Community Advisory Council January 22, 2018

Greetings Regrets: Guests: David Ducharme Marc Garson Susan Ralyea Cathy Cuylle Guests: Lloy Wylie, Assistant Professor, Schulich Interfaculty Program in Public Health Cathy Vandersluis, VP Surgical Services, Cardiac Care and Neurosciences Dr. Emil Schemitsch, Chair/Chief, Surgery Regrets David Ducharme Marc Garson Susan Ralyea will be delayed or may not make it Lloy has joined us to present a patient story Cathy and Emil will be joining us later in meeting Welcome to new members Nicole Gauthier, Manager Patient Experience who is replacing Jill Sanga who is on maternity leave after having a baby girl a few weeks ago And Chris Harris, Director of Patient Safety and Experience I will ask each of them to introduce themselves in our roundtable discussions

Today’s Agenda Greeting and introductions Review and approval of November 6 meeting minutes Roundtable updates Membership update Results of year-end survey Patient Story Refreshment & Networking break Presentation and discussion: Surgery Wait Times Wrap-up On today’s agenda is surgery wait time, a topic that the council recommended almost a year ago.

Approval of November 6, 2017 Minutes Comments or Questions?

Roundtable Updates CFI ED Volumes MH – new beds and location New CEO Strategic Plan and MVV

Membership Update Overview: CAC members – 2 year term - renewable for a maximum of 3 terms (6 years). January 2013 - start of the first term for all original members December 2018 will be the end of the renewable term for original members (5) CAC currently has 15 members (10 community and 5 LHSC)

Members’ Terms Name Term End Date Number of Terms – each 2 years Completed (renewable 3 times) Charlene Beynon December 31, 2018 3 terms completed David DuCharme Mark Garson Dwayne Linner Bill Peel David Steven 1 term completed Scott Courtice December 31, 2019 Kiona Greene 2 terms completed Susan Ralyea Anita Sutton Those who are in term 1 or term 2 we hope that you will also stay with us for 3 terms.

Membership Update Goal: seeking 3-5 new community members Forward names/contact info of potential candidates to Michele 3 potential community members in varying stages of process I am pleased to update that Scott Courtice has accepted the Co-Chair position starting in January 2019 when Marc is finished his term

Diversity Matrix To ensure a balanced representation and mix of community members and LHSC staff and physicians Ask of each member to complete diversity matrix (paper) or electronic and submit to Michele before next meeting Those of you who have been with us for a few years will recall that we do a diversity matrix regularly to ensure we have rich makeup and balance of community members and LHSC staff and physicians Please take a few minutes to complete right now or send it electronically to Cathy before next meeting in March

Results of 2017 Year-End Survey   TOTAL RESPONDENTS = 4 Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied Length  1 3 Location 1 2 Time Agenda Topics Rules of the Road Share end of year survey results – this year only 4 respondents

Results of Year-End Survey Would you prefer that CAC meetings start later? No (keep at 4pm) 4 Yes (start at 4:30pm) Yes (start at 5pm)

Results of Year-End Survey Would you prefer the meeting time to move completely? No (keep at 4pm) 4 Yes – move to mornings (7am to 9am) Yes – move to evenings (7pm to 9pm) Other

Results of Year-End Survey  How satisfied were you with the presentation topics discussed during the 2017 CAC meetings? TOTAL RESPONDENTS = 4 Very Unsatisfied Unsatisfied Neutral Satisfied Very Satisfied Annual CEO discussion    1 1 2 Insights report of public perception Strategic Plan consultation – Mission, Vision, Values 3 Informing LHSC’s Strategic Plan Patient Stories

Results of Year-End Survey  Patient Stories: Indicate your level of agreement with the statements TOTAL RESPONDENTS = 4 Disagree Strongly Disagree Neutral Agree Strongly Agree The purpose of sharing the stories was clear 3 1 The stories are relevant to the role of the council The stories improved my understanding of PFCC 2 The discussions were well facilitated

Results of Year-End Survey Do you have any suggestions for additional agenda items/topics? More information on Performance Indicators – e.g. Surgery Cancellations, Hospital Acquired Infections. Although nothing submitted in the survey, always open to suggestions for items or topics for discussion Send an e-mail to Cathy or bring to meeting your thoughts

Results of Year-End Survey Do you have any comments about the CAC? Meetings could be shorter – like, 90 minutes. 2 hours is a bit long. Good sharing of information at each meeting.

Results of Year-End Survey Discussion

Patient Story Nicole Gauthier, Manager LHSC, Patient Experience Lloy Wylie Nicole Today we are going to be showing a video of a patient story of an indigenous man Introduce Lloy via brief intro

Listening to Patient and Family Stories Listen for patient and family-centred care elements: Learning and reflection Reflect on your feelings, thoughts and perceptions. What questions and insights surface for you? Nicole As we watch the video, I would ask you to listen for patient and family-centred care elements – respect and dignity, collaboration and empowerment, information sharing and communication and coordination and comprehensiveness. After the videos are over, I am going to ask you to share your learning and reflection Over to Lloy

Listening to Patient and Family Stories James’ patient story Lloy provides a brief intro and then plays the videos back to back 2 short vignettes produced by students that showcase the barriers for indigenous people

Listening to Patient and Family Stories Listen for patient and family-centred care elements: Learning and reflection Reflect on your feelings, thoughts and perceptions. What questions and insights surface for you? Nicole starts off the discussion Lloy provide context and answers as appropriate

Listening to Patient and Family Stories Discussion, Comments and Questions Nicole – look forward to bringing you more patient stories for us to discuss

Refreshment Break

Surgical Wait Times Cathy Vandersluis, VP Surgical Services, Cardiac Care and Neurosciences Dr. Emil Schemitsch, Chair/Chief, Surgery

Provincial Wait Times Strategy Goal: to improve public access to surgeries and procedures delivered to Ontarians; implement new initiatives to improve ER processes; and create a system of accountability through transparent reporting of wait time. Tracking wait times in Ontario is an important step towards improving access to health services. It will help identify ways to increase efficiencies, standardize best practices and target funding to help reduce wait times. At LHSC, we remain dedicated to improving access to care and continue our work to reduce wait times. Focus today on Cancer Surgeries, Cardiac Surgeries and Orthopedic Surgeries including Hip and Knee replacement; however strategy includes all surgeries

Provincial Wait Times Strategy Visitors to www.ontariowaittimes.com can generate a list of hospitals and their reported wait times for surgeries and procedures. The website gives the user a snapshot of wait times for a three-month time period (for example, October to December). Wait times are measured in days, and reflect the length of time from the decision to have surgery to the completion of the procedure, for those patients who had surgery within the identified time period.

Referral Received By Surgeon’s Office First Consult With Surgeon WAIT ONE WAIT TWO Referral Received By Surgeon’s Office First Consult With Surgeon Wait 1 will measure the time a patient waits from the date the referral is first received from the referring doctor to the date of first consultation with a Surgeon. The collection and measurement of Wait 1 data helps provides a complete picture of the patient journey to help improve processes for access to healthcare for surgical patients in Ontario. Wait 2, is defined as the amount of time that the patient waits for surgical procedures. Wait 2 is measured from the Decision to Treat Date to the date the procedure is performed. Surgery Date Decision To Treat

Surgical Wait Times at LHSC Surgical wait times at LHSC are listed within the following categories from the Ministry of Health and Long-Term Care's website: Cancer Surgeries Cardiac Surgeries and Procedures Orthopedic Surgeries (hip and knee replacement) Other Surgeries Focus today on Cancer Surgeries Cardiac Surgeries and Procedures Orthopedic Surgeries (Hip and knee replacement)

Surgical Wait Times at LHSC Wait Times Office Tracks by surgeon to identify those with patients who are not going to meet the target to get into the operating room or are over target and by how many days This information is sent out weekly to each surgical service for cancer patients and less frequently for other patients.

Surgical Wait Times at LHSC Balanced Score Cards Structured process for measuring and monitoring quality indicators like wait times. Information is released every 3 months (quarter) Every chief of a surgical service receives this information as well as the Directors of Surgery for follow up

Q3 Cancer Surgery Balanced Scorecard Results Please note: Oncology= confirmed diagnosis Benign = believed to be non-cancerous Fiscal 2017-18 Q3 Result for Surgical Wait Times (Balanced Scorecard) Corporate UH Surgical Care VH Surgical Care Surgical Consult Wait (Oncology) 83.1% 85.1% 82.5% Surgical Treatment Wait (Oncology) 84.5% 89.5%   Surgical Consult Wait (Benign) 87.3% 92.9% 83.3% Surgical Treatment Wait (Benign) 78.7% 67.4% 87.0% Source: WTIS

Cancer Surgery Wait Times Procedure FQ3 2017/18 Ontario LHSC % Cases Completed within Access Target - Surgery (Wait 2) Breast 85 94 Central Nervous System 87 89 Digestive System - Colorectal 37 80 Digestive System - Esophagus 53 62 Digestive System - Hepatopancreatobiliary 86 97 Digestive System - Stomach 63 75 Endocrine (Thyroid, Endocrine Pancreas, Adrenal Ph 70 65 Genitourinary (excluding Prostate) 54 92 Gynaecological Head and Neck (excluding Thyroid) 55 66 Lung 60 64 Lymphomas 26 100 Ophthalmic 79   Peripheral Nervous System Prostate 69 Sarcoma - Bone 74 Skin - Carcinoma 88 Skin - Melanoma 96 Sarcoma - Soft Tissue 78 Wait 2 - All Priorities combined Priority 2 Target =14 days, Priority 3 Target = 28 days Priority 4 Target = 84 days

Cancer Surgeries Fiscal Quarter Cancer Surgery Wait Times at LHSC % Cases Completed within Access Target - Surgery (Wait 1) % Cases Completed within Access Target - Surgery (Wait 2) FQ1 2016/17 67 74 FQ2 2016/17 72 73 FQ3 2016/17 FQ4 2016/17 FQ1 2017/18 75 76 FQ2 2017/18 78 77 FQ3 2017/18 79 80 Provincial Target is 90% Wait 2 - All Priorities combined Priority 2 Target =14 days, Priority 3 Target = 28 days Priority 4 Target = 84 days

Cancer Surgeries LHSC Number of Cases Removed from Waitlist Number of Cases added to Waitlist Throughput Ratio FY15/16 2741 2598 1.06 FY16/17 3088 3038 1.02 FY17-18 Q1 to Q3 2435 (3,247 projected for entire year) 1

What does this mean? We are: serving more cancer patients each year. gradually improving our performance in getting people to the operating room in a timely manner. doing better overall compared to the provincial system Please note: Cancer surgery patients compete for the same operating room time as emergency cases, priority funded cases who also have their own wait times with no increased funding to add operating room time. BOTTOM LINE – We need to find ways to do better!

What are we doing to address it? Standardizing referral processes, centralized intake and revising current escalation processes (Q4 and F18). New surgery dashboard created that gives “real time” information in meeting expectations and finding the balance between cases Capacity review – operating room time to be dedicated to the completion of cancer cases F19 Chiefs of surgery to be accountable to improving performance – setting clear expectations and articulating the “consequences” of not meeting those expectations

Cardiac Surgery Wait Times Cardiac Bypass Surgery  FY 2017/18 LHSC 90P (Number of day for 90% of Patients to have Surgery - Wait 2) Q1 FY 2017/18 38.5 Q2 FY 2017/18 38 Q3 FY 2017/18 37 Only Priority 4 cases. Provincial Target Wait 2: Priority 4=182 days

What does this mean? We are able to get cardiac surgery and cardiology patients (e.g. pacemakers) access to care in a timely fashion. Please note: There is specific funding given to LHSC by the province that has to be used exclusively for these patients. We can’t divert money meant to serve cardiac patients to cancer patients for example.

Joint Replacement Surgery Wait Times Procedure FQ3 2017/18 Ontario LHSC % Cases Completed within Access Target - Surgery (Wait 2) Hip Replacement 77 31 Knee Replacement 73 19 Provincial Target is 90% All Priorities combined: Priority 2=42 days, Priority 3= 84 days Priority 4=182 days

Wait 1 and Wait 2 % Completed in Target   FQ3 2017/18 LHSC % Cases Completed within Access Target - Surgery (Wait 1) % Cases Completed within Access Target - Surgery (Wait 2) Hip Replacement 95 31 Knee Replacement 19 All Priorities combined Wait 1: Priority 2= 30 days, Priority 3=90 days Priority 4= 182 days Wait 2: Priority 2=42 days, Priority 3= 84 days Priority 4=182 days

LHSC Throughput LHSC Procedure Number of Cases Removed from Waitlist Number of Cases added to Waitlist Throughput Ratio FY17-18 Q1 to Q3 Primary Hip Replacement 709 863 0.82 Primary Knee Replacement 892 985 0.91

What does this mean? We have >2,000 patients waiting for a joint replacement on our waiting list. We received funding from the LHIN in December to complete another 190 cases but that will not measurably improve the waitlists. The funding formula funds growth in population (Greater Toronto area) not high burden of disease (Southwestern Ontario). BOTTOM LINE: We need to advocate for more resources.

These surgeries are covered under the Quality Based Procedures program. LHSC is only funded for a certain number of cases per year ( 724 hips and 1003 knees). Demand significantly outstrips the amount of funding

What are we doing to address it? New provincial funding received to implement a program to create a central referral system, to manage waitlist in a more timely fashion – reduce duplicate referrals, allow for next available surgeon, early screening for low back pain Centralized intake for hips and knees Integrated spine assessment centre = Provincial MSK Initiative

What else are we doing to address wait times? Tier 1 Operating Rooms and RAPSTOR solution New Surgicentre Re-focusing acceptance of referrals for LHIN’s within our responsibility (Southwest, Erie-St. Clair and Waterloo-Wellington) Working with other partners (St. Joseph’s Healthcare) to maximize capacity within the city and region

Comments or Questions?

Wrap-Up Check-in Next CAC Meeting: Proposing a change in date March 27, 2018 @ 4pm C3-301B *Note new location and change in date Change of date to Tuesday, March 27 at same time to accommodate Dr. Paul Woods Note new location on the same floor around the corner