Ontario Wait Time Strategy Visit to Champlain June 25, 2008

1. Ontario Wait Time StrategyVisit to ChamplainJune 25, 2008 Alan R. Hudson, OC, FRCSC

2. Cataract Surgery 90th Percentile Wait Time Trend

3. Cataract Surgery Wait Times – LHIN Variation

4. Hip Replacement 90th Percentile Wait Time Trend

5. Cancer Surgery 90th Percentile Wait Time Trend

6. Champlain LHIN Priority Analysis – May 08 data

7. MRI 90th Percentile Wait Time Trend

8. CT 90th Percentile Wait Time Trend

9. Progress to Date

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

11. Champlain LHIN Wait Time Trend Analysis May 2008 Data

12. Champlain LHIN Monthly Trend

13. Champlain LHIN Hospital Performance – May 2008 data

14. Champlain LHIN Ranking 2007/08 • Champlain LHIN has ranked within the bottom 3 LHINs across the priority wait time service area in 2007/08 Other Provincial Programs

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

16. Other ATC and MLAA Performance and Ranking-2007/08 • 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.

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

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

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. PROVINCE CHAMPLAIN LHIN Hip Replacement Surgery is circled as an example; however, all service areas apply

24. Surgeon Level Variability

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

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

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

28. Summary • 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.

29. ER € € € € € € € € € € € € € ‚ ‚ ‚ ‚ ‚ ‚ ‚ € ‚ ‚ € € € € € € € € ‚ ‚ ‚ ‚ ‚ ‚ ‚ € € € € € € € ‚ € € € € € € ‚ ‚ ‚ ‚ ‚ ‚ € The ER Strategy calls for System-wide Improvements 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 Reducing Demand for Services Increasing Supply of Services Improving Processes within the ER Alternate Levels Alternate Levels OR of Care of Care € € € € ‚ ‚ Community and home-based services ED ER Home Home Home ‚ € € ‚ ‚ ‚ ‚ ‚ ‚ ‚ € € € € € € € € € € € € H € € € € € € ‚ ‚ H ‚ ‚ ‚ ‚ ‚ ‚ Rehabilitation Rehabilitation Rehabilitation Rehabilitation € € € € ‚ ‚ ‚ ‚ ‚ ‚ ‚ ‚ ‚ ‚ € € € € € € € € € € € € € € € € € € ‚ ‚ ‚ ‚ ‚ ‚ ‚ ‚ Complex and Continuing Care ‚ ‚ ‚ ‚ ‚ ‚ ‚ ‚ € € € € ‚ € € € € € € € € € € € € ‚ ‚ € € € € € € ‚ ‚ ‚ ‚ ‚ ‚ ‚ ‚ ‚ ‚ ‚ € € Long Term Long Term Care Long Term Long Term Care Care Care • Aging at Home • Family Health Care for All • Chronic Disease Prevention and Management (Diabetes) • Mental Health and Addiction • Emergency Room Strategy • HHR - Emergency Department Coverage • Aging at Home (ALC) • High Growth Hospital Funding 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

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. ER Transfer ALC Institution Communities * * * Booked Admission * *

34. Percent of Acute Care Beds Occupied by ALC PatientsBy LHIN About 2,900 patients are waiting daily in acute care for ALC 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

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

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

37. ALC Long-Term Care Home 15,587 IP Acute Beds (*) 8.84% Other Community / Home care 2.18% Rehabilitation 13.71% Complex Continuing Care unit 7.39% 81.43% IP Acute Beds 18.57% IP Acute Beds 57.89% Palliative care unit or hospice 5.35% 12.1% admissions/year (**) Sub-acute or convalescent care 3.39% Home 1.24% 5,216,000 visits/year (***) (*) “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. ED

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

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

40. EDRS Indicators – Process Flow Diagram

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

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

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

44. Patient Satisfaction Survey Ontario Emergency Department by Hospital Location in LHIN Source:National Ambulatory Care Reporting System 2005-2006, CIHI Survey Results Summary (2005-2006):

45. $109 ER/ALC

46. www.ontariowaittimes.com