Meeting - Champlain LHIN

Transcription

1900 City Park Drive, Suite 204
Ottawa, ON K1J 1A3
Tel 613.747.6784 • Fax 613.747.6519
Toll Free 1.866.902.5446
www.champlainlhin.on.ca
1900, promenade City Park, bureau 204
Ottawa, ON K1J 1A3
Téléphone : 613 747-6784 • Télécopieur : 613 747-6519
Sans frais : 1 866 902-5446
www.rlisschamplain.on.ca
BOARD MEETING AGENDA
June 24, 2015 – 12:00 noon
Calédonia Community Centre, 6900 County Rd. #22, St-Bernardin, ON K0B 1N0
(See link on page 3 for directions)
Documents
Attached,
Posted or PreCirculated
Agenda
Item
&Time
1
Action
D= Decision
I = Information
S= Strategic
Discussion
Call to Order and Moment of Reflection
12:00-12:02
2
Conflict of Interest Declarations
12:02-12:04
3
D
Approval of Agenda
12:04-12:06
4
Chair’s Introductory Remarks and Report
12:06-12:16
5
CEO’s Report
12:16-12:36
6
Consent Agenda Items
12:36-12:40
6.1 Approval of Minutes: March 25, April 22 and May 27,
2015 Meetings
6.2 Approval of Annual Report-Year-ended March 31, 2015
6.3 Authorize the negotiating team to act on behalf of the
Champlain LHIN to coordinate and manage the
negotiations process for the development of the 20162019 Long Term Care Service Accountability
Agreement template
6.4 Approval from the Finance & Audit Committee:
Quarterly reports for the fourth quarter; 2015-16
decision making framework and weights; policy
regarding commitment and spending authority
.
D
To be posted
once approved
by Board
To be posted
once approved
by Ministry
No public
document
No public
document
Strategic Plan
Reference(s)
(see legend below)
Documents
Attached,
Agenda
Item
&
Time
7
Performance Accountability
12:40-1:40
7.1 Presentation of Fourth Quarter Performance Scorecard
(B. Schnarch); Management Comments and Discussion
on the Year’s Performance by the Board (C. LeClerc)
1:40-2:00
7.2 Approval (final) of 2015-2016 Annual Business Plan
(C. Martel)
Action
D= Decision
I = Information
S=Strategic
Discussion
Strategic
Plan
Reference(s)
I&S
1,2,3
To be posted
once approved
by Ministry
D
1,2,3
Yes
D
Mission,
Vision,
Mandate
Yes
S
Yes
D
Yes
D
Yes
Yes
Yes
I
I
Yes
(see legend
below)
Break (2:00 to 2:20)
8
Regional Planning and Community Engagement
2:20-2:40
8.1 Report on 2014-2015 community engagement activity
and approval of 2015/2016 Community Engagement
Plan (J. Searson)
2:40-3:10
8.2 2016-2019 Integrated Health Services Plan
Development—progress and key steps taken to date,
forthcoming steps and discussions on substantive matters
arising to date. (JP Boisclair/ C. LeClerc/ C. Martell)
9
Planning Approvals Required
3:10-3:25
9.1 Champlain Maternal Newborn Strategic Plan (C. Martel,
M.-J. Trépanier)
3:25-3:45
1,2,3
9.2 Champlain Hospice Palliative Care Strategic Plan (E.
Graves, N. Valk)
10
3:45-4:05
Board Committee Stewardship Reports and Matters
Arising Therefrom
10.1 Community Nominations (A. Brewer)
10.2 French Language Services (P. Tessier)
10.3 Governance (R. Reid)
10.4 CEO Performance Evaluation & Compensation (D.
Somppi)
10.5 Finance & Audit – Approval of proposed annual
operational budget 2015-16 (M. Biron)
11
In-Camera Session
4:05-4:50
Motion to move into closed session to: Approve confidential
minutes; receive confidential information from the CEO and Board
Chair; receive confidential information from the Community
Nominations and CEO Performance Evaluation and Compensation
Committees, and to make recommendations to the Board.
Note: Open session reconvenes immediately after in-camera session
No public
document
Yes
No public
document
1,2,3
I
D
I&D
2
Documents
Attached,
Agenda
Item
&
Time
12
Action
D= Decision
I = Information
S=Strategic
Discussion
Strategic
Plan
Reference(s)
Termination of Meeting
Strategic Plan References
1=Increase coordination and integration of services among hospitals
2=Build strong foundation of integrated primary and community care
3=Improve coordination and transitions of care
Directions: Calédonia Community Centre
Participants requiring accessibility supports or special accommodation
may contact [email protected] prior to the meeting.
Public documents and presentations distributed will be available on our website.
External Guest Speakers List:
Marie-Josée Trépanier, Regional Director, Champlain Maternal Newborn Regional Program (item 9.1)
Nadine Valk, Executive Director, Champlain Hospice Palliative Care Program (item 9.2)
3
(see legend
below)
Champlain Health System
Performance and Accomplishments
Report for the Champlain LHIN Board
June 2015
Table of Contents
Page Number(s)
Section A
Executive Summary
A1-A2
Section B
Summary of Performance by Domain
B1
Section C
Overview Status of All Indicators
C1
Section D
Ministry LHIN Performance Agreement (MLPA) Indicator Trends
D1
Section E
Detailed Indicator Performance Report*
E1-E25
Timely Access to the Care Needed
Right Care, Right Place
High Quality, Safe and Effective Care
Champlain LHIN Organizational Health
Healh System Fiscal Management & Value
Performance Indicator Refresh Schedule
E1-E7
E8-E12
E13-E17
E18-E21
E22-E24
E25
Section F
Methodology
F1-F2
Section G
Acronyms
G1
* Includes indicators with updated data this quarter
Section A – Executive Summary
Background
The report to the Board is used to assess how the LHIN is performing and identify priorities for action as
well as successes that we can learn from and expand upon. It provides a broad overview of the LHIN’s
system level outcomes in six domains:
 Timely to the Care Needed
 Right Care, Right Place
 Positive Healthcare Experience (this domain is under development and does not currently have
indicators)
 High Quality, Safe and Effective Care
 Champlain LHIN Organizational Health
 Health System Fiscal Management and Value
A high level overview of the status and trend of each domain is shown on page B1. For a set of priority
indicators, the report provides performance information, describes related activities, risks and
opportunities for further action. Only indicators with new data since the previous report are shown in
section E. Some indicators are being monitored and evaluated to identify the need for potential future
activities.
Indicator Highlights
Overall, the Champlain LHIN continues to show good performance on most of its timely access indicators
and the domain score continues to be green with a few exceptions. Specifically:
 Wait time in emergency room for admitted patients is longer and performance is now above the
baseline and the target. This is likely due to seasonality. There was a similar result in the fourth
quarter of the previous year. Wait times for patients that were not admitted are meeting targets.
 Wait times for CT scans have continued to slip this quarter and are now below the target and
baseline. Wait times are being closely monitored and the LHIN is working closely with the
hospitals.
 The LHIN continues to be challenged in meeting MRI wait times for non-urgent scans. All
hospitals are meeting efficiency targets in terms of the number of scans performed per hour. The
introduction of a new imager in Pembroke next fall will assist to improve the wait time. The
LHIN is continuing to work with the regional diagnostic imaging steering committee and
assistance through an external resource is being sought.
 The percentage of people having their cardiac bypass completed within the target has improved
significantly this quarter from 56% in Q2 to 97% in Q4 and is now meeting 90% regional target
due to significant efforts by the University of Ottawa Heart Institute.
Champlain Health System Performance and Accomplishments: June 2015
A1
High Quality, Safe and Effective Care and Right Care, Right Place
The domain score for High Quality, Safe and Effective Care is orange and has declined this quarter. The
indicators in this domain where we are not meeting targets include readmissions for chronic conditions
and all three falls related indicators. The domain score for Right Care, Right Place has continued to slip
and is now in the yellow zone due to declining performance on repeat substance abuse visitors, alternate
level of care for palliative care patients, and two indicators on community care.
Seniors
The Champlain LHIN is doing well on pressure ulcer indicators, but performance on all three
falls (resulting in injuries) indicators is worse than baseline and target. The Champlain LHIN is
implementing an integrated falls prevention program in the region to target people in the
community. Tools to support screening and assessment across the continuum of care are also
being piloted and implemented.
The LHIN is performing well on indicators related to supporting clients with high needs in the
community.
Community Care Prevention of Hospital Care
Hospitalization for ambulatory care sensitive conditions and emergency room visits for
conditions that could be treated in a primary care setting are not achieving targets. There have
been a number of initiatives implemented to support chronic disease management in the
community and to improve performance on this indicator.
Mental Health Services
Performance on repeat emergency visits for substance abuse conditions has weakened from last
quarter, while repeat emergency visits for mental health conditions has improved. New
investments are being initiated in residential stabilization for people with substance abuse issues.
Capacity planning is also underway to review investments in community withdrawal
management.
The Champlain LHIN is achieving its targets at the organizational level and the overall domain score is
green. The number of Annual Business Plan initiatives that are achieving their planned milestones is 75%,
and is below the target. The staff turnover rate has declined this year and is now meeting targets.
Health System Fiscal Management and Value
Overall, most facilities in the region were forecasted to achieve balanced budgets by year-end. The LHIN
collaborates with health service providers on an ongoing basis to monitor budgets and initiate
performance improvement plans if necessary. The LHIN works with facilities that are forecasted to have
deficits to ensure a break-even operating position by year-end. Cost efficiency and performance on health
system funding reform for hospitals is below expected performance and the LHIN is working with
hospitals to improve efficiency.
A2
Section B - Summary of Performance by Domain
7 of 8 indicators *
0 indicators *
4 of 8 indicators *
10 of 11 indicators *
5 of 7 indicators *
11 of 13 indicators *
2.60 to 3.00
2.20
1.80
1.40
1.00
to
to
to
to
2.59
2.19
1.79
1.39
Average score for the Domain Based on average of
indicators with available scores (Green status = 3
points, yellow = 2, red = 1)
Red/Yellow/Green coding is based on approved
targets.
*identifies the number of indicators contributing to the domain score for the most recent period
B1
Section C - Overview Status of All Indicators (indicator page number in brackets)
(E1)
1.1 Time in ER (Admitted Patients) *
(E1)
1.2 Time in ER (Complex patients, Not Admitted) *
(E2)
1.3 Time in ER (Uncomplicated - Not Admitted) *
(E2)
1.4 Cancer Surgery Wait Time *
(E3)
1.5 Cardiac By-Pass Surgery Wait Time *
1.6 Cataract Surgery Wait Time *
(E3)
(E4)
1.7 Hip Replacement Wait Time *
(E4)
1.8 Knee Replacement Wait Tme *
(E5)
1.9 MRI Scan Wait Time *
(E5)
1.10 CT Scan Wait Time *
(E6)
1.11 Wait for Home Care (Community Clients) *
(E6)
1.12 Adults With a Primary Care Provider *
1.13 Timely (Same / Next Day) Access to a Primary Care Provider *
4.1
4.2
4.3
4.4
4.5
(E7)
(E8)
Patients in Acute Hospital Beds Needing Other Care (%ALC) *
Repeat Mental Health ED visitors *
(E8)
Repeat Substance Abuse ED visitors *
(E9)
High Priority Clients Receiving CCAC Care at Home *
(E9)
(E10)
Long Term Care Placements for Highest Priority Clients *
(E10)
Admission to LTC Homes from Community *
Patients Designated ALC Who Were Discharged to Long Term Care Homes *
(E11)
2.8 ALC days Attributable to Palliative Care Patients *
(E11)
2.9 Hospitalization Rate for Ambulatory Care Sensitive Conditions *
(E12)
2.10 ER Visits for Conditions That Could be Treated in a Primary Care Setting. *
(E12)
Positive Healthcare Experience
(E14)
(E15)
4.6 Hospitalization Due to Falls Among Long-Term Care Residents *
4.7 Fall-Related Emergency Department Visit Rate Among Seniors *
4.8 Fall-Related Hospitalization Rate Among Seniors *
(E17)
2.1
2.2
2.3
2.4
2.5
2.6
2.7
Readmissions for Certain Chronic Conditions *
(E13)
Early Elective Low-Risk Repeat C-Sections *
(E14)
Complex Care Hospital Patients with New Pressure Ulcers *
Long Term Care Residents with New Pressure Ulcers *
Physician Visit Within 7 days of Discharge *
(E15)
(E16)
(E16)
(E18)
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
Status of LHIN Annual Business Plan Initiatives *
(E19)
LHIN Enterprise Risk Assessment *
LHIN Operational Budget Variance *
(E19)
(E20)
LHIN Staff Turnover *
(E20)
Twitter Followers *
(E21)
Champlain LHIN YouTube Views *
LHIN Employee Satisfaction
(E21)
Website Traffic *
6.1
6.2
6.3
6.4
6.5
6.6
6.7
(E22)
Hospital Cost Efficiency *
CCAC Home Care Cost Efficiency
Total Margin - Hospitals *
(E22)
(E23)
Total Margin - CCAC *
Total Margin - CHC Agencies *
(E23)
(E24)
Total Margin - CSS Agencies *
Total Margin - Mental Health and Addictions Agencies *
(E24)
Positive Healthcare Experience indicators under development
Indicator meets the LHIN target for the
recent period
Indicator is above baseline, but below
LHIN target for the recent period
Indicator is below target and below
baseline for the recent period
Indicator does not have a LHIN target
Indicator is under development
Red/Yellow/Green coding is based on approved
targets
* Updated this quarter with new inform ation in
section E. See page E20-21 for indicator refresh
schedule.
C1
Performance Indicator (PI)
90th percentile ER length of stay for non-admitted minor uncomplicated (CTAS IV-V) patients 1
3
Percent of priority IV cases completed within access target (182 days) for hip replacement
Percent of priority IV cases completed within access target (182 days) for knee replacement
8
14.2%
127.0
9.5%
TBD
21.0%
61.0%
90.0%
67.0%
90.0%
90.0%
70.0%
94.0%
91.3%
93.0%
4.9
8.2
27.7
66.0
13.5%
75.0%
50.0%
80.0%
80.0%
90.0%
90.0%
90.0%
4.5
8.0
25.8
LHIN Target
(2013/14 to
2014/15)
2013/14
TBD
Repeat Unscheduled Emergency Visits within 30 Days for Mental Health Conditions ‡2
Repeat Unscheduled Emergency Visits within 30 Days for Substance Abuse Conditions ‡2
14
15
81.0
12.8%
59.7%
43.4%
83.2%
77.4%
90.9%
83.0%
94.9%
4.8
8.1
29.6
25.9%
17.7%
16.5%
24.8%
17.7%
14.5%
21.8%
18.2%
17.4%
22.5%
15.7%
16.8%
57.0
13.0%
81.4%
41.0%
88.6%
79.4%
91.3%
84.0%
97.4%
4.5
7.7
26.7
26.4%
18.1%
15.9%
56.0
10.6%
85.1%
38.4%
85.8%
84.2%
89.9%
56.0%
97.4%
4.7
7.8
26.2
27.5%
18.2%
15.6%
55.0
12.3%
76.4%
30.7%
88.3%
89.8%
89.5%
75.0%
97.4%
4.5
7.5
25.2
28.5%
17.7%
17.1%
58.0
11.2%
59.4%
34.2%
93.4%
94.7%
89.2%
97.0%
98.1%
4.4
7.5
30.1
The LHIN result does not meet the target for this indicator and has not improved from baseline
Note: Colour coding for previous quarters has been updated to match the methodology being used
as of 2013/14, so may not match colour coding released previously.
The LHIN result does not meet the target for this indicator but has improved from baseline
2 Q3 2014/15 Data (Oct, Nov, Dec 2014)
3 Q2 2014/15 (Jul, Aug, Sep 2014)
The LHIN result has met its target
1 Q4 2014/15 Data (Jan, Feb, Mar 2015)
Notes (Refers to 12-May-15 data only)
The methodology for indicator #12 for Q2-Q3 2013/14: In 2013 the ministry completed its physiotherapy reform which included an expansion of in-home physiotherapy for 60,000 more seniors and people with
mobility issues in order to clear current waitlists. This substantial influx of new physiotherapy clients into the CCACs resulted in an increase of the 90th percentile wait time and an increase in new clients.
The methodology for indicator #12 for Q1 2013/14 was revised as follows to align with Health Quality Ontario: excludes first services that were respite (15); placement (14) or other (99). In addition the first service
record must now be coded with In-Home SRC codes (91-95). These new criteritions had a minimal effect on the 90th percentile - 50% of the LHINs had no change, the other 50% had on average between 1 - 2
day difference. Overall an additional 0.3% of clients were excluded compared to the previous methodology. The previous quarters have been updated with the most recent data and using the revised
methodology for trending purposes.
Note: The reporting for indicators #4 to #10 has been revised starting 2013/14 therefore there were no targets for previous quarters and colour coding cannot be determined. Previous Agreements included the 90th percentile wait times for these surgical and diagnostic imaging services.
‡
The methodology for these indicators has been revised starting 2013/14. Results may not be comparable to the previous Agreement.
* Indicator also has a provincial internal goal of 25 hours.
** Indicator also has a provincial internal goal of 7 hours.
TBD
TBD
Readmission within 30 Days for Selected CMGs3
13
2014/15
Q4
Q1
Q2
Q3
Q4
12-May-2014 12-Aug-2014 12-Nov-2014 9-Feb-2015 12-May-2015
Objective: To implement evidence-based practice to drive quality and value and improve health outcomes.
Expected outcomes: Persons will receive quality inpatient care and coordinate post-discharge care, leading to reduced admission rates that may improve survival, quality of life, and other outcomes without increasing cost.
11
Percentage of Alternate Level of Care (ALC) Days - By LHIN of Institution 2
90th Percentile Wait Time for CCAC In-Home Services - Application from Community Setting to first
12
CCAC Service (excluding case management)2
3: Quality and improved health outcomes
Objective: To improve system integration and enhance coordination of care while ensuring better transitions to various care settings.
Expected outcomes: Persons will be able to navigate the health care system and receive the care they need, when and where they need it.
9 Percent of priority IV cases completed within access target (28 days) for MRI scans
10 Percent of priority IV cases completed within access target (28 days) for CT scans 1
2: Integration and coordination of care
1
1
90.0%
Percent of priority IV cases completed within access target (182 days) for cataract surgery 1
7
1
90.0%
Percent of priority IV cases completed within access target (90 days) for cardiac by-pass surgery
90.0%
6
1
Percent of priority IV cases completed within access target (84 days) for cancer surgery
5
90.0%
4 hours
8 hours**
8 hours*
LHIN Starting
Point or
Provincial
Baseline
target
(2013/14 to
2014/15)
4
1
90th percentile ER length of stay for non-admitted complex (CTAS I-III) patients
2
1
90th percentile ER length of stay for admitted patients 1
1
Objective: To enhance person-centred care.
Expected outcomes: Persons will experience improved access to healthcare services identified below in alignment with best practices.
1: Access to healthcare services
PI No.
Section D - Ministry LHIN Performance Agreement (MLPA) Indicator Trends
D1
11
6
10
12
4
12
8
5
3
13
8 (tied)
4
12 (tied)
13
6
Rank
(Indicators with updated data this quarter)
June 2015
TIMELY ACCESS TO THE CARE NEEDED
MLPA
1.1 T ime in ER (Admitted Patients)
Lower Values are Better
30.1
30
LHIN Target
25.8
Q4 - 14-15
Hours
27.5
25
Baseline - 27.7
22.5
Prov Target - 8.0
Q1
13-14
Q2
13-14
Trend
Rank - 6
Q3
13-14
LHIN Target
Q4
13-14
Q1
14-15
Provincial Target
Q2
14-15
Q3
14-15
Baseline
LHIN
Q4
14-15
Prov Target (8.0)
ONT
3 3 .3
WW
23
ESC
2 5 .8
SW
2 8 .1
TC
2 8 .8
SE
2 8 .9
CHP
3 0 .1
NSM
3 1 .8
NW
3 4 .6
CE
3 7 .3
C
3 8 .1
NE
3 8 .8
MH
3 9 .7
4 0 .5
HNHB
4 1 .6
CW
0
20
40
Hours
Notes: 90th percentile: 90 out of 100 high urgency cases were completed in less time. Seasonal indicator, best performance expected in Q1 and
Q2.
Indicator Technical Description
Champlain's performance target for emergency room length of stay for admitted patients was not achieved this quarter. This
indicator reflects the seasonal pressures that were experienced this winter throughout the province with high emergency
room volumes of patients requiring admission and high inpatient volumes creating significant patient flow challenges. The
LHIN continues to emphasize initiatives to reduce alternative level of care including Home First, Assisted Living and
Convalescent Care. The indicator performance will reflect the decreasing pressure on the number of patients awaiting an
alternate level of care in the coming quarter.
MLPA
1.2 T ime in ER (Complex patients, Not Admitted)
Prov Target (8.0)
LHIN Target
8.0
8
Hours
Q4 - 14-15
Baseline - 8.2
7.8
7.6
7.5
Prov Target - 8.0
7.4
Rank - 13
Q1
13-14
Q2
13-14
Trend
Q3
13-14
LHIN Target
Q4
13-14
Q1
14-15
Provincial Target
Q2
14-15
Q3
14-15
Baseline
LHIN
Q4
14-15
ONT
NE
CE
MH
WW
SW
NSM
C
SE
NW
ESC
CW
HNHB
CHP
TC
6 .8
0
2.5
5 .5
6 .1
6 .2
6 .3
6 .3
6 .4
6 .5
6 .7
6 .9
7
7 .1
7 .3
7 .5
7 .7
5
7.5
Hours
Q2.
Champlain successfully met its target for this indicator despite a continued increase in overall volumes for non-admitted
complex patients during the difficult winter season. Hospitals continue to refine and improve their patient care processes and
to utilize emergency room diversion initiatives such as the Geriatric Emergency Management and Nurse Led Outreach Team
programs.
E1
MLPA
1.3 T ime in ER (Uncomplicated - Not Admitted)
Prov Target (4.0)
4.8
LHIN Target
4.5
4.7
Hours
Q4 - 14-15
4.6
4.5
Baseline - 4.9
4.4
4.4
4.3
Prov Target - 4.0
Q1
13-14
Q2
13-14
Trend
Rank - 12 (tied)
Q3
13-14
LHIN Target
Q4
13-14
Q1
14-15
Provincial Target
Q2
14-15
Q3
14-15
Baseline
LHIN
Q4
14-15
ONT
C
CW
MH
SW
NE
ESC
NW
CE
NSM
WW
SE
CHP
TC
HNHB
0
4
3 .4
3 .5
3 .6
3 .6
3 .9
3 .9
3 .9
4
4 .3
4 .3
4 .4
4 .4
4 .4
4 .7
4
2
Hours
Q2.
The Champlain LHIN met it performance target for this indicator. Fast Track Zones continue to be the main strategy to
decrease the length of stay for this population within the emergency departments. The LHIN continues to implement
initiatives such as Health Links and chronic disease management to better coordinate and manage care in the community for
people with complex and chronic care needs. Improved coordination of community care reduces the number of visits to the
emergency room for patients with higher needs and helps to manage wait times.
MLPA
1.4 Cancer Surgery Wait T ime
Prov Target (90.0)
Higher Values are Better
98.1
97.5
LHIN Target
90.0
Q4 - 14-15
%
95
Baseline - 93.0
Prov Target - 90.0
92.5
90
87.5
Rank - 4
Q1
13-14
Trend
Q2
13-14
Q3
13-14
LHIN Target
Q4
13-14
Q1
14-15
Provincial Target
Q2
14-15
Q3
14-15
Baseline
LHIN
Q4
14-15
ONT
C
NSM
WW
CHP
CE
SE
ESC
NW
TC
NE
CW
SW
MH
HNHB
0
25
50
9 4 .6
100
100
99
9 8 .1
9 7 .9
9 6 .5
9 5 .7
9 5 .1
9 4 .1
9 3 .7
9 3 .2
9 2 .9
9 2 .8
8 4 .7
75
100
%
Notes: % cases completed within access target (84 days)
The Champlain LHIN continues to exceed the 90% provincial target for completing priority IV cancer surgery procedures
within 84 days. We have consistently met the 90% target for the last two years and been above 97% for the last year.
We continue to monitor wait times and collaborate with Cancer Care Ontario and the Regional Cancer Program in local
planning and performance management and will adjust strategies if necessary.
E2
MLPA
1.5 Cardiac By-Pass Surgery Wait T ime
Prov Target (90.0)
100
97
LHIN Target
90.0
ONT
99
C
100
HNHB
100
Q4 - 14-15
%
80
60
Baseline - 91.3
40
Prov Target - 90.0
Q1
13-14
Q2
13-14
Q3
13-14
Q4
13-14
Q1
14-15
Q2
14-15
Q3
14-15
Q4
14-15
SE
100
SW
100
WW
100
MH
99
TC
99
CHP
97
NE
Trend
Rank - 8 (tied)
LHIN Target
Provincial Target
Baseline
97
LHIN
0
25
50
75
100
%
Notes: % cases completed within access target (90 days). Only University of Ottawa Heart Institute performs this procedure , therefore no
hospital level data presented.
Cardiac care services are delivered through the University of Ottawa Heart Institute (UOHI). UOHI has greatly improved its
wait times over the last two quarters though additional weekend surgical time and protected cardiac bypass slots, improved
client triage and additional cardiac intensive care beds. Referral patterns will continue be monitored to ensure patients can be
treated within target wait times.
MLPA
1.6 Cataract Surgery Wait T ime
Prov Target (90.0)
LHIN Target
90.0
91
%
Q4 - 14-15
90
Baseline - 94.0
89.2
Prov Target - 90.0
89
Rank - 13
Q1
13-14
Q2
13-14
Trend
Q3
13-14
LHIN Target
Q4
13-14
Q1
14-15
Provincial Target
Q2
14-15
Q3
14-15
Baseline
LHIN
Q4
14-15
ONT
C
CE
ESC
NW
SE
SW
WW
NE
NSM
CW
MH
TC
CHP
HNHB
0
25
50
9 1 .9
9 9 .7
9 7 .6
9 5 .5
9 4 .9
9 3 .8
9 3 .1
9 2 .7
9 2 .1
9 1 .3
9 1 .1
9 0 .9
8 9 .7
8 9 .2
8 5 .1
75
100
%
The performance indicator for cataract surgery almost achieved the provincial target of 90% in the fourth quarter 2014-15 for
completing non-urgent (priority 4) cataract surgeries within 182 days. The Champlain LHIN will follow-up with providers as
necessary to ensure that performance meets the target.
The LHIN has initiated a Vision Care Committee to develop a plan for vision care services in the region.
E3
MLPA
1.7 Hip Replacement Wait T ime
Prov Target (90.0)
94.7
LHIN Target
80.0
90
%
Q4 - 14-15
80
Baseline - 70.0
70
Prov Target - 90.0
Q1
13-14
Q2
13-14
Trend
Rank - 3
Q3
13-14
LHIN Target
Q4
13-14
Q1
14-15
Provincial Target
Q2
14-15
Q3
14-15
Baseline
Q4
14-15
LHIN
ONT
C
WW
CHP
MH
CE
NW
NSM
ESC
TC
HNHB
NE
SW
SE
CW
8 7 .7
9 8 .9
9 6 .1
9 4 .7
9 4 .1
94
8 9 .6
8 8 .7
8 7 .4
8 4 .4
8 2 .6
8 2 .2
8 0 .5
0
6 1 .2
5 0 .8
25
50
75
100
%
Champlain is now well above the regional and provincial targets (80%, 90%), with 95% of patients treated within 182 days.
The indicator has consistently improved since Q3 2013/14 when Central Intake was mandated throughout the region which
has now equalized wait times between surgeons. Central Intake and Assessment Centers (CIAC) continue to meet targets
despite a significant increase in referrals. Following a provincial survey of orthopedic central intake centers, the Ministry of
Health commented that the Champlain CIAC model for Hip and Knee Replacement is the most effective in the province and
followed up by visiting the Queensway-Carleton central intake site.
MLPA
1.8 Knee Replacement Wait T me
Prov Target (90.0)
93.4
LHIN Target
80.0
90
%
Q4 - 14-15
85
Baseline - 67.0
80
Prov Target - 90.0
75
Rank - 5
Q1
13-14
Q2
13-14
Trend
Q3
13-14
LHIN Target
Q4
13-14
Q1
14-15
Provincial Target
Q2
14-15
Q3
14-15
Baseline
LHIN
Q4
14-15
ONT
C
WW
CE
TC
CHP
NSM
SE
ESC
MH
NE
HNHB
SW
NW
CW
8 4 .8
0
25
9 8 .2
9 5 .7
9 4 .2
9 3 .5
9 3 .4
8 8 .7
8 2 .5
8 1 .2
8 0 .5
7 7 .7
7 4 .6
7 3 .4
6 1 .9
5 6 .6
50
75
100
%
Champlain is well above the regional and provincial targets (80%, 90%) with 93% of patients treated within 182 days. The
indicator has consistently improved since Q3 2013/14 when Central Intake was mandated throughout the region which has
now equalized wait times between surgeons. Central Intake and Assessment Centers (CIAC) continue to meet targets despite
a significant increase in referrals. Following a provincial survey of orthopedic central intake centers, the Ministry of Health
commented that the Champlain CIAC model for Hip and Knee Replacement is the most effective in the province and followed
up by visiting the Queensway-Carleton central intake site.
E4
MLPA
1.9 MRI Scan Wait T ime
LHIN Target
50.0
50
Q4 - 14-15
%
40
34.2
Baseline - 21.0
30
Prov Target - 90.0
20
Q1
13-14
Q2
13-14
Trend
Rank - 8
Q3
13-14
LHIN Target
Q4
13-14
Q1
14-15
Provincial Target
Q2
14-15
Baseline
Q3
14-15
Q4
14-15
LHIN
ONT
3 9 .5
CE
6 3 .2
HNHB
5 7 .6
C
4 8 .1
WW
4 6 .5
NE
4 3 .4
SE
36
NW
3 4 .6
CHP
3 4 .2
TC
2 8 .1
SW
2 7 .8
MH
19
ESC
1 8 .6
NSM 1 3 .3
CW 1 3 .1
0
25
50
%
The LHIN continues to be challenged in meeting MRI wait times for non-urgent scans. MRI efficiency meets or exceeds
provincial targets at all Champlain sites. Patients continue to be transferred from hospitals with longer wait times to hospitals
with shorter wait times.
Pembroke is on track for their MRI machine to become operational in the fall of 2015. This will improve access to the service
for their residents and increase its overall capacity by 3%. However, the impact on the Champlain LHIN's overall wait time
will be small due to its low scan volumes.
Several sites supplement LHIN funding for MRI hours but were contemplating stopping the practice in April 2015 due to fiscal
pressures. The LHIN is working with regional Diagnostic Imaging groups to better understand the potential impact and
identify mitigation strategies and assistance through an external resource is being sought.
MLPA
1.10 CT Scan Wait T ime
Prov Target (90.0)
LHIN Target
75.0
80
Q4 - 14-15
59.4
%
60
Baseline - 61.0
40
Prov Target - 90.0
20
Rank - 12
Q1
13-14
Q2
13-14
Trend
Q3
13-14
LHIN Target
Q4
13-14
Q1
14-15
Provincial Target
Q2
14-15
Baseline
Q3
14-15
LHIN
Q4
14-15
ONT
ESC
SE
C
CE
WW
CW
HNHB
NE
SW
NW
NSM
CHP
TC
MH
7 3 .9
9 7 .1
9 3 .6
9 1 .1
8 7 .4
0
7 3 .6
7 1 .8
69
6 8 .9
6 5 .9
6 4 .3
6 1 .3
5 9 .4
5 6 .4
4 5 .3
25
50
75
100
%
Performance on CT scan wait times continued to slip in the final quarter of the year falling below the target while a number of
measures were underway to improve efficiency and increase hours of service including moving patients from sites with longer
wait time sites to sites with shorter wait times.
Several of the hospitals in the supplement LHIN CT funding but are contemplating reducing their contribution as a result of
budget pressures. The impact on wait times is being studied.
We will continue to monitor results as this work continues and will adjust strategies as necessary.
E5
MLPA
1.11 Wait for Home Care (Community Clients)
150
LHIN Target
66.0
Q3 - 14-15
Days
125
100
Baseline - 127.0
75
Prov Target - None
50
58
Q4
12-13
Trend
Rank - 12
Q1
13-14
Q2
13-14
LHIN Target
Q3
13-14
Q4
13-14
Provincial Target
Q1
14-15
Q2
14-15
Baseline
LHIN
Q3
14-15
No Prov target
ONT
27
WW 1 2
ESC 1 5
CW
18
SE
20
SW
20
HNHB
21
CE
22
MH
23
TC
24
NW
28
C
31
CHP
58
NE
NSM
0
25
50
76
77
75
Days
Notes: 90th percentile: 90 out of 100 clients received service within less time. CCAC data. No drill down to hospital level data.
The 90th percentile wait time for CCAC in-home services has been consistently better than target in the last few quarters.
Initiatives are in place to increase the efficiency of intake and to monitor the wait list. Targeted funding to CCAC to support
reducing the wait list has been implemented.
IHSP
1.12 Adults With a Primary Care Provider
No Prov target
LHIN Target
None
%
93.5
Baseline - None
Prov Target - None
93
92.5
92.5
92
Rank - N/A
Oct 12-Sep 13
Trend
LHIN Target
Jul 13-Jun 14
Provincial Target
Jan 14-Dec 14
Baseline
LHIN
ONT
SE
NSM
WW
ESC
HNHB
SW
MH
C
CW
CE
CHP
TC
NE
NW
0
25
50
94
9 7 .3
9 6 .5
9 6 .5
96
9 5 .7
9 4 .8
9 4 .5
9 4 .2
9 3 .8
9 3 .7
9 2 .5
9 1 .8
8 8 .3
8 7 .3
75
100
%
Notes: The survey sample is a rolling sample with overlapping time periods, therefore individuals who responded may be included in more than one
result. Source: Health Care Experience Survey, Ministry of Health and Long-Term Care.
The Champlain LHIN is working on initiatives to increase the number of residents who have a
regular family physician. This work involves:
• collaborating with the Community Care Access Centre (CCAC) Health Care Connect program to make process improvements
• working with physicians at The Ottawa Hospital Rapid Referral Clinic and the Chronic Pain Clinic to encourage referrals to
primary care services
• working with primary care providers in Health Links.
All patients with complex needs in three operational Health Links are attached to primary care services. Primary care
attachment is improving through the Health Care Connect program.
E6
IHSP
1.13 T imely (Same / Next Day) Access to a Primary Care Provider
No Prov target
44
LHIN Target
None
%
43
42.5
Baseline - None
42
Prov Target - None
41
Rank - 9
Oct 12-Sep 13
Trend
LHIN Target
Jul 13-Jun 14
Provincial Target
Oct 13-Sep 14
Baseline
LHIN
ONT
CW
TC
C
HNHB
MH
ESC
SW
WW
CHP
SE
CE
NSM
NE
NW
4 4 .4
5 7 .4
4 9 .6
4 8 .1
4 7 .5
4 6 .4
4 6 .2
4 6 .1
4 3 .4
4 2 .5
4 2 .3
3 9 .2
0
3 0 .6
2 9 .3
2 5 .5
20
40
60
%
Notes: Source: Health Care Experience Survey, Ministry of Health and Long-Term Care.
The LHIN is funding a three-year Quality Practice Facilitator project. This project is an evidence-based intervention to build
capacity in interested primary care practices to improve chronic disease management and/or implement office efficiencies for
advanced access (same day/next day appointments). To date, 25 physicians are enrolled in the program with a potential
impact on 75 to 500 patients with high needs per physician. Feedback from physicians attending the Champlain Primary Care
Congress show keen interest by primary care providers in continuing to do work on quality management and improve access
for their patients.
E7
RIGHT CARE, RIGHT PLACE
MLPA
2.1 Patients in Acute Hospital Beds Needing Other Care (%ALC)
Prov Target (9.5)
14
LHIN Target
13.5
Q3 - 14-15
%
13
12
11.2
Baseline - 14.2
11
Prov Target - 9.5
10
Q4
12-13
Q1
13-14
Trend
Rank - 4
Q2
13-14
LHIN Target
Q3
13-14
Q4
13-14
Provincial Target
Q1
14-15
Q2
14-15
Baseline
LHIN
Q3
14-15
ONT
CW
SW
TC
CHP
WW
SE
MH
C
ESC
CE
HNHB
NSM
NW
NE
14
7
7 .3
0
10
1 1 .2
12
1 4 .3
1 4 .5
1 4 .5
1 5 .8
1 6 .5
1 8 .3
2 0 .1
2 1 .6
2 2 .6
10
20
%
Notes:
The Champlain LHIN improved its performance from last quarter and achieved its target for percent of Alternate Level of Care
(ALC). Additional Convalescent Care bed capacity and the provision of Enhanced Services by the Champlain CCAC to support
patients to go home from the hospital were crucial in reducing number of days patients stay in acute care hospitals when
they can be better cared for elsewhere.
MLPA
2.2 Repeat Mental Health ED visitors
No Prov target
19
LHIN Target
17.7
Q3 - 14-15
18
%
17.7
17
Baseline - 17.7
16
Prov Target - None
15
Rank - 6
Q4
12-13
Q1
13-14
Trend
Q2
13-14
LHIN Target
Q3
13-14
Q4
13-14
Provincial Target
Q1
14-15
Baseline
Q2
14-15
LHIN
Q3
14-15
ONT
NW
NSM
WW
C
MH
CHP
ESC
HNHB
NE
SW
CE
SE
CW
TC
1 9 .5
1 5 .6
16
1 7 .2
1 7 .3
1 7 .6
1 7 .7
1 7 .8
18
1 8 .2
1 8 .6
19
2 0 .7
0
2 5 .5
2 6 .4
20
10
%
Notes: Results delayed as data from the subsequent quarter is needed to identify repeat visits up to 30 days later
The re-visit rate has seen a modest improvement (decrease) despite an increase in the total number of visitors. A similar
pattern was seen across the province and in nine other LHINs. Community transitional case management services offered at
the hospital point-of-care, coordinated access services and increased walk-in counselling services may be having the desired
impact on this indicator.
E8
MLPA
2.3 Repeat Substance Abuse ED visitors
No Prov target
28.5
LHIN Target
24.8
27.5
%
Q3 - 14-15
25
22.5
Baseline - 25.9
20
Prov Target - None
Q4
12-13
Trend
Rank - 11
Q1
13-14
Q2
13-14
LHIN Target
Q3
13-14
Q4
13-14
Provincial Target
Q1
14-15
Q2
14-15
Baseline
LHIN
Q3
14-15
ONT
SW
WW
CE
ESC
NSM
SE
CW
MH
C
HNHB
CHP
NE
TC
NW
3 0 .5
1 8 .4
2 2 .8
23
2 3 .2
2 3 .7
2 4 .3
2 5 .3
2 5 .5
2 5 .9
2 7 .9
2 8 .5
3 0 .6
0
3 8 .4
4 3 .5
40
20
%
Notes: Results delayed as data from the subsequent quarter is needed to identify repeat visits up to 30 days later
The number of individuals re-visiting the emergency department remained the same (190) between the last two reporting
periods. However the total number of initial visits decreased which caused the calculated rate to increase (worsen). New
investments in residential stabilization will begin to have an impact in the coming months and it is expected that the rate will
improve. Further capacity planning is also underway to review investments in community withdrawal management.
SAA
2.4 High Priority Clients Receiving CCAC Care at Home
No Prov target
Higher values are Better
6,676
LHIN Target
5685.6
6,500
Q3 - 14-15
Clients
6,000
5,500
Baseline - 5677.0
5,000
Prov Target - None
4,500
Rank - N/A
Q4
12-13
Trend
Q1
13-14
Q2
13-14
LHIN Target
Q3
13-14
Q4
13-14
Provincial Target
Q1
14-15
Q2
14-15
Baseline
LHIN
Q3
14-15
CE
C
HNHB
CHP
SW
TC
MH
NE
SE
WW
NSM
ESC
CW
NW
9 ,1 5 2
9 ,0 4 8
6 ,8 7 1
6 ,6 7 6
5 ,7 0 0
5 ,3 3 7
3 ,9 2 8
3 ,6 4 7
3 ,0 8 0
3 ,0 6 5
2 ,6 8 1
2 ,5 6 3
2 ,5 2 2
1 ,4 1 7
0k
2.5k
5k
7.5k
Clients
Notes: No Rank. Result is a function of LHIN size. Ontario total not shown due to scale issues.
The number of high priority clients receiving CCAC Care at home has steadily increased over the past two years. The success
of programs such as Home First, Stay at Home and wound care continue to result in high acuity clients being cared for in the
community. There was a small increase in client numbers again this quarter.
E9
SAA
2.5 Long T erm Care Placements for Highest Priority Clients
No Prov target
Higher values are Better
83
LHIN Target
82.0
82
%
Q3 - 14-15
80
Baseline - 80.3
78
Prov Target - None
76
Q4
12-13
Q1
13-14
Trend
Rank - 4
Q2
13-14
LHIN Target
Q3
13-14
Q4
13-14
Provincial Target
Q1
14-15
Baseline
Q2
14-15
Q3
14-15
LHIN
ONT
SW
CE
C
CHP
MH
ESC
NSM
NE
CW
SE
HNHB
TC
WW
NW
0
25
50
82
88
86
84
83
83
82
82
80
79
79
78
78
78
77
75
%
Notes:
Long term care placement for highest priority clients continues to exceed the target. The LHIN will continue to monitor the
performance of its providers.
IHSP
2.6 Admission to LT C Homes from Community
LHIN Target
72.8
80
Q4 - 14-15
%
77
75
No comparison LHIN data to display
Baseline - 72.8
70
Prov Target - None
65
Rank - N/A
Q3
12-13
Q4
12-13
Trend
Q1
13-14
LHIN Target
Q2
13-14
Q3
13-14
Provincial Target
Q4
13-14
Baseline
Q1
14-15
Q4
14-15
LHIN
Notes:
High hospital occupancy during the winter resulted in a slight reduction of the number of people admitted to long-term care
homes directly from the community as more patients were admitted to long-term care from acute and sub-acute facilities.
E10
IHSP
2.7 Patients Designated ALC Who Were Discharged to Long T erm Care Homes
17.5
LHIN Target
9.2
Q3 - 14-15
%
15
12.5
Baseline - 11.7
10
7.5
Prov Target - None
9.4
Q4
12-13
Q1
13-14
Trend
Rank - 9
Q2
13-14
LHIN Target
Q3
13-14
Q4
13-14
Provincial Target
Q1
14-15
Q2
14-15
Baseline
LHIN
Q3
14-15
No Prov target
ONT
9
WW 0 .1
TC
5 .4
HNHB
5 .7
NSM
6 .5
ESC
6 .6
CW
6 .8
MH
7 .3
C
8
CHP
9 .4
NW
1 1 .1
NE
1 5 .5
SE
2 0 .4
2 1 .1
CE
24
SW
0
10
20
%
Notes:
During this quarter, fewer patients waiting an alternate level of care were discharged to long-term care homes. Active
collaboration between hospitals (acute and sub-acute),the CCAC and the LHIN ensured that patients were directed to other
supportive resources such as Home Care, Convalescent Care, Complex Continuous Care, Rehabilitation, or Community
Support Services. Patients admitted to long-term care homes from the community was also reduced as more clients were
moved to long-term care from sub-acute care facilities in this quarter.
IHSP
2.8 ALC days Attributable to Palliative Care Patients
No Prov target
LHIN Target
2.1
3
3
%
Q3 - 14-15
2
Baseline - 2.1
Prov Target - None
1
Rank - 5
Q4
12-13
Q1
13-14
Trend
Q2
13-14
LHIN Target
Q3
13-14
Q4
13-14
Provincial Target
Q1
14-15
Baseline
Q2
14-15
LHIN
Q3
14-15
ONT
CW 0
SW
1 .2
CE 1 .7
NE 2 .1
CHP
3
SE
3 .1
C
MH
NW
HNHB
ESC
TC
WW
NSM
0
2.5
4
4 .6
4 .6
4 .7
4 .8
5 .8
6 .7
8
10
5
7.5
10
%
Notes:
The percentage of ALC days attributable to palliative care increased slightly (.3%) over last quarter. The variation may be in
part due to the lower hospice occupancy in December, which often reflects family and patient preferences at that time of
year. A central referral system has been established to improve access to hospice and inpatient palliative care beds in
Ottawa. The regional program will be evaluating this new process to determine if there are efficiencies and process
improvements that can be implemented.
E11
IHSP
2.9 Hospitalization Rate for Ambulatory Care Sensitive Conditions
No Prov target
65
LHIN Target
60.0
63.8
per 100,000
Q3 - 14-15
Baseline - 60.0
60
55
50
Prov Target - None
Q4
12-13
Q1
13-14
Trend
Rank - 5
Q2
13-14
LHIN Target
Q3
13-14
Q4
13-14
Provincial Target
Q1
14-15
Baseline
Q2
14-15
Q3
14-15
LHIN
ONT
C
MH
TC
WW
CHP
CW
CE
HNHB
ESC
SW
NSM
SE
NW
NE
6 8 .1
4 1 .8
4 5 .3
6 1 .7
6 3 .4
6 3 .8
6 5 .8
6 6 .8
7 4 .9
7 7 .1
7 7 .2
8 0 .8
8 3 .6
0
1 0 3 .7
1 0 7 .7
100
50
per 100,000
Notes: Age standardized rate per 100,000 population aged 74 years and younger.
The Champlain LHIN continues to invest in initiatives that provide quality chronic disease services across the region to
prevent hospitalizations.
Two projects designed to enhance access to HIV, endocrinology and chronic pain clinics have served over 300 patients with
medically complex needs. The initiatives have resulted in a significant reduction in emergency department visits and hospital
readmissions. A third project, eConsultation is being expanded. The eConsult project provides primary care providers with
easy access to specialist consultation across the region.
Other projects to lower hospitalization rates for clients with chronic disease include: the Champlain Quality Care Practice
Facilitation Program; a Rapid Intervention Clinic for heart failure patients; and investments to expand pulmonary
rehabilitation and cardiac rehabilitation services across the region. Cross-sector partnerships between chronic disease and the
mental health partners are also underway to better serve patients with multiple comorbidities who have complex needs.
IHSP
2.10 ER Visits for Conditions T hat Could be T reated in a Primary Care Setting.
LHIN Target
5.7
7
6.7
per 1000
Q3 - 14-15
6
Baseline - 5.7
5
Prov Target - None
4
Rank - 8
Q4
12-13
Q1
13-14
Trend
Q2
13-14
LHIN Target
Q3
13-14
Q4
13-14
Provincial Target
Q1
14-15
Baseline
Q2
14-15
LHIN
Q3
14-15
No Prov target
ONT
5 .4
CW
1 .6
C
1 .8
MH
1 .8
TC 2 .3
WW
3 .6
CE
3 .7
HNHB
6 .1
CHP
6 .7
ESC
8 .6
NSM
9
NW
9 .3
SW
1 2 .8
1 2 .9
SE
1 4 .3
NE
0
5
10
15
per 1,000
Notes: Age-standardized rate per 1,000
The Champlain LHIN continues to monitor this indicator. Health Links improve coordination of care for high needs, complex
patients who are living in the community. Health Links continue to expand across the region and are expected to reduce the
number of ER visits for these high needs patients.
In addition, CHEO has implemented an awareness campaign to direct families to primary care in non-urgent medical
situations.
E12
HIGH QUALITY, SAFE AND EFFECTIVE CARE
MLPA
4.1 Readmissions for Certain Chronic Conditions
No Prov target
17.5
LHIN Target
14.5
17.1
Q2 - 14-15
%
17
Baseline - 16.5
Prov Target - None
16.5
16
15.5
Rank - 10
Q3
12-13
Trend
Q4
12-13
Q1
13-14
LHIN Target
Q2
13-14
Q3
13-14
Provincial Target
Q4
13-14
Q1
14-15
Baseline
LHIN
Q2
14-15
ONT
CW
C
NW
ESC
CE
HNHB
MH
SW
NSM
CHP
WW
TC
SE
NE
0
5
1 6 .7
1 5 .1
1 5 .4
1 5 .7
1 5 .7
1 6 .1
1 6 .3
1 6 .4
1 6 .9
1 6 .9
1 7 .1
1 7 .1
1 7 .6
1 7 .7
1 9 .6
10
15
20
%
Notes: Readmission within 30 days for stroke, chronic obstructive pulmonary disease, pneumonia, congestive heart failure, diabetes, selected
cardiac conditions, selected gastrointestinal conditions.Results delayed as data from the subsequent quarter is needed to identify repeat visits.
The LHIN continues to work with hospitals, networks and partners to implement best practice across the region related to
chronic disease care. There have been program investments this year related to heart failure, diabetes and COPD including
expansion of cardiac rehabilitation services and pulmonary rehabilitation services. New acute stroke units have been
established, as well as a Transitional Care Program which has served over 185 patients with heart failure and at high risk of
readmission.
The LHIN is working with health service providers and patient and caregiver representatives to establish ten Health Links in
our region for patients with the highest complexity and service use to ensure coordination of care and quicker access to
primary care and other services. Six Health Links have been approved by the Ministry of Health and Long-Term Care. Three of
which have begun implementation. To date, care plans have been established for over 15 patients with complex needs to
improve the coordination of care in their local communities.
Evaluation results from demonstration projects related to high risk/high need patients in central Ottawa and Hawkesbury
have shown decreased readmissions to hospital and emergency department visits within 30 days of discharge. Over 300
patients have been part of these projects to date. These one year projects are providing a foundation for Health Links in their
respective communities.
E13
IHSP
4.2 Early Elective Low-Risk Repeat C-Sections
LHIN Target
20.0
30
Q2 - 14-15
%
20
12
10
Baseline - 15.3
0
Prov Target - 11.0
Q3
12-13
Q4
12-13
Trend
Rank - 2
Q1
13-14
LHIN Target
Q2
13-14
Q3
13-14
Provincial Target
Q4
13-14
Baseline
Q1
14-15
Q2
14-15
LHIN
Prov Target (11.0)
ONT
3 5 .6
SE 3 .1
CHP
12
ESC
1 8 .9
CE
2 3 .2
SW
2 6 .7
MH
2 7 .7
NSM
3 2 .8
CW
3 8 .1
HNHB
4 3 .9
NW
4 4 .4
WW
4 4 .4
TC
5 2 .9
5 3 .1
C
5 3 .8
NE
0
20
40
%
Notes: No Ministry target, however, target of below 20% established as part of agreements with Champlain hospitals. BORN target is 11%.
Performance on this indicator in Q2 2014-15 is below the baseline and better than the LHIN target. We are presently the
second best performing LHIN in the province. Activities undertaken to improve performance include: the Champlain Maternal
Newborn Regional Program asked hospitals to identify physician and nurse champions to lead improvement on this indicator.
Hospitals were encouraged to use this indicator as a quality indicator and to add it to their quality committee agendas. This
key indicator is also addressed during the Regional Program’s annual visits to hospitals and the Regional Program team is
available to provide guidance or assistance. A target of below 20% has been included in 2015-16 accountability agreements
between the LHIN and the hospitals. We expect Champlain's rate to remain among the lowest in the province and to continue
to decrease.
IHSP
4.3 Complex Care Hospital Patients with New Pressure Ulcers
Lower values are Better
1.4
LHIN Target
2.4
1.3
Q3 - 14-15
%
1.2
1.1
1.1
Baseline - 1.2
1
Prov Target - None
0.9
Rank - 3
Q4
12-13
Q1
13-14
Trend
Q2
13-14
LHIN Target
Q3
13-14
Q4
13-14
Provincial Target
Q1
14-15
Q2
14-15
Baseline
LHIN
Q3
14-15
No Prov target
ONT
2 .2
CW 0 .8
SE 0 .9
CHP
1 .1
NE
1 .2
MH
1 .6
TC
1 .8
NSM
2
CE
2 .2
HNHB
2 .3
ESC
2 .8
WW
3
SW
C
NW
0
2
4 .6
4 .7
4 .7
4
%
Notes:
Champlain continues to meet its target for this indicator and is one of the best performing LHINs in the province.
Performance trends will continue to be monitored and strategies implemented as appropriate.
E14
IHSP
4.4 Long T erm Care Residents with New Pressure Ulcers
No Prov target
2.7
LHIN Target
2.4
2.6
Q3 - 14-15
2.5
%
2.5
2.4
Baseline - 2.7
2.3
2.2
Prov Target - None
Q4
12-13
Q1
13-14
Trend
Rank - 5 (tied)
Q2
13-14
LHIN Target
Q3
13-14
Q4
13-14
Provincial Target
Q1
14-15
Q2
14-15
Baseline
LHIN
Q3
14-15
ONT
C
NW
TC
MH
CE
CHP
CW
NSM
SE
HNHB
NE
ESC
WW
SW
0
1
2 .5
2 .1
2 .2
2 .2
2 .3
2 .5
2 .5
2 .5
2 .6
2 .6
2 .7
2 .8
2 .9
3
3 .1
2
3
%
Notes: Not available at the Long-Term Care facility level.
In the third quarter Champlain's performance was better than baseline but slightly above the target. The relative change in
indicator performance in the quarter was small and so the performance trend will continue to be monitored.
IHSP
4.5 Physician Visit Within 7 days of Discharge
No Prov target
44.3
LHIN Target
None
%
42.5
40
Baseline - None
Prov Target - None
37.5
Rank - 9
Q2
12-13
Trend
Q3
12-13
Q4
12-13
LHIN Target
Q1
13-14
Q2
13-14
Provincial Target
Q3
13-14
Q4
13-14
Baseline
LHIN
Q1
14-15
ONT
CW
MH
C
TC
SE
CE
HNHB
ESC
CHP
WW
NSM
SW
NE
NW
4 6 .6
0
5 5 .2
5 4 .6
5 2 .6
5 0 .1
4 8 .6
48
4 7 .7
4 5 .5
4 4 .3
4 2 .8
4 1 .5
4 0 .3
3 6 .1
3 3 .9
20
40
%
Notes:
Two Ministry-funded demonstration projects for medically complex patients in central Ottawa and Hawkesbury were
implemented this past year. These projects included arranging physician follow-up visits within 7 days of discharge for
complex patients as well as pharmacy follow-up for medication management. The Health Links initiatives will use these
projects as their foundation. Patients with complex needs who are part of Health Links, if hospitalized, will be followed postdischarge. The Champlain Primary Care Physician Lead is working with hospitals on improved discharge planning processes
and forms.
E15
IHSP
4.6 Hospitalization Due to Falls Among Long-T erm Care Residents
No Prov target
917.9
LHIN Target
683.0
800
per 100,000
Q3 - 14-15
600
Baseline - 690.0
400
Prov Target - None
Q4
12-13
Trend
Rank - 13
Q1
13-14
Q2
13-14
LHIN Target
Q3
13-14
Q4
13-14
Provincial Target
Q1
14-15
Q2
14-15
Baseline
LHIN
Q3
14-15
ONT
NE
NSM
SE
CW
CE
SW
TC
HNHB
NW
MH
ESC
CHP
WW
0
9 0 5 .8
6 1 3 .5
6 5 9 .6
7 6 4 .3
7 9 0 .5
8 0 6 .1
8 1 8 .5
8 4 2 .9
8 5 4 .3
8 6 7 .6
8 7 1 .7
8 9 3 .1
9 1 7 .9
9 3 4 .3
500
750
250
per 100,000
Notes:
The Champlain LHIN is implementing an integrated falls prevention program in the region that focuses on reducing falls
among people in the community. For additional information on these initiatives see indicator "4.7 Fall-related emergency
department visit rate among seniors". This indicator is linked to the overall rates of falls in long-term care homes to monitor
the need for action in the coming fiscal year.
IHSP
4.7 Fall-Related Emergency Department Visit Rate Among Seniors
No Prov target
LHIN Target
1648.0
per 100,000
Q3 - 14-15
1,720
1,700
1,650
Baseline - 1655.0
1,600
Prov Target - None
1,550
Rank - 13
Q4
12-13
Trend
Q1
13-14
Q2
13-14
LHIN Target
Q3
13-14
Q4
13-14
Provincial Target
Q1
14-15
Q2
14-15
Baseline
LHIN
Q3
14-15
ONT
CW
C
CE
MH
NW
WW
NSM
TC
ESC
HNHB
NE
SW
CHP
SE
0
1 ,4 6 7 .9
1 ,1 6 6 .9
1 ,2 2 9 .4
1 ,2 5 5 .8
1 ,2 7 2 .8
1 ,3 6 1 .1
1 ,3 7 6 .9
1 ,5 1 4 .7
1 ,5 2 4 .6
1 ,5 3 1 .8
1 ,5 9 0 .3
1 ,6 3 4 .8
1 ,6 3 9 .9
1 ,7 2 0
1 ,7 7 0 .4
500
1,000
1,500
per 100,000
Notes: Number of falls resulting in emergency department visits per 100,000 people aged 65 or older. Includes people living in the community and
in institutional settings.
In 2012 the Champlain LHIN established the Champlain Regional Falls Prevention Steering Committee to support the
integration of falls prevention across the continuum of care and across the Champlain region. A Falls Prevention Algorithm
was developed and standardized screening and assessment tools were piloted and adopted.
In the third quarter, the adoption of the standardized screening, the algorithm and the personal support worker education
module were initiated in number of sites and communities and selected retirement homes.
The impact of the Falls Prevention strategy and algorithm on this indicator is expected to improve over time as adoption
increases across the region.
E16
IHSP
4.8 Fall-Related Hospitalization Rate Among Seniors
No Prov target
468.7
LHIN Target
409.0
450
per 100,000
Q3 - 14-15
425
Baseline - 415.0
400
Prov Target - None
375
Rank - 14
Q4
12-13
Trend
Q1
13-14
Q2
13-14
LHIN Target
Q3
13-14
Q4
13-14
Provincial Target
Q1
14-15
Q2
14-15
Baseline
LHIN
Q3
14-15
ONT
NW
C
CE
NSM
CW
MH
WW
NE
ESC
SW
TC
HNHB
SE
CHP
0
3 5 1 .1
2 6 2 .2
2 6 4 .6
2 6 7 .8
2 9 2 .6
2 9 3 .5
3 2 9 .7
3 3 6 .6
3 6 6 .2
3 7 0 .7
3 8 7 .4
3 9 0 .3
4 0 2 .4
4 3 5 .4
4 6 8 .7
200
400
per 100,000
Notes:
As described in the previous indicator, in 2012 the Champlain LHIN established a regional steering committee which is
working to implement a regional strategy to reduce falls among seniors. This work is also expected to reduce serious injuries
requiring visits to emergency departments and hospitalizations.
E17
CHAMPLAIN LHIN ORGANIZATIONAL HEALTH
OPS
5.1 Status of LHIN Annual Business Plan Initiatives
LHIN Target
85.0
Q4 - 14-15
% on track
90
80
Baseline - None
Prov Target - None
75.4
70
Rank - N/A
Q1
14-15
Q2
14-15
Trend
Q3
14-15
LHIN Target
Baseline
Q4
14-15
LHIN
Notes: The percentage of Annual Business Plan initiatives that are on track to meet milestones
Of the 57 interventions identified in the Annual Business Plan (ABP), 43 achieved all of their planned milestones by the end
of the fiscal year. Progress was made on the remaining interventions; however implementation timelines for some projects
(e.g. Health Links, introduction of Ontario Perception of Care tool, implementation of a new MRI in Pembroke) have required
adjustment. The provincial Specialty-Based Clinic initiative was put on hold by MOHLTC. Due to limited funds, several
planned investments (e.g. Assisted Living expansion) identified in the draft ABP were deferred and have been considered in
the development of the draft 2015/16 ABP. For some incomplete interventions, implementation will continue into the
2015/16 fiscal year. For example, we will ensure that Aboriginal cultural safety training is provided to selected health service
providers in 2015/16.
E18
OPS
5.2 LHIN Enterprise Risk Assessment
20
LHIN Target
None
#
15
10
Baseline - None
5
Prov Target - None
0
11
10
9
9
4
5
6
6
Q1
14-15
Q2
14-15
Q3
14-15
Q4
14-15
Unmitigated
Rank - N/A
Partially Mitigated
Fully Mitigated
Notes: Includes only the 15 risks/categories ranked as high or extreme risk by the Champlain LHIN Board in 2014. The status, after mitigation, is
based on quarterly assessment by the LHIN’s senior management team, ranking each risk as unmitigated (red), partially mitigated (yellow) or fully
mitigated (green).
The risk register was reviewed and mitigation strategies updated with new information as required. There was no change in
the risk assessment status for any of the risks being monitored and there were no new risks identified for this quarter.
OPS
5.3 LHIN Operational Budget Variance
Values close to zero are better
10
LHIN Target
From -10% to -10%
%
0
Baseline - None
-10
Prov Target - None
-20
Rank - N/A
Q1
13-14
Q2
13-14
Q3
13-14
Q4
13-14
Quarter Variance
Q1
14-15
Q2
14-15
Q3
14-15
Q4
14-15
Cumulative Variance
Notes: * Actual fiscal year spending does not include Amortization and any affect of Deferred Capital Contribution. Q4-2015 report, the 14/15
budget was revised to reflect the Ministry initiated $53,000 recovery from Diabetes and to reflect the additional budget provided by LHIN
Collaborative joining the translation program
The LHIN Operational Budget Variance graph illustrates the quarter-by-quarter variance between actual spending during the
quarter relative to the budget for that quarter.
Although the quarterly budget is allocated straight-line across quarters, the actual spending pattern is not. The LHIN spends
conservatively early in the fiscal year with an increase in spending in the later quarters as we become more clear about the
amount of resources available.
As of the fourth quarter of 2014-2015, the LHIN is tracking under budget by -4.8%.
E19
OPS
5.4 LHIN Staff T urnover
LHIN Target
15.0
Q4 - 14-15
%
20
10
Baseline - 15.4
6.5
0
Prov Target - None
Q4
10-11
Q4
11-12
Trend
Rank - N/A
Q4
12-13
LHIN Target
Baseline
Q4
13-14
Q4
14-15
LHIN
Notes: The number of employees departed includes voluntary exits only does not include short-term contracts that ended.
The Champlain LHIN rate of voluntary staff turnover for fiscal year 2014-2015 is 6.5% and meets the target.
Of the staff departures during the fiscal year ended March 31, 2015:
• 33% of the staff had been with the LHIN for a year.
• 33% of the staff had been with the LHIN for less than two (2) years.
• 33% of the staff had been with the LHIN for more than two years.
Exit interviews are conducted to understand factors contributing to the voluntary staff turnover. Of the staff that provided
answers to the exit interview, the primary reasons for accepting other employment fall into two general categories;
employment that was more aligned with their education and a new opportunity with greater opportunities for growth.
OPS
5.5 T witter Followers
1,198
1,200
LHIN Target
1000.0
Q4 - 14-15
#
1,000
800
Baseline - None
Prov Target - None
Rank - N/A
600
Q1
14-15
Q2
14-15
Trend
LHIN Target
Q3
14-15
Baseline
Q4
14-15
LHIN
Notes: Includes English plus French accounts. Counts as two if on both.
The Champlain LHIN reached its 2014-15 target of 1,000 Twitter followers a quarter before the year-end target (Total English
and French accounts) and is now well above target. The LHIN has shown a steady increase of followers this year.
E20
OPS
5.6 Champlain LHIN YouT ube Views
2,000
LHIN Target
None
#
1,500
1,000
650
Baseline - None
500
0
Prov Target - None
Q1
13-14
Q2
13-14
Q3
13-14
Q4
13-14
Trend
Rank - N/A
LHIN Target
Q1
14-15
Baseline
Q2
14-15
Q3
14-15
Q4
14-15
LHIN
Notes: Number of new videos fluctuates from quarter to quarter (may be none)
YouTube views fluctuate depending on whether new content is uploaded. In 2015-16, the plan is to consistently post videos
associated with LHINfo Minute documents, which will help integrate communications products and increase interest across
modalities.
OPS
5.8 Website T raffic
60k
LHIN Target
None
52,569
46,600
49,107
8,712
8,905
8,522
Q1
14-15
Q2
14-15
Q3
14-15
53,614
#
40k
20k
Baseline - None
Prov Target - None
11,125
0k
Rank - N/A
Page Views
Q4
14-15
Users
Notes: Number of page views: Data from Google Analytics
The Champlain LHIN experienced an increase in website traffic this quarter, especially the number of users. Strategies were
in place to optimize website traffic, in particular keeping the call-outs on the home page fresh.
E21
HEALTH SYSTEM FISCAL MANAGEMENT AND VALUE
HSFR
6.1 Hospital Cost Efficiency
No Prov target
ONT
C
NW
CE
W
MH
HNHB
TC
CW
NE
ESC
SW
CHP
NSM
SE
5
LHIN Target
None
3.1
3.01
%
2.5
0
Baseline - None
-2.5
Prov Target - None
-5
12-13
13-14
Rank - 12
-0.2
-5
-2.5
-2
-2
-1.8
-1.6
-0.6
-0.2
0.4
1.8
2.5
3
4
4.5
-5
-2.5
0
2.5
%
Notes: Numbers below 0 indicate that actual expenses are lower than expected expenses. Includes only large hospitals and excludes nonmodelled expenses (included in 2012/13). Source: 2013-14 Hospital HBAM Results Summary from MoHLTC. Additional information here.
The hospital cost efficiency indicator is based on the Health Based Allocation Model(HBAM) results from the Ministry of Health
and Long-Term Care that is part of Health System Funding Reform (HSFR). HBAM divides a fixed provincial funding amount
to hospitals across the province based on the expected (average) cost of providing services after adjusting for patient
characteristics such as age and complexity. This fiscal year (2014/15) was the third year of HSFR implementation. Overall,
the LHIN cost performance (using 2012/13 data) was unfavorable meaning that actual expenditures were higher than
expected in comparison with other hospitals in the province. This resulted in a base funding reduction for the hospital sector
in Champlain LHIN. The 2013/14 data continues to show unfavourable performance which will negatively affect 2015/16
funding. Champlain hospitals have taken several steps to address cost efficiencies and the system is working together to
improve HSFR performance.
SAA
6.3 T otal Margin - Hospitals
No Prov target
Values closer to zero are better
10
LHIN Target
0
Q3 - 14-15
%
5
Baseline - None
0
Prov Target - None
-5
12-13
Q4
13-14
Q2
13-14
Q3
13-14
Q4
Rank - N/A
14-15
Q2
14-15
Q3
CE
NE
MH
C
NSM
CHP
TC
HNHB
WW
SW
ESC
SE
-0.2
NW -0.4
-0.9
CW
3.3
2.9
2.2
1.4
1.2
1.1
1
0.8
0.4
0.2
0.1
0
2
%
Notes: Numbers above 0 indicate that revenues are higher than expenses. Q1 figures are not requested of facilities. Figures for Q2 and Q3 are
forecasted figures. Figures for Q4 show actual results. Additional information here.
At the end of the third quarter, several hospitals were forecasting deficits while at the same time working on strategies to
mitigate. CHEO, Renfrew and Winchester have been successful in these efforts and are expected to break-even for fiscal
2014-15. Other forecasted deficits are small in magnitude and could be absorbed by the respective hospitals on a one-time
basis if they are unsuccessful in mitigating them.
E22
SAA
6.4 T otal Margin - Community Care Access Centre
No Prov target
SW
1.5
WW
0.7
10
LHIN Target
0
CHP
Q3 - 14-15
0.2
C
0
CW
0
NE
0
%
5
Baseline - None
NSM
0
0
MH
-0.9
NW
-1
TC
Prov Target - None
-5
-1
HNHB
12-13
Q4
13-14
Q2
13-14
Q3
13-14
Q4
14-15
Q2
14-15
Q3
-2.2
ESC
-3.3
Rank - N/A
-2
0
%
The CCAC continues to manage service activity volume based on available funding. The CCAC has achieved its administrative
cost saving targets to balance the budget. While the CCAC has maintained wait lists for some services, it was able to achieve
its wait time target during this period. The forecast to break even at year-end includes provisions for amounts repayable for
service volumes not met in selected programs.
SAA
6.5 T otal Margin - Community Health Centres
No Prov target
10
LHIN Target
0
Q3 - 14-15
%
5
Baseline - None
0
Prov Target - None
-5
12-13
Q4
13-14
Q2
13-14
Q3
13-14
Q4
Rank - N/A
14-15
Q2
14-15
Q3
NSM
7.5
5.4
CE
4.3
NE
3.8
HNHB
2.7
SW
2
SE
1.6
ESC
0.9
WW
0.6
CHP
0.5
TC
NW 0.2
C 0
CW 0
0
2.5
5
7.5
%
At the end of the third quarter the sector was operating with an average margin of 0.58%. All 11 Community Health Centres
completed the year with a balanced or small surplus position. CHC accountability agreements are monitored on a quarterly
basis.
E23
SAA
6.6 T otal Margin - Community Support Services
No Prov target
10
LHIN Target
0
Q3 - 14-15
%
5
Baseline - None
0
Prov Target - None
-5
12-13
Q4
13-14
Q2
13-14
Q3
13-14
Q4
14-15
Q2
14-15
Q3
CE
CW
CHP
ESC
SW
WW
C
NE
HNHB
MH
TC
NSM
SE
NW
1.9
0.9
0.8
0.7
0.7
0.7
0.6
0.6
0.3
0
-0.2
-0.2
-0.9
-1
-1
Rank - N/A
0
1
2
%
As of the third quarter the Community Support Service (CSS) sector was forecasting to have a budget surplus at year-end.
Most organizations are in a balanced or surplus position while a few are reporting minor deficits or one time surpluses. The
surpluses are primarily the result of some additional funds received late in the second half of the fiscal year. The LHIN
continues to monitor each CSS agency’s accountability agreement on a quarterly basis and initiates performance
improvement planning as needed.
SAA
6.7 T otal Margin - Mental Health and Addictions Agencies
No Prov target
10
LHIN Target
0
Q3 - 14-15
%
5
Baseline - None
0
Prov Target - None
-5
12-13
Q4
13-14
Q2
13-14
Q3
13-14
Q4
Rank - N/A
14-15
Q2
14-15
Q3
NE
2
CE
1.4
WW
C
1
1
CHP
SW
0.9
SE
0.8
0.8
MH
ESC
0.8
NSM
0.7
0.3
CW
NW
0.3
TC 0.2
HNHB 0
0
4.8
2
4
%
The Mental Health and Addictions Health Service Providers are on track to achieve financial and activity targets. This sector
registered a Total Margin surplus of 1.16 in the third quarter of 2014-15.
E24
Performance Indicator Refresh Schedule
Indicator
Most Recent Period
1.1 Time in ER (Admitted Patients)
14-15, Q4
1.2 Time in ER (Complex patients, Not Admitted)
14-15, Q4
1.3 Time in ER (Uncomplicated - Not Admitted)
14-15, Q4
1.4 Cancer Surgery Wait Time
14-15, Q4
1.5 Cardiac By-Pass Surgery Wait Time
14-15, Q4
1.6 Cataract Surgery Wait Time
14-15, Q4
1.7 Hip Replacement Wait Time
14-15, Q4
1.8 Knee Replacement Wait Tme
14-15, Q4
1.9 MRI Scan Wait Time
14-15, Q4
1.10 CT Scan Wait Time
14-15, Q4
14-15, Q3
Jan 14-Dec 14
1.13 Timely (Same / Next Day) Access to a Primary Care Provider
Oct 13-Sep 14
14-15, Q3
14-15, Q3
14-15, Q3
14-15, Q3
2.5 Long Term Care Placements for Highest Priority Clients
14-15, Q3
2.6 Admission to LTC Homes from Community
14-15, Q4
2.7 Patients Designated ALC Who Were Discharged to Long Term Care Homes
14-15, Q3
14-15, Q3
14-15, Q3
2.10 ER Visits for Conditions That Could be Treated in a Primary Care Setting.
14-15, Q3
Positive Healthcare Experience
Positive Healthcare Experience indicators under development
14-15, Q2
14-15, Q2
14-15, Q3
4.4 Long Term Care Residents with New Pressure Ulcers
14-15, Q3
14-15, Q1
4.6 Hospitalization Due to Falls Among Long-Term Care Residents
14-15, Q3
14-15, Q3
14-15, Q3
14-15, Q4
14-15, Q4
14-15, Q4
5.4 LHIN Staff Turnover
14-15, Q4
5.5 Twitter Followers
14-15, Q4
5.6 Champlain LHIN YouTube Views
14-15, Q4
5.7 LHIN Employee Satisfaction
14-15, Q2
5.8 Website Traffic
14-15, Q4
13-14
6.2 CCAC Home Care Cost Efficiency
12-13
6.3 Total Margin - Hospitals
14-15, Q3
6.4 Total Margin - CCAC
14-15, Q3
6.5 Total Margin - CHC Agencies
14-15, Q3
6.6 Total Margin - CSS Agencies
14-15, Q3
6.7 Total Margin - Mental Health and Addictions Agencies
14-15, Q3
New Data in
Board Report
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
E25
Section F—Methodology
The following describes the methodology used to develop the scorecard.
Section B - Domain Scores
An overall composite score for each domain was derived by modifying each corresponding indicator
measurement scale into a standardized common scale. Indicators were scored based on their status for
the LHIN target.
 3 = Green status which means that performance is meeting or better than target and baseline
 2 = Yellow status which means that performance is better than baseline, but not yet achieving
target
 1= Red status which means that performance has not achieved baseline and/or target.
 Grey status indicators are not included in the domain score because they do not have a target.
The domain score is the average score of all the indicators in that domain that have targets.
The graphs show the trend of each domain’s composite score over the last 4 available periods of data.
Section E – Detailed Indicator Performance Report
Details on the methodology for calculating individual indicators are attached to the electronic version of
the Scorecard in the technical notes. Any exceptions to the methodology shown below are also available
in the technical notes.
Baseline
Baselines are the average performance from the previous year (usually fiscal year) where available.
Rank
Champlain’s rank is based on a numerical ordering of all the other LHINs with a rank of 1 being the top
performing LHIN in Ontario and 14, the worst. A tie with another LHIN will be given the same rank. For
example, if 2 LHlNs are tied for #7, both are given a rank of 7 and the next best LHIN will be given a rank
of 9.
Target Setting Approach
Provincial targets where applicable are set by the Ministry of Health and Long-Term Care.
LHIN targets were set based on the following approach:
1. Indicators contained in the Ministry LHIN Performance Agreement (MLPA)
2013-14 targets were extended to 2014-15 by the Ministry of Health and Long Term
Care. These targets are set by the Ministry in collaboration with the LHIN.
F1
Indicators with sufficient data/information:
If sufficient information is available, the target is set based on the previous year’s
baseline for the Champlain LHIN. If Champlain’s performance is among the top 7 ranked
LHINs, the target will be set to the 7th best LHIN’s performance for the previous year. If
performance is among the bottom 7 LHINs, the target will be set to improve
performance.
2. Indicators with partial data For indicators with partial data available, targets have been set based on industry best
practice and/or historical evidence. In some cases, LHIN targets were set based on
targets set for the region’s individual health care providers (e.g. indicator 4.2 Early
Elective Low-Risk Repeat C-Sections).
3. Indicators with insufficient data
For indicators where there is no industry standard and insufficient historical evidence,
no target has been proposed. Once more data are available, a baseline and target will
be set.
F2
Section G –Acronyms
CCAC
Community Care Access Centre
CT
Computed Tomography
HSAA
Hospital Services Accountability Agreement
HSFR
Health System Funding Reform
IHSP
Integrated Health Services Plan
LSAA
Long-Term Care Accountability Agreement
MLPA
Ministry-LHIN Performance Agreement
MRI
Magnetic Resonance Imaging
MSAA
Multi-Sectoral Accountability Agreement
OPS
Operations
Q
Fiscal Quarter
SAA
Service Accountability Agreement
G1
Champlain Health System
Performance Highlights
June 2015
Brian Schnarch, Director of System Performance and Analysis
Presented to Champlain LHIN Board of Directors
June 24, 2015
Summary Results
How Recent is the Data?
2014-15, Q4
2014-15, Q3
2014-15, Q2 or Q1
Older
1.1 Time in ER (Admitted Patients)
1.2 Time in ER (Complex patients, Not Admitted)
1.3 Time in ER (Uncomplicated - Not Admitted)
1.4 Cancer Surgery Wait Time
1.5 Cardiac By-Pass Surgery Wait Time
1.6 Cataract Surgery Wait Time
1.7 Hip Replacement Wait Time
1.8 Knee Replacement Wait Tme
1.9 MRI Scan Wait Time
1.10 CT Scan Wait Time
1.13 Timely (Same / Next Day) Access to a Primary Care Provider
2.5 Long Term Care Placements for Highest Priority Clients
2.6 Admission to LTC Homes from Community
2.7 Patients Designated ALC Who Were Discharged to LTC Homes
2.10 ER Visits for Conds That Could be Treated in a Primary Care Setting
4.4 Long Term Care Residents with New Pressure Ulcers
4.6 Hospitalization Due to Falls Among Long-Term Care Residents
5.4 LHIN Staff Turnover
5.5 Twitter Followers
5.6 Champlain LHIN YouTube Views
5.7 LHIN Employee Satisfaction
5.8 Website Traffic
6.2 CCAC Home Care Cost Efficiency
6.3 Total Margin - Hospitals
6.4 Total Margin - CCAC
6.5 Total Margin - CHC Agencies
6.6 Total Margin - CSS Agencies
6.7 Total Margin - Mental Health and Addictions Agencies
3
Domain Level, Relative to Targets
4
Performance Against Targets
MLPA indicators Other Indicators All indicators
Meeting target
60% (9)
59% (13)
59% (22)
Almost meeting target
7% (1)
9% (2)
8% (3)
Not meeting target
33% (5)
32% (7)
32% (12)
Total
100% (15)
100% (22)
100% (37)
No target set
8
8
5
Number of MLPA Indicator Targets Currently Being Met (/15)
Champlain
Central
North West
South West
Central East
Toronto Central
Waterloo Wellington
North East
South East
Mississauga Halton
Central West
Erie St. Clair
Hamilt Niag Haldimand Brant
North Simcoe Muskoka
9
9
8
8
7
7
7
6
6
6
5
4
3
2
0
2
4
6
8
10
6
Year over Year Change in Performance
MLPA indicators Other Indicators All indicators
Improved
8 (53%)
11 (44%)
19 (48%)
Little change*
5 (33%)
5 (20%)
10 (25%)
Deteriorated
2 (13%)
9 (36%)
11 (27%)
Total
15 (100%)
25 (100%)
40 (100%)
<1 year data
5
5
*Little change= within 3%. Based on most recent available data and same period one year earlier.
7
Number of MLPA Indicators That Improved Year over Year (/15)*
Champlain
South East
Central
South West
North East
Toronto Central
Erie St. Clair
Hamil Niag Haldimand Brant
North West
Waterloo Wellington
North Simcoe Muskoka
Central East
Central West
Mississauga Halton
10*
9
9
9
7
7
7
6
5
5
4
4
4
3
0
2
4
6
8
10
12
Based on most recent available data and same period one year earlier. 10 indicators improved but reported as
8 on previous slide because those that improved by <3% bit were counted as “little change”.
8
Ongoing
Challenges
In Champlain
Indicators That Deteriorated and Did Not Meet Target
Indicator
MRI Scan Wait Time
Repeat Substance Abuse ED visitors
ALC days Attributable to Palliative Care Patients
ER Visits for Conditions That Could be Treated in a Primary Care Setting
Fall-Related Emergency Department Visit Rate Among Seniors
Fall-Related Hospitalization Rate Among Seniors
Hospitalization Due to Falls Among Long-T erm Care Residents
MLPA
x
x
10
MRI Scan Wait Time
11
Repeat Substance Abuse ED Visitors
12
Alternate Level of Care Days Attributable to
Palliative Care Patients
13
ER Visits for Conditions That Could be Treated
in a Primary Care Setting
14
Falls-Related Emergency Department Visit Rate
Among Seniors
15
Falls-Related Hospitalization Rate Among Seniors
16
Hospitalization Due to Falls Among Long-Term
Care Residents
17
Next Steps
• Indicator development:
•
•
•
•
Patient experience
French language services
Aligned with MLPA 2015-16
Aligned with IHSP 2016-19
• Continue to focus attention and drive
performance improvement
• Next issue: September
MLPA=Ministry-LHIN Performance Agreement: IHSP= Integrated Health Services Plan.
18
Appendix
Additional detail
19
All Indicators Relative to Targets
Improved
Patients in Acute Hospital Beds Needing Other Care (%ALC)
Cancer Surgery Wait Time
Cardiac By-Pass Surgery Wait Time
Hip Replacement Wait Time
Knee Replacement Wait Time
Time in ER (Complex patients, Not Admitted)
Time in ER (Uncomplicated - Not Admitted)
Wait for Home Care (Community Clients)
Early Elective Low-Risk Repeat C-Sections
High Priority Clients Receiving CCAC Care at Home
LHIN Operational Budget Variance
LHIN Staff Turnover
Long T erm Care Residents with New Pressure Ulcers
Long Term Care Placements for Highest Priority Clients
Patients Designated ALC Who Were Discharged to Long Term Care Homes
Total Margin - Community Care Access Centre
Total Margin - Community Health Centres
Total Margin - Hospitals
Total Margin - Mental Health and Addictions Agencies
MLPA
x
x
x
x
x
x
x
x
21
Little change
Repeat Mental Health ED visitors
Cataract Surgery Wait Time
CT Scan Wait Time
Readmissions for Certain Chronic Conditions
Time in ER (Admitted Patients)
Admission to LTC Homes from Community
Adults With a Primary Care Provider
Hospital Cost Efficiency
Hospitalization Rate for Ambulatory Care Sensitive Conditions
Physician Visit Within 7 days of Discharge
MLPA
x
x
x
x
x
22
Deteriorated
MRI Scan Wait Time
Repeat Substance Abuse ED visitors
ALC days Attributable to Palliative Care Patients
Champlain LHIN YouT ube Views
Complex Care Hospital Patients with New Pressure Ulcers
ER Visits for Conditions That Could be Treated in a Primary Care Setting
Fall-Related Emergency Department Visit Rate Among Seniors
Fall-Related Hospitalization Rate Among Seniors
Hospitalization Due to Falls Among Long-T erm Care Residents
Total Margin - Community Support Services
Timely (Same / Next Day) Access to a Primary Care Provider
MLPA
x
x
23
<1 year of data
LHIN Employee Satisfaction
LHIN Enterprise Risk Assessment
Status of LHIN Annual Business Plan Initiatives
Twitter Followers
Website Traffic
MLPA
24
2015-16 Champlain LHIN
Annual Business Plan
Presentation to the Champlain LHIN Board of Directors
June 24, 2015
What is the ABP?
•
Outlines how the LHIN will use its various resources to achieve its
strategic directions and goals
•
Focuses on the 2015/16 fiscal year and projects out to 2017/18
•
Follows Ministry of Health and Long Term Care (MOHLTC)
guidelines and pre-set format
•
Highlights those interventions where the LHIN is the main driver and
plays a significant role in the execution of the intervention
•
The ABP is not intended to list:
• All interventions that involve the LHIN as a partner and/or funder
• Initiatives associated with internal operations
2
ABP Development Process
•
ABP development involved several written exercises and discussions to
ensure alignment with:
• Integrated Health Service Plan (IHSP) & Ministry-LHIN Performance
Agreement (MLPA)
• MOHLTC Announcements (e.g. Health Links, Health System Funding
Reform)
• French Language Services planning efforts
•
Staff participated in a retreat that was used to build a shared understanding of
our planned work and identify opportunities for collaboration
•
ABP was developed based on funding and resource assumptions
•
Sections on Aboriginal Health were informed through engagement with the
Aboriginal Health Circle Forum (AHCF).
3
2013-2016 IHSP Alignment
ABP is designed to have
strong alignment with the
IHSP
Interventions align with
our 3 IHSP Strategies
Produce results in 6 Key
Result Areas
An intervention may
impact one or more Key
Result Area
The degree of focus on
particular KRAs changes
over the course of the
three year IHSP
4
IHSP Strategies
Strategy #1 - Build a strong foundation of integrated primary, home
and community care
Number of 2015/16 ABP Interventions = 23
Examples:
• Provide competency training on Aboriginal culture to mental health
and addiction service providers
•
Establish new mental health and addictions services within new
housing settings targeted to the homeless using a "Housing First“
approach
•
Support Health Links across the region to implement coordinated care
plans for people with complex health needs
5
IHSP Strategies
Strategy #2 - Improve coordination and transitions of care
Examples:
• Sustain and expand Champlain's electronic consultation service,
enhancing interaction between family physicians and specialists to
improve patient care
•
Implement standardized referral forms and processes to facilitate
transfers from acute care hospitals to other settings
•
Implement process to allow community support service agencies to
meet personal care needs of persons with lower levels of care need
6
IHSP Strategies
Strategy #3 - Increase coordination and integration of services among
hospitals
Examples:
• Implementation of the local elements of Health System Funding
Reform for 2015/16
•
Implement Small Hospital Transformation Initiatives (Electronic
Medical Record adoption, Educational Course Repository, Regional
Pharmacy, Clinical Information Integration)
•
Reduce wait times for Computed Tomography (CT) and Magnetic
Resonance Imaging (MRI), including the implementation of a new
MRI in Pembroke
7
Measures, Risks, and Enablers
•
Measures were selected that relate
to the interventions in the ABP
and our IHSP Key Result Areas.
Many ABP measures appear on
the LHIN Performance Scorecard.
•
Risks – e.g. Financial/Economic, Project Complexity,
Technical Issues, Change Management
•
Enablers – e.g. HSP collaboration, existing momentum,
information/information technology, MOHLTC leadership
& commitment
8
LHIN Spending and Staffing Plans
LHIN Spending Plan
• Reflects 2014/15 audited figures
• Provides overview of the 2015/16 LHIN Operating Budget and
projections until 2017/18
• Does not include special initiative funding provided to the LHIN
LHIN Staffing Plan
• Provides overview of 2015-16 LHIN Staffing Plan and projections
until 2017/18
• Does not include temporary positions
9
Communications and Community Engagement Plans
Communications Plan
• Details the measurable communications objectives for 2015/16
• Describes target audience, key messages and tactics
• Explains evaluation of communication strategy
Community Engagement (CE) Plan
• Explains the LHIN’s commitment to Community Engagement
• A more comprehensive detailing of community engagement
activities is available in the 2015/16 Community Engagement Plan
10
Changes Since March Draft ABP
•
Added Transmittal Letter
•
Updated to reflect new information:
• Health Link status
• Provincial directions
• Resource Assumptions
•
LHIN Operations Spending Plan updated to reflect
2014/15 audit and 2015/16 approved budget
11
Questions?
12
Board Motion
Be It Resolved that the Champlain LHIN
Board of Directors approves the 2015-16
Champlain LHIN Annual Business Plan
13
Community Engagement
Report 2014-15
Plan 2015-16
Jessica Searson
Board Presentation
June 24, 2015
Agenda
1) Community Engagement at the Champlain LHIN
2) Report 2014-15
3) Plan 2015-16
4) Board Motion to Approve Community Engagement Plan
2015-16
2
What is Community Engagement?
“People working
collaboratively, through
inspired action and learning,
to create and realize bold
visions for their common
future.”
- Tamarack Institute for Community
Engagement
3
Through community engagement we can
achieve:
• Focus on needs of people
• Enhanced local accountability
• Shared sense of understanding
and responsibility for health
system improvements
• Informed decision-making,
focused on needs of people
impacted
• Locally sustainable solutions,
appropriate to each community
4
Community Engagement Report 2014-15
Key Questions:
• Who did we engage?
• What are outcomes of community
engagement?
• What are the key findings?
• How many people did we reach?
• How did we engage with the
community?
5
Who did we engage?
• Members of the public
• Health consumers
• Health professionals
• Health service providers
• Specific populations
• Strategic partners
6
How many people did we reach?
• Over 180 one-time and 95 ongoing engagements.
• Connected with approximately 8,000 people
• Roughly 38% with health consumers and members of the
public
7
Expanding Health Consumer Engagement
• Increased health consumer
engagement from 18% last
year to 38% this year
• Variety of strategies and
techniques used (e.g. client
voices, patient
representatives, survey)
Health
Consumers /
Public
38%
Health
Providers /
Partners /
Professionals
62%
8
Patient Enquiries / Complaints (2014-15)
9
Patient Enquiries / Complaints (2014-15)
10
How did we engage?
• Meetings
• Initiative-specific engagements
(e.g. Mental Health and Diabetes
Knowledge Exchange)
• Advisory Committees and
Groups
• Traditional and social media
• Board Meeting “Meet-andGreet” sessions
11
Population-based Engagement
• Consultations to inform
decisions and improve and
expand mental health and
addictions services for
Aboriginal people
• Collaborative session on
immigrant health issues with
board members and staff from
Ottawa-based Community
Health Centres
• Partnering with Le Réseau to
support French-language
services designation
12
Mental Health and Diabetes Knowledge
Exchange
• Workshop on how health care
providers can work together
to better understand the
complexities of living with
diabetes and mental illnesses
“…This has been one of the best
training/education days….and I am
looking forward to putting some of
the training (and tools discovered
during training) into practice.
It was nice to have a client tell their
story and a family member, and then
to allow them to participate in
discussions during our case studies
as well.”
13
Outcomes of Community Engagement
350
300
41
45
250
200
150
Other Outcomes
64
60
Fostered new relationships and linkages
Increased public awareness of LHIN’s
work
Advanced Transformation Efforts
100
50
Advanced Planning Efforts
120
0
Number of community engagement activities
14
Key Findings
• Met four key outcomes of our
community engagement
strategy this year
• Relationship-building and
bringing people together to
spark unique initiatives
• Patients First: continue to
expand health consumer
engagement and
opportunities for meaningful
engagement
15
Community Engagement Plan 2015-16
1) Foster better understanding of LHIN and support for programs in
development of a person-centred health system
2) Collaborate with Providers and partners to improve community
engagement practices
3) Engage local communities to advance key result areas for health
system change.
16
Foster Better Understanding of LHIN and
Support for its Programs
• Host monthly board meetings
and meet-and-greet sessions
in cities and towns across the
region
• Participate in health service
provider public events (e.g.
Annual General Meetings,
health fairs and symposia)
17
Collaborate with Providers and Partners to
Improve Community Engagement Practices
• Community Engagement in
the development of the
Integrated Health Service
Plan
• Patient Experience
Representatives
• Collaborate with health
service providers in the
creation of the Transitional
Aged Youth Investment
Strategy
• Establish a Regional
Leadership Team in palliative
care
18
Advance Key Result Areas (examples of networks)
• Acquired Brain Injury Coalition
• Addictions and Mental Health
Network of Champlain
• Champlain Cardiovascular
Disease Prevention Network
• Champlain Community Support
Network
• Champlain Critical Care
Network
• Health Professional Advisory
Committee
• Health System Funding Reform
Partnership
• Hospital CEOs and CCAC
Leadership
• Long-Term Care Liaison
Committee
• Rehabilitation Network of
Champlain.
19
Population-based Engagement
• Collaborate with Le Réseau to
organize a seniors’ health fair in
Casselman
• Participate in the Ottawa
Immigration Forum to exchange
information programs and
collaborate on future actions
• Engagement to identify the gaps
in services, priorities and needs
of Aboriginal people for
coordinated diabetes care and
services
20
Evaluation
• Use participant evaluation and
feedback forms at community
engagement events
• Assess the achievements of our
goals to advance the Integrated
Health Service Plan 2013-16
• Monitor performance against
Community Engagement Plan
• Continuously improve processes
to ensure meaningful
participation in LHIN planning
and decision-making.
21
Questions
22
Motion
• Whereas community engagement is
integral when developing priorities
and plans,
• Be It Resolved that the Board
approve the proposed
Community Engagement Plan 201516.
• Whereas the LHIN has designed its
Community Engagement Plan to
support the achievement of the IHSP
2013-16 key result areas and health
improvement initiatives of the
Annual Business Plan 2015-16,
23
2016-19 Integrated Health Service Plan
Presentation to the Champlain LHIN Board
June 24, 2015
Objectives
• Strategic Planning Overview
• Approval of Vision, Mission and Values
• Forthcoming Key Steps
2
Context – Local Health System Integration Act
The Integrated Health Service Plan…
“shall include a vision, priorities and strategic directions for
the local health system and shall set out strategies to
integrate the local health system in order to achieve the
purpose of this Act,… and shall be consistent with a
provincial strategic plan, and the funding that the network
receives.”
3
Change is Necessary to Our Environment
Ontario’s health care system is facing significant challenges over the next few years
Fiscal Challenge
Demographic Challenge
•
•
Historic levels of investment
growth are not seen to be
sustainable
Complex Health Challenge
•
•
Source: MOHLTC
A small number of patients use
a disproportionate amount of
resources
Making better use of our
health care resources so
people get the most
appropriate care
•
The cost of care for a senior
is 3x higher than for the
average person
Changing demographics will
result in a higher cost to the
system
Unhealthy Lifestyle Challenge
•
Unhealthy eating, lack of
activity and smoking levels
may lead to increased
chronic disease
4
Key Assumptions
 Building upon progress to date….
 Growth from within…
5
Elements of a Strategic Plan
Strategic
Foundation
Goals /Health
Outcomes
• Vision, Mission, Values
• What are we aiming to achieve & for whom?
Strategic
Directions
• Where are we going?
Priorities &
Actions
• How do we get there?
Performance
Measures
• What does success look like?
6
Provincial Alignment
• MOHLTC Patients First: Action Plan
for Health Care:
• A caring, integrated experience for patients
• Faster access to quality health services
• For all Ontarians at every life stage
7
Key Initiatives that must be Reflected in the Plan
1. Mental Health and Addictions Strategy
2. Health System Funding Reform
3. Home and Community Care
4. Health Links
5. Palliative Care
8
Source: Integrated Health Services Plan 2016/17 to 2018/19 Memo from Nancy Naylor, April 28, 2015
LHIN IHSPs Over Time
2007-2010
•Access
•Primary Health Services for
Healthy Communities
•Chronic Disease Prevention
and Management
•Addictions and Mental
Health
•Elderly with Complex and
Chronic Conditions
•E-Health Strategy
2010-2013
2013-2016
•People with Complex Health
Conditions
•More people are involved in
planning their health
services
•People with Pre-Diabetes or
Diabetes
•People with Mental Health
Issues and/or Problematic
Substance Use
•Residents of Champlain
2016-2019
•More people receive quality,
evidence-based care
•More people with mental
health conditions &
addictions have access to
services
•More seniors are cared for in
their communities
•More people with complex
health conditions are able to
manage their conditions
•More people at end-of-life,
families and caregivers
receive palliative care
supports in their setting of
choice
?
9
Planned Board Engagements
Preparation
& Planning
Environmental
Scan
Board approves:
• High-level
development plan
• Patient /
community
engagement
approach
Board reviews:
• Current state of
Champlain Health
System. (e.g.
environmental
scan, patient
experience
surveys etc.)
• May
–
Governance
Committee
6th
Board reviews:
• Definition of an
integrated,
patient-centred
system
• May 21st
Strategic
Framework
Stakeholder
Engagement
Board approves:
• Draft strategic
framework
• Draft target
populations and
outcomes
• Board participates
in stakeholder
engagement
sessions (June 8 –
• May 27th – June
11th
Board reviews:
• LHIN Mission,
Vision, Values
• June 24th – Board
Mtg.
Oct 4)
• Interim and final
summaries of
stakeholder
feedback (mid-
Sept to mid-Oct)
Strategic Plan
& Measurement
Board approves:
• Draft strategic
directions
• Sept 15th
• Draft actions and
indicators
• Sept 23rd
• Final IHSP
• Nov 25th –
Board Mtg.
• May 21st
10
Our Strategic Foundation
• Vision: Healthy people and healthy communities
supported by a quality, accessible health system
• Mission: Building a coordinated, integrated and
accountable health system for people where and
when they need it
• Values: Respect, Trust, Openness, Integrity,
Accountability
11
Champlain Integrated Health System Planning Process
1
Preparation &
Planning
• Internal Project Team
• Pan-LHIN IHSP Roadmap
• Board Approval of Approach
2
Current state of Champlain Health
System e.g.
• LHIN Scorecard
• Provincial Environmental Scan
• Sub-LHIN analyses
• Patient experience surveys
May –June 2015.
4
Stakeholder
Engagement
• Patient /Family Advisory Group
• Preliminary Survey Consultation
• Communities of Practice
• Health Care User Consultations
• Summaries of stakeholder
feedback
July – October 2015.
3
Environmental Scan
•
•
Approval of Strategic Foundation
(Vision. Mission, Values)
Draft Priority Populations and
health outcomes
June-July 2015.
5
Draft Strategic Plan
& Measurement
Strategic
Framework
June 2015.
6
Final Report
Draft Strategic Directions
Draft Strategic initiatives & indicators
Sept – October 2015
November 25, 2015
12
CMNRP WILL ADD VALUE TO ITS PARTNERS BY:
1.
Championing the transition of the maternal-newborn continuum of care from
hospital to community
The Calling
There is a growing interest from families, communities and hospital leadership to strengthen the patient
voice, enrich the family experience and deliver more cost-effective yet quality care by “normalizing” all of
the components associated with the pregnancy and birth experience. This will require a significant shift
over time from hospital-based to community-based services, through the establishment of fully
integrated services directly in the community. New provincial priorities, recent pilot initiatives in birthing
centres and out-patient clinics, coupled with the growing availability of innovative mobile technologies in
personal health assessment and monitoring support the timeliness of this strategy.
The Objectives
1.1 Establish a complete care-mapping pathway for the maternal newborn care spectrum (from
pregnancy to postnatal period) to guide future expansion of community-based resources and to
inform system-capacity planning within the respective LHINs.
1.2 Reduce the average hospital postpartum length of stay by enhancing the capacity to follow women
and newborns in the community.
1.3 Support strategies that assist the Ottawa Birth & Wellness Centre’s continuing growth and success
in meeting its targets.
1.4 Increase the voice and engagement of women and families in the design and delivery of all aspects
of perinatal care services throughout the region.
April 2015
Page 1
CMNRP’s Strategic Imperatives 2015-2018
2.
Driving performance and quality through metrics and data
The Calling
The Champlain and South-East LHINs need to increase their utilization of BORN and other data to effect
system and facility change and to track progress on broader provincial and regional care initiatives.
Individual facilities need readily available information to measure the implementation rates and the
impact of change initiatives on both the quality of care and the patient experience. The translation of
system data to LHIN- and facility-specific information will require data analysis capacity.
The Objectives
2.1 Establish regional data monitoring, use and analysis capacity to guide LHIN-wide system
planning and identify performance and quality-improvement priorities.
2.2 Achieve and/or sustain green status on current BORN Dashboard Key Performance Indicators.
2.3 Engage hospitals and community agencies in the implementation of maternal-newborn best
practices, in line with regional and provincial priorities∗.
2.4 Develop key maternal-newborn performance and quality metrics for LHIN incorporation in
accountability agreements.
3.
Fostering knowledge-to-action (KTA)
The Calling
Programs that promote inter-professional knowledge and skill acquisition, enhancement and
maintenance remain a priority need of CMNRP partners. However, the need to build capacity and
contain costs are driving CMNRP to deliver education through a train-the-trainer model with content
heavily focused on helping partner organizations meet regional and provincial initiatives. Other
knowledge-to-action (KTA) activities, including current site visits, need to be re-designed and
strengthened to support new trends, specific local needs and inter-organizational participation.
The Objectives
3.1 Shift CMNRP’s educational focus to building knowledge and skill across professions and scopes of
practice through a “train-the trainer” model.
3.2 Focus KTA efforts on supporting regional and provincial initiatives and priorities*.
3.3 Re-design the site visit program for increased value, impact and cost effectiveness.
∗
E.g. MOHLTC’s Hyperbilirubinemia and Cesarean Section Quality-Based Procedures (QBPs), Baby Friendly Initiative (BFI)
April 2015
Page 2
CMNRP’s Strategic Imperatives 2015-2018
4.
Achieving sustainability to deliver on CMNRP’s vision
The Calling
The current funding model is basically a “user-pay system” where a small amount of base administrative
funding from the LHIN is supplemented by partner membership funding and by revenue-generating
activities. As the financial pressures within the partner organizations increase, the stability of CMNRP’s
service delivery will be threatened regularly by each partner’s crisis-driven fiscal decisions. Forcing
CMNRP to conduct off-setting revenue-generation activities will detract from its core mandate and
jeopardize its critical deliverables. CMNRP needs to not only increase its visible relevance to the
individual needs of its ultimate funding sources, but also inject clarity in and give a voice to the value the
network brings to the partners and the entire region.
The Objectives
4.1 Secure an alternate funding model that will enable and support CMNRP in delivering on its new
strategic directions.
4.2 Prioritize and re-align financial and human resources to deliver on the new strategic directions.
4.3 Review the governance and committee structure of CMNRP to ensure supportive oversight of and
participation in the new strategic directions.
4.4 Maximize the “partner experience” with CMNRP through a structured partner engagement plan.
4.5 ‘Take the Stage’ – Craft and communicate the stories that demonstrate the value-add of CMNRP’s
results and system-wide impacts.
April 2015
Page 3
Champlain Maternal Newborn Regional Program
Strategic Imperatives 2015-2018
Presentation to the Champlain LHIN Board of Directors
June 24, 2015
Introduction
•
2006 – Broad consultation on regional maternal newborn services
•
2010 – LHIN decision to establish regional program
•
CMNRP:
• Supports the provision of evidence-informed, high quality health
care and health promotion for mothers, newborns and families,
for improved health outcomes
• Supported by an Advisory Network and several sub-committees
• Advisory body to both the Champlain and South East LHINs
•
Proposed CMNRP Strategic Imperatives 2015-18 are well aligned
with Champlain LHIN Strategic Plan
2
A Few Accomplishments
•
CMNRP key role in reducing early elective, low-risk C-sections.
– 2014/15 Q2 = 12%. Ranked 2nd of 14 LHINs
•
CMNRP regional guideline was adapted by the province to create
the Hyperbilirubinemia Quality Based Procedure
•
Regional Documentation Tools and various guidelines
•
Providers of consultations and professional development in the
region
•
Neonatal Nurse Practitioner Program – clinical care and teaching
supports to neonatal units in Champlain
•
Led the successful application to MOHLTC for the establishment of
the Ottawa Birth & Wellness Centre in Ottawa
•
Leading a Midwifery Capacity Task Force to address demand
3
Strategic Plan 2015-2018
Overview of Process and Plan
4
Objectives
 Review environmental scan process
 Share CMNRP’s Strategic Imperatives for
2015-2018
5
What informed us …..
Stakeholders
survey data
Thoughtleaders
interviews
Trend
analysis
summary
CMNRP
Forum
CMNRP
Network
Staff input
CMNRP
standing
committees
SE
Network
meeting
6
CMNRP Strategic Planning
Key Stakeholders Consultations & Interviews 2014-15

















CMNRP Program Staff
Interview with Champlain LHIN’s CEO
CMNRP Network
Quality Performance Management Committee
Breastfeeding Promotion Committee
CMNRP’s Annual Forum
Family Advisory Committee
Inter-professional Education Research Committee
South East Maternal-Newborn Network
Steering Committee
Interview with PCMCH’s Executive Director
Key stakeholders online survey
Interview with South West Network (London)
Interview with BORN’s Director
Interview with OPH’s Associate Medical Officer of Health
Interview with South East Network’s Co-Chairs
Interviews with TOH, CHEO, KGH leadership
Nov. 5 + survey
Nov. 6
Nov. 7 & Dec. 2
Nov. 17
Nov. 18
Nov. 20
Nov. 25
Nov. 26
Nov. 26
Dec. 12
Dec. 5
Dec. 16 - Jan.7
Dec. 30
Jan. 5
Jan. 22
Jan. 23
Feb.-March
Draft of Strategic Imperatives presented to CMNRP Team and CMNRP Committees
through March-April 2015
BORN – Better Outcomes Registry and Network
OPH – Ottawa Public Health
PCMCH – Provincial Council for Maternal and Child Health
TOH – The Ottawa Hospital
CHEO – Children’s Hospital of Eastern Ontario
KGH – Kingston General Hospital
7
Trends with the women
and families…
More of a “consumer” than patient mindset
Greater hunger for information
More intense, personalized birthing experience
More engagement and involvement in the planning
process
 Fewer interventions – a continuing trend towards
normalizing and “de-medicalizing” the birth experience
 Higher expectations re: accessibility
 Different generation than many of the service
providers



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8
Sample of the highest-impact trends
for CMNRP
Technology revolution
Financial challenges
Re-direction of Ministry funding into other specialty areas
Accountability – value, impact metrics, customized services
Declining birthrate in some areas affecting skill acquisition/ retention
Efforts to ‘normalize’ pregnancy/birth position hospital care as the
exception and drive toward reduced length of stay
 Growing tension between system maximization through
centralization vs. delivery of services closer to home
 Other new provincial programs on the scene – e.g. Best Start

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9
Our answer to the
vision question:
“What is this world of tomorrow
calling CMNRP to be?”
10
CMNRP:
Standardizing the Care,
Customizing the Experience
Along the Maternal-Newborn
Care Continuum
11
CMNRP will add value to its partners by:
1. Championing the transition of the maternal-newborn
continuum of care from hospital to community
Strategic Objectives for March 31, 2018:
1.1 Establish a complete care-mapping pathway for the
maternal newborn care spectrum (from pregnancy to
postnatal period) to guide future expansion of
community-based resources and to inform systemcapacity planning within the respective LHINs.
1.2 Reduce the average hospital postpartum length of stay
by enhancing the capacity to follow women and
newborns in the community.
1.3 Support strategies that assist the Ottawa Birth &
Wellness Centre’s continuing growth and success in
meeting its targets.
1.4 Increase the voice and engagement of women and
families in the design and delivery of all aspects of
perinatal care services throughout the region.
12
2. Driving performance and quality through metrics
and data
2.1 Establish regional data monitoring, use and analysis capacity to
guide LHIN-wide system planning and identify performance and
quality-improvement priorities.
2.2 Achieve and/or sustain green status on all current BORN
Dashboard Key Performance Indicators.
2.3 Engage hospitals and community agencies in the implementation of
maternal-newborn best practices, in line with regional and provincial
priorities*
2.4 Develop key maternal-newborn performance and quality metrics for
LHIN incorporation in accountability agreements.
*e.g. MOHLTC’s Quality Based Procedures (QBPs),
Baby Friendly Initiative (BFI)
13
3. Fostering knowledge-to-action (KTA)
3.1 Shift CMNRP’s educational focus to building knowledge and skill
across professions and scopes of practice through a “train-the
trainer” model.
3.2 Focus KTA efforts on supporting regional and provincial initiatives
and priorities *
3.3 Re-design KTA activities such as the site visit program for
increased value, impact and cost effectiveness.
14
4. Achieving sustainability to deliver on CMNRP’s vision
4.1 Secure an alternate funding model that will enable and support
CMNRP in delivering on its new strategic directions.
4.2 Prioritize and re-align financial and human resources to deliver on
the new strategic directions.
4.3 Review the governance and committee structure of CMNRP to
ensure supportive oversight of and participation in the new strategic
directions.
4.4 Maximize the “partner experience” with CMNRP through a
structured partner engagement plan.
4.5 ‘Take the Stage’ – Craft and communicate the stories that
demonstrate the value-add of CMNRP’s results and system-wide
impacts.
15
www.cmnrp.ca
16
Board Motion
Be It Resolved that
the Champlain LHIN Board of Directors
endorses the 2015-18 Strategic Imperatives of the
Champlain Maternal Newborn Regional Program
17
Champlain Hospice Palliative Care Action Plan
2014-2019
By the Champlain Hospice Palliative Care Program
July 2014
1
Table of Contents
_Toc392246054
1. Foreword .................................................................................................................................... 3
2. Key recommendations at a glance ............................................................................................... 4
3. Introduction ................................................................................................................................ 5
4. Importance of Hospice Palliative Care .......................................................................................... 7
5. Strategic Directions ..................................................................................................................... 8
Our Vision ...................................................................................................................................... 8
Our Values and Assumptions ........................................................................................................ 8
The importance of building a regional system ............................................................................. 8
Proposed Hospice Palliative Care System ..................................................................................... 9
Recommended Hospice Palliative Care Service Model ................................................................ 9
Advocacy as a strategy to advance hospice palliative care ........................................................ 11
6. Implications for Stakeholders .................................................................................................... 12
7. Focus Areas ............................................................................................................................... 15
Focus area 1: Equitable access to hospice palliative care ......................................................... 15
Focus area 2: Hospice palliative care across a full continuum of care ...................................... 17
Focus area 3: Capacity building across care settings .................................................................. 19
8. Priorities ................................................................................................................................... 21
9. The Action Plan ......................................................................................................................... 23
10. References .............................................................................................................................. 26
11. Appendices.............................................................................................................................. 27
Appendix A: Champlain Hospice Palliative Consultations – Invitees and Participants............... 27
Appendix B: Detailed Current and Projected Acute Palliative and Residential Hospice Beds ... 35
Appendix C: Champlain Hospice Palliative Care Indicators ........................................................ 37
Appendix D: The Rural Hospice Palliative Care Program Framework ........................................ 40
2
1. Foreword
A message from the Chair of the Champlain Hospice Palliative Care Program Board
In 2010, the Champlain Local Health Integration Network brought the challenge of managing end-oflife care for citizens of the Champlain region front and centre. It provided the Regional Hospice
Palliative Care Program with the mandate and resources to integrate and better coordinate the
delivery of hospice palliative care in all settings.
Since then, the Champlain Hospice Palliative Care Program actively engaged many stakeholders to
identify and address key issues in order to provide easier, timely, and more access to coordinated
hospice palliative care to all residents of Champlain. This Action Plan is the outcome of these
consultations and focuses on providing equitable access and building capacity across care settings.
Over the next five years, implementation of this plan will aim to ensure that there will be
comprehensive hospice palliative care available to all residents of Champlain. It will ensure that across
Champlain people can live out their lives with quality care, and with as much dignity and comfort as
possible. It will also position Champlain to become a region of excellence, which can be leveraged
across the province.
Achieving these changes will require sustainable funding to provide the highest quality hospice
palliative care the plan outlines.
Most importantly, it will require strong leadership, partnership and cooperation among all
stakeholders. We all will need to “lift our game” to enable change. This Strategy and Action Plan
illustrates the direction we need to take.
Sylvie Lefebvre
Board Chair
3
2. Key recommendations at a glance
The recommendations in this Action Plan are the result of an analysis of evidence and consultations
with multiple community and health system partners and stakeholders over the last three years.
Recommendations have been organised into three focus areas to advance comprehensive hospice
palliative care across Champlain over the next five years.
Focus Area 1: Equitable access to hospice palliative care
Hospice palliative care services need to be designed to be accessible to all who need them and have
sustainable funding. Specifically, we need to:
1. Ensure hospice palliative care services are responsive to the diversity of all residents of Champlain. This
includes: urban, rural and remote populations; Francophone and other culturally/linguistically diverse
populations; Aboriginal communities; and other vulnerable populations, such as children, individuals
living with disabilities, GLBTQ and the homeless.
2. Provide sustainable funding for residential hospices by increasing funds to a minimum of 80% of total
operating costs.
3. Establish dedicated funds to develop and/or enhance inter-professional palliative care teams in
hospitals across Champlain.
4. Develop a strategy to engage primary care providers to provide palliative care to their own patients.
Focus Area 2: Hospice palliative care across a full continuum of care
A comprehensive continuum of care is required to support more individuals who desire to remain in
their communities until the end of their lives. This support is for individuals, caregivers and their
families from diagnosis through to and beyond death. Specifically, we need to:
1.
2.
3.
4.
Enhance in-home palliative care services.
Increase access to day hospice and home visiting services.
Increase the number of residential hospice beds across Champlain.
Ensure the staffing level for the tertiary Palliative Care Unit is appropriate to meet the complex physical,
social and spiritual needs of individuals and their families.
Focus Area 3: Capacity building across care settings
Building capacity across our health care system will develop a strong and sustainable foundation for
which to build enhanced hospice palliative care services. Specifically, we need to:
1. Implement a public awareness campaign in Champlain about hospice palliative care, advanced care
planning, and how to access local services.
2. Finalize and implement a regional bereavement plan.
3. Enhance capacity at the primary level to provide palliative care services.
4. Implement and promote a regional strategy and standards for palliative care education across care
setting, across professionals, and from school to the workplace.
5. Implement and monitor targeted standards and performance indicators.
4
6. Implement the rural framework to build capacity in rural communities.
7. Assess the feasibility to implement electronic tool to integrate services.
8. Support the development of volunteer programs.
3. Introduction
The Champlain Local Health Integration Network (LHIN) has identified hospice palliative care as a
priority in their Integrated Health Service Plan 2013-2016. Specifically, the LHIN is working to ensure
“more people at end of life, families and caregivers receive palliative care supports in their setting of
choice”. The Champlain Hospice Palliative Care Program has been given the mandate from the
Champlain LHIN to set strategic directions and coordinate hospice palliative care services to achieve
this goal.
The Champlain Hospice Palliative Care Program (The Regional Program) has been collaborating with
community members and partners to provide a comprehensive continuum of hospice palliative care
services in Champlain since its inception in 2010. We are working towards a hospice palliative care
system that is accessible, integrated across the region, sustainable, high quality, and improves the
health and quality of life of individuals, families, and caregivers both preceding and following death.
Under the leadership of The Regional Program, and with the support of multiple partners and the
Champlain LHIN, there has been significant progress to advance and integrate hospice palliative care
services across Champlain since 2011. For example:

An integrated hospice was established in Ottawa which expanded community hospice services,
increased the number of residential hospice beds at Hospice Care Ottawa from nine to nineteen, and
contributed to the development of a centralized access point for hospice palliative care in Ottawa.

A unique model to provide residential hospice services in Barry’s Bay, a remote community in Renfrew
County, was developed and implemented.

Volunteer visiting services and community hospice programs were expanded in Kemptville.

Hospice palliative care services in hospitals and hospices across 12 program sites have been connected
through the Ontario Telemedicine Network with support from The OutCare Foundation and the
Champlain LHIN.

Palliative Care Nurse Practitioners were integrated with the well-established Palliative Pain and
Symptom Management Team to create the new Regional Palliative Consultation Team to support
capacity building among primary care providers.

Standards and indicators were developed for our local hospice palliative care organizations to support
regional planning and organizational quality improvement initiatives.
This Action Plan is the result of an analysis of evidence and consultations with multiple community
and health system partners and stakeholders over the last three years. Prioritized recommendations
are identified in this Action Plan to advance hospice palliative care across Champlain over the next
five years. Thanks to the many individuals and organizations that contributed to the development of
5
this plan by identifying local successes, challenges and potential solutions to enhance hospice
palliative care for all people in all areas across Champlain. It would not have been possible without
you.
This Action Plan builds on two cornerstone documents: 1) The inaugural Champlain Hospice Palliative
Care Program Plan (May 2010); and 2) Advancing High Quality, High Value Palliative Care in Ontario:
A Declaration of Partnership and Commitment to Action (December 2011)1. The inaugural plan set
out a vision to strengthen and coordinate end of life care across Champlain and was instrumental in
the establishment of The Regional Program in 2011. The Declaration of Partnership outlines guiding
principles, goals, and specific action commitments for Regional Hospice Palliative Care Programs,
LHINs, Ministry of Health and Long Term Care, and other hospice palliative care stakeholders across
Ontario.
This Action Plan is designed to be used by both health system planners and local organizations to
advance hospice palliative care in Champlain aligned with our regional vision.
6
4. Importance of Hospice Palliative Care
Hospice palliative care is a philosophy of care that aims to relieve suffering and improve the quality of
living and dying. It strives to help individuals, families and caregivers to:
 Enhance quality of life prior to death by addressing the physical, psychological, social, spiritual
and practical issues, and their associated expectations, needs, hopes and fears;
 Prepare for and manage self-determined life closure and the dying process;
 Cope with loss and grief during the illness and bereavement; and
 Die with dignity in their place of choice1.
Despite significant progress to advance hospice palliative care both locally and provincially over the
past years, there continues to be inadequate and inequitable access to integrated and comprehensive
hospice palliative care. Furthermore, it is expected the demand for hospice palliative care will
increase as a growing percentage of our population gets older and more individuals are living with
chronic disease. It is estimated that only 16-30% of Canadians have some level of access to hospice
palliative care and the majority of deaths currently occur in hospital2.
For individuals at end of life, access to hospice palliative care can mean: a better quality of life; care
that is less aggressive and more consistent with their preference; and the ability to receive care and
die in their place of choice.
Support for families and caregivers is also inadequate and inconsistent. It is estimated more than
150000 family members and friends across Champlain are currently providing care —including those
caring for someone at end-of life3. Given our aging population, the number of caregivers and the
burden on those caregivers is expected to increase.
For families and caregivers, access to hospice palliative care can mean: enhanced support to reduce
the emotional, physical and psychosocial stresses; respite; confidence the end of life care plan is in
accordance with their loved ones’ wishes; and improved bereavement.
Lastly, the current system is not integrated or resourced enough to provide comprehensive hospice
palliative care from diagnosis to end of life to bereavement for all who need it.
For the health system, access to an integrated continuum of hospice palliative care services means:
improved client and family experience; improved health outcomes; and more cost effective health
care.
7
5. Strategic Directions
Our Vision
The vision established for advancing hospice palliative care in The Declaration and Commitment to
Action (Dec 2011) is:
Adults and children with progressive life-limiting illness, their families and their caregivers will
receive the holistic, proactive, timely and continuous care and support they need, through the
entire spectrum of care both preceding and following death, to:
 help them live as they choose, and
 optimize their quality of life, comfort, dignity and security.
Our Values and Assumptions
The following values and assumptions from The Declaration of Partnership guided the development of
this vision and our own Action Plan:
1. All Ontarians should have equitable access to high quality care and support to optimize their
ability to live well with a progressive life-limiting illness wherever they reside or receive care.
2. The individual with a progressive life-limiting illness and their family are at the centre of care.
3. Family members, friends and community groups provide most of the care needed.
4. Quality is a key driver to achieve system goals.
5. Increasing sustainability and value is a central focus of improvement.
The importance of building a regional system
Implementing a regional approach to health planning and service delivery is an effective way of
enabling health systems to make significant improvements in health care delivery. Regionalization
promotes a broader approach to health systems design; rather than focusing on individual providers
and organizations, it promotes planning and coordination of services to meet population needs that
can continuously adjust in dynamic and sometimes unpredictable ways.
This approach has yielded significant success in palliative and end-of-life care where innovators in
jurisdictions across the world, such as Edmonton and Surrey (Canada), Australia, New Zealand, and
Catalonia and Estremadura (Spain) have adopted such an approach since the early 1990s4-6. Results
have included improved access to and quality of hospice palliative care services, significant reductions
in acute care hospitals as the place of death for individuals with cancer, increased access to hospices
and palliative home care services and significant cost-savings for their respective health care systems.
We can learn from and adapt the best practices from this global work to meet the needs of residents
in Champlain.
8
The Champlain Hospice Palliative Care Program was the first Regional Palliative Care Program
established in Ontario. We hope to create a “region of excellence” as we leverage our community
strengths and the work of multiple partners to create an effective system of hospice palliative care.
See Appendix A for a list of individuals and organizations consulted during the development of this
Action Plan.
Proposed Hospice Palliative Care System
Excellent hospice palliative care has the same elements as excellent chronic disease management.
Our health care system must shift to a model that integrates hospice palliative care and support for
adults and children with chronic disease across the full continuum from diagnosis until death and
through bereavement.
The needs of individuals with progressive life limiting illnesses vary across the illness trajectory. For
some, the trajectory may be relatively short (i.e. weeks to months), but for others it may be many
months and even years. Diagram 1 depicts how both chronic disease modifying treatments and
hospice palliative care align along the illness trajectory to provide different levels of support at
diagnosis through to and beyond death.
Diagram 1: Child & Adult Hospice Palliative Care – Chronic Disease Continuum Model
Source: The Canadian Hospice Palliative Care Association (2002)
Recommended Hospice Palliative Care Service Model
Currently, individuals with advanced chronic disease(s) or complex care needs often receive care that
is reactive, targeted, disease-focused, centered on curative treatment, and delivered by multiple
individual providers in distinct acute episodes.
A proposed new model of providing hospice palliative care is to organize “virtual extended interprofessional teams” to wrap delivery around the adult or child and their family and caregivers in
accordance with the individuals’ preferences for care. In this model, adults and children with
advanced chronic disease(s) and their informal support network will receive care and support that is
9
proactive, holistic, person and family-focused, centered on quality of life and symptom management
issues, and delivered by a virtually integrated inter-professional team in a coordinated, continuallyupdated care plan, that encompasses all care settings in which the client receives care.
Diagram 2 depicts the many partners and systems within the health sector that need to align to
provide seamless person- and family-focused care. There is recognition of the important role of
family, caregivers and community support services to ensure hospice palliative care is available in a
setting of choice.
The focus of this model of care is to improve a person’s quality of life and manage symptoms, not just
extend life. This model is intended to enable individuals to stay in their home as long as possible,
increase access to hospice palliative care across care settings, and reduce the number of deaths in
acute care hospitals.
Diagram 2: Circle of Care – A model for integrated hospice palliative care
Source: Advancing High Quality, High Value Palliative Care in Ontario: A Declaration of Partnership and Commitment to Action (2011,2013)
This circle of care is applicable across all levels of care: primary, secondary and tertiary (see Diagram
3). Most palliative care needs can be addressed at the primary level (e.g. primary care, home care,
community support services). We will strive to enhance this circle of care across all levels of care,
with a focus on building capacity at the primary level with support from regionally organized specialist
resources.
10
Diagram 3: Levels of Palliative Care
Source: Adapted from Australian Population-based Palliative Approach Model
Advocacy as a strategy to advance hospice palliative care
Many system-level issues that impact the quality and delivery of hospice palliative care services are
outside of the control of both The Regional Program and the Champlain LHIN. Advocacy is a strategy
to influence these system-level factors (e.g. public policy and resource allocation decisions).
The Regional Program has the mandate to advocate for funding to advance hospice palliative care
priorities across Champlain. Thus, The Regional Program will advocate for issues that align with the
recommendations in this Action Plan on behalf of hospice palliative care providers and organizations.
Specifically, the Champlain Hospice Palliative Care Program will:
 Support the advocacy efforts of Hospice Palliative Care Ontario (HPCO) to increase adequate
and sustainable funding for local residential hospices.
 Advocate for sustainable funding and a single region-wide alternate funding plan for
physicians to provide hospice palliative care, including consultation, coaching and mentoring
of their peers.
11
6. Implications for Stakeholders
This strategy will have positive impacts on individuals, families, the health system and government.
How will this Strategy and Action Plan impact these populations?
People who are dying and their families
• Easier, timely, and more equitable access to coordinated hospice palliative care.
• Timely access to quality care that is focused on improving quality of life, comfort, dignity, and
spirituality in the setting of choice.
• They are at the centre of a full continuum of care and involved in making their own care
decisions regardless of where they reside and access services across Champlain.
• Advanced care planning is integrated into primary care, well ahead of when people will need
end-of-life care.
• More convenience and travel time-savings by centralized intake and better matching
individuals to the hospice palliative care support that is closer to the place of residence of
their caregivers and family members.
• Ongoing involvement of their family physician throughout the disease trajectory.
• Reduced wait times and 24/7 support and assistance from skilled inter-professional teams
including after-hours nurse consultation and the possibility of nurse/physician home visits
in critical cases.
• Level of assurance that the quality of care meets or exceeds standards; able to expect same
level of service quality across Champlain; understanding that mechanisms for
accountability and continuous improvement are in place.
• More people are able to die at home. Community-based services provide support to
individuals in their homes for as long as possible; when no longer able to stay at home, a
residential hospice provides an alternative to meet the needs of end-of-life care.
Health Care Providers in Champlain
• Enhanced capacity through education, knowledge transfer and resources will enable
community providers and specialists to focus their efforts on the individuals who are most
in need of their specific skillsets.
12
• More skills for primary care providers, and health care professionals providing them with a
greater sense of being valued for their work and easing the burden of compassion fatigue.
• A change in organizational culture will be facilitated, bringing partners together, building
relationships and confidence in the partnership model.
• Inter-professional teams will be essential to integrating the palliative care approach and will
provide a source of expert advice for family physicians and other community based
providers.
• Strong role and more support for family physicians who will take lead responsibility in caring
for their patients
• Key roles for nurses and other members of inter-professional teams as program facilitators,
care coordinators, home care providers, educators.
• The compassion and commitment of volunteers will play an essential role in making an
integrated system work in Champlain to provide care to many more people that would
otherwise be reached. A strong volunteer program will need to actively nurtured and
supported.
• Common standards, frameworks and assessment tools to provide the foundation for an
integrated hospice palliative care approach and continually improve services.
• Accreditation will improve efficiency, accountability and confidence that standard services are
being provided.
The Health System and Government
• More individuals and their families will have improved health outcomes and quality of life.
• More people at end of life, families, and caregivers, receive palliative care supports in their
setting of choice
• More individuals, families, caregivers, and health care providers will have a positive experience
with the health system.
• Shorter stays and reductions in inappropriate admissions to acute care hospitals will translate
into more effective and efficient use of health care resources.
• Faster delivery of service improvements and lower overall system costs
• Single access point as well as triage of cases will mean efficient use of resources, less
duplication, and more timely care for patients/families.
• Stronger, more consistent policy leads to a more integrated approach to end-of-life care in the
community and shifts palliative care from being a specialized service available to a few, to
a more general integrated service, available to all people where they live and receive care.
13
• Accreditation and the implementation of systems to monitor and evaluate will provide
reasonable level of assurance that Champlain HPC is well-run and provides good return on
investment and providing information on effectiveness, efficiency, and client satisfaction.
14
7. Focus Areas
The strategic directions are supported by a comprehensive plan organised into three integrated focus
areas for action over the next five years:
1. Equitable access to hospice palliative care
2. Hospice palliative care across a full continuum of care
3. Capacity building across care settings
These focus areas and respective recommendations provide specific guidance to advance hospice
palliative care locally in alignment with the Declaration of Partnership and Commitment to Action.
Focus area 1: Equitable access to hospice palliative care
Anticipated Outcomes by 2019:



Individuals, caregivers and families will have better timely access to hospice palliative care,
regardless of income, culture, health status, or place of residence across Champlain.
Individuals will have enhanced quality of life prior to death.
Caregivers and families will be supported and have improved bereavement before and
after the death of a loved one.
What we need to do to get there:
1. Ensure hospice palliative care services are responsive to the diversity of all residents of Champlain
region. This includes: urban, rural and remote populations; Francophone and other
culturally/linguistically diverse populations; Aboriginal communities; and other vulnerable
populations, such as children, individuals living with disabilities, GLBTQ and the homeless.
1.1. Support the Local Palliative Care Networks in each sub-region across Champlain. These networks
engage community members and work collaboratively to identify, develop and implement local
solutions and partnerships to ensure hospice palliative care services are responsive to the needs of
urban and rural communities. It is recognized that there may be opportunities for these committees to
collaborate with emerging provincial initiatives, such as the development of Health Links and Primary
Care Networks.
1.2. Enhance access to palliative care services in French by building capacity where needed, leveraging
existing resources and integrating the needs of Francophones in the planning of new
initiatives/programs.
1.3. Ensure community-based palliative care is planned in collaboration with Aboriginal people, and
mechanisms are in place for this care to be flexible to meet the unique needs of each Aboriginal
community.
15
2. Provide sustainable funding for residential hospices by increasing funds to a minimum of 80% of
total operating costs.
Funding for residential hospices is not consistent across the region and does not provide for all operational
costs. As a result, residential hospices are required to fundraise a significant percentage of their
operational costs. Financially stable residential hospices can provide high quality care at a lower cost than
hospital-based care.
3. Establish dedicated funds to develop and/or enhance inter-professional palliative care teams in
hospitals across Champlain.
Most of the hospitals in Ottawa have palliative care consultation teams. However the current resources
cannot meet the current demand or anticipated increased demand. Over the past years, referrals to these
teams have been increasing, especially for patients with non-cancer diagnoses. Currently, formal
consultation support in small community hospitals outside of Ottawa is inconsistent and often lacking.
These teams would provide a continuum of support from consultation, shared care through to substitute
(take over) care.
4. Develop a strategy to engage primary care providers to provide palliative care to their own
patients.
Most palliative care needs can be addressed at the primary level. When primary care providers are
involved earlier in an individual’s care, it is more likely the individual will be connected with timely
community resources and the physician will also provide end of life care.
4.1. Develop a strategy and support existing initiatives to involve primary care providers early when their
patients are receiving treatment at the Regional Cancer Program, The Heart Institute, and other
specialized care.
4.2. Develop and maintain a region-wide database of primary care providers providing palliative care to
their own patients and those who are willing to take on new patients with palliative care needs.
16
Focus area 2: Hospice palliative care across a full continuum of care


Home and community-based hospice palliative care will be available for more individuals who
desire to remain in their communities until the end of their lives.
A full continuum of hospice palliative care will be available for more individuals, caregivers and
families, based on population and service needs. This continuum includes early physician
involvement, home/residential care, residential hospice, chronic palliative care, respite care,
tertiary hospice palliative care unit, and bereavement.
1. Enhance in-home palliative care services to include Long Term Care Homes.
Adequate and appropriate home care is an essential component of hospice care. This care may be
provided by CCAC and/or primary care providers. During consultations, several constraints were identified
to provide consistent home care across Champlain, but specifically in rural and Aboriginal communities
such as: cost and availability of transportation; limited professional services; ability to recruit human
resources; and timely access to medications. Most Canadians have indicated they would prefer to receive
end-of-life care and to die at home, however this is not the current situation2.
1.1 Engage community members, health and social service providers to develop a strategy to coordinate
and enhance in-home palliative care by leveraging community strengths, and enhancing partnerships
and technology.
2. Increase access to day hospice and home visiting services
Day hospice and hospice-at-home programs are typically volunteer-based and provide the foundation of
hospice community services. Day hospice programs provide diversion, support and respite to individuals
and their families, as well as, access to care and assessment. Hospice at home programs offer emotional
support and practical help to individuals facing a life-threatening illness who are being cared for at home.
2.1. Enhance community programming prior to adding residential hospice beds to better assess need and
potential impact since these services form the foundation of hospice care.
3. Increase the number of funded residential hospice beds by 32 across Champlain to reduce the gap
by 70% by 2019.
There are currently seven residential hospices in the Champlain region with a total of 40 adult hospice
beds, 8 pediatric hospice beds, and 15 hospice beds for the homeless population. It is estimated 138 beds
are required across Champlain to meet the needs of the population. This estimate is based on the GomezBatiste recommendation for communities to have 10 hospice palliative care beds per 100 000 inhabitants;
of these beds, 1/3 should be acute palliative care beds and 2/3 should be residential hospice beds.
17
A business case was developed in 2011 to establish a plan to increase residential hospice beds in Ottawa
from 9 to 40 beds; implementation of this plan has already begun yet there are still gaps in both Ottawa
and surrounding rural communities. Table 1 outlines gaps in availability of acute palliative and residential
hospice beds across Champlain and projected increases to reduce this gap. These projections are based on
total population, thus may be underestimates as the percentage of individuals older than 65 years of age is
increasing. See Appendix B for a more detailed plan.
Establishing and sustaining freestanding residential hospices in communities with less than 100000
residents poses unique challenges. Creative solutions to provide these services in rural communities need
to be explored. These plans for increasing residential hospice beds will need to be flexible to align with
changing community needs and capacity.
3.1. Explore options such as the concept of floating beds or other initiatives for rural and remote
communities across Champlain.
Table 1: Current and Projected Acute Palliative and Residential Hospice Beds in Champlain
City/County
Estimated
Population
(2019)ˆ
Age > 65
yrs
Ottawa
1,019,266
Eastern Counties
203,773
Renfrew
104,775
161,480
(16%)
43,704
(21%)
23,729
(23%)
8,220
(24%)
3,895
(24%)
North Lanark
+
34,694
+
North Grenville
Floating beds **
++
TOTAL
15,930
1,376,187
238,738
(17%)
Estimated
need*
Number of
beds
available
(2014)
Projected
number of
beds
available
(2019)
96
102
73
20
10
16
10
11
~
11
4
0
**
2
0
**
138
0
94
2-4
123
ˆ Source: Min. Finance
+
Based on Champlain’s 2011 portions of Lanark, Leeds and Grenville Counties
++
Champlain Total is correct. Summing all geographies overestimated the total due to estimation that are needed for North Lanark and North Grenville
* based on Gomez-Batiste recommendation: 10 hospice palliative care beds are required per 100 000 inhabitants: 1/3 acute
palliative care beds and 2/3 residential hospice
** floating beds concept to be assessed
~ 3 beds currently not receiving LHIN funding, request for these beds to be funded by 2019
4. Ensure the staffing level for the tertiary Palliative Care Unit is appropriate to meet the complex
physical, social and spiritual needs of individuals and their families.
Recent changes in hospital funding have created challenges for palliative care units to provide safe and
high quality care. In Champlain, Bruyère Continuing Care is the only health service organization with a
palliative care unit with 31 acute palliative care beds. Across Ontario, there is considerable variability in
resources and complexity of care required in acute palliative care units, however many face significant
financial and staffing barriers including Bruyère Continuing Care6.
18
Focus area 3: Capacity building across care settings





Hospice palliative care services will be provided across all care settings (e.g. primary care,
home care, hospital) across the Champlain region (e.g. urban, rural, remote).
Hospice palliative care services will be sustainable and consistent with best practices.
The hospice palliative care health system will be better integrated by linking sectors and
services by common practices, processes, and education.
Primary, secondary and tertiary levels of palliative care will be accessible 24/7 for more
individuals and families.
Children and their families will have improved transitions from pediatric to adult services.
1. Implement a public awareness campaign in Champlain about hospice palliative care, advanced
care planning, and how to access local services.
Building greater awareness about the hospice palliative care approach and local services is essential to
demystify death and dying and encourage residents to have plans in place for their end of life journey. A
communications plan for the Champlain Hospice Palliative Care Program was completed in 2013 that
outlines target audiences and strategies for this campaign.
2. Finalize and implement a regional bereavement plan
Bereavement was consistently highlighted as one of the greatest gaps in the hospice palliative care health
system during consultations. Bereavement support is imbedded in a number of community programs,
however these support services are not always accessible as they are typically time limited and provided by
volunteers. Spiritual support services offered by hospitals, community agencies and faith-based
organizations also provide bereavement support and counseling, but likewise have limited capacity and are
in high demand.
Consultations have already begun to develop a comprehensive bereavement plan that: identifies existing
services within both public, private and faith-based sectors; proposes models for new and expanded
bereavement services; and identifies unique solutions to meet the needs of our diverse population,
including Francophones, Aboriginal people, children, and urban, rural and remote populations.
3. Enhance capacity at the primary level to provide palliative care services.
Primary level palliative care providers (e.g. family physicians, nurse practitioners, cardiologist, oncologists,
etc.) require essential palliative care competencies and, at times, may require the support of a specialistlevel palliative care consultation team to provide this care. These palliative care consultation teams are
intended to provide support through education, consultation and/or shared care, with the aim of building
capacity of the primary care provider versus taking over care of the patient. Implementing
interprofessional palliative care consultation teams in both community and hospital settings have shown
to: improve patient care quality; reduce unnecessary laboratory services; reduce intensive care unit and
overall hospital admissions; and reduce health care costs7-12.
19
This model has shown to be effective in various Canadian jurisdictions to increase access to and
competence of primary care physicians providing palliative care services13-14. This model was examined
locally in four academic family medicine clinics in Ottawa; by the end of the three year project, most of the
physicians in three of the four clinics were providing palliative and end of life care, including doing home
visits and caring for their patients in hospice.
3.1. Evaluate the recently integrated Regional Palliative Consultation Team by 2017 to assess efficacy,
adequacy of resources, and potential to expand to further enhance capacity among primary care
providers and allied health professionals in both urban and rural regions across Champlain.
3.2. Enhance the pediatric 24/7 on-call system to meet the unique needs of children
4. Coordinate the development and implementation of a regional educational strategy and
standards for palliative care education across care settings, across professions, and from school to
the workplace.
Education and continuing professional development are central pillars of a high quality integrated system
of hospice palliative care. An education retreat was held in April 2014 with stakeholders. The objective of
this retreat was to develop a regional palliative care education strategy, which is underway.
5. Implement and monitor targeted standards and performance indicators.
System-level accountability, evaluation, monitoring and reporting can be used to optimize the patient
experience and quality of care provided to individuals, families and caregivers. Standards for local hospice
palliative care providers and organizations were developed over the past two years and approved by The
Regional Program Board (see Appendix C). The Regional Program will continue to support implementation
and analysis of standards and performance indicators with hospice palliative care providers across
Champlain. Specifically, common technical specifications will be drafted; data collection mechanisms and
reporting processes will be developed in collaboration with health service providers; and resources
developed to reduce the burden of data collection for health service providers. The data and analysis will
be shared with stakeholders to inform both regional and organizational planning and quality improvement
initiatives.
5.1. Identify specific standards, indicators and common technical specifications for inclusion in
accountability agreements between hospice palliative care organizations and the LHIN.
6. Implement the rural framework to build capacity in rural communities.
Rural and remote communities have unique challenges to build capacity and ensure equitable access to
high quality hospice palliative care services. For example, limited transportation, number of health service
providers, and access to medications are challenges our local rural communities are currently experiencing.
A rural retreat was held in 2012 to draft a rural framework for hospice palliative care; this framework
identifies the key elements of a rural program and high priority issues to address (see Appendix D).
Creative solutions to provide hospice palliative care services in rural and remote communities need to be
further explored to enhance this framework.
7. Leverage existing technology and explore other opportunities to enhance and integrate services
across Champlain.
Technology can be used as a vehicle to build capacity and enhance access to primary, secondary and
tertiary palliative care services. For example: a) the CCAC, Hospice Care Ottawa and Bruyère formed a
20
partnership to implement a central referral and triage system for hospice palliative care beds in Ottawa;
and b) the OutCare Foundation supported the development of TeleLink an initiative currently being used to
link hospice care providers across Champlain with the Division of Palliative Care’s weekly journal rounds
and academic city-wide rounds.
8. Support the development of volunteer programs
Volunteers are essential for a high performing hospice palliative care system. Volunteers provide: personal
care and support for individuals; respite for caregivers; bereavement support to caregivers and families;
facilitation of day hospice programs; administrative support for hospice palliative care agencies; support
for fundraising activities; and many other gifts.
8.1. Build upon existing community volunteers and infrastructure to enhance volunteer programs across
hospice palliative care agencies, integrate services, and ensure a positive volunteer experience.
8.2. Ensure all client care volunteers complete a recognized training program and ongoing education
opportunities.
8. Priorities
High priority recommendations are those that are recommended to be addressed early in the Action
Plan. These activities will build capacity and form the foundation of our hospice palliative care
system, advance current initiatives, leverage opportunities for growth and community strengths, will
impact a significant number of individuals across Champlain, and/or address urgent needs.
Medium and lower priority recommendations are those that are required to advance hospice
palliative care but may not address an urgent need, require other activities to occur or relationships
to be developed in advance, and/or require significant investment or organizational/systemic
changes.
The priority level for each recommendation is identified in Section 9: The Action Plan.
The high priority recommendations focus on:
 Increasing the number of residential hospice beds and providing sustainable funding;

Engaging primary care providers and building capacity at the primary level;

Enhancing in-home palliative care services;

Implementing a regional bereavement plan; and

Developing and enhancing volunteer programs.
21
22
9. The Action Plan
A priority and projected timeline has been identified for each recommendation. These priorities and timelines outlined in this action plan
will inform the development of an annual work plan for The Regional Program and progress will be evaluated on an annual basis.
FOCUS AREA 1: EQUITABLE ACCESS TO HOSPICE PALLIATIVE CARE
Priority
1.
Ensure hospice palliative care services are responsive to the diversity of all
residents of Champlain region. This includes: urban, rural and remote
populations; Francophone and other culturally/linguistically diverse populations;
Aboriginal communities; and other vulnerable populations, such as children,
individuals living with disabilities, GLBTQ and the homeless.
Medium
1.1. Support the Local Palliative Care Networks in each sub-region across
Champlain. These networks engage community members and work
collaboratively to identify, develop and implement local solutions and
partnerships to ensure hospice palliative care services are responsive to
the needs of urban and rural communities. there may be opportunities for
these committees to collaborate with emerging provincial initiatives, such
as the development of Health Links and Primary Care Networks.
Medium
1.2. Enhance access to palliative care services in French by building capacity
where needed, leveraging existing resources and integrating the needs of
Francophones in the planning of new initiatives/programs.
High
1.3. Ensure community-based palliative care is planned in collaboration with
Aboriginal people, and mechanisms are in place for this care to be flexible
to meet the unique needs of each Aboriginal community.
High
2.
Provide sustainable funding for residential hospices by increasing funds to a
minimum of 80% of total operating costs.
High
3.
Establish dedicated funds to develop and/or enhance inter-professional
palliative care teams in hospitals across Champlain.
Medium
23
2014/15
2015/16
2016/17
2017/18
2018/19
4.
Develop a strategy to engage primary care providers to provide palliative care to
their own patients.
High
4.1. Develop a strategy and support existing initiatives to involve primary care
providers early when their patients are receiving treatment at the Regional
Cancer Program, The Heart Institute, and other specialized care.
High
4.2. Develop and maintain a region-wide database of primary care providers
providing palliative care to their own patients and those who are willing to
take on new patients with palliative care needs.
Low
FOCUS AREA 2: HOSPICE PALLIATIVE CARE ACROSS A CONTINUUM
Priority
1.
Enhance in-home palliative care services
High
1.2 Engage community members, health and social service providers to develop
a strategy to coordinate and enhance in-home palliative care by
leveraging community strengths, and enhancing partnerships and
technology.
Medium
Increase access to day hospice and home visiting services
Medium
2.1. Enhance community programming prior to adding residential hospice beds
to better assess need and potential impact since these services form the
foundation of hospice care.
High
Increase the number of residential hospice beds by 32 across Champlain to
reduce the gap by 70% by 2019.
High
3.1. Assess and pilot the concept of floating hospice beds for rural and remote
communities across Champlain.
Medium
Enhance the staffing level for the Palliative Care Unit to be appropriate to meet
the complex physical, social and spiritual needs of individuals and their families.
Low
2.
3.
4.
24
2014/15
2015/16
2016/17
2017/18
2018/19
FOCUS AREA 3: CAPACITY BUILDING ACROSS CARE SETTINGS
Priority
1.
Implement a public awareness campaign in Champlain about hospice palliative
care, advanced care planning, and how to access local services.
Medium
2.
Finalize and implement a regional bereavement plan
High
3.
Enhance capacity at the primary level to provide palliative care services.
Medium
3.1. Evaluate the recently integrated Regional Palliative Consultation Team by
2017 to assess efficacy, adequacy of resources, and potential to expand to
further enhance capacity among primary care providers and allied health
professionals in both urban and rural regions across Champlain.
Medium
3.2 Enhance the pediatric 24/7 on-call system to meet the unique needs of
children
Medium
4.
Coordinate the development and implementation of a regional educational
strategy and standards for palliative care education across care settings, across
professions, and from school to the workplace.
Medium
5.
Implement and monitor targeted standards and performance indicators.
Low
5.1. Identify specific standards, indicators and common technical specifications
for inclusion in accountability agreements between hospice palliative care
organizations and the LHIN.
Low
6.
Implement the rural framework to build capacity in rural communities.
Medium
7.
Leverage existing technology and explore other opportunities to enhance and
integrate services across Champlain.
Low
8.
Support the development of volunteer programs
High
8.1. Build upon existing community volunteers and infrastructure to enhance
volunteer programs across hospice palliative care agencies, integrate
services, and ensure a positive volunteer experience.
High
8.2. Offer all volunteers a recognized training program and ongoing education
opportunities.
High
25
2014/15
2015/16
2016/17
2017/18
2018/19
10. References
1.
Ontario Ministry of Health and Long Term Care. (December 2011, 2013). Advancing High Quality, High Value Palliative
Care in Ontario: A Declaration of Partnership and Commitment to Action. Available at:
http://health.gov.on.ca/en/public/programs/ltc/docs/palliative%20care_report.pdf
2.
Carstairs, S. (June 2010). Raising the Bar: A Roadmap for the Future of Palliative Care in Canada. Available at:
http://www.chpca.net/media/7859/Raising_the_Bar_June_2010.pdf
3.
Canadian Caregiver Coalition. (2012). Caregiver Facts. Available at: http://www.ccc-ccan.ca
4.
Bruera E, Neumann C, Gagnon B, et al. (1999). Edmonton Regional Palliative Care Program: impact on patterns of
terminal care. CMAJ;161:290‐293.
5.
Fassbender K, Fainsinger R, Brenneis C, Brown P, Braun T, Jacobs P. (2005). Utilization and costs of the introduction of
system‐wide palliative care in Alberta, 1993‐2000. J Palliat Med;19(7):513‐520.
6.
Towns K, Dougherty E, Kevork N, Wiljer D, et al. (2012). Availability of Services in Ontario Hospices and Hospitals
Providing Inpatient Palliative Care. J Palliat Med;15(5):527-534.
7.
Gómez‐Batiste, A. Tuca, E. Corrales, J. Porta‐Sales, M. Amor, J. Espinosa, J. Borràs, I. de la Mata, X. (2006). Resource
Consumption and Costs of Palliative Care Services in Spain: A Multicenter Prospective Study. J Pain Symptom
Manage;31(6):522–532.
8.
Gómez-Batiste X, Porta-Sales J, Pascual A, Nabal M, Espinosa J, et al. Catalonia WHO Palliative Care Demonstration
Project at 15 Years (2005). J Pain Symptom Manage;33:584-590
9.
Jennifer S. Temel, Joseph A. Greer, Alona Muzikansky, Emily Gallagher, Sonal Admane et al. (2010). Early Palliative
Care for Patients with Metastatic Non-Small-Cell Lung Cancer. NEJM;363:733-742
10. National Institute for Clinical Excellence. (2004). Guidance on Cancer Services: Improving Supportive and Palliative
Care for Adults with Cancer (The Manual). Published by the National Institute for Clinical Excellence, London UK.
11. Bruera E, Neumann C, Gagnon B, et al. (1999). Edmonton Regional Palliative Care Program: impact on patterns of
terminal care. CMAJ;161:290-293.
12. Fassbender K, Fainsinger R, Brenneis C, Brown P, Braun T, Jacobs F. (2005). Utilization and costs of the introduction of
system-wide palliative care in Alberta, 1993 to 2000. J Palliat Med;19:513-520.
13. Gómez-Batiste, X. et al. (2006). Resource Consumption and Costs of Palliative Care Services in Spain: A Multicenter
Prospective Study. J Pain Symptom Manage;31(6):522-532.
14. Marshal D, et al. (2008). Enhancing family physician capacity to deliver quality palliative home care: An end-of-life,
shared-care model. Can Fam Physician;54:1703.e1-7.
15. Klinger C, et al. (2013). Resource utilization and cost analyses of home-based palliative care service provision: The
Niagara West End-of-Life Shared-Care Project. J Palliat Med;27(2):115-122
26
11. Appendices
Appendix A: Champlain Hospice Palliative Consultations – Invitees and Participants
July 19, 2013 – Barry’s Bay
ORGANIZATION
INVITEE
PARTICIPANTS
Madawaska Valley Hospice Palliative
Care
Eva Kulas
Bob Ogilvie
Lisa Hubers
Karen Wagner
Colleen Buch
Bill Beahen
Margaret Ogilvie
Glenda owens
Toni Lavigne-Conway
Dr. Jason Malinowski
Hospice Palliative Care Program
Josée Charboneau
Diane Caughey
Dr. José Pereira
Jean-François Pagé
Célestin Abedi
Peggy Taillon
LHIN
Nicole Lafrenière-Davis
James Fahey
Saint Francis Memorial Hospital
Randy Penney
Jasna Boyd
Madawaska Communities Circle of
Health
Joanne King
CCAC
Penny Sands
27
July 31, 2013 - Renfrew
ORGANIZATION
INVITEE
PARTICIPANTS
Almonte Hub Hospice
Glenda Jones
Christine Bois
Glenda Jones
Christine Bois
Almonte General Hosp
Mary Wilson Trider
Mary Wilson Trider
Arnprior & District Hosp
Eric Hanna
Leah Levesque
Leah Levesque
Carleton Place & District Hosp
Toni Surko
Toni Surko
Deep River & District Hosp
Gary Sims
Gary Sims
Marianhill
Linda M. Tracey
Linda M. Tracey
Pembroke Regional Hosp
Pierre Noel
Sabine Mersmann
Sabine Mersmann
Renfrew Hospice
Diane Caughey
Diane Caughey
Renfrew Victoria Hosp
Randy V. Penney
Bruyère - Pain & Symptom
Management
Erin McCabe
Erin McCabe
August 7, 2013 - Cornwall
ORGANIZATION
INVITEE
PARTICIPANTS
Bayshore Home Health
Leslie Marvell
Leslie Marvell
Bruyère Contininuing Care
Danielle Sinden
Danielle Sinden
Canadian Red Cross Society
Colette Lavictoire
Colette Lavictoire
Carefor
Ghislaine Lalonde
Jason Samson
Richard Thompson
Jason Samson
Richard Thompson
CCAC
28
Centre Marysabel Center
Centre de soins palliatifs Hospice
Simons
Cornwall Hospice
Lucie Houle
Louise Beaupré
Marianne Vancaemelbeke
Ingrid Aartman
Dr. Mary Jane Randlett
Maria Badek
Dr. Clara Leigh
JoAnn Tessier
Marlene Power
Dr. Mary Jane Randlett
Maria Badek
Dr. Clara Leigh
Dundas County Hospice
Bea VanGilst
Bea VanGilst
Glengarry NP Led Clinic
Penelope Smith
Penelope Smith
Glen-Stor-Dun Lodge
Linda Giesel
Mary Johnson
Norm Quenneville
Sylvie Lefebvre
Sylvie Lefebvre
Cornwall Community Hospital
Hawkesbury & District General
Hospital
Marlene Power
Hopital Glengarry Memorial
Dr. André Borduas
Shelley Coleman
LHIN
James Fahey
Maxville Manor
Sue MacDonald
Sue MacDonald
Mohawk Council of Akwesasne
Frances Renaud
Sarah Thompson
Frances Renaud
Sarah Thompson
Kerri Schnobb
Seaway Valley CHC
Kerri Schnobb
Barbara Knotes
Debbie St.John-de-Wit
St. Joseph Continiuning Care
Martina Anderegg
Martina Anderegg
Winchester District Memorial
Hospital
Lynn Hall
Le Réseau
Saint Elizabeth Health Care
29
Woodland Villa
Michael Rasenberg
Parisian Manor
Andrew Lauzon
August 19, 2013 - Kemptville
ORGANIZATION
INVITEE
PARTICIPANTS
Beth Donovan Hospice
Hospice Care Ottawa
Dawn Rodger
Sue Walker
Chris McBean
Lisa Sullivan
Dawn Rodger
Sue Walker
Chris McBean
Lisa Sullivan
Kemptville Hospital
Catherine Van Vliet
LHIN
James Fahey
James Fahey
ORGANIZATION
INVITEE
PARTICIPANTS
Hawkesbury & District General Hosp
Sylvie Lefebvre
Sylvie Lefebvre
Dr. Renée Arnold
Dr. André Borduas
Marc Leboutillier
Diane Drapeau
Suzanne Sauvé
Renée Arnold
André Borduas
Marc Leboutillier
Local Physicians
September 5, 2013 - Hawkesbury
Carefor
Jason Samson
Louise Beaupré
Cornwall Hospice
Maria Badek
Maria Badek
Simons
Ingrid Aartman
Ingrid Aartman
CCAC
Lucie Houle
Lucie Houle
30
Richard Thompson
Pierre D'Aoust
ORGANIZATION
INVITEE
PARTICIPANTS
Leslie Marvell
Mohawk Council of Akwesasne
Frances Renaud
Sarah Thompson
Joelle Regnier
Frances Renaud
Sarah Thompson
Joelle Regnier
Rita Busat/Peggy Taillon
ORGANIZATION
INVITEE
PARTICIPANTS
Bruyère Continuing Care
Dr. José Pereira
Marc Guevremont
Peter Lawlor
Colleen Cuddy
Teresa M. Lee
Anne Roberts
Dr. Bernard Leduc
Dr. José Pereira
Réseau des services de santé en
francais
October 25, 2013 - Akwesasne
October 31, 2013 - Ottawa
Montfort Hospital
LHIN
James Fahey
Chantale LeClerc
The Ottawa Hospital
Lynn Kachuik
Jim Worthington
Paula Doering
Edward Fitzgibbon
Alice Retik
Queensway Carleton Hospital
Anne Roberts
Therese Antoun
Dr. José Pereira
Alice Retik
Andrew Knight
November 6, 2013 - Renfrew
ORGANIZATION
INVITEE
PARTICIPANTS
Almonte Hub Hospice
Christine Bois
Wendy Powell
Christine Bois
31
Almonte General Hosp
Mary Wilson Trider
Mary Wilson Trider
Arnprior & District Hosp
Eric Hanna
Leah Levesque
Leah Levesque
Carleton Place & District Hosp
Toni Surko
Toni Surko
Deep River & District Hosp
Gary Sims
Marianhill
Linda M. Tracey
Pembroke Regional Hosp
Pierre Noel
Sabine Mersmann
Renfrew Hospice
Diane Caughey
Renfrew Victoria Hosp
Randy V. Penney
Bruyère - Pain & Symptom
Management
Erin McCabe
Erin McCabe
ORGANIZATION
INVITEE
PARTICIPANTS
Bruyère Continuing Care
José Pereira
Marc Guevremont
Peter Lawlor
Teresa M. Lee
Anne Roberts
Therese Antoun
James Fahey
José Pereira
Lynn Kachuik
Jim Worthington
Paula Doering
Edward Fitzgibbon
Alice Retik
Andrew Knight
José Pereira
Lynn Kachuik
INVITEE
PARTICIPANTS
Linda M. Tracey
Diane Caughey
November 12, 2013 - Ottawa
Montfort Hospital
LHIN
The Ottawa Hospital
Queensway Carleton Hospital
Teresa M. Lee
Anne Roberts
Therese Antoun
November 13, 2013 - Arnprior
ORGANIZATION
32
Algonquins of Pikwàknagàn First
Nation
Peggy Dick
Peggy Dick
Maureen Kauffeldt
Maureen Kaufeldt
November 15, 2013 - Hawkesbury
ORGANIZATION
INVITEE
PARTICIPANTS
Hawkesbury & District General Hosp
Sylvie Lefebvre
Sylvie Lefebvre
Dr. Renée Arnold
Dr. André Borduas
Marc Leboutiller
Marielle Heuvelmans
Leslie Marvell
Carefor
Donna Tinker
Donna Tinker
Louise Beaupré
Pierre Paul Lalonde
Maria Badek
Louise Beaupré
Pierre Paul Lalonde
Maria Badek
Simons
Ingrid Aartman
Ingrid Aartman
CCAC
Lucie Houle
Glenda Owens
Pierre D'Aoust
Glenda Owens
Pierre D'Aoust
Cornwall Hospice
francais
Dr. André Borduas
November 20 – Dec 20, 2013 - Ottawa
ORGANIZATION
INVITEE
PARTICIPANTS
Hospice Care Ottawa
Lisa Sullivan
Lisa Sullivan
Ottawa Inner City Health Inc.
Wendy Muckle
Wendy Muckle
HPCO
Rick Firth
Rick Firth
Roger's House
Lloyd Cowin
Lloyd Cowin
33
francais
34
Appendix B:
Detailed Current and Projected Acute Palliative and Residential Hospice Beds in Champlain
City/County
Estimated
Population
(2019)ˆ
Age 65+
years
Ottawa
Palliative Care Unit
(Bruyère)
Roger’s House (children)
Hospice Care Ottawa
Mission Ottawa
(homeless)
Stormont-Dundas-Glengarry
Hospice Cornwall
Prescott-Russell
Hawkesbury
Renfrew
Hospice Renfrew
Hospice Madawaska
Marianhill
+
North Lanark
1,019,266
161,480
(16%)
North Grenville
+
Floating beds **
++
TOTAL
Estimated
need*
102
Number of
beds
available
(2014)
73
31
Projected
number of
beds
available
(2019)
96
31
8
19
15
10
40
15
10
10
16
10
6
11
6
2
3
**
203,773
43,704
(21%)
20
104,775
23,729
(23%)
10
34,694
8,220
(24%)
3,895
(24%)
4
0
11
6
2
~
3
0
2
0
**
138
0
94
2-4
123
15,930
1,376,187
238,738
(17%)
ˆ Source: Min. Finance
+
Based on Champlain’s 2011 portions of Lanark, Leeds and Grenville Counties
++
Champlain Total is correct. Summing all geographies overestimated the total due to estimation that are needed for North Lanark and North Grenville
* based on Gomez-Batiste recommendation: for every 100 000 inhabitants, 10 hospice palliative care beds are required: 1/3 acute
palliative care beds and 2/3 residential hospice
** floating beds concept to be assessed
~ Currently not receiving LHIN funding, request for these beds to be funded by 2019
35
36
Appendix C: Champlain Hospice Palliative Care Indicators
37
38
39
Appendix D: The Rural Hospice Palliative Care Program Framework
CHAMPLAIN REGIONAL HOSPICE PALLIATIVE CARE PROGRAM
RURAL HOSPICE PALLIATIVE CARE PROGRAM FRAMEWORK
October 2013
Based on the work done at the Champlain HPC Program’s Rural Retreat in 2012 (with input from “best”
practices for rural programs across the country), a literature review, work done in the Madawaska Valley
and other rural communities.
For the purpose of this framework, we recognize that within rural communities there are “larger” towns of
10,000 or more inhabitants which have urban features, “smaller” towns and villages of less than 10,000
inhabitants, “rural areas” which are primarily farming communities and “remote communities” with very
sparse population densities.
Goal of a Rural Hospice Palliative Care Framework
•
•
•
•
Ensure that key elements are addressed and/or included when rural-based Hospice Palliative Care
Programs are developed in the Champlain Region;
Ensure standardization of Rural models across the Champlain Region, while allowing some flexibility to
address local unique circumstances;
Ensure success and sustainability of rural-based HPC Programs in the Champlain Region;
Apply best evidence and best practices from the literature and from other Canadian and International
jurisdictions with respect to establishing rural-based HPC Programs.
Guiding Principles
The Champlain Regional Hospice Palliative Care Program:
• Recognizes that key elements are required to ensure appropriateness and success of rural-based
Hospice Palliative Care access;
• Recognizes that rural and isolated areas within the Champlain LHIN region may have specific unique
circumstances that require some flexibility need to be recognized;
• Rural HPC care programs, as with urban-based programs, need to be effective, sustainable, efficient,
high quality and optimize local and existing resources;
• Development of HPC programs take time (usually several years) and are undertaken in phases, with
high priority elements addressed in the earlier phases.
Champlain Regional HPC Program’s “Rural HPC Framework”
•
•
Proposals in areas in the region wishing to implement HPC programs in rural areas should address each
of the key elements. It is not expected that all elements will be implemented from the outset, but the
intention should be to integrate them over time (approximately 3 to 5 years).
The HIGH PRIORITY elements should be implemented in the early phases.
40
–
The First Phase in all the projects should be the establishment of a Local HPC Team to plan,
implement and monitor the HPC program locally (using Dr. Marie Lou Kelley’s Rural Model).
• This team should include volunteers, health professionals (includes nurses, doctors,
social workers and other allied health professionals), health care administrators,
community leaders and other stakeholders.
Key elements of a Rural-Based HPC Program in the Champlain Region
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Local Hospice Palliative Care Implementation Team (HIGH PRIORITY)
Volunteer Program (HIGH PRIORITY)
Ensure Access to Primary, Secondary and Tertiary Level of Palliative Care 24/7 (HIGH PRIORITY)
Education Strategy for local Health Care Providers (e.g. physicians, nurses, SWs, pharmacists, etc)
(HIGH PRIORITY)
Home Care Services (HIGH PRIORITY)
Hospice community programs
Use of standardized symptom and needs screening and assessment
Inpatient care model that is population and resource based
Public Awareness campaign (including Advance Care Planning)
Use of E-Health technologies to enhance access to care
Access to appropriate medications and supplies
Medical equipment loan program
Standards and Performance Indicators
Element 1: Local Hospice Palliative Care Implementation Team
•
•
•
The role of the Local Hospice Palliative Care Team (Local Team) is to develop the proposal and
implement, monitor and maintain local HPC services. Use Dr. Mary Lou Kelley’s Rural Model of local
capacity building
The Local Palliative Care Team (LPCT) should include:
– HPC champions of clinicians, public members, administrators, volunteers, and other
stakeholders.
– A Family physician champion
– CCAC care coordinator
– Community leader(s)
The Local HPC Team is to work closely with the Champlain Regional Hospice Palliative Care Program
and LHIN to develop the proposal.
Element 2: Volunteer Program
•
•
•
•
Volunteers constitute a key component of HPC programs.
The Plan should include resources to provide Logistical Support and Coordination of HPC volunteers
The Plan must include a recognized Training Program for local volunteers.
The volunteer program assists or supports hospice-in-the-community services, such as day-hospice and
hospice-at-home programs, as well as any hospice-type residential program.
41
Element 3: Ensure Access to Primary, Secondary and Tertiary Level of Palliative Care 24/7
•
•
•
It is recognized that patients and families experience many different needs across the illness trajectory;
some of them uncomplicated while others may be complex.
To adequately meet these needs, three levels of services is required;
– A) Primary Level (e.g. provided by family physicians and generalist nurses)
– B) Secondary Level (health care providers with additional competencies and experience to
address more complicated cases)
– C) Tertiary Level (specialists in palliative care to provide clinical and education support to
Secondary and Primary-level providers).
The Champlain HPC Program has described these various levels and the competencies required in each
in its Primary, Secondary and Tertiary Model document of the Standards Committee (please refer to
that document).
•
Primary level
– As many as possible of the family physicians in the area should provide palliative care to their
patients and serve as the Most Responsible Physician (MRP)
– The “Ask the Question?” approach (“Will I be surprised if this patient dies in the next 6 to 12
months?”) should be activated in all family practice medicine clinics to identify patients who
could benefit from a palliative care approach (sometimes alongside efforts to control the
disease.
– The goal of this is to ensure earlier goals of care discussions, advance care directive discussions
and symptom assessment & management.
– Family Medicine clinics should be encouraged to maintain a "Palliative Care Registry“ of
“palliative” patients (defined using the “surprise question” above) so that at any given time a
list can be generated of patients requiring HPC services.
– This will require some adaptation of their charting processes (including EMRs).
•
Secondary level
– Requires physicians and/or nurses (NP or APN) with additional training and experience in
palliative care.
– The role is to support local colleagues in providing HPC by providing consultation support
without taking over the care of the patients as MRP in most cases.
– Training: Ideally, a physician or NP with specialist level training (one year residency in the case
of MDs and HPC Certification through the Canadian Nursing Association for nurses). However,
in the absence of that, then someone with more training than basic level- LEAP Plus at least 4
months training program (that includes some clinical rotation time with the regional specialist
level team and coaching by that team) and with ongoing support from the Palliative
Consultation Service (PACS/PPSMCS), will suffice.
– The person(s) should participate regularly in regional HPC continuing professional development
activities such as the Academic City Wide and Journal Club Rounds (via Telelink).
– Ideally, these persons should be remunerated using a AFP or salary model so that they are able
to provide clinical support (without being driven to a fee for service model), education and
quality improvement activities) in their region.
•
Tertiary level
– To be provided by the Division of Palliative Care (out of Bruyère Continuing Care and TOH) and
by the Nurse Practitioners and APN of PACS/PPSMCS.
42
–
–
–
Clinical Support
• Regular team meetings, using Telelink, between the local HPC providers and the PACS
team to review difficult cases (team consultation).
• Just-in-time availability of PACS to support colleagues in the rural area.
Education Support
• The specialist team should participate in any education development program geared
towards doctors, nurses and pharmacists in the region.
Quality Improvement Support
• The specialist team should provide input on quality improvement programs or project
in the region, particularly when they relate to clinical care.
Element 4: Education Strategy for local Health Care Providers
•
•
•
The Champlain Regional HPC Program recognizes the importance of educating local health care
professionals on the basics of providing HPC and to support these professionals with specialist level
services should they require them.
The rural HPC program should include a strategy for continuing professional development (CPD) and
continuing medical education (CME) for local physicians, nurses, pharmacists, SW, etc on HPC.
This is to include delivering Pallium LEAP courses locally and linking up local health care professionals
to the Bruyère Thursday Evening Series and any other HPC-related CPD activities.
Element 5: Home Care Services
•
•
•
•
•
•
Adequate and appropriate home care is a key component of any HPC program.
Home Care services should be optimized.
CCAC Care Managers and Nurse Agency nurses should all receive Pallium LEAP training in HPC.
The patient's own family physician should be the MRP and should be able to provide, for those patients
in the terminal phase, home visits and on-call support, as well as prompt availability to nurses when
advice is required. Should this not be forthcoming, the patient and family should approach the
physician to change to another physician.
The Champlain Regional Program also recognizes that there are some limitations to putting in place
indefinite 24/7 home services (due to lack of personnel, funding, etc). In these situations, an alternative
setting of care, such as a local hospital, or residential hospice may be required.
Family caregivers are an integral component of the Home Care Team, alongside the CCAC Care
Manager, Agency Nurse and family physician.
Element 6: Hospice community programs
•
•
Volunteer-led programs to provide community outreach, Hospice -Day and Hospice at-home programs
should be in place as a cornerstone of the program. These programs may also include a Bereavement
Support Program
Rural residential hospice teams (eg Renfrew Hospice, Cornwall Hospice) can serve as hubs for these
services.
Element 7: Use of standardized symptom and needs screening and assessment
•
The following approaches and screening and assessment instruments should be used in routine
practice:
43
–
•
Edmonton Symptom Assessment Scales (ESAS)
• To screen for and assess key physical and emotional symptoms
– Palliative Performance Scale (PPS)
• To assess functional status, which guides prognosticating and decision-making
– Confusion Assessment Method (CAM)
• To screen for and diagnose delirium.
– Richmond Agitation Sedation Scale for Palliative Care (RASS-Pal)
• To assesses levels of agitation and of sedation
The following approaches should be used in routine practice:
– Ask the "Surprise question" (and mortality risk indicators) in regular practice to identify
patients who could benefit from a palliative care approach earlier
– Palliative Alerts
• To guide implementation of HPC resources and services
– “Speak Up” CHPCA Program on Advance Care Planning
Element 8: Inpatient care model that is population and resource based
•
•
•
It is recognized that generally free-standing hospices with less than 9 to 10 beds are challenging to
sustain.. A population of at least 80 000 to 100 000 is required to justify a hospice. The Champlain
framework recognizes the need for residential or in-patients care for some patients and recognize also
the realities of rural areas. When larger communities covering a rural population of 60,000-80,000
inhabitants, a hospice of 6 to 10 beds may be considered. Alternatively, another model particularly for
smaller communities would be some 4 to 6 beds in an existing healthcare facility.
There is also the “Madawaska model” based on geographic realities that may make it difficult at times
to care for non-ambulatory patients who are not complex at home. A small number of flexible beds in
an existing facility (e.g. LTC or hospital) with care provided by CCAC and volunteers. However, if a
patient’s needs increase to the point that CCAC is no longer able to provide the services in the “chronic
care volunteer hospice”, the patient should be admitted to the local hospital if home is not an option.
– Patients with high acuity-level needs requiring sustained 24/7 in-patient care should be
admitted to the local hospital.
Rural Hospice programs should take in considerations the Hospice Palliative Care Ontario standards.
Element 9: Public Awareness campaign: What is Palliative Care and Advance Care Planning?
•
•
A strategy should be developed for a public awareness campaign in the region.
This should include”
– Advance Care Planning campaign (using the Speak Up materials)
– What is Hospice Palliative Care campaign (The Regional Program will prepare some messaging
material for that)
– The campaign should include exposure in the local media and events, including reaching out to
local church communities to assist in making the public aware.
Element 10: Use of E-Health technologies to enhance access to care
•
Two Health Information Technologies should be considered to enhance rural access to the different
level of care:
1. Telemedicine using Telelink:
44
–
Local rural teams to use Telelink to link up with the Division of Palliative Care’s weekly journal
rounds and twice-monthly academic city wide rounds
2. Videophone technology:
– The Champlain HPC program is collaborating with CISCO to explore the use of videophones to
connect patients from their homes with their CCAC case managers and nurses.
Element 11: Access to appropriate medications and supplies
•
•
An “Emergency Kit” with essential medications and supplies should be placed in the homes of homecare patients with PPS scores of 30% or less. In larger urban areas, a process to rapidly access
emergency medications and supplies should be implemented (instead of Emergency kits)- this would
require rapid 24/7 access to a local pharmacy who could provide these.
– The PPSCMS has developed a list of essential medications and supplies.
There should be a plan to provide access to pumps and hypodermoclysis supplies locally.
– This requires close collaboration with the local hospital and/or a local pharmacy
Element 12: Medical equipment loan program
•
There should be a program/process in place locally to provide hospital beds and other equipment such
as wheelchairs, particularly those not covered by CCAC Services.
Element 13: Standards and Performance Indicators
•
•
•
The program will identify standards for its various programs/services.
– Those of the Champlain Regional Program that apply should be included, plus any additional
ones identified locally.
The program will identify performance indicators to audit services.
– Those of the Champlain Regional Program that apply should be included, plus any additional
ones identified locally.
There will be a mechanism in place to collect data related to the performance indicators.
45
Hospice Palliative Care in Champlain
Action Plan 2014-19
Presenters:
- Elan Graves, Senior Integration Specialist, Champlain LHIN
- Sylvie Lefebvre, Chair, Champlain Hospice Palliative Care Board
- Nadine Valk, Executive Director, Champlain Hospice Palliative Care Program
Event:
Champlain LHIN Board Meeting
Date
June 24, 2015
Objectives
•
Introduce the Champlain Hospice Palliative Care (HPC)
Action Plan 2014-2019
•
Discuss how this Action Plan will be implemented.
2
Champlain LHIN
Integrated Health Service Plan 2013-2016
for a Person-Centred Regional Health Care System
Vision:
Healthy people
and healthy
communities
supported by a
quality, accessible
health system
Mission:
Building a
coordinated,
integrated and
accountable health
system for people
where and when
they need it
Values:
Respect, Trust,
Openness,
Integrity,
Accountability
Champlain Hospice Palliative Care Program
•
Established in 2010, based on recommendation from the
Champlain Hospice Palliative and End-of-Life Network.
•
Champlain LHIN recognizes the Champlain HPC
Program as the official voice of HPC in Champlain
•
Program mandate is to plan for comprehensive and
integrated HPC services and build capacity across the
Champlain region by working collaboratively with health
care providers.
4
Action Plan Development
•
Action Plan builds on two cornerstone documents:
1) Inaugural Champlain Hospice Palliative Care Program Plan (May 2010)
2) Advancing High Quality, High Value Palliative Care in Ontario: A
Declaration of Partnership and Commitment to Action (December 2011)
•
Plan is based on broad regional stakeholder consultation
and includes a framework for rural services and
consideration of services for Aboriginal and Francophone
communities
5
Key Accomplishments
CHPCP has supported, led and/or endorsed the:
•
Creation of an integrated hospice (Hospice Care Ottawa) to expand
community HPC services and increase number of residential hospice
beds in the City of Ottawa
•
Development of a common central-intake and referral tool for
palliative care beds at Bruyère and residential hospice in Ottawa
•
Development of the Madawaska Valley Hospice Palliative Care
Program, including volunteer training, community hospice services,
and a 2-bed residential hospice in Barry’s Bay.
6
Key Accomplishments
CHPCP has supported, led and/or endorsed the:
•
Addition of five new Palliative Care Nurse Practitioner positions to form an
integrated Regional Palliative Consultation Team to support capacity
building in the region
•
Development of a regional bereavement plan, rural hospice palliative care
program framework and regional education strategy
•
Development and enhancement of community HPC services across
Champlain (e.g. Kemptville, Renfrew, Ottawa, Cornwall, Williamsburg,
Hawkesbury)
•
Development of priority quality of care indicators across multiple domains
for health and social service sectors providing hospice palliative care
7
ACTION PLAN 2014-2019
8
KEY FOCUS AREAS
9
Equitable Access
Care Across the
Continuum
Capacity Building
Rural Framework
PRIORITIES FOR ACTION
10
• High priority recommendations focus on:
• Increasing the number of residential hospice beds;
• Engaging primary care providers and building
capacity at the primary level;
• Enhancing in-home palliative care services;
• Implementing a regional bereavement plan; and
• Developing and enhancing volunteer programs.
PROVINCIAL CLINICAL STANDARDS
Systems &
Accountability
PCS1
Regional Programs
The Public
PCS2
Public Health Strategy
Clinicians
PCS3
Professional Development & Education
PCS4
Physician Workforce
PCS5
eHealth & Technology
PCS6
Advance Care Planning & End-of-Life Treatment Plans
PCS7
Gold Standards Framework & Registries
PCS8
Pediatric Palliative Care Strategy
PCS9
Aboriginal Palliative Care Strategy
Tools to Improve
Direct Care
Direct Care
Teams and
Settings
11
PCS10 Building Capacity at the Primary Level
PCS11
Hospice Palliative Care Teams
PCS12
Residential Hospices and Palliative Care Units
11
PRIORITIES
2015-2016
PRIORITIES 2015-2016
12
ACCESS
CARE
CAPACITY
Develop a strategy to engage
primary providers
Enhance community
programming/Increase
access to day hospice and
home visiting services
Facilitate bereavement
support and advance care
planning
PCS 3/PCS4/PCS5/PCS10
PCS2/PCS5/PCS12
PCS2/PCS3/PCS6
Rural Framework (Local HPC teams, Volunteer Programs, Access, Education, Home Care)
Ensure hospice palliative care services are responsive to the diversity of all residents (PCS9)
Implement and monitor targeted standards and performance indicators
12
Access
•Develop a strategy to engage to primary providers
13
• Develop strategy and support existing initiatives to involve
primary care providers early when their patients are
receiving treatment at Regional Cancer Center/Heart
Institute
• Develop region-wide database of primary health care
providers (HCP) providing palliative care to their own
patients & “foster physicians.”
• Develop training and professional development
opportunities for primary care providers and health care
professionals (Difficult Discussions/regional calendar)
Access
•Develop a strategy to engage to primary providers
14
• Providing HCPs with a greater sense of being
valued for their work:
•
Promote access to regional teams (evaluation Regional
Palliative Consultation Team )
•
Provide easy access to materials, information, and
resources (e.g. website redevelopment)
•
Create central point of access for palliative care system
(Assess Central Referral and Triage and plan for
regional roll-out)
•
Advocacy & support for provincial
framework
CARE
•Enhance community programming
15
• In-home & access to day hospice and visiting
programs:
• Community development information & planning
package to support increased access to day
hospice/home visiting
• “Floating bed” pilot development (exploring concept
with Pikwàkanagàn First Nation and others)
• Health System Improvement Proposal planning &
review process
• Ontario Telemedicine Network evaluation
CAPACITY
•Facilitate Bereavement Support & ACP
16
• Regional Bereavement Support Leadership Team
• Regional Advance Care Planning (ACP) Leadership team
(Standardizing Goals of Care Designation)
• Facilitate training, education and/or support initiatives
for healthcare professionals, volunteers and caregivers.
(e.g. bereavement support for service providers)
• HPC and ACP Public education initiatives
(e.g. Speakers Bureau, inventory, materials)
•EVALUATE & SUSTAIN
17
• Creating a self-improving system (through meaningful
and manageable data collection & reporting)
• Decision Support Coordinator
• Data Sharing agreements, data collection and
quality improvement/evaluation initiatives
• Identify critical success factors/celebrate their
achievement/share best practices.
•OUTCOMES
18
We will know the system is changing when:
- More people are cared for by their primary care
provider at the end of life
- More people have their wishes communicated and
respected through advance care plans
- More people are able to die in their place of choice
QUESTIONS?
• Questions for Reflection:
• What advice does the LHIN Board have for the Regional
Program as it implements the Action Plan?
• What advice does the LHIN Board have for system planning
and development that ensures that care needs at the end
of life are part of the continuum of service, regardless of
diagnosis?
• Are there additional considerations that could strengthen
the proposed approach to ensuring that each person’s
wishes for care are communicated through the process of
advance care planning?
19
Board Motion
Whereas it is understood that implementation of additional or
expanded hospice palliative care services will be contingent
on available funding, be it resolved that the Champlain LHIN
Board endorses the strategic directions presented in the
Hospice Palliative Care Regional Program Five-Year Action
Plan (2014-19).
20
Ottawa, ON K1J 1A3
Tel 613.747.6784 • Fax 613.747.6519
Toll Free 1.866.902.5446
Ottawa, ON K1J 1A3
Sans frais : 1 866 902-5446
GOVERNANCE COMMITTEE
May 6, 2015 - 3:00 p.m.
Champlain LHIN: Resource Room (basement suite 101)
1900 City Park Drive, Ottawa
MINUTES
Board Members in Attendance
Staff/Guests
Regrets
R. Reid (Committee Chair)
E. Ashfield
A. Brewer
D. Somppi **
JP Boisclair
C. LeClerc
R. Olfert
C. Martell
J. Fahey
S. Bleau (recorder)
**Joined via teleconference
TOPIC
1
2
RESULTS - ACTIONS
Call to order & Declaration:
Conflict of Interest
The meeting is called to order at 3:00 p.m.
Approval of Agenda
There being no objection, the agenda is approved as presented:
David Somppi declares a potential conflict of interest re:
PriceWaterhouse Coopers.
Moved: Alexa Brewer
Seconded: Elaine Ashfield
All in Favour
Carried
3
3.1 Consent Agenda:
There being no objection, the agenda is approved as distributed.

Moved: Elaine Ashfield
Seconded: David Somppi
All in Favour
Carried
Approval of Minutes:
March 4, 2015
1
3.2 Business Arising from the
Minutes:



Use of Closed Sessions 2014-15: Randy Reid speaks to the final
version of the compilation regarding the use of in-camera sessions
during Board meetings. The group is in agreement with the results
(19% of monthly Board meetings were held in-camera). This
calculation does not include public committee meetings or public
education sessions. It is agreed that for fiscal year 2015-2016 all
Board and committee meetings, as well as Board education
sessions will be included in the calculation. ACTION: S. Bleau
Update on the Collaborative Governance Survey (pan-LHIN):
Results have not been compiled yet by the LHIN Shared Services
and will be shared at a later date.
Update on the Aboriginal Board Committee: Work accomplished
to date by Y. Boyer’s and LHIN staff is on hold pending the
appointment of her replacement on the Board. The posting for her
position has been extended to May 20, 2015.
NEW BUSINESS
Board Management
There is no item for discussion under Board Management today.
4
The review and analysis of committees’ terms of reference and work
plans to identify gap and duplication is deferred to the Governance
Agenda of September 9, 2015. ACTION: S. Bleau
Governance Committee Management
5
Review Governance Committee
Work Plan 2015-16
5.1
The work plan was distributed for information.
6.1
Endorse Approach to Development of 2016-2019 Integrated
Health Services Plan:
Strategic Planning
6
Planning for next Integrated
Health Services Plan (IHSP)
James Fahey, Director of Planning, and Cal Martell, Senior Director,
Health System Integration present the proposed approach for the
development of the next IHSP, including development of timelines
and proposed agenda for the Board retreats later in May.
Lengthy discussion follows and several suggestions are made by
2
members of the committee. Amendments will be made to the slide
deck before it is presented at the Board Retreat on May 21st.
6.2
Define the Role of Patient and Family Advisors
The group agrees in principle with patient engagement. An important
part of the discussion also revolved around the manner in which to
best ensure an appropriate level engagement with stakeholders. The
group concludes that stakeholder and patient engagement will be
further discussed between management and the full Board at the
retreat on May 21st.
6.3


Proposed Timeline for the Development of the Integrated
Health Services Plan (IHSP) 2016-19 :
The group approves the Agenda for May 21st Strategic Board
Retreat as presented.
Group agrees in principle with the proposed timeline for the
development of the IHSP as presented.
The Governance Committee agrees that Board Members who are not
part of the this committee will receive some of the material
distributed and be informed that this group is agreeable with the
proposed approach, process and timeline presented for the
development of the next Integrated Health Services Plan, as well as
with the draft agenda for the May 21st Board Retreat. ACTION:
Chantale LeClerc/JP Boisclair
7
7.1 Approve Board
Plan 2015-16
The proposed plan was distributed to committee members earlier for
their consideration. The committee consults with Alexa Brewer and
Elaine Ashfield who participated in a working group with LHIN staff
to help produce the Board’s community engagement plan for 20152016. Both members are in agreement with the proposed plan and
the group agrees that a presentation/further discussion of the Board’s
community engagement plan is not needed today.
The Board will receive a presentation by Jessica Searson,
Community Engagement Coordinator, of the Champlain LHIN
Community Engagement Report for 2014-2015 and plan for 20152016 at the Board meeting of June 22, 2015.
3
Committee Oversight
8
There has no item for discussion under Committee Oversight today.
Other Duties
9
Board Committee Membership: Randy Reid and JP Boisclair
communicate that following an analysis of other LHIN Boards, the
committee structure is satisfactory and will remain. Following recent
changes to the Board’s membership, as well as requests received by a
few members, the Board Chair and Chair of the Governance
Committee consulted with members and made a few changes to some
committees’ membership: These changes will be communicated to
all members and are listed below. ACTION: JP Boisclair/R. Reid.



Elaine Ashfield will move to Finance and Audit Committee
and no longer sit on the Governance Committee.
Jocelyne Beauchamp remains Vice Chair, but will no longer
sit on the Finance and Audit and will no longer chair the
French Language Services, but will remain as a member.
Pierre Tessier will chair the French Language Services and be
a member on the Finance and Audit Committee.
The group agrees to add to the Governance Committee agenda in
September a discussion around transparency in our discussions at
Board meetings. ACTION: S. Bleau
Board Meeting Agenda: JP Boisclair informs the group that the
Board meeting agenda will be drafted with the CEO and Board Chair
in consultation with the Board’s Vice-Chair and Chair of the
Governance Committee. The goal is to review the agenda and
provide strategic thinking in the development process.
Board Skills Matrix: Following the arrival of the Board Chair and
Board Member, Jean-Pierre Boisclair and Pierre Tessier, the Ministry
requested a revised Board Skills Matrix. JP Boisclair revised and
forwarded the amended matrix. This latter will also be shared with
the Board. ACTION: S. Bleau
4
Conclusion
There being no further business the meeting adjourns at 5:10 p.m.
Moved: Alexa Brewer
FUTURE MEETINGS
September 9, 2015
November 11, 2015
January 13, 2016
March 1, 2016
5
Ottawa, ON K1J 1A3
Tel 613.747.6784 • Fax 613.747.6519
Toll Free 1.866.902.5446
Ottawa, ON K1J 1A3
Sans frais : 1 866 902-5446
Finance & Audit Committee
May 25, 2015 at 3:00 p.m.
Champlain LHIN: Resource Room (basement suite 101)
Minutes
Attendance: M. Biron (Committee Chair), JP Boisclair, P. Tessier, E. Ashfield. R. Reid, C.
LeClerc, E. Partington, S. Williamson.
Guests: G. Gauthier, S. Stewart (Auditors)
Meeting Results
Call to Order:
1
The meeting is called to order at 3:00 p.m.
Marie Biron welcomes two new members to the Finance & Audit Committee: Elaine Ashfield and
Pierre Tessier.
Declaration of Conflict of Interest:
None.
Approval of Agenda:
2
Additional items:
 7.2 Internal Audit Plan
 7.3 Policy: Commitment and Spending Authority
 6.1 To move to top of meeting
There being no objection, the agenda is approved as amended.
Moved by: JP Boisclair
Seconded by: P. Tessier
All in Favour
Carried
Consent Agenda:
There being no objection, the item under the consent agenda is approved as presented:
 Approval of Minutes: January 26, 2015
3
Moved: R. Reid
Seconded: E. Ashfield
All in Favour
Carried
4
No business arising.
NEW BUSINESS
Financial Plans & Financial Overview
Approval of Quarterly Reports (2014-15 Q4)
5
5.1 Cash Advance Update (for health service providers):
No cash advance provided in the fourth quarter.
5.2 Capital Planning:
An update regarding capital planning projects was pre-circulated. No further questions from
members.
5.3 Health Service Providers Allocation Report:
The report on allocation was pre-circulated and a high level summary on the allocation is provided by
S. Williamson. No further questions from members.
5.4 Approval of 2015-16 Decision Making Framework Weights:
The group agrees not to update weights on an annual basis, but perform a review following the
approval of the Integrated Health Services Plan. This change in process will be reflected during the
Board’s annual review exercise in the appropriate work plans (add to Board work plan and remove
from Finance & Audit). ACTION: S. Bleau & Committee Chairs.
Suggestion: When the Board reviews the framework, it should consider aggregating some of the
criteria.
MOTION (for the Board’s consent agenda, June 24, 2015):
That the Finance and Audit Committee recommends the Board approves the fourth quarterly
reports as presented:
 Cash Advance (2014-15 Q4)
2



Capital Planning (2014-15 Q4)
Health Service Provider Allocation (2014-15 Q4)
2015-16 Decision Making Framework and Weights.
Moved by: E. Ashfield
All in Favour
Carried
Oversight of External Audit Function
6
6.1 Approval of the Auditors Report and Audit Financial Statements (
(including in-camera session)
Audit Report:
Auditors S. Stewart and G. Gauthier present a high level summary of the audit report 2014-15.
Overall comments from the auditors are that the Champlain LHIN provided a clean audit, staff
members were well prepared and cooperated fully. One correction remains to be made under
materiality (page 5). A few clarifications are provided during the presentation. A revised final
version will be provided to the Board on May 27th.
Financial Statements:
S. Williamson reviews the financial statements. He points to a few amendments to be made. A final
version will be distributed to the Board on May 27th.
MOTION (To be tabled at the Board meeting May 27, 2015):
That the Finance and Audit Committee recommends the Board approves the Auditors Report,
as amended; and the audited financial statements for 2014-15, as amended.
Moved: R. Reid
Seconded: P. Tessier
All in Favour
Carried
In-Camera Session:
THAT 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
3

To receive confidential briefing from the Auditors (without LHIN staff members in attendance)
Moved: R. Reid
Seconded: JP Boisclair
All Favour
Carried
The meeting returns to the public session and there is no issue to report in the public domain.
Some of the comments made by the auditors during the closed sessions are echoed by M. Biron who
commends Champlain LHIN staff members for delivering another clean audit. Also she thanks
members of the committee for their ongoing diligence.
Internal Control and Financial Risk Management
7
7.1 Review and Approve Expense Claims of the Board Chair (2014-15 Q4)
The report is reviewed with the group.
MOTION:
That the Finance and Audit Committee approves the Acting Board Chair and Board Chair
expense and per diem claim reimbursed in 2014-15 Q4 as presented.
Moved by: P. Tessier
Seconded by: R. Reid
Recused: JP Boisclair, Chair
Carried
7.2 Internal Audit Plan:
M. Biron provides background on an earlier decision of this committee (January 2015 meeting) to
add to the work plan an internal control (compliance audit) that will take place annually during
summer months. The plan for this audit is presented by S. Williamson. Discussion follows
regarding a reasonable sample number of transactions to be audited. It is also suggested to provide in
the analysis of the audit, the financial impact of the observations. It is noted that the original goal of
this audit is not only address compliance, but to assure the Board that financial transactions are
appropriate and process controls effectively mitigate the risk of fraud. Results of this audit will be
presented to the committee in October and may lead to some adjustments in our policies or processes.
Audit results will also be shared with the Board in the fall.
MOTION:
That the Finance and Audit Committee approves the internal audit plan as presented.
4
Moved by: P. Tessier
Carried
7.3 Policy – Commitment & Spending Authority:
C. LeClerc explains the policy has been updated to reflect changes in the Champlain LHIN structure
(additional director level). The revised policy includes appropriate delegated authority to Directors,
as well as other less significant changes. Some amendments are suggested by members.
The group agrees with the proposed revisions. In view of providing delegated authority to Director
this summer, the revised policy will be presented to the Board by M. Biron on June 24 as part of her
report. ACTION: M. Biron/C. Leclerc
The group agrees that the current practice (as per Governance terms of reference) of bringing all
finance related policies to the Governance Committee prior to going to the Board will be amended.
ACTION: Modify Finance & Audit Committee terms of reference to reflect that policies
revised and approved by this committee will go directly to the Board for approval.
MOTION (To be tabled at the Board Meeting June 24, 2015):
That the Finance & Audit Committee recommends the Board approves the policy regarding
commitment and spending authority as amended.
Moved by: E. Ashfield
Carried
Compliance with Laws and Regulations
8
Oversight of Programs
9
9.1 Review Annual Budget for LHIN Operations (2015-16)
The operational budget is presented and clarifications are provided regarding adjustments made from
last year’s budget.
9.2 Review & Approve LHIN Operations Financial Reports (2014-15 Q4)
The financial report is presented.
5
9.3 Review & Approve Use of Consultant Report (2014-15 Q4)
The report is tabled. No further questions.
MOTION (for the Board’s consent agenda June 24, 2015):
That the Finance and Audit Committee recommends the Board approves the following reports
as presented:
 Annual Operational Budget 2015-16
 LHIN Financial Report (2014-15 Q4)
 Use of Consultant Report (2014-15 Q4)
Moved by : JP Boisclair
All in favour
Carried
Development of Annual Work Plan
10
10.1 Review & Update 2015-16 Committee Work Plan
It is noted that the work plan will also reflect the change to its terms of reference relating to policy
approval, i.e. finance related policies approved by this committee will go directly to the Board for
approval.
The meeting concludes at 5:05 p.m.
Moved to Adjourn JP Boisclair
FUTURE MEETINGS
11
July 27, 2015
October 26, 2015
January 18, 2016
February 29, 2016
Marie Biron, Committee Chair
6

Meeting - Champlain LHIN

Transcription

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