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Central East Local Health Integration Network CEO Report to the Board

December 19, 2012

Table of Contents

Transformational Leadership ............................................................................. 2 Service and System Integration ......................................................................... 3 Mental Health and Addictions ............................................................................ 7 Integrations ....................................................................................................... 8 Aboriginal Services ......................................................................................... 10 IHSP Strategic Aims ........................................................................................ 12 Enablers – eHealth .......................................................................................... 13 Community Engagement ................................................................................. 16 Operations ...................................................................................................... 21 Appendices ..................................................................................................... 23

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Central East Local Health Integration Network CEO Report to the Board

December 19, 2012 The following is a compilation of some of the major activities/events undertaken during the month of December in support of the Central East LHIN’s Strategic Directions;

a) Transformational Leadership, b) Quality and Safety, c) Service and System Integration, and d) Fiscal Responsibility.

Transformational Leadership: The LHIN organization will demonstrate accountability and systems-thinking in all decision-making and leadership actions, reward innovation which is aligned with the Integrated Health Service Plan (IHSP) 2010 - 2013 and model fair, transparent, and honest interaction with one another and with Health Service Providers. Service and System Integration/Quality and Safety: The LHIN organization will create an integrated system of care that is easily accessible, sustainable and achieves good outcomes. Healthcare will be people-centred in safe environments of quality care. Fiscal Responsibility: The LHIN organization will maintain a primary focus on quality as a driver for cost-effectiveness and measure cost efficiency against our strategic priorities. The Central East LHIN is working towards achievement of the Strategic Aims of the 2010-2013 IHSP; 1. Save a Million Hours of Time Patients Spend in the Emergency Departments by 2013; and 2. Reduce the Impact of Vascular Disease by 10% by 2013 (2010-2013 IHSP).

Transformational Leadership The LHIN organization will demonstrate accountability and systems-thinking in all decision-making and leadership actions, reward innovation which is aligned with the Integrated Health Service Plan (IHSP) 2010 - 2013 and model fair, transparent, and honest interaction with one another and with Health Service Providers. Emergency Services Leadership: On November 29, 2012, a regularly scheduled joint meeting of the provincial Emergency Department LHIN Leads and Emergency Department/Alternative Level of Care (ED/ALC) Performance Leads was held. Key work being undertaken at this time includes the following:

Emergency Room Reporting – Performance data was reviewed related to Length of Stay (LOS), Time to Disposition and Time to an inpatient bed;

Access to Primary Care Coding - The issue around access to Primary Health Care Code was discussed and it was acknowledged that there was a need to address this specifically with regards to patients presenting at ER; and

Pay for Results – The 2012-13 funding letters were reviewed. MOHLTC will provide recovery updates for FY 2010-11 and 2011-12. A frequently asked questions and answers guide has been made available with relation to the current year funding.

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Home First: Following a comprehensive ramping up process, Home First was launched at Ontario Shores on December 3, 2012. The implementation has been proceeding as planned. A Community Partners meeting was held on December 5 to consider two examples of some of the very complex people who are awaiting discharge from Ontario Shores. This community participation and buy in is crucial, since these are the services that will provide the discharge destinations for Ontario Shores clients. The meeting was an important step in developing and enhancing the relationships between Ontario Shores and the community. Home First has been enthusiastically led by the Central East Community Care Access Centre (CECCAC) and Ontario Shores. Post-Implementation debriefs have been conducted on a daily basis. The Central East LHIN Home First Sustainability Oversight Committee met on December 6. Central East LHIN staff attended and engaged in a full discussion of the current status of Home First and the outcomes as illustrated by the CECCAC Home First indicators. 2013-2016 Integrated Health Service Plan (IHSP): The 2013-2016 Central East LHIN Integrated Health Service Plan will provide a blueprint for change for the local health care system that will outline shared priorities, strategies and proposed outcomes. This document will also form the basis of accountability agreements with all Central East LHIN health service providers. The strategic aims were first presented to the Board on September 26, where the aims focused on the “Community First” theme –

By improving service provision in the community, the Central East LHIN’s IHSP aims to reduce:

Demand for long-term care for seniors;

The impact of vascular disease;

The need for hospital-based care for mental health and addications; and

The number of patients that receive palliative care in the hospital when they would prefer to spend their time at home.

The IHSP has been forwarded to the Ministry of Health and Long-Term Care for review. It will be translated into French and published on the Central East LHIN website on January 28, 2013. The IHSP will then be shared with planning partners and Central East Health Service Providers to educate them on our plan and gain their assistance in achieving our new strategic aims:

Reduce the demand for Long-Term Care so that seniors spend 320,000 more days at home in their communities by 2016.

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Continue to improve the Vascular Health of residents so they spend 25,000 more days at home in their communities by 2016.

Strengthen the system of supports for people with Mental Health and Addiction issues so they spend 15,000 more days at home in their communities by 2016.

Increase the number of Palliative patients who die at home by choice and spend 12,000 more days in their communities by 2016.

Through the guidance of the priorities listed below, the Central East LHIN remains committed to improving the overall health of the population, enhancing the patient experience and reducing while controlling the per capita cost of care:

1. Continuing to oversee System Design and Integration,

2. Addressing Access and Wait Time issues; 3. Managing Capacity Planning and Funding

Reform;

4. Enhancing Access to Primary Care; 5. Supporting Transitions in Care and eHealth

initiatives, and; 6. Promoting Quality & Safety procedures with our

providers.

The Central East LHIN will continue socializing the priorities and aims with the balance of our Government Relations stakeholders throughout December and January. Health Care Connects Reporting: The Health Care Connects (HCC) program was launched in February 2009 to support the placement or ‘connection’ of individuals without a primary care provider with a comprehensive primary care practice. The update below is reflective of results to date from February 12, 2009 to October 31, 2012. The following identifies the number of actively registered patients through HCC and those that have been referred to a family health care provider for care (Note: Complex Vulnerable (CV) patients represent those patients with greater health needs):

Total number of referred patients= 19,501

Total number of CV referred patients= 1,545

Total number of active registered patients= 5,752

Total number of active registered CV patients= 598 The following identifies the average distance between patients’ homes and the provider to whom they have been referred by HCC:

73% of patients live within 10 km

19% of patients live within 10-25 km

8% of patients live over 25 km away The following provides an overview of the length of time from a patient’s registration with the HCC program to their referral to a family health care provider:

% of patients referred in <30 days= 63

% of CV patients referred in <30 days= 66 Notes: The HCC’s FSA (postal code) chart data represent cumulative numbers since the program’s inception in February 2009 (not point in time for reporting month). The program is voluntary and as a result all unattached patients will not be accounted for. HCC reports are not an accurate reflection of current unattached needs; reports remain draft.

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Service and System Integration

The LHIN organization will create an integrated system of care that is easily accessible, sustainable and achieves good outcomes. Healthcare will be people-centred in safe environments of quality care. Clinical Service Plan – Orthopaedics: All LHINs are required to submit a regional surgical orthopaedic plan by January 30, 2013. This is in conjunction with several system imperatives including: health system funding reform (HSFR), Quality Based Procedures (QBP) implementation and our ongoing pursuit of quality improvement and system sustainability. The Central East LHIN, in consultation with various stakeholders including hospital and medical leadership and the CECCAC, is developing an approach that integrates the requirements of the surgical orthopaedic plan and the rehabilitation services planning, focusing on access, quality and value for money objectives, and is implementation ready in fiscal year 2013-14. The approach will include three pillars of activity:

a) Orthopaedic Surgical Planning; b) Rehabilitation Service Delivery Model Planning (inpatient and outpatient); and c) Transition Management Planning (RM&R).

Orthopaedic Surgical Planning The Orthopaedic Surgical Task Group had its kick-off meeting on November 23, 2012. The group’s Terms of Reference were agreed upon. Initial timelines were presented and the group had an opportunity to raise concerns they had with the current system. Information is now being collected to ensure that the group has a comprehensive understanding of the current state of orthopaedic surgical care in the Central East LHIN. Dr. James Waddell has been recruited to chair the Orthopaedic Surgical Task Group. Dr. Waddell is an Orthopaedic Surgeon and has held a number of positions, including Surgeon-in-Chief at St. Michael’s Hospital. Recently, he acted as chair for the Expert Panel for Orthopaedic Surgery for the Province of Ontario. Dr. Waddell’s deep experience with the Orthopaedic Surgical system will be of huge benefit to the Central East LHIN’s Orthopaedic Surgical Task Group. The Task Group’s next meeting will be held on December 20, 2012 and possibilities for new models of care will be discussed. Rehabilitation Service Delivery Model Planning Membership and a draft Terms of Reference are now being established for an Orthopaedic Rehab Task group. This group will examine the current landscape of Rehabilitation for Orthopaedic issues, as well as examining ways to improve the delivery of rehab care. Maternal Child Health Update: The Request for Proposals (RFP) for the Advanced Neonatal Care and Pediatric Consulting will be posted through the CECCAC office the week of December 10

th, 2012. The deadline for interested individuals/teams to

submit their application will be mid-January 2013, to allow sufficient time over the holiday period for applications to be completed.

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During the month of December we will be posting an Expression of Interest for membership for the establishment of the Central East LHIN Maternal Child Youth Advisory Committee. Once we have received nominations for membership we will determine our participation on the committee. Terms of Reference have been drafted and will be shared with the committee during a kick-off meeting in January. This committee will function in an advisory capacity, providing leadership to all relevant health service providers, partners, key stakeholders, including the Provincial Council Maternal Newborn Health (PCMCH) and the Central East LHIN to support the adoption of evidence-based practice with the goal of improving the health of mothers and newborns. The overall role of the Advisory Committee will be to promote standardization, implementation of evidence and best practices within women’s and children’s programs. The Central East LHIN has put forward the names of both Leanne McCullough and Sheri Ferkl as our representation on the PCMCH Transportation Advisory Committee. This decision is an interim decision as we work on the development of the Maternal Child Youth Advisory Committee. Once the Advisory Committee is functional we will re-evaluate our representation on the PCMCH Transportation Advisory to ensure individuals involved in the Central East LHIN Maternal Child Youth activities have opportunities to participate on the Provincial Tables. On December 5, an update was provided to the Public Health Medical Officer’s on Baby Friendly Hospital Initiatives. The Maternal Child Youth Advisory Committee should be a venue to further discuss benefits and risks related to adopting more formal approaches to creating “Baby Friendly” hospitals. Presently, without a full understanding of impact and risks, and considering available resources of the LHIN, Public Health and local Hospitals, it would be ill advised to adopt a strategy without further analysis and stakeholder engagement. Integrated Provincial Falls Prevention Framework & Toolkit: To date, the Central East LHIN and its four (4) Public Health Units (PHUs) have been working together to support the implementation of the Integrated Provincial Falls Prevention Framework & Toolkit. Specifically: 1) Greater collaboration between PHUs and LHINs; 2) Learning and knowledge transfer; and 3) Strengthening of cooperation and partnership in terms of planning. On November 14, the Central East LHIN Falls Prevention PHU Engagement meeting took place with our Public Health Managers. During this meeting we had an informative presentation from Shehnaz Fakim with the Mississauga Halton LHIN. We were able to learn from an early adopter LHIN their process for implementing a Falls Prevention initiative, challenges/barriers, and quick win/successes. Next steps for Falls Prevention in the Central East LHIN will involve the establishment of a Falls Prevention Advisory Committee within the Central East LHIN and development of a draft Terms of Reference. We anticipate the Advisory Committee will become functional in the early months of 2013. Behavioural Supports Ontario (BSO) Program: Quality Improvement (QI) activity in the long-term care sector continues, with each of the three cluster-based BSO Implementation Teams accomplishing the following:

Further development of customized plans for engagement of Phase II long-term care homes;

Completion of a Sustainability Tool for early-adopter homes; and

Development of 2013 communication plans and events for enhancing the sustainability of BSO initiatives.

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Further supporting QI, the BSO Team led the delivery of seven (7) PDSA (Plan-Do-Study-Act)/Coaching Calls with 100% early-adopter LTCH involvement and 55% involvement by Phase II homes (increase from 50% level in October). Also during the month, advancement was made in the following areas: 1. Training: Through the efforts of the BSO Team with the support and involvement of the Early Adopter

homes, a successful three-day Residents First – BSO Improvement Facilitator training event provided education on the various elements of BSO programming/service to staff from many Phase II homes. Training covered various aspects of quality improvement and content that could be used to implement BSO including, tools kits, efficiency, interventions, PDSA, facilitation skills, change models, and sustainability.

2. Education: Four (4) training sessions (PIECES (2); Montessori (2) were delivered to over 100 participants. 3. Community Service Value Stream Mapping: A two-day event at month-end brought more than thirty

people together (not including BSO team) to formally launch the community phase of the BSO initiative. The event successfully identified a high-level future-state process and is to be followed by three (3) Kaizen events (one in each cluster) scheduled for January 2013.

4. Evaluation: The Hay Group is conducting the provincial BSO evaluation and in November they led four focus groups within Central East at the following locations: Wynfield (Durham); Riverview (North East); and, Trilogy and Shepherd Lodge (Scarborough). Group results/outcomes are expected to be released shortly. In addition to the focus groups, 437 individual surveys were sent out covering all the LHIN’s LTCHs (with a submission deadline of December 10

th), distributed as follows:

Five (5) surveys to each Phase II home; Ten (10) surveys to each early adopter home; and Balance of surveys to members of Integrated Care Team;

Mental Health and Addictions Discontinuation of OxyContin: Earlier this year, Health Canada pulled the patent for OxyContin as a response to growing concerns of substance abuse and over-prescription. The LHINs have been communicating any recognizable service pressures from the local health service providers to the Ministry on a monthly basis. There were no changes in service pressures related to the discontinuation of OxyContin, as noted in December’s monthly report to the Ministry. There are ongoing known pressures which continue to face the First Nations and Urban Aboriginal communities within the Central East LHIN. Currently, FourCAST is working with the Aboriginal service providers in Peterborough to improve their capacity to offer service to people who are using OxyContin and other substances. At the last Board meeting, it was reported that the patent restriction expired on November 25, presenting as an opportunity for generic brands of what was previously ‘OxyContin’ to be produced and sold in Canada. A total of six (6) pharmaceutical companies have been approved by Health Canada to market their brand of the drug. This may have some impact on Central East LHIN Service Providers and service recipients. At a provincial level, Minister of Health, Deb Mathews, has taken a stance on this and has encouraged other provinces to follow. Ontario has quickly drafted a regulation to restrict access to generic OxyContin unless it in a tamper-resistant form (similar to the new Oxyneo). Regulations require public posting for 30 days to allow for public feedback. If approved, the regulation will be retroactive to November 30. There has been some indication that the Minister will advance Legislation that will limit OxyContin distribution to very specific criteria. The effects of the Health Canada patent approval remain unknown as it is unclear about whether the province can intervene to block distribution in Ontario, given that the Federal government has approved its use. It is not clear what decisions the province would make about the drug being available under Ontario Drug Benefits. The

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price point of the drug is unclear. The more affordable it is, the higher the likelihood of accessibility which could lead to the similar situation of substance overuse. It is unclear what formulations are being proposed which differ between the generic brand and OxyContin and whether the properties will remain the same. It is also not clear if the substitution of other opiates would encourage users to return to the generic OxyContin.

We know that the Opiate strategy, including narcotic monitoring, has had an impact on prescribing practices in previous similar prescribed drugs. New prescribing guidelines from the College of Physicians and Surgeons Ontario have been developed with training attached for addictive substances. Mentor programs for pain management have been implemented in the province through the College of Physicians and Surgeons of Ontario. The Federal government will not alter their process for drug approval. This made the approval of the generic form of this drug inevitable. Central East LHIN staff will continue to monitor this situation closely and will provide the Board with regular updates. Scarborough Addictions Expansion: The business case, received from Lakeridge Health/Pinewood has been approved. It has been sent to the Ministry for their information and comments. The Pinewood program is now fully operational in Scarborough and has been welcomed by both the hospitals and the community. Development of the Central East LHIN Opiate Strategy: Staff have been working with the Central East LHIN Integrated Addictions providers to develop an Opiate strategy. It is expected to be presented to the Central East LHIN Board in January. Assertive Community Treatment Team (ACTT) Value Stream Mapping: The Assertive Community Treatment Team (ACTT) Value Stream Mapping process is underway with Ontario Shores supporting this activity. Central East LHIN staff have received the completed business case for this activity and it is in the process of approval. Central East LHIN Hospital to Home – ED Avoidance Coalition Steering Committee: The Hospital to Home (H2H) Steering Committee’s met on November 30. The local Coalition groups are continuing to meet. The ongoing local reports have been very positive. The Project Scorecard has been approved at the November meeting of the Steering Committee. Peterborough Regional Health Centre has now provided their data. The Co-Chairs of the Central East LHIN H2H Steering Committee provided a presentation to the Central East LHIN Senior Team on December 17. Mental Health Nurses in Schools: The Mental Health Nurses in Schools initiative is moving forward. All nine Nurses are now in place. Their focus will be on supporting students who are transitioning between hospital and community. The nurses are currently making connections in the community. This has included outreach to the First Nations and to the Disordered Eating Program at Lakeridge Health. A full Steering Committee meeting is expected to take place in January. Meetings with Children’s Assessment Service Providers: The Children’s Assessment Service Providers group met on November 29. The current state assessment of services has been completed. The group has now formed a subcommittee that will begin work on both a short and long term strategy that will provide advice to the LHIN regarding the effective provision of these services. These comprehensive assessment services have not been included in the discussions of the Paediatric and Adolescent Psychiatric Services Group.

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Paediatric and Adolescent Psychiatric Services in the Central East LHIN: A full day meeting was held on November 23 at Ontario Shores to consider a future state model for Paediatric and Adolescent Psychiatric services in the Central East LHIN. Currently, a “Straw Dog’ of the model is being developed that will be circulated to members of the group for their input and approval before moving forward.

Mobile Crisis Intervention Team (MCIT) GTA Planning: Central East LHIN staff attended a meeting held at the Toronto Central LHIN concerning Mobile Crisis Intervention Team services in the GTA. A further meeting is scheduled for December 12 at the Toronto Central LHIN to continue discussions.

Ontario Shores Centre for Mental Health Sciences/Oshawa Community Health Centre OTN Initiative: Central East LHIN staff approved a pilot project that will use Sessional Fees to provide Psychiatric Consultation and Capacity Building at the Oshawa Community Health Centre through an Ontario Telemedicine Network (OTN) initiative. This is being supported by Ontario Shores Centre for Mental Health Sciences.

Integrations Community Health Services Integration Strategy: The purpose of the project is to implement a facilitated integration process to achieve the ‘Community First Strategic Aim’ in each of the Durham, Scarborough and Northeast Service Clusters. The project will result in the identification of a preferred community health services integration model for each service cluster. Strategic Aim: Design and implement a cluster-based service delivery model for Community Support Services and Community Health Centre agencies by 2015 through integration of front-line services, back office functions, leadership and/or governance to:

• improve client access to high-quality services, • create readiness for future health system transformation and, • make the best use of the public’s investment.

Integration Planning Process in Halliburton County Given changes to the Central East LHIN’s Community Health Services Integration Strategy approved by the Board at its November meeting, efforts are now focusing on leveraging the significant work completed to date in Haliburton County with a retooled process that adds the health service providers in Kawartha Lakes. On November 30, 2012, a teleconference was held with staff and some governance liaison members of all participating agencies in the Haliburton County integration planning process to fully inform them of the changes and field questions and concerns they had. Through the month of December, agencies are taking the change in process to their respective Boards and will plan on returning to the discussion table in January 2013. LHIN staff are preparing a revised critical path for the project inclusive of tracking towards the completion of a directional plan by the end of February 2013 pertaining to the Small, Rural and Northern Small Hospital Transformation funding. Scarborough Integration Planning Process Based on changes in the Community Health Services Integration Strategy, the Scarborough process is being postponed until mid-2013.

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Aboriginal Services Central East LHIN First Nations Health Advisory Circle and Métis, Non-Status and Inuit Health Advisory Circle: Both Health Advisory Circles met in November. Neither meeting was well attended and many of the items for discussion have been deferred to the next meeting. Each of the Central East LHIN Health Advisory Circles has planned meetings for January 2013.

Memorandum of Understanding (MOU) between the Alderville First Nation and the Central East CCAC A very successful initial meeting was held with the Alderville First Nation and the Central East CCAC in November. A further meeting to finalize the MOU was scheduled to take place at the Alderville First Nation on December 17, 2012.

French Language Services

Francophone Community Engagement: The Société Santé en Français (SSF) (French Language Health Society) held its 6

th Annual Convention in

Ottawa from November 21 to 24. All LHIN French Language Services Leads participated in the event. There were approximately 450 French Language Health professionals, including representatives from 17 French Language Networks from across Canada. The event was well attended by Health Administrators, politicians, stakeholders and community organizations. The three days were spent discussing issues and the future of French Language Health Services. Topics included the ‘Context of the Evolving Health Care System’, and ‘Expertise on Standards for Culturally and Linguistically Appropriate Services in Health’. This proved as a valuable opportunity to discuss the Community First aims of the Central East LHIN including the context and priorities of our 2013-16 Integrated Health Service Plan. Central East LHIN was commended for initiatives to recognize Francophone issues and promote cultural competency. Francophone Committee on Mental Health: The governance of the francophone committee on Mental Health, which was led by CAMH, is being transferred to French Language Health Planning Entities #3 & 4, while increasing accountability to the Francophone population in providing their respective LHIN with key recommendations on Mental Health. Staff at the Central East LHIN will be meeting with staff from Entité #4 in January to provide information on mental health initiatives specific to the Central East LHIN.

Francophone Memory Centre Committee and Bed Occupancy subcommittee: Bendale Acres Long-Term Care Home in Scarborough has charged a Memory Centre Subcommittee with the task to undertake a feasibility study on the establishment of a memory centre. French Language Services staff at the Central East LHIN have been actively participating in the Francophone Working Group at Bendale Acres. A business case is being prepared by Dr. Guy Proulx, who is an expert of various clinical tools in the field of aging, in partnership with Glendon College and in collaboration with Francophone Entity #4. The business case will be submitted to Central East LHIN for funding and is aimed at building the capacity and existing services at Bendale Acres for Francophones. The working group on Francophone Bed Occupancy at Bendale Acres Long-Term Care Home has continued meeting in Scarborough with the LHIN, CECCAC and Entité #4. With respect to bed occupancy, stakeholder discussions have prompted the development of Strategic Marketing and Promotion on Francophone-designated beds at Bendale Acres Long-Term Care Home.

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Francophone Self-Management Committee on Chronic Disease: The Self-Management of Chronic Disease working group has completed an evaluation of the French Training session from September 2012. We are exploring the possibility of holding an additional two (2) training sessions in French, one session in Scarborough and one in Durham region.

Hospice Palliative Care Central East Hospice Palliative Care Network (CEHPCN): The Central East Hospice Palliative Care Network (CEHPCN) received multiple Expression of Interest (EOI) applications to support new membership. All applications were reviewed and ranked by the EOI Review Committee. Three interested parties were recommended as new CEHPCN members. Highlighted applicants will be contacted over the next few weeks and invited to participate at the next Network meeting as new members. Interdisciplinary Palliative Education: The Central East LHIN’s Hospice Education Working Group has been meeting on a biweekly basis to discuss planning and organization of interdisciplinary education within our regions three (3) clusters. Working Group representatives include: Hospice Peterborough, Durham Hospice and the Scarborough Centre for Healthy Communities and the CEHPCN Coordinator. The Working Group is organizing palliative education courses for this transitional year (2012/13). This includes two (2) Fundamentals of Hospice Palliative Care courses in both Durham and Scarborough and one Comprehensive Advanced Hospice Palliative Care course in the North East. Working Group representatives are also looking to plan two “Education Days” within each cluster focusing on topics such as Advanced Care Planning, Caregiver Relief, the Palliative Performance Scale (PPS) and Edmonton Symptom Assessment System (ESAS).

Physician Palliative Education: The Central East LHIN, in collaboration with Drs Howard Burke, Larry Erlick and Scott Allan are organizing the Learning Essential Approaches to Palliative Care (LEAP) at The Scarborough Hospital (TSH) in 2013. The following dates have been confirmed in The Scarborough Hospital’s General Campus Auditorium:

January 16 from 1:30-4:30pm;

January 23 from 1:30-4:30pm;

January 30 from 1:30-4:30pm;

February 13 from 1:30-4:30pm; and

February 27 from 1:30-4:30pm.

The LEAP course outline as highlighted by the Pallium Project website is identified below (http://www.pallium.ca/infoware/Pallium_CHPCAItem618_LEAP_ResDesc.pdf):

Module 1: Creating Context;

Module 2: Gastro-Intestinal Problems;

Module 3: Palliative Pain Management;

Module 4: Respiratory Problems;

Module 5: Communication;

Module 6: Depression, Anxiety and Suffering;

Module 7: Grief and Bereavement;

Module 8: Delirium;

Module 9: Palliative Sedation;

Module 10 Last Days and Hours; and

Module 11: Working As a Team.

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To date, approximately 40 physicians, medical student residents, Nurse Practitioners (including hospital and community) and Palliative Pain and Symptom Management Consultants have expressed interest. The LHIN has also met with the Central East CCAC to discuss monitoring targets and requirements as well as clarify expense process logistics. Residential Hospice: Scarborough continues to dialogue with the Central East LHIN in search of a way to make Residential Hospice services available in this community. Yee Hong has taken the lead in exploring prospective partners to support the delivery of hospice palliative care services in Scarborough and how they might be better integrated to provide for a more sustainable context in which Residential Hospice services can be located. On November 13, health service providers from across Scarborough came together to commence operational level discussions regarding how they might collaborate more substantively, extend the range of hospice palliative care services available to include the introduction of an Residential Hospice option and make the system more accessible to those requiring such care.

IHSP Strategic Aims Save a Million Hours of Time Spent in the Emergency Room Department Stocktake Report The Stocktake report is a unified report of all LHIN activities and performance to the Ministry of Health and Long-Term Care. It is collaboratively completed by representatives of all LHIN portfolios to communicate our strategies and plans clearly. The Fall Cycle Stocktake report template was published by the Ministry of Health and Long-Term Care on November 13 and the completed report was submitted to MOHLTC on November 27. The following summarizes some of the more salient aspects of the report:

Percentage Alternative Level of Care (% ALC): The Central East LHIN’s Q1 12/13 percent ALC days was 12.62%, well below the LHIN’s MLPA target of 15.20%, yet higher than the provincial target of 9.46%. Central East has seen a significant decline in this indicator over the last two quarters; however, discussions with several hospitals foreshadow an upward trend for the next reporting period.

For Admitted Emergency Department Length of Stay (ED-LOS), Central East wait times decreased from 48 hours in Q4 11/12 to 33.7 hours in Q1 12/13 to 31.9 hours in Q2 12/13. While Central East performance is below its MLPA target of 36 hours, it still remains above the provincial interim target of 25 hours.

For Non-Admitted High Acuity ED-LOS, Central East has sat at 6.7 hours for the first half of 12/13, below the LHIN and provincial target of 7 hours.

Central East, like most of the province, continues to be challenged with readmissions rates for select CMGs and repeat unplanned emergency visits within 30 days for mental health and substance abuse conditions.

Central East LHIN met all of its Surgical and Diagnostic wait times for Q2 12/13 except for wait times for cancer surgery which saw a spike due to an extended vacation for a surgeon during that quarter.

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Enablers – eHealth eHealth Strategic Plan: The Central East LHIN has initiated the development of an eHealth Strategic Plan by building on the 2007 eHealth Strategic Plan and making revisions to address current and emerging needs and requirements in support of the LHIN IHSP and the provincial eHealth Ontario strategy. This revised plan should inform and enable the development of a GTA LHIN Cluster strategy.

eHealth Leads from the Central Ontario LHINs Cluster continue to collaborate with the Ministry and eHealth Ontario to create a work plan to support the cluster and LHIN strategies. The Cluster Chief Information Officer is leading the discussion with the Provincial agencies to collaborate and to develop the detailed plans for implementation within the LHINs. The eHealth senior project manager from the Central East LHIN has taken the lead on the development of a communications plan for the cluster LHINs to focus on the delivery of key messages to accompany the Cluster strategy and the individual LHIN-level strategy. The communication plan outlines the process and tools that will be implemented to engage stakeholders, communicate the strategy; and manage emerging issues. All six LHIN eHealth Steering Committees are being consulted to help shape and finalize the plan, ensuring it is representative of the various sectors’ needs. cGTA – ConnectingGTA: ConnectingGTA is a project with the five (5) GTA LHINs structured to “integrate electronic patient information from across the care continuum, and make it available at the point-of-care, to improve the patient and clinician experience”. The ConnectingGTA project will allow 700 service providers to securely share patient health information across the five (5) GTA Local Health Integration Networks (LHINs). Currently, electronic health information is contained in silos within the system. Over time, all 700 service providers will be connected under one “electronic roof” – allowing patient information to move from one service provider to another within the system. Program activities will focus on populating the ConnectingGTA solution with clinical data and then providing clinicians, from across the care continuum, with viewing capabilities to use that data to improve patient care. The ConnectingGTA Program is pleased to announce that the ConnectingGTA Front-End Solution procurement is now complete (Appendix A). The ConnectingGTA Clinical Document Repository (CDR) is scheduled to be populated by site before April 30, 2013. The ConnectingGTA Solution Go-Live process will commence in November 2013. Clinical adoption kick-off sessions were held with more than 35 participants from the early adopter sites. The Clinicians are set to participate in the Clinical Solution design sessions which started on November 21. The ConnectingGTA Program announced that for the first time in the Greater Toronto Area, access to critical lab data in the Ontario Laboratories Information System (OLIS) has been made widely available to clinicians to improve the delivery of patient care. More than 30,000 clinicians can now access data in OLIS and feedback in the first month of Go-Live shows that clinicians and their patients/clients are already starting to benefit (Appendix B). Integrated Indicator Report The ConnectingGTA program team has spent the past couple of months improving the Indicator Report (Appendix C). Finalizing the Indicator Report was dependent on the completion of the ConnectingGTA Program Timeline and the ConnectingGTA Integrated Program Plan which were both finalized in the month of November. In addition, feedback previously provided by Early Adopter site executives and Site Project Managers (PMs) was instrumental in the redevelopment of the Report.

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Resource Matching and Referral (RM&R): Resource Matching and Referral (RM&R) is an electronic information and referral system that matches patients/clients to the earliest available services that best meet their individual needs. RM&R improves the patient/client experience and is designed to ensure all individuals have equitable access to safe and high quality services. It is a powerful tool that can be applied to reduce Alternate Level of Care (ALC) days and contributes to lower Emergency Room (ER) wait times. The MOHLTC has confirmed funding related to Step 5 deliverables for the Provincial RM&R project. In the last phase of the project, all three clusters worked on all four referral pathways to provide input into the provincial Minimum Data Set report. In the current phase a pathway has been assigned to each cluster for initial implementation. Cluster 2 has been assigned the Acute to Long Term Care pathway which includes refinement of forms and the referral process. The Central East LHIN RM&R Steering Committee has made a decision to simultaneously proceed with implementing the pathway for Rehab/CCC locally and subsequently align with the standardized system for this pathway. From the provincial delivery perspective Cluster 3 has been assigned with the role of implementing this pathway for free-standing Rehab and CCC. The Central East LHIN does not have any free standing Rehab/CCC beds. The November RM&R Steering Committee meeting focused on refreshing and refocusing the RM&R process as it relates to Rehab/CCC and also worked towards visually depicting the preferred option for scoping and spreading the implementation. A decision was made to establish a Working/Steering Committee to oversee the implementation with representation from all the hospitals in the Central East LHIN. CMH and HHHS will be provided with the option to participate, though the decision to join will rest with the two organizations. The hospital membership will include two members who are subject matter experts from each hospital; one from acute and the other from post-acute with decision making ability. A plan will be developed to streamline the referral process for both CCC and Rehab pathways but the CCC implementation will be rolled out first. The implementation will be one hospital at a time first for CCC and then Rehab and all units in that hospital will be a part of the implementation. The lessons learned from the first deployment will be used to guide/refine subsequent implementations. The hospitals that have both CCC and Rehab in the Central East LHIN are: Rouge Valley Health System, Lakeridge Health Corporation and Peterborough Regional Health Centre. One of these hospitals will be requested to be a volunteer as a pilot site for implementation.

The assigned pathway for each cluster:

Cluster Pathway for Initial Implementation

Rationale

Cluster 1 CCAC In-Home Participated in discussions and agreed to refining the CCAC In-home referral pathway

Cluster 2 Long Term Care Significant development in RM&R system for LTC pathway with Bed-Level Matching (BLM) functionality Opportunity to match BLM needs to standardized form

Cluster 3 Rehab/CCC Only Cluster with free-standing Rehab and CCC facilities (with exception of Cluster 2)

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Fiscal Responsibility: Resource investments in the Central East LHIN will be fiscally responsible and prudent Funding and Allocations: The following funding letters were issued in November to our Health Service Providers –

2012/13 Health System Funding Reform (HSFR) Health-Based Allocation Model (HBAM) – Additional Mitigation Funding: Ross Memorial Hospital (RMH) received $396,100 in one-time funding for fiscal year 2012/13. The purpose of the funding is to mitigate impacts related to the HBAM and Quality-Based Procedure (QBP) components of the HSFR. This additional one-time mitigation funding is applied in cases where the percentage decrease in overall funding with revenue adjustment, compared to overall funding without revenue adjustment, is greater than 0.5%.

2012/13 HSFR – QBP – Chronic Kidney Disease (CKD) Carve-Out: this is further to the Ministry of Health and Long-Term Care’s (MOHLTC’s) decision to carve out the hospital base funding associated with Home Dialysis related services from the hospital global budget in 2012/13. Cancer Care Ontario (CCO) will manage this QBP going forward. This is no longer the responsibility of the LHIN to manage. Funding for these home services will be allocated by CCO Ontario Renal Network (ORN). Base funding has been carved out from: a) Peterborough Regional Health Centre (PRHC) in the amount of ($3,161,700); b) The Scarborough Hospital (TSH) in the amount of ($8,592,400); and c) Lakeridge Health (LH) in the amount of ($5,249,300).

2012-2015 Managing Obstetrical Risk Efficiency Demonstration Project: MOREOB

is a comprehensive, three-year program that integrates patient safety, professional development and performance improvement programs for caregivers and administrators in hospital obstetrics units. The program focuses on key elements to foster an environment of safety. These elements include culture, communication, collaboration, teamwork, reflective learning and system improvements.

The following is being flowed to Health Services Providers (HSPs) as one-time funding:

HSP Fiscal Year: 2012/13 Fiscal Year: 2013/14 Fiscal Year: 2014/15

RMH

$30,575

$30,575

$30,575

PRHC

$47,225

$47,225

$47,225

Fiscal Responsibility: HOSPITAL SECTOR Hospital Service Accountability Agreement (2012/15 H-SAA): At the request of the Hospital-CCAC Chief Financial Leadership Group (HCFLG), additional discussions were held to strategize around the uncertainties under the new HSFR funding environment. The discussion provided some perspective and guidance around the next steps for the Quality-Based Procedure Working Group (QBPWG). The HCFLG was also assured that despite the unknowns, there is enough certainty to support assumptions and move forward with the 2013-16 H-SAA negotiations.

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To date, no further direction or communication has been received from H-SAA Steering Committee on the 2013-16 H-SAA process. At the Central East LHIN level, however, the LHIN has met with three hospitals to date – Ontario Shores Centre for Mental Health Sciences (OSCMHS), RMH, and Haliburton Highlands Health Services (HHHS). The purpose of the negotiation meetings is to discuss their current and forecasted performance for 2012/13, as well as hospital pressures and plans for 2013/14. To date, all of the meetings have been informative and consultative. Without any indication of what new indicators and targets will be introduced into this process, the Central East LHIN and all hospitals, to-date, have successfully negotiated targets for all known indicators to move into the 2013-16 agreement. The remainder of the meetings will be completed by mid-December. Any additional negotiations required due to the introduction of new indicators will be managed either by email or teleconference between now and March 31, 2013. Hospital Sector Performance and Risks: Northumberland Hill Hospital (NHH) Performance Factor NHH has demonstrated a marked improvement in their forecasted year-end position, Q2 ($206,700) which is down from the first quarter position of ($435,448). This is due in part to additional revenues received as a result of computed tomography (CT) wait times hours increase, increase in cataract funding, Pay-for-Results (P4R), chronic kidney disease (CKD) funding and Ontario Health Insurance Plan (OHIP) fees: The hospital continues to work to address the following pressures:

1. Decline in revenue base as a result of (a) decrease in patient/insurance coverage, (b) increase in occupancy reducing the hospital's flexibility to place patients in preferred accommodations, and (c) increase in isolations due to outbreaks or repatriated patients.

2. Need for additional staffing and supplies to manage the higher than planned (a) occupancy and acuity in the intensive-care unit (ICU) (patient days up 14% and occupancy up 8% from same period last year; ventilator occupancy increased by 8% from last year), and (b) increase in number and length of stay of admitted patients in the ED (increased by 11% from same period last year).

Savings related to mitigating strategies implemented since Q1 include: 1. Reduction in sick time through the attendance awareness program; 2. Reduction in overtime by approximately 0.56% since 2011/2012; 3. Implementation of non-urgent patient transportation policy in October 2012 to reduce patient

transportation costs in Q3 and Q4; 4. Savings achieved due to vacancies being filled.

Hospital Sector Working Groups: Hospital-Community Care Access Centre Financial Leadership Group (HCFLG): A brief HCFLG meeting was held just prior to the QBPWG meeting in November. The focus of the meeting was primarily on the H-SAA process, and the effect of the Health System Funding Reform (HSFR), QBPs and HBAM on their ability to establish targets. The known elements of the target setting process were identified, along with the assumptions that can be reasonably made, given the available information. As mentioned above, a follow-up meeting was held to discuss the assumptions in further detail.

Quality-Based Procedure (QBP) Working Group (QBPWG): The November QBPWG meeting was held on November 16

th and focused on the following:

Recap of work completed to-date;

Clarification on Ministry carve out;

Mitigation funding & Rehabilitation update;

2008-13 H-SAA requirements for opting in or out of a service;

Upcoming QBPs – years 2 and 3 (2013/14 and 2015/16);

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Potential groupings of QBPs; and

Discussion of work-plan to begin addressing QBPs in years 2 and 3. A follow-up survey was sent out to all members on December 4

th to determine a recommendation on:

- Final QBP groupings (i.e. cardiovascular); - Prioritization of each grouping; - Time spent on each grouping; - Whether to work on QBPs sequentially or concurrently;

o Which QBP grouping(s) each HSP should be involved with or take a lead role. The next QBPWG meeting is scheduled as a videoconference on December 20

th and will present the results of

this survey and continue to move the QBP process forward. Additionally, we will begin discussion on the scope of the working group and begin to develop the Terms of Reference. However, staff are aware of discussions by the Provincial Steering Committee that impact which QBPs will be moving forward in fiscal 2013/14 and 1014/15. These potential changes may require the strategy to be revisited. Wait Time Strategy Working Group (WTSWG) The WTSWG group met on November 22, 2012. Northumberland Hills Hospitals (NHH) and PRHC were above their wait time targets for cataract surgery, and The Scarborough Hospital (TSH) for cancer surgery. All hospitals continue to work with their surgeons and enhance internal processes to reduce their wait times. For Magnetic Resonance Imaging (MRI), LH, NHH and RMH were above their targets. Additional MRI hours approved during the November Board meeting will assist with reducing wait times. The Ministry’s in-year reallocation process is underway and any unmet wait time volumes identified will be reallocated amongst the Central East LHIN hospitals if possible. The group is also awaiting the funding letter from the Ministry to confirm the allocation of 127 bilateral cataract procedures. This one-time funding is in addition to the QBP funding for cataracts. Diagnostic Imaging (DI) Working Group At the November 9th DI Working Group meeting, the group continued discussion surrounding the strategies to achieve objectives and completed the prioritization exercise by rating each strategy on an impact and effort matrix. This will lead to the creation of a work-plan for the group, with priorities to take forward to the WTSWG. The next meeting will be held on December 14

th.

Lab Group: The Lab group met on November 26, 2012. A regional Transfusion Safety Officer (TSO) was again discussed and the group is planning to submit a Health System Improvement Pre-Proposal (H-SIP) for the next fiscal year. The group will also develop its own terms of reference, and the Chair has volunteered to draft it for the next meeting in February 2013. Hospital Sector Initiatives: SUBMIT Update: A business case has been submitted to the Ministry requesting financial assistance to begin development of a Diagnostic Imaging module that would allow connectivity with primary care physicians, hospital surgeons and specialists with the LHIN hospital registration/scheduling systems for diagnostic imaging. See Appendix D. Orthopaedic Quality Scorecard (OQS) The November meeting was cancelled due to a conflict with the HealthAchieve 2012 conference. The December meeting was also cancelled as the 2012/13 Q2 OQS was not yet available.

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Fiscal Responsibility: COMMUNITY SECTOR Community Support Services (CSS), Community Health Centre (CHC), and Community Mental Health & Addictions (CMHA) Multi-Sector Service Accountability Agreement (M-SAA): For the 2013/14 M-SAA refresh, all HSPs had to submit their completed CAPS by November 30, 2012. The Central East LHIN is following up with any outstanding submissions in early December. The LHIN also received the M-SAA package, including the amending letter/schedule and supporting materials, on November 30

th.

The CAPS/M-SAA Work Group will be holding a Pan-LHIN education session on December 3

rd. The Central

East LHIN will follow-up by scheduling a HSP education session in early December. Target negotiations will take place in December 2012 and January 2013, and all M-SAAs are expected to be executed by March 31, 2013. Please see the attached M-SAA Communique for additional information and timelines. Specifically, note the introduction of several new indicators for the community sector. There is some flexibility on how LHINs will determine targets with respect to these new indicators, in order to achieve the best outcomes for the system. See Appendix E. Performance and Risks: Central East Community Care Access Centre (CECCAC)

The CCAC has communicated to the LHIN that at present they are tracking a deficit but they have strategies which if supported by the LHIN will allow them to produce surpluses in January through March that would result in a balanced position. They had a meeting scheduled with the LHIN senior team on December 10 to outline their assumptions and strategies. See Appendix F.

Fiscal Responsibility: LONG TERM CARE SECTOR Long-Term Care Homes (LTCH) Service Accountability Agreement (L-SAA): LTCHs submitted their LTCH Accountability Planning Submission (LAPS) on November 15

th. The LAPS is used

to populate their final L-SAA, which will be completed by March 31, 2012. We are currently following up and conducting a preliminary review of their submissions. The LHIN will receive final indicators, target-setting guidelines, and other technical documents in December and will provide this information to LTCHs in early January. Where necessary, negotiations will take place with LTCHs. Long Term Care Sector Performance and Risk: Craiglee Nursing Home As of November 13, 2012 the ownership of the license for Craiglee Nursing Home was transferred to a wholly owned subsidiary of Southbridge Health Care LP named CVH (No. 1) LP. An L-SAA effective until March 31, 2013 was also signed by our CEO and Board Chair, as per the motion assigning delegation to do so at the February 2012 Central East LHIN Board meeting. In order to ensure that the level of care provided at the Craiglee remains consistent, Southbridge has chosen Extendicare (Canada) Inc. to manage all aspects of the home. Extendicare has been managing this home since April 2009 so this will not be a change for residents or staff. Long Term Care Sector Initiatives Beds in Abeyance (BIA) The Central East LHIN has two homes with beds in abeyance. BIA may refer to beds which exist in an operating LTCH or previously may have been physically removed from the LTCH either by demolition, change

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to another use, or by some other means. The intent of placing a bed in abeyance is to retain the license and return the bed to service at a future date. When a bed has been placed in abeyance, the beds are not counted towards the home’s occupancy rate and the LHINs have authority under the Ministry/LHIN Performance Agreement to reallocate the funding associated with these beds to other services. Until recently, no formal process has existed to do so. An application has been submitted use of the BIA funding of $340,000 to address other LHIN pressures. The LHIN is awaiting further communication from the MOHLTC as to the status of the application.

Fiscal Responsibility: CROSS SECTOR Self Reporting Initiative (SRI): Functionality has been restored to the SRI system and all agencies have been asked to upload their Q2 submission by December 4, 2012. Despite the technical issues experienced with SRI, approximately 80% of agencies were able to submit their Q2 report by the amended due date of November 15, 2012. The Central East LHIN has been reviewing Q2 submissions focusing on financial and statistical reviews and following up with agencies as required. Ministry-LHIN Performance Agreement (MLPA) Performance Requirements Surgical and Diagnostic Imaging: The September 2012 results are summarized in the MLPA Performance Indicator Dashboard attached (Appendix G). The Central East LHIN is meeting all 90

th percentile wait times targets, except for cancer

surgery. The increased wait times for cancer surgery were mainly driven by surgeons taking vacations during July and August. Cancer surgery wait times are already heading in the right direction and are expected to decrease further in the next few months. MRI wait times have been increasing since Q1, but the additional MRI hours approved during the November Board meeting will assist with reducing wait times and help the LHIN achieve its MLPA target.

Community Engagement Community Engagement is the foundation of all activity at the Central East LHIN. Being more responsive to local needs and opportunities requires ongoing dialogue and planning with those who use and deliver health services. Engagement with a wide range of stakeholders can be conducted at various levels including informing and educating; gathering input; consulting; involving and empowering. To assist us in tracking our Community Engagement activities, an ongoing Calendar of Events is kept up to date and shared weekly with staff. It documents all engagement activities with a wide range of stakeholders. Many of these events are also posted on the Central East LHIN website: www.centraleastlhin.on.ca/showcalender.aspx. Below are listings of recent activities that the Central East LHIN staff were involved in –

Community Engagement for the Central East LHIN IHSP 2013-2016 continued in November with the following events:

o Presentation to Durham/Lakeridge Health Medical Society on November 1; o Presentation to Peterborough County Medical Society on November 5; o Presentation to Scarborough Community Council on November 6; o Presentation to Peterborough County Council on November 7; o Presentation to Uxbridge Council and Ajax Council on November 12; o Presentation to City of Peterborough Council on November 13; o Presentation to City of Pickering Council on November 19; o Presentation to City of Kawartha Lakes Council on November 20;

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o Presentation to Township of Scugog Council on November 26; o Presentation to City of Oshawa Council on November 26; and o Presentation to Township of Brock Council on December 3.

Several Behavioural Supports Ontario (BSO) events took place over the last month. A three-day joint event on November 6,7,8, with Health Quality Ontario and the Central East LHIN BSO team, was held in Oshawa with members of our long term sector that focused two days on Residents First Quality Improvement Facilitation Training followed by a Behavioural Support focused day with the same providers. A Value Stream Mapping event was held on November 26 and 27 with our BSO team and the Community Support Services sector.

On November 8, we welcomed Minister Matthews to the Central East LHIN as she announced the opening of the Centre for Complex Diabetes Care at The Scarborough Hospital. At the same time, we welcomed members of the CCDC teams at the Peterborough Regional Health Centre and Lakeridge Health who participated in the announcement via OTN.

The Minister continued her tour of the Central East LHIN with a visit to Northumberland Hills Hospital board meeting on the evening of November 8 to learn more about the PATH project and a visit to Peterborough Regional Health Centre on November 9 to announce improvements to surgical and diagnostic wait times across the Province.

Also on November 9, the Central East LHIN staff participated in a Seniors Forum in Ajax, hosted by MPP Joe Dickson. During the event, MPP Dickson and the Central East LHIN announced the 4% funding to the Community Sector in Durham Region.

On November 13, MPP Jeff Leal, made the same 4% funding announcement for the Northeast Cluster at an event in Havelock.

On November 29, Paul Barker presented with Valmay Barkey to the Ross Memorial Board of Directors and reported on the work of the Quality Based Procedures working group.

Health Quality Ontario and staff from the Central East LHIN facilitated a pilot Peer to Peer Quality Improvement Plan workshop with all Central East LHIN hospitals on December 4.

Website The Central East LHIN website continues to be a primary vehicle for both communication and engagement with our stakeholders with new information posted on the 2013-16 IHSP PROPOSED Strategic Aims, integration activities, performance results and accountability agreements. From November 1 – 30, 2012 there were 8,320 visits made by 5,022 unique visitors. There were 25,501 pages viewed, a slight increase over the number of pages viewed in the previous month. As is noted every month, the Career page continues to have the greatest number of “hits” and providers continue to request space on the page to post their job opportunities. Traffic increased substantially when a number of Central East LHIN job postings went up. An analysis of traffic spikes shows significant increases on November 12

th, 14

th and 29

th when new information

was posted on the RSGS entity, the Central East LHIN career postings were updated and the November 28th

Board package was posted. As of December 12, another 34 people had subscribed to the Central East LHIN website bringing the total to 2,235. Social Media The LHIN continues to post new tweets to its Twitter Account @CentralEastLHIN to generate awareness of LHIN initiatives and opportunities with our followers and those who “retweet” our “tweets.”

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As of December 12, the Central East LHIN Twitter account has 454 followers (an increase of over 46 since November). We continue to attract interest from a variety of stakeholders including provincial associations, health care providers, elected officials and their staff, media and the general public who “retweet” or make comments about what we have posted. We are now starting to attach photos from various events to our “tweets” in order to better share our stories. We continue to encourage people to subscribe to the website and to follow us on Twitter in order to be alerted to new content and new information as it is posted. This will ensure our communities are informed, educated, can provide input, be involved and consulted on the work being done to create an integrated system of care that provides better care, better health and better value for money.

Operations

In managing the Minister of Health’s request for all LHINs to publish expenses from quarter one (Q1) for the Board of Directors, CEO and Senior Directors, the Central East LHIN has posted these expenses online to support our commitment to be accountable and transparent. The Corporate Business Support Unit continues to identify and mitigate risk by ensuring compliance with Directives, business processes, and governance practices. Central East LHIN is in the process of implementing a software upgrade of Contact Resources Management (CRM), which is a contact management tool on a Microsoft platform. The contract vendor, NetDexterity, was working with the LSSO to complete the software upgrade to CRM 11. An implementation team consisting of Central East LHIN staff has been struck to manage the all-staff roll out and training for the utilization of this tool. CRM is presently being used as a tool for issues management and complaint tracking and the new roll-out will expand the usage to all staff as the main contact database for all health service providers, stakeholders and affiliated contacts with the Central East LHIN. Members of the Executive Support Committee have completed training as ‘power users’. The database is now available and End User Training Plans have been developed and all staff will receive training in January and February as part of the roll-out. Staffing Announcements On November 19, Central East LHIN welcomed Sherry Harvey as the new Senior Finance Consultant in the System Finance Performance Management unit. Ms. Harvey has worked previously in the CHC sector for over 20 years, with her most recent position being at Flemingdon Health Centre as the Director of Finance and Administration. Sherry is a Certified Management Accountant. Her responsibilities include being the CHC and CSS co-lead as well as overseeing Capital projects, and involvement in funding reallocations, Hospital Infrastructure Renewal Funding (HIRF) and the Enterprise Risk Management (ERM) process. Welcome aboard!

Other Announcements New Board member for North West LHIN: Tina Copenace was appointed to the North West LHIN Board on November 18, 2012 for a three-year Order in Council term by the Lieutenant Governor. CEO appointed at the North Simcoe Muskoka LHIN: On December 5, Board Chair at the North Simcoe Muskoka LHIN announced Jill Tettman as the new CEO. Ms. Tettman has been with the North Simcoe

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Muskoka LHIN since January 2006 and has served in a number of senior roles over the past 15 years, including the interim CEO of the North Simcoe Muskoka LHIN and previous to that the Chief Operating Officer. Respectfully Submitted,

Deborah Hammons Chief Executive Officer Central East Local Health Integration Network

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Appendices

Appendix A

CCIM sp bltn.pdf

Appendix B

CCIM OLIS.pdf

Appendix C

CCIM indicator report.pdf

Appendix D

SUBMIT.pdf

Appendix E

M-SAA Communique.pdf

Appendix F

CCAC report.pdf

Appendix G

MLPA Dashboard.pdf