North Simcoe Muskoka LHIN

Transcription

1 Further NSM LHIN HEALTH SYSTEM IMPROVEMENT PROPOSAL FORM Instructions for Use: Download (save) the file to your hard-drive or network. Rename the file in the following manner: name of your organization_cfp_code. Complete all fields (cells) highlighted in yellow. You can enter text directly into the text boxes or cut and paste from other documents. Once completed, all proposals must be ed to the NSM LHIN at Section 1 - Proposal Title and Submitting Health Service Provider Information Proposal Title: Muskoka & Area Health System Transformation 1.5 (MAHST 1.5) Name of proposing organization Contact Information The District Municipality of Muskoka in respect of The Pines Long Term Care Home and on behalf of MAHST Contact Name (Lead organization) Rick Williams Contact Name Cheryl Faber Title Commissioner of Community Director, Community Services Title Services Programs & MAHST Contact Address 70 Pine Street, Bracebridge, ON 70 Pine Street, Bracebridge, ON Contact Address P1L 1N3 P1L 1N3 rick.williams@muskoka.on.ca cheryl.faber@muskoka.on.ca Telephone x334 Telephone x469 Submission Information and Accountability Statement Date Submitted: June 29, 2017 By submitting this form, I confirm that the information provided in the *note, as per approval comment below: District proposal is complete and accurate to Submitted by: Chair, John Klinck upon District Council s the best of my knowledge at the time approval will forward signed HSIP at this time. of submission. Section 2 - Type of Submission RFP CODE Undertakings The undersigned agrees that this proposal can be shared with members of an Expert Review Panel drawn from within and outside the North Simcoe Muskoka LHIN. Section 3 - Authorization to Submit Has this Proposal been approved by your organization's CEO/ED? MAHST s HSIP will be ratified through recommendation by District Council on July 17, Once approved, recommendation will be forwarded to the NSM LHIN prior to the July 24, 2017 Board meeting (informed N.Walker June 27/17) Section 4 Alignment to NSM LHIN Integrated Health Service Plan (IHSP) Signature: *note, as per approval comment below, signed final version to follow. Note: CEO/ED Approval is mandatory prior to LHIN consideration of this proposal Please describe how your proposal will impact at least one of the NSM LHIN Strategic Priorities Improve Access to Appropriate Care Muskoka and Area Health System Transformation (MAHST) 1.0 has established key design elements to guide the deliverables and recommendation for future state transformation in Muskoka and area, included under the key areas of governance and strategy and the delivery 1

2 Enhance access to timely and appropriate primary care Improve access to high quality acute and specialty care Provide health equity and enable access to appropriate and culturally safe care Build Capacity and Enhance Coordination Enable consistent and coordinated home and community care Establish infrastructure to improve care for seniors and older adults Strengthen partnerships at the community and sublhin regional levels Improve patient flow, transitions of care and coordination between providers Drive System Sustainability Advance quality, best practice and innovation across the local health care system Ensure accountability for current investments and evaluate opportunities to improve capacity of care model (Appendix A). Each of these elements, along with the implementation plan to be submitted to the LHIN on June 30 th speak to and demonstrate aligned action planning and outcomes associated with each of the North Simcoe Muskoka Local Health Integration Network s (NSM LHIN s) Integrated Health Servie Plan (IHSP) Strategic Priorities and Annual Business Plan (ABP) goals (as outlined to the left). To ensure alignment and consistency in planning with the LHIN s Strategic Priorities, the NSM LHIN appointed Larry Saunders, Board member and Neil Walker, Vice President Health System Transformation to be the LHIN s Executive Committee and General Council members / representatives. Both parties have been actively engaged and participating in the design of the Muskoka and Area Health System Transformation efforts, whereby weekly conversations have validated linkages with overarching strategic directions for this work. To this end and since inception of the project design phase (late fall 2016), the MAHST Executive Committee, General Council and four Working Groups have undertaken to align the work not only to the LHIN s IHSP and ABP, but also with the Ministry of Health s Patients First Act (2016), Ontario s Action Plan for Health Care (2015), the Local Health Integration Act (2006), the NSM LHIN s Minister Mandate Letter (May, 2017), the Care Connection Second Curve Desired Future State Model (2014). Improve Access to Appropriate Care The MAHST initiative was endorsed, approved and funded by the NSM LHIN Board commencing July The June 30, 2017 deliverables established by the LHIN are included in the final report: A recommended framework / design for health system transformation for Muskoka and area, including a set of preliminary recommendations for local health system change; A draft implementation plan to support achieving the framework / design; A draft new governance structure plan; and A progress report on tasks remaining and projected timeframe to complete project. The new MAHST Framework is aligned with the LHIN s strategic priorities as it addresses the following: Enhanced access to timely and appropriate primary care Improved access to high quality acute and specialty care Provides health equity and enables access to appropriate and culturally safe care Enables consistent and coordinated home and community care Improves patient flow, transitions of care and coordination between providers Build Capacity and Enhance Coordination Through local community commitment and a strong coalition of the willing, system-wide transformation in Muskoka and area has grown over the past four to five years through the successes and achievements of the Muskoka Community Health Link and Muskoka Community Health Hub projects. In addition future capital planning underway at Muskoka Algonquin Healthcare (MAHC), through the development of their master plan and master program, the community has identified the need for strategic partnership planning across the full continuum of care. The community recognizes the system is more than one single entity it s a whole system of programs, services and organizations working together to serve the community, now and in the future. The MAHST Community Planning model is aligned with this LHIN strategic priority as it addresses the following: Strengthens partnerships at the community and sub-regional level 2

3 4(a). Briefly describe the proposal Drive System Sustainability The MAHST Council has been appointed to oversee a grassroots process that engages health, social services and community stakeholders to help develop recommendations to ensure the region s health care system is designed to meet the needs of the people who live in Muskoka and area, and designed by those who best understand local needs. MAHST s goal is to design a quality health care system that achieves Better Care for the person, Better Health for the population, Better Experience for the providers and Better Value for the system. The vision is that by 2017 We Will have designed a model and implementation plan to transition to an improved health care system in Muskoka; and by 2018 We Will have an integrated governance structure in place. The new MAHST Governance & Sustainability Model is aligned with this LHIN strategic priority as it addresses the following: Advances quality, best practice and innovation across the local health care system and ensures accountability for current investments and evaluation of opportunities to improve capacity Section 4 - Proposal Description Funds are requested to support MAHST during the transition phase from July 1, 2017 to March 31, During this period, the transformation plan will be refined and the organizational infrastructure put in place to direct full implementation of Muskoka and area health system transformation.the Working Group members who volunteered their time and expertise to design the transformation plan are committed to continue working with MAHST during implementation but require enhanced staff support and leadership at this stage of the process. As stated above, the NSM LHIN initially endorsed and funded the Muskoka and Area Health System Transformation design work (MAHST 1.0) though the remainder of and into the first quarter of to achieve the deliverables in the funding letter (Dec. 16, 2016 and revised April 17, 2017). With June 30 th fast approaching, the MAHST Executive Committee, along with the members of the General Council and four Working Groups have prepared the submission to the LHIN along with implementation plans for the key change areas associated with governance, sustainability, programs and services and information management and technology. (Appendix B) Over the course of the last month, the Executive Committee, General Council and Working Group Leads have met and discussed the work ahead between July 1/17 and March 31/18. The focus during this timeframe for MAHST will be to: Design and make refinements to the change areas at the program and service level (e.g., establish My Health Team, coordination and integration of Mental Health and Addiction services in Muskoka across ages, populations and level of care needs, etc.) Validate and continue to engage stakeholder audiences on the proposed changes and recommendations outlined in the implementation plans in order to build on the extensive efforts and person-centred designing to date prior to the June 30 th deadline, which include various stakeholders that cross public, provider and political audiences; Implement the required recommendations in order of sequence and priority to achieve the vision of having designed a model and implementation plan to transition to an improved health care system in Muskoka and the appropriate next steps to achieve an integrated governance structure in MAHST 2.0 (e.g., policy, legislation and legal review, becoming a health service provider, process and order of incorporation, etc.). In order to transition from MAHST 1.0 to 1.5 and be successful, the MAHST Executive has committed to continuing their role until the end of March, 2018 in order to keep the current leadership in place. The required resources to support the depth and breadth of the design, refinement, validation, engagement and implementation efforts will need the continuation of LHIN support and investment. Financial commitment is a key factor for success in transition, however the LHIN s leadership in other areas is recognized as a success factor including continued leadership with the Ministry, connecting efforts in Information Management and Technology areas, programmatic efficiencies through transition of CCAC services 3

4 linked with primary care, roll out and testing of Patients First Act recommendations and continued improvements to be aligned with the Ministry and LHIN priorities outlined in the 2017/18 Mandate Letter including: Transparency and public accountability; Improve the patient experience; Build healthy communities informed by population health planning; Equity, quality improvement, consistency and outcomes-based delivery; Primary care; Hospitals and partners; Specialist care; Home and community care; Mental health and addictions; and Innovation, health technologies and digital health (see 4c for more information re: Year 1 deliverables). Through outcomes of improvement designing, Muskoka area providers with service accountability agreements with either the LHIN and/or the Ministry would proposed that operating surplus funds be committed to the MAHST 1.5 process, thus retaining and redirecting funds locally to support transition activities undertaken between July 1/17 and Mar. 31/18. 4(b). Briefly describe the following: As the MAHST design phase has unfolded and the key change areas identified, the new service delivery model of care specifically needs to meet needs of our three target populations and/or residents of Muskoka and area that access the system here. These include: 60,599 1 Muskoka Permanent residents + 8,673 2 East Parry Sound Permanent residents 84,460 3 Seasonal Residents estimated; and 3 million+ 4 Tourists that pass through Muskoka annually. The expected impact to Muskoka and area health care is to design a quality health system that achieves the quadruple aim of Better Health for the population, Better Care for the person, Better Experience for the providers and Better Value for the system. Better Health for the population: Individuals are educated equipped to better manage their own care Public Health policy and programs Mental Health services and programs Social services and community outreach Muskokans are healthier Better Care for the person: Have a Physician or a Nurse Practitioner Access on the day of your choice, including weekends and/or evenings Find your way in the system (wayfinding) Navigate the health care system Coordination of care for your complex needs Access to My Health Team Right care, in the right place at right time Better Experience for the Providers: Team mates and services at your fingertips Work as an inter-disciplinary team Smooth transitions and follow up Communicate and share information Consent provided and privacy protected Attract and retain best health care providers 1 Source: Canada Census Source: Canada Census Online Source: The District Municipality of Muskoka, 4 Stats Canada Travel Survey reported 2.7 million chose Muskoka as their travel destination in It should be noted international visitors are not captured in this survey. The Regional Tourism Organization (RTO12) which includes a broader catchment area of Muskoka, Parry Sound and Algonquin Park reports 4.3 million visitors to the area in

5 Better Value for the System: Maximize income, capital and operating Minimize spending, capital and operating Minimize waste and duplication Retain and redirect funds locally Collaborative and integrated governance with collective vision and strategy Sustainable health system for our future For example Better Care for the Person specifically, the identified change areas associated with the Programs and Services implementation plan (Person-Centred Care for Better Health) are focused on three levels of care triaging and/or entry points into the system as it relates to the complexity of need of the individual requiring care. No matter whether an individual is a permanent or seasonal resident and/or a tourist in Muskoka, wayfinding, care coordination and system navigation tools and processes, along with the appropriate level of care for each will ensure the right care is delivered in the right place, at the right time and for the right cost to the system (Better Health, Better Care, Better Experience and Better Value). 4(c). Organization Experience: Describe how your organization will leverage your existing programs and services (e.g. efficiency). Demonstrate the use of best practice evidence and standardized assessment tools. Please reference any supporting documentation, research papers and/or business cases. MAHST represents a backbone organization (in the language of Collective Impact literature) that brings together skilled leadership from across health, social and community service, and business sectors. These innovative leaders have contributed extensive personal and organizational experience and resources to the MAHST project. The NSM LHIN appointed Dr. Adalsteinn Brown as Co-Chair and Special Advisor to MAHST to steward and be provocative with best practice, evidence informed research, academic preparation, and model comparisons from around the world. The best practice research and evidence review informed the MAHST Design Elements, and the key change areas along with the corresponding recommendations. Table below outlines an overview of best practice review conducted. As well, in the MAHST Report to the LHIN due June 30, 2017, a complete appendix outlines the research conducted for this work. Ontario Primary Care Model Comparisons Costing and model comparisons Torbay, UK and Northern Ireland Integrating health and social care improving care for Mrs. Smith Systems, not Structure Sweden Improving Patient Flow Project A person s Journey Our Esther Exploring Accountable Care in Canada & Nova Scotia model Integrating financial and quality incentives Central Oregon Deschutes County Improvement Plan Collaborative Emergency Centre Experience (CEC) Due to the transformation efforts and design thinking associated with MAHST (1.0), there have been new conversations and on the ground opportunities for health system partners to collaborate, innovate and stretch mindsets to look at new ways of doing business together. Based on the dedicated efforts of the four Working Groups since January, implementation recommendations for change / improvement have been compiled. As determined at the June 8/17 Executive and Combined 5

6 Working Groups meeting focus needs to continue over the remainder of in key priorities areas aligned with the Ministry - NSM LHIN Mandate Letter (May 2017). With focused priorities, MAHST s continued transformation efforts will achieve Better Care for the People, Better Experience for the Providers and Better Value for the System leading to Better Health for our Population over time. Year 1 deliverables ( ) below were endorsed at the MAHST General Council meeting on June 22, STRATEGIC ELEMENT: LEADERSHIP AND SYSTEM ARCHITECTURE FOR TOMORROW 1.1 Improve service management by establishing a new corporation Muskoka and Area Health (MAH) with a single integrated governance model 1.5 Achieve savings to retain and re-deploy locally and ensure funds follow the individual STRATEGIC ELEMENT: PERSON-CENTRED CARE FOR BETTER HEALTH 2.1 Design and organize a system around Primary Care with expanded services to establish My Health Team 2.2 Improve access to care. Primary Care appointments will be scheduled for the individual on the day of choosing and access to Urgent Care will be available 2.3 Improved Efficiency, Reduce Waste. There will be standardized navigation forms and systems in place. There will be less duplication and improved access to programs and services 2.4 Supports and processes in place to enable improved system navigation for individuals needing care 2.5 Ensure coordinated and better integrated Mental Health and Addiction Services in Muskoka and area for all ages, populations and required level of care 2.6 Future Acute Care redevelopment - Work with MAHC to incorporate outcomes of new system design into future acute care re-development planning STRATEGIC ELEMENT: INFORMATION MANAGEMENT AND TECHNOLOGY FOR A BETTER SYSTEM 3.1 Establish an Information Management and Technology (IM&T) Strategy for MAH STRATEGIC ELEMENT: COMMUNICATION AND ENGAGEMENT FOR COMMUNITY PARTNERSHIP 4.1 Establish and execute a Communication and Engagement Strategy to support transitional implementation of transformation plan and ongoing system design and refinement 4(d). Stakeholder Consultation:Briefly describe stakeholder consultation in preparation for this proposal. MAHST has been a collaborative and collective effort at the community level. With having an Executive Committee of 10 members, a General Council of 12 additional members and four Working Groups of between 5 12 members each, the number of engaged individuals, providers and community members is vast. Weekly meetings encompass between members, with monthly sessions hosting between commitment individuals. Between April and June 2017, MAHST and its Stakeholder Relations Working Group committed to extensive stakeholder engagement and relationship management. This time was used to validate and garner input and/or feedback on the proposed model and the key change areas. Over 600 individuals have been part of the discussion to date and conversations continue. Targeted workshops to Board Governors, Physicians and Nurse Practitioners, and front line health care providers (through an experience based design session) as well as various presentations and conversations were held with community groups / organizations, municipalities and individuals with lived experience. The MAHST June 30 th report to the NSM LHIN provides a fulsome stakeholder engagement progress report and the input from these sessions were folded into the development of the final report. See Appendix C as the MAHST Communications and Engagement plan the Stakeholder Relations group used to guide their work. 4(e). Partnerships: How will your organization work in partnership with other stakeholders to provide service (for example, hospital, home and community care, primary care, mental health/addictions)? As outlined in the MAHST Framework (Appendix B), the types of agencies / organizations that will be brought into the design and establishment of My Health Team (multi-disciplinary team) are listed there. This will be inclusive of the programs and services that an individual will require to meet their holistic needs, including primary health and social care. 6

7 The stakeholders actively participating in the MAHST work to date include: Algonquin Family Health Team CMHA Muskoka Parry Sound Cottage Country Family Health Team The District Municipality of Muskoka Community Services, Long-Term Care and Paramedic Services Medical Doctors (7); Nurse Practitioners (2); Surgeon (1) Midwives of Muskoka Muskoka Algonquin Healthcare North Muskoka Nurse Practitioner Led Clinic 6 Area Municipalities in Muskoka Bracebridge, Gravenhurst, Georgian Bay, Huntsville, Lake of Bays, and Muskoka Lakes Simcoe Muskoka District Health Unit The Friends Many others through the stakeholder engagement sessions, including LHIN funded agencies and others funded through other Ministries (e.g. Community and Social Services) and/or the Ministry of Health and Long-Term Care. 4(f). Please describe staff expertise and capacity to deliver the required nature and level of services associated with this initiative; for example clinical knowledge of target population, past experience with subject matter. As outlined, MAHST is a collaborative partnership of key community leaders and agencies / organizations from across Muskoka and area with the required expertise from across many sectors and experiences of the individuals involved. The Chair and Co-Chair / Special Advisor have been also chosen based on their capabilities and expertise related to system transformation, change management and community grass roots development. MAHST has the strength of senior team members and functional supports from The District Municipality of Muskoka who have had numerous opportunities to lead and manage complex projects of this nature, including Health Links, Economic Development, Ontario Works, Social Housing, Long-Term Care and Paramedic Services. The District has the infrastructure and resources to augment the administrative management of the financials, human resources, IT and infrastructure required for this project. MAHST, through funding to support the project has established a Project Management office with a Director, Communication and Community Engagement Lead, and two Project Coordinators. Consulting expertise has been acquired for project documentation and health information analytics. Moving forward into MAHST 1.5, the budget outlines the evolving expertise and resources that will be needed to venture into implementation with a much more hands on change / transformation effort by way of actioning the recommendations outlined above for year 1. 4(g). Please describe the outcome metrics and formal processes to support evaluation of the program and continuous quality improvement. As outlined in the recommendations, establishing and developing a Muskoka and Area Health System Performance Monitoring and Management framework will be undertaken. This will align with the quadruple aim, the LHIN sub-region performance metrics and any standard Health Quality Ontario Measurements. This framework will also reflect key principles identified by the Executive Committee during their review of leading research in the field. The evaluation of the process outcomes to achieve year 1 deliverables will be extremely important to monitor and measure success indicative for implementation over the next four years. For example, as My Health Team is established, evaluation will be conducted on the process and also the outcomes in which My Health Team achieves as it relates to the quadruple aim better health, better care, better experience and better value. Once this evaluation is underway and commencing to capture results, this will then inform the design and capacity required within the rest of the health system (e.g. acute care, specialty care, regional program access, etc.). 7

8 4(h). Alignment with Diversity and Equity: Describe how this proposal addresses the needs of underserved populations and underserved areas, addressing diversity and equity issues such as: Within Muskoka, there is a diverse permanent population that is aging faster than the rest of the province, has a growing number of people living in poverty and an increasing number of individuals living with a disability. As well, there are two First Nation Communities in Muskoka that serve individuals living both on reserve and off reserve whom access both traditional practices and mainstream services Moose Deer Point with approximately 200 residents and Wahta Mohawk First Nation with 175 residents 5. Compounded with the diversity of the permanent population, approximately 85,000 seasonal residents add to the complexity and diversity, which bears pressure on equitable and accessible service here. Through the involvement of The District Municipality of Muskoka Community Services and the Simcoe Muskoka Public Health Unit, strong linkages are being made among social service, public health and the broader health system. Creating a person-centred model enables a holistic approach to care for residents of Muakoka and area - including those currently unattached to a primary care provider. Conversations continue between members of MAHST and both Chiefs from Moose Deer Point and Wahta Mohawk First Nation communities regarding the recommendations of MAHST and to garner their participation involvement in MAHST 1.5. The NSM LHIN has also been in discussion with both First Nations and has encouraged their participation in the MAHST design and implementation process. Health Equity is on the radar for many organizations within Muskoka and as transformation commences with the establishment of My Health Team(s), this will be a major consideration in the design and structure of health team(s). 4(i). Please complete the chart below outlining annualized targets. Functional Centre Benchmark Average Unit Cost (eg. provincial, sub-sector, NSM LHIN) Proposed Unit Cost* Client Activity (Indicator) e.g.: # of visits Example: 7* COM - Crisis Intervention - Mental Health Provincial & Regional Health System Development Provincial cost per unit of service is $45.95/visit Methodology: Describe formula per indicator e.g.: 1 unit = 1 resident day # of visits 1 unit = 1 visit Annual Budgeted Units of Service e.g.: 500 N/A N/A N/A N/A N/A N/A *If the proposed unit cost is higher than the benchmark unit cost, please provide rationale: Not Applicable Section 5 - Staffing Model Type of Staff (e.g. RN, NP, OT, SW) Number of Staff Members FTEs) Recruitment Plan Annual Individuals Served per Functional Centre e.g.: 600 Project Director 1.0 FTE Already in place with potential for extension to meet timelines. Project Coordinator 1.0 FTE Recruitment underway currently. Project Stream Lead / Facilitator 4 x 1.0 FTEs Recruitment will progress upon LHINs approval of the HSIP (Summer 2017) Other Contracted Resources Required for Project Various Expert resources and/or services are leveraged as needed throughout the project (e.g., decision support / performance management; evaluation; clinical lead; privacy information advisor; legal advisor; incorporation advisor, etc.) 5 Website sources: i) and ii) 8

9 Section 6- Performance: Identify measurable performance indicators and specific targets expected. Design Phase Annual Target (by June 30/17) A recommended framework / design for health system transformation for Muskoka and area including a set of preliminary recommendations for local health system change A draft implementation plan to support achieving the framework / design A draft new governance structure plan A progress report on tasks remaining and projected timeframe to complete project Report with recommendations to the NSM LHIN (Q1 Target by June 30/17) Implementation Phase Annual Target (by Mar. 31/18) Deliverables for the Implementation Phase will be set following the NSM LHIN Board s endorsement of the final report and preliminary recommendations, included as priority are the Year 1 Deliverables (as outlined above). Section 7 - Financial Details: Please provide best estimates of all costs anticipated for your proposal Financial Options Project Secretariat / Resources / Consulting Expertise Non- Compensation (Please Specify) Provide details below Insert dollar values only Current Year-8 mths Aug 17 to Mar 18 Annual (12 months) 1.0 FTE Project Director (total burden) $96,680 $145, FTE Project Stream Leads / Facilitators* (total burden contract) $281,440 $422, FTE Project Coordinator (total burden contract) $46,800 $70, FTE Clinical Project Lead** $33,333 $50,000 Evaluation Specialist Consulting Services $52,000 $78,000 Decision Support / Performance Mgmt Consulting Services $42,400 $63,400 Privacy Information Framework Consulting Services $20,000 $30,000 Legal Review and Incorporation Advisor Consulting Services $33,000 $49,500 Chair & Co-Chair (2 roles per diem) $62,400 $93,600 Travel / Meals / Hotels (Project Secretariat + Chair + Co- Chair) $13,800 $20,700 Teleconferencing $1,200 $1,800 Program Supplies (Cell, Computer, Licenses, Meeting supplies ) $37,496 $56,244 Advertising (marketing, product development, communications) $11,200 $16,800 Office Equipment (supplies, equipment) $5,800 $8,700 Program Services other (transportation, administration fee) $63,360 $95,040 Rent External (space and improvements) $14,600 $21,900 Total $815, $1,223, Funding support opportunities a) NSM LHIN One-Time Funding to Support MAHST; b) MOHLTC Funding to Support (advocated via NSM LHIN); c) Provider Operating Surplus Redeployment (LHIN and/or Ministry funded providers) 9

10 Notes * Each will lead a priority work area to be undertaken in Year 1 aligned with the implementation plan, including: 1) Leadership and System Architecture for Tomorrow; 2) Person-Centred Care for Better Tomorrow; 3) Information Management and Technology for a Better System; and 4) Communication and Engagement for Community Partnerships. ** Currently clinical leaders and community individuals have extensively volunteered of their time, leading to the success of MAHST 1.0. Throughout MAHST 1.5 and into 2.0, the time associated with this required leadership may need to be addressed (e.g. through sessional fees, honorariums, etc.). Section 8 Major Milestones: list and describe major milestones for the development, implementation and evaluation of this proposal. *for detail implementation plan (Appendix 1) in MAHST Report (June 30/17) Milestone Leadership and Architecture for Tomorrow Improve service management by establishing a new corporation Muskoka and Area Health (MAH) with a single integrated governance model Achieve savings to retain and redeploy savings locally and ensure funds follow the individual crossing LHIN and agency service boundaries as necessary Description Establish and incorporate Muskoka and Area Health (MAH) to provide a Service Management, Service Delivery and Coordination role (e.g., conduct a legal review, articles of incorporation, etc.) Transition Plans negotiated and approved through NSM LHIN and MOHLTC to become a new Health Service Provider, as a new corporation Current Health Service Provider corporations remain in place unless voluntary realignment and/or integration occur and aligned with MAHST (e.g., FHT, LTC, ) Create a mechanism and/or funding model to retain and re-deploy savings locally and ensure funds follow the patients (savings redeployed to underserved programs and service areas, funding models improved) Establish within the new Muskoka and area funding model the key priority areas with an associated impact timeframe for improvements and savings over short, medium, and longer term, including: better management of high user of the health system (top 1 to 5%), population health improvements with Public Health, acute care consolidation, increased revenues by attracting demand for local service, repatriation of care, and new revenue sources Target Start Date Expected Date of Completion July 1/17 Mar 31/18 July 1/17 Over course of next 4 years of the plan - after Mar. 31/18 10

11 Person-Centred Care for Better Health Information Management and Technology for a Better System Communication and Engagement for Community Partnerships Design and organize a system around Primary Care with expanded services to establish My Health Team Improve Access to Care. Primary Care appointments will be scheduled for the individual on the day of choosing and access to urgent care will be available Improve Efficiency, Reduce Waste. There will be standardized navigation forms and systems in place/there will be less duplication and improved access to programs and services Supports and processes in place to enable improved system navigation for individuals needing care Ensure coordinated and better integrated Mental Health & Addictions Services in Muskoka for all ages, populations and required level of care Future acute care redevelopment work with MAHC to incorporate outcomes of new system design into future acute care redevelopment planning Develop an overarching Information Management and Technology Strategy aligned with the implementation of the recommendations for Muskoka and Area Health, including governance, sustainability, and the person-centred care model transformation Establish and execute a Communication and Engagement Strategy to support transitional implementation of transformation plan and ongoing system design and refinement July 1/18 End dates vary on the initiatives associate with each deliverable spanning across 5 years (Mar. 31/22) July 1/17 Mar 31/18 July 1/17 Mar. 31/18 Section 9 - Risk and Risk Mitigation: The following section is designed to identify high-level risk considerations and risk mitigation strategies for your proposal Describe Major Risks and Mitigation Strategies to implementation. Consider political, patient, funding, program/service and/or media risks. Risk Loss of momentum and commitment of partners to continue with a long undue break in time due to review, endorsement process and approvals (both report and financial request). Likewise, failure to provide necessary staff to support ongoing efforts of the volunteer working groups threatens continuity and capacity to continue. Loss of confidence and feeling of security of the public with the required and validated Risk Level (High, Medium, Low) High High Mitigation Strategy Communication direct to MAHST Executive Committee, General Council and Working Group members following LHIN Board meeting (July 24/17) Follow up directly on media requests based on public launch of MAHST Report on July 4/17 to continue to educate and build awareness of next steps / recommendations. Hold information meeting with new LHIN Board Chair, LHIN staff and MAHST Chair, Co-Chair and Director to raise awareness in preparation for LHIN Board meeting (July 2017). Continued MAHST Chair, Co-Chair, Director and NSM LHIN leadership over summer maintaining stakeholder relationships per engagements and presentations scheduled. Communication and engagement planning and strategies need to continue, along with: o Project updates to distribution list Post-Mitigation Risk Level (High, Medium, Low) High (*as certain amount of this is out of MAHST control until LHIN Board endorses report and approves funding and enables MAHST to continue) High (*as certain amount of this is out of MAHST 11

12 transformation changes to the Muskoka & Area Health System based on the intensity and level of stakeholder engagement conducted over last 3 6 months. Lack of timely commitment to Muskoka Algonquin Healthcare s current operating pressures and ongoing capital planning now that this work is anchored by the MAHST endorsement and recommendations. If MAHST approval process held up, could have a negative impact to MAHC, as well as the public and political confidence in the transformation changes required. Lack of action and achievements on Year 1 MAHST deliverables before the writ is dropped and provincial legislature is prorogued end of April / first of May for a June 7/18 election. High High o o o o Stakeholder presentations (locally and provincially) Media inquiries and follow up Press release July 4/17 to publically launch the report and recommendations Etc. MAHC continue to meet with NSM LHIN and Ministry to mitigate current operating pressures and utilize MAHST framework and vision to help enable solutions. MAHC work with MAHST to plan together on the strategies required based on the implementation of My Health Team and the evaluation of these changes to inform the capital planning process. Relates to the three above risks identified. Should MAHST and its partners not receive NSM LHIN Board Endorsement to continue / proceed with Year 1 deliverables, as well as the funding required to enact the recommendations in the MOHLTC NSM LHIN Mandate letter, the window of opportunity closes as May 1, 2018 approaches. control until LHIN Board endorses report, approves funding and enables MAHST to continue) High (*as certain amount of this is out of MAHST control until LHIN Board endorses report, approves funding and enables MAHST to continue) Section 10 In some cases, additional approvals may be required to be eligible for funding (i.e. a new functional centre, major capital purchases, etc.). Please check the list below to identify if any of the following are related to the proposal being submitted. *all expenditures outlined in budget for MAHST 1.5 Approvals Yes New service (i.e. new functional centre) Major capital purchases Renovations Office Relocation Other No No No No No High 12