1. No category

140 Allstate Parkway
Suite 210
Markham, ON
L3R 5Y8
Tel: 905-948-1872
Fax: 905-948-8011
Toll Free: 1-866-392-5446
http://www.lhins.on.ca
CEO REPORT
JUNE 24, 2008
Page 1
140, Allstate Parkway
bureau 210
Markham, ON
L3R 5Y8
Tél: 905-948-1872
Téléc: 905-948-8011
Sans frais: 1-866-392-5446
http://www.lhins.on.ca
CEO REPORT
JUNE 24, 2008
TABLE OF CONTENT
1.0
MINISTRY OF HEALTH ............................................................................................... 4
1.1
1.2
1.3
1.13
Additional Base and One-Time Funding for Central LHIN (APPENDIX 1.1) .......................... 4
Vaughan Community Health Centre Capital Project (APPENDIX 1.2) ................................. 4
Aging at Home – Detailed Plan – Central LHIN Agency Approved to provide
Community Support Services (APPENDIX 1.3) .............................................................. 4
Annual Service Plan – 2009-10 Guidelines (APPENDIX 1.4) ............................................ 4
Alternate Levels of Care and Emergency Room Strategy (APPENDIX 1.5).......................... 5
Community and Long-Term Care Stabilization Increases, 2008/09 (APPENDIX 1.6) ........... 5
Adjusted 2008/09 Allocation for LHIN Operations and Payment Schedule (APPENDIX
1.7) .......................................................................................................................... 5
Interim Contract Management Guidelines for Community Care Access Centres .................. 6
Status Update on Agency Audits and Reviews Project (APPENDIX 1.9) ............................ 6
Aging at Home Vans (APPENDIX 1.10) ......................................................................... 6
Additional Base Funding for Operations of Hospitals for Growth Funding and Small
Hospitals (APPENDIX 1.11) ......................................................................................... 7
Ontario Paediatric Wait Time Strategy (PWTS) – One-time Incremental Funding
(APPENDIX 1.12) ....................................................................................................... 7
New Public Reporting in Patient Safety Indicators (APPENDIX 1.13 .................................. 7
2.0
LEGISLATION UPDATE ............................................................................................... 8
2.1
Increasing Access to Qualified Health Professionals of Ontarians Act (APPENDIX 2.1) ........ 8
3.0
CENTRAL LHIN UPDATES ........................................................................................... 8
3.1
3.1.1
3.1.2
3.1.3
3.1.4
3.2
3.3
3.4
3.5
3.6
3.7
3.8
3.9
3.10
3.11
3.12
3.13
Board Meeting – Follow-Up Items – May 27, 2008 ........................................................ 8
Health Infrastructure Renewal Fund (HIRF) For Fiscal year 2007/08.................................. 8
Ontario Nurses Association (ONA) Settlement Funding (APPENDIX 3.1.2) ......................... 9
Wait Times Incremental Allocations (APPENDIX 3.1.3) ................................................... 9
Board Development Day .............................................................................................. 9
2008/09 Business Plan (APPENDIX 3.2)........................................................................ 9
Compliance Declaration – June 2008 (APPENDIX 3.3).................................................... 9
IHSP Action Plan (APPENDIX 3.4) .............................................................................. 10
LHIN Urgent Priority Fund – Central LHIN (APPENDIX 3.5) ............................................ 10
Quarterly Ministry-LHIN Accountability Agreement Performance Report .......................... 10
Paediatric Surgical One-Time Funding Allocations ......................................................... 11
Residential Hospice Planning...................................................................................... 11
The Neurological Services Advisory Network ............................................................... 11
Aging at Home Year One Project Slate Update ............................................................. 12
Central LHIN Back Office Integration Forum ................................................................. 12
Draft Integration Strategy (APPENDIX 3.12) ................................................................ 12
Brief Overview of the impact to Central LHIN from Ontario’s $109 million investment
to reduce wait times in the Emergency Room .............................................................. 13
Health Service Needs Assessment and Gap Analysis (APPENDIX 3.14)........................... 14
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
3.14
Page 2
3.15
3.16
Central LHIN Health Professional Advisory Committee (APPENDIX 3.15)......................... 15
French Language Services in the Central LHIN – Update ............................................... 15
4.0
HEALTH SERVICE PROVIDERS................................................................................... 15
4.1
4.6
Provincial Programs Q3 in-year reallocation process - Southlake Regional Health
Centre (APPENDIX 4.1)............................................................................................. 15
Vaughan Dialysis Satellite Proposal (APPENDIX 4.2) ..................................................... 16
President & CEO Announced at Stevenson Memorial Hospital (APPENDIX 4.3) ................ 16
New CT Scanner for Stevenson Memorial Hospital (APPENDIX 4.4) ............................... 16
York Central Hospital - Letter of Recommendation – CIHR Partnership Award
(APPENDIX 4.5) ....................................................................................................... 16
Central LHIN/Toronto Central LHIN – e-Health Update (APPENDIX 4.6) ........................... 17
5.0
OTHER UPDATES..................................................................................................... 17
5.1
QMonitor 2008, Ontario Health Quality Council (APPENDIX 5.1).................................... 17
4.2
4.3
4.4
4.5
APPENDICES ...................................................................................................................... 18
Page 3
CEO REPORT
JUNE 24, 2008
1.0
MINISTRY OF HEALTH
1.1
Additional Base and One-Time Funding for Central LHIN (APPENDIX 1.1)
In a letter dated June 2, 2008, the Minister of Health and Long-Term Care confirmed that the
Central LHIN will receive $27,059,400 in additional base and one-time funding starting in 2008/09
fiscal year for the Operations of Hospitals.
On April 13, 2008 this funding was announced for all hospitals in Ontario. The Central LHIN’s
share includes:
•
•
•
•
1.2
$6,998,000 in base growth funding
$3,689,900 in base funding for Post Construction Operating Plan
$74,300 in base funding for small hospitals, and
$16,297,200 in one-time funding for select Wait Times initiatives.
Vaughan Community Health Centre Capital Project (APPENDIX 1.2)
In a letter dated June 4, 2008, Meryl Hodnett, Acting Director, Capital Planning and Strategies
Branch, Ministry of Health and Long-Term Care advised the Chair of the Vaughan Healthcare
Foundation that the Ministry has completed its review of the sketch plan and pre-tender documents
for the Vaughan Community Health Centre capital project to undertake leasehold improvements at
9401 Jane Street, Vaughan. After obtaining the necessary approvals, they can proceed with the
call of public tenders. A copy of the letter is included in the appendices.
1.3
Aging at Home – Detailed Plan – Central LHIN Agency Approved to provide Community
Support Services (APPENDIX 1.3)
In a letter dated June 2, 2008, Carrie Hayward, Director, LHIN Liaison Branch advised that the
Minister has approved St. Clair West Services as an agency to provide new Community Support
Services. A copy of the letter is included in the appendices.
1.4
Annual Service Plan – 2009-10 Guidelines (APPENDIX 1.4)
In an e-mail communicated dated May 30, 3008, Carrie Hayward, Director, LHIN Liaison Branch
provided LHINs with the 2009-10 Annual Service Plan Guidelines. Changes have been made to the
process to better meet the needs of LHINs as identified in feedback provided to the Ministry.
Additional materials (Financial Tables) will be distributed once LHIN budgets have been completed.
The Annual Service Plan Guidelines are included in the appendices.
additional attachments are posted on the Central LHIN Update.
Page 4
The complete package and
1.5
Alternate Levels of Care and Emergency Room Strategy (APPENDIX 1.5)
A memo dated May 26, 2008 was received from Carrie Hayward, Director, LHIN Liaison Branch
advising that the government expects LHINs to propose and agree to aggressive Alternate Levels Of
Care (ALC) related targets in light of the investments made to date by the government, work LHINs
have initiated, and the priority that LHINs have made to reduce ALC pressures. The memo informed
the LHINs on two new announcements which will unveil the government’s ALC and ER strategies.
A copy of the memo is included in the appendices.
The Ministry provided brief overviews of the elements of each strategy to be rolled out. The ALC
announcement was scheduled for May 28 and the Emergency Room Strategy announcement for
May 30, 2008. See the attached memo for further details. Included in the appendices are
documents related to these announcements including, the news release, backgrounder and fact
sheet.
1.6
Community and Long-Term Care Stabilization Increases, 2008/09 (APPENDIX 1.6)
In a letter dated May 28, 2008, George Smitherman, Minister of Health and Long-Term Care
advised that the government is planning to provide for stabilization base funding increases, in
2008/09 for the Long-Term Care Community Support, Mental Health and Addiction Services,
Community Care Access Centres and Long-Term Care Homes. The total stabilization increase for all
LHINs is $127.5 million.
The government’s planned base funding increase, over and above the 2007/08 base allocation for
Central LHIN is as follows:
4% increase for Community Care Access Centres;
2.25% increase for Community Support Services (CSS);
2.25% increase for Assisted Living Services in Supportive Housing;
2.25% increase for Acquired Brain Injury (ABI);
2.25% increase for Community Mental Health;
2.25% increase for Addiction Programs; and
1.5% increase for Long-Term care Homes (LTC Homes).
In a memo dated June 5, 2008, the Central LHIN communicated these details to all Central LHIN
community sector health service providers in order to assist them in better planning for the delivery
of services for this fiscal year. For further details please see appendices.
1.7
Adjusted 2008/09 Allocation for LHIN Operations and Payment Schedule (APPENDIX 1.7)
On May 27, 2008, Carrie Hayward, Director, LHIN Liaison Branch notifying Central LHIN that the
operating funding has been revised to $4,259,237 for 2008/09. This incremental funding is 23.1%
of Central LHIN’s base funding last year. This increase reflects a $40,000 incremental base lease.
The Ministry has held in reserve an amount to address the requirement for Hamilton Niagara
Haldimand Brant (HNHD) LHIN related to their new office building. This holdback includes base and
Page 5
on-time costs. In 2009/10, the on-time costs and any residual amount not required by HNHD will
be redistributed to all LHINs.
Semi-monthly payments will be adjusted to reflect this incremental allocation. Adjusted payment
schedule for 2008-09:
Payment on May 30:
$277,313 (including retroactive adjustment of $99,847)
All Subsequent payments:
$177,466
Central LHIN’s 2008/09 Operating Budget is on the agenda for Board approval on June 24, 2008.
1.8
Interim Contract Management Guidelines for Community Care Access Centres
On June 2, 2008 a memo was sent to all Community Care Access Centres (CCACs) Executive
Directors and Board Chairs providing the CCACs with interim contract management guidelines. The
interim guidelines will help CCACs manage service provider contracts and will support continuity in
client care service delivery throughout the review period. The interim guidelines provide direction on
tract renewals and extensions. Please see appendices for further details.
1.9
Status Update on Agency Audits and Reviews Project (APPENDIX 1.9)
The LHIN Liaison Branch embarked on a project to develop, with LHINs, guidelines to assist LHINs in
conducting agency audits and reviews. The purpose of the jointly developed guidelines will be to
foster the creation of principles, protocols, and tools to assist LHINs and the Ministry in:
•
•
•
Identifying when agency audits and reviews are required;
Supporting performance improvement frameworks; and,
Identifying a continuum of interventions (i.e. providing assistance and/or intervention required
that is appropriate to the situation and the roles and responsibilities of the LHINs and Ministry).
The impetus for this project is contained in the Ministry LHIN Accountability Agreement (MLAA)
Schedule 7, Part B (3b). Please see attached appendices for further details.
1.10
Aging at Home Vans (APPENDIX 1.10)
In a letter dated June 5, 2008, Carrie Hayward, Director, LHIN Liaison Branch advised the Central
LHIN that the vans will be ready for pickup from Chrysler dealerships beginning June 13 in time for
planned local announcements on June 19-21, 2008.
Costs associated with branding, transportation of vehicles from the manufacturer to and from the
branding site as well as the GST on the purchase price of each van were not included as part of the
original payment to health services providers. A total of $15,221.20 will be flowed to the Central
LHIN to cover these additional costs. Details are included in the appendices.
Page 6
1.11
Additional Base Funding for Operations of Hospitals for Growth Funding and Small Hospitals
(APPENDIX 1.11)
The Central LHIN has been allocated $6,998,000 in base growth funding. These funds are to be
allocated as base dollars to hospitals facing the fastest growth and the service pressures associated
with these demands. In addition, $74,300 has been allocated in base funding for small hospitals.
Please see attached document outlining how overall allocation was determined using the Health
Based Allocation Model (HBAM).
1.12
Ontario Paediatric Wait Time Strategy (PWTS) – One-time Incremental Funding (APPENDIX
1.12)
The Central LHIN has been approved for one-time incremental funding in the amount of $183,600
This one-time incremental funding will support the performance of 173 additional paediatric surgical
procedures that are tob e completed between April 1, 2008 and March 31, 2009. For further
details please see letters included in the appendices.
Service
Procedure
Base Volume
Dental/Oral Surgery
All Dental procedures
885
(inclusive of Extractions/
Restorations
Ophthalmology
All Ophthalmology
12
Surgery
procedures (inclusive of
Strabismus Repair)
Otolaryngology
Tonsillectomy &
1,087
Adenoidectomy
Myringotomy & Tube
291
Placement
Urology Surgery
Orchiopexy
16
Pyeloplasty
1
Total LHIN One-Time WTS Incremental Volume Allocation for fiscal year
2008/09
1.13
One-Time Incremental
PWTS LHIN Volume
Allocations
114
4
38
13
3
1
173
New Public Reporting in Patient Safety Indicators (APPENDIX 1.13
On May 28, 2008, the government introduced full public reporting on eight patient safety
indicators – including Clostridium difficile (C. difficile) – as part of a comprehensive plan to
create an unprecedented level of transparency in Ontario’s hospitals.
On September 30, 2008, all Ontario hospitals will be required to publicly report on C.
difficile rates in their facilities through a public website.
Page 7
Patient Safety Indicator
Clostridium difficile (C. difficile)
Methicillin-resistant Staphylococcus aureus (MRSA)
Vancomycin-resistant Enterococci (VRE)
Hospital Standardized Mortality Ratio (HSMR)
–mortality rates
Rates of ventilator-associated pneumonia
Rates of central line infections
Rates of Surgical site infections
Hand hygiene compliance among health care workers
Start Date of Public Reporting
Sept. 30, 2008
Dec. 31, 2008
Dec. 31, 2008
Dec. 31, 2008
April
April
April
April
30,
30,
30,
30,
2009
2009
2009
2009
A copy of the news release is included in the appendices.
2.0
LEGISLATION UPDATE
2.1
Increasing Access to Qualified Health Professionals of Ontarians Act (APPENDIX 2.1)
On June, 16, 2008 the government introduced new legislation that would ease the way for
internationally trained health care providers to practice in the province.
The legislation – Increasing Access to Qualified Health Professionals for Ontarians Act – will, if
passed, change the mandate of all regulatory colleges to acknowledge that access to health care is
a matter of public interest. Ontario has 23 regulated health professions.
This legislation is one part of a bigger plan to remove barriers for internationally trained doctors.
Over the summer, the McGuinty government will also be working closely with The College of
Physicians and Surgeons of Ontario on regulation changes that would ease the transition to practice
for foreign-trained doctors. The plan, based on the Report on Removing Barriers for International
Medical Doctors by Etobicoke-Lakeshore MPP Laurel Broten, Parliamentary Assistant to the Minister
of Health and Long-Term Care, details five major recommendations on how to further increase the
number of international medical doctors in Ontario.
This legislation is part of the government’s strategy to meet the needs of unattached patients,
reduce wait times and provide older Ontarians with care closer to home.
3.0
CENTRAL LHIN UPDATES
3.1
Board Meeting – Follow-Up Items – May 27, 2008
3.1.1
Health Infrastructure Renewal Fund (HIRF) For Fiscal year 2007/08
At the Board Meeting held on May 27, 2008, a question was raised as to the process for funding
the Health Infrastructure Renewal Fund (HIRF) initiative.
Page 8
The newly established process by the Ministry is that funding is determined and allocated by the
Ministry to the Hospitals in fiscal year 2007-08.
Hospitals are then asked to develop specific infrastructure proposals for consideration and approval
by the LHINs.
Following LHIN Board approval, hospitals undertake to implement the projects in the following year
(2008-09).
Due to the capital nature of the initiative, which may often take more than one year to complete,
the Ministry has approved hospitals to carry over funding from 2007-08 to 2008-09 to complete
the projects. This is an exception to the general accounting rule that funds for a particular fiscal
year are spent in that year.
3.1.2
Ontario Nurses Association (ONA) Settlement Funding (APPENDIX 3.1.2)
At the Board Meeting held on May 27, 2008, a question was raised as to the monitoring process
used for funding the Ontario Nurses Association (ONA) union settlement.
As part of the communication to the hospitals, details of funding have been provided. Hospitals
have been asked to provide actual costs.
Expenditures above the Ministry funding (i.e. deficit) is the hospital’s responsibility. Expenditures
below the Ministry funding (i.e. surplus) are recovered by the Ministry.
The report back is sent from the hospital to the Ministry.
A copy of this communication from the CEO to one of the Central LHIN hospitals is attached. Please
note that this communication was sent only after the Board approved this initiative.
3.1.3
Wait Times Incremental Allocations (APPENDIX 3.1.3)
As requested at the Board Meeting held on May 27, 2008, a letter dated June 2, 2008 was sent to
Carrie Hayward, Director, LHIN Liaison Branch explaining the Board’s position with respect to
incremental MRI allocations. The letter is included in the appendices.
3.1.4
Board Development Day
A Board Development Day will be scheduled in month for August 6th.
3.2
2008/09 Business Plan (APPENDIX 3.2)
An updated Business Plan is included in the appendices.
3.3
Compliance Declaration – June 2008 (APPENDIX 3.3)
A compliance declaration for June 2008 is included in the appendices.
Page 9
3.4
IHSP Action Plan (APPENDIX 3.4)
The IHSP Action Plan is included in the appendices.
3.5
LHIN Urgent Priority Fund – Central LHIN (APPENDIX 3.5)
A) 2007/08 LHIN Urgent Priorities Fund - Report Back on Slate of Projects
B) Draft Considerations for the 2008/09 Fund
The following provides a report back to the Board on the status of the projects that were approved
for funding through the 2007/08 LHIN Urgent Priorities Fund. The package includes the original
slate of 17 projects and an associated summary table that provides high level project status,
learnings and next steps. For the 2008/09 allocation this package includes an up to date 2008/09
slate in addition to a high level slide deck to share draft considerations for planning for the 2008/09
LHIN Urgent Priority Fund.
Highlights 2007/08
• Funding received in the Fall of 2007
• Final review of project submissions by Ministry with three week turn around. Submissions to
Ministry required before end of January 2008
• Three projects have approved allocations for 2008 funding – from 2007 board resolution and
one 2007 project (Centralized Access) has a placeholder for 2008 funding (~ 500k) for which
details and approval request may come to the board over the summer. One new project has
been approved by the board for 2008 funding
• Our records approximate that several projects have come in under budget and hence have some
unspent dollars (overall ~ 40k). Just recently we have been informed by the Ministry regarding
their intended process to recover unspent monies for LHIN Urgent Priorities which will impact
monies allocated for our Community Sector Capacity Building – risk reduction project. For this
project $200k was allocated to the hospital sector to conduct a two part project that included a
risk self assessment survey first to then determine capacity building options thereafter. Part one
has been completed however, part two monies will be recovered and are a substantial part of
the project allocation
Highlights 2008/09
•
•
3.6
Per the Ministry of Health and Long Term Care funding announcement on May 30, 2008,
$1,588,122 of the total 2008/09 LHIN Urgent Priorities allocation of $3,609,369 will need to
be applied specifically to Alternative Level of Care initiatives. The administrative details and
criteria are pending.
Of the $3,609,369 allocated to the Central LHIN for 2008/2009 minus the Alternative Level of
Care allocation, minus the allocations approved in 2007 there remains an unallocated balance of
$1,702,247.
Quarterly Ministry-LHIN Accountability Agreement Performance Report
All MLAA performance reporting requirements for Q1 have been waived by the Ministry of Health
and Long-Term Care.
Page 10
3.7
Paediatric Surgical One-Time Funding Allocations
North York General Hospital’s allocated volumes for 2008/09 are 135. In 2007/08, they were
allocated 134. Although the total volume is similar to last year, the resulting funding for 2008/09 is
$69,900 less than in 2007/08.
Last year, North York General’s allocations were spread between Paediatric General Surgery,
Dental/Oral Surgery and Otolaryngology Surgery.
In 2008/09, Ontario’s Paediatric Wait Time Strategy was unable to allocate any General Surgery
funds and therefore no volumes were assigned for this procedure. Dental/Oral Surgery was granted
priority status by the Paediatric Wait Time Strategy and, as a result, all requests for Dental/Oral
Surgery were allocated this year.
As a result, the bulk of North York General’s Paediatric allocations for 2008/09 are in Dental/Oral
Surgery. Dental/Oral Surgery is funded at a rate of $1,063 per procedure. Last year, General
Surgery was funded at a rate of $1,638. The difference in total funding that North York General
received compared to this year is a result of the shift to Dental/Oral Surgery as a priority.
3.8
Residential Hospice Planning
The Central LHIN Hospice Palliative Care Network is overseeing the development of a Residential
Hospice Plan for the Central LHIN. In 2005 the Ministry of Health and Long-Term Care made an
announcement to improve end-of-life care services in Ontario. That announcement included some
nursing and personal support service funding for the Central CCAC to support a new residential
hospice in York Region.
Planning is underway for a 10-bed residential hospice, led by the Hospice Palliative Care Network in
partnership with Southlake Regional Health Centre. The plan will include the development of a
functional program, care delivery model, physical structure, citing options, and operational and
capital cost requirements. The residential hospice plan will also identify how the services will be
integrated with other hospice palliative care services in York Region.
A draft functional program has been received by the Central LHIN and the Hospice Palliative Care
Network for review. Community engagement is underway. Functional Programming has been
received and is under review. Site selection criteria development and review are also underway at
this time.
3.9
The Neurological Services Advisory Network
The Neurological Services Advisory Network has been meeting regularly and has contributed to the
development and implementation of a service inventory through Community Care Resource (CCAC
Service Inventory). Health service provider consultation and collaboration with consumers/caregivers
contributed to this achievement.
Page 11
At this particular time, the Central LHIN would like to acknowledge the contributions and
accomplishments of this network. Future needs and areas of focus are pending through the Health
Services Needs Assessment and Gap Analysis.
3.10
Aging at Home Year One Project Slate Update
On June 4th the Ministry flagged a concern regarding Central LHIN’s Community Alternatives to
Long Term Care ($3.2M) project as a potential conflict with ministry legislation and/or regulation.
Given that June 6th was the cutoff date for funding to flow in July, and that this issue could not be
resolved, resolution is still pending. Work is underway with the Ministry as the Central LHIN project
proposed is similar to projects proposed and flowed funding in other jurisdictions. The LHIN will
continue to work with the Ministry and its health service providers to move this project forward as it
is a cornerstone of the Aging at Home strategy and includes the development of a model that could
be scalable and efficient for client access and service delivery in Central LHIN. This project entails
providing a basket of services in the community to prevent or delay admission to long term care.
On June 11th the Ministry provided preliminary approval for two projects;
1) Polypharmacy ($42M)
2) 30 bed long term care conversion to convalescent ($1.56M)
3.11
Central LHIN Back Office Integration Forum
On Tuesday June 3rd, the Central LHIN held a Back-office Integration Forum. The purpose of the
Forum was to provide education about back-office integration, to profile some examples of backoffice integration initiatives and to provide information about Central LHIN support for a facilitated
back-office integration initiative in 2008-2009.The forum was attended by over 60 individuals,
representing the three sectors targeted for participation: hospices, community support service
agencies and mental health and addictions agencies. Representatives of some Central LHIN
hospitals were also in attendance.
In follow-up to the Forum, 25 organizations, out of 40 that attended, have submitted a completed
Expression of Interest form, indicating their organization’s possible interest in participating in a
facilitated back-office integration initiative during 2008-2009. Common areas of interest for backoffice integration include: procurement/group purchasing and integrated finance. A lesser number
of respondents have also indicated an interest in sharing information technology, data management
services and/or human resource functions (e.g. recruitment, policies, legal).
3.12
Draft Integration Strategy (APPENDIX 3.12)
A high level draft integration strategy for Central LHIN has been developed to begin to frame our
dialogue around areas of focus to stimulate integration activity. The draft strategy identifies support
for various levels of activities to begin to create a culture to foster and support integration activities
among our health service providers. Further development of the strategy will continue in addition to
refinement of criteria and internal process and management steps that may be required. Further
updates will be shared as they are developed.
Page 12
3.13 Brief Overview of the impact to Central LHIN from Ontario’s $109 million investment to
reduce wait times in the Emergency Room
Administrative details from the Ministry are pending and the following is our understanding to date.
The investment is comprised of the following five components:
1. $39.5 Million for a Performance Fund targeting Ontario’s 23 poorest performing emergency
rooms.
It is anticipated that the Emergency Room Pay-For-Results Program will offer a bonus to eligible
hospitals for achieving specific Emergency Room Length of Stay targets. The process used by the
Ministry to identify eligible hospitals for year one allocations began with first selecting hospitals
having 30,000 or more ER visits. Within this group, three criteria were used to determine hospital
eligibility (in italics are new associated targets):
a) The hospitals with the largest number of patients waiting beyond 24 hours.
• This will address those hospitals with the most extreme waiting times. (Target moving
forward will be that no more than 2% of total emergency room patient volume can have a
length of stay exceed 24hours)
b) The hospitals with the highest volume of patients outside of the recommended targets.
• This will make the most significant impact province-wide, capturing hospitals on the basis of
performance and volume.
c) The hospitals with the highest percentage of patients waiting longer than the recommended
targets.
• This will ensure the program reaches the hospitals with the worst Length-of-Stay
performance. This addresses performance only, without taking volume of ER visits into
account.
Recommended Targets:
Target: 5% absolute improvement in the proportion of CTAS I, II and III patients treated (measured
against NACRS 2006/2007 baseline data)
• Within 8 hours for CTAS I and II patients
• Within 6 hours for CTAS III patients
Target: Improvement in the proportion of patients treated within 4 hours for CTAS IV and V
patients (measured against NACRS 2006/2007 baseline data)
Using the above process and criteria three hospitals (4 sites) in Central LHIN have been identified for
funding however, the final provider-specific allocations may change pending ongoing planning
between the LHIN, its hospitals and its community partners in the development of multi-partner
strategies to improve emergency room performance.
North York General Hospital $1,443,137
York Central Hospital $1,322,570
Humber River Regional Hosp-Humber Mem $956,182
Humber River Regional Hosp-York-Finch $926,331
Page 13
2. $38.5 million for increased home care personal support and homemaking services and enhanced
integration between hospitals and Community Care Access Centres
Administrative details are pending.
3. $22 million in new priority funding for Ontario’s 14 Local Health Integration Networks (LHINs) to
invest in local solutions to further address ALC pressures.
For Central LHIN this represents $1.6 M to be set aside within the 2008/09 LHIN Urgent Priority
Allocation of $3.6 M. The $1.6 M is the incremental increase from annualizing the $2 M allocation
provided late in the 2007/08 fiscal year.
4. $4.5 million for dedicated nurses to care for patients who arrive in the Emergency Room by
ambulance to ease ambulance offload delays.
Funds for this initiative are being allocated to municipalities. The Region of York will receive
$375,000 in 2008/09 with implementation expected to commence in the second quarter.
5. $4.5 million for new nurse-led outreach teams to provide more care to patients in long-term care
homes to avoid transfers to the ER
It is not clear what the impact is for Central LHIN. There may be one outreach team per LHIN. This
initiative is expected to commence in late summer or early Fall 2008.
3.14
Health Service Needs Assessment and Gap Analysis (APPENDIX 3.14)
A progress update has been provided for Central LHIN’s Health Service Needs Assessment and Gap
Analysis. A key development is the process to begin to focus the “domains of interest” for the
project. Additional follow up information regarding sources of data that will be utilized and sourced
for this project is provided below.
Data Sources
KPMG and Infonaut are collecting and analyzing data that are based on the Central LHIN’s actual
population characteristics (age, ethnicity, gender, incidence and prevalence rate of diseases,
socioeconomic factors, etc…) and predicted growth. The first focus of the analysis is on health
needs of the Central LHIN's population, and subsequent analysis will look at the utilization of
services - both current and as projected into the future. Where possible the ministry’s own
prescribed methodologies and published planning guides for the health need assessment will be
used.
Data being used includes the most recent 2005 Canadian Community Health Survey which will
provide specific disease rates for our Central LHIN population; and the most recent 2006 Canadian
Census which will be used to identify the Central LHIN’s demographics such as the
age/sex/income/employment/smoking/education etc. at the postal code level of analysis. In many
cases, the Canadian Community Health Survey and Census data are the most comprehensive
population based data available for the LHIN's population.
Page 14
Using the above data sets will allow us to replicate and integrate prior work of Statistics Canada,
Health Canada, ICES, and Cancer Care Ontario and advance these findings in detail so that they are
directly applicable to the Central LHIN. The Canadian Community Health Survey and Census data
sets are also supplemented with client level service utilization information from the following
sources to assist the analysis and modeling of the future health/service requirements of the Central
LHIN's population:
•
•
•
Hospital Discharge Abstract Database
National Ambulatory Care Reporting System
Community Care Access Centre and other client level service delivery information as
appropriate
The above quantitative analysis is being supplemented by qualitative information from our health
service providers and we are also currently considering a random sample survey of our population
that would complement the analysis by asking our community about the service needs and gaps as
they perceive them.
3.15
Central LHIN Health Professional Advisory Committee (APPENDIX 3.15)
The Central LHIN Health Professional Advisory Committee held its second meeting on June 16,
2008. Minutes of the inaugural meeting of March 31, 2008 are included in the appendices.
3.16
French Language Services in the Central LHIN – Update
Since February, Central LHIN has met with both the Réseau Franco-Santé du Sud de l’Ontario and
the Regional French Language Health Consultant to discuss the direction and effective ways to
move forward for French Language Health Services in Central LHIN. Outcomes of the meetings
included the development of broad principles and a high level workplan.
At present, several
activities are underway to support the first steps in the workplan which revolve around better
understanding the current state. Key activities include the Service Needs Assessment and Gap
Analysis, the development of a Health Human Resources Risk Reduction Plan – for which a
component of this project will capture health human resources data on French-speaking employees
in the Central LHIN and the development of a community engagement plan.
The Central LHIN French Language Health Services workplan will be further developed and refined in
the coming months. It is anticipated that implementation of the community engagement strategy
may involve cross-LHIN collaboration as both the Toronto Central and Mississauga Halton LHINs
have expressed interest in exploring such an opportunity with Central LHIN.
Central LHIN also continues to collaborate and work with the Regional Consultant to provide input
into the consultant’s French Language Health Services Integrated workplan for 2008/2009 - which
is expected to be submitted to the Ministry of Health and Long-Term Care.
4.0
HEALTH SERVICE PROVIDERS
4.1
Provincial Programs Q3 in-year reallocation process - Southlake Regional Health Centre
(APPENDIX 4.1)
Page 15
In a letter dated May 28, 2008, Health Minister George Smitherman notified Southlake Regional
Health Centre that they have been approved for one-time funding of $281,800 as part of the
Ministry’s 2007/08 Provincial Programs Q3 in-year reallocation process.
4.2
Vaughan Dialysis Satellite Proposal (APPENDIX 4.2)
A letter was sent to Kathryn Pagonis, Director, Provincial Program Branch from Jo-anne Marr, Vice
President, Programs, York Central Hospital seeking advice and direction on a leasing arrangement
with the Vaughan Health Campus of Care. York Central signed a letter of intent to enter into a
leasing arrangement with Vaughan with the support of the MOHLTC and the Central LHIN.
4.3
President & CEO Announced at Stevenson Memorial Hospital (APPENDIX 4.3)
On June 12, 2008, the Board of Directors of Stevenson Memorial Hospital issued a press release
announcing that Gary Ryan has been appointed as the President & CEO of Stevenson Memorial
Hospital effective immediately.
Mr. Ryan will report to the Board. He will perform his duties as President and CEO on the basis of
2.5 days per week. His remaining time will be spent in his role as a Vice President at Southlake
Regional Health Centre (SRHC) with his services to SMH provided under the terms of a management
services contract.
Under the management services contract, SRHC will provide management and administration
services to SMH while recognizing that SMH shall maintain its separate governance and the SMH
Board will continue to ensure that the hospital is managed and administered according to the needs
of the community and the Public Hospitals Act. The agreement requires that the appointment of the
President and CEO must be approved by the Board of SMH.
4.4
New CT Scanner for Stevenson Memorial Hospital (APPENDIX 4.4)
On June 12, 2008, a press release was issued by Stevenson Memorial Hospital (SMH) announcing
that the Ministry of Health and Long Term Care has approved the installation and operation of a CT
(CAT) scanner.
The CT scanner will cost the Hospital $1 million to acquire and approximately $2 million in capital
funds for construction to house the new state-of-the art technology. Capital funding for both the
scanner and the construction and installation costs has been planned for in the current Capital
Campaign of the SMH Foundation, "Here's to Your Good Health." The campaign has been very
successful with 70 per cent of its $5 million target already raised.
4.5
York Central Hospital - Letter of Recommendation – CIHR Partnership Award (APPENDIX
4.5)
A Letter of Recommendation was sent to Ms. Marilyn Desrosiers, Research Officer, Canadian
Institute of Health Research from Bruce Harber recommending Dr. Peter Tsasis, Assistant Professor,
Faculty of Health, York University for research project, “Developing a System Scorecard for a Local
Health Integrated Network.” A copy of the letter is included in the appendices.
Page 16
4.6
Central LHIN/Toronto Central LHIN – e-Health Update (APPENDIX 4.6)
Central and Toronto Central LHINs Joint e-Health Council have developed a draft Joint e-Health
Strategy that is currently being circulated within the Senior Management Teams at tboth LHINs for
feedback and advice. The Joint e-Health Strategy is the product of merging and refreshing the
previous LHIN e-Health Strategies and is informed by the Provincial e-Health Strategy and priority
projects. Please see update included in the appendices.
5.0
OTHER UPDATES
5.1
QMonitor 2008, Ontario Health Quality Council (APPENDIX 5.1)
The Ontario Health Quality Council (OHQC) was created by the Government of Ontario in September
2005 as an independent body formed to monitor the Ontario health care system and report to the
public on its performance. The Ontario Health Council issued its yearly report QMonitor, 2008 on
the quality of publicly funded health care system.
QMonitor 2008 Report Highlights:
•
•
•
•
Ontario is failing to meet the chronic disease challenge. We could be saving 8,000 more lives a
year.
Most Ontarians can’t get to see their family doctors within two days of becoming sick. Many
need help just to find a doctor.
Wait times are coming down for cataract surgery, knee and hip replacements, and cancer
surgery, but not for CT and MRI scans.
The pace of change needs to be speeded up and become more system-wide.
A brochure summarizing the report is included in the appendices.
Respectfully submitted,
Hy Eliasoph, CEO
Page 17
APPENDICES
Page 18
APPENDIX 1.1
APPENDIX 1.2
APPENDIX 1.3
APPENDIX 1.4
Annual Service Plan: 2009/10
A Guide for LHINs
May 30, 2008
Annual Service Plan – 2009-10 Guidelines
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1. Introduction
The reporting relationship between the Ministry of Health and Long-Term Care (below “the
Ministry”) and Local Health Integration Networks (LHINs) is grounded in the legal
requirements included in the Local Health System Integration Act, 2006 (LHSIA), the
Memorandum of Understanding (MOU) between both parties and by the Ministry-LHIN
Accountability Agreements (MLAA). It is also grounded in government directives such as the
Agency Establishment and Accountability Directive (AEAD – see Appendix A). The AEAD
includes the requirements and processes for agency business planning.
Many of these reporting obligations are set out in Schedule 8: Integrated Reporting and
supported by Schedules 5, 6 and 10 of the MLAAs. The process and content for various
reports is further guided by the timing and informational requirements of the Government and
Ministry’s fiscal cycle. Finally, the LHINs’ Annual Service Plan (ASP) is aligned with the
broad planning framework, which encompasses the Ministry’s forthcoming 10-year Health
System Strategic Plan and the LHINs’ 3-year Integrated Health Service Plans (IHSP).
1.1.
LHIN Obligations
LHSIA requires LHINs to produce an annual “plan for spending the funding that the network
receives…, which spending shall be in accordance with the appropriation from which the
Minister has provided the funding to the network” (LHSIA 2006, c. 4, s. 18 (2)). These
guidelines outline LHIN responsibilities with respect to their ASPs. Although LHINs have
some flexibility in the creation and development of their ASP, there is a need to ensure a
consistent approach. Furthermore, as per LHSIA, the Ministry can also require the LHINs to
provide other reports and information (s. 18 (4)).
1.2.
Ministry Obligations
The Ministry will support LHINs in development of the various reports in order to ensure
clarity and consistency. The Ministry will also “provide any training, instructions, materials,
templates, forms and guidelines to the LHIN to assist the LHIN with the completion of the
reports” (MLAA, Schedule 8, B2) listed in the schedule. The Ministry will supply relevant
information to LHINs in order to support them in the preparation of the various reports. Such
information includes health service provider (HSP) financial transaction information held by
the Financial Management Branch of the Ministry.
1.3.
Joint Obligations
In their shared accountability to the public and other stakeholders, such as the Ministry of
Finance, LHINs and the Ministry will “work together to ensure a timely flow of
information to fulfil the reporting requirements of both parties” and will “respond in a
timely manner to requests for information and access to records of one another, including
financial records, to fulfil the reporting and other obligations of the parties” under the
MLAA (MLAA, Schedule 8, B3).
Annual Service Plan – 2009-10 Guidelines
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2. 2009-10 Annual Service Plan – Overview
2.1.
General
LHINs are now planning for integrated health care services throughout Ontario. ASPs
operationalize the LHIN’s IHSP, their three year plan for the broad direction and priorities for
their local health system. The following guidelines have been established to help support the
completion of the ASPs, which focus, in detail, on the LHINs proposed specific activities in
the upcoming fiscal year and outline out-year operational plans.
LHINs are required, through their ASPs, to indicate how they plan to deliver on the promise of
the IHSP and provide the basis of support for their priorities, objectives and associated funding
realignments (if required). It may also provide updates to these priorities as derived through
further community engagement activities and other environmental scanning since release of
the IHSP. These plans for the local health system will help the public understand how their
LHIN is planning to specifically address the needs of their community through its spending
and related activities in the upcoming year and out-years.
MINISTRY STRATEGIC
PLAN
The Ministry’s 10 year
strategic plan will set direction
for the health system
provincially
INTEGRATED HEALTH
SERVICE PLAN (IHSP)
The LHIN planning document that
broadly identifies and describes
priorities and directions over the 3
year period ending in 2009-10.
ANNUAL SERVICE PLAN (ASP)
Plans describing the annual activities,
and associated spending plans, that will
be conducted in order to implement the
IHSP for the next 3 years, with emphasis
on the coming fiscal year
Annual Service Plan – 2009-10 Guidelines
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2.2.
The 2009/10 Annual Service Plan – A Revised Process
After consideration of the challenges encountered with the 2008/09 process and feedback
received from LHIN and Ministry officials, a new format for 2009/10 has been adopted. It
creates a three-part ASP, in keeping with the fiscal, reporting and planning cycles. The new
ASP is designed to better meet LHIN needs, while continuing to complement the Ministry and
Government’s fiscal cycle.
ASP Component
Content
Due Date
Annual Business The LHIN 3-year business plan produced for the public, October 31st, 2008
HSPs and government stakeholders fulfils the LHIN’s
Plan
obligations under the Agency Establishment and
Accountability Directive (Appendix A) and specifies
how the LHIN will allocate its resources to meet the
objectives of its IHSP.
Multi-Year Risk Using the Risk Summary Template, the LHIN will September 30th, 2008
provide a detailed assessment of its multi-year risks and
Report
associated mitigation strategies. This report will be
incorporated into the second quarter report to provide a
complementary examination of risks with the in-year
risks documented in Q2 risk summary template.
Priorities for New This document will propose new investments at an August 31st, 2008
individual or cross-LHIN level. Such investments will
Investment
be those which are beyond LHIN capacity and approved
allocations. It may be used to feed into Ministry’s
Results-based Plan (RbP).
All guidelines, templates and supporting reference documents for these complementary
documents are being provided together in order to assist LHINs in the concurrent development
of all the components of their ASP and reflect the inter-relatedness of the three parts. While
the Annual Business Plan document will be a stand-alone plan to be shared with the LHIN’s
stakeholders, it will be closely connected to the content of the other two ASP elements. The
2009-10 ASP format allows for more time than in the previous year’s process to submit the
annual business plan and the risk report components.
Annual Service Plan – 2009-10 Guidelines
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3.
Components of the Annual Business Plan
As per the Agency Establishment and Accountability Directive (see Appendix A), at a
minimum LHINs are required to submit the following information in their agency’s business
plan. The Annual Business Plan section of the ASP is due October 31st.
Outline of Annual Business Plan
1. Transmittal letter from the LHIN Board Chair
2. Executive Summary
3. Introduction
4. Environment Scan of Opportunities and Risks to the Local Health System
5. Detailed Plans for the Local Health System
a. IHSP Priority
b. Context
c. Current Status
d. Implementation Plans
e. Performance Considerations
f.
Risks and Mitigation Strategies
6. Financial Summary
7. Planning for LHIN Operations
8. Communications Plan
Annual Service Plan – 2009-10 Guidelines
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Detailed Requirements of Annual Business Plan Components
3.1 Transmittal Letter from
the LHIN Board Chair
As per the AEAD, the agency’s business plan is to be reviewed by its
governing board. The transmittal letter is a memo to the Assistant Deputy
Minister, Health System Accountability and Planning Division, signed by the
Board Chair that provides a context for the LHIN’s Annual Service Plan It
may state:
•
the reason for reporting (e.g., commitment under Local Health System
Integration Act, 2006 to discharge the LHIN mandate to achieve
transformation and be accountable to stakeholders);
•
the focus for the LHIN plan and related considerations in meeting the
needs of the local health system and its stakeholders;
•
any elements of the report that the Chair deems appropriate such as key
LHIN initiatives and spending plans for the coming year.
The LHIN may use any format it deems appropriate, provided the letter is
signed by the Board Chair, confirming Board review and approval of the draft
ASP.
3.2 Executive Summary
Provide a short summary of the LHIN’s business plan that includes key
commitments and highlights of strategies for the planning period.
3.3 Introduction
This section provides an introduction to the ASP, reflecting the LHIN’s
understanding of its legislated objects and accountabilities to its stakeholders,
thereby giving the context of the ASP. Explaining the LHIN’s mandate
provides the reader with a frame of reference for the LHIN’s intended activities
during the planning period.
The introduction provides a concise overview of the services currently provided
by the LHIN and its local health system and information on how the ASP
advances the LHIN’s strategic plan (i.e IHSP priorities) and that of the
provincial health system. The introduction also includes the following
elements:
•
Statement of purpose/overview of the ASP (e.g., multi-year planning,
key directions/focus for the LHIN and local health system), which
explains why the LHIN is mandated to develop an ASP and how the
LHIN interprets this responsibility to its stakeholders;
•
Explanation of how the proposed ASP links with the priorities
identified in IHSPs, key commitments of the MLAA and with
Ministry’s strategic directions and government priorities.
The LHIN may also discuss its mission, vision and/or key objectives (as
included in the IHSP) with reference to how they guide the ASP. The
Introduction is expected to be a high level preamble to the text in order to set
the stage in the mind of the general reader. The specific plan details will be
Annual Service Plan – 2009-10 Guidelines
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discussed in section 3.5.
3.4 Environmental Scan of
Opportunities and Risks
The environmental scan sets the context for the business environment in which
the LHIN is operating; for example, the environment considered could be
LHIN-specific, regional or provincial in scope. It could be related to economics
or demographics. It could also relate to health services or broader determinants
of health. It assesses whether the environment is likely to change in future and,
if so, how this would affect the LHIN. It is the first step toward identification
of risks and sets out the realistic planning assumptions on which the ASP
priorities are based.
While it is not expected that the LHIN would conduct a new community
engagement process for their ASP, it is expected that information upon which
the planning assumptions are based will be relevant and applicable to the
planning period.
The environmental scan included in the ASP should:
•
•
•
•
•
discuss major cost drivers affecting the LHIN and its local health
system; (e.g., costs related to specific sectors; demographic trends;
staffing and accommodation costs);
assess local conditions/issues, regional health concerns and community
needs that affect the provision of health services in the LHIN,
including gaps in service;
discuss identified issues and trends with potential impact on the
commitments set forth in the MLAA and priorities identified in the
IHSP;
consider government policies and priorities (e.g. Throne speech,
Budget,
platform
commitments)
and
new
or
pending
legislation/regulations and how they could impact on LHINs and/or
HSPs; and
comment on major service planning or integration efforts underway.
Threats and opportunities identified in this section could include such
considerations as changes in immigration trends and need for mental health
programs specific to growing cultural groups, impact of new long-term
care legislation on care provision in the LHIN’s long-term care homes in
the LHIN or changes in hospital utilization patterns.
–
3.5 Detailed Plans for the
Local Health system
The detailed plans for the local health system provide an overview of the
LHIN’s multi-year plan, linking initiatives to performance impacts and
associated risks. This section of the business plan, which forms the core of the
ASP, will outline how the LHIN will implement its strategic plan within its
multi-year allocation.
Each sub-section of the Detailed Plans will focus on one of the LHIN’s IHSP
priorities or a key element thereof (e.g. Seniors or Supportive Housing for
Seniors) and will include the following components:
Annual Service Plan – 2009-10 Guidelines
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•
IHSP Priority – provides the heading and theme for the sub-section.
•
Current Status – current status of services in the LHIN related to the
priority, such as number of HSPs, service volumes, gaps in services,
cross-boundary issues.
•
Context – how the priority relates to the local health system?
•
What makes it a priority; what are the LHIN’s goals and objectives for
the priority?
•
Implementation Plans – what does the LHIN specifically plan to do
(and how) in the upcoming fiscal year (plans for the 2 out-years can be
more general); provide timelines, key considerations and major
milestones; who are the partners with the LHIN in the plan; what is the
role of other stakeholders (e.g. planning bodies, HSPs) and thirdparties (e.g. other ministries, non-LHIN service providers); what are
the implications for LHIN Operations?
•
Performance Considerations – what are the expected outcomes of the
plan; what are impacts on MLAA performance measures? Identify
benchmarks, if applicable.
•
Risks Identified and Mitigation Strategies – what threats and/or
opportunities are presented by the plan; what are the threats to and
opportunities for achievement of the plan?
•
Fiscal Implications – How does the LHIN plan to manage the cost of
the initiative? What are the specific sources of funding? Are
complementary funds available from the other sources identified
above?
Each subsection of the detailed plans must identify performance impacts in
consideration of the performance objectives and measures set out in the
MLAA.
Each performance indicator in the MLAA should be considered in one or
more components of the local health system plan, thus outlining the
LHIN’s plan for achievement of that performance element.
Risks will be identified and assessed at a high level for each initiative;
mitigation strategies will be proposed. Additional details will have been
provided in the Multi-Year Risk Report (see Section 4), as appropriate.
Initiatives involving third parties, such as other LHINs and non-LHIN local
service providers, and services funded by other Ministries should be clearly
identified as such.
3.6 Financial Summary –
Local Health System by
Sector
The LHIN is required to
complete
a
narrative
Setting out anticipated expenditures and revenues over a three year period
demonstrates how the LHIN proposes to allocate its approved resources in
order to fulfill its mandate and provides a detailed road map to the achievement
of the LHIN’s priorities.
The table provided as Appendix B provides a summary of the LHIN’s spending
plans (in thousands), including planned allocations for the coming fiscal year
and spending targets for two out-years. The financial summary will also
Annual Service Plan – 2009-10 Guidelines
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component and supporting
templates, portions of which
will be pre-populated by the
Ministry.
identify any variance between original sector funding targets and planned
expenses resulting from the reallocation of funds between sectors.
The Financial Summary will be pre-filled with the previous year’s actuals,
current year’s budget and predetermined expense limits and targets. InterLHIN transfers (Appendix C) will also be identified and may be outside of the
individual LHIN’s funding envelope, as long as the overall funding envelope
for all LHINs is not exceeded. All LHINs affected by the transfer must
complete this template and balance with each other.
The ASP must follow Public Sector Accounting Board (PSAB) principles in its
preparation and verification. This includes identification of Government
Reporting Entity (GRE) revenues and expenses.
The Financial Summary Table included as Appendix B includes additional
detail required as illustration for the Ministry of the LHIN’s financial
management plans. Financial information will be provided in a condensed
format for the June 2009 finalized ASP, to include planned expense only for the
three years of the ASP, in addition to the 2007-08 actuals and 2008-09 budget.
Notes: (1) Total annual Planned Expenses for each LHIN must be equal to
Total Annual Funding Target per LHIN for the same year (unless adjusted
through the inter-LHIN transfer table) (2) Where Total Annual Funding Target
is unknown, assume that it is flat-lined from the previous year.
3.7 Planning for LHINs’
Operations
The Operational Plan describes the LHIN’s specific goals, objectives and
associated plans and planned Operational Expenses per budget category for the
coming fiscal year, and the two subsequent years.
Text section:
The LHIN is required to
complete
a
narrative
component and supporting
templates, portions of which
will be pre-populated by the
Ministry.
Identify the LHIN’s plan for the operation of its business including specific
initiatives for the coming years, and associated performance impacts and
identified risks for each.
Use the following headings for sub-sections of your LHIN’s Operational
Plans:
• LHIN Operational Goal or Objective
• Current Status
• Context
• Implementation Plans
• Performance Considerations
• Risks and Mitigation Strategies
• Fiscal Implications
This section should also include a description and plans for specific
initiatives for which the LHIN receives additional operational funding (e.g.
e-health, aboriginal health planning).
Annual Service Plan – 2009-10 Guidelines
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This section may also be used to describe LHIN plans for community
engagement, Health Provider Advisory Council, etc.
This section will also explain how the LHIN will provide French language
services in compliance with the French Language Services Act and how it
will engage and plan with its francophone communities.
An organizational chart is recommended in order to help the reader to more
fully understand the structure of the LHIN’s operations.
Tables:
Financial Plan (Appendix D) – anticipated revenues and expenses for the
coming fiscal year and two additional out years.
Staffing plan (Appendix E) - outline current and proposed staffing levels
for the LHIN’s operations, broken down by standard staffing categories.
Full-Time Equivalents (FTE) for the LHIN, as of March 31st of the relevant
fiscal year, should be entered into the appropriate space on the table.
Note: LHIN Operations annual total planned expenses cannot exceed LHIN
Operations annual total funding target. Any noted variance between funding
targets and planned expenses must be negative (i.e., must result in a positive
balance). In addition, no reallocations from HSP transfer payment budgets to
the LHIN’s operational budget are permitted.
3.8 Communications Plan
The ASP will become a public document as an appendix to the Ministry-LHIN
Accountability Agreement (see Section 6); as such, it must follow Visual
Identity Guidelines as provided by the Ministry (see Appendix F).
The communications plan will outline the LHIN’s overall strategy for sharing
its business plan with its stakeholders, including a description of the key
communications vehicles the LHIN will employ to get its key messages across
to the public and stakeholders over the planning horizon. This will include
identifying target audiences, preparing stakeholder analysis and include
anticipated positive and negative reactions, listing three or four key messages
and proposing the communications rollout.
The ASP will become a public document and will therefore need to be available
in both English and French.
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4. Multi-Year Risk Report
4.1.
Timelines and Context
The LHIN Multi-Year Risk Report is intended to complement, and not to repeat, those
risks presented in the Quarterly Risk Report; hence it is being submitted at the end of Q2
(September 30) with the Quarterly Report. The Multi-Year Risk Report is meant to deal
only with risks which will emerge in the years relevant to the ASP, thus focusing further
out in the LHIN’s planning horizon.
The current guidelines build on the revised Risk Summary Guidelines (“guidelines”)
(Appendix G) and support the use of the ASP Risk Summary Template (RST) (Appendix
H) to complete this component of the ASP. The sections of the guidelines referring to
‘current year’ (steps 7 to 9) are not relevant to the ASP RST; these columns have been
deleted from the template. The ASP RST will serve to assist the LHIN and Ministry in
fully comprehending the LHIN’s identified multi-year risks and the LHIN’s proposed
mitigation strategies. For additional information, including an illustration of risk
documentation, see Risk Summary Guidelines. N.B. GRE/non-GRE instructions apply to
the ASP RST.
4.2.
Introduction
Risk management is a vital function of the LHIN’s operations, ensuring that opportunities
and threats to priorities and objectives for the local health systems are continually
identified, assessed, acted on, monitored and communicated on a multi-year basis.
It serves to inform LHIN planning and the realization of local health system objectives,
and assists both LHINs and the Ministry in forecasting in-year and future management
plans, concerns and strengths. This leads to greater fiscal and system management
prudence.
As part of the ASP process, LHINs are required to communicate material risks to the
Ministry. These risks will be analyzed by the Ministry and discussed with the LHINs,
through the Results-based Planning process. The full identification of threats and
opportunities is necessary to ensure that achievement of the LHIN’s IHSP priorities,
through risk management plans, is considered from all possible angles.
Annual Service Plan – 2009-10 Guidelines
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LHIN Risks and the Ministry
In keeping with its stewardship role, the Ministry needs to be made aware of the
threats and opportunities faced by the LHINs and their local health systems. This
will enable the Ministry to collaboratively assist LHINs in managing them. Risk
reporting will benefit the Ministry in enabling it to prepare for those issues,
identified by LHINs, which may pose challenges or offer potential benefits to the
health system. This process will play a significant part in contributing to the
development of the Ministry’s multi-year plan, and to the Ministry of Finance’s
ability to monitor broad and potential risks to the province’s fiscal plan.
4.3.
Scope/Materiality
In their reports to the Ministry, LHINs are to identify significant risks that they
determine through their respective assessment and validation processes may not be
manageable at the LHIN level. From the Ministry’s perspective, significant risks are
those identified by the LHIN as having a high likelihood and significant impact and
which the management plans do not sufficiently mitigate. These risks are identified
and assessed based on the LHIN’s expertise, judgment and knowledge of their local
system.
LHINs should report significant risks that affect the following areas:
•
Risks to Objectives identified in the Integrated Health Service Plans:
Through the Integrated Health Service Plans (IHSPs) each LHIN has identified
key priorities within their local system. If significant risks emerge that could
jeopardize the achievement of these priorities, that information should be
communicated to the Ministry.
•
Risk to Obligations identified in the Ministry-LHIN Accountability
Agreement:
The Ministry has identified a list of objectives, based on the Ministry-LHIN
Accountability Agreements (MLAAs), which it considers important. If
achievement of these objectives is at significant risk, the LHIN is required to
communicate this information to the Ministry.
Objectives at risk identified by the Ministry are:
1.
2.
3.
4.
Balanced Budget
Multi-year Expense Limits
Protected Volumes as Outlined in the MLAA
Performance Indicators:
• 90th Percentile Wait Times for Cancer Surgery
• 90th Percentile Wait Times for Cardiac By-Pass Procedures
• 90th Percentile Wait Times for Cataract Surgery
• 90th Percentile Wait Times for Hip and Knee Replacement
• 90th Percentile Wait Times for Diagnostic (MRI/CT) Scan
• Readmission Rates for Acute Myocardial Infarction (AMI)
• Percentage of Alternate Level of Care (ALC) days
Annual Service Plan – 2009-10 Guidelines
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•
•
•
•
Rate of Emergency Department Visits that could be Managed
Elsewhere
Hospitalization Rate for Ambulatory Care Sensitive Conditions
(ACSC)
Median Wait Time to Long-Term Home Placement
Risks to Key Government Priorities:
The LHIN should report to the Ministry significant risks that may impair the
achievement of key government priorities.
The ER Strategy and the Family Health Care Strategy are examples of two
current key government strategies. The ministry would need to be aware of
significant risks to elements of these two strategies.
The ER Strategy Includes:
The Family Health Care Strategy
Includes:
• Reducing the number of ER visits
• 50 new Family Health Teams
• The Aging@Home Strategy to enable • 25 Nurse Practitioner-led clinics
seniors to continues living in their
homes
• Better chronic disease management
• 9,000 new nurses
• More home care
• Improved community-base
health and addiction treatment
mental
Through their day-to-day business operations, LHINs are able to develop plans to
reallocate funding in order to address specific risks that they identify, ensuring that
any reallocations are consistent with the parameters set by the Ministry. Through the
risk summary template, LHINs are to identify their most material multi-year,
unmanaged risks (i.e. those that cannot be fully addressed through the reallocation
process or exercise of other LHIN authority) to the Ministry along with a proposed
management plan.
Risks reported through the Multi-Year Risk Report may be specific to an individual
HSP, LHIN, or may affect all LHINs. LHINs may decide whether to report
individually or collectively on such shared risks. If reported collectively, the risk
should be identified using the ‘All LHINs’ reference code (see Section 4.4)
The risk information should be communicated at the sector level. However, at the
discretion of the LHIN, risk information may be further disaggregated at the HSP level.
This may be appropriate in cases where the risks are attributed to specific HSPs. See main
document, Risk Summary Guidelines, for further details.
4.4.
ASP Risk Reference Number
Assign a summary reference number to each identified risk to track and prevent
duplication of risk recording. In creating the summary reference number, please use
the following format:
Annual Service Plan – 2009-10 Guidelines
- 13 -
LHIN ID Code – Year – “ASP” – serial number
Please use a code from the following list that corresponds to your LHIN for the
Summary Reference Number:
LHIN
Code
LHIN
Code
Erie St. Clair
01
Central
08
South West
02
Central East
09
Waterloo Wellington
03
South East
10
Hamilton Niagara
Haldimand Brant
04
Champlain
11
Central West
05
North Simcoe Muskoka
12
Mississauga Halton
06
North East
13
Toronto Central
07
North West
14
All LHINs (collectively)
15
•
Add date: Year (the first year to which the ASP pertains)
•
Add “ASP”
•
Assign a three digit number to the risk serial number.
For example:
Summary Ref. #
01-09-ASP-001
4.5.
Examples
Scenario A (Collective)
All LHINs will be renegotiating their Service Accountability Agreements with the Long-Term
Care Sector in 2009-10. The Long-Term Care sector is subject to expense limits which limit
its ability to respond to new Long-Term Care legislation. It is expected that a number of issues
will arise during the negotiations and that additional funds may be sought by the sector in order
to meet these new care requirements. LHINs may decide to submit this risk collectively and
offer a province-wide mitigation strategy.
Annual Service Plan – 2009-10 Guidelines
- 14 -
Scenario B (Individual)
LHIN A does not have a stroke centre located within its boundaries. One of its IHSP priorities
is seniors, with stroke care an important subset of that priority. Although neighbouring LHINs
are currently able to support the needs of LHIN A’s residents, they are expected to be at
capacity in coming years. The LHIN identifies the need to develop a stroke strategy in order to
meet the needs of its local community and aging population in coming years. The LHIN
identifies the requirements of the strategy, resources needed and suggests management
strategies for meeting these needs.
Annual Service Plan – 2009-10 Guidelines
- 15 -
5. Priorities for New Investment
LHINs should ensure that their Priorities for New Investment (PNI) submission is received by
the Ministry by August 31, 2008.
In the context of global economic challenges, the Ontario Government has chosen a prudent
approach in managing the Province’s finances. This will mean that the Ministry will need to
closely examine any new investment requests to ensure they are well supported and LHINs
will need to provide evidence that funding of their proposal from limited government revenues
can be justified.
LHINs are asked to identify Priorities for New Investment (PNIs). These would be new
initiatives which are outside LHINs’ capacity and/or approved allocation. Although distinct
from the LHIN’s business plan component of the ASP, the identification of those potential
gaps or opportunities should be tied specifically to a priority identified in the Annual Business
Plan component of the ASP as well as the risks and mitigation strategies proposed in the
ASP’s Multi-Year Risk Report.
PNIs may be of two types:
•
Individual – a priority identified at the local level beyond the LHIN’s fiscal
capacity to manage after all other options are exhausted. These priorities are
unique to the LHIN and require individual solutions.
•
Cross-LHIN – multiple LHINs have identified a common issue requiring a
collective approach. These may be regional (e.g. GTA, Northern) or provincial
(i.e. all 14 LHINs) in nature.
In a case where a LHIN is identifying multiple needs, the LHIN should rank the PNIs in order
of priority. Cross-LHIN PNIs will only need to be prioritized if more than one has been
submitted by the same group of LHINs; thus, if all LHINs collaborate on several PNIs, they
will need to agree on the priority ranking of these submissions.
The full PNI should be no longer than 2-3 pages in length. The LHIN may also attach
supporting documentation; however, the Ministry’s focus will rest on the required sections.
The Ministry will review the submissions and will alert the LHINs to the possibility of
integration of the PNI into the Ministry RbP submission as soon as possible. Among the
criteria against which the PNI will be measured by the Ministry are fit with the Ministry’s
fiscal and strategic plan, as well as performance and risk considerations.
Elements of PNI submission (due August 31)
Initial PNI Submission
Description
Brief description and purpose. Services that would be provided and their
anticipated outcomes. Eligibility criteria and recipients if appropriate.
LHIN role/relationship to initiative. How request supports the priorities
and broader strategic objectives. Historical information or relevant
caseload/expenditure data if appropriate.
Annual Service Plan – 2009-10 Guidelines
- 16 -
Multi-Year
Costing
Initiative
Provide estimated annual costs of initiative.
of
Fiscal Year
2009-10
2010-11
2011-12
TimeLimited
Funding
Annual
Operating
Cost (Base)
Total
PNI
and
Case
Rationale
Business
How initiative would impact on LHIN TP programs (e.g., its
delivery, its stakeholders, program authorization, its funding levels,
etc.) and how the changes will be implemented to the TP programs.
Specify steps that would be taken to ensure compliance with the Ontario
Public Service Transfer Payment Accountability Directive (refer to
Appendix I)
Provide a clear rationale to support request for Ministry decisions
including:
•
Program design or transformation proposed (including
governance, accountability, program criteria, implementation
plan details, performance measures).
•
Description of new funding or incremental changes to
previously approved funding and what will be done/delivered
compared to current program (e.g., what is the
government/Ontarians going to get out of this).
•
Explanation of what will happen if initiative does not proceed
(possible consideration of other LHINs/HSPs undertaking
initiative as part of their normal workload without increase in
funding)
As clearly and concisely as possible, develop a compelling business case
to justify the decisions and resources requested. Provide supporting data,
supporting research and other evidence to support investment.
Performance
Measures (Part 1)
Identify one or more program level performance measures that will be
used to demonstrate the contribution of the initiative toward achievement
of objectives for your LHIN and that support LHIN and Ministry
priorities.
Annual Service Plan – 2009-10 Guidelines
- 17 -
Subsequent PNI Submission
IF AGREED-UPON WITH THE MINISTRY, THE FOLLOWING SECTIONS ARE TO BE
SUBMITTED IN COMPLETION OF THE PNI, LIKELY ON VERY SHORT NOTICE,
FOR POSSIBLE INCLUSION IN MINISTRY RbP SUBMISSION. THE LHIN WILL
NEED TO HAVE THE INFORMATION READILY AT HAND FOR A VERY SHORT
TURNAROUND, IN ORDER TO HELP THE MINISTRY MEET TIMELINES WHICH
HAVE IN THE PAST BEEN ON THE ORDER OF 24-48 HOURS.
**THE LHIN MAY, AT ITS DISCRETION, PROVIDE THE ENTIRE PNI ON AUGUST
31ST, RATHER THAN WAITING FOR APPROVAL. HOWEVER, THE LHIN MUST
KEEP IN MIND THE POTENTIAL LIMITATIONS OF PNIs, AS IDENTIFIED ABOVE.
Performance
Measures (Part 2)
Building on Performance Measures, Part 1, provide a statement
of result which should include: performance measure (e.g.,
quantifiable information that provides a reliable basis for directly
assessing achievement, change and/or performance over time);
the most recent result(s) related to the measure; the 2009-10
fiscal-year target identified for the measure (or, alternatively, a
statement of ‘directional’ change or anticipated improvement, if
the measure is ‘new’ or significantly changed from previous
years); and the 2011-12 (i.e., longer term) target identified for
the measure.
For example, a performance measure statement of result might
read as follows:
A new stroke strategy is to be developed in 2009-10
which will improve access to care and support
integration of services. The initiative is expected to
increase the number of clients receiving rehabilitation to
X, reduce the time from onset of symptoms to treatment
and rehabilitation by Y and reduce the percentage of
post-stroke clients requiring long-term care placement to
Z by 2011-12.
Risk Analysis and
Mitigation Strategy
Identify one or more risks associated with the initiative; this may be a
threat or opportunity, it may be a risk of proceeding or not proceeding
with the PNI. Consider the criteria above in your risk analysis.
For initiatives with significant change/risk, this section may be used to
complement the information provided through the Multi-Year Risk
Report. LHINs should include:
•
What actions/strategies will be taken to mitigate these
risks?
•
Implications of risk: use action verbs (avoid the passive
voice) to indicate the most likely chain of events, including
the most probable outcome. Identify a range of possibilities
and any uncertainties where appropriate. Use the same tight
Annual Service Plan – 2009-10 Guidelines
- 18 -
writing style as in the description. Describe how the
materializing key risk will affect program objectives,
delivery and/or government priorities. While speculation
about the future will likely be required, make sure it is
defensible and reasonable. Provide only the degree of detail
required to fully appreciate the implications that the
materialized key risk would have on the initiative’s
objectives and operations.
•
Communications
and Stakeholder
Engagement
What potential obstacles (fiscal, policy, internal/external
cost drivers, planning assumptions) may affect the
LHIN/Ministry’s ability to achieve its objectives? How
might this occur?
Identify any key stakeholders affected by this initiative. Provide a brief
communication outline for this initiative; e.g., how do you explain this
activity to decision-makers and LHIN residents.
If new or changes are proposed to programs:
•
Describe the communications approach (e.g., including
implementation plan, issue management strategy/positioning,
“people friendly” key messages, etc.).
•
Describe how the LHIN plans to engage stakeholders in
implementation.
•
Provide details of any agreements relating to the request that
may be in place. Outline the key issues associated with the
agreements and how these affect/support the request.
Annual Service Plan – 2009-10 Guidelines
- 19 -
6. Finalizing the ASP
Finalizing of the 2009-10 ASP will require the updating of the LHIN Annual Business
Plan (Section 3) as per Ministry instructions, including Visual Identity Guidelines
(Appendix H). The Ministry will endeavour to provide these instructions as soon after
the release of the Provincial Budget as possible. This update will include any required
changes as per discussions of the business plan since the draft was submitted on October
31st, plus any necessary changes to reflect new funding for the years relevant to the ASP.
This could be funding for 2009-10, 2010-11 and/or 2011-12 announced in-year (i.e. in
2008-09) or in the 2009 Provincial budget. These numbers will be reflected in the LHINs
planned expense in the Financial Summary Table to be included with the finalized ASP.
The Priorities for New Investment (Section 5) and Multi-Year Risk Report (Section 4)
will not be included in finalization of the ASP. Since the Annual Business Plan is a
stand-alone document, it should not include explicit references to these other two
documents and, therefore, should not require major changes, other than those identified
above.
The finalized ASP will be appended to the refreshed Ministry-LHIN Accountability
Agreement for 2009-10 and will be translated into French.
Annual Service Plan – 2009-10 Guidelines
- 20 -
Attachments to be included with Annual Service Plan materials:
Appendix A: Agency Establishment and Accountability Directive
Appendix B: Financial Summary by Sector
Appendix C: Inter-LHIN Transfer Table
Appendix D: LHIN Operations Financial Table
Appendix E: LHIN Operations Staffing Summary
Appendix F: Visual Identity Guidelines
Appendix G: Risk Summary Guidelines (2008 Revised)
Appendix H: ASP Risk Summary Template
Appendix I: Transfer Payment Accountability Directive
Annual Service Plan – 2009-10 Guidelines
- 21 -
APPENDIX 1.5a
APPENDIX 1.5b
APPENDIX 1.5c
NEWS
Ministry of Health and Long-Term Care
ONTARIO TACKLES ER WAITS WITH $109 MILLION INVESTMENT
Enhanced Home Care Coverage and Efforts Targeted At Poorest Performing Hospital
Emergency Rooms Lead the Way
NEWS
May 30, 2008
2008/nr-xxx
TORONTO – Responding to challenges patients are facing in emergency rooms (ERs), the Ontario
government is taking numerous coordinated steps to reduce wait times and improve patient
satisfaction.
A major factor causing long ER wait times is the high number of alternate level of care (ALC) patients
occupying acute care hospital beds, making it difficult to admit patients from the ER to hospital. ALC
patients are unable to be discharged because the appropriate kind of care they require is not always
available. Today’s announcement is making much more of that care available.
Ontario’s $109 million investment includes:
ƒ
ƒ
ƒ
ƒ
ƒ
$39.5 Million for a Performance Fund targeting Ontario’s 23 poorest performing emergency rooms,
IT enhancements and coaching teams to enhance hospital efficiency
$38.5 million for increased home care personal support and homemaking services and enhanced
integration between hospitals and Community Care Access Centres
$22 million in new priority funding for Ontario’s 14 Local Health Integration Networks (LHINs) to
invest in local solutions to further address ALC pressures
$4.5 million for dedicated nurses to care for patients who arrive at ERs by ambulance to ease
ambulance offload delays
$4.5 million for new nurse-led outreach teams to provide more care to patients in long-term care
homes to avoid transfers to the ER
With today’s announcement, Dr. Michael Schull, Sr. Scientist, ICES and Director of Emergency Care
at University of Toronto, is being appointed Expert Panel Lead – ER Wait Times. Also, Dr. Kevin
Smith, President and CEO of St. Joseph’s Healthcare in Hamilton, is being appointed Expert Panel
Lead - Alternative Level of Care (ALC).
In April, George Smitherman, Minister of Health and Long-Term Care, unveiled his government’s top
two overarching health priorities for the next several years: reducing emergency room wait times and
family health care for all. Today’s announcement is the first in a series and builds momentum on ER
wait times reductions.
QUOTES
“You cannot have a good performing emergency room so long as the ER can’t admit patients to
hospital,” said George Smitherman, Deputy Premier and Minister of Health and Long-Term Care. .
“These changes will free up our emergency rooms to do what they do best – treat emergencies.”
“Fixing ER wait times is the foremost challenge for the entire health care system,” said Dr. Alan
Hudson, Lead of Access to Services and Wait Times. “It requires strong leadership by hospitals,
LHINs and the community sector, working together to deliver better care for the patients of Ontario.
Given that Ontarians make more than five million visits to ERs they deserve nothing less.”
“By enhancing the options patients have to receive the care they need in the most appropriate setting,
these investments will relieve pressures on hospitals,” said Dr. Kevin Smith, President and CEO of St.
Joseph’s Healthcare in Hamilton and ALC lead. “By reducing pressures on ERs, we will reduce wait
times and increase patient satisfaction.”
“The government is taking a far-reaching and systemic approach to solving the ER backlogs,” said Dr.
Michael Schull, Expert Panel Lead of ER Wait Times. “These initiatives will help to improve the flow of
patients in the ER and ensure they receive the care they need sooner.” (to be approved)
QUICK FACTS
ƒ
ƒ
ƒ
There are 163 emergency rooms in the province, with 2.8 million people making 5.25 million visits
to these ERs each year.
The Ontario Hospital Association indicates that seniors who are awaiting access to appropriate
care elsewhere, occupy 18.6 per cent of hospitals beds in the province; 58 per cent are waiting for
long-term care (LTC) home placement.
Nearly 60 per cent of LTC homes in the province have more than 50 residents sent to hospital
each year.
LEARN MORE
Learn more about Ontario’s comprehensive strategy to improve access to care for all Ontarians.
Laurel Ostfield, Minister’s Office, 416-212-4048
Mark Nesbitt, Ministry of Health and Long-Term Care, 416-314-6197
ontario.ca/health-news
Disponible en français
APPENDIX 1.5d
FACT SHEET
Ministry of Health and Long-Term Care
ALTERNATE LEVEL OF CARE PATIENTS
Patients in an acute hospital bed are there because they require acute care services. This
means they need short-term, intensive medical treatment for an illness, injury or recovery from
surgery.
Once patients complete this “acute care” phase of treatment, they often then require an
alternate level of care (ALC). ALC patients are individuals in a hospital bed who would be better
cared for in an alternate setting.
What is an alternate level of care?
When patients need an alternate level of care, it means they may require:
•
•
•
•
•
•
a long-term care home bed
complex continuing care bed
a convalescent care bed
a rehabilitation care bed
home care
palliative care
More than 18 per cent of patients who are currently in a hospital bed in Ontario are in need of
an alternate level of care.
How do ALC patients contribute to backlogs in the emergency room?
Hospitals need a regular flow of patients moving in and out.
New patients are coming into hospitals all the time either through the emergency room (ER) or
through scheduled appointments for surgery. At the same time, hospital patients receive acute
care services and then go home or await an alternate level of care.
When patients remain in an acute hospital bed because the alternate level of care they need is
unavailable, they are not receiving appropriate care in the best appropriate setting. They are
also in a bed that could be better used for a patient who needs acute hospital care.
This creates a domino effect in hospitals when there are no beds available.
Patients who arrive in the emergency room and need to be admitted to an acute care bed are
then stuck in an ER bed awaiting transfer to a regular hospital bed.
When all the ER beds are occupied, physicians do not have beds in which to examine or treat
patients. This creates long wait times in the ER which are very stressful for both patients and
staff.
Laurel Ostfield, Minister’s Office, 416-212-4048
Mark Nesbitt, Ministry of Health and Long-Term Care,
416-314-6197
ontario.ca/health-news
Disponible en français
APPENDIX 1.5e
ER/ALC Announcement Breakdown
Initiative
Targeting 23 hospitals with
ERs facing the greatest
challenges
New funding for local ALC
programs (Urgent Priorities
Fund)
Increased Home Care
Services and Enhanced
Integration Between Hospitals
and Community
Shown as $38.5M in announcement
Ministry lead
Wait Times Strategy
(Melissa Farrell)
Funding
$29.8 million
Allocated to
LHINs to allocate to
hospitals and community
partners
LHINs based on LHINproposals
LLB (John Babos)
$22 million
HSSD for change to
regulation (Debra Bell)
$30 million for CCAC
service maximums
LHINs for CCACs
$8.5 million for
community projects to
enhance integration
between hospital and
CCAC and other
community partners
$4.5 million
Wait Times Strategy
Strategic Investment
Planning for funding
allocation (Marilyn
Elliott)
Wait Times Strategy
(Melissa Farrell)
Nurses Dedicated to Ease
Ambulance Offload Delays
Wait Times Strategy
(Melissa Farrell)
Nurse-led Long-Term Care
Wait Times Strategy
(Melissa Farrell)
Wait Times Strategy
(Melissa Farrell)
$4.5 million
Wait Times Strategy
$7.5 million
Wait Times Strategy
Wait Times Strategy
(Melissa Farrell)
$2 million
Wait Times Strategy (for
the Emergency Department
Reporting System)
Creating Process
Improvement Programs that
Assist Hospitals in Improving
Patient Flow in the ER
Collecting and Reporting
Information to Monitor
Progress
Shaded – LHIN managed
Not shaded – Ministry managed
CONFIDENTIAL – NOT FOR DISTRIBUTION
Funds will be distributed to
municipalities by the
Ministry
APPENDIX 1.6a
APPENDIX 1.6b
140 Allstate Parkway
Suite 210
Markham, ON
L3R 5Y8
Tel: 905-948-1872
Fax: 905-948-8011
Toll Free: 1-866-392-5446
http://www.lhins.on.ca
140, Allstate Parkway
bureau 210
Markham, ON
L3R 5Y8
Tél: 905-948-1872
Téléc: 905-948-8011
Sans frais: 1-866-392-5446
http://www.lhins.on.ca
June 5, 2008
Memorandum to:
From:
Re:
All Central LHIN Community Sector Health Service Providers
Hy Eliasoph, Chief Executive Officer, Central LHIN
Stabilization Increase for 2008/09
Further to our communication dated May 16, 2008 on the preparation of your 2008/09
budget submission, I am pleased to advise that you may budget for stabilization base
funding increases in 2008/09, as follows:
ƒ a 4% increase for the Community Care Access Centre (CCAC);
ƒ a 2.25% increase for Community Support Services (CSS);
ƒ a 2.25% increase for Assisted Living Services in Supportive Housing;
ƒ a 2.25% increase for Acquired Brain Injury (ABI);
ƒ a 2.25% increase for Community Mental Health; and
ƒ a 2.25% increase for Addictions Programs.
The stabilization increases may be included as additional revenue along with associated
expenditures as part of your 2008/09 budget submission. However, please do not make
any expenditure commitments until your budget is reviewed by the Central LHIN and
approval has been provided.
We are providing you with these details in order to assist you in better planning for the
delivery of services for this fiscal year.
With respect to the 4% increase for the Community Care Access Centre, the increase is to
be allocated to a mix of both stabilization and expansion-related activities.
If you have any questions, please contact Naj Hassam, Team Lead, Funding and Allocation
at [email protected] or 905-948-1872 ext. 211.
Sincerely,
Hy Eliasoph
CEO
Central LHIN
APPENDIX 1.7
APPENDIX 1.9
APPENDIX 1.10
APPENDIX 1.11
APPENDIX 1.12a
APPENDIX 1.12b
APPENDIX 1.13
NEWS
Ministry of Health and Long-Term Care
ONTARIO LAUNCHES TRANSPARENCY IN PATIENT SAFETY
INDICATORS
C. difficile Rates To Be Made Public Beginning September 30th
As McGuinty Government Strengthens Reporting Regulations
May 28, 2008
2008/nr-28
NEWS
The Ontario government is introducing full public reporting on eight patient safety indicators –
including Clostridium difficile (C. difficile) – as part of a comprehensive plan to create an
unprecedented level of transparency in Ontario’s hospitals.
On September 30, 2008, all Ontario hospitals will be required to publicly report on C. difficile
rates in their facilities through a public website.
As part of this comprehensive initiative, Dr. Michael Baker, physician-in-chief at the University
Health Network, is being appointed Executive Lead – Patient Safety to oversee the
government’s patient safety agenda. He will build upon initiatives already taken such as the
hospital hand hygiene program.
The list of patient safety indicators is:
Patient Safety Indicator
Clostridium difficile (C. difficile)
Methicillin-resistant Staphylococcus aureus (MRSA)
Vancomycin-resistant Enterococci (VRE)
Hospital Standardized Mortality Ratio (HSMR) –
mortality rates
Rates of ventilator-associated pneumonia
Rates of central line infections
Rates of Surgical site infections
Hand hygiene compliance among health care
workers
Start Date of Public Reporting
Sept. 30, 2008
Dec. 31, 2008
Dec. 31, 2008
Dec. 31, 2008
April 30, 2009
April 30, 2009
April 30, 2009
April 30, 2009
Hospitals will also be required to immediately report C. difficile outbreaks to their local public
health units so that Medical Officers of Health have the information they need to monitor and
respond to emergent outbreaks.
QUOTES
“The new reporting framework reflects our commitment to uphold the highest standards of care
for Ontario’s patients,” said George Smitherman, Deputy Premier and Minister of Health and
Long-Term Care. “Transparency may not always provide us with the news we want to hear but it
leads to the actions we all need to take to combat the risks of infection.”
“This is very important – we need to let the public know how our hospitals are performing,” said
Dr. Michael Baker. “We can then measure our progress in improving safety standards. This
announcement on reporting places us among the leaders of patient safety in hospitals across
the country.”
“Ontario's hospitals are committed to providing the safest possible care to patients," said Tom
Closson, President and CEO of the Ontario Hospital Association. "We strongly support the
public reporting of patient safety indicators because we believe it will inspire improved
performance, enhance patient safety, and strengthen the public's confidence in Ontario's
hospitals."
QUICK FACTS
ƒ
C. difficile is a bacterium that causes diarrhea and more serious intestinal conditions.
ƒ
C. difficile is the most common cause of infectious diarrhea in hospitalized patients in the
industrialized world.
ƒ
The use of antibiotics increases the chances of developing C. difficile diarrhea as it alters
the normal level of good bacteria found in the intestines and colon.
ƒ
Good hand hygiene is the single-most effective way to prevent the spread of infectious
diseases like C. difficile
LEARN MORE
Learn more about C. difficile best practices for all health care settings.
Learn more about Ontario’s hand hygiene initiative Just Clean Your Hands and Operation
Health Protection.
Laurel Ostfield, Minister’s Office, 416-212-4048
Mark Nesbitt, Ministry of Health and Long-Term Care,
416-314-6197
Dr. Michael Baker, University Health Network, (416) 340-4636
ontario.ca/health-news
Disponible en français
APPENDIX 2.1
NEWS
Ministry of Health and Long-Term Care
MCGUINTY GOVERNMENT INTRODUCES LEGISLATION THAT
WOULD MAKE ACCESS TO HEALTH PROFESSIONALS A PUBLIC
INTEREST
Bill Would Have Regulatory Colleges Consider Needs of Unattached Patients
In Process of Licensing Internationally Trained Health Providers
NEWS
June 16, 2008
2008/nr-033
Ontario is introducing new legislation that would ease the way for internationally trained health
care providers to practice in the province.
The legislation – Increasing Access to Qualified Health Professionals for Ontarians Act – will, if
passed, change the mandate of all regulatory colleges to acknowledge that access to health
care is a matter of public interest. Ontario has 23 regulated health professions.
This legislation is one part of a bigger plan to remove barriers for internationally trained doctors.
Over the summer, the McGuinty government will also be working closely with The College of
Physicians and Surgeons of Ontario on regulation changes that would ease the transition to
practice for foreign-trained doctors. The plan, based on the Report on Removing Barriers for
International Medical Doctors by Etobicoke-Lakeshore MPP Laurel Broten, Parliamentary
Assistant to the Minister of Health and Long-Term Care, details five major recommendations on
how to further increase the number of international medical doctors in Ontario.
This legislation is part of the government’s strategy to meet the needs of unattached patients,
reduce wait times and provide older Ontarians with care closer to home.
QUOTES
“Ontario is a leader in Canada in providing opportunities for internationally trained doctors to
practice medicine,” said George Smitherman, Deputy Premier and Minister of Health and LongTerm Care. “Through this new legislation and Laurel Broten’s plan, Ontarians’ access to a
family doctor would improve as barriers for qualified internationally trained doctors are removed,
allowing them to practise medicine sooner.”
QUICK FACTS
ƒ
ƒ
ƒ
ƒ
More than 5,000 internationally trained doctors are practicing in Ontario, representing almost
a quarter of the physician workforce
About 630 IMGs are currently in residency training
For the fourth straight year, more certificates were issued to IMGs than to Ontario graduates
by The College of Physicians and Surgeons of Ontario (CPSO)
CPSO also reports the number of full practice certificates issued to IMGs this year was the
highest in 20 years, marking the seventh straight year of an increasing number of
certificates for internationally trained doctors
LEARN MORE
Read Laurel Broten’s Report on International Medical Doctors.
Find out how internationally-trained doctors can qualify for professional practice in Ontario.
Laurel Ostfield, Minister’s Office, 416-212-4048
John Yoannou, Ministry of Health and Long-Term Care, 416-314-6197
ontario.ca/health-news
Disponible en français
APPENDIX 3.1.2
140 Allstate Parkway
Suite 210
Markham, ON
L3R 5Y8
Tel: 905-948-1872
Fax: 905-948-8011
Toll Free: 1-866-392-5446
http://www.lhins.on.ca
140, Allstate Parkway
bureau 210
Markham, ON
L3R 5Y8
Tél: 905-948-1872
Téléc: 905-948-8011
Sans frais: 1-866-392-5446
http://ww.lhins.on.ca
May 28, 2008
Mr. Bruce Harber
President & Chief Executive Officer
York Central Hospital
10 Trench Street
Richmond Hill ON L4C 4Z3
Dear Mr. Harber:
We are pleased to approve one-time funding of $1,530,400 relating to the recent Ontario
Nurses Association (ONA) settlement ratified on March 20, 2008. The agreement provided for
a one-time retroactive payment to nurses for fiscal 2007/08 based on information provided by
your hospital to the Ontario Hospital Association (OHA).
As specified in the ONA agreement, hospitals are required to process payment to staff on or
before May 1, 2008. To support this timeline, an unscheduled payment will be provided to your
hospital prior to this May 1 requirement.
We would ask, subsequent to making payments to your staff, that you complete the attached
reconciliation form and return it by June 6, 2008 to the attention of:
Lillian Lo
Financial Management Branch
5700 Yonge Street, 12th Floor, Toronto, ON M2M 4K5
Sincerely,
Hy Eliasoph
Chief Executive Officer
Central Local Health Integration Network
Attachment
c:
Ken Morrison, Chairman of the Board of Directors, Central LHIN
Terry Villella, Financial Services Director, York Central Hospital
Reconciliation Form
ONA Settlement
Location / Name:
Facility No.:
LHIN:
Richmond Hill York Central Hospital
701
Central
2007/08 One-Time Payment
1 - ONA Hospital Allocation
2 - Actual Hospital ONA Payment
3 - Variance (1 - 2)
($)
1,530,400
Note: Variances greater than $100 will be recovered.
The following signatures confirm the accuracy of the above stated information and
that all payments have been dispersed as per ONA ratified agreement:
President and Chief Executive Officer
Date
Chief Financial Officer
Date
Please return this form by June 6, 2008 to the attention of:
Lillian Lo
Financial Management Branch
th
5700 Yonge Street, 12 Floor
Toronto ON M2M 4K5
APPENDIX 3.1.3
140 Allstate Parkway
Suite 210
Markham, ON
L3R 5Y8
Tel: 905-948-1872
Fax: 905-948-8011
Toll Free: 1-866-392-5446
http://www.lhins.on.ca
140, Allstate Parkway
bureau 210
Markham, ON
L3R 5Y8
Tél: 905-948-1872
Téléc: 905-948-8011
Sans frais: 1-866-392-5446
http://www.lhins.on.ca
June 2, 2008
Ms. Carrie Hayward
Director, LHIN Liaison Branch
Ministry of Health and Long-Term Care
5th Floor, Hepburn Block
80 Grosvenor Street
Toronto ON M7A 1R3
Dear Ms. Hayward:
Re: Central LHIN’s 2008/09 MRI Wait Time Allocation
As part of the 2008/09 wait time allocations, Central LHIN’s MRI allocation decreased by
approximately 19%, representing 3,690 less hours this year as compared to the 2007/08 allocation.
Both the Central LHIN Board and the Wait Time Strategic Planning Group do not support the
decrease in the 2008/09 MRI incremental hours.
This decrease will negatively impact our Ministry-LHIN Accountability Agreement (MLAA) Wait Time
Target for MRI and is likely to create disruption to hospital infrastructure/investment for Diagnostic
Imaging.
Wait Time volumes and funding are a significant component to the hospital accountability
agreements. It is difficult for the Central LHIN and hospitals to decrease MRI wait times given the
decreased allocation. It is also difficult for the LHIN to manage wait times given the uncertainty in
allocations. For these reasons, at the May 27, 2008 Central LHIN Board Meeting, the staff
recommendations for MRI targets in the MLAA refresh were endorsed as follows: 105 days for
2008/09 (up from 70 days); and 95 days for 2009/10 (up from 55 days).
Sincerely,
Hy Eliasoph
CEO, Central LHIN
/at
c. Ken Morrison, Chairman of the Board of Directors
APPENDIX 3.2
Central LHIN
2008/09 Business Plan Status Report
June 24, 2008
PART A
MINISTRY/CLHIN ACCOUNTABILITY AGREEMENT
PART B
OTHER BUSINESS PLAN REQUIREMENTS
PART C
RISK MANAGEMENT REPORT
PART D
QUARTERLY MLAA PERFORMANCE REPORT
08/09 Business Plan Status Report - Updated June 24, 2008
Note: Changes highlighted BOLD.
1
Status Legend
On-track
slightly off-plan
significantly off
2008/09 Business Plan Status Report – June 24, 2008
PART A- MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
AA Schedule
Schedule 1:General
Schedule 2: Community Engagement, Planning &
Integration
Schedule 3: Local Health System Management
Schedule 4: Information Management
Supports
Schedule 5: Financial Management
Schedule 6: Financial Processing Protocols
Schedule 7: Local Health System Compliance Protocols
Schedule 8: Integrated Reporting
Schedule 10: Local Health System
Performance
Pages
3
4-5
5-7
Status
Budget announcement and MLAA refresh underway.
Several IHSP priority activities underway through support of
Urgent Priorities Funding, and Aboriginal engagement
funding. The MOHLTC Strategic Plan has been delayed. No
changes to the IHSP are planned for the refresh until six
months following the release of the strategy as per the
MLAA.
Satisfactory progress to date. Some items finalized; other
processes & tools under development. Discussions are ongoing with hospitals projecting a deficit.
Provincial Forum to be developed.
8
8-11
12
12
13-14
CLHIN financial resources continue to be challenged. In
particular new capital requirements will be an issue.
CLHIN has fully complied, however, CLHIN resources
continue to be challenged.
A process has been established with the Performance
Improvement and Compliance branch to notify CLHIN of any
Long-Term Care sector non-compliance.
CLHIN in compliance
CLHIN in compliance
15
Schedule 11: e-Health
Part B: Other Business Plan Requirements
15-16
Part C: Risk Management Report
18
Part D: Quarterly MLAA Performance Report
19
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
Comments
17
Activities on track.
Requirements being met.
Several financial risks are emerging with the hospital sector.
MLAA scorecard and commentary will be provided
Jun/Sept/Dec/Mar
2
Status Legend
On-track
slightly off-plan
significantly off
2008/09 Business Plan Status Report – June 24, 2008
PART A- MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
Schedule 1: General
#
MOHLTC Obligation
CLHIN Requirement
Deadline
Activities
Part C. Phase II for 2007-2008
1.1
Develop provisions to address and add to the Schedules in the following areas:
June 30
(a) Schedule 5: Financial Management, related to capital.
(b) Schedule 7: Local Health System Compliance Protocols;
(c) Schedule 9: Allocations
(d) Schedule 10: Local Health System Performance, performance benchmarks,
baselines, LHIN targets and performance corridors for the performance indicators as
set out in Tables A, B and C of the Schedule.
1.2
These schedules are being
updated through the MLAA
refresh.
The Ministry has provided draft
schedules for discussion with
Central LHIN staff.
Develop provisions in a timely manner about elements of the financial management
framework related to results-oriented planning, fiscal prudence and parameters for
the treatment of surplus funds.
Ongoing
Parameters for treatment of
surplus funds are outstanding.
Ministry has shared a draft
proposal with Senior Directors. An
update will be provided to the
Board when the Ministry has
issued a policy.
Part D. Annual Review Update
1.3
Review within 120 days of a budget announcement by the Government of Ontario:
July 23
Schedule 3: Local Health System Management
Schedule 9: Allocations; and
Schedule 10: Local Health System Performance
1.4
The Ministry has provided draft
schedules for discussion with
Central LHIN staff.
Work together to complete, an evaluation of their effectiveness in carrying out the
transition and devolution of authority contemplated by the AA.
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
Budget announced on March 25,
2008.
3
Spring 2008
Status Legend
On-track
Ministry to present findings on
June 18, 2008.
slightly off-plan
significantly off
Status
2008/09 Business Plan Status Report – June 24, 2008
PART A- MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
Schedule 2: Community Engagement, Planning & Integration
#
MOHLTC Obligation
2.1
N/A
2.2
N/A
2.3
2.4
CLHIN Requirement
Deadline
Part B. Community Engagement Performance Obligations
Regularly review community engagement
Ongoing
strategy and plan.
Report on community engagement activities in
June 30,
the Annual Report.
2008
Part C: Planning Performance Obligations
Develop and update, as necessary, an Integrated Health System Planning Guide to support
the development of the Provincial Strategic Plan and the IHSP.
Release the Provincial Strategic Plan in
Spring 2007.
Within six months of the release of the
Provincial Strategic Plan, update and release,
the 2007/08- 2009/10 IHSP, and release the
updated IHSP to the MOHLTC and the public.
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
4
Status Legend
Ongoing
TBD
On-track
Activities
Deadline for submission to the
MOHLTC of final 2007-08
Annual Report is June 30, 2008.
A draft of the Annual Report is
being revised to reflect Board
feedback. Community
Engagement activities are
reflected in the annual report.
Work Plans have been developed
for all IHSP implementation
activities; terms of reference for
each successor group has been
approved by the Board. Several
activities are underway with
approval of the Board, and
funding from the Urgent Priorities
Fund. Aging at Home initiatives
approved by the Ministry are
underway with approval of the
board, and funding is
anticipated to flow in June
2008.
Strategic plan delayed. IHSP
refresh date unknown.
slightly off-plan
significantly off
Status
2008/09 Business Plan Status Report – June 24, 2008
PART A- MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
2.5
Develop a process to review the functions
of health systems planning Organizations,
other than LHINs.
2.6
N/A
2.7
N/A
2.8
Provide to the MOHLTC:
(i) Advice on the functions of health system
planning organizations, other than LHINs; and
(ii) Information on any significant proposed
changes to its IHSP.
Reflect the IHSP in the Annual Service Plan
required under Schedule 5.
Demonstrate progress on the implementation
of IHSP priorities, and report in the LHINs
Annual Report.
Part D: Integration Performance Obligations
Consult with the MOHLTC prior to issuing a decision to integrate or to stop the integration
under sections 26 or 27 of the Act and include a report on its integration activities in its
Annual Report.
N/A
Central LHIN is participating in
municipal planning for
pandemic/influenza response.
No changes to the IHSP are planned
prior to the refresh.
Completed
Aug. 31
IHSP priorities are articulated in
the Annual Service Plan.
Completed
2006/07 Annual Report complete
and submitted.
Ongoing
To date, four voluntary and one
facilitated integration decision
completed.
Schedule 3: Local Health System Management
#
MOHLTC Obligation
3.1
N/A
3.2
Provide the LHIN with, and develop
as appropriate, those provincial
standards (such as operational or
service standards and policies, and
program eligibility) that apply to health
service providers, including providing
the LHIN with relevant program
manuals.
3.3
N/A
CLHIN Requirement
Deadline
Part B: General Performance Obligations
Make decisions about which services will be
Ongoing
provided including service volumes, performance
requirements, and funding.
Require health service providers to provide
services funded by the LHIN in accordance with
applicable legislation, provincial policies,
standards, operating manuals and service
accountability.
TBD
Develop a plan to negotiate new service
accountability agreements.
TBD
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
5
Status Legend
Activities
A Service Needs and Gap
Analysis for Central LHIN is
underway.
Some policy and program
manuals have been provided.
The LHIN organizational structure
was not designed to provide
program management services
with respect to Health Service
Providers.
On-track
New template for Public and
Private hospital accountability
developed.
slightly off-plan
significantly off
Status
2008/09 Business Plan Status Report – June 24, 2008
PART A- MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
For 2008/09 a plan is under
development for all community
agencies (CCAC, CHC, CSS and
CMHA)
3.4
N/A
3.5
N/A
Negotiate in 2007/2008 with each hospital a
service accountability agreement that will
commence on April 1, 2008.
Apr 1/08
Negotiations are still on-going. It
is expected that a number of
H-SAAS will be signed in May
and June 2008.
Part C: Sector Specific Performance Parameters
Consult with the MOHLTC on any proposed
Ongoing
service changes regarding Specialized Hospital
Services.
Acute Sector- Programs Funded Through Hospital Base Budgets and Provincial Resources
3.6
Notify LHIN of provincial/regional
delivery models that must be
maintained.
Maintain funding and require hospitals that provide
these services to maintain the volume or activity
levels and scope of service delivery.
Ongoing
Provide advice to the MOHLTC. Incorporate into
Hospital Service Accountability Agreement.
Ongoing
No changes to date.
Acute Care -Provincial Strategies
3.7
Determine strategic and operational
program policy (funding model and
accountability framework).
Acute Sector- Cancer Programs
3.8
Support service delivery of cancer programs in hospitals in CLHIN.
Ongoing
CLHIN Cancer Services Steering
Cttee continues to meet to
discuss service delivery issues.
Acute Sector- Wait Time Strategy
3.9
Determine all elements of wait time
strategy (consult with LHIN).
Incorporate service requirements into Hospital
and Community Care Access Centre Service
Agreements.
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
6
Status Legend
Ongoing
On-track
slightly off-plan
significantly off
2008/09 Business Plan Status Report – June 24, 2008
PART A- MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
Acute Sector- Critical Care Strategy
3.10
3.11
Both parties will select a critical care leader for the LHINs geographic area and determine
the critical care leader’s accountability requirements to the LHIN and MOHLTC.
Consult with the LHIN and determine
Incorporate applicable specifications in service
specifications. For 2008/09 review
Accountability Agreements identified in the Critical
Critical Care Strategy to determine
Care Strategy.
future directions.
Complete
Dr. Donna McRitchie has been
selected as critical care leader.
Ongoing
Long Term Care Homes-NOTE: The Financial Management Branch is aware of specific bed types and special funding arrangements and cash flows appropriately
Long Term Care Homes - Convalescent Care Beds
3.12
Determine which Long Term Care
Homes operators will provide the
service.
Fund and incorporate into service agreements.
Ongoing
To be evaluated against
Alternate Level of Care
pressures and Aging at Home
funding.
Fund per MOHLTC per Diem and require
compliance with per Diem envelop spending.
Ongoing
New 2008/09 Per Diem rates
finalized by the Ministry and
communicated to LTC homes.
Long Term Care Homes - Total Funding per Diem
3.13
Determine per Diem rate
Long Term Care Homes - Construction Cost Funding (CCF)
3.14 Determine the Construction Cost Funding Provide Construction Cost Funding per Diem to
per Diem and which Long Term Care
Homes will receive it.
Ongoing
selected Long Term Care Homes and make
recommendations re new Construction Cost
Funding applications.
Long Term Care Homes - Interim and Transitional Beds
3.15
Determine number of interim and/or
transitional beds.
Fund and incorporate into service agreements.
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
7
Status Legend
Ongoing
On-track
To be evaluated against
Alternate Level of Care
pressures and Aging at Home
funding.
slightly off-plan
significantly off
2008/09 Business Plan Status Report – June 24, 2008
PART A- MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
Long Term Care Homes - Beds in Abeyance
3.16
Approve beds in Abeyance
applications.
Manage applications, make recommendations to
MOHLTC, monitor need to re-open beds and as
necessary restore them to operation.
Ongoing
No applications received
Monitor short stay bed utilization of each Long
Term Care Homes home operator. Take action as
appropriate to improve the utilization of these
beds.
Ongoing
Developing a monitoring process
with the Community Care Access
Centre. However, utilization is
generally very high.
Long Term Care Homes - Short Stay (Respite)
3.17
Determine the threshold for occupancy
for short stay beds.
Schedule 4: Information Management Supports
#
MOHLTC Obligation
4.1
CLHIN Requirement
Part B. Performance Obligations
Develop a Provincial Forum, for the purposes of identifying pertinent information management
topics and making recommendations to the MOHLTC. Coordinate communications with health
service providers, and avoid duplicating data and information sources and holdings.
4.2
N/A
Deadline
Activities
Ongoing
Require health service providers to submit data
and information (including financial) to the
MOHLTC, Canadian Institute of Health Information,
or other third party. Improve data quality and
timelines as necessary.
Ongoing
CLHIN Requirement
Part B. Performance Obligations
Deadline
Status
Some progress to date.
Schedule 5: Financial Management
#
MOHLTC Obligation
Activities
Multi-Year Funding Targets
5.1
Provide multi-year funding targets
Refresh 2008/09 Annual Service Plan
complete
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
8
Status Legend
On-track
2008/09 ASP was refreshed.
slightly off-plan
significantly off
Status
2008/09 Business Plan Status Report – June 24, 2008
PART A- MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
5.2
Provide multi-year funding targets
Advise each public hospital of its multi-year
funding targets for Hospital Accountability
Agreements.
Completed
Funding targets for Hospital
Accountability Agreements
communicated and
incorporated into HAPS/HSAA.
Multi-Year Funding Targets (contin)
5.3
Provide multi-year funding targets
Prepare a plan to implement multi-year funding
targets for other health service providers.
Ongoing
Jointly develop policies and plans to introduce and ensure compliance with annual balanced
budget provisions.
Ongoing
Primary responsibility is
Ministry. Not initiated.
Annual Balanced Budget Requirements
5.4
5.5
N/A
Plan and achieve an annual balanced budget for
its Operating and Transfer Payment Budgets and
submit annual balanced budget forecasts to the
MOHLTC as part of Annual Service Plan and
include annual balanced budget provision in
agreements with Health Service Providers.
Ongoing
CLHIN is working with all
Health Service Providers to
reinforce that balanced
budgets are required. Only
balanced budgets are
accepted.
Where Health Service
Providers forecast reflect
potential year-end deficits,
CLHIN staff will meet with the
Senior Management of the
agency to determine
appropriate mitigation
strategies.
CLHIN Operating Budget:
Total Operating Budget has
been assigned to Central
LHIN. Internal allocations
underway.
Transfer Payment Budget:
CLHIN will operate within its
allocated transfer payment
envelope.
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
9
Status Legend
On-track
slightly off-plan
significantly off
2008/09 Business Plan Status Report – June 24, 2008
PART A- MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
In-Year and Year–End Reallocations
5.6
N/A
5.7
N/A
Provide Quarterly Reports the last day of each
quarter. Report on the: LHIN Quarterly Forecast
by Sector, including forecast of year-end position,
planned in-year reallocations, and actual in-year
reallocations; Risk Summary and related
mitigation strategies; Performance Variance on
indicators.
Last day of
each
quarter
(June 30/08
Oct 1/08
Dec 31/08
Mar 31/09)
Submit Annual Report including: Community
Engagement and Integration Activities; LHIN’s
Audited Financial Statements; LHIN’s
engagement with planning entities.
June 30,
2008
Risk Management Framework
5.8
Develop LHIN Risk Management Tools
and Policies in accordance with Ontario
Public Service Risk Management
Framework (2001) and Risk Management
Policy (2002).
Using MOHLTC Tools and Policies, report on
identified risks and related mitigation strategies in
Annual Service Plan and quarterly regular reports.
5.9
Develop a Chart of Accounts for LHINs that is operable between all LHINs and MOHLTC.
Jun 2008
Sept 2008
Dec 2008
Completed
Chart of Accounts completed &
utilized effective April 1/2007.
Capital-General Provisions
5.10
Carry out capital planning in alignment with the Provincial Strategic Plan.
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
10
N/A
Status Legend
On-track
The Ministry has not yet
released a Provincial Strategic
Plan.
slightly off-plan
significantly off
2008/09 Business Plan Status Report – June 24, 2008
PART A- MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
Capital Initiatives
5.11
Work together to enable the LHIN to provide advice about the consistency of a health service
provider’s Capital Initiative review and approval processes.
Ongoing
The MOHLTC/C-LHIN Capital
Working Group is developing
a Provincial approach to
aligning capital with
operating.
C-LHIN has proposed a
coordinated approach to
reviewing/planning capital
projects among C-LHIN
hospitals.
Own-Funds Capital Projects
5.12
Enable the LHIN to provide advice about the consistency of a public hospital’s Own-Funds Capital
Project and devolve the review and approval process for Own-Funds Capital Projects from the
MOHLTC to the LHIN, as appropriate.
Ongoing
The MOHLTC/LHIN Capital
Working Group is developing a
policy and guidelines on how
Own Funds Capital will be
managed by the LHINs and a
process for LHIN engagement
with Providers and provisions
under the Public Hospitals Act.
Ongoing
For 2007/08, the MOHLTC has
allocated Health Infrastructure
Renewal Funds (HIRF) to each
eligible hospital. Individual
hospital proposals have been
approved by the CLHIN
Board.
Completed
Information has been provided
by MOHLTC. CLHIN feedback
was sent and is completed.
Health Infrastructure Renewal Fund (HIRF)
5.13
Work together to enable the LHIN to begin approving Health Infrastructure Renewal Fund projects
starting in Fall 2007.
Post-Construction Operating Plan (PCOP)
5.14
Provide by June 30/07 guidelines for the
eligibility, approval and funding of projects
using the PCOP funding
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
N/A
11
Status Legend
On-track
slightly off-plan
significantly off
2008/09 Business Plan Status Report – June 24, 2008
PART A- MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
Schedule 6: Financial Processing Protocols
#
6.1
6.2
6.3
MOHLTC Obligation
Manage payment process for LHINs.
Review and Approve potential
reallocations from LHINs.
Collect and provide forecast information to
LHINs.
CLHIN Requirement
Deadline
Part B. Performance Obligations
Request payments to be made and
adjustments to payments to health
service providers.
Monitor the financial information of health
service providers, and direct the MOHLTC
on potential reallocations and
adjustments.
Provide expenditure forecasts in quarterly
and year end reports.
Activities
Status
Ongoing
Ongoing
Ongoing
Schedule 7: Local Health System Compliance Protocols
#
7.1
7.2
MOHLTC Obligation
CLHIN Requirement
Deadline
Part B. Performance Obligations
Work together to proactively assess and mitigate risks to the local health system that
arise or may arise from the MOHLTC’s activities. Jointly develop guidelines for the
LHIN on conducting audits, inspections, and reviews of health service providers.
Jointly develop protocols for the consultations and information exchanges between the
LHIN and the MOHLTC.
Inform the LHIN as soon as reasonably
Inform the MOHLTC of any nonpossible of any non-compliance (either
compliance by a health service provider
legislative or otherwise) by a long-term
with an assigned agreement, a service
care home operator.
accountability agreement, or legislation,
including program standards. Provide the
results of any audit or review of a health
service provider.
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
12
Status Legend
Ongoing
Ongoing
On-track
Activities
The Ministry working group has
shared a proposed draft for
review.
A process has been established
with the Performance Improvement
and Compliance branch to notify
CLHIN of any Long-Term Care
sector non-compliance. The LHIN
organizational structure was not
designed to perform program
management.
slightly off-plan
significantly off
Status
2008/09 Business Plan Status Report – June 24, 2008
PART A- MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
Schedule 8: Integrated Reporting
#
MOHLTC Obligation
CLHIN Requirement
Deadline
Activities
Part B. Performance Obligations
Quarterly Regular and Consolidation Reports
8.1
Provide instructions, forms, templates
Submit to the MOHLTC financial information
as specified
8.2
Preliminary annual calendarized cash
flow schedule by April 15 and final by
July 31
Consolidation Reporting
N/A
8.3
Ongoing
April 15
July 31
N/A
Submitted May 28
Completed
8.4
8.5
8.6
8.7
8.8
8.9
8.10
Collect and provide information for
Advertising Review Board annual
fiscal report.
Approved allocation for the current
fiscal year and funding targets for the
next three years by June 30
Provide data on performance indicators
as follows:
2006-07 Q3 by May 15
2006-07 Q4 by August 15
2007-08 Q1 by November 15 (wait
times and LTC)
2007-08 Q1 and Q2 by Feb 15, 2008
Provide report containing year-to-date
expenditures by June 8
Provide expenditure details each year
reporting Communications contracts
Report sent May 28, 2008
Completed
N/A
June 30
N/A
Completed
First Quarter Report
June 30
Provide report containing year-to-date
expenditures by September 7
Second Quarter Report
Sept 7
Provide report containing year-to-date
expenditures by December 7
Third Quarter Report
Dec 7
Fourth Quarter Report (optional – if required)
March 31/08
Work with the LHIN to provide a
forecast of year end (Performance
variance if required) by March 31, 2008
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
13
Status Legend
On-track
slightly off-plan
significantly off
Status
2008/09 Business Plan Status Report – June 24, 2008
PART A- MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
Year End Reports
8.11
8.12
8.13
Provide for each fiscal year the form
for the financial content of the Annual
Report and the form for the Year-end
Consolidation Report.
Provide Annual Report requirements
(non-financial content) by February
15, 2008 and forms for Annual Report
(financial content) by March 31, 2008
Submit to the MOHLTC the year-end
consolidation report, for each fiscal year to
which this Agreement applies.
Completed
Submit to the MOHLTC an Annual Report for
the previous fiscal year in accordance with
MOHLTC requirements, which includes:
i) The effectiveness of the LHIN’S community
engagement strategy using the common
assessment tool.
ii) Engagement with planning entities
prescribed under the Act.
iii) A report on the LHIN’s integration activities.
iv) A report on the performance of the local
health system on all performance indicators.
June 30/08
N/A
Completed
Provide by April 30 of each year,
information for the preceding fiscal
year on transfer payments to support
the preparation of Year-end Reports.
Submitted May 28
Deadline for submission
to the MOHLTC of final
2007-08 Annual Report is
June 30, 2008.
A draft of the Annual
Report is being revised to
reflect Board feedback.
Content meets Ministry
requirements.
Annual Service Plan and Multi-year Consolidation Reports
8.14
8.15
Provide the forms and information
requirements for the Annual Service
Plan and Multi-year Consolidation
Report by May 31 of each fiscal year.
Provide the forms and information
requirements for the Annual Service
Plan and Multi-year Consolidation
Report by May 31 of each fiscal year.
Submit to the MOHLTC a draft Annual Service
Plan, form provided by the MOHLTC.
Submit to the MOHLTC a Multi-year
Consolidation Report, consistent with the draft
Annual Service Plan, using the form provided
by the MOHLTC.
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
14
Status Legend
August 31
Completed
On-track
Submitted May 28
slightly off-plan
significantly off
2008/09 Business Plan Status Report – June 24, 2008
PART A- MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
Schedule 10: Local Health System Performance
#
MOHLTC Obligation
CLHIN Requirement
Deadline
Activities
Status
Part B. Performance Obligations
General Obligations
10.1
10.2
Provide calculated results for the
performance indicators and support
performance information.
10.3
10.4
Achieve performance targets for the
performance indicators.
Ongoing
Work with the MOHLTC, Cancer Care Ontario
and health service providers to achieve the
results for the 90th Percentile Wait Times for
Cancer Surgery performance indicator.
Report quarterly on mitigation strategies and
performance improvement plans for
performance indicators.
Ongoing
Overall performance achieved to
date.
Cancer surgery performance
targets achieved to date.
Last day of
each quarter
(Sept 30/08
Dec 31/08
Mar 31/09)
Report on the performance of the local health
system on all performance indicators in the
LHIN Annual Report.
June 30/08
CLHIN Requirement
Deadline
Schedule 11: e-Health
#
MOHLTC Obligation
11.1
Part B. Performance Obligations
Inform one another of significant issues or initiatives that contribute to or impact on
provincial or local e-Health issues, strategies or work plans.
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
15
Status Legend
Ongoing
On-track
Activities
The new Provincial E-Health
Strategy and priority areas of
investment will be announced in
the spring/summer of 2008.
slightly off-plan
significantly off
Status
11.2
Provide the LHIN with provincial
e-Health priorities and strategic
directions and provide any updates.
Implement the approved LHIN e-Health
strategy through its LHIN e-Health Work Plan
and service accountability agreements with
health service providers.
Ongoing
11.3
Inform the LHIN of a provincial
e-Health governance model that will
be established to oversee the
implementation of provincial e-Health
priorities and strategic directions.
Develop and implement the e-Health
governance model for the local health system
to oversee the development and management
of the LHIN e-Health Strategy.
Ongoing
11.4
Review and approve the LHIN
e-Health Strategy after it is submitted
by the LHIN and provide a Dedicated
Funding Envelope to the LHIN.
Submit to the MOHLTC a LHIN e-Health
Strategy. Once approved by the MOHLTC,
release approved LHIN e-Health Strategy and
any updates to the public. Use the Dedicated
Funding Envelope to provide funding.
Ongoing
08/09 Business Plan Status Report - Updated June 24, 2008
Note: Changes highlighted BOLD.
16
Status Legend
On-track
Drug Viewer expansion - 4 of 6
Hospitals scheduled for Wave 1,
starting Dec 2007.
Wait Time Information System
WTIS expansion in progress
Critical Care Information System
CCIS implemented
Emergency Department
Reporting System EDRS in
progress (Southlake Regional
Hospital agreed to be a beta site)
In late 2007, the Central LHIN
decided to merge its eHealth
Committee with the Toronto
Central LHIN e Health Council to
form a Joint eHealth Council with
representation from all sectors.
The members of the original
Central LHIN eHealth Committee
will serve as a local advisory body
to the new Joint eHealth Council
Our first meeting was held on Nov
21st 2007.
Central LHIN has submitted its eHealth Strategy to MOHLTC. The
strategy is in line with the
Provincial e-Health plan.
07/08 funding is restricted to
provincial initiatives, $275,000
planning budget for CLHIN.
slightly off-plan
significantly off
2008/09 Business Plan Status Report – June 24, 2008
MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
PART B – OTHER BUSINESS PLAN
Operations
#
1.1
MOHLTC Obligation
1.2
CLHIN Requirement
Arrange for an annual audit of the LHIN.
Deadline
Recruit LHIN staff.
Ongoing
1.3
Develop and Implement LHIN Transfer
Payment Approval and Authorization Policy.
April/07
Activities
CLHIN Audit completed during
the week of April 28/08.
Currently Recruiting For:
- Decision Support Analyst
- Funding Consultant
Status
Recently Recruited:
- Senior Coordinator, PCA (mat
leave)
- Performance Analyst
Communications Mgr (mat
leave)
Completed. Board Approved and
communicated to Ministry in April
Accountability Requirements
#
1.4
1.5
1.6
1.7
MOHLTC Obligation
CLHIN Requirement
Procurement Report – required by
Memorandum of Understanding directives.
Information to be provided to Ontario Health
Quality Council on request (required per Local
Health System Information Act).
Auditors Report.
Annual Freedom of Information Report required per Freedom of Information and
Protection of Privacy Act.
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
17
Status Legend
Deadline
Sept 2008
Activities
LHIN Liaison Branch to determine
process and forward to LHINs
On Request
Completed
Board Approved May 27, 2008
Completed
On-track
slightly off-plan
significantly off
Status
2008/09 Business Plan Status Report – June 24, 2008
MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
Board/Governance Requirements
#
1.8
MOHLTC Obligation
CLHIN Requirement
Bylaw Review.
Deadline
Completed
1.9
Report on Board and Director performance
assessment for the 07/08 fiscal year
Jun 30/08
Activities
“By-law No. 1” and “By-law No. 2”
was approved by the Central
LHIN Board on September 25,
2007.
Working with the other LHIN
Board Chairs to create a common
tool for individual Board member
assessment and evaluation.
Status
PART C – RISK MANAGEMENT REPORT
Risk
Hospital 2007/08 forecasts indicate that 3 of
the CLHIN public hospitals are forecasting
year-end deficits.
Of the 7 Public Hospitals, 3 are balanced and
their HAPS are CLHIN and Board approved.
Potential Impacts
Mitigation Strategy
Final audited YE positions will be available in
June 2008.
A number of hospitals may require a further extension of
their 2007/08 HAA.
Of the 3 Private Hospitals, 2 are balanced
and their HAPS have been approved by the
Board.
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
Staff continue to have discussions with the 4
remaining hospitals.
Staff continue to have discussions with the 1
remaining hospital.
18
Status Legend
On-track
slightly off-plan
significantly off
2008/09 Business Plan Status Report – June 24, 2008
MINISTRY/LHIN ACCOUNTABILITY AGREEMENT
PART D – QUARTERLY MLAA PERFORMANCE REPORT
All MLAA performance reporting requirements for Q1 have been waived.
08/09 Business Plan Status Report- Updated May 27, 2008
Note: Changes highlighted BOLD.
19
Status Legend
On-track
slightly off-plan
significantly off
APPENDIX 3.3
APPENDIX 3.4
2008/09
Planning, Integration &
Community Engagement
IHSP and Emerging Priority
Action Plan
June 24, 2008
2008/09 IHSP Action Plan - Updated June 13, 2008
Table
Page
1
IHSP Priority - Seniors
1
2
IHSP Priority - Mental Health and Addictions
1
3
IHSP Priority - Chronic Disease Management and
Prevention (CDMP)
2
4
IHSP Priority - Neurological Services
3
5
IHSP Priority - Wait Times
4
6
Emergency Services
5
7
Palliative/End-of-Life Care
5
8
Community Engagement
5
9
Integration Activities In Progress
6
Integration Activities Complete-2007/08 & 2008/09
7
10
2008/09 IHSP Action Plan - Updated June 13, 2008
TABLE 1 : IHSP Priority - Seniors
#
Workgroup
1.1
Long-Term Care
Description of Deliverable
1.2
Aging at Home
To strategize on key issues related to long-term
care homes and caregiver supports within a service
continuum (e.g. supports for behaviour
management and technology related strategies for
enhanced service delivery, such as remote
consultation with hospital-based physicians to
minimize travel for residents in long-term care.
Year One Project Service Agreements
1.3
Aging at Home
Year Two Detailed Plan
1.4
Aging at Home
Year One In Year Surplus and/or Reallocation
To Board
CEO Report
for
Information
July 2008
For Approval
May 2008
Tentative For
Approval
October 2008
Tentative For
Approval
September
2008
Activities
Status
Long-Term Care funding and staffing issues
backgrounder completed.
Ministry confirmation received for 20
Workplan under development
High level workplan in place
TABLE 2 : IHSP Priority - Mental Health and Addictions
#
Workgroup
2.1
Primary Care
2.2
Consumer/Survivor
Leadership team
Description of Deliverable
To Board
Facilitate development of partnerships between
family health teams and mental health/addictions
health service providers to enhance delivery of care
and enhance access to primary care for people
with MHA problems. No resources anticipated
Development of a consumer/survivor network
including website, education, and support activities
and family engagement strategies. Currently
funded by the MOHLTC to provide advice to the
LHINs; no further resources anticipated
CEO Report
For
Information
November
2008
CEO Report
For
Information
September
2008
Activities
Status
Exploring opportunities for integration with
FHTs and CHCs. Meeting with all FTHS in
Fall 2008.
Website and newsletter operational.
Undertaking community engagement with
consumer/survivors across the LHIN to
develop Network membership.
1
Status Legend
On-track
slightly off-plan
significantly off
2008/09 IHSP Action Plan - Updated June 13, 2008
TABLE 2 : IHSP Priority - Mental Health and Addictions
#
Workgroup
Description of Deliverable
To Board
CEO Report
For
Information
July 2008
CEO Report
for
information in
June 2008
CEO Report
For
Information
June 2008
CEO Report
For
Information
June 2008
2.3
Communications
Development of LHIN website webpage to
disseminate information about LHIN MH/A
activities, current research, and educational events
2.4
Centralized access
Centralized access
2.5
Diversity
Mental Health and Addictions Cultural Competency
Project
2.6
Education
Education Strategy Phase II
Activities
Status
Webpage launched
First phase approved through LHIN Urgent
Priorities 07/08. Final reported expected
July 2008
Diversity Lens currently being applied with
Health Service Providers
Workplan under development for education
to OW/ODSP and hospital Emergency
Department Staff
TABLE 3 : IHSP Priority - Chronic Disease Management and Prevention (CDMP)
#
Workgroup
Description of Deliverable
3.1
CDMP Advisory
Network
Provide leadership to plan, coordinate & evaluate
CDMP services/programs.
3.2
System Design and
Service
Coordination (for
chronic disease
patients)
Work group of CDMP Advisory Network;
Deliverables include increasing access for diabetics
in northern end of Central LHIN; increasing
coordination of diabetes care; developing a
continuum of care for diabetes; .
To Board
Work
underway not
anticipated to
require board
approval
Work
underway not
anticipated to
require board
approval
Activities
Status
Two projects funded through CLHIN urgent
priorities. Will continue to develop work of
Network and incorporate Information
Management solution where
appropriate/possible.
Finalizing approach the work group will use
to consider the continuum of care and the
coordination of services.
2
Status Legend
On-track
slightly off-plan
significantly off
2008/09 IHSP Action Plan - Updated June 13, 2008
TABLE 3 : IHSP Priority - Chronic Disease Management and Prevention (CDMP)
#
3.3
Workgroup
CDMP Self
Management
Description of Deliverable
To Board
Activities
Work
underway not
anticipated to
require board
approval
First set of workshops delivered in 2007/08;
workshops being revised based on
evaluations and will be offered throughout
the year.
Description of Deliverable
To Board
Activities
Develop an inventory of organizations and specific
neurological services available in the Central LHIN.
Develop a strategy to prevent unilateral service
changes or withdrawals, by health service
providers of programs and services.
CEO Report
for
Information
June 2008
Work group of CDMP Advisory Network
Deliverables include workshops, seminars,
reference document; service inventory
Status
TABLE 4 : IHSP Priority – Neurological Services
#
4.1
Workgroup
Neurological
Services Advisory
Network
Status
A model for identifying the continuum of
care for services is under review A strategy
for preventing unilateral service changes or
withdrawals was identified. A questionnaire
for health service providers is complete and
is being considered as an enhancement to
an existing database. A summary report of
the group activities and deliverables is being
developed.
Network will be standing down until further
findings from Service Need Assessment and
Gap Analysis complete
3
Status Legend
On-track
slightly off-plan
significantly off
2008/09 IHSP Action Plan - Updated June 13, 2008
TABLE 5: IHSP Priority-Wait Times
#
5.1
5.2
5.3
Workgroup
Wait Times
Strategic Planning
Group
Description of Deliverable
To Board
Activities
Enhance capacity for wait times priority services.
Develop models for high volume service delivery.
On-going
Completed:
- 2007/08 wait times allocation
process, resulted in higher volumes
for cataract and hip/knee
replacement procedures, and more
hours for MRI
- Moving towards implementation of
two centres of high volume for
cataracts (one in the north and one
in the south of the LHIN). Overall
wait times continue to improve.
- 2007/08 in-year intra- & inter-LHIN
reallocation process resulted in
additional volumes for cataract,
hip/knee replacement and CT
hours.
- 2008/09 allocations completed but
resulted in lower MRI hours than
07/08
Streamline data collection and interpretation to
achieve full utilization of services
On-Going
Stronger link with Wait Times Information
Office to improve data quality, streamline
data flow and expand availability.
Build a seamless system of care from a patients
perspective through:
•
Consistent and timely reporting of wait times
•
Coordinated referral and follow-up
N/A
Status
14 LHINs collaborated with MOHLTC to
develop a standardized Wait Time
scorecard.
CLHIN supporting new models of care (e.g.,
NYGH Branson Site and Southlake Medical
Arts Building) that will be comprehensive
centres for wait times priority services.
These models include common assessment
and other collaborative processes
4
Status Legend
On-track
slightly off-plan
significantly off
2008/09 IHSP Action Plan - Updated June 13, 2008
TABLE 6: IHSP Priority- Emergency Services
Description of Deliverable
#
6.1
Create the Emergency Services Advisory Network. This
group will develop a strategy and action plan to address
and mitigate challenges faced by residents of the Central
LHIN.
Activities may include exploring initiatives that:
1. improve access for patients,
2. increased coordination and collaboration between
hospitals
3. improve data collection and management.
To Board
Activities
Recommendations
for ER
Performance Fund
Anticipated
Status
Emergency Services Advisory Network has
recruited a LTC representative and is currently
recruiting a primary care representative.
The ED lead and the Central LHIN are currently
exploring opportunities for alignment with the
provincial emergency department strategy. ER
Performance workplan underway.
TABLE 7 : Palliative/End-of-Life Care
#
7.1
Workgroup
Palliative/Endof-Life Care
Steering
Committee
Description of Deliverable
To Board
Activities
Status
Provide leadership to plan, coordinate &
evaluate palliative/EOL care; to improve
quality, choice & access to palliative/EOL
care.
CEO Report
for
Information
June 2008
Planning for residential hospice in York Region
nearing completion. Website under development.
Open space forum to explore integration opportunities
planned for June 3, 2008
TABLE 8: Community Engagement
#
8.1
Description of Deliverable
To Board
Activities
Central LHIN Stakeholder Engagement Strategy (February
2006)
Approved in
2006
Revised Stakeholder Engagement Strategy (March 2008)
August 2008
ƒ
Status
Revised Stakeholder Engagement Strategy
developed
5
Status Legend
On-track
slightly off-plan
significantly off
2008/09 IHSP Action Plan - Updated June 13, 2008
8.2
Central LHIN Communications Strategy
•
Faith and Ethno-cultural engagement
•
Business engagement
•
Education engagement
8.3
•
Aboriginals
Themes
provided in
March 2008
ƒ
ƒ
ƒ
CEO Report for
information July
2008
ƒ
Faith engagement - complete
Business engagement - complete
Education sector engagement - held 6 sessions
to determine best outreach methods with the
sector. Held 3 sessions with multi- sectoral
planning tables. Additional sessions are
currently being planned with the outreach
continuing into the 08/09 fiscal.
A focused community engagement initiative with
Aboriginals is nearing completion.
Table 9: Integration Activities In Progress
Project Name
My Friends Place Divestment from Consumer Survivor Project Simcoe
County to the Krasman Centre
Stevenson Memorial Hospital
Markham Stouffville Hospitals
Bethany Lodge/Markhaven
North York Central Meals on Wheels
Cataract Services
Decision Date
To Board for
Approval in
September
2008
To Board for
Approval in
July 2008
To Board for
approval in July
2008
To Board for
approval in
Summer 2008
To Board for
Approval in
October 2008
TBD
Description/Partners
Status
Facilitated integration initiative with North Simcoe
Muskoka LHIN to transfer funding for MY Friends
Place in Alliston from the Consumer Survivor
Project Simcoe County in NSM LHIN to the
Krasman Centre in Central LHIN
Part of HAPS Process
Part of HAPS Process
Financial Collaborative
Don Mills Foundation for Seniors
Wait Time Strategic Planning Group
6
Status Legend
On-track
slightly off-plan
significantly off
2008/09 IHSP Action Plan - Updated June 13, 2008
Table 10: Integration Activities Complete ( 2007/08 & 2008/09)
Project Name
Decision Date
Description/Partners
Deaf Access Simcoe/The Canadian Hearing Society
June 2007
North York General Hospital/St. John’s Rehab Hospital
November
2007
Central Ontario Hospital Procurement Alliance
Feb 2008
Voluntary integration request May 2007 for colocation of services. Request was a cross-LHIN
initiative with North Simcoe Muskoka LHIN.
Supported by Board June 26, 2007.
Voluntary integration request to transfer short-term
rehabilitation capacity from North York General
Hospital to St. John’s Rehab Hospital. Supported
by Board November 27, 2007.
Voluntary integration request received January 18,
2008. York Central Hospital, Markham Stouffville
Hospital, and Southlake Regional Health Centre to
participate in a supply chain management initiative
with hospitals in the NSM and CE LHINs. Supported
by Board February 25, 2008
Voluntary integration request received January 31,
2008 by North York General Hospital to participate
in a group purchasing initiative with 24 other
hospitals in Ontario. Supported by Board March 25,
2008
Facilitated integration initiative with North Simcoe
Muskoka LHIN to transfer funding for Matthews
House Hospice in Alliston from Hospice Simcoe in
NSM LHIN to Hospice Alliance in CLHIN.
Council of Academic Hospitals of Ontario Capital Equipment Group
Purchasing Initiative
Matthews House Hospice Divestment from Hospice Simcoe to Hospice
Alliance
March 2008
April 2008
Status
7
Status Legend
On-track
slightly off-plan
significantly off
APPENDIX 3.5a
2007/08 Central LHIN Urgent Priorities Fund Slate of Approved Projects
Item
Health Service Provider(s)
Seniors
1.Behavioural Unit Plan for Long-Term Care
2.Supportive Housing Local Needs Assessment
Subtotal
Unionville Home Society
St. John's Rehab
Mental Health & Addicitons
3.Cultural Competence Tool - Board Approved
4.Educational Initiatives
5.Mental Health Local Needs Assessment
6.Centralized Access
Subtotal
CMHA Toronto
Addiction Services for York Region
St. John's Rehab
York Support Services Network
Chronic Disease Prevention & Management
7.CDMP Self Management - Board Approved
8.Community Outreach Collaborative
Subtotal
YEE HONG
Southlake Regional Health Centre
9.LongStay Bed Conversion to Convalescent
10.Healthcare Human Resource - risk reduction plan
11.Community Sector Capacity Building - risk reduction
12.IHSP Evaluation Framework
13.Integration Activities
14.Diversity & Inclusion Communities of Practice
15.CT Waitlist
16.IHSP Summit
17. Maintaining OR capacity
BOARD APPROVED
Base
Fiscal Year 2007-2008
One-Time
Total
0
42,000
80,000
122,000
200,000
200,000
40,000
14,000
80,000
0
134,000
0
46,000
150,000
196,000
CCAC
YEE HONG
St. John's Rehab
Aphasia Institute
Bethany Lodge; North York Meals on Wheels
Circle of Care
CLHIN Hospitals
Circle of Care
Humber River Regional
Comments
Tabled for Board, November 2007
Tabled for Board, November 2007
122,000
Tabled
Tabled
Tabled
Tabled
1,368,900
Unallocated Balance
TOTAL Priorities Funding
Updated June 12, 2008
October 23, 2007
November 2007
November 2007
November 2007
Tabled for Board, October 23, 2007
Tabled for Board, December 18, 2007
196,000
Tabled
Tabled
Tabled
Tabled
Tabled
Tabled
Tabled
Tabled
1,368,900
347
2,021,247
#2 & #5 Supportive Housing and Mental Health Local Needs Assessment were incorporated into the larger project: Service Needs Assessment and Gap Analysis.
Of the $2,021,247 allocated to the Central LHIN, $2,020,900 was allocated to the projects outlined above leaving an unallocated balance of $347.
Board,
Board,
Board,
Board,
334,000
200,000
80,000
200,000
52,500
100,000
50,400
403,500
50,000
232,500
0
for
for
for
for
for
for
for
for
for
for
for
for
Board,
Board,
Board,
Board,
Board,
Board,
Board,
Board,
November 2007
November 2007
November 2007
November 2007
November 2007
December 18, 2007
December 18, 2007
December 18, 2007
APPENDIX 3.5b
Central LHIN Urgent Priorities Fund 08/09
Item
BOARD APPROVED
Health Service Provider(s)
Sector
Fiscal Year 2008-2009
Base
One-Time
Total
Total Allocation
Mental Health & Addicitons
Cultural Competence Tool - Board Approved
Educational Initiatives
Centralized Access
Subtotal
CMHA Toronto
Addiction Services for York Region
York Support Services Network
Yee Hong
Diversity and Inclusion Communities of Practice
Black Creek Community Health Centre
CMHP
CMHP
CMHP
LTC
60,000
50,000
Board Approved, October 2007
Board Approved, November 2007
Placeholder
500000
110,000
110,000
104,000
104,000
104,000
-
500,000
Board Approved, October 2007
-
105,000
Board Approved, April 2008
ALC Placeholder
Will be tabled for Board approval at
a future date
1,702,247
105,000
Updated June 11, 2008
Comments
3,609,369
Chronic Disease Prevention & Management
CDMP Self Management - Board Approved
Subtotal
Unallocated Balance
PROPOSED PROJECTS
Fiscal Year 2008-2009
Base
One-Time
Total
3,290,369
-
APPENDIX 3.5c
LHIN URGENT PRIORITIES 2007/2008
LHIN PRIORITY
Status
SENIORS
1. Behavioural Support Report completed
Unit
Learnings
Next Steps
There is a need for Behavioural Support Units in Central LHIN.
A plan detailing a proposed bed model is developed based on
best practices.
Draft and final report to be shared to inform Service Needs and Gap
Assessment and to support Alternative Levels of Care initiatives.
Implementation of a demonstration project to be considered, funding
opportunities within MOHLTC, Aging at Home, etc… to be explored.
Project lead retained, initial meetings with agencies completed
.An environmental scan of best practices on mental health and
diversity is underway to provide insight into cultural competence
capacity within our mental health and addictions providers.The
results will be used to inform the training and peer mentorship
provided to agencies before post assessment to be completed
by March 31,2009
The evaluation consultant will work in tandem with our epidemiologist
to ensure that data collected is relevant and meaningful to Central
LHIN during the pre and post assessment. Initial feedback from
agencies shows that they are open to the process and willing to
provide their full participation. The education and evaluation strategy
are being developed by the working group in conjunction with the
project coordinator.
4.Education Initiatives Ongoing Project
Board approved for Completion date of
fiscal 07/08 and 08/09 March 31st 2009.High
Level Workplan has
been developed
Developing an education strategy to deliver training for
emergency department, Ontario Works and Ontario Disability
Support Program staff on mental health and addictions.
Focus is to provide a base of knowledge on mental health and
addictions issues and incorporate sensitivity training in service
delivery for staff. Conducted a preliminary survey to directors of
hospitals' mental health units to inform planning
The Mental Health and Addictions Education working group is
leading the project and report to the Mental Health and Addictions
Network. The next steps are to : Conduct phone interviews and gather
more detailed information and assess the training needs to develop
the education strategy. Research on what type of training Ontario
Works and Ontario Disability Support Program staff have been
provided already and to identify gaps that could inform the planning.
6.Centralized Access Draft Interim Report
Board approval will be Rec'd
sought in 08/09
Deliverables for this project included a report outlining a
Final report expected July 2008; funding recommendation will be
collaborative model for system intake for individual support
brought to Board for approval following analysis of report.
services in the Central LHIN. An interim report was received in
April 2008 and was vetted through the Mental Health and
Addiction Network, and the Consumer/Survivor Network in May
2008. Comments are being reviewed by the Project Steering
Committee. Recommendations and an implementation plan are
expected in July 2008. Resources to support change
management for successful implementation will be required in
implementation start-up; transitional oversight structure required
to support implementation. Additional deliverables included an
interim wait list management system which has been achieved
in both York/South Simcoe and North Toronto. Funding was
also provided to York Region for short-term case management
to wait listed clients.
MENTAL HEALTH
AND ADDICTIONS
3.Cultural Competence Ongoing Completion
Tool Board approved date of March 31st
2009.Project is on track
for fiscal 07/08 and
08/09
Updated June 12, 2008
1
LHIN URGENT PRIORITIES 2007/2008
LHIN PRIORITY
Status
Learnings
Next Steps
CDMP
7.CDMP Self
Management Board
approved for fiscal
07/08 and 08/09
Ongoing Project
Completion date of
March 31st 2009
8. Community
In progress
Outreach Collaborative
08/09 funding
through Aging at
Home
Proceeding to Plan: two workshops offered in 07/08; evaluation
results used to refine workshops; workshops were video
streamed & will be made available online
Project ongoing through 08/09 Urgent Priorities; key deliverables
include 7x4-hour workshops; 7x1-hour workshops; evaluations of
each; broad participation in workshops
Critical to be flexible cause the project require shared staff
Process to set up a call service to patients if they don't go to clinic to
between Hospital and VON. The two had to create new
find out why and provide in home service if necessary. Find out
processes to deal with there projected staff that required a
reasons for no shows captured on database to analyze trends and
management committee. Joint recruitment was required which
increase access. New Diabetes clinic is being set up-location is
was time consuming and needed approval from both
identified and planning is underway.
corporations. There also needed to be more clarity about
deliverables cause partnership accountable and they need clarity
regarding roles.
OTHER
9. 30 Long Stay Bed
Conversion to
Convalescent
08/09 funding
through Aging at
Home
In progress confirmation received
that Aging at Home
funding to be flowed
from ministry
10. Healthcare Human Currently at 65%
Resource Risk
completion. Final
Reduction Plan
Report date ~ June
27th
Updated June 12, 2008
Proceeding to Plan. MOHLTC advised of additional review
required which has been completed successfully at Union Villa,
Maple Centre review still pending.
MOHLTC have completed their compliance review and we have
received verbal confirmation from LHIN Liaison Branch that funding
will flow in the phase two Aging at Home project batch.
The Health Human Resource Advisory Group identified top 15
professions that they deemed to be of 'high need' and therefore
pose the greatest risk in terms of recruitment and retention.
Some agencies have excess capacity in some of these 'high
need' professions, so much so that these professionals are
working in administrative positions. Wage disparity, retraining of
internationally trained professionals, cultural and language
barriers are the key health human resource challenges
identified. The consulting firm is also looking at the Health
Human Resource needs with respect to the Aging at Home
strategy and the opportunities (and demands) that that will
create. The final report will address the deliverables outlined in
the project charter (i.e. current capacity; identify gaps; develop
mitigation strategies; develop forecasting tool; and develop
retention and recruitment strategies).
Final report due June 27th. Health Human Resource forecasting tool
is under development which the Central LHIN Health Service
Providers will be able to use to forecast their own human resource
needs. Develop LHIN wide recruitment and retention strategies. The
consulting firm provides regular updates to the Health Human
Resourced Advisory Group. The final report will be shared to inform
the larger Service Needs Assessment and Gap Analysis project
currently underway.
2
LHIN URGENT PRIORITIES 2007/2008
Learnings
Next Steps
11.Community Sector Final Report submitted.
Capacity Building 28 out of 34 agencies
Risk Reduction
responded. The
ministry has recently
informed us of the
process they will use to
recover urgent priority
dollars which will impact
our ability to use the
balance of the budget
to carry out activities to
build capacity and
mitigate risk. Further
detail,
recommendations and
proposed solution to
come to the board over
the summer.
LHIN PRIORITY
Status
A web survey was used to gather information on risk areas
identified by community support service agencies. Although, no
consistent areas of risk were identified across all 28 Community
Support Service agencies, three common and overlapping areas
of risk were identified by a number of agencies as key areas of
organization vulnerability; these include funding, staffing and
service capacity. The top service delivery vulnerabilities
identified include staffing, infrastructure and service delivery.
The availability of health human resources was identified by 29%
of the respondents as the top service delivery vulnerability. The
other areas identified as 'high risk' were 'outdated systems' (i.e.
technology) and 'compensation and benefits'. The report
supports activities such as the recent Central LHIN back office
integration forum.
Further analysis is underway to identify opportunities to mitigate risks.
Further projects and processes are expected to evolve from this work.
Individual agency reports to be shared with each health service
provider that participated to assist them to manage their own risks.
12. IHSP Evaluation
Framework with York
University (part one)
In progress. End date
~ Aug 2008
Development of outcome map framework underway - for Central Steering Committee formulated. Key stakeholder interviews complete
LHIN
- synthesis underway to develop outcome map. Process and funding
to be determined for part two of project.
13.Integration Project Bethany Lodge &
Markhaven Back
Office Integration
Project
Integration PreSlide deck presentation of general learnings to date - was
Proposal Template
shared at back office integration forum and is available on
Rec'd December 20/07. website
Integration Proposal
anticipated Fall 2008 to
implement one finance
department, one HR
department, and one IT
department. Funding
was provided by the
LHIN to develop a
common IT platform to
facilitate the financial
and IT integration.
Updated June 12, 2008
Development of common policies & procedures, and the
reorganization of staffing will be completed upon approval of the
Central LHIN Board in Fall 2008.
3
LHIN URGENT PRIORITIES 2007/2008
LHIN PRIORITY
Status
Learnings
Next Steps
13. Integration Project - Integration PreHealth Service Providers are reviewing HR impact, legislative
"Strategic
Proposal Template
and accountability requirements.
Restructuring:
Rec'd December 07.
Strengthening
Governance integration
Community Support
request expected Fall
Services in North
2008.
York/North Toronto" North York Central
Meals on
Wheels/Better Living
Health and Community
Services (formerly Don
Mills Foundation for
Seniors)
Detailed plans will be developed in September 2008, with Health
Service Providers Board consideration in September 2008.
Submission of Governance Integration Request to Central LHIN
expected Fall 2008
14. a Diversity and
Inclusion - Board
leadership
Report submitted May
26, 2008
Review by Diversity and Inclusion Advisory Group (June). Proposal
to be developed to support continued board leadership. It is likely
projects for implementation will come forward for future board
approval.
14. b Diversity and
Inclusion Communities of
Practice. Board
approved for 08/09
07/08 Complete. 08/09 A fully developed promising practice inventory - training and peer Updates during year to be provided in Planning Integration and
project funding to be
support sessions for service providers - educational materials to Community Engagement Action Plan (CEO Report)
flowed June 08
support clients in accessing services - new outreach materials to
help newcomers, improved linkages between community groups
and health service providers
15. CT Waitlist
Completed
Reduction of Wait Times-Total Additional Volume Hours 1, 614
None at this time
16. IHSP Summit
Completed
Health service provider boards willing to become more engaged
around the Integrated Health Service Plan. Providers and
boards shared favourable feedback on LHINs activities and role
to date in bringing providers together.
Second follow up communication package drafted to provide further
detail to providers around the 65 items raised and self identified
leaders for particular items from the day. Further summary
information has also been drafted that includes action items and next
steps from the day.
17. Funding for
Maintaining OR
Capacity
Completed
Perform the following additional cases ( over base and
incremental wait time volumes): 72 barriatric, 45 hip/knee, 60
cancer-leading to a reduction in wait times.
None at this time
Updated June 12, 2008
Central LHIN policies and tools were reviewed by a consultant
using criteria drawn from research and practice.
Recommendations are very ambitious and will be prioritized at
the Diversity & Inclusion Advisory Group in June.
4
APPENDIX 3.5d
Draft
2008/2009 Portfolio
Management Decision
Prioritizing Tools & Processes
Central LHIN
June 24, 2008
6/18/2008
1
Broad Considerations
√ There is a need to have broad allocation and
reallocation goals
√ Decision Criteria to be developed with specific
funding source in mind - where stipulations exist
from the Ministry or parameters exist (e.g. one
time)
√ Forward thinking activity to improve ability to
work within timelines and business cycle
constraints
-------------------------------------------------------------------------• Known sources of funding
• Yet to be known sources of funding (e.g in year
surplus)
Developing Shared Goals and
Criteria to to Guide Activity
Benefits and purpose include:
– Better able to identify and articulate a platform
to base allocation/reallocation decisions for the
2008/2009 funds
– Timely to enable improved alignment with
business cycle
– To create opportunity for time to plan, reflect
and approve
– To improve transparency
– To streamline process for stakeholders and
health service providers
Draft Goals of
Allocation/Reallocation Strategy
Goal #1
Improve system performance and
support health service providers
Goal #2 Ensure focus on meeting MLAA
Goal #3 Ensure focus to advance IHSP
Goal #4 Support integration activities to
improve system performance (access,
coordination, quality, efficiency)
Known Sources of Funding
Source
07/08
08/09
LHIN Urgent
Priorities
$ 2,
021,247
$ 3,609,369
ALC =
$1,588,122
Unallocated
=
$1,702,247
Aging at Home
MOH Criteria
Pending
Seniors, LTC,
Community
Services, ALC,
Innovation,
Wellness
Central LHIN
Criteria
Additional
Information
MLAA
pressures,
Projects that
do not have
any other
sources of
MOH funding
2008/2009
criteria from MOH
(including ALC
initiatives) have
not been received
Slate of Projects
to be presented
in July/August 08
and Nov/Dec 08
(?).
Year 2
Strategy under
development
Unknown Sources of Funding
Source
07/08
08/09
MOH Criteria
Central LHIN
Criteria
Additional
Information
Aging at Home
Year One in
year surplus
and projects
held back (if
any)
TBD
~ $5 M
estimate
To be
reallocated
consistent with
AAH strategy.
Innovation
encouraged.
Innovation.
Addressing gaps,
Fast tracking
year two
projects,
enhancing
existing year one
projects
Anticipated
plan to board
August 2008
Health Service
Providers
In Year 1
Operation
Surplus
07/08 CMHA
748,683
07/08 CSS
07/08 Hospital
1,224,166
07/08 CCAC
1,200,000
TBD
None
Previous
Commitments –
if any
Earliest
allocation date
November
2008
Additional Criteria
Proposals that support initial goals may go through a
second screen of criteria that may include the
following in addition to the application of a scoring
and prioritizing tool specific to the funding source
• Support of recommendation from the Service Need
Assessment and Gap Analysis Support Health
Human Resource Risk Reduction Plan
• Reduce LHIN risk (operational and system)
• Support mitigation of health human resource risk
(shortage)
General Sources of Funding
Requests
Health Service Improvement Proposals received
through the year will be sorted as follows:
1. Integration – if applicable
2. Health service provider in-year pressure
3. Health service provider minor capital (one-time)
4. Health service provider reallocation within
existing budget
5. System performance improvements
LHIN Urgent Priority Fund –
2008/09
• Decision criteria to be refined for the unallocated
balance
• Decision criteria to be developed for the
Alternative Level of Care allocation
• Suggest at least two presentations to the board of
slates for approval (suggest late summer and late
fall as a contingency)
APPENDIX 3.12
Central LHIN
DRAFT Integration Strategy
June 24, 2008
6/18/2008
1
Purpose of Strategy
• To articulate intended goals, audiences, messages,
timelines, processes and areas of focus
• To provide system leadership and develop capacity for
integration
• To foster a culture of integration and support readiness for
system change
• To catalyze integration activities
Integration Strategy Goals 2008/10
• Promote system leadership through Health Service
Providers
• Optimize the use of resources e.g. human resources, admin
& direct service funding
• Support a shared service model of integration for the
willing CSS and Mental Health sector providers
• Support the hospitals in fulfilling Schedule B commitments
• Prepare the CSS/Mental Health sectors for Schedule B
commitments (2009/10)
Legislation
• Local Health System Integration Act, 2006
– Provides authority to the LHINs
– Defines integration
– Broadly outlines LHIN decision process
regarding integration
Legislation
“Integrate” includes:
• To co-ordinate services and interactions between different
persons and entities
• To partner with another person or entity in providing
services or in operating
• To transfer, merge or amalgamate services, operations,
persons or entities
• To start or cease providing services,
• To cease to operate or to dissolve or wind up the
operations of a person or entity
Types of Integration
• Voluntary e.g. integration activities voluntarily initiated by
health service providers
• Facilitated e.g. integration activities involving at least one
health service provider, and facilitated or negotiated by the
LHIN
• Required e.g. LHIN or ministry may require HSPs to
provide or cease to provide services, or transfer services
from one location or HSP
• Integration by funding e.g. new/transferred funding to
health service providers
Levels of Integration
• Governance or corporate integration e.g. merger or
amalgamation, transfer of funding
• Administrative integration e.g. back-office
• Service integration e.g. coordination
Context for Integration
• Central LHIN has 96 Health Service Providers in six
sectors:
– Hospital
– Community Mental Health and Addictions
– Community Support Services
– Community Care Access Centre
– Community Health Centre
– Long Term Care
• Integration may involve Health Service Providers in other
LHINs
• Integration may involve organizations not funded by the
LHIN
Status – Corporate Integration Activity
– Voluntary
– NYGH/SJRH transfer of short-term rehabilitation services
– North York Centre Meals on Wheels/Don Mills
Foundation merger (pending)
– Facilitated
– Transfer of Matthews House Hospice
– Transfer of My Friends’ Place (pending)
– By Funding
– Stevenson/Southlake Management Collaborative
(pending)
Status – Administrative Integration
– Voluntary
– Canadian Hearing Society/Deaf Access Simcoe
co-location
– COHPA group purchasing
– CAHO group purchasing
– Markhaven/Bethany Lodge financial services
(pending)
Status – Service Integration
– Voluntary
– Alzheimers Society of York Region/Region of
York transportation (pending)
– Facilitated
– Doorways to Care (pending)
– By Funding
– Stevenson/Southlake Maternity Services
(pending)
Current Related Activity – Building
Momentum
Central LHIN
• Governance Councils have shared information related to
the role of the Health Service Provider Board in the health
system
• IHSP Leadership Summit
• H-SAA Schedule B integration requirements – currently
hospitals only
• Back-Office Integration Forum
Current Related Activity – Building
Momentum
Cross-LHIN
• Work continues on a Toolkit on Governance Relationships
& Voluntary Integration
• Provincial integration repository development underway
Priming the Pump – Signs of Readiness
• A Joint eHealth Council has been established by the
Toronto Central LHIN and the Central LHIN. Two
Networks have “integration” workgroups
• The CSS capacity initiative through Aging at Home is a
pre-integration step
• New funding opportunities pose an opportunity to shape
the system
Activities to Support the Integration Strategy in 2008-2010
Strategy Elements
Types of Activities
System Leadership
Governance Council Meetings
Continue to support development of Governance Toolkit and implement
locally
IHSP Summit
Integration
Readiness, Culture
Conduct Targeted Education Activities
LHIN staff integration learning events to promote facilitated integration
through IHSP Networks
General education through Central LHIN Networks
HSP Back-Office Forums targeted at community agencies
Develop LHIN staff & Board decision tools
Develop tools for HSPs, including performance indicators
Catalyze Integration
Activities
Provide support for voluntary and facilitated integration through leadership
recognition, funding, knowledge transfer, & decision making
Identify and support local integration-related activities arising via AAH
initiative, CDMP initiative, Hospice Palliative Care
Activities to Support the Integration Strategy in 2008-2010
Strategy Elements
Focus – 08/09
Focus – 09/10
System Leadership
•Governance Councils
•Governance Toolkit –
Knowledge Transfer on
Voluntary Integration
•Governance Councils
•Conflict resolution & change
management
Integration Readiness, Culture
•Knowledge Exchange –
Integration 101
•Network Development
•Tool Development
•Performance Indicator
Development
•Content Development for
09/10 Activities
•Develop & Implement
Communication Strategy
•Knowledge Exchange –
Integration 201 (Integration
Examples, Tools, Mentorship)
* There is also ongoing work associated with gathering information and supporting providers with voluntary and
LHIN-facilitated, integration requests
Activities to Support the Integration Strategy
in 2008-2010
Strategy Elements
Focus – 08/09
Focus – 09/10
Catalyze Integration Activities*
•Back-Office Integration
Initiatives
•Implementation of Voluntary
& Facilitated Initatives
identified through networks
e.g. centralized access, centres
of excellence
•H-SAA
•Schedule B
•Schedule B (CSS & MHA)
* There is also ongoing work associated with gathering information and supporting providers with voluntary and
LHIN-facilitated, integration requests
Resources to Support the Integration Strategy
in 2008-2010
Strategy Elements
08/09 Resources for …
09/10 Resources for …
System Leadership
•Gov Toolkit Distribution
•Gov Council Logistics
•Content Development for Year 2 (Change,
conflict)
•Gov Council Logistics
Integration Readiness,
Culture
•Knowledge Exchange Forum Logistics
•Tool(s) - Integration Repository, Phase II
•Performance Indicator Development
•Content Development for Year 2:
Integration 201, Mentorship
•Communication Strategy Development &
Implementation
•Tool Production & Dissemination,
•Knowledge Exchange Forum
Logistics
* There is also ongoing work associated with gathering information and supporting providers with voluntary and
LHIN-facilitated, integration requests
Resources to Support the Integration
Strategy in 2008-2010
Strategy Elements
08/09 Resources for …
09/10 Resources for …
Catalyze Integration
Activities*
•Back-Office Integration Initiative (Forum,
Project Manager, Start-UP costs)
•Schedule B (Hospitals)
•Emerging Integration Activities – Seed
funding
•Content Development for CSSA (Schedule
B)
•Service Integration Initiatives
Project Manager, Start-up costs)
•Schedule B (CSSA) – Seed funding
•Emerging Integration Activities –
Seed Funding
* There is also ongoing work associated with gathering information and supporting providers with voluntary and
LHIN-facilitated, integration requests
APPENDIX 3.14
Health Service Needs
Assessment and Gap
Analysis
Board Update
June 24, 2008
6/18/2008
1
Contents
• Progress Update
• Criteria for Determining Appropriate Levels of
Analysis
• What We Are Analyzing (Domains of Interest)
• How We Are Analyzing it (Analytical Framework)
• Next Steps
Project Timelines
Apr
M ay
Jun
Jul
Aug
Sep
Oct
Phase I:
1)
Start-up & Planning
2)
Data Collection , Analysis and
Stakeholder Input
(Identify Needs)
3) Analysis & Reporting
(Identify Gaps and M odels)
Phase II:
4)
Stakeholder Validation
Phase III:
5)
Finalize & Present Report
Advisory Committee
Review
Design
Apr 29
Progress
Report
M ay 19th
Progress
Report
Jul 21
Progress
Report
Aug 18
Progress
Report
Sept 22
Final
Report
Oct 20
Domains of Interest
Quaternary
The domains of
interest define
program areas
within the LHIN;
reflecting current
models of the LHIN,
but also looking
forward
programmatically
Tertiary
Secondary
Primary Care + Community
Services
Family and Support Network
Self Management
Wellness
Criteria for Determining Appropriate Levels of
Analysis
The criteria below assist in determining the appropriate levels of analysis for each of the domains. The criteria below were
selected to help identify those areas of focus for the LHIN and the province over the next several years that will provide
opportunities for funding, balancing local needs and provincial priorities.
Criteria
Rationale
Identified as a priority by the LHIN
Priorities identified in the LHIN IHSP, driven by immediate concerns
of the community through a community engagement process
Identified as a priority by the MOHLTC
Areas of focus for the MOHLTC; indicating areas where planning
efforts are focused on a provincial level in which the LHIN will be
required to align
Top 75% volume drivers for the LHIN
Identifies the top service areas for the LHIN that touch the majority
of LHIN residents
Identified as an Ministry-LHIN Accountability Agreement
(MLAA) Indicator
Identifies those areas of focus for quality improvement for both the
MOHLTC and the LHIN
Considerations that arise from the Population Scan or
Qualitative Analysis
Identifies those areas that may be of local concern that are not
immediately reflected in the data and current priorities
Within the LHIN mandate
This final criteria helps to filter out any priority areas outside the
LHIN mandate to ensure focused data analyses are based on those
areas within the scope of LHIN funding
Other considerations
that may arise from the
population scan and
qualitative analysis
Application of the Criteria
The following table demonstrates how the criteria have been applied across the domains of
interest to identify which areas would benefit most from more detailed analysis
Domains of Interest
LHIN
Priority
(IHSP)
Primary Health Services
Ministry
Priority
MLAA
Indicator
X
X
X
Emergency Services
X
X
Chronic Diseases
X
X
Cancer Services
X
X
X
Top 75% LHIN
Volume Drivers
X
Seniors Services
X
X
Mental Health & Addictions
X
X
X
5
X
X
4
X
X
5
X
1
X
2
X
4
X
Musculoskeletal
Gastrointestinal
Disabilities / ABI
X
X
X
4
X
1
X
X
2
X
X
4
X
2
X
2
X
1
Palliative End-of-Life
Cardiovascular Services
Score
X*
X
Maternity
Population
Scan Identified
2
Infectious Diseases
Neurological Services
Within the
LHIN
Mandate
X
X
Note: Domains scored 4 and over will be subject to more detailed analysis (Data collected to date from the population scan and qualitative interviews points to the need to capture
Mental Health and Addictions)
*Injury and Poisoning
Analytical Framework
The data analysis will be conducted using the following framework,
covering all domains:
Population Scan
Comparative Peer
Reviewed Material and
Publications
Interviews and
Focus Groups
Quantitative
Scan
Data analysis examining the population of the
LHIN, growth patterns, as well as the health
status, risk factors, disease prevalence and
utilization
Data analysis using available reports and
publications, examining quantitative and
qualitative data (LHIN specific where possible)
Interviews and focus groups capturing
qualitative aspects to support quantitative
analysis
Quantitative data analysis using primary data
sources (e.g. DAD. NACRS etc.)
How the Data Analysis Translates
Analysis of the domains, subject to focused quantitative analysis, will provide the ability to
draw out multiple dimensions as shown by the sample below:
Women’s
Health
Cardiovascular Services
Cancer Services
Mental Health & Addictions
Children’s
Service
Ethnocultural
Supporting Analytical Concepts
Analytical Concepts cross all domains: These are the enablers and the foundational pieces that will be
analyzed to support the domains of interest as appropriate.
Analytical Concepts
System Coordination & Navigation
Health Human Resources
IM/IT
Diversity
Quality
Determinants of Health
Gender (e.g. Women's Health)
Lifespan (E.g. Children's Services)
LHIN Population Socio-Demographic Analysis
Overview of the Analytical Outcome
•
•
Overall Population Profile
Disease/Study Profile
•
Utilization / Actual Experience
•
•
•
Gaps (Expected vs. Actual)
Suggested Factors Affecting Gaps
Service Needs Assessment
•
Considerations
–
–
–
–
–
Who are they
Where do they live
Timeframe of analysis
What are the risk factors
Relative Risks vs. LHIN and Ontario
–
–
Patients & Cases - When available
Healthcare Provider Locations and Services (based on available data )
–
–
In LHIN / Out of LHIN
In Planning Area / Out of Planning Area – Referral and Flow
–
–
–
E.g. Suitability of Planning Areas in delivery of localized care
Areas for further quantitative analysis
Information deficits and gaps
Example: Quantitative Analysis on
Diabetes
•
Initial quantitative analysis has been completed on Diabetes
•
Method of analysis: Population approach using the 2006 Census and 2005 Canadian
Health Survey (CHS) with available Primary Data for Service Volume
•
Important health determinants for Diabetes (and across a number of disease groups)
are being calculated at a low geographic level & projected forward up to 10 years
•
Considering Canada and Ontario to isolate ‘determinants’
•
Modeling to create a Risk profile that considers ALL the important determinants
– Age, ethnicity, gender, income, education etc. at low geographic level
•
•
•
Central results to the Province and other LHINs – grouped minus the Central LHIN
Analysis will show if an area (ex. Planning Area) has a higher risk profile than the
Province/LHIN now & into the future – and to what degree
Validating model results with published studies as well as Primary Data for actual
experience
Diabetes: Central LHIN Hospitals - 2006/07 In-patient Catchment Area
12
Source: PHPDB for Hospital DAD 2006/07
Next Steps
Apr
M ay
Jun
Jul
Aug
Sep
Oct
Phase I:
1)
Start-up & Planning
2)
Data Collection , Analysis and
Stakeholder Input
(Identify Needs)
3) Analysis & Reporting
(Identify Gaps and M odels)
Phase II:
4)
Stakeholder Validation
Phase III:
5)
Finalize & Present Report
Advisory Committee
Review
Design
Apr 29
Progress
Report
M ay 19th
Progress
Report
Jul 21
Progress
Report
Aug 18
Progress
Report
Sept 22
Final
Report
Oct 20
APPENDIX 3.15
APPENDIX 4.1
APPENDIX 4.2
York Central Hospital
10 Trench Street
Richmond Hill, ON
Canada L4C 4Z3
Phone 905-883-1212
Fax 905-883-2455
www.yorkcentral.on.ca
June 4, 2008
by email: [email protected]
Kathryn Pagonis
Director, Provincial Programs Branch
Ministry of Health & Long-Term Care
5th Floor, 5700 Yonge Street
Toronto ON M2M 4K5
Dear Kathryn:
Please accept this letter as follow-up to our conversations with your team this week
regarding the status of our Vaughan Dialysis Satellite proposal. In response to a request
to work collaboratively with the Vaughan Health Campus of Care in the fall of 2007, we
signed a letter of intent to enter into a leasing arrangement with Vaughan with the support
of the MOHLTC and the Central LHIN. The deadline for lease execution in Vaughan
was June 1, 2008, and the landlord is requesting lease execution as soon as possible
(targeted date is Friday, June 6th). It is critical that we maintain a good relationship with
Vaughan; hence we would like to support their request.
We are seeking your advice and direction in order that we can move forward with this
process as soon as possible. I would add that your team and the team at Central LHIN
have been extremely supportive throughout this process, and I would like to formally
acknowledge your support.
Please call me at 905-883-2045 or 647-271-6644 (Blackberry) if you would like to
discuss further.
Regards,
Jo-anne Marr
Vice President, Programs
Copy to:
Bruce Harber, President & CEO, York Central Hospital
David Bannister, Chair, YCH Board
Hy Eliasoph, CEO, Central Local Health Integration Network
APPENDIX 4.3
FOR IMMEDIATE RELEASE
June 12, 2008
Stevenson Memorial Hospital Board
Announces New President and Chief Executive Officer
ALLISTON, ON. - The Board of Directors of Stevenson Memorial Hospital (SMH) announced today the
appointment of Gary Ryan as President and Chief Executive Officer Stevenson Memorial, effective
immediately. Mr. Ryan has served as interim-President and CEO since September of 2007.
“Gary Ryan has proven his commitment to Stevenson Memorial and our hospital’s continued role in
serving the needs of our community,” said Ted Vandevis, Board-designate Chair of the SMH Board. “His
service and accomplishments in working with the entire staff over the past eight months amounts to a
lengthy job interview. Our Board is very confident in Gary’s knowledge, abilities and style of leadership,”
he added.
Mr. Ryan will report to the Board. He will perform his duties as President and CEO on the basis of 2.5
days per week. His remaining time will be spent in his role as a Vice President at Southlake Regional
Health Centre (SRHC) with his services to SMH provided under the terms of a management services
contract.
Under the management services contract, SRHC will provide management and administration services to
SMH while recognizing that SMH shall maintain its separate governance and the SMH Board will
continue to ensure that the hospital is managed and administered according to the needs of the community
and the Public Hospitals Act. The agreement requires that the appointment of the President and CEO must
be approved by the Board of SMH.
“Ongoing collaboration and partnership between Stevenson Memorial Hospital and Southlake Regional
Health Centre is important to maximizing the resources we can bring to patients,” said Mark Rochon,
Supervisor at SMH. “Local Health Integration Networks expect to see a system-wide approach to health
care,” he added.
Mr. Rochon noted that other community hospitals in Ontario have made similar arrangements,
maintaining local governance while sharing resources with larger facilities, to improve services to the
community.
For the past 20 years of his career. Mr. Ryan has worked in health care administration at Southlake
Regional Health Centre, managing a diverse range of hospital departments. Mr. Ryan is currently the Vice
President for Acute Care, Rehabilitation and Complex Rehabilitation Services at Southlake Regional
Health Centre.
“I have enjoyed working with the team at Stevenson Memorial over the past months and look forward to
tackling the challenges that we face in the coming years,” said Mr. Ryan. “I have listened carefully to the
staff members and the community and want to work with everyone to ensure we deliver the best possible
clinical programs and also engage the system for services we need to share,” he added.
“This management services agreement will allow us to strengthen the relationship between the two
hospitals for higher quality outcomes and to ensure the most effective use of resources,” said Mr.
Vandevis. “By sharing administrative and support costs, we can devote more to the most important
priority of treating and healing patients,” he added.
-30 -
For further information contact:
Kathryn (Kate) Mooij
Community Relations Coordinator
Stevenson Memorial Hospital
(705) 435-3377 ext # 3254
APPENDIX 4.4
FOR IMMEDIATE RELEASE
June 12, 2008
Stevenson Memorial Hospital Receives Approval
For CT Scanner
ALLISTON, ON. - Stevenson Memorial Hospital (SMH) today announced that it has received
approval from the Ministry of Health and Long Term Care for the installation and operation of a
CT (CAT) scanner.
“SMH has a compelling case to have a CT scanner on site and we are delighted with the Ministry
approval,” said Gary Ryan, President and Chief Executive Officer of Stevenson Memorial
Hospital. “Our community is one of the fastest growing regions in Canada and it’s essential that
SMH, as a model community hospital, keeps pace with this growth and continues to deliver
quality health care to residents.”
The CT Scanner will cost the Hospital $1 million to acquire and approximately $2 million in
capital funds for construction to house the new state-of-the art technology. Capital funding for
both the scanner and the construction and installation costs has been planned for in the current
Capital Campaign of the SMH Foundation, “Here’s to Your Good Health.” The campaign has
been very successful with 70 per cent of its $5 million target already raised.
“Once the CT is operating on a full schedule, it will eventually eliminate the need for patients to
travel to Southlake Regional Health Centre or other facilities,” said SMH Board-designate Chair
Ted Vandevis. “This is an exciting milestone in the Hospital’s history. We applaud and thank our
community volunteers and the SMH Foundation for working so hard to help make this a reality.”
The goal is for the scanner to be installed and operational by April 2009. Initially operating
Monday to Friday from 8:00 a.m. to 4:00 p.m., it will have the capacity for 2,000 patients in its
first year. Emergency scans will be available after hours for head injuries. Currently, patients
requiring CT scans are transported by ambulance to other local facilities, the closest being over
50 kilometres away, with nurse accompaniment. In 2006/2007, about 350 SMH patients were
referred out for CT scans.
Installation plans for the CT scanner are currently being finalized, but the scanner will be located
in new space contiguous with the existing Diagnostic Imaging Department and the Emergency
Department.
- 30 For further information contact:
Kathryn (Kate) Mooij
Community Relations Coordinator
Stevenson Memorial Hospital
(705) 435-3377 ext # 3254
(Alliston) -
-30For further information contact:
Edward Takacs
President and CEO
Stevenson Memorial Hospital
(705) 435-6281
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APPENDIX 4.5
4......
York Central Hospital
10 Trench Street
Phone
905-883-1212
Richmond Hill, ON
Canada L4C 4Z3
www.yorkcentral.on.ca
Fax 905-883-2455
York Central"
Hospital
for better health care
for better health
May 28, 2008
Ms. Marilyn Desrosiers
Research Officer
Partnerships for Health System Improvement (PHSI)
Canadian Institutes of Health Research
Room 97, 160 Elgin Street
Address locator: 4809A
Ottawa, ON KIA OW9
Dear Ms. Marilyn Desrosiers:
Re:
Letter of Recommendation
CIHR Partnership Award!
Dr. Peter Tsasis, Assistant Professor, Faculty of Health, York University
Research Project: Developing a System Scorecardfor a Local Health Integrated
Network
The passing of the LHIN Act (2006) has ushered in a new focus on the coordination,
planning, integration, and financing of healthcare services. Although the LHINs have been
instrumental in taking the first steps towards these objectives, the system still needs to
make more progress on the coordination and integration of services. Although there are
some synergies in this direction between the hospitals, additional efforts are required as
well as the linkages between hospitals and the community services sector.
In terms of a system scorecard that will facilitate strategy development and execution, the
present situation is fragmented. There are some components in place, i.e., Accountability
Agreements (AAs) between the Ministry and the LHINs and AAs between the LHINS and
the provider organizations. What is lacking is a Provincial Strategy that should be
embedded in the AAs between government and LHINs. We are unsure of the status of
balanced scorecards (BSCs) within LHIN AAs. There are no performance management
templates to evaluate progress of the Integrated Health Services Plan (IHSP) with the
LHIN. While there is unanimous support for the development and implementation of
chronic disease management continuums, there are no mechanisms to horizontally
integrate/coordinate the relevant hospital and community-based services. Furthermore,
there is a need to create AAs and BSCs to support the continuums and achieve mutual
targets and outcomes. In addition, if there are any health status outcomes or inter-LHIN
activity, there are no mechanisms to create interdependent system scorecards with entities
outside the responsibility of the LHIN, i.e., Public Health, Family Health Team,
relationships with academic health science centres.
.../2
..
'-
Hospitals are in the process of signing off on the 2008-2010 Hospital Services
Accountability Agreements (H-SAA). Schedule B, Section 9, outlines LHIN-specific
performance obligations. The focus and emphasis of Schedule B is on collaborative
initiatives between the hospitals and the Central LHIN. One ofthe sections states that
"Hospitals, along with community organizations participate in the development of a LHIN
system-wide balanced scorecard to measure and report on system performance.".
Essentially, there will be three organizations responsible for moving the partnership
forward to ensure more effective health services, Le., York University, York Central
Hospital (YCH), and the Central LHIN. YCH is currently involved with York University
through a research collaborative spearheaded by Dr. Peter Tsasis at the Faculty of Health
and the Knowledge Mobilization Unit which involves a tri-partite partnership between
YCH, Town of Richmond Hill, and the York Region School Board. Furthermore, through
our committed and continued relationship York University and YCH maintain ongoing
communications with the Japanese Association of Hospitals using the BSC in terms of
lessons learned and comparative progress whereby its translation of knowledge can benefit
and be applied to our healthcare services.
It is hoped that by bringing the aforementioned health research communities together, our
central objective can be met; that is, to create a system scorecard that can be leveraged to
other LHIN jurisdictions (14 in total) for implementation.
cc: Dr. Peter Tsasis, Assistant Professor, Faculty of Health, York University
Hy Eliasoph, CEO, Central Local Health Integration Network
--
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APPENDIX 4.6
e-Health Update – June 10, 2008
Over the last several months, the Central and Toronto Central LHINs Joint e-Health Council have
developed a draft Joint e-Health Strategy that is currently being circulated within the Senior
Management Teams at both LHINs for feedback and advice. The Joint e-Health Strategy is the
product of merging and refreshing the previous LHIN e-Health Strategies and is informed by the
Provincial e-Health Strategy and priority projects.
The Joint e-Health Strategy is focused around four key priorities:
ƒ Support Implementation of Provincial e-Health Initiatives – which includes necessary
infrastructure such as registries, Ontario Lab Information System (OLIS), Drug Information
System (DIS), Wait Time Information System (WTIS), completing implementation of
Diagnostic Imaging /PACS, Panorama Public Health System, and Telemedicine.
o
Chronic disease management as the focus for improvement initiatives (beginning with
diabetes).
ƒ Improve the ability to Exchange Information across the Health System – including
initiatives such as the GTA-wide Health Information Access Layer (HIAL).
ƒ Improve the Care Process – through initiatives such as resource matching and referral
management.
ƒ Support Patient Participation in their Health Care – through initiatives such as Patient
Portals.
In addition to refining the Strategy based on feedback from the LHINs, next steps include the
development of a communication plan that will maximize exposure to the Strategy at the Health
Service Provider level, as well for the clients/patients of the Central and Toronto Central LHINs.
A full-time e-Health resource has been hired as the first-step in establishing a Joint e-Health
Program. The resource is the main point of contact for e-Health at the LHINs for day-to-day
business, reporting to the LHIN e-Health Leads for the Central and Toronto Central LHINs. As
further requirements are defined for each LHIN, a support model will be recommended to the
LHIN Senior Management Teams.
e-Health Project Updates: Connectivity and Secure Mail Projects
Connectivity – Smart Systems for Health Agency (SSHA) Network Refresh Project (NRP)
The Smart Systems for Health (SSHA) Network Refresh Project (NRP) will expand network
bandwidth to 24 sites in Central LHIN.
Deployment Status as of May 31st, 2008
◦
Vendor install – 13 out of 24 complete (54%)
◦
Migration – 7 out of 24 complete (29%)
Next Steps
Central LHIN sites will continue to be scheduled for Migration as the SSHA circuit becomes
ready.
Secure Mail Project (ONEMail)
The Secure e-Mail Project consists of rolling out the SSHA Secure Mail to 120 Central LHIN
health service providers, including hospitals, community support services, mental health and
addiction agencies and long term care facilities. Connection to the SSHA Network is a
prerequisite.
Deployment Status as of May 31st, 2008 (for Wave I and Wave II sites)
◦
12 sites are fully deployed on ONE Mail
◦
24 sites are in progress
◦
12 sites are on hold (either due to client resource constraints or due to circuit delays – client
has a pre-requisite need for SSHA network connection)
◦
2 sites are not interested in ONE Mail connection at this time
Next Steps
The Joint e-Health Office will begin to engage approximately 40 Wave III sites (Long-Term Care
facilities). The first step for interested sites is to attend an SSHA-led informaiotn session, which
will be scheduled for July 2008.
APPENDIX 5.1