South West LHIN Exchange Newsletter - November 2016 

Independence for Ayah and her family 

Often times a person with complex needs requires just one piece of equipment in order to stay in their home. Through a fund, created by the South West LHIN as part of its Access to Care planning, funding to purchase and install a chair lift in for Ayah Al-Rubaie’s home meant she could remain safely at home with her family.

The Community Support Services Flexible Short-term Fund provides urgent time-limited funds to meet unexpected or transitional needs of CSS clients in the South West LHIN. The fund assists individuals to remain in their homes, to prevent hospitalization and/or prevent premature admission to long-term care.

Watch how this funding helps to support people with complex needs in remaining at home in the South West LHIN

Engagement continues on proposed Patients First legislation

After receiving a second reading last month, Bill 41, Patients First Act, 2016, was referred to the Standing Committee on the Legislative Assembly. The committee held public hearings in Toronto and written submissions on the proposed law were accepted throughout November. The committee is  scheduled to meet for a clause-by-clause review of the bill on November 30.

While the draft legislation makes its way through the Legislature, the South West LHIN continues its work on its sub-region geographies. Recently, system and sub-region leaders came together on October 31, 2016 to provide input, advice and recommendations on the functions and structures required to advance Patients First in the South West LHIN.

Following this discussion, area provider tables are currently being asked for their guidance on the overarching vision, principles and core functions for the patient and family advisory committee, the Health System Renewal Advisory Committee, and sub-region integration tables.

Family physicians and nurse practitioners delivering primary care have also been taking part in sub-region primary care forums in their own areas to discuss local primary health care. More than 100 primary care providers registered to attend 11 local sessions across our geography in October and November.

The South West LHIN continues to engage and consult with patients, caregivers, health service providers, primary care providers, stakeholder associations, Indigenous peoples, Francophone communities, and other system partners.

Resources, including videos, presentations, and background information, are posted regularly to the South West LHIN website.

Know where to go – Planning for the holidays

It is time again to look ahead to the predictable challenges the busy holiday season brings to the health system. The LHIN is working with all health care partners to ensure that the health system is ready to meet the needs of the people in our communities during the holidays.

The LHIN is again working closely with the hospitals and the South West CCAC across our geography to maintain discharge practices and service levels over the holidays. Bed huddle discussions with all hospitals and the CCAC will also take place when required during this two week period.

We made great strides last year as a result of the partnerships and 100% participation from both the South West CCAC and all hospitals in our LHIN.

As part of this ongoing work, we ask that you be proactive in reaching out to the public to share when and where they can access services over the holidays. To help with this task, the LHIN, in partnership with, developed a holiday resource page that is now available year-round to share options for non-emergency medical access during the holidays. It is available at Printing off and displaying this resource page in a high-traffic area throughout the holidays would go a long way in supporting this initiative. You can also check Twitter and look for the hashtag #KnowWhereToGo.

Celebrating the advance of Health Links approach to care through learning

Participants gathered in Stratford in November to celebrate the achievements of the London Middlesex and Huron Perth teams who have implemented the Coordinated Care Planning approach. This was the final learning session for Cohort 1 participants which will build upon the learning sessions of March 2015, September 2016, and March 2016.

The event was also an opportunity to learn from the teams’ improvement experiences in implementing the Coordinated Care Planning process. The goal being to enable local providers to continue to work in partnership with patients and spread this patient-centred approach to care.

A second cohort held its first session in October 2016, with additional cohort sessions being planned. More information and resources from the first two sessions are available

Refreshed online Report on Performance shows how we are performing

As part of our commitment to accountability and transparency, the South West LHIN re-designed its quarterly Report on Performance to provide a more user-friendly experience and to better monitor progress against intended outcomes included in our Integrated Health Service Plan 2016-19. The refreshed Report on Performance is now available as part of a new, easy-to-navigate webpage and interactive web-based tool that provides quarterly performance reporting for the South West LHIN.


  • Interactive web-based performance tool (Tableau) – A quarterly e-Tool that shows the drill-down of performance to the LHIN, sub-region, and health service provider level (where available).
  • Report on Performance Report (Scorecard, Big Dot and Priority Summaries) – Includes performance and comparison trends for each of the four big dots and 25 system level measures, a profile of Big Dot progress, and Priority Summaries detailing how we are progressing against key metrics, including a summary of direct impact interventions targeting improvement and considerations for future action.
  • Backgrounder – Explains system-level measures (how targets were set and how to interpret the measures).
  • Technical Specifications – Provides more detailed information about measures including data sources and inclusion/exclusion criteria.

 The Report on Performance is available quarterly as follows:

  • The e-Tool will be available on our website in (Q1 September, Q2 December, Q3  March, and Q4 June)
  • The Report on Performance will be provided to the Board of Directors, as part of the board package in (Q1 October, Q2 January, Q3 April, Q4 July)

These resources and tools provide better access to information on shared system indicators that we hope will stimulate dialogue and collaboration for improvement.

If you have any questions, please email (with "ROP" in the subject line)

Connected Care: Building capacity and strengthening peer support in the South West LHIN

Peer support is recognized as an essential and valued component of a client-centered, recovery-oriented system of mental health and addictions care in the South West. Peer support is associated with a reduction in hospitalization for mental illness, reduction in length of hospital stays, improved social supports, and quality of life.

The South West LHIN has a vision to create a connected, seamless system that provides consistent and equitable peer support built on promising practices across the South West LHIN. The LHIN has been working with Consumer Support Initiative (CSI), peer support agencies and mental health and addictions providers since December 2015 to enhance peer support, through integration, at the sub-region level.

The rationale for integrating peer support programs into lead mental health and addictions organizations in each sub-region is to enhance access to services and expand peer support programs for clients with mental health and addictions concerns. By collaborating with larger organizations, CSIs/peer support programs will be able to strengthen and expand the services they offer.  This would not only allow them to respond to more people in need of support, but would let them benefit from training and other  supports a larger organization can offer.

It is anticipated that peer support integration will be complete by March 31, 2017, and will focus on implementation and evaluation of the new model in 2017/18.

Meanwhile, there are already areas in the South West LHIN where clients are benefiting from integrated services.

In Oxford, the Oxford Self Help Network (OSHN) has a drop-in centre located in the Canadian Mental Health Association (CMHA) Oxford Branch office. The centre hosts daily social opportunities and meaningful activities such as group games and craft classes. The design of the drop in facility is intentionally welcoming and bright with a focus on knowing names. Members and clients report that they feel like this is “their place,” and a place to belong.

“Peer support services are a critical part of the continuum of care for people experiencing mental or addictions illnesses,” says Mike McMahon, Executive Director, CMHA Oxford. “By ensuring Peer Support services are truly tangible when an individual is ready to take the next step in their recovery journey has helped many to decide that they no longer require Intense Case Management Supports, as just one example.” 

This co-location has meant that clients can access services in one stop. For instance, they could play a game with friends, then make the short trip down the hall to see their case manager or attend a diagnostic group. It has meant that members are not travelling to various sites for supports and has allowed for seamless referrals between the two organizations. A client of CMHA might be more amenable to access a program at OSHN because of its co-location and vice versa. OSHN members staff the reception desk at CMHA and the co-location has meant that peer support has a very visible presence in the community. The two organizations work closely to share resources on an on-going and daily basis, and while they have historically been independent organizations, their services have been delivered in an integrated, collaborative way and perceived to be embedded.

“Imagine how proud an individual is to move from intensive health services into a peer support relationship, to now facilitating a mood disorders group and doing one-on-one peer support,” says Laura Earle, Executive Director, Oxford Self Help Network.

Visit the for more information on peer support in Oxford county

Spreading successful quality initiatives 

The key to making an immediate impact on the quality of health care in the South West LHIN is to focus on transitions and by spreading successful quality improvement initiatives, rather than piloting new projects.

According to Dr. Rob Annis, Clinical Quality Lead for the regional Quality Table for the South West LHIN, local pilot projects across the South West LHIN have experienced success. The challenge has been spreading those ideas to other areas.

“It rarely happens,” said Dr. Annis. “And that to me is the provincial gap with respect to health care.”

That is why Dr. Annis and the Clinical Quality Table for the South West LHIN are now focusing on spreading those successful pilot projects across the LHIN. 

St. Thomas Elgin General Hospital’s success in reducing readmission rates and transitioning patients to primary care providers is one of those successful projects.

When St. Thomas Elgin General Hospital noted they were experiencing higher readmission rates in 2014, the hospital began an initiative to increase the number of people seeing their primary care provider within seven days of a hospital discharge.

This was done by increasing the timeliness of discharge summaries and by having hospital staff schedule follow up appointments with primary care providers for all acute medical patients being discharged.    

The results were compelling. Since October 2015, 90 per cent of discharge summaries are sent from the hospital to primary care within 48 hours; 82 per cent of patients have a scheduled follow up appointment; and a reduced variation in actual to expected readmission.

The key to spreading successful projects like the one at St. Thomas will be for the Table to get the data to the relevant people and organizations who could benefit from these initiatives, and ensure there is organizational and institutional support for the change.

“It’s not enough to say that it worked over there and you should do it; you have to be able to explain why it is important and how it can help,” said Dr. Annis.  

Crisis support line available in French

Language should not be a barrier to reaching out when you are in crisis and need to talk to someone. The LHIN-funded crisis phone line, Reach Out, is available 24 hours a day and seven days a week  to help people with addictions and mental health needs living in London, Middlesex, Oxford and Elgin Counties – the  crisis line, known in French as À l’écoute also offers services to Francophones.

 Reach Out staff are trained to deal with individuals who are: 

  • Experiencing a serious mental health or addictions problem;
  • Experiencing a crisis;
  • Experiencing emotional trauma, depression or anxiety;
  • At risk to harm themselves or others;
  • Having suicidal thoughts; and
  • Substance abuse, gaming, internet disorder and problem gambling.

À l’écoute offers French callers crisis support, friendly listening, information and educations, or an appointment with a French-speaking mental health and addictions professional. Families, caregivers and health care providers can also use the line to learn about French resources for loved ones or clients.

You can Reach Out by phone at 519-433-2023 or toll free at 1-866-933-2023.

Enhancing the quality of Ontario’s addictions and mental health system

Within the South West, more than half of LHIN-funded mental health and addiction programs have started and or are planning to use a new and validated client feedback tool that will support quality improvement initiatives in Ministry of Health and Long-Term Care and LHIN-funded mental health, addictions and concurrent disorder programs across Ontario.

The Ontario Perception of Care Tool for Mental Health and Addictions (OPOC-MHA) extends beyond client satisfaction, looking at the client’s perception of the services they receive relative to an expected quality of care. Actionable items within the OPOC-MHA can be used to bring about necessary change in areas such as enhancing access, quality of care and safety.

Implementation support is being provided by a regional coach and provincial team from the Provincial System Support Program at the Centre for Addiction and Mental Health. Implementation support (available until March 31, 2017) assists with implementation planning, training and capacity building for the new tool, as well as sustainability planning.

Feedback indicates clients are pleased their input is being used to improve service quality:

  • “It’s important we know our voices are heard.”
  • “This treats our experience as a form of evidence.”

For more information, Deanna Huggett, Implementation Coach,, 519-858-5158 x 20166.