140 Allstate Parkway Suite 210 Markham, ON L3R 5Y8 Tel: 905-948-1872 Fax: 905-948-8011 Toll Free: 1-866-392-5446 http://www.lhins.on.ca 140, Allstate Parkway bureau 210 Markham, ON L3R 5Y8 Tél: 905-948-1872 Téléc: 905-948-8011 Sans frais: 1-866-392-5446 http://ww.lhins.on.ca October 31, 2006 Mr. Hugh MacLeod Associate Deputy Minister Health System Accountability and Performance Division Hepburn Block 10th Flr 80 Grosvenor St Toronto, ON M7A 1R3 Dear Mr. MacLeod: RE: 2006/2007 Accountability Agreement Quarter 2 Report on Integrated Health Service Plan As required by our 2006/2007 Accountability Agreement, we submit herein the Central LHIN second quarter submission. As you know this submission includes a copy of our Integrated Health Service Plan (IHSP), a document that we believe clearly sets the stage for development of our three-year Annual Plan. As you will see, our work on developing the IHSP has resulted in many provider forums that are actively working to improve wait times and advance other priority initiatives of the Ministry. In addition, we have provided the Central LHIN interim update on governance, a Q2 financial forecast and our first quarterly performance progress report. Should your staff require any clarifications please have them contact Hy Eliasoph, Chief Executive Officer at 905-948-1872 x 210. Yours truly, Ken Morrison Chairman of the Board of Directors /at c: Hy Eliasoph, CEO, Central LHIN Tracey Mill, Director, LHIN Legislation Project, Ministry of Health and Long-Term Care (Attach.)
Accountability Agreement (Schedule C): LHIN Quarterly Progress Report Template (2006-2007 Accountability Agreement Interim Report on Governance, Schedule C) LHIN: CENTRAL Progress Reporting Period: Q2-06/07 Submission Date: October 31, 2006
LHIN Accountability Agreement Q2 Report Schedule C Interim Report on Governance Establish and maintain a governance model for the Board, including structures, processes, and committees, as appropriate and/or as directed by regulation Actions to Date Governance model being developed by the Board. Board Chair and Vice Chair have been appointed. Board meetings are held monthly. Minutes are recorded and copies are forwarded to the Ministry. Under the Local Health System Integration Act, 2006, LHINs are required to establish three committees: Community Nomination Committee, Audit Committee and Health Professionals Advisory Committee. The final Ontario Regulation 417/06 which outlines requirements to establish Audit Committee and Community Nominations Committee was published in The Ontario Gazette on September 26, 2006. Nominating Committee: Consistent with the Ministry s instructions for recruiting community-based Board members, a Nominations Committee was established in September 2005. A comprehensive nominations process was carried out. Three public information sessions were held. The Nominations Committee reviewed approximately 80 applications of which 14 candidates were interviewed. Selected candidates were recommended to the Minister. The Nominations Committee was disbanded when the recruitment process was completed. Audit Committee: An Audit Committee was established in March 2006 Terms of Reference were developed and approved on September 26, 2006 for recommendation to the Board. Public consultations were completed in September 2006 and the final regulation was published. Terms of Reference will be updated to reflect the Regulation 417/06 LHIN: CENTRAL Page 2
Establish and maintain a governance model for the Board, including structures, processes, and committees, as appropriate and/or as directed by regulation Health Professionals Advisory Committee: Public consultations were completed by September 29, 2006 The Central LHIN CEO is developing a process composition and terms of reference for recommendation to the Central LHIN Board. Public Board Meetings: Procedural Guidelines for Meetings of the Board of Directors have been developed for the LHINs. Processes have been developed for Open/Public Board meetings. The first Central LHIN Public Meeting was held October 24, 2006 Committees of the Board will also conduct open meetings. Central LHIN will establish a new Community Nominating Committee and Terms of Reference will be developed. Processes for Public Board Meetings will be reviewed and amended as necessary Collaborate with other local health integration networks to identify and adopt a board effectiveness assessment too. Use that tool to carry out an annual assessment of the LHIN Board and Director performance Actions to Date A committee of Board Chairs, led by Foster Loucks, is reviewing board assessment tools. Central LHIN's vice chair, Arthur Walker, is participating as a member of this committee. LHINs will be developing an assessment tool and process. We would then use this process prior to the end of this fiscal year to assess the Central LHIN Board s effectiveness. LHIN: CENTRAL Page 3
Develop and implement an ongoing orientation and professional development program for all Board members Actions to Date ORIENTATION ACTIVITIES: Central LHIN - orientation(s) completed - established orientation process in place Central LHIN Board Orientation was held on February 15, 2006 A future Board Orientation Session is being proposed to address individual Board needs PROFESSIONAL DEVELOPMENT: Through to September 2006 monthly - extended Board meetings Board development & education has been added to the Board agenda as a standing item A Board development & education schedule has been developed Education topics conducted to date: TOPIC SPEAKER DATE Interim Draft of IHSP for Approval in Hy Eliasoph May 23, 2006 Principle IM/IT/E-Health Interim Report for Approval Hy Eliasoph May 23, 2006 in Principle Strategic Plan Update for Approval Lisa Purdy May 23, 2006 Seniors Advisory Group Deborah Egan/Dr. Gabriel Chan/.Fern June 27, 2006 Teplitsky Neurological Services Brenda MacPherson/John Butler June 27, 2006 Chronic Disease Prevention & Management Maria Milanetti June 27, 2006 Mental Health and Addiction Mary Lou Holm/Steve Lurie/Pattie Reed July 18, 2006 Hospital Priorities Hy Eliasoph July 18, 2006 Streams Malcolm Moffatt/ John Butler July 18, 2006 Wait Times Phoebe Jibunoh July 18, 2006 Strategic Plan Hy Eliasoph July 18, 2006 Streams Steve Lough August 15, 2006 Human and Health Resources Steve Lurie/Colleen Zakoor August 15, 2006 Efficiency Rouhan Coutinho August 15, 2006 Mental Health and Addiction Patty Reed August 15, 2006 IHSP Review Template Hy Eliasoph August 15, 2006 IHSP Update Hy Eliasoph September 26, 2006 Open Houses Hy Eliasoph September 26, 2006 Integrated Health Services Plan Hy Eliasoph October 24, 2006 LHIN: CENTRAL Page 4
Develop and implement an ongoing orientation and professional development program for all Board members ORIENTATION ACTIVITIES: Provincial LHIN-wide orientation by MOHLTC scheduled for Nov 1-3, 2006 Future Board Orientation sessions will be scheduled as needed. PROFESSIONAL DEVELOPMENT: Board Members will be asked to identify individual education needs and Central LHIN will develop individual learning plans. Education topics planned for future Board meetings: TOPIC SPEAKER DATE Critical Care Response Dr. Donna McRitchie November 28, 2006 Ontario Hospital Report November 28, 2006 Ontario Health Quality Council Angie Heydon November 28, 2006 Governance Maureen A. Quigley December 19, 2006 Bill 140, Long Term Care Legislation Cancer Care Ontario Terry Sullivan Drugs & Pharmaceutical Briefing Emergency Services Family Health Teams/Family Dr. Val Rachlis Physicians Group Genetics Programs Kirby Report Information and Privacy Commission Public Health Registered Nurses of Ontario Rural Ontario Medical Practitioners LHIN: CENTRAL Page 5
Implement phases I and II of the MOHLTC-approved Conflict of Interest Policy for LHIN Board Members Actions to Date Policy developed and circulated by MOHLTC. The Board is in the process of coordinating interview dates with Board members and the ethics Commissioner. LHIN: CENTRAL Page 6
Accountability Agreement (Schedule D): LHIN Quarterly Progress Report Template (Progress on the 2006-2007 Accountability Agreement Performance Deliverables, Schedule D) LHIN: CENTRAL Progress Reporting Period: Q2-06/07 Submission Date: October 31, 2006 August 2006 (version)
LHIN QUARTERLY PROGRESS REPORT TEMPLATE COMPLETION This quarterly progress report template has been developed by the Ontario Ministry of Health and Long-Term Care to assist Local Health Integration Networks to report progress against commitments outlined in Schedule D of the Accountability Agreement 2006-2007. Please refer to the accompanying document LHIN Quarterly Progress Reporting Overview (Schedule D) for additional context and detail, including performance indicator definitions. Please complete and submit a progress report each quarter, by completing: The underlined fields and LHIN name in the footer section; The LHIN contact information in section 1; and The tables in section 3 (note that each table, when completed, should be no more than one page in length). Please note that the completion of the tables on pages 15 & 16 of section 3 is optional. LHIN QUARTERLY PROGRESS REPORT SUBMISSION Upon completion of this template, please submit it by e-mail to: Ontario Ministry of Health and Long-Term Care (MOHLTC) Health System Strategy Division 56 Wellesley Street West, 15 th Floor Toronto, ON M5A 2S3 Attention: Tracey Mill, Director, LHIN Project Team c/o Ellen Nemetz Telephone: (416) 327-9298 Fax: (416) 327-8313 E-mail: Ellen.Nemetz@moh.gov.on.ca Note: An electronic copy of the progress report must be submitted by e-mail by 4 p.m. of the quarterly progress reporting deadline listed in the 2006-2007 Accountability Agreement. LHIN: CENTRAL Page 2
1. KEY LHIN CONTACT FOR QUARTERLY PROGRESS REPORTING (SCHEDULE D) Please provide the following information about your Local Health Integration Network. CENTRAL Paul Barker Senior Director, Performance Contract and Allocation 2. LHIN QUARTERLY PERFORMANCE PROFILE In Q2, Q3 and Q4 LHIN data reports (called performance profiles in this document)will be generated by the MOHLTC and made available to LHINs according to the Data Release Commitments in Schedule D of the 2006/07 Accountability Agreement. Data reports will be posted on the Health Information Portal (for all indicators except 1a) and LHINs will be notified. Data reports related to Indicator 1a will be sent directly to LHINs by the Wait Times Strategy. Performance Indicator definitions are found in the 2006-2007 LHIN Quarterly Progress Reporting Overview. Indicator Detail 1a 1a1. Median Wait Times (WT) in Priority Areas - Cancer Surgery N/A 1a2. Median WT in Priority Areas - Cardiac Care Angiography Angioplasty By-Pass 1a3. Median WT in Priority Areas - Cataract Surgery N/A 1a4. Median WT in Priority Areas - Joint Replacement Total Hip Replacement 1a5. Median WT in Priority Areas Diagnostic Imaging Total Knee Replacement MRI 1b Median Time to Long-Term Care Home (LTCH) Placement CT All From Acute From Community 1c Perception of Quality of Care N/A 1d Percentage of Alternate Level of Care (ALC) Days N/A 1e Readmission Rate: Acute Myocardial Infarction (AMI) N/A Information to inform regular discussions about indicators 2a and 2b will be made available to LHINs at their request by the Wait Times Information Office and the Critical Care Strategy respectively. Indicator Element 2a. Improvements in Surgical Throughput N/A 2b. Critical Care Capacity Development N/A LHIN Pro gress Report for Q2 06/07 Submitted October 31, 2006 LHIN: CENTRAL Page 3
3. LHIN QUARTERLY PERFORMANCE MEETINGS Quarterly Progress Reports: Indicators 1a to 1e In the tables that follow, please describe the results of meeting(s) between the LHIN and HSPs to discuss performance in indicators 1a through 1e. Describe the Meeting Process used by LHINs and HSPs to explore performance in each indicator area that was discussed. This may include a summary description of the meeting(s) and information about HSPs representation 1. Describe the Discussion Themes or Conclusions of the discussions, and summarize any follow-up strategies or actions in the section. In subsequent quarters, you may report on the progress of any implementation. Indicator 1a Specific Reporting Considerations. In reporting on discussions with health service providers regarding wait times in priority areas, the Ministry is particularly interested in learning about discussions in the following areas: Reducing inequity between hospitals within the LHIN re: wait times Establishment of partnerships between health service providers in the LHIN re: wait time services Alleviating barriers to increasing capacity for wait time services Discussions with other LHINs re: cross-lhin wait time issues Changes to existing service delivery models and referral patterns that will lead to reduced wait times or enhanced quality of care for wait time services Regular Progress Reports: Indicators 2a & 2b The Accountability Agreement requires LHINs to report regularly, as opposed to quarterly, on indicators 2a and 2b. While meeting discussions about these performance areas may be captured in the Quarterly Progress Report, completion of these sections of the template (pages 15 & 16) is optional. 1 HSP Representation: Hospitals, Long-Term Care Homes (LTCH), Community Care Access Centres (CCAC), Community Support Service Agencies (CSSA), Community Mental Health & Addiction Agencies (CMHA), Community Health Centres (CHC), Other LHIN: CENTRAL Page 4
Summary of Central LHIN Performance Q2 06/07 Indicator Central LHIN Cancer Surgery (Summary) Median wait times for all hospitals have been decreasing Central LHIN below provincial average All but one hospital meets benchmark Cardiac Care Median wait times for all hospitals have been decreasing Angiography meets benchmark, but both Angioplasty and Bypass Surgery exceed benchmark Cataract Surgery Median wait times for all hospitals have been decreasing Central LHIN less than 5% over provincial average All hospitals meet benchmark except Humber River and North York General and Don Mills Surgical, but new Branson Centre of High Volume project should address that issue Joint Replacement Median wait times for all hospitals have been decreasing For Hip Replacement all hospitals meet benchmark except Humber River and York Central, but new volumes announced in September and North York General mobile assessment initiative should improve results. For Knee Replacement no hospitals meet benchmark, but again new volumes announced in September and North York General mobile assessment initiative should improve results. Diagnostic Imaging Median wait times for all hospitals have been decreasing Although Central LHIN is below provincial average, only Markham/Stouffville and York Central meet benchmark for MRI, but new volumes announced in September should improve results. Only Markham/Stouffville meets benchmark for CT, but new volumes announced in September should improve results. Median Time LTC Placement For 2005/06 median time to placement was 26 days (the third lowest wait), compared to a low of 18 days and high of 102 days in other LHINs That performance with 2,651 placements was based on 2,103 placements, second only to Central East LHIN Perception Quality of Care Percentage of population (18+) that rated the quality of health care provided in Ontario over last 5 years to be same/improved was 56.4% provincially and 51.8% in Central LHIN LHIN results ranged from 47.2% to 70.4% % ALC Days For 2005/06 Central LHIN had %ALC days of 6.8%, compared to 7.29% provincially. North York General and Markham/Stoufville had %ALC days in excess of Central LHIN average (12.6% and 10.4% respectively). AMI Readmission Rate Percentage of unplanned inpatient hospital readmissions for AMI or another relevant diagnosis within 28 days of an initial hospitalization for AMI For 2005/06 the provincial rate for AMI Readmission was 4.68% and Central LHIN had a rate of 4.27% LHIN results ranged from 2.98% to 8.95% LHIN: CENTRAL Page 5
Indicator Meeting Process Discussion Themes or Conclusions 1a1. Median Wait Times in Priority Areas - Cancer Surgery In Central LHIN we have acknowledged that cancer services should be planned and executed consistent with the Ontario Cancer Plan, the evolving structure of our Cancer Care Ontario (CCO) Regional Cancer Program (RCP) and LHIN-wide cancer strategy. The RCP is a virtual program, linking cancer care providers, organizations and decision-makers across the spectrum of cancer care in our LHIN. Each RCP is charged with implementing the priorities of the Ontario Cancer Plan (developed by CCO), with a focus on improving access to quality cancer services within its community. RCPs build on the existing relationships, networks and collaborative programs already established among cancer care providers in their regions. We have been working closely with Dr. Louis Balogh, Regional Vice President for CCO. The Central LHIN is an active participant on the Central LHIN Cancer Care Services Steering Committee and has worked closely with the Chair to facilitate meetings. Membership includes representation from the five acute care hospitals, from CCAC s, from CCO and consumers (the latter is yet to be appointed). A number of core functions of RCP s directly impact cancer wait times: planning leading cancer service planning within the LHIN area, as part of province-wide planning identifying and leading strategies to meet local needs for service integration, coordination and quality improvement working to improve clinical practices and cancer services locally by: supporting the adoption of provincial standards disseminating information about the region s performance relative to standards and other regions reporting to the public about the performance of local cancer services treatment including participation in CCO s radiation and systemic therapy programs, the Ontario government s wait time strategy for cancer surgeries and associated clinical quality activities (e.g., adopting a standard pathology reporting system to improve treatment decisions, and establishing the multi-disciplinary tumour board to review patient treatment plans) supportive care promoting multi-disciplinary collaboration, involving pharmacy, nutrition, social work, psychology, pastoral care, etc., to improve the coordination and quality of service provision, In addition, the Central LHIN Steering Committee has set out several objectives, including: linking providers of cancer care and plan for a cancer care continuum, integrating cancer services into a seamless system of patient care working collaboratively with cancer care providers to ensure the implementation of the Ontario Cancer Plan identifying opportunities for future planning (capital and operational), and further integration and coordination of services fostering the development and delivery of program excellence ensuring meaningful patient and consumer input monitoring CCO statistical reports, activities and other external developments which may impact on the delivery of cancer care services identifying issues and establishing processes for resolution, relating to the delivery of comprehensive cancer care services, and through the Regional VP, make recommendations to the CCO on strategic clinical and administrative priorities and the allocation of resources. Since the first meeting of May 8, 2006 the Steering Committee has been meeting monthly (with exception of August) with the agenda focused on team building, collaboration, sharing of information, supporting members in their program development and aligning the Central LHIN with the CCO Ontario Cancer Plan. Dr. Balogh, who chairs the committee, is also a member of the Central LHIN Wait Time Strategic Planning Group. He has agreed to conduct discussions on cancer surgery wait times at his Steering Committee and bring forward issues/themes and plans to further reduce wait times to the WTSPG. These plans will then be subject to similar assessment and monitoring as other plans related to the priority wait time services. In the current fiscal year, every acute care hospital is involved in the Surgical wait Time Strategy and have been allocated additional volumes in at least one of the areas of surgical oncology, hips & knees, cataracts, CT and MRI. The Cancer Care Services Steering Committee will prepare a comprehensive migration plan that will provide a current state assessment, identify cancer care issues, analyze patient issues, verify data collection and validation methodologies, examine service delivery gaps, establish improvement goals and strategies, investigate resource implications, and determine action plans. Dr. Balogh will present a preliminary update and summary of the work of the Steering Committee at the November meeting of the WTSPG. LHIN: CENTRAL Page 6
Indicator Meeting Process Discussion Themes or Conclusions 1a2. Median Wait Times in Priority Areas - Cardiac Care The Central LHIN Senior Director, Performance Contract Management has been in discussion with The Director of Clinical Practice at the Cardiac Care Network (CCN) to develop an appropriate process to collaborate on strategies to reduce wait times for cardiac procedures. As a result of these early discussions with Central LHIN, CCN is investigating options to engage all LHINs. CCN has committed to be at the table to help with discussions and is now recruiting a Director of Planning and Liaison (expected to be hired in late November) to assist in this interaction. In addition, we have discussed the best approach to manage cardiac wait times with our Central LHIN Wait Time Strategic Planning Group (WTSPG). The WTSPG felt that the most appropriate expertise to review performance and identify opportunities for improvements in cardiac care services would reside in Regional Cardiac Programs and could be enhanced by best practice knowledge from the Cardiac Care Network. The WTSPG has recommended that we convene a new Central LHIN Cardiac Care Steering Committee. The complicating factor in forming such a group is the fact that unlike the Regional Cancer Program where one Regional Centre is identified for the LHIN, there are numerous Cardiac Centres and Regional Programs that provide services to Central LHIN residents. For example, while Markham/Stouffville hospital makes referrals to Southlake Regional Cardiac Centre, North York General would generally send their patients to Sunnybrook and other Central LHIN hospitals direct clients to other Regional Centres. CCN Discussions: Currently there is a provincial approach to cardiac service wait times in which CCN works with the MOHLTC to set targets and monitor the performance of each centre. One of the biggest capacity issues in cardiac services results from the fixed geography of service providers. Although overall wait times are decreasing regional disparity is of concern in ensuring equitable access to service for all Ontario cardiac patients. In March 2005, CCN released their 10 Point Plan for cardiac services, Optimizing Access to Advanced Cardiac Care. The 10 Point Plan was endorsed by Dr. Alan Hudson, Lead for the Wait Time Project Since release of that plan a number of processes have been established by CCN to evaluate and make recommendations on system performance. Specifically, CCN has established 1) a multidisciplinary volunteer committee (comprised of individuals from CCN member hospitals) to develop best practice guidelines related to access management at a system level, 2) initiated the development of efficiency benchmarks related to operational efficiency and best practice for cardiac surgery and interventional room activities and 3) formed the Data Management Working Group, to identify emerging trends related to wait times and access to cardiac surgery, angiography, angioplasty and arrhythmia services from a local, LHIN and provincial perspective. The Network has recently completed a discussion paper, Cardiac Surgery in Ontario. Ensuring Continued Excellence and Leadership in Patient Care that has identified a number of recommendations and discussion points intended to facilitate dialogue around emerging issues that directly impact cardiac surgery in the province of Ontario. (e.g. shifting trends such as decreasing surgical volumes in the face of increasing angioplasty volumes.). The paper is expected to be released December of 2006. WTSPG Discussions: The Central LHIN Cardiac Service Steering Committee will have representatives (Regional Vice President and Physician Lead) from each Regional Cardiac Program servicing Central LHIN. Each Central LHIN hospital and the new Central LHIN CCAC will be asked to provide an appropriate member and CCN will be requested to participate through the new Director of Planning and Liaison position. Central LHIN will organize the first quarterly meeting of the Central LHIN Cardiac Care Steering Committee to take place prior to December 31, 2006. In the following quarter CCN will be asked to present findings from the implementation of the 10 Point Plan, Cardiac Surgery in Ontario. Ensuring Continued Excellence and Leadership in Patient Care discussion paper and other relevant data analysis. Based on that information and other expert advice provided by the committee an action plan will be developed with respect to improvement of cardiac wait times. LHIN: CENTRAL Page 7
Indicator Meeting Process Discussion Themes or Conclusions 1a3. Median Wait Times in Priority Areas - Cataract Surgery In March of 2006 Central LHIN convened a Wait Time Strategic Planning Group (WTSPG). Membership includes all hospitals providing wait time services, the two CCAC s in Central LHIN and two others outside the LHIN that provide rehab services to Central LHIN residents. In addition, the one rehab hospital, a private hospital (providing cataract services) and the Ontario Wait Time Project provided members. The mandate of this group is to Create/validate a Central LHIN inventory of Wait Time service distribution and volumes and where possible, identify volumes of services delivered to residents of Central LHIN vs. non-residents; Determine local need (i.e. based on Central LHIN population and demographics); Perform Gap Analysis re supply/inventory and local need Identify supports necessary to sustain existing services and as appropriate facilitate enhanced services Explore opportunities for Central LHIN to develop Centres of High Volume and/or Centres of Excellence; Design a recommended end-state distribution of services and associated supports; Develop a migration strategy to transition from the current to future state; and Develop an evaluation framework that includes identification and education regarding best practices to ensure continuous improvement of Wait Times management in Central LHIN The WTSPG has decided to defer to CCO (through the Central LHIN Cancer Care Services Steering Committee) and convene a new Central LHIN Cardiac Care Steering Committee with CCN membership to ensure that planning and recommendations/actions to reduce wait times in cancer and cardiac services occurs. Each of cataracts, joint replacement (i.e. hips/knees) and diagnostic imaging (i.e. MRI/CT) have been deemed an Area of Focus and members of the WTSPG have taken a lead role to develop and coordinate tools and processes to identify issues and opportunities and share best practice activities. Prior to implementation of the WTSPG all activity related to wait time services was largely contained in individual organizations and little collaboration occurred. The WTSPG identified the non-collaborative approach and physician credentialing as major blockers to innovative more efficient and effective use of scarce resources. All members have agreed to a more open approach whereby proposals regarding new volumes of cataracts, joints replacement or diagnostic imaging are now being shared with all members and openly discussed. In fact, all members recently responded to a June request by the Ministry for new volumes of cataracts and joint replacements in a LHIN-wide proposal that was endorsed by all hospitals and CCACs. This proposal also articulated the intent of member hospitals to begin working with medical staff in their organizations to investigate issues and explore options to implement a LHIN-wide enabling strategy that allows surgeons and other practitioners to work in more than one hospital. The WTSPG meets monthly, but comes together via teleconference to address urgent issues, Ministry requests for new volumes or to share details of new innovations. There have been numerous discussions on key issues related to an organization s ability to deliver cataract services. Members identified the following barriers/opportunitities: o Patient preference (seasonal, surgeon-specific, site) o Assessment (as an entry point to a map of a full continuum of care) o Capacity (human resource anesthesiologists and ophthalmologists, beds, operating room time) o Communication, collaboration and coordination across the full patient pathway. It became evident that other members, in some cases, had surplus capacity in exactly those areas that were unavailable in another organization. This has led to development and implementation of a survey that identified both constraints and capacity in each organization (including CCAC/rehab organizations) that was shared back with all members to encourage discussion of possible collaboration/partnerships. The use of the new information along with open discussion of new innovative approaches has led to several new partnerships in Central LHIN. Markham/Stouffville and Humber River Regional are both now participating in implementation of a new Centre of Excellence/High Volume at the Branson site of North York General Hospital. To provide a more focused approach, cataracts have been selected as an Area of Focus for the WTSPG. Under leadership of a WTSPG member, populationneed based analysis/planning for the cataracts services in Central LHIN will be initiated. The intent is to identify the appropriate volume of this service then again review all identified capacity to determine the best model for delivery. Central LHIN and North York General will also continue to develop and promote the Branson Cataract Centre of High Volume initiative. LHIN: CENTRAL Page 8
Indicator Meeting Process Discussion Themes or Conclusions 1a4. Median Wait Times in Priority Areas - Joint Replacement In March of 2006 Central LHIN convened a Wait Time Strategic Planning Group (WTSPG). Membership includes all hospitals providing wait time services, the two CCAC s in Central LHIN and two others outside the LHIN that provide rehab services to Central LHIN residents. In addition, the one rehab hospital, a private hospital (providing cataract services) and the Ontario Wait Time Project provided members. The mandate of this group is to Create/validate a Central LHIN inventory of Wait Time service distribution and volumes and where possible, identify volumes of services delivered to residents of Central LHIN vs. non-residents; Determine local need (i.e. based on Central LHIN population and demographics); Perform Gap Analysis re supply/inventory and local need Identify supports necessary to sustain existing services and as appropriate facilitate enhanced services Explore opportunities for Central LHIN to develop Centres of High Volume and/or Centres of Excellence; Design a recommended end-state distribution of services and associated supports; Develop a migration strategy to transition from the current to future state; and Develop an evaluation framework that includes identification and education regarding best practices to ensure continuous improvement of Wait Times management in Central LHIN The WTSPG has decided to defer to CCO (through the Central LHIN Cancer Care Services Steering Committee) and convene a new Central LHIN Cardiac Care Steering Committee with CCN membership to ensure that planning and recommendations/actions to reduce wait times in cancer and cardiac services occurs. Each of cataracts, joint replacement (i.e. hips/knees) and diagnostic imaging (i.e. MRI/CT) have been deemed an Area of Focus and members of the WTSPG have taken a lead role to develop and coordinate tools and processes to identify issues and opportunities and share best practice activities. Prior to implementation of the WTSPG all activity related to wait time services was largely contained in individual organizations and little collaboration occurred. The WTSPG identified the non-collaborative approach and physician credentialing as major blockers to innovative more efficient and effective use of scarce resources. All members have agreed to a more open approach whereby proposals regarding new volumes of cataracts, joints replacement or diagnostic imaging are now being shared with all members and openly discussed. In fact, all members recently responded to a June request by the Ministry for new volumes of cataracts and joint replacements in a LHIN-wide proposal that was endorsed by all hospitals and CCACs. This proposal also articulated the intent of member hospitals to begin working with medical staff in their organizations to investigate issues and explore options to implement a LHINwide enabling strategy that allows surgeons and other practitioners to work in more than one hospital. The WTSPG meets monthly, but comes together via teleconference to address urgent issues, Ministry requests for new volumes or to share details of new innovations. There have been numerous discussions on key issues related to an organization s ability to deliver joint replacement. Members identified the following barriers/opportunitities: o Patient preference (seasonal, surgeon-specific, site) o Assessment (as an entry point to a map of a full continuum of care) o Capacity (human resources anesthesiologists and orthopedists, beds, operating room time) o CCAC / Rehabilitation (capacity, communication) o Communication, collaboration and coordination across the full patient pathway. It became evident that other members, in some cases, had surplus capacity in exactly those areas that were unavailable in another organization. This has led to development and implementation of a survey that identified both constraints and capacity in each organization (including CCAC/rehab organizations) that was shared back with all members to encourage discussion of possible collaboration/partnerships. The use of the new information along with open discussion of new innovative approaches has led to several new partnerships in Central LHIN. Markham/Stouffville and York Central are participating in a mobile joint assessment initiative being led by North York General. To provide a more focused approach, joint replacement has been selected as an Area of Focus for the WTSPG. Under leadership of a WTSPG member, population-need based analysis/planning for the joint replacement services in Central LHIN will be initiated. The intent is to identify the appropriate volume of this service then again review all identified capacity to determine the best model for delivery. LHIN: CENTRAL Page 9
Indicator Meeting Process Discussion Themes or Conclusions 1a5. Median Wait Times in Priority Areas Diagnostic Imaging In March of 2006 Central LHIN convened a Wait Time Strategic Planning Group (WTSPG). Membership includes all hospitals providing wait time services, the two CCAC s in Central LHIN and two others outside the LHIN that provide rehab services to Central LHIN residents. In addition, the one rehab hospital, a private hospital (providing cataract services) and the Ontario Wait Time Project provided members. The mandate of this group is to Create/validate a Central LHIN inventory of Wait Time service distribution and volumes and where possible, identify volumes of services delivered to residents of Central LHIN vs. non-residents; Determine local need (i.e. based on Central LHIN population and demographics); Perform Gap Analysis re supply/inventory and local need Identify supports necessary to sustain existing services and as appropriate facilitate enhanced services Design a recommended end-state distribution of services and associated supports; Develop a migration strategy to transition from the current to future state; and Develop an evaluation framework that includes identification and education regarding best practices to ensure continuous improvement of Wait Times management in Central LHIN The WTSPG has decided to defer to CCO (through the Central LHIN Cancer Care Services Steering Committee) and convene a new Central LHIN Cardiac Care Steering Committee with CCN membership to ensure that planning and recommendations/actions to reduce wait times in cancer and cardiac services occurs. Each of cataracts, joint replacement (i.e. hips/knees) and diagnostic imaging (i.e. MRI/CT) have been deemed an Area of Focus and members of the WTSPG have taken a lead role to develop and coordinate tools and processes to identify issues and opportunities and share best practice activities. Prior to implementation of the WTSPG all activity related to wait time services was largely contained in individual organizations and little collaboration occurred. The WTSPG identified the non-collaborative approach as a major blocker to innovative more efficient and effective use of scarce resources. All members have agreed to a more open approach whereby proposals regarding new machines and/or new volumes of MRI/CT services are now being shared with all members and openly discussed The WTSPG meets monthly, but comes together via teleconference to address urgent issues, Ministry requests for new volumes or to share details of new innovations. This collaboration and open discussion led to several new partnerships in Central LHIN. In September the Wait Time Project requested information on potential additional MRI/CT capacity in the LHIN hospitals. Central LHIN hospitals received an increase of 4,784 hours / 7,176 exams in MRI and 1,330 hours / 4, 665 exams in CT services for the balance of 2006/07. These additional services are expected to reduce Central LHIN diagnostic imaging wait times. To provide a more focused approach, diagnostic imaging has been selected as an Area of Focus for the WTSPG. Under leadership of a WTSPG member, population-need based analysis/planning for the diagnostic imaging services in Central LHIN will be initiated. The intent is to identify the appropriate volume of this service then again review all identified capacity to determine the best model for delivery. In the interim, Humber River hospital has made a request/proposal to the Ministry to add an additional MRI and Stevenson is exploring the option of acquiring a CT. These additional machines and their associated volumes, if approved, will provide a sustainable reduction in wait times for diagnostic imaging in Central LHIN. In addition a recent new MRI at Royal Victoria presents cross-lhin opportunity to access more timely service. Both of these proposals will be reviewed by the WTSPG Area of Focus-Diagnostic Services team as part of their broader system review. LHIN: CENTRAL Page 10
Indicator Meeting Process 1b. Median Time to Long-Term Care Home Placement Through our Community Engagement processes, the Central LHIN identified Seniors and Specialized Geriatric Services as a priority. Subsequently a Seniors Advisory Committee was established. That committee has representation from both providers (i.e. hospitals, CCACs, long term care homes, community agencies) and consumers. Discussion Themes or Conclusions Although the Committee identified a number of strengths in the existing system of seniors services they also identified areas that could be improved. In particular services could be better organized and delivered more effectively. Seniors had difficulty identifying/understanding the services and had difficulty accessing the services. In addition there seemed to be insufficient links between providers and a lack of innovative approaches to address service gaps in the system. Central LHIN continues to experience ALC pressures in its hospitals. Although the high rate of % ALC is derived from individuals waiting for placement into many types of services (e.g. rehab, mental health, chronic care and LTC), the prominent component in Central LHIN are patients waiting for placement into LTC homes. It is worthy of note that the several of our hospitals with high %ALC (> than 30%) are located in areas of Central LHIN with very high seniors populations and insufficient numbers of LTC beds. The most recent data from York Central suggests that the total number of days waiting for LTC will DOUBLE for 2006-07 compared to last year if the current rate of increase continues. At that facility the average wait per patient has gone from 9.1 days (average for 2005/06) to 14.1 days 2006/07 (year to date). In June 2006, long term care homes in Central LHIN organized themselves into a Network in order to facilitate their involvement in, and understanding of, Central LHIN activities. To investigate the issues and develop potential options to improve wait time for long term care homes (LTC) placement, Central LHIN will contact the Network and ask them to select 3 to 5 members to sit on a Central LHIN LTC Work Group. The Work Group will also include representatives from CCACs, hospitals and consumer groups. It is anticipated that the group would meet monthly and involve participants in a process to consider strategies to improve current bed placement processes, to increase collaboration between sectors and to improve transitions for clients. This group will also look for best practices among the LHINs and develop a process to disseminate the information in Central LHIN. The group will also review the ALC issue, from the context of LTC placement. In addition, the Central LHIN IHSP has identified that a new model of care, the Doorways to Care Model, which will be piloted. This model includes strengthening system knowledge and links between providers and consideration of a 1-800-seniors info line. It is hoped that this model would facilitate access to LTC homes and reduce wait times. LHIN: CENTRAL Page 11
Indicator Meeting Process 1c. Perception of Quality of Care The Central LHIN Decision Support Advisory Group (DSAG) is composed of local experts in decision support in hospitals, CCACs and some community agencies. This group was asked to review this indicator and provide feedback on the results and suggest a process to better understand what is currently in place to address patient/client perception of quality of care. Discussion Themes or Conclusions Since DSAG had previously reviewed and provided feedback on the Local Health System Scorecard there was initially confusion on the indicator. The Scorecard used different data (National Health Survey results) than the current indicator (2006/07 Primary Care Access Survey Data). It was generally considered that the data not helpful because it was based in primary care only and did not provide enough detail or information to be useful in drawing conclusions. However, it appears that the Central LHIN performance in this area may be below the provincial average due to the severe shortage of primary care providers in our LHIN, which has one of the greatest population growth rates in the province. This position is supported by many of the consumer comments recorded at our Roundtable and Open House community engagements. Rather than focus on the actual results of this indicator (when it is not clear what the indicator is measuring i.e. does this one indicator truly reflect the perception of quality of care) the members of DSAG suggested that, given the LHIN s values of patient centred care, we begin with determining the extent to which providers are measuring client/patient satisfaction and the quality of care and service they receive. Through DSAG a very brief survey will be conducted with all Central LHIN health service providers. The survey will ask: Do they have a process to assess patient satisfaction with care/services (Y/N); What is the process for monitoring and identifying areas for improvement (Post discharge follow-up calls/focus groups/patient Comment Cards/Complaint or Compliment processes/surveys, etc.); and Is the information used to drive Quality Improvement processes in the organization (Y/N) They will also be asked if they would like to share any innovation or best practice in this area with other providers in the LHIN through the LHIN or through the Ministry s Innovation website. All providers will then be invited to attend an upcoming Central LHIN Innovations Breakfast at which time the results will be shared, volunteer organizations will showcase innovations in patient satisfaction processes and expert speakers (maybe someone from the Quality Council) will also share best practice. LHIN: CENTRAL Page 12
Indicator Meeting Process Discussion Themes or Conclusions 1d. Percentage of Alternate Level of Care Days The Central LHIN Decision Support Advisory Group (DSAG) is composed of local experts in decision support in hospitals, CCACs and some community agencies. This group was asked to perform an initial high level review of ALC statistics to determine if a common trend was apparent. Overall performance related to %ALC in Central LHIN is somewhat better than the provincial average performance however it is considerably below in two hospitals, North York General and Markham/Stouffville. Although the high rate of % ALC is derived from individuals waiting for placement into many types of services (e.g. rehab, mental health, chronic care and LTC), the prominent component in Central LHIN are patients waiting for placement into LTC homes. Recent data indicated that almost 40% of all Central LHIN ALC days were related to LTC and our hospitals with high %ALC had particularly high LTC components (e.g. Markham Stouffville had almost 60% ALC days waiting for LTC). Additional LTC beds opened by the province several years ago had temporarily improved the ALC situation, but those beds are now fully occupied and %ALC is again increasing. Members of DSAG have also indicated that the ALC problem is growing throughout our LHIN and will start to become a more common hospital issue. It was felt that the complexities in the ALC issue are too great to be addressed at one time. Instead it was agreed that a phased approach in which a specific discrete component issue could be studied and change effected would be the preferred approach. Since a key ALC issue in Central LHIN is an ageing population (in a number of areas in the LHIN) and poor availability of LTC beds (again in select areas of the LHIN) the initial phase of ALC review will focus on LTC. In addressing the issue of ALC, the following objectives will be considered: Data/Information to address the complexities associated with ALC explore options to obtain more relevant data such as wait to access long-term care beds vs. specialized rehabilitation services. Population scoping clarify the composition of those persons who have been designated as ALC and the relationship between ALC and waiting times to LTC Homes. Access to services develop a comprehensive understanding of current service and capacity. Communication facilitate a greater level of communication between stakeholders Policy review and alignment of relevant municipal and provincial government policies. Health Human Resources alignment with the Central LHIN HHR Strategy. DSAG deferred the initial phase of this review to the LTC Working Group, but committed to provide analytical support and expertise to the process. As a best practice exercise the hospitals and CCACs in Central LHIN agreed to share their ALC and/or placement policies and procedures with one another to leverage processes that appeared to be effective. In addition, the ALC issue has been delegated initially to the new Central LHIN LTC Work Group to review in the context of median wait time to placement in LTC, which will be part of their mandate to improve. The MOHLTC has also created an Alternate Level of Care Working Group to address the alternate level of care issue on a provincial basis. There is membership from providers on this committee and the report, with recommendations, is due in November 2006. Once available the report will be reviewed by the DSAG and Central LHIN LTC Working Group to assess applicability of any recommendations to Central LHIN. LHIN: CENTRAL Page 13
Indicator Meeting Process 1e. Readmission Rate: Acute Myocardial Infarction No meetings have been scheduled to date for this indicator. Discussion Themes or Conclusions Central LHIN performs relatively well in this indicator. Three year age and sex standardized rates have been consistently lower in the LHIN compared to the province overall for 2004/05 and for each quarter in 05/06. Current data (Q4 of 2005/06) has Central LHIN at 4.27% while the provincial average is 4.68%. It is likey that performance in this area will only be improved through a joint effort by both cardiologists and our hospital ER physicians. Generally this is an area that has benefited by adoption of clinical best practices. In the Median Wait Times in Priority Areas - Cardiac Surgery item we described a cross-lhin initiative in collaboration with the Cardiac Care Network. We are planning a Central LHIN/North Simcoe Muskoka LHIN/ CCN best practice education and workshop session for first quarter of 2007. Cardiologists will be invited to attend that session. The % Readmission Rate for AMI will be added to the agenda of that day as a discussion and actionable item. Subsequent to that session the results of the %AMI discussions will be taken to the Central LHIN ER Steering Committee and assessment and determination of an appropriate forum to involve the ER physicians and cardiologists will be completed. LHIN: CENTRAL Page 14