1 Mission: To lead a high-quality, integrated health system for our residents Vision: Better Health Better Futures Core Value: We value acting in the best interest of our residents health and wellbeing Meeting Date: February 25, 2016 Action: Topic: Information Item 14.0 - Health System Annual Business Plan Progress and Risk Review Update PURPOSE To provide the Board with an update on the 2015-2016 Annual Business Plan (ABP) highlighting risks, milestones, and current/forecasted year end system dashboard performance and the interventions needed to turn the system dashboards from red to green. BACKGROUND INFORMATION Waterloo Wellington Local Health Integration Network (WWLHIN) governors and staff are working closely with Health Service Provider governors and leaders to achieve our commitments to residents as outlined in the 2015-2016 Annual Business Plan (ABP). We monitor the achievement of system change initiatives and key metrics using a dashboard reported publically on our web site. The current system dashboard is in Appendix A. Below is a summary of milestones and risks in the achievement of the Annual Business Plan. Our Priority: Enhancing Access to Primary Care MILESTONES: All 9 initiatives within this priority area are on track and/or complete. Milestone highlights: Chronic Disease Prevention Management (CDPM) WWLHIN is ranked 1 st amongst LHINs for the lowest overall hospital readmission rates for chronic conditions. This result is primarily driven by low readmissions rates at St. Mary s General Hospital, Cambridge Memorial Hospital and Groves Memorial Hospital. St. Mary s hospital has implemented the Integrated Comprehensive Care (ICC) model where the patient stays connected to their hospital team for 60 days after discharge. This model has demonstrated improvement in patient experience. A WWLHIN CDPM planning document has been developed to help inform improvements within the Sub-LHIN planning areas. This document includes a current state assessment of CDPM and leading practices that health service providers can consider. Primary care physicians were involved in the design and review of this report. This report will released on the WWLHIN website as a resource. 1
Syrian Refugee update To date, approximately 500 refugees have arrived in the WWLHIN, with 1,250 arriving by the end of March /April 2016. Local physician leaders and organizations have quickly come together to welcome, assess need and provide required services. Of particular note, the health needs of refugees are being determined through a central assessment process, connections being quickly made to required services with more permanent connections to primary care then being established. The feedback from refugees is that not interpretor and translation services are not readily available or consistently used by Health Service Providers. System Coordinated Access using Innovative Procurement to build an online referral prototype A multi-lhin tender (8 LHINs, with WWLHIN as lead) was released in mid-december 2015 to develop an online referral prototype so referral to key health services are managed efficiently. The responses will be review in the spring, with the prototype design and build commencing in the summer. Care providers need a better way and need tools beyond their current paper and fax approaches; electronic referral will ensure residents can get timely care. Telehealthcare strategy A WWLHIN Telehealthcare plan was developed as a planning resource for sub-lhin planning areas. This document provides an environmental scan on enabling technologies, current state of telemedince by sector and leading practices for telemedince and telehomecare. By the end of March 2016, approximately 18 Long Term Care homes will be enabled with telemedicine, with the remaining homes being equipped by September. This technology will allow homes to access key specialist care (e.g. geriatrician care, palliative care, pain and symptom management) to avoid unnecessary emergency department visits or hospitalizations. PERFORMANCE FACTORS* 1 There are no performance factors specific to Enhancing Access to Primary Care. DASHBOARD METRIC RISKS: High needs residents will have individual coordinated care plans developed through a Health Link in Waterloo Wellington Cambridge North Dumfries Health Links are now on target for their coordinated care plans. Guelph Health Links have fallen behind their set target. Actions taken: Guelph Health Links is providing the WWLHIN with their plan to achieve year-end targets. Each Health Link is exploring how to ensure that coordinated care plans are created for all people in the health system who have complex care needs. This will require the support of all health service providers who care for those who have complex care needs. On February 1 st 2016, over 300 Health services providers came together to learn how their organization can help to create and share coordinated care plans in support 1 *PERFORMANCE FACTOR definition: any matter that significantly affects a party s ability to fulfill its obligations under this Agreement. Performance Improvement Plan (PIP) to address performance factor. 2
of individuals with complex care needs. KW4 Health Link has recently engaged over 250 primary care providers requesting their help to created coordinated care plans for their patients with complex care needs. A provincial system for secure on-line sharing of care plans is also being piloted in Guelph and Rural Wellington. Projected Year End Forecast: Green. Further Intervention needed? No. Residents will experience a decreased rate of hospital readmissions for chronic conditions Grand River Hospital, Guelph General Hospital and North Wellington Health Care (NWHC) are not meeting target. As mentioned above, St. Mary s, Cambridge Memorial Hospital and Groves Memorial Hospital have a lower number of hospital readmissions for chronic conditions. As a result the overall results is achieving target. Actions taken: Guelph General Hospital (GGH), the Guelph Family Health Team, CCAC and other system providers in Guelph have established a sub-lhin leadership table and plan to significantly reduce readmissions rates for 2 key chronic conditions COPD and CHF. NWHC is submitting a root cause analysis and performance improvement plan by mid-february to achieve target by mid-february. GRH will provide their performance improvement plan by March to achieve target. Projected Year End Forecast: Green. Further Intervention needed? No. Our Priority: Creating a More Seamless and Coordinated Health Care Experience MILESTONES: WWLHIN Hospital CEO s have directed the integrated clinical councils to focus attention on achieving targets for ALC, surgical wait times and diagnostics procedures and the achievement of the Quality Based Procedures. This direction was supported by the WWLHIN hospital Board Chairs and Vice chairs at the February 10 th meeting. PERFORMANCE FACTORS* 2 Waterloo Wellington CCAC: The CCAC has self-disclosed a performance factor related to a projected deficit. The WWCCAC has submitted a performance improvement plan which is being monitored through monthly meetings between the WWLHIN and the WWCCAC. WWCCAC continues to service more people with increasing complexity in the community. The WWLHIN 2 *PERFORMANCE FACTOR definition: any matter that significantly affects a party s ability to fulfill its obligations under this Agreement. Performance Improvement Plan (PIP) to address performance factor. 3
continues to work with the CCAC to find innovative ways to address this risk while remaining committed to continue to strengthen home and community services. North Wellington Health Care/Groves Memorial Community Hospitals: The hospitals were issued a performance factor early 2015. See agenda item #15 Groves Memorial Community Hospital/North Wellington Health Care - New Alliance Agreement. The performance factor will be reassessed after the implementation of the New Alliance Agreement implementation April 1 st 2016. Canadian Mental Health Association Waterloo Wellington Dufferin - Here 24/7. Contract amended with new service volumes, with monthly monitoring of spending forecasts has been completed. We continue to monitor the financial position on a monthly basis. DASHBOARD METRIC RISKS: 5 day wait time for personal support services CCAC is not currently achieving this target. Actions taken: WWLHIN continues to work with MOHLTC to account for patient preference within this metric. CCAC is also cleaning up their data and expect to achieve target by 4 th quarter. Projected Year End Forecast: Green with data error corrected. Further Intervention needed? No Percentage of days residents spend in acute care hospital beds when they should be receiving their care in a more appropriate location (ALC) All hospitals are not meeting this target. Actions taken: Extensive root cause analysis was completed by the WWLHIN and CCAC staff. 4 areas of focus were identified that need to be addressed: inconsistent designation practices by physicians; inefficient and variable discharge work across hospital and CCAC teams; increased refusals from Long Term Care due to responsive behaviors and high intensity needs patients; and lack of safe stable housing and supports for patients waiting for housing and those with Mental Health and Addictions needs. Hospital and community service leaders have instructed integrated clinical councils to focus on their attention on how they can help to turn the ALC metric green. Councils are creating plans to accomplish this task. Hospital governors are also engaged and overseeing turning this metric green. Projected Year End Forecast: Red Further Intervention needed? No. 4
Our Priority: Leading a Quality Healthcare System Using Evidence-based Practice MILESTONES: The Hospital/Home and Community Care CEO Network reviewed the progress of the Integrated Clinical Council for 2015/16. As a result of this review the CEO network agreed to provide concrete direction and focus for the council. For 2016/17 they directed the councils to focus on turning system dashboards green - specifically the five metrics that are currently red - ALC, Hip Replacements, Knee Replacements, MRI Scans, Cataract Surgeries. They also provided direction for the councils to achieve set Quality Based Procedures (QBPs). This direction was also supported by the WWLHIN hospital Board Chairs and Vice chairs meeting February 10 th. Integrated Clinical Councils are creating plans with these outcomes in mind. PERFORMANCE FACTORS* 3 Grand River Hospital and Guelph General Hospital Hip/Knee Replacement Surgical Wait Times The hospitals are not meeting wait time targets and have submitted Performance Improvement Plans (PIP) to the WWLHIN. The hospitals, along with the Surgical Integrated clinical council (February 2016) has turned its attention to understand the root cause for the below target results. Strategies to achieve target: o WWLHIN is reallocating Quality Based Procedure (QBP) volumes both within and between hospitals in Q4 2015/16 in order to increase surgical service delivery to address wait time pressures. o GRH completed additional unfunded volumes and enhanced coding practices to improve performance o GGH completed a waitlist management review to improve knee replacement wait times in Q3. o The integrated clinical council will focus on implementing a central referral intake and assessment process and the adoption of an orthopedic pre-surgical clinic with greater involvement of physiotherapists pre surgery. This proposed model could lead to improved wait times and reduced demand for knee and shoulder MRI scans. Cambridge Memorial Hospital, Guelph General Hospital and St. Mary s General Hospital Cataract Wait Times The hospitals are not meeting wait time targets and have submitted Performance Improvement Plans (PIP) to the WWLHIN by March 2016. The hospitals, along with the Surgical Integrated clinical council (February 2016), have turned its attention to understand the root cause for the below target results and address the issues. 3 *PERFORMANCE FACTOR definition: any matter that significantly affects a party s ability to fulfill its obligations under this Agreement. Performance Improvement Plan (PIP) to address performance factor. 5
Strategies to achieve target: o WWLHIN is reallocating Quality Based Procedure (QBP) volumes both within and between hospitals in Q4 2015/16 in order to increase surgical service delivery to address wait time pressures. These efforts will allow for additional cataract procedures to be completed across Waterloo Wellington in Q4. Grand River Hospital MRI Wait times Grand River Hospital, Guelph General Hospital and Cambridge hospital are not meeting wait time targets. A MRI performance factor was issued for Grand River on August 2014 for declining performance and GRH has submitted a PIP which staff are monitoring. WWLHIN hospitals has the highest MRI efficiency (highest number of scans per hour, best room turnover time) and greatest demand (growth since 2009 and current demand per hour) in Ontario. In the Guelph sub-lhin area, GGH completes approximately 4,000 MRI scans (or about 25% of GGH s MRI funding) each year servicing out-of-lhin residents, mostly coming from the Central West and Mississauga Halton LHINs. Strategies to achieve target o GRH identified a data issue and is working with Access to Care, Cancer Care Ontario to resolve the issue and to re-submit data. Hospital and system-level results for Q3 have been negatively impacted by this issue. o Focus at Diagnostic Imaging Council in February 2016 to understand root cause analysis and develop system action plan by March 2016, with an emphasis on implementing central referral intake. The re-allocation of Wait Time Strategy (WTS) funding both within and between hospitals will lead to additional MRI hours being completed in Q4. Allocation of 2016/17 WTS funding on a population- and referral-based model will improve equity in the allocation of MRI hours across the sub-lhin areas. o WWLHIN submitted briefing note to Ministry requesting targets to be reviewed and additional MRI funding. o WWLHIN staff are meeting with KMH Labs, the Independent Health Facility with an MRI scanner located in Kitchener, in March 2016 to discuss opportunities to improve MRI access for our residents. Grand River Hospital and St. Mary s General Hospital CT Wait Times The hospitals are not meeting wait time targets and WWLHIN have requested performance improvement plans. Strategies to achieve target o GRH continues working internally on resolving data submission errors and working with Access to Care, Cancer Care Ontario to re-submit Q3 data. o GRH has performed unfunded CT hours in 2015/16 in order to address wait time pressures. o The re-allocation of WTS funding both within and between hospitals will lead to additional CT hours being completed in Q4. 6
o o o Allocation of 2016/17 WTS funding on a population- and referral-based model will improve equity in the allocation of CT hours across the sub-lhin areas. SMGH experienced interruptions to CT service in Q3 due to equipment malfunction and renovations required for the installation of a new CT scanner which is to be operational in February. Re-allocation scenarios within existing funding have been explored. St. Joseph s Health Centre Guelph Aphasia Day Program was not meeting attendance day targets. The program is now on track with expected volume improvements through to fiscal year end. DASHBOARD METRIC RISKS: Timely access to non-emergency Cataract surgery (See performance factor above) Projected Year End Forecast: Red Further Intervention needed? Yes. Surgical council will create plan to get to green. Senior hospital staff and medical leadership involved. Hospital governors engaged Timely access to non-emergency Hip and Knee replacement surgery (See performance factors above). Projected Year End Forecast: Red Further Intervention needed? Yes. Surigcal council will create plan to get to green. Senior hospital staff and medical leadership involved. Hospital governors engaged Timely access to non-emergency MRIs: (see Performance Factors above). Projected Year End Forecast: Red Further Intervention needed? No. Timely access to non-emergency CT (see Performance Factors above). Projected Year End Forecast: Yellow Further Intervention needed? Yes. PIP submissions from GRH and SMGH are required. MILESTONES: Seasonal Surge Additional hospital resources were added during the December holiday season (physicians, nurses, beds, and discharge staff) to ensure improved hospital flow and fewer backlogs in the emergency department. This resulted in improved patient flow when compared to last year. Hospital ED visits and admissions are half the rate of last year and it is expected that rates are continuing to decline. Hospitals and Long Term Care homes are working together to create a 7 day a week acceptance policy. Quality Improvement Day WWLHIN/ Health Quality Ontario Over 300 system leaders gathered in their sub-lhin areas on February 1, 2016 to learn about the Patient First Action plan and to learn more from Health Quality Ontario to advance integrated quality 7
improvement plans. Participants reviewed population health information and performance within their sub-lhin area and identified key areas of collective focus. Some sub-lhin areas had already identified their focus areas e.g. Guelph and Wellington Mental health and addiction. Other areas began to explore common areas of of focus. Participants were asked to bring with them their quality improvement plans. Participants reviewed common aresa of focus. Leaders also identified how their organization can better support the development of coordinated care plans for residents who have complex care needs. A summary report is being developed that will be shared with each sub-lhin area leader to assist in their planning. The spring governance sessions will build off of the outcomes from February 1, 2016. INITIATIVES AT RISK: Accelerate best practice through the system-wide adoption of electronic clinical order sets for Quality Based Procedures The use of electronic order sets by care teams will help reduce variability, help ensure standardized best practice care based on evidence and will help contain costs. Delays were encountered completing due diligence for patient privacy, technical elements and clinical change management. Cataracts went live February 2016. WWLHIN seeks to progress to Stage 5 of the QBP adoption scale in 2016-17, with a focus on CHF, COPD and Stroke care in the community. This is a focus for each integrated clinical council. NEXT STEPS The WWLHIN will continue to monitor, manage and address areas of risk as well as celebrate the successes in our system. RECOMMENDATION N/A. 8
Appendix A WWLHIN System Dashboard February 16, 2016 9 8
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