management report to the mh lhin board of directors ... · management report to the board –...

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Management Report to the MH LHIN Board of Directors – January 2009 I MOHLTC Updates ED Wait Times

Ontario will soon announce the “Emergency Room (ER) Wait Time Strategy” with public targets. Part of this strategy is to provide some additional funds to the LHIN to enable the hospitals in the LHIN to work towards the provincial target with annual improvements. The “Pay-for-Results” strategy will be communicated soon. All LHINs are expected to provide an “Action Plan” by mid-March 2009.

CCACs

The MOHLTC announced in December 2008 a new strategy that will strengthen the way Community Care Access Centres (CCACs) make arrangements for home care services, provide information and referrals to community-related services, and authorize admission to long-term care homes. Highlights of the strategy include:

♦ Strengthening accountability for home care services among service providers and CCACs by implementing quality measures and a public reporting system

♦ Improving the current CCAC competitive bidding process to ensure consistent, quality care for clients and to enhance transparency and fairness in the selection of service providers

♦ Enabling CCACs to provide clients with care teams suited to their medical condition

♦ Expanding the role of CCACs to include placing clients in adult day programs and supportive housing, providing services such as diagnostic and respiratory therapy, and offer nursing and other treatment services in group settings.

II Progress on ASP / ABP Priorities Aging at Home Overarching Plan

All LHINs had to submit the “Aging at Home Overarching Plan” to the Ministry. The LHIN met with the Provincial ALC lead (Dr. K. Smith) and Ministry officials to discuss this plan on January 16, 2009.

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Management Report to the Board – January 2009

This comprehensive plan will set the directions for focus in addressing the ER wait times and ALC reduction targets.

Aging at Home Year 2 Investments (2009/10)

The MH LHIN issued a call for proposals for investments in Year 2 of the Aging at Home Strategy in mid October 2008. The call for proposals focused on targeted investments (such as supports for daily living (SDL) and adult day services) and strategic investments (such as transportation, specialized geriatric services). An open call for investments was also requested for services related to Alzheimer support, home assistance, safety programs and respite.

An evaluation committee reviewed 47 detailed proposals in early November and December. The evaluation committee identified a number of initiatives that will benefit from a LHIN wide approach to service delivery. The Board will consider the recommendations at its January meeting. A complete package of all recommended aging at home initiatives for 2009/10 will be sent to the Ministry on January 30, 2009.

All initiatives must demonstrate how they will:

- Take referrals from in-patient care (reduce ALC days) and ER; - Increase capacity for “at risk” seniors in the community (to “age at home”) as an alternative

to ALC, unnecessary ER use and avoid Long-Term Care (LTC) placement unless needed, - Reduce reliance on LTC homes as the only option to it being the last option.

Final confirmation of all 09/10 A @ H initiatives will not occur until after the throne speech (late spring). Health service providers will not be notified of the outcome of this process until that time. However, the LHIN will request the Ministry of Health and Long Term Care (MOHLTC) allow us to confirm final allocations by March 31, 2009.

Appropriate Level of Care

Long Term Care as a Last Resort Strategy

• Launched new strategy at Halton Healthcare to address ALC pressures October 14, 2008 • The process requires that all patients unable to leave hospital without a discharge plan

involving community support / institutional care are seen by CCAC initially to determine if the patient can return home with supports where longer term planning can occur

• Since the launch we have seen a reduction in “ALC – LTC” from 22 – 24 % to 15% • Same approach is being mounted at Trillium Health Centre.

Medworxx The three hospitals have agreed to use a common tool to assess all ALC patients

• A Hospital and CCAC Steering Committee was initiated in October to implement this tool. • Implementation is underway starting and this tool will be fully implemented by March 1,

2009.

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Mississauga Life Care - Restore Program Performance

ADMISSIONS # CLIENTS DISCHARGES %

Trillium 83 Home 80%

Credit Valley 29 LTC 4%

Halton Healthcare 7 Hospital 13%

Other Hospitals 1 Deceased 3%

Community 7 Total 95 100%

Supports in Daily Living (SDL)

Significant ramp-up of this program is occurring with the “mobile” concept operational January 26, 2009. This other SDL outreach initiatives will further reduce ALCs and unnecessary ER visits.

Outcomes of SDL YTD Total (2 SDL Agencies)

Impact on Hospital (ER, ALC, General Beds) # of ALC clients taken out of hospital into SDL (not previously SDL

clients – new) 7

# of days reduced from hospital LOS (as a result of the new 2-bed unit at OSCR) 164

# of ER visits diverted (SDL 24-hour response) 25 # of clients returned back to SDL from hospital (clients on SDL services

prior to hospitalization) 66

# of general hospital clients taken into SDL (not previously SDL clients – new) 5

Impact on LTC Homes # of clients taken out of LTC homes into SDL 6 # of clients that came off of the LTC waitlist 5 # of clients diverted from LTC (may or may not be waitlisted:

avoidance of crisis placement) 39

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Wait Times

• General Surgery 90th percentile wait times decreased by 2% last month and 98% of cases were completed within the priority 4 access target of 182 days.

• Mississauga Halton LHIN is among the top three in the province for wait times for Angiography, angioplasty and bypass surgery.

• MRI 90th percentile decreased by 11% since last month and is 4% below baseline. • CT 90th percentile increased by 3% since last month and is 33% lower than baseline.

Community Agencies Group Purchasing & Supply Chain

A committee to explore and implement group purchasing and supply chain efficiencies has been struck with membership from the community sector, shared services west, and the LHIN. The group will have the first meeting soon.

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Clinical Services Integration (Acute Care)

Program Integration

The Steering Committee met on January 20, 2009. Functional plans for vascular and neurosurgery are completed. CVH has sent the thoracic oncology surgery proposal to Cancer Care Ontario. It is expected that the vascular thoracic surgery program will be implemented in Spring 2009.

Mental Health and Addictions 0% 25% 50% 75% 100% % Completion

Oct 2008 Dec 2009 SIGMHA and Task Team meetings continue to be well attended as team members begin to appreciate the potential impact to our health system through collaboration and synergy.

The Integration Task Team will use the Weiss’s Partnership Self Assessment Tool to evaluate existing partnerships in order to determine what factors contributed to the success of the partnership and in collaboration with each partnership to identify opportunities to strengthen integration. The evaluation tool will be distributed in February with the results analysed in March. The Co-Location Team now includes 7 organizations which are interested in co-locating in Oakville. The parameters of this project have been finalized and a job profile for a Project Manager has been developed. The team has consulted with 4 successful co-location initiatives and the information gathered has helped to determine key success factors, funding structures and staffing requirements to sustain such initiatives.

The Quality Team has participated in 2 teleconferences with the MOHLTC Lead for MIS, Janice Smith and members of her management team. The MIS team report that these discussions have increased their understanding of the clinical implications of the current definitions and highlighted some of the challenges in promoting quality data across both hospital and community based services and across mental health and addiction services. Questions from SIGMHA helped focus these discussions and the responses have been documented and shared at the last SIGMHA meeting, with the understanding that any changes to the present system will be rolled out in sync with the MIS version 6.3 release, scheduled for March 2009.

Palliative Care

The MH LHIN is currently undertaking a high level situational analysis pertaining to palliative care. The purpose of this review is to first identify, understand and assess the current state of palliative care services across the MH LHIN. From this basis, we will work with key stakeholders in developing a more robust, integrated system for palliative care that is built on the existing strengths.

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Preventing and Managing Long-Lasting (Chronic) Conditions

The Self-Management Task Group is developing a LHIN wide strategy to build capacity for self-management among health care professionals and individuals with chronic conditions. The objectives of the strategy are to increase awareness and application of the principles and concepts of self management by creating a common foundation (skills, language and definitions). The initial target population for this strategy are Health Care Professionals in Hospital Based Chronic Disease Clinics (Renal, Diabetes, Cardiac Rehab, etc), CCAC and Primary Care Providers (CHC, Family Health Teams, and Physicians). The strategy is designed to build upon the existing capacity within the LHIN and accommodates a wide spectrum of learning needs. This initiative builds upon the partnership work underway between the MH LHIN and Saint Elizabeth Healthcare (Aging at Home Project) that provides 12 chronic disease self-management programs entitled, "Building Bridges to Better Health" in 2008/09 across the LHIN.

eHealth

Sarah Kramer, CEO of eHealth Ontario will be presenting the draft provincial eHealth strategy to the eHealth Ontario Board of Directors at their annual retreat late January. It is her intention to gather feedback and then socialize the draft strategy at the February eHealth retreat. Once all feedback has been gathered and approvals in place, the final strategy will be presented in March 2009. Key Messages from the CEO of EHealth: a. eHealth Ontario is a new agency that will play the leading role in harnessing technology and

innovation to improve patient care, safety and access in support of the governments overall health strategy.

b. eHealth Ontario’s mandate is greater than that of the former SSHA or the current MOHLTC eHealth Program. eHealth Ontario’s scope:

c. Provide a single, harmonized, coherent province-wide eHealth Strategy d. Align through a single point of accountability for eHealth in Ontario e. Avoid duplication, fragmentation or proliferation of eHealth Strategy efforts.

The eHealth Strategy Refresh update was presented to the Health Leaders Collaborative. It was well received. CourtYard presented and facilitated a discussion with the CEOs. It was a positive meeting with a very health and constructive dialogue among the leadership.

Upcoming Major Milestones

• LHIN PMO draft charter has been developed and shared with the CEO for feedback

• LHIN eHealth Coordinator has been retained. Karen McClure joined the MH eHealth team

January 5th and has been actively working with Provincial eHealth the Implementation and Adoption teams in the early stages of this engagement.

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Management Report to the Board November 2008

• The GTA Portal and HIAL initiative continues as planned. The recommendations to be taken

forward by this committee to eHealth Ontario are scheduled for late February. Sarah Kramer, CEO of eHealth Ontario will be presenting the draft provincial eHealth strategy to the eHealth Ontario Board of Directors at their annual retreat late January. It is her intention to gather feedback and then socialized the draft strategy at the February eHealth retreat. Once all feedback has been gathered and approvals in place, the final strategy will be presented in March 2009.

Aboriginal Community Engagement and Planning:

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The MH LHIN continues to lead work in partnership with the five GTA LHINs in developing a draft Aboriginal Community Engagement plan leveraging resources and planning efforts, particularly for the Off Reserve / Urban Aboriginal population in the GTA LHINs. An engagement event is planned with the GTA Aboriginal Leaders for March 3, 2009, at the Native Canadian Cultural Centre in Toronto. Our goal at this session is to secure their guidance and participation in the organization of future engagement events to ensure that these sessions are mutually productive and beneficial.

Francophone Community Engagement and Planning: The Ministry of Health and Long Term Care proposes a new regulation that would require each LHIN to establish a committee no later than six months after the regulations comes into force in order to engage the Francophone community on the local health system. The five GTA LHINs continue their planning discussions and strategy development for joint, collaborative community engagement plans where feasible. In addition the Mississauga Halton LHIN is working closely with the Ministry Francophone consultant building planning activities in accordance with the proposed regulations, including a HHR French Language Service (FLS) survey, key stakeholder engagement activities in support of the IHSP and planning meetings with four identified agencies in the LHIN. The HHR FLS survey will be distributed to all health service providers (HSP) in our LHIN with the goal of collecting data from each HSP by occupation type, in terms of their French language skills, competency, French speaking patient identification, recruitment strategies, etc. Our target is to distribute this survey in early February with a results summary targeted for the end of March.

III Notable HSP Activities

• N/A

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Management Report to the Board November 2008

IV Key Meetings / Emerging Issues

Provincial Priorities Working Group

Narendra sits on a joint LHIN-MOHLTC Provincial Programs Working Group where discussions are taking place on all aspects of the various programs currently provincially managed or LHIN managed such as cardiovascular services and dialysis. The LHIN interests are expanding the definition of the use of funds in these areas with new technology and to maximize quality and access to care. The focus is on: a) The 2008/09 deficit in dialysis programs in Ontario has been addressed. The surplus in

cardiovascular program and the need to come up with a solution for 2008/09 will be completed in the next 2-3 weeks.

b) A strategy to address realistic needs in Dialysis and Cardiac programs in 2009/10 has been agreed to, including the need to “right size” the programs across the Province.

Refreshing the Integrated Health Service Plan (IHSP) The MH LHIN is beginning the work on refreshing the IHSP for 2010/11 – 2012/13. This refreshed IHSP will be delivered to the public in the fall of 2009. The refreshed IHSP will focus further on defining the health care system needs and strategies to integrate the local health system. The project is just getting underway and further communications on the roll-out of the planned approach will be forthcoming in the coming weeks. Launch of Multi-Sectoral Service Accountability Agreement (M-SAA) For All Community Agencies Including CCAC

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June 2008 March 2009

Significant work is underway to review the Community Annual Planning Submission (CAPS) submitted by all MH&A HSPs. The LHIN has undertaken an extensive process to communicate and assist all HSPs in completing the requirements for the submission. High level overview of the M-SAA process was presented and more detailed information provided, along with training on the CAPS and identification of some of the performance indicators. There was a Q&A teleconferencing session with the LHIN Provincial Leads for the CAPS development. Answers to these Q&A and other Ministry provided Q&A is available on the MH LHIN website. Hospitals Accountability Agreements (2008/09/10) Substantive discussions have taken place with all hospitals to lift the waiver and on the need to be balanced. The LHIN expects to have 2009/10 balanced agreements signed off by two hospitals by January 21, 2009. L:\Board Templates\Management Reports\January 09\Management Report - January Board Meeting.doc



Management Report to the MH LHIN Board of Directors – February 2009 I MOHLTC Updates MOH LHIN ED Strategy Monthly Meeting

Senior LHIN staff attended the first monthly meeting of all LHIN ED strategy leads (non medical) with the ministry team to discuss various issues including a reporting template.

ED Wait Times 2009/10 Performance

The Ministry of Health and Long Term Care will fund 50 EDs across the province in 2009/10 as part of the Year II ED/ALC Strategy. In the MH LHIN the following sites have been identified: Trillium Health Centre- Mississauga site, Credit Valley Hospital, and Halton Healthcare Services – Oakville and Georgetown sites. The Provincial targets are to reduce ED wait times by 10 percent in the following:

• Admitted patients treated within length of stay target < 8 hours • Non-admitted high acuity patients: CTAS I-II < 8 hours, CTAS III < 6 hours • Non-admitted low acuity patients: CTAS IV-V <4 hours

The ministry is expected to confirm each hospital site baseline targets in Spring 2009. The MH LHIN will submit a LHIN Action Plan based on the Pay for Performance Program for the designated hospitals by March 16, 2009. On February 17, the hospitals met with the LHIN and ED Lead to review the preliminary planning and shared information among the hospitals and further discuss potential LHIN wide initiatives. Hospitals will submit their plans to the LHIN by March 9th and a follow-up meeting is being planned to confirm LHIN wide approach that would be incorporated into the plan to be submitted to the ministry.

II Progress on ASP / ABP Priorities Aging At Home

Assist Model Implementation Planning

The Mississauga Halton LHIN is embarking on the implementation of the intake/discharge, information & referral and navigation components of the ASSIST (All-Inclusive Seamless Services for Independence of Seniors’ Today and Tomorrow) model - a collaborative initiative aimed at:

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Management Report to the Board – February 2009

• enabling seniors leaving hospital to easily access the services and supports in the community • connecting community dwelling seniors/caregivers to find the community health and

specialized services they need • assisting seniors/caregivers to live healthier and active lives in their communities

As a first step in the implementation design, the team led by Ray Applebaum is holding an intense four-day implementation planning session on February 17, 18, 19, and 20th for up to 30 participants who we hope will represent the range of front-line and managerial roles within in the hospitals (in-patient and ED), CCAC, specialized geriatric services, family health teams, community support services, LTC day programs, supportive housing, and other organizations that primarily serve seniors in the community. This four-day planning event will design the ASSIST model implementation using the lean methodology for quality improvement planning with a qualified lean facilitator, Ron Bercaw. The anticipated outcomes of this session are: • confirmation of the ASSIST intake/discharge, information & referral, and navigation

process(s) • a clear plan for the tools, roles and enabling technologies for the proposed intake/discharge,

information & referral, and navigation process (s) • an overall project plan to guide this phase of implementation The results of this planning event will be shared with stakeholders following the session. A one (1) hour “Report Out” session will be held on February 20th at 2:30 p.m. of the Value Stream Analysis session at the Canadian Coptic Centre, 1245 Eglinton Avenue West, Mississauga.

Supports for Daily Living

• The innovative Mobile SDL services was launched this month and it will have additional

capacity. • The new SDL referral and eligibility process had been confirmed with the CCAC and SDL

providers and implemented. The process is designed to fit with the new HOME FIRST culture whereby patients will be discharged from hospital to home with CCAC services where needed until referral and eligibility to SDL is completed.

Media Coverage As part of the ED strategy coverage in the media, two of the MH LHINs innovative programs – RESTORE (Mississauga Life Centre) and the new model for Supports for Daily Living (SDL) were featured in the Toronto Star. We want to thank all of our providers for their great cooperation in development of these two programs and other initiatives.


ALC Steering Committee Progress Report

1A Priority Status • On January 26, 2009 a 1A Priority status was given to all hospitals in the MH LHIN to help

address significant ER gridlock pressures over the past two months.

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• A focus of the 1A is on the hard to service population in acute care waiting for LTC

Placement. In the past 2 weeks 22 patients were placed through a collaborative effort with hospitals, CCAC and LTC homes. This is about 50 % of the “hard to serve” ALC patient population in hospitals. This process should continue beyond the time of 1A status.

• 1A designation timeline is to end of February with a planned evaluation at that point to determine if there is a need to continue.

• The HOME FIRST initiative has had the most impact thus far in changing discharge culture across an entire hospital to decrease ALC percentages and numbers of new ALC patients each month. It is our most significant initiative to help us achieve the ALC (in acute care) target (2008/09 – 9.8%). The HOME FIRST approach is to make every effort to enhance community services to facilitate discharge from hospital. This may be achieved through CCAC services, SDL, Restore Program to minimize the number of patients who would need to remain in hospital to wait for LTC placement.

Geriatric Navigation System

• Geriatric System Navigation has been implemented at both HHS and CVH, with plans for

THC as soon as possible. The Geriatric System Navigation is a program that provides CCAC follow up for all patients 75+ who have been assessed in the ER and released. At the end of January, 969 patients were referred from ED at CVH and HHS. Of these 267 were active with CCAC services, 47 were from LTC homes.

Long Tem Care Homes Sector Meeting

The LHIN has had regular meetings with this sector following the group’s regular monthly meetings. Attendance at these meetings has been less than desirable. As a result, the LHIN requested a special meeting of Long-term Care Home Administrators and their corporate leadership on Thursday, February 19, 2009. at the Mississauga Halton LHIN office. This meeting will be the first of a regular (every two months) series of meetings to be hosted by the Mississauga Halton LHIN as a forum to identify and discuss priority initiatives of the LHIN that involve long-term care homes and provide the sector opportunity for valued input and comment. These meetings will be instrumental to move forward many initiatives that are designed to improve overall system service capacity and provide additional supports for long-term care homes to increase their capacity to admit higher needs residents who currently are in hospitals. It will set the stage for initiatives that will occur in the upcoming year and also provide updates on key integration initiatives and successes of the ED/ALC strategy that involve or relate to long-term care homes in our community. The Restore Program at Mississauga Life Care is one such successful program that was mentioned in a recent Toronto Star article.

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Wait Times

Wait Times and MLAA Targets

Mississauga Halton LHIN has just received its data for Q3 2008-09 MLAA Indicators and the MLAA Reporting Dashboard is shown below. The LHIN is doing well in most areas where it is below baseline or within the established corridor.

Based on this information, the MH LHIN is required to report to the Ministry on two indicators – Median Wait Time to Long Term Care Placement (at 98 days) and Percentage ALC days at 11.12%. Staff is following up with the ministry regarding discrepancy with the numbers for the Median Wait Time for LTC placement. Median Wait time to LTC Placement The 2008/09 target for median wait time to LTC placement is 70.5 days. The current wait time for the third quarter is 98 days which is outside the performance corridors. There is a discrepancy in the calculation of this wait time that we are following up with the ministry. While the wait times for people placed from hospital and community have gone down the cumulative wait time have increased.

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Percentage of ALC Patient Days The ALC patient target for 2008/09 is 9.8 percent. The current percentage for the third quarter is 11.12 percent which is outside the performance corridor. We expect that a number of the ED and Aging at Home initiatives will reduce the median wait time to LTC placement and reduce the ALC patient days through enhanced CCAC community services, and the mobile Supports for Daily Living initiatives which should improve the flow and discharge of patients back to the community and defer or reduce the need for LTC placement. As these programs have only been initiated late in Q3 and into Q4, we expect to begin to see results by the end of Q4.

Community Sector Supply Chain Integration with Shared Services West (SSW)

A committee to explore and implement group purchasing and supply chain efficiencies has been struck with membership from the community sector, Shared Services West, MH CCAC and the LHIN. This group met on February 18, 2009 to review draft terms of reference and process moving forward. Prior to this meeting Narendra Shah and Sue Turcotte met with the project manager from shared services west to review project plan and scope. The purpose of this initiative is to explore the cost-savings to be derived with all purchasing centralized and procured through Shared Services West.

Clinical Services Integration (Acute Care)

The Steering Committee met on January 20, 2009. Functional plans for a regional vascular and neurosurgery are completed. CVH has sent the regional thoracic oncology surgery proposal to Cancer Care Ontario. It is expected that the vascular and thoracic surgery programs will be implemented in Spring 2009. Capacity Review of Critical Care, ER and Perioperative Areas The LHIN along with the three hospitals has engaged PRISM Partners Inc. to develop a plan for the best use of hospital Emergency Room, Critical Care and Perioperative (Operating Theatres, Post Anaesthetic Care Units, Pre-op/Surgical Holding areas and Procedure Rooms) facilities in the MH LHIN to promote the best possible care for MH LHIN residents. This plan will consider optimizing the available facility capacity now and over the next 5 years, with consideration to approved major capital projects. Success Factors • Development of recommendations that are supported by MH LHIN stakeholders and based on

best practice evidence • Development of recommendations that will support a larger MH LHIN Acute Services Study

and future planning by MH LHIN hospitals • Development of recommendations that are pragmatic and implementable now • Findings that will specifically enlighten planning around alternative settings for surgical

procedures, critical care and emergency services

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Deliverables will be:

1. A robust review of international and national best practice literature in the delivery of perioperative, emergency and critical care services.

2. Recommendations for the best use of MH LHIN hospitals based on optimizing the available capacity of Emergency Rooms, Critical Care and Perioperative areas over the next five years.


Oct 2008 March 2009 Dec 2009 Implementation of the recommendations from the Systems Integration Group for Mental Health and Addictions (SIGMHA) continues. (SIGMHA is made up of 35 plus volunteer members, at executive level, from the various mental health and addiction agencies and organizations within the LHIN, families and clients.) A number of task teams were established under SIGMHA to implement the voluntary integration of a service delivery model for mental health and addictions.

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The task team activities and progress on meeting their objectives are highlighted in the following table. SIGMHA Task Team Status Update Virtual Integration - Currently exploring a virtual integration assessment

tool and methodology that could be used in the assessment of current integration projects.

Quality Measurement & Evaluation - Continue working with the MIS Advisory Committee on the development of common data definitions specifically related to ‘visits’ and ‘occasions’.

Co-Location - Parameters for the co-location initiative have been finalized. Currently working on space requirements & design of co-location site. The initial co-location site will be Oakville; followed by Milton/Acton.

Road Show - The task group has completed its objective which involved promoting and socializing key community stakeholders on the work being carried out by SIGMHA. A series of presentations were held in the Fall 2008 at hospital ground rounds; CEO/ED community service sectors in Halton and Peel; and Boards of Directors of MH&A agencies LHIN wide.

Education & Training - A framework for education with defined principles and goals has been developed. Three workshops are being planned across the LHIN in the month of March 2009 to raise awareness of this framework. A one day workshop is being organized bringing together the leadership of both mental health and addiction services to identify existing enablers and barriers to the integration of services around a client and develop a work plan to drive the next phase of integration. In addition, a one day workshop is being organized for clients, families, community and service providers to come together and draft a set of ‘Recovery’ principles and values which would be adopted by all service providers within our LHIN.

- In addition, in the area of risk management, Dr. Paul Links, Chair of Suicide Studies, U of T will present an advanced workshop diagnostic differentials in suicide risk assessment which will be open to all clinicians.

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Integrated Palliative Care

The LHIN engaged to a consultant to complete situational analysis for palliative care in the MH LHIN was completed. A framework has been designed which will outline the continuum of care for palliative patients in our LHIN (based on the success of a similar framework used for the ALC strategy). A meeting with key stakeholders who provide any care to palliative patients in our LHIN will be scheduled for March. The intended outcome for this meeting is to start to look at how/where palliative patients are currently receiving care, which will lead to constructive discussions about what is the appropriate level of care that they should be receiving and in what setting. We will be working with key stakeholders in developing a more robust, integrated system for palliative care that is built on existing strengths and capacity in our current system.

Primary Health Care (PHC)

The structure and deliverables of this DPA Team are currently being revisited and a meeting with the co-leads (Connie Day and Dr. Corinne Breen) is scheduled for the second week of March. Some key deliverables for this team have been completed including, “Regional Credentialing” is being implemented in the next few months in our hospitals; and a key report on investigating specific and significant gaps in access to PHC has been completed. Some other key initiatives including the development and implementation of a comprehensive physician engagement strategy and eHealth initiatives will also be examined.

Preventing and Managing Long-Lasting (Chronic) Conditions Self-Management Task Group

The Self-Management Task Group continues to implement a LHIN wide strategy to build capacity for self-management among health care professionals and individuals with chronic conditions. The objectives of the strategy are to increase awareness and application of the principles and concepts of self management by creating a common foundation (skills, language and definitions). There are four components to the strategy designed to address a wide spectrum of learning needs:

1) One Hour Workshop: How Self-Management Can Make a Real Difference

After a brief introduction to the rationale, guiding principles and SM strategy for the MH LHIN, participants will learn more about SM tools such as goal setting, action planning, and problem solving. This workshop will allow participants to begin using these tools in patient encounters.

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2) Four Hour Workshop: Working Together to Bring Self- Management to our Community

This workshop is suited to those already familiar with the rationale and guiding principles for SM in the MH LHIN, and who are familiar with SM techniques. In this ½ day workshop, participants will have ample opportunity to practice SM techniques such as goal setting, action planning, and problem solving in both individual and group settings. Using a case based approach, we will develop strategies specific to each clinician’s practice/environment.

3) Train the Trainer: Stanford CDSMP Leader Training Sessions

This 4 day program is suited to individuals interested in leading a Stanford Chronic Disease Self-Management Program (CDSMP) in their community. Participants will become Certified Lay Leaders of the Stanford CDSMP. Working in pairs, they will be able to deliver the scripted, 6-week (1 session per week) program outlined by Stanford, in their own community, for persons with chronic disease. There will be an expectation that 1 Stanford program will be run by the lay leaders (in pairs) within a year.

4) Six Week Stanford CDSMP Training Sessions: Maximize Your Health

This program is a workshop given two and a half hours, once a week, for six weeks, in community settings. This group program is open to adults with chronic health problems. Workshops are facilitated by two trained lay leaders. It is the process in which the program is taught that makes it effective. Classes are highly participative, where mutual support and success build the participants’ confidence in their ability to manage their health and maintain active and fulfilling lives. Topics covered include: 1) techniques to deal with problems such as frustration, fatigue, pain and isolation, 2) appropriate exercise for maintaining and improving strength, flexibility, and endurance, 3) appropriate use of medications, 4) communicating effectively with family, friends, and health professionals, 5) nutrition, and, 6) how to evaluate new treatments.

Diabetes Education Task Group

In response to a chart review of ER Visits in the MH LHIN for Hypoglycemia, the Diabetes Education Task Group is implementing LHIN wide diabetes education sessions for Medical Directors and staff of LTC Homes to improve the quality of care of residents with diabetes in Long Term Care (LTC) Homes.

The education sessions for Medical Directors, entitled Effective and Simple Insulin Regimes for the LTC Population will be provided in March. The education sessions for LTC Homes will be scheduled in consultation with the LTC Homes and will occur over the next several months.

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Connecting the Dots on South Asians and Stroke:

A one day planning session is being held on March 4, 2009 to explore issues around South Asians and Stroke in the GTA. Health Nexus is leading this session of Connecting the Dots (CTD) which is a multi-sectoral, community engagement initiative that helps us work together differently for better stroke (and chronic disease) outcomes and improved health for all. The CTD brings together a wide cross-section of community leaders to address complex problems in a new and innovative way.

eHealth

The provincial eHealth Strategy was released in draft form on February 4, 2009. An executive summary of the larger strategy has been circulated to the MH LHIN Board of Directors and will be discussed by the CIO during the February board meeting. Upcoming Major Milestones

• The draft eHealth Strategy Refresh will be pre-circulated to the Health Leaders Collaborative for

the March 17 meeting. The CourtYard Group will be facilitating this discussion lead by John Ronson, Senior Partner and Kathy Winter, Sr. Engagement Lead and Principle. Once completed a final draft of the strategy will be presented to the Board of Directors.

• In collaboration with the Community Care Sector the MH LHIN has approved one time funding

of $125K to develop a Community Care Sector provider portal which will facilitate electronic workflow and online collaboration through a web-based portal infrastructure. The initiative will be lead by Karen McClure, eHealth Coordinator. It is our intention to complete the development phase of this work by the end of March 31, 2009. A “go live” date is to be determined and dependent on sector preparedness for integration (education, communication, etc.).


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Planning is in the final stages for the March 3, 2009 community engagement even with the GTA Aboriginal leadership. The event has now be named, Strengthening the Circle, and will take place at the Native Canadian Cultural Centre in Toronto. The MH LHIN continues to lead this work in partnership with the five GTA LHINs leveraging resources and planning efforts, particularly for the Off Reserve / Urban Aboriginal population in the GTA LHINs. Our goal at this session is to secure from the Aboriginal leadership their guidance and participation in the organization of future engagement events to ensure that these sessions are mutually productive and beneficial. At the present time we have 20 confirmed attendees with representation from each of the 5 GTA LHINs. Board Director, Ted Morris will be joining us.

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Francophone Community Engagement and Planning: The Ministry of Health and Long Term Care proposes a new regulation that would require each LHIN to establish a committee no later than six months after the regulations comes into force in order to engage the Francophone community on the local health system. The five GTA LHINs continue their planning discussions and strategy development for joint, collaborative community engagement plans where feasible. The French Language Service (FLS) survey has been completed and is ready for distribution to all Health Service Providers that have not been designated or identified to provide services in French, with the goal of collecting data from each HSP by occupation type, in terms of their French language skills, competency, French speaking patient identification, recruitment strategies, etc. Our target is to distribute this survey in early March with a results summary targeted for the end of April. MH LHIN Francophone leadership have been briefed on the IHSP process and planning efforts and they will be actively involved in planning and participating in the community engagement session for their leadership and their communities targeted for the April / May timeframe. As well, the MH LHIN continues to work closely with the Ministry Francophone consultant, France Tolhurst, building key stakeholder relationships within the Francophone community, including recent attendance at a Francophone New Immigrant Regional Session. We continue to work on the development of a briefing session with the current identified agencies (4) in the MH LHIN to review their requirements under the French Language Services Act.


Launch of Multi-Sectoral Service Accountability Agreement (M-SAA) For All Community Agencies Including CCAC

The Mississauga Halton LHIN will require the new M-SAA agreements signed by March 31, 2009 with 12 Mental Health & Addiction Providers, 36 Community Support Services Providers and the CCAC. All the MH LHIN HSPs have submitted their CAPS documents and LHIN staff is progressing towards final compilation of the documents to send to the provider Boards for review and sign-off:

• 40% of our HSP submissions are now ready to have the agreement templates populated • 74% have been analysed and now require some minor follow-up questions about their

submissions

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The following tracking chart shows our progress towards meeting the March 31 deadline:

Tracking of MH LHIN M-SAA Process

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TotalAgencies

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During our regular Quarterly Community Support Services Sector Meeting (March 6) we will update all of our HSPs on the progress of the M-SAA process, provide further details around the MH LHIN Performance Indicators and answer any questions they may have. We anticipate that the majority of providers will have received their M-SAA agreements for review in advance of this date.


Accountability Development Team John Magill and Narendra sit on the joint Ministry/LHIN Accountability Development Committee (ADT) where amendments to the 3 year Ministry LHIN Accountability Agreement (MLAA) will be made for 2009/10 fiscal year. The evolving role of the Ministry and LHINs will enable better alignment of roles and responsibilities and reflected in the revised MLAA.

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Management Report to the Board February 2009

Provincial Priorities Working Group

Narendra sits on a joint LHIN-MOHLTC Provincial Programs Working Group where discussions are taking place on all aspects of the various programs currently provincially managed or LHIN managed such as cardiovascular services and dialysis. The focus is on: a) The 2008/09 deficit in dialysis programs in Ontario has been addressed. The surplus in

cardiovascular program and the need to come up with a solution for 2008/09 is now completed.

b) A strategy to address realistic needs in Dialysis and Cardiac programs in 2009/10 has been agreed to, including the need to “right size” the programs across the Province.

Refreshing the Integrated Health Service Plan (IHSP) An internal Working Group and Project Lead have been identified for this corporate project. Weekly meetings have been scheduled and a Project Charter has been completed. The refresh of the environmental scan is well underway, including the most recent data and analyses that are available. As well, a situational analysis has been completed which identifies and maps out to the first IHSP all of the deliverables and initiatives that have either been completed, or are currently underway. This analysis is a cross reference to all of the integration initiatives that our LHIN has been/is involved in. The environmental scan and situational analysis will be stand alone documents that will be posted on our website, with the former also consisting of 3 additional appendices: i) CDPM, ii) Seniors/A@H and iii) ED/ALC data, as there is abundance of data/info for these sections. A project timeline has been completed which outlines key deliverables and all of the community engagement activities. An RFP is currently being issued to obtain services to provide innovative citizen engagement. L:\Board Templates\Management Reports\February 09\Management Report - February Board Meeting.doc



Management Report to the MH LHIN Board of Directors – March 2009 I MOHLTC Updates MOH LHIN ER/ALC Wait Time Strategy

The chart below outlines the overall goals of ER/ALC Wait Times Strategy

The ER/ALC Wait Time Strategy has clearly defined goals to reduce time spent in the ER

KEY ENABLERS

*ER/ALC Information Strategy *Public Awareness Campaign, including website on ER alternatives, TV & media

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Management Report to the Board – March 2009

Monthly Meeting with the Ministry on ED Wait Times

The second meeting of the MOHLTC/LHIN ED Leads meeting was held on March 17, 2009. The ministry reviewed the key performance indicators that will be monitored through the Stocktake Report which will be submitted to the Ministry by April 29, 2009. ED Pay For Performance: Performance Indicators The key performance indicators include: 1. Reduce ER demand: rates of ED visits for conditions that may be treated elsewhere 2. Increase ER capacity/performance:

(i) Time spent in ER for CTAS 1, 2, 3 admitted patients (ii) Time spent in ER for CTAS 4, 5 non-admitted patients

3. Improve Bed Utilization:

(i) Percent ALC days (ii) Number of days from ALC designation to discharge (proposed).

The attached Appendix A, “Provincial View by LHIN”, provides a provincial overview of the 14 LHINs current performance in these areas. The most challenging area for all LHINs and the MH LHIN in particular is the ED wait times for admitted patients.

MH LHIN ED Action Plan 2009-10

With extensive engagement of our ED lead and the LHIN’s ED wait times group, the MH LHIN has developed its 2009/10 ED Performance Improvement Action Plan Strategies. The 2009/10 MH LHIN ED Action Plan was submitted to the ministry on March 16, 2009. The next meeting is planned with the MH LHIN hospital ED leadership on additional LHIN wide strategies to address ED pressures. This meeting is scheduled for April 3, 2009. The Ministry will respond to the Plan by March 30th and planning allocation letters with performance expectations will be sent first week in April 2009.

II Progress on ASP / ABP Priorities Aging At Home

Assist Model Implementation Planning

An intense four-day implementation planning session (February 17 – 20th) using the lean methodology for quality improvement was held to design the intake, information and referral and navigation process(es) for the ASSIST model. Lean thinking has two key themes: elimination of waste or non-value added activities and respect for all people. The session included 30+ participants from across the health system.

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Critical steps in the Value Steam Analysis:

1. Identify boundaries for the process and key measures. 2. Define customers and specify value – as determined through the customer. The customer was

seniors and their families / caregivers. 3. Map the current state using case scenarios and then see the waste (e.g. wait lists, re-work). Waste is

“any activity that takes time, space, or resources but does not contribute directly to satisfying the needs of a Customer”.

4. Identify the attributes of the perfect process and barriers to achieving the perfect process. 5. Design the new process.

Outcomes from the Value Stream Analysis:

Understanding of the customer and what’s of value to them. Wastes associated with the current process. New process including high-level overview of tools, roles and enabling technologies required. 21 detailed action plans to achieve the new process.

Currently, work is underway to develop a detailed work plan and business requirement for new process. Wait Times Wait Times Volumes and Allocation 2009/10 The Ministry has confirmed LHIN-wide wait times planning allocation for MH LHIN for 2009/10 at $8.224M which represents 11.2% of reduction from 2008-09. The overall reduction for the province is 11.3% with LHIN to LHIN reduction of between 2.8% - 3.2%. Based on this allocation, through extensive work with all hospitals, the LHIN has submitted a plan for numbers of procedures to be completed for cataracts, hips and knees, CT and MRI. Several factors were used including current wait times performance, implications on ER wait times performance, and health human resources implications. Once the LHIN volumes and allocations plan is accepted by the Ministry, formal allocation letters will be sent to our hospitals by end of March, 2009. Cataract Wait Time Guarantee Provincial Program Launch

A Memorandum of Understanding was signed by the Minister of Health and Long-Term Care and his federal counterpart outlining their mutual commitment towards reducing wait times for cataract surgery through the implementation of a surgery guarantee on March 15, 2007.

On March 27, 2007, the Government of Ontario publicly announced its commitment towards establishing a province-wide cataract surgery wait time guarantee within the public health care system.

The Timely Cataract Surgery Pilot Program launched in the Champlain LHIN on November 28, 2008. The province-wide initiative will be implemented in March, 2009.

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Hospital Wait Time Compliance Incentive – starting in 2009-10, the originating hospital (from whose wait list the patient is taken) will cover the patient’s procedural costs if timely surgery is provided at another facility. Originating hospitals will also partially offset travel expenses (where applicable). Please note that for 2008-09 only (since hospitals have already signed their 2008-09 cataract funding conditions) the Ministry will cover the patient’s procedural costs at another facility and partially offset their travel expenses (where applicable) under an interim processing scheme.

Care Connection – clinical treatment coordinator (utilizing the same Community Care Access Centre (CCAC) – based Care Connectors as the Health Care Connect program).

Patient Education – Ophthalmologists will initially inform the patient of the program. Family physicians will be provided with education materials so they can counsel their patients as well, should the need arise.


Comparative of ALC Performance The chart below on ALC is based on the latest data available. The MH LHIN is doing relatively well, still above the agreed to target of 9.8% +/- 10%. The excellent work of the ALC Steering Committee, its sub-groups and all providers need to be sustained to deal with this challenge.

Comparison of Province and Mississauga Halton LHIN %ALC of Acute Patient Days2006/07 and 2007/08

6.467.12 7.15

8.849.48 9.19

10.0810.88

12.94

11.1210.73

11.37

12.57

13.72

12.7713.51

14.31

15.14 15.2014.83

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By Quarter

% A

LC MH LHIN

Ontario

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1A Priority Status for Hospital Patients Waiting for LTC Placement Due to seniors ED admit to be pressures, the LHIN involved a 1A Priority Status.

1A status continued to February 28th The target group for 1A Priority has been limited to all hard to serve individuals in acute care will

continue as 1A for four additional weeks. Hard to serve individuals are those ALC patients waiting who require special needs, including those for behavioural or mental health needs, complex medical needs, i.e. kidney dialysis patients. As of March 18, a significant number of patients have been placed through collaborative efforts.

Hard to Serve Population

Working with hospitals to “hard wire” process to ensure firm action plans and strategies in place to assist in successful transition of hard to serve patients to long–term care

Peel Halton Acquired Brain Injury Services currently working with THC on several potential clients identified

Facilitated meeting with THC Psycho geriatric Outreach and Halton Psycho geriatric Outreach to ensure consistent approaches and clarification in how to coordinate their services across the MH geography

System review of current capacity for secure versus demand as well as basic bed demand versus access to basic beds continues.

Home First Strategy: Every effort is made to discharge people home, and from there determine the level of services to sustain the clients at home, Supports for Daily Living, or start the LTC placement process

HHS process completed in December 2008 THC launched Feb 9th – work is continuing to reinforce protocols and maximize impact of new

initiative Meeting with CVH completed – plans for presentations at MAC and clinical leadership meetings

underway.

Medworxx, a hospital clinical utilization management tool

Implementation and training continue with the 3 hospitals with the expectation that the system will be operational by the end of March in the medical surgical units

Meetings being scheduled for implementation of the tool in CCC / Rehab areas.

Supports For Daily Living (SDL)

Regional Service Delivery Framework/model completed Mobile SDL has 11 clients on services and has diverted two from LTC 43 more applicants under review Additional service introduced at THC between 9 pm and 6 am - Mobile workers can meet patients

treated and released at emergency department from their home and assist them to get settled and check in on them overnight. Roll out to CVH and HHS to occur in March.

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Geriatric System Navigation, CCAC case manager follow-up with 75+ patients from the ERs

CVH roll out continues to be very successful HHS implementation – complete THC to implement April 1st Over 1200 referrals by end of February.

Transitional Services Work Group:

Snapshot tool for CCC analysis developed Snapshot of all current CCC clients completed (analysis pending) Updated work plan to include Palliative Care Services and Rehab Services.


The community sector has been appraised of the project scope through a communiqué and at the community sector quarterly meeting on March 6. To date, the feedback for this project has been positive. Shared Services West has begun its initial review of procurement and supply chain activities with those agencies that are on the Steering Committee.

Capacity Review of Critical Care, ER and Perioperative Areas The LHIN along with the three hospitals has engaged PRISM Partners Inc. to develop a plan for the best use of hospital Emergency Room, Critical Care and Perioperative (Operating Theatres, Post Anaesthetic Care Units, Pre-op/Surgical Holding areas and Procedure Rooms) facilities in the MH LHIN to promote the best possible care for MH LHIN residents. This plan will consider optimizing the available facility capacity now and over the next 5 years, with consideration to approved major capital projects. The project team has been established and phase I has started with the collection and review of documentation from each hospital. A literature search is underway and qualitative data is currently being received. Stakeholder consultation and site visits are planned for March to early May. An Expert Clinical Panel is currently being set up that includes representatives from MH LHIN hospitals as well as provincially recognized experts. The expert panel includes:

Dr. Eric Letovsky (Emergency Care Lead) Dr. Laurence Chau (Critical Care Lead) Dr. Gary McIsaac (Peri-operative Lead) Nurse Leads (Peri-operative): Lina Rinaldi, Ronda Warrian and representatives for HHS Dr. Thomas Stewart, Critical Care, PRISM Dr. Bryce Taylor, Perioperative Services, PRISM Betty Watt, RN, Perioperative Services, PRISM Dr. Paul Hawkins, Emergency Services, PRISM.

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Oct 2008 March 2009 Dec 2009 Implementation of the recommendations from the Systems Integration Group for Mental Health and Addictions (SIGMHA) continues. (SIGMHA is made up of 35 plus volunteer members, at executive level, from the various mental health and addiction agencies and organizations within the LHIN, families and clients.) A number of task teams were established under SIGMHA to implement the voluntary integration of a service delivery model for mental health and addictions.

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The task team activities and progress on meeting their objectives are highlighted in the following table. SIGMHA Task Team Status Update Virtual Integration - Utilizing the Weiss Partnership Assessment

Synergy Tool (PSAT), all partnerships which met set criteria were assessed to better understand the factors that contribute to the success of the partnerships and to identify opportunities for the future. The response rate has been high and generally positive. A report is being generated on the overall results plus an individualized report for each partnership.

Quality Measurement & Evaluation - In keeping with the LHIN Quality Indicator Framework, the team is reviewing client satisfaction surveys with the aim to rollout a tool that will be used by all service providers. This would allow for benchmarking not only across similar organizations within our LHIN but within other jurisdictions.

- As the only LHIN with an increase in early return ED visits, the team is starting to investigate what could be contributing to this phenomena, what strategies are being employed in other areas to reduce ED visits for people with mental health problems and opportunities for improvement.

Co-Location - With clear parameters established for a Co-Location project in Oakville, the team is shifting its focus to other regions of LHIN 6. A community meeting was held on March 4th in Milton for all mental health and addiction service providers. This meeting was led by an external facilitator and was the first step in establishing a ‘multi-purpose’ hub in North Halton. A business case is being written to determine the financial viability of these hubs.

Road Show - Two presentations are being made in March to front line staff groups, in both Mississauga and Oakville. These are the last presentations scheduled. However, the team will respond to ongoing requests as needed.

Education & Training - Activity is focused on the organization of three workshops which are being rolled out this month. A one day workshop is being organized bringing together the leadership of both mental health and addiction services to identify existing enablers and barriers to the integration of services around a client and develop a work plan to drive the next phase of integration. In addition, a one day workshop is being organized for clients, families, and community and service providers to come together and draft a set of ‘Recovery’ principles and values which would be adopted by all service providers within our LHIN.

- In addition, in the area of risk management, Dr. Paul Links, Chair of Suicide Studies, U of T will present an advanced workshop diagnostic differentials in suicide risk assessment which will be open to all clinicians.

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A meeting with key stakeholders who provide care to palliative patients in our LHIN has been scheduled for March 30, 2009. This meeting will be the first in a series of meetings intended to look at how/where palliative patients are currently receiving care, moving to constructive discussions about what is the appropriate level of care that they should be receiving in each setting. We will be working with key stakeholders to develop a more robust, integrated system for palliative care that is built on existing strengths and capacity in our current system.


A meeting with the co-leads (Connie Day and Dr. Corinne Breen) was held to discuss the accomplishments of the Detailed Planning Action (DPA) team and to plan activities for the next year. It was agreed the DPA team will revisit the terms of reference in light of their accomplishments and taking into consideration the changing healthcare landscape. The next DPA team meeting will be scheduled for April and guest speakers from the MH LHIN eHealth office will be invited to discuss the Physician eHealth strategy and plan.

Preventing and Managing Long-Lasting (Chronic) Conditions Self-Management Task Group

The Self-Management Task Group continues to oversee the implementation of a LHIN wide strategy to build capacity for self-management among health care professionals and individuals with chronic conditions. The objectives of the strategy are to increase awareness and application of the principles and concepts of self management by creating a common foundation (skills, language and definitions).

The workshops have been offered over the past month to health care professionals within the CCAC, Family Health Teams and Hospital Based Clinics. The feedback from the participants has been positive.

Diabetes Education Task Group

In response to a chart review of ER visits in the MH LHIN for Hypoglycemia, the Diabetes Education Task Group is implementing LHIN wide diabetes education sessions for Medical Directors and staff of LTC Homes to improve the quality of care of residents with diabetes in Long Term Care (LTC) Homes.

The education sessions for Medical Directors, entitled Effective and Simple Insulin Regimes for the LTC Population took place on March 2, 2009. The education sessions for LTC Homes are underway over the next few months.

eHealth

The provincial eHealth Strategy was released on March 18, 2009 and will be posted publicly on March 19, 2009. The eHealth Strategy Refresh is entering its final stage; an executive summary was shared with the Health Leaders Collaborative and a final draft of the Strategy will be tabled at the April 21, Health Leaders Collaborative meeting for discussion and potential approval. The eHealth Advisory Committee continues to work with the Health Leaders Collaborative on developing a governance model under which the eHealth Strategy will be executed and the eHealth Advisory Committee will operate. Important to note - the MH eHealth Strategy is completely aligned with the Provincial Strategy. We are building provincially and aligning locally.

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• The ongoing Development of the Community Sector Provider Portal is continuing as planned, as is the

introduction of blackberry functionally with ONE MAIL for this sector. A high-level introduction of the scope and deliverables was shared with the community sector HSPs at their quarterly Metamorphosis meeting. It was well received.

• A RFQ was issued for a Diabetes Readiness Assessment and a Physician eHealth Strategy and it is our

intention to proceed with the development of these strategies in collaboration with CW LHIN within the next few weeks. These strategies are in support of both our local and provincial eHealth outcomes.


0% 25% 50% 75% 100% % Completion

On March 3, 2009, Ted Morris, Board Member of the MH LHIN and Diane Koz, Manager of Communications and Community Engagement participated in a community engagement event with the GTA Aboriginal leadership. A key theme was building aboriginal community engagement strategies. A report on the outcomes of the event will be made available once the report is completed.

Francophone Community Engagement and Planning:

Bill Campbell, Director of Health System Development and Diane Koz, Manager of Communications and Community Engagement at the MH LHIN participated in the public launch of Our Health, Our Priority Project in March 2008. This two-year project is an initiative funded by the Ontario Trillium Foundation (OTF) to allow for increased participation by the Francophone community in planning French-language services. The project will enhance the ability of local communities to work effectively with government organizations such as the LHINs and other health agencies. The project also aims to support the work of volunteers from the Francophone community to allow them to equip themselves with the means to receive and maintain an optimal level of physical, mental, social and economical well-being, individually as well as collectively. The project is a joint partnership with Le Centre de Services de santé-Peel et Halton Inc.; L’ACFO de London Sarnia, Le Comite santé Centre-Est (ACFO de Durham-Peterborough) et al FAFO (Federation des aines et des retraites francophones de l’Ontario).

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Launch of Multi-Sectoral Service Accountability Agreement (M-SAA) For All Community Agencies Including MH CCAC

The Mississauga Halton LHIN will require the new M-SAA agreements signed by March 31, 2009 with 12 Mental Health & Addiction Providers, 36 Community Support Services Providers and the CCAC. The following tracking chart shows our progress towards meeting the March 31 deadline. To date, all final M-SAA documents have been sent to the HSPs, with the exception of the MH CCAC, 11 agreements have been signed back by the HSPs, and 11 of these have been fully executed with the LHIN Board Chair signature to the agreements.

Tracking of MH LHIN M-SAA Process

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It is expected that all Community Support Services and Mental Health and Addictions HSPs will have Board sign back or administrative sign off for the M-SAA agreements by the March 31st deadline.

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Accountability Development Team (ADT) John Magill and Narendra sit on the joint Ministry/LHIN Accountability Development Committee (ADT) where amendments to the 3 year Ministry LHIN Accountability Agreement (MLAA) will be made for 2009/10 fiscal year. The evolving role of the Ministry and LHINs will enable better alignment of roles and responsibilities and reflected in the revised MLAA. The next meeting of the ADT is on March 24th. Provincial Priorities Working Group

Narendra sits on a joint LHIN-MOHLTC Provincial Programs Working Group where discussions are taking place on all aspects of the various programs currently provincially managed or LHIN managed such as cardiovascular services and dialysis. The focus is on: a) The 2008/09 deficit in dialysis programs in Ontario has been addressed. The surplus in cardiovascular

program provincially and the need to come up with a one-time solution for 2008/09 is now completed. b) A strategy to address realistic needs in Dialysis and Cardiac programs in 2009/10 has been agreed to,

including the need to “right size” the programs across the Province. All surpluses will now be recovered by the Ministry.

Refreshing the Integrated Health Service Plan (IHSP2) The refresh of the environmental scan has been completed, along with 4 appendices: i) ER/ALC, ii) Seniors/A@H community engagement, iii) Diabetes and physician/people survey results, and iv) eHealth strategy. As well, a progress report on the current IHSP 2007-2010 has been completed which identifies and maps out to the first IHSP all of the deliverables and initiatives that have either been completed, or are currently underway. This report is a cross reference to all of the integration initiatives that our LHIN has been/is involved in. The environmental scan and progress report will be shared and reviewed with members of the Integration Advisory Group (IAG) in March. IHSP2 materials will be posted to an eBinder that the Board will receive over the next week in preparation for the IHSP2 Board Workshop scheduled for April 2, 2009. The materials completed to date, with other inputs (such as direction from the MOHLTC, local community engagement completed to date, etc) and alignment with the Board Decision Criteria (with a revised lens applicable to Strategic Priority identification) will be used to help the Board identify draft strategic priorities and draft integration priorities for inclusion in IHSP2. These will then go out for consultation to key stakeholder groups over the months of April – June. Concurrently, an RFP has been issued by the MH LHIN seeking consultant services to help with the IHSP2, to specifically aid in the development and execution of community engagement events and design and completion of the final IHSP in a format applicable for public consumption. The deadline for applications is March 20, 2009 and the successful vendor will be selected the week of April 13, 2009.

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The Change Foundation Community Engagement Symposium & Workshop Bill Campbell, Director Health System Development, Diane Koz, Manager Communications and Community Engagement, and Kim Delahunt, Senior Team Lead Health System Development attended a workshop in Toronto in March 2009 sponsored by the Change Foundation. Titled Community Engagement & the LHINs:Truth and Consequences Symposium & Workshop, the focus of the workshop was on better understanding the key dimensions of community engagement, including ways to effectively frame community engagement strategies or issues. L:\Board Templates\Management Reports\March 09\Management Report - March Board Meeting.doc



Management Report to the MH LHIN Board of Directors – April 2009 I MOHLTC Updates MOH LHIN ER/ALC Wait Time Strategy

MH LHIN Emergency Department (ED) Action Plan – 2009/10 The MH LHIN’s ED Action Plan was well received by the Ministry which noted that the LHIN “submitted a well documented plan that supports the provincial objective on improving ED operations…” Four of our five ED sites will participate in the ED Pay-for-Results initiative in 2009/10. These sites include:

The Credit Valley Hospital Trillium Health Centre – Mississauga Halton Healthcare Services Corporation – Oakville Halton Healthcare Services Corporation – Georgetown.

The hospitals have proceeded to implement the 10% wait times reduction target as of April 1, 2009. The LHIN ED Wait Times Group is now focusing on LHIN-wide initiatives to assist with overall wait times reduction and increase patient satisfaction.

II Progress on Annual Service Plan Priorities Aging At Home 2009/10 The Ministry has reviewed the LHIN’s proposed initiatives for 2009/10 with respect to any policy issues. The LHIN expects formal approval of our strategies in the next few weeks. LTC Home Capital Renewal Strategy

On April 3, 2009 the MOHLTC announced the release of Phase 1 of the LTC Home renewal strategy. The LTC Home Renewal Strategy was initially announced by the Ministry in July 2007 and is the capital plan for the redevelopment of 35,000 “B”, “C” and upgraded “D” class long-term care beds in the province. Redevelopment will occur in 5 phases over a 10 year period. The goal of the strategy is to bring all homes up the current design standards that will:

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Management Report to the Board – April 2009

Facilitate the provision of quality resident care in an environment that is comfortable, aesthetically pleasing and as “home-like” as possible

Support well-coordinated, interdisciplinary care for residents who have diverse care requirements.

The deadline for submission of proposals to the Ministry is July 31, 2009 and it is anticipated that funding announcements will be made by the end of the Fall 2009. The Ministry and LHINs will conduct a joint proposal review process. The Ministry will review proposals to assess eligibility, financial capacity and the operator’s operational and compliance history. The LHINs will assess the ability of proposals to meet local LHIN priorities. A web-based seminar on April 29, 2009 will provide greater detail on the role of the Ministry and LHINs in both the application and evaluation process. A detailed project work plan will be developed as the result of the information obtained from this seminar.

Wait Times Wait Times Volumes and Allocation 2009/10 The Ministry has confirmed LHIN-wide wait times planning allocation for MH LHIN for 2009/10 at $8.224M which represents 11.2% of reduction from 2008-09. Based on this allocation, through extensive work with all hospitals, the LHIN submitted a plan for numbers of procedures to be completed for cataracts, hips and knees, CT and MRI. Several factors were used in determining allocations including current wait times performance, implications on ER wait times performance, and health human resources implications. The LHIN plan has been accepted by the Ministry and formal allocation letters were sent to our hospitals in early April, 2009.

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Wait Times Performance March 2009

Highlights:

Cataract surgery wait times increased by 50% or 41 days since the previous month, with 93% of cases completed within the priority 4 access target of 182 days. The increase was all at Credit Valley Hospital and they are investigating the cause of such a large increase in light of the new Cataract Wait Times Guarantee

Hip replacement wait times increased by 11% (17 days) since last month, while knee replacement wait times decreased by 10%. Both are significantly lower than baseline

MRI 90th percentile increased by 8% or 8 days since last month with only 27% of cases completed with the access target of 28 days.


1A Priority Status

1A status for individual hospital patients ended March 27th and as a result there was significant movement of Hard to Serve patients to LTC

Draft recommendations for application of 1A in MH LHIN developed by Senior Leaders Group to assist in future consideration of need for 1A designation

Sustainable strategies are being put into place in acute care and community to maintain gains made during 1A period (including Home First, Hard to Serve processes, enhanced meetings with Discharge Team and CCAC staff to identify and address discharge barriers)

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Work is continuing with hospitals and CCAC to “hard wire” processes to ensure firm action plans and strategies are in place to assist in successful transition of hard to serve patients to long–term care with the outreach support from PHABIS and Psycho Geriatric Programs

Procedure document is in draft based on actual work to date. This draft will be shared with ALC – TOG committee for finalization and sharing with all hospitals for use within respective organizations

A system review of current capacity for basic bed demand versus access to basic beds was completed. It appears that there is varied demand for basic beds across LHIN based on socioeconomic conditions (higher # patients at THC for basic than CVH and HHS).

Availability of basic beds inconsistent and at times low. The MH LHIN has written a letter requesting LTC Homes call in all basic bed vacancies (and not move a patient inside the home in to that bed) for a period of time to assist with hospital pressures. Future practice for LTC involves alternating an internal move and calling in basic bed vacancy to create a more sustainable patient flow for patients waiting for a basic bed.

Home First Strategy

THC implementation continues. Work over the last month at THC focused on ensuring consistent application of the process and escalation strategies when barriers or refusals encountered by THC and/or CCAC staff

HHS continues to maintain low levels of new ALC to LTC applications Meeting with CVH to develop implementation plan scheduled for April 8, 2009

Medworxx

Region-wide tool for ALC Management – Medworxx Tool Implementation and training for Med / Surg module completed at THC and HHS CVH is working with Medworxx on the changes to their Med / Surg tables to match THC and HHS Complex Continuing Care/ Rehab tables are scheduled for development in April.

. Supports For Daily Living (SDL)

Centralized referral to SDL completed: centralized coordinator seconded from one HSP and in place for pilot period to end of September where evaluation will follow – referral process with CCAC initiated and is being smoothed out

An operations committee is to be established (will meet in April) with SDL stakeholders and will focus on timely identification and resolution of operational issues with the new SDL model

Implementation of Common Health Assessment (CHA) – software vendor selection completed for CHA in partnership with the SE LHIN – software product completed by March 31st – implementation of software beginning in April with completion date (training, installation, process) anticipated for the fall of 2009 – project lead from SDL group chosen – decision to utilize same project manager for MH and SE LHINs to maximize consistency

Supportive Housing/Assisted Living across Canada: MH LHIN has been accepted as one presenter for a Plenary Session at the inter-RAI National Conference in Halifax – the University of Calgary, the University of Waterloo, the Northern Health Authority in New Brunswick and the MH LHIN are the presenters of information concerning the work taking place in SDL/Assisted Living across the country and the use of data to support decision-making in this sector.

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Provincial Assisted Living in Supportive Housing Working Group: work is progressing on this committee in order to make recommendations to the MOHLTC concerning Assisted Living/SDL – work to be completed and recommendations forwarded in May.

Geriatric System Navigation

1566 referrals to GSN program was received, 68 from LTC, 380 known to CCAC or CCAC service started from ED, 1118 contacted by GSN team – Note all seen patients had a family physician

GSN reviewed alternatives to ED use with all contacts: • Routine visits to family doctor for management of conditions • Walk – in Clinics in neighbourhood • Telehealth

Information / Referral made by GSN includes: Lab services 50%, Meals on Wheels 80%, Lifeline / Connect Care services 15%, Housekeeping 90%, Outside Home Maintenance 98%, Adult Day Program info and / or referral 70%, Transportation assistance 90%

THC started referring to GSN as of April 1, 2009.


An analysis of snapshot data from complex continuing care was completed and is being reviewed for trends, gaps, issues

Review of current co-payment practices is underway. A report will be generated to identify similarities and differences across MH LHIN hospitals

Communications Strategy

Communications materials created have been circulated to steering committee and ALC TOG members

Further circulation strategies via Communicators group planned


The steering committee has developed and approved a procurement survey that will be completed by each community agency that describes their work, spending, contracting, and purchasing activities completed by organizational resources. This on-line survey will supplement the in-depth review that Shared Services West is undertaking with the steering committee agencies. The results of these two activities will determine the next steps needed in the feasibility study.

Capacity Review of Critical Care, ER and Perioperative Areas This project is being led by the MH LHIN in partnership with the three hospital corporations to develop a plan for the best use of hospital Emergency Room, Critical Care and Perioperative (Operating Theatres, Post Anaesthetic Care Units, Pre-op/Surgical Holding areas and Procedure Rooms). PRISM Inc. is leading the project and the key activities completed to date include:

- completion of the initial literature review for the best practice review component of the project;

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- completion of a preliminary collection and review of the data to identify and understand the

macro quantitative factors; and - coordination of the Expert Panel kick-off meeting, scheduling of site visits and stakeholder

consultations are taking place.


Oct 2008 April 2009 Dec 2009 The Service Integration Group for Mental Health and Addictions (SIGMHA) produced a number of key deliverables by end of April 2009 including:

Completion of an assessment of current partnerships Development of a common tool and process to assess client satisfaction with mental health and

addiction services within the MH LHIN Conducted 3 workshops to support the integration agenda Facilitated a meeting between psychiatrists and primary care providers to develop a ‘shared care’

model Designed a brochure for Primary Care providers, detailing mental health and addiction services in

the MH LHIN to promote access to the right service.


A first meeting was held in March with key stakeholders from various palliative care settings and across sectors and this started the process of looking at what services and where palliative patients can receive care. This started constructive discussions about what is the appropriate level of care that they should be receiving in each setting. Three future meeting dates have been scheduled over the next 2 months. We will be working with key stakeholders to ultimately develop a more robust, integrated system for palliative care that is built on existing strengths and capacity in our current system.


A DPA team meeting was held on April 14, 2009 and accomplishments to date and current status at the MH LHIN were reviewed. Guest speakers from the MH LHIN eHealth office also attended to discuss the current and parallel work on the Physician eHealth strategy and plan. There was a discussion about next steps and solidifying a clear focus on initiatives for the next year. Next steps for this team include completing an evaluation to obtain feedback on the DPA team process to date, involvement, and opportunities for improvement. LHIN staff agreed to come back to the next meeting with a clear set of deliverables and actions for this group to pursue. The team recognized the importance of ensuring that some current pieces of work including Regional Credentialing and the Family Health Team / MH CCAC Case Manager Partnership project need to be seen to full completion.

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The draft strategic and integration priorities for 2010 -2013 were also reviewed as part of the Integrated Health Service Plan (IHSP) refresh presentation. This group made an observation about the perception of Primary Health Care not being a primary strategic priority in the next IHSP, as it appears to be only an enabler, and hence of less importance. This was noted, and was clarified by stating that the 4 draft strategic priorities are of equal importance to the 3 enablers and that Primary Health Care is still a main focus and priority for the MH LHIN, and that this group will play an important role in moving this agenda forward. The next meeting date for this DPA team is scheduled for June 24, 2009.

Preventing and Managing Long-Lasting (Chronic) Conditions

Self-Management Task Group

The Self-Management Task Group continues to oversee the implementation of a LHIN wide strategy to build capacity for self-management among health care professionals and individuals with chronic conditions. The objectives of the strategy are to increase awareness and application of the principles and concepts of self management by creating a common foundation (skills, language and definitions) among health care providers.

The One (1) Hour and Four (4) Hour workshops are 90% implemented. Nineteen (19) workshops were held for 203 Health Care Providers across the LHIN at the three hospitals, CCAC, Family Health Teams and Halton Region Public Health Department. Initial feedback on the workshops has been positive. A full report summarizing the evaluation is being completed.

eHealth

MH and CW LHINs have jointly embarked on two key eHealth “readiness” activities;

(1) Diabetes Readiness Assessment Plan (2) Physician eHealth Strategy

The approach is to have broad physician participation and be inclusive of appropriate stakeholders as early as possible in the process. It is our intention to complete this work by the end of June, 2009. We have already presented in two separate forms to the primary care physicians in both LHINs and the approach is being well received. We hope to have strong physician participation in the development of the strategy. Upcoming Major Milestones

• The ongoing Development of the Community Sector Provider Portal is continuing as planned. Mock-ups

of the actual portal are being socialized with the community sector stakeholders. The group appears to be very excited by the potential of this opportunity.

• The eHealth Strategy Refresh has entered its final stage; a workshop to develop a governance model is

being scheduled. Once this work is complete, we will be presenting a final draft to the Health Leaders Collaborative. Once approved, we will present the final eHealth Strategy to the Board.

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Francophone Community Engagement and Planning:

The Francophone community is currently being invited to attend a community engagement event on Saturday, May 9, 2009 from 10:00 am till 2:00pm. This event will focus on the refresh of the Integrated Health Service Plan. A planning teleconference occurred on April 15th which involved numerous Francophone Leaders, and Bill Campbell, Kim Delahunt and Roberta Lee from the MH LHIN. This call marked the first step in preparing for the bigger community event on May 9th, as the leaders have been engaged to solicit community representation and engage key citizens. It is anticipated that there will be approximately 30 Francophone that will attend this event, and it will be conducted in French. A report following this event will be produced and made available.


Multi-Sectoral Service Accountability Agreements (M-SAA) For All Community Agencies Including MH CCAC

The MH LHIN has successfully executed all agreements in time except for one HSP. This is remarkable achievement and we thank our LHIN team and all community HSPs for this great outcome.

The Metamorphosis leadership team has moved quickly on the Accreditation performance requirement in our M-SAAs and has scheduled an information session for MH LHIN HSPs on the morning of June 5th. Selected accreditation agencies will be presenting and other speakers such as Dr. Ben Chan (CEO of Ontario Health Quality Council) will talk about accreditation.


LHIN/Ministry Accountability Development Team (ADT) John Magill and Narendra sit on the joint Ministry/LHIN Accountability Development Committee (ADT) which will propose amendments to the third year of the “Ministry LHIN Accountability Agreement”. The focus of the amendments is mostly on reducing the burden of reporting requirements; and more clarity on role and funding requirements for dialysis and cardiac surgery. Provincial ALC Definition Adoption Strategy Executive Advisory Committee The Province has developed and communicated an ALC definition that applies to all patients in all patient beds in a hospital including acute, complex continuing care, mental health and rehabilitation. An Executive Advisory Committee made up of OHA, OMA, RNAO, Ontario Health Quality Council, LHINs (represented by Narendra Shah, COO MH LHIN and Pat Mandy, CEO, HNHB LHIN) has been selected to provide advice on the roll out of this definition as of July 1, 2009. A Clinical Advisory Committee under Dr. Peter Nord, (V.P. Medical at Providence Care, Toronto) will develop communication material and tools to help hospitals adopt this definition.

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MOHLTC/LHIN Capital Working Group Bill Campbell sits on a joint LHIN/MOHLTC Capital Working Group where discussions are taking place to link program and service planning with the capital planning process. The Capital Working Group has engaged the services of PRISM Partners Inc. to assist in developing a set of tools, processes and communication strategies that delineate how the ministry and LHINs will work in partnership for the identification, development and implementation of capital projects in the health care field. A discussion paper is currently being drafted that will serve as the basis for consultations with LHINs and both hospital and community sector representatives. PRISM will establish the consultation schedule.

Refreshing the Integrated Health Service Plan (IHSP2) Following the Board Workshop held on April 2, 2009, preparation for upcoming community engagement events has been the main focus. Board recommendations have been incorporated into materials being presented at all of the upcoming community engagement events. The MH LHIN website has been updated to include a new section for the IHSP2, and many materials have now been posted online. A full calendar of events depicting various community engagement sections is available, and an online survey for members of the public is now available for completion on the website and these results will also be included in the final consultation report. The RFP that was issued by the MH LHIN seeking consultant services to help with the IHSP2, specifically to aid in the development and execution of community engagement events and design and completion of the final IHSP in a format applicable for public consumption closed. The successful vendor MASS LBP was notified on April 2, 2009 and has begun working with the MH LHIN Senior Team. They will be facilitating many of the community engagement events and will be producing reports and e-bulletins after each event which will be posted on our website and shared publicly. MASS LBP will also be producing a final consultation report for the end of June, and will be producing a draft IHSP by the end of July, 2009. Health Professionals Advisory Committee (HPAC) The recruitment process to fill the vacancies on HPAC is complete, with the exception of a representative from the College of Dietitians. The four new members represent the College of Nurses [two (2) Registered Nurses and one (1) Registered Practical Nurse] and the College of Physicians and Surgeons. The draft Integrated Health Service Plan (IHSP2) was presented to HPAC at the meeting on Monday April 20th and feedback was obtained on the draft Strategic Priorities for 2010-2012. Ontario Long-Term Care Association (OLTCA) Annual Conference The MH LHIN’s COO, Narendra Shah, was asked to be a part of a panel presentation with the LHIN’s LTC sector leads (Brent Chambers and Julie Wong) to discuss the successful engagement by the LHIN with this sector to further the ALC/ER agenda and improve overall capacity of this sector.

L:\Board Templates\Management Reports\April 09\Management Report -April Board Meeting.doc



Management Report to the MH LHIN Board of Directors – May 2009 I MOHLTC Updates

Expansion Family/Health Team

Ministry has commenced a process to create 50 new family health teams with a proposal call that addresses targeted needs (unattached patients; prevalence of chronic diseases; ratio of GP/FPs in LHIN/10,000 population etc.

Minister’s Advisory Group on Mental Health The Minister of Health and Long Term Care has established a Minister’s Advisory Group on Mental Health and Addictions. This Advisory Group will help lay the foundation for a 10-year strategy on mental health and addictions needs and priorities. The final release of the report will be Spring 2010. The Advisory Group held a priority setting workshop in December 2008 and identified 5 themes for consultation:

1. System Design 2. Healthy Communities 3. Consumers Partnerships 4. Early Identification and Intervention 5. Supporting Front-line Workers

A number of approaches have been put in place by the government to provide input into these themes including:

Select Committee (all Party) of the Legislature for Mental and Addictions; Provincial consultation with organizations and consumers to provide input into the themes and

overall strategy; Interministerial Collaboration meetings and LHIN consultations with local providers and consumers (April-October)

The MH LHIN is facilitating consumer and local provider input in a number of ways. A survey was emailed to all mental health and addiction service providers and members of the Systems Integration for Mental Health and Addictions Group (SIGMHA) (which include consumers). In the past month, the LHIN also conducted both consumer and provider workshops inviting input into the five themes. MH LHIN staff will be providing input into the System Design theme through one-to-one interviews being conducted by the Ministry the last week of May.

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Management Report to the Board – May 2009

II Progress on Annual Service Plan Priorities

LHIN ER/ALC Wait Time Strategy

MH LHIN Emergency Department (ED) Targets – 2009/10 Four of our six ED sites will participate in the ED Pay-for-Results initiative in 2009/10. These sites include:

The Credit Valley Hospital Trillium Health Centre – Mississauga Halton Healthcare Services Corporation – Oakville Halton Healthcare Services Corporation – Georgetown.

Targets for 2009/10 have been set for each of the above four ER sites.

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ER/ALC Quarterly Performance Review Meeting with the Ministry

Bill MacLeod and Narendra Shah met with the Ministry ADM on May 6, 2009 to review the quarterly Stocktake Report on the LHIN performance in ALC and ER. The LHIN outlined the Pay for Results hospital’s action plans and the results to date on LHIN wide initiates to improve the flow of patients and reduce the number of ALC patient days in hospital.

Critical Care The Critical Care Committee continues to meet quarterly. The committee met on May 20, 2009 to discuss performance indicators, CCIS data reporting, and surge capacity planning. An update was provided regarding the Trillium Health Centre Intensive Care Unit Expansion, the Credit Valley Hospital Critical Care Bed Proposal and PRISM Peri-operative/Critical Care Project.

Integration Activities

The health service providers are currently engaged across the LHIN on integration activities to support health system improvement and to improve access to the most appropriate levels of care: the following initiatives have been facilitated by the LHIN.

Hospital

As part of the MH LHIN Acute Care Services Group, Halton Healthcare Services (HHS) is taking the lead on the development of a Regional Chronic Kidney Disease Program and planning for the needs across the LHIN.

Under the leadership of Trillium Health Care (THC), a LHIN wide approach to the implementation of infection control best practices is currently being finalized with the hospitals.

Under the leadership of the ED Lead Group, LHIN wide strategies to reduce the ED wait time are being developed.

Community Support Services

Dorothy Ley Hospice is currently exploring the possibility of sharing the position of

Executive Director with Perem House in Toronto Central LHIN. MH LHIN staff is in communication with TC LHIN on this matter.

The Supports for Daily Living/ Supportive Housing health service providers are implementing a common assessment tool and common intake across the sector.

Aging At Home 2009/10

On May 19, 2009 the Ontario Government and the Mississauga Halton LHIN announced an expansion to the Aging at Home program and community care initiatives to help more seniors live independently and reduce pressures on Ontario’s emergency rooms.

As part of the successful Aging at Home program, the MH LHIN is investing $19.1 million in 2009/10, an increase of $11.4 million, to help seniors receive needed health services in the comfort and dignity of their own homes and communities, instead of a hospital. The Aging at Home program combines traditional health services – such as home care– with new, locally-driven, innovative approaches to caring for seniors.

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The MH LHIN has also received $4.3 million for increased home care, personal support and homemaking services to be provided through MH Community Care Access Centre. On May 19, 2009, MH LHIN formally announced many of the Aging at Home initiatives funded for 2009/10 at the Yee Hong Centre for Geriatric Care. At the announcement, Bob Delaney M.P.P. made opening remarks on behalf of the government and Enola Stoyle, chair of Audit and Finance Committees, spoke on behalf of the Board. The experiences of some elderly clients and their families who benefited from the programs funded in 2008/09 were the highlight of this important event.

Long-Term Care Homes

LTC Home Capital Renewal Strategy Update The Ministry has provided LHINs with an allocation process outline which identifies key milestones and timeframes associated with the review of proposals for renewal of LTC home beds in phase one. Capital Renewal Strategy is to upgrade the level B and C Homes. The MH LHIN has 1347 beds eligible for renewal. This represents 31% of our total bed complement.

Reports and/or recommendations associated with each milestone will be brought to the Board as necessary. Long-Term Care Home Annual Planning Submission (LAPS) and Long-Term Care Home Service Accountability Agreement (L-SAA) In alignment with the Local Health System Integration Act, 2006, all Long-Term Care Homes will be required to sign an L-SAA with the LHIN by March 31, 2010. The first L-SAA will cover the two year period of 2010- 2012. The Ministry and LHINs have established an L-SAA steering committee and LAPS working group to guide the development of these new documents. Rob Low of the MH LHIN is on this

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working group. It is anticipated that work on the development of the LAPS and L-SAA will be completed by early Fall 2009. The general process will be similar in nature to the M-SAAs signed with all community support agencies and H-SAAs for the hospital sector.

Long-Term Care Home Act, 2007 Regulation Development and Consultation On May 5, 2009 the Ministry released the first set of draft regulations in support of the Long-term Care Homes Act, 2007. The Long-Term Care Homes Act, 2007 (LTCHA), which received Royal Assent on June 4, 2007, is the cornerstone of the government’s strategy to improve and strengthen care for residents in long-term care (LTC) homes. The Ministry of Health and Long-Term Care is currently posting on its website the first set of proposed draft regulations for a 30-day public consultation. Due to the complexity of the legislation and the extent of regulations required, a second set of regulations is being drafted and will be provided for public consultation in the fall of 2009. This initial set of draft regulations is intended to:

Improve waiting list management, and enhance the eligibility criteria for admissions to long-term care homes giving priority to placement of people with higher care needs

Strengthen requirements for prevention, early identification and treatment of potential areas of high risk such as skin and wound care, continence care, fall prevention, pain management, and responsive behaviours (i.e. this means each resident who is incontinent would have an individualized bowel and bladder plan based on an assessment that identified the contributing factors and any specific interventions)

Introduce clear definitions of abuse and neglect and strengthen accountability for investigating and addressing all alleged, suspected or witnessed incidents of abuse or neglect of residents.

Increase requirements to minimize restraining of residents, ensure that measures are in place for the comfort and safety of residents who are restrained by a physical device and prohibit certain devices from being used to restrain residents.

Require an infection prevention and control program that focuses on monitoring, outbreak management, training and hand hygiene.

LHIN – LTC Sector Leadership Meetings The LHIN has been actively engaging long-term care homes within our area to support implementation of ALC/ED pressure reduction initiatives involving long-term care (Nurse Practitioner program, Restore, ABI and Mental Health Geriatric outreach teams) and relationship building to support implementation of the L-SAA in 2010 and future LTC planning work. The meetings occur at the LHIN office every two months and involve Administrators and corporate representatives of the major LTC chains that operate in our area. Future meeting dates include July 9, September 9, and November 12. Meetings have been well received by the participants and provide a forum for communication of LHIN based initiatives and to receive feedback from LTC providers.


Home First Strategy

THC implementation of Home First is complete and they have demonstrated a significant shift in identification of new ALC – LTC. Fewer patients are being identified as ALC – LTC. Previous averages were 8 – 12 new ALC – LTC / week. The average in the month of April was 2 – 6 / week.

HHS continues to maintain low levels of new ALC to LTC applications.

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CVH implementing Home First with official launch scheduled for June 1, 2009.

Medworxx

Reasons and details tables for Complex Continuing Care and Rehabilitation were completed. Implementation and training for CCC / Rehab module is scheduled for May (this has been delayed

due to some unforeseen circumstances with the vendor) should occur in June. Supports For Daily Living

Newly initiated operations committee met in April with Peel Senior Link, OSCR, Nucleus Independent Living, CCAC and the LHIN. Discussion focused on alignment of referral processes and smoothing of information flow between the various organizations. Monthly meetings planned ongoing.


Geriatric System Navigation (GSN) program has been fully deployed and is now supporting all seniors (75+) who are treated and released from any one of the MH LHIN emergency departments. Nearly 2000 referrals to date.

At the end of May an analysis will begin on the referrals from the first six months to determine how many of the patients referred to the GSN team presented back to the emergency department or were admitted to acute care.


Transitional Services Work Group will be put on hold for the next several months while a new project is initiated.

New project will focus on leading practice models for delivery of Complex Continuing Care / Slow Stream Rehabilitation and Restore / Convalescent models. The goal is to identify LHIN wide models for consideration by the ALC Steering Committee and hospital CEOs. The project is set to begin May 25, 2009.

1A Priority Status

Draft algorithm developed (based on recommendations for application of 1A in MH LHIN reported last month) – final approval pending by Senior Leaders Group and LHIN.


Continuing to work with hospitals and CCAC to “hard wire” a process to ensure firm action plans and strategies are in place to assist in successful transition of hard to serve patients to long-term care.

The focus is on maximizing the use of LHIN investments to support successful transitions to LTC.

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Work through the ALC TOG group is underway to streamline communication strategies and options

to ensure successful transition of hard to serve patients from acute care to LTC. Suggestions to CCAC for further sustainable strategies to help decrease the number of patients

waiting for LTC in hospital are being considered by CCAC for feasibility.

Mississauga Halton LHIN Annual Audit (for fiscal year 2008/09)

The LHIN successfully completed its annual external audit and the results of which will be in the annual report.

Ministry Internal Audit

The Health Audit Service Team of the Ministry of Health and Long-Term Care and the Ministry of Health Promotion will complete an integrated review of the LHINs during the 2009/10 fiscal year. The engagement objectives are:

To assess the efficiency and operating effectiveness of key LHIN business processes in place to ensure effective local health system service delivery in Community Engagement, Local Health System Planning, Funding and Allocation, and Accountability and Performance Management;

To assess the efficiency and operating effectiveness of LHIN entity-level controls, relevant information systems, and, operational and financial management processes; and

To assess LHIN compliance with key elements of selected MBC Directives outlined in the MOU and implementation of key processes required by the MLAA.

Three LHINs were selected to participate in this audit; the Mississauga Halton LHIN is one of the three, along with the South East and North East LHINs.

Capacity Review of Critical Care, ER and Perioperative Areas

This project is being led by the MH LHIN in partnership with the three hospital corporations to develop a plan for the best use of hospital Emergency Room, Critical Care and Perioperative (Operating Theatres, Post Anaesthetic Care Units, Pre-op/Surgical Holding areas and Procedure Rooms). PRISM Inc. is leading the project and the key activities completed to date include:

Development of the best practice review documents, including Ambulatory, Cardiac,

General, Orthopaedic Surgery, Minimal Invasive Surgery, Ophthalmology, and Anaesthesia; Review of the data to identify and understand the macro quantitative factors; and Expert Panel site visits and stakeholder consultations (are currently taking place).

Renewal of Hospital Accountability Guidelines (HAPS)

LHINs are collectively working on developing a revised two-year hospital accountability planning guidelines. Sue Turcotte of the MH LHIN is on the Guidelines Team. The focus of the guidelines will be to drive transformational change in the design and delivery of hospital services with a focus on patient care.

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Refreshing the Integrated Health Service Plan

The MH LHIN is required to update its 3 year strategic plan (called the Integrated Health Service Plan or IHSP) and submit this plan to the Ministry of Health and Long-Term Care by November 2009. The LHIN Board has identified a broad set of strategic priorities for 2010-2013 for consultation with our public. Community engagement activities continue during the months of April, May and June on the draft priorities.

The MH LHIN website includes a comprehensive update on all the activities and reports related to refreshing the Integrated Health Service Plan. The proposed priorities along with a calendar of community engagement activities can be found at the following website: http://www.mississaugahaltonlhin.on.ca. The public is invited to respond to the draft priorities through an on-line survey. In addition, the following community engagement events have occurred or will take place:

April 23 - Diverse community workshop May 5 – Health Service Provider all-day workshop (over 100 participants) May 9 – Francophone community workshop May 30 & June 13 – a 2-day event called the Citizen’s Reference Panel (which includes

randomly selected members of the public to participate in providing input into the proposed strategic directions).

June 1 – Physician CME event at Trillium Health Centre.

In addition to the community engagement activities, many of the existing LHIN networks and groups have also engaged local residents through consultation or focus group sessions to gain their perspective on local health care priorities for the next three years

Integration Advisory Group (IAG); Health Care Professionals Advisory Committee (HPAC); Systems Integration for Mental Health and Addictions working group (SIGMHA); Chronic Disease Prevention Management Network (which includes the Diabetes and Self-

Management Task Groups); and The Seniors’ Health and Wellness Advisory Group.

All of these engagements will help to develop the next IHSP.

eHealth

The Physician eHealth Strategy and Diabetes Readiness Assessment work is nearing completion and will be published in early June. An update on the Diabetes Readiness Assessment will be presented at the board/staff session on June 4. The Physician eHealth Strategy was well received and Ontario MD has expressed an interest in the strategy work and is providing resources to help further engage the physicians with respect to EMR adoption and implementation. The first volume of the MH “eConnects” Newsletter was circulated to our HSPs, eHealth Advisory Committee and staff on May 19, 2009. It can be reviewed on-line at the MH LHIN website Mississauga Halton Local Health Integration Network. This is the first electronic publication of our eHealth communications. We have also created an eConnects email address for any questions or comments

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MH and CW LHINs have jointly embarked on two key eHealth “readiness” activities;

(1) Diabetes Readiness Assessment Plan (2) Physician eHealth Strategy

The approach is to have broad physician participation and be inclusive of appropriate stakeholders as early as possible in the process. It is our intention to complete this work by the end of June, 2009. We have already presented in two separate forms to the primary care physicians in both LHINs and the approach is being well received. We hope to have strong physician participation in the development of the strategy. Upcoming Major Milestones

The Community Sector Provider Portal is continuing as planned. The mock-up portal has

received positive feedback for everyone. The roll-out of this initiative will be September ’09. We will be socializing the draft strategy with the senior management of the hospitals,

community sector agencies and local CCAC to solicit feedback before finalizing a draft iteration which will be presented to the Health Leaders Collaborative. Once approved, we will present the final eHealth Strategy to the Board.


MH LHIN Quarterly Community Sector Meeting

The next Quarterly Meeting for our CSS and MH&A HSPs is June 18, 2009. The MH LHIN staff is in the process of setting the agenda items in consultation with the Metamorphosis Leadership.


LHIN/Ministry Accountability Development Team (ADT) John Magill and Narendra sit on the joint Ministry/LHIN Accountability Development Committee (ADT) which will propose amendments to the third year of the “Ministry LHIN Accountability Agreement”. The focus of the amendments is mostly on reducing the burden of reporting requirements; and more clarity on role and funding requirements for dialysis and cardiac surgery.

Provincial ALC Definition Adoption Strategy Executive Advisory Committee

The Province has developed and communicated an ALC definition that applies to all patients in all patient beds in a hospital including acute care, complex continuing care, mental health and rehabilitation. An Executive Advisory Committee made up of OHA, OMA, RNAO, Ontario Health Quality Council, LHINs (represented by Narendra Shah, COO, MH LHIN and Pat Mandy, CEO, HNHB LHIN) has been selected to provide advice on the roll out of this definition as of July 1, 2009. A Clinical Advisory

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Committee under Dr. Peter Nord, (V.P. Medical at Providence Care, Toronto) has developed communication material and tools to help hospitals adopt this definition. A webcast session for all LHINs and all hospitals was sponsored by the OHA on May 20, 2009. With the broadening of an ALC definition to include complex continuing care and rehabilitation beds, the baseline number for ALC days and targets will need to be re-set by the Province. L:\Board Templates\Management Reports\May 09\Management Report -May Board Meeting.doc



Management Report to the MH LHIN Board of Directors – June 2009

I MOHLTC Updates

Expansion Family/Health Team The Ministry is in the process of finalizing the call for proposals, including call locations, evaluation criteria for application assessment and key communications in advance of an anticipated early Summer 2009 Call for Proposals for the new FHTs and NP led Clinics. The LHIN is working with a Ministry/LHIN Engagement Working Group on the pre-call stage for proposals to provide knowledge and information about the capacity issues at the sub-LHIN level that will better inform the evaluation process.

II Progress on Annual Business Plan Priorities


Each ER Pay for Results funded hospital is implementing the strategies identified in their Action Plan, according to the initial funding allocation. ER Leaders Meeting was held on June 12, 2009. Hospitals are submitting additional initiatives for LHIN approval and allocation of the remaining ER Pay for Results year II funding.

Wait Times

The MH LHIN Wait Times Committee met for the Quarterly Wait Times Meeting on June 2, 2009. The Committee was updated on the final 09-10 MLAA Wait Times Targets negotiated by the MH LHIN and on the fact that the LHIN did meet the Wait Times Targets for 08-09. There was concern raised about the reduction in cancer volumes for 09-10 Wait Times and the increasing trend for cancer wait times (still far below the provincial target). A separate meeting is planned with the Regional VP for Cancer Care Ontario – Dr. Fine, to investigate the volumes and wait times.

Diagnostic Imaging Sub-Committee A letter addressed to all Physicians in the MH LHIN was sent out on June 12, 2009 asking them to use new redesigned DI requisitions forms. These requisitions will allow the doctor and patient the option to be booked into the hospital having the shortest waitlist. We expect that this will start to even out the wait list amongst the 3 hospitals in the LHIN and reduce the likelihood of “no shows”. Results for this pilot initiative will be monitored.

Management Report to the Board – June 2009

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Mental Health and Addiction Services The SIGMHA (Systems Integration Mental Health and Addictions) group has recently produced and printed a Mental Health and Addictions Resource Guide. This guide provides information on mental health and addiction services available throughout the MH LHIN and is now being distributed to family practice physicians and HSPs across the LHIN. A new work group has been established under SIGMHA to begin exploring the issues associated with transitional aged youth. This is intended to support the transition of youth with mental health and addiction needs into adult services in a seamless manner.

III Integration Activities

The health service providers are currently engaged across the LHIN on integration activities to support health system improvement and to improve access to the most appropriate levels of care. The the following initiatives have been facilitated by the LHIN:

A. Hospital

1. As part of the MH LHIN Acute Care Services Group, Halton Healthcare Services (HHS) is

taking the lead on the development of a Regional Chronic Kidney Disease Program and planning for the needs across the LHIN.

2. Under the leadership of Trillium Health Care (THC), a LHIN wide approach to the implementation of infection control best practices is currently being finalized with the hospitals.

3. Under the leadership of the ED Lead Group, LHIN wide strategies to reduce the ED wait time are being developed.

4. Review the prospect on an integrated regional maternal and child care program.

B. Community Support Services

Dorothy Ley Hospice has developed an agreement with Perem House to share the position of Executive Director. MH LHIN staff is in communication with TC LHIN on this matter.

The Supports for Daily Living/ Supportive Housing health service providers are implementing a common assessment tool and common intake across the sector.

THC and MH CCAC have agreed to a joint IT Director effective April 2009.


Annual Increase for Resident Co-payment

On May 28, 2009 the MOHLTC announced changes to the accommodation co-payment rates for LTC home residents. Resident co-payment rates increase annually by the increase in inflation as measured by the Consumer Price Index (CPI) for the preceding year. Effective July 1, 2009 the long-term care home basic daily maximum resident co-payment rate will increase from the current rate of $51.88 to $53.07 per day. This represents an increase of $1.19 per day or 2.3%.



The Table below shows the co-payment rates effective July 1, 2009

Type of Accommodation Daily Rate Monthly Rate Basic $53.07 $1,614.21 Semi-private (basic rate plus a maximum of $8.00)

$61.07 $1,857.55

Private (basic rate plus a maximum of $18.00)

$71.07 $2,161.71

Short-Stay $24.53 $1,059.29

Level of Care Per Diem Funding Increases for LTC Homes Long-term care home per diem funding is provided within three main envelope areas that include Nursing and Personal Care (NPC), Program and Support Services (PSS), and accommodation that includes Raw Food and Other Accommodation. Each year the ministry announces adjustments to the per diem funding amounts. On May 28, 2009 the Ministry announced an increase to the accommodation funding envelope for LTC Homes. This increase, effective July 1, 2009 includes funding for raw food as well as areas included in other accommodation. Raw Food funding will increase from $7.15 per resident per day to $7.31, an increase of $0.16. Other accommodation funding will increase from $46.74 to $47.59, an increase of $0.85. Increases to the Nursing and Personal Care (NPC) envelope and the Program and Support Services (PSS) envelope were also identified by the MOHLTC on June 3, 2009. The funding for the Nursing and Personal Care envelope has increased $2.28 from $77.32 to $79.60 per resident per day. The funding in the Program and Support Services envelope has increased $0.22 from $7.35 to $7.57 per resident per day. A lump sum retroactive payment for April and May will be included in the June monthly payment to LTC homes. This funding is to be used to improve healthcare and quality of life for residents in long-term care homes.

The following chart identifies the new funding levels and dates that the increases take effect.

Envelope Prior to April 1, 2009

1.27% increase in base funding to support resident

care needs (effective April 1,

2009)

Stabilization increase in per diem by 1.87%

(on 90% of NPC/PSS)

(effective April 1, 2009)

Co-payment increase effective

July 1, 2009

Total New per diem

for 2009/2010 as of July

1, 2009

Nursing and Personal Care (based on a CMI of 100)

$77.32 0.98 1.30 N/A 79.60

Program and Support Services

$7.35 0.10 0.12 N/A 7.57

Raw Food $7.15 N/A N/A 0.16 7.31 Other Accommodation $46.74 N/A N/A 0.85 47.59

Total (CMI of 100) $138.56 1.08 1.42 1.01 142.07

The next meeting of the LTC Home leadership group with the MH LHIN will take place on Thursday July 9, 2009. Draft agenda items include, Impact of the Nurse Practitioner program on reducing ED visits from LTC Homes, an overview of the service accountability agreements to be signed with LTC Homes for 2010/11 and 2011/2012, update of services to support hard to serve individuals.




Home First Strategy THC continues to demonstrate success in discharging patients home. Weekly averages over the past

month are 0 – 2 new ALC – LTC / week. Previous averages were 8 – 12 new ALC – LTC / week. The hospital has reported positive patient flow through the organization.

HHS has shown a slight increase in the identification of new ALC to LTC applications - this is being reviewed to better understand possible causes of the change.

CVH implemented Home First June 1, 2009. Receiving many requests for presentations from other LHINs as they see the success of this initiative.

Medworxx

Implementation and training for CCC / Rehab module being scheduled for June / July (this had been delayed due to some unforeseen circumstances with the vendor).

Met with Medworxx in May to discuss alignment with new ALC definition (which will be effective July 1, 2009). Medworxx has a project team working to ensure system accurately maps to new definition - however the current design is not dissimilar to the provincial approach.

Supports For Daily Living

Working to connect Geriatric System Navigation referrals to Peel Senior Link and OSCR if residents of the buildings they support have a visit to the emergency department.

It was identified that even though an event may occur to a tenant if that person is not on their services they would not know – connecting to Geriatric System Navigators would provide further options for these tenants.


Met with this team to discuss expansion of service network to potentially receive referrals from primary care physicians who identify patients on their roster they may be concerned about.

Meeting to occur in June with system partners to discuss pilot strategy to link with primary care. Transitional Services Work Group

New project will focus on leading practice models for delivery of Complex Continuing Care / Slow Stream Rehabilitation and Restore / Convalescent models. The goal is to identify LHIN wide models for consideration by the ALC Steering Committee and hospital CEOs.

Kick off meeting for new project scheduled for June 11, 2009. Working group members are senior leaders from all 3 hospitals and CCAC with support from subject

matter experts throughout the process. Project to wrap up in September with recommendation for LHIN wide model coming from the

working group.


Specific process improvements are geared towards attempting to standardized (where possible) medications / treatments / medical equipment to align with available stock and expertise available in the long-term care setting.




The Health Audit Service Team of the Ministry of Health and Long-Term Care and the Ministry of Health Promotion are onsite and are in the process of completing their audit of all aspects of the LHIN's mandate. Specific focus is on procurement policy application. It is expected that a preliminary report of their findings (MH LHIN) will be available in the fall, and a report on Year 1 LHIN audit findings will be available in the new year.

Capacity Review of Critical Care, ER and Perioperative Areas PRISM Inc. is leading a project in partnership with the MH LHIN and the three hospital corporations to develop a plan for the best use of hospital Emergency Room, Critical Care and Perioperative (Operating Theatres, Post Anaesthetic Care Units, Pre-op/Surgical Holding areas and Procedure Rooms). During the latter part of June, site visits at all hospital sites are planned and will be completed by the Expert Panel.

Refreshing the Integrated Health Service Plan The MH LHIN is required to update its 3 year strategic plan (called the Integrated Health Service Plan or IHSP) and submit this plan to the Ministry of Health and Long-Term Care by November 2009. The LHIN Board has identified a broad set of strategic priorities for 2010-2013 for consultation with our public. Community engagement activities have been completed and we engaged approximately 767 individuals over the past 3 months.

The MH LHIN website includes a comprehensive update on all the activities and reports related to refreshing the Integrated Health Service Plan. The proposed priorities along with a calendar of community engagement activities can be found at the following website: http://www.mississaugahaltonlhin.on.ca. The following community engagement events have occurred:

Apr 20 – Health Professionals Advisory Committee April 23 - Diverse communities session May 5 – Health Service Provider all-day workshop (over 100 participants) May 7 - Systems Integration for Mental Health and Addictions working group meeting May 8 – Aboriginal Leaders meeting May 9 – Francophone community session May 12 - Seniors’ Health and Wellness Advisory Group May 14 – Long-Term Care Administrators group May 22 – Integration Advisory Group May 28 – MPP Breakfast meeting May 30 & June 13 – a 2-day event called the Citizen’s Reference Panel (which includes

randomly selected members of the public to participate in providing input into the proposed strategic directions)

June 1 – Physician CME event June 3 - Chronic Disease Prevention and Management Network (which includes the Diabetes

and Self-Management Task Groups) Online Web Survey (436 surveys completed)

All of these engagements will help to develop our next 3-year IHSP.



Next steps involve a final consultation report being drafted for the end of June. This consultation report will highlight feedback and common themes from all of the above sessions, and will outline agreement and consistencies with the proposed strategic and integration priorities, and will also outline opportunities for the LHIN to consider. Following the completion and review and consideration of the consultation report, the proposed priorities will be reviewed and edited. An all staff meeting has been scheduled for July 17, 2009 to engage all LHIN members for input into revisions on the priorities, and the consultation report and revisions to the proposed strategic and integration priorities for the next IHSP will be presented to the Board on Aug 6, 2009 during a special IHSP Board meeting.

eHealth The refreshed draft LHIN eHealth Strategy is being socialized with the senior management of the hospitals, community sector agencies and local CCAC to solicit feedback before finalizing and seeking approval from the LHIN Board. This consultative process will continue over the summer months. The Diabetes Readiness Assessment and Plan was completed. This report provides advice to the LHIN on key areas of focus to align with the provincial diabetes agenda including:

Implementation of the Ontario Diabetes Strategy Participation in the Baseline Diabetes Dataset Initiative (BDDI) Rollout of the Diabetes Registry

The Physician eHealth Strategy is nearing completion and the LHIN’s interest has been very well received by physicians across the LHIN and by OntarioMD. OntarioMD is a subsidiary of the Ontario Medical Association (OMA) who receives funding from eHealth Ontario. Their principal mandate is to guide and support physicians who qualify for funding in the process of adopting EMRs into their clinical practice. OntarioMD will continue to control funding to physicians for EMR implementation to support the provincial eHealth strategy. This report provides advice on areas of focus to increase adoption of eHealth solutions by physicians in MH LHIN. Currently MH LHIN has the lowest EMR adoption rate in the province. There are 2 resulting focus for the LHIN over the next 3 years:

A plan to significantly increase EMR implementation, and An integration and regional provider portal plan

The LHIN eHealth office is working very closely with OntarioMD to collaboratively develop plans to expand EMR adoption in primary care practices across the LHIN over the next 3 years. OntarioMD is dedicating resources to work with physicians in MH LHIN with the guidance and oversight of the LHIN eHealth Office. A new program for funding physicians for EMRs will be finalized in June 2009 with a formal public announcement in the Summer. The LHIN eHealth office is working very closely with the provincial teams working on eReferral solutions to define the provincial solution and to secure funding for LHIN implementation projects. Funding for these two initiatives is expected to begin in Fall 2009.

ED/CCAC Notification Resource Matching and Referral




Consultation on the draft LHIN eHealth strategy will continue over the summer. Finalization of the Physician eHealth plans and initiation of project activities to support the

increased adoption of IT solutions by physician across the LHIN. The Community Sector Provider Portal project is continuing as planned. Development is well

underway with increased focus on business content and adoption activities. The roll-out of this new portal will occur throughout the Fall.

Investigation into options to support Blackberry email services for community sector providers continues. This is more complex than initially anticipated due to capacity constraints. The LHIN eHealth office is now facilitating collaboration with several vendors including RIM and Rogers, to assist in providing this solution. We hope to provide a solution with a phased approach to user adoption in Fall 2009.

IV Notable HSP Activities

MH LHIN Quarterly Community Sector Meeting

The CSS and MH&A Quarterly Sector Meeting was held on June 18, 2009 at the Hilton Garden Inn. Agenda items included information on LHIN initiatives (ER/ALC, A@H, IHSP, SIGMHA, ASSIST, Joint Purchasing etc), reporting requirements, accreditation and e-Health update.

V Community Engagement

Community Engagement Evaluation Framework A survey (to be administered via Survey Monkey) has been developed by researchers from McMaster University to aid LHINs in evaluating community engagement (CE) efforts over the past couple of years. This survey will be administered in all LHINs to local Advisory Groups or Teams that have been involved with the LHIN planning and CE activities. The link to the survey will be sent out from each LHIN’s CEO’s office to all Advisory / Team members and the results from this survey will be collated by a research student at McMaster University. The timelines aim to have this survey and result collation completed by the end of the summer.

Aboriginal On Saturday, June 6, 2009 an event entitled “A Gathering – Peel’s Aboriginal Celebration” occurred at Chinguacousy Park and the MH LHIN hosted a shared booth together with the CW LHIN. It is estimated that over 900 people attended this event featuring Aboriginal entertainment and Elder teachings.



Francophone On May 22, 2009, LHIN staff and our MOHLTC Francophone consultant met with Francophone leaders from our LHIN to talk about planning and future funding opportunities. A good discussion occurred about their Aging at Home Submission and future opportunities and it was decided that regular quarterly meetings would be scheduled to ensure ongoing dialogue and collaboration continue.

VI Key Meetings / Emerging Issues

Alternate Level of Care (ALC)

In partnership with the Ministry of Health and Long-Term Care, OHA held an "Alternate Level of Care (ALC): Moving Beyond Acute Care conference on June 15, 2009 in Toronto. Narendra Shah co-chaired the program with Lynn Guerriero, Director, Wait Time Information Program, Cancer Care Ontario. Judy Bowyer, Senior Lead, Performance and Integration with the MH LHIN made a presentation on two MH LHIN initiatives, Geriatric Mental Health Outreach and Supports for Daily Living. The presentation provided an overview, information on research data and current results of the initiatives. There is a lot of interest in other areas of the province with respect to our innovative initiatives.



Management Report to the MH LHIN Board of Directors – July 2009

I MOHLTC Updates

Expansion of Nurse Practitioner Led Clinics and Family Health Teams The Ontario government is inviting applications from health care providers and/or community-based groups to establish a total of eight Nurse Practitioner-Led Clinics and 19 new Family Health Teams in the following LHINs: North West, North East, Erie St. Clair, North Simcoe Muskoka, Central West, Central East, Champlain and South East. These LHINs were selected based on the percentage of residents without a family health care provider, the prevalence of chronic disease, and current access to health care services. The call for applications closed July 30, 2009 and the FHTs and new nurse practitioner led clinics will be awarded in the Fall of 2009.

Mental Health and Addictions Strategy Summit The Ministry of Health and Long Term Care released a discussion paper, Every Door is the Right Door on July 14, 2009 to contribute to the development of a 10 year mental health and addictions strategy. The paper was released at the Open Minds – Health Minds Summit co-hosted by Minister David Caplan and his Advisory Group on Mental Health and Addictions. The provincial summit was an opportunity for approximately 1,000 consumers and experts from across Ontario to contribute ideas towards the development of Ontario’s Mental Health and Addictions Strategy. The Mississauga Halton LHIN was well represented with ten client and family members, ten service providers and LHIN staff. The Summit was held in Toronto on July 12th and 13th where feedback was provided on the newly released discussion paper, Every Door is the Right Door.

Ontario Renal Network Announced In July 2009, the Ministry of Health and Long Term Care announced that they are working with Cancer Care Ontario to implement a new Ontario Renal Network (ORN). The ORN will provide coordination and integration of renal care across the province with active involvement from the renal community. The priorities identified by the ORN for the upcoming year include establishing consistent standards and guidelines for renal care and creating a performance measurement framework. Dr. Judith Miller has been appointed the Clinical Lead for the ORN, and Ms. Treva McCumber as the Administrative Lead.

Management Report to the Board – July 2009

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The ORN is in the process of establishing roles and responsibilities for clinical and administrative leads at the local LHIN level that will liaise with the ORN. The ORN is collaborating with Halton Healthcare Services, the lead for the MH LHIN Renal Integration Steering Committee to jointly select representatives from the MH LHIN. On July 17th, the MH LHIN coordinated a meet and greet visit for the ORN Administrative Lead, Ms. Treva McCumber with members of the Credit Valley Hospital and Halton Healthcare Services CKD Regional Programs. An information session was held on June 25th, 2009 to provide information regarding the evolving Ontario Renal Network. A copy of the presentations is available at the Cancer Care Ontario website: http://www.cancercare.on.ca

Ontario Diabetes Strategy

In July 2009, the MOHLTC announced that Cancer Care Ontario would be involved in the implementation of the Ontario Diabetes Strategy (ODS). The goal of the ODS is to improve the health and healthcare of Ontarians with diabetes or who are at risk of diabetes. A key component of the ODS is the expansion of Diabetes Education Programs in each LHIN and the identification of a regional coordinating centre that will support Cancer Care Ontario (CCO) and the LHIN in the implementation of the strategy. The LHINs will be provided updated prevalence and planning data to assist in identifying suitable locations for program expansions. In addition, the LHIN will recommend an existing centre to assume the regional leadership role in coordinating diabetes services in the MH LHIN. The MH LHIN established a Diabetes Education Task Group in June 2008 with the goal of creating a consistent, standardized approach to diabetes education across the LHIN. Membership on the task group involves representatives from all 6 local Diabetes Education Centres, the Canadian Diabetes Association and Ministry of Health and Long Term representative (ad hoc). The accomplishments of this task group are listed below. As a result of their work, the LHIN is well positioned to work with Cancer Care Ontario and the MOHLTC to implement the evolving ODS. Task Group Accomplishments Information Gathering

Physician Survey Survey for Adults with Diabetes Chart review of hypoglycemics in ER (07/09) Meeting with LTC Home Administrators Inventory of Diabetes Programs and Service.

Quick Wins

Standardized LHIN wide education program for all 27 LTC Homes in the MH LHIN Targeted education sessions for LTC Medical Directors and Nurse Practitioners Development and dissemination of an Insulin Starter Kit for Health Professionals Development of Information Pamphlet for Diabetes Education Program in MH LHIN.





Each ER Pay for Results funded hospital continues to implement the strategies identified in their Action Plan. The ER Leaders meeting was held on July 10, 2009. A thought provoking presentation was made by representatives of St. Michael's Hospital where they described their very successful approach and strategies to imbed a quality improvement process and philosophy around flow and throughput of patients in their care.

Palliative Care Planning

The MH LHIN is co-leading a project to develop a LHIN-wide palliative care model that reduces the need for ER visits and ALC days for palliative patients and improves access to palliative care services across the LHIN. A working group consisting of multiple partners across the health care sector, is working to develop a palliative care model that is coordinated, comprehensive, client-centred, and accessible for patients and their families in the community. The project began in July and is expected to be completed in October 2009.

Mental Health and Addiction Services SIGMHA’s (Systems Integration Group Mental Health and Addictions) Quality Task Team created a common tool and process for surveying client satisfaction with services. This survey is being rolled out by mental health and addiction services within our LHIN and will allow for benchmarking across services. A task team of SIGMHA has undertaken a review and analysis to understand why our LHIN is showing an increase in the early return visits to Emergency Departments by people with mental health and addiction issues. The data has revealed that the top CMG (case mix groups) seen in our hospital ERs were substance abuse and anxiety disorders with a recidivism rate of 27% returns within 30 days; 32% are between the ages of 19 and 34. Referral practices by diagnosis have been matched with current wait times to these services. Meetings are being held with key services such as ACT teams, to identify strategies to increase community capacity with the goal of reducing ER visits. The Co-location Task Team identified the creation of seven multi-service hubs across the LHIN as an integration opportunity. The team has been working with several agencies on The Human Service Centres in Peel Region and reached agreement that these centres will serve as our co-location hubs in the Mississauga area. Four mental health and addiction service agencies have indicated interest in participating in these initiatives. As a result of a request for proposal to secure project management support, DTZ Bernicke will work with participating organizations to secure tenant contracts and conduct a current state analysis by October 1st. This company is also working to develop the Human Services Centres of Peel which will enable ongoing collaboration and resource sharing across these initiatives.




Hospital

Under the leadership of Trillium Health Centre (THC), a LHIN-wide approach to the implementation of infection control best practices is being executed. These include: MH LHIN-wide hospital oriented Antibiotic Stewardship Model; Environmental Cleaning Education Program and MH LHIN-wide hospital oriented Infection Control Best Practices Auditing Program.


Performance indicator requirements specific to Client Satisfaction Surveys as part of the M-SAA are now being submitted. MH LHIN staff will be analyzing the information and compiling a summary of results.

Those CSS agencies receiving Aging at Home funding Year 2 will have all sign backs complete by July 24th. In the interim the agencies are gearing up for accepting clients into the new funded areas of their programs. Out of the 15 programs funded in the CSS sector for Year 2 Aging at Home, 14 (93.3%) will have their programs open by the end of September.

Supports for Daily Living/Supportive Housing continues to implement a wider expansion of the C.H.A (Common Health Assessment) instrument. The current agencies are training more staff in becoming assessors utilizing the C.H.A. This will be followed by the implementation of the CHA software. Underway in preparation for the implementation is an inventory of readiness for the SDL sector. The Project Manager and Project Lead within the MH LHIN have begun the Steering Committee meetings. The Project manager for the MH LHIN is a joint position with the SE LHIN. This will provide consistency in implementation processes, data storage and report writing for comparison purposes.

Presentations

MH LHIN staff was invited to present at the International RAI Conference held in Halifax in June. The presentation was a joint symposium on Supportive Housing research and innovative practice across Canada. Kristina Hall, Executive Director of Nucleus Independent Living and Judy Bowyer presented the perspective from Ontario specific to the MH LHIN implementation of the “mobile” SDL model, data to date and how these initiatives are addressing the ALC/ER/LTC issues.


Public notice of proposed sale of long-term care beds The Ministry of Health and Long-Term Care issued a public notice concerning regarding a request to purchase 220 long-term care beds and issue of license to Trillium Health Care upon completion of a new 220 bed long-term care home in Etobicoke. If the ministry provides approval for the proposal it is anticipated that the project would be completed and operational by the end of 2012.




Home First Strategy

THC continues to demonstrate success in discharging patients home. The hospital continues to report positive patient flow through the organization.

Last month we reported HHS had shown a slight increase in the identification of new ALC to LTC applications – this was localized to the Georgetown site and has been addressed.

CVH began the roll out of Home First June 1, 2009 – The ALC Strategy Leader has attended and provided education sessions for many different groups. Progress is being monitored weekly.

MH LHIN has received many requests for presentations from other LHINs as they see the success of this initiative. A province-wide Video Conference event is being planned for August.

Medworxx (Hospital Utilization Management Tool)

Implementation and training for CCC / Rehab module was held in June / July. Medworxx is to host a LHIN-wide session to review reporting capability to support MH LHIN

system planning.

Supports For Daily Living Continue work to connect Geriatric System Navigation referrals to Peel Senior Link and OSCR if

residents of the buildings they support have a visit to the emergency department. It was identified that even though an event may occur to a tenant if that person is not on their services

they would not know – connecting to Geriatric System Navigators would provide further options for these tenants.


Met with system partners to discuss pilot strategy to link with primary care and potentially with proposed Geriatric Assessment Clinics and other programs.

CCAC will write a proposal to the LHIN regarding options. Transitional Services Work Group

The kick off meeting for the project was held June 11, 2009. The focus of the Transitional Services Working Group is post acute care including Complex Continuing Care, Rehabilitation and the LTC Short Stay program.

The working group is developing a LHIN-wide model with a recommendation expected in September.

"Hard to Serve" ALC Patients

Hospitals and CCAC continue to work to ‘hard wire’ the process to ensure firm action plans and strategies are in place to assist in successful transition of hard to serve patients to long-term care.

The ALC TOG group is continuing to streamline communication strategies and options to ensure successful transition of Hard to Serve patients from acute care to LTC. Specific process improvements are geared towards standardizing (where possible) medications / treatments / medical equipment to align with available stock and expertise available in the long-term care setting.



New ALC Definition

The ALC Lead worked with all three hospital ALC Leads to ensure consistent application and interpretation of the new ALC definition (for July 1, 2009)

Hospitals are educating staff on new guidelines as some patients not previously identified as ALC will now be under the definition.

We anticipate a minor increase in ALC as a result.


The Health Audit Service Team of the Ministry of Health and Long-Term Care and the Ministry of Health Promotion has completed their field work at the LHIN, and are following up with some questions via email. They have begun to draft their report of the LHIN and we anticipate receiving a preliminary report on their findings in early fall.

Capacity Review of Critical Care, ER and Perioperative Areas PRISM Inc. is leading a project in partnership with the MH LHIN and the three hospital corporations to develop a plan for the best use of hospital Emergency Room, Critical Care and Perioperative (Operating Theatres, Post Anaesthetic Care Units, Pre-op/Surgical Holding areas and Procedure Rooms). The expert panel is currently wrapping up their interviews. A report is expected by early August.

Refreshing the Integrated Health Service Plan The MH LHIN is required to update its 3 year strategic plan (called the Integrated Health Service Plan or IHSP) and submit this plan to the Ministry of Health and Long-Term Care by November 2009. The LHIN Board has identified a broad set of strategic priorities for 2010-2013 for consultation with our public. Community engagement activities have been completed and we engaged approximately 767 individuals over the past 3 months. The final consultation report is almost completed. This consultation report will highlight feedback and common themes from all of community engagement sessions, and will outline agreement and consistencies with the proposed strategic and integration priorities, and will also outline opportunities for the LHIN to consider. An all staff meeting was held on July 17, 2009. An update on the timeline and project plan was given, and feedback from the community engagement events was reviewed. All LHIN staff members were then asked for input into revisions on the proposed priorities. A revised set of goals, actions and outcomes for each strategic priority were reviewed by everyone. The final consultation report and revisions to the proposed strategic and integration priorities for the next IHSP will be presented to the Board on Aug 6, 2009 during a special IHSP Board meeting. The Citizen’s Reference Panel final report, photo book and a video will also be shown during that meeting.



eHealth

The refreshed draft LHIN eHealth Strategy is being discussed with the senior management of the hospitals, community sector agencies and local CCAC to solicit feedback before finalizing and seeking approval from the LHIN Board. Two HSP forums are scheduled for this purpose in August 2009. The LHIN eHealth office is initiating a new Physician eHealth Steering Committee in July jointly with Central West LHIN as an outcome of the recently completed Physician eHealth Strategy. Physician leaders from across the two LHINs and executives from OntarioMD have been invited to participate. This group will support and oversee the plans to significantly increase EMR adoption in primary care physician practices across the LHINs over the next 3 years. Bill MacLeod, Andrew Hussain and Karen McClure are meeting with Brian Forster, CEO of OntarioMD in July and continue to work very closely with OntarioMD to coordinate communication of the new EMR funding program for physicians and allocate resources within our LHIN. +The Community Sector Provider Portal project is continuing as planned. Development is well underway with increased focus on business content and adoption activities. The roll-out of this new portal will occur throughout the Fall. Investigation into options to support Blackberry email services for community sector providers continues. This is more complex than initially anticipated due to capacity constraints. The LHIN eHealth office is now facilitating collaboration with several vendors including RIM and Rogers, to assist in providing this solution. We hope to provide a solution with a phased approach to user adoption in Fall 2009. The second publication of the MH “eConnects” Newsletter was circulated to our HSPs, eHealth Advisory Committee, staff and subscribers on July 13, 2009. It can be reviewed on-line at the MH LHIN website Mississauga Halton Local Health Integration Network.


MH LHIN Quality Network

The MH LHIN Quality Network met on June 23, 2009. The compilation of an MH LHIN Skills Inventory and Project Inventory across our 3 hospitals is almost complete. This will be supplemented by any additional information from our LTC, CSS and MH&A Sectors. During this meeting, the team carried out a process mapping exercise around an MH LHIN ER patient requiring surgery. Gaps in data were identified during the mapping and going forward, the map will be validated amongst the team and more LHIN system mapping will be undertaken. Next meeting is August 25, 2009.




Unemployment and Health Workshop On July 13, 2009, a full day workshop was held at the Coptic Centre which looked at understanding and responding to the health impacts of unemployment. This workshop was organized by the Region of Peel Public Health and Human Services. Sponsors of this event included the MH LHIN, CW LHIN, and the Ontario Agency for Health Protection and Promotion and partners included the United Way of Peel Region, Social Planning Council of Peel, Service Canada and the Ontario Public Health Association.

MH CCAC and MH LHIN Community Engagement Meetings

During July and August, meetings with the CCAC will occur as we look at possible opportunities to work together and partner on future community engagement initiatives as our catchment areas directly align. Goals and objectives for community engagement for both the CCAC and LHIN will be reviewed to look for commonalities and opportunities to possibly work together.

GTA Community Engagement Leads Meeting

All of the GTA community engagement (CE) leads met during the last week of June at the CW LHIN to discuss common areas of focus and partnership, including Aboriginal Health, Francophone Health, and IHSP refresh processes. The GTA LHINs are working together on collecting information about Health Service Providers and the number of staff who can/do provide services in French. The results of these surveys will be collated and reviewed at the next GTA CE Leads meeting in the fall of 2009. A relationship framework for GTA LHINs around Aboriginal Health is also being finalized and another CE event will be planned to occur before the end of 2009.

Francophone

Regular meetings have now been set up with our local Francophone leaders and LHIN staff. The purpose of these meetings is to talk about current LHIN initiatives and opportunities for Francophone involvement, and planning for Francophone language health services in our LHIN. The next meeting is scheduled for the end of August.



VI Key Meetings / Emerging Issues

MOHLTC/LHIN Capital Working Group The Ministry/LHIN Capital Working Group which has been developing a framework for obtaining LHIN advice in the early stages of capital planning, in keeping with the Ministry-LHIN Accountability Agreement (MLAA). The Ministry has begun working with LHINs using this draft framework. As the process unfolds, there will be opportunity to revise the framework to ensure that it is workable for all players, including health service providers (HSPs), LHINs and the ministry. The draft framework will be presented to the LHIN CEOs, Senior Directors and the Ministry Management/LHIN CEO joint committee in September and October 2009. Training and orientation for those directly involved with the capital planning process has been identified as work that needs to be done in moving forward.



Management Report to the MH LHIN Board of Directors – September 2009

I MOHLTC Updates

Ontario Diabetes Strategy (ODS) - Update As part of the Ontario Diabetes Strategy (ODS) to improve the health of Ontarians with diabetes, the Ministry of Health and Long Term Care (MOHLTC) is planning to increase the number of Diabetes Education Teams (DET) across the province. A Diabetes Education Team consists of one Registered Nurse and one Registered Dietitian and is funded directly by the MOHTLC. The Ministry asked the Mississauga Halton LHIN (MH LHIN) to recommend locations for the expansion of three (3) DETs and to target areas of unmet need, high prevalence and increasing incidence of diabetes. The recommendations were developed collaboratively with the MH LHIN Diabetes Education Task Group following a review of information provided by the Ministry, ICES diabetes prevalence and resource maps, discussions with the Executive Directors of the Family Health Teams and information gathered over the past year through the MH LHIN diabetes inventory. Consideration was given to the need to promote outreach services within our community to increase access to diabetes education and care for people with diabetes. The LHIN’s recommendations target high risk areas that need diabetes education and care. The Ministry will be reviewing the recommendations with LHIN staff at the end of September.

Management Report to the Board – September 2009

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The MH LHIN Wait Times Committee met on September 8, 2009 to review wait times and wait time volume projections.

For the month of July 2009, wait times for Cancer Surgery have increased but are still below the provincial access target. Cataract surgery wait times continue to be an issue at CVH due to the wait list for one particular surgeon. CVH is addressing this issue. Patients have been made aware of the opportunity to use the Cataract Wait Time Guarantee but no calls have been made to the Care Connector at the CCAC about the “Guarantee”. The MH LHIN is overall wait time for cataract surgery is still significantly below the provincial access target. MRI wait times have also increased and the Diagnostic Imaging presented a special report to the Committee on some of their findings.



12 of the 14 LHINs are showing large increases in MRI wait times over the first quarter of 09-10. MH LHIN is #6 on the chart below.

MRI Wait Time in Ontario Q1 – 2009/10


Provincial LHIN ED Leads Forum

The MHLHIN participated in the quarterly ED/ALC Performance Leads September 15th meeting. This was a joint meeting with the LHIN staff ED leads to discuss specific ER initiatives that contribute to the hospitals success in meeting the ER Pay for Results Targets.

ALC Patients in Hospitals

The MH LHIN MLAA target for the percentage of ALC patient days in 2008/09 is 9.8%. The LHIN performance for the year was higher at 12.8% with transitional bed days removed, the ALC target was at 9.5% in August. Currently the ALC’s rate is about 9.0%.



Mental Health and Addiction Services

Between 2006/07 and 2008/09, MOHLTC data indicates that early return visits (>30days) increased at all three hospitals, from 8% to 12%. With the aim to reduce inappropriate use of Emergency departments, SIGMHA is focused on identifying strategies to improve access to community MH & A services. This includes processes to prioritize ED referrals to mental health community services and identifying best practices in community treatment of depression and anxiety. Transitional Aged Youth (TAY) task team approved its Terms of Reference and reviewed quantitative data in Mississauga Halton region. They identified what is working well in the current system and where the gaps are. Membership has increased to include representatives from both adult mental health and addiction services with co-leads, one from youth services and the other from adult services.

2010-2011 Annual Business Plan (ABP) The MH LHIN received guidelines for completing the 2010/11 ABP from the MOHLTC on August 31, 2009. As a LHIN we are obligated to produce an annual business plan (ABP) to the MOHLTC (LHSIA 2006, c.4, s.18 (2)). The plan needs to align with the broader planning framework which encompasses the Ministry’s strategic priorities and the LHIN’s 3-year IHSP. The LHIN is now developing a work plan and approach for completing the ABP for 2010/11. .

Respite Services Respite services were identified as a need through the community engagement activities with seniors and their caregivers / families which took place in the Summer of 2008. Seniors stressed that respite care is very important as caregivers need support and assistance, and ‘a break’ from caring for an elderly family member or spouse. Participants stated the need for more funding for accessible and affordable respite care, for education for caregivers on supports available to them, and the need to provide preventative respite care in order to assist seniors with stress management. In addition, the provision of respite services is known to prevent caregiver burnout, deterioration of health and prolonged ability to care for a loved one. Consequently preventing premature institutionalization and increasing the ability of seniors to remain at home for as long as possible. To improve access and create an integrated approach to provision of respite services across the LHIN, the LHIN, along with health service providers identified the needs / gaps for respite services in the community, determined the immediate respite capacity required and determine the best approach to delivery of respite services. A report is currently being drafted which summarizes key findings (including results of an online caregiver survey and gaps), provides recommendations for the immediate respite capacity required, and identifies the best approach to delivery of respite services as well as for improving access to current respite services.




Regional Clinical Services Update Capacity Review of Critical Care, ER and Perioperative Areas

PRISM Inc. is leading a project in partnership with the MH LHIN and the three hospital corporations to develop a plan for the most effective use of existing capacity over the next 5 years related to hospital Emergency Room, Critical Care and Perioperative Services (Operating rooms, Post Anaesthetic Care Units, Pre-op/Surgical areas and Procedure Rooms). PRISM will present a draft report in early October.


Supports for Daily Living (SDL)

A 2 hour best practice information session was presented via video conference on September 16, 2009. Over 20 sites registered for the session. The presenters were Narendra Shah, Kristina Hall (ED,Nucleus), Judy Bowyer, a family physician and a client’s daughter. This video conference offered an overview of the MH LHIN’s transformation of Supportive Housing to Supports in Daily Living (SDL), the SDL Framework and the major models operating under the framework. These models go beyond use of the current social housing buildings to innovative ways to deliver “supports” in seniors current homes. The model provides flexibility for the delivery of 24/7 service and is resulting in acceptance of clients directly from hospitals; to reduce Emergency Department use and an alternative to long term care. Data, stories from clients and families, communication materials, centralized referrals/waitlist information, eligibility and other work completed by the MH LHIN SDL Work Group was presented. All the SDL videoconference material is available on the MH LHIN website.

Refreshing the Integrated Health Service Plan (2010-13) A draft of the final IHSP has been written and is undergoing an internal review. Validation of the strategic priorities and enabling strategies has also occurred at meetings of the Integration Advisory Group and the Healthcare Leaders Collaborative. A first draft of the final IHSP will be reviewed by the Board at the September Board meeting and if required, a special Board meeting for the IHSP will be held on October 1, 2009.



Long-Term Care (LTC) Home Sector

1. Long-Term Care Home Accountability Planning Submission (LAPS)

Rob Low, Sr. Lead, Performance and Integration is the provincial lead for the development of the LAPS Guidelines document that will be used to support the completion of the Long-Term Care Home Service Accountability Agreement (L-SAA). This new agreement is to be signed by all 27 LTCHs within our LHIN and will be effective April 1, 2010.

The following is a summary of activities and key dates associated with LAPS and L-SAA

September 18 – webcast education session for LHIN staff on the long-term care home sector and also the LAPS Guidelines, presented by Rob Low

Development of LAPS education presentation for use to LHINs with local LTCHs to be released September 24.

September 24 – planned release of LAPS Guidelines to LHINs and the LTCH sector Local LAPS information session for all 27 LTCHs to be scheduled within the next month Submission of LAPS to the LHIN by November 13, 2009 Review of LAPS and negotiation with LTCHs – November and December Signing of LSAA – by March 31, 2010 LSAA effective April 1, 2010

2. Release of Part 2 of proposed draft regulations to support the Long-Term Care Homes Act, 2007.

On September 15, 2009 the Ministry released the second part of draft regulations to support the Long-Term Care Homes Act, 2007. The proposed draft regulation is part of the province’s efforts to improve the care of more than 75,000 residents and to strengthen the accountability of the long-term care home sector. This proposed draft regulation would:

Strengthen resident care, programs and services. Improve the operation of long-term care homes through enhanced staff training. Protect residents and enhance accountability by clarifying resident co-payments and non-

allowable resident charges. Reduce potential risks to residents and promote consistency by specifying the factors to be taken

into account when issuing orders. Part two of the proposed draft regulation is being posted on the Ministry of Health’s website - http://www.health.gov.on.ca/en/legislation/ The draft regulations have been released for a 30-day public consultation period. All interested individuals and groups are invited to submit their feedback to the Ministry no later than October 15, 2009.

3. Long-Term Care Home Renewal Strategy

The first phase of the ministry’s strategy for the renewal of LTCHs with class B and C beds is underway. Submissions were due to the ministry by September 31, 2009. The ministry has completed their review of submissions and has released these to the LHINS to review and make recommendations for approval. Final recommendations from each LHIN are due to the Ministry by October 22. Each LHIN will review submissions against local priorities for the development of LTCHs in their area.



eHealth

The second eHealth Strategy refresh forum was held on September 1st for the MH LHIN. They were well attended and attendees were engaged and contributed to the Q&A portion. The survey results from the HSPs are due mid-September; the feedback will be reviewed and used for finalizing the LHIN eHealth Strategy. The final version will be presented to the MH board once the final version is approved by the Health Leaders Collaborative. The Physician eHealth Steering Committee is well underway with meetings scheduled for the third Thursday of each month. The joint MH, CW LHIN, and Ontario MD letter was sent to all physicians across both LHINs and appears to have been well received. There is strong interest from the Primary Care physicians in the 2009-10 EMR funding program from Ontario MD. Announcement of the funding may be late October 2009. In August 2009, the Physician eHealth department under eHO approached MH LHIN to explore the potential integration of OLIS into an EMR. They were interested in Summerville FHT because of the forward thinking leadership at Summerville. After several weeks of discussions with the various stakeholders including Summerville, the project was approved. This pilot is a joint venture with the Physician eHealth department and MH LHIN bringing together OLIS, Ontario MD, Summerville FHT, and XWAVE in what will be the first demonstration of OLIS functioning in a “pull” environment with in an EMR product. The purpose of this pilot is to develop a living lab that would allow for data gathering which would then inform future integrations of OLIS with in EMRs. The Community Sector Provider Portal project is continuing as planned. User Acceptance Testing (UAT) sessions took place the week of September 7th at the Trillium Hospital. Go live date is schedule for late November, 2009. The LHIN eHealth Office is continuing to move ahead with the provincial eHealth projects and supporting committees for ED/CCAC Notification and Resource Matching and Referral (RM&R). eHealth Ontario has now given the LHINs the opportunity to secure funding for eHealth initiatives under three specific categories; (1) Resource Matching and Referral, (2) Physician eHealth, (3) Implementation and Adoption Readiness. All proposals will meet a set of criteria outlined by eHealth Ontario. All of the submissions are aligned with the revised MH eHealth Strategy. The list of regional priorities from the MH eHealth Strategy was the foundation used to generate the list of proposal ideas. The MH eHealth Strategy is aligned with the Provincial eHealth Strategy. All proposals must be approved by the LHIN CEO and show a completion date of this fiscal year. Submissions are due September 18th and funding decisions are expected end of October.




Community Sector HSPs Accreditation

Metamorphosis, Seniors Health Research Transfer Network (SHRTN) and Ontario Community Support Association (OCSA) have posted all the videos and presentation slides from the June 5th Accreditation event online on the OCSA website. Address is: http://www.ocsa.on.ca/video/video_download.html

Metamorphosis representatives met with LHIN Management and staff on September 17 to present their multi-year plan for accreditation. LHIN and Metamorphosis will jointly announce an implementation plan at the Quarterly Community Sector Meeting on September 25th.

Hospital Service Accountability Agreement (H-SAA) / Hospital Accountability Planning Submission (HAPS) 2010-2012

On September 15th, the MH LHIN held the second meeting with the hospital executives regarding the development of the H-SAA 2010-2012. Monthly meetings are planned.


Meetings with MPPs and Constituency Staff

The Board Chair and Manager, Communications and Community Engagement have been meeting with MPPs and their constituency staff over the past few weeks. To date, the LHIN has met with five MPPs. The primary purpose of these meetings is to review the list of potential new Board members and the thorough process undertaken by the Board and the Nominations Committee in the selection of these candidates. A secondary purpose of the meetings is to formally introduce the Manager, Communications and Community Engagement as a contact person for office staff if health related questions or queries arise, and to ensure that successful and joint announcements continue to occur. A third purpose of the meetings is to mention that the survey questions used for MPPs by KPMG during the LHIN-wide Board Effectiveness Review are being replicated by the MH LHIN and sent out to all of our MPPs to get an idea of how we are doing locally. The meetings that have occurred to date have been very positive and to keep the lines of communication open and to further build relationships, an information session for constituency staff is being organized by the MH LHIN and will occur during the next month. The CCAC will be invited to attend this meeting to give an overview of their services and enhancements over the past few months.

Governance to Governance Session

The next Governance to Governance session is scheduled for September 30, 2009. The topic for this session is our next Integrated Health Service Plan: 2010-2013. A demonstration of the Governance Portal that is being utilized in a few other LHINs will also occur. Currently, there are 102 participants registered (as of Sept 16/09) and 70% of those are either Board Members or Board Chairs.



Meeting with Leaders from our Aboriginal Community

A meeting with the Chair of the Peel Aboriginal Network and the President of the Credit River Métis Council occurred on September 16, 2009. It was an informational session during which upcoming health events were shared and discussions around future opportunities for community engagement occurred. The Aboriginal lead from the Central West LHIN also attended this meeting.

Francophone

The Executive Director from the Centre francophone de Toronto and the Executive Director from Les Centres d'Accueil Héritage attended a meeting at the LHIN office to explore potential opportunities to partner in the delivery of French Language Health Services in the MH LHIN. The MOHLTC French Language Services Consultant also attended this meeting. These two organizations are made up of a significant number of health care professionals who deliver services in French. Future opportunities where health care professionals are needed to deliver services in French in the MH LHIN will perhaps be easier to deliver through partnerships with these two organizations. A planning meeting with our French Language Services consultant is scheduled for early October to discuss next steps following the successful completion of the French Language Services inventory completed by MH LHIN HSPs. The five identified agencies in our LHIN will be approached to determine if they are any further in working towards official designation and to query if they are still the most appropriate and interested organizations.

VI Communications

Monthly meetings with the Directors of Communications from our 3 hospitals and the MH CCAC have now been set up. Our next meeting is scheduled for September 29, 2009. These meetings are primarily designed to be an opportunity to share information about key activities within each organization and to discuss and relevant communication activities that may need to occur. At the September meeting a guest speaker – Steve Gibson, a lawyer with a downtown firm, will be attending to review the recent Accessibility for Ontarians with Disabilities Act (AODA) as his firm has developed some templates to help hospitals and organizations in the province ensure that they are compliant with the standards.



VII Key Meetings / Emerging Issues

LHIN Effectiveness Framework KPMP has been charged by MOHLTC to develop a LHIN effectiveness framework. Narendra Shah along with four LHIN CEOs and Senior Directors will represent the LHINs.

CT Scanners

The Ministry of Health and Long Term Care has approved Halton Healthcare Services’ application for a CT scanner at the Georgetown Hospital site. Pet Scanner (Positron Emissions Tomography (PET) PET is a nuclear medicine diagnostic imaging technology examination, but not a treatment. Since 2003, Ontario has been providing PET scans within an evaluation framework to determine when PET scans assist treating physicians in making treatment recommendations to their patients. Ontario is now making PET scanning a publicly insured health service available to cancer and cardiac patients under conditions where PET scans have been proven to be clinically effective. On July 31, 2009, the Ministry of Health and Long Term Care filed an amendment to Regulation 552 of R.R.O 1990 of the Ontario Health Insurance Act, listing those services in the Schedule of Benefits- Physician Services. This regulation will come into force October 1, 2009. The amendments maybe accessed on line at http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_900552_e.htm



Management Report to the MH LHIN Board of Directors – October 2009 II MMOOHHLLTTCC UUppddaatteess

LHIN Effectiveness Framework KPMP has been charged by MOHLTC to develop a LHIN effectiveness framework. Narendra Shah along with four LHIN CEOs and Senior Directors are representing the LHINs. Leadership from the OHA and OACCAC are also involved in the deliberations along with Ken Deane, ADM.

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ALC Patients in Hospitals As of September 30, 2009, the ALC rate for the LHIN for the first two quarters was 8.8% without transitional beds.

Aboriginal

The MH LHIN is one of several partners participating in two initiatives that are funded through the Aboriginal Health Transition Funding Adaptation envelope. This Federal envelope supports initiatives that aim to adapt existing health programs to the unique needs of all aboriginal peoples including those in urban areas and Métis settlement and communities. The partners involved in these two initiatives include Six Nations and the Aboriginal Health Centre, Waterloo Wellington LHIN and HNHB LHIN. The two projects include: Aboriginal Hospital Discharge Planning and Aboriginal Children’s Health and Well Being. The MH LHIN will be engaging our Aboriginal community in LHIN planning, priorities, and implementation of Aboriginal Health and Wellness Programs.

Palliative Care Initiative

MH LHIN staff worked with a Palliative Care Initiative Working Group over the summer and early Fall months to develop a LHIN-wide approach to palliative care services. The key deliverables of this working group have now been completed and include:

A MH LHIN Palliative Care Model with recommendations to move a LHIN-wide comprehensive palliative approach forward.

Management Report to the Board – October 2009

L:\Board Meetings\09 10 29 Meeting\Management Report - October 09.doc Page 2 of 9

A Family Focus Group Report on palliative care based on input from community members

experiences with palliative care. A Stakeholder Event to obtain input and feedback on a LHIN-wide approach to palliative care.

LHIN staff is currently working on steps to implement the recommendations for a LHIN-wide approach to palliative care aimed at reducing patient days in palliative care in hospitals.

Mental Health and Addiction Services

The MH LHIN co-hosted the Halton Shared Space Forum on September 18, 2009 in collaboration with Halton’s Centre for Social Innovation. This Forum provided for an exploration of shared spaces and shared resources for the Halton non-profit sector. Opening remarks were provided by Gary Carr, Halton Region Chair and Jane McCarthy, MH LHIN Board member. Attendance at this half day workshop exceeded 100, representing 53 not-for-profit organizations in Halton. A comprehensive follow-up plan has been implemented and new organizations will be invited to join a project steering committee. The MH LHIN Systems Integration for Mental Health and Addictions (SIGMHA) committee continues its work with implementing a co-location initiative where seven mental health and addiction organizations in the MH LHIN will share space to provide integrated client services. Attention is now focused on the governance model for each site. Following legal consultation, participating organizations have signed contracts with DTZ Barnicke for project management services. This service is now focused on an analysis of current space requirements for the Oakville and Milton sites and negotiation with current landlords re: lease changes as needed.

MH LHIN Respite Services MH LHIN staff worked with key stakeholders over the summer months to develop a LHIN-wide approach to respite services. The outcomes of the work included identification of the needs/gaps for respite services in the community, capacity required, and the best approach to delivery of respite services.

Key Recommendations that emerged from the work:

1. Expand In-Home Respite Services. 2. Develop Caregiver Education & Resources. 3. Create Capacity for Emergency Respite Services. 4. Develop / Adopt Caregiver Risk Screen. 5. Streamline and coordinate access to respite services. 6. Review Access to Adult Day Programs and develop a common wait list / vacancy list. 7. Continue to monitor the utilization of respite beds in LTC Homes and assess the need for respite

beds as part of the planning for LTC Homes.

On September 30, 2009, the MH LHIN issued a call for proposals for the provision of in-home respite service (only) across the LHIN as a part of the 2009/10 Aging at Home Strategy. Deadline for submission was October 15, 2009. All proposals will be evaluated based on established criteria.

Specialized Geriatric Services Strategy

In 2008/09, the Mississauga Halton LHIN initiated work on the creation of a Regional Geriatric Program. First phase of the initiative was to develop a blueprint for specialized geriatric services (SGS) with the goal of improving access to SGS in order to support quality of care for frail seniors with complex needs.



The SGS blueprint identifies the comprehensive mix of core clinical services that are necessary to create a continuum of care that support frail seniors to live independently in their own homes and communities and gaps in service. It also outlines organizational and structural components required to create an integrated and coordinated continuum. The second phase of the initiative is the creation of a “Centre of Care in Geriatrics” which will incorporate a broader spectrum of geriatric services. It will also promote best practices, attract and retain geriatric clinicians, and academic affiliation. LHIN staff will consult with and seek feedback from key stakeholders regarding the proposed blueprint for SGS. The next steps include the establishment of a Lead organization to assume accountability for the regional geriatric program and implement the SGS blueprint. As a part of the 2009/10 Aging at Home Strategy, the Mississauga Halton LHIN invested in the following initiatives to build capacity and improve access to specialized geriatric services:

Expansion of the Geriatric Medical Outreach Program at Trillium Health Centre. Creation of five Urgent Geriatric Assessment Clinics across the LHIN, to provide timely

comprehensive geriatric assessments for patients seen in the Emergency Department but not requiring admission due to acute medical illness.

Implementation of a Geriatrician Mentorship role at Halton Healthcare Services (HHS). The Medical Mentor, Geriatric Medicine provides advice to the clinical and administrative staff at HHS with respect to the clinical care and planning for geriatric patients.

Expansion of the Falls Prevention Clinics to Halton Healthcare Services and Trillium Health Centre to provide a comprehensive assessment and targeted interventions for seniors with an established high risk of recurrent falls, in order to prevent serious injury and hospitalization.

IIIIII IInntteeggrraattiioonn AAccttiivviittiieess

Regional Clinical Services Update

MH LHIN Renal Integration Steering Committee

Voluntary Integration

The two Chronic Kidney Disease Regional Programs (Credit Valley Hospital and Halton Healthcare Services) are partnering with two Long Term Care Homes (Leisureworld, Mississauga and Wyndham Manor, Oakville) to seek Ministry of Health approval and funding to provide peritoneal dialysis services to residents of their Long Term Care Homes. This voluntary integration will provide, for the first time, eligible CKD clients of LTC Homes the ability to choose their preferred modality: peritoneal dialysis or hemodialysis The provision of peritoneal dialysis in LTC Homes is part of a broader provincial initiative to increase the proportion of home dialysis therapies to 40% of total dialysis therapies.




Supports for Daily Living (SDL)

Work is continuing on ramping up services with the agencies that have received Aging at Home funding for the 2009/10 fiscal year. Clients with higher level acuity needs are being brought onto SDL service while those identified with Homemaking/Home Help needs alone are being referred over to Links2Care. Links2Care was funded by the MH LHIN to provide Homemaking/Home Help service border-to-border for the 2009/10 fiscal year. Referrals to the SDL central intake are increasing. From March 2009 to September 2009 referrals have increased from 2 per week to over 40 per week. All referrals are being vetted for appropriateness, prioritized and sent to SDL agencies for acceptance. All clients are assessed using the Common Health Assessment (C.H.A.) instrument or have had a RAI-HC (RAI-Home Care) assessment completed by the CCAC which SDL agencies will then utilize.

The implementation of the C.H.A. software continues for all SDL agencies. This is targeted for completion by the end of the fall. Standardization of processes, training packages and content as well as other consistencies has proceeded smoothly with the SE LHIN who is working jointly with us in implementing the C.H.A. software for provider agencies. The work and cooperation has been very successful and has led to requests for the group to publish a paper on their efforts.

Refreshing the Integrated Health Service Plan (2010-13)

A final draft of the IHSP will be sent out to all Board members the week of Oct. 19 – 23, 2009. This draft includes revisions made based on the Board’s comments and suggestions provided at the September Board meeting, and also reflects comments from the entire senior team at the LHIN. This draft will also be posted on the MH LHIN website and an email blast will go out to all participants and HSPs asking for their comments and feedback. We will take comments and feedback until the end of the month. This final draft of the IHSP will also be submitted to the MOHLTC (as requested by them). A verbal update will be given at the October Board meeting regarding the feedback received. The final design and layout of the IHSP will also begin the week of Oct. 19th. The Board will be receiving a final draft of the IHSP which will showcase the layout during the week of Nov. 9th. Final revisions will be made prior to Nov. 18th as the final version will go to the Board on Nov. 19th as final approval will be needed at the Nov. 26th Board meeting.

. Appropriate Level of Care (ALC)

Transitional Services Work Group

The final report of the Work Group is expected by the end of November, with recommendations for a framework for post acute transitional services for the MH LHIN. Current work involves the review of preliminary data from the Medworxx Utilization Management Tool across all 5 hospital sites, to inform the need for specialized services in such areas as long term rehabilitation and restorative care, specialized behavioural management program for responsive behaviours, and palliative care in complex continuing care.

LHIN ER/ALC Strategies

ED Leaders met on October 22nd. The monthly performance of each hospital was reviewed (see the following charts) and strategies successful in reducing the ED LOS and specifically meeting targets were shared for LHIN-wide hospital implementation. Ambulance off load time was presented by the EMS representatives.



Enhanced community supports that impact the Emergency Room was reviewed and their impact discussed. The results for the first six months suggest progress is being made in the right direction.

Indicator #1 - Proportion of Admitted patients treated within the LOS target of ≤ 8 hours(Funded Sites)

30% 30%

25%

83%

39%

23%

32%36%

29%

71%

44%

31%31%34%

27%

71%

57%

22%

31%33%

27%

75%

46%

25%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PROVINCE MH LHIN Credit Valley Hospital,The

Georgetown Hospital(Halton Healthcare

Services)

Oakville-TrafalgarMemorial Hospital(Halton Healthcare

Services)

Trillium Health Centre- Mississauga

Perc

ent trea

ted w

ithin tar

get

April-09 May-09 Jun-09 Q1 09/10

Target

Baseline

Source: EDRS - Mississauga Halton LHIN ED Pay For Results Performance Report Jun09

Indicator #3 - Proportion of Non-admitted low acuity patients treated within the LOS target of ≤ 4 hours

78%

87%91% 90%

86%

80%79%

88%

93%90% 89%

81%78%

87%

92%88%

86%

81%78%

87%

92%90%

87%

81%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



Services)


Services)


Per

cen

tage trea

ted w

ithin

tar

get

April-09 May-09 Jun-09 Q1 09/10

Target

Baseline


Indicator #2 - Proportion of Non-admitted high acuity patients treated within their respective targets of ≤ 8 hours for CTAS I - II and ≤ 6 hours for CTAS III (Funded Sites)

77%81%

84%

95%

87%

65%

79%

84%87%

94%90%

72%

78%

83%86%

93%90%

68%

78%

83%86%

94%

89%

68%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



Services)


Services)


Per

centa

ge within

tar

get

April-09 May-09 Jun-09 Q1 09/10

Target

Baseline




IIVV NNoottaabbllee HHSSPP AAccttiivviittiieess Community Sector HSPs Accreditation

Metamorphosis, Seniors Health Research Transfer Network (SHRTN) and Ontario Community Support Association (OCSA) presented their accreditation plans at the Quarterly Community Sector Meeting on September 25th. The key elements of the plan are:

Metamorphosis recommends a multi-year phased approach which reflects the capacity and realities of existing accreditation bodies to complete accreditation for the 43 MH LHIN HSPs as well as their normal on-going business. In addition the CCAC has announced that they require all of their contracted providers to be accredited within 5 years further restricting the capacity of current accreditation bodies.

Metamorphosis proposes a 4 year accreditation plan from October 1, 2009 – September 30, 2013. Because some of the HSPs will be participating in the accreditation process at a later date and

also because some of the smaller HSPs have little knowledge of accreditation and its benefits, Metamorphosis recommends a “stepped up” process of quality improvement. MH LHIN HSPs will identify their timelines for: Participation in Accreditation Skills Development Workshops. Participation in OCSA Benchmarks of Excellence Program. Quality and Accreditation Leadership Circles.


The MH LHIN will hold the third meeting with the hospital executives regarding the development of the H-SAA 2010-1012. Given Ontario’s serious economic problems and the significant impact on government revenues, the government is not yet able to provide hospitals and LHINs with financial planning information for 2010/11 and 2011/12 and it is not yet known when this information will be available. Despite these challenges, all hospitals have fiduciary responsibility to maintain a balanced budget and that LHINs are also required to do so through their legislation. The direction from the ministry is that hospitals will not submit completed HAPS to their LHINs by November 30th, 2009, although they are encouraged to continue to work closely together in planning for 2010/11. There is an opportunity for hospitals and LHINs to collaborate in creative strategies to respond to this new environment. The ministry has directed that:

The HAPS process and H-SAA will likely change from a two year to a one year term covering 2010/11.

An extension of the existing H-SAA between LHINs and hospitals is very likely for this one year period.

Working closely with the MOHLTC, the Steering Committee will examine and address the performance.

Management issues related to extending the existing H-SAA for 2010/11 with the intent of minimizing the administrative burden on LHINs and hospitals;

Work to re-establish a two year HAPS process and H-SAA for 2011/12 and beyond will still continue.

Moderate Surge Planning

Experience with SARS in 2003 and recent experiences of other countries with H1N1 have signaled the importance of developing an effective critical care system to accommodate surges. A time-limited LHIN-based inter-hospital Critical Care Surge Planning Task Force was convened in September 2009, a



subcommittee of the Critical Care Committee, to develop a system-level plan to address a moderate surge for critical care in the Mississauga Halton LHIN. The MH LHIN Critical Care Surge Capacity Management Plan is being developed. It will outline an approach to management and communication and inter-hospital protocols to facilitate managing a moderate surge.

Celebrating Innovations in Health Care Expo 2009

Celebrating Innovations in Health Care Expo is a showcase of initiatives that are driving health care system renewal in Ontario. The Credit Valley Hospital submission entitled “Which Innovation Averted 87.4% Emergency Department Transfers? NPSTAT did!” has been chosen to participate in the Expo to host an exhibit booth. This year’s Expo takes place on November 18, 2009 at the Metro Toronto Convention Centre in Toronto.

The MH LHIN funds the Nurse Practitioner Supporting Teams Averting Transfer (NPSTAT) Program through the Aging at Home investments. The program includes a multi-disciplinary team of long-term care home staff, physicians, a primary care nurse practitioner, CCAC case managers working collaboratively to support LTC homes with the ongoing management of residents who have sudden or semi-urgent injuries or illnesses. The team facilitates discharge of residents back from hospitals.

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The Board Chair, CEO, and Manager, Communications and Community Engagement continue to meet with MPPs and their constituency staff. To date, the LHIN has met with eight MPPs. The primary purpose of these meetings is to review the list of potential new Board members and the thorough process undertaken by the Board and the Nominations Committee in the selection of these candidates. A secondary purpose of the meetings is to formally introduce the Manager, Communications and Community Engagement as a contact person for office staff if health related questions or queries arise, and to ensure that successful and joint announcements continue to occur. A third purpose of the meetings is to mention that the survey questions used for MPPs by KPMG during the LHIN-wide Board Effectiveness Review have been replicated by the MH LHIN and sent out to all of our MPPs to get an idea of how we are doing locally. A couple of MPPs have stated that they do not respond to surveys and to date two responses have been received. The meetings that have occurred to date have been very positive and to keep the lines of communication open and to further build relationships, an information session for constituency staff is being organized by the MH LHIN and will occur during the next month. The date for this information session with constituency office staff is set for Monday, November 30, 2009 and the CCAC and all three hospitals will attend this meeting to give an overview of their services, enhancements and to give contact info to MPP office staff for outstanding and future questions.




The September 30th Governance to Governance (G2G) session occurred and was a success. The topic for this session was our next Integrated Health Service Plan: 2010-2013 and Narendra Shah made the presentation. A demonstration of the Governance Portal that is being utilized in a few other LHINs also occurred. There were 98 attendees (out of 109 registrants) and 70% of those were either Board Members or Board Chairs. There were 6 comments or questions that were left for the LHIN to respond to and answers are currently being drafted. The next G2G session is scheduled for Wednesday, November 25, 2009 at the Mississauga Living Arts Centre in the Staging Room. The topic for this next session is: Performance Management and your own Accountability Agreement.

French Language Services Planning A planning meeting with our French Language Services consultant occurred in October to discuss our next steps following the successful completion of the French Language Services inventory completed by MH LHIN HSPs. The five identified agencies in our LHIN have been invited to attend a meeting on November 13, 2009. The purpose of this meeting includes the following:

1. Review the identification process under the French Language Services Act and what this means for identified agencies.

2. Review their survey results about French speaking Health Human Resources and current offerings of health services in French.

3. To discuss where they all are in regards to their implementation plans for providing French language health services and moving towards becoming designated agencies.

4. To work together on opportunities for moving forward. Physician Engagement Think Tank Meeting

The Manager of Communications and Community Engagement hosted a meeting which included individuals from the MH LHIN, Health Force Ontario, MH CCAC, OMA and Pfizer to discuss the development of a physician engagement strategy. Best practices were reviewed and current initiatives in this field were also discussed and next steps were determined.

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Monthly meetings with the Directors of Communications from our 3 hospitals and the MH CCAC occur. The September meeting included a presentation by a guest speaker – Steve Gibson, a lawyer from Respect in the Workplace who reviewed the recent Accessibility for Ontarians with Disabilities Act (AODA) and templates that his company has developed to help hospitals and other organizations in the province ensure that they are compliant with these standards. Another guest, Susan Swartzack from the MH LHIN also attended to provide an update and seek marketing and communications advice about the Self-Management programs currently being offered in the MH LHIN.



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Management Report to the MH LHIN Board of Directors – November 2009 II MMOOHHLLTTCC UUppddaatteess

MLAA 2009-10 Q2 Reporting

(A) (B) (C) (D) (G)

PI #. Performance IndicatorIndicator

TypeProvincial

TargetLHIN Starting Point 2009/10

LHIN Performance Target - 2009 /10

Projected Performance

Target Oct. 31, 2009 Actual Performance

1 90th Percentile Wait Times for Cancer Surgery 1 Access 84 Days 51 50 50.50 60

2

90th Percentile Wait Times for Cardiac By-Pass

Procedures 1 Access 182 Days 182 182 182.00 44

3 90th Percentile Wait Times for Cataract Surgery 1 Access 182 Days 98 95 96.50 92

4 90th Percentile Wait Times for Hip Replacement 1 Access 182 Days 183 172 177.50 149

5

90th Percentile Wait Times for Knee Replacement 1 Access 182 Days 209 182 195.50 155

6

90th Percentile Wait Times for Diagnostic MRI

Scan 1 Access 28 Days 102 95 98.50 119

7

90th Percentile Wait Times for Diagnostic CT Scan 1 Access 28 Days 37 35 36.00 42

8

Median Wait Time to Long-Term Care Home

Placement -All Placements 2 Integration 50 Days 96 84 90.00 122

NOTES1 = Actual Performance Value is from Q2 2009/10 (Jul, Aug, & Sep 2009) 2 = Actual Performance Value is from Q1 2009/10 (Apr, May & Jun 2009)

FOR ALL INDICATORS

Column Definition:(A) Per Schedule 10 of the signed Accountability Agreement

(B) Per Ministry-LHIN Interpretation Letter: MLAA Performance Indicators and Targets(C) Per Schedule 10 of the signed Accountability Agreement

ASSIGNING COLOURS TO COLUMN (G):

Attention - Above MLAA Performance Variance Report Required.

Mississauga Halton LHIN MLAA Performance Indicators2009/2010 - October 31, 2009

Column

Doing Well - Below LHIN Starting PointMonitor - Above LHIN Starting Point

Management Report to the Board – November 2009

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The MH LHIN is required to report to the Ministry on two indicators: 90th Percentile Wait Times for Cancer Surgery and Median Wait Time to Long Term Care Home Placement. 90th Percentile Wait Times for Cancer Surgery The wait time of 60 days is still significantly below the provincial target of 84 days. The LHIN appears to have plateaued in performance with respect to the 90th percentile wait times. The re-fresh of the strategic plan at the CVH will place a further emphasis on cancer and the chief of surgery has submitted a plan to focus on several targeted sites for improvement. This will result in a distribution of resources more aligned to patient demand. The region will continue to promote process improvement in complex surgical areas such as thoracic malignancy, gynecologic malignancy and hepato-biliary surgery (proposal to have Trillium act as primary site for the LHIN). Preliminary data from Cancer Care Ontario (CCO) has shown a reduction in waits in both of the aforementioned areas (lung and gyne). The introduction of a diagnostic assessment program at the Peel Regional Cancer Centre (PRCC) has drastically reduced the time for workup of patients with suspected breast tumors and a parallel program for colorectal cancer will be launched in 2010 that will be expanded to all participating hospitals. These initiatives will result in some further reduction in wait times and this should be enhanced with the opening of additional service capacity at Trillium and CVH. We need to be aware of the natural growth in cancer activity in our region that will continue for the foreseeable future. This will continue to put a strain on our system. Median Wait Time to Long Term Care Placement The Q1 2009/10 median wait time to placement of 122 days is a decrease of 12% as compared to 139 days in Q4 2008/09. This decrease between Q4 2008/09 and Q1 2009/10 is the result of ALC strategies that have been implemented to reduce the number of ALC patients in hospitals. Emphasis has been placed upon the placement of hard to serve patients with long LOS who had being waiting for placement in CCC, Rehab or Mental Health hospital beds. This is the result of concerted efforts by hospitals, CCAC, and LTC Homes, with the support of specialized outreach teams, including Geriatric Mental Health, Acquired Brain Injury, and Nurse Practitioner programs. At the end of September there were 11 hard to serve individuals waiting for LTC placement within all areas of the MH LHIN hospitals.




ED/ALC Strategies

MH LHIN ED/ALC Strategy Lead

We would like to welcome Cindy Hawkswell to her new role as the ED/ALC Strategy Lead for the MH LHIN. We are looking forward to Cindy’s experience in utilization management and coaching skills to assist the LHIN in sustaining the gains we have made to expedite the flow of patients, reduce ED treatment times and align our various strategies from a systems perspective to address ED/ALC targets. Most recently, Cindy was the Manager of the ICU at Trillium Health Centre and has worked with the Ministry of Health and Long-Term Care as a coach with the Critical Care Secretariat. Cindy has led both surge and pandemic planning at Trillium and is enthusiastic about this opportunity as the ED/ALC Strategy Leader for MH LHIN.

ED Leaders Group

ED Leaders will meet on November 20th. The monthly performance of each hospital will be reviewed and strategies successful in reducing the ED LOS and specifically meeting targets will be discussed further. Effective strategies will be shared for LHIN-wide hospital implementation. Hospital efficiency improvements have been the focus of hospital ED Leaders to date. Particular interest will now be on those initiatives that influence the Time to Admit portion of the emergency room experience. This time stamp appears to be most influential on the ED Wait time. In addition to the efficiency improvements the ED Leaders will now broaden their view of ER experience to focus on ED attendance also, by studying the subsets of patients that attend ED and the opportunities to avert an attendance by better upstream management of these patients or by diverting them to a more appropriate setting for care (eg. Clinic).

Appropriate Level of Care (ALC)

Review of Hospital ALC Discharges The MH LHIN has facilitated and supported an ALC Review as a quality project across all hospital sites to be carried out in November. Over the last year considerable success has been achieved in the reduction of the percentage of ALC patient days in hospitals across the LHIN. Much of this success has been the result of the efforts of the community and hospital partners through the Home First Approach in discharge planning. Work continues to maximize the available acute care capacity and to improve the system flow of patient by developing and implementing system wide best practices and innovative strategies. The focus of this ALC review is on the sustainability of practices supporting the early identification of need for discharge planning, a multi-discipline team approach to planning for post acute care and effective mechanisms at the points of handoff through the discharge process. Staff of the hospital and CCAC were engaged in defining the project Membership on the team includes Cindy Hawkswell, ED/ALC Strategy lead,



community representatives Margaret Bouillon, LTC Homes, Michelle Mackenzie, LTC Restore Program, Kristina Hall, Supports for Daily Living. Judy Bowyer, MH LHIN staff help facilitate this process. The results of the review will be reported to the MH LHIN and the MH ALC Senior Leaders’ Group.

Annual Business Plan 2010/11

The MH LHIN has received the guidelines from the MOHLTC for completing and submitting the 2010/11 ABP. The purpose of the plan as specified in the legislation (LHSIA 2006, c.4,s.18(2)) is to operationalize the goals and objectives of each priority area within the IHSP into detailed action plans for the upcoming fiscal year. The expectation is that the first draft be submitted to the MOHLTC by January 31, 2010. A final plan is to be submitted to the MOHLTC in the spring of 2010 once budget allocations have been announced by the MOHLTC. The MH LHIN Board will review the draft in their January 2010 meeting.

Clinical Services Integration Regional Maternal, Newborn, Child and Youth Integration Steering Group

A Steering Group has recently formed to lead the development and implementation of a “regional maternal, newborn, child and youth plan” for services within the Mississauga Halton LHIN. The group will work in keeping with the MH LHIN clinical integration principles for working together and decision making. The CEO of Credit Valley Hospital is the sponsor of this work which is being co-chaired by Dr. Ann Bayliss, Chief of Paediatrics, Credit Valley Hospital and Patti Cochrane, Vice-President Patient Services and Quality, Trillium Health Centre. Membership includes hospital representatives (Chiefs of Obstetrics, Chiefs of Paediatrics, Vice-Presidents, and Maternal Child Program Directors). Other members include representation from mid-wives, public health, family medicine, CCAC, Child Health Network, Erinoak Children’s Treatment Centre, Child psychiatrist, and the LHIN. This Steering Group will be accountable to the MH LHIN through the Clinical Integration Steering Committee. The group has met twice (October and November) to begin mapping out the current service situation, identification of gaps in service, and opportunities for synergy/realignment of services in the context of a regional delivery model.

Ontario Diabetes Strategy (ODS) – Update On Thursday November 12, 2009 the Ministry announced that they are providing Ontarians with diabetes, and those at risk with more supports and services to help them better manage diabetes. They also announced targets to ensure that Ontario Diabetes Strategy is producing results. The new provincial targets include:

Attaching all people with diabetes to a primary health care provider Ensuring that 80 per cent of people with diabetes, aged 18 and older, have all three diabetes tests

completed. To help meet these targets, the province is moving forward with a number of new initiatives that will further help people manage and prevent diabetes, including:



Creating 51 new diabetes education teams across the province Expanding chronic kidney condition services, including additional clinic visits and increased dialysis

treatment at home Creating up to 14 regional coordination centres to help better organize and manage local diabetes

programs Expanding diabetes care and prevention resources, including new education kits for newly-diagnosed

patients, community-based prevention programs for high-risk groups, enhanced services through EatRight Ontario and a new Stand Up to Diabetes website.

The details regarding specific LHIN level supports is pending as of November 12, 2009.

Mental Health and Addiction Services Dr. Brian Rush, Clinical Researcher, Centre for Mental Health and Addictions presented to SIGMHA on the use of common screening tools as a strategy towards integration. He cautioned that although the co-morbidity rates for mental health issues among addiction clients is 70-80%, the prevalence of addictions among those diagnosed with a mental illness is only 15-25%. This supports the ongoing need for specialized services and for cross-assessment for all client groups. The Integration Task Team is following up on these recommendations and reviewing screening tools that could be implemented across all services. With the goal of developing a ‘no wrong door’ strategy to improve access to services, this Task Team completed a survey to determine current intake and referral practices and identify current resources for this function across the MH LHIN. The Education and Training Task Team conducted six focus groups for families and clients as a strategy to develop a user friendly learning needs survey. The feedback from these groups was extensive and has given direction to the rollout of a community education program. This program will be rolled out in the Spring, 2010 in different geography areas; this lecture series will be geared to help the public identify mental health and addiction problems and how to seek help.

Access, Information, Referral and Intake Project (ASSIST)

The Access, Information, Referral and Intake (ASSIST) project is well underway. To date, 24 health service providers within the LHIN have participated in the project through the 3 task teams and Steering Committee.

The current project has 3 stages:

1. Design and Development 2. Test Phase Preparation 3. Test Phase Operations.

Design and Development This stage involved the development of the tools and processes for information, referral and intake and was completed October 2009.

Key deliverables:

Common intake and referral form including a risk screening tool Common processes and protocols for intake screening and referral for services Common user-friendly service definitions.

The team has also developed a measurement plan for the test phase.



MH LHIN Respite Services

On September 30, 2009, the MH LHIN issued a call for proposals for the provision of in-home respite service (only) across the LHIN as a part of the 2009/10 Aging at Home Strategy. Deadline for submission was October 15, 2009. The LHIN received seven proposals. Each proposal was carefully reviewed and scored using pre-established Board Decision criteria. In addition to the criteria noted above, the proposals were reviewed against the following:

Readiness to implement the initiative by January 01, 2010 Equity to the provision of services to recognizable populations Partnerships between existing Health Service Providers (HSPs) or between an existing HSP and a non

health service provider(s). Current performance and/or organizational capacity to delivery service LHIN-wide service How the service will be integrated with other respite services in the organization and/or across the

MH LHIN to create coordinated access to respite services Cost-effectiveness Experience and expertise in provision of respite services including the ability to assess the “right”

clients for this service The MH LHIN is currently working with the successful health service provider and their partners to

operationalize the service.

Specialized Geriatric Services Strategy

On November 25th, a Healthcare Provider Consultation will be held on the 5 year strategic plan, Specialized Geriatric Services Strategy: A Prescription for the Future. This session will provide providers and professionals serving Mississauga Halton LHIN frail seniors’ an opportunity to learn about the proposed Strategy as well as provide feedback.

Aging at Home Strategy

On November 3rd, 2009, the MH LHIN issued a Call for Proposal for 2010/11 Aging at Home (AAH) funding allocations in the following priority areas:

1. Supports for Daily Living 2. Volunteer Visiting Hospice 3. Continence care services for seniors living at home / community 4. Admission Avoidance/ Timely Discharge Initiatives aimed at reducing inappropriate use of hospital

beds and ER e.g. comprehensive wound care follow-up 5. Outreach Programs 6. Chronic Disease Prevention and Management.

The call is based on an assumption that the Ministry will allocate funds in 2010/11.

In addition, the LHIN is making strategic decisions in a number of areas that will carry forward into the Year III AAH Strategy including:



Intensive In-Home Respite Service Palliative care focused on reducing current acute beds utilization by 1/3rd Additional temporary transitional bed capacity to enable appropriate discharge from acute care and

transition back to the community Additional adult day programs and supports for daily living (SDL) services Mental health crisis intervention, support and assistance services Addiction services Transportation services Behavioural unit in Long-Term Care Home.

The deadline for submissions is noon on Friday, November 20, 2009.



eHealth

The OntarioMD (OMD) has officially announced the Physician EMR funding for this fiscal year. Given the work that MH LHIN had undertaken earlier this year with regards to the Physician eHealth Strategy we are well positioned to work with OMD and our Physician Steering Committee on how best to approach our primary care physicians and the facilitation of the EMR funding strategy. Our team has met several times over the last two weeks with OMD’s engagement team and it is our intention to develop a series of working sessions to help move our physicians through the process. OMD and their engagement team will be presenting to our Physician eHealth Steering Committee on November 19th with the intention of requesting feedback on how best to work with the physicians on how to optimism the successful adoption of the program. The funding of the OLIS EMR project has been secured. The contract has been signed by Summerville FHT and xwave (the EMR vendor). The work now continues as planned and we are anticipating the “living lab” environment to be completed and operational by the end of December, 2009. The Community Sector Provider Portal project is continuing as planned. The second wave of User Acceptance Testing (UAT) sessions will take place the week of November 23, 2009. The go-live date has been moved into January 2010 as a result of the technical integration of the two-factor authentication and security requirements necessary for the appropriate management of personal health information. The submissions for the funding requests from eHealth Ontario for local initiatives is still in process and awaiting a decision. We hope to hear back by the end of November or early December with respect to those proposals that have been approved and subsequently funded.

Refreshing the Integrated Health Service Plan (2010-2013) The final and penultimate draft of the IHSP has been sent to all Board members. This final draft includes revisions made based on the Board’s comments and suggestions provided at the September Board meeting,



and also reflects comments from the entire senior team at the LHIN. This final draft also includes another strategic priority entitled: “Create LHIN-wide regional programs”. This was previously embedded as a goal within the priority: “Improving access, quality and sustainability of the health system” but it was pulled out to emphasize its importance. The final draft was also submitted to the Ministry of Health and Long-Term Care as per their request to preview all IHSPs from all LHINs. The feedback that we received was very positive and reaffirmed our thinking as their comments aligned with the intent of our IHSP. A staff recommendation for Board approval of the final draft IHSP will be presented to the Board at its Nov. 26th meeting. The roll out strategy for the public release of our IHSP: 2010-2013 is scheduled for November 30, 2009. A version will be posted on our website and an email blast will go out to all of our stakeholders and partners across the LHIN. Printed copies will also be sent to all of our HSP executives and Board Chairs and other key stakeholders such as MPPs during the week of Dec 1-4.

.

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The MH LHIN and Hospital H-SAA meeting was held on November 13, 2009. The Joint OHA/LHIN H-SAA Steering Committee has created an interim process that the LHINs, the OHA, and the government have agreed upon as a reasonable approach to planning for the fiscal year 2010-11. The H-SAA Steering Committee is recommending that given the uncertainty at this time an extension of the existing agreement is the most appropriate course of action to follow. In the interim, hospitals will submit a Management Planning and Risk Report due December 15th, 2009. Hospitals will continue to operate with a focus toward a balanced budget plan, using numbers we know in conjunction with the revenue planning scenarios of 0%, 1% and 2%.


Long-Term Care Home Accountability Planning Submission (LAPS)

The 27 Long-Term Care homes within the MH LHIN will be submitting their LAPS document to the LHIN by the deadline of November 20, 2009. The LAPS document, completed by each long-term care home will provide the LHIN with information that will be required to develop the individual Long-Term Care Home Accountability Agreements that will take effect as of April 1, 2010. LHIN staff will undertake the process to review each LAPS document in November and December and generate the individual L-SAAs in January for sign off prior to March 31, 2010. Throughout October and November a number of communiqués and frequently asked questions documents were developed and provided to the long-term care homes to assist them in completing the LAPS forms. An initial information session was held for the 27 LTC homes within the MH LHIN on October 7th and additional discussion on the LAPS forms occurred with homes at the regularly scheduled meeting of home administrators and LHIN staff on November 12, 2009.





An information session with constituency office staff is set for Monday, November 30, 2009 and the CCAC and all three hospitals will attend this meeting to give an overview of their services, enhancements and to give contact info to MPP office staff for outstanding and future questions. Currently there are 12 office staff confirmed to attend and they will be representing 7 of our 10 MPP offices. This is the first information session that will be hosted at the LHIN and another one will be planned for next year.


The next Governance to Governance (G2G) session is scheduled for November 25, 2009 at the Mississauga Living Arts Centre in the Staging Room. The topic for this session will be “Performance Management and your own Accountability Agreement” and the presentation will be made by Bill MacLeod. There are currently 96 registrants (as of Nov 18/09) and 70% of those are either Board Members or Board Chairs.

French Language Services Planning

An information session with our identified agencies under the French Language Services Act occurred on November 13, 2009. The MH LHIN has 5 identified agencies which are:

Alzheimer Society of Peel Credit Valley Hospital Mississauga Halton Community Care Access Centre Ontario March of Dimes Trillium Health Centre – Sexual Assault Centre

This information session reviewed the process and history of how they became identified agencies or programs, what it means to be an identified agency, and the requirements and reporting accountability to the MH LHIN. Each identified agency is required to complete and submit an Implementation Plan to the LHIN and this is due on April 30, 2010. Another meeting will be scheduled in the New Year to check in on their progress with the completion of their Implementation Plans and to answer any outstanding questions.

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The MH LHIN is committed to supporting and advancing a professional culture of shared values and behaviours which are consistent with the mission and mandate of the organization. MH LHIN’s diversity and health equity agenda will be characterized by a holistic approach. The MH LHIN will strive to reduce health disparities as a shared responsibility with its health service providers by integrating health equity into strategies and activities that fall within our mandate and influence. Over the past few months, extensive material and literature on this topic were reviewed to help shape the MH LHIN’s Health Equity Plan. Some key resources that were used include papers on health equity published by the Wellesley Institute, referring to the Toronto Central LHIN framework for creating health equity, materials published by the Diversity Health Practitioners Network and by reviewing some of the local strategies being employed by some of our HSPs, and by reviewing many other resources. Board input and feedback was also received from one individual and has been incorporated and Brij Chadda’s paper on “Diversity on a LHIN Board



– June 26, 2009” is an appendix to the full report posted on the LHIN website. An executive summary is attached.

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Local Health Integration Collaborative (LHINC) Bill MacLeod chaired the first full session of the LHINC Council and the key messages from that meeting are attached as an appendix.



Management Report to the MH LHIN Board of Directors – December 2009 II MMOOHHLLTTCC UUppddaatteess


ED/ALC Strategies

The Quarterly Stocktake Report (Q1 09/10) was submitted to the MOHLTC and the quarterly meeting with ADM took place December 3, 2009. Recognition was given to the MH LHIN for the exemplary performance in moving closer, and in some cases exceeding the ALC rate for Q1 of 2009/10. With respect to ED performance, progress is being made and Trillium Health Centre (THC) is undertaking several efforts including Performance Improvement Plan (PIP) where an external team will assist THC in this area. Through the monthly ED reporting Tool, MH LHIN staff continuously monitors each hospital and site performance as they track against the targets and work closely with the ED Leaders Operations Group and MH LHIN Decision Support Group to ensure timely data capture and evaluation of performance. ED Leaders will meet again on January 10th 2010. The monthly performance of each hospital will be reviewed and strategies successful in reducing the ED LOS and specifically meeting targets will be discussed further. Effective strategies will be shared for LHIN-wide hospital implementation.

Provincial Council for Maternal Child Health

A Provincial Council for Maternal Child Health (PCMCH) regional network is establishing a cross sector working group. The Provincial Council scope is primary, secondary, tertiary and quaternary maternal, newborn, child and youth health services, delivered in community and hospital settings. The Council’s working group will review the current state of regional perinatal and/or child health networks across the province and will make recommendations for optimal structure, function/roles, membership, governance, and funding model for regional networks; develop an optimal relationship between regional networks, PCMCH, and the LHINs; develop a strategy to ensure regional networks across the province; and develop a strategy for implementation and knowledge translation systems. The ministries of MOHLTC, MoE, and the MCYS will be reviewing the School Health Support Services (SHSS) overall program and its mandate, access, strengthen and weaknesses in program delivery, funding, and coordination of services. The ministries have hired Deloitte & Touche LLP to conduct the review on behalf of the government and provide a final report by July 31, 2010.

Management Report to the Board – December 2009

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MH LHIN Francophone Community Engagement The MH LHIN continues to meet with the Centré de services de santé – Peel et Halton (CSSPH) on a quarterly basis. The MH LHIN also recently participated in a GTA wide French Language Service Survey. There was a 78% response rate in the MH LHIN. The number of French-speaking staff by occupation were identified. The survey also identified whether mechanisms were in place to identify French-speaking clients. All survey results were compiled with the other 4 LHINs (Toronto Central, Central, Central West, and Central East) results. A 5 GTA LHIN Executive Summary of the results has been completed and 261 health service providers completed the survey, for a response rate of 53%. From the data collected in the GTA, approximately 40% of respondents reported having one or more French speaking staff members at varying level of oral proficiency. Future plans are to develop and implement a Francophone healthcare needs assessment.

Ontario Diabetes Strategy (ODS) – Update The first Regional Diabetes Newsletter has been launched, which is a collaborative initiative by the diabetes programs in the Mississauga Halton LHIN. The purpose of this newsletter is to update physicians and health care professionals in our community about new diabetes initiatives in our LHIN and province. A copy of the newsletter is available on the MH LHIN website. The MH LHIN diabetes teams are implementing a new pilot project to provide outreach diabetes services within physician offices (targeting Family Health Groups or independent physicians). In alignment with the Ontario Diabetes Strategy, the goal of this project is to increase access to diabetes education and care.

Mental Health and Addiction Services Work has begun on the implementation of the LHIN’s new investment in mental health and addictions, Strengthening Community Supports for Concurrent Disorders Initiative. The purpose of this initiative is to reduce repeat ED visits at the MH LHIN hospitals. The project is comprised of the following key components:

1. Enhanced Community Crisis Supports for Concurrent Disorders clients. 2. Expansion of Community Chemical Withdrawal Management Services across the MH LHIN. 3. Expanding Case Management Services for Concurrent Disorders throughout the MH LHIN,

providing priority access to those clients released from the ED or inpatient units, and the community withdrawal management.

These services will be evaluated on the basis of giving priority for service to the concurrent disorder or addiction clients who visit the ED and will assist in reducing one or more of the following performance measures:

Reduction of early return ED visits for substance abuse by 80%, Reduction of ED visits for substance abuse/concurrent disorders by 10%, Reduced length of stay in ED for substance abuse/concurrent disordered clients, Reduced average length of stay in hospital, Reduced wait times for case management for concurrent disorders.

Utilizing standard selection criteria including performance and leadership capacity, Canadian Mental Health Association of Halton has been selected to lead this initiative. They will work with two addiction and three mental health organizations to implement all aspects of this initiative, including leveraging of existing services to increase capacity and the creation of standardized process.



Aging at Home Strategy

Call for Proposals

The Mississauga Halton LHIN received a positive response to the Year III Aging at Home Call for proposals. The LHIN received 36 detailed proposals and the total of the requests for funding received in the proposals was over $24 million. The Proposal Review Committee met on December 8th and 9th to review and evaluate the proposals based on the Board’s Decision Criteria. The Committee will be reconvening in January, 2010 to develop a prioritize list of recommendations for the Board’s consideration.



eHealth

The MH LHIN continues to develop a collaboration approach with OntarioMD and the OMA with respect to facilitating EMR implementation and adoption under the new program in an effort to increase our adoption rate. The Ontario Laboratories Information System (OLIS) Electronic Medical Records (EMR) integration project with Summerville FHT continues as planned with a “go-live” date of January, 2010 in which the Province will be able to gather the data elements as defined in the Proof of Concept. The service level agreements and contracts are in the final stages of negotiation between Metamorphous and Trillium. The go-live date is on track for January, 2010. It is our intention to present this portal to the Board of Directors with a date yet to be determined.

Refreshing the Integrated Health Service Plan: 2010-2013 – Official Release The final IHSP: 2010 – 2013 for the MH LHIN was released publicly on November 30, 2009. Both an English and French version were posted onto our website and an email blast with the IHSP as an attachment and links to our website were sent out the week of Nov 30/09 to all of our HSPs, key stakeholders and participants from all of our community engagement sessions. Printed copies of the booklet version are currently being produced and will be sent to all of our HSP executives and Board Chairs and other key stakeholders such as MPPs in the New Year. All MH LHIN Board Members and staff will also receive a printed booklet version.



MH LHIN Transportation Strategy

On behalf of the MH LHIN Transportation Group, consisting of a collaboration of regional, municipal, provider and cross boundary partners, the Canadian Red Cross has sent to publish a media release detailing the transportation agency partners serving seniors requiring health-related rides within the LHIN. Eligible seniors will be connected to the most appropriate provider through a toll free number supporting all organizations. This will enable seniors to access service effectively when and where needed, while augmenting the Aging at Home Strategy initiatives and other LHIN priorities. The release will appear in local newspapers serving the MH LHIN region, on the LHIN website, and forwarded to all LHIN health service providers.

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MH LHIN CSS and MH&A Quarterly Sector Meeting – December 10, 2009

The quarterly sector meeting was held at the Hilton Garden Inn in Oakville. LHIN Staff provided updates on LHIN Strategic Priorities and new initiatives such as MH&A and palliative care investments as well as updates on ED/ALC, ASSIST, Shared Services West and Finance. In addition LHIN staff ensures that we receive feedback and ideas from our HSPs. In this meeting we asked them to identify integration opportunities.


Each hospital has submitted a high level initial submission on initiatives that will need to be taken under the scenario planning of 0%, 1% or 2% increase in base budgets in 2010-11. These scenarios are meant to help guide further discussions between hospitals and LHIN in the time ahead. Over the next few weeks, senior level discussion will take place with all LHINs, LHINs and the Ministry and local MH LHIN specific deliberations to consider options available and strategies to deal with the fiscal reality. The government of Ontario fully understands the importance of providing LHINs and hospitals with a planning target as soon as possible. The government, LHINs and the entire health system are working together to remain focused on access to quality care while also making responsible financial and operating decisions.


Long-Term Care Home Accountability Planning Submission (LAPS)

The target date for Long-Term Care Homes to submit their LAPS document was November 22, 2009. 24 of 27 homes submitted their documents as of this date and the remaining 3 homes submitted documents within the next week. Staff is reviewing the documents for completion, accuracy and consistency of information. Where staff may have question, the long-term care home will be contacted to provide clarification and where necessary revise the information presented in the LAPS forms.



The template for the Long-Term Care Home Service Accountability Agreement (L-SAA) is in development and anticipated to be available for board review in January. Once the L-SAA template is approved, staff will initiate work to populate the schedules attached to the agreement with information provided in the LAPS forms and create individual agreements for all homes. All agreements must be signed by March 31, 2010 and will take effect as of April 1, 2010. All homes will be provided an update to the process at the next LTC Home – LHIN meeting scheduled for January 14, 2010. LTC Home Quality Improvement Initiative – “Residents First” The MH LHIN is one of four LHINs that are involved in the Residents First quality improvement project for LTC homes. The project is sponsored by the Ontario Health Quality Initiative (OHQC). This new provincial initiative brings together all stakeholders in the long-term care sector in a concerted effort to raise the quality of resident care to a level that is the best in Canada. Expected outcomes include reduced adverse events and improved clinical outcomes, reduced visits to emergency departments, and a consistent and overall enhancement in both resident experience and staff satisfaction. In the first year of implementation, participating homes will be part of a LHIN-based learning collaborative, where a team within their home (five people per team) will work with other teams on the following topic areas:

• Emergency department (ED) avoidance • Resident experience …as well as one of the following clinical topic areas of the team’s choosing:

• Pressure ulcer prevention • Falls prevention • Continence care

Materials explaining the project have been forwarded to all 27 long-term care homes in our area and requesting homes to volunteer for participation in this project. It is hoped that 8 to 10 homes will participate in the project. In total 100 homes across the province will be involved in the project. Currently 4 homes have indicated that they are willing to participate. A formal communication plan for the project will be launched in January.



A Governance to Governance (G2G) session was held on November 25, 2009 at the Mississauga Living Arts Centre in the Staging Room. The topic for this session was “Performance Management and your own Accountability Agreement” and the presentation was made by Bill MacLeod. There were over 90 people in attendance. The materials from the session were distributed and an evaluation and feedback survey is currently out for completion and 14 surveys have been completed as of Dec 16/09. A reminder email has gone out asking for participants to complete the survey and the results will be compiled in the New Year and session format and topics will be revised accordingly. An offer of collaboration from Carolyn Giddings, Co-chair of Metamorphosis came forward to John Magill. Carolyn offered herself and some other Board Members to come forward to meet with the MH LHIN to help develop future G2G sessions. This offer was graciously accepted and a meeting is currently being set up to discuss the next session which is scheduled for Wednesday, January 27, 2010. The location has not yet been confirmed for this next G2G session.



GTA Community Engagement Leads Meeting

The MH LHIN hosted a GTA Community Leads meeting on December 7, 2009. This meeting brings together the leads for the portfolios of Francophone Language Services, Aboriginal Health and Health Equity/Diversity, along with the French Language Services Consultants from the MOHLTC for the five GTA LHINs (MH, CW, CE, Central and Toronto Central). Collaboration on a GTA wide Aboriginal engagement session is being planned for March, 2010 and ongoing collaboration around the French Language Services Survey that each GTA LHIN completed is underway. The GTA LHINs will be submitting a funding proposal to both the Reseau franco-sante du Sud de l’Ontario (RFSSO) and the Canada-Ontario Agreement on French-Language Services 2010-11 Special Projects Funding Call. These proposals will focus on completing a literature review and needs assessment GTA wide and also at each LHIN level to help with future French language service delivery planning and execution in areas of need.

VVII CCoommmmuunniiccaattiioonnss Local Health Integration Collaborative (LHINC)