1. Community Advisory Council
January 22, 2018

2. 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

3. 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.

4. Approval of November 6, 2017 Minutes
Comments or Questions?

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

6. Membership Update Overview:
CAC members – 2 year term - renewable for a maximum of 3 terms (6 years).
January 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)

7. 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.

8. 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

9. 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

10. 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

11. 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)

12. 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

13. 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

14. 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

15. 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 to Cathy or bring to meeting your thoughts

16. 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.

17. Results of Year-End Survey
Discussion

18. 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

19. 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

20. 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

21. 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

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

23. Refreshment Break

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

25. 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

26. Provincial Wait Times Strategy
Visitors to  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.

27. 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

28. 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)

29. 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.

30. 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

31. Q3 Cancer Surgery Balanced Scorecard Results
Please note:
Oncology= confirmed diagnosis Benign = believed to be non-cancerous
Fiscal 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

32. 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

33. 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

34. 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

35. 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!

36. 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

37. 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

38. 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.

39. 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

40. 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

41. 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

42. 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.

43. 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

44. 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

45. 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

46. Comments or Questions?

47. Wrap-Up Check-in Next CAC Meeting:
Proposing a change in date
March 27, 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