Meeting Materials - Central West LHIN
Transcription
Meeting Materials - Central West LHIN
BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER BOARD OF DIRECTORS’ MEETING Regular Agenda WEDNESDAY, JUNE 22, 2016 Commencing at 5:00 p.m. at the Central West LHIN Office 8 Nelson Street West, Suite 300, Brampton, Ontario Board Members: John McDermid (Acting Chair), Ken Topping (Member) Lorraine Gandolfo (Member), Suzan Hall (Member), Pardeep Singh Nagra (Member), Adrian Bita (Member), Jeff Payne (Member) LHIN Staff: Scott McLeod (CEO), Brock Hovey, Mark Edmonds, Tom Miller, Michele Williams, Elizabeth Salvaterra Regrets: Maria Britto (Board Chair) # 1.0 Agenda Item Call to Order 1.1 Approval of Agenda (Attachment) 1.2 Conflict of Interest 2.0 Consent Agenda (Attachment) 3.0 3.1 Report from the Board Chair To be Accomplished The Chair to welcome Guests and any Observers from the public and clarify the meeting format. To review and approve the Agenda for the Meeting. To remind members of the Conflict of Interest Policy and procedures for declaring a potential conflict. To review and approve the Consent Agenda and remove items to the Regular Agenda for further discussion, as required. Board Members to receive a verbal update from the Board Chair and opportunity for Board Members to ask questions and seek clarification. Lead John McDermid 5:00 – 5:05 p.m. Board Members 5:05 – 5:15 p.m. John McDermid 5:15 – 5:35 p.m. 3.2 Report from the Chief Executive Officer (Attachment) Board Members to receive a brief overview of Scott McLeod the CEO’s written monthly report and an opportunity to highlight specific activities, as well as an opportunity for Board Members to ask questions and seek clarification. 4.0 Board Education / Generative Dialogue 4.1 Patients’ First Legislation Board Members to discuss the introduction of the Scott McLeod (Attachment) Patients’ First Legislation 5.0 Strategic Dialogue 5.1 2015-2016 Balanced Scorecard Spring/Year-End Cycle - (Attachment) 5.2 2016/17 – 1st Quarter (Q1) Enterprise Risk Management (ERM) Report - (Attachment) Time Board Members to receive an overview of the Brock Hovey/ 2015-2016 Central West LHIN Balanced Elizabeth Salvaterra Scorecard Spring/Year-End Cycle Board Members to review and approve the 2016- Brock Hovey 2017 – 1st Quarter (Q1) Enterprise Risk Management (ERM) Report 1 5:35 – 6:05 p.m. 6:05 – 6:25 p.m. 6:25 – 6:40 p.m. BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER # Agenda Item To be Accomplished 5.3 2015-2016 Annual Report (Attachment) 6.0 Lead Time Board Members to review and approve changes incorporated into the 2015-2016 Annual Report since the last Board Meeting Mark Edmonds/ Tom Miller 6:40 – 6:50 p.m. Board Members to receive a verbal update on discussions held at the Quality Committee meeting of Monday, June 13, 2016 and the Board to approve any recommendations coming forward from that meeting John McDermid 6:50 – 7:00 p.m. 6.2 Verbal Report from Board Members to receive a verbal update on Governance Committee Meeting – discussions held at the Governance Committee Thursday, June 9, 2016 meeting of Thursday, June 9, 2016 and the Board to approve any recommendations coming forward from that meeting Lorraine Gandolfo 7:00 – 7:10 p.m. 6.3 Verbal Report from Finance & Audit Committee Meeting) – Monday, June 20, 2016 (Attachment Adrian Bita 7:10 – 7:20 p.m. Fiduciary Dialogue 6.1 Verbal Report of the Quality Committee Meeting – Monday, June 13, 2016 Board Members to receive a verbal update on discussions held at the Finance & Audit Committee meeting of Monday, June 20, 2016 and the Board to approve any recommendations coming forward from that meeting ß 2016/2017 - 1st Quarter (Q1) Report 6.4 Quarterly CEO Attestation (Attachment) Board Members to approve the 2016-2017 - 1st Quarter (Q1) CEO Attestation (for the period March 1, 2016 to June 30, 2016) Scott McLeod 7:20 – 7:30 p.m. 7.0 In-Camera Session As required John McDermid 7:30 p.m. 8.0 Adjournment of Meeting To summarize action items and adjourn meeting John McDermid 8:00 p.m. ITEMS ATTACHED TO AGENDA – FOR INFORMATION ONLY: 1. Osler/Headwaters/CCAC Regional Service Model 2. Region of Peel – Community Water Fluoridation Committee – Reports and Presentation, June 9, 2016 (3 Attachments) Date of Next Board of Directors’ Meeting: WEDNESDAY, SEPTEMBER 28, 2016 Central West LHIN Office, 8 Nelson Street West, Suite 300 Brampton, Ontario 2 2 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 3 3 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER MEMORANDUM To: All Osler Staff, Physicians, and Volunteers From: Cathy Hecimovich, CEO Liz Ruegg, President and CEO Matthew Anderson, President and CEO Date: Monday, June 13, 2016 Subject: Regional Service Model Over the past two years, the back office partnership has enabled new and innovative ways to deliver care across our three organizations to benefit the more than 1.3 million people we serve in Central West region. This unique partnership supports our shared vision to put patients at the center of all we do by strategically aligning administrative functions and reinvesting savings into patient care. In support of our shared commitment to improve access to care and create a long-term sustainable model, we have evolved the Joint Back Office to a new regional Service Model and increased our regional vice president complement from five to six. Our new regional non-clinical executive team now includes two dedicated VP, Corporate Services roles responsible for operations excellence at Headwaters Health Care Centre and the Central West CCAC respectively and four Joint VPs. The VPs Corporate Services will work in partnership with the Joint VPs to ensure delivery of non-clinical support services across the region. Today, we are pleased to announce our new non-clinical support services VPs complement. Bob Varga has accepted the role of VP, Corporate Services at CW CCAC. Bob will report directly to Cathy Hecimovich and have onsite responsibility for Human Resources/Organizational Development (HR/OD), Finance, Facilities, IM/IT, Patient Experience, Communications/Strategy, Privacy, Contracts and Service Provider Relations. Bob will be located onsite at the CCAC. Monique Porlier has accepted the role of interim VP, Corporate Services at Headwaters. Monique will start on June 14, 2016 and have onsite responsibility for HR/OD, Finance, Facilities, IM/IT and Biomedical Engineering, Patient Experience, Communications/Strategy, Maintenance/Facilities, Food Services, Materials Management and Security. Monique joins us from the Canadian Cancer Society and prior to that, Halton Healthcare Services, where she was a senior operations and finance executive at both. Monique will be located onsite at Headwaters. To accommodate these onsite positions, we have restructured the existing JVP portfolios to shift from five regional positions to four. This new model supports our partnership, continues the work of our regional teams and aligns with the Ministry of Health and Long-Term Care’s vision of health care transformation in Ontario. Service Model Communications All Staff Memo FINAL June 13, 2016 4 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER Joint VPs include: Susan deRyk, JVP, Service Quality and Community Relations - with new responsibilities for Patient Registration, Locating/Switchboard and Library Services in addition to Patient Experience, Communications, Strategy, and (Osler’s) Print Shop/Mailroom. This portfolio is well-positioned to promote a positive patient experience by bundling patient and community-facing support service areas. Ann Ford, JVP, Information Technology and Redevelopment - with new responsibilities for IT in addition to Redevelopment, Facilities, Security and Parking. This portfolio promotes innovation in technology, infrastructure and facilities development across the region. Florine Lobo, Joint Chief Financial Officer & JVP, Organizational Performance - with new responsibilities for Information Management: Decision Support, Health Records & Business Intelligence in addition to Financial Services. This portfolio promotes innovative solutions and strategic financial advice to support service delivery. Christine Nuernberger, JVP, Human Resources & Organizational Development - with new responsibilities for the Project Management Office (PMO) in addition to HR and OD. This portfolio will focus on promoting a culture of excellence across the region, supporting our Evidence Based Leadership (EBL), change management and project leadership. As a result of the realignment to the Service Model, there are several responsibility and reporting shifts for a number of Executive Directors, Directors and Managers across all three organizations. Everyone directly affected has been personally notified. A copy of the organization charts will be available within the next day on the intranet. We look forward to continuing to find additional ways to partner to enhance patient care and increase access to health care services close to home within the Central West region. Thank you for your support as we continue to work together to benefit the patients, families and communities we collectively serve. Service Model Communications All Staff Memo FINAL June 13, 2016 5 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 6 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 7 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 8 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 9 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 10 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 11 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 12 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 13 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 14 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 15 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 16 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 17 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 18 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 19 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 20 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 21 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 22 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 23 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 24 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 25 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 26 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 27 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 28 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 29 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 30 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 31 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 32 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 33 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 34 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 35 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 36 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CALL TO ORDER 37 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA BOARD OF DIRECTORS’ MEETING 2.0 Consent Agenda WEDNESDAY, JUNE 22, 2016 8 Nelson Street West, Suite 300 Brampton, Ontario ________________________________________________________________________________________ Attachments: 2.1 Minutes of Board of Directors’ Meeting held Wednesday, May 25, 2016 2.2 Minutes of Finance & Audit Committee Meeting held Tuesday, May 24, 2016 2.3 Minutes of Governance Committee Meeting held Thursday, April 14, 2016 2.4 Minutes of Quality Committee Meeting held Monday, April 11, 2016 38 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA MINUTES OF THE BOARD OF DIRECTORS’ MEETING WEDNESDAY, MAY 25, 2016 Commencing at 2:00 p.m. 55 John Street (Village of Alton) Caledon, Ontario Board Members Present: LHIN Staff Present: Maria Britto (Board Chair), John McDermid (Vice Chair), Lorraine Gandolfo (Member), Suzan Hall (Member), Pardeep Singh Nagra (Member), Adrian Bita (Member), Jeff Payne (Member) Scott McLeod (CEO), Brock Hovey, Mark Edmonds, Michele Williams, Tom Miller Regrets: Gerry Merkley (Member) 1.0 Call to Order Maria Britto, Board Chair, called the Board Meeting to order at 2:00 p.m. and noted regrets for Gerry Merkley, Board Member. There were no Observers in attendance. 1.1 Approval of Agenda MOVED by Suzan Hall and SECONDED by Adrian Bita, that the Regular Agenda for the Central West LHIN Board of Directors’ meeting of Wednesday, May 25, 2016 be approved, as circulated. CARRIED 1.2 Conflict of Interest Maria reminded Members of the need to declare a Conflict of Interest with respect to any items that could potentially place them in a conflict situation. There were no declarations. She requested that all cell phones be turned off or muted during the meeting. 2.0 Consent Agenda Maria reminded Board Members that the process is that they can ask questions for clarification from the Consent Agenda, but if further discussion is required, the item will be pulled and added to the Regular Agenda. Scott advised that all action items from the Board Minutes of Wednesday, April 27, 2016 have been addressed. 39 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA He noted that he had heard back from Peel Public Health regarding the Board’s inquiry regarding dental screening in French Language speaking schools. Peel Public Health has confirmed that dental screening does take place in both the Public and Catholic Boards’ French Language speaking schools in the Region of Peel. There was a request to pull Item #2.3 ‘Explanation and Clarification of Actual Cost Per Weighted Case and Expected Cost Per Weighted Case’ from the Consent Agenda for further discussion. It was agreed that the item would be discussed immediately. Brock Hovey then reviewed the briefing note that had been included which provided a bit of background on the current ‘trending’ of actual versus expected costs and volumes for both William Osler Health System and Headwaters Health Care Centre. He noted that the LHIN is working with the hospitals and the Ministry to better understand the factors that may be contributing to this trending. It was noted that while the data presented in the graphs are correct, the Y-axis scale does not begin at “0” making the change look much more significant than it actually is. For example, Headwaters Actual Cost per Weighted cases has been increasing over the last number of years from $4,909 to $5,283; an increase of $374 over 2 years, but because the Y-Axis begins at $4,700 it makes this increase appear much more dramatic graphically. Brock noted that he would follow up again with Ministry staff to try to gain further insight into what might be driving this with respect to Headwaters, and will report back to the Board. ACTION: Brock Hovey MOVED by John McDermid and SECONDED by Pardeep Singh Nagra, that the Central West LHIN Board of Directors approves the Consent Agenda, as amended. CARRIED 3.0 Report of the Board Chair and Chief Executive Officer 3.1 Report of the Board Chair Maria provided a brief update on some of her meetings and activities over the past month, including updates on the status of LHIN Board recruitment, speaking engagements at various organizations including the Rotary Club of Palgrave and preparations for the Board of Directors’ Retreat. She also provided an update on the work of the Healthy Communities Initiative, noting that this group is moving along very well. Ken Topping advised that there is a group in Dufferin County called ‘Headwaters Community in Action’ (HCIA), who is doing some similar work and that he would forward their contact information to Maria. ACTION: Ken Topping 3.2 Report of the Chief Executive Officer Scott referenced his CEO Report, highlighting the following areas: __________________________________________________________ Minutes of Central West LHIN Board of Directors’ Meeting held Wednesday, May 25, 2016 Page 2 of 5 40 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA Health Links There has been an exponential increase in the number of care plans related to Health Links in the Central West in the last quarter, far exceeding most other LHINs. The outcomes continue to show significant reductions in utilization of ED and inpatient volumes, as well as better ‘Quality of Life’. Future evaluations will also include ‘Patient Experience’. Palliative Care/End of Life The LHIN anticipates hearing soon regarding the first round of approvals for residential hospice beds, noting that based on a ‘population-based assessment of needs’, the Central West should have 36 Residential Hospice Beds. Currently we have ten, which is a significant gap. Scott noted that Margaret Paan, has accepted the position of Director of the Central West Palliative Care Network. Margaret has been an active member of the Central West Network and will be able to transition easily into this role. She will have a dual reporting relationship to both the Central West LHIN CEO and the Regional Vice President of the Carlo Fidani Cancer Centre at Trillium Health Partners. Hospital 2 Home The Central West LHIN is one of six pilots that have been approved as part of the Home and Community Strategy. The pilot provides bundled payment to William Osler, who then manages the full continuum of care for 2 specific conditions, including the acute and short-term, post-acute community care. While still early days, the pilot is seeing significant improvements in length of stay and hours of care. Headwaters Health Care Centre Groundbreaking A ground breaking event for the $10 million Ambulatory Care expansion and Operating Room upgrades at Headwaters Health Care Centre will take place May 26th. The community has waited a very long time for these much-needed improvements. Senior Director Recruitment This process for recruitment of the Central West LHIN Senior Director of Health System Integration is well underway with Knightsbridge, who have indicated that there has been considerable interest in the position. 4.0 Board Education/Generative Dialogue There was no scheduled Board Education/Generative Dialogue session this month. 5.0 Strategic Dialogue 5.1 2015-2016 Annual Report Board Members reviewed a first draft of the 2015-2016 Central West LHIN Annual Report and provided preliminary feedback. Scott advised that the document follows the usual required format and is due for __________________________________________________________ Minutes of Central West LHIN Board of Directors’ Meeting held Wednesday, May 25, 2016 Page 3 of 5 41 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA submission to the Ministry of Health and Long-Term Care by June 30, 2016. Board Members were asked to provide feedback or suggested changes by June 10th. The document will be revised accordingly, and a final Draft will be brought to the June Board Meeting for approval. 5.2 2016-2017 Annual Business Plan A final annotated draft of the 2016-2017 Annual Business Plan (ABP), incorporating changes requested by the Ministry was reviewed by Board Members and a brief discussion followed. The final ABP is due to the Ministry of Health and Long-Term Care by June 17th. . 5.3 Executive Leadership Development in the Central West LHIN Scott advised that the Executive Leadership Development Program has now completed three modules with approximately 45 participants at each, for a total of approximately 135 graduates including several primary care physicians, many of them who are highly engaged and now attending Governance & Leadership and other LHIN events. He noted that it has been a highly successful program and requested the Board’s approval of a 4th module, subject to the LHIN receiving the Community Funding and having availability of one-time funding. A brief discussion followed. 6.0 MOVED by John McDermid and SECONDED by Ken Topping, that the Central West LHIN Board of Directors approves the continuation of the Central West Executive Leadership Development Program for 2016-2017, subject to receiving our Community Funding and having availability of one-time funding. CARRIED Fiduciary Dialogue 6.1 Verbal Report of the Finance & Audit Committee Adrian Bita provided an overview of discussions at the Finance & Audit Committee meeting Tuesday, May 24, 2016 noting that the Committee had reviewed the Post Audit Report and audited financial statements with Steve Stewart from Deloitte. Steve had advised that it had been a very clean audit, that good internal controls were in place, and that the LHIN staff had been very cooperative throughout the process. Adrian advised that as per usual practice, all staff had been excused from the meeting for a brief discussion with Committee Members and the Auditor only. MOVED by Jeff Payne and SECONDED by Lorraine Gandolfo, that the Central West LHIN Board of Directors approves the 2015-2016 Central West LHIN Post Audit Report and audited financial statements for the period ending March 31, 2016, as circulated. CARRIED __________________________________________________________ Minutes of Central West LHIN Board of Directors’ Meeting held Wednesday, May 25, 2016 Page 4 of 5 42 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA Adrian advised that Committee Members had also reviewed the final 2015-2016 Funding Allocations and were very pleased that staff had been able to move the majority of the funding out to the health service providers very quickly this year. Staff were congratulated on their efforts. 6.2 Verbal Update from Quality Committee John McDermid advised that the Quality Committee had not met in May, but that he had recently participated in interviews for the Clinical Quality Lead position, announcing that Dr. Tamara Wallington had been the successful candidate. He noted that Dr. Wallington is a staff physician at William Osler Health System in the Department of Medicine, and Corporate Medical Director for Quality and Patient Safety. In her new role, she will have the opportunity to influence positive change that will result in improved patient outcomes, experience of care and value for money with the ultimate goal of aligning the Quality agenda while engaging Central West LHIN communities to build on and help accelerate existing efforts to promote a culture of quality. 7.0 In-Camera Session MOVED by Ken Topping and SECONDED by Pardeep Singh Nagra that, at 3:50 p.m., the Central West LHIN Board of Directors consider Matters of Public Interest in a Closed Session as set out by the Local Health Integration Act, 2006, s.9(5)(a), and further, that Staff Members in attendance be invited to stay for this portion of the meeting. CARRIED MOVED by John McDermid and SECONDED by Adrian Bita that, at 4:20 p.m., the Central West LHIN Board of Directors’ meeting be moved Out-of-Camera and back into the Regular Session. CARRIED 8.0 Adjournment of Board Meeting MOVED by Suzan Hall and SECONDED by Jeff Payne, that there being no further business for discussion, that the Central West LHIN Board of Directors’ Meeting of Wednesday, May 25, 2016 be adjourned at 4:20 p.m. CARRIED _____________________________ Maria Britto, Board Chair _________________________ Scott McLeod, CEO __________________________________________________________ Minutes of Central West LHIN Board of Directors’ Meeting held Wednesday, May 25, 2016 Page 5 of 5 43 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA MINUTES OF THE FINANCE & AUDIT COMMITTEE MEETING OF THE CENTRAL WEST LOCAL HEALTH INTEGRATION NETWORK Held Tuesday, May 24, 2016 at 6:00 p.m 8 Nelson Street West, Suite 300, Brampton, Ontario Committee Members Present: Gerry Merkley (Committee Chair), Ken Topping (Member), Maria Britto (Board Chair), John McDermid (Vice Chair), Pardeep Singh Nagra (Member), Adrian Bita (Member) Staff Members Present: Scott McLeod (CEO), Brock Hovey, Michele Williams, Michael Buchert, Tellis George Guest: Steve Stewart, Partner, Deloitte 1.0 Call to Order & Declaration of Conflict of Interest Gerry Merkley, Committee Chair and all staff members attended the meeting at the LHIN Office. The rest of the Members and Steve Stewart from Deloitte, participated via Teleconference as had been agreed to earlier in the day. Gerry called the meeting to order at 6:00 p.m. and asked if there were any declarations of Conflict of Interest. There were none. 1.1 Approval of Agenda MOVED by Pardeep Singh Nagra and SECONDED by Adrian Bita, that the Regular Agenda, as circulated, be approved. CARRIED 1.2 Conflict of Interest Gerry asked Committee Members if there were any declarations of Conflict of Interest with respect to agenda items. There were none. 44 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA 2.0 Approval of Previous Minutes 2.1 Minutes of Finance & Audit Committee Meeting held Monday, March 21, 2016 MOVED by John McDermid and SECONDED by Adrian Bita, that the minutes of the Finance & Audit Committee meeting of Monday, March 21, 2016 be approved, as circulated. CARRIED 3.0 2015-2016 Funding Allocation Summary Brock and staff members provided an overview, for information, of the 2015-2016 Funding Allocation Summary, which provides a breakdown of 2015-2016 funding to health service provider organizations from the period April 1, 2015 to March 31, 2016. A brief discussion followed and Gerry commended the staff on getting such a significant amount of money out to the health service providers so quickly this year, recognizing the amount of time and effort it would have taken to get this done. She expressed how great it was for her to see this happen as the outgoing Chair of the Finance & Audit Committee and encouraged the LHIN to continue this practice in the future. 4.0 2015-2016 Post Audit Report and Audited Financial Statements ending March 31, 2016 Gerry welcomed Steve Stewart, Partner with Deloitte, to the meeting. Steve provided an overview of the 2015-2016 Central West LHIN audit process, noting that there had not been any significant deficiencies and that overall, there was a very good internal control system in place. He advised that there had not been any restrictions placed on the Auditors by LHIN staff and there had been full cooperation from both LHIN management and staff prior to and during the audit process. Steve answered various questions from Members and at this point in the meeting (6:50 p.m.), the meeting was moved In-Camera for a brief discussion with Committee Members and the Auditor only. All staff were excused from the meeting. At 6:55 p.m., the meeting moved Out of Camera and back into the open session with all staff returning. Gerry thanked all staff for their efforts throughout the audit process, noting that the Committee was very pleased with having such a clean audit report. She congratulated Brock Hovey, Michael Buchert, Tellis George, Alan Hernandez, and the rest of the Finance Team for their good work. __________________________________________________ Minutes of Finance & Audit Committee Meeting held Tuesday, May 24, 2016 Page 2 of 3 45 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA MOVED by Adrian Bita and SECONDED by John McDermid, that the Finance & Audit Committee recommends approval of the 2015-2016 Central West LHIN Post Audit Report and Audited Financial Statements for the period ending March 31, 2016 as circulated. CARRIED 5.0 In-Camera Session There were no recorded minutes of the brief In-Camera session that took place with the Committee Members and the Auditor between 6:50 p.m. to 6:55 p.m. 6.0 Adjournment of Meeting MOVED by Pardeep Singh Nagra and SECONDED by Adrian Bita, that there being no further business for discussion, that the Finance & Audit Committee meeting be adjourned at 7:00 p.m. CARRIED ___________________________ Gerry Merkley, Chair Finance & Audit Committee __________________________________________________ Minutes of Finance & Audit Committee Meeting held Tuesday, May 24, 2016 Page 3 of 3 46 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA MINUTES OF THE GOVERNANCE COMMITTEE MEETING OF THE CENTRAL WEST LOCAL HEALTH INTEGRATION NETWORK HELD THURSDAY, APRIL 14, 2016 AT 5:00 P.M. 8 Nelson Street West, Suite 300, Brampton, Ontario Committee Members Present: Lorraine Gandolfo (Committee Chair), Maria Britto (Board Chair), John McDermid (Vice Chair), Ken Topping (Member), Suzan Hall (Member), Adrian Bita (Member), Jeff Payne (Member) Staff Members Present: Scott McLeod (CEO), Michele Williams (Board & CEO Liaison) 1.0 Call to Order & Declaration of Conflict of Interest Lorraine Gandolfo, Committee Chair, called the meeting to order at 5:00 p.m. and asked if there were any declarations of Conflict of Interest. There were none. 2.0 Approval of Agenda MOVED by Adrian Bita and SECONDED by Ken Topping, that the Regular Agenda for the Governance Committee meeting of Thursday, April 14, 2016 be approved, as circulated. CARRIED 3.0 Consent Agenda 3.1 Approval of Previous Minutes – Thursday, February 11, 2016 There were no errors or omissions noted in the previous minutes. Scott advised that all action items were either underway or complete. MOVED by Ken Topping and SECONDED by Suzan Hall, that the minutes of the Governance Committee meeting of Thursday, February 11, 2016 be approved, as circulated. CARRIED 4.0 2014-2015 Pan-LHIN Whole Board Evaluation – Comparative Results for the 14 LHINs Committee Members briefly reviewed the comparative results for the 14 LHINs and Scott noted that this had been circulated for information purposes only, as requested at a previous meeting. 47 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA 5.0 Central West LHIN 2014-2015 Whole Board Evaluation – ‘Opportunities for Development’ Action Plan Committee Members reviewed the 2014-2015 Central West LHIN Whole Board Evaluation – ‘Opportunities for Development Action Plan’ and a few specific areas that had been identified as potential areas for development/action at the last Governance Committee meeting including: - A refresh on the current ‘Legislated Authority’ of the Board (will be scheduled for the September 2016 Board Education session) Completion of a ‘Risk Template’ related to the number of Board Members who will be leaving the Board this year and the potential governance impact it poses for the Board (underway) One-on-One Meetings with the Board Chair (underway) 6.0 Update on Central West LHIN Governance & Leadership Forum – Tuesday, April 26, 2016 Scott provided a brief overview of the proposed Agenda for the April 26th Governance & Leadership Forum entitled ‘Creating a Culture of High Performance’, and based on the 5 Pillars of the Studer philosophy. He noted that materials would be distributed to registered participants prior to the event for ‘pre-reading’. At this time, there are approximately 90 people registered and a final email blast will be going out by the end of the week along with the pre-reading materials. Central West LHIN Board Members will also be copied on the email. 7.0 Central West LHIN Board of Directors’ Retreat Scott provided an update on planning for the May Board of Directors’ Retreat on ‘Patients First’, noting that the date of Thursday, May 26, 2016 had been confirmed and will be combined with an afternoon Board Meeting on Wednesday, May 25th with a dinner and farewell event for the three Central West LHIN Board Members who will be retiring this year. He advised that preliminary discussions with John Whincup of Optimus SBR (who will be Facilitating the Board Retreat) had led to a draft outline of what the day could look like, including some or all, of the following elements: - Implications – structured review of potential legislative changes, key elements from ‘Patients First’, review of the Rules of Engagement, and Ministry expectations Gaps and Issues- identification of gaps and issues related to governance and oversight of operations Prioritization – development of criteria and ranking of issues Identification of Solutions and Actions – brainstorming session to identify solutions and begin identifying actions (for example, Transition Plan, and work that needs to take place with the CCAC Board) Action Planning – development of an initial Action Plan that identifies what needs to happen for the Transition Plan to be implemented, what the next steps are for operations and what can be done now until the legislation is enacted Scott noted that work on the logistics with the off-site venue for both days are currently underway and that further information including a draft of a Retreat Agenda would be circulated to Board Members in the next couple of weeks. _____________________________________________________________________________ Minutes of Central West LHIN Governance Committee Meeting held Thurs., April 14, 2016 Page 2 of 3 48 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA 8.0 Governance Policy & Bylaw Review Scott provided a brief update on the review of LHIN Bylaws, noting that at the current time, they are still under review. He advised that the Central West LHIN Governance Policy on ‘Priority-Setting and Decision-Making Framework’, is in the process of a re-write by staff and will be brought back to the next Governance Committee meeting for review and recommended approval. 9.0 Board Appointments Maria provided a brief update on some of the ongoing discussions and challenges with the Board recruitment process, reminding Committee Members that we had submitted our advertisement for three new Board Members back in December 2015. There was a brief discussion about the OIC process, and Committee Members requested that a copy of the PanLHIN Board Chair correspondence that had recently been sent to the Minister outlining some of the current challenges with the public appointments process in addition to other governance items, be circulated to the full Board. Scott advised that a copy of the correspondence would be provided in the April Board package of materials. ACTION: Michele Williams 10.0 Adjournment of Meeting MOVED by John McDermid and SECONDED by Jeff Payne that at 6:20 p.m., the Governance Committee be adjourned. CARRIED _______________________ Lorraine Gandolfo, Chair Governance Committee _____________________________________________________________________________ Minutes of Central West LHIN Governance Committee Meeting held Thurs., April 14, 2016 Page 3 of 3 49 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA Quality Committee MINUTES Date: Time: Location: April 11, 2016 5:00 – 7:00 pm Main Boardroom Committee Members Present: LHIN Staff Present: 1.0 John McDermid (Chair), Maria Britto (Board Chair), Suzan Hall (Member), Jeff Payne (Member), Ken Topping (Member), Cynthia Majewski (Volunteer), Bernard Souche (Volunteer) Scott McLeod, Brock Hovey, Nancy LaBelle, Jas Rai, Suzanne Robinson, Dave Pearson Call to Order and Declaration of Conflict of Interest The meeting was called to order at 5:00 p.m. No conflicts of interest were declared. 2.0 Approval of Agenda Approval of the Agenda for the April 11th, 2016 Meeting MOVED by Jeff Payne and SECONDED by Suzan Hall that the Agenda be approved as circulated. CARRIED 3.0 Approval of Minutes Approval of Minutes of the March 7th, 2015 Meeting. MOVED by Jeff Payne and SECONDED by Suzan Hall that the Minutes of the March 7, 2016 meeting be approved as circulated. CARRIED 4.0 Update on System Level Aims The Chair thanked Jeff Payne for chairing the meeting last month. The Chair asked members if they had any comments about meeting with the constituents. Members felt the meetings were very productive and provided a lot of good information. 50 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA Brock introduced Suzanne Robinson and Dave Pearson (staff) to provide an update on System Level Aims. Suzanne addressed Improve Access to Mental Health and Addiction Services. Data shows that repeat Emergency Department (ED) visits within 30 days for mental health have improved over the last year with a downward trend, we are now at 14.1%, showing a downward trend compared to the provincial target of 16.3%. We have achieved a 10% change. Data indicates that ED visits have reduced by 60% with the InSTED program in place. Also, clients recommended by Crisis Services for an ED visit are triaged as requiring acute care and are admitted, showing that the need for an ED visit was appropriately assessed and the visit was necessary. Substance abuse metrics have not changed. We are reviewing data available from the MOHLTC, which specifically shows there are about 30 individuals who were identified as those with repeat visits. Data indicates that 75-80% repeat visits are related to alcohol use. Members asked if there was any visibility to the numbers of mental health patients visiting ED, specifically beyond 30 days. Suzanne advised that at this time there is no tracking above 30 days. As for the overall volume, numbers are steady, and there is a low number at Headwaters. Volumes are holding but not sure beyond 30 days. Suzanne informed members that there is no indication at this time that the Syrian refugees have had any impact on this number, have not seen any data that reflects that. At this time Suzanne turned it over to Dave Pearson. Dave addressed Improve System Navigation and informed members that by March 31st we are at 3,000 completed Health Links (HL) care plans for identified complex patients. Dave did seek some clarification from leadership that the target will remain at 10,000 going forward. The number is important, as HL is about system transformation. Dave informed members that we continue to support identification of HL patients and using Suzanne’s previous example, to look at how to support appropriate population groups such as mental health (as well as palliative care, primary care and Telehomecare) to ensure patients such as those 30 individuals with repeat visits have completed, coordinated care plans. Members asked why we chose 10,000 care plans. Dave advised that based on a data scan, we know we have around 40,000 clients that meet the definition of complex patients. Some of those patients needs may become less complex, and some will pass on - 10,000 seemed like a fairly good stretch target to begin to address these numbers. The plan is to continue to build the number of completed coordinated care plans for complex patients and numbers show that Brampton and Bramalea have improved, Bolton is a little behind, and Etobicoke is doing very well with almost 900 care plans in the last quarter. From a Pan-LHIN perspective, there is much more focus on HL provincially. HQO has looked at how we (Central West LHIN) do care rounds and how we use care tools, as we are ahead of other LHINs in our numbers. The idea is to share successes so we can all learn from each other. Dave informed members that as care plans are developed, HSPs can monitor and trend hospital utilization by HL patients to determine decreased reliance on the ED. Dufferin did this for the first 200-300 people, and it resulted in a 40% reduction in length of stay. As these are complex patients, you will notice at 60-90 days there is a return to the ED. 5.0 Overview of Quality at the Central West LHIN Brock reminded the members of the Health Quality Ontario (HQO) Quality Dimensions. A health system with a culture of quality that is: Central West LHIN... Making Healthy Change Happen 51 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA Safe Effective Patient-centred Efficient Timely Equitable Brock provided an overview of the Central West LHIN Quality Map in a schematic drawing to demonstrate how quality concepts at the provincial, regional and local levels fit together to drive quality across the system. Further discussions focused on quality structures within Central West and Brock advised that public representation will be at the Advisory Groups i.e. Regional Quality Table. In addition, HQO has recommended a member of the public be involved and the CEO advised members that in the Patient’s First legislative we will expect to see a patient/family counsel. 6.0 Third Party Health Service Provider (HSP) Survey Nancy LaBelle provided an overview of the Health Service Provider (HSP) Survey. Establishing a quality framework was ranked lowest in importance of LHIN activities by organizations. Health system funding and planning scored very high. There is an opportunity for HSPs at the regional level, to align quality across the system provincially and locally by developing an infrastructure. There is an opportunity during the HSP Quality Forum to lever collaboration and gain knowledge so that we can drive an agenda to result in some real collaboration with the HSPs. HSPs are learning from each other, and the fact that we now require HSPs to be accredited, quality is moving up on the importance list. It was noted that there are only 13 HSPs not accredited at this time, there may be one or two that may not be accredited by 2017. HSPs agree that this is a lot of work but it is worth doing. Quality initiatives should be shared publically, via a public facing document. Brock advised that a couple of years ago we published a document called “spotlight on quality”, and we have a section in every newsletter on quality. One of the criticism about quality is that it gets siloed. Every core action group should have a quality agenda item. It was suggested a report be sent out to our HSPs regarding our roadshow, this can be added as part of the next newsletter. 7.0 Patient Experience in the Central West LHIN Nancy LaBelle provided a summary of what happened in the province and in Central West LHIN. This is very high on the provincial agenda, as documented in the Auditor General Report. It is a system level aim for us and is in our IHSP and Annual Business Plan. From our meetings with HSPs it was evident that they are very engaged, there are some commonalities, and differences to develop across the LHIN on these measures. Central West LHIN... Making Healthy Change Happen 52 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA The Hospitals have a new Regional Chief Patient Experience Officer in place. Hospitals still use the NRC tool which has a delay in getting data, so staff follow up with a telephone call to patients in order to get real time information. Hospitals are focusing on the “top box” scores which are scored as yes or definitely for “would you recommend this hospital” questions, this is new for 2016/17. The CHCs quality dimensions are focused on being timely and patient-centred. The priority primary care indicators are: timely access to primary care; patient involvement in decision in care; primary care provider spending enough time with them; and opportunity to ask questions. CHC’s conduct regular client satisfaction surveys, via focus groups or surveys accessible via an iPad placed in waiting rooms. CCAC’s asks three specific questions: overall rating of care and service provided; rating of management or care provided by a Care Coordinator; and rating of service provided. In Long-Term Care (LTC) we heard that client satisfaction measurement is legislated, i.e. annual surveys of residents and their families. There are a variety of tools used for surveys in LTC homes, for example, Sienna homes are using Promatura – it has quality dimensions attached to the questions, a very good tool. In 2012 the OLTCA did a survey to assess survey methodologies. CSS - these agencies are not required to submit QIP to HQO at this time. The MSAA does outline requirements to measure client satisfaction in three areas: overall care received say about care and treatment treated with dignity and respect It was noted that there’s a component of healthcare we are not responsible for, people are going into private clinics to get tests but don’t get results in a timely manner, we have no control over these clinics. We want to align our work at the provincial level, as well as the local level Brock informed members that there are common threads here as we are looking at patient experience and patient satisfaction. HQO has tabled where they are heading provincially and we are trying to blend our efforts with theirs to avoid duplication while remaining focused on a Central West solution. Brock advised members that all HSPs said they would be interested in a collaborative survey, there is an opportunity to collaborate. Although some HSPs have been using their surveys for years, there is an opportunity to transition from patient satisfaction to patient experience, so HSPs do not lose the continuity of information. The Chair thanked Nancy for the presentation. 8.0 Central West LHIN Quality Event and Quality Awards Two briefing notes were provided to members. Discussion followed about sponsoring the Central West LHIN to profile the work being done. Central West LHIN... Making Healthy Change Happen 53 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA Discussion followed regarding collaborating with other LHINs. Mississauga Halton LHIN just had an event in September, they had a budget of $32,000 and done in conjunction with HQO. Brock informed members that a number of LHINs have already done or have events scheduled in the next few weeks. The Central West plans to have an all-day session. The Chair suggested we bring in community leaders, invite service clubs, all kinds of people to talk about quality, bring in a speaker, but don’t want it to be another G2G. Also an opportunity to invite politicians. We should use this forum to give our HSPs a chance to talk about their programs, so community can hear what is going on locally in healthcare. The CEO suggested that our physicians be involved too. There is great value in partnering as we don’t have a lot of cross-boundary joint providers. Brock advised that South West LHIN’s event attracts 500+ people, they have been doing this for a number of years. It was agreed that there is a lot of work for Staff to do to organize this forum, engaging a top speaker, bringing in new content, tools as well as development of criteria, and panel. Discussion about the Quality Award followed, this would be part of the quality event to recognize our providers across the different sectors. Other LHINs have already done this type of event/award. We will get some feedback, what award is it going to be, is it strictly quality or leadership in healthcare. It was suggested that criteria regarding diversity and dealing with the ethnic communities would fall under this award. Brock advised that the Committee will look to the Chair to recommend a couple of Committee Members to sit on a small panel. We would need to engage an expert facilitator, with a nominal budget. 9.0 Updates/ References Interviews will be conducted on May 2nd for the Quality Clinical Lead, HQO will have a representative on the interview panel. The Quality Clinical Lead will join this committee. LHIN-wide, three Leads have been appointed, a few are ready to announce, and each LHIN is at a different level. Status of the Regional Quality Table – this table brings a number of clinicians to the table, so the Quality Clinical Lead will be at this table and keep this committee in the loop on what’s going on with this group. 10.0 Work Plan Update The work plan and status of each activity/deliverable was reviewed with the members. 11.0 Date of Next Meeting Date to be confirmed. May 9th, 2016 or June 13th at 5:00 pm, to be held at The Central West LHIN. 12.0 Adjournment of Meeting Central West LHIN... Making Healthy Change Happen 54 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - CONSENT AGENDA Brock provided a brief overview of the key deliverables which included: An RFS to engage an event planner Interview and select the Clinical Quality Lead Establish Clinical Quality Table and HSP Quality Leaders Forum Establish task groups for patient experience and quality awards MOVED by Suzan Hall and SECONDED by Jeff Payne that the Quality Committee Meeting of Monday, April 11, 2016, be adjourned at 7:30 p.m. CARRIED ________________________________________ John McDermid, Committee Chair Quality Committee Central West Local Health Integration Network Central West LHIN... Making Healthy Change Happen 55 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - REPORT OF BOARD CHAIR AND CEO CEO Report to the Central West LHIN Board of Directors June 22, 2016 1. Build Integrated Networks of Care 1.1 Health Links and Primary Care With the recent recruitment of an Integrated Decision Support Consultant that supports the Central West Health Links there is new capacity to monitor the outcomes related to Health Links. A recent report, completed in May reviewed the 6-month pre and post hospital utilization of 606 patients with care plans developed between April 1 st and September 30th, 2015. A pre/post analysis of Inpatient (IP) and Emergency Department (ED) utilization was completed. The results show a decrease in IP utilization of 31%, while the average length of stay remained consistent at ten days. ED visits also dropped dramatically by 29%. Over the coming months additional outcomes will be monitored and made available to the Health Link Leads and Leadership that will demonstrate additional outcomes and impact for complex patients in the Central West LHIN. Leads and co-leads met with the LHIN on June 10th to develop a Health Links budget for 2016/17, the focus of the budget will be to continue to make gains in completed care plans while maximizing the use of existing community and partner resources. 1.2 Telemedicine and Telehomecare The Central West LHIN’s Telemedicine and Telehomecare Advisory Steering Committee met on May 27th and reviewed the current status on implementing and integrating virtual care in Health Links and Mental Health. In the Health Links environment, over 100 telemedicine events have occurred since its launch in March and there is positive reception and adoption of the technology. In areas of acute mental health, telemedicine has been integrated into psychiatry services provided by William Osler Health System (Osler) to Headwaters Health Care Centre’s ED (HHCC), preventing unnecessary patient transfers from Orangeville to Brampton. Telemedicine has become an effective tool in Child and Adolescent Mental Health services by enhancing the continuum of care across multiple sectors. In areas of community mental health, virtual care has been well integrated into addiction treatment, especially among methadone-prescribing physicians and the Central West LHIN Narcotics Strategy multi-disciplinary outreach team. Community mental health providers are utilizing telemedicine to increase access to psychiatry services and psycho-educational group therapy. Overall, the Mental Health and Addictions therapeutic area of care currently represents 92% of all telemedicine activity within the Central West LHIN. LHIN staff continue to review organizational telemedicine plans submitted by community Health 56 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - REPORT OF BOARD CHAIR AND CEO Service Providers (HSPs) and are working to close the gap in understanding virtual care solutions. The LHIN, in partnership with HSPs and the Ontario Telemedicine Network (OTN), will continue to implement and integrate telemedicine solutions in the areas of Health Links, Palliative Care, Mental Health and Addictions and, starting this fiscal year, virtual care will be integrating into areas of Chronic Disease Prevention and Management. The Regional Telehomecare (THC) program has enrolled 1,840 patients into the program and currently 246 patients are being monitored. Provincially, Ontario’s THC program for Congestive Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD) has demonstrated consistent outcomes with greater than 50% reductions in hospital ED and IP visits for over 9,000 patients. Scott McLeod, is a member of the Provincial Telehomecare Executive Steering Committee along with two other LHIN CEOs, Infoway Regional VP and OTN CEO. The Executive Steering Committee is chaired by Nancy Naylor, Associate Deputy Minister, Delivery and Implementation at the Ministry of Health and Long-Term Care (MOHLTC). Locally, the Regional Program continues to build on the integration of THC in Assisted Living settings and will expand this reach over the next fiscal year. 1.3 Home and Community Care Renewal Bill 210, the Patients First Act, was introduced into the legislature on Thursday, June 2nd. If passed, this legislation will amend 20 different Acts, including significant change to the Local Health System Integration Act (LHSIA). The intention of the changes is to give patients and their families faster and better access to care by placing them at the center of an integrated system. The Patient’s First Act would give LHINs an expanded role most notably in the areas of primary care and home and community care. Health System Integration staff reviewed and provided comment on the MOHLTC first draft of the Levels of Care (LOC) document. This initiative is in response to a finding by the Auditor General of Ontario of significant variation in access and quality of home care services across the province. The goal of the LOC initiative is to ensure that Ontarians receive consistent high quality home and community care regardless of where they live. The MOHLTC conducted community engagements with patients and their families, providers and received input from an Expert Panel on Home and Community Care. Once complete, the LOC Framework will provide patients and their families a transparent, easily understood roadmap of service eligibility. The LOC Framework will allow care coordinators to evaluate patient complexity and develop equitable care plans while maintaining clinical discretion and flexibility. Next steps include continued engagement including workshops leading to a piloting of the Framework beginning in the summer of 2016. The LHIN received $100,000 in Community Infrastructure Renewal Funds. The purpose of these funds is to assist eligible community-based HSPs to address small capital projects that relate to health and safety concerns, accessibility requirements and/or patient comfort issues. LHIN staff reviewed building survey results and recommended funds be allocated to Peel Cheshire Homes Brampton to replace the Heating Ventilation and Air Conditioning (HVAC) unit and to Peace Ranch to replace baseboard heating and safety rails. 1.4 Mental Health and Addictions Services The Mental Health and Addictions Services Core Action Group (CAG) met on June 1st and discussed their Work Group’s final report on the System Access Model. It included a two-year implementation plan and business process maps for how individuals access information about services, proceed to intake/registration, and be matched and transitioned to services. CAG members had detailed, small group discussions to decide endorsement of the recommendations to operationalize the model. The CAG is expected to formally accept the report in its entirety at a Central West LHIN... Making Healthy Change Happen / Le RLISS du Centre-Ouest... Favorisons la santé 2 57 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - REPORT OF BOARD CHAIR AND CEO July meeting. A key factor about the phased implementation is Patients First i.e. spreading the access model beyond mental health and addictions to serve residents in sub-LHIN regions. Among the projects underway that advances implementation of the model, are training on the new provincial addictions screening tool and on the Ontario Perception of Care client experience survey, adoption of a tool to determine required level of care, and refreshing the comprehensive inventory of individual and group services for upload to an existing resource database e.g. Connex Ontario and/or Central West Healthline. LHIN staff continue to monitor and support the integration of services in Dufferin County, primarily a transfer from Waterloo Wellington to the Peel Branch of the Canadian Mental Health Association (CMHA). Further to the Board Briefing Note of March 23rd, 2016, services were categorized as Group A and B. The transfer of Group A services and associated funding is underway with a detailed implementation plan being followed by CMHA Peel. The services known as Group B requires the involvement of the LHIN because there are multiple funding sources implicated. As such, Performance, Finance, and Integration staff are helping to revise funding arrangements through the Mississauga Halton LHIN with one of their HSPs, Dufferin County, and Alzheimer’s Society of Dufferin. In keeping with current agreements with providers in the Central West LHIN, the remaining Group B services transfer will be to the CMHA Peel Branch for seniors and Osler for eating disorders. LHIN staff continue to facilitate the integration of Peace Ranch and SHIP (Supportive Housing in Peel). This will result in Peace Ranch transitioning under the governance of SHIP. The process was delayed as Peace Ranch managed the Executive Director’s resignation and resulting vacancy. Based on a draft submission completed in March, the LHIN, SHIP and Peace Ranch in mid-June completed a more comprehensive Implementation Plan. It articulated the findings of their due diligence and the recommendation to proceed, considering the timelines required to complete the legal process and to properly manage human resources. The anticipated base and one-time costs of the integration were included and are under review by LHIN staff. An update to last month’s report on Homes for Special Care (HSC), there is only one remaining in the Central West LHIN. MOHLTC had indicated there were three however one is in another LHIN. A second one in Brampton was closed as the operator is recently deceased and the lease terminated. SHIP informed the LHIN of the closure and confirmed that they helped to transition the clients who resided at this home. The one HSC in the LHIN is in Caledon and has a capacity to serve 46 clients. LHIN staff remain engaged in the MOHLTC modernization of the HSC program through the representation by four LHINs on the provincial work group. 1.5 Palliative and End-of-Life Care The LHIN welcomed Margaret Paan to the role of Central West Palliative Care Network Director on June 6 th. Margaret will now lead the efforts to evolve the current network into one that is compatible with the emerging directions from the Ontario Palliative Care Network. LHIN staff continue to explore possibilities for the development and operation of a new residential hospice. Discussions have been held with existing hospice operators, municipalities, and service clubs to gage interest and capacity to undertake this challenging initiative. The Ontario Palliative Care Network (OPCN) is continuing its work on standardizing the approach to palliative care across the province. The OPCN has produced and disseminated draft Terms of Reference for local Palliative Care Networks, Role Descriptions for Network Directors and Clinical Leads, and recommendations for standardized Central West LHIN... Making Healthy Change Happen / Le RLISS du Centre-Ouest... Favorisons la santé 3 58 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - REPORT OF BOARD CHAIR AND CEO terminology. The OPCN is scheduling sessions with each LHIN over the course of the summer to discuss local readiness for the transition to the new structure. 1.6 Long-Term Care Renewal The Region of Peel is moving forward with plans for the redevelopment of the Peel Manor site. Region staff have shared their desire to introduce a PACE model to this site which will incorporate the rebuilt Long-Term Care (LTC) home along with other services for seniors such as assisted living, adult day programs, meals on wheels, congregate dining, etc. The Region is hosting a workshop on the PACE model in June which LHIN staff will contribute to. 2. Drive Quality & Value 2.1 Improve the Patient Experience Health Quality Ontario is collaborating with clinical experts, patients and caregivers in the development of quality standards to support the delivery of best-evidence care. A quality standard is a concise set of easy-to-understand statements outlining the best care possible for patients with selected conditions, based on the best available evidence. As quality standards are developed and used, they will: o help patients and families know what to expect (and ask for) in their care o help health care providers know what care they should provide o help organizations measure, assess and improve performance in caring for patients with these conditions 2.2 Quality and Innovation Following a competitive process, Dr. Tamara Wallington has been named the successful candidate for the role of Central West LHIN Clinical Quality Lead. In this role, Tamara will have a dual reporting relationship to the Chief, Clinical Quality at Health Quality Ontario (HQO), and the Chief Executive Officer of the Central West LHIN. Tamara is trained in internal medicine, public health and preventive medicine and is a staff physician at Osler in the Department of Medicine. She is also the Corporate Medical Director for Quality and Patient Safety. Tamara brings significant experience to this new role of Clinical Quality Lead, having led numerous quality improvement initiatives in recent years. She is passionate about the delivery of high-quality, evidence-based care and we look forward to working with her to advance the quality agenda in Central West. With the Clinical Quality Lead now in place, planning for a Regional Quality Table can now move forward at an accelerated pace. Chaired by the Clinical Quality Lead, the Regional Quality Table has a mandate to engage providers in a culture of quality care, improve partnerships, foster innovation, build capacity, facilitate knowledge exchange and develop and implement an integrated regional quality plan. Through the summer months, a membership selection process will be initiated along with planning for the inaugural meeting of the Regional Quality Table in September. At the same time, planning for a similarly structured table called the HSP Quality Leaders Forum will take place. Intended to work in parallel with the Regional Quality Table, this Forum will bring together quality leaders from Central West HSPs to collaborate, plan and support system-level quality initiatives. It will be chaired by the Central West Quality Lead with an inaugural meeting also expected in September. Central West LHIN... Making Healthy Change Happen / Le RLISS du Centre-Ouest... Favorisons la santé 4 59 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - REPORT OF BOARD CHAIR AND CEO With the tabling of the Patients First legislation, impacts to existing legislation, including the Excellent Care for All Act (ECFAA) are expected. Monitoring changes in requirements to remain in compliance with the legislation will remain a key focus so expectations can be communicated and met by Central West HSPs. 2.3 Health System Funding Reform (HSFR) The Central West LHIN continues to anticipate receiving the Central West CCAC 2016/2017 HSFR results. The MOHLTC has indicated the results should be released shortly. Community Investment funding has not been released to the LHIN, and is anticipated shortly. Central West LHIN staff has prepared for the release of funds. 2.4 Enabling Technology integration ConnectingGTA (cGTA) – As the first of three regional integration hubs being created in Ontario, ConnectingGTA supports eHealth Ontario’s clinical priorities and accelerates the delivery of electronic health records by integrating electronic patient data from across six LHINs – Central, Central East, Central West, Mississauga Halton, Toronto Central, and North Simcoe Muskoka. The cGTA solution houses hospital reports including: o visit information o ED reports o Discharge Summaries o Medication Profiles o Allergy Information o Consult reports along with CCAC information including visit info, referral info, service info, assessments, diagnostic imaging reports and lab results. Forty-eight Early Adopter sites are now live with over 41,000 enrolled users. Osler is an early adopter site and has enrolled over 4,700 users. Users who actively use cGTA increases every week. HHCC is in rollout one of the expansion phase. They are currently contributing data to the cGTA data repository and are on target to be able to view data from all participating sites by August 2016. In addition to the hospital activity, two Family Health Teams (FHT) (Queen Square and Wise Elephant), the Region of Peel, Central West CCAC and Kipling Acres currently have access to view data using cGTA. Eight additional Central West LHIN HSPs are also included in the cGTA expansion phase representing and are targeted to go-live with viewing this fiscal year. Project Management Office (PMO) Business Plan – Enabling Technologies for Integration (ETI) 2016-17 – The Enabling Technologies for Integration business plan includes details for how the Central Ontario LHINs will leverage the ETI PMO funding to advance the creation of the Electronic Health Record (EHR) across the Central Ontario Cluster and within the Central West LHIN. The MOHLTC has completed its review of the first draft of the business plan and has provided feedback along with requests for additional information. The changes recommended by the MOHLTC have been incorporated and the requested additional information provided. It is expected that the MOHLTC will complete review activities and approve the business plan by the end of June 2016. Central West LHIN... Making Healthy Change Happen / Le RLISS du Centre-Ouest... Favorisons la santé 5 60 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - REPORT OF BOARD CHAIR AND CEO 3. Connect & Inform 3.1 Communications and Community Engagement Press Releases/Publications Ontario Introduces Legislation to Further Improve Patient Access and Experience - Patients First Act Would Deliver on Action Plan for Health Care: Ontario has introduced new legislation that would, if passed, improve access to health care services by giving patients and their families faster and better access to care and putting them at the centre of a truly integrated health system. Read more… Patients First: Reporting Back on the Proposal to Strengthen Patient-Centred Health Care in Ontario: As outlined in Ontario’s Patients First: Action Plan for Health Care, the province is committed to putting patients at the centre of a truly integrated health system by giving them better access to care no matter where they live. As part of this plan, Ontario released Patients First: Proposal to Strengthen Patient-Centred Health Care in Ontario for feedback and consultation. Ontarians were invited to provide feedback on the discussion paper a variety of ways, including in-person meetings, email, web surveys and webinars. Patients First: Reporting Back on the Proposal to Strengthen Patient-Centred Health Care in Ontario is a summary of what the ministry heard. It will inform next steps in giving patients better access to care no matter where they live. Ontario Launches $222 Million First Nations Health Action Plan - Province Supporting Indigenous Health Care: Ontario is investing nearly $222 million over the next three years to ensure Indigenous people have access to more culturally appropriate care and improved outcomes, focusing on the North where there are significant gaps in health services. Read more… Announcement - Dr. Tamara Wallington, MD, FRCPC : Following a competitive process, it is our great pleasure to announce Dr. Tamara Wallington as the successful candidate in the role of Central West Local Health Integration Network (LHIN) Clinical Quality Lead. Read more… Meetings/Events (Past) Communications provided support for the following meetings/events as required: Thursday, May 26th, 2016 Tuesday, May 31st, 2016 Thursday, June 2nd, 2016 Wednesday, June 8th, 2016 Sunday, June 12th, 2016 Monday, June 13th, 2016 Monday, June 13th, 2016 Thursday, June 16th, 2016 Thursday, June 16th, 2016 Tuesday, June 21st, 2016 HHCC ground-breaking ceremony: Remarks provided by John McDermid Ontario Chiropractic Association: Presentation provided by Mark Edmonds South West LHIN Quality Symposium: Attended by Tom Miller Palgrave Rotary: Presentation by Maria Britto Catholic Family Services of Peel Annual High Tea: Attended by Maria Britto Family Services of Peel AGM: Attended by Suzan Hall Central West CCAC AGM: Remarks provided by Maria Britto Peel Halton Dufferin Acquired Brain Injury Services 5th Anniversary Celebration of Orangeville Office: Remarks provided by Ken Topping CANES AGM and Community Engagement Forum: Attended by Suzan Hall and Mark Edmonds Caledon Community Services AGM: Attended by Adrian Bita, Scott McLeod Central West LHIN... Making Healthy Change Happen / Le RLISS du Centre-Ouest... Favorisons la santé 6 61 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - REPORT OF BOARD CHAIR AND CEO Tuesday, June 21st, 2016 Wednesday, June 22nd, 2016 and Brock Hovey HHCC AGM: Remarks provided by Maria Britto. Also attended by John McDermid, Ken Topping and Suzan Hall William Osler Health System AGM and Etobicoke General Ground Breaking: Remarks provided by Maria Britto. Also attended by Suzan Hall Meetings/Events (Future) Communications will provide support for the following upcoming meetings/events as required: Saturday, June 25th, 2016 Tuesday, June 28th, 2016 Wednesday, June 29th, 2016 Peel Cheshire Homes AGM: Remarks provided by Maria Britto. Also attended by Suzan Hall Friends and Advocates Peel AGM: Attended by Adrian Bita Caledon Meals on Wheels AGM: Remarks provided by Maria Britto. Also attended by Ken Topping, Adrian Bita and Brock Hovey Annual Business Plan 2016-2017 | Following approval as revised at the May Board of Directors Meeting, the 20162017 Central West LHIN Annual Business Plan was finalized in both English and French, and submitted to the MOHLTC ahead of the requested deadline of Friday, June 17th, 2016. Annual Report 2015-2016 Website | Subsequent to the May Board of Directors meeting, edits received from members of the Board and Senior Management Team have been incorporated into a final version. This version, with its accompanying Briefing Note, is now presented to the Central West LHIN Board of Directors for final review and approval. Submission deadlines for LHINs to submit their 2015-2016 Annual Reports to the MOHLTC are… English: June 30th, 2016 and French: August 31st, 2016. 3.2 French Language Services The French Language Services Coordinator and the Director, Health System Integration responsible for mental health met with Josée Roy, Reflet Salvéo’s new Planning Agent responsible for mental health. This was an introductory meeting to align the work of Reflet Salvéo with the Central West LHIN’s Integrated Health Services Plan 2016-2019 and Annual Business Plan 2016-2017. The French Language Services Coordinator participated in the launch of Reflet Salvéo’s inter-LHIN work group on promoting safe spaces within HSPs. The work follows a recommendation from Reflet Salvéo’s Annual Advisory Report and a study done by the Entity on the needs of the Francophone LGBTQIA* Community (Lesbian, Gay, Bisexual, Transsexual, Queer, Intersex, Asexual) in the Greater Toronto Area. 3.3 Aboriginal Services The Annual Provincial Aboriginal LHIN Network conference took place in Grand Bend and Kettle Point First Nation from May 17th to 19th. Priorities for the Aboriginal LHINs leads network for 2015-16 include: o Indigenous Cultural Competency and education; o building community partnerships; and o access to primary care and population health. Central West LHIN... Making Healthy Change Happen / Le RLISS du Centre-Ouest... Favorisons la santé 7 62 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - REPORT OF BOARD CHAIR AND CEO Four sub-groups were created to build action items for each of the priority areas. The Aboriginal Health Consultant was tasked to lead the Indigenous Cultural Competency and education sub-group. 4. Demonstrate System Leadership 4.1 Population Health Diversity and Health Equity – The Central West LHIN staff continues to work with Colour of Poverty – Colour of Change (COP-COC) to lead and implement the piloting of Socio-demographic Data Collection at pilot HSPs over this next fiscal year. Currently Socio-demographic Data Collection training is being led over the summer with data collection occurring during the fall and winter months. By the end of this fiscal year, pilot organizations will provide a report on the success and lessons of this type of data collection to inform the expansion of this work in the Central West LHIN. The intention is to collect this information and utilize the data to improve access for populations that should otherwise be utilizing the services. Such a project has a high potential to link neighbourhood demographics to the current access and utilization of services in the health care system further informing organizational and system level program investments and expansion. As stated in the LHIN’s Annual Business Plan, staff will begin the process of gathering perspectives and research on the development of the Central West LHIN’s Health Equity Charter. A local charter in alignment with provincial and local cross sector partners will highlight the importance of this work to improve equitable access to all populations in the LHIN. Charters developed by the Community Health Centres (CHCs) and the Regional Diversity Roundtable (RDR) along with oversight and advice from members of the LHIN’s Diversity and Health Equity Core Action Group will inform the development of the Central West LHIN Health Equity Charter. 4.2 Dementia Strategy LHINs are awaiting the roll out of the next MOHLTC discussion document. 4.3 Build on the Momentum Chronic Disease Prevention and Management Initiative - The LHIN Aboriginal Health Consultant presented at the June 8th Chronic Disease Prevention and Management Core Action Group regarding an opportunity for HSPs to participate in an on-line “Indigenous Cultural Competency” training program. Information was shared by members regarding the priorities and activities in their 2016/17 work plans. Seniors and the pre-diabetes patient populations were identified as priorities. Central West LHIN... Making Healthy Change Happen / Le RLISS du Centre-Ouest... Favorisons la santé 8 63 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - REPORT OF BOARD CHAIR AND CEO 5. Operational Excellence 5.1 Service Accountability Agreements Update Previously, hospital agreements (HSAAs) were extended by three months from April 1st to June 30th, 2016, in anticipation that a new HSAA would be ready for local implementation. At this point, the OHA is not prepared to approve the simple HSAA, prior to the implementation of the Multi-Purpose HSAA. The Multi-Purpose HSAA template is very important to the OHA. It is the prospect of a Multi-Purpose HSAA template that has motivated the OHA to actively negotiate the new simple HSAA. The development of the Multi-Purpose HSAA template is a complex process which requires significant consultation with the LHIN SAA leads and with the OHA. The Steering Committee remains committed to finalizing this template as soon as reasonably possible. In order to allow time to complete this work, the HSAA Steering Committee has advised LHINs across the Province to further extend their current agreements to March 31st, 2017. The Central West LHIN has followed this advice and has successfully extended its current H-SAAs to March 31st, 2017, by amending agreement. 6. Select CEO Updates 6.1 Provincial Aboriginal Planning Meeting On May 17th and 18th I attended the Provincial Aboriginal Planning Meeting along with the Aboriginal Leads and the LHIN CEOs in Grand Bend. The purpose of the session is to establish provincial priorities across the 14 LHINs. 6.2 e-Health Investment and Sustainment Board Meeting A meeting was held on May 20th. Recent agenda items included: o Developing a “Retail” Version of the Strategy o eHealth Governance: implementing the Clinician eHealth Council & Community Care eHealth Committee 6.3 LHIN Leadership Council Meeting The Leadership Council met on June 2nd. Agenda items included o Priorities for Dialogue on Patients First Discussion Document o Update from Chairs on the local status of governance structure and engagements related to Patients First o Update on Patients First Discussion Document – provided by Dr. Bob Bell 6.4 LHIN CEO Council Meeting The CEO Council met on June 2nd. The CEO Council had their regular business meeting following the Leadership Councils. Central West LHIN... Making Healthy Change Happen / Le RLISS du Centre-Ouest... Favorisons la santé 9 64 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - REPORT OF BOARD CHAIR AND CEO 6.5 MOHLTC Executive Leadership Team and LHIN CEOs Joint Meeting On June 7th and 8th I participated in a two-day Executive Leadership team meeting. Discussion items included: o Update on Northern Investment Rollout o ALC Update o Urgent Priorities Funding Guidelines o LHN Renewal Discussion o Walk-through of Bill 201: The Patients First Act, 2016 o Patient Engagement 6.6 Health Service Provider Site Visits Consistent with my Objectives I have continued the process of meeting with individual HSPs to understand current challenges and opportunities. Recently I have met with the following HSPs: o Richview Community Care – June 1st o Malton Village – June 14th o Punjabi Community Health Services –June 15th o Wellfort Community Health Services – June 16th 6.7 Digital Health Steward Executive Committee This Committee had their first meeting on June 3rd. The role and purpose of the committee is: o Continued provincial Telehomecare support o New e-Models of Care oversight (eMC3) o Digital Health stewardship 7. On the Horizon 7.1 e-Health Steering Committee Meeting The next meeting of the Committee is scheduled for June 15th. 7.2 KPMG Event – Value Optimization I have been invited to attend this event taking place on June 16th. 7.3 MSAA Advisory Committee Meeting The next meeting is scheduled to take place on June 17th. Central West LHIN... Making Healthy Change Happen / Le RLISS du Centre-Ouest... Favorisons la santé 10 65 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - REPORT OF BOARD CHAIR AND CEO 7.4 Rotman Day June 22nd is scheduled for presentations by the participants and certificates will be awarded at this event. 7.5 Health Service Provider Site Visits The following site visits are booked and will conclude site visits for this year: o Peel Senior Link – June 20th o Supportive Housing in Peel – June 20th o United Achievers Community Services – July 4th 8. Outstanding People Margaret Paan, Director, Central West Palliative Care Network A Registered Nurse by trade, Margaret is a passionate healthcare leader who joined the Central West Palliative Care Network (CWPCN) from her role as Director, Patient Care Services at the Central West Community Care Access Centre (CCAC), a role which she held since 2009. During that time, Margaret was responsible for various portfolios including palliative and endof -life care. Margaret Paan has worked in health care for almost 20 years in a variety of roles and sectors including acute care, outpatient, government and community care. Margaret holds a Bachelor of Science in Nursing from Ryerson Polytechnic University, a Masters of Nursing Administration from the University of Toronto, has completed the Central West Advanced Health System Leadership Program at the University of Toronto’s Rotman School of Management and most recently completed the IDEAS Advanced Learning Program at the University of Toronto. Among her many notable accomplishments, Margaret led the Central West CCAC Neighbourhood Transformation Project which included a redesign of patient care service teams into sub-LHIN geographies and aligned all Care Coordinators to Primary Care across the region. Margaret’s involvement in supporting the integration and development of Central West and Mississauga Halton CCAC Palliative Care Teams and services helped to promote health equity and consistency of care for clients, families and broader communities at large. As Lead for the Central West Palliative Early Identification Project, Margaret helped to ensure palliative patients remained at the centre of care, identifying them early in their palliative journeys so as to improve their access to and coordination of care, as well as quality and length of life. Margaret is also a blessed and busy mother of 4 and enjoys living in the beautiful rural area of Dufferin. Central West LHIN... Making Healthy Change Happen / Le RLISS du Centre-Ouest... Favorisons la santé 11 66 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 1ST SESSION, 41ST LEGISLATURE, ONTARIO 65 ELIZABETH II, 2016 1re SESSION, 41e LÉGISLATURE, ONTARIO 65 ELIZABETH II, 2016 Bill 210 Projet de loi 210 An Act to amend various Acts in the interest of patient-centred care Loi modifiant diverses lois dans l’intérêt des soins axés sur les patients The Hon. E. Hoskins L’honorable E. Hoskins Minister of Health and Long-Term Care Ministre de la Santé et des Soins de longue durée Government Bill Projet de loi du gouvernement 1st Reading 1re lecture June 2, 2016 2nd Reading 2e lecture 3rd Reading 3e lecture Royal Assent Sanction royale 2 juin 2016 Imprimé par l’Assemblée législative de l’Ontario Printed by the Legislative Assembly of Ontario 67 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE EXPLANATORY NOTE NOTE EXPLICATIVE The Bill amends the Local Health System Integration Act, 2006 and makes related amendments to several other Acts. The major elements of the Bill are described below. Le projet de loi modifie la Loi de 2006 sur l’intégration du système de santé local et apporte des modifications connexes à plusieurs autres lois. Les éléments principaux du projet de loi sont exposés ci-dessous. Local Health System Integration Act, 2006 Loi de 2006 sur l’intégration du système de santé local Community care access corporations (CCACs) are removed from the definition of a “health service provider”. Several new entities are added. Les sociétés d’accès aux soins communautaires sont supprimées de la définition de «fournisseur de services de santé». Plusieurs nouvelles entités y sont ajoutées. The Lieutenant Governor in Council is given the power to change the geographic area of local health integration networks by regulation. Le lieutenant-gouverneur en conseil est investi du pouvoir de modifier, par règlement, la zone géographique que servent les réseaux locaux d’intégration des services de santé. New subsection 4 (5) specifies that subsection 1 (4) of the Labour Relations Act, 1995 does not apply to local health integration networks. Le nouveau paragraphe 4 (5) précise que le paragraphe 1 (4) de la Loi de 1995 sur les relations de travail ne s’applique pas aux réseaux locaux d’intégration des services de santé. The objects of local health integration networks are modified. Several amendments are made to the size of the board of directors of these networks and to the term of members of the board of directors. La mission des réseaux locaux d’intégration des services de santé est modifiée. Plusieurs modifications sont apportées à la taille du conseil d’administration de ces réseaux et au mandat de leurs membres. The boards of directors of local health integration networks are provided with new by-law making authorities, including the ability to appoint officers and delegate certain powers to other persons. Le conseil d’administration des réseaux locaux d’intégration des services de santé est investi de nouveaux pouvoirs en matière d’adoption de règlements administratifs, notamment le pouvoir de nommer des dirigeants et de déléguer certains pouvoirs à d’autres personnes. New section 11.1 gives the Minister of Health and Long-Term Care the power to issue operational or policy directives to local health integration networks. Local health integration networks must comply with these. Le nouvel article 11.1 confère au ministre de la Santé et des Soins de longue durée le pouvoir de donner des directives opérationnelles ou en matière de politique aux réseaux locaux d’intégration des services de santé. Les réseaux doivent se conformer à ces directives. New section 11.2 gives the Minister the power to issue provincial standards for the provision of health services. Local health integration networks and health service providers must comply with these. Le nouvel article 11.2 confère au ministre le pouvoir d’établir des normes provinciales relativement à la prestation de services de santé. Les réseaux locaux d’intégration des services de santé et les fournisseurs de services de santé doivent se conformer à ces normes. New section 12.1 gives the Minister the power to appoint investigators to investigate local health integration networks. New section 12.2 allows the Lieutenant Governor in Council to appoint a supervisor for local health integration networks, on the recommendation of the Minister, if the Lieutenant Governor in Council considers it to be in the public interest to do so. Le nouvel article 12.1 confère au ministre le pouvoir de nommer des personnes chargées d’enquêter sur les réseaux locaux d’intégration des services de santé. Le nouvel article 12.2 permet au lieutenant-gouverneur en conseil, sur la recommandation du ministre et s’il estime que l’intérêt public le justifie, de nommer un superviseur pour les réseaux locaux d’intégration des services de santé. Local health integration networks are required to establish geographic sub-regions in their local health system for the purposes of planning, funding and service integration. They must develop strategic directions and plans for these sub-regions in their integrated health service plan. Les réseaux locaux d’intégration des services de santé sont tenus de créer des sous-zones géographiques dans leur système de santé local pour la planification, le financement et l’intégration des services. Ils doivent élaborer des orientations et des plans stratégiques pour ces sous-zones dans leur plan de services de santé intégrés. Local health integration networks are required to establish one or more patient and family advisory committees. The establishment of a health professionals advisory committee becomes optional. Les réseaux locaux d’intégration des services de santé sont tenus de créer un ou plusieurs comités consultatifs patients-familles. La création de comités consultatifs de professionnels de la santé devient facultative. Local health integration networks are given the ability to provide funding to health service providers in respect of services provided in or for the geographic area of another network. Les réseaux locaux d’intégration des services de santé sont investis du pouvoir d’accorder un financement aux fournisseurs de services de santé à l’égard des services fournis dans la zone géographique que sert un autre réseau ou pour cette zone. New procedures and requirements are provided for service accountability agreements. The provision about local health integration networks not being allowed to enter into agreements or other arrangements that restrict or prevent an individual from receiving services based on the geographic area in which the individual resides is re-enacted in a new section. De nouvelles modalités et exigences sont prévues en ce qui concerne les ententes de responsabilisation en matière de services. La disposition selon laquelle les réseaux locaux d’intégration des services de santé ne doivent conclure aucune entente ni aucun autre arrangement ayant pour effet d’empêcher un particulier de recevoir des services en fonction de la zone géographique où il réside, ou d’imposer des restrictions à cet égard, est réédictée dans un nouvel article. i 68 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE New section 20.2 allows local health integration networks to issue operational or policy directives to a health provider to which it provides funding. The health service provider must comply with these. Le nouvel article 20.2 permet aux réseaux locaux d’intégration des services de santé de donner des directives opérationnelles ou en matière de politique à un fournisseur de services de santé à qui il accorde un financement. Le fournisseur de services de santé doit se conformer à ces directives. Local health integration networks are given the power to engage in or permit operational reviews or peer reviews of a health provider’s activities. Les réseaux locaux d’intégration des services de santé sont investis du pouvoir de procéder à un examen de gestion ou à un examen par des pairs des activités d’un fournisseur de services de santé ou d’autoriser de tels examens. Local health integration networks are given the power to appoint investigators to investigate certain health service providers that receive funding from the network. The local health integration network may appoint a health service provider supervisor to exercise the powers of the governing body of certain health service providers if it considers it to be appropriate to do so in the public interest. Les réseaux locaux d’intégration des services de santé sont investis du pouvoir de nommer des personnes chargées d’enquêter sur certains fournisseurs de services de santé qui reçoivent un financement de leur part. Les réseaux peuvent, s’ils estiment que l’intérêt public le justifie, nommer un superviseur pour certains fournisseurs de services de santé chargé d’exercer les pouvoirs de leur corps dirigeant. Section 27 is amended to revise and update the local health integration networks’ integration power. L’article 27 est modifié pour réviser et mettre à jour le pouvoir d’intégration des réseaux locaux d’intégration des services de santé. New Part V.1 is added to the Act. New subsection 34.2 (1) provides the Minister with the ability to transfer the assets, liabilities, rights, obligations and employees of a community care access corporation to the local health integration network that has the same geographic area as the CCAC. Various rules regarding these transfers are set out. La nouvelle partie V.1 est ajoutée à la Loi. Le nouveau paragraphe 34.2 (1) confère au ministre le pouvoir de transférer les éléments d’actif, éléments de passif, droits et obligations d’une société d’accès aux soins communautaires au réseau local d’intégration des services de santé qui sert la même zone géographique que la société. Le ministre dispose aussi du pouvoir de muter les employés de la société à un tel réseau. Diverses règles relatives à ces transferts et mutations sont énoncées. Employees transferred under an order become employees of the local health integration network affected by the order. Les employés mutés par suite d’un tel arrêté deviennent les employés du réseau local d’intégration des services de santé visé par l’arrêté. The Minister is also given the power to make an order to dissolve a CCAC that is affected by an order under subsection 34.2 (1). The legal effect of this order is set out. Le ministre est également investi du pouvoir de prendre un arrêté pour dissoudre une société d’accès aux soins communautaires visée par un arrêté pris en vertu du paragraphe 34.2 (1). L’effet juridique de cet arrêté est énoncé. Guidelines are provided to specify certain factors that the Lieutenant Governor in Council or the Minister may consider when making a decision in the public interest under the Act. Des lignes directrices sont prévues pour préciser certains facteurs que le lieutenant-gouverneur en conseil ou le ministre peut prendre en considération lorsqu’il prend une décision dans l’intérêt public dans le cadre de la Loi. No proceeding for damages, with certain exceptions, may be commenced against the Crown, the Minister, local health integration networks, members, directors or officers of local health integration networks, investigators, supervisors, and any person employed by the Crown, the Minister or a local health integration network with respect to certain actions or omissions under the Act. This does not prevent a claim for compensation with respect to the delivery of services by or arranged by a local health integration network. Sont irrecevables les instances en dommages-intérêts, sauf certaines exceptions, qui sont introduites contre la Couronne, le ministre, les réseaux locaux d’intégration des services de santé ou leurs membres, administrateurs ou dirigeants, les enquêteurs, les superviseurs et toute personne employée par la Couronne, le ministre ou un réseau pour un acte ou un manquement visé par la Loi. La disposition n’a pas pour effet d’empêcher la présentation d’une demande d’indemnisation à l’égard de la prestation des services fournis ou organisés par un réseau local d’intégration des services de santé. The Lieutenant Governor in Council is given the power to make regulations requiring prescribed persons and entities to provide certain information and reports to local health integration networks. Le lieutenant-gouverneur en conseil est investi du pouvoir d’exiger, par règlement, que des personnes et entités prescrites fournissent certains renseignements et rapports aux réseaux locaux d’intégration des services de santé. The Lieutenant Governor in Council is given the power to incorporate a corporation without share capital to provide shared services to local health integration networks and others. The Minister is given the power to make an order transferring the assets, liabilities, rights, obligations and employees from the Ontario Association of Community Care Access Centres to this corporation. Various rules regarding these transfers are set out. Le lieutenant-gouverneur en conseil est investi du pouvoir de constituer une personne morale sans capital-actions pour fournir des services partagés aux réseaux locaux d’intégration des services de santé et à d’autres entités. Le ministre, quant à lui, est investi du pouvoir de transférer, par arrêté, les éléments d’actif, éléments de passif, droits et obligations de l’Ontario Association of Community Care Access Centres à cette personne morale. Il dispose aussi du pouvoir de muter les employés de l’Association à la personne morale. Diverses règles régissant ces transferts sont énoncées. Broader Public Sector Accountability Act, 2010 Loi de 2010 sur la responsabilisation du secteur parapublic Several amendments are made to remove references to CCACs. Plusieurs modifications sont apportées à cette loi pour supprimer les mentions des sociétés d’accès aux soins communautaires. ii 69 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE Broader Public Sector Executive Compensation Act, 2014 Loi de 2014 sur la rémunération des cadres du secteur parapublic A reference to CCACs is removed. Une mention des sociétés d’accès aux soins communautaires est supprimée. Commitment to the Future of Medicare Act, 2004 Loi de 2004 sur l’engagement d’assurer l’avenir de l’assurance-santé Part III of this Act is repealed. La partie III de cette loi est abrogée. Community Care Access Corporations Act, 2001 Loi de 2001 sur les sociétés d’accès aux soins communautaires This Act is repealed. Cette loi est abrogée. Electronic Cigarettes Act, 2015 Loi de 2015 sur les cigarettes électroniques The reference to CCACs in the definition of “home health-care worker” is removed and replaced with a reference to local health integration networks. La mention de la société d’accès aux soins communautaires dans la définition de «travailleur de la santé à domicile» est supprimée et remplacée par une mention d’un réseau local d’intégration des services de santé. Employment Standards Act, 2000 Loi de 2000 sur les normes d’emploi Several consequential amendments are made. A provision dealing with assignment employees providing services under a contract with a CCAC is removed and replaced with a similar provision in respect of local health integration networks. Plusieurs modifications corrélatives sont apportées. Une disposition traitant des employés ponctuels qui fournissent des services aux termes d’un contrat conclu avec une société d’accès aux soins communautaires est supprimée et remplacée par une disposition similaire à l’égard des réseaux locaux d’intégration des services de santé. Excellent Care for All Act, 2010 Loi de 2010 sur l’excellence des soins pour tous The Council is given the ability to make clinical standards recommendations to the Minister. The Council is also given the ability to receive, retain and use revenue outside of the Consolidated Revenue Fund. Other powers and duties with respect to financial matters are set out. Changes are made to the purpose, timing, and content of the Council’s reporting obligations. Le Conseil est investi du pouvoir de formuler des recommandations sur les normes de soins cliniques au ministre. Il peut aussi recevoir, conserver et utiliser les recettes qui ne font pas partie du Trésor. D’autres pouvoirs et fonctions à l’égard des questions financières sont énoncés. Des modifications sont apportées aux objectifs, aux délais et au contenu des rapports que doit préparer le Conseil. The Crown and members, officers, employees and agents of the Council and are protected from certain types of liability. This does not protect the Council itself from liability. La Couronne et les membres, dirigeants, employés et mandataires du Conseil sont dégagés de certains types de responsabilité, mais le Conseil demeure, quant à lui, responsable à l’égard de certaines causes d’action. The Patient Ombudsman is given oversight of complaints about home and patient care, and other prescribed services, provided by local health integration networks. Time limits for complaints to the Patient Ombudsman may be set in regulations. La supervision des plaintes relatives aux soins à domicile et aux patients et à d’autres services prescrits fournis par les réseaux locaux d’intégration des services de santé est confiée à l’ombudsman des patients. Des délais pour la présentation des plaintes auprès de l’ombudsman des patients peuvent être fixés dans les règlements. Health Insurance Act Loi sur l’assurance-santé The Minister is allowed to make local health integration networks an agent of the Minister for the purpose of certain funding arrangements. Le ministre peut constituer un réseau local d’intégration des services de santé comme son mandataire pour ce qui est de certains arrangements en matière de financement. Health Protection and Promotion Act Loi sur la protection et la promotion de la santé Medical officers of health are required to engage with their local health integration networks. The Chief Medical Officer of Health is given the power to issue directives to local health integration networks, rather than CCACs. Les médecins-hygiénistes sont tenus de collaborer avec leur réseau local d’intégration des services de santé. Le médecinhygiéniste en chef a le pouvoir de donner des directives aux réseaux locaux d’intégration des services de santé plutôt qu’aux sociétés d’accès aux soins communautaires. Home Care and Community Services Act, 1994 Loi de 1994 sur les services de soins à domicile et les services communautaires Several amendments are made to permit the Minister to approve and fund local health integration networks and provide the services currently provided by CCACs under the Act. Approved agencies are permitted to charge fees for homemaking and community support services, while local health integration networks are prohibited from charging such fees. A protection from liability is set out. Plusieurs modifications sont apportées pour permettre au ministre d’agréer et de financer les réseaux locaux d’intégration des services de santé aux fins de la fourniture des services actuellement fournis par des sociétés d’accès aux soins communautaires dans le cadre de la Loi. Les organismes agréés peuvent exiger le paiement de services d’aides familiales et de services de soutien communautaire, alors que les réseaux locaux d’intégration des services de santé ne peuvent exiger de tels paiements. Une disposition sur l’immunité est énoncée. iii 70 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE Ministry of Health and Long-Term Care Act Loi sur le ministère de la Santé et des Soins de longue durée The Minister is given the power to establish a Patient and Family Advisory Council. Le ministre est investi du pouvoir de créer un conseil consultatif patients-familles. Ombudsman Act Loi sur l’ombudsman The Ombudsman Act is amended to provide that it does not apply to local health integration networks with respect to certain matters that are to be overseen by the Patient Ombudsman. La Loi sur l’ombudsman est modifiée afin qu’elle ne s’applique pas aux réseaux locaux d’intégration des services de santé à l’égard de certaines questions qui relèvent de l’ombudsman des patients. Personal Health Information Protection Act, 2004 Loi de 2004 sur la protection des renseignements personnels sur la santé CCACs are removed from the list of health information custodians. Les sociétés d’accès aux soins communautaires sont supprimées de la liste des dépositaires de renseignements sur la santé. Poverty Reduction Act, 2009 Loi de 2009 sur la réduction de la pauvreté A reference to CCACs is removed. Une mention de la société d’accès aux soins communautaires est supprimée. Private Hospitals Act Loi sur les hôpitaux privés The Minister is given the power to issue operational or policy directives to a licensee of a private hospital. These directives must be complied with. Le ministre est investi du pouvoir de donner des directives opérationnelles ou en matière de politique au titulaire de permis d’exploitation d’un hôpital privé. Ces directives doivent être respectées. Public Hospitals Act Loi sur les hôpitaux publics The Minister must make certain reports on hospitals public. Le ministre doit mettre certains rapports sur des hôpitaux à la disposition du public. The Minister is given the power to issue operational or policy directives to the board of a hospital. These directives must be complied with. Le pouvoir de donner des directives opérationnelles ou en matière de politique au conseil d’un hôpital est conféré au ministre. Ces directives doivent être respectées. Public Sector Labour Relations Transition Act, 1997 Loi de 1997 sur les relations de travail liées à la transition dans le secteur public A reference to a local health integration network is added to the definition of “health service integration”. Une mention des réseaux locaux d’intégration des services de santé est ajoutée à la définition de «intégration des services de santé». Retirement Homes Act, 2010 Loi de 2010 sur les maisons de retraite A reference to CCACs is removed and a new reference to local health integration networks is added. Une mention de la société d’accès aux soins communautaires est supprimée et une nouvelle mention du réseau local d’intégration des services de santé est ajoutée. Smoke-Free Ontario Act Loi favorisant un Ontario sans fumée A reference to CCACs is removed and a new reference to local health integration networks is added. Une mention de la société d’accès aux soins communautaires est supprimée et une nouvelle mention du réseau local d’intégration des services de santé est ajoutée. iv 71 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 72 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE Bill 210 2016 Projet de loi 210 2016 An Act to amend various Acts in the interest of patient-centred care Loi modifiant diverses lois dans l’intérêt des soins axés sur les patients Her Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows: Sa Majesté, sur l’avis et avec le consentement de l’Assemblée législative de la province de l’Ontario, édicte : LOCAL HEALTH SYSTEM INTEGRATION ACT, 2006 LOI DE 2006 SUR L’INTÉGRATION DU SYSTÈME DE SANTÉ LOCAL 1. (1) Subsection 2 (1) of the Local Health System Integration Act, 2006 is amended by adding the following definition: 1. (1) Le paragraphe 2 (1) de la Loi de 2006 sur l’intégration du système de santé local est modifié par adjonction de la définition suivante : “medical officer of health” has the same meaning as in the Health Protection and Promotion Act; (“médecinhygiéniste”) «médecin-hygiéniste» S’entend au sens de la Loi sur la protection et la promotion de la santé. («medical officer of health») (2) Paragraph 7 of the definition of “health service provider” in subsection 2 (2) of the Act is repealed. (2) La disposition 7 de la définition de «fournisseur de services de santé» au paragraphe 2 (2) de la Loi est abrogée. (3) Paragraph 11 of the definition of “health service provider” in subsection 2 (2) of the Act is repealed and the following substituted: (3) La disposition 11 de la définition de «fournisseur de services de santé» au paragraphe 2 (2) de la Loi est abrogée et remplacée par ce qui suit : 11. A not for profit entity that operates a family health team. 11. Une entité sans but lucratif qui encadre une équipe de santé familiale. 12. A not for profit entity that operates a nursepractitioner-led clinic. 12. Une entité sans but lucratif qui fait fonctionner une clinique dirigée par du personnel infirmier praticien. 13. A not for profit entity that operates an Aboriginal health access centre. 13. Une entité sans but lucratif qui fait fonctionner un centre d’accès aux services de santé pour les Autochtones. 14. A person or entity that provides primary care nursing services, maternal care or inter-professional primary care programs and services. 14. Une personne ou entité qui fournit des services infirmiers de soins primaires, des soins maternels ou des programmes et services interprofessionnels de soins primaires. 15. A not for profit entity that provides palliative care services, including a hospice. 15. Une entité sans but lucratif qui fournit des services de soins palliatifs et fait notamment fonctionner un hospice. 16. A person or entity that provides physiotherapy services in a clinic setting that is not otherwise a health service provider. 16. Une personne ou entité qui fournit des services de physiothérapie dans une clinique qui n’est pas par ailleurs un fournisseur de services de santé. 17. Any other person or entity or class of persons or entities that is prescribed. 17. Toute autre personne ou entité prescrite ou toute catégorie prescrite de personnes ou d’entités. 2. (1) Subsection 3 (4) of the Act is amended by adding the following clause: 2. (1) Le paragraphe 3 (4) de la Loi est modifié par adjonction de l’alinéa suivant : (b.1) change the geographic area of one or more local health integration networks; b.1) modifier la zone géographique que servent un ou plusieurs réseaux locaux d’intégration des services de santé; 73 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 2 PATIENTS FIRST ACT, 2016 (2) Clause 3 (4) (d) of the Act is amended by striking out the portion before subclause (i) and substituting the following: (2) L’alinéa 3 (4) d) de la Loi est modifié par remplacement du passage qui précède le sous-alinéa (i) par ce qui suit : (d) do all things necessary to accomplish the amalgamation, dissolution, division or change of geographic area of one or more local health integration networks made by a regulation under clause (a), (b) or (b.1), including, d) prendre les mesures nécessaires soit à la fusion, la dissolution ou la division d’un ou de plusieurs réseaux locaux d’intégration des services de santé, soit à la modification de leur zone géographique, à laquelle il est procédé par règlement pris en vertu de l’alinéa a), b) ou b.1) et, notamment : . . . . . . . . . . 3. Section 4 of the Act is amended by adding the following subsection: 3. L’article 4 de la Loi est modifié par adjonction du paragraphe suivant : Non-application of single employer rule Non-application de la règle d’un seul employeur (5) Subsection 1 (4) of the Labour Relations Act, 1995 does not apply to a local health integration network. (5) Le paragraphe 1 (4) de la Loi de 1995 sur les relations de travail ne s’applique pas à un réseau local d’intégration des services de santé. 4. (1) Clause 5 (b) of the Act is repealed and the following substituted: 4. (1) L’alinéa 5 b) de la Loi est abrogé et remplacé par ce qui suit : (b) to identify and plan for the health service needs of the local health system, including needs regarding physician resources, in accordance with provincial plans and priorities and to make recommendations to the Minister about that system, including capital funding needs for it; b) déterminer les besoins du système de santé local en matière de services de santé, notamment les besoins concernant les effectifs médicaux, et prendre des dispositions à leur égard conformément aux plans et priorités provinciaux, et faire des recommandations au ministre au sujet du système, y compris ses besoins en matière de financement d’immobilisations; (2) Section 5 of the Act is amended by adding the following clause: (2) L’article 5 de la Loi est modifié par adjonction de l’alinéa suivant : (e.1) to promote health equity, reduce health disparities and inequities, and respect the diversity of communities in the planning, design, delivery and evaluation of services; e.1) promouvoir l’équité et réduire les disparités et les inégalités dans le domaine de la santé, et respecter la diversité des collectivités dans le cadre de la planification, la conception, la prestation et l’évaluation des services; (3) Section 5 of the Act is amended by striking out “and” at the end of clause (m) and by adding the following clauses: (3) L’article 5 de la Loi est modifié par adjonction des alinéas suivants : (m.1) to provide health and related social services and supplies and equipment for the care of persons in home, community and other settings and to provide goods and services to assist caregivers in the provision of care for such persons; m.1) fournir des services de santé et des services sociaux connexes ainsi que des fournitures et de l’équipement pour soigner des personnes à domicile, dans la collectivité et ailleurs, et fournir des biens et des services pour aider les fournisseurs de soins à fournir des soins à ces personnes; (m.2) to manage the placement of persons into long-term care homes, supportive housing programs, chronic care and rehabilitation beds in hospitals, and other programs and places where community services are provided under the Home Care and Community Services Act, 1994; m.2) gérer le placement de personnes dans des foyers de soins de longue durée, des programmes de logement avec services de soutien, des lits de malades chroniques et des lits de réadaptation d’hôpitaux, et d’autres programmes et endroits où des services communautaires sont fournis dans le cadre de la Loi de 1994 sur les services de soins à domicile et les services communautaires; (m.3) to provide information to the public about, and make referrals to, health and social services; m.3) fournir des renseignements au public sur les services de santé et les services sociaux, et faire des renvois vers ces services; (m.4) to fund non-health services that are related to health services that are funded by the Minister or a local health integration network; and m.4) financer des services non sanitaires qui sont liés aux services de santé que finance le ministre ou un réseau local d’intégration des services de santé; 74 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 3 5. Paragraphs 6 and 7 of subsection 6 (3) of the Act are repealed. 5. Les dispositions 6 et 7 du paragraphe 6 (3) de la Loi sont abrogées. 6. (1) Subsection 7 (1) of the Act is repealed and the following substituted: 6. (1) Le paragraphe 7 (1) de la Loi est abrogé et remplacé par ce qui suit : Board of directors Conseil d’administration (1) Each local health integration network shall consist of no more than 12 members appointed by the Lieutenant Governor in Council who shall form the board of directors of the network, except that the Lieutenant Governor in Council may prescribe a higher number of members that is not more than 14. (1) Chaque réseau local d’intégration des services de santé se compose d’au plus 12 membres que nomme le lieutenant-gouverneur en conseil et qui en constituent le conseil d’administration. Toutefois, le lieutenantgouverneur en conseil peut prescrire un nombre plus élevé de membres, qui ne peut être supérieur à 14. (2) Subsection 7 (2) of the Act is repealed and the following substituted: (2) Le paragraphe 7 (2) de la Loi est abrogé et remplacé par ce qui suit : Term Mandat (2) Subject to subsection (3), the following provisions apply respecting the term of members of the board of directors of a local health integration network: (2) Sous réserve du paragraphe (3), les dispositions suivantes s’appliquent à l’égard du mandat des membres du conseil d’administration d’un réseau local d’intégration des services de santé : 1. Each member shall hold office for a term of up to three years at the pleasure of the Lieutenant Governor in Council and may be reappointed for any number of terms of up to three years. 1. Chaque membre occupe son poste pour un mandat d’au plus trois ans, dont la durée est laissée à la discrétion du lieutenant-gouverneur en conseil. Son mandat est renouvelable, une ou plusieurs fois, pour des périodes d’au plus trois ans chacune. 2. Despite paragraph 1, no person may be a member for more than six years in total. 2. Malgré la disposition 1, personne ne peut être membre du conseil d’administration pendant plus de six ans en tout. 3. Despite paragraph 2, a member who is designated as chair under subsection (6) after serving at least three years as a member may, despite anything else in subsection (6), be appointed for one further term of up to three years while designated as chair. 3. Malgré la disposition 2, le membre désigné comme président en application du paragraphe (6), après avoir siégé à titre de membre pendant au moins trois ans, peut, malgré ce paragraphe, être nommé pour un autre mandat d’au plus trois ans pendant sa désignation comme président. (3) Subsection 7 (4) of the Act is repealed. (3) Le paragraphe 7 (4) de la Loi est abrogé. (4) Subsection 7 (10) of the Act is repealed and the following substituted: (4) Le paragraphe 7 (10) de la Loi est abrogé et remplacé par ce qui suit : Where no designation Absence de désignation (10) If the Lieutenant Governor in Council has not designated a chair or a vice-chair of a network, the members of the board of directors may select a chair or vicechair from among their members to hold office as provided for by by-law, until such time as the Lieutenant Governor in Council makes a designation. (10) Si le lieutenant-gouverneur en conseil n’a pas désigné de président ou de vice-président d’un réseau local d’intégration des services de santé, les membres du conseil d’administration peuvent choisir, parmi eux, un président ou un vice-président qui demeure en fonction, comme le prévoit le règlement administratif, jusqu’à ce que le lieutenant-gouverneur en conseil fasse une désignation. 7. (1) Subsection 8 (2) of the Act is repealed and the following substituted: 7. (1) Le paragraphe 8 (2) de la Loi est abrogé et remplacé par ce qui suit : By-laws and resolutions Règlements administratifs et résolutions (2) Subject to subsections (3) and (4), a board of directors may make by-laws and pass resolutions regulating its proceedings and generally for the conduct and management of the affairs of the local health integration network including establishing committees. (2) Sous réserve des paragraphes (3) et (4), le conseil d’administration peut adopter des règlements administratifs et des résolutions pour régir la conduite de ses délibérations et traiter, de façon générale, de la conduite et de la gestion des affaires du réseau local d’intégration des services de santé, y compris créer des comités. 75 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 4 PATIENTS FIRST ACT, 2016 Officers Dirigeants (2.1) Without limiting the generality of subsection (2), a board of directors may make by-laws or pass resolutions to appoint officers and assign to them such powers and duties as the board considers appropriate. (2.1) Sans préjudice de la portée générale du paragraphe (2), le conseil d’administration peut, par règlement administratif ou résolution, nommer des dirigeants et leur attribuer les pouvoirs et fonctions qu’il estime appropriés. Delegation Délégation (2.2) A board of directors may delegate any of its powers or duties under this Act or any other Act to such person or persons as the board considers appropriate and may impose conditions and restrictions with respect to the delegation. (2.2) Le conseil d’administration peut déléguer les pouvoirs ou les fonctions que lui attribue la présente loi ou toute autre loi à la ou aux personnes qu’il juge compétentes et assortir cette délégation de conditions et de restrictions. Restrictions on delegation Restrictions : délégation (2.3) Despite subsection (2.2), a board of directors may not delegate any power under the following provisions of this Act: (2.3) Malgré le paragraphe (2.2), un conseil d’administration ne peut déléguer aucun pouvoir prévu en vertu des dispositions suivantes de la présente loi : 1. Subsection 20 (7). 1. Le paragraphe 20 (7). 2. Clause 25 (2) (a). 2. L’alinéa 25 (2) a). 3. Section 26. 3. L’article 26. 4. Section 27. 4. L’article 27. (2) Subsection 8 (2.3) of the Act, as enacted by subsection (1), is amended by adding the following paragraphs: (2) Le paragraphe 8 (2.3) de la Loi, tel qu’il est édicté par le paragraphe (1), est modifié par adjonction des dispositions suivantes : 1.1 Section 20.2. 1.1 L’article 20.2. 1.2 Section 21.1. 1.2 L’article 21.1. 1.3 Section 21.2. 1.3 L’article 21.2. (3) Subsection 8 (8) of the Act is repealed. (3) Le paragraphe 8 (8) de la Loi est abrogé. 8. Section 9 of the Act is amended by adding the following subsection: 8. L’article 9 de la Loi est modifié par adjonction du paragraphe suivant : Educational or training sessions Séances d’éducation ou de formation (5.1) Despite subsection (4), a local health integration network may exclude the public from a meeting if the following conditions are both satisfied: (5.1) Malgré le paragraphe (4), une réunion du réseau local d’intégration des services de santé peut se tenir à huis clos s’il est satisfait aux deux conditions suivantes : 1. The meeting is held for the purpose of educating or training the members of the local health integration network. 1. La réunion a pour but l’éducation ou la formation des membres du réseau local d’intégration des services de santé. 2. At the meeting, no member discusses or otherwise deals with any matter in a way that materially advances the decision-making of the local health integration network. 2. Lors de la réunion, aucun membre ne discute ou ne traite autrement d’une question d’une manière qui fait avancer de façon importante la prise de décision du réseau local d’intégration des services de santé. 9. Section 10 of the Act is amended by adding the following subsection: 9. L’article 10 de la Loi est modifié par adjonction du paragraphe suivant : Medical officer of health engagement Participation d’un médecin-hygiéniste (3.1) A local health integration network shall ensure that its chief executive officer engages with each medical officer of health for any health unit located in whole or in part within the geographic area of the network, or with the medical officer of health’s delegate, on an ongoing basis on issues related to local health system planning, funding and service delivery. (3.1) Les réseaux locaux d’intégration des services de santé veillent à ce que leur chef de la direction participe, de façon soutenue, avec chaque médecin-hygiéniste d’une circonscription sanitaire située entièrement ou en partie dans la zone géographique que sert chaque réseau, ou son délégué, à l’étude de questions liées à la planification et au financement du système de santé local et à la prestation de services au sein du système. 76 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 5 10. The Act is amended by adding the following sections: 10. La Loi est modifiée par adjonction des articles suivants : Directives by Minister Directives du ministre 11.1 (1) The Minister may issue operational or policy directives to a local health integration network where the Minister considers it to be in the public interest to do so. 11.1 (1) Le ministre peut donner des directives opérationnelles ou en matière de politique à un réseau local d’intégration des services de santé s’il estime que l’intérêt public le justifie. Binding Caractère obligatoire des directives (2) A local health integration network shall comply with every directive of the Minister. (2) Le réseau local d’intégration des services de santé doit se conformer aux directives du ministre. General or particular Portée (3) An operational or policy directive of the Minister may be general or particular in its application. (3) La directive opérationnelle ou en matière de politique du ministre peut avoir une portée générale ou particulière. Non-application of Legislation Act, 2006 Non-application de la Loi de 2006 sur la législation (4) Part III (Regulations) of the Legislation Act, 2006 does not apply to operational or policy directives. (4) La partie III (Règlements) de la Loi de 2006 sur la législation ne s’applique pas aux directives opérationnelles ou en matière de politique. Public availability Mise à disposition du public (5) The Minister shall make every directive under this section available to the public. (5) Le ministre met chaque directive donnée en vertu du présent article à la disposition du public. Law prevails Primauté du droit (6) For greater certainty, in the event of a conflict between a directive issued under this section and a provision of any applicable Act or rule of any applicable law, the Act or rule prevails. (6) Il est entendu que, en cas d’incompatibilité entre une directive donnée en vertu du présent article et une disposition de toute loi applicable ou règle de toute loi applicable, la loi ou la règle l’emporte. Provincial standards Normes provinciales 11.2 (1) The Minister may issue provincial standards for the provision of health services that are provided or arranged by local health integration networks or health service providers where the Minister considers it to be in the public interest to do so. 11.2 (1) S’il estime que l’intérêt public le justifie, le ministre peut établir des normes provinciales relativement à la prestation des services de santé que fournissent ou qu’organisent les réseaux locaux d’intégration des services de santé ou les fournisseurs de services de santé. General or particular Portée (2) A standard of the Minister may be general or particular in its application. (2) Une norme du ministre peut avoir une portée générale ou particulière. Obligations re standards Obligations : normes (3) Every local health integration network and health service provider to which a standard under this section is directed shall comply with the standard. (3) Chaque réseau local d’intégration des services de santé et fournisseur de services de santé visé par une norme établie en vertu du présent article doit s’y conformer. Non-application of Legislation Act, 2006 Non-application de la Loi de 2006 sur la législation (4) Part III (Regulations) of the Legislation Act, 2006 does not apply to a standard under this section. (4) La partie III (Règlements) de la Loi de 2006 sur la législation ne s’applique pas à une norme établie en vertu du présent article. Resolving differences over priorities Règlement des différends concernant les priorités (5) If a standard of a local health integration network or a health service provider conflicts with a provincial standard, the provincial standard prevails. (5) En cas d’incompatibilité entre une norme d’un réseau local d’intégration des services de santé ou d’un fournisseur de services de santé et une norme provinciale, la norme provinciale l’emporte. Same Idem (6) In the event of a conflict between a standard issued under this section and a provision of any applicable Act or (6) En cas d’incompatibilité entre une norme établie en vertu du présent article et une disposition de toute loi ap- 77 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 6 PATIENTS FIRST ACT, 2016 rule of any applicable law, the Act or rule prevails. plicable ou règle de toute loi applicable, la loi ou la règle l’emporte. Public availability Mise à disposition du public (7) The Minister shall make every standard under this section available to the public. (7) Le ministre met chaque norme établie en vertu du présent article à la disposition du public. 11. The Act is amended by adding the following sections: 11. La Loi est modifiée par adjonction des articles suivants : Investigators Enquêteurs 12.1 (1) The Minister may appoint one or more investigators to investigate and report on the quality of the management and administration of a local health integration network, or any other matter relating to a local health integration network, where the Minister considers it in the public interest to do so. 12.1 (1) Le ministre peut, s’il estime que l’intérêt public le justifie, nommer un ou plusieurs enquêteurs pour enquêter et présenter un rapport sur la qualité de la gestion et de l’administration d’un réseau local d’intégration des services de santé ou sur toute autre question relative à un réseau. Powers Pouvoirs (2) An investigator may, without a warrant and at reasonable times, (2) L’enquêteur peut, sans mandat et à toute heure raisonnable : (a) enter the premises of a local health integration network; and a) pénétrer dans les locaux d’un réseau local d’intégration des services de santé; (b) inspect the premises and the records relevant to the investigation. b) inspecter les locaux et les documents qui se rapportent à l’enquête. Identification Identification (3) An investigator conducting an investigation shall produce, on request, evidence of his or her appointment. (3) L’enquêteur qui effectue une enquête produit, sur demande, une attestation de sa nomination. Powers of investigator Pouvoirs de l’enquêteur (4) An investigator conducting an investigation may, (4) L’enquêteur qui effectue une enquête peut : (a) require the production of records or anything else that is relevant to the investigation, including books of account, documents, bank accounts, vouchers, correspondence and payroll records, records of staff hours worked and records of personal health information; a) exiger la production de dossiers ou d’autres choses qui se rapportent à l’enquête, y compris les livres de comptes, documents et comptes bancaires, les pièces justificatives, la correspondance et les documents relatifs à la paie, aux heures de travail effectuées par le personnel et aux renseignements personnels sur la santé; (b) examine and copy any record or thing required under clause (a); b) examiner et tirer des copies des dossiers ou choses exigés en vertu de l’alinéa a); (c) upon giving a receipt and showing the evidence of appointment, remove a record or anything else that is relevant to the investigation for review or copying, as long as the review or copying is carried out with reasonable dispatch and the record or thing is promptly returned to the local health integration network; c) après avoir donné un récépissé à cet effet et produit l’attestation de nomination, enlever des dossiers ou d’autres choses qui se rapportent à l’enquête afin de les examiner ou d’en tirer des copies, à condition de faire l’examen ou de tirer les copies avec une diligence raisonnable et de retourner promptement les dossiers ou choses au réseau local d’intégration des services de santé; (d) in order to produce a record in readable form, use data storage, information processing or retrieval devices or systems that are normally used in carrying on business in the place; and d) afin de produire un dossier sous une forme lisible, recourir aux dispositifs ou systèmes de stockage, de traitement ou de récupération des données qui sont utilisés habituellement pour exercer les activités dans l’endroit; (e) question a person on matters relevant to the investigation. e) interroger des personnes sur des questions qui se rapportent à l’enquête. Obligation to produce and assist Production de dossiers et aide obligatoires (5) If an investigator requires the production of a record or anything else that is relevant to the investigation, (5) Si un enquêteur exige la production de dossiers ou d’autres choses qui se rapportent à l’enquête, la personne 78 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 7 the person who has custody of the record or thing shall produce it and, in the case of a record, shall on request provide any assistance that is reasonably necessary to interpret the record or to produce it in a readable form. qui a la garde de ces dossiers ou choses les produit et, dans le cas de dossiers, fournit, sur demande, l’aide qui est raisonnablement nécessaire pour les interpréter ou les produire sous une forme lisible. Confidentiality Confidentialité (6) An investigator and his or her agents shall keep confidential all information that comes to the investigator’s knowledge in the course of an investigation under this Act and shall not communicate any information to any other person except as required by law or except where the communication is to the Minister or a person employed in or performing services for the Ministry. (6) Un enquêteur et ses mandataires préservent le caractère confidentiel de tous les renseignements venant à la connaissance de l’enquêteur dans le cadre d’une enquête effectuée en vertu de la présente loi et ne doivent en communiquer aucun à qui que ce soit, sauf si la loi l’exige ou si la communication est faite au ministre ou à une personne qui est employée dans le ministère ou qui fournit des services pour le ministère. Report Rapport (7) The investigator shall, upon completion of an investigation, make a report in writing to the Minister. (7) L’enquêteur présente un rapport écrit au ministre à l’issue de l’enquête. Same Idem (8) The Minister shall cause a copy of the report of an investigation to be delivered to the chair of the board of directors of the local health integration network. (8) Le ministre fait remettre une copie du rapport de l’enquête au président du conseil d’administration du réseau local d’intégration des services de santé. Public availability Mise à disposition du public (9) The Minister shall make every report of an investigation available to the public. (9) Le ministre met chaque rapport d’enquête à la disposition du public. Personal health information to be removed Suppression des renseignements personnels sur la santé (10) Before making a report available to the public under subsection (9), the Minister shall ensure that all personal health information in the report is redacted. (10) Avant de mettre un rapport à la disposition du public conformément au paragraphe (9), le ministre veille à ce que tous les renseignements personnels sur la santé qui y figurent soient retranchés. Local health integration network supervisor Superviseur du réseau local d’intégration des services de santé 12.2 (1) On the recommendation of the Minister, the Lieutenant Governor in Council may appoint a person as a local health integration network supervisor where the Lieutenant Governor in Council considers it in the public interest to do so. 12.2 (1) Sur la recommandation du ministre, le lieutenant-gouverneur en conseil peut, s’il estime que l’intérêt public le justifie, nommer une personne superviseur d’un réseau local d’intégration des services de santé. Notice of appointment Avis de nomination (2) The Minister shall give the board of a local health integration network at least 14 days notice before recommending to the Lieutenant Governor in Council that a local health integration network supervisor be appointed. (2) Le ministre donne au conseil d’un réseau local d’intégration des services de santé un préavis d’au moins 14 jours avant de recommander au lieutenant-gouverneur en conseil de nommer un superviseur pour le réseau. Term of office Mandat (3) The appointment of a local health integration network supervisor is valid until terminated by order of the Lieutenant Governor in Council. (3) Le superviseur nommé pour un réseau local d’intégration des services de santé reste en fonction jusqu’à ce que le lieutenant-gouverneur en conseil mette fin, par décret, à son mandat. Powers of supervisor Pouvoirs du superviseur (4) Unless the appointment provides otherwise, a local health integration network supervisor has the exclusive right to exercise all of the powers of the board of the network and of the network and its officers. (4) Sauf disposition contraire de l’acte de nomination, le superviseur d’un réseau local d’intégration des services de santé a le droit exclusif d’exercer tous les pouvoirs du conseil du réseau, du réseau et de ses dirigeants. Same Idem (5) The Lieutenant Governor in Council may specify the powers and duties of a local health integration network supervisor appointed under this section and the terms and conditions governing those powers and duties. (5) Le lieutenant-gouverneur en conseil peut préciser les pouvoirs et fonctions du superviseur d’un réseau local d’intégration des services de santé nommé en vertu du présent article ainsi que les conditions les régissant. 79 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 8 PATIENTS FIRST ACT, 2016 Additional powers of supervisor Pouvoirs supplémentaires du superviseur (6) If, under the order of the Lieutenant Governor in Council, the board of the network continues to have the right to act with regard to any matters, any such act of the board is valid only if approved in writing by the local health integration network supervisor. (6) Si, aux termes du décret du lieutenant-gouverneur en conseil, le conseil du réseau local d’intégration des services de santé continue d’avoir le droit d’agir à l’égard d’une question quelconque, ses actions ne sont valides que si elles sont approuvées par écrit par le superviseur du réseau. Right of access Droit d’accès (7) A local health integration network supervisor appointed for a local health integration network has the same rights as the board and the chief executive officer of the network in respect of the documents, records and information of the board and the network. (7) Le superviseur nommé pour un réseau local d’intégration des services de santé possède les mêmes droits que le conseil et le chef de la direction du réseau en ce qui concerne les documents, dossiers et renseignements du conseil et du réseau. Minister’s directions Directives du ministre (8) The Minister may issue directions to a local health integration network supervisor with regard to any matter within the jurisdiction of the supervisor. (8) Le ministre peut donner au superviseur d’un réseau local d’intégration des services de santé des directives sur toute question relevant de la compétence du superviseur. Directions to be followed Obligation de suivre les directives (9) A local health integration network supervisor shall carry out every direction of the Minister. (9) Le superviseur d’un réseau local d’intégration des services de santé doit exécuter les directives du ministre. Report to Minister Rapport présenté au ministre (10) A local health integration network supervisor shall report to the Minister as required by the Minister. (10) Le superviseur d’un réseau local d’intégration des services de santé présente un rapport au ministre à la demande de ce dernier. Public availability Mise à disposition du public (11) The Minister shall make every report of a supervisor available to the public. (11) Le ministre met chaque rapport du superviseur à la disposition du public. Personal health information to be removed Suppression des renseignements personnels sur la santé (12) Before making a report available to the public under subsection (11), the Minister shall ensure that all personal health information in the report is redacted. (12) Avant de mettre un rapport à la disposition du public conformément au paragraphe (11), le ministre veille à ce que tous les renseignements personnels sur la santé qui y figurent soient retranchés. 12. The Act is amended by adding the following section: 12. La Loi est modifiée par adjonction de l’article suivant : Sub-regions Sous-zones 14.1 (1) Each local health system integration network shall establish geographic sub-regions in its local health system for the purposes of planning, funding and integrating services within those geographic sub-regions. 14.1 (1) Chaque réseau local d’intégration des services de santé crée des sous-zones géographiques dans son système de santé local pour les besoins de la planification, du financement et de l’intégration des services dans ces souszones. Maps Carte (2) Each network shall make a map of the sub-regions available to the public. (2) Chaque réseau local d’intégration des services de santé met une carte des sous-zones à la disposition du public. 13. (1) Section 15 of the Act is amended by adding the following subsection: 13. (1) L’article 15 de la Loi est modifié par adjonction du paragraphe suivant : Sub-regions, direction Sous-zones : orientation (2.1) The integrated health service plan shall include strategic directions and plans for the geographic subregions of a local health system in order to achieve the purposes of this Act. (2.1) Le plan de services de santé intégrés comprend une orientation et des plans stratégiques pour les souszones géographiques d’un système de santé local afin de réaliser l’objet de la présente loi. (2) Section 15 of the Act is amended by adding the following subsection: (2) L’article 15 de la Loi est modifié par adjonction du paragraphe suivant : 80 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 9 Consultations Consultations (4) A local health integration network shall engage and seek advice from each board of health for any health unit located in whole or in part within the geographic area of the network in developing its integrated health service plan. (4) Le réseau local d’intégration des services de santé fait participer chaque conseil de santé d’une circonscription sanitaire située entièrement ou en partie dans la zone géographique qu’il sert à l’élaboration de son plan de services de santé intégrés et le consulte à cet égard. 14. (1) Section 16 of the Act is amended by adding the following subsection: 14. (1) L’article 16 de la Loi est modifié par adjonction du paragraphe suivant : Patient and family advisory committee Comité consultatif patients-familles (4.1) Each local health integration network shall establish one or more patient and family advisory committees. (4.1) Chaque réseau local d’intégration des services de santé crée un ou plusieurs comités consultatifs patientsfamilles. (2) Subsection 16 (5) of the Act is amended by striking out “shall establish” and substituting “may establish”. (2) Le paragraphe 16 (5) de la Loi est modifié par remplacement de «crée» par «peut créer». 15. Part IV of the Act is amended by adding the following section: 15. La partie IV de la Loi est modifiée par adjonction de l’article suivant : “Personal health information” Renseignements personnels sur la santé 16.1 In this Part, 16.1 La définition qui suit s’applique à la présente partie. “personal health information” has the same meaning as in section 4 of the Personal Health Information Protection Act, 2004, except that subsection 4 (3) of that Act does not apply. «renseignements personnels sur la santé» S’entend au sens de l’article 4 de la Loi de 2004 sur la protection des renseignements personnels sur la santé, sauf que le paragraphe 4 (3) de cette loi ne s’applique pas. 16. Subsection 18 (4) of the Act is amended by striking out “as defined in subsection 31 (5) of the Commitment to the Future of Medicare Act, 2004”. 16. Le paragraphe 18 (4) de la Loi est modifié par suppression de «au sens du paragraphe 31 (5) de la Loi de 2004 sur l’engagement d’assurer l’avenir de l’assurance-santé». 17. Subsection 19 (1) of the Act is repealed and the following substituted: 17. Le paragraphe 19 (1) de la Loi est abrogé et remplacé par ce qui suit : Funding of health service providers Financement des fournisseurs de services de santé (1) A local health integration network may provide funding, (1) Un réseau local d’intégration des services de santé peut accorder un financement : (a) to a health service provider in respect of services that the service provider provides in or for the geographic area of the network; and a) à un fournisseur de services de santé à l’égard des services que celui-ci fournit dans la zone géographique que sert le réseau ou pour cette zone; (b) to a health service provider in respect of services that the service provider provides in or for the geographic area of another network. b) à un fournisseur de services de santé à l’égard des services que celui-ci fournit dans la zone géographique que sert un autre réseau ou pour cette zone. 18. Section 20 of the Act is repealed and the following substituted: 18. L’article 20 de la Loi est abrogé et remplacé par ce qui suit : Service accountability agreement Entente de responsabilisation en matière de services 20. (1) Where a local health integration network proposes to provide funding to a health service provider or amend a service accountability agreement with a health service provider, the network and the provider shall enter into a service accountability agreement or amend such an agreement in accordance with this section. 20. (1) Si un réseau local d’intégration des services de santé se propose d’accorder un financement à un fournisseur de services de santé ou de modifier une entente de responsabilisation en matière de services conclue avec un fournisseur, le réseau et le fournisseur concluent une entente de responsabilisation en matière de services ou modifient une telle entente conformément au présent article. Notification required Avis requis (2) A local health integration network shall notify a health service provider that it intends to enter into a service accountability agreement with the provider or that it (2) Le réseau local d’intégration des services de santé avise le fournisseur de services de santé qu’il a l’intention de conclure une entente de responsabilisation en matière 81 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 10 PATIENTS FIRST ACT, 2016 seeks to amend such an agreement. de services avec lui ou qu’il demande la modification d’une telle entente. Negotiation Négociation (3) After being notified under subsection (2), the parties shall seek to negotiate the terms and conditions of the service accountability agreement or the amendment. (3) Après avoir reçu l’avis prévu au paragraphe (2), les parties cherchent à négocier les conditions de l’entente de responsabilisation en matière de services ou de la modification. Where agreement cannot be negotiated Cas où aucune négociation n’a eu lieu (4) If the parties have not negotiated a service accountability agreement or an amendment within 90 days of the notice under subsection (2), then, any time after the 90th day, the network may deliver a notice of an offer to the provider setting out the terms and conditions of the proposed agreement or amendment, and the network shall notify the Minister of that offer. (4) Si les parties n’ont pas négocié d’entente de responsabilisation en matière de services ou de modification à une telle entente dans les 90 jours de l’avis prévu au paragraphe (2), le réseau peut, après le 90 e jour, remettre un avis d’offre au fournisseur dans lequel il énonce les conditions de l’entente proposée ou de la modification proposée. Le réseau avise le ministre de cette offre. Deemed acceptance Offre réputée acceptée (5) If the provider does not deliver a rejection notice within 30 days of receiving the notice of an offer under subsection (4), then the notice of offer shall be deemed to be the service accountability agreement between the network and the provider or an amendment to such an agreement, as the case may be, and the network and the provider shall comply with that agreement. (5) Si le fournisseur ne remet pas un avis de rejet de l’offre dans les 30 jours de la réception de l’avis d’offre prévu au paragraphe (4), cet avis est réputé être soit l’entente de responsabilisation en matière de services conclue entre le réseau et le fournisseur, soit une modification à une telle entente. Le réseau et le fournisseur doivent alors se conformer à l’entente. Rejection Rejet (6) The provider may reject any offer referred to in subsection (4) by providing a notice to the network and the Minister within 30 days of receiving the notice of offer from the network. (6) Le fournisseur peut rejeter toute offre visée au paragraphe (4) en remettant un avis à cet effet au réseau et au ministre dans les 30 jours de la réception de l’avis d’offre de la part du réseau. Setting the terms Fixation des conditions (7) If the provider delivers a notice under subsection (6), (7) Si le fournisseur remet l’avis prévu au paragraphe (6) : (a) the local health integration network may at any time give notice to the provider and the Minister that it intends to set the terms and conditions of the service accountability agreement or amendment to such an agreement, as the case may be; and a) le réseau local d’intégration des services de santé peut, en tout temps, donner au fournisseur et au ministre un avis les informant qu’il a l’intention de fixer les conditions de l’entente de responsabilisation en matière de services ou de la modification à une telle entente, selon le cas; (b) at any time more than 30 days after giving notice under clause (a), if the network and the provider have not negotiated a service accountability agreement or amendment, as the case may be, the network may, if it considers it in the public interest to do so, set the terms and conditions of the service accountability agreement or amendment, and the network and the provider shall comply with those terms and conditions. b) en tout temps plus de 30 jours après avoir donné l’avis prévu à l’alinéa a) et si le réseau et lui n’ont pas négocié d’entente de responsabilisation en matière de services ou de modification à une telle entente, selon le cas, le réseau peut, s’il estime que l’intérêt public le justifie, fixer les conditions de l’entente ou de la modification, auquel cas le réseau et le fournisseur doivent s’y conformer. Saving Exception (8) Nothing in subsection (4), (5), (6) or (7) prevents the network and the provider from negotiating a service accountability agreement during the time period set out in subsection (4) or (6) or from agreeing to amend a service accountability agreement that is deemed under subsection (5). (8) Le paragraphe (4), (5), (6) ou (7) n’a pas pour effet d’empêcher le réseau et le fournisseur de négocier une entente de responsabilisation en matière de services pendant le délai prévu au paragraphe (4) ou (6) ou de convenir de modifier l’entente réputée conclue en application du paragraphe (5). No restriction on patient mobility Aucune restriction à l’égard de la mobilité des malades 20.1 (1) A local health integration network shall not enter into any agreement or other arrangement, including 20.1 (1) Les réseaux locaux d’intégration des services de santé ne doivent conclure aucune entente ni aucun 82 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 11 issuing an integration decision under Part V of this Act, that restricts or prevents an individual from receiving services based on the geographic area in which the individual resides. autre arrangement, y compris prendre une décision d’intégration dans le cadre de la partie V de la présente loi, qui a pour effet d’empêcher un particulier de recevoir des services en fonction de la zone géographique où il réside ou d’imposer des restrictions à cet égard. Geographic restrictions for homecare services Restrictions géographiques pour les services de soins à domicile (2) For greater certainty, subsection (1) applies to a service accountability agreement in respect of funding provided by a local health integration network for the delivery of services by a health service provider under section 20, but it does not apply to any agreement between a local health integration network and a service provider under the Home Care and Community Services Act, 1994 that requires the service provider to deliver services in the geographic area or a sub-region of the network. (2) Il est entendu que le paragraphe (1) s’applique à une entente de responsabilisation en matière de services à l’égard d’un financement accordé par un réseau local d’intégration des services de santé pour la prestation de services par un fournisseur de services de santé en vertu de l’article 20. Toutefois, il ne s’applique pas à une entente conclue entre un réseau et un fournisseur de services dans le cadre de la Loi de 1994 sur les services de soins à domicile et les services communautaires qui exige que le fournisseur fournisse des services dans la zone ou la souszone géographique que sert le réseau. 19. The Act is amended by adding the following section: 19. La Loi est modifiée par adjonction de l’article suivant : Directives by local health integration networks Directives des réseaux locaux d’intégration des services de santé 20.2 (1) A local health integration network may issue operational or policy directives to a health service provider to which it provides funding where the network considers it to be in the public interest to do so. 20.2 (1) Un réseau local d’intégration des services de santé peut donner des directives opérationnelles ou en matière de politique à un fournisseur de services de santé à qui il accorde un financement s’il estime que l’intérêt public le justifie. Exception Exception (2) Subsection (1) does not apply to a licensee within the meaning of the Long-Term Care Homes Act, 2007. (2) Le paragraphe (1) ne s’applique pas à un titulaire de permis au sens de la Loi de 2007 sur les foyers de soins de longue durée. Binding Caractère obligatoire des directives (3) A health service provider shall comply with every directive of a local health integration network. (3) Le fournisseur de services de santé doit se conformer aux directives du réseau local d’intégration des services de santé. General or particular Portée (4) An operational or policy directive of a local health integration network may be general or particular in its application. (4) La directive opérationnelle ou en matière de politique du réseau local d’intégration des services de santé peut avoir une portée générale ou particulière. Law prevails Primauté du droit (5) For greater certainty, in the event of a conflict between a directive issued under this section and a provision of any applicable Act or rule of any applicable law, the Act or rule prevails. (5) Il est entendu que, en cas d’incompatibilité entre une directive donnée en vertu du présent article et une disposition de toute loi applicable ou règle de toute loi applicable, la loi ou la règle l’emporte. Non-application of Legislation Act, 2006 Non-application de la Loi de 2006 sur la législation (6) Part III (Regulations) of the Legislation Act, 2006 does not apply to the operational or policy directives. (6) La partie III (Règlements) de la Loi de 2006 sur la législation ne s’applique pas aux directives opérationnelles ou en matière de politique. Public availability Mise à disposition du public (7) A local health integration network shall make every directive under this section available to the public. (7) Le réseau local d’intégration des services de santé met chaque directive donnée en vertu du présent article à la disposition du public. 20. Section 21 of the Act is repealed and the following substituted: 20. L’article 21 de la Loi est abrogé et remplacé par ce qui suit : Audits, reviews, etc. Vérifications et examens 21. A local health integration network may at any time 21. Un réseau local d’intégration des services de santé 83 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 12 PATIENTS FIRST ACT, 2016 direct that a health service provider that receives funding from the network, peut en tout temps enjoindre à un fournisseur de services de santé qui reçoit un financement de lui de faire ce qui suit : (a) engage or permit one or more auditors licensed under the Public Accounting Act, 2004 to audit the accounts and financial transactions of the service provider; or a) engager un ou plusieurs vérificateurs titulaires d’un permis délivré en vertu de la Loi de 2004 sur l’expertise comptable pour vérifier ses comptes et ses opérations financières ou les y autoriser; (b) engage in or permit an operational review or peer review of the provider’s activities. b) procéder à un examen de gestion ou à un examen par des pairs de ses activités ou autoriser un tel examen. 21. The Act is amended by adding the following sections: 21. La Loi est modifiée par adjonction des articles suivants : Investigators Enquêteurs 21.1 (1) A local health integration network may appoint one or more investigators to investigate and report on the quality of the management of a health service provider, the quality of the care and treatment of persons by a health service provider or any other matter relating to a health service provider where the local health integration network considers it to be in the public interest to do so. 21.1 (1) Un réseau local d’intégration des services de santé peut, s’il estime que l’intérêt public le justifie, nommer un ou plusieurs enquêteurs pour enquêter et présenter un rapport sur la qualité de la gestion d’un fournisseur de services de santé, la qualité des soins et des traitements fournis aux personnes par un fournisseur de services de santé, ou toute autre question relative à un fournisseur de services de santé. Application Champ d’application (2) Subsection (1) applies to health service providers that receive funding from the local health integration network but does not apply to a licensee within the meaning of the Long-Term Care Homes Act, 2007. (2) Le paragraphe (1) s’applique aux fournisseurs de services de santé qui reçoivent un financement du réseau local d’intégration des services de santé. Toutefois, il ne s’applique pas à un titulaire de permis au sens de la Loi de 2007 sur les foyers de soins de longue durée. Powers Pouvoirs (3) An investigator may, without a warrant and at reasonable times, (a) enter the premises of a health service provider that may be investigated under this section; (3) L’enquêteur peut, sans mandat et à toute heure raisonnable : a) pénétrer dans les locaux d’un fournisseur de services de santé pouvant faire l’objet d’une enquête en vertu du présent article; b) sous réserve du paragraphe (4), pénétrer dans tout local où un fournisseur de services de santé fournit des services; c) inspecter les locaux et examiner les services qui y sont fournis et les documents qui se rapportent à l’enquête. (b) subject to subsection (4), enter any premises where a health service provider provides services; and (c) inspect the premises, the services provided on the premises and the records relevant to the investigation. Dwellings Logements (4) No investigator shall enter a place that is being used as a dwelling, except with the consent of the occupier. (4) L’enquêteur ne doit pas pénétrer dans un lieu qui sert de logement, sauf si l’occupant des lieux y consent. Identification Identification (5) An investigator conducting an investigation shall produce, on request, evidence of his or her appointment. (5) L’enquêteur qui effectue une enquête produit, sur demande, une attestation de sa nomination. Powers of investigator conducting investigation Pouvoirs de l’enquêteur (6) An investigator conducting an investigation may, (6) L’enquêteur qui effectue une enquête peut : (a) require the production of records or anything else that is relevant to the investigation, including books of account, documents, bank accounts, vouchers, correspondence and payroll records, records of staff hours worked and records of personal health information; a) exiger la production de dossiers ou d’autres choses qui se rapportent à l’enquête, y compris les livres de comptes, documents et comptes bancaires, les pièces justificatives, la correspondance et les documents relatifs à la paie, aux heures de travail effectuées par le personnel et aux renseignements personnels sur la santé; 84 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 13 (b) examine and copy any record or thing required under clause (a); b) examiner et tirer des copies des dossiers ou des choses exigés en vertu de l’alinéa a); (c) upon giving a receipt and showing the evidence of appointment, remove a record or anything else that is relevant to the investigation for review or copying, as long as the review or copying is carried out with reasonable dispatch and the record or thing is promptly returned to the local health integration network; c) après avoir donné un récépissé à cet effet et produit l’attestation de nomination, enlever des dossiers ou d’autres choses qui se rapportent à l’enquête afin de les examiner ou d’en tirer des copies, à condition de faire l’examen ou de tirer les copies avec une diligence raisonnable et de retourner promptement les dossiers ou choses au réseau local d’intégration des services de santé; (d) in order to produce a record in readable form, use data storage, information processing or retrieval devices or systems that are normally used in carrying on business in the place; and d) afin de produire un dossier sous une forme lisible, recourir aux dispositifs ou systèmes de stockage, de traitement ou de récupération des données qui sont utilisés habituellement pour exercer les activités dans l’endroit; (e) question a person on matters relevant to the investigation. e) interroger des personnes sur des questions qui se rapportent à l’enquête. Obligation to produce and assist Production de dossiers et aide obligatoires (7) If an investigator requires the production of a record or anything else that is relevant to the investigation under this section, the person who has custody of the record or thing shall produce it and, in the case of a record, shall on request provide any assistance that is reasonably necessary to interpret the record or to produce it in a readable form. (7) Si un enquêteur exige la production de dossiers ou d’autres choses qui se rapportent à l’enquête en vertu du présent article, la personne qui a la garde de ces dossiers ou choses les produit et, dans le cas de dossiers, fournit, sur demande, l’aide qui est raisonnablement nécessaire pour les interpréter ou les produire sous une forme lisible. Confidentiality Confidentialité (8) An investigator and his or her agents shall keep confidential all information that comes to the investigator’s knowledge in the course of an investigation under this Act and shall not communicate any information to any other person except as required by law or except where the communication is to the local health integration network or a person employed in or performing services for the local health integration network. (8) Un enquêteur et ses mandataires préservent le caractère confidentiel de tous les renseignements venant à la connaissance de l’enquêteur dans le cadre d’une enquête effectuée en vertu de la présente loi et ne doivent en communiquer aucun à qui que ce soit, sauf si la loi l’exige ou si la communication est faite au réseau local d’intégration des services de santé ou à une personne qui est employée dans le réseau ou qui fournit des services pour le réseau. Report of investigator Rapport de l’enquêteur (9) The investigator shall, upon completion of an investigation, make a report in writing to the local health integration network. (9) L’enquêteur présente un rapport écrit au réseau local d’intégration des services de santé à l’issue de l’enquête. Report Rapport (10) The local health integration network shall cause a copy of the report of an investigation to be delivered to the health service provider. (10) Le réseau local d’intégration des services de santé fait remettre une copie du rapport d’enquête au fournisseur de services de santé. Public availability Mise à disposition du public (11) The local health integration network shall make every report of an investigation available to the public. (11) Le réseau local d’intégration des services de santé met chaque rapport d’enquête à la disposition du public. Personal health information to be removed Suppression des renseignements personnels sur la santé (12) Before making a report public under subsection (11), the local health integration network shall ensure that all personal health information in the report is redacted. (12) Avant de mettre un rapport à la disposition du public conformément au paragraphe (11), le réseau local d’intégration des services de santé veille à ce que tous les renseignements personnels sur la santé qui y figurent soient retranchés. Health service provider supervisor Superviseur du fournisseur de services de santé 21.2 (1) A local health integration network may appoint a person as a health service provider supervisor of a 21.2 (1) Le réseau local d’intégration des services de santé peut, s’il estime que l’intérêt public le justifie, 85 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 14 PATIENTS FIRST ACT, 2016 health service provider to which it provides funding when it considers it to be appropriate to do so in the public interest. nommer une personne superviseur d’un fournisseur de services de santé du fournisseur à qui il accorde un financement. Certain providers excepted Exception : certains fournisseurs (2) This section does not apply with respect to a health service provider that is, (2) Le présent article ne s’applique pas à l’égard d’un fournisseur de services de santé qui est : (a) a person or entity that operates a hospital within the meaning of the Public Hospitals Act or a private hospital within the meaning of the Private Hospitals Act; or a) une personne ou entité qui fait fonctionner un hôpital au sens de la Loi sur les hôpitaux publics ou qui exploite un hôpital privé au sens de la Loi sur les hôpitaux privés; (b) a licensee within the meaning of the Long-Term Care Homes Act, 2007. b) un titulaire de permis au sens de la Loi de 2007 sur les foyers de soins de longue durée. Notice of appointment Avis de nomination (3) The local health integration network shall give the governing body of the health service provider at least 14 days notice before appointing the supervisor. (3) Le réseau local d’intégration des services de santé donne au corps dirigeant du fournisseur de services de santé un préavis d’au moins 14 jours avant de nommer un superviseur. Immediate appointment Nomination immédiate (4) Subsection (3) does not apply if there are not enough members of the governing body to form a quorum. (4) Le paragraphe (3) ne s’applique pas s’il n’y a pas assez de membres du corps dirigeant pour constituer le quorum. Term of office Mandat (5) The appointment of a health service provider supervisor is valid until terminated by order of the network. (5) Le superviseur nommé pour un fournisseur de services de santé reste en fonction jusqu’à ce que le réseau mette fin, par ordre, à son mandat. Powers of supervisor Pouvoirs du superviseur (6) Unless the appointment provides otherwise, a health service provider supervisor has the exclusive right to exercise all of the powers of the governing body of the provider and its officers. (6) Sauf disposition contraire de l’acte de nomination, le superviseur d’un fournisseur de services de santé a le droit exclusif d’exercer tous les pouvoirs du corps dirigeant du fournisseur et de ses dirigeants. Same Idem (7) The local health integration network may specify the powers and duties of a health service provider supervisor appointed under this section and the terms and conditions governing those powers and duties. (7) Le réseau local d’intégration des services de santé peut préciser les pouvoirs et fonctions du superviseur d’un fournisseur de services de santé nommé en vertu du présent article ainsi que les conditions les régissant. Additional powers of supervisor Pouvoirs supplémentaires du superviseur (8) If, under the order of the network, the governing body continues to have the right to act with regard to any matters, any such act of the body is valid only if approved in writing by the health service provider supervisor. (8) Si, aux termes de l’ordre du réseau, le corps dirigeant continue d’avoir le droit d’agir à l’égard d’une question quelconque, ses actions ne sont valides que si elles sont approuvées par écrit par le superviseur du fournisseur de services de santé. Right of access Droit d’accès (9) A health service provider supervisor appointed for a health service provider has the same rights as the governing body and the chief executive officer of the provider in respect of the documents, records and information of the body and the provider. (9) Le superviseur nommé pour un fournisseur de services de santé possède les mêmes droits que le corps dirigeant et le chef de la direction du fournisseur en ce qui concerne les documents, dossiers et renseignements du corps dirigeant et du fournisseur. Reports Rapport présenté au réseau (10) A health service provider supervisor shall make a report to the network as required by the network. (10) Le superviseur d’un fournisseur de services de santé présente un rapport au réseau local d’intégration des services de santé à la demande de ce dernier. Network’s directions Directives du réseau (11) The local health integration network may issue (11) Le réseau local d’intégration des services de santé 86 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 15 directions to a health service provider supervisor with regard to any matter within the jurisdiction of the supervisor. peut donner au superviseur d’un fournisseur de services de santé des directives sur toute question relevant de la compétence du superviseur. Directions to be followed Obligation de suivre les directives (12) A health service provider supervisor shall carry out every direction of the network. (12) Le superviseur d’un fournisseur de services de santé doit exécuter les directives du réseau local d’intégration des services de santé. Public availability Mise à disposition du public (13) The network shall make every report of a supervisor available to the public. (13) Le réseau local d’intégration des services de santé met chaque rapport du superviseur à la disposition du public. Personal health information to be removed Suppression des renseignements personnels sur la santé (14) Before making a report public under subsection (13), the network shall ensure that all personal health information in the report is redacted. (14) Avant de mettre un rapport à la disposition du public conformément au paragraphe (13), le réseau veille à ce que tous les renseignements personnels sur la santé qui y figurent soient retranchés. 22. (1) Subsection 22 (1) of the Act is amended by striking out “as defined in subsection 31 (5) of the Commitment to the Future of Medicare Act, 2004”. 22. (1) Le paragraphe 22 (1) de la Loi est modifié par suppression de «au sens du paragraphe 31 (5) de la Loi de 2004 sur l’engagement d’assurer l’avenir de l’assurance-santé,». (2) Subsection 22 (2) of the Act is amended by striking out, (2) Le paragraphe 22 (2) de la Loi est modifié par suppression de : (a) “as defined in subsection 31 (5) of the Commitment to the Future of Medicare Act, 2004”; and a) «au sens du paragraphe 31 (5) de la Loi de 2004 sur l’engagement d’assurer l’avenir de l’assurance-santé,»; (b) “or Part III of the latter Act”. b) «la partie III de cette loi ou». (3) Clause 22 (4) (a) of the Act is amended by striking out “or Part III of the Commitment to the Future of Medicare Act, 2004”. (3) L’alinéa 22 (4) a) de la Loi est modifié par suppression de «ou la partie III de la Loi de 2004 sur l’engagement d’assurer l’avenir de l’assurance-santé». 23. (1) The following provisions of section 27 of the Act are amended by striking out “60” and substituting “90”: 1. Clause (3) (c). 23. (1) Les dispositions suivantes de l’article 27 de la Loi sont modifiées par remplacement de «60» par «90» : 1. L’alinéa (3) c). 2. Clause (3) (d), in the portion before subclause (i). 3. Subsection (4), in the portion before clause (a). 2. L’alinéa (3) d), dans le passage qui précède le sous-alinéa (i). 3. Le paragraphe (4), dans le passage qui précède l’alinéa a). 4. Le paragraphe (6). 4. Subsection (6). (2) Subsection 27 (3) of the Act is amended by striking out “and” at the end of subclause (d) (iii) and by adding the following clause: (2) Le paragraphe 27 (3) de la Loi est modifié par adjonction de l’alinéa suivant : (d.1) despite clauses (c) and (d), may proceed with the integration at any time if the network notifies the provider that the network does not intend to give notice of a proposed decision under subsection (4) or issue a decision under subsection (6); and d.1) malgré les alinéas c) et d), peut procéder à l’intégration en tout temps si le réseau l’avise qu’il n’a pas l’intention de donner un avis du projet de décision en vertu du paragraphe (4) ou de prendre une décision en vertu du paragraphe (6); (3) Section 27 of the Act is amended by adding the following subsections: (3) L’article 27 de la Loi est modifié par adjonction des paragraphes suivants : Exceptions Exceptions (3.1) Subsection (3) does not apply to an integration that requires a decision of the Minister or a director under the Independent Health Facilities Act or the Long-Term Care Homes Act, 2007. (3.1) Le paragraphe (3) ne s’applique pas à une intégration qui est assujettie à une décision du ministre ou d’un directeur dans le cadre de la Loi sur les établissements de santé autonomes ou de la Loi de 2007 sur les foyers de soins de longue durée. 87 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 16 PATIENTS FIRST ACT, 2016 Requirements of notice Exigences relatives à l’avis (3.2) A notice under clause (3) (a) must include, (3.2) L’avis prévu à l’alinéa (3) a) doit comprendre ce qui suit : (a) a description of the integration proposed by the health service provider, including the identity of the parties involved with the integration; a) une description de l’intégration proposée par le fournisseur de services de santé, notamment l’identité des parties visées par l’intégration; (b) the health service provider’s analysis of any financial implications, service delivery implications, health system implication or human resource implications of the proposed integration, where applicable; b) l’analyse, par le fournisseur de services de santé, des incidences du projet d’intégration sur, le cas échéant, les finances, la prestation de services, le système de santé ou les ressources humaines; (c) where applicable, a description of any community engagement processes that the provider used to consider the proposed integration, and a description of any issues that were raised in those consultation processes and the provider’s analysis, if any, of those issues; c) une description, le cas échéant, des processus de participation communautaire auxquels le fournisseur a eu recours pour examiner le projet d’intégration, ainsi qu’une description des questions soulevées pendant ces processus de consultation et de l’analyse, par le fournisseur, de ces questions, s’il y a lieu; (d) a description of the proposed timing or staging of the implementation of the proposed integration; and d) une description du délai ou du déroulement proposé en ce qui concerne la mise en oeuvre du projet d’intégration; (e) a description of the level of approval received by the provider within its organization. e) une description du niveau d’approbation reçu par le fournisseur au sein de son organisme. (4) Subsection 27 (4) of the Act is amended by adding the following clause: (4) Le paragraphe 27 (4) de la Loi est modifié par adjonction de l’alinéa suivant : (0.a) request more information about the proposed integration from the provider and where such a request has been made, 0.a) demander au fournisseur d’autres renseignements sur le projet d’intégration, et si une telle demande a été faite : (i) the provider shall provide such information within 30 days of the request by the network, and (i) le fournisseur fournit ces renseignements dans les 30 jours de la demande du réseau, (ii) the time limit for the network to take the steps set out in clauses (a), (b) and (c) shall be extended by an additional 90 days; (ii) le délai imparti au réseau pour prendre les mesures énoncées aux alinéas a), b) et c) est prorogé d’une période additionnelle de 90 jours; 24. Subsection 31 (3) of the Act is amended by striking out “a person who suffers” and substituting “a person or entity, including a health service provider, who suffers”. 24. Le paragraphe 31 (3) de la Loi est modifié par remplacement de «quiconque subit» par «la personne ou entité, y compris le fournisseur de services de santé, qui subit». 25. L’article 33 de la Loi est abrogé. 25. Section 33 of the Act is repealed. 26. The Act is amended by adding the following Part: 26. La Loi est modifiée par adjonction de la partie suivante : PART V.1 TRANSFER OF COMMUNITY CARE ACCESS CORPORATIONS TO LOCAL HEALTH INTEGRATION NETWORKS PARTIE V.1 TRANSFERT DES SOCIÉTÉS D’ACCÈS AUX SOINS COMMUNAUTAIRES AUX RÉSEAUX LOCAUX D’INTÉGRATION DES SERVICES DE SANTÉ Definition Définition 34.1 In this Part, 34.1 La définition qui suit s’applique à la présente partie. “community care access corporation” means a corporation continued or incorporated under the Community Care Access Corporations Act, 2001. «société d’accès aux soins communautaires» Personne morale qui est prorogée ou constituée sous le régime de la Loi de 2001 sur les sociétés d’accès aux soins communautaires. 88 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 17 Transfer order Arrêté de transfert ou de mutation 34.2 (1) Despite anything in the Community Care Access Corporations Act, 2001, the Corporations Act or any other Act, but subject to the processes and requirements set out in this Part and any regulations made under this Part, the Minister may make an order, 34.2 (1) Malgré la Loi de 2001 sur les sociétés d’accès aux soins communautaires, la Loi sur les personnes morales ou toute autre loi, mais sous réserve des méthodes et exigences énoncées dans la présente partie et des règlements pris en vertu de la présente partie, le ministre peut, par arrêté : (a) transferring all of the assets, liabilities, rights and obligations of a community care access corporation to the local health integration network that has the same geographic area as the community care access corporation; and a) transférer tous les éléments d’actif, éléments de passif, droits et obligations d’une société d’accès aux soins communautaires au réseau local d’intégration des services de santé qui sert la même zone géographique que la société; (b) transferring all of the employees of a community care access corporation to the local health integration network that has the same geographic area as the community care access corporation. b) muter tous les employés d’une société d’accès aux soins communautaires au réseau local d’intégration des services de santé qui sert la même zone géographique que la société. Notification requirement Avis exigé (2) Before the Minister makes an order under subsection (1), the Minister shall notify the affected community care access corporation and local health integration network. (2) Avant de prendre un arrêté en vertu du paragraphe (1), le ministre doit aviser la société d’accès aux soins communautaires et le réseau local d’intégration des services de santé visés. Contents of order Contenu de l’arrêté (3) An order made under subsection (1), (3) L’arrêté pris en vertu du paragraphe (1) : (a) shall specify a date on which the transfer of assets, liabilities, rights, obligations or employees, as the case may be, takes effect; and a) doit préciser la date à laquelle le transfert des éléments d’actif, éléments de passif, droits et obligations ou la mutation des employés, selon le cas, prend effet; (b) may specify that issues arising out of the interpretation of the order be resolved by the method specified in the order. b) peut préciser que les questions soulevées par l’interprétation de l’arrêté soient réglées de la façon que précise celui-ci. Non-application of Legislation Act, 2006 Non-application de la Loi de 2006 sur la législation (4) Part III (Regulations) of the Legislation Act, 2006 does not apply to an order made under subsection (1). (4) La partie III (Règlements) de la Loi de 2006 sur la législation ne s’applique pas à un arrêté pris en vertu du paragraphe (1). Notice of order Avis de l’arrêté (5) The Minister shall provide each affected community care access corporation and local health integration network with a copy of the order, and shall make the order available to the public. (5) Le ministre remet une copie de l’arrêté à chaque société d’accès aux soins communautaires et à chaque réseau local d’intégration des services de santé visés et met l’arrêté à la disposition du public. Same, duty of corporation Idem, obligation de la société (6) Each community care access corporation and local health integration network that receives a copy of an order provided under subsection (5) shall, (6) Chaque société d’accès aux soins communautaires et chaque réseau local d’intégration des services de santé qui reçoivent une copie de l’arrêté prévu au paragraphe (5) : (a) provide notice of the order and make copies available to affected employees and their bargaining agents and to other persons or entities whose contracts are affected by the order; and a) d’une part, avisent de l’arrêté les employés visés et leurs agents négociateurs ainsi que les autres personnes ou entités dont les contrats sont visés par l’arrêté et en mettent des copies à leur disposition; (b) make copies of the order available to the public. b) d’autre part, mettent des copies de l’arrêté à la disposition du public. Assumption of rights, obligations, etc. Prise en charge des droits et des obligations 34.3 (1) If the Minister makes an order under subsection 34.2 (1), 34.3 (1) Si le ministre prend un arrêté en vertu du paragraphe 34.2 (1) : 89 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 18 PATIENTS FIRST ACT, 2016 (a) the local health integration network affected by the transfer assumes the operations, activities and affairs of the community care access corporation affected by the transfer, as of the date of the transfer; and a) le réseau local d’intégration des services de santé visé par le transfert prend en charge, à la date du transfert, les opérations, activités et affaires de la société d’accès aux soins communautaires visée par le transfert; (b) all assets, liabilities, rights and obligations of the community care access corporation affected by the transfer, including contractual rights, interests, approvals, registrations and entitlements that exist immediately before the transfer date continue as the assets, liabilities, rights and obligations of the local health integration network affected by the transfer, and are transferred to the local health integration network affected by the transfer, without compensation. b) tous les éléments d’actif, éléments de passif, droits et obligations de la société d’accès aux soins communautaires visée par le transfert, notamment les droits contractuels ainsi que les intérêts, approbations et enregistrements qui existent immédiatement avant la date du transfert, continuent d’être les éléments d’actif, les éléments de passif, les droits et les obligations du réseau local d’intégration des services de santé visé par le transfert et lui sont transférés, sans versement d’indemnité. Convictions, rulings etc. Décisions judiciaires ou quasi judiciaires (2) A conviction against, or ruling, order or judgment in favour of or against a community care access corporation affected by a transfer may be enforced by or against the local health integration network affected by the transfer. (2) Toute décision judiciaire ou quasi judiciaire rendue en faveur d’une société d’accès aux soins communautaires visée par le transfert ou contre elle peut être exécutée par le réseau local d’intégration des services de santé visé par le transfert ou à son encontre. Civil actions, etc. Actions civiles (3) The local health integration network affected by a transfer shall be deemed to be the party plaintiff or the party defendant, as the case may be, in any civil action commenced by or against the community care access corporation affected by the transfer before the date of the transfer. (3) Le réseau local d’intégration des services de santé visé par le transfert est réputé partie demanderesse ou partie défenderesse, selon le cas, dans toute action civile intentée avant la date du transfert, soit par la société d’accès aux soins communautaires visée par le transfert, soit contre elle. No change of control Contrôle intact (4) A transfer of the assets, liabilities, rights and obligations of the community care access corporation to the local health integration network shall not constitute a change of control of the community care access corporation in respect of any asset, liability, right or obligation of the community care access corporation affected by the transfer. (4) Le transfert des éléments d’actif, éléments de passif, droits et obligations de la société d’accès aux soins communautaires au réseau local d’intégration des services de santé ne constitue pas un changement de contrôle de la société relativement aux éléments d’actif, éléments de passif, droits et obligations de la société visée par le transfert. No breach, etc. Non-assimilation à une violation (5) A transfer is deemed not to, (5) Un transfert est réputé ne pas : (a) constitute a breach, termination, repudiation or frustration of any contract, including a contract of employment or insurance or a collective agreement; a) constituer une violation, résiliation, répudiation ou impossibilité d’exécution d’un contrat, y compris un contrat de travail ou d’assurance ou une convention collective; (b) constitute a breach of any Act, regulation or municipal by-law; b) constituer une violation d’une loi ou d’un règlement, notamment municipal; (c) constitute an event of default or force majeure; c) constituer un cas de défaut ou une force majeure; (d) give rise to a breach, termination, repudiation or frustration of any licence, permit or other right; d) donner lieu à une violation, révocation, répudiation ou impossibilité d’exécution d’un permis, d’une autorisation ou d’un autre droit; (e) give rise to any right to terminate or repudiate a contract, licence, permit or other right; or e) donner le droit de résilier un contrat ou de révoquer un droit, notamment un permis ou une autorisation, ni le droit de les répudier; (f) give rise to any estoppel. f) donner lieu à une préclusion. 90 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 19 No new cause of action Aucune nouvelle cause d’action (6) A transfer does not create any new cause of action in favour of, (6) Le transfert n’a pas pour effet de créer une nouvelle cause d’action en faveur : (a) a holder of a debt instrument that was issued by the community care access corporation affected by the transfer before the transfer; or a) soit du détenteur d’un titre d’emprunt émis par la société d’accès aux soins communautaires visée par le transfert avant le transfert; (b) a party to a contract with the community care access corporation affected by the transfer that was entered into before the transfer. b) soit d’une partie à un contrat conclu avec la société d’accès aux soins communautaires visée par le transfert avant le transfert. Transfer binding Personnes liées par le transfert (7) Despite any other Act that requires notice or registration of a transfer, a transfer is binding on the local health integration network affected by the transfer and all other persons. (7) Malgré toute autre loi qui exige la remise d’un avis en cas d’un transfert ou son enregistrement, le transfert lie le réseau local d’intégration des services de santé visé par le transfert et les autres personnes. Non-application of other Acts Non-application d’autres lois (8) The Bulk Sales Act, the Land Transfer Tax Act and the Retail Sales Tax Act do not apply to the transfer. (8) La Loi sur la vente en bloc, la Loi sur les droits de cession immobilière et la Loi sur la taxe de vente au détail ne s’appliquent pas au transfert. Application of FIPPA Application de la Loi sur l’accès à l’information et la protection de la vie privée (9) The Freedom of Information and Protection of Privacy Act applies to a record that is transferred from a community care access corporation to a local health integration network, unless the record was in the custody or control of the community care access corporation before January 1, 2007. (9) La Loi sur l’accès à l’information et la protection de la vie privée s’applique à un dossier qui est transféré d’une société d’accès aux soins communautaires à un réseau local d’intégration des services de santé, sauf si la société avait la garde ou le contrôle du dossier avant le 1er janvier 2007. Transfer of property held for specified charitable purpose Transfert de biens détenus à des fins de bienfaisance déterminées (10) If a Minister’s order transfers to a local health integration network property that a community care access corporation holds for a specified charitable purpose, the local health integration network shall use it for the specified charitable purpose. (10) Si un arrêté du ministre transfère à un réseau local d’intégration des services de santé des biens que détient une société d’accès aux soins communautaires à des fins de bienfaisance déterminées, le réseau les utilise à ces fins. Application Champ d’application (11) Subsection (10) applies whether the will, deed or other document by which the gift, trust, bequest, devise or grant is made, is executed before or after this section comes into force. (11) Le paragraphe (10) s’applique, que le testament, l’acte ou l’autre document par lequel est fait le don, la fiducie, le legs ou la cession soit passé avant ou après l’entrée en vigueur du présent article. Regulations Règlements (12) The Lieutenant Governor in Council may make regulations, (12) Le lieutenant-gouverneur en conseil peut, par règlement : (a) prescribing contracts to which subsections (5) and (6) do not apply; a) prescrire des contrats soustraits à l’application des paragraphes (5) et (6); (b) prescribing Acts, in addition to those listed in subsection (8), that do not apply to the transfer. b) prescrire des lois, outre celles énumérées au paragraphe (8), qui ne s’appliquent pas au transfert. Non-application of s. 38 Non-application de l’art. 38 (13) Section 38 does not apply to the making of regulations under subsection (12). (13) L’article 38 ne s’applique pas à la prise de règlements en vertu du paragraphe (12). No expropriation Aucune expropriation (14) Nothing in this Part and nothing done or not done in accordance with this Part constitutes an expropriation or injurious affection for the purposes of the Expropriations Act or otherwise at law. (14) Ni la présente partie ni une mesure prise ou non prise conformément à celle-ci ne constitue une expropriation ou un effet préjudiciable pour l’application de la Loi sur l’expropriation ou par ailleurs en droit. 91 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 20 PATIENTS FIRST ACT, 2016 Immunity re transfer Immunité en ce qui concerne le transfert (15) No proceeding for damages or otherwise shall be commenced against a local health integration network, a director or officer of the network or any person employed by the network in respect of a claim, (15) Sont irrecevables les instances en dommagesintérêts ou autres qui sont introduites contre un réseau local d’intégration des services de santé, un administrateur ou un dirigeant du réseau, ou quiconque est employé par un réseau, à l’égard d’une réclamation fondée : (a) that arises in connection with a transfer; or a) soit sur ce qui est visé par un transfert; (b) that arises solely in connection with events that occurred prior to the effective date of the transfer. b) soit uniquement sur des événements survenus avant la date d’effet du transfert . Definition Définition (16) In this section and in section 34.4, (16) La définition qui suit s’applique au présent article et à l’article 34.4. “transfer” means a transfer made pursuant to an order under subsection 34.2 (1). «transfert» Transfert et mutation effectués conformément à un arrêté pris en vertu du paragraphe 34.2 (1). Employees continued Maintien des employés 34.4 (1) Persons who are employees of a community care access corporation affected by an order under subsection 34.2 (1) immediately before its dissolution become employees of the local health integration network affected by the order as of the date of the transfer. 34.4 (1) Les personnes qui sont des employés d’une société d’accès aux soins communautaires visée par un arrêté pris en vertu du paragraphe 34.2 (1), immédiatement avant sa dissolution, deviennent des employés du réseau local d’intégration des services de santé visé par l’arrêté à la date du transfert. Same Idem (2) For all purposes, the employment of the employees described in subsection (1) immediately before and after the dissolution of the community care access corporation affected by the transfer is continuous. (2) À toutes fins, l’emploi des employés visés au paragraphe (1) immédiatement avant et après la dissolution de la société d’accès aux soins communautaires visée par le transfert est continu. Same Idem (3) For all purposes, including the purposes of an employment contract, a collective agreement and the Employment Standards Act, 2000, the employment of the employees described in subsection (1) is not terminated or severed and those employees are not constructively dismissed because of the transfer. (3) À toutes fins, notamment aux fins d’un contrat de travail ou d’une convention collective et pour l’application de la Loi de 2000 sur les normes d’emploi, l’emploi des employés visés au paragraphe (1) ne prend pas fin et ces employés ne sont pas licenciés et ne font pas l’objet d’un congédiement implicite en raison du transfert. Terms of employment Conditions d’emploi (4) All rights, duties and liabilities relating to all employees and former employees of the community care access corporation affected by the transfer that are vested in or bind the community care access corporation affected by the transfer immediately before the effective date of the transfer are vested in or bind the local health integration network affected by the transfer instead of the community care access corporation affected by the transfer immediately after the transfer. (4) Les droits et obligations rattachés à tous les employés, actuels et anciens, de la société d’accès aux soins communautaires visée par le transfert qui sont dévolus à la société, ou qui la lient, immédiatement avant la date d’effet du transfert, sont dévolus au réseau local d’intégration des services de santé visé par le transfert, ou le lient, immédiatement après le transfert. Application of s. 69 of Labour Relations Act, 1995 Application de l’art. 69 de la Loi de 1995 sur les relations de travail (5) A transfer is deemed to be a sale of a business under section 69 of the Labour Relations Act, 1995 and that section applies to the transfer. (5) Un transfert est réputé une vente d’une entreprise en application de l’article 69 de la Loi de 1995 sur les relations de travail et cet article s’applique au transfert. Non-application of s. 9, Public Sector Labour Relations Transition Act, 1997 Non-application de l’art. 9 de la Loi de 1997 sur les relations de travail liées à la transition dans le secteur public (6) A transfer is not a health services integration for the purposes of section 9 of the Public Sector Labour Relations Transition Act, 1997. (6) Un transfert n’est pas une intégration des services de santé pour l’application de l’article 9 de la Loi de 1997 sur les relations de travail liées à la transition dans le secteur public. 92 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 21 Application of ss. 36 (2) to (7), Public Sector Labour Relations Transition Act, 1997 Application des par. 36 (2) à (7) de la Loi de 1997 sur les relations de travail liées à la transition dans le secteur public (7) Subsections 36 (2) to (7) of the Public Sector Labour Relations Transition Act, 1997 apply to a collective agreement binding on a local health integration network and a bargaining agent that represented employees subject to a transfer. (7) Les paragraphes 36 (2) à (7) de la Loi de 1997 sur les relations de travail liées à la transition dans le secteur public s’appliquent à une convention collective qui lie un réseau local d’intégration des services de santé et un agent négociateur qui représentait des employés faisant l’objet d’un transfert. Same Idem (8) For the purposes of subsections 36 (2) to (7) of the Public Sector Labour Relations Transition Act, 1997, the community care access corporation and the local health integration network subject to a transfer are predecessor employers and the local health integration network is the successor employer. (8) Pour l’application des paragraphes 36 (2) à (7) de la Loi de 1997 sur les relations de travail liées à la transition dans le secteur public, la société d’accès aux soins communautaires et le réseau local d’intégration des services de santé qui font l’objet d’un transfert sont les employeurs précédents et le réseau local d’intégration des services de santé est l’employeur qui succède. Dissolution order Arrêté de dissolution 34.5 (1) The Minister may make an order to dissolve a community care access corporation that is affected by an order made under subsection 34.2 (1). 34.5 (1) Le ministre peut, par arrêté, dissoudre une société d’accès aux soins communautaires visée par un arrêté pris en vertu du paragraphe 34.2 (1). Dissolution of community care access corporation Dissolution d’une société d’accès aux soins communautaires (2) If the Minister makes an order under subsection (1), the community care access corporation affected by the order is dissolved as of the date specified in the order, despite any requirement that would otherwise apply under the Community Care Access Corporations Act, 2001. (2) Si le ministre prend un arrêté en vertu du paragraphe (1), la société d’accès aux soins communautaires visée par l’arrêté est dissoute à la date précisée dans l’arrêté malgré toute exigence qui s’appliquerait par ailleurs en application de la Loi de 2001 sur les sociétés d’accès aux soins communautaires. Members terminated Perte de la qualité de membre (3) The persons who are the members of the community care access corporation affected by the order immediately before the dissolution cease to be members on the day of the dissolution. (3) Les personnes qui sont membres de la société d’accès aux soins communautaires visée par l’arrêté immédiatement avant la dissolution de celle-ci cessent d’en être membres le jour de la dissolution. Directors terminated Expiration du mandat des administrateurs (4) The terms of office of the directors and officers of the community care access corporation affected by the order who are in office immediately before its dissolution are terminated on the day of the dissolution. (4) Le mandat des administrateurs et des dirigeants de la société d’accès aux soins communautaires visée par l’arrêté qui sont en fonction immédiatement avant la dissolution de celle-ci expire le jour de la dissolution. Final annual report Rapport annuel final (5) Despite the dissolution of a community care access corporation affected by an order, the chair and chief executive officer of the local health integration network affected by the order shall prepare and deliver the annual report for every fiscal year of the community care access corporation affected by the order before its dissolution for which the annual report has not already been delivered by the community care access corporation. (5) Malgré la dissolution d’une société d’accès aux soins communautaires visée par un arrêté, le président et chef de la direction du réseau local d’intégration des services de santé visé par l’arrêté prépare et remet le rapport annuel pour chaque exercice de la société visée par l’arrêté pour lequel celle-ci n’a pas remis de rapport annuel avant sa dissolution. Same Idem (6) For the purposes of subsection (5), if the community care access corporation affected by the order is dissolved in any year on a date other than March 31, its last fiscal year is deemed to be from the preceding April 1 to the date of its dissolution. (6) Pour l’application du paragraphe (5), si la société d’accès aux soins communautaires visée par l’arrêté est dissoute à une date autre que le 31 mars d’une année quelconque, son dernier exercice est réputé courir du 1er avril précédent jusqu’à la date de sa dissolution. Other filings Autres dépôts (7) The chair and chief executive officer of the local health integration network affected by the order shall (7) Le président et le chef de la direction du réseau local d’intégration des services de santé visé par l’arrêté 93 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 22 PATIENTS FIRST ACT, 2016 make any other filings or reports that a community care access corporation may make or that would have been required of the community care access corporation immediately before its dissolution, and the chair and chief executive officer are deemed to have all the rights of a member, director or officer of the community care access corporation to make the filings or reports. déposent les autres documents et remettent les autres rapports que la société d’accès aux soins communautaires peut préparer ou qui auraient été exigés d’elle immédiatement avant sa dissolution. Le président et le chef de la direction sont réputés avoir les droits d’un membre, d’un administrateur ou d’un dirigeant de la société pour le dépôt de documents ou la remise de rapports. No change of control Contrôle intact (8) The dissolution of the community care access corporation affected by the order shall not constitute a change of control of the community care access corporation in respect of any asset, liability, right or obligation of the community care access corporation referred to in subsection (1). (8) La dissolution de la société d’accès aux soins communautaires visée par l’arrêté ne constitue pas un changement de contrôle de la société relativement à ses éléments d’actif, éléments de passif, droits et obligations visés au paragraphe (1). 27. (1) Section 35 of the Act is repealed and the following substituted: 27. (1) L’article 35 de la Loi est abrogé et remplacé par ce qui suit : Public interest Intérêt public 35. In making a decision in the public interest under this Act, the Lieutenant Governor in Council, the Minister or a local health integration network, as the case may be, may consider any matter they regard as relevant including, without limiting the generality of the foregoing, 35. Lorsqu’il prend une décision dans l’intérêt public en vertu de la présente loi, le lieutenant-gouverneur en conseil, le ministre ou le réseau local d’intégration des services de santé, selon le cas, peut prendre en considération toute question qu’il estime pertinente, et notamment les questions qui se rapportent à ce qui suit : a) la qualité de la gestion et de l’administration du réseau local d’intégration des services de santé ou du fournisseur de services de santé, selon le cas; b) la saine gestion du système de soins de santé en général; c) la disponibilité de ressources financières aux fins de la gestion du système de soins de santé et de la prestation des services de santé; d) l’accessibilité aux services de santé dans la zone ou la sous-zone géographique où se trouve le réseau local d’intégration des services de santé ou le fournisseur de services de santé, selon le cas; e) la qualité des soins et des traitements fournis aux malades. (a) the quality of the management and administration of the local health integration network or the health service provider, as the case may be; (b) the proper management of the health care system in general; (c) the availability of financial resources for the management of the health care system and for the delivery of health care services; (d) the accessibility to health services in the geographic area or sub-region where the local health integration network or the health service provider, as the case may be, is located; and (e) the quality of the care and treatment of patients. No liability Immunité 35.1 (1) No proceeding for damages or otherwise, other than an application for judicial review under the Judicial Review Procedure Act or a claim for compensation that is permitted under subsection 31 (3), shall be commenced against any of the following with respect to any act done or omitted to be done or any decision, directive, standard or order made or issued under this Act that is done in good faith in the execution or intended execution of a power or duty under this Act: 35.1 (1) Sont irrecevables les instances en dommagesintérêts ou autres, à l’exception des requêtes en révision judiciaire présentées en vertu de la Loi sur la procédure de révision judiciaire ou des demandes d’indemnisation autorisées par le paragraphe 31 (3), qui sont introduites contre les personnes ou entités suivantes pour un acte qu’elles ont accompli ou omis d’accomplir ou pour une décision ou un arrêté qu’elles ont pris, un ordre ou une directive qu’elles ont donné, ou une norme qu’elles ont établie de bonne foi en vertu de la présente loi dans l’exercice effectif ou censé tel des pouvoirs ou des fonctions que celle-ci leur attribue : 1. La Couronne. 1. The Crown. 2. The Minister. 2. Le ministre. 3. A local health integration network. 3. Un réseau local d’intégration des services de santé. 4. Any member, director or officer of a local health integration network or an agent or a volunteer of a local health integration network. 4. Un membre, un administrateur ou un dirigeant d’un réseau local d’intégration des services de santé, ou un mandataire ou un bénévole d’un réseau. 94 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 23 5. Any person employed by the Crown, the Minister or a local health integration network. 5. Toute personne employée par la Couronne, le ministre ou un réseau local d’intégration des services de santé. 6. An investigator or a supervisor appointed under section 12.1 or 12.2, or their staffs. 6. Un enquêteur ou un superviseur nommé en application de l’article 12.1 ou 12.2, ou son personnel. No protection re negligent health service delivery Aucune protection : négligence dans la prestation de services de santé (2) Nothing in subsection (1) prevents a claim for compensation with respect to the delivery of services by a local health integration network or the delivery of services arranged by a local health integration network, and, for greater certainty, a local health integration network does not deliver services, and services are not arranged by a local health integration network, when the network funds services under subsection 19 (1) to be delivered by a health service provider. (2) Le paragraphe (1) n’a pas pour effet d’empêcher la présentation d’une demande d’indemnisation à l’égard de la prestation des services fournis ou organisés par un réseau local d’intégration des services de santé. Il est entendu qu’un réseau local d’intégration des services de santé ne fournit pas ni n’organise de services quand il finance la prestation de services par un fournisseur de services de santé en vertu du paragraphe 19 (1). (2) Paragraph 6 of subsection 35.1 (1) of the Act, as enacted by subsection (1), is amended by striking out “under section 12.1 or 12.2” and substituting “under section 12.1, 12.2, 21.1 or 21.2”. (2) La disposition 6 du paragraphe 35.1 (1) de la Loi, telle qu’elle est édictée par le paragraphe (1), est modifiée par remplacement de «en application de l’article 12.1 ou 12.2» par «en application de l’article 12.1, 12.2, 21.1 ou 21.2». 28. Subsection 37 (1) of the Act is amended by adding the following clause: 28. Le paragraphe 37 (1) de la Loi est modifié par adjonction de l’alinéa suivant : (i.1) respecting the content or terms and conditions of a service accountability agreement under section 20; i.1) traiter du contenu ou des conditions d’une entente de responsabilisation en matière de services visée à l’article 20; 29. The Act is amended by adding the following section: 29. La Loi est modifiée par adjonction de l’article suivant : Information and reports Renseignements et rapports 37.1 The Lieutenant Governor in Council may make regulations requiring prescribed persons and entities to provide information and reports to a local health integration network about the following for planning, performance management and any other duties of a network: 37.1 Le lieutenant-gouverneur en conseil peut, par règlement, exiger que les personnes et entités prescrites fournissent des renseignements et des rapports à un réseau local d’intégration des services de santé au sujet des éléments suivants aux fins, d’une part, de la planification des activités du réseau et, d’autre part, de la gestion du rendement de son personnel et de toute autre fonction d’un réseau : 1. Physician resource issues such as opening and closing of practices, transitions and changes to practices, retirements from practices and change of location of practices. 1. Les questions liées aux effectifs médicaux, comme l’ouverture et la fermeture de cabinets de médecins, les transitions et les changements au sein des cabinets, les départs à la retraite et les changements d’emplacement des cabinets. 2. Physician practices in the local health system such as policies for accepting and discharging patients, practice profiles, practice wait-times, and practice coverage for after-hours services, vacations, leaves and other absences. 2. Les pratiques médicales dans le système de santé local, comme les politiques d’acceptation et de mise en congé des patients, le profil des cabinets, les délais d’attente et la permanence après les heures normales de travail, pendant les vacances, les congés et d’autres absences. 30. Sections 39 and 40 of the Act are repealed and the following substituted: 30. Les articles 39 et 40 de la Loi sont abrogés et remplacés par ce qui suit : Corporation Personne morale 39. (1) The Lieutenant Governor in Council may by regulation incorporate a corporation without share capital to provide shared services to local health integration networks and others. 39. (1) Le lieutenant-gouverneur en conseil peut, par règlement, constituer une personne morale sans capitalactions pour fournir des services partagés aux réseaux locaux d’intégration des services de santé et à d’autres entités. 95 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 24 PATIENTS FIRST ACT, 2016 Matters in regulations Questions traitées par règlement (2) The Lieutenant Governor in Council may, in the regulations incorporating the corporation without share capital, or in other regulations, make regulations with respect to the following: (2) Dans les règlements qui constituent la personne morale sans capital-actions, ou dans d’autres règlements, le lieutenant-gouverneur en conseil peut, par règlement, traiter de ce qui suit : 1. The name of the corporation. 1. La dénomination sociale de la personne morale. 2. The conditions and restrictions that apply with respect to the corporation. 2. Les conditions et restrictions qui s’appliquent à l’égard de la personne morale. 3. The composition of the corporation. 3. La composition de la personne morale. 4. The composition of the board of directors and the appointment and remuneration of directors. As an option, the regulation may authorize the Lieutenant Governor in Council to make the appointment and determine the remuneration. 5. The objects of the corporation, which may include the provision of shared services to local health integration networks, health service providers or other entities whose primary function is to deliver health services. 4. La composition du conseil d’administration ainsi que la nomination et la rémunération des administrateurs. Le règlement peut, à la place, autoriser le lieutenant-gouverneur en conseil à nommer les administrateurs et à fixer leur rémunération. 5. Les objets de la personne morale, lesquels peuvent comprendre la prestation de services partagés aux réseaux locaux d’intégration des services de santé, aux fournisseurs de services de santé ou à d’autres entités dont la fonction principale consiste à fournir des services de santé. 6. La capacité ainsi que les droits, les pouvoirs et les privilèges de la personne morale et les restrictions auxquelles ils sont assujettis. 7. Le mandat d’un président et d’un ou de plusieurs vice-présidents, et leurs fonctions. 8. La nomination et la rémunération du chef de la direction. Le règlement peut, à la place, autoriser le lieutenant-gouverneur en conseil à nommer le chef de la direction et à fixer sa rémunération. 6. The capacity, rights, powers and privileges of the corporation and any restrictions on them. 7. The office of a chair and one or more vice-chairs, and their functions. 8. The appointment and remuneration of the chief executive officer. As an option, the regulation may authorize the Lieutenant Governor in Council to make the appointment and determine the remuneration. 9. The appointment of auditors. 9. La nomination des vérificateurs. 10. The frequency, nature and scope of reporting from the corporation and to whom the reports will be given. 11. The corporation’s authority to employ or otherwise engage persons for the proper conduct of its activities. 12. Requirements for the investigation, review and audits of the corporation by the Minister or his or her delegate. 10. La fréquence, la nature et la portée des rapports de la personne morale ainsi que les destinataires des rapports. 11. Le pouvoir de la personne morale d’employer ou d’engager autrement des personnes pour la bonne conduite de ses activités. 12. Les exigences applicables aux enquêtes, examens et vérifications de la personne morale par le ministre ou son délégué. 13. The application or non-application to the corporation of the Business Corporations Act, the Corporations Information Act or the Corporations Act or any provisions of those Acts or any successor of those Acts or any regulations under any of those Acts. 13. L’application ou la non-application à la personne morale de la Loi sur les sociétés par actions, de la Loi sur les renseignements exigés des personnes morales ou de la Loi sur les personnes morales ou de toute loi qui les remplace ou de tout règlement pris en vertu de ces lois. 14. The procedures and administration of the corporation. 14. Le mode de fonctionnement et l’administration de la personne morale. 15. Directives and policies that the Minister may issue to the corporation relating to the exercise of its powers or the performance of its duties and the duty of the board of directors to ensure that the directives and policies are implemented promptly and efficiently. 15. Les directives données et les politiques communiquées par le ministre à la personne morale relativement à l’exercice de ses pouvoirs ou de ses fonctions et à l’obligation du conseil d’administration de veiller à ce que ces directives et politiques soient mises en oeuvre promptement et efficacement. 96 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 16. Any other matters the Lieutenant Governor in Council considers necessary or desirable. 25 16. Toute autre question que le lieutenant-gouverneur en conseil estime nécessaire ou souhaitable. Crown agency or not Organisme de la Couronne (3) The corporation is not a Crown agent for any purpose unless a regulation specifies otherwise. (3) Sauf disposition contraire d’un règlement, la personne morale n’est à aucune fin un mandataire de la Couronne. Non-application of s. 38 Non-application de l’art. 38 (4) Section 38 does not apply to the making of a regulation under this section. (4) L’article 38 ne s’applique pas à la prise de règlements en vertu du présent article. No personal liability Immunité (5) No action or other proceeding for damages may be instituted against any member, director, officer, employee or agent of the corporation for any act done in the execution or intended execution of the person’s duty or for any alleged neglect or default in the execution in good faith of the person’s duty. (5) Sont irrecevables les actions ou autres instances en dommages-intérêts introduites contre un membre, un administrateur, un dirigeant, un employé ou un mandataire de la personne morale pour un acte accompli dans l’exercice effectif ou censé tel des fonctions de la personne ou pour une négligence ou un manquement qu’elle aurait commis dans l’exercice de bonne foi de ses fonctions. Non-application of single employer rule Non-application de la règle d’un seul employeur (6) Subsection 1 (4) of the Labour Relations Act, 1995 does not apply to the corporation. (6) Le paragraphe 1 (4) de la Loi de 1995 sur les relations de travail ne s’applique pas à la personne morale. Restrictions on borrowing, etc. Restrictions : emprunts (7) If the corporation is a Crown agent for any purpose, it shall not, as a Crown agent, borrow, invest funds or manage financial risks, unless it is permitted to do so by regulation and unless the activity is authorized by a bylaw that has been approved in writing by the Minister of Health and Long-Term Care and by the Minister of Finance. (7) La personne morale qui est un mandataire de la Couronne à quelque fin que ce soit ne peut, à ce titre, contracter des emprunts, effectuer des placements ou gérer des risques financiers, à moins que, d’une part, il lui soit permis par règlement de le faire et, d’autre part, l’activité soit autorisée par un règlement administratif que le ministre de la Santé et des Soins de longue durée et le ministre des Finances ont approuvé par écrit. Same Idem (8) Subject to subsection (9), the Ontario Financing Authority shall co-ordinate and arrange all borrowing, investing of funds and managing of financial risks for the corporation. (8) Sous réserve du paragraphe (9), l’Office ontarien de financement coordonne et organise les activités d’emprunt, de placement et de gestion des risques financiers pour la personne morale. Direction re borrowing, etc. Directives : activités d’emprunt et autres opérations (9) The Minister of Finance may, in writing, direct a person other than the Ontario Financing Authority to coordinate and arrange the borrowing, investing of funds and managing of financial risks for the corporation. (9) Le ministre des Finances peut, par écrit, ordonner à une personne autre que l’Office ontarien de financement de coordonner et d’organiser les activités d’emprunt, de placement et de gestion des risques financiers pour la personne morale. Same Idem (10) The direction under subsection (9) may be general or specific and may include terms and conditions that the Minister of Finance considers advisable. (10) L’ordre visé au paragraphe (9) peut avoir une portée générale ou particulière et peut être assorti des conditions que le ministre des Finances estime souhaitables. Use of certain revenues Utilisation de certaines recettes (11) If the corporation is a Crown agent for any purpose, the revenues that it receives as a Crown agent shall be used for the purposes specified by regulation, and for no other purpose. (11) La personne morale qui est un mandataire de la Couronne à quelque fin que ce soit ne peut affecter les recettes qu’elle touche à ce titre qu’aux fins précisées par règlement et à nulle autre fin. Definition Définition (12) In this section and in section 40, (12) La définition qui suit s’applique au présent article et à l’article 40. 97 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 26 PATIENTS FIRST ACT, 2016 “corporation” means the corporation without share capital incorporated by regulation under subsection (1). «personne morale» Personne morale sans capital-actions constituée par règlement en vertu du paragraphe (1). Transfer order Arrêté de transfert ou de mutation 40. (1) Despite anything in the Corporations Act or any other Act, but subject to the processes and requirements set out in this section and any regulations made under this section, the Minister may make an order, 40. (1) Malgré la Loi sur les personnes morales ou toute autre loi, mais sous réserve des méthodes et exigences énoncées au présent article et des règlements pris en vertu du présent article, le ministre peut, par arrêté : (a) transferring the assets, liabilities, rights and obligations from the Ontario Association of Community Care Access Centres or its successor corporation to a corporation without share capital incorporated under subsection 39 (1); and a) transférer les éléments d’actif, éléments de passif, droits et obligations de l’Ontario Association of Community Care Access Centres ou de la personne morale remplaçante à une personne morale sans capital-actions constituée en vertu du paragraphe 39 (1); (b) transferring employees from the Ontario Association of Community Care Access Centres or its successor corporation to a corporation without share capital incorporated under subsection 39 (1), and transferring the rights, duties and obligations of the Ontario Association of Community Care Access Centres or its successor corporation to its employees and former employees. b) muter les employés de l’Ontario Association of Community Care Access Centres ou de la personne morale remplaçante à une personne morale sans capital-actions constituée en vertu du paragraphe 39 (1), et transférer les droits, fonctions et obligations de l’Ontario Association of Community Care Access Centres ou de la personne morale remplaçante à ses employés, actuels et anciens. Notification requirement Avis exigé (2) Before the Minister makes an order under subsection (1), the Minister shall notify the affected corporations. (2) Avant de prendre un arrêté en vertu du paragraphe (1), le ministre doit aviser les personnes morales visées. Contents of order Contenu de l’arrêté (3) An order made under subsection (1), (3) L’arrêté pris en vertu du paragraphe (1) : (a) shall specify a date on which the transfer of assets, liabilities, rights, obligations or employees, as the case may be, takes effect; and a) doit préciser la date à laquelle le transfert des éléments d’actif, éléments de passif, droits et obligations ou la mutation des employés, selon le cas, prend effet; (b) may specify that issues arising out of the interpretation of the order be resolved by the method specified in the order. b) peut préciser que les questions soulevées par l’interprétation de l’arrêté sont réglées de la façon que précise celui-ci. Non-application of Legislation Act, 2006 Non-application de la Loi de 2006 sur la législation (4) Part III (Regulations) of the Legislation Act, 2006 does not apply to an order made under subsection (1). (4) La partie III (Règlements) de la Loi de 2006 sur la législation ne s’applique pas à un arrêté pris en vertu du paragraphe (1). Notice of order Avis de l’arrêté (5) The Minister shall provide each affected corporation with a copy of the order, and shall make the order available to the public. (5) Le ministre remet une copie de l’arrêté à chaque personne morale visée et met l’arrêté à la disposition du public. Same, duty of corporation Idem, obligation de la personne morale (6) Each corporation that receives a copy of an order provided under subsection (5) shall, (6) Chaque personne morale qui reçoit une copie de l’arrêté conformément au paragraphe (5) : (a) provide notice of the order and make copies available to affected employees and their bargaining agents and to other persons or entities whose contracts are affected by the order; and a) d’une part, avise de l’arrêté les employés visés et leurs agents négociateurs ainsi que les autres personnes ou entités dont les contrats sont visés par l’arrêté et en met des copies à leur disposition; (b) make copies of the order available to the public. b) d’autre part, met des copies de l’arrêté à la disposition du public. Rules regarding a transfer of assets by order Règles : transfert d’éléments d’actif par arrêté (7) The following provisions apply to the transfer of (7) Sauf disposition contraire des règlements, les dis- 98 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 27 assets, liabilities, rights and obligations to a corporation without share capital incorporated under subsection 39 (1) in accordance with an order made under subsection (1), unless the regulations provide otherwise: positions suivantes s’appliquent au transfert des éléments d’actif, éléments de passif, droits et obligations à une personne morale sans capital-actions constituée en vertu du paragraphe 39 (1) conformément à un arrêté pris en vertu du paragraphe (1) : 1. A conviction against, or ruling, order or judgment in favour of or against a person from whom any assets, liabilities, rights or obligations are transferred to the corporation may be enforced by or against the corporation. 1. Toute décision judiciaire ou quasi judiciaire rendue en faveur d’une personne dont des éléments d’actif, éléments de passif, droits et obligations sont transférés à la personne morale, ou contre elle, peut être exécutée par la personne morale ou à son encontre. 2. The corporation shall be deemed to be the party plaintiff or the party defendant, as the case may be, in any civil action commenced by or against a person from whom any assets, liabilities, rights or obligations are transferred to the corporation before the date of the transfer. 2. La personne morale est réputée partie demanderesse ou partie défenderesse, selon le cas, dans toute action civile intentée avant la date du transfert, soit par une personne dont des éléments d’actif, éléments de passif, droits et obligations sont transférés à la personne morale, soit contre elle. 3. A transfer of the assets, liabilities, rights and obligations from a person to the corporation shall not constitute a change of control in respect of any asset, liability, right or obligation of the person. 3. Le transfert des éléments d’actif, éléments de passif, droits et obligations d’une personne à une personne morale ne constitue pas un changement de contrôle relativement aux éléments d’actif, éléments de passif, droits et obligations de la personne. 4. Le transfert des éléments d’actif, éléments de passif, droits et obligations d’une personne à une personne morale est réputé ne pas : i. constituer une violation, résiliation, répudiation ou impossibilité d’exécution d’un contrat, y compris un contrat de travail ou d’assurance, ii. constituer une violation d’une loi ou d’un règlement, notamment municipal, iii. constituer un cas de défaut ou une force majeure, iv. donner lieu à une violation, révocation, répudiation ou impossibilité d’exécution d’un permis, d’une autorisation ou d’un autre droit, v. donner le droit de résilier un contrat ou de révoquer un droit, notamment un permis ou une autorisation, ni le droit de les répudier, vi. donner lieu à une préclusion. 4. A transfer of the assets, liabilities, rights and obligations from a person to the corporation is deemed not to, i. constitute a breach, termination, repudiation or frustration of any contract, including a contract of employment or insurance, ii. constitute a breach of any Act, regulation or municipal by-law, iii. constitute an event of default or force majeure, iv. give rise to a breach, termination, repudiation or frustration of any licence, permit or other right, v. give rise to any right to terminate or repudiate a contract, licence, permit or other right, or vi. give rise to any estoppel. 5. A transfer of the assets, liabilities, rights and obligations from a person to the corporation does not create any new cause of action in favour of, 5. Le transfert des éléments d’actif, éléments de passif, droits et obligations d’une personne à une personne morale n’a pas pour effet de créer une nouvelle cause d’action en faveur : i. soit du détenteur d’un titre d’emprunt émis par la personne avant le transfert, ii. soit d’une partie à un contrat conclu avec la personne avant le transfert. 6. Malgré toute autre loi qui exige la remise d’un avis en cas d’un transfert ou son enregistrement, le transfert lie la personne morale et les autres personnes. i. a holder of a debt instrument that was issued by the person before the transfer, or ii. a party to a contract with the person that was entered into before the transfer. 6. Despite any other Act that requires notice or registration of a transfer, a transfer is binding on the corporation and all other persons. 7. The Bulk Sales Act, the Land Transfer Tax Act and the Retail Sales Tax Act do not apply to the transfer. 7. La Loi sur la vente en bloc, la Loi sur les droits de cession immobilière et la Loi sur la taxe de vente au détail ne s’appliquent pas au transfert. 99 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 28 PATIENTS FIRST ACT, 2016 8. Nothing in this section and nothing done or not done in accordance with this section constitutes an expropriation or injurious affection for the purposes of the Expropriations Act or otherwise at law. 8. Ni le présent article ni une mesure prise ou non prise conformément à celui-ci ne constitue une expropriation ou un effet préjudiciable pour l’application de la Loi sur l’expropriation ou par ailleurs en droit. 9. Sont irrecevables les instances en dommagesintérêts ou autres qui sont introduites contre la personne morale, un administrateur ou un dirigeant de la personne morale, ou quiconque est employé par la personne morale à l’égard d’une réclamation fondée : i. d’une part, sur ce qui est visé par un transfert conformément à un règlement pris en vertu du présent article, ii. d’autre part, uniquement sur des événements survenus avant la date d’effet du transfert. 9. No proceeding for damages or otherwise shall be commenced against the corporation, a director or officer of the corporation or any person employed by the corporation in respect of a claim, i. that arises in connection with a transfer in accordance with a regulation made under this section, and ii. that arises solely in connection with events that occurred prior to the effective date of the transfer. Rules regarding a transfer of employees by order Règles : mutation d’employés par arrêté (8) The following provisions apply to an order to transfer employees from the Ontario Association of Community Care Access Centres or its successors to a corporation without share capital incorporated under subsection 39 (1) in accordance with an order made under subsection (1), unless the regulations provide otherwise: (8) Sauf disposition contraire des règlements, les dispositions suivantes s’appliquent à l’arrêté de mutation d’employés de l’Ontario Association of Community Care Access Centres ou de ses successeurs à une personne morale sans capital-actions constituée en vertu du paragraphe 39 (1) conformément à un arrêté pris en vertu du paragraphe (1) : 1. Les personnes qui sont des employés de l’Ontario Association of Community Care Access Centres deviennent des employés de la personne morale à la date du transfert. 2. À toutes fins, l’emploi des employés visés à la disposition 1 ne prend pas fin et ces employés ne font pas l’objet d’un congédiement implicite en raison du transfert à la personne morale. 3. À toutes fins, l’emploi des employés visés à la disposition 1 immédiatement avant et après le transfert à la personne morale est continu. 4. Les conditions d’emploi de chacun des employés visés à la disposition 1 immédiatement avant le transfert à la personne morale demeurent leurs conditions d’emploi immédiatement après le transfert. 1. Persons who are employees of the Ontario Association of Community Care Access Centres become employees of the corporation with effect from the date of the transfer. 2. For all purposes, the employment of the employees described in paragraph 1 is not terminated and those employees are not constructively dismissed because of a transfer to the corporation. 3. For all purposes, the employment of the employees described in paragraph 1 immediately before and after the transfer to the corporation is continuous. 4. The terms and conditions of employment for each of the employees described in paragraph 1 as they existed immediately before the transfer to the corporation continue to be the terms and conditions of their employment with the corporation immediately following the transfer. Regulations Règlements (9) The Lieutenant Governor in Council may make regulations, (9) Le lieutenant-gouverneur en conseil peut, par règlement : (a) governing the transfer of assets, liabilities, rights and obligations in accordance with an order made under subsection (1); a) régir le transfert des éléments d’actif, éléments de passif, droits et obligations conformément à un arrêté pris en vertu du paragraphe (1); (b) governing the transfer of employees in accordance with an order made under subsection (1); b) régir la mutation d’employés conformément à un arrêté pris en vertu du paragraphe (1); (c) prescribing Acts, in addition to those listed in paragraph 7 of subsection (7), that do not apply to a transfer. c) prescrire des lois, en plus de celles qui sont énumérées à la disposition 7 du paragraphe (7), qui ne s’appliquent pas à un transfert. Non-application of s. 38 Non-application de l’art. 38 (10) Section 38 does not apply to the making of a regulation under this section. (10) L’article 38 ne s’applique pas à la prise de règlements en vertu du présent article. 100 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS OTHER AMENDMENTS, REPEALS, ETC. 29 AUTRES MODIFICATIONS ET ABROGATIONS Broader Public Sector Accountability Act, 2010 Loi de 2010 sur la responsabilisation du secteur parapublic 31. (1) The definition of “community care access corporation” in subsection 1 (1) of the Broader Public Sector Accountability Act, 2010 is repealed. 31. (1) La définition de «société d’accès aux soins communautaires» au paragraphe 1 (1) de la Loi de 2010 sur la responsabilisation du secteur parapublic est abrogée. (2) Clause (e) of the definition of “designated broader public sector organization” in subsection 1 (1) of the Act is repealed. (2) L’alinéa e) de la définition de «organisme désigné du secteur parapublic» au paragraphe 1 (1) de la Loi est abrogé. Broader Public Sector Executive Compensation Act, 2014 Loi de 2014 sur la rémunération des cadres du secteur parapublic 32. Paragraph 8 of subsection 3 (1) of the Broader Public Sector Executive Compensation Act, 2014 is repealed. 32. La disposition 8 du paragraphe 3 (1) de la Loi de 2014 sur la rémunération des cadres du secteur parapublic est abrogée. Commitment to the Future of Medicare Act, 2004 Loi de 2004 sur l’engagement d’assurer l’avenir de l’assurance-santé 33. Part III of the Commitment to the Future of Medicare Act, 2004 is repealed. 33. La partie III de la Loi de 2004 sur l’engagement d’assurer l’avenir de l’assurance-santé est abrogée. Community Care Access Corporations Act, 2001 Loi de 2001 sur les sociétés d’accès aux soins communautaires 34. The Community Care Access Corporations Act, 2001 is repealed. 34. La Loi de 2001 sur les sociétés d’accès aux soins communautaires est abrogée. Electronic Cigarettes Act, 2015 Loi de 2015 sur les cigarettes électroniques 35. (1) Clause (a) of the definition of “home healthcare worker” in subsection 11 (5) of the Electronic Cigarettes Act, 2015 is repealed. 35. (1) L’alinéa a) de la définition de «travailleur de la santé à domicile» au paragraphe 11 (5) de la Loi de 2015 sur les cigarettes électroniques est abrogé. (2) The definition of “home health-care worker” in subsection 11 (5) of the Act is amended by adding the following clause: (2) La définition de «travailleur de la santé à domicile» au paragraphe 11 (5) de la Loi est modifiée par adjonction de l’alinéa suivant : (a.1) a local health integration network as defined in section 2 of the Local Health System Integration Act, 2006, or a.1) soit un réseau local d’intégration des services de santé au sens de l’article 2 de la Loi de 2006 sur l’intégration du système de santé local; Employment Standards Act, 2000 Loi de 2000 sur les normes d’emploi 36. (1) Section 74.2 of the Employment Standards Act, 2000 is amended by striking out “Long-Term Care Act, 1994” in the portion before clause (a) and substituting “Home Care and Community Services Act, 1994”. 36. (1) L’article 74.2 de la Loi de 2000 sur les normes d’emploi est modifié par remplacement de «Loi de 1994 sur les soins de longue durée» par «Loi de 1994 sur les services de soins à domicile et les services communautaires» dans le passage qui précède l’alinéa a). (2) Section 74.2 of the Act is repealed. (2) L’article 74.2 de la Loi est abrogé. (3) The Act is amended by adding the following section: (3) La Loi est modifiée par adjonction de l’article suivant : Assignment employees Employés ponctuels 74.2.1 This Part does not apply in relation to an individual who is an assignment employee assigned to provide professional services, personal support services or homemaking services as defined in the Home Care and Community Services Act, 1994 if the assignment is made under a contract between, 74.2.1 La présente partie ne s’applique pas à l’égard d’un particulier qui est un employé ponctuel affecté à la fourniture de services professionnels, de services de soutien personnel ou de services d’aides familiales au sens de la Loi de 1994 sur les services de soins à domicile et les services communautaires si l’affectation est effectuée aux termes d’un contrat conclu entre : (a) the individual and a local health integration network within the meaning of the Local Health System Integration Act, 2006; or a) soit le particulier et un réseau local d’intégration des services de santé au sens de la Loi de 2006 sur l’intégration du système de santé local; (b) an employer of the individual and a local health integration network within the meaning of the Local Health System Integration Act, 2006. b) soit un employeur du particulier et un réseau local d’intégration des services de santé au sens de la Loi de 2006 sur l’intégration du système de santé local. 101 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 30 PATIENTS FIRST ACT, 2016 Excellent Care for All Act, 2010 Loi de 2010 sur l’excellence des soins pour tous 37. (1) Clause (b) of the definition of “health sector organization” in section 1 of the Excellent Care for All Act, 2010 is repealed. 37. (1) L’alinéa b) de la définition de «organisme du secteur de la santé» à l’article 1 de la Loi de 2010 sur l’excellence des soins pour tous est abrogé. (2) The definition of “health sector organization” in section 1 of the Act is amended by striking out “and” at the end of clause (c) and by adding the following clause: (2) La définition de «organisme du secteur de la santé» à l’article 1 de la Loi est modifiée par adjonction de l’alinéa suivant : (c.1) a local health integration network within the meaning of the Local Health System Integration Act, 2006, but only with respect to, c.1) un réseau local d’intégration des services de santé au sens de la Loi de 2006 sur l’intégration du système de santé local, mais seulement en ce qui concerne ce qui suit, selon le cas : (i) professional services, personal support services and homemaking services as defined in the Home Care and Community Services Act, 1994 provided by or arranged by a local health integration network under that Act, (i) les services professionnels, les services de soutien personnel et les services d’aides familiales au sens de la Loi de 1994 sur les services de soins à domicile et les services communautaires fournis ou organisés par un réseau local d’intégration des services de santé en application de cette loi, (ii) the placement of a person into, (ii) le placement de personnes : (A) a long-term care home within the meaning of the Long-Term Care Homes Act, 2007, (A) dans des foyers de soins de longue durée au sens de la Loi de 2007 sur les foyers de soins de longue durée, (B) a supportive housing program funded by the Ministry of Health and LongTerm Care or a local health integration network under the Home Care and Community Services Act, 1994, (B) dans un programme de logements avec services de soutien financé par le ministère de la Santé et des Soins de longue durée ou un réseau local d’intégration des services de santé en application de la Loi de 1994 sur les services de soins à domicile et les services communautaires, (C) a chronic care or rehabilitation bed in a hospital within the meaning of the Public Hospitals Act, or (C) dans des lits de malades chroniques ou des lits de réadaptation d’hôpitaux dans un hôpital au sens de la Loi sur les hôpitaux publics, (D) an adult day program that is provided under the Home Care and Community Services Act, 1994, or (D) dans des programmes de jour pour adultes prévus en application de la Loi de 1994 sur les services de soins à domicile et les services communautaires, (iii) any other services that are prescribed, and (iii) les autres services qui sont prescrits; (3) Subsection 10 (1) of the Act is amended by adding “as a corporation without share capital” at the end. (3) Le paragraphe 10 (1) de la Loi est modifié par insertion de «à titre de personne morale sans capitalactions» après «prorogé». (4) The Act is amended by adding the following sections: (4) La Loi est modifiée par adjonction des articles suivants : Crown agent Mandataire de la Couronne 10.1 The Council is for all its purposes an agent of the Crown and its powers may be exercised only as an agent of the Crown. 10.1 Le Conseil est, à toutes ses fins, un mandataire de la Couronne et il exerce ses pouvoirs uniquement en cette qualité. Powers of Council Pouvoirs du Conseil 10.2 (1) The Council has the capacity, rights, powers and privileges of a natural person for carrying out its functions, except as limited by this Act or the regulations. 10.2 (1) Le Conseil a la capacité ainsi que les droits, pouvoirs et privilèges d’une personne physique pour exercer ses fonctions, sous réserve des restrictions qu’imposent la présente loi ou les règlements. 102 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 31 Revenues and assets Recettes et éléments d’actif (2) Despite Part I of the Financial Administration Act, the assets and revenues of the Council do not form part of the Consolidated Revenue Fund. (2) Malgré la partie I de la Loi sur l’administration financière, les éléments d’actif et les recettes du Conseil ne font pas partie du Trésor. Use of revenues Utilisation des recettes (3) The Council shall carry out its operations without the purpose of gain for its members and all revenues of the Council, including all money or assets received by the Council by grant, gift, contribution, profit or otherwise, shall be used to further its functions. (3) Le Conseil exerce ses activités sans but lucratif pour ses membres et les recettes, y compris toutes les sommes d’argent ou tous les éléments d’actif qu’il reçoit, notamment sous forme de cession, subvention, don, contribution et profit, servent à l’exercice de ses fonctions. Lieutenant Governor in Council approval Approbation du lieutenant-gouverneur en conseil (4) The Council shall not, without the approval of the Lieutenant Governor in Council, (4) Le Conseil ne doit pas faire ce qui suit sans l’approbation du lieutenant-gouverneur en conseil : (a) acquire, dispose, lease, mortgage, charge, hypothecate or otherwise transfer or encumber any interest in real property; a) transférer ou grever, notamment en acquérant, en aliénant, en louant à bail ou en nantissant, notamment par hypothèque ou charge, un intérêt sur un bien immeuble; (b) pledge, charge or encumber any of its personal property; b) mettre en gage ou grever, notamment par charge, un de ses biens meubles; (c) create a subsidiary; or c) créer une filiale; (d) do anything else that the regulations provide may not be done without such approval. d) exercer les autres fonctions qui, selon ce que prévoient les règlements, ne peuvent être exercées sans une telle approbation. Investments, etc. Placements et autres opérations 10.3 (1) The power of the Council to borrow, make short-term investments of funds, manage risk associated with financing and investment or incur liabilities in order to facilitate financing by others may only be exercised under the authority of a by-law that has been approved in writing by the Minister and the Minister of Finance. 10.3 (1) Le pouvoir qu’a le Conseil de contracter des emprunts, de faire des placements de fonds à court terme, de gérer les risques rattachés au financement et aux placements, ou de contracter des dettes pour faciliter le financement par d’autres ne peut être exercé qu’en vertu d’un règlement administratif que le ministre et le ministre des Finances ont approuvé par écrit. Co-ordination of financing activities Coordination des activités de financement (2) All borrowing, financing, short-term investment of funds and financial risk management activities of the Council shall be co-ordinated and arranged by the Ontario Financing Authority, unless the Minister of Finance approves otherwise. (2) L’Office ontarien de financement coordonne et organise les activités d’emprunt, de financement, de placement de fonds à court terme et de gestion des risques financiers du Conseil, sauf approbation contraire du ministre des Finances. Control Contrôle 10.4 (1) The affairs of the Council are under the management and control of its board of directors. 10.4 (1) Le conseil d’administration du Conseil assure la gestion et le contrôle des affaires du Conseil. By-laws Règlements administratifs (2) The Council may, subject to the approval of the Minister, pass by-laws and resolutions for conducting and managing its affairs, including, (2) Le Conseil peut, sous réserve de l’approbation du ministre, adopter des règlements administratifs et des résolutions pour traiter de la conduite et de la gestion de ses affaires, notamment : (a) appointing officers and assigning to them such powers and duties as the board considers appropriate; a) nommer des dirigeants et leur attribuer les pouvoirs et fonctions que le Conseil juge appropriés; (b) maintaining bank accounts and making other banking arrangements; b) tenir des comptes en banque et prendre d’autres dispositions bancaires; (c) establishing committees, including committees to develop recommendations about clinical care standards and performance measures; and c) créer des comités, notamment pour la formulation de recommandations sur les normes de soins cliniques et les mesures de rendement; 103 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 32 PATIENTS FIRST ACT, 2016 (d) anything else provided for in the regulations. d) exercer les autres fonctions que prévoient les règlements. Delegation of Council functions Délégation des fonctions du Conseil (3) Subject to the approval of the Minister, the Council may by by-law delegate any of its powers or functions to a committee that is established under the by-laws of the Council. (3) Sous réserve de l’approbation du ministre, le Conseil peut, par règlement administratif, déléguer ses pouvoirs ou fonctions à un comité créé en vertu de ses règlements administratifs. Conditions, etc. and delegation Conditions ou restrictions : délégation (4) A delegation under subsection (3) is subject to any conditions or restrictions set out in the by-law. (4) La délégation visée au paragraphe (3) est assujettie aux conditions ou restrictions énoncées dans le règlement administratif. (5) Section 11 of the Act is repealed and the following substituted: (5) L’article 11 de la Loi est abrogé et remplacé par ce qui suit : No personal liability Immunité 11. (1) No action or other proceeding for damages may be instituted against any member, officer, employee or agent of the Council, or a member of a committee established under the by-laws of the Council for any act done in the execution or intended execution in good faith of the person’s function or duty under this Act or the regulations or for any alleged neglect or default in the execution in good faith of the person’s function or duty. 11. (1) Sont irrecevables les actions ou autres instances en dommages-intérêts introduites contre un membre, un dirigeant, un employé ou un mandataire du Conseil, ou un membre d’un comité créé en vertu des règlements administratifs du Conseil, pour un acte accompli de bonne foi dans l’exercice effectif ou censé tel des attributions que lui attribuent la présente loi ou les règlements ou pour une négligence ou un manquement qu’il aurait commis dans l’exercice de bonne foi de ses attributions. Council remains liable Le Conseil demeure responsable (2) Subsection (1) does not relieve the Council of any liability to which it would otherwise be subject in respect of a cause of action arising from any act, neglect or default referred to in subsection (1). (2) Le paragraphe (1) n’a pas pour effet de dégager le Conseil de la responsabilité qu’il serait autrement tenu d’assumer à l’égard d’une cause d’action découlant d’un acte, d’une négligence ou d’un manquement visé au paragraphe (1). No actions or proceedings against the Crown Immunité de la Couronne 11.1 (1) No action or other proceeding for damages may be instituted against the Crown, the Minister or any person employed by the Crown for any act, neglect or default by a person referred to in subsection 11 (1) or for any act, neglect or default by the Council. 11.1 (1) Sont irrecevables les actions ou autres instances en dommages-intérêts introduites contre la Couronne, le ministre ou toute personne employée par la Couronne pour un acte, une négligence ou un manquement commis par une personne visée au paragraphe 11 (1) ou pour un acte, une négligence ou un manquement commis par le Conseil. Same Idem (2) Subsection (1) does not apply to a proceeding to enforce against the Crown its obligations under a written agreement under which the Crown expressly assumes liability for the acts or omissions of the Council. (2) Le paragraphe (1) ne s’applique pas aux instances introduites pour exécuter contre la Couronne les obligations que lui impose une entente écrite aux termes de laquelle la Couronne engage expressément sa responsabilité pour les actes ou omissions du Conseil. Unpaid judgments against the Council Jugements contre le Conseil 11.2 The Minister of Finance shall pay from the Consolidated Revenue Fund the amount of any judgment against the Council that remains unpaid after the Council has made all reasonable efforts, including liquidating its assets, to pay the amount of the judgment. 11.2 Le ministre des Finances prélève sur le Trésor le montant de tout jugement rendu contre le Conseil qui demeure impayé une fois que le Conseil a fait des efforts raisonnables pour l’acquitter, notamment en liquidant ses éléments d’actif. (6) Subclause 12 (1) (a) (iii) of the Act is amended by striking out “consumer” at the beginning and substituting “patient”. (6) Le sous-alinéa 12 (1) a) (iii) de la Loi est modifié par remplacement de «de la clientèle» par «des patients» à la fin du sous-alinéa. (7) Clause 12 (1) (c) of the Act is repealed and the following substituted: (7) L’alinéa 12 (1) c) de la Loi est abrogé et remplacé par ce qui suit : 104 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 33 (c) to promote health care that is supported by the best available scientific evidence by, c) promouvoir les soins de santé qu’appuient les meilleures preuves scientifiques disponibles : (i) making recommendations to health care organizations and other entities on clinical care standards (i) en faisant des recommandations aux organismes de soins de santé et autres entités sur les normes de soins cliniques, (ii) making recommendations to the Minister concerning, (ii) en faisant des recommandations au ministre concernant : (A) the Government of Ontario’s provision of funding for health care services and medical devices, and (A) l’offre, par le gouvernement de l’Ontario, d’un financement au titre des services de soins de santé et des dispositifs médicaux, (B) clinical care standards and performance measures relating to topics or areas that the Minister may specify; (B) les normes en matière de soins cliniques et les mesures de rendement relatives aux sujets ou domaines que précise le ministre; (8) Subsection 12 (4) of the Act is amended by striking out “subclause (1) (c) (ii)” at the end and substituting “clause (1) (c)”. (8) Le paragraphe 12 (4) de la Loi est modifié par remplacement de «au sous-alinéa (1) c) (ii)» par «à l’alinéa (1) c)» à la fin du paragraphe. (9) Section 13 of the Act is repealed and the following substituted: (9) L’article 13 de la Loi est abrogé et remplacé par ce qui suit : Reports Rapports 13. (1) The Council shall deliver to the Minister, 13. (1) Le Conseil présente au ministre : (a) a yearly report on the state of the health system in Ontario, and a) un rapport annuel sur l’état du système de santé en Ontario; (b) any other reports required by the Minister. b) les autres rapports qu’exige le ministre. Publication on website Publication sur un site Web (2) The Council shall publish any recommendation it makes under clause 12 (1) (c) on its website. (2) Le Conseil publie toute recommandation qu’il fait en application de l’alinéa 12 (1) c) sur son site Web. Tabling Dépôt du rapport annuel (3) The Minister shall table every yearly report under this section in the Legislative Assembly within 30 days of receiving it from the Council. (3) Le ministre dépose chaque rapport annuel prévu au présent article devant l’Assemblée législative au plus tard 30 jours après l’avoir reçu du Conseil. Purpose of reporting Objectifs des rapports (4) The purpose of reporting under clause (1) (a) is to, (4) Les rapports prévus à l’alinéa (1) a) sont rédigés aux fins suivantes : (a) encourage and promote an integrated, patient centred health system; a) encourager et promouvoir un système de santé intégré et axé sur les patients; (b) make the Ontario health system more transparent and accountable; b) accroître la transparence du système de santé de l’Ontario et le responsabiliser davantage; (c) track long-term progress in meeting Ontario’s health goals and commitments; and c) suivre les progrès à long terme accomplis en vue d’atteindre les buts fixés et de tenir les engagements pris pour l’Ontario en matière de santé; (d) help Ontarians to better understand their health system. d) aider la population ontarienne à mieux comprendre son système de santé. (10) The definition of “patient or former patient” in subsection 13.1 (9) of the Act is amended as follows: (10) La définition de «patient ou ancien patient» au paragraphe 13.1 (9) de la Loi est modifiée comme suit : 1. Par adjonction de l’alinéa suivant : 1. By adding the following clause: (c.1) a person who receives or has received services from a local health integration network, but only with respect to matters described in clause (c.1) of c.1) une personne qui reçoit ou a reçu des services d’un réseau local d’intégration des services de santé, mais uniquement à l’égard des questions visées à 105 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 34 PATIENTS FIRST ACT, 2016 the definition of “health sector organization” in section 1, l’alinéa c.1) de la définition de «organisme du secteur de la santé» à l’article 1; 2. By striking out “(c) or (d)” in clause (e) and substituting “(c), (c.1) or (d)”. 2. Par remplacement de «c) ou d)» par «c), c.1) ou d)» à l’alinéa e). (11) Subsection 13.2 (1) of the Act is amended by striking out “A patient” at the beginning of the portion before clause (a) and substituting “Subject to any prescribed limitations with respect to time, a patient”. (11) Le paragraphe 13.2 (1) de la Loi est modifié par remplacement de «Tout patient» par «Sous réserve des restrictions prescrites quant aux délais, tout patient» au début du passage qui précède l’alinéa a). (12) Subsections 13.7 (1) and (2) of the Act are repealed and the following substituted: (12) Les paragraphes 13.7 (1) et (2) de la Loi sont abrogés et remplacés par ce qui suit : Immunity Immunité (1) No proceeding shall be commenced against the patient ombudsman or any employee of the Council for any act done or omitted in good faith in the execution or intended execution of the patient ombudsman’s functions under this Act. (1) Sont irrecevables les instances introduites contre l’ombudsman des patients ou un employé du Conseil pour un acte accompli ou omis de bonne foi dans l’exercice effectif ou censé tel des fonctions de l’ombudsman que lui attribue la présente loi. (13) Clause 16 (1) (d) of the Act is amended by striking out “structure and legal status” at the end and substituting “and structure”. (13) L’alinéa 16 (1) d) de la Loi est modifié par remplacement de «, la structure et le statut juridique» par «et la structure». (14) Clause 16 (1) (p) of the Act is repealed and the following substituted: (14) L’alinéa 16 (1) p) de la Loi est abrogé et remplacé par ce qui suit : (p) governing the purposes for which the Council may use its assets and revenues; p) régir les fins pour lesquelles le Conseil peut utiliser ses éléments d’actif et ses recettes; (p.1) governing the Council’s ability to borrow or invest funds and the Council’s management of financial risks; p.1) régir la capacité du Conseil à contracter des emprunts, faire des placements et gérer des risques financiers; Health Insurance Act Loi sur l’assurance-santé 38. Section 2 of the Health Insurance Act is amended by adding the following subsection: 38. L’article 2 de la Loi sur l’assurance-santé est modifié par adjonction du paragraphe suivant : LHIN as agent RLISS en tant que mandataire (2.1) The Minister may appoint a local health integration network within the meaning of the Local Health System Integration Act, 2006 as the Minister’s agent for the purpose of carrying out any function, obligation or right under an arrangement referred to in clause 2 (2) (a) of this Act, and the network shall have all rights and obligations of the Minister under such an arrangement to the extent that the network has been appointed as the Minister’s agent, despite any provision of such an arrangement. The Minister shall give notice of the appointment of a network as an agent of the Minister to any other parties to the arrangement. (2.1) Le ministre peut constituer un réseau local d’intégration des services de santé au sens de la Loi de 2006 sur l’intégration du système de santé local comme son mandataire afin d’exercer toute fonction ou obligation ou tout droit aux termes d’une entente prévue à l’alinéa 2 (2) a) de la présente loi. Le réseau détient l’ensemble des droits et obligations du ministre aux termes d’une telle entente dans la mesure où il a été constitué mandataire du ministre, malgré toute disposition de l’entente. Le ministre donne avis de la constitution du réseau en tant que son mandataire aux autres parties à l’entente. Health Protection and Promotion Act Loi sur la protection et la promotion de la santé 39. (1) Section 67 of the Health Protection and Promotion Act is amended by adding the following subsections: 39. (1) L’article 67 de la Loi sur la protection et la promotion de la santé est modifié par adjonction des paragraphes suivants : Engagement with LHIN Participation du RLISS (5) The medical officer of health of a board of health shall engage on issues relating to local health system planning, funding and service delivery with the chief executive officer or chief executive officers of the local health integration network or networks whose geographic area or areas cover the health unit served by the board of health. (5) Le médecin-hygiéniste d’un conseil de santé fait participer le ou les chefs de la direction du ou des réseaux locaux d’intégration des services de santé dont la ou les zones géographiques couvrent la circonscription sanitaire qui est du ressort du conseil de santé à l’étude des questions liées à la planification et au financement du système de santé local et à la prestation de services au sein du système. 106 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 35 Delegation Délégation (6) A medical officer of health may only delegate his or her responsibilities under subsection (5) to another medical officer of health for a health unit within the relevant local health integration network, with the agreement of that other medical officer of health. (6) Le médecin-hygiéniste ne peut déléguer les responsabilités qui lui sont attribuées conformément au paragraphe (5) qu’à un autre médecin-hygiéniste d’une circonscription sanitaire se trouvant au sein du réseau local d’intégration des services de santé pertinent, avec l’accord de cet autre médecin-hygiéniste. (2) Paragraph 2 of the definition of “health care provider or health care entity” in subsection 77.7 (6) of the Act is repealed and the following substituted (2) La disposition 2 de la définition de «fournisseur de soins de santé ou entité chargée de la fourniture de soins de santé» au paragraphe 77.7 (6) de la Loi est abrogée et remplacée par ce qui suit : 2. A service provider within the meaning of the Home Care and Community Services Act, 1994 who provides a community service to which that Act applies. 2. Le fournisseur de services au sens de la Loi de 1994 sur les services de soins à domicile et les services communautaires qui fournit un service communautaire auquel s’applique cette loi. (3) Paragraph 3 of the definition of “health care provider or health care entity” in subsection 77.7 (6) of the Act is repealed. (3) La disposition 3 de la définition de «fournisseur de soins de santé ou entité chargée de la fourniture de soins de santé» au paragraphe 77.7 (6) de la Loi est abrogée. (4) Paragraph 5 of the definition of “health care provider or health care entity” in subsection 77.7 (6) of the Act is repealed and the following substituted: (4) La disposition 5 de la définition de «fournisseur de soins de santé ou entité chargée de la fourniture de soins de santé» au paragraphe 77.7 (6) de la Loi est abrogée et remplacée par ce qui suit : 5. A pharmacy within the meaning of the Drug and Pharmacies Regulation Act. 5. Une pharmacie au sens de la Loi sur la réglementation des médicaments et des pharmacies. (5) The definition of “health care provider or health care entity” in subsection 77.7 (6) of the Act is amended by adding the following paragraph: (5) La définition de «fournisseur de soins de santé ou entité chargée de la fourniture de soins de santé» au paragraphe 77.7 (6) de la Loi est modifiée par adjonction de la disposition suivante : 9.1 A local health integration network within the meaning of the Local Health System Integration Act, 2006. 9.1 Un réseau local d’intégration des services de santé au sens de la Loi de 2006 sur l’intégration du système de santé local. Home Care and Community Services Act, 1994 Loi de 1994 sur les services de soins à domicile et les services communautaires 40. (1) Subsection 28 (2) of the Home Care and Community Services Act, 1994 is repealed and the following substituted: 40. (1) Le paragraphe 28 (2) de la Loi de 1994 sur les services de soins à domicile et les services communautaires est abrogé et remplacé par ce qui suit : Rules for charges for other services Règles applicables à la facturation d’autres services (2) Subject to subsection (3), if an approved agency provides or arranges the provision to a person of a homemaking or community support service in accordance with the person’s plan of service, the approved agency may require payment from the person for the service and may accept a payment made by or on behalf of the person for the service. (2) Sous réserve du paragraphe (3), si l’organisme agréé fournit ou fait en sorte que soit fourni un service d’aides familiales ou un service de soutien communautaire à une personne, conformément au programme de services de cette dernière, il peut exiger d’elle le paiement du service et accepter un paiement effectué par elle ou par quiconque agit en son nom pour le service. LHINs providing services Fourniture de services par le RLISS (3) If a local health integration network provides or arranges the provision to a person of a homemaking or community support service in accordance with the person’s plan of service, the network shall not require payment from the person for the service and shall not accept a payment made by or on behalf of the person for the service. (3) Si un réseau local d’intégration des services de santé fournit ou fait en sorte que soit fourni un service d’aides familiales ou un service de soutien communautaire à une personne, conformément au programme de services de cette dernière, il ne doit pas exiger d’elle le paiement du service, ni accepter de paiement effectué par elle ou par quiconque agit en son nom pour le service. (2) The Act is amended by adding the following Part: (2) La Loi est modifiée par adjonction de la partie suivante : 107 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 36 PATIENTS FIRST ACT, 2016 PART VII.1 PROVISION OF COMMUNITY SERVICES BY LOCAL HEALTH INTEGRATION NETWORKS PARTIE VII.1 FOURNITURE DE SERVICES COMMUNAUTAIRES PAR LE RÉSEAU LOCAL D’INTÉGRATION DES SERVICES DE SANTÉ Provision of community services Fourniture d’un service communautaire 28.1 (1) Despite subsection 5 (1), the Minister may approve a local health integration network to provide a community service for the residents of the geographic area of the local health integration network. 28.1 (1) Malgré le paragraphe 5 (1), le ministre peut agréer un réseau local d’intégration des services de santé aux fins de la fourniture d’un service communautaire aux résidents de la zone géographique qui est de son ressort. Effective date of approval Date de prise d’effet de l’agrément (2) If the Minister so specifies, an approval under subsection (1) shall be deemed to have taken effect on a day fixed by the Minister that is before the day on which the approval is given. (2) Si le ministre le précise, l’agrément qu’il donne en vertu du paragraphe (1) est réputé avoir pris effet le jour fixé par le ministre, lequel est antérieur au jour où l’agrément est donné. Terms and conditions Conditions 28.2 The Minister may impose terms and conditions on an approval given under subsection 28.1 (1) and may from time to time amend or remove the terms and conditions or impose new terms and conditions. 28.2 Le ministre peut assortir de conditions l’agrément qu’il donne en vertu du paragraphe 28.1 (1) et peut, de temps à autre, modifier ou supprimer ces conditions ou en imposer de nouvelles. Funding, etc. Financement 28.3 (1) If the Minister approves a local health integration network to provide a community service under section 28.1, the Minister may, 28.3 (1) Si le ministre agrée un réseau local d’intégration des services de santé aux fins de la fourniture de services communautaires en vertu de l’article 28.1, il peut : (a) fund the local health integration network for the purpose of providing community services and set terms and conditions with respect to such funding; and a) accorder un financement au réseau local d’intégration des services de santé aux fins de la fourniture de services communautaires et en fixer les conditions; (b) enter into an agreement with the local health integration network for the purpose of providing community services. b) conclure avec le réseau local d’intégration des services de santé une entente aux fins de la fourniture d’un service communautaire. Deemed accountability agreement Entente de responsabilisation présumée (2) An agreement entered into under subsection (1) is deemed to be an accountability agreement for the purposes of section 18 of the Local Health System Integration Act, 2006. (2) L’entente conclue en application du paragraphe (1) est réputée une entente de responsabilisation pour l’application de l’article 18 de la Loi de 2006 sur l’intégration du système de santé local. Application of Act to LHIN providing community services Application de la Loi à la fourniture de service communautaire par le RLISS 28.4 (1) When a local health integration network provides a community service as approved by the Minister under subsection 28.1 (1), the network is deemed to be an approved agency or service provider, as the case may be, for the purpose of this Act and the regulations under this Act, and the network shall provide the services in accordance with this Act and the regulations under this Act except that the following provisions of this Act and the regulations that apply under those sections do not apply to a network: 28.4 (1) Si un réseau local d’intégration des services de santé fournit un service communautaire conformément à l’agrément prévu au paragraphe 28.1 (1), il est réputé un organisme agréé ou un fournisseur de services, selon le cas, pour l’application de la présente loi et des règlements pris en vertu de celle-ci, et il fournit les services conformément à la présente loi et aux règlements pris en vertu de celle-ci. Toutefois, les dispositions suivantes de la présente loi et les règlements qui s’appliquent en vertu de ces articles ne s’appliquent pas au réseau : 1. Sections 19, 20, 21. 1. Les articles 19, 20 et 21. 2. Clause 25 (2) (e) and subsection 25 (5). 2. L’alinéa 25 (2) e) et le paragraphe 25 (5). 3. Clause 31 (b). 3. L’alinéa 31 b). 4. Part X (other than subsection 56 (1)). 4. La partie X (à l’exception du paragraphe 56 (1)). 108 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 37 Clarification Précision (2) For greater clarity, a local health integration network is deemed to be an approved agency and not a service provider for the purposes of clauses 25 (2) (a) and (b), subsection 26 (1) and section 29. (2) Il est entendu qu’un réseau local d’intégration des services de santé est réputé un organisme agréé et non un fournisseur de services pour l’application des alinéas 25 (2) a) et b), du paragraphe 26 (1) et de l’article 29. Funding by LHINs Financement par le RLISS 28.5 (1) The Minister may approve a local health integration network to provide funding to or on behalf of a person to purchase a prescribed community service in accordance with this section. 28.5 (1) Le ministre peut agréer un réseau local d’intégration des services de santé pour qu’il accorde un financement à une personne ou à quiconque agit en son nom pour acheter un service communautaire prescrit conformément au présent article. Effective date of approval Date de prise d’effet de l’agrément (2) If the Minister so specifies, an approval under subsection (1) shall be deemed to have taken effect on a day fixed by the Minister that is before the day on which the approval is given. (2) Si le ministre le précise, l’agrément qu’il donne en vertu du paragraphe (1) est réputé avoir pris effet le jour fixé par le ministre, lequel est antérieur au jour où l’agrément est donné. Terms and conditions of approval Conditions de l’agrément (3) The Minister may impose terms and conditions on an approval given under subsection (1) and may from time to time amend or remove the terms and conditions or impose new terms and conditions. (3) Le ministre peut assortir de conditions l’agrément qu’il donne en vertu du paragraphe (1) et peut, de temps à autre, modifier ou supprimer ces conditions ou en imposer de nouvelles. Requirements Exigences (4) The following requirements apply with respect to funding provided by a local health integration network pursuant to an approval given under subsection (1): (4) Les exigences suivantes s’appliquent à l’égard du financement accordé par un réseau local d’intégration des services de santé conformément à un agrément donné en vertu du paragraphe (1) : 1. The network may only provide funding for those community services that are prescribed. 1. Le réseau peut accorder un financement uniquement pour les services communautaires qui sont prescrits. 2. Funding may only be provided for a person for whom the network has developed a plan of service under section 22. 2. Le financement peut être accordé uniquement à l’égard d’une personne pour laquelle le réseau a élaboré un programme de services en application de l’article 22. 3. The person may apply to the network for the funding after the plan of service has been developed, and the network may determine whether the person is eligible for funding in accordance with the approval and the regulations, if any. 3. Après l’élaboration du programme de services, la personne peut faire une demande de financement au réseau. Celui-ci peut alors établir si la personne est admissible au financement conformément à l’agrément et aux règlements, le cas échéant. 4. If the network determines that the person is eligible to receive funding, the network may provide the funding based upon the person’s plan of service, and in accordance with the approval and the regulations, if any. 4. S’il établit que la personne est admissible à recevoir un financement, le réseau peut accorder le financement à la personne en fonction de son programme de services et conformément à l’agrément et aux règlements, le cas échéant. 5. The network shall, when it reviews and evaluates the person’s plan of service under subsection 22 (2), make any revisions to the funding that are appropriate in consequence, and despite paragraph 7, Part IX applies with respect to a decision by the network respecting the amount of any community services to be included in the person’s plan of service. 5. Après le réexamen et l’évaluation du programme de services de la personne en application du paragraphe 22 (2), le réseau apporte au financement les révisions appropriées qui résultent du réexamen et de l’évaluation. Malgré la disposition 7, la partie IX s’applique à l’égard d’une décision du réseau relativement au montant de tout service communautaire à inclure dans le programme de services de la personne. 6. The local health integration network may impose terms and conditions on the funding provided to or on behalf of the person to purchase the community 6. Le réseau local d’intégration des services de santé peut imposer des conditions relativement au financement accordé à la personne ou à quiconque agit 109 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 38 PATIENTS FIRST ACT, 2016 services set out in the person’s plan of service and may from time to time amend or remove the terms and conditions or impose new terms and conditions. en son nom pour l’achat des services communautaires énoncés dans le programme de services de la personne. Il peut, de temps à autre, modifier ou supprimer ces conditions ou en imposer de nouvelles. 7. The other provisions of this Act, and the regulations made under this Act, do not apply to the network, other than, 7. Les autres dispositions de la présente loi et les règlements pris en vertu de celle-ci ne s’appliquent pas au réseau, à l’exception de ce qui suit : i. the definitions in Part II, i. les définitions de la partie II, ii. section 22, ii. l’article 22, iii. sections 59, 59.1, 64 and 66, iii. les articles 59, 59.1, 64 et 66, iv. the regulations made for the purposes of this section, iv. les règlements pris pour l’application du présent article, v. any provisions of this Act or the regulations that are made to apply by virtue of regulations made for the purposes of this section. v. les dispositions de la présente loi ou des règlements pris pour s’appliquer par l’effet des règlements pris pour l’application du présent article. Protection from liability Immunité (5) No action or other proceeding for damages or otherwise, other than an application for judicial review under the Judicial Review Procedure Act, shall be commenced against the Crown, the Minister, a local health integration network, any member, director or officer of a local health integration network, or any person employed by the Crown, the Minister or a local health integration network with respect to any act done or omitted to be done or any decision made under this section that is done in good faith in the execution or intended execution of a power or duty under this section. (5) Sont irrecevables les actions ou autres instances, notamment celles en dommages-intérêts, à l’exception des requêtes en révision judiciaire présentées en vertu de la Loi sur la procédure de révision judiciaire, qui sont introduites contre la Couronne, le ministre, un réseau local d’intégration des services de santé ou un membre, administrateur ou dirigeant d’un tel réseau, ou quiconque est employé par la Couronne, le ministre ou un tel réseau, pour un acte qu’ils ont accompli ou omis d’accomplir ou pour une décision qu’ils ont prise de bonne foi en vertu du présent article dans l’exercice effectif ou censé tel des pouvoirs ou des fonctions que leur attribue celui-ci. (3) The definition of “approved services” in subsection 59 (1) of the Act is amended by adding “and includes services for which funding is provided under section 28.5” at the end. (3) La définition de «services approuvés» au paragraphe 59 (1) de la Loi est modifiée par insertion de «S’entend en outre des services pour lesquels un financement est accordé en vertu de l’article 28.5.» à la fin de la définition. (4) Subsection 62 (2) of the Act is amended by adding “or section 28.3” after “clause 4 (c)” in the portion before clause (a). (4) Le paragraphe 62 (2) de la Loi est modifié par insertion de «ou de l’article 28.3» après «l’alinéa 4 c)» dans le passage qui précède l’alinéa a). (5) Paragraph 1 of subsection 64 (1) of the Act is repealed and the following substituted: (5) La disposition 1 du paragraphe 64 (1) de la Loi est abrogée et remplacée par ce qui suit : 1. Ensuring compliance with this Act, the regulations, an agreement made under clause 4 (c) or clause 28.3 (1) (b), a service accountability agreement with a local health integration network or a term or condition imposed by the Minister under this Act. 1. S’assurer de l’observation de la présente loi, des règlements, d’une entente conclue en vertu de l’alinéa 4 c) ou de l’alinéa 28.3 (1) b), d’une entente de responsabilisation en matière de services conclue avec un réseau local d’intégration des services de santé ou d’une condition imposée par le ministre en vertu de la présente loi. (6) Subsection 68 (1) of the Act is amended by adding the following paragraphs: (6) Le paragraphe 68 (1) de la Loi est modifié par adjonction des dispositions suivantes : 27.1 governing approvals, funding and related matters for the purposes of section 28.5; 27.1 régir les agréments, le financement et les questions connexes pour l’application de l’article 28.5; 27.2 prescribing the community services that may be funded for the purposes of section 28.5; 27.2 prescrire les services communautaires qui peuvent être financés pour l’application de l’article 28.5; 27.3 providing for additional provisions of this Act and the regulations that apply to the provision of fund- 27.3 prévoir des dispositions supplémentaires de la présente loi et des règlements qui s’appliquent au fi- 110 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS ing under section 28.5, and clarifying the application of this Act and the regulations to such funding; 39 nancement accordé en vertu de l’article 28.5 et préciser l’application de la présente loi et des règlements à un tel financement; Ministry of Health and Long-Term Care Act Loi sur le ministère de la Santé et des Soins de longue durée 41. The Ministry of Health and Long-Term Care Act is amended by adding the following section: 41. La Loi sur le ministère de la Santé et des Soins de longue durée est modifiée par adjonction de l’article suivant : Patient and Family Advisory Council Conseil consultatif patients-familles 10. The Minister may establish a Patient and Family Advisory Council to provide patient perspectives and advice on strategic health policy priorities to the Minister. 10. Le ministre peut créer un conseil consultatif patients-familles chargé de lui présenter le point de vue des patients et de lui fournir des conseils sur les priorités stratégiques en ce qui concerne les politiques en matière de santé. Ombudsman Act Loi sur l’ombudsman 42. Section 13 of the Ombudsman Act is amended by adding the following subsection: 42. L’article 13 de la Loi sur l’ombudsman est modifié par adjonction du paragraphe suivant : Application to local health integration networks Non-application aux réseaux locaux d’intégration des services de santé (9) This Act does not apply to local health integration networks within the meaning of the Local Health System Integration Act, 2006 with respect to matters described in subclauses (c.1) (i), (ii) and (iii) of the definition of “health sector organization” in section 1 of the Excellent Care for All Act, 2010. (9) La présente loi ne s’applique pas aux réseaux locaux d’intégration des services de santé au sens de la Loi de 2006 sur l’intégration du système de santé locale à l’égard des questions visées aux sous-alinéas c.1) (i), (ii) et (iii) de la définition de «organisme du secteur de la santé» à l’article 1 de la Loi de 2010 sur l’excellence des soins pour tous. Personal Health Information Protection Act, 2004 Loi de 2004 sur la protection des renseignements personnels sur la santé 43. (1) Paragraph 3 of the definition of “health information custodian” in subsection 3 (1) of the Personal Health Information Protection Act, 2004 is repealed. 43. (1) La disposition 3 de la définition de «dépositaire de renseignements sur la santé» au paragraphe 3 (1) de la Loi de 2004 sur la protection des renseignements personnels sur la santé est abrogée. (2) Paragraph 2 of subsection 3 (6) of the Act is repealed. (2) La disposition 2 du paragraphe 3 (6) de la Loi est abrogée. (3) The Act is amended by striking out “paragraph 1, 2, 3 or 4 of the definition of “health information custodian”” wherever it appears in the following provisions and substituting in each case “paragraph 1, 2 or 4 of the definition of “health information custodian””: (3) La Loi est modifiée par remplacement de «la disposition 1, 2, 3 ou 4 de la définition de «dépositaire de renseignements sur la santé»» par «la disposition 1, 2 ou 4 de la définition de «dépositaire de renseignements sur la santé»» partout où figure cette expression dans les dispositions suivantes : 1. Subsections 20 (2) and (3). 1. Les paragraphes 20 (2) et (3). 2. Clause 38 (1) (a). 2. L’alinéa 38 (1) a). 3. Subclause 39 (1) (d) (i). 3. Le sous-alinéa 39 (1) d) (i). Poverty Reduction Act, 2009 Loi de 2009 sur la réduction de la pauvreté 44. Clause 8 (1) (c) of the Poverty Reduction Act, 2009 is amended by striking out “community care access corporations”. 44. L’alinéa 8 (1) c) de la Loi de 2009 sur la réduction de la pauvreté est modifié par suppression de «les sociétés d’accès aux soins communautaires,». Private Hospitals Act Loi sur les hôpitaux privés 45. (1) The Private Hospitals Act is amended by adding the following section: 45. (1) La Loi sur les hôpitaux privés est modifiée par adjonction de l’article suivant : Directives by Minister Directives du ministre 14.1 (1) The Minister may issue operational or policy directives to a licensee of a private hospital where the Minister considers it to be in the public interest to do so. 14.1 (1) Le ministre peut donner des directives opérationnelles ou en matière de politique au titulaire de permis d’exploitation d’un hôpital privé s’il estime que l’intérêt public le justifie. 111 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 40 PATIENTS FIRST ACT, 2016 Binding Caractère obligatoire des directives (2) A licensee shall carry out every directive of the Minister. (2) Le titulaire de permis doit exécuter les directives du ministre. General or particular Portée (3) An operational or policy directive of the Minister may be general or particular in its application. (3) La directive opérationnelle ou en matière de politique du ministre peut avoir une portée générale ou particulière. Law prevails Primauté du droit (4) For greater certainty, in the event of a conflict between a directive issued under this section and a provision of any applicable Act or rule of any applicable law, the Act or rule prevails. (4) Il est entendu que, en cas d’incompatibilité entre une directive donnée en vertu du présent article et une disposition de toute loi applicable ou règle de toute loi applicable, la loi ou la règle l’emporte. Non-application of Legislation Act, 2006 Non-application de la Loi de 2006 sur la législation (5) Part III (Regulations) of the Legislation Act, 2006 does not apply to the operational or policy directives. (5) La partie III (Règlements) de la Loi de 2006 sur la législation ne s’applique pas aux directives opérationnelles ou en matière de politique. Public availability Mise à disposition du public (6) The Minister shall make every directive under this section available to the public. (6) Le ministre met chaque directive donnée en vertu du présent article à la disposition du public. (2) Section 15.3 of the Act is amended by striking out “15.1 or 15.2” and substituting “14.1, 15.1 or 15.2”. (2) L’article 15.3 de la Loi est modifié par remplacement de «15.1 ou 15.2» par «14.1, 15.1 ou 15.2». (3) Clause 15.6 (a) of the Act is repealed and the following substituted: (3) L’alinéa 15.6 a) de la Loi est abrogé et remplacé par ce qui suit : (a) the issuing of a directive under section 14.1 or a decision, revocation, termination or reduction under section 15.1 or 15.2; or a) toute directive donnée en vertu de l’article 14.1 ou toute décision prise ou toute révocation de permis ou cessation ou réduction de paiements faite en vertu de l’article 15.1 ou 15.2; Public Hospitals Act Loi sur les hôpitaux publics 46. (1) Section 8 of the Public Hospitals Act is amended by adding the following subsections: 46. (1) L’article 8 de la Loi sur les hôpitaux publics est modifié par adjonction des paragraphes suivants : Disclosure Divulgation (5) The Minister shall make the report public. (5) Le ministre met le rapport à la disposition du public. Personal health information to be removed Suppression des renseignements personnels sur la santé (6) Before making the report public, the Minister shall ensure that all personal health information in the report is redacted. (6) Avant de mettre un rapport à la disposition du public, le ministre veille à ce que tous les renseignements personnels sur la santé qui y figurent soient retranchés. (2) The Act is amended by adding the following section: (2) La Loi est modifiée par adjonction de l’article suivant : Directives by Minister Directives du ministre 8.1 (1) The Minister may issue operational or policy directives to the board of a hospital where the Minister considers it to be in the public interest to do so. 8.1 (1) Le ministre peut donner des directives opérationnelles ou en matière de politique au conseil d’un hôpital s’il estime que l’intérêt public le justifie. Binding Caractère obligatoire des directives (2) A board shall carry out every directive of the Minister. (2) Le conseil doit exécuter les directives du ministre. General or particular Portée (3) An operational or policy directive of the Minister may be general or particular in its application. (3) La directive opérationnelle ou en matière de politique du ministre peut avoir une portée générale ou particulière. 112 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 41 Law prevails Primauté du droit (4) For greater certainty, in the event of a conflict between a directive issued under this section and a provision of any applicable Act or rule of any applicable law, the Act or rule prevails. (4) Il est entendu que, en cas d’incompatibilité entre une directive donnée en vertu du présent article et une disposition de toute loi applicable ou règle de toute loi applicable, la loi ou la règle l’emporte. Non-application of Legislation Act, 2006 Non-application de la Loi de 2006 sur la législation (5) Part III (Regulations) of the Legislation Act, 2006 does not apply to the operational or policy directives. (5) La partie III (Règlements) de la Loi de 2006 sur la législation ne s’applique pas aux directives opérationnelles ou en matière de politique. Public availability Mise à disposition du public (6) The Minister shall make every directive under this section available to the public. (3) Section 9 of the Act is amended by adding the following subsections: (6) Le ministre met chaque directive donnée en vertu du présent article à la disposition du public. (3) L’article 9 de la Loi est modifié par adjonction des paragraphes suivants : Disclosure Divulgation (9.1) The Minister shall make any report provided to the Minister under subsection (9) public. (9.1) Le ministre met tout rapport qui lui est remis en application du paragraphe (9) à la disposition du public. Personal health information to be removed Suppression des renseignements personnels sur la santé (9.2) Before making the report public, the Minister shall ensure that all personal health information in the report is redacted. (4) Subsection 9.1 (2) of the Act is repealed and the following substituted: (9.2) Avant de mettre le rapport à la disposition du public, le ministre veille à ce que tous les renseignements personnels sur la santé qui y figurent soient retranchés. (4) Le paragraphe 9.1 (2) de la Loi est abrogé et remplacé par ce qui : No proceeding against Crown Immunité de la Couronne (2) No proceeding, other than a proceeding referred to in subsection 10 (2), shall be commenced against the Crown or the Minister with respect to a decision or direction under section 5, 6 or 9, the issuing of a directive under section 8.1, the appointment of an investigator or a hospital supervisor under section 8 or 9, the appointment of an inspector under section 18 or any action or omission of an investigator, hospital supervisor or inspector done in good faith in the performance of a power or of an authority under any of those sections or under the regulations. (2) Sont irrecevables les instances, autres que celles visées au paragraphe 10 (2), introduites contre la Couronne ou le ministre à l’égard d’une décision, d’une directive ou d’un ordre visé à l’article 5, 6 ou 9, d’une directive visée à l’article 8.1, de la nomination d’un enquêteur ou du superviseur d’un hôpital visée à l’article 8 ou 9, de la nomination d’un inspecteur visée à l’article 18 ou d’un acte ou d’une omission commis de bonne foi par un enquêteur, le superviseur d’un hôpital ou un inspecteur dans l’exercice d’un pouvoir conféré par l’un ou l’autre de ces articles ou par les règlements. (5) Subsection 18 (4) of the Act is repealed and the following substituted: (5) Le paragraphe 18 (4) de la Loi est abrogé et remplacé par ce qui suit : Disclosure Divulgation (4) The Minister shall make any report provided to the Minister under subsection (2) public. (4) Le ministre met tout rapport qui lui est remis en application du paragraphe (2) à la disposition du public. Personal health information to be removed Suppression des renseignements personnels sur la santé (5) Before making a report public, the Minister shall ensure that all personal health information in the report is redacted. (5) Avant de mettre un rapport à la disposition du public, le ministre veille à ce que tous les renseignements personnels sur la santé qui y figurent soient retranchés. Public Sector Labour Relations Transition Act, 1997 Loi de 1997 sur les relations de travail liées à la transition dans le secteur public 47. The definition of “health services integration” in section 2 of the Public Sector Labour Relations Transition Act, 1997 is amended by striking out “either” at the end of the portion before clause (a), by striking out “or” at the end of clause (a), by adding “or” at the end of clause (b) and by adding the following clause: 47. La définition de «intégration des services de santé» à l’article 2 de la Loi de 1997 sur les relations de travail liées à la transition dans le secteur public est modifiée par adjonction de l’alinéa suivant : (c) a local health integration network; c) soit un réseau local d’intégration des services de santé. 113 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE 42 PATIENTS FIRST ACT, 2016 Retirement Homes Act, 2010 Loi de 2010 sur les maisons de retraite 48. (1) Clause 54 (2) (p) of the Retirement Homes Act, 2010 is repealed. 48. (1) L’alinéa 54 (2) p) de la Loi de 2010 sur les maisons de retraite est abrogé. (2) Subsection 54 (2) of the Act is amended by adding the following clause: (2) Le paragraphe 54 (2) de la Loi est modifié par adjonction de l’alinéa suivant : (p.1) contact information for the local health integration network within the meaning of the Local Health System Integration Act, 2006 for the geographic area in which the retirement home is located; p.1) les coordonnées du réseau local d’intégration des services de santé au sens de la Loi de 2006 sur l’intégration du système de santé local qui dessert la zone géographique où est située la maison de retraite; Smoke-Free Ontario Act Loi favorisant un Ontario sans fumée 49. (1) Clause (a) of the definition of “home healthcare worker” in subsection 9.1 (5) of the Smoke-Free Ontario Act is repealed. 49. (1) L’alinéa a) de la définition de «travailleur de la santé à domicile» au paragraphe 9.1 (5) de la Loi favorisant un Ontario sans fumée est abrogé. (2) The definition of “home health-care worker” in subsection 9.1 (5) of the Act is amended by adding the following clause: (2) La définition de «travailleur de la santé à domicile» au paragraphe 9.1 (5) de la Loi est modifiée par adjonction de l’alinéa suivant : (a.1) a local health integration network as defined in section 2 of the Local Health System Integration Act, 2006; or a.1) soit un réseau local d’intégration des services de santé au sens de l’article 2 de la Loi de 2006 sur l’intégration du système de santé local; COMMENCEMENT AND SHORT TITLE ENTRÉE EN VIGUEUR ET TITRE ABRÉGÉ Commencement Entrée en vigueur 50. (1) Subject to subsections (2), (3) and (4), this Act comes into force on the day it receives Royal Assent. 50. (1) Sous réserve des paragraphes (2), (3) et (4), la présente loi entre en vigueur le jour où elle reçoit la sanction royale. Same Idem (2) Subsections 37 (1) and (2) come into force on the later of the day section 1 of Schedule 5 to the Public Sector and MPP Accountability and Transparency Act, 2014 comes into force and the day this Act receives Royal Assent. (2) Les paragraphes 37 (1) et (2) entrent en vigueur le dernier en date du jour de l’entrée en vigueur de l’article 1 de l’annexe 5 de la Loi de 2014 sur la responsabilisation et la transparence du secteur public et des députés et du jour où la présente loi reçoit la sanction royale. Same Idem (3) Subsections 37 (10), (11) and (12) and section 42 come into force on the later of the day section 4 of Schedule 5 to the Public Sector and MPP Accountability and Transparency Act, 2014 comes into force and the day this Act receives Royal Assent. (3) Les paragraphes 37 (10), (11) et (12) et l’article 42 entrent en vigueur le dernier en date du jour de l’entrée en vigueur de l’article 4 de l’annexe 5 de la Loi de 2014 sur la responsabilisation et la transparence du secteur public et des députés et du jour où la présente loi reçoit la sanction royale. Same Idem (4) The following provisions of this Act come into force on a day to be named by proclamation of the Lieutenant Governor: (4) Les dispositions suivantes de la présente loi entrent en vigueur le jour que le lieutenant-gouverneur fixe par proclamation : 1. Subsection 1 (2). 1. Le paragraphe 1 (2). 2. Subsection 7 (2). 2. Le paragraphe 7 (2). 3. Section 19. 3. L’article 19. 4. Section 21. 4. L’article 21. 5. Subsection 27 (2). 5. Le paragraphe 27 (2). 6. Section 31. 6. L’article 31. 7. Section 32. 7. L’article 32. 8. Section 34. 8. L’article 34. 114 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - BOARD EDUCATION / GENERATIVE DIALOGUE LOI DE 2016 DONNANT LA PRIORITÉ AUX PATIENTS 9. Subsection 35 (1). 9. Le paragraphe 35 (1). 10. Subsection 36 (2). 10. Le paragraphe 36 (2). 11. Subsection 39 (3). 11. Le paragraphe 39 (3). 12. Section 43. 12. L’article 43. 13. Section 44. 13. L’article 44. 14. Subsection 48 (1). 14. Le paragraphe 48 (1). 15. Subsection 49 (1). 15. Le paragraphe 49 (1). 43 Short title Titre abrégé 51. The short title of this Act is the Patients First Act, 2016. 51. Le titre abrégé de la présente loi est Loi de 2016 donnant la priorité aux patients. 115 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Briefing Note Report to: Central West LHIN Board of Directors Agenda Number: Item # 5.1 Subject: Balanced Scorecard Spring/Year-End Cycle 2015/16 Purpose: For Information Date: Wednesday, June 22, 2016 Key Contact: Brock Hovey, Senior Director Health System Performance Elizabeth Salvaterra, Director Decision Support Recommended Motion: N/A Background Summary : Please find attached the Spring/Year-End Cycle 15/16 Central West LHIN Balanced Scorecard Dashboard. Indicators requiring investigation this cycle included the following: #2 90th percentile ED length of stay for high acuity patients #6 90th percentile wait time for CCAC in-home services from community setting #10 Repeat unscheduled emergency visits for substance abuse conditions #17 Percent of home care clients with complex needs who received their first personal support visit within 5 days of authorization #19 Proportion of wait time indicators achieving target #22 Proportion of falls indicators achieving target Indicators #2 and #10 were red for the last four quarters. Indicator #19 has been red in every quarter since July 2013. Indicator #6 is red for the first time since Q2 14/15, but is green for the year-end. Indicator #17 has been yellow for all reporting quarters available (Q1 13/14) and is red for the first time. It is yellow for the yearend. Indicator #22 is red for the first time in nearly two years (since Q4 13/14), but is green for the year-end. Details on the reasons for the performance and the initiatives underway are included in the attached dashboard. Options Considered: N/A 116 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Impact Analysis: Alignment with Strategic Priorities Improve access to Care Stream Line Transitions and Navigation Drive Quality and Value Build on the Momentum Governance Best Practice Operational Excellence Enterprise Risk Implementation Plan: N/A Attachments: 2013-2016 Central West LHIN BSC Dashboard – 2015 Spring/Year-End Cycle 2 117 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE 2013-2016 Central West LHIN Balanced Scorecard Dashboard--2015/16 Winter Cycle Fall Winter Spring YTD/ final Measures Actual Summer Target 2015-16 ≤ ≤ ≤ ≤ ≤ ≤ ≥ 4 hours 8 hours 9.46 % TBD days TBD days 21 days TBD % Q4 15/16 3.7 Q4 15/16 10.3 Q3 15/16 8.3% Q2 15/16 17.0 Q2 15/16 21.0 Q3 15/16 18.0 10/14-09/15 86.4% 3.7 10.2 5.6% 8.0 15.0 16.0 85.7% 3.5 10.8 6.5% 11.0 14.0 19.0 84.4% 3.8 11.3 6.1% 13.5 20 31.0 80.9% 3.7 10.6 6.0% 12.0 16.0 21.0 N/A ≤ ≤ ≤ ≤ ≤ ≤ ≤ ≤ 1.2 per 1,000 population 16.3 % 22.4 % TBD per 100,000 population 157 per 100,000 population 69.8 per 100,000 population 15.5 % 12.7 % Q3 15/16 Q3 15/16 Q3 15/16 Q3 15/16 Q3 15/16 Q3 15/16 Q2 15/16 Q4 15/16 1.3 15.8% 26.0% 462 143.7 67.4 14.8% 5.9% 1.2 15.0% 29.5% 490 148.7 68.7 15.5% 5.3% 1.1 14.1% 31.0% 468 139.8 68.8 16.2% 4.9% 1.1 17.4% 29.1% 506 168.5 69.3 15.6% 6.0% 3.5 15.6% 29.1% 481 150.2 208.0 16.0% 5.5% ≥ ≥ ≥ = ≥ = = ≥ 55 % 95 % 95 % 6/6 indicators TBD % 3/3 indicators 2/2 indicators TBD % 10/14-09/15 Q3 15/16 Q3 15/16 Q4 15/16 Q2 15/16 Q4 15/16 Q3 15/16 Q3 15/16 52.4% 93.3% 96.9% 0/6 53.0% 2/3 2/2 68.1% 53.8% 93.8% 96.6% 0/6 57.4% 2/3 2/2 87.4% 50.6% 89.0% 95.8% 1/6 57.6% 3/3 2/2 87.8% 53.0% 83.6% 95.2% 0/6 54.2% 2/3 1/2 89.4% 53.0% 88.4% 95.9% 0/6 56.0% 2/3 2/2 N/A ≥ = = TBD % TBD per 51 HSP's TBD per 51 HSP's 11/15-04/16 62.5% Q4 15/16 33/51 Q4 15/16 37/51 63.4% 33/51 37/51 61.9% 33/51 37/51 64.3% 33/51 37/51 66.7% 33/51 37/51 = = 100 % 100 % March 31 March 31 Current Period LHIN Resident Experience 1. 90th percentile ED length of stay for low acuity patients 2. 90th percentile ED length of stay for high acuity patients 3. Percentage of ALC days experienced by patients discharged from acute inpatient hospital beds 4. CCAC wait times from application to eligibility determination for LTCH placements: from acute-care setting 5. CCAC wait times from application to eligibility determination for LTCH placements: from community setting 6. 90th percentile wait time for CCAC in-home services from community setting 7. Overall satisfaction with health care in the community Value (Quality/$) 8. Rate of emergency visits for conditions best managed elsewhere 9. Repeat unscheduled emergency visits within 30 days for mental health conditions 10. Repeat unscheduled emergency visits within 30 days for substance abuse conditions 11. Rate of ED visits in youths for mental health and substance abuse conditions 12. Rate of unscheduled emergency visits for hyperglycemia or hypoglycemia 13. Hospitalization rate for ambulatory care sensitive conditions per 100,0000 population 14. Readmissions within 30 days for selected HBAM Inpatient Grouper (HIG) Conditions 15. ALC Rate (inpatient capacity lost to ALC) System Performance 16. Proportion of residents with access to primary care by the next day 17. Percent of home care clients with complex needs who received their first personal support visit within 5 days of authorization 18. Percent of home care clients who received their first nursing visit within 5 days of authorization 19. Proportion of wait time indicators achieving target (6 MLAA indicators) 20. Percent of acute care patients who have had a follow-up with a physician within 7 days of discharge 21. Proportion of nosocomial infection indicators achieving target 22. Proportion of falls indicators achieving target 23. Percent of palliative care patients discharged from hospital with home support Learning & Growth 24. % of eligible IAR organizations with active user accounts 25. Number of HSP's that are accredited 26. Number of HSP's that have Quality Improvement Plans that they have shared with the LHIN Project Management Percent IHSP projects on target Percent base cycles on target 118 75.0% 100.0% 81.0% 92.0% 93.3% 90.9% 92% 91% 84.7% 93.2% Legend within target not within target, but not of concern not within target, and of concern N/A BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE 2013-2016 Central West LHIN Balanced Scorecard Dashboard--2015/16 Spring Cycle Drill Down Measure Target 2015-16 Current Period Performance Initiatives Commentary LHIN Resident Experience ≤ 8 hours Q4 15/16 11.3 ≤ 8 hours Year-End 15/16 10.6 2. 90th percentile ED length of stay for high acuity patients Initiatives addressing ED length of stay for complex patients are focused exclusively on Patient Experience patients admitted to inpatient beds, as the experience of patients discharged home In 2015/16, the Central West LHIN ranked eleventh out of fourteen LHINs for high (the overwhelming majority) is well within the best practice target. acuity emergency department length of stay (EDLOS), with 84% of complex patients discharged from Central West LHIN emergency departments within the target of 8 ED length of stay for complex patients includes two patient cohorts, each of which has hours. At 10.57 hours for the year, Central West performance was just over half an substantially different experiences in the emergency department. High acuity patients hour longer than provincial performance as a whole. who are discharged from the ED spend the majority of their length of stay in value added activities, such as assessment and treatment. Patients who are admitted to an Non-Admitted Patients inpatient bed spend the vast majority of their length of stay simply waiting for an Of the 212,181 patients in the complex category in the Central West LHIN for 2015/16, impatient bed to become available (time to inpatient bed). Combining these two groups 180,439 (85%) were discharged home from the ED. 90th percentile (90P) EDLOS for masks the very poor experience of the latter group. these patients was 7.1 hours, with 93% being discharged within the target of 8 hours. EDLOS at the 50th percentile (median) was 3.3 hours. Patients in this category are not spending excessive time in Central West LHIN emergency departments. Barriers to discharge from the ED have largely to do with inpatient capacity. Most patients occupying hospital beds in the Central West LHIN are not designated ALC, and the LHIN also has one of the shortest acute lengths of stay in the province. Patients occupying hospital inpatient beds in large measure need to be there. ≤ 8 hours Q4 15/16 47.3 2a. 90th Percentile ED length of stay for admitted patients ≤ 8 hours Year-End 15/16 Multiple providers have initiatives in place that are intended to reduce ED visits for vulnerable patients, prevent admission to an inpatient bed where possible and streamline it when unavoidable, prevent ALC designation, and increase capacity both inside and outside of the hospital--all these interventions will decrease the LOS experienced by admitted patients. However, the greatest issue is that there is simply more demand for acute hospital beds than there is supply. 35.7 ≤ 21 days Q3 15/16 31.0 ≤ 21 days Year-to-date Q1-Q3 15/16 21.0 6. 90th percentile wait time for CCAC in-home services from community setting The escalating rate of referral volumes is fast outstripping the availability of funding to support higher volumes within the limitations of the Central West CCAC budget. As patients are prioritized and triaged by complexity and service type, and an increasing number of patients are waitlisted for services (with the exception of those referred for nursing support), waitlists grow. As the number of patients on the waitlist grows, so does the number of days waiting. When patients are removed from the waitlist, their cumulative days waiting factor into the performance calculation for this indicator. As long as escalating demand continues to outstrip available services as per funded levels of activity, the Central West CCAC will continue to implement strategies to manage volumes "at the door" including waitlisting and performance on this indicator will be variable and vulnerable to further decline. Page 2 of 6 119 Performance for admitted patients in 2015/16 was as follows: Volume % within 8 hrs 90P 50P BCH 17,587 28% 49.7 hrs 12.2 hrs EGH 10,960 36% 48.7 hrs 10.5 hrs HHCC 3,195 77% 13.3 hrs 5.8 hrs LHIN 31,742 36% 35.7 hrs 10.5 hrs Time to Decision The maximum amount of time that any patient should spend in the ED is 8 hours. For 10% of patients, the time taken to make the decision to admit them was more than 10.7 hours. Time to Inpatient Bed This segment measures the time between the decision to admit and the patient being transferred to the inpatient bed they need. 10% of patients waited more than 39.5 hours, meaning that 75% of the time that these patients spent in the emergency department was wait time. At the 50th percentile, time to inpatient bed was only 5.3 hours, indicating that performance is strongly influenced by the very long wait times experienced by a small number of patients. From October - December 2015, 1,799 clients were served with a 90th percentile wait time of 31 days. The Central West missed the provincial target by 10 days and performed worse (longer) than provincial performance of 29 days. For the fiscal year, the Central West LHIN met the provincial target and performance was better (shorter) than the province by 9 days. BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE 2013-2016 Central West LHIN Balanced Scorecard Dashboard--2015/16 Spring Cycle Drill Down Measure Target 2015-16 Current Period Performance Initiatives Commentary The LHIN met with InSTED partners SHIP - Supportive Housing in Peel, Punjabi Community Health Services and Canadian Mental Health Association Peel Branch to discuss the 1-year program review report. Partners highlighted where the program was not adhering to the model as they anticipated although the program is achieving good outcomes for clients. Program documentation will be revised to reflect actual operating practices. Partners are also asked to better reflect the impact of all aspects of the program, in particular the strategy to support clients while they wait for longer-term clinical support. LHIN staff will continue discussions with the partners to ensure service quality, including equitable access to short-term support. From October-December 2015, LHIN performance was 29.1%, above (worse) both the baseline (26.1%) and the provincial target (22.4%). The Central West CCAC engages in a "Care Within Funding" leadership discussion biweekly to proactively develop a response to changing pressures and new infusions of funds as immediately as possible and continually tweak service allocation strategies to ensure care plans are as efficiently conservative as possible, and the highest risk patients are prioritized. In Q3 2015/2016, the CCAC admitted (to service or waitlist) more than double the number of PSW patients as in the same quarter in 2014/15 (average of 298 a month versus 138 a month), while nursing referrals increased somewhat from an average of 800 a month admitted to an average of 870 a month. Increased referral volumes were from both the community and the acute sector. Value (Quality/$) ≤ 22.4% Q3 15/16 29.1% ≤ 22.4% Year-to-date Q1-Q3 15/16 29.1% 10. Repeat unscheduled emergency visits within 30 days for substance abuse conditions In this period, there were 832 total ED visits in the Central West LHIN for substance abuse conditions. 242 of those visits were repeat visits, made by a total of 116 people. The InSTED program at William Osler Health System from April to December 2015 served 166 substance abuse clients and repeat visits totaled 166 for the 30 days prior to engagement with InSTED. In the 30 days after service from the program, repeat visits were reduced by 59% to 68 visits. The program exceeded the annual target of clients served, by 38% in the first three quarters. Of note, the annual capacity of In addition to the InSTED program, the LHIN is working in collaboration with addiction InSTED is 500 mental health and addiction clients. Capacity is a significant issue as services providers to identify interventions to address more specific reasons for alcohol the number of unique patients visiting the ED is growing. Over the last year, the visits (e.g. withdrawal). Identification of consistently high users i.e. repeat visits is number of unique patients with visits is up 22% having increased over each quarter required and providers are working together to ensure that this is done. Further, a from 529, to 617, to 630, and in Q3, to 644. GTA LHIN review of mental health and addiction crisis services includes assessing opportunities to improve the use of residential withdrawal management centres as a Consistently, for 75% of the ED visits for substance abuse, the substance in question site for substance abuse crisis intervention. LHIN Senior Directors are in the process is alcohol, a legal substance for which there is no provincial strategy targeting abuse. of reviewing the final report from LHIN Leads for Mental Health and Addictions. System Performance 17. Percent of home care clients with complex needs who received their first personal support visit within 5 days of authorization ≥ 95% Q3 15/16 83.6% ≥ 95% Year-to-date Q1-Q3 15/16 88.4% The organization, at this point in time, prioritizes the provision of nursing services over PSW services. That is, within finite resources an increasing proportion of dollars is being allocated to a proportionally high volume of nursing patients, who are not waitlisted, forcing increased waitlisting of patients waiting for Personal Support Services to offset the costs. The decision to prioritize allocation of available resources to nursing before Personal Support Services is informed by ethical decision making practices, management of clinical risk, the immediate system impact that would be triggered if nursing patients were declined service, and the availability of alternative options to patients and families. Page 3 of 6 120 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE 2013-2016 Central West LHIN Balanced Scorecard Dashboard--2015/16 Spring Cycle Drill Down Measure Target 2015-16 Current Period Performance 19. Proportion of wait time indicators achieving target 6/6 Q4 15/16 Year-End 0/6 19a. Proportion of wait time indicators achieving target: Percent of Priority II-IV Cancer Surgeries Completed within access target days (PII - 14, PIII - 28, PIV - 84) Initiatives For the 2015/16 year, changes have been made to the wait times indicators in the MLAA. Cancer and Cataract surgeries have been moved from the accountability section to the monitoring section, and % within target is now measured for all but the highest priority patients, rather than only the lowest priority, as in the past two years. Please see specifics of strategies and performance explanation below: ≥ 90% ≥ 90% Q4 15/16 Year-End 15/16 87.5% 88.6% The decentralized booking process with the respective surgeons' offices responsible for booking appointments at Osler allows for improved wait time monitoring. Active monitoring has assisted in the adjustment of OR blocks and resource allocation, as required, to enhance access to surgery. In addition, the hospital's surgical program has established a team to monitor performance and provide recommendations to Surgeons' Offices to improve the quality of wait list records. The team also introduced new OR schedules in FY 2015/16 to ensure that there is adquate OR capacity to perform oncology procedures. Percent of Priority II-IV Cataract Surgeries completed within access target days (PII - 42, PIII - 84, PIV - 182) ≥ 90% ≥ 90% Q4 15/16 Year-End 15/16 88.8% 87.1% The LHIN is within 10% of the provincial access target in Q4 15/16, ranking sixth out of 14 LHIN's. Performance was nearly 1 percentage point better (higher) than provincial performance. Performance for the fiscal year was 1.4% below target, but 0.5 percentage points better than provincial performance. Local performance in Q4 was as follows: Volume % within access days BCH 261 84% EGH 111 95% HHCC 11 91% Headwaters Health Care Centre has begun implementing the recommendations of its surgical process improvement project which was initiated in Q1 15/16. The project aims to increase efficiencies in OR time utilization and scheduling of OR blocks. The implementation entails four streams of work which are: governance, OR block utilization, model of care changes and supply chain opportunities. 19b. Proportion of wait time indicators achieving target: Commentary The hospital is also working on several rapid cycle improvements, including turn around times and cancellations. Headwater is also adding a fourth OR as part of its redevelopment project. Based on discussions initiated by the LHIN with Osler and Cancer Care Ontario, the two organziations are collaborating to review and audit surgical wait lists at Osler to accurately reflect demand by identifying any open cases that should be removed. One of the goals of the project is to close open cases that are no longer valid. As part of ongoing maintenannce, the project requires Osler to establish a process to validate and attest to the accuracy of wait lists by wait time priority, confirm that Surgeons' Offices are using the correct wait list entry codes and identify open cases that are outliers and determine follow up actions with Surgeons' Offices. The project is expected to conclude by July 30, 2016. Page 4 of 6 121 The LHIN is below the provincial access target in Q4 15/16, by 1.2 percentage points, ranking seventh out of 14 LHINs, and performing 1.4 percentage points better than the province as a whole. Performance for the fiscal year was 3.0 percentage points below target and 1 percentage points worse (lower) than provincial performance. The year end volumes of cataract surgeries performed is at 108.7% and 100.2% of funded volumes for Headwaters and Osler, respectively - Headwaters and Osler performed 47 and 12 more cases, respectively, than the funding allocation for the fiscal year. BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE 2013-2016 Central West LHIN Balanced Scorecard Dashboard--2015/16 Spring Cycle Drill Down Measure 19c. Proportion of wait time indicators achieving target: Percent of Priority II-IV Hip Replacement Surgeries completed within access target days (PII - 42, PIII - 84, PIV - 182) Target 2015-16 Current Period Performance ≥ 90% Q4 15/16 71.8% ≥ 90% Year-End 15/16 67.5% Initiatives Commentary The musculoskeletal (MSK) clinic at Osler assesses patients' treatment requirements Hip: The LHIN ranked tenth out of 14 LHINs in Q4. Performance for the fiscal year was to determine referrals to surgeons. The goal of the MSK clinic is to achieve efficiencies 18.2% below target and 7.9 percentage points worse (lower) than provincial for wait time targets through efficient and timely assessments. The MSK clinic is performance. aligned with provincial guidelines. Osler completed more hip replacement surgeries than were added to the waitlist in Q4. Osler's complex integration wait time reporting standard has improved wait time There were 178 priority II-IV patients on the waitlist at the beginning of Q4, and another reporting accuracy. The efficient management of "surrendered" OR blocks and 78 were added to the waitlist during the quarter. 85 Priority II-IV surgeries were scheduling the OR three months in advance have contributed to improvements and completed in this period, 33% of the total waitlist of 256. better planning of OR utilization times, with priority given to surgeons who are below target in terms of volume. The year end volumes of hip replacement surgeries performed is at 103% of funded volumes - Osler completed 9 more cases than was allocated for the fiscal year. As previously noted in indicator 19b commentary, Osler and Cancer Care Ontario are collaborating to review and audit surgical wait lists at Osler and is expected to conclude Knee: The LHIN ranked twelfth out of 14 LHINs in Q4. Performance has worsened by July 30, 2016. since last quarter, with performance 15 percentage points lower than in Q3 15/16. Performance for the fiscal year was 22.5% below target and 6.8 percentage points worse (lower) than provincial performance. Osler completed more knee replacement surgeries than were added to the waitlist in Q4, but the waitlist continues to grow. There were 826 Priority II-IV patients on the waitlist at the beginning of Q4, and another 227 were added to the waitlist during the quarter. 248 Priority II-IV surgeries were completed in this period, 24% of the total waitlist of 1,053. 19d. Proportion of wait time indicators achieving target: Percent of Priority II-IV Knee Replacement Surgeries completed within access target days (PII - 42, PIII - 84, PIV - 281) The year end volumes of knee replacement surgeries performed is at 108% of funded volumes - Osler completed 74 more cases than was allocated for the fiscal year. ≥ 90% Q4 15/16 60.1% ≥ 90% Year-End 15/16 72.2% All efficiency measures suggested by the Ministry and by the LHIN have been implemented, but demand for knee replacements continues to far outstrip supply. Page 5 of 6 122 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE 2013-2016 Central West LHIN Balanced Scorecard Dashboard--2015/16 Spring Cycle Drill Down Measure Target 2015-16 Current Period Performance Initiatives Osler continues to increase efficiencies, streamline booking processes and audit the booking system to reduce the number of "no shows." The hospital continues to adjust operational hours to increase throughput. As part of this adjustment, one magnet at each hospital has been operational 24x7 since FY 2015/16. 19e. Proportion of wait time indicators achieving target: Percent of Priority II-IV MRI scans completed within access target days (2, 10, 28) ≥ 90% ≥ 90% Q4 15/16 Year-End 15/16 33.4% In order to manage an increase in ER and inpatient referrals, inpatient appointments were created. Beginning in FY 2015/16, inpatient weekend scans are available at both hospital sites to manage demand and improve performance for inpatient wait times. A process to assess MRI requests for appropriateness through radiologist protocolling was also implemented. Percent of Priority II-IV CT Scans Completed within access target days (2, 10, 28) 22. Proportion of falls indicators achieving target Rate of in-hospital fractures in Central West facilities per 100,000 inpatient days ≥ 90% ≥ 90% Q4 15/16 Year-End 15/16 From 2010 to 2014, Osler's MRI volumes increased by 48%, slightly higher than the average provincial increase of 46%. The hospital performed 35,019 PII-PIV scans in FY 2015/16, an increase of over 15% from last year's volumes. There was a reduction of one FTE, effective April 1, 2016. This will result in a reduction of nearly 10 appointments per week. Based on this, and demand factors, no improvement in performance is anticipated. 33.3% Osler continues to engage in workflow and throughput engineering by adjusting hours of operation to meet demand, while Headwaters has added extra slots during the week and on weekends to clear the backlog. Initiatives implemented at Headwaters, such as educating staff on the priority levels and targets, have contributed to performance improvements. 19f. Proportion of wait time indicators achieving target: Commentary The LHIN ranked tenth out of 14 LHIN's in Q4, with performance similar to last quarter's. Performance for the fiscal year was 56.7% below target and 5 percentage points worse (lower) than provincial performance. 80.4% 71.5% 2/2 Q3 15/16 1/2 2/2 Q4 14/15 Q3 15/16 2/2 As part of the Extended Hours Project, staffing has been increased marginally at the Etobicoke General Hospital site of Osler to manage demand, while five additional appointments per day have been added to the roster at the Brampton Civic Hospital site. Local performance in Q4 was as follows: Volume % within access days BCH 4,922 65% EGH 3,909 97% HHCC 925 94% Osler and Headwaters are committed to preventing in-hospital fractures and falls. Both hospitals have implemented a a rigorous falls prevention program that has been recognized by Accreditation Canada as a leading practice to address the risks. The comprehensive strategy includes a falls screen risk assessment tool, a falls scene investigation process for post falls assessments, purposeful and frequent rounding, instituting environmental safety measures such as exit alarm beds and appropriate use of least restraint policies. The prevention programs aims are to promote a patientcentred environment supporting patient independence, establishes guidelines for the prevention of falls and the standardized management of falls while maintaining the safety of patients, families and staff members. Both hospitals have have mechanisms for patient, family and staff education to reduce occurrences of falls. The reasons for the fractures are multi-factorial--patients who fall are often confused and despite having falls reduction strategies in place, they may still fall while in hospital and suffer fractures. It is most unfortunate when falls result in a fracture and we treat falls resulting in fractures as a learning opportunity to prevent recurrences in the future. Project Management Page 6 of 6 123 The LHIN ranked sixth out of 14 LHINs in Q4, performing 6 percentage points better (higher) than the province as a whole. Performance for the fiscal year was 18.5% below target and 3 percentage points worse (lower) than provincial performance. Central West ranked ninth among all of the LHINs for the fiscal year.. The proportion of Priority II-IV CT scans completed within access target has improved from the last three quarters.The LHIN’s performance is 9 percentage points better than in Q3. The number of scans completed has also increased. Central West LHIN hospitals performed 36,414 PII-PIV CT scans in FY 2015/16, an increase of over 17% from the last year's volumes. In October - December 2015, a total of 7 patients suffered in-hospital fractures in a Central West LHIN hospital - one at Headwaters, two at Etobicoke General and four at Bramptom Civic. The rate of in-hospital fractures in Q3 15/16 was 10.5 per 100,000 inpatient days, above the provincial target of 10. This rate has not been above the provincial target of 10 for nearly two years (since Q4 13/14). For January 2015 - December 2015, the rate of in-hospital fractures in Central West LHIN hospitals was 8.6 per 100,000 inpatient days and met the the provincial target. BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Briefing Note Report to: Agenda Number: Subject: Purpose: Date: Key Contact(s): Central West LHIN Board of Directors Item # 5.2 2016/17 Q1 Enterprise Risk Management (ERM) Report For Approval June 22, 2016 Brock Hovey, Senior Director, Health System Performance, Hyder Yusafzai, Specialist, Performance and Quality Recommended Motion: That the Central West LHIN Board of Directors approve the 2016/17 Q1 Enterprise Risk Management Report. Background Summary: Since FY 2013/14, the Central West LHIN has implemented ERM based on the application of a coordinated approach to the completion of identified steps including: risk identification, assessment, mapping, planning, and, monitoring. High Level Process for Updating Current Risks and Identifying New Risks The LHIN has established a standardized process for on-going risk management and monitoring, identification of new risks and quarterly reporting. Potential risks are ranked in terms of relative priority (the combination of impact of the risk occurring x probability of the risk occurring). Quarterly updates are received by the LHIN’s Operational Risk Manager (ORM) from the respective risk owners for their risks and include information related to the status of the risk and the implementation of mitigation strategies. The Senior Management Team (SMT) undertakes an in-depth review of all enterprise risks on a quarterly basis. Based on this, risks with a relative priority ranking score of 8 and above are reported to the Board. Risk Consolidation The 2016/17 Q1 ERM Report is the ninth consolidated report being provided to the Board for approval on a quarterly basis. The Report includes components from the following risk sources: ß ß ß Detailed Agency Risk Assessment Report which is submitted to the Ministry of Health and Long-Term Care (MOHLTC). The updated Agency Risk Report was submitted to the MOHLTC on May 25, 2016, subsequent to approval by the LHIN CEO Quarterly Risk Summary, which is a component of the Quarterly Report submitted to the MOHLTC in Q1, Q2 and Q3. There is no requirement to submit this report in Q4. Central West LHIN’s ERM risk repository, reported on a quarterly basis (June, September, December and March of each fiscal year). 124 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE 2016/17 Q1 Quarterly Report to the MOHLTC Risks that are being reported to the MOHLTC, as part of the Risk Summary for the 2016/17 Q1 Quarterly Report include the following: ß ß ß ß ß Risk ID # 3: Increased ALC Days and/or ER visits for patients waiting for placement in Long-Term Care Homes (In category of top risks) Risk ID # 80: Maintenance of the Self – Reporting Initiative (SRI) System Risk ID # 82: Home and Community Care Renewal Risk ID # 83: Sustainability of United Achievers Risk ID # 85: LHIN Board Member Turnover Enterprise Risk Management 2016/17 Q1 Review – Status Update All risks were reviewed in terms of risk decision (accept, mitigate, transfer and avoid), risk status (pending acceptance, open, realized, expired), mitigation strategies, probable causes, contingency plans, triggers and scoring in terms of impact and probability. Key changes between Q4 (January to March 2016) and Q1 (April to June 2016) are highlighted below: ß The number of risks has increased from 30 to 32 ß Two newly identified risks have been added in current reporting and are included in the category of top risks: ÿ Risk ID # 83: Sustainability of United Achievers (priority ranking score of 8) ÿ Risk ID # 85: LHIN Board Members Turnover (priority ranking score of 9) ß The number of top risks reported to the Board has increased from 6 to 8 based on a reassessment of mitigation strategies and priority rankings (see Attachment 1). ß Risk decisions have changed between March and June 2016: Risk Decision March 2016 June 2016 Accept 5 4 Mitigate 25 28 Transfer 0 0 Avoid 0 0 TOTAL 30 32 Options Considered (if not applicable indicate N/A): N/A Impact Analysis (please check all that apply): Central West LHIN... Making Healthy Change Happen 125 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE ☐Alignment with Strategic ☐Build Integrated Networks of Care ☐Drive Quality and Value ☐Connect and Inform ☐Demonstrate System Leadership ☒Governance Best Practice ☒Operational Excellence ☒Enterprise Risk Implementation Plan: The ORM will continue to lead the ERM process to review existing risks and identify new risks in preparation for 2016/17 Q2 reporting to the Board. Attachments: ß ß ß A summary diagram plotting the top 8 risks, as of June 2016, that were assigned a relative priority score of 8 or more (representing risks that are considered high to medium impact and/or high to medium probability) and a corresponding list of the top 8 risks including short risk description, colour-coded LHIN risk category, and the relative priority, impact and probability scores for each risk (Attachment 1) Risk Management Worksheets for the top 8 risks, with detailed information on description of the risk event, mitigation/prevention options, probable causes, contingency plans and triggers (Attachment 2) Two diagrams reflecting heat maps that highlight the number of risks associated with the relative priority scores (based on impact x probability) and the changes between March and June 2016. Over time the objective is for risks to move below the risk tolerance line on the heat map demonstrating effective mitigation strategies and contingency planning (Attachment 3). Central West LHIN... Making Healthy Change Happen 126 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Central West LHIN... Making Healthy Change Happen 127 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE High Attachment 1 Central West LHIN Highest Scored Risks (“Top 8”) – June 2016 Relative Priority = Impact x Probability Impact Score Probability Score 15 Access to health services locally is limited due to availability of funding that is unable to keep pace with the demands and needs of an increasing population. 12 3 4 82 In December 2015, the Ministry of Health and Long-Term Care released a discussion paper that calls for fundamental structural change to the CCAC system and proposes to eliminate the Board and the organization and embed the CCAC functions within the LHIN. There is a risk, should legislation be approved, that during the transition period there is an exodus of key governors, senior leaders, and other staff that could leave the organization vulnerable and risk continuity of service delivery. 9 3 3 3 Access to long-term care is restricted and system flow is impacted resulting in an increase in ALC days for hospital admitted patients waiting for LTCH placement; and/or ER visit volumes and/or admissions to hospital increase from LTCH clients waiting in the community for placement in LTCH, increasing waiting list for LTCH placement. 9 3 3 Operational 58 Lack of physician support for LHIN initiatives (e.g. Health Links). 9 3 3 Financial 78 9 3 3 9 3 3 8 2 4 8 2 4 15 27 Ref ID 83 Risk Description 3.7 Probability 3 58 78 82 85 Low Legend- Risk Category Low 2.3 2.3 Impact Reputational 3.7 High 85 Strategic 83 27 128 The Central West CCAC (CW CCAC) has continued to prioritize clients based on high acuity, which may result in lower acuity clients not receiving home care services. This can potentially impact escalation of hospital ED volumes a nd ALC days. The LHIN Board of Directors has three vacancies creating a challenge for the Board as a whole to meet their governance obligations with a reduced number of appointed Board members. The viability of United Achievers as an organization and provision of services to its clients is at risk, as it has lost temporary funding to support the position of Executive Director. Central West LHIN does not achieve its Ministry LHIN Accountability Agreement (MLAA) obligations. BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Attachment 2 Risk Management Worksheets for the Top 8 Risks 129 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Central West LHIN... Making Healthy Change Happen 130 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Risk Management Worksheet Table 1-Risk Management Worksheet Risk Name: Increased ALC days and/or ER visits for patients/clients waiting for placement in Long-Term Care Homes (LTCHs) Owner: B. Hovey + M. Edmonds Risk Decision (accept, mitigate, transfer, avoid): Mitigate Description of the Risk Event: Access to long-term care is restricted and system flow is impacted resulting in an increase in ALC days for hospital admitted patients waiting for LTCH placement; and/or ER visit volumes and/or admissions to hospital 131 Risk ID #: 3 (Component of Q1 2016/17 Quarterly Report to the MOHLTC) Date Identified: September 2013 Date of Last Review: ß November 31, 2013 ß February 27, 2014 ß May 16, 2014 ß August 21, 2014 ß November 18, 2014 ß February 12, 2015 ß May 22, 2015 ß August 21, 2015 ß October 6, 2015 ß February 16, 2016 ß May 11, 2016 Date of Last Revision: ß March 12, 2014 ß September 10, 2014 ß February 12, 2015 ß June 5, 2015 ß August 21, 2015 ß September 8, 2015 ß February 16, 2016 Risk Status (pending acceptance, open, realized, expired): Open Mitigation/Prevention Options: ÿ Reduce demand for Long-Term Care (LTC) by increasing resources in community-based programs such as BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE increase from LTCH clients waiting in the community for placement in LTCH, increasing waiting list for LTCH placement. ÿ ÿ ÿ ÿ Probable Causes: Contingency Plan(s): ÿ High occupancy in LTCH and slower turnover of LTCH beds. There will be a temporary reduction in Central West’s LTC bed capacity as a result of the City of Toronto’s – Kipling Acres LTCH Redevelopment: ß ß assisted living, day programs and home care When warranted, increase the number of Assess and Restore and LTCH beds dependant on capacity and funding to implement LHIN worked with the MOHLTC to reallocate BIA funding to alternate services that can mitigate the impact on the temporary loss of LTCH capacity in the community. The funding reallocation has been aligned with the targeted occupancy timeframe Produce a multi-year redevelopment plan for the eligible LTC homes in keeping with the schedule developed by the MOHLTC. Develop a plan to maintain an appropriate number of beds per 1000 population. Phase 1 – 75 Beds in Abeyance (BIA) beds: October 31, 2013 to December 31, 2015 Phase 2 – Additional 70 BIA beds (total 145 beds) to September, 2016. ÿ Aging LTCH capital infrastructure, resulting in less than desirable accommodations ÿ Government policy not aligned with capacity (e.g. people can wait until a bed becomes 2 132 ÿ Stem demand for LTC by increasing capacity in community-based services for seniors such as enhanced community programming – wait at home/ stay at home / home first, home care, assisted living, and adult day programs ÿ Creation of temporary LTCH beds in Region of Peel Homes ÿ Collaborative flow strategies working with Central West HSPs ÿ Creation of restorative care beds in Brampton and Orangeville to reduce the impact of temporary loss of capacity. BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE available in their preferred place, there are empty beds in undesirable facilities) ÿ Service pressures due to growth in the elderly population ÿ In January 2016, Kipling Acres informed the LHIN of a delay in construction for Phase II. Occupancy is set for September 2016 but the programs funded by the BIA money will ramp down in June 2016. This two month gap in program availability may lead to an increase in time to placement in LTC. Probability & Impact: 9 Probability:3 Impact:3 Triggers: ÿ ALC rates increase for hospital patients waiting for LTCH placement ÿ ER visit volume increases for clients waiting for placement to LTCH ÿ Admissions to acute services increase for clients waiting for placement in LTCH ÿ Ramp down of programs funded by BIA may cause an increase in ALC rates. ÿ Increase in time to placement and waitlists, and reduced occupancy in LTCH. #3 3 133 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Risk Management Worksheet Table 1-Risk Management Worksheet Risk Name: Able to meet future needs of population Owner: M. Edmonds Risk Decision (accept, mitigate, transfer, avoid): Mitigate Description of the Risk Event: Access to health services locally is limited due to availability of funding that is unable to keep pace with the demands and needs of an increasing population. Risk ID #: 15 Date Identified: June 2013 Date of Last Review: ß November 31, 2013 ß February 27, 2014 ß May 16, 2014 ß August 21, 2014 ß November 21, 2014 ß February 25, 2015 ß May 22, 2015 ß August 28, 2015 ß November 6, 2015 ß February 16, 2016 ß May 11, 2016 Date of Last Revision: ß November 31, 2013 ß August 21, 2014 ß February 25, 2015 Risk Status (pending acceptance, open, realized, expired): Open Mitigation/Prevention Options: ÿ Focus on reducing severity of the impact, rather than on probability of occurrence ÿ On-going efforts with MOHLTC to address and improve historical underfunding, for example, HBAM, HSFR, annual funding increases ÿ LHIN in partnership with local HSPs works within annual planning cycles and processes to address high needs and support high impact initiatives to mitigate impact 134 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE ÿ Work with community and HSPs on development of IHSP and annual planning cycles ÿ LHIN to continue advocacy for more equitable funding / population based funding ÿ Focus on promotion and prevention strategies where able, to improve population health ÿ Based on IHSP strategic direction - Improve Access to Care - catalogue services, monitor utilization and analyze trends, determine capacity, prioritize funding increases, seek funding for areas of care that require additional capacity, monitor best practices, implement a system of health care ÿ Focus increases in community-based funding to MOHLTC and LHIN priorities to improve and expand care in the community ÿ Utilize community capacity study findings as a tool for identifying and direction for addressing local needs. Probable Causes: Contingency Plan(s): ÿ Very high population growth LHIN – population growth far exceeding funding growth ÿ Historical underfunding issue not being corrected quickly enough ÿ New funding models based on historical “base”, funding and utilization ÿ No MOHLTC appetite for “repatriation” in models – bringing people closer to home – beyond new funding models ÿ May be data quality issues informing new funding models ÿ Seniors, though not high in numbers, have high rate of growth and relatively high users of health resources ÿ Large number of births and large cohort of children 2 135 ÿ The LHIN continues to undertake in year allocation/reallocation to address unforeseen pressures that can be addressed to maximize available resources ÿ Where able, increase capacity in community settings by providing additional funding for in-home care ÿ Stem demand for LTC by increasing capacity in community-based services for seniors, such as home care, assisted living housing, and adult day programs. BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE ÿ Individuals "fall through the cracks" due to insufficient services and navigation supports being in place (mental health, addiction, seniors). Probability & Impact: 12 Probability: 4 Impact: 3 Triggers: Longer waiting lists Increased volumes of requests Higher occupancy rates Complaints and media reports Longer waiting lists for services ABP reporting identifies missed targets Increased ALC days in acute care and rehab beds ÿ Increased use of ER. ÿ ÿ ÿ ÿ ÿ ÿ ÿ #15 3 136 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Risk Management Worksheet Table 1-Risk Management Worksheet Risk Name: Ministry LHIN Accountability Agreement (MLAA) achievement Owner: B. Hovey Risk Decision (accept, mitigate, transfer, avoid): Mitigate Description of the Risk Event: Central West LHIN does not achieve its MLAA obligations. Risk ID #: 27 Date Identified: August 2013 Date of Last Review: ß November 31, 2013 ß February 27, 2014 ß June 9, 2014 ß September 4, 2014 ß November 30, 2014 ß March 2, 2015 ß June 2, 2015 ß September 8, 2015 ß November 12, 2015 ß March 7, 2016 ß May 24, 2016 Date of Last Revision: ß November 31, 2013 ß June 9, 2014 ß September 10, 2014 ß June 2, 2015 ß November 12, 2015 Risk Status (pending acceptance, open, realized, expired): Open Mitigation/Prevention Options: ÿ Orientation of new Board and staff members includes review of the MOU and MLAA documents ÿ Assure LHIN compliance declarations are developed and approved, as required 137 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE ÿ LHIN works with the MOHLTC to ensure that realistic and achievable targets are developed and finalized in a timely manner ÿ Assure quarterly meetings with the MOHLTC on LHIN performance are comprehensive and clearly identify challenges, as well as accomplishments ÿ Assure LHIN quarterly financial and risk reporting to the MOHLTC is comprehensive ÿ Assure funding complies with MOHLTC directives ÿ Assure that the ABP reflects the IHSP and aligns with major strategies within the LHIN that meets the LHIN’s obligation to manage the performance of the local health system ÿ Hold regular meetings with HSPs to review performance and related targets ÿ Annual audit of the LHIN ÿ Work of the Central West LHIN Quality Committee – establishing System Level AIMS – linked to IHSP3 and MLAA performance to drive improvement ÿ Patient Flow and Wait Time initiatives with Central West HSPs align and monitor efforts to improve performance. Probable Causes: Contingency Plan(s): ÿ HSP financial and volumes forecasts inaccurate ÿ Unexpected financial and volumes pressures lead to non-compliance ÿ Performance obligations not met by HSPs leading to MLAA targets not being met ÿ MLAA targets not reflective of system performance capability 2 138 ÿ Notify the MOHLTC in a timely manner of a performance factor that may prevent the LHIN from meeting its MOU / MLAA obligations ÿ If applicable, renegotiate financial and/or performance requirements ÿ Ensure that the LHIN Board has understanding of factors leading to non- BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE ÿ LHIN’s internal systems not sufficient to meet financial/performance and reporting requirements ÿ Delay in finalization of provincial Wait Time Strategy allocations – not keeping pace with demand. compliance and degree to which the LHIN can aid with improving performance. Triggers: Probability & Impact: 8 Probability: 4 Impact: 2 ÿ Forecasts of an unbalanced position ÿ Performance failing to meet negotiated targets (MLAA indicators) ÿ Non-compliance with the terms of the MLAA ÿ MOHLTC notifies the LHIN of outstanding obligations. #27 3 139 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Risk Management Worksheet Table 1-Risk Management Worksheet Risk Name: Lack of physician support for LHIN initiatives Owner: M. Edmonds + D. Pearson Risk ID #: 58 Risk Decision (accept, mitigate, transfer, avoid): Mitigate 140 Date Identified: June 2013 Date of Last Review: ß November 31, 2013 ß February 27, 2014 ß June 9, 2014 ß September 4, 2014 ß November 21, 2014 ß February 25, 2015 ß May 22, 2015 ß August 28, 2015 ß November 6, 2015 ß February 16, 2016 ß May 11, 2016 Date of Last Revision: ß December 10, 2013 ß February 10, 2014 ß March 21, 2014 ß June 19, 2014 ß September 11, 2014 ß November 21, 2014 ß May 22, 2015 ß August 28, 2015 ß November 6, 2015 ß February 16, 2016 ß May 11, 2016 Risk Status (pending acceptance, open, realized, expired): Open BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Description of the Risk Event: Mitigation/Prevention Options: Lack of physician support for LHIN initiatives (e.g. Health Links). ÿ Implement a managed growth model of physician engagement / relationship development ÿ Continue to invest in local physician’s development through initiatives like Rotman Leadership Program offered by the University of Toronto ÿ Continue efforts to work with Ontario Medical Association (OMA) and Ontario College of Family Physicians (OCFP) physician leaders ÿ Support work of Primary Care Lead ÿ Continue the work of the Primary Care Network ÿ As appropriate, revitalize the Health Professionals Advisory Committee. Probable Causes: Contingency Plan(s): Physicians are not accountable to the LHIN Perception of time commitment Poor communications by LHIN No remuneration for time and involvement Government relations with physicians - no OMA agreement, with physicians feeling unvalued and dis-empowered, mounting legal and media campaign ÿ Attention associated with Patients First discussion paper related to the LHIN’s expanding role in primary care planning and monitoring may provoke negative reactions in some segments of physician community. ÿ ÿ ÿ ÿ ÿ Probability & Impact: 9 Probability: 3 Impact: 3 ÿ Continue efforts to work with OMA/OCFP physician and executive leadership ÿ “Go to them” approach. Don’t expect physicians to come to the LHIN - the LHIN will be nimble and go to them. Triggers: ÿ Inability to advance physician enabled projects 2 141 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE ÿ Provincial OMA negotiations ÿ Resignations/non-renewal of contracts with existing physician leads. #58 3 142 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Risk Management Worksheet Table 1-Risk Management Worksheet Risk Name: Central West CCAC Service Volume Pressures Owner: B. Hovey + T. George Risk ID #: 78 Risk Decision (accept, mitigate, transfer, avoid): Mitigate Description of the Risk Event: Central West CCAC (CW CCAC) has continued to prioritize clients based on high acuity, which may result in lower acuity clients not receiving home care services. This can potentially impact escalation of hospital ED volumes and ALC days. 143 Date Identified: July 15, 2014 Date of Last Review: ß August 18, 2014 ß September 4, 2014 ß November 26, 2014 ß February 23, 2015 ß May 25, 2015 ß September 1, 2015 ß November 5, 2015 ß March 9, 2016 ß May 11, 2016 Date of Last Revision: ß August 18, 2014 ß September 4, 2014 ß September 16, 2014 ß November 26, 2014 ß February 23, 2015 ß June 5, 2015 ß September 1, 2015 ß March 9, 2016 Risk Status (pending acceptance, open, realized, expired): Open Mitigation/Prevention Options: ÿ The LHIN brings the CW CCAC and the hospitals together to develop mitigation strategies to maintain system flow ÿ The CW CCAC commits to balancing its budget within the respective fiscal year BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE ÿ Based on a balanced budget position, the CW CCAC develops an analysis of client services and the associated impact on the provision of these services ÿ The Central West LHIN will continue to work with the MOHLTC and the CW CCAC to maximize the allocation of additional funding ÿ Ongoing communication strategies to monitor impact ÿ Appropriate allocation of additional funds, when available. Probable Causes: Contingency Plan(s): ÿ Delay in funding announcements ÿ High population growth rate in the Central West LHIN ÿ Increasingly complex and resource-intense patients presenting for care ÿ CW CCAC’s inability to align resources that match demand in the respective fiscal year. ÿ Early determination of annual funding to CW CCAC, if any ÿ LHIN staff will consider CW CCAC pressures in the in-year reallocation process. Triggers: Probability & Impact: 9 Probability: 3 Impact: 3 ÿ Increase in patient referrals ÿ Projected CW CCAC deficit ÿ Other Health Service Providers inform the LHIN that CW CCAC services are not keeping pace with demand ÿ Client complaint(s) ÿ Client advocate/Ombudsman expresses concern on behalf of a client ÿ Increased ED visits from the community. 2 144 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE # 78 3 145 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Risk Management Worksheet Table 1-Risk Management Worksheet Risk Name: Maintenance of the Self – Reporting Initiative (SRI) System Owner: B. Hovey + Neil McIntosh Risk Decision (accept, mitigate, transfer, avoid): Accept Description of the Risk Event: Performance management of Health Services Providers (HSPs) is a core LHIN mandate. The information used to assess performance and adherence to volumes and targets specified in Service Accountability Agreements entered into between the LHINs and HSPs, is inputted and stored in the SRI system - a MOHLTC purchased and directed system which ensures all HSP information is commonly and centrally available. The MOHLTC is responsible for the 146 Risk ID #: 80 (Component of Q1 2016/17 Quarterly Report to the MOHLTC) Date Identified: September 17, 2014 Date of Last Review: ß September 17, 2014 ß November 14, 2014 ß November 21, 2014 ß February 23, 2015 ß June 5, 2015 ß July 31, 2015 ß November 2, 2015 ß January 19, 2016 ß May 11, 2016 Date of Last Revision: ß September 24, 2014 ß February 23, 2015 ß June 10, 2015 ß November 2, 2015 Risk Status (pending acceptance, open, realized, expired): Open Mitigation/Prevention Options: ÿ The MOHLTC adopt its full mandate as it is related to the SRI system ÿ If LHINs are required to adopt the mandate as it relates to the SRI system, then additional dedicated FTEs are required ÿ LHIN Senior Management work with the MOHLTC to develop a feasible, mutually acceptable sustainability plan. BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE maintenance of a central information system for both the LHIN and its own use. LHIN's have participated in the implementation of this system and have devoted extensive staff time as an aid to its partners at the MOHLTC, which has experienced internal staffing adjustments and pressures. However, the current SRI system and related HSP reporting process continues to require LHINs to conduct extensive technical work to create the submission forms and the technical specifications documentation that accompany them this is the work for which LHIN staff do not have the requisite technical expertise. Further, the related workload is intensive. In this regard, the LHIN's have not been staffed to deliver this support on a long-term basis. The current approach is not likely to be sustainable, with a significant risk to both the MOHLTC and LHINs in terms of the ability to deliver adequately on the mutual quarterly reporting and performance management mandates, both from a local and provincial perspective. Probable Causes: Contingency Plan(s): ÿ The MOHLTC has experienced internal staffing adjustments and pressures and does not have adequate capacity for SRI maintenance ÿ LHINs not staffed to deliver SRI related support on a long-term basis. Probability & Impact: 6 Probability: 3 Impact: 2 ÿ Excel based quarterly financial and statistical reporting to be submitted to the LHIN by HSPs via email, with a copy shared with the MOHLTC ÿ Planning submissions related to various sectoral SAAs to be submitted to the LHIN via email, with a copy shared with the MOHLTC. Triggers: ÿ SRI Functionality is compromised and reports are corrupted, not saved or inaccessible 2 147 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE ÿ HSP does not capture all funding and volumes data in the lines appropriated in the reporting ÿ Templates may not be uploaded correctly and/or SRI system is not accessible due to technical issues ÿ LHINs may be required to incorporate corrections after the submission deadline, resulting in delays. # 80 3 148 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Risk Management Worksheet Table 1-Risk Management Worksheet Risk Name: Home and Community Care Renewal Owner: S. McLeod Risk Decision (accept, mitigate, transfer, avoid): Mitigate Description of the Risk Event: In December 2015, the Ministry of Health and LongTerm Care (MOHLTC) released a discussion paper that calls for fundamental structural change to the CCAC system and proposes to eliminate the Board and the organization and embed the CCAC functions within the LHIN. There is a risk, should legislation be approved, that during the transition period there is an exodus of key governors, senior leaders, and other staff that could leave the organization vulnerable and risk continuity of service delivery. 149 Risk ID #: 82 (Component of Q1 2016/17 Quarterly Report to the MOHLTC) Date Identified: February 8, 2016 Date of Last Review: ß March 7, 2016 Date of Last Revision: ß Risk Status (pending acceptance, open, realized, expired): Open Mitigation/Prevention Options: ÿ The LHIN has reached out to the Central West CCAC (CW CCAC) at the Governance and staff level to offer support and assistance ÿ The LHIN and the MOHLTC have emphasized the importance of a strong home and community care system and provided assurances that all staff in collective agreements will be protected and there will be a smooth transition to the LHIN, should legislation be approved ÿ The LHIN Board and CW CCAC Board have agreed to establish a joint Governance Committee to oversee a smooth transition, should legislation be approved ÿ The MOHLTC will establish a provincial transition team to oversee communications and a smooth transition of enterprise wide activities, subsequent to the passage of proposed legislation BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE ÿ Once the direction is confirmed, based on passage of proposed legislation, the LHIN will establish a local transition team to manage a smooth transition of staff into the LHIN and begin working closely with CW CCAC management ÿ As soon as possible, subsequent to the passage of proposed legislation, the LHIN will provide key staff an understanding of the process for transition into the new LHIN organization and ideally with assurances regarding their individual roles. Probable Causes: Contingency Plan(s): ÿ Governors, senior staff, and staff of the CW CCAC are leaving because they do not see a future for themselves at the organization or they do not agree with the proposed change. ÿ Development of a local communications strategy for the public and for staff to provide assurances that home and community care services will not be impacted during the transition ÿ If governance oversight is of concern, then the LHIN Board may assume greater oversight during the transition ÿ If there is a loss of key senior staff positions, temporary / interim appointments could be used to fill the gaps. Probability & Impact: 9 Probability: 3 Impact: 3 Triggers: ÿ CW CCAC advises that they are losing key individuals and/or are unable to recruit to key positions ÿ CW CCAC advises that Board members are resigning or simply not engaging as part of the Board. 2 150 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE #82 3 151 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Risk Management Worksheet Table 1-Risk Management Worksheet Risk Name: Sustainability of United Achievers Owner: B. Hovey + N. McIntosh Risk Decision (accept, mitigate, transfer, avoid): Mitigate Description of the Risk Event: The viability of United Achievers as an organization and provision of services to its clients is at risk, as it has lost temporary funding to the support the position of Executive Director. Probable Causes: Risk ID #: 83 (Component of Q1 2016/17 Quarterly Report to the MOHLTC) Date Identified: May 13, 2016 Date of Last Review: ß May 13, 2016 Date of Last Revision: ß Risk Status (pending acceptance, open, realized, expired): Open Mitigation/Prevention Options: ÿ Implement enhanced monitoring/ reporting for United Achievers ÿ Establish quality indicators as part of the enhanced monitoring process ÿ Implement regular meetings to discuss performance and quality results. Contingency Plan(s): ÿ Loss of funding support from the third party funder. Probability & Impact: 8 Probability: 4 Impact: 2 ÿ Withdraw funding from United Achievers and identify another suitable Health Service Provider (HSP) to deliver services currently being provided. Triggers: ÿ Departure of Executive Director from United Achievers ÿ Failure to submit regular financial reports on a quarterly basis. 152 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE ÿ Inability to communicate with United Achievers ÿ A worsening financial position. ÿ Failure to meet service volume targets ÿ Non-compliance with MSAA obligations and/or timelines. # 83 2 153 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Risk Management Worksheet Table 1-Risk Management Worksheet Risk Name: LHIN Board Member Turnover Owner: S. McLeod Risk Decision (accept, mitigate, transfer, avoid): Mitigate Description of the Risk Event: The LHIN Board of Directors has 3 or more vacancies creating a challenge for the Board as a whole to meet their governance obligations with a reduced number of appointed Board members. Tenures of three members of the Central West LHIN Board of Directors will be ending between June and October 2016. The LHIN has initiated the process of filling the resulting vacancies. However, based on previous experience with the Public Appointments Secretariat (PAS), appointments or reappointments of Board Members do not happen in a timely way leaving vacancies on the Board at any one time (3 or more). Filling these vacancies is crucial to the efficient governance of the LHIN from a strategic oversight perspective, as departing Board members are either Chairs or members of the following key committees: ÿ Finance & Audit Committee 154 Risk ID #: 85 (Component of Q1 2016/17 Quarterly Report to the MOHLTC) Date Identified: May 17, 2016 Date of Last Review: ß May 17, 2016 Date of Last Revision: ß May 24, 2016 Risk Status (pending acceptance, open, realized, expired): Open Mitigation/Prevention Options: ÿ The Board Governance Committee and the Nominations Committee monitor status of all Board Member appointments on a regular basis ÿ The Board through the CEO/Board Liaison ensures that there are internal processes in place to complete submissions for appointment and reappointment on a timely basis (at least 6 months in advance) ÿ The Board Liaison establishes a strong relationship with staff in the PAS to gain insight into the process, understand Central West LHIN submission status, and advance issues as required ÿ The Nominations committee works to ensure appropriate recruitment approaches for members based on pending vacancies and the skills based assessment of needs BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE ÿ CEO Performance Review & Compensation Committee ÿ Governance Committee ÿ Quality Committee. Probable Causes: ÿ The Committee and the Chair maintain a list of potential Board members who may be worth considering. Contingency Plan(s): ÿ Poor advance planning on the part of the LHIN to initiate the process early enough ÿ Delays on part of the PAS or the Ministers office in processing of submissions from the LHIN. ÿ Challenges in recruitment of qualified Board Members. ÿ Delays resulting from the complex multi-level review process before appointments are finalized. Probability & Impact: 9 Probability: 3 Impact: 3 ÿ In the event of significant reduction in the number of Board members, the Chair and CEO would raise this issue as a matter of urgent attention to the MOHLTC / Minister’s office. ÿ Where key gaps on committee’s occur, the Chair, in collaboration with Board Members would appoint members to concurrent Board committees for an interim period to ensure that LHIN governance and oversight is not impacted ÿ If the number of Board members becomes so low, the Board will operate as a committee of the whole. Triggers: ÿ Board members terms of appointments coming due and appointment process is not seeming to progress ÿ 3 or more vacant Board member positions. 2 155 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE #85 3 156 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Attachment 3 Central West LHIN Enterprise Risks – Changes in Relative Priority Rankings Number of Risks by Relative Priority Before Risk Mitigation & Contingency March 2016 PROBABILITY IMPACT 1. Rare 2. Unlikely 3. Possible 4. Likely Number of Risks by Relative Priority After Risk Mitigation & Contingency June 2016 PROBABILITY IMPACT 5. Almost Certain 5. Extreme 5. Extreme 4. Significant 4. Significant 3. Moderate 3. Moderate 2. Minor 2. Minor 1. Insignificant Note: Cells contain the number of risks that received this ranking based on probability x impact 157 1. Rare 2. Unlikely 3. Possible 4. Likely 5. Almost Certain BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Briefing Note Report to: Agenda Number: Subject: Purpose: Date: Key Contact(s): Central West LHIN Board of Directors Item # 5.3 Annual Report 2015-2016 (AR 2015/16) For Review and Approval Wednesday, June 22, 2016 ∑ Scott McLeod, CEO ∑ Mark Edmonds, Acting Senior Director, Health System Integration ∑ Tom Miller, Director, Communications and Community Engagement Recommended Motion: ∑ That the Central West LHIN Board of Directors approve final draft of AR 2015/16. Background Summary: ∑ An original draft of AR 2015/16 was presented to the Central West LHIN Board of Directors in May 2016. ∑ Edits and recommendations have since been received and incorporated. ∑ A final draft is now presented for review and approval. ∑ Submission deadlines to the Ministry of Health and Long-Term Care, LHIN Liaison Branch, are as follows: English - June 30, 2016 and French – no later than August 31, 2016. Impact Analysis (please check all that apply): ☐Alignment with Strategic Directions ☐Build Integrated Networks of Care ☐Drive Quality and Value ☐Connect and Inform ☐Demonstrate System Leadership ☐Governance Best Practice ☒Operational Excellence ☒Enterprise Risk Implementation Plan: ∑ Following Board approval AR 2015/16 will be printed and submitted to the MOHLTC based on the above noted deadlines. Attachments: ∑ AR 2015/16 Final Draft (Annotated) 158 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Together, Making Healthy Change Happen Annual Report 2015 - 2016 June 2016 159 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE MANDATE The Central West Local Health Integration Network (LHIN) was established under the Local Health System Integration Act (LHSIA, 2006) and given authority to plan, fund, integrate and monitor the local health care system for the purpose of improving the health of residents who live in communities within the LHIN’s geographic boundaries. MISSION To improve access to and the quality of, health services for residents of the Central West LHIN, through strengthened integration and coordination of health care services. CONTENTS 3 Message from the Board Chair and CEO 6 Board of Directors 7 Glossary 8 Overview 9 Section 1 | Context 9 1.1 Strategic Directions and Alignment 10 1.2 By the Numbers 15 Section 2 | Healthy Change 2.1 Improve Access to Care 15 18 19 22 VISION “To create a health care system that helps people stay healthy, delivers good care when people need it and will be there for our children and grandchildren.” 26 2.2.1 Improve linkages with and among primary/family health care and other providers in the health care system 28 2.2.2 Improve System Navigation Resources 28 2.2.3 Increase system collaboration through use of information Technologies 2.3 Drive Quality and Value 30 2.3.1 Ensure an overarching LHIN quality framework 31 2.3.2 Optimize use of health care resources to foster better Value GUIDING PRINCIPLES The Central West LHIN has adopted the following principles to guide its planning processes: Equitable access based on patient/client need Preservation of patient/client choice People-centered, community-focused care that is responsive to local population needs Primary Health/Family Health Care Chronic Disease Prevention and Management Programs Mental Health and Addictions Services Community-Based Services for Seniors 2.2 Streamline Transitions and Navigation of the System VALUES Person-centred Transparency Integrity Stewardship 2.1.1 2.1.2 2.1.3 2.1.4 2.4 Build Momentum 34 36 36 37 38 2.4.1 2.4.2 2.4.3 2.4.4 2.4.5 Aboriginal Health Diversity and Health Equity French Language Services Palliative and End-of-life Care Women’s and Children’s Health 39 Section 3 | Central West LHIN Performance 53 Section 4 | Engaging LHIN Communities 57 The Road Ahead... IHSP 2016-19 62 Financial Statements Measureable, results-driven outcomes based on strategic policy formulation, business planning and information management Shared accountability among providers, government, community Central West LHIN | Annual Report 2015/16 1 and citizens. 160 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Together, Making Healthy Change Happen 161 2 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE TOGETHER, MAKING HEALTHY CHANGE HAPPEN A Message from the Board Chair and CEO Maria Britto Board Chair Scott McLeod CEO The Central West Local Health Integration Network (LHIN) is pleased to present Annual Report 2015-2016 (AR 2015/16),showcasing progress and achievements made during fiscal year April 1, 2015 through March 31, 2016. This represents the the third and final year of the LHIN’s current strategic plan, otherwise known as an Integrated Health Service Plan (IHSP), IHSP 2013-2016. Together, Making Healthy Change Happen takes its title from a shared sense of responsibility. It reflects an understanding and acceptance that by working together, as a collaborative team of health service providers (HSPs), community partners, residents and the LHIN organization, we can do so much more to bring about “healthy change” across the local health care system. Accordingly, during 2015/16 and throughout the entire span of IHSP 2013-2016, it was as a team that the LHIN remained committed to the development of a more accessible and integrated local health care system, responsive to the needs of residents and patients while delivering better value for money. The Central West LHIN was one of the first of Ontario’s 14 LHINs to implement Health Links fully across its entire geographic area and, a majority of LHIN residents (94%) now report having a regular family doctor. The three emergency departments (EDs) located in the Central West LHIN have lower proportions of low acuity visits compared to the province on the whole, and the lowest rate of ED visits among the 14 LHINs for minor conditions including conjunctivitis (pink eye), cystitis (bladder infections), otitis media (earache) and upper respiratory infections (colds). These are conditions that are most appropriately managed by a family doctor, and the low rates of ED visits associated with them suggests that Central West LHIN residents have good access to primary care. Rates of unnecessary ED visits and readmissions to hospital due to complications associated with diabetes have decreased. The continued success of the LHIN’s Regional Telehomecare Program is a strong example of how residents are self-managing their chronic conditions, thereby reducing the number of unnecessary ED visits and hospitalizations. The Central West LHIN spent 2015/16 continuing its work with community and hospital partners to establish the right continuum of adult, community-based mental health and addictions services that are easily accessible by all residents, regardless of where they look for them or who they ask for help. 3 Central West LHIN | Annual Report 2015/16 162 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE With a rapidly growing and aging population, the LHIN undertook a comprehensive, long-term community capacity study of services for seniors, to identify current service gaps and potential future challenges within in the system. As an identified best practice in seniors care, funding to assisted living programs was increased threefold over an eighteen month period, adding 205 assisted living spaces in Shelburne, Orangeville, Brampton, Etobicoke and Woodbridge. A LHIN investment of $1.4M continued to help seniors with complex medical conditions, who have experienced a recent loss of strength or mobility. The LHIN made multi-year Assess and Restore money available to the Central West Community Care Access Centre’s (CCAC’s) home independence program, which provides targeted rehabilitation services to frail elderly in their homes. At the Peel Manor adult day program, community funding was used to extend the hours of operation to accommodate additional seniors every day. There are now nine adult day programs in the Central West LHIN, with a capacity to serve 248 seniors. In support of enhanced access to physiotherapy services, the Central West LHIN provided the Central West CCAC with a base funding allocation of $1.3 million to coordinate expanded home physiotherapy services for 2,036 additional physiotherapy clients, implementing 149 exercise and falls prevention classes in 36 locations across Central West LHIN. Continuing to have positive, sustained results for the patient and local health care system, the LHIN’s regional Telehomecare program enrolled 1,728 patients. The in-Patient admission rate dropped from 1.92 episodes/patient pre -program enrollment, to 0.46 episodes/patient after discharge. Average length of stay decreased, on average, by more than a day post discharge, and the ED visit rate dropped significantly from 3.10 visits/patient pre enrollment to 0.91 visits/patient post discharge. Throughout 2015, the Central West Palliative Care Network (CWPCN) applied the provincial Declaration Document of 2011 to further develop a local palliative care system and, as a founding partner in the development of a joint palliative and end-of-life care “Pledge”, the Central West LHIN took a leadership role in continuing to advance the palliative and end-of-life agenda. The Peel Aboriginal Network (PAN) was recognized as an Indigenous Friendship Centre, and the LHIN will continue to work closely with the Network moving into the next three years. 2015 also saw the ongoing development of a collaborative care project between Reflet Salvéo and the Central West LHIN. Known as the Coalition pour les aînés francophones de Peel (CAF), CAF brings together the collective efforts of le Club du Bel Âge, la Retraite Active et le Cercle des Aînés Noirs Francophones de l’Ontario to help address both current and future service demands for seniors from a Francophone perspective. Following a number of infrastructure announcements in 2013/14 and 2014/15, 2015/16 saw the advancement and physical development of important projects at several sites, including Etobicoke General Hospital (EGH), Headwaters Health Care Centre (HHCC), Kipling Acres, Peel Memorial Centre for Integrated Health and Wellness, Rexdale Community Health Centre and WellFort Community Health Centre. Together, Making Healthy Change Happen 163 4 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Ambitious yet actionable, and flexible in its ability to adapt to the changing needs of the health care environment, it is rooted in the common vision and priorities of Ontario’s Patients First: Action Plan for Health Care, and common objectives of Ontario’s 14 LHINs. Focused on quality and outcomes it is built upon four strategic directions which, together with their respective strategic initiatives and actions, act as the foundation of a bold but realistic roadmap for the local health care community. Working together, these directions, initiatives and actions establish a comprehensive, focused and disciplined approach toward the attainment of desired outcomes, and reaffirm the Central West LHIN’s commitment to put people and patients at the centre of their local health care system … to improve their health care outcomes and experiences. IHSP 2016-2019 provides the Central West LHIN with the foundation necessary to meet new challenges, and to take a leadership role in the advancement of high-quality, patient-centred health care across Ontario. IHSP 2016-19 provides the Central West LHIN with the foundation necessary to meet new challenges, and to take a leadership role in the advancement of high-quality, patient-centred health care across Ontario. Both residents and health care professionals alike place high value on their health care system, and the need for it to be responsive to local communities. The Central West LHIN thanks the many HSPs, community partners and local residents who have actively engaged in helping to bring about healthy change across their local health care system. Their dedication, commitment and collaborative efforts toward the provision of high-quality, person-centred, local health care is transforming a bold vision into reality. Is there still a lot more to accomplish… absolutely! With system building there will always be room for improvement. Nevertheless, , but the local health care system is further ahead today than when the Central West LHIN was first established a decade ago. Is the LHIN up to the challenges that lie ahead… lLet there be no doubt, the LHIN is up to the challenges answer is a resounding yes! that lie ahead and together, we will make healthy change happen. Kindest Regards, Maria Britto Board Chair, Central West LHIN 5 Scott McLeod Chief Executive Officer, Central West LHIN Central West LHIN | Annual Report 2015/16 164 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE BOARD OF DIRECTORS Maria Britto * Chair June 9/11 – June 8/14 June 9/14 – June 8/17 * Denotes Reappointment Hon. John McDermid * Vice Chair Adrian Bita Director Lorraine Gandolfo * Director Suzan Hall * Director June 9/11 – June 8/14 June 9/14 – June 8/17 May 6/15 – May 5/18 Oct. 27/10 – Oct. 26/13 Oct. 27/13 – Oct. 26/16 May 17/11 – May 16/14 May 17/14 – May 16/17 Gerry Merkley * Director Jeff Payne Director Ken Topping * Director June 17/10 – June 16/13 June 17/13 – June 16/16 Pardeep Singh Nagra * Director May 27/15 - May 26/18 June 9/11 – June 8/14 June 9/14 – June 8/17 Oct. 6/10 – Oct. 5/13 Oct. 6/13 – Oct. 5/16 Together, Making Healthy Change Happen 165 6 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE GLOSSARY ABP ALC AR BCH BSO CAF CCAC CDPM CHC(s) CHF COPD CSS(s) CWPCN ED(s) EGH EMR FHG(s) FHO(s) FHT(s) FLS 7 Annual Business Plan Alternate Level of Care Annual Report Brampton Civic Hospital Behavioural Supports Ontario Coalition pour les aînés francophones de Peel Community Care Access Centre Chronic Disease prevention and Management Community Health Center(s) Congestive Heart Failure Chronic Obstructive Pulmonary Disease Community Support Service(s) Central West Palliative Care Network Emergency Department(s) Etobicoke General Hospital Electronic Medical Record Family Health Group(s) Family Health Organization(s) Family Health Team(s) French Language Services H2H HHCC HIP HRM HSP(s) HQO IAR IDEAS IHSP IM IT LHIN(s) LHSIA LTC MOHLTC OTN PAN SAM InSTED QBP(s) Hospital to Home Headwaters Health Care Centre Home Independence Program Hospital Report Manager Health Service Provider(s) Health Quality Ontario Integrated Assessment Record Improving and Driving Excellence Across Sectors Integrated Health Service Plan Information Management Information Technology Local Health Integration Network(s) Local Health System Integration Act Long-Term Care Ministry of Health and Long-Term Care Ontario Telemedicine Network Provincial Aboriginal Network System Access Model Short-Term Emergency Department Diversion Quality-Based Procedure(s) Central West LHIN | Annual Report 2015/16 166 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE OVERVIEW An extension of IHSP 2013-2016, Annual Report 2015-2016 showcases the progress and achievements made for the fiscal year beginning April 1, 2015 and ending March 31, 2016. It outlines how together, with local health service providers (HSPs) and the broader health care sector, the Central West LHIN has made notable gains related to the strategic directions identified in IHSP 2013-2016, and specific actions identified in ABP 2015-2016. Highlights include... Section 1 | Context - Overview of the Central West LHIN’s strategic directions; alignment with the Ministry of Health and Long-Term Care (MOHLTC) and pan-LHIN priorities; and, population and health profiles of local residents. Section 2 | Healthy Change - Specific achievements and progress made in support of ABP 2015-16 and IHSP 2013-2016. Section 3 | Central West LHIN Performance Indicators - Review of 2015/16 system performance and financial accountabilities established between the MOHLTC and Central West LHIN. Section 4 | Engaging Central West LHIN Communities - Summary of communications and community engagement activities during the 2015/16 fiscal year. “The Road Ahead” - Looking ahead to IHSP 2016-2019. Financial Statements - Comprehensive outline of the Central West LHIN’s audited financial statements including an independent auditor’s report, statements of financial position, activities, changes in net debt and cash flows. Together, Making Healthy Change Happen 167 8 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE CONTEXT 1.1 Strategic Directions and Alignment Aligned with Ontario’s first Action Plan for Health Care, IHSP 2013-2016 focuses on four strategic directions and their related initiatives. It outlines the Central West LHIN’s priorities with respect to placing patients first, building a more accessible and integrated local health care system responsive to their needs while simultaneously delivering better value for money. 9 Central West LHIN | Annual Report 2015/16 168 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE 1.2 By the Numbers Population Profile The Central West LHIN has grown substantially over the past decade, from 740,000 residents in 2006 to over 922,000 present day (seven percent of Ontario’s population). With the highest projected growth rate in the province, over 17,000 new residents each year, the LHIN’s population is expected to grow to almost 1.1 million by 2025. Not only is the Central West LHIN’s population growing, it is aging. By 2025, the population of seniors (those aged 65 or more) is expected to increase by 62%, from 111,000 to 180,000. One of the most geographically and ethnically diverse LHINs in the province, 86% of LHIN residents reside in urban areas, 8% in a suburban setting and 7% in rural communities. 47% of residents are immigrants, seven percent of whom are new to Canada within five years.The LHIN is also home to over 14,000 Francophone residents and 5,600 residents who self-report as aboriginal people. Over the past five years, notable investments have improved access to a variety of health care programs and services in the Central West LHIN. Regardless of the challenges associated with the realities of a rapidly growing, ageing, and ethnically diverse population the LHIN,in collaboration with health service providers (HSPs) and community partners, remains committed to the planning, development and delivery of innovative and creative health care programs and services that meet the current and future needs of LHIN communities. Together, Making Healthy Change Happen 169 10 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Home to over 920,000 residents, the Central West LHIN is a mosaic of geographic and cultural diversity 11 Central West LHIN | Annual Report 2015/16 170 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Health Profile and Access to Care Timely and appropriate access to primary health care are key objectives identified in Ontario’s first Action Plan for Health Care and IHSP 2013-2016. While almost all ( 94%) of LHIN residents report having a regular primary care provider, only 53% report the ability to see a primary care provider on the same or next day when sick. These indicators are particularly important for the Central West LHIN’s population given the prevalence of certain chronic conditions and premature mortality. Between 2009 and 2013 the proportion of Central West LHIN residents with at least one chronic condition decreased, and is significantly lower than the province. Prevalence decreased for every chronic condition, with the exception of Chronic Obstructive Pulmonary Disease (COPD). The prevalence rate of COPD doubled in the Central West LHIN, from 2.1% to 5.0%, while Ontario’s rate remained the same. Meanwhile, given the unique blend of an unprecedented growth in the seniors population combined with higher proportions of high risk ethnic groups residing within the Central West LHIN, the prevention and management of diabetes will continue to remain a local priority. Many chronic conditions can be prevented or their onset delayed. Smoking, misuse of alcohol, excess weight, poor diet and physical inactivity are well established modifiable risk factors for many chronic conditions. The Central West LHIN has the lowest percentage of smokers (12%) and the second lowest proportion of heavy drinkers (12%) in the province. Conversely, rates for obesity (56%) and physical inactivity (54%) are higher than provincial values. In 2015/16, there were 256,437 ED visits to hospitals in the Central West LHIN, an increase of 18% over 2010/11. With 27% more visits annually than the next busiest site, Brampton Civic Hospital (BCH) is home to the busiest ED in Canada. Hospitals in the Central West LHIN had the lowest rate of visits best treated in alternative primary care settings (a 30% reduction since 2010/11), meaning that the very high number of ED visits are appropriate. ED length of stay for patients discharged home from EDs in the Central West LHIN consistently meets provincial targets. However, length of stay for patients requiring admission to an inpatient bed is substantially higher than target, suggesting a need for continued investment in inpatient capacity. Together, Making Healthy Change Happen 171 12 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Health Care Resources and their Use Over the past seven years a 21% increase in base funding, totalling $156 million (from $727 million in 2009/10 to $883 million in 2015/16), has resulted in improved access to a variety of health care programs and services in the Central West LHIN. More specifically, through a budget of $883 million provided by the MOHLTC, the Central West LHIN funds HSPs and community partners in the regions of Brampton, Caledon, Dufferin County, Malton, north Etobicoke and west Woodbridge. 2 hospital corporations across three sites… attending over 70,000 hospital admissions and 250,000 emergency department visits/year 1 Community Care Access Centre (CCAC)… serving over 32,500 clients/year 23 Long-Term Care (LTC) Homes … providing an estimated 750,000 resident days/year 2 Community Health Centers (CHC) across 5 locations… delivering over 25,000 primary care visits/year 15 Community Support Service (CSS) agencies… offering services to over 40,000 clients/year 8 mental health and addictions organizations… providing over 20,000 interactions to local LHIN residents/year. Service Accountability Agreements (SAAs) Funded HSPs Base Funding % of LHIN Funding Acute Care Hospitals 2 $533,247,731 60.4% Community Care Access Centres (CCACs) 1 $115,820,159 13.2% Community Health Centres (CHCs) 2 $12,182,882 1.5% Community Support Services (CSS) 15 $22,791,232 2.6% Long-Term Care (LTC) Homes 23 $158,625,567 17.9% Mental Health and Addictions Services Total 13 8 $37,883,405 4.4% 52 $883,716,367 100% Central West LHIN | Annual Report 2015/16 172 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE SIGNIFICANT sector investments* over the past seven years to improve the health and healthy outcomes of Central West LHIN residents. (*Increase from 2009/10 yearend, to 2015/16year-end) Hospitals $465,884,631 $533, 247,731 Community Care Access Centres $77,593,209 $115,820,159 Community Health Centre’s $6,668,770 $12,182,882 Long-Term Care Homes $136,059,183 $158,625,567 Mental Health and Addictions $30,647,492 $37,883,405 $67,363,100 or 14% $38,226,950 or 49% $5,514,112 or 83% $22,566,384 or 17% $7,235,913 or 24% Community Support Services (incl. Assisted Living) $11,523,426 $22,791,232 $727,403,702 (2009/10) $11,267,806 or 98% $883,716,367 (2015/16) $156,312,665 or 21% Together, Making Healthy Change Happen 173 14 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE HEALTHY CHANGE “Healthy Change” reflects upon local initiatives, specific work and accomplishments related to the four strategic directions identified in IHSP 2013-2016 including Improve Access to Care, Streamline Transitions and Navigation of the System, Drive Quality and Value, and Build on the Momentum. These activities outline how, together with health service providers (HSPs) and community partners, the Central West LHIN has continued to place patients first throughout 2015/16. 2.1 Improve Access to Care 2.1.1 Improve Access to Primary/Family Health Care Throughout 2015/16 the Central West LHIN continued to work with Family Health Teams (FHTs), Community Health Centres (CHCs), and other primary care practitioners practicing in other models of organized care, to ensure residents have timely access to multi-disciplinary primary care, provided in appropriate settings as close to home as possible. Of note, the LHIN is working with providers to develop systems and processes that will prevent or delay deterioration in the activities of daily living, whch will reduce avoidable admissions to hospital and applications to Long-Term Care. Current Status | Approximately 560 family physicians provide care throughout the Central West LHIN (*Ontario Physician Health Data Resource Centre, 2013). Residents have access to six FHTs, two CHCs, 33 Family Health Groups (FHGs), 13 Family Health Organizations (FHOs), and over 180 individual fee-for-service practitioners. Attachment to a primary care physician is high, with 94% of residents of the Central West LHIN reporting they had a regular family doctor in 2015 (*Health Care Experience Survey, December 2015). While most residents report having a family doctor, only 53% of residents reported that they could see their primary care provider on the same or next day when sick. 15 Central West LHIN | Annual Report 2015/16 174 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Residents do not appear to be turning to local emergency departments (EDs) for conditions that should be manageable within the community. Despite Brampton Civic Hospital (BCH) having the busiest ED in both Canada and Ontario (137,818 visits in 2015/16, as compared to 123,132 at Humber River Regional in Ontario), the three EDs in the Central West LHIN have lower proportions of low acuity visits compared to the province as a whole (Canadian Triage and Acuity Scale (CTAS) IV/V: 17% vs. 32%) and the lowest rate of ED visits among the 14 LHINs for conditions such as conjunctivitis, cystitis, otitis media and upper respiratory infections, that could be treated in primary care settings (1.1 per 1,000 population aged 1-74 years in 2013/14). As one of the first of Ontario’s 14 LHINs to implement five Health Links fully across its entire geographic area (Bolton-Caledon, Bramalea and Area, Brampton and Area, Dufferin Area and North Etobicoke-Malton-West Woodbridge), the Central West LHIN continued to play a key role in the collaborative design and implementation of Health Links in 2015/16. HealthLinks is an innovative approach to care, designed to drive positive outcomes for patients with complex conditions… patients who typically have multiple diagnoses and complex medication regimens, and whose circumstances significantly impair their ability to perform one or more activities in their daily living. HealthLinks bring together multiple health care providers and their services within a local area - hospitals, family doctors, Long-Term Care Homes, community partners and other organizations – so that everyone involved in a patients circle of care, knows and understands their health goals, shares information, and works collaboratively to place the patients’ needs first. When multiple health service provider’s work together as a team, patients receive better, more coordinated care. HealthLinks places patients at the centre of care, so they can feel supported and more confident about their health and healthy outcomes. HealthLinks Reduce… the need for emergency department visits and inpatient admissions avoidable re-admission to hospitals after discharge time for referral from primary care doctor to specialist appointment applications to long term care Improve… patients’ experience as they navigate in and around the health care system the patients’ quality of life access to family care for seniors and patients with complex conditions. Together, Making Healthy Change Happen 175 16 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Within any given year, the number of complex high needs patients in the Central West LHIN is projected to be approximately 42,000 or five percent of the Central West LHIN’s total population. Based on a common definition of complex high needs patients, ... those with four or more comorbidities, ... ongoing identification of the Health Links patient population continued throughout 2015/16, with Health Links Care Coordinators continuing to develop tailored, individualized care plans for each patient. It is also important to note that throughout 2015/16 the Central West LHIN continued to support the work of the Central West Primary Care Network. Led by the Primary Care Lead, Dr. Frank Martino, this collective supports and develops diverse partnerships and strategies to engage local primary care practitioners, particularly in relation to initiatives such as Health Links. Thanks to the collaborative work of Health Links, HSPs and community partners, the LHIN has increased the capacity of primary care providers to care for the needs of the most complex patients, improving their outcomes through comprehensive individualized care planning among local partners. As the LHIN population grows and ages rapidly over the next several years, Health Links will continue to play an increasingly important role, addressing the capacity of primary care providers to care seamlessly for complex high needs patients and encouraging greater collaboration among local providers in order to improve outcomes. Coordinated Care Improves Outcomes “Nasir”, an 82-year-old married man, who speaks no English, frequently visited his nearby hospital ED to obtain free acetaminophen. A Care Coordinator and translator, from the local Health Link associated with the Central West CCAC, discovered that Nasir had been visiting the ED to relieve pain from an untreated hernia. He did not know to arrange for surgery through the specialist he had been referred to. Through the Health Link, the patient’s primary care provider and CCAC Care Coordinator developed a tailored coordinated care plan to meet Nasir’s pre and post-operative needs. Following surgery and post-discharge, the care coordinator continued to work closely with Nasir and his family doctor to ensure receipt of appropriate care in line with the care plan and Nasir’s changing needs. Submitted by the Central West CCAC *Names have been amended to ensure privacy 17 Central West LHIN | Annual Report 2015/16 176 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE 2.1.2 Improve Access to Chronic Disease Prevention and Management Programs Throughout 2015/16, the Central West LHIN worked with community partners to continue to improve the treatment and management of chronic diseases in the community, increasing capacity for the self-management of chronic conditions. This included efforts made to improve the coordination of regional diabetes services, and the ongoing expansion of education and selfmanagement programs for chronic conditions including Congestive Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD). Current Status | The active client caseload for Central West LHIN residents attending local diabetes education programs continued to increase. Despite the LHIN having the third highest prevalence rate of diabetes in Ontario, ryRates of unnecessary ED visits and readmissions to hospital due to complications associated with diabetes... hyper and hypoglycemia... have decreased to below the established target rate of ≤198 per 100,000 populations. Meanwhile, the number of readmissions to hospital within 30 days of discharge, for conditions related to diabetes, was at or below the evidence-based expected rate in all four quarters. These indicators reflect the collective success of the Central West LHIN’s diabetes education and self-management programs. The ongoing success of the LHIN’s regional Telehomecare program is another strong example of how residents are using improvements in technology to self-manage care from the comfort of their own homes, while helping to enable better value through the reduction of unnecessary ED visits and hospitalizations. Commented [A1]: This call out has now been populated with updated content. The Central West Regional Telehomecare Program makes it possible for residents with diabetes, CHF and COPD to self-manage their care from the comfort of home. Patients are referred to the program from a number of regional partners and, through the assistance of technology, are monitored by Telehomecare nurses working from the host organization William Osler Health System (Osler). Evaluations of the first Telehomecare patients revealed a 40% reduction in ED visits and 49% reduction in hospitalizations. These results demonstrate the ability of patients to better self-manage their conditions within their communities, avoiding and preventing unnecessary use of acute/ambulatory services. At the end of 2015/16, theTelehomecare program had enrolled 1,728 clients and continues to have positive sustained results for patients and the healthcare system. Together, Making Healthy Change Happen 177 18 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE In collaboration with William Osler Health System (Osler) and the Wise Elephant Family Health Team, the Central West LHIN was pleased to present the 5th Annual Chronic Disease Prevention and Management Conference. With development of IHSP 2016-2019 taking place throughout most of 2015/16, over 170 participants were challenged to use the conference as an opportunity to "start thinking about tomorrow... today," using the event as as a forum for information gathering and knowledge exchange to inform the IHSP planning process, and plan for the future of the local health care system. The conference also reaffirmed the LHIN’s continued work with community partners to increase capacity for the self-management of chronic conditions in order to improve the treatment and management of chronic diseases in the community. Efforts made to improve the coordination of regional diabetes services will continue, and the expansion of education and self-management programs, including Telehomecare, for chronic diseases including CHF and COPD will move forward. 2.1.3 Improve Access to Mental Health & Addictions Services In 2011, the Ontario government released Open Minds, Healthy Minds: Ontario’s Comprehensive Mental Health and Addictions Strategy, a long-term comprehensive approach to transforming the mental health system. The first three years of this strategy focused on children and youth. In 2015/16, Building on years one through three, which focused on children and youth, the Central West LHIN spent 2015/16 focused on aligning with years four through ten of Open Minds, Healthy Minds: Ontario’s Comprehensive Mental Health and Addictions Strategy. The LHIN expanded beyond the scope of chirdren and youth to More specifically, the LHIN continued its work with community and hospital partners in establishing the right continuum of adult, community-based services, easily accessible for all residents regardless of where they look or whom they ask for help. Current Status | The Central West LHIN funds eight HSPs which collectively delivered over 20,000 mental health and addictions interactions to local LHIN residents in 2015/16. Services range in function, intensity and duration, and include case management, crisis response, counselling and treatment, early intervention, support within housing, residential withdrawal management, diversion and court support, social rehabilitation, recreation, health promotion and employment support. Providers are being guided by a vision for Mental Health and Addictions services that Emerged from a series of discussions among HSPs and the LHIN two years ago - “high quality and seamless services that are easily accessed, efficient, available in a timely way, and meet the changing needs of people over their lifetime”. The LHIN and HSPs discussed existing service capacity, strengths and challenges within the system, and determined priorities for program investments in both 2014/15 and 2015/16. 19 Central West LHIN | Annual Report 2015/16 178 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE An investment of $3.9 million over the past two years has led to a number of notable gains within the Mental Health and Addictions sector. $3.9 MILLION Improved access to Mental Health & Addictions Services Reduced existing combined wait list for long-term case management and early intervention Integration of addiction consultation services for residents working with Health Links to develop a single, coordinated care plan. Enhancement of crisis services whereby clients and their families engage more meaningfully with crisis workers, and involvement of specially trained police officers who, teamed with a regulated health professional, intervene more appropriately. Adoption of person-centered and family-involved crisis planning approach consistent with local child and youth services’ practice that defers to clients to decide more practical strategies for self-managing a crisis, increasing the likelihood that the crisis plan will be followed. Planned implementation is underway. Enhancement of family support and expansion of social rehabilitation/recreation, as a systemic way to support client access to and movement between services with varying levels of intensity as needed. Augmentation of front-line practitioners for short-term case management and brief therapy to respond more immediately to the presenting issue and to more readily assess need for longer term support. Efficient use of known housing stock to provide support within housing to 16 additional individuals and a planned approach for another 84 people, reducing the wait list by 25%. Capability for mental health and addictions staff to provide Together, Making Healthy Change Happen coordinated care in the ED, enabled through access to relevant, electronic clinical records (with client consent) at Osler and the Central West CCAC. 179 20 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Improving the quality and use of crisis services provides residents with an alternative to repeated use of the ED. It also enables first responders to better identify when it is necessary for residents to visit the ED. Accordingly, the LHIN’s Short-Term Emergency Department Diversion (InSTED) matured throughout 2015/16, and is successfully providing clients with immediate short-term case management, often while they are still in the ED. Data shows that the rate of repeat ED visits within 30 days for mental health has improved over the last year. The visit rate for Q4 14/15 through Q3 15/16 (the accountability period for FY 2015/16) is 15.6% better than both the provincial target of 16.3% and provincial performance of 19.2%. Through reporting from Crisis Services and InSTED programs, there appears to be a correlation between these targeted community-based investments and the improvement in mental health repeat visits. For instance, Crisis Services are better identifying the need for a hospital visit through more comprehensive assessments. More of the clients recommended by Crisis Services for an ED visit are triaged as requiring acute care and are admitted, showing that the need for an ED visit was appropriately assessed and the visit was necessary. Clients have also self-reported a 60% reduction in repeat visits for mental health following engagement. Meanwhile, in February 2016, the Canadian Mental Health Association Peel Branch (CMHA Peel) and the Caledon Detachment of the Ontario Provincial Police (OPP) announced expansion of 24.7 Crisis Support Peel into Caledon. The launch of this program with Caledon OPP builds on the success that 24.7 Crisis Support Peel has experienced over the last year in partnership with Peel Regional Police. Since program redesign and enhancement last March, 24.7 Crisis Support Peel has exceeded all expectations with almost 20,000 interactions (calls, visits, follow-ups) with individuals in mental health or addictions crisis. Despite this, the apprehension rate for the program is only 9% (under Section 17 of the Mental Health Act, police have authority to apprehend and take someone to hospital). Almost 100% of those clients have been admitted to hospital, reducing unnecessary ED visits. Over the last three years, attention was focused on development of a System Access Model (SAM) for Mental Health and Addictions services, ensuring alignment to similar initiatives taking place in surrounding LHINs. There is full support to establish coordinated access that provides comprehensive information about support and treatment options based on the level of need, and that facilitates service transitions or interim support while waiting. The SAM was endorsed through consultations with persons with lived experience (consumers), children’s mental health, development services, social services, family services, as well as within mental health and addictions sectors. Scaled, phased implementation is planned for 2016, with one-time investments having helped to build the foundational operating aspects of the model i.e., business processes, clinical screening and assessment tools, service inventory, and pathways. With concurrent evolution of Health Links and coordinated care planning, and advent of the discussion paper Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario, discussions have ensued regarding expanding 21 Central West LHIN | Annual Report 2015/16 180 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE access to care to a more integrated, holistic model across a broader array of services through use of information technologies. Improving mental health services throughout the lifespan is one step toward ensuring the needs of Central West LHIN residents are placed first; that they remain at the centre of care, receiving better access, better quality and better value from their local healthcare system. Through early identification and intervention and enhanced community-based services, the LHIN is working to ensure that residents with mental health and addictions receive timely access to the most appropriate services as close to home as possible. 2.1.4 Improve Access to Community-Based Services for Seniors In 2015/16 the Central West LHIN continued to work with funded community service providers to develop strategies that support seniors in the community, increasing their quality of life. This work is aligned with the province’s Seniors Care Strategy and aims to reduce avoidable ED visits, hospital admissions and Alternative Level of Care (ALC) designations. Current Status | The Central West LHIN funds community-based agencies that deliver services to support the independent living of seniors within the community. Services include social/safety visiting, congregate dining, adult day programs, transportation, exercise/falls prevention, chronic disease management, caregiver support, independence training, psychogeriatrics, assisted living, respite and palliative care. The LHIN also provides funding to the Central West CCAC to deliver nursing care, rehabilitation and personal support services, rapid response nursing, palliative care, community clinics and supportive living. The Central West CCAC also coordinates admission to 23 LTC homes across the LHIN. 24.7 Crisis Support Peel Expanded into Caledon 24.7 Crisis Support Peel is a community crisis service comprised of specially trained plainclothes police officers and mental health professionals. They provide timely response to adults (16 years and over) experiencing a mental health or addictions crisis; individuals having difficulties coping; and family, caregivers and friends needing support. The expansion of this mental health and addictions crisis service builds on the success of 24.7 Crisis Support Peel already in place in Brampton and Mississauga in partnership with Peel Regional Police. 24.7 Crisis Support Peel features an integrated team for maximum flexibility and responsiveness, comprised of mental health professionals and specially trained police officers. Together, Making Healthy Change Happen 181 22 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE In keeping with other crisis models, officers are in plain clothes and drive unmarked vehicles, which can help to reduce the stigma surrounding mental illness and also helps to protect the privacy of the clients. This anonymity also allows clients to feel more at ease with officers, promoting a more open and trusting relationship and allowing the team to conduct a thorough and accurate mental health assessment. Capacity Planning Over the next several years, the Central West LHIN is expected to experience unprecedented growth, higher than that of the province. By 2025, the total LHIN population is expected to surpass 1,099,000, of which nearly 180,000 are expected to be 65 years of age and older. With this rapidly growing and aging population, the LHIN continues to focus on those who are most in need of health care services, and has steadily prepared for this extraordinary growth and increased demand through innovative thinking and current and future planning. Guided by recommendations in Dr. Samir Sinha’s “Living Longer, Living Well” report, the Central West LHIN undertook a comprehensive, long term community capacity study of services for seniors, to identify current service gaps and potential future challenges within in the system. This work contributed to the development of IHSP 2016-19, it represents a truly collaborative effort about a topic of mutual interest among the Central West and Mississauga-Halton LHINs, multiple HSPs, and community partners. The study places patients first by seeking to develop a community health services plan that meets the needs of a growing and aging population in both LHINs… a plan that helps people to stay healthy; delivers high-quality, patient-centred care, where and when needed; and that will be there for their children and grandchildren. . Home and Community Care The Central West LHIN funds 15 Community Support Service (CSS) agencies who collectively serve over 40,000 clients per year. The Central West CCAC serves over 32,500 clients per year. Over the past three years, use of home care services has significantly increased. The number of home care clients in Central West LHIN has increased by 15%, and home care hours have increased by 51%, indicating an increase both in the number and the acuity of home care clients. As the LHIN’s population continues to grow and age, the local health care system is shifting from acute or hospital-based care, to community-based services. As the demand and need for these services continues to grow, the LHIN must consider the capacity of home care services that will be required to meet future demand. Throughout 2015/16, home and community care renewal aimed to keep seniors, particularly the medically complex and frail, safe, healthy and in their homes longer by having physicians, other health care providers and patients work together to ensuringe appropriate access to care in the home and communitysector. As an identified best practice in seniors care, the Central West LHIN increased funding to assisted living programs, adding 205 assisted living spaces in Shelburne, Orangeville, Brampton, Etobicoke and Woodbridge, and bringing the total number of funded places to 629. The Alzheimer Society of Dufferin County and Alzheimer Society of Peel received funds to expand joint “First Link” programs which support individuals living with dementia and their families. 23 Central West LHIN | Annual Report 2015/16 182 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE A LHIN investment of $1.4M continued to help seniors with complex medical conditions who have experienced a recent loss of strength or mobility, making multi-year Assess and Restore funding available to the Central West CCAC’s home independence program (HIP), which provides targeted rehabilitation services to frail elderly in their homes. At the Peel Manor Adult Day Program, community funding was used to extend the hours of operation to accommodate additional seniors every day. There are now nine adult day programs in the Central West LHIN, with a capacity to serve 248 seniors. New base funding was designated to expand adult day service hours, home care, respite programs, caregiver support programs, and Tele-Check programs. And, the LHIN has continued to invest in the Behavioural Supports Ontario (BSO) program, building on successes noted in In 2015/16 the LHIN continued to invest in the highly successful Behavioural Supports Ontario (BSO) propgram . Aa 2014 evaluation of the program indicated that behavioural support champions and psychogeriatric resource consultants embedded in Central West LHIN Long-Term Care Homes, were able to reduce responsive behaviours in identified residents by 47%. Addtionally, results showed a significant decline in the uese of physical restraints and, i in-home assessments that trigger worsening behavioural symptoms. The LHIN continued to build on these success by supporting the Buidling on this success,which showed that 23 behavioural support champions embedded in each of the LTC homes, along with the 7 psychogeriatric resource consultants, were able to reduce the number of responsive behaviours of identified clients by 47%. In addition, the rates of LTC Home assessments that trigger worsening behavioural symptoms have declined, with a noted substantial decline in the reported use of physical restraints. Highly successful, Oover 200 unique BSO program referrals were received in each of the first three quarters of 2015/16, while . while over 4,050 active patients and their caregivers have been supported during that same time period. The Central West CCAC, Headwaters Health Care Centre (HHCC) and Osler, as well as the Ontario Telemedicine Network (OTN) and the Central West LHIN, completed development of the Hospital to Home (H2H) program. An innovative new model of care, H2H helps to improve clinical handoffs and information-sharing when patients leave hospital. This means that patients receive short-term nursing from the same care team after they return home. Right now, H2H is primarily supporting patients with urinary tract infections and cellulitis but will later expand to help those with more complex needs. $1.3M Investment in Exercise and Falls Prevention Together, Making Healthy Change Happen 183 24 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Throughout 2015/16, the Central West CCAC successfully implemented 149 Exercise and Falls Prevention classes across the Central West LHIN. The class structure varies based on the frailty of seniors, with some classes focusing on patients with COPD, and some on stroke patients. The Central West LHIN continues to work with the Central West CCAC and system partners (i.e. City of Brampton) and HSPs to increase referrals and engage seniors. Moving forward, the LHIN will continue to explore innovative ways to increase accessibility and attendance via telemedicine. In addition, a social determinants of health lens will be integrated to maximize seniors’ social engagement and education through cross sector partnerships and collaborations. Magic Abounds when Daycare and Seniors Home Share Same Roof (With thanks to the Toronto Star) In the second-floor lounge at Toronto’s Kipling Acres Long-Term Care home, about 15 seniors in wheelchairs and walkers gather to the throbbing techno beat of “Gangnam Style” by Korean pop rapper PSY. Mary Offen, 82, lights up as the children arrive. Her wheelchair rocks while both feet tap to the music. “I love to dance and I love them,” she says, grabbing the outstretched hands of 3year-old Heaven Tulloch-Rankine. The children from the daycare centre downstairs revel in the adoration and, while some of them are timid at first, they are soon waving colourful pom-poms, shaking tambourines and cuddling up to the seniors. Since the redevelopment of Kipling Acres, and with increased awareness of the benefits of intergenerational connections, daycare has played a larger role in the home. The centre’s playground opens onto a courtyard that serves residents, an adult day program, and a new seniors’ community centre. Lounges with large windows on every floor of the 192bed home also overlook the courtyard so seniors can watch the children play. The “move and groove” sessions along with bimonthly cooking, crafts, bingo and other activities are part of the home’s regular programming to help build connections between the children and the seniors. This is in addition to Halloween costume parades, visits from Santa at Christmas and celebrations for other special days. Opportunities for spontaneous interaction are also encouraged. 25 Children learn through experience and at Kipling Acres, they get to experience another generation they might not see at home. “It was a nice surprise when I saw this,” says Andres Quiroga whose daughter Yolanda, 3, and 20-month-old son, Isaac, attend the centre. “It’s nice for my children to see someone like their grandfather,” says Quiroga. His 75-year-old father lives CentralinWest LHIN | Annual 2015/16 Colombia and theReport children haven’t yet met him. “Yolanda is more kind to older people since coming here,” he says. “She is more interested.” Linda Koslowski, whose 82-year-old mother Stella has Alzheimer’s and has been a resident at Kipling Acres for just over a year, says having a child-care centre in the home has been a wonderful bonus. “My mother loves kids. When I take her out to the mall, we have to stop at 184 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE 2.2 Streamline Transitions and Navigation of the System 2.2.1 Improve Linkages With and Among Primary Health/Family Health Care and other Providers in the Health Care System Through Health Links, the Central West LHIN is commited to supporting increased coordination in primary care settings, ensuring the provision of collaborative community-based care. Health Links is designed to drive positive outcomes for patients with complex conditions… patients who typically have multiple diagnoses and complex medication regimens, and whose circumstances significantly impair their ability to perform one or more activities in their daily living. Current Status | As one of the first of Ontario’s 14 LHINs to fully implement five Health Links across its entire geographic area (Bolton-Caledon, Bramalea and Area, Brampton and Area, Dufferin Area and North Etobicoke-Malton-West Woodbridge), the Central West LHIN continued to play a key role in the collaborative design and implementation of Health Links in 2015/16. Based on a common definition of complex high needs patients, those with four or more comorbidities, ongoing identification of the Health Links patient population continued throughout 2015/16, with Health Links Care Coordinators continuing to develop tailored, individualized care plans for each. Continuing to have positive, sustained results for the patient and local health care system, the LHIN’s Regional Telehomecare Program enrolled 1,728 patients. The inpatient visit rate dropped from 1.92 episodes/patient pre-program enrollment, to 0.46 episodes/patient after discharge. Average length of stay decreased, on average, by more than a day post discharge, and the ED visit rate dropped significantly from 3.10 visits/patient pre enrollment to 0.91 visits/patient post Together, Making Healthy Change Happen 185 26 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE discharge. The Central West LHIN is currently working with OTN to integrate a health equity lens to the program to improve access to vulnerable and marginalized populations in the LHIN. Notably, over the past year, eligible residents with CHF and COPD were better able to self-manage their care with the support of technology placed in their home through the regional Telehomecare program. Patients are referred to the program from a number of regional partners and, through the assistance of technology, are monitored by Telehomecare Nurses working from the host organization William Osler Health System. Two goals of Ontario’s Patients First: Action Plan for Health Care are... “to have a family health care provider for every Ontarian who wants one”, and “to provide more patients with faster, more convenient access to care.” Building upon work accomplished in 2015, Health Links will continue to encourage greater collaboration among existing local health care professionals. It follows that with improved coordination and information sharing, identified residents will receive faster care, spend less time waiting for services, and be supported by a team of health care providers at all levels of the health care system. Commented [A2]: This section call out has now been populated with current information. 27 Central West LHIN | Annual Report 2015/16 186 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Sustained Indications for Health Links Health Links are teams of local health providers who offer patients with complex conditions better coordinated care through the development of care plans that meet the specific needs of the patient to improve transitions among health care providers. The following graph represents inpatient and ED utilization across Central West LHIN Health Links between the period April 1 2015 and September 30, 2015. 606 unique patients with individualized, coordinated care plans are represented. decreased by 31% and ED visits decreased by 29% after care plans were initiated. A “before and after” analysis indicates that total inpatient episodes Commented [A3]: This section call out has now been populated with current information. Together, Making Healthy Change Happen 187 28 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Telehomecare in the Central West LHIN The Telehomecare program enables patients with chronic heart failure (CHF) and/or chronic obstructive pulmonary disease (COPD), who have visited the hospital multiple times, to selfmanage their chronic conditions from the comfort of their own homes or local communities. Ontario’s Telehomecare program has demonstrated consistent outcomes with greater than 50% reductions in hospital ED and IP visits for over 9,000 patients. Through 2015/16 the Central West LHIN Telehomecare program received 3,363 referrals, 1,728 clients were enrolled, and 1,467clients had been discharged. The above graph shows a notable decrease in both inpatient episodes and emergency department visits during and after implementation of Telehomecare. post-discharge ED visit rate dropped by discharge inpatient admissions rate by 75%. In 2015/16, the 71% and post- 2.2.2 Improve System Navigation Resources Throughout 2015/16 the Central West LHIN continued to work with HSPs and community partners to understand and address barriers to system access, developing integrated care pathways and care plans to help understand where and when to access needed health care after discharge from hospital. In so doing, the LHIN sought to partner with community and government agencies to strengthen system navigation and support the establishment and use of services, such as Health Links and Telehomecare. Current Status | Although Llength of stay has decreased and stabalized for for those patients discharged from the ED to home. have decreased and stabilized, ongoing innovation and commitment from all systems partners is required to maintain the positive gains made, while support further improvement. At the same time,Meanwhile, reducing wait times for patients admitted to an inpatient bed remains remains a challenge. there have been increasing difficulties in reducing wait times for patients admitted to an inpatient bed. It follows that there has been a need to direct attention on inpatients, throughput and inpatient admission avoidance through continued focus direct attention on the a system-level view of to patient flow, both within the hospital and at the points of transition between health service providers. Since its inception in 2013, the work of the Central West LHIN Patient Flow Core Action Group has been focused on formulating recommendationsdeveloping and implementing strategies that support thisapproach. to address these issues. In 2015/16, the Central West LHIN remained committed to ensuring residents received improved access to care in the most appropriate settings. LHIN priorities are reflected across a number of priority areas including the Central West CCAC’s expanded role of waitlist management, ongoing support for Home First, development of the Hospital 2 Home program, improving the quality and 29 Central West LHIN | Annual Report 2015/16 188 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE use of crisis services, further implementation of information technologies such as Telehomecare and Telemedicine, and the ongoing implementation of Health Links. 2.2.3 Increase System Collaboration through the use of Information Technologies Information technology (IT) and information management (IM) are enablers for patient empowerment, and secure patient information exchange between providers. They reduce duplication and frustrationby eliminating the need for patients to repeat the same information on multiple occasions to different health care professionals. And, they support patients, their caregivers and health care professionals to share information, coordinating services quickly and efficiently between transitions in care. Current Status | In 2015/16, the Central West LHIN continued to make significant strides in planning and implementing enabling technology solutions. All hospitals in the LHIN are now live using Hospital Report Manager (HRM). HRM electronically delivers medical record reports (e.g. discharge summaries) and transcribed diagnostic imaging reports from hospitals, directly into the patients’ charts in the Primary Care Physicians’Electronic Medical Record (EMR) system. Brampton Civic Hospital (BCH), Etobicoke General Hospital (EGH) and HHCC are continuing to expand electronic access of their hospital reports to primary care physicians and specialists through the use of the HRM product. The Central West LHIN continues to have the highest EMR adoption rate in the province for primary care physicians at 87% (vs. 77%), and specialists at 62% (vs. 30%), enabling the greater sharing of consistent electronic information among HSPs. The Integrated Assessment Record (IAR) allows client assessments to move with the client between HSPs, enabling participating HSPs to upload and view case histories from consenting clients. HSPs are better able to effectively plan, coordinate and deliver care. The tool also streamlines patient information so there is less duplication and faster access to services. Use of the IAR by HSPs in the Central West LHIN is stable at 63%. Providers include the Central West CCAC, 11 Community Support Service Providers, 7 Mental Health Service Providers and 23 LongTerm Care Homes. Throughout 2015/16 the Connecting GTA (cGTA) project continued to work with HSPs to provide a single point of access to patient health information. Osler is live feeding data to the cGTA data repository, and viewing patient information from 11 early adopter hospitals and six CCACs located in the GTA. HHCC, along with 10 additional Central West LHIN HSPs, is included in the cGTA expansion phase, expected to go live in the 2016/17 fiscal year. Represented are HSPs from the Primary Care, LTC Home, Mental Health and Addictions, and Community Support Services (CSS) sectors. In 2015, to better understand IM/IT in the community sector, a survey was issued to Community Sector HSPs across the Central, Central East, Central West and Mississauga Halton LHINs. The survey collected a broad range of data that has been populated into a database tool for analysis. The collated and cleansed data has been assessed and identification of a set of IM/IT opportunities Together, Making Healthy Change Happen 189 30 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE that can be specifically targeted to home and community care HSPs have been identified. Implementation of identified opportunities are currently being assessed for future implementation. The need for central intake processes and a referral management solution to support the intake processes, has been identified by multiple providers for multiple patient care pathways across the Central West LHIN. Work will continue in 2016/17 to identify and define patient care pathways that would benefit from a central intake model and support the implementation of a single referral management solution. Examples of care pathways include Health Link referrals, Mental Health and Additions referrals, Diabetes referrals, and Primary Care to Specialist referrals. The Ontario Lab Information System (OLIS) has collected more than 85% of the provinces lab test results through connections with hospitals, community labs and public health labs. HHCC and Osler continue to populate OLIS with test results from their labs. Approximately 430 clinicians in the Central West LHIN can now view OLIS data for their patients through their EMR systems. 2.3 Drive Quality and Value 2.3.1 Ensure an Overarching LHIN Quality Framework In 2015/16, the Central West LHIN remained hard at work supporting initiatives that improve quality and increase capacity for improvement. The LHIN incorporated patient/client experience into quality indicators, and developed a collaborative and integrated approach with HSPs to support the further development of quality improvement plans and undertake accreditation processes. Current Status | The Central West LHIN is committed to the implementation of a local quality framework and agenda that places patients first, enhancing their experience with the local health care system while enabling improved outcomes. All funded HSPs in the LHIN have signed Service Accountability Agreements (SAAs) that detail specific performance expectations to be achieved over the term of the agreements. In all of the accountability agreements it holds with HSPs, the Central West LHIN has incorporated a requirement for them to be accredited by March 31, 2017. Progress against this requirement is on track. 31 Central West LHIN | Annual Report 2015/16 190 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Meanwhile, in accordance with legislation, the LHIN has aslo required HSPs to submit Quality Improvement Plans (QIPs), which outline an organizations quality improvement goals for the following year.The Excellent Care for All Act 2010 requires all public hospitals, inter-disciplinary primary health care organizations, CCACs and Long-Term Care homes to develop and submit an annual Quality Improvement Plan (QIP). Beyond legislative requirments, to support system alignment and identify priorities for local quality improvement initiatives, the LHIN has additionally required that quality plans be completed by community support service agencies. Next steps will involve collaboration with local HSPs to identify opportunities to align quality strategies and support for system level quality improvement aims – Improve System Navigation, Improve Access to Mental Health and Addictions Services, and Improve System Navigation - established by the LHIN in 2014/15. With implementation of a new three-year health system plan expected in 2016/17, the LHIN will determine the need to revisit, confirm existing, and/or establish additional quality improvement aims that reflect priories identified in IHSP 2016-2019. The Central West LHIN Board of Directors maintained a focus on good governance in 2015/16. A highlight among health care professionals across the LHIN are the LHIN-hosted Governance and Leadership Forums. With 2015/16 representing a year of transition, the ability to engage with and harness the thoughts of over 180 health care professionals at one time, proved invaluable to the planning processes related to IHSP 2016-2019 and the MOHLTC discussion paper Patients First: A Proposal to Strengthen Patient-Centred Care in Ontario. 2.3.2 Optimize Use of Health Care Resources to Foster Better Value Hospitals beds are a valuable and often scarce resource. When people are unnecessarily admitted to hospital or are designated Alternative Level of Care (ALC) Alternate Level of Care (ALC) refers to those patients who continue to occupy hospital beds after they have completed a course of treatment for which they were admitted and no longer require the care associated with those beds. they are, by definition, not receiving the right care in the right place. Alternate Level of Care (ALC) refers to those patients who continue to occupy hospital beds after they have completed a course of treatment for which they were admitted and no longer require the care associated with those beds. For a variety of reasons, these patients experience barriers to discharge from hospital. , place at the right time., hindering access to those who need them most. Inaccessible resources drive up wait times across the entire health care system. , which is why i In 2015/16, the Central West LHIN worked to improve access to acute care capacity. . Specifically, the LHIN sought to provide more appropriate care to all residents by supporting expanded community-based services and by seeking improvements in admission, bed use, and discharge processes. Additionally, the LHIN continued to implement Health System Funding Reform (HSFR) initiatives that support best practice, cost-effective treatment and care. Current Status | In 2015/16 the Central West LHIN hads the highest proportion of high-acuity ED visits in the province. . In 2014/15,More specifically, when compared to the province (68%), 81% vs. 68% of all ED visits were triaged as high-acuity. The result… 13% of all ED visits and 16% of high-acuity ED visits resulted in an inpatient admission. The LHIN met provincial ED wait time targets for patients discharged to the community from the ED, discharging 93% of low-acuity patients within four hours, and 93% of high-acuity patients within eight hours of presenting in the Together, Making Healthy Change Happen 191 32 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE ED. These improvements are largely attributable to the Pay for Results program, now in its ninth year, which targets patience experience in the ED. The number of patients processed through the system without being designated as ALC continued to increase, and the number of patients being discharged with an ALC designation declined.Central West LHIN ALC designations (1,479) and discharges (1,508) declined in 2015/16. In the Central West LHIN 1,479 patients were designated ALC, while 1,508 ALC-designated patients were discharged. A total of 20,065 ALC days were accumulated in 2014/15. Although the Central West LHIN maintains one of the lowest rates of inpatient capacity lost to ALC, work continues toward reducing ALC designations. In 2013/14, funding for selected surgeries and diagnostic wait times shifted to a new Quality-Based Procedures (QBP) model in which HSPs are expected to deliver these procedures within funded amounts while maintaining or improving wait times. Since QBP implementation, the LHIN has experienced improvement in wait times for diagnostic imaging. Notably in 2015/16, 72% of patients received computerized tomography (CT) within the provincial access target of 28 days. Governance and Leadership Forums... Together, Making Healthy Change Happen With respect to magnetic resonance imaging (MRI), the Central West LHIN has moved from rates below 20% in 2010/11, to performance above 71% in 2015/16. In 2015/16 more than 89% of cancer surgeries and over 87% of cataract surgeries were consistently performed within provincial access targets. Opportunities for improvement remain. Wait times for hip and knee replacement continue to grow and the number of residents receiving these surgeries within the provincial access target continues to decline. The LHIN has worked with its hospitals to improve performance, but the overwhelming demand for these procedures continues to outstrip the supply. Health System Funding Reform 33 Central West LHIN | Annual Report 2015/16 192 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE The Central West LHIN and many local HSPs now operate in a patient-based funding environment known as Health System Funding Reform (HSFR). HSFR is a new way of funding hospitals and community providers based on the burden of illness and care needs in the community, where patients actually go for care, the quality of providers’ care, and the efficiency of that care. It represents a more fair means ofconsistent approach to funding health care across the province that also incents the best possible care in the most efficient way possible – in other words, to drive quality and value. Throughout 2015/16 and moving forward, the Central West LHIN intends to further support the provincial HSFR strategy, and work to better align funding to need and evidence-based practice. Throughout 2015/16, the Central West LHIN continued to advance the provincial HSFR strategy through active participation in the pan-LHIN HSFR Advisory Committee, and the MOHLTC’s renewed HSFR governance structure and implementation of annual HSFR initiatives with local HSPs. The Central West LHIN continued to identify and monitor the health service needs of the local community, and work towards the goal of putting patient’s needs first while aligning funding and delivery of high quality care in an affordable and sustainable manner. HSPs in the Central West LHIN actively supported HSFR quality improvement and change management strategies by participating in three cohorts of the provincial Improving and Driving Excellence across Sectors (IDEAS) program, and continued to collaborate on implementation of Quality- Based Procedures (QBPs). To date HSP leadership have established a number of QBP implementation teams that have or are currently implementing strategies for alignment with best practice and health outcomes. Planning is underway to work more closely with Health Quality Ontario (HQO) that will further align QBP and quality goals locally. In September 2015, the MOHLTC announced six innovative projects focused on the patient experience that would test innovative integrated approaches of service delivery and new integrated funding models intended to improve the delivery of quality, evidenced-based care to patients. Hospital to Home (H2H): The Central West Integrated Care Model was one of these selected projectsselected as a 3-year proof of concept project. . H2H is a model of care that will better enable seamless patient transitions from the hospital to the community. It is a joint initiative of the Central West CCAC, HHCC and William Osler Health System (Osler), working in partnership with OTN. In Q3 2015/16, H2H began to enroll patients from Osler’s Etobicoke General Hospital (EGH) site, with implementation at HHCC and Osler’s Brampton Civic Hospital (BCH) site in Q4. In its first year, H2H will support patients diagnosed with cellulitis and/or urinary tract infections requiring short-term nursing interventions. In years two and three, the model will be expanded to more complex care using both nursing and interdisciplinary models, including palliative care, stroke, chronic diseases, and appropriate post-surgical procedures., and redefine the interactions and experiences of these patients with the health care system. At the writing fo this report, 282 patients had been enrolled in the H2H model of care, and a total of 1,857 nursing visits had been conducted by the end of the fiscal year. Early data suggests that this intervention is having positive impacts on ED visits, hospital admissions, average hospital Length-of-Stay (LOS), average community LOS, as well as the average number of nursing visits in the community, when compared to the pre-intervention period. The H2H model supports a strategic shift to more community-focused, scheduled care, supporting people to receive care in their homes or in the community, helping prevent unnecessary emergency department visits and hospital admissions, shortening the acute length of stay for admitted patients, providing greater continuity of care and enhancing the patient experience. Together, Making Healthy Change Happen 193 34 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Central West LHIN investment strategies are informed through assessment of local health needs 2.4 Build on the Momentum Throughout 2015/16 the Central West LHIN devoted time, attention and resources to long-standing initiatives that are aligned with provincial directions and priorities. 2.4.1 Aboriginal Health The Central West LHIN has continued to actively engage local Aboriginal communities, with the aim of better understanding local health and service delivery issues from wellness to mental health, chronic disease management, and palliative care perspectives. The Central West LHIN is committed to building capacity within the health system to ensure Aboriginal communities receive culturally competent care; care that recognizes and is tailored to particular social, cultural, and linguistic needs. It follows that, toTo further understand and recognize the importance of cultural competency, in relation to Aboriginal health, Central West LHIN staff and Board Members and select HSP staff members have completed the Indigenous Cultural Competency training program offered through the Provincial Health Services Authority in BC, and have actively taken part in Métis information and training sessions. Meanwhile, LHIN CEOs and Aboriginal Health Leads took part in the Provincial Aboriginal LHIN Network Planning Conference, further establishing strategic priorities to advance Aboriginal health, the likes of which helped toand inform the development of IHSP 2016-2019. LHIN CEOs and Aboriginal Health Leads took part in the Provincial Aboriginal LHIN Network Planning Conference, establishing strategic priorities to advance Aboriginal healthand inform the development of IHSP 2016-2019. During 2015/16, the LHIN partnered with the Métis Nation of Ontario (MNO) Credit River Métis Council and the Mississauga Halton LHIN to hold Powley Day Celebrations at the Island Lake Conservation area. Thanks to this partnership, voyageur canoe trips and other community health 35 Central West LHIN | Annual Report 2015/16 194 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE activities were provided to as many as 60 participants. It was an excellent opportunity for the MNO Credit River Métis Council to showcase and support their culture and identity with Métis and nonMétis peoples alike. The Central West LHIN in partnership with the Mississauga Halton LHIN, the Credit River Metis Council, the Dufferin County Cultural Resource Centre and the Peel Aboriginal Network held engagement sessions on the development of IHSP 2016-2019 and discussion paper Patients First: A proposal to strengthen patient centred care in Ontario. This laid the groundwork for the drafting of inaugural Terms of Reference for the Central West LHIN and Mississauga Halton LHIN Indigenous Health Advisory Circle. Commented [A4]: Revised section from author. 2.4.2 Diversity and Health Equity Throughout 2015/16, the LHIN’s Diversity and Health Equity Core Action Group continued to explore and apply effective ways to improve cultural competency and minimize gaps for vulnerable populations. In partnership with the MOHLTC, Health Quality Ontario (HQO) Regional Diversity Roundtable, and Peel Newcomer Strategy Group the Central West LHIN identified key areas of focus including a need to further integrate use of the Health Equity Impact Assessment (HEIA) tool. HSPs are now using the tool to plan improved access to care for marginalized populations. Ongoing training is being supported by the LHIN to ensure sustainable and meaningful use of the tool. Championed by the LHIN, a host of nine organizations representing primary care, acute care, and community mental health and addictions services are taking part in a pilot project to collect sociodemographic information from those who enter and use local health care services. In 2015/16, all acute and community providers submited progress reports on the implementation of health equity plans. Submission of yearly progress reports ensures consistent movement towards the integration of health equity practices, and improvement of equitable access to care. The Central West LHIN also took a leadership role in developing a pan-LHIN collaborative with the mandate to discuss local and provincial opportunities that advance the work of health equity and improve population health for the residents across Ontario. Building Bridges for Inclusive Care in Peel Together, Making Healthy Change Happen 195 36 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE The Region of Peel was proud to have been selected as one of 18 Provincial Service Collaboratives, a key source of input for years one to three of the MOHLTC’s ten-year Mental Health and Addictions Strategy. Produced in 2015, the video Building Bridges for Inclusive Care Care in Peel highlights the coming together of various faith communities and mental health service providers, to improve recognition of mental health issues and access to supports by children and youth. And, wWhile the provincial Mental Health and Additions Sstrategy continues to move forward beyond year three, it is under the leadership of Punjabi Community Health Services that the work of this collaborative has continued to make an impact beyond its original mandate. Partnering for Change The introduction in 2015 of Partnering for Change (P4C), a new therapy program that sends therapists directly into school classrooms, has been praised by parents and school officials for giving children with special needs access to occupational therapists without having to leave the comfort and convenience of their classrooms. Originally developed at McMaster University to bring therapy to the children who need it, P4C is a collaboration with schools, so that teachers can work alongside therapists and learn some of the therapists’ techniques to help the students on an ongoing basis. Thanks to P4C, organizers say they have been able to do much more with the same amount of resources. P4C is now working in more than 60 schools across Peel, Halton and Hamilton-Wentworth. And more school districts have expressed an interest in adopting the model. Supporting New Syrian Canadians Of the many happenings that captured the world’s attention in 2015/16, perhaps none was more compelling that the Syrian Refugee Crisis. A unifying humanitarian issue, health care professionals across the Central West With a vibrant francophone community, the The Central West LHIN includes a vibrant francophone community and in 2015/16 continued to work to enable that is looking for better access to local health care services in French in 2015/16. Together with LHIN HSPs and Reflet Salvéo, the local French Language Services (FLS) planning entity, the Central West LHIN ensured the application of an FLS lens to local and provincial planning including IHSP 2016-19 and Ontario’s Patients First: Action Plan for Health Care. . 37 Central West LHIN | Annual Report 2015/16 196 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Accordingly, inIn collaboration with HSPs and Reflet Salvéo, – the local French Language Francophone population, supporting the development and use of common FLS indicators. The LHIN continued to work closely and collaboratively with Reflet Salvéo, particularly in areas related to engaging the francophone community, capacity building and service planning. Priorities and actions were identified and outlined in a Joint Annual Action Plan between Reflet Salvéo and the Central West, Mississauga Halton and Toronto Central LHINs. Year-end reporting by each identified for FLS HSPs reported an increase of 34%in the number of Francophone residents who requested service in French from 2014/15. The work of the coalition is supported by the Central West and Mississauga Halton LHINs, Reflet Salvéo and Le Cercle de l’amitié, Well Fort Community Health Services, Oasis Centre des Femmes, l’Équipe de Santé familiale Credit Valley and le Réseau franco-santé sud de l’Ontario. for the Francophone Seniors Coalition Ongoing development of a collaborative care project between Reflet Salvéo and the Central West LHIN continued in 2015/16. Known as the Coalition pour les aînés francophones (CAF) de Peel, the CAF Cercle des Aînés Noirs Francophones de l’Ontario to help address both current and future service demands for Seniors from a Francophone perspective. Working together as a collaborative makes it easier for Francophone seniors to become better informed about activities and services offered to them in the community. It also helps to improve overall service delivery. 2.4.4 Palliative and End-of-Life Care Made up of all palliative care providers who care for residents throughout the Central West LHIN, the Central West Palliative Care Network (CWPCN) guided the development of palliative care services in the Central West LHIN throughout 2015/16, and has been doing so since 2009. These services are delivered in local hospitals, private homes, LTC Homes, and in one residential and one community hospice. One adjacent residential hospice and two community hospices also provide care to residents of the Central West LHIN. Together, Making Healthy Change Happen 197 38 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE In 2015/16 the Central West LHIN was proud to take a leadership role in advancing the local palliative and end-of-life care conversation by futher developing a joint palliative end-of-life care “Pledge”. Introduced to over 300 health care profeesionals at the CWPCN Annual Conference, the Pledge is inspired by a quote taken from the Canadian Hospice Palliative Care Association’s Living Lessons® report. It reflects a collective commitment to deliver on the promise of providing outstanding palliative care. Recognizing a sense of collective responsibility, conference participants shared their "personal pledge" toward the delivery of outstanding palliative care across the Central West LHIN byposting their commitments on "pledge boards" placed outside of the main conference hall for public viewing. In 2015, the Ministry of Health and Long-Term Care (MOHLTC) announced a major change in the structure of palliative care networks. A new Ontario Palliative Care Network (OPCN) has been created, along with a provincial secretariat that will be responsible for providing provincial oversight of 14 LHIN palliative care networks. The Central West LHIN recognizes that the delivery of outstanding palliative care is essential for individuals and families throughout the LHIN’s highly diverse population. While provincially, Ontario’s palliative care strategy is realigning palliative care networks, locally the Central West LHIN wants to ensure residents die in a place of their choosing. Accordingly, the LHIN has and will remain focused on ensuring that... Through a reconstituted CWPCN, the LHIN will work to ensure: 39 Central West LHIN | Annual Report 2015/16 198 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE capacity is enhanced for palliative care in the home and community diverse palliative care needs of the community are met public and health care providers understand options available for palliative and end-of-life care virtual technology is used as a value-add means to bring care closer to home. 2.4.5 Women and Childrens Health Throughout 2015/16, the LHIN worked with local providers to improve the quality of, and access to, women and children’s health services, while at the same time aligning its work with provincial initiatives. The Central West LHIN worked with the Provincial Council for Maternal Child Health (PCMCH) to improve access to care for children with medical complexities. The LHIN is also currently involved in the development of the local Special Needs Strategy for Peel and Dufferin in alignment with a provincial strategy to improve services for children and youth with special needs in Ontario. This required collaborating across sectors, working in partnership with with providers funded by the Ministry of Child and Youth Services (MCYS), Ministry of Community and Social Services (MCSS), Ministry of Education (MEDU), and MOHLTC. South Asian Community Outreach Forum Hosted by Bethell Hospice, Heart House Hospice and the Punjabi Community Health Services the Central West LHIN was once again proud to be part of the annual South Asian Community Forum on palliative and end-of–life care. The session attracted over 150participants who, through interactive discussions were able to learn more about what types of palliative and end-of-life services are currently available in their local communities. Understanding the important culture-specific aspects of palliative care helps to inform the planning process in order to create a system that is both patient-centred and responsive to culturally-specific needs. Together, Making Healthy Change Happen 199 40 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE PERFORMANCE The Ministry-LHIN Accountability Agreement (MLAA), sometimes called the Ministry-LHIN Performance Agreement, is an agreement between each of Ontario’s 14 LHINs and the Ministry of Health and Long-Term Care (MOHLTC). It outlines the obligations and responsibilities of both organizations with respect to the planning, funding and integration of local health care services. The MLAA includes measures used to assess the LHINs performance which, from time-to-time, are modified according to the changing priorities of the health care system. As of fiscal year 2015/16, the MLAA lists 24 measures in three categories Performance: Provincial targets have been established for the 14 performance measures, based on best practice and clinical evidence where possible. LHINs must report to the ministry on their performance against these targets on a quarterly and annual basis. Monitoring: Provincial targets have been established for some, but not all, of the 8 monitoring measures. LHINs are not required to report on monitoring measures, but they often provide important supplemental or explanatory information about the performance measures. Developmental: Provincial targets have not been established for the 2 developmental measures. These measures focus on emerging priorities of Ontario’s health system, and their definitions are subject to change as they are developed. Commented [A5]: Introduction rewritten by author. CENTRAL WEST LHIN MLAA INDICATORS 2015/16 ANNUAL REPORT DATA Provincial No. Indicator Provincial 2014/15 Most target Fiscal Year Recent Result Quarter LHIN 2015/16 Result (ytd)*** 2014/15 Most Recent Fiscal Year Quarter Result 2015/16 Result (ytd)*** 1. Performance Indicators 1 Percentage of home care clients with complex needs who received their personal support visit within 5 days of the date that they were authorized for personal support 95.00% 85.39% 86.55% 85.28% 92.23% 83.58% 88.43% 2 Percentage of home care clients who received their nursing visit within 5 days of the date they were authorized for nursing services* 95.00% 93.71% 93.21% 93.66% 96.52% 95.19% 95.86% 3 90th Percentile Wait Time for CCAC In-Home Services - Application from Community Setting to first CCAC Service (excluding case management)* 21 days 29.00 29.00 30.00 19.00 31.00 21.00 4 90th percentile emergency department (ED) length of stay for complex patients 8 hours 10.13 10.48 9.97 10.85 11.25 10.57 5 90th percentile emergency department (ED) length of stay for minor/uncomplicated patients 4 hours 4.03 4.28 4.07 3.50 3.80 3.68 6 Percent of priority 2, 3 and 4 cases completed within access target for MRI scans 90.00% 41.75% 40.37% 38.41% 25.35% 33.37% 33.34% 7 Percent of priority 2, 3 and 4 cases completed within access target for CT scans 90.00% 77.77% 74.08% 74.60% 79.03% 80.38% 71.51% 8 Percent of priority 2, 3 and 4 cases completed within access target for hip replacement 90.00% 81.51% 79.63% 79.97% 47.47% 71.76% 67.50% 9 Percent of priority 2, 3 and 4 cases completed within access target for knee replacement 41 services* Central West LHIN | Annual Report 2015/16 90.00% 79.76% 78.18% 79.14% 47.88% 60.08% 72.19% 10 Percentage of Alternate Level of Care (ALC) Days* 9.46% 14.35% 14.15% 14.16% 7.14% 6.06% 6.02% 11 ALC rate 12.70% 13.70% 14.12% 12 Repeat Unscheduled Emergency Visits within 30 Days for Mental Health Conditions* 16.30% 19.62% 20.33% 13.98% 6.26% 6.00% 5.53% 24.74% 26.09% 25.02% 200 Repeat Unscheduled Emergency Visits within 30 Days for Substance Abuse 20.28% BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE The following section provides an overview of MLAA indicators grouped by which sector of the health care system they are measuring. Primary Care Primary care is the day-to-day healthcare provided by family doctors and other health care professionals in the community. Primary care measures in the Central West LHIN are included as monitoring indicators, but do not have target performance associated with them. Monitoring Indicator #19: Rate of emergency visits for conditions best managed elsewhere per 1,000 population | Rate of low acuity emergency visits that could be treated in alternative primary care settings for patients aged 1-74 years. Conditions include: Conjunctivitis (pink eye) Upper Respiratory Infection (cough/cold) Otitis Media (earache) Cystitis (urinary tract infection). For patients who are not seniors and have no other complications, the four conditions listed above are not emergencies and should usually be treated in a setting other than the emergency department (ED). If patients are arriving at EDs for these conditions, it indicates that these patients did not have adequate access to primary care, either because they do not have a primary care provider, because they were not aware of the availability of their primary care provider, or their primary care provider was not available to them within a reasonable time. In 2015/16, the Central West LHIN rated best in the province for this indicator, suggesting that LHIN residents have better mechanisms for dealing with urgent, but non-emergent, health care issues than most Ontarians. Monitoring Indicator #19 Monitoring Indicator #20: Hospitalization rate for ambulatory care sensitive conditions per 100,000 population* | Rate of hospitalization for ambulatory care sensitive conditions per 100,000 population age < 75. Conditions include: Grand mal status and other epileptic convulsions Congestive heart failure (CHF) and pulmonary edema Together, Making Healthy Change Happen 201 42 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Chronic obstructive pulmonary disease (emphysema and bronchitis) Asthma Diabetes Hypertension Angina. When managed effectively in primary care and/or the community, ambulatory care sensitive conditions should not lead to hospitalizations. Hospitalizations for these conditions are often referred to as avoidable hospitalizations and indirectly measure the ability of the health care system to manage chronic conditions, access to primary care and care in the community. Optimizing management of these conditions can potentially contribute to both improved patient health outcomes and more efficient resource utilization. In 2015/16, the Central West LHIN ranked 4th out of 14 LHINs for this indicator. Monitoring Indicator #20 Monitoring Indicator #21: Percentage of acute care patients who had a follow-up with a physician within 7 days of discharge | Percentage of patients with a hospital stay for specified conditions who saw their physician within 7 days of discharge. Conditions include: Acute myocardial infarction (age 45+) (heart attack) Cardiac conditions other than heart attack (age 40+) Congestive heart failure (age 45+) Chronic obstructive pulmonary disease (age 45+) (emphysema and bronchitis) Pneumonia Diabetes Stroke (age 45+) Gastrointestinal disease. Chronic conditions that are not managed appropriately are a cause of substantial avoidable interactions with the health care system. When a patient with a chronic condition experiences an exacerbation of that condition, it often requires an ED visit and admission to an inpatient bed. The combination of appropriate care while in hospital, seamless handoff of care to community providers, and appropriate follow-up and preventative care in the community can prevent recurrence of exacerbations and repeated admissions to either the ED or the hospital. 43 Central West LHIN | Annual Report 2015/16 202 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE One of the most important steps in this preventative sequence is connection with the patient’s primary care provider shortly after discharge from the hospital. In 2015/16, the Central West LHIN rated best in the province for this indicator. Monitoring Indicator #21 System Integration and Access Performance Indicator #14: Readmission within 30 days for selected Health-Based Allocation Model Inpatient Grouper (HIG) conditions | This indicator measures what proportion of patients being treated for chronic disease(s) required subsequent admissions to hospital after an initial hospital stay. This performance indicator is closely related to the monitoring indicator immediately above—the chronic conditions being addressed are the same, and follow-up with a primary care provider after discharge is one of the interventions likely to prevent readmission. In 2015/16, the Central West LHIN ranked 6th out of 14 LHINs for this indicator. Performance Indicator #14 Together, Making Healthy Change Happen 203 44 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Home and Community Care To prevent or delay visits to EDs, hospitalizations, and applications to Long Term Care (LTC), and to enable discharge from hospital, Community Care Access Centres (CCAC’s) provide a variety of in-home support services in addition to assisting local residents navigate a host of additional community services. LHINs are measured on the time it takes for a resident to receive CCAC support services, after having applied for the the service. This period includes both the time from application to assessment and from assessment to delivery of services. Performance Indicator #1: Percentage of home care clients with complex needs who received their personal support visit within 5 days of the date that they were authorized for personal support services Services provided in the home prevent or delay emergency department visits and hospitalizations. The provincial access target for the time between when clients are authorized for personal support and the time that they begin receiving that support is five days. At a system level, we measure what proportion of the clients receiving services are receiving them within that provincial target. In calendar year 2015, the Central West LHIN ranked 6th out of 14 LHINs for this indicator, with 88% of clients receiving their personal support visit within 5 days. Performance Indicator #1 Performance Indicator #2: Percentage of home care clients who received their nursing visit within 5 days of the date they were authorized for nursing services | Services provided in the home prevent or delay ED visits and hospitalizations. The provincial access target for the time between when clients are authorized for nursing services and the time that they begin receiving that support is five days. At a system level, we measure what proportion of the clients receiving services are receiving them within that provincial target. At 95%, the Central West LHIN was the only LHIN meeting the provincial target in this indicator during calendar year 2015. 45 Central West LHIN | Annual Report 2015/16 204 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Performance Indicator #2 Performance Indicator #3: 90th Percentile Wait Time for CCAC In-Home Services Application from Community Setting to first CCAC Service (excluding case management) | The longer a client who needs in-home services at home waits to receive it, the more likely it is that that client’s condition will deteriorate, and that they will require a visit to the emergency department and potential hospitalization. The provincial access target for the time between when clients are authorized for in-home services and the time that they begin receiving that support is 21 days. The Central West LHIN met this target during calendar year 2015, ranking 5th out of 14 LHINs. An increase in wait time in the third quarter is reflective of an influx of funding into the system which allowed a larger number of people to be removed from the waitlist. Performance Indicator #3 Health and Wellness of Ontarians... Mental Health Visits to hospital EDs may be the appropriate point of access to care for individuals with mental health and substance abuse conditions who are in crisis. Repeat emergency visits generally indicate premature discharge or a lack of coordination with post-discharge care and can contribute to emergency visit pressures. Given the chronic nature of the mental health and substance abuse conditions, access to effective community services should reduce the number of repeat unscheduled emergency visits for Ontario Together, Making Healthy Change Happen 205 46 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE residents. This measure attempts indirectly to measure the availability and quality of community services for patients with mental health and substance abuse conditions. It also supports the future development and improvement of data collected that could be used to measure the quality and availability of community mental health and substance abuse services directly, especially relating to wait times. Performance Indicator #12: Repeat Unscheduled Emergency Visits within 30 Days for Mental Health Conditions | Within this calculation, the MOHLTC considers a repeat visit” to have occurred every time a patient is transferred from one ED to another. This despite the fact that these transfers took place within the same “episode of care”, with no opportunity for the patient to receive community services between the two departments. In-depth analysis at the Central West LHIN level suggests that when these types of transfers are excluded from the measurement, actual performance is much better than what is purported by the provincial calculation. More Central West LHIN residents are receiving the care they need in the community to prevent repeat visits to EDs. Performance Indicator #12 Performance Indicator #13: Repeat Unscheduled Emergency Visits within 30 Days for Substance Abuse Conditions | LHIN analysis shows that patients with substance abuse conditions are also receiving better services than is suggested by provincial reporting. However, the difference is not as pronounced as it is for patients with mental health conditions. During the performance period (January-December 2015) alcohol accounted for more than 80% percent of repeat visits for substance abuse, and fewer than 30 patients accounted for more than 50% of the repeat visits. Performance Indicator #13 47 Central West LHIN | Annual Report 2015/16 206 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Wait Times Wait time indicators measure the proportion of patients who received their surgical or diagnostic imaging procedures within established provincial access targets. Patients waiting for these procedures are placed, by their physician, into one of four categories according to how quickly they need the procedures. LHIN performance is measured for patients in the all but the most urgent category; Priority I patients are expected to receive services immediately. Diagnostic Imaging Performance Indicator #6: Percent of priority 2, 3 and 4 cases completed within access target for magnetic resonance imaging (MRI) scans| In 2015/16, the Central West LHIN ranked 10th out of 14 LHINs in this indicator, with 33% of patients receiving a diagnostic MRI within the provincial access targets, 5 percentage points lower than the province as a whole. The LHIN has neither the physical nor the financial capacity to meet the local demand for MRI scans. Performance Indicator #6 Performance Indicator #7: Percent of priority 2, 3 and 4 cases completed within access target for computerized tomography (CT) scans | In 2015/16, the Central West LHIN ranked 9th out of 14 LHINs for this indicator, with 72% of patients receiving a diagnostic CT within the provincial access targets, 4 percentage points lower than the province as a whole. Performance Indicator #7 Together, Making Healthy Change Happen 207 48 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Surgical Procedures Performance Indicator #8: Percent of priority 2, 3 and 4 cases completed within access target for hip replacement | While demand for joint replacement elective surgeries continues to outstrip funded supply, Central West LHIN hospitals completed all surgeries for which the MOHLTC allocated funding for in 2013/14. These numbers were not sufficient to clear the wait list. Performance Indicator #8 Performance Indicator #9: Percent of priority 2, 3 and 4 cases completed within access target for knee replacement | As with hip replacement surgeries, the demand for knee replacement elective surgeries exceeds the supply currently funded by the Ministry of Health and Long-Term Care. Performance Indicator #9 49 Central West LHIN | Annual Report 2015/16 208 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Monitoring Indicator #15: Percent of priority 2, 3 and 4 cases completed within access target for cancer surgery | The Central West LHIN missed the provincial target of 90% by only one percentage point in 2015/16. Monitoring Indicator #15 Monitoring Indicator #16: Percent of priority 2, 3 and 4 cases completed within access target for cardiac by-pass surgery | No hospitals within the Central West LHIN provide cardiac by-pass procedures. There is no chart for this monitoring indicator. Monitoring Indicator #17: Percent of priority 2, 3 and 4 cases completed within access target for cataract surgery | The Central West LHIN missed the provincial target of 90% by only three percentage points in 2015/16, and completed all funded procedures. Monitoring Indicator #17 Together, Making Healthy Change Happen 209 50 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Hospital Care Emergency Department (ED) Length of Stay Emergency department (ED) indicators measure the length of time from patient arrival at the ED, to patient discharge from the ED. This measure includes wait time as well as diagnosis, treatment and monitoring time. Performance Indicator #4: 90th percentile emergency department (ED) length of stay for complex patients | Most patients who are triaged as high acuity or who require admission to an inpatient bed benefit from up to 8 hours in the emergency department. This time is spent being assessed, treated, and stabilized, and allows the physicians at the hospital to make a decision about whether the patient can be discharged home or needs to be admitted to an inpatient unit. After 8 hours, it is more likely that additional time spent in the emergency department does not add value to the patient’s care, and that if they have not already been discharged home, they would be better off with the longer-term and more specialized care associated with an inpatient unit. Central West LHIN performance in 2015/16 missed the provincial target by just under three hours—this performance is entirely due to the wait time experienced by patients waiting in the ED for admission to an inpatient unit. The Central West LHIN has the highestproportion of high acuity ED visits of any LHIN, and the lowest admission rate for high acuity patients. It also has the lowest ALC rate of any LHIN. However, Brampton Civic Hospital (BCH) consistently experiences both the highest overall volume of any ED in Canada, leading to a greater need for acute hospital capacity than exists in the LHIN. Fluctuations in performance indicate the LHIN’s response to and management of these volumes. Performance Indicator #4 51 Central West LHIN | Annual Report 2015/16 210 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Performance Indicator #5: 90th percentile emergency department (ED) length of stay for minor/uncomplicated patients | Most patients who are triaged as having a minor or uncomplicated problem benefit from up to 4 hours in the emergency department. This time is spent being assessed, treated, and stabilized. After 4 hours, it is more likely that additional time spent in the emergency department does not add value to the patient’s care, and that at least some of the time spent in the ED has been spent waiting. In 2015/16, Central West LHIN length of stay for low acuity patients was third best in the province, well within the 4-hour provincial target. Performance Indicator #5 Alternate Level of Care When a hospital inpatient has completed her hospital stay, she should be discharged to the next most appropriate destination for her condition. Alternate Level of Care (ALC) refers to those patients who continue to occupy hospital beds after they have completed a course of treatment for which they were admitted and no longer require the care associated with those beds. For a variety of reasons, these patients experience barriers to discharge from hospital. The patient could be waiting for a lower level of care within a hospital, or for a lower level of care in the community or long term care. Performance Indicator #11: ALC rate | Every hospital bed occupied by a patient designated ALC is a bed that is no longer included in the overall hospital’s capacity. A patient who is designated ALC is occupying a hospital bed that, in many cases, is needed by a patient waiting in a different part of the system, such as the emergency department. Additionally, a day in a higher level of care costs the system more than a day in a lower level of care. A reduction in ALC days results in more beds being available for those who need in-hospital treatment and makes better use of health system resources. In 2015/16, the Central West LHIN had the lowest (best) ALC rate in the province, keeping the majority of inpatient capacity in use by patients needing it at the time. Together, Making Healthy Change Happen 211 52 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Performance Indicator #11 Performance Indicator #10: Percentage of Alternate Level of Care (ALC) Days | All ALC days are non-value added for the patient; they are pure wait time, during which by definition the patient is not receiving the care theyneed. In addition, a patient who is designated ALC is in a riskier environment than necessary (potentially exposed to hospital-acquired infections, not being activated and socialized). Patients remain in hospital longer than necessary for various reasons, including room availability in residential facilities, delay’s in discharge, and social and familial situations. The Central West LHIN had the best performance of all 14 LHINs during the caledndar year 2015, meaning that patients who were discharged from Central West LHIN hospitals spent less time waiting for care in their homes, in Long-Term Care or in post-acute beds. In 2015/16, the LHIN was one of only two LHINs to meet the provincial target for this indicator. Performance Indicator #10 53 Central West LHIN | Annual Report 2015/16 212 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Long Term Care These measures are indications of the Central West LHIN resident’s experience—how long did it take for residents to be evaluated for eligibility for care in a Long-Term Care Home (LTCH). 100% of the time measured for this metric is wait time, and therefore non-value added. The CCAC determines a person’s eligibility for admission to an LTCH based on parameters and requirements outlined by the MOHLTC. There are no performance targets for these measures. Monitoring Indicator #18(a): CCAC wait times from application to eligibility determination for long-term care home placements: from community setting | Nine out of ten Central West LHIN residents awaiting assessment in their homes waited up to 16 days for this assessment between October 2014 and September 2015. The Central West LHIN ranked 8th out of 14 LHINs in this measure. Monitoring Indicator #18a Monitoring Indicator #18(b): .CCAC wait times from application to eligibility determination for long-term care home placements: from acute-care setting | Nine out of ten Central West LHIN residents awaiting assessment in hospital waited up to 12 days for this assessment between October 2014 and September 2015. The Central West LHIN ranked 12th out of 14 LHINs in this measure Monitoring Indicator #18b Together, Making Healthy Change Happen 213 54 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE GAGING LHIN COMMUNITIES The Local Health System Integration Act (LHSIA) is based, in part, on a belief that the health care needs of local communities are best understood by those who live and work in them. It follows that the ability to understand the needs of local Central West LHIN communitiesis predicated on developing meaningful relationships, in large part through effective community engagement. Community engagement itself, is as much about helping LHIN residents to better understand their local health care system, as it is about listening to their perceptions and needs, empowering them to be active participants in the planning process. In 2015/16 the Central West LHIN conducted communications and community engagement activities with the following objectives in mind: Business Objectives Improve access to care Streamline transitions and navigation of the system Drive quality and value Build on the momentum Communication Objectives 55 Educate and build broad stakeholder awareness of Central West LHIN strategic imperatives and priorities identified in IHSP 3 (above noted business objectives). Foster an understanding of the need for continued health system transformation. Build ongoing support for an integrated sustainable local health care system that places the needs of patients first, and patients themselves at the centre of their local health care system. Central West LHIN | Annual Report 2015/16 214 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Raise awareness of the Central West LHIN’s role, its unique characteristics, value proposition, caliber and credibility of work, and importance within the local health care system. Educate and build awareness among HSPs regarding shared accountability for local health system transformation and the alignment of their respective /initiatives with IHSP 3. Continue to build strong, trusted relationships with HSP communications teams across the Central West LHIN, working together to optimize communication resources and coordinated services. Throughout 2105/16 the Central West LHIN continued to place an emphasis on the strong, meaningful relationships it has developed with residents, HSPs, community partners and those agencies not funded by the LHIN but whose activities contribute to the overall design and integration of their local health care system. The Central West LHIN executed its communications and community engagement activities through use of a variety of tools/tactics including… News Releases As required, to highlight/promote Central West LHIN activities/events. eNewsletter – “Working Together for Healthy Change” Monthly electronic periodicals providing updates on local LHIN activities, issued to a broad, general stakeholder audience. Mid-year Community Update Year-to-date progress report to the community, highlighting progress made in regard to IHSP and ABP deliverables. MPP Meetings Quarterly face-to-face updates and information sharing sessions. Governance and Senior Leadership Forum Three sessions held in 2015/16 - Two re: IHSP 2016/19 - Patients First Discussion Paper Contingent on schedule availability. Regional, Municipal, Civic Council Meetings Annual Business Plan Published annually. Annual Report Published annually for the year previous. Board Materials Posted to Central West LHIN Website ahead of and following monthly Board meetings. Together, Making Healthy Change Happen 215 56 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Patients First Discussion Paper... join the conversation With 2015/16 being a year of transition... a year of planning for the future... one of the more notable engagement initiatives took place in support of the MOHLTC discussion paperIn December 2015, the MOHLTC released a discussion paper entitled Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario. In February 2015 the MOHLTC released Ontario’s Patients First: Action Plan for Health Care, the next phase of Ontario's plan for changing and improving Ontario's health system. Building on the progress that's been made since 2012 under the original Action Plan for Health Care, it exemplifies the commitment to put people and patients at the centre of the system by focusing on putting patients' needs first. Subsequently, in December, the Ministry released the aforementioned discussion paper, providing more detail regarding four key components designed to support the next phase of the Ministry’s plan to reduce structural issues that create inequities. They include:The discussion paper outlined four key proposals including: More effective integration of services and greater equity Timely access to primary care, and seamless links between primary care and other services More consistent and accessible home and community care Stronger links between population and public health and other health service. With release of the discussion paper, the Ministry asked Ontario’s LHINs to assist with stakeholder engagement, obtaining input regarding the proposals contained within, and advice about how to further integrate improvements across the health care system. Recognizing that the health care needs of local communities are best understood by those who live and work in them, theThe Central West LHIN embraced the Ministry request by conducteding a series of face-to-face engagement sessions with a variety of stakeholders. The LHINs approach was to conduct public engagement session in each of the More specifically, invaluable feedback was on the future of Ontario’s health care system was obtained from residents in each of the Central West LHIN's five sub-geographic areas, while also conducting targeted stakeholder consultations with , Aboriginal and Francophone communities, the Central West LHIN Primary Care Network, and Governors and leaders from HSPs across the LHIN. Over 300 residents and health care professionals joined in the conversation to be active participants in shaping the future of their local health care system, their ideas being compiled and submitted to the Ministry in a comprehensive report of findings. How are we doing?... resident and HSP satisfaction In 2015/16, as part of this engagement supported development ofIn developing IHSP 2016-2019, the LHIN conducted a quantitative telephone studyrandom sample telephone poll to gather opinions from a representative sample of residents regarding their knowledge, attitudes, and opinions of the local health care system. It was the fourth such study, building on similar research conducted in 2006, 2009 and 2013. It also served to validate the priorities and directions highlighted in IHSP 2016-2019. 57 Central West LHIN | Annual Report 2015/16 216 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Of note, LHIN residents remain concerned about wait times, as well as the impact of chronic diseases and an aging population. Of those residents who said that the Central West LHIN is moving in the right direction, the most common reasons for this response was that health care/services have improved. Among those who say health care/services have improved, it is largely attributed to improved access and efficiencies. The highest rated health care service within the LHIN is primary care. And, LHIN residents hold high expectations of health care services, with nearly all residents saying they agree with the statement... “the health care system should strive to provide health care in the home and community, not just in hospitals.” The Central West LHIN also conducted a third survey of regional Health Service Providers in 2015/16. Once again, the survey was designed to better understand the relationship between LHIN and local HSPs, as well as how providers feel the region as a whole has moved forward on local health system priorities. Survey results were very positive and largely comparable to those obtained in 2014. Health system funding and planning, along with community engagement are the top three LHIN activities HSPs placed the most importance on. The LHIN has and continues to build very strong relationships with HSPs in the region. Consistent with the 2014 survey, quantitative results demonstrated no areas where respondents felt primarily negative about the LHIN or its efforts. HSPs are aware of, and understand, the broader health system challenges faced by the LHIN and, while they are of concern for HSPs they see the LHIN as a partner in addressing those concerns. Together, Making Healthy Change Happen 217 58 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE The Road Ahead… Planning for and Realizing the Future. Capital Investment Following a number of infrastructure announcements in 2013 and 2014, 2015 saw the advancement and physical development of a number of important projects, all of which are being designed with the needs of LHIN residents and patients at their centre. Etobicoke General Hospital William Osler Health System’s Etobicoke General Hospital (EGH) site reached another important milestone in its redevelopment journey. In November, Osler and Infrastructure Ontario (IO) announced that the Request for Proposals phase of the project had been closed after a six-month period. At the writing of this report Osler and IO have since awarded a fixed price contract to Etobicoke Healthcare Partnership (EHP) to design, build, finance and maintain a new four-storey wing at Etobicoke General Hospital. 59 Central West LHIN | Annual Report 2015/16 218 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Construction of the new wing is expected to be completed in late 2018. Upon completion, the wing will add approximately 250,000 square feet of space to the hospital and house the services most urgently needed by the community it serves including... - a larger, state-of-the-art emergency department Cardiac Care and Intensive Care Units a Maternal newborn unit with birthing suites and a specialized nursery a new ambulatory procedures unit Cardiorespiratory and neurodiagnostic services. Osler is also planning for the construction of a new ancillary building on the EGH Site. Expected to begin in May 2016, this building will house a number of outpatient programs and services, including a fracture clinic, diagnostic imaging, and a satellite dialysis program. Peel Memorial Centre for Integrated Health and Wellness The summer of 2015 saw the “topping off” of the new Peel Memorial Centre for Integrated Health and construction on this wonderful new facility is progressing steadily. With completion of the exterior brickwork and penthouse siding, much of the construction activity moved inside the building, and the signature multi-coloured glass wall in the main lobby is in place, ready to greet patients and visitors as they enter the building. Slated for completion in early 2017, Peel Memorial is a new, state-of-the-art hospital that will provide complimentary services to Brampton Civic Hospital, offering a range of specialty clinics, day programs and services – from high-tech diagnostics and surgery, to women's and children's health. Space has also been allocated for education classrooms where patients and family members will be able to learn from health care professionals about how to take a more active role in managing their own health. Headwaters Health Care Centre Throughout 2015/16, Headwaters Health Care Centre (HHCC) continued to prepare for its expansion and renovation project, a significant step forward in increasing access to important health care services for the growing community. Addition of the new space is the first major expansion of the hospital since it opened at its current location in 1997. A new, 8,200 square foot extension will be home to much-needed clinics, services and programs like chemotherapy, minor procedures, orthopaedics and telemedicine. HHCC is also taking on an exciting renovation of existing hospital space to add another operating room, improve reception and expand pre- and post-surgical recovery areas. Together, Making Healthy Change Happen 219 60 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE “Building” Healthy Communities Not only have capital projects progressed at Central West LHIN hospitals, so too have they moved forward across LHIN communities. - WellFort Community Health Centre | Expansion is taking place at the Malton satellite to accommodate additional programming including primary care, youth services, oral healthcare, health promotion programs, physiotherapy, and chiropody and diabetes education. - Rexdale Community Health Centre | The Jamestown satellite project will provide much needs services to the local community including primary care, dental services, and diabetes education. - Rexdale Community Health Centre |The Kipling Dixon proposal will result in improvements to this existing location, expanding square footage to improve and enhance program service delivery. - Kipling Acres | Redevelopment of Kipling Acres continues following the opening of Phase 1 in March 2014, representing an initial 192 bed home. Phase 2, currently under construction an additional 145 beds, is expend to open in 2016. Healthy Communities Initiative Building healthy communities is more than bricks and mortar. Like many communities around the globe and across Canada, Brampton is addressing a common need, ensuring children, youth, adults and families are engaged in active healthy living so as to reduce their risk of health concerns and chronic illness. In 2015 the Central West LHIN was proud to take a leadership role in the development of the Healthy Communities Initiative, bringing together community leaders and partners to explore ways in which to create an active, healthy community, and to develop a plan for getting more PEOPLE, more ACTIVE, more OFTEN... mentally, physically and spiritually. The Central West LHIN will continue to take a leadership role in this initiative moving forward in 2016/17. Patients First and IHSP 2016-19 61 Central West LHIN | Annual Report 2015/16 220 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE In 2015/16, there was perhaps no greater example of planning for the future than with the release of Ontario’s Patients First: Action Plan for Health Care and the subsequent planning and development of the LHIN’s new Integrated Health Service Plan... IHSP 2016-19. Ontario’s Patients First: Action Plan for Health Care Released by the Minister of Health and Long-Term Care (MOHLTC) in February 2015, Ontario’s Patients First: Action Plan for Health Care builds on a strong foundation set by Ontario’s original Action Plan for Health Care in 2012, and strengthens the government’s commitment to put patients first by improving their health care experience. While the 2012 Action Plan led to a number of important successes, it has been recognized that there still exists much work to be done to improve the patient experience, make the health care system more transparent and accountable, and to ensure the universal health care system will be there when needed for generations to come. Ontario’s Patients First: Action Plan for Health Care recognizes the economic and demographic realities of finite financial resources and a growing and aging population. It also recognizes the need to approach such realities from a different perspective, where we ask how we can ensure universality, improve access, and deliver the highest quality of care to people. The answer is a matter of choice... choice rooted in evidence-based practices; patient experiences; a commitment to equity, access and universality; and decision making where patients come first. In planning for the future the Central West LHIN was guided by Patients First in planning and developing IHSP 2016-19; working to understand and predict the unique needs of people living within its geography, supporting models that best serve local residents. The development of IHSP 2016-2019 was guided by Ontario’s Patients First: Action Plan for Health Care. Although the LHIN is not accountable for all of the initiatives identified in Patients First, local priorities and initiatives outlined in IHSP 2016-19 align with the objectives contained in the plan. IHSP 2016-19 IHSP 2016-2019 is the Central West LHIN’s fourth strategic plan. It defines the LHIN’s mission, vision, values and strategic priorities, outlining how it will go about achieving them. Building on the momentum of its earlier IHSPs it outlines how together, with HSPs and community partners, the LHIN intends to plan, integrate, fund and monitor the local health care system. These efforts are discussed in terms of the LHIN’s Strategic Directions, Initiatives and Actions. Ambitious yet actionable, and flexible in its ability to adapt to the changing needs of the health care environment, IHSP 2016-19 is rooted in the common vision and priorities of Ontario’s Patients First: Action Plan for Health Care, and common objectives of Ontario’s 14 LHINs. It has also been developed based on an environmental scan of the LHIN, input from community members, client groups and local Health Service Providers (HSPs), and with guidance from the Central West LHIN Board of Directors and staff. Working together, these Directions, Initiatives and Actions establish a comprehensive, focused and disciplined approach toward the attainment of desired outcomes, and reaffirm the Central West Together, Making Healthy Change Happen 221 62 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE LHIN’s commitment to put people and patients at the centre of their local health care system… to improve their health care outcomes and experiences. To advance the priorities outlined in IHSP 2016-19, the Central West LHIN will continue to focus on partnerships among patients, caregivers, providers, cross-sector partners and the community at large. The LHIN will also monitor and report on its progress to the Ministry of Health and LongTerm Care (MOHLTC), and broader community. Through a variety of reports that include the Central West LHIN’s Annual Business Plans (ABPs) and Annual Reports (ARs), local residents, patients and providers will have access to up-to-date information about the performance of their local health care system, and how well the LHIN is progressing with its Strategic Directions. The Central West LHIN has been a significant driver of healthy change since 2006. Gains that have been achieved, and those it plans to achieve in the future, are based on hard work by HSPs, community partners and the LHIN over the past decade. While the local health care system is further ahead today, much work remains to be done – particularly in achieving a genuinely integrated health system. IHSP 2016-19 provides the Central West LHIN with the foundation necessary to meet new challenges and to take a leadership role in the advancement of high-quality, patient-centred health care across Ontario. Both residents and health care professionals alike place high value on their health care system, and the need for it to be responsive to local communities. Accordingly, putting patients first will remain a shared responsibility as we move forward Together... Making Healthy Change Happen! 63 Central West LHIN | Annual Report 2015/16 222 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Together, Making Healthy Change Happen 223 64 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE Insert Audited Financial Statements here 65 Central West LHIN | Annual Report 2015/16 224 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - STRATEGIC DIALOGUE 8 Nelson Street West, Suite 300 Brampton, ON L6X 4J2 Tel: 905 455-1281 • Fax: 905 455-0427 Toll Free: 1 866 370-5446 www.centralwestlhin.on.ca ISSN 1913-5718 The Central West LHIN Annual Report 2014/15 is available in both English and French. Together, Making Healthy Change Happen 225 66 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - FIDUCIARY DIALOGUE 8 Nelson Street West, Suite 300 Brampton, ON L6X 4J2 Tel: 905 455-1281 Fax: 905 455-0427 Toll Free: 1 866 370-5446 www.centralwestlhin.on.ca CENTRAL WEST LHIN 2016-2017 First Quarter Report June 30, 2016 226 8, rue Nelson Ouest, bureau 300 Brampton, ON L6X 4J2 Téléphone : 905 455-1281 Sans frais : 1 866 370-5446 Télécopieur : 905 455-0427 www.rlisscentre-ouest.on.ca BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - FIDUCIARY DIALOGUE TABLE OF CONTENTS A – Transmittal Letter................................................................................................................. 3 B – Local Health System Update ............................................................................................... 4 C – Status Update on Special Initiatives..................................................................................... 4 D – Status Update on Integration Activities ................................................................................ 4 E – Quarterly Balance Sheet Forecast Tables............................................................................ 4 F – Sector Forecast ................................................................................................................... 4 G – Report on LHIN Operations ................................................................................................. 4 Attachment 1, CW LHIN – Balance Sheet Forecast for Q1 16-17, June 30 Attachment 2, CW LHIN – Sector Forecast for Q1 16-17, June 30 Attachment 3, CW LHIN – LHIN Operation Forecast for Q1 16-17, June 30 Central West LHIN... Making Healthy Change Happen Le RLISS du Centre-Ouest... Favorisons la santé 2 227 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - FIDUCIARY DIALOGUE A – Transmittal Letter June 30, 2016 MEMORANDUM TO: Kathryn McCulloch, Director, LHIN Liaison Branch Ministry of Health and Long-Term Care FROM: Scott McLeod CEO Central West LHIN RE: 2016/17 FIRST QUARTER REPORT Please accept the attached report on Central West LHIN’s 2016/17 First Quarter position. It is submitted in accordance with the reporting requirements established in the Ministry-LHIN Performance Agreement. This First Quarter Report will be recommended for approval to the Board at the Central West LHIN’s Finance and Audit Committee meeting of June 20, 2016 and for subsequent approval by the Central West LHIN Board of Directors on June 22, 2016. A final and approved version will be submitted to the Ministry of Health and Long – Term Care by June 30, 2016. If you have any questions or comments, please contact me at (905) 455-1281 x211. Sincerely Scott McLeod CEO, Central West LHIN Central West LHIN... Making Healthy Change Happen Le RLISS du Centre-Ouest... Favorisons la santé 3 228 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - FIDUCIARY DIALOGUE B – Local Health System Update As per the Quarterly Reporting Guidelines, updates on the major issues related to the Central West LHIN’s local health system are only to be completed for the Second Quarter Report. C – Status Update on Special Initiatives As per the Quarterly Reporting Guidelines and direction received from the Ministry of Health and Long-Term Care (Ministry), status updates on Special Initiatives in the Central West LHIN are required at the request of the Ministry. The Ministry has not requested a status update for the First Quarter. D – Status Update on Integration Activities As per the Quarterly Reporting Guidelines, updates on the major issues related to the Central West LHIN’s local health system are only to be completed for the Second Quarter Report. E – Quarterly Balance Sheet Forecast Tables See Attachment 1, CW-LHIN - Balance Sheet Forecast for Q1 16-17, June 30, 2016. F – Sector Forecast The Central West LHIN is forecasting a balanced position by year end, 2016/17. See Attachment 2, CW-LHIN - Sector Forecast for Q1 16-17, June 30, 2016. G – Report on LHIN Operations As of Q1 2016/17, the Central West LHIN is projecting a balanced position. See Attachment 3, CW LHIN - LHIN Operation Forecast for Q1 16-17, June 30, 2016. Central West LHIN... Making Healthy Change Happen Le RLISS du Centre-Ouest... Favorisons la santé 4 229 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - FIDUCIARY DIALOGUE LHIN #: 239_Central West Attachment 1: 2016-17 Quarterly Balance Sheet Forecast Purpose: To collect quarterly balance sheet forecasts information for central agency submission as required by the Treasury Board Secretariat. Instructions: 1. Please input all values as positives i.e. absolute dollars. Boxes marked grey are formulae which will produce the expected results. 2. Column E: is the 12 months actual for 2015/16. This column should match the March 31st, 2016 audited financial statements 3. Column G: input Q1 estimates for the first quarter (i.e.3 months) of 2016-17 fiscal year. 4. Column I: input the 12 months forecast as at March 31, 2017 for fiscal 2016-17 for Deferred Capital Contributions and Deferred Operating Revenues only. 5. If you need further clarification, please contact: Tao Qian tel. 416-325-1562, email: [email protected] Balance Sheet As at: E ACTUAL (12 months) March 31, 2016 G Q1 ESTIMATE (3 months) June 30, 2016 I FORECAST (12 months) March 31, 2017 ASSETS: 1. Cash 2. Accounts Receivable from: MOHLTC Health Service Providers (including Hospitals) LHINs Other Govt. Reporting Entities ( excluding Hospitals and GREs above) Other Accounts Receivable & Prepaid Sub-Total 3. Tangible Capital Assets i. Capital Costs: a. Beginning Balance b. In-year additions / (disposals) c. Ending balance ii. Accumulated Amortization: a. Beginning Balance b. less: amortization on disposed assets c. In-year amortization d. Ending balance NET BOOK VALUE (i less ii) 1,251,774 843,193 439,533 68,049 39,903 28,179 114,509 593,945 70,198 166,426 1,107,911 1,107,911 1,107,911 1,107,911 1,069,563 1,090,899 21,336 1,090,899 1,090,899 17,012 17,012 1,862,731 1,026,631 4. All Other Assets: TOTAL ASSETS LIABILITIES: 5. Accounts Payable and Accrued Liabilities to: MOHLTC 624,171 Health Service Providers (including Hospitals) 439,533 LHINs 11,339 Other Govt. Reporting Entities ( Excluding Hospitals and GREs above) Other Accounts Payable 770,676 Sub-Total 1,845,719 6. Deferred Capital Contributions from the Province (i.e. MOHLTC & Other GREs) a. Beginning Balance b. In-year Capital Contributions Received/To Be Received c. Amortization for the Year d. Ending Balance 7. Deferred Revenue from the Province (i.e. MOHLTC & Other GREs) a. Beginning Balance b. In-year Contributions Received/To Be Received c. Recognized in Income for the Year d. Ending Balance 8. All Other liabilities TOTAL LIABILITIES NET ASSETS / (LIABILITIES) Completed by: Contact Tel. #: Date Completed: 230 317,398 1,009,619 - - - - - - - - - 17,012 17,012 1,862,731 1,026,631 - Notes/Comments: 624,172 68,049 - - BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - FIDUCIARY DIALOGUE Attachment Two CENTRAL WEST LHIN QUARTERLY FORECAST BY SECTOR - FIRST QUARTER ($000'S) (A) Funding Allocation (Note 1) By Sector (Based on draft MLPA - May 31/2016 Update) Operation of Hospitals TOTAL (B) In-Year Adjustments (Note 1) 530,656.3 Payments to Government Reporting Entity (GREs) (Note 1) 530,656.27 Grants to compensate for municipal taxation - public hospitals TOTAL Long-Term Care Homes TOTAL 156,735.5 156,735.54 Community Care Access Centres TOTAL - (D) Actuals (IFIS) (Note 1) April to May (C=A+B) Revised Allocation Payments to non-GRE Recipients 89,503.5 (231.0) 0.0 0.0 - (E) Estimated June Expenditure (Note 2) TOTAL ACTUALS 89,272.5 43,392.0 0.0 26,225.0 26,225.0 114,945.6 114,945.57 0.0 19,246.9 19,246.9 13,620.0 13,619.98 17.4 2,455.2 2,472.6 Assisted Living Services in Supportive Housing TOTAL 11,730.7 11,730.73 0.0 1,781.8 Community Health Centres TOTAL 12,114.2 12,114.21 0.0 2,017.0 Community Mental Health TOTAL 32,452.1 32,452.13 592.2 4,839.1 5,431.3 6,030.8 6,030.83 552.2 453.1 1,005.3 TOTAL ESTIMATE 43,392.0 - Community Support Services TOTAL Addictions Program TOTAL Payments to Payments to Government non-GRE Reporting Entity Recipients (GREs) (F) Forecast by Quarter 1 (Q1) 12,958.9 12,958.9 9,489.5 9,489.5 926.0 933.0 1,781.8 1,150.8 1,150.8 2,017.0 1,011.6 1,011.6 292.4 2,389.4 276.0 226.5 7.0 Payments to Government Reporting Entity (GREs) 132,895.5 - Payments to non-GRE Recipients (231.0) - (G) Forecast by Quarter 2 (Q2) TOTAL Q1 FORECAST 132,664.5 % Expended Payments to Payments to to-date Government non-GRE Reporting Recipients Entity (GREs) 25.0% - 132,664.53 - 132,664.53 % Expended to-date 50.0% - - 39,183.9 39,183.9 - 39,183.89 39,183.89 50.0% - 28,736.4 28,736.4 25.0% - 28,736.39 28,736.39 50.0% 3,381.2 3,405.6 25.0% 24.40 3,381.18 3,405.58 50.0% - 2,932.7 2,932.7 25.0% - 2,932.68 2,932.68 - 3,028.6 3,028.6 25.0% - 3,028.55 3,028.55 50.0% 2,681.8 884.6 7,228.5 8,113.0 25.0% 884.56 7,228.47 8,113.03 50.0% 502.5 828.1 679.6 1,507.7 25.0% 828.14 679.57 1,507.71 50.0% 24.4 25.0% - TOTAL Q2 FORECAST 50.0% Acquired Brain Injury TOTAL - - 0.0 0.0 - - - - - - - - Specialty Psychiatric Hospitals TOTAL - - 0.0 0.0 - - - - - - - - Grants to compensate for municipal taxation - psych hospitals TOTAL - - 0.0 0.0 - - - - - - - - 94.2 - - 794.57 794.57 36.4% 85,965.3 220,366.9 50.0% Initiatives (Note 3) 2,438.7 2,438.72 94.2 - TOTAL LHIN 880,724.0 0.0 880,724.0 90,665.3 56,787.1 147,452.3 94.2 94.2 85,033.9 219,666.5 3.9% - 43,967.4 28,246.8 Note: 1. No input required for Column A, B, C, and D, and these columns are locked. 2. Detail input required for Column E, G, H, and I related to the monthly/quarterly Estimated Expenditure. 3. Actual payments (IFIS) for TP sectors above may include payments related to initiatives. 231 72,214.2 134,632.6 24.9% 134,401.6 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - FIDUCIARY DIALOGUE (H) Forecast by Quarter 3 (Q3) (I) Forecast by Quarter 4 (Q4) (J=D+E+F+G+H+I) Forecast Year-end Position (J-C) Variance By Sector Payments to Government Reporting Entity (GREs) Operation of Hospitals TOTAL 132,664.53 Payments to non-GRE Recipients - TOTAL Q3 FORECAST 132,664.53 % Expended to-date 75.0% Payments to Government Reporting Entity (GREs) 132,662.68 Payments to non-GRE Recipients - TOTAL Q4 FORECAST 132,662.68 % Expended to-date 100.0% Explanation of Variance Payments to Payments to TOTAL YEAREND Government non-GRE POSITION Reporting Entity Recipients (GREs) 530,887.27 (231.00) 530,656.27 - Grants to compensate for municipal taxation - public hospitals TOTAL Long-Term Care Homes TOTAL - 39,183.89 39,183.89 75.0% - 39,183.89 39,183.89 100.0% - 156,735.54 156,735.54 - Community Care Access Centres TOTAL - 28,736.39 28,736.39 75.0% - 28,736.39 28,736.39 100.0% - 114,945.57 114,945.57 - 75.0% 22.07 100.0% 95.26 Community Support Services TOTAL 24.40 - 3,381.18 - 3,405.58 - - 3,381.18 - 3,403.25 - - 13,524.71 - 13,619.98 - - Assisted Living Services in Supportive Housing TOTAL - 2,932.68 2,932.68 75.0% - 2,932.68 2,932.68 100.0% - 11,730.73 11,730.73 - Community Health Centres TOTAL - 3,028.55 3,028.55 75.0% - 3,028.55 3,028.55 100.0% - 12,114.21 12,114.21 - Community Mental Health TOTAL Addictions Program TOTAL 884.56 7,228.47 8,113.03 75.0% 884.56 7,228.47 8,113.03 100.0% 3,538.24 28,913.88 32,452.13 - 828.14 679.57 1,507.71 75.0% 828.14 679.57 1,507.71 100.0% 3,312.56 2,718.28 6,030.83 - Acquired Brain Injury TOTAL - - - - - - - - - - Specialty Psychiatric Hospitals TOTAL - - - - - - - - - - Grants to compensate for municipal taxation - psych hospitals TOTAL - - - - - - - - - - Initiatives (Note 3) - 496.65 496.65 56.8% 85,667.4 220,069.0 74.9% TOTAL LHIN 134,401.6 - 134,397.4 1,053.35 1,053.35 100.0% 86,224.1 220,621.5 100.0% Note: 1. No input required for Column A, B, C, and D, and these columns are locked. 2. Detail input required for Column E, G, H, and I related to the monthly/quarterly Estimated Expenditure. 3. Actual payments (IFIS) for TP sectors above may include payments related to initiatives. 232 - 537,833.3 2,438.72 2,438.72 342,890.6 880,724.0 - 0.0 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - FIDUCIARY DIALOGUE CENTRAL WEST LOCAL HEALTH INTEGRATION NETWORK Attachment 3: LHIN Operations and Initiatives Forecast Q1 16/17 Fiscal 2016-2017 Central West Local Health Integration Network Q1 LHIN Operations Report and Forecast YTD Budget vs YTD Actuals Category SALARY & WAGES Salaries & Wages HOOPP Other Benefits TRANSPORTATION & COMMUNICATION Staff Travel Governance Travel Communications YTD Budget June 2016 YTD May 2016 Actuals & June 2016 Forecast Annual Budget vs Annual Forecast YTD Variance Surplus/(Deficit) Annual Budget Forecast to Year End Variance Surplus/(Deficit) Variance Explanation 774,319 73,482 80,229 928,030 656,035 65,784 79,864 801,683 118,284 7,698 365 126,347 3,097,275 293,928 320,915 3,712,118 3,097,275 293,928 320,915 3,712,118 - 5,500 3,750 16,500 25,750 1,351 1,142 4,262 6,754 4,150 2,608 12,239 18,996 22,000 15,000 66,000 103,000 22,000 15,000 66,000 103,000 - 57,960 5,000 25 50,795 2,389 1,531 86,258 10,369 12,500 15,500 23,075 7,500 15,000 14,000 301,902 36,037 2,220 21 12,976 805 1,708 86,184 10,391 2,488 13,544 21,672 12,172 3,000 3,624 206,843 21,923 2,780 4 37,819 1,584 (176) 74 (22) 10,012 1,956 1,403 (4,672) 12,000 10,376 95,060 231,840 20,000 100 203,180 9,556 6,125 345,032 41,475 50,000 62,000 92,300 30,000 60,000 56,000 1,207,609 231,840 20,000 100 203,180 9,556 6,125 345,032 41,475 50,000 62,000 92,300 30,000 60,000 56,000 1,207,609 - 6,250 12,069 18,319 3,318 8,252 11,571 2,932 3,817 6,748 25,000 48,276 73,276 25,000 48,276 73,276 - 6,250 6,250 - 6,250 6,250 25,000 25,000 25,000 25,000 - 253,400 5,121,003 5,121,003 - YTD positive variance due to vacancies in the DRCC Medical Leads positions * * * SERVICES Accommodation Advertising Banking Consulting Fees Equipment Rentals Insurance LSSO Shared Costs LHIN Collaborative Other Meeting Expenses Board Chair's Per Diem expenses Other Board Members' Per Diem expenses Other Governance Costs Printing and Translation Staff Development SUPPLIES & EQUIPMENT IT Equipment Office Supplies & Equipment MINOR CAPITAL ASSETS Minor Capital Assets Purchased TOTAL LHIN OPERATIONS, DRCC, ER/ALC 1,280,251 1,026,850 * Expenses expect to be higher in Q3 & Q4 based on past experience 233 YTD positive variance due to $20K cheque for settlement of Insurance Claim related to flood * Consulting projects planned for Q2 - Q4 * YTD negative variance due to G2G in April * * Expect to spend in Q4 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - FIDUCIARY DIALOGUE CENTRAL WEST LOCAL HEALTH INTEGRATION NETWORK Attachment 3: LHIN Operations and Initiatives Forecast Q1 16/17 Fiscal 2016-2017 YTD Budget vs YTD Actuals Category YTD Budget June 2016 YTD May 2016 Actuals & June 2016 Forecast Annual Budget vs Annual Forecast YTD Variance Surplus/(Deficit) Annual Budget Forecast to Year End Variance Surplus/(Deficit) Variance Explanation ABORIGINAL COMMUNITY ENGAGEMENT 1,875 1,875 - 1,875 1,875 7,500 7,500 7,500 7,500 - 26,500 26,500 24,621 24,621 1,879 1,879 106,000 106,000 106,000 106,000 - 18,750 18,750 18,000 18,000 750 750 75,000 75,000 75,000 75,000 - 18,750 18,750 18,000 18,000 750 750 75,000 75,000 75,000 75,000 - 18,750 18,750 18,000 18,000 750 750 75,000 75,000 75,000 75,000 - 105,750 130,500 236,250 42,754 134,065 176,819 62,996 (3,565) 59,431 423,000 522,000 945,000 423,000 522,000 945,000 - Expenses expected to occur for Q2 - Q4 FRENCH LANGUAGE SERVICES *CRITICAL CARE LEAD *ED LEAD *PRIMARY CARE LEAD E-HEALTH ** CW LHIN ** PROJECT MANAGEMENT OFFICE TOTAL LHIN INITIATIVES GRAND TOTAL 320,875 255,440 65,435 1,283,500 1,283,500 - 1,601,126 1,282,290 318,835 6,404,503 6,404,503 - * Funding has not been confirmed/received ** Budget amounts reflect current year CW LHIN managed funds - balance of cluster funding to be distributed to other LHIN's 234 E-health projects planned for Q2 - Q4 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - FIDUCIARY DIALOGUE Central West LHIN I RLISS du Centre-Ouest CENTRAL WEST LOCAL HEALTH INTEGRATION NETWORK CEO ATTESTATION 2016-2017 — 1ST Quarter (QI) Prepared in accordance with section 14 of the Broader Public Sector Accountability Act, 2010 (BPSAA) To: The Board of the Central West Local Health Integration Network (the “Board”) From: Scott McLeod, Chief Executive Officer Central West Local Health Integration Network Date: Wednesday, June 15, 2016 Re: CEO Attestation for the 1st Quarter (QI) of 2016-2017 (April 1, 2016 to June 30, 2016) the “Applicable Period” On behalf of the Central West LHIN (the LHIN) I attest to: • • • • • the completion and accuracy of reports required of the LHIN, pursuant to section 5 of the BPSAA, on the use of consultants; the LHIN’s compliance with the prohibition, in secon 4 of the BPSAA, on engaging lobbyist services using public funds; the LHIN’s compliance with all of its obligations under applicable directives issued by the Management Board of Cabinet; the LHIN’s compliance with its obligations under the Memorandum of Understanding with the Ministry of Health and Long-Term Care; and the LHIN’s compliance with its obligations under the Ministry LHIN Accountability Agreement/Ministry LHIN Performance Agreement in effect, during the Applicable Period. In making this Attestation, I have exercised care and diligence that would reasonably be expected of a Chief Executive Officer in these circumstances, including making due inquiries of LHIN staff that have knowledge of these matters. I further certify that any material exceptions to this Attestation are documented in the attached Schedule A. ‘óntario If.two.k k4. d.,wvku d. ,.eti 235 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - FIDUCIARY DIALOGUE Dated at Brampton, Ontario on Wednesday, June 15, 2016. ot McLeod C e Executive Officer Cen al West Local Health Integration Network I hereby certify that this Attestation has been approved by the Board of Directors of the Central West Local Health Integration Network. Maria Britto Chair, Board of Directors Central West Local Health Integration Network 2 236 BOARD OF DIRECTORS' MEETING - WED., JUNE 22, 2016 - FIDUCIARY DIALOGUE Central West Local Health Integration Network SCHEDULE ‘A’ TO CEO ATTESTATION For the Applicable Period 2016/2017 1St Quarter (Ql) (April 1, 2016 to June 30, 2016) — Note to LHIN Boards re Schedule A. If the LHIN has no exceptions to declare, please insert “no known exceptions” under each of following below: 1. Memorandum of Understanding No known exceptions. 2. Ministry-LHIN Accountability Agreement (MLAA), Ministry-LHIN Performance Agreement (MLPA) in effect No known exceptions. 3. Completion and accuracy of reports required pursuant to Section 5 of the BPSAA; EXCEPTION: The LHIN has determined that the terms and conditions on which all fourteen LHINs acquired insurance breach the LHINs’ obligations under LHSIA, the Financial Administration Act, the MOU and possibly the MLPA. The LHIN is endeavouring to resolve this accidental breach by seeking approvals required by LHSIA, the Financial Administration Act, the MOU and the MLPA. This process began with a submission by Toronto Central LHIN, on behalf of all LHINs, to the Ministry of Health and Long-Term Care (the “Ministry”). The LHINs await a response from the Ministry. 4. Prohibition, in section 4, of the BPSAA, on engaging lobbyist services using public funds; No known exceptions. 5. Compliance with applicable directives issued by the Management Board of Cabinet (including Procurement, Travel, Meals and Hospitality, and Perquisites Directives) No known exceptions. 3 237