item agenda item lead decision/ time information...201 queens avenue, suite 700 london, on n6a 1j1...

201 Queens Avenue, Suite 700 London, ON N6A 1J1 Tel: 519 672-0445 • Fax: 519 672-6562 Toll Free: 1 866 294-5446 www.southwestlhin.on.ca

Board of Directors’ Meeting Wednesday, June 22, 2011

3:00-5:00 pm Ingersoll District Memorial Arena – 97 Mutual Street, Ingersoll Ontario

AGENDA Item Agenda Item Lead Decision/

Information Time

1. Call to order Chair 3:00-3:05 2. Declaration of Conflict of Interest Chair 3:05-3:10 3. Approval of Agenda Chair Decision 3:10-3:15 4. 4.1 4.2 4.3

Consent Agenda Items Approval of Minutes: Board of Directors-May 25, 2011 Board Committee-June 8, 2011

Terms of Reference-Board To Board Reference Group Senior Leadership Report M Barrett/M Brintnell/K Gillis/L Johnson/G Lanteigne/J White

Chair Chair Leadership

Decision Decision Information

3:15-3:20

5. 5.1 5.2 5.3 5.4

Agenda Items for Decision/Information Urgent Care Centre/Emergency Department System of Care External Review Report 2011/12 Priorities for Investment Plan Report from the Audit Committee

2011/12 Draft South West LHIN Operational Budget

End-of-Life Hospice Care in Grey-Bruce

K Smith M Brintnell/ K Gillis R Bolton K Gillis

Information Decision Decision Information

3:20-3:50 3:50-4:05 4:05-4:20 4:20-4:35

6. Closed Session (if required) Chair Decision 7. Date and Location of Next Meeting

July - Time and Location to be Confirmed Chair

8. Adjournment

1

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- 1 -

Report to the Board of Directors

Board to Board Reference Group – Terms of Reference

Meeting Date:

June 22, 2011

Submitted By:

Jeff Low, Board Chair

Submitted To:

Board of Directors Board Committee

Purpose:

Information Only Decision

Suggested Motion THAT the South West LHIN Board of Directors approve the 2011-12 Terms of Reference for the Board to Board Reference Group. . Background To ensure proactive consideration of governance related issues associated with the Blueprint and Integrated Health Service Plan, the South West LHIN Board established the South West LHIN Board to Board Reference Group, comprised of Directors from across the health care system and geography of the South West. The South West LHIN Board to Board Reference Group provides a forum for the discussion of governance matters of interest to the South West LHIN and local Health Service Provider governing bodies. Meetings are chaired by the Board Chair of the South West LHIN. The South West LHIN Board to Board Reference Group includes two Board Directors from the South West LHIN, and ten to twelve Board members from Health Service Provider organizations across the South West including: Community Support Services, Mental Health and Addiction Agencies, Community Health Centres, Community Care Access Centre (CCAC), Hospitals and Long-Term Care Homes.

The Board to Board Reference group meets a minimum of three times per year. The last meeting was held on March 31, 2011 at which time the Terms of Reference were reviewed and revised for the year 2011-12. Recommendation was made regarding Accountability (s3.2): The Terms of Reference of the Board to Board Reference Group will be reviewed annually by the Board to Board Reference Group and approved by the Board of Directors of the South West LHIN.

Agenda Item 4.2a

South West LHIN Board to Board Reference Group

Terms of Reference

Page 1 of 5

Agenda Item 4.2b

TTeerrmmss ooff RReeffeerreennccee South West LHIN Board to Board Reference Group March 2011

South West LHIN Board to Board Reference Group

Terms of Reference

Page 2 of 5

1. Background/Context

The South West LHIN’s Mission Statement is:

The South West LHIN brings people and organizations together to build a health care system that balances access, quality and sustainability.

In keeping with our commitment to work in partnership, the South West LHIN Board of Directors is committed to building effective working relationships with Health Service Provider governing bodies to collectively advance the health system goals identified for the South West LHIN and to ensure ongoing support for a high quality, accessible and sustainable system of health care services within our LHIN.

The South West LHIN is devoted to our core set of values and believes that these values are also of importance to all Health Service Providers and health care partners within the South West.

South West LHIN Values:

Compassion – “We appreciate that our actions have real implications for people and communities”

Courage – “We will make difficult decisions and challenge the status quo when required”

Evidence-informed – “Our decisions will be guided by the best available information”

Innovation – “We will encourage and support new thinking and the sharing of new knowledge”

Integrity – “We will act in a fair, consistent and unbiased manner”

Trust and Respect – “We believe in mutual trust and respect”

The South West LHIN recognizes that creating a sustainable quality health care system that is able to meet growing demands requires careful planning and good decisions. While we have one of the best health care systems in the world, we are facing growing pressures from an aging population, shortages of skilled health care providers and increasing costs. We are addressing these opportunities and pressures to ensure the system remains robust and is accessible now and for future generations. The LHIN is working closely with health providers and the public, to improve the way we approach care delivery through the implementation of directions contained in two key documents.

South West LHIN Board to Board Reference Group Page 3 of 5

Terms of Reference

The Health System Design Blueprint – Vision 2022 is the South West LHIN’s long-range plan and provides the foundation for decisions of the LHIN. It will be put into action through a series of three-year plans, the first being the Integrated Health Service Plan (IHSP) – 2010-2013. The IHSP lays out specific priorities, as well as measures to ensure that we are successful. To ensure proactive consideration of governance related issues associated with the Blueprint and Integrated Health Service Plan, the South West LHIN Board established the South West LHIN Board to Board Reference Group, comprised of Directors from across the health care system and geography of the South West.

2. Mandate

2.1. Role of the South West LHIN Board to Board Reference Group

The South West LHIN Board to Board Reference Group will provide a forum for the discussion of governance matters of interest to the South West LHIN and local Health Service Provider governing bodies. Specific issues that will be considered by the Reference Group will include but will not be limited to:

Approaches for engaging health service provider governors and the broader community in the roll out of the Health System Design Blueprint – Vision 2022 and Integrated Health Service Plan 2010-2013;

Governance perspectives on the current and future state of health care in the South West and the role and expectations of governors; and

Other matters of relevance to health care governors in the South West LHIN.

3. Membership

3.1. Membership

The South West LHIN Board to Board Reference Group will include two (2) Board Directors from the South West LHIN and ten to twelve Board members from Health Service Provider organizations across the South West including:

Community Support Services Mental Health and Addiction Agencies Community Health Centres Community Care Access Centre (CCAC) Hospitals Long-Term Care Homes

The Board to Board Reference Group will be chaired by the South West LHIN Board Chair.


Terms of Reference

The Membership terms will be staggered to ensure continuity.

Membership will reflect the geographical diversity across the South West LHIN. Vacant positions will be filled through a call of expressions of interest. The applications will be reviewed by the Board Chair and two other members from the South West LHIN Board and applicants will be chosen based upon geographical representation and/or health service representation.

3.2. Accountability

The South West LHIN Board to Board Reference Group is convened by the South West LHIN Board of Directors to provide an opportunity for informed dialogue and discussion with Health Service Provider governors regarding governance matters of interest in the South West LHIN. The Terms of Reference of the Board to Board Reference Group will be reviewed annually by the Board to Board Reference Group and approved by the Board of Directors of the South West LHIN.

3.3. Individual Roles

Individual members will:

Provide input and advice to the rollout of the Health System Design Blueprint – Vision 2022 and Integrated Health Service Plan 2010-2013.

Participate fully in the exchange of information and identification of issues of relevance. Consider ideas and issues raised and provide guidance and input as appropriate. Consider system level and organizational implications and impacts of issues under

consideration. Participate in the development of an annual work plan.

4. Logistics and Processes

4.1. Role of the Chair

The Chair will be responsible for coordinating the development of the meeting agenda and leading the meeting in a way that ensures advancement of the agenda within the timelines allocated for specific agenda items. The Chair will ensure that input is solicited from all reference group members when establishing reference group objectives and meeting agendas. The Chair will ensure that an annual work plan is established by the group.

4.2. Delegates

It is expected that members will regularly attend meetings, however, it is recognized that on occasion individual members may need to send a delegate to the meeting due to unavoidable scheduling conflicts. If members are sending a delegate, it is important to ensure consistency in terms of the individual selected to attend as a delegate and the use of delegates should be kept to a minimum to ensure continuity. Permission should be sought from the Chair in advance of


Terms of Reference

sending delegates to a meeting. It is the responsibility of members to ensure that delegates are appropriately briefed and debriefed prior to and following any meetings that they attend.

4.3. Frequency of Meetings

The Board to Board Reference Group will meet a minimum of three (3) times per year (March, June, October) or at the call of the Chair.

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Report to the Board of Directors Senior Leadership Report

Meeting Date:

June 22, 2011

Submitted By:

Michael Barrett, Chief Executive Officer Kelly Gillis, Senior Director, Planning, Integration and Community Engagement Mark Brintnell, Senior Director, Performance, Contract and Accountability Glenn Lanteigne, Chief Information Officer and eHealth Lead Julie White, Director, Communications and Customer Service Lisa Johnson, Manager of Corporate Services

Submitted To:


Purpose: Information Decision

Strategic Items Senior Friendly Hospital Strategy Across the province, the 14 LHINs have agreed to initiate a Senior Friendly Hospital Strategy. Research shows that seniors are more vulnerable to adverse events and complications the longer they stay in the hospital. They have a two-fold risk of adverse events (i.e., falls, pressure ulcers, surgical complications, and hospital acquired delirium). One-third of frail seniors lose independent function as a result of hospital practices. These risks increase the likelihood that seniors will not be able to be discharged and will become ALC. Goal of the Senior Friendly Hospital strategy: Hospital environments (including physical design) that accommodate and respond to seniors’ physical and mental health needs, promote good health (i.e., nutrition, activation), are safe (i.e., prevent drug interactions, hospital-acquired infections, falls etc.), and involve and empower all seniors, their families and caregivers to be full participants in their care. After their acute care is completed, seniors will regain their health so that they can transition to the next level of care – post-acute, home, community or long-term care. The first step of the strategy was for each hospital to complete an assessment to identify successful senior friendly care initiatives, gaps and opportunities for coordinated action. The South West Regional Geriatric Program assisted the LHIN to collate the self assessments and create a summary report that reflects promising practices and areas for improvement in the South West LHIN. These summary reports provide the framework for moving the Senior Friendly Initiative forward, and will also be used to summarize initiatives across Ontario. Through this strategy, Ontario hospitals will adopt the principles of a Senior Friendly Hospital and implement individual and joint actions over time to achieve

Agenda Item 4.3

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senior friendly hospitals province-wide. Common indicators will be developed to drive and sustain continual performance improvement.

The South West LHIN’s summary in addition to feedback related to each hospital’s submission will be released to the hospitals June 14, 2011. The summary document will also be posted on the LHIN website. It is expected that a provincial summary will be available July 29, 2011. The South West LHIN will work with hospitals in late summer/fall to create a shared understanding of best practices and common quality improvement initiatives currently underway related to both the Senior Friendly Hospital strategy and the Quality Improvement Plans recently completed by the hospitals. Mental Health and Addictions Capacity Planning Project Update The Mental Health and Addictions (MH&A) Community Capacity Planning Project is well underway. The purpose of the project is to identify system capacity issues resulting from the growing demand for addiction and mental health services in both community and hospital settings, emerging trends in service use, and redistribution of specialty mental health beds, specialty non-bedded services and ambulatory service redesign. To date the following activities have been completed:

Cross referencing and consolidation of existing mental health and addictions reports and recommendations

Updating and validation of existing report data Completion of prevalence rate projections Identification of emerging population health needs and anticipated demand growth Engagement activities have been initiated and will be completed throughout June and July

The capacity planning report is to be completed by September and will include:

Identified priorities for existing service coordination or new investments necessary to resolve service pressures

Evidence based, best or emerging practices for identified service gaps An implementation plan for immediate, short, medium, and long term needs focused on 3

actionable priorities for each geographic area within the South West LHIN (North, Central, South)

Identification of additional mental health and addiction needs for ongoing system transformation

Plans are underway for a public information session in October to share the results of the report and intended next steps. A session for mental health and addictions health service provider governors is also being planned. Aboriginal Update As part of the LHIN CEOs Aboriginal Health Charter, on May 25-27, 2011 the CEOs and Aboriginal Health Leads met in Sioux Lookout for an Aboriginal Planning session to learn more about Aboriginal health issues, share health planning and community engagement information and identify areas for pan LHIN collaboration for this fiscal year. The South West LHIN CEO and Aboriginal Health Lead attended.

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The three day meeting began with a tour of two northern remote First Nations communities and a key note address from former Assembly of First Nations National Chief Ovide Mercredi, current Chief for Grand Rapids First Nation in Manitoba, a Cultural Awareness training session with Kelly Brownbell, and a presentation about current Aboriginal health from the Aboriginal Health Strategy Unit, Health Systems Strategy Division, Ministry of Health and Long Term Care. The CEO and Staff from the new Sioux Lookout Meno Ya Win Health Centre and Centre of Excellence for Aboriginal Health also presented about how they developed cultural safety and incorporated traditional healing systems with western medicine systems and practice. The participants also enjoyed a traditional Oji-Cree meal, traditional drumming and dancing. A pre-meeting survey of Aboriginal engagement activities and interests for pan LHIN efforts indicated multiple areas of work for LHINs. Mental health and addictions, diabetes, health data and information, successful engagement strategies, incorporating traditional health and healing, creating cultural safe care across the system, hiring competent Aboriginal health leads and ensuring LHIN staff are culturally competent were identified as areas for collaboration. The time to discuss the priorities for this fiscal was limited. However, the group identified mental health and addictions as the number one priority followed by increasing CEO relations with key departments of the MOHLTC and other Ontario Ministries dealing with Aboriginal health thereby encouraging intergovernmental collaboration and lastly, improving the skill and cultural competence of Aboriginal Health Leads, LHIN Boards and staff. The full proceedings from this meeting are not yet available. Operational Items Woodstock General Hospital – Cash Advance Woodstock General Hospital (WGH), Infrastructure Ontario (IO) and the Ministry of Health and Long-Term Care (MOHLTC) were recently informed by Revenue Canada that all tax amounts as part of capital redevelopment projects must be paid as a single payment. Tax payments are due three weeks following the month of substantial completion. Substantial completion at WGH is late June 2011 making the payment due by July 22, 2011. The original understanding of the hospital, IO and MOHLTC was that tax payments would be paid in installments according to the 30 year payment schedule. The LHIN was requested to consider a cash advance to address this immediate payment. Essentially, WGH would receive a $30 million dollar cash advance and the amount would be recovered upon the hospital receiving its tax credit. The LHIN has requested all required documentation to support this transaction and will be requiring the hospital to sign-back on the cash advance arrangement consistent with the LHIN’s current cash advance policy. Long-Term Care Home Peer Review – Knollcrest Lodge Knollcrest Lodge (located in Milverton) recently met with the LHIN Chair and CEO to discuss several factors that are creating operational and financial challenges. The LTC Home is projecting a deficit position at the end of 2011. The factors impacting the LTC Home include operating efficiencies of smaller, rural LTC Homes, resident acuity levels impacting on care costs, strengthened regulations and the operational impacts these have on staff training, and fixed expenses (i.e. mortgage expense) of the past redevelopment. Knollcrest Lodge is working hard to draw in other revenue sources but these efforts have not addressed the financial pressures. The LHIN agreed that bringing in a third

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party with direct LTC Home operational experience would be a logical and an appropriate next step. The LHIN will be working with Knollcrest Lodge to put in place the necessary third party to help the LTC Home identify opportunities to address the current operational challenges. Once the peer review details have been worked out, LHIN staff will bring this back to the LHIN Board. Notice of Integration: Home and Community Support Services (HCSS) of Grey Bruce with Meals on Wheels Services On June 1, 2011, Andy Underwood, Executive Director at HCSS notified the LHIN that HCSS has been approached by a number of small communities within the past six months, with the goal of taking over existing Meals on Wheels (MOW) programs. These communities include Meaford, Port Elgin, Southampton, Kincardine and Teeswater. With the exception of Southampton all of these MOW programs are experiencing volunteer fatigue and cannot continue. In the case of Southampton, the long time food source (Southampton Hospital) quit providing food as of May 27, 2011 as they moved to re-thermalized food, which resulted in a reduction of kitchen staff and an inability to support the MOW program. HCSS has taken on the service and the volumes for these smaller communities, with minimal cost. Because HCSS is already established with offices and volunteers in these communities, they are able to assume these volumes without any anticipated issues. Meaford has since reorganized their MOW program and have communicated that they do not require support from HCSS at this time. HCSS took over the Port Elgin MOW as of January 2011 and Southampton on May 30, 2011. HCSS has committed to taking over the Kincardine and Teeswater MOW programs as soon as possible in order to avoid a gap in service which would create hardship for many of the seniors in these communities who utilize this service. HCSS has shifted some internal resources in order to pick up these programs as quickly as possible and ensure suitable food sources as well as adequate volunteer and client support.

All of these MOW programs are long established within their communities and have been completely self sufficient with no outside funding source. The LHIN provides no funding to any of these MOW programs. HCSS will not require additional funding from the LHIN in order to support these programs; however these additional MOW programs will increase projected units of service contained in the 2011-2014 M-SSA. At this point, the increase in volumes should not cause them to exceed the 10% corridor associated with their MSAA targets. The following criteria were used to determine if the integration proposal should be taken to the South West LHIN Board for formal consideration:

Impact on Services (from public’s perspective) Impact on Labour Impact on Accountability Agreement Funding implications for LHIN Potential for significant (over $50,000) cost savings Impact on HSP management structure All governance or corporate integration go to Board

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Integration activities also come to the Board through new funding (e.g. AAH) All integration items will be reported to the Board – those not formally considered by the Board

would be included in monthly CEO report The purpose of the criteria is to identify initiatives that require due diligence by the Board on integration activities with a significant impact and to support swift implementation of minor service integration activities with limited impact. LHIN staff reviewed the integration and determined that a formal review by the South West LHIN Board of Directors was not necessary. LHIN staff agreed that there would be little to no impact in relation to any of the above criteria and that this request is a minor service integration activity. HCSS has been advised that the South West LHIN will take no action with respect to this integration. Communications Media relations The total number of media stories tracked by the communications department (were posted online) was 17 in the month of May, down 12 from April. Five of the stories were access to care (and Aging at Home) related stories. May 2, the LHIN issued a media release regarding operational funding for the new South East Grey Community Health Centre. A media release regarding the appointments of Barbara West-Bartley, Gerry Moss and Robert Wood to the South West LHIN Board of Directors. On May 19, the LHIN issued a media release regarding appointment of Dr. Kevin Smith as an external reviewer of clinical coverage at London’s emergency departments and urgent care centre. On May 24, a media advisory was issued to encourage attendance at the May 25th public engagement session in London. South West LHIN Exchange The May edition of Exchange was a special edition, featuring coverage of the April 28th South West LHIN Quality Symposium. Stories include:

Easton shares the story of his Massive Improvement Machine New thinking needed in health care: Lewis Sustainability of public health care key issue for Minister Local successes and provincial best practices resulting in improved access to care by getting

people home first Quality takes centre stage in South West LHIN Board members have a critical role: Easton Harnessing the power of a team South West LHIN setting best practices in critical care Quality Award program launched

Website & social media During the month of May, there were 4,017 visits to the South West LHIN website, down 571 visits from the month of April. A total of 10,722 pages were viewed by 2,609 visitors compared to last month’s 12,792 pages viewed by 2,680 visitors. The average time they spent on the site was 2

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minutes and 13 seconds. Among the top pages viewed were the careers, about our LHIN and the Board meetings page. At the end of May, we had 960 MyPage subscribers – 26 more than in the previous month. MyPage subscribers are people who select to have new South West LHIN website content sent directly to their inbox. On May 31, there were 136 fans of the South West LHIN Facebook page – up seven from the previous month and 110 of our fans are active users. There were 20 new posts by the LHIN during the month and 5,355 post views. On May 31, there were 1,292 followers of the @SouthWestLHIN account on Twitter (110 more than the previous month) and it had amassed 3,269 tweets – 265 during the month of May. For two weeks, the South West LHIN You Tube Page was ranked #1 for the most views of any non-profit in Canada and on one day, we were #97 of all non-profit channels in the world. There were 1,045 video views of the South West LHIN You Tube channel in May. The top-viewed video during this period was the high-risk seniors pilot project presentation that was created as part of the “roving reporter” report from the 1st Annual South West LHIN Quality Symposium. The second most viewed video is one that was shown at the symposium regarding the eShift program. All sessions from the symposium are also posted on the LHIN’s You Tube channel.

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Report to the Board of Directors External Review of Clinical Coverage of the City of London

Urgent Care Centre and Emergency Department System of Care

Meeting Date:

June 22, 2011

Submitted By:

Michael Barrett, Chief Executive Officer Mark Brintnell, Senior Director, Performance, Contract and Accountability

Submitted To:



Background When first opened in 2005, the Urgent Care Centre (UCC) at St. Joseph’s Health Care (SJHC), London operated from 8:00am to 10:00pm and functioned as an integral part of the emergency/urgent care system in the City of London. For the past year, the UCC has struggled with providing physician coverage for all shifts, and the operating hours have now been reduced to the current 8:00am to 4:00pm, seven days a week. As a result, the South West LHIN appointed Dr. Kevin Smith, Present and CEO, St. Joseph’s Health System, Hamilton to lead a review of clinical coverage of the city of London Urgent Care Centre and Emergency Department system of care. The Terms of Reference are attached. The goal of the review is to develop an Action Plan that identifies both immediate (June-August) interventions and longer-term plans that will ensure optimal use of the UCC and appropriate clinical coverage in the City of London emergency/urgent care system. The South West LHIN’s current Integrated Health Service Plan identifies the need to enhance access and sustainability of hospital-based treatment and care related to emergency services by focusing on recruitment and retention, coverage and capacity. Current Status Dr. Smith is currently completing his review and assessment of the UCC and emergency departments across the City of London. On Monday, June 20th the final Action Plan report is to be publicly released confirming a number of recommendations to address the immediate needs and longer-term plans that will ensure optimal use of the UCC and appropriate clinical coverage in the City of London emergency/urgent care system. The final Action Plan report will be issued to the LHIN Board upon its release on June 20th and Dr. Smith will deliver the report to the LHIN Board at its meeting on June 22nd.

Agenda Item 5.1

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Next Steps The London hospitals will be taking action to address the recommendations within the report and will regularly report to the LHIN on progress achieved. The South West LHIN will continue to monitor the situation and Dr. Smith will return in six months to conduct an assessment of implementation and achievement of original objectives behind the recommendations.

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External Review of Clinical Coverage of the City of London

Urgent Care Centre and Emergency Department System

Terms of Reference

Hospitals: St. Joseph’s Health Care, London and London Health Sciences Centre Local Health Integration Network: South West Review Type: External Review External Reviewer: Dr. Kevin Smith, President and CEO, St. Joseph’s Health System, Hamilton Document Version: May 16, 2011 / v1.2 Issue When first opened in 2005, the Urgent Care Centre (UCC) at St. Joseph’s Health Care (SJHC), London operated from 8:00am to 10:00pm and functioned as an integral part of the emergency/urgent care system in the City of London. For the past year, the UCC has struggled with providing physician coverage for all shifts, and the operating hours have now been reduced to the current 8:00am to 4:00pm, seven days a week. The South West LHIN’s current Integrated Health Service Plan identifies the need to enhance access and sustainability of hospital-based treatment and care related to emergency services by focusing on recruitment and retention, coverage and capacity. Goal of the External Review To develop an Action Plan that identifies both immediate (June/July/August) interventions and longer-term plans that will ensure optimal use of the UCC and appropriate clinical coverage in the City of London emergency/urgent care system. Aims of the External Review To understand clinical coverage issues at the UCC and emergency departments in the

City of London; To understand the volume and acuity levels being seen at the UCC and the emergency

departments; To understand the respective and collective roles of both the SJHC UCC and London

Health Science Centre (LHSC) emergency departments as part of the emergency/urgent care system across the City of London, including the academic (research and education) focus of the London hospitals;

To understand the city-wide medical coverage plan, and the associated competing factors impacting the use of the physician pool, in keeping the UCC and emergency departments fully staffed;

To evaluate the feasibility of other models of service to keep the UCC and emergency departments fully staffed;

To understand how the emergency/urgent care system interacts with the primary care system in the City of London; and

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To provide the public with an opportunity to give input on the emergency/urgent care system in the City of London.

Deliverables A written Action Plan with action steps, rationale, timelines, outcomes, and critical success factors required to ensure full clinical coverage of the City of London UCC and emergency departments. The Action Plan will: Be delivered in two components: 1) immediate interventions & 2) longer-term plans; Outline the specific immediate interventions, action steps and timelines required to

maintain existing UCC operations, and a return to a fully staffed UCC; Identify specific risks and corresponding strategies to mitigate or manage these risks

associated with the immediate interventions; Outline longer term plans, action steps and timelines to ensure the optimal use of the

UCC as part of a sustainable care centre in the City of London emergency/urgent care system;

Identify specific risks and corresponding strategies to mitigate or manage these risks associated with the longer term plans;

Identify competing factors in how the UCC and emergency departments use the existing physician pool and identify changes (practice and/or policy) to mitigate against these competing factors;

Identify changes to be considered to the city-wide medical coverage plan, including rationale for the changes; and

Comment on opportunities to strengthen continuity between the emergency/urgent care and primary care systems.

Accountability and Structure The External Reviewer is accountable to the South West LHIN The External Reviewer will submit the Action Plan to SJHC, LHSC and the South West

LHIN The External Review Steering Committee will be comprised of the External Reviewer, one

member from each hospital Board, one member from each hospital senior leadership team, one member from each hospital clinical leadership team, one member from LHIN senior leadership team, any other member as deemed required by the External Reviewer

The External Review Team is accountable to and appointed by the External Reviewer and will include experts needed to assist throughout the process

Role of the External Reviewer The External Reviewer will: Chair the External Review Steering Committee responsible for overseeing the external

review process, and provide actions to SJHC and LHSC for implementation; Lead the work of the External Review Team responsible for the information and ground

work required in achieving the review deliverables; Consult, engage and learn from hospital medical and administrative leaders regarding the

external review aims and proposed actions; Work with the SJHC and LHSC senior leadership teams and clinical professionals to

identify and confirm both the immediate interventions and longer-term plans, and the associated implementation plans;

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Remain available for further advice to the hospitals and/or LHIN during the implementation of the identified interventions and strategies; and

Conduct an assessment of the performance improvement achievements within six to nine months following implementation of the Action Plan.

Role of the Hospitals SJHC and LHSC will: Appoint members from their respective Boards and senior leadership teams to the

External Review Steering Committee; Support the external review team and provide all necessary and appropriate information

and access to staff required to understand the aims and achieve the deliverables; Develop an implementation and monitoring plan for each action, including key metrics and

timelines; Develop an internal communications plan, and in partnership with the LHIN, develop an

external communications plan; Present the proposed actions to the respective hospital Board of Directors for approval; Be responsible for all costs associated with the external review process; Implement and monitor the approved actions.

Role of the South West LHIN The LHIN will: Appoint a member of the senior leadership team to the Review Committee; In partnership with the hospitals, develop an external communications plan; Receive both components of the Action Plan; Liaise with the hospital during the implementation and monitoring periods; and Ensure the hospitals fully implement the approved actions.

Milestones and Timeline

1. The review will begin the week of May 16, 2011; 2. The immediate interventions component of the Action Plan will be completed by Monday,

May 30, 2011; 3. The longer-term plans component of the Action Plan will be completed by Monday, June

20, 2011; and 4. Both the immediate interventions and longer-term plans will be available to the South

West LHIN Board or Directors for reference upon their completion. End

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Report to the Board of Directors 2011/12 Priorities for Investment Plan

Meeting Date:

June 22, 2011

Submitted By:

Mark Brintnell, Senior Director, Performance, Contract and Accountability Kelly Gillis, Senior Director, Planning, Integration & Community EngagementGlenn Lanteigne, Chief Information Officer and eHealth Lead

Submitted To:



Suggested Motions THAT the South West Local Health Integration Network Board of Directors approves the allocation of $3,251,100 in one-time funding in 2011/12 in support of the following projects: Access to Care, Quest for Quality in Chronic Disease Prevention and Management, Addiction Services Coordination Project, Data Quality Improvement – Mental Health and Addictions, and Training and Implementation of the GAIN-SS Screener in the South West LHIN. THAT the South West Local Health Integration Network Board of Directors approves the allocation of $142,350 in one-time funding in 2011/12 in support of the LHIN-wide Wound Management Initiative and $64,000 annually in support of the Aboriginal Health Lead in Strengthening Aboriginal Partnerships in South Western Ontario. Background In the past few fiscal years the South West LHIN has supported a variety of local healthcare initiatives spread across virtually all sectors as part of the priorities for investment planning. For 2011/12, the South West LHIN is narrowing the investment plan to target several key areas in our pursuit of an integrated health system of care. These areas of focus support our set goals and priorities within the Health System Design Blueprint Vision 2022 and 2010-13 Integrated Health Service Plan (IHSP) and will help us achieve system improvements for patients/clients. On April 27 2011, the South West LHIN Board of Directors approved the following key areas of focus for our Priorities for Investment Plan in 2011/12: 1. Access to care for seniors and adults with complex needs 2. Integrating care for individuals with or at risk of chronic illness 3. Integrating care for individuals with or at risk of mental health and addictions issues 4. Sustainability of hospital based programs and services 5. Integration Support Program (now called Integration Implementation Support Program) 6. Community Sector One-Time Minor Infrastructure Program

Agenda Item 5.2

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The LHIN Urgent Priorities Fund (UPF) allocation is the main source of funding being used for these projects. The balance (<$100K) is being funded through funds held in reserve with hospitals. The UPF is an annual allocation received from the Ministry of Health and Long-Term Care to focus on local priorities, government priorities, and performance improvement against set targets included in the 2011/12 Ministry-LHIN Performance Agreement (MLPA). The total 11/12 allocation received for the South West LHIN is $4,538,409 with a requirement that 44% is allocated in support of projects that reduce ER wait times and Alternate Level of Care (ALC). Due to funding commitments for approved projects from prior years (see investment summary attachment), the total funding available for new project approvals in 2011/12 is $3,223,744. Our LHIN continues to only allocate the UPF as one-time dollars to ensure we maintain our flexibility to seed and incent projects and initiatives. Current Status This report is focused on the first three priorities for investment. The five projects and total funding amounts are:

Access to Care: $1,900,700 Quest for Quality – Chronic Disease Prevention and Management: $1,100,400 Addiction Services Coordination Project: $100,000 Data Quality Improvement – Mental Health and Addictions: $100,000 Training and Implementation of the GAIN-SS Screener in the South West LHIN: $50,000

A two-page proposal overview for each project is attached to this report. In addition, a regular South West LHIN Investment Summary is attached to provide further allocation details on the discretionary funding available to the LHIN. Please note that a full project charter has been developed for each project. Project charters were created with the input and support of health service provider partners involved with each initiative. It is important to note that virtually all project partners are providing in-kind resources (people or infrastructure) in support of these projects. Assessment Process The project charters for the Access to Care and Quest for Quality projects have been reviewed by a sub-committee of the LHIN’s Health System Leadership Council and items for improvement from the sub-committee have been incorporated in the project charters. The sub-committee used the recently adopted LHIN Decision-Making Framework to guide the assessment deliberations. The project charters for the three mental health and addictions projects were prioritized and reviewed by the South West Addictions and Mental Health Coalition (health service provider based group). Next Steps Pending LHIN Board consideration of the project proposals, accountability agreements will be put in place with project partners to support the final deliverables, reporting requirements, and funding flow. A report on progress will be brought forward to the LHIN Board each quarter on the projects within the 2011/12 Priorities for Investment Plan. The remaining Priorities for Investment areas of focus will be brought forward to the LHIN Board in September (priorities #4 & #5) and January (priority #6).

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Additional Priorities for Investments may be brought forward to the Board in the Fall in response to emerging priorities and the availability of resources. The below additional two items require South West LHIN Board consideration: Aboriginal Health Lead – Strengthening Aboriginal Partnerships in South Western Ontario The South West LHIN identified the hiring of a dedicated Aboriginal Health Lead in partnership with the Erie St. Clair LHIN and the Southwest Ontario Aboriginal Health Access Centre (SOAHAC), as a priority for investment in 2008/09. At that time, $55,000 was approved as the South West LHIN’s share and allocated to SOAHAC. The role of the Aboriginal Health Lead is to work in partnership with Aboriginal communities, including the five First Nation communities across the South West LHIN and urban Aboriginal partners, to develop positive working relationships and support the identification and implementation of targeted strategies to improve health services and health outcomes for Aboriginals. With the recent hiring of our new Aboriginal Health Lead, an updated budget to cover the salary and expense costs for this position was established. The new allocation required from the South West LHIN is $64,000. Going forward, this amount will be required on an annual basis as the Erie St. Clair and South West LHINs have determined that the Aboriginal Health Lead position should be a permanent role within our respective LHINs. LHIN-wide Wound Management Initiative The South West LHIN approved the LHIN-wide Wound Management Initiative as a priority for investment in 2009/10. Although the LHIN-wide Wound Management Initiative was identified as a three year project, the LHIN was in the practice of keeping its financial commitments to no more than two fiscal years. The initiative created an integrated, evidence-based wound care framework to guide the provision of best-practice wound care across primary, community, long-term care and hospital settings. A lot of effort has been undertaken to implement an education framework to ensure the model is sustained. Finally, work is underway to create a purchasing structure that will ensure wound supplies and products are selected based on the framework and supports need. Outcomes to date include:

23 Physician Engagement sessions 6 Focus Groups Kaisan Events 71 Education sessions (community) with >2000 participants 3 annual data review/evaluations for community clients

o Goal to reduce Daily/BID visit 10% - 15% max o Focus Diabetic Foot, Leg and Pressure Ulcers o Open surgical wounds o Additional focus on VAC therapy

The LHIN-wide Wound Management Initiative has made tremendous strides in achieving the objectives. LHIN staff recommends approval of $142,350 in 2011/12 in support of the third and final year of the initiative. The final year will include the triggers required to sustain the work and achieve the longer term benefits and cost savings identified in the work to-date. End.

Agenda Item 5.2a

South West LHIN 2011/12 Priorities for Investment Plan: Proposal Overview

South West LHIN 2011/12 Priorities for Investment Plan 1

Priorities for Investment Area of Focus – Identify the Integrated Health Service Plan strategic direction being advanced

Enhance Capacity and Integration of Primary, Specialized and Community Based Care - Access to Care for Seniors and Adults with Complex Needs

Project Name

Access to Care

Project Partners

South West Community Care Access Centre (project lead) Hospitals of the South West LHIN Community Support Service Agencies Assisted Living/Supportive Housing Agencies Mental Health and Addiction Agencies

Project Description – Identify the opportunity being targeted

Alternate Level of Care (ALC) pressures in hospitals have long been recognized as a symptom or consequence of health systems inadequately aligned with the needs of the aging and complex population. Senior’s health and well-being is a common LHIN priority and the Excellent Care for All Act is the vehicle to mobilize and align hospitals and health service providers across the province. Implementation of Access to Care can reduce the demand for Long Term Care (LTC) and facilitate clients receiving the right care in the right place at the right time.

Across the province, each LHIN has committed to a series of inter-related initiatives that impact the lives of seniors and adults with complex needs and the communities in which they live. Access to Care is driven by a coordinated, province-wide communications campaign to reach and engage people and all parts of the health care system to measurably improve Ontarian’s access to care. Access to care is a transition management philosophy and approach focused on keeping patients –specifically seniors and adults with complex needs –safe in their homes for as long as possible with community supports by aligning resources and access across the continuum of care to meet the healthcare needs of patients and their families.

The implementation of the components of Access to Care will be accomplished using a staged approach across the South West and will build on the successes experienced in other areas of the province. Access to Care will begin by aligning the following three coordinated strategies across the South West:

Implement Home First - When a person enters a hospital with an acute episode, CCAC and Hospital will consider all other options before LTC placement, and only highest needs seniors and adults with complex needs are referred/admitted to LTC. Home First will promote a cultural shift towards proactive discharge planning with home as the primary discharge destination. Implementation will begin in London at London Health Sciences Centre at Victoria and University Hospital sites, followed by St. Thomas, Tillsonburg, Owen Sound, and Woodstock.

Agenda Item 5.2a



Realign Assisted Living/ Supportive Housing/ Adult Day Programs (AL/SH/ADP) community capacity and implement the CCAC expanded role to facilitate single point access to these services.

Realign Complex Continuing Care and Rehabilitation bed capacity in hospital and implement the CCAC expanded role to facilitate single point access to these services.

Project Goals and Objectives – Identify the outcomes being targeted for improvement

Increasing acute care bed capacity will improve Alternate Level of Care days, lower emergency room wait times, and improve patient flow through our hospitals and into the community. The project will be measured by: Lower percentage of ALC Days Shorter ER wait times Lower ED visits for people with complex needs Lower percentage of same day referral to CCAC Lower percentage of LTCH applications initiated in hospital Lower number of patients transferred from hospital to LTCH Higher number of people with complex needs supported in community setting Highest need seniors placed in long term care home setting

Project Success Factors and Associated Risks

Clear understanding, willingness to change current business processes and active participation of health service providers and community partners

Senior leadership sponsorship Community (public) engagement on Home First philosophy Ability to shift and enhance resources to meet demand

Project Funding – Identify how the goals and objectives translate into value for money

The project requires $ 1,900,700 in one-time funding in fiscal year 2011/12.

The cost per patient day of acute care is greater than the cost of alternate care. Achieving the goals and objectives will improve the health care experiences and quality of life of people in addition to more people receiving the right care by the right provider in the right setting. This will maximize the intended use of current resources.

Project Timeline – Confirm when the project will be completed or if ongoing, identify key timeline milestones

The initial phase of the project will be completed March 31, 2012 with the expectation that resources will be reconsidered for phase 2 in 2012/13 to enable implementation and spread LHIN wide.

Project Sustainability and Spread – Identify how the work will be sustained and any intentions to spread across the LHIN

Agenda Item 5.2a



The Home First spread plan to be completed by February 28, 2012 and sustainability plan March 31, 2012. Spread/Sustainability plans for AL/SH/ADP and CCC/Rehab are part of the deliverables of the project but dates will be determined in Phase 2. End.

Agenda Item 5.2b



Priorities for Investment Area of Focus – Identify the Integrated Health Service Plan strategic direction being advanced Enhance Capacity and Integration of Primary, Specialized and Community Based Care - Integrating Care for Individuals Living with or at Risk of Chronic Illness Project Name Quest for Quality – Chronic Disease Prevention and Management Project Partners South West Community Care Access Centre (Lead for QI and Coaching components) Hospitals of the South West LHIN (Leads for information technology components) Primary care physicians and other community partners Project Description – Identify the opportunity being targeted The purpose of this initiative is to ensure that the successes achieved to-date through Partnerships for Health are built upon, the gains made are sustained and that partnerships among primary care, the Community Care Access Centre, and other health care providers continue to be strengthened. From a quality improvement perspective: The priority will focus on sustaining the gains made by the 73 primary care practices and partners

that participated in Partnerships for Health with the potential goal of achieving 100% commitment of these teams to continue participating in quality improvement activities related to diabetes care, chronic obstructive pulmonary disease, and asthma.

Teams will receive support for quality improvement activities through the Quality and Process Improvement Program (and establishing linkages with other Program participants).

The project partners will develop recommendations for spread and sustainability plans for improved chronic disease management which will include recommendations for spread to additional primary care practices in year 2 of this project.

The project will also create a qualitative and quantitative performance framework to measure outcomes and ensure sustained results.

From an eHealth perspective: An eHealth Support Program will be established to provide technology support to participating

teams (i.e. coaching on use of technology to enable quality improvement activities). As capacity allows, a secondary responsibility of the eHealth Support Program will be to support SPIRE (Southwest Physician Office Interface to Regional EMR) sites that want to learn how to run the searches and queries used by the quality improvement team participants. Of the approx. 200 practices currently engaged in SPIRE, it is expected that approx. 5% may make requests for help running searches and queries.

The electronic capture and exchange of clinical information enables members of the integrated care team to more easily share information and monitor their collective progress towards improvements. The project will also enable hospital-based diabetes educators to expand the use of electronic record systems to capture and share information. New, or modifications to existing, forms, templates and flow sheets will be created to enable the Diabetes Education Centres (DECs) involved in the project to capture assessment information within their hospital’s information system.

Agenda Item 5.2b



Individual patient reports will also be created to enable DECs to share information with their primary care and community partners to update them on progress, etc. Population level reports will be created which will enable the Diabetes Educators to monitor improvements with their diabetes patient population (e.g. changes in clinical outcomes).

Project Goals and Objectives – Identify the outcomes being targeted for improvement Maintain a quality improvement mechanism to either sustain or improve patient/client process and

clinical outcomes Support information management and use of technology (i.e. support use of technology to capture,

retrieve and share information) Support team functioning (i.e. inter-professional team building and functioning) and partnering Engage patients/clients as an active member of care team and support providers in Self

Management skills Project Success Factors and Associated Risks Primary care physician leadership and participation Partnering and engagement of key stakeholders Acquisition of required human resources Communications plan Ongoing quality improvement supports Project Funding – Identify how the goals and objectives translate into value for money The project requires $1,100,400 in one-time funding in fiscal year 2011/12. The continued support for integrated care teams will impact approximately 6,500 diabetes patients across 73 family practices within the LHIN and continue to drive improvements in processes and outcomes across the system. Ensuring access to education opportunities and coaching resources will enable teams to embed quality improvement processes into practice so that improvements will be sustained and new opportunities to improve continue to be identified. Many of these partnerships, improved interactions, and communication among team members are expected to benefit the non-diabetes patients as well (projected to be greater than 65,000). The investment in IT will ensure all DECs across the region are able to make use of their hospital information system and enable improved monitoring and communication regarding all of their diabetes patients (including the subset in common with family practices participating in the project).

Project Timeline – Confirm when the project will be completed or if ongoing, identify key timeline milestones The initial phase of the project will be completed March 31, 2012 with the expectation that resources will be considered for phase 2 in 2012/13 to enable implementation and spread LHIN wide. Project Sustainability and Spread – Identify how the work will be sustained and any intentions to spread across the LHIN Spread and sustainability plans are a deliverable of the project. End.

Agenda Item 5.2c



Priorities for Investment Area of Focus – Identify the Integrated Health Service Plan strategic direction being advanced Enhance Capacity and Integration of Primary, Specialized and Community Based Care – People Living with Mental Health and Addictions Challenges Project Name Addiction Services Coordination Project Project Partners Addiction Services of Thames Valley/ Mission Services London (Project Lead) Salvation Army Centre of Hope WOTCH - My Sisters' Place London Health Sciences Centre London Intercommunity Health Centre City of London Project Description This proposal presents a plan for an expanded range of service options to meet a broader spectrum of needs in London and surrounding areas, including Community Withdrawal Management Services (CWMS) and Day Withdrawal Management services, residential Withdrawal Management and Managed Alcohol. The program will leverage the collective resources of partner organizations to provide a continuum of community-based services. The goal of this project is to look at a continuum of services for people who have targeted/moderate and lower complexity needs who could receive community based withdrawal management services through to residential withdrawal management services and residential managed alcohol treatment to meet more specialized and high/complex needs. Integration efforts would consist of Community Withdrawal Counselors working closely with and complementing the existing residential withdrawal management services in London and after-hours telephone support for clients. The population served by these programs often seeks treatment in the emergency department (ED), creating significant burden to the patient and ED wait times, poor use of hospital base resources and related emergency services such as Emergency Medical Services (EMS), police and the judicial system. This project will define a continuum of services that could be provided through coordination of existing services and resources as well as enhanced resources that would be required for implementation of a full continuum of service to reduce inappropriate use of emergency services and better use of existing community based health services. Project Goals and Objectives – Identify the outcomes being targeted for improvement Reduce emergency room visits

Agenda Item 5.2c



Reduce emergency medical service calls Identify system gaps Increase coordination and appropriate use of existing withdrawal management service by:

Building treatment protocols for managed alcohol program and interdependency on partner programs

Identifying program cost Identifying better use of residential service coordination to provide transition housing and program

support Identifying realignment of existing expenditures to contribute to program operations

Project Success Factors and Associated Risks Success Factors: Partner engagement ED, police and EMS support Risks: Demand exceeding supply Lack of existing resources Project Funding – Identify how the goals and objectives translate into value for money The project requires $100,000 in one-time funding in fiscal year 2011/12. The approximate total cost for local policing, EMS and emergency department services is $1,495,780 annually to provide care for a subsection of the population for which this project would intend to plan community based service. By moving the care to the community, the annual service cost is estimated at $943,000 while reducing demand on emergency services. The project will serve to understand what allocation of existing resources could be better used through coordination of existing services. Project Timeline The project will be completed by March 31, 2012. Project Sustainability and Spread With the completion of the project, issues of sustainability of existing programs should be addressed with opportunities to enhance service delivery to an underserved population. The model may serve as a spread plan for other areas in the South West LHIN. End.

Agenda Item 5.2d



Priorities for Investment Area of Focus – Identify the Integrated Health Service Plan strategic direction being advanced Enhance Capacity and Integration of Primary, Specialized and Community Based Care – People Living with Mental Health and Addictions Challenges Project Name Data Quality Improvement – Mental Health and Addictions Project Partners South West Addictions and Mental Health Coalition (SWAMHC) with HOPE Grey Bruce Mental Health and Addictions Services as Lead Project Description This proposal presents a plan for improving data quality with the mental health and addictions sector, initially focusing on Management Information System reporting compliance. The project lead would host Management Information System (MIS) training workshops for mental health and addiction health service providers serving the South West LHIN in order to:

establish a shared understanding of Ontario Healthcare Reporting Standards and consistent interpretation of MIS data points

establish a shared understanding of reporting requirements provide a forum for provider feedback and suggestions to the MOHLTC regarding

improvements to the MIS data collected by the mental health and addiction sectors and MIS reporting procedures and requirements

foster greater consistency of provider approaches to data collection and reporting across the mental health and addiction sectors

improve the quality of data used by providers and by the LHIN for decision-making and system planning and development

lay the groundwork for development of a data analysis working group that will equip the SWAMHC and LHIN with useful data about system gaps and service needs

Project Goals and Objectives – Identify the outcomes being targeted for improvement The project is to ensure that there is a consistent and standardized reporting process of client activity across HSPs within the South West region resulting in improved data quality for decision-making and system development, coordination and integration. Project Success Factors and Associated Risks Success Factors: HSPs agree with the purpose of the workshops HSPs are able to schedule a sufficient number of staff to attend the workshops

Agenda Item 5.2d



Risks: Potential change to service accountability agreement targets and performance standards Large number of HSPs in the South West LHIN Project Funding – Identify how the goals and objectives translate into value for money The project requires $100,000 in one-time funding in fiscal year 2011/12. The project investment is expected to enable the LHIN and MOHLTC to influence the reporting requirements and standards and their interpretation, increase the consistency and reliability of reporting to improve system performance and improve data quality for agency and system planning, priority-setting and resource allocation.

Project Timeline The project will be completed by March 31, 2012. Project Sustainability and Spread With the completion of the project, issues of sustainability will be addressed through ongoing oversight from the South West Addictions and Mental Health Coalition. The model is intended to serve the South West LHIN and has potential to spread to other LHIN areas. End.

Agenda Item 5.2e



Priorities for Investment Area of Focus – Identify the Integrated Health Service Plan strategic direction being advanced Enhance Capacity and Integration of Primary, Specialized and Community Based Care – People Living with Mental Health and Addictions Challenges Project Name Training and Implementation of the GAIN-SS Screener in the South West LHIN - Part II Project Partners Centre for Addiction and Mental Health (project lead) South West Addictions and Mental Health Coalition Project Description Implementation of Standardized Concurrent Disorders Screening tool (GAIN-SS) in Mental Health and Addiction agencies of the South West LHIN was completed March 31 2010. In that project, over 350 health service providers (HSPs) were trained to administer the GAIN-SS. Evaluation of the project demonstrated that uptake was slow. However, there continues to be interest in being trained in use of the GAIN by HSPs and allied health professionals. As well, standardized screening has been recommended in recent Ontario planning documents (e.g. Every Door is the Right Door). Current implementation research (e.g. Fixsen et al, 2005) suggests a model to ensure better integration of new tools into existing practice.

The first goal of this project is to test a version of this model in the South West LHIN with trained HSPs, both new and already trained in the use of the GAIN-SS. The anticipated outcome of this part of the project will be increased use of the GAIN-SS.

A second goal of this project will be to broaden the base of HSPs using the GAIN-SS. The project will train and establish implementation standards (after Fixsen) in non-addiction and mental health agencies such as Family Health Teams, Community Health Centres and Ontario Works. The anticipated outcome of this part of the project will be having more diverse service providers using the tool.

Project Goals and Objectives – Identify the outcomes being targeted for improvement The project is to train HSPs beyond addiction and mental health and test of a new implementation model.

Project Success Factors and Associated Risks Success Factors: Recruitment of HSPs for training Participation of HSPs and agencies in implementation Project team ability to support implementation

Agenda Item 5.2e



Alignment with Provincial and CAMH GAIN SS Projects Risks: Low uptake by agencies and HSPs Time-limited project Project Funding – Identify how the goals and objectives translate into value for money The project requires $50,000 in one-time funding in fiscal year 2011/12. The project investment is expected to improve quality of care due to early identification of mental health and addiction issues and lead to more streamlined referral to appropriate services. Project Timeline The project will be completed by September 1, 2012. Project Sustainability and Spread With the completion of the project, issues of sustainability will be addressed through ongoing oversight from the South West Addictions and Mental Health Coalition. The model is intended to serve the South West LHIN and has potential to spread to other LHIN areas. End.

South West LHIN Investment Summary 6/14/2011

1

Initiative/Project TitleLead Health Service

ProviderStatus 2011/12 2012/13 2013/14

Urgent Priorities Fund - Core - One-Time South West LHIN Allocation 2,541,509 2,541,509 2,541,509

South West LHIN Program and Services Inventory – Phase 2 South West CCAC Approved -360,000 0 0

Diabetes Education Improvement Project in Thames Valley

Tillsonburg District Memorial Hospital Approved -21,625 0 0

Strengthening Aboriginal Partnerships Southwestern Ontario Aboriginal Health Access Centre Pending -64,000 -64,000 -64,000

LHIN-wide Wound Management Initiative South West CCAC Pending -142,350 0 0

Quest for Quality - Chronic Disease Prevention and Management South West CCAC Pending -1,100,400

Addiction Services Coordination Project Addictions Services of Thames Valley and Partners Pending -100,000

Data Quality and Improvement - Mental Health and Addictions HOPE Grey Bruce Pending -8,644

GAIN SS Screener - Training and Implementation TBD Pending -50,000

Access to Care South West CCAC Pending -694,490

Total Available: 0 2,477,509 2,477,509

Urgent Priorities Fund - Dedicated ED/ALC - One-Time

South West LHIN Allocation 1,996,900 1,996,900 1,996,900

eShift Service Delivery Model for Clients who are at End of Life South West CCAC Approved -790,690

Access to Care South West CCAC Pending -1,206,210

Total Available: 0 1,996,900 1,996,900

Hospital Recoveries Held in Reserve Hospital

Prior Year Recovery plus $66,586 Annual Base*

London Health Sciences Centre Reserve 2,633,531 2,700,117 2,766,703

Prio Year Recovery Stratford General Hospital Reserve 808,500 717,144 717,144

Data Quality and Improvement - Mental Health and Addictions HOPE Grey Bruce Pending -91,356

Total Available: 3,350,675 3,417,261 3,483,847

Residential Hospice - Base* South West LHIN Allocation 1,224,496 1,224,496 1,224,496

South West End of Life Network - Collaborative Planning Process South West CCAC Approved -50,000 0 0

Total Available: 1,174,496 1,224,496 1,224,496Total Available - All Sources: 4,525,171 9,116,166 9,182,752

* Subject to Base AdjustmentsNote: the "Status" column signifies LHIN Board approval/pending; project approval is also subject to annual confirmation of allocations through the provincial budget and estimates process.

Report of the Audit Committee Draft Operational Budget 2011/2012

Meeting Date:

June 22, 2011

Submitted By:

Ron Bolton, Audit Committee Chair

Submitted To:


Purpose:

Information Only Decision

Suggested Motion THAT the South West LHIN Board of Directors approve the draft operational budget for 2011/2012, as recommended by the Audit Committee on June 15, 2011, subject to confirmation of the final funding allocation for the South West LHIN by the Ministry of Health and Long-Term Care. Background The South West LHIN funding for the Operational Budget and eHealth Budget for 2011/2012 has not yet been confirmed by the Ministry of Health and Long-Term Care (MOHLTC).

The budget was prepared based on a full staff complement and a balanced year-end position. Prior year actual expenditures were incorporated into 2011/12 projected expenditures. We anticipate additional revenue for project-specific funding and some of the staff salaries will be

applied to these funding accounts for those individuals that support these initiatives. Revenue: At the time of the preparation of the 2011/12 operational budget, the revenue expectation of $6,286,201 is comprised of the following: Annual base funding of $5,294,419:

Base funding from 2010/11 carry forward including base increase of $76,200 (which was confirmed by MOHLTC on December 1, 2010) - $5,153,419

French Language Services - $106,000 Aboriginal Planning - $35,000

Other: Deferred Capital Revenue of $141,782 (any amounts received that are used to fund expenditures that are capital assets are recorded as deferred capital revenue and are recognized as revenue over the useful life of the asset) One-time initiatives of $850,000:

eHealth project funding - $600,000 Emergency Department (ED) Lead - $75,000 Critical Care Lead - $75,000 ER / ALC Funding - $100,000

Agenda Item 5.3

Expenditures: In developing the 2011/12 budget, the actual expenditures for 2010/11 were incorporated into the analysis. The expenditures are described as follows:

Salaries and Benefits: 2011/12 salary and benefits are based on a full staff complement with no additional positions added from approved staff complement in the previous year. No cost of living allowance (COLA) has been factored into the 2011/12 budgeted amount. The increase in expense in the 2011/12 budget when compared to the 2010/11 actuals can be attributed to the following:

• Additional $45K budgeted for those staff eligible to receive performance increases from 2010/11 in accordance with the Public Sector Compensation Restraint to Protect Public Services Act, 2010;

• Additional $133K budgeted for those positions which were not filled for the entire 2010/11 due to staff turnover and subsequent recruitment period. These positions are now budgeted for the entire 12 months of the 2011/12 year;

• Additional $178K budgeted to fill two positions from approved staff complement which were not filled in 2010/11.

Governance: The expenditures include board complement of 8 members. There are three components: board per diems; board travel; and other board expenses like meeting expenses, retreats, etc. There is one member position that remains vacant and is anticipated for a large component of this fiscal year.

Travel: Based on staffing complement with a small anticipated increase over last fiscal. Consulting Services & Projects: Consulting costs are comprised of committed external services like

annual audit, annual report, website refresh, as well as funds available for project spending. Communications/Forums: The expenditures include the Quality Symposium held in April 2011.

Anticipated events include annual Ontario Medical Association sessions and community engagement. Supplies/Equipment/Maintenance: These expenses are comprised of office supplies, printing of the

community bulletin and corporate brochure, staff training and development (based on staffing), staff recruitment activity and meeting expense. o The LHINs are required to complete an IT infrastructure renewal and each LHIN anticipated

$200,000 allocated to upgrades. LHIN Shared Service Office (LSSO) will oversee this project. At this time, the LHIN has not included this expense in the 2011/12 budget.

Accommodations expenses: These expenses are comprised of mail/courier, voice/data, furniture/equipment, and general repairs/insurance. Costs are similar to last fiscal’s expenses.

Lease expense: Lease expense was offset by an expense recovery from Partnership for Health in 2010/11 (which will not exist in the 2011/12 budget).

Common Services LSSO and LHINC: The costs for common services are expected to remain the same for 2011/12, with the exception of the IT upgrade noted above.

Amortization expense: Amortization expense is offset by Capital Revenue of $141,782.This expense is a calculation of existing assets as detailed in the LHIN Asset Continuity Schedule.

Initiatives: These funds must be used for services as specified by the Ministry of Health and Long-Term Care. As a result, the expenditures match the funding.

eHealth Initiative: The funding and associated expenditures for the eHealth initiative are broken out in a separate column of the 2011/12 budget. The most significant portion of the costs is associated with salaries and benefits. The salaries are based on existing contracts up to expiry dates. All other expenses are inline with last fiscal’s actual expenditures.

ED Lead: This position was recently filled with a start date of June 1, 2011. Critical Care Lead: This position is filled and the LHIN continues to provide this service. ER/ALC Lead: This position is currently vacant with recruitment in place. The LHIN anticipates that

the position will be filled at the end of June 2011. French Language Services: This position was filled in April 2011. Aboriginal Planning: The position of Aboriginal Health Lead was filled in April 2011. The LHIN

anticipates using the funding for planning purposes.

6/16/2011 DRAFTYear End Budget eHealth Budget *

2010/2011 2010/2011 2011/2012 2011/20122011/12

over 10/11 % NoteRevenue

Transfer Payments (Operational) 5,099,732 5,112,220 5,153,419 53,687 1.05%Aboriginal Planning 4,702 35,000 ER/ALC Funding 100,000 - 100,000 - - 2 Critical Care Funding 75,000 - 75,000 - - 2 French Language Services 10,000 72,000 106,000 96,000 Capital Revenue 149,628 149,630 141,782 (7,846) (5.24%)eHealth Funding 940,795 600,000 600,000 600,000 (340,795) (36.22%) 2 ED Lead Funding 51,817 75,000 75,000 23,183 44.74% 2

Total Revenue 6,431,674 6,008,850 600,000 6,286,201 (175,771) (2.73%) 1

ExpensesSalaries 2,735,223 2,901,510 565,490 3,091,820 356,597 13.04% 3, 7Benefits 507,538 595,600 50,890 556,530 48,992 9.65%

Subtotal (Salaries & Benefits) 3,242,761 3,497,110 616,380 3,648,350 405,589 12.51%Governance 127,295 237,780 - 147,810 20,515 16.12% 4 Travel 48,656 85,000 15,000 51,000 2,344 4.82%Consulting Services & Projects 749,350 145,730 176,929 (572,421) (76.39%) 5 Banking Services 581 - 600 19 3.27%Communications / Forums 8,089 25,000 - 47,600 39,511 488.45%Supplies/Equipment/Maintenance 217,586 375,500 20,230 225,500 7,914 3.64%

Subtotal (Other Business Expenses) 1,151,557 869,010 35,230 649,439 (502,118) (43.60%)Accommodations 118,599 194,000 5,400 124,000 5,401 4.55%Lease Expense 165,226 135,000 39,280 225,340 60,114 36.38% 8 Common Services - LSSO 359,495 360,000 - 360,000 505 0.14%LHINC 50,000 50,000 - 50,000 - -Amortization Expense 149,628 149,630 - 141,782 (7,846) InitiativesFrench Language Services 9,318 72,000 - 106,000 96,682 Aboriginal Planning 4,702 - 35,000 Critical Care Lead 74,643 - 75,000 ER/ALC 97,676 - 100,000 ED Lead 38,810 75,000 - 75,000 36,190 93.25%eHealth Expenses 936,039 607,100 - 696,290 (239,749) (25.61%)

Total Operating Expenses 6,398,454 6,008,850 696,290 6,286,201 (145,232) 77.6%Prior Period Expenses - - - - Net Income (Loss) 33,220 - (96,290) - (30,539)

Budget Assumptions:1. Year end revenue for 2010/11 includes in year increases and was reduced by capital purchases and in-year recoveries.2. No revenue confirmed surrounding one-time funding (eHealth, ER/ALC, Critical Care Lead, and ED Lead).

4. Governance budget based on present board complement of 8 members.

7. eHealth salaries are based on contracts expiring on March 31, 2012.

* which includes eHealth funding of $600,000.

5. Consulting costs are comprised of committed external services like annual audit, annual report, website refresh, as well as funds available for project spending.6. Other expenses: The LHINs are required to complete an IT infrastructure renewal and each LHIN anticipated $200,000 allocated to upgrades. LSSO will oversee this project. At this time, the LHIN has not included this expense in the 2011/12 budget.

8. Lease expense was offset by an expense recovery from Partnership for Health in 2010/11 (which will not exist in the 2011/12 budget).

Variance

Southwest Local Health Integration NetworkIncome Statement

2011/2012 Budget - DRAFT

3. 2011/12 salary and benefits are based on a full staff complement with no additional positions added from approved staff complement in the previous year. No cost of living allowance (COLA) has been factored into the 2011/12 budgeted amount. The increase in expense in the 2011/12 budget when compared to the 2010/11 actuals can be attributed to the following: Additional $45K budgeted for those staff eligible to receive performance increases from 2010/11 in accordance with the Public Sector Compensation Restraint to Protect Public Services Act, 2010; Additional $133K budgeted for those positions which were not filled for the entire 2010/11 due to staff turnover and subsequent recruitment period. These positions are now budgeted for the entire 12 months of the 2011/12 year; Additional $178K budgeted to fill two positions from approved staff complement which were not filled in 2010/11.

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