Meeting Date: Action: Topic:

October 27, 2011 Information & Discussion Waterloo Wellington Community Care Access Centre

Purpose: The purpose of this briefing note is to provide an update to the WWLHIN Board of Directors on an emerging risk with the Waterloo Wellington Community Care Access Centre (WWCCAC), and to inform discussions regarding next steps. Recommendation: N/A

Background: The WWCCAC has not met the following performance obligations in its service accountability agreement: It has declared that it anticipates a year-end deficit in 2011/12 of $2.6 million and is seeking a waiver of this obligation (letter from Kevin Mercer, September 27, 2011) It has not met the September deliverables under the service accountability agreement for the Right Care Framework: Accelerated Response Team (progress meeting October 6, 2011)

In response to the anticipated deficit, it concluded that it would be unable to meet its service obligations under the SAA without implementing service changes. The CCAC identified a number of service changes advised health service providers ( HSPs) that these changes would be implemented without approval of the LHIN. The LHIN was informed of this action by copy of communication to the HSPs. On October 17, 2011, in accordance with the terms of the SAA, the WWLHIN provided the WWCCAC with notice and sought a meeting to discuss the matters that were affecting the CCACs ability to fulfill its obligations under the SAA (Performance Factors). The WWCCAC subsequently informed its service providers that the proposed service changes were under review and that there would be no service changes at this time. Page1of3

The Finance and Audit Committee had a discussion regarding the WWCCAC at its meeting on October 19. The Committee recognized the material risk to the Waterloo Wellington healthcare system and endorsed the action steps outlined in this briefing note. Background: The WWLHIN has invested significantly in the WWCCAC, recognizing its integral role in providing home care services, as well as its leadership role as system navigator to ensure patients receive the right care, in the right place, at the right time. The WWCCACs base funding has increased by 30% since 2008/09, including an additional 3% in operating funding received this year, and the $4.9M for the continuation of the new Integrated Assisted Living Program (IALP). The LHIN has also invested an additional $3.5 million over two years for delivery on specific strategic initiatives. In 2011/12, the WWCCAC has a budget of $109 million to provide quality care for residents in Waterloo Wellington. It is important to emphasize that WWLHIN concerns are not isolated to the proposed service changes and missed deliverables. While the WWCCAC has identified a priority of addressing financial aspects of supply and demand, there are broader concerns and system issues in relation to the need for the WWCCAC to fully realize its role in our local healthcare system. These issues have been the subject of dialogue between the two organizations for several months. Given our mutual interest in addressing potential performance issues as soon as possible, we will be using the Draft Guidelines for Community Health Service Providers Audits and Reviews which were circulated to Health Service Providers in August 2011. These guidelines are intended to assist in undertaking transparent processes in identifying and responding effectively and consistently to Health Service Provider issues. The Guidelines provide a framework to identify and assess issues of concern, the Sentinel Signals Scorecard (Scorecard). The Scorecard uses four quadrants: Organizational Health Quality of Care, Patient Safety, Service Provision and Community Support Financial/Operational Health Employee Health and Safety

Appendix A sets out the Draft Guidelines which also contains common key sentinel signals for Community Care Access Centres. Next Steps: The WWLHIN will work with the WWCCAC to identify ways for it to fulfil its obligations under the SAA to provide quality care for residents in Waterloo Wellington. To that end, the following actions are planned: 1. The Board Chairs of the two organizations are meeting on October 21. An oral report will be provided at the Board meeting on October 27. Page2of3

2. A performance meeting with the WWCCAC is being scheduled. A review of the Sentinel Signals Scorecard will be a part of the discussion at the meeting. Each of the two organizations will be asked to come to the meeting prepared to discuss the Scorecard, identify related issues, and develop a plan for moving forward. 3. The WWCCAC will be required to develop and implement a Performance Improvement Plan that is acceptable to the WWLHIN. This plan will include actions and timelines the WWCCAC will take to resolve the Performance Factors and address each of the sentinel signals identified during the performance meeting. 4. WWLHIN consideration of the WWCCACs proposed service changes will include assessments of the potential impact on patients, patient access to care, and on other health service providers.