Board of Directors Meeting Tuesday November 18, :00 to 5:00 pm. Teleconference: Access Code: # AGENDA

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1 Board of Directors Meeting Tuesday November 18, :00 to 5:00 pm Teleconference: Access Code: # AGENDA Item Agenda Item Lead Decision/ Time Information 1. Call to Order Chair 2:00-2:02 2. Declaration of Conflict of Interest Chair 2:02-2:03 3. Approval of Agenda Chair Decision 2:03-2: :05-2: Consent Agenda Items Approval of Minutes: Board of Directors- October 21, 2014 Audit Committee Minutes - May 15, 2014 Senior Leadership Report M Barrett/M Brintnell/K Gillis/L Johnson/ A Jackson Chair Committee Chair Senior Leadership Decision Information Information Presentations HPHA Vision 2013 Integration Update and Alignment with Selected South West LHIN Initiatives K Gillis Andrew Williams Information 2:15-2: Agenda Items for Decision 2014/15 Priorities For Investment Plan: Use of Remaining Funds Agenda Items for Information Annual Business Plan Approach Assess and Restore Guideline and related funding allocation Governance Board Chair Report Board Director Reports Governance & Nominations Committee Update Board and Senior Leadership Retreat Update & Next Steps M Brintnell K Gillis K Gillis Chair Directors Committee Chair Committee Chair Decision Information Information Information Information Information Information 2:45-3:00 3:00-3:20 3:20-4:00 9. New Business Chair Discussion 4:00-4: Closed Session (if required) Chair Decision 4:30-5: Date and Location of Next Meeting Tuesday, December 16, 2014, 2:00 to 5:00 pm Parkwood Institute, Mental Health Care Building, 550 Wellington Rd, London, Main Boardroom, F Adjournment Chair 5:00

2 201 Queens Avenue, Suite 700 London, Ontario N6A 1J1 Tel: Fax: Toll-free: South West LHIN Board of Directors Meeting Minutes Tuesday October 21, 2014 Kikendaasogamig Elementary School, 45 Farm Road, Cape Croker Present: Staff: Regrets: Ron Bolton, Vice Chair ( Acting Chair) Ron Lipsett, Secretary Gerry Moss, Board Director Wilfred Riecker, Board Director Lori Van Opstal, Board Director Aniko Varpalotai, Board Director Barbara West-Bartley, Board Director Michael Barrett, Chief Executive Officer Kelly Gillis, Senior Director, System Design & Integration Mark Brintnell, Senior Director, Performance & Accountability Teresa Lannin, (A) Director, Communications & Community Engagement Stacey Griffin, Executive Office Coordinator Marilyn Robbins, Executive Office Assistant Jeff Low, Board Chair Andrew Chunilall, Board Director 1. Call to Order Welcome and Introductions Ron Bolton (A) Chair called the meeting to order at 2:36 p.m. There was quorum and two members of the public were in attendance. 2. Declaration of Conflict of Interest No Declaration of Conflict of Interest was declared. 3. Approval of Agenda MOVED BY: SECONDED BY: Gerry Moss Aniko Varpalotai THAT the Board of Directors meeting agenda for October 21, 2014 be approved as presented with the noted changes. 1

3 201 Queens Avenue, Suite 700 London, Ontario N6A 1J1 Tel: Fax: Toll-free: Agenda item 4.4 Enterprise Risk Management 2014/15 Second Quarter Report was moved from consent to the main agenda as item 6.2 for discussion. Agenda item 4.4 Clinical Services Plan Update was moved from consent to the main agenda as item 6.3 for discussion. Agenda item 4.6 South West LHIN ehealth Priorities Update was moved from the consent to the main agenda as item 6.4 for discussion CARRIED 4. Consent Agenda Items MOVED BY: Barbara West-Bartley SECONDED BY: Gerry Moss THAT the consent agenda items be received and approved as circulated in the agenda package CARRIED 5 Agenda Items for Decision 5.1 South West LHIN 2014/15 Priorities for Investment Plan MOVED BY: Gerry Moss SECONDED BY: Lori Van Opstal THAT the South West LHIN Board of Directors approve the South West LHIN 2014/15 Priorities for Investment Plan as submitted in the Board package dated October 21, 2014 subject to receipt of the funding letter from the Ministry of Health and Long-Term Care; AND THAT the South West LHIN Board of Directors delegate the implementation of the approved South West LHIN 2014/15 Priorities for Investment Plan to the South West LHIN CEO once the ministry funding letter is received provided the funding letter contains no substantive changes from the funding amounts identified in the plan. CARRIED 5.2 Pre-Capital Submission Central Community Health Centre MOVED BY: Aniko Varpalotai SECONDED BY: Wilried Riecker THAT the South West Local Health Integration Network Board of Directors endorses Part A of the Central Community Health Centre Pre-Capital submission to the Ministry of Health and Long Term Care. CARRIED 5.3 Contract for Auditing Services MOVED BY: SECONDED BY: Ron Bolton Ron Lipsett 2

4 201 Queens Avenue, Suite 700 London, Ontario N6A 1J1 Tel: Fax: Toll-free: THAT based on the recommendation of the South West LHIN Audit Committee at its October 10, 2014 meeting, the South West LHIN Board appoint Deloitte and Touche LLP as the Auditors of the South West LHIN for a three-year period of April 1, 2015 to March 31, 2018 subsequent to the current contract term that ends on March 31, 2015 CARRIED 5.4 Governance Policies A-5, A-6, A-7, A-12, B-2, and C-2. MOVED BY: SECONDED BY: Aniko Varaplotai Wilfred Riecker THAT the South West LHIN Board of Directors adopt Governance Policies A-5 (Legislative Requirements), A-6 (Directors Code of Conduct), A-7 (Conflict of Interest), A-12 (Board Development), B-2 (Communication to the Board (External) and C-2 (Commitment to Employees) as recommended by the Governance and Nominations Committee. CARRIED 6. Agenda Items for Information 6.1 Mental Health Amalgamation Lessons Learned Final Report MOVED BY: SECONDED BY: Barbara West-Bartley Gerry Moss THAT the South West LHIN Board of Directors receive the document titled Mental Health Amalgamation, London/Middlesex Lessons Learned Final Report, August CARRIED 6.2 Enterprise Risk Management (ERM) 2014/15 Second Quarter Report The board heard in response to a question raised that risk management reporting has been captured through the quarterly reporting process. At the request of the board, the ERM reports are being prepared quarterly and brought forward to the board. The board reviewed the red sections under the risk register. 6.3 Clinical Services Plan Update The board heard in response to a question raised that all three streams are ongoing and have done a current state. Updates are provided through the South West LHIN/Hospital/ CCAC CEO Leadership Forum. 6.4 South West LHIN ehealth Priorities Update The board heard in response to a question raised the progress that has been made in the past year with SPIRE. 3

5 201 Queens Avenue, Suite 700 London, Ontario N6A 1J1 Tel: Fax: Toll-free: Governance 7.1 Board Chair Report No report was tabled. 7.2 Board Director Reports Board Directors were invited to provide brief verbal reports on their individual activities and observations since the last meeting of the board. Lori Van Opstal indictaed she attended the Health Care Governance Forum on September 26, 27, 2014 and an ehealth Worlds Standrads day one-hour online video broadcast on October 15, Wilfred Riecker attended the Health Care Governance Forum on September 26, 27, Barabra West-Bartley - attended the Health Care Governance Forum on September 26, 27, 2014 and has started the Indigenous Cultural Competency (ICC) Training Program 8.3 Governance Committee Update No report was tabled. 8.4 Retreat Planning Task Force Update Gerry Moss indicated that a preliminary summary of the feedback from the retreat has been prepared and that the actions and notes will be brought forward to the next meeting. 9. New Business No new business was tabled 10. Closed Session No closed session was held. 11. Date and Location of Next Meeting Tuesday, November 18, 2014 at the Mitchell & District Arena, 185 Wellington St N, Mitchell, ON, Howie Morenz Room 12. Adjournment The meeting was adjourned by Ron Bolton at 4:00 p.m. 4

6 201 Queens Avenue, Suite 700 London, Ontario N6A 1J1 Tel: Fax: Toll-free: APPROVED: Ron Bolton, (Acting) Board Chair SOUTH WEST LHIN Date: Ron Lipsett, SECRETARY SOUTH WEST LHIN Date: 5

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10 Agenda item 4.3 Report to the Board of Directors Senior Leadership Report Meeting Date: November 18, 2014 Submitted By: Michael Barrett, Chief Executive Officer Kelly Gillis, Senior Director, System Design and Integration Mark Brintnell, Senior Director, Performance and Accountability Lisa Johnson, Controller & Manager of Corporate Services Ashley Jackson, Director, Communications & Community Engagement Submitted To: Board of Directors Board Committee Purpose: Information Decision Fall Community HSP Reporting Information Sessions Last month the South West LHIN Performance and Accountability team held three reporting information sessions on M-SAA reporting techniques for community health service providers. These sessions were designed to support community sector provider partners in strengthening services for clients and their families, achieving value for money and improving sustainability of the system by monitoring our mutual reporting obligations. The information and training sessions were held in Owen Sound (Oct. 1), Stratford (Oct. 7) and London (Oct. 8). LHIN staff provided information on the LHIN s new quarterly review process, worked to increase providers knowledge with M-SAA reporting requirements and shared information on report submission and quality. Over 85% of community providers attended over the 3 sessions that were presented. Feedback received from providers was that the sessions were very helpful and the knowledge and tools shared will assist them working with the LHIN moving forward. Based on evaluations handed out and collected, 94% of attendees agreed that the day was a success in providing them new knowledge and 84% of respondents agreed that the sessions reflected their learning goals and needs. Communications September Activity South West LHIN Media 2 articles on London Paramedics getting the ability to care for non-urgent patients An article on the need for more health care workers in Perth County An article on Toyota s donation of a RAV 4 to CMHA Oxford An article on the flu shot a London hospitals

11 Senior Leadership Report Page 2 An article on Grey Bruce Health Services adding IT jobs An article on Indigenous cultural training for health work An article on bed redistribution in Huron and Perth An article on a $1 million donation to St Thomas Hospital An article on World Hospice Day An article on a provincial award for Stratford Nurse Amanda Price An article on Ebola masks at London Health Sciences Centre (LHSC) An article on the new CMHA office in Goderich An article on the Health Care Heroes radiothon An article on Community Living Kincardine donating Money to the Alzheimer s Society of Grey- Bruce An article on additional Psychiatric nurses at Victoria Hospital An article on overall Ebola preparedness at London Health Sciences Centre An article on Ebola preparedness at Grey Bruce Health Services An article on fundraising for Clinton Public Hospital An article on fundraising for the Alzheimer s Society of Huron County An article on funding for the Oxford County paramedicine program An article on robotic surgery developed at LHSC gaining acceptance in the health care system An article on the new Markdale hospital An article on mental health info for Hanover, Chesley students An article on a new internal medicine specialist at Huron Perth Healthcare Alliance An article on the budget deficit at South Bruce Grey Health Centre An article on the Lawson Research Institute Social Media and South West LHIN Website Web and Social Media Web Total Visitors (Sessions) New Visitors (Users) Q1 Q2 Q3 Apr May June July Aug Sep Oct 4,070 Sessi ons 3,854 2,295 Users *: 1,374 Sessi ons 2,655 Users *: 1,439 Sessi ons 3,472 Users *: 1,936 Sessi ons 2,794 Users *: 1,504 Sessi ons 2,916 Users *: 1,734 Session s 2,155 Users: 1,354 Page Views 11, ,555 9,431 8,515 7,834 4,685 My Page 1,182 1,184 1,185 1,187 1,190 1,192 1,173 Subscribers Social Twitter Followers 3,529 3,638 3,665 3, 714 3,766 3,824 3,680 Tweets (7,881 to date) Facebook Friends ( Likes ) Facebook Posts New YouTube Videos YouTube Views (350+ videos) 35,072 35, , , , , ,516

12 Senior Leadership Report Page 3 *Google Analytics has changed how they report data on web traffic from Visitors and New Visitors to the more accurate Sessions and Users. Session: Total number of Sessions within the date range. A session is the period time a user is actively engaged with your website, app, etc. All usage data (Screen Views, Events, Ecommerce, etc.) is associated with a session. User: Users that have had at least one session within the selected date range. Includes both new and returning users. Tracking the data backwards, it matches up with previous months reporting on Visitors and New Visitors, allowing a valid comparison to previous reports.

13 Agenda item 5.1 Report to the Board of Directors HPHA Vision 2013 Integration Update and Alignment with Selected South West LHIN Initiatives Meeting Date: November 18, 2014 Submitted By: Kelly Gillis, Senior Director, System Design & Integration Jana Fear, System Design & Integration Specialist Susan Warner, System Design & Integration Project Lead Submitted To: Board of Directors Board Committee Purpose: Information Only Decision Purpose To provide the South West LHIN Board of Directors with an update on progress, impacts, issues and next steps related to the Huron Perth Healthcare Alliance (HPHA) Bed Realignment and Interprofessional Practice Model Implementation (formerly HPHA - Vision 2013 integration) and to identify interdependencies between Vision 2013 changes and selected South West LHIN initiatives. Andrew Williams, HPHA Chief Executive Officer (CEO), will also be attending the upcoming Board of Directors meeting to provide an overview and update regarding this initiative. Alignment to Integrated Health Service Plan (IHSP) Strategic Directions and Key Drivers Improve Access to Family Health Care Improve Coordination and Transitions of Care for Those Most Dependent on Health Services Drive Safety through Evidence Based Practice Increase the Value of Our Health System for the People We Serve Key Drivers Technology to Connect and Communicate Quality and Value Connecting and Empowering People Impact on Big Dot Outcomes Reducing 15,000 emergency room visits and hospital readmissions, resulting in 10,000 more days at home Increasing the availability of family health care Increasing availability and access for community supports for people resulting in 17,000 more days at home

14 Huron Perth Healthcare Alliance Vision 2013 Integration Update Page 2 Background The Huron Perth Healthcare Alliance (HPHA) - Vision 2013 Notice of Integration was received on October 1, The initiaitve involved three main components: 1. Create Critical Mass through Bed Redistribution: In order to improve access to medical and surgical beds, Vision 2013 includes a plan to redistribute bed types across the four sites. 2. Realignment of Services: To facilitate recruitment and retention as well as ensure high quality, safe care, Vision 2013 includes a plan to create more consistent groupings of patients among its four sites. 3. Adjust Emergency Department (ED) Hours to Strengthen ER System of Care*: To increase recruitment, stabilize retention, and reduce the risk of unplanned ED closures due to physician and nursing coverage issues, the original HPHA Vision 2013 plan included two 24/7 EDs and two 16/7 EDs across four sites. *Note: The original plan to reduce ED hours at 2 of the 4 sites has since been adjusted to ensure that all 4 sites retain 24/7 ED services The integration was considered by the South West LHIN Board of Directors on November 24, 2010 and the following motions were approved: THAT the South West Local Health Integration Network (LHIN) Board of Directors does not wish to issue an Integration Decision related to the intended integration entitled Huron Perth Healthcare Alliance (HPHA) - Vision 2013, for the first two components of the plan that do not relate to changes to Emergency Departments, as proposed in the Notice of Integration submitted to the South West LHIN on October 1, 2010; and THAT the South West Local Health Integration Network (LHIN) Board of Directors requires the HPHA to ensure the completion of the detailed planning necessary to mitigate any risks or potential risks in the implementation of Vision HPHA Vision 2013 proposed to address health human resources challenges, ensure maximum quality and patient safety, improve access to services, and demonstrate fiscal responsibility. The challenges experienced by HPHA at the time of developing this vision included: Shortage of health care professionals; Disproportionate distribution of services across four sites; and Increased quality and patient safety standards expectations. The Vision 2013 planning process was based on the following three principles: 1. Retain four sites with viable roles; 2. Support equitable standards of quality and safety for patients; and 3. Live within their means. Status of Inter-professional Practice Model Implementation and Services and Bed Realignment: Interprofessional Practice Model of Care To support the integration of HPHA services, the hospitals introduced an Interprofessional Practice 1 model of care in September 2010 where healthcare professionals work to their full scope of practice in a person-centered care model based on evidence-informed practice HPHA s implementation plan included organization-wide training on the principles of interprofessional collaborative person-centered practice and the introduction of Unit Action Councils (UACs) on all inpatient units and across clinical support departments 1 Interprofessional Practice is defined as the provision of comprehensive health services to patients by multiple health caregivers, who work collaboratively to deliver quality care within and across settings 2

15 Huron Perth Healthcare Alliance Vision 2013 Integration Update Page 3 To date: o All nurses and Allied health care providers have received a 4 hour workshop on professional practice including accountability, communication, documentation, etc.; and o 5 Collaborative Care Model Planning Teams have been working through a team mandate to plan the Collaborative Care Model and inform the Bed Realignment Logistics Team. Next steps: o Skills workshops for RPNs to advance to full scope of practice (blood and blood products, NG tube insertion &tube feeds, telephone and verbal orders, etc.) o Working through the Collaborative Care Model design o Team Leader education Nov (LEADS Program) Completion: December 2014, in alignment with bed shifts Consolidation of Adult Outpatient Physiotherapy Services Prior to the consolidation, therapy resources were inequitably distributed across all four sites, presenting challenges with recruitment, retention and access to services. Consolidation of adult outpatient physiotherapy from 4 sites to 2 sites (Seaforth and St. Marys sites) to enhance inpatient therapy resources and begin transformation of the rehab model of care. Implemented June 2012 In July 2014, outpatient services were further enhanced through Episodes of Care funding that was allocated as part of the provincial physiotherapy reform initiative. Consolidation of Cataracts Procedures Due to significant overlap of catchment areas for the Cataracts programs previously provided at the Stratford and Clinton sites, HPHA submitted detailed plans for consolidation of Cataracts procedures at the Clinton site to the LHIN in December It was determined that the Clinton site has the best infrastructure to allow for site specialization of ambulatory procedures. Results of a detailed review of the Cataracts shift were presented to the Board in April, 2014 and it was concluded that it was consistent with, and supported, the direction and goals of Vision Implemented May 6, 2014 Bed Realignment In response to updated data and system changes, HPHA has refined the bed number, type and siting recommendations (e.g. CCC/Rehab) projected in the original Vision 2013 document, along with some other key pieces of work and has revised its proposed future bed numbers to reflect occupancy patterns as follows: Types of Beds Total HPHA Current Beds Vision 2013 Revised Bed Numbers Proposed Changes Compared to Current Beds Rehab No change currently planned Complex Continuing Care beds net decrease (increase of 5 beds at Clinton and 5 beds at St. Marys; decrease of 3 beds at Seaforth and 13 beds at Stratford) Surgical beds decrease at Stratford site Medical beds net decrease (increase of 3 beds at Stratford; decrease of 2 3

16 Huron Perth Healthcare Alliance Vision 2013 Integration Update Page 4 Types of Beds Total HPHA Current Beds Vision 2013 Revised Bed Numbers Proposed Changes Compared to Current Beds beds at Clinton, 4 beds at Seaforth, and 5 beds at St. Marys) ICU No change Telemetry No change Paediatrics No change Special Care Nursery No change Obstetrics No change Mental Health No change TOTAL beds decrease overall As part of the overall Vision 2013 Bed Realignment change, HPHA engaged consultants to assist with developing a refreshed Rehabilitative Model of Care for its Seaforth site that will provide general rehabilitation inpatient care. The planned bed shifts will enable the implementation of the rehabilitative model by providing focused care at various sites as follows: Stratford Hospital: o CCC beds will provide care to medically complex patients o Rehab beds will be dedicated for stroke rehabilitation as part of their Integrated Stroke Unit (see below) Seaforth Hospital: o CCC beds will have a primarily Assess and Restore rehabilitative care focus o Rehab beds will be for patients with general rehab needs (orthopedic and medically complex) Clinton and St Marys sites: o CCC beds will provide care for patients with Assess and Restore sub-acute complex care such as patients with responsive behaviours needs and those who, over the course of their journey, may become designated Alternative Level of Care while awaiting placement to a more appropriate setting. Expected implementation: December 2014 Impacts of Bed Realignment: Because of the significance of the bed realignments in relation to other key areas of Clinical Services Planning (CSP) within our LHIN, namely the South West LHIN Phase II CCC/Rehab Bed Realignment initiative and the South West LHIN Stroke Capacity Assessment & Best Practice Implementation Project, the LHIN has conducted a review to ensure that the planned shifts are consistent with both the directions identified within the original Vision 2013 Notice of Integration and also support the direction and goals of the related CSP initiatives: Phase II CCC/Rehab Bed Realignment; and Stroke Capacity Assessment & Best Practice Implementation. Alignment with South West LHIN CCC/Rehab Realignment Initiative: Recommendations for Phase II realignment of the CCC/Rehab resources were established based on a review of the previously established Guiding Principles for CCC/Rehab bed realignment recommendations, a review of recent system change impacts within the South West LHIN, a review of empty CCC and Rehab beds, and another refresh of the Bed Projection Model. Based on these analyses, the Steering Committee recommended the following: 4

17 Huron Perth Healthcare Alliance Vision 2013 Integration Update Page 5 Add 11 CCC beds to London to increase from 82 to 93 CCC beds Reduce CCC beds from the Huron Perth region to decrease from 76 to CCC beds Add 4-7 Rehab beds to London to increase from 113 to Rehab beds Add 1-2 Rehab beds to the Huron Perth region to increase from 23 to Rehab beds In late April, Huron Perth hospitals indicated that: They would collaborate to achieve a reduction of 26 CCC beds to arrive at a total of 50 CCC beds by March 31, 2015; They supported the recommendation to add 2 Rehab beds; and They signaled a commitment to decreasing the Huron Perth CCC beds to 43 by March 31, 2016 and subsequently to 34 by March 31, 2017 with adjustments accordingly per changes in utilization. The Steering Committee recommendations and next steps were shared with the LHIN Board of Directors at its May 20, 2014 meeting. Subsequently, LHIN staff asked the Huron Perth hospitals to provide a proposed 3-year siting plan to achieve the above reductions. To date, the Huron Perth partners have provided a recommended year 1 siting plan for CCC beds in Huron Perth. The partners have not provided recommendations related to the siting of rehab beds overall or the year 2 and 3 siting plans for CCC beds. The current siting recommendation from the Huron Perth partners is reflected below: Hospital Current Rehab Beds Proposed Rehab March Current CCC Beds Proposed CCC Mar Proposed CCC March 2016 Proposed CCC March 2017 AMGH TBC TBC Listowel TBC TBC Wingham 5 5* 12 5 TBC TBC South Huron 4 4* 4 1*(retain 3 as TBC TBC acute) Clinton TBC TBC St. Marys TBC TBC Seaforth 0 9* 10 7 TBC TBC Stratford 14 5* 20 7 TBC TBC TOTAL (+2) *Note: These recommendations have been provided by hospital administration and have not been through a formal board approval process; recommendations from the Huron Perth partners for rehab siting in year 1 and both rehab and CCC siting in future years are pending. Alignment with South West LHIN Stroke Capacity Assessment & Best Practice Implementation: Draft recommendations for stroke capacity planning, including clinical best practices for emergent, acute and rehabilitative stroke care regionally, and for regional acute and rehabilitation capacity are coming forward in November. Clinical best practices identifies a role for an Integrated Stroke Unit whereby acute and rehabilitative stroke care is conducted within the region s Designated Stroke Centre Results of the capacity assessment suggest that 8 rehabilitation beds are required to meet best practice stroke rehabilitation care for residents of Huron and Perth As a Designated Stroke Centre, HPHA plans to implement the stroke best practices, including developing an Integrated Stroke Unit, initially dedicating the planned 5 rehabilitation beds at its Stratford site. 5

18 Huron Perth Healthcare Alliance Vision 2013 Integration Update Page 6 Current Status and Issues Related to CCC/Rehab Bed Realignment and the Stroke Capacity Assessment & Best Practice Implementation In accordance with HPHA s realignment timelines and other related bed shifts (medicine and surgical beds), all bed shifts, including initial CCC/Rehab bed shifts, are scheduled for implementation early in December of this year; while there have been some changes from the original Vision 2013 directions, the planned changes are generally consistent with the intent of the original submission. A Human Resources plan is in place and has been executed (notification to impacted staff complete; hiring for PSWs in process). Facilitated integration CCC/Rehab bed realignment activities among the Huron Perth hospitals are in process but timelines have had to be revised and therefore this process will not conclude prior to HPHA s implementation. All hospitals involved in planning the Phase II CCC/Rehab bed realignment have indicated commitment to complete Year 1 bed shifts prior to fiscal year end but a number of items are still outstanding and further Community Engagement will be required. The hospitals in Huron and Perth were asked to identify their recommendations for a 3-year siting plan for CCC/Rehab beds and related reductions and have not yet completed a recommended siting plan. Subsequently, the South west LHIN has agreed that a 2-year plan will be sufficient at this point recognizing that the third year will be informed by learnings from year 1 and 2. As noted previously, draft recommendations for stroke capacity planning, including recommended number of stroke rehab beds are coming forward in November as part of the Stroke Clinical Service Planning initiative; the impact of dedicating rehab beds for stroke care on access to general rehabilitation is also being assessed; both of these inputs will inform the 2-year siting plan for the Huron Perth hospitals. South West LHIN staff are working closely with HPHA and all Huron Perth hospital partners to ensure alignment of the HPHA Vision 2013 directions and the South West LHIN CCC/Rehab bed realignment and Stroke Capacity Assessment & Best Practice Implementation initiatives. Highlights from the LHIN Review of HPHA Vision 2013 Bed Realignment Impacts on Services (from public s perspective) Community engagement occurred over 18 months in the early stages of Vision 2013, with 4 town hall meetings, two separate community workshops with non HPHA facilitators, paper survey and telephone survey executed and collated by external organizations. Other engagement has occurred through the planning and change management process, including: o Regular updates at the hospitals Local Advisory Council meetings and HPHA s Board Advances. o Press releases; and o A meeting with the Health Coalition. HPHA hospitals are reducing the total number of beds; because there is a shift in siting of beds and services, some communities will gain beds and services while others will see a reduction. Some members of the public may perceive a loss of access to services while those in communities that will receive a new service directly in their community may perceive a benefit. In particular, the changes will impact those residents of Stratford who need access to a general rehabilitation bed because that care will be provided at Seaforth Hospital, and those residents of surrounding areas who might be currently receiving their stroke rehabilitation in a general rehab bed in another hospital are expected to receive it at Stratford General Hospital. Ultimately, however, in both these cases, this enables better clinical service delivery to optimize patient outcomes. 6

19 Huron Perth Healthcare Alliance Vision 2013 Integration Update Page 7 Impact on Labour The Interprofessional Practice Model of Care involves professionals working to their full scope of practice. The Registered Practical Nurse group was impacted by this change. There is an increase in Registered Nurse (RN) hours with the Charge Nurse role from 7.5 hrs/day 5 days a week changing to a Team Leader role 12hrs/day 7 days a week. The addition of Personal Support Workers (PSWs) and an increase in RN and unit clerk hours results in an overall increase in staffing hours. By implementing PSWs and extending unit clerk coverage the time nurses spent in nonnursing tasks enables more time spent in direct patient care which is a positive change for nurses. This collaborative care model encourages collaborative care amongst all care providers breaking down the silos of each professional doing their piece of care in isolation of the other care providers. Therapy staff have been reassigned to meet the needs of patients at each site. HPHA has a labour adjustment / human resources plan in place and has been working closely with the unions on these plans. o The planned closure of the 17 beds triggered the collective agreement process of early retirement and lay-offs with the goal of no involuntary lay-offs. HPHA has also implemented a staff communications plan to ensure staff are kept informed of the changes. Impact on Health Service Provider (HSP) Management / Board Structure None Implications for the LHIN Funding Impact: o HPHA has ensured that all internal shifts will be accomplished within its current budget. o HPHA is projecting a moderate deficit to year end and the LHIN will monitor this as the year end approaches and will work with HPHA to ensure appropriate mitigation. Impact to Service Accountability Agreements (SAAs): o Shifts in the beds will be reflected in H-SAA agreements to recognize the volume shifts at each site. Impact to Outcomes Associated with the CCC/Rehab shifts, HPHA is implementing a Rehabilitative Model of Care that will enable appropriate level of rehabilitative care across all sites; Introducing dedicated stroke rehab to HPHA s stroke unit at its Stratford site will enable HPHA to provide best practice stroke care; Distributing its rehabilitative care services across all sites will support access close to home; Decreasing the number of surgery and medicine beds should result in minimal impact since those beds are not currently operational, however, it may impact their flex capacity in situations where occupancy is high. All of these shifts will need to be monitored closely for any unintended negative impacts. Next Steps 1. HPHA will continue to provide monthly reports on identified process and outcome measures. 2. LHIN staff will continue to meet quarterly with the team at HPHA to monitor impacts of implementation. 3. LHIN staff will continue to work with HPHA and other hospitals in Huron and Perth regarding the Complex Continuing Care and Rehabilitation (CCC/rehab) service delivery model and bed distribution in the Huron Perth geographic area; 7

20 Huron Perth Healthcare Alliance Vision 2013 Integration Update Page 8 CCC/Rehab bed realignment is expected to occur through a facilitated integration process with 2 year siting recommendations including siting of rehab beds coming forward to LHIN staff in December; motions for Board approval at each hospital expected to occur in January and Facilitated Integration motion expected to come forward to the South West LHIN Board in February of LHIN staff will continue to work with HPHA on implementation of Stroke best practices, including implementation of the stroke rehab beds in alignment with the overall South West LHIN Stroke Capacity Assessment & Best Practice Implementation. 5. The South West LHIN will work with its hospital partners in completing any additional necessary engagements with municipal governments in early 2015 to discuss these changes and other health planning work currently underway. As well, we will work with our hospital partners to identify any additional engagements required. 8

21 Report to the Board of Directors South West LHIN 2014/15 Priorities for Investment Plan Agenda item 6.1 Meeting Date: November 18, 2014 Submitted By: Mark Brintnell, Senior Director, Performance and Accountability Submitted To: Board of Directors Board Committee Purpose: Information Decision Suggested Motion THAT the South West Local Health Integration Network Board of Directors approves the allocation of up to $4,300,000 in 2014/15 from the community sector base increase in support of the Community Sector One-time Minor Infrastructure Program. Purpose The purpose of this report is to seek approval for the Community Sector One-Time Minor Infrastructure Program ( Program ) in 2014/15 using surplus funds from the community sector base funding increase. Background On October 21, 2014, the LHIN Board delegated the authority to the Chief Executive Office to execute the Priorities for Investment Plan which allocated new community sector base funding and LHIN Urgent Priorities Fund funding. The LHIN is now in receipt of all provincial funding approvals and staff has confirmed that our PFI Plan will achieve the objectives defined within the funding letters and no changes to our current PFI Plan are required. The new funding received by the LHIN was for 6 months but due to timing of provincial approvals, local allocation process and decisions, and health service provider start-up, it was identified at that time that there will be surplus funds available for further one-time investment in 2014/15. Any unspent funding by the end of the fiscal year is subject to the provincial reconciliation and settlement process and will be returned to the provincial treasury. In order to maximize the appropriate use of the remaining new funds in the current fiscal year, LHIN staff proposes to again offer the Program in 2014/15. This is the seventh year the South West LHIN would be offering the Program to community sector health service provider partners. Many community sector partners struggle with identifying sufficient fiscal resources to invest in their infrastructure, equipment and training. The Program gives them an opportunity to access one-time funds that otherwise would be difficult to access in order to enhance delivery of their LHIN-funded services and programs. The Program ensures the funds are invested within the community sector consistent with the original intent of the Ontario government. The Program has been oversubscribed each year it has been offered, signaling its need and popularity.

22 Current State The total one-time funding available to support the Program is approx. $4,300,000. This amount is made up of funds from the community base allocation which would not be spent in time for fiscal year end. These funds are base commitments in 2015/16. Next Steps Subject to the Board s consideration of this request, LHIN staff will implement the Program immediately in order to maximize the appropriate use of the in-year surplus funds. Consistent with previous years, results from the Program will be shared back with the LHIN Board prior to the end of the fiscal year. End.

23 Agenda item 7.1 Report to the Board of Directors Annual Business Plan Approach Meeting Date: November 18, 2014 Submitted By: Kelly Gillis, Senior Director, System Design and Integration Submitted To: Board of Directors Board Committee Purpose: Information Only Decision Purpose The purpose of this briefing is to provide information and receive guidance and support regarding the proposed approach to develop the draft Annual Business Plan (ABP) due to the Ministry by February 28, Ministry/LHIN Accountability Framework The Annual Business Plan (ABP) is a key component of the Ministry/LHIN accountability framework. The accountability and reporting relationship between the Ministry and LHINs is grounded in the legal requirements in Local Health System Integration Act, 2006 (LHSIA), the Memorandum of Understanding (MOU) between both parties and the Ministry-LHIN Performance Agreement (MLPA), in addition to government directives such as the Agency Establishment and Accountability Directive (AEAD). AEAD requires all agencies to produce a business plan annually that includes mandate; strategic directions; current and future programs; resources required; risk; assessment and mitigation strategies; environmental scan; staff numbers and compensation; performance measures and 3 year targets; financial budget over 3 years; implementation plan and communication plan. LHSIA requires LHINs to produce an annual plan for spending the funding that the network receives., which spending shall be in accordance with the appropriation from which the Minister has provided the funding to the network (LHSIA 2006, c.4, s. 18 (2)). French Language Services and needs of First Nations and Aboriginal peoples must also be included in the plan. Annual Business Plans are to align with the Ministry s Action Plan, the Excellent Care for All Act (ECFAA) and each LHIN s Integrated Health Service Plan. The ABP should build on and demonstrate progress against the goals and action plans in the and ABPs, and should also consider the priorities noted in the Minister Mandate Letters.

24 Annual Business Plan Approach Board Report Page 2 Cascade of Planning and Reporting The following depicts the planning and reporting relationship between the Ministry, the LHIN and Health Service Providers: Annual Business Plan Recommended Approach Given thatt this is the third and final Annual Business Plan to align to the IHSP and a particular format is required by the Ministry, it iss recommended that the Annual Business Plan follow the same format as last year s plan and include updated informationn to reflect how the LHIN is continuing to advance the IHSP. The proposed outline follows: ABP 2015/16 Content Sections Context Core Content Requirements (titles) Transmittal letter from LHIN Board Chair Mandate of the South West LHIN Our Context Overview of Strategic Directions and Improvement Objectives Identification of Key Drivers to Achieve System Improvements Business Objectives Integrated Health Service Plan Priorities Implementation of Initiatives

25 Annual Business Plan Approach Board Report Page 3 ABP 2015/16 Requirements (titles) Content Sections 2.3 Accountability, Performance and Improvement Activities 2.4 Accountability and Financial Budget LHIN Operations 3.1 Operations Spending Plan 3.2 Staffing Plan Communications and Community Engagement 4.1 Communications Plan Overview 4.2 Community Engagement Plan Overview Appendix A Appendix B Appendix C Appendix D Implementation of Initiatives Integration Activities Capital Projects Portfolio Performance Directly Aligned to Scorecard Timeline Phases Phase I October/November - Gather information related to Ministry of Health and Long Term Care (MOHLTC) expectations, determine internal approach to complete, create timeline, determine expectations of final ABP document; Engagement of Board and staff Phase II November/December - Create and distribute 2014/15 ABP Status Report for Board; Draft ABP Sections of ABP content completed by identified staff Phase III January/February - Senior Leadership Review, Board Review and Approval of Draft ABP Phase IV February June - Draft ABP sent to Ministry, Ministry Response, Provincial Budget Announcement updates to draft ABP, Final approval by LHIN Board, Final ABP sent to Ministry with updated Financials; Ministers final approval within 120 days of budget announcement Next Steps LHIN staff will bring forward a 2014/15 ABP Status Report identifying the status of key components of the current Annual Business Plan in December. A draft Annual Business Plan will be brought forward to the Board for review in January. A revised draft Annual Business Plan will be brought forward to the Board for approval and subsequent submission to the Ministry in February.

26 Agenda item 7.2 Report to the Board of Directors Assess and Restore Guideline and Related Funding Allocation Meeting Date: November 18, 2014 Submitted By: Kelly Gillis, Senior Director, System Design and Integration Susan Warner, Project Lead, System Design and Integration Kristy McQueen, System Design and Integration Lead Submitted To: Board of Directors Board Committee Purpose: Information Only Decision Purpose The purpose of this report is to update the South West LHIN Board of Directors on the Assess and Restore Guideline and related funding soon to be released by the Ministry of Health and Long Term Care, and the South West LHIN s approach to implementing the Assess and Restore Guideline. Alignment to Integrated Health Service Plan (IHSP) Strategic Directions and Key Drivers Improve Access to Family Health Care Improve Coordination and Transitions of Care for Those Most Dependent on Health Services Drive Safety through Evidence Based Practice Increase the Value of Our Health System for the People We Serve Key Drivers Technology to Connect and Communicate Quality and Value Connecting and Empowering People Impact on Big Dot Outcomes Reducing 15,000 emergency room visits and hospital readmissions, resulting in 10,000 more days at home Increasing the availability of family health care Increasing availability and access for community supports for people resulting in 17,000 more days at home Background Assess and Restore Guideline: The Ministry of Health and Long Term Care is preparing to release an Assess and Restore Guideline, intended to improve access to Assess and Restore (A&R) interventions targeted at supporting those 2/

27 Assess and Restore One Time Funding Allocation Page 2 who may have experienced functional decline and who need additional support to regain functional independence and live in their homes longer and thus help to prevent hospitalization and institutionalization (typically frail seniors). The Guideline describes Assess and Restore services across the continuum and encompasses the following key elements: 1. Screening of at risk seniors in community, primary care and hospital settings; 2. Assessment to determine whether a person is high risk for loss of independence, has restorative potential, and requires facility-based care; 3. Navigation and placement to the appropriate provider, setting and type of care; 4. Facility based A&R interventions based on best practices in care delivery; and 5. Transitions home with linkages to primary care and other community supports. The Guideline supports and aligns to the work of the Provincial Rehabilitative Care Alliance (RCA), and in particular, its priority to: Develop a standardized, system-wide best practice rehabilitative approach to the care of frail seniors and people who are medically complex in the context of an Assess and Restore Framework. Under the Guideline, LHINs are responsible for: Capacity planning to ensure that the resources necessary to deliver A&R interventions are available and coordinated across the continuum of care; Collaborating with Health Service Providers to develop and disseminate shared protocols and standardized tools for each stage of the A&R journey; Cooperating with CCACs and hospitals to develop provincial, operational-level admission criteria and service descriptions for hospital programs delivering A&R interventions; Identifying provincial performance measurement indicators. One Time Funding in Fiscal In December, 2013, the Minister of Health provided the South West LHIN with Assess and Restore one-time funding in the amount of $686,700, to be used in the remaining months of the fiscal year to: create additional access and service capacity in the community to facilitate appropriate utilization of hospital and Long-Term Care Home (LTCH) resources; minimize the likelihood of premature and avoidable dependency, debility and related medical complications; and reduce premature long-stay admissions to a Long-Term Care Home and unnecessary emergency department visits and hospital admissions At its January, 2014 meeting the South West LHIN Board of Directors received a report summarizing the South West LHIN s focused engagement approach with health service providers projects and identified a list of the projects that went forward for funding under the South West LHIN CEO s Delegation of Authority. A summary of projects funded in 2013/14 and the outcomes/deliverables from each is provided as Attachment 1. New Multi-Year Funding The Ministry of Health and Long Term Care is providing multi-year funding (2014/15; 2015/16; 2016/17) to each LHIN to support them in their Assess and Restore guideline implementation. We have been informed that our allocation per fiscal year is expected to be $874,000 (this amount is to be confirmed). Funding is to be used to fulfill the service delivery roles and responsibilities of LHINs and Health Service Providers (HSPs) described within each of the 5 elements of the Guideline.

28 Assess and Restore One Time Funding Allocation Page 3 Based on its analysis of projects funded last year, the Ministry provided a list of 10 projects that are scalable and meaningful in advancing the A&R Guideline. In addition, the Ministry consulted with LHIN leads, LHIN CEOs and the RCA to identify the process for making funding decisions and a list of project types and suggested initiatives. LHINs are expected to align their projects with this list and to consider building on or implementing projects in the list of projects completed in that were identified by the Ministry. LHINs are also encouraged to consider collaborating on projects and to leverage the work and expertise of the RCA to identify and implement projects that could have province-wide application. Ministry s Approach to LHIN Project Identification: The Ministry has called all LHINs to a meeting on November 14, 2014 to further discuss and identify: A&R funding approach and goals, eligible project types, LHIN preliminary project interests, and project collaboration opportunities; and 2. Potential performance indicators. A key outcome of this day will be common understanding of LHIN project interests and identification of opportunities for collaboration among LHINs. Following this, LHINs are to work with each other, the RCA and their HSPs to plan the projects. Early indication is that the Ministry will be requesting confirmation of projects and funding amounts for this year by early December. In anticipation of this guideline and funding announcement, the South West LHIN staff sought input from the members of the Adult Day Program Network, the Assisted Living Network, the Long Term Care Homes Network, the South West LHIN CCAC our Health Links Lead, and the South West LHIN Rehabilitative Care Committee. Through this engagement several ideas for initiatives have emerged which now need to be cross-checked against the Ministry s requirements. Next Steps 1. LHIN staff to consider the project ideas put forth to date and identify those that fit within the parameters announced on November 6, 2014 and that could leverage this year s funding to build the foundation for work in 2014/15 and 2015/ LHIN Staff and Health Links Project Manager to participate in the Ministry hosted planning session on November 14, Based on the outcome of that day, LHIN staff will engage with HSPs and the South West LHIN Rehabilitative Care Committee (and other LHINs as identified at the November 14 meeting) to finalize projects for completion within this fiscal year, including deliverables and funding requirements. 4. Proposals will be brought forward to the South West LHIN Internal Alignment Team for their review. 5. Final project initiatives and funding requirements will be brought forward to the South West LHIN CEO for final approval under his delegated authority. 6. An update on the status of this funding will be provided to the South West LHIN Board of Directors in December, 2014.