LHIN has the 2nd highest population and one of the largest senior populations. CE LHIN's bed capacity continues to remain relatively unchanged and client demand is in excess of bed availability (beds are at almost 1% capacity utilization). This impacts not only LTC Homes but other streams of care such as Rehab, CCC, Home Care, etc. Other factors that can impact wait lists for LTC Home Beds include socio demographic factors, personal choice, etc. In terms of placements, CE LHIN has the highest number of clients placed in the province (as of January 21 LTC Home System Report). The increased demand and aging machines remains a concern. Hospitals CT wait times slightly increased by 4.8% from Q2 to Q3. This is an CE LHIN are addressing this via the CE LHIN Wait Time Strategy Working achievement as 4 hospitals have growing patient waitlists above Group (WTSWG) and other related initiatives/strategies. Aging machines 5 but are able to maintain the number of days waited without are not capable of conducting more complex scans to accommodate the wait times increasing substantially. Continuing pressures such as type of scans required (e.g. breast surgery, etc.), not handle increases in scans that take longer to complete and aging machines. Hospitals demand. Due to budgetary concerns, hospitals are not able to deliver historically provided CT services above their funded volumes but as volumes that aren't funded (as done in prior fiscal years). Improvements hospitals continue to remain committed to balancing, wait times expected with addition of 1 MRI machine at each of LHC and at RMH continue to be impacted. CE LHIN has re allocated some in year (pending in 21/11). 5 CE LHIN hospitals were re allocated an additional surplus funds from other sectors, an additional 2,77 CT hours 1,288 MRI hours in 29/1 but also have increasing patient demand. allocated to 4 hospitals th Percentile WT for Hip Replacement th Percentile WT for Knee Replacement th Percentile WT for Cancer Surgery th Percentile WT for Cataract Surgery 29/1 Q3 29/1 Q3 29/1 Q3 29/1 Q Trend of 9th Percentile WT for Hip Replacement Trend of 9th Percentile WT for Knee Replacement 5 Trend of 9th Percentile WT for Cancer Surgery Trend of 9th Percentile WT for Cataract Surgery 8/9 Q3 8/9 Q4 9/1 Q1 9/1 Q2 9/1 Q3 8/9 Q3 8/9 Q4 9/1 Q1 9/1 Q2 9/1 Q3 8/9 Q3 8/9 Q4 9/1 Q1 9/1 Q2 9/1 Q3 8/9 Q3 8/9 Q4 9/1 Q1 9/1 Q2 9/1 Q3 Throughout the fiscal year to Q3, CE LHIN wait time performance for Hip Replacements has been below both the CE LHIN and Provincial Target. All hospitals have been below target wait times (exception of RVHS). For RVHS, increased wait times are due to unexpected OR closures and changes in referal patterns. There are 3 hospitals not able to deliver Hip/Knee Replacement funded volumes, RMH, LHC RVHS (due to loss of Surgeon, other staffing issues OR closures). CE LHIN transferred 15 Hips/Knees to TSH in Feb 21. Knee Replacements is consistently below both the CE LHIN Provincial Target for this fiscal year. Q3 indicates only 2 hospitals with higher wait times than the CE LHIN target, RMH LHC. RMH has been over from Q1 to Q3, due to the loss of an Ortho. Surgeon (recruited a replacement in early Nov 29). LHC has been over primarily, but due to flooding in their OR in Nov 29 and some staffing issues, its surgery volumes were impacted. RVHS has shown improvements from Q2 and are now under the CE LHIN target as of Q3. CE LHIN Hospitals have been consistently well below both the CE LHIN Provincial Target in all 3 fiscal quarters. 3 Physicians hired at RVHS. 4 Hospitals have current patients on a wait list (largest number of pactients at TSH). None of the 4 hospitals were awarded incremental one time funding and for those who did, not all the cancer surgery types were funded. Of the 2 hospitals who received one time incremental funding (LHC NHH), only NHH is able to perform more cancer surgeries if funding is available. CE LHIN performance is consistently below both CE LHIN Provincial targets with only 1 or 2 hospitals who are outliers (above CE LHIN target). For RVHS, in Q1, above both CE LHIN Provincial targets but subsequent fiscal quarters, Q2 Q3, indicate marked improvements and are now below targets. TSH has consistently been above the CE LHIN target from Q1 to Q3. They are able to perform more cataract surgeries but due to lack of funding and budgetary concerns, have closed for 6 weeks despite the highest patient wait lists in CE LHIN. 5% 4% 3% Proportion of Admitted Patients 1% 8% 6% Proportion of Non Admitted High Acuity 1% 8% 6% Proportion of Non Admitted Low Acuity CHART LEGEND [MLAA Defined] excl ER Indicators Chart 28 LHIN Starting Point: Baseline results, provision of a "starting point" to facilitate performance measurement 2% 1% % 4% 2% % 4% 2% % Chart 29 LHIN Starting Point: Baseline results, provision of a "starting point" to facilitate performance measurement 5% 4% 3% 2% 1% Dec 9 Trend of Proportion of Admitted Patients 1% 8% 6% 4% 2% Dec 9 Trend of Proportion: Non Admitted High Acuity 1% 8% 6% 4% 2% Dec 9 Trend of Proportion: Non Admitted Low Acuity Chart LHIN Actual (for ER indicators, All sites): A calculated Performance Indicator value for each fiscal period reported Chart ER LHIN Actual (only funded sites): A calculated Performance Indicator value for each fiscal period reported Chart LHIN Target: Measurable outcome determined by Ministry vis à vis LHIN specific baseline information fiscal year LHIN target values % Aug 9 Sep 9 Oct 9 Nov 9 Dec 9 Dashboard Current vs Trend Dashboard Current vs Trend Dashboard Current vs Trend As of Q2, CE LHIN hospitals have reported a relatively stable % of patients treated within target from Q1 to Q2 (less than % variance). Lakeridge's Oshawa Port Perry sites are reporting 2.6% to 4.9% increase from baseline with TSH Birchmount increasing by 1.5% in Q2. More current reports for Q3 from Cancer Care Ontario's EDRS reports indicates that 2 of the 3 sites are continuing to improve although LHC's Port Perry site has slighly decreased (less than 1%). In Q3, PRHC, RMH RVHS (both sites) have improved. Overall, CE LHIN's ER sites are still below the target ( 19.23% as of Q2)..9% from Baseline in Q2 with 1.2% in Q3.7% from Baseline in Q2 with 1.6% in Q3 % Aug 9 Sep 9 Oct 9 Nov 9 Dec 9 Q2 Wait time performance was approximately 5.28% below the CE LHIN target with NHH, RVHS (both sites), TSH (both sites) LHC (Oshawa site) showing improvements from baseline. The proportion of non admitted high acuity patients is steadily improving from a trend perspective with all hospitals reporting improvements from baseline in Q2, carried forward in Q3 with the exception of TSH(Birchmount). Q2 performance is above the LHIN starting point. 29/1Q3 Wait Time performance is slightly under the target, Q3 Actuals = 86% with Target = 89%. 1.3% improvement from baseline as of Q2 Q3 1.8% improvement from Baseline in Q2 with a 2.5% in Q3 % Aug 9 Sep 9 Oct 9 Nov 9 Dec 9 As of 29/1Q2, CE LHIN ER sites were approximately 5.8% below the LHIN target with a trend from Q2 to Q3 reporting slight improvements. Q2 performance was on par with the LHIN starting point/baseline. As of Q2, LHC (Oshawa), RVHS (Centenary) at (11.3%) RVHS(Ajax), NHH TSH (both sites) are above their baseline. As of Q3, 4 sites (except TSH's 2 sites) have continued their improved performance from baseline with CMH RMH showing improvements from baseline. RVHS continues to show above average improvements from baseline and as of Q3 = 18.8% improvement from baseline. 29/1Q3 performance is on par with the target, 85.85% Actuals for funded sites vs 86% Target for funded sites..3% improvement from Baseline in Q2 with a 2.6% in Q3 2.6% improvement from Baseline in Q2 with a 4.2% in Q3 Upper Lower Chart Corridors: An acceptable range of results determined for each indicator [Upper vs Lower] DASHBOARD LEGEND [MLAA Defined, Q1 to Q4] Doing Well, Below Corridor LHIN Starting Point ER Indicators: Meeting Target or above Target Improving In Corridor Equal or Below LHIN Starting Point.ER Indicators: Improvement from Baseline but not meeting Target Monitor In Corridor, Above LHIN Starting Point..ER Indicators: No Significant Change, <1% "+/ " Attention Above Corridor, Reporting Required. ER Indicators: Not meeting Target and not showing improvement Improving [up for ER] Getting Worse [down for ER] Data Sources: LHIN - MLAA Dashboard via Wait Time Information System and Other Sources By: PCA - CE LHIN

5 CENTRAL EAST LOCAL HEALTH INTEGRATION NETWORK MLAA SYSTEM LEVEL STATUS REPORT 29/1 Q3 Wait Times [WT] 9th Percentile, Median Rates 2% % of ALC Days by Institution 15 Median WT to LTC Home 15 9th Percentile WT for MRI Scan 9th Percentile WT for CT Scan 1% % 29/1 Q3 29/1 Q2 29/1 Q3 29/1 Q3 2% Trend of % of ALC Days by Institution 15 Trend of Median WT to LTC Home 15 Trend of 9th Percentile WT for MRI Scan 6 Trend of 9th Percentile WT for CT Scan 15% % 3 5% % 8/9 Q3 8/9 Q4 9/1 Q1 9/1 Q2 9/1 Q3 8/9 Q2 8/9 Q3 8/9 Q4 9/1 Q1 9/1 Q2 8/9 Q3 8/9 Q4 9/1 Q1 9/1 Q2 9/1 Q3 8/9 Q3 8/9 Q4 9/1 Q1 9/1 Q2 9/1 Q3 CE LHIN's major driver in the % of ALC Days continues to be wait time to be placed into a LTC Home. In accordance with the CE LHIN ALC weekly survey, 6 CE LHIN hospitals have seen improvements, including CMH, HHHS, NHH, LHC Port Perry, RVHS Centenary TSH Birchmount in 29/1Q3. Exception is RMH where there have been slight increases (3% Nov to 32.5% Dec). CE LHIN has the 2nd highest population and one of the largest senior populations. CE LHIN's bed capacity continues to remain relatively unchanged and client demand is in excess of bed availability (beds are at almost 1% capacity utilization). This impacts not only LTC Homes but other streams of care such as Rehab, CCC, Home Care, etc. Other factors that can impact wait lists for LTC Home Beds include sociodemographic factors, personal choice, etc. In terms of placements, CE LHIN has the highest number of clients placed in the province (as of January 21 LTC Home System Report). The increased demand and aging machines remains a concern. Hospitals CE LHIN are addressing this via the CE LHIN Wait Time Strategy Working Group (WTSWG) and other related initiatives/strategies. Aging machines are not capable of conducting more complex scans to accommodate the type of scans required (e.g. breast surgery, etc.), not handle increases in demand. Due to budgetary concerns, hospitals are not able to deliver volumes that aren't funded (as done in prior fiscal years). Improvements expected with addition of 1 MRI machine at each of LHC and at RMH (pending in 21/11). 5 CE LHIN hospitals were re allocated an additional 1,288 MRI hours in 29/1 but also have increasing patient demand. CT wait times slightly increased by 4.8% from Q2 to Q3. This is an achievement as 4 hospitals have growing patient waitlists above 5 but are able to maintain the number of days waited without wait times increasing substantially. Continuing pressures such as scans that take longer to complete and aging machines. Hospitals historically provided CT services above their funded volumes but as hospitals continue to remain committed to balancing, wait times continue to be impacted. CE LHIN has re allocated some in year surplus funds from other sectors, an additional 2,77 CT hours allocated to 4 hospitals. Page 5 of 7

6 CENTRAL EAST LOCAL HEALTH INTEGRATION NETWORK MLAA SYSTEM LEVEL STATUS REPORT 29/1 Q3 Wait Times [WT] 9th Percentile, Median Rates 3 9th Percentile WT for Hip Replacement 3 9th Percentile WT for Knee Replacement 6 9th Percentile WT for Cancer Surgery 2 9th Percentile WT for Cataract Surgery /1 Q3 29/1 Q3 29/1 Q3 29/1 Q3 3 2 Trend of 9th Percentile WT for Hip Replacement 3 2 Trend of 9th Percentile WT for Knee Replacement 5 Trend of 9th Percentile WT for Cancer Surgery 2 15 Trend of 9th Percentile WT for Cataract Surgery /9 Q3 8/9 Q4 9/1 Q1 9/1 Q2 9/1 Q3 8/9 Q3 8/9 Q4 9/1 Q1 9/1 Q2 9/1 Q3 8/9 Q3 8/9 Q4 9/1 Q1 9/1 Q2 9/1 Q3 8/9 Q3 8/9 Q4 9/1 Q1 9/1 Q2 9/1 Q3 Throughout the fiscal year to Q3, CE LHIN wait time performance for Hip Replacements has been below both the CE LHIN and Provincial Target. All hospitals have been below target wait times (exception of RVHS). For RVHS, increased wait times are due to unexpected OR closures and changes in referal patterns. There are 3 hospitals not able to deliver Hip/Knee Replacement funded volumes, RMH, LHC RVHS (due to loss of Surgeon, other staffing issues OR closures). CE LHIN transferred 15 Hips/Knees to TSH in Feb 21. Knee Replacements is consistently below both the CE LHIN Provincial Target for this fiscal year. Q3 indicates only 2 hospitals with higher wait times than the CE LHIN target, RMH LHC. RMH has been over from Q1 to Q3, due to the loss of an Ortho. Surgeon (recruited a replacement in early Nov 29). LHC has been over primarily, but due to flooding in their OR in Nov 29 and some staffing issues, its surgery volumes were impacted. RVHS has shown improvements from Q2 and are now under the CE LHIN target as of Q3. CE LHIN Hospitals have been consistently well below both the CE LHIN Provincial Target in all 3 fiscal quarters. 3 Physicians hired at RVHS. 4 Hospitals have current patients on a wait list (largest number of pactients at TSH). None of the 4 hospitals were awarded incremental one time funding and for those who did, not all the cancer surgery types were funded. Of the 2 hospitals who received one time incremental funding (LHC NHH), only NHH is able to perform more cancer surgeries if funding is available. CE LHIN performance is consistently below both CE LHIN Provincial targets with only 1 or 2 hospitals who are outliers (above CE LHIN target). For RVHS, in Q1, above both CE LHIN Provincial targets but subsequent fiscal quarters, Q2 Q3, indicate marked improvements and are now below targets. TSH has consistently been above the CE LHIN target from Q1 to Q3. They are able to perform more cataract surgeries but due to lack of funding and budgetary concerns, have closed for 6 weeks despite the highest patient wait lists in CE LHIN. Page 6 of 7

7 45% 4% 35% 3% % 2% 15% 1% 5% % 5% 4% 3% 2% 1% % Proportion of Admitted Patients Dec 9 Trend of Proportion of Admitted Patients Aug 9 Sep 9 Oct 9 Nov 9 Dec 9 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % CENTRAL EAST LOCAL HEALTH INTEGRATION NETWORK MLAA SYSTEM LEVEL STATUS REPORT 29/1 Q3 Wait Times [WT] 9th Percentile, Median Rates Proportion of Non Admitted High Acuity Dec 9 Trend of Proportion: Non Admitted High Acuity Aug 9 Sep 9 Oct 9 Nov 9 Dec 9 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % Proportion of Non Admitted Low Acuity Dec 9 Trend of Proportion: Non Admitted Low Acuity Aug 9 Sep 9 Oct 9 Nov 9 Dec 9 CHART LEGEND [MLAA Defined] excl ER Indicators Chart 28 LHIN Starting Point: Baseline results, provision of a "starting point" to facilitate performance measurement Chart 29 LHIN Starting Point: Baseline results, provision of a "starting point" to facilitate performance measurement Chart LHIN Actual (for ER indicators, All sites): A calculated Performance Indicator value for each fiscal period reported Chart ER LHIN Actual (only funded sites): A calculated Performance Indicator value for each fiscal period reported Chart LHIN Target: Measurable outcome determined by Ministry vis à vis LHIN specific baseline information fiscal year LHIN target values Chart Corridors: An acceptable range of results determined for each indicator [Upper vs Lower] Upper Lower Dashboard Current vs Trend Dashboard Current vs Trend Dashboard Current vs Trend As of Q2, CE LHIN hospitals have reported a relatively stable % of patients treated within target from Q1 to Q2 (less than % variance). Lakeridge's Oshawa Port Perry sites are reporting 2.6% to 4.9% increase from baseline with TSH Birchmount increasing by 1.5% in Q2. More current reports for Q3 from Cancer Care Ontario's EDRS reports indicates that 2 of the 3 sites are continuing to improve although LHC's Port Perry site has slighly decreased (less than 1%). In Q3, PRHC, RMH RVHS (both sites) have improved. Overall, CE LHIN's ER sites are still below the target ( 19.23% as of Q2)..9% from Baseline in Q2 with 1.2% in Q3.7% from Baseline in Q2 with 1.6% in Q3 Q2 Wait time performance was approximately 5.28% below the CE LHIN target with NHH, RVHS (both sites), TSH (both sites) LHC (Oshawa site) showing improvements from baseline. The proportion of non admitted high acuity patients is steadily improving from a trend perspective with all hospitals reporting improvements from baseline in Q2, carried forward in Q3 with the exception of TSH(Birchmount). Q2 performance is above the LHIN starting point. 29/1Q3 Wait Time performance is slightly under the target, Q3 Actuals = 86% with Target = 89%. 1.3% improvement from baseline as of Q2 Q3 1.8% improvement from Baseline in Q2 with a 2.5% in Q3 As of 29/1Q2, CE LHIN ER sites were approximately 5.8% below the LHIN target with a trend from Q2 to Q3 reporting slight improvements. Q2 performance was on par with the LHIN starting point/baseline. As of Q2, LHC (Oshawa), RVHS (Centenary) at (11.3%) RVHS(Ajax), NHH TSH (both sites) are above their baseline. As of Q3, 4 sites (except TSH's 2 sites) have continued their improved performance from baseline with CMH RMH showing improvements from baseline. RVHS continues to show above average improvements from baseline and as of Q3 = 18.8% improvement from baseline. 29/1Q3 performance is on par with the target, 85.85% Actuals for funded sites vs 86% Target for funded sites..3% improvement from Baseline in Q2 with a 2.6% in Q3 2.6% improvement from Baseline in Q2 with a 4.2% in Q3 DASHBOARD LEGEND [MLAA Defined, Q1 to Q4] Doing Well, Below Corridor LHIN Starting Point ER Indicators: Meeting Target or above Target Improving In Corridor Equal or Below LHIN Starting Point.ER Indicators: Improvement from Baseline but not meeting Target Monitor In Corridor, Above LHIN Starting Point..ER Indicators: No Significant Change, <1% "+/ " Attention Above Corridor, Reporting Required. ER Indicators: Not meeting Target and not showing improvement Improving [up for ER] Getting Worse [down for ER] Page 7 of 7