Central East Local Health Integration Network CEO Report to the Board June 25, 2014

Central East Local Health Integration Network CEO Report to the Board June 25, 2014 Table of Contents Transformational Leadership... 2 Health Service and System Integration... 5 Quality and Safety... 8 IHSP Strategic Aims... 8 Community Investments... 10 Seniors... 11 Vascular Health... 11 Mental Health and Addictions... 13 Palliative Care... 13 Aboriginal Services... 14 French Language Services... 15 Enablers... 16 Improving Access to Primary Care... 16 Access and Wait Times Including Emergency Department, Surgical and Diagnostic Services... 17 Fiscal Responsibility... 17 Hospital Sector... 19 Community Sector:... 22 Long-Term Care Sector... 23 Cross Sector... 24 Community Engagement... 24 Operations... 26 Other Announcements... 26 Appendices... 26 Community First Keeping at the forefront, the health care needs of our current and future local residents, changing demographics, fiscal realities, Ontario s Action Plan for Health and the LHIN Mission and Vision, the overarching Central East LHIN Integrated Health Services Plan (IHSP) and its strategic aims can be described as Community First. The following is a compilation of some of the major activities/events undertaken over the month of June in support of the Central East LHIN s Strategic Directions; Transformational Leadership: The Central East LHIN Board will lead the transformation of the health care system into a culture of interdependence. Quality and Safety: Health care will be people-centred in safe environments of quality care. Health Service and System Integration: Create an integrated system of care that is easily accessed, sustainable and achieves good outcomes. Fiscal Responsibility: Resource investments in the Central East LHIN will be fiscally responsible and prudent. 1

Central East Local Health Integration Network CEO Report to the Board June 25, 2014 The Central East LHIN is working towards achievement of the Strategic Aims of the 2013-2016 Integrated Health Service Plan; 1. Reduce the demand for long-term care so that seniors spend 320,000 more days at home in their communities by 2016. 2. Continue to improve the vascular health of residents so they spend 25,000 more days at home in their communities by 2016. 3. Strengthen the system of supports for people with Mental Health and Addiction issues so they spend 15,000 more days at home in their communities by 2016. 4. Increase the number of palliative patients who die at home by choice and spend 12,000 more days in their communities by 2016. Transformational Leadership The Central East LHIN Board will lead the transformation of the health care system into a culture of interdependence. After the events at Japan s Fukushima Daiichi nuclear generating station, various levels of government and the appropriate regulatory bodies developed an action plan to improve the system s preparedness to respond to severe accidents. This led to an initiative by Ontario Power Generation (OPG) for a full scale nuclear emergency response exercise to include regional, provincial and federal bodies as well as the utility itself. Exercise Unified Response, which was held from May 26th to 28th, was designed to test the interoperability of various levels of government (regional, provincial and federal) and their agencies, OPG and the health system in order to demonstrate that the emergency response of the participating organizations could ensure the safety of the public and the environment. The exercise scenario included inclement weather, a tornado, a power outage, a controlled release of radioactive materials and an evacuation of a hospital, a long-term care home and the surrounding community. From the health system perspective, the Ministry of Health and Long-Term Care (MOHLTC) and a number of health care stakeholders actively participated in this exercise including the MOHLTC Emergency Management Branch (EMB) which activated the Ministry Emergency Operations Centre (MEOC), the Emergency Medical Assistance Team (EMAT), the Central East (CE) Local Health Integration Network (LHIN), Lakeridge Health, Durham Emergency Management Office (DEMO) and Emergency Medical Services (DEMS). As approved by the LHIN CEOs, the LHINs emergency management role is intended to support the local health system to prepare for, respond to and recover from emergency events. Ensuring continued access to health care services and maintaining local health system capacity during emergency events is critical and is an important role for the LHINs as emergency management partners. Participating in this exercise provided another opportunity, after the 2013 Ice Storm, to test this role. While the scenario wasn t real, players from all three levels of government, emergency responders, OPG, the LHIN and the hospital played as if it was real. The exercise was also supported by a password-protected website that had media reports and social media accounts to simulate real media interest and community feedback as the scenario rolled out. Staff from the LHIN participated in biweekly Exercise Health Design Team meetings during the preparation phase of the exercise. During the exercise response phase, LHIN staff actively participated as Controllers and 2

Players in the communication and coordination, supporting the delivery and implementation of the exercise. This included playing with designated health care partners and simulating play with other stakeholders not involved in the event. The LHIN Senior Team was involved throughout the three day event, receiving regular briefings from the LHIN s designated emergency management staff and providing direction in managing the response from a local health perspective. LHIN staff were brought into the scenario during the May 27th staff meeting where we simulated a check-in call to share information and discuss ongoing responses. The exercise provided a welcomed opportunity to test some of the LHIN s existing policies including HR 207 Inclement Weather, the Inclement Weather Communication Tree and the evolving Central East LHIN Emergency Response Handbook being prepared by the LHIN s Health and Safety Committee, which is currently in DRAFT form. It also allowed LHIN staff to test the accuracy of the After Hours Contact Fan out List that includes after hour contact information for all hospitals, the CCAC, MOHLTC and staff. Some of the learnings from an internal perspective included the ethical consequences of asking staff to participate in the active management of the event and supporting their mental health and wellness. It also highlighted the need for additional emergency supplies such as flashlights, water, etc. to be readily available when staff are required to seek shelter in the office. These gaps will be addressed by the Health and Safety Committee and Senior Team. From an external perspective, the LHIN was able to demonstrate the value add it provides during the active Response phase of any emergency in managing the communication flow between local providers and regional/provincial resources and supporting shared logistical planning between the diverse group of health service providers in our communities. The Ministry Emergency Operations Centre (MEOC) relied on the LHIN for ongoing updates on the system impact of the emergency as the LHIN communicated with all of its providers. Lakeridge Health came through the LHIN to request the support of the Emergency Medical Assistance Team and when they needed dosimeters (to measure radiation levels) for their staff. The Durham Emergency Management Office and Emergency Medical Services came to the LHIN for information on resources required to evacuate long-term care homes. Staff from the Central East LHIN participated in the EMAT hotwash (debriefing) at the end of the three-day exercise. EMAT, which has been in place since the SARS crisis of 2003, is operated by the Sunnybrook Centre for Pre-hospital Medicine, a division of Sunnybrook Health Sciences Centre. With a core staff responsible for clinical care, planning, operations, logistics and communication it can quickly assemble teams of highly trained subject matter experts from across the province to send teams into communities where health care resources have been overwhelmed. For more information on EMAT, please visit the Sunnybrook website and click on http://prehospitalmedicine.sunnybrook.ca/about-emat/ The LHIN was asked to provide its feedback during the debrief and we used this opportunity to outline the role that the LHIN played in the exercise and the role we have in managing the local system response. We also thanked the team for being available at a moment s notice to support our health service providers and our local residents. Rob Burgess, senior director of the Sunnybrook Centre for Pre-hospital Medicine commended Central East LHIN for its leadership in local Emergency Management response and specifically referenced the 2013 Ice Storm when our LHIN, in partnership with our health service providers, developed a local system solution when resources were stretched so that EMAT could go to Sunnybrook and keep the trauma unit running after the whole site lost power. 3

The LHIN is now moving forward with finalizing our internal Emergency Management Response Handbook and will be participating in an Emergency Management Learning Exercise with the Ministry s Emergency Management Branch staff on June 24th. We are also completing a survey sent out by the Ministry s Emergency Management Branch in order to develop an After Action Report that will help improve the Radiation Health Response Plan (RHRP), MEOC Simulation Cell communication processes, and exercise design preparation. In the fall, LHIN staff will be establishing a planning table with our health care providers to begin finalizing our External Emergency Management Plan in order to be ready for the 2015 Pan Am/Para Pan games. This will be aligned with the pan LHIN processes being developed by the TC LHIN. Stocktake: The Spring Cycle Stocktake report template was published by the Ministry of Health and Long-Term Care (MOHLTC) on May 12, 2014 and the completed report was submitted prior to the Ministry before the due date of June 2, 2014. The following summarizes some of the more salient aspects of the report: Percentage Alternative Level of Care (% ALC): The Central East LHIN s Q3 13/14 percentage ALC days were 14.18%, which is above the Ministry-LHIN Performance Agreement (MLPA) target of 12.80%, and higher than the provincial target of 9.46%. The performance for Q3 2013/14 has decreased from 15.60% in Q3 2013/14. As a reminder, the challenge with this indicator is that it is measured only when a patient is discharged from the hospital. The numbers will rise during periods when there has been success in discharging a large number of patients designated ALC, or patients who have been in that designation for a long period of time. The Central East LHIN is continuously engaging hospital leadership and community partners in identifying issues/concerns and possible solutions to the ALC issues. Admitted Emergency Department Length of Stay (ED-LOS): For Q4 2013/14 the Central East LHIN did not meet the 2013/14 performance target. There has been an increase in LOS of 6.9 hours over the previous quarter or an increase of 23%. If compared to the same period last year, the increase in LOS is 2.3 hours or 7%. For Q4 in 13/14, the Central East LHIN LOS is 6.8 hours above the target or 22%. Historically, January has had the highest ED-LOS for Admitted Patients. There has been significant growth in overall ED volumes, specifically ED Admit volumes which have exceeded both the existing and the additional capacity created. As an example, Rouge Valley Health System Ajax Pickering is experiencing tremendous growth in patients admitted through the ED, a 16.3% increase since 2009. Overall, the Central East LHIN performance is moving in the right direction. Central East LHIN s Q4 12/13 performance is the second most improved LHIN over last year s baseline. Non-Admitted High Acuity ED-LOS: The Central East LHIN performance for this indicator is 6.1 hours for Q4 13/14. Compared to the same period in Fiscal 12/13, the Central East LHIN performance has remained unchanged. The Central East LHIN performance for Q4 2013/14 was 1.9 hours or 24% better than the provincial performance target. The Central East LHIN performance for Q4 2013/14 is 0.4 hours or 6.5% below the performance target. Overall, performance in this indicator has remained fairly stable. Central East LHIN, like most of the province, continues to be challenged with readmissions rates for select Case Mix Groups (CMGs) and repeat unplanned emergency visits within 30 days for mental health and substance abuse conditions. Although the rate of readmission increased from the previous quarter, the Central East LHIN is still 4 th out of all 14 LHINs for the lowest re-admission rates. Central East LHIN met all of its Surgical and Diagnostic wait times for Q4 12/13. 4

Life or Limb and Repatriation Policy: On May 30, 2014, LHIN representatives met with Critical Care Services Ontario (CCSO) to discuss the implementation of the Life or Limb and Repatriation policy. An overview was provided on CritiCall Ontario s Provincial Hospital Resource System (PHRS). CritiCall Ontario is requesting the LHINs assistance in updating information on the specialty services and resources available at Central East LHIN hospital sites. CCSO is planning LHIN Town Hall meetings to focus on Repatriation, Life or Limb Policy Implementation, PHRS Service Inventory, Critical Care Information System (CCIS) Data Quality in the fall 2014. Health Service and System Integration The Central East LHIN organization will create an integrated system of care that is easily accessed, sustainable and achieves good outcomes. Integrated Orthopaedic Capacity Plan (IOCP) Implementation: Directional Plans have been submitted to the Central East LHIN by each of the three clusters. On May 13 th, a presentation on the Directional Plans was given to the Central East Executive Committee (CEEC), following this, Central East LHIN staff finalized the responses to the three Orthopaedic Planning and Implementation Committees (OPICs). The responses will also provide an opportunity for all three OPICs to review the Directional Plans from all clusters. The following is a summary of comments in response to the Directional Plans: OPIC meetings and Directional Plans are a good start (especially for relationship building), but planning needs to be further developed; Directional Plans have described some action items, responsibilities, timeframes and rationale, but plans need to consider all key system changes; Detailed Project Plans/Terms of Reference need to be developed; Standard regular reporting on progress of OPICs needs to be developed; Common priorities need to be supported through a centralized oversight mechanism (i.e. LHIN or Advisory Committee); Accountability for implementation of IOCP needs to be confirmed; and OPICs need to proceed as planned considering feedback provided. LHIN staff will be conducting a follow-up meeting collectively with the OPICs to provide feedback on the Directional Plans and further strategize on the implementation. OPICs will continue to plan implementation and establish a standardized reporting process for quarterly updates. Paediatric Physician Remuneration Survey Central East LHIN, during the month of April, disseminated the Physician Remuneration Survey to our hospital partners to conduct an environmental scan to review remuneration models, call schedule, clinic hours, and service volumes by clinic, etc. In May 2014, the Central East LHIN staff conducted an analysis of the responses and presented to the Central East Executive Council (CEEC) on May 13 th 2014. Survey questions were related to Physician Remuneration, Patient Volumes & Clinics and Benefits & Demographics. Next steps include collaborating to clearly identify key issues and areas for action and any required areas for Quality Improvement Plans, review of current physician subspecialties and determine if there are gaps for future need. The group will also continue to ensure that our hospital partners can provide an accessible and quality paediatric service, equitably across the LHIN. 5

Health Links: Health Links Coordination and Oversight An oversight and coordination structure across all Health Links has been initiated to ensure efficient planning and implementation, consistent communication and shared best practices. The Health Links Planning Teams meet weekly to discuss the implementation strategy, physician engagement strategy, patient engagement strategy, timelines and communications for each of the four new Health Links and have contemplated key aspects of a future infrastructure to provide a LHIN-wide oversight to all Health Links. Expressions of Interest (EOIs) for four (4) new Health Links (HLs) in the Central East LHIN (Halliburton County - City of Kawartha Lakes, Northumberland County, Scarborough North and Scarborough South) were distributed to health care providers on May 13, 2014 and completed EOIs were returned back by June 11, 2014. Initial meetings with the partners from each Health Link are currently being planned and Readiness Assessments are to be submitted to the Central East LHIN Senior Team in July 2014. Durham North East Health Link (DNEHL) Both the Design Team and the Steering Committee met in May 2014 and continued to move forward with the implementation of the project plan. The Coordinated Care Plan Improvement Team and the Transitions Improvement Team have both begun small tests of change following quality improvement methodology and have reported early results to the Design Team for discussion and feedback. The Coordinated Care Plan Improvement Team is currently testing the use of the Coordinated Care Plan between the Canadian Mental Health Association Durham (CMHA-D) and the Oshawa Community Health Centre for two (2) complex patients. The Transitions Improvement Team is currently gaining insights from patients and hospital into the process for booking primary care follow up appointments in the hospital. An additional test of primary care notifications is also being developed with two (2) patients. The Peterborough Health Link continues to move forward with the implementation of the following three Improvement Teams: Care Coordination Plan (CCP) Improvement Team A total of 57 plans are in progress. Upon conclusion of the Central East Community Care Access Centre (CECCAC) Discharge Support Meetings (DSM) audit, it was concluded that 79 DSMs occurred within the Fiscal Year 2013/14, and 21 DSMs within Q4 alone. Each of these meetings includes the patient and several service providers. The CCP team has been working to build on the Home First processes to initiate CCPs as part of the discharge planning processes, where appropriate. Further review of the data will take place in addition to an examination of how to initiate the Care Coordination Tool. The CECCAC is working to integrate CCP into internal business processes with Health Links and CCP education tools being developed. The Information Technology (IT) working group and project office are working with Health Quality Innovation Collaborative (HQIC) to develop a project plan for implementation of the HQIC solution (Yammer). Transitions Improvement Team The Transitions Improvement Team continues to work on quality improvement initiatives and they are currently on the Plan-Do-Study-Act Cycle #.5: the notification and follow-up appointment. The future opportunities that have been identified are the risk of readmission and medication reconciliation. Patient Engagement Working Group The Patient Engagement working group continues to develop the PHL engagement strategy. A recommendation from Patients Canada is being reviewed by the working group. Current tools that have been created include a Frequently Asked Questions (FAQs) document that is currently being assessed for literacy level and the CECCAC application package that is being reviewed and modified for use by the Health Links. Next steps 6

include linking with the Durham Health Link to work on the application and orientation package for potential patient volunteers. Community Health Services (CHS) Integration Strategy: Integration Planning Process in Haliburton County and City of Kawartha Lakes (CKL) In November 2012, the Central East LHIN Board approved a motion to initiate an integration plan for the North East Cluster. The Hospital and Community Health Services Integration-Haliburton County and the City of Kawartha Lakes Health Services Integration Plan was presented to the Central East LHIN Board on December 18, 2013. The integration strategy is sub-divided into three areas: One Entity Haliburton County Integration: Voluntary merger between Community Care Haliburton County (CCHC) and Haliburton Highlands Health Services (HHHS) into one entity and the transfer of LHIN-funded services, currently being provided by Supportive Initiative for Residents in the County of Haliburton (SIRCH) and Victorian Order of Nurses (VON), to one entity. The result of the transition planning work is a Haliburton County Community Health Service Integration - Transition Plan, which was presented to the Boards of each organization involved in these changes at their May 2014 meetings. All participating Boards have approved and endorsed the Transition Plan. The Transition Plan was submitted to the Central East LHIN on March 31, 2014 and will be considered for final decision making at the Central East LHIN Board meeting on June 25, 2014. Confirmation of Two Entities in the City of Kawartha Lakes: Ross Memorial Hospital (RMH) and Community Care City of Kawartha Lakes (CCCKL) were confirmed, through the integration process, to continue with their own governance and leadership. The accountability for Adult Day Program would be transferred from VON to CCCKL. As well, the Acquired Brain Injury (ABI) Adult Day Services in the City of Kawartha Lakes will be transferred from VON to Four Counties Brain Injury Association. The benefits of this transition include aligning a specialized program with an organization that focuses on the needs of individuals with an acquired brain injury. The CCCKL-VON Transition Team and Four Counties- VON Transition Team continue to meet to develop their transition plans. Status reports will be provided to the Central East LHIN Board in June. Northumberland County Implementation The Northumberland County Integration Planning Team (NCIPT) continues to move forward with implementation planning. Team members are meeting every two weeks. As part of the June 25 th, 2014 Board meeting, the Northumberland County Integration Planning Team (IPT) will be presenting their transition plans. Durham Cluster CHS Integration Strategy a) Congregate Dining Services & Supportive Housing (Faith Place and Community Care Durham) The Faith Place, Community Care Durham Integration was completed as of April 1, 2014. The LHIN has been receiving regular updates from Community Care Durham that the Integration is proceeding well with no current issues. b) Durham Hospice and Victorian Order of Nurses (VON) The Durham Hospice and Victorian Order of Nurses Integration Plan was not submitted to the LHIN as planned. There are continuing negotiations required between the two parties. Central East LHIN staff are currently working with the Providers to resolve these issues and will table this item for the Board s decision at the July 23, 2014 Board meeting. 7

c) Oshawa Community Health Centre (CHC) and The Youth Centre The Central East LHIN has received the decisions of The Youth Centre and the Oshawa Community Health Centre Boards. There is no further update to report as discussions are ongoing regarding next steps. Scarborough Cluster CHS Integration Strategy The Scarborough Integration Planning Team (IPT) continued weekly meetings throughout the month of May and on May 21, 2014, the Scarborough Community Health Services (CHS) Integration Planning Team (IPT) held a Stakeholder Engagement session at the Scarborough Centre for Healthy Communities Hub. The purpose of this session was to receive comments and suggestions on the proposed DRAFT Integrated Service Delivery Model. There were over 20 participants from various community organizations and hospitals across Scarborough including Community Support Services, Hospitals, Toronto Community Housing, Public Health and the Central East Community Care Access Centre (CCAC) The engagement session was well received by the stakeholders who provided valuable feedback to further support development of the elements of the DRAFT Integrated Service Delivery Model: Best Practices Committee Standard Intake and Assessment Task Force Back Office Integrations Information Technology Support Procurement of Supplies Volunteer Recruitment and Training Next steps for the Scarborough CHS Integration Planning Team include completing Stakeholder and Staff Engagement sessions and integrate feedback into the final report and prepare for the upcoming governors check-in meeting to be held on June 19, 2014. Peterborough City/County CHS Integration Strategy The Peterborough CHS Integration continues to progress forward in preparation for the June 25, 2014 Central East LHIN Board Meeting. In advance of the June 25 th LHIN Board meeting, the six IPT organizations are presenting the Final Integration Plan to their Board of Directors to seek support before tabling the plan for approval by the LHIN Board. Quality and Safety Health care will be people-centred in safe environments of quality care. Maternal Child Health: Advisory Committee During the month of June, the Central East LHIN Maternal, Neonatal and Paediatric Advisory Committee have been working to populate membership on the two working groups Education & Resource Committee and the Quality & Performance Measurement Committee. Expanding our membership to establish working groups will provide the opportunity to achieve the emerging themes and areas of focus resulting from the engagement sessions. Next steps include planning for the Strategic Plan and Visioning, continuing data analysis of the stakeholder engagement sessions and populating the two Working Groups. The Central East LHIN has prepared a letter of support for the Grandview Children s Capital Development Plan. We look forward to future partnerships with the Children s Treatment Centre. 8

Caesarean Section (C-Section) Quality Improvement Plans (QIPs): On May 2, 2014, Northumberland Hills Hospital (NHH) submitted to the Central East LHIN, their Q4 2013/2014 Quality Improvement Plan for Caesarean Section Rates. In the initial submission from NHH, on July 23, 2013, seven quality improvement recommendations were identified. In the current Q4 report, NHH has demonstrated progress and completion of several of the actions required to achieve the outlined recommendations, more specifically: Recommendation #1 Communication of a C-section and induction quality metrics to be shared with the maternal/child team on a monthly basis demonstrates that education sessions have been provided to share quality data and educate the interdisciplinary team on initiatives being utilized to reduce C-section rates. Furthermore, monthly reviews of all C-sections and induction rates are completed by the quality and practice committee at NHH. In March 2014, the lead midwife shared a Vaginal Birth After Caesarean (VBAC) pamphlet for use in the program at NHH. The pamphlet will be taken to the next Quality and Practice Committee in May 2014. This recommendation will improve patient education with regards to VBAC vs. repeat C-section. Caesarean Section Rate 2013/2014 (Q4): NHH demonstrated a reduction in their C-section rates for Q2 and Q3 compared to Q1; however, in Q4 there was an increase by 3.9% (compared to Q3). Q4 was heavily influenced by March 2014 (40.5% C-section rate). March 2014 rates were driven by an increase in primary C- sections. NHH conducted a critical review of all C-sections performed in March and concluded that all cases performed were appropriate and required for a number of accepted indications. Induction Rate 2013/2014 (Q4): The induction rates at NHH continue to be stable throughout the year, with Q4 having a 15.7 induction rate, which is in the acceptable range from a national and provincial target standpoint. A recommendation was adopted to implement an induction booking form checklist to ensure physicians and midwives are aware that inductions will only be performed when there is a medical or obstetrical indication or at 41 completed weeks of gestation. Northumberland Hills Hospital will continue monitoring the quality improvement recommendations established and ensure the C-section rates continue to decrease, specifically the primary C-section rates. A similar report will be prepared following receipt of the Q4 2013/2014 Quality Improvement Plan from Ross Memorial Hospital (RMH). Behavioural Supports Ontario (BSO) Program: 1. Sustainability Report Further discussion on next steps and direction took place at the Provincial Behavioural Supports Ontario (BSO) Operations Table meeting on May 1, 2014. In April 2014, a presentation on sustainability was given to the Ministry-Management Committee (MMC) and LHIN CEO Table and the five key areas of discussion that emerged around operations were: Continue to include Lived Experience of the family, client and providers in system design; Need for standard system performance indicators; Need to facilitate knowledge exchange mechanisms across LHINs; Increase focus on elements of each BSO model that work rather than models as a whole; and Spreading knowledge gained from BSO to other initiatives and populations. 9

2. Long Term Care: The Scarborough Community of Practice Behavioural Assessment Tool (BAT) Kaizen Workshop held on May 14 th was attended by 69 participants from five (5) Early Adopter homes, eleven (11) Phase 2 homes and Integrated Care Team members. The North East Community of Practice BAT Kaizen held May 29 th was attended by 81 participants from five (5) Early Adopter homes, 17 Phase 2 homes and Integrated Care Team members. One additional workshop was planned for June 3 rd in Durham. Once the three workshops are complete, a BAT working group will be formed to review suggestions and update the BAT. 3. Metrics and Evaluation: The metrics submission rate for LTCH homes for April 2014 was 83%. It is anticipated that this number will increase with the May 2014 submissions as the homes become accustomed to the new reporting template. 4. Training and Education: The Psycho-geriatric Resource Consultants (PRCs) met on May 16 th to create the draft 2014/15 Training and Education Schedule. The training summary and calendar will be posted on the Central East LHIN BSO webpage in June. 5. Community: The organizations (all four GAIN Clinics and two GAIN Community Teams) provided with BSO Community funding are proceeding with recruiting BSO clinicians to become an integral part of the inter-professional GAIN teams. Three of seven BSO clinicians have been hired to date. Paralleling the ongoing recruitment of BSO clinicians by GAIN teams, a role development committee has been established that will include all seven clinicians, Psychogeriatric Resource Consultants as well as representatives from the Seniors Care Network. The committee is tasked with developing and guiding the implementation of the BSO role in GAIN. 6. BSO Design Team The Design Team determined four broad strategic aims to inform the 2014/15 work plan as: Spread and Sustainability (including accountability mechanisms); Therapeutic Interventions; Resident Transitions; and Evaluation of systems of care for highest needs population such as Behaviour Supports Units. IHSP Strategic Aims Community Investments Assisted Living for High Risk Seniors: The Central East LHIN continues to work collaboratively with the Central East CCAC (CECCAC), Community Care Durham, Carefirst Seniors and Community Services Association, CCCKL, VON and Yee Hong Centre for Geriatric Care in supporting and caring for seniors at risk of premature and/or unnecessary admission to facility care. The Assisted Living Services for High Risk Seniors (ALS-HRS) services in the Central East LHIN is delivering 24 hour, personal support services, essential homemaking, care coordination, and emergency response services for high risk seniors in their homes. Where possible, clients are being transferred from CECCAC Homemaking Services to those provided by the community agencies listed above. The CECCAC, Central East LHIN and the agencies are working in collaboration to monitor impact on clients based on the agreed upon outcome and process indicators 10

Seniors Geriatric Assessment and Intervention Network (GAIN) Community Teams: Central East LHIN s redesign and expansion of GAIN continued throughout the months of May and June. The four hospital-based teams worked hand-in-hand with the six new community teams, by referring clients/patients previously on their wait lists, including seniors with complex issues that will be enrolled in intensive case management services and by providing the necessary training, supervision and job shadowing so that the community teams will be able to conduct Comprehensive Geriatric Assessments. The GAIN Design Team met on May 29, 2014. The focal point of discussion was establishing a cluster-based common intake process. More work is needed to understand and design this process, for it to work effectively with the GAIN teams. Senior Friendly Hospital (SFH) Strategy: The Seniors Care Network Senior Friendly Hospital (SFH) Working Group continues to meet on a monthly basis. The initial activities identified for implementation in the 2014/15 SFH Workplan remain a focus. The inaugural meetings of both the SFH Walkabout Task Group and the Gerontological Foundation Task Group have been held. Both groups will be developing frameworks to bring to the SFH Working Group for discussion. A status update report and the final report on the funding allocation for SFH initiatives were submitted to the LHIN. Overall, the majority of the allocated funding was utilized for education/training, and/or data collection and submissions. The 2014/15 Workplan was revised and approved by the Central East SFH Working Group. A draft Seniors Care Network SFH Working Group Scorecard has been approved by the SFH Working Group members. A SFH information letter along with the 2014/15 SFH Workplan was forwarded to each of the nine Central East LHIN hospital CEOs to provide them with an overview of the work of the SFH Working Group as well as to request their support for the SFH Working Group 2014/15 Workplan. A SFH briefing note was forwarded to the members of the Central East LHIN Vice President & Chief Nursing Executive Steering Committee on May 26, 2014. The document was intended to provide a status update as well as generate enthusiasm and buy-in for SFH care throughout the Central East LHIN. Additional activities/actions have been slated for implementation later in the year. Vascular Health Vascular Health Strategic Aim Coalition: The LHIN s diabetes and vascular health team presented updates to the Board on the key elements of the diabetes and vascular aim, as well as highlighting the work of the Coalition and the team. The presentation demonstrated the achievements, opportunities and next steps to continue progress towards the achievement of the Vascular Strategic Aim. The Coalition is currently planning for their upcoming meeting in June where further updates of regional projects/programs will be discussed. Stroke Quality-Based Procedure (QBP) Working Group: The Central East Stroke Quality-Based Procedure (QBP) Working Group continues to make progress on building structures to support collaborative and appropriate engagement for decision-making on stroke QBP options. Reporting to the Health System Funding Reform Local Partnership (HSFR-LP) on a bi-monthly basis, the group consists of Coordinators, Managers and Directors from across the Central East LHIN who review the flows across the stroke care continuum from a QBP-perspective to help the clusters identify best practices. The group continues to roll-up feedback on the Decision-Making Framework that will be used to evaluate QBP options from delegates representing the hospital facilities and all the Chiefs of Emergency Medical Services. 11

Next steps include expanding the Working Group membership to include a stroke volunteer who will serve as an ad hoc member and participate in the review of QBP criteria, representing the patient perspective. Building of the Weighting and Rating Tool for preparing the weighting and rating of the criteria against stroke QBP planning options has begun. The group will be bringing feedback on the criteria forward as part of the next report to the HSFR-LP. Diabetes: Diabetes Reporting The Ministry-LHIN Diabetes Education Program (DEP) Performance Management Committee has solicited feedback from all LHINs on approaches for target amendment negotiations. The final approach is an overarching framework with a set minimum caseload benchmark. This includes a rationale to create additional incentives for each DEP to focus on appropriate supports for patient presentations while also managing their capacities. As of 2014/15, DEPs are using new templates for reporting indicators and budget submissions. Several technical issues and adjustments have been managed through regular communication with the DEPs to resolve. Based on the new templates, both Q1 & Q2 quarterly reports will be due at the same time. A meeting for June has been set with all DEPs to discuss the process and next steps for target amendments. Diabetes Quality Improvement Plans (QIP) The Scarborough DEP cluster continues to meet bi-weekly to develop process improvements and monitoring of changes identified in 2013/14 Quality Improvement Plans. The four areas reported monthly to the LHIN include: Communications with referring parties; Enhancing collaboration initiatives; Metrics on re-referral patterns within the cluster and caseload changes; and Development and utility of a patient experience survey to consolidate best-quality health outcomes. The group will continue to present these updates to the LHIN with an expectation of ongoing evaluation and appropriate action plans for identifying opportunities for improved coordination of care amongst the programs. A similar process is to be completed with the Durham and North East clusters in the coming months. CECCAC Centre for Complex Diabetes Care (CCDC) A total of 44 new Centre for Complex Diabetes Care (CCDC) patient referrals were received and assessed by the Central East CCAC in April for the three care delivery sites (Lakeridge Health, Peterborough Regional Health Centre and The Scarborough Hospital). These new referrals are in addition to the 567 active patients that were recorded at the end of Q4 (March 31, 2014). Centralized Diabetes Intake (CDI) A total of 26 referrals for Diabetes Education Programs were received and assessed by the Central East CCAC in April 2014. The Central East CCAC is also in the process of releasing an instructional video for Centralized Diabetes Intake that is expected to be finalized in July. Central East CCAC Diabetes Services and Regional Cardiac Care Program: A review was conducted on the Cardiac Rehabilitation and Secondary Prevention services Hub at RVHS, more specifically focusing on the year-end report. It was noted that the initiative has surpassed almost all metrics. Moving forward, there are plans to pilot an integration initiative between the Regional Cardiac Care program and Diabetes Centralized Intake by first identifying a small cohort of individuals who flow through both intakes and who qualify for services for either stream and further identifying metrics to capture any value-add for patients from a system perspective and streamlining service access for residents across the Central East LHIN. 12

A value stream mapping event was held on June 4 th focussing on the current and future states. Participants included staff from the Central East CCAC, Central East LHIN, Central East CCDC and Central East Regional Cardiac Care Program. The aim is to continue to build upon an integrated vascular health network within the Central East LHIN. Ontario Renal Network: Capacity planning for the Ontario Renal Network (ORN) for renal services continues with the focus on supporting standardized processes and practices across the region and initiatives will be reflected in a revised Regional Plan. Mental Health and Addictions Implementation Strategy for the Central East LHIN s Mental Health and Addiction Strategic Aim: The first meeting of the Central East LHIN Strategic Coordinating Council will take place on June 20. The meeting will be spent introducing Council Members to the process and the projects. Council meetings will be held on a quarterly basis at rotating locations across the LHIN. Assertive Community Treatment Team (ACTT) Value Stream Mapping (VSM): The ACTT Now Project is proceeding according to its Project Plan. Implementation of the Step Down" model has taken place. Remaining quality-based improvement measures are in the process of being completed. Child and Adolescent Hospital-Based Psychiatric Services: The Child and Adolescent Hospital-Based Psychiatric Services are moving forward, but it has been challenging to bring everyone to the table at the same time. This is largely due to the multiple demands on Health Service Providers. The Steering Committee and Project Manager are working with the Working Group members to find innovative ways to move the project forward. Home First @ Ontario Shores: The implementation of Home First at Ontario Shores is on track. Partners are engaged in problem solving by providing community supports for complex clients. This process has also promoted a positive working relationship between the CECCAC and both community and hospital Mental Health and Addictions service providers. Community Crisis Review: Lead Health Service Providers, including Canadian Mental Health Association Haliburton Kawartha Pine Ridge (CMHA-HKPR) and Durham Mental Health Services have met with the Project Manager and are now in the process of recruiting members to sit on the Steering Committee. It is expected that the project will be fully underway by mid-june. Palliative Care Provincial Hospice Palliative Care Data and Performance Subcommittee: Another full day Data and Performance Subcommittee face-to-face meeting has been tentatively booked for June 26, 2014, at the Michener Institute. The primary objective of this meeting is to review action items identified on April 3 rd and confirm group consensus regarding next steps which includes: Updates from identified Technical and Patient and Caregiver Experience Working Groups; Follow up from Health Quality Ontario/Subcommittee discussions regarding potential alignment of indicator work; Review of Knowledge Education and Transfer Symposium details and next steps; and Confirmation of Palliative Care Concepts and work-to-date to be presented to the Provincial Steering Committee. 13

Central East Hospice Palliative Care Network (CEHPCN): The CEHPCN came together for their bi-monthly meeting on May 6 th to support the following objectives: To review and discuss the endorsement from the Central East LHIN Board in April, including endorsement of Regional Palliative Plan, subsequent motions and next steps. To provide updates regarding local residential hospice planning and high level integration/implementation discussions. To highlight recent palliative education, Palliative Pain and Symptom Management Consultants and provincial end of life care updates. Network members, at the meeting, agreed that a LHIN-Wide Communication Plan needs to be developed immediately in order to spread awareness of the LHIN-endorsed Plan, the role of the Network and priority recommendations. The Central East Hospice Palliative Care Network Coordinator will be working with Communications staff at the LHIN to develop a LHIN-wide Communications Plan to support consistent/standard messaging, communication milestones, identify important stakeholders, settings and settings. There will be the implementation of five (5) priority recommendations to be initiated at a pan-lhin level and not by cluster and each priority recommendation will be chaired by a Network member. This individual will be responsible for leading the implementation of the identified recommendation and reporting back to the Network on progress to date. The Central East Hospice Palliative Care Network Coordinator will be charged with supporting the priority implementation of next steps which may include helping to coordinate individual priority discussions. The next meeting is scheduled for July 8, 2014. Palliative Education: Wrap up of the final 2013/14 Peterborough Learning Essential Approaches to Palliative and End of Life Care (LEAP) course continues, including the submission of all pre-and post-course documentation and presenting of Certificates of Completion. In mid-may, the Central East LHIN, in collaboration with Lead Facilitator Dr. Howard Burke, completed the twoday condensed LEAP course at Ross Memorial Hospital. The next course offering is being coordinated in the Scarborough Region at the Scarborough Centre for Healthy Communities in July/August 2014. Dr. Rahim Abdulhussein has agreed to act as the Lead Facilitator for this course. Registration will be open throughout June. The Central East Education Working Group continues to support discussions and improvement opportunities for physician and interdisciplinary palliative education. Currently, the group is working on a briefing note to be presented to the LHIN highlighting recommendations to support improvements in education planning (i.e. course offerings, funding allocations, results of Hospice Peterborough s Education Consulting report, etc.)..aboriginal Services Métis, Non-Status and Inuit Health Advisory Circle: The Central East LHIN Métis, Non-Status and Inuit Health Advisory Circle did not meet this month. This Circle will meet again on July 7, 2014. First Nations (FN) Health Advisory Circle: The Central East LHIN First Nations Health Advisory Circle met at the Hiawatha First Nation on June 12, 2014. The Agenda included a discussion of the Cultural Safety Indicator, the Mental Health, Palliative Care and Diabetes Strategies and local information and developments. 14

Ontario Telemedicine Network (OTN) Capacity for First Nations: Both the Curve Lake First Nation and the Alderville First Nation have their machines up and operating. They are both currently investigating opportunities to use the service for direct health care services and for training staff. Mental Health and Addictions: A follow up meeting was held at the Hiawatha First Nation on June 25, 2014 with the Mental Health and Addictions providers in the LHIN. The focus was on developing a plan to move forward with service delivery that meets the needs of the Indigenous People residing in the Central East LHIN. One-Time Aboriginal Project Funding: The additional Provider workshops that were held throughout May were quite successful. The LHIN is awaiting the final Project Report. This project will expand the capacity of the system to provide treatment to Aboriginal People in the Northeast Cluster who are dealing with a Concurrent Disorder, and the project was scheduled for completion at the end of FY 13/14. Provincial Aboriginal LHIN Leads Meeting in Ottawa James Meloche, the Central East LHIN Acting CEO and the Central East LHIN Aboriginal Lead attended the Provincial Aboriginal LHIN Leads meeting in Ottawa. Much of the focus was on Inuit People. This provided an excellent opportunity to connect with the Inuit Community in Ottawa, who have a connection with the Inuit Community residing in this LHIN. The meeting was also attended by one member of each of the Central East LHIN Aboriginal Health Advisory Circles. The presence of similar delegates from across the Province provided rich opportunities for dialogue and discussion. The Central East LHIN Aboriginal Staff Lead was elected as Co- Chair of the Provincial Aboriginal LHIN Leads Network. French Language Services Coalition For Healthy Francophone Communities in Scarborough (CHFCS): The Francophone Coalition met on May 21 st and welcomed the new French Language Services Health Promoter. The first draft of the Coalition s 2014/2016 Action Plan was reviewed, which is aligned with the Central East LHIN s 2013/16 Strategic Aims and key priorities. The planned initiatives for the Francophone Coalition will be driven by Quality Improvement (QI) guidelines to evaluate and measure target conditions with a goal of achieving health improvements and sustaining wellness for the Francophones in the Scarborough cluster. Francophone Adult Day Program (ADP) in Oshawa: The Francophone Adult Day Program (ADP) is operational in Oshawa. Francophone seniors who benefit from this service have expressed a great deal of satisfaction. To date, a total of ten clients are attending the program, which has a capacity of 15. There are another three (3) new clients who were scheduled to register by the middle of May 2014. Presently, the ADP program includes one hour of physical exercise which is adapted to the needs and capacity of each client. Their motivation level is high as they can see and feel the benefits of exercising both physically and mentally. As reported by the Executive Director of Les Centres d Accueil Héritage: Very quickly, the recreationists have been able to establish a warm, friendly and secure environment for the participants. The clients are more assertive as they feel comfortable in their program environment. 15