Management Report to the MH LHIN Board of Directors October 2009

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1 700 Dorval Drive, Suite 500 Oakville, ON L6K 3V3 Tel: Fax: Toll Free: Management Report to the MH LHIN Board of Directors October 2009 I MOHLTC Updates LHIN Effectiveness Framework KPMP has been charged by MOHLTC to develop a LHIN effectiveness framework. Narendra Shah along with four LHIN CEOs and Senior Directors are representing the LHINs. Leadership from the OHA and OACCAC are also involved in the deliberations along with Ken Deane, ADM. II Progress on Annual Business Plan Priorities ALC Patients in Hospitals As of September 30, 2009, the ALC rate for the LHIN for the first two quarters was 8.8% without transitional beds. Aboriginal The MH LHIN is one of several partners participating in two initiatives that are funded through the Aboriginal Health Transition Funding Adaptation envelope. This Federal envelope supports initiatives that aim to adapt existing health programs to the unique needs of all aboriginal peoples including those in urban areas and Métis settlement and communities. The partners involved in these two initiatives include Six Nations and the Aboriginal Health Centre, Waterloo Wellington LHIN and HNHB LHIN. The two projects include: Aboriginal Hospital Discharge Planning and Aboriginal Children s Health and Well Being. The MH LHIN will be engaging our Aboriginal community in LHIN planning, priorities, and implementation of Aboriginal Health and Wellness Programs. Palliative Care Initiative MH LHIN staff worked with a Palliative Care Initiative Working Group over the summer and early Fall months to develop a LHIN-wide approach to palliative care services. The key deliverables of this working group have now been completed and include: A MH LHIN Palliative Care Model with recommendations to move a LHIN-wide comprehensive palliative approach forward.

2 A Family Focus Group Report on palliative care based on input from community members experiences with palliative care. A Stakeholder Event to obtain input and feedback on a LHIN-wide approach to palliative care. LHIN staff is currently working on steps to implement the recommendations for a LHIN-wide approach to palliative care aimed at reducing patient days in palliative care in hospitals. Mental Health and Addiction Services The MH LHIN co-hosted the Halton Shared Space Forum on September 18, 2009 in collaboration with Halton s Centre for Social Innovation. This Forum provided for an exploration of shared spaces and shared resources for the Halton non-profit sector. Opening remarks were provided by Gary Carr, Halton Region Chair and Jane McCarthy, MH LHIN Board member. Attendance at this half day workshop exceeded 100, representing 53 not-for-profit organizations in Halton. A comprehensive follow-up plan has been implemented and new organizations will be invited to join a project steering committee. The MH LHIN Systems Integration for Mental Health and Addictions (SIGMHA) committee continues its work with implementing a co-location initiative where seven mental health and addiction organizations in the MH LHIN will share space to provide integrated client services. Attention is now focused on the governance model for each site. Following legal consultation, participating organizations have signed contracts with DTZ Barnicke for project management services. This service is now focused on an analysis of current space requirements for the Oakville and Milton sites and negotiation with current landlords re: lease changes as needed. MH LHIN Respite Services MH LHIN staff worked with key stakeholders over the summer months to develop a LHIN-wide approach to respite services. The outcomes of the work included identification of the needs/gaps for respite services in the community, capacity required, and the best approach to delivery of respite services. Key Recommendations that emerged from the work: 1. Expand In-Home Respite Services. 2. Develop Caregiver Education & Resources. 3. Create Capacity for Emergency Respite Services. 4. Develop / Adopt Caregiver Risk Screen. 5. Streamline and coordinate access to respite services. 6. Review Access to Adult Day Programs and develop a common wait list / vacancy list. 7. Continue to monitor the utilization of respite beds in LTC Homes and assess the need for respite beds as part of the planning for LTC Homes. On September 30, 2009, the MH LHIN issued a call for proposals for the provision of in-home respite service (only) across the LHIN as a part of the 2009/10 Aging at Home Strategy. Deadline for submission was October 15, All proposals will be evaluated based on established criteria. Specialized Geriatric Services Strategy In 2008/09, the Mississauga Halton LHIN initiated work on the creation of a Regional Geriatric Program. First phase of the initiative was to develop a blueprint for specialized geriatric services (SGS) with the goal of improving access to SGS in order to support quality of care for frail seniors with complex needs. C:\Documents and Settings\varleyk\Local Settings\Temporary Internet Files\OLK37\Management Report - October 09.doc Page 2 of 9

3 The SGS blueprint identifies the comprehensive mix of core clinical services that are necessary to create a continuum of care that support frail seniors to live independently in their own homes and communities and gaps in service. It also outlines organizational and structural components required to create an integrated and coordinated continuum. The second phase of the initiative is the creation of a Centre of Care in Geriatrics which will incorporate a broader spectrum of geriatric services. It will also promote best practices, attract and retain geriatric clinicians, and academic affiliation. LHIN staff will consult with and seek feedback from key stakeholders regarding the proposed blueprint for SGS. The next steps include the establishment of a Lead organization to assume accountability for the regional geriatric program and implement the SGS blueprint. As a part of the 2009/10 Aging at Home Strategy, the Mississauga Halton LHIN invested in the following initiatives to build capacity and improve access to specialized geriatric services: Expansion of the Geriatric Medical Outreach Program at Trillium Health Centre. Creation of five Urgent Geriatric Assessment Clinics across the LHIN, to provide timely comprehensive geriatric assessments for patients seen in the Emergency Department but not requiring admission due to acute medical illness. Implementation of a Geriatrician Mentorship role at Halton Healthcare Services (HHS). The Medical Mentor, Geriatric Medicine provides advice to the clinical and administrative staff at HHS with respect to the clinical care and planning for geriatric patients. Expansion of the Falls Prevention Clinics to Halton Healthcare Services and Trillium Health Centre to provide a comprehensive assessment and targeted interventions for seniors with an established high risk of recurrent falls, in order to prevent serious injury and hospitalization. III Integration Activities Regional Clinical Services Update MH LHIN Renal Integration Steering Committee Voluntary Integration The two Chronic Kidney Disease Regional Programs (Credit Valley Hospital and Halton Healthcare are partnering with two Long Term Care Homes (Leisureworld, Mississauga and Wyndham Manor, Oakville) to seek Ministry of Health approval and funding to provide peritoneal dialysis services to residents of their Long Term Care Homes. This voluntary integration will provide, for the first time, eligible CKD clients of LTC Homes the ability to choose their preferred modality: peritoneal dialysis or hemodialysis. It is anticipated that the details of this partnership will be developed within the next month. The provision of peritoneal dialysis in LTC Homes is part of a broader provincial initiative to increase the proportion of home dialysis therapies to 40% of total dialysis therapies. C:\Documents and Settings\varleyk\Local Settings\Temporary Internet Files\OLK37\Management Report - October 09.doc Page 3 of 9

4 Community Support Services Supports for Daily Living (SDL) Work is continuing on ramping up services with the agencies that have received Aging at Home funding for the 2009/10 fiscal year. Clients with higher level acuity needs are being brought onto SDL service while those identified with Homemaking/Home Help needs alone are being referred over to Links2Care. Links2Care was funded by the MH LHIN to provide Homemaking/Home Help service border-to-border for the 2009/10 fiscal year. Referrals to the SDL central intake are increasing. From March 2009 to September 2009 referrals have increased from 2 per week to over 40 per week. All referrals are being vetted for appropriateness, prioritized and sent to SDL agencies for acceptance. All clients are assessed using the Common Health Assessment (C.H.A.) instrument or have had a RAI-HC (RAI-Home Care) assessment completed by the CCAC which SDL agencies will then utilize. The implementation of the C.H.A. software continues for all SDL agencies. This is targeted for completion by the end of the fall. Standardization of processes, training packages and content as well as other consistencies has proceeded smoothly with the SE LHIN who is working jointly with us in implementing the C.H.A. software for provider agencies. The work and cooperation has been very successful and has led to requests for the group to publish a paper on their efforts. Refreshing the Integrated Health Service Plan ( ). A final draft of the IHSP will be sent out to all Board members the week of Oct , This draft includes revisions made based on the Board s comments and suggestions provided at the September Board meeting, and also reflects comments from the entire senior team at the LHIN. This draft will also be posted on the MH LHIN website and an blast will go out to all participants and HSPs asking for their comments and feedback. We will take comments and feedback until the end of the month. This final draft of the IHSP will also be submitted to the MOHLTC (as requested by them). A verbal update will be given at the October Board meeting regarding the feedback received. The final design and layout of the IHSP will also begin the week of Oct. 19 th. The Board will be receiving a final draft of the IHSP which will showcase the layout during the week of Nov. 9 th. Final revisions will be made prior to Nov. 18 th as the final version will go to the Board on Nov. 19 th as final approval will be needed at the Nov. 26 th Board meeting. Appropriate Level of Care (ALC) Transitional Services Work Group The final report of the Work Group is expected by the end of November, with recommendations for a framework for post acute transitional services for the MH LHIN. Current work involves the review of preliminary data from the Medworxx Utilization Management Tool across all 5 hospital sites, to inform the need for specialized services in such areas as long term rehabilitation and restorative care, specialized behavioural management program for responsive behaviours, and palliative care in complex continuing care. LHIN ER/ALC Strategies ED Leaders met on October 22 nd. The monthly performance of each hospital was reviewed (see the following charts) and strategies successful in reducing the ED LOS and specifically meeting targets were shared for LHIN-wide hospital implementation. Ambulance off load time was presented by the EMS representatives. C:\Documents and Settings\varleyk\Local Settings\Temporary Internet Files\OLK37\Management Report - October 09.doc Page 4 of 9

5 Enhanced community supports that impact the Emergency Room was reviewed and their impact discussed. The results for the first six months suggest progress is being made in the right direction. 100% Indicator #1 - Proportion of Admitted patients treated within the LOS target of 8 hours (Funded Sites) Source: EDRS - Mississauga Halton LHIN ED Pay For Results Performance Report Jun09 83% 80% 75% Percent treated within target 70% 60% 50% 40% 30% 36% 34% 32% 33% 30% 31% 31% 30% 29% 27% 27% 25% 71% 71% 57% 46% 44% 39% 31% 25% 23% 22% 20% 10% 0% PROVINCE MH LHIN Credit Valley Hospital, The Target Baseline Georgetown Hospital Oakville-Trafalgar Memorial Hospital Trillium Health Centre - Mississauga April-09 May-09 Jun-09 Q1 09/10 Percentage within target 100% 80% 70% 60% 50% 40% 30% Indicator #2 - Proportion of Non-admitted high acuity patients treated within their respective targets of 8 hours for CTAS I - II and 6 hours for CTAS III (Funded Sites) 77% 79% 78% 78% Source: EDRS - Mississauga Halton LHIN ED Pay For Results Performance Report Jun09 81% 84% 83% 83% 84% 86% 86% 95% 94% 93% 94% 89% 65% 72% 68% 68% 20% 10% 0% PROVINCE MH LHIN Credit Valley Hospital, The Target Baseline Georgetown Hospital Oakville-Trafalgar Memorial Hospital Trillium Health Centre - Mississauga April-09 May-09 Jun-09 Q1 09/10 100% Indicator #3 - Proportion of Non-admitted low acuity patients treated within the LOS target of 4 hours Source: EDRS - Mississauga Halton LHIN ED Pay For Results Performance Report Jun09 88% 93% 91% 92% 92% 88% 89% 86% 86% 80% 78% 79% 78% 78% 80% 81% 81% 81% Percentage treated within target 70% 60% 50% 40% 30% 20% 10% 0% PROVINCE MH LHIN Credit Valley Hospital, The Target Baseline Georgetown Hospital Oakville-Trafalgar Memorial Hospital Trillium Health Centre - Mississauga April-09 May-09 Jun-09 Q1 09/10 C:\Documents and Settings\varleyk\Local Settings\Temporary Internet Files\OLK37\Management Report - October 09.doc Page 5 of 9

6 IV Notable HSP Activities Community Sector HSPs Accreditation Metamorphosis, Seniors Health Research Transfer Network (SHRTN) and Ontario Community Support Association (OCSA) presented their accreditation plans at the Quarterly Community Sector Meeting on September 25 th. The key elements of the plan are: Metamorphosis recommends a multi-year phased approach which reflects the capacity and realities of existing accreditation bodies to complete accreditation for the 43 MH LHIN HSPs as well as their normal on-going business. In addition the CCAC has announced that they require all of their contracted providers to be accredited within 5 years further restricting the capacity of current accreditation bodies. Metamorphosis proposes a 4 year accreditation plan from October 1, 2009 September 30, Because some of the HSPs will be participating in the accreditation process at a later date and also because some of the smaller HSPs have little knowledge of accreditation and its benefits, Metamorphosis recommends a stepped up process of quality improvement. MH LHIN HSPs will identify their timelines for: Participation in Accreditation Skills Development Workshops. Participation in OCSA Benchmarks of Excellence Program. Quality and Accreditation Leadership Circles. Hospital Service Accountability Agreement (H-SAA) / Hospital Accountability Planning Submission (HAPS) The MH LHIN will hold the third meeting with the hospital executives regarding the development of the H- SAA Given Ontario s serious economic problems and the significant impact on government revenues, the government is not yet able to provide hospitals and LHINs with financial planning information for 2010/11 and 2011/12 and it is not yet known when this information will be available. Despite these challenges, all hospitals have fiduciary responsibility to maintain a balanced budget and that LHINs are also required to do so through their legislation. The direction from the ministry is that hospitals will not submit completed HAPS to their LHINs by November 30 th, 2009, although they are encouraged to continue to work closely together in planning for 2010/11. There is an opportunity for hospitals and LHINs to collaborate in creative strategies to respond to this new environment. The ministry has directed that: The HAPS process and H-SAA will likely change from a two year to a one year term covering 2010/11. An extension of the existing H-SAA between LHINs and hospitals is very likely for this one year period. Working closely with the MOHLTC, the Steering Committee will examine and address the performance. Management issues related to extending the existing H-SAA for 2010/11 with the intent of minimizing the administrative burden on LHINs and hospitals; Work to re-establish a two year HAPS process and H-SAA for 2011/12 and beyond will still continue. Moderate Surge Planning Experience with SARS in 2003 and recent experiences of other countries with H1N1 have signaled the importance of developing an effective critical care system to accommodate surges. A time-limited LHINbased inter-hospital Critical Care Surge Planning Task Force was convened in September 2009, a C:\Documents and Settings\varleyk\Local Settings\Temporary Internet Files\OLK37\Management Report - October 09.doc Page 6 of 9

7 subcommittee of the Critical Care Committee, to develop a system-level plan to address a moderate surge for critical care in the Mississauga Halton LHIN. The MH LHIN Critical Care Surge Capacity Management Plan is being developed. It will outline an approach to management and communication and inter-hospital protocols to facilitate managing a moderate surge. Celebrating Innovations in Health Care Expo 2009 Celebrating Innovations in Health Care Expo is a showcase of initiatives that are driving health care system renewal in Ontario. The Credit Valley Hospital submission entitled Which Innovation Averted 87.4% Emergency Department Transfers? NPSTAT did! has been chosen to participate in the Expo to host an exhibit booth. This year s Expo takes place on November 18, 2009 at the Metro Toronto Convention Centre in Toronto. The MH LHIN funds the Nurse Practitioner Supporting Teams Averting Transfer (NPSTAT) Program through the Aging at Home investments. The program includes a multi-disciplinary team of long-term care home staff, physicians, a primary care nurse practitioner, CCAC case managers working collaboratively to support LTC homes with the ongoing management of residents who have sudden or semi-urgent injuries or illnesses. The team facilitates discharge of residents back from hospitals. V Community Engagement Meetings with MPPs and Constituency Staff The Board Chair, CEO, and Manager, Communications and Community Engagement continue to meet with MPPs and their constituency staff. To date, the LHIN has met with eight MPPs. The primary purpose of these meetings is to review the list of potential new Board members and the thorough process undertaken by the Board and the Nominations Committee in the selection of these candidates. A secondary purpose of the meetings is to formally introduce the Manager, Communications and Community Engagement as a contact person for office staff if health related questions or queries arise, and to ensure that successful and joint announcements continue to occur. A third purpose of the meetings is to mention that the survey questions used for MPPs by KPMG during the LHIN-wide Board Effectiveness Review have been replicated by the MH LHIN and sent out to all of our MPPs to get an idea of how we are doing locally. A couple of MPPs have stated that they do not respond to surveys and to date two responses have been received. The meetings that have occurred to date have been very positive and to keep the lines of communication open and to further build relationships, an information session for constituency staff is being organized by the MH LHIN and will occur during the next month. The date for this information session with constituency office staff is set for Monday, November 30, 2009 and the CCAC and all three hospitals will attend this meeting to give an overview of their services, enhancements and to give contact info to MPP office staff for outstanding and future questions. C:\Documents and Settings\varleyk\Local Settings\Temporary Internet Files\OLK37\Management Report - October 09.doc Page 7 of 9

8 Governance to Governance Session The September 30 th Governance to Governance (G2G) session occurred and was a success. The topic for this session was our next Integrated Health Service Plan: and Narendra Shah made the presentation. A demonstration of the Governance Portal that is being utilized in a few other LHINs also occurred. There were 98 attendees (out of 109 registrants) and 70% of those were either Board Members or Board Chairs. There were 6 comments or questions that were left for the LHIN to respond to and answers are currently being drafted. The next G2G session is scheduled for Wednesday, November 25, 2009 at the Mississauga Living Arts Centre in the Staging Room. The topic for this next session is: Performance Management and your own Accountability Agreement. French Language Services Planning A planning meeting with our French Language Services consultant occurred in October to discuss our next steps following the successful completion of the French Language Services inventory completed by MH LHIN HSPs. The five identified agencies in our LHIN have been invited to attend a meeting on November 13, The purpose of this meeting includes the following: 1. Review the identification process under the French Language Services Act and what this means for identified agencies. 2. Review their survey results about French speaking Health Human Resources and current offerings of health services in French. 3. To discuss where they all are in regards to their implementation plans for providing French language health services and moving towards becoming designated agencies. 4. To work together on opportunities for moving forward. Physician Engagement Think Tank Meeting The Manager of Communications and Community Engagement hosted a meeting which included individuals from the MH LHIN, Health Force Ontario, MH CCAC, OMA and Pfizer to discuss the development of a physician engagement strategy. Best practices were reviewed and current initiatives in this field were also discussed and next steps were determined. VI Communications Monthly meetings with the Directors of Communications from our 3 hospitals and the MH CCAC occur. The September meeting included a presentation by a guest speaker Steve Gibson, a lawyer from Respect in the Workplace who reviewed the recent Accessibility for Ontarians with Disabilities Act (AODA) and templates that his company has developed to help hospitals and other organizations in the province ensure that they are compliant with these standards. Another guest, Susan Swartzack from the MH LHIN also attended to provide an update and seek marketing and communications advice about the Self-Management programs currently being offered in the MH LHIN. C:\Documents and Settings\varleyk\Local Settings\Temporary Internet Files\OLK37\Management Report - October 09.doc Page 8 of 9

9 VII Key Meetings / Emerging Issues C:\Documents and Settings\varleyk\Local Settings\Temporary Internet Files\OLK37\Management Report - October 09.doc Page 9 of 9

Spring 2011: Central East LHIN Options paper developed

Glenna Raymond, Chair, RSGS Governance Authority Victoria van Hemert, RSGS Executive Director 1 Spring 2011: Central East LHIN Options paper developed Called for new entity to oversee and improve the coordination