Annual Business Plan - Central LHIN/media/sites/... · Care. This part of the ASP – called the...

Annual Business Plan 2009-2010

Table of Contents ........................... 4EXECUTIVE SUMMARY FOR ANNUAL BUSINESS PLAN..................................

THE STRUCTURE: ........................................................................................................................................ 4 ........................... 4

........................... 7

HIGHLIGHTS: ....................................................................................................................

INTRODUCTION............................................................................................................

........................... 7 8

........................... 9 9

CAL HEALTH

STATEMENT OF PURPOSE.................................................................................................LEGISLATIVE OBJECTIVES AND STAKEHOLDER RESPONSIBILITIES .......................................................OUR MANDATE ..................................................................................................................OUR VISION, MISSION AND CORE VALUES...................................................................................................

ENVIRONMENTAL SCAN OF OPPORTUNITIES AND THREATS TO THE LOSYSTEM .................................................................................................................................................... 10

......................... 10 RISKS AND OPPORTUNITIES.............................................................................................1. POPULATION ENSITD Y ............................................................................................................................ 10 2. POPULATION SIZE AND GROWTH RATE .................................................................................................. 12 3. CENTRAL LHIN POPULATION PYRAMID, 2004 AND 2016 ...................................................................... 12 4. DIVERSITY......................................................................................................................5. I M /I T S

......................... 13 NFORMATION ANAGEMENT NFORMATION ECHNOLOGY UPPORTS................................................ 15

......................... 16

......................... 16

......................... 17

......................... 18

SUB-LHIN PLANNING AREAS ..........................................................................................FRENCH LANGUAGE SERVICE .........................................................................................ABORIGINAL HEALTH SERVICES.....................................................................................

DETAILED PLANS FOR THE LOCAL HEALTH SYSTEM ...................................

18 ......................... 27

34 ......................... 39

S 45 ......................... 50 ......................... 56

FINANCIAL SUMMARY........................................................................................................................ 61

SENIORS AND SPECIALIZED GERIATRIC SERVICES.................................................................................MENTAL HEALTH AND ADDICTION.................................................................................HOSPICE PALIATIVE CARE .......................................................................................................................CHRONIC DISEASE MANAGEMENT AND PREVENTION...................................................EMERGENCY ERVICES.............................................................................................................................CANCER ....... ................ ......................................................................................................WAIT TIMES......................................................................................................................

PLANNING FOR LHIN OPERATIONS ............................................................................................... 61

LHIN OPERATIONS ................................................................................................................................... 61 SPECIAL FUNDING REQUESTS................................................................................................................... 61 PLANNING FOR LHIN’S OPERATIONS...................................................................................................... 63

3

COMMUNICATIONS PLAN.................................................................................................................. 64

......................... 64

......................... 64

......................... 65

......................... 65 KEY STAKEHOLDERS/AUDIENCE.............................................................................................................. 65

......................... 65

CONCLUSION ......................................................................................................................................... 66

STRATEGIC COMMUNICATIONS.......................................................................................DEVELOPING A COMMUNICATIONS FRAMEWORK.........................................................GOALS ...............................................................................................................................OBJECTIVES ......................................................................................................................

KEY MESSAGES.................................................................................................................

4

ss Plan began its role as manager of the

health care system in the areas of North Toronto, York Region and South Simcoe. The creation of 14 d.

of the Annual Service Plan (ASP) is to provide key direction and focus for the LHIN and h system.

ably population growth, urban-rural settlement

he prescribed Care. This part of the ASP – called the Annual

Business Plan (ABP) – essentially addresses two broad areas: Central LHIN’s organizational operations ntral LHIN health system.

he Ministry of Health

tured seven priorities, all designed to achieve four system level goals of access, coordination, quality and

P priority. Since that visory Network has

resulted in the development of a questionnaire for health service providers and is being considered as an

ing priorities for are. However,

ed a derivative of both the Seniors Priority and the Emergency Service Priority, and are incorporated in this plan. It includes capacity building for alternate level of care in targeted areas, efforts to improve patient flow, and ongoing performance monitoring. All our health system projects contained in the ASP are aligned with the Ministry’s goals, our Vision, Mission and Values, and to our IHSP. Each project incorporates measures that are reported regularly through the Ministry-LHIN Accountability Agreement with an aim to improve health system integration. The detailed plans that address our priorities and strategies at the local level are outlined in this ABP and include:

Executive Summary for Annual BusineOn April 1, 2007, the Central Local Health Integration Network (LHIN)

LHINs across the province has forever changed the way our health system is manage The objective the local healt

The Structure: The ASP includes an environmental scan that identifies major system drivers, notaging, high levels of ethno-culturally diverse newcomers and an evolving urban-subpattern. Also outlined are the more specific projects and plans targeted for 2009-2010, using tguidelines from the Ministry of Health and Long-Term

and the Ce

As part of the ASP process, business cases were also developed and submitted to tand Long-Term Care that identified priorities for funding. Highlights: To guide our work, Central LHIN developed an Integrated Health Service Plan (IHSP) and fea

efficiency. In our 2008-2009 ABP, Central LHIN identified Neurological Services as an IHStime, the initiatives and planning aspects driven by our Neurological Services Ad

enhancement to an existing database. Meanwhile, Hospice Palliative Care and Alternative Level of Care have become emergCentral LHIN. In large part, this is driven by the Ministry of Health and Long-Term Cthese priorities are consider

5

t Home, a provincial care and services

ment to reduce Emergency Department wait times and Alternate Level of Care days. Community sector

ged as an alternative to more costly hospital service provision.

actively working with York Central Hospital to upgrade mental health services, the implementation of odel for case management services and utilizing Family Health Teams to serve

hat will positively impact this sector with a commitment to , evaluation and

has identified that the prevalence of chronic disease is lower in Central LHIN than in the province. However, these numbers are forecasted

disease is to prevent ering different at builds on our

y Services me from those 65 care facilities who

to improve mergency Department

e the LHINs to monitor hospital success.

patients will now

innovative Interim Cancer Centre model to provide radiation treatment consultations to and from their

As illustrated in our 2008-2009 MLAA, Central LHIN performs better than the provincial targets in cancer surgery, cardiac by-pass, CT and cataract procedures. However, due to our LHIN’s rapidly aging population and changes in utilization pattern, challenges remain in the area of joint replacement and MRI wait times.

Our ABP, as it relates to LHIN operations, illustrates that the current level of staffing is inadequate to meet all the performance expectations identified in the MOHLTC-LHIN Accountability Agreement, to deliver a strong accountability framework in concert with health service providers, to realize value from existing base allocations provided to health service providers and to make progress on integration efforts.

1. Seniors and Specialized Geriatric Services In August 2007, the Minister of Health and Long-Term Care announced Aging astrategy to help streamline, promote integration and build community capacity offor seniors. Services for seniors are aligned well with the provincial strategy with a commit

resources are being levera 2. Mental Health and Addiction Gaps in mental health and addiction services remain unresolved in Central LHIN. While the LHIN is

a centralized access mpeople with mental health and addiction will not be realized until 2009-2010. 3. Hospice Palliative Care The LHIN has identified opportunities taddress patient and family care, education, communications, advocacy, integrationresearch. 4. Chronic Disease Management and Prevention Our Health Service Needs Assessment and Gap Analysis project

to change as the LHIN’s population ages. The main strategy to reducing chronic the onset of the disease or delay the onset of complications. Central LHIN is considapproaches to improving health outcomes and to develop an overall focused plan thIHSP and can be implemented by health care providers within current services. 5. EmergencOver the next 10 years, the largest growth in Emergency Department visits will coand over. One strategy to address this is the Nurse-led Outreach Team to long-termwould provide care to the residents that would otherwise visit the ER. In an effort performance, Central LHIN welcomes the government’s efforts to develop an EReporting System which will enabl 6. Cancer The timely diagnosis, treatment and care for all cancer patients are high priorities and a continuingchallenge in Ontario. To reduce trips for Central LHIN residents to Toronto, cancerbenefit from anand support directly at Southlake with a free shuttle service to transport patientsappointments at Princess Margaret Hospital. 7. Wait Times

6

nd in our LHIN. laboratively with our communities in evolving and implementing our plan,

re, the LHIN’s to the LHIN’s

r complex health system challenges. This ABP is meant to provide a framework for further discussion and action among all these essential partners. Only through this kind of partnership can common goals be achieved.

The ASP will continue to evolve in response to changes in the broader health system aWe will work closely and coland will update it on an annual basis. Central LHIN believes that the Minister and Ministry of Health and Long-Term Cacommunities, service providers and other stakeholders share in and contribute jointlycommitment to equitable and pragmatic solutions fo

7

n

ice Plan (ASP) is a multi-year planning document that provides key direction and focus

rategies, and a review of the external environment. The plan is a result of ongoing stakeholder engagement with people

and meetings, d future design.

the basis for transformation of the local health system and it assists stakeholders (including the o understand how Central LHIN will address its community’s needs, based on four health

s

4. Efficiency

ssue is the a means to better serve the LHIN’s

communities. This focus is aligned with Ministry’s strategic direction that “access” is a key priority along

rocess. As directed by lth system include Ministry-LHIN

Accountability Agreement indicators as well as draft Ministry priorities.

priorities and entral LHIN. The priorities for change identified in the

Integrated Health Service Plan and outlined in the ASP focus on improving health resources in the community. This strategy is intended to enable financial stability by increasing the use of appropriate health care settings and efficiency in service delivery according to local health needs.

Central LHIN priorities reflect the broad and extensive input, participation and contribution of our stakeholders – including the many organizations and providers that deliver health services in our LHIN, health interest groups and associations, and, of course, our public, including consumers, patients and clients, and their families and support networks.

IntroductioStatement of Purpose The Annual Servfor Central LHIN as it works to implement the strategic priorities outlined in the Integrated Health Service Plan (IHSP).

Central LHIN has developed its ASP within the context of provincial priorities and st

who live or deliver services in Central LHIN. Forums include: community roundtables Central LHIN Board discussion, Central LHIN planning groups, a needs assessment an

It providesgeneral public) tsystem goals:

1. Acces

2. Coordination

3. Quality

It is primarily the focus on under-service on which this ASP is grounded. Solving this iessential transformation necessary to bring about change as

with the ability to provide local services to residents close to home.

Developing effective performance measures is a key part of the strategic planning pthe Ministry, the measurements contained in our plans for the local hea

The Annual Service Plan is also a commitment to achieving clearly defined goals, enablers for sustaining health care in C

8

Our priorities and strategies addressed in the plan are:

ed Geriatric Services

d Addiction

onic Disease Management and Prevention

ency Services

These priorities are a reflection of our understanding of the current state of the health system and needs of ponse to changes in the broader health system

and collaboratively with our communities in

red to develop an Annual Service Plan, as outlined by the Local Health System Integration Act (LHSIA), the Memorandum of Understanding (MOU) between the Ministry and LHINs, the Ministry-LHIN Accountability Agreement and the Agency Establishment and Accountability Directive (AEAD). The Annual Service Plan is a public plan produced for the community, health service providers and government stakeholders that will be appended to the Ministry-LHIN Accountability Agreement in June 2009.

1. Seniors and Specializ

2. Mental Health an

3. Hospice Palliative Care

4. Chr

5. Emerg

6. Cancer

7. Wait Times

our communities. Our plan will continue to evolve in resand in our communities. We will continue to work closelyevolving and implementing our plan, and will update it on an annual basis.

Legislative Objectives and Stakeholder Responsibilities Each LHIN is requi

Our Mandate

Health services in Ontario are often delivered in isolation of one another. People mustsystem, often without adequate support and guidance. Despite health care spending thagrow, our health system is

navigate a complex t has continued to

strained. Through their mandate to plan, coordinate, integrate and fund local health services, LHINs will address these issues and make changes in our health system that truly make a

s.

Central LHIN’s Vision, Mission, and Core Values were developed with input from our health service e us as we work

em that reflects and meets the needs of the people in our LHIN.

Service Plan are driven by the vision and mission

:

Our Mission:

ed Health System for our Communities

Our Values:

Collaboration and Partnerships System Responsiveness and Quality People and Community Focused Openness and Transparency

difference in our communitie

Our Vision, Mission and Core Values

providers and community stakeholders, our Board and our staff. They serve to guidtowards a health syst

The Integrated Health Service Plan and the Annual adopted by Central LHIN.

Our Vision

Caring Communities – Healthier people

Enable Access to an Integrat

The Central LHIN Strategic Plan was developed to guide the Central LHIN’s activities from 2007 to 2010 and beyond, in alignment with our Integrated Health Service Plan. Since the plan was first developed, our

9 Board of Directors has identified two additional strategic priorities: Leadership in Aging at Home, and Quality.

10

ies and Threats to the Local Health System

Analysis has been aps, and how the

support the ns to the under-

s to Central LHIN and its communities, it will take at ited to services in

ress service gaps in

defined as the chance of something happening that will impact on the achievement of objectives. It is can represent an unachieved opportunity, or a threat to the achievement of

es related to priorities identified in the LHIN’s merging priorities. Finally the scan summarizes the findings of these components and

.

Environmental Scan of Opportunit

A common thread that runs through the environmental scan and the community engagement process reflects the existence of gaps in delivering services to Central LHIN communities.undertaken to determine the origins of this lack of capacity, the areas of service ggrowing underserviced issue may be addressed in a fiscally responsible way on a go-forward basis.

In this regard, Central LHIN welcomes the Government of Ontario’s announcement to planning of hospital services in Vaughan. Hospital services will be one of the solutioserviced issue. Even though this is welcome newleast five years before this initiative helps address service gaps and it will be largely limthe institutional sector. There remains an immediate gap and a pressing need to addthe community sector across Central LHIN.

This environmental scan first addresses population-related issues and their risks and opportunities. Risk is

important to note that it objectives. The scan then presents risks and opportunitiIHSP as well as esubsequently identifies several other issues that are taken into account in this ASP

Risks and Opportunities 1. Population Density The figure below illustrates the population density within Central LHIN. Most of the pconcentrated in the south central part of the LHIN (northern Toronto and southern Yoralthough there is a corridor of moderate population density

opulation is k Region),

stretching north and south anchored on Yonge Street and on adjacent major north-south arterial roads.

This population density pattern exhibits a risk: • The needs of the large and densely populated south central part of the LHIN can overshadow

the needs of people in the more northerly rural and semi-rural parts of the LHIN – needs are made more complex by the challenges of transportation difficulties in getting to services that are often some distance away in the densely populated areas.

11

Environmental Scan

ea of substantial and

• Service coordination can sometimes more easily be achieved when services are closer n.

Central LHIN Population Density

Central LHIN Population by Dissemination Area (DA), from 2001 Census (1 Dot=100 people)

This population density pattern exhibits an opportunity:

• The concentration of a large population in the south central part of the LHIN allows for economies of scale. Service sites and programs can be larger in an arconcentrated population.

together within an area of concentrated populatio

Environmental Scan

2. Population Size and Growth Rate Central LHIN is the most populous LHIN in Ontario and is home to 1.66 million approximately 12.9% of

12

people, or Ontario’s population. It is one of the fastest growing regions in the province,

with an annual growth rate of 3.3% over the last 10 years. Over the next 10 years the population is

ted, the LHIN can find that its service planning is composition. In Central LHIN, planning

thin the LHIN, but

H tion also poses an opportunity:

sary for a range of specialized y increasing access to service) with

population will decrease and thereby create an issue of over-.

As well, Central LHIN’s population will grow older, as exhibited in the figure below.

3. Central LHIN Population Pyramid, 2004 and 2016

projected to continue to grow.

A large and rapidly growing population poses a risk: • Growth of population can outstrip the growth of services. • Unless planning is thorough and far sigh

inadequate to meet future population size and must take into account large numbers of people who do not live wiwho will live within it in the short and medium term.

owever, a large and rapidly growing popula• A large population can provide the critical mass neces

health services to be located within the LHIN (therebno appreciable risk that thecapacity of services in the community

2.93.2

3.43.4

3.53.5

3.9

3.93.3

2.81.9

1.61.3

1.00.6

0.20.1

2.83.13.23.23.3

3.54.0

4.34.6

4.13.5

2.82.0

1.71.5

1.31.0

0.50.3

5 4 3 2 1 0 1 2 3 4 5 6

-0-45-9

10-1415-1920-2425-2930-34

45-4950-555-560-665-70

90-84

8 990

5 Ye

ar A

ge G

roup

s

Percent of Total Population

4.24.5

35-3940-44

494

69-74

75-78

5-8+

Male Population % 2004 Female Population % 2004 2016 Projected Population

13

Environmental Scan

2 years. This ‘shift ease in the of potential health

population. Currently Central LHIN has the third highest number of seniors of all ntral LHIN will have the highest numbers of seniors

This upward shift poses a risk: anning and service provision for an older population can lag behind the growth of

It also poses an opportunity: A larger older population can provide the critical mass for introduction of some specialized

pulation base.

The population of Central LHIN is projected to experience a ‘shift up’ over the next 1up’ signifies a bulge in the proportion of seniors in the LHIN’s population and a decrproportion of children and youth. The proportion of seniors is an important indicatorservice needs in aLHINs in Ontario. By 2017, it is projected that Ce65-plus of all LHINs.

• Service plthe older population.

•services that could not feasibly be provided locally for a smaller po

4. Diversity The residents of Central LHIN are more ethnically diverse in comparison to other LHINs and the province. Central LHIN has the highest proportion of immigrants in the province. These newcomers are

, and Vaughan. n Central LHIN,

culturally and linguistically appropriate services for the richly diverse communities.

ustration below n the composition of the immigrant population for 2007. As a result the Central

rage of visible minorities and recent

Although ence of Aboriginal/First Nations and Francophone populations in been based on the need to ensure culturally and linguistically appropriate

lenges in providing t of cultural

competence becomes a necessity. It also poses an opportunity:

• More equitable access can be accomplished by building greater capacity in agencies to address barriers to access for diverse groups in planning and evaluating services. Central LHIN has and will continue to work with hospitals and community service providers to develop annual health equity plans as per schedule B of the H-SAA. A health equity framework and planning guidelines have been developed for hospitals and will be tailored for community service providers.

concentrated in several municipalities, particularly Toronto, Richmond Hill, MarkhamThirty-six percent of our population identify themselves as visible minorities. WithiNorth Toronto, Markham and Vaughan are the most likely areas to face challenges providing

Central LHIN has seen high immigration rates over the last several decades. The illprovides information oLHIN has a population with almost twice the provincial aveimmigrants.

there is a relatively low presCentral LHIN, planning hasserv esic to these populations.

A large, diverse and growing ethnocultural population entails risk in that: • Health and social service providers in Central LHIN face significant chal services that are culturally and linguistically appropriate, and developmen

Environmental Sc

Number of Immigrants from Top Five Countries of Origin, 2007

an

14

15

Environmental Scan

5. Information Management/Information Technology Supports

a residents is, and will continue to be, significantly affected by factors impacting health human resources, specifically their supply, and the availability of

e Central LHIN in light of an aging population, ates, and high

al prosperity and living care services can be

rvices and o deliver these services, and the information

es in an efficient, as information oth patient and providers,

plemented in a sufficiently integrated way in Ontario or is that many of

ent with the directions of the province, the Central LHIN recognizes the potential benefits that eHealth can offer and

sustain the health pecifically, the Central LHIN aims to:

d Referral ;

ation across the health system, through initiative such as

hnologies like the

vincial Diabetes

Together the priorities form the basis of the Central LHIN eHealth strategy, which is a joint strategy with the Toronto Central LHIN. The collaboration with the Toronto Central LHIN also is indicative of progress toward collaboratively building supports that ultimately centre around the clients/patients that we serve, across LHIN boundaries.

In addition to participating in multi-LHIN eHealth initiatives, such as Connecting GTA, and participating in provincially driven programs like the ED-CCAC Notification system and the Diabetes Registry, the Central LHIN intends to lay the ground work this fiscal, 2009/2010, for the implementation of Resource

The capacity to meet the needs of Central LHIN are

information management and information technology supports. Chronic diseases will continue to be a challenge for thincreasing incidence of asthma, diabetes, and obesity, lower breast cancer screening rmortality and hospitalization rates associated with these diseases. The recent and continued projected downturn in the economy will surely test locstandards. These economic pressures may also affect how, and to what extent, healthfunded. These trends point to the need to ensure the availability of appropriate types of health seprograms, the appropriate mix of health human resources tmanagement and information technology supports to enable providers to deliver servicsafe, and consistent manner. The Electronic Health (or eHealth) can be definedtechnology that makes integrated health information available electronically to bacross the continuum of care, in a manner that protects patient privacy. Historically, eHealth initiatives have not been imin the Central LHIN area to take full advantage of their potential. One challengeorganizations use legacy systems that do not communicate with each other. In alignm

aims to overcome historical barriers to deliver the technological supports required to care system. More s

- Improve the care process, through initiatives such as the Resource Matching anprogram

- Improve the ability to exchange informConnecting GTA;

- Support the patient/client’s participation in his/her own health care, through tecpatient portal;

- Support the implementation of provincial eHealth initiatives, including the proRegistry and the Wait Time Information System.

16

of the Central LHIN s the technology

the provincial ct, the

implementation of Resource Matching and Referral is one of six recommendations listed in the provincial

e Ministry, eHealth Ontario, and its geographical ronto Central LHIN, to identify and leverage common solutions on the use of

elivery of care.

ted only at the ealth services are obscured.

variations in health care utilization patterns and demographic, health status and socio-economic characteristics, the LHIN has identified seven sub-LHIN planning areas.

tanding of and

e sub-LHIN planning areas using a population-based approach that is based on cioeconomic

as

to a population g areas of North

or French Language Services. 50.6 % of Francophones live in the h East York. The remaining are in South Simcoe and

in Central LHIN. e:

rgery, Genetics, Emergency, and Maternal and Child services

• Southlake Regional Health Centre: Cancer and Cardiac Care • St. John’s Rehabilitation Hospital From the Central LHIN Workforce Planning survey, 17 Health Service Providers surveyed indicated French as an existing and emerging language need within their organization. A French Language Services Survey has been developed to capture information on access and availability of French services. Dissemination of the survey is planned for later this fiscal year.

Matching and Referral. This effort will require the support and direct involvement Health Service Providers and will largely focus on business process re-design, versuitself. The focus on Resource Matching and Referral in 2009/2010 is in alignment withdirections to address Emergency Room (ER)and Alternative Level of Care (ALC) issues. In fa

ER/ALC Information Strategy to address ER wait times and reduce ALC days.

The Central LHIN will continue to work with thpartners, including the Totechnology to support the d

Sub-LHIN Planning Areas When data on Central LHIN’s population of more than 1.66 million residents are presenLHIN level, variations in the population’s health status and level of access to hBecause of these significant geographic

Data on each of these areas facilitate health planning by increasing the LHIN’s underspopulation characteristics, local health-related issues, specific health needs of communities differences in population health across the LHIN.

The LHIN identified thesassessment of the size and distribution of the population, socio-demographic and socharacteristics and inpatient hospital utilization patterns. The LHIN may modify the sub-LHIN areas new data become available and as the LHIN’s knowledge increases.

French Language Service Approximately 1.3 % of the Central LHIN population is Francophone. This translates size of 17, 620. About 40 % of the Francophone population resides in the three planninYork (NY) which is a designated area fregions of Central York, South West York, and SoutNorthern York Region.

Three hospitals are identified to deliver French language services for specific programsThe following hospitals and programs identified for French language services ar• North York General Hospital: Mental Health, Su

17

in the Georgina re services and the

ty have been ues facing the First st Nation children on e Georgina Island

eaningful input ctivities and

riginal Steering Committee comprised of Central LHIN Aboriginal leaders has been created to oversee the implementation of a project designed to plan for health care services that will address the specific needs of the Aboriginal population residing in Central LHIN. This project is expected to be completed by March 2010.

Aboriginal Health Services Central LHIN has developed relationships with a small Aboriginal community locatedIsland. Through the environmental scan, issues related to access to primary health caimpact of the social determinants of health on the overall health status of this communiidentified. Obesity and diabetes have been identified as the most prevalent health issNation community on Georgina Island. It is estimated that more than 75% of the FirGeorgina Island are obese, and clinic records suggest that one in four members of thcommunity has diabetes. Developing and understanding of local issues and ensuring mwith the Aboriginal community is being carried out through community engagement aparticipating in provincial initiatives. An Abo

18

ystem ized Geriatric Services

tion in Central LHIN. Over the next 10 years, the estimated growth rate for this age cohort will be close to 40%.2 With a

ve the highest

of seniors living in Central LHIN are located in North York Central (16.9%), th rate predictions are growth increases by as

% of the clients served were seniors which has a s, namely Personal Support Workers and Nursing.

6 seniors accounted for6:

s

• 73.21% of discharges from rehabilitation beds plex continuing care admissions, and

complex continuing care6

Ethno-cultural Diversity

Detailed Plans for the Local Health SSeniors and SpecialENVIRONMENTAL SCAN:

Seniors, aged 65 and over, are currently estimated to comprise 12%1 of the popula

projected population of over 280, 000 by the year 2018, Central LHIN is poised to hanumbers of seniors in the entire province of Ontario.3 The largest concentration North York West (14.8%) and North York East (14.4%)4, however once growapplied, South East York, York Central and South West York show significantearly as 20135. In 2007/08, the Central CCAC reported that 60

ourcesignificant impact on Health Human ResCentral LHIN hospital data indicates that in 2005/0

• 31.2% of acute care case• 67.51% of the total days of stay in acute care • 86.96% of alternate level of care days

• 85.91% of com• 19.89% of emergency room visits

In April 2008, the top 3 discharge destinations for alternate level of care patients in Central LHIN hospitals included: long-term care homes, inpatient rehabilitation, and

HIN7 with the majority of visible minorities as a higher number of

th9. Culturally appropriate services for seniors from diverse ethnic backgrounds need to be enhanced.

Central LHIN is the second most ethno-culturally diverse Lbeing Chinese and South Asian8. Compared to provincial average, Central LHIN hrecent immigrants, higher population of visible minorities and higher population grow

1 Service Needs Assessment and Gap Analysis (SNAGA) – Interim Report, p.19 2 SNAGA, Interim Report, p.19 3 Source: Service Needs Assessment and Gap Analysis and Ministry of Health and Long-Term Care, Population Projections 2008-2018. Provincial Health Planning Database Ver 17.07, Extracted Feb 2008) 4 SNAGA, Interim Report, p.22. % Population Aged 65+ in Central LHIN by Planning Area 5 SNAGA, Interim Report, p. 23. Population Aged 65+ Percent Growth by Planning Area 6 Data source for all utilization statistics given: the Ministry of Health and Long Term Care, 2006. 7 SNAGA, Interim Report, p.10. Comparison of LHIN Population Profiles 8 SNAGA, Interim Report, p. 9

19

aregivers in the

livery of services to unities)

ffered. Enhance

5. Build an integrated system of services for seniors and their caregivers in the Central LHIN by seminate

for Central LHIN. It is considered to be a derivative of riority and the Emergency Service Priority, and is incorporated into this detailed plan.

ity building to build alternate levels of care in targeted areas, efforts to improve patient g performance monitoring.

ome Strategy which is ays. These services

leveraging ces as an alternative to more costly hospital service provision.

care beds to

appropriate el of care patient

enhanced o psycho geriatric ll Central LHIN

hospitals with emergency rooms. In addition to this, a coordinated network has been created to support stronger linkages between providers for greater knowledge exchange and care coordination.

rganize system navigation resources for seniors and their caregivers in Central

LHIN • Central LHIN has launched and implemented the Doorways to Care program. This program

continues to expand and provide ongoing training for Doorways to Care system navigators.

GOALS & OBJECTIVES (from IHSP)

1. Enhance Specialized Geriatric Service Capacity within the Central LHIN2. Strengthen and organize system navigation resources for seniors and their c

Central LHIN 3. Develop cultural competence across Central LHIN organizations in the de

seniors from diverse groups (e.g. ethno-cultural, religious and linguistic comm4. Optimize the deployment of resources to ensure full utilization of services o

transportation for seniors to available health services

improving linkages between providers and strengthening their capacity to disinformation, make referrals and coordinate services.

Alternate Level of Care is an emerging priorityboth the Seniors PIt includes capacflow, and ongoin

CURRENT STATUS 2008/2009 Activities Services for seniors are aligned with both our IHSP goals as well as the Aging at Hcommitted to reducing Emergency Room Wait Times and Alternate Level of Care dare being offered at various points along the healthcare continuum with an emphasis oncommunity sector resour

In addition to priorities outlined in the IHSP, Central LHIN has converted 30 long-termconvalescent care beds to better facilitate patient flow out of acute care beds and allowrecovery time for seniors post surgery or after an acute episode. As well, alternate levflow to long-term care homes will be enhanced via the proposed expansion of interim long-term care beds and the Wait at Home program. 1. Enhance Specialized Geriatric Service Capacity within Central LHIN

• Through the Aging at Home strategy, Specialized Geriatric Services have beenthrough the creation of two new geriatric outreach teams, enhancements tsupports and five new Geriatric Emergency Medicine (GEM) nurses for a

2. Strengthen and o

9 SNAGA, Interim Report, p. 9

20

izations in the delivery of services to seniors from

lans to the LHIN in ork’s template and

dimensions rch, the physical

me, we have , supportive

standardized tools adopted through best practice exercises will be modified to reduce barriers

ude translation services mmunication tools.

offered. Enhance

Home, Central LHIN received eight new vans which have been allocated Central LHIN has

ting a

5. l LHIN by inate information,

es ormation and referral

ommunity supports, mmunity agencies.

lation services to

at Home, community capacity and service coordination has been supported through programs such as Home at Last (hospital to community), Community as an Alternative

unity), nd enhanced

interventions. Explore future .

Seniors services for 2009/10 will continue to build off 2008/09 Aging at Home investments and further support the strategic alignment to both the IHSP as well as Aging at Home Strategy. 1. Enhance Specialized Geriatric Service Capacity within Central LHIN

• Continue to improve coordination between services and providers, as well as reduce gaps in services specifically in the areas of dementia and psycho geriatric requirements. This work will potentially be funded through the Aging at Home strategy. 712 additional seniors with dementia will receive support services through the Aging at Home strategy for 2009/10, and a total of 1020 seniors will receive psycho geriatric services.

3. Develop competence across Central LHIN organvarious ethno-cultural, religious and linguistic communities

• Three Central LHIN hospitals voluntarily submitted Senior Friendly p2009. These plans are based on the Regional Geriatric Program Netwdemonstrate how the organization will address the needs of seniors acrossincluding care processes, the emotional environment, ethics and reseaenvironment and the organization’s overall commitment. Through Aging at Hoestablished new cultural-specific programming that includes day programshousing accommodations, hearing counselors, and caregiver support services. All

identified by diverse populations in service delivery. Tools may incland/ or pictographically adapted co

4. Optimize the deployment of resources to ensure full utilization of servicestransportation for seniors to available health service

• Through Aging atto health service providers. In addition to this ministry investment,enhanced transportation ride services in all regions of the LHIN and is pilocollaborative model in the north between a community support agency and Southlake Regional Health Centre.

Build an integrated system of services for seniors and their caregivers in Centraimproving linkages between providers and strengthening their capacity to dissemmake referrals and coordinate servic1) Doorways to Care is a model operating as the first point of contact for inf

services to the public. This program will facilitate an increase in referrals to cand bridge gaps in referral patterns between hospitals, the CCAC and coDoorways to Care is a telephone information and referral service offering transpromote greater equitable access.

2) Through Aging

to Long-Term Care Placement (CCAC Long Term Care waitlist clients to commPolypharmacy Medication Management for at Risk Seniors Post Discharge asupportive housing projects which include multiple partnerships and options for a self-managed care demonstration project

3) PLANNED ACTIVITIES:

2009/10 Activities:

21

ilitation services and improve re.

care facilities as well as ii) the ate.

caregivers in the

are program. lude possible cross-LHIN referral activity within the Doorways to Care

referral service as well as e-health solutions to increase service efficiency. f best practices and

of services to

tral LHIN as well additional seniors

different ethno cultural groups to receive ethno culturally specific services in 2009/10, and ental health challenges,

ill benefit from increased services. It is projected that 582 ive additional

4. Optimize the deployment of resources to ensure full utilization of services offered. Enhance

oth health service e of existing fleets ls, coordinated

inate information,

are will continue to improve linkages between community providers and the uld provide a cost efficient solution

ation will remain

enhanced. Included is an exploration of linking primary care providers within the Aging at Home continuum and possibly target a reduction in unnecessary patient transfers from long-term care homes to hospital as well as an expansion of the Community Referrals by Emergency Medicine Services (CREMS).

3) Potentially invest in a demonstration project focused on self-care for seniors. Considerations include the availability of eHealth tools such as resource matching and referral management solutions and ONEMail. These solutions will enable providers to efficiently refer patients to appropriate services and share electronic information securely, respectively.

• Explore the opportunities to enhance specialized geriatric rehabpatient flow via eReferral related to rehabilitation and complex continuing ca

• Key considerations may include i) investigation of possible regulatory barriers related to Behavioral Support Unit demonstration project within long termintegral role primary care providers play within the Aging at Home mand

2. Strengthen and organize system navigation resources for seniors and theirCentral LHIN • Evaluate and possibly expand sector membership within the Doorways to C• Considerations inc

• Continue to build community capacity through technology, development orisk reduction initiatives.

3. Develop cultural competence across Central LHIN organizations in the deliveryseniors from various ethno-cultural, religious and linguistic communities • Increase access to service in both underserved geographic locations within Cen

as underserved populations. The Aging at Home strategy will enable 1098from538 seniors with specials needs such as those with physical disabilities, mthose with aphasia or loss of hearing wseniors residing in underserved geographic areas of the Central LHIN will receservices.

transportation for seniors to available health service • Centrally coordinated transportation services for Central LHIN by leveraging b

provider as well as subject matter expertise. This project would optimize usagof Central LHIN agencies (including Aging at Home vans), best practice modedriver training as well as community points of access for seniors living in Central LHIN.

5. Build an integrated system of services for seniors and their caregivers in Central LHIN by improving linkages between providers and strengthening their capacity to dissemmake referrals and coordinate services 1) Doorways to C

public, and explore opportunities where Doorways to Care cowhich contributes to reducing Alternate Level of Care days.

2) Through the Aging at Home Strategy, system integration and service coordinpart of Aging at Home funding criteria as new initiatives are selected and existing initiatives are

22

ments and further me Strategy. Focused effort will

gency Room Diversion.

f improved coordination of cho geriatric

port services. Invest in community-based specialized geriatric rehabilitation services.

caregivers in Central

r Doorways to Care services throughout Central LHIN. This includes improved linkages between hospitals and

ays to Care type

y of services to s

mpact Assessment tool to evaluate health equity for seniors living in the Central

-adapted service at high risk

4. entral LHIN by linkages between providers and strengthening their capacity to disseminate information,

make referrals and coordinate services ease service delivery

y and 3) align with Central LHIN Quality and performance improvement initiatives and

Central LHIN.

12 Activities:

e year Aging at

1. Enhance Specialized Geriatric Service Capacity within Central LHIN Examine remaining gaps in service and make necessary adjustments and possible investments to further psycho-geriatric supports. Future planning is required.

2. Strengthen and organize system navigation resources for seniors and their caregivers in Central LHIN Further planning and evaluation is required to assess future activities within the Doorways to Care framework. Key items for consideration include availability of eHealth solutions as well as the feasibility of process development to encourage greater hospital to community referral activity.

2010/11 Activities: Seniors services for 2010/11 will continue to build off existing Aging at Home investsupport the strategic alignment to both the IHSP as well as Aging at Hobe placed on reducing Alternate Level of Care days and Emer 1. Enhance Specialized Geriatric Service Capacity within Central LHIN

Invest in Emergency Department Diversion projects which are a result oSpecialized Geriatric Services. Evaluate existing geriatric outreach teams and psysup

2. Strengthen and organize system navigation resources for seniors and their LHIN Implement recommendations for service improve and enhancements identified fo

community agencies. If available, create seamless processes with other Doorwprojects in other LHINs (e.g. Toronto Central LHIN). Possible implementation of further e-health tools if available.

3. Develop cultural competence across Central LHIN organizations in the deliverseniors from various ethno-cultural, religious and linguistic communitieImplement a Health ILHIN. Continue to support successful Aging at Home initiatives which promote culturallydelivery and develop targeted health promotion and prevention initiatives aimed populations.

Build an integrated system of services for seniors and their caregivers in the C

improving

Streamline primary care led projects to 1) optimize resources involved, 2) increfficiencministry data reporting requirements Continue to plan, invest and evaluation supportive housing service needs in the

2011/ Services for seniors in 2011/12 will depend upon the findings and impact of the threHome Strategy.

23

ery of services to

Plan and possibly implement selected recommendations from the Health Impact Assessment tool livery specifics.

ntral LHIN by eminate information,

Explore opportunities to further health promotion and prevention programs in a coordinated and omponent within the

011/12 are primarily focused on the outcome of the three year Aging at Home Strategy. It is anticipated that adjustments will be made to funding and projects after the third year to

alth in Central LHIN. vides advice and direction related to seniors strategy and Aging at Home

or supportive

rs-related needs

rs within Central ill be i) compiling a

of a centralized

t service providers ll as ad hoc work

edicated to long-

iverse populations tribute to overall planning

and programming

• York Region Transit, Georgina Transit, Regional Municipality of York and other transportation providers – to develop centralized model

• Central CCAC – advising on overall system flow as Aging at Home program effect discharge and referral patterns

• Central LHIN Joint Hospital/CCAC Collaborative – providing input on alternate level of care considerations, including information from the Alternate Level of Care website

• Ministry of Health and Long-Term Care – seeking advise on compliance and policy issues on long term care bed development

• Health Human Resources Workgroup – this Central LHIN workgroup will provide advice

3. tions in the deliv

seniors from various ethno-cultural, religious and linguistic communities Develop cultural competence across Central LHIN organiza

evaluation conducted in 2010/11. Future planning is required for service de

4. Build an integrated system of s ervices for seniors and their caregivers in Ceimproving linkages between providers and strengthening their capacity to dissmake referrals and coordinate services

accessible fashion throughout Central LHIN. Establish a self-managed care cCentral LHIN’s Seniors Health Framework.

Considerations for 2

align with the needs of Central LHIN at that time. Future planning is required. PARTIES INVOLVED:

• Seniors Advisory Network – comprised of all sectors related to seniors’ heThis group pro

• Regional Municipality of York and City of Toronto which assist in planning fhousing requirements for seniors

• Citizen’s Expert Panel for Seniors – comprised of seniors (consumers) who are both users and/or caregivers residing in Central LHIN. This group provides feedback on seniowithin Central LHIN

• Central LHIN Transportation Workgroup – comprised of health service provideLHIN who provide a transportation program for seniors. This workgroup wbest practices model and ii) providing expertise and advise to the developmentmodel for service

• Community Support Service Network – comprised of all community supporwithin Central LHIN. Participants are involved for planning purposes as wegroups

• Supportive Housing Workgroup – comprised of Central LHIN stakeholders dterm planning for supportive housing requirements in Central LHIN

• Community Engagement Session – conducted throughout Central LHIN with dwhich con

• Aging at Home Leads Group – comprised of all Aging at Home leads from across the fourteen LHINs. Participants plan and coordinate Aging at Home strategic direction

• United Way of Toronto and United Way of York Region – to develop grassroots connections for cultural access to community support

24

initiatives. nd implementation

ent and evaluation of psycho geriatric outreach teams, supportive housing to seniors with mental illness and/or dementia, and behavioral units in long-term care homes.

towards health human resource issues that arise as a result of Aging at Home• Mental Health and Addiction Network – this Network will provide advice a

support to specialized geriatric service activities including the developm

PERFORMANCE: PERFORMANCE :

Wait Times is the time from the “decision to treat, to time treatment is received.” The 90th Percentile means the point at which nine out of 10 patients received their treatment

* See Client Outcomes on page 26

th90 percentile Wait Times for

Central LHIN Target for 2009-10 49 Days

Provincial Target Met 182 Days


Central LHIN Target for 2009-10 MRI: 95 Days CT: 28 Days

Central LHIN Target for 2009-10

Knee: 182 Days Hip: 182 Days

90th PercenHi

tile Wait Times for p and Knee Replacement

Central LHIN Target for 2009-10 34%

xProportion of non-admitted high a ity

ed within respecAS 1-2; ≤ 6 hrs for CTAS

cutive targets patients treat

of ≤ 8 hrs for CT

xMedian Wait Times of Long-Term Care Home Placement

x Percentage of Alternate Level of Care Days

xProportion of non admitted low acuity

ed with LOS target of ≤ to 4 hrs

Central LHIN Target 86%


Central LHIN Target 8.7%

patients treat

Central LHIN Target 85 Days

90th percentile Wait times for Cardiac By-Pass Procedures

90th Percentile Wait Times for Cataract Surgery

90th percentile Wait Times for Diagnostic (MRI/CT) Scan

x Expand community capacity

Ensure quality & capacity in service delivery through continuous improvement

x Enable self-care x Proportion of Patients Admitted within Cancer Surgery LOS Target of ≤ to 8 hours

Promote healthy living x

Strengthen communities

Ensure evidence-based results

x

Pursue smarter resource allocation

x Respond to the diverse needs of Ontario's communities

25

26

t

visits by seniors to the emergency department.

MedHome is currently and will continue to support community service delivery as an

ent.

Percentage ALC Days ber of projects

Promote Health Living te, Aging at Home has addressed diabetes and stroke however it is our intention to continue

a reduction in

E a Home strategy for

to Care Closer to Home ing the

me. As such, we have n more remote areas of

tral LHIN through the man resource planning as well as information technology

ding community capacity through ing.

Stre of services, increasing

wledge transfer between sectors as well as providing an increase in the number of services available to seniors living in Central LHIN.


• Throughout the evolution of Aging at Home over the course of three years, Central LHIN will be closely monitoring projects and ensuring continuous improvement and enhanced linkages where applicable throughout the system. Doorways to Care which was launched in June 2008 will also continuously monitor and evaluate its impact and explore new ways to interface within the system.

CLIENT OUTCOMES: Ra e of Emergency Department visits that could be managed elsewhere

• Aging at Home has and will continue to support emergency department diversion projects to reduce the number of unnecessary

ian Wait time to Long-Term Care Placement • Aging at

alternative to waiting on the Long Term Care waitlist for premature placem

• Aging at Home is focused on reducing ALC days, and as such includes a numaligned with this indicator.

• To dato build upon health promotion and prevention programs ultimately leading tooverall hospital usage.

n ble Self Care • We are exploring options which would incorporate self-care into the Aging at

Central LHIN. This is to be determined.

Provide Timely Access • With the goal of most Aging at Home projects, we are working towards increas

accessibility and coordination of services for seniors currently living at hoenhanced transportation services to bridge distance issues for those living ithe LHIN.

E px and community capacity

• Investments have been made into increasing community capacity in the Cendevelopment of best practices, huupgrades. The LHIN intends to continue its support of builAging at Home, however details are to be determined based upon further plann

ngthen Communities: • Aging at Home strengthens communities through increasing coordination

kno

27

scessibility to service

ng a Health Impact Assessment tool in 2010/11 to evaluate health equity for seniors from the perspective of our

ICATIONS:

eHealth: Requires additional funding for a resource matching and referral system for Doorways to Care atching for other types of geriatric services (e.g. to rehabilitation beds and

20% of Canadians will personally experience a mental of Health and Long-

d with a population (aged 15 and dents may need various types of mental health services in

the n

lth conditions and

• 2.6% of Canadians have alcohol dependence

This suggests that a minimum of 35,730 people in Central LHIN may require some type of support for

ked 11 out 14)

ports improved access to services and the timely

ss, referral and coordination. 2. Develop an inclusive and responsive service system to address the current and emerging needs of

ethno-racial communities within culturally-competent environments. Ensure consumers and families can participate fully in the planning, delivery and evaluation of services.

3. Establish the Mental Health and Addictions Network as a Central LHIN advisory group focused

Re pond to the diverse needs of Ontario's communities • Aging at Home has included a number of programs designed to increase ac

for our diverse communities within Central LHIN. We will be implementi

providers.

FISCAL IMPL Required Funding:

and eReferral and resource mservices). Mental Health and Addiction ENVIRONMENTAL SCAN: According to statistics from Health Canada (2002), illness10. The prevalence rate for a serious mental illness as defined by the MinistryTerm Care is 2.5 – 3% of the population11. Based on this statistic anover), of 1,374,249, a minimum of 41,227 resi

Ce tral LHIN during their lifetime.

In 2006/07, 6.7% of Emergency Department visits were patients seen for mental hea5.5% were for intentional self-harm12. In Canada: 13.

• 9% of women and 25% of men are high-risk drinkers. • More than 1% of the population has drug dependence

drug and alcohol dependence at some point during their lifetime. The Central LHIN allots $33 per capita and is one of the lowest per capita funding (ranallocations for community mental health and addiction services in the Province, GOALS & OBJECTIVES (from IHSP):

Develop a comprehensive information system that supce. sharing of client and servi

1. Develop clearly defined systems for acce

10 A Report on Mental Illnesses in Canada, Health Canada, October 2002 11 Making It Happen, Ontario, 1999 12 Mental Health and Addictions in Ontario LHINs, Ontario, 2008 13 ibid

28

tegrates mental of care that is elop strategies for

ded supports addressing the broader determinants of health (affordable housing, income supports, education, and transportation). Enhance information and referral capacity and

system based on the recovery philosophy, where people receive the types and levels of support that are ir needs, minimizing inequities in access to services, and acknowledging the pressures

and urban disparities, and cultural diversity.

ons Network made up of Health rship organizations (research,

in six key activities:

ollection tools

t disorder education to Health Service Providers io Disability Support

rtment staff.

of the access cy project.

over into 2009/10.

In addition, Central LHIN has been actively working with York Central Hospital to upgrade their mental health services to meet the requirements for Schedule 1 designation under the Mental Health Act. Designation was granted by the Ministry of Health and Long-Term Care in August 2008. Through the Aging at Home Strategy, three initiatives were funded that impact on the mental health of seniors, and support mental health services in Central LHIN: Expansion of the Psycho-geriatric Outreach Team in York Region; supportive housing for seniors in North Toronto, and Extreme Cleaning: a consumer/survivor business supporting seniors at risk of losing their housing due to the maintenance of the unit.

on system planning and coordination. 4. Promote a service configuration that is comprehensive, accessible and that in

health, addictions and other cross-sectoral services into a seamless continuumavailable to everyone in Central LHIN. Assist consumers and families to devaccessing nee

coordinate services.

The Central LHIN vision for the mental health and addiction sector is a client-centred, consumer-driven

consistent with theof high growth areas, rural CURRENT STATUS: 2008/2009 Activities

dTo ate, Central LHIN has established a Mental Health and Addictiiders, consumer/survivors, family members, and partneService Prov

education, social services). The Network has been engaged 1. Centralized Access Model

• Development of a centralized access model for case management services. 2. Data Quality

• Enhance data quality using existing Ministry data c3. Education

• 1) Providing concurren2 ) Providing mental health and addiction education to Ontario Works/Ontar

Program/Emergency Depa4. Cultural Competence

• Increasing the cultural competency of Health Service Providers. 5. Development of a mental health and addiction webpage 6. Supporting Family Health Teams

• Creating a better support system for Family Health Teams in enable them to serve people with mental health and addiction problems.

Several of these initiatives will be complete in March 2009 including the development model, the data quality project, education initiatives, the website, and cultural competenImplementation of the access model and the Family Health Team initiative will carry

29

h service e gaps, with the

ervice coordination, nd residential), and

ddiction Network has focused its activities on the first e 2009/10 and 2010/11 activities focus on service configuration, support services, and the

to reduce the gaps in service.

rvice ramework and

as been developed. zed wait list and

tification, unctions, with specific strategies to address the needs of under-

framework have already been implemented by Health ever, additional resources will be required to

port Strategy

e 2009/10 fiscal year. Plan Priorities for Investment based

ation will er into 2010/11.

ployment Support Strategy

ss case has been submitted under the Annual Service Plan Priorities for Investment based

tegration Strategy

ation sector, and

primary care. 5. Development and Implementation of a Residential Withdrawal Management Program

• Led by the Mental Health and Addictions Network. • This initiative is being carried over from 2008/09, with completion in mid-09/10. • A business case for the operating funding has been submitted under the Annual Service Plan

Priorities for Investment. • Local planning is being undertaken to develop an implementation plan in anticipation of future

funding.

PLANNED ACTIVITIES: Central LHIN still has significant gaps in service that cannot be resolved solely througreconfiguration. The Mental Health and Addiction Network has identified many servichighest priorities being supportive housing, cultural competence, case management, saccess, family support, employment support, withdrawal management (both medical ayouth services. To date, the Mental Health and Afour goals. Thbroader determinants of health 2009/10 Activities 1. Implementation of the Centralized Access Model for Case Management Se

• Led by a Central LHIN Partners Steering Committee, a coordinated access fimplementation plan h

• A “hub model” with lead agencies has been proposed, including a centraliwaitlist management, improved use of technology to support wait time idenmanagement and peer support fserved, marginalized groups.

• Several of the key components of theService Providers within existing resources; howsupport implementation of this initiative.

2. Development of a Family Outreach and Sup

• Led by Mental Health and Addictions Network. • This initiative will be developed in th• A business case has been submitted under the Annual Service

on preliminary discussions with the Network. If funds are received, implementcommence in 2009/10 with carry ov

3. Development of a Consumer/Survivor Em

• Led by Mental Health and Addictions Network. • This initiative will be developed in 2009/10, with completion in early 10/11. • A busine

on preliminary discussions with the Network. 4. Development and Implementation of a Cross-Sector Collaboration/In

• Led by Mental Health and Addictions Network. • This initiative is being carried over from 2008/09, with completion in early 09/10.• The sectors being included are children’s services, developmental services, educ

30

ion Problem itiative will provide a

nd supports for people with addiction problems.

• Supportive housing is one of the priorities for Central LHIN’s Aging At Home Strategy. hrough the Strategy.

8.

l LHIN is considering a demonstration project under the Aging At Home Strategy for behavioral supports in two Long-Term Care Homes.

ng: Led by the Mental ith Toronto Central

l Health and Addictions Network, this initiative will be undertaken if new funding is received through the Annual

in early 2010/11.

d Implementation of Supportive Housing for People with Addiction Problems: A ng the rent

Ministry of Health onal allocation of 40 supportive housing units with staff to

orts at a 1:8 ratio. Funding to be provided through the Ministry of Health and Long-Term Care Supportive Housing for People with Problematic Substance Abuse Initiative unit reallocation for

5 upport additional

2

tion Problems: A ng the rent

supplement and support dollars) in 2009/10. Central LHIN is working with the Ministry of Health and Long-Term Care to acquire an additional allocation of 40 supportive housing units with staff to client supports at a 1:8 ratio. Funding to be provided through the Ministry of Health and Long-Term Care Supportive Housing for People with Problematic Substance Abuse Initiative unit reallocation for 2010/11 and 2011/12.

Evaluation of new initiatives: Central LHIN will partner with the leads for the above-noted activities to evaluate the impact of these initiatives on the mental health of Central LHIN residents, as well as their impact on Emergency Department utilization and Alternate Levels of Care.

6. Development and Implementation of Supportive Housing for People with Addict• In partnership with the Ministry of Health and Long-Term Care this new in

minimum of eight supportive housing units a

7. Expansion of supportive housing for seniors with dementia

• It is expected that additional units for seniors with dementia will be funded t

Behavioral supports in Long-Term Care Homes• Centra

2010/11 Activities 1. Enhancement of the Centralized Access Model to include Supportive Housi

Health and Addictions Network, this initiative will be undertaken in partnership wLHIN.

2. Implementation of a Family Outreach and Support Strategy: Lead by the Menta

Service Plan Priorities for Investment. 3. Development of a Consumer/Survivor Employment Support Strategy: Led by Mental Health and

Addictions Network, this initiative will be developed in 2009/10, with completion 4. Development an

preliminary allocation has been provided to Central LHIN for eight units (includisupplement and support dollars) in 2009/10. Central LHIN is working with the and Long-Term Care to acquire an additiclient supp

2010/11 and 2011/12.

. Psycho-geriatric Outreach Teams: The 2010/11 Aging at Home Strategy may spsycho-geriatric outreach teams in Central LHIN.

011/12 Activities 1. Development and Implementation of Supportive Housing for People with Addic

preliminary allocation has been provided to Central LHIN for eight units (includi

31

PARTIES INVOLVED:

roviders in Central as Health Service

boundaries or to cludes partnership organizations such as Jewish

. Participants are

outcomes of the ency Project is also being shared with GTA LHINs.

entral LHIN in the

York and City of Toronto- are partners in planning for supportive housing and residential withdrawal management services.

• Local Board of Education- will be involved in the development of cross-sectoral initiatives with the education sector.

• The Mental Health and Addictions Network- made up of all Health Service P

LHIN that receive funding for Mental Health and Addiction Services, as well Providers outside of the LHIN that either deliver services in Central LHINCentral LHIN residents. As well the Network inChild and Family Services, shelter services, youth services, and educationinvolved in planning at the Network and Work Group levels.

• GTA LHINs- involved in the Centralized Access project. Information and Cultural Compet

• The Ministry of Community and Social Services - has partnered with the Cdelivery of mental health and addiction education to Ontario Works and Ontario DisabilitySupport Program staff.

• Municipalities: Region of

:



PERFORMANCE






Knee: 182 Days

Central LHIN Target for 2009-10 Hip: 182 Days

90th PercenHi




ed within respective targets of ≤ 8 hrs for CTAS 1-2; ≤ 6 hrs for CTAS

cupatients treat

Median Wait Times of Long-Term Care Home Placement







patients treat


90th percentile Wc B

ait times for Cardia y-Pass Procedures





x Enable self-care



x Proportion of Patients Admitted within Cancer Surgery LOS Target of ≤ to 8 hours

x Ensure evidence-bas

Promote healthy living

ed results

x


32

33

OMES:

rtive housing entral LHIN

housing services, and

erm intervention

rse needs of

rgency Department use due to increased peer and family support services, services, and the implementation

for residential withdrawal management services.

s

pport, Emergency sulting in a reduction of

toms of mental illness

& capacity in service delivery through continuous improvement • Early identification and support to people with addiction problems through the implementation of

ships with the

ntral LHIN has annualized

ies for New

ing: Funding may be

ing initiative into gh the Urgent Priorities Fund in 2010/11.

plementation of this submitted under

the Annual Service Plan Priorities for New Investment. Development and Implementation of a Consumer/Survivor Employment Support Strategy: Implementation of this strategy is expected to cost $265,500 in annualized funding. A business case has been submitted under the Annual Service Plan Priorities for New Investment. Development and Implementation of a Residential Withdrawal Management Program: Implementation of this strategy is expected to cost $1.5M in annualized funding, plus major capital funding that will be quantified through the development of a Functional Program. A business case for the operating funding

CLIENT OUTC Percentage ALC days

• increased access to mental health and addiction case management and supposervices in C

• reduced number of ALC days due to increased availability of supportivestreamlined access

• reduction in wait times between service inquiry and assessment or short-t Rate of Emergency Dept visits that could be managed elsewhere/ Respond to the diveOntario's communities

• Decreased Emeincreased professional community supports, simplified access to

Expand community capacity

• Increased capacity to respond to diverse communities through existing service Enable self-care

• Early identification and support to people with mental illness through family suDepartment staff education, and partnerships with the education sector relong-term symp

Ensure quality

residential withdrawal management services, supportive housing and partnereducation sector

FISCAL IMPLICATIONS: Required Funding: Implementation of the Centralized Access Model for Case Management Services: Ceidentified $200,000 through the Urgent Priorities Fund to develop this initiative. $500,000 in funding has been requested through a business case in the Annual Service Plan PrioritInvestment to fully implement and sustain the program.

Enhancement of the Centralized Access Model to include Supportive Housrequired to extend the Toronto Central LHIN Centralized Access for Supportive Housthe Central LHIN; developmental funding may be secured throu Development and Implementation of a Family Outreach and Support Strategy: Imstrategy is expected to cost $215,500 in annualized funding. A business case has been

34

t Home: costs associated with Aging At Home initiatives for 2010/11 and 2011/12 have not been

n Problems: A pplement

ealth and Long-Term o acquire an additional allocation of 40 supportive housing units with staff to client supports at a

1:8 ratio. Funding to be provided through the Ministry of Health and Long-Term Care Supportive ith Problematic Substance Abuse Initiative unit reallocation for 2010/11 and

ng quality, cost-effective end-of-life care is a considerable challenge facing the health care system her

iding appropriate s; however, the

in hospital

sit emergency departments unnecessarily because their choices are f expert palliative care. Many more patients and families could manage

comfortable death at e no formal training

HIN Hospice Palliative e.

Service Plan; however, the LHIN has since identified oppor s vision for

for persons with a progressive life-threatening illness through timely response to changing patient needs and conditions

vely address luation and research.

The Provincial End-of-Life Care Strategy has three objectives:

1. Shift care of the dying from the acute setting to appropriate alternate settings of individual preference

2. Enhance client-centred and interdisciplinary end-of-life care service delivery capacity in the

has been submitted under the Annual Service Plan Priorities for New Investment. Aging Adetermined.

Targeted Investments from other sources: Development and Implementation of Supportive Housing for People with Addictiopreliminary allocation has been provided to Central LHIN for eight units (including the rent suand support dollars) in 2009/10. Central LHIN is working with the Ministry of HCare t

Housing for People w2011/12. Hospice Paliative Care ENVIROMENTAL SCAN: Deliverigiven our aging population and increasing incidence of cancer, cardio-pulmonary conditions, and otchronic diseases. Current research contends that community-based approaches to provend-of-life care are more cost effective and responsive to the diverse needs of consumermajority of Canadians (approximately 73-75%) and 66% of Ontarians continue to diesettings.14 Many patients die in hospital or vilimited due to the inaccessibility oto accomplish their goal of staying at home as long as possible and having a peaceful home if improvement to access to care is provided. Many nurses and physicians havor experience in managing the complex needs of palliative patients. The Central LCare Network activities will have a positive impact on the current state of palliative car GOALS & OBJECTIVES (from IHSP): Hospice palliative care was not included in the Central LHIN Integration Health

tunities to positively impact this sector. Central LHIN’hospice palliative care is to improve quality, efficiency, choice, and access to care

throughout the continuum of care. The Hospice Palliative Care Network endeavours to positipatient and family care, education, communication & advocacy, integration, and eva

14 Dying in Canada: Is it an Institutionalized, Technology Supported Experience. D.K. Heyland et. al, Journal of Palliative Care,16, 2000.

35

well as those planned for the following years, align with and objectives outlined above.

TUS:

ive Care Network comprised of members his initiative

entral LHIN

perational plan)

rough the 2008/09

ing comfortably at home if mily. Studies have shown that the availability of a

e goals. This initiative palliative care services in Central LHIN, enhancing access to

in-home hospice palliative care, providing integrated care, and enhancing system navigation. A in this initiative.

Hospice Palliative Care Network website ervice Providers,

amilies.

on

5. Core Competencies

nd promotion of core competencies for nurses and personal support workers clients

ents 7. Identification of integration opportunities PLANNED ACTIVITIES: 2009/10 and 2010/11: 1. Implementation of a residential hospice in York Region

• Led by Southlake Regional Health Centre, in partnership with the Central CCAC and the Central LHIN Hospice Palliative Care Network, a York Region site for a 10-bed residential hospice will

community, and 3. Improve access, coordination and consistency of services and supports across the province.

All 2008/09 Central LHIN activities, as support Provincial

CURRENT STA 2008/2009 Activities In October 2007, Central LHIN established a Hospice Palliatrepresenting hospitals, community providers, hospices, physicians, and the Central CCAC. T

swa in response to the Ministry’s policy guidelines for the End-of-Life Strategy. The CHospice Palliative Care Network has been engaged in seven key activities:

1. Development of a residential hospice plan (including Functional Program and o• Plan is for York Region. The Functional Program is complete, and the Operational Plan is being

developed 2. Development and implementation of an interdisciplinary team model (funded th

Aging at Home Strategy). • Aging at home will include staying at home as long as possible and dy

that is the choice of the person and their faspecialized consultation team for palliative care is necessary to meet thesstrengthens the capacity of hospice

business plan for electronic connectivity among providers is included 3. Central LHIN

• Development of a website to promote knowledge exchange with Health SNetwork members, consumers, and f

4. Ontario Cancer Symptom Management Collaborative and Promotion (including commassessment tools)

• Identification aproviding care to hospice palliative care

6. Dyspnea education

• Education for direct care providers to reduce Emergency Department use by palliative care cli

36

rships with the l requirements for this

requested through the Aging at Home Initiative.

tnership with the my Latner Centre, e, advanced

support, and expert intervention. The goal is to prevent unnecessary trips to the Emergency Department,

eath where home or hospice would have been their choice. me Strategy.

3. activities for

iatives to promote the are Network.

eligion and ethnicity and its role in caring is important for end of life care since cultural perspective influence attitudes toward

alth Service cy to enhance the

upported an Open Space Forum focused on integration for hospice ntified through that forum, as well as through the n established to identify the potential impact and

unities for these integration activities.

ified for future development/investigation include: orative volunteer training

T eP R

• Central LHIN Hospice Palliative Care Network Steering Committee- members include hospitals, community providers, hospices, physicians, and the Central CCAC. Their role is to provide leadership for the integration of hospice palliative care services in the Central LHIN.

• Health Service Providers and volunteers – provide advice to the Network on the needs of palliative care recipients, and support planning and implementation of hospice palliative care activities undertaken by the Network as work group participants and health care champions.

• Municipalities – partnerships with municipalities are key to the successful implementation of residential hospice services as it relates to property and zoning.

be secured and a hospice built in keeping with the Functional Program. PartneRegion of York and community donors are key to the success of the capitainitiative. On-going operating funds will be

2. Development of additional in-home interdisciplinary team

• Led by the Cancer Care Centre at Southlake Regional Health Centre, in parCentral LHIN Hospice Palliative Care Network, Mount Sinai Hospital’s Temand the Central CCAC, this initiative target seniors and others with progressivillnesses who require pain and symptom management, psychosocial and spiritual

admission to hospital, and hospital dThis is an expansion of the 2008/09 initiative funded through the Aging at Ho

Continued education to Health Service Providers • The Education and Research & Evaluation Work Groups will identify education

hospice providers, clients, and their families. Funding for educational initgoals of this initiative is a line item for the Central LHIN Hospice Palliative C

• Understanding of culture, r

professionals providingsickness, dying, death and grief. The educational activities need to provide HeProviders with an understanding and tools on how to deliver cultural competendelivery of care.

4. Integration of day hospice service

• In June 2008, Central LHIN sproviders. A number of activities have been ideIntegration Work Group. Task groups have beeimplementation opport

• The top five integration activities identI. collab

II. fund-raising and awareness III. resource matching and referral management solutions IV. board member education V. community education

se activities will carry over into 2009/10 and 2010/11. hA TIES INVOLVED:

PERFORMANCE:



90th percentile Wait Times for





Central LHIN Target for 2009-10 Hip: 182 Days Knee: 182 Days

90th PercenHi



Proportion of non-admitted high a ity ed within respec

AS 1-2; ≤ 6 hrs for CTAS


of ≤ 8 hrs for CT

x

Percentage of Alternate Level of Care Days

Proportion of non admitted low acuity ed with LOS target of ≤ to 4

hrs




Centra arget 85 Days

patients treat

l LHIN T






Enable self-care Proportion of Patients Admitted within

x Respond to the diversOntario's communities

e needs of

x Strengthen communities

x Ensure evidence-based results



x

Cancer Surgery LOS Target of ≤ to 8 hours

37

38

Medh the Aging At Home

llows people to stay at home longer, perhaps until the end of their life. Long-term care inary team.

Per• The introduction of a residential hospice in York Region, as an alternative to institutional care for

e, will allow people to

Rat• The Hospice Palliative Care Network provided education and practical tools to nurses and

ill one of the most

ptrategy, including a 10-

ams.

ecare teams to

g as possible.

ty and Capacity in Service Delivery Through Continuous I p

n, Education, and Integration Work inate common assessment and referral tools for use across

in the hospice palliative care sector. As well, the Network delivers an annual nce to disseminate and exchange knowledge on best care practices.

partner with faith

Required Funding: Implementation of a residential hospice in York Region: Southlake Regional Health Centre is the lead for this initiative to build a 10-bed residential hospice. Central LHIN plans to provide $500,000 in operating funds, through the Aging at Home Initiative for this project. See below for plans to raise capital for this project (Targeted Investments from other sources). In addition, the Ministry of Health and Long-Term Care is providing $580,000 for nursing and personal support through the Central CCAC.

CLIENT OUTCOMES:

ian Wait Time to Long-Term Care • The introduction of multi-disciplinary teams in the Central LHIN throug

Strategy ais less likely required for an individual receiving care through the multi-discipl

centage ALC Days

those nearing the end of the their lives, who may not be able to die at hombe discharged from hospital to an appropriate care community.

e of Emergency Dept Visits that could be Managed Elsewhere

personal support workers on dyspnea at their October 2008 conference. Additional training wbe provided throughout the year, with the support of the CCAC. Dyspnea iscommon reasons for a palliative client to access emergency department services.

Ex and Community Capacity

• The Network is introducing new services through the Aging At Home Sbed residential hospice in York Region, and multi-disciplinary palliative care te

Str ngthen Communities

• Communities are strengthened by working together in both formal and informal support people with terminal illnesses to stay in their community for as lon

Ensure Evidence Based Results/Ensure Qualim rovement

• The Hospice Palliative Care Network Research & EvaluatioGroups are working together to dissemdisciplines withconfere

Respond to the Diverse Needs of Ontario’s Communities • One of the goals of the residential hospice and the multi-disciplinary team is to

and ethno-cultural groups to meet the diverse needs of palliative patients. FISCAL IMPLICATIONS:

39

nding to support additional in-home

Continued education for Health Service Providers: Funding to support this initiative is provided through

Funding to support integration initiatives with day hospices will be

ential hospices is local communities. A property request has been made to Regional

ns will be sought

Development of additional in-home interdisciplinary teams: A proposal for a Central LHIN palliative bmitted by at the Chief of Staff at Southlake Regional

007. Approval of this proposal would support physician participation in the

and the economy is substantive and ding cause of avoidable death and disability and account for a 15 Chronic disease is considered a condition that develops slowly

over time, is long lasting and often progresses in severity. While chronic conditions can be managed or ses including cancer,

ructive pulmonary disease, asthma 16

• 25% visits to general practitioners

hronic conditions

Central LHIN focus on diabetes for 2008/09 was to align itself with the main activities of the Joint eHealth Strategy and the Ministry of Health and Long-Term Care. In July 2008, the Ministry announced it was launching a new $741 million diabetes strategy that aims to prevent, manage and treat diabetes. The

Development of additional in-home interdisciplinary teams: Fuinterdisciplinary teams will be requested through the Aging at Home Initiative.

the Central LHIN Hospice Palliative Care Network. Integration of day hospice services:requested through the Urgent Priorities Fund. Targeted Investments from other sources: Implementation of a residential hospice in York Region: The development of residtraditionally well supported byMunicipality of York Region based on the Functional Program. Community donatiowith the support of the Southlake Regional Health Centre Hospital Foundation to raise capital costs to build this 10-bed residential hospice.

care physician Alternate Payment Plan was suHealth Centre in April 2interdisciplinary teams. Chronic Disease Management and Prevention ENVIRONMENTAL SCAN:

The burden of chronic conditions on people, the health care systemgrowing. Chronic conditions are the lealarge share of health service utilization.

controlled, there usually is no cure. Chronic conditions encompass a number of diseadiabetes, depression, heart disease, hypertension, stroke, chronic obstand arthritis. In Central LHIN, the above nine chronic conditions accounted for:

• 10% emergency room visits

Thirty-nine percent (39%) of residents in Central LHIN had at least one of the nine clisted above and 42% of residents aged 65-plus had two or more of these conditions.

15 Health Council of Canada (2007). Why Health Care Renewal Matters: Learning from Canadians with Chronic Conditions. Toronto: Health Council. www.healthcouncilcanada.ca 16 Health System Intelligence Project (2007). Chronic Conditions in Central LHIN. Ministry of Health and Long-Term Care, Toronto

40

mple, the diabetes focused its short-

ly to help support the local implementation of the diabetes registry.

care

patients with chronic disease . municipal

nt) to support health promotion and disease prevention elf-management support for people with chronic diseases in the LHIN

ntegrated continuum of care for chronic diseases to health care providers in Central .

e prevalence of chronic recasted to change. Over

al LHIN. The 65-13% and the 85 plus

d to grow by 43%. These numbers are significant because people over the age of 65 project further

gher than the provincial average in specific planning areas of Central LHIN including the North York West area. Central LHIN is now in an enviable

mmodate the growth in numbers of people

T emented by the Chronic D

to diabetes care in rural Central LHIN ng home tele-monitoring and home visits as well as

t strategies g of training

PLANNED ACTIVITIES:

A wide range of risk factors influence the development and onset for chronic disease including age, behavioral lifestyle factors and socio-economic factors. Evidence has long identified that chronic disease can be prevented or delayed. The main strategy to reducing chronic disease is to prevent the onset of the disease, or if disease is present, to delay the onset of complications. This can occur throughout the continuum of care by many different providers. More robust community services with in-home supports for those with chronic disease can prevent or delay complications. Reduced fragmentation between health service providers can be achieved through better service coordination and communication (e.g. electronic

Ministry of Health is developing some components of the strategy centrally, for exaregistry, which will be implemented locally. Central LHIN’s eHealth office has alsoterm efforts on diabetes, specifical

GOALS & OBJECTIVES (from IHSP):

1. Assist people with chronic disease access treatment across the continuu2. Assist health care providers (including primary care) implement electronic solutions (including

m of

Electronic Medical Records) to improve quality of care for their3. Establish a working group of health care providers and other stakeholders (e.g

governme4. Increase s5. Promote an i

LHINCURRENT STATUS:

2008/09 Activities

The Health Services Needs Assessment and Gap Analysis project identified that thdisease is lower in the Central LHIN than in the province. These numbers are fothe next 10 years, the number people aged 65 and older will grow substantially in Centr74 age cohort is expected to grow by 56%, the 75-84 cohort is expected to grow by cohort is expectehave two or more chronic diseases. The Service Needs Assessment and Gap Analysisillustrated that the rate of growth of diabetes will be hi

position of having a window of opportunity to plan to accowith chronic disease.

wo key strategic initiatives from the IHSP, as described below, are being implisease Management and Prevention (CDMP) Advisory Network:

1. Increasing access • Using a multi-pronged approach includi

development of new rural clinics

2. Increasing the health provider skills to deliver chronic disease self-managemen• This is being accomplished through provider training, website video streamin

workshops, website resources and materials, and continuing education credits

41

e for the patient leading r these different

plan that builds on the nd that can be implemented by health care providers within current services.

n The plan will be

onsider implementing ivities identified in the plan. The intent of this action is to help focus the efforts of

verall impact achieved. Performance indicators will be he hospitals and

ary programs that ated that if 33% of

ld save $70 million annually on treatment LHIN will

nsider practical primary and se will be shared with

Technology (IM/IT) Fact Sheet emonstrated to improve the quality of care for people with chronic diseases. The

ity will be providers, s registry will be

4. Sng at Home funding, a stroke prevention program will be established to focus on

lderly population. also consider how Stroke System

d considering alignment with the LHIN borders. The CDMP Advisory Network will monitor these discussions and engage the OSS as appropriate. Should stroke treatment be addressed, the CDMP Advisory Committee will engage the appropriate neurology support.

• Humber River Regional Hospital and York Central Hospital, the Central LHIN’s two Regional

Chronic Kidney Disease Centres, will meet regularly to plan dialysis services at a LHIN-wide level, especially community supports. Other dialysis providers will be invited and included in meetings and implemented as appropriate.

health record). In turn, the reduced fragmentation results in more continuous carto better health outcomes. The aim of the CDMP Advisory Network is to consideapproaches to improving health outcomes and to develop an overall focusedoriginal IHSP a

2009/10 Activities:

1. Chronic Disease Management and Prevention Strategic and Outcome-oriented Pla• This plan will be created by the newly established CDMP Advisory Network.

broadly distributed to providers within Central LHIN with an invitation to csome of the actdifferent providers to maximize the oestablished using the information and data already being collected from both tcommunity agencies.

2. Multidisciplinary and Multi-sectoral Working Group

• The 2007 Ontario Health Quality Council report identified some interdisciplinwere successful in other jurisdictions in preventing diabetes. The Council estimthe diabetes cases in Ontario could be prevented it woucosts growing to $500 million annually in three years. Building on this, Centralestablish a multidisciplinary and multi-sectoral Working Group to cosecondary prevention activities that can be rolled into current practice. Theproviders who can implement on a voluntary basis.

Information Management / Information 3.• IM/IT has been d

critical success factors identified in the literature as enhancing IM/IT capacsummarized in a fact sheet which will be widely distributed to Central LHIN particularly primary care providers. Information about the Ministry’s diabeteshared with providers as it becomes available.

troke and Diabetes/Dialysis • Through Agi

preventing hypertension, the primary stroke risk factor of stroke, within the eThe CDMP Advisory Committee will provide advise to the project and will best to leverage the project learnings throughout Central LHIN. The Ontario(OSS) is reviewing its borders an

42

2010/11 Activities:

ties to advance the CDMP Advisory Network’s three priority areas – Prevention, IT/IM and Continuum of Care will

ill have been in the field for one year and preliminary data orts, if any, could

der high risk

• The dialysis network will likely be expanded to a LHIN-wide Network of dialysis providers to r collaborative opportunities such as training. The stroke prevention program should have

preliminary evaluation results identifying the elements of the program that have had the desired

l in previous years

P R

nizations (e.g. ction and guidance

• CDMP Coalition- membership represents health service providers addressing chronic disease in central LHIN, consumers, partnership organizations, research and academic organizations. This group meets biannually with the role of providing multiple perspectives and input to the strategic plans and direction developed by the Advisory Network.

• CDMP Work Groups- currently the Self-Management Workgroup and the System Coordination Workgroup. Consists of health service providers and partnership organizations who implement a specific project as directed by the Advisory Network.

• Activities initiated in 2009/10 will continue and expand in 2010/11. The activi

be reviewed and those showing impact will be continued.

• The Ministry’s diabetes registry wabout successes and challenges will be reviewed to determine what suppenhance the implementation of the registry.

• During this fiscal year, the CDMP Advisory Network will also start to consipopulations and develop interventions targeted specifically for these groups.

conside

impact and those elements that may need revision.

2011/12 Activities:

• The activities for 2011/2012 will depend on what was shown to be successfuand had a positive impact on the quality of service.

A TIES INVOLVED:

• CDMP Advisory Network- consists of health service providers, partnership orgapublic health); the role of this committee is to provide the overall strategic direfor chronic disease integration and coordination in Central LHIN.

PERFORMANCE:







Knee: 182 Days

Central LHIN Target for 2009-10 Hip: 182 Days

90th PercenHi



Proportion of non-admitted high a ity ed within respec

AS 1-2; ≤ 6 hrs for CTAS


of ≤ 8 hrs for CT




hrs




patients treat







x Enable self-care

Respond to the diverse needs of Ontario's communities



Pursue sma er resource art llocation


th90 percentile Wait Times for Proportion of Patients Admitted within Cancer Surgery LOS Target of ≤ to 8 hours

43

44

CLIENT OUTCOMES:

ld be managed

ity services to the rural s of the LHIN through developing rural diabetes clinics and providing in-home care to

of ED visits

lf-care: the self-management project trains providers to assist patients in developing a

Pro

y living: both the rural diabetes project and the self-management project include linkages with municipal

pacity unity capacity: the rural diabetes project is enhancing/creating three new

nity-based diabetes clinics as well as providing in-home care for frail seniors with diabetes

d Prevention System Level Strategic Plan: The plan, completed in stem level

, CCAC and

funding costs for CCAC and all hospitals for full implementation in Central LHIN will be addressed and readmissions to

Multi-sectoral Working Group Primary and Secondary Prevention: Implementation of this strategy is expected to cost $500,000 in developmental work. Annualized funding requirements can be calculated once the developmental work is completed.

Patient Self Management for Stroke and Diabetes: Building on the project completed in 2008/09, implementation of this part of the strategy will cost approximately $250,000 in developmental costs. Annualized funding requirements can be calculated through the development phase.

P ovr ide timely access to care closer to home/ Rate of Emergency Dept visits that couelsewhere

• ED visits managed elsewhere: this is accomplished by providing communareaimprove diabetes control that lead to better diabetes outcomes and a reduction

Enable self-care

• Enable setailored approach to manage their chronic disease thereby enabling self-care

mote healthy living • Promote health

health promoting messages. The rural diabetes program also provides recreation facilities for people with chronic disease.

Expand community ca• Expand comm

commu

FISCAL IMPLICATIONS:

Required Funding:

Chronic Disease Management anMarch 2009, identified Clinical Pathways/Transitions as a priority for action to improve syprocesses and patient outcomes. A developmental pilot project involving one hospitalprimary care will require approximately $700,000 which will be requested through AAH. Annualized

during the pilot project. This will permit services to be provided in the communityhospital /emergency department reduced.

45

are used by millions epartments across the

in the province. h volume

are categorized as high volume 18 ergency

reasing population.

vice Plan as the

primary care mergency services.

g approximately ion of visits that the

19

North Y nal Health Centre

me. Fewer than 6% of nts occur outside of the LHIN. With regards to the

ian Triage ith the national

• The majority of services provided in the Emergency Department in Central LHIN are at Canadian Triage and Acuity Scale (CTAS) level III3.

• Only 0.49% of Emergency Services are at Canadian Triage and Acuity Scale (CTAS) level I;

aged 65 and over make up

Emergency ServicesENVIRONMENTAL SCAN Emergency Department services play an important role in our health care system and of Ontarians each year; in 2006/2007, there were 5,262,529 visits to Emergency DProvince. This represents about 40 Emergency Department visits for every 100 people70% of all Emergency Department visits in the province occurred in teaching and higcommunity hospitals.17 The 6 acute care hospitals in Central LHINcommunity hospitals (i.e. annual number of visits are greater than 30,000). The demand for EmDepartment services within the province is expected to increase, in line with the incAddressing Emergency Department wait times is a key initiative of the Ministry.

Central LHIN has deemed Emergency Services a priority in our Integrated Health Seremergency service capacity is strained by population growth, decreasing availability ofphysicians and lack of alternatives to e In 2006/2007, Central LHIN had 411,672 visits to Emergency Departments, representin8% of the total Emergency Department visits in Ontario which is on par to the proportCentral LHIN as one of 14 LHINs would expect.

ork General Hospital, Humber River Regional Hospital and Southlake Regioaccounted for the largest proportion of Central LHIN Emergency Department voluEmergency Department visits by Central LHIN resideCanadian Triage Acuity Scale: 20

• The majority of Emergency Department services in Central LHIN are for CanadAcuity Scale level IV21 accounting for approximately 40%. This is on par waverage (40.2%).

both of these are on par with provincial trends. • Of all the Canadian Triage and Acuity Scale (CTAS) level I, those

52.8% of the cases.

17 Understanding Emergency Department Wait Times: How Long Do People Spend in Emergency Department Wait Times: How Long Do People Spend in Emergency Departments in Ontario?, Canadian Institute for Health Information, January 2007 18 Canadian Institute for Health Informatics 19 Service Needs Assessment and Gap Analysis (SNAGA). KPMG. November, 2008. 20 Understanding Emergency Department Wait Times: How Long Do People Spend in Emergency Department Wait Times: How Long Do People Spend in Emergency Departments in Ontario?, Canadian Institute for Health Information, January 2007 21 Canadian Triage & Acuity Scale (CTAS) is a tool that enables Emergency Departments (ED) to triage patients according to type and severity so as to ensure that the sickest patients are seen first (Level I = resuscitation; Level II = Emergent; Level III = Urgent; Level IV = Less Urgent; Level V = Non Urgent)

46

e from the 65 and over l be the 20 – 34

expected population aster than the

provinc

ened to 2% most 4%. Emergency Department cases within the LHIN

ergency Department

d projections indicate that Central LHIN’s Emergency Department visits will grow ovincial average which could mean the need for more emergency services.

Central LHIN established the Emergency Services Advisory Network as outlined within its Integrated H comprised of Emergency Department physicians, nurses, and a mmunity Care A term workgroups to develop recommendations to

rm Care facilities)

ns in the Hospital ing Access to

Central LHIN Emergency Department Lead and Emergency Services Advisory Network are actively involved with the implementation of the Ministry of Health and Long-Term Care’s Emergency

ated Health Services Plan t/Alternate Level of Care

strategy includes a $109 Million investment to reduce wait times in the Emergency Departments and nent of this strategy is the development

ency Department Reporting System which will enable the LHINs to monitor the performance of hospital emergency departments commencing in fall 2008. Another component of the Emergency Services/Alternate Levels of Care strategy is the Nurse-led

Over the next 10 years, the largest growth in emergency department users will comcohort, which is expected to experience a 40% growth. The next largest growth wilcohorts, and the 35 – 64 cohorts. Assuming current service delivery models andgrowth within the LHIN, Emergency Department cases will grow within the LHIN f

ial rate: 22 • By 2011, the number of Emergency Department cases within the LHIN will grow by over

4%, while the provincial rate will only grow by around 3% • By 2013, the gap between the LHIN and provincial averages will have wid• By 2018, the gap will increase to alwill have grown by 15% as compared to 2006/2007, while the provincial Emvisits will have increased to just fewer than 12%

The aforementionefaster than the pr

CURRENT STATUS: 2008/2009 Activities:

ealth Service Plan. The Network isdministrators, Toronto and York Region Emergency Medical Services and Central Coccess Centre. The Network has established short-

improve access to: 1. Specialist (Consultant) Response Time 2. Diagnostic Imaging and Lab Services 3. Rapid Response Team (i.e. a team deployed to treat elderly patients in Long-Te4. Support Services (e.g. Social Worker, GEM Nurse, etc)

These workgroups were established in response to some of the recommendatioEmergency Department and Ambulance Effectiveness Working Group entitled “ImprovEmergency Services: A System Commitment” (Summer, 2005).23 These recommendations are expected to be presented to the Network in January 2009.

Department/Alternate Level of Care strategy and moving Central LHIN’s Integrforward. The Ministry of Health and Long-Term Care’s Emergency Departmen

reduce Alternate Level of Care days in acute hospitals. A compoby the Province of an Emerg

22 Service Needs Assessment and Gap Analysis (SNAGA). KPMG. November, 2008. 23 Also knows as the Schwartz Report.

47

vide care to the ncy Department. This

of Directors ent will be

l Community Care Access Centre via the Emergency Room Notification initiative – this initiative will be implemented in three Central LHIN hospitals with plans for expansions to other

Central LHIN, including barriers that impact

ary care providers, community and long-term care providers and emergency services.

N.

e is an emerging priority for Central LHIN, driven in large part by the Ministry of Health and Long-Term Care. It is considered to be a derivative of both the Seniors Priority and the

vice Priority, and is incorporated in this plan. It includes capacity building for alternate prove patient flow, and ongoing performance monitoring.

tation Plans , the Emergency Services Advisory Network will develop implementation plans to

execute the goals and objectives mentioned above. Over the course of the year, the proposed p for input to so take into

visit including

P R

• The Emergency Services Advisory Network- made up Emergency personnel from the acute hospitals in Central LHIN and Central Community Care Access Centre as well as a representative from a Long-Term Care facility. Participants are involved in planning at the Network and Work Group levels.

• Municipalities: Emergency Medical Service- representatives from the Region of York & City of Toronto are members on the Advisory Network.

• Central LHIN Emergency Department Lead- has monthly meetings with other LHIN counterparts and Ministry of Health representatives.

Outreach Team to long-term care facilities. The objective of this team would be to proresidents of long-term care home who would otherwise be destined for the Emergeinitiative is anticipated to be implemented in the fall 2008, pending Ministry and Boardapproval. Moreover, seniors 85 years and above, that end up in the Emergency Departmflagged by the Centra

hospitals within our LHIN. GOALS & OBJECTIVES (from IHSP):

Emergency Services Priority Goals are as follows: 1. Identify barriers to access for emergency services in

patients from diverse communities s between prim2. Develop communication and transition strategie

3. Assess patient and provider satisfaction with emergency services. 4. Improve flow through procedures in emergency departments in Central LHI5. Develop strategies to add alternatives to emergency services.

Alternate Level of Car

Emergency Serlevel of care in targeted areas, efforts to im PLANNED ACTIVITIES: 2009/10 Activities:

1. Development of Implemen• In 2008/2009

implementation plan will be shared with the Diversity and Inclusion Workgrouensure that needs of diverse populations are being considered. The plan will alconsideration the contributing factors that result in an Emergency Departmentsocial determinants of health.

A TIES INVOLVED:

PERFORMANCE:









Knee: 182 Days Hip: 182 Days

90th PercenHi






of ≤ 8 hrs for CT








patients treat







Enable self-care x Proportion of Patients Admitted within Cancer Surgery LOS Target of ≤ to 8 hours



x Ensure evidence-ba


sed results

x

Pursue sma er resource allocation rt

48

49

CLIENT OUTCOMES:

mes to Central

tment Pay for Results strategy, wait times at Hospital, North York General Hospital and York Central Hospital

recommendations

Acute Myocardial Infarction (AMI) tegy, which includes

ives to address urgent cardiac cases, the readmission rates for acute myocardial infarction

t the nurse-led outreach team will increase community capacity through

ement en for the Emergency

Pay for Results.

• As a result of the deliberations and recommendations by the various working groups under the the Emergency Services Advisory Network, it is expected that Central LHIN residents

FISCAL IMPLICATIONS:

m Care has announced funding for the ED/ALC strategy year 1 of a multi-year strategy, to achieve specific performance goals in 23 targeted hospitals, three of which are in Central LHIN. Once the workgroups within the Network submit their recommendations (in January 2009), it is expected that the implementation of these recommendations will have a funding impact, the magnitude of which is unclear at this time. It would assist Central LHIN in formulating a long-term Emergency Services plan if the Ontario Emergency Services short-term and long-term strategies, including funding allocations, were to be shared so as to ensure alignment and a shared vision.

Rate of Emergency Department visits that could be managed elsewhere: • As a result of the nurse-led outreach team, volume of transfers from long-term care ho

LHIN hospitals is expected to decrease. • It is expected that as a result of the Emergency Depar

Humber River RegionalEmergency departments will decrease for Central LHIN residents.

Ensure evidence-based results • The Emergency Department Pay for Results initiatives are aligned with the

put forth in the Schwartz Report, 2005. Readmission Rates for• It is expected that as a result of the Emergency Department Pay for Results stra

initiatshould decrease.

Expand community capacity • It is expected tha

training. Ensure quality & capacity in service delivery through continuous improv• Patient satisfaction is also expected to increase as a result of initiatives undertak

Services

guidance ofwill be able to access same or similar services across the Central LHIN hospitals within accepted timeframes.

Required Funding: Emergency Department/Alternate Level Care strategy: The Ministry of Health and Long-Ter

50

the five-year ses of mortality and

owing diseases in Ontario today. Cancer statistics, compiled by Cancer Care Ontario Ontario, demonstrate the

exte o

in every three Ontarians will be diagnosed with cancer at some point in life

ately 25,000 lives

potential years of life lost in people under 40 to 74,000 in 2014

% of new cancer cases occur in people aged 50 or older next three years,

this number is expected to increase to 460,000 b is ugh reductions in known risk

factors

te locally e seen throughout the province:25.

C e Population Count

Central 2007 7,400 3,009 1,657,047

Central 2010 8,271 3,287 1,765,619

Central 2015 9,824 3,756 1,940,232

Cancer ENVIRONMENTAL SCAN:

While cancer survival rates have been steadily increasing over the past several years (survival rate for most cancers now exceeds 50%), cancer is still one of the leading cauone of the fastest gr(CCO), the lead agency for the coordination and provision of cancer services in

24nt f the challenge:

• More than 50,000 Ontarians are diagnosed with cancer each year • One• Two out of three Ontario households have been affected by cancer

n Ontario, claiming approxim• Cancer is the second leading cause of death ieach year

• Cancer is the number one cause of • The number of new cancer cases is expected to grow from 54,000 in 2004• 85• approximately 410,000 people in Ontario are living with cancer; over the

• Approximately 50% of the urden of cancer preventable thro

The data presented below for Central LHIN illustra the them

LHIN Calendar Year ancer Incidenc Cancer Mortality

24 National Cancer Institute of Canada: Canadian Cancer Statistics 2002. 25 Ontario Cancer Registry, Cancer Care Ontario; Population Projections, Ontario Ministry of Finance; Postal Code to LHIN Conversion, Ontario Ministry of Health

51

GOALS & OBJECTIVES (from IHSP):

HIN hospitals and ional Cancer Program Steering Committee,

under the auspices of CCO. With a mandate to assist the LHIN in developing a plan for cancer care

atively with cancer care providers to ensure the implementation of the Ontario

her integration and

gful patient and consumer input which may impact

7. To identify issues and establish processes for resolution, relating to the delivery of comprehensive ervices, and

8. Through the Regional Vice President, to make recommendations to the CCO on strategic clinical nistrative priorities and the allocation of resources.

T ith representatives o Cp Mo

m patient X-rays,

ips and promotions

The Committee is also working to strengthen the relationship between Southlake and Princess Margaret Hospital, a centre of excellence that provides one of the largest comprehensive cancer programs in the world to support Southlake as it develops its new Regional Cancer Centre. An innovative Interim Cancer Centre model has been developed at Southlake to provide radiation treatment consultations and support directly on the Southlake campus with a free shuttle service to transport patients to and from their radiation therapy appointments at Princess Margaret Hospital. This will reduce trips to Toronto for cancer patients requiring radiation therapy because the radiation consultations with oncologists will occur at Southlake.

Central LHIN, in collaboration with CCO, Southlake Hospital, and other Central Lhealth service providers, established a Central LHIN Reg

services, the Steering Committee set out several objectives, including:

1. To link providers of cancer care and plan for a cancer care continuum, which integrates cancer services to provide a seamless system of patient care

2. To work collaborCancer Plan

3. To identify opportunities for future planning (capital and operational), and furtcoordination of services

4. To foster the development and delivery of program excellence 5. To ensure meanin6. To monitor CCO statistical reports, activities and other external developments

on the delivery of cancer care services

cancer care s

and admi

CURRENT STATUS:

2008/2009 Activities:

o ate, Central LHIN has established a Cancer Care Services Steering Committee, wf CO, Southlake Regional Health Centre, and other Central LHIN hospitals and health service

d

roviders.

st recently, the Steering Committee has: 1. Endorsed a project to develop a hospital-wide digital storage and retrieval syste

• This system will allow health service providers at Southlake to access and viewultrasounds, mammograms, and other images online.

2. ColonCancerCheck • Supported the new province-wide cancer screening program through partnersh

within various sectors in our LHIN, and public service messages on local transit.

52

PLANNED ACTIVITIES:

continuing ncer Programs in

ers, organizations, idual organizations

raphic area, each d by CCO), with a gional Cancer ady established

among cancer care providers in their regions. The partnership between Regional Cancer Programs, local l Ontario patients. n and provision of

Central LHIN is performing within the provincial corridor regarding surgical wait times with HRRH and ided to reduce the wait time

erceived as a negative reward. In addition, as wai ps in those wait times. CCO listened rgets”.

n,

nt assessed

are 14 key areas that the LHIN is responsible to over see and cancer is one of the 14 key areas. An e in negotiation with the

M n hree areas.

most part any patient who wishes to receive roups of patients imately 25% of

plant, head and

) • Patients who choose to travel outside the LHIN (5-10%)

Despite every effort to accommodate the needs of our population, it is acknowledged that there will be a fourth group of patients, those that would have to travel outside the LHIN in order to receive treatment within acceptable wait times. Currently the region does not have the capacity to treat all patients residing within Central LHIN. Based on 2006/07-travel pattern, at least 50% of patients receiving treatment traveled to Toronto-Central LHIN. The average Central LHIN outflow rate of 60% is not uniform across the LHIN, with less than 30% of

2009/10

Cancer Care Ontario: The timely diagnosis, treatment and care for all cancer patients are high priorities and achallenge in Ontario. In response to this challenge, CCO has established Regional Caeach LHIN. Regional Cancer Programs are virtual programs linking cancer care providand decision-makers across the spectrum of cancer care in each LHIN. While indivand agencies are responsible for delivering cancer services to the patients in their geogRCP is charged with implementing the priorities of the Ontario Cancer Plan (developefocus on improving access to quality cancer services within its diverse community. RePrograms build on the existing relationships, networks and collaborative programs alre

cancer care providers, and CCO is crucial to delivering well-coordinated services to alThis partnership has been reconfigured within the LHINs to ensure that the coordinatiocancer services is aligned with other health services at the local level.

NYGH leading the pack. As Central LHIN is performing well, CCO decfurther. CCO was contacted and notified that this may be p

t times drop, it becomes increasingly more challenging to effect further dro but maintained that lower targets were achievable and decided on the “stretch ta

The committee identified the following concerns around Cancer Care Ontario’s decisio• Might not technically be possible to reduce the wait time further • With a wait time less than one month the median is 2 -3 weeks • There would be more advantages to monitor how long it takes to get a patie Thereagr ement has not been reached with the government in all 14 areas. Three are still

istry and the LHIN does not as yet have responsibii lity for any of those other t

Plan (OCP), for the In keeping with the Ontario Cancertreatment close to home will be able to do so. We anticipate that there will be three gwho will be expected to receive their care outside Central LHIN, representing approxpatients.

• Those receiving specialized treatments for acute leukemia, bone marrow transneck cancers, sarcomas amongst other rarer cancers (~5%)

• Patients participating in clinical trials not available within the LHIN (5-10%

53

to the Toronto outflow, Central

L f a growing population, reduce patient wait times and enhance access to cancer

at within the LHIN s

few or no specialized physicians who solely treat benign hematology. Patients that require high intensity chemotherapy (acute leukemia/bone marrow transplants) or combined

2007 travel patterns indicate that a high percentage of patients with prostate cancer are currently treated in

percentage of gynecological oncology cases travel to Toronto Central LHIN due to the small number of specialized surgical oncologists treating these tumors. We recognize that CCO will be issuing

ber of gynecology oncology centers required to met the demand and m in of the report on Central LHIN and specificallycurrently PARTI

embers from Cancer Care Ontario, Southlake Regional Health Centre, other Central LHIN hospitals, health service providers, and members of three public health units. Under the auspices of CCO, this group assists Central LHIN in developing a plan for cancer care services, early detection, and prevention of disease in the population. As per the Ontario Cancer Plan, the fourth goal is quality of care. Part of the information comes from the clients themselves through the hospitals. So the steering group helps to ensure these surveys are conducted and client feedback is obtained.

patients in the north central area of Central LHIN receiving treatment outside its boundaries. The higher interregional outflow to the south of the LHIN is not surprising given the close proximityCentral LHIN. By providing increased capacity locally and decreasing the interregional

HIN can meet the needs otreatment services closer to home. Major disease site groups managed locally include breast, colon, prostate and lung. Significant hematological malignancies are also treated within the LHIN. It is worth mentioning thbenign hematology is treated by the Hematologists/Oncologists in addition to their oncology workload athere are

chemotherapy/surgery/radiation (head and neck) generally receive care in the Toronto Central LHIN as is appropriate.

the Toronto Central LHIN. Many of these patients require radiation therapy and it is anticipated that as this new service becomes available at Southlake Regional Cancer Centre, more patients will be able to be treated closer to home. A high

recommendations related to the numa tain the highest quality of care. We will need to assess the potential impact

on North York General Hospital, where there is a gynecologist-oncologist .

ES INVOLVED:

• Central LHIN Regional Cancer Program- consists of m

54

:



PERFORMANCE





Central LHIN Target for 2009-10 8.7 percent


Percentage ALC days

Provide timely access to care closer to home

90th PercenHi


Central LHIN Target for 2009-10 85 days


Proportion of non-admitted high acuity patients treated within respective targets of ≤ 8 hrs for CTAS 1-2; ≤ 6 hrs for CT3

AS

Proportion of non admitted low acuity patients treated with LOS target of ≤ to 4 hrs




Proportion of non admitted low acuity patients treated with LOS target of ≤ to 4 hrs





x Enable self-care


x Strengthen communities

x Ensure evidence-ba

Pursue sma er resource allocation

sed results


rt

x

x

x

an Wait time to Long-Term Care MediHome Placement

percentile Wait Times for x 90Cancer Surgery

th

55

NT OUTCOMES:

to cancer care.

provide care close to home. The timeliness of treatments can have a significant impact on cancer es, prognosis and quality of life.

Enaealthy eating and active living, as well as

ng policies. Provide timely access to care closer to home/ Strengthen communities

ient who wishes to

Ens h continuous imp

prove the quality get the best scientific evidence applied in clinical practice. The PEBC

ing the development of evidence-based practice guidelines and standards in 11 disease areas, as well as in seven clinical guidelines groups. The PEBC’s evidence-based

es and standards are designed to facilitate evidence-based decision making by clinicians,

red Funding:

stemic treatments ce and human

realistic, but not be upport at the level

us community here is a need to examine the inconsistent distribution of

resources among the academic versus community based hospitals. Certain levels of resources are needed by teaching hospitals, but are just as important for community hospitals where the patient population resides and where growth is significant. The projection is for a five year plan and we should consider what is reasonable and achievable in next few years with the resources we currently have. The Cancer Care Services Steering Committee felt that our projections should reflect the expected repatriation of patients back to our LHIN, volumes that provide enough critical mass for hospitals to be self-sufficient regardless of size. However, once Annual Financing and Procurement model is agreed, it is crucial for hospitals to receive support and funding to fill positions.

CLIE 90th percentile Wait Times for Cancer Surgery

• Wait times are an important measure of how quickly people are getting access They also indicate the health care system’s ability to meet the needs of all cancer patients and

patients’ treatment outcom

ble self-care/ Promote Healthy Living • Nearly 50% of cancers can be prevented through h

through regular cancer screening and the implementation of health-promoti

• In keeping with the Ontario Cancer Plan (OCP), for the most part, any patreceive treatment close to home will be able to do so.

ure evidence-based results/ Ensure quality & capacity in service delivery througrovement / Pursue smarter resource allocation • Cancer Care Ontario’s Program in Evidence-Based Care’s (PEBC) role is to im

of cancer care by helping does this by lead

guidelinsystem leaders, and policy makers.

FISCAL IMPLICATIONS: Requi Regional Systemic Therapy Program: Members meet to determine the volume of syour LHIN could deliver if we had the ideal infrastructure including funds, physical sparesources in place. After discussion among the committee it was felt we should be constrained by current deficiencies and project what truly could be achieved, with srequired. Examination of the inconsistent distribution of resources among the academic versbased hospitals: It was further identified that t

56

decisive action to shorten wait times for patients by establishing wait , hip and

Ontario's access targets were developed after consultation with clinical experts from across Ontario. They anage the way patients

atment.

umber of procedures to reduce the backlog that has developed over the last decade, investments in new, more

achines, standardizing best practices for both medical and administrative functions, and collecting and reporting accurate and up-to-date data on wait times to allow

countability.

GOALS &

wait time priority services.

ines and metrics to ensure there are no negative impacts to other non-wait time services within each specialty.

e data collection and interpretation to fully use services.

rting of wait times,

our 2008/09 MLAA refresh, Central LHIN generally performs better than the provincial ery, cardiac by-pass, CT and cataract procedures. However due to the Central

in in the area of joint .

To improve performance for cataracts and joint replacement the LHIN has turned to collaborative innovative models such as high volume centres and common assessments to improve performance. For MRI and CT it is necessary to add machines and/or introduce additional shifts using existing equipment to reduce wait times. 1. Cataract Wait Times:

• Because of high population growth and an aging population Central LHIN will continue to face high demand for this procedure.

Wait Times ENVIRONMENTAL SCAN: The Ontario government has takentime access targets in five key areas – cancer surgery, cardiac bypass surgery, cataract surgeryknee replacement and MRI and CT scans.

reflect a new priority system being developed to better and more consistently maccess key services across the province, based on the urgency of their need for tre Other elements of Ontario’s Wait Times Strategy include significantly increasing the n

efficient technology such as MRI m

better decision making and increase ac

OBJECTIVES (from IHSP):

1. Enhance capacity to reduce wait times.

2. Reinforce foundation for collaborative planning for

3. Through expert panels, develop guidel

4. Streamlin

5. Support education about wait time priority services, consistent and timely repo

and a coordinated referral and follow-up process. CURRENT STATUS : 2008/2009 Activities: As illustrated in targets in cancer surg

ILH N’s rapidly aging population and changes in utilization patterns, challenges remareplacement and MRI wait times

57

n part by the higher ithin the Central LHIN) will continue to

generate high demand for these procedures in the Central LHIN.

t the LHIN’s will increase cantly more time per

ed a cardiologist hlake will be home to one of the few innovative cardiac centres

mproved cardiac disease diagnosis and treatment. There will be an and risk in ability to

4.

places significant pressures on current capacity. ll reap benefits because patients and the LHIN will experience a decrease in cardiac

zation. This is expected to become the standard of care for a segment of the cardiac patient population.

P A 200

1. Improve Wait Times er than on an individual

tigating new collaborative

PARTIES INVOLVED:

• Wait Time Strategic Planning Group – includes all Central LHIN hospitals and the Central Community Care Access Centre. This group oversees the LHIN’s analysis of wait time performance and assists it in identifying strategies to address performance issues.

2. Hip and Knee Replacement Wait Times: • High population growth coupled with an aging population (accounted for i

than average inflow of seniors to retirement areas w

3. MRI Wait Times:

• In the rapidly developing field of Cardiac MRI, the demand for MRI services aRegional Cardiac Centre (operated by the Southlake Regional Health Centre)dramatically. In addition to increased volumes, these procedures take signifistudy. In response to this developing trend and demand, Southlake has recruitwith expertise in the field. Soutrelying on MRI scans for iincrease in longer and more complex MRI scans, resulting in more pressurecommit to provincial targets in out-years.

CT Wait Times: • The development of CT cardiac angiography

Such scans wicatheteri

L NNED ACTIVITIES:

9/2010 Activities

• Central LHIN aims to improve wait times through a system approach rathinstitutional basis. To that end, Central LHIN will work towards invesand innovative models.

PERFORMANCEFORMANCE:



:








x 90th PercenHi



Proportion of non-admitted high acuity ed within respective targets

AS 1-2; ≤ 6 hrs for CTAS patients treatof ≤ 8 hrs for CT




hrs




patients treat


x 90th percentile Wait times for Cardiac By-Pass Procedures

x 90th Percentile Wait Times for Cataract Surgery

x 90th percentile Wait Times for Diagnostic (MRI/CT) Scan

Expand community capacity


Enable self-care

Respond to the diverse needs of Ontario's communities


x th90 percentile Wait Times for Proportion of Patients Admitted within


Pursue sma er resource art llocation


Cancer Surgery LOS Target of ≤ to 8 hours

58

59

ental allocations

14,629,341) replacements ($9,173,400)

• 465 cancer surgeries ($3,404,473) )

T t he Wait Times Strategy: $107,248,884 P c arch 2008 (April 1, 2008 to March 31, 2009)

• Cataract surgery waits have gone DOWN 3.52% • Hip replacement waits have gone DOWN 15.47%

nt waits have gone DOWN 13.33% it have gone DOWN 10%

e gone UP 11.42%

ATIONS : Required Funding: Ongoing Wait time Funding: Central LHIN hospitals have highlighted the critical need to transform current one-time funding assistance for the wait time strategy into ongoing base funding to bring about stability in the system.

CLIENT OUTCOMES:

Wait Time Strategy: 2008/09 increm

• 4,044 cataract surgeries ($$

2,826,100) • 925 cardiac procedures (

int • 1356 hip and knee jo

• 21,533 MRI hours ($5,598,580• 1618 CT hours ($404,600)

Total 2008/09 incremental funding: $27,267,694

o al incremental funding since the launch of t

er ent change comparison of March 2009 vs. M

• Knee replaceme• MRI wa• CT scans hav

FISCAL IMPLIC

60

:

IHSP priorities and emerging priority are activities that are planned to be undertaken within Central LHIN’s approved allocation. The purpose of the performance tables provided is to assist the reader to understand how planned initiatives align with performance targets. As Emergency Wait Times targets have defined new expectations for Central LHIN, no confirmative data has been provided on page 59. It is important to understand that the initiatives described herein and on their own will not ensure that performance targets are attained as they are system level indicators. As part of more macro planning and funding processes Central LHIN is undertaking initiatives and developing principles that will pursue smarter resource allocation and ensuring responsiveness to system results. Through accountability agreement, the Central LHIN acknowledges the roles of our health service providers in attaining our system level performance indicators. Central LHIN will continue to monitor system performance and adapt new funding initiatives to potentially target unmet indicators as required.

l LHIN T49 Days





PERFORMANCE

x th90 percentile Wait Times for

Note: The proposed initiatives described within the detailed plan per our

Hip: 182 Days Knee: 182 Days

Centra arget for 2009-10

x 90th PercenHi



xProportion of non-admitted high acuity


patients treatof ≤ 8 hrs for CT

tive targets




ed with LOS target of ≤ to 4




patients treathrs


x 90th percentile Wait times for Cardiac By-Pass Procedures

x 90th Percentile Wait Times for Cataract Surgery

x 90th percentile Wait Times for Diagnostic (MRI/CT) Scan



x Enable self-care x Proportion of Patients Admitted within Cancer Surgery LOS Target of ≤ to 8 hours


Strengthen communities x

x Ensure evidence-based results

x

Pursue smarter resource allocation x

x Respond to the diverse neOntario's communities

eds of

61

ary

nvironment Scan n, Central LHIN has one of the highest growth areas in Ontario, and there is a growing need for expansion

does not have the flexibility or excess resources for transfer to other sectors.

2. Ministry announced initiatives, some of which have not been reflected in Schedule 9

mandate and achieve its priorities.

LHIN Operations

Financial Summ

Central LHIN has not identified any reallocations between sectors. As reflected in the Esectioof services in all sectors. Central LHIN

Our expenditure plan is made up of:

1. A three-year plan as reflected in Schedule 9 of MLAA;

The three-year plan proposes to fulfill Central LHIN

Planning for LHIN Operations

As Central LHIN assumes the role of local systems manager, it continues to implement a strong financial accountability framework so health service providers can operate within Hospital Service Accountability Agreements (H-SAA) and Multi-Service Accountability Agreements (M-SAA) defined expectations.

itted to focusing energies on initiatives that align with the IHSP, Ministry priorities and pliance with Minister-LHIN Accountability Agreement including attaining MLAA performance targets.

erating Budget:

. eHealth - $600,000

Central LHIN is commcom Special Funding Requests

The following are some of the special projects that are planned, as part of Central LHIN Op

1 :

LHIN established a ncial and human

resources. Health Services Providers from sectors across both LHINs comprise the Joint eHealth Council, providing strategic advice regarding the development and implementation of a Joint eHealth Strategy. Resources in the Joint eHealth Office are situated in both LHINs, with a shared Manager, and serve as the hub for eHealth activity at the LHIN levels, ensuring alignment with the provincial eHealth directions. Some of the LHIN eHealth projects that are planned over the next several years include: Resource Matching and Referral project, which will enable the seamless and effective transfer of clients across the heath system utilizing established business process standards, participation in provincial initiatives, such as the ED/CCAC Notification System. The Central LHIN also looks forward to participating in the

In order to achieve a cost effective program, the Central LHIN and Toronto CentralJoint eHealth Council and a shared eHealth Office to leverage value from their fina

62

betes Registry, a solution that will identify people living with diabetes and monitor best practice care guidelines.

ffice to manage the e-get (36%) is applied $316,000 ource Matching and

itiative, approved by the Board on May 26, 2009. In 2008-09, the Ministry had provided e-Health Lead has been requested to provide an operating plan for 2009-

provincial roll-out of the Dia

The resources required would fund the costs of e-Health Project Management Ohealth deployment initiative within Central LHIN. A substantial part of the budto staff costs charged back through University Health Network. Approximatelyrepresenting 53% of the budget is to fund the initial assessment costs of the ResReferral in$483,700 for e-Health. The 10 deliverables.

2. Vaughan Capital Project- $215,000

In October 2008 the Ministry provided $190,000 to assist the Central LHIN with the costs of developing the Master Program component for the planned hospital services in Vaughan. The

with this project. additional resources required of $25,000 would fund internal LHIN costs associated

3. ER/ALC Performance Lead - $100,000

The resources required relates to the cost of one FTE dedicated to monitor and report on LHIN activities re targets. This funding

accountabilities of

Response (ALC/ER) mance Lead to support the LHIN CEO and senior management team

for Performance,

rmance Contract and Allocation Workgroup’s performance efforts incorporating MLAA requirements

t performance

• Integrate processes for planning, performance management and funding for new initiatives

4. Aboriginal Health - $20,000

relating to efforts to meet Emergency Department and Alternative Level of Carepresents an annualized cost that was funded for part of the 2008-09 year. The keythe position are as follows: • Represent the Central LHIN as the Alternate Levels of Care/Emergency

Perfor• Develop Performance framework in key areas including Aging at Home, Pay

Urgent Priorities and “Quality” • Liaise with Perfo

• Support and build the new Integrated Health Service Priority (IHSP) 2 Projecframework:

• Provide analysis of performance reporting to Senior Management

rove health outcomes for the Aboriginal population within the Central LHIN boundary was approved by the Board on April

gaps by engaging the

5. ED Lead − $75,000

This one-time funding is needed to develop an Aboriginal Health Strategy to imp

28, 2009. This funding will support consulting help to assess program service Aboriginal organizations and communities.

This funding is required to potentially reimburse the Central LHIN for the cost of our ED Lead for work to be done with LHIN representatives and hospitals in developing a comprehensive ER strategy, which is designed to improve access, quality and system integration.

The Central LHIN Emergency Department Leader has dual reporting responsibilities – to the LHIN CEO and to the Provincial Lead of the Emergency Department Wait Times. The key accountabilities of the position are as follows:

63

I.

uarterly basis mentation and other system improvements

for Emergency Department Human Resource Planning II. LHIN-Level Responsibilities

ss the hospitals in the

nt Network composed of appropriate graphic area, designated LHIN staff and other

ampion improvements in Emergency Department service delivery

Provincial Responsibilities • Participate on ED LHIN Leader Provincial Table • Contribute to a provincial analysis of Emergency Department data on a q• Support the Emergency Department Strategy imple• Responsible

• Advise the LHIN CEO regarding Emergency Department resources acroLHIN’s geographic area

• Organize and Chair the LHIN Emergency Departmerepresentatives from hospital in the LHIN’s georelevant stakeholders

• Ch• Lead surge capacity planning, rehearsal and event management

6. Aging at Home

The Aging at Home initiative in Central LHIN amount to investment of $106 Million over three years. Strategic lopment of the Aging at Home initiative requires additional staffing support. The Central LHIN plans to

iative.

Planning for LHIN’s Operations

s available to the LHIN are used as effectively as key Ministry strategies and accountabilities defined in the

Objectives: 1. To recruit and retain staff with the required skills and experience to provide leadership and depth of

knowledge to achieve operational goal articulated above. 2. To build a strong performance management culture. 3. To continue to engage and build strong relationships with health service providers and the

community as well as the French-speaking and Aboriginal populations to inform strategy and tactical planning

devecontinue to discuss the possibility of enhancing staffing to support Aging at Home init

Goals: 1. To ensure that financial and human resource

possible to achieve intended outcomes of Ministry-LHIN Accountability Agreement.

64

lan elements for announcements and rollouts but does not, by itself,

The approved Annual Service Plan will be made available in English and French to the public, health

tion activities related to the Annual Service Plan will be determined based on ng-Term Care, in coordination with all other LHINs.

program. This will initiatives.

mary role of the communications function is to work in conjunction with the LHIN’s senior ate an effective unications;

oth internal and external

oduction to and education an organization. As Central LHIN moves towards a more pro-

unction will evolve from a service provider to a es and programs are leveraged across

the LHIN. Working with local rnal and on.

Developing a Communications Framework

ough with existing ws releases, web site, media relations, briefings, board

ications that reflect the LHIN’s role in planning, coordinating, integrating and funding health services.

o Status: Some work done to date on the website, (Aging at Home, SNAGA and IHSP 2.) Also, proactive communication with media and MPPs through Health Check-In. Next steps to be determined and prioritized.

• Long-Term - Mission and mandate based communications that reflect the LHIN objectives and

goals. Prepare a framework and proactive approach to the communications function. (i.e., refreshing the LHIN’s communications strategy, prioritizing tactics and establishing realistic timelines, ultimately leading to improved communications with audiences.)

Communications PThe Annual Service Plan contains manyrequire a separate strategic communications plan.

service providers, and other partners by posting it on the Central LHIN website.

The timing of communicadirection from the Ministry of Health and Lo

Strategic Communications Successful communications evolves from a well-planned and properly implementedresult in increased awareness, understanding, trust and support for Central LHIN

The primanagement team and Board of Directors and the MOHLTC to plan, initiate and evalucommunications program for the LHIN. This program should focus on two-way commensuring that timely and accurate information is disseminated and received by baudiences.

The early stages of the communications function at the LHIN included the introf communications, its role and purpose inactive strategic positioning, the communications fstrategic partner. Integrated communications ensures that initiativ

media, enhanced web-based communications, and effective intecommunity engagement strategies will all support a proactive communications functi

Communications activities should be positioned over the following timeframes:

• Short-Term – Focus on issues/event driven communications and follow-thrprocesses. (I.e., Health Check-In, nemeetings)

o Status: In progress

• Mid-Term – Program or initiative-based pro-active commun

65

Goals 1. To raise awareness of the Central LHIN and Ministry of Health and Long-Term Care priorities 2. To promote collaborative and innovative thinking that generates system change 3. To support the evolution of an integrated health care service delivery approach 4. To shift from organizational focus to system collaboration

Objectives 1. To create new opportunities for public participation in Central LHIN planning. 2. To validate the relevance of existing priorities and determine emerging issues among public

stakeholders and health service providers. 3. To promote the IHSP process, opportunities for public participation and health service provider

engagement, and share outcomes through multi-channel communication approaches 4. To enhance the visibility and reputation of Central LHIN through proactive media and government

relations.

Key Stakeholders/Audience Public • Residents who live, work

and receive services within Central LHIN boundaries (including ethno-cultural and other marginalized groups)

• Patients/ clients/ consumers and family members

• Aboriginals and First Nations

• Francophone

Health Service Providers

• Network and Advisory Group Members

• Health Professionals Advisory Committee

• Health Service Pro evid r Leadership and front line staff

• Physicians/ Family Health Teams

• Public Health • Other health care practitioners

Stakeholders of Interest/Influence • Board of Directors • Central LHIN staff • Ministry of Health and Long-

Term Care • Government (Municipal,

Regional, Provincial, Federal) • Other LHINs • Provincial Associations • Community Service Sector • Education Sector • Media

Key Messages Local participation, contribution and accountability

Working with our community, to create a strong client centered health care system.

Central LHIN Focus

Work to ensure community needs are met and aligned with Ministry and LHIN priorities

Value of Input = Outcome

Together we can create a more accessible network of health service for our communities.

66

Conclusion The key to effective communications at Central LHIN is to design and implement a comprehensive, structured communications program that will build public commitment and support for the health system and the LHIN mandate.

Two-way communications is critical to the success of the organization. Communications can accomplish the objectives identified with the support from all levels within the organization. Central LHIN needs to incorporate communications as an integral part of the planning of all significant and potential projects that have implications for LHIN audiences. This ensures that early involvement and/or communications with staff, residents and other audiences is adequate and appropriate.

Annual Business Plan - Central LHIN/media/sites/... · Care. This part of the ASP – called the...

Documents

Transcript of Annual Business Plan - Central LHIN/media/sites/... · Care. This part of the ASP – called the...