Board of Directors Meeting Wednesday, September 22, 2010

1:00 p.m. – 4:00 p.m. St Marys Golf & Country Club

AGENDA

Agenda Item Lead Decision/

Information Time

Allotted 1. Call to Order – Welcome and Introductions Chair

2. Declaration of Conflict of Interest Chair 3. Approval of Agenda

Chair Decision 1:00-1:05

4. Approval of Minutes 4.1 Board of Directors – August 11, 2010 4.2 Board Committee – September 8, 2010

Chair

Decision 1:05-1:10

5. Items for Decision: 1:10-3:30 5.1

5.2 5.3 5.4 5.5 5.6 5.7 5.8

Bylaw 1 & 2 Amendment recommendation LHIN 2010/11 Operational Budget Board Committee Terms of Reference Enterprise Risk Management Integration: 5.5a) London Breast Cancer Coordination Project 5.5b) Tier II Mental Health Divestment 5.5c) Huron Addiction Services/Choices for Change Woodstock & Area Community Health Centre Capital Proposal 2010/11 Priorities for Investment Health Service Providers 2009/10 Q4 Results

Chair M Barrett Chair M Brintnell M Brintnell K Gillis K Gillis M Brintnell M Brintnell/ K Gillis M Brintnell

Decision Decision Decision Decision Decision Decision Decision Decision Decision Decision Information

6. Board and Senior Staff Reports 6.1

6.2 6.3

Senior Leadership Report * M Brintnell, K Gillis, J White, G Lanteigne Board Chair Report Board Members Report

M Barrett Chair Directors

Information Information Information

3:40-3:45 3:45-3:50

7. Closed Session (as required)

8. Date and Location of Next Meetings

Board Committee Meeting – October 13, 2010, London Board of Directors Meeting – October 27, 2010, Durham

Chair

9. Adjournment Chair 4:00

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South West LHIN Board of Directors’ Meeting

Minutes August 11, 2010

South West LHIN Office – Main Boardroom

Present: John Van Bastelaar, Chair (A) Kerry Blagrave, Secretary

Ron Bolton, Director Sheryl Feagan , Director

Ron Lipsett, Director Janet McEwen, Director

Linda Stevenson, Director Staff: Michael Barrett, CEO Mark Brintnell, Senior Director, Performance, Contract and Accountability Rita Casciano, Corporate Coordinator Stacey Griffin, Executive Assistant to the CEO Julie White, Director, Communications Regrets: Murray Bryant, Director 1. Call to Order – Welcome and Introductions

The Chair called the meeting to order at 1:02 p.m. There was quorum and 9 members of the public were in attendance. The Chair welcomed two new Directors, Sheryl Feagan and Ron Lipsett, as well as the members of the public.

2. Declaration of Conflict of Interest There was no declaration of conflict of interest. 3. Approval of Agenda

The agenda was reviewed and the Chair indicated that under agenda item 8, Date and Location of Next Meetings, the next meeting will be a Board Committee meeting, held in London at the South West LHIN office and the next Board of Directors meeting will be held in St Marys on September 22, 2010. The chair noted that today no closed session will be held.

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MOVED BY: Linda Stevenson SECONDED BY: Janet McEwen THAT the Board of Directors’ meeting agenda for August 11, 2010 be amended and approved.

CARRIED

4. Approval of Minutes 4.1 Board of Directors – July 14, 2010 MOVED BY: Ron Bolton SECONDED BY: Kerry Blagrave THAT the Board of Directors’ meeting minutes from July 14, 2010 be approved as presented/amended.

5. Reports CARRIED

5.1 Woodstock General Hospital Own Funds Capital Request

Mark Brintnell provided background on the Woodstock General Hospital (WGH) Own Funds Capital proposal to construct a 30,000 square foot medical office building (MOB) with leasable space. The MOB has the potential for WGH to earn an estimated $290,000 annually, which would assist with the hospital operations. The communities’ local share in the amount of $5,329,698 has been secured by the WGH Foundation to fund this project. The proposal indicates several advantages, including improved access to physician services and through the continuum of the health care system, with an emphasis on improved community and primary care.

MOVED BY: Janet McEwen SECONDED BY: Linda Stevenson THAT the South West Local Health Integration Network Board of Directors indicates to the Ministry of Health and Long-Term Care that it endorses the proposed Woodstock General Hospital Own Funds Capital Project for a Medical Office Building at 310 Juliana Road in Woodstock, Ontario.

CARRIED

5.2 2010/11 Priorities for Investment Plan Mark Brintnell provided background on the following funding sources: Urgent Priorities Fund – Core; Urgent Priorities Fund – Dedicated; Funds Held in Reserve; In-year Health Service Provider Surplus Funds – Residential Hospice (RH) Funds. Mark spoke in depth regarding each proposed project and how they will advance set goals and priorities within the Health

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System Design Blueprint Vision 2022 and 2010-13 Integrated Health Service Plan (IHSP). The key areas of focus include: Emergency Department (ED) and Alternate Level of Care (ALC); Centrally Coordinated Resource Capacity; Population-based Integrated Health Services; Quality Improvement Program; Decision-making Infrastructure; and End of Life Care. Project progress will be shared with the LHIN Board on a quarterly basis. Next steps will include additional project proposals coming forward in September or October as part of Phase 2 of the 2010/11 Priorities for Investment Plan. Discussion highlights included: • Urology cancer surgery wait time data and how project changes could potentially be

applied to other cancer surgery wait times. A number of factors impact these surgeries including demand of physicians, type of surgery and ability to have surgery elsewhere .

• CCAC capacity to ensure they are able to fulfill project deliverables given the number of projects the CCAC is a part of.

• Educational and training opportunities for Long-Term Care homes in other areas of the LHIN will continue to be considered.

• Aboriginal funding opportunities exist through Aging at Home and new base funding through the province.

MOVED: Ron Bolton

SECONDED BY: Kerry Blagrave

THAT the South West Local Health Integration Network (LHIN) Board of Directors approves the allocation of $1,722,506 in one-time funding in 2010/11 and $360,000 in one-time funding in 2011/12 in support of the projects included in Phase 1 of the 2010/11 Priorities for Investment Plan as outlined in Appendix A. Identified funding required in 2011/12 is subject to allocations through the 2011/12 provincial estimates process. In Phase 1 of the South West LHIN Programs and Services Inventory project, a data repository was created that contains detailed information on health services in the region, as a first step toward developing a fully integrated online data repository. Phase 2 proposes to enhance thehealthline.ca database to support the inclusion of these rich information resources and make them available and easily accessible to health care providers, planners and consumers. The vision or end state is to create an information resource rich enough to support self-management, information and referral, service coordination and case management, and health care planning across the region.

CARRIED

5.3 Wait Time Strategy Update Mark Brintnell reviewed the report which details wait times within the South West LHIN. The

report highlights that since its launch in November 2005, the Ontario Wait Time Strategy has

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had significant impact on improving access to care and lowering wait times. Ontario continues to improve and is a Canadian leader with the shortest wait times for most priority service areas. The majority of Ontario patients receive surgical and imaging procedures within clinical targets and wait significantly less compared to 2005 (baseline year). Ontario has initiated a search process for a Provincial Clinical Lead – a physician who is visionary and strategic and committed to engaging the clinician community in driving healthcare forward. The Province has appointed Dr. Jonathan Irish as the interim Provincial Clinical Lead for six months. The South West LHIN is profiling performance in a series of performance profiles in our monthly newsletter and noted that MRI scans have had a 58% improvement.

5.4 2010-13 Long Term Care Home Service Accountability Agreements (L-SAA) Mark Brintnell reviewed the report and highlighted that on June 23rd the South West LHIN Board of Directors approved the Board Chair and CEO to execute the final L-SAAs on behalf of the LHIN. The LHIN has negotiated and received all 75 signed L-SAAs from our Long Term Care Homes. John Van Bastelaar and Michael Barrett will execute the L-SAAs effective July 1, 2010 to March 31, 2013 and copies will be issued to the LTC Homes by the end of August 2010. The South West LHIN is working with the new LTC Home PeopleCare Oakcrossing to put in place a new L-SAA. New LTC Homes will have an L-SAA in place once each LTC home is assigned to the LHIN by the MOHLTC. 5.5 Enterprise Risk Management Mark Brintnell reviewed the report and highlighted that the South West LHIN is establishing an Enterprise Risk Management (ERM) System. An ERM is a systematic process of identifying, analyzing and responding to risk. It involves developing flexible strategies aimed at preventing any negative event from occurring or to minimize any potential harm and provide reasonable assurance regarding the achievement of the organization’s objectives. Major risks include: Operational Risk, Financial Risk, Reputational Risk, and Strategic Risk. Mark reviewed the roles and responsibilities of the Board related to Enterprise Risk Management. A full board report will be presented at the September 22, 2010 Board of Directors meeting. Discussion highlights include:

• Reputational risk is increased with media reporting of negative events. • Continued transparency and clarity of LHIN. • Continue with communication strategies to provide good news coverage. • Risk of Health Service Providers being unaware of LHIN Strategic Plans.

5.6 2010/11 Community Sector Base Funding Increases Mark Brintnell reviewed the report and highlighted that the LHIN has received confirmation of the 2010/11 community sector base funding increases of 2% and 2.5 % for the South West

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CCAC. The South West CCAC is also receiving new base funds for increased service maximums for homecare personal support and homemaking services. The information has been shared with our health service providers but individual letters have not yet been processed. The South West LHIN previously approved the across the board allocation of new funds to community sectors within their current M-SAA of 2.25%. If providers are unable to fulfil performance obligations per their current M-SAA with the confirmed increase of 2%, the LHIN will work with the provider to amend the M-SAA as required and the LHIN board will be made aware of negotiations. However, the Board agreed that the existing signed M-SAAs would not be amended at this time. The Board went for break at 2:27 pm The Board returned from break at 2:42 pm

6. Reports 6.1 Senior Leadership Report

The Board was provided with detailed information contained in the Senior Leadership Report: • LHIN staff have continued to work with the Huron Perth Healthcare Alliance (HPHA) to

provide guidance regarding the level of information required as part of it Notice of Integration;

• LHIN staff and board members met with the St Marys Mayor, Jamie Hahn and members of the Community Action Group as well as another member of the public on August 5th, 2010 to listen to their views regarding HPHA Vision 2013. The group has provided the LHIN with two binders of information. This information is available to all board and staff. A letter of thank you was sent to the group.

• The Ministry of Health and Long-Term Care issued a call May 6, 2010 for applications from health care providers and/or community-based groups for the establishment of 30 new (Wave 5) Family Health Teams; and the applications will be reviewed by the LHIN staff.

• The Ministry of Health and Long-Term Care issued a call May 10, 2010 call for applications for 14 new (Wave 3) Nurse Practitioner-Led Clinics (NPLCs); and the applications will be reviewed by the LHIN staff.

• Review of a capital project request for the Wingham District Hospital’s (WDH) revised proposal/business case and recommended the endorsement of Phase 1 of their four-phased redevelopment plan;

• The Ministry of Health and Long-Term Care (MOHLTC) issued a Call for Proposals to LHINs for new MRI base hours. Hospitals qualified if they could operate within 10/11 and have the ability to purchase a new MRI machine/magnet or use an existing MRI machine/magnet that is not currently financially supported by the MOHLTC.

• Michael Barrett announced the appointment of Glenn Lanteigne to the position of Chief Information Officer / eHealth Lead effective August 3, 2010; and Patty Chapman has accepted the position of Planning and Integration Lead – Mental Health and Addictions. Recruitment continues for Project Management Office Lead; Performance Improvement Lead and Financial Analyst.

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• The LHIN has received the Ombudsman’s report. There is a focus on educational sessions as part of Bylaw #2. The South West LHIN has been open and transparent and all meetings have been open to the public. A revision to the bylaw will be brought back to the board at a future meeting for approval. Recommendations in the report are to strengthen community engagement process. The LHINs are currently reviewing and adopting community engagement guidelines.

6.2 Communications Update

Julie White provided an overview of the Communication Update Report of the stories tracked in July, and a South West LHIN electronic and social media update. Julie corrected an error in the report and noted that it should read that as of July 31, 2010. The @South West LHIN Twitter account had 357 followers. Julie added that the communications team is currently refreshing content on the website and also noted that the Community Engagement Policy and Community Engagement plan will be coming forward to the board in the coming months.

6.3 Board Chair Report

• The fall board retreat will be scheduled later in November; Directors were asked to remove any dates on hold in their calendar.

• As of September, all Board Committee meetings will be held at the South West LHIN office and our Board of Directors meetings will be held in one of our communities. We will continue to hold a success story presentation and a Board to Board engagement session prior to each Board of Directors meeting.

• The Board will meet once in December. The meeting will be a Board of Directors meeting on December 8th and will be held in London. All dates will be posted on our website

• John informed the Board that he will be on vacation during the November Board Committee and Board of Directors meetings and that Kerry Blagrave will Chair the meetings.

• Board members were asked to review the “LHIN Guide to Good Governance Action Framework” for their participation in task groups. Task groups will be formed at the September 8th Board Committee meeting.

• Expense claims and per diem electronic forms must be submitted electronically and submitted on a monthly basis to the Corporate Coordinator.

• Janet McEwen was thanked for Chairing the Audit Committee Chair. She is requesting to step down from this position. The next meeting of the Audit Committee will be held on September 8th, 2010

6.4 Board Members Report The following updates were given by the Board members:

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• Ron Lipsett – Pleased to be on the Board, received orientation with John Van Bastelaar and Michael Barrett this morning. Hope to make a positive contribution to the Board.

• Sheryl Feagan - Pleased to be a new member of the Board. Received orientation with John Van Bastelaar and Michael Barrett this morning. Looks forward to participating on the Board.

• Ron Bolton attended the St. Marys Community Action Group meeting, and the Ribbon Cutting & Grand Opening Ceremonies - New North Wing Stratford General Hospital Kerry Blagrave attended the Ribbon Cutting & Grand Opening Ceremonies - New North Wing Stratford General Hospital

7. Date and Location of Next Meeting

Board Committee – September 8, 2010 South West LHIN Office, London

8. Adjournment The meeting was adjourned by Kerry Blagrave at 3:31 p.m.

CARRIED

APPROVED: ______________________________

JOHN VAN BASTELAAR, CHAIR (A) SOUTH WEST LHIN

Date: ________________________

_____________________________ KERRY BLAGRAVE, SECRETARY

SOUTH WEST LHIN

Date: ________________________

South West LHIN Board Committee Meeting

Minutes Wednesday, September 8, 2010

South West LHIN Main Board Room

Present: John Van Bastelaar, Chair (A) Ron Lipsett, Director

Janet McEwen, Director Linda Stevenson, Director Ron Bolton, Director Murray Bryant, Director Sheryl Feagan, Director Staff: Michael Barrett, CEO Mark Brintnell, Senior Director, Performance, Contract and Accountability Kelly Gillis, Senior Director, Planning, Integration and Community Engagement Julie White, Director, Communications and Customer Service Glenn Lanteigne, Chief Information Officer, eHealth Lead Patty Chapman, Planning & Integration Lead

Stacey Griffin, Executive Assistant to CEO Rita Casciano, Corporate Coordinator

Regrets: Kerry Blagrave, Secretary 1. Call to Order – Welcome and Introductions

The Chair called the meeting to order at 1:00 p.m. There was quorum and 5 members of the public were in attendance.

2. Declaration of Conflict of Interest There was no declaration of conflict of interest. 3. Approval of Agenda

The following item was added to the agenda: 9. Closed session

MOVED BY: Janet McEwen SECONDED BY: Murray Bryant

THAT the Board Committee meeting agenda for September 8, 2010 be approved as amended.

CARRIED

4. Strategic Items: 4.1 Mental Health Divestment

Sandy Whittall, Integrated Vice President, Mental Health Services, St. Joseph’s Health Care, London and London Health Sciences Centre provided a mental health Tier 2 divestment presentation which included a summary of background and the journey to date with Health Services Restructuring Commission (HSRC) Directives for Tier 1-transfer of governance and management of psychiatric hospitals from province; Tier 2-divestment of inpatient services and resulting system reduction in overall bed numbers; and Tier 3-reinvestment by government in community treatment and support. Program transfer methodology outlines an iterative, collaborative process with all Tier 2 partners and the Ministry of Health and Long-Term Care (MOHLTC) over a five year period with methodology updated to 2010/11 budget. Sandy outlined the human resources transfer status; patient transfer planning and impacts of a protracted divestment process.

5. Board Committee Terms of Reference Review: The Board Chair (A) reviewed the Board Committee Terms of Reference which were established 18 months ago with the intent of the Board Committee to focus on governance and strategic directions. The updated Terms of Reference were presented to the Board Committee for discussion. The Board Committee members felt that the wording of bullet 5 of #2 needed to reflect that the succession planning for the office of Board Chair and Chairperson was not done independently but by working with the Minister of Health and Long-Term Care’s office. • change bullet 5 of “Board, Committee and Director Evaluation to read “Work with Minister’s

office to ensure succession planning for the Board Chair and the chairperson” prior to consideration of approval.

• Further discussion of Board Committee members suggested the Board Committee Chair contact the past Board Chair and Board members for exit interview comments.

• Chair contacts past Board Chair and Board members and provides a summary of exit interview comments.

6. Guide to Good Governance Overview Presentation:

The Board Chair (A) presented a Guide to Good Governance Overview highlighting Board Committee background; leading practices in governance, member’s roles and responsibilities; Board meeting evaluation and policy documents. The Board Committee discussed evaluation of the Board effectiveness; post meeting evaluations and whether there was a Board post meeting survey used by other LHINs that could be modified and used by the South West LHIN Board Committee. The Board

Committee discussed the roles and responsibilities; how the Board Committee has the responsibilities for the Health Service Providers (HSP) funding but not individual components of HSP. There are performance measure indicators which are presented to the Board on a quarterly basis to keep the Board apprised. The Board Committee members discussed the Vision and Mission statements and the soft skills of trust, respect and openness. The following items were actioned: • Consultation with all LHINs regarding a post meeting assessment and draft brought

forward to Governance Committee to review. • Michael Barrett to consult regarding Conflict of Interest clarification regarding consulting

and contract stipulations for past Board members.

The Board Committee took a break at 3:45 pm

The Board Committee resumed session at 3:50 pm 7. Back to Basics Overview Presentation

Michael Barrett provided a presentation “Back to Basics Moving Forward in the South West LHIN” The purpose of the presentation was to provide a common understanding of the LHINs organization’s foundational components; a picture of the future decision-making environment and set content for future Board Committee dialogue on our Integrated Health Service Plan (IHSP), Implementation Framework, eHealth Strategy and Planning and Performance Framework.

8. Governance: 8.1 LHIN Guide to Good Governance Implementation

John Van Bastelaar reviewed the Implementation of the LHIN Guide to Good Governance that was submitted to Minister Matthews on June 15, 2010. The Board Committee members had a discussion regarding the document activities, participants and outcomes.

8.2 Task/Committee Membership Following discussion, Board Committee Members formed membership of the following committees; however, due to the absence of Kerry Blagrave from today’s Board Committee meeting, a draft of committee membership will be distributed, providing Kerry the opportunity to join in committee membership. The Corporate Coordinator will distribute the Board Committee Membership draft list.

8.2 a) Governance Committee Governance Committee is comprised of the board chair, and two board members.

8.2 b) Audit Committee Audit Committee is comprised of the board chair, and three board members.. 8.2 c) Board Nomination Committee The Board Nomination Committee is comprised of the board chair, two board members and

three external members.

8.2 d) CEO Performance Task Force The CEO Performance Task Force is comprised of the board chair, and two board members.

8.2 e) Board Retreat

Murray Bryant provided an overview of the work done to date. The outline of the retreat is to invite the four neighbouring LHINs (North Simcoe Muskoka; Waterloo Wellington; Hamilton Niagara Haldimand Brant and Erie St. Clair LHIN) to participate in a one and a half day retreat in London. The retreat to begin with an afternoon presentation on a health services model which parallel’s the Ontario model, the second day format as classroom sessions to address issues and what they mean to each LHIN. Michael Barrett to confirm procurement process by the end of September 17th

, allowing for planning of a November retreat.

8.4 Communication Policy

Julie White provided information for discussion regarding a communication policy to establish best practices to ensure messages are delivered consistently and appropriately to key stakeholders. The draft communication policy will be taken forward to the Governance Committee for review prior to the Board of Directors for consideration of approval.

9. Closed Session

MOVED BY: Linda Stevenson SECONDED BY: Murray Bryant THAT the South West LHIN Board Committee move into closed session at 3:53 pm

MOVED BY: Linda Stevenson CARRIED

SECONDED BY: Sheryl Feagan

THAT the South West LHIN Board Committee rise from closed session at 4:05 pm.

CARRIED

The Chair (A) reported that discussion regarding legal matters were held in the closed session. 9. Date and Location of Next Meeting

Board of Directors’ Meeting – September 22, 2010 St. Marys Golf and Country Club

10. Adjournment The meeting was adjourned by Ron Lipsett at 4:08 p.m.

CARRIED

APPROVED: _____________________________ John Van Bastelaar, CHAIR (A)

SOUTH WEST LHIN

Date: ________________________

_____________________________

Janet McEwen, SECRETARY(A) SOUTH WEST LHIN

Date: ________________________

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Report to the Board of Directors Amendment of Bylaw #1 and Bylaw #2

Meeting Date:

September 22, 2010

Submitted By:

John Van Bastelaar ( A) Board Chair

Submitted To:

Board of Directors Board Committee

Purpose:

Information Only Decision

Suggested Motion

(i) THAT By-law #1 be amended by deleting “, educational” from the second sentence of the definition for “Board Meeting” in s. 1.01; and that

(ii) THAT By-law #2 be amended by deleting “, educational” from second sentence of subsection 1.02.”

AND THAT the South West LHIN Board Chair (Acting) be authorized to execute the amended Bylaw #1 and Bylaw#2, effective September 22, 2010 on behalf of the South West LHIN. Note: A two thirds majority vote is required by board members present for the motion to be passed.

Agenda Item 5.1

BY-LAW NO. 1 A by-law relating generally to the

conduct of the affairs of SOUTH WEST LOCAL HEALTH INTEGRATION NETWORK

One - Interpretation Contents

Two - Objects, Powers and Area of Operations Three - Affairs of the Corporation Four - Members of the Board Five - Committees of the Board Six - Officers Seven - Protection of Board Members, Officers and others Eight - Notices Nine - Effective Date BE IT ENACTED as a by-law of the Corporation as follows:

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TABLE OF CONTENTS

1.0 Interpretation 1.01 Definitions 1.02 Interpretation 1.03 Headings

2.0 Objects, Powers and Area of Operations 2.01 Objects 2.02 Powers 2.03 Property

3.0 Affairs of the Corporation 3.01 Head Office 3.02 Corporate Seal 3.03 Financial Year 3.04 Execution of Instruments 3.05 Banking Arrangements 3.06 Cheques, Drafts, Notes, etc. 3.07 Expenditures 3.08 Auditors 3.09 Amendment of By-laws 3.10 Annual Report

4.0 Members of the Board 4.01 Board Members 4.02 Excluded Persons 4.03 Number 4.04 Qualifications 4.05 Elected Office 4.06 Resignation 4.07 Term and Reappointment 4.08 Non-Transfer of Membership and Vacancies 4.09 Duties of the Board 4.10 Remuneration 4.11 Open Meetings 4.12 Conflicts of Interest 4.13 No Conflict of Interest

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5.01 Prescribed Board Committees 5.02 Other Board Committees 5.03 Advisory Bodies 5.04 Executive Committee 5.05 Audit Committee 5.06 Community Nominations Committee 5.07 Members of Board Committees

6.0 Officers 6.01 Appointment 6.02 Chair 6.03 Vice-Chair 6.04 Secretary 6.05 Treasurer 6.06 Chief Executive Officer 6.07 Powers and Duties of Officers 6.08 Term of Office 6.09 Remuneration of Officers 6.10 Agents and Attorneys

7.0 Protection of Members, Officers and Others

7.01 Limitation of Liability 7.02 Indemnity and Insurance

8.0 Notices 8.01 Method of Giving Notices 8.02 Notice of Board Meetings 8.03 Computation of Time 8.04 Omissions and Errors 8.05 Waiver of Notice

9.0 Effective Date 9.01 Effective Date

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SECTION ONE INTERPRETATION

1.01 Definitions

“

. - In the by-laws of the Corporation, unless the context otherwise requires:

Act” means the Local Health System Integration Act, 2006 , or any statute that may be substituted therefor, as from time to time amended; “appoint” includes “elect” and vice versa; “associate” includes with respect to an individual, any member of the individual’s immediate family who resides with the individual, including a child, parent, sibling, spouse, including a common law partner, or a same-sex partner of such individual; “board” means the board of directors of the Corporation; “Board Meeting” means a meeting of the board for the purpose of making a decision or recommendation, the taking of an action or the giving of advice in respect of any matter within the board’s jurisdiction. A meeting of Members for social purposes other than conducting Corporation business is not a Board Meeting. “Board Committee” means any committee where a majority of members are Board Members; “Board Member” means an individual appointed by the Lieutenant Governor in Council to be member of the board; “by-laws” means this by-law and all other by-laws of the Corporation from time to time in force and effect; “Chair” means the Member designated by the Lieutenant Governor in Council to be the Chair of the Corporation; “Corporation” means the corporation without share capital continued under the Act and named “South West Local Health Integration Network“ in English and “Réseau local d'intégration des services de santé du Sud-Ouest“ in French; “geographic area” has the meaning set out in section 2(1) of the Act; “LHIN” means any local health integration network;

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“Minister” means the Minister of Health and Long-Term Care or such other member of the Executive Council to whom the responsibility for LHINs may be assigned under the Executive Council Act; “Secretary” means the Board Member appointed by the board to be Secretary pursuant to this by-law; “special resolution” “special resolution” means a resolution passed by at least two-thirds of the votes cast at a Board Meeting or by the consent in writing of all the Members entitled to vote at such meeting; “Vice-Chair”

1.02

means the Board Member or Board Members appointed by the board, in accordance with this by-law.

Interpretation

. – All terms which are used in the by-laws of the Corporation and which are not otherwise defined shall have the meanings given to such terms in the Act or regulations made under the Act. Words importing the singular number include the plural and vice versa; words importing gender include the masculine, feminine and neuter genders; and words importing a person include an individual, partnership, association, body corporate, trustee, executor, administrator and legal representative. In the event of any inconsistencies between the by-laws of the Corporation, the Act and any regulations made under the Act, the order of precedence shall be the Act, the regulations and the by-laws, unless such by-laws have been approved by the Minister, in which case the by-law will govern.

1.03 Headings

SECTION TWO

. - The headings in this by-law are inserted for convenience of reference only and shall not affect the construction or interpretation of this by-law.

OBJECTS, POWERS AND AREA OF OPERATIONS

2.01 Objects

. – The objects of the Corporation are to plan, fund and integrate the local health system as set out in the Act.

2.02 Powers

. – Except as limited by the Act, the Corporation has the capacity, rights, powers and privileges of a natural person for carrying out its objects.

2.03 Property. – The property of the Corporation is not charitable property and

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shall, on amalgamation, division or dissolution, be distributed or disposed of in accordance with the terms of the Act.

SECTION THREE

AFFAIRS OF THE CORPORATION 3.01 Head Office

. - Until changed by special resolution and with the approval of the Minister, the head office of the Corporation shall be in the [XXXX] in the Province of Ontario, Canada, and at such location therein as the board may from time to time determine.

3.02 Corporate Seal.

- The Corporation may, but need not, have a corporate seal and if one is adopted it shall be in a form approved from time to time by the board.

3.03 Financial Year

. - The fiscal year of the Corporation shall end on March 31 of each year.

3.04 Execution of Instruments

. - Deeds, transfers, assignments, contracts, obligations, certificates and other instruments may be signed on behalf of the Corporation by two Board Members, one of whom holds the office of Chair of the board, Vice-Chair or Secretary. In addition, the board may from time to time direct the manner in which and the person or persons by whom any particular instrument or class of instruments may or shall be signed. Any signing officer may affix the corporate seal to any instrument requiring the same.

3.05 Banking Arrangements

. - The banking business of the Corporation, including any short-term investments, shall be transacted with the Government of Ontario’s bank of record as may from time to time be designated, and shall be conducted in accordance with any agreement with the Minister.

3.06 Cheques, Drafts, Notes, etc.

- All cheques, drafts and orders for the payment of money and all notes and acceptances and bills of exchange shall be signed by two persons, and in such manner, as the board may from time to time designate by resolution.

3.07 Expenditures

. - Subject to the Act and the by-laws, the board shall have the power to authorize expenditures on behalf of the Corporation, from time to time, and may delegate by resolution to a Board Member or officer the right to employ and pay salaries to employees. The board shall have the power to make expenditures for the purpose of furthering the objects of the Corporation.

3.08 Auditors

. - The Board Members shall appoint an auditor to audit the accounts of the Corporation annually.

3.09 Amendment of By-laws. – Subject to the provisions set out in the Act, any

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existing by-law of the Corporation not embodied in the Act may be repealed or amended by a special resolution. If the Minister requires the board to submit a proposed by-law to the Minister for approval before making the by-law concerned, the board shall not make the by-law concerned until the Minister approves it. If the Minister requires the board to submit an existing by-law to the Minister for approval (a) the by-law concerned ceases to be effective from the time that the Minister imposes the requirement until the Minister approves the by-law; (b) anything that the board has done in compliance with the by-law concerned before the Minister imposes the requirement is valid; and (c) the board may do anything that, before the Minister imposes the requirement, it has agreed to do. 3.10 Annual Report.

SECTION FOUR

– An annual report on the affairs and operations of the Corporation for the preceding fiscal year shall be submitted by the Corporation to the Minister in accordance with the Act. The annual report shall include audited financial statements for the fiscal year of the Corporation to which the report relates; data relating specifically to Aboriginal health issues addressed by the Corporation; and any additional information specified in any agreement with the Minister. The annual report shall be signed by the Chair and one other Board Member of the Corporation and shall be in the form that the Minister specifies.

MEMBERS OF THE BOARD OF DIRECTORS

4.01 Board Members

. -Subject to the Act and these by-laws, the Board Members shall consist only of persons who have a background in health care, public administration, management, accounting, finance, law, human resources, labour relations, communications or information technology or such other skills and professions that can assist a board in meeting its objects who are appointed by the Lieutenant Governor in Council after consideration of the above qualifications.

4.02 Excluded Persons

(a) a member of the board, chief executive officer, an officer, employee or staff of:

. − Unless otherwise permitted by the Minister, no person shall be a Board Member of the Corporation if such person is:

(i) any corporation, agency or entity that represents the interests of persons who are part of the health sector and whose main purpose is advocacy for the interest of those persons;

(ii) a College of a health profession or group of health professions as defined under the Regulated Health Professions Act, 199

(iii) an entity that receives funding from a LHIN; 1; or

(b) an employee of the Ministry of Health and Long-Term Care; (c) an employee of the Corporation; or (d) an associate of any person referred to in Sections 4.02(a), (b) or (c).

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4.03 Number

. − There shall be no more than nine Board Members of the Corporation.

4.04 Qualifications.

(a) be at least eighteen years of age;

− In addition to the qualifications set out in Section 4.01, each Board Member shall:

(b) not be an undischarged bankrupt; (c) be a person interested in furthering the objects of the Corporation; and (d) attend Board Meetings on a regular basis.

4.05 Elected Office

. − Members shall resign from their positions to seek nomination for, be a candidate for, or hold a provincial or federal elected office.

4.06 Resignation

. – Board Members may resign at any time by resignation in writing given to the Chair of the Corporation and to the Minister. A resignation shall be effective on the later of the date specified in the letter of resignation, or the date the letter of resignation is received by the Chair. A Board Member shall remain liable for payment of any assessment or other sum levied or which becomes payable by the Board Member to the Corporation prior to the effective date of such resignation.

4.07 Term and Reappointment

. - The term of a Board Member shall be for up to three years. A Board Member may be reappointed for a second term at the discretion of the Lieutenant Governor in Council.

4.08 Non-Transfer of Membership and Vacancies.

(a) upon the death of the Board Member;

− The office of a Board Member is not transferable. A Board Member ceases to be a Board Member: :

(b) when the Board Member’s term of appointment expires and is not renewed; (c) when the Board Member’s appointment is revoked by the Lieutenant

Governor in Council; or (d) when the Board Member falls within the categories of excluded persons

in Sections 4.02, 4.04, or 4.05 of this By-law. A Board Member who falls within the categories in Sections 4.02, 4.04, or 4.05 shall immediately inform the Chair of such fact and shall resign.

4.09 Duties of the Board

4.10

. − The affairs of the Corporation shall be under the management and control of the board of directors.

Remuneration. − The Corporation shall provide remuneration to the Board Members as established by the Lieutenant Governor in Council. The Corporation shall also reimburse the Board Members for reasonable travelling and other expenses properly incurred by them in attending Board Meetings or Board Committee Meetings.

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4.11 Open Meetings

. − Board Meetings shall be open to the public and shall be conducted in accordance with By-law No. 2.. In addition, if the Minister has given the Corporation a policy on open meetings for the Corporation pursuant to any agreement with the Minister, the board shall follow the requirements of such policy.

4.12 Conflicts of Interest

. − The board shall develop, in accordance with the Act and any other applicable legislation, conflict of interest policies for the Board Members and employees of the LHIN that are consistent with the rules of the government of Ontario’s Conflict of Interest & Post-Service Directive for Public Servants and Officials under the Public Service Act.

4.13 No Conflict of Interest

. − Board Members are subject to the conflict of interest policy developed in accordance with Section4.12. The board shall ensure that the Corporation’s operations are carried out without a conflict of interest by any Board Member, officer or employee.

SECTION FIVE COMMITTEES OF THE BOARD

5.01 Prescribed Board Committees. - The board will establish any committees of the board that the Minister prescribes under the Act. Prescribed committees shall be incorporated into this by-law as required committees. The Board will appoint as members of the committees the persons who meet the qualifications, if any, that the Minister specifies in the regulation and will ensure that the committees operate in accordance with the other requirements, if any, that the Minister specifies in the regulation.

5.02 Other Board Committees. – the board may establish any committees that the board may require from time to time by resolution and may delegate to any such Board Committee any of the powers of the board, subject to any rules and terms of reference imposed from time to time by the board. 5.03 Advisory Bodies

5.04

. - The board shall appoint such advisory bodies as are prescribed or as it may deem advisable. Advisory bodies, whether committees or otherwise, may not exercise powers of the board

Executive Commit tee. - Whenever the board consists of more than six Board Members, the board may, but is not required to, establish an Executive Committee. To do so, the board shall elect from its Board Members an executive committee consisting of not less than three, which committee shall have power to fix its quorum at not less than a majority of its number and may exercise all the

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powers of the board, subject to any terms of reference imposed from time to time by the board. The Chair shall be a member of the executive committee. 5.05 Audit Committee. – the board shall have an Audit Committee which shall report to and be accountable to the board. The Audit Committee shall review and provide advice and recommendations to the board on: (i) the Corporation’s obligations with respect to appropriate accounting and

financial reporting; (ii) whom the Corporation should appoint annually as its auditor; (iii) the annual audit plan of the Corporation; (iv) the audited financial statements of the Corporation; (v) appropriate risk management activities; (vi) whom a health service provider should appoint as its auditor to audit its

accounts and financial transactions, if the Corporation directs the service provider under section 21 of the Act to have such an auditor; and

(vii) on any other matters required by the board.

5.06 Community Nominations Committee

. – the board shall have a Community Nominations Committee which shall report to and be accountable to the board. The Community Nominations Committee shall, (i) give notice to the public of vacancies on the board of directors of the

network; (ii) inform the public about the objects and role of the network; (iii) identify potential appointees to the board of directors of the network

through a local community nomination process; (iv) recommend to the board of directors of the network potential appointees

to the board of directors of the network; and (v) undertake any other matters required by the board.

5.07 Members of Board Committees.

- The board may, by resolution, (i) appoint and remove committee members; and (ii) fill vacancies on committees. The chief executive officer or his or her designate may be invited to attend meetings of a board committee as a non-voting member.

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SECTION SIX OFFICERS

6.01 Appointment

. – Subject to the provisions of the Act and this By-law, the board shall from time to time appoint a Chair and a Secretary and may appoint one or more Vice-Chairs (to which title may be added words indicating seniority or function), a treasurer, chief executive officer and such other officers as the board may determine, including one or more assistants to any of the officers so appointed. Subject to the Act and this by-law, one person may hold more than one office. The board may specify the duties of and, in accordance with this by-law and subject to the Act, delegate to such officers powers to manage the business and affairs of the Corporation. An officer, other than Chair and Vice-Chair, may, but need not, be a Board Member, but the chief executive officer shall not be a Board Member.

6.02 Chair

6.03

. − The board shall appoint the Board Member designated by the Lieutenant Governor in Council pursuant to the Act, as Chair. The Chair shall chair, when present and able, all Board Meetings, and the executive committee; sign all documents requiring the Chair’s signature; ensure that all minutes are an accurate reflection of the meetings by signing them when approved; and perform any other duties assigned by the board.

Vice-Chair

. - The board shall appoint the Board Member designated by the Lieutenant Governor in Council pursuant to the Act as a Vice-Chair of the Corporation. If no such person is designated, the board may appoint from time to time one Vice-Chair. If so appointed, the Vice-Chair shall have such powers and duties as the board may specify until such time as a Vice-Chair is designated by the Lieutenant Governor in Council. During the absence or disability of the Chair, the Vice-Chair shall also have the powers and duties of that office.

6.04 Secretary. - The board shall appoint a Secretary. The Secretary shall be empowered by the board to carry on the affairs of the Corporation generally under the supervision of the Chair. The Secretary shall be responsible for insuring the preparation and accuracy of minutes of all Board Meetings and shall enter or cause to be entered in records kept for that purpose minutes of all Board and Board Committeee proceedings. The Secretary shall give or cause to be given, as and when instructed, all notices to Board Members, officers, Board Committee members and the public and shall be the custodian of the stamp or mechanical device generally used for affixing the corporate seal of the Corporation and of all books, records and instruments belonging to the Corporation, except when some other officer or agent has been appointed for that purpose. The Secretary shall have such other powers and duties as

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otherwise may be specified by the board. 6.05 Treasurer

6.06

. - The board may from time to time appoint a treasurer. The treasurer shall keep proper accounting records of the financial activities of the Corporation, and shall be responsible for the deposit of money, the safekeeping of securities and the disbursement of the funds of the Corporation. The treasurer shall render to the board whenever required an account of all transactions of the treasurer and of the financial position of the Corporation. The treasurer shall have such other powers and duties as otherwise may be specified. If a treasurer is not appointed, the duties of the treasurer shall be carried out by the Secretary or such other officer as the board may from time to time determine.

Chief Executive Officer.

(i) except such matters and duties as by law must be transacted or

performed by the board; and

− The board shall from time to time appoint as chief executive officer the person acceptable to the board. The board shall delegate to the chief executive officer full power to manage and direct the business and affairs of the Corporation and to employ and discharge agents and employees of the Corporation:

(ii) subject to such restrictions and policies as are passed by the board. The chief executive officer shall conform to all lawful orders given by the board and shall at all reasonable times give to the Board Members or any of them all information they may require regarding the affairs of the Corporation. 6.07 Powers and Duties of Officers

. - The powers and duties of all officers shall be such as the terms of their engagement call for or as the board or (except for those whose powers and duties are to be specified only by the board) the chief executive officer may specify. The board and (except as aforesaid) the chief executive officer may, from time to time and subject to the provisions of the Act, vary, add to or limit the powers and duties of any officer. Any of the powers and duties of an officer to whom an assistant has been appointed may be exercised and performed by such assistant, unless the board or the chief executive officer otherwise directs.

6.08 Term of Office. - The board, in its discretion, may remove any officer of the Corporation, other than the Chair, and the Vice-Chair where the Lieutenant Governor in Council has approved a person as the Vice-Chair of the Corporation. Each officer appointed by the board shall hold office until a successor is appointed or until an earlier resignation is received by the Corporation.

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6.09 Remuneration of Officers.

6.10

- The officers, who are neither Board Members nor the chief executive officer, shall be paid such remuneration for their services as the board may from time to time determine. If the Minister fixes ranges for the salary or other remuneration and benefits of a chief executive officer, the board shall provide its chief executive officer a salary or other remuneration and benefits within such ranges as are set by the Minister.

Agents and Attorneys

. - The Corporation, by or under the authority of the board, shall have power from time to time to appoint agents or attorneys for the Corporation in Ontario with such powers (including the power to sub delegate) of management, administration or otherwise as may be thought fit.

SECTION SEVEN PROTECTION OF MEMBERS, OFFICERS AND OTHERS

7.01 Limitation of Liability

(a) the acts, receipts, neglects or defaults of any other Board Member, officer or employee;

. - Every Board Member and officer of the Corporation in exercising the powers and discharging the duties of a Board Member or officer shall act honestly and in good faith with a view to the best interests of the Corporation and exercise the care, diligence and skill that a reasonably prudent person would exercise in comparable circumstances. Subject to the foregoing, no Board Member or officer shall be liable to the Corporation for:

(b) any loss, damage or expense happening to the Corporation through the insufficiency or deficiency of title to any property acquired for or on behalf of the Corporation;

(c) the insufficiency or deficiency of any security in or upon which any of the moneys of the Corporation shall be invested;

(d) any loss or damage arising from the bankruptcy, insolvency or tortious acts of any person with whom any of the moneys, securities or effects of the Corporation shall be deposited;

(e) any loss occasioned by any error of judgment or oversight on the part of the Board Member or officer; or

(f) any other loss, damage or misfortune which shall happen in the execution of the duties of such office or in relation thereto, provided that the Board Member or officer has acted in accordance with the Act, its regulations, or this by-law and the loss has not arisen from the wilful neglect or dishonesty of the Board Member or officer.

7.02 Indemnity and Insurance - Subject to the Act and obtaining the approval of the Minister, the Corporation shall indemnify an officer in such form of indemnity as approved by the Minister. The Corporation shall not purchase directors and officers liability insurance without the permission of the Minister.

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SECTION EIGHT NOTICES

8.01 Method of Giving Notices

8.02

. – Subject to 8.02, any notice (which term includes any communication or document) to be given (which term includes sent, delivered or served) pursuant to the Act, the by-laws or otherwise to a Board Member, Board Committee Member or officer shall be sufficiently given if delivered personally to the person to whom it is to be given or if delivered to the last address of such person as recorded in the books of the Corporation or if sent to said address by any means of wire or wireless or any other form of transmitted or recorded communication. A notice so delivered shall be deemed to have been given when it is delivered personally or at the address aforesaid; and a notice sent by any means of wire or wireless or any other form of transmitted or recorded communication shall be deemed to have been given when transmitted, or delivered to the appropriate communication company or agency or its representative for dispatch. The Secretary may change the address on the Corporation’s books of any Board Member, officer, auditor or member of a Board Committee in accordance with any information believed to be reliable.

Notice of Board Meeting.

8.03

– Notwithstanding 8.01, notices for Board and Board Committee meetings shall be governed by the provisions of s. 4.0 of By-law No. 2.

Computation of Time

. - In computing the date when notice must be given under any provision requiring a specified number of days’ notice of any meeting or other event, the date of giving the notice shall be excluded and the date of the meeting or other event shall be included.

8.04 Omissions and Errors

. - The accidental omission to give any notice to any Board Member, or officer or the non-receipt of any notice by any Member, or officer or any error in any notice not affecting the substance thereof shall not invalidate any action taken at any meeting held pursuant to such notice or otherwise founded thereon.

8.05 Waiver of Notice

. - Any Board Member, or officer may waive any notice required to be given under any provision of the Act, the by-laws or otherwise and such waiver, whether given before or after the meeting or other event of which notice is required to be given, shall cure any default in giving such notice.

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SECTION NINE EFFECTIVE DATE

9.01 Effective date

PASSED by the board the 22nd day of September,

. - Subject to the provisions of the Act, this by-law shall come into force when passed by motion of the board.

2010

.

Chair

Secretary

BY-LAW NO. 2 A by-law relating generally to the

conduct of Board and Board Committee Meetings of the

SOUTH WEST LOCAL HEALTH INTEGRATION NETWORK (THE “Corporation”)

BE IT ENACTED as a by-law of the Corporation as follows:

Table of Contents 1.0 Interpretation

1. 1 Definitions 1. 2 Board Meetings 1. 3 Interpretation 1. 4 Headings

2.0 Application of By-law No. 2 2.1 Board Meeting, Board Committee Meetings 2. 2 Other Meetings 3.0 Frequency, Location and Calling of Board Meetings 3. 1 Frequency 3. 2 Location 3.3 Calling a Board Meeting 3.4 Date and Time 4.0 Notice 4.1 Notice to Board Members 4.2 Notice to the Public 4.3 Purpose of the Meeting 4.4 Notice to Board Members of Subsequent Meetings 4.5 Special Board Meetings 4.6 Delivery of Notice 4.7 Errors and Omissions 4.8 Waiver of Notice 5.0 Use of Video and/or Telecommunication Devices or Facilities 5.1 Attendance by Board Members 5.2 Attendance by the Public 5.3 Disruption of Meetings

6.0 Quorum 6.1 Quorum for the Conduct of Business 6.2 Quorum and Board Vacancies 6.3 Lack of a Quorum

7.0 Agenda 7.1 Availability 7.2 Content 7.3 Preliminary Matters 7.4 Order of Business 7.5 Scheduling of Agenda Items 7.6 Adjournment Prior to Completion of Agenda 8.0 Chairing the Meeting 8.1 Chair of the Meeting 8.2 Duties of the Chair 8.3 Chair in Control 8.4 Appeals of Procedural Decisions of the Chair 9.0 Motions, Resolutions & Voting 9.1 Decision-making Process 9.2 Votes Must be Taken 9.3 Common Motions 9.4 One Board Member, One Vote; Majority Rules 9.5 Outcome of the Vote 9.6 Recording of Results 9.7 Voting during Meetings held by Electronic Means 9.8 Abstaining from Voting 10.0 Rules of Debate & Board Members Code of Conduct 10.1 Chair to Control Debate 10.2 Participation in the Debate 10.3 Opportunity to Speak 10.4 Participation by Electronic Means 10.5 Fiduciary Duty to Support Majority 10.6 Code of Conduct 11.0 Closed Sessions 11.1 General 11.2 Discussions Permitted in a Closed Session 11.3 Giving Notice of a Closed Session 11.4 Agendas 11.5 Moving into a Closed Session 11.6 Proceedings During the Closed Session 11.7 Concluding the Closed Session 11.8 Minutes of Proceedings During Closed Sessions 11.9 Annual Review and Report 12.0 Minutes 12.1 Content of Minutes 12.2 Circulation of Draft Minutes 12.3 Approval of Minutes 12.4 Public Access to Minutes

13.0 Public Access 13.1 Notice to the Public 13.2 Accommodation 13.3 Access to Agendas 13.4 Access to Non-Confidential Materials 13.5 Recording of Proceedings 13.6 Questions 14.0 Effective Date 14.1 Effective Date Appendices A: Sample Agenda B: Common Motions and Appeals C: Form of Motion for a Closed Session

CONFIDENTIAL – FOR INTERNAL DISTRIBUTION ONLY

SECTION ONE INTERPRETATION

1.01 Definitions

. - In the by-laws of the Corporation, unless the context otherwise requires:

“Act

” means the Local Health System Integration Act, 2006, or any statute that may be substituted therefor, as from time to time amended;

“appoint

” includes “elect” and vice versa;

“associate

” includes with respect to an individual, any member of the individual’s immediate family who resides with the individual, including a child, parent, sibling, spouse, including a common law partner, or a same-sex partner of such individual;

“board

” means the board of directors of the Corporation;

“Board Committee

” means any committee where a majority of members are Board Members;

“Board Committee Meeting

” means a meeting of the members of a Board Committee;

“Board Meeting

” has the meaning set out in ss 1.2 below;

“Board Member

” means an individual appointed by the Lieutenant Governor in Council to be member of the board;

“By-law No. 1

“ means the by-law No. 1 duly passed by the board;

“by-laws

” means this by-law and all other by-laws of the Corporation from time to time in force and effect;

“Chair

” means the Board Member designated by the Lieutenant Governor in Council to be the chair of the Corporation;

“Closed Session

” means a session of a Board Meeting during which non- Board Members may be excluded to enable certain matters to be considered in confidence, pursuant to the provisions of s.9(5) of the Act;

“Committee Member” and “Committee Members

” means one and more than one member of a Board Committee, whether a Board Member or member of the public.

“Corporation” means the corporation without share capital continued under the

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Act and named “South West Local Health Integration Network“ in English and “Réseau local d'intégration des services de santé du Sud-Ouest“ in French; “geographic area” has the meaning set out in section 2(1) of the Act; “LHIN” means any local health integration network; “Minister” means the Minister of Health and Long-Term Care or such other member of the Executive Council to whom the responsibility for LHINs may be assigned under the Executive Council Act; “present” means physically in attendance at the Board Meeting or, if properly authorized, in attendance by electronic means; “Quorum” means a majority of Board Members; “Secretary” means the individual appointed by the board to be secretary pursuant to By- Law No. 1; “Special Board Meeting” means a meeting to deal with a matter which, in the opinion of the Chair, the acting Chair or a majority of the board, requires action before the next regularly scheduled Board Meeting. “special resolution” means a resolution that must obtain at least two-thirds of the votes cast at a Board Meeting in order to be approved; “Vice Chair” means the Board Member appointed by the board, in accordance with By-law #1, to be the Vice-Chair of the Corporation.

1.02 “Board Meeting” means a

1.03

meeting of the board for the purpose of making a decision or recommendation, the taking of an action or the giving of advice in respect of any matter within the board’s jurisdiction. A meeting of Board Members for social purposes other than conducting Corporation business is not a Board Meeting. Where the Board Members attend a meeting held by another organization or entity, or visit another organization or entity, the meeting will not be considered a Board Meeting subject to these guidelines, unless the Board Members will be making a decision or recommendation, taking an action or giving advice to the Corporation in respect of any matter within the board’s jurisdiction.

Interpretation which are not otherwise defined shall have the meanings given to such terms in

the Act or regulations made under the Act. Words importing the singular number include the plural and vice versa; words importing gender include the masculine,

. – All terms which are used in the by-laws of the Corporation and

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feminine and neuter genders; and words importing a person include an individual, partnership, association, body corporate, trustee, executor, administrator and legal representative.

1.04 Headings

. - The headings in this by-law are inserted for convenience of reference only and shall not affect the construction or interpretation of this by-law.

SECTION TWO - APPLICATION OF BY-LAW No. 2

2.01 Board Meetings, Board Committee Meetings

(a) The procedures outlined in this guideline apply to the conduct of Board Meetings and to the conduct of Board Committee Meetings.

(b) When applied to Board Committee Meetings, the term “Board” shall be replaced

with “Board Committee”, the term “Board Meeting” shall be replaced with “Board Committee Meeting”, the term “Board Member” shall be replaced with “Committee Member”, and the term “Chair” shall refer to the chairperson of the Board Committee, as appropriate.

(c) All points of order or procedures not addressed in this guideline shall be resolved

with reference to “Procedures for Board Meetings and Organizations”, 3rd edition, Kerr, M.K. and King, H.W., Carswell, 1996.

2.02 Other Meetings - The chair of any meeting other than a Board Meeting or a Board Committee Meeting may choose to follow the procedures set out in this By-law, in whole or in part. A decision to follow the procedures shall be made, and communicated to all participants, prior to the start of the meeting.

SECTION THREE - FREQUENCY, LOCATION AND CALLING OF BOARD MEETINGS

3.01 Frequency. - The board will meet at least four times within a calendar year. 3.02 Location. - (a) Unless all Board Members participate pursuant to subsection 5.1, all Board Meetings shall be held within the geographic area of the Corporation.

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(b) Subject to (a) the board shall meet at such time and such place as the board or the Chair determines. 3.03 Calling a Board Meeting

3.04

. - Subject to this by-law, meetings of the board shall be held from time to time at such time and at such place as the board, the chair or a majority of directors may determine.

Date and Time

4.01

. The board may fix the date and time of regularly scheduled Board Meetings by resolution.

SECTION FOUR – NOTICE

Notice to Board Members

4.02

. – Notice of the time and place of each Board Meeting other than Special Board Meetings shall be given to each Board Member, not less than ten business days before the date of the Board Meeting. In computing the date when notice must be given, the date of giving the notice shall be excluded and the date of the Board Meeting or other event shall be included. If the Board Members pass a resolution fixing the place and time of regular Board Meetings, and provided that a copy of the resolution is given to each Board Member then no other notice will be required.

Notice to the Public

. - (a) The date, location and time of Board Meetings, other than Special Board Meetings, will be available to the public no less than 10 business days prior to the Board Meeting on the Corporation’s website. The board will make such other announcements by advertising or otherwise as the board deems appropriate.

(b) If the public may access the Board Meeting via video or teleconferencing technology, then the notice to the public shall specify the locations at which the tele or video conferencing will be available.

4.03 Purpose of the Board Meeting

. - A notice need not specify the purpose of or the business to be transacted at the Board Meeting.

4.04 Notice to Board Members of Subsequent Board Meetings

. – Notice of a subsequent Board Meeting is not required to be given to Board Members if the time and place of the next Board Meeting is announced during a Board Meeting.

4.05 Special Board Meetings. - Notice of a Special Board Meeting shall be given by contacting all Board Members and advising them of the time and place of the

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Board Meeting. The date, location and time of Special Board Meetings will be provided to the public by posting a notice on the Corporation’s website as soon as reasonably possible after the date for the Special Board Meeting has been set. In all other respects, the notice to the public of a Special Board Meeting shall be as set out in s.4.02, above.

4.06 Delivery of Notice

. - Notice shall be delivered to each Board Member at the last address provided by them. Delivery shall be personal, by courier, e-mail or voice-mail. Delivery shall be deemed to have occurred: (i) on the day it is delivered personally; (ii) on the day it is delivered by courier to the address provided; or (iii) on the day it is transmitted by e-mail or voice-mail, provided that such transmission occurs before 5:00 pm, or on the next day if transmitted after 5:00 pm.

4.7 Errors and Omissions

. – Neither an error that does not affect the substance of the notice nor the accidental omission to give any notice to any Board Member or the public, shall invalidate any action taken at any Board Meeting held pursuant to such notice.

4.8 Waiver of Notice

SECTION FIVE – USE OF VIDEO AND/OR TELECOMMUNICATION DEVICES OR FACILITIES

5.1 Attendance by Board Members. - A Board Member may participate in a Board Meeting by means of telephone, electronic, video-conferencing or other communication facilities as permit all persons participating in the Board Meeting to communicate with each other simultaneously and instantaneously. Such a Board Member will be deemed to be present at the Board Meeting.

5.2 Attendance by the Public. - At the discretion of the board, the public may be

permitted to attend the Board Meeting via video-conferencing or tele-conferencing. If alternate means of access are made available by the board, then the Notice to the public shall specify the locations at which the tele or video conferencing will be available. The Notice shall also include any restrictions that may be applicable to such access.

. - Any Board Member may waive any notice required to be given under these guidelines before, during or after the Board Meeting for which notice should have been given in accordance with these guidelines. A waiver shall cure any default in giving such notice.

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5.3 Disruption. - In the event that a Board Meeting that is being accessed electronically is encountering either interference or disruption caused by those participating electronically, the Chair may direct the electronic access to be terminated.

SECTION SIX – QUORUM

6.1 Quorum for the Conduct of Business. - A Quorum must be present for the Board Members to be able to exercise their powers, i.e. transact business at a Board Meeting. A Quorum for a Board Committee Meeting shall be a majority of the Committee’s Members or such other number as may be set out in the applicable terms of reference. If a Board Meeting is held electronically, the Chair will periodically do a role call to ensure that a Quorum remains in effect.

6.2 Quorum and Board Vacancies. - Where there is a vacancy in the board, the remaining Board Members may exercise all the powers of the board so long as a Quorum remains as follows: # of Members Appointed: 9 8 7 6 5 4 3 2 1 # Required for a Quorum 5 5 4 4 3 3 2 2 1

6.3 Lack of a Quorum. – The board cannot make a decision in the absence of a

Quorum. If an existing Quorum at a given meeting is lost temporarily through the withdrawal of a Board Member due to a conflict of interest, then the meeting may continue, but no decision can be made on the issue that gave rise to the declaration of conflict. If a Quorum is lost permanently through the departure of a Board Member, then the Board Meeting should be terminated as soon as reasonably possible after the Quorum is lost. At the discretion of the Chair the meeting can continue for items not requiring a board decision provided that such items are not required to inform a subsequent decision.

SECTION SEVEN – AGENDA

7.1 Availability. - An agenda of business to be conducted will be prepared and distributed to the Board Members five business days prior to each Board Meeting. The agenda will be accompanied by copies of any supplementary material to be discussed or considered at the Board Meeting.

7.2 Content. - The agenda will identify the date, time and location of the Board Meeting and, where applicable, the dial-in number or other means by which

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Board Members may participate. Where possible, the agenda will also identify whether it is proposed that the Board Meeting include a Closed Session.

7.3 Preliminary Matters. - Each agenda will require the Chair to (i) identify those Board Members and other participants present, (ii) recognize a Quorum; and (iii) call for a declaration of conflicts of interest, prior to the conduct of any business. An example of an agenda is set out in Appendix A.

7.4 Order of Business. - Unless otherwise agreed by the Board Members present at

the Board Meeting, business will be conducted in the order set out in the agenda. A proposal to change the order of agenda items may be made at the beginning of a Board Meeting and shall require a majority vote to approve.

7.5 Scheduling of Agenda Items. - In order to be placed on the agenda, an item

requiring a decision by the board must be submitted to the Secretary at least seven business days before the Board Meeting. No additional matters requiring a decision by the board may be brought forward at a regular Board Meeting unless the matter is on the agenda –except that new matters requiring a decision before the next regularly scheduled Board Meeting be added to the agenda by a majority vote.

7.6 Adjournment Prior to Completion of Agenda. - If a Board Meeting is

adjourned prior to the consideration of all items on the agenda, then the items shall be placed on the agenda for the next Board Meeting.

SECTION EIGHT - CHAIRING THE MEETING 8.1 Chair of the Meeting. - The Chair, or in the absence of the Chair, the Vice-

Chair, shall preside as Chair of the Board Meeting. If neither the Chair, nor the Vice-Chair is present, then the Board Members present shall choose one of their number to be the Chair.

8.2 Duties of the Chair. - It shall be the duty of the Chair of the Board Meeting:

a) to preserve order and decorum and decide all questions of order, subject to an appeal to the board;

b) to appropriately manage, in accordance with the Conflict of Interest

guidelines, any conflict of interest issue that is raised during the Board Meeting;

b) to receive and submit, in the proper manner, all motions presented by the

Board Members;

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c) to put to vote all questions which are properly brought before the board or

necessarily arise in the course of proceedings, and to announce the results;

d) to call by name any Board Member persisting in breach of the rules of

order and may order a Board Member to vacate the room; and e) to ensure that the decisions of the Board Members are in conformity with

the laws and by-laws governing the activities of the board and its Board Members.

8.3 Chair in Control. -

(a) Rulings or directives from the Chair will be followed by all attendees. (b) The Chair may exclude members of the public for improper conduct or

disruptive behaviour. The determination what is improper conduct or disruptive behaviour is within the discretion of the Chair. The Chair may recess the Board Meeting and or call for assistance from local authorities to enable the removal of members of the public.

(c) The Chair may terminate the Board Meeting, prior to the conclusion of

board business, if in the opinion of the Chair such an action is necessary. 8.4 Appeals of Procedural Decisions of the Chair. - Any Board Member may

appeal a procedural decision of the Chair to the board. An appeal of a procedural decision of the Chair shall be chaired by the Vice Chair.

SECTION NINE – MOTIONS, RESOLUTIONS & VOTING

9.1 Board Members Decisions. – Board Member’s decisions are made by motion in the following manner:

(a) a matter requiring a decision is introduced by the Chair; (b) a motion in respect of the decision is made by a Board Member; (c) where applicable, a second Board Member seconds the motion; (d) debate occurs on the motion; and (e) a vote is taken.

9.2 Votes Must be Taken. - Unless a motion or a second is withdrawn, motions

must be voted on.

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9.3 Common Motions. - A table of common motions together with suggested forms of the motions is appended to these guidelines as Appendix B.

9.4 One Member, One Vote; Majority Rules – Each Board Member, including the

Chair, has one vote. Every question before the board shall be decided by a majority of the votes cast on a motion. In the event of a tie, the Chair does not have a deciding vote.

9.5 Outcome of the vote. - The Chair shall declare the outcome of the vote on all

questions. Should the outcome be disputed, the vote shall be retaken. 9.6 Recording of results. - Any Board Member may require the outcome of a vote

to be recorded. A request for a recorded vote may be made before or after the vote. Where a recorded vote is not requested, the minutes will simply reflect that a motion was approved or not approved.

9.7 Voting during electronic Board Meetings. -When a vote is called, the Chair will first ask for those opposed to the motion. If no one is opposed, the motion will be considered to be carried. If there is opposition a roll call vote will be held and the Chair will declare the number of votes cast in favour, the number of votes cast against and whether the motion is carried.

9.8 Abstaining from Voting. – All Board Members present shall vote on all motions

put to the board except in the following circumstances: (i) they have declared a conflict of interest; or (ii) the matter calls for the approval of minutes of a Board Meeting at which they were not present; or (iii) they are prohibited by law.

With the exception of Board Members in the above circumstances, Board Members present who do not vote shall be deemed to have voted against the motion in question.

SECTION TEN - RULES OF DEBATE & BOARD MEMBERS CODE OF CONDUCT 10.1 Chair to Control Debate. - Every Board Member must be recognized by the

Chair prior to speaking to any question or motion. Board Members will address all comments to the Chair. At the discretion of the Chair, questions asked by a Board Member may be answered by a third party, prior to receiving another Board Member’s comments.

10.2 Participation in the Debate. – Board Members will (i) speak in the order

indicated by, and within the time limits set by the Chair; (ii) confine their remarks to the merits of the motion; (iii) not attack another Board Member’s motives; (iv) not prolong debate unnecessarily by restating previously made

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points of view. 10.3 All Members to Speak. – Board Members who have spoken to a motion

previously, will respect the Chair’s need to hear from all Board Members prior to hearing from a Board Member twice.

10.4 Participation by Electronic Means. – In any meeting where some or all of the

Board Members are participating by electronic means, all participants will identify themselves before making any comments.

10.5 Fiduciary Duty to Support Majority. – Board Members will debate items fully

but will support the decision by the majority of Board Members once the result of the vote has been declared by the Chair.

10.6 Code of Conduct. – Board Members will

(i) conduct themselves professionally and in a manner consistent with all applicable law, codes of conduct, guidelines and directives; (ii) come to Board Meetings prepared and having read all materials provided in advance; (iii) confine their remarks to the motion or other question, will not use any indecorous or offensive language and shall avoid personal comments or observations; (iv) be, and be seen to be, impartial and objective during Board Meetings; (v) participate fully in Board Meetings; (vi) not disclose the content of confidential proceedings or materials; (vii) understand the board’s role in policy-making and its separation from the daily conduct of Corporation administration and management; (viii) recognize that authority resides with the board as a whole and not with individual Board Members; and (ix) recognize that the Chair is the primary spokesperson for the board and

that the Chair and the CEO are the primary spokespersons for the Corporation. Board Members will direct requests from third parties for information or participation in external events, to the Chair or the Secretary.

SECTION ELEVEN - CLOSED SESSIONS

11.1 In General. - Proceedings in a Closed Session are confidential. They are attended only by the Board Members present at the Board Meeting and those individuals whose presence the Board Members have agreed is required for the Closed Session. All information provided at a closed session shall remain confidential. Where a discussion held in a Closed Session leads to a general policy decision the Board Members may determine that the information be made public.

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11.2 Discussions Permitted to be held in a Closed Session. - The Act permits a

Corporation to exclude the public from any part of a Board Meeting where the following circumstances exist:

(i) Personal or Public Interest: financial, personal or other matters may be

disclosed of such a nature that the desirability of avoiding public disclosure of them in the interest of any person affected or in the public interest outweighs the desirability of adhering to the principle that Board Meetings be open to the public;

(ii) Public Security: matters of public security will be discussed; (iii) Security of the Corporation and its Board Members: the security of the

Board Members or property of the Corporation will be discussed; (iv) Personal Health Information: personal health information, as defined

in section 4 of the Personal Health Information Protection Act, 2004

(xi) Deliberations on whether to move into a Closed Session: the board will deliberate whether to exclude the public from a Board Meeting, and the deliberations will consider whether one or more of clauses (i) through (x) are applicable to the matters proposed to be discussed in a Closed

, will be discussed;

(v) Prejudice to Legal Proceedings: a person involved in a civil or criminal

proceeding may be prejudiced; (vi) Safety: the safety of a person may be jeopardized; (vii) Personnel Matters: personnel matters involving an identifiable individual,

including an employee of the Corporation, will be discussed;

(viii) Labour Relations: negotiations or anticipated negotiations between the Corporation and a person, bargaining agent or party to a proceeding or an anticipated proceeding relating to labour relations or a person’s employment by the Corporation will be discussed;

(ix) Matters subject to Solicitor Client Privilege: litigation or contemplated litigation affecting the network will be discussed, or any legal advice provided to the Corporation will be discussed, or any other matter subject to solicitor-client privilege will be discussed;

(x) Matters Prescribed by Regulation: matters identified in a regulation

under the Act as permissible to discuss in a Closed Session.

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Session. 11.3 Giving Notice of a Closed Session. – Where it is possible that the Board

Members will discuss a matter requiring the exclusion of the public from a significant portion of the Board Meeting, it would be prudent to disclose this possibility in advance. In these circumstances the notice of the Board Meeting that is given to the public, should clearly indicate that the majority of the Board Meeting may be closed to the public in accordance with the Act to discuss matters concerning the nature of the matters to be discussed.

11.4 Agendas. - Where it is known in advance that a portion of a Board Meeting may

be closed to the public, a separate agenda should be prepared for the Closed Session and circulated only to the Board Members. This would occur, for example, when the board must approve the minutes of a Closed Session held during the last Board Meeting.

11.5 Moving into a Closed Session. -

(a) Before the proceedings of a Board Meeting can be closed to the public, a vote must be held on a motion that (i) proposes to exclude the public; (ii) clearly identifies the nature of the matter to be considered during the Closed Session; and (iii) provides the general reasons why the public is being excluded.

(b) This vote occurs during the regular Board Meeting. Even where the Board

Members anticipate that most of the Board Meeting will need to be conducted in a closed session, the board must still give notice to the public of a Board Meeting, call the Board Meeting to order in an open session, and vote to move into a Closed Session, before it can conduct business in a Closed Session.

(c) The outcome of the vote is recorded in the minutes. In addition, it is

recommended that Board Members record each Closed Session using the form attached as Appendix C.

11.6 Proceedings During the Closed Session. - Normal Board Meeting procedures

are followed during a Closed Session, including the taking of minutes, the making of and the voting on motions. In addition:

(i) only Board Members and specifically identified individuals are eligible to

attend Closed Session proceedings; (ii) only those matters identified in the public portion of the Board Meeting can

be discussed; (iii) the proceedings are confidential unless the Board Members, in a Closed

Session agree otherwise; (iv) minutes of the proceedings are recorded.

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11.7 Concluding the Closed Session. - When the Board Members have finished

their confidential discussions on the identified matters, they must receive and then vote on a motion to conclude the Closed Session and approve the business conducted during the Closed Session. On approval of this motion, the public portion of the Board Meeting resumes. At this time, the board’s first item of business is to report on and approve the business conducted during the Closed Session, unless the Board Members formally agree that it is in the best interests of the Corporation that an action taken during a Closed Session should not be reported in the minutes. In that event, the minutes of the Board Meeting must indicate that such a thing has occurred.

11.8 Minutes of Proceedings During Closed Sessions. - Minutes will be kept for all

proceedings conducted in a Closed Session. The minutes of proceedings in Closed Session are confidential and available only to those persons who were eligible to attend the Closed Session – unless the Board Members, during a Closed Session, agree otherwise. Those Board Members and other individuals who take part in the Closed Session or who are permitted to consult the minutes of the Closed Session are deemed to have agreed to maintain the confidentiality of the proceedings. Minutes of the Closed Session should not be circulated. Copies should be retained by the Corporation and filed separately from all other types of minutes. Minutes of a Closed Session must be approved or amended only in a Closed Session.

11.9 Annual Review and Report. - The board will review its use of Closed Sessions

to ensure that in practice, it properly balances the requirements for, and benefits of, public access to the board and the ability of the board to deal efficiently with the full business agenda in the time normally set aside for Board Meetings. This review will be conducted annually as part of the larger board evaluation process.

SECTION TWELVE - MINUTES 12.1 Content of Minutes. - The Secretary shall ensure that minutes of Board

Meetings shall consist of a record of all proceedings taken by the Board Members.

12.2 Circulation of Draft Minutes. –The Secretary shall ensure that minutes shall be

provided in draft form to the Board Members within 30 days of the Board Meeting.

12.3 Approval of Minutes. - Minutes shall be approved by the Board Members at the

next subsequent Board Meeting.

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12.4 Public Access. - Approved minutes shall be posted on the Corporation’s web-

site within 30 days of approval. Minutes of Closed Sessions shall not be made public.

SECTION THIRTEEN - PUBLIC ACCESS 13.1 Notice to the Public. - The schedule (date, location and time) of Board Meetings

will be available to the public no less than 10 business days prior to the meeting on the Corporation’s website. The board will make such other announcements by advertising or otherwise as the board deems appropriate.

13.2 Accommodation. - Board Meetings or facilities through which proceedings will

be accessible by tele or video conferencing should be held at accessible locations with reasonable accommodation made for the public. However if space is limited, the notice issued pursuant to 13.1 should advise the public accordingly, e.g. that seating will be available on a first come first served basis, that attendance may need to be restricted to a maximum number to comply with fire and other regulations, or that advance registration will be required.

13.3 Access to Agendas. - The agenda for the Board Meeting will be posted on the

Corporation’s web-site and available in person through the Corporation’s office, no later than 24 hours after distribution to the Board Members.

13.4 Access to Non-Confidential Materials. – Non-confidential materials to be

considered by the Board Members during the Board Meeting may be posted on the Corporation web-site. At the Board Members’ discretion copies of materials may be made available through the Corporation office, at the location of the Board Meeting or at the locations where video or teleconferencing facilities are made available.

13.5 Recording of Proceedings. - A Board Meeting may be recorded for broadcast

on the radio, television or via the internet. Notices will be posted and attendance by an individual member of the public is implicit consent by that individual to the use of the recording for any purpose.

13.6 Questions. - Questions will not be taken from the public, including the media,

during the Board Meeting.

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SECTION FOURTEEN - EFFECTIVE DATE

14.01 Effective Date. - Subject to the provisions of the Act, this by-law shall come

into force when passed by motion of the board. PASSED by the board the 22nd day of September 2010

.

Chair

Secretary

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APPENDIX A: SAMPLE AGENDA

[insert name] Local Health Integration Network (the “Corporation”) Meeting of the Members of the Board

[Insert Date], [Insert time i.e. from x – y]

[Insert location]

A G E N D A

ITEM

TIME

TOPIC

PRESENTER/ DISCUSSANT

PURPOSES/ OUTCOME REQUIRED Information Discussion Decision

A. CONVENING THE MEETING Call to Order – recognition of a quorum Approval of the Agenda Declaration of Conflicts

B. MINUTES OF THE LAST MEETING Approval of Minutes Matters arising from Minutes

C. REPORTS Chair CEO Members/Committee

D. NEW/OTHER BUSINESS

E. CLOSED SESSION Approval of Minutes of last closed

session

F. BOARD EDUCATION

F. MEETING ADJOURNMENT Legend: * Circulated with Agenda, ** to be circulated prior to meeting, *** to be circulated at meeting Distribution: Guests:

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APPENDIX B – Form of Common Motions & Appeals

General Notes: Please see “Procedures for Meetings and Organizations” by Kerr & King for further information.

1. Approving an Agenda Motion: That the agenda be approved as circulated. Motion: That [insert item] be added to the agenda. 2. Approving the Minutes of a Prior Meeting Motion: That the minutes of the meeting of [insert date] be approved. 3. Amending a Motion under consideration: Motion: That the motion under the consideration be amended by [insert]. Motion: That the motion under consideration be withdrawn. 4. Referring an item to Committee: Motion: That the [name issue] be referred to the [insert name of committee]. 5. Receiving or Accepting a Report: Motion: That the board receive the [insert] report. Motion: That the [insert] report be accepted. 6. Amending or Rescinding a Motion made at a previous meeting Motion: That the motion passed by the board on [insert date] be amended by [insert amendment]. Motion: That the motion passed by the board on [insert date] be rescinded. 7. Moving into a Closed Session Motion: That the board consider [identify the nature of the matter(s)] in a closed session

pursuant to ss 9(5)(x) of the Local Health Systems Integration Act, 2006 s.9(5)(x). Motion: That [identify the persons] join the board in the closed session. 8. Moving out of the Closed Session: Motion: That the closed session be concluded. 9. Receiving and Approving the Chair’s Report on a Closed Session Motion: That the Chair’s report be received and approved. 10. Adjournment of Meeting Motion: That the meeting be adjourned. 11. Appeals to the Chair (a) “I wish to speak ahead of others in order to correct the remarks made by the previous speaker with respect to (state the issue).” (b) I wish for a recount of the vote (c) I wish to appeal the ruling of the chair

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APPENDIX C

Form of Motion for a Closed Session

[insert name] Local Health Integration Network (the “Corporation’)

Date: ____________________ □ Board Meeting □ Committee Meeting: _________________________________ [insert name] MOVED BY________________________SECONDED BY________________________ That the Board Members attending the meeting specified above move into a closed session pursuant to the following exception(s) set out in s. 9(5) of the Local Health Integration Act, 2006:

□ Personal or public interest □ Public security □ Security of the Corporation and its directors □ Personal health information □ Prejudice to legal proceedings □ Safety □ Personnel matters □ Labour relations □ Matters subject to solicitor client privilege □ Matters prescribed by regulation □ Deliberations on whether to move into a closed session

and further that the following persons be permitted to attend: _____________________________________________________________________ _____________________________________________________________________

Carried □ Lost □ Chair’s signature: ______________________________________

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Report to the Board of Directors Operating Budget 2010/2011

Meeting Date:

September 22, 2010

Submitted By:

Michael Barrett, CEO Lisa Johnson, Manager of Corporate Services

Submitted To:

Board of Directors Board Committee

Purpose:

Information Only Decision

Suggested Motion THAT the South West LHIN Board of Directors approves the operating budget for 2010/2011, as recommended by the Audit Committee on September 8, 2010, subject to confirmation of the final funding allocation for the South West LHIN by the Ministry of Health and Long-Term Care. Background The South West LHIN funding for the Operating Budget and eHealth Budget for 2010/2011 has not yet been confirmed by the Ministry of Health and Long-Term Care.

• The budget was prepared based on a full staff complement and a balanced year-end position. • We anticipate additional revenue for project-specific funding and some of the staff salaries will

be applied to these funding accounts for those individuals that support these initiatives. • The South West LHIN Audit Committee recommended to the South West LHIN Board of

Directors at its September 8, 2010 meeting to approve the draft Operating Budget with the amendment to add additional explanatory notes.

Agenda Item 5.2

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Year End2009/2010

NoteeHealth

Budget2010/2011

10/11over 09/10 % Note

Revenue Transfer Payments 4,998,659 5,112,220 113,561 2.27% 1 ER/ALC Funding 100,000 (100,000) -100.00%Diabetes Funding 67,178 (67,178) -100.00% French Language Services 72,000 72,000Capital Revenue 325,756 149,630 (176,126) -54.07% eHealth Funding 486,921 600,000 600,000 113,079 23.22% ED Lead Funding 60,356 75,000 14,644 24.26% Total Revenue 6,038,870 600,000 6,008,850 (30,020) -0.50% 2

Expenses Salaries 2,494,096 418,450 2,901,510 407,414 16.34% 3Benefits 538,699 50,090 595,600 56,901 10.56% Subtotal (Salaries & Benefits) 3,032,795 468,540 3,497,110 464,315 15.31%Governance 224,139 237,780 13,641 6.09% 4Travel 84,597 12,000 85,000 403 0.48% Consulting Services 634,381 22,000 145,730 (488,651) -77.03% 5Communications / Forums 22,792 - 25,000 2,208 9.69% Supplies/Equipment/Maintenance 401,280 21,000 375,500 (25,780) -6.42% Subtotal (Other Business Expenses) 1,367,189 55,000 869,010 (498,179) -36.44% Accommodations 255,055 44,280 194,000 (61,055) -23.94%Lease Expense 135,796 39,280 135,000 (796) -0.59% Common Services - LSSO 362,714 360,000 (2,714) -0.75% LHINC 12,286 50,000 37,714 306.97% Amortization Expense 325,756 149,630 (176,126)French Language Services 72,000 72,000eHealth Expenses 486,923 607,100 120,177 24.68% ED Lead 60,356 75,000 14,644 24.26% Total Operating Expenses 6,038,870 607,100 6,008,850 (30,020) -0.50% Net Income (Loss) 0 (7,100) 0 0

Budget Assumptions:1- Year end revenue for 2009/10 was $5,112,220, but has been reduced as a result of year-end recoveries by MOHLTC.2 - No revenue confirmed surrounding one-time project funding (ER/ALC, Diabetes, AHTF, eHealth).

4 - Governance budget based on RBP information.

General Notes:(i) Operating Budget recommended for approval by South West LHIN Audit Committee on September 8, 2010.(ii) The South West LHIN Operating Budget is 0.29% of the overall LHIN allocation including Health Service Providers.(iii) Full-time Equivalents = 36. LHIN and eHealth includes 30 full-time and 6 e-Health contract employees.

South West Local Health Integration Network2010/2011 Operating Budget

3 - Increase in salary costs between 2009/10 and 2010/11 are due to the fact that vacant positions are now filled and due to performance increases earned in 2009/10 paid in 2010/11. For performance increases, salaries over $150,000 were limited to 1.5%. No COLA as per directives.

Variance

5 - Base consulting costs as already committed for 2010/2011 with $74k general consulting balance of funds available to re-allocate as required.

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Report to the Board of Directors Amendment of Board Committee

Terms of Reference

Meeting Date:

September 22, 2010

Submitted By:

John Van Bastelaar (A) Board Chair

Submitted To:

Board of Directors Board Committee

Purpose:

Information Only Decision

Suggested Motion

(i) THAT based on the discussion of the South West Local Health Integration Board Committee at its meeting of September 8, 2010, the South West Local Health Integration Network Board of Directors approve the attached Board Committee Terms of Reference

Agenda Item 5.3

South West Local Health Integration Network

Board Committee Terms of Reference

Role: The purpose of the Board Committee is to deal with governance and strategic issues in greater detail than what would be possible in a regular Board meeting. These issues are not formally adopted or endorsed, but may be presented to a subsequent meeting of the Board of Directors as a recommendation. The function of the Board Committee is deliberation, not decision. The Board Committee shall be comprised of the entire membership of the South West LHIN Board of Directors. Key Responsibilities: In general, the Board Committee shall review, discuss and deliberate information and reports that include, but are not limited to the following governance and strategic issues: 1. Board Director Recruitment and Re-Appointment

Advise the Board of current Board members’ re-appointments prior to the determination of a public recruitment process;

Ensure a Nominating Committee is recommended to the Board that will undertake a public invitation, pursuant to the Local Health System Integration Act (LHSIA), to potential Directors as vacancies arise on the Board.

2. Board, Committee and Director Evaluation

Review and recommend to the Board the annual allocation of members to committees and task forces to ensure continuity of committee and task force membership;

Review and recommend to the Board the mandate, scope, duties and responsibilities of task forces and committees;

Review and make recommendations to the Board for the establishment or disbanding of any task force or committee;

Pursuant to the Ministry-LHIN Performance Agreement (MLPA) and with the assistance of the Board Chair, establish and conduct an annual evaluation of the Board, Board Committees, and Directors that is consistent with the evaluation process for all LHIN Boards;

Work with Minister’s office to ensure succession planning for the Board Chair and the chairperson of each committee

Agenda Item 5.3

2

3. Board Development and Education Develop, recommend and organize development/education priorities for the Board; Recommend and organize education and development opportunities resulting from the

annual Board evaluation. 4. Chief Executive Officer Performance Evaluation

Ensure a committee or task force is established which will undertake, on behalf of the Board, an annual performance evaluation of the CEO;

Oversee and monitor CEO performance in conjunction with annual work plans identified in the evaluation process, and monitor consistency with work plans developed for the Board, CEO and senior leadership.

5. Governance Principles and Policies

Develop and recommend to the Board, policies and procedures to maintain high standards of governance;

Monitor governance best practices in order to make recommendations to the Board for improvements to the Board’s governance system;

Oversee processes related to evaluation of Board effectiveness; Review and recommend by-laws; Review and recommend Board policies and procedures; Such matters as may be referred by the Board, from time to time.

6. Long-Term Planning

Review with the senior management team, health care system developments and legislative changes that may have an impact on financial resources or performance (health service providers and operating) and report to the Board.

7. Strategic Discussion In preparation for upcoming decisions at Board meetings, participate in discussions which

will increase the Board’s level of knowledge of current health system issues; This dialogue will centre on the governance role of strategic issues to ensure that the

Board is not moving into operational discussions; 8. Enterprise Risk Management

Identify unusual risks and oversee the senior leadership team’s plan to address unusual or unanticipated risks and make recommendations to the Board; and

Review and make recommendations concerning the quality and integrity of senior leadership’s internal controls.

9. System-Wide Management and Risk Reporting

Report to the Board the investigation and follow-up by staff of health service providers’ risks which may impact on service delivery.

10. Other

Perform other such duties delegated to it by the Board; Review and up-date its mandate on a regular basis.

3

Membership: The Board Committee shall be comprised of the full membership of the Board of Directors; The chairperson of the Board Committee shall be the Board Chair. The Board Committee Chair

shall recommend a proposed agenda of the meetings in consultation with the CEO. Meetings and Quorum: The meetings of the Board Committee shall be open to the public, with the exception of those

items requiring a closed session; The Board Committee should meet as often as necessary to transact business, but not less than 8

times per year; Minutes of each meeting must be prepared and circulated to the Board of Directors; and A quorum at all meetings must include a majority of Directors of the LHIN. Communication: The Committee shall: Be accountable to all stakeholders of the LHIN Have open communication with the senior leadership team, other committee members and work

to strengthen the Committee’s knowledge of current and prospective issues; and Insist on open discussions with the senior leadership team about issues of quality and integrity. Committee Performance The performance and effectiveness of the Committee and its individual members shall be assessed annually as part of the Board’s evaluation process. The activities of the Board Committee shall be assessed in relation to its mandate. In this way, the Board Committee will be continually improving and updating its mandate to meet the current issues of the LHIN and the environment in which it operates. Amendments These terms of reference may be amended by the Board of Directors. Approval Date: Last Review Date: September 8, 2010

Page 1 of 2

Report to the Board of Directors Enterprise Risk Management

Meeting Date:

September 22, 2010

Submitted By:

Mark Brintnell, Senior Director, Performance, Contract and Accountability

Submitted To:

Board of Directors Board Committee

Purpose: Information Decision Motion THAT the South West Local Health Integration Network Board of Directors endorse the Enterprise Risk Management system for use by the South West LHIN. Purpose The purpose of this report is to seek LHIN Board endorsement of the proposed Enterprise Risk Management (ERM) system (see attachment) to be piloted beginning in the third quarter of 2010/11. This report is the third and final report in response to the LHIN Board request for an ERM system. Background The South West LHIN is committed to an Integrated Health System of Care to support health care providers in planning for change and finding new ways to work together to meet the evolving needs of all communities within the South West LHIN. In addition, preserving its reputational and financial integrity in order to continue its mission is important to the LHIN. Currently, risk management within the South West LHIN has been addressed through a variety of processes including:

• Quarterly reporting of financial risks to the Ministry of Health and Long-Term Care • Quarterly reporting of variances related to performance requirements in the Ministry-LHIN

Performance Agreement (formerly Ministry-LHIN Accountability Agreement) • Risk identification and elevation within specific program or project activities

However, an assessment of risk on an organization or enterprise-wide basis is missing from our risk management approach. The proposed ERM system will enable the LHIN to approach risk in a “holistic” manner to ensure all elements of risk are being monitored, reviewed and addressed as appropriate and required. What is ERM? ERM is a systematic process of identifying, analyzing and responding to risk. The “what” of risk is anything of variable uncertainty and significance that interferes with the achievement of business strategies and objectives. It involves developing flexible strategies aimed at preventing any negative event from occurring or to minimize any potential harm and provide reasonable assurance regarding the achievement of the organization’s objectives.

Agenda Item 5.4

Page 2 of 2

The establishment of an ERM system is founded on the philosophy that leadership sets the tone and directs efforts across the organization to foster a culture that values learning, innovation, responsible risk taking, continuous improvement and commitment to address the underlying system factors that contribute to risk. An ERM system should satisfy the following objectives:

• Achieve quality and safety goals and financial performance targets, plus protecting and enhancing the LHIN reputation.

• Outline risk identification strategies, risk mitigation processes and monitoring and reporting to achieve effective ERM.

• Establish a structured analytical process that focuses on identifying and eliminating risks that will impact on achievement of objectives.

The benefits of an ERM system to the LHIN are:

• Proactive rather than reactive management of risk resulting in more successes, fewer setbacks, and more effective operations and controls.

• More effective and structured approach to opportunities and threats by managing the associated risks in effective and efficient ways.

• Improved stakeholder trust and confidence in the organization. • Better corporate governance through improved understanding of risks, their control and

general resilience and robustness of the organization. ERM can be viewed as a natural evolution of the process of risk management. Often organizations address risk in “silos”, with the management of various departments each conducted as narrowly focused and fragmented activities. Under ERM, all risk areas would function as parts of an integrated, strategic, and enterprise-wide system. While risk management is coordinated with senior-level oversight, employees at all levels of the organization using ERM are encouraged to view risk management as an integral and ongoing part of their jobs. Operational accountability demands that all agencies including the LHINs, health service providers, and the MOHLTC, must demonstrate accountability through risk management by recognizing, reviewing and analyzing key risk concepts and considerations. Next Steps It is proposed that the ERM system be piloted for Q3 2010/11. Risk information consistent with the roles and responsibilities of the LHIN Board will be brought forward on a quarterly basis for discussion.

South West Local Health Integration Network Enterprise Risk Management

DRAFT Policy and Procedure Specifications Document

Draft Version 1 Sep-10

1

1. PURPOSE To clearly define the roles, responsibilities and expectations for Enterprise Risk Management (ERM) at the South West LHIN; to determine the organization’s risk tolerance; and to standardize the components of the ERM process, including identification, analysis, monitoring, prevention and mitigation.

2. POLICY STATEMENT

The South West LHIN is committed to an Integrated Health System of Care to support health care providers in planning for change and finding new ways to work together to meet the evolving needs of all communities within the South West LHIN.

Mechanisms are in place to support the routine analysis of risks inherent in the activities the South West LHIN undertakes. Risk is managed using approved ERM plans. The ERM plans include processes to identify and analyze risk and also strategies to monitor, prevent and mitigate risk.

Team members at all levels of the organization are involved in the identification of risks and the development of practical ERM strategies or measures. This ensures that team members understand their roles and responsibilities in leveraging and deploying resources in achieving the vision, mission and values of the organization.

3. SCOPE

The policy would apply to all aspects of South West LHIN operations and South West LHIN responsibilities with respect to building capacity within the local health system, improving quality and access to care and championing innovation in partnership with health service providers and consistent with the Ministry-LHIN Performance Agreement. These requirements and responsibilities must be aligned with provincial legislation, regulations, standards and policies.

4. GUIDING PRINCIPLES

ERM at the South West LHIN is founded on the philosophy that leadership is critical across the organization and local health system to foster a culture that values learning, innovation, responsible risk-taking, continuous improvement and commitment to address the underlying system factors that contribute to risk.

The unique role of leadership is to establish the value system in the organization and local health system, set strategic goals/aims for activities to be undertaken, align efforts within the organization to achieve those goals/aims, provide resources for the creation of effective systems, remove obstacles and require adherence to known best practices. ERM must be clearly communicated and understood, with capacity being built in a learning rather than punitive environment.

5. DEFINITIONS

Risk refers to the uncertainty that surrounds future events and outcomes. The uncertainties include: the severity of the event and the expected likelihood/frequency of the event occurring. In order to operationally be accountable, all entities operating within the local system must demonstrate accountability through ERM by recognizing, reviewing and analyzing key risk concepts and considerations that may impact their performance.

South West Local Health Integration Network Enterprise Risk Management

DRAFT Policy and Procedure Specifications Document

Draft Version 1 Sep-10

2

Risk South West LHIN Operations

South West LHIN Local Health System

Operational Risk: The risk of direct or indirect loss or inability to provide core services, especially to stakeholders, resulting from inadequate or failed internal processes and resources (including human resources), people and systems or from external events.

Operational risks involve factors such as technical or equipment malfunctions or human error (i.e., lack of prioritization, management support or expertise, etc.)

Risk may include the design and implementation of measures and processes that support accountability and oversight, being able to attract talent with experience in transformation and change management and addressing broader system-wide pressures for healthcare resources.

Financial Risk: The risk of financial loss. This may include effectiveness of internal controls, financial processes for reporting, budgeting, and fiscal stewardship as well as the monitoring of full financial and performance reporting.

In addition, as an organization, this also refers to the ability to access sufficient levels of funding.

In addition, the ability of the providers to earn, raise or access funding (base or one-time operating and/or infrastructure capital) and can be associated with the transfer of risk.

Reputational Risk: The risk of significant negative public opinion that results in a critical loss of confidence.

This risk may involve actions that create a lasting negative image of, or loss of confidence in, the overall operations of the South West LHIN.

This risk may be associated or transferred to other partners depending on an organization’s actions.

Strategic Risk: The risk associated with the organization’s initial strategy selection, execution or modification over time, resulting in a lack of achievement of the organization’s overall objectives.

Processes and mitigation must be sustainable, defensible and make sense in the context of an organization’s risk and operational priorities.

Processes and mitigation must be sustainable, defensible and make sense in the context of an organization’s risk and operational priorities.

Risk Tolerance is the level of risk that an organization is willing to accept. Risk tolerance determines the timing of actions/strategies to address the risk (e.g. in the immediate, medium-term or long-term timeframe).

Enterprise Risk Management is a systemic process of identifying, analyzing and responding to risk (anything of variable uncertainty and significance that interferes with the achievement of strategies and objectives). It involves developing flexible strategies aimed at preventing any negative event from occurring or to minimize any potential harm and provide reasonable assurance regarding the achievement of the organization’s objectives.

6. PROCEDURE

6.1 Roles and Responsibilities for Enterprise Risk Management

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6.1.1 South West LHIN Board of Directors

Ensure the Chief Executive Officer has in place each of the four elements of the Risk Control Cycle (see Appendix 3); knowledgeably approve the broad level of risk tolerance for the South West LHIN; ensure systems and processes are in place to identify and manage the broad range of risks; monitor those prioritized risks reported in senior management’s Risk Register (see Appendix 1); and review with senior management any required changes to the Strategic Directions that result from the identification of new risks and/or opportunities. The LHIN Board delegates authority and responsibility for ERM to the South West LHIN CEO.

6.1.2 South West LHIN Management

The South West LHIN CEO has the overall responsibility for ERM and will ensure that senior management establishes and carries out the Risk Control Cycle steps (see Appendix 3). The CEO will ensure that all ERM activities are coordinated and no major risk is overlooked. The CEO provides a minimum of quarterly reports (with the addition of timely reports of significant events as appropriate) to the South West LHIN Board, using the Risk Register to highlight risks that could affect the achievement of the Strategic Directions.

The senior management team, through the CEO, provides analytical reports and recommendations regarding risk to the South West LHIN Board. The senior management team is responsible to:

Oversee the development, implementation and review of ERM policies, procedures and plans. Develop, recommend and oversee plans and processes for identifying risk across the South West LHIN. Develop and implement a standardized risk analysis framework including: the severity of the event and the expected likelihood/frequency of the event occurring. Oversee the assessment and analysis of critical incidents. Provide analytical reports and recommendations.

6.1.3 Other South West LHIN Team Members

South West LHIN team members are responsible to identify risks and participate in the creation of practical ERM strategies and measures. In addition, South West LHIN team members directly involved in system design, implementation and integration, and quality improvement have inherent responsibility to identify risks in those programs and projects and to assist in developing and implementing ERM strategies and measures. They will develop and implement health service provider programs that accurately and effectively measure key risk areas. They will also facilitate the inclusion of information from relevant risk analyses into the South West LHIN Risk Register and program quality or performance improvement plans.

6.2 Risk Tolerance

A global risk tolerance statement is not practical, given the complex nature of the LHIN, the significant mandate against provincial legislation and the multiple service delivery models performed by health service providers. Risk must be assessed and managed at multiple levels: balancing both individual organization needs and risk to the local health care system. Risk is accepted knowing that management policies and procedures are in place to assess and reduce risks that may result in: reputation damage; financial loss or exposure; breakdown in information integrity; or incidents of legislative or regulatory non-compliance. When sufficient controls and processes do not exist and/or the

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magnitude of the risk is extreme, tolerance is considerably reduced and immediate action may be required.

6.3 Enterprise Risk Management Process

Management of risk involves determining which risks are likely to affect public interests, public trust, strategic goals/aims, operational priorities, fiscal resources, or services and programs. It requires documentation of the risk characteristics and identifying potential strategies to deal with them should they occur. ERM is not a one-time event; it should be performed on a regular basis and be integrated into regular business practices.

6.3.1 Risk Identification

The process through which the organization becomes aware of risks that constitutes potential exposures. Risk may be identified at the level of the individual, the level of the organization or the level of the local health system. The South West LHIN identifies risks from internal and external sources.

Internal Information Sources include (but not limited to) the following:

South West LHIN Operations South West LHIN Local Health Service Providers

Audit Audit or Operational Analysis

Contracts, Financial Reports Contracts, Financial Reports, Reconciliation

Compliance reporting against provincial legislation, regulations, standards and policies

Compliance reports against provincial legislation, regulations, standards and policies

Issues Management and Incident Reports Issues Management and Incident Reports Compliance with South West LHIN directives, policies and procedures

Compliance with organizational directives, policies and procedures

Strategic and business planning (e.g. Integrated Health Service Plan, Annual Business Plan)

Strategic and business planning (e.g. organizational strategic plan, annual business planning)

Ministry-LHIN Performance Agreement reporting

Service Accountability Agreement reporting

External Information Sources include (but is not limited to) the following:

South West LHIN Operations and South West LHIN Local Health Service Providers Government or Ministry of Health and Long-Term Care announcements Office of the Auditor General of Ontario or Ombudsman Ontario reporting Health system reports from provincial organizations (i.e. Ontario Health Quality Council, Canadian Institute for Health Information, Institute for Clinical Evaluative Sciences) Health service reports from local health service providers Community engagement and communications with South West LHIN communities Media

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6.3.2 Risk Analysis

The process of determining the potential severity/consequence of the loss associated with an identified risk and the likelihood/frequency that such a loss will occur. It is the evaluation of current and past experience which will determine the potential effect risk will have on the individual, organization or local system and to ascertain which risks are significant enough to warrant intervention.

Risk Analysis is determined using four steps (see Appendix 2). In the case of South West LHIN, the framework must be applied within the context of the LHIN organization and the LHIN management role within the health system.

Step 1: Assign the Severity/Consequence of Risk: Minor, Moderate, Significant. Step 2: Assign the Likelihood/Frequency of the Risk Occurring: High, Medium, Low. Step 3: Score Risk using Risk Matrix. Step 4: Prioritize Action: Immediate, Medium-Term, Long-Term.

6.3.4 Risk Prevention and Mitigate Strategies

During the risk analysis process, the risk matrix will result in a risk score that prioritizes the prevention and control actions. Control or mitigation strategies are identified and implemented, as appropriate. Risk Management should primarily focus on those risks that are the most likely to occur and which will most impact an individual, the organization or the local health system as a whole. Prevention, Control and Mitigation Strategies include:

Risk Avoidance: Includes making changes to strategy, plans or budgets in order to eliminate a specific known risk where the risks that are posed outweigh the benefits. It could also include not performing the activity. Avoidance may seem the answer to all risks, but avoiding risks also means losing out on the potential gain that accepting (retaining) the risk may have allowed.

Risk Reduction/Mitigation: Involves methods that reduce the likelihood/frequency and/or the severity/consequence of the risk to an acceptable level. Many healthcare risks may be near impossible to completely eliminate, however there are often steps that can be taken to reduce the risk.

Risk Shifting/Transfer: This occurs when the organization shifts risk to a third party through legislation, contract, insurance or other means, which helps the initial party manage risk and mitigate losses.

Risk Retention/Acceptance: Proceed while developing a plan or contingency knowing and accepting that the risk will occur and planning to deal with the consequences of the risk.

7. APPENDICES (appended as resources) Appendix 1A: South West LHIN Operations Risk Register Appendix 1B: South West LHIN Health System Risk Register Appendix 2A: Risk Analysis Framework – South West LHIN Operations Appendix 2B: Risk Analysis Framework – South West LHIN Local Health System Appendix 3: Risk Mitigate Cycle

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Appendix 1A: South West LHIN Operations Risk Register

RISK #

RISK TITLE

PRIMARY OBJECTIV

E 1 AT RISK

SECONDARY

OBJECTIVE 2 AT

RISK

RISK TO ACHIEVEME

NT OF OBJECTIVE

SECTOR

FREQUENCY /

LIKELIHOOD 3

SEVERITY4 / CONSEQUEN

CE

RISK LEVEL

6

RISK TREN

D

CURRENT YEAR

QUANTITATIVE

IMPACT /COST

TOLERANCE

ACTION

RISK MANAGEME

NT CAPABILITY

RISK MANAGEMENT

PLAN 5

Notes: 1. For the MOHLTC Quarterly Risk Report, the primary objectives are: a) Balanced Budget; b) Multi-year expense limits; c) WT Protected Volumes; d) Key Government Priorities; e) LTC

Placement; f) ED LOS; g) Other – please describe 2. The secondary objectives can be more broad and descriptive. For example: Client services, ALC/ED, Mental Health, Integration, Financial, 3. Frequency / Likelihood has a drop down list with options of: Low; Medium or High (similarly the other columns for Tolerance, Action and Risk Management capability have drop down menus to

ensure consistency of data entry) 4. Each row, for the Severity/Consequence column is split into 2 sub rows. The top row relating to the LHIN Health System effect and the bottom sub row relating to the HSP effect. Each cell has

a drop down list with options of Minor; Moderate or Significant (for instance a risk of $100,000 for an agency with a total budget of $300,000 is a significant consequence, yet for a LHIN with a $2 billion dollar budget it may be minor)

5. Mitigation Plan will outline one of the 4 strategies; a) Risk Avoidance; b) Risk Reduction/Mitigation; c) Risk Shifting/Transfer; d) Risk Retention/Acceptance 6. RISK LEVELS:

Green – steady state Yellow – Caution required Red – Alert: Action required

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Appendix 1B: South West LHIN Local Health System Risk Register

RISK #

RISK TITLE

PRIMARY OBJECTIV

E 1 AT RISK

SECONDARY

OBJECTIVE 2 AT

RISK

RISK TO ACHIEVEME

NT OF OBJECTIVE

SECTOR

FREQUENCY /

LIKELIHOOD 3

SEVERITY 4 / CONSEQUEN

CE

RISK LEVEL

6

RISK TREN

D

CURRENT YEAR

QUANTITATIVE

IMPACT /COST

TOLERANCE

ACTION

RISK MANAGEME

NT CAPABILITY

RISK MANAGEMENT

PLAN 5

Green – steady state Yellow – Caution required Red – Alert: Action required

Notes: 1. For the MOHLTC Quarterly Risk Report, the primary objectives are: a) Balanced Budget; b) Multi-year expense limits; c) WT Protected Volumes; d) Key Government Priorities; e) LTC

Placement; f) ED LOS; g) Other – please describe 2. The secondary objectives can be more broad and descriptive. For example: Client services, ALC/ED, Mental Health, Integration, Financial, 3. Frequency / Likelihood has a drop down list with options of: Low; Medium or High (similarly the other columns for Tolerance, Action and Risk Management capability have drop down menus to

ensure consistency of data entry) 4. Each row, for the Severity/Consequence column is split into 2 sub rows. The top row relating to the LHIN Health System effect and the bottom sub row relating to the HSP effect. Each cell has

a drop down list with options of Minor; Moderate or Significant (for instance a risk of $100,000 for an agency with a total budget of $300,000 is a significant consequence, yet for a LHIN with a $2 billion dollar budget it may be minor)

5. Mitigation Plan will outline one of the 4 strategies; a) Risk Avoidance; b) Risk Reduction/Mitigation; c) Risk Shifting/Transfer; d) Risk Retention/Acceptance 6. RISK LEVELS:

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Appendix 2A: Risk Analysis Framework – LHIN Operations

Step One: Assign the Severity/Consequence

MINOR MODERATE SIGNIFICANT

Ope

ratio

nal R

isk

Cor

pora

te

Gov

erna

nce

Board Business is not always conducted according to best practices and resources provided through the Guide to Good Governance.

On occasion business undertaken by the LHIN Board is unknowingly undertaken and may not be compliance, in all material respects, with all applicable laws of Canada and the Province of Ontario, including the Local Health System Integration Act (LHSIA), and with the Memorandum of Understanding (MOU), the Ministry LHIN Performance Agreement (MLPA) and all applicable Ontario Public Service (OPS) Directives and Ministry of Health and Long-Term Care (MOHLTC) Policies and Protocols (including the Transfer Payment Accountability Directive, Procurement Directives and the Travel, Meal and Hospitality Expenses Directive).

Business is knowingly undertaken by the LHIN which is not in compliance, in all material respects, with all applicable laws of Canada and the Province of Ontario, including the Local Health System Integration Act (LHSIA), and with the Memorandum of Understanding (MOU), the Ministry LHIN performance Agreement (MLPA) and all applicable Ontario Public Service (OPS) Directives and Ministry of Health and Long-Term Care (MOHLTC) Policies and Protocols (including the Transfer Payment Accountability Directive, Procurement Directives and the Travel, Meal and Hospitality Expenses Directive).

Issu

es

Man

agem

ent LHIN Issues Management Process exceeds the

timeline of 15 days for response LHIN Issues Management Process is on occasion not adhered to and issues are on occasion not dealt with in a timely or effective manner posing a potential reputational risk or recurrence of issue.

No Issues Management Process Exists or is not being followed.

Hum

an R

esou

rces

Minor issues with employee payments, income tax source deductions, Employer Health Tax or Employment Insurance, resulting in adjustments.

Minor infractions workplace practices

Contraventions to the code of conduct and any policies or procedures.

Temporary staff vacancies exist.

If the LHIN has not met some of its obligations with respect to the payment of performance payments.

Non-compliance with corrective actions against the Health & Safety Standards

Continued contravention to the code of conduct and any policy and procedures

If the LHIN has not met all of its obligations with respect to employee payments, income tax source deductions, Employer Health Tax or Employment Insurance. The LHIN is knowingly in contravention of the Labour Standards Act resulting in legal actions, rulings and appeals.

If the LHIN does not full fill its benefits and pension obligations.

If the LHIN is unable to full fill resources for paid leaves and absences.

Termination due to destruction of work product and or information pertaining to the LHINs assets.

Employee workload is excessive at times resulting in decreased morale.

Employee workload is consistently excessive resulting in high turn-over and employee loss of time cost.

Deliverables cannot be achieved with the current human resources available to the organization.

Info

rmat

ion

Tech

nolo

gy Sporadic loss or inconvenience of business function

Low adherence to IT policies and procedures.

Ongoing issues with IT equipment (i.e.: network issues), resulting in increased costs and loss of productivity.

Non adherence to IT policies and procedures.

Severe or major loss of electronic data or records.

Server crash unable to use network.

Theft of computer hardware and software.

Faci

lity

Limited Occupational Health and Safety concerns Power outages for less than 3 hours

Several Occupational Health and Safety concerns remain outstanding. Power outages for more than 1 day

Occupational Health and Safety concerns not addressed and policies/procedures not followed for corrective action. Fire or flood destruction

Lega

l &

Reg

ulat

ory

There is an order, action, suit or proceeding, at law or in equity threatened against, the LHIN or its business or assets.

There is an order, action, suit or proceeding, at law or in equity pending against, the LHIN or its business or assets. The LHIN is represented by LSSO Legal Council, creating a strain on LHIN human and financial resources.

There is an order, action, suit or proceeding, at law or in equity pending against, the LHIN or its business or assets. The outcomes of the proceeding could impact LHINs across the province and legislation.

Priv

acy

FOI/FIPPA Requests are not dealt with in a timely manner resulting in reminders or complaints.

Contravention of the Privacy Act.

Contravention of the code of conduct and communications polices and procedures.

Sudden increase in FOI/FIPPA Requests without internal resources to support the process.

FOI/FIPPA Requests demonstrate that the LHIN is in contravention of a directive or legislation and potentially expose the LHIN to Reputational Risk.

Rep

utat

iona

l R

isk

LHIN receives criticism in media

LHIN occasionally encounters relationship issues with health service providers

LHIN receives undue criticism in media LHIN encounters continued strain in working successfully with health service providers

LHIN is unable to respond to undue criticism in the media and its ability to maintain public confidence is in jeopardy

LHIN is unable to work successfully with many health service providers impacting its management requirements

Stra

tegi

c R

isk

Operational matters occasionally distract LHIN leadership from a continued focus on the strategic directions.

Strategic directions are not aligned with the Blueprint or IHSP and decisions are too focused on operational matters. The organization may not be able to meet deliverables and strategic aims.

Most decisions are not advancing strategic aims.

Fina

ncia

l Ris

k

Internal controls are not sufficient to identify, monitor, and mitigate LHIN operational, compliance and financial reporting risks. Staff resources are consumed with mitigating risks as they occur.

Internal controls are lacking in key areas to identify, monitor, and mitigate LHIN operational, compliance and financial reporting risks.

External Auditors may report on key findings and report to the audit committee of the Board.

Fraud, illegal acts, non-compliance with regulatory requirements, unusual transactions of significant loss, unusual related party transactions.

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Appendix 2B: Risk Analysis Framework – Health System

Step One: Assign the Severity/Consequence

MINOR MODERATE SIGNIFICANT

Ope

ratio

nal R

isk

(HSP

s/H

ealth

Sys

tem

)

Envi

ronm

enta

l &

In

fras

truc

ture

Infection control processes somewhat delayed but no loss in service delivery

Minor environmental damage with limited cleanup required

Infection control processes somewhat delayed with some disruption in service delivery

Some cleanup required but no permanent damage

Reduced efficiency with some delay in service delivery

Catastrophic infection or communicable disease outbreak

Severe loss of service delivery

Shut down of facility and reduction of services

Qua

lity

Car

e &

Sa

fety

(P

atie

nt

& S

taff)

Event caused inconvenience but no apparent injury Event caused minimal loss of time or minimal restrictions

May be threat of potential legal actions

Death or permanent injury

Pending legal action

Priv

acy

&

Secu

rity Event created no apparent breach of confidentiality Damage to records

Potential breach of confidentiality (loss, unauthorized disposal)

Significant breach of privacy (theft, unauthorized disclosure)

Hea

lth

Hum

an

Res

ourc

e Minor disruption in staff-temporary loss of staff (i.e. injury or vacation)

Major disruption in staff-permanent loss of staff (i.e. resignation, retirement etc.)

Permanent and /or not restorable loss of staff (i.e. loss of funded position etc.)

Info

rmat

ion

Tech

nolo

gy Sporadic loss or inconvenience of business

function

Slight out of date or incompatible IT resources

Partial loss or inconvenience of business function, data or controls

Significant out of date or incompatible IT resources

Severe or major loss of electronic data or records within system

Major or total inability to use an application or system

Proj

ects

Small chance that deadlines or objectives will not be met or will be delayed

Delivery of operable solutions will not be met in timely manner

Reporting delayed or submitted with errors or omissions

Goals and objectives missed and severe inability to recover from loss. Failure to deliver

Timelines missed. Appropriate resources not available

Prog

ram

s Delivery of operable solutions somewhat delayed Reporting is delayed or quality is poor Goals and objectives missed and severe inability to recover from loss. Failure to deliver

Perf

orm

ance

M

anag

emen

t 5% of providers outside corridors 5-15% of providers outside corridors >15% of providers outside corridors

Lega

l &

Reg

ulat

ory

Slight delay in contracts or agreement templates and processes being finalized

Rare and/or minimal non-compliances with provincial policies, programs, legislation or regulations

New or changing regulations (e.g. Restorative beds vs. LTC beds)

Delay in resolution of negotiations

Frequent minimal or rare more significant non-compliances with provincial policies, programs, legislation or regulations

Legislative or regulatory breaches of any of the Acts

Contravention of compliance regulations

Missing final deadline for contract execution

Frequent more significant or any major non-compliances with provincial policies, programs, legislation or regulations

Stak

ehol

der

Rel

atio

ns HSP actions inconsistent with LHIN directions Inconsistent governance and/or management issues with

HSPs

HSP carries out action without communicating with LHIN

Inconsistent HSP information with significant impacts to health system

MLP

A R

isk

Perf

orm

ance

R

isk

Not meeting target and outside of corridor for 1-2 MLPA indicators

Not meeting target and outside of corridor for 3-5 MLPA indicators

Not meeting target and outside of corridor for >5 MLPA indicators

Stra

tegi

c R

isk

(i.

e.

IHSP

)

Setback in achieving strategic direction/goals or objectives. Failure to meet objectives by year 1

Performance reporting and measurement indicate variance from expectations. Failure to meet objectives by year 2

Breakdown of community partnerships and alliances.

Failure to meet objectives by year 3

Fina

ncia

l Ris

k

Deficit, loss of assets or loss of funding < 1% of HSP allocation

Occasional delays in reporting financial information

Deficit, loss of assets or loss of funding between 1-2% of HSP allocation

Trend in financial reporting delays

Deficit, loss of assets or loss of funding >3% of HSP allocation

Deliberate misuse of public funds (Fraud)

Major Delay or error in asset management or capital planning

Consistently delayed in submitting financial reports

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Rep

utat

iona

l R

isk

Negative comments with respect o the LHIN in media , public or HSP communications

Perceptible loss of public confidence

Major loss of reputation or confidence in the LHIN’s ability to manage by HPS and/or government

Negative Auditor General/Ombudsman Reports

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Step Two: Assign the Likelihood/Frequency of Recurrence

Likelihood / Frequency Definition

High Is expected to occur immediately or in a short period of time unless circumstances change. (one or more times per month)

Medium Will probably occur in most circumstances. (once every two to three months)

Low Could occur at sometime (once every year) or in exceptional circumstances (once every three to five years).

Step Three: Risk Matrix

SEVERITY

LIK

ELIH

OO

D /

FREQ

UN

CY

Minor Moderate Significant

High

Medium

Low

Step Four: Risk Tolerance & Action Required

This information is not meant to be prescriptive and is intended for guidance. The LHIN Board is responsible for defining the level of acceptable risk.

TOLERANCE ACTION

Low Requires urgent action. The LHIN Board is made aware and ensures the implementation of immediate corrective action.

Medium Medium Term-Actions implemented as soon as possible and no later than one year.

High Long Term-Implemented when resources permit

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Report to the Board of Directors

London Breast Cancer Coordination Project: Diagnostics and Treatment

Meeting Date: September 22, 2010 Submitted by: Mark Brintnell, Senior Director, Performance, Contract and Accountability Julie Girard, Team Lead, Planning and Integration Submitted to: Board of Directors Board Committee Purpose: Information Decision Suggested Motion: THAT the South West Local Health Integration Network Board of Directors does not wish to issue an Integration Decision related to the intended integration entitled “London Breast Cancer Coordination Project: Diagnostic & Surgical Treatment”, as proposed in the Project Proposal. Background: On September 8, 2010, the South West LHIN received a Notice of Integration (attached) from St. Joseph’s Health Care, London (SJHC) and London Health Sciences Centre (LHSC) entitled the “London Breast Cancer Coordination Project: Diagnostics & Surgical Treatment”. Both hospitals boards have approved the project. The purpose of the project is to consolidate and coordinate breast cancer screening, diagnostic and surgery services at SJHC. The objectives are to deliver equitable service, reduce the associated wait times for services from diagnosis to breast cancer surgery, and expedite the referral of these patients through to London Regional Cancer Program (LRCP) for other cancer treatment and services. The integrated model will be patient focused and deliver multidisciplinary care including education and support for the patient and their caregivers. It is anticipated that lessons learned from this project will be applicable to other cancer diseases to facilitate continuous improvement in care for all cancer patients. Both LHSC and SJHC have agreed to transfer funds between institutions in order to consolidate breast cancer diagnostics and surgical treatments at SJHC. The request is for the LHIN to transfer net funding of $1,018,976 from LHSC to SJHC. As outlined in section 27 of The Local Health Systems Integration Act (LHSIA), upon receipt of a Notice of Integration the LHIN may consider if the proposed integration is in the public interest. This will include consideration of whether the proposed integration is consistent with the LHIN’s Integrated Health Service Plan 2010-13 and any other relevant matter as decided by the LHIN Board.

Agenda Item 5.5a

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The Board then has two options:

1. LHIN does not object to intended integration: LHSIA allows the LHIN 60 days to consider the notice of intended integration from a HSP. If the LHIN does not object to the intended integration, it may simply choose to take no action. In that case, after 60 days have elapsed from the day the HSP gave the LHIN notice, the provider may proceed with the integration. While the Act does not require it to do so, the LHIN may choose to notify the HSP that it does not intend to issue a decision stopping the integration.

2. LHIN has concerns about intended integration: If the LHIN has concerns about the intended integration based on the notice from the HSP, it can take steps towards preventing the integration from proceeding. The LHIN must notify the HSP within 60 days of receiving the Notice of Integration that it proposes to issue a decision ordering the provider not to proceed with the integration. The LHIN must provide a copy of the proposed decision to the HSP and must make copies of the decision available to the public, also within the 60 day timeframe.

LHIN staff has reviewed the proposal and provided analysis in the form of an integration evaluation (attached). The analysis included:

Public interest consideration and impacts Community engagement Other organizational impacts LHIN organizational impacts

LHIN staff did not identify any areas of concern and support the London Breast Cancer Coordination Project: Diagnostic & Surgical Treatment. In order to not interfere with quality of care, the LHIN recognizes the need for the consolidation to continue with timelines outlined in the project charter. Next Steps:

Transfer of net funding from LHSC to SJHC and amendments to Hospital Service Accountability Agreements – Complete by end of October 2010

Consolidate all Breast Imaging to SJHC in current Breast Imaging department - September 10, 2010

Consolidate Breast Surgery to SJHC (exchange the type of general surgery ambulatory cases done between LHSC and SJHC) - September 10, 2010

Consolidate Breast Assessment and Surgery-only Clinics to temporary space at SJHC – September 10, 2010

Consolidate all SJHC Breast Assessment Imaging Services and Breast Surgery Clinics to shared space – September 1, 2011

LHSC/SJHC Breast Care Consolidation Project: Diagnostics and Treatment - Integration Evaluation: Page 1 of 9

INTEGRATION EVALUATION TOOL

Integration Title: London Breast Cancer Coordination Project: Diagnostic & Surgical Treatment

HSPs Involved: London Health Sciences Centre (LHSC) and St Joseph’s Health Care, London (SJHC)

LHIN Staff Reviewing: Rebecca McKee, Julie Girard and Scott Chambers

Building on the stated purpose of LHSIA and subsequent Ministry and legal guidance to the LHINs, integration initiatives should at a minimum result in:

√ Improved Access and Quality of Care √ Coordinated Healthcare √ Improved Navigation through the Continuum of Care √ Effective and Efficient Service Delivery √ Alignment with the IHSP √ A consideration of the Public Interest

The evaluation considers four areas of analysis to understand if the integration initiative meets these criteria. The four areas of analysis include:

1. Public interest considerations and impacts 2. Community engagement 3. Other operational impacts 4. LHIN organization impacts

LHSC/SJHC Breast Care Consolidation Project: Diagnostics and Treatment - Integration Evaluation: Page 2 of 9

1. PUBLIC INTEREST CONSIDERATIONS AND IMPACTS:

Considerations Yes/No Comments and/or Concerns

Does the integration promote appropriate, coordinated, effective and efficient health services?

Yes

Currently there are 3 sites for breast screening, 2 sites for diagnosis, 3 sites for surgery and 4 surgical follow up clinical sites. The same woman may traverse multiple sites for care. A goal of this integration is to create 1 screening site, 1 diagnosis site, 1 surgery site and 1 surgical follow up site creating a consolidated rapid access Breast Cancer Diagnostic and Surgery Centre that will enable women to easily navigate their cancer journey from screening through diagnosis and surgery.

Does the integration promote better access to high quality health services?

Yes

Consolidating all screening appointments, and using digital mammography equipment that can process higher volumes of patients, will add approximately 20% more capacity.

Radiologists will read all digital screening cases on Picture Archiving and Communication System (PACS) workstations that are located in various centres across London and thereby eliminating travel time and expenses

Does the integration achieve quality improvements in clinical outcomes, health service delivery, and/or system performance?

Yes

Women will ideally have all necessary imaging and breast biopsy in 1 day. Standardized automatic referral process for a patient with a positive cancer diagnosis would occur to the next available surgeon appointment in the consolidated service at SJHC. Breast surgery operating room resources would be scheduled in such a way to increase efficiency and capacity

Currently wait times from abnormal screen to surgery are almost twice the Ontario provincial average. London’s average is 10 weeks for women referred for specific concerns and 13 weeks for women referred from the Ontario Breast Screening Program (OBSP) and for a patient diagnosed with breast cancer originally referred by her family doctor for a breast concern is 10 weeks. A goal of this integration is to reach a target of 7 weeks through redesign of processes, teams and booking systems

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Considerations Yes/No Comments and/or Concerns

Does the integration support patient/client and person centered health care?

Yes

Parkwood Hospital: Breast screening will be located at Parkwood Hospital. Upon arrival, women will

have access to ample parking, and a warm welcoming atmosphere to register for their appointment. All women will have access to a digital mammogram on site, and results will be provided to them within two weeks. If a follow up referral is recommended by the Radiologist, the women will automatically be referred to the breast assessment program at SJHC, and an appointment time organized with the patient at the time results are provided.

Breast Care Centre at SJHC: Central registration with a team of volunteers All necessary imaging tests, including a tissue core biopsy if necessary, will be

performed the same day. The nurse navigator on site will provide education or support needed during this diagnostic visit.

With a positive cancer diagnosis, women will be referred to the next available surgeon appointment. Women will return to the centre, checking in with the same volunteers and staff

After surgical treatment women will return to the Breast Care Centre for follow up and referred to London Regional Cancer Program (LRCP) for further breast cancer care and non-surgical treatment as appropriate

Does the integration promote efficient and effective management of the local health system to ensure sustainability?

Yes An anticipated impact of this integration is to leverage the infrastructure for longer

range program planning of services, research and teaching, including outreach to others within the South West LHIN

Does the integration ensure value for money? Yes

Capital equipment resources need to be managed to ensure upgrades in technology are planned and cost effective. The consolidation will reduce the actual number of units required and concurrently upgrade the standard to full digital units

Consolidating all screening appointments, and using digital mammography equipment that can process higher volumes of patients, will add approximately 20% more capacity.

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Potential Impacts Indicate: No Impact, Negative Impact or Positive Impact

Clarify the Potential Impact and Provide Comments and/or Concerns

Impact on patient/client care and on the population of the LHIN in terms of such things as: access, choice, equity, quality, timeliness, continuity and coordination of services, and health outcomes

Positive Impact

Patient Care Quality Improvements include: With the consolidation of screening and diagnostic imaging programs under the

management of SJHC all women serviced will have access to digital imaging, proven to increase the cancer detection rate in younger women and women with dense breast tissue. All women will be offered same day “one stop” service for breast assessment/diagnosis

A multidisciplinary team approach to care, with consultation between radiologists and surgeons functioning in shared clinic space, will offer women increased confidence in their treatment plans and reduce the need for multiple return appointments

The coordination of diagnosis and treatment services between imaging, surgery and oncology will enhance the patient experience and reduce the associated anxiety with current wait times for appointments. The patient will be supported by an expert navigation team on site, with the support model starting when a woman accesses breast assessment services and continues in a seamless approach through the entire personal care journey. This care model will standardize education provided to all patients and refer women to proper supportive care services tailored to their needs

Locating this breast centre in properly planned space will ensure patient confidentiality and privacy during appointments. Improvements in ergonomic design will promote efficiency and flexibility for different types of visits

Women who are plastic surgery reconstruction candidates will be seen by the Clinical Nurse Specialist supporting the plastics program

Impact on achievement of the goals of the IHSP or provincial strategic plan

Positive Impact

This integration supports the IHSP’s second strategic direction Centrally Coordinated Resource Capacity and optimizes the use of targeted resources to improve access and complement the management of health and wellness at the more local and multi community levels

Key enablers related to Multi-level System of Navigation and information technology are also strengthened

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Potential Impacts Indicate: No Impact, Negative Impact or Positive Impact

Clarify the Potential Impact and Provide Comments and/or Concerns

Impact on specific subpopulations, diverse communities and any vulnerable populations in the LHIN

Positive Impact on vulnerable populations

Digital imaging is proven to increase cancer detection, however is not offered to all women in London. The OBSP located on Talbot Street in London is overdue to have dated equipment replaced and a PACS infrastructure is non-existent in its rented community clinic space. Consolidation of imaging would standardize digital equipment access. Digital breast mammography is already standardized at SJHC and their breast ultrasound performance is exceptional. SJHC installed a new MRI machine in 2009, specifically obtained with breast cancer management as a priority, that extends the abilities to assess higher risk cancers

The current composition of surgical support teams across the city is variable and contributes to inconsistent service to women with breast cancer. Consolidation will improve service access for patients

Impact on labour and employment relations

Positive Impact

Human resource improvements A multidisciplinary program will be developed to promote future recruitment,

education and research opportunities to ensure sustainability of the breast care service. This breast program will provide support to other breast care centres in the region to consistently direct the standard of care for all women

Human Resource teams will be consolidated to one pool of breast diagnostic and surgical specialists, to provide consistent relief and support for workload management in a shared space environment, to maintain sustainability of the model of service

With dispersion of services across London, human resources are fragmented and relief coverage is unreliable. A goal of the consolidation is that there will be one multi-disciplinary pool of specialists, to provide consistent relief and support for workload management, and to sustain the model of service

No Impact No new human resources are required to support this initiative.

Potential Negative Impact

A risk noted in the charter is that there could be a loss of human resources if they are not willing to move with the program. A mitigation strategy consisting of a replacement plan and training of required personnel has been developed.

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Potential Impacts Indicate: No Impact, Negative Impact or Positive Impact

Clarify the Potential Impact and Provide Comments and/or Concerns

Downstream impacts on health service providers and other entities in terms of such things as : capacity, services provided, continuity and coordination of services, population(s) served, and governance

No Impact

There will be no changes to the provision of OBSP by non-hospital providers located in London or across the rest of the South West LHIN; breast cancer diagnostic and surgery services located outside of London; or the range of breast cancer treatment and care services provided by the LRCP

Impact on use of resources and health system sustainability Positive Impact

A minor procedure room will be developed as part of the Breast Care Centre that would help to avoid some operating room procedures

The centre will standardize practices and optimize patient flow

Impact on relationships, collaboration and partnerships Positive Impact

Teams would function side-by-side, and a critical mass of physicians and staff would be achieved

The Parkwood imaging staff will be a part of the breast imaging team and further the team size and scope

2. COMMUNITY ENGAGEMENT: The voluntary integration materials should identify any community engagement and/or consultation that occurred and describe the outcome. Components of the engagement should address the system impacts of the integration, including the impacts listed above (patient/client care, goals of IHSP, labour, etc) Under sections 16(6) of LHSIA, HSPs must engage the “community of diverse persons and entities” where they provide services when they develop plans and set priorities. LHSIA does not define “community of diverse persons and entities” for HSPs. Some guidance is found in section 16(2) of LHSIA, which defines the LHIN “community” as:

Patients and other individuals in the LHIN’s geographic area HSPs and others that provide services in or for the local health system Employees involved in the local health system Some LHINs interpret the health service provider “community” to also include funders

There is no similar provision in LHSIA concerning the extent of engagement required by HSPs. An inclusive definition in line with the Act’s definition is to consider community engagement as involving all those members/stakeholders of the healthcare “community”, including HSPs, health care professionals, patients/clients, consumer support groups, funders and residents in broad health care planning.

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Engagement thus most effectively happens at all levels, from governance to the front lines and community residents. Engagement unlocks and leverages system planning expertise to create real solutions; incorporates knowledge about health needs, experiences and satisfaction; provides a means for emerging trends to be identified; and ultimately can stimulate collective responsibility towards the health system. Community Engagement Comments and/or Concerns: Things to consider: Yes/No Community was engaged. Do you feel all the necessary stakeholders were engaged? If not, who else should be engaged? Appendix A Stakeholder Engagement Summary (2008-2009) and Appendix B (Communications Critical Path) in the charter outline the engagement and communications that have or will occur. Highlights include:

Stakeholders have been engaged since October 29, 2008 regarding the consolidation of services Engagement occurred to map out the current state of a patient’s journey with breast cancer Front line staff were consulted at all sites Used the engagement to identify current gaps in the system and how they could improve support and education for patients based on

following actual patient experiences and their stories Public and media communications

The review team feels that all audiences have, or will be engaged appropriately. 3. OTHER OPERATIONAL IMPACTS IF APPLICABLE:

Other considerations: Does this proposal provide…. (indicate yes, no or not applicable)

Comments and/or Concerns

An overview of the program components and supporting services, Inpatient volumes (cases, weighted cases and patient days) and costs, Outpatient volumes and costs, Administrative and support services units and costs (e.g. administration, diagnostic & therapeutics, outpatient clinics, etc.)

Yes

Annualized funding amount to be transferred from LHSC to SJHC is $1,018,976 Operating Visit Volumes of Consolidated Service (see chart below)

Program Current SJHC

Current LHSC

Current LRCP

Consolidated SJHC

Imaging Breast Screening 5008 3589 10,000 (OBSP)

18,597 (Parkwood)

Imaging Breast Assessment 7285 3315 10,600 (SJHC) Breast Surgery OR cases 512 298 853 Breast Clinic Visits 525 4678 1257 6460

Services to be provided: Individuals to be served

Breast Imaging: 29,197 Breast Clinic Visits: 7576 Breast Surgery: 810

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Other considerations: Does this proposal provide…. (indicate yes, no or not applicable)

Comments and/or Concerns

A summary of the human resources plan for employees, including physicians, and the financial implications of the plan

Yes

Staff currently providing breast care across the city will be consolidated using the program transfer method agreed to by LHSC and SJHC in previous transfers

No new human resources are required to support this initiative or reduction of staff as positions moving from LHSC equal positions available at SJHC so there should be no financial implications

A description of the program decanting and measures to minimize disruption to patient service (transition plans)

Yes

Consolidate all Breast Imaging to SJHC in current Breast Imaging department - September 10, 2010

Consolidate Breast Surgery to SJHC (exchange the type of general surgery ambulatory cases done between LHSC and SJHC) - September 10, 2010

Consolidate Breast Assessment and Surgery-only Clinics to temporary space at SJHC – September 10, 2010

Consolidate all SJHC Breast Assessment Imaging Services and Breast Surgery Clinics to shared space – September 1, 2011

Implications of the program transfer on capital requirements, if applicable Yes Successful demonstration of previous transfers between LHSC and SJHC through

defined program transfer method

Evidence that regulatory and licensing requirements will be met, as appropriate (e.g. lab licensing in the case of laboratory transfers)

N/A

For partnerships or other similar joint arrangements, demonstration that the proposed venture does not place the assets of the HSP(s) at risk or create an operating liability for the HSP(s)

Yes Successful demonstration of previous transfers between LHSC and SJHC through defined program transfer method

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4. IMPACT TO LHIN ORGANIZATION:

Impact Indicate: No Impact, Negative Impact or

Positive Impact Implications for LHIN Organization, Comments and/or Concerns

Financial No Impact Transfer of $1,018,979 annualized funding from LHSC to SJHC requested

Policies and/or Procedures Potential Negative Regarding timeline of September 10 transfer of services and timelines with assumed LHIN approval. Concern that implementation occurring within the 60 days from Notice of Integration (LHSIA)

Return on Investment Positive Impact The goal of the integration is improved wait times, with only a transfer of funding from LHSC to SJHC

Public Relations Potential Negative A risk identified in the project charter is “reduction in access location for breast patients”. The charter identifies a mitigation strategy for this risk being a full marketing plan developed to promote the benefits of new service.

Additional Comments and/or Concerns:

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Project Charter

PROJECT INFORMATION Project Name Project Acronym or No. London Breast Cancer Coordination Project: Diagnostics & Surgical Treatment <assigned by LHIN>

Target Project Completion Date Budget (Funding Transfer Amount) Notice of Integration 2011-09-01 $1,018,976 Yes

HSP Lead Organization HSP Partner Organization(s)

St. Josephs Health Care London London Health Sciences Centre, London Regional Cancer Program

HSP Project Sponsor HSP Project Manager/Lead Glen Kearns, IVP Clinical Support Services & Information Technology Services Kirsten Krull, IVP Surgery Services Brian Orr, RVP Cancer Services

Jane Stacey, Coordinator, Rapid Access Oncology

LHIN Project Sponsor LHIN Project Lead

PROJECT DESCRIPTION Project Purpose: Explain the purpose of this project by describing, at a high-level, the background necessary to understand why the project was started, what will be done. What is this project aiming to achieve? What is its vision? What need or opportunity will it address? What problem will it solve?

The London Breast Cancer Coordination Project: Diagnostics & Surgical Treatment will improve access for breast cancer patients who are referred for breast cancer screening, diagnostic and surgery in London. The SJHC three year strategic plan has prioritized this project under Care and Performance Improvement: Rapid Patient Access to Oncology. For clarification, not included are changes to: the provision of Ontario Breast Screening Program services by non-hospital providers located in London or across the rest of the LHIN; breast cancer diagnostic and surgery services located outside of London; or the range of breast cancer treatment and care services provided by the London Regional Cancer Program. Problems and Overall Goals: • Multiple service locations exist within London for breast cancer care with variation in approaches, supports,

and standards. Currently there are 3 sites for breast screening, 2 sites for diagnosis, 3 sites for surgery, and 4 surgical follow up clinical sites. The same woman may traverse multiple sites for care. The goal: to integrate the services between LHSC, the OBSP, and St. Joseph’s Health care to create 1 screening site, 1 diagnosis site, 1 surgery site, and1 surgical follow up clinic site. In so doing, we create a consolidated rapid access Breast Cancer Diagnostic and Surgery Centre that will enable women to easily navigate their cancer journey from screening through diagnosis and surgery. There will be consistent standards, education, and approaches that are based upon best practices in the field. The breast cancer patients will continue to be referred to the London Regional Cancer Program for multi-disciplinary care and non-surgical

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treatment. • Wait times from abnormal screen to surgery are almost twice the Ontario provincial average: London’s

average is 10 weeks for women referred for specific concerns, and 13 weeks for women referred from the Ontario Breast Screening Program. The goal: With consolidation, to redesign of processes, teams, and booking systems, to reach a target of 7 weeks.

• With the dispersion of services across London currently, human resources are fragmented and relief coverage is unreliable. The goal: With consolidation there will be one multi-disciplinary pool of specialists, to provide consistent relief and support for workload management, and to sustain the model of service. This approach will also ensure ongoing recruitment of breast imaging specialists and surgeons to provide sustainable support for this Breast Care service and engage in future breast cancer research.

• Capital equipment resources need to be managed to ensure upgrades in technology are planned, and cost effective. London currently has a mix of analogue and digital mammography units. A new MRI unit was placed into SJHC in 2009 in part to meet the growing needs for Breast MRI diagnostics. The goal: With consolidation, to optimize the use of technologies and in so doing reduce the actual number of units required and concurrently upgrade the standard to full digitally units. Digital mammography units are the best practice standard for detection of small lesions, especially through dense breast tissue. Digital information will also allow reading to occur from any picture archive computer workstations in London. Consolidation will occur in the facility with purposefully planned breast MRI access.

Project Description: • All London-based breast cancer surgery will be consolidated to SJHC. The Department of General

Surgery is keen to move towards improving service access for patients, expanding the interdisciplinary team approach to care, and to manage their workloads as a general surgery team. Breast cancer reconstruction is a specialized Plastics and General Surgery service with most already occurring at SJHC. Reconstruction is a southwestern Ontario service.

• All London-based Breast Assessment services will be consolidated to SJHC. The city wide London Imaging Leadership group supports realignment of Breast Assessment services to support consolidated breast surgery at SJHC. Through the Program Transfer methodology, and in the interim, before physical consolidation is completed, SJHC Imaging will assume management of all breast imaging services currently serviced through the Mammography programs at SJHC and Victoria Hospital of LHSC.

• London-based Breast cancer diagnostic and surgery-only clinic services will be coordinated at SJHC. Following surgery, breast cancer patients will be referred to the London Regional Cancer Program for multi-disciplinary care and non-surgical treatment as appropriate.

Health Service Clients/Stakeholders (i.e., target populations)General Description Equity

This proposal responds primarily to the needs of the following population(s):

All residents of the London region (targeted audience is primarily female, although males are accepted for services when necessary) accessing services for either a breast screening detected abnormality: or referral from a family practitioner for a clinical breast concern. Every patient journey is tailored specific to their breast imaging and surgical needs, and patients will be referred to the London Regional Cancer Program for further multidisciplinary cancer care and non-surgical treatment to complete their

Aboriginal Francophone Rural/Remote Populations Inner-urban (e.g., homeless) Populations Religious, Ethno-Racial or Linguistic Minorities (please

specify): X Sex/Gender Primarily Female; Males included when

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breast cancer journey. identified Sexual Orientation/LGBT Low Income/Under-employed Persons with Disabilities (e.g., physical, intellectual, sensory, learning, mental illness)

X General Population X Other, please specify: Breast Cancer patients

Where Service/Initiative is Accessed Please indicate where the service/initiative identified in this project can be accessed (check one):

This service/initiative serves one community and is offered at one place or site. Patients/clients/consumers travel within their community for this service (Local Community)

This service/initiative serves two or more communities and is offered at two or more sites. Patients/clients/consumers may have to travel outside of their local community for this service (Multi-Community)

X This service is provided in one place or site, but serves all of the LHIN Community. As such, patients/clients/consumers may have to travel out of town to receive this service (LHIN Community)

Please indicate the specific area(s) (e.g., town, city, county, etc.) from which the service will draw clients/stakeholders:

The vast majority are from London, but other communities served for diagnosis to surgery include Tillsonburg, St. Thomas, Strathroy, Goderich. Complex cases may come from anywhere within the SWLHIN or Erie St. Claire LHIN. Many patients from all of southwest Ontario access SJHC for reconstructive breast cancer surgery. This is not new nor is this service changing with the integration/consolidation.

Health Service(s) Improvements for Clients/Stakeholders Describe how clients and families will benefit from your idea (e.g., improved quality of care, faster access to care, easier movement through the system, etc.)

The Case for Change The incidence of breast cancers is rising in the city of London with an aging population and improved diagnosis. Statistics tracked across Ontario indicate a shortfall in London meeting provincial wait times from abnormal diagnosis to surgery. The benchmark target is 7 weeks; the current average time for a patient who has a breast cancer diagnosed through the Ontario Breast Screening Program (OBSP) is 13 weeks and for a patient diagnosed with breast cancer originally referred by her family doctor for a breast concern is 10 weeks. (Refer to following chart) April 1 2008 – Oct 1 2008 Cumulative

Target (wks) 90th

Percentile

*SJHC *LHSC **SJHC **LHSC Future Target

Abnormal screen to first assessment

3 wks 25% 63% 90%

Diagnostic imaging confirmed benign

4 wks 27% 62% 90%

**Diagnostic referral for clinical concern

* OBSP screened Time Interval from Abnormal Screen to Surgery

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Diagnostic imaging with tissue biopsy

5 wks 26% 71% 61% 65% 90%

Diagnostic imaging to malignant surgery

7 wks 0% 0% 38% 44% 90%

The notion of consolidating breast cancer screening, diagnosis, and surgery services at St. Joseph’s Health Care is not new. The current case for change includes the following:

• Patients currently experience multiple consults with various clinicians across London and timely, coordinated flow of patient information between the various centres can be problematic. Consolidation of breast screening, diagnostics and surgery services, offers the potential to smooth information flow, provide automatic referrals, and improve queuing of appointments. In addition, it offers an ability to have imaging and surgery staff come together to form more sizable and efficient teams.

• Digital imaging is proven to increase cancer detection however is not offered to all women in London. The OBSP located on Talbot Street in London is over due to have dated equipment replaced and a PACS infrastructure is non-existent in its rented community clinic space. Consolidation of imaging would standardize digital equipment access. Digital breast mammography is already standardized at St. Joseph’s and their breast ultrasound performance is exceptional. St. Joseph’s installed a new MRI machine in 2009, specifically obtained with breast cancer management as a priority, that extends the abilities to assess higher risk cancers.

• The Division of General Surgery is keen to move toward consolidation to improve service access for patients, expand the team approach to care, and manage their workloads as a team. The current composition of surgical support teams across the city is variable and contributes to inconsistent service to women with a breast cancer.

• St. Joseph’s breast cancer reconstruction is well established with a highly functioning surgical supportive care team.

• Proper clinic design in a dedicated space at SJHC would improve patient confidentiality and concurrently facilitate throughput and allow for future planning and expansion of clinic services offered.

Besides the direct case for change associated with breast cancer care, there are other compelling issues that are arising especially within the next year, and influenced by major program transfers associated with M2P2. They include the following:

• Greater delineation of St. Joseph’s Hospital ambulatory specialization and available capacity and resources.

• Growing needs to create imaging capacity to better meet urgent acute imaging needs at Victoria Hospital and needed capacity for the birthing program expansion.

VISION AND OBJECTIVES OF A CONSOLIDATED AND COORDINATED SERVICE MODEL AT ST. JOSEPH’S HEALTH CARE The vision is the creation of a consolidated Breast Care Centre at St. Joseph’s Hospital within the vacated space of the Women’s Health Centre at M2P2. This would consolidate diagnostic imaging and surgery clinics into one location. A minor procedure room within the centre would be developed and opens new possibilities to avoid some operating room procedures. Medical and operational leadership would be delineated. The centre would standardize practices and optimize patient flow. Teams would function side-by-side, and a critical mass of physicians and staff would finally be achieved. The breast screening program would be consolidated at Parkwood Hospital which would finally offer a PACS infrastructure to support a fully digital service, ample parking, adequate space to handle flow of large volumes of people, and conveys a non-acute medical model of service. The Parkwood imaging staff will be part of the breast imaging team and further the team size and

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scope. Improvement Objectives Wait time reduction across the breast cancer screening to surgery journey With commitment to a coordinated multidisciplinary service at SJHC, we will reduce the average time for the complete care journey for all women diagnosed with breast cancer to benchmark target of 7 weeks. Women will ideally have all necessary imaging and breast biopsy in 1 day. Standardized automatic referral process for a patient with a positive cancer diagnosis would occur to the next available surgeon appointment in the consolidated service at SJHC. Breast surgery operating room resources would be scheduled in such a way to increase efficiency and capacity.

Patient care quality improvements

• With the consolidation of screening and diagnostic imaging programs under the management of SJHC all women serviced will have access to digital imaging, proven to increase the cancer detection rate in younger women and women with dense breast tissue. All women will be offered same day “one stop” service for breast assessment/diagnosis.

• A multidisciplinary team approach to care, with consultation between radiologists and surgeons functioning in shared clinic space, will offer women increased confidence in their treatment plans and reduce the need for multiple return appointments.

• The coordination of diagnostic and treatment services between imaging, surgery and oncology will enhance the patient experience and reduce the associated anxiety with current wait times for appointments. The patient will be supported by an expert navigation team on site, with the support model starting when a women accesses breast assessment services and continues in a seamless approach through the entire personal care journey. This care model will standardize education provided to all patients and refer women to proper supportive care services tailored to their needs.

• Locating this breast center in properly planned space will ensure patient confidentiality and privacy during appointments. Improvements in ergonomic design will promote efficiency and flexibility for different types of visits.

• Women who are plastic surgery reconstruction candidates will be seen by the Clinical Nurse Specialist supporting the plastics program.

Breast screening will be located at Parkwood Hospital. Upon arrival, women will have access to ample parking, and a warm welcoming atmosphere to register for their appointment. All women will have access to a digital mammogram on site, and results will be provided to them within two weeks. If a follow up referral is recommended by the Radiologist, the women will be automatically referred to the breast assessment program at St. Joseph’s Hospital, and an appointment time organized with the patient at the time results are provided. Women referred for an abnormality detected from the screening program, or directly referred by their family doctor for a clinical breast concern, will be offered the next available appointment at the breast assessment program at St. Joseph’s Hospital. The day of the appointment, women will check into a central registration area in the dedicated Breast Care Centre, while a team of volunteers on site will provide way finding support for patients to the breast assessment imaging area. All necessary imaging tests, including a tissue core biopsy if necessary, will be performed the same day. The nurse navigator on site will provide education or support needed during this diagnostic imaging visit. With a positive cancer diagnosis from the breast assessment program, women will be referred to the next available surgeon appointment in the Breast Care Center. Women will return to the Centre, checking in with

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the same familiar friendly faces at the central registration desk. Volunteers will guide the woman back to our surgery clinic area. The surgeon will meet with the patient, discuss treatment options and formulate a surgical treatment plan. The nurse navigator, (from the same team of nurse navigators that rotate through imaging and clinic services) will provide continued support for the patient. Patients identified with high risk additional needs will be referred to the Centre’s Advanced Practice Nurse, and referred to additional supportive care resources if needed. After surgical treatment, women will return to the Breast Care Centre for follow up. Clinical pathways and visit frequency will be developed using best practice guidelines. Patients will referred to LRCP for further breast cancer care and non-surgical treatment as appropriate. Operating Visit Volumes of Consolidated Service:

Program Current SJHC

Current LHSC

Current LRCP

Consolidated SJHC

Imaging Breast Screening 5008 3589 10000 (OBSP)

18597 Parkwood

Imaging Breast Assessment

7285 3315 10600 SJHC

Breast Surgery OR cases 512 298 852 Breast Clinic Visits 525 4678 1257 6460

Human resource improvements • A multidisciplinary program will be developed to promote future recruitment, education and research

opportunities to ensure sustainability of the breast care service. This breast program will provide support to other breast care centers in the region to consistently direct the standard of care for all women.

• Human Resource teams will be consolidated to one pool of breast diagnostic and surgical specialists, to provide consistent relief and support for workload management in a shared space environment, to maintain sustainability of the model of service.

Operating efficiency improvements

• Consolidating all screening appointments, and using digital mammography equipment that can process higher volumes of patients, will add approximately 20% more capacity. An analogue mammography unit processes 3 cases per hour whereas a digital unit processing 5 cases per hour.

• Radiologists will read all digital screening cases on PACS workstations that are located in various centres across London and thereby eliminate travel time and expenses.

• Coordinating breast assessment/diagnosis appointments to one day will decrease technologist and Radiologist workload by providing patient results in one visit; instead of reviewing the patient history each time the patient returns for multiple imaging visits to obtain the final imaging diagnosis.

• Creating a team of nurse navigators rotating through imaging and surgery services will provide a seamless support model of care for the patient through her entire care journey.

• Consolidating administrative, technologist and nursing teams will allow for sustainability in our human resource model, providing necessary coverage for vacation time and relief

• Consolidating breast cancer diagnostic and surgery clinic services to one dedicated and ergonomically designed space will reduce current issues of patient privacy and confidentiality

• The minor procedure room in the Breast Care Centre will allow surgeons to remove clinically appropriate cases out of the operating room and thereby release operating room resources.

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• Dedicated nursing support will assist in the detailed work up of new breast cancer patients thereby optimizing use of surgeon time.

• Dedicated nursing support will facilitate follow up surgery-only breast clinic follow-up visits, in addition to the referral of breast cancer patient to LRCP for further multidisciplinary care and non-surgical treatment.

• Consolidating all screening appointments, and using digital mammography that can process higher volumes of patients, will add approximately 20% capacity. An analogue unit can process 3 cases per hour, whereas a digital unit can process 5 cases per hour.

Project Scope Describe specific items that will (“in-scope”) and will not (“out-of-scope”) be included as part of the work performed on this project. Consider specific features, functions, quality needs or other “must have” requirements and place them in the in-scope section. Spell out any exclusions (i.e., work that will not be performed) in the out-of-scope section.

In-Scope Out-of-Scope • Coordination of all breast imaging at SJHC • Consolidation of OBSP screening services, currently

offered by London’s Hospitals, at SJHC • Coordination of London-based breast surgery at SJHC • Coordination of London-based breast cancer diagnostic

and surgery clinic services at SJHC. • Education standards deliverable to breast cancer

diagnostic and surgery patients seen at SJHC. • Coordinate with LRCP to ensure breast cancer

patients, during the diagnostic and surgery treatment phases of their cancer journey, have access to LRCP and community agencies delivering support services.

• Adjust the Cancer Care Ontario allocation of breast cancer base and incremental cases between LHSC and SJHC to reflect the transfer of all breast surgery cases to SJHC.

• Non Cancer plastic breast surgery • Any change in the scope of breast cancer treatment,

supportive care, patient education, research and training provided at the London Regional Cancer program.

• Provision of breast cancer care beyond diagnostic and surgical services.

Integration

Is this an integration opportunity? X Yes No

If yes, please check which type of integration opportunity:

Voluntary Integration (Integration Decision at LHIN’s discretion). If checked, please sign below.

Funding Integration (No Integration Decision required)

Facilitated Integration (Integration Decision required)

Required Integration (Integration Decision required)

Comments:

I acknowledge that this submission is a formal notice of a proposed integration to the LHIN.

Signature:

Name:

Date:

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Target Project Completion Date: 2011-09-01

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ALIGNMENT Strategic Alignment: Describe linkages to South West LHIN directions, provincial priorities and/or organizational strategies. Blueprint/IHSP Alignment

The project aligns to the following South West LHIN Blueprint Approaches & IHSP Directions:

Primary Alignment (check one)

X

Population-based Integrated Health Services

Seniors & Adults with Complex Needs

Chronic Disease Prevention and Management

Mental Health and Addictions

Centrally Coordinated Resource Capacity

Emergency Services

Critical Care

Medicine

Surgery

Secondary Alignment (check one)

Comments: Centrally Coordinated resource capacity for breast imaging services is also included in this project

Key Enablers

The project aligns to the following Key Enabler (check one):

Information & Clinical Technology

X System Navigation

Human Resource Strategies

Implementation & Accountability

Provincial Priorities

This project aligns to the following Provincial Priorities (e.g., ALC/ER, Diabetes, Family Health, Wait times):

Wait times for Breast Cancer screening, diagnostic and surgery services offered in London.

Impacts on Organization(s) System Impacts

Identify the impacts this project is expected to have on the health care system in the South West LHIN:

The purpose of this project is to consolidate and coordinate breast cancer screening, diagnostic and surgery services at SJHC. The objectives are to deliver equitable service, reduce the associated wait times for services from diagnosis to breast cancer surgery, and expedite the referral of these patients through to London Regional Cancer Program (LRCP) for other cancer treatment and services. The integrated model will be patient focused and deliver multidisciplinary care including education and support for the patient and their caregivers. It is anticipated that lessons learned from this project will be applicable to other cancer diseases to facilitate continuous improvement in care for all cancer patients.

Organizational Objectives and Strategies

Identify the organizational objectives and strategies this project aligns to (e.g., improved performance measurement, cultural shifts, improvement processes/methodologies):

Breast Care Consolidation Project; Diagnostics and Treatment Project Charter

Target Project Completion Date: 2011-09-01

South West Local Health Integration Network Page 9 of 16

The SJHC refreshed three year strategic plan has prioritized a project under Performance Excellence: to achieve our benchmark wait time of 7 weeks from abnormal assessment to first operative treatment for 90% of patients we care for with breast cancer.

Process Change Impacts

Identify the process change impacts this project will have on your organization or on other organizations (e.g., increased efficiency, improved performance reporting):

• Improved performance in wait times from abnormal screening to surgery.

• Patient care quality improvements including: offering digital mammography to all women, and providing a multidisciplinary team approach to care, with consultation between Radiologists and surgeons functioning in shared clinic space to offer women confidence in their treatment plans

• Human resource improvements to promote future recruitment, education and research opportunities to ensure stability of breast care service

• Operating efficiency improvements to potentially regain capacity to service more women.

• To leverage the infrastructure for longer range program planning of services, research, and teaching, including outreach to others within the SWLHIN.

Related Projects & Initiatives

Are there dependencies with other initiatives or projects (at the organizational, LHIN or Provincial level)?

Yes X No

If “yes”, please describe below.

Project/ Initiative Interdependency & Impact

List the project or initiative. State the dependency and indicate how the dependency impacts your project.

• •

• •

• •

Are there opportunities to spread to Local Community, Multi-Community, LHIN Community (as described above)?

Yes No X Not Sure

If “yes”, please describe below.

Streamlining our current approaches however not intended to have any other impacts outside of London.

PROJECT PERFORMANCE Project Goals, Objectives & Performance Measures Provide the details of what this project aims to accomplish by listing its specific goals, objectives and deliverables. State the goals in terms of high-level outcomes to be achieved. Identify specific objectives and deliverables for each goal listed. Objectives are clear statements of specific activities/tasks that must be performed to achieve the goals. Identify both project product/service and people/organization change objectives. Performance measurement indicators and targets are

Breast Care Consolidation Project; Diagnostics and Treatment Project Charter

Target Project Completion Date: 2011-09-01

South West Local Health Integration Network Page 10 of 16

used to determine if objectives and expected results have been successfully achieved.

Goals Objectives Performance Measurements

Indicators Targets

List all goals to be achieved by the project. Ensure alignment with project purpose.

For each goal, list specific objectives that will signify achievement of goal when finished.

For each objective, list the performance measurement indicator and target that will be used to evaluate success of results achieved.

Improved Wait Times • Improve Wait times and access in London for breast assessment and surgery to meet the current provincial benchmarks

• CCO provincial reporting on breast cancer screening, diagnostic and surgery wait times for London and S.W. LHIN.

Consistent education and support for all patents

• Patient satisfaction scores will improve

• Patient satisfaction survey

Project Timelines & Deliverables

Indicate when the project will take place. Provide a preliminary estimate for the duration of the project by documenting the target completion dates for high-level project milestones. Milestones are significant project events that usually signify completion of project phases or major deliverables.

Milestones Deliverables Dates

Description. Give clear definition of the milestone and/or deliverable, clarifying how you will know when it has been successfully achieved.

Absolute date where possible or time from start of project.

Consolidate all Breast Imaging to SJHC in current Breast Imaging department Consolidate all breast screening to dedicated breast screening centre at Parkwood site, SJHC

All Breast imaging and breast assessment from VH consolidated to SJHC following program transfer All OBSP Talbot St. Hub volumes consolidated to SJHC

2010-09-10 2011-05-31

Consolidate breast surgery to SJHC (exchange the type of general surgery ambulatory cases done between LHSC and SJHC)

The London breast surgeons will perform the majority of breast surgery at SJHC. Less than 10 cases per year will continue to be performed at LHSC due to case complexity. London’s Hospitals cancer surgery agreements with Cancer Care Ontario will be adjusted to reflect the transfer of breast cancer surgery cases from LHSC to SJHC. Ambulatory general surgical case volume is being exchanged between LHSC and SJHC (e.g. cholecystectomy and hernia repairs will move to LHSC while breast surgery moves out of LHSC to SJHC).

2010-09-10

Consolidate breast assessment and All breast diagnostic and surgery-only 2010-09-10

Breast Care Consolidation Project; Diagnostics and Treatment Project Charter

Target Project Completion Date: 2011-09-01

South West Local Health Integration Network Page 11 of 16

surgery-only clinics to temporary space at SJHC

clinic services including pre operative treatment planning and post operative surgery-only follow up will facilitated at SJHC

Consolidate all SJHC breast assessment imaging services and breast surgery clinics to shared space

Move breast imaging and breast clinics into shared space; renovated Women’s Health Space at SJHC

2011-09-01

PROJECT TEAM MEMBERS Project Team Identify who is needed on the core project team to complete project deliverables and achieve goals and objectives. What skills, knowledge and experiences are required? Consider the need for special expertise to deal with people and organization change challenges. This section may include any new Human Resource(s) required to support the project.

Team Member and/or Title/Profession, Organization

Role on the Project Required Involvement

Estimated Duration Level of Effort

Provide names and/or titles/professions of core project team members.

Describe the role & responsibility of each core project team member.

Indicate target dates or number of weeks/months.

Indicate full-time or days per week/month.

Anne Marie McIlmoyl Director of Surgical Services SJHC

Project Sponsor 1 day per week

Anthony Orfanides Director Medical Imaging LHSC/SJHC

Project Sponsor 1 day per month

Howard Hansford Site Leader Medical Imaging SJHC

Imaging Implementation 2 days per week

Suzie Almedia Coordinator Surgical Services SJHC

Surgery Implementation 2 days per week

Millie Litt OBSP Breast Screening Implementation

1 day per week

General Surgeon, Breast Surgery Medical Director

Lining up the general surgeon team

3 days per month

Dr. Don Taves Diagnostic Imaging, Breast Imaging Medical Director

Lining up the Imaging team 3 days per month

Sheldon Bumstead & Cathy Monchamp, HR Managers

Human Resources logistics & union communications between SJHC and LHSC

2 days per month

Dahlia Reich, PR Consultant Public Relations—Communications Plan

2 days per month

Michelle Campbell, St. Joseph’s Foundation President

Fundraising for Breast Centre Renovations & Parkwood Renovations

3 days per month

Project Oversight Identify who is responsible for decision-making and oversight of scope, changes, etc.

Breast Care Consolidation Project; Diagnostics and Treatment Project Charter

Target Project Completion Date: 2011-09-01

South West Local Health Integration Network Page 12 of 16

Glen Kearns, Kirsten Krull, Brian Orr

Project Partners Is this project carried out in partnership with other groups/organizations? Indicate who else, in addition to those listed as project team members above, has committed to contributing to this project. Partners are individuals, groups or organizations who work together towards joint interests to achieve common goals. Identify shared, mutually beneficial objectives below and the contributions of each partner.

Partners Common Interests & Priorities Roles & Responsibilities List names, groups or organizations. State shared objectives and identify

priorities for each partner listed. What commitments have been made?

Millie Litt OBSP Consolidation of breast imaging services

Participation on core implementation team

Brian Orr – VP LRCP & RVP S.W. Regional Cancer Program

Consolidation of breast cancer surgery-only clinics Improvement in wait times Adjustments to cancer surgery agreements.

Project Sponsor

Silvie Crawford and Carol Rhiger, Directors of Surgical Care, LHSC

Successful transfer of surgical elements

Regular contact through all stages and reporting back to site Perioperative Committees

Unions for nurses, and technologists Ensuring staff are handled appropriately during the transition

Communications started summer 2009 and we received support for the consolidation. HR and unions in regular contact to work through logistics. Very small number of staff impacted.

Project Stakeholders Stakeholders are individuals or organizations that have a vested interest in the initiative. They are either affected by, or can have an affect on, the project. Anyone whose interests may be positively or negatively impacted by the project or anyone that may exert influence over the project or its results is considered a project stakeholder. All stakeholders must be identified and managed appropriately.

Stakeholders Interests & Needs Management Strategies List names, groups or organizations. Why are they stakeholders? How are

they involved? How will the project manage expectations and meet their needs and requirements?

London Health Sciences Centre Current provider of Cancer and Breast Imaging and Breast Surgery services

Key leadership roles are part of implementation team

St. Joseph’s Health Care, London Current provider of Breast Imaging and Breast Surgery Services

Key leadership roles are part of implementation team

London Regional Cancer Program Provides comprehensive multidispilinary care for breast and other cancers from screening to end-of-life, as well as non-surgical treatment of cancers, cancer education and research.

Key leadership role in providing coordination of beast cancer care to patients in Southwestern Ontario

South West Regional Cancer Program Cancer Care Ontario’s responsibility for integrating cancer care services

Key leadership in ensure coordinated and quality of care provided to cancer

Breast Care Consolidation Project; Diagnostics and Treatment Project Charter

Target Project Completion Date: 2011-09-01

South West Local Health Integration Network Page 13 of 16

within the South West LHIN. patients across the South West LHIN.

Please see Appendix A for a summary of Stakeholder Engagements between 2008-09

PROJECT RESOURCES

Human Resources Provide an overview of the new Human Resources (HR) required to support the initiative beginning with year one as well as additional hires in year two. As well, consider volunteer resources to be leveraged to support the information and provide information on these resources.

Position Title and Designation Required (if applicable) (e.g., PSW, Case Manager)

Project Start-up Ongoing Project Support

No new human resources are required to support the initiative. Project is the consolidation of diagnostic and surgery Breast Cancer Services at both organizations

Volunteer Services Project Start-up Ongoing Project Support

Services to be provided: OHRS Functional Centre Description Individuals to be Served Service Units/Volumes

Breast Imaging 29197

Breast Clinic Visits 7576

Breast Surgery 810

Funding Details

No new funding required. We will be transferring funds from LHSC to SJHC using the historical program transfer methodology used by the London hospitals for approximately 30 transfers that have taken place between 1998-2005.

Ongoing Base Funding Budget Comments

Breast Care Consolidation Project; Diagnostics and Treatment Project Charter

Target Project Completion Date: 2011-09-01

South West Local Health Integration Network Page 14 of 16

Other Funding Sources

Total Net Ongoing Base Funding Required from LHIN

$

Start-Up One-Time Funding Budget Comments

Consultation/Training

Information/Technology

Staff

Other (specify in comments)

Total Funding Required

Other Funding Sources

Total Net One-Time Funding Required from LHIN

$

TOTAL FUNDING REQUIRED FROM LHIN (Ongoing Base + One-Time)

$

In-Kind Contributions Are there any in-kind contributions? Yes x No

If yes, describe:

PROJECT COMMUNICATIONS

Project Team Communications Identify information needs of steering committee, project sponsor, project manager, team members, working groups, partners, stakeholders and others. List strategies for ensuring that right information is provided to right audience in most suitable and timely manner. Be sure to identify format and frequency of communication between the project manager and project sponsor regarding project status, performance, risks, issues, etc. Please refer to Appendix B: Communication Plan Breast Project

PROJECT RISKS & CHALLENGES

Project Risks Document high-level project risks apparent at this point that could either positively or negatively impact the achievement of project goals and objectives. Focus on risks that are likely to happen and have a significant effect on project success. Be sure to consider risks associated with people & organization change, knowledge management and transition to operations.

Risk Likelihood of Occurrence

Potential Impact Organization Capacity to Manage Risk

Mitigation Strategy

Brief description of risk.

High, Medium, Low High, Medium, Low High, Medium, Low High level strategy to address risk.

Loss of Human Resources; not willing to move with program

High High High Replacement Plan in place for recruitment and training of required personnel

Breast Care Consolidation Project; Diagnostics and Treatment Project Charter

Target Project Completion Date: 2011-09-01

South West Local Health Integration Network Page 15 of 16

Reduction in access location for breast patients

Med Med Med Full marketing plan developed to promote benefits of new service

Critical Success Factors Define key factors that are critical to success of the project. These conditions must be satisfied to enable successful completion of project objectives and deliverables. Include significant events or decisions that need to take place. Whenever possible, ensure factors you list are measurable.

• Implementation of interim space for Breast Surgery clinic and Breast Imaging Sept. 10, 2010

• Implementation of new space for Breast Screening at Parkwood Hospital – May 2011

• Implementation of the Breast Care Centre which is new space that combines Breast Surgery Clinics and Breast Imaging in one location

• Registered Technologists certified in Mammography, and Radiologists specializing in Breast Imaging

• Digital imaging and access to Picture Archiving Computer Systems

Assumptions & Constraints Assumptions are external factors that, at the time of writing the charter, are considered true, real or certain for purposes of planning. Certain unverified or unknown aspects that are likely to happen must be assumed as facts to proceed. Constraints are factors that are outside the control of the project team, that restrict or regulate the project. They limit available options and affect performance of the project.

Assumptions Constraints

List the assumptions made to date. What did you have to assume to be true to complete the charter?

List project constraints. Consider time, budget, scope, quality, availability/skills of resources, priorities, etc.

The London Imaging Leadership group will continue to support consolidation of breast imaging services to SJHC

Existing human resource teams may choose not to move with consolidation of programs

The general surgery group will support complex breast (needing in-pt care) surgery patients and those who are at high risk related to anesthesia care at LHSC. Volume of less than 10 per year.

Parking implications identified with an increase in SJHC Out Patient services; balance should be realized with the move of Women’s Health services at M2P2

The breast surgeons will deliver service from a consolidated breast clinic model at SJHC

Medical coverage is currently limited at SJHC to enable general surgeons to support IP Beds

Equipment program transfer methodology to be applied between the corporations.

Limited cancer care support services on site at SJHC, but available through LRCP.

Pathology services continue through the pathology lab hub. On site pathology at SJHC reduced some time ago. Laboratory collection locations change and costs move accordingly.

The London Regional Cancer Program will continue to work in partnership with the project team to identify opportunities to enhance oncology services through the new breast care program at SJHC

Breast Care Consolidation Project; Diagnostics and Treatment Project Charter

Target Project Completion Date: 2011-09-01

South West Local Health Integration Network Page 16 of 16

PROJECT REPORTING SCHEDULE <TO BE COMPLETED BY THE LHIN>

Project Status Reports

Based on the Estimated Project Duration of and Target Project Completion Date of [yyyy-mm-dd], Project Status Reports are to be submitted to the LHIN according to the following schedule:

Report # Reporting Period [yyyy-mm-dd to yyyy-mm-dd] Report Deadline [yyyy-mm-dd]

1 to

2 to

3 to

4 to

Project Close-out Reports

Based on the Target Project Completion Date of [yyyy-mm-dd], the Project Close-out Report is to be submitted to the LHIN on the following date:

Please submit Project Status Reports and Close-out Report to Michelle Hay, michelle.hay@lhins.on.ca

POLICY / LEGAL / PRIVACY & SECURITY / STANDARDS CONSIDERATION <LHIN will populate this section with standard legal wording re: FIPPA and procurement directives.>

APPENDIX A

Breast Consolidation --Stakeholder Engagement Summary (2008-2009) Stakeholder engagement.occurred to map out the current state of a breast cancer journey on behalf of the patient. Front line staff were consulted at all sites, through imaging, surgery and oncology services to identify current gaps in the system, and how we could improve support and education for patients based on following actual patient experiences and their stories. The following chart outlines the meetings held to engage stakeholders and front line staff.

Deliverable Start date End date Stakeholder Meeting Date Service Mapping Imaging

Oct. 22, 2008 Nov 25, 2008 Introduction Breast Imaging VH Oct 29,2008

Current ST. JOSEPH’S HEALTH CARE, LONDON Breast Steering Committee

Nov 5,2008

Introduction Breast Imaging ST. JOSEPH’S HEALTH CARE, LONDON

Nov 7,2008

VH Mammography review Nov 12,2008 Dr. Keith Sparrow VH Radiology Nov 12, 2008 ST. JOSEPH’S HEALTH CARE,

LONDON Mammography review Nov 17,2008

Dr. Don Taves ST. JOSEPH’S HEALTH CARE, LONDON Radiology

Nov 18,2008

OBSP Talbot Hub Nov 19,2008 Imaging Service presentation

City Imaging Directors; VP Glen Kearns

Nov 25,2008

City Imaging Directors Dec 1,2008 OBSP Directors, Imaging Directors Dec 8,2008 Navigator review ST. JOSEPH’S

HEALTH CARE, LONDON Dec 9,2008

City Radiology group, VP Glen Kearns

Jan 14,2009

City Radiology group, VP Glen Kearns

Jan 26,2009

Imaging Presentation to Breast Steering Committee

Jan 27,2009

Independent chart review

Dec 2,2008 Jan 6,2008 Independent chart review VH Dec 2,2008

Independent chart review ST. JOSEPH’S HEALTH CARE, LONDON

Dec 4,2008

Independent chart review ST. JOSEPH’S HEALTH CARE, LONDON

Dec 10,2008

Independent chart review ST. JOSEPH’S HEALTH CARE, LONDON

Dec 16,2008

Service Mapping Surgery

Nov 21,2008 Jan 26,2009 Introduction to Muriel Brackstone Nov 4,2008

Introduction to city Surgery directors Oct 29,2008 Introduction to Muriel Brackstone Nov 4, 2008 Introduction to Surgery director ST.

JOSEPH’S HEALTH CARE, LONDON

Nov 19,2008

APN breast support ST. JOSEPH’S HEALTH CARE, LONDON

Nov 21,2008

WTIS surgery quarterly meeting Nov 26,2008 APN support VH Dec 8,2008 Dr. Brackstone clinic LRCP Dec11,2008 Dr. Engel clinic LRCP; Pat Baruth Dec 12,2008 City Surgery directors Dec 16,2008 Pre Admit ST. JOSEPH’S HEALTH

CARE, LONDON Dec 16,2008

Dr, Scott clinic VH Dec 18,2008 City surgery directors, volume review Jan 5,2009 Dr. Brackstone clinic ST. JOSEPH’S

HEALTH CARE, LONDON Jan 9,2009

Pre Admit, Day Surgery VH Jan 14,2009 Day Surgery ST. JOSEPH’S

HEALTH CARE, LONDON Jan 16,2009

Pre Admit Day Surgery UH Jan 19,2009 Dr. Garvin clinic VH Jan 19,2009 Clinic Director review ST. JOSEPH’S

HEALTH CARE, LONDON Jan 22,2009

Pre Admit, PACU, VH Jan 23,2009 City Director surgery Volume Review Jan 26,2009 Surgery Service Presentation

City Surgery directors; VP Kirsten KrullNaraj

Mid Feb,2009

Surgery stakeholders, planning Feb, 2009 Surgery presentation to Breast

Steering committee TBA Mar, 2009

Service Mapping Oncology

Feb, 2009 April 2009 Introduction Dr. Ted Vandenburg TBA Feb 2009

Breast Steering Nov 1,2008 June, 2009 1st meeting of regional membership Jan 27,2009

committee Imaging presentation

2nd meeting TBA March 2009 Surgery presentation

Stakeholder Blog Feb 2009 Dec 2009 Information management planning Dec 17, 2008 Patient Advisory Group

Feb 2009 Dec 2009 Report to Steering committee As required

Project charter Feb 2009 Sept 2009 Acceptance by Steering committee TBA March 2009

APPENDIX B

Breast Care Diagnosis and Surgery Consolidation Project

Communications Critical Path

Timeframe Audience Tactic Spokesperson Responsibility Status May 17 Union Leaders Face to face

meeting(s) HR, Howard Hansford

HR, Howard Hansford Completed

May 26 Imaging and surgical staff impacted by consolidation

Open forums (for affected staff) - St. Joe’s A.M. - LHSC P.M.

Howard Hansford - LHSC rep?

Howard Hansford, Suzie Almeida, LHSC counterparts

Completed

May 27 Hospital Leadership and MAC (include foundation and HR leaders)

Email – joint, to come from Cliff

Cliff Nordal, CEO Glen Kearns, IVP CSS Kirsten Krull VP Surgery

Corporate Communications Completed

May 27 Public Reactive media statement

Cliff Nordal, CEO Glen Kearns, IVP CSS Kirsten Krull VP Surgery

Corporate Communications Completed

May 27 – after leader email

Staff and Physicians Community partners

Email/memo- joint To come from Cliff Nordal

Cliff Nordal, CEO Glen Kearns, IVP CSS Kirsten Krull Naraj, VP Surgery

Corporate Communications Completed

May 31 Affected LHSC staff

Letters re: new positions available at SJHC – June 18 deadline

HR HR Completed

June OBSP patients Wording – to explaining appt. options.

OBSP Staff Corp. Communications Complete and sent to OBSP

July St. Joe’s Imprint story None Corp. communications Complete July Mammography

and breast assessment patients

Letter explaining appts. Will be booked at St. Joe’s

Anthony Orfanides

Corp. Communications Complete and sent

August Referring physicians

Letter directing referrals to St. Joe’s

Glen Kearns and Anthony Orfanides

Corp. Communications Complete and sent

August Surgery clinic patients

Letter advising them appts. Have moved to St. Joe’s

Patient’s doctor

Corp. Communications Complete and sent

August LHIN Letter to submit consolidation for voluntary integration approval

Karen Belaire Karen Belaire Complete

Pre LHIN approval

LHSC and St. Joseph’s boards

Letter – advise of current status - update LHIN approval process

Cliff Nordal Cliff Nordal To be completed

Pre LHIN approval

LHSC and St. Joseph’s foundations

Letter – advise of current status - update LHIN approval process

Cliff Nordal Cliff Nordal To be completed

Post LHIN approval

LHSC and St. Joseph’s foundations

Share consolidation communications plan

None Corp. Communications To be completed

Post LHIN approval

LHSC The Page story None Corp. communications To be completed – will run after LHIN approval

Post LHIN approval

Media/public Media release - joint

Glen Kearns/Kristen Krull, Dr. Taves, Dr. Brackstone, Jane Stacey

Corporate Communications

To be completed and run after LHIN approval

Post LHIN approval

Vim and Vigour – fall issue

General article on consolidation plans – St. Joseph’s

Jane Stacey Corporate communications Complete – ran 1st week of August

Oct. 2010-May 2011

Staff impacted, all staff as appropriate

Emails, memos, E-Print, Imprint as services move

Glen/Kirsten, directors

Corporate communications When necessary

-Separate story telling as required by both organizations

Oct. 2010- Sept. 2011

Public Letters, post card reminders , telephone call reminders, info sheet, Internet messages as services/bookings move

Glen Kearns/Kristen Krull

Corporate communications Surgeons offices

When necessary

Sept/Oct. 2011

Media Media release, completion of new Breast Diagnostics and Surgical Care Centre

Glen/Kirsten Corporate communications After LHIN approval

Sept/Oct. 2011

all staff, leaders, patients, community partners, volunteers media,

Opening celebration

Cliff, foundation, IO, St. Joseph’s and LHSC leadership

Corporate communications/foundation

After LHIN approval

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Report to the Board of Directors Integration: Tier 2 Transfer of Specialized Mental Health Services from St.

Joseph’s Health Care, London to Grand River Hospital

Meeting Date:

September 22, 2010

Submitted By:

Kelly Gillis, Senior Director, Planning, Integration & Community EngagementPatty Chapman, Planning & Integration Lead Rebecca McKee, Planning & Integration Specialist

Submitted To:

Board of Directors Board Committee

Purpose:

Information Only Decision

Suggested Motion THAT the South West Local Health Integration Network (LHIN) Board of Directors does not wish to issue an Integration Decision related to the intended integration entitled “Tier 2 Transfer from St. Joseph’s Health Care, London (SJHC) to Grand River Hospital (GRH),” as proposed in the Notice of Integration submitted to the South West LHIN on August 27, 2010.

Purpose The purpose of this report is to provide information to the South West LHIN Board of Directors to enable the Board to determine whether or not it wishes to issue an Integration Decision regarding the transfer of 50 specialized mental health care beds and associated resources from SJHC to GRH. This decision is related to the first phase of the Tier 2 divestment of mental health services in Southwestern Ontario and details regarding the transfer are provided in the attached Notice of Integration letter (attachment 1). Background In 1997, the Health Services Restructuring Commission (HSRC) directed the “transfer of inpatient programs currently at London Psychiatric Hospital and the St. Thomas Psychiatric Hospital…59 beds for longer-term mental health programs to be located in the city of Waterloo.” Subsequent wording in the Directions to GRH identified “…50 longer-term mental health beds by 2003.” Longer-term mental health beds are generally expected to provide 60-90 days of inpatient care while acute inpatient beds are generally expected to provide up to 14 days of inpatient care. The HSRC further identified a transfer of 59 longer-term inpatient beds to Windsor Regional Hospital (WRH), 14 longer-term inpatient beds to St. Joseph’s Health Care Hamilton (SJHCH) and 15 acute care beds to St. Thomas Elgin General Hospital (STEGH).

Agenda Item 5.5b

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The transfer of 50 beds from SJHC to GRH represents the first phase of a multiple transfer of psychiatric beds across 4 LHINs (Erie St. Clair, South West, Waterloo-Wellington, and Hamilton Niagara Haldimand Brant). SJHC and GRH each provided a formal notice of integration to their respective LHINs on August 27, 2010 regarding their intent to transfer and/or receive new services in accordance with Section 27 of the Local Health Systems Integration Act, 2006 (LHSIA). The outstanding need for additional capacity for schedule 1 services (generally expected to provide up to 14 days of inpatient care) in Cambridge, as called for in a separate HSRC report for the Waterloo area, presented a significant challenge to the completion of planning for the transfer of services, patients and staff to Grand River hospital. As such, the MOHLTC has committed to providing incremental operating funding for new acute mental health beds in the Cambridge Memorial and Grand River hospitals. The Ministry expects that acute mental health services for Cambridge area residents will continue to be provided by SJHC in London or for SJHC to arrange for London Health Sciences Centre to take on this role until capacity in the Waterloo-Wellington (WW) LHIN is in place, which is expected to occur by March /April 2011. The Ministry will review the costs associated with providing these services in light of the hospitals’ overall financial position once the additional capacity is operational in the WW LHIN. SJHC will continue to provide access to specialized longer-term mental health care services (e.g. Dual Diagnosis) to the region post Tier 2. As Tier 2 divestment continues, subsequent details will continue to be presented to the South West LHIN Board and decisions related to the additional phases of Tier 2 will be required. A detailed backgrounder regarding Tier 2 Divestment is attached to this package as optional reading. Issuing an Integration Decision As outlined in Section 27 of LHSIA, upon receipt of a Notice of Integration the LHIN may consider if the proposed integration is in the public interest. This will include consideration of whether the proposed integration is consistent with the LHIN’s Integrated Health Service Plan and any other relevant matter as decided by the LHIN Board. The Board then has two options:

1. LHIN does not object to intended integration: LHSIA allows the LHIN 60 days to consider the notice of intended integration from a HSP. If the LHIN does not object to the intended integration, it may simply choose to take no action. In that case, after 60 days have elapsed from the day the HSP gave the LHIN notice, the provider may proceed with the integration. While the Act does not require it to do so, the LHIN may choose to notify the HSP that it does not intend to issue a decision stopping the integration.

2. LHIN has concerns about intended integration: If the LHIN has concerns about the

intended integration based on the notice from the HSP, it can take steps towards preventing the integration from proceeding. The LHIN must notify the HSP within 60 days of receiving the Notice of Integration that it proposes to issue a decision ordering the provider not to proceed with the integration. The LHIN must provide a copy of the proposed decision to the HSP and

- 3 -

must make copies of the decision available to the public, also within the 60 day timeframe.

Recommendation LHIN staff have reviewed the proposed integration and provided analysis in the form of the attached integration evaluation. The analysis includes:

Public interest consideration and impacts Community engagement Other organizational impacts LHIN organizational impacts

LHIN staff has confirmed the due diligence related to SJHC and GRH’s planning for Tier 2 transfer of patients, services and staff, and therefore, recommend that the LHIN not issue an integration decision to stop or amend the integration. LHIN staff has however highlighted the following risks and mitigating strategies that the South West LHIN Board of Directors will need to monitor as mental health divestment continues. Identified Risks and Mitigating Strategies

In the short term, with the transfer of resources to GRH and the continued need for SJHC to continue to provide schedule 1 care to Cambridge area residents, access to inpatient mental health care in the South West will be impacted.

The planning for divestment has occurred over several years. As highlighted by the HSRC, ensuring that adequate community supports are in place as bed numbers are reduced continues to be a priority but will be influenced by the agreed upon program transfer methodology. This methodology is a financial calculation based on patient volumes. Due to annual base funding agreements anticipated to be lower than the rate of inflation growth, the overall funds for transfer are reduced as well as the expected residual funding associated with the reduced bed numbers, anticipated to be available for re-investment to enhance community capacity (generally referred to as Tier 3). Coupled with this challenge is the recognition that the demand for mental health services continues to grow as reflected by community providers in their annual submissions to the LHIN.

Full implementation of the HSRC directives related to Tier 2 requires the STEGH Functional Plan and Capital Build approval and completion in a timely manner.

Risk Mitigation Strategies:

SJHC has a coordinated access systems in place which will enable the monitoring of wait times within the South West. The LHIN will be putting a process in place to ensure receipt of the wait time information on a regular basis in order to monitor any negative impacts to access. In addition, all partners will continue to implement the necessary steps to ensure that the additional capacity approved for Waterloo Wellington is implemented on time so that the primary responsibility for schedule 1 care of Cambridge area residents can transfer in

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March/April 2011. The South West LHIN will be engaging in a review of Tier 3 requirements and related impacts

to the 4 LHINs involved in Tier 2. Further communication and engagement is planned to address concerns highlighted by stakeholders.

The Select Committee on Mental Health and Addictions has presented a 10 year strategy to build a comprehensive mental health and addictions plan for Ontario. Included in the recommendations are an assessment of the need for acute care psychiatric beds for both children and adults by region and the identification of a basket of core institutional, residential and community services available in every region for clients of all ages in order to address identified gaps, and eliminate duplication. The South West LHIN will continue to pursue the outcome of the report recommendations with the MOHLTC.

The South West LHIN will continue to work with STEGH and MOHLTC Capital Branch through the approval process. Discussions regarding the need for a contingency plan have begun among the ministry, LHIN, SJHC and STEGH.

Next Steps Related to the Divestment to GRH

September 2010 - SJHC and GRH Boards to review and approve Transfer Agreement September 2010 - SJHC to provide staff notice of transfer and GRH to provide offers of

employment to current SJHC staff September 2010 and ongoing - Communication regarding transfer process continues with

stakeholders October 2010 - Staff transferred from SJHC to GRH November - December 2010 - Patients transferred from SJHC to GRH As required - Transfer of net funding from SJHC to GRH December 2010 - Revisions to SJHC H-SAA March/April 2011 – Incremental schedule 1 capacity enhancements completed for Cambridge

area residents in Waterloo Wellington LHIN. Note: Additional background information is attached for the Board’s information Definitions: Longer-term mental health beds are generally expected to provide 60-90 days of inpatient care. Acute mental health beds, also known as schedule 1 beds, are generally expected to provide up to 14 days of inpatient care.

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INTEGRATION EVALUATION TOOL

Voluntary Integration Title: Tier 2 Transfer from St. Joseph’s Health Care, London (SJHC) to Grand River Hospital (GRH)

HSPs Involved: St. Joseph’s Health Care, London (SJHC) and Grand River Hospital (GRH)

LHIN Staff Reviewing: Patty Chapman, Rebecca McKee, Scott Chambers

Building on the stated purpose of LHSIA and subsequent Ministry and legal guidance to the LHINs, voluntary integration initiatives should at a minimum result in:

√ Improved Access and Quality of Care √ Coordinated Healthcare √ Improved Navigation through the Continuum of Care √ Effective and Efficient Service Delivery √ Alignment with the IHSP √ A consideration of the Public Interest

The evaluation considers four areas of analysis to understand if the integration initiative meets these criteria. The four areas of analysis include:

1. Public interest considerations and impacts 2. Community engagement 3. Other operational impacts 4. LHIN organization impacts

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1. PUBLIC INTEREST CONSIDERATIONS AND IMPACTS: In determining whether it is in the public interest to issue a decision requiring or stopping integration, a LHIN may want to consider and balance any of the following considerations and potential impacts that apply in the circumstances:

Considerations Yes/No Comments and/or Concerns

Does the integration promote appropriate, coordinated, effective and efficient health services?

Yes

Will provide access to adult longer-term mental health services close to home for patients and families in Waterloo Wellington region

Will reduce duplication of administrative functions associated with inter-hospital patient transfers

Will be able to better build local care capacity, effectively use resources and increase capacity to track performance and accountability indicators

Will comply with 1997 Health Services Restructuring Committee directions related to divestment of mental health hospital beds

HSP and stakeholders continue to question the appropriate level of hospital and community service supply to meet the growing demand for mental health services throughout the province

Does the integration promote better access to high quality health services? Yes

Will provide access to same level of services but services closer to home for patients in WW LHIN and proximity to their families and loved ones

Will provide more timely access to Assertive Community Treatment Teams (ACTT) and other community based support services for patients from WW LHIN,

Will reduce patient wait time in local emergency rooms by reducing need for transfer to SJHC for admission

Will allow transition teams to support people being discharged from hospital in their local community while they wait for full community support services (e.g. ACTT, CMHA, housing, etc.)The use of services in the South West LHIN by patients from the WW LHIN is proportionate to the number of beds being transferred to GRH so the transfer should not negatively affect access to high quality health services for patients in the South West LHIN (in the short term there may be a negative impact as SJHC will continue to be the schedule 1 provider for Cambridge residents until additional schedule 1 capacity is developed)

A continuum of hospital based health care services will be easier for the public to access (e.g. medical and mental health services)

SJHC will continue to provide access to highly specialized (quaternary) services such as adolescent, dual diagnosis and highly complex patients through bedded and consultative services

Does the integration achieve quality improvements in clinical outcomes, health service delivery, and/or system

Yes Service integration with other health professionals and organizations will be improved

(hospitals, CMHA, etc) as they will have one geographic location for the continuum of care provision (acute, longer-term, crisis and community services)

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Considerations Yes/No Comments and/or Concerns performance? Performance and accountability requirements will be tracked locally and flow of

service delivery enhanced leading to quality improvements – better ability to track, trend and improve local health system performance

Does the integration support patient/client and person centered health care?

Yes

The goal of the Tier 2 transfer is to provide access to care as close to home as possible

Will integrate levels of care (crisis, acute, longer-term, community care), closer to home, improve organizational capacity and effectiveness in caring for mental health needs, enhance patient access to community support, provide family support and access to their loved ones, improve the quality of life of local citizens, and promote recovery

Does the integration promote efficient and effective management of the local health system to ensure sustainability?

Yes

Will strengthen integration hospital and community service delivery to return patients to community based living as soon as possible

Will allow a more comprehensive delivery of quality program and services and a more timely access to local services

The Ministry of Health has provided resources for additional schedule 1 (acute care) capacity in the WW LHIN

Does the integration ensure value for money? Yes

While there is not anticipated saving of dollars, resources will be transferred from SJHC to GRH, increasing local capacity and more effectively enabling patient navigation through levels of care (e.g., crisis, acute, longer term, community)

Eliminating inter-hospital transfers should reduce duplication of administration functions and transportation

Potential Impacts Indicate: No Impact, Negative Impact or Positive Impact

Clarify the Potential Impact and Provide Comments and/or Concerns

Impact on patient/client care and on the population of the LHIN in terms of such things as: access, choice, equity, quality, timeliness, continuity and coordination of services, and health outcomes

Positive

SJHC will continue to provide consultation to GRH for highly complex patients

Improved quality and coordination by delivering all levels of services (crisis, acute, longer-term, community) for clients as close to home as possible

Improved access, flow and after care Transitional challenges anticipated related to access during bed decanting

from SJHC, occupancy growth at GRH and community support service capacity building

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Potential Impacts Indicate: No Impact, Negative Impact or Positive Impact

Clarify the Potential Impact and Provide Comments and/or Concerns

SJHC coordinated access and outreach teams will focus efforts on timely patient flow and assistance with community integration

Significant planning for transition, placement and support for each individual patient has occurred between SJHC and GRH teams

Patient choice has been paramount in planning and all but 1 patient has chosen to relocate to their home community

Impact on achievement of the goals of the IHSP or provincial strategic plan Positive

Primary alignment to enhanced capacity and integration of primary, specialized and community based care for people living with mental health and addiction challenges

Secondary alignment to enhanced access and sustainability of hospital based treatment and care related to emergency, medical and surgical services

Impact on specific subpopulations, diverse communities and any vulnerable populations in the LHIN

Positive

Will continue to provide services for specialized diagnosis (e.g., adolescent, dual diagnosis) and acute care needs

Schedule 1 (acute care) service capacity being built in WW LHIN with the anticipated opening of 16 Schedule 1 beds by spring of 2011

SJHC to provide Schedule 1 services until the new beds are operating Better coordination of services closer to home will benefit the patients and

their families

Impact on labour and employment relations Managed

Human resources Labour Adjustment Plans will be created on a site by site basis

Staff will be retained to the extent the collective agreement and labour relations process permits (those who do not wish to transfer may be eligible for retraining options) representative bargaining unit is yet to be determined

They are committed to offering current employees first access to employment in the new location

Impact on staff has been minimized to the extent possible under labour adjustment conditions (bumping and severance conditions may apply)

The same level and type of service is to be provided for the patients, however renewed orientation, training and support will be conducted

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Potential Impacts Indicate: No Impact, Negative Impact or Positive Impact

Clarify the Potential Impact and Provide Comments and/or Concerns

Downstream impacts on health service providers and other entities in terms of such things as: capacity, services provided, continuity and coordination of services, population(s) served, and governance

Positive

It is anticipated that other local health service providers will be able to coordinate discharge services provided to the populations served with their community hospital

It will be easier for community organizations to coordinate discharge and admission services across the geographic area

Future health system planning and performance evaluation will be enhanced by providing a full continuum of mental health services within the WW LHIN

Full continuum of mental health services will continue to be provided in South West LHIN

Impact on use of resources and health system sustainability Positive

The transfer moves resources and capacity to the patients’ home hospital Patients and families will no longer need to rely on inter-hospital transfers

to receive general mental health services and care GRH local system capacity will be enhanced with influx of beds, related

funding and health human resources as per the program transfer methodology

GRH organizational capacity will be increased to meet the needs of the population and to meet the changing accountability requirements in the health care system

SJHC will no longer need to provide the capacity to address the needs of Waterloo-Wellington area adults with general mental health needs and make more effective use of administrative, managerial and clinical resources of both hospitals

Impact on relationships, collaboration and partnerships No impact to positive

The organizations will continue to partner to address the complex care needs of people with mental health issues

Local community resources will continue to work to enhance existing relationship to provide access to care

Receiving hospitals have partnered to building and agree to a Program Transfer Methodology

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2. COMMUNITY ENGAGEMENT: The integration materials should identify any community engagement and/or consultation that occurred and describe the outcome. Components of the engagement should address the system impacts of the integration, including the impacts listed above (patient/client care, goals of IHSP, labour, etc) Under sections 16(6) of LHSIA, HSPs must engage the “community of diverse persons and entities” where they provide services when they develop plans and set priorities. LHSIA does not define “community of diverse persons and entities” for HSPs. Some guidance is found in section 16(2) of LHSIA, which defines the LHIN “community” as:

Patients and other individuals in the LHIN’s geographic area HSPs and others that provide services in or for the local health system Employees involved in the local health system Some LHINs interpret the health service provider “community” to also include funders

There is no similar provision in LHSIA concerning the extent of engagement required by HSPs. An inclusive definition in line with the Act’s definition is to consider community engagement as involving all those members/stakeholders of the healthcare “community”, including HSPs, health care professionals, patients/clients, consumer support groups, funders and residents in broad health care planning. Engagement thus most effectively happens at all levels, from governance to the front lines and community residents. Engagement unlocks and leverages system planning expertise to create real solutions; incorporates knowledge about health needs, experiences and satisfaction; provides a means for emerging trends to be identified; and ultimately can stimulate collective responsibility towards the health system. Community Engagement Comments and/or Concerns: Things to consider: Yes/No Community was engaged. Do you feel all the necessary stakeholders were engaged? If not, who else should be engaged? The Health Services Restructuring Commission (HSRC) engaged extensively through its process which resulted in several directions received in 1997. In 2000, the Ministry of Health signed a Service Agreement with SJHC as the Tier 1 receiving hospital of the former London and St. Thomas Psychiatric Hospitals. To move the HSRC directions forward, multiple stakeholders groups have been engaged and consulted. In 2003, the hospitals and Ministry developed common targets and times with Post Tier 1 planning principles developed. At the same time the Southwest Mental Health Implementation Task Force report was developed through a rigorous engagement and consultation process to further inform Tier 2 and community capacity needs across the Southwest Region. Functional planning and program transfer methodology involved a significant engagement process of hospital and community partners through 2004 to 2008. During this period of time Infrastructure Ontario was established and engaged in the process, reviews of SJHC mental health programs and funding conducted, Tier 3 working Group Report published, LHINs established, Tier 2 receiving hospitals functional plans, planning principles and program transfer methodology revised, and Hospital Services Accountability Agreements legislated. 2009 began an updating of program transfer methodology and receiving facility readiness. Specific transfer and occupancy planning with patients, families, substitute decision makers, and staff has occurred throughout 2010. Future engagement activities are planned related to Tier 2 moves to Windsor, Hamilton and St. Thomas. Engagement activities included:

Stakeholder engagement

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Community engagement South West Mental Health Implementation Task Force with significant community, provider and consumer participation Presentations and consultation related to the two new facilities Ongoing communication and dialogue regarding the planning status of the new facilities and the divestments to staff, patients and families

on a regular basis – more recently on a monthly basis Presentations and dialogue with South West Mental Health Networks GRH conduced number of community engagement sessions GRH held targeted focus groups to discuss the program plans for new services and impact on the system Town hall meetings with GRH staff and volunteers Open houses and tours to staff, volunteers, members of the Family Advisory Group, and the Mental Health and Addictions Network Core

Action Group

A comprehensive list of engagements was received by the South West LHIN as an addendum to the Notice of Integration and is available upon request. Additional information is also outlined in the backgrounder provided in the Board package. LHIN staff identified many community engagement activities over the past 10 years with specific staff and patient planning related to Phase 1 (SJHC to GRH) of the Tier 2 divestment; however, there continues to be stakeholder concerns expressed about the potential impacts of Tier 2 divestment for access to mental health services. There continues to be a perception that Tier 2 will result in a loss of service. Across the 4 LHINs involved in the SJHC Tier 2 divestment, there will continue to be 35 beds per 100, 000 population which is consistent with the HSRC bed ratios projected for 2003. The starting point for the HSRC in planning capacity for in-patient mental health services was the proposed ratios outlined in the MOHLTC policy document, Putting People First (1993). This document proposed a target bed ratio of 30 mental health beds for every 100,000 (adult population) in the province by 2003. 60% of these were to be allocated for acute in-patient mental health (16 beds/100,000) and 40 % to longer term mental health (14 beds/100,000). All of the communities that were issued Notices of Intention to Issue Directions during the first few months of the HSRC’s mandate considered the planning target to be “too ambitious”. In particular, there were concerns that it would not allow sufficient time and flexibility to achieve this shift without putting access and quality at risk. Another concern was that appropriate community supports would not be in place in sufficient time to meet patient needs resulting from the closure of mental health beds. In response to these concerns the HSRC undertook an internal review of the planning guideline. While the HSRC agreed that the 30 beds per 100,000 target was an appropriate benchmark to work toward, it suggested that the following interim targets be applied for hospital-based mental health bed planning:

• By the year 2000: 37 beds per 100,000 (adult) population including 21 beds per 100,000 for acute mental health beds and 16 beds per 100,000 for long-term mental health.

• By the year 2003: 35 beds per 100,000 (adult) population including 21 beds per 100,000 population for acute mental health and 14 beds per 100,000 for longer term mental health beds.

These guidelines were released in the discussion paper, Rebuilding Ontario’s Health System. Source: Looking Back, Looking Forward: The Ontario Health Services Restructuring Commission (1996-2000) - a Legacy Report, March 2000.

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3. OTHER OPERATIONAL IMPACTS IF APPLICABLE:

Other considerations: Does this proposal provide…. (indicate yes, no or not applicable)

Comments and/or Concerns

An overview of the program components and supporting services, Inpatient volumes (cases, weighted cases and patient days) and costs, Outpatient volumes and costs, Administrative and support services units and costs (e.g. administration, diagnostic & therapeutics, outpatient clinics, etc.)

Yes

See “Program Transfer Methodology” section of the Notice of Integration

The development of the Program Transfer Methodology was an iterative, collaborative process with all Tier 2 partners and the MOHLTC over a five year period

The transfer agreement outlines a process for the flow of resources to GRH over the duration of the transfer

A summary of the human resources plan for employees, including physicians, and the financial implications of the plan

Yes

See “Human Resources Transfer” section of the Notice of Integration

The process to move staff followed normal human resource protocol in compliance with labour contract language

A description of the program decanting and measures to minimize disruption to patient service (transition plans)

Yes

See “Patient Transfer Planning” section of the Notice of Integration

Principals for patient transfer include: SJHC clients have priority for beds Preparation of both patient and families for the move Planning for transfer of ACT Team clients and other outpatients Planning with CCAC for early transfer of patients to long term care in

Grand River catchment The Patient Transfer Planning also includes: Logistics and internal adjustment planning Patient and family communication and supports Potential gap in service delivery identified in fall 2009 GRH will continue to access specialized adolescent care, dual

diagnosis and consultation services. Forensic Psychiatry will continue to serve as a province resource

SJHC will continue to provide assistance in capacity building and

consultation SJHC will work with its Tier 2 tertiary care partners to develop a

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Other considerations: Does this proposal provide…. (indicate yes, no or not applicable)

Comments and/or Concerns

provide access to specialized services (e.g. dual diagnosis and adolescent care) and make use of expertise in areas of consultation and capacity building

Implications of the program transfer on capital requirements, if applicable No

August 20-10, the Minister of Health announcement that operating and capital funding would be provided to Waterloo Wellington hospitals to open 16 schedule 1 beds by the spring of 2011. SJHC will continue to care for those patients until that date

The Program Transfer Methodology provides an allocation for capital requirements as agreed to by the partnering hospitals

Evidence that regulatory and licensing requirements will be met, as appropriate (e.g. lab licensing in the case of laboratory transfers)

N/A

For partnerships or other similar joint arrangements, demonstration that the proposed venture does not place the assets of the HSP(s) at risk or create an operating liability for the HSP(s)

N/A

The Program Transfer Methodology outlines the resource allocation agreed to by the Tier 2 partners.

The respective H-SAAs will be amended to reflect the revised funding level and volumes.

A new facility designed to support the post-Tier 2 bed count is planned and will provide enhanced space and an efficient footprint.

No legal barriers known to completion

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4. IMPACT TO LHIN ORGANIZATION:

Impact Indicate: No Impact, Negative Impact or Positive Impact

Implications for LHIN Organization, Comments and/or Concerns

Financial No impact

The overall LHIN MLPA transfer payment funding total will be reduced by the amount transferred to the Waterloo Wellington LHIN (to support GRH), but the reduction is proportionate to the migrating cost. The LHIN-hospital H-SAA will be revised to reflect the new funding and volumes and the LHIN-ministry MLPA will be adjusted using the quarterly report process.

Policies and/or Procedures No impact This integration will not affect LHIN policies or procedures

Aligns with LHSIA

Return on Investment Positive Transfer of staff to provide care close to home, reducing patient transfer and care planning

costs

Public Relations Positive and Negative

Positive: Will provide a template for remaining Tier 2 divestment processes (Windsor, Hamilton, St. Thomas)

Negative: It is anticipated that stakeholders will continue to communicate concerns about system capacity, the perceived loss to the system and the lack of adequate levels of community support available through the divestment process

Additional Comments and/or Concerns: Retaining enough funding to support Tier 3 initiatives presents a significant risk at this point as the cost to support Tier 2 divestment has outpaced funding increases over the term between formation of the plan and today. In the short term, the need for SJHC to continue to be the primary provider of schedule 1 capacity for Cambridge area residents will negatively impact access in the South West.

 

 

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201 Queens Avenue, Suite 700 

London, ON  N6A 1J1 

Tel: 519 672‐0445 • Fax: 519 672‐6562

Tier 2 Divestment Backgrounder 

Sept. 14, 2010 

Background: 

In 2001, St. Joseph’s assumed the governance and management of London Psychiatric Hospital and St. Thomas 

Psychiatric Hospital as part of the 1997 Health Services Restructuring Commission directives. This divestment, 

called Tier 1, represented the largest transfer of mental health services in Ontario. Four other transfers of 

Provincial Psychiatric Hospitals to public hospitals occurred including Brockville, Hamilton, Kingston and 

Thunder Bay. These transfers were the first of a three‐tier plan.  

Tier 2 divestment (now underway in southwestern Ontario) involves the transfer of beds and resources from 

St. Joseph’s Health Care (SJHC) London to regional hospitals. Grand River (Cambridge) is the first receiving 

hospital followed by Windsor Regional Hospital, St. Joseph’s Health Care Hamilton and St. Thomas Elgin 

General Hospital. Transferring beds to regional hospitals will give patients and their families the opportunity to 

be cared for the in their home communities. Tier 2 will facilitate a model of care change from the current 

institutional model to a rehabilitative model of mental health care. It is about providing care closer to home. 

Tier 3, the final portion of the Province’s plan, involves the creation of community supports to help patients re‐

integrate and positively function in their home communities. Planning discussions are now underway between 

the four LHINs involved (South West, Waterloo‐Wellington, Hamilton Niagara Haldimand Brant and Erie‐St. 

Clair). 

Timelines & Engagement 

Significant community engagement has occurred since the Tier 1 transfer. Along with monthly meetings with 

Southwest Ontario mental health networks that are organized by county, other stakeholder engagement 

activities broadly include:  

2003 o Tier 2 receiving hospitals work with MOH to develop Post Tier 1 Planning Principles  o Southwest Mental Health Implementation Task Force consultation and report completion 

2004 o SJHC completes multiple internal and external consultations for functional plans o SJHC completes functional plan submissions o Consultation meetings with MOH, HRT and SJHC o Tier 2 partners consultation and planning 

 

 

 

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201 Queens Avenue, Suite 700 

London, ON  N6A 1J1 

Tel: 519 672‐0445 • Fax: 519 672‐6562

2005 o Tier 2 receiving hospitals jointly draft program transfer methodology o Tier 2 receiving hospitals jointly draft adjusted transfer timelines due to the implementation 

of Infrastructure Ontario 

2006 o A “rightsizing review” and Peer review of SJHC is completed to confirm mental health dollars  o MOHLTC engages stakeholders in a Tier 3 Divestment Working Group and delivers a report 

2007 o Grand River Hospital goes to tender o St. Joseph’s Hamilton resubmits functional plan o Windsor initiates facility planning o SJHC beings functional program revisions with internal and external stakeholder engagement 

events o SJHC right‐sizes mental health operations based on 2006 report o St. Thomas Elgin General Hospital submits updated costing information to MOH o Tier 2 partners continue planning meetings 

2008 o Tier 2 partners endorse Program Transfer Methodology o Tier 2 partners revise Planning Principles o Southwest Addictions and Mental Health Coalition consultation o Presentation to the South West LHIN Board o South West LHIN Board of Directors provide support for SJHC’s plan to build 168 bed capacity 

and operate 156, up from 144 beds, on opening at the Parkwood Hospital site, and the MOHLTC’s approved increase of the original 74 beds to 89 beds for Forensic services based on provincial needs for St. Thomas site 

2009 o Tier 2 partners work towards implementing first Tier 2 divestment to Grand River Hospital o SJHC conducts Quarterly staff forums o SJHC presents to London Public Hearings London Committee of Adjustment; London Urban 

Design Review Panel  o SJHC participates in media engagement about new facilities regarding Request for 

Qualifications Release; Shortlist Bidder Announcement o SJHC meets twice with St. Thomas and Central Elgin City Council (July and November) o SJHC Foundation’s public hospital magazine, Vim & Vigour, publishes articles quarterly 

2010 o SJHC conducts monthly staff forums o SJHC Foundation’s public hospital magazine, Vim & Vigour, publishes articles quarterly o SJHC presents to the London Chapter of The Schizophrenia Society of Ontario o New mental health facilities sign unveilings occur in London and St. Thomas o Mental health care consultations with area MPP’s 

 

 

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201 Queens Avenue, Suite 700 

London, ON  N6A 1J1 

Tel: 519 672‐0445 • Fax: 519 672‐6562

o Letters and phone calls delivered to patients, families and substitute decision makers regarding Tier 2 divestment process 

o SJHC Annual Community Meeting provides update on new mental health facilities and Tier 2 divestment process 

o SJHC’s Family Forum Newsletter sent to patients and families including information on Tier 2 divestment process 

o SJHC formally presents Tier 2 and new facilities update to Southwest Addiction and Mental Health Coalition, Grey Bruce Network, Middlesex, Oxford and Elgin Networks, Huron Perth Network  

o Grand River Hospital facility completed o Minister of Health dedicates resources to enhance Waterloo Wellington Schedule 1 capacity 

by 16 beds o Tier 2 partners complete detailed transfer plans and establish program transfer methodology 

agreement and transfer agreement between SJHC and Grand River  o SJHC participates in media engagement about new facilities regarding Request for Proposals 

Release o SJHC capital confirmed through Infrastructure Ontario’s Design, Build, Finance, and Maintain  

 o In addition to the above activities, there have been ongoing discussions among SJHC and all of 

the mental health networks in South West Ontario regarding the stages of divestment and the planning for the new buildings and associated services.  

  

The original plan for Tier 2 called for all 4 divestments to occur within a 12 month period and all were 

contingent on new construction. Due to significant delays in the construction approvals, the original times 

outlined in the restructuring documents were not achieved. In 2008, partners determined that they needed to 

move forward with divestment as new facilities are ready.  

Detailed Tier 2 implementation planning between SJHC and Grand River Hospital has been taking place over 

the past year. On May 11, 2010 staff at the SJHC ‐ Regional Mental Health Care was advised of the 

decommissioning of two units at RMHC in support of the Tier 2 transfer to Grand River. The unions have been 

kept informed of the process as it has evolved. Patients and families have also been kept informed and 

involved in planning. 

St. Joseph’s indicated at the April 2010 CEO Summit that once the transfer of beds takes place, their 

organization would no longer provide Schedule 1 services to residents from the Cambridge area. 

Following significant discussion and involvement of the Minister’s Office, the Schedule 1 issue has been 

resolved. The Minister has provided clear directions: 

 

 

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201 Queens Avenue, Suite 700 

London, ON  N6A 1J1 

Tel: 519 672‐0445 • Fax: 519 672‐6562

SJHC will continue to provide acute mental health services for Cambridge area patients until the capacity for these services in Waterloo Wellington is in place (March/April 2011) 

The Ministry will review St. Joes’ costs associated with providing these services, once the services are relocated to Waterloo Wellington. 

LHINs are to work with their hospital partners to ensure Tier 2 divestment of 50 longer‐term mental health beds, as recommended by HSRC, is completed Fall 2010. 

Hospitals need to finalize the transfer agreement to facilitate a smooth transition as soon as possible.  

On June 23, 2010, communicators from all five hospitals and four LHINS met at Parkwood Hospital in London 

Ontario to discuss a joint external communication plan for Tier 2  divestment. This meeting resulted from a 

desired outcome expressed at the April 7, 2010 Tier 2 CEO Summit.  

On August 20, communicators from SJHC, GRH, Cambridge Memorial Hospital, and the South West and 

Waterloo Wellington LHIN had a teleconference and agreed to work jointly to assist in the successful transfer 

of mental health beds to Grand River and Schedule 1 services to both Grand River and Cambridge Memorial. 

On August 27, the hospitals provided their notices of integration to their respective LHINs. On Aug. 30th, SJHC 

and Grand River officials jointly met with OPSEU representatives at RHMC and they were advised that Nov. 2nd 

is the date now being targeted for the move of the first three inpatients as well as for the Assertive Community 

Treatment Team (ACTT). Staffs who are transferring to GRH will also become employees of GRH on Nov. 2nd. 

They will not receive their offers of employment from GRH until the transfer agreement is approved by the 

GRH Board of Directors (Sept. 15th). They could begin orientation at Grand River as early as Oct. 4th.  The 

Transfer Agreement was received at the South West LHIN September 3 and remains confidential until 

approved by the respective hospital Boards. 

Both hospitals have collectively engaged patients, families and community providers throughout the Tier 2 

process. Patient and family choice has driven detailed individual care plans with all but 1 Waterloo‐Wellington 

resident choosing to relocate to the home geography.  To the extent possible, those patients eligible for 

alternate levels of placement in Waterloo Wellington have been engaged by the CCAC for integration into 

community settings and others requiring ongoing treatment in hospital have been identified for placement at 

the new GRH mental health site. All patient transfers are expected to be completed by Dec 10, 2010. Appendix 

1 provides an overview of key milestones and timelines associated with the transfer.  

   

 

 

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SJHC provided a briefing to the South West LHIN Board on September 8 regarding the detailed planning to date 

and in preparation for the South West LHIN Board review of the Notice of Integration scheduled for September 

22. The Notice of Integration received from Grand River Hospital will be reviewed by the Waterloo Wellington 

LHIN Board September 23. 

The City of London’s Protective Services Committee heard a presentation from SJHC and the South West LHIN 

on September 13 regarding system design and mental health divestment. This generated discussion about 

mental health bed numbers per 100,000 population, access to mental health services and the level of mental 

health and addiction community capacity and related investment. Across the 4 LHINs affected by the Tier 2 

divestment of the former St. Thomas and London Psychiatric Hospitals the beds per 100,000 population are 

calculated at 35/100,000. Community investment in the London area community mental health services is 

approximately $34 million. Although there was no media coverage, the Community & Protective Services 

Committee meeting did raise the Committee’s concern regarding reinvestment into community mental health 

services from the anticipated savings from divestiture of psychiatric hospital beds. At this date in the process, 

the dollars for potential reinvestment are calculated at approximately $3 million. The committee expressed 

concern about lack of adequate community based resources and passed a motion to work closely with 

providers and the mental health community to advocate for additional resources.   

Tier 2 Next Steps: 

2011/12 o Windsor Regional occupancy readiness 

2013/14  o St. Joseph’s Hamilton and SJHC construction complete and ready to occupy o St. Thomas Elgin General construction and  occupancy readiness need to be completed 

 

Two issues remain central to the successful completion of the divestment of the former Psychiatric Hospitals in 

the South West LHIN. 

1. The building of Schedule 1 capacity at St. Thomas Elgin General Hospital must move foreward expeditiously to facilitate the final transfer. Already we are aware that due to delays in the capital process, it is not possible for the schedule 1 build to be completed in time to receive the beds that are scheduled to be divested from SJHC. Contingency planning discussions are underway among SJHC, STEGH, the Ministry and the South West LHIN.  

2. Tier 3 community re‐investment must be addressed. As noted previously, the four LHINs involved in this process are engaged in planning discussions to ensure the timely completion of Tier 3. Ensuring the availability of adequate resources to support community investment will be a critical. 

 

 

 

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Appendix 1: Key Milestones and Timelines 

Event Date Overview Details

Waterloo Wellington LHIN Board

Aug. 18 High-level overview of Tier 2 divestment provided

2 members of media in attendance, no coverage to date

Minister announcement on resolution to acute needs

Aug. 20

Briefing of union representative re: Schedule 1

Aug 20 St. Joe’s update to staff to ensure staff are aware of Sched 1 update and efforts being made to ensure smooth transition

Grand River Hospital Board of Directors

Aug. 24 Briefing note to update Board on Tier 2 divestment ( in-camera )

St.. Joseph’s & GRH joint meeting with union

Aug 30

SJHC submits notice of integration to SW LHIN

Aug 27

60 days – takes calendar to Oct. 25th

GRH submits notice of integration to WW LHIN

Aug 27 60 days – takes calendar to Oct. 25th

St. Joseph’s Health Care Board

Sept. 7 Transfer agreement approval Open session

South West LHIN Board Committee

Sept. 8 High-level overview of Tier 2 planning process – Sandy Whittall

Open session

SJHC & GRH joint town hall session for affected staff

Sept 10 To provide those directly involved with an opportunity to ask questions

City of London Community & Protective Services Committee

Sept. 13 Overview on Tier 2 (provided by SJHC) and of regional mental health planning (SWLHIN)

Open session

 

 

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Grand River Hospital Board Meeting

Sept 15 Transfer agreement approval Open session

Tier 3 discussion between LHINs

Sept 16 HNHB, WW, SW & ESC LHINs

South West LHIN Board of Directors

Sept. 22 Discussion on integration request (provided appropriate time for review once request is submitted).

In St Marys, ON, open session – OPSEU reps have indicated they will be in attendance

Waterloo Wellington LHIN Board of Directors

Sept 23 Discussion on integration request (provided appropriate time for review once request is submitted).

Open Session - Kitchener

GRH occupancy of new build area – Freeport site

Early October

Staff orientation begins at GRH

Early October

Grand opening of new beds at GRH

Oct. 22 or Oct. 29

Celebration of opening of new build area – opportunity for media tours, etc.

Windsor Regional Hospital Occupancy ready

2011/12

St. Joseph’s Hamilton Occupancy ready

2013/14

St. Joseph’s London construction complete

2013/14

St. Thomas Elgin General timeline for approvals and construction

TBD

The above timeline & following key messages are from the joint communications plan (between the SW & WW 

LHINs, St. Joseph’s Health Care London, Grand River Hospital & Cambridge Memorial Hospital) 

 

 

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Primary Key Messages: (Developed jointly) 

We anticipate that our first patients to be transferred will move closer to their home community on November 2nd.  

This is about providing patient‐centred care closer to home. We are working with each and every patient who is being transferred to ensure their care is shaped by an individualized assessment plan. 

St. Joseph’s Health Care London will continue to provide consultation for highly complex care, assisting to build capacity in the receiving hospital community. 

During this transition phase, St. Joe’s coordinated access team will continue to provide timely access to St. Joseph’s Health Care services. 

While ensuring quality care for our patients is our top priority, we also appreciate the significance of these changes in the lives of front‐line care providers. Together, St. Joseph’s Health Care London and Grand River Hospital have been working hard to ensure that staff are kept up‐to‐date on the transfer process. 

As we work toward the date of November 2nd, a number of milestones remain. All parties are actively seeking appropriate approvals to meet the deadlines. 

(Hospitals): We are currently working to finalize the transfer agreement and it will need approval of the hospital Boards. We anticipate that will happen by Sept. 15th. 

(LHINs): The hospital partners are working to finalize the transfer agreement and it will need the approval of their respective Boards. We anticipate that will happen by Sept. 15th. 

(Hospitals): On August 27, we submitted our notice of integration to the XX LHIN. 

(LHINs): On August 27, we received a notice of integration from (hospital). Our staff members are reviewing the information provided and our Board will address the request at its meeting on Sept. XX. 

 

Key messages for patients and their families to prepare for transfer. 

Our goal is to ensure all individuals have access to care as close to home as possible. 

All patients at the Regional Mental Health Centre from the Waterloo‐Wellington area who are interested in returning to their home community will be transferred. 

We have spoken with patients from the Waterloo‐Wellington area and/or their substitute decision makers about the opportunity to transfer closer to home. All patients – with the exception of two have agreed to transfer. Many are pleased to have their loved ones closer to home. 

We anticipate the first three inpatients will transfer on November 2nd, along with the Assertive Community Treatment Team clients. The transfer of inpatients will be complete by the week of December 6.  

 

 

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DRAFT Questions & Answers 

 Q: Do all patients from Waterloo Region and Wellington County have to transfer? 

All patients at the Regional Mental Health Centre from the Waterloo Wellington area who are interested in returning to their home community will be transferred. 

We have spoken with patients from the Waterloo Wellington area and/or their substitute decision makers about the opportunity to transfer closer to home. All patients – with the exception of two have agreed to transfer. Many are pleased to have their loved ones closer to home.  

Q: How long will it take for the transfer to happen? 

We anticipate the first three inpatients will transfer on November 2nd, along with the Assertive Community Treatment Team clients. The transfer of inpatients will be complete by the week of December 6. 

 

Q. What is an Assertive Community Treatment Team and how do they support mental health patients? 

Assertive Community Treatment is a team treatment approach designed to provide comprehensive, community‐based psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness.  Among the services ACT teams provide are: case management, initial and ongoing assessments; psychiatric services; employment and housing assistance; family support and education; substance abuse services; and other services and supports critical to an individual's ability to live successfully in the community. 

 

Q: How will you ensure the needs of patients don’t get lost in the transfer? 

Every partner involved in this process is committed to focusing on the patients and meeting their needs to support a smooth transition as possible.  We have done this through a very detailed and planned process which includes clinical and physician leaders from the two hospitals who have been involved in patient care planning discussions since July 2008. A Patient Reintegration Steering Committee was set up in March by Grand River to ensure a smooth transition for each and every patient. This steering committee includes representatives from the two hospitals, as well as other local hospital, community mental health services and LHIN representatives from Waterloo Wellington. This group has conducted individual assessments for each patient to identify the most appropriate setting for them. The committee has also worked with Regional Mental Health Care treatment teams to identify community placement needs for long stay and Alternate Level of Care patients.  

 

 

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Q: When will offers of employment be issued to staff members who are transferring from St. Joe’s? 

All of the partners understand the anxiety caused by delays in the transfer process and would like to express our appreciation to affected staff members and their families, for their patience.  Once the Grand River Hospital Board of Directors signs off on the transfer agreement, and with support from the Waterloo Wellington LHIN, offers of employment will be made.   

Q: The union is talking about asking for compensation for staff members who are affected by the delay. 

What does that process look like? 

We are currently awaiting further clarification from the union’s leadership on this issue. We understand that they are working directly with staff to assess their needs.  

Q: What is happening with Schedule 1 beds for residents of Waterloo Region and Wellington County? 

We are pleased to have a commitment from the Minister of Health and Long‐Term Care to ensure that Schedule 1 services are provided close to home for area residents. The WWLHIN in partnership with Cambridge Memorial Hospital is now working actively with the Ministry to discuss and finalize details of the Schedule 1 plan.  

Q: (Cambridge Memorial Hospital) When are renovations beginning on the 5th floor and what will they 

involve? 

The renovations for the Mental Health beds will get underway once we have a finalized plan developed in conjunction with the WWLHIN and the Ministry.  

Q: Why is the divestment to Grand River Hospital happening now – while some of the others are years 

away? 

Initially, the Tier 2 divestments to Kitchener, Windsor, Hamilton and St. Thomas were to take place over a 12‐month period. Each of these projects, however, requires new construction. Due to significant delays in construction approvals, the original times outlined by the HSRC were not achieved. In 2008, the partners recognized that divestments would need to move forward as facilities were ready. 

In Grand River Hospital’s case, once the construction project was approved, capital redevelopment has proceeded well. The project remains on schedule for completion this fall.  

Q: Why has it taken so long for this transfer to take place? It was suppose to be completed by 2003. 

Initially, the Tier 2 divestments to Kitchener, Windsor, Hamilton and St. Thomas were to take place over a 12‐month period. Each of these projects, however, requires new construction. Due to significant  

 

 

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delays in construction approvals, the original times outlined by the HSRC were not achieved. In 2008, the partners recognized that divestments would need to move forward as facilities were ready. 

 

Q: What about community consultation – doesn’t the integration process require significant 

engagement? 

The HSRC directions were made following extensive stakeholder and community engagement in the mid 1990s. Subsequent to the directions, the South West Mental Health Implementation Task Force put together a report on how to implement the direction. That task force included significant community, provider and consumer participation. 

Between 2001 and 2003, St. Joseph’s held significant community presentations and consultation related to the facilities that are being built post‐divestment. Since then, there has been ongoing communication and dialogue regarding the planning status of the new facilities and the divestments to staff, patients and families on a regular basis. Several presentations and dialogue about the divestment, new facility development and ongoing services at Regional Mental Health Care have been provided to South West mental health networks. 

Grand River Hospital has also held a number of community engagement sessions in planning for the transfer of mental health services to Waterloo Wellington. Targeted focus groups to discuss program plans for the new services were held a year ago with a wide array of providers, patients and family members. Open houses and tours have been offered to staff members interested in transferring from St. Joseph’s and others. A Specialized Mental Health Community Advisory Group is beginning to meet this fall to ensure system coordination and optimal patient care continues throughout the evolution of enhanced programs and services in the Waterloo Wellington area. 

The recently released report by the Select Committee to review Mental Health and Addictions Services also identified the importance of having services close to home for mental health patients.  The relocation of mental health beds supports this important recommendation from the Select Committee.   

Q: What is a transfer agreement? How did it come about? 

The transfer agreement outlines the process for the flow of resources from St. Joseph’s Health Care London to Grand River Hospital over the duration of the transfer. It is based on a program transfer methodology that resulted from an iterative, collaborative process with all Tier 2 partners. The methodology was endorsed in January 2008 and has been updated to reflect the 2010/11 budget.  

Q: Why is the number of staff that St. Joseph’s identified to transfer not the same as the number of staff 

Grand River Hospital has identified to accept? 

The gap in numbers between the hospitals is due to a different care model between both organizations. Each hospital that will be receiving beds and resources from St. Joseph’s will create their own distinct care model.

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Agenda Item 5.5c

Report to the Board Committee

Integration through Funding Huron Addiction Services and Choices for Change

Meeting Date: September 22, 2010 Submitted by: Kelly Gillis, Senior Director, Planning, Integration and Community Engagement Carrie Jeffreys, Planning & Integration Lead Rebecca McKee, Planning & Integration Specialist Carolyn Ridley, Financial Analyst Submitted to: Board of Directors Board Committee Purpose: Information Decision Suggested Motion: THAT the South West LHIN Board of Directors support the expansion of Choices for Change services to include the provision of addiction services for Huron County as described in the project charter submitted by Choices for Change and that the Board of Directors allocate up to a maximum of $214,000 in one-time funding from funds held in reserve to Choices for Change to support the integration of services. Background: Since October 2008, Choices for Change (CFC) has provided clinical supervision, program development and representation at various planning tables for Huron Addiction Services (HAS). This was a result of lack of personnel at HAS with the expertise to provide these services. In January 2009, a meeting was held to determine the viability of an integration of HAS with CFC. Following this, a report was commissioned (LHIN funded) outlining the various options for integration. This report was submitted by Glenda Clarke and Associates on January 25, 2010. As the Board is aware, following receipt of this report, HAS notified the LHIN of their decision to terminate its Multi-Sector Service Accountability Agreement (M-SAA) with the LHIN effective December 31, 2010. At the June 9, 2010 Board Committee Meeting, the LHIN Board of Directors was advised that the LHIN was awaiting a response from CFC regarding whether or not it was supportive of moving forward as the health service provider of these services in Huron County. At its July 14th meeting, the Board of Directors for CFC agreed to move forward with integrating HAS with CFC’s operations. CFC subsequently submitted a Project Charter to the LHIN reflecting this decision and requesting one-time financial assistance to support the integration process.

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As indicated in the Project Charter, CFC would like to expand services into Huron County for a number of reasons, the most notable being the concern of loss of addiction treatment services in Huron County. CFC has expertise in addiction treatment service delivery and they anticipate being able to replicate this success in Huron County, which is currently underserviced. The vision is that HAS services will cease with the creation of a “new” agency based on the blending of the two organizational cultures and practices to meet the addiction treatment needs of clients in Huron and Perth Counties. CFC has identified one-time costs that would be associated with incorporating the services of both organizations into one organization. The one-time costs associated with establishing a new office location and managing human resource and organizational issues have been estimated at $214,000. The base funding of the two organizations will be consolidated upon the termination of the M-SAA for HAS and the negotiation of amendments to the M-SAA for CFC resulting in total base funding of $1,130,333 (2010/11 base allocation). LHIN staff has reviewed the Project Charter and provided analysis in the form of a funding integration evaluation. The analysis included:

• Public interest consideration and impacts • Community engagement • Other organizational impacts • LHIN organizational impacts • Financial impacts

LHIN staff did not identify any areas of concern and recommends that the South West LHIN Board of Directors support this initiative. Next Steps:

• CFC will need to work with HAS to develop a detailed transition plan to ensure the smooth transfer of clients and outlining CFC’s role, HAS’s role and the LHIN’s role in the process

• Negotiations between Huron County Health Unit and CFC regarding transfer of HAS assets is complete and agreement signed: October 30, 2010

• Development of service delivery model including development of partnerships and exploration of new funding opportunities for service in place: November 5, 2010

• CFC to work with LHIN staff to determine fiscal 2010/11 plan and amendments made to existing M-SAA: November 30, 2010

• All required client files transferred: December 20, 2010 • Funding to HAS terminated December 31, 2010 • Fiscal 2010/11 funding to commence with CFC effective January 1, 2011

Note: Additional background material is attached for the Board’s information

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Project Charter

PROJECT INFORMATION Project Name Project Acronym or No. Integration of Huron Addiction Services and Choices for Change <assigned by LHIN>

Target Project Completion Date Budget Notice of Integration?

2010/12/31 $214,000 No

HSP Lead Organization HSP Partner Organization(s)

Choices for Change: Alcohol, Drug & Gambling Counseling Centre

Huron County Health Unit – Huron Addiction Services

HSP Project Sponsor HSP Project Manager/Lead Choices for Change: Alcohol, Drug & Gambling Counseling Centre

Catherine Hardman

LHIN Project Sponsor LHIN Project Lead Kelly Gillis Carrie Jeffreys

PROJECT DESCRIPTION Project Purpose: Explain the purpose of this project by describing, at a high-level, the background necessary to understand why the project was started, what will be done. What is this project aiming to achieve? What is its vision? What need or opportunity will it address? What problem will it solve?

Since October, 2008, Choices for Change (CFC) has provided Clinical Supervision, Program Development and representation at various planning tables for Huron Addiction Services (HAS). This was a result of lack of personnel at Huron County Health Unit/Huron Addiction Services with the expertise to provide these services. In January, 2009 a meeting was held to determine the viability of an integration of Huron Addiction Services with Choices for Change. Following this, a report was commissioned outlining the various options for integration. In March, 2010, the Huron County Board of Health provided notice to the South West LHIN that they are terminating their Multi-Sector Accountability Agreement as of December 31, 2010. Following this, Choices for Change was approached to consider expanding their services to Huron County.

At the July 14, 2010 Board meeting for Choices for Change, it was agreed to move forward with the integration of Huron Addiction Services with our operations, by a majority vote. Choices for Change would like to expand services into Huron County for a number of reasons, the most notable being the concern of loss of addiction treatment services in Huron County. As well, Choices for Change has expertise in addiction treatment service delivery and has been successful in growing the agency to meet client needs, particularly, over the past 4 - 5 years. The hope would be to be able to duplicate this success in Huron County, which is significantly under serviced currently. There has also been significant community support, from partner organizations, for Choices for Change taking this step. This includes but is not limited to, the Avon Maitland School Board, Huron Perth District Catholic School Board, members of the Huron Perth Mental Health and Addiction Network, HAS Advisory Committee. The organization has an excellent reputation with community partners and is seen as the most logical choice to move this project forward.

In order to complete the project, a number of tasks would need to be completed as outlined below in the project scope and objectives. Most importantly would be the hiring of expertise to guide the project and ensuring the human resource issues are dealt with in a fair and competent manner. The vision would be the cease of HAS services with the creation of a “new” agency based on the blending of two organizational cultures and practices to meet the addiction treatment needs of clients in Huron and Perth Counties.

Integration of Huron Addiction Services and Choices for Change Project Charter

Target Project Completion Date: <yyyy-mm-dd>

South West Local Health Integration Network Page 2 of 15

Health Service Clients/Stakeholders (i.e., target populations)General Description Equity

This proposal responds primarily to the needs of the following population(s):

This project targets the populations of Huron and Perth County who are experiencing problems related to either their own or someone else’s substance use or gambling behaviour.

Aboriginal

Francophone

Rural/Remote Populations

Inner-urban (e.g., homeless) Populations

Religious, Ethno-Racial or Linguistic Minorities (please specify): Mennonite

Sex/Gender

Sexual Orientation/LGBT

Low Income/Under-employed

Persons with Disabilities (e.g., physical, intellectual, sensory, learning, mental illness)

General Population

Other, please specify:

Where Service/Initiative is Accessed Please indicate where the service/initiative identified in this project can be accessed (check one):

This service/initiative serves one community and is offered at one place or site. Patients/clients/consumers travel within their community for this service (Local Community)

This service/initiative serves two or more communities and is offered at two or more sites. Patients/clients/consumers may have to travel outside of their local community for this service (Multi-Community)

This service is provided in one place or site, but serves all of the LHIN Community. As such, patients/clients/consumers may have to travel out of town to receive this service (LHIN Community)

Please indicate the specific area(s) (e.g., town, city, county, etc.) from which the service will draw clients/stakeholders:

Huron and Perth Counties

Health Service(s) Improvements for Clients/Stakeholders Describe how clients and families will benefit from your idea (e.g., improved quality of care, faster access to care, easier movement through the system, etc.)

As the Huron County Health Unit has provided notice to the South West LHIN they are terminating their provision of addiction treatment services, without this project, it is possible there would be no provision of these services in Huron County. This would be a significant loss to the communities it currently serves, and could also create capacity issues for the surrounding services, as they would struggle to take on the additional clients that would surely come their way. The creation of longer wait lists for these services will impact the quality and access of services to the client.

Integration of Huron Addiction Services and Choices for Change Project Charter

Target Project Completion Date: <yyyy-mm-dd>

South West Local Health Integration Network Page 3 of 15

Project Scope Describe specific items that will (“in-scope”) and will not (“out-of-scope”) be included as part of the work performed on this project. Consider specific features, functions, quality needs or other “must have” requirements and place them in the in-scope section. Spell out any exclusions (i.e., work that will not be performed) in the out-of-scope section.

In-Scope Out-of-Scope Detailed implementation plan and timelines for , clients,

services, board members and community partners working with the County of Huron

Human Resources requirements including negotiation with the Union, hiring of staff, staff/team development If necessary, negotiation with the Union would be done in partnership with the Huron County Human Resource department. A process would be developed for the hiring of the staff to ensure objectivity and fairness. The staff/team development, would be facilitated sessions with staff which may include the board to build the vision, service delivery model and teambuilding activities.

Communicating to the existing clients of Huron Addiction Services regarding the integration and ensure a smooth transition. This communication would include consultation with the existing staff and leaders of the Huron County Health Unit, to ensure consistent and clear messaging.

Location for services in Huron County and office set up including IT, phones, videoconferencing set up

Development of service delivery model, including development of partnerships and exploring new funding opportunities for service

Budget development

Governance development including new board member recruitment and training, bylaw and board policy development. Board recruitment would include connecting with members of the Advisory Committee for HAS as possible members.

Development of communication plan for staff, boards, partners and the broader community. All communications would be in partnership with Huron County Health Unit to ensure there is consistency in messaging to the community and partners.

Negotiation with the Huron County Health Unit and County of Huron in regards to transfer to assets related to Huron Addiction Services.

Negotiation of amendments to existing MSAA (fiscal 2010/11) with CFC

Taking on other services, staff and assets that are not LHIN funded outside the identified Huron Addiction Services in Huron County

CIntegration

Integration of Huron Addiction Services and Choices for Change Project Charter

Target Project Completion Date: <yyyy-mm-dd>

South West Local Health Integration Network Page 4 of 15

Is this an integration opportunity? Yes No

If yes, please check which type of integration opportunity:

Voluntary Integration (Integration Decision at LHIN’s discretion). If checked, please sign below.

Funding Integration (no integration decision required)

Facilitated Integration (Integration Decision required)

Required Integration (Integration Decision required)

Comments: This integration is considered a funding integration where no formal integration decision is required. For the purposes of acknowledging receipt of the project charter the submission will be signed and dated.

I acknowledge that this submission is a formal notice of a proposed integration to the LHIN.

Signature:

Name:

Date:

ALIGNMENT Strategic Alignment: Describe linkages to South West LHIN directions, provincial priorities and/or organizational strategies. Blueprint/IHSP Alignment

The project aligns to the following South West LHIN Blueprint Approaches & IHSP Directions:

Primary Alignment (check one)

Population-based Integrated Health Services

Seniors & Adults with Complex Needs

Chronic Disease Prevention and Management

Mental Health and Addictions

Centrally Coordinated Resource Capacity

Emergency Services

Critical Care

Medicine

Surgery

Secondary Alignment (check one)

Comments: Although the project doesn’t specifically fit under the Centrally Coordinated Resource Capacity, it will allow for access

and intake across the two counties for all services offered by Choices for Change and allow for expansion of these services.

Key Enablers

The project aligns to the following Key Enabler (check one):

Information & Clinical Technology

System Navigation

Human Resource Strategies

Implementation & Accountability

Integration of Huron Addiction Services and Choices for Change Project Charter

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Provincial Priorities

This project aligns to the following Provincial Priorities (e.g., ALC/ER, Diabetes, Family Health, Wait times):

Wait times, hopefully by having more resources available for both counties, this will decrease the wait times for intake and assessment services, particularly for Huron County.

This project also aligns with the Provincial Strategy for Mental Health and Addictions, as outlined in the “Every Door is the Right Door” document. Throughout the document there is reference to partnerships both within and outside the system, standardization and the provision of high quality services. Currently both HAS and CFC have partnerships with various organizations within both counties but they differ based on resources and services offered. With this integration, stronger partnerships will be able to be built particularly with other organizations that service both Huron and Perth. With one organization focused primarily on addiction treatment provision, there is a better chance of standardization and compliance with provincial standards for care. The Huron County Health Unit’s mandate is public health, not addiction treatment. They have admittedly struggled in the past to ensure they are meeting standards and their services are in compliance with best practice.

Impacts on Organization(s) System Impacts

Identify the impacts this project is expected to have on the health care system in the South West LHIN:

The impact of this project would be continuation of addiction treatment services with potential for improvement, through new and expanded partnerships with other health care providers and community partners. Currently Huron Addiction Services does not have someone in a leadership position to look for and create opportunities for service expansion and partnerships, and as a result, the program has been stagnant for many years. As stated, Choices for Change has an excellent reputation for service delivery and their expertise in addiction treatment. They are often sought out for this expertise by other health care services as addiction is an issue that crosses many areas. To date the ability to offer this expertise to improve services across the health continuum in Huron County has been limited.

Organizational Objectives and Strategies

Identify the organizational objectives and strategies this project aligns to (e.g., improved performance measurement, cultural shifts, improvement processes/methodologies):

This project aligns with the objective of Choices for Change to expand services and ensure services are based on best practices. Choices for Change has a proven record for implementing new programs to meet the needs of clients based on what is considered best practice for the addiction treatment system. The services in Huron County are in need of revision to ensure they are meeting the needs of the clients and meeting best practice guidelines.

Process Change Impacts

Identify the process change impacts this project will have on your organization or on other organizations (e.g., increased efficiency, improved performance reporting):

This integration will improve the delivery of addiction treatment services particularly in Huron County. Choices for Change has a number of programs and initiatives not currently available to the citizens of Huron County, ie. Auricular Acupuncture, youth programming. With this integration, we expect to be able to expand these programs into Huron County. It will also increase administrative efficiency and reporting. Currently the reporting for Huron Addiction Services is done by the County of Huron. They are not as knowledgeable about the work of Huron Addiction Services and therefore can not truly ensure the statistics being reported are accurate.

Many organizations in Huron and Perth counties service both counties. With this integration it will allow better partnerships and alignments with both health and community partners. Currently there are different agreements and services being provided in the Counties as a result of different administrations and resources.

Integration of Huron Addiction Services and Choices for Change Project Charter

Target Project Completion Date: <yyyy-mm-dd>

South West Local Health Integration Network Page 6 of 15

Related Projects & Initiatives

Are there dependencies with other initiatives or projects (at the organizational, LHIN or Provincial level)?

Yes No

If “yes”, please describe below.

Project/ Initiative Interdependency & Impact

List the project or initiative. State the dependency and indicate how the dependency impacts your project.

n/a

Are there opportunities to spread to Local Community, Multi-Community, LHIN Community (as described above)?

Yes No

If “yes”, please describe below.

PROJECT PERFORMANCE Project Goals, Objectives & Performance Measures Provide the details of what this project aims to accomplish by listing its specific goals, objectives and deliverables. State the goals in terms of high-level outcomes to be achieved. Identify specific objectives and deliverables for each goal listed. Objectives are clear statements of specific activities/tasks that must be performed to achieve the goals. Identify both project product/service and people/organization change objectives. Performance measurement indicators and targets are used to determine if objectives and expected results have been successfully achieved.

Goals Objectives Performance Measurements

Indicators Targets

List all goals to be achieved by the project. Ensure alignment with project purpose.

For each goal, list specific objectives and/or deliverables that will signify achievement of goal when finished.

For each objective/deliverable, list the performance measurement indicator and target that will be used to evaluate success of results achieved.

To start delivery of addiction treatment services by Choices for Change in Huron County.

To communicate to the community, clients and partners about the integration

Develop a service

delivery plan that is within current resources

Engage CUPE in

negotiations regarding Huron County staff (if necessary)

A communication plan is developed which includes communication strategies for the community, clients, staff and partners

A plan is developed which ensures current level of service in each county and increases where possible service in Huron County

Meeting is scheduled Hiring process is developed

Plan complete and executed

Plan is complete and

within budget allocation Meeting complete and

negotiation successful Hiring of staff is complete

Integration of Huron Addiction Services and Choices for Change Project Charter

Target Project Completion Date: <yyyy-mm-dd>

South West Local Health Integration Network Page 7 of 15

Goals Objectives Performance Measurements

Indicators Targets

Hire staff for Huron County

Development of the

staff team Transition of existing

Huron clients to new agency

Ensure transfer of

negotiated assets to CFC

Develop a detailed

budget for services Negotiate

amendments to existing MSAA

A plan is developed to

include team/staff development for new organization

Clients are informed of change and provided necessary support.

Information for clients is successfully transferred to CFC database.

A plan is developed

between CFC and County of Huron to ensure transfer of all required assets

A budget is completed. Changes to existing MSAA

are successfully negotiated

Through evaluation of

activities, staff indicate comfort with new organizational structure

Through evaluation, clients indicate comfort with new organization and are in Choices for Change database

Negotiated assets are

transferred. Budget is complete and

approved by the Board of Directors

Signed MSAA by December 31, 2010

Project Timelines & Deliverables

Indicate when the project will take place. Provide a preliminary estimate for the duration of the project by documenting the target completion dates for high-level project milestones. Milestones are significant project events that usually signify completion of project phases or major deliverables.

Milestones Deliverables Dates

Description. Give clear definition of the milestone and/or deliverable, clarifying how you will know when it has been successfully achieved.

Absolute date where possible or time from start of project.

Procurement of consultant Consultant is hired 2010-09-17

Procurement of legal advisor for project. Legal advisor for project is retained. 2010-09-17

Development of communication plan for staff, boards, partners and the broader community

A plan is developed, including dates for releases and community events..

2010-09-20

Implementation of communication plan, including possible client and public forums, press releases etc.

The communication plan is executed. 2010-12-31

Location for services in Huron County and office set up including IT, phones, videoconferencing set up

Location is secured and schedule for installation of IT etc. is complete

2010-10-30

Integration of Huron Addiction Services and Choices for Change Project Charter

Target Project Completion Date: <yyyy-mm-dd>

South West Local Health Integration Network Page 8 of 15

Milestones Deliverables Dates

Negotiation with Huron County Health Unit regarding transfer of assets, ie. Computers, desks etc. to CFC.

Negotiations are complete and agreement signed.

2010-10-30

Human Resources including negotiation with the Union (if necessary), hiring of staff.

Negotiation with CUPE is complete and hiring process developed and staff hired

2010-11-30

Work with LHIN to amend current MSAA. New MSAA is developed for approval. 2010-11-30

Budget development Budget developed within existing resources 2010-11-05

Development of service delivery model, including development of partnerships and exploring new funding opportunities for service

Model is complete and ensure existing services are in place

2010-11-05

Approval of budget and service delivery model by CFC Board of Directors.

Approval received for budget and delivery model.

2010-11-10

Governance development including new board member recruitment and training, bylaw and board policy development

New board members are installed and training/retreat scheduled.

2010-11-30

Staff teambuilding/planning events are planned.

Dates and facilitator secured for events. 2010-10-30

All required client files are Transferred. DATIS has transferred all HAS client files to CFC database. The necessary changes to the Connex Ontario database are complete.

2010-12-20

Purchase of service contract with Avon Maitland District School Board for youth services in Huron.

Contract is negotiated and signed 2010-12-31

Governance training for new board. Training in complete. 2011-01-21

Board bylaws/ policy revision/development retreat

Bylaws and policy revision/development complete

2011-03-15

Staff development Facilitated event focus on service delivery, agency values etc. is complete.

2011-03-15

As Huron County has decided to terminate the HAS staff as of December 31, 2010, a hiring process for staff will need to be put in place. All current staff will be invited to apply and provided they meet the required criteria, will be interviewed.

Integration of Huron Addiction Services and Choices for Change Project Charter

Target Project Completion Date: <yyyy-mm-dd>

South West Local Health Integration Network Page 9 of 15

The existing MSAA needs to be amended by November 30, 2010. This is the date of completion for this milestone but work on this will begin in October. The goal would be to have it approved by the CFC Board at their November meeting. In regards to the Communication Plan, once the plan is developed there will various dates when information will be released to provide updates and have forums for both clients and the community as necessary to ensure clarity and confidence in the process. This will begin in early September and continue throughout the length of the project. Open houses for the primary locations of the main offices in Huron and Perth may have to wait until the spring depending on weather. Staff development is targeted to be completed by March 15, 2011. This would be to assist in the development of a staff team for the new agency. CFC builds into their budget teambuilding opportunities and all staff training events throughout the year as well. The initial sessions would be in addition to this and seen as a “kick off” for the team development. A new Strategic Plan will also need to be developed for the agency. This will likely include both Board and Staff. At this time, it is unclear if this would be part of the one time costs or budgeted into the 2011-2012 budget.

PROJECT TEAM MEMBERS Project Team Identify who is needed on the core project team to complete project deliverables and achieve goals and objectives. What skills, knowledge and experiences are required? Consider the need for special expertise to deal with people and organization change challenges. This section may include any new Human Resource(s) required to support the project.

Team Member and/or Title/Profession, Organization

Role on the Project Required Involvement

Estimated Duration Level of Effort

Provide names and/or titles/professions of core project team members.

Describe the role & responsibility of each core project team member.

Indicate target dates or number of weeks/months.

Indicate full-time or days per week/month.

Catherine Hardman Oversee the completion of all objectives and targets for the project.

4 months 2-3 full days per week

Dr. Nancy Cameron/ Brad Lucas

Work in partnership with CFC to ensure smooth transition of HAS clients etc. to CFC

4 months 1-2 days per week

**Consultant To provide guidance and ensure all the necessary tasks are completed

4 month 1 day per week

Legal consultation To provide guidance, particularly regarding HR issues

4 months 3 days per month

CFC and HCHU Board of Directors

Provide guidance, expertise and support to the process

4 months 1 day per month

Project Oversight Identify who is responsible for decision-making and oversight of scope, changes, etc.

Catherine Hardman, Executive Director of Choices for Change in consultation with the Board of Directors for CFC.

Integration of Huron Addiction Services and Choices for Change Project Charter

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Project Partners Is this project carried out in partnership with other groups/organizations? Indicate who else, in addition to those listed as project team members above, has committed to contributing to this project. Partners are individuals, groups or organizations who work together towards joint interests to achieve common goals. Identify shared, mutually beneficial objectives below and the contributions of each partner.

Partners Common Interests & Priorities Roles & Responsibilities List names, groups or organizations. State shared objectives and identify

priorities for each partner listed. What commitments have been made?

Huron Perth Health Care Alliance –Mental Health Services

To share costs to ensure optimal service delivery for clients

Possible shared location for service delivery. HPHA Mental Health Services is located in Seaforth. There have been discussions about locating the Huron services for CFC in the same building and therefore being able to share back office resources and support staff.

Project Stakeholders Stakeholders are individuals or organizations that have a vested interest in the initiative. They are either affected by, or can have an affect on, the project. Anyone whose interests may be positively or negatively impacted by the project or anyone that may exert influence over the project or its results is considered a project stakeholder. All stakeholders must be identified and managed appropriately.

Stakeholders Interests & Needs Management Strategies List names, groups or organizations. Why are they stakeholders? How are

they involved? How will the project manage expectations and meet their needs and requirements?

Clients of Huron Addiction Services and Choices for Change

They are stakeholders because they are directly impacted by the services delivered by the organization

There will be communication with the clients regarding changes and timelines. Open forums will be held to hear their concerns and answer questions and confirm commitment to continued service delivery.

Members of the Huron Perth Addiction and Mental Health Network

They are stakeholders as they partner with both organizations currently on a number of initiatives.

They will be kept informed of the project objectives and targets. Any concerns will be dealt with in an open forum at regularly scheduled meetings.

Members of the South West Addiction and Mental Health Coalition

They are stakeholders as they are tasked with monitoring changes in the addiction and mental health system in the South West LHIN.

They will be kept informed of the project objectives and targets. Any concerns will be dealt with in an open forum at regularly scheduled meetings.

Members of the Huron Perth Area Provider Table

They are stakeholders as there are partnerships with both organizations and this planning table is tasked with monitoring and planning for health services in Huron Perth.

They will be kept informed of the project objectives and targets. Any concerns will be dealt with in an open forum at regularly scheduled meetings.

Integration of Huron Addiction Services and Choices for Change Project Charter

Target Project Completion Date: <yyyy-mm-dd>

South West Local Health Integration Network Page 11 of 15

Stakeholders Interests & Needs Management Strategies Communities of Huron and Perth County

Addiction impacts many people and the communities need to know services are available to them and how the changes may impact this.

There will be press releases and if necessary an open forum to discuss changes and hear concerns.

Staff from both HAS and CFC They are stakeholders as they are directly impacted by the changes to the agency.

Staff of both HAS and CFC will be kept up to date on progress through regular staff meetings and memo. They will also be included in the development of the service delivery model. Management will always be available for questions or concerns as we move forward.

PROJECT RESOURCES

Human Resources Provide an overview of the new Human Resources (HR) required to support the initiative beginning with year one as well as additional hires in year two. As well, consider volunteer resources to be leveraged to support the information and provide information on these resources.

Position Title and Designation Required (if applicable) (e.g., PSW, Case Manager)

Project Start-up Ongoing Project Support

Volunteer Services Project Start-up Ongoing Project Support

Services to be provided: OHRS Functional Centre Description Individuals to be Served Service Units/Volumes

Funding Details

Ongoing Base Funding Budget Comments

Salaries and Wages $772,624 This combines both HAS and CFC Substance Abuse and Problem Gambling budgets, utilizing the 2010/11 existing budget.

Benefits $155,534 Same as above.

Supplies and Sundry Exp. $227,383 Same as above

Other (specify in comments)

Total Funding Required $1,155,541

Other Funding Sources $25,208 Ministry of Children and Youth Services

Total Net Ongoing Base Funding Required from LHIN

$1,130,333 The 2010/11 base budgets for HAS and CFC combined.

Integration of Huron Addiction Services and Choices for Change Project Charter

Target Project Completion Date: <yyyy-mm-dd>

South West Local Health Integration Network Page 12 of 15

Start-Up One-Time Funding Budget Comments

Consultation/Training $31,000 Includes consultant to guide process, board and staff facilitated sessions. As well, included is $3500 for training of staff in Community Withdrawal Management which includes Auricular Acupuncture for Huron County.

Information/Technology $30,000 Includes phones, computer and videoconferencing set up. See attached report for further details.

Other (specify in comments) $153,000 Includes “Rebranding” of the organization, i.e. new stationary, business cards, etc. Open houses for each location. Legal Fees which may result from discussions with the union currently representing the Huron Addiction Services staff. Restructuring costs are estimated to be incurred primarily for human resource issues arising through the integration of the staff and services. Leasehold improvements for new location and office signage.

Total Funding Required $214,000

Other Funding Sources

Total Net One-Time Funding Required from LHIN

$214,000

TOTAL FUNDING REQUIRED FROM LHIN (Ongoing Base + One-Time)

$1,344,333

In-Kind Contributions Are there any in-kind contributions? Yes No

If yes, describe: Time of the CFC Executive Director, Financial Manager and Board of

Directors. Also it’s likely both agency staff will provide time to the planning of services for the new organization.

Integration of Huron Addiction Services and Choices for Change Project Charter

Target Project Completion Date: <yyyy-mm-dd>

South West Local Health Integration Network Page 13 of 15

PROJECT COMMUNICATIONS

Project Team Communications Identify information needs of steering committee, project sponsor, project manager, team members, working groups, partners, stakeholders and others. List strategies for ensuring that right information is provided to right audience in most suitable and timely manner. Be sure to identify format and frequency of communication between the project manager and project sponsor regarding project status, performance, risks, issues, etc.

Audience Information Needs Format & Timing Responsible

To whom? List recipients of the information.

What? State what information will be communicated?

How? When? How often? Explain method and frequency.

Who? Identify who will provide information.

CFC and HAS clients The integration of the two organizations, including timelines and what it will mean for them.

The information will be communicated through pubic notices in the offices, letters to the clients, through staff. Frequency will be at least monthly

Executive Director, staff, board.

CFC and HAS staff Workplan and timelines, progress on objectives.

Bi-weekly at staff meetings Executive Director

External Communications

Identify plan for communicating project status, performance, risks, issues, etc. to external audiences (e.g., public, other health service providers, provincial government). List strategies for ensuring that right information is provided to right audience in most suitable and timely manner. Be sure to identify format and frequency of communication.

Audience Information Format & Timing Responsible

To whom? List recipients of the information.

What? State what information will be communicated?

How? When? How often? Explain method and frequency.

Who? Identify who will provide information.

Partner and other community agencies., ie. members of the Huron Perth Mental Health and Addiction Network, Huron Perth Area Provider Council, HP Community Planning Table, South West Addiction and Mental Health Coalition, South West Addiction Services Network

The decision by CFC to expand services. Timelines and milestones that will impact them. Service delivery model.

Monthly at meetings, more often if partnership impacted.

Executive Director and Board

General community The decision by CFC board to expand services to Huron. Timelines. Impact on services

Through media, ie. radio and newspaper,, public meetings. Monthly

Executive Director, Board of Directors.

MPP’s for both Huron and Perth

The integration is occurring and what this will mean for services.

Face to face meeting Executive Director and Board of Directors.

Integration of Huron Addiction Services and Choices for Change Project Charter

Target Project Completion Date: <yyyy-mm-dd>

South West Local Health Integration Network Page 14 of 15

PROJECT RISKS & CHALLENGES

Project Risks Document high-level project risks apparent at this point that could either positively or negatively impact the achievement of project goals and objectives. Focus on risks that are likely to happen and have a significant effect on project success. Be sure to consider risks associated with people & organization change, knowledge management and transition to operations.

Risk Likelihood of Occurrence

Potential Impact Organization Capacity to Manage Risk

Mitigation Strategy

Brief description of risk.

High, Medium, Low

High, Medium, Low

High, Medium, Low High level strategy to address risk.

Unionization of all agency frontline staff

Medium High Medium Negotiate with union to only represent current Huron positions.

Inability to increase service in Huron

Medium High High Rework current positions and way of providing services.

New staff team not integrated

Medium High High Ensure teambuilding is on-going and well planned and facilitated. Feedback from staff on the success of this goal.

Procurement of consultant and legal takes more time than anticipated

Medium Medium High Ensure other areas of the integration will continue to move forward as planned.

Critical Success Factors Define key factors that are critical to success of the project. These conditions must be satisfied to enable successful completion of project objectives and deliverables. Include significant events or decisions that need to take place. Whenever possible, ensure factors you list are measurable.

LHIN Board to approve the one time costs.

Timelines for deliverables are met.

Assumptions & Constraints Assumptions are external factors that, at the time of writing the charter, are considered true, real or certain for purposes of planning. Certain unverified or unknown aspects that are likely to happen must be assumed as facts to proceed. Constraints are factors that are outside the control of the project team, that restrict or regulate the project. They limit available options and affect performance of the project.

Assumptions Constraints

List the assumptions made to date. What did you have to assume to be true to complete the charter?

List project constraints. Consider time, budget, scope, quality, availability/skills of resources, priorities, etc.

That all parties, CFC and HAS are in agreement this is the most favourable option.

No one time funding to enable the process of integration.

That CFC has the capacity to take on this project.

The community partners in Huron and Perth are supportive of this integration.

A consultant and legal advise will be procured within anticipated timelines

Integration of Huron Addiction Services and Choices for Change Project Charter

Target Project Completion Date: <yyyy-mm-dd>

South West Local Health Integration Network Page 15 of 15

PROJECT REPORTING SCHEDULE <TO BE COMPLETED BY THE LHIN>

Project Status Reports

Based on the Estimated Project Duration of and Target Project Completion Date of [yyyy-mm-dd], Project Status Reports are to be submitted to the LHIN according to the following schedule:

Report # Reporting Period [yyyy-mm-dd to yyyy-mm-dd] Report Deadline [yyyy-mm-dd]

1 to

2 to

3 to

4 to

Project Close-out Reports

Based on the Target Project Completion Date of [yyyy-mm-dd], the Project Close-out Report is to be submitted to the LHIN on the following date:

Please submit Project Status Reports and Close-out Report to Michelle Hay, michelle.hay@lhins.on.ca

Choice for Change and Huron Addiction Services Integration Evaluation: Page 1 of 9

FUNDING INTEGRATION EVALUATION TOOL

Voluntary Integration Title: Integration of Huron Addiction Services and Choices for Change

HSPs Involved: Choices for Change: Alcohol, Drug & Gambling Counseling Centre (CFC) Huron County Health Unit – Huron Addiction Services (HAS)

LHIN Staff Reviewing: Carrie Jeffrey’s, Carolyn Ridley, Rebecca McKee

Building on the stated purpose of LHSIA and subsequent Ministry and legal guidance to the LHINs, integration initiatives should at a minimum result in:

√ Improved Access and Quality of Care √ Coordinated Healthcare √ Improved Navigation through the Continuum of Care √ Effective and Efficient Service Delivery √ Alignment with the IHSP √ A consideration of the Public Interest

The evaluation considers four areas of analysis to understand if the integration initiative meets these criteria. The four areas of analysis include:

1. Public interest considerations and impacts 2. Community engagement 3. Other operational impacts 4. LHIN organization impacts

Choice for Change and Huron Addiction Services Integration Evaluation: Page 2 of 9

1. PUBLIC INTEREST CONSIDERATIONS AND IMPACTS:

Considerations Yes/No Comments and/or Concerns

Does the integration promote appropriate, coordinated, effective and efficient health services?

Yes

Since October 2008, CFC has provided Clinical Supervision, Program Development and representation at various planning tables for HAS. This was due to a lack of personnel with the expertise at HAS to provide these services. This history of coordinating services demonstrates coordinated, effective and efficient health services that will likely continue. The Huron County Health Unit which currently operates HAS is not mandated to provide addiction services, and does not have the skills and expertise to provide leadership in addiction treatment services. CFC does have the skills and expertise and already provides these services in Perth County.

Does the integration promote better access to high quality health services? Yes

Huron County is already under serviced in terms of addiction services (HAS is the only LHIN funded organization that provides addiction services in Huron County). CFC currently provides high quality addiction services in Perth County and have wanted to expand services into Huron County. This integration provides the opportunity for them to expand into Huron County and provide continuation of services to Huron County.

Does the integration achieve quality improvements in clinical outcomes, health service delivery, and/or system performance?

Yes

This project aligns with the objective of CFC to expand services and ensure services are based on best practices. CFC has a proven record for implementing new programs to meet the needs of clients based on what is considered best practice for the addiction treatment system. The services in Huron County are in need of revision to ensure they are meeting the needs of the clients and meeting best practice guidelines.

Does the integration support patient/client and person centered health care? Yes

The vision of the “new” agency is based on the blending of two organizational cultures and practices to meet the addiction treatment needs of clients in Huron and Perth Counties.

Choice for Change and Huron Addiction Services Integration Evaluation: Page 3 of 9

Considerations Yes/No Comments and/or Concerns

Does the integration promote efficient and effective management of the local health system to ensure sustainability?

Yes

Currently HAS does not have someone in a leadership position to look for and create opportunities for service expansion and partnerships and as a result, the program has been stagnant for many years. Through new and expanded partnerships with other health care providers and community partners, services for those impacted by either substance use or gambling will be improved. There are no identified concerns in terms of current CFC leadership, staffing and Board. Therefore, we would expect sustainability as a result of the integration.

Does the integration ensure value for money? Yes

The leadership and expertise is already in place, staff is already in place and the intent is to hire existing HAS staff. Therefore there would be continuity of leadership and staff with the willingness to enhance expertise with existing base funding on an ongoing basis.

Potential Impacts Indicate: No Impact, Negative Impact or Positive Impact

Clarify the Potential Impact and Provide Comments and/or Concerns

Impact on patient/client care and on the population of the LHIN in terms of such things as: access, choice, equity, quality, timeliness, continuity and coordination of services, and health outcomes

Positive

The Huron County Health Unit has provided notice to the South West LHIN to terminate their provision of addiction treatment services as of December 31, 2010. Without this existing health service provider, it is possible there would be no provision of these services in Huron County. This would be a significant loss to the communities it currently serves and could also create capacity issues for the surrounding services as they would struggle to take on the additional clients that would surely come their way. The creation of longer wait lists for these services will impact the quality and access of services to the client. With CFC taking on these services would provide a positive impact on patient/client care in terms of continuity and coordination of services.

Impact on achievement of the goals of the IHSP or provincial strategic plan Positive This integration aligns with strategic direction #1 – Enhance capacity

and integration of primary specialized and community-based care

Choice for Change and Huron Addiction Services Integration Evaluation: Page 4 of 9

Potential Impacts Indicate: No Impact, Negative Impact or Positive Impact

Clarify the Potential Impact and Provide Comments and/or Concerns

Impact on specific subpopulations, diverse communities and any vulnerable populations in the LHIN

Positive This integration would have a positive impact on a vulnerable population (those with addiction issues) in a specific subpopulation (Huron County).

Impact on labour and employment relations Unclear

It is possible that CFC may be faced with a ‘related’ employer claim by CUPE given that HAS staff are unionized. Should this be the case, costs will be incurred either to argue against such a claim OR to negotiate a first collective agreement with CUPE.

Downstream impacts on health service providers and other entities in terms of such things as : capacity, services provided, continuity and coordination of services, population(s) served, and governance

Positive

CFC taking over the provision of addiction services will ensure that there is no downstream impacts on health service providers (no impact on capacity, services provided, continuity etc) Without addiction services in Huron County it could create capacity issues for surrounding services in the community.

Impact on use of resources and health system sustainability No impact CFC plans to work within the existing budgets/resources after initial one

time funding

Impact on relationships, collaboration and partnerships Positive

Through new and expanded partnerships with other health care providers and community partners, services for those impacted by either substance use or gambling will be improved.

2. COMMUNITY ENGAGEMENT: The voluntary integration materials should identify any community engagement and/or consultation that occurred and describe the outcome. Components of the engagement should address the system impacts of the integration, including the impacts listed above (patient/client care, goals of IHSP, labour, etc) Under sections 16(6) of LHSIA, HSPs must engage the “community of diverse persons and entities” where they provide services when they develop plans and set priorities. LHSIA does not define “community of diverse persons and entities” for HSPs. Some guidance is found in section 16(2) of LHSIA, which defines the LHIN “community” as:

Patients and other individuals in the LHIN’s geographic area HSPs and others that provide services in or for the local health system Employees involved in the local health system Some LHINs interpret the health service provider “community” to also include funders

Choice for Change and Huron Addiction Services Integration Evaluation: Page 5 of 9

There is no similar provision in LHSIA concerning the extent of engagement required by HSPs. An inclusive definition in line with the Act’s definition is to consider community engagement as involving all those members/stakeholders of the healthcare “community”, including HSPs, health care professionals, patients/clients, consumer support groups, funders and residents in broad health care planning. Engagement thus most effectively happens at all levels, from governance to the front lines and community residents. Engagement unlocks and leverages system planning expertise to create real solutions; incorporates knowledge about health needs, experiences and satisfaction; provides a means for emerging trends to be identified; and ultimately can stimulate collective responsibility towards the health system. Community Engagement Comments and/or Concerns: Things to consider: Yes/No Community was engaged. Do you feel all the necessary stakeholders were engaged? If not, who else should be engaged?

“Communicating to the existing clients of HAS regarding the integration and ensure a smooth transition” is considered “in scope” in their charter

Staff focus groups and community stakeholder consultations were conducted and are summarized in the Voluntary Integration Report

Further communication and engagement activities are detailed in the project charter

3. OTHER OPERATIONAL IMPACTS IF APPLICABLE:

Other considerations: Does this proposal provide…. (indicate yes, no or not applicable)

Comments and/or Concerns

An overview of the program components and supporting services, Inpatient volumes (cases, weighted cases and patient days) and costs, Outpatient volumes and costs, Administrative and support services units and costs (e.g. administration, diagnostic & therapeutics, outpatient clinics, etc.)

Yes

A Programs Overview can be found in the “Voluntary Integration Report” prepared by Glenda Clarke and Associates (structure, mission, vision, values, incentives, job descriptions and human resources details along with financial implications) An appendix outlining the services provided and service levels for each organization is included

A summary of the human resources plan for employees, including physicians, and the financial implications of the plan

No A transition plan will need to be developed between CFC and HAS with a deadline for deliverables

Choice for Change and Huron Addiction Services Integration Evaluation: Page 6 of 9

A description of the program decanting and measures to minimize disruption to patient service (transition plans)

No A transition plan will need to be developed between CFC and HAS with a deadline for deliverables

Implications of the program transfer on capital requirements, if applicable n/a

Evidence that regulatory and licensing requirements will be met, as appropriate (e.g. lab licensing in the case of laboratory transfers)

n/a

For partnerships or other similar joint arrangements, demonstration that the proposed venture does not place the assets of the HSP(s) at risk or create an operating liability for the HSP(s)

No A transition plan will need to be developed between CFC and HAS with a deadline for deliverables

4. IMPACT TO LHIN ORGANIZATION:

Impact Indicate: No

Impact, Negative Impact or Positive

Impact Implications for LHIN Organization, Comments and/or Concerns

Financial Impact (not sure that

it’s positive or negative)

One-time costs $214,000 (see Financial Impact Analysis below)

Policies and/or Procedures Impact (not sure that

it’s positive or negative)

Amendments to CFC’s M-SAA or a new M-SAA will need to be put in place to account for the expanded/new services formerly delivered through HAS

Return on Investment

Public Relations Positive This integration will ensure addiction services will continue to be provided in Huron County

Choice for Change and Huron Addiction Services Integration Evaluation: Page 7 of 9

Additional Comments and/or Concerns: Should the South West LHIN Board of Directors support this initiative, as per the requirements of their current M-SAA, Huron Addictions Services will be directed to work with Choices for Change to develop a detailed transition plan in collaboration with CFC to ensure a smooth process as the current services provided by HAS are discontinued and the new/expanded services are implemented by CFC

FINANCIAL IMPACT ANALYSIS

Item Description Estimated Cost LHIN Comments

COSTS RELATED TO ESTABLISHING NEW OFFICE LOCATION (START UP COSTS)

Phone technology Purchase of new phone system for new office location and installation/ set-up of same $15,000

The review does not see any issue with these costs as a new office will need to be established for the Huron staff. Suggest this money could come from urgent priorities fund or one-time infrastructure funds.

Leasehold improvements for new office location(s)

Renovation/construction, painting, flooring, lighting, etc of new office location(s) to meet service provision needs. This will be negotiated with landlord and may be incorporated into lease

$20,000

Office set up

Including purchasing and running computer cables, phone lines, setting up technology (including videoconferencing equipment), etc and moving furniture from present location(s) if applicable

$15,000

Office signage Cost will vary depending on location and style of sign that is chosen $2,500

TOTAL $52,500

Associated Risks: Low – this would show support for integration opportunities with little financial support from the LHIN required Review team in agreement with this cost

HUMAN RESOURSE AND ORGANIZATIONAL ONE-TIME COSTS

Consultant To develop a detailed workplan including contracting a facilitator for the processes outlined below

$10,000

Choice for Change and Huron Addiction Services Integration Evaluation: Page 8 of 9

Item Description Estimated Cost LHIN Comments

Board and staff process

To develop a new mission, vision and core values for the organization – estimated 2 days Facilitator Facility (travel, space, food – overnight

accommodation not required as event scheduled close enough to accommodate travel to/from home each day)

$6,000 $4,000

Staff development process

To build on core values and look at what will be the common practices and policies used across the organization – estimated 2 days but not necessarily consecutive Facilitator Facility

$5,000 $2,500

Open houses Should be held at both Huron and Perth locations as further evidence that this is a new organization

$3,000

‘Rebranding’ of the organization

Reprinting of stationary, business cards, pamphlets, website redevelopment, signage, notice to stakeholders, etc

$7,500 Could these costs be absorbed in CFC’s internal budget for normal stationary, business cards, etc costs? (Signage covered in start up costs)

Training of staff in Community Withdrawal Management

Includes Auricular Acupuncture for Huron County $3,500

SUB-TOTAL Total of all HR/Organizational Costs $41,500

LEGAL/RESTRUCTURING COSTS

Choice for Change and Huron Addiction Services Integration Evaluation: Page 9 of 9

Item Description Estimated Cost LHIN Comments

Legal/Restructuring fees

Estimated legal costs which may result from discussions with the union currently representing the Huron Addiction Services staff. Restructuring costs are estimated to be incurred primarily for human resource issues arising through the integration of the staff and services.

$120,000

TOTAL Includes ALL One-time Costs $214,000

Page 1 of 3

Report to the Board of Directors

Woods toc k and Area C ommunity Health C entre C apital P ropos al: S tage 2.0 F unc tional P rogram

Meeting Date: September 22, 2010 Submitted by: Mark Brintnell, Senior Director, Performance, Contract and Accountability Laura Salisbury, Financial Analyst Julie Girard, Team Lead, Planning and Integration Submitted to: Board of Directors Board Committee Purpose: Information Decision Suggested Motion: THAT the South West Local Health Integration Network Board of Directors indicates to the Ministry of Health and Long-Term Care that it endorses the services and programs as outlined in the Woodstock and Area Community Health Centre Functional Program for its permanent location in Woodstock, Ontario. Background WACHC’s Pre-operational Plan (POP) was approved by the South West LHIN Board Committee on June 10, 2009. Next steps at that time were identified as negotiation of a Multi-Sector Service Accountability Agreement (M-SAA) with WACHC to enable WACHC to move forward with their staffing plan, interim capital space, programs and services and planning for the permanent capital space. The M-SAA was finalized in November 2009 and the WACHC interim site became operational in February 2010 serving the catchment area and priority populations identified in the POP. With the previous approval of the POP, WACHC had LHIN Board endorsement to proceed with the next step in the capital planning process, which is the development of the Functional Program (FP) and determination of the permanent capital site. WACHC submitted a hard-copy of their FP, which is available for any Board member who wishes to review the detailed plan. WACHC Proposal

Agenda Item 5.6

Functional Program WACHC expands upon the details provided in the POP, with a focus on providing primary healthcare in Woodstock and Oxford County for people with mental health and addictions, youth, low-income families, isolated seniors and uninsured individuals. As well, community engagement sessions with local agencies helped to identify additional service gaps within the community, and in response additional programs to address the gaps, specifically a Youth Program and a Wellness Program, which were not a part of the original POP submitted to the LHIN.

Page 2 of 3

Permanent Site Proposal WACHC proposes to renovate and lease space at a local, historically-significant building in downtown Woodstock, formerly the Post Office Building. The building was recently sold and the owner has undertaken extensive renovations to prepare the building for lease. In addition, the building has adequate parking, outdoor activity space and is adjacent to key community partners including Community Employment Services, CMHA Oxford and Oxford county administration offices. The total available square footage of the building is 30,000 sq ft with a proposed initial occupancy of approximately 16,050 square feet and a cost of $3,417,003 which includes $148,905 related to the newly proposed Youth and Wellness Programs. WACHC requests reconsideration of their space needs from a “small” CHC (15-18 FTEs) to a “medium” CHC (19-22 FTEs). As the WACHC has an approved staffing plan for 17.6 FTEs, their plan includes a growth factor, which would increase the capital planning size to medium in a relatively short period of time. As such, given the approved catchment area of Woodstock, Tillsonburg and Ingersoll, with related population of approximately 140,000, LHIN staff is also supportive of this change. Targeted occupancy is June 2012. South West LHIN Review and Conclusion Functional Program The WACHC Functional Program has been elaborated upon and provides more fulsome context including deliverables for the POP and is in aligned to the South West LHIN’s priorities identified in the Integrated Health Service Plan 2010-13 and Blueprint Vision 2022. WACHC has identified in their work plan the priority populations to be served, the programs and services to help address the service needs, and, high level performance objectives including the goals and associated objectives expected to be achieved in the first year of operation. The LHIN’s review of the status of the stated goals confirms that WACHC leadership and governance continues to achieve set goals in a collaborative manner, continually engaging community partners and residents as they develop and refine their strategic and business plan. Permanent Site The WACHC followed multiple rigorous RFP processes (3 in total) to ensure a comprehensive review and final determination of the permanent WACHC site. The ultimate recommendation was determined through the Facilities Steering Committee, comprised of area partners, which brought the preferred option forward to the WACHC Board of Directors for consideration and ultimately, unanimous approval for the site. Costing for the capital component of the site was determined using recent and best information available, including a comparable CHC in progress project. In addition, should the capital component be approved by the MOHLTC, the CHC would undergo a quantity survey, which then itemizes the renovation on a very granular level. LHIN staff is supportive of the recommendation to occupy the former Post Office as the permanent site for WACHC. Next Steps: Subject to South West LHIN Board consideration of the programs and services of WACHC’s Functional Program, the CHC focused capital review process continues with a letter of endorsement (including motion) from the South West LHIN to MOHLTC LHIN Liaison Branch, CHC Division and Health Capital Investment Branch for use in the subsequent ministry review and consideration for approval of capital investment.

Page 3 of 3

Appendix A: Capital Planning Process

*Above capital process is modified for new CHC development

Overview of Capital Planning Process Planning Grants:

3 possible approval milestones: proposal development, functional program, design development

Construction Grant

Stage 1 Proposal/ Business Case (Part A & B)

Stage 2 Functional Program (Part A & B)

Stage 3 Preliminary Design Or Output Specifications

Stage 4 Working Drawings Or Output Specifications

Stage 5 Implementation

Review and approval of Stage 1 Submission. Functional Program grant.

Review and approval of Stage 2 Functional Program. Design Development grant

Review and approval of blocks and sketch plans; approval to proceed to working drawings OR blocks/output specifications

Review and approval to tender & implement/issue RFP OR approval to award construction contract/ Project Agreement.

Pre-Capital (Part A & B)

Requires Government approval to

plan

Requires Government approval to construct

Review and support of Pre-Capital Submission. Proposal Development grant

Page 1 of 6

Report to the Board of Directors 2010/11 P riorities for Inves tment P lan – P has e 2

Meeting Date:

September 22, 2010

Submitted By:

Mark Brintnell, Senior Director, Performance, Contract & Accountability Kelly Gillis, Senior Director, Planning, Integration & Community Engagement

Submitted To:

Board of Directors Board Committee

Purpose: Information Decision Suggested Motion THAT the South West Local Health Integration Network Board of Directors approves the allocation of $1,497,123 in one-time funding in 2010/11 and $21,625 in one-time funding in 2011/12 in support of the projects included in Phase 2 of the 2010/11 Priorities for Investment Plan as outlined in Appendix A. Identified funding required in 2011/12 is subject to allocations through the 2011/12 provincial estimates process. Background The South West LHIN has several funding envelopes that are being targeted for investment in projects that will advance our set goals and priorities within the Health System Design Blueprint Vision 2022 and 2010-13 Integrated Health Service Plan (IHSP). The total sources of 2010/11 funding identified for investment through phases 1 and 2 include: Funding Source Purpose of Funds Amount Urgent Priorities Fund - Core Focus on local priorities, government priorities, and

demonstrate progress on performance targets $1,946,954

Urgent Priorities Fund – Dedicated (ER/ALC)

Focus on strategies that address ER/ALC pressures

$1,996,900

Funds Held in Reserve Focus on local priorities, government priorities, and demonstrate progress on performance targets

*$2,049,027

In-year Health Service Provider Surplus Funds – Residential Hospice (RH) Funds

Focus on developing residential hospices and end of life care

$1,274,840

*Amount has been restated based on a recent reconciliation The Urgent Priorities Fund Core and Dedicated (ER/ALC) allocation is an annual allocation received from the Ministry of Health and Long-Term Care to focus on local priorities, government priorities, and performance improvement against set targets included in the 2010-12 Ministry-LHIN Performance Agreement (MLPA). The total 10/11 allocation received for the South West LHIN is $4,538,409. Due to funding commitments for approved projects from prior years, the total funding available for new project approvals is $3,943,854. Our LHIN has focused on one-time investments to maintain our flexibility to seed and incent projects and initiatives.

Agenda Item 5.7

Page 2 of 6

The Funds Held in Reserve funding is from accumulated prior-year surplus funds in the areas of provincial programs, regional infection control, and emergency services coordination. These funds have been targeted for re-investment in local priorities, government priorities and performance improvement against set targets included in the 2010-12 MLPA and are currently held in reserve at London Health Sciences Centre and Stratford General Hospital. The total funding available is $2,049,027 but these funds are not required to be spent within 2010/11. The In-year Health Service Provider Surplus Funds are from the allocation targeted for the remaining two (London and Grey Bruce) developing residential hospices. These funds are base operating dollars to support nursing and personal support costs of operating a residential hospice and flow through the South West CCAC allocation. Grey Bruce is expected to become operational in Q4 of 10/11 with an outreach end of life care model. The submission of this proposal has been delayed but will be brought forward in October as part of a full report on the current status of residential hospice development. However, given neither developing residential hospice will be fully operational in 10/11 surplus funds are available for reinvestment in support of end of life care. The total funding available is $1,274,840. Any additional health service provider in-year surplus funds will be confirmed following Q2 and Q3 and brought forward for board consideration for reinvestment. Current Status The South West LHIN is focused on advancing our set goals and priorities within the Health System Design Blueprint Vision 2022 and 2010-13 IHSP. The key areas of focus for phases 1 and 2 of the Priorities for Investment Plan include:

• ED and ALC • Centrally Coordinated Resource Capacity • Population-based Integrated Health Services • Quality Improvement Program • Decision-making Infrastructure • End of Life Care

A number of existing and new investment opportunities to advance projects within the above identified key areas were brought forward and vetted against the following parameters:

• Strong alignment with Blueprint and IHSP principles and priorities; • Ability to enhance progress against performance indicator targets established through the

MLPA; • Demonstrates readiness for implementation (i.e. no policy barriers) and identified risks can be

managed; and • Demonstrates value for money and alignment with LHIN Annual Business Plan.

Phase 1 of the Priorities for Investment Plan was approved by the LHIN Board on August 11th, 2010. This report addresses phase 2 of the Priorities for Investment Plan. A Project Proposal for each project being recommended is included with this report. One-time funding is being recommended for each of the proposed projects. The Project Proposals (see Appendix A) as part of phase 2 for LHIN Board consideration include:

• Diabetes Improvement Education • Resource Matching & Referral • Non-urgent Patient Transportation • eShift Service Delivery Model for End of Life Care Clients

Page 3 of 6

The below chart shows the original funding amount against the allocation of funds approved through phase 1 and requested for phase 2 of the Priorities for Investment Plan. Funding Source Balance Urgent Priorities Fund – Core

Opening Allocation Approved Funding Phase 1

Requested Funding Phase 2 Balance Remaining

$1,946,954

-$1,627,506 -$130,000 *$189,448

Urgent Priorities Fund – Dedicated Opening Allocation

Approved Funding Phase 1 Requested Funding Phase 2

Balance Remaining

$1,996,900

-$0 -$1,367,123

$629,777 Funds Held in Reserve

Opening Allocation Approved Funding Phase 1

Requested Funding Phase 2 Balance Remaining

$2,049,027

-$0 -$0

$2,049,027 In-year HSP Surplus Funds – RH

Opening Allocation Approved Funding Phase 1

Requested Funding Phase 2 Balance Remaining

$1,274,840

-$95,000 -$0

*$1,179,840 *The proposed Choices for Change Integration proposal (Board Report 5.5c) will require $214,000 in one-time funding to be allocated from UPF Core (leaving a $0 balance) and the remainder from In-year HSP Surplus Funds - RH. Next Steps Pending LHIN Board consideration of the proposals, Project Charters will be developed to guide the implementation of each project. Project progress will be shared with the LHIN Board on a quarterly basis. South West LHIN staff continues to work on other investment opportunities that will potentially require fiscal resources to achieve objectives in advancing our Blueprint and IHSP. These opportunities will be brought forward when our due diligence is complete and a recommendation can be determined.

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Appendix A – Project Proposal and Financial Summary

Project Proposal Brief Project Description Area of Focus Requested Funding

Funding Source

1 Diabetes Education Improvement Project in Thames Valley

This project will facilitate knowledge translation between Diabetes Education Centres and the Regional Coordinating Centre to ensure that the most current evidence based standards of care are adhered to. Implementing a “coordination” function in the South will put in place process improvements and gain economy of scale by pooling other existing administrative tools and resources to maximize “on the ground” resources to serve more clients directly. Additionally, the coordination resource will work with and develop the teams to help them work to their maximum capacity, centralize and coordinate outreach services, coordinate wait times for the DECs to facilitate patient choice between shortest wait or closest DEC, and set processes in place to standardize care across DECs. Implementing this function in the south will enable the nurse dietitian teams to focus on care delivery, increasing patient flow and better serving the underserviced area of the South. It will also strengthen the ability of the RCC to perform its function.

Quality Improvement Program

$7,000 (10/11) $21,625 (11/12)

UPF - Core

2 HEATHePATHWAYS RM&R Phase 2

The Erie St. Clair, South West, Waterloo Wellington and Hamilton Niagara Haldimand Brant LHINs have established a four LHIN collaborative to work together to meet Phase 1 and Phase 2 Resource Matching & Referral project objectives and position themselves for success in the implementation of an RM&R (Resource Matching & Referral) solution.

CHIS (Consolidation Health Information Services) has taken the lead on behalf of the 4 LHIN collaborative to complete Phase 1 of the HEALTHePATHWAYS RM&R Project which developed a Current State Assessment and identified key considerations for a future state with an RM&R solution.

Phase 2 has five key stages that build on the future state considerations identified in Phase 1 and defines the future state business process model and requirements and the technical requirements for an RM&R solution, as

Decision-making Infrastructure / eHealth

$181,088 (10/11) UPF Dedicated

Page 5 of 6

well as conducting a market assessment of RM&R solutions that will inform the requirements. Lastly, the outcome of Phase 2 will include a business case for procurement and implementation of an RM&R solution and completion of a Phase 3 project charter.

3 Non Urgent Patient Transportation Project

The project will consist of five streams/phases: Stakeholder hospital representatives and LHIN representatives will convene to agree on project outcomes and deliverables. This phase will include clarification of need, building awareness of “best in class” standards for Patient Transportation and finally agreement on project outcomes, deliverables and time lines. Endorsement and approval of these outcomes will be sought from the LHIN CEO’s and the LHIN Board. Development of supplier certification standards that would be used as part of the RFP. These service standards would form the basis of a minimum set of compliance standards that service providers would need to deliver on and demonstrate compliance. This would assure purchasers of a certain level of quality in the absence of a regulatory framework. This would include patient transportation standards as well as key standards applicable to hospital operations such as the communication of infectious disease status of patients Development of service level agreements with measurement and compliance standards which facilitate audits of service provided. Development of common processes and procedures related to the interface with patient transportation providers, common decision criteria for the use of non-urgent patient transportation and common framework for billing patients and insurance providers The group comprised of SWLHIN hospital representatives may participate in a LHIN-wide RFP for patient transportation services through the auspices of Health Care Materials Management (a joint venture of St Joseph's and LHSC which provides purchasing, logistics

Centrally Coordinated Resource Capacity

$123,000 (10/11) UPF Core

Page 6 of 6

and contracting services to a wide range of hospitals in the SW LHIN). It should be noted that the South West LHIN has received requests from providers and communities seeking financial support for non-urgent patient transportation. Although this project won’t commit the LHIN to financial resources for non-urgent patient transportation, it will help identify opportunities for hospitals and communities to create a system of non-urgent transportation.

4 eShift Service Delivery Model for Clients who are at End of Life

When a person is confronted with an incurable illness one of the most difficult decisions is choosing where to die. While palliative hospital beds and residential hospice are desirable options for some, more and more individuals are choosing to die at home encircled in the care their family and other loved ones. For these caregivers, the final days can be draining physically, emotionally and spiritually. Shift Nursing provided through CCAC can be a significant support for families. Shift nurses are scarce and often already engaged in supporting long-stay medically fragile clients; shift nurses with palliative skills are rarer still. Personal support workers can also be a significant support for families and it is often the PSW with whom the client and family form the strongest bond. But PSWs are limited in their scope of practice and traditionally have not been able to provide the medical component of care so even though CACC can provide more than the usual number of hours for clients at end of life, families may still have sleep interrupted or not be able to leave the home because the PSW cannot provide adequate pain and symptom management. Based on the success of the eShift service for the medically fragile, the CCAC is adapting and expanding the eShift model for clients who are at end of life. As the pilot with medically fragile has demonstrated, this model is an effective strategy to build HHR capacity, leverage and spread limited specialty knowledge and skills, and ultimately provide Ontarians with better healthcare.

End of Life Care $1,186,035 (10/11) UPF Dedicated

Page 1 of 15

Project Proposal

PROJ ECT INFORMATION Project Name Date Submitted Project Acronym or No. Diabetes Education Improvement Project in Thames Valley

2010-07-19 <assigned by LHIN>

Estimated Duration of Project Estimated Budget Notice of Integration?

18 months $28,625* (*reflects LHIN share) No

Lead Organization Project Sponsor Lead Organization Contact Information Project Sponsor Name (e.g., CEO/ Executive Director):

CEO Tillsonburg & District Hospital

Project Manager/ Lead Contact Name:

Julie Gilvesy

Organization Name: Tillsonburg & District Hospital

Address: 167 Rolph Street, Tillsonburg, ON N4G 3Y9

Telephone: 519-842-3611 x201

Email: Julie.gilvesy@tillsonburghospital.on.ca

Partner Organization Contact Information Partner Organization Contact Information

Contact Name: Paul Collins, Chair Contact Name: Andy Kroeker

Organization Name: Thames Valley Planning Partnership Executive Committee

Organization Name: West Elgin Community Health Centre

Address: 189 Elm Street, St. Thomas, ON N5P 3W2

Address: 153 Main Street, PO Box 761, West Lorne, ON N0L 2P0

Telephone: 519-631-2030 x2184 Telephone: 519-768-1715

Email: pcollins@stegh.on.ca Email: akroeker@wechc.on.ca

Partner Organization Contact Information Partner Organization Contact Information

Contact Name: Cate Melito Contact Name: Michelle Hurtubise

Organization Name: Woodstock and Area Community Health Centre

Organization Name: London Intercommunity Health Centre

Address: 400 Dundas Street, Woodstock, ON N4S 1B9

Address: 659 Dundas Street East, London, ON N5W 2Z1

Telephone: 519-539-1111 x211 Telephone: 519-668-0875 x245

Email: cmelito@wachc.ca Email: mhurtubise@lihc.on.ca

Partner Organization Contact Information

Contact Name: Brian Dokis

Organization Name: SOAHAC

Address: 427 William Street, Suite 425, London, ON N6B 3E1

Telephone: 519-672-4079

Email: executivedr@soahac.on.ca

<insert Project Acronym or No.> Project Proposal

Date Submitted: <yyyy-mm-dd>

South West Local Health Integration Network Page 2 of 15

PROJECT DESCRIPTION Project Purpose Explain the purpose of this project by describing, at a high-level, the background necessary to understand why the project was started, what will be done. What is this project aiming to achieve? What is its vision? What need or opportunity will it address? What problem will it solve? (maximum half page)

In June of 2009, at the request of the Ministry of Health and Long Term Care, the South West LHIN submitted recommendations for model of care and service expansion to the Ontario Diabetes Strategy which incorporated sub-LHIN and LHIN-wide co-ordination of diabetes services.

Since the north and central geographic areas of our LHIN already have functional coordinated diabetes programs, the need for coordination in the south was identified. The Grey Bruce Health Services Diabetes and Huron Perth Healthcare Alliance programs have proven to be effective in forming relationships, establishing, planning, maintaining standards, and gaining administrative efficiencies. There is a notable difference in the number of patients seen by these two programs and the independently coordinated approach in the south that is exemplified by different approaches to service delivery, resource utilization and Diabetes Education Centre (DEC) to DEC networking and standardization. Often times, front-line providers in the south perform a variety of administrative tasks such as marketing their services and linking to other parts of the system involved in patient care. Recently, the LHIN has facilitated DEC to DEC networking, as previously there was limited opportunity for this, as well as limited, if any, standardization of practice across DECs.

Implementing a “coordination” function in the south will mitigate these challenges by putting in place process improvements and gain economy of scale by pooling other existing administrative tools and resources to maximize “on the ground” resources to serve more clients directly. Additionally, the coordination resource will work with and develop the teams to help them work to their maximum capacity, centralize and coordinate outreach services, coordinate wait times for the DECs to facilitate patient choice between shortest wait or closest DEC, and set processes in place to standardize care across DECs. The coordinator will also ensure that performance metrics roll up, and be the primary administrative contact with the Regional Coordinating Centre (RCC). Implementing this function in the south will enable the nurse dietitian teams to focus on care delivery, increasing patient flow and better serving the underserviced area of the south. It will also strengthen the ability of the RCC to perform its function. The Thames Valley Hospital Planning Partnership, the Community Health Centres (CHC) that host DECs and the CCAC (as host of the RCC) have been considering how best to facilitate this process. In the spring of 2010, the Ministry supported the recommendation for a one year project to focus on improvement in the coordination of diabetes services in the south geographic area of the LHIN. The Ministry has identified that as of April 1, 2011, the funds allocated to this project will be applied to a front line clinical diabetes education resource. Given that the funds for this project are not likely to flow until late in the summer of 2010, in practical terms, that means that the project will have approximately a 6 month life cycle. The Thames Valley partners, including the CHCs that host DECs, have all agreed that eighteen month duration is preferred, and are willing to support extending the project by contributing funds or in-kind resources to ensure the success of this project. The South West LHIN has also indicated it would provide funds to support this.

At this time, the project charter for this project is in draft and circulated to the TVHPP and partners for their review.

Health Service Clients/Stakeholders (i.e., target populations) Who are the health service clients/stakeholders (i.e., target populations) that will benefit from this proposal?

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General Description (e.g., individuals over 65) Equity This proposal responds primarily to the needs of the

following population(s):

Adults with type 1 or type 2 diabetes residing in part of Norfolk, Oxford, Elgin and Middlesex counties of the South West LHIN.

Aboriginal

Francophone

Rural/Remote Populations

Inner-urban (e.g., homeless) Populations

Religious, Ethno-Racial or Linguistic Minorities (please specify):

Sex/Gender

Sexual Orientation/LGBT

Low Income/Under-employed

Persons with Disabilities (e.g., physical, intellectual, sensory, learning, mental illness)

General Population

Other, please specify:

Where Service/Initiative is Accessed Please indicate where the service/initiative identified in this project can be accessed (check one):

This service/initiative serves one community and is offered at one place or site. Patients/clients/consumers travel within their community for this service (Local Community)

This service/initiative serves two or more communities and is offered at two or more sites. Patients/clients/consumers may have to travel outside of their local community for this service (Multi-Community)

This service is provided in one place or site, but serves all of the LHIN Community. As such, patients/clients/consumers may have to travel out of town to receive this service (LHIN Community)

Please indicate the specific area(s) (e.g., town, city, county, etc.) from which the service will draw clients/stakeholders:

• Part of Norfolk County

• Oxford County

• Elgin County

• Middlesex County

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Health Service(s) Improvements for Clients/Stakeholders Describe how clients and families will benefit from your idea (e.g., improved quality of care, faster access to care, easier movement through the system, etc.)

• Based on an analysis of ratio of clinical diabetes to population with diabetes, when compared to the north and central programs, it appears that the south geographic area has the capacity to serve an additional 6,000 people per year with their existing resources.

Improved Access to Care

• By improving DEC to DEC coordination, relationships and lines of communication, those DECs that have longer wait lists may be able to divert some of the clients to neighbouring DECs that have capacity.

• By sharing best practices for outreach, DECs will be able to leverage each other’s processes for case finding.

• By leveraging common administrative tools and functions, clinical staff in smaller DECs will be freed up to provide clinical services rather than administrative services.

Consistent Application of Care Standards

This process will facilitate knowledge translation between DECs and between the RCC and DECs to ensure that the most current evidence based standards of care are adhered to.

Project Scope Describe specific items that will (“in-scope”) and will not (“out-of-scope”) be included as part of the work performed on this project. Consider specific features, functions, quality needs or other “must have” requirements and place them in the in-scope section. Spell out any exclusions (i.e., work that will not be performed) in the out-of-scope section.

In-Scope Out-of-Scope

• Seven DEC Programs in Thames Valley area

The project recognizes that the following will need to be consulted as needed throughout the project

• DEC programs outside of this geographic area (for networking / learning purposes)

• Family Health Teams providing diabetes services

• Specialist programs (including renal)

• Teams involved in Partnerships for Health

• Aboriginal diabetes programs

• Diabetes services provided through community support services

• Other services across the LHIN continuum

• DEC programs and services outside of the South West LHIN

• This project will not attempt to identify or develop new evidence based protocols

• This project will not result in recommendations about DEC program allotted FTES (whether to reduce or increase). The focus is on maximizing existing capacity within the DECs current programs.

• Pediatric diabetes services

• Diabetes prevention services

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Integration

Is this an integration opportunity? Yes No

If yes, please check which type of integration opportunity (check one):

Voluntary Integration (Integration Decision at LHIN’s discretion)

Funding Integration (Integration Decision at LHIN’s discretion)

Facilitated Integration (Integration Decision required)

Required Integration (Integration Decision required)

Comments:

I acknowledge that this submission is not a formal notice of a proposed integration to the LHIN as contemplated by s. 27 of the Local Health System Integration Act, 2006 (“LHSIA”). Health service providers wishing to provide notice to the LHIN of a proposed integration under s. 27 of LHSIA should contact the LHIN for more information.

Signature:

Name:

Date:

ALIGNMENT Strategic Alignment: Describe linkages to South West LHIN directions, provincial priorities and/or organizational strategies. Blueprint/IHSP Alignment

The project aligns to the following South West LHIN Blueprint Approaches & IHSP Directions:

Primary Alignment (check one)

Population-based Integrated Health Services

Seniors & Adults with Complex Needs

Chronic Disease Prevention and Management

Mental Health and Addictions

Centrally Coordinated Resource Capacity Emergency Services

Critical Care

Medicine

Surgery

Secondary Alignment (check one)

Comments:

Key Enablers

The project aligns to the following Key Enabler (check one):

Information & Clinical Technology

System Navigation

Human Resource Strategies

Implementation & Accountability

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Provincial Priorities

This project aligns to the following Provincial Priorities (e.g., ALC/ER, Diabetes, Family Health, Wait times):

Ontario Diabetes Strategy

Impacts on Health Care System and Organization(s) System Impacts

Identify the impacts this project is expected to have on the health care system in the South West LHIN:

• In partnership with the South West LHIN and RCC, this initiative will result in identifying and addressing service gaps and opportunities to enhance quality of diabetes service delivery for improved access and quality.

Improved Process to Identify Planning Needs and Opportunities to Enhance Quality

Organizational Objectives and Strategies

Identify the organizational objectives and strategies this project aligns to (e.g., improved performance measurement, cultural shifts, improvement processes/methodologies):

This is a quality improvement project and will leverage knowledge gained through the Partnerships for Health Project.

Process Change Impacts

Identify the process change impacts this project will have on your organization or on other organizations (e.g., increased efficiency, improved performance reporting):

• This project will result in changed and improved relationships between DECs.

The project will result in changed processes within DECs and in how DECs work together. Because it will rely heavily on knowledge transfer, team development and implementing ongoing improvement strategies, process and potentially some structural changes will occur.

Related Projects & Initiatives

Are there dependencies with other initiatives or projects (at the organizational, LHIN or Provincial level)?

Yes No

If “yes”, please describe below.

• Final funding approval for position through the ODS is granted through the government’s estimates process.

• Hospitals’ and CHCs’ ability to provide financial support with surplus dollars may depend on LHIN approval.

Those hospitals with no surplus may not be able to contribute.

Project/ Initiative Interdependency & Impact

List the project or initiative. State the dependency and indicate how the dependency impacts your project.

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• Partnerships for Health • Opportunity to utilize refined continuum of care pathways and/or tools for coordination (e.g., standardized referral forms, tested wait time strategies)

• Diabetes Regional Coordination Centre • Opportunity to align with RCC’s metrics for process improvements in coordination of diabetes services

• MHA, St Thomas, Tillsonburg project through Partnerships for Health & SW LHIN with Regional Shared Services to develop and implement electronic health record for DECs (outpatient, ambulatory diabetes centres)

• Opportunity to align and leverage

Are there opportunities to spread to Local Community, Multi-Community, LHIN Community (as described above)?

Yes No

If “yes”, please describe below.

The scope of this project includes multiple communities in Oxford, Middlesex, Elgin, and Norfolk counties. With the link to the RCC, outcomes realized through this project may spread to central and northern counties within the SW LHIN.

PROJECT PERFORMANCE Project Goals, Objectives & Performance Measures Provide the details of what this project aims to accomplish by listing its specific goals, objectives and deliverables. State the goals in terms of high-level outcomes to be achieved. Identify specific objectives and deliverables for each goal listed. Objectives are clear statements of specific activities/tasks that must be performed to achieve the goals. Identify both project product/service and people/organization change objectives. Performance measurement indicators and targets are used to determine if objectives and expected results have been successfully achieved.

Goals Objectives Performance Measurements

Indicators Targets

List all goals to be achieved by the project. Ensure alignment with project purpose.

For each goal, list specific objectives and/or deliverables that will signify achievement of goal when finished.

For each objective/deliverable, list the performance measurement indicator and target that will be used to evaluate success of results achieved.

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Improved coordination among the seven DECS in the Thames Valley Planning area in order to achieve standardization in quality of care provided to DEC clients

• Facilitate meetings/dialogue with all seven DECs and ODS to understand current reporting methods

• Gain common agreement on reporting definitions

• Utilize common definitions for reporting

• Establish process to track and report on best practice common indicators

Increased reporting consistency across all DECs

Consistent use of best practices across all DECs

Increase in average number of clients aged 18 and older that have all 3 tests (cholesterol, retinal eye exam, and HbA1c) w/in recommended guidelines, for optimal diabetes management

Adoption of process to track best practice common indicators

100% of partners utilize same definitions for reporting

20% increase average number of clients that have all 3 tests

100% of partners adopt best evidence care algorithm

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Improved coordination among the seven DECS in the Thames Valley Planning area in order to improve patient access to quality diabetes services at DECs

Stage One

• Develop process to understand current capacity and utilization of services within DECs.

• Develop an algorithm which maps the referral process (i.e., flow of client back and forth between primary care – DEC – specialist) for diabetes services and diabetes education resources within Thames Valley area

• Develop common definition of capacity to reflect complexity of patient seen

• Facilitate implementation of utilization best practices to other DECs

• Establish process to share real-time waitlists between DECs

• Establish common process for shared waitlist management, where applicable

Stage Two

• Understand current state for outreach provision across all DECs

• Identify and share best practices and tools utilized by DECs for outreach

• Spread adoption and implementation of best practices for outreach

Increased average # of clients served in the Thames Valley area weighted by agreed definition of DEC capacity

Decreased average time from when a new client appointment is booked and when the appointment occurs

Decreased variance in waitlists between DECs

Stage Two

• Consistent use of best practices for outreach across all DECs

10% increase from baseline

10% decrease from baseline

10% decrease in variance

Project Timelines & Deliverables

Indicate when the project will take place. Provide a preliminary estimate for the duration of the project by documenting the target completion dates for high-level project milestones. Milestones are significant project events that usually signify completion of project phases or major deliverables.

Key Milestones Key Deliverables Key Dates

Description. Give clear definition of the milestone and/or deliverable, clarifying how you will know when it has been successfully achieved.

Estimated date where possible or time from start of project.

<insert Project Acronym or No.> Project Proposal

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Recruitment and hiring of key human resources for project

• Diabetes Education Coordinator & administrative support positions hired

• Position descriptions developed & posted before funding flows

Assumption: Flow of funding starts Sept 2010 October 1, 2010

Inaugural meeting with all participating DECs to launch this project

• Setting the stage for the project; clarifying project mandate and scope; clarifying questions or concerns

October 30, 2010

Workplan established for project • Workplan reviewed and signed off by project team

November 15, 2010

Standardization in quality of care objectives are met

• Meeting held with ODS and participating DECs to understand current reporting methods

• Common agreement on reporting definitions achieved.

• Standardized definitions utilized across all DECs for reporting

• Process to track and report on best practice indicators established and utilized

November 30th, 2010 December 31st, 2010 January 31st, 2011 February 28th, 2011

Patient Access Stage 1 objectives are met

• Capacity and utilization of services analysis complete

• Common definitions established

• Real wait-time list shared

May 31, 2011 June 30th, 2011 June 30th, 2011

Patient Access Stage 2 objectives are met

Current state assessment for outreach provision across all DECs completed

Best practices and tools for outreach utilized by DECs identified

Best practices for outreach adopted and implemented across DECs

November 30th, 2011 December 31st, 2011 March 15th, 2012

Project Outcomes Meeting with all Participating DECs to celebrate outcomes, share lessons learned, and identify potential next steps regarding sustaining the gains achieved

Celebratory meeting held with participating DECs, project team, project sponsors, and steering committee members

March 31st, 2012

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Final Report on Project Outcomes Completed

Final Report documenting deliverables and outcomes achieved completed

March 31st, 2012

PROJECT TEAM MEMBERS Project Team Identify who is needed on the core project team to complete project deliverables and achieve goals and objectives. What skills, knowledge and experiences are required? Consider the need for special expertise to deal with people and organization change challenges. This section may include any new Human Resource(s) required to support the project.

Team Member and/or Title/Profession, Organization Role on the Project

Provide names and/or titles/professions of core project team members.

Describe the role & responsibility of each core project team member.

Diabetes Education Coordinator Project Lead

Administrative Assistant for Project

Partnerships for Health DEC participant Share evidence-based PDSAs related to access, standardization of care and common care algorithms

CHC DEC representation Provide perspective of DEC processes within CHC setting

Hospital DEC representation Provide perspective of DEC processes within hospital setting

SOAHAC DEC representation Provide perspective of DEC processes within community setting within Aboriginal context

DRCC representation Share ODS direction and opportunity to leverage data collection tools/methods; best practices re. standards of care

Project Partners Is this project carried out in partnership with other groups/organizations? Indicate who else, in addition to those listed as project team members above, has committed to contributing to this project. Partners are individuals, groups or organizations who work together towards joint interests to achieve common goals.

• Thames Valley Hospital Planning Partnership CEOs

• Diabetes Regional Coordination Centre

• South West LHIN

• Ontario Diabetes Strategy

Project Stakeholders Stakeholders are individuals or organizations that have a vested interest in the initiative. They are either affected by, or can have an affect on, the project. Anyone whose interests may be positively or negatively impacted by the project or anyone that may exert influence over the project or its results is considered a project stakeholder. All stakeholders must be identified and managed appropriately.

• Primary health care services

• Communities for outreach and unattached patients

• Emergency Departments in Thames Valley Area

• Community Pharmacies

PROJECT RESOURCES

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Human Resources Provide an overview of any new Human Resources (HR) required to support the initiative beginning with year one as well as additional hires in year two. As well, consider volunteer resources to be leveraged to support the information and provide information on these resources.

Position Title and Designation Required (if applicable) (e.g., PSW, Case Manager)

Project Start-up Ongoing Project Support

Diabetes Educator Coordinator

Administrative Assistant

Volunteer Services Project Start-up Ongoing Project Support

Services to be provided: OHRS Functional Centre Description Individuals to be Served Service Units/Volumes

Funding Details Ongoing Base Funding Budget Comments

Year 1 September 1, 2010 – March 31, 2011

Salaries and Wages

Benefits

Supplies and Sundry Exp.

Other (specify in comments)

Total Funding Required

Other Funding Sources

Year 2 April 1 2011 – March 31, 2012

Salaries and Wages

Benefits

Supplies and Sundry Exp.

Other (specify in comments)

Total Funding Required

Other Funding Sources

Total Net Ongoing Base Funding Required from LHIN

Start-Up One-Time Funding Budget Year 1 Budget Year 2 Comments

Consultation/Training

Information/Technology

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Staff 62,500 125,000 1 FTE Diabetes Education Coordinator 10 hrs/wk of administrative support

Other (specify in comments) 17,000 6,000 Year 1 - 2 computers, blackberries, desks, chairs, phone line, faxing, travel costs – start up for 2 positions are required, for when ODS funding stops for Coordinator position, position reverts to a clinical front-line provider, and associated start-up items follow the front-line provider position Year 2 - phone line, faxing, travel costs

Total Funding Required 79,500 131,000

Other Funding Sources 72,500 109,375 Year 1 – ODS funding for Coordinator, admin support and operation costs for position plus ODS is providing one-time start up for the 1 FTE Year 2 – SJHC, LIHC, MHA, WEchc, STEGH, Woodstock, and Tillsonburg contribute equal shares to salary of Coordinator & administrative support ($15,625)

Total Net One-Time Funding Required from LHIN

7,000 21,625

TOTAL FUNDING REQUIRED FROM LHIN (Ongoing Base + One-Time)

7,000 21,625 SW LHIN contributes equal share to salaries of Coordinator & admin and pays for operating and start-up costs ($15,625 = 6,000)

In-Kind Contributions Are there any in-kind contributions? Yes No

If yes, describe: If yes, describe: All partners are cost-sharing twelve months of project. Ontario Diabetes Strategy is funding first 6 months of salary for FTE coordinator position, including 10 hrs/week of Administrative Support

PROJECT RISKS & CHALLENGES

Project Risks Document high-level project risks apparent at this point that could either positively or negatively impact the achievement of project goals and objectives. Focus on risks that are likely to happen and have a significant effect on project success. Be sure to consider risks associated with people & organization change, knowledge management and transition to operations.

Risk Likelihood of Occurrence

Potential Impact Organization Capacity to Manage Risk

Mitigation Strategy

Brief description of risk.

High, Medium, Low High, Medium, Low High, Medium, Low High level strategy to address risk.

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Collection of metrics identified to assess success of project may not be sustainable throughout the life of the project

Medium Medium High Early assessment of availability of data; adjust metrics accordingly; utilize proxy measures where needed; and modify ongoing collection to targeted points in time throughout life of project

Scope of project may need to be redefined or narrowed based on initial mapping of processes across DECS

Medium Medium High Business process mapping is the starting point of this project and is an evidence-based method to better understand gaps and areas for improvement. Re-scoping will enable the project to target areas for improvement that will have the largest positive impact

Potential for hired Coordinator to primarily be resourced to host agency’s DEC program

Low High High Coordinator will report directly to VP Clinical Services of host organization, rather than report within DEC program of host organization

Political challenges within or across partner organizations limit Coordinator’s ability to achieve project deliverables

Medium High High Coordinator directly reports to VP Clinical Services; and able to escalate to TVHPP and partners.

Competing priorities within participating DECs limits their ability to participate in the planning & assessment activities needed to achieve project goals

High High High Alignment of work plan with timing of DEC priorities to maximize opportunities for DEC participation.

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DECs minimize their participation in the project because of perceptions about losing DEC resources as a result of project

Medium High High Project will being with an inaugural meeting to present project goals and emphasize that project is not about reducing FTEs at participating DECs but to enhance capacity by sharing best practices

Loss of funding for the project from MOHLTC or from Partners

Medium High Medium If MOHLTC withdraws funding, project duration will need to shorten Partners contributing to project will sign a MOU for their commitment

Contracted project coordinator may leave position before end of project

Medium High Medium A member of the project team from participating DEC is seconded to the Coordinator position for duration of project

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Project Proposal

PROJ ECT INFORMATION Project Name Date Submitted Project Acronym or No. HEATHePATHWAYS RM&R Phase 2 2010-07-28 <assigned by LHIN>

Estimated Duration of Project Estimated Budget Notice of Integration?

5 months $ 724,350 / 4 LHINs = $ 181,088 No

Lead Organization Project Sponsor Lead Organization Contact Information Project Sponsor Name (e.g., CEO/ Executive Director):

Erie St. Clair HSP, TBD

Project Manager/ Lead Contact Name:

Organization Name:

Address:

Telephone:

Email:

Partner Organization Contact Information Partner Organization Contact Information

Contact Name: Contact Name:

Organization Name: Organization Name:

Address: Address:

Telephone: Telephone:

Email: Email:

PROJECT DESCRIPTION Project Purpose Explain the purpose of this project by describing, at a high-level, the background necessary to understand why the project was started, what will be done. What is this project aiming to achieve? What is its vision? What need or opportunity will it address? What problem will it solve? (maximum half page)

The Erie St. Clair, South West, Waterloo Wellington and Hamilton Niagara Haldimand Brant LHINs have established a four LHIN collaborative to work together to meet Phase 1 and Phase 2 Resource Matching & Referral project objectives and position themselves for success in the implementation of an RM&R solution.

CHIS (Consolidation Health Information Services) has taken the lead on behalf of the 4 LHIN collaborative to complete Phase 1 of the HEALTHePATHWAYS RM&R Project which developed a Current State Assessment and identified key considerations for a future state with an RM&R solution.

Phase 2 has five key stages that build on the future state considerations identified in Phase 1 and defines the future state business process model and requirements and the technical requirements for an RM&R solution, as well as conducting a market assessment of RM&R solutions that will inform the requirements. Lastly, the outcome of Phase 2 will include a business case for procurement and implementation of an RM&R solution and completion of a Phase 3 project charter.

Health Service Clients/Stakeholders (i.e., target populations)

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Who are the health service clients/stakeholders (i.e., target populations) that will benefit from this proposal? General Description (e.g., individuals over 65) Equity

This proposal responds primarily to the needs of the following population(s):

Individuals currently occupying an acute care bed with an ALC designation.

Aboriginal

Francophone

Rural/Remote Populations

Inner-urban (e.g., homeless) Populations

Religious, Ethno-Racial or Linguistic Minorities (please specify):

Sex/Gender

Sexual Orientation/LGBT

Low Income/Under-employed

Persons with Disabilities (e.g., physical, intellectual, sensory, learning, mental illness)

General Population

Other, please specify:

Where Service/Initiative is Accessed Please indicate where the service/initiative identified in this project can be accessed (check one):

This service/initiative serves one community and is offered at one place or site. Patients/clients/consumers travel within their community for this service (Local Community)

This service/initiative serves two or more communities and is offered at two or more sites. Patients/clients/consumers may have to travel outside of their local community for this service (Multi-Community)

This service is provided in one place or site, but serves all of the LHIN Community. As such, patients/clients/consumers may have to travel out of town to receive this service (LHIN Community)

Please indicate the specific area(s) (e.g., town, city, county, etc.) from which the service will draw clients/stakeholders:

This project will impact the HSP’s within the four pathways as identified in the In-Scope section below. Once implemented the clients/stakeholders that utilize services within these HSP’s will benefit from the project.

Health Service(s) Improvements for Clients/Stakeholders Describe how clients and families will benefit from your idea (e.g., improved quality of care, faster access to care, easier movement through the system, etc.)

The HEALTHePATHWAYS Resource Matching and Referral Solution (RM&R) project is intended to reduce the days patients spend waiting in acute care hospitals for Alternate Levels of Care (ALC). It is also aimed at improving the patient’s experience by informing their decision making about all viable post acute care options, so that families and their hospital health care team can make decisions that are right for each patient scenario.

Project Scope Describe specific items that will (“in-scope”) and will not (“out-of-scope”) be included as part of the work performed on this project. Consider specific features, functions, quality needs or other “must have” requirements and place them in the in-scope section. Spell out any exclusions (i.e., work that will not be performed) in the out-of-scope section.

In-Scope Out-of-Scope

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1. Phase 2 stakeholder engagement and communication plan

2. Future State Business Process Model

definition

3. Technical Readiness Assessment

4. Performance Measurement Requirement

5. Market Assessment to inform requirements RM&R solution requirements definition in alignment to provincial reference model:

• Final Business requirements

• Final Technical requirements

• Final Privacy requirements

• Final Security requirements

• Solution Definition

6. Draft Phase 3 HEALTHePATHWAYS Business Case

7. Draft Phase 3 HEALTHePATHWAYS

Project Charter

1. Collection of performance measurement indicators (baseline and targets)

2. Completion of an RFP and procurement of

the RM&R solution

3. Implementation planning for an RM&R Solution

4. Implementation of the RM&R solution

Integration

Is this an integration opportunity? Yes No

If yes, please check which type of integration opportunity (check one):

Voluntary Integration (Integration Decision at LHIN’s discretion)

Funding Integration (Integration Decision at LHIN’s discretion)

Facilitated Integration (Integration Decision required)

Required Integration (Integration Decision required)

Comments:

I acknowledge that this submission is not a formal notice of a proposed integration to the LHIN as contemplated by s. 27 of the Local Health System Integration Act, 2006 (“LHSIA”). Health service providers wishing to provide notice to the LHIN of a proposed integration under s. 27 of LHSIA should contact the LHIN for more information.

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Signature:

Name:

Date:

ALIGNMENT Strategic Alignment: Describe linkages to South West LHIN directions, provincial priorities and/or organizational strategies. Blueprint/IHSP Alignment

The project aligns to the following South West LHIN Blueprint Approaches & IHSP Directions:

Primary Alignment (check one)

Population-based Integrated Health Services

Seniors & Adults with Complex Needs

Chronic Disease Prevention and Management

Mental Health and Addictions

Centrally Coordinated Resource Capacity

Emergency Services

Critical Care

Medicine

Surgery

Secondary Alignment (check one)

Comments:

Key Enablers

The project aligns to the following Key Enabler (check one):

Information & Clinical Technology

System Navigation

Human Resource Strategies

Implementation & Accountability

Provincial Priorities

This project aligns to the following Provincial Priorities (e.g., ALC/ER, Diabetes, Family Health, Wait times):

The Province has identified the ALC issue as a key priority and has developed the Emergency Room and Alternate Level of Care (ER/ALC) Wait Time Strategy to improve the long wait times for healthcare services across the province. This strategy includes an initial set of RM&R tools and processes focused on four critical pathways as follows:

• Acute to Rehab • Acute to Complex Continuing Care • Acute to Community Care Access Centre to LTC • Acute to Community Care Access Centre to Homecare

Impacts on Health Care System and Organization(s)

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System Impacts

Identify the impacts this project is expected to have on the health care system in the South West LHIN:

When the final RM&R solution is implemented it is expected to result in a decrease in ALC patient days within all four LHINS.

Organizational Objectives and Strategies

Identify the organizational objectives and strategies this project aligns to (e.g., improved performance measurement, cultural shifts, improvement processes/methodologies):

The RM&R project aligns to one of the South West LHIN’s strategic directions as outlined in the current IHSP: Enhance Access and Sustainability of Hospital-based Treatment and Care Related to:

• Emergency Services • Medicine, Surgical and Critical Care Services

Process Change Impacts

Identify the process change impacts this project will have on your organization or on other organizations (e.g., increased efficiency, improved performance reporting):

Each organization participating in the RM&R solution will experience significant process changes as a result of the new capabilities the solution will offer. This will result in increased efficiency in finding and placing patients into the most appropriate destination for their care and it will decrease the days patients spend waiting in acute care hospitals for Alternate Levels of Care (ALC).

Related Projects & Initiatives

Are there dependencies with other initiatives or projects (at the organizational, LHIN or Provincial level)?

Yes No

If “yes”, please describe below.

Project/ Initiative Interdependency & Impact

List the project or initiative. State the dependency and indicate how the dependency impacts your project.

• ALC RM&R eHealth Ontario Project • By completing this phase (2) of the project it positions the 4 LHINs to move forward with procurement and implementation of a solution pending the release of additional funding by eHealth Ontario.

• Future phases of the RM&R project can not be completed unless additional funding is secured.

• •

Are there opportunities to spread to Local Community, Multi-Community, LHIN Community (as described above)?

Yes No

If “yes”, please describe below.

Once the initial four in-scope pathways are implemented there are other pathways that can explored. For example, the SW LHIN will be interested in exploring the acute to acute pathway.

PROJECT PERFORMANCE

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Project Goals, Objectives & Performance Measures Provide the details of what this project aims to accomplish by listing its specific goals, objectives and deliverables. State the goals in terms of high-level outcomes to be achieved. Identify specific objectives and deliverables for each goal listed. Objectives are clear statements of specific activities/tasks that must be performed to achieve the goals. Identify both project product/service and people/organization change objectives. Performance measurement indicators and targets are used to determine if objectives and expected results have been successfully achieved.

Goals Objectives Performance Measurements

Indicators Targets

List all goals to be achieved by the project. Ensure alignment with project purpose.

For each goal, list specific objectives and/or deliverables that will signify achievement of goal when finished.

For each objective/deliverable, list the performance measurement indicator and target that will be used to evaluate success of results achieved.

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Develop recommendations for an RM&R solution addressing gaps as identified in the current state assessment.

• Define and develop the future state business process model for RM&R, the business information and data requirements and the technical, privacy and security requirements for an RM&R solution, aligned with the Provincial Reference Model

• Assess the market for

available RM&R solutions to inform finalization of the business and, technical requirements

• Develop an options analysis to facilitate decision making of the optimal LHIN clustering model for procurement, implementation and ongoing operations of an RM&R solution

• Develop the business

case for procurement and implementation of an RM&R solution to support request(s) for funding for future phases of the project.

• For the purposes of this phase of the project (Phase 2), the measures of success will be equal to the Key Deliverables as listed in the next section.

• Completion of Key Deliverables on time and on budget

Project Timelines & Deliverables

Indicate when the project will take place. Provide a preliminary estimate for the duration of the project by documenting the target completion dates for high-level project milestones. Milestones are significant project events that usually signify completion of project phases or major deliverables.

Key Milestones Key Deliverables Key Dates

Description. Give clear definition of the milestone and/or deliverable, clarifying how you will know when it has been successfully achieved.

Estimated date where possible or time from start of project.

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Stage I – Initial Planning • RFP Development, Posting, Evaluation and Contracting

• Detailed Project Plan Completed • Stakeholder Engagement and

Communication Plan Complete

2010-11-30 [yyyy-mm-dd]

Stage II – Business Model Definition

• Technical Readiness Assessment Complete

• Future State Business Model Defined

2010-11-30 [yyyy-mm-dd]

Stage III – Draft Requirements Definition

• Draft Business Requirements Complete

• Draft Technical Requirements Complete

• Privacy and Security Requirements Complete

• Vendor Assessment Complete

2011-01-31 [yyyy-mm-dd]

Stage IV – Final Solution Definition and Agreement on Next Steps

• Finalized Solution Defined • Decision on LHIN Clustering Model

Made

2011-01-31[yyyy-mm-dd]

Stage V – Phase 3 Project Charter and Business Case Development

• Business Case Complete • Phase 3 Project Charter Complete

2011-01-31 [yyyy-mm-dd]

PROJECT TEAM MEMBERS Project Team Identify who is needed on the core project team to complete project deliverables and achieve goals and objectives. What skills, knowledge and experiences are required? Consider the need for special expertise to deal with people and organization change challenges. This section may include any new Human Resource(s) required to support the project.

Team Member and/or Title/Profession, Organization Role on the Project

Provide names and/or titles/professions of core project team members.

Describe the role & responsibility of each core project team member.

Project Lead • Provides leadership and direction to the team • Responsible for successful and timely completion

of the project deliverables • Manages stakeholder relationships, partners and

sponsor’s expectations • Consults regularly with Executive Lead, Project

Sponsor and provides status updates as required • Manage relationships with Cancer Care Ontario,

eHealth Ontario, and other partners • Manage relationships with other initiatives e.g.,

Ontario LHIN Technology Hub Project (OLTP); Ontario LHIN Privacy Project (OLPP)

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• Support Project Lead in successful and timely completion of the project

Project Management Team Project Manager Project Control Officer

• Responsible for the efficient, accurate and timely delivery of project milestones through project planning, management of resources and reporting to Project Lead

• Manage the project budgets, schedules and project management processes/deliverables (e.g., issues, change, risks, etc.)

• Facilitate the definition of business requirements and business models to support business goals, objectives, and needs

Business Requirements Definition Team Business Lead Business Analysts Subject Matter Advisors (from LHINs, CCACs and Health Service Providers)

• Alignment of business model to the Provincial Reference Model

• Facilitate implementation planning • Analyze, communicate and validate requirements

for changes to business processes that enable the project to achieve its goals

• Facilitate the definition of performance measurement requirements

• Facilitate the definition of information requirements and information models to support business goals, objectives, and needs, and business models

• Provide in-depth knowledge of clinical processes, referral processes and information requirements

• Ensure project meets all privacy, policy and security requirements

• Analysis, assessment, development, and enhancement of appropriate health informatics standards that support business requirements

• Leverage business requirements, eHealth Blueprint and the Ontario LHIN Technology Hub Project to define the solution’s technical requirements, high level use cases, conceptual data model, business network diagrams, high level architecture, service definitions, business network diagrams and technology standards

Technical Requirements Definition Team

Technical / Architecture Lead

Systems Analyst

Subject Matter Advisors (from LHINs, CCACs and Health Service Providers)

• Develop stakeholder engagement and communications plan

Communications Team Communications & Stakeholder Engagement Lead • Ensure communication plan and all tactical

communications are reviewed and approved • Develop communications as required

Project Partners

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Is this project carried out in partnership with other groups/organizations? Indicate who else, in addition to those listed as project team members above, has committed to contributing to this project. Partners are individuals, groups or organizations who work together towards joint interests to achieve common goals.

• Consolidated Health Information Systems (CHIS)

• ESC, WW, HNHB, SW LHIN’s

• ESC, WW, HNHB, SW CCAC’s

Project Stakeholders Stakeholders are individuals or organizations that have a vested interest in the initiative. They are either affected by, or can have an affect on, the project. Anyone whose interests may be positively or negatively impacted by the project or anyone that may exert influence over the project or its results is considered a project stakeholder. All stakeholders must be identified and managed appropriately.

• ESC, WW, HNHB, SW LHIN hospitals

• ESC, WW, HNHB, SW LHIN LTC Homes

• ESC, WW, HNHB, SW LHIN Rehab Facilities

• ESC, WW, HNHB, SW LHIN Complex Continuing Care facilities

• eHealth Ontario, MoHLTC

PROJECT RESOURCES

Human Resources Provide an overview of any new Human Resources (HR) required to support the initiative beginning with year one as well as additional hires in year two. As well, consider volunteer resources to be leveraged to support the information and provide information on these resources.

Position Title and Designation Required (if applicable) (e.g., PSW, Case Manager)

Project Start-up Ongoing Project Support

Business Lead (1) 1600/day*60 days*1*1 = $96,000

Business Analysts (2) 1200/day*60 days*2*1 = $144,000

Technical Lead (1) 1600/day*60 days*1*1 = $96,000

Systems Analyst (1) 1200/day*60 days *1*1 = $72,000

Project Manager (1) (.75 FTE) 5 months $62,500

Project Support (2) (.25 FTE) 5 months $34,000

CCAC Lead Backfill and Support (4) (.4 FTE) 5 months

$134,000

Volunteer Services Project Start-up Ongoing Project Support

Services to be provided: OHRS Functional Centre Description Individuals to be Served Service Units/Volumes

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Funding Details Ongoing Base Funding Budget Comments

Salaries and Wages

Benefits

Supplies and Sundry Exp.

Other (specify in comments)

Total Funding Required

Other Funding Sources

Total Net Ongoing Base Funding Required from LHIN

0

Start-Up One-Time Funding Budget Comments

Consultation/Training

Information/Technology

Staff $704,350 See breakdown in HR section

Other (specify in comments) $20,000 Meetings, Travel, Communications

Total Funding Required

Other Funding Sources

Total Net One-Time Funding Required from LHIN

$724,350 divided by 4 LHINS = $181,088

TOTAL FUNDING REQUIRED FROM LHIN (Ongoing Base + One-Time)

$181,088

In-Kind Contributions Are there any in-kind contributions? Yes No

If yes, describe: Several key stakeholders with the 4 LHIN’s will be contributing their time and expertise in this project, similar to Phase 1.

PROJECT RISKS & CHALLENGES

Project Risks Document high-level project risks apparent at this point that could either positively or negatively impact the achievement of project goals and objectives. Focus on risks that are likely to happen and have a significant effect on project success. Be sure to consider risks associated with people & organization change, knowledge management and transition to operations.

Risk Likelihood of Occurrence

Potential Impact Organization Capacity to

Manage Risk

Mitigation Strategy

Brief description of risk.

High, Medium, Low

High, Medium, Low

High, Medium, Low

High level strategy to address risk.

Internal resource capacity and resource availability

High High Medium • Leverage other regional/LHIN initiatives, investments and resources in order to reduce duplicated effort

• Procurement of 3rd party resources

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Not delivering on scope

High High High • Strong project management and change control processes, and iterative development

• Leveraging existing people, technology and solutions

• Phased approach for functionality, content and data to make it more manageable

• Frequent communication with key stakeholders on key priorities, issues and progress.

Readiness of LHIN to engage

High High High • Early engagement with LHIN leadership and key stakeholder with the LHINs

• Establish stakeholder advisory groups / panels to inform implementation planning

• Frequent communication with key stakeholders on key priorities, issues and progress

Existing ALC e-Referral and Resource matching solutions implemented may not comply with standards

High High Medium • Identify and validate impact on existing solutions

• Incorporate findings into standards

Privacy and legal implications of PHI are unknown

High High Medium • Conduct privacy impact assessment early

• Consider privacy and legal impacts

Lack of stakeholder engagement and buy-in

Medium High Medium • Develop and execute stakeholder engagement and consultation strategy and plan

• Early engagement of LHINs, physicians, hospitals and other local service providers

Confusion re. process and e-Referral accountability

High Medium High • Develop and execute stakeholder communications strategy and plan

• Develop communications to explain process and accountabilities

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Access to management, clinical and other key stakeholders

Medium Medium Medium • Ensure leadership support is available via project steering committee

• Clarify and minimize meeting time/ time pulled from regular duties

• Develop meeting plan for standard and potential adhoc meetings including dates/ venues and participants

• Build on existing governance/working group structures

Scope Creep Medium Medium High • Strong project management and change control processes, and iterative development

• Strong change management process

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Project Proposal

PROJ ECT INFORMATION Project Name Date Submitted Project Acronym or No. Non Urgent Patient Transportation Project 2010.09.10 Assigned by LHIN

Estimated Duration of Project Estimated Budget Notice of Integration?

12 months $123,000.00 No

Lead Organization Project Sponsor Lead Organization Contact Information Project Sponsor Name (e.g., CEO/ Executive Director):

Neil Johnson Integrated Vice President London Health Sciences Centre and St. Joseph’s Health Care

Project Manager/ Lead Contact Name:

Ann Toman, Manager Corporate Clinical Operations/Catherine Glover, Director Corporate Clinical Operations

Organization Name: London Health Sciences Centre

Address: 339 Windermere Road, London, ON N6A 5A5

Telephone: 519-685-8500

Email: Catherine.glover@lhsc.on.ca

Partner Organization Contact Information Partner Organization Contact Information

Contact Name: Toby O’Hara Contact Name:

Organization Name: Health Care Materials Management

Organization Name:

Address: 188 Stronach Ave, London ON N5V 3A1

Address:

Telephone: 519-453-7888 Telephone:

Email: Toby.OHara@sjhc.london.on.ca Email:

PROJECT DESCRIPTION Project Purpose Non-urgent patient transportation is a service that is provided by many hospitals in the SW LHIN. It is used to move stable patients between facilities and for immobile patients to such care areas as dialysis units. Non-urgent transportation companies began in response to a need created when ambulance services were downloaded to the municipalities. As the services changed and multi-site hospitals developed, hospitals could not meet their operational needs by waiting for EMS transportation. Transportation companies developed new businesses to meet the need. In Ontario, unlike EMS Services, there are no regulations to govern the quality of services provided by non-urgent patient transportation providers. This puts hospitals in a challenging situation in ascertaining who can meet their service needs. The potential exists to have a variety of standards across the LHIN. LHSC and St. Joseph’s have extended the current non urgent transportation contract with their current Patient Transportation Vendor (Voyageur Transportation) for six months. The current contract lapses on March 31/2011. The additional six months will allow LHSC and SJHC to truly collaborate with others in the Region and be in position to tender a joint contract in April 2011. With over $3 million in expenditures on patient transportation, these hospitals represent the largest consumers of services in the SW LHIN. LHSC staff also have consulted with a variety of other hospitals in Toronto and eastern Ontario and provider agencies such as Base Hospital and have expertise in establishing standards and protocols for non-urgent patient transportation. The clinical protocol used by LHSC and SJHC has been widely adopted in Ontario and is considered a “best practice” for decision making in the use of Non Emergency transportation. In addition LHSC operates the SW Ontario Regional Base Hospital Program (SWORBH). As the operator of LHSC also possesses

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the requisite knowledge of land ambulance standards which are a useful resource when considering standards for non emergency transportation. The project will consist of five phases;

• Engagement Phase: Stakeholder hospital representatives and LHIN representatives will convene to agree on project outcomes and deliverables. This phase will include clarification of need, building awareness of “best in class” standards for Patient Transportation and finally agreement on project outcomes, deliverables and time lines. Endorsement and approval of these outcomes will be sought from the LHIN CEO’s and the LHIN Board.

• Development of supplier certification standards that would be used as part of the RFP. These service standards

would form the basis of a minimum set of compliance standards that service providers would need to deliver on and demonstrate compliance. This would assure purchasers of a certain level of quality in the absence of a regulatory framework. This would include patient transportation standards as well as key standards applicable to hospital operations such as the communication of infectious disease status of patients

• Development of service level agreements with measurement and compliance standards which facilitate audits of service provided.

• Development of common processes and procedures related to the interface with patient transportation providers, common decision criteria for the use of non-urgent patient transportation and common framework for billing patients and insurance providers

• The group comprised of SWLHIN hospital representatives will participate in a LHIN-wide RFP for patient transportation services through the auspices of Health Care Materials Management (a joint venture of St Joseph's and LHSC which provides purchasing, logistics and contracting services to a wide range of hospitals in the SW LHIN)

Who are the health service clients/stakeholders (i.e., target populations) that will benefit from this proposal? General Description (e.g., individuals over 65) Equity

This proposal responds primarily to the needs of the following population(s):

Hospitalized clients requiring transportation between hospital sites and to other hospital corporations are in the scope of this project. Patients requiring transportation to ambulatory or procedural clinic visits due to clinical condition: Inter hospital Transfers for diagnostic, consult or clinic treatment Patient Discharge Transfer : the transfer of a person following their discharge from hospital which may be to home including LTC

Aboriginal

Francophone

Rural/Remote Populations

Inner-urban (e.g., homeless) Populations

Religious, Ethno-Racial or Linguistic Minorities (please specify):

Sex/Gender

Sexual Orientation/LGBT

Low Income/Under-employed

Persons with Disabilities (e.g., physical, intellectual, sensory, learning, mental illness)

General Population

Other, please specify:

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Where Service/Initiative is Accessed Please indicate where the service/initiative identified in this project can be accessed (check one):

This service/initiative serves one community and is offered at one place or site. Patients/clients/consumers travel within their community for this service (Local Community)

This service/initiative serves two or more communities and is offered at two or more sites. Patients/clients/consumers may have to travel outside of their local community for this service (Multi-Community)

This service is provided in one place or site, but serves all of the LHIN Community. As such, patients/clients/consumers may have to travel out of town to receive this service (LHIN Community)

Please indicate the specific area(s) (e.g., town, city, county, etc.) from which the service will draw clients/stakeholders:

Any Hospital in the SWLHIN

Health Service(s) Improvements for Clients/Stakeholders Describe how clients and families will benefit from your idea (e.g., improved quality of care, faster access to care, easier movement through the system, etc.)

• Improved quality of transportation service through the application of defined service standards across the SW LHIN. These will include minimum standards for vehicles and on board equipment and minimum qualifications for drivers.

• Common processes to decide on the use of Non-urgent versus EMS transportation based in clinical decision making which matches the transportation and escort needs to the patient’s medical condition.

• Clinical oversight of the contracts will serve to maintain quality and manage risk

• Common approaches to standardized billing processes for patients will ensure cost containment.

• Use of service standards that meet hospital requirements (e.g. infection control)

• Potential lower cost of delivery of services due to larger group purchasing.

Project Scope Describe specific items that will (“in-scope”) and will not (“out-of-scope”) be included as part of the work performed on this project. Consider specific features, functions, quality needs or other “must have” requirements and place them in the in-scope section. Spell out any exclusions (i.e., work that will not be performed) in the out-of-scope section.

In-Scope Out-of-Scope

• Non urgent patient transportation RFP

• Non urgent Patient transportation service standards

• Hospital and non-urgent patient transportation operational supplier certification and standards.

• Consistent billing practices which will assure consumers of transparent and replicable practices throughout the region.

• Current state of spending on Non urgent transportation by hospitals in the South West.

• Clinical decision algorithm for choice of patient transport method.

• Increased funding for transportation

• Expansion of service delivery

Integration

Is this an integration opportunity? Yes No

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If yes, please check which type of integration opportunity (check one):

Voluntary Integration (Integration Decision at LHIN’s discretion)

Funding Integration (Integration Decision at LHIN’s discretion)

Facilitated Integration (Integration Decision required)

Required Integration (Integration Decision required)

Comments:

I acknowledge that this submission is not a formal notice of a proposed integration to the LHIN as contemplated by s. 27 of the Local Health System Integration Act, 2006 (“LHSIA”). Health service providers wishing to provide notice to the LHIN of a proposed integration under s. 27 of LHSIA should contact the LHIN for more information.

Signature:

Name:

Date:

ALIGNMENT Strategic Alignment: Describe linkages to South West LHIN directions, provincial priorities and/or organizational strategies. Blueprint/IHSP Alignment

The project aligns to the following South West LHIN Blueprint Approaches & IHSP Directions:

Primary Alignment (check one)

Population-based Integrated Health Services

Seniors & Adults with Complex Needs

Chronic Disease Prevention and Management

Mental Health and Addictions

Centrally Coordinated Resource Capacity

Emergency Services

Critical Care

Medicine

Surgery

Secondary Alignment (check one)

Comments:

Key Enablers

The project aligns to the following Key Enabler (check one):

Information & Clinical Technology

System Navigation

Human Resource Strategies

Implementation & Accountability

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Provincial Priorities

This project aligns to the following Provincial Priorities (e.g., ALC/ER, Diabetes, Family Health, Wait times):

Efficient use of transportation resources both emergency and non emergency is a key element of an effective access and flow system and has a demonstrable impact on patient wait times. Currently in the province there are extensive delays for non urgent patients who await EMS transport. Thus a patient waits in a sending facility holding a bed while the bed in the receiving facility lies idle. At the same time use of EMS resource for non emergency transport puts burden on this already strained resource.

LHIN wide engagement in this project also positions the LHIN to lead in the province in addressing recommendations of two recent MoHLTC reports (i.e. the Expert Panel report “Improving Access to Emergency Care: Addressing System Issues” and Emergency Department and Ambulance Effectiveness Working Group report “Improving Access to Emergency Services: A System Commitment”).

In both documents a Province wide interfacility transport system is recommended. An interfacity transport system which makes best use of land and air ambulance and non-emergency transportation with regulation of the latter is recommended. The reports encourage development of coordinated system through collaboration between LHIN’s municipalities and Hospitals. The reports further note that current non emergency transportation systems are costly and pose a risk to patients through lack of standardized quality control processes and regulation of employees. The recent gains which hospitals in the SW LHIN have achieved through One Number Access project creates a collaborative platform which can serve as the foundation to further enhance access and flow projects. This platform is an ideal starting point for system improvement in use of non emergent patient transportation in the SW LHIN.

Impacts on Health Care System and Organization(s) System Impacts

Identify the impacts this project is expected to have on the health care system in the South West LHIN:

Improved flow of patients through all components of the regional health system, potentially improves access (reduced wait times through efficient bed clearance and increased throughput) and discharge processes (potentially reduced wait times and cost through improved staff utilization). Assurance of minimum competency standards may improve service utilization (through improvements in end user confidence), reduction in risk and improvements in patient satisfaction and safety. This may improve efficiency of utilization of regional health services, beds and patient satisfaction.

Organizational Objectives and Strategies

Identify the organizational objectives and strategies this project aligns to (e.g., improved performance measurement, cultural shifts, improvement processes/methodologies)

Reduction in fractured approach to patient transportation may yield scope and volume that will permit region-wide application of best practice, enforcement of hospital-defined needs and measurement of performance to drive service improvement and efficiency. This project may also permit centres who would not have met volume thresholds to trigger private service delivery to access non-ambulance patient transfer services. This may have a positive impact on primary care efficiency and EMS service delivery. Establishment of service levels and minimum standards for providers in the SW LHIN may position the SW to lead in the recommended Provincial regulation of non emergency service providers.

Process Change Impacts

Identify the process change impacts this project will have on your organization or on other organizations (e.g., increased efficiency, improved performance reporting)

Standardized process – improves predictability of volumes & outcome, reduces risk and improves patient satisfaction. Permits measurement, reporting and evaluation of performance measures aimed at driving improvement and ensuring contracted services are meeting performance benchmarks. Standard processes lead to reduced variation and improved efficiency for providers and customers. Overall enhancement in system access and flow is expected.

Related Projects & Initiatives

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Are there dependencies with other initiatives or projects (at the organizational, LHIN or Provincial level)?

Yes No

If “yes”, please describe below.

Project/ Initiative Interdependency & Impact

List the project or initiative. State the dependency and indicate how the dependency impacts your project.

• SW LHIN Patient Access Project

• Complimentary, Integration of processes of transport will facilitate inter hospital transfers

• •

• •

Are there opportunities to spread to Local Community, Multi-Community, LHIN Community (as described above)?

Yes No

If “yes”, please describe below.

Although there is great opportunity to spread the success and standards anticipated in the project, collaboration of participating hospitals is required from the inception of the project. This is an important project risk mitigation plan (i.e. participating hospitals will collaborate and develop service level expectations together and agree on these early in the project prior to entering into an RFP process).

PROJECT PERFORMANCE Project Goals, Objectives & Performance Measures Provide the details of what this project aims to accomplish by listing its specific goals, objectives and deliverables. State the goals in terms of high-level outcomes to be achieved. Identify specific objectives and deliverables for each goal listed. Objectives are clear statements of specific activities/tasks that must be performed to achieve the goals. Identify both project product/service and people/organization change objectives. Performance measurement indicators and targets are used to determine if objectives and expected results have been successfully achieved.

Goals Objectives Performance Measurements

Indicators Targets

List all goals to be achieved by the project. Ensure alignment with project purpose.

For each goal, list specific objectives and/or deliverables that will signify achievement of goal when finished.

For each objective/deliverable, list the performance measurement indicator and target that will be used to evaluate success of results achieved.

Participation in a LHIN-wide RFP for patient transportation services through the auspices of Health Care Materials Management

• Group purchasing to ensure best possible price provision to participating hospitals.

•

•

• Pre and post measure of hospital spending on patient transportation

•

•

•

•

•

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Development of supplier certification standards that would be used as part of the RFP.

• Central oversight of compliance to standards: audit of vehicle and on board equipment, staff training and qualification through regular audits and reporting metrics.

•

•

• Audit content and frequency of staff training, equipment and vehicle maintenance

•

•

•

•

•

Development of service measurement processes to ensure compliance

• Development and implementation of clinically based decision criteria for use of patient transport.

• Central evaluation of wait times post discharge and impact on Average Length of Stay

• Metrics to include infection control practices; safety training; vehicle standards; on board equipment standards; and minimum driver qualifications and evidence of regular training of drivers.

• Wait times for transportation

• Reduction in burden on EMS service for non emergency transport.

•

•

•

•

Development of common processes and procedures related to the interface with patient transportation providers, common decision criteria for the use of non-urgent patient transportation and common framework for billing patients and insurance providers

• Centrally managed infrastructure creating efficient business practices to support participating hospitals

•

• Metric will be to compare pre and post implementation spending on non urgent patient transportation

• Metric to compare and measure planned reduction in EMS utilization for non urgent patients.

•

•

•

•

•

Project Timelines & Deliverables

Indicate when the project will take place. Provide a preliminary estimate for the duration of the project by documenting the target completion dates for high-level project milestones. Milestones are significant project events that usually signify completion of project phases or major deliverables.

Key Milestones Key Deliverables Key Dates

Description. Give clear definition of the milestone and/or deliverable, clarifying how you will know when it has been successfully achieved.

Estimated date where possible or time from start of project.

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Approval of Project and Funding by the SWLHIN Board of Directors

Finalized charter and funding letter

2010-09-22

Kick off Steering Committee formed and first meeting scheduled

2010-10-30

Work Team Formed and begin work on Service Standards Complete by

Continue monthly Steering committee meeting. Review reference material and begin work on Service standards

2011-02-20

Issue RFP 2011-04-30

Develop Common Processes 2011-02-30

Evaluate and award RFP 2011-6-30

Implement standards and new vendors

2011-06-30

PROJECT TEAM MEMBERS Project Team Identify who is needed on the core project team to complete project deliverables and achieve goals and objectives. What skills, knowledge and experiences are required? Consider the need for special expertise to deal with people and organization change challenges. This section may include any new Human Resource(s) required to support the project.

Team Member and/or Title/Profession, Organization Role on the Project

Provide names and/or titles/professions of core project team members.

Describe the role & responsibility of each core project team member.

Physician Emergency Physician with knowledge and expertise in patient transportation will be a member of the Steering Committee

Paul Collins, Tom McHugh (representative from their organization). Neil Johnson as the Senior Sponsor from LHSC/SJHC

These Senior Leaders will form an important part of the Steering Committee . Steering committee will be comprised of senior leaders (or their delegates) from participating Hospitals in the SWLHIN.

Base Hospital Content knowledge and expertise on Service standards and provider training and audits.

LHSC and SJHC Project Leader from LHSC who is a recognized content expert in Non Emergent Patient Transportation. SJHC will also provide a project team representative

Staff members from participating Hospitals for the project work team

Staff members from participating SWLHIN hospitals who regularly arrange patient transportation will be essential content experts for the project team

Project Partners

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Is this project carried out in partnership with other groups/organizations? Indicate who else, in addition to those listed as project team members above, has committed to contributing to this project. Partners are individuals, groups or organizations who work together towards joint interests to achieve common goals.

• It is anticipated that the project will be endorsed by the SW LHIN Hospital CEO group and that participation of all LHIN Hospitals may be realized

• HMMS is a project Partner

Project Stakeholders Stakeholders are individuals or organizations that have a vested interest in the initiative. They are either affected by, or can have an affect on, the project. Anyone whose interests may be positively or negatively impacted by the project or anyone that may exert influence over the project or its results is considered a project stakeholder. All stakeholders must be identified and managed appropriately.

• Participating Hospitals in the SWLHIN

• Non Emergency Transportation Providers

• EMS Providers

• MoHLTC

• SW LHIN Board and SWLHIN CEO’s

PROJECT RESOURCES

Human Resources Provide an overview of any new Human Resources (HR) required to support the initiative beginning with year one as well as additional hires in year two. As well, consider volunteer resources to be leveraged to support the information and provide information on these resources.

Position Title and Designation Required (if applicable) (e.g., PSW, Case Manager)

Project Start-up Ongoing Project Support

Project Management

One Full Time One Full Time

RFP Support HMMS In kind HMMS In Kind

Volunteer Services Project Start-up Ongoing Project Support

Services to be provided: OHRS Functional Centre Description Individuals to be Served Service Units/Volumes

Funding Details Ongoing Base Funding Budget Comments

Salaries and Wages $100,000.00 Project Manager Salary

Benefits $ 20,000.00

Supplies and Sundry Exp. $3,000 Paper, Telephone and photocopier supplies, t-con charges and travel

Other (specify in comments)

Non Urgent Patient Transportation Project Project Proposal

Date Submitted: 20100910 >

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Total Funding Required $123,000.00

Other Funding Sources In Kind LHSC/SJHC HMMS

Non Urgent and EMS sector expertise. Purchasing and contract negotiation

Total Net Ongoing Base Funding Required from LHIN

0

Start-Up One-Time Funding Budget Comments

Consultation/Training

Information/Technology

Staff

Other (specify in comments)

Total Funding Required

Other Funding Sources

Total Net One-Time Funding Required from LHIN

$ 123,000.00

TOTAL FUNDING REQUIRED FROM LHIN (Ongoing Base + One-Time)

$ 123,000.00

In-Kind Contributions Are there any in-kind contributions? Yes No

Hospital Material Management (HMMS) Staff for RFP London Health Sciences Centre Non Urgent Transportation expertise for project leadership (LHSC) Southwestern Ontario Base Hospital (SWOBH) staff for service standards expertise. Participating Hospital staff from Hospitals in the SWLHIN

PROJECT RISKS & CHALLENGES

Project Risks Document high-level project risks apparent at this point that could either positively or negatively impact the achievement of project goals and objectives. Focus on risks that are likely to happen and have a significant effect on project success. Be sure to consider risks associated with people & organization change, knowledge management and transition to operations.

Risk Likelihood of Occurrence

Potential Impact Organization Capacity to Manage Risk

Mitigation Strategy

Brief description of risk.

High, Medium, Low High, Medium, Low High, Medium, Low High level strategy to address risk.

Lack of buy in from hospitals

Low High High LHIN CEO group will be invited to participate. Participating hospitals will engage in the entire project process.

Non Urgent Patient Transportation Project Project Proposal

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Challenges from community vendor

Low Low High As service standards are clarified potential vendors can be advised through the RFP process on the requirements of the SWLHIN Hospital group.

Unavailability of support and project resources

High Low Medium Rescope project and or extend project deadline

Ongoing sustainability and funding resources for transportation services

High High Medium and this will vary throughout the LHIN and amongst hospitals in the LHIN

Establish baseline of current spend patterns for participating hospitals in the SWLHIN (reference same work completed in the Central East LHIN

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Project Proposal

PROJ ECT INFORMATION Project Name Date Submitted:

July 26, 2010 Project Acronym or No.

eShift Service Delivery Model for Clients who are at End of Life

2010-07-26 <assigned by LHIN>

Estimated Duration of Project Estimated Budget Notice of Integration?

To March 30, 2011 $1,186,035

No

Lead Organization Project Sponsor Lead Organization Contact Information Project Sponsor Name (e.g., CEO/ Executive Director):

Sandra Coleman, Chief Executive Officer SW CCAC

Project Manager/ Lead Contact Name:

Megan Nichols

Organization Name: South West CCAC

Address: 356 Oxford St West, London ON

Telephone: 519-495-5945

Email: Megan.Nichols@sw.ccac-ont.ca

Partner Organization Contact Information Partner Organization Contact Information

Contact Name: Lyn LeClair South West District Executive Director

Contact Name: Patrick Blanshard President

Organization Name: VON Middlesex-Elgin Organization Name: Sensory Technology

Address: Suite 100 - 1151 Florence St. London Ontario N5W 2M7

Address: Suite 300-717 Richmond Street London ON

Telephone: 519-659-2273 Ext. 3224 Telephone: 519-663-2057

Email: lyn.leclair@von.ca Email: pblanshard@sensorytech.ca

PROJECT DESCRIPTION Project Purpose

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When a person is confronted with an incurable illness one of the most difficult decisions is choosing where to die. While palliative hospital beds and residential hospice are desirable options for some, more and more individuals are choosing to die at home encircled in the care their family and other loved ones. For these caregivers, the final days can be draining physically, emotionally and spiritually. Shift Nursing provided through CCAC can be a significant support for families. Unfortunately shift nurses are scarce and often already engaged in supporting long-stay medically fragile clients; shift nurses with palliative skills are rarer still. Personal support workers can also be a significant support for families and it is often the PSW with whom the client and family form the strongest bond. But PSWs are limited in their scope of practice and traditionally have not been able to provide the medical component of care so even though CACC can provide more than the usual number of hours for clients at end of life, families may still have sleep interrupted or not be able to leave the home because the PSW cannot provide adequate pain and symptom management. Based on the success of the eShift service for the medically fragile, the CCAC is adapting and expanding the eShift model for clients who are at end of life. As the pilot with medically fragile has demonstrated, this model is an effective strategy to build HHR capacity, leverage and spread limited specialty knowledge and skills, and ultimately provide Ontarians with better healthcare PSW’s have been specially trained to observe and report back signs and symptoms to a remote nurse via technology. As with the original eShift model, the nurse reviews the information and when necessary delegates specific care tasks to the PSW to carry out on behalf of the nurse. The visiting nurse also interacts with the stationary delegating nurse via technology so that at all times everyone is working from the same care plan. The same secure web portal provided by Sensory Technologies for the original eShift model is being used and an electronic application specific to end of life care is under development. This model is aligned with the ICCP objectives and has been recognized by the ICCP group as a potential solution to the challenges the project is facing for rural populations. From the outset of the development of the eShift model, it was anticipated that costs associated with maintaining the portal and providing the necessary hardware for data transmission would be assumed through rates established in the RFP process to provide this specialized service. It was anticipated that an RFP would be issued allowing new contracts to commence in the fall of 2010. However the MoHLTC moratorium on RFP’s remains in place and extensions to existing contracts is required. To ensure sufficient stability to sustain the current gains made for medically fragile children and support the development for palliative, the CCAC is currently in negotiations with service providers to extend contracts to March 31, 2012. It is vital that the maintenance of the portal and development of applications be supported so clients can continue to receive service through this model. We are seeking funding to support the continued development and provision of the model until March 2011.

Health Service Clients/Stakeholders (i.e., target populations) The model will support end of life clients who wish to die in their own home as well as continue to support paediatric clients with medically complex care needs who require long-term support. The care teams for these clients will also benefit since the technology used allows for increased communication across team members so that all members have real-time information about the client. The CCAC Case Manager can also log on to the portal and review the care provided over each shift for the client. Physicians, other providers and family members will have access to “view only” portals that allow them to review the ongoing care for the client as well. Providers will be able to update themselves on the client condition before arriving at the home. Family members who are not local will have the capacity to keep informed of how their loved one is doing. Hospitals will also benefit since increased availability of bedside care has the potential to divert clients from visiting the ER or being admitted to hospital.

General Description (e.g., individuals over 65) Equity This proposal responds primarily to the needs of the

following population(s):

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Clients with complex medical care needs and clients requiring palliative care as they near end of life.

Aboriginal

Francophone

Rural/Remote Populations

Inner-urban (e.g., homeless) Populations

Religious, Ethno-Racial or Linguistic Minorities (please specify):

Sex/Gender

Sexual Orientation/LGBT

Low Income/Under-employed

Persons with Disabilities (e.g., physical, intellectual, sensory, learning, mental illness)

General Population

Other, please specify: End of Life clients

Where Service/Initiative is Accessed Please indicate where the service/initiative identified in this project can be accessed (check one):

This service/initiative serves one community and is offered at one place or site. Patients/clients/consumers travel within their community for this service (Local Community)

This service/initiative serves two or more communities and is offered at two or more sites. Patients/clients/consumers may have to travel outside of their local community for this service (Multi-Community)

This service is provided in one place or site, but serves all of the LHIN Community. As such, patients/clients/consumers may have to travel out of town to receive this service (LHIN Community)

Please indicate the specific area(s) (e.g., town, city, county, etc.) from which the service will draw clients/stakeholders:

Elgin, London-Middlesex, Grey-Bruce, Huron Perth, Oxford-Norfolk for medically fragile. For end of life, model is being piloted in London with intent to expand across the SW region.

Health Service(s) Improvements for Clients/Stakeholders

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Describe how clients and families will benefit from your idea (e.g., improved quality of care, faster access to care, easier movement through the system, etc.)

Population A: End of Life:

Families caring for loved ones who are dying face exhaustion and increased stress if they are not provided with adequate supports. Palliative-trained community HHR resources have often not been available in sufficient volume to provide shift nursing services to meet end of life needs. Clients and families have either had to cope alone to support their loved one to end their journey at home or clients forfeit the choice to die at home and end up dying in hospital All these factors that have social and fiscal impact on community and government. This model of care has only a modest positive impact on the cost per client per year however the real benefit is the utilization of nursing staff. Because we can assign two or more clients to one nurse we can maximize one nurse’s clinical expertise and ability to support this small but resource intense population

Population B: Complex/Fragile

Families coping with profoundly disabled, medically fragile children face an enormous burden emotionally, physically and sometimes financially. Significant medical advancements saw this population grow substantially through the 1980’s and 1990’s. The population has stabilized but technological advancements allow these children to live longer than ever before and many are surviving into adulthood. Despite the advancements these children still require 24-hour surveillance for survival which means their families need to provide constant care. Most families must turn to outside assistance in order to sleep at night. This model of care increases our ability to provide night shifts that are required so that families can cope with the long-term burden of care that associated with a medically-fragile child.

Project Scope Describe specific items that will (“in-scope”) and will not (“out-of-scope”) be included as part of the work performed on this project. Consider specific features, functions, quality needs or other “must have” requirements and place them in the in-scope section. Spell out any exclusions (i.e., work that will not be performed) in the out-of-scope section.

In-Scope Out-of-Scope

• Increased service to medically fragile and end of life clients

• Expansion of scope of practice for Personal Support Workers

• Continued development of e-Health applications that support delivery of in-home services

•

• Other disease states

• Provision of eShift to end of life clients living in places other than their own home i.e. retirement homes, residential hospice

•

•

Integration

Is this an integration opportunity? Yes No

If yes, please check which type of integration opportunity (check one):

Voluntary Integration (Integration Decision at LHIN’s discretion)

Funding Integration (Integration Decision at LHIN’s discretion)

Facilitated Integration (Integration Decision required)

Required Integration (Integration Decision required)

Comments:

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I acknowledge that this submission is not a formal notice of a proposed integration to the LHIN as contemplated by s. 27 of the Local Health System Integration Act, 2006 (“LHSIA”). Health service providers wishing to provide notice to the LHIN of a proposed integration under s. 27 of LHSIA should contact the LHIN for more information.

Signature:

Name:

Date:

ALIGNMENT Strategic Alignment: Describe linkages to South West LHIN directions, provincial priorities and/or organizational strategies. Blueprint/IHSP Alignment

The project aligns to the following South West LHIN Blueprint Approaches & IHSP Directions:

Primary Alignment (check one)

Population-based Integrated Health Services

Seniors & Adults with Complex Needs

Chronic Disease Prevention and Management

Mental Health and Addictions

Centrally Coordinated Resource Capacity

Emergency Services

Critical Care

Medicine

Surgery

Secondary Alignment (check one)

Comments:

Key Enablers

The project aligns to the following Key Enabler (check one):

Information & Clinical Technology

System Navigation

X Human Resource Strategies

Implementation & Accountability

Provincial Priorities

This project aligns to the following Provincial Priorities (e.g., ALC/ER, Diabetes, Family Health, Wait times):

ALC/ER

Impacts on Health Care System and Organization(s)

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System Impacts

Identify the impacts this project is expected to have on the health care system in the South West LHIN:

System: Based on the success with the medically fragile population, applying the model to the end of life population will provide sustainable and enhanced team-based, in-home supports for a larger number of clients reducing demand on hospital resources. Clinical: The initial paediatric pilot has proven effective in utilizing human resources in a different method while working within current regulations (Delegation). We have just begun providing service to palliative clients under the same model and already it is clear that we are able to support clients for whom we did not previously have sufficient resources. With the limited resources assigned to the palliative pilot, we have already accrued a waiting list for the service. Financial: If we can increase the number of clients served by this nurse/psw model then the unit cost of technology per unit of service delivered becomes sustainable and affordable within the current managed competition model. We are seeking one time financial support for training and development costs but anticipate that this service delivery model will be sustainable with our regular budgeted service costs going forward.

Human Resources: Shift nursing is generally overnight which is not a popular work schedule. Overnight shifts that also require specialized skills such as paediatrics or palliative care are in very short supply and shrinking due to the nursing demographic. Often shift nursing care plans contain a significant number of care tasks that do not require a nurse and are normally managed by a PSW. Using a nurse to provide PSW-level care is a waste of scarce clinical resources. Maximizing PSW’s ability to complete delegated clinical tasks along with their normal PSW tasks ensures that we are reserving nurses for care that truly requires a nurse.

Organizational Objectives and Strategies

Identify the organizational objectives and strategies this project aligns to (e.g., improved performance measurement, cultural shifts, improvement processes/methodologies):

CCAC is committed to:

• Meet palliative client needs and ensure that clients who wish to die at home have the support to do so

• Continue to meet the needs of families caring for medically-fragile children so that these children can remain at home with their families

• Reducing unnecessary hospital use associated caregiver burden and lack of clinical care in the home setting

Process Change Impacts

Identify the process change impacts this project will have on your organization or on other organizations (e.g., increased efficiency, improved performance reporting):

• The addition of the remote delegating nurse to the care team for palliative clients will impact how the client’s care plan is managed. Processes will need to be developed that enable both nurses to work collaboratively to keep the care plan up to date at all times.

• Technology will change the way that all palliative care team members interact.

Related Projects & Initiatives

Are there dependencies with other initiatives or projects (at the organizational, LHIN or Provincial level)?

X Yes No

If “yes”, please describe below.

Project/ Initiative Interdependency & Impact

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List the project or initiative. State the dependency and indicate how the dependency impacts your project.

• Integrated Client Care Project (ICCP) • The provincial work group has identified End of Life as a potential next phase, of which South West may be a candidate.

• Grey Bruce Palliative Outreach • Impact unknown - potential duplication for some clients

• •

Are there opportunities to spread to Local Community, Multi-Community, LHIN Community (as described above)?

Yes No

If “yes”, please describe below.

This model is already spreading across the SW CCAC region and has also garnered interest from other CCAC/LHIN regions and non-CCAC sectors. Hospitals in particular have expressed interest in the technology that enables this service delivery model as a potential means of offering virtual care.

PROJECT PERFORMANCE Project Goals, Objectives & Performance Measures Provide the details of what this project aims to accomplish by listing its specific goals, objectives and deliverables. State the goals in terms of high-level outcomes to be achieved. Identify specific objectives and deliverables for each goal listed. Objectives are clear statements of specific activities/tasks that must be performed to achieve the goals. Identify both project product/service and people/organization change objectives. Performance measurement indicators and targets are used to determine if objectives and expected results have been successfully achieved.

Goals Objectives Performance Measurements

Indicators Targets

List all goals to be achieved by the project. Ensure alignment with project purpose.

For each goal, list specific objectives and/or deliverables that will signify achievement of goal when finished.

For each objective/deliverable, list the performance measurement indicator and target that will be used to evaluate success of results achieved.

To increase access to shift nursing services that provide respite for families supporting individuals who are medically fragile or nearing end of life

• Decreased caregiver burden • Number of medically fragile and end of life clients who receive eShift nursing services

• No clients waiting for shift services

Increase the number of clients who die at home when this was the indicated choice of place to die

• Clients’ pain and symptoms managed successfully at home

• Percentage of clients who die at home by choice this fiscal compared to last (75.8%)

• 80%

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Increase communication among team members

• All team members aware of current client status via access to client electronic chart on secure web portal

• Number of different team members who access the electronic chart

• Nurses

• Case Managers

• Physicians

• Families

Project Timelines & Deliverables

Indicate when the project will take place. Provide a preliminary estimate for the duration of the project by documenting the target completion dates for high-level project milestones. Milestones are significant project events that usually signify completion of project phases or major deliverables.

Key Milestones Key Deliverables Key Dates

Description. Give clear definition of the milestone and/or deliverable, clarifying how you will know when it has been successfully achieved.

Estimated date where possible or time from start of project.

Web application for end of life care developed and deployed

Multiple eShift teams actively using end of life application to record clinical observations and communicate with other team members

2010-12-31

PSWs trained and integrated in shift nursing program to provide care for end of life clients

10 PSWs trained and providing care 2010-03-30

Physician portal active Physicians using portal to access client information and/or share information with other team members

2010-03-30

Family portal active Family members able to use portal to access client information

2010-03-30

PROJECT TEAM MEMBERS Project Team Identify who is needed on the core project team to complete project deliverables and achieve goals and objectives. What skills, knowledge and experiences are required? Consider the need for special expertise to deal with people and organization change challenges. This section may include any new Human Resource(s) required to support the project.

Team Member and/or Title/Profession, Organization Role on the Project

Provide names and/or titles/professions of core project team members.

Describe the role & responsibility of each core project team member.

Gordon Milak, Senior Director, Performance Management and Accountability – SW CCAC

Executive Project Sponsor – Overall accountability for project

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Megan Nichols, Regional Manager Client Services SW CCAC

Project Sponsor, Business – Accountable for development of clinical and program indicators

Maeve Armstrong, Client Services Manager SW CCAC Project Manager, Clinical – Accountable for client enrollment in the project

Lyn LeClair, South West District Executive Director, VON Middlesex Elgin

Provider Sponsor – Accountable for provider performance and participation in project

Patrick Blanshard, President, Sensory Technologies Project Manager, Technical- Accountable for technology for the project including development of applications and secure web portal

Project Partners Is this project carried out in partnership with other groups/organizations? Indicate who else, in addition to those listed as project team members above, has committed to contributing to this project. Partners are individuals, groups or organizations who work together towards joint interests to achieve common goals.

• Palliative Pain & Symptom Management Consultation Program

•

Project Stakeholders Stakeholders are individuals or organizations that have a vested interest in the initiative. They are either affected by, or can have an affect on, the project. Anyone whose interests may be positively or negatively impacted by the project or anyone that may exert influence over the project or its results is considered a project stakeholder. All stakeholders must be identified and managed appropriately.

• London Regional Cancer Program

• London Health Sciences Centre Emergency and Inpatient departments

• Primary Care Physicians

PROJECT RESOURCES

Human Resources Provide an overview of any new Human Resources (HR) required to support the initiative beginning with year one as well as additional hires in year two. As well, consider volunteer resources to be leveraged to support the information and provide information on these resources.

Position Title and Designation Required (if applicable) (e.g., PSW, Case Manager)

Project Start-up Ongoing Project Support

Volunteer Services Project Start-up Ongoing Project Support

Services to be provided:

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OHRS Functional Centre Description Individuals to be Served Service Units/Volumes

Funding Details Ongoing Base Funding Budget Comments

Salaries and Wages

Benefits

Supplies and Sundry Exp.

Other (specify in comments)

Total Funding Required

Other Funding Sources

Total Net Ongoing Base Funding Required from LHIN

Start-Up One-Time Funding Budget Comments

Consultation/Training F2010-11 $12,305 F2011-12 $24,610 Total $36,915

Training for front line provider & clinical support

Information/Technology F2010-11 $104,400 F2011-12 $208,800 Total $313,200

Staff F2010-11 $278,640 F2011-12 $557,280 Total $835,920

Incremental purchased service, project lead & supports

Other (specify in comments)

Total Funding Required F2010-11 $395,345 F2011-12 $790,690 Total $1,186,035

Other Funding Sources

Total Net One-Time Funding Required from LHIN

$1,186,035

TOTAL FUNDING REQUIRED FROM LHIN (Ongoing Base + One-Time)

$1,186,035

In-Kind Contributions Are there any in-kind contributions? Yes No

If yes, describe:

PROJECT RISKS & CHALLENGES

Project Risks

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Document high-level project risks apparent at this point that could either positively or negatively impact the achievement of project goals and objectives. Focus on risks that are likely to happen and have a significant effect on project success. Be sure to consider risks associated with people & organization change, knowledge management and transition to operations.

Risk Likelihood of Occurrence

Potential Impact Organization Capacity to Manage Risk

Mitigation Strategy

Brief description of risk.

High, Medium, Low High, Medium, Low High, Medium, Low High level strategy to address risk.

Challenge recruiting/retaining PSWs interested in training for the advanced scope of practice

Low High High To date we have been able to recruit from within the PSW employee pool at VON; if we are not able to find suitable candidates in the future then we would recruit externally

Client/family acceptance of service delivery model

Low High High Need to be proactive in describing services available to these populations when they are admitted for CCAC service so they understand that this model may be part of their care plan; include descriptions of this service delivery model in fact sheets, booklets, etc. provided to clients/caregivers; engage our hospital and other health care partners in promoting this model to our mutual clients

Technology failure Low Medium High In the event that technology is not available, a contingency plan needs to be in place that enables the connection between ePSW and remote nurse; this is built into the workflow process for this service delivery model

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Report to the Board of Directors Health Service Provider 2009/10 Fourth Quarter Results

Meeting Date: September 22, 2010 Submitted by: Mark Brintnell, Senior Director, Performance, Contract and Accountability Scott Chambers, Team Lead, Finance Submitted to: Board of Directors Board Committee Purpose: Information Decision

The purpose of this report is to bring forward the results of South West LHIN Health Service Provider (HSPs) 2009/10 Fourth Quarter (Q4) Reports submitted on June 30, 2010. Hospitals Appendix 1 provides a table that lists the year end confirmed numbers against the key Hospital Service Accountability Agreement (H-SAA) financial indicator: year end total margin. All hospitals are within the performance standard for the other H-SAA performance and global volume measures (e.g. inpatient weighted days, ambulatory care visits etc.). Alexandra Hospital (Ingersoll) and Alexandra Marine & General Hospital (Goderich) ended the year in a negative total margin position inconsistent with their commitment of a balanced budget per the current H-SAAs. Letters were issued to both hospitals to confirm the H-SAA total margin obligation, reinforce it is the hospital’s obligation to address the negative total margin, and seek confirmation on how the hospital will return to a balanced financial position before the end of this current fiscal year. Grey Bruce Health Services, Strathroy Middlesex General Hospital, and Woodstock General Hospital all posted positive total margins confirming improved financial performance against their H-SAAs which allowed a negative total margin due to deficit projections. Letters acknowledging the effort these hospitals have made to deliver a balanced budget were issued to each hospital CEO. Hospitals are allowed to retain year end surplus amounts if the funding can be applied to sustain or improve hospital services in subsequent periods. Community Health Service Providers Appendix 2 provides a list of the year end Fund Type 2 (LHIN funding) financial position for the community sector HSPs. Community HSPs typically receive funding from various sources and apply other Fund Types (e.g. fundraising revenue) to reach a balanced financial position. Many HSPs use other (Fund Type 3) funding sources to offset Fund Type 2 deficits. If the HSP has not included off-setting Fund Type 3 revenue to address the budget forecast, a letter was issued to remind the HSP of

Agenda Item 5.8

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the balanced budget provision of the M-SAA and to request a plan to reach a balanced position (as indicated in Appendix 2 notes). Year end surplus amounts reported by community sector health service providers (HSP) will be recovered to the provincial treasury if confirmed by the Annual Reconciliation Report process conducted by the MOHLTC Financial Management Branch. Year end deficits are not funded. Long-Term Care Homes Long-Term Care Homes (LTCHs) do not submit quarterly reports to the LHINs. LTCHs are funded using a per diem formula that is meant to cover all eligible costs. The formula adjusts for increases and decreases in occupancy and resident revenue. The value of quarterly financial reports would be modest. The MOHLTC monitors this system through Revenue/Occupancy Reporting. Attachments: Appendix 1 Appendix 2 End.

Appendix 1 - Hospital Projected Year End Surplus / Deficit as at 2009/10 Q4 (Sorted By Ratio: Total Margin as % of Projected Revenue)

Name Surplus/(Deficit) Fund Type 1

Surplus/(Deficit) All Fund Types Total Margin

Ratio: Total Margin as % of

RevenueWorking Capital Note:

Alexandra Hospital (Ingersoll) (379,662) (482,601) (366,545) -2.01% 487,939Alexandra Marine & General (Goderich) (240,103) (594,338) (240,103) -1.10% (2,280,976)Wingham & District Hospital 10,962 (219,734) 10,962 0.07% 3,065,355South Huron Hospital Assoc. (Exeter) 139,387 22,217 18,668 0.18% 93,991Woodstock General Hospital 163,572 11,254 131,201 0.21% (850,835)Tillsonburg District Memorial Hospital 56,074 (328,539) 56,074 0.22% 6,211,272Stratford General Hospital 617,637 (118,862) 617,637 0.72% (10,376,620)Four Counties Health Services 165,558 3,138 85,115 0.76% 2,847,073South Bruce Grey Health Center 344,506 (314,488) 344,506 0.81% 5,876,827St. Marys Memorial Hospital 82,586 (107,153) 82,586 0.87% 1,454,439Clinton Public Hospital 101,035 (50,253) 101,035 0.91% 1,175,457Seaforth Community Hospital 77,314 (6,707) 77,314 1.01% (304,570)Hanover & District Hospital 193,912 (19,817) 193,912 1.14% 862,657Grey Bruce Health Services 1,897,776 579,199 1,897,776 1.15% (15,774)Listowel Memorial Hospital 381,982 71,993 381,982 2.15% 4,675,797St. Thomas Elgin General Hospital 1,718,395 418,806 1,718,395 2.18% (10,254,428)St Joseph's Health Care, London 30,010,962 13,875,266 10,348,129 2.22% 5,034,735London Health Sciences Centre 37,663,000 23,035,000 28,284,000 2.88% (18,366,365)Strathroy Middlesex General Hospital 1,494,469 819,160 1,382,954 3.91% (342,412)Woodstock Private Hospital 59,627 59,044 59,627 5.48% (17,131)

74,558,989 36,652,585 45,185,225 (11,023,569)

Definitions

Fund Type 1 surplus/(deficit):

Surplus/(deficit) all Fund Types:

Total Margin:

Surplus/(deficit) from hospital operations including building amortization and amortization of related donations, interest on long term liabilities, and grants and unrealized gains and losses

Fund Type 1 above plus Fund Type 2 (community programs) plus Fund Type 3 (other, e.g. Federal Gov't program)

Surplus/(deficit) all Fund Types excluding building amortization and amortization of related donations and grants, interest on long term liabilities, and unrealized gains and losses (exlusion applies to all three Fund Types)

Appendix 2: Community Sector Year End Surplus/(Deficit) as at Q4

NameFund Type 2

Surplus/(Deficit)

Surplus/(Deficit) as a % of Fund

Type 2 Revenue*Note

ADDICTION SERVICES OF THAMES VALLEY - CMH&A (2,008) -0.15% Deficit not offset by other funds; M-SAA compliance letter will be sentALEXANDRA HOSPITAL - CMH&A 0 0.00%ALEXANDRA MARINE AND GENERAL HOSPITAL - CMH&A 0 0.00%Alzheimer Society of Elgin-St. Thomas 0 0.00%Alzheimer Society of Grey-Bruce 0 0.00%Alzheimer Society of Huron County Inc. 0 0.00%Alzheimer Society of London and Middlesex 0 0.00%Alzheimer Society of Oxford (124,881) -40.98% Fund Type 3 revenue used to balanceAlzheimer Society of Perth County 0 0.00%Blue Water Rest Home Inc. (1,011) -0.56% Deficit not offset by other funds; M-SAA compliance letter will be sentBoys' and Girls' Club of London (806) -0.09% Deficit not offset by other funds; M-SAA compliance letter will be sentCANADIAN MENTAL HEALTH ASSOCIATION, ELGIN BRANCH - CMH&A 36,086 1.02%CANADIAN MENTAL HEALTH ASSOCIATION, GREY BRUCE BRANCH - CMH& (8,743) -0.55% Deficit not offset by other funds; M-SAA compliance letter will be sentCANADIAN MENTAL HEALTH ASSOCIATION, HURON PERTH BRANCH - CM 4,207 0.19%CANADIAN MENTAL HEALTH ASSOCIATION, LONDON-MIDDLESEX BRANC (4,732) -0.16% Fund Type 3 revenue used to balanceCANADIAN MENTAL HEALTH ASSOCIATION-OXFORD COUNTY BRANCH - C 78,888 2.49%CAN-VOICE CONSUMER/SURVIVOR COMMUNITY SUPPORT SERVICES - CM (2,364) -1.16% Deficit not offset by other funds; M-SAA compliance letter will be sentCentral Community Health Centre 0 0.00%Cheshire Homes of London, Inc. 357,505 3.96% Attendant Outreach program - salary and benefit lines under budgetChippewas of Nawash Unceded First Nation Report not filedCHOICES FOR CHANGE, ALCOHOL, DRUG AND GAMBLING COUNSELLING (23,561) -2.96% Fund Type 3 revenue used to balanceCommunity Health Services - Canadian Red Cross, Woodstock Branch (120) -0.01% Deficit not offset by other funds; M-SAA compliance letter will be sentCorporation of the City of London (Dearness Home) 30,170 5.28% Under budget on most expense linesCorporation of the City of St. Thomas - Valleyview Home 320,075 56.47% Further information on this surplus requested (reply pending)Corporation of the County of Elgin 6,301 1.99%CORPORATION OF THE COUNTY OF HURON - CMH&A 0 0.00%Council for London Seniors 0 0.00%Craigwiel Gardens 0 0.00%CREST SUPPORT SERVICES (MEADOWCREST) INC - CMH&A (6,887) -0.52% Fund Type 3 revenue used to balanceDale Brain Injury Services Inc. 150,164 4.34% Non-LHIN revenue greater than budgetFAMILY SERVICE THAMES VALLEY - CMH&A 0 0.00%Family Services Perth-Huron 0 0.00%Four Counties Health Services (3,056) -0.66% Fund Type 1 (hospital) revenue used to balanceG & B HOUSE - CMH&A (64,660) -17.40% Fund Type 3 revenue used to balanceGoverning Council of the Salvation Army in Canada (The) 2,616 2.63%GREY BRUCE COMMUNITY HEALTH CORPORATION - CMH&A 140,024 2.64% Non-LHIN revenue greater than budget; expenses under budgetGREY BRUCE HEALTH SERVICES - CMH&A (2,435) -0.06% Fund Type 1 (hospital) revenue used to balanceHome and Community Support Services of Grey-Bruce Report not filed Staff turnover; working with LHIN staff to train and file reportHospice of London Inc. (32,457) -5.98% Funded through other funds, not reflected in CATHuron Hospice Volunteer Service 5,118 4.78%Hutton House Association for Adults with Disabilities (2,633) -0.74% Fund Type 3 revenue used to balanceIngersoll Services for Seniors 20,875 5.49%KIIKEEWANNIIKAAN SOUTH WEST REGIONAL HEALING LODGE - CMH&A 0 0.00%Knollcrest Lodge Limited 1,499 0.33%LONDON HEALTH SCIENCES CENTRE - CMH&A 2,703 0.05%LONDON INTERCOMMUNITY HEALTH CENTRE 42,829 0.88%London Regional AIDS Hospice, O/A John Gordon Home Report not filedMcCormick Home for the Aged (Women's Christian Association) 0 0.00%Meals on Wheels London (14,849) -1.03% Deficit not offset by other funds; M-SAA compliance letter will be sentMidwestern Adult Day Services 0 0.00%

Appendix 2: Community Sector Year End Surplus/(Deficit) as at Q4

NameFund Type 2

Surplus/(Deficit)

Surplus/(Deficit) as a % of Fund

Type 2 Revenue*Note

MISSION SERVICES OF LONDON - CMH&A 0 0.00%Mornington, Ellice and Milverton Wheels to Meals (379) -2.90% Deficit not offset by other funds; M-SAA compliance letter will be sentNorth Perth Community Hospice Inc. (13,547) -27.06% Fund Type 3 revenue used to balanceONEIDA FIRST NATION OF THE THAMES - CMH&A 11,300 5.18%Over 55 (London) Inc. 0 0.00%OXFORD SELF-HELP NETWORK - CMH&A 21 0.02%Participation House Support Services - London and Area 0 0.00%Participation Lodge - Grey Bruce 0 0.00%PHOENIX SURVIVORS, PERTH COUNTY - CMH&A 1,591 1.26%PSYCHIATRIC SURVIVORS NETWORK OF ELGIN - CMH&A (718) -0.40% Deficit not offset by other funds; M-SAA compliance letter will be sentRitz Lutheran Villa 2,106 0.59%SEARCH COMMUNITY MENTAL HEALTH SERVICES - CMH&A (6,995) -0.67% Fund Type 3 revenue used to balanceSherwood Forest (Trinity) Housing Corporation 11,817 3.60%South West Community Care Access Centre (1,639,941) -0.99% Performance improvement plan in placeSOUTHWEST ONTARIO ABORIGINAL HEALTH ACCESS CENTRE - CMH&A (103) -0.06% Deficit not offset by other funds; M-SAA compliance letter will be sentSpruce Lodge Home for the Aged 16 0.00%ST JOSEPH'S HEALTH CARE, LONDON - CMH&A (4,724) -0.05% Fund Type 1 (hospital) revenue used to balanceSt. Joseph's Health Care - Parkwood Pain and Symptom Management (9,788) -2.69% Fund Type 1 (hospital) revenue used to balanceSt. Joseph's Health Care London - Third Age Outreach Program (0) 0.00%St. Mary's and Area Home Support Services 0 0.00%St. Marys And Area Mobility Service 0 0.00%STRATFORD GENERAL HOSPITAL - CMH&A 44,026 1.30%Stratford Meals on Wheels and Neighbourly Services 0 0.00%The Canadian Hearing Society - London Region (6,775) -2.91% Fund Type 3 revenue used to balanceThe Canadian National Institute for the Blind - Ont Div - London (507,788) -169.29% Local agency deficit to be funded from national organizationThe Governing Council of Salvation Army Canada - London Village 0 0.00%Tillsonburg & District Multi-Service Centre 39,645 2.91%Town and Country Support Services 49,391 2.06%TURNING POINT INCORPORATED - CMH&A (2,769) -0.56% Fund Type 3 revenue used to balanceVictorian Order of Nurses - Oxford Branch (0) 0.00%Victorian Order of Nurses - Perth-Huron Branch 0 0.00%Victorian Order of Nurses for Canada - Ontario Branch Grey-Bruce 171,149 11.36% Under budget on most expense linesVictorian Order of Nurses for Canada - Ontario Branch Middlesex 113,013 2.35%VIOLENCE AGAINST WOMEN SERVICES, ELGIN COUNTY - CMH&A 0 0.00%WEST ELGIN COMMUNITY HEALTH CENTRE 157,281 3.69% Non-LHIN revenue greater than budgetWESTERN ONTARIO THERAPEUTIC COMMUNITY HOSTEL - CMH&A (10,920) -0.15% Deficit not offset by other funds; M-SAA compliance letter will be sentWOMEN'S EMERGENCY CENTRE-OXFORD, INC. - CMH&A 0 0.00%WOMEN'S SHELTER, SECOND STAGE HOUSING AND COUNSELLING SERV Report not filedWoodstock and Area Community Health Centre 39,526 5.78%WOODSTOCK GENERAL HOSPITAL - CMH&A 0 0.00%

Net total: (1,578,415)

Fund Type 2 is used to capture revenue and expenses applied to the community sector, e.g. community support services, community mental healthFund Type 3 is used to capture funding fand associated expemses from other levels of government and other sources

LHIN staff are working with agencies to collect late reports; in several cases the agency is having technical difficulty uploading the forms to the web site

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Report to the Board of Directors Senior Leadership Report

Meeting Date:

September 22, 2010

Submitted By:

Michael Barrett, Chief Executive Officer Kelly Gillis, Senior Director, Planning, Integration & Community Engagement Mark Brintnell, Senior Director, Performance, Contract and Accountability Glenn Lanteigne, Chief Information Officer Julie White, Director of Communications & Customer Service

Submitted To:

Board of Directors Board Committee

Purpose:

Information Decision

Strategic Health System Leadership Council (HSLC) The Health System Leadership Council will have its first meeting on Thursday, September 23rd and we are in the process of final confirmation for membership. At next weeks meeting, we will be confirming the Terms of Reference and this will be shared with the Board in October. Operations Service Accountability Agreement and Funding Update Hospitals were required to submit their budget plans by September 10th to reflect confirmed funding for 10/11. LHIN staff has been working to review and assess these submissions. Any Hospital Service Accountability Agreement (H-SAA) amendment requiring LHIN Board direction will be brought forward in October. The H-SAA amendment process is expected to be completed by end of October. Funding letters for our community sector providers reflecting the recently confirmed funding for 10/11 are being released. Given the confirmed funding is not materially different than the planning target in the existing Multi-Sector Service Accountability Agreement (M-SAA) for all community providers, we are anticipating providers will be able to meet their current performance obligations set out in the existing M-SAAs. If a community provider is unable to meet its current performance obligations, the LHIN will work with them to amend the M-SAA as required and appropriate. Any M-SAA amendment requiring LHIN Board direction will be brought forward in October. The M-SAA amendment process is expected to be completed by end of October. 2011-13 H-SAA and M-SAA – LHINs have launched the process required to successfully put in place new H-SAAs and M-SAAs effective April 1, 2011. These SAAs are being conducted simultaneously. The LHIN Board will begin to receive regular updates on the progress achieved with these processes as the work unfolds.

Agenda Item 6.1

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Communications Presentation to City of London’s Community & Protective Services Committee On September 13, Kelly Gillis and Dr. Sarah Jarmain from St. Joseph’s Health Care London made a delegation to the City of London’s Community & Protective Services Committee regarding Tier 2 divestment and mental health planning in the area. The Community & Protective Services Committee did raise its concern regarding reinvestment into community mental health services from the anticipated savings from divestiture of psychiatric hospital beds. At this date in the process, the dollars for potential reinvestment are calculated at approximately $3 million. The committee expressed concern about lack of adequate community based resources and passed a motion to work closely with the LHIN, providers and the mental health community to advocate for additional resources. Media Overview Over the course of August, there were 16 media stories tracked by the Communications team that directly mentioned the South West LHIN. This is up from seven stories in July, but is less than the 21 pieces in June. Five of the stories were about the Huron Perth Healthcare Alliance’s Vision 2013 process (specifically, the potential reduction of Emergency Department hours of operation at the St. Marys Memorial Hospital site). Three of the stories are in relation to the Tier 2 transfer of mental health services from St. Joseph’s Health Care London to the Cambridge area and three others are in relation to the Ombudsman’s recent report on LHINs. South West LHIN Electronic and Social Media Similar to the media coverage, there was more social media traffic in August than there was during the month of July. The South West LHIN website had 13,817 unique visitors in August, up 11,756 in July and 12,041 in June. A site visit is defined as “as series of page requests from the same uniquely identified user with time of no more than 30 minutes between each page request or they go to another site.” There were 202,665 page views between August 1 and 31, up from 179,296 in July and 190,727 in June. A page view is defined as the loading of a single page of information in response to a user clicking on a link. In August, there were 805 My Page subscribers, up eight from the July total and continuing an upward trend from the beginning of the year. As of August 31, the @SouthWestLHIN Twitter account had 449 followers – up 92 since July 31 and 156 followers since June 31. As of August 31, the LHIN had posted 822 “tweets” – 154 during the month of August alone. The @GET_ENGAGED account was up 103 followers for a total of 986 and has posted 2,935 tweets.

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As of August 31, there were 107 fans of the South West LHIN facebook page (up four from the previous month), and the LHIN posted 20 content updates to the page during the month of August. At the end of the month, 29% of our fans were male and 11% were aged 55+. No new videos were added to the South West LHIN’s You Tube channel in August. In all, there were 247 video downloads during the month of August – up 34 from July, but still down from 327 in June.