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

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

                                                                                                                                                                   2
Toronto Central Local Health Integration Network Annual Business Plan: 2018-2019 - Toronto Central LHIN
Strategic Approach ............................................................................................................................................ 69
   Tactics................................................................................................................................................................ 69
   Evaluation .......................................................................................................................................................... 70
10. Community Engagement ................................................................................................................................ 72
Appendix A ............................................................................................................................................................ 77
   Corporate Snapshot Indicators: ......................................................................................................................... 77

                                                                                                                                                                 3
Toronto Central Local Health Integration Network Annual Business Plan: 2018-2019 - Toronto Central LHIN
A. Transmittal Letter from the LHIN Board Chair

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

2
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

                                                                                                            6
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                     Key commitments, goals, actions and/or
  Priorities                                    outcomes from the LHIN’s ABP

  Transparency and Public                       Toronto Central LHIN is committed to deliver on our Ministry-
  Accountability                                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                     Toronto Central LHIN believes that good health is more than
  Informed by Population Health                 the absence of disease. In 2018/19, the LHIN will continue our
  Planning                                      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.

                                                                                                            7
Minister’s Mandate Letter        Key commitments, goals, actions and/or
Priorities                       outcomes from the LHIN’s ABP
Equity, Quality Improvement,     Toronto Central LHIN is taking a population health approach
Consistency and Outcomes-Based   to planning at the local level and is committed to health
Delivery                         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).

                                                                                             8
Minister’s Mandate Letter         Key commitments, goals, actions and/or
Priorities                        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   Toronto Central LHIN has developed a Digital Health Strategy
and Digital Health                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.

                                                                                              9
Minister’s Mandate Letter                      Key commitments, goals, actions and/or
  Priorities                                     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

                                                                                                             10
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

                                                                                                         11
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).

                                                                                                            12
275,385 residents
                                                                 21 neighbourhoods
                                                                 6389.4 people/km2

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).

                                                                                                      13
158,730 residents
                                                                  9 neighbourhoods
                                                                  7247.9 people/km2

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.

                                                                                                      14
347,820 residents
                                                                19 neighbourhoods
                                                                9057.8 people/km2

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.

                                                                                                        15
203,700 residents
                                                               13 neighbourhoods
                                                               5250.0 people/km2

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.

                                                                                                        16
245,490 residents
                                                               15 neighbourhoods
                                                               4909.8 people/km2

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).

                                                                                                      17
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         • Priorities and direction from the
                                  Ministry direction impact the              ministry could change in 2018/19
                                  LHIN’s ongoing business goals
                                                                           • The LHIN will continue to monitor the
                                • Activities in the first half of the        political landscape and develop plans
                                  fiscal year 2018/19 may impact             for any foreseeable changes in health
                                  the LHINs                                  sector priorities

Growing Importance of           • In Summer 2017 the Ministry of           • Toronto Central LHIN will continue to
Digital Health                    Health and Long-Term Care                  work with providers to embrace digital
                                  released a Digital Health Strategy         health technologies, monitor the
                                  and Ten Point Action Plan to be            impacts of digital health disruption and
                                  aligned with the Patients First            identify opportunities where we can be
                                  mandate                                    a leader in adoption to achieve our
                                                                             business goals
                                • 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

Expanded Mandate and            • The Patients First Act was               • As the LHIN is impacted by provincial
Responsibilities Related to       passed in late 2016 and                    direction, it is critical that the business
Patients First Act                empowers the LHIN with new                 goals of the organization over the next
                                  responsibilities and a broader             year are aligned with the expanded
                                  mandate within the health system           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              • Toronto Central LHIN will place patient
                                  becoming ever more involved in             experience and outcomes at the
                                  their own care and as advocates;           centre of our planning and we will
                                  they are asking for the right care,        continue to use and expand our
                                  at the right time, in the right place      mechanisms to include the patient
                                                                             voice in all that we do
                                • While patients may receive
                                  excellent care from individual
                                  care organizations, coordination
                                  and communication across the
                                  system can be improved

                                                                                                               18
Environmental Factor       Description                              Implications for Toronto Central LHIN

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

Population Health and       • Planning across different sectors      • Through our sub-region collaborative
Equity                        is critical to improving the health      partners, Toronto Central LHIN has
                              of the broader population. This          identified subsets of the population
                              means continuing our planning in         that have the poorest health outcomes
                              conjunction with housing, social         relative to the rest of the population,
                              services, justice, emergency             and is implementing targeted
                              responders and many other                approaches to improve the health of
                              partners in the community                those specific groups

Community Care              • Shifting funding and support to        • Toronto Central LHIN is using our
                              strengthen community services is         Regional Quality Table to advance
                              a priority, and it was identified        cross-sectoral priorities for measuring
                              that measuring quality of care is        and improving quality of care
                              critical to assessing the impacts
                                                                     • 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 across        • Toronto Central LHIN will continue to
Health Service Providers      the LHIN have collaborated with          support our health service providers to
                              one another, and Toronto Central         make decisions regarding integration
                              LHIN, and found opportunities to         which support providing excellent
                              integrate and work more closely          patient care and value for the health
                              together                                 system
                            • There are examples of these
                              voluntary, LHIN-supported
                              integrations across the health
                              care system within community
                              and acute care

                                                                                                      19
Environmental Factor          Description                              Implications for Toronto Central LHIN

Convergence in Health           • Moving towards a system of care        • As a system funder, integrator,
Care Sector                       which puts the patient at the            performance manager, and service
                                  centre will require leveraging           provider, Toronto Central LHIN is well
                                  technologies and capacities from         positioned to work with our health
                                  across the health ecosystem              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           • The Toronto Central LHIN’s Home and
                                  rapidly growing and                      Community Care delivery may
                                  simultaneously the proportion            continue to see increased demand for
                                  over the age of 70 is increasing         services which will need to be
                                                                           managed through close partnership
                                                                           with Community Support Services

Increasing Complexity of        • There is an ever-increasing            • As the complexity of clients served by
Clients in Home and               number of patients and citizens          Toronto Central LHIN Home and
Community Care                    who have multiple co-morbidities         Community Care increases, we must
                                  and complex health issues                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            • There have been reported               • We must work with our Service
Support Workers                   shortages of key healthcare              Provider Organizations and
                                  professionals, notably Personal          Community Support Service Health
                                  Support Workers, which may               Service Providers to understand
                                  impact the delivery of community         where there may be limitations to the
                                  services in the LHIN                     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.

                                                                                                          20
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      Expected               Measurement of Success
                                    by March 2019        Completion Date:

Improve performance of MLAA         Ongoing              March 31, 2019         Improve performance on MLAA
indicators                                                                      indicators towards provincial
                                                                                targets

Operationalize a performance        Complete             March 31, 2019         Dashboard completed, data
measurement framework for                                                       analyzed and reported to the
strategic goals, priorities and                                                 Board
organizational performance

Collaborate with LHINs to           In progress          March 31, 2020         Pan-LHIN performance
develop a pan-LHIN                                                              management framework in place
performance management
framework

Participate in Enterprise-Wide      Ongoing              March 31, 2019         Action plan initiated
review with HSSOntario and
initiate implementation of action
plan

                                                                                                            21
Risks / Mitigations:

Risk/Barrier                                                 Mitigation

Ensuring providers understand and are able to meet           Work closely with health service providers to set a
MLAA indicator targets                                       clear strategy for improvement with incremental goals
                                                             to improve outcomes over time.

Data may not be available for measurement of (non-           Continue to establish databases and data collection
MLAA) indicators                                             methods, increasing the comprehensiveness of data
                                                             sources while considering timeliness and quality.

Some programs may deliver additional improvements            Work with hospitals, health service, and community
that currently do not fit within our current measurements    providers to determine feasible assessment of new
and metrics                                                  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

                                                                                                              22
Action Plan:

Action Plan                       Expected Status        Expected               Measurement of Success
                                  by March 2019          Completion Date:

Continue to strengthen the        Complete               March 31, 2019         Increase percentage of Citizens’
Citizens’ Panel and Home and                                                    Panel members who report
Community Care PFAC                                                             satisfaction regarding
                                                                                engagement by the LHIN
                                                                                (satisfied or above)

Continue to implement plan for    Complete               March 31, 2019         Participation of at least one (1)
Community Engagement in                                                         Citizen Advisor or Panel Member
Sub-Regions                                                                     at local sub-region sessions

Embed the client voice in LHIN    In progress            March 31, 2020         Assignment of at least one (1)
planning and operations                                                         Citizen Advisor to identified LHIN
                                                                                planning and operational
                                                                                committees

  Risks / Mitigations:

    Risk/Barrier                                             Mitigation

    For patient/client engagement to be effective the        Build the capacity for effective patient engagement
    LHIN will need to ensure that it is embedded             within Toronto Central LHIN, so that the patient/client
    throughout the organization.                             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        The LHIN will focus on removing barriers to full
    understanding of specific areas of focus such as care    engagement through a variety of knowledge building
    coordination, hospital readmissions etc. are critical    and exchange initiatives.
    success factors in enabling citizens to provide input
    at all levels of engagement, including up to co-
    creation.

  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)

                                                                                                              23
We believe that good health is more than the absence of disease. Reorienting the health care system to take
  into consideration the broader social determinants of health that go beyond clinical and curative services is a
  major shift, which can only be achieved through long-term strategic partnerships. This includes non-traditional
  partnerships with organizations outside the health care system, such as shelters, police, housing, and
  employment centres, to work toward addressing the full range of factors that impact health.
  In 2017/18, Toronto Central LHIN launched our Population Health and Equity Table with representatives from
  across health services, clinicians, Toronto Public Health, academia, research, social services, and Citizens’
  Panel members. The Table provided guidance to the LHIN on their work plan focusing on four key areas: Needs
  Assessment; Health Equity; Practice-Based Population Health; and Partnership with Toronto Public Health.
  This work has resulted in a coordinated response to opioid overdoses in Toronto Central LHIN in partnership
  with Toronto Public Health. As well, the LHIN has refreshed our Health Equity Data collection project with Sinai
  Health Systems, and developed detailed sub-region demographic and utilization data.
  Planning in smaller geographies fosters the ability to focus on specific populations where the data and
  community engagement point to the need for tailored strategies and efforts. The local collaborative concept
  brings a network of providers together with primary care providers and other partners (e.g. City of Toronto or
  Toronto Community Housing) to offer seamless, accessible and integrated services.
  The City of Toronto and Toronto Central LHIN have partnered with the collective aim to improve the quality of
  life for similar population groups - the City from a social service and delivery view and Toronto Central LHIN
  from a health care view. The City of Toronto and Toronto Central LHIN built on our current accomplishments
  and close working relationship by establishing an agreement in 2017/18 to support a much closer strategic and
  working relationship between both partners well into the future. A joint Steering Committee between the City,
  Toronto Public Health and the LHIN has been established to provide oversight and guidance on key priorities
  that will improve outcomes for Torontonians.

  Goals:
      •   Strengthen our partnership with the City of Toronto and Toronto Public Health to achieve sustained,
          coordinated planning and decision making between the LHIN and the City
      •   Continue to assess local population health needs, identifying vulnerable populations and high needs
          areas for targeted improvements
      •   Leverage the five sub-region planning areas as the focal point for population-based planning, service
          alignment and integration, quality improvement, and partnership building to improve patient experience
          and outcomes

  Government Priorities:
      •   With input from patients, providers and partners, assess local population health needs, patient access to
          the services they need, wait times and the capacity of health providers to serve the community
      •   Through sub-region (community level) planning, identify how providers will collaborate to address health
          gaps, and improve patient experience and outcomes
      •   Work with public health and other health care providers to incorporate health promotion strategies in
          integrated planning, with a special focus on chronic disease prevention

  Action Plan:

Action Plan                      Expected Status        Expected               Measurement of Success
                                 by March 2019          Completion Date:

Advance a population-based       In progress            March 31, 2020         Population-based funding
funding approach at the LHIN                                                   framework is defined for sub-
sub-region level                                                               regions

                                                                                                            24
You can also read
Next slide ... Cancel