1. Ontario Wait Time Strategy Visit to Champlain June 25, 2008 Alan R. Hudson, OC, FRCSC

2. 2 Cataract Surgery 90 th Percentile Wait Time Trend

3. 3 Cataract Surgery Wait Times – LHIN Variation

4. 4 Hip Replacement 90 th Percentile Wait Time Trend

5. 5 Cancer Surgery 90 th Percentile Wait Time Trend

6. 6 Champlain LHIN Priority Analysis – May 08 data

7. 7 MRI 90 th Percentile Wait Time Trend

8. 8 CT 90 th Percentile Wait Time Trend

9. 9 Progress to Date

10. 10 Note: Based on priority level 4 targets. Current State (May 2008) - % of cases completed within target

11. 11 Champlain LHIN Wait Time Trend Analysis May 2008 Data

12. 12 Champlain LHIN Monthly Trend

13. 13 Champlain LHIN Hospital Performance – May 2008 data

14. 14 Champlain LHIN Ranking 2007/08 Service Area90th Percentile Wait TimeRank Cancer Surgery8114 Cataract Surgery22913 Hip Replacement34813 Knee Replacement41214 MRI16812 (14 in Q4) CT6312 Cardiac Bypass7811 (out of 13) Service AreaCurrent StatusRank Systemic Therapy~Median 6 Weeks12 Radiation61% completed within 14 days8 Colonoscopy-6% of Expected Colonoscopy volumes completed9 Other Provincial Programs Champlain LHIN has ranked within the bottom 3 LHINs across the priority wait time service area in 2007/08

15. 15 Champlain LHIN’s current wait time performance is still significantly higher than the Province

16. 16 Other ATC and MLAA Performance and Ranking-2007/08 Other ATC InitiativesCurrent StatusRank Surgical Efficiency92%(Q3 & Q4)4th CCIS-Avoidable Days ICU Occupancy 8.6%(Q4)6th 85.2% (Q4)4th EDRSAWAITING DATA Thus far, the Champlain LHIN has had positive performance in the other ATC initiatives Other MLAA indicators highlight the fact that ALC (and specifically LTC within the ALC population) continues to be a challenging factor for the LHIN. MLAA Performance IndicatorsCurrent StatusRank Percentage of ALC Days18.6%12 Rates of ED visits for conditions that may be treated in alternative primary care settings 7.48 Median Time to Long-Term Care Placement 169 days14

17. 17 Champlain LHIN makes up approximately 10% of the Provincial volumes for the priority service areas. TOH is the only adult tertiary care center 65% of the adult surgery is provided by TOH Second largest provider of cancer surgery in the province Largest provider of cataract surgery in the province

18. 18 Significant proportion of patients currently waiting for a priority surgery are in the Champlain LHIN Long waits at the Champlain LHIN are expected to continue

19. 19 Champlain LHIN has not seen a significant reduction in the number of patients waiting compared to the Province. This is particularly evident for hip replacements, where the Province has seen an 12% decrease in the number of patients on the wait list since July 2007.

20. 20 Champlain LHIN did not meet their 2007/08 Wait Time Performance Targets for 6 of the 7 service areas. Champlain LHIN set some of the highest targets compared to other LHINs for 2007/08 Significantly higher than the Provincial Targets Within performance corridor for 4 of the 7 services

21. 21 For service areas where the Province has seen a significant shift in performance, Champlain LHIN still has a skewed wait time distribution PROVINCECHAMPLAIN LHIN

22. 22 Cataract Surgery-Champlain is the only LHIN above the Provincial Target Cataract Surgery 90th Percentile Wait Time Trend –Provincial 0 50 100 150 200 250 300 350 Aug-Sep 05 Oct-Nov 05 Dec-Jan 06 Feb-Mar 06 Apr-May 06 Jun-Jul 06 Aug-Sep 06 Oct-Nov 06 Dec-Jan 07 Feb-Mar 07 Apr-May 07 Jun-Jul 07 Aug 07 Sep 07 Oct 07 Nov 07 Dec 07 Jan 08 Feb 08 Mar 08Apr-08 Wait Days trendline Priority 4 Target - 182 days Cataract Surgery 90th Percentile Wait Time By LHIN

23. 23 At the Provincial level, less percentage of high priority surgical patients are seen within target. However, this is much more evident in the Champlain LHIN. PROVINCECHAMPLAIN LHIN Hip Replacement Surgery is circled as an example; however, all service areas apply

24. 24 Surgeon Level Variability

25. 25 Provincial vs. Champlain LHIN Surgeon Wait Time Variation Hip Replacement-Q4 2007/08 Significant variation in Surgeon wait times across the Champlain LHIN.

26. 26 Provincial vs. Champlain LHIN Surgeon Wait Time Variation Knee Replacement-Q4 2007/08 Significant variation in Surgeon wait times across the Champlain LHIN. (cont’d)

27. 27 Any performance improvements in the Champlain LHIN wait times would improve the Provincial wait times

28. 28 The Champlain LHIN makes up a large proportion of the Province’s wait time volumes and the current queue for all service areas. With a large volume and poor overall performance, the LHIN has a significant impact to the Province’s wait time performance. This also applies to other MLAA indicators and other cancer service areas. Since the LHIN has a large number of patients currently waiting for surgical and DI services, the trend of poor performance will continue. The LHIN is currently below the Provincial target for all service areas and is not meeting the access targets of urgent patients. The targets set with the MOHLTC are considerably higher than the targets set by other LHINs. Summary

29. 29 The infrastructure and resources to reduce demand and increase supply cannot be put in place overnight, therefore, efforts must start early and will take time to show results The ER Strategy calls for System-wide Improvements  ‚   ‚  Increasing Supply of Services Improving Processes within the ER Reducing Demand for Services OR H H  ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚  ER  ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚   ‚  ED ER ‚‚    ‚   ‚ ‚ ‚ ‚  ‚   ‚ ‚ ‚   ‚  ‚‚   ‚  ‚    ‚‚    ‚   ‚ ‚ ‚ ‚ ‚ ‚  ‚   ‚   ‚ ‚ ‚ ‚ ‚   ‚  ‚  ‚‚‚‚   ‚  ‚  ‚‚    Home Rehabilitation ‚ Long Term Care Long Term Care ‚ Alternate Levels of Care Home Community and home-based services Rehabilitation ‚ Long Term Care Long Term Care ‚ Alternate Levels of Care Complex and Continuing Care ‚ Reducing ER Wait Times and Improving Public Satisfaction can only be achieved by making improvements across the entire system Therefore, accountability for improvement must rest with Hospital Boards and CEOs, LHIN Boards and CEOs and community partners such as CCACs Aging at Home Family Health Care for All Chronic Disease Prevention and Management (Diabetes) Mental Health and Addiction Aging at Home (ALC) High Growth Hospital Funding Emergency Room Strategy HHR - Emergency Department Coverage

30. 30 Michael Schull, MD – Chair, ER Expert Panel Kevin Smith, D. Phil – Expert Lead, ALC Hugh MacLeod, MA – OMA Negotiations Sarah Kramer, MSc – IM/IT

31. 31 ER Transfer InstitutionCommunities Booked Admission * * * * * ALC

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34. 34 Percent of Acute Care Beds Occupied by ALC Patients By LHIN Percent of Acute Care Beds Occupied by ALC Patients = Number of patients in an acute care bed waiting for an ALC Total acute care beds Source: OHA April 2008 ALC Survey Results About 2,900 patients are waiting daily in acute care for ALC

35. 35 Number of Patients in Emergency Waiting for an In-patient Bed By LHIN (at any given point in time) Ontario = 849 Source: OHA April 2008 ALC Survey Results

36. 36 Number of Patients in Emergency Waiting for an In-patient Bed Since December 2007 (at any given point in time) ALC Survey Results – December 2007 to April 2008 17% increase Source: OHA April 2008 ALC Survey Results

37. 37 ALC 15,587 IP Acute Beds (*) 81.43% IP Acute Beds18.57% IP Acute Beds 5,216,000 visits/year (***) 12.1% admissions/year (**) Rehabilitation Complex Continuing Care unit Palliative care unit or hospice Other Long-Term Care Home Community / Home care Sub-acute or convalescent care 13.71% 7.39% 5.35% 3.39% 2.18% 1.24% Home 57.89% 8.84% ED (*) “Alternate Level of Care ALC”, OHA ALC Survey Results, Feb 2008 (**) “Review of ED Services in Waterloo Wellington”, Waterloo Wellington LHIN, Dec 2006 (***) “Hospital Report : Emergency Department Care”, HRRC 2007.

38. 38 Distribution of ED Lengths of Stay in FY2006, by CTAS level

39. 39 Distribution of ED Lengths of Stay in FY2600, by CTAS level (cont’d)

40. 40 EDRS Indicators – Process Flow Diagram

41. 41 EDRS Implementation Timeline All Hospitals submitting data to EDRS BetaWave 1Wave 2 % of EDRS hospitals6%55%26% Q2 07/08 Q3 07/08 Q4 07/08 Q1 08/09 Q2 08/09 Q3 08/09 Q4 08/09 Public Reporting of ED Wait Times Technical Development Beta Testing Hospital Training Wave 1 and Wave 2 Implementation

42. 42 Client Registry WTIS is part of a broader agenda to improve access to care EDRS Emergency Room MRI/CT OR After Care (i.e. Rehab, Home Care) Nursing Unit Primary Provider Specialist ICU Other Diagnostic Procedures Other Specialized Services (Systemic; Radiation) Screening WTIS – Wait 1 pilot             Wait 2 adult & paeds Neurosurgery Colon Cancer Screening SETP CCIS Quality/Safety Indicators ALC

43. 43 Proposed ER Strategy Timeline January 2008 July 2008 January 2009 January 2010 January 2011 July 2009 July 2010 July 2011 January 2012 Provincial election (Oct. 2011) Readiness to announce multi-year ER-LOS targets (Dec. 2008) Premier commits to reduce ER wait times (Oct. 2007) ER wait time goals achieved (Jul. 2011) Pay-for-Results Y1 allocation (Jul. 2008) ER wait times publicly reported (Feb. 2009) Pay-for-Results Y2 allocation including expanded list of hospitals (Mar. 2009) Pay-for-Results Y3 allocation (Apr. 2010) Pay-for-Results Y4 allocation (Apr.2011) Hospitals submit public satisfaction survey results (Jan. 2009 and quarterly from Jul. 2009) Increase ER/CCAC resources (Apr. 2009) CCAC demonstration projects for ER diversion begin (Jul. 2008) Expand CCAC/ER diversion demonstration projects (Jul. 2009) ER HHR plan complete, implementation begins (Nov. 2008) Online ED patient flow Toolkit and expert program launched (Nov. 2008) Hospitals selected for Expert Teams (Apr. 2009) Hospitals selected for Expert Teams (Apr. 2011) Hospitals selected for Expert Teams (Apr. 2010) Public awareness campaign begins (Aug. 2008-Jul. 2009) Target Communication to key stakeholders (Jul. 2008-Jan.2009) Hospitals selected for Expert Teams (Oct. 2008) Minister announces ER/ALC policy changes to public and stakeholders (Apr. 2008) Preliminary EDIS results available; re-calibrate ER Strategy (Oct. 2008)

44. 44 Patient Satisfaction Survey Ontario Emergency Department by Hospital Location in LHIN Source: National Ambulatory Care Reporting System 2005-2006, CIHI Overall Impressions – Patients’ assessments, overall, of their hospital stays.74.4 Communication – Patients’ assessments of how well information was communicated to them or family during ER stay.66.9 Consideration – Patients’ assessments of whether they were treated with respect and courtesy by doctors, nurses and other staff during their stays in the ED. 72.8 Responsiveness – Patients’ assessments of the amount of time they waited to see doctors and nurses and receive test results; assessments of pain management; assessments of team work; and the staff’s responsiveness to their needs. 65.4 Survey Results Summary (2005-2006):

45. 45 $109 ER/ALC $39.523 Hospitals $38.5Home Care/CCAC $22.014 LHINs/ALC $4.5Nurses/Ambulance Offload $4.5LTC Outreach Teams

46. 46 www.ontariowaittimes.com