Annual Business Plan: 2018/19 - Toronto Central LHIN

Annual Business Plan: 2018/19 - Toronto Central LHIN

Annual Business Plan: 2018/19 - Toronto Central LHIN

Toronto Central Local Health Integration Network Annual Business Plan: 2018-2019

Annual Business Plan: 2018/19 - Toronto Central LHIN

2 Table of Contents Table of Contents . 2 1. Context . 4 A. Transmittal Letter from the LHIN Board Chair . 4 B. Mandate (confirmation of the LHIN’s mandate) and Strategic Directions . 5 C. Alignment with the Priorities of the Minister’s Mandate Letter . 7 D. Overview of the LHIN’s current and forthcoming programs/activities . 10 E. Environmental Scan . 18 2. Health System Oversight and Management . 21 2.1 Transparency and Public Accountability . 21 2.2 Improve the Patient Experience .

22 2.3 Build Healthy Communities Informed by Population Health Planning . 23 2.4 Equity, Quality Improvement, Consistency and Outcomes-Based Delivery . 26 2.5 Primary Care . 28 2.6 Hospital and Partners . 29 2.7 Specialist Care . 32 2.8 Long-Term Care . 33 2.9 Dementia Care . 35 2.10 Mental Health and Addictions . 37 2.11 Innovation, Health Technologies and Digital Health . 39 3. LHIN-Delivered Home and Community Care . 41 3.1 Home and Community Care . 41 4. French Language Services (FLS . 45 5. Indigenous Peoples . 47 6. Performance Measures . 49 7. Risks and Mitigation Plans . 59 8. LHIN Operations and Staffing Tables .

62 Table A: LHIN Spending Plan . 62 Table B: LHIN Staffing Plan (Full-Time Equivalents or FTE1 . 64 9. Integrated Communications Strategy . 66 Business Objectives . 66 Communications Objectives . 66 Context . 66 Target Audiences . 66 Key Messages . 67

Annual Business Plan: 2018/19 - Toronto Central LHIN

3 Strategic Approach . 69 Tactics . 69 Evaluation . 70 10. Community Engagement . 72 Appendix A . 77 Corporate Snapshot Indicators . 77

Annual Business Plan: 2018/19 - Toronto Central LHIN

425 Bloor Street East, Suite 201 Toronto, ON M4W 3R4 Tel: 416 921-7453 • Fax: 416 921-0117 Toll Free: 1 866 383-5446 www.torontocentrallhin.on.ca March 13, 2018 Dr. Helena Jaczek Minister of Health and Long-Term Care 10th Floor, Hepburn Block, 80 Grosvenor St, Toronto, Ontario, M7A 2C4 Dear Dr. Jaczek, Please find attached the Toronto Central Local Health Integrated Network (LHIN) Annual Business Plan (ABP) for 2018/19.

The ABP sets out how Toronto Central LHIN will operationalize and deliver on the priorities in the 2018-2019 Integrated Health Service Plan (IHSP- 4) for next fiscal year. The ABP is an exciting opportunity to plan for the year ahead and outlines the Toronto Central LHIN’s plans to progress against all strategic priority areas reflected in the 2018/19 Ministers Mandate letter. Incorporating the planning and delivery of Home and Community Care, the ABP outlines our approach to engaging and partnering with our citizens, stakeholders and partners to realize our collective goals to advance the health of our population.

The Toronto Central LHIN remains committed to deliver on our Ministry-LHIN Accountability Agreement (MLAA) indicators and will continue to progress on achievement of targets and implement opportunities for improvement. In 2018/19 the Toronto Central LHIN will continue with our sub-regional planning and sustain our commitment to building health equity using a population health approach to proactively plan and design a robust health system. Service provision across the health system will, as always, remain a key priority for the Toronto Central LHIN and we will continue to evolve the model of care and improve quality outcomes for our clients and citizens.

Our executive leadership team, along with the LHIN Board of Directors, will provide the leadership and governance required to deliver our new mandate including the planning, funding and integration of health services as well as the coordination and delivery of home care services. A. Transmittal Letter from the LHIN Board Chair

Annual Business Plan: 2018/19 - Toronto Central LHIN

2 We look forward to the MOHLTC feedback on the plan and to continuing to collaborate with the MOHLTC, other LHINs, and health service providers and communities in Toronto Central LHIN to deliver on the ABP for the people we serve.

Sincerely, Dr. Vivek Goel C: Mr. Tim Hadwen, Assistant Deputy Minister, Health System Accountability and Performance Division, MOHLTC

6 B. Mandate (confirmation of the LHIN’s mandate) and Strategic Directions Toronto Central Local Health Integration Network (LHIN) is one of fourteen (14) local health-planning organizations that serve Ontario. Toronto Central LHIN is responsible for providing excellent health care for the 1.3 million citizens in our region, as well as care and support for thousands of people who live outside of our catchment area but access services within the City of Toronto. Specifically, Toronto Central LHIN manages a system of service-based sectors and individual providers within the City of Toronto including: • More than 1,300 Independent Health Facilities, Specialists, Family Practice / General Physicians, and Diagnostic Imaging Services • 21 Service Provider Organizations • 17 Community Health Centres • 17 Hospitals • 59 Community Support Service Agencies • 75 Community Mental Health and Addictions Agencies • 36 Long-term Care Homes The passage of the Patients First Act, on December 7th, 2016, was intended to change the experience of the patient/client/resident/caregiver by strengthening the relationship between primary care/community care and the health care system, thereby improving access, coordination of care and their ability to navigate the health care system.

Beginning in May 2017, the responsibilities of the Community Care Access Centres were transferred to the LHINs. And with that transfer, the mandate of Toronto Central LHIN was expanded beyond funding, planning, implementing and evaluating local health services, to include coordination and delivery of publicly funded home and community care services.

With a rapidly aging population and an increase in clients with complex medical issues, the scope and role of home care and community care must evolve. Over the last five years, Toronto Central LHIN has seen a 73% increase in the proportion of higher needs clients with complex health and chronic conditions. This is a critical time for the LHIN to consider how home care can be better supported and integrated within the health care system. Following the successful transition to one organization in June 2017, Toronto Central LHIN is now directed by the November 2017 Mandate Letter from the Minister of Health and Long-Term Care, to transform the health care system and improve the health of citizens in the Toronto Central region.

In addition, Toronto Central LHIN is presently undertaking a strategic planning exercise to focus the direction and goals of the organization over the coming years to improve patient care and the overall health of the population, in a fiscally responsible manner.

As outlined in the letter from the minister, the mandate of Toronto Central LHIN is to create an Integrated Health Service Delivery Network (IHSDN), which includes: • Primary Care Providers • Inter-professional Health Care Teams • Hospitals • Public Health • Mental Health and Addictions • Home and Community Care Our engagements with patients, health service providers, caregivers, and residents have given us substantial insights into what is required of us to improve the care experience with a focus on: • Access • Navigation / Coordination, and • Communication The current Toronto Central LHIN strategic plan expires in 2018.

Given Toronto Central LHIN’s change in

7 mandate, the strategic plan was modified in 2017/2018 to reflect both legacy organizations in an interim strategy aligned with Five Strategic Priorities: • Designing Health Care with Citizens • Taking a Population Health Approach • Transforming Primary Health and Community Care • Achieving Excellence in Operations • Leading and Supporting Our People The Annual Business Plan for 2018-2019 is based on our existing strategic priorities and the Minister’s mandate letter. As we are presently developing our new strategic plan, which will guide Toronto Central LHIN into the future, our business goals will evolve to align with our new strategy.

C. Alignment with the Priorities of the Minister’s Mandate Letter In developing this year’s Annual Business Plan, Toronto Central LHIN aligned all activities to the Mandate Letter received from the Ministry of Health and Long-Term Care on November 24, 2017. The following is a summary of those activities planned for 2018/19: Minister’s Mandate Letter Priorities Key commitments, goals, actions and/or outcomes from the LHIN’s ABP Transparency and Public Accountability Toronto Central LHIN is committed to deliver on our Ministry- LHIN Accountability Agreement (M-LAA) indicators for 2018/19. We have developed and continue to evolve our internal performance management frameworks and dashboards, which are key tools in providing our leadership up-to-date information to direct our performance improvement plans.

Improve the Patient Experience In 2018/19 Toronto Central LHIN’s Citizens’ Panel will continue to focus on target initiatives defined by the Panel including integration of the patient/client voice in local planning, community engagement with a focus on vulnerable/marginalized populations and implementation of our LHIN’s Strategic Plan. The LHIN has also implemented a Patient and Family Advisory Committee (PFAC) for Home and Community Care to ensure that our clients’, family members’, and caregivers’ point of view, perspective, and experience are heard and integrated into our service and quality improvements.

Build Healthy Communities Informed by Population Health Planning Toronto Central LHIN believes that good health is more than the absence of disease. In 2018/19, the LHIN will continue our sub-region planning collaboration, which includes non-health providers in areas of identified high-need. As well, the LHIN will continue to improve population health outcomes built on a foundation of integrated and optimized planning for health and social service programming and infrastructure. This work will be enabled by a strategic and operational partnership between the City and Toronto Central LHIN.

8 Minister’s Mandate Letter Priorities Key commitments, goals, actions and/or outcomes from the LHIN’s ABP Equity, Quality Improvement, Consistency and Outcomes-Based Delivery Toronto Central LHIN is taking a population health approach to planning at the local level and is committed to health equity. This means that the LHIN is using data informed by community consultation to understand the greatest gaps in health, and to target efforts and investment. The LHIN recognizes that many populations require the combined effort of health and social sectors to develop joined prevention initiatives, early intervention and targeted interventions in order to significantly improve their health outcomes.

Primary Care Toronto Central LHIN has established a core network and mechanisms to engage primary care providers on an ongoing basis in planning and designing a health system that incorporates and integrates the primary care sector as envisioned in the Patients First mandate. In 2018/19 the LHIN will continue implementation of our Integrated Primary Care Strategy to strengthen connections across the system and improve outcomes for patients. Hospitals and Partners Toronto Central LHIN has a strong hospital network who are instrumental in our system improvement work. The hospitals collaboratively work through our LHIN committee structures to address quality, access and patient experience.

In 2018/19 there will be specific system improvement work targeting reducing avoidable hospital readmissions in collaboration with community and primary care. The LHIN will continue to work with our hospital network to implement current integrated funding models for bundled care, and support the identification of new, and innovative models to support quality, efficiency and effective care. Specialist Care Access to specialized services is a key strategy to complement our sub-regional/population health strategy.

Through our primary care, community and hospital partnerships, Toronto Central LHIN will model a consistent approach and method to access specialized services for appropriate patients from Toronto Central LHIN, Greater Toronto Area (GTA) and across the province. In partnership with our primary care network we will advance access to specialized services for providers through the expansion of Seamless Care Optimizing the Patient Experience (SCOPE).

9 Minister’s Mandate Letter Priorities Key commitments, goals, actions and/or outcomes from the LHIN’s ABP Long-Term Care Toronto Central LHIN supports empowering seniors to make the choices that are right for them when it comes to their care, their independence, and how they access government services - whether that's finding ways to keep up an active lifestyle or getting the support needed to live at home longer.

In 2018/19 the LHIN will continue to prioritize assessing and building capacity in Long-Term Care to meet the evolving needs and demands of the system. This includes identifying new, innovative models of care, leveraging enhanced community supports and redeveloping existing, and building new beds. This multi-pronged approach to mitigating capacity limitations is only possible through partnership with health service providers, the City of Toronto, and other system leaders.

Dementia Care Toronto Central LHIN will continue efforts which commenced in 2017/18 aimed at strengthening care delivery and coordination in long-term care homes, the broader community, and inpatient settings. In 2018/19, with the release of the Dementia Strategy, the LHIN will work to further coordinate and align existing services to create an integrated, effective client and caregiver-centered system that addresses a broad range of client needs, across multiple service delivery settings. Mental Health and Addictions In 2018/19, the LHIN will continue to focus on community-based mental health and addictions through the development of integrated health service delivery networks, targeted initiatives as part of the Opioid strategy, and coordinated access to structured psychotherapy and supportive housing.

Innovation, Health Technologies and Digital Health Toronto Central LHIN has developed a Digital Health Strategy that positions the LHIN and its health service providers to continue to move forward priority projects from the province in digital health.

In 2018/19 Toronto Central LHIN will begin the implementation of a Digital Delivery Centre of Excellence that leverages our regional and system assets to ensure the capacity and capabilities to meet the implementation goals and continuous improvement outlined in the Digital Health Plan. As well, the work that will continue as part of our Digital Health Strategy will establish Toronto Central LHIN as leaders and key influencers in digital health to further accelerate achievement of our local goals and priorities.

10 Minister’s Mandate Letter Priorities Key commitments, goals, actions and/or outcomes from the LHIN’s ABP Home and Community Care Shifting funding and support to strengthen community services is a priority, and it was identified that measuring quality of care is critical to assessing the impacts.

Toronto Central LHIN will continue to focus on reducing home and community care wait times by implementing our Right Place of Care strategy, and identifying opportunities to improve coordination and consistency with input from patients, caregivers and partners.

As well, Toronto Central LHIN will continue to work with the Toronto Central Palliative Care Network to implement the Ontario Palliative Care Network’s (OPCN) 3-year Action Plan. D. Overview of the LHIN’s current and forthcoming programs/activities New LHIN Organization: Over the past year, Toronto Central LHIN’s role expanded from planning, funding and integrating to include the delivery of home and community care. The LHIN is leveraging this new role as a service provider to strengthen integrated and collaborative planning in order to improve outcomes for patients. Our vision for an integrated health service delivery network includes a full system of care with clear and equitable access for all those who live or receive services in Toronto Central LHIN.

The LHIN’s role can be seen in three parts which are the keys to unlocking system potential: 1. Creating a strong foundation: it is our role to create one common vision for Toronto Central LHIN, and to plan a path forward that is based in evidence, aligns with government direction, and responds to what citizens need 2. Bringing citizens and partners to the table: it is also our role to understand what our citizens need, and to bring all of our partners together to plan with citizens and local communities

11 3. Enabling transformation: leveraging our legislative mandate to fund, integrate, performance manage, and provide high quality home care services. Primary Care: Toronto Central LHIN launched a consultation with a broad range of physicians and partners in early 2016 to inform the development of an integrated Primary Care Strategy. This strategy identified five (5) priorities: 1. Attachment, Access and Continuity; 2. Access to Interprofessional Teams; 3. Discharge Planning; 4. Access to Specialists; and 5. Secure Communications. Primary Care Clinical Leads (PCCLs) have been recruited into leadership positions in each of our five sub- regions within Toronto Central LHIN.

Their focus is to lead planning and engagement at the system and local level focused on these five priorities in order to improve patient access, service integration and system efficiency.

Integrated Home and Community Care: A move toward integrated community care requires collaboration across many providers, and must be guided by a shared vision for health service delivery that responds to local needs. Toronto Central LHIN has launched an integrated community care vision informed by our clients, caregivers, providers, and partners with the following priorities: 1. Simplified and Coordinated Access to Home and Community-Based Services 2. Improving Capacity and Client Flow 3. Easy Navigation and Care Coordination 4. Common Service Standards 5. Common Assessment and Referral Tools Strategic Partnerships: There is a strong commitment to working together between the City of Toronto and Toronto Central LHIN, building on current relationships and shared initiatives to address Torontonians’ health and well-being.

As well, downtown Toronto is growing four times faster than the City as a whole. There is a recognition of the impact of this urban growth on the health system and a desire for more a more integrated approach to planning that incorporates joint

12 impact assessments to align health services with the needs of the growing population. Key data sources are available and will be leveraged for enhanced and innovative program planning and delivery. There are opportunities to expand our effective partnerships to optimize services and outcomes for our shared public. As well, there are significant opportunities for better, faster, and more coherent decision-making processes between the City and Toronto Central LHIN. In order to do this, organizations need a better understanding of each other’s role, mandate and assets.

Recognizing these opportunities, the City of Toronto and Toronto Central LHIN have committed to a sustained and coordinated strategic partnership that will enable improved service delivery, deliver greater resource efficiency to support a healthier Toronto.

The Partnership Agreement outlines identified areas of joint action, supported by data-sharing and a structure for joint decision-making. Population Health and Equity Strategy: Toronto Central LHIN is taking a population health approach to planning at the local level. This means that the LHIN is using data, informed by community consultation to understand the greatest gaps in health, and to target efforts and investment. The LHIN recognizes that many populations require the combined effort of health and social sectors to develop joined prevention initiatives, early intervention and targeted interventions in order to significantly improve their health outcomes.

For this reason, the LHIN has developed an extensive partnership table that will provide oversight three key streams of work: 1. Generating tools that will help us understand and stratify the population into smaller groups based on need and risk.

2. Seeking to develop health equity solutions for particular populations whose health outcomes are significantly poorer than the broader group. 3. Providing tools to clinicians to help them more effectively serve particular groups of patients and clients. There are four core components to the Population Health and Equity Strategy that include: Health-Based Assessment; Health Equity; Practice-Based Population Health; and Strengthening our Partnership with Toronto Public Health. Local Collaboratives: The Toronto Central LHIN has established five sub-regions to serve as the focal point for population-based planning, service alignment and integration, and performance improvement.

Several sessions of Local Collaborative meetings have brought together more than 280 Health Service Providers, partners and residents throughout the year to develop a deeper understanding of the local neighbourhoods and populations within each sub-region.

Over this past year the Local Collaboratives identified priority areas for improvement, informed the development of a Collaborative Agreement, and delved deeper into data that captured the unique needs of each sub-region at the neighbourhood level. A profile of each sub-region has been included below (please note that the neighbourhoods that are split between two sub-regions are represented in both sub-regions).

13 East Toronto sub-region overview: • Highest percentage (23.1%) of children and youth (aged 0-19 years) in 2016 among the sub-regions and compared to Toronto Central LHIN (17.9%).

• Highest percentage (6.7%) of recent immigrants (arrived between 2011 and 2016) compared to the other sub-regions. • In 2016, highest percentage of visible minorities (43.0%) compared to the other sub-regions; most heavily represented visible minorities are South Asian, Chinese and Black. • Highest marginalization scores compared to other sub-regions (2011).

• In 2016, a relatively high percentage of the sub-region population (3.9%) have no knowledge of English or French. • In 2016, highest percentage (28.3%) of children younger than six living below the low income measure compared to other sub- regions. Second highest percentage of overall population (22.7%) living below the low income measure. • Four neighbourhoods are estimated to experience more than 20% growth in the next 10-15 years; Clairlea-Birchmount (27%), Thorncliffe Park (24%), Birchcliffe-Cliffside (23%), and South Riverdale (21%) while the remaining 17 neighbourhoods are estimated to have growth less than 15%.

Health status: • Highest rate of total hospital births for women aged 15-49: 47.7/1000 women (fiscal years 2012/13 to 2014/15). • Highest number of deaths (1,712) and second highest crude death rate (634.6/100,000 population) among sub-regions in 2011. • Highest prevalence rate for all chronic diseases among the sub-regions for 20 years and older (for COPD 35+ years) (fiscal year 2014/215). Primary care and other health service providers: • As of March 31, 2017, there were 235 primary care physicians, with 19% practicing in Community Health Centres or Family Health Teams. Some neighbourhoods have very few (one or two) primary care physicians.

• Neighbourhoods with the lowest levels of primary care continuity include Thorncliffe Park (27.8%), Flemingdon Park (24.3%) and Taylor-Massey (23.3%), in fiscal years 2011/12 and 2012/13. • Michael Garron Hospital is the main hospital in the area. There are also nine Community Support Services, five Community Mental Health and Addictions agencies and eight Long-term Care Homes. Health service utilization: • 27% (25,430) of a total 94,279 Emergency Department visits were of low urgency during fiscal year 2015/16.

• 13.5% of the total number of hospital inpatient days were designated as Alternate Level of Care (ALC).

275,385 residents 21 neighbourhoods 6389.4 people/km2

14 Mid-East sub-region overview: • In 2016, had the smallest land area of all the sub-regions, at 21.9 km2, the smallest sub-region population, comprising 13% of Toronto Central LHIN and the second highest population density of the sub-regions. • In 2016, almost 75% of the population were adults aged 20-64. Youth aged 0-19 and seniors aged 65 and older each make up ~13% of the sub-region. • In 2016, the most heavily represented visible minorities were Chinese, South Asian and Black. • Compared to the other sub-regions, had the highest percentage (3.3%) of those who report French as their mother tongue in 2016.

• Relatively high marginalization scores compared to other sub- regions (2011).

• Second highest number of homeless shelters in Toronto Central LHIN (21) (most in Moss Park, and Church-Yonge Corridor) with the highest number of shelter beds (2,030 beds). • In 2016, relatively high percentage (24.0%) of population, with the highest percentages of children under the age of 18 (30.4%) and seniors aged 65 and older (23.0%), living below the low income measure compared to other sub-regions. • Relatively high percentage (6.0%) of recent immigrants (2011-2016) • In 2016, highest percentage (36.2%) of lone parent families compared to other sub-regions.

• Four neighbourhoods are estimated to experience extremely high growth in the next 10-15 years: Waterfront Communities-The Island (125%), Regent Park (117%), Church-Yonge Corridor (106%), and Moss Park (71%).

Health status: • Second lowest rate of total hospital births for women aged 15-49: 31.2/1000 (fiscal years 2012/13-14/15). • Lowest number of deaths (770) and second lowest crude death rate (537.0/100,000 population) among sub- regions in 2011. • Particularly high rates for all chronic diseases among the sub-regions for adults 20 years and older. Primary care and other health service providers: • As of March 31, 2017, there were 215 primary care physicians, with 55% practicing in Community Health Centres or Family Health Teams.

• Neighbourhoods with the lowest levels of primary care continuity include Waterfront Communities-The Island (26.9%), Moss Park (25.4%), and Church-Yonge Corridor (24.9%), in fiscal years 2011/12 and 2012/13. • Main hospital is St. Michael’s Hospital. Highest concentration of Community Mental Health and Addiction agencies (23), high number of Community Support Services (15) and four Long-term Care Homes. High number of health/community providers serving the Indigenous population. Health service utilization: • 25.7% (14,437) of total visits to Emergency Department (56,259) were of low urgency in fiscal year 2015/16.

158,730 residents 9 neighbourhoods 7247.9 people/km2

15 Mid-West sub-region overview: • In 2016, Mid-West sub-region had the largest population (28% of Toronto Central LHIN) and the highest population density compared to other sub-regions. • From 2011 to 2016, experienced the highest population growth (14%) compared to other sub-regions • In 2016, nearly three-quarters (74%) of the population were adults aged 20-64. Children aged 0-19 and seniors aged 65+ each represented 13% of the sub-region population • Relatively low rate of recent immigrants (4.9%) in 2011-2016. • In 2016, highest percentage (5.4%) of individuals with no knowledge of English or French compared to other sub-regions.

2.4% of the population reported French as their mother tongue.

• In 2016, 18.8% of the population living below the low income measure. • Mid-West had the highest number of homeless shelters in the LHIN (22) (most in Kensington-Chinatown, followed by Niagara and Annex) with a total of 1,099 beds. • In 2016, relatively high percentage (33.8%) of lone parent families compared to other sub-regions. • Three neighbourhoods are estimated to experience high growth in the next 10-15 years: Waterfront Communities-The Island (125%), Bay Street Corridor (74%), and Kensington-Chinatown (53%). Health status: • Lowest rate of total hospital births for women aged 15-49: 30.3/1000 (fiscal years 2012/13 to 2014/15).

• Second highest number of deaths (1,633), but lowest crude death rate (534.2/100,000 population) among sub-regions in 2011. • Low prevalence of chronic diseases compared to Toronto Central LHIN in fiscal year 2014/15. Weston-Pellam Park and Keelesdale- Eglinton West had remarkably high prevalence across the neighbourhoods for all diseases.

Primary care and other health service providers: • As of March 31, 2017, there were 493 primary care physicians, the highest number per sub-region, with 26% practicing in Community Health Centres or Family Health Teams. • High percentage of people with low primary care continuity (21.3%), with highest rates of low continuity seen in Niagara (29.2%) and Waterfront Communities-The Island (26.9%) in fiscal years 2011/12 and 2012/13 • Has three academic hospitals (Sinai Health, University Health Network and Women’s College Hospital) and two specialty hospitals (Centre for Addiction and Mental Health and The Hospital for Sick Children) leading to high inflow of patients from outside the sub-region.

• High number of Community Mental Health and Addiction agencies (20), Community Support Services (13) and 12 Long-term Care Homes located in the sub-region. Highest number of hospitals (five) located within the sub-region Health service utilization: 25.7% (30,799) of total visits to the Emergency Department (120,034) were of low urgency in fiscal year 2015/16. 347,820 residents 19 neighbourhoods 9057.8 people/km2

16 North sub-region overview: • Highest percentage (16.0%) of seniors older than 65 years in 2016 amongst the sub-regions • Relatively high percentage (22.0%) of youth (aged 0-19) in 2016 compared to other sub-regions and Toronto Central LHIN overall (17.9%).

• Low growth rate (2%) between 2011 and 2016. • Lowest percentage (24.5%) of lone parent families in 2016 compared to other sub-regions. • 5.7% of the population were recent immigrants (arriving between 2011 and 2016). • Lowest marginalization scores (2011) compared to other sub-regions. • In 2016, highest percentage (71.5%) of those who report English as their mother tongue and lowest percentage (1.2%) of those with no knowledge of English or French.

• In 2016, lowest percentage of population living below the low income measure for all ages (13.0%), for children younger than six (11.4%), youth younger than 18 (12.0%), and seniors 65 years and older (13.8%). • 12 (of 13) neighbourhoods are estimated to have growth of 20% or less in the next 10-15 years while Mount Pleasant West is estimated to experience growth of 90%. Health status: • Rate of total hospital births for women aged 15-49: 36.5/1000 (fiscal years 2012/13 to 2014/15). • 1,212 deaths with a crude death rate of 608.9 per 100,000 population in 2011.

• Lowest prevalence rates for Diabetes, Mental Health Visits and chronic obstructive pulmonary disease (COPD) of all sub-regions.

Primary care and other health service providers: • As of March 31, 2017, there were 215 primary care physicians, with the lowest percentage (13%) practicing in Community Health Centres or Family Health Teams. • Better primary care continuity for enrolled and non-enrolled residents compared to other sub-regions. Neighbourhoods with the lowest levels of continuity include Humewood-Cedarvale (22.9%), Forest Hill North (22.4%) and Englemount-Lawrence (22.2%) in fiscal years 2011/12 and 2012/13. • Three academic hospitals (Sunnybrook, Baycrest and Holland Bloorview), nine Community Support Services, three Community Mental Health and Addictions agencies and three Long-term Care Homes.

Health service utilization: • 23.8% (13,373) of total visits to Emergency Departments (56,148) were of low urgency in fiscal year 2015/16.

• 15.6% of the total number of hospital inpatient days were designated as Alternate Level of Care. 203,700 residents 13 neighbourhoods 5250.0 people/km2

17 West sub-region overview: • In 2016, the second highest percentage of seniors aged 65 and older (14.9%) compared to the other sub- regions. • Slightly higher percentage of children and youth aged 0-19 in 2016 (18.9%) compared to Toronto Central LHIN (17.9%). • In 2016, lowest population density of all sub-regions and the highest land area (50km2) • Had the lowest percentage (4.4%) of recent immigrants from 2011 to 2016 compared to the other sub- regions.

• 17.2% of the population, with 19.0% of children under the age of six, 19.2% of youth under the age of 18 and 17.9% of seniors aged 65 and older, living under the low income measure in 2016 • Four neighbourhoods are estimated to have moderate growth in 10-15 years: Islington-City Centre West (57%), Mimico (57%), High Park North (37%), and Junction Area (27%) while the remaining 11 neighbourhoods are estimated to experience growth of 20% or less. Health status: • Second highest rate of total hospital births for women aged 15- 49: 38.8/1000 (fiscal years 2012/213 to 2014/15). • 1,518 deaths with the highest crude death rate (652.6/100,000) among sub-regions.

• Slightly higher prevalence of chronic diseases compared to Toronto Central LHIN. Mount Dennis, New Toronto and Rockcliffe-Smythe are characterized by high prevalence rates. New Toronto had remarkably higher rates across all conditions apart from diabetes (fiscal year 2014/15). Primary care and other health service providers: • As of March 31, 2017, there were 187 primary care physicians, the lowest of all the sub-regions, with 25% practicing in Community Health Centres or Family Health Teams. • Slightly lower proportion of adults with low primary care continuity (25.9%) compared to Toronto Central LHIN (26.1%).

Neighbourhoods with the lowest levels of continuity include; Rockcliffe-Smythe (24.8%), Mount Dennis (24.6%) and New Toronto (24.3%) in fiscal years 2011/12 and 2012/13 • Main hospital is St Joseph’s Health Centre, two rehabilitation/complex continuing care hospitals, nine Long- term Care Homes, eight Community Mental Health and Addictions, and five Community Support Services agencies.

Health service utilization: • 28.8% (28,818) of total emergency department visits (100,172) were of low urgency in fiscal year 2015/16. • 15.7% of the total hospital inpatient days were designated as Alternative Level of Care (ALC). 245,490 residents 15 neighbourhoods 4909.8 people/km2

18 E. Environmental Scan After conducting an environmental scan, Toronto Central LHIN has identified several environmental factors that impact our business planning for 2018/19. Environmental Factor Description Implications for Toronto Central LHIN Political Environment • Provincial politics and emerging Ministry direction impact the LHIN’s ongoing business goals • Activities in the first half of the fiscal year 2018/19 may impact the LHINs • Priorities and direction from the ministry could change in 2018/19 • The LHIN will continue to monitor the political landscape and develop plans for any foreseeable changes in health sector priorities Growing Importance of Digital Health • In Summer 2017 the Ministry of Health and Long-Term Care released a Digital Health Strategy and Ten Point Action Plan to be aligned with the Patients First mandate • Toronto Central LHIN has developed and is implementing a local Digital Health Strategy that will define how the organization will improve the health of our residents and communities by ensuring information and tools are available to support better care and patient experience • Toronto Central LHIN will continue to work with providers to embrace digital health technologies, monitor the impacts of digital health disruption and identify opportunities where we can be a leader in adoption to achieve our business goals Expanded Mandate and Responsibilities Related to Patients First Act • The Patients First Act was passed in late 2016 and empowers the LHIN with new responsibilities and a broader mandate within the health system • As the LHIN is impacted by provincial direction, it is critical that the business goals of the organization over the next year are aligned with the expanded mandate from the Patients First Act and any further direction from the ministry related to the expanded powers and responsibility, including integrating targeted improvements in home and community care within our broader strategic planning process Patient Advocacy • Patients and caregivers are becoming ever more involved in their own care and as advocates; they are asking for the right care, at the right time, in the right place • While patients may receive excellent care from individual care organizations, coordination and communication across the system can be improved • Toronto Central LHIN will place patient experience and outcomes at the centre of our planning and we will continue to use and expand our mechanisms to include the patient voice in all that we do

19 Environmental Factor Description Implications for Toronto Central LHIN Cross-LHIN Collaboration • Toronto Central LHIN provides more services to people living outside of its catchment area than any other LHIN • As many of the large academic hospitals and regional treatment centres are located in downtown Toronto, residents who live outside of Toronto Central LHIN will often seek treatment here, and then return to their own community for primary and follow- up care • Many individuals who live outside of Toronto Central LHIN, but work downtown will continue to seek primary health care services during the day within the LHIN • Planning for provision of health care services must be done with a keen eye to those patients who will return home outside of this LHIN to receive their care upon discharge; this requires close collaboration with our neighbouring LHINs • We must recognize the important work our regional and provincial resources play, where these providers are relied upon to be not only local resources but also care for patients outside of their immediate geography Population Health and Equity • Planning across different sectors is critical to improving the health of the broader population.

This means continuing our planning in conjunction with housing, social services, justice, emergency responders and many other partners in the community • Through our sub-region collaborative partners, Toronto Central LHIN has identified subsets of the population that have the poorest health outcomes relative to the rest of the population, and is implementing targeted approaches to improve the health of those specific groups Community Care • Shifting funding and support to strengthen community services is a priority, and it was identified that measuring quality of care is critical to assessing the impacts • Toronto Central LHIN is using our Regional Quality Table to advance cross-sectoral priorities for measuring and improving quality of care • With the LHIN’s expanded mandate, we must work with our partners to take full advantage of our position as a funder, system planner, and now a service provider to continually find and execute on opportunities to improve patient outcome and experience Voluntary Integration of Health Service Providers • Health service providers across the LHIN have collaborated with one another, and Toronto Central LHIN, and found opportunities to integrate and work more closely together • There are examples of these voluntary, LHIN-supported integrations across the health care system within community and acute care • Toronto Central LHIN will continue to support our health service providers to make decisions regarding integration which support providing excellent patient care and value for the health system

20 Environmental Factor Description Implications for Toronto Central LHIN Convergence in Health Care Sector • Moving towards a system of care which puts the patient at the centre will require leveraging technologies and capacities from across the health ecosystem • As a system funder, integrator, performance manager, and service provider, Toronto Central LHIN is well positioned to work with our health service providers and the broader system to identify opportunities to continue to evolve value for patients Population Growth in GTA • The population of the GTA is rapidly growing and simultaneously the proportion over the age of 70 is increasing • The Toronto Central LHIN’s Home and Community Care delivery may continue to see increased demand for services which will need to be managed through close partnership with Community Support Services Increasing Complexity of Clients in Home and Community Care • There is an ever-increasing number of patients and citizens who have multiple co-morbidities and complex health issues • As the complexity of clients served by Toronto Central LHIN Home and Community Care increases, we must have strategies in place to manage these complex patients and partner with our service provider organizations and health service providers to optimize the use of system resources Shortage of Personal Support Workers • There have been reported shortages of key healthcare professionals, notably Personal Support Workers, which may impact the delivery of community services in the LHIN • We must work with our Service Provider Organizations and Community Support Service Health Service Providers to understand where there may be limitations to the services they can provide due to staffing shortages and develop solutions to mitigate and solve these challenges We have considered all of this external factors and their implications as we developed our business goals for the 2018/19 fiscal year.

21 2. Health System Oversight and Management 2.1 Transparency and Public Accountability Toronto Central LHIN is committed to deliver on our Ministry-LHIN Accountability Agreement (MLAA) indicators for 2018/19. Throughout the ABP, initiatives have been identified to target specific MLAA indicators which are listed in Section 6. The LHIN has developed and continues to evolve our internal performance management frameworks and dashboards, which are key tools in providing our leadership up-to-date information to direct our performance improvement plans. As well, the LHIN continues to share health system achievements and performance publicly through our website and through ongoing engagement with our health service providers (HSP), service provider organizations (SPO) and the community.

Goals: • Expand public reporting of performance metrics to drive provider excellence in care delivery • Complete an enterprise review in partnership with Health Shared Services Ontario (HSSOntario) and develop a work plan to implement recommendations Government Priorities: • Continue to be accountable for outcomes and report on your progress towards achieving health system performance targets • Collaborate with the ministry to develop performance targets to measure the success of transformational activities and publicly report on progress and outcomes • Effectively manage all operational, strategic and financial risks encountered by the LHIN while ensuring alignment with government priorities and achievement of business objectives • Work with HSSOntario to complete an enterprise-wide review of the LHINs that identifies opportunities for improving efficiency and effectiveness, and opportunities for savings that can be reinvested into patient care.

Action Plan: Action Plan Expected Status by March 2019 Expected Completion Date: Measurement of Success Improve performance of MLAA indicators Ongoing March 31, 2019 Improve performance on MLAA indicators towards provincial targets Operationalize a performance measurement framework for strategic goals, priorities and organizational performance Complete March 31, 2019 Dashboard completed, data analyzed and reported to the Board Collaborate with LHINs to develop a pan-LHIN performance management framework In progress March 31, 2020 Pan-LHIN performance management framework in place Participate in Enterprise-Wide review with HSSOntario and initiate implementation of action plan Ongoing March 31, 2019 Action plan initiated

22 Risks / Mitigations: Risk/Barrier Mitigation Ensuring providers understand and are able to meet MLAA indicator targets Work closely with health service providers to set a clear strategy for improvement with incremental goals to improve outcomes over time. Data may not be available for measurement of (non- MLAA) indicators Continue to establish databases and data collection methods, increasing the comprehensiveness of data sources while considering timeliness and quality. Some programs may deliver additional improvements that currently do not fit within our current measurements and metrics Work with hospitals, health service, and community providers to determine feasible assessment of new ventures.

Different sources of data will be identified through partnerships.

2.2 Improve the Patient Experience Toronto Central LHIN strives to improve the patient, client, and caregiver experience for those who live in, and receive care, within our catchment area. Through initiatives targeted at ensuring the patient voice and citizen needs are captured in our planning and delivery of health services, we endeavor to design and support the implementation of a care system that is informed by patients/clients and caregivers. Our goal is to achieve a patient experience that is: • seamless, where transitions are barrier-free across sectors and facilities; • supported by open and effective communication between patient and provider as well as, across providers; • culturally appropriate and culturally competent, and • inclusive of family and caregivers – across all generations.

In 2017/18 Toronto Central LHIN refreshed our Citizens’ Panel with new membership that reflects our diverse population and the LHIN’s expanded mandate. Toronto Central LHIN has implemented a Patient and Family Advisory Committee (PFAC) for Home and Community Care to ensure that our clients’, family members’, and caregivers’ point of view, perspective, and experience are not only heard, but also integrated into our service delivery and quality improvements.

In 2018/19 the Citizens’ Panel will continue to focus on target initiatives defined by the Panel including integration of the patient/client voice in local planning, implementation of our LHIN’s community engagement strategy with a focus on hearing the voice of our vulnerable or marginalized populations, and implementation of our LHIN Strategic Plan. Goals: • Improve patient experience for clients of Toronto Central LHIN and the citizens of the region through implementation of the LHINs community engagement strategy • Include the citizen voice in all appropriate aspects of LHIN’s mandate including planning, funding, integration and service delivery Government Priorities: • Continue to engage the LHIN’s Citizens’ Panel and Home and Community Care PFAC to ensure patients and families are involved in health care priority setting and decision-making • Work towards improving transitions for patients between different health sectors and providers so that patients receive seamless, coordinated care and only tell their story once • Support patients and families by implementing initiatives that reduce caregiver distress

23 Action Plan: Action Plan Expected Status by March 2019 Expected Completion Date: Measurement of Success Continue to strengthen the Citizens’ Panel and Home and Community Care PFAC Complete March 31, 2019 Increase percentage of Citizens’ Panel members who report satisfaction regarding engagement by the LHIN (satisfied or above) Continue to implement plan for Community Engagement in Sub-Regions Complete March 31, 2019 Participation of at least one (1) Citizen Advisor or Panel Member at local sub-region sessions Embed the client voice in LHIN planning and operations In progress March 31, 2020 Assignment of at least one (1) Citizen Advisor to identified LHIN planning and operational committees Risks / Mitigations: Risk/Barrier Mitigation For patient/client engagement to be effective the LHIN will need to ensure that it is embedded throughout the organization.

Build the capacity for effective patient engagement within Toronto Central LHIN, so that the patient/client voice is key in shaping our programs, services and initiatives designed to improve care in the LHIN. Knowledge of how the health care system works and understanding of specific areas of focus such as care coordination, hospital readmissions etc. are critical success factors in enabling citizens to provide input at all levels of engagement, including up to co- creation. The LHIN will focus on removing barriers to full engagement through a variety of knowledge building and exchange initiatives.

2.3 Build Healthy Communities Informed by Population Health Planning Planning across the health care system has generally been focused on meeting the needs of those actively receiving health care. Evidence suggests that by adopting a population health approach and by proactively planning for the health needs of all people, both patients and the system will benefit. In taking this approach, we are reorienting the work of Toronto Central LHIN towards activities that aim to improve the health status of the population as a whole, as well as its many sub-populations.

In 2017/18, Toronto Central LHIN hosted Governance-to-Governance (G2G) sessions, which were identified as part of our work plan in Implementing the Integration Program.

This feedback was incorporated into an updated Integration Strategy to guide engagement, planning, and integration approvals aligned with the LHIN’s expanded mandate outlined in the Patients First Act 2016. This updated strategy reflects four key areas of action: 1. Create Integrated Service Delivery Networks (to respond to local needs) 2. Support back-office integration (to build shared capacity) 3. Set standards for services (ensuring positive client/patient experiences and outcomes) 4. Harmonize funding for services (to create equitable funding and strengthen accountability)

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