the NE LHIN Board of Directors Package
Transcription
the NE LHIN Board of Directors Package
NORTH EAST LOCAL HEALTH INTEGRATION NETWORK BOARD OF DIRECTORS MEETING Wednesday April 8, 2015 1:30pm-4:30pm Teleconference PUBLIC: 877-695-6349 PASSCODE: 9188586 NOTE: ITEM DIRECTORS ARE REQUESTED TO NOTIFY THE CHAIR PRIOR TO THE COMMENCEMENT OF THE BOARD MEETING WITH RESPECT TO POTENTIAL CONFLICTS OF INTEREST ARISING FROM ITEMS ON THE AGENDA. TIME TOPIC LEAD PROPOSED OUTCOME PAGE # BOARD OF DIRECTORS MEETING – REGULAR SESSION 1.0 1 min Call to Order: Introductions of attendees 2.0 1 min Declaration of Conflict of Interest 3.0 2 min Approval of Agenda 4.0 1 min Approval of Consent Agenda (If there are no items requiring removal into regular agenda) Danielle Bélanger-Corbin Danielle Bélanger-Corbin Danielle Bélanger-Corbin Danielle Bélanger-Corbin D D CONSENT AGENDA 5.0 Board Attendance Danielle Bélanger-Corbin I 4 6.0 Media Tracker Louise Paquette I 5 7.0 Attestation of Compliance Kate Fyfe D 10 8.0 Approval of Minutes of Board meeting of th January 27 , 2015 Danielle Bélanger-Corbin D 14 REGULAR AGENDA 9.0 15 min Report from the Chair a) Generative discussion on Collaborative Governance b) Board Survey Summary c) Appointments Directive Danielle Bélanger-Corbin 11 20 I 31 10.0 11.0 10 min I Report from Audit Committee • Risk Assessment Report 10 min • Report on Funding Allocations 12.0 I Louise Paquette I Cynthia Stables I • Telehomecare Next Steps Tamara Shewciw I • Orthopedic Plan Results Martha Auchinleck I 55 75 Kate Fyfe D 78 Proceed to closed session to discuss matters involving: Labour relations Danielle BélangerCorbin D Report from the closed session Danielle BélangerCorbin D Danielle BélangerCorbin I CEO Update • Funding priorities for fiscal 2015-16 60 min 13.0 20 min 14.0 1 min 20.0 21.0 Engagement Updates (Complaint Summary, Engagement Tracker, Northerner’s Survey Responses, IHSP Development Financial/Performance Update • 2015-2016 LHIN Operations Budget Next Meeting: • June 10, 2015 Board Meeting 1 min 32 40 Dr. Colin Germond • 19.0 Rick Cooper Report from Governance Committee Adjournment of Board Meeting Danielle BélangerCorbin D=Decision, I=Information 22 RESOLUTION NORTH EAST LOCAL HEALTH INTEGRATION NETWORK (the “Corporation”) Motion No.: 2015-BD00XX MOVED: _____________________________________ SECONDED: _____________________________________ Wednesday April 8, 2015 RESOLVED THAT: The agenda for the Board of Directors meeting of Wednesday April 8 be approved as presented. _____________________________________ Danielle Bélanger-Corbin Chair 3 LEGEND * Meeting held via teleconference FF Director attended meeting in person TC Director attended meeting via teleconference VC Director attended meeting via videoconference ____ Director was entirely absent from meeting N/A No longer a Board Director 2015 BOARD OF DIRECTORS MEETING ATTENDANCE North East Local Health Integration Network Members of the Board of Directors January 27 Sudbury Danielle Bélanger-Corbin, Board Chair TC Dr. Colin Germond TC Santina Marasco TC Rick Cooper TC Dawn Madahbee TC Denis Bérubé TC Toni Nanne-Little _____ April 8 Sudbury June 10 Members of the Board of Directors Audit Committee February 26 Dr. Colin Germond, Chair Danielle Bélanger-Corbin Rick Cooper Dawn Madahbee TC TC TC _ Members of the Board of Directors Governance Committee February 26 Rick Cooper, Chair Danielle Bélanger-Corbin Santina Marasco Denis Bérubé Toni Nanne-Little TC TC TC TC TC 4 September 10 November 26 May 14 October 8 May 14 October 8 Media Tracker and Analysis January 20, 2015 – March 24, 2015 Key Findings and Analysis Overall Media: From January 20, 2015 to March 24, 2015 the North East LHIN was featured in more than 43 news articles, radio, and TV reports. Large and small media outlets continue to respond to our materials. Reporters often turn to the LHIN to be a spokesperson on stories they are working on in health care, and often outside of LHIN work. Several media outlets have now expressed interest in publishing regular health care columns. According to the Ministry of Health’s most recent media analysis report which measures overall media exposure for health care in Ontario, the Northern LHIN regions (both NE and NW) had the strongest “favourable” tone of coverage towards health care system, local coverage. CEO Blog Although the blogs generate smaller media interest, they are read by hundreds of Northerners and generate some of our highest website page views. The blogs continue to provide an intimate and accessible connection for Northerners to the LHIN CEO. For instance, the latest CEO’s Blog, entitled Florence’s Living Legacy, was viewed over 400 times and received numerous positive feedback from fellow Northerners. Below are some of the comments received: "This is a powerful blog. And this philosophy should be implemented in schools for education plans for students; in the mental health system, in the justice system – in any system where we want to make a person’s life better." - Anna "J’ai lu ton blog avec beaucoup d’intérêt, car il reflète la réalité. Une réalité qui se transforme lentement mais surement grâce à vos efforts continus. Faut continuer à intégrer, à briser les silos et à encourager les organisations à travailler ensemble pour le bien-être de tous. Bravo!" – Guylaine Well done. Merci - Denis Social Media: Our social media following continues to grow daily, with our Twitter page exceeding 2,150 followers. Our Facebook page is also growing but at a much slower rate, with 190 followers. The most popular post this period was February 9, when we tweeted about the LHIN-funded Virtual Critical Care Unit and its expansion to seven additional hospitals. On Twitter, the post had nearly 1,700 views, and our Facebook account saw approximately 565 views. We continue to ensure Tweets and Facebook posts are accompanied by an interesting photo, allowing for greater pickup and more reach. 5 Website The website continues to be the largest online medium with the greatest amount of reach for the North East LHIN. For this time period, the website saw over 21,000 page views, up from 15,000 page views three months prior. Homepage content is updated several times weekly, and often on a daily basis, to keep the site fresh and to continue to draw people to the site. Website statistics, January 20 to March 23, 2015 Sessions: Number of visits to the website. Users: Number of people visiting the website. Includes both new and returning visitors. Pageviews: The total number of pages viewed. Repeated views of a single page are counted. Pages/Session: The average number of pages viewed during a visit to the site. Avg. Session Duration: The average time on our site is slowly increasing. Our content and promotion images are becoming more engaging and we are now keeping people on our site longer than before. Bounce Rate: The percentage of single page visits. % New Sessions: The percentage of new visits continues to be high, at just more than 33%. We’ve always realized a fairly high percentage of new visits. This could be attributed to the items we are sending out as press releases linking back to our website. Facebook Our number of followers on Facebook is continuing to grow slowly, as we now have 190 people who ‘Like’ us and follow our updates. The number of people who talk about, share, or like our posts has remained steady overall. Our most popular stories on Facebook from January 20 to March 24, 2015 included a post on Virtual Critical Care and its expansion to seven new hospitals, which received 565 views, and a post on the mental health funding announcement in March, which saw 316 views. Number of users who viewed North East LHIN Facebook posts from January 20 to March 24, 2015. 6 Twitter Our Twitter presence continues to grow, and increases by an average of 15 followers weekly. Our Twitter page is viewed an average of over 1,000 times per week, and we continue to post photos, media releases, and retweets relating to health care in the Northeast. This has allowed the NE LHIN twitter page to grow to over 2,150 followers. We continue to post in both English and French and interact with our followers. Releases that are posted to our Twitter feed drive hits to our website, which strengthens our overall media reach in the North East. Our most popular tweet for Date Followers March 2015 2150 this period was the Virtual Critical Care announcement which February 2015 2106 received over 1,700 views on Twitter alone. January 2015 December 2014 November 2014 October 2014 September 2014 August 2014 July 2014 June 2014 May 2014 April 2014 March 2014 February 2014 January 2014 December 2013 November 2013 October 2013 September 2013 August 2013 July 2013 June 2013 May 2013 Feb 2013 January 2013 December 2012 2065 2025 2001 1978 1953 1920 1890 1844 1792 1757 1711 1668 1610 1598 1569 1513 1455 1425 1346 1291 1234 1135 1041 990 Followers 2500 2000 1500 1000 500 0 Earned Media 1. Funding Announcement: North East LHIN Invests in Home and Community Care for Seniors in Espanola (Jan 22). Facebook hits: 33; Twitter hits: 430; Media pick-up: Mid North Monitor. 2. Sharing Quality Improvement Ideas to Benefit Northern Patient Care (Jan 22). Facebook hits: 37; Twitter hits: 367, Media pick-up: Moose FM Timmins. 3. New Year or Old Year – It’s Still Diabetes to Me (Jan 27). Facebook hits: 34; Twitter hits: 824; Media pick-up: Bay Today. 4. Sudbury-made post stroke program expands to new cities - Northern Life (Jan 27). 5. First Nations Community Support Services Summit (Jan 30). Facebook hits: 27; Twitter hits: 697; Media pick-up: MooseFM Timmins. 6. Virtual Critical Care Expands To Seven New Hospitals: Article submitted to Canadian Health Care Technology magazine – Dr. Manchuk was interviewed for future publication (Feb 3). 7 7. Local LHIN reacts to recent survey on senior health care – Timmins 99.3 radio (Feb 3). 8. KDH and EDH moving forward to hire CEO – Northern News (Feb 6). 9. Health centre-led initiatives will benefit patient care across Manitoulin Island – Manitoulin Expositor (Feb 9). 10. Virtual Critical Care Expands To Seven New Hospitals (Feb 9). Facebook hits: 565; Twitter hits:1,652; Media pick-up: CBC, Northern Life. 11. North East LHIN Salutes -- Making House Calls to Seniors in Espanola and Connecting them to Care (Feb 11). Facebook hits: 22; Twitter hits: 534; Media pick-up: CBC; Sudbury Star. 12. Funding Announcement: North East LHIN Helping Seniors in North Bay and Mattawa Get Care in Community (Feb 13). Facebook hits: 58; Twitter hits: 689; Media pick-up: North Bay Nugget, BayToday, CKAT radio North Bay, Cogeco TV and CTV. 13. Another Physician Leader Starts Work with the North East LHIN (Feb 17). Facebook hits: 28; Twitter hits: 362; Media pick-up: Timmins Daily Press. 14. Shadows of the Mind Film Festival - North East LHIN Sponsors Ernest and Celestine (Feb 18). Facebook hits: 35; Twitter hits: 467; Media pick-up: Sault Star. 15. North East LHIN continues to support medical team trips for care for seniors living in coastal communities (Feb 23). Facebook hits: 148; Twitter hits: 374; Media pick-up: CBC radio, MooseFM Timmins, Tweet by Dr. Eric Hoskins, Timmins Daily Press. 16. Home care top issue in online survey: LHIN - Northern Life and BayToday (Feb 24). 17. Fentanyl Patch 4 Patch exchange program announced - Local2Sault Ste. Marie (Feb 24). 18. North East LHIN - Patient Experience Survey - Wawa-News (Feb 25). 19. Sudbury Physician Takes on Leadership Role at the North East LHIN (Feb 26). Facebook hits: 62; Twitter hits: 608; Media pick-up: Northern Life, Sudbury Star. 20. North East Local Health Integration Network (NE LHIN) Welcomes New Senior Director (Feb 27). Media pick-up: Northern Life, Sudbury Star. 21. North East LHIN Speaks to Importance of Northern Voices and Partnerships in Strengthening Northeastern Ontario’s Health Care System (March 2). Facebook hits: 37; Twitter hits: 432; Media pick-up: WawaNews. 22. Louise's March Blog - Florence’s Living Legacy (March 4). Facebook hits: 43; Twitter hits: 389; Media pick-up: WawaNews. 23. Funding Announcement in North Bay: North East LHIN Invests in Meeting the Needs of People Experiencing Mental Health and Addictions Issues (March 11). Facebook hits: 316; Twitter hits: 541; Media pick-up: BayToday, North Bay Nugget, CTV, Cogeco, CKAT North Bay, WawaNews, Northern Ontario Medical Journal. 8 24. Ontario government invests in mental health and addictions - Manitoulin Expositor (March 11). 25. New Board Director from Sault Ste. Marie Joins North East LHIN Board of Directors (March 12). Facebook hits: 55; Twitter hits: 277; Media pick-up: Sault Star, West Parry Sound Health Centre newsletter. 26. Small, Medium and Large Northeastern Hospitals Collaborate to Improve Pharmacy Services (March 16) Facebook hits: 128; Twitter hits: 247; Media pick-up: Interview with Radio-Canada, Parry Sound MooseFM, North Bay 600 CKAT, CJKL Kirkland radio. 27. Northern Ontario Medical Journal (March 2015): Review sets out roles of hub and feeder hospitals, NE LHIN helping seniors in North Bay and Mattawa, North Bay Mobile Crisis Team pairs police, nurses, PATH program helps patients with hospital-to-home transitions, Primary care memory clinics speed assessments. 28. Northerners Share Strong Opinions about Home and Community Care (March 24) ) Facebook hits: 50; Twitter hits:209; Media pick-up: Wawa-News, CJKL Kirkland radio, live interview on CBC radio. Marketing/Advertising Northern Ontario Medical Journal Ad - Spring 2015 Issue 9 555 Oak Street East, 3rd Floor North Bay, ON P1B 8E3 Tel: 705 840-2872 Toll Free: 1 866 906-5446 Fax: 705 840-0142 www.nelhin.on.ca 555, rue Oak Est, 3e étage North Bay, ON P1B 8E3 Téléphone : 705 840-2872 Sans frais : 1 866 906-5446 Télécopieur : 705 840-0142 www.rlissne.on.ca ATTESTATION Prepared in accordance with section 14 of the Broader Public Sector Accountability Act, 2010 (BPSAA) TO: The Board of Directors of the North East LHIN, (the “Board”) FROM: Louise Paquette Chief Executive Officer North East LHIN Date: April 8, 2015 RE: January 1, 2015 to March 31, 2015 (“the Applicable Period”) On behalf of the North East LHIN (the LHIN) I attest to: • • • • • the completion and accuracy of reports required of the LHIN, pursuant to section 5 of the BPSAA, on the use of consultants; the LHIN’s compliance with the prohibition, in section 4 of the BPSAA, on engaging lobbyist services using public funds; the LHIN’s compliance with all of its obligations under applicable directives issued by the Management Board of Cabinet; the LHIN’s compliance with its obligations under the Memorandum of Understanding with the Ministry of Health and Long-Term Care; and the LHIN’s compliance with its obligations under the Ministry LHIN Accountability Agreement/Ministry LHIN Performance Agreement in effect, during the Applicable Period. …/2 10 -2In making this attestation, I have exercised care and diligence that would reasonably be expected of a Chief Executive Officer in these circumstances, including making due inquiries of LHIN staff that have knowledge of these matters. I further certify that any material exceptions to this attestation are documented in the attached Schedule A. Dated at Sudbury, Ontario this April 8, 2015: Louise Paquette Chief Executive Officer North East LHIN I certify that this attestation has been approved by the board of the North East LHIN on April 8, 2015. Danielle Bélanger-Corbin Chair, Board of Directors North East LHIN 11 SCHEDULE A to Attestation Note to LHIN Boards re Schedule A. If the LHIN has no exceptions to declare, please insert “no known exceptions” under each of following below: 1. Memorandum of Understanding 2. Ministry-LHIN Accountability Agreement (MLAA)/Ministry-LHIN Performance Agreement (MLPA) in effect 3. Completion and accuracy of reports required pursuant to Section 5 of the BPSAA; 4. Prohibition, in section 4, of the BPSAA, on engaging lobbyist services using public funds; 5. Compliance with applicable directives issued by the Management Board of Cabinet (including Procurement, Travel, Meals and Hospitality, and Perquisites Directives – to be added once ss. 14(1)(c.1) of the Act is proclaimed into force) If the LHIN has exceptions to declare under 1-5, please: • • • list them accordingly; provide a rationale for each exception in respect of why the LHIN did not comply; and describe what actions have been, or will be taken, to address each exception. Please note that if any exceptions declared in a previous declaration of compliance made by the Board on behalf of the LHIN continue through this reporting period, they must also be declared in Schedule A of this declaration. If you are in doubt as to how to complete this Schedule, please contact your legal counsel. Please delete this note before completing Schedule A. 12 SCHEDULE A to Attestation For North East LHIN For the Applicable Period: January 1 to March 31, 2015 1. 2. MEMORANDUM OF UNDERSTANDING; AND MINISTRY LHIN ACCOUNTABILITY AGREEMENT/MINISTRY LHIN PERFORMANCE AGREEMENT Possible Non-Compliance. The NE LHIN has determined that the terms and conditions on which all fourteen LHINs acquired insurance breach the LHINs’ obligations under LHSIA, the Financial Administration Act, the MOU and possibly the MLPA. The NE LHIN is endeavoring to resolve this accidental breach by seeking approvals required by LHSIA, the Financial Administration Act, the MOU and the MLPA. Toronto Central LHIN, on behalf of all LHINs, continues to work on a submission to the Ministry of Health and Long-Term Care and the Ministry of Finance. 3. COMPLETION AND ACCURACY OF REPORTS REQUIRED PURSUANT TO SECTION 5 OF THE BPSAA NO KNOWN EXCEPTIONS 4. PROHIBITION ON ENGAGING LOBBYIST SERVICES USING PUBLIC FUNDS PURSUANT TO SECTION 4 OF THE BPSAA NO KNOWN EXCEPTIONS 5. COMPLIANCE W ITH APPLICABLE DIRECTIVES ISSUED BY MANAGEMENT BOARD OF CABINET a. OPS PROCUREMENT DIRECTIVE NO KNOWN EXCEPTIONS b. OPS TRAVEL, MEAL AND HOSPITALITY EXPENSES DIRECTIVE NO KNOWN EXCEPTIONS c. [TO BE ADDED ONCE SS. 14(1)(C.1) IS PROCLAIMED INTO FORCE] OPS PERQUISITES DIRECTIVE NO KNOWN EXCEPTIONS 13 MINUTES OF PROCEEDINGS NORTH EAST LOCAL HEALTH INTEGRATION NETWORK BOARD OF DIRECTORS MEETING January 27, 2015 9:00am Teleconference PARTICIPANTS: Danielle Bélanger-Corbin Santina Marasco Dawn Madahbee Dr. Colin Germond Denis Bérubé Louise Paquette Cynthia Stables Tamara Shewciw Kate Fyfe Terry Tilleczek Martha Auchinleck REGRETS: Rick Cooper SCRIBE: Micheline Beaudry AGENDA ITEM DISCUSSION ITEM 1.0 Call to order: Introductions of attendees Chair Danielle Bélanger-Corbin called the meeting to order at 9:04 am. Declaration of Conflict of Interest No conflicts of interest declared. ITEM 2.0 ITEM 3.0 Approval of Agenda Added to agenda – Item 9d – MLPA motion {MOTION 2015-BD0094} That the agenda for the Board of Directors meeting of th Tuesday, January 27 , 2015 be approved with addition of Item 9D. MOVED: Colin Germond / SECONDED: Dawn Madahbee {CARRIED} ITEM 4.0 Approval of Consent Agenda Includes the following items: 5.0 Board Attendance 6.0 Media Tracker 7.0 Attestation of Compliance 8.0 Approval of Minutes of past Board meeting of December 8th and 17th, 2014 Page 1 14 ACTION RESPONSIBLE {MOTION 2015-BD0095} The consent agenda for the Board of Directors meeting of Tuesday, January 27th be approved as presented including: - Board Attendance - Media Tracker - Attestation of Compliance - Approval of Minutes of past Board meeting of December 8th and 17th MOVED: Santina Marasco / SECONDED: Denis Bérubé {CARRIED} ITEM 9.0 Report from the Chair a) Update from LHIN leadership meeting on January 22nd, 2015 – Danielle Bélanger-Corbin reported that both Dr. Bob Bell and Dr. Hoskins participated in the meeting of January 22nd 2015 and highlights include : OMA negotiations between government and OMA Home and Community Care – upcoming “Donner” report Action Plan 2.0 (February 2, 2015) The Auditor General is looking at governance within LHINs. More information will be available in the next couple of months. The scope of the audit has not yet been decided; still at preliminary stage. Audit information will be forwarded to board members when it’s received. Sub Committee Strategic Direction 3.0 is being developed. Danielle reported that she and Kirsten Farago, NE LHIN Long-Term Care Lead, met with Associate Minister of Health and Long-Term Care, Dipika Damerla regarding the challenges that we Northeastern Ontario faces regarding long-term care. The Ministry has 3000 LTC beds that will be re-developed. In the NE LHIN, 19 of the 40 LTC homes are eligible for this redevelopment. b) NE LHIN Board Appointment Update – Danielle reported that one candidate is awaiting approval from the Order in Council. Four applications have been received and will be reviewed at the Governance committee on February 26th. Two openings are remaining to be on the Board. c) Appointment of Vice Chair – Appointment of a ViceChair requires the approval of the Order in Council. Page 2 15 A briefing note will be provided to the board on the status of LTC homes redevelopment. Kirsten Farago {MOTION 2015-BD0096} The NE LHIN Board of Directors recommend that to the Public Appointments Secretariat and the Minister that Mr. Rick Cooper be appointed as Vice-Chair of the Board. MOVED: Denis Bérubé / SECONDED: Colin Germond {CARRIED} Committee Memberships: Governance – Rick Cooper (Chair), Santina Marasco and Denis Bérubé. The new member appointed to the Board will also be asked to sit on Governance. Danielle BélangerCorbin will remain on committee as ex-officio. Audit – Dr. Colin Germond (Chair), Rick Cooper and Dawn Madahbee. Danielle Bélanger-Corbin will remain on committee as ex-officio. Dr. Colin Gemond has agreed to sit on the Health Professional Advisory Committee. Dawn Madahbee has agree to sit on the Local Aboriginal Health Committee. New board members have been mandated for a one day governance session. Denis Bérubé and Danielle BélangerCorbin will be attending the French session in the Spring. Date has yet to be determined. Dawn Madahbee will participate at English session. d) MLPA Motion It has been requested that the LHIN Leadership Council and Chair Council act on behalf of the LHIN to coordinate and manage the negotiation process for the renewal of the LHIN-Ministry Performance Agreement for 2015-16. A document with details of the process and principles for the Provincial LHIN Negotiating Committee has been provided to the board members. {MOTION 2015-BD0097} The North East LHIN Board of Directors hereby authorizes the LHIN Leadership Council, through a small Work Group with representation from LHIN CEOs and Board Chairs, to act on behalf of the LHIN to coordinate and manage the negotiation process for the renewal of the LHIN-Ministry Performance Agreement for 2015/16. MOVED: Dawn Madahbee / SECONDED: Colin Germond {CARRIED} Page 3 16 New members to attend governance session. Denis Bérubé Dawn Madahbee ITEM 10.0 Financial/Performance Update a) Operations Update Kate Fyfe provided presented the third quarter operations report. {MOTION 2015-BD0098} Be it resolves that the board accepts the report as presented. MOVED: Colin Germond / SECONDED: Denis Bérubé {CARRIED} ITEM 11.0 Integration: Martha Auchinleck reported that the Englehart and District Hospital and Kirkland and District Hospital submitted a notice of intent to integrate. {MOTION 2015-BD0099} WHEREAS the Englehart and District Hospital and the Kirkland and District Hospital intend to enter into a voluntary, horizontal integration in the form of a partnership agreement at the executive and management levels; AND WHEREAS, through the partnership, the hospitals will jointly manage the health services that are currently provided, while planning together for the future, with the hiring of a single Chief Executive Officer for both organizations; AND WHEREAS, through the partnership, the hospitals will develop one mission, one vision and one set of values, and will create a strategic plan to propel them towards their shared vision; THEREFORE BE IT RESOLVED THAT, upon the NE LHIN’s review of both organizations’ notice of intended integration under Section 27 of the LHSIA, the Board of Directors of the NE LHIN will not stop the request for a Shared Leadership and Planning integration between the Englehart and District Hospital and the Kirkland and District Hospital. MOVED: Santina Marasco / SECONDED: Colin Germond {CARRIED} ITEM 12.0 Proceed to Closed session to discuss matters involving: Labour relations Matters prescribed by regulation {MOTION 2015-BD00100} Page 4 17 Variance column to be added to operations forecast summary graph. Kate Fyfe “The members attending this meeting move into a Closed Session pursuant to the following exceptions of LHINS set out in s.9(5) of the Local Health Integration Act, 2006.” ☒ Labour relations BE IT FURTHER RESOLVED THAT; the following persons be permitted to attend: For the discussion regarding Matters prescribed by regulations: Louise Paquette, CEO Kate Fyfe, Senior Director Martha Auchinleck, Senior Director Terry Tilleczek, Senior Director Cynthia Stables, Director Tamara Shewciw, Chief Information Officer Micheline Beaudry, Executive Assistant to the CEO and Board Liaison MOVED: Rick Cooper / SECONDED: Colin Germond ITEM 17.0 {CARRIED} Report from the Closed session {MOTION 2015-BD00101} The Board of Directors of the NE LHIN received the report of its Closed Session meeting of January 27th, 2015. MOVED: Denis Bérubé / SECONDED: Santina Marasco ITEM 18.0 ITEM 19.0 {CARRIED} Next Meetings February 26, 2015 (Audit and Governance) April 8, 2015 (Board) Adjournment of Board Meeting {MOTION 2015-BD00102} The North East LHIN Board of Directors meeting of January 27th, 2015 be adjourned at 10:42 am. MOVED: Rick Cooper/ SECONDED: Colin Germond {CARRIED} AGENDA DEVELOPMENT FOR NEXT MEETING __________________________ Danielle Bélanger-Corbin Chair __________________________ Colin Germond Director Page 5 18 RESOLUTION NORTH EAST LOCAL HEALTH INTEGRATION NETWORK (the “Corporation”) Motion No.: 2015-BD00XX MOVED: _____________________________________ SECONDED: _____________________________________ April 8, 2015 RESOLVED THAT: The consent agenda for the Board of Directors meeting of April 8 be approved as presented including: - Board Attendance - Media Tracker - Attestation of Compliance - Approval of Minutes of Board meetings of January 27, 2015 _____________________________________ Danielle Bélanger-Corbin Chair 19 Purpose: To summarize individual LHIN discussions on collaborative governance and results of the participant evaluation, and to recommend next steps. To: LHIN Leadership Council From: Collaborative Governance Work Group Date: January 9, 2014 Meeting Date: January 22, 2015 Action: For decision KEY RECOMMENDATIONS: 1. That LHIN Board Chairs distribute this document to their Boards, including the summary of individual LHIN discussions, and have a generative discussion at a future Board meeting. A brief summary of the Board’s discussion will be submitted to the Work Group to guide planning of further work. 2. That the Work Group conduct a survey of LHINs to gather LHIN experiences with collaborative governance and to determine whether there is collective interest in holding a second panLHIN education session to discuss these experiences and case studies. 3. That the Leadership Council bring back as a priority for 2015/16 to improve our use of technology for pan-LHIN Board education and collaboration (this was identified about 2 years ago as an area for collective work) or consider an annual face-to-face education session for LHIN Boards. BACKGROUND/CONTEXT The pan-LHIN board education session on collaborative governance was held on November 27, 2014. This report provides a brief summary of the individual LHIN discussions of collaborative governance held immediately following the pan-LHIN session, and the results of a participant evaluation of the session conducted in December 2014. More detailed summaries of the LHIN discussions and the survey results are available from the Collaborative Governance Work Group. LHIN DISCUSSIONS OF COLLABORATIVE GOVERNANCE Common themes from LHIN discussions following the pan-LHIN education session include: FINAL – January 15, 2015 1|P a g e 20 Integration is more than mergers; there is a full spectrum of collaboration options of which merger is only one. LHIN and our HSP efforts need to address the full range of integration possibilities. Integration itself is not the goal, rather it is a means to achieve the real goal of improved patient care and patient outcomes. The focus should be on “integrated care” not “integration”. We can do more to educate HSP Boards that acting in the “best interests” of their organization includes an obligation under LHSIA to seek opportunities for health system integration. LHINs should work together to communicate this message consistently across all LHINs. Much more can be learned from individual LHIN experience with collaborative governance and local health system integration. Future collective efforts should focus on sharing case studies and best practices from the experience of each LHIN. EDUCATION SESSION EVALUATION Key themes from the participant evaluation survey of the pan-LHIN education session include: Very positive feedback about the individual LHIN discussions following the education session. Some noted the benefit of having HSPs present for, or participating in, the LHIN discussion. For many, the pan-LHIN session supported the objective of providing continuous education for LHIN Boards and the advance material was useful to prepare for the meeting. Some suggested better communications about the session objective and why it was held at that time. Many found the refresher on LHSIA and integration obligations useful, while some felt it provided no new information for experienced Board members in particular. The presentations received very positive feedback. Greater use of individual LHIN examples and case studies was suggested for future sessions. While technology is a good way to conduct pan-LHIN education, many felt a more interactive platform is needed to allow real-time questions and dialogue. More training and experience with the existing technology was suggested also so sessions run more smoothly. HSP participation in LHIN Board education sessions should be clarified and materials made available in French and English. Content should focus on and engage all health sectors equally. The LHINs need to develop and communicate a shared understanding of collaborative governance including what it is, what it means to LHINs, and how it relates to our collective goal of a patient-centered health system. LESSONS LEARNED The Collaborative Governance Work Group identifies the following lessons learned from its experience planning the education session and the feedback received from participants: FINAL – January 15, 2015 2|P a g e 21 There is an overarching shared interest in strengthening the LHIN capacity for local integration that aligns with an overall provincial integrated health system. There is a shared interest in providing information and education to HSPs on collaborative governance and supporting the capacity-building of HSPs for local integration leadership and management. This includes communicating to HSPs in a clear and consistent manner about their role in integration and their obligations to seek integration opportunities. There is support for further pan-LHIN Board education on topics of shared interest. Given the unique approaches, priorities and perspectives of LHINs, all education topics are not suited to a collective effort. Those topics best suited to pan-LHIN Board education are either new to all LHINs, so there is a common interest in establishing the same base of knowledge, or are topics in which all LHINs have experience, so there is a collective benefit in sharing experiences and best practices. Further work is needed to improve the use of available technologies, such as OTN, so that panLHIN sessions are more interactive, accessible from multiple locations and run smoothly. There was agreement over a year ago to use technology to support collective LHIN Board education, but this was not included in the Leadership Council priorities for the current year. Further attention should be put towards maximizing the use of available technologies and a discussion held about whether to hold an annual face-to-face session for LHIN Board members. The objectives, planning parameters and expected outcomes of a pan-LHIN initiative need to be approved in advance by the Leadership Council to ensure that a Work Group has clear direction and all LHINs have the same understanding of how it will unfold. Last minute changes need to be discussed and approved by the Leadership Council. NEXT STEPS The feedback received from LHIN Boards and individual participants in the pan-LHIN education session indicates a collective interest in doing more to share experiences and learnings amongst LHINs and to provide information and education for HSPs. RECOMMENDATIONS The Collaborative Governance Work Group makes the following recommendations to the LHIN Leadership Council: 1. That LHIN Board Chairs distribute this document to their Boards, including the summary of individual LHIN discussions, and have a generative discussion at a future Board meeting. A brief summary of the Board’s discussion will be submitted to the Work Group to guide planning of further work. FINAL – January 15, 2015 3|P a g e 22 2. That the Work Group conduct a survey of LHINs to gather LHIN experiences with collaborative governance and to determine whether there is collective interest in holding a second pan-LHIN education session to discuss these experiences and case studies. 3. That the Leadership Council bring back as a priority for 2015/16 to improve our use of technology for pan-LHIN Board education and collaboration (this was identified about 2 years ago as an area for collective work) or consider an annual face-to-face education session for LHIN Boards. ATTACHMENT: Appendix A: Summary of LHIN Discussions on Collaborative Governance FINAL – January 15, 2015 4|P a g e 23 Summary of LHIN Discussions on Collaborative Governance After the pan-LHIN education session, each LHIN Board discussed three questions asking LHINs to reflect on the session and their own experience with collaborative governance and integration. The following is a summary of the individual LHIN discussion notes submitted to the Collaborative Governance Work Group. Question 1: What is your most important takeaway about the opportunities of collaborative governance from the session today? INTEGRATION IS MORE THAN MERGERS It reinforced that there are many ways to develop a more integrated and coordinated system before considering full merger. Integration is only one of many options along a continuum of options. It reinforced that integration is only one of the tools LHINs have to build a better health care system and better outcomes for the patient. Integration is not an end in itself. Anne Corbett’s “Ten Tips for Successful Integration” was very helpful as was the scaling of integration she spoke about – voluntary to amalgamation. The review of the definition of “integration” was helpful. There are many different opportunities and ways in which HSPs can work together, long before full integration is the answer – it doesn’t have to be all or nothing. Most HSPs assume that integration means only full merger and dissolution but there are less drastic steps that yield positive results. BETTER PATIENT CARE AND OUTCOMES IS THE GOAL An integrated system is not the goal, better patient care and patient outcomes are. Integration means HSP boards working collaboratively by sector, across sectors, and across borders and taking decisions that will affect and change the health system in a positive manner. It also means being more efficient with our resources and finding better ways to serve the population of our LHIN. To focus on a patient’s needs through the continuum of care and ensure better transitions in care. The “driver” for any further collaborative governance work amongst LHINs and with HSPs should be to collectively improve the patient (caregiver/family) experience. It is important to remember that LHINs have the authority to restrict funding however HSPs do not have the authority to restrict services – this is a fine line. Integrations must be in the best interests of the people and patients and must not impact service delivery in a negative way. FINAL – January 15, 2015 5|P a g e 24 If we are working towards system integration it needs to be the focus. The idea of integration may be a distraction. The interests of the patient need to be a focus all the time instead of what HSPs can and cannot provide. “BEST INTERESTS” INCLUDES SEEKING INTEGRATION OPPORTUNITIES The clarity that an HSP Board’s responsibility to support system integration and identify integration opportunities falls within its duty “to act in the best interests” of its own organization. It is clear that HSP Boards need to see through a system lens not only their own organizational lens. LHINs need to educate HSP Boards about this role. The Board noted that they were not aware that every health service provider is obliged to seek integration opportunities in the health care system. Other influences such as budget pressures and Health Links create integration opportunities that should be leveraged to develop more integrated care for patients. There is a need to raise awareness amongst HSPs about their role in identifying opportunities for integration. Perhaps it could be listed as an accountability in the service accountability agreements. The challenge is putting collaborative governance theory into practice with HSPs who view their long-standing structure as essential. The fear of change is real with all providers, especially smaller ones. VALUE OF LEARNING FROM EACH LHIN’S EXPERIENCE It was valuable to hear some of what other LHINs are doing. It would be helpful to develop better mechanisms to continue to share experiences with each other. The session reinforced we are on the right track in the work we are doing in our LHIN. Focus future sessions on understanding each LHIN’s knowledge and practices. Our LHIN’s current level of governor-to-governor engagement is quite strong, specifically between HSP and LHIN governors. An example is our Governance Advisory Councils which meet at least three times a year. The LHINs would benefit from more collaborative work with each other to get a window on the complexity of working together. OPPORTUNITIES FOR FURTHER PAN-LHIN ACTIVITY Offer a similar session or recorded session for orientation of LHIN Board members. A more interactive session is suggested using case studies or scenarios where LHIN Board members could work through situations. Include a case study on a failed integration and the lessons learned. FINAL – January 15, 2015 6|P a g e 25 Look at how other ministries are achieving cross-organizational coordination in governance processes, for example the work on accessibility currently underway by the Ministry of Child and Youth Services. There is merit in awaiting the results of the recent LHSIA review which may identify possible opportunities for the LHINs to implement collectively. The Ministry’s support of LHINs’ authority and integration efforts needs to be clear. The Ministry needs to support the LHINs’ authority when it comes to integration. Use Health Links to enhance and compel collaborative governance. Question 2: What new ideas or learnings could you consider or incorporate into efforts to further advance integration in your LHIN? The role of HSP governors in supporting increased integration, and in supporting it as a priority for their CEO/Executive Director, and as an important element of the transformation agenda. Each LHIN faces different challenges because the capacity of HSPs to undertake integration varies widely by organization. Some rely on the LHIN to provide direct assistance and support. It is the LHIN’s responsibility to formally educate HSP Boards (and the HSP Boards’ public) about the range of collaborative opportunities and their obligation to look for integration (broadly defined) opportunities. Further Board to Board sessions are helpful in developing this understanding. With HSP Board understanding and support, more successful integrations can take place, improving the health care system for patients. We will continue to collaborate with our HSP Boards focused on supporting and accelerating the outcomes of our Integrated Health Services Plan (IHSP). Implement a campaign to better educate our HSPs on integration and their responsibilities and obligations regarding integration. The Board discussed whether we are providing an appropriate level of governance support for these agencies. The Board agreed to discuss this with the agencies at our next Board to Board meetings with the sectors. Ask Anne Corbett if we can send the article Integration Transactions: The Role of the Board and possibly her slides to HSP Boards and ask them to table for discussion at their next Board meeting, in anticipation of a future Governance to Governance session or a regular education session. Focus integration and coordination efforts and communications around the needs of the patient. Our Board would be interested in evaluating the current governance engagement strategies that we use in our integration work. We have modeled them around best practices and feedback from providers and chose to engage the Chairs of HSPs early in the process. FINAL – January 15, 2015 7|P a g e 26 Acting on our legislative authority and taking the bold steps needed to continue to include integration in our local transformation agenda. LHINs must have the support of the Ministry and Minister in enacting our legislative authority. Integrations can be very challenging to carry through and communities need assistance and education to support them – this is a very resource intensive exercise for the small compliment of staff at most LHINs. Shift the emphasis from “integration” to “integrated care.” Question 3: Provincially, Collaborative Governance has been identified as a topic for collective work by the LHINs this year. What would you like this collective effort to focus on? SHARE INFORMATION AND LEARNINGS AMONGST LHINs Provide a forum to share each LHIN’s experience, practices and learnings about collaborative governance and system change. Provide educational resources but recognize regional differences and let individual LHINs lead when it comes to establishing what is to be done within their own regions. The Collaborative Governance Work Group should focus on sharing successes and case studies with insight into how the integration was planned and completed and the difference it made to patients. Understanding what is working in other LHINs, particularly what strategies and approaches work when there is push back. We would be interested in further exploring ideas of collaboration across LHIN governors, this could include future sessions where we hear from some of the other Boards on integration best practices. We would like to have a better understanding of what other LHINs are doing and what they feel are the strengths of their governance structures. We appreciate the information shared by NSM LHIN and would be interested in hearing if there are aspects of the model that would be changed. Also, would like to know whether this model has resulted in better patient outcomes and learn more about the “Governance Coordinating Council.” Developing best practices and messages for supporting integration. Compile success stories, challenges and obstacles from the experience across the LHINs. An example in our LHIN would be the recent mental health and addictions amalgamation best practices and lessons learned. There is interest in creating a central clearing house for this type of information for all system partners. The governance portal is a good example but it has not been maintained. FINAL – January 15, 2015 8|P a g e 27 Understanding the best practices for various types of situations / circumstances, with an emphasis on being able to articulate the tangible and measurable outcomes. Defining common metrics to assess the system impacts of amalgamations. While each amalgamation would be unique, there may be common elements, such as cost savings and improved patient experience, which would be relevant in all amalgamations. Benefits of defining common metrics would be enhanced ability to compare the impact and outcomes of amalgamations (e.g., one large scale hospital amalgamation versus another one) and consistent interpretation of metrics. CLARIFY PAN-LHIN, LHIN, HSP ROLES Clarifying the role of collaborative governance at the provincial pan-LHIN level and individual LHIN level. Developing a white paper on collaborative governance that defines the concept within the health care sector might be a worthwhile project. It could provide consistent messaging from the LHINs. Each LHIN would supplement the core document with specific examples of success from within their LHIN and use it as an educational/information piece. We often focus on integration of HSPs but could focus more on integration at a system level (i.e. at Board level having a super Board to formally integrate ideas and communication). Other strategies for promoting communication at a Board level could also be a focus. PROVIDE INFORMATION, EDUCATION AND SUPPORT TO HSPs Educating HSPs is pivotal and we spend a lot of time educating the public, through ongoing engagement and communication efforts, about the need for a more coordinated local system. It is helpful for HSPs to hear what other HSPs are doing in other parts of the province with respect to integration, quality improvement and the patient/client experience. Knowing that others are taking a similar approach both encourages and supports momentum locally. Continue to communicate the expectation that HSP governors need to play a role in the oversight of their own organizations within the broader context of the health system. This includes teleconferences, education by associations (e.g., OHA) and local LHIN governance to governance work. Have Anne Corbett conduct 2 or 3 further, in-depth sessions that HSPs could participate in such as a regional presentation. Develop a set of guidelines for HSP Boards to use to pursue integration at a governance level. HSPs in our LHIN would benefit from a workshop on this topic. This could include a session for individual sectors to support our work to commence a LTC plan and a CSS plan. FINAL – January 15, 2015 9|P a g e 28 HSP Boards need access to tools developed in our LHIN to help with their collaborative governance and application. Tools available on our website include a Board-to-Board Collaborative Governance Toolkit (Champlain LHIN) HSP Boards need to learn a lot – first their fiduciary duties and about the health system in general, then look at the bigger picture. Boards that are mature can focus more on their role in system improvement. More education is needed for HSP Boards related to collaborative governance – we must define integration, what it looks like for HSPs and the results that LHINs expect. The changes needed must start at the grassroots level – it has to come from the community in order to get the buy-in and momentum needed to make it happen. LHINs are doing all they can on engagement and communication. Policy setting and support from the Ministry and Minister need to be there also to complement the work of the LHINs. Hold sessions on a regional basis. Have a document that captures the whole picture. LHINs must get HSPs working on integration. Consider who the integration champions are and how they could collaborate and speak with others about their success. About 50% of governors at a recent governance course indicated that the resources aren’t sufficient for what is required. We have resources to govern our own boards but not beyond that. We need to support Boards and think of different strategies and opportunities based on the state of each HSP Board. Develop a framework for communications around change management (similar to the framework for community engagement). Given the different sizes of organizations involved in amalgamations, it may make sense to have the framework customized to size of organizations – large versus small to medium. It is likely that we will see more amalgamations in the future; the communications framework would provide organizations with a starting template covering to whom, how and when to communicate changes. Benefits would be increased efficiency (the entities would not have to “start from scratch”), opportunities for smaller scale amalgamations to learn from larger amalgamations and vice versa, and improved stakeholder relations as the change communications framework would help ensure key constituencies are covered and the impact monitored. Focus on best practice for integration, lessons learned from integrations and any kits or documents that could be used, especially by smaller organizations that need support. OTHER FEEDBACK LHIN Leadership Council needs to start having discussions with OHA, what integration means and what it means to govern it. Pan-LHIN Board education sessions need to be more frequent. They are good mechanisms to talk about topics with all Boards present. FINAL – January 15, 2015 10 | P a g e 29 The session seemed very hospital centric. More focus on collaborative governance theory would be helpful. The overall objective of the session was not clear and not sure there was a collective understanding of “collaborative governance” following the session. A suggestion was made during our discussion related to the Deputy Minister’s presentation – for us to build a blueprint of what the future health system is supposed to look like and establish a common strategic vision for the Boards of what the system needs to look like (i.e., role of the hospitals, big and small). FINAL – January 15, 2015 11 | P a g e 30 Ministry of the Attorney General Ministère du Procureur général Legal Services Branch Direction des services juridiques Local Health Integration Networks Les réseau locaux d’intégration des services de santé 425 Bloor Street East, Ste 501, Toronto, Ontario, M4W 3R4 425, rue Bloor Est, Bureau 501, Toronto (Ontario), M4W 3R4 Direct Line: (416) 969.3593 E-mail: Jeffrey.Simser@lhins.on.ca The New Agencies & Appointees Directive On February 2, 2015 the government’s new Agencies & Appointees Directive came into force. This new directive consolidates the Agency Establishment & Accountability Directive with the Government Appointee Directive. LHINs are now classified as “boardgoverned provincial agencies.” Highlights for the LHINs The new Directive applies to the LHIN and sets out a framework for governance, accountability, appointments and remuneration. New: o Risk reporting: Ministries are to report on agency risks quarterly and that requirement is likely to filter down to the LHINs, who currently report annually. o Mandate Reviews: agency mandate reviews are required every seven years (s. 39 of LHSIA has a review provision and last year there was Standing Committee work); and, o MOU Reviews: MOUs are deemed to have their termination dates removed, with a review required upon a change of a Chair or a Minister; the LHIN MOU expires in 2017 and has such a provision already, which the Ministry declined to use when Minister Hoskins was appointed. Not New for the LHINs: there are requirements that may be new for other agencies, but not the LHINs, for example: annual Chair and CEO attestations of compliance for laws and directives; the public posting of agency MOUs, Business Plans and Annual Reports; and the submission of agency business plans within 3 months of the end of fiscal. Clarifications for LHIN Board members: there are some clarifications respecting appointees and their remuneration. There is no obligation to re-appoint existing members, no appointee entitlement to severance or termination pay, and clarifications around terms of remuneration (length of a working day, appointees are not entitled to reimbursement of professional dues or fees, payments must only be made to the person named in the appointment instrument and so on). Of Passing Interest: a number of the new provisions may only be of passing interest: mandatory requirements for short-term advisory bodies and special advisors (including rules for remuneration and an ethical framework) Questions? Email us: Jeffrey.Simser@LHINS.ON.CA 31 Risk Management Framework and Agency Establishment and Accountability Directive (AEAD) Risk Assessments 32 Risk Management Framework and Tools Embedding Risk Management into all Business Processes Planning Risk INFO Local System Performance 33 Financial Management Risk Management Process State Objectives Identify Risk Assess (Measure) Plan & Take Action Monitor & Report MOH had adapted the Ontario Public Sector (OPS) Risk Management Framework (including tools and guidelines for LHINs) - this method includes non-financial risk specific to healthcare, including risk impact/likelihood/tolerance 34 Agency Establishment and Accountability Directive (AEAD) Risk Assessments Purpose of the Risk Assessments: Ensures proactive and strategic agency risk management Establishes ministry’s risk oversight measurements Establishes accountability mechanism that provides due diligence over agency operations Allows ministry to better manage corporate risks and improve oversight 35 AEAD Agency Risk Assessment Template Risk Description OPS- Categories of Risk Instructions: This section is a guide to describe the Risk being faced by the organization. Questions that should be answered here include: 1. What is the Risk? 2. What is the source of the risk - that is, what event can trigger the risk? 4. What is the financial implication of the risk (quantitative or qualitative) 5. Why do you think this is a risk? Ref Risk Analysis (H/M) Objective # Likelihood Impact Overall Risk Rating □ Strategic □ Accountability/Governance □ Operational □ Workforce □ Information Technology & Infrastructure □ Other Ministry Comments (Risk Description) * For guidance, see Appendix D for a complete description of the risk categories Ministry Residual Risk Analysis Comments Key Mitigation Target Risk Mitigation Risk Consequence/Impact (Mitigation Action) Mitigations Start Owner Status Date □ Mandate □ Financial Current/ □ Reputational Proposed 36 AEAD Risk Assessment Anchors - Guide L High i k Medium e li Low h o o d Medium High High Low Medium High Low Low Medium Low Medium High Impact Anchors (Agency Risk Analysis) Impact Very Low Financial <=5% Mandate 100% Reputational <1 Mth Low Medium >5%<=10% High Very High >10%<=15% >15%<=20% >20% >=90%<100% >=80%<90% >=50%<80% <50% >1<=2 Mths >2<=3 Mths >3<=5 Mths Explanation Percent of Financial Target at Risk of not being achieved Number of Agency Operational Objectives achieved >5 Mths Number of months the Agency will have negative news coverage in a year Anchors (Project Risk Analysis) Impact Very Low Budget Requirements <=5% Time <1 Mth 100% Low >5%<=10% Medium High Very High >10%<=15% >15%<=20% >20% >=90%<100% >=80%<90% >=50%<80% <50% >1<=2 Mths >2<=3 Mths >3<=5Mths Explanation Percent of project cost that exceed project budget estimate Percent of project requirements completed successfully 37 Time project was completed above estimated project schedule >5Mths Identified High Risks & Mitigation High Risks Accountability / Governace • LHIN Operations/Expenses • Community Engagement • Planning • Funding Processes • Performance Reporting by third parties. Operations • Procurement process compliance Workforce • Conflict of Interest • Code of Ethics policy Mitigation • LHIN Board of Directors provides direction to CEO and LHIN staff in terms of actions items to be implemented to manage risk identified by third party reviews. • Ensure that all steps taken in each procurement process has been completed accurately and all steps have been noted to the legal department. • Employees read and acknowledge our Conflict of Interest and our Code of Ethics policy annually through a formal sign off process on an annual basis. 38 Identified Medium Risks & Mitigation Medium Risks Mitigation Strategic • risks related to implementing (or not implementing) initiatives to achieve required and desired outcomes • LHIN Board reviews/approves Quarterly Reports (including Risk Reporting and Risk Summary), and the annual risk management plan. Accountability/Governance • compliance reporting • legal services (LSB) • financial reporting • delegation of authority • directives, regulation changes • and failure of health service provider (HSP) to deliver on commitments • Follow-up on non-compliance, review and seek legal services Utilize standard templates Senior management and board to review financial reporting, clear delegation of authority established Review any government policy changes Regularly review and oversight on HSP reporting • • • • Workforce • • External events, often unforeseeable (such as weather events, political events, 39 significant infection outbreaks) LHINs regularly engage HSPs, giving all parties the opportunity to discuss issues and risks and thereby ensure a collective focus on system priorities Community Sector Funding Allocation 2014.15 Presentation to NELHIN Audit Committee Kathleen Fyfe, Senior Director System Performance 40 Speech from the Throne NE LHIN Investment Cycle Provincial Budget ADM Funding Letter Priorities - IHSP Decision to Fund Monitoring and Evaluation of Outcomes Business Case - Criteria Performance - MLPA Regional/Local Tables Support Planning - Studies, Provincial tables LHIN Officers 41 LHIN Provincial Strategic Framework A snapshot of Health System Priorities for Ontario and Northeastern Ontario Improve Population Health Improve Experience with the Health System 42 Improve Sustainability of the Health System Putting “Patients First” Means … Norbert Burgdorf, Barry Lyons, and Mary Coulas, Patient Advisors with the Sault Area Hospital, have been able to make changes in the way patients receive cancer care at the hospital. They spoke at the NE LHIN’s Patient Engagement Session, cohosted with the Change Foundation, in May 2014. • Supporting people to make healthier choices and help prevent disease and illness. • Engaging people on health care, so we fully understand their needs and concerns. • Focusing on people, not just their illness. • Providing care that is coordinated and integrated, so a patient can get the right care from the right providers. 43 What does this means for the North East? Provincial priorities align well with NE LHIN’s area of focus: • Increase ACCESS to care • Coordination to CONNECT patients/client to care • INFORM so people, especially seniors, make the right decisions about their health. • PROTECT through quality and evidenced based care • Strengthen/Modernize Home and Community based care 44 In her 80s, Mary Clancy leads Stand Up Classes for seniors in Sudbury – 55 of 111 new LHIN Funded classes started in Sept.2014. Mary provided participant feedback at a planning meeting last fall. o Year 3 of our Integrated Health Service Plan (IHSP) o Continued focus on 4 priorities – o o o o Primary Care Care Coordination Mental Health & Addictions Special Populations o Continued engagement with Northerners to develop priorities for IHSP 2016-2019 45 6 Louise chats with Regional Chief Angus Toulouse and organizer Edith Mercieca at the First Nations CSS Summit on Jan. 30, 2015, in Sudbury. Strengthening Home and Community Care • Provincial Panel (April, 2014) - Dr. Gail Donner, Dr. Samir Sinha, Cathy Fooks, Donna Thomson, Dr. Kevin Smith and Joe McReynolds. Report submitted Jan 30, 2015. • NE LHIN launches survey (Nov. 2014) 10 questions • 1,009 completed surveys • 93% from Northerners, not providers. • Response rate equivalent to 23,500 had the survey gone province wide. 46 What Northerners Want … • • • • • • Access Accountability of funding Coordination and integration Health human resources Communication, education and engagement Cultural diversity and Northern perspective “Establish a balance between hospital care and community and home based care. Each has its place and one should not be to the detriment of the other.” “Care providers NEED to communicate with one another.” 47 Community Investments 2014/15 Base Allocation - $6.2 M Service Delivery Enhancements Enhancement Transportation Services CSS services (Cochrane) CCAC Palliative Care (Algoma Shared Care team) Mobile Crisis Stay on Your Feet Assisted Living (152 clients) Special Populations - $760,000 Service Integration/System Coordination - $530,000 Primary Care - $372,000 Service Delivery Enhancements - $4,500,000 Special Populations PSW Training Geriatric Clinics Coast and Geriatric Services Enhancements CSS Weenusk & Attiwapiskat Service Integration Alzheimer Sudbury, North Bay Red Cross – First nation development lead Primary Care Corner Clinic service expansion and One-time Service Delivery Enhancements Enhancement Transportation Services CSS services (Cochrane) CCAC Palliative Care (Algoma Shared Care team) Mobile Crisis Stay on Your Feet Assisted Living (152 clients) 48 Mental Health and Addictions 2014/15 Base Allocation - $2 M Housing initiatives • CMHA SSM & SSM Municipal Housing Initiative • Increased rent supplements across the region • Nipissing ABI Housing Housing - $427,000 Service Delivery Enhancements - $622,000 Service enhancements Peer Support - $19,000 • Supporting Phoenix Rising to find an accessible site • enhance case management with Nipissing mental health housing & supports services • Transitional community support Sudbury • Transitional Case Management Algoma Public Health • Enhanced Case Management Mattawa • Brief intervention case management North Bay Special Populations - $533,000 Service Integration/System Coordination - $399,000 Peer support • (PEP) A Peer Support worker for Mattawa & area Special Populations • Establish Managed Alcohol Program for chronic alcohol • Aboriginal Treatment Centre enhanced services Service Integration/system co-ordination • • • • 49 Community Mobilization Sudbury Community Mobilization North Bay Centralized Access North Shore Tribal Council North Shore Tribal Council Program Operational review Evaluation and Monitoring 50 Evaluation of Business Case Proposals • Criteria (Decision Making Framework): Accessible, Effective, Safe, Patient-Centred, Equitable, Efficient, Appropriately Resourced, Integrated, Population Health • Alignment with LHIN Priorities & Performance: What priority of our IHSP does it advance? What MLPA metrics will be moved and measured? • Connect • Planning 51 MLPA Targets for North East LHIN and HUB Hospitals, 2014/15 Report generation date: November 2014 based on Stocktake MLPA Indicators at Q2 2014/15 52 NE LHIN Integrated Health Service Plan (IHSP) Scorecard Scorecard indicator Metric date Target Desired Current direction Trend IHSP GOAL 1 - INCREASE PRIMARY CARE COORDINATION Reduce unnecessary visits to the emergency room that can otherwise Q4 13/14 14.5% be supported in primary care Health Care Connects: Maintain NE LHIN rate of >75% registered Oct 2014 75% 77% patients referred to primary care Health Care Experience Survey primary care attachment results - % Jun 2014 90% age 16 + reporting attached to primary care Health Care Experience Survey primary care attachment result - % Jun 2014 31% reporting can get appointment within 48 hrs IHSP GOAL 2 - ENHANCE CARE COORDINATION AND TRANSITIONS CCAC service wait time: the “5 day” wait for: 1) nursing; CCAC service wait time: the “5 day” wait for: 2) personal support for complex clients Percent ALC days Q2 2014 90% 95% Q2 2014 90% 86% Q1 2014 22% 21.3% Reduce non-value added time in the emergency room (ER) for Q2 2014 26.7 patients needing admission: "Time to inpatient bed" - hours IHSP GOAL 3 - MAKE MENTAL HEALTH AND SUBSTANCE USE TREATMENT MORE ACCESSIBLE Reduce repeat unscheduled emergency visits within 30 days for Q1 2014 16.5% 16.2% mental health conditions Reduce repeat unscheduled emergency visits within 30 days for Q1 2014 25.0% 25.7% substance abuse conditions Increase telemedicine sites dedicated to mental health and Q2 2014 8 9 substance abuse. IHSP GOAL 4 - TARGET NEEDS OF CULTURALLY DIVERSE POPULATION GROUPS Aboriginal: Improve access by HSPs engaged in cultural sensitivity training Aboriginal: Improve access by reducing wait time to mental health/substance abuse services Francophone: Increase the number of HSPs designated as providers of French language services from 40 to 45 - LHIN supported Francophone: Increase the number of HSPs designated as providers of French language services from 40 to 45 - Cabinet supported Goal accomplished Indicator to be developed Indicator to be developed Q2 2014 45 44 45 42 53 Q2 2014 Thank You Questions? Quality health care when you need it. Des services de santé de qualité au moment voulu. Ezhi gshkitoong go waani zhi mino yang naadgo wendming pii ndo wendaagog 54 Telehomecare (THC) in the NE LHIN 55 Tamara Shewciw, CIO/eHealth Lead April 8, 2015 Background Timmins 2006 pilot Efficiencies realized in the pilot phase: • • • • • 64-66 % decrease in average number of hospital admissions per patient per month 72-74% reduction in emergency department visits 16-33% decrease in number of primary care physician visits 95-97% reduction in walk-in clinic visits High levels of patient and provider satisfaction 56 Background MOHLTC Expansion Project • To expand the success of the initial telehomecare pilot program for chronic disease management to the remainder of the province, focusing on CHF, COPD, and diabetes • Identification of a single host agency within each LHIN that would be responsible for nurse recruitment, budgeting and equipment provisioning • NE LHIN selected in 2012 as one of three early adopter LHINs • NE CCAC is our host THC agency 57 Overview – What is Telehomecare? Telehomecare: A Patient Centred Model Clinician Health Coaching: Efficient MRP Engagement: Teaching the Patient how to selfmanage & meet their goals Clinician provides regular updates, consults as required Patient Empowerment: At home; Sets Personal Goals; Submits vitals/ health responses Remote Patient Monitoring: Simple Technology in Home: Weekday feeds & Alerts Tablet, BP Cuff, Scale & Pulse oximeter 58 Overview – What is Telehomecare? 59 5 Current State 8 (of 14) LHINs and over 4500 patients enrolled… Seven LHINs, 9 Hosts are Currently Live: - 5. Central West (William Osler Health System) - 7. Toronto Central (CCAC) - 8. Central (HealthLinks via - SouthLake & CCAC) 13. North East (CCAC) 14. North West (CCAC & TBRHSC) 1. Erie St. Clair (CCAC) - 12. North Simcoe Muskoka (CCAC) LHINs in the Planning Stage: - 2. South West (CCAC) 6 6 60 Results Consistent results across LHINs – 48-56% reduction in ED visits – 44-57% reduction in Hospital Admissions TC -reduced ED Visits by 48% and Hospital Admissions by 44%. 7 7 CW - reduced ED Visits by 56% and Hospital Admissions by 58%. 61 Central - reduced ED Visits by 48% and Hospital Admissions by 57%. Sustained Results, 6 months post Both CW and TC demonstrate sustained reduction in ED visits and hospital admissions -- 6 months after the completion of the Telehomecare program. 8 8 62 Telehomecare Patient Feedback Patient Experience (Toronto Central Results) – 87% of the patients would definitely recommend the program to others – 98% agreed that the THC nurses understood what was important to them – Managing medications properly was the most important patient learning “I can’t see why anyone wouldn’t want to try Telehomecare. It was so simple, so enjoyable to learn. I’d rather do this than leave it to chance. It’s my life I’m dealing with…I’m looking for just a little longevity. It’s a no brainer.” - Ian, Telehomecare Patient 9 9 63 64 65 66 67 NE LHIN THC Current Model 14 • CCAC core team of nurses = 5 FTE (RN & RPN) • Partnerships with: − Telemedicine Coordinator Nurse (2 sites) − Group Health Centre − FHTs • 680 units, evaluating enrolment to provincial asset management pool • Engagement and Physician lead • Disease expansion to Diabetes in 15/16 FY, also exploring Palliative Care, Mental Health and Prevention/Maintenance 68 NE LHIN THC Stats NE LHIN Status Current Enrolments in Fiscal Year Enrolments in Total for the Program Number of Current Active Patients 611 1,369 368 Referral Source Hospital 9% CCAC 60% Primary Care 26% Other 5% Disease Type 15 CHF 49% COPD 51% 69 Alignment • Part of Minister’s new Action Plan • Alignment with healthcare transformation initiatives including: − QBPs − Health Links − New Integrated Care Models • 16 Supports and enables NE LHIN Integrated Health Service Plan (IHSP) 70 QBP HUB Hospital – COPD/CHF Smaller Hospital Smaller Hospital: Low Acuity Pts. discharge from ED Average Acuity Pts. (ward) still admitted at small hospital High Acuity -transfer to HUB ICU from ED HUB Hospital: Low Acuity Pts. discharge from ED Average Acuity Pts. (ward) admitted High Acuity (Vented/Critical Care) Establish a CHF and COPD outpatient chronic disease clinic – goal: reduce readmissions Occasional Short BIPAP (6-12 hrs.) will stay at small hospital Access to CHF/COPD clinics with telemedicine suppor t Standardized Care Plans/Order Sets Standardized Care Plans/Order Sets Likely needs CCAC enhancements and connections to FHT 17 Likely needs CCAC enhancements and connections to FHT 71 Challenges • General awareness • Patient referrals to the program • NE LHIN specific evaluation 18 72 Collective Opportunity • Establish monthly enrolment targets for hospitals based on their annual CHF/COPD patient admissions / readmission rates • Formalize automatic referrals on clinical hospital order sets/pathways particularly for the emergency departments • Leverage QBP process • Step down for hub COPD/CHF clinics (transition to home) • Community hospital COPD/CHF clinics 19 • Align with emerging models of care e.g. HSN Telehomecare Post-Acute Pilot • Align with Health Links by considering “opt-in” model for all Health Links patients (high % of complex patients tend to have COPD or CHF) 73 Thank You Questions? 74 Communiqué to NE LHIN Orthopaedic Surgeons From NE LHIN CEO Louise Paquette In January 2013, the NE LHIN completed a first-ever Integrated Orthopaedic Capacity Plan (IOCP) for Northeastern Ontario. The key goals were to provide evidenced-based data that would help to: Reduce wait times for surgeries and increase volumes Provide care as close to home as possible Deliver quality-based care Key strategies to achieve these goals included: Increase volumes to repatriate patients who left the NE LHIN for surgery Improve reporting of data by surgeons Enhance the role of the North East Joint Assessment Centres (NE JAC) Improve rehabilitation services February 2015 Percentage of non-urgent hip and knee replacements completed within Provincial access target of 182 days Then (Dec 2012) Now (Dec 2014) 100% 71% 50% 79% 73% 57% 0% Strategy 1: Increase volumes to repatriate patients Overall the NE LHIN has increased the volume of hip and knee replacements by 15% since 2012/13 resulting in 654 more surgeries. Hospitals in the NE LHIN have consistently performed below the 4.4 day target for average length of stay for hip and knee replacements. Hospitals in the NE LHIN have consistently performed above the 90% target for the percentage of patients discharged home after hip and knee replacement surgery. Wait times for knee replacements has almost halved from 409 days (90th percentile) to 258 and hips wait times have reduced from 279 to 206. Almost 80% of hip surgeries are making the target of 182 days (vs. 71% in 2012) and 73 % of knees (vs. 53% in 2012). Hips Knees Wait time (days) for hip and knee replacements 90th percentile wait (days) The NE LHIN is pleased to provide you with this two-year update on the progress that has been made. Your efforts in your daily practice to achieve the strategies outlined above are making a difference. While more work remains to be done, the progress made thus far is allowing Northerners to get the care they need more quickly and efficiently – system progress that is benefitting people living in Northeastern Ontario! Thank you in advance for staying focussed on your efforts to move these strategies forward. Then (Dec 2012) Now (Dec 2014) 500 400 409 300 200 279 258 206 100 0 Hips Knees Unilateral Hip and Knee Replacements Hips Knees In 2009, 56% of primary hip replacements for local residents were completed in NE hospitals compared to 82% in 2014. Similarly for primary knee replacements, 69% were completed in NE hospitals compared to 83% in 2014. While there is still work to do, there has been a marked improvement in providing care closer to home. 75 # of surgeries 2000 In 2009 the NE LHIN identified the need to treat people as close to home as possible and started focussing efforts to repatriate hip and knee surgeries to hub hospitals. 1500 1000 500 1,277 555 1,468 640 1,468 742 0 2012/13 funded 2014/15 funded 2014/15 planned Strategy 2: Improve reporting of data by surgeons NE LHIN hospitals have worked closely with surgeons’ office staff to ensure timely and accurate data is submitted to Cancer Care Ontario’s Wait Time Information System. In addition, hospitals engage with their surgeons to review wait time and OQS data. The NE LHIN’s Wait Time and Volumes Subcommittee meets quarterly to review performance with hospital leadership and make recommendations for improvement. The importance of good data to continue to drive evidence-based results cannot be overstated. Your efforts in this regards are both paramount and appreciated. % of primary hip and knee surgeries completed in the NE LHIN for NE residents % hips % knees 100% 80% 82% 83% 60% 40% 69% 56% 20% 0% 2009 NE JACs provide a centralized, coordinated access point for patients with conditions such as osteoarthritis to be assessed for joint replacement surgery and are now seen as best practice. The NE JACs have completed over 19,000 assessments and currently 67% of assessed patients do not require a surgeon’s consultation. The success of the JACs with hip and knee replacement has led to the expansion of the assessment program to shoulders in 2014, consistent with the goals of the IOCP. NE JAC Assessments and % of patients not requiring surgical consult Assessments % NOT resulting in surgeon consult # of assessments JACs for hip and knee replacement were established in the five surgical hospitals in the NE including: Health Sciences North, North Bay Regional Health Centre, Sault Area Hospital, Timmins and District Hospital and the West Parry Sound Health Centre. Staffed by Advanced Practice Physiotherapists trained by local surgeons and supported by administrative staff, the JACs ensure that patients who need surgery are sent to surgeons for consultation and those patients who could benefit from other strategies to stabilize/improve their condition receive those interventions. 2014 7000 67% 6000 53% 5000 6,618 4000 5,820 3000 4,606 2000 1000 2,729 0 80% 70% 60% 50% 40% 30% 20% 10% 0% % of patients no consult req'd Strategy 3: North East Joint Assessment Centres (NE JACs) Strategy 4: Improve Rehabilitation Services Access to timely rehabilitation is key for successful patient outcomes after hip and knee replacement surgery. In the NE LHIN, rehabilitation can be provided by: the NE CCAC through homecare assessment and service provision; hospital-based inpatient rehabilitation and/or outpatient programs; patient access to third-party (private) physiotherapy. 76 In 2012, the NE LHIN established its Local HSFR Partnership consisting of NE clinical and administrative leadership to be the steward of implementing Quality Based Procedures (QBP). One of the first tasks was the review of and implementation of the NE LHIN’s Clinical Services Review (CSR). The CSR provided recommendations on the implementation of clinical handbooks for each QBP including hip and knee replacements. Over the past year the Local Partnership continues to steer the implementation process. Physio Reform Funding In all 29 clinics in the NE LHIN (16 community-based; 12 hospital-based and 1 CHC) received a portion of 5372 Episodes of Care (EoC) to provide outpatient physio to patients meeting criteria, which includes people recently discharged as an inpatient of a hospital and in need of physiotherapy clinic services. Note that post hip and knee replacement patients can qualify for this service. Third-party (private) Physiotherapy There are no databases enabling comparison of patient experience over time concerning third party private physiotherapy for rehabilitation related to joint replacements. EoC reporting from private community physiotherapy clinics and hospital based EoC funded clinics is just underway. LHINs will be in receipt of data by 2015/16 which will provide information on the types of patients and services provided. NE CCAC support to hip and knee replacement rehabilitation Hips 1200 1,237 1,208 1,134 1000 800 600 400 717 686 627 507 551 472 200 0 2012/13 The NE LHIN has embarked on a comprehensive review of rehabilitation services in-sync with provincial directions through the Provincial Rehabilitative Care Alliance. Planning for rehabilitation includes ensuring linkage to and coordination with QBP planning. The NE LHIN’s Clinical Services Review compared current practice in discharge of joint replacement patients to inpatient rehabilitation to proposed provincial targets. Total 1400 Inpatient Rehabilitation Knees Currently 0.5% access inpatient rehab. The Province’s target is 10%. Planning for enhanced rehabilitation across the NE LHIN is taking these stats into consideration. The goals of the review of rehabilitative care include evaluating alignment in the NE LHIN with standardized definitions for inpatient bedded levels of care as well as community-based levels of rehabilitative care across the continuum. Joint replacement and where it “fits” in this continuum is an important component of the review and subsequent system planning. 77 2013/14 2014/15 (projected from Q2) ITEM # 13 NORTH EAST LHIN BOARD OF DIRECTORS BRIEFING NOTE 2015-16 LHIN OPERATIONS BUDGET 2015-03-27 Marc Demers PROPOSED RESOLUTION/MOTION: WHEREAS the 2015.16 NELHIN Operations Budget incorporates the planning targets for the year; WHEREAS the financial plan will be revisited and revised to align with the approved operating allocation once confirmed; BE IT RESOLVED THAT: The North East LHIN Board of Directors received and approved the NELHIN Operations Budget for the 2015-2016 fiscal year as presented on April 7, 2015. BACKGROUND: Budget Development Process The NELHIN Annual Budget consists of revenues and expenditures in the amount of $7.8 million. The budget plan sets out a balanced operating position. The operating plan was developed based on financial assumptions giving consideration to the following: • Prior year activity and actual operating performance • No adjustment to funding sources • Adjustment to operating expenditures for known contractual obligations and inflation The schedule of revenue and expenditures by category with a comparative to prior year budget and actual operating positions, are provided below. Key variances include the following: 78 • • • One-time capital cost of $92.7k to renovate (reduce office space) the North Bay office will equate to $66k in annualized lease cost reduction Additional $30k in LSSO Shared Costs committed from all LHINs Additional $30k in Translation required based on new shared translation agreement ANALYSIS: REVENUE SALARY & WAGES TRANSPORTATION & COMMUNICATION SERVICES SUPPLIES & IT TOTAL OPERATIONAL EXPENSES SURPLUS/(DEFICIT) 2013-14 Actual 2014-15 Budget 2014-15 Actual (Projected) 2015-16 Proposed Budget 7,747,312 5,515,798 311,557 1,825,120 94,837 7,747,312 - 7,868,301 5,735,277 315,000 1,778,024 40,000 7,868,301 - 7,856,972 5,673,812 300,000 1,831,160 52,000 7,856,972 - 7,775,601 5,644,846 320,000 1,770,755 40,000 7,775,601 - Proposed Budget Increase / (Decrease) (92,700) (90,431) 5,000 (7,269) (92,700) - KEY MESSAGES: • • • Total revenue and expenses unchanged from previous budget year Cash flow will be monitored closely early in fiscal year due to delay in initiative funding and additional expenditures related to North Bay office renovation expected to be due in near the end of Q1 The budget plan will be revisited once funding confirmation is received, planned adjustments will be incorporated to align to the approved operating allocation NEXT STEPS: • • • Implement approved budget and finalize monthly distribution Communicate cash flow concerns with LLB and MOH Incorporate required changes to budget resulting from Ministry funding confirmation. Reference Documents • 2015-16 Budget 79 RESOLUTION NORTH EAST LOCAL HEALTH INTEGRATION NETWORK (the “Corporation”) Motion No.: 2015-BD00XX MOVED: _____________________________________ SECONDED: _____________________________________ Wednesday April 8, 2015 RESOLVED THAT: “The members attending this meeting move into a Closed Session pursuant to the following exceptions of LHINS set out in s.9(5) of the Local Health Integration Act, 2006.” ☐ Personal or public interest ☐ Public security ☐ Security of the LHIN and its directors ☐ Personal health information ☐ Prejudice to legal proceedings ☐ Safety ☐ Personal matters ☒ Labour relations ☐ Matters subject to solicitor client privilege ☐ Matters prescribed by regulation ☐ Deliberations on whether to move into a Closed Session BE IT FURTHER RESOLVED THAT; the following persons be permitted to attend: Louise Paquette, CEO Kate Fyfe, Senior Director Martha Auchinleck, Senior Director Terry Tilleczek, Senior Director Cynthia Stables, Director Tamara Shewciw, Chief Information Officer Micheline Beaudry, Executive Assistant to the CEO and Board Liaison _________________________________ Danielle Bélanger-Corbin Chair 80 RESOLUTION NORTH EAST LOCAL HEALTH INTEGRATION NETWORK (the “Corporation”) Motion No.: 2015-BD00xx MOVED: _____________________________________ SECONDED: _____________________________________ Wednesday April 8, 2015 RESOLVED THAT: The Board of Directors of the NE LHIN received the report of its Closed Session meeting of April 8, 2015. _________________________________ Danielle Bélanger-Corbin Chair 81 Resolution North East Local Health Integration Network (the “Corporation”) Motion No.: 2015-BD00XX MOVED: _____________________________________ SECONDED _____________________________________ Wednesday April 8, 2015 RESOLVED THAT: The North East LHIN Board of Directors meeting of Wednesday April 8 be adjourned at ____________. _________________________________ Danielle Bélanger-Corbin Chair 82