item 3 - centrallhin.on.ca · 1.0 meeting called to order 1:00 mr. john langs 2.0...

BOARD OF DIRECTORS September 25, 2012

1:00pm- 3:00pm Vaughan Community Health Centre, 9401 Jane Street, Suite 206, Vaughan

AGENDA

1.0 MEETING CALLED TO ORDER 1:00 Mr. John Langs

2.0 NOTICE/RECOGNITION OF A QUORUM Mr. John Langs 2.1 Identify Invited Guests/Participants

3.0 APPROVAL OF AGENDA Mr. John Langs 3.1 Welcome Members of the Public

4.0 DECLARATION OF CONFLICTS OF INTEREST Mr. John Langs

5.0 REVIEW OF MINUTES Mr. John Langs

5.1 June 26, 2012

6.0 CHAIRMAN’S REPORT 1:15 Mr. John Langs 6.1 Ministry of Health Announcements 6.2 Joint LHIN Chair/CEO Meeting- September 20, 2012 6.3 LHIN Chair Meeting- September 20, 2012 6.4 Hospital/CCAC Chairs Meeting- September 13, 2012

7.0 CEO’S REPORT – ITEMS FOR APPROVAL 1:20 Ms. Kim Baker

7.1 Ministry Bundled Allocations 7.1.1 Post Construction Operating Plan Funding

7.2 LHIN Allocations 7.2.1 Community Sector Base Funding Increase

7.3 Accountability Agreements 7.3.1 2012-2013 Hospital Service Accountability Amending Agreements 7.3.2 Community Health Centres – In Year Revision of Performance Indicators

7.4 2010-13 Long-Term Care Service Accountability Agreement – Casa Verde 7.5 Memorandum of Understanding

8.0 CEO’S REPORT - ITEMS FOR INFORMATION 1:50 Ms. Kim Baker

8.1 E-Health Update Ms. Sophie Outar

9.0 REPORTS OF COMMITTEES 2:00 Mr. John Langs 9.1 Audit Committee Report Mr. John Rogers

9.1.1 Revised Audit Committee Membership 9.1.2 Revised Terms of Reference for Audit Committee 9.1.3 Whistleblower Policy

ITEM 3.0

of 2

10.0 OTHER BUSINESS (ADDED TO AGENDA) Mr. John Langs 11.0 FUTURE MEETINGS 2:15 Mr. John Langs

11.1 Board Meetings • October 30, 2012- 1pm-3pm- School of Thought, 100 Allstate Parkway, Markham

12.0 BOARD DEVELOPMENT & EDUCATION Mr. John Langs

12.1 Presentation- Primary Care and the Central LHIN Dr. David Kaplan 12.2 Presentation- Vaughan CHC Ms. Isabel Araya

13.0 MOTION MOVING INTO A CLOSED SESSION 3:00 Mr. John Langs 13.1 Review of Minutes

13.1.1 June 29, 2012 13.2 Business Arising

13.2.1 Health Service Provider Updates 13.3 New Business

13.3.1 2012-2013 Hospital Service Accountability Amending Agreements 13.4 For Information

13.4.1 Consultant Report 13.4.2 Community Sector Quarterly Performance 13.4.3 Hospital Sector Quarterly Performance 13.4.4 LSSO/LHINC 11/12 Financial Report 13.4.5 Board Member Nomination Process and Timelines 13.4.6 Board Development Day 13.4.7 Report on LHIIN Chairs/CEOs Workgroups

13.0 RECESS/PUBLIC DIALOGUE 3:00-3:30 Mr. John Langs 14.0 CHAIRMAN’S REPORT OF A CLOSED SESSION (IF REQUIRED) Mr. John Langs

15.0 MOTION OF TERMINATION 4:00 Mr. John Langs

** To follow

Central LHIN – CEO Report- Items for Information

Central LHIN Board of Directors Page 1 CEO Report –September 25, 2012

Table of Contents

1.0 CEO HIGHLIGHTS ..................................................................................................................................... 2

1.1 INTEGRATED HEALTH SERVICE PLAN 2013 - 2016 COMMUNITY ENGAGEMENT ................ 2

1.2 QUALITY ...................................................................................................................................................... 3

1.2.1 HEALTH QUALITY ONTARIO ........................................................................................................ 3

1.2.2 CENTRAL LHIN QUALITY COLLABORATIVE – IMPROVING FLOW IN THE EMERGENCY DEPARTMENT FOR MENTAL HEALTH AND ADDICTION SERVICES ...................................... 3

1.3 2012-13 MINISTRY-LHIN PERFORMANCE AGREEMENT (MLPA) TARGETS (APPENDIX A) 3

1.4 2010/12 MINISTRY-LHIN PERFORMANCE AGREEMENT STATUS REPORT (APPENDIX B)……………………………………………………………………………………………...3

1.5 LHIN PERFORMANCE INDICATORS- 2012/13 FIRST QUARTER UPDATE (APPENDIX C) ...... 4

1.6 COMMUNITY SECTOR COMPLIANCE PROCESS UPDATE ............................................................ 4

1.7 LONG-TERM CARE HOME SERVICE ACCOUNTABILITY AGREEMENT (L-SAA) PROCESS UPDATE ........................................................................................................................................................ 4

1.8 MULTI-SECTOR SERVICE ACCOUNTABILITY AGREEMENT (M-SAA) REFRESH PROCESS UPDATE ........................................................................................................................................................ 5

1.9 FUNDING ALLOCATION (APPENDIX D)……………………………………………………………..5 1.10 2011/12 YEAR END VOLUNTARY INTEGRATION STATUS REPORTS.......................................... 6

1.11 REGIONAL PALLIATIVE HOSPICE CARE PROGRAM UPDATE ................................................... 6

1.12 ASSISTED LIVING/SUPPORTING HOUSING SERVICES FUNDING UPDATE ............................. 7

1.13 COMPLIANCE DECLARATION (APPENDIX E) .................................................................................. 7

1.14 EHEALTH UPDATES ................................................................................................................................. 7

1.14.1 RESOURCE MATCHING & REFERRAL (RM&R)……………………………………………………..7

1.14.2 COMMUNITY SECTOR SCREENING TOOL…………………………………………………………….7

1.14.3 ONTARIO TELEMEDICINE NETWORK (APPENDIX F)…………………………………….………..7

1.15 BOARD DELEGATION APPROVALS…………………………………………………………………..8



1.0 CEO HIGHLIGHTS

1.1 Integrated Health Service Plan 2013 - 2016 Community Engagement The first phase of the community engagement supporting the development of the Central LHIN Integrated Health Service Plan (IHSP) 2013-2016 concluded at the start of September, 2012. This phase included targeted outreach to existing service provider partnerships, special populations, health experts and local leadership and the broader public/community. Through community engagement sessions, sustained media relations, the electronic distribution of material, and the help of local health service providers and municipalities Central LHIN reached over 1 million residents and over 184 representatives of Central LHIN health service providers and stakeholders. A robust evaluation process was developed and implemented to support the first phase of community engagement to document the feedback received. This included recording the feedback received in the individual engagement sessions, the dissemination of an IHSP survey to engagement session participants and the public, and a standing offer to receive written submissions from stakeholders. To date, 102 survey submissions were received from the general public, 70 completed surveys were received from health service providers, and 6 written submissions were received from health service providers or stakeholder groups. Overall, the feedback has been positive and supportive of the LHIN’s engagement process as well as the draft Strategic Framework, Vision, Strategic Principles and Strategic Priorities. Results and feedback through engagement with the public supported the importance of the following:

• Receiving major services such as cancer or stroke treatments a through regional provider that can offer up-to-date, specialized care;

• Receiving follow-up care with a family doctor, nurse practitioner or nurse within one week of discharge from the hospital;

• Improving the ease of navigating the health system; and • Expanding focus on creating a more integrated system, including better access to services and more

services offered in the community setting.

Feedback from health service providers and stakeholders included recommendations to focus on: • Addressing the needs of an aging population and supporting healthy aging; • Improving linkages with, and access to, primary care; • Improving collaboration between sectors and stakeholders including utilizing quality improvement methods

that spread leading practices and expertise across LHIN health service providers; • Addressing health prevention and promotion; and • Maintaining and enhancing recent Central LHIN initiatives and building on existing community sector

services to reduce ALC and avoid unnecessary ED visits.

The second phase of community engagement was launched in September, 2012, which includes specific requests to local health system representatives to review and provide feedback on the draft text of the IHSP. The outcomes of the second phase of this engagement will be incorporated into the final draft of the IHSP which will be presented to the Board for approval in November, 2012.

Quality/Stakeholder Engagement



1.2 Quality 1.2.1 Health Quality Ontario

In June, we reported that Health Quality Ontario (HQO) was launching its bestPATH initiative that will focus on improving the experience of care, health outcomes and system effectiveness through accessible and coordinated care for Ontarians with complex chronic illnesses. On September 6, 2012, HQO and the Ministry of Health and Long-Term Care made a joint presentation to Central LHIN and solicited our feedback on the development of bestPATH integrated communities to deliver care. The goal is to launch the integrated communities by January 2013. HQO was very interested in the collaborative initiatives already taking place within Central LHIN and we are well positioned to be involved in the first wave of implementation.

1.2.2 Central LHIN Quality Collaborative – Improving Flow in the Emergency Department for Mental Health and Addiction Services

In June we reported on the Quality Collaborative: Improving Flow in the Emergency Department for Mental Health and Addiction Services held at North York General Hospital. Central LHIN has shared the findings from the session with participants and posted the summary on the Central LHIN website. In addition, Central LHIN is leveraging its current structures to share the Collaborative’s findings. As a first step, Central LHIN will be leading a discussion at the September Central LHIN Chiefs of ED meeting to identify and encourage opportunities for implementation at Central LHIN hospitals.

1.3 2012-13 Ministry-LHIN Performance Agreement (MLPA) Targets (Appendix A) The current MLPA is being extended for one year and the Ministry and the LHIN are required to sign an amending agreement for 2012/13. This amending agreement states that the performance targets, financial allocations, and reporting requirements are to be established/updated for 2012/13. LHINs currently report on 15 MLPA indicators covering Alternate Level of Care/Emergency Room, surgical and diagnostic wait times, quality/Excellent Care for All, mental health and substance abuse, and access to community care. The eleven ALC/ED and wait time indicators have provincial targets as well as local LHIN targets, while the remaining indicators only have local LHIN targets. In August 2012, Central LHIN Management negotiated with the Ministry to arrive at the targets included in the appendices. The negotiations utilized the target setting approach discussed during the June 2012 LHIN CEO meeting. This approach takes into consideration the following:

• Continuing to demonstrate progress on the indicators in the MLPA; • Maintaining gains that have been achieved on specific indicators provincially or in specific LHINs; • Reducing the variation or gap in performance across the province, and • Focusing on the community sector and expected improvements while considering current performance.

1.4 2010/12 Ministry-LHIN Performance Agreement Status Report (Appendix B) The quarterly status report of the 2010-12 Ministry-LHIN Performance Agreement is included in the appendices.

System Accountability and Performance



1.5 LHIN Performance Indicators- 2012/13 First Quarter Update (Appendix C) In mid-August, Central LHIN received its first quarter performance results for about 30 indicators on the MLPA and Stocktake reports from the Ministry of Health/Access to Care. These indicators include emergency department wait times, alternate level of care days, surgical and diagnostic wait times, among others. For the second consecutive quarter, Central LHIN hospitals collectively have met all the LHIN-specific MLPA targets on surgical and diagnostic wait time indicators. Central LHIN was the only LHIN to accomplish this achievement. A review of the results (see summary results below) indicates that Central LHIN hospitals continue to hold the gains in achieving targets across most of the MLPA indicators. Of note: • 90th percentile wait times ranked second lowest in the province for three indicators (including, cataract, hip and

cancer) • There were a total of ten indicators for which results outperformed the LHIN target including:

• 90P ER LOS for Admitted Patients; • 90P ER LOS for Non-Admitted Minor Patients; • 90P Time for CCAC in-Home Services; • 90P Wait Time for Cancer Surgery; • 90P Wait Time for Cataract Surgery; • 90P Wait Time for Cardiac By-Pass Procedures; • 90P Wait Time for Hip Replacement; • 90P Wait Time for Knee Replacement; • 90P Wait Time for Diagnostic MRI Scan; • 90P Wait Time for Diagnostic CT Scan.

Further analysis is underway in preparation for a meeting with the Ministry on October 1, 2012. 1.6 Community Sector Compliance Process Update In September 2011, the Central LHIN Board reviewed the Draft Central LHIN Community Sector Compliance Process, and the final version was subsequently provided to all Community Sector health service providers. This process supplemented the “Draft Guidelines for Community Health Service Providers Audits and Reviews” provided by the Ministry, and outlined potential consequences as a result of non-compliance with the M-SAA. Non-compliance may include but is not limited to activity and financial performance, reporting requirements, and adherence to directives, guidelines and policies. As this was a new process and there are multiple performance targets, the LHIN set a compliance threshold of 60% achievement of performance targets within corridors. Expected compliance with balanced budgets and Ministry and LHIN guidelines and policies is 100% with no exceptions. The LHIN has worked with health service providers to correct situations of non-compliance and has shared learning across organizations to improve future compliance. As a result, the LHIN has increased the compliance threshold to 80% achievement of performance targets within corridors effective fiscal 2012/13. Expected compliance with balanced budgets and Ministry and LHIN guidelines and policies remains at 100%. 1.7 Long-Term Care Home Service Accountability Agreement (L-SAA) Process Update The current L-SAAs signed between the Central Local Health Integration Network (LHIN) and the long-term care home providers it funds will expire on March 31, 2013. A new process has been initiated with the long-term care sector to collaborate on the development of the next L-SAA effective April 1, 2013. The Provincial L-SAA Steering Committee has been established to support the development of the new L-SAA. The Steering Committee will be supported by two work groups, which will include sector representation. Similar to the prior accountability agreement process, long-term care health service providers will be required to submit a Long-Term Care Accountability Planning Submissions (LAPS) to facilitate the development of home-



specific details of the L-SAA. The LAPS will be due to the LHINs by November 15, 2012. LAPS Education sessions will be held to provide health service providers with the guidelines, user guides and supporting materials to complete the LAPS. LHIN staff provided an introduction to the new L-SAA and the proposed timelines to the long-term care sector in mid-August 2012. 1.8 Multi-Sector Service Accountability Agreement (M-SAA) Refresh Process Update The current M-SAA is a three year Agreement extending from 2011 to 2014. In the absence of definitive ministry funding targets in 2011, Health Service Providers (HSPs) completed the Community Accountability Planning Submission (CAPS) based on a planning assumption of a 0% base adjustment for the first two years of the Agreement. Year 3 of the M-SAA was marked “TBD” in anticipation of further information on planning targets from the Ministry. M-SAA Schedules need to be refreshed to update the planning assumptions, financial and service information and performance expectations for Year 3 (2013-14) of the current M-SAA. The Provincial M-SAA Steering Committee met on July 18th, 2012 to support consistency in the Year 3 amendment process and to ensure a common approach to updating the Agreement. The following principles were agreed:

• Based on current fiscal restraints, Year 3 of the M-SAA will maintain a planning assumption of a 0% base adjustment across the sector.

• When definitive information on funding is provided by the Ministry, the M-SAA could be refreshed at that time if a LHIN plans to increase an HSP’s base budget.

• A coordinated and simplified process will be established to minimize administrative requirements and promote efficiencies when amending the Agreements.

Key Steps and proposed timelines related to the Year 3 Amendment process are listed below:

• Mid Oct – Launch of the M-SAA Year 3 Amendment Process. Year 3 amendment and educational materials will be provided by the LHINs to HSPs.

• Nov 30 – Submissions due. Completed amendment materials submitted by the HSPs to LHINs reflecting current base budget allocations and target service levels.

• Dec 1 to Jan 31 – Local consultations between LHINs and HSPs to finalize the Year 3 Amendment for HSP Boards sign off.

• Jan 31 – M-SAA Year 3 Amendments signed. All M-SAAs are due to LHINs with HSP Board sign-off by January 31, 2013.

• April 1 – Year 3 of the current 2011-14 M-SAA will come into effect on April 1, 2013. 1.9 Funding Allocations (Appendix D) Hospital Municipal Tax Grants Each Year the Ministry of Health and Long-Term Care provides a funding adjustment to compensate public hospitals for municipal taxes they have paid. This funding is calculated at the rate of $75 per Rated Bed. Based on this calculation, the LHIN was allocated $252,300 for 2012/13 to flow to the hospitals. Long Term Care Sector Funding Changes In June the LHIN provided to the Board information regarding the impact of the revised co-payment and per diem rate increases communicated by the Ministry effective July 1, 2012 on LHIN created interim and convalescent care beds. The Ministry has subsequently informed the LHIN of the following increases: Effective April 1, 2012

• A 1% increase to Nursing and Personal Care (NPC) and Program and Support Services (PSS) for Interim Beds.



• A 1% increase in the Convalescent Care Additional Subsidy which is comprised of Nursing and Personal Care, Program and Support Services and Other Accommodation envelopes.

Effective July 1, 2012 • Convert the 2011-2012 one-time funding to base funding for interim and convalescent care beds in order to

cover inflationary increases for meal and accommodation costs. This was originally set to expire on June 30, 2012.

Details on the additional funding amounts for LHIN created interim and convalescent care beds is included in the appendix.

1.10 2011/12 Year End Voluntary Integration Status Reports Central LHIN regularly monitors outcomes and the status of health system integrations undertaken per the Local Health System Integration Act, 2006, by requiring health service providers to submit ongoing reports. Central received year-end status reports from: Alliance Hospice and Better Living Health and Community Services, the Central LHIN Eye Care Committee, Stevenson Memorial Hospital and Matthews House Hospice, and York West Active Living Centre and St. Clair Services for Seniors. Central LHIN staff have reviewed the integration reports, key outcomes include:

• The first year of the Better Living Health and Community Services and Alliance Hospice integration resulted in an additional 33 visiting hospice clients, 185 transportation clients and 339 case management clients; approximately $19,000 in reinvested cost efficiencies; and an integrated client database.

• The Regional Ophthalmology integration resulted in a 13% decrease for 90th percentile wait-times for cataract surgery in Central LHIN since May, 2011, increased efficiencies including a 47% decrease in patient-turnover time at North York General Hospital, and increased quality through the implementation of ophthalmology specific quality improvement plans that have resulted in 100% positive patient satisfaction scores at both sites in 2011/12.

• The Stevenson Memorial Hospital and Matthews House Hospice integration increased reporting efficiency and effectiveness with respect to performance and financial information to the LHIN.

• The York West Active Living Centre and St. Clair Services for Seniors integration resulted in the delivery of congregate dining services for an additional 157 clients and foot care services for 17 additional clients.

These positive results are supportive of the LHINs past and continued efforts to encourage local health service providers to identify opportunities for collaboration and partnership. Staff will continue to monitor the outcomes and status of Central LHIN integrations related to their anticipated outcomes (access, effectiveness, quality and coordination), and will share additional findings regarding integration results in future CEO reports as they become available. 1.11 Regional Palliative Hospice Care Program Update In June 2012, an expression of interest was posted, followed by a request for proposals for an Operational Lead Agency to lead Central LHIN’s Regional Palliative Hospice Care Program. The role of the Operational Lead Agency will be to leverage the work completed by the Central Hospice Palliative Care Network to build a regional hospice palliative program as presented to the Central LHIN Board of Directors on June 26, 2012. This follows the release of a document entitled “Declaration of Partnership and Commitment to Action” in December 2011. A key deliverable of this report is to restructure services to reflect a regional palliative program, where resources are standardized and coordinated at the regional level. Following the evaluation of the expression of interest and request for proposals, Central CCAC was identified as the successful proponent to lead the development of a Regional

Other Updates



Palliative Hospice Care Program in the Central LHIN by March 31, 2015. Staff are working on the detailed financial review and confirmation of the deliverables and performance metrics with the Central CCAC. 1.12 Assisted Living/Supporting Housing Services Funding Update In June 2012, Central LHIN released a request for pre-proposals from eligible community service providers to expand on existing services to address the following targeted priorities: assisted living services for high risk seniors, transitional/short-term assisted living services for individuals with mental illness and addictions, and cluster/congregate care for younger adults with complex medical needs. Staff conducted a review of the twenty-two submitted pre-proposals using Expert Choice and have invited seven organizations to submit Health System Improvement Plans by September 28, 2012. Final funding allocations will be shared with the Central LHIN Board of Directors. Launch is targeted for December 2012. 1.13 Compliance Declaration (Appendix E) The Compliance Declaration for September 2012 is included in the appendices. 1.14 eHealth Updates 1.14.1 Resource Matching & Referral (RM&R) In July 2012 Central LHIN went live with an expansion of electronic resource matching and referral. Electronic referrals for rehabilitation inpatient services can now be sent directly from acute care hospitals in Central LHIN to rehab hospitals in Toronto Central LHIN. Both LHINs share a common electronic solution which allows for seamless matching of patient requirements with available hospital resources. This is anticipated to enable quicker access to the appropriate level of care for Central LHIN patients. 1.14.2 Community Sector Patient Screening Tool Central LHIN will begin deployment of a standardized assessment tool to be used in the Community sector in October 2012. This tool will allow clients to be pre-screened to determine if a comprehensive assessment is required. In the case where no further assessment is necessary, the results of the pre-screening will be used to determine the appropriate support services for the client. Benefits to the client resulting from implementing this client-focused common assessment tool include:

- common language among health service providers involved in the client’s care and - reduced need to ask the client for the same information multiple times

The initiative is targeted to be completed by March 31, 2013. 1.14.3 Ontario Telemedicine Network During the first quarter of fiscal 2012/13, Ontario Telemedicine Network hosting in Central LHIN has increased by over 100%, with clinical hosting increasing by over 200%. Central LHIN’s usage of Ontario Telemedicine Network as a participant was the highest in the province. Psychiatry and Mental Health services account for 91% of Central LHIN’s Telemedicine activity, which is above the provincial average of 73%. Details of Central LHIN’s Ontario Telemedicine Network utilization are included in the appendices (Appendix F).



1.15 Board Delegation Approvals In the absence of a Board meeting the Board Chair approved the following: Central LHIN Annual Submission on the Use of Consultants LHINs are required under the Broader Public Sector Accountability Act to submit to the Ministry an annual report on the use of consultants. The Audit Committee reviewed Central LHIN’s report on consultant use for the period April 1, 2011 to March 31, 2012 and recommended that the report be approved for submission to the Ministry.

Behavioural Supports Ontario On August 17, 2012, the Central LHIN Board of Directors approved funding Cummer Lodge for 16 Specialty Behavioural Support Beds as an enhanced program under the Behavioural Supports Ontario initiative. This funding is not contingent on receiving designation from the Ministry of Health and Long-term Care as a Specialty Unit. In accordance with the Central LHIN Board of Directors approval to delegate authority to the Chair in the absence of a July and August 2012 Board Meeting, the permanent funding for the 16 Specialty Behavioural Support Bed Pilot through Behavioural Supports Ontario was disbursed to Cummer Lodge. The Aging at Home funding of $398,538 for the pilot project will be recovered.

11/12 Baseline

11/12 Target

11/12 FY Result and

12/13 Baseline

(See notes)

Result Most Recent Quarter

Available

12/13 Target

Emergency Room/Alternate Level of Care

Percentage of ALC days 1 9.46 16.10% 13.01% 15.64% 17.52% 15.00%

90th Percentile ER length of stay for admitted patients 2 8 hrsProvincial

Interim Goal: 25 hrs

44.28 36 40.75 44.97 36

90th percentile ER length of stay for non-admitted complex

patients 2Provincial

Interim Goal: 7 hrs

7.83 7.83 7.42 7.57 7

90th percentile ER length of stay for non-admitted minor/

uncomplicated patients 24 hrs 3.9 3.9 3.73 3.87 4

Surgical Wait Times

90th percentile wait times for Cancer Surgery 2 84 46 47 41 38 47

90th percentile wait times for Cardiac By-Pass Procedures 2 182 64 63 55 40 63

90th percentile wait times for Cataract Surgery 2 182 102 102 80 80 100

90th percentile wait times for Hip Replacement Surgery 2 182 150 139 141 131 139

90th percentile wait times for Knee Replacement Surgery 2 182 162 154 160 150 154Diagnostic Wait Times

90th percentile wait times for Diagnostic MRI Scan 2 28 147 112 102 66 90

90th percentile wait times for Diagnostic CT Scan 2 28 37 34 30 26 30

Excellent Care for All/Quality

Readmission within 30 Days for Selected Case Mix Groups

(CMGs) 3TBD 15.19% 14.40% 15.13% 16.14% 15.00%

Mental Health and Substance Abuse

Repeat Unscheduled Emergency Visits within 30 Days for

Mental Health Conditions 3TBD 17.90% 17.00% 17.11% 17.68% 17.00%

Repeat Unscheduled Emergency Visits within 30 Days for

Substance Abuse Conditions 3TBD 20.70% 19.70% 18.88% 20.53% 18.70%

Access to Community Care

90th Percentile Wait Time from Community for CCAC In-Home Services – Application from Community Setting to first CCAC

Service (excluding case management) 1

TBD 39 37.1 25 23 27

3 Baseline based on most recent 4 Quarters of data (Q3 10/11 to Q2 11/12)

Confirming of 2012/13 Targets for Central LHIN

Indicator Provincial Target

1 Baseline based on most recent 4 Quarters of data (Q4 10/11 to Q3 11/12)2 Baseline based on FY 11/12 result

LHIN

MatthewsT

Typewritten Text

Appendix A

2010/12 Ministry-LHIN Performance Agreement

Part One: Status Update

The 2010/12 Ministry-LHIN Performance Agreement was signed on July 25, 2011. Although the 2012-13 fiscal year has commenced, the Central LHIN and MOHLTC are currently operating under last year’s Agreement. Both parties are fulfilling their obligations under this agreement.

Part Two: Summary of Obligations

This section summarizes the mutual obligations of the Ministry and the Central LHIN that are subject to periodic/ongoing action.

Schedule 1: General # MOHLTC LHIN Status

Government Priorities and Provincial Strategies 1.1 - Establish priorities and develop provincial

strategies to support these priorities and determine any specifications and conditions of LHIN funding.

- Work with the MOHLTC and health service providers to achieve government priorities and implement provincial strategies

Ongoing Key Enablers: - Wait Times Strategic Planning Group - eHealth Steering Committee - Primary Care Action Group

Consistency 1.2 - Identify issues and initiatives requiring

consistency across LHINs and develop principles and parameters for policies and procedures.

- Develop and implement procedures and practices based on MOHLTC criteria and work with other LHINs to identify issues and initiatives requiring consistency not otherwise addressed by the MOHLTC.

Ongoing Key Enablers: - Whistleblower Policy - Cash Advance Policy - Capital Policy - Board per diem Policy

Local Health System Coordination and Integration 1.3 n/a - Develop, implement and monitor achievement of

Integrated Health Service Plan (IHSP). - Work with health service providers and other LHINs to improve governance, coordination and integration of health care delivery between and among LHINs - Optimize and utilize capacity of CCAC

Ongoing

Appendix B

Community Engagement 1.4

n/a

- Regularly review community engagement activities/strategies to align with best practices - Engage local planning entities as prescribed under LHSIA - Report on activities and performance measurement results in the Annual Report

Ongoing

1.5 - Develop guidelines for community engagement including principles, best practices, and performance indicators to measure the effectiveness of LHIN community engagement strategies - Publicly post performance indicators for community engagement and the performance measurement results by LHIN on the MOHLTC and LHIN websites.

Ongoing Key Enabler: - Health Service Provider Community Engagement Guiding Principles and Checklist.

Information Management

1.6 - Develop and communicate data standards, data quality definitions, and reporting timelines

- Require health service providers to submit data and information to the MOHLTC, Canadian Institute for Health Informatics or other third parties under the terms of Accountability Agreements.

- Hospital and Community Sector Agreements completed - Long-Term Care sector is in progress

1.7 - In collaboration with the LHIN, identify LHIN data/information requirements to support data infrastructure for LHIN operational needs

- Identify LHIN data/information requirements to support LHIN analysis at the local level and work with the MOHLTC to develop appropriate methodology, consistent data analysis and reporting

Current activity includes data under pinning Health System Funding Reform (HSFR)and High Users

1.8 - Receive data and information from health service providers on behalf of the LHIN and provide timely access to the appropriate data to support health system needs

- Work with health service providers to improve data quality and timeliness as necessary.

Ongoing Key Enablers: - Review of HSFR data

1.9 - Work with LHINs to create a forum to identify, discuss and propose strategies to address data and information gaps, information and decision support requirements, standards and data quality issues.

n/a

Current activity has focused on HSFR communications including face to face meetings, Ask the Expert and webinars

1.10 - Avoid duplicating data and information management infrastructure and processes, determine and prioritize data and information products, and streamline reporting requirements and timelines for the LHIN and health service providers

Ongoing Current activity has focused on aligning new initiative indicators with existing service accountability agreements.

Compliance Protocols

1.11 - Will retain its compliance, inspection and enforcement authorities under legislation;

- Conduct or commission audits and reviews of health service providers as necessary , including financial and performance audits of long-term care homes

Ongoing

1.12 - Consult the LHIN as appropriate when considering the following for a health service provider: appointing an investigator or supervisor; ordering suspension of activity or closure, revoking licenses

- Inform the MOHLTC of health service provider non-compliance and the results of any audit or review conducted by or commissioned by the LHIN.

Ongoing

1.13 - Authority for licensing, approving, inspecting and enforcing long-term care home legislation including inspecting operators for compliance. Will inform the LHIN of any compliance issues

- Inform the MOHLTC of a long-term care home operator experiencing financial issues that may cause non-compliance, or any instances of non-compliance with long-term care home legislation.

No activity

1.14 - Develop guidelines for the LHINs on conducting audits, inspections, and reviews of health service providers

Completed

eHealth 1.15 Provide the LHIN with:

- provincial strategic directions and priorities for eHealth, and seek input; - funding as recommended by eHealth Ontario

- Provide input to the MOHLTC and eHealth Ontario -Prepare an annual LHIN eHealth plan that aligns with the provincial eHealth priorities and strategic directions; - Report on eHealth initiatives in the LHIN annual report; - Use funding to implement the specific approved eHealth initiatives

Ongoing Key Enablers: - Central LHIN eHealth Steering Committee - creation of Central Ontario Electronic Health Cluster

1.16 - Develop and implement polices required for the implementation and/or operation of specific eHealth initiatives

n/a Ongoing

1.17 - Set technical and information management standards, including architecture, technology, privacy and security, and, in consultation with the LHIN, implementation / compliance timeframes.

- Include eHealth commitments in service accountability agreements with health service providers

Accountability Agreements for hospitals include eHealth related requirements

1.18 - Work together and in conjunction with eHealth Ontario as appropriate to: (a) Participate in provincial discussions of eHealth issues to identify options to support the roll out of eHealth initiatives (b) Inform one another of significant issues or initiatives that contribute to or impact on provincial or local eHealth issues, strategies or work plans

Ongoing

Capital – General Provisions 1.19 - Consider recommendations from the LHIN about

the capital needs of the local health system. - Make recommendations to the MOHLTC about the capital needs of the local health system.

Ongoing

1.20 - Work together to implement the jointly developed capital planning framework for the early capital planning stages (Pre-capital, Proposal and Functional Program).

Ongoing

Capital Initiatives 1.21 - Review a health service provider’s Pre-Capital

Proposal, and Functional Program submissions related to physical and cost elements, and provide approval for a Health Service Provider to move to the next stage of planning.

- Provide recommendations on the program and service elements upon review of a health service provider’s Pre-Capital, Proposal and Functional Program submission.

Ongoing Current activity includes Mackenzie Health’s Vaughan site

1.22 - Work together to ensure local and provincial program alignment as well as alignment between the programs and services, and physical and cost elements, of a health service provider’s submission at the early planning stages.

Ongoing

Own-Funds Capital Projects 1.23 - Enable the LHIN to provide advice about the consistency of a public hospital’s Own-Funds Capital Project

with local health system needs during review and approval processes, including Pre-Capital, Proposal, and Functional Program stages

Ongoing

Health Infrastructure Renewal Fund (HIRF) and Post-Construction Operating Plan (PCOP)

1.24 -Determine the amount of the Dedicated Funding Envelope and conditions of such funding

- Provide funding to public hospitals in accordance with the conditions and incorporate any conditions of the funding into service accountability agreements.

- HIRF information is not provided in time from the Ministry to include in Service Accountability Agreements - Conducting annual review of PCOP submissions

Emergency Management

1.25 - Develop guidelines and/or protocols clarifying roles and responsibilities related to emergency management.

Ongoing

General Performance Obligations 1.26 - Provide the LHIN with, and develop provincial

standards, directives and guidelines that apply to health service providers, including providing the LHIN with relevant program manuals.

- Provide a Certificate of Compliance to the MOHLTC of its compliance with applicable: legislation; provincial policies; standards; operating manuals; directives; and guidelines - Carry out Ministry obligations in any agreements assigned to the LHIN - Require health service providers to provide services funded by the LHIN in accordance with applicable legislation; directives; and guidelines including Broader Public Sector Accountability Act compliance attestations.

Ongoing The process is outlined in the Broader Public Sector Accountability Act.

Annual Review and Update 1.27 - The Schedules in this agreement will be reviewed and updated annually, as necessary to better reflect the

Primary Purpose, within 120 days of a budget announcement of the Government of Ontario: In progress

Schedule 2: Local Health System Program Specific Management

# MOHLTC Obligation CLHIN Requirement Status Provincial Programs

2.1 - Determine provincial programs and communicate these to the LHINs.

- Work with the MOHLTC in the rollout of new programs as required.

Ongoing Current activity includes the Behavioural Supports Ontario Initiative and new CCAC

nursing positions

2.2 - Determine any specifications and conditions of funding, including a dedicated funding envelope

- Monitor the local delivery of provincial programs and report to the MOHLTC.

Ongoing

2.3 - Establish criteria to assess and review provincial programs; define roles and responsibilities related to delivery; develop performance management, monitoring and evaluation processes.

- Work with other LHINs to coordinate provincial program service delivery

Ongoing Current activity includes the Behavioural Supports Ontario Initiative

Long-Term Care Homes (LTCH) – Total Funding per Diem 2.4 - Determine funding policies

- Provide funding to the operators for each approved or licensed bed

Ongoing Key Enabler: - Long-Term Care Home Service Accountability Agreements

2.5 - Determine any net projected unused funding for all LHINs and allocate a share of unused funding remaining.

- Require LTCH operators to provide information for the reconciliation of long-term care funding

- No Activity by LHIN - Ministry process is ongoing

LTC Homes - Construction Funding Subsidy (CFS) 2.6 - Determine the per diem and the homes that will receive the

per diem, including any conditions of funding. - Provide funding to operators for each approved or licensed bed.

No activity

LTC Homes – Assignment of LTC Service Agreement 2.7 - Request the LHIN to consent to an assignment of the

service agreement, to the Lender or person designated by the Lender, where provided in an Acknowledgement and Consent Agreement or Development Agreement.

- Consent to the assignment of the L-SAA as requested by the MOHLTC, subject to terms and conditions similar to those of either the ACA or Development Agreement

No current activity.

Long-Term Care (LTC) Homes - Beds in Abeyance 2.8 - Approve Beds in Abeyance applications with LHIN

recommendation - Make recommendations to MOHLTC on Beds in Abeyance Applications

In Progress. One Long-Term Care Home request under review.

2.9 - Review and approve LHIN request to temporarily use Bed in Abeyance funding

- May request approval from the MOHLTC to temporarily use the amount of funding available as a result of any approved Beds in Abeyance .

One request in progress.

LTC Homes - Short-Stay Respite 2.10 - Determine the minimum threshold for occupancy for short-

stay respite beds - Take action to improve the utilization of short stay beds - May set a threshold for occupancy of short-stay beds that is higher than the minimum set by the MOHLTC - Determine the operators that will provide short-stay beds and the number of beds

Completed for fiscal 2012.

LTC Homes - Convalescent Care Beds 2.11 - Determine a Dedicated Funding Envelope for Convalescent

Care Beds and set conditions of funding - In consultation with the LHIN, determine the number of beds to be funded and the LTC homes that will provide them

- Use the Dedicated Funding Envelope to fund LTC home operators

Ongoing Key Enabler: - Long-Term Care Home Service Accountability Agreements

2.12 - Provide a pre-occupancy review of the LTC home prior to additional LHIN funding

- Determine whether to fund operators for additional beds, including the number of beds, outside of the Dedicated Funding Envelope using the LHIN’s allocation, not to exceed the number of beds licensed or approved by the MOHLTC

Ongoing

LTC Homes - Interim Beds 2.13 - Determine the Dedicated Funding Envelope for the

number of Interim Beds that were funded through the envelope as of March 31, 2008; and set conditions of funding

- In consultation with the LHIN, determine annually the operators of these beds.

- Use the Dedicated Funding Envelope for Interim Beds, and incorporate any conditions of funding into L-SAAs

Completed for fiscal 2012.

2.14 - Provide approval to LHIN to increase the approved or licensed bed capacity at an LTC home or approve a new LTC home for Interim Beds outside of the Dedicated Funding Envelope.

- May fund LTC home operators with Ministry approval, for additional Interim Beds that are not funded through the Dedicated Funding Envelope with LHIN funding.

Ongoing. -Interim beds are funded by the LHIN in two facilities.

2.15 - Manage and fund LTC Homes directly for the following LTC programs: Municipal Tax Allowance Fund; Rate Reduction Program; Exceptional Circumstances Funding; High Intensity Needs Fund & Lab Cost; Occupancy Based Funding; Pay Equity Program; High Wage Transition Fund

n/a Completed

Community Health Centres 2.16 - Determine the Dedicated Funding Envelope for the

provision of services to uninsured persons - Use the Dedicated Funding Envelope to fund as advised

Ongoing Key Enabler: - Multi-Sector Service Accountability Agreements.

Community Mental Health 2.17 - Determine the Dedicated Funding Envelope for programs

and services and advise the LHIN of parameters, provincial strategies and interests for Community Mental Health.

- Use the Dedicated funding envelope to fund health service providers

Ongoing Key Enabler: - Multi-Sector Service Accountability Agreements

2.18 - Advise the LHIN of parameters for the following services: Crisis, Case Coordination/Management, Supportive Housing, Functional Rehabilitation, and Treatment.

- Fund health service providers


2.19 - Advise the LHIN of the number and type of forensic mental health beds and the designated hospitals if applicable.

- Require designated hospitals to provide the number and type of Forensic Mental Health beds as determined by the MOHLTC and discuss any changes to service delivery or service levels with the MOHLTC

Not applicable

2.20

n/a

- Maintain or increase the number of Assertive Community Treatment Teams at or above 2006/07 levels; maintain the level of Supportive Housing – Support Services funded by the LHIN; require hospitals, as designated by the MOHLTC, to provide Schedule 1-5 services under the Mental Health Act at least at the service levels provided in 2006-2007.

Completed

2.21 - Work with each other and the Eating Disorder Network to allocate any new funding No Activity

2.22 - Review funding parameters annually Ongoing

Addictions 2.23 Determine the Dedicated Funding Envelope for:

i) Problem Gambling Treatment Services ii) Programs for pregnant women with addictions funded

through the federal Early Childhood Development Initiative

- Use the Dedicated Funding Envelopes for the services - Fund the provision by health service providers of:

i) withdrawal management ii) counseling, treatment and support

services iii) methadone case management (at

2006/07 level) iv) supportive housing for People with

Problematic Substance Use


Community Care Access Centres 2.24 - Determine the Dedicated Funding Envelope for

children/youth in Private and Home Schools for School Health Support Services

- Use the Dedicated Funding Envelopes of which it is advised - Advise the MOHLTC if additional funding is required for School Health Support Services

Ongoing Key Enabler: - Multi-Sector Service Accountability Agreements - Monitoring of wait lists

Compensation under Specified Initiatives / Agreements 2.25 - Determine the Dedicated Funding Envelope for

compensation and benefits under specific initiatives or agreements for persons who are paid directly by health service providers for the provision of health services.

- Require health service providers to use the Dedicated Funding Envelope for the compensation and benefits for those identified


Ministry-Managed Programs 2.26 - Seek LHIN input and advice on these programs and

services where appropriate - Advise the LHIN of material changes to these programs and services

n/a No activity

Schedule 3: Funding and Allocations

# MOHLTC Obligation CLHIN Requirement Status 3.1 - Provide the LHIN with its allocation of funding for current

fiscal year, and funding targets for the next fiscal year if available - Provide the LHIN with a list of Dedicated Funding Envelopes for the current fiscal year

- Allocate funding in accordance with the LHSIA, theAnnual Business Plan and this Agreement.

Ongoing

3.2

n/a

- Plan for balanced operations and transfer payment budgets, and require health service providers to achieve a balanced budget

Ongoing Key Enabler: - Condition included in Service Accountability Agreements with Hospital and Community Sectors.

3.3 - Develop and issue policies, directives and guidelines related to financial management

- Comply with MOHLTC financial management policies and directives.

Ongoing

3.4 - Issue interpretations and modifications relating to Public Sector Accounting Board (PSAB) standards, based on advice from the Office of the Provincial Controller.

- Prepare financial reports and statements on Operating and Transfer Payment Budgets, including the Annual Business Plan, based on the Public Sector Accounting Board (PSAB) standards, subject to modifications and interpretations issued by the MOHLTC. - Maintain documentation to support all financial statements and related payment instructions.

Ongoing

3.5 - Maintain a Chart of Accounts for LHINs that is interoperable between all LHINs and the Ongoing

MOHLTC

Schedule 4: Local Health System Performance

# MOHLTC Obligation CLHIN Requirement Status 4.1

n/a

- Measure and improve performance at the local level through service accountability agreements with health service providers.

Ongoing Key Enabler: - Regular review and follow-up of performance with health service providers.

4.2 - Provide LHIN with calculated results for the indicators included in the agreement quarterly - Provide the LHIN with technical documentation on the performance indicators

- Work to achieve the LHIN’s performance targets for the performance indicators, and report quarterly on performance as well as in the Annual Report

Ongoing Key Enabler: Stocktake Report

Schedule 5: Integrated Reporting # MOHLTC Obligation CLHIN Requirement Status

5.1 - Provide necessary training, instructions, materials, templates, forms, and guidelines to the LHINs to assist with the completion of reports

n/a Ongoing

5.2 - Develop reporting requirements relating to government priorities n/a

Ongoing

5.3 - Provide data on the performance indicators as set out in Schedule 4: Local Health System Performance (above) n/a

Ongoing

5.4 - Work together to ensure a timely flow of information to fulfill the reporting requirements of both parties Ongoing

5.5 - Respond in a timely manner to requests for information and access to records of one another, to fulfill the reporting and other obligations of the parties.

Ongoing

5.6 - Jointly evaluate the reporting processes each year, and recommend process and content improvements. No activity

5.7 - Finalize the Annual Business Plan within 120 days of a budget announcement by the Government of Ontario as part of the annual review

Completed

Performance Indicators: NOTE: Performance against targets will be reported through the Stocktake Report.

Indicator Target 90th Percentile Wait Times for Cancer Surgery 47 days 90th Percentile Wait Times for Cardiac By-Pass Procedures 63 days 90th Percentile Wait Times for Cataract Surgery 100 days 90th Percentile Wait Times for Knee Replacement 154 days 90th Percentile for Hip Replacement 139 days 90th Percentile Wait Times for Diagnostic MRI Scan 90 days 90th Percentile Wait Times for Diagnostic CT Scan 30 days Percentage of Alternate Level of Care (ALC) Days 15% 90th Percentile ER Length of Stay for Admitted Patients 36 hours 90th Percentile ER Length of Stay for Non-Admitted Complex (CTAS I-III) Patients 7 hours 90th Percentile ER Length of Stay for Non-Admitted Minor Uncomplicated (CTAS IV-V) Patients

4 hours

Repeat Unscheduled Emergency Visits within 30 Days for Mental Health Conditions 17% Repeat Unscheduled Emergency Visits within 30 Days for Substance Abuse Conditions

18.7%

Readmission within 30 Days for Selected CMGs 15% 90th Percentile Wait Time for CCAC In-Home Services – Application from Community Setting to first CCAC Service (excluding case management)

27

Stocktake Category IndicatorsMLPA

indicator? Target

C LHIN

Performance

ONT

Performance

Better than

ONT?

90P ER LOS for Admitted Patients (Q1 12/13) 36 33.9 28.38

90P ER LOS for Non‐Admitted Complex Patients (Q1 12/13) 7.0 7.5 7.23

90P ER LOS for Non‐Admitted Minor/Uncomplicated Patients (Q1 12/13) 4.0 3.8 4.17

90P Time to Inpatient Bed (Decision to Admit to Left ER) (Q1 12/13)* TBD * 26.6 22.0

90P Time to Physician Initial Assessment (Q1 12/13) No Target3.0 ‐ Improved

from Baseline3.4

Percent positive rating to the patient satisfaction survey question: “Overall,

how would you rate the care you received in the Emergency Department” No Target

80% ‐ Improved

from BaselineN/A

Number of ER Unscheduled Visits by quarter per 1000 population (Q3

11/12)No Target Baseline N/A N/A

NLOT ‐ Unscheduled ER visits/1,000 active LTC residents ‐ High Acuity **

(Q4 11/12)No Target**

190 ‐ Improved

from BaselineN/A

NLOT ‐ Unscheduled ER visits/1,000 active LTC residents ‐ Low Acuity **

(Q4 11/12)No Target**

15 ‐ Improved

from BaselineN/A

NLOT ‐ # of Unscheduled ER Visits/1,000 active LTC residents resulting in an

inpatient admission ** (Q4 11/12)No Target**

101 ‐ Within 10%

of BaselineN/A

Percentage ALC Days (Q4 11/12) 15 16.77 14.44%

90P Time for CCAC In‐Home Services ‐ Application from Community Setting

to first CCAC Service (excluding case management) (Q4 11/12)27 23 36

Number of Days from ALC designation to discharge by discharge destination

(Q1 12/13)No Target Baseline N/A N/A

Central LHIN ‐ Stocktake Performance Summary ‐ August 2012

Increase ER

Capacity/Performance

Improve Bed Utilization

Performance Legend

Met or Exceeded Target

Did not meet Target but within 10% target

Did not meet target (and not within 10% of target)

No Target

Repeat Unplanned ER Visits within 30 days for mental health conditions (Q3

11/12)17% 18.09% 18.33%

Repeat Unplanned ER Visits within 30 days for substance abuse conditions

(Q3 11/12)18.7% 21.1% 28%

30 Day Readmission Rate for selected CMGs (Case Mix Groups) (Q3 11/12) 15.0% 16.10% 16.23%

Proportion of Primary Unilateral Hip or Knee Joint Replacement patients

discharged home (Q4 11/12)90% +/‐ 9%

70% N/A

Average Length of Stay (days) of primary unilateral Hip or Knee Joint

Replacement patients discharged home (Q4 11/12)4.4 4.5 N/A

90P Wait Time for Cancer Surgery (Q1 12/13) 47 35 53

90P Wait Time for Cataract Surgery (Q1 12/13) 100 77 127

90P Wait Time for Cardiac By‐Pass Procedures (Q1 12/13) 63 41.2 42

90P Wait Time for Hip Replacement (Q1 12/13) 139 121 189

90P Wait Time for Knee Replacement (Q1 12/13) 154 148 227

90P Wait Time for Diagnostic MRI Scan (Q1 12/13) 90 57 84

90P Wait Time for Diagnostic CT Scan (Q1 12/13) 30 27 33

***

Although target on Stocktake says "TBD/10% Improvement in 90th Percentile)", since baseline is 32.5 hours, performance will be green

New Indicator Definition for this Stocktake ‐ Target and Non NLOT LTC values have not been calculated

The Number of ALC open cases (in hospital) by Inpatient Service Acute and Post‐Acute Care

The Number of ALC Patients in hospital staying 30 days and longer by Inpatient Service Acute and Post‐Acute Care

Percentage of Hospital Inpatient Discharges before 11:00 am

Transitional Care Program (TCP) Average Length of Stay (ALOS) by Program Type

Supplementary

Reduce Repeat ER Visits

within 30 Days for

Mental Health and

Substance Abuse

Excellent Care for All

Surgical and Diagnostic

Imaging Wait Times

L:\C. Operations (LHIN Activities)\Strategic Alignment ‐ Stocktake & Ministry Reports\Stocktake Reports\2012 Stocktake ‐ Round 14 (Aug 2012)\Stocktake_Summary_of_Indicators_for_KBaker

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Appendix C

Funding Allocations – June to September 2012

Management delegation of authority levels in accordance with CFIN-4 are as follows:

A. New Transfer Payment from the Ministry:

to $25,000 Director, Performance, Funding and Allocation to $99,999 Senior Director, Performance, Funding and Allocation to $499,999 Chief Executive Officer

B. Budget Reallocations within a Health Service Provider:

to $50,000 per Health Service Provider Senior Director, Performance, Funding and Allocation

to $250,000 per Health Service Provider Chief Executive Officer C. Budget Reallocations between Health Service Providers:

to $499,999 per provider Chief Executive Officer

Approvals Health Service Provider

DelegationType

Approval Date 2012/13 Funding

Description

Stevenson Memorial Hospital

A June 25, 2012 $5,775 Compensation for municipal taxation.

Markham Stouffville Hospital


Southlake Regional Health Centre


Mackenzie Health A June 25, 2012 $44,025 Compensation for municipal taxation.

Humber River Regional Hospital


North York General Hospital


St. John’s Rehabilitation Hospital


York Region Maple Health Centre

A September 14, 2012 $3,816 Per diem increase for LHIN created convalescent care beds.

Appendix D

Health Service Provider

DelegationType

Approval Date 2012/13 Funding

Description

Union Villa A September 14, 2012 $3,816 Per diem increase for LHIN created convalescent care beds.

Hawthorn Place Care Centre

A September 14, 2012 $6,106 Per diem increase for LHIN created convalescent care beds.

York Central Hospital LTC

A September 14, 2012 $10,979 Per diem increase for LHIN created interim beds.

Southlake Residential Care Village

A September 14, 2012 $11,446 Per diem increase for LHIN created interim beds.

Total $288,463

60 Renfrew Drive, Suite 300 Markham, ON L3R 0E1 Tel: 905 948-1872 • Fax: 905 948-8011 Toll Free: 1 866 392-5446 www.centrallhin.on.ca

TO: The Board of Directors, Central Local Health Integration Networks (the “LHIN”) FROM: Kim Baker Chief Executive Officer (“CEO”) REPORTING PERIOD: July and August 2012 RE: CEO Certificate of Compliance ====================================================================== I have reviewed, or caused to be reviewed, such files, books, records and accounts of the LHIN and have made, or caused to be made, such enquiries of the financial, accounting and other personnel of the LHIN as I have determined necessary for the purposes of this certificate. In my capacity as CEO of the LHIN, and for the reporting period identified above, I hereby certify that to the best of my knowledge and except as set out on Schedule A: 1. Salaries and Benefits. The LHIN has met all of its obligations in respect of the payment of all employee salaries

and wages, vacation pay, holiday pay, termination pay, severance pay, bonuses and benefits. The LHIN is in compliance with the provisions of the Public Sector Compensation Restraint to Protect Public Services Act, 2010.

2. Statutory Deductions. The LHIN has met all of its obligations in respect of the deduction, withholding and or remittance as the case may be, of funds under the Income Tax Act, (Canada), the Income Tax Act, (Ontario), the Employer Health Tax Act (Ontario), the Employment Insurance Act (Canada), the Canada Pension Plan Act (Canada); and the Retail Sales Tax Act (Ontario).

3. Financial Statements. The financial statements of the LHIN, as at their respective dates of preparation, were accurate and complete in all material respects.

4. Insurance. All insurance policies remained in full force and effect. The LHIN was not in default with respect to any of the provisions contained in any insurance policy and did not fail to give any notice or present any claim under any insurance policy in a timely manner.

5. Compliance. The LHIN conducted its business in compliance with: (i) all applicable laws of the Province of Ontario and Canada; (ii) the terms of the memorandum of understanding and the accountability agreement currently in effect

between the LHIN and the Ministry of Health and Long Term Care; and (iii) all intra LHIN agreements, including the Shared Services Agreement and the LHIN Collaborative

agreement. 6. Ibid. Without limiting the foregoing, the LHIN did not breach the terms of the Local Health System Integration

Act, the Financial Administration Act, the Travel and Expense Directive, the Procurement Directive, the Perquisites Directive, or the Broader Public Sector Accountability Act

Dated this 17th day of September 2012 _____________________________________ Kim Baker, Chief Executive Officer

Appendix E

2

Schedule A Nil.

Telemedicine Utilization by Event Type LHIN 8: Q1 11/12 vs. Q1 12/13

Telemedicine Utilization by LHIN: Q1 12/13*

*“Hosted” refers to the site that initiates an event. “Participated” refers to the site(s) joining the event. For clinical events, the patient site is considered the host, while the consultant site is the participant. Utilization in this chart is specific only to such activity occurring within a LHIN.

Site lists available at www.otn.ca/en/otn/site-locations/

Top Therapeutic Areas of Care: Ontario: Q1 12/13

Top Therapeutic Areas of Care: LHIN 8: Q1 12/13

3,386 2,540 3,3841,776

678 1531,650 1,454

7,219

3,863

7,790

1,972

13,023

10,371

1,962

3,982

1,257

2,7502,046 1,882

10,056

21,444

4,311

2,567

4,531

1,972

8,143

5,260

0

5,000

10,000

15,000

20,000

25,000

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Hosted

Participated

Psychiatry / Mental Health73%

Internal Medicine

9%

Oncology5%

Surgery3%

Other11%

324

89 136

1,171

122 161

0

200

400

600

800

1,000

1,200

1,400

Clinical Educational Administrative

2011/12

2012/13

Psychiatry/Mental Health

91%

Internal Medicine

2%

Surgery1%

Other7%

www.otn.ca/en/otn/site-locations/

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Appendix F


CENTRAL LHIN BOARD OF DIRECTORS BRIEFING NOTE MINISTRY OF HEALTH BUNDLED ALLOCATIONS

SEPTEMBER 25, 2012 PROPOSED RESOLUTION: WHEREAS in a letter dated August 16, 2012, the Ministry of Health and Long-Term Care approved $10,813,800 as 2012/13 base Post-Construction Operating Plan (PCOP) funding to support service expansions and other costs associated with completion of capital projects at Central LHIN hospitals; BE IT RESOLVED THAT: “The Central LHIN Board of Directors approves the disbursement of the Ministry of Health and Long-Term Care’s 2012/13 base allocation of $10,813,800 for Post-Construction Operating Plan funding as detailed below:”

Hospital Additional Base Funding

Markham Stouffville Hospital $7,157,000 Southlake Regional Health Centre $2,564,300 St. John’s Rehabilitation Hospital $1,092,500

PURPOSE: To seek Board approval for the Ministry of Health and Long-Term Care’s 2012/13 base allocation for Post Construction Operating Plan (PCOP) funding. ANALYSIS: Post Construction Operating Plan (PCOP) funding is issued when each phase of a capital project has reached substantial completion, and control is transferred to the health service provider. This incremental funding is provided over a three year window in order to support the start up and ramping up of the functional program elements approved as part of the capital project. The Ministry may also provide additional PCOP support to approved service expansions beyond the three year period. In a letter dated August 16, 2012, the Ministry of Health and Long-Term Care approved $10,813,800 as 2012/13 base Post-Construction Operating Plan (PCOP) funding to support service expansions and other costs associated with completion of capital projects at Central LHIN hospitals.

ITEM 7.1.


BACKGROUND: St. John’s Rehabilitation Hospital In June 2007, the Ministry approved redevelopment at St. John’s Hospital inpatient and ambulatory care facilities. The construction will be completed during the current fiscal year. The funding in fiscal 2012/13 covers facility and equipment costs as well as incremental hospital operating expenses to provide additional nursing visits and outpatient physiotherapy, occupational therapy, language pathology, social work, clinical nutrition and prosthetics attendance days as a result of the redevelopment. Southlake Regional Health Centre In December 2006, the Ministry committed $60.3 million for the Southlake Integrated Regional cancer Centre project. The hospital was funded for facility and start-up costs in fiscal 2009/10. The current year’s funding is for incremental hospital operating expenses for increased systemic therapy, post systemic therapy and palliative and support care visits. Markham Stouffville Hospital Markham Stouffville Hospital was originally constructed to serve a population of approximately 110,000 and at present is serving over 300,000 people. The hospital is expanding and renovating its existing site to increase capacity from 205 to 309 beds and to increase capacity for emergency and ambulatory visits. The first patient will be seen at the new site in March 2013. PCOP funding in fiscal 2012/13 is for costs related to the facility expansion.

The following table details this funding by service type and identifies additional service volumes to be provided in 2012/13:

Markham Stouffville Hospital

St. John's Rehabilitation Hospital

Southlake Regional Health Centre

Redevelopment Phase 1B Redevelopment

Regional Cancer Centre

Service Unit of Funding

Funding Rate Funding

2012/13 Additional Volumes Funding

2012/13 Addition

al Volumes

Funding

Nursing Visit $120.82 1,398 $168,900

Diagnostic & Therapeutic – Physiotherapy

Attendance Days

$66.75 3,073 $205,100

Diagnostic & Therapeutic –Occupational Therapy

Attendance Days

$78.44 2,360 $185,100

Diagnostic & Therapeutic – Language Pathology

Attendance Days

$107.95 161 $17,300

Diagnostic & Therapeutic – Social Work

Attendance Days

$130.30 468 $61,000

Diagnostic & Therapeutic – Clinical Nutrition

Attendance Days

$111.56 21 $2,400

Prosthetics Attendance Days

$71.39 265 $18,900

Ambulatory Care - Day/Night Care - Systemic

Visit $442.06 1,871 $827,100

Ambulatory Care - Day/Night Care -Palliative & Support Care

Visit $220.39 2,354 $518,800

Ambulatory Care - Day/Night Care Pre & Post Systemic

Visit $440.17 2,768 $1,218,400

Facility Costs $696,800 $289,700 Equipment Amortization

$1,259,500 $144,100

Start-up $5,200,700 Total Funding $7,157,000 $1,092,500 $2,564,300

ITEM 7.2 CENTRAL LHIN BOARD OF DIRECTORS BRIEFING NOTE

2012/13 COMMUNITY SECTOR BASE FUNDING INCREASES SEPTEMBER 25, 2012

PROPOSED RESOLUTION:

WHEREAS in a letter received August 15, 2012, the Ministry provided the details of 4% community sector base funding increase of $14,315,900 for fiscal 2012/13 which is part of the 2012 Budget announcement; WHEREAS additional Personal Support Worker hours of 119,727 must be provided within the allocation of the incremental base funding; WHEREAS a minimum of $2 million must be allocated to augment/establish interdisciplinary clinics to provide Methadone and Suboxone opioid substitution treatment programs and to design support services for pregnant and parenting women with opiate addictions; WHEREAS the LHIN has discretion to allocate the remaining funds to reduce ER/ALC rates, reduce avoidable hospital readmissions, including 30 day readmissions or to support seniors to remain in the community through additional service delivery; BE IT RESOLVED THAT: “The Central LHIN Board of Directors: (a) Approves a 2012/13 base allocation increase of $8,738,000 to the Central LHIN CCAC with the following criteria:

i. A minimum $1,100,000 for additional client spots in the Central LHIN CCAC Home First

program;

ii. A minimum of $1,100,000 to support the additional Home First clients who will receive ongoing CCAC services when they are discharged from the Home First program and remain at home in the community;

iii. A maximum of $6,538,000 for additional services to support clients who are referred for

CCAC services; and

iv. The above funding allocations must be used to provide a minimum of 119,727 additional personal support worker hours.


b) Delegates authority to the CEO and Board Chair to execute the CCAC M-SAA amendment

c) Delegates authority to the CEO to disburse the funds upon signing the amendment

d) Delegates authority to the CEO to determine the health service providers for the $2 million

allocation to augment/establish interdisciplinary clinics to provide Methadone and Suboxone opioid substitution treatment programs and to design support services for pregnant and parenting women with opiate addictions.

PURPOSE:

a. To seek Board approval for a fiscal 2012/13 base funding increase of $8,738,000 for the Central LHIN CCAC which represents a portion of the 4% community sector base funding increase of $14,315,900 allocated to Central LHIN.

b. To seek Board approval for delegation to the CEO to determine which health service providers will augment or establish the Methadone and Suboxone opioid programs.

ANALYSIS: 2012/13 Base Funding Increases for Community Service Providers – $14,315,900 In a letter dated August 15, 2012, the Ministry provided the details of the 4% community sector base funding increase for 2012/13 which is part of the 2012 Budget announcement for the community service sector including: Community Care Access Centres, Community Support Services, Assisted Living Services in Supportive Housing, Community Mental Health and Addictions Agencies, Acquired Brain Injury Services, and Community Health Centres. The LHINs are given the discretion to allocate funding increases to health service providers for targeted priorities and increased services. The targeted priorities include the following requirements:

• to provide an additional 119,727 personal support work hours

• to allocate a minimum of $2 million to augment/establish interdisciplinary clinics to provide Methadone and Suboxone opioid substitution treatment programs and to design support services for pregnant and parenting women with opiate addictions

• to reduce ER/ALC rates and reduce avoidable hospital readmissions by enhancing or expanding home and community services.

Central LHIN CCAC Home First is a successful CCAC program to reduce hospital ALC rates and provide patient/client care in the community setting. The Program provides for a maximum of 60 days of intense support in the community for an ALC patient discharged from a hospital. After the 60 days on Home First, the client is discharged to another destination. In fiscal 2011/12 the discharge pattern from Home First was as follows:

8%5%

4%5%

7%

2%69%

Admitted to Hospital

Admitted to LTC

Died at Home

Died in Hospital

Discharged From CCAC

Palliative Care Services

Regular CCAC Services

The current M-SAA with Central CCAC requires 150 spots to be provided for Home First clients. Under the current program, the 150 spots turn over every sixty days or approximately six times per year. This equates to approximately 900 patients being served annually through the program. As illustrated above, 69% of clients are discharged to regular CCAC services for an average of 1.66 years. The average age of clients on the Home First program is between 81 and 84 years of age. The additional funding of $1.1 million will create another 25 spots on the Home First program which will allow for an additional 150 clients to be served over the course of a year. As approximately 69% will be discharged from Home First to regular CCAC services, an additional $1,100,000 must be allocated to support these clients on regular CCAC services. In addition to being referred through Home First, clients are referred to regular CCAC services from the hospital or primary care physicians or may contact the CCAC directly through the call centre. At June year-to-

date the Central CCAC was providing services for approximately 24,000 clients from all referral sources. This is an increase of 2,000 clients over last year and is not sustainable without additional funding. The allocation of $6,538,000 will fund the CCAC for approximately 580 clients annually on regular services. These clients will be provided with a combination of nursing, personal support, occupational therapy, physiotherapy, speech pathology, social work and nutritional counseling, depending on individual client needs. The most frequently provided service is personal support work with seniors making up approximately 80% of the clients receiving these services. A requirement of the Ministry funding allocation is to provide an additional 119,727 personal support worker hours over base funding levels. At June year-to-date, the Central CCAC had already provided approximately 89,000 hours over the June year-to-date budget and will be able to meet the target set by the Ministry. The dollar value associated with these hours is approximately $3.6 million and may be spent within the Home First program or for clients referred directly to regular services. CURRENT STATUS: Central CCAC There is increasing demand both from the hospitals and the community for increased services and the CCAC has projected a level of demand growth that cannot be provided with the historical service delivery model. Central LHIN has been working with the CCAC to refine the Home First program based on prior years experience and to develop the CCAC service targets for the additional funding. This work has resulted in Home First being refined in terms of length of stay on the program before discharge and hours of service provided. More clients can now be served for the same funding. In addition, the CCAC has identified savings in administration expenses. The Central LHIN and CCAC continue to work closely together to monitor the situation to ensure that spending on direct client care is maximized. Methadone and Suboxone opioid treatment programs Ontario’s prescription narcotic use is the highest in Canada and it is increasingly recognized as one of the primary forms of illicit drug use. From 2004 to 2008, the number of admissions to publicly funded addictions treatment programs has doubled and since 2004, the number of oxycodone-related deaths has also nearly doubled. The use of narcotics has had a disproportionate impact on the First Nations communities, with an estimated 70% – 80% of residents in some communities having an opioid addiction. The Ministry of Health and Long Term Care has allocated $2 million to Central LHIN to fund the enhancement of community based interdisciplinary opioid treatment programs, and treatment and ancillary services for pregnant and parenting women with opioid addictions. The funding parameters allow for allocation to either or both programs but must be delivered by community-based health service providers currently accountable to the LHIN. Performance measures and reporting requirements are specific to the program framework established by the MOHLTC and will be included in the multi-sector service accountability agreements (M-SAA).

Central LHIN currently funds six health service providers for addictions services, including the two largest providers, Addiction Services York Region and Humber River Regional Hospital. In 2012-2013, for the first quarter there were 1,838 clients serviced by Central LHIN providers. In addition, there are 9 Methadone Maintenance Treatment clinics in Central LHIN that are privately operated with 1,577 active patients as of July 2012. Demand for drug and/or alcohol treatment services continues to increase in Central LHIN, with wait lists for access to treatment programs exceeding an average of 89 days based on the ConnexOntario database.

BALANCE OF FUNDS: The balance of the 4% community sector base funding increase of $14,315,900 for fiscal 2012/13, totaling $3,577,900, will be allocated pending the outcome of the RFP processes for Assisted Living/Supportive Housing Services and the Regional Hospice Palliative Care Program – Operational Lead Agency as outlined in the June 26, 2012 Board briefing note, In-Year Allocation Priorities, Fiscal Year 2012-13.

NEXT STEPS: Central CCAC Central LHIN staff will communicate the incremental base funding upon Board approval. The M-SAA will be amended to reflect the funding and service delivery targets. In addition, the Central LHIN will request the CCAC to continue to take additional action to reduce administrative expenses and redirect the savings to front line service delivery. The LHIN requests the CCAC to consider the following best practices which are in the spirit of Ministry Directives:

• No out of province travel; • Limit the attendees at any single conference; • No catering/food at internal meetings which do not have a client present; • All employees must take their annual vacation with no option for vacation payouts; • No subscriptions; • No accommodations for meetings within the GTA; • No branded give-a-ways; • Review of staff I/T eligibility for Blackberries, cell phones, iPads etc. • Review of staff eligibility for reimbursement of professional dues; • Employee payment for parking at head office locations; • Reduce inventories of office supplies; • Ensure expense reimbursement policy exists with per diems in line with Ministry amounts; • Other as may be suggested by the CCAC.

Methadone and Suboxone opioid treatment programs Central LHIN staff will continue to work with health service providers, experts and other stakeholders in planning for the allocations of resources, including a planning session in early October. Central LHIN will release a request for proposals in Fall 2012 to allocate the funds.

Briefing Note Updated: September 18, 2012


CENTRAL LHIN BOARD OF DIRECTORS BRIEFING NOTE 2012/2013 HOSPITAL SERVICE ACCOUNTABILITY AMENDING AGREEMENTS

SEPTEMBER 25, 2012 PROPOSED RESOLUTION: WHEREAS the current Hospital Service Accountability Amending Agreements expire on September 30, 2012; and WHEREAS the LHIN has been provided with a provincial Amending Agreement template; and WHEREAS the Central LHIN public hospitals with the exception of Markham Stouffville Hospital, have developed balanced budgets, volumes and performance targets based on Health System Funding Reform allocations provided by the Ministry; and WHEREAS Stevenson Memorial Hospital and the private hospitals have developed plans based on 0% increases in funding as directed by the Ministry; and WHEREAS individual hospital 90th percentile performance targets have been set in a manner that will achieve the Ministry-LHIN Performance Agreement targets; and WHEREAS the Hospital Service Accountability Agreement between St. Johns Rehabilitation Hospital and Central LHIN is set to expire on September 30, 2012 and the integration between St. John’s Rehabilitation Hospital and Sunnybrook Health Sciences took effect on July 1, 2012; and WHEREAS the LHIN has not received the funding letter from the Ministry with the final hospital allocations; BE IT RESOLVED THAT: “The Central LHIN Board of Directors:

a) Approves the amended 2012-13 Hospital Service Accountability Agreements for each of the following public hospitals:

• Humber River Regional Hospital • North York General Hospital • Southlake Regional Health Centre • Stevenson Memorial Hospital • MacKenzie Health (formerly York Central Hospital)



b) Approves the 2012/2013 funding, volume and performance targets for each of the public hospitals, as follows, to be included in the 2012/13 Hospital Service Accountability Amending Agreements:

Humber River

Regional Hospital

Stevenson Memorial Hospital

North York General Hospital

Southlake Regional

Health Centre

MacKenzie Health

Total Health System Funding $259,565,342 $18,649,696 $238,666,242 $262,484,121 $195,549,700 ED Weighted Cases 4,953 TBD 5,215 3,811 3,865 Total Acute Inpatient Weighted Cases 33,921 1,985 30,830 28,803 19,889 Day Surgery Weighted Cases 5,677 550 5,415 5,406 2,390 Complex Continuing Care RUG Weighted Patient Days n/a n/a n/a 13,930 30,005

Mental Health Weighted Inpatient Days 17,790 n/a 18,845 10,345 7,369 Inpatient Rehabilitation Weighted Cases 250 n/a Na 371 325 Emergency Visits 114,451 27,000 116,500 85,929 80,700 Ambulatory Care Visits 220,645 25,392 161,500 211,673 162,002 Current Ratio 0.75 0.80 0.80 0.50 0.80 Year End Total Margin 0% 0.36% 0.96% 1.36% 0% Cases of Ventilator-Associated Pneumonia (Cases/Days) 0 0 0 0 0.80

Central Line Infection Rate (Cases/Days) 0 0 0 0 0.42 Hospital-Acquired Cases of Clostridium Difficile Infections (Cases/Days) 0 0 0.52 0.27 0.54

Hospital-Acquired Cases of Vancomycin Resistant Enterococcus (Cases/Days) 0 0 0 0 0

Hospital-Acquired Cases of Methicillin Resistant Staphylococcus Aureus (Cases/Days)

0 0 0 0 0

90P ER LOS Admitted 39.4 18.9 25.73 30.3 37.7 90P ER LOS Non-Admitted Complex 8 6.5 7.1 6.9 6.9 90P ER LOS Non-Admitted Minor-Uncomplicated 4.1 4.1 3.5 3.5 3.8

90P Wait Time for Cancer Surgery 47 n/a 47 47 47 90P Wait Time for Cardiac By-Pass Surgery n/a n/a n/a 63 n/a 90P Wait Time for Cataract Surgery 80 56 92 86 n/a 90P Wait Time for Hip Replacement Surgery 122 Na 117 157 137 90P Wait Time for Knee Replacement Surgery 135 Na 127 169 153 90P Wait Time for MRI Scan 100 Na 80 80 75 90P Wait Time for CT Scan 25 32 17 45 30 % ALC Days 16 15 14.5 13.7 14.7

c) Approves the amended 2012-13 Private Hospital Service Accountability Agreements for the

fiscal year April 1, 2012 to March 31, 2013 with no changes to previously approved funding, volume and performance targets for each of the following private hospitals:



• Don Mills Surgical Unit Ltd • Shouldice Hospital Ltd • St. Joseph’s Private Hospital and Infirmary

d) Delegates authority to the Chair and CEO to sign the 2012/13 Hospital Service Accountability

Amending Agreements by September 30, 2012, for Central LHIN hospitals;

e) Delegate authority to the CEO to refine the hospital funding, volume and performance targets as may be required to reflect information received from the Ministry which has not been incorporated in the Amending Agreements; and

f) Delegates authority to the CEO to flow funding to the hospitals, upon receipt of the signed Amendments from the hospitals and the funding letter from the Ministry; and

g) Approves the termination of the St. John’s Rehabilitation Hospital Service Accountability Agreement and delegates authority to the CEO to sign the termination letter.”

PURPOSE: To seek Board approval:

a) To amend the period of the 2012-13 Hospital Service Accountability Amending Agreements to cover the full fiscal year from April 1, 2012 to March 31, 2013

b) Of the management recommended targets for volumes and performance indicators for the five public hospitals based on the information available to the LHINs from the Ministry up to and including September 7, 2012

c) To delegate authority to the Chair and CEO to sign the Agreements d) Terminate the Hospital Service Accountability Agreement with St. John’s Rehab Hospital and to delegate

authority to the CEO to sign the termination letter e) To delegate authority to the CEO to refine the hospital funding, volume and performance targets as may

be required to reflect information received from the Ministry which has not been incorporated in the Amending Agreements

f) To flow funding to the hospitals upon receipt of the hospital signed Agreements and the Ministry funding letter for the LHIN.

ANALYSIS:

Hospital Service Accountability Amending Agreement Process for Public Hospitals

In June 2012, the Central LHIN Board of Directors approved amendments to six public Hospital Service Accountability Agreements and three private Hospital Service Accountability Agreements which extended the term of the existing Agreements an additional three months from July 1, 2012 to September 30, 2012. Several



volume and performance targets were set to “TBD” as the information to set the targets was not available from the Ministry.

Throughout the summer as new information was received, Central LHIN and hospitals had discussions and made revisions to hospital planning assumptions resulting in agreement on revised 2012/13 planning targets. As such, performance targets were set and agreed to for all indicators based on the best available information as of September 7, 2012, subject to LHIN Board approval. The hospitals have begun to engage their Boards based on the information available up to this date, and some hospital Board Committees have recommended the approval of the Amending Agreements contingent on Central LHIN Board approval.

The 2012/13 recommended Hospital Service Accountability Amending Agreement volume and performance targets are based on the following:

1. Global Volumes: • Expected Health Based Allocation Methodology (HBAM) Volumes; and • 2012/13 Hospital Accountability Planning Submission (HAPS) budgeted volumes; and • Three-year average performance from 2009/10 through 2011/12.

2. Patient Safety Indicators: • Each hospitals’ 2012/13 Quality Improvement Plan (QIP) targets submitted to Health Quality

Ontario; and • Historical performance.

3. 90th Percentile Targets:

• Historical performance • Ministry funding levels • LHIN purchased volumes • Hospitals Needs and Capacity Survey • Ministry-LHIN Performance Targets

4. Current ratio: Each hospital’s budgeted amount was used. Two hospitals, Humber River Regional Hospital and Southlake Regional Health Centre, budgeted less than the provincial standard of 0.8 and will provide the LHIN with a 3 year plan to return to within the 0.8 to 2.0 corridor.

5. The hospitals have all submitted balanced budgets.

The following information was received from the Ministry subsequent to September 7th or remains outstanding. The hospital targets will require refinements when the complete information has been received.

• Final funding letter from Ministry for the 2012/13 Wait Time Strategy funding and volumes (now received)

• Publication of the final Quality Based Procedure volumes with the exception of bi-lateral cataracts (now received)

• Confirmation of Quality Based Procedure funding (still pending)



• Bi-lateral cataract procedures volumes and funding (still pending) • Post-construction Operating Plan funding (now received) • Ministry funding letter to the LHIN for the 2012/13 hospital funding allocation (still pending) • Chronic Kidney Disease volumes (still pending)

LHIN-Specific Obligations Minimal changes have been made to the LHIN-specific obligations included in Schedule E-3.1 for the 2012/13 H-SAA Amending Agreement. The changes are as follows:

• Removal of reference to targets set as TBD until September 30, 2012 • Removal of legacy indicators (Mental Inpatient Days and Acute Rehab Patient Days). These indicators

have been replaced provincially with weighted patient days/cases indicators.

Hospital Service Accountability Amending Agreement Process for Private Hospitals

No changes have been made to funding or performance targets previously approved by the Central LHIN Board in June 2012. The agreements are being amended to cover the full fiscal year April 1, 2012 to March 31, 2013.

St. John’s Rehabilitation Hospital The LHIN’s agreement with St. John’s Rehab expires on September 30, 2012. The amalgamation between St. John’s Rehab Hospital and Sunnybrook Health Sciences took effect on July 1, 2012. Under the Amalgamation Agreement, Sunnybrook Health Sciences has assumed accountability for St. John’s obligations. Accordingly, Central LHIN staff has been working with Toronto Central LHIN, LHIN legal counsel and Sunnybrook Health Sciences to facilitate a smooth transition of accountability and funding. Effective October 1, 2012 Sunnybrook Health Sciences and Toronto Central LHIN will be entering into an Accountability Agreement for the funding previously allocated to St. John’s Rehab Hospital. The Ministry will reduce the Central LHIN funding allocation for hospitals and re-allocate the funding to Toronto Central LHIN. Sunnybrook Health Sciences has certain ongoing reporting obligations to Central LHIN under the Integration Agreement between the hospitals and as required by the Ministry. In addition, Central LHIN has requested three months to December 31, 2012 to assess whether St. John’s Rehab Hospital met their obligations to Central LHIN under the Hospital Service Accountability Agreement for the period April 1, 2012 to September 30, 2012.

CURRENT STATUS:

Hospitals are currently being funded by the LHIN at the 2011/12 base funding amount plus any approved in-year funding allocations. Current Accountability Agreements are set to expire on September 30, 2012. The



LHIN cannot flow funds to hospitals without an Accountability Agreement. Central LHIN has therefore engaged senior management at the hospitals to discuss the 2012/13 H-SAA Amending Agreement process and the details of the hospital budget submissions. Five public hospitals and three private hospitals have taken or will be taking their Agreements for Board signature by September 30, 2012 so that the LHIN may continue to flow funding.

A provincial template has been provided for use by LHINs and hospitals for the final 2012/13 Agreement. NEXT STEPS:

Upon Board approval of the resolutions, the Board Chair and CEO will execute the Hospital Board approved Agreements. The LHIN CEO will also send a termination letter to Sunnybrook Health Sciences confirming the termination of the Hospital Service Accountability Agreement with St. John’s and outlining the continuing obligations of Sunnybrook Health Sciences.

Upon receipt of the outstanding items from the Ministry, including the LHIN funding letter, the LHIN will issue letters to the hospitals incorporating required refinements to funding and volume and performance targets and will adjust the cash flow to the hospitals.


CENTRAL LHIN BOARD OF DIRECTORS BRIEFING NOTE COMMUNITY HEALTH CENTRE IN YEAR REVISION OF PERFORMANCE INDICATORS

SEPTEMBER 25, 2012

PROPOSED RESOLUTION: WHEREAS the Community Health Centre sector has been working collaboratively with LHINs to address Community Health Centre accountability indicator obligations as contained in the 2011-2014 Multi-Sector Service Accountability Agreements (“M-SAAs”); and WHEREAS these obligations include setting targets and reporting on outcomes for two new accountability indicators for fiscal 2012/13; enhancing the definitions and query extracts for existing accountability indicators; and introducing a new developmental indicator; and WHEREAS the process, timelines and principles for the Community Health Centre implementation plan were approved at the Provincial M-SAA Steering Committee; and WHEREAS the changes required to systems and contractual obligations to accommodate the outcomes described will be applied retroactively to April 1, 2012 and be reported on by Community Health Centres for Q2 of fiscal 2012/13; and WHEREAS Schedule E2b of the current 2011-2014 M-SAA should be amended by October 12, 2012 in order to provide time for Community Health Centres to submit their Q2 results. BE IT RESOLVED THAT: “The Central LHIN Board of Directors:

a) Approves the following principles for negotiation of the performance targets: 1. Central LHIN will facilitate target setting discussions using historical data provided through

the Provincial M-SAA Steering Committee 2. The average monthly historical performance from January 1, 2011 to June 30, 2012 (adjusted

for known one-time impacts) will be used as 2012/13 targets 3. Indicator performance corridors will be calculated based on the Provincial Community Health

Centre Indicator Technical Specification Guideline released August 28, 2012 4. Performance obligations will be monitored on a quarterly basis by Central LHIN staff.

b) Delegates authority to the CEO to negotiate the performance targets in Schedule E2b of the 2011-

2014 Multi-Sector Service Accountability Agreement and execute the amendment for the following two Community Health Centres: 1. Vaughan Community Health Centre Corporation 2. Black Creek Community Health Centre

Item 7.3.2



PURPOSE: To seek Central LHIN Board approval of:

a) The broad principles to guide LHIN staff to set targets for new performance indicators; modify targets for existing performance indicators and set targets for the new explanatory indicator

b) Delegation of authority to the CEO to negotiate the new performance targets, modify the existing performance targets, and negotiate the new explanatory target for Vaughan Community Health Centre Corporation and Black Creek Community Health Centre.

c) Delegation of authority to the CEO to execute the M-SAA amendment. ANALYSIS: Central LHIN is refreshing existing Community Health Centre accountability targets, setting new accountability indicators and targets and setting an explanatory indicator and target in Schedule E2b of the Multi-Sector Service Accountability Agreement, effective April 1, 2012. Refresh of Current Accountability Indicators due to updated Provincial Definitions:

• Cervical cancer screening (pap tests) • Colorectal screening • Inter-professional diabetes care rate

Additional Accountability Indicators (Effective April 1, 2012):

• Influenza vaccination rate • Breast screening rate • Periodic health exam rate • Vacancy rate of nurse practitioners and physicians

New Developmental Indicator for Fiscal 2012/2013 (To Be Classified as Accountability Indicator in 2013/2014)

• Access to Community Health Centre Primary Care Clinical Team LHINs and Community Health Centres have been provided with LHIN legal approved templates for the M-SAA amendments, technical support and historical data in most cases, to facilitate the target setting process. Historical data for the vacancy rate for Nurse Practitioners and Physicians is not readily available. Central LHIN will work with the Community Health Centres to set the performance targets for this indicator based on information provided by the organizations. BACKGROUND: As outlined in the provincial M-SAA Steering Committee Communique #5, the Committee agreed on the following key principles to guide the performance indicator refresh process:

• Ensure alignment to LHIN Health System Performance Indicator Framework


• Utilize a standard published process to modify existing and/or add new accountability indicators to minimize administrative burden on HSPs and LHINs and ensure information is used proactively to drive system performance

• Performance indicators deemed as accountability indicators need an approach to volume and standards that includes technical specifications, and its incorporation into the M-SAA should occur in time for reporting cycles

• Communications concerning process, definition and implementation of accountability indicators in Service Accountability Agreements should be distributed concurrently to Health Service Providers and LHINs to ensure clarity and effective implementation.

NEXT STEPS: Upon negotiation of the targets using the Central LHIN principles outlined in the resolution, Schedule E2b of the M-SAA will be amended for Vaughan Community Health Centre Corporation and Black Creek Community Health Centre.

60 Renfrew Drive, Suite 300 Markham, Ontario L3R 0E1 Tel: 905 948-1872 • Fax: 905 948-8011 Toll Free: 1 866 392-5446 www.centrallhin.on.ca

CENTRAL LHIN BOARD OF DIRECTORS BRIEFING NOTE CHANGE IN LONG TERM CARE HOME LICENSEE

SEPTEBMER 25, 2012 PROPOSED RESOLUTION: WHEREAS Central LHIN has entered into a Long-Term Care Service Accountability Agreement with Paragon Health Care Inc. (“Paragon”), the licensee for the long-term care home known as Casa Verde Health Centre; and WHEREAS in a letter dated July 25, 2012, the Ministry approved the transfer of the license for Casa Verde Health Centre from Paragon Health Care Inc. to Downsview Long Term Care Centre Limited (“Downsview”). BE IT RESOLVED THAT: “The Central LHIN Board of Directors:

a) Approves the termination of the Long-Term Care Service Accountability Agreement between Central LHIN and Paragon Health Centre Inc. effective July 24, 2012, and delegates authority to the CEO to sign the termination letter;

b) Approves Central LHIN to enter into a Long-Term Care Service Accountability Agreement with Downsview Long Term Care Centre Limited effective July 25, 2012, and delegates authority to the Chair and CEO to execute the agreement;

c) Approves the LHIN to facilitate the transfer of funding from Paragon Health Care Inc. to Downsview Long Term Care Centre upon completion of the above."

PURPOSE: To seek Central LHIN Board approval to:

a) Terminate the Long-Term Care Home Service Accountability Agreement between Central LHIN and Paragon Health Center Inc. effective July 24, 2012, and delegate authority to the CEO to sign the termination letter

b) Enter into a Long-Term Care Service Accountability Agreement between Central LHIN and Downsview Long Term Care Centre effective July 25, 2012, and delegate authority to the Chair and CEO to execute the agreement

c) Facilitate the transfer of funding from Paragon Health Center Inc. to Downsview Long Term Care Centre upon completion of the above.

ITEM 7.4

60 Renfrew Drive, Suite 300 Markham, Ontario L3R 0E1 Tel: 905 948-1872 • Fax: 905 948-8011 Toll Free: 1 866 392-5446 www.centrallhin.on.ca

ANALYSIS:

In March 2011, Central LHIN was advised by the MOHLTC that Casa Verde Health Centre whose license is held by Paragon Health Care Inc., was the subject of a purchase proposal from GEM Healthcare Group Limited and Court-Appointed Interim Receiver Deloitte & Touch (Appendix A). The MOHLTC requested input from Central LHIN which was subsequently provided in support of the transfer. GEM Healthcare Group Limited, owner of Downsview Long Term Care Centre, subsequently assigned the Agreement of Purchase and Sale to Downsview Long Term Care Centre Limited (Appendix B). On December 13, 2011 the MOHLTC provided Downsview Long Term Care Centre Limited notice that it had completed the Licensing Transaction Review and that the proposed transaction would be approved subsequent to certain conditions being met (Appendix C). Downsview Long Term Care Centre has satisfied the requirements of the Ministry and as of July 25, 2012, Paragon Health Care Inc. transferred 252 licensed/approved beds to Downsview Long Term Care Centre Limited. Downsview Long Term Care Centre Limited has been operating the Long-Term Care Home under the name of Downsview Long Term Care Centre. Downsview Long Term Care Centre Limited has submitted the documents required by the LHIN and the Financial Management Branch of the Ministry to enter into a Long Term Care Service Accountability Agreement. These included a Long-Term Care Home Accountability Planning Submission, bank account information, and the Certificate of Incorporation. According to documents submitted, the authorized signatories for the Purchaser are Mr. Syed M. Hussain, CEO of Downsview Long Term Care Centre Limited and Ms. Gloria Hussain, Secretary of Downsview Long Term Care Centre Limited. BACKGROUND:

All Long-Term Care homes are governed and managed by the Long-Term Care Homes Act, 2007 (LTCHA or the Act). The Ministry sets the operating and quality standards and monitors compliance on a quarterly basis. The Ministry retains the right of providing final approval in the matter of purchase and sale of a home, notwithstanding that the Accountability Agreement is between the LHIN and the Operator. NEXT STEPS: Following approval of the proposed Board resolution, the LHIN will terminate the Long-Term Care Service Accountability Agreement with Paragon Health Care Inc. and sign a new Agreement with Downsview Long Term Care Centre Limited. Central LHIN staff will also advise the Financial Management Branch of the Ministry to transfer funding to Downsview Long Term Care Centre Limited from Paragon Health Care Inc.

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Deloitte & Touche Inc. Brookfield Place 181 Bay Street Suite 1400 Toronto ON M5J 2V1 Canada Tel: 416-775-7326 Fax: 416-601-6690 www.deloitte.ca

July 16, 2012 Ministry of Health and Long-Term Care Health System Accountability and Performance Division Performance Improvement and Compliance Branch 55 St. Clair Avenue West, 8th Floor Toronto, ON M4V 2Y7 Attention: Ms. Karen Slater Director (A), Performance Improvement and Compliance Branch Director under the Long-Term Care Homes Act, 2007 Dear Sirs: Re: Licensing Transaction Review – Licence Transfer of Casa Verde Health Centre in North

York (Home #1041) We are writing to you in connection with the Agreement of Purchase and Sale, as amended, between Deloitte & Touche Inc., solely in its capacity as court-appointed interim receiver and receiver and manager of Paragon Health Care Inc. (“Paragon”) and Paragon Health Care (Ontario) Inc. and not it its personal capacity (the “Receiver” or “Vendor”) and GEM Health Care Group Limited (the “Purchaser”) dated October 20, 2010 (the “APS”). The Purchaser subsequently assigned the agreement to Downsview Long Term Care Centre Limited (“Downsview”). Further to our letter dated June 22, 2012 in which we advised the Ministry of Health and Long-Term Care (“Ministry”) that the closing date of the transaction contemplated under the APS (the “Closing Date”) was to be July 26, 2012, please be advised that the Closing Date of the transaction has been changed to July 25, 2012. Accordingly, the Vendor hereby surrenders its current licence effective July 25, 2012 conditional upon the closing of the APS with the Purchaser and the issuance of a new Long-Term Care Home Licence by the Ministry to Downsview on the Closing Date. Yours very truly, Deloitte & Touche Inc. in its capacity as Court-Appointed Interim Receiver and Receiver and Manager of Paragon Health Care Inc. and Paragon Health Care (Ontario) Inc. and not in its personal capacity Per: Hartley Bricks, MBA, CA•CIRP Vice President cc: Syed Hussain & James Balcom, GEM Health Care Group Limited Robert Miller, Chaitons LLP Clifton Prophet, Harry VanderLugt & Leila Burden-Nixon, Gowling Lafleur Henderson LLP

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Appendix C

CENTRAL LHIN BOARD OF DIRECTORS BRIEFING NOTE Memorandum of Understanding

with Her Majesty the Queen in Right of Ontario as represented by The Minister of Health and Long-Term Care

SEPTEMBER 25, 2012 PROPOSED RESOLUTION: WHEREAS The LHIN Memorandum of Understanding (MOU) is for a 5 year term. The current MOU, the first LHIN MOU, was entered into April 1, 2007 and was due to expire March 31, 2012 but continues in force until it is replaced by a new one. BE IT RESOLVED THAT: “The Central LHIN Board of Directors approves the content of the Memorandum of Understanding between Her Majesty the Queen in Right of Ontario as represented by The Minister of Health and Long-Term Care and the LHIN attached to this motion; and authorizes the Chair to sign, on behalf of the LHIN, a copy of the Memorandum of Understanding that is substantially similar to the attached Memorandum of Understanding.” PURPOSE: To seek Board approval for the Chair to sign, on behalf of the LHIN, a copy of the Memorandum of understanding that s substantially similar to the attached Memorandum of Understanding. ANALYSIS: The Memorandum of Understanding that each LHIN has with Her Majesty the Queen in Right of Ontario as represented by The Minister of Health and Long-Term Care (MOU), like the Local Health System Integration Act, 2006 (LHSIA) and the LHINs’ By-Laws is a foundation document of the LHIN.

The requirement for an MOU comes from Management Board of Cabinet’s “Agency Establishment and Accountability Directive” which requires every agency of the Province to have an MOU in place that “reflects the accountability framework in addition to the parties’ mutual understanding of the responsibilities of the ministry and the agency”. (Directive page 6)

ITEM 7.5

The purpose of the MOU is: (i) Set out the accountability relationships between the Minister and the Central

LHIN; (ii) Clarify the roles and responsibilities of the Minister, the Chair, the Deputy

Minister, the CEO, and the Board; and (iii) Set out the expectations for the operational, administrative, financial, staffing,

auditing and reporting arrangements between the LHIN and the Ministry. “[The MOU] clarifies the roles, relationships, and mutual expectations, notifies readers of the accountability mechanisms in place to ensure good governance and accountability. While it is generally not intended to serve as a legal contract that is enforceable by the courts, it is an administrative agreement that serves as an important tool that promotes mutual understanding of the roles and responsibilities of each party.” (Directive page 23) A small committee of LHIN Chairs and CEOs was set up to work with the Ministry of Health and Long-Term Care to review the MOU. Although the LHINs expected to work from the current MOU, the Ministry presented a completely new document based on a new template MOU required by the Ministry of Government Services.

As a result, a line by line comparison between the current MOU and the one proposed is not possible. However, the overall thrust of the proposed MOU is consistent for the most part with the current MOU.

In our negotiations with the Ministry, there were two contentious issues.

1. The designation of Senior Directors as designated senior positions for the purposes of the COI rules – The most significant impact of this is that it imposes additional restraints on post-LHIN employment opportunities for Senior Directors in certain narrowly defined circumstances. Chairs and CEOs were given more detailed information about this and an opportunity to

provide feedback during the MOU negotiations. The vast majority agreed to accept the government’s position, given that the government was absolutely firm on this issue.

2. Communications Protocols for LHIN/Ministry Communications (Appendix 2 of the MOU) Again a standard template was presented by the Ministry. This was not acceptable to the

LHINs as it placed severe constraints on public engagement and communications, which were inconsistent with the LHINs mandate and duty to engage the public. Ultimately the language was modified significantly with the input of the LHIN communication leads.

The negotiating committee strongly recommends that the board of all LHINs approve the new MOU.

1

MEMORANDUM OF UNDERSTANDING

Between

Her Majesty the Queen in Right of Ontario as represented by The Minister of Health and Long-Term Care

And

Central Local Health Integration Network

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CONTENTS

1. Purpose ...................................................................................... 1

2. Definitions .................................................................................. 1

3. LHIN’s Legal Authority and Mandate ....................................... 2

4. Crown Agent Status .................................................................. 3

5. LHIN Classification .................................................................... 3

6. Guiding Principles ..................................................................... 3

7. Accountability Relationships ................................................... 4 7.1 Minister .......................................................................................................... 4 7.2 Chair .............................................................................................................. 4 7.3 Board of Directors.......................................................................................... 4 7.4 Deputy Minister ............................................................................................. 4 7.5 LHIN Chief Executive Officer (CEO) .............................................................. 4

8. Conflict of Interest ..................................................................... 5

9. Roles and Responsibilities ....................................................... 5 9.1 Minister .......................................................................................................... 5 9.2 Chair .............................................................................................................. 6 9.3 Board of Directors.......................................................................................... 8 9.4 Deputy Minister ........................................................................................... 10 9.5 LHIN Chief Executive Officer ....................................................................... 12

10. Treasury Board / Management Board of Cabinet Directives 14

11. Accountability Agreement ...................................................... 14

12. Annual Reporting Requirements ............................................ 14 12.1 Annual Business Plan .................................................................................. 14 12.2 Annual Reports ............................................................................................ 15 12.3 Other Reports .............................................................................................. 15

13. Communications ..................................................................... 15

14. Administrative Arrangements ................................................ 16 14.1 Applicable TB/MBC and Ministry of Finance Directives ............................... 16 14.2 Common Issues and Common Services ..................................................... 17 14.3 Administrative and Organizational Support Services ................................... 18 14.4 Legal Services ............................................................................................. 18 14.5 Audit Services ............................................................................................. 18 14.6 Freedom of Information and Protection of Privacy ...................................... 18 14.7 Records Management ................................................................................. 18 14.8 Human Resource Services .......................................................................... 19 14.9 Information Management (IM) &Information Technology (IT) Infrastructure

Development and Management .................................................................. 19

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15. Financial Arrangements .......................................................... 19 15.1 Funding ....................................................................................................... 19 15.2 Financial Reports......................................................................................... 19 15.3 Taxation Status: Harmonized Sales Tax (HST) ........................................... 20

16. Audit and Review Arrangements ............................................ 20 16.1 Audits (other than Annual Financial Audits) ................................................. 20

17. Staffing and Appointees ......................................................... 20 17.1 Staffing ........................................................................................................ 20 17.2 Appointments .............................................................................................. 21 17.3 Qualifications of a Board Member ............................................................... 21 17.4 Term of Appointment ................................................................................... 22 17.5 Resignation of Board Members ................................................................... 22 17.6 Termination of Membership ......................................................................... 22

18. Liability Protection and Insurance ......................................... 22

19. Effective Date, Duration and Periodic Review of the MOU ... 22 19.1 Effective Date of MOU ................................................................................. 22 19.2 Reviews ....................................................................................................... 23

20. Signatures ................................................................................ 23

Appendix 1: Applicable TB/MBC and Ministry of Finance Directives ..................... 24

Appendix 2: Information Exchange, Communications and Issues Management Protocol Between MOHLTC Communications and Information Branch (CIB) and the LHIN ............................................................................................................................... 25

Appendix 3: Administrative or Organizational Support Services ............................ 31

Appendix 4: Designated Senior Positions in the LHIN for the Purposes of Post Service Conflict of Interest Rules ................................................................................ 32

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1. Purpose a. The purpose of this

Memorandum of Understanding is to:

(i) Set out the accountability relationships between the Minister and the Central LHIN;

(ii) Clarify the roles and responsibilities of the Minister, the Chair, the Deputy

Minister, the CEO, and the Board; and (iii) Set out the expectations for the operational, administrative, financial,

staffing, auditing and reporting arrangements between the LHIN and the Ministry.

b. This MOU should be read together with LHSIA and the Accountability Agreement This MOU does not affect, modify or limit the powers of the LHIN as set out in LHSIA, or interfere with the responsibilities of any of its parties as established by law. In case of a conflict between this MOU and any act or regulation, the act or regulation prevails. In case of a conflict between this MOU and the Accountability Agreement, the Accountability Agreement prevails.

2. Definitions In this MOU: a. “Accountability Agreement” means the Accountability Agreement between the

Ministry and the LHIN that is required by LHSIA.

b. “AEAD” means the TB/MBC Agency Establishment and Accountability Directive.

c. “Board” means the board of directors of the LHIN. d. “Chair” means the chair of the Board. e. “Board Member” means an individual appointed to the Board by the

Lieutenant Governor in Council. f. “CEO” means the Chief Executive Officer of the LHIN. g. “Common Issue” means an issue, policy or other matter on which the LHINs

want or are required by the Ministry, to have a common position. In the absence of agreement, an issue, policy or other matter will be deemed to be a Common Issue, and subject to the provisions of subsection 14.2 with the support of a least two-thirds of the LHINs.

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h. “Common Service” means a service required, used or available for use, by all LHINs. In the absence of agreement, a service will be identified as a Common Service, and subject to the provisions of subsection 14.2, with the support of at least two-thirds of the LHINs.

i. “Conflict of Interest Rules” means the rules set out in Ontario Regulation

381/07 or the rules approved by the Conflict of Interest Commissioner for the LHIN as the case may be.

j. “Deputy Minister” means the Deputy Minister of the Ministry. k. “Directives” means the directives listed in Appendix 1, which directives may

be revised, replaced or added to in accordance with section 10. l. “LHIN” means the Central Local Health Integration Network. m. “LHINs” means all the local health integration networks established or

continued as corporations under LHSIA. n. “LHSIA” means the Local Health Integration Act, 2006. o. “MBC” means Management Board of Cabinet. p. “Minister” means Minister of the Ministry. q. “Ministry” means the Ministry of Health and Long-Term Care. r. “MOU” means this memorandum of understanding required by the AEAD as

the same may be amended from time to time and includes all appendices. s. “PSOA” means the Public Service of Ontario Act, 2006, S.O. 2006, c. 35,

Schedule A. t. “TB” means Treasury Board. 3. LHIN’s Legal Authority and Mandate a. The legal authority of the LHIN is set out in LHSIA. b. The LHIN also exercises powers and authority under other legislation

including the Commitment to the Future of Medicare Act, 2004. c. Further to section 5 of LHSIA, the objects of the LHIN are to plan, fund and

integrate the local health system to achieve the purposes of LHSIA. d. The LHIN is a corporation without share capital. Neither the Corporations Act

nor the Corporations Information Act apply to the LHIN, except as prescribed under LHSIA.

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e. The LHIN has the capacity, rights, powers and privileges of a natural person for carrying out its objects, except as limited by LHSIA.

f. Subsection 134(1) and section 136 of the Business Corporations Act apply to

the LHIN, subject to the limitations set out in LHSIA. 4. Crown Agent Status The LHIN is a Crown agency within the meaning of the Crown Agency Act and may exercise its powers only as an agent of the Crown pursuant to subsection 4(1) of LHSIA. 5. LHIN Classification The LHIN is classified as an operational service agency under the AEAD. 6. Guiding Principles The parties agree to the following principles: (i) LHINs have a unique and important responsibility to manage local health

care needs across the health system on behalf of the government of Ontario.

(ii) The Minister acknowledges that the LHIN exercises powers and performs

duties in accordance with its mandate. (iii) The Minister acknowledges that the LHIN plays a meaningful role in the

development of the policies and programs of the government, as well as in the implementation of those policies and delivery of programs.

(iv) The Board acknowledges that accountability is a fundamental principle to

be observed in the management, administration and operations of the LHIN.

(v) As an agency of the government, the LHIN conducts itself according to the

management principles of the Government of Ontario. These principles include ethical behaviour; prudent; efficient, and lawful use of public resources; fairness; high quality service to the public; and openness and transparency to the extent allowed under law.

(vi) The LHIN and the Ministry agree to avoid duplication of services wherever

possible.

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7. Accountability Relationships 7.1 Minister The Minister is accountable: a. to Cabinet for attesting, reporting, and responding to Cabinet on the

performance of the LHIN and its compliance with the government’s operational policies and broad policy directions, and

b. for receiving and ensuring that the LHIN’s annual report is made available to

the public after tabling it in the Legislative Assembly. 7.2 Chair The Chair is accountable:

a. to the Board and to the Minister for the performance of the LHIN and for

carrying out the roles and responsibilities assigned to the Chair by LHSIA, other applicable legislation, this MOU, the Accountability Agreement and the Directives, and

b. for reporting to the Minister, as requested, on the LHIN’s activities. 7.3 Board of Directors The Board is accountable to the Minister, through the Chair, for the oversight and governance of the LHIN, setting goals, objectives and strategic direction for the LHIN within its mandate, and for carrying out the roles and responsibilities assigned to it by LHSIA, other applicable legislation, the Directives, the Accountability Agreement and this MOU. 7.4 Deputy Minister

The Deputy Minister is accountable to the Secretary of the Cabinet and the Minister for the performance of the Ministry in providing administrative and organizational support to the LHIN and for carrying out the roles and responsibilities assigned by the Minister, LHSIA, applicable TB/MBC and Ministry of Finance directives, the Accountability Agreement and this MOU. 7.5 LHIN Chief Executive Officer (CEO) The CEO is accountable to the Board, through the Chair, for carrying out the roles and responsibilities assigned to the CEO by the Board, LHSIA, this MOU, the Accountability Agreement and the Directives, including the management of the LHIN’s operations and staff.

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8. Conflict of Interest a. The LHIN’s employees and Board Members are required to follow the Conflict

of Interest Rules. b. The Chair is responsible for ensuring that appointees and staff of the LHIN

are informed of the ethical rules to which they are subject, including the rules on conflict of interest, political activity and protected disclosure of wrongdoing that apply to the LHIN.

c. The designated senior positions for the purposes of the Conflict of Interest

Rules are set out in Appendix 4.

9. Roles and Responsibilities 9.1 Minister The Minister is responsible to Cabinet for: a. Reporting and responding to the Legislative Assembly on the affairs of the

LHIN b. Attesting, reporting and responding to TB/MBC on the LHIN’s performance,

compliance with applicable TB/MBC directives, the government’s operational policies and policy directions

c. Where required, recommending to TB/MBC the merger, any change to the

LHIN’s mandate or dissolution of the LHIN d. Recommending to TB/MBC the powers to be given to, or revoked from, the

LHIN when a change to the mandate of the LHIN is being proposed e. Determining at any time the need for a review or audit of the LHIN, and

recommending to TB/MBC any changes to the governance or administration of the LHIN resulting from any such review or audit

f. When appropriate or necessary, taking action or directing that corrective

action be taken with respect to the LHIN’s administration or operations g. Receiving the LHIN’s annual report and ensuring that the annual report is

made available to the public after tabling it in the Legislative Assembly h. Providing strategic direction to the LHIN for the health system and informing

the Chair of the government’s priorities and broad policy directions for the LHIN

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i. Consulting, as appropriate, with the Chair (and others) on significant new directions or when the government is considering regulatory or legislative changes for the LHIN

j. Developing the LHIN’s MOU and Accountability Agreement with the LHIN and

signing the MOU and the Accountability Agreement. k. Recommending the LHIN’s MOU to TB/MBC for approval before it is signed

by the parties. l. Reviewing and approving the LHIN’s annual business plan m. Recommending to TB/MBC any provincial funding to be allocated to the LHIN n. Directing the Board, through the Chair, to undertake reviews of the LHIN on a

periodic basis, and making recommendations to TB/MBC as may be required after such reviews are completed

o. Providing direction on the development of the LHIN’s annual business plan p. Reviewing the advice or recommendation of the Chair on candidates for

appointment or re-appointment to the Board. q. Recommending a Chair and a vice-chair for designation by the Lieutenant

Governor in Council r. Meeting with the Chair or the Board annually. 9.2 Chair The Chair is responsible for: a. Providing leadership to the Board and monitoring the Board’s performance. b. On behalf of the Board, seeking strategic policy direction for the LHIN from

the Minister. c. Communicating strategic directions and decisions of the Board to the CEO. d. Convening and chairing meetings of the Board in accordance with the by-

laws. e. Representing the Board at meetings with the Minister, the Deputy Minister,

Joint LHIN meetings or on working groups, and delegating this role in whole or in part to Board Members as necessary or appropriate.

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f. Communicating to the Board about the meetings that the Chair attends, including the substance of the issues discussed and any consensus reached for consideration by the Board.

g. Communicating the Board’s position back to the Minister, the Deputy Minister,

Joint LHIN meetings or working groups as the case may be. h. On behalf of the Board, communicating in a timely manner with the Minister

regarding any issues or events that may concern, or can reasonably be expected to concern the Minister in the exercise of the Minister’s responsibilities relating to the LHIN or the local health system.

i. Consulting, on behalf of the Board, with the Minister in advance regarding any

activity which may have an impact on the government and Ministry’s policies, directives or procedures, or on the LHIN’s mandate, powers or responsibilities as set out in LHSIA, the MOU or the Accountability Agreement.

j. Keeping the Minister informed of upcoming appointment vacancies and

providing recommendations for appointments or re-appointments. k. Signing the MOU and the Accountability Agreement on behalf of the Board as

authorized by the Board. l. Ensuring that LHIN staff and Board members are informed of applicable

Directives with which the LHIN is required to comply. m. Ensuring that Board Members are informed of their responsibilities under the

PSOA with regard to the rules of ethical conduct including the oaths, Conflict of Interest Rules, political activity rules and wrong-doing.

n. Carrying out effective public communications and relations for the LHIN as its

chief spokesperson, in partnership with the CEO, and delegating this role in whole or in part to Board Members as necessary or appropriate.

o. Ensuring the evaluation of the performance of the CEO in consultation with

the Board and pursuant to performance criteria established by the Board. Performance criteria should be based on best practices in the health sector for senior managers.

p. Cooperating with any review or audit of the LHIN directed by the Minister or

TB/MBC. q. Fulfilling the role of ethics executive for Board Members under the PSOA,

requiring Board Members to comply with the PSOA and applicable rules in respect of conflict of interest, political activity, and the protected disclosure of wrongdoing.

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r. Promoting ethical conduct and ensuring that all Board Members are familiar with their responsibilities under the PSOA with regard to the rules of ethical conduct, including the oaths, Conflict of Interest Rules, political activity rules and the protected disclosure of wrongdoing.

s. Ensuring that the LHIN designates designated senior positions in the LHIN,

including Board Members, for the purposes of the Conflict of Interest Rules. t. Reviewing and approving claims for per diems and expenses of Board

Members. u. Making attestations on behalf of the Board under, and ensuring that the

expenses of the Board Members are posted in accordance with, the Broader Public Sector Accountability Act, 2010.

9.3 Board of Directors The Board is responsible for: a. Setting the goals, objectives, and strategic directions for the LHIN consistent

with its mandate as defined by LHSIA, applicable government policies, and this MOU

b. Monitoring the performance of the LHIN. c. Directing the affairs of the LHIN and setting overall priorities so as to fulfill its

mandate d. Directing the development of, reviewing, and approving the LHIN’s annual

business plan, budget and annual report, and submitting them to the Minister in accordance with the time lines specified in the Directives, this MOU, or within the timelines agreed upon with the Ministry.

e. Ensuring that the LHIN operates within its approved budget allocation in

fulfilling its mandate. f. Reporting to the Minister, through the Chair, as requested on the LHIN’s

activities within agreed upon timelines. g. Making decisions consistent with the annual business plan approved for the

LHIN and ensuring that the LHIN operates within its allocations. h. Ensuring that the LHIN manages its affairs in compliance with the Directives. i. Ensuring that the LHIN uses public funds prudently and only for the business

of the LHIN based on the principle of value for money, and in compliance with applicable legislation and the Directives.

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j. Ensuring that LHIN funds are used with integrity, honesty, fairness and effective controllership.

k. Establishing such Board committees or oversight mechanisms as required by

LHSIA or as may be required to advise the Board on the effective management, governance or accountability procedures for the LHIN

l. Developing written position descriptions, roles and responsibilities for Board

committee chairs and members m. Approving the MOU for the LHIN and the Accountability Agreement in a timely

manner and authorizing the Chair to sign the MOU and the Accountability Agreement on behalf of the LHIN.

n. Approving the LHIN’s reports and reviews that may be requested by the

Minister from time to time for submission to the Minister within agreed upon timelines.

o. Ensuring that Board Members have received sufficient training to carry out

their duties and responsibilities. p. Performing an annual assessment of the effectiveness of the Board as a

whole and on Board Members using tools common to all LHINs. q. Directing the development of an appropriate risk management framework and

a risk management plan and arranging for risk-based reviews and audits of the LHIN as needed.

r. Requiring that LHIN employees and Board Members abide by the Conflict of

Interest Rules. s. Complying with the Conflict of Interest Rules, including the post service

provisions that apply to designated senior positions in the LHIN. t. Ensuring that appropriate management systems are in place (financial,

information technology, human resource) for the effective administration of the LHIN.

u. Establishing performance measures, targets and management systems for

monitoring and assessing the operational performance of the LHIN v. Directing corrective action on the functioning or operations of the LHIN, if

needed w. Cooperating with and sharing any relevant information on any risk-based or

periodic review directed by the minister or TB/MBC

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x. Consulting, as appropriate, with stakeholders on the LHIN’s goals, objectives and strategic directions

y. Providing advice to the government, through the Minister, on issues within or

affecting the LHIN’s mandate and operations. z. Providing both the Minister and the Minister of Finance with a copy of every

audit report of the LHIN, a copy of the LHIN’s response to each report, and any recommendations in the report.

aa. Advising the Minister annually on any outstanding audit recommendations. bb. Ensuring that an appropriate framework is in place for LHIN staff and Board

Members to receive adequate orientation and training. cc. Ensuring that a process for responding to and resolving complaints from the

public is in place. dd. Establishing performance criteria for the evaluation of the performance of the

CEO. Performance criteria should be based on best practices in the health sector for senior managers.

ee. Complying with the Directives. 9.4 Deputy Minister The Deputy Minister is responsible for: a. Advising and assisting the Minister regarding the Minister’s responsibilities for

the LHIN. b. Advising the Minister on the requirements of the AEAD, the Government

Appointees Directive and other directives that apply to the LHIN. c. Recommending to the Minister, as may be necessary, the evaluation or

review, including a risk-based review, of the LHIN or any of its programs, or changes to the management framework or operations of the LHIN.

d. Facilitating regular briefings and consultations between the Chair and

Minister, and between Ministry staff and LHIN staff. e. Attesting to TB/MBC as required, to the LHIN compliance with the mandatory

accountability requirements set out in the AEAD. f. Ensuring that the Ministry and the LHIN have the capacity and systems in

place for on-going risk-based management, including appropriate oversight of the LHIN.

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g. Ensuring that the LHIN has an appropriate risk management framework and a risk management plan in place for managing risks that the LHIN may encounter in meeting its program or service delivery objectives.

h. Undertaking timely risk-based reviews of the LHIN, its management or

operations, as may be directed by the Minister or TB/MBC. i. Establishing a framework for reviewing and assessing the LHIN’s annual

business plans and other reports. j. Supporting the Minister in reviewing the performance of the LHIN. k. Monitoring the LHIN on behalf of the Minister while respecting the LHIN's

authority, identifying needs for corrective action where warranted, and recommending to the Minister ways of resolving any issues that might arise from time to time.

l. Advising the Minister on documents submitted by the LHIN to the Minister for

review or approval, or both. m. Submitting to the Minister, as part of the annual planning process, a risk

assessment and management plan for each risk category. n. Undertaking reviews of the LHIN as may be directed by the Minister. o. Cooperating with any review of the LHIN as directed by the Minister or

TB/MBC. p. Developing the LHIN’s MOU and the Accountability Agreement with the LHIN

as directed by the Minister. q. Consulting with the LHIN’s CEO or chair, as needed, on matters of mutual

importance including services provided by the Ministry and compliance with the Directives and Ministry policies.

r. Meeting with the Chair as needed or as directed by the Minister. s. Arranging for administrative, financial and other support to the LHIN as

specified in this MOU. t. Informing the Chair, in writing, of new government directives and any

exceptions to or exemptions in whole or in part from TB/MBC directives or Ministry administrative policies.

u. When required, submitting a report to the secretaries of TB/MBC on the wind-

down of the LHIN, disposition of any assets, completion of any outstanding responsibilities by the LHIN, and the termination of any appointments.

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9.5 LHIN Chief Executive Officer The Chief Executive Officer is responsible for: a. Managing the day-to-day operations of the LHIN in accordance with LHSIA,

the Accountability Agreement, the MOU, the Directives, and accepted business and financial practices

b. Advising the Chair on the requirements of and compliance with the Directives

and other TB/MBC and Ministry of Finance policies, and LHIN by-laws and policies

c. Complying with the Directives. d. Ensuring that LHIN staff is aware of, their responsibilities under, and requiring

LHIN staff to comply with, the Directives. e. Applying policies and procedures so that public funds are used prudently, with

integrity and honesty and only for the business of the LHIN f. Providing leadership and management to the LHIN employees, including

financial resources management g. Establishing and applying a financial management framework for the LHIN in

accordance with applicable Minister of Finance controllership directives, policies and guidelines

h. Translating the goals, objectives and strategic directions of the Board into

operational plans and activities in accordance with the LHIN’s approved business plan

i. Ensuring that the LHIN has the oversight capacity and an effective oversight

framework in place for monitoring its management and operations j. Keeping the Board, through the Chair, informed with respect to

implementation of policy and the operations of the LHIN k. Keeping the Board, through the Chair, informed about operational matters l. Establishing systems to ensure that the LHIN operates within its approved

business plan m. Ensuring that the LHIN has an appropriate risk management framework and

risk management plan in place as directed by the Board n. Supporting the Chair and Board in meeting their responsibilities

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o. Developing the LHIN’s MOU and Accountability Agreement with the Ministry as directed by the Board

p. Preparing annual reports and business plans for the LHIN as directed by the

Board q. Preparing financial reports for approval by the Board r. Carrying out in-year monitoring of the LHIN’s performance and reporting on

results to the Board through the Chair s. Keeping the Ministry and the Chair advised on issues or events that may

concern the Minister, the Deputy Minister and the Chair in the exercise of their responsibilities

t. Seeking support and advice from the Board or the Ministry, as appropriate, on

LHIN management issues u. Establishing a system for the retention of LHIN documents and for making

such documents publicly available when appropriate, for complying with the Freedom of Information and Protection of Privacy Act and the Archives and Recordkeeping Act where applicable

v. Undertaking timely risk-based reviews of the LHIN’s management and

operations w. Consulting with the Deputy Minister as needed, on matters of mutual

importance, including services provided by the Ministry, and on TB/MBC and Ministry of Finance directives and Ministry policies

x. Cooperating with a periodic review directed by the Minister or TB/MBC y. Preparing, for approval by the Board, a performance review system for staff

and implementing the system z. Promoting ethical conduct and ensuring that all employees of the LHIN are

familiar with the ethical requirements of the PSOA. Ensuring that staff of the LHIN are informed of their responsibilities under the PSOA with regard to the rules of ethical conduct (Part IV of the PSOA), including the oaths, Conflict of Interest Rules, political activity rules and wrongdoing.

aa. Fulfilling the role of ethics executive for employees of the LHIN under the

PSOA, and requiring employees to comply with the PSOA and the applicable rules in respect of conflict of interest, political activity, and the protected disclosure of wrongdoing.

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10. Treasury Board / Management Board of Cabinet Directives a. The LHIN is subject to the TB/MBC directives listed in Appendix 1 to this

MOU along with all related guidelines and policies, all as amended or replaced from time to time. The Ministry may from time to time provide the LHIN with one or more amended or replacement directives. The LHIN will be subject to each such revised or replacement directive when the LHIN receives it from the Ministry.

b. If TB/MBC issues a new directive that applies to the LHIN during the term of

this MOU, the Ministry will provide the new directive to the LHIN. The LHIN will be subject to the new TB/MBC directive when the LHIN receives it from the Ministry.

c. The Ministry will revise Appendix 1 to reflect each revised, replacement and

new directive, if any, and provide any such revised Appendix 1 to the LHIN as soon as is practicable after the Ministry provides the revised, replacement or new directive to the LHIN.

11. Accountability Agreement a. The Minister and the LHIN have entered into an Accountability Agreement.

As required by section 18 of LHSIA the current Accountability Agreement is for two years, from April 1, 2010 until March 31, 2012, as extended, and includes the following: (i) performance goals and objectives for the LHIN and the local health

system; (ii) performance standards, targets and measures for the LHIN and the

local health system; (iii) requirements for the LHIN to report on the performance of the LHIN

and the local health system; (iv) a plan for spending the funding that the LHIN receives from the

Minister under section 17 of LHSIA, which spending shall be in accordance with the appropriation from which the Minister has provided the funding to the LHIN;

(v) a progressive performance management process for the LHIN.

12. Annual Reporting Requirements 12.1 Annual Business Plan a. The Board will ensure that the Minister is provided annually with the LHIN’s

annual business plan covering a minimum of three years from the current fiscal year that includes a financial budget, a risk management plan, and a communications plan for approval within the timelines established by the Minister for this purpose.

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b. The Board is responsible for ensuring that the LHIN’s annual business plan meets the requirements of the AEAD.

c. The Board will ensure that the business plan includes a risk assessment and

risk management plan to assist the Ministry in developing its risk assessment and risk management plan information in accordance with the requirement of the AEAD, to assess risks, develop and maintain necessary records and report to TB/MBC.

d. The Minister will review the LHIN's annual business plan and will promptly

advise the chair whether or not he/she concurs with the directions proposed by the LHIN. The Minister may advise the Chair where and in what manner the LHIN’s plans vary from government or Ministry policy or priorities as may be required, and the LHIN will revise its plan accordingly

e. The Board is responsible for ensuring that the LHIN’s annual business plan

includes a system of performance measures and reporting on the achievement of the objectives set out in the annual business plan. The system must include performance goals, how they will be achieved, and target results and time frames

f. In addition, TB/MBC may require the Minister to submit the LHIN’s annual

business plan to TB/MBC for review at any time. 12.2 Annual Reports The Board is responsible for ensuring that the LHIN’s annual report is submitted to the Minister for tabling in the legislative assembly. The Chair will submit the annual report, on behalf of the Board, to the Minister within 90 days of the LHIN’s fiscal year end. 12.3 Other Reports The Board will ensure that: a. Such reports as are required by the Accountability Agreement are submitted

to the Ministry in accordance with the Accountability Agreement. b. At the request of the Minister or Deputy Minister, any information that may be

required from time-to-time for the purpose of Ministry administration, is submitted to the Ministry.

13. Communications a. The parties to this MOU recognize that the timely exchange of information on

the operations and administration of the LHIN is essential for the Minister to meet the Minister’s responsibilities for reporting and responding to the Legislative Assembly on the affairs of the LHIN. The parties also recognize

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that it is essential for the Chair to be kept informed of the government initiatives and broad policy directions that may affect the LHIN’s mandate and functions.

b. The parties, therefore, agree as follows:

(i) The Chair will keep the Minister advised, in a timely manner, of all planned events and issues that concern or can be reasonably expected to concern the Minister in the exercise of the Minister’s responsibilities

(ii) The Minister will consult with the Chair, as appropriate, on broad

government policy initiatives or legislation being considered by the government that may impact on the LHIN’s mandate or functions

(iii) The Minister and the Chair will consult with each other on public

communications strategies and publications. They will keep each other informed of the results of stakeholder and other public consultations and discussions

(iv) The Minister and the Chair will meet at least annually, or as requested by

either party, to discuss issues relating to the fulfillment of the LHIN’s mandate, management and operations

(v) The Deputy Minister and the CEO will meet at least quarterly to discuss

issues relating to the efficient operation of the LHIN and the provision of services by the Ministry to the LHIN

(vi) The LHIN and Ministry will adhere to the Information Exchange,

Communications and Issues Management Protocol between MOHLTC Communications and Information Branch (CIB) and the LHIN set out in Appendix 2 to this MOU.

14. Administrative Arrangements 14.1 Applicable TB/MBC and Ministry of Finance Directives a. The Board is responsible for ensuring that the LHIN operates in accordance

with all applicable Directives, as well as applicable Ministry financial and administrative policies and procedures.

b. The Board is responsible for ensuring that the legal, financial and other

interests of the government in intellectual property are protected in any contract that the LHIN may enter into with a third party that involves the creation of intellectual property.

c. The Board is responsible for ensuring that clear expectations are established

for transfer payment recipients, and for ensuring effective diligence when setting up and monitoring transfer payment contracts to ensure public

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services are delivered, commitments are fulfilled and the right controls are in place to ensure the prudent use of taxpayers’ money.

14.2 Common Issues and Common Services a. The LHIN acknowledges that it is one LHIN in a province-wide network of

LHINs under LHSIA, each of which is subject to the same objects and substantially the same obligations as a result of its agency relationship with the Ministry. Without limiting the foregoing each LHIN:

(i) is subject to LHSIA; (ii) has the same memorandum of understanding with the Government; (iii) has substantially the same by-laws as each other LHIN; (iv) has the same Conflict of Interest Rules; (v) has substantially the same basic operating policies; and (vi) has substantially the same Accountability Agreement and performance

requirements.

b. Recognizing the inherent efficiencies for both the Ministry and the LHINs in maintaining common structures and policies, the LHIN agrees that it will act in concert with the other LHINs to resolve Common Issues in a common manner. The LHIN agrees that it will respect and abide by the position approved by a two-thirds majority of the LHINs if a consensus cannot be reached through discussion and debate.

c. The LHIN further acknowledges that, as a condition of establishing the LHINs,

TBC/MBC directed the Ministry to ensure that Common Services were delivered efficiently and cost effectively to the LHINs. Accepting that centralized sourcing and sharing of services is an efficient and effective use of LHIN resources, the LHIN agrees to enter into a shared services agreement with the other LHINs to enable the procurement and management of Common Services on behalf of all the LHINs. The LHIN agrees that it will respect and abide by the direction on Common Services approved by a two thirds majority of the LHINs if a consensus cannot be reached through discussion and debate.

d. For the purpose of the above paragraphs, the position of each LHIN will be

determined by the CEO or the Board, as appropriate, and will be represented to the group of LHINs by the CEO or Chair. The common position will be determined by a vote conducted in-person, by e-mail or by any combination of methods that allow all LHINs to communicate their position to the other LHINs. The results of the vote will be tabulated and confirmed by the LHINs’ legal counsel or such other person as may be determined from time to time.

e. The Ministry will recognize positions determined by the above process as the

common position of the LHINs on a Common Issue or Common Service.

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14.3 Administrative and Organizational Support Services a. The Deputy Minister is responsible for providing the LHIN with the

administrative and organizational support services listed in Appendix 3 to this MOU.

b. Appendix 3 may be reviewed at any time at the request of either party c. The Deputy Minister will ensure that the support or services provided to the

LHIN are of the same quality as those provided to the Ministry’s own divisions and branches.

14.4 Legal Services a. The LHIN requires legal services. These services are to be provided in

accordance with the Ministry of the Attorney General's Corporate Operating Policy on Acquiring and Using Legal Services.

b. The LHIN shall use the same in-house counsel as all other LHINs, either

directly or indirectly through a shared service arrangement among the LHINs. 14.5 Audit Services Each Board shall appoint the same auditor as all other LHINs for its annual financial audit. Notwithstanding the foregoing, the conduct of the audit is under the direction and control of the Board. 14.6 Freedom of Information and Protection of Privacy The CEO is the institution head for the purposes of the Freedom of Information and Protection of Privacy Act. 14.7 Records Management a. The Board is responsible for ensuring that a system is in place for the

creation, collection, maintenance, and disposal of records. b. The Board through the Chair is responsible for ensuring that the LHIN

complies with the Archives and Recordkeeping Act, 2006, S.O. 2006, Chapter 34, Schedule A.

c. Each LHIN shall appoint the same individual to assume corporate

responsibility for the management of recorded information pursuant to the Directive on Management of Recorded Information.

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14.8 Human Resource Services Each LHIN shall utilize substantially similar employment policies and practices. Each LHIN shall use or employ the same human resources services as all other LHINs either directly or indirectly through a shared service arrangement among the LHINs. 14.9 Information Management (IM) &Information Technology (IT)

Infrastructure Development and Management Each LHIN shall use the same IM and IT infrastructure, standards, practices and policies as all other LHINs. 15. Financial Arrangements 15.1 Funding a. The LHIN is funded through transfer payments from the Ministry in

accordance with the terms of LHSIA and the Accountability Agreement. b. When ordered to do so by the Minister of Finance, pursuant to Section 16.4 of

the Financial Administration Act, the LHIN shall pay into the Consolidated Revenue Fund any money that the Minister of Finance determines is surplus to its requirements.

c. Pursuant to Section 28 of the Financial Administration Act, the LHIN shall not

enter into any financial arrangement or commitment, guarantee, indemnity or similar transaction that may increase, directly or indirectly, the indebtedness or contingent liabilities of the Government of Ontario without the written approval of the Minister of Finance. The Minister’s approval is required before seeking statutory approval from the Minister of Finance.

d. Financial procedures of the LHIN must be in accordance with TB/MBC and

Ministry of Finance directives and guidelines and other applicable government direction.

e. Recovered costs and other revenues, if any, are paid as received to the

Consolidated Revenue Fund, unless LHSIA provides otherwise, and may not be applied to administrative expenditures of the LHIN unless otherwise provided by LHSIA.

f. The Minister on behalf of the Government is entitled to recover any unspent

operating or grant monies provided by the Minister to the LHIN. 15.2 Financial Reports a. The LHIN shall provide, on instruction from the Ministry of Finance, the

LHIN’s financial information for consolidation into the Public Accounts.

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b. The LHIN will submit to the Ministry of Finance its salary information

according to the Public Sector Salary Disclosure Act. c. The Board will provide to the Minister audited annual financial statements,

and will include them as part of the LHIN’s annual report. The statements will be provided in a format that is in accordance with the province’s stated accounting policies issued by the Office of the Provincial Controller.

15.3 Taxation Status: Harmonized Sales Tax (HST) The LHIN receives a CVAT rebate under the Comprehensive Integrated Tax Coordination Agreement. 16. Audit and Review Arrangements 16.1 Audits (other than Annual Financial Audits) a. The LHIN is subject to periodic review and value-for-money audit by the

Auditor General of Ontario under the Auditor General Act or by the Ontario Internal Audit Division.

b. The Ontario Internal Audit Division may also carry out an internal audit, if

approved to do so by the Ministry’s Audit Committee or by the Corporate Audit Committee.

c. Regardless of any annual external audit, the Minister may direct that the LHIN

be audited at any time. d. The Board will promptly provide a copy of every report from an audit to the

Minister and the Minister of Finance. The LHIN will also provide a copy of its response to the audit report and any recommendations therein. The LHIN will advise the Minister annually on any outstanding audit recommendations.

e. The Board may request an external audit of the financial transactions or

management controls of the LHIN at the LHIN’s expense. 17. Staffing and Appointees 17.1 Staffing a. The LHIN employees, other than the CEO, report to and are accountable to

the CEO for their performance under LHSIA. b. The CEO is employed by the LHIN under LHSIA.

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17.2 Appointments a. The Members of the Board are appointed by the Lieutenant Governor in

Council on the recommendation of the Minister pursuant to subsection 7(1) of LHSIA.

b. The Chair and the Vice Chair are designated by the Lieutenant Governor in

Council on the recommendation of the Minister pursuant to subsection 7(6) of LHSIA.

17.3 Qualifications of a Board Member a. Board Members must meet the following criteria:

1. be at least eighteen years of age; 2. not be an undischarged bankrupt; 3. be interested in furthering the objects of the LHIN; and 4. attend directors meetings on a regular basis.

b. As part of the appointment process for Board Members the Minister will

consider for appointment persons who have a background in health care, public administration, management, accounting, finance, law, human resources, labour relations, communications, information technology, marketing, or such other skills and professions that can assist a Board in meeting the LHIN’s objects;

c. Except as may be permitted by the Lieutenant Governor in Council, Board

Members cannot be:

1. a member of the board, chief executive officer, an officer, employee or staff of: A. any corporation, agency or entity that represents the

interests of persons who are part of the health sector and whose main purpose is advocacy for the interests of those persons;

B. a College of a health profession or group of health professions as defined under the Regulated Health Professions Act, 1991; or

C. an entity that receives funding from a LHIN; 2. an employee of the Ministry; 3. an employee of the LHIN; or 4. an associate of any person referred to in 1, 2, or 3 above, where

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

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17.4 Term of Appointment Board Members will be appointed by the Lieutenant Governor in Council for a term of up to three years at the pleasure of the Lieutenant Governor in Council and may be reappointed for one further term of up to three years. If a person ceases to be a Board Member before the term of the member expires, the first term of the person’s successor shall be for the remainder of the first person’s term or 13 months, whichever is the longer. 17.5 Resignation of Board Members a. Board Members may resign at any time by resignation in writing given to the

Chair and to the Minister. b. Board Members must resign if the Board Member no longer meets the

qualifications set out in 17.3. Board Members wishing to seek nomination for, be a candidate for, or hold a municipal, provincial or federal elected office, are subject to the provisions of the PSOA.

17.6 Termination of Membership A Board Member ceases to be a Board Member, if before the term of the Board Member expires: 1. the Lieutenant Governor in Council revokes the Board Member’s

appointment; or 2. the Board Member dies, resigns as a Board Member, or becomes a bankrupt. 18. Liability Protection and Insurance The LHIN will purchase third party liability insurance coverage to protect itself against claims that might arise from anything done or omitted to be done by the LHIN or its directors, officers, employees, or agents, and from anything done or omitted to be done where bodily or personal injury, death, or property damage, including loss of use thereof, is caused. 19. Effective Date, Duration and Periodic Review of the MOU 19.1 Effective Date of MOU a. This MOU becomes effective on the date it is signed by both of the parties. b. This MOU will continue in effect for five years from the effective date subject

to 19.1(c). c. This MOU will remain in force for no more than six months after its expiry date

until a new signed MOU is provided to the Secretary, MBC. d. If a new Minister or Chair takes office before this MOU expires, the Minister

and Chair must affirm by letter that the MOU will continue in force without a

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review; or alternatively, they may agree to revise it. A copy of the letter of affirmation between the Minister and Chair must be provided to the Secretary, Management Board of Cabinet within six months of the new party or parties’ commencement.

e. Without affecting the effective date of this MOU, either the Minister or Chair

may initiate a review of this MOU by written request to the other. f. A full review of this MOU will be conducted prior to its expiry and not more

than five years following the date it came into effect or immediately in the event of a significant change to the LHIN’s mandate, powers or governance structure as a result of an amendment to LHSIA.

19.2 Reviews a. The LHIN may be subject to a review at the discretion and direction of

TB/MBC or the Minister. The review may cover such matters relating to the LHIN that are determined by TB/MBC or the Minister, and may include the mandate, powers, governance structure and/or operations of the LHIN.

b. The Minister will consult the Chair as appropriate during any such review. c. The Board, the Chair and the CEO will cooperate in any review. 20. Signatures

______________________ _____________________ John Langs Date

LHIN Chair Central LHIN

_________________________ _____________________ Deb Matthews Date Minister Ministry of Health and Long-Term Care This Memorandum of Understanding was approved by Management Board of Cabinet on August 15, 2012.

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Appendix 1: Applicable TB/MBC and Ministry of Finance Directives 1. The following TB/MBC and Ministry of Finance directives and policies, as well

as any additional policies or guidelines related to the listed directives and policies, apply to the LHIN:

• Accountability Directive • Accounting for Order in Council Appointees Policy • Advertising Content Directive and Government Advertising Act, 2004 • Agency Establishment and Accountability Directive • Cash Management Directive • Communications in French Directive • Disclosure of Wrongdoing Directive • Freedom of Information and Protection of Privacy Directive • Government Appointees Directive • Government Publications Directive • Indemnification Directive • Internal Audit Directive • Internal Controls Directive • Management of Recorded Information Directive • Managing, Distributing and Pricing Government Information (Intellectual

Property) • Prerequisites Directive • Procurement Directive • Procurement Directive on Advertising, Public and Media Relations, and

Creative Communications Services • Procurement Directive (Public Opinion Polls and Market Research

Studies) • Real Property and Accommodation Directive • Relocation expenses for Employees Directive • Transfer Payment Accountability Directive • Travel, Meal and Hospitality Expenses Directive • Visual Identity Directive

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Appendix 2: Information Exchange, Communications and Issues Management Protocol Between MOHLTC Communications and Information Branch and the LHIN

General Agreement. The parties recognize that the timely exchange of information and consultation is essential to success in discharging their respective responsibilities. 1. The Ministry acknowledges that the LHINs, individually and collectively,

have consistently developed, with the Ministry and CIB, a productive and collaborative approach to communications, issues and crisis management. The purpose of this Appendix 2 is to facilitate and ensure effective collaboration in the development and coordination of public and major stakeholder relations communications, particularly related to provincial initiatives being executed at pan-LHIN and local levels, and issues impacting the LHINs and the Ministry. To this end, the LHIN, CIB and other Ministry communications staff will work together in an ongoing and systematic manner to ensure that joint communications planning and implementation are efficient and streamlined, accommodate the dynamic nature of the LHINs’ work, and enable the LHINs to fulfill their mandate. It is with this understanding that the parties have agreed to this Appendix 2.

2. Where the term “major” is used in this Appendix 2, it is intended to refer to products, plans, reports, activities and other matters, as the case may be, that are directed to the media or that are likely to draw media attention; that may be high profile with public or providers; and/ or are likely to be contentious.

Duty to Advise Minister. The Board, through its Chair, shall keep the Minister advised of issues or events that concern or can be reasonably expected to concern the Minister in the exercise of his or her responsibilities. These issues or events will be communicated by the Chair to the Minister within the timeframes required in this MOU. Communications. Communications between the LHIN and the Ministry of Health and Long-Term Care’s Communications and Information Branch (“CIB”) regarding matters that fall within advertising, marketing communications, public relations, communications planning and issues management will be between the LHIN CEO (or his or her designate) and the Assistant Deputy Minister of CIB (or his or her designate). These parties or their designates will liaise on activities to which this Appendix 2 applies.

Major LHIN communications products and plans, including positioning statements and key messaging, will be shared with the CIB as set out in this Appendix 2, to enable alignment and consistency with the government’s overall communications objectives, strategies and key messages. These products and

Advertising, Marketing Communications, Public Relations and Positioning

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plans will be subject to the review and approval process established for the CIB in support of the Minister to the extent required by this Appendix 2.

1. The parties acknowledge that a professional and effective communications program is critical to the success of the LHIN in Ontario. The LHIN and CIB will work collaboratively to develop an annual pan-LHIN / Ministry communications strategy which will encompass both public and health service provider-focused communications initiatives that support the LHIN’s mandate, as well as enable alignment in overall positioning, messaging and timing of activities, where applicable with Ministry priorities. This pan-LHIN / Ministry communications strategy will be contained in the preamble of the LHIN’s own annual communications plan required to be included in its annual business plan (the “LHIN Specific Plan”).

Guiding Principles

2. All local communications activities will be conducted in a systematic manner, according to the LHIN Specific Plan. All pan-LHIN communications activities will be conducted in a systematic manner according to any applicable pan-LHIN communications plans. The LHIN-Specific Plan and any additional pan-LHIN communications plans will be reviewed and approved by the LHIN CEO (or his or her designate) and the Assistant Deputy Minister of CIB (or his or her designate), as required. The Ministry, through CIB, will be apprised of all major local LHIN communications plans in accordance with the provisions of this Appendix 2 set out below under the heading “Implementation Operations.”

3. Government of Ontario protocols, including: Advertising Review Board criteria, the Government Advertising Act, visual identity standards and the requirement of sourcing to Ministry vendors of record, will apply in all cases. The Ministry will notify the LHIN of all such protocols that are not part of the listed Directives.

Relevant Directives on Procurement and Content The acquisition of communications services shall be conducted according to the Directives. This includes agencies providing advertising, creative, public relations, market research or media buying services. Any communication agencies retained by the LHIN will be engaged through established Advertising Review Board processes and guidelines. Communications Planning. The LHIN shall develop and implement a LHIN Specific Plan each year, which will form part of the LHIN’s annual business plan submission to the Ministry. This communications plan, which will contain a preamble based on the collaborative development of a pan-LHIN / Ministry communications strategy, will be shared with the CIB and approved by the LHIN Board and the LHIN CEO, and submitted by the LHIN CEO (or designate) to

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CIB’s Assistant Deputy Minister (or designate) for review, before final approval of the entire annual business plan by the Ministry. Consistent with Annual Business Plan. The LHIN will use best efforts to ensure that communications products arising from the communication plan will be in keeping with the LHIN Specific Plan for that fiscal year included in its annual business plan submission to the Ministry. Coordination of Communications Plan. The LHIN CEO (or designate) and the Ministry’s Assistant Deputy Minister (or designate) of CIB will work co-operatively to implement a comprehensive, multifaceted communications plan that is coordinated with Ministry efforts to support and facilitate the mandate of the LHIN described in Section 3 of the MOU. Market Research. Any market research undertaken by the LHIN will be carried out by an approved vendor of record of the government following the Directives and in accordance with a business case approved in accordance with the Directives. In addition, the LHIN will follow such vendor of record research proposal and implementation process as may be agreed to by both parties in advance of any research expenditures and based on the approval of a business case by CIB. The LHIN will provide to CIB, in a timely manner, the results of any public, health service provider, or other market research activities of the LHIN relating to measurement or evaluation of campaigns or programs or concerning the development of communications plans or strategies. In fulfilling its mandate, the LHIN regularly carries out research within its local community in relation to health care matters and otherwise in fulfillment of its mandate (“LHIN Information Gathering - Research”). This research, which provides the LHIN with input from the public and other stakeholders within its community, may be undertaken via social media, impromptu meetings with community groups, service clubs and other special interest groups, town halls, community forums, and other means. For certainty, the provisions relating to market research above, do not apply to any such LHIN Information Gathering - Research. Evaluation. The LHIN will provide CIB with such communications program activities performance data and evaluation reports, as may be agreed to by both parties.

(b) prior to issuing any news release or other planned media communications, consult with the Assistant Deputy Minister of CIB (or designate) within the

Implementation Operations Notification of CIB. The LHIN’s CEO (or designate) will: (a) keep the Assistant Deputy Minister of CIB (or designate) fully apprised of

significant developments and issues likely to be contentious as soon as reasonably possible as outlined in the timelines below to enable appropriate government review and response;

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timelines set out below under “Content of Timing and Communications”; and

(c) be accountable for notifying CIB of issues as soon as reasonably possible after these come to the attention of the LHIN.

Notification of LHIN. The CIB will be accountable to the LHIN for: (a) ensuring that issues raised by the LHIN are brought to the attention of the

Minister’s Office through established issue management protocols and procedures;

(b) keeping it fully apprised of developments and issues as soon as possible as outlined in the timelines below to ensure appropriate LHIN review and response and

(c) providing any required feedback to the LHIN work in a timely fashion and as soon as possible or as agreed upon at the time of notification.

Issue Management Protocols. The LHIN and the Ministry shall follow established Ministry and Government issue management protocols and procedures for responding to media issues or other issues or events relating to the LHIN that may be reasonably expected to concern the Government. This includes release of major reports or major publications through reporting mechanisms as agreed to by both parties. Publications and Web Design. The LHIN’s communications activities and branding shall be managed in accordance with this Appendix 2 and the Directives. Print and web-based publications (e.g., reports) and communications products (e.g., brochure, advertisement) will be developed and produced according to the Directives and will adhere to any Ministry or Government approval protocol. Consultation with/reporting to the MOHLTC. As set out in this Appendix 2 and otherwise in this MOU, the LHIN shall review with CIB planned public communication strategies for major communications relating to health service provider outreach activities and the release of major publications; and will report on the status of such communications projects on a quarterly basis, or at such other times as may be agreed to by both parties. Reasonable Advance Notice. The LHIN and the CIB shall provide each other with reasonable advance notice on the content and timing of any public announcement, news release or media communication. In accordance with Appendix 2 and otherwise with this MOU. Urgent or Emerging Issues. Despite the time frames set out below for specific types of communications, all public announcements and media communications related to urgent issues or issues likely to be contentious shall require either the CIB or the LHIN, as the case may be, to provide the other party with notice of such announcement or communication as soon as possible prior to release.

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Content and Timing of Communications. The CIB shall provide the LHIN with reasonable advance notice of the content and timing of all communications that are relevant to the work of the LHIN. The LHIN will provide CIB with advance notice on LHIN communications pursuant to the parameters below,

a) News releases – identify as “DRAFT” as soon as reasonably possible, identify as “FINAL” and share materials 5 working days before release for review and approval;

unless otherwise agreed to prior to release or implementation:

b) Major web designs – 10 working days before launching; c) Major digital marketing strategy (including websites) – 10 working days

prior to LHIN briefing of MOHLTC CIB; d) Major marketing communications materials (print collateral such as

pamphlets, posters) - 10 working days prior to production and 20 working days prior to public release;

e) Articles such as in trade publications (magazines, newsletters) 20 working days prior to public release.

f) Recommended advertising creative –15 working days prior to voluntary submission to Office of the Auditor General (“OAG”); or in the case of web, internet or social media prior to final production;

g) OAG; or in the case of web, internet or social media prior to final production;

h) Recommended media buying plan – 10 working days prior to submission to OAG and any media expenditures have been undertaken;

i) Plans for major advertising campaigns (including media strategy) 15 working days prior to production;

j) Major reports which have impact on the delivery of health services within the LHIN but are not identified in the annual business plan or in the Integrated Health Service Plan

k) Market research business case – 20 working days prior to the issuing of a Request for Services to suppliers on the government’s vendor of record list.

Notice of Public Consultations. The LHIN and the CIB shall each ensure that it notifies the other party when either the LHIN or the Ministry, as the case may be, undertakes public consultations that in the case of the Ministry, are relevant to the LHIN, and that in the case of the LHIN, that are related to its mandate. Results of Public Consultations. The LHIN and the CIB shall each inform the other party of the results of stakeholder and other public consultations and discussions and will seek input into plans to implement same. Notification of Public Notices The LHIN must provide reasonable advance notice of public notices or regulatory advertising to the CIB.

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Review of Paid advertising As requested by the Ministry, major advertising plans must be reviewed in advance by the CIB prior to creative development and/or the purchase of media, for compliance with the Government Advertising Act, 2004 and its regulations, as amended (the “GAA”) along with any applicable communications-related directive. Review under GAA. If an item is deemed reviewable under the GAA, the CIB will manage the submission with the Office of the Auditor General on behalf of the LHIN, using the protocols established for submission. The Office of the Auditor General requires seven business days from receipt to review submissions. CIB requires 3 business days to review the submission. Third party advertising is deemed reviewable if the following 3 conditions apply:

government provides funding for advertising +

government logo appears on the ad +

government approves the content Acknowledgement of Ministry. The LHIN shall acknowledge the financial support of the Government through the Ministry in all its financial, educational and promotional and communications materials and reports in accordance with the Directives, considering established visual identity standards of the Government of Ontario, as currently reflected in LHINs logo. Principal Media Focus. The LHIN will act as the principal media focus for LHIN initiatives. Duty to Respond. The LHIN will respond to public inquiries, complaints and concerns with respect to the activities and operations of the LHIN and will report any potential or foreseeable issues, as relevant, to CIB.

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Appendix 3: Administrative or Organizational Support Services

(i) process payments of funding to health service providers and assist the LHIN to respond to questions raised by health services providers about the payment processing;

Financial Payments and Reports The Ministry’s Financial Management Branch shall, on behalf of the LHIN and as directed by the LHIN:

(ii) assist the LHIN with in-year and year-end financial reporting by health

service providers, including collecting the reports, assessing the data for accuracy and reasonableness and providing the reporting to the LHIN in such form and with such analysis as the Ministry and the LHIN may determine; and

(iii) reconcile and settle funding payments made to health service providers as

directed by the LHIN. Operational Support The Ministry and the LHIN will work together to develop appropriate policies related to the operational support of the LHIN by the Ministry.

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Appendix 4: Designated Senior Positions in the LHIN for the Purposes of Post Service Conflict of Interest Rules • LHIN Board Members, including the Chair of the Board • CEO • Chief Operating Officer and/or Chief Financial Officer, if any • Senior Directors or equivalent positions

1

eHealth Strategic Plan 2012/2013

Board of Directors Meeting

September 25, 2012

Item 8.1

Background

• The Ministry-LHIN Performance Agreement (MLPA) requires LHINs to have eHealth strategic plans

• LHINs have formed 3 clusters to oversee eHealth initiatives

• Central LHIN is in the Central Ontario Cluster (Cluster 2)

• Cluster plans are under development for 2013/2014

• Central LHIN has developed a one year plan for 2012/2013 through the Central LHIN eHealth Steering Committee

2

3

eHealth Strategic Priorities and Initiatives

Strategic Priorities

• Electronic Medical Record Adoption (EMR) • An EMR is an electronic medical record used to document and receive patient

health information most often in a primary care setting • Central LHIN wishes to increase primary care physician adoption of EMRs • Physician adoption will increase as more patient information can be

electronically transferred to EMRs

Strategic Initiatives

• Implement Hospital Report Manager (HRM) • The HRM solution facilitates the secure electronic transfer of medical,

diagnostic imaging and cardio respiratory reports from hospital records to physicians’ Electronic Medical Records (EMR)

• All Central LHIN public hospitals to implement HRM by March 31, 2013

4



• Telemedicine Expansion • Telemedicine consists of using specialized I/T equipment and software to

support audio/visual consultations between physicians and patients across a secure network

• Central LHIN is a leading user of telemedicine and wishes to expand the use of telemedicine to improve access to care


• Develop a proposal for telemedicine expansion initiatives • Telemedicine is a growing field and offers the potential for increased access to

specialized care, care for remote populations, and care for patients who have difficulty attending a physician’s office

• A proposal will be developed for initiatives in Central LHIN

5



• Build Information Management and Information Technology (IM/IT) Capability in the Community Sector

• Patient care continues to shift to the community sector • A gap exists between the information management and technology capability in

the Community sector and other sectors in the continuum of care • There is a need to build information management and technology capability


• Implement Integrated Assessment Record (IAR) and assessment tools

• Using a common electronic assessment form as its foundation, a secure centralized assessment repository will be built in the long-term care, mental health and community support services sectors.

• Clients need only be assessed once for the same information across the continuum of care.

6



• Resource Matching & Referral (RM&R) Expansion • Resource Matching & Referral is an electronic solution that matches patients

care requirements to available health care services • RM&R speeds up the referral and matching process by replacing a paper based

system and improves the completeness of patient referrals • Central LHIN wishes to expand the use of the RM&R solution to other care

pathways


• Implement RM&R to Family Health Teams • In fiscal 2011/12 Central LHIN purchased the software licenses for the RM&R

solution in community based providers • Central LHIN wishes to use these licenses to enable electronic patient referrals

from Family Health Teams to CCAC services • This expansion will improve patient transitions across the continuum of care

Operational Priority and Initiative

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Operational Priority

• Stabilize RM&R from Phase 1 implementation • Central LHIN continues to work with RM&R users in hospitals to address post-

implementation issues after the successful implementation of Phase 1 • As a principle, any expansion of RM&R will be built on a solid foundation with

existing concerns resolved

Operational Initiative

• The RM&R Post Implementation Evaluation report outlines lessons learned and challenges experienced in Phase 1of RM&R implementation

• Central LHIN has implemented an RM&R escalation structure to ensure that concerns and feedback from end-users are appropriately communicated, addressed and closed.

How does this align with the eHealth Ontario Blueprint?

8

9

Required Stakeholder

How Purpose When

Physicians from Family Health Teams and Community Health Centres

Primary Care Advisory Council

To engage physicians and obtain feedback

Sept. 21, 2012 8-9:30am

eHealth Steering Committee Members

Central LHN eHealth Steering Committee

To advise hospitals of technical implications, to support physician engagement and to obtain feedback and recommendations

Sept. 28, 2012 9-11am

Hospital CEOs LHIN/Hospital CEOs Meeting

To obtain hospital executive support to expand RM&R and leverage any existing working relationships with physicians

TBD

Next Steps: Stakeholder Engagement for RM&R in Family Health Teams

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Strategic Priority Strategic LHIN Initiative

Description LHIN Objective (2012-2013)

Electronic Medical Record (EMR) Adoption

EMR Enablement through Hospital Report Manager Solution.

Hospital Report Manager (HRM) is a solution which enables hospital patient discharge data to populate physician EMRs. This initiative will encourage physicians to adopt EMRs as the EMR content expands.

Through the Central LHIN’s project charter with eHealth Ontario, the LHIN is working with OntarioMD to enable HRM in all Central LHIN hospitals by the end of fiscal 2012-13.

Telemedicine Expansiion Expansion of telemedicine use across Central LHIN.

Telemedicine is an enabling technology for shifting patient care from acute care settings to the community. Central LHIN is investigating ways to increase the penetration of telemedicine capabilities.

Central LHIN will investigate initiatives to expand telemedicine use. A plan will be developed and a proposal for funding will be submitted.

Build IM/IT Capability in the Community Sector

Implement the Integrated Assessment Record (IAR) in all community Health Service Providers.

The IAR is an electronic solution which enables sharing of a client’s assessment forms across health service providers. As care continues to shift to the community sector, there is a need for capability building and cost-savings for community-based providers.

Central LHIN has set a target of 90% implementation of the IAR by community health service providers by the end of fiscal 2012-13.

Resource Matching & Referral Expansion

Expand the RM&R pathway to enable Family Health Teams to electronically refer patients to the CCAC.

Central LHIN through the CCAC has purchased RM&R licenses for community health service providers, which include Family Health Teams. A draft implementation plan has been prepared by Health Tech.

Central LHIN will engage with Family Health Teams to discuss the implementation of this solution. An agreed to implementation plan and initial deployment will be achieved by the end of fiscal 2012-13.

Operational Initiatives Initiative Description Current Sate

(April 1, 2012) End State

(March 31, 2013)

Stabilizing Resource Matching & Referral (RM&R) (RM&R Post Implementation Activities)

Some concerns and feedback were communicated to Central LHIN after Phase 1 of the RM&R implementation was complete. The eHealth Steering Committee expressed interest in ensuring that expansion of RM&R does not begin until these issues from Phase 1 have been resolved. See issues log dated May 2012.

There was no fulsome process for gathering issues and concerns, issue resolution and report back to end-users.

In collaboration with CCAC, a documented and transparent process will be established for RM&R end-users to communicate issues/concerns. The key issues identified by the end users will be resolved and communicated via a report. This report will include the issues log and the resolution of each item.

South West LHIN Physician’s Office Interface to Regional Electronic Medical Records (SPIRE)/Hospital Report Manager (HRM) Video

http://www.youtube.com/watch?v=-hCFMcTO5f8

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CENTRAL LHIN BOARD OF DIRECTORS

SEPTEMBER 25, 2012

PROPOSED RESOLUTION FOR APPROVAL OF REVISED AUDIT COMMITTEE MEMBERSHIP

PROPOSED RESOLUTION: BE IT RESOLVED THAT: “The Central LHIN Board of Directors approves the recommendation of the Audit Committee to appoint Mr. Stephen Quinlan to the Central LHIN Audit Committee .”

ITEM 9.1.1



SEPTEMBER 25, 2012

PROPOSED RESOLUTION FOR APPROVAL OF REVISED AUDIT COMMITTEE TERMS OF REFERENCE

PROPOSED RESOLUTION: WHEREAS the Audit Committee Terms of Reference were approved by the Board on October 31, 2011; and WHEREAS the Audit Committee membership should not exceed four members so that the Committee does not represent a de facto Board majority; and WHEREAS the Audit Committee is recommending for approval the removal of the Board Chair as a required member of the Audit Committee; BE IT RESOLVED THAT: “The Central LHIN Board of Directors approves the recommendations of Audit Committee to revise the Audit Committee Terms of Reference.”

ITEM 9.1.2


CENTRAL LOCAL HEALTH INTEGRATION NETWORK BOARD OF DIRECTORS AUDIT COMMITTEE

Originated: January 22, 2007 Revised: October 19, 2011 September 25, 2012

Approved:

TERMS OF REFERENCE I. DUTIES

Ontario Regulation 417.06 issued under the Local Health System Integration Act, 2006, establishes that the duties of the Audit Committee (the “Committee”) of the Central Local Health Integration Network (the “network”) shall be to “review and provide advice and recommendations to the Board of Directors of the network on, (a) the network’s obligations with respect to appropriate accounting and financial reporting, (b) whom the network should appoint annually as its auditor, (c) the annual audit plan of the network (d) the audited financial statements of the network (e) appropriate risk management activities and internal control systems (f) whom a health service provider should appoint as its auditor to audit its accounts and financial

transactions, if the network directs the service provider under section 21 of the Act to have such an auditor.”

II. COMPOSITION AND OPERATIONS 1. Membership:

The Committee shall be composed of: - Two to four members, all of whom are members of the Board of Directors. The Board shall

appoint one of the Committee members to be the Committee Chair. Resources (Non-Voting): - Board Chair, ex Officio - CEO - Senior Director, Performance Contract Allocation - Director, Finance and Risk Management

2. Term of Office: Members of the Committee will be appointed annually. To ensure continuity, it is recommended that at least two members of the Committee be re-appointed annually.

3. Quorum:

A quorum shall be two members of the Committee.

4. Number of Meetings: Meetings of the Committee shall be held at least quarterly (four times per year) or at the call of the Chair.

Item 9.1.2

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5. Guidelines:

The Committee shall operate in a manner that is consistent with the Regulations as they are provided by the Ministry of Health and Long Term Care (MOHLTC).

6. Skills and Experience: All Committee members shall be “financially literate"1 and at least one member shall have “accounting or related financial expertise”.

III. DUTIES AND RESPONSIBILITIES

Subject to the powers and duties of the Board, the Committee will perform the following duties:

1. Financial Statements and Other Financial Reporting

The Committee will: a. review and recommend:

i. the accounting policies and financial reporting practices used by the Central LHIN; ii. any significant proposed changes in financial reporting and accounting policies and

practices to be adopted by the Central LHIN; and iii. any new or pending developments in accounting and reporting standards that may

affect the Central LHIN. b. review and discuss financial statements and reports including:

i. annual audited and quarterly financial statements. ii. issues on which management has made estimates or judgments that had a

significant effect on the financial statements; iii. the reasonableness of the estimates and judgments, and significant transactions

with related parties.

c. Recommend approval of the financial statements to the board.

2. Financial Risk Management, Internal Control and Information Systems The committee will review and obtain reasonable assurance that the financial risk management, internal control and information systems are operating effectively to produce accurate, appropriate and timely management and financial information. This includes:

a. review the Central LHINs financial risk management controls and policies and oversee management’s establishment of an adequate system of internal controls and risk management systems to mitigate financial risks and to ensure strong internal financial control environment exists;

b. have a clear understanding of the risks of fraud and error and review management’s response to these risks;

c. obtain reasonable assurance that the information systems are reliable and the systems of internal controls are properly designed and effectively implemented through discussions with and reports from management and the external auditor;

d. consider the potential risk of management override of controls or other inappropriate influence over the financial reporting process;

e. enquire into the conditions of the books and records and the adequacy of resources to the accounting functions and internal controls;

f. review management steps to implement and maintain appropriate internal control procedures including a review of policies;

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g. review adequacy of security of information, information systems and recovery plans; and h. monitor compliance with statutory and regulatory obligations.

3. External Audit

The Committee will review the planning and results of external audit activities and the ongoing relationship with the external auditor. This includes: a. review and recommend to the Board for approval, re-engagement or appointment of the

external auditor and the associated fees; b. the external auditors shall be advised of the names of the Committee members and will receive

notice of and can be invited to attend meetings of the Audit Committee, and can be heard at those meetings on matters relating to the Auditor’s duties;

c. review the annual external audit plan, including but not limited to the following: i. engagement letter;

ii. objectives and scope of the external audit work; iii. procedures for quarterly review of financial statements; iv. materiality limit; v. areas of audit risk;

vi. staffing; vii. timetable; and

viii. proposed fees. d. meet with the external auditor to discuss Central LHIN’s annual financial statements and the

auditor’s report including the appropriateness of accounting policies and underlying estimates; e. review and advise the Board with respect to the planning, conduct and reporting of the annual

audit, including but not limited to: i. any difficulties encountered, or restriction imposed by management, during the annual

audit; ii. any significant accounting or financial reporting issue;

iii. the auditor’s evaluation of Central LHINs system of internal controls, procedures and documentation;

iv. the post audit or management letter containing any findings or recommendation of the external auditor, including management’s response thereto and the subsequent follow-up to any identified internal control weaknesses;

v. any other matters the external auditor brings to the Committee’s attention; and vi. assess the performance and consider the annual appointment of external auditors for

recommendation to the Board. f. review the auditor’s report on all material subsidiaries; g. review and receive assurances on the independence of the external auditor; h. review the non-audit services to be provided by the external auditor’s firm or its affiliates

(including estimated fees), and consider the impact on the independence of the external audit; i. meet periodically, and, at least annually, with the external auditor without management present

on an in camera basis; and j. recommend to the Board the approval of the audited financial statements.

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4. Communications

The Committee shall: a. be accountable to the Board; b. have open communication with management, other Committee members, and advisors,

as applicable to strengthen the Committee’s knowledge of current and prospective issues; and

c. insist on open discussion with management and the external auditor about issues of quality and integrity.

IV. ACCOUNTABILITY

The Committee Chair has the responsibility to make periodic reports to the Board, as requested, on financial reporting matters relative to Central LHIN. The Committee shall report its discussions to the Board by maintaining minutes of its meetings and providing an oral report at the next Board meeting.

V. EVALUATION The Committee shall conduct and present to the Board an annual evaluation of the performance of the Committee and its members. The Committee shall report to the Board on the proceedings at each meeting and, on an annual basis, report on the performance of the Committee in the fulfillment of its duties under the mandate delegated by the Board. Reporting will include the adequacy of the terms of reference and recommend any proposed changes to the Board for approval.

1 Financial literacy is defined as the ability to read and understand a balance sheet, income statement and a cash flow statement.



SEPTEMBER 25, 2012 PROPOSED RESOLUTION FOR APPROVAL OF

GP-003 WHISTLEBLOWER POLICY

PROPOSED RESOLUTION: WHEREAS the proposed Whistleblower policy was developed by taking directly those sections of the Public Services of Ontario Act, 2006 that apply to the LHINs; WHEREAS this policy was brought forward to the Central LHIN Audit Committee at the meeting on July 11, 2012; WHEREAS management has incorporated the Committee’s requested changes to the policy as presented; WHEREAS this policy will apply to both staff and Board members, and once approved will also be adopted for the LHIN HR manual; BE IT RESOLVED THAT: “The Central LHIN Board of Directors approves the recommendations of the Audit Committee to approve GP-003 Whistle Blower Policy.”

ITEM 9.1.3

Whistleblower Policy – GP-003 Page 1 of 5

Central LHIN Governance Manual

Title:

Whistleblower Policy Policy Number: GP-003

Originated: September 25, 2012

Board Approved:

Purpose: To set out the LHIN’s obligations under the Public Service of Ontario Act with respect to the disclosure of wrongdoing and to establish the Central LHIN process for disclosure and investigation of wrongdoing. Scope: This policy applies to all Central LHIN staff and board members, with relation to Central LHIN operations. This policy is not intended to cover matters of alleged wrong doing related to health service providers.

Background:

Part VI of the Public Service of Ontario Act, 2006 (PSOA) establishes a process by which public servants may disclose wrongdoing in the public service in Ontario and be protected from reprisal. The protection from reprisal extends to public servants involved in any proceeding under the disclosure of wrongdoing framework (e.g. witnesses). Each organization and ministry of the public service has an ethics executive who is prepared to receive disclosures of wrongdoing. The PSOA also establishes the role of the Integrity Commissioner, an officer of the legislative assembly, with the power and authority to investigate and publicly report on allegations of wrongdoing.

The PSOA prohibits any person from taking any action that adversely affects the employment or appointment including working conditions of a public servant because the public servant has made a disclosure of wrongdoing to the ethics executive or to the IC. Other public servants, including those directly involved in an investigation of wrongdoing (e.g. witnesses), are also protected against reprisal.

Policy:

The Central LHIN endeavors to maintain the utmost integrity in the operation of the LHIN, and the internal controls and operating procedures are intended to detect and to prevent or deter improper activities; however, at times these systems may not provide perfect safeguards against improper conduct. LHIN employees and Board members owe a duty of loyalty to the LHIN, which includes a responsibility to bring to the attention of the Corporation instances of Wrongdoing. The LHIN is committed to complying with the PSOA, Management Board of Cabinet’s Disclosure of Wrongdoing Directive (the Directive), and to protecting the funds, assets and resources of the LHIN. Accordingly, it is the Policy of the LHIN to ensure that when an Employee or Board member has reasonable grounds to believe that another Employee or Board member has committed or is about to commit a financial or other Wrongdoing, as defined in this Policy:

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a. the employee or Board member may disclose this information through a clearly defined process; b. the matter will be reviewed and, if warranted, investigated by the ethics executive; c. the Employee or Board member will be protected from reprisals; d. the individual who is the subject of the disclosure (“the Subject”) will be provided an opportunity

to respond to allegations; e. all parties to an investigation will be treated fairly; f. confidentiality will be maintained to the greatest extent possible; g. if Wrongdoing is found, appropriate remedial and disciplinary actions will be taken.

Improper Disclosure will be viewed as Employee misconduct and will be met with appropriate disciplinary action, up to and including termination of employment. Improper Disclosure means a disclosure made in bad faith, which may include providing false information, making disclosures that the Discloser knows are baseless, or making repeated disclosure concerning matters that have been previously examined and determined by the ethics executive.

Procedure: 1. A LHIN employee or Board member (“Discloser”) who wishes to disclose a wrongdoing has the

following options: report the information internally in writing to his or her ethics executive using the Disclosure of

Wrongdoing form; or report the information to the Integrity Commissioner if he or she feels that internal disclosure

would not be appropriate. The Integrity Commissioner may investigate the claim directly or refer the matter back to the ethics executive.

2. If unsure, he/she may contact the appropriate director within the organization (e.g. finance department regarding an expenditure issue) or his/her direct manager for guidance. Directors and managers should not provide guidance on whether to disclose or not, but can provide advice on how to make a disclosure and can direct employees where to find more information. To avoid misunderstanding, employees should immediately be informed in writing that directors and managers are obligated to act on information that is provided to them should they consider it to be of a serious nature, whether or not the public servant considers it to be a disclosure under the Disclosure of Wrongdoing Directive.

3. A Discloser may also disclose directly to the Integrity Commissioner if the matter has already been disclosed internally and he or she believes on reasonable grounds that the matter has not been appropriately dealt with. A disclosure may also be made directly to the Integrity Commissioner without prior internal disclosure. When disclosing to the Integrity Commissioner, if there is insufficient detail to allow for an assessment the Discloser may be contacted for additional information.

4. The ethics executive is responsible for assessing every disclosure to determine whether there is enough information to address the issue, and if so, whether the allegation should be addressed via this process or in another forum. In the case of anonymous disclosures where there is insufficient information, the matter cannot proceed. The ethics executive will determine that a disclosure will not proceed in the following circumstances:


i. the subject matter of the disclosure is a matter already being dealt with through another statutory process; for example, there is already a complaint filed with the Ontario Human Rights Commission, or being dealt with by a law enforcement body,

ii. the subject matter of the disclosure relates solely to a public policy decision; the disclosure of wrongdoing provisions are not designed to be an avenue for addressing disagreement with a policy decision,

iii. the subject matter of the disclosure relates to an adjudicative decision; the disclosure of wrongdoing provisions are not intended to question or consider court or tribunal decisions as these are already subject to judicial review processes,

iv. the subject matter of the disclosure relates to prosecutorial discretion; for example, a plea bargain,

v. the disclosure is frivolous, vexatious, made in bad faith, or unimportant, or vi. there has been a substantial delay between the subject matter of the disclosure and the

disclosure itself, so that proceeding would serve no useful purpose.

5. The ethics executive could also refuse to deal with a disclosure if: a. the disclosure is related to an employment or labour relations matter that could be dealt

with through a dispute resolution mechanism, including a grievance procedure – it is not the intention to duplicate or replace the procedures already in place to address labour relations, or

b. there is another valid reason for not pursuing the matter.

Should the ethics executive determine that the matter does not fall within the disclosure framework, he/she has the discretion to address the matter under other applicable policies.

6. While addressing and resolving disclosures, the ethics executive and others involved in conducting and administering the process must ensure the process is fair, timely, and as confidential as possible. Confidentiality will be maintained and identities of those making the disclosure (“the Discloser”), witnesses, and Subjects will be protected except in those situations where the interests of fairness require that that a person’s identity be provided to one or more persons.

7. During the process of addressing disclosures, Disclosers and Subjects have the right to be represented or accompanied by another person of their choice (including legal counsel, at their own cost).

8. Subjects who are identified in a disclosure as being involved or responsible for wrongdoing will be informed of the allegations and given the opportunity to respond to them.

9. As the ethics executive proceeds with addressing a disclosure of wrongdoing, all employees and board members are obligated to comply with the ethics executive’s direction. Staff or Board members must not obstruct any investigation or process, and they must not destroy, falsify or conceal material or information. Anyone who knowingly makes a false or misleading statement or destroys, alters, conceals or falsifies a document, knowing that it is likely to be relevant to an investigation or proceeding, is guilty of an offence and liable, upon conviction under the Provincial Offences Act, to a fine.

10. During an investigation, the ethics executive cannot require certain types of information including:


information that is certified by the Deputy Attorney General as being information that could jeopardize a criminal proceeding, or that could breach Cabinet privilege

Information that is certified by the Commissioner of the Ontario Provincial Police as being information that could compromise an investigation into a criminal matter, or

Information that is subject to solicitor-client privilege, or is prepared by a lawyer in connection to litigation.

11. The ethics executive may consult with advisors available to them dependent on the nature of the issue, including legal services, human resources and others.

12. If the allegation of wrongdoing will be investigated, the ethics executive is accountable for the process, including ensuring that the matter is dealt with in a timely manner. Others within the public body may be involved in addressing disclosures; the ethics executive is responsible for providing advice and guidance during the process.

13. If a Board or arbitrator finds that reprisal took place, it may order a remedy for damages incurred, for example compensating for loss of remuneration. Any public servant found responsible for the reprisal is subject to disciplinary measures, including suspension or dismissal and if guilty of an offence may be prosecuted and liable upon conviction, for a fine. Reporting The ethics executive is responsible for informing the Discloser in writing whether the disclosure was not accepted, accepted but not investigated or investigated and concluded. Where the disclosure was accepted, the ethics executive is responsible for informing the Subject how the disclosure was dealt with. The ethics executive must keep well-documented records of disclosures and the results of each disclosure.

Definitions

Ethics Executive The Chair of the Central LHIN Board of Directors is the ethics executive for appointees as prescribed under subsection 71 (1.1) of the Act. For Central LHIN staff, the Chief Executive Officer is the ethics executive, as prescribed through O. Regulation 147/10 s.2 (1).

Public Servant

The term includes employees and appointees of public bodies. Local Health Integration Networks are listed as Public Bodies under Regulation 146/10 of the PSOA.

Reprisal

Reprisal includes, but is not limited to, ending or threatening to end employment or appointment, discipline, threat of discipline or penalty, and coercion or intimidation. Employees of public bodies who believe they have been the subject of a reprisal have the right to have the matter dealt with:

through binding arbitration under a collective agreement or filing a grievance under the arbitration provisions of a collective agreement, through application to the Ontario Labour Relations Board;


through the Public Service Grievance Board for employees appointed by the Public Service Commission under Part III of the Act who are not covered by a collective agreement;

through the Ontario Labour Relations Board for employees who do not have a right to binding arbitration of the grievance under a collective agreement; or

under the Police Services Act if a person is subject to a rule or code of discipline under the Act.

Wrongdoing

The following conduct of a public servant is considered wrongdoing:

a contravention of an Act (federal or provincial) or regulation, acts or omissions that create a grave danger to life, health or safety of persons, or to the

environment, gross mismanagement (e.g. gross waste of money, abuse of authority, abuse of public assets), directing or counselling a person to commit a wrongdoing listed above.

In addition, there are three types of information that cannot be divulged, either in a disclosure or in any process addressing the disclosure. These exceptions are well recognized in law:

information that is subject to solicitor-client privilege; information that would reveal the substance of the deliberations of Cabinet (Cabinet privilege); or anything that is prepared by or for counsel for a ministry or public body for use in giving legal

advice or in regards to litigation.

References and Supporting Documents:

Public Service of Ontario Act, 2006 Management Board of Cabinet’s Disclosure of Wrongdoing Directive Central LHIN Disclosure of Wrongdoing Form

Review:

This Policy will be reviewed annually by the Central LHIN Audit Committee.

Disclosure of Wrongdoing Form

1. Name of person making disclosure (please print):

Name - Print

a) What is your position?

b) If you no longer work at the Central LHIN, when did you cease employment?

2. Contact Information (required) :

3. I am (check one):

An Employee A Board Director None of the above

4. The disclosure of wrongdoing relates to (check one or more which apply):

(a) A contravention by a public servant (b) An act or omission by a public servant that creates a grave danger to life, health, safety or

the environment where the danger is unreasonable (c) Gross mismanagement by a public servant in the work of the public service of Ontario (d) Directing or counseling a person to commit a wrongdoing that falls into these categories

Confidential mailing address with postal code Confidential email:

Telephone number(s): Home: ( ) Cell: ( )

PART 1: YOUR INFORMATION

PART 2: DISCLOSURE OF WRONGDOING

5. If you checked 4 (a), please specify which Act or Regulation: 6. a) Date(s) when the wrongdoing was committed: b) Date(s) when you became aware that a wrongdoing had been committed: 7. Details of wrongdoing (bullet point format):

8. Other relevant information (only if necessary and use bullet point format): 9. Person (s) alleged to be responsible for the wrongdoing: 10. To the best of your knowledge, are the facts at issue in this potential disclosure the subject of

an action or processing before any other legal, administrative or public bodies? Yes No 11. If yes:

(a) Before which body and since when?

(b) What is the current status./outcome of the action or proceeding?

1. Name:

Position:

3. Name:

Position:

2. Name:

Position:

4. Name:

Position:

Unless required by law or permitted under the Public Service of Ontario Act, 2006, (the “PSOA”), the Integrity Executive will not disclose any information collected pursuant to his or her duties, powers or functions under part VI of the PSOA. However, where the interests of fairness require, personal information may be disclosed on a need to know basis. Principles of fairness require that an alleged wrongdoer be advised of the substance of the allegations. As well, you should be aware that there may be some cases where the allegations will be so unique or distinct that the identity of the discloser will be obvious from the facts. In such cases, despite exercising all precautions we cannot guarantee that a discloser’s identity remains confidential. Submit this form and any additional documentation to the attention of the CEO for employee disclosures and the Chairman of the Board for Board Director disclosures. I seek to file a disclosure of potential wrongdoing with the Integrity Executive in accordance with the Central LHIN Whistleblower policy and Part IV of the PSOA. Signature: Date: For Additional Information: Central LHIN Whistleblower Policy Public Service of Ontario Act, 2006 Disclosure of Wrongdoing Directive Office of the Integrity Commissioner (www.oico.on.ca)

PART 3: WHAT ARE YOUR EXPECTATIONS and/or DESIRED OUTCOME FOR MAKING THIS DISCLOSURE?

PART 4: CONFIDENTIALITY

PART 5: WHERE TO SEND THIS FORM

PART 6: SIGNATURE

Primary Care Update

Dr. David Kaplan Central LHIN Primary Care Lead

Item 12.1

PRIMARY CARE “ADVANCED ACCESS” SURVEY

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Types of Family Practice Scheduling • Advanced Access – Patients calling to schedule a visit are

offered an appointment with their provider on their day of choice, which may be the same day or a pre-booked appointment for a future day.

• Open Access – Patients calling to schedule a visit are offered an appointment with their provider the same day; minimal pre-booked appointments.

• Carve-out – Approximately 2/3rds of a clinic day is pre-booked. Patients calling to schedule an urgent visit are offered an appointment with a provider on the same day.

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Characteristics of Respondents

Practice Model of MDs Payment Model of MDs

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FFS 12%

CHC 1%

FHG 30%

FHN 30%

FHO 27%

FFS, 42%

Salary, 1%

Blended Cap, 57%

Advanced Access Schedule vs. Traditional Models

AA vs. Traditional Model All Reported Scheduling

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74%

26%

Traditional Advanced Access

None 35%

AA 17%

OA 9%

Carve-out 39%

None AA OA Carve-out

Time to Urgent Primary Care Appointment

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0-1 days 61%

1-3 days 27%

3-5 days 10%

5-7 days 1%

7+ days 1%

0-1 days1-3 days3-5 days5-7 days7+ days

Time to Non-Urgent Primary Care Appointment

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0-1 days 18%

1-3 days 37%

3-5 days 20%

5-7 days 11%

7+ days 14%

0-1 days1-3 days3-5 days5-7 days7+ days

Urgent Appointments < 24hrs

• Any form of non-traditional scheduling seems to be associated with ability to access MD <24hrs

P=0.014

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Non-Urgent Appointments <3d

• Any form of non-traditional scheduling seems to be associated with ability to access MD <3d for NON-urgent matters

P=.003

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Non-Urgent Appointments <5d

• Only Advanced Access scheduling seems to be associated with ability to access MD <5d for NON-urgent matters P=0.016

• Any form of non-traditional scheduling seems not to be associated with ability to access MD <5d for NON-urgent matters P=0.27

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PRIMARY CARE COUNCIL

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Central LHIN Primary Care Committees Primary Care Council Primary Care Action Group

Purpose • to connect primary care providers in the Central LHIN in order to address common issues pertaining to primary care across the continuum of health care in the Central LHIN

• to serve as a communication link to, and champions with, local, regional, and provincial contacts, organizations and community partners

• to share best practices in primary care across the LHIN

• to provide system level advice and guidance to the Central LHIN and the PCPL in support of the successful implementation of the Central LHIN Advancing Primary Care strategy, which includes:

Preventing avoidable hospitalizations and re-hospitalizations Promoting advanced access to primary care Improving access to primary care for unattached patients

Governance • Dr. David M. Kaplan & Dr. Marla Ash are co-chairs • self-regulated; no formal governance structure • PCPs “own” it - main thing is that this network is

connected with all regional bodies

• Dr. David M. Kaplan (PCPL) and Nancy Lum-Wilson (Director of Health System Planning & Design) are co-chairs

• Terms of Reference drafted by LHIN and agreed upon by PCAG members

Membership • comprised of local primary care physicians and nurse practitioners and led by champions located in each of the LHIN’s planning areas

• PCPs may receive stipend that is not attached to attendance at meetings, but rather for engaging MD and NP colleagues in their local networks

• strategic membership selected from PCPs, hospitals, Public Health, Long-term Care and other regional bodies that interact with primary care

Accountability • run “by primary care providers for primary care providers”

• accountability for usage of funds to funding partners

• accountable to the LHIN Board via CEO • Dr. Kaplan has provided in-person reports to the LHIN

Board

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Primary Care Council – A Network of Networks

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Primary Care Council Membership

1. Dr. David Kaplan (co-chair), Central LHIN Primary Care Physician Lead 2. Dr. Marla Ash (co-chair), Regional Primary Care Lead, Central Regional Cancer Program, CCO 3. Dr. Jordan Solmon, Physician, Jane-Finch Family Health Team 4. Dr. Allan Grill, Family Physician, Vice-Chair, Markham Family Health Team 5. Ms. Lorraine Johnston, Nurse Practitioner, Stevenson Memorial Hospital 6. Dr. Art Kushner, Chief of Family Practice, Humber River Regional Hospital – Church Site 7. Dr. Steven Litsas, Physician Lead, Woodbridge Family Health Team 8. Dr. Ralph Masi, Family Physician, Humber River Family Health Organization 9. Mr. Maurice Michelin, Nurse Practitioner, Emery-Keelesdale Nurse Practitioner-Led Clinic 10. Dr. Monique Moreau, Family Physician, Alliston 11. Dr. Tim Nicholas, Family Physician, Southlake Academic Family Health Team, Aurora 12. Dr. Eligio Palermo, Family Physician, Dixon Medical Clinic 13. Dr. Franklin Sheps, Family Physician, Bathurst North Family Health Organization 14. Dr. Nick Voudouris, Medical Director for Seniors and Chronic Medical Illnesses at Mackenzie Health

• Standing Invited Guests

Nancy Lum-Wilson, Director , Health System Planning & Design, Central LHIN Shirin Ansari-Tadi, Senior Consultant, Community Engagement, Central LHIN Sandra Cella, Director, Client Services CCAC / Health Care Connect Ms. Jane Ottman, Regional Manager, Ontario Medical Association

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Ongoing Primary Care Projects

• Created database of primary care for Central LHIN • After hours care collaboration across patient enrolled

models • Providing hospital record access to community family

physicians • FHT & CCAC collaboration • Collaborating in the establishment of the Central

LHIN Complex Centre for Diabetes Care • Connecting Care Steering Committee at NYGH • Common Hospital Discharge Process

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VCHC a t a G lance

VCHC’s family doctor & client International Women’s Day Celebration After school drop in program participants

Community Gardening program Language Interpretation Round table event Student & volunteer appreciation event

VCHC’s summer camp

ACCREDITED BY COMMUNITY ORGANIZATIONAL HEALTH INC., NOVEMBER 4, 2011

VCHC’s Let’s Dance program VCHC’s Yoga program

Item 12.2

The only CHC in York Region

Opened February 17, 2009

Open 58 hours per week: Saturdays and 3 evenings

Home visits – On-call services 24/7

Accredited by Community Organizational Health Inc., November 4, 2011

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Magic Windows program High School Co-op student at placement Diabetes Healthy Living Fair

Comprehensive Accessible Client and community focused Interdisciplinary Integrated Community governed Inclusive of the social determinants of

health

CHC Model of Care

Focuses on primary health care, illness prevention, health promotion, community capacity and service integration.

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VCHC Staff & Board

CLHIN – VCHC Staff

3 Medical Doctors 3.5 Community Health Workers 2 Medical Secretaries

3 Nurse Practitioners

Community Engagement

Worker/Health Promotion Team Lead

2 Medical Secretary Reliefs

Registered Practical Nurse 0.6 Registered Dietitian Systems Navigator

Chiropodist Receptionist Social Worker

Physiotherapist/Clinical Team Lead Administrative Assistant Finance Coordinator

Data Management Coordinator

Programs and Services Director Executive Director

MOHLTC – Diabetes Education Team

2 Registered Dietitians Social Worker

3 Diabetes Nurse Educators Chiropodist

Diabetes Administrative Assistant Diabetes Program Coordinator

VCHC Board of Directors: 15 board members

Tony Carella David Rubin

Bernie DiVona Rooholah Shabon

Daniele Zanotti Umberto Cellupica

Noor Din Aslam Daud

O.P. Lamba Lana Yetman

Alan Shefman Naseer Ahmed

Pierina Minna Quinto Annibale

Sandra Yeung-Racco

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Serving over 7,000 registered clients: (5,000 Clinical and Health Promotion) (2,000 Diabetes Education Program

Since inception served approximately 200 non-insured clients Annual household income: 0-19,000=14% ; 20,000-39,000=18% ; 40,000-59,000=9%; 60,000 and

higher=19% (Income data obtained from 60% of VCHC clients) Average composition of household is 3 or 4 family members Social programs mainly addressing issues of priority populations: youth, seniors and people with

mental health/addiction issues.

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VCHC Clients

VCHC’s Community Consultation

Elspeth Heyworth Centre for Women

YOGA FOR SENIORS (55+) MENTAL HEALTH COUNSELLING AT BLUE WILLOW COMMUNITY CENTRE Elspeth Heyworth Centre for Women and VCHC is offering free yoga sessions for older adults (ages 55+ years)

Human Endeavour

HOPE ADULT DAY PROGRAM Community-based program provided by Human Endeavour in partnership with Vaughan Community Health Centre and Mackenzie Richmond Hill Hospital (formerly York Central Hospital). The program provides structured and supervised activities in a group setting for eligible ethno-cultural and South Asian frail seniors with cognitive, physical and communicative impairments. The activities are planned to provide mental, physical and social stimulation.

Father Ermanno Bulfon Community Centre

ACTIVE LIVING AND EXERCISE PROGRAM Seniors wellness workshops on the importance of physical activity and injury prevention.

Jewish Russian Community Centre

Human Endeavour

Human Endeavour COMMUNITY GARDENING AND WALKING PROGRAM Seniors (55+) participate in gardening and trail walking.

York University – Faculty of Dance LET’S DANCE PROGRAM This program offers a mixture of dance forms, dancing without partners, and emphasis on injury prevention. Classes are led by a York University dance instructor

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Partners Program Description Priority Population

Seniors

Current Collaborations: HEALTH PROMOTION PROGRAMS

Partners Program Description

York University, Faculty of Education READY FOR SUCCESS TUTORING PROGRAM Provides high school students who are struggling academically with access to free tutoring in order to help them improve their grades.

Maple High School

York Region District School Board

Maple High School 3-5 ALIVE YOUTH DROP-IN AT MAPLE HIGH SCHOOL This program provides a safe and friendly space for youth to learn basic life skills, engage in recreation and maintain a healthy lifestyle at no cost to Maple High School students.

City of Vaughan

COMPASS

The Canadian Red Cross Society RED CROSS TRAINING PROGRAMS (Baby Sitting, PeopleSavers) These free training programs provide youth with an opportunity to develop new skills relating to child development, injury prevention, safety, and basic first aid. Youth receive a certificate upon graduation.

Priority Population

Youth

Forest Run Public School MONEY TREE FINANCIAL LITERACY PROGRAM This financial literacy program provides youth with information on money values, saving and banking, obtaining a chequing or savings accounts, etc.

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Elspeth Heyworth Centre for Women YOGA FOR ADULTS (ages of 18-54) Yoga sessions for women and their partners

Vitanova Foundation

FINANCIAL LITERACY PROGRAM The program focuses on basic money management skills to individuals experiencing addiction issues. It covers topics such as saving money, budgeting, managing debt, consumerism and basic investing.


York University, Faculty of Education READY FOR SUCCESS TUTORING PROGRAM Provides elementary students who are struggling academically with access to free tutoring in order to help them improve their grades.

Joseph A. Gibson Public School

York Region District School Board

York Region Community and Health Services

TRANSITION TO PARENTING An educational support group to help families with the transition during pregnancy or after the birth of a baby.

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Priority Population

Mental Health & Addiction


Mackenzie Richmond Hill Hospital (formerly York Central Hospital)

LIVING WITH STROKE Community-based support and educational program designed for stroke survivors and their caregivers to gain confidence in managing the challenges of living with stroke. STROKE PEER SUPPORT GROUP A peer support group that evolved from graduates of the Living With Stroke program. This support group is for stroke survivors and their caregivers held at the VCHC.

March of Dimes

Heart and Stroke Foundation

Priority Population

Young Families


York Region Community and Health Services SEXUAL HEALTH CLINIC Provides sexual health education and clinical services to residents living in Vaughan.

Mackenzie Richmond Hill Hospital (formerly York Central Hospital)

NON-INSURED SERVICES Provide acute services to non-insured patients, both antenatal and non obstetric.

Southlake Regional Health Centre THORACIC SURGERY CLINIC Providing post operation care services to residents living in Vaughan.

Canadian Mental Health Association (CMHA) – York Region

PSYCHIATRIC CARE CMHA psychiatrist providing clinical expertise and guidance to VCHC clinicians through individual case reviews.

Woodbridge Medical Centre, Thornhill Medical Centre, Middlefield Medical Centre

TYPE 2 DIABETES EDUCATION AND MANAGEMENT Providing individual counseling to clients of Woodbridge, Thornhill, and Middlefield Medical Centres.


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Current Collaborations: PRIMARY HEALTH CARE AND DIABETES EDUCATION Partners Program Description

Centre for Addiction and Mental Health NICOTINE REPLACEMENT THERAPY PROGRAM Smoking cessation program to help clients quit smoking

Primary Health Care

Diabetes Education Program

SCHOOLS

York University

Ryerson University

Seneca College

St. Jean de Brebeuf Catholic High School

Maple High Public School

St. Joan of Arc Catholic High School

Joseph A. Gibson Public School

NETWORKS

Together for Vaughan

Vaughan Social Action Council,

Healthy Aging Working Group of York Region,

Community Diabetes Education Network of Toronto,

Seniors Service Providers of York Region,

York Regional Police District 4– Community Liaison Committee

York Region’s Human Services Planning Board

Mackenzie Health President’s Advisory Council

VCHC offers student placements

to the following schools

VCHC is a member of the following networks

Current Collaborations SCHOOLS AND NETWORKS

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MSAA Indicators

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Indicator Provincial Average

(Q4 2012) VCHC Target VCHC Results

as of July 31

PAP 54% 70% 87%

Diabetes 78% 88% 93%

FOBT 39% 55% 74%

Annual Deliverables 2011/2012

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Deliverables Target VCHC Results

Active Clients (Clients who received individual services or registered

in group sessions in last 3 years) 3,000 4,687

Individual Encounters (Face-to-Face encounters)

16,000 20,963

Telephone Encounters 1,860 2,301

2011=97%

79%

20% 1%

Strongly Agree = 79%

Agree = 20%

Neutral = 0%

Strongly Disagree = 1%

2010=99%

67%

30%

3%

Strongly Agree = 67%

Agree = 30%

Neutral = 3%

Strongly Disagree = 0%

2010-2011 Client Satisfaction Results Client Level of Satisfaction with VCHC’s Programs and Services

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Core Funding:

Additional Funding:

Vaughan Community Health Centre Budget for 2012/2013 Total = $4,395,132

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$3,448,872.00, 78%

$870,131.00, 20%

$65,400.00, 2% Central Local Health Integration Network $3,448,872(78%)

Ministry of Health and Long Term Care - DiabetesEducation Program $870,131 (20%)

Ontario Trillium Foundation - System Navigation CaseManager $65,400 (1%)

Royal Bank of Canada - Summer Day Camp $5,000

York Region Transit - subsidy $2,500

Human Resources and Skills Development Canada -Canada Summer Jobs $3,229

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Questions?

and

Thank you!