Hamilton Urban Core Community Health Center Update Hamilton Niagara Haldimand Brant Local Health Integration Network Board of Directors August 28, 2013 1
Presentation Outline: • Pre-Capital Submission • March 2013 Review and Performance Improvement Plan • Primary Care • Fourth Quarter Submission • Recommendations 2
Ministry-LHIN Performance Agreement (MLPA) - Cascading Accountability MOHLTC MLPA LHIN H-SAA Health Service HNHB LHIN M-SAA Providers L-SAA 3
Pre-Capital Submission - Background • Summer of 2010, HNHB LHIN (Hamilton Niagara Haldimand Brant Local Health Integration Network) working with HUC CHC (Hamilton Urban Core Community Health Centre) on pre-capital submission. • HUC CHC pre-capital submission sought to improve and expand the physical condition of the facilities in order to meet the current program and service delivery needs of the organization. • Initially, submission reflected a request to triple the size of the current facility, and double the current staffing and operating budget. • This expansion was not supported by a demonstration of need, nor was there a source of funding available. 4
Pre-Capital Submission – March 2012 • In March 2012, HNHB LHIN Board endorsed the program and services component of the HUC CHC pre-capital submission, based on the assumption of current programming, staffing and funding levels in order to provide appropriate facilities for current operations. • This endorsement was provided on condition of the validation of the data (volumes, staffing and projections). 5
Pre-Capital Submission – HNHB LHIN Position HNHB LHIN staff have consistently reinforced the same key messages to HUC CHC: • There is a need for new capital space to provide services to the clients served. • There are no new operational dollars available to support expansion of CHC (Community Health Centres) programs and services; • The HNHB LHIN has consistently supported a capital project based on current budget and FTEs (full time employees); and, • That the inconsistent data (capital) provided by HUC CHC to the MOH (Ministry of Health) and HNHB LHIN has prevented approval of the next stage of the capital project. 6
Pre-Capital Submission – Current Status • May 2013, HUC CHC experienced a flood • On June 4, 2013, HUC CHC’s Executive Director indicated to HNHB LHIN that they will not revise their pre-capital submission to the ministry in order to align with their current budget and FTE’s; rather they will be seeking a “Minister’s intervention” to get their current proposal approved. • On July 17, 2013 HNHB LHIN asked HUC CHC if they had a risk management plan for the continuity of service, given the recent flood and the condition of HUC CHC’s current building. 7
Pre-Capital Submission – Current Status • On July 19, 2013, HUC CHC’s Executive Director responded with “We are very committed to providing quality services to the clients and populations accessing Hamilton Urban Core and appreciate your commitment also. Over the years we have developed procedures for ensuring client service and safety in emergency situations such as the flood and continue to exercise due diligence.” • On August 22, 2013 – HUC CHC’s Executive Director called HNHB LHIN’s Chief Executive Officer to discuss remediation issues resulting from the flood that occurred at HUC CHC. • HUC CHC indicated that mold damage occurred due to the flood. Remediation and restoration work taking place over the next few weeks with no impact on patients or services. 8
March 2013 Review • A review of operations was conducted by HNHB LHIN staff in March 2013. • A key finding from this review indicated that HUC CHC was using 1.5 FTEs funded by HNHB LHIN for primary care (as per the Multi- Service Accountability Agreement) to fund 5.65 unfunded FTEs for non-primary care activities. • The HUC CHC has communicated to HNHB LHIN difficulty in the recruitment of primary care professionals. • HNHB LHIN Board requested a Performance Improvement Plan (PIP) from HUC CHC as per its authority under the MSAA (Multi- Service Accountability Agreement) be provided to HNHB LHIN by June 30, 2013. 9
Performance Improvement Plan (PIP) – June 2013 That HNHB LHIN requires HUC CHC to prepare and implement a PIP by June 30, 2013 that requires: • 10.3(b) of the M-SAA to be fulfilled within 30 days (Executive Director Performance plan), if not currently in place; • A report from HUC CHC’s Board identifying all M-SAA obligations with which it is not currently complying within 30 days; • On-time and accurate quarterly reporting in a format acceptable to HNHB LHIN; • Accuracy of reporting to be signed off by the Executive Director and by the Board Chair before submission to HNHB LHIN; 10
Performance Improvement Plan (PIP) – June 2013 cont’d • Funding designated for the 1.0 FTE Physician, 0.5 FTE Nurse Practitioner and 1.0 FTE Data Analyst to be used for these positions or to be returned to HNHB LHIN. HNHB LHIN staff to work with HUC CHC leadership to determine the best implementation date for this during the fiscal 2013/14 year; • An investigation of community integration opportunities to reduce administrative costs. 11
PIP – HUC CHC Submission - Highlights PIP Requirement HUC CHC PIP Possible Next Steps 10.3(b) of the M-SAA to be HUC CHC indicated that a HNHB LHIN to request Executive fulfilled within 30 days plan is in place. Director Performance Plan (Executive Director Performance plan), if not currently in place. 1. See Below A report from HUC CHC’s HUC CHC identified three Board within 30 days areas not in compliance: 2. See Below identifying all M-SAA 1. Report on community 3. Providing HNHB LHIN with engagement and certificates of insurance. No obligations with which it is not currently complying. integration actions required 2. Late reporting 3. Providing copies of renewed insurance certificates 12
PIP – HUC CHC Submission - Highlights PIP Requirement HUC CHC PIP Possible Next Steps On-time and accurate HUC CHC will make every - HNHB LHIN to request a copy of the sign quarterly reporting in effort to ensure the accuracy off process. -During the March 2013 review, HUC CHC a format acceptable to and timeliness of reports to the HNHB LHIN HNHB LHIN. staff identified issues with inconsistent HUC CHC has developed a reporting of client service activity by Accuracy of reporting sign-off process for reports to clinicians. A policy has been put in place to to be signed off by HNHB LHIN as most of the address this issue. -HNHB LHIN to request a report from HUC the Executive current reporting mechanisms Director and by the do not have accommodations CHC on the impact of this policy in Board Chair before for sign-off. improving the timeliness and accuracy of submission to HNHB The Executive Director and clinical reporting of client data. LHIN. Board Chair will review and -During the March 2013 review, HUC CHC sign-off on reports to the staff indicated that the organization has a HNHB LHIN prior to their wait list for services. submission. -HNHB LHIN to request a report from HUC CHC on their wait list per service and strategies in use to manage access to programs and services. 13
PIP – HUC CHC Submission - Highlights PIP Requirement HUC CHC PIP Possible Next Steps Funding designated HUC CHC will ensure that On July 19, 2013, HUC CHC Executive for the 1.0 FTE funding designated for the Director reported that they have received Physician, 0.5 FTE positions identified will be favourable responses to recruitment efforts and Nurse Practitioner used for those positions anticipate adding to the primary health care unless otherwise approved staff shortly, most likely first with a Nurse and 1.0 FTE Data Analyst to be used through HNHB LHIN Practitioner. for these positions prescribed processes. or be returned to All contracts to improve Funding for unfilled Primary Care FTEs HNHB LHIN. access and support the (including 1.0 FTE Physician and 0.5 FTE provision of client services Nurse Practitioner) will be re-allocated in Q3 HNHB LHIN staff using in-year salary surplus (Quarter 3) if the positions remain unfilled. to work with HUC during the period ending This funding will be reallocated to provide CHC leadership to March 31, 2013 were primary care services. determine the best terminated at March 31, 2013. implementation date for this during fiscal There has been no further use 2013/14. of in-year salary surplus in the current fiscal year. 14
PIP – HUC CHC Submission - Highlights PIP Requirement HUC CHC PIP Possible Next Steps An investigation of HUC CHC continues to explore and HNHB LHIN requests an annual community examine opportunities to reduce report of integration activities due integration administrative costs. As at March 31, sixty days after the end of the opportunities to 2013 the administrative cost was reduced fiscal year 2013-2014. reduce by 2% to 14% rather than the previous administrative costs. 16%. Further analysis and investigation of community integration opportunities will be used to continue to make every effort to reduce administrative costs. 15
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