partners in care - erie st. clair ccac strategic plan 2014/2015

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PARTNERS IN CAREE r i e S t . C l a i r C o m m u n i t y C a r e A c c e s s C e n t r e

ESC CCACSTRATEGIC PLAN2 0 1 4 / 2 0 1 5 – 2 0 1 6 / 2 0 1 7

E S C C C A C S t r a t e g i c P l a n 2 0 1 4 / 2 0 1 5 - 2 0 1 6 / 2 0 1 7E S C C C A C S t r a t e g i c P l a n 2 0 1 4 / 2 0 1 5 - 2 0 1 6 / 2 0 1 7 E S C C C A C S t r a t e g i c P l a n 2 0 1 4 / 2 0 1 5 - 2 0 1 6 / 2 0 1 72

GUIDED BY OUR MISSION & VALUES.

E S C C C A C S t r a t e g i c P l a n 2 0 1 4 / 2 0 1 5 - 2 0 1 6 / 2 0 1 7E S C C C A C S t r a t e g i c P l a n 2 0 1 4 / 2 0 1 5 - 2 0 1 6 / 2 0 1 7

TABLE OF CONTENTSOur Vision, Mission & Values ................................................................................................................. 1

A Message from the Board Chair and CEO .......................................................................................... 2

About the Erie St. Clair CCAC ............................................................................................................... 3

2010-2013 Strategic Plan Review .....................................................................................................5 - 6

The Erie St. Clair Region ...................................................................................................................7 - 8 • Environmental Scan: Facts & Figures

Developing Partners in Care: The 2014/15 - 2016/17 Strategic Plan .............................................. 9 - 10

Partners in Care: Strategic Plan 2014/15 - 2016/17 .........................................................................11 - 12

2014/15 – 2016/17 Strategic Directions ......................................................................................... 14 - 16

2014/15 – 2016/17 Strategic Enablers .......................................................................................... 18 - 20

Monitoring Performance: Erie St. Clair CCAC Balanced Scorecard ............................................ 21 - 22

Accountability and Transparency .................................................................................................23 - 24

Acknowledgements / Partners in Engagement ............................................................................25 - 27

Feedback & Questions ........................................................................................................................28

ESC CCACSTRATEGIC PLAN2 0 1 4 / 2 0 1 5 – 2 0 1 6 / 2 0 1 7

GUIDED BY OUR MISSION & VALUES.

E S C C C A C S t r a t e g i c P l a n 2 0 1 4 / 2 0 1 5 - 2 0 1 6 / 2 0 1 7 E S C C C A C S t r a t e g i c P l a n 2 0 1 4 / 2 0 1 5 - 2 0 1 6 / 2 0 1 71

OUR VISION, MISSION & VALUESOUR VISIONOutstanding Care – Every Person, Every Day.

OUR MISSIONTo deliver a seamless experience through the health system for people in our diverse communities, providing equitable

access, individualized care coordination and quality health care.

OUR VALUESThe Voice of Our Patients – The Erie St. Clair CCAC’s Patient Declaration of Values

OUR PATIENTS THE ERIE ST. CLAIR CCAC Supporting my dignity is showing me that you care. We will demonstrate respect for your dignity and you will know

that we care.

I will feel your compassion when you listen Understanding your hopes and desires will be central to to my story. the care we provide.

I feel better when I receive clear communication By communicating effectively, the care we provide will about my care. have better outcomes for you.

Accountability for the trust I have placed in you Having your trust is a privilege; we will work with you is important to me. to responsibly meet your expectations.

When the care I receive is efficient, I can be more By being efficient we will facilitate your independence.independent.

E S C C C A C S t r a t e g i c P l a n 2 0 1 4 / 2 0 1 5 - 2 0 1 6 / 2 0 1 7 E S C C C A C S t r a t e g i c P l a n 2 0 1 4 / 2 0 1 5 - 2 0 1 6 / 2 0 1 7 2

A MESSAGE FROM THE CEO/BOARD CHAIR Planning to meet the home care needs of the residents of Erie St. Clair is the work of an entire community. We estimate

hundreds of our partners, staff, patients and caregivers have contributed to the development of Partners in Care: Strategic

Plan 2014/15 – 2016/17.

Achieving our Vision, Outstanding Care – Every Person, Every Day, requires complete dedication to the idea that we cannot

succeed without the hard work of our frontline staff and managers, our community partners, and the insight and thoughtful

contributions of patients and caregivers.

The Strategic Plan 2014/15 – 2016/17 was created over 10 months in 2014. It is a process that began with an in depth review

by the Board of Directors, and the consultation of our partners from the support service, multicultural and government

sectors and clinical staff across Erie St. Clair, and concluded in the fall with our Accountability Sessions

in Windsor, Chatham and Sarnia. These sessions will be repeated on an annual basis to check-in with our community

to make sure we are on track, and meeting the care needs in Erie St. Clair.

This consultation process helped establish three Strategic Directions: Delivery of Patient and Family Centred Care, Reducing

the Impact of Chronic Disease, Be the Partner of Choice in Enhanced Care Coordination. The three Strategic Directions will

be achieved with the help our three Strategic Enablers: Value for Investment, Effective use of Technology and being an

Employer of Choice.

The strength of this plan is the result of many valuable contributions, and we believe that as we commit to collaborating

with the community we will achieve great things. We invite you to join us.

Kathryn Biondi Lori MarshallChair, Board of Directors Chief Executive Officer


ABOUT THE ERIE ST. CLAIR CCAC The Erie St. Clair Community Care Access Centre (CCAC) is one of 14 community-based, independent health care

agencies funded by the Ministry of Health and Long-Term Care through the Erie St. Clair Local Health Integration

Network (ESC LHIN). Over the last year, the CCAC has offered care to nearly 38,000 residents in our region. In addition,

we provided advice, information, and connections to other community services to thousands of others.

The CCAC delivers services through the lens of our Patient Declaration of Values, in three core areas:

• Conduct health assessments to establish the care needs of individuals referred to the CCAC

• Serve as leaders in care coordination for all health care and support service-related information in our communities

• Partner with our patients, health providers and communities to provide quality care delivery

• Conduct assessments, placement and manage waiting lists for long-term care homes in Erie St. Clair

Care coordination is at the heart of the services provided by the CCAC. CCAC Care Coordinators support patients who

are referred to the CCAC and may be eligible for a variety of services in the community, including nursing, personal

support, physiotherapy, occupational therapy, speech/language therapy, social work, and nutritional counselling.

Our Care Coordinators will take the time to understand patient needs and determine which services, either from the

CCAC or in the community, they may require. Once eligibility is determined, a CCAC Care Coordinator will work with

patients, their loved ones, community partners, and other care providers to implement a care plan.

Our goal is to support residents so that they may live in their home with greater independence, avoid hospital

admission, access support services in the community, and when necessary, explore long-term care options when

it becomes too difficult to live independently at home.

The Erie St. Clair CCAC provides care to nearly 38,000 patients each year. In partnership with

our patients, their families, our care providers and communities, over the past year the CCAC

has successfully;

• Supported over 19,300 patients in transitioning from hospital to home

• Supported 4,200 patients in their move to long-term care

• Provided care to over 5,100 children and youth

• Coordinated care by helping an additional 8,480 patients by connecting them to supports and services in the community through

the CCAC’s Information and Referral services

GUIDED BY OUR MISSION

& VALUES.


GUIDED BY OUR MISSION

& VALUES.

THE ERIE ST. CLAIR CCAC PROVIDES

CARE TO NEARLY 38,000 PATIENTS

EACH YEAR.


STRATEGIC PLAN 2010-2013 – DRIVING QUALITY CARE IN OUR COMMUNITY TOGETHER In 2010, the Erie St. Clair CCAC launched its strategic plan, identifying 5 key priority areas to ensure the continued

provision of high quality home care in the community. These priority areas are Quality Client Services, Accountability

and Transparency, Partnering with Our Communities, Supporting our Staff and a Focus on Continuous Improvement

and Innovation.

Over the life span of this strategic plan, the achievements in each of our priority areas help build a stronger community

care system, while teaching our CCAC a great deal about opportunities with our partners, innovation in our work place,

and the needs of our patients and caregivers. The following is a brief review of our work and accomplishments during

the implementation of this strategic plan.

QUALITY CLIENT SERVICESOur Objective: We will strive to exceed expectations in delivering excellent service by making full use of staff and partner resources,

data, and emerging electronic tools.

Our Achievements:

• Ensuring hospital based, CCAC clinical staff have the technology and training to utilize the Resident Assessment Instrument – Contact Assessment tool.

• The development of an Ethical Framework to support decision making.

• Reduction in patient waiting times for Personal Support Worker services, among the lowest in Ontario.

ACCOUNTABILITY AND TRANSPARENCYOur Objective:We will use new methods to clearly identify what we do, who we serve, and how we make our decisions.

Our Achievements:

• Achievement of full accreditation with the Commission on Accreditation of Rehabilitation Facilities (CARF).

• Together with provincial counterparts, launched the regional CCAC health information website www.eriestclairhealthline.ca.

• Development of back office integration with local partners to reduce costs of administration in the local health system.


PARTNERING WITH OUR COMMUNITIESOur Objective:We will seek new opportunities to work together with stakeholders to

improve the health and wellbeing of our communities and our vulnerable

populations.

Our Achievements:

• Launch and implementation of the Home First philosophy, ensuring a greater number of patients are accessing their care in the home.

• The development of our Patient Declaration of Values.

• Through the use of our customized technology, managing and increasing referrals to community support services.

SUPPORTING OUR STAFFOur Objective:We will invest in our staff to further develop our strengths in meeting our client and community needs.

Our Achievements:

• Achievement of robust staff participation in provincial and local staff engagement initiatives, and plan development.

• Development of a staff education model for frontline clinical and administrative staff.

FOCUS ON CONTINUOUS IMPROVEMENT AND INNOVATIONOur Objective:We will seek opportunities to become more efficient and to improve outcomes for clients, including the pursuit of

technology and electronic health system improvements.

Our Achievements:

• Supporting the development and initiation of a local model for the treatment of residents suffering from Chronic Obstructive Pulmonary Disorder (COPD).

• Supporting a greater number of end-of-life patients who make the choice to die at home.

The 2010-2013 Strategic Plan has been brought to a close, and our achievements have served to improve the quality

of patient care with our partners, created a more transparent organization and has been driven by our dedicated staff.

This period has also laid the groundwork for the next strategic plan, one that seeks to dramatically increase the role

of our staff, partners, patients and caregivers in how community and home based care is provided over the next

three years.


THE ERIE ST. CLAIR CCAC REGION • 620,954 residents • 57 retirement residences

• 7,311 square kilometers • 5 schools boards with 277 schools

• 5 hospital corporations across 8 sites • 2 residential hospices

• 10 Family Health Teams across 20 sites • 32 Community Support Agencies

• 4 Community Health Centres across 14 sites • 1 Community Health Link

• 36 long-term care homes • 3 nurse practitioner-led clinics

The Erie St. Clair region is home to diverse patient populations with unique health care needs; differing in some areas

significantly from the rest of the province. Understanding these unique care needs of our residents and partnering in

their care is integral to the CCAC’s success and also to the development of our Strategic Plan.

The Erie St. Clair Local Health Integration Network (ESC LHIN) also recently completed the third Integrated Health

Service Plan (IHSP 3) 2013-2016 that outlines key health system strategic directions. These directions and the

information within the IHSP 3 was integral to informing the CCAC’s strategic planning process as we work to

collaboratively improve the local health system and address the varying needs of our communities. The following data

was extracted from the ESC LHIN’s IHSP 3, unless otherwise indicated. (http://www.eriestclairlhin.on.ca/Accountability/

IHSP/IHSP3-2013-2016/IHSP%203%20-%202013-2016.aspx)

ENVIRONMENTAL SCAN KEY FACTS & FIGURES

Ontario

• 37 per cent of Ontario residents aged 12+ have a chronic condition and 15 per cent have multiple conditions.

• Prevalence of multiple chronic conditions increase dramatically with age. Forty-four percent of those aged 65-74 and 55 per cent of those aged 75+ have more than one chronic condition.

• Chronic conditions account for 6 out of 10 deaths, 2 out of 10 acute hospital separations, and 3 out of 10 acute hospital days.

• In Ontario, chronic diseases are the leading cause of death and disability. Almost 80% of Ontarians over the age of 45 have a chronic condition and approximately 70% suffer from two or more of these conditions. (MoHLTC - http://www.health.gov.on.ca/en/pro/programs/cdpm/ )

• When these conditions are left untreated or are poorly managed this results in a decreased quality of life for patients and it predisposes them to other chronic conditions. (MoHLTC - http://www.health.gov.on.ca/en/pro/programs/cdpm/ )


Erie St. Clair Region

• In 2011, almost 16 per cent of the population was seniors (aged 65+); up from 14 per cent in 2006. By 2016, seniors will account for 18 per cent of the Erie St. Clair population; by 2021, it will be 21 per cent.

• Approximately 14 per cent of Erie St. Clair residents say they usually experience moderate or severe pain discomfort, and 31 per cent say they experience activity limitations because of long-term physical or mental health problems. Not surprisingly, prevalence of pain/discomfort and activity limitation increases with age.

• Erie St. Clair residents have significantly higher prevalence of smoking, heavy drinking, and excess weight compared to the province, and a lower prevalence of adequate fruit/vegetable consumption. These risk factors contribute to many cancers and chronic conditions including heart disease, stroke, chronic obstructive pulmonary disease (COPD), diabetes, and osteoarthritis.

• Erie St. Clair has the highest prevalence of overweight/obesity (62 per cent of residents aged 18+), and the lowest prevalence of adequate fruit/vegetable consumption (65 per cent of residents consume fewer than five servings daily) among the 14 LHINs.

• 41 per cent of Erie St. Clair residents (aged 12+) have a chronic condition and 17 per cent have multiple conditions.

• Prevalence of multiple chronic conditions increases dramatically with age; over half of Erie St. Clair residents aged 65+ have two or more chronic conditions.

• Chronic conditions account for 6 out of 10 deaths, 1 out of 4 acute hospital separations, and 3 out of 10 acute hospital days for Erie St. Clair residents.

• The prevalence of most chronic conditions in Erie St. Clair, except arthritis, is similar to provincial rates. Arthritis prevalence is significantly higher. See Table 1.

• Mortality and hospitalization rates for all chronic conditions, except asthma, are higher than provincial rates. See Table 1.

Table 1

Condition Erie St. Clair Ontario Comment Trend

Prevalence (2009 & 2010), rate per 100, aged 12+

Arthritis (aged 14+) 21.9↑ 17.2

Asthma 7.6 8.4 Decreasing

Cancer 1.8 1.9

COPD (aged 35+) 3.8 4.2

Diabetes 7.7 6.9 3rd highest Increasing

High blood pressure 19.9 17.4 3rd highest Increasing

Heart disease 5.2 4.9

Suffer from effects of stroke 1.5* 1.1 2nd highest

Have a chronic condition 40.9 37.0

Have multiple chronic conditions1 17.4 15.2

Diabetes prevalence, aged 18+ (BDDI) 10.6 9.7

↑ LHIN result is significantly higher than Ontario. ↓ LHIN result is significantly lower than Ontario.* High sampling variability-estimate must be used with caution.1 - Of the selected conditions on this list


DEVELOPING PARTNERS IN CARE: THE 2014/15 – 2016/17 STRATEGIC PLANThe creation of the Strategic Plan required a thorough process of consultation and engagement, followed by

development and finally implementation. The CCAC is one of the few health service providers spanning the entirety

of Windsor and Essex County, Sarnia and Lambton County and Chatham-Kent, the entirety of the region of Erie St.

Clair. The services provided by the CCAC impact 1 out of every 18 homes in our region, our Care Coordinators are in

every hospital, and aim to work closely with the dozens of local agencies in our community. With such a broad reach,

we have a responsibility to be thorough in our consultation and engagement, and inclusive in our development and

implementation.

PHASES IN PLANNING The development of the Strategic Plan occurred over four distinct phases in a planning cycle meant to allow the

board and staff of the CCAC to take stock and oversee the closure of the prior strategic plan and review the current

environment, engage a broad number of partners, patients and stakeholders, develop the plan, and validate this plan

through an accountability process with the community.

PHASE 1 PHASE 2 PHASE 3 PHASE 4Laying the Foundation Engagement Accountability and ImplementationSeptember 2013 January 2014 Development November 2014 - December 2013 - September 2014 September 2014 - December 2014

- October 2014

• Review of Mission • Partner and • Regional • Board Approval and Vision Stakeholder Accountability of Strategic Plan

Consultations Sessions• Environment and • Performance Stakeholders • Board review: • Development Management

What Defines of Goals and Framework • Approval of Success? Objectives Development Patient

Declaration • Strategic • Development of • Community of Values Directions Work Plans and Partner

Developed Involvement


LAYING THE FOUNDATIONIn Phase 1, the Board of Directors spent time reviewing the CCAC sector Mission and Vision. The goal of this review

was to achieve a common understanding of the Mission and Vision to best understand how the CCAC could achieve

our mission, and continue to reach for our vision. At this time, the Board undertook a review of the local and provincial

community care environment, and assessed our relationships with our partners and stakeholders in the community.

Finally, the Patient Declaration of Values was approved, reinforcing the foundation of the planning process.

ENGAGEMENTIn Phase 2, we reached out to the community of partners, patients and caregivers, staff and stakeholders. Over the

course of nearly 120 days, we engaged 19 groups in over 26 different consultation sessions, based on the following

principles:

• Consultations would leverage input from stakeholders closest to the patient / public where possible.

• Key consultations with distinct stakeholder groups, which include the First Nations, Francophone and multicultural groups.

• The primary means of consultation would be interview-based to provide for rich data collection.

During this phase, the board considered the consultation results, and based on the foundation in the prior phase,

contributed to the formulation of the Strategic Directions by asking “What will success look like to the CCAC?”

ACCOUNTABILITY AND DEVELOPMENTDuring Phase 3, at this stage of the development of the Strategic Plan, the information from engagement and

consultations has been reviewed, and the Strategic Directions and Enablers have been drafted. The next step was

to validate this information with the individuals and groups that were consulted as part of the Engagement phase.

Accountability Sessions were founded and supported the development of the components of the Strategic Plan

that would allow the CCAC to determine which initiatives and programs to develop in order to achieve our Strategic

Directions. (See Accountability Sessions on page 23) These goals and objectives are then laid out into work plans for

each department to undertake.

IMPLEMENTATIONFinally, in Phase 4 the Board of Directors provided approval to Partners in Care: Strategic Plan 2014/15 – 2016/17.

During this phase, the Erie St. Clair CCAC underwent an organizational change that included movement of leadership,

reporting structures and staff changes. During this time, work was begun on developing a framework that will connect

the performance of the administration of the CCAC with the goals and objectives that must be achieved in the plan.

During this phase, the CCAC is changing how it undertakes its work, and has adopted a direction that will support

increasing involvement from patients and caregivers, as well as partners from the community. The CCAC believes this

model will help improve outcomes, and better meet the needs of our patients.

PHASE 4


PARTNERS IN CARE: STRATEGIC PLAN 2014/15-2016/17OUTSTANDING CARE - EVERY PERSON, EVERY DAY. The Erie St. Clair CCAC’s vision inspires us each and every day to ensure we are providing the best possible care to our

patients, partnering with and within our communities and participating actively as responsible and coordinated health

system leaders. Our strategic priorities for the next three years were developed with an understanding that in order

to achieve our vision, we must aim to achieve excellence by continuously improving and providing care that positively

impacts our patients and their families. The high standards are set for us to achieve.

GUIDED BY OUR MISSION AND VALUES. Delivering a seamless experience through the health system for those in our diverse communities requires a

commitment and dedication to superior care delivery. The Erie St. Clair CCAC’s 2014/15 – 2016/17 Strategic Plan focuses

on how to achieve excellence using the very fundamentals of our mission statement: we aim to provide care that is

coordinated, individualized, accessible and high-quality. We do this guided by the voice of our patient, remembering the

key tenets of a patient’s care journey: We are accountable to our patients, we will communicate effectively with them,

we have compassion for their care needs, we will provide care efficiently and we will always respect the dignity of our

patients and the individual circumstances they face.

WE WILL BUILD ON EFFECTIVE AND EFFICIENT USE OF OUR RESOURCES.The Erie St. Clair CCAC’s resources are the building blocks to achieving our strategic vision. They are the resources that

allow us to ensure we achieve excellence in community care. Our focus is on our valuable resources and by improving

these, coupled with leveraging our existing strengths; we are making the best use of tax dollars, the talent of our human

resources and the value of our contributions to community care delivery.

WE ADVANCE THE QUALITY AND SAFETY OF CARE DELIVERY THROUGH PARTNERSHIP.

The key to our success is partnership. We aim to achieve excellence in community

care through key partnerships that allow us to better understand the needs of our

patients, our communities, and of our stakeholders and to address them readily.

We aim to involve patients and families in all that we do; we will reduce the impact

of chronic illnesses by supporting those living with chronic diseases and improving

system outcomes. We will also be the partner of choice for all health partners to

ensure the success of shared system goals, resulting in better patient outcomes,

satisfaction and value for the health system.


Table 2

To achieve our Vision… Outstanding Care, Every Person, Every Day

We advance the Quality & Safety

of Care we deliver through partnership.

We will engage with our community to learn from

the patient experience and deliver patient and

family centred care.

We will collaborate with our partners in care to reduce

the impact of chronic disease.

We will be the partner of choice in enhanced care

coordination to deliver the right care in the right place

and at the right time.

• Increased involvement of patients & families

in operations.

• Increased patient satisfaction.

• Reduced patient risk.

• Reduced reliance on hospital based care for chronic disease.

• Reduced time from referral to first visit from hospital

or community.

• Achievement of shared goals with partners.

• Increased volume of service while serving

increasingly complex patient needs.

We build on the Effective and

Efficient use of our resources.

We will provide value for the investment in home

& community care.

We will deliver care and service leveraging the

effective use of technology.

We will be an employer of choice.

• Balanced budget.

• Reduced cost of care per patient.

• Increased use of telemedicine and

telehome monitoring.

• Increased access to electronic health record by

providers and patients.

• Increased staff satisfaction.

• Reduced overtime, absenteeism and

injury rates.

• Increased investment in staff development.

Guided by our Mission and Values.

Accountability • Communication • Compassion • Efficiency • Dignity

To deliver a seamless experience through the health system for people in our diverse communities, providing equitable access, individualized care coordination

and quality health care.


WE ADVANCE THE QUALITY & SAFETY OF CARE WE DELIVER THROUGH PARTNERSHIP.

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STRATEGIC DIRECTIONS The Erie St. Clair CCAC is pleased to introduce our 2014/15-2016/17 Strategic Directions. Partnering for care requires

special attention to understanding the needs of those we aim to assist. Our patients and families will be at the center

of all that we do; recognizing that delivering quality care also means we must be a responsible and effective system

partner. Through collaboration with our health partners, we aim to achieve the best possible outcomes for our patients

while providing value for the system. These strategic directions will enable us to do work differently and provide quality

care in innovative ways. It is out hope to partner with our community, patients and caregivers.

WE WILL ENGAGE WITH OUR COMMUNITY TO LEARN FROM THE PATIENT EXPERIENCE AND DELIVER PATIENT AND FAMILY CENTRED CARE.• Increased involvement of patients and families in operations

• Increased patient satisfaction and reduced patient risk

1 Create a framework for Patient and Family Centred Care II. Provide education to Care Coordinators and Team to be adopted by the organization when developing Assistants regarding the importance of communication detailed action plans for goals and objectives. with patients. Ensure patient stories are included in the

educational sharing.I. Complete an organizational readiness assessment from the Institute for Patient and Family Centred Care (IPFCC). III. Develop a communication plan to share and celebrate

changes that have been made to policy and practices as a II. Develop a plan to implement recommendations from the result of PFCC implementation.findings of readiness assessment.

IV. Evaluate the implementation of the PFCC framework and III. Patient and Family Centred Care (PFCC) education for identify any areas of opportunity for further expansion of leaders, board members and all staff. This will also be PFCC.included in the orientation process/materials for new staff.

Empower patients and families in IV. ey service provider staff members 4

Provide training to k their care.about PFCC. Ensure that service providers include PFCC subject matter into their orientation processes for all new I. Ensure each site and all functional areas have access staff. to at least one Patient and Family Advisor (PFA).

V. Assess the current state by completing a review of all II. Engage every department with their Patient and Family policies and reference documents with functional centres Advisors to determine one “Plan-Do, Study-Act” (PDSA) across the organization to ensure they are patient and family quality improvement for completion and reporting annually.centred.

III. Implement the RNAO Best Practice Guidelines for Client

2 Create a Patient and Family Council and other means to Centred Care into the provision of care. increase patient and family involvement in operations.

IV. Explore moving from one central PFA council to more I. Create an orientation program for Patient and Family programmatically based councils (e.g. Oncology, Seniors, Advisors (PFAs) and ongoing support. School Health, etc.).

II. Develop Terms of Reference for the PFA Council.

III. Introduce the role of Patient and Family Advisors (PFAs) 5 Monitor and improve patient satisfaction and evaluate

impact of patient and family centred care at the Erie St. Clair CCAC.

to the operations of ESC CCAC.I.Review the need and possible options for a brief patient

IV. Create the role of the Patient and Family Advisor (PFA) survey that would be completed in a timelier manner on a and Chair of PFA Council. regular basis.

V. Begin recruitment phase for Patient and Family Advisors II. Explore the opportunity of completing one combined and Chair of PFA Council. patient survey with other partners in care

to reduce duplication from the patient perspective.

3 Improve communication with patients, families and internal and external stakeholders. III. Review the results from annual NRC Canada survey

throughout the organization on annual basis and identify I. Review the patient related communication between the at least one performance improvement strategy to be CCAC and our partners through the lens of PFCC and identify addressed across the organization.any opportunities for improvement.


WE WILL COLLABORATE WITH OUR PARTNERS IN CARE TO REDUCE THE IMPACT OF CHRONIC DISEASE.• Reduced reliance on hospital-based care for chronic disease

• Reduced time from referral to visit from hospital or community

1 Adopt an organizational framework for the introduction of Patient and Family Centred Care in the delivery of Chronic Disease Management Programs.

I. Establish a Chronic Disease Management Council (CDMC) to guide the successful implementation of this Strategic Direction including staff, service providers, community agencies, primary care and hospitals. Patient and Family Advisors will be active members.

II. Create, implement and report on at least one improvement strategy with patients and families in each functional area on an annual basis to improve through the review of NRC Canada information.

III. Create a mechanism to ensure understanding by all appropriate staff of available and up-to-date resources in the community to support navigation of patients living with chronic disease.

2 Implement evidence-based practices for Chronic Disease Management including opportunities for self-management and increased patient independence.

I. Improve average cost per short stay acute patients achieving alignment with provincial benchmarks for length of stay and by promoting the use of CCAC clinics as an alternative to home visits.

II. Align nursing utilizations with the provincial benchmark by promoting the concept of independence, safe discharge and transition to more appropriate community services.

III. Work with Chronic Disease Management Council and other partners in care to develop and implement a cost-effective approach that enhances the focus on promoting self-management, thereby supporting improved independence of patients and caregivers.

IV. Work with Chronic Disease Management Council to review all CCAC Care Guides used by Care Coordinators to support cost effective service planning and care coordination for chronic disease patients which are patient-centred and outcome-based.

3 Enhance Communication to patients, families and partner organizations regarding the role of the CCAC in Chronic Disease Management.

I. Integrate CCAC Chronic Disease Management programs to promote and facilitate improved Care Coordinator referral and patient access and review overlap and duplication with other organizations to streamline care and service delivery.

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II. In collaboration with communication staff, develop cost-effective strategies and tools to enhance the awareness of integrated services for Chronic Disease Management.

III. Support ED and ALC strategies in ESC LHIN by enhancing in-home restorative resources for patients in collaboration with hospital and community stakeholders involved in the Geriatric Care Path in ESC LHIN region.

4 Collaborate with partners on the development of integrated care plans providing proactive care coordination and system navigation.

I. Align Personal Support service utilization with provincial benchmarks.

II. Improve the average cost per lower needs patient.

III. Expand linkage and collaboration of Care Coordinators to primary care practitioners and primary care teams within each of the established Health Links in ESC LHIN region in a cost-neutral manner to the CCAC.

IV. Create mechanism to ensure primary care providers know how to access the CCAC to collaborate with the CCAC in working with their patients living with chronic disease.

V. Implement all goals and objectives associated with Health Links projects in which the CCAC is a partner.

5 Monitor impact of increased access to evidence-based Chronic Disease Management programs.

I. Monitor CCAC patient admissions to ED beginning with CKHA (eNotification).

II. Expand services to the complex and chronic patient populations while reducing reliance on CCAC services for those of low and mild needs.

III. Ensure assessment and admission processes support patients in effectively linking and accessing community resources (CA2 and CDM referral benchmarks).

IV. Monitor patient readmissions to CCAC services when discharged to community services and Chronic Disease Management Programs.


WE WILL BE THE PARTNER OF CHOICE IN ENHANCED CARE COORDINATION TO DELIVER THE RIGHT CARE IN THE RIGHT PLACE AND AT THE RIGHT TIME. • Achievement of shared goals with partners.

• Increased volume of service while serving increasingly complex patient needs.

1 Adopt organizational framework for the introduction of Patient and Family Centred Care to enhanced Care Coordination.

I. Establish an Enhanced Care Coordination Council to guide the successful implementation of this Strategic Direction made up of staff, service providers, community agencies, primary care and hospitals. Patient and Family Advisors (PFAs) will be active members.

II. Create a mechanism to ensure understanding by all appropriate staff of available resources in community partner organizations to support navigation of patients towards other care and service options.

III. Create, implement and report on at least one improvement strategy with patients and families in each functional area on an annual basis through review of NRC Canada information.

2 Enhance management of transitions across the system from hospital, through community and home.

I. Continue work with Resource Matching and Referral (RM&R) initiative to ensure smooth transitions to long-term care.

II. Ensure CCAC care plans are cost-effective and do not introduce duplications of available community services.

III. Educate Care Coordinators and service providers to ensure that patients are supported, by staggering service initiation and by having patients actively establish plans for discharge upon admission.

IV. Review options to develop and implement a centralized intake queue for enhancing the management of patient referrals.

V. Review the “Client Care Model” and Care Coordinator staffing to plan for cost-neutral transitioning to new patient management roles in the organization as the patient population served changes.

3 Enhance communication to patients, families and partner organizations regarding the role of the CCAC in care coordination.

I. Ensure that all patients receive information upon admission regarding available community resources; including direct linkages as agreed to (CA2 and CDM referrals).

II. Work with Enhanced Care Coordination Council to develop and enhance communication tools and mechanisms that will support an improved understanding of the role of the CCAC in care coordination and the Care Coordinator role.

III. Review concept of job shadowing across partners in care organizations to enhance staff knowledge of available resources and processes.

4 Create and strengthen partnerships with other organizations to enhance care coordination.

I. Working with stakeholders, ensure that enabling technology is implemented, within available resources, as it becomes available to support enhanced care coordination (e.g. Clinical Connect and eNotification).

II. Improve average cost per short stay acute patients achieving alignment with provincial benchmarks for length of stay and by promoting the use of CCAC clinics as an alternative to home visits.

III. Align nursing utilization with the provincial benchmark by promoting the concept of independence, safe discharge and transition to more appropriate community services.

IV. Strengthen partnerships with assisted living/supportive housing providers to enhance coordinated access and care coordination of patients.

5 Monitor impact of enhanced care coordination.

I. Monitor trends, report and act on personal support service utilization, if not on target.

II. Monitor trends, report and act on nursing service utilization, if not on target.

III. Review and ensure that assessment and admission processes are supporting patients in effectively linking and accessing available community resources (CA2 and CDM referral benchmarks).

IV. Review transitions in care scores on NRC Canada survey with Enhanced Care Coordination Council and act with at least one improvement project, per year, in each patient service functional area.

V. Monitor patient readmissions to CCAC service when discharged to community services and Chronic Disease Management programs and act if metric is not on target.

PAT

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STRATEGICDIRECTIONS


WE BUILD ON THE EFFECTIVE AND EFFICIENT USE OF OUR RESOURCES.

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STRATEGIC ENABLERS In order to achieve the strategic goals of the Erie St. Clair CCAC’s 2014/15-2016/17 Strategic Plan, we aim to strengthen our existing resources and talent, while increasing the opportunity for innovation and efficiency. The following Strategic Enablers provide the foundation for the success of our Strategic Plan. These strategic enablers will enable us to do work differently, and achievements in these areas allow us to attend to the needs of our patients, families, communities and partners.

WE WILL PROVIDE VALUE FOR THE INVESTMENT IN HOME AND COMMUNITY CARE.• Balanced Budget

• Reduced cost of care per patient

1 Adopt organizational framework for the introduction of Patient and Family Centred Care to provide value for the investment in home and community care.

I. Explore, model and implement a strategy to accurately predict patient volumes by program with input from other organizations, patients and families.

II. Include Patient and Family Advisors (PFAs) in the review of contracts with service providers.

III. Ensure all proposals for new projects include a Patient and Family Advisor (PFA) at the table. Initial project will be the Sarnia-Lambton Integrated Care discussions.

IV. Initiate process to ensure budgets and operating plans are reviewed with Patients and Family Advisors to review allocation process and solicit feedback.

2 Improve awareness regarding the drivers of costs in home and community care and reduce waste and non-value added functions in CCAC processes.

I. Identify administrative savings as outlined in the ESC LHIN Operational Intervention Strategy, including the review of the organization’s footprint. Demonstrate where dollars are moved into patient care or to support front-line activities.

II. Establish an internal audit committee to review compliancy in contracts, funding targets, financial policies, value for money policies that would include standards for decision making, metrics, costs, etc.

III. Conduct an improvement processes review for data sharing between organizations to determine if streamlining is possible, identifying what is value-added, what are the barriers and/or opportunities.

IV. Automate monthly reporting, identifying a selected monthly performance indicator to monitor ESC CCAC spend rate/benchmark.

V. Review and revise financial expense policies to ensure they align with BPA guidelines.

3 Improve coordination of administrative and support services both within the CCAC and with partner organizations.

I. Develop plan to educate front-line staff on services available both internally and externally (e.g. job shadowing, lunch-and-learns, annual bulletins, etc.). Implement networking and focus groups to educate these stakeholders to ensure a better understanding.

II. Review the Waterloo Wellington CCAC program for screening referrals to identify feasibility of ESC CCAC implementing the program.

III. Develop a communication plan for all stakeholders (patients, families, administrators, decision makers, municipal and provincial leaders, etc.) to have a better understanding of what the CCAC can and cannot offer and what community support service agencies can provide.

IV. Review and report on Integrated Shared Services model (CMHA) detailing improvements, savings, unexpected expenses, risks and overall outcome.

V. Improve contract management processes such as tracking and performance measurement and metrics to review issues, evaluate cost and the value of proposed solutions or corrections. Identify an improvement plan based on the review.

4 Increase awareness and promote access by patients and families to services outside of the CCAC.

I. Without duplicating external resources, develop a “catalogue” of services for patients/caregivers who are not eligible for CCAC service; empower patients and caregivers to take responsibility for their healthcare. Educate families on the ability to purchase their own services or how they might access other care.

II. Explore with other community agencies the ability to create a real-time report of available services with vacancies and wait times identified.

III. Explore opportunities to provide congregate care services in rural areas (e.g. flex clinics) in-kind, generate revenue.

IV. Draft a policy outlining opportunities for year-end surplus dollars; identify allowable one-time purchases to support patient care equipment purchases (compression stockings) or clinical education opportunities.

5 Monitor impact of organizational changes to value for investment in home and community care.

I. Develop and automate performance for identified dedicated funding envelopes (e.g. nursing initiative, PSW enhancement, etc.).

II. Design and implement departmental budgets; assign accountability; monitor performance including accomplishment of objectives related to nursing and PSW benchmarking in Chronic Disease Management and Care Coordination Strategic Directions.

III. Restructure respite care where service is available from community support service agencies.

IV. Stay within funding envelopes for Ministry of Health and Long-Term Care (MoHLTC) funded positions.


WE WILL DELIVER CARE AND SERVICE LEVERAGING THE EFFECTIVE USE OF TECHNOLOGY.• Increased use of telemedicine and telehomecare monitoring

• Increased access to electronic health record by providers and patients

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1 Adopt organizational framework for the introduction of Patient and Family Centred Care to leverage the effective use of technology.

I. Provide organization-wide education on patient and family centred uses of technology for the future and considerations for adoption.

II. Create Strategy and Performance Management Framework supporting full organization to align with Patient and Family Centred Care framework.

III. Development of Patient / Caregiver advisory model to support patient centred adoption of technology-based care and services.

2 Optimize use of technology to full potential and to enhance efficiencies.

I. Initiate project development for the use of Automated Provider Reports with contracted providers on cost-neutral basis.

II. Support organizational efficiency through a revamp of the Intranet tools and capabilities.

III. Review CCAC policies and procedures to ensure Event Tracking Management System (ETMS) deployment to service providers is standardized.

IV. Achieve full utilization and efficient use of Ontario Telemedicine Network (OTN) resources and assess future direction for CCAC within existing or designated funding.

V. Review existing ETMS procedures to ensure full deployment to service providers.

3 Further the development of an electronic health record.

I. Expand use of common cost-effective technology among identified community agencies to facilitate record sharing and referrals.

II. Initiate project development for the use of cost-effective E-referral to community support services with local agencies.

III. Roll out of E-referral project to community support service agencies across Erie St. Clair.

IV. Review options to provide patients and families with cost-effective access to electronic information through a portal or other technologies.

V. Ensure alignment of CCAC electronic tool and health record development and planning with cSWO strategic planning objectives and achieve shared goals and objectives.

4 Increase use of technology to support self-management and independence for patients and families.

I. Achieve full development and utilization of the ErieStClairhealthline.ca website.

II. Review of other patient-specific technologies that may support greater independence in the activities of daily living in the home for formulary consideration within available resources.

III. Review the use of technologies that reduce the impact of social or physical isolation for individuals living at home and implement within available resources.

IV. Telehomecare targets achieved over program delivery period.

5 Monitor impact of technology in achieving the organization’s goals.

I. Review technology program implementation and outcomes in patient and family advisory involvement.

II. Explore alignment of technology enabler with existing and future patient and caregiver feedback tools and practices.

III. Explore alternative technologies that would support the evaluation of patient satisfaction.

IV. Develop framework and tools for regular evaluation of all planning indicators.


WE WILL BE AN EMPLOYER OF CHOICE.• Increased staff satisfaction

• Reduced overtime, absenteeism and injury rates

• Increased investment in staff development ENABLERSSTRATEGIC

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1 Adopt organizational framework for the introduction of Patient and Family Centred Care to become an employer of choice.

I. Incorporate information about the culture of Patient and Family Centred Care and the Patient Family Advisor (PFA) Council into the Corporate Orientation program.

II. Develop a robust professional practice model building on the strengths of Patient and Family Centred Care.

III. Review existing Human Resources (HR) policies to reference patient and family centred care.

IV. Implement inclusion of Patient and Family Advisors (PFAs) in recruitment process.

V. Review other areas, as appropriate, for inclusion of Patient and Family Advisors (PFAs) in Human Resources processes.

2 Build trust and increase transparency through enhanced communication within organization.

I. Implement the practice of sharing Full Time Employees (FTEs) in labour management meetings with ONA and CUPE and institute an annual presentation of operational plan and financial projections.

II. Ensure monthly portfolio meetings at every level of the organization to ensure cascading messages to and feedback from front-line staff.

III. Establish policy review committee/process with representation from all portfolios including Patient and Family Advisors (PFAs) to review and recommend approval to Executive Leadership Team and implement practice of sharing all changes to reference documents/policies with Labour Management prior to implementation.

IV. Introduce monthly Leadership Forums in addition to targeted programs to provide:

• Clear accountability expectations

• Effective coaching/feedback

• Foster positive communication

• Cultivate the practice of “listening to learn”

V. Implement the strategic utilization of Human Resource Management System.

• Build report-writing competency in HR

• Implement recruitment module

• Expand on employee self-service options (e.g. change of personal information, etc.).

3 Set clear performance expectations throughout organization.

I. Review all job descriptions to ensure current terminology and duties and consistency with Patient and Family Centred Care; implement biennial review moving forward.

II. Ensure 95% of performance appraisals are completed by due date/within 2 months of due date; to ensure timely feedback.

III. Develop planning and performance standards and balanced score card for each functional area; develop implementation plan inclusive of communication plan and education for staff. Collaborate with staff and patients by developing a working committee to review these standards.

IV. Develop new performance appraisal tool for staff; provide education to staff; ensure information and copy of form is issued during corporate orientation.

4 Strengthen leadership.

I. Complete organizational restructuring.

II. Reduce the number of grievances that are not resolved internally by 5%.

III. Review and enhance the corporate orientation program.

IV. Develop and implement education on a respectful workplace with the goal of reducing the number of reported bullying and harassment complaints by 10%.

V. Develop a management orientation program.

5 Monitor and improve employee satisfaction and evaluate impact of “Employer of Choice” strategies.

I. Development of plans for each functional area/centre in consultation with staff to improve quality of work-life including reduced sick time and improved work-life safety.

II. Implement RNAO Best Practice Guidelines on Healthy Work Environment.

III. Support the building of relief budgets; over hire in spring to cover annual average turnover and right-size staffing numbers to maintain appropriate staffing levels to reduce overtime.

IV. Implement Employee Engagement Survey (EES) to evaluate employee engagement/satisfaction.

V. Support departments in the development of workload measurement standards and tools.


MONITORING PERFORMANCETHE ERIE ST. CLAIR CCAC’S BALANCED SCORECARDThe Erie St. Clair CCAC’s Balanced Scorecard is a quarterly reporting measure used to monitor performance and

accountability. The quarterly balanced scorecard incorporates performance indicators from the Multi-Sector Service

Accountability Agreement (M-SAA), The Erie St. Clair CCAC’s Quality Improvement Plan (QIP) and our own indicators

of the progress on the implementation of the Erie St. Clair CCAC’s 2014/15-2016/17 Strategic Plan.

QUALITY PATIENT CARE

Patient satisfaction

LEARNING ESC CCACSTRA FINANCIAL & GROWTH TEGIC PLAN

& VISION HEALTHWORK LIFE Balanced position at year-endPlan developed to address staff satisfaction 2 0 1 4 / 2 0 1 5 • 2 0 1 6 / 2 0 1 72 0 1 4 / 2 0 1 5 – 2 0 1 6 / 2 0 1 7

INTERNAL BUSINESS PROCESSESStrategic plan on target


THE ERIE ST. CLAIR CCAC PROVIDES REGULAR PERFORMANCE UPDATES Available online at www.healthcareathome.ca/eriestclair


OUR ANNUAL ACCOUNTABILITY SESSIONSIn September 2014 the first Annual Accountability Sessions were held in Chatham, Sarnia and Windsor. Partners,

patients and caregivers, elected officials, board members and CCAC staff were invited to review our Strategic Directions

and Enablers, and inform the development of the goals and objectives that will populate the work plans of the CCAC.

The Accountability Sessions will occur each fall for the entire life cycle of the Strategic Plan. The contributions received

during these sessions are critical first to establishing the initial plan, and second, to be accountable for our work, and

make sure we are on the right track.


MONITORING ACCOUNTABILITYThe success of the Erie St. Clair CCAC’s 2014/15 – 2016/17 Strategic Plan relies on the continued monitoring of

performance and accountability at every level of the organization. The Erie St. Clair CCAC is dedicated to continually

increasing transparency and accountability, this is how we will accomplish this:

• In the fall of 2014, the Erie St. Clair CCAC had undergone a complete reorganization of internal staff structure including the management of portfolios to support the Strategic Directions and the implementation of the Strategic Plan.

• The CCAC has aligned the Strategic Plan to the front-line staff roles so that each individual in the organization understands their role in achieving the plan.

Performance meetings are held monthly for Executive Leadership Team (ELT) to review progress on goals, objectives and financial performance (full Balanced Scorecard is reviewed quarterly).

Management Leadership Forum will provide a general overview of organizational performance on a monthly basis and will provide the opportunity to share and discuss information as it relates to their departmental and individual goals and objectives.

Each Executive Leader will have monthly meetings with their portfolio management prior to the ELT performance meeting, ensuring quick response to Strategic targets that are on track or those that require attention.

Each Director will have monthly meetings with their direct reports (portfolio) and will discuss the departmental goals, objectives and progress of the Strategic Plan.

Each Manager will have monthly meetings with their staff (portfolio) and will discuss the departmental goals, objectives and progress of the Strategic Plan.

Agendas for “Portfolio Meetings” will be pre-populated with cascading messages to ensure consistency of messaging which can then be customized for each area, ensuring CCAC staff are collaborating and are cohesively working towards common priorities.

The Erie St. Clair CCAC also acknowledges the importance of feedback and

collaboration from our stakeholders and the public in the success of achieving our

Strategic Plan. The Erie St. Clair CCAC’s 2014/15 – 2016/17 Strategic Plan is posted on

our website, along with our Strategic Plan deliverables showing our progress and our

quarterly Balanced Scorecard. We welcome your continued partnership and ask for

your feedback and support as we engage in the delivery of our vision for quality

community care over the next three years.

WE ASK YOU TO PARTNER IN CARE WITH US.


OUR PARTNERS IN CARE/ ACKNOWLEDGEMENTSThe Erie St. Clair CCAC’s 2014/15 – 2016/17 Strategic Plan has been developed using a collaborative process; bringing

the efforts and ideas of hundreds of participants to create a vision and direction for quality community care.

We would like to thank the following participants for their hard work and dedication to partnering with us in care.

Agnes Soulard Lambton Elderly Outreach

Alan Stevenson Canadian Mental Health Association

Alana Bellemore Erie St. Clair CCAC

Alison Drew Erie St. Clair CCAC

Amelia Morrison Children’s Treatment Centre of Chatham-Kent

Amy Maroon Erie St. Clair CCAC

Ana Milojevic Multicultural Council of Windsor & Essex County

Anca Barna Erie St. Clair CCAC

Andrew Ward Victorian Order of Nurses (VON)

Angela Hovey PACE Homecare

Angela Poole Erie St. Clair CCAC

Ann LeClair Community Representative / Caregiver

Ann Petrlich Community Representative / Caregiver

Anne Dumouchelle Erie St. Clair CCAC

Ann Marie Thompson Nutritional Management Services

April Nelmes March of Dimes Canada

Ashley McLellan Chatham-Kent Community Health Centre

Barb Frayne Erie St. Clair CCAC

Barb Iacono Family Services Windsor

Barbara Keyes Community Representative / Caregiver

Beth Bridgeman Erie St. Clair CCAC

Betty Kuchta Erie St. Clair CCAC

Beverley Lawrence Erie St. Clair CCAC

Bob Rawlinson New Beginnings ABI and Stroke Recovery Association

Bonnie Pacuta Community Representative / Caregiver

Brenda Benishek Community Representative / Caregiver

Brenda Wilson Erie St. Clair CCAC

Brent Semande Erie St. Clair CCAC

Brian Gray Harrow Family Health Team

Brian Hillman Town of Tecumseh

Caen Suni Erie St. Clair CCAC

Carolyn Catterson County of Lambton

Carolanne Gillam Bayshore Home Health

Cathleen Scartner Erie St. Clair CCAC

Cathy Collard Erie St. Clair CCAC

Cecile Rumiel Erie St. Clair CCAC

Chelsie MacIlwain Erie St. Clair CCAC Board of Directors

Cheryl Somers Erie St. Clair CCAC

Cheryl Thompkins Canadian Red Cross

Cheryl Zaffino Erie St. Clair CCAC

Chris Doyle County of Lambton

Chris Irwin Erie St. Clair CCAC

Chris O'Gorman Bayshore Home Health

Christine Roberts Red Cross Care Partners

Christine Romanick Erie St. Clair CCAC

Christie SmithCommunity Representative / Caregiver

Chuck Gascoyne The Office of Percy Hatfield, Member of Provincial Parliament, M.P.P.

Cindy Africh Erie St. Clair CCAC

Cindy Gagnier John McGivney Children’s Treatment Centre

Cindy Stokes Erie St. Clair CCAC

Connie Quinn Vaillant Erie St. Clair CCAC Board of Directors

Danielle Mangat Erie St. Clair CCAC

Dave Holland Erie St. Clair CCAC

Deb Blake Family Services Kent

Debbie Cercone City of Windsor

Debra Hermsen St. Clair College

Dela Horley The Office of Bob Bailey, Member of Provincial Parliament, M.P.P.

Denise Dedobbeleer Erie St. Clair CCAC

Denise Waddick Thamesview Family Health Team

Denise Malhotra Erie St. Clair CCAC

Diane Mulcaster Erie St. Clair CCAC

Diane Lozon Family Services Kent

Dipti Patel The United Way

Don Shropshire Municipality of Chatham-Kent

Don Pitt Family Counselling Centre

Dorothy Bondy-Stevenson Erie St. Clair CCAC

Dr. Frank DeMarco Physician

Dr. Glen Bartlett Windsor-Essex Community Health Centre

Dr. Glen Maddison Physician

Dr. Gordon Simmons Erie St. Clair CCAC Board of Directors

Dr. Hanle Yap Physician

Dr. Ian Campbell Physician

Dr. Jason Denys Physician

Dr. Ken Blanchette St. Clair College

Edna Cudney Community Representative / Caregiver

Elaine Whitmore John McGivney Children’s Treatment Centre

Evelyn Pigott The Office of Lisa Gretzky, Member of Provincial Parliament, M.P.P.

Fay Lawn Erie St. Clair CCAC

Francine Poirier Erie St. Clair CCAC

Frank Chalmers Erie St. Clair LHIN

Glenda Mailloux Erie St. Clair CCAC

Guy Gignac Conseil scolaire catholique Providence

Heather Brown Erie St. Clair CCAC

Heather Martin Vision Nursing Home

Helen Bechard Erie St. Clair CCAC

Herbert Schwarz Community Representative /Caregiver

Hollie Mitchell-Rice Erie St. Clair CCAC

Holly Rice-Mitchell Erie St. Clair CCAC

Holly Withers Pathways Health Centre for Children

Ivan Nicoletti Erie St. Clair CCAC

Jacques Kenny Erie St. Clair/South West French Language Health Planning Entity

Jacquie Stephens Erie St. Clair CCAC

James Greenway Erie St. Clair CCAC Board of Directors

Jane Dalziel County of Lambton

Janet Boyle St. Clair Catholic District School Board

Janet Griffin Erie St. Clair CCAC

Jason Wallen Erie St. Clair CCAC

Jeewen Gill Erie St. Clair CCAC Board of Directors

Jeff Harvey Lambton Meadowview Villa

Jeneane Fast Local Immigration Partnership

Jenna Martin Erie St. Clair CCAC

Jennifer Allison Trillium Villa Nursing Home

Jennifer Klassen Windsor-Essex Catholic District School Board

Jennifer Hill Erie St. Clair CCAC Board of Directors


Jennifer Middleton Tilbury Manor Linda Sabatini Hospice of Windsor Nadine Manroe Wakerwell Erie St. Clair CCAC& Essex CountyJennifer Tremblay Erie St. Clair CCAC Nancy Musson Huron LodgeLinda McCann Four Counties Day ProgramJenny Greensmith Pathways Health Nancy Vanner Community Representative

Centre for Children Lisa Conley Erie St. Clair CCAC / Caregiver

Jessica Smith St. Andrew’s Residence Liz Zantingh Lambton Kent District Natasha Greenlee Nutritional Management School Board ServicesJill Howes Community Representative

/ Caregiver Lori Gall New Beginnings ABI Nicole Hunter Victorian Order of Nurses (VON)and Stroke Recovery AssociationJill Schweitzer Erie St. Clair CCAC Nicole da Silva The Office of Rick Nicholls, Lori Marshall Erie St. Clair CCAC Member of Provincial Parliament, M.P.P.Jing Lian Erie St. Clair CCACLorna de Witt University of Windsor Nora Nelson Red Cross Care PartnersJoanne Chortos Erie St. Clair CCACLucy Coppola Erie St. Clair CCAC Omar Aboelela Pace HomecareJoe Perry Hospice of Windsor & Essex CountyLucy Harrison Walpole Island First Nations Paige Bressette Kettle and Stoney Point Jola Szuwara Erie St. Clair CCAC Health Centre Lucy Brown Municipality of Chatham-KentJon Dunn Canadian Mental Health Association Pam Burford Erie St. Clair CCACLynn Ann Gallaway Watford Quality Jon Ann Meko Erie St. Clair CCAC Care Centre Pam Roth Erie St. Clair CCAC

Judy Beswick Saint Elizabeth Lynda Debuck Erie St. Clair CCAC Pat Hillier Community Representative Judy Bolton Community Representative / CaregiverLynn Calder Assisted Living Southwestern / Caregiver Ontario Patricia Samson Erie St. Clair CCACJudy Doan Alzheimer Society Marc Holmes Erie St. Clair CCAC Patrick Kolowicz Hotel Dieu Grace Healthcareof Sarnia Lambton

Marcela Diaz Multicultural Council of Windsor Paul Brown Erie St. Clair LHINJudy Wolanski Erie St. Clair CCAC & Essex County Paul Dusten St. Joseph's HospiceJulie Bastien Erie St. Clair CCAC Marg Bushey Erie St. Clair CCAC Paul Levac Conseil scolaire catholique Kali Garneau Erie St. Clair CCAC Margaret Moons Community Representative ProvidenceKaren MacNeil Red Cross Care Partners / Caregiver Paula Thomas Revera Home HealthKaren Riley Pharmacy Marie Wilson Community Representative Paula Vanthournout Erie St. Clair CCAC/ CaregiverKathy Bresett North Lambton Community Peggy Neuhart Erie St. Clair CCACHealth Centre Mario Aquilina Erie St. Clair CCAC

Philip Jessom Community Representative Kathryn Biondi Erie St. Clair CCAC Chair Mark Erdelyan Erie St. Clair LHIN / Caregiverof the Board of Directors Mark Ferrari Windsor Family Health Team Ralph Ganter Erie St. Clair LHINKathy O’Hara-Wilson Township of Enniskillen Mark Wybenga South Essex Community Rebecca Belore Municipality of Chatham-KentKelley Doyle Erie St. Clair CCAC CouncilRebecca Rivait Erie St. Clair CCACKelly Hall County of Lambton - Housing Marshall Kern Erie St. Clair CCAC Board

Services of Directors Rene Verellen Canadian Red Cross

Kelly Huys Erie St. Clair CCAC Marlin Freeman Erie St. Clair CCAC Renée Trombley Erie St. Clair CCAC

Kelly Stack Essex Community Services Marsha Sparnaay Erie St. Clair CCAC Renée Moisson Chatham-Kent Community Health CentreKelly Jones Erie St. Clair CCAC Marthe Dumont Erie St. Clair LHINRhonda Gibson Lambton Elderly OutreachKelly Griffiths Tilbury District Family Mary Ann Shaule Marshall Gowland Manor

Health Team Richard Zsoldos ParaMed Home Health CareMary Ellen Parker Alzheimer Society Kerry Clark Erie St. Clair CCAC of Chatham-Kent Rick Nicholls Member of Provincial

Parliament, M.P.P.Kim Helmer Erie St. Clair CCAC Mary Gates Community Representative / Caregiver Robert DeLaet Erie St. Clair CCACKim Tessier Victorian Order of Nurses (VON)Maura Purdon Erie St. Clair CCAC Robert Dye Erie St. Clair CCAC Board Kim Brooks Bayshore Home Health of DirectorsMaureen Eyres Erie St. Clair CCAC

Kim Evans Erie St. Clair CCAC Robert Lefebvre Erie St. Clair CCACMelanie Evers Community Representative Kim Van Dam Heron Terrace / Caregiver Ron Sheppard Erie St. Clair LHINKristen Williams Chatham-Kent Community Melissa Murdoch Bayshore Home Health Rose Shepherd Erie St. Clair CCACHealth Centre

Merle Duchesne LifeMark Health Centre Sadra Hardeep Windsor-Essex Community Larry Lafranier St. Joseph's Hospice Health CentreMichael Timmerman Country Village Laura Campbell Marshall Gowland Manor Health Care Centre Sally Bennett Alzheimer Society of Windsor Laura Johnson Chatham-Kent Family & Essex CountyMichelle Mineau Erie St. Clair CCACHealth Team Sandra Lariviere Erie St. Clair LHINMichelle Penfold Erie St. Clair CCACLaura Stewart Erie St. Clair CCAC Sandra Lascelle Erie St. Clair CCACMichelle Reinisch Community Laurie Badder Erie St. Clair CCAC Representative / Caregiver Sandra Trubyk Erie St. Clair CCACLaurie Taylor Erie St. Clair CCAC Michelle Roe The Office of Bob Bailey, Sara Lopetrone Erie St. Clair CCACLawrence Graham Erie St. Clair CCAC Member of Provincial Parliament, M.P.P.

Sara Plain Aamjiwnaang First NationLinda Baptista South Essex Community Monica Lewandowski Erie St. Clair CCAC

Sarah Milner Central Lambton Family Council Monique Murray Erie St. Clair CCAC Health Team


Shannon Kondracki Erie St. Clair CCAC Tammy Fauteux Canadian Red Cross Warren Reinisch Erie St. Clair CCAC Board of DirectorsShannon Nead Community Representative Tanya Adams Banwell Gardens

/ Caregiver Wendy Asher Lambton CollegeTaras Natyshak Member of Provincial Sharon Benishek Community Representative Parliament, M.P.P. Ying Zhao Erie St. Clair CCAC/ Caregiver Teresa Piruzza Past Member of Provincial Yolanda Stanczak Community Representative Shelley Simone Erie St. Clair CCAC Parliament, M.P.P. / Caregiver

Shelley Wilkins Municipality of Chatham-Kent Theresa Renaud Erie St. Clair CCAC Yvan Poulin Erie St. Clair / South West French Language Health Planning EntitySofia Montgomery Erie St. Clair CCAC Tina Badour Erie St. Clair CCAC

Stephanie Ferrera Local Immigration Tina Beneteau Assisted Living Partnership Southwestern Ontario

Sue Denomy Bluewater Health Tiziana B Berlasty Erie St. Clair CCAC

Sue Gelinas Erie St. Clair CCAC Tom Bain County of Essex

Sue Oneschuk Community Representative Tony Hebert Erie St. Clair CCAC/ Caregiver Tricia Geerts Red Cross Care PartnersSue Watson VHA Home Healthcare Tricia Khan Erie St. Clair CCACSusan Wood Erie St. Clair CCAC Trina Ciphery Erie St. Clair CCACSuzanne Leonard Erie St. Clair CCAC Tony Mallette Lambton CollegeSylvia Persaud Erie St. Clair CCAC Walter Copeland Erie St. Clair CCAC Board Tami Gillier Riverview Gardens of Directors


FEEDBACK & QUESTIONSIn order for the CCAC to continually improve its quality of service, we welcome feedback from our patients and

our communities. We encourage you to contact us with any feedback or questions you may have about our

2103/14 – 2016/7 Strategic Plan or our services.

The Erie St. Clair CCAC is committed to providing accessible information and communication to all patients, employees,

partners and public. As such, we recognize that persons with disabilities may require information in accessible formats.

Should you require this document or any CCAC materials or communications support in an accessible format or if you

would like to provide us with feedback, we would like to hear from you.

Please present your questions, comments or requests to the Erie St. Clair CCAC in person, or in the following ways:

Connect with the CCAC:By phone .................................................. 1-888-447-4468

TTY ........................................................... 519-258-8092

By email ................................................... [email protected]

Via the internet ........................................ healthcareathome.ca/eriestclair

By mail ..................................................... 712 Richmond Street, PO Box 306, Chatham, Ontario N7M 5K4

Please also join the conversation and connect with us on the following social networks:

Facebook (https://www.facebook.com/eriestclairccac)

Twitter (https://twitter.com/ErieStClairCCAC)

LinkedIn (http://www.linkedin.com/company/erie-st.-clair-community-care-access-centre)

YouTube (http://www.youtube.com/user/ErieStClair)

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partners in care - erie st. clair ccac strategic plan 2014/2015

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