Hospital Service Accountability Agreements:

Schedules & IndicatorsFiscal 2016/17

Presented in Fall 2015

Agenda1. Context2. HSAA Organizational Structure3. Changes to HSAA Schedules for 2016-174. HSAA Indicator Work Group5. Approach to Indicator Selection6. Snapshots of Provincial Logic Model, Indicator Validation Tool, and

Expert Choice Program7. Updates to HSAA Indicators8. New Service Volume Technical Specifications9. Next Steps10. Questions11. Appendix A: HSAA Indicator Work Group Membership12. Appendix B: HSAA Planning & Schedules Work Group Membership

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Context HSAA Schedules and Indicators

• The HSAA Template Agreement is envisioned to be a multi-year agreement established through consultative stakeholder meetings between the LHINs, hospitals, the OHA and MOHLTC. The Schedules content will be negotiated annually.

• This presentation will focus on updates to the Schedules for 2016/17, particularly the Performance Indicators Schedule.

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HSAA Organizational StructureCreating an ownership framework

Hospitals(OHA)

HSAA Steering Committee

HSAA Planning & Schedules

Work Group

SRI Reports

Work Group

HSAA Indicator

Work Group

LHINs

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HSAA Organizational StructureCreating an ownership framework

• The HSAA Indicators Work Group is co-led by Mark Brintnell, Senior Director, South West LHIN, and Imtiaz Daniel, Director, Financial Analytics and System Performance, Ontario Hospital Association.

• The HSAA Planning & Schedules Work Group is co-led by Sherry Kennedy, Chief Operating Officer of the South East LHIN, and May Chang, Executive Vice President, Strategy & Patient Experience, Markham Stouffville Hospital.

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Changes to HSAA Schedules for 2016-17

Schedule A (Funding) Cancer Care Ontario and Ontario Renal Network funding is now on a single line in the schedule.

Schedule C2 (Service Volumes)This schedule will now mirror the following HAPS worksheets:• Bariatric• Critical Care• Cardiac• Clinical Activity• Neurosciences• QBP• Transplant• Wait Times• Other Programs

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Changes to HSAA Schedules for 2016-17

Schedule E (Project Funding)Removed from 2016-17 Schedules.

Schedule C1 (Performance Indicators)Information about the performance indicator schedule is outlined in the following slides within this presentation.

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• The HSAA Indicators Work Group (IWG) is comprised of representation from involved hospital, LHIN and MOHLTC leaders with backgrounds in program delivery, performance improvement and finance (see Appendix A for membership list).

• The core deliverables of the HSAA Indicators Work Group were to:

• Review current indicators and develop recommendations to ensure alignment with pan-LHIN system imperatives and ensure a manageable number of indicators

• Update technical specifications and target setting guidelines based on the endorsed indicators

• Develop other communication and education materials as needed

HSAA Indicator Work Group

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• The following mechanisms were utilized to help guide the indicator selection process:

• SAA Indicator Toolkit (containing a Provincial Strategic Framework and Provincial Logic Model)

• Indicator Validation Tool

• Expert Choice software (group decision-making program)

• Ballot voting

• In-person and teleconference discussions

Approach to Indicator Selection

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• The following process was used by the HSAA IWG to arrive at the final list of indicators for 2016/17:

1. Reviewed Provincial Logic Model

2. Reviewed existing slate of HSAA indicators

3. Reviewed slate of new MLAA indicators and discussed overlap with existing HSAA indicators

4. Reviewed Indicator Validation Tool criteria (strategic alignment, reliability, actionability, directional trending, timeliness of data, feasibility, clarity, directional validity, comparability, and applicability to Accountability Agreement)

5. Shared historical data for the proposed indicators

Approach to Indicator Selection

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6. Evaluated each indicator against the criteria outlined in the Indicator Validation Tool through Expert Choice software

7. Reviewed and discussed results from validation exercise to determine a slate of proposed indicators

8. Voted on selected indicators with respect to their classifications

Approach to Indicator Selection

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Snapshot: Indicator Validation Tool

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Snapshot: Expert Choice Program

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• Several new indicators will be adopted into the HSAA indicator slate. They measure many of the same areas as performance indicators within the 2015-16 HSAA indicator slate. They include:• Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for Hip

Replacements • Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for Knee

Replacements• Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for MRI • Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for CT scans• ALC Rate*• 90th Percentile Emergency Department (ED) length of stay for Complex Patients• 90th percentile ED Length of Stay for Minor/Uncomplicated Patients

Updates to HSAA Indicators

Performance Indicators

15* Technical specifications for this indicator were updated from the 2015-16 HSAA Technical Specifications.

• Several HSAA performance indicators will retain their classification in 2016-17:• Rate of Hospital Acquired Cases of Clostridium Difficile Infections• Current Ratio• Total Margin (all sector)

Updates to HSAA Indicators

Performance Indicators

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• Several new indicators will be adopted into the HSAA indicator slate. They include:• Percentage of ALC Days*• Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for

Cancer Surgery• Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for

Cardiac By-Pass Surgery• Percent of Priority 2, 3 and 4 Cases Completed within Access Targets for

Cataract Surgery

Updates to HSAA Indicators

Explanatory Indicators

17* Technical specifications for this indicator were updated from the 2015-16 HSAA Technical Specifications.

• A number of HSAA explanatory indicators will retain their classification in 2016-17:• Hospital Standardized Mortality Ratio• Rate of Ventilator-Associated Pneumonia• Rate of Central Line Infection• Rate of Hospital Acquired Cases of Methicillin Resistant Staphylococcus Aureus• Percent of Stroke/TIA Patients Admitted to a Stroke Unit During Their Inpatient

Stay*• Total Margin (Hospital Sector Only)• Adjusted Working Funds / Total Revenue %

• Rate of Hospital Acquired Cases of Vancomycin Resistant Enterococcus, which was an explanatory indicator in 2015-16, will not be included in the 2016-17 slate.

Updates to HSAA Indicators

Explanatory Indicators

18* Technical specifications for this indicator were updated from the 2015-16 HSAA Technical Specifications.

• There are 3 indicators with classifications that are to be determined:• Repeat Unscheduled Emergency Visits within 30 days for Mental Health

Conditions• Repeat Unscheduled Emergency Visits within 30 days for Substance

Abuse Conditions• Readmissions within 30 days for selected HBAM Inpatient Grouper (HIG)

Conditions

• Further work on these indicators will follow. Any changes in status will be communicated as soon as they have been endorsed by the Steering Committee.

Updates to HSAA Indicators

Indicators with Classifications To Be Determined

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New Service Volume Technical Specifications

• A number of service volume technical specifications have been developed and will be included in the 2016-17 HSAA Indicator Technical Specifications document:• Congestive heart failure (CHF)• Stroke - hemorrhage• Stroke – ischemic or unspecified• Stroke – transient ischemic attack (TIA)• Non-cardiac vascular – aortic aneurysm (AA)• Non-cardiac vascular – lower extremity occlusive disease (LEOD)• Acute primary unilateral hip replacement• Inpatient rehab for primary unilateral hip replacement• Acute primary unilateral knee replacement• Inpatient rehab for primary unilateral knee replacement• Acute primary bilateral joint replacement (hip/knee)• Inpatient rehab primary bilateral joint replacement (hip/knee)

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New Service Volume Technical Specifications (cont’d)

• Hip fracture• Knee arthroscopy• Neonatal jaundice (hyperbilirubinemia)• Tonsillectomy• Chronic obstructive pulmonary disease (copd)• Pneumonia• Cataract

• The service volume technical specification for ED Weighted Cases has also been refined and is included in the HSAA Technical Specifications.

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Next Steps: Indicators

• The HSAA IWG will continue to meet and work on the following deliverables:

• Continue work on the outstanding indicators and seek endorsement from the Steering Committee

• Review lessons learned from validation approach to continually streamline and improve internal processes

• Liaise with external stakeholder groups as necessary to enhance understanding of, and continually improve upon, proposed and existing indicators for next cycle

• Assess indicator set to ensure ideal alignment of hospital performance and accountabilities to system outcomes, as well as to other key work streams like Quality Improvement Plans

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Next Steps: Schedule Changes for 2016-17

• Two new schedules added to the Eforms (One stop publishing)

• French Language translation will be built into the schedules and automated.

• Schedule C2 now includes all planned volumes in HAPS. Only those lines that are planned in HAPS will appear in the final schedules.

• The Additional Input file will be eliminated in 2017-18 (Next Year)

• Cancer Care Ontario and the Ontario Renal Network funding are consolidated on a single line in Schedule A.

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Questions?

Please contact your local LHIN.

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Appendix A: Indicator Work Group Membership

Sector Organization Individual, TitleLHIN SW LHIN Mark Brintnell, Senior Director (Co-Chair)OHA Ontario Hospital Association Imtiaz Daniel, Director (Co-Chair)

Hospital Markham Stouffville Hospital May Chang, Executive VP, Strategy and Patient Experience

Hospital Grey Bruce Health Services Martin Mazza, CFOHospital Ontario Shores John Chen, VP Finance and Support ServicesHospital Sunnybrook Health Sciences Centre Darren Gerson, Senior Director, Decision SupportHospital MHA Nancy Maltby, COOHospital SJHC Hamilton Jane Loncke, DirectorHospital Joseph Brant Hospital Cheryl Williams, VP Patient Care Services and Chief

Nurse ExecutiveMOHLTC Ministry of Health and Long-Term Care Jillian Paul, Manager

MOHLTC Ministry of Health and Long-Term Care Naomi Kasman, Senior Health Analyst

MOHLTC Ministry of Health and Long-Term Care Thomas Custers, Manager

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Appendix A: Indicator Work Group Membership (cont’d)

Sector Organization Individual, TitleMOHLTC Ministry of Health and Long-Term Care Domenic Della Ventura, Team LeadMOHLTC Ministry of Health and Long-Term Care Nam Bains, Manager

HQO Health Quality Ontario Gail Dobell, DirectorLHIN NE LHIN Marc Demers, Controller / Corporate Services

ManagerLHIN Central LHIN Jennifer Chiarcossi, Sr. Business Analyst

LHIN HNHB LHIN Ajay Bhardwaj, Advisor

LHIN CE LHIN Marilee Suter, Lead, Decision Support

LHIN TC LHIN Chris Sulway, Senior Consultant

LHIN TC LHIN Ranjeeta Wadhwani, Analyst

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Sector Organization Individual, TitleLHIN SE LHIN Sherry Kennedy, COO (Co-Chair)

Hospital Markham Stouffville Hospital May Chang, Executive VP, Strategy & Patient Experience (Co-Chair)

Hospital Collingwood General & Marine Hospital Michael Lacroix, Vice President, Corporate Services & CFO

Hospital North York General Hospital Deepak Sharma, Director, Decision SupportHospital Red Lake Margaret Cochenour

Memorial HospitalPaul Chatelain, Former President and CEO

Hospital St Michael’s Hospital Tomi Nieminen, DirectorHospital Trillium Health Partners Carol Vinette-Hancharyk, Director, Financial Strategy &

Deputy Chief Financial OfficerMOHLTC Ministry of Health and Long-Term Care Maria van Dyk, Team Lead

OHA Ontario Hospital Association Imtiaz Daniel, Director, Financial Analytics and System Performance

Appendix B: HSAA Planning & Schedules Work Group Membership

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Sector Organization Individual, TitleLHIN CH LHIN Elizabeth Woodbury, Senior Accountability SpecialistLHIN MH LHIN Andrew Wahab, Senior Lead of Funding and AllocationLHIN NE LHIN Marc Demers, Controller / Corporate Services ManagerLHIN NE LHIN Joan Tonon, Data Analyst LHIN NW LHIN Kevin Holder, Senior ConsultantLHIN SE LHIN Mike McClelland, Senior Financial AnalystLHIN SW LHIN Scott Chambers, Team LeadLHIN SW LHIN Betty Wang, Financial AnalystLHIN TC LHIN Chris Sulway, Senior ConsultantLHIN MH LHIN Laura Salisbury, Executive Lead (Observer)

Appendix B: HSAA Planning & Schedules Work Group Membership (cont’d)

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