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AGENDA OPEN SESSION BOARD MEETING

Wednesday, March 28, 2018 Bluewater Health Board Room – R-4-810

5:00 pm Directors:

Marg Dragan, Treasurer Anthony Iafrate Bill Gillam Jenny Greensmith

Louis Guimond Brian Knott Dr. Guy Kohlmeier Katherine Mantha

Bob McKinley Wayne Pease, Chair Fred Vanderheide Paul Wiersma, Vice-Chair

Ex-Officio Directors: Mike Lapaine Dr. Michel Haddad

Shannon Landry Dr. Sharon Rutledge

Dr. Nathan Taylor

Professional Staff Staff and Guests:

Dr. Kapil Kohli Samer Abou-Sweid

Laurie Zimmer Julia Oosterman

Paula Reaume-Zimmer Kathy Alexander

Recorder: Melissa Rondinelli *attached

NO. TOPIC ACTION TIME PRESENTER 1.0 CALL TO ORDER: WELCOME AND OPENING REMARKS 1 min Wayne Pease

1.1 Report on February In-Camera Board Meeting 2 mins Wayne Pease

2.0 AGENDA APPROVAL

2.1 Approval of Agenda Decision 1 min Wayne Pease

2.2 Declaration of Conflict of Interest Decision 1 min Wayne Pease

3.0 CONSENT AGENDA

3.1 ITEMS TO BE RECEIVED – REPORTS Wayne Pease

3.1.1 Board Chair* Information Wayne Pease

3.1.2 Professional Staff Association Report* Information Dr. S. Rutledge

3.2 ITEMS FOR APPROVAL Wayne Pease

3.2.1 Open Session Board Minutes – February 28, 2018* Decision 2 mins Wayne Pease

4.0 PRESIDENT AND CEO REPORT* Information 5 mins Mike Lapaine

5.0 BOARD DECISIONS/OVERSIGHT

5.1 2018-19 Quality Improvement Plan (QIP)* Decision 15 mins Linda Schaefer Paul Wiersma

5.2 Quality Committee Highlights* Information 2 mins Paul Wiersma

5.3 Quality Committee Performance Scorecard* Discussion 5 mins Paul Wiersma

5.4 Resource Utilization & Audit Committee Highlights* Information 2 mins Marg Dragan

NO. TOPIC ACTION TIME PRESENTER 5.5 Accountability Agreements*

• Hospital Service Accountability Agreement (H-SAA)*

• Multi-Sector Service Accountability Agreement Extension (M-SSA)*

Decision 5 mins Marg Dragan

5.6 Financial Statements* Decision 5 mins Marg Dragan

5.7 Resource Utilization and Audit Committee Performance Scorecard*

Discussion 5 mins Marg Dragan

5.8 Medical Advisory Committee Highlights* Information 2 mins Dr. M. Haddad

5.9 Bluewater Health Foundation Report* Information 2 mins Kathy Alexander

6.0 POLICY FORMATION – None

7.0 OPEN FORUM Opportunity for Directors to reflect on how patients, families and community were considered in discussions

Discussion 5 mins Wayne Pease

8.0 IN-CAMERA AGENDA ITEMS – March 2018 Information 1 min Wayne Pease

9.0 ADJOURNMENT: Next Meeting: April 25, 2018 Wayne Pease

Bluewater Health Board of Directors

Open Session Meeting March 28, 2018

Proposed Motions

AGENDA ITEM MOTION

2.1 Agenda to approve the agenda as presented 3.0 Consent Agenda to receive and approve the items

presented in the Consent Agenda including:

• Reports • Open Session Board Minutes –

February 28, 2018 5.2 Quality Improvement Plan to approve the 2018-19 Quality

Improvement Plan as presented. 5.5 Accountability Agreements The Board authorizes the Board Chair

and the CEO to sign the extension of the existing M-SAA and HSAA agreements as well as the 2018-20 H-SAA Agreement as provided by the ESC LHIN, to ensure the ongoing flowing of funding from the ESC LHIN to Bluewater Health.

5.6 Financial Statements* to approve the financial statement for the period ended January 31, 2018 as presented.

Board Chair Report

I would like to highlight my activities as Chair for the period of February 24 to March 23, 2018: February 28, 2018 Prepared for and chaired the Bluewater Health Board Meetings

March 8, 2018 Attended the Resource Utilization and Audit Committee meeting

March 20, 2018 Met with President and CEO to prepare for the March Board meeting

March 21, 2018 Attended the Professional Staff Association Quarterly Meeting

Various dates Communicated with BWH staff and Board members regarding hospital and Board business

Wayne L. Pease

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President of the Professional Staff Association (PSA) Report

March 2018 I would like to highlight my activities as PSA President: February 28, 2018 Prepared for and attended the Board meeting March 21, 2018 Prepared for and chaired the quarterly PSA Meeting March 21, 2018 Prepared for and attended the Medical Advisory Committee

(MAC) meeting

Dr. Sharon Rutledge

MINUTES

OPEN SESSION BOARD MEETING Wednesday, February 28, 2018

Directors:

Marg Dragan, Treasurer √ Anthony Iafrate √ Bill Gillam √ by phone Jenny Greensmith √

Louis Guimond √ Brian Knott √ Dr. Guy Kohlmeier √ Katherine Mantha √

Bob McKinley - R Wayne Pease, Chair √ Fred Vanderheide √ Paul Wiersma, Vice-Chair √

Ex-Officio Directors:

Mike Lapaine √ Dr. Michel Haddad √

Shannon Landry √ Dr. Sharon Rutledge√

Dr. Nathan Taylor - R

Professional Staff, Staff and Guests:

Dr. Kapil Kohli – R Samer Abou-Sweid √

Laurie Zimmer - R Julia Oosterman √

Paula Reaume-Zimmer -R Kathy Alexander-R

Recorder: Melissa Rondinelli (*attached in the minute record book)

1.0 CALL TO ORDER - Wayne Pease called the meeting to order at 5:01 pm and welcomed the

Board and guests. 1.1 Report on January and February In-Camera Board Meeting - Wayne reported on the items

discussed at recent In-Camera Board meetings. 2.0 AGENDA APPROVAL

2.1 Approval of Agenda* Motion (K. Mantha/A. Iafrate) and carried: to approve the agenda as presented.

2.2 Declaration of Conflict of Interest – Wayne invited Directors to share any conflicts. None were declared.

3.0 CONSENT AGENDA

3.1 ITEMS TO BE RECEIVED – REPORTS 3.1.1 Board Chair* 3.1.2 Professional Staff Association Report* 3.1.3 Facilities Quarterly Report* 3.1.4 Analysis of Loans and Investments* 3.1.5 2014-17 Multi-Sector Accountability Agreement (M-SAA) Extension*

3.2 ITEMS FOR APPROVAL 3.2.1 Open Session Board Minutes – January 24, 2018* 3.2.2 Policy Revision - Environmental Stewardship Policy*

Bluewater Health – Open Meeting February 28, 2018 Page 2 ____________________________________________________________________________

3.2.3 Chief Financial Officer Certificate* Louis Guimond abstained from voting on item 3.2.1 since he was not present for the meeting. Motion (P. Wiersma/B. Knott) and carried: to receive and approve the items presented in the Consent Agenda including: • Reports • Open Session Board Minutes – January 24, 2018 • Policy Revision – Environmental Stewardship Policy • Chief Financial Officer Certificate

4.0 PRESIDENT AND CEO REPORT*

Mike presented his report and highlighted the “Share-Care” initiative underway for psychiatrists to begin meeting with primary care providers and patients outside of the hospital. He explained there has been an unprecedented surge in the Emergency Department (ED) for Mental Health services and in order to deal with these demands, BWH has to work more collaboratively with its partners. Mike noted recent data has shown that for 50% of mental health patients that presented to the ED, it was their first interaction with the healthcare system. This initiative will help to identify and intervene with patients earlier to improve outcomes. Mike then commended the BWH Mental Health team for its work on this new care model. Dr. Kohlmeier asked if this program will reach out to the schools to focus on care for youth and adolescents. It was explained this model will focus on primary care patients to begin with. Mike advised he would share the idea of linking to the schools with the team. Lastly, Paul Wiersma thanked the Communications team for their work on the website refresh.

5.0 BOARD DECISIONS/OVERSIGHT

5.1 Rural Health Capital Improvement Project at Charlotte Eleanor Englehart Hospital (CEEH) of Bluewater Health - Stage 1 – Part A and B Section 2.2 Submission* Mike explained the Erie St. Clair Local Health Integration Network (ESC LHIN) and Ministry of Health and Long-Term Care (Ministry) recently requested BWH provide them with Stage 1 – Parts A and B of the project submission to be reviewed and approved simultaneously. He noted the BWH Board previously approved Part A, which included the service delivery model and redevelopment strategy. Part B includes: the service support infrastructure report, business case options and analysis, and the facility development plan. Next, Mike reviewed Phase 1 of the project which includes the following priorities for redevelopment: renovations to the Emergency Department and Diagnostic Imaging and public access. He reported the preliminary estimate for Phase 1 is $8.8M, and there is opportunity to apply for grants for building infrastructure upgrades up to $5.8M. If BWH gets a portion of the grants it applies for, this will help to offset the cost of the project.


Mike then reviewed phases two to four of the overall project, all part of a 25 year concept. He explained the importance now is to improve the infrastructure for future development. Mike added the plan may change over time, and BWH will have to go through due diligence for each phase, since data, projections and assumptions may change. It was questioned if the County is aware of the financial support required. Mike explained the BWH Foundation shared a letter with them outlining the hospital’s needs over the next few years. He also confirmed there are no other grants available than the HIRF and HEEP grants being sought.

5.2 By-law Amendments* Brian Knott explained BWH began a legal review of its By-laws in late 2016, which were last

reviewed in 2014. He noted a number of changes were recommended by legal counsel based on the Ontario Hospital Association prototype, legislation and best practice. These changes include: separation of the document into two documents, style changes, simplified language, and the substantive changes outlined in the legal memos included with the briefing note. Brian explained the Governance and Nominating Committee (G&N) and By-laws Sub-Committee of the Medical Advisory Committee (MAC) reviewed the changes with legal counsel, and input was sought from the Professional Staff Association. There were no comments by the PSA on the final versions of the By-laws. He also added legal advice was sought about whether recent changes to the Corporations Act necessitated any further amendments, and BWH was advised some of these changes were already covered through legislation, and others could be dealt with when the Not-for-Profit Corporations Act is amended, which is expected in 2020. Louis noted the numbers referenced in the legal memo were off by one. Brian acknowledged this oversight, and explained the numbers were correct at the time of the sub-committee reviews, however since then another item was removed resulting in the difference.

Motion (B. Knott/A. Iafrate) and carried: to approve the amended Corporate By-law of

Bluewater Health and the amended Professional Staff By-laws of Bluewater Health as presented.

It was clarified the Board would be moving to approve both By-laws. Jenny Greensmith

inquired if it was common to have two By-laws. Brian confirmed the majority of organizations have two documents providing for more ease if revisions are required, and it is considered best practice. Paul thanked the G&N Committee for its work on the project, noting the By-laws are easier to read now.

Motion (P. Wiersma/M. Dragan) and carried: to suspend the meeting and move to the

Special Members Meeting.


The Open Session meeting reconvened at 5:33 pm.

5.3 2018-19 Annual Human Resources Plan* Marg Dragan presented the plan and highlighted some of the key findings including:

• 54% of staff are 25-44 years old • 21% of the workforce is eligible for retirement, with an average age of retirement of

60.5 years • An average of 11 staff members are hired each month • The BWH turnover rate is 7.4% which matches the provincial average • There has been an increase in the number of pregnancy and parental leaves

Marg advised a new Bill has increased the length of parental leaves from 12 to 18 months and it is currently unknown how this will impact the organization. She noted the BWH Human Resources Department is well aware of the needs of the organization and has plans in place to address them as identified. Motion (M. Dragan/K. Mantha) and carried: to approve the 2018-19 Human Resources Plan. BWH management was complimented on the report by several Board members and it was highlighted that over 25% of staff have over 20 years in service at BWH. Brian asked if there is any sense of whether the culture of kindness is impacting prospective employees and turnover. Mike advised the staff engagement survey is underway and there should be data available on this shortly. It was noted a new video has been created for prospective employees to watch, which explains the culture of kindness initiative and the importance of how feeling supported translates to better patient care. There were no further questions or comments.

5.4 2018-19 Annual Physician Human Resources Plan* Marg presented the plan and deferred any questions to Dr. Haddad. It was explained the report provides a high level overview of supply and demand for physicians across the province, Sarnia-Lambton recruitment needs, and the positions filled the past year. Mike commended Dr. Haddad and the Medical Affairs office for their recruitment efforts this year. Wayne asked if any physicians resigned during the period. Dr. Haddad reported several physicians have left BWH or plan to leave, yet the net is still positive and work is underway to recruit three more new physicians, including a child psychiatrist. It was questioned why the physicians left. Dr. Haddad explained the moves were related to personal reasons. He suggested retention of physicians is not an issue for BWH. Dr. Haddad also noted a funding request has been submitted to the Ministry for a geriatrician. Dr. Kohlmeier asked if the Ministry would pay the total remuneration for the


position. It was explained the position would likely be funded as a salary position and will not affect the hospital’s budget, rather BWH would be required to provide space and support to the physician. Jenny Greensmith asked if BWH makes an effort to offer a position to the partner of a physician when they are recruited. Dr. Haddad explained each department is responsible for its own recruitment needs. Fred Vanderheide mentioned a recent article where he learned there is a shortage of residency positions. Dr. Haddad explained enrollment has increased therefore the number of residency spots has become tighter. He noted he is working to develop a residency program in Sarnia.

Jenny requested BWH consider recruiting a paediatrician with a specialty in development

disorders given a physician currently travels from London five times per year to assess local children. Dr. Haddad explained the volume needs to be high enough to sustain this speciality in the community, which is why Sarnia relies on London for many specialty services.

Katherine Mantha noted BWH requires two ED physicians and there is competition for this specialty. She asked how BWH is addressing this. Dr. Haddad responded efforts are underway to develop the residency program to grow the specialty locally. He also noted two new ED physicians were recruited in January.

Motion (M. Dragan/F. Vanderheide) and carried unanimously: to approve the 2018-19 Physician Human Resources Plan.

5.5 Financial Statement* Marg presented the Financial Statement for the period ended December 31, 2017 and

noted the year to date operating surplus is $1.4M. She reported BWH has been notified it will be eligible for surge funding in the amount of $685K for the additional beds utilized over the winter months, however the financial statement does not included this potential revenue pending written confirmation. Marg also noted BWH is forecasting to end the year at or better than budgeted. There were no comments or concerns raised.

Motion (M. Dragan/P. Wiersma) and carried: to approve the Financial Statement for the

period ended December 31, 2017 as presented. 5.6 Governance and Nominating Committee Highlights*

Brian presented the Committee Highlights and noted Accreditation will be taking place in April 2019. He reported BWH received Accreditation with Exemplary Standing in 2014 and Accreditation Canada has increased it standards since then. Brian explained a gap analysis was completed which identified areas for improvement that will be addressed. He advised the Board will receive education and hear a lot about Accreditation in the year ahead.


Jenny asked about the gaps and whether the standards have changed. Brian explained it is natural to have gaps since the standards do change. Louis inquired about the Ethics gap identified. Shannon Landry explained the Ethics Committee is currently working on a new Ethical Framework and plans to provide a toolkit for Board Members to refer to when making decisions. Julia added BWH had already identified many of the gaps as areas for improvement and had been working on them. Paul clarified the hospital has an Ethics Framework and Policy, the Accreditation standard is about whether the Board looks at each decision through an ethical lens when recommendations come forward. The new tool will make this exercise more explicit. It was also noted BWH will be making improvements to Board succession planning in terms of the selection process for the Chair position. Lastly, Brian noted Dr. Jeffrey Turnbull has been selected as the guest speaker for BWH’s Annual General Meeting on June 27, 2017.

5.7 Quality Committee Highlights* Paul presented the Committee Highlights and complimented staff for the Department

Reports received by the Committee, which highlight their quality initiatives. He also noted the Committee was updated on the Quality Improvement Plan which will come before the Board next month and commented on the effectiveness of the Committee. There were no questions or concerns raised.

5.8 Quality Committee Performance Scorecard

Paul presented the scorecard and highlighted the following: • Medication Reconciliation at Discharge – It was noted the definition has changed to

exclude patients that left without being seen. • Difficult to Speak Up if I Perceive a Problem with Patient Care – not reaching target

based on 165 responses of 1800 employees • Total High Severity Patient Safety Incidents – 0 for the reporting period. • 90th Percentile ED Length of Stay for Complex Patients – Currently at 8.7 hours and

making progress at both sites. • ALC Rate % – exceeding target at 18.6% . Noted slight change in definition. • 30-day Mental Health Readmission – on target • Readmission within 30 days for COPD – not reaching target. Included as indicator on

2018/19 Quality Improvement Plan. • Strengthen Patient and Family-Centred Care indicators (Note: white boxes indicate

preliminary data) o ED results positive overall o Inpatient results off target

• Inspired People indicators – positive overall There were no questions or concerns raised.

Bluewater Health – Open Meeting February 28, 2018 Page 7 ____________________________________________________________________________ 5.9 Resource Utilization and Audit Committee (RUAC) Performance Scorecard*

Marg presented the scorecard and highlighted the following indicators updated this month: • 90th Percentile ED Wait Time (Admitted Patients) – Sarnia hospital not reaching

target despite focused work underway. CEEH on target. • ALC Rate %– discussed above. • Absenteeism rate – This indicator should read 2.94 and is within 5% of target for Q3. • Cost per Weighted Case – not reaching target in three of the four indicators due to

costs increasing fast than the number of cases, and cases decreasing. Rehab area on target.

• Mental Health Cost per Patient Day – on target. • QBP Financial Exposure – underachievement is due to fewer cancer surgeries being

performed. • Surplus – positive year end surplus expected

Paul requested clarification on the absenteeism rate. It was confirmed the target is 3.1 days per quarter or 12.4 days per year. It was noted this annual target is in line with other sectors.

5.10 Resource Utilization and Audit Committee (RUAC) Highlights

Marg presented the Committee Highlights for February and brought attention to the items reviewed and discussed by RUAC. Jenny Greensmith asked if funds from the Englehart Investments will be used for the capital redevelopment project. Mike explained the investment is set up as an endowment fund and BWH is provided with interest from it.

5.11 Medical Advisory Committee Highlights* Dr. Haddad presented the Committee Highlights and acknowledged the Surgery, Anaesthesia and Mental Health teams for their work to offer electroconvulsive therapy (ECT) services for BWH patients with depression which began this week.

6.0 POLICY FORMATION - None

7.0 OPEN FORUM Brian reported he attended a workshop at BWH yesterday focused on understanding Indigenous people. He encouraged members to attend the workshop if it is offered again as it was very well done and informative. Marg then shared her patient experience as an outpatient at BWH, noting she was impressed by the efficiency of her care. Wayne closed the meeting by sharing a patient story that resulted in raising funds for cuddle cots in the Maternal Infant Child department.

8.0 IN-CAMERA AGENDA ITEMS

Wayne advised the Board will be meeting In-Camera following this meeting to discuss executive compensation, personnel issues and recommendations from MAC.

Bluewater Health – Open Meeting February 28, 2018 Page 8 ____________________________________________________________________________ 9.0 ADJOURNMENT Motion (A. Iafrate/K. Mantha) and carried: to adjourn the meeting at 6:26 pm. ________________________ ____________________________ Wayne L. Pease Mike Lapaine Chair Secretary Board of Bluewater Health Board of Bluewater Health

___________________________ Melissa Rondinelli Senior Executive Assistant Recorder

Research Study Published in International Journal Reducing discomfort during biopsy is the topic of a recent Bluewater Health study accepted by the Journal of Medical Imaging and Radiation Sciences (JMIRS), an international, peer-reviewed publication. Large-scale hospitals conduct research regularly; it’s impressive for a hospital of our size since the design, implementation and revision process for publishing a study is a very challenging endeavor. The article, Effect of Topical Anaesthetic Cream on Pain during Periareolar Injection of Technetium Tc99m Sulfur Colloid for Sentinel Lymph Node Biopsy in Breast Cancer: A Randomized Control Trial, can be viewed online at https://www.sciencedirect.com/science/article/pii/S1939865417301200 until May 2. The study focuses on a procedure called a ‘sentinel lymph node biopsy’ that is often part of breast cancer surgery. A sentinel lymph node biopsy involves injecting a ‘tracer’ before surgery to locate the lymph nodes closest to the tumor and then removing these during surgery. Patients have indicated the tracer injection procedure can be very painful. Bluewater Health Patient Navigator Sarah Canning reviewed published literature to explore what options were available. She discovered little evidence supporting the use of a topical anaesthetic cream so she designed a research study to add to the scientific knowledge. Canning invited Statistician Dr. Mikelle Bryson-Campbell and Dr. Rajeev Suryavanshi, Surgeon at Bluewater Health, to be her partners in the study. The study aids research in clarifying the current conflicting research and identified areas for future research and refinement in the sentinel node biopsy procedure as the findings indicate topical anaesthetic cream does not significantly reduce pain during the procedure. Quality Improvement Plan (QIP) The Excellent Care for All Act (ECFAA) requires hospitals to annually develop a formal, documented set of quality commitments to its patients, clients, staff and community to improve quality through focused targets and actions. Our 2018-19 Quality Improvement Plan (QIP) builds on the successes and lessons learned from past years, and is evidence of our commitment to providing high quality, safe patient care. The QIP contains six key objectives each with measures and targets designed to provide a clear understanding of organizational priorities and allow for provincial comparability. The Patient Experience Partners helped develop the QIP action plans and were involved in choosing the indicators. After being approved by the Board of Directors, the QIP will be publicly posted on our website on March 29 along with a news release. Electroconvulsive Therapy is Now Available Bluewater Health has added Electroconvulsive Therapy (ECT) to the treatment options available for people who have been diagnosed with significant mental health illnesses in Sarnia-Lambton. ECT has proven to be a safe, effective treatment for patients who may not have responded to other treatments. For people who suffer from severe,

Report to the Board from President & CEO Mike Lapaine

March 2018

https://www.sciencedirect.com/science/article/pii/S1939865417301200

treatment-resistant illness, mania and/or schizophrenia, ECT treatment can improve quality of life and is often life-saving for the patient. ECT involves passing a small, controlled electric current between two metal discs (electrodes) that are applied on the surface of the patient’s scalp and/or temple which stimulates the brain, causing a controlled therapeutic seizure. The therapy is painless as patients are under a general anesthetic during the treatment. A Bluewater Health treatment team, inclusive of a psychiatrist, an anesthesiologist and nurses, are responsible for administering ECT for patients. The total number of treatments depend on the patient’s needs and how they respond to the therapy; for depression, a typical range is from six to 12 treatments. Initially, a patient will remain in hospital for monitoring of side effects and adjustments in the treatment plan. Once the treatment plan is established, patients may continue their treatments on an out-patient basis. Upon completion of their ECT treatment, patients will continue working with their psychiatrist and healthcare team to determine any further treatment plan and follow up care. MIC Earlier Pre-Admit Primary care providers such as family physicians and nurse practitioners coordinate with obstetricians and midwives – both specialists in pregnancy and childbirth – to ensure expectant moms receive the best care possible and the information they need in terms of proper nutrition, medications, exercise and more. One important milestone for pregnant women is their pre-admission appointment at the hospital where they will deliver their baby. Until recently, local physicians and midwives provided information about delivery when their patients reached approximately 32 weeks gestation. Women then scheduled a pre-admission appointment at Bluewater Health about four to six weeks later to learn how to prepare for labour and their baby’s birth. For some women, this meant they went into labour before their obstetrical pre-admission visit. With a change implemented March 1, expectant mothers will have their obstetrical pre-admission appointment between 24 and 28 weeks gestation. Evidence shows that providing information to women earlier in their pregnancy is beneficial, and it also meets a provincial recommendation.

Year-end Funding Announced Bluewater Health has recently been awarded additional funding in three key areas: Surge Funding, Quality Based Procedure (QBP) Funding for hips and knees and the temporary Withdrawal Management beds. Bluewater Health’s financial records for February 2018 will include $500,000 in surge funding based on acute beds that were opened during the surge period, to the end of February. The total potential funding available to Bluewater Health from November 15, 2017 to March 31, 2018 is $856,000 based on day-to-day use of additional beds. The hospital will receive an in-year adjustment of $518,581, largely for an increase in hip and knee replacements. This additional funding is a reallocation from the LHIN based on year-end volume projections. The LHIN has confirmed the annualized funding for the temporary Withdrawal Management beds in the amount of $1,000,037. Public Sector Salary Disclosure Each year since 1996, and in keeping with the Public Sector Salary Disclosure (PSSD) Act, Bluewater Health has publicly reported the names, salaries and taxable benefits of those who earned $100,000 or more in the previous calendar year. Twenty-nine registered nurses are among the 2017 list of 65 unionized and non-unionized staff. PSSD will be reported on the Ontario Ministry of Finance website, https://www.ontario.ca/page/public-sector-salary-disclosure, by March 29. HIS Update The five hospitals in Erie St. Clair (ESC) have agreed to strategically regionalize on a common Hospital Information System (HIS); the Cerner solution has been identified as the appropriate HIS platform for ESC to use, in partnership with a broad number of existing Ontario Cerner Hospitals. ESC will be looking to join a Provincial Cerner HUB over the next

https://www.ontario.ca/page/public-sector-salary-disclosure

one to five years. A third party vendor (KPMG) will be helping us start the initial phases of our ESC Regional HIS project, over a short 12-week period. They will be focusing on Change Management, Communications, Governance, and starting activities around Workflow, Technology, Reporting, and Data. There is broad Hospital leadership support for this project and there is an expectation that we will all benefit, as will our patients, from the advancement in not only technology, but our processes, standards, and partnerships with other organizations.

8th Annual Bridging Excellence Award Finalists The Bridging Excellence Awards recognize individuals and teams for their outstanding contribution, dedication, and commitment to excellence. To be nominated for this award is an honour in itself. A multidisciplinary selection committee, with representation from Executives, the Board of Directors, Human Resources, the Healthy Living Team, and past BEA finalists and recipients, was tasked with difficult deliberations to determine our finalists. Award recipients in each award category will be announced at the annual Recognition Ceremony on Thursday, April 26, 2018. Retirees and service award recipients from five to 50 years will also be honored during the ceremony. BEA finalists are: Vision Award Finalists Paramedic Program Team Critical Care Outreach Team Pharmacy Boxpicker Implementation Team Values Awards Finalists Carlo Olivotto, Senior Biomedical Technologist Jody Battle, Charge Nurse, Emergency Department, Petrolia Nicole Strong, Administrative Assistant, Medical Programs Dan Edwards, Volunteer Jane Cadman, Volunteer Mission Award Finalists Joanne Beaulieu, Payroll Analyst Deb Croteau, Director, Diagnostic Services Pat Davis, Volunteer Kindness Event Our Healthy Living Team and the Culture of Kindness Employee Council sponsored an event to mark Employee Appreciation Day on March 2. Employee groups were treated to bananas, along with a note to say “Thanks a bunch.” More than 1,000 bananas were distributed throughout the two hospitals. Board Recruitment Under the leadership of the board’s Governance and Nominating Committee, Bluewater Health is currently recruiting unpaid volunteers for the Board of Directors. We are seeking a mix of skills, experience, qualities and diversity representative of the Sarnia-Lambton community. Applications are available at www.bluewaterhealth.ca/boardrecruitment. Applications are due to Melissa Rondinelli by April 6.

http://www.bluewaterhealth.ca/boardrecruitment

Integrated Care Bluewater Health and the Lambton County Lake Huron Health Link have announced a new integrated position focused on growing and supporting Ontario’s Health Links initiatives in Sarnia Lambton. Health Links is an integrated patient-centred approach to care that focuses on enhancing and coordinating the care for patients living with multiple chronic conditions and complex needs, by ensuring each patient has a Coordinated Care Plan (CCP) and ongoing care coordination. At Bluewater Health, the Health Links/Patient Flow Coordinator works both within the hospital and community to facilitate patient flow and ensure access to care and services for these patients. The Patient Flow role has been in place at Bluewater Health for a number of years and the ability to combine the organizational view of patient flow with ensuring a seamless transition for a vulnerable population of patients returning to community is a natural fit. Charlotte Eleanor Englehart Hospital Renewal The Stage 1 Part A & B for Phase 1 has been submitted to the ESC LHIN and the Ministry of Health & Long-Term Care (Health Capital Investment Branch). They are reviewing the submission and we have not heard anything back from them to date. We are scheduled to be on the ESC LHIN BOD agenda for April 10, where we hope we will receive their endorsement for Part A of the submission. The LHIN only reviews and endorses Part A. Fundraising Hoedown for Healthcare, a joint event with CEEH Foundation in support of Rural Health, will be held May 11 at the Greenwood Recreation Centre.

http://www.health.gov.on.ca/en/pro/programs/transformation/com_healthlinks.aspx

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Bluewater Health Briefing Note

Name of Committee: Board of Directors Date of Meeting: March 28, 2018 Submitted by: Shannon Landry Subject: Quality Improvement Plan Purpose of Report: Information Input Approval

Situation The Board and CEO are required to approve the annual 2018/19 Quality Improvement Plan (QIP) for submission to Health Quality Ontario (HQO) on March 31, 2018.

Background Since 2010, with the inception of the Excellent Care for All Act (ECFAA), hospitals were required to develop a QIP to commit to a continuous improvement process for all the patients served and for our community health. Within the development of the QIP, at Bluewater Health (BWH), a 2% executive compensation was also integrated as part of the process. The 2% of executive salaries have been held back pending determination by the Board of Directors, who review the progress on how the targets are met within indicators in the QIP.

Analysis HQO, which oversees all QIP’s, has no prescribed or directed indicators that must be used, with the exception of the occasional mandatory indicator. Specifically, this year tracking workplace violence incidents is mandatory in the hospital sector. There is no target attached to this indicator as HQO is recommending ‘baseline data’ be collected, only. HQO allows individual organizations the flexibility to adapt indicators to what may be unique in their particular environment. At BWH, staff, patients, physicians and Board Quality members have agreed on six indicators for 2018/19: two patient experience indicators (total of four due to measuring inpatient and emergency for each), two readmission rates, emergency department wait times for admitted patients, and workplace violence incidents.

Along with selection of the indicators in the QIP, target setting for the respective indicators is a key component for improving quality of patient care, for staff morale on seeing improvements and for monitoring key strategic actions that align with indicators. The setting of these targets is as much an art as a science. Although some targets are considered objective, there are also targets that have a degree of subjectivity making it important to monitor trends over time for those respective indicators. Also, some of the indicators chosen are global in nature and require cooperation from external partners over whom the hospital has little or no authority,

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make setting meaningful progress toward the target an indication that our patients are receiving improvement in the quality of care.

HQO states that the spirit of the QIP is to encourage a culture of continuous quality improvement, meaning the indicator targets are used as drivers for the journey of constantly improving quality, and this is of more important than the achievement of the particular target. Because of this, considerable work has been put into the plan this year, specifically target setting, identifying both the science of target setting and the role of meaningful progress toward a target in considering whether there is improvements in the quality of care.

The methodology used was a framework called Rationale Target Setting Methodology (Zirps, 2012) and University of Illinois biostatistics and epidemiology work. The solid, consistent utilization of the methodology for target setting helped to identify realistic targets, make meaningful progress toward stretch goals and identify the environmental landscape to support reaching the target.

Executive Compensation of 2% is a component of the QIP. Traditionally the 2% has been determined as 0.5% recovered for sufficient achievement on any 1 of the indicators (achievement of 4 making total recovery of the 2%). The indicators, carefully chosen as representing various aspects of healthcare experience from a multi-dimensional perspective for our patients, infer improvement in the quality of care for patients if any one of the indicators shows progress.

To the ‘spirit of the QIP” the Board of Directors has always exercised a degree of subjectivity in awarding the 2% hold-back to the executive team. It was further suggested, and similar to previous years, achievement of meaningful progress on four of the six indicators would be used to determine whether to award the salary hold-back. That is consistent with reviewing the lack of external authority and the global aspect of the indicators.

Recommendation The Board approve the 2018/19 QIP as presented.

“Our Plan with Our Patients”QIP 2018/2019

Linda Schaefer

Looking Back

2017/2018 QIP Indicator Target BWH Performance

(as per last year QIP specifications)

Peer Comparator

Performance

ALC Rate 21% 18.98%(Q2 FY 2017/2018)

12.7% Exceeds Target

ED Wait Time Complex Patients

8hrs. 9.1hrs(Jan. 2017-Dec.

2017)

10.1hrs. Better than our Comparator

Patient Overall Experience:Emergency Department

Inpatient49.1%75.9%

49.8%69.5%

(Q1 &Q2 2017/18)

N/A65.4%

ED- Exceeds Target IP- Better than our

ComparatorReceived Enough Information on Discharge:

Emergency DepartmentInpatient

81%61.6%

81.3%(Q1, Q2 2017/2018)

56.7%(Q1 2017/18)

82.5%54.3%

ED- Meeting our Target IP- Better than our

Comparator

Readmission Rate Mental Health and Addictions 16.5%

10.8%(FY 2016/17)

TO BE VERIFIED

14.1% Exceeds Target

Readmission COPD Patients(Crude Data, Not Risk Adjusted)

16.9% 16.9%(Jan 2016-Dec. 2016)

18.2% Meeting our Target

Moving Forward

Looking Ahead 2018-2019- PRIORITY CHOICESPriority Indicators Current Target Performance

YTDConsiderations

Readmissions for:CHF/COPD/ Stroke

COPD 16.9% COPD 15.4% Cross Sector QIP

Readmission for Mental Health

16.5% 15.8% Aligns with bed capacity concerns for admitted MH

Received enough discharge information

ED 81%INPT 61.6%

ED 80.7%INPT 57.2%

Aligns with common feedback received.

Home Support Palliative

Not measured

Recommend Care(We measure Overall Experience)

ED 49.1 %INPT 75.9%

ED 50%INPT 69.4%

Currently use 2 question scale for ED and 5 question scale for INPT

ALC rate 21% 18.19% Also captured in HSAA data

MED Reconciliationon discharge

93%

59% of Frontline and PEPS




Target Setting

Incorporated Trend Data

Defined the Landscape

Linked to Effort and Defined

Success

Rational Target Setting

Realistic trajectory for performance Logical understanding of resources Achievable assessments

2018/2019Indicators

BWH Performance

Peer Comparator

Target

Workplace Violence Collecting baseline dataED Wait Time Admitted Patients 24.9hrs.

(Jan. 2017-Dec. 2017)34.4hrs. 20hrs.

(Jan. 2018-Dec. 2018)* Making meaningful

progress towards


Inpatient(Inpatient will now include all inpatient areas)

48.5%71.3%

(2016/17 Q4, 2017/18 Q1, Q2)

N/A65.4%

50.6%72%

(2017/18 Q4, 2018/19 Q1, Q2)

Received Enough Information on Discharge: Emergency Department


82.6%57.4%

(2016/17 Q4, 2017/18 Q1, Q2)

82.5%54.3%

83%61.6%

(2017/18 Q4, 2018/19 Q1, Q2)

* Making meaningful progress towards

Readmission Rate Mental Health and Addictions

15.8%( 2017/18 Q1, Q2)

14.1% 14.1%(2018/19 Q1, Q2)

Readmission COPD Patients

(Crude Data, Not Risk Adjusted)

17.9%(2016/17 Q4,

2017/18 Q1, Q2)

18.2% 16.4%(2017/18 Q4,

2018/19 Q1, Q2)• Making meaningful

progress towards

QIP Narrative

Our Plan for Our Patients

QI Achievements

Alternate Level of Care

Population Health and

Equity

Collaboration and

Integration

Opioid Treatment Planning

Workplace Violence

Percentage of respondents who responded positively to the following question:

• Understood what symptoms to look for before leaving the ED (correlates with enough information on discharge for the inpatient survey)

Measured using the Ontario Emergency Department Patient Experience of Care (EDPEC). Survey was revised in April 2016 and therefore there is no matching historical data available for the survey questions prior.

Quality Dimension: Patient Experience ED

Understood what symptoms to look for before leaving

ED Apr-16 69.6%

May-16 81.5% Jun-16 82.7% Jul-16 86.7%

Aug-16 82.5% Sep-16 86.9% Oct-16 89.1% Nov-16 85.2% Dec-16 85.9% Jan-17 82.3% Feb-17 87.5% Mar-17 84.7% Apr-17 94.1%

May-17 87.5% Jun-17 72.5% Jul-17 81.6%

Aug-17 70.9% Sep-17 80.6% Oct-17 72.1% Nov-17 82.6% Dec-17 low “n”

Quality Dimension: Received Enough Information on Discharge-ED

Current Performance YTD 2017/2018

(April-Dec. open data)

81.0%

Current Target

81.0%

Current Performance with QIP chosen time period

(Q4 2016/17, Q1,Q2 2017/18)

82.6%

Proposed Target

83%

Target Justification: Discharge Information: Trend data is variable and current value is met but close to the goal then the target will be set as an increase aligned with our peer comparator.

Peer Comparator 82.5%

OPEN DATA

2016

/201

7 Q

1,Q

2,Q

3 20

17/2

018

Percentage of respondents who responded positively to the following question: • Rate your overall experience (ED)


Quality Dimension: Patient Experience ED

Overall Experience ED

Apr-16 46.4% May-16 58.9% Jun-16 41.5% Jul-16 51.6%


May-17 50.8% Jun-17 46.0% Jul-17 48.6%


2016

/201

7 Q

1,Q

2,Q

3 20

17/2

018



48.9%

Current Target

49.1%


(Q4 2016/17, Q1,Q2 2017/18)

48.5%

Proposed Target

50.6%

OPEN DATA

Quality Dimension: Overall Patient Experience-ED

Target Justification: Overall Experience: Trend data is variable and current value is met but close to the goal then the target will be set as a 1.5% increase keeping in mind that there are many changes planned which may cause fluctuation of this metric as we align to these changes.


• Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital?


Quality Dimension: Patient Experience Inpatient

Received enough information Inpatient

Apr-16 61.1% May-16 59.4% Jun-16 60.6% Jul-16 55.3%


May-17 55.6% Jun-17 57.1% Jul-17 52.6%




57.2%

Current Target

61.6%


(Q4 2016/17, Q1,Q2 2017/18)

57.4%

Proposed Target

61.6%

Target Justification: Discharge Information: Trend data is variable and current value is far from the goal then the target will remain status.

Peer Comparator 54.3%%

OPEN DATA

Quality Dimension: Received Enough Information on Discharge- Inpatient 20

16/2

017

Q1,

Q2,

Q3

2017

/201

8


• Rate your overall experience (Inpatient)


Quality Dimension: Patient Experience Inpatient

Overall Rating of Experience-

Inpatient Apr-16 80.4%

May-16 75.0% Jun-16 76.4% Jul-16 75.0%


May-17 67.3% Jun-17 66.0% Jul-17 67.8%


Peer Comparator 65.4%

Quality Dimension: Overall Experience- Inpatient


(April-Oct.)

69.6% Current Target

75.9%


(Q4 2016/17, Q1,Q2 2017/18)

71.3%

Proposed Target

72%

OPEN DATA

2016

/201

7 Q

1, Q

2,Q

3 20

17/2

018

Target Justification: Overall Experience: Trend data is variable and current value far from the goal then the target will decrease to a realistic target keeping in mind our peer comparator is performing 6.6% less than our proposed target.

Definition:

The measuring unit of this indicator is an admission for chronic obstructive pulmonary disease (COPD), as defined for the QBP. Results are expressed as risk-adjusted all-cause 30-day non-elective readmission rate among patients admitted to Ontario acute care facilities.

Crude rate ONLY; Not Risk-adjusted rate Please note: Risk adjusted data typically may be +/- up to 2% of the crude data.

Crude Rate (QBP cohort) Note

2013/14 FQ1 21.12013/14 FQ2 20.62013/14 FQ3 26.92013/14 FQ4 20.92014/15 FQ1 21.22014/15 FQ2 23.92014/15 FQ3 11.32014/15 FQ4 17.02015/16 FQ1 11.02015/16 FQ2 18.82015/16 FQ3 19.52015/16 FQ4 15.52016/17 FQ1 12.32016/17 FQ2 16.72016/17 FQ3 19.32016/17 FQ4 18.82017/18 FQ1 15.42017/18 FQ2 19.2

Results are expressed as crude rates all-cause 30-day non-elective readmissions; the Crude results will differ to Risk-adjusted results required by QIP; the internal results are not official values (risk-adjusted all- cause 30-day non-elective readmission rate among patients admitted to any Ontario acute care facilities).

Quality Dimension: Effective Transitions Readmission Rate for COPD

Current Performance Q1/Q2 2017/2018

17.2%

Current Target

16.9% Current Performance with

QIP chosen time period (Q4 2016/17, Q1,Q2

2017/18)

17.9% Proposed Target

16.4%

Target Justification:

The trend data shows variability and the current value is far from the goal. The target will be set as an improvement goal, in view of the collaborative efforts across Sarnia Lambton cross sectors.

12.30%16.70%

19.30% 18.80%

15.40%

19.20%

0%5%

10%15%20%25%

30 Day all-cause Readmission for COPD

Target 16.9%

Pref

erre

d Tr

endi

ng

Rate of psychiatric (mental health and addiction) discharges that are followed within 30 days by another mental health and addiction admission.

Measurement: Rate per 100 discharges

Exclusion: Age <15 or >105

Full admission assessment: this assessment is completed when the net length of stay is greater than 72 hours (3 days); Excludes short stay assessments- length of stay less than 72 hours. Data for performance is collected based on Full Admission Assessments.

Admission Assessment (%) BWH Peer LHIN Prov

FY 2013/14 12.0 10.0 9.5 9.9 FY 2014/15 8.7 10.1 9.2 10.1 FY 2015/16 18.5 13.1 12.9 11.3 FY 2016/17 10.8 12.7 10.7 11.0 FY 2017/18 Q1 19.2 13.5 15.7 11.5 FY 2017/18 Q2 12.0 13.9 11.8 11.6

Quality Dimension: Effective Transitions Readmission Rate for Mental Illness or an Addiction

Current Performance Q1/Q2

15.8%

Current Target

16.5%

Current Performance with

QIP chosen time period (Q4 2016/17, Q1,Q2

2017/18)

14.8%

Proposed Target

14.1%


Trending data shows an increase of admissions in Q1, but current performance value for 2017/2018 to date is surpassing the goal. The target will be set lower to promote consistent improvements in the coming year.

15.6

21.4

15.5

20.1

8.5

12.5

8.6

13.0

19.2

12.0

0.0

5.0

10.0

15.0

20.0

25.0

2015/16FQ1

2015/16FQ2

2015/16FQ3

2015/16FQ4

2016/17FQ1

2016/17FQ2

2016/17FQ3

2016/17FQ4

2017/18FQ1

2017/18FQ2

%

30-Day Mental Health Readmission*30 days or less since last discharge from this facil ity

Target 16.5%

Pref

erre

d Tr

endi

ng.

Admission Assessment (%)

2013/14 FQ1 9.92013/14 FQ2 10.12013/14 FQ3 18.22013/14 FQ4 9.72014/15 FQ1 5.32014/15 FQ2 10.92014/15 FQ3 11.62014/15 FQ4 7.52015/16 FQ1 15.62015/16 FQ2 21.42015/16 FQ3 15.52015/16 FQ4 20.12016/17 FQ1 8.52016/17 FQ2 12.52016/17 FQ3 8.62016/17 FQ4 13.02017/18 FQ1 19.22017/18 FQ2 12.0

The total ED length of stay where 9 out of 10 admitted patients completed their visits.

ED LOS defined as the time from triage or registration, whichever comes first, to the time the patient leaves the ED.

Calendar Year ER LOS for Admitted Patients: 90th Percentile - Sarnia Site

Jan. 2013 – Dec. 2013 22.6 Jan. 2014 – Dec. 2014 22.0 Jan. 2015 – Dec. 2015 23.8 Jan. 2016 – Dec. 2016 24.6 Jan. 2017 – Dec. 2017 24.9

Current Performance Jan. 2017- Dec. 2017

24.9 hrs. Target 2017/2018

20 hrs.


(Jan-Dec. 2017)

24.9 Proposed Target

20 hrs.

Quality Dimension: Timely Access 90th Percentile ED Length of Stay (LOS) Admitted Patient Population


The trend data is far from the goal. Significant resources allocations are being utilized to improve this metric so the target will be set as a “stretch-goal”. We know this will be a slow downward trend and therefore, the overall year performance may not average out to 20hrs, but our aim is to have the December data reflect the target of 20hrs.

15.618.0

14.6

21.0

16.6

25.9 26.130.1

27.6 28.2

0.0

5.0

10.0

15.0

20.0

25.0

30.0

2013 2014 2015 2016 2017

90th

Per

cent

ile (h

ours

)

ER LOS for Admitted Patients: 90th Percentile -Sarnia Site

Lowest 90th Percentile Highest 90th Percentile

Jan 17 27.2 Feb 17 20.2 Mar 17 24.9 Apr 17 26.5 May 17 23.9 Jun 17 27.6 Jul 17 16.6 Aug 17 20.9 Sep 17 25.1 Oct 17 27.1 Nov 17 28.2 Dec 17 25.5

This indicator measures the number of reported workplace violence incidents by hospital workers (as defined by the OHSA) within a 12- month period.

Measurement: Number of workplace violence incidents reported

There will be no target as the 2017/2018 year will be utilized to collect baseline data.

Quality Dimension: Safe Overall Incidents of Workplace Violence

Current Performance

Collecting Baseline

Target

Increase the number of reported incidents


Focus will be on building on reporting culture, therefore the target for this indicator direction will be of an increase in the number of reported incidents.


Focus will be on building a reporting culture, therefore the direction for this indicator will be to increase the number of reported incidents.

2018/2019Indicators

BWH Performance

Peer Comparator

Target

Workplace Violence Collecting baseline dataED Wait Time Admitted Patients 24.9hrs.

(Jan. 2017-Dec. 2017)34.4hrs. 20hrs.

(Jan. 2018-Dec. 2018)* Making meaningful

progress towards



48.5%71.3%

(2016/17 Q4, 2017/18 Q1, Q2)

N/A65.4%

50.6%72%

(2017/18 Q4, 2018/19 Q1, Q2)

Received Enough Information on Discharge: Emergency Department


82.6%57.4%

(2016/17 Q4, 2017/18 Q1, Q2)

82.5%54.3%

83%61.6%

(2017/18 Q4, 2018/19 Q1, Q2)

* Making meaningful progress towards

Readmission Rate Mental Health and Addictions

15.8%( 2017/18 Q1, Q2)

14.1% 14.1%(2018/19 Q1, Q2)

Readmission COPD Patients

(Crude Data, Not Risk Adjusted)

17.9%(2016/17 Q4,

2017/18 Q1, Q2)

18.2% 16.4%(2017/18 Q4,

2018/19 Q1, Q2)• Making meaningful

progress towards

Bluewater Health 1 89 Norman Street, Sarnia, Ontario N7T 6S3

Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario

3/31/2018

This document is intended to provide health care organizations in Ontario with guidance as to how they can develop a Quality Improvement Plan. While much effort and care has gone into preparing this document, this document should not be relied on as legal advice and organizations should consult with their legal, governance and other relevant advisors as appropriate in preparing their quality improvement plans. Furthermore, organizations are free to design their own public quality improvement plans using alternative formats and contents, provided that they submit a version of their quality improvement plan to Health Quality Ontario (if required) in the format described herein.


Overview Overview

Bluewater Health’s Mission, “We create exemplary healthcare experiences with patients and families every time” and our Vision, “Exceptional Care, Exceptional People, Exceptional Relationships” compel our constant quest for quality. In 2016, we introduced a five-year Strategic Plan, with four strategic priorities: Quality Care, Outstanding Performance, Inspired People and Exceptional Relationships. That plan and our annual Quality Improvement Plan (QIP) are symbiotic in nature, each enabling and supporting the other.

The priorities intentionally encircle ‘Emily’ – representing a composite of every patient and family we have cared for in the past, present or future. The strategic plan is presented in Emily’s voice – as provided to us by our Patient Experience Partners. We believe that everyone, whether bedside or boardroom, contributes to Emily’s experience of care.

The design of our strategic plan is that of a kaleidoscope, intended to illustrate the constant shift and change in healthcare to meet new government directions and requirements, and higher expectations for transparency, integration, performance and efficiency.

Bluewater Health’s 2016-21 Strategic Plan is available publicly at www.kaleidoscopeofcare.ca

http://www.kaleidoscopeofcare.ca/


From experience, we know the development of a QIP ensures we remain on track to meet the high standards and expectations of our patients and families, staff, and community. Our 2018-19 QIP builds on the successes and lessons learned from past years, and is evidence of our commitment to providing high quality, safe patient care.

Bluewater Health has developed the 2018-2019 QIP around six key objectives, each with its own measures and targets designed to provide a clear direction for organizational priorities. In preparing this year’s plan, the organization’s current performance and targets were analyzed and challenged. Targets were linked to current efforts or to influence future efforts. We define success by meeting a target, or by making meaningful progress toward a target. The embedded initiatives align with the Bluewater Health strategic plan and seek to improve outcomes, improve access to care, and to focus on the experience of care and caring.

Increase patients’ perceptions and satisfaction with their care experience Current State Aim How will we get there?

Emergency Department:

48.5%

Inpatient Unit:

71.3%


50.6%

Inpatient Unit:

72%

(2017/18 Q4, 2018/19 Q1, Q2)

• Increase engagement by Patient Experience Partners (PEPs) with patients and frontline staff

• Improve how we plan for discharge • PEP-led strategy to reduce patient fears and anxieties

**For both the Emergency Department and Inpatient unit the current state and future aim are based on a positive response of 9-10 on a 0 to 10 scale for overall rating of experience


Improve the information and support patients receive prior to being discharged Current State Aim How will we get there?


82.6%

Inpatient Unit:

57.4%


83%

Inpatient Unit:

61.6%

(2017/18 Q4, 2018/19 Q1, Q2)

• Collaborative standardized discharge strategy to improve the information shared with patients

• Patient Oriented Discharge (POD) summary • Increase PEP engagement on discharge process and

strategy • Integrated Discharge and Health Links role

**Emergency Department – The current state and future aim are based on a ‘Yes’ response when offered the chance to answer ‘Yes’ or ‘No’ to the question “Before leaving the Emergency Department, did you understand what symptoms or health problems to look out for when you left the Emergency Department?” **Inpatient Unit – The current state and future aim are based on a positive response rating of 9-10 on a 0 to 10 scale to the question “Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital”

Decrease the readmission rates for patients with Chronic Obstructive Pulmonary Disease (COPD)

Current State Aim How will we get there?

17.9%

16.4%

(2017/18 Q4, 2018/19 Q1, Q2)

• Increase collaboration between Bluewater Health and cross sector partners

• Collaborative QIP action plan for community stakeholders and partners

Decrease hospital readmission rates for patients with mental illness or an addiction


14.8%

14.1%

(2017/18 Q4, 2018/19 Q1, Q2)

• Improve collaborative treatment planning and handover with community partners

• Utilize Residential Withdrawal Management beds • Strengthen the newly developed ‘Weekend Project’ in

collaboration with CMHA • Incorporate the concepts of the ‘Weekend Project’ into

daily practice


Decrease Emergency Department (ED) length of stay (90th percentile) for admitted patients


24.9 hours 20 hours

(2017/18 Q4, 2018/19 Q1, Q2)

• Implement a collaborative planning team for improved bed management and time to inpatient bed

• Concerted effort on cultural changes within the organization for improved access for our patients

Foster an environment of reporting for workplace violence incidents

Aim How will we get there?

Focus on building a reporting culture

• Streamline reporting system for workplace violence incidents • Improve awareness of workplace violence by inter-professional

collaborative team • Focus on building a reporting culture

Our QIP is also linked to:

• Hospital Service Accountability Agreement • P4R, the Ministry’s pay-for-results program to achieve Emergency Department targets • Accreditation Canada’s Required Organizational Practices • Canadian Patient Safety Institute recommendations • Safer Healthcare Now (C. Difficile rates and medication reconciliation completion rates) • Provincial Infectious Disease Advisory Committee recommendations and targets • Registered Nurses Association of Ontario Best Practice Guidelines • Ministry of Health and Long-Term Care Action Plan for Health Care Throughout the QIP planning process we identified challenges inherent in the current healthcare context:

1. Hospital base funding has decreased over the past six years while at the same time operating and inflationary costs continue to increase.

2. Single year and late communication of funding envelope allows for limited predictability for planning and implementation.

3. The growing number of initiatives emerging from the ESC LHIN place pressures on our current human resources.

4. Ministry of Health and Long-Term Care directed roles and responsibilities, which are outside the control of Bluewater Health, can have an impact on our ability to achieve optimal performance.


Describe your organization's greatest QI achievements from the past year Quality Based Procedure Entry Point

The Ministry of Health and Long Term Care funded a provincial clinical quality focused project to develop and implement digital Quality Based Procedure (QBP) order sets in Ontario hospitals. Bluewater Health joined the program with peers from the region to form LHIN cohorts. Our providers now have access to electronic order sets through the use of a cloud based software. This was a collaborative effort between Bluewater Health, Transform Support Services Ontario, and Think Research Corporation to install, integrate, and configure the EP software. To date, 54 Entry Point QBP Order Sets have been implemented by Bluewater Health.

Organ and Tissue Donation

Bluewater Health was recognized by the Trillium Gift of Life Network for its dedication to organ and tissue donation in Ontario. Bluewater Health was presented with the Provincial Conversion Rate Award for meeting or exceeding the target of a 58 per cent conversion rate set by Trillium Gift of Life Network. The conversion rate is the percentage of potential organ donors that went on to become actual donors. Organ donation is a complex process and the conversion rate reflects how well Trillium Gift of Life Network and Bluewater Health work together to save lives.

Choosing Wisely

Bluewater Health developed a committee aimed at proactively implementing Choosing Wisely initiatives throughout the hospital. The Choosing Wisely Canada campaign aims to help physicians and patients engage in healthy conversation about unnecessary tests, treatments and procedures. This encourages collaboration to make smart and effective choices to ensure high quality care. The committee works to identify the most impactful applications of Choosing Wisely recommendations at Bluewater Health. It encourages innovative practices, coordinates and monitors organizational improvement initiatives, and links with the South-Western Academic Health Network (SWAHN) and Choosing Wisely Canada. Physicians are engaged in the Choosing Wisely process because they feel patients have better health outcomes when they are partners in their care. Choosing Wisely initiatives are promoted throughout the hospital using a variety of communication techniques such as Choosing Wisely posters in Emergency Department waiting rooms and a Choosing Wisely message on every television screen.

There are currently three quality improvement initiatives underway. These include:

• Reducing the use of antibiotics for viral infections • Reducing utilization of antibiotics in the Intensive Care Unit • Improved communication between the hospital and the primary care provider on discharge

Diagnostic Imaging recently completed a year-long study to identify the number of unnecessary rib x-rays and develop subsequent recommendations to reduce these tests. In 2016, an audit showed 851 rib x-rays were completed at an average of 71 per month. Following the recommendations released after this audit, the total


number of rib x rays decreased drastically to 479 in 2017 at an average of 40 per month. This has reduced our patients’ risk of unnecessary exposure.

Good Catch Program

Bluewater Health introduced a new initiative in October 2017 called the ‘Good Catch Program.’ The aim of the initiative is to document and learn from ‘Near Miss’ events – these are events that have not reached a patient, but without intervention, could have resulted in a patient safety incident. The intent is to learn from these events and understand them as predictors of system errors. These events are entered into the Incident and Feedback Reporting System. The goal of this initiative is to enhance patient safety by increasing ‘Near Miss’ reporting by 10%. Employees are encouraged to report near misses and are rewarded with an entrance to our weekly draw. All near misses are reviewed, and the learnings are disseminated throughout the organization.


Resident, Patient, Client Engagement and relations Patient Experience Partners (PEPs) are patients and families who have experienced the healthcare journey at Bluewater Health, and volunteer their time as advocates for future patients and families. The PEPs participated in the development of the QIP by attending our World Café, which gave them the opportunity to choose the indicators they felt were important for improving the patient experience at Bluewater Health. The PEPs are committed to monitoring the QIP metrics and progress throughout the year, and they are active on the Quality Patient Experience Committee, the Quality Committee of the Board, program councils and the discharge strategy team. They are included in any new quality initiative as an advocate for the patient’s voice. In preparation of the 2018/2019 QIP, PEPs participate in an information meeting to explain what the QIP is, why it matters, and QIP changes for the upcoming year. Bluewater Health demonstrated an investment in its PEPs by sending one of the co-chairs to the Patient and Family Advisory Skills Exchange. This course provided the co-chair with the ability to pass on knowledge and tools necessary for fellow PEPs to participate confidently in initiatives, projects, and committees.

Collaboration and Integration The Health Quality Partners of Sarnia-Lambton

The Health Quality Partners of Sarnia-Lambton committee includes over 20 cross-sector partners and a Bluewater Patient Experience Partner seeking to improve the patient journey during transitions of care. The identification of a common QIP indicator has been established with the goal of working towards effective transitions for patients with Chronic Obstructive Pulmonary Disease (COPD). A collaborative work plan with identified action items to improve transitions of care for patients with COPD is being developed. This team meets bi-monthly to review and action change ideas to improve transitions of care and care coordination for the COPD population by a collaborative approach across the sectors.

Health Links Patient Flow Coordinator

The Health Links Patient Flow Coordinator is a newly-integrated position resulting from a collaboration between Health Links and Bluewater Health. This new role is responsible for identifying patients in hospital appropriate for Health Links and facilitating referral processes in collaboration with hospital staff. The coordinator works both in the hospital as well as in the community. A coordinated care plan will be completed on patients prior to discharge. The integrated position is a role model for the Patients First approach, focusing on patient satisfaction and qualitative evaluation of programs in addition to required quantitative data points. We aim to create an integrated way to collaborate with community partners such as the Community Paramedic Program, Canadian Mental health Association (CMHA), and primary care organizations to ensure quality care incorporates a Health Links approach.


Engagement of Clinicians, Leadership & Staff

For the 2018/2019 QIP development, a rigorous process was utilized to engage the various stakeholders in the identification of upcoming quality metrics. Bluewater Health used selection criteria built upon previous years’ criteria to guide the identification of indicators. When selecting indicators the following criteria were used: i) aligns with BWH strategic plan, ii) organizational cross-sector and provincial priorities considered, iii) Health Quality Ontario’s “priority indicators” selected if warrants organizational focus for improvement, and iv) frontline staff, managers, and Patient Experience Partners (PEPs) considerations. These criteria were used and indicators were selected through organizational and board approval. Teams worked to identify change ideas to improve the systems that support the goals within the indicator metrics. In particular, the PEP team met and strategized action plans to support improved patient perception and experience. Following approval of the QIP for the 2018/2019 year, each department will identify process measures to support the QIP indicators which are then placed on the departmental “performance boards” for awareness and to identify what each department can do to improve quality for Bluewater Health. QIP indicators are also placed on departmental scorecards throughout the organization.

Population Health and Equity Considerations Community Paramedic Program

In early 2017, the Community Paramedic Program was developed through a collaborative partnership with Bluewater Health and the Lambton County Emergency Medical Services (EMS). The program is designed to help high users of EMS and the health system to live independently at home – this can include seniors, those with chronic pain, and those requiring regular medical services. Visits are scheduled and occur during the day in the patient’s community setting. The frequency of visits is based on the patient’s physical health condition and medical needs. This program is provided at no additional cost to the patient. The aim of the program is to demonstrate output measures such as:

• Patient demographics • Number of home visits and specific interventions • Number of community referrals • Number of assessments of patients • Financial indicators

The intended purpose is to decrease Emergency Department (ED) patient volumes, decrease 911 calls by frequent users, decrease ambulance offload times and delays in the ED, and increase patient satisfaction.


Indigenous Community Collaboration

In April 2017, Bluewater Health established a set of priorities pertaining to the Indigenous communities served by our hospital. The key objectives included enhanced Indigenous patient care, support for transitions, improved navigation, and establishing collaborative connections between Indigenous communities and mental health and addiction services. Working in collaboration with the Aamjiwnaang, and Kettle and Stony Point communities, Bluewater Health has taken steps to incorporate advanced cultural safety training into its strategy and awareness campaign, support the development of the Indigenous Patient Navigator, developed an Indigenous Patient Care committee, and assist with the creation of formal agreements/relationships with local Indigenous communities and/or groups.

We understand the need to work alongside our Indigenous partners at the community level and the individual level. It is important to balance an understanding of the experiences of the community as a whole as well as the needs and specificities of these community members as individuals and patients.

Labour Birth Recovery Postpartum – Indigenous Birthing Room

In June 2017, Bluewater Health opened its newly renovated birthing rooms. The rooms were designed to allow expectant mothers to stay in the same room throughout labour, birth, recovery and postpartum, and represent a new birthing experience in the unit. One of the rooms was specially designed for Indigenous births. Its size allows for larger families, traditional ceremonies, and incorporates Indigenous art into the space. Traditional birth customs such as cedar baths and liquid smudging can be performed on site. The addition of the Indigenous birthing room was an opportunity for Bluewater Health to strengthen its relationship with First Nations communities. It increases the organization’s awareness of cultural sensitivity when caring for patients and families that come to our hospital.

Access to the Right Level of Care - Addressing ALC Bluewater Health has been successful in reducing Alternate Level of Care (ALC) numbers, in part through the use of the ALC Avoidance Framework. Bluewater Health adapted the 12 leading practices of the framework to its capacity and context: a small urban and rural area. Bluewater Health’s success has relied on early and improved communication with patients identified as high-risk for ALC by providing information on all the options available to them. It also involves improved communications with healthcare providers and physicians around ALC risk and supporting improved patient decision-making and experience.

In June 2017 Bluewater Health hosted a cross-sector symposium for adopting leading practices for care transitions. The aim of this event was to renew the Home First strategy for Sarnia-Lambton by putting patients at the center of their healthcare and strengthening community partnerships. Additionally, a Staytrack reporting system has been implemented across Bluewater Health as a method of assessing barriers to discharge and focusing discharge planning to address these barriers. For this upcoming year our objective is to strengthen partnerships and transitions. Bluewater Health will be hosting another cross-sector symposium to focus on these elements with the goal of positive transitions.


Opioid Prescribing for the Treatment of Pain and Opioid Use Disorder Bluewater Health has been working toward securing a residential withdrawal management facility in the community. As part of Ontario’s comprehensive strategy to prevent opioid addiction and overdose, the Erie St. Clair Local Health Integration Network invested in regional supports to help people impacted by opioid addiction and overdose. Through this investment Bluewater Health opened seven temporary substance withdrawal management beds in January to help people living with addiction. This will improve access to important addiction services in Sarnia-Lambton while planning for the new community-based withdrawal management facility continues.

Patient who come to the Emergency Department (ED) for chronic pain and/or to seek opioid pain medications will be assessed and the ED Physician will develop a treatment plan to address the patient’s needs.

• If the ED Physician believes the patient will benefit from the use of an opioid pain medication, he/she will prescribe a short course prescription of these medications (usually not more than three days)

• The ED Physician will advise the patient’s primary care provider of the treatment plan • Patients will be instructed to follow up with their primary care provider within three or four days • If a patient does not have a primary care provider, he/she will be connected with primary care providers

who are accepting patients and/or other community partners who have agreed to see these patients quickly

• ED Physicians will not refill opioid prescriptions for patients who have presented at the ED in the past and have chosen not to follow up with a primary care provider

Workplace Violence Prevention Bluewater Health is taking steps to raise awareness, and reduce the amount of workplace violence events experienced by staff. Our workplace violence leads have recently organized and participated in a LHIN-wide meeting that included representation from each acute care hospital in the Erie St. Clair area, members of the Public Services Health and Safety Association, and the Ministry of Labour. This meeting introduced new workplace violence reduction tools, and provided a vehicle for each organization to share its ideas and progress on reducing workplace violence. Bluewater Health has formed a multi-disciplinary Workplace Violence Prevention Committee that has implemented new “zero tolerance” signage, and continues to improve polices on aggressive patient flagging, patient and family education, and assessment and reassessment of patients. The committee, which includes patient representatives, has completed a workplace inspection using a Ministry of Labour-endorsed tool, and is in the process of reviewing training requirements of staff. Bluewater Health recognizes each employee has the right to a violence-free workplace, and with the help of the Workplace Violence Prevention Committee, is utilizing a quality-driven approach to improve reporting, and reduce violent events.


Performance Based Compensation The purpose of performance-based compensation related to the Excellent Care for All Act (ECFAA) is to drive accountability for the delivery of quality improvement plans. Performance-based compensation can help organizations to achieve both short and long-term goals. Performance-based compensation will enable organizations to:

1. Drive performance and improve quality care 2. Establish clear performance expectations 3. Create clarity about expected outcomes 4. Ensure consistency in application of the performance incentive 5. Drive transparency in the performance incentive process 6. Drive accountability of the team to deliver on the Quality Improvement Plan 7. Enable teamwork and a shared purpose

Compensation for the entire executive team at Bluewater Health is linked to our organization’s achievement of quality improvement targets set out in our annual Quality Improvement Plan. The executive team refers to the:

• President & Chief Executive Officer • Chief of Professional Staff • Vice President, Operations • Vice President, Operations • Integrated Vice President, Mental Health and Addiction Services • Chief Nursing Executive • Chief, Communications and Public Affairs

Our 2018-19 Pay for Performance Plan is in compliance with the Excellent Care for All Act, 2010 and the Public Sector Compensation Restraint to Protect Public Services Act, 2010. In January 2018 Bluewater Health participated in public consultation related to Ontario’s public sector executive compensation.

For each of our executives, 2% of their current base salary will be withheld and is "at risk" and linked to Bluewater Health achieving the targets set out in its 2018-19 Quality Improvement Plan on the indicators outlined below. For each indicator target achieved, the executives will receive 0.5% of their salary, where the 2% will be received if four out of five targets are met or have made meaningful progress towards as defined.


Specifically, the 5 targets are the following:

Indicator Current Performance

YTD

Goal

Reduce readmissions for mental illness or an addiction

14.8% 14.1%

(Make meaningful progress towards goal during 2017/2018 Q4, 2018/2019 Q1, Q2)

Reduce readmissions for patients with Chronic Obstructive Pulmonary Disease (COPD)

17.9% 16.4%


Decrease Emergency Department (ED) length of stay for admitted patients

24.9hrs. 20hrs.


Improve the patient’s experience 48.5%% (ED) 50.6% (ED)

71.3% (Inpatient)

72% (Inpatient)


Increase the amount of information patients receive when leaving the hospital

82.6% (ED) 83% (ED)

57.4% (Inpatient)

61.6% (Inpatient)


Please note Workplace Violence indicator is collecting baseline for this coming year and therefore no target will be assigned. Contact Information Bluewater Health, Sarnia 89 Norman Street Sarnia, Ontario N7T 6S3 Tel: (519) 464-4400 Fax: (519) 464-4407 Charlotte Eleanor Englehart Hospital of Bluewater Health 450 Blanche Street Petrolia, Ontario N0N 1R0 Tel: (519) 882-4325 Fax: (519)882-


Sign-off It is recommended that the following individuals review and sign-off on your organization’s Quality Improvement Plan (where applicable): I have reviewed and approved our organization’s Quality Improvement Plan Wayne Pease, Chair, Bluewater Health Board of Directors Paul Wiersma, Chair, Quality Committee of the Board Mike Lapaine, President & Chief Executive Officer Dr. Michel Haddad, Chief of Staff Dr. Renato Pasqualucci, Chair, Quality Patient Experience Committee Dave Remy, Chair, Quality Patient Experience Committee

Quality Committee of the Board Highlights

March 19, 2018

Program Report: Critical Care & Respiratory Therapy, Director Critical Care & Respiratory Therapy Lisa Regan, Manager Critical Care & Respiratory Therapy Deb Matchett and Dr. Cuccarolo Medical Director of Critical Care Medicine • Success: Critical Care Outreach Team (CCOT) put into place December 2016 has been successful in

diverting patients from the ICU. Nurses utilize the Early Warning Scoring System to assess when to contact the team to put strategies in place. This is helping with patient care, patient flow and budget.

• Success: Continuous Renal Replacement Therapy (Dialysis) is being provided to ICU patients at the bedside. This is avoiding transports to London and treatment efficiency for the patient.

• Challenge: Lack of knowledge with respect to Smoking Cessation Resources in the community is causing a decline in referrals to the Smoker Help Line. A relaunch of the Lambton Tobacco Network to increase awareness and education will occur April 1st. Smoking is a factor in COPD Readmissions.

Program Report: Pharmacy–Medication Reconciliation at Discharge, Director Pharmacy Andrea Wist • the quality of medication reconciliations is linked to the quality of the best possible medication histories

being completed - data is showing that only 50% of the histories are being completed by pharmacy technicians and the histories not completed by pharmacy technicians are not at the same quality level

• discharge medication reconciliation is much more difficult for the physicians if the history has not been completed by a pharmacy technician within the IATRIC software

• information was shared regarding a pilot being conducted in Medicine where a Pharmacist Discharge Facilitator is on hand to review medications with patients prior to discharge

• quality medication reconciliations are proven to reduce adverse drug events post discharge, prevent ED visits and re-admissions as well as improve overall rating of patient experience

Quality and Patient Safety Program, Director Quality & Patient Experience Dave Remy and Linda Schaefer, Manager Quality and Patient Safety • 3 Nursing students from Windsor are working in collaboration with Professional Practice on a

comprehensive review of BWH falls prevention program – audits are taking place to look at compliancy and results will be provided for improvements

• signage has been developed by the workplace violence prevention team – No Excuse for Abuse posters and banners will be going up in the next few weeks

• Skills Days bring through approximately 100 front line staff, managers, PEPs and community members – these days provide necessary education on topics such as: legal and risk management, wound care, and available community support services

• accreditation gap reporting will be available soon – next step will be to develop action plans • adverse event data fro Q1 thru Q3 2017/2018 was provided • critical incidents for 2017/18 were provided Collaborative Planning Update, Samer Abou-Sweid and Laurie Zimmer shared the work that is being done by a large team of individuals on Re-designing Our Care Journey…No One Waits. The provided slides outline the team, purpose and vision of the work. The aim of the project is defined in slide 9: “By October 1, 2019, each Emily will be able to safely access the right care, in the right place, with the right provider, with no delay greater than 2 hours”. Submitted by: Paul Wiersma

Meets/Exceeds Target .

Within 5% of Target

Worse than Target by 5+%

Data Unavailable

FOI Masked due to n size <5

Italics n Size between 6 - 30

* no established target

ⱡ corporate target

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

Jul

17

Aug

17

Sep

17

Oct

17

Nov

17

Dec

17

Jan

18 Re

po

rt

Pe

rio

d

YTD

1QIP/

HSAAn/a * 96 97 97 97 97 97 95 97 97 97 96 96 98 98 97 95

Apr -

Mar97%

Med Rec at Discharge calculation now excludes

disposition X (left without being seen), locations

Emergency Department Inpatient (EDIN) and Day

Surgery (SURDS). Scorecard data has been

modified to reflect this change.

◄

2 SP n/a 49.6% 0.00 0.00 0.00 0.00Apr -

Mar46.9%

Top Box Responses for all sectors, n size for current

reporting period 165. No data available for Q2 as

the survey was not administered.

◄

3 0 n/a 0 0Apr -

Mar7

0.0% ◄

Sarnia 7.9 8.0 8.3 10.1 8.1 9.3 9.6 9.0 9.7 8.0 8.9 9.8 9.4 9.7 8.7 10.7 10.7 0 ◄

Petrolia 3.7 3.2 4.0 4.1 3.9 4.3 4.4 3.9 4.0 4.1 4.7 4.0 5.0 3.7 3.8 4.6 4.60.0

◄

Exceptional Relationships - Expand innovative partnerships and collaborations to improve experiences, services, transitions and community

5QIP/

HSAA12.7% 21.0% 23.3 21.1 21.6 18.4 17.2 18.5 16.7 17.8 -- 21.5 17.2 17.7 18.6 14.8 15.7 0.0

Apr -

Mar17.5%

ALC Rate denominator has changed with the

implementation of the Daily Bed Census Summary

in June 2017, values are subject to change ◄

6 QIP n/a 16.5% 0.0 0.0 0.0 0.0Apr-

Mar15.8%

OMHRS assessments: 30 days or less since last

discharge from this facility; excluding short-stay

assessments0.0

7 QIP 18.2% 16.9% 0.0 0.0 0.0 0.0Apr-

Mar17.2%

This is preliminary data and is subject to change ◄

ED n/a 49.1% 46.2 46.7 53.1 41.7 43.5 53.3 55.8 50.8 46.0 48.6 50.9 46.6 51.2 38.9 56.2 44.4 49.0%Positive score = 9 & 10

◄

Inpatient 65.0% 75.9% 70.3 76.5 62.0 68.4 72.2 82.1 78.0 67.3 66.0 67.8 75.5 63.1 73.7 66.1 56.5 81.2 69.0%Positive score = 9 & 10

◄

ED 82.2% 81.0% 89.1 85.2 85.9 82.3 87.5 84.7 94.1 87.5 72.5 81.6 70.9 80.6 70.5 83.0 91.8 100 81.9%Positive score = Yes

◄

Inpatient 53.7% 61.6% 54.7 53.6 53.4 63.8 61.0 53.7 57.4 55.6 57.1 52.6 67.3 44.6 62.2 56.7 51.1 56.2 56.1%Positive score = Completely

◄

Inspired People - Advance our culture of kindness with an intention to learn, lead, collaborate and celebrate

10 SP n/a 67.3% 0.0 0.0 0.0Apr -

Mar69.4%

Strategic Engagement Survey, top Box Responses

employees; current reporting period n=137 ◄

ED n/a 64.5% 71.7 57.4 70.3 68.9 66.7 69.5 66.7 62.9 57.7 73.0 70.4 71.2 55.8 66.7 74.5 88.9 66.9%Positive score = Yes, definitely

◄

Inpatient n/a 80.4% 84.8 75.0 81.3 75.9 73.4 88.3 81.4 81.8 71.4 81.7 85.7 82.1 84.0 76.9 80.4 62.5 80.2%Positive score = Yes, definitely

◄

12 SP n/a * 0.0Apr -

Mar74.3%

YTD is Top Box Responses for all sectors, current

reporting period n=165 ◄

10.1

hrs

<=8

hrs

Apr -

Mar

Apr -

Mar

Jan-

Dec

12.0

Q3 16/17 Q4 16/17 Q1 17/18

66.3

61.3

73.168.2

15.4 19.2

QIP

64.2 0.00

Strengthen Patient and Family-Centred Care

8.6 19.2

ALC Rate % -All Inpatient Services

(Sarnia and Petrolia)

13.0

19.3 18.8

Up

da

ted

Comments

45.6

0

Q3 17/18Q4

17/18

5

YTD Performance

41.9

2

Q2 17/18

43.0

2

49.4

Quality Care - Assure the right care, in the right place, at the right time, by the right provider

9

11

Readmission within 30 days for

COPD

Was Patient/Family

Treated with Kindness

Is a Culture of Kindness Promoted

at BWH

Supervisor helps access training

and development

Overall Rating of

ExperienceQIP

Performance Indicator Ref.

Ingrain patient safety

Improve access to care

#

Pe

er

Co

mp

ara

tor

BW

H

Ta

rge

tDifficult to speak up if perceive a

problem with patient care

Medication Reconciliation at

Discharge

Total High Severity Patient Safety

Incidents

4

90th Percentile ED

Length of Stay for

Complex Patients

Bluewater Health Quality Committee

Performance Scorecard

77.5

SPApr -

Mar

Build sustainable partnerships and collaborations

QIP/

HSAA/

P4R

30-Day Mental Health Readmission

Focus on the experience of care and caring

69.1

0

8

60.1

Leaving hospital did

patients receive

enough information

n size: 9 n size: 9

n size: 16 n size: 16

Is a Culture of Kindness Promoted at Bluewater Health

Target:

N/A

YTD n size: 432

Quality Committee Key Performance Indicators



Target

49.6%



Difficult to speak up if perceive a

problem with Patient Care

YTD n size: 432

Received Enough

Information Emergency


21.0%

June data unavailable

province-wide due to daily

bed census summary

methodology changes

Data unavailable for

January



Strengthen Patient and Family-Centered Care

Overall Rating of Experience

Emergency Department

BWH Target

56.2%BWH Target

61.6%

BWH Target

49.1%


Inpatient Units

BWH Target

75.9%

44.4%

81.2%

Received Enough

Information Inpatient

BWH Target

81.0%

100%

96 97 97 97 97 9795 97 97 97 96 96 98 98 97

95

60

70

80

90

100

OCT

16

NOV

16

DEC

16

JAN

17

FEB

17

MAR

17

APR

17

MAY

17

JUN

17

JUL

17

AUG

17

SEP

17

OCT

17

NOV

17

DEC

17

JAN

18

Medication Reconciliation at Discharge

2

0

5

2

0

0 1 2 3 4 5 6

Q3 16/17

Q4 16/17

Q1 17/18

Q2 17/18

Q3 17/18

Total High Severity Incidents

23.3

21.1

21.6

18.4

17.2

18.5

16.7

17.8

0.0

21.5

17.2

17.7

18.6

14.8

15.7

0.0

5.0

10.0

15.0

20.0

25.0

Oct 16

Nov 16

Dec16

Jan17

Feb 17

Mar 17

Apr17

May17

Jun17

Jul17

Aug17

Sep17

Oct17

Nov17

Dec17

Jan18

ALC Rate % - All Inpatient Services (Sarnia & Petrolia)

ALC Rate Provincial Target BWH Target

0.0

20.0

40.0

60.0

80.0

100.0

Oct 16

Nov 16

Dec16

Jan17

Feb 17

Mar 17

Apr17

May17

Jun17

Jul17

Aug17

Sep17

Oct17

Nov17

Dec17

Jan18


ED Inpatient ED Target IP Target

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Oct 16

Nov 16

Dec16

Jan17

Feb 17

Mar 17

Apr17

May17

Jun17

Jul17

Aug17

Sep17

Oct17

Nov17

Dec17

Jan18

Leaving Hospital did Patients Receive Enough Information

ED Inpatient BWH ED Target BWH IP Target

71.7

57.4

70.3

68.9

66.7

69.5

66.7

62.9

57.7

73.0

70.4

71.2

55.8

66.7

74.5

88.9

84.8

75.0

81.3

75.9

73.4

88.3

81.4

81.8

71.4

81.7

85.7

82.1

84.0

76.9

80.4

62.5

0.0

20.0

40.0

60.0

80.0

100.0

Oct 16

Nov 16

Dec16

Jan17

Feb 17

Mar 17

Apr17

May17

Jun17

Jul17

Aug17

Sep17

Oct17

Nov17

Dec17

Jan18

Was Patient/Family Treated with Kindness

ED Inpatient BWH ED Target BWH IP Target

74.3%

46.9%

7.9

8.0

8.3

10.1

8.1

9.3

9.6

9.0

9.7

8.0

8.9

9.8

9.4

9.7

8.7

10.7

3.7

3.2

4.0

4.1

3.9

4.3

4.4

3.9

4.0

4.1

4.7

4.0

5.0

3.7

3.8

4.6

0

2

4

6

8

10

12

Oct 16

Nov 16

Dec16

Jan17

Feb 17

Mar 17

Apr17

May17

Jun17

Jul17

Aug17

Sep17

Oct17

Nov17

Dec17

Jan18

90th Percentile ED Length of Stay for Complex Patients

Sarnia Petrolia Peer Comparator BWH Target

Resource Utilization and Audit Committee (RUAC)

March 8, 2018 Highlights

Multi-Sector Accountability Agreement (M-SAA) The Committee was advised the M-SAA agreement will be forwarded to the Board from approval as it was not received in time for the March 8th RUAC meeting. BWH is required to enter into a M-SAA and/or amend the 2014-17 agreement by March 31, 2018. Collaborative Planning Update Julie Acker and Kim Kraeft, Specialists, Performance and Transformation, provided a presentation on the Collaborative Planning work underway at the hospital to improve patient flow across the continuum of care. They highlighted some of the challenges BWH is facing and noted the initiative addresses the patients’ journey pre/post the hospital. The Committee was informed that several focus groups have been held with front line staff to seek their input on some of challenges BWH is facing, and that the themes were similar in all the groups. A Collaborative Planning Team has been established made up of physician, volunteer, Directors/Managers and front-line representatives to seek their input into the process. The Committee had a fulsome discussion regarding the current state; the pressures; engagement with our community partners; and, the barriers. 2017-18 – Emergency Pay for Performance (P4R) Presentation Nadine Neve, Manager, Patient Access and Flow, Emergency Services and Sexual Assault and Domestic Violence, provided a presentation on the 2017-18 Emergency Pay for Performance (P4R) program. She highlighted the successes of the Visit Program (Community Paramedic Program (CPP)); Treatment Assessment Zone and the CMHA Collaborative initiatives. It was noted there was a 58% reduction in 911 calls; a 45% reduction in ED visits for active patients and a 65% reduction in ED visits for patients discharged from the CPP. The Committee then received an update on the initiatives for 2018-19: CPP program; the Rapid Assessment Zone; the ED Workflow Renewal; Improve Access to Inpatient beds and Emergency Department Information System. It was noted the Community Paramedic Team was nominated for the Bridging Excellence Awards and BWH has been asked to speak about the CPP Program at the ESC LHIN P4R Forum in May as it has only be implemented since August 2018. Attestation to the Record of Employees’ 2017 Salaries and Benefits The Committee received an update on the 2017 Record of Employees’ Salaries and Benefits. The information will be posted on the hospital website on April 1, 2018. Hospital Information System The Committee received an update regarding the hospital information system. They were advised that KPMG will be working with the ESC LHIN hospitals to conduct a readiness assessment, develop a long-term change management and communications/adoption strategy as the hospitals move forward with the provincial Cerner solution. BWH will roll out the provincial Cerner solution in three to four years.

In addition, the following will be coming forward separately for Board approval:

- Hospital Service Accountability Agreement (H-SAA) - Monthly Financial Statement

Submitted by: Marg Dragan Chair, Resource Utilization and Audit Committee

1

Bluewater Health Briefing Note

Name of Committee: Board of Directors Date of Meeting: March 28, 2018 Submitted by: Marlene Kerwin Subject: Hospital Service Accountability Agreement (HSAA)

Multi-Sector Accountability Agreement (M-SAA) Purpose of Report: Information Input Approval

Situation The Ministry of Health and Long-Term Care requires a Board approved accountability agreement between the hospital and the Erie St. Clair LHIN to allow for the continued flow of funding for hospital operations. The requested approval of the Hospital Service Accountability Agreement (HSAA) is an extension for the period April 1, 2018 to September 30, 2018 and the Hospital Service Accountability Agreement for the period April 1, 2018 to March 31, 2020.

The hospital Board is also asked to approve an extension to our existing Multi-Sector Accountability Agreement (M-SAA) to allow for the continued flow of funding for our community sector programs that are managed through the hospital. The requested approval is for an MSAA extension for the period April 1, 2018 to June 30, 2018.

Background Each year, the Board is asked to approve the hospital’s HSAA and M-SAA agreements. These agreements are typically presented to the Resource Utilization & Audit Committee (RUAC) before going to the Board. For the requested extension for 2018, the M-SAA was not received in time to go to the RUAC Committee and thus is being presented directly to the Board.

The HSAA reflects what was submitted in the HAPS budget for the 2018/19 fiscal year. The M-SAA reflects what was submitted in the Community Annual Planning Submission (CAPS) budget for the 2018/19 fiscal year. When the HAPS was submitted, final hospital funding was unknown. Once 2018/19 funding is finalized, the direction from the ESC LHIN is to revise the HAPS and approve an amended HSAA.

Similarly, the ESC LHIN is conducting on-going reviews of the CAPS submissions. Once these reviews are finalized, a revised CAPS budget for 2018/19 will be brought forward to the Board for approval which will support an amended M-SAA requiring Board Approval.

X

2

Recommendation The Board of Directors authorizes the Board Chair and the CEO to sign the extension of our existing M-SAA and HSAA agreements as well as the 2018-20 H-SAA Agreement as provided by the ESC LHIN, to ensure the ongoing flowing of funding from the ESC LHIN to Bluewater Health.

HSAA Amending Agreement – new HSAA, current Schedules Page 1

H-SAA AMENDING AGREEMENT

THIS AMENDING AGREEMENT (the “Agreement”) is made as of the 1st day of April, 2018 B E T W E E N:

ERIE ST. CLAIR LOCAL HEALTH INTEGRATION NETWORK (the “LHIN”)

AND

Bluewater Health (the “Hospital”)

WHEREAS the LHIN and the Hospital (together the “Parties”) entered into a hospital service accountability agreement that took effect April 1, 2008 (the “H-SAA”); AND WHEREAS pursuant to various amending agreements the term of the H-SAA has been extended to March 31, 2018; AND WHEREAS the Parties have entered into, or will enter into a hospital service accountability agreement that will take effect April 1, 2018 and will terminate on March 31, 2020 (the “new HSAA”); AND WHEREAS the Parties have agreed to continue to work to finalize new schedules for the 2018 -19 Fiscal Year to replace the Schedules (the “New Schedules”); NOW THEREFORE in consideration of mutual promises and agreements contained in this Agreement and other good and valuable consideration, the parties agree as follows:

1.0 Definitions. Except as otherwise defined in this Agreement, all terms shall have the meaning ascribed to them in the new HSAA. References in this Agreement to the H-SAA mean the H-SAA as amended and extended.

2.0 Amendments. 2.1 Agreed Amendments. The HSAA is amended as set out in this Article 2. 2.2 Schedules under New HSAA. Immediately upon the new HSAA coming into

effect, the Schedules, as defined in the H-SAA, will be the Schedules for the purposes of, and as defined in, the new HSAA.

2.3 Schedule Definition Amended. The definition of Schedule is amended to

include the attached Supplementary Schedule AA.


2.4 New Schedules. Upon agreement of the Parties, the new Schedules shall replace the Schedules for purposes of the new HSAA.

3.0 Effective Date. The amendments set out in Article 2 shall take effect on April

1, 2018. All other terms of the H-SAA shall remain in full force and effect. 4.0 Governing Law. This Agreement and the rights, obligations and relations of the

Parties will be governed by and construed in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein.

5.0 Counterparts. This Agreement may be executed in any number of

counterparts, each of which will be deemed an original, but all of which together will constitute one and the same instrument.

6.0 Entire Agreement. This Agreement constitutes the entire agreement between

the Parties with respect to the subject matter contained in this Agreement and supersedes all prior oral or written representations and agreements.

IN WITNESS WHEREOF the Parties have executed this Agreement on the dates set out below. ERIE ST. CLAIR LOCAL HEALTH INTEGRATION NETWORK By: ________________________________ _______________________________ Martin Girash, Board Chair Date

And by: ________________________________ _______________________________ Ralph Ganter, CEO Date Bluewater Health By: _________________________________ ______________________________ Board Chair Date And by: _________________________________ ______________________________ Mike Lapaine, President & CEO Date


HOSPITAL SERVICE ACCOUNTABILITY AGREEMENT FOR 2018 -2020

SUPPLEMENTARY SCHEDULE AA 1. Despite any other provision of this Agreement, the Schedules are effective until

September 30, 2018 and no longer, unless otherwise agreed to in writing by the parties.

Erie St. Clair LOCAL HEALTH INTEGRATION NETWORK

(the “LHIN”)

and

Bluewater Health (the “Hospital”) ____________________________________ Hospital Service Accountability Agreement for 2018 - 2020

Hospital Service Accountability Agreement for 2018-2020

2

TABLE OF CONTENTS ARTICLE 1. DEFINITIONS AND INTERPRETATION ......................................................................... 3

ARTICLE 2. APPLICATION AND TERM OF AGREEMENT ............................................................... 8

ARTICLE 3. OBLIGATIONS OF THE PARTIES ................................................................................. 8

ARTICLE 4. FUNDING ...................................................................................................................... 10

ARTICLE 5. REPAYMENT AND RECOVERY OF FUNDING ........................................................... 12

ARTICLE 6. HOSPITAL SERVICES ................................................................................................. 13

ARTICLE 7. PLANNING AND INTEGRATION .................................................................................. 14

ARTICLE 8. REPORTING ................................................................................................................. 16

ARTICLE 9. PERFORMANCE MANAGEMENT, IMPROVEMENT AND REMEDIATION ................. 18

ARTICLE 10. REPRESENTATIONS, WARRANTIES AND COVENANTS ....................................... 20

ARTICLE 11. ISSUE RESOLUTION ................................................................................................. 20

ARTICLE 12. INSURANCE AND INDEMNITY .................................................................................. 21

ARTICLE 13. REMEDIES FOR NON-COMPLIANCE ....................................................................... 24

ARTICLE 14. NOTICE ....................................................................................................................... 24

ARTICLE 15. ACKNOWLEDGEMENT OF LHIN SUPPORT ............................................................ 25

ARTICLE 16. ADDITIONAL PROVISIONS ....................................................................................... 25

SCHEDULES

Schedule A: Funding Allocation Schedule B: Reporting Requirement Schedule C: Indicators and Volumes Schedule C.1: Performance Indicators Schedule C.2: Service Volumes Schedule C.3: LHIN Indicators and Volumes Schedule C.4: PCOP Targeted Funding & Volumes


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BACKGROUND

This service accountability agreement, entered into pursuant to the Local Health System Integration Act, 2006 (“LHSIA”), reflects and supports the commitment of the LHIN and the Hospital to, separately, jointly, and in cooperation with other stakeholders, work diligently and collaboratively toward the achievement of the purpose of LHSIA, namely “to provide for an integrated health system to improve the health of Ontarians through better access to high quality health services, co-ordinated health care in local health systems and across the province and effective and efficient management of the health system at the local level by local health integration networks”. The Hospital and the LHIN, being committed to a health care system as envisioned by LHSIA and the Patient’s First: Action Plan for Health Care (“Patients First”), intend to cooperate to advance the purpose and objects of LHSIA and the further development of a patient-centered, integrated, accountable, transparent, and evidence-based health system contemplated by LHSIA and Patients First. They will do so by such actions as: supporting the development and implementation of sub-regions and Health Links to facilitate regional integrated health care service delivery; breaking down silos that inhibit the seamless transition of patients within the health care system; striving for the highest quality and continuous improvement in the delivery of health services and in all aspects of the health system, including by identifying and addressing the root causes of health inequities, and by improving access to primary care, mental health and addiction services and wait times for specialists; and otherwise striving for the highest quality and continuous improvement in the delivery of health services and in all aspects of the health system. The Hospital and the LHIN are committed to working together, and with others, to achieve evolving provincial priorities described: in mandate letters from the Minister of Health and Long-Term Care to the LHIN, from time to time; in the provincial strategic plan for the health system; and, in the LHIN’s Integrated Health Services Plan. In this context, the Hospital and the LHIN agree that the LHIN will provide funding to the Hospital on the terms and conditions set out in this Agreement to enable the provision of services to the local health system by the Hospital. In consideration of their respective agreements set out below, the LHIN and the Hospital covenant and agree as follows:

Article 1. DEFINITIONS AND INTERPRETATION

1.1 Definitions. The following definitions are applicable to terms used in this Agreement:

Accountability Agreement means the accountability agreement, as that term is defined in LHSIA, in place between the LHIN and the MOHLTC during a Funding Year, currently referred to as the “Ministry-LHIN Accountability Agreement";

Agreement means this agreement and includes the Schedules, as amended from time to time;

Annual Balanced Operating Budget means that in each Funding Year of the term of this Agreement, the total expenses of the Hospital are less than or equal to the total revenue, from all sources, of the Hospital when using the consolidated corporate income statements (all fund types and sector codes). Total Hospital revenues exclude interdepartmental recoveries and


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facility-related deferred revenues, while total Hospital expenses exclude interdepartmental expenses, facility-related amortization expenses and facility-related interest on long-term liabilities;

Applicable Law means all federal, provincial or municipal laws, regulations, common law, any orders, rules, or by-laws that are applicable to the parties, the Hospital Services, this Agreement and the parties’ obligations under this Agreement during the term of this Agreement;

Applicable Policy means any rules, policies, directives, or standards of practice issued or adopted by the MOHLTC or other ministries or agencies of the Province of Ontario that are applicable to the Hospital, the Hospital Services, this Agreement and the parties’ obligations under this Agreement during the term of this Agreement and that are available to the Hospital on a website of a ministry or agency of the Province of Ontario or that the Hospital has received from the LHIN, the MOHLTC, an agency of the Province or otherwise (For certainty, Applicable Policy does not include any rules, policies, directives, or standards of practice issued or adopted unilaterally by one or more Local Health Integration Network.);

Board means board of directors;

CEO means chief executive officer;

Chair means the chair of the Board;

Confidential Information means information disclosed or made available by one party to the other that is marked or otherwise identified as confidential by the disclosing party at the time of disclosure and all other information that would be understood by the parties, exercising reasonable judgment, to be confidential. Confidential Information does not include information that: (i) is or becomes available in the public domain through no act of the receiving party; (ii) is received by the receiving party from another person who has no obligation of confidence to the disclosing party; or (iii) was developed independently by the receiving party without any reliance on the disclosing party’s Confidential Information;

Days means calendar days;

Digital Health means the coordinated use of digital technologies to electronically integrate points of care and transform the way care is delivered, in order to improve the quality, access, productivity and sustainability of the healthcare system. Key application areas of Digital Health in Ontario include, but are not limited to:

• Electronic health information systems (e.g., electronic medical records, hospital information systems, electronic referral and scheduling systems, digital imaging and archiving systems, chronic disease management systems, laboratory information systems, drug information and ePrescribing systems)

• Electronic health information access systems (e.g., provider portals, consumer Digital Health)

• Underlying enabling systems (e.g., client/provider/user registries, health information access layer)

• Remote healthcare delivery systems (e.g., telemedicine services)


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Digital Health Board (DHB) is a board that provides advice to the MOHLTC on the development and implementation of the Digital Health Action Plan (as defined in the Accountability Agreement). DHB is chaired by the Deputy Minister of Health and Long-Term Care, and membership includes the LHIN Chief Executive Officers.

Effective Date means April 1, 2018;

Explanatory Indicator means a measure of the Hospital’s performance for which no Performance Target is set. Technical specifications of specific Explanatory Indicators can be found in the HSAA Indicator Technical Specifications;

Factors Beyond the Hospital’s Control include occurrences that are, in whole or in part, caused by persons or entities or events beyond the Hospital’s control. Examples may include, but are not limited to, the following:

(a) significant costs associated with complying with new or amended Government of Ontario technical standards or guidelines, Applicable Law or Applicable Policy;

(b) the availability of health care in the community (long-term care, home care, and primary care);

(c) the availability of health human resources;

(d) arbitration decisions that affect Hospital employee compensation packages, including wage, benefit and pension compensation, which exceed reasonable Hospital planned compensation settlement increases and in certain cases non-monetary arbitration awards that significantly impact upon Hospital operational flexibility; and

(e) catastrophic events, such as natural disasters and infectious disease outbreaks;

FIPPA means the Freedom of Information and Protection of Privacy Act, Ontario and the regulations made under it, as it and they may be amended from time to time;

Funding Year means, in the case of the first Funding Year, the period commencing on the Effective Date and ending on the following March 31, and in the case of Funding Years subsequent to the first Funding Year, the period of 12 consecutive months beginning on April 1 following the end of the previous Funding Year and ending on the following March 31;

Funding means the funding provided by the LHIN to the Hospital in each Funding Year under this Agreement;

GAAP means generally accepted accounting principles;

Health System Funding Reform has the meaning ascribed to it in the Accountability Agreement, and is a funding strategy that features quality-based funding to facilitate fiscal sustainability through high quality, evidence-based and patient-centred care;

Hospital’s Personnel and Volunteers means the directors, officers, employees, agents, volunteers and other representatives of the Hospital. In addition to the foregoing, Hospital’s Personnel and Volunteers include the contractors and subcontractors and their respective shareholders, directors, officers, employees, agents, volunteers or other representatives;


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Hospital Services means the clinical services provided by the Hospital and the operational activities that support those clinical services, that are funded in whole or in part by the LHIN, and includes the type, volume, frequency and availability of Hospital Services;

HSAA Indicator Technical Specifications means the document entitled “HSAA Indicator Technical Specifications” as it may be amended or replaced from time to time;

Indemnified Parties means the LHIN and its officers, employees, directors, independent contractors, subcontractors, agents, successors and assigns and her Majesty the Queen in Right of Ontario and her Ministers, appointees and employees, independent contractors, subcontractors, agents and assigns. Indemnified Parties also includes any person participating in a Review conducted under this Agreement, by or on behalf of the LHIN;

Improvement Plan means a plan that the Hospital may be required to develop under Article 9 of this Agreement;

Interest Income means interest earned on Funding that has been provided subject to recovery;

LHSIA means the Local Health System Integration Act, 2006 and the regulations made under it, as it and they may be amended from time to time;

Mandate Letter has the meaning ascribed to it in the Memorandum of Understanding and means a letter from the MOHLTC to the LHIN establishing priorities in accordance with the Premier of Ontario’s mandate letter to the MOHLTC. Memorandum of Understanding means the memorandum of understanding between the LHIN and the MOHLTC in effect from time to time in accordance with the Management Board of Cabinet “Agencies and Appointments Directive”.

MOHLTC means the Minister or the Ministry of Health and Long-Term Care, as the context requires;

Notice means any notice or other communication required to be provided pursuant to this Agreement or LHSIA;

Performance Corridor means the acceptable range of results around a Performance Target;

Performance Factor means any matter that could or will significantly affect a party’s ability to fulfill its obligations under this Agreement;

Performance Indicator means a measure of Hospital performance for which a Performance Target is set;

Performance Standard means the acceptable range of performance for a Performance Indicator or Service Volume that results when a Performance Corridor is applied to a Performance Target (as described in the Schedules and the HSAA Indicator Technical Specifications);

Performance Target means the planned level of performance expected of the Hospital in respect of Performance Indicators or Service Volumes;


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person or entity includes any individual and any corporation, partnership, firm, joint venture or other single or collective form of organization under which business may be conducted;

Planning Submission means the Hospital Board-approved planning document submitted by the Hospital to the LHIN. The form, content and scheduling of the Planning Submission will be identified by the LHIN;

Post-Construction Operating Plan (PCOP) Funding and PCOP Funding means any annualized operating funding provided under this Agreement, whether by a funding letter or other amendment, to support service expansions and other costs occurring in conjunction with completion of an approved capital project, as may be set out in Schedule A and further detailed in Schedule C.4;

Program Parameter means, in respect of a program, any one or more of the provincial standards (such as operational, financial or service standards and policies, operating manuals and program eligibility), directives, guidelines and expectations and requirements for that program that are established or required by the MOHLTC; and that the Hospital has been made aware of or ought reasonably to have been aware of; and that are available to the Hospital on a website of a ministry or agency of the Province of Ontario or that the Hospital has received from the LHIN, the MOHLTC, an agency of the Province or otherwise;

Reports means the reports described in Schedule B as well as any other reports or information required to be provided under LHSIA or this Agreement;

Review means a financial or operational audit, investigation, inspection or other form of review requested or required by the LHIN under the terms of LHSIA or this Agreement, but does not include the annual audit of the Hospital’s financial statements;

Schedule means any one of, and “Schedules” mean any two or more, as the context requires, of the Schedules appended to this Agreement, including the following:

Schedule A: Funding Allocation Schedule B: Reporting Requirements Schedule C: Indicators and Volumes Schedule C.1: Performance Indicators Schedule C.2: Service Volumes Schedule C.3: LHIN Indicators and Volumes Schedule C.4: PCOP Targeted Funding & Volumes

Service Volume means a measure of Hospital Services for which a Performance Target has been set.

2008-18 H-SAA means the Hospital Service Accountability Agreement for 2008-10 as amended and extended to March 31, 2018.


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1.2 Interpretation. Words in the singular include the plural and vice-versa. Words in one gender include all genders. The words “including” and “includes” are not intended to be limiting and mean “including without limitation” or “includes without limitation”, as the case may. The headings do not form part of this Agreement. They are for convenience of reference only and do not affect the interpretation of this Agreement. Terms used in the Schedules have the meanings set out in this Agreement unless separately and specifically defined in a Schedule in which case the definition in the Schedule governs for the purposes of that Schedule.

1.3 HSAA Indicator Technical Specification. This Agreement will be interpreted with reference to the HSAA Indicator Technical Specifications.

1.4 Denominational Hospitals. For the purpose of interpreting this Agreement, nothing in this Agreement is intended to, and this Agreement will not be interpreted to, unjustifiably, as determined under section 1 of the Canadian Charter of Rights and Freedoms, require a Hospital with a denominational mission to provide a service or to perform a service in a manner that is contrary to the denominational mission of the Hospital.

Article 2. APPLICATION AND TERM OF AGREEMENT

2.1 A Service Accountability Agreement. This Agreement is a service accountability agreement for the purposes of section 20(1) of LHSIA.

2.2 Term. The term of this Agreement will commence on the Effective Date and will expire on March 31, 2020, unless extended pursuant to its terms.

Article 3. OBLIGATIONS OF THE PARTIES

3.1 The LHIN. The LHIN will fulfill its obligations under this Agreement in accordance with the terms of this Agreement, Applicable Law and Applicable Policy.

3.2 The Hospital.

3.2.1 The Hospital will provide the Hospital Services and otherwise fulfill its obligations under this Agreement in accordance with the terms of this Agreement, Applicable Law, Applicable Policy and Program Parameters. Without limiting the foregoing, the Hospital acknowledges:

that all Funding will be provided in accordance with the requirements of LHSIA, including the terms and conditions of the Accountability Agreement;

that it is prohibited from using Funding for compensation increases prohibited by Applicable Law;

its obligation to follow the Broader Public Sector Procurement Directive issued by the Management Board of Cabinet as the same may be replaced or amended from time to time; and

its obligation to post a copy of this Agreement in a conspicuous public place at its sites of operations to which this Agreement applies, and on its public website if the Hospital operates a public website.

3.2.2 When providing the Hospital Services, the Hospital will meet all of the Performance Standards and other terms and conditions applicable to the Hospital Services that have been mutually agreed to by the parties.


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3.2.3 The LHIN will receive a Mandate Letter from the MOHLTC annually. Each Mandate Letter articulates areas of focus for the LHIN, and the MOHLTC’s expectation that the LHIN and the health service providers it funds will collaborate to advance these areas of focus. To assist the Hospital in its collaborative efforts with the LHIN, the LHIN will share each relevant Mandate Letter with the Hospital.

3.3 Subcontracting for the Provision of Hospital Services.

3.3.1 Subject to the provisions of LHSIA, the Hospital may subcontract the provision of some or all of the Hospital Services. For the purposes of this Agreement, actions taken or not taken by the subcontractor and Hospital Services provided by the subcontractor will be deemed actions taken or not taken by the Hospital and Hospital Services provided by the Hospital.

3.3.2 The terms of any subcontract entered into by the Hospital will:

enable the Hospital to meet its obligations under this Agreement; and

not limit or restrict the ability of the LHIN to conduct any audit or Review of the Hospital necessary to enable the LHIN to confirm that the Hospital has complied with the terms of this Agreement.

3.4 Conflict of Interest. The Hospital has adopted (or will adopt, within 60 Days of the Effective Date) and will maintain, in writing, for the term of this Agreement, a conflict of interest policy that includes requirements for disclosure and effective management of perceived, actual and potential conflict of interest and a code of conduct, for directors, officers, employees, professional staff members and volunteers. The Hospital will provide the LHIN with a copy of its conflict of interest policy upon request at any time and from time to time.

3.5 French Language Services. The Hospital shall comply with the requirements and obligations set out in the “Guide to Requirements and Obligations Pertaining to French Language Health Services”. This obligation does not limit or otherwise prevent the LHIN and the Hospital from negotiating specific local obligations relating to French language services, that do not conflict with the guide.

3.6 Designated Psychiatric Facilities. If the Hospital is designated as a psychiatric facility under the Mental Health Act, it will provide the essential mental health services in accordance with the specific designation for each designated site of the Hospital, and discuss any material changes to the service delivery models or service levels with the MOHLTC.

3.7 Digital Health. The Hospital shall make best efforts to:

assist the LHIN to prepare its annual LHIN Digital Health plan that aligns with provincial Digital Health priorities;

assist the LHIN to implement the LHIN Digital Health plan and include, in its annual Planning Submission, its plans for achieving the agreed upon Digital Health initiatives;

track the Hospital’s Digital Health performance against the LHIN Digital Health plan; and

comply with any clinical, technical, and information management standards, including those related to data, architecture, technology, privacy and security, set for the Hospital by the MOHLTC within the timeframes set by the MOHLTC.


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Despite Article 9 of this Agreement, to the extent that the Hospital is unable to comply, or anticipates it will be unable to comply with the foregoing without adversely impacting its ability to perform its other obligations under this Agreement, the Hospital, in consultation with the LHIN, will refer the matter to the Digital Health Board and its subcommittees, including the Hospital Information System Renewal Advisory Panel, for resolution.

Article 4. FUNDING

4.1 Annual Funding. Subject to the terms of this Agreement, the LHIN:

4.1.1 will provide the Funding identified in Schedule A to the Hospital for the purpose of providing or ensuring the provision of the Hospital Services; and

4.1.2 will deposit the Funding in equal installments, twice monthly, over the term of this Agreement, into an account designated by the Hospital provided that the account resides at a Canadian financial institution and is in the name of the Hospital.

4.2 Funding Limited. The LHIN is not responsible for any commitment or expenditure by the Hospital in excess of the Funding that the Hospital makes in order to meet its commitments under this Agreement, nor does this Agreement commit the LHIN to provide additional funds during or beyond the term of this Agreement.

4.3 Limitation on Payment of Funding. Despite section 4.1, the LHIN will not provide any Funding to the Hospital in respect of a Funding Year until the agreement for that Funding Year has been duly signed on behalf of the Hospital, whether by amendment to this Agreement or otherwise. Despite the foregoing, if:

4.3.1 the Hospital is unable to obtain necessary approval of its Board prior to the beginning of a Funding Year; and

4.3.2 the Hospital notifies the LHIN:

that it requires this Agreement to be extended to enable the Hospital to obtain the necessary approval of its Board; and,

of the date by which the Hospital Board’s approval will be obtained,

then, with the written approval of the LHIN, this Agreement and Funding for the then-current Funding Year will continue into the following Funding Year for a period of time specified by the LHIN.

4.4 Rebates, Credits, Refunds and Interest Income. The Hospital will incorporate all rebates, credits, refunds and Interest Income that it receives from the use of the Funding into its budget, in accordance with GAAP. The Hospital will use reasonable estimates of anticipated rebates, credits and refunds in its budgeting process. The Hospital will use any rebates, credits, refunds and Interest Income that it receives from the use of the Funding to provide Hospital Services unless otherwise agreed to by the LHIN.

4.5 Conditions on Funding.

4.5.1 The Hospital will:


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use the Funding only for the purpose of providing the Hospital Services in accordance with the terms of this Agreement and any amendments to this Agreement, whether by funding letter or otherwise;

not use in-year Funding for major building renovations or construction, or for direct expenses relating to research projects; and,

plan for and maintain an Annual Balanced Operating Budget.

Facilitating an Annual Balanced Operating Budget. The parties will work together to identify budgetary flexibility and manage in-year risks and pressures to facilitate the achievement of an Annual Balanced Operating Budget for the Hospital.

Waiver. Upon written request of the Hospital, the LHIN may, in its discretion, waive the obligation to achieve an Annual Balanced Operating Budget on such terms and conditions as the LHIN may deem appropriate. Where such a waiver is granted, it and the conditions attached to it will form part of this Agreement.

4.5.2 All Funding is subject to all Applicable Law and Applicable Policy, including Health System Funding Reform, as it may evolve or be replaced over the term of this Agreement.

4.6 PCOP. The Hospital acknowledges and agrees that, despite any other provision of this Agreement, unless expressly agreed otherwise in writing, all PCOP Funding is subject to all of the terms and conditions of the funding letter or letters pursuant to which it was initially provided and all of the terms and conditions of this Agreement. For certainty, those funding letters are attached as Schedule C.4.

4.7 Estimated Funding Allocations.

4.7.1 The Hospital’s receipt of any “Estimated Funding Allocation” in Schedule A is subject to section 4.8 below and subsequent written confirmation from the LHIN.

4.7.2 In the event the Funding confirmed by the LHIN is less than the Estimated Funding Allocation, the LHIN will have no obligation to adjust any related performance requirements unless and until the Hospital demonstrates to the LHIN’s satisfaction that the Hospital is unable to achieve the expected performance requirements with the confirmed Funding. In such circumstances the gap between the Estimated Funding and the confirmed Funding will be deemed to be material.

4.7.3 In the event of a material gap in Funding, the LHIN and the Hospital will adjust the related performance requirements.

4.8 Appropriation. Funding under this Agreement is conditional upon an appropriation of moneys by the Legislature of Ontario to the MOHLTC and funding of the LHIN by the MOHLTC pursuant to LHSIA. If the LHIN does not receive its anticipated funding, the LHIN will not be obligated to make the payments required by this Agreement.

4.9 Funding Increases. Before the LHIN can make an allocation of additional funds to the Hospital, the parties will: (1) agree on the amount of the increase; (2) agree on any terms and conditions that will apply to the increase; and (3) execute an amendment to this Agreement that reflects the agreement reached.


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Article 5. REPAYMENT AND RECOVERY OF FUNDING

5.1 Funding Recovery. Recovery of Funding may occur for the following reasons:

5.1.1 the LHIN makes an overpayment to the Hospital that results in the Hospital receiving more Funding than specified in this Agreement and any funding letters;

5.1.2 a financial reduction under section 13.1 is assessed;

5.1.3 as a result of a system planning process under section 7.2.7;

5.1.4 as a result of an integration decision made under LHSIA by the LHIN; or 5.1.5 to temporarily reallocate Funding to cover incremental costs of another provider where the

Hospital has reduced Hospital Services outside of the applicable Performance Corridor without agreement of the LHIN and the services are provided by another provider; and

5.1.6 with respect only to Funding that has been provided expressly subject to recovery, contractual conditions for recovery of such Funding are met; and

if in the Hospital’s reasonable opinion or in the LHIN’s reasonable opinion after consulting with the Hospital, the Hospital will not be able to use the Funding in accordance with the terms and conditions on which it was provided.

5.2 Process for Recovery of Funding Generally.

5.2.1 Generally, if the LHIN, acting reasonably, determines that a recovery of Funding under section 5.1 is appropriate, then the LHIN will give 30 Days’ Notice to the Hospital.

5.2.2 The Notice will describe:

the amount of the proposed recovery;

the term of the recovery, if not permanent;

the proposed timing of the recovery;

the reasons for the recovery; and

the amendments, if any, that the LHIN proposes be made to the Hospital’s obligations under this Agreement.

5.2.3 Where a Hospital disputes any matter set out in the Notice, the parties will discuss the circumstances that resulted in the Notice and the Hospital may make representations to the LHIN about the matters set out in the Notice within 14 Days of receiving the Notice.

5.2.4 The LHIN will consider the representations made by the Hospital and will advise the Hospital of its decision. Funding recoveries, if any, will occur in accordance with the timing set out in the LHIN’s decision. No recovery of Funding will be implemented earlier than 30 Days after the delivery of the Notice.

5.3 Process for Recovery of Funding as a Result of System Planning or Integration. If Hospital Services are reduced as a result of a system planning process under section 7.2.7 or an integration decision made under LHSIA, the LHIN may recover Funding as agreed in the process in section 7.2.7 or as set out in the decision, and the process set out in section 5.2 will apply.


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5.4 Full Consideration. In making a determination under section 5.2, the LHIN will act reasonably and will consider the impact, if any, that a recovery of Funding will have on the Hospital’s ability to meet its obligations under this Agreement.

5.5 Consideration of Weighted Cases. Where a settlement and recovery is primarily based on volumes of cases performed by the Hospital, the LHIN may consider the Hospital’s actual total weighted cases.

5.6 Hospital’s Retention of Operating Surplus. In accordance with the MOHLTC’s 1982 (revised 1999) Business Oriented New Development Policy (BOND), the Hospital will retain any net income or operating surplus of income over expenses earned in a Funding Year, subject to any in-year or year-end adjustments to Funding in accordance with Article 5. Any net income or operating surplus retained by the Hospital under the BOND policy must be used in accordance with the BOND policy. If using operating surplus to start or expand the provision of clinical services, the Hospital will comply with section 7.2.1.

5.7 LHIN Discretion Regarding Case Load Volumes. The LHIN may consider, where appropriate, accepting case load volumes that are less than a Service Volume or Performance Standard, and the LHIN may decide not to settle and recover from the Hospital if such variations in volumes are: (1) only a small percentage of volumes; or (2) due to a fluctuation in demand for the services.

5.8 Settlement and Recovery of Funding for Prior Years.

5.8.1 The Hospital acknowledges that settlement and recovery of Funding can occur up to seven years after the provision of Funding.

5.8.2 The Hospital agrees that if the parties are directed in writing to do so by the MOHLTC, the LHIN will settle and recover funding provided by the MOHLTC to the Hospital prior to the transition of the funding for the services or program to the LHIN, provided that such settlement and recovery occurs within seven years of the provision of the funding by the MOHLTC. All such settlements and recoveries will be subject to the terms applicable to the original provision of funding.

5.9 Debt Due.

5.9.1 If the LHIN requires the re-payment by the Hospital of any Funding in accordance with this Agreement, the amount required will be deemed to be a debt owing to the Crown by the Hospital. The LHIN may adjust future Funding instalments to recover the amounts owed or may, at its discretion, direct the Hospital to pay the amount owing to the Crown. The Hospital will comply with any such direction.

5.9.2 All amounts owing to the Crown will be paid by cheque payable to the “Ontario Minister of Finance” and mailed to the LHIN at the address provided in section 14.1.

5.9.3 The LHIN may charge the Hospital interest on any amount owing by the Hospital at the then current interest rate charged by the Province of Ontario on accounts receivable.

Article 6. HOSPITAL SERVICES

6.1 Hospital Services. The Hospital will:


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6.1.1 achieve the Performance Standards described in the Schedules and the HSAA Indicator Technical Specifications;

6.1.2 not reduce, stop, start, expand, cease to provide or transfer the provision of Hospital Services to another hospital or to another site of the Hospital if such action would result in the Hospital being unable to achieve the Performance Standards described in the Schedules and the HSAA Indicator Technical Specifications; and

6.1.3 not restrict or refuse the provision of Hospital Services that are funded by the LHIN to an individual, directly or indirectly, based on the geographic area in which the person resides in Ontario, and will establish a policy prohibiting any health care professional providing services at the Hospital, including physicians, from doing the same.

Article 7. PLANNING AND INTEGRATION

7.1 Planning for Future Years.

7.1.1 Multi-Year Planning. The Planning Submission will be submitted to the LHIN at the time and in the format required by the LHIN and may require the Hospital to incorporate:

prudent multi-year financial forecasts;

plans for the achievement of Performance Targets; and

realistic risk management strategies in respect of (a) and (b).

The Hospital’s Planning Submission will be aligned with the LHIN’s current integrated health service plan, as defined in LHSIA, and will reflect local LHIN priorities and initiatives. If the LHIN has provided multi-year planning targets for the Hospital, the Planning Submissions will reflect the planning targets.

7.1.2 Multi-Year Planning Targets. Schedule A may reflect an allocation for the first Funding Year of this Agreement as well as planning targets for up to two additional years, consistent with the term of this Agreement. In such an event:

the Hospital acknowledges that if it is provided with planning targets, these targets are:

targets only; provided solely for the purposes of planning; subject to confirmation; and may be changed at the discretion of the LHIN in consultation with the

Hospital. The Hospital will proactively manage the risks associated with multi-year planning and the potential changes to the planning targets; and

the LHIN agrees that it will communicate any material changes to the planning targets as soon as reasonably possible.

7.2 System Planning.

“Pre-proposal” means a notice from the Hospital to the LHIN that informs the LHIN of a potential integration for the health system in sufficient detail to enable the LHIN to assess how the integration would impact the Hospital Services, Funding and the local health system, including access to, and quality and cost of, services.


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The parties acknowledge that sections 8.7, 8.8 and 8.9 may apply to a confidential pre-proposal.

7.2.1 General. As required by LHSIA, the parties will separately and in conjunction with each other identify opportunities to integrate the services of the local health system to provide appropriate, co-ordinated, effective and efficient services. The Hospital acknowledges the importance of advance notice for system planning purposes. If the Hospital is planning to significantly reduce, stop, start, expand or cease to provide clinical services and operational activities that support those clinical services or to transfer any such services to another site of the Hospital, whether within or outside of the geographic area of the LHIN, and such action does not result in the Hospital being unable to achieve the Performance Standards described in the Schedules and the HSAA Indicator Technical Specification, then the Hospital will inform the LHIN of such change with a view to providing the LHIN with time to mitigate adverse impacts.

7.2.2 Pre-proposal. The Hospital may inform the LHIN, by means of a pre-proposal, of integration opportunities in the local health system. The Hospital will inform the LHIN by means of a pre-proposal if the Hospital is considering an integration of its services with those of another person or entity.

7.2.3 Further Consideration of Pre-proposal. Following the LHIN’s review and evaluation of the pre-proposal and subject to section 7.2.5, the LHIN may invite the Hospital to submit a detailed proposal and business case for further analysis. The LHIN will provide the Hospital with guidelines for the development of a detailed proposal and business case.

7.2.4 LHIN Evaluation of the Pre-proposal not Consent. A pre-proposal will not constitute a notice of an integration under section 27 of LHSIA. The LHIN’s assent to develop the concept outlined in a pre-proposal does not: (a) constitute the LHIN’s approval to proceed with an integration; (b) presume the LHIN will not issue a decision ordering the Hospital not to proceed with the integration under section 27 of LHSIA; or (c) preclude the LHIN from exercising its powers under section 25 or section 26 of LHSIA.

7.2.5 Act Prevails. Nothing in this section prevents the Hospital from providing the LHIN with notice of integration at any time in accordance with section 27 of LHSIA.

7.2.6 Definitions. In this Article 7.0 the terms “integrate”, “integration” and “services” have the same meanings as are attributed to them in LHSIA, including sections 2(1) and 23, of LHSIA and those meanings may be amended from time to time.

7.2.7 Process for System Planning. If:

the Hospital has identified an opportunity to integrate its Hospital Services with that of one or more other health service providers;

the health service provider or providers, as the case may be, has or have agreed to the proposed integration with the Hospital;

the Hospital and the health service provider or providers, as the case may be, has or have agreed on the amount of funds needed to be transferred from the Hospital to one or more other health service providers to effect the integration as planned between them and the Hospital has notified the LHIN of this amount;

the Hospital has complied with its obligations under section 27 of LHSIA, the integration proceeds or will proceed as planned in accordance with LHSIA;


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then the LHIN may recover from the Hospital, Funding specified in Schedule A and agreed by the Hospital as needed to facilitate the integration.

7.3 Reviews and Approvals.

7.3.1 Timely Response. Subject to section 7.3.2, and except as expressly provided by the terms of this Agreement, the LHIN will respond to Hospital submissions requiring a response from the LHIN in a timely manner and in any event, within any time period set out in Schedule B. If the LHIN has not responded to the Hospital within the time period set out in Schedule B, following consultation with the Hospital, the LHIN will provide the Hospital with written Notice of the reasons for the delay and a new expected date of response. If a delayed response from the LHIN could reasonably be expected to have a prejudicial effect on the Hospital, the Hospital may refer the matter for issue resolution under Article 11.

7.3.2 Exceptions. Section 7.3.1 does not apply to: (i) any notice provided to the LHIN under section 27 of LHSIA, which will be subject to the timelines of LHSIA; and (ii) any report required to be submitted to the MOHLTC by the LHIN for which the MOHLTC response is required before the LHIN can respond.

Article 8. REPORTING

8.1 Generally. The LHIN’s ability to enable its local health system to provide appropriate, co-ordinated, effective and efficient services, as contemplated by LHSIA, is dependent on the timely collection and analysis of accurate information.

8.2 General Reporting Obligations. The Hospital will provide to the LHIN, or to such other person or entity as the parties may reasonably agree, in the form and within the time specified by the LHIN, the Reports, other than personal health information as defined in LHSIA, that the LHIN requires for the purposes of exercising its powers and duties under this Agreement, LHSIA or for the purposes that are prescribed under any Applicable Law. For certainty, nothing in this section 8.2 or in this Agreement restricts or otherwise limits the LHIN’s right to access or to require access to personal health information as defined in LHSIA, in accordance with Applicable Law.

8.3 Certain Specific Reporting Obligations. Without limiting the foregoing, the Hospital will fulfill the specific reporting requirements set out in Schedule B. The Hospital will ensure that all Reports are in a form satisfactory to the LHIN, are complete, accurate and signed on behalf of the Hospital by an authorized signing officer, and are provided to the LHIN in a timely manner.

8.4 Additional Reporting Obligations.

8.4.1 French Language Services. If the Hospital is required to provide services to the public in French under the provisions of the French Language Services Act, the Hospital will submit a French language services report to the LHIN annually. If the Hospital is not required to provide services to the public in French under the provisions of the French Language Service Act, the Hospital will provide a report to the LHIN annually that outlines how the Hospital addresses the needs of its local Francophone community.

8.4.2 Community Engagement and Integration. The Hospital will report annually on its community engagement and integration activities and at such other times as the LHIN may request from time to time, using any templates provided by the LHIN.


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8.4.3 Reporting to Certain Third Parties. The Hospital will submit all such data and information to the MOHLTC, Canadian Institute for Health Information or to any other third party, as may be required by any health data reporting requirements or standards communicated by the MOHLTC to the Hospital. To the extent that the Hospital is unable to comply with the foregoing without adversely impacting its ability to perform its other obligations under this Agreement, the Hospital may notify the LHIN and the parties will escalate the matter to their respective CEOs and Board Chairs, if so requested by either party.

8.5 System Impacts. Throughout the term of this Agreement, the Hospital will promptly inform the LHIN of any matter that the Hospital becomes aware of that materially impacts or is likely to materially impact the health system, or could otherwise be reasonably expected to concern the LHIN.

8.6 Hospital Board Reports.

8.6.1 Hospital Board to be Informed. Periodically throughout the Funding Year and at least quarterly, the Hospital’s Board will receive from the Hospital’s Board committees, CEO and other appropriate officers, such reports as are necessary to keep the Board, as the governing body of the Hospital, appropriately informed of the performance by the Hospital of its obligations under this Agreement, including the degree to which the Hospital has met, and will continue throughout the Funding Year to meet, its Performance Targets and its obligation to plan for and achieve an Annual Balanced Operating Budget.

8.6.2 Hospital Board to Report to LHIN. The Hospital will provide to the LHIN, annually, and quarterly upon request of the LHIN, a declaration of the Hospital’s Board, signed by the Chair, declaring that the Board has received the reports referred to in this Section.

8.7 Confidential Information. The receiving party will treat Confidential Information of the disclosing party as confidential and will not disclose Confidential Information except:

8.7.1 with the prior consent of the disclosing party; or

8.7.2 as required by law or by a court or other lawful authority, including LHSIA and FIPPA.

8.8 Required Disclosure. If the receiving party is required, by law or by a court or by other lawful authority, to disclose Confidential Information of the disclosing party, the receiving party will: promptly notify the disclosing party before making any such disclosure, if such notice is not prohibited by law, the court or other lawful authority; cooperate with the disclosing party on the proposed form and nature of the disclosure; and, ensure that any disclosure is made in accordance with the requirements of Applicable Law and within the parameters of the specific requirements of the court or other lawful authority.

8.9 LHIN Public Meetings. The Hospital acknowledges that all meetings of the LHIN Board and its committees will be open to the public under LHSIA, subject to the exceptions contained in LHSIA. The LHIN acknowledges that the Confidential Information of the Hospital may fall within the exceptions contained in LHSIA.

8.10 Document Retention and Record Maintenance. The Hospital will:


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8.10.1 retain all records (as that term is defined in FIPPA) related to the Hospital’s performance of its obligations under this Agreement for seven years after this Agreement ceases to be in effect, whether due to expiry or otherwise. The Hospital’s obligations under this section will survive if this Agreement ceases to be in effect, whether due to expiry or otherwise;

8.10.2 keep all financial records, invoices and other financially-related documents relating to the Funding or otherwise to the Hospital Services in a manner consistent with international financial reporting standards as advised by the Hospital’s auditor; and

8.10.3 keep all non-financial documents and records relating to the Funding or otherwise to the Hospital Services in a manner consistent with all Applicable Law.

8.11 Final Reports. If this Agreement ceases to be in effect, whether due to expiry or otherwise, the Hospital will provide to the LHIN all such reports as the LHIN may reasonably request relating to, or as a result of, this Agreement ceasing to be in effect.

Article 9. PERFORMANCE MANAGEMENT, IMPROVEMENT AND REMEDIATION

9.1 General Approach. The parties will strive to achieve on-going performance improvement. They will follow a proactive, collaborative and responsive approach to performance management and improvement. Either party may request a meeting at any time. The parties will use their best efforts to meet as soon as possible following a request.

9.2 Notice of a Performance Factor. Each party will notify the other party, as soon as reasonably possible, of any Performance Factor. The Notice will:

9.2.1 describe the Performance Factor and its actual or anticipated impact;

9.2.2 include a description of any action the party is undertaking, or plans to undertake, to remedy or mitigate the Performance Factor;

9.2.3 indicate whether the party is requesting a meeting to discuss the Performance Factor; and

9.2.4 address any other issue or matter the party wishes to raise with the other party, including whether the Performance Factor may be a Factor Beyond the Hospital’s Control.

9.2.5 The recipient party will acknowledge in writing receipt of the Notice within seven Days of the date on which the Notice was received (“Date of the Notice”).

9.3 Performance Meetings. Where a meeting has been requested under section 9.2.3, the parties will meet to discuss the Performance Factor within 14 Days of the Date of the Notice. The LHIN can require a meeting to discuss the Hospital’s performance of its obligations under this Agreement, including a result for a Performance Indicator or a Service Volume that falls outside the applicable Performance Standard.

9.4 Performance Meeting Purpose. During a performance meeting, the parties will:

9.4.1 discuss the causes of the Performance Factor;

9.4.2 discuss the impact of the Performance Factor on the local health system and the risk resulting from non-performance; and

9.4.3 determine the steps to be taken to remedy or mitigate the impact of the Performance Factor (the “Performance Improvement Process”).


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9.5 Performance Improvement Process.

9.5.1 The purpose of the Performance Improvement Process is to remedy or mitigate the impact of a Performance Factor. The Performance Improvement Process may include:

a requirement that the Hospital develop an Improvement Plan; or

an amendment of the Hospital’s obligations as mutually agreed by the parties.

9.5.2 Any Performance Improvement Process begun under a prior agreement will continue under this Agreement. Any performance improvement required by a LHIN under a prior agreement will be deemed to be a requirement of this Agreement until fulfilled.

9.6 Factors Beyond the Hospital’s Control. If the LHIN, acting reasonably, determines that the Performance Factor is, in whole or in part, a Factor Beyond the Hospital’s Control:

9.6.1 the LHIN will collaborate with the Hospital to develop and implement a mutually agreed upon joint response plan which may include an amendment of the Hospital’s obligations under this Agreement;

9.6.2 the LHIN will not require the Hospital to prepare an Improvement Plan; and

9.6.3 the failure to meet an obligation under this Agreement will not be considered a breach of this Agreement to the extent that failure is caused by a Factor Beyond the Hospital’s Control.

9.7 Hospital Improvement Plan.

9.7.1 Development of an Improvement Plan. If, as part of a Performance Improvement Process, the LHIN requires the Hospital to develop an Improvement Plan, the process for the development and management of the Improvement Plan is as follows:

The Hospital will submit the Improvement Plan to the LHIN within 30 Days of receiving the LHIN’s request. In the Improvement Plan, the Hospital will identify remedial actions and milestones for monitoring performance improvement and the date by which the Hospital expects to meet its obligations.

Within 15 business Days of its receipt of the Improvement Plan, the LHIN will advise the Hospital which, if any, remedial actions the Hospital should implement immediately. If the LHIN is unable to approve the Improvement Plan as presented by the Hospital, subsequent approvals will be provided as the Improvement Plan is revised to the satisfaction of the LHIN.

The Hospital will implement all aspects of the Improvement Plan for which it has received written approval from the LHIN, upon receipt of such approval.

The Hospital will report quarterly on progress under the Improvement Plan, unless the LHIN advises the Hospital to report on a more frequent basis. If Hospital performance under the Improvement Plan does not improve by the timelines in the Improvement Plan, the LHIN may agree to revisions to the Improvement Plan.

The LHIN may require, and the Hospital will permit and assist the LHIN in conducting, a Review of the Hospital to assist the LHIN in its consideration and approval of the Improvement Plan. The Hospital will pay the costs of this Review.


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9.7.2 Peer/LHIN Review of Improvement Plan. If Hospital performance under the Improvement Plan does not improve in accordance with the Improvement Plan, or if the Hospital is unable to develop an Improvement Plan satisfactory to the LHIN, the LHIN may appoint an independent team to assist the Hospital to develop an Improvement Plan or revise an existing Improvement Plan. The independent team will include a representative from another hospital selected with input from the Ontario Hospital Association. The independent team will work closely with the representatives from the Hospital and the LHIN. The Hospital will submit a new Improvement Plan or revisions to an existing Improvement Plan within 60 Days of the appointment of the independent team or within such other time as may be agreed to by the parties.

Article 10. REPRESENTATIONS, WARRANTIES AND COVENANTS

10.1 General. The Hospital represents, warrants and covenants that:

10.1.1 it is, and will continue for the term of this Agreement to be, a validly existing legal entity with full power to fulfill its obligations under this Agreement;

10.1.2 subject to Applicable Law, it has made reasonable efforts to ensure that the Hospital Services are and will continue to be provided by persons with the experience, expertise, professional qualifications, licensing and skills necessary to complete their respective tasks;

10.1.3 it holds all permits, licences, consents, intellectual property rights and authorities necessary to perform its obligations under this Agreement;

10.1.4 all information (including information relating to any eligibility requirements for Funding) that the Hospital provided to the LHIN in support of its request for Funding was true and complete at the time the Hospital provided it, and will, subject to the provision of Notice otherwise, continue to be materially true and complete for the term of this Agreement; and

10.1.5 it does and will continue to operate for the term of this Agreement, in compliance with Applicable Law and Applicable Policy.

10.2 Execution of Agreement. The Hospital represents and warrants that:

10.2.1 it has the full power and authority to enter into this Agreement; and

10.2.2 it has taken all necessary actions to authorize the execution of this Agreement.

10.3 Governance. The Hospital represents, warrants and covenants that it will follow good governance practices comparable to those set out in the Ontario Hospital Association’s Governance Centre of Excellence’s “Guide to Good Governance” as it may be amended; will undertake an accreditation process which will include a review of its governance practices; and will promptly remedy any deficiencies that are identified during that accreditation process.

10.4 Supporting Documentation. The Hospital acknowledges that the LHIN may, pursuant to section 22 of LHSIA, require proof of the matters referred to in this Article 10.

Article 11. ISSUE RESOLUTION

11.1 Principles to be Applied. The parties acknowledge that it is desirable to use reasonable efforts to resolve issues and disputes in a collaborative manner. This includes avoiding disputes by clearly articulating expectations, establishing clear lines of communication, and respecting each party’s interests.


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11.2 Informal Resolution. The parties acknowledge that it is desirable to use reasonable efforts to resolve all issues and disputes through informal discussion and resolution. To facilitate and encourage this informal resolution process, the parties may jointly develop a written issues statement. Such an issues statement may:

11.2.1 describe the facts and events leading to the issue or dispute;

11.2.2 consider:

the severity of the issue or dispute, including risk, likelihood of harm, likelihood of the situation worsening with time, scope and magnitude of the impact, likely impact with and without prompt action taken;

whether the issue or dispute is isolated or part of a pattern;

the likelihood of the issue or dispute recurring and if recurring, the length of time between occurrences;

whether or not the issue or dispute is long-standing; and

whether previous mitigation strategies have been ignored; and

11.2.3 list potential options for its resolution, which may include:

performance management, in accordance with sections 9.4 through 9.7;

a Review of the Hospital or a facilitated resolution, which may involve the assistance of external supports, such a peers, coaches, mentors and facilitators (“Facilitation”).

11.3 Escalation. If the issue or dispute cannot be resolved at the level at which it first arose, either party may refer it to the senior staff member of the LHIN who is responsible for this Agreement and to his or her counterpart in the senior management of the Hospital. If the dispute cannot be resolved at this level of senior management, either party may refer it to its respective CEO. The CEOs may meet within 14 Days of this referral and attempt to resolve the issue or dispute. If the issue or dispute remains unresolved 30 Days after the first meeting of the CEOs, then either party may refer it to their respective Board Chairs (or Board member designate) who may attempt to resolve the issue or dispute.

11.4 Reviews and Facilitations. The Hospital will cooperate in every Review and Facilitation. The Hospital acknowledges that for the purposes of any Review, the LHIN may exercise its powers under sections 21 and 22 of LHSIA.

11.5 LHIN Resolution. Nothing in this Agreement prevents the LHIN from exercising any statutory or other legal right or power, or from pursuing the appointment of a supervisor of the Hospital with the MOHLTC, at any time.

Article 12. INSURANCE AND INDEMNITY

12.1 Limitation of Liability. The Indemnified Parties will not be liable to the Hospital or any of the Hospital’s Personnel and Volunteers for costs, losses, claims, liabilities and damages howsoever caused arising out of or in any way related to the Hospital Services or otherwise in connection with this Agreement, unless caused by the negligence or wilful misconduct of the Indemnified Parties.


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12.2 Same. For greater certainty and without limiting section 12.1, the LHIN is not liable for how the Hospital and the Hospital’s Personnel and Volunteers carry out the Hospital Services and is therefore not responsible to the Hospital for such Hospital Services; moreover the LHIN is not contracting with, or employing, any of the Hospital’s Personnel and Volunteers to carry out the terms of this Agreement. As such, the LHIN is not liable for contracting with, employing or terminating a contract or the employment of, any of the Hospital’s Personnel and Volunteers required to carry out this Agreement, nor for the withholding, collection or payment of any taxes, premiums, contributions or any other remittances due to government for the Hospital’s Personnel and Volunteers required by the Hospital to perform its obligations under this Agreement.

12.3 Indemnification. The Hospital will indemnify and hold harmless the Indemnified Parties from and against any and all costs, expenses, losses, liabilities, damages and expenses (including legal, expert and consultant fees), causes of action, actions, claims, demands, lawsuits or other proceedings (collectively “Claims”) by whomever made, sustained, brought or prosecuted (including for third party bodily injury (including death), personal injury and property damage) in any way based upon, occasioned by or attributable to anything done or omitted to be done by the Hospital or the Hospital’s Personnel and Volunteers in the course of performance of the Hospital’s obligations under, or otherwise in connection with, this Agreement, unless caused by the negligence or wilful misconduct of an Indemnified Party.

12.4 Insurance.

12.4.1 Required Insurance. The Hospital will put into effect and maintain, for the term of this Agreement, at its own expense, with insurers having a secure A.M. Best rating of B+ or greater, or the equivalent, all the necessary and appropriate insurance that a prudent person in the business of the Hospital would maintain including the following.

Commercial General Liability Insurance. Commercial general liability insurance, for third-party bodily injury, personal injury and property damage to an inclusive limit of not less than five million dollars per occurrence and not less than two million dollars for products and completed operations in the aggregate. The policy will include the following clauses:


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The Indemnified Parties as additional insureds; Contractual Liability; Cross Liability; Products and Completed Operations Liability; Employers Liability and Voluntary Compensation unless the Hospital

can provide proof of Workplace Safety and Insurance Act, 1997 (“WSIA”) coverage as described in section 12.4.2(b);

Non-Owned automobile coverage with blanket contractual and physical damage coverage for hired automobiles, except that such coverage may nevertheless exclude liability assumed by any person insured by the policy voluntarily under any contract or agreement other than directors, officers, employees and volunteers of the Hospital pertaining only to the liability arising out of the use or operation of their automobiles while on the business of the Hospital; and

A thirty-day written notice of cancellation, termination or material change.

All-Risk Property Insurance. All-risk property insurance on property of every description providing coverage to a limit of not less than the full replacement cost, including earthquake and flood. Such insurance will be written to include replacement cost value. All reasonable deductibles and/or self-insured retentions are the responsibility of the Hospital.

Boiler and Machinery Insurance. Boiler and machinery insurance (including pressure objects, machinery objects and service supply objects) on a comprehensive basis. Such insurance will be written to include repair and replacement value. All reasonable deductibles and/or self-insured retentions are the responsibility of the Hospital.

Professional Liability Insurance. Professional liability insurance to an inclusive limit of not less than five million dollars per occurrence for each claim of negligence resulting in bodily injury, death or property damage, arising directly or indirectly from the professional services rendered by the Hospital, its officers, agents or employees.

Directors and Officers Liability Insurance. Directors and officers liability insurance to an inclusive limit of not less than two million dollars per claim, with an annual aggregate of not less than four million dollars, responding to claims of wrongful acts of the Hospital’s directors, officers and board committee members and of the Hospital’s volunteer association and auxiliary in the discharge of their duties on behalf of the Hospital or the volunteer association or auxiliary, as applicable.

12.4.2 Proof of Insurance. As requested by the LHIN from time to time, the Hospital will provide the LHIN with proof of the insurance required by this Agreement in the form of any one or more of:

a valid certificate of insurance that references this Agreement and confirms the required coverage;

a valid WSIA Clearance Certificate or a letter of good standing, as applicable, unless the Hospital has in effect Employers Liability and Voluntary Compensation as described above; and

copy of each insurance policy.


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12.4.3 Subcontractors. The Hospital will ensure that each of its subcontractors obtains all the necessary and appropriate insurance that a prudent person in the business of the subcontractor would maintain.

Article 13. REMEDIES FOR NON-COMPLIANCE

13.1 Planning Cycle. The success of the planning cycle depends on the timely performance of each party. To ensure delays do not have a material adverse effect on Hospital Services or LHIN operations, the following provisions apply:

13.1.1 If the LHIN fails to meet an obligation or due date in Schedule B, the LHIN may do one or all of the following:

adjust funding for the Funding Year to offset a material adverse effect on Hospital Services resulting from the delay; and/or

work with the Hospital in developing a plan to offset any material adverse effect on Hospital Services resulting from the delay, including providing LHIN approvals for any necessary changes in Hospital Services.

13.1.2 At the discretion of the LHIN, the Hospital may be subject to a financial reduction if the Hospital’s:

Planning Submission is received by the LHIN after the due date in Schedule B without prior LHIN approval of such delay;

Planning Submission is incomplete;

quarterly performance reports are not provided when due; or

financial and/or clinical data requirements are late, incomplete or inaccurate.

If assessed, the financial reduction will be as follows:

if received within seven Days after the due date, incomplete or inaccurate, the financial penalty will be the greater of: (i) a reduction of 0.03% of the Hospital’s total Funding; or (ii) $2,000; and

for every full or partial week of non-compliance thereafter, the rate will be one half of the initial financial reduction.

Article 14. NOTICE

14.1 Notice. A Notice will be in writing; delivered personally, by pre-paid courier, by any form of mail where evidence of receipt is provided by the post office, or by facsimile with confirmation of receipt, or by email where no delivery failure notification has been received. For certainty, delivery failure notification includes an automated ‘out of office’ notification. A Notice will be addressed to the other party as provided below or as either party will later designate to the other in writing:

To the LHIN: To the Hospital:

Erie St. Clair Local Health Integration Network Bluewater Health 712 Richmond Street 89 Norman Street Chatham ON N7M 5J5 Sarnia ON N7T 6S3


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Attn: Chief Executive Officer Attn: President & Chief Executive Officer

Fax: Fax:

Email: [email protected] Email: [email protected]

14.2 Notices Effective From. A Notice will be deemed to have been duly given one business day after delivery if the Notice is delivered personally, by pre-paid courier or by mail. A Notice that is delivered by facsimile with confirmation of receipt or by email where no delivery failure notification has been received will be deemed to have been duly given one business day after the facsimile or email was sent.

Article 15. ACKNOWLEDGEMENT OF LHIN SUPPORT

15.1 Publication. For the purposes of this Article 15, the term “Publication” means: an annual report; a strategic plan; a material publication on a consultation about a possible integration; a material publication on community engagement; and, a material report to the community that the Hospital develops and makes available to the public in electronic or hard copy.

15.1.1 Acknowledgment of Funding Support. The following statement will be included on the Hospital’s website, on all Publications and, upon request of the LHIN, on any other publication of the Hospital relating to a Hospital initiative:

“Bluewater Health receives funding from the Erie St. Clair Local Health Integration Network. The opinions expressed in this publication do not necessarily represent the views of the Erie St. Clair Local Health Integration Network.”

Upon request of the LHIN, the Hospital will include a statement in a form acceptable to the LHIN, acknowledging the support of the Province.

15.2 Insignia and Logo. Neither party may use any insignia or logo of the other party without the prior written permission of the other party. For the Hospital, this includes the insignia and logo of Her Majesty the Queen in right of Ontario.

Article 16. ADDITIONAL PROVISIONS

16.1 Interpretation. In the event of a conflict or inconsistency in any provision of this Agreement, the main body of this Agreement will prevail over the Schedules.

16.2 Amendment of Agreement. This Agreement may only be amended by a written agreement duly executed by the parties.

16.3 Invalidity or Unenforceability of Any Provision. The invalidity or unenforceability of any provision of this Agreement will not affect the validity or enforceability of any other provision of this Agreement and any invalid or unenforceable provision will be deemed to be severed.

16.4 No Assignment. The Hospital will not assign this Agreement or the Funding in whole or in part, directly or indirectly, without the prior written consent of the LHIN. The LHIN may assign this Agreement or any of its rights and obligations under this Agreement to any one or more of the Local Health Integration Networks or to the MOHLTC.

mailto:[email protected]



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16.5 LHIN is an Agent of the Crown. The parties acknowledge that the LHIN is an agent of the Crown and may only act as an agent of the Crown in accordance with the provisions of LHSIA. Notwithstanding anything else in this Agreement, any express or implied reference to the LHIN providing an indemnity or any other form of indebtedness or contingent liability that would directly or indirectly increase the indebtedness or contingent liabilities of the LHIN or Ontario, whether at the time of execution of this Agreement or at any time during the term of this Agreement, will be void and of no legal effect.

16.6 Parties Independent. The parties are and will at all times remain independent of each other and are not and will not represent themselves to be the agent, joint venturer, partner or employee of the other. No representations will be made or acts taken by either party which could establish or imply any apparent relationship of agency, joint venture, partnership or employment and neither party will be bound in any manner whatsoever by any agreements, warranties or representations made by the other party to any other person or entity, nor with respect to any other action of the other party.

16.7 Survival. The provisions in Articles 1 (Definitions and Interpretation) and 5 (Repayment and Recovery of Funding), sections 8.7 (Confidential Information), 8.8 (Required Disclosure), 8.9 (LHIN Public Meetings), 8.10 (Document Retention and Record Maintenance), 8.11 (Final Reports), and Articles 12 (Insurance and Indemnity), 14 (Notices) and 16 (Additional Provisions) will continue in full force and effect for a period of seven years from the date this Agreement ceases to be in effect, whether due to expiry or otherwise.

16.8 Waiver. A party may only rely on a waiver of the party’s failure to comply with any term of this Agreement if the other party has provided a written and signed Notice of waiver. Any waiver must refer to a specific failure to comply and will not have the effect of waiving any subsequent failures to comply.

16.9 Counterparts. This Agreement may be executed in any number of counterparts, each of which will be deemed an original, but all of which together will constitute one and the same instrument.

16.10 Further Assurances. The parties agree to do or cause to be done all acts or things necessary to implement and carry into effect this Agreement to its full extent.

16.11 Governing Law. This Agreement and the rights, obligations and relations of the parties hereto will be governed by and construed in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein. Any litigation or arbitration arising in connection with this Agreement will be conducted in Ontario unless the parties agree in writing otherwise.

16.12 Entire Agreement. This Agreement forms the entire Agreement between the parties and supersedes all prior oral or written representations and agreements, except that where the LHIN has provided Funding to the Hospital pursuant to an amendment to the 2008-18 H-SAA or to this Agreement, whether by funding letter or otherwise, and an amount of Funding for the same purpose is set out in Schedule A, that Funding is subject to all of the terms and conditions on which funding for that purpose was initially provided, unless those terms and conditions have been superseded by any terms or conditions of this Agreement or by the HSAA Indicator Technical Specifications, or unless they conflict with Applicable Law or Applicable Policy.


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IN WITNESS WHEREOF the parties have executed this Agreement made effective as of April 1, 2018

Bluewater Health

By:

Date Board Chair

I sign as a representative of the Hospital, not in my personal capacity, and I represent that I have authority to bind the Hospital.

And By:

Mike Lapaine Date President & CEO

I sign as a representative of the Hospital, not in my personal capacity, and I represent that I have authority to bind the Hospital.

ERIE ST. CLAIR LOCAL HEALTH INTEGRATION NETWORK

By:

Martin Girash Board Chair Date

And By:

Ralph Ganter Date CEO

TEMPLATE MULTI-SECTOR SERVICE ACCOUNTABILITY AGREEMENT April 1, 2018 to June 30, 2018

SERVICE ACCOUNTABILITY AGREEMENT

with

Bluewater Health

Effective Date: April 1, 2018

Index to Agreement

ARTICLE 1.0 - DEFINITIONS & INTERPRETATIONARTICLE 2.0 - TERM AND NATURE OF THIS AGREEMENTARTICLE 3.0 - PROVISION OF SERVICESARTICLE 4.0 - FUNDINGARTICLE 5.0 - REPAYMENT AND RECOVERY OF FUNDINGARTICLE 6.0 - PLANNING & INTEGRATIONARTICLE 7.0 - PERFORMANCEARTICLE 8.0 - REPORTING, ACCOUNTING AND REVIEWARTICLE 9.0 - ACKNOWLEDGEMENT OF LHIN SUPPORTARTICLE 10.0 - REPRESENTATIONS, WARRANTIES AND COVENANTSARTICLE 11.0 - LIMITATION OF LIABILITY, INDEMNITY & INSURANCEARTICLE 12.0 - TERMINATION OF AGREEMENTARTICLE 13.0 - NOTICEARTICLE 14.0 - ADDITIONAL PROVISIONSARTICLE 15.0 - ENTIRE AGREEMENT

Schedules

A - Detailed Description of Services B - Service Plan C - Reports D - Directives, Guidelines, Policies & Standards E - Performance F - Project Funding Agreement Template G - Declaration of Compliance

Multi-Sector Service Accountability Agreement April 1, 2018 – June 30, 2018 Page 2

THE AGREEMENT effective as of the 1st day of April, 2018

B E T W E E N :

ERIE ST. CLAIR LOCAL HEALTH INTEGRATION NETWORK (the “LHIN”)

- and -

Bluewater Health (the “HSP”)

Background:

This service accountability agreement, entered into pursuant to the Local Health System Integration Act, 2006 (“LHSIA”), reflects and supports the commitment of the LHIN and the HSP to, separately, jointly, and in cooperation with other stakeholders, work diligently and collaboratively toward the achievement of the purpose of LHSIA, namely “to provide for an integrated health system to improve the health of Ontarians through better access to high quality health services, co-ordinated health care in local health systems and across the province and effective and efficient management of the health system at the local level by local health integration networks”.

The HSP and the LHIN, being committed to a health care system as envisioned by LHSIA and the Patient’s First: Action Plan for Health Care (“Patients First”), intend to cooperate to advance the purpose and objects of LHSIA and the further development of a patient-centered, integrated, accountable, transparent, and evidence-based health system contemplated by LHSIA and Patients First. They will do so by such actions as: supporting the development and implementation of sub-regions and Health Links to facilitate regional integrated health care service delivery; breaking down silos that inhibit the seamless transition of patients within the health care system; striving for the highest quality and continuous improvement in the delivery of health services and in all aspects of the health system, including by identifying and addressing the root causes of health inequities, and by improving access to primary care, mental health and addiction services and wait times for specialists; and otherwise striving for the highest quality and continuous improvement in the delivery of health services and in all aspects of the health system.

The HSP and the LHIN are committed to working together, and with others, to achieve evolving provincial priorities described: in mandate letters from the Minister of Health and Long-Term Care to the LHIN, from time to time; in the provincial strategic plan for the health system; and, in the LHIN’s Integrated Health Services Plan.

In this context, the HSP and the LHIN agree that the LHIN will provide funding to the HSP on the terms and conditions set out in this Agreement to enable the provision of services to the local health system by the HSP.

In consideration of their respective agreements set out below, the LHIN and the HSP covenant and agree as follows:


ARTICLE 1.0 - DEFINITIONS & INTERPRETATION

1.1 Definitions. In this Agreement the following terms will have the following meanings:

“Accountability Agreement” means the accountability agreement, as that term is defined in LHSIA, in place between the LHIN and the MOHLTC during a Funding Year, currently referred to as the Ministry-LHIN Accountability Agreement;

“Active Offer” means the clear and proactive offer of service in French to individuals, from the first point of contact, without placing the responsibility of requesting services in French on the individual;

“Agreement” means this agreement and includes the Schedules, as amended from time to time;

“Annual Balanced Budget” means that, in each Funding Year of the term of this Agreement, the total revenues of the HSP are greater than or equal to the total expenses, from all sources, of the HSP;

“Applicable Law” means all federal, provincial or municipal laws, regulations, common law, any orders, rules or by-laws that are applicable to the HSP, the Services, this Agreement and the parties’ obligations under this Agreement during the term of this Agreement;

“Applicable Policy” means any rules, policies, directives, standards of practice or Program Parameters issued or adopted by the LHIN, the MOHLTC or other ministries or agencies of the province of Ontario that are applicable to the HSP, the Services, this Agreement and the parties’ obligations under this Agreement during the term of this Agreement. Without limiting the generality of the foregoing, Applicable Policy includes the other documents identified in Schedule D;

“Board” means:

(1) in respect of an HSP that does not have a Long-Term Care Home ServiceAccountability Agreement with the LHIN and is:

(a) a corporation, the board of directors;(b) a First Nation, the band council; and(c) a municipality, the municipal council;and,

(2) in respect of an HSP that has a Long-Term Care Home Service AccountabilityAgreement with the LHIN and is:

(a) a corporation, the board of directors;(b) a First Nation, the band council;(c) a municipality, the committee of management;


(d) a board of management established by one or more municipalities or by oneor more First Nations’ band councils, the members of the board ofmanagement;

“BPSAA” means the Broader Public Sector Accountability Act, 2010 and regulations made under it, as it and they may be amended from time to time;

“Budget” means the budget approved by the LHIN and appended to this Agreement in Schedule B;

“CEO” means the individual accountable to the Board for the provision of the Services in accordance with the terms of this Agreement;

“Chair” means, if the HSP is:

(a) a corporation, the Chair of the Board;(b) a First Nation, the Chief; and(c) a municipality, the Mayor,

or such other person properly authorized by the Board or under Applicable Law;

“Compliance Declaration” means a compliance declaration substantially in the form set out in Schedule G;

“Confidential Information” means information that is: (1) marked or otherwise identified as confidential by the disclosing party at the time the information is provided to the receiving party; and (2) eligible for exclusion from disclosure at a public board meeting in accordance with section 9 of LHSIA. Confidential Information does not include information that: (a) was known to the receiving party prior to receiving the information from the disclosing party; (b) has become publicly known through no wrongful act of the receiving party; or (c) is required to be disclosed by law, provided that the receiving party provides Notice in a timely manner of such requirement to the disclosing party, consults with the disclosing party on the proposed form and nature of the disclosure, and ensures that any disclosure is made in strict accordance with Applicable Law;

“Conflict of Interest” in respect of an HSP, includes any situation or circumstance where: in relation to the performance of its obligations under this Agreement:

(a) the HSP;(b) a member of the HSP’s Board; or(c) any person employed by the HSP who has the capacity to influence the

HSP’s decision,

has other commitments, relationships or financial interests that:

(a) could or could be seen to interfere with the HSP’s objective, unbiased andimpartial exercise of its judgement; or

(b) could or could be seen to compromise, impair or be incompatible with theeffective performance of its obligations under this Agreement;

“Controlling Shareholder” of a corporation means a shareholder who or which holds (or another person who or which holds for the benefit of such shareholder), other than by way of security only, voting securities of such corporation carrying more than 50% of the votes for the election of directors, provided that the votes carried by such securities


are sufficient, if exercised, to elect a majority of the board of directors of such corporation;

“Days” means calendar days;

“Digital Health” has the meaning ascribed to it in the Accountability Agreement and means the coordinated and integrated use of electronic systems, information and communication technologies to facilitate the collection, exchange and management of personal health information in order to improve the quality, access, productivity and sustainability of the healthcare system;

Designated means designated as a public service agency under the FLSA;

“Effective Date” means April 1, 2014;

“Explanatory Indicator” means a measure of the HSP’s performance for which no Performance Target is set. Technical specifications of specific Explanatory Indicators can be found in the “MSAA Indicator Technical Specifications document”.

“FIPPA” means the Freedom of Information and Protection of Privacy Act (Ontario) and the regulations made it as it and they may be amended from time to time;

“FLSA” means the French Language Services Act and the regulations made under the French Language Services Act, as it and they may be amended from time to time;

“Funding” means the amounts of money provided by the LHIN to the HSP in each Funding Year of this Agreement;

“Funding Year” means in the case of the first Funding Year, the period commencing on the Effective Date and ending on the following March 31, and in the case of Funding Years subsequent to the first Funding Year, the period commencing on the date that is April 1 following the end of the previous Funding Year and ending on the following March 31;

“HSP’s Personnel and Volunteers” means the controlling shareholders (if any), directors, officers, employees, agents, volunteers and other representatives of the HSP. In addition to the foregoing, HSP’s Personnel and Volunteers shall include the contractors and subcontractors and their respective shareholders, directors, officers, employees, agents, volunteers or other representatives;

“Identified” means identified by the LHIN or the Ministry to provide French language services;

“Indemnified Parties” means the LHIN and its officers, employees, directors, independent contractors, subcontractors, agents, successors and assigns and her Majesty the Queen in Right of Ontario and her Ministers, appointees and employees,


independent contractors, subcontractors, agents and assigns. Indemnified parties also includes any person participating on behalf of the LHIN in a Review;

“Interest Income” means interest earned on the Funding;

“LHIN Cluster” has the meaning ascribed to it in the Accountability Agreement and is a grouping of LHINs for the purpose of advancing Digital Health initiatives through regional coordination aligned with the MOHLTC’s provincial priorities.

“LHSIA” means the Local Health System Integration Act, 2006, and the regulations made under it, as it and they may be amended from time to time;

“Mandate Letter” has the meaning ascribed to it in the Memorandum of Understanding between MOHLTC and the LHIN, and means a letter from the Minister to the LHIN establishing priorities in accordance with the Premier’s mandate letter to the Minister.

“MOHLTC” means the Minister or the Ministry of Health and Long-Term Care, as the context requires;

“MSAA Indicator Technical Specifications document” means, as the context requires, either or both of the document entitled “Multi-Sector Service Accountability Agreement 2014-19: Indicator Technical Specifications October 20, 2017” and the document entitled “2016-17 Multi-Sector Service Accountability Agreements (MSAA) Target and Corridor Setting Guideline” as they may be amended or replaced from time to time;

“Notice” means any notice or other communication required to be provided pursuant to this Agreement or LHSIA;

“Performance Agreement” means an agreement between an HSP and its CEO that requires the CEO to perform in a manner that enables the HSP to achieve the terms of this Agreement and any additional performance improvement targets set out in the HSP’s annual quality improvement plan under the Excellent Care for All Act, 2010;

“Performance Corridor” means the acceptable range of results around a Performance Target.

“Performance Factor” means any matter that could or will significantly affect a party’s ability to fulfill its obligations under this Agreement;

“Performance Indicator” means a measure of HSP performance for which a Performance Target is set; technical specifications of specific Performance Indicators can be found in the MSAA Indicator Technical Specifications document;

“Performance Standard” means the acceptable range of performance for a Performance Indicator or a Service Volume that results when a Performance Corridor is applied to a Performance Target.

“Performance Target” means the level of performance expected of the HSP in respect of a Performance Indicator or a Service Volume.


“person or entity” includes any individual and any corporation, partnership, firm, joint venture or other single or collective form of organization under which business may be conducted;

“Planning Submission” or “CAPS” or “Community Accountability Planning Submission” means the HSP Board approved planning document submitted by the HSP to the LHIN. The form, content and scheduling of the Planning Submission will be identified by the LHIN;

“Program Parameter” means, in respect of a program, the provincial standards (such as operational, financial or service standards and policies, operating manuals and program eligibility), directives, guidelines and expectations and requirements for that program;

“Project Funding Agreement” means an agreement in the form of Schedule F that incorporates the terms of this Agreement and enables the LHIN to provide one-time or short term funding for a specific project or service that is not already described in Schedule A;

“Reports” means the reports described in Schedule C as well as any other reports or information required to be provided under LHSIA or this Agreement;

“Review” means a financial or operational audit, investigation, inspection or other form of review requested or required by the LHIN under the terms of LHSIA or this Agreement, but does not include the annual audit of the HSP’s financial statements;

“Schedule” means any one of, and “Schedules” mean any two or more, as the context requires, of the schedules appended to this Agreement including the following:

Schedule C: Reports

Schedule D: Directives, Guidelines and Policies

Schedule E: Performance

Schedule G: Declaration of Compliance

“Service Plan” means the Operating Plan and Budget appended as Schedule B;

“Services” means the care, programs, goods and other services described in Schedule A and in any Project Funding Agreement executed pursuant to this Agreement. “Services” includes the type, volume, frequency and availability of the care, programs, goods and other services;


“Service Volume” means a measure of Services for which a Performance Target is set;

“Transition Plan” means a transition plan, acceptable to the LHIN that indicates how the needs of the HSP’s clients will be met following the termination of this Agreement and how the transition of the clients to new service providers will be effected in a timely manner; and

“2014-18 MSAA” means the Multi-Sector Service Accountability Agreement April 1, 2014 to March 31, 2018.

1.2 Interpretation. Words in the singular include the plural and vice-versa. Words in one gender include all genders. The words “including” and “includes” are not intended to be limiting and shall mean “including without limitation” or “includes without limitation”, as the case may be. The headings do not form part of this Agreement. They are for convenience of reference only and will not affect the interpretation of this Agreement. Terms used in the Schedules shall have the meanings set out in this Agreement unless separately and specifically defined in a Schedule in which case the definition in the Schedule shall govern for the purposes of that Schedule.

1.3 MSAA Indicator Technical Specification Document. This Agreement shall be interpreted with reference to the MSAA Indicator Technical Specifications Document.

ARTICLE 2.0 - TERM AND NATURE OF THIS AGREEMENT

2.1 Term. The term of this Agreement will commence on the Effective Date and will expire on June 30, 2018 unless terminated earlier or extended pursuant to its terms.

2.2 A Service Accountability Agreement. This Agreement is a service accountability agreement for the purposes of section 20(1) of LHSIA.

ARTICLE 3.0 - PROVISION OF SERVICES

3.1 Provision of Services.

(a) The HSP will provide the Services in accordance with, and otherwise complywith:

the terms of this Agreement, including the Service Plan;

Applicable Law; and

Applicable Policy.

(b) When providing the Services, the HSP will meet the Performance Standardsand conditions identified in Schedule E.


(c) Unless otherwise provided in this Agreement, the HSP will not reduce, stop,start, expand, cease to provide or transfer the provision of the Services orchange its Service Plan except with Notice to the LHIN, and if required byApplicable Law or Applicable Policy, the prior written consent of the LHIN.

(d) The HSP will not restrict or refuse the provision of Services to an individual,directly or indirectly, based on the geographic area in which the person residesin Ontario.

3.2 Subcontracting for the Provision of Services.

(a) The parties acknowledge that, subject to the provisions of LHSIA, the HSP maysubcontract the provision of some or all of the Services. For the purposes ofthis Agreement, actions taken or not taken by the subcontractor, and Servicesprovided by the subcontractor, will be deemed actions taken or not taken by theHSP, and Services provided by the HSP.

(b) When entering into a subcontract the HSP agrees that the terms of thesubcontract will enable the HSP to meet its obligations under this Agreement.Without limiting the foregoing, the HSP will include a provision that permits theLHIN or its authorized representatives, to audit the subcontractor in respect ofthe subcontract if the LHIN or its authorized representatives determines thatsuch an audit would be necessary to confirm that the HSP has complied withthe terms of this Agreement.

(c) Nothing contained in this Agreement or a subcontract will create a contractualrelationship between any subcontractor or its directors, officers, employees,agents, partners, affiliates or volunteers and the LHIN.

3.3 Conflict of Interest. The HSP will use the Funding, provide the Services and otherwise fulfil its obligations under this Agreement, without an actual, potential or perceived Conflict of Interest. The HSP will disclose to the LHIN without delay any situation that a reasonable person would interpret as an actual, potential or perceived Conflict of Interest and comply with any requirements prescribed by the LHIN to resolve any Conflict of Interest.

3.4 Digital Health. The HSP agrees to:

(a) assist the LHIN to implement provincial e-health priorities for 2017-18 andthereafter in accordance with the Accountability Agreement, as may beamended or replaced from time to time;

(b) comply with any technical and information management standards, includingthose related to data, architecture, technology, privacy and security set forhealth service providers by MOHLTC or the LHIN within the timeframes set byMOHLTC or the LHIN as the case may be;


(c) implement and use the approved provincial Digital Health solutions identified inthe LHIN Digital Health plan;

(d) implement technology solutions that are compatible or interoperable with theprovincial blueprint and with the LHIN Cluster Digital Health plan; and

(e) include in its annual Planning Submissions, plans for achieving Digital Healthpriority initiatives.

3.5 French Language Services.

3.5.1 The LHIN will provide the MOHLTC “Guide to Requirements and Obligations of LHIN French Language Services” to the HSP and the HSP will fulfill its roles, responsibilities and other obligations set out therein.

3.5.2 If Not Identified or Designated. If the HSP has not been Designated or Identified it will:

(a) develop and implement a plan to address the needs of the localFrancophone community, including the provision of information on servicesavailable in French;

(b) work towards applying the principles of Active Offer in the provision ofservices;

(c) provide a report to the LHIN that outlines how the HSP addresses theneeds of its local Francophone community; and,

(d) collect and submit to the LHIN as requested by the LHIN from time to time,French language service data.

3.5.3 If Identified. If the HSP is Identified it will:

(a) work towards applying the principles of Active Offer in the provision ofservices;

(b) provide services to the public in French in accordance with its existingFrench language services capacity;

(c) develop, and provide to the LHIN upon request from time to time, a plan tobecome Designated by the date agreed to by the HSP and the LHIN;

(d) continuously work towards improving its capacity to provide services inFrench and toward becoming Designated within the time frame agreed toby the parties;

(e) provide a report to the LHIN that outlines progress in its capacity to provideservices in French and toward becoming Designated;

(f) annually, provide a report to the LHIN that outlines how it addresses theneeds of its local Francophone community;

(g) collect and submit to the LHIN, as requested by the LHIN from time to time,French language services data.

3.5.4 If Designated. If the HSP is Designated it will:

(a) apply the principles of Active Offer in the provision of services;


(b) continue to provide services to the public in French in accordance with theprovisions of the FLSA ;

(c) maintain its French language services capacity;(d) submit a French language implementation report to the LHIN on the date

specified by the LHIN, and thereafter, on each anniversary of that date, oron such other dates as the LHIN may, by notice, require;

(e) collect and submit to the LHIN as requested by the LHIN from time to time,French language services data.

3.6 Minister’s Mandate Letter language. The LHIN will receive a Mandate Letter from the Minister annually. Each Mandate Letter articulates areas of focus for the LHIN, and the Minister’s expectation that the LHIN and health service providers it funds will collaborate to advance these areas of focus. To assist the HSP in its collaborative efforts with the LHIN, the LHIN will share each relevant Mandate Letter with the HSP. The LHIN may also add local obligations to Schedule E as appropriate to further advance any priorities set put in a Mandate Letter.

3.7 Policies, Guidelines, Directives and Standards. Either the LHIN or the MOHLTC will give the HSP Notice of any amendments to the manuals, guidelines or policies identified in Schedule D. Amendments will be effective in accordance with the terms of the amendment. By signing a copy of this Agreement the HSP acknowledges that it has a copy of the documents identified in Schedule D.

ARTICLE 4.0 - FUNDING

4.1 Funding. Subject to the terms of this Agreement, and in accordance with the applicable provisions of the Accountability Agreement, the LHIN:

(a) will provide the funds identified in Schedule B to the HSP for the purpose ofproviding or ensuring the provision of the Services;

(b) and

(c) will deposit the funds in regular instalments, once or twice monthly, over theterm of this Agreement, into an account designated by the HSP provided thatthe account resides at a Canadian financial institution and is in the name of theHSP.

4.2 Limitation on Payment of Funding. Despite section 4.1, the LHIN:

(a) will not provide any funds to the HSP until this Agreement is fully executed;

(b) may pro-rate the funds identified in Schedule B to the date on which thisAgreement is signed, if that date is after April 1;


(c) will not provide any funds to the HSP until the HSP meets the insurancerequirements described in section 11.4;

(d) will not be required to continue to provide funds in the event the HSP breachesany of its obligations under this Agreement, until the breach is remedied to theLHIN’s satisfaction; and

(e) upon notice to the HSP, may adjust the amount of funds it provides to the HSPin any Funding Year based upon the LHIN’s assessment of the informationcontained in the Reports.

4.3 Appropriation. Funding under this Agreement is conditional upon an appropriation of moneys by the Legislature of Ontario to the MOHLTC and funding of the LHIN by the MOHLTC pursuant to LHSIA. If the LHIN does not receive its anticipated funding the LHIN will not be obligated to make the payments required by this Agreement.

4.4 Additional Funding.

(a) Unless the LHIN has agreed to do so in writing, the LHIN is not required toprovide additional funds to the HSP for providing additional Services or forexceeding the requirements of Schedule E.

(b) The HSP may request additional funding by submitting a proposal to amend itsService Plan. The HSP will abide by all decisions of the LHIN with respect to aproposal to amend the Service Plan and will make whatever changes arerequested or approved by the LHIN. The Service Plan will be amended toinclude any approved additional funding.

(c) Funding Increases. Before the LHIN can make an allocation of additional fundsto the HSP, the parties will: (1) agree on the amount of the increase; (2) agreeon any terms and conditions that will apply to the increase; and (3) execute anamendment to this Agreement that reflects the agreement reached.

4.5 Conditions of Funding.

(a) The HSP will:

fulfill all obligations in this Agreement;

use the Funding only for the purpose of providing the Services in accordance with Applicable Law, Applicable Policy and the terms of this Agreement;

spend the Funding only in accordance with the Service Plan; and

plan for and achieve an Annual Balanced Budget.


(b) The LHIN may add such additional terms or conditions on the use of theFunding which it considers appropriate for the proper expenditure andmanagement of the Funding.

(c) All Funding is subject to all Applicable Law and Applicable Policy, includingHealth System Funding Reform, as it may evolve or be replaced over the termof this Agreement

4.6 Interest.

(a) If the LHIN provides the Funding to the HSP prior to the HSP’s immediate needfor the Funding, the HSP shall place the Funding in an interest bearing accountin the name of the HSP at a Canadian financial institution.

(b) Interest Income must be used, within the fiscal year in which it is received, toprovide the Services.

(c) Interest Income will be reported to the LHIN and is subject to year-endreconciliation. In the event that some or all of the Interest Income is not used toprovide the Services,

the LHIN may deduct the amount equal to the unused Interest Income from any further Funding instalments under this or any other agreement with the HSP; and/or

the LHIN may require the HSP to pay an amount equal to the unused Interest Income to the Ministry of Finance.

4.7 Rebates, Credits and Refunds. The HSP:

(a) acknowledges that rebates, credits and refunds it anticipates receiving from theuse of the Funding have been incorporated in its Budget;

(b) agrees that it will advise the LHIN if it receives any unanticipated rebates,credits and refunds from the use of the Funding, or from the use of fundingreceived from either the LHIN or the MOHLTC in years prior to this Agreementthat was not recorded in the year of the related expenditure;

(c) agrees that all rebates, credits and refunds referred to in (b) will be consideredFunding in the year that the rebates are received, regardless of the year towhich the rebate relates.

4.8 Procurement of Goods and Services.

(a) If the HSP is subject to the procurement provisions of the BPSAA, the HSP willabide by all directives and guidelines issued by the Management Board ofCabinet that are applicable to the HSP pursuant to the BPSAA.


(b) If the HSP is not subject to the procurement provisions of the BPSAA, the HSPwill have a procurement policy in place that requires the acquisition of supplies,equipment or services valued at over $25,000 through a competitive processthat ensures the best value for funds expended. If the HSP acquires supplies,equipment or services with the Funding it will do so through a process that isconsistent with this policy.

4.9 Disposition. The HSP will not, without the LHIN’s prior written consent, sell, lease or otherwise dispose of any assets purchased with Funding, the cost of which exceeded $25,000 at the time of purchase.

ARTICLE 5.0 - REPAYMENT AND RECOVERY OF FUNDING

5.1 Repayment and Recovery.

(a) At the End of a Funding Year. If, in any Funding Year, the HSP has not spentall of the Funding the LHIN will require the repayment of the unspent Funding.

(b) On Termination or Expiration of this Agreement. Upon termination or expiryof this Agreement, the LHIN will require the repayment of any Fundingremaining in the possession or under the control of the HSP and the payment ofan amount equal to any Funding the HSP used for purposes not permitted bythis Agreement.

(c) On Reconciliation and Settlement. If the year-end reconciliation andsettlement process demonstrates that the HSP received Funding in excess of itsconfirmed funds, the LHIN will require the repayment of the excess Funding.

(d) As a Result of Performance Management or System Planning. If Servicesare adjusted, as a result of the performance management or system planningprocesses, the LHIN may adjust the Funding to be paid under Schedule B,require the repayment of excess Funding and/or adjust the amount of any futurefunding installments accordingly.

(e) In the Event of Forecasted Surpluses. If the HSP is forecasting a surplus, theLHIN may adjust the amount of Funding to be paid under Schedule B, requirethe repayment of excess Funding and/or adjust the amount of any futurefunding installments accordingly.

(f) On the Request of the LHIN. The HSP will, at the request of the LHIN, repaythe whole or any part of the Funding, or an amount equal thereto if the HSP:

has provided false information to the LHIN knowing it to be false;

breaches a term or condition of this Agreement and does not, within 30 Days after receiving Notice from the LHIN take reasonable steps to remedy the breach; or


breaches any Applicable Law that directly relates to the provision of, or ensuring the provision of, the Services.

(g) Subsections 5.1(c) and (d) do not apply to Funding already expended properlyin accordance with this Agreement. The LHIN will, at its sole discretion, andwithout liability or penalty, determine whether the Funding has been expendedproperly in accordance with this Agreement.

5.2 Provision for the Recovery of Funding. The HSP will make reasonable and prudent provision for the recovery by the LHIN of any Funding for which the conditions of Funding set out in section 4.5 are not met and will hold this Funding in accordance with the provisions of section 4.6 until such time as reconciliation and settlement has occurred with the LHIN. Interest earned on Funding will be reported and recovered in accordance with section 4.6.

5.3 Settlement and Recovery of Funding for Prior Years. (a) The HSP acknowledges that settlement and recovery of Funding can occur up

to seven years after the provision of Funding.

(b) Recognizing the transition of responsibilities from the MOHLTC to the LHIN, theHSP agrees that if the parties are directed in writing to do so by the MOHLTC,the LHIN will settle and recover funding provided by the MOHLTC to the HSPprior to the transition of the Funding for the Services to the LHIN, provided thatsuch settlement and recovery occurs within seven years of the provision of thefunding by the MOHLTC. All such settlements and recoveries will be subject tothe terms applicable to the original provision of funding.

5.4 Debt Due.

(a) If the LHIN requires the re-payment by the HSP of any Funding, the amountrequired will be deemed to be a debt owing to the Crown by the HSP. The LHINmay adjust future funding instalments to recover the amounts owed or may, atits discretion direct the HSP to pay the amount owing to the Crown and the HSPshall comply immediately with any such direction.

(b) All amounts repayable to the Crown will be paid by cheque payable to the“Ontario Minister of Finance” and mailed or delivered to the LHIN at the addressprovided in section 13.1.


5.5 Interest Rate. The LHIN may charge the HSP interest on any amount owing by the HSP at the then current interest rate charged by the Province of Ontario on accounts receivable.

ARTICLE 6.0 - PLANNING & INTEGRATION

6.1 Planning for Future Years.

(a) Advance Notice. The LHIN will give at least sixty Days’ Notice to the HSP ofthe date by which a CAPS must be submitted to the LHIN.

(b) Multi-Year Planning. The CAPS will be in a form acceptable to the LHIN andmay be required to incorporate (1) prudent multi-year financial forecasts; (2)plans for the achievement of performance targets; and (3) realistic riskmanagement strategies. It will be aligned with the LHIN’s then currentIntegrated Health Service Plan and will reflect local LHIN priorities andinitiatives. If the LHIN has provided multi-year planning targets for the HSP, theCAPS will reflect the planning targets.

(c) Multi-year Planning Targets. Schedule B may reflect an allocation for the firstFunding Year of this Agreement as well as planning targets for up to twoadditional years, consistent with the term of this Agreement. In such an event,

the HSP acknowledges that if it is provided with planning targets, these targets are: (A) targets only, (B) provided solely for the purposes of planning, (C) are subject to confirmation, and (D) may be changed at the discretion of the LHIN in consultation with the HSP. The HSP will proactively manage the risks associated with multi-year planning and the potential changes to the planning targets; and

the LHIN agrees that it will communicate any changes to the planning targets as soon as reasonably possible.

(d) Service Accountability Agreements. The HSP acknowledges that if the LHINand the HSP enter into negotiations for a subsequent service accountabilityagreement, subsequent funding may be interrupted if the next serviceaccountability agreement is not executed on or before the expiration date of thisAgreement.

6.2 Community Engagement & Integration Activities.

(a) Community Engagement. The HSP will engage the community of diversepersons and entities in the area where it provides health services when settingpriorities for the delivery of health services and when developing plans forsubmission to the LHIN including but not limited to CAPS and integrationproposals. As part of its community engagement activities, the HSPs will havein place and utilize effective mechanisms for engaging families, caregivers,


clients, residents, patients and other individuals who use the services of the HSP, to help inform the HSP plans, including the HSP’s contribution to the establishment and implementation by the LHIN of geographic sub-regions in its local health system.

(b) Integration. The HSP will, separately and in conjunction with the LHIN and otherhealth service providers, identify opportunities to integrate the services of thelocal health system to provide appropriate, co-coordinated, effective andefficient services.

(c) Reporting. The HSP will report on its community engagement and integrationactivities, using any templates provided by the LHIN, as requested by the LHINand in any event, in its year-end report to the LHIN.

6.3 Planning and Integration Activity Pre-proposals

(a) General. A pre-proposal process has been developed to: (1) reduce the costsincurred by an HSP when proposing operational or service changes; (2) assistthe HSP to carry out its statutory obligations; and (3) enable an effective andefficient response by the LHIN. Subject to specific direction from the LHIN, thispre-proposal process will be used in the following instances:

the HSP is considering an integration or an integration of services, as defined in LHSIA between the HSP and another person or entity;

the HSP is proposing to reduce, stop, start, expand or transfer the location of services, which for certainty includes: the transfer of Services from the HSP to another person or entity whether within or outside of the LHIN; and the relocation or transfer of services from one of the HSP’s sites to another of the HSP’s sites whether within or outside of the LHIN;

to identify opportunities to integrate the services of the local health system, other than those identified in (1) or (2) above; or

if requested by the LHIN.

(b) LHIN Evaluation of the Pre-proposal. Use of the pre-proposal process is notformal Notice of a proposed integration under section 27 of LHSIA. LHINconsent to develop the project concept outlined in a pre-proposal does notconstitute approval to proceed with the project. Nor does LHIN consent todevelop a project concept presume the issuance of a favourable decision,should such a decision be required by sections 25 or 27 of LHSIA. Followingthe LHIN’s review and evaluation, the HSP may be invited to submit a detailedproposal and a business plan for further analysis. Guidelines for thedevelopment of a detailed proposal and business case will be provided by theLHIN.


6.4 Proposing Integration Activities in the Planning Submission. No integration activity described in section 6.3 may be proposed in a CAPS unless the LHIN has consented, in writing, to its inclusion pursuant to the process set out in section 6.3(b).

6.5 Definitions. In this section 6.0, the terms “integrate”, “integration” and “services” have the same meanings attributed to them in section 2(1) and section 23 respectively of LHSIA, as it and they may be amended from time to time.

ARTICLE 7.0 - PERFORMANCE

7.1 Performance. The parties will strive to achieve on-going performance improvement. They will address performance improvement in a proactive, collaborative and responsive manner.

7.2 Performance Factors.

(a) Each party will notify the other party of the existence of a Performance Factor,as soon as reasonably possible after the party becomes aware of thePerformance Factor. The Notice will:

describe the Performance Factor and its actual or anticipated impact;

include a description of any action the party is undertaking, or plans to undertake, to remedy or mitigate the Performance Factor;

indicate whether the party is requesting a meeting to discuss the Performance Factor; and

address any other issue or matter the party wishes to raise with the other party.

(b) The recipient party will provide a written acknowledgment of receipt of theNotice within seven Days of the date on which the Notice was received (“Date ofthe Notice”).

(c) Where a meeting has been requested under paragraph 7.2(a)(3), the partiesagree to meet and discuss the Performance Factors within fourteen Days of theDate of the Notice, in accordance with the provisions of section 7.3.

7.3 Performance Meetings During a meeting on performance, the parties will:

(a) discuss the causes of a Performance Factor;

(b) discuss the impact of a Performance Factor on the local health system and therisk resulting from non-performance; and


(c) determine the steps to be taken to remedy or mitigate the impact of the Performance Factor (the “Performance Improvement Process”).

7.4 The Performance Improvement Process.

(a) The Performance Improvement Process will focus on the risks of non-performance and problem-solving. It may include one or more of the followingactions:

a requirement that the HSP develop and implement an improvement plan that is acceptable to the LHIN;

the conduct of a Review;

a revision and amendment of the HSP’s obligations; and/or

an in-year, or year-end, adjustment to the Funding,

among other possible means of responding to the Performance Factor or improving performance.

(b) Any performance improvement process begun under a prior serviceaccountability agreement that was not completed under the prior agreement willcontinue under this Agreement. Any performance improvement required by aLHIN under a prior service accountability agreement will be deemed to be arequirement of this Agreement until fulfilled or waived by the LHIN.

ARTICLE 8.0 - REPORTING, ACCOUNTING AND REVIEW

8.1 Reporting.

(a) Generally. The LHIN’s ability to enable its local health system to provideappropriate, co-ordinated, effective and efficient health services, ascontemplated by LHSIA, is heavily dependent on the timely collection andanalysis of accurate information. The HSP acknowledges that the timelyprovision of accurate information related to the HSP, and its performance of itsobligations under this Agreement, is under the HSP’s control.

(b) Specific Obligations. The HSP:

will provide to the LHIN, or to such other entity as the LHIN may direct, in the form and within the time specified by the LHIN, the Reports, other than personal health information as defined in LHSIA, that (1) the LHIN requires for the purposes of exercising its powers and duties under this Agreement, the Accountability Agreement, LHSIA or for the purposes that are prescribed under any Applicable Law;


will fulfil the specific reporting requirements set out in Schedule C;

will ensure that every Report is complete, accurate, signed on behalf of the HSP by an authorized signing officer where required and provided in a timely manner and in a form satisfactory to the LHIN; and

agrees that every Report submitted to the LHIN by or on behalf of the HSP, will be deemed to have been authorized by the HSP for submission.

For certainty, nothing in this section 8.1 or in this Agreement restricts or otherwise limits the LHIN’s right to access or to require access to personal health information as defined in LHSIA, in accordance with Applicable Law for purposes of carrying out the LHIN’s statutory objects to achieve the purposes of LHSIA, including to provide certain services, supplies and equipment in accordance with section 5(m.1) of LHSIA and to manage placement of persons in accordance with section 5(m.2).

(c) French Language Services. If the HSP is required to provide services to thepublic in French under the provisions of the French Language Services Act, theHSP will be required to submit a French language services report to the LHIN.If the HSP is not required to provide services to the public in French under theprovisions of the French Language Service Act, it will be required to provide areport to the LHIN that outlines how the HSP addresses the needs of its localFrancophone community.

(d) Declaration of Compliance. Within 90 days of the HSP’s fiscal year-end, theBoard will issue a Compliance Declaration declaring that the HSP has compliedwith the terms of this Agreement. The form of the declaration is set out inSchedule G and may be amended by the LHIN from time to time through theterm of this Agreement.

(e) Financial Reductions. Notwithstanding any other provision of thisAgreement, and at the discretion of the LHIN, the HSP may be subject to afinancial reduction in any of the following circumstances:

its CAPS is received after the due date;

its CAPS is incomplete;

the quarterly performance reports are not provided when due; or

financial or clinical data requirements are late, incomplete or inaccurate,

where the errors or delay were not as a result of LHIN actions or inaction or the actions or inactions of persons acting on behalf of the LHIN. If assessed, the financial reduction will be as follows:


if received within 7 days after the due date, incomplete or inaccurate, the financial penalty will be the greater of (1) a reduction of 0.02 percent (0.02%) of the Funding; or (2) two hundred and fifty dollars ($250.00); and

for every full or partial week of non-compliance thereafter, the rate will be one half of the initial reduction.

8.2 Reviews.

(a) During the term of this Agreement and for seven years after the term of thisAgreement, the HSP agrees that the LHIN or its authorized representatives mayconduct a Review of the HSP to confirm the HSP’s fulfillment of its obligationsunder this Agreement. For these purposes the LHIN or its authorizedrepresentatives may, upon twenty-four hours’ Notice to the HSP and duringnormal business hours enter the HSP’s premises to:

inspect and copy any financial records, invoices and other finance-related documents, other than personal health information as defined in LHSIA, in the possession or under the control of the HSP which relate to the Funding or otherwise to the Services; and

inspect and copy non-financial records, other than personal health information as defined in LHSIA, in the possession or under the control of the HSP which relate to the Funding, the Services or otherwise to the performance of the HSP under this Agreement.

(b) The cost of any Review will be borne by the HSP if the Review: (1) was madenecessary because the HSP did not comply with a requirement under LHSIA orthis Agreement; or (2) indicates that the HSP has not fulfilled its obligationsunder this Agreement, including its obligations under Applicable Law andApplicable Policy.

(c) To assist in respect of the rights set out in (a) above, the HSP shall disclose anyinformation requested by the LHIN or its authorized representatives, and shalldo so in a form requested by the LHIN or its authorized representatives.

(d) The HSP may not commence a proceeding for damages or otherwise againstany person with respect to any act done or omitted to be done, any conclusionreached or report submitted that is done in good faith in respect of a Review.

(e) HSP’s obligations under this section 8.2 will survive any termination orexpiration of this Agreement.

8.3 Document Retention and Record Maintenance. The HSP will

(a) retain all records (as that term is defined in FIPPA) related to the HSP’sperformance of its obligations under this Agreement for seven years after the


termination or expiration of the term of this Agreement. The HSP’s obligations under this section will survive any termination or expiry of this Agreement;

(b) keep all financial records, invoices and other finance-related documents relatingto the Funding or otherwise to the Services in a manner consistent with eithergenerally accepted accounting principles or international financial reportingstandards as advised by the HSP’s auditor; and

(c) keep all non-financial documents and records relating to the Funding orotherwise to the Services in a manner consistent with all Applicable Law.

8.4 Disclosure of Information.

(a) FIPPA. The HSP acknowledges that the LHIN is bound by FIPPA and that anyinformation provided to the LHIN in connection with this Agreement may besubject to disclosure in accordance with FIPPA.

(b) Confidential Information. The parties will treat Confidential Information asconfidential and will not disclose Confidential Information except with theconsent of the disclosing party or as permitted or required under FIPPA or thePersonal Health Information Protection Act, 2004, LHSIA, court order, subpoenaor other Applicable Law. Notwithstanding the foregoing, the LHIN may discloseinformation that it collects under this Agreement in accordance with LHSIA.

8.5 Transparency. The HSP will post a copy of this Agreement and each Compliance Declaration submitted to the LHIN during the term of this Agreement in a conspicuous and easily accessible public place at its sites of operations to which this Agreement applies and on its public website, if the HSP operates a public website.

8.6 Auditor General. For greater certainty the LHIN’s rights under this article are in addition to any rights provided to the Auditor General under the Auditor General Act (Ontario).

ARTICLE 9.0 - ACKNOWLEDGEMENT OF LHIN SUPPORT

9.1 Publication. For the purposes of this Article 9, the term “publication” means any material on or concerning the Services that the HSP makes available to the public, regardless of whether the material is provided electronically or in hard copy. Examples include a web-site, an advertisement, a brochure, promotional documents and a report. Materials that are prepared by the HSP in order to fulfil its reporting obligations under this Agreement are not included in the term “publication”.

9.2 Acknowledgment of Funding Support.

(a) The HSP agrees all publications will include


an acknowledgment of the Funding provided by the LHIN and the Government of Ontario. Prior to including an acknowledgement in any publication, the HSP will obtain the LHIN’s approval of the form of acknowledgement. The LHIN may, at its discretion, decide that an acknowledgement is not necessary; and

a statement indicating that the views expressed in the publication are the views of the HSP and do not necessarily reflect those of the LHIN or the Government of Ontario.

(b) The HSP shall not use any insignia or logo of Her Majesty the Queen in right ofOntario, including those of the LHIN, unless it has received the prior writtenpermission of the LHIN to do so.

ARTICLE 10.0 - REPRESENTATIONS, WARRANTIES AND COVENANTS

10.1 General. The HSP represents, warrants and covenants that:

(a) it is, and will continue for the term of this Agreement to be, a validly existinglegal entity with full power to fulfill its obligations under this Agreement;

(b) it has the experience and expertise necessary to carry out the Services;

(c) it holds all permits, licences, consents, intellectual property rights andauthorities necessary to perform its obligations under this Agreement;

(d) all information (including information relating to any eligibility requirements forFunding) that the HSP provided to the LHIN in support of its request for Fundingwas true and complete at the time the HSP provided it, and will, subject to theprovision of Notice otherwise, continue to be true and complete for the term ofthis Agreement; and

(e) it does, and will continue for the term of this Agreement to, operate incompliance with all Applicable Law and Applicable Policy, including observingwhere applicable, the requirements of the Corporations Act or successorlegislation and the HSP's by-laws in respect of, but not limited to, the holding ofboard meetings, the requirements of quorum for decision-making, themaintenance of minutes for all board and committee meetings and the holdingof members meetings.

10.2 Execution of Agreement. The HSP represents and warrants that:

(a) it has the full power and authority to enter into this Agreement; and

(b) it has taken all necessary actions to authorize the execution of thisAgreement.


10.3 Governance.

(a) The HSP represents, warrants and covenants that it has established, and willmaintain for the period during which this Agreement is in effect, policies andprocedures:

that set out a code of conduct for, and that identify the ethical responsibilities for all persons at all levels of the HSP’s organization;

to ensure the ongoing effective functioning of the HSP;

for effective and appropriate decision-making;

for effective and prudent risk-management, including the identification and management of potential, actual and perceived conflicts of interest;

for the prudent and effective management of the Funding;

to monitor and ensure the accurate and timely fulfillment of the HSP’s obligations under this Agreement and compliance with LHSIA;

to enable the preparation, approval and delivery of all Reports;

to address complaints about the provision of Services, the management or governance of the HSP; and

to deal with such other matters as the HSP considers necessary to ensure that the HSP carries out its obligations under this Agreement.

(b) The HSP represents and warrants that:

it has, or will have within 60 days of the execution of this Agreement, a Performance Agreement with its CEO that ties the CEO’s compensation plan to the CEO’s performance;

it will take all reasonable care to ensure that its CEO complies with the Performance Agreement;

it will enforce the HSP’s rights under the Performance Agreement; and

any compensation award provided to the CEO during the term of this Agreement will be pursuant to an evaluation of the CEO’s performance under the Performance Agreement and the CEO’s achievement of performance goals and performance improvement targets and in compliance with Applicable Law.

“compensation award”, for the purposes of Section 10.3(b)(4) above, means all forms of payment, benefits and perquisites paid or provided, directly or


indirectly, to or for the benefit of a CEO who performs duties and functions that entitle him or her to be paid.

10.4 Funding, Services and Reporting. The HSP represents warrants and covenants that

(a) the Funding is, and will continued to be, used only to provide the Services inaccordance with the terms of this Agreement;

(b) the Services are and will continue to be provided;

by persons with the expertise, professional qualifications, licensing and skills necessary to complete their respective tasks; and

in compliance with Applicable Law and Applicable Policy;

(c) every Report is accurate and in full compliance with the provisions of thisAgreement, including any particular requirements applicable to the Report andany material change to a Report will be communicated to the LHIN immediately.

10.5 Supporting Documentation. Upon request, the HSP will provide the LHIN with proof of the matters referred to in this Article.

ARTICLE 11.0 - LIMITATION OF LIABILITY, INDEMNITY & INSURANCE

11.1 Limitation of Liability. The Indemnified Parties will not be liable to the HSP or any of the HSP’s Personnel and Volunteers for costs, losses, claims, liabilities and damages howsoever caused arising out of or in any way related to the Services or otherwise in connection with this Agreement, unless caused by the negligence or wilful act of any of the Indemnified Parties.

11.2 Ibid. For greater certainty and without limiting section 11.1, the LHIN is not liable for how the HSP and the HSP’s Personnel and Volunteers carry out the Services and is therefore not responsible to the HSP for such Services. Moreover the LHIN is not contracting with or employing any HSP’s Personnel and Volunteers to carry out the terms of this Agreement. As such, it is not liable for contracting with, employing or terminating a contract with or the employment of any HSP’s Personnel and Volunteers required to carry out this Agreement, nor for the withholding, collection or payment of any taxes, premiums, contributions or any other remittances due to government for the HSP’s Personnel and Volunteers required by the HSP to carry out this Agreement.

11.3 Indemnification. The HSP hereby agrees to indemnify and hold harmless the Indemnified Parties from and against any and all liability, loss, costs, damages and expenses (including legal, expert and consultant costs), causes of action, actions, claims, demands, lawsuits or other proceedings (collectively, the “Claims”), by whomever made, sustained, brought or prosecuted (including for third party bodily injury (including death), personal injury and property damage), in any way based upon,


occasioned by or attributable to anything done or omitted to be done by the HSP or the HSP’s Personnel and Volunteers, in the course of the performance of the HSP’s obligations under, or otherwise in connection with, this Agreement, unless caused by the negligence or wilful misconduct of any Indemnified Parties.

11.4 Insurance.

(a) Generally. The HSP shall protect itself from and against all claims that mightarise from anything done or omitted to be done by the HSP and the HSP’sPersonnel and Volunteers under this Agreement and more specifically all claimsthat might arise from anything done or omitted to be done under this Agreementwhere bodily injury (including personal injury), death or property damage,including loss of use of property is caused.

(b) Required Insurance. The HSP will put into effect and maintain, with insurershaving a secure A.M. Best rating of B+ or greater, or the equivalent, allnecessary and appropriate insurance that a prudent person in the business ofthe HSP would maintain, including, but not limited to, the following at its ownexpense:

Commercial General Liability Insurance, for third party bodily injury, personal injury and property damage to an inclusive limit of not less than two million dollars per occurrence and not less than two million dollars products and completed operations aggregate. The policy will include the following clauses:

a. The Indemnified Parties as additional insureds;b. Contractual Liability;c. Cross-Liability;d. Products and Completed Operations Liability;e. Employers Liability and Voluntary Compensation unless the HSP

complies with the Section below entitled “Proof of WSIACoverage”;

f. Tenants Legal Liability; (for premises/building leases only);g. Non-Owned automobile coverage with blanket contractual

coverage for hired automobiles; and,h. A thirty-Day written notice of cancellation, termination or material

change.

Proof of WSIA Coverage. Unless the HSP puts into effect andmaintains Employers Liability and Voluntary Compensation as set out above, the HSP will provide the LHIN with a valid Workplace Safety and Insurance Act, 1997 (WSIA) Clearance Certificate and any renewal replacements, and will pay all amounts required to be paid to maintain a valid WSIA Clearance Certificate throughout the term of this Agreement.

All Risk Property Insurance on property of every description, for the term, providing coverage to a limit of not less than the full replacement cost, including earthquake and flood. All reasonable deductibles and self-insured retentions are the responsibility of the HSP.


Comprehensive Crime insurance, Disappearance, Destruction and Dishonest coverage.

Errors and Omissions Liability Insurance insuring liability for errors and omissions in the provision of any professional services as part of the Services or failure to perform any such professional services, in the amount of not less than two million dollars per claim and in the annual aggregate.

(c) Certificates of Insurance. The HSP will provide the LHIN with proof of theinsurance required by this Agreement in the form of a valid certificate ofinsurance that references this Agreement and confirms the required coverage,on or before the commencement of this Agreement, and renewal replacementson or before the expiry of any such insurance. Upon the request of the LHIN, acopy of each insurance policy shall be made available to it. The HSP shallensure that each of its subcontractors obtains all the necessary and appropriateinsurance that a prudent person in the business of the subcontractor wouldmaintain and that the Indemnified Parties are named as additional insureds withrespect to any liability arising in the course of performance of thesubcontractor's obligations under the subcontract.

ARTICLE 12.0 - TERMINATION OF AGREEMENT

12.1 Termination by the LHIN.

(a) Without Cause. The LHIN may terminate this Agreement at any time, for anyreason, upon giving at least sixty Days’ Notice to the HSP.

(b) Where No Appropriation. If, as provided for in section 4.3, the LHIN does notreceive the necessary funding from the MOHLTC, the LHIN may terminate thisAgreement immediately by giving Notice to the HSP.

(c) For Cause. The LHIN may terminate this Agreement immediately upon givingNotice to the HSP if:

in the opinion of the LHIN:

a. the HSP has knowingly provided false or misleading informationregarding its funding request or in any other communication withthe LHIN;

b. the HSP breaches any material provision of this Agreement;c. the HSP is unable to provide or has discontinued the Services; ord. it is not reasonable for the HSP to continue to provide the

Services;

the nature of the HSP’s business, or its corporate status,changes so that it no longer meets the applicable eligibility requirements of the program under which the LHIN provides the Funding;


the HSP makes an assignment, proposal, compromise, or arrangement for the benefit of creditors, or is petitioned into bankruptcy, or files for the appointment of a receiver; or

the HSP ceases to carry on business.

(d) Material Breach. A breach of a material provision of this Agreement includes,but is not limited to:

misuse of Funding;

a failure or inability to provide the Services as set out in the Service Plan;

a failure to provide the Compliance Declaration;

a failure to implement, or follow, a Performance Agreement, Performance Improvement Process or a Transition Plan;

a failure to respond to LHIN requests in a timely manner;

a failure to: A) advise the LHIN of actual, potential or perceived Conflict of Interest; or B) comply with any requirements prescribed by the LHIN to resolve a Conflict of Interest; and

a Conflict of Interest that cannot be resolved.

(e) Transition Plan. In the event of termination by the LHIN pursuant to thissection, the LHIN and the HSP will develop a Transition Plan. The HSP agreesthat it will take all actions, and provide all information, required by the LHIN tofacilitate the transition of the HSP’s clients.

12.2 Termination by the HSP.

(a) The HSP may terminate this Agreement at any time, for any reason, upon givingsix months’ Notice (or such shorter period as may be agreed by the HSP andthe LHIN) to the LHIN provided that the Notice is accompanied by:

satisfactory evidence that the HSP has taken all necessary actions to authorize the termination of this Agreement; and

a Transition Plan, acceptable to the LHIN, that indicates how the needs of the HSP’s clients will be met following the termination and how the transition of the clients to new service providers will be effected within the six month Notice period.

(b) In the event that the HSP fails to provide an acceptable Transition Plan, theLHIN may reduce Funding payable to the HSP prior to termination of thisAgreement to compensate the LHIN for transition costs.


12.3 Opportunity to Remedy.

(a) Opportunity to Remedy. If the LHIN considers that it is appropriate to allowthe HSP an opportunity to remedy a breach of this Agreement, the LHIN maygive the HSP an opportunity to remedy the breach by giving the HSP Notice ofthe particulars of the breach and of the period of time within which the HSP isrequired to remedy the breach. The Notice will also advise the HSP that theLHIN will terminate this Agreement:

at the end of the Notice period provided for in the Notice if the HSP fails to remedy the breach within the time specified in the Notice; or

prior to the end of the Notice period provided for in the Notice if it becomes apparent to the LHIN that the HSP cannot completely remedy the breach within that time or such further period of time as the LHIN considers reasonable, or the HSP is not proceeding to remedy the breach in a way that is satisfactory to the LHIN.

(b) Failure to Remedy. If the LHIN has provided the HSP with an opportunity toremedy the breach, and:

the HSP does not remedy the breach within the time period specified in the Notice;

it becomes apparent to the LHIN that the HSP cannot completely remedy the breach within the time specified in the Notice or such further period of time as the LHIN considers reasonable; or

the HSP is not proceeding to remedy the breach in a way that is satisfactory to the LHIN,

(c) then the LHIN may immediately terminate this Agreement by giving Notice oftermination to the HSP.

12.4 Consequences of Termination.

(a) If this Agreement is terminated pursuant to this Article, the LHIN may:

cancel all further Funding instalments;

demand the repayment of any Funding remaining in the possession or under the control of the HSP;

determine the HSP’s reasonable costs to wind down the Services; and

permit the HSP to offset the costs determined pursuant to section (3), against the amount owing pursuant to section (2).


12.5 Effective Date. Termination under this Article will take effect as set out in the Notice.

12.6 Corrective Action. Despite its right to terminate this Agreement pursuant to this Article, the LHIN may choose not to terminate this Agreement and may take whatever corrective action it considers necessary and appropriate, including suspending Funding for such period as the LHIN determines, to ensure the successful completion of the Services in accordance with the terms of this Agreement.

ARTICLE 13.0 - NOTICE

13.1

13.2

Notice. A Notice will be in writing; delivered personally, by pre-paid courier, by any form of mail where evidence of receipt is provided by the post office, or by facsimile with confirmation of receipt, or by email where no delivery failure notification has been received. For certainty, delivery failure notification includes an automated ‘out of office’ notification. A Notice will be addressed to the other party as provided below or as either party will later designate to the other in writing:

To the LHIN:

Erie St. Clair Local Health Integration Network 712 Richmond Street Chatham, ON N7M 5J5

Attn: Chief Executive Officer Fax:519-351-9672 Email: [email protected]

To the HSP:

Bluewater Health 89 Norman Street Sarnia, ON N7T 6S3

Attn: President & Chief Executive Officer Fax: Email: [email protected]

Notices Effective From. A Notice will be deemed to have been duly given one business day after delivery if the Notice is delivered personally, by pre-paid courier or by mail. A Notice that is delivered by facsimile with confirmation of receipt or by email



where no delivery failure notification has been received will be deemed to have been duly given one business day after the facsimile or email was sent.

ARTICLE 14.0 - ADDITIONAL PROVISIONS

14.1 Interpretation. In the event of a conflict or inconsistency in any provision of this Agreement, the main body of this Agreement will prevail over the Schedules.

14.2 Invalidity or Unenforceability of Any Provision. The invalidity or unenforceability of any provision of this Agreement will not affect the validity or enforceability of any other provision of this Agreement and any invalid or unenforceable provision will be deemed to be severed.

14.3 Waiver. A party may only rely on a waiver of the party’s failure to comply with any term of this Agreement if the other party has provided a written and signed Notice of waiver. Any waiver must refer to a specific failure to comply and will not have the effect of waiving any subsequent failures to comply.

14.4 Parties Independent. The parties are and will at all times remain independent of each other and are not and will not represent themselves to be the agent, joint venturer, partner or employee of the other. No representations will be made or acts taken by either party which could establish or imply any apparent relationship of agency, joint venture, partnership or employment and neither party will be bound in any manner whatsoever by any agreements, warranties or representations made by the other party to any other person or entity, nor with respect to any other action of the other party.

14.5 LHIN is an Agent of the Crown. The parties acknowledge that the LHIN is an agent of the Crown and may only act as an agent of the Crown in accordance with the provisions of LHSIA. Notwithstanding anything else in this Agreement, any express or implied reference to the LHIN providing an indemnity or any other form of indebtedness or contingent liability that would directly or indirectly increase the indebtedness or contingent liabilities of the LHIN or of Ontario, whether at the time of execution of this Agreement or at any time during the term of this Agreement, will be void and of no legal effect.

14.6 Express Rights and Remedies Not Limited. The express rights and remedies of the LHIN are in addition to and will not limit any other rights and remedies available to the LHIN at law or in equity. For further certainty, the LHIN has not waived any provision of any applicable statute, including LHSIA, nor the right to exercise its rights under these statutes at any time.

14.7 No Assignment. The HSP will not assign this Agreement or the Funding in whole or in part, directly or indirectly, without the prior written consent of the LHIN. No assignment


or subcontract shall relieve the HSP from its obligations under this Agreement or impose any liability upon the LHIN to any assignee or subcontractor. The LHIN may assign this Agreement or any of its rights and obligations under this Agreement to any one or more of the LHINs or to the MOHLTC.

14.8 Governing Law. This Agreement and the rights, obligations and relations of the parties hereto will be governed by and construed in accordance with the laws of the Province of Ontario and the federal laws of Canada applicable therein. Any litigation arising in connection with this Agreement will be conducted in Ontario unless the parties agree in writing otherwise.

14.9 Survival. The provisions in Articles 1.0, 5.0, 8.0, 10.5, 11.0, 13.0, 14.0 and 15.0 will continue in full force and effect for a period of seven years from the date of expiry or termination of this Agreement. [NTD: may need to be updated]

14.10 Further Assurances. The parties agree to do or cause to be done all acts or things necessary to implement and carry into effect this Agreement to its full extent.

14.11 Amendment of Agreement. This Agreement may only be amended by a written agreement duly executed by the parties.

14.12 Counterparts. This Agreement may be executed in any number of counterparts, each of which will be deemed an original, but all of which together will constitute one and the same instrument.

ARTICLE 15.0 - ENTIRE AGREEMENT

15.1 Entire Agreement. This is Agreement forms the entire Agreement between the parties and supersedes all prior oral or written representations and agreements, except that where the LHIN has provided Funding to the HSP pursuant to an amendment to the Multi-Sector Accountability Agreement April 1, 2014 to March 31, 2018 or to this Agreement, whether by Project Funding Agreement or otherwise, and an amount of Funding for the same purpose is set out in the Schedules, that Funding is subject to all of the terms and conditions on which funding for that purpose was initially provided, unless those terms and conditions have been superseded by any terms or conditions of this Agreement or by the MSAA Indicator Technical Specifications document, or unless they conflict with Applicable Law or Applicable Policy.


The parties have executed this Agreement on the dates set out below.

ERIE ST. CLAIR LOCAL HEALTH INTEGRATION NETWORK

By: ________________________________ ________________________________ Martin Girash, Board Chair Date

And by: _________________________________ ________________________________ Ralph Ganter, CEO Date

Bluewater Health

By: _________________________________ ________________________________ Board Chair Date I have authority to bind the HSP

And by: ________________________ ________________________________ Mr. Mike Lapaine, Date President & Chief Executive Officer I have authority to bind the HSP

Schedule C: Reports

Community Mental Health and Addictions Services2018-2019

Health Service Provider: Bluewater Health

Schedule D: Directives , Guidelines and Policies

Community Mental Health and Addictions Services2018-2019


Schedule E2c: CMH&A Sector Specific Indicators2018-2019


18-19

Performance Indicators2018-2019

Target

Performance

Standard

No Performance Indicators - -

Explanatory Indicators

Repeat Unplanned Emergency Visits within 30 days for Mental Health conditions

Repeat Unplanned Emergency Visits within 30 days for Substance Abuse conditions

Average Number of Days Waited from Referral/Application to Initial Assessment Complete

Average number of days waited from Initial Assessment Complete to Service Initiation

Schedule E3a Local: All

2018-2019


Language and Indigenous Identity Report

All HSPs will provide annually a report on the number of patients/clients by mother tongue, official language and

Indigenous identity.

HSPs will develop a mechanism to track the language characteristics of their patients/clients to understand

opportunities for culturally sensitive services, using the following questions:

1. Report on number of patients/clients by mother tongue and official language.

a) Mother Tongue:

• English • French • Other (specify what other language is)

b) Official Language (if mother tongue is not English or French):

• English • French

2. Report on number of patients/clients that identify themselves as Indigenous:

• First Nation • Inuit • Metis • Non-Status • Urban

Annual reports are to be submitted no later than April 30, of each year and sent to: [email protected]

Health Equity

The Erie St. Clair LHIN is striving towards a culturally competent and safe health system that respectfully and adequately

responds to inequities, diverse values and beliefs of all residents in the Erie St. Clair LHIN in order to improve their health

outcomes and experience. As part of the service accountability agreement with the Erie St. Clair LHIN, all Health Service

Providers will demonstrate action to positively impacting the health status of all residents, including consideration for social

determinants of health and specific focus on Indigenous people, Francophones, newcomers/immigrants and vulnerable

populations.

The Health Equity report is submitted annually by HSPs to the ESC LHIN, and the 2018-19 report will be completed in a Survey

format with specific focus on equity at intake. HSPs will receive a link for the survey by April 4, 2018.

Annual reports are to be submitted no later than April 30, of each year and sent to: [email protected]

Schedule E3a Local: All

2018-2019


Patient / Client Complaints Policy and Procedure

All health service providers will provide an annual attestation that an internal patient and / or client complaints

policy and procedure is in place, and followed. The attestation will be submitted at Q4, consistent with the time of

reports contained in Schedule C – Reports, June 30th of each year to [email protected].

Schedule E3b Local: CHC Local Indicators

2018-2019


Diabetes Education Program (DEP) - (ADEPs and PDEPs)

The HSP will submit a Program Description and Proposed Annual Work Plan (Schedule A) by April 30th 2017 to the

Erie St. Clair LHIN in Microsoft Word format. As part of the proposed annual work plan, the HSP is required to

submit a signed copy of the proposed financial annual budget (Schedule B) and activity targets (Schedule C), as well

as complete the Update Program Contact Information form. The HSP will provide the LHIN with quarterly status

reports by completing Schedule A and Schedule B. It will also communicate any changes to the program and/or

Program Contact Information. The quarterly reporting dates will follow and align with the Supplementary Reporting

(SRI) dates found on Schedule C: Reports found in this MSAA. As such, the HSP is required to report on fiscal

2017/18 progress by the following dates:Q1 and Q2 update – report due to the LHIN on November 7th, 2017 Q3

update – report due to the LHIN on February 7th, 2018 Q4 update – report due to the LHIN on June 7th, 2018 YE

update – report due to the LHIN on June 30th, 2018 The Annual Work Plan and Quarterly Status reports should be

sent to the Erie St. Clair LHIN by way of electronic copy to [email protected].

Schedule E3c Local: CMH&A Local Indicators

2018-2019


Mental Health

Provide and maintain service description updates with ConnexOntario. Implement the Ontario Perception of Care

Quality Satisfaction Measure. Provide update information at the ESC LHIN request as per program resource

changes and or wait list pressures and any other data elements that are not captured by OHRS MIS.

Addictions

Provide and maintain service description updates with ConnexOntario. Implement the Ontario Perception of Care

Quality Satisfaction Measure. Provide update information at the ESC LHIN request as per program resource

changes and or wait list pressures and any other data elements that are not captured by OHRS MIS. Dedicated

assessment and referral services (CKHA, HDGH and BWH) will use the GAINs and Inter RAI tools as per the Pilot.

Schedule E3 FLS Local: Non-Identified Organizations

2018-2019


Responsiveness to Francophone community needs

All HSPs that are not identified for the provision of French-language services will identify their French-speaking

clients. They will also maintain a list of proficient French-speaking staff as well as their proficiency level. This

information will be used by HSPs to help with the establishment of an environment where people’s linguistic

backgrounds are collected, linked with existing health services data and utilized in health services and health system

planning to ensure services are culturally and linguistically responsive to the needs of patients/clients.

As per schedule C, non-identified HSPs will provide yearly a brief FLS report to the LHIN, using the template

provided by the LHIN and submit to: [email protected]

Schedule G: Declaration of Compliance

2018-2019


DECLARATION OF COMPLIANCEIssued pursuant to the M-SAA effective April 1, 2014

To: The Board of Directors of the [insert name of LHIN] Local Health Integration Network (the “LHIN”). Attn: Board Chair.

From: The Board of Directors (the “Board”) of the [insert name of HSP] (the “HSP”)

Date: [insert date]

Re: April 1, 2017 –March 31, 2018 (the “Applicable Period”)

Unless otherwise defined in this declaration, capitalized terms have the same meaning as set out in the M-SAA between the LHIN and the HSP effective April 1, 2014.

The Board has authorized me, by resolution dated [insert date], to declare to you as follows:

After making inquiries of the [insert name and position of person responsible for managing the HSP on a day to day basis, e.g. the Chief Executive Office or the Executive Director] and other appropriate officers of the HSP and subject to any exceptions identified on Appendix 1 to this Declaration of Compliance, to the best of the Board’s knowledge and belief, the HSP has fulfilled, its obligations under the service accountability agreement (the “M-SAA”) in effect during the Applicable Period.

Without limiting the generality of the foregoing, the HSP has complied with:

(i) Article 4.8 of the M-SAA concerning applicable procurement practices;(ii) The Local Health System Integration Act, 2006; and(iii) The Public Sector Compensation Restraint to Protect Public Services Act, 2010.

_______________________________[insert name of Chair], [insert title]

Statement of Revenue and ExpenseForecast surplus/(deficit) as at March 31, 2018Based upon the ten (10) months ended January 31, 2018(000's)

17/18 17/18 17/18 17/18 17/18 17/18 Projected 17/18 NotesYTD YTD YTD YTD % Annual Forecast Variance to Forecast %

Budget Actual Variance Variance Budget Amount Budget Variance

Revenue $

LHIN Revenue 121,883 122,428 545 0% 145,384 145,814 430 0% 1Cancer Care Ontario Revenue 5,370 5,202 (167) -3% 6,405 6,310 (95) -1% 2Paymaster Funding 1,095 1,077 (18) -2% 1,306 1,288 (18) -1%OHIP Revenue 10,550 10,492 (59) -1% 12,585 12,515 (70) -1% 3Patient Revenue - Other 1,106 1,564 458 41% 1,319 1,778 458 35% 4Room differential 2,272 2,437 165 7% 2,710 2,875 165 6% 5Co-payment 352 377 25 7% 420 445 25 6%External Recoveries 2,262 1,996 (266) -12% 2,766 2,725 (41) -1% 6Parking Revenue 895 827 (67) -8% 1,067 1,000 (67) -6%Other Revenue 135 176 41 31% 161 195 34 21%Deferred Equipment Grants 2,191 2,051 (140) -6% 2,616 2,616 - 0%Interest and Donations 50 108 58 115% 60 118 58 96%

Total Revenue $ 148,161 148,736 575 0% 176,799 177,679 879 0%

Expenses $

Salaries and Wages 72,651 73,380 (729) -1% 86,984 87,863 (879) -1% 7Medical Staff Remuneration 16,919 16,703 217 1% 20,182 20,198 (16) 0% 3Employee Benefits 19,065 19,381 (316) -2% 23,566 23,881 (316) -1% 7Employee Future Benefits 226 116 111 49% 270 270 - 0%Utilities, Buildings & Grounds 4,355 3,918 437 10% 5,195 4,721 474 9% 8Equipment Expense 5,165 5,285 (121) -2% 6,183 6,273 (91) -1%Supplies and Expenses 9,874 10,070 (196) -2% 11,793 11,825 (32) 0%Contracted Out Services 2,976 2,986 (10) 0% 3,549 3,559 (10) 0%Medical/Surgical Supplies 6,891 7,083 (191) -3% 8,220 8,386 (166) -2% 9Drug Expense 4,272 4,630 (358) -8% 5,096 5,435 (339) -7% 2Interest Expense 162 125 37 23% 194 146 47 24%Amortization 4,260 4,051 209 5% 5,717 5,283 434 8% 10

Total Expenses $ 146,816 147,726 (909) -1% 176,948 177,841 (893) -1%

Hospital Operating Surplus/(Deficit) $ 1,345 1,010 (335) n/a (149) (163) (14) n/a

Net Marketed Service Surplus/(Deficit) 269 208 (61) -23% 321 240 (81) -25% 11

Net Other Vote Surplus/(Deficit) 6 - (6) n/a 0 0 - n/a

LHIN Operating Surplus/(Deficit) $ 1,620 1,218 (402) 172 77 (95)

Deferred Building Grants 7,380 7,461 81 1% 8,854 8,854 - 0%Building Amortization (8,671) (8,655) 16 0% (10,405) (10,405) - 0%Interest on L/T Liabilities (141) (94) 46 -33% (168) (168) - 0%

Operating Surplus/(Deficit) $ 189 (70) (260) (1,546) (1,641) (95)

Notes to Financial StatementsJanuary 31, 2018 Actual and Full Year Forecast

Note 1

Note 2

YTD Actual Annual Budget

Year-End Forecast

$ 2,107,086 $ 2,200,000 $ 2,613,354

$ 2,928,617 $ 4,001,349 $ 3,493,285 $ 166,793 $ 203,570 $ 203,570

$ 5,202,496 $ 6,404,919 $ 6,310,209

Note 3

Note 4

Note 5

Note 6

Note 7

Note 8

Note 9

Note 10

Note 11

Total Funding

Amortization expense is expected to be under budget by approx. $434K at year-end. Not all approved capital items will be purchased by the end of the fiscal year which supports this positive variance.

Ontario Breast Screening Program Funding

Bluewater Health is forecasting a small surplus of $77K for the 17/18 fiscal year which is lower than the December forecasted surplus of $249K. At the end of January the hospital has a surplus of $1.2M. The hospital has been experiencing a surge of patient activity that began in late December. This increase in activity has put added pressure on staffing. As such, the hospital is forecasting a smaller surplus for year-end compared to the January year-to-date performance. The hospital was granted funding to open additional beds in anticipation of increased needs due to influenza, etc. that we are currently experiencing. This potential funding has not been incorporated into the forecasted LHIN funding.

LHIN Revenue is forecasted to be $430K better than budget for year-end. This positive variance is funding for physician compensation for which there is an offsetting expense in Medical Staff remuneration. At this point in time, the hospital plans on achieving all Ministry funded QBPs. The hospital also received notice of an increase to base funding of $139K related to the Assess & Restore program. This funding increase has been incorporated into the forecast.

Bluewater Health does OHIP billings for various physician groups. There is an offsetting Med Staff Remuneration expense for these billings. The YTD negative variance is primarily Nuclear Med and ECG.

Patient Revenue - Other is a combination of WSIB Revenue, Revenue from Other Provinces, Revenue from Non-Residents, and Revenue paid directly by Patients. As of the end of January, these revenues were better than budget by $458K. This positive variance is comprised of Revenue from WSIB ($54K), Other Provinces ($285K), Non-Residents ($80K), and Self Pay Revenue ($39K). The hospital anticipates maintaining this positive variance to year-end.

Bluewater Health receives CCO funding for Oncology Drugs, QBPs, and the Ontario Breast Screening Program. Bluewater Health is not forecasting achieving all QBP funding for Cancer Surgeries and the Oncology program. There is also an overage in our drug expense related to CCO funded drugs.

Description

Oncology Drug Funding

QBP Funding (Cancer Surgeries, Endoscopy, Systemic Therapy)

Net Marketed Services Surplus/(Deficit) is the net income earned on the hospital's non-core business. This includes the retail pharmacy and building rental income. The majority of this variance is a result of the retail pharmacy. There were some initial one time expenses related to the expansion of the retail pharmacy which is impacting the YTD surplus and the forecasted surplus.

Room Differential revenue is better than budget by $165K at the end of January. The majority of this positive variance is from the Rehab unit. The hospital anticipates maintaining this positive variance to year-end.

Utilities are under budget $437K as of the end of January. The budget was increased to align with the 16/17 actual utility expense with an anticipated increase in utilities. The current year spending is consistent with the prior year. The hospital is not anticipating an increase in utility expense to the magnitude of what was incorporated into the budget.

Salaries & benefits are over budget $1M at the end of January. The hospital anticipates ending the year with a $1.2M negative budget variance. The hospital is experiencing a surge in patient activity that began late December. This increased activity has put additional pressures on staffing resulting in a forecasted overage at year-end. The hospital has been granted bed surge funding which could potentially offset some of this overage.

Med/Surg supplies are forecasted to be over budget by $166K at year-end. This is in-line with the current negative variance.

External Recoveries are under budget by $266K at the end of January. This negative variance is primarily the result of a timing difference between budget distribution and receipt of funds. It is anticipated that this negative variance will lessen to a negative variance of $41K for year-end.

Balance SheetAs at January 31, 2018Comparison to January 31, 2017(000's)

% Change

Assets

Current AssetsOperating Cash $ 9,478 4,303 120%Investments - CEE Site 1,273 1,625 -22%Accounts Receivable 5,851 8,171 -28%Accounts Receivable - MOHLTC 518 214 142% Inventories 741 436 70%Prepaid Expenses 1,462 1,246 17%

Total Current Assets 19,323 15,996 21%

Fixed AssetsLand and Land Improvements 7,446 7,456Building/Building services Equipment 332,088 334,153Furniture and Equipment 87,383 84,583Less: Accumulated Amortization (172,604) 254,313 (162,750) 263,441 -3%Construction in Progress 1,246 1,961 -36%Other Non Current Assets 353 335 5%

Total Fixed Assets 255,912 265,737 -4%

Total Assets $ 275,235 281,733 -2%

Current LiabilitiesAccounts Payable 3,192 1,414 126% Accounts Payable - MOHLTC 1,757 769 128%Accrued Salaries & Vacation Pay 7,546 9,911 -24%Current Portion - Long Term Debt 182 84 117%Other Liabilities 8,351 8,509 -2%

Total Current Liabilities 21,027 20,687 2%

Long Term LiabilitiesLong Term Bank Loans Payable 4,076 2,157 89%Deferred Revenue 221,628 229,929 -4%Post Employment Benefits 15,706 15,945 -2%Other L/T Liabilities 1,567 1,032 52%

Total Long Term Liabilities $ 242,978 249,064 -2%

EquityOpening Equity 11,300 12,100Accumulated Remeasurement Gain/(Loss) (17)R&E Surplus/(Deficit) (70) (100)

Total equity 11,230 11,983 -6%

Total Liabilities and Equity $ 275,235 281,733 -2%

Hospital Accountability Agreement Indicators: Negotiated Target

Current Ratio 0.86 0.69 0.64

Adjusted Working Capital 3,780$ 31$ 89$

Note: Current ratio excludes CEEH Site Investments

Adjusted Working Capital is calculated using the definition of the Working Capital Funding Initiative

Jan-18 Jan-17

2017/18 2016/17Actual Actual

Meets/Exceeds Target .

Within 5% of Target

Worse than Target by 5+%

Data Unavailable

FOI Masked due to n size <5

Italics n Size between 6 - 30

* no established target

ⱡ corporate target

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

Jul

17

Aug

17

Sep

17

Oct

17

Nov

17

Dec

17

Jan

18 Re

po

rt

Pe

rio

d

YTD

Sarnia 7.9 8.0 8.3 10.1 8.1 9.3 9.6 9.0 9.7 8.0 8.9 9.8 9.4 9.7 8.7 10.7 10.7 0 ◄

Petrolia 3.7 3.2 4.0 4.1 3.9 4.3 4.4 3.9 4.0 4.1 4.7 4.0 5.0 3.7 3.8 4.6 4.60.0

◄

Sarnia 22.4 27.5 21.5 27.2 19.9 24.9 26.5 23.9 27.6 16.6 20.9 25.1 27.0 28.2 25.5 30.6 30.6 0 ◄

Petrolia 5.6 7.8 6.1 7.5 7.7 7.3 7.2 7.9 8.8 7.3 6.9 8.4 13.8 10.1 7.0 7.8 7.80.0

◄


3QIP/

HSAA12.7% 21.0% 23.3 21.1 21.6 18.4 17.2 18.5 16.7 17.8 -- 21.5 17.2 17.7 18.6 14.8 15.7 0.0

Apr -

Mar17.5%

ALC Rate denominator has changed with the

implementation of the Daily Bed Census Summary

in June 2017, values are subject to change ◄


4 0.00 3.10 3.10Apr -

Mar0.00

00

5 n/a $5,366 $5,937

Our overall expenses for this indicator have

increased by $1.38M compared to Q3 of 16/17

while our weighted cases are 343 lower for the

same period.

◄

6 n/a $5,419 $5,853


increased by $889K and our weighted cases have

increased by approx. 63 cases compared to Q3

16/17.

◄

7 n/a $12,703 $10,446

0

◄

8 n/a $517Apr -

Mar$618


decreased by $470K compared to Q3 of 16/17. The

weighted patient days have decreased asa well. ◄

9 0 n/a $350 $325 $326 $331 $333 $354 $332 $341 $290 $278 $285 $289 $303 $300 $302 $303 $302Apr-

Mar$302 0 ◄

10 n/a $0 -$598 -$670 -$614 -$202 $0 $0 -$59 $0 $0 $0 -$160 -$238 -$350 -$370 -$418 -$426Apr -

Mar-$426

Under achievement is primarily due to fewer cancer

surgeries being performed and fewer chemotherapy

treatments

◄

11 0 n/a $172 $1,350 $804 $639 $1,220 $794 $883 $142 $206 $349 $762 $1,096 $873 $1,411 $1,141 $1,370 $1,218Apr -

Mar$1,218 0 ◄

12 HSAA n/a $89 $151 -$443 $179 $31 $47 $818 $1,422 $2,705 $2,934 $3,003 $4,228 $3,638 $3,881 $3,425 $3,921 $3,780Apr -

Mar$3,780 0 ◄

13 0 n/a % 29 34 44 66 81 83 0 0 15 21 22 23 26 36 36 40Apr -

Mar40% 0 ◄

10.1

hrs

<=8

hrs

<= 20

hrs

Jan-

Dec

Jan-

Dec

0.00

$544

Q3 16/17 Q4 16/17 Q1 17/18

Outstanding Performance - Optimize roles, resources, revenues, technology and innovation

Demonstrate accountability and efficiency

% Capital Budget Spent Actual YTD

ED Outpatient

(12% of overall activity)

Acute Inpatient & Day

Surgery (53% of overall

activity)

Rehab Inpatient

(4% of overall activity)

Ensure continuous investment in strategic infrastructure

Surplus/(Deficit) Actual YTD in 000s

$5,594

QBP Financial Exposure (Potential lost revenue

related to QBP achievement) Actual YTD in 000s

$5,599

$5,642

$618 $0

$5,937

ALC Rate % -All Inpatient Services

(Sarnia and Petrolia)

$10,446 $0

$0

Up

da

ted

Comments

Q3 17/18Q4

17/18YTD PerformanceQ2 17/18


Adjusted Working Capital Actual YTD in 000s

Mental Health Inpatient Cost per Patient Day

$10,248

$5,925

$5,991

# Performance Indicator Ref.


Pe

er

Co

mp

ara

tor

BW

H

Ta

rge

t

1

2

$5,853 $0

33.2

hrs

90th Percentile ED Length of Stay

for Complex Patients

90th Percentile ED Wait Times

(Admitted Patients)

3.25

$5,669

Bluewater Health Resource Utilization &

Audit Committee Performance Scorecard

Apr -

Mar

P4R

2.80


Cost per Weighted

Case (Actual YTD):

2.92

QIP/

HSAA/

P4R

$11,150 $10,964

$622$559

SP

Absenteeism Rate- (avg # 7.5hr sick days)-All

Staff

Promote individual, team and professional development

Continuing Care Cost per Weighted Patient Day

2.803.38

Quarter Rate

Q3 16/17 3.4

Q4 16/17 2.9

Q1 17/18 2.8

Q2 17/18 2.8Q3 17/18 3.25

BWH Target

3.1

Resource Utilization & Audit Committee Key Performance Indicators


Outstanding Performance - Optimize roles, resources, revenues, technology and innovation




Absenteeism Rate- (avg # 7.5hr sick days)

All Staff



21.0%

June data unavailable

province-wide due to daily

bed census summary

methodology changes

Data unavailable for

January



BWH Target

23.3

21.1

21.6

18.4

17.2

18.5

16.7

17.8

0.0

21.5

17.2

17.7

18.6

14.8

15.7

0.0

5.0

10.0

15.0

20.0

25.0

Oct 16

Nov 16

Dec16

Jan17

Feb 17

Mar 17

Apr17

May17

Jun17

Jul17

Aug17

Sep17

Oct17

Nov17

Dec17

Jan18

ALC Rate % - All Inpatient Services (Sarnia & Petrolia)

ALC Rate Provincial Target BWH Target

-$443

$31 $47$151 $179$818

$1,422

$2,705 $2,934 $3,003

$4,228$3,638 $3,881

$3,425$3,921 $3,780

-$1,000

$0

$1,000

$2,000

$3,000

$4,000

$5,000

Oct

16

Nov 1

6

Dec

16

Jan 1

7

Feb 1

7

Mar

17

Apr

17

May 1

7

Jun 1

7

Jul 17

Aug 1

7

Sep 1

7

Oct

17

Nov 1

7

Dec

17

Jan 1

8

Adjusted Working Capital YTD in 000s

0102030405060708090

100

Oct 16

Nov 16

Dec16

Jan17

Feb 17

Mar 17

Apr17

May17

Jun17

Jul17

Aug17

Sep17

Oct17

Nov17

Dec17

Jan18

% Capital Budget Spent Actual YTD

$5,669

$5,599

$5,991

$5,937

$5,400 $5,500 $5,600 $5,700 $5,800 $5,900 $6,000 $6,100

Q3 16/17

Q4 16/17

Q1 17/18

Q3 17/18

Cost per Weighted Case (Actual YTD)Acute Inpatient & Day Surgery (53% of overall activity)

Q1/Q2 17/18

$5,594

$5,642

$5,925

$5,853

$5,400$5,500$5,600$5,700$5,800$5,900$6,000

Q3 16/17

Q4 16/17

Q1 17/18

Q3 17/18

Cost per Weighted Case (Actual YTD)ER Outpatient (12% of overall activity)

Q1/Q2 17/18

7.9

8.0

8.3

10.1

8.1

9.3

9.6

9.0

9.7

8.0

8.9

9.8

9.4

9.7

8.7

10.7

3.7

3.2

4.0

4.1

3.9

4.3

4.4

3.9

4.0

4.1

4.7

4.0

5.0

3.7

3.8

4.6

0

2

4

6

8

10

12

Oct 16

Nov 16

Dec16

Jan17

Feb 17

Mar 17

Apr17

May17

Jun17

Jul17

Aug17

Sep17

Oct17

Nov17

Dec17

Jan18

90th Percentile ED Length of Stay for Complex Patients

Sarnia Petrolia Peer Comparator BWH Target

22.4

27.5

21.5

27.2

19.9

24.9

26.5

23.9

27.6

16.6

20.9

25.1

27.0

28.2

25.5

30.65

.6 7.8

6.1 7.5

7.7

7.3

7.2 7.9 8.8

7.3

6.9 8.4

13.8

10.1

7.0 7.8

BWH Target

Peer Comparator

05

101520253035

Oct 16

Nov 16

Dec16

Jan17

Feb 17

Mar 17

Apr17

May17

Jun17

Jul17

Aug17

Sep17

Oct17

Nov17

Dec17

Jan18

90th Percentile ED Wait Times (Admitted Patients)

Sarnia Petrolia

Bluewater Health Target

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18 Q3 17/18

Absenteeism Rate - (avg # 7.5hr sick days) All Staff

1

Medical Advisory Committee (MAC) Highlights

March 21, 2018

Quality Improvement Initiatives MAC:

• Received an update on a new patient flow initiative • Approved recommendations from the Pharmacy and Therapeutics Committee

and the Infection and Prevention Control Committee • Approved updates to the Discharge of Patients Policy • Approved the BWH Exposure to Illicit Drugs Policy • Was updated on work underway for a draft resuscitation policy and code form • Was advised that an investigation into new voice recognition software for

dictation of reports is underway • Discussed the need to better support transgender patients and those with autism

due to referral time for services in London • Received a budget update and was thanked for their support during the seasonal

surge Physician Education, Development and Engagement

• Professional Staff were encouraged to complete the Physician Engagement Survey, apply for executive positions on the Professional Staff Association and consider becoming an Adjunct Professor.

• Members learned 22 physicians have received PICC line training with more training being offered in April.

• An article entitled “Building Connections with Patients and Families in the Intensive Care Unit” was shared and discussed.

• Members discussed ways to support physician wellness and health initiatives • Learned a new communication tool to keep Professional Staff up-to-date called

“Medical Matters” has been launched. • Discussed upcoming events:

o BWH Leadership Retreat - March 23, 2018 o BWH Annual Medical Education Symposium - April 7, 2018 o Physician Meet and Greet Breakfast Event– April 13, 2018 o Choosing Wisely Committee Presentation – April 25, 2018 o Annual Staff Recognition Ceremony and Bridging Excellence Awards -

April 26, 2018 o Physician Family BBQ – July 28, 2018 o Adjust professor training by Schulich School of Medicine – Sept. 22, 2018

Recruitment

• A new respirologist has recently signed on and recruitment efforts continue for emergency, neurology, plastic surgery and hospitalist positions.

Submitted by: Mike Haddad, MD, Chief of Professional Staff

Congratulations to the winner’s of this year’s Dream Home! John Lennox and Kathie Howes and their two sons have chosen to keep this year’s home! We are grateful to Nelson Peters of Elite Homes, Urban Escape and all of the suppliers for designing, building and decorating the Dream Home. The Foundation is proud to have built the province’s fist ever VisitAble home.

An extra special thank you to the following for all of their time and effort in ensuring the Dream Home lottery is a success for the Foundation:

• The open house hosts who welcome all who tour the home• Volunteers who drive around Sarnia-Lambton and pick up tickets for us • The community businesses who sell tickets on our behalf• Sell off Vacations and Crowley’s Heart to Heart Jewelry for our early bird prize donations• The incredible Dream Home committee • Our office volunteers Bob, Sue-Elin and Pam for selling all the tickets!

We are excited to announce the return of Hoedown for Healthcare, an event planned together with CEEH Foundation benefitting rural health initiatives. The hoedown will take place May 11th, 2018 at Greenwood Recreation Centre in Petrolia and is generously sponsored by Bluewater Power, Kelgor and the Petrolia Lions. Tickets are available now for $20 and available at Bluewater Health Foundation or CEEH of Bluewater Health. We hope y’all will come on out for a foot stomping, toe tapping good time!

The spring edition of Pulse came out March 21st and includes a focus on the Dream Home winners, the ribbon cutting of the temporary Withdrawal Management beds, volunteer and donor profiles, and the introduction of new medical specialists at Bluewater Health. Watch for it in your inbox and home mailbox, or online on our website.

Respectfully submitted,

Kathy AlexanderExecutive Director

Executive Director Report March 2018

Quality Committee Performance Indicator Definitions and Graphs

Performance Indicator

Quality Care – Assure the right care, in the right place, at the right time, by the right provider


1 Medication Reconciliation at Discharge

2 Difficult to speak up if I perceive a problem with patient care

3 Total High Severity Patient Safety Incidents


4 90th Percentile ED Length of Stay for Complex Patients

Exceptional Relationships – Expand innovative partnerships and collaborations to improve experiences, services, transitions and community health


5 ALC Rate % - All Inpatient Services (Sarnia & Petrolia)

6 30 day Mental Health Readmission

7 Readmission within 30 days for COPD

Strengthen Patient and Family – Centered Care

8 Overall Rating of Experience

9 Leaving hospital did Patient receive enough information

Inspired People – Advance our culture of kindness with an intention to learn, lead, collaborate and celebrate


10 Supervisor helps access training and development

11 Was Patient/Family Treated with Kindness

12 Is a Culture of Kindness Promoted at Bluewater Health

Employees

Professional Staff

Volunteer

Revised: December 4, 2017 Next Update: February 2018 Page 2 of 13

Indicator Name: Medication Reconciliation at Discharge

Alignment: Quality and Patient Experience Committee (QPEC)/Quality Committee of the Board (QCB)

Strategic Goal: Ingrain patient safety

Definition: Total percentage of patients for whom Discharge Medication Reconciliation was finalized as a proportion of the total number of patients discharged from the hospital.

Rationale: Hospital discharge is a critical interface of care where patients are at a high risk of medication discrepancies as they transition out of the hospital. The goal of discharge medication reconciliation is to reconcile the medications the patient is taking prior to admission and those initiated in hospital, with the medications they should be taking post-discharge to ensure all changes are intentional and that discrepancies are resolved prior to discharge. This should result in avoidance of therapeutic duplications, omissions, unnecessary medications and confusion.

Additional Specifications: Exclusions: 1. Mothers delivered and Newborns, including Newborn

Repatriations 2. Patients with Meditech Discharge Dispositions:

I. Expired II. Triaged/Reg'd/Left Against Medical Advice (AMA)

III. Site to Site (CEEH to Sarnia or vice versa) IV. Signed Medical Release V. Transfer

VI. Transfer to another Acute Care Facility VII. Transfer to an Ambulatory Care Clinic

Peer Comparator: No peer comparator data available

80

82

84

86

88

90

92

94

96

98

100

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

July

17

Aug

17

Sep

17

Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

% P

erc

en

tag

e F

ina

lize

d

up

on

Dis

ch

arg

e

Medication Reconciliation Upon Discharge

Pre

ferre

d T

ren

din

g


Indicator Name: It is difficult to speak up if perceive a problem with patient care


Strategic Goal: Ingrain Patient Safety

Definition: This is a custom employee survey question that asks employees to respond to the statement “in this unit it is difficult to speak up if I perceive a problem with patient care”. The top box responses request respondents to “strongly disagree” and “disagree” with the proposed statement. A higher percentage of employees disagreeing or strongly disagreeing with this statement is preferred.

Rationale: “It is difficult to speak up if I perceive a problem with patient care” is a measure that comes from a reliable and valid survey through patient safety research. To ensure we can track and measure this indicator we will assess a baseline and target by sending staff surveys thorough a Survey Monkey process. This indicator is a measure indicative of patient safety culture throughout the organization and will identify how safe the inter-professional team feels to report patient safety incidents. The development, dissemination, education and implementation of a Quality and Patient Safety Plan will enable a culture of safety by enhancing knowledge transfer of the importance of reporting patient safety incidents to improve quality and safety of the patients we serve.

Additional Specifications: This indicator was released in December 2016. Responses to this question are collected routinely in a Strategic Engagement survey.

Target for 17/18: 49.6%

Bluewater Health Target 49.6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17

Apr17

May17

Jun17

Q3 16/17 Q4 16/17 Q1 17/18

Dif

ficu

lt

to s

pe

ak u

p

Difficult to Speak up if Perceive a Problem with Patient Care

Our Status

Pre

ferre

d Tre

nd

ing


Indicator Name: Total High Severity Patient Safety Incidents


Strategic Goal: Ingrain patient safety

Definition: This measure tracks the total number of patient safety incidents categorized as Level 4 or Level 5. An example of a Level 4 patient safety incident is a fall in which the patient falls and sustains a fractured hip requiring surgical repair.

Rationale: A patient safety incident is an event or circumstance that could have resulted, or did result, in unnecessary harm to a patient. Bluewater Health FY17/18 Target for Total High Severity Patient Safety Incidents is set 0, “as zero patient harm is an indisputable goal that must be a priority for all stakeholders. It is the right thing to do for patients and families.” (Cochrane et. al. 2017, p.66) In compliance with the Public Hospital’s Act, there is an obligation of hospitals to report critical incidents to the Quality Committee of the Board.

Additional Specifications: On September 6, 2017, Bluewater Health implemented a new incident reporting system RL6. With the implementation of the new incident reporting software the severity levels have been amended to reflect the updated guidelines set by the Ontario Hospital Association (OHA). Level 4 - Patient outcome is symptomatic, requiring life-saving

intervention or major surgical/medical intervention, shortening life expectancy or causing major permanent or long-term harm or loss of function.

Level 5 - On balance of probabilities, death was caused or brought forward in the short-term by the incident.


Bluewater Health Target

-1

0

1

2

3

4

5

Jul16

Aug16

Sep16

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17

Apr17

May17

Jun17

July17

Aug17

Sep17

Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

Nu

mb

er

of

Hig

h S

ev

eri

ty P

ati

en

t S

afe

ty I

ncid

en

ts

Total High Severity Patient Safety Incidents

Pre

ferr

ed

Tre

nd

ing


Indicator Name: 90th Percentile Emergency Department (ED) Length of Stay for Complex Patients

Alignment: Quality and Patient Experience Committee (QPEC)/ Committee of the Board (QCB)/Performance & Utilization Committee (PUC)/Resource Utilization & Audit Committee (RUAC)

Strategic Goal: Improve access to care

Definition: The total ED length of stay where 9 out of 10 complex patients completed their visits. ED Length of Stay defined as the time from triage or registration, whichever comes first, to the time the patient leaves the ED.

Rationale:

Additional Specifications:

Peer Comparator: Ontario high-volume community hospitals

Sarnia Site

Petrolia Site

Target

Ontario high-volume community hospitals 16/17

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

July

17

Aug

17

Sep

17

Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

ED

LO

S (

ho

urs

)

90th Percentile ED Wait Times Complex Patients

Pre

ferr

ed

Tre

nd

ing

Status-Sarnia

Status-CEEH

Revised: January 26, 2018 Next Update: February 2018 Page 6 of 13

Indicator Name: Alternative Level of Care (ALC) Rate %-All Inpatient Services

Alignment: Quality and Patient Experience Committee (QPEC), Quality Committee of the Board (QCB), Performance & Utilization Committee (PUC), Resource Utilization & Audit Committee (RUAC)

Strategic Goal: Build sustainable partnerships and collaborations

Definition: The rate at which patients who have been designated ALC occupy inpatient beds.

Rationale: Ensuring that each patient receives the appropriate level of care at all times during their healthcare journey is a priority at Bluewater Health. Our goal is for Emily to receive the right care, given at the right time, in the right place, always. The ALC rate represents an opportunity for inpatients to be transitioned to the next level of care, where their care needs and the services provided are better matched. Multiple factors can influence ALC rate, including overall hospital occupancy, and availability of resources both internal and external to the hospital.

Additional Specifications: ALC Rate = Total ALC Days x100% Total Inpatient Days

ALC Rate is defined as the total ALC Days contributed to the total Inpatient Bed Days in a given time period, expressed as a percentage. The numerator comes from the Wait Times Information System ALC days. The Denominator is from the Bed Census Summary (BCS) data submitted daily through the Health Data Branch portal.

Exclusions: 1. ALC cases discontinued due to ‘Data Entry Error’2. ALC cases identified by the facility for exclusion.3. ALC Days is excluded for the portion of the time when Inpatient

Service = Discharge Destination for Post-Acute Care (e.g. in aCC Bed with a destination of Rehab)

4. Patient days contributed by inpatients in the EmergencyDepartment

The ALC Rate indicator methodology makes the assumption that the Inpatient Service data element (as defined in the WTIS) is comparable to the Bed Type data element (as defined in the BCS).

Peer Comparator: Ontario hospital value

ALC Rate

Bluewater HealthTarget

Provincial Target FY 17/18

ALC Days

0

200

400

600

800

1000

1200

1400

1600

1800

2000

0

5

10

15

20

25

30

35

40

45

50

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

July

17

Aug

17

Sep

17

Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

AL

C D

ay

s In

pa

tie

nt

Se

rvic

es

AL

C R

ate

%

ALC Rate % -All Inpatient Services (Sarnia and Petrolia)

Pre

ferr

ed

Tre

nd

ing Our Status


Indicator Name: 30 day Mental Health Readmission



Definition: The percentage of Ontario Mental Health Reporting System (OMHRS) full admissions that were discharged 30 days ago or less from this facility.

Rationale:

Additional Specifications: Numerator: Number of 30-day readmissions (30 days or less since last discharge from this facility; all diagnostic categories) Denominator: Total number of admissions (Admission assessments with valid HCN; all diagnostic categories)


Target

0.00

5.00

10.00

15.00

20.00

25.00

Apr

16

May

16

Jun

16

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

Q1 16/17 Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18

% o

f 3

0 D

ay

Me

nta

l H

ea

lth

Re

ad

mis

sio

ns

30 Day Mental Health Readmissions

Pre

ferr

ed

Tre

nd

ing

Our Status

Our Status


Indicator Name: Readmission within 30 days for Chronic Obstructive Pulmonary Disease (COPD)

Alignment: Quality and Patient Experience Committee (QPEC)/ Quality Committee of the Board (QCB)


Definition: The measuring unit of this indicator is an admission for COPD, as defined for the quality based procedure (QBP). Results are expressed as risk-adjusted all-cause 30-day non-elective readmission rate among patients admitted to Ontario acute care facilities.

Rationale: Readmission rates are considered a marker of poor hospital performance. High rates may indicate inadequate care, inadequate follow up, and inadequate preparation for discharge or poor doctor to doctor communication at the time of discharge. Reducing readmission rates benefit the patient through a higher quality of care and the hospital through cost containment.

Additional Specifications: The % of acute hospital inpatients discharged with COPD case mix group (CMGs) that are readmitted to any acute inpatient hospital that reports to Integrated Decision Support (IDS) for non-elective patient care, for any reason, within 30 days of the discharge for index admission. Values are generated by a report that is a proxy for the Ministry Local Health Integration Network (LHIN) Accountability Agreement (MLAA) indicator reported quarterly by Health Analytics Branch (HAB). The values will differ slightly to those reported by HAB as IDS does not capture data for all hospital sites in the province, and there is an inability to apply some inclusions/exclusions. Report is based on technical specs for "Readmissions within 30 days for selected health based allocation model (HBAM) Inpatient Grouper (HIG) conditions", using CMGs instead of HIGs. Therefore, this information should be considered an approximation that can be used for timelier monitoring.

Peer Comparator: Crude calculation of 30 day readmission for COPD in the Erie St Clair LHIN Hospitals for Fiscal Year 16/17 – 18.2%

Target

ESC-LHIN Crude Rate 18.2%

10%

12%

14%

16%

18%

20%

22%

24%

Apr

16

May

16

Jun

16

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

Q1 16/17 Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18

% o

f B

WH

P

ati

en

ts R

ea

dm

itte

d to

BW

H w

ith

in 3

0 D

ay

s

(Se

lect

HIG

s)

30 Day Readmission for COPD

Pre

ferr

ed

Tre

nd

ing

Our StatusOur Status


Indicator Name: Overall Rating of Experience


Strategic Goal: Strengthen Patient and Family-Centered Care

Definition: Overall Rating of Experience: Inpatient (IP) and Emergency Department (ED), patients are asked to rate their hospital experience on a scale from 0 to 10, with 0 being I had very poor experience and 10 being I had a very good experience.

Rationale: Patient experience measurement is an industry best practice and hospitals are required to survey patients at least once every fiscal

year, according to Ontario’s Excellent Care for All Act (ECFAA),

2010. “We create exemplary healthcare experiences with patients and families every time”, is the mission of Bluewater Health. These questions reflect how well the hospital is achieving its overall mission. The patient experience is what we strive to excel at. Measurement of patient experience is important because it provides an opportunity to improve care, enhance strategic decision making, meet patients’ expectations, effectively manage and monitor healthcare performance, and document benchmarks for the organization.

Additional Specifications: Scores are calculated using the following measure recommended by the National Research Corporation Canada (NRCC): Positive - Positive measure type is calculated by counting “Positive” response (i.e. 9-10 or Yes, Definitely or Always) and dividing by the total number of responses. Inclusion Criteria: - Patients who have received active treatment at Bluewater

Health - 18 years or older at the time of admission - Alive at the time of discharge

Exclusion Criteria: - Patients who have notified Bluewater Health they wish to be

excluded from the mailing list - Patients who are stillborn or deceased while in the hospital

- Patients with no fixed address - Psychiatric patients (unless being specifically surveyed using

the Mental Health inpatient or outpatient survey tool) - Patients who present with evidence of sexual assault or with

sensitive issues (e.g. miscarriage)

Peer Comparator: The Ontario Hospital Association Patient Reported Performance Management (OHA PRPM) benchmark includes OHA member hospitals. The Ontario Inpatient (IP) Community Hospital (Hosp) Average compares hospitals of the same size within the province. Peer comparators are updated quarterly.

Inpatient OHA-PRPM – 68.2% Ontario IP Community Hosp Average – 65.4%

Emergency Department (ED) There is no peer comparator as this is a Bluewater Health custom question for the Emergency Department Patient Experience of Care Survey (EDPEC)

Target for 2017/2018: ED - 49.1% Inpatient – 75.9%

ED Target 49.1%

Inpatient Target 75.9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jul16

Aug16

Sep16

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17

Apr17

May17

Jun17

Jul17

Aug16

Sep16

Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

Ov

era

ll R

ati

ng

of

Exp

eri

en

ce


ED InpatientOur Status

Preferred

Trend

ing

Our Status

Our Status

http://www.health.gov.on.ca/en/pro/programs/ecfa/legislation/patientsurvey/update.aspx


Indicator Name: Leaving hospital did patients receive enough information


Strategic Goal: Strengthen Patient and Family-Centered Care

Definition: As Emily leaves the hospital, this indicator asks the question of whether Emily perceives that she received the information she needed from Bluewater Health Staff and Physicians before leaving our care. This question is asked of both inpatients and emergency department patients. Inpatient Question: Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital? Not at all/ Partly/ Quite a bit/ Completely Emergency Department Patient Question: Before you left the emergency department, did you understand what symptoms or health problems to look out for when you left the emergency department? Yes/No

Rationale: Patient experience measurement is an industry best practice and hospitals are required to survey patients at least once every fiscal

year, according to Ontario’s Excellent Care for All Act (ECFAA),

2010.




excluded from the mailing list - Patients who are stillborn or deceased while in the hospital - Patients with no fixed address

- Psychiatric patients (unless being specifically surveyed using the Mental Health inpatient or outpatient survey tool)

- Patients who present with evidence of sexual assault or with sensitive issues (e.g. miscarriage)

Peer Comparator: The Ontario Hospital Association Patient Reported Performance Management (OHA PRPM) benchmark includes OHA member hospitals. The Ontario Inpatient (IP) Community Hospital (Hosp) Average and the Ontario ED Community Hosp Average is a comparator of hospitals of the same size. Peer comparators are updated quarterly. Inpatient OHA PRMP – 57.5% Ontario IP Community Hosp Average – 54.3% ED OHA PRMP – 84.2% Ontario ED Community Hosp Average – 82.5%

Target 2017/2018: ED—81.0% Inpatient –61.6%

Emergency Department Target 81.0%

Inpatient Target 61.6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

Jul

17

Aug

16

Sep

16

Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

Re

ceiv

ed

en

ou

gh

In

form

ati

on

Leaving Hospital did Patients receive Enough

Information

ED Inpatient

Our Status

Pre

ferre

d T

rend

ing



Indicator Name: Supervisor helps access training and development


Strategic Goal: Focus on the experience of care and caring

Definition: This is a custom employee survey question that will ask “My Supervisor helps me to access training and development?”

The top box responses request respondents to “Agree” and “Strongly Agree” with the proposed statement. A higher percentage of employees agreeing or strongly agreeing with this statement is preferred.

Rationale: Ensuring that each patient receives the best care possible begins with exceptional care providers. Bluewater Health is committed to strengthening the skills and education of our employees. This commitment to education promotes inspired people who will advance our culture of kindness with an intention to learn, lead, collaborate and celebrate. Evidence suggests that investment in employee training and development leads to employees feeling more valued and willing and able to invest in their work. Employee training and development supports efficiencies and standardized procedures, risk reduction, patient safety and quality of patient care. Research links high levels of employee engagement with increased patient satisfaction when an organization focuses on processes and people. This reflects on the organization’s ability to provide opportunities for personal development to stay up to date with latest techniques and technologies and recognize employees for acquiring additional skills and knowledge sets.


Target for 2017/2018: 67.3%

Bluewater Health Target 67.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17

Apr17

May17

Jun17

Q3 16/17 Q4 16/17 Q1 17/18

Su

pe

rvis

or

he

lps a

cce

ss t

rain

ing

&

de

ve

lop

me

nt

Supervisor Helps Access Training and Development Our Status

Pre

ferre

d Tre

nd

ing


Indicator Name: Was Patient/Family Treated with Kindness



Definition: This is a new, custom question for Bluewater Health’s patient experience surveys which are mailed to a random selection of patients after they are discharged. Our aim is that the culture of kindness at Bluewater Health will be increasingly felt by our patients and families over time. This question asks Emily to reflect and respond to the statement “Were you and your family treated with kindness by employees, volunteers and physicians at Bluewater Health?” Responses available for this question are as follows: No/ Yes, somewhat/ Yes, mostly/ Yes definitely

Rationale: Exemplary healthcare experiences begin with kindness. We understand that patients expect courtesy, respect and dignity, beginning with an expression and attitude of kindness and caring. We understand that having highly skilled and competent staff isn’t enough. Ensuring that you and your family are treated with kindness is a key focus of Bluewater Health’s commitment to Patient & Family-Centered Care. Patient experience measurement is an industry best practice and hospitals are required to survey patients

at least once every fiscal year, according to Ontario’s Excellent Care for All Act (ECFAA), 2010.




excluded from the mailing list - Patients who are stillborn or deceased while in the hospital - Patients with no fixed address

- Psychiatric patients (unless being specifically surveyed using the Mental Health inpatient or outpatient survey tool)

- Patients who present with evidence of sexual assault or with sensitive issues (e.g. miscarriage)

Peer Comparator: This is a Bluewater Health custom question and no peer comparator data is available. NRC Health establishes benchmarks/peer comparators based on the following requirements:

- Made up of one year of data - Questions must be used by at least five facilities

Must have at least 1000 responses for the question

Target for 2017/18: ED - 64.5% Inpatient - 80.4%

ED Target 64.5%

IP Target 80.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jul16

Aug16

Sep16

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17

Apr17

May17

Jun17

Jul17

Aug16

Sep16

Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

Wa

s P

ati

en

t/Fa

mily

Tr

ea

ted

wit

h K

ind

ne

ss

Was Patient/Family Treated with KindnessED Inpatient

Our Status

Preferred

Trend

ing




Indicator Name: Is a Culture of Kindness Promoted at Bluewater Health



Definition: This is a custom survey question that will ask “Is a culture of kindness promoted at BWH?” Top Box responses from Employees, Professional Staff and Volunteers are displayed. The top box responses request respondents to “Agree” and “Strongly Agree” with the proposed statement. A higher percentage of employees agreeing or strongly agreeing with this statement is preferred.

Rationale: Bluewater health is committed to strengthening our culture of kindness while we deliver Quality Care to Emily. Creating a kindness culture in the workplace reduces stress, fosters relationships, increases psychological wellness and health and leads to increased engagement, energy and resiliency at work. Evidence suggests that high engagement influences human resource goals of increased retention and recruitment, high job performance and lower absenteeism. Research links high levels of employee engagement with increased patient satisfaction when an organization focuses on processes and people. Caring for people creates a workforce with physical energy, mental focus and the emotional drive necessary to provide exemplary care to Emily every day. The culture of kindness has been measured in the “joy” people bring to work; it is palpable throughout the organization and referred to as measuring “humanity”.


Target for 2017/2018: Employees – 65.9% Professional Staff - 60.1% Volunteers - 84.1%

Employee Target 65.9%

Prof. Staff Target 60.1%

Volunteer Target 84.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17

Apr17

May17

Jun17

Q3 16/17 Q4 16/17 Q1 17/18

Is a

Culture

of Kin

dness

Pro

mote

d a

t BW

H

Is a Culture of Kindness Promoted at Bluewater Health

Employees Prof. Staff Volunteers

Pre

ferre

d Tre

nd

ing

Our Status

Resource Utilization & Audit Committee Indicator Definitions and Graphs

Performance Indicator

Quality Care – Assure the right care, in the right place, at the right time, by the right provider


1 90th Percentile ED Length of Stay for Complex Patients Sarnia

Petrolia

2 90th Percentile ED Wait Times (Admitted Patients) Sarnia

Petrolia

Exceptional Relationships – Expand innovative partnerships and collaborations to improve experiences, services, transitions and community health


3 ALC Rate % - All Inpatient Services (Sarnia & Petrolia)

Inspired People – Advance our culture of kindness with an intention to learn, lead, collaborate and celebrate


4 Absenteeism Rate – (avg. # 7.5hr sick days) – All Staff

Outstanding Performance – Optimize roles, resources, revenues, technology and innovation


5 Cost per Weighted Case: Acute Inpatient & Day Surgery (53% of overall activity) Actual YTD

6 Cost per Weighted Case: ED Outpatient (12% of overall activity) Actual YTD

7 Cost per Weighted Case: Rehab Inpatient (4% of overall activity) Actual YTD

8 Continuing Care Cost per Patient Day Actual YTD

9 Mental Health Cost per Patient Day Actual YTD

10 QBP Financial Exposure (Potential lost revenue related to QBP achievement) Actual YTD

11 Surplus/(Deficit) in 000s Actual YTD


12 Adjusted Working Capital (in 000s) Actual YTD

13 % of Capital Budget Spent Actual YTD


Indicator Name: 90th Percentile Emergency Department (ED) Length of Stay for Complex Patients

Alignment: Quality and Patient Experience Committee (QPEC)/Quality Committee of the Board (QCB)/Performance & Utilization Committee (PUC)/Resource Utilization & Audit Committee (RUAC)


Definition: The total ED length of stay where 9 out of 10 complex patients completed their visits. ED Length of Stay defined as the time from triage or registration, whichever comes first, to the time the patient leaves the ED.

Rationale:



Sarnia Site

Petrolia Site

Target


0.0

2.0

4.0

6.0

8.0

10.0

12.0

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

July

17

Aug

17

Sep

17

Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

ED

LO

S (

ho

urs

)

90th Percentile ED Wait Times Complex Patients

Pre

ferr

ed

Tre

nd

ing

Status-Sarnia

Status-CEEH


Indicator Name: 90th Percentile Emergency Department Length of Stay for Admitted Patients

Alignment: Performance & Utilization Committee (PUC)/Resource Utilization & Audit Committee (RUAC)


Definition: ED length of stay for admitted visits is defined as the time from triage or registration, whichever comes first, to the time the patient leaves the ED to an inpatient bed. It is measured in hours. The 90th percentile is the maximum length of time in which 9 of 10 of admitted patients have completed their ED visit and have been moved to an inpatient unit. A small number is desirable.

Rationale: Time is crucial to the effectiveness and outcome of patient care, especially for emergency patients. In conjunction with other indicators, this can be used to monitor the total length of time admitted patients spend in the ED in an effort to improve the efficiency and, ultimately, the outcome of patient care. This measure remains one of Bluewater Health’s top priorities in our Quality Improvement Plan (QIP) and Strategic Plan.

Additional Specifications: Inclusions:

1. Admitted unscheduled emergency visits2. ED visits with a valid and known registration date/time or

triage date/time and a valid and known date/time the patientleft the ED

Exclusions:

1. Scheduled emergency visits2. Non-admitted unscheduled emergency visits3. Visits with both unknown/invalid registration and triage

date/time OR with unknown/invalid patient left ED date/time


Sarnia Site

Petrolia Site

Target


0

5

10

15

20

25

30

35

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

July

17

Aug

17

Sep

17

Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

ED

LO

S (

ho

urs

)

90th Percentile ED Wait Times (Admitted Patients)

Pre

ferr

ed

Tre

nd

ing

Status-Sarnia

Status-CEE


Indicator Name: Alternative Level of Care (ALC) Rate %-All Inpatient Services

Alignment: Quality and Patient Experience Committee (QPEC), Quality Committee of the Board (QCB), Performance & Utilization Committee (PUC), Resource Utilization & Audit Committee (RUAC)


Definition: The rate at which patients who have been designated ALC occupy inpatient beds.

Rationale: Ensuring that each patient receives the appropriate level of care at all times during their healthcare journey is a priority at Bluewater Health. Our goal is for Emily to receive the right care, given at the right time, in the right place, always. The ALC rate represents an opportunity for inpatients to be transitioned to the next level of care, where their care needs and the services provided are better matched. Multiple factors can influence ALC rate, including overall hospital occupancy, and availability of resources both internal and external to the hospital.

Additional Specifications: ALC Rate = Total ALC Days x100% Total Inpatient Days

ALC Rate is defined as the total ALC Days contributed to the total Inpatient Bed Days in a given time period, expressed as a percentage. The numerator comes from the Wait Times Information System ALC days. The Denominator is from the Bed Census Summary (BCS) data submitted daily through the Health Data Branch portal.

Exclusions: 1. ALC cases discontinued due to ‘Data Entry Error’2. ALC cases identified by the facility for exclusion.3. ALC Days is excluded for the portion of the time when Inpatient

Service = Discharge Destination for Post-Acute Care (e.g. in aCC Bed with a destination of Rehab)

4. Patient days contributed by inpatients in the EmergencyDepartment

The ALC Rate indicator methodology makes the assumption that the Inpatient Service data element (as defined in the WTIS) is comparable to the Bed Type data element (as defined in the BCS).

Peer Comparator: Ontario hospital value

ALC Rate

Bluewater HealthTarget

Provincial Target FY 17/18

ALC Days

0

200

400

600

800

1000

1200

1400

1600

1800

2000

0

5

10

15

20

25

30

35

40

45

50

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

July

17

Aug

17

Sep

17

Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

AL

C D

ay

s In

pa

tie

nt

Se

rvic

es

AL

C R

ate

%

ALC Rate % -All Inpatient Services (Sarnia and Petrolia)

Pre

ferr

ed

Tre

nd

ing Our Status


Indicator Name: Absenteeism Rate

Alignment: Resource Utilization and Audit Committee (RUAC)/ Performance Utilization and Audit Committee (PUC)

Strategic Goal: Develop a sustainable plan for services, facilities, capital equipment and technology

Definition: Paid sick hours divided by 7.5 hrs. (for normal shift), divided by number of Full time and Permanent Part Time eligible employees.

Rationale: A lower absenteeism rate is preferred. Lower absenteeism is aligned with employee overall wellness.


Peer Comparator: Ontario Hospital Association Average

Target

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

July

17

Aug

17

Sep

17

Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

Ab

se

nte

eis

m R

ate

Absenteeism Rate- (avg # 7.5hr sick days)-All Staff

Pre

ferr

ed

Tre

nd

ing



Indicator Name: Acute Cost per Weighted Case

Alignment: Resource Utilization and Audit Committee (RUAC)/Performance Utilization Committee (PUC)

Strategic Goal: Demonstrate accountability and efficiency

Definition: Acute Cost per Weighted Case is an indicator that measures the cost associated with caring for a standard acute patient. It is calculated as total acute inpatient and newborn expenses (both direct and indirect) divided by acute inpatient weighted cases. The direct costs are the expenses incurred in the departments providing service to our acute patients (i.e. Medicine, Surgery, and Obstetrics). The indirect costs are an allocation of Administration and Support expenses (i.e. Housekeeping, Lab, Pharmacy, etc.). A weighted case is a case with an assigned Resource Intensity Weight (RIW).

Rationale: This is an important indicator as it tracks how an organization is utilizing its resources. It combines the financial spending with the activity that drives the spending. By focusing on weighted cases, comparability is enhanced as differences in acuity, severity and complexity of cases are taken into consideration.


Peer Comparator: No established peer comparator data

Target

5000

5100

5200

5300

5400

5500

5600

5700

5800

5900

6000

Apr

16

May

16

Jun

16

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

July

17

Aug

17

Sep

17

Q1 16/17 Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

Co

st

pe

r W

eig

hte

d C

ase

Cost per Weighted Case: Acute Inpatient & Day Surgery (53% of overall activity)

Pre

ferr

ed

Tre

nd

ing

Our Status

Our Status


Indicator Name: Emergency Department (ED) Outpatient Cost per Weighted Case



Definition: ED Outpatient Cost per Weighted Case is an indicator that measures the cost associated with caring for a standard Emergency department patient. It is calculated as total emergency department expenses (both direct and indirect) divided by ED outpatient weighted cases. The direct costs are the expenses incurred in the departments providing service to our ED patients (both Sarnia & Petrolia sites). The indirect costs are an allocation of Administration and Support expenses (i.e. Housekeeping, Lab, Pharmacy, etc). A weighted case is a case with an assigned Resource Intensity Weight (RIW).

Rationale: This is an important indicator as it tracks how an organization is utilizing its resources. It combines the financial spending with the activity that drives the spending. By focusing on weighted cases, comparability is enhanced as differences in acuity, severity and complexity of cases are taken into consideration.



Target

5000

5100

5200

5300

5400

5500

5600

5700

5800

5900

6000

Apr

16

May

16

Jun

16

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

July

17

Aug

17

Sep

17

Q1 16/17 Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

Co

st

pe

r W

eig

hte

d C

ase

Cost per Weighted Case: ER Outpatient (12% of overall activity)

Pre

ferr

ed

Tre

nd

ing

Our Status

Our Status


Indicator Name: Rehab Cost per Weighted Case



Definition: Rehab Inpatient Cost per Weighted Case is an indicator that measures the costs associated with caring for a standard rehab patient. It is calculated as total inpatient rehab expenses (both direct and indirect) divided by rehab weighted cases. The direct costs are the expenses incurred in the departments providing service to our rehab inpatients. The indirect costs are an allocation of Administration and Support expenses (i.e. Housekeeping, Lab, Pharmacy, etc.). A rehab weighted case is a case assigned a relative weight using the rehabilitation patient grouper (RPG).

Rationale: This is an important indicator as it tracks how an organization is utilizing its resources. It combines the financial spending with the activity that drives the spending. By focusing on weighted patient days, comparability is enhanced as differences in acuity, severity and complexity of cases are taken into consideration.



Target

8900

9900

10900

11900

12900

13900

Apr

16

May

16

Jun

16

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

July

17

Aug

17

Sep

17

Q1 16/17 Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

Co

st

per

Weig

hte

d C

ase

Cost per Weighted Case: Rehab Inpatient(4% of overall activity)

Pre

ferr

ed

Tre

nd

ing

Our Status



Indicator Name: Continuing Care Cost per Weighted Patient Day



Definition: Continuing Care Inpatient Cost per Weighted Patient Day is an indicator that measures the costs of providing inpatient care to complex continuing care patients, and is stated on a weighted patient day basis. It is calculated as total inpatient continuing care expenses (both direct and indirect) divided by total RUG weighted patient days (RWPDs). The direct costs are the expenses incurred in the departments providing service to our continuing care inpatients. The indirect costs are an allocation of Administration and Support expenses (i.e. Housekeeping, Lab, Pharmacy, etc.). RWPDs are patient days weighted using an appropriate cost weight (CMI). The CMI is a cost weight reflecting the relative resource use of an individual within a specific RUG group compared with the overall average resource use for all Ontario complex continuing care residents.

Rationale: This is an important indicator as it tracks how an organization is utilizing its resources. It combines the financial spending with the activity that drives the spending. By focusing on weighted patient days, comparability is enhanced as differences in acuity, severity and complexity of cases are taken into consideration.

Additional Specifications: This indicator is also referred to as Cost per RUG weighted patient day (RWPD) where RUG stands for Resource Utilization Group.


Target

300

350

400

450

500

550

600

650

700

Apr

16

May

16

Jun

16

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

July

17

Aug

17

Sep

17

Q1 16/17 Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

Co

st

pe

r W

eig

hte

d C

ase

Cost per Weighted Patient Day: Continuing Care

Inpatient

Pre

ferr

ed

Tre

nd

ing



Indicator Name: Mental Health Inpatient Cost per Patient Day



Definition: Mental Health Inpatient Cost per Patient Day is an indicator that measures the cost associated with caring for a Mental Health inpatient. It is calculated as total inpatient mental health departmental expenses divided by total inpatient mental health patient days.

Rationale:


Peer Comparator: To be determined

Target

250

270

290

310

330

350

370

390

Jul16

Aug16

Sep16

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17

Apr17

May17

Jun17

July17

Aug17

Sep17

Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

Mental Health Cost per Patient Day

Pre

ferr

ed

Tre

nd

ing

Our Status


Indicator Name: Quality Based Procedure (QBP) Financial Exposure (Potential lost revenue related to QBP achievement)



Definition: Represents the potential lost revenue associated with under achievement of QBP funded volumes for both Ministry funded and CCO funded quality based procedures.

Rationale: The intent is that the hospital will achieve all anticipated volumes and not have to return any QBP funding to the Ministry and/or CCO.



-$700,000

-$600,000

-$500,000

-$400,000

-$300,000

-$200,000

-$100,000

$0

$100,000

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

July

17

Aug

17

Sep

17

Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

Re

ve

nu

e

QBP Financial Exposure (Potential lost revenue related to QBP achievement)

Pre

ferre

d T

ren

din

g

Our Status

Our StatusOur StatusOur StatusOur Status


Indicator Name: Surplus/(Deficit) in 000s



Definition: The amount of operating revenue in excess of operating expense from regular hospital operations. This amount excludes building amortization, building deferred grants/donations and interest on long-term liabilities.

Rationale: The hospital compares its actual results to the Board approved budget. The hospital plans for a surplus each year.


Peer Comparator: Not applicable

Target

0.00

200.00

400.00

600.00

800.00

1000.00

1200.00

1400.00

1600.00

1800.00

2000.00

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

July

17

Aug

17

Sep

17

Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

Su

rplu

s/(D

eficit

) in

00

0s

Surplus/(Deficit) in 000s

Pre

ferre

d T

ren

din

g

Our Status

Our StatusOr StatusOur Status


Indicator Name: Adjusted Working Capital (in 000s)


Strategic Goal: Ensure continuous investment in strategic infrastructure

Definition: Adjusted Working Capital is calculated as the hospital’s total current assets less current liabilities from its balance sheet. This definition is then adjusted per Ministry direction to exclude current liabilities such as vacation accrual, etc. and to exclude any externally restricted current assets/liabilities.

Rationale: Adjusted working capital is a critical indicator to evaluate the hospital’s financial outlook. A strong working capital position indicates a readiness for potential capital investment.


Peer Comparator: Not applicable

Target

-$1,000.00

$0.00

$1,000.00

$2,000.00

$3,000.00

$4,000.00

$5,000.00

Jul

16

Aug

16

Sep

16

Oct

16

Nov

16

Dec

16

Jan

17

Feb

17

Mar

17

Apr

17

May

17

Jun

17

July

17

Aug

17

Sep

17

Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

Wo

rkin

g C

ap

ital

in 0

00

s

Adjusted Working Capital (in 000s)

Pre

ferre

d T

ren

din

g

Our Status



Indicator Name: Percentage of Capital Budget Spent


Strategic Goal: Ensure continuous investment in strategic infrastructure

Definition: Capital purchases made during the time period as a percentage of the overall capital budget for that period. The overall budget includes a budget for contingency items. If capital items are carried over from a previous year, the capital budget associated with those carry over items will also be included in the denominator for this indicator.

Rationale:



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Jul16

Aug16

Sep16

Oct16

Nov16

Dec16

Jan17

Feb17

Mar17

Apr17

May17

Jun17

July17

Aug17

Sep17

Q2 16/17 Q3 16/17 Q4 16/17 Q1 17/18 Q2 17/18

Perc

enta

ge o

f Capita

l Budget Spent

Percentage of Capital Budget Spent

Pre

ferre

d T

ren

din

g

covid-19 information | bluewater health - agenda · 2019. 12. 16. · 5.1 2018-19 quality...

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