Implementing the Integration

Planning Program
Implementation Plan for the Integration Review Project: “Advancing
the Integration Conversation”
October 7, 2016
 Toronto Central LHIN
INTEGRATION PLANNING PROGRAM: IMPLEMENTATION PLAN

TABLE OF CONTENTS

1. EXECUTIVE SUMMARY ...................................................................................... 4

2. IMPLEMENTING THE INTEGRATION REVIEW RECOMMENDATIONS..................... 6

3. RECOMMENDATIONS OF THE INTEGRATION REVIEW PROJECT ........................... 8

4. DESIGNING THE PATH FORWARD ...................................................................... 9

5. IMPLEMENTATION PLAN: HOW TO EXECUTE.................................................... 11

Recommendations Inform Steps of an “Integration Planning Program” ......................... 11
Alignment of Integration Planning Program to Recommendations ................................. 12
Step 1: Change Management Planning & Execution ........................................................ 13
Step 1.1 Change Management Planning ................................................................. 13
Step 1.2 Communications Planning ........................................................................ 14
Step 1.3 Integration Knowledge Centre Development ........................................... 14
Step 1.4 Integration Toolkit Launch ........................................................................ 14
Step 2: Governance Setup ................................................................................................ 15
Step 2.1 LHIN Sub-Region Integration Planning - Governance Setup ..................... 15
Step 2.2 Governance-to-Governance (G2G) Planning & Execution ........................ 15
Step 3: Opportunity Identification & Prioritization .......................................................... 16
Step 3.1 Population Health & Needs Assessment................................................... 16
Step 3.2 HSP Performance Assessment .................................................................. 17
Step 3.3 Organizational Assessment Tool Application ............................................ 17
Step 3.4 Prioritization & Opportunity Identification............................................... 17
Step 4: Implementation .................................................................................................... 18
Step 4.1 Support Voluntary Integrations ................................................................ 19
Step 4.2 Support Facilitated Integrations – HSP Focus ........................................... 19
Step 4.3 Support Facilitated Integrations – Population Health Focus .................... 19
Step 5: Evaluation ............................................................................................................. 20
Step 5.1 Evaluation Setup & Planning ..................................................................... 20
Step 5.2 Conduct Ongoing Monitoring & Evaluation .............................................. 21

6. PROGRAM IMPLEMENTATION IS COMPLEX ..................................................... 22

Attitudes 22
Conditions 23
Resources 24
TC LHIN Staff ........................................................................................................... 24

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Communications Support ....................................................................................... 25

Additional Funding .................................................................................................. 25

7. MEASURING OUR SUCCESS.............................................................................. 26

Reporting................................................................................................................. 26

8. APPENDICES ................................................................................................... 27
Appendix 1: Guiding Principles ......................................................................................... 27
Appendix 2: Detailed Implementation Plans .................................................................... 29
Appendix 3: Detailed Timeline .......................................................................................... 30
Timeline and Dependencies Table .......................................................................... 31
Appendix 4: Implementation Support Tools ..................................................................... 33
A. Change Management Framework ............................................................. 33
B. Stakeholder Analysis Tool .......................................................................... 34
C. Communications Strategy Template .......................................................... 36
D. Organizational Assessment Tool ................................................................ 37
E. Scorecard Tracker ...................................................................................... 38
F. Issues and Gaps Roster .............................................................................. 39

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1. Executive Summary
Health Service Providers (HSPs) and the Toronto Central LHIN have a shared accountability to
build a health care system that provides the best possible experiences and health outcomes for
clients, patients and their families, while delivering excellent value. Integration activities –
including partnerships, collaborations, program and service transfers, as well as mergers – are a
strategic option that should be considered by local HSPs to be able to deliver the best services to
Toronto Central LHIN residents. No organization has the knowledge, skills or capacity to do it all,
so system partners must work in new ways together to achieve common goals.

In early 2016, the Toronto Central LHIN commissioned the Integration Review Project to identify
opportunities for more effective integration of services to achieve better and equitable overall
outcomes for the entire Toronto Central LHIN population. This project resulted in seven (7)
recommendations that were endorsed by the Toronto Central LHIN Board of Directors. This
document outlines an implementation plan for these recommendations through a set of
integrated implementation activities, the Integration Planning Program.

Built on change management principles, and through consultation with a variety of experts on
integration, the Integration Planning Program is also aligned with the Toronto Central LHIN goals
of a Healthier Toronto, Positive Patient Experiences, and System Sustainability.

The Integration Planning Program includes five (5) major steps to be implemented over a three-
year timeframe:

Many of the steps and sub-steps for the Implementation Plan will be implemented simultaneously
and complement each other – successes in one area will contribute to successes in others.
Furthermore, many elements of the implementation will begin immediately, whereas other
elements will not begin until later in Year 1 or even Year 2 given their dependencies on other
activities within this Program, or with local or provincial directions. Key elements of Steps 1, 3, 4,
and 5 will begin immediately in November 2016, while Step 2 will begin later in 2017 in alignment
with the launch of the LHIN Sub-region Planning Tables.

The following graphic provides the sequencing for implementation of the Integration Planning
Program.

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This document describes the activities, timelines, and considerations for successful
implementation of the Integration Planning Program, and an approach to measuring progress and
outcomes.

2. Implementing the Integration Review

Recommendations
Health Service Providers (HSPs) and the Toronto Central LHIN have a shared accountability to
build a health care system that provides the best possible experiences and health outcomes for
clients, patients and their families. Decreased growth in health spending, developments in health
policy, new models of care and technology advancements, and the evolving needs of the
populations served require new ways of thinking and new ways of supporting the delivery of
health care and support services. Consultations with clients, patients and HSPs confirm that in this
changing environment it is imperative that HSPs and the Toronto Central LHIN seek different and
better ways of thinking about and pursuing integration. This does not mean only mergers – but
rather, and perhaps more importantly, it is about:
 Establishing formal partnerships and collaborations between relevant HSPs to better
meet the needs of specific client and patient populations in a geography;
 Formally articulating and strengthening the continuum of care across HSPs and sectors
for clients and patients with specific care conditions;
 Standardizing approaches to care and service in focused sectors;
 Integrating programs and services to improve quality, access and outcomes; and,
 Building shared capacity in key back office functions that are necessary to support the
efficient and effective delivery of care.

In early 2016, the Toronto Central LHIN commissioned the Integration Review Project to identify
opportunities for more effective integration of services to achieve better and equitable overall
outcomes for the entire Toronto Central LHIN population. Specifically, the Toronto Central LHIN
asked the Integration Review Project Steering Committee to consider the following:
1. How to leverage continued success and build the momentum of voluntary integrations;
2. When and how the Toronto Central LHIN should use facilitated integrations; and,
3. To identify specific opportunities in the Toronto Central LHIN where integration could be
used as a means to improve system performance, as well as outcomes and experiences
of clients and patients

As a result, the Steering Committee developed a framework for understanding the spectrum of
integration activities, to emphasize that this is not just about mergers and acquisitions - it is also

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about formal partnerships and collaborations of all types that create systems of care for our
clients and patients that will lead to the best outcomes, experiences, and value for money:

In April 2016, the findings of the review and seven (7) recommendations were presented to, and
endorsed by, the Toronto Central LHIN Board of Directors. As a next step, the Board of Directors
asked that the Toronto Central LHIN staff develop a comprehensive work plan to define activities
and considerations for the implementation of all of the Integration Review Project
recommendations. This document describes the activities, timelines, and considerations for a set
of integrated implementation activities, the Integration Planning Program, that will achieve the
outcomes described in the Integration Review Project report, and that is aligned with broader
LHIN and provincial directions.

The full Integration Review Project Report and Reference Document (including Integration
Toolkit) can be found at the following location:

http://www.torontocentrallhin.on.ca/forhsps/intergration.aspx

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3. Recommendations of the Integration Review

Project
The Integration Review Project identified the following recommendations, which were informed
by clients, patients, and HSPs, and by what leading practices suggest should be done:

Recommendations to the LHIN

Create a Culture of Integration and Change
Recommendation 1: Create a shared understanding across the Toronto Central LHIN that integration
means a spectrum of activities – not only organizational mergers – to create desired change,
including partnerships, collaborations, transfers and consolidations of programs, services, and back
office administrative functions within and across sectors.
Drive Effective System Performance
Recommendation 2: The Toronto Central LHIN should establish Sub-LHIN Region Integration Tables
tasked with system planning, and identifying, prioritizing, and coordinating integrations that will
create better client/patient outcomes and experiences, especially in community mental health and
addictions, home and community care, and primary care services and programs, consistent with
existing Service Accountability Agreements, the Toronto Central LHIN’s agreement with the Ministry
of Health and Long-term Care, and the Toronto Central LHIN’s Strategic Plan priorities.
Recommendation 3: The Toronto Central LHIN should drive system change by identifying,
encouraging, and if needed, facilitating and supporting integrations that will have a measureable
positive impact on the health of the population in Toronto Central LHIN and beyond, consistent with
existing Service Accountability Agreements, the Toronto Central LHIN’s agreement with the Ministry
of Health and Long-term Care, and the Toronto Central LHIN’s Strategic Plan priorities.
Build Capacity and Success for Health Service Providers
Recommendation 4: To build the viability and effectiveness of health service providers, the Toronto
Central LHIN should actively work with those HSPs which are struggling to meet performance targets
to identify and act upon strategic options that may include a range of integration solutions.
Recommendation 5: The Toronto Central LHIN should facilitate inter-HSP conversations at the HSP
governance level about the benefits and realities of integration to create Toronto Central LHIN-wide
momentum for Voluntary Integration strategies.
Sustain and Build on the Successes of Voluntary Integrations

Recommendation 6: The Toronto Central LHIN should create and maintain an integration knowledge
centre to share the successes and challenges of integration and to support those exploring,
assessing, planning and implementing integrations in Toronto Central LHIN.

Recommendation 7: The Toronto Central LHIN should widely launch the Integration Toolkit to
enable Health Service Providers to explore, assess and plan for Voluntary Integrations.

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4. Designing the Path Forward

The Implementation Plan was developed through a consultative process that leveraged the
successes and lessons learned through the development of the Integration Review Project, in
which over 400 stakeholders were engaged in early 2016. Additional engagement activities were
conducted in Fall of 2016 with the following groups:

Toronto Central LHIN Senior LHIN Representatives from

Integration Review Project
Leadership and members of non-Toronto Central LHIN
Steering Committee
the Board of Directors regions

• Individuals were •The full steering •Leadership of a number

engaged in interviews committee participated of LHINs participated in
and/or working sessions in a series of three interviews to provide
to understand key local working sessions to build detailed implementation
priorities and to ensure and refine the content of process steps and specific
alignment with local and this document, considerations that have
provincial directions and incorporating critical been applied in this
complementary work themes gained through implementation plan,
streams experiences doing developed through their
different types of experiences in
integration activities and implementing similar
transformations initiatives.

The findings from engaging the above groups through over 20 interviews and multiple working
sessions were used to design the Integration Planning Program, which is a comprehensive
program of implementation activities that work together to achieve the desired deliverables and
outcomes as articulated in the seven (7) recommendations of the Integration Review Project. The
following graphic provides an overview of the plan to implement the Integration Planning
Program (further details on each step are provided in later sections):

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The implementation of the steps is a complex undertaking, so additional considerations and

context have been provided to supplement the activities. The following framework was applied
to categorize various implementation considerations relevant to each step:

Measures (Integration Review Project

Dimension Definition and/or implementation planning
process)

The political economy for Engagement: Interviews, survey and

change: the vision of a focus groups with clients, patients,
Attitudes different future and the caregivers, HSP Leaders and Board
motivations and members, LHIN (Toronto Central and
commitment to achieve it other) and Ministry of Health and Long-
Term Care representatives
The laws, structures,
systems, etc. necessary to
Conditions Data & Documentation Review:
mandate, support and
Engagement findings through various
manage the change
forums (e.g. Patients First
consultations); pertinent strategic
The human, physical and
planning documents (local and
financial resources needed
Resources provincial); population health and
to support or facilitate the
utilization data; literature and leading
change
systems research

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5. Implementation Plan: How to Execute

Recommendations Inform Steps of an “Integration Planning Program”
The recommendations were designed to achieve a set of objectives through a process of parallel
implementation, where success on one recommendation will result in success in others.
Accordingly, there are significant interdependencies between the different recommendations, so
the approach to implementing all seven must be to consider them as a package, through the
design of an “Integration Planning Program.”

The Integration Planning Program is made up of five major steps that support the execution of all
seven (7) recommendations, including:
1. Change Management Planning & Execution;
2. Governance Setup;
3. Opportunity Identification & Prioritization;
4. Implementation; and,
5. Evaluation.

The figure below identifies the sub-steps within each of the major steps, which are described in
further detail in the remainder of this Section, as well as in Appendix 2.

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Alignment of Integration Planning Program to Recommendations

The five steps of the Integration Planning Program are fully aligned with each of the 7
recommendations, and the approach is expected to achieve all outcomes as indicated in the
Integration Review Project. The figure below notes which recommendations are specifically
fulfilled by each step in the Integration Planning Program.

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Step 1: Change Management Planning & Execution

The foundational first step in implementation of the Integration Planning Program is essential in
setting the context for integration across the LHIN – integration is a spectrum of activities, not
just about mergers and acquisitions. Partners within the LHIN are being called on to think about
integration in new ways, requiring careful design and change management to ensure that local
transformation is done right. The following steps provide an overview of the implementation
activities that are needed to develop and apply leading practice change management principles,
and to establish tools and infrastructure to support integration activities (Additional detail on each
of the implementation steps and considerations is provided in Appendix 2).

Step 1.1 Change Management Planning

Engaging HSPs and system partners in real dialogue will be critical to expanding on definitions of
integration (across the spectrum) that can support the evolution of a culture of integration and a
clear common vision for its application as a tool that achieves common system goals. The impetus
for change through integration is grounded in basic principles tied to the goals in the LHIN’s
Strategic Plan; increasing the quality of client and patient outcomes and experiences, and creating
a more sustainable system.

Development of a comprehensive change management plan is imperative for generating buy-in

and ensuring effective implementation of integration across the LHIN. The plan will be based on
best practice change management strategies that involve creating a common vision for change,
good leadership, meaningful engagement, empowerment of teams, innovation and focus on
sustaining successes. Identifying change leads and champions will help to foster peer-to-peer
discussions across the region, generate trust and support the creation of a culture of
accountability. A Change Management Framework is provided in Appendix 4 to support change
planning.

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Step 1.2 Communications Planning

Consultations revealed that for some HSPs in the LHIN, integration is a term that elicits feelings of
anxiety and fear about the impact of change, while others indicated that they are excited about
the possibilities that integration can provide. Underpinning a solid change management plan will
be the development and implementation of a full and targeted communications plan that is
informed by the values and motivations of each stakeholder group and that highlights incentives
for participation. A comprehensive communications plan will provide a means to mitigate risks by
clarifying key messages and fostering trust by demonstrating a commitment to transparency. In
addition, celebration of successful integrations that positively impact organizational and/or
system performance will spur excitement and promote integration as a valuable tool. Timing and
frequency of communications must be considered and feedback mechanisms embedded to
promote engagement and respond to questions. A Communications Strategy Template is
provided in Appendix 4.

Step 1.3 Integration Knowledge Centre Development

Change and integration momentum will be supported by the launch of the Integration Knowledge
Centre to provide resources and foster engagement with the topic of integration between HSPs
and throughout the LHIN. The design of the Knowledge Center needs to involve consultation with
future users to understand their needs and ensure the system will respond to them.
Technical/hosting requirements for the centre will need to be identified and it should be built on
existing infrastructure, as possible. Stakeholders will need to be engaged to build out Knowledge
Centre content and contribute on an ongoing basis post-launch. Information will need to be
monitored for utility and feedback should be elicited often to identify gaps to be addressed.

Step 1.4 Integration Toolkit Launch

The Integration Toolkit will be widely launched across the LHIN as a tool to increase understanding
of the spectrum of integration activities and to serve as a resource for HSPs. The Toolkit is a
resource that can support HSPs and systems to begin self-assessments for integrations of all types,
to identify potential integration partners, to assess the feasibility of potential integration
opportunities and to begin planning for implementation. Launch of the Toolkit will be integrated
into the overall Integration Communications Strategy and aligned with other dissemination and
knowledge transfer activities, leveraging existing and new forums, online locations, and
communication blasts. The benefits of using the Toolkit will be highlighted and TC LHIN staff will
need to promote use through their day-to-day efforts. Evaluation of the impact and relevance of
the Toolkit’s content will be considered on a regular basis, and it will be updated, as required.

Additional implementation detail and considerations are provided in Appendix 2.

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Step 2: Governance Setup

While discussion about integration will need to be fostered at all levels, it is particularly important
that the program be planned, monitored and promoted at a system and governance level, with
the engagement of stakeholders outside the Toronto Central LHIN itself. HSP leaders will be
involved proactively in this process through the LHIN Sub-Region Planning Tables and board
members through G2G meetings that stimulate productive discussion and offer real value.

Step 2.1 LHIN Sub-Region Integration Planning - Governance Setup

LHIN Sub-Region Planning Tables are currently being established across the LHIN, and are being
tasked with system planning; local system partners will be developing plans to create better
systems of care that are focused on improving outcomes, experiences and value in communities.
Integration is one tool that the partners may apply to achieve these outcomes. Building on the
activities and structures of the LHIN Sub-Region work stream occurring in parallel, integration
discussions will be required to complement the other activities and to build momentum across
the LHIN.

For each LHIN Sub-Region, an Integration Facilitator will need to be identified and a governance
structure established to drive participation in Planning Tables, and to manage discussions about
integration. LHIN-wide parameters for the role of the Planning Tables and specific Terms of
Reference will need to be developed in alignment with the Sub-Region planning work stream, as
well as a regular schedule for forums to discuss system gaps and opportunities and how
integration activities could respond. It will be important to ensure alignment with broader change
management and communication efforts to address apprehensions and to promote messaging of
integration as a means to achieve LHIN-wide goals.

Step 2.2 Governance-to-Governance (G2G) Planning & Execution

Benefits and realities of integration as a means to achieve system-level goals will be further
understood by facilitating inter-HSP conversations at the governance and leadership levels.
Scheduling focused meetings with clear objectives on a quarterly basis with HSP Board members
and Senior Leaders from across the LHIN and Sub-Regions, depending on topics, will be important
to facilitate the desired integration conversations. To drive attendance and sustainability,

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agendas will include components of education, celebration, actions, decisions and guest speakers
that support collaboration and promote integration as a strategic option. Each meeting needs to
have clear purpose and objectives focused on overall opportunity, rather than operational
barriers, and will include a report out of key discussion messages and action items. Effectiveness
will be evaluated after each meeting and over time.

Additional implementation detail and considerations are provided in Appendix 2.

Step 3: Opportunity Identification & Prioritization

The ability of integration to support the creation of a more sustainable and client-centred system
rests on the collection, analysis and interpretation of quality data that leads to accurate and
effective identification of integration opportunities. These opportunities may be driven by unmet
population health needs or underperforming HSPs. While data can draw attention to an
opportunity, it simply provides the starting point to dig deeper into the details of the situation,
where discussion with HSPs and Sub-Region Planning tables will be needed to clarify what is really
going on. Once information is validated, activities that best serve the achievement of system goals
can be prioritized.

Step 3.1 Population Health & Needs Assessment

A key means of identifying opportunities for system improvements that can be supported via
integrations will be through the assessment of the population health needs across the LHIN and
in each Sub-Region. Ways in which population health needs can be measured using existing
population data will first need to be identified, and then findings consolidated into population
health data packages to be shared at the Sub-Region level. Sub-Regions will need to help validate
data using evidence drawn from their experiences, to identify root causes and to prioritize local
needs to inform a LHIN-wide needs and capacity assessment that will provide a deep dive into the
issues and to direct resources to priorities. LHIN Decision Support will be required to support data
analysis and interpretation, and measures for population health should be outcome-based and
focused on system-level progress (i.e. ALC, Readmissions, etc.).

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Step 3.2 HSP Performance Assessment

To conduct a performance assessment of HSPs, a key first step is to confirm the metrics and
measures that will be used to assess the ‘health’ of LHIN-funded organizations, with most metrics
leveraged from the HSP360 tool and Service Accountability Agreements. Once confirmed, these
metrics can be used to conduct a general assessment of HSPs, and determine which are falling
below the median when compared to all HSPs across the LHIN on particular metrics. As part of
the analysis, the LHIN will work with identified HSPs to confirm and validate data and to
collaboratively develop solutions to address any issues. Results will inform a performance
discussion with all HSPs to determine the reasons for their performance, whether good or bad,
and serve as a platform for regular conversations of continuous quality improvement. While
integration may be a strategic option to address issues, it must be carefully considered in each
specific context to ensure it is an appropriate approach.

Step 3.3 Organizational Assessment Tool Application

To support a deeper assessment of HSPs that have either been identified through the
Performance Assessment or that are going through transitional change of some sort, the LHIN will
apply the Organizational Assessment Tool to assess risk factors related to sustainability and
operational effectiveness. It will also be available to HSPs to support self-assessment and will help
to drive integration dialogues, given that it would include key measures that indicate candidacy
for integration.

To support uptake, the LHIN will develop a launch plan for the Tool that includes target audiences
and awareness-building approaches. Once launched, LHIN staff can start using the Tool, applying
it to those organizations that have been identified as low (below median) performers. To support
broader use beyond LHIN staff, the Tool will be launched across the entire LHIN, with HSPs
encouraged to adopt it and apply it themselves to their own organizations.

Based on results from these assessments, additional organizations that require facilitated
integration support will be identified, and LHIN involvement will be defined based on criteria
established in the Integration Review Project. Overall, the application of the Tool will be
encouraged to occur twice a year for organizations below the median (at least one of which will
occur during the SAA review cycle).

Step 3.4 Prioritization & Opportunity Identification

Integration is a tool that can be used to address issues with individual HSPs, but also to improve
care systems to better population health. Based on the results of the population needs
assessment, HSP performance assessments, and the assessments done using the Organizational
Assessment Tool, the LHIN should develop a list of priority HSPs and/or care pathways that may

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be candidates for integration of various types. These candidates will be included in an annual
LHIN-wide Integration Implementation Plan that identifies specific steps and milestones, and also
assigns accountabilities.

In alignment with the Integration Implementation Plan, the LHIN will initiate conversations with
candidate HSPs and system partners to determine their appetite for voluntary integration. Based
on the list of candidates and their readiness for different types of integration, the LHIN can then
work to support a combination of voluntary and facilitated integrations, using the Toolkit
described in the Integration Review Report to determine the escalation process for intervention,
where voluntary is always the preferred method.

Additional implementation detail and considerations are provided in Appendix 2.

Step 4: Implementation
Voluntary integrations are the ideal processes that should be supported and encouraged, where
groups come together when it makes sense and have a solid case for integrating, in whatever
form. The LHIN can play a key role in promoting voluntary integrations by acting as a collaborative
partner and providing essential resources and support to support exploration, assessment of
feasibility, and planning and implementation. There will be instances when HSPs and system
partners require additional support to build the necessary momentum, and the LHIN will have a
more active role in encouraging those opportunities to progress when the case is strong. In those
instances, when the need for integration has been identified as a priority – whether as a result of
HSP or system performance or population health - the LHIN will need to step in and facilitate the
process in alignment with the escalation protocol indicated in the Integration Review Project.

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Step 4.1 Support Voluntary Integrations

When HSPs and care systems indicate their intentions to explore integration voluntarily, the LHIN
will provide appropriate levels of support to these efforts. This will include assessing the
appropriateness of the integration (based on the Principles outlined in Appendix 1). If deemed
appropriate, the LHIN will then support the various phases of integration, as required, including
exploration, assessing feasibility, planning, and implementation. If the integration is not
determined to be beneficial, then the LHIN can also help determine how the proposed integration
model can be redesigned to increase its feasibility and appropriateness. The LHIN will then
monitor the progress of the integration as appropriate, identifying potential risks on an ongoing
basis. Lessons and outcomes from this work will also be added to the Integration Knowledge
Centre.

Step 4.2 Support Facilitated Integrations – HSP Focus

Based on the results from the data and performance analysis in Step 3, the LHIN will prioritize and
identify the HSPs that would benefit from LHIN intervention to implement an integration plan that
is well supported by evidence and that has high potential to create substantial improvements in
client outcomes, experiences and overall value.

Based on this list, the LHIN will initiate exploratory conversations with relevant HSPs and partners
to determine their appetite for pursuing integration. The output of these dialogues will be a
pathway to voluntary integration or the initiation of a facilitated integration process (with as little
LHIN intervention as is absolutely necessary). The LHIN will bring together CEOs/EDs and Board
Chairs from relevant organizations to assess evidence and risk, and determine an action plan to
move forward – through integration or other means. Based on this action plan, the LHIN will
provide the appropriate level of support to facilitate the integration, leveraging the escalation
protocol described in the Integration Review Project Report. From there, the LHIN will monitor
and support facilitated integrations on an ongoing basis. Lessons and outcomes from this work
will also be added to the Knowledge Centre.

Step 4.3 Support Facilitated Integrations – Population Health Focus

In parallel to the integration efforts that are focused on HSP performance and sustainability, the
data and performance analysis from Step 3 will also support the identification of population
health needs that can be more effectively addressed using models of integrated services. Based
on the data, the LHIN will work with the Sub-Region Planning Tables to understand if momentum
to address population needs is sufficient, and then identify potential HSP and program/service
groups that are best positioned to address these priority populations.

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Once opportunities are identified, the LHIN will initiate conversations with relevant HSPs and
partners to determine if there is openness to voluntary integration, or if a facilitated integration
process is required. If organizations are not open to considering these options, the LHIN will then
bring together EDs/CEOs and Board Chairs from relevant organizations to assess strategic options
and determine an action plan to move forward. Based on this action plan, the LHIN will provide
the appropriate level of support to facilitate the integration, leveraging the escalation protocol
described in the Integration Review Project Report. From there the LHIN will monitor and support
facilitated integrations on an ongoing basis. Lessons and outcomes from this work will also be
added to the Knowledge Centre.

Additional implementation detail and considerations are provided in Appendix 2.

Step 5: Evaluation
Ongoing evaluation will be a key component of the Integration Planning Program to monitor
effectiveness and support continuous improvement and ongoing relevance of the Integration
Planning Program. Integrating evaluation into program activities from the outset will facilitate
this, and will enable the LHIN to monitor both progress on program implementation as well as on
system-level outcomes as a result of integration activities. Results of evaluation activities will be
monitored and communicated at regular intervals and improvements made towards ongoing
implementation management.

Step 5.1 Evaluation Setup & Planning

To support monitoring and evaluation efforts throughout the integration, the LHIN will first focus
on evaluative planning, setting up the structures and processes that will be used throughout the
implementation. A key first step will be to validate the logic model and theory of change for the
Program that was developed in September 2016. Based on the strengthened model, the LHIN will
then determine the specific Integration Program components that should be monitored and
evaluated directly, such as the Change Management Strategy, the Knowledge Centre and the G2G
sessions.

To support the overall evaluation, outcome data collection methods will be built into ongoing HSP
integration activities. In addition, data collection tools and approaches will be designed to monitor
each of the distinct integration activities. The LHIN will build a data repository to support ongoing
tracking, data management, and reporting, as well as a reporting template that will support

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updates to LHIN senior management and the Board on integration activities, outputs, outcomes
and impact.

Step 5.2 Conduct Ongoing Monitoring & Evaluation

Following evaluation planning, the LHIN will be able to conduct a variety of monitoring and
evaluation activities throughout the implementation process. This will include adding reporting
and results check-ins to LHIN meeting agendas, to ensure results are monitored and support
ongoing implementation management and improvement. Based on the planned evaluation
activities, the LHIN will conduct formative evaluations of integration activities, tools, and outputs,
such as the Knowledge Centre and Integration Toolkit. These evaluations will occur on an annual
basis.

Near the end of Year 2, the LHIN will begin annual outcome-focused evaluations of HSP
integrations. These evaluations will focus on determining the extent to which individual
integrations achieved improvements in the quality of service, the client and patient experience or
addressed HSP sustainability issues. It will also assess how these integrations supported the LHIN’s
strategic priorities. These evaluations will primarily be focused on individual HSPs that have gone
through an integration, as well as care pathways that have been integrated, and can occur on an
annual basis beginning in Year 2. Based on the evaluation plan, available results can support
monthly reporting to LHIN senior management, as well as quarterly reporting to the TC LHIN
Board.

Additional implementation detail and considerations are provided in Appendix 2.

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6. Program Implementation is Complex

To support the effective implementation of the Integration Planning Program, a number of
important considerations have been identified; general themes are described below within the
categories of Attitudes, Conditions and Resources. Additional detail is available in Appendix 2,
where specific considerations for each of the implementation steps are described.

Attitudes
For some HSPs in Toronto Central LHIN, integration is a term that elicits feelings of anxiety and
fear. These concerns are mainly rooted in uncertainty about how change is going to impact
programs and organizations, potential staff layoffs, maintaining the unique identities of HSPs and
their connections to diverse communities, and the possibility of relinquishing control or not
having a say in how services are provided. Other HSPs indicated that they are excited about the
possibilities that integration can provide across the LHIN, and how HSPs might work in innovative
ways together to build a more coordinated system that is well informed by the voices of clients,
patients, and their families, as well as by the staff delivering the services.

In building a culture of integration more broadly, some of the considerations for shifting negative
attitudes and leveraging positive attitudes include:
 Successfully developing a shared understanding that integration means a spectrum of
activities
 Establishing a larger vision for what an integrated system looks like and fostering an
underlying understanding that true transformation is required in alignment with guiding
principles
 Developing a culture of accountability for achieving system and client objectives and an
expectation of continuous improvement: “Am I doing this the best possible way?” “Am I
keeping up with leading practices?” “Is what I am doing having the intended impact?”
 Creating an understanding that no one organization has the capacity, skills, and
knowledge to serve all individuals in its community and ensure the best possible
outcomes, and therefore each one has an obligation to clients and to other organizations
in the system to work collaboratively and pursue integration activities in order to do so

Communications and change management practices will need to address any concerns
directly through open and transparent messaging:
 Always focus messaging on integration as a means to drive better outcomes, experiences
and value for our population
 Promote opportunities for integration, especially for those HSPs which are experiencing
sustainability issues, as a way to provide valued services in a more sustainable way and
better serve patient, client and community needs

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 Leverage Board forums to provide key messaging that will educate members and provide
support for integration conversations; leaders and Boards of HSPs are more likely to trust
other HSPs who have gone through integration processes; leveraging peer networks to
advance conversations and actions will support better success
 Communicate processes for decision-making and eligibility criteria effectively and
consistently using change management principles, clarifying that analyses are for
directional purposes and further discussion will always be part of the process

Conditions
The Integration Review Project and its recommendations are being implemented in a time of
complexity and transformation, and is not occurring in silo. Driven by the Patients First agenda,
the LHIN Renewal is a critical and widespread provincial initiative that this project complements
at a regional level. Given the immensity of the transformation, provincial direction will be a
significant influence on the way this Program is implemented over time, thus, the approach must
be flexible and adaptable, yet continuously focused on the guiding principles.

Promoting a culture of integration will require that the LHIN carefully attend to and manage
aspects of the environment that are within its control and use best practice change management
strategies to build and maintain momentum. As such, the following conditions will need to be
created:
 The core group for planning and implementing integration activities will need to include
key LHIN staff and leads for various LHIN Renewal forums and groups, representing key
sectors and groups; LHIN Sub-Region leads, Primary Care leads, Home and Community
Care integration leads, representatives of Community MH&A, Acute sectors,
patients/clients/caregivers
 Create an environment of open communication and lead by example, displaying expected
behaviours, and being consistent and clear with messaging. Ensure broad stakeholder
participation in all aspects of change management and system design. Start by identifying
change champions to own the overall change effort, guide change, build excitement,
ensure engagement and communicate, as well as change leads to enable implementation
of change, develop trust, coach staff and identify risks
 In communications and discussions, include specific examples of how integrations of all
types happened, as well as outcomes and lessons learned (as per integration knowledge
centre, using a case study approach), and promote HSP use of the Knowledge Centre to
contribute their own examples and lessons learned
 Data quality needs to rigorously and accurately reflect organizational and system
performance; improvements to the reliability of current database will be required to build
trust in the data

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 Tie success on integration initiatives to patient/client experience and outcomes with a

focus on continuous quality improvement and talk about experiences broadly, allowing
HSPs opportunities to celebrate their successes publicly as well

Resources
Implementing the Integration Planning Program will require support from a number of different
resources throughout the three-year implementation plan. Some resources will be required on
an ongoing basis to launch, promote and sustain a culture of integration and the processes, while
others will be needed only for specific activities over a limited period of time.

TC LHIN Staff
Creating a culture of integration must start inside the LHIN, where all staff will need to become
fluent with the goals of the program, elements of the implementation plan and available tools, to
champion integration activities across the LHIN. This is especially important for leadership and
staff who are responsible for monitoring performance, negotiating SAAs and communicating with
HSPs on a regular basis, as their roles will need to be expanded to include tasks and activities that
involve identifying integration opportunities, fostering discussions and facilitating integrations, as
necessary.
Integration Facilitator

It is recommended that the LHIN recruit a focused facilitator to drive integration-related work,
including developing and implementing change management and communications plans,
establishing governance forums, supporting Sub-Region planning, primary care and home and
community care integration, and setting up the infrastructure for tools and evaluation (in
alignment with these parallel work streams). It is anticipated that the Integration Facilitator will
be regularly working in the community with providers, clients/patients and other stakeholders to
co-design local health systems that are in alignment with overall LHIN goals, as well as driving data
analyses, and liaising with core members of the LHIN team. The role is likely a full time position
(1.0 FTE), with the additional support of the LHIN’s data analysis function. The Integration
Facilitator should have the following general attributes:
 Action-oriented
 Understand the human and political dynamics within TC LHIN, particularly across home
and community care, primary care and community mental health and addictions
 Ability to facilitate complex and challenging situations to achieve results
 Excellent communicator
 Understand provincial directions of LHIN Renewal and Patients First
 Experience in managing complex projects and stakeholder groups, specifically in system
transformation

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LHIN Decision Support

The Integration Planning Program is reliant on accurate and comprehensive data collection,
analysis and interpretation and will require LHIN Decision Support to extend its efforts in this
capacity to provide information that will identify integration opportunities based on population
health needs and HSP performance. LHIN decision support will likely help to support
supplementary data collection as well as key elements of the outcome evaluation, particularly as
it relates to HSP performance and outcomes, as well as system-level changes among MLAA
indicators. A capacity assessment of the current data functions within the LHIN should be
completed to understand ability to take on this role, or if a new position is required.

Communications Support
The Communications function will be required to support the development of the
communications strategy, as well as to execute the activities that will be outlined in the plan. This
will include involvement of the Senior Director as well as other communications staff in strategy
development to write communication briefs, prepare presentations, among other activities. The
demand on the Communications Department will be greatest during the first year, as
communications will be a major support of successfully implementing the change management
plan.

Additional Funding
Funding will be required to support a number of implementation activities; the largest cost is
anticipated to be direct funding support to HSPs who are pursuing various stages of integration,
to provide funding for project management support, mediation, legal, consulting, research, etc.
As the momentum for integration builds, there will likely be more demands on LHIN resources for
these purposes, so selection criteria will need to be developed to support decision-making.

In addition, many integration program activities will take the form of events or workshops. Each
of these may require a combination of funding to support these activities (event space, catering,
and materials) as well as logistical support (planning, coordination, etc.). The logistical support
could likely fall under the duties of the facilitator noted earlier. One-time funding will be necessary
for development of the Knowledge Centre, as well as limited funds for ongoing maintenance.

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7. Measuring our Success

As described earlier, and outlined in detail in Appendix 2: Detailed Implementation Plans,
monitoring and evaluation are key components of the Integration Planning Program. While Step
5 outlines specific activities and indicators for each component of the integration logic model, a
small number of key indicators should be monitored on an ongoing basis. These indicators
summarize results from key elements of the integration program, and will help demonstrate if the
integration efforts are on track. They are primarily focused on the volume and type of integrations
that are occurring, in addition to key activity and output summary measures. The dashboard also
includes some measures of outcomes and impact of the integration work, which may not see
results until the later years of the integration. The dashboard should be updated monthly based
on available data.
Dashboard Indicators Data Source
Volume of G2G sessions TC LHIN (via Integration activity work plan,
activity history)
Total # of integrations planned or TC LHIN (via Integration business case
approved submissions, and HSP outreach)
# of successful integrations that used the HSPs (via self-reporting, service accountability
Toolkit or Knowledge Centre agreements, and outcome evaluation data
collection)
Proportions of integrations that have HSPs (via self-reporting, service accountability
achieved their expected outcomes agreements, and outcome evaluation data
collection)

Reporting
The dashboard, along with other elements of the integration evaluation, will support multiple
types of ongoing reporting. The dashboard, along with additional activity and output measures
will support ongoing monitoring of the integration activities, particularly in its first year where the
focus will be on the implementation process. It will also support the longer-term assessment of
program outcomes, as the volume of integrations increases and HSPs determine their expected
outcomes. During the course of the implementation, it is expected that the dashboard will support
monthly reporting to LHIN management, including those that oversee the suite of integration
efforts. The dashboard will also support quarterly reporting to the LHIN Board. The LHIN should
also consider an annual summary of integration efforts and results that can support the LHIN’s
Annual Report. This summary would also be supported by the dashboard, and could be
supplemented with additional measures (outlined in the Appendix), and success stories, either
from recent integrations or based on those that are added to the Knowledge Centre.

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8. Appendices
Appendix 1: Guiding Principles
An output of the Integration Review Project was a list of Guiding Principles that are meant to
inform integration discussions. The Guiding Principles are aligned with TC LHIN goals, and meant
to inform HSPs as they consider potential integrations. These Guiding Principles have been
summarized below.

Guiding Principle Description and Desired Outcome of Guiding Principle

Toronto Central LHIN Goal: A Healthier Toronto

Integration The integration will streamline transitions along the continuum of care, leading
should improve to fewer clients/patients missing needed care.
transitions along This principle speaks to the Patients First: Ontario’s Action Plan for Health Care.
the continuum of The “Patients First” mandate focuses on connecting services – delivering better
care coordinated and integrated care in the community, closer to home.
It also aligns to the Toronto Central LHIN’s vision of a health care system which
will provide coordinated plans of care for targeted populations to assist them to
get the right care when and where they need it.

Integration The integration will improve overall health of communities by minimizing health
should create disparities and responding to the needs of at-risk populations or those with poor
healthier health outcomes.
communities in
Toronto Central
LHIN

Toronto Central LHIN Goal: Positive Patient Experiences

Integration Integration will improve the quality of programs and/or services provided,
should enhance leading to better health outcomes and client/patient experiences.
client/patient
health outcomes
and experience

Integration Integration will enhance access to programs and/or services for populations or
should improve geographies in the Toronto Central LHIN.
access to care

Toronto Central LHIN Goal: System Sustainability

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Guiding Principle Description and Desired Outcome of Guiding Principle

Integrations Integration will link together different sectors such as health, public health,
should be broad housing, social services, justice and many others to collaboratively improve the
reaching and health of the broader population through clear care/support pathways for
have system- clients/patients.
level impacts Integrations should help programs/services work better together in small regions
or areas to provide focused care that addresses the holistic, broad and unique
needs of the local communities.

Integrations Integration will enhance the operations and financial stability of the partners as a
should create whole, leading to an enhanced ability to meet yearly performance and financial
sustainability and targets. It will also lower costs of care per client, without negatively impacting
organizational quality. This principle speaks to the Patients First: Ontario’s Action Plan for
stability Health Care. The “Patients First” mandate focuses on protecting our universal
public health care system – making decisions based on value and quality, to
sustain the system for generations to come.

Integrations Integration will maintain or increase organizational efficiencies and reduce

should create unnecessary costs, as well as duplications of services or functions across the
organizational Toronto Central LHIN. This principle speaks to the delivery of key clinical services
efficiencies and business operations which improve client/patient outcomes at the same or
lower cost.

Overall Guiding Principles and Requirements

Strategic The vision for the integration is aligned to the Toronto Central LHIN’s Strategic
Alignment Plan, as well as with Ministry directives.

Interest in A strong level of interest exists amongst key stakeholders (i.e. senior
Integration management, the Board etc.) to investigate the possibility of an integration to
achieve a common vision.

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Appendix 2: Detailed Implementation Plans

Refer to attachment: Implementation Plan Draft Detailed Implementation Steps

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Appendix 3: Detailed Timeline

Refer to attachment: Implementation Plan Draft Detailed Timeline

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Timeline and Dependencies Table

Step Timeline Considerations
Step 1: Change Management Planning & Execution
A crucial first step, change management planning should be
1.1 Change Management Planning
completed by Q3 FY 2016/17.
Communications planning is dependent on Step 1.1 and will
support the planning and promotion efforts of both the
1.2 Communications Planning Knowledge Centre and the Integration Toolkit. It should begin
as soon as Step 1.1 is complete and be completed before the
end of Q4 FY 2016/17.
Knowledge Centre The development of the knowledge centre can begin in Q3 FY
1.3
Development 2016/17, with the aim to ‘go live’ by the end of Q1 FY 2017/18.
To make it successful, it is important to think of the Integration
Toolkit like a ‘program’, as it requires education, walkthroughs
1.4 Integration Toolkit Launch and significant resource support. Development and planning
can begin in Q4 2016/17, with a launch date by the end of Year
1 of Implementation (Q2 2017-18).
Step 2: Governance Setup
Planning for LHIN sub-regions can and will begin in the fall of
2016. Once setup, sub-region planning tables should formally
be discussing integration on their agendas during meetings in
Q1 2017/18. Depending on the sub-region, these integration
2.1 LHIN Sub-Region Setup
and planning discussions should take a full 12 months, with the
tables ready to support implementing integrations by Q1
2018/19. At this point, ongoing evaluation of the tables and
their efforts to support outcomes can also begin.
For the governance-to-governance outreach, the planning and
design of the outreach sessions can begin in Q2 2017/18.
2.2 G2G Planning and Execution Actual outreach and sessions will then occur through Q3 and
Q4 2017/18. An evaluative assessment/check-in on the
approach will occur in Q1 2018/19.
Step 3: Opportunity Identification & Prioritization
The development and analysis of population health data will
take place from Q3 2016/17 to Q1 2017/18, which can then
Population Health and Needs
3.1 inform the sub-region meetings that will begin in Q1 2017/18.
Assessment
Data will be revisited in Q3 to support additional analyses and
the needs of the sub-region planning tables.
Step 3.2 can begin immediately by strengthening the HSP 360
data portal with a particular focus on the self-reporting
3.2 HSP Performance Assessment
initiative. This data can support LHIN sub-region planning, with
data to be updated in Q2 2017/18.
Organizational Assessment Step 3.3 will be informed by both 3.1 and 3.2. It will begin in
3.3
Tool Q1 2017/18 to support LHIN sub-region planning. A list of
3.4 Prioritization & Opportunity priority organizations that are likely candidates for integration
Identification will be developed by Q3 2017/18 (before SAA negotiations

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begin). From there implementation of integrations (both

voluntary and facilitated integrations) can begin.
Step 4: Implementation
4.1 Support Voluntary Integrations Support for voluntary integrations can begin right away in Q3
4.2 Support Facilitated Integrations 2016/17. This support can continue throughout the
implementation to FY 2019/20. Support for facilitated
integrations (including those that are supported by
Support Facilitated Integrations
4.3 population health results) can begin in Q1 2017/18 as the
– Population Health
data and the sub-region tables identify opportunities and
priority organizations.
Step 5: Evaluation
Evaluation planning can start immediately in Q3 2016/17. This
will support all aspects of evaluation including monitoring
5.1 Evaluation Planning
integration activities and outputs, evaluating outcomes, and
assessing impact.
While evaluations of specific integration activities can begin in
5.2 Evaluation Execution Q3 2017/18, the first outcome evaluation can occur in Q1
2018/19.

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Appendix 4: Implementation Support Tools

A. Change Management Framework

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B. Stakeholder Analysis Tool

The following tool provides a simple framework to list and evaluate stakeholder groups when considering communications planning. Each
group should be listed down the left side column, then additional content completed based on a general understanding of their values,
incentives, power, influence and interest; this information can be used to design messaging and a strategy for communication.
Power and Interest - How much do Interest Key Messaging – Based on
Power and Influence –
Stakeholder Segment Values – What do they care Incentives – What will Influence they care about this Score (High, previous columns, how should
# How do they impact
and Key Individuals about? motivate them? Score (High, initiative and how it is Medium, messages be positioned with
decisions of others?
Medium, Low) addressed? Low) this group?
Ex. Board members -Overall success of the -Overall success of the -Oversight of organization -Highly interested in Focus on:
organization and system organization and overall success of this initiative -Impact
-Their position on Board system -Oversight of CEO -Will want to be kept -Sustainability
-Financial health -Ability to volunteer -Significant role in informed regularly -System level strategy
-Doing good governance and contribute advising the CEO and
H H
-Succession planning for -Development of Leadership on strategic
Leadership roles governance skills matters
-Impact of organization -Role in advising partners
and funders on strategic
matters
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

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To complement the stakeholder analysis tool, the following framework provides a guide on how stakeholder groups may be managed based on
their level of influence and interest in the particular situation. The data developed through the previous table tool will help a user “plot” where
each stakeholder group would fall, and how they might be managed. Important to note, is that stakeholders often shift to different quadrants
throughout project lifecycles, so this tool should be used continuously to reassess.

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C. Communications Strategy Template

The Communications Strategy Template is useful to organize communications activities; for each stakeholder group identified in the
previous tool, a user would indicate the key messaging, method and type of communication, follow up activities, and other notes.

Organization/Division/Group/Etc. Name
Project Name
Delivery Required
Comms Target Goal(s) / Target Supporting
ID Communications Item Key Messaging Medium/ Msg Sender Documents & Status Additional Notes
Phase Audience Expected Outcome(s) Date Resource(s)
Vehicle Deliverables
Who is the Individuals Any Progress
i.e.
What is being communication required to documentation towards the
Pre-Change Event Communications

List the purpose and expectations from individual

communicated? (i.e. directed Individual(s) support the to support the communicatio
List the key elements/takeaways the audience of the communication (i.e. Date which the speaker,
status update, committee towards? There who will deliver communication key n (i.e. under
1 which the target audience should informing, awareness, gaining communicatio team
messaging, employee should be one the (i.e. develop communicatio development,
know following the communication feedback, achieving buy-in, questions n will occur meetings,
town hall, announcement, audience per communication key n (i.e. FAQ pending,
opportunity, etc.) emails,
etc.) communication messaging, guides, delayed,
etc.
item. etc.) handouts, etc.) complete, etc.)

3
Communications
Change Event

6
Immediate Post-Change Event
Communications

8
Ongoing Communications

10

11

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D. Organizational Assessment Tool

The Organizational Assessment Screener tool supports Step 3.3 of the implementation. Specifically, it provides a simple checklist
questionnaire for an HSP to conduct a self-assessment of a number of performance, governance and overall managerial issues to
determine if a deeper organizational assessment is required with LHIN support. Regardless of the specific answers, the tool provides an
opportunity for dialogue on a number of key issues, which, depending on the outcome, can eventually lead to voluntary or facilitated
integrations.

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E. Scorecard Tracker
In support of the overall evaluation, as well as the Scorecard outlined earlier, this tracking tool
will support ongoing monitoring and reporting of key measures related to the integration
program. For each measure, this tool supports the centralized collection of target, baseline and
ongoing results information, making it easy to track progress and submit results to TC LHIN senior
management, as well as the Board.

Year 1 Year 2 Year 3

Dashboard Indicators Data Source Target Baseline
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
Volume of Toolkit TC LHIN (via Google
downloads Analytics)
TC LHIN (via
Integration activity
Volume of G2G sessions
work plan, activity
history)
TC LHIN (via
Total # of integrations Integration business
planned or approved case submissions,
and HSP outreach)

TC LHIN (via follow-

up assessment of
Total # of completed
approved
integrations
integration business
cases)
TC LHIN (via
Total # of voluntary
integration business
integrations
case submissions)

Proportion of all TC LHIN (via

integrations that are integration business
voluntary case submissions)

Proportion of
TC LHIN (via
integration business
integration business
case submissions that
case submissions)
are approved
Proportion of
TC LHIN (via
integrations that
integration business
develop expected
case submissions)
outcomes
HSPs (via self-
# of successful reporting, service
integrations that used accountability
the Toolkit or agreements, and
Knowledge Centre outcome evaluation
data collection)
HSPs (via self-
# of G2Gs that
reporting, SAAs, and
contributed to
outcome evaluation
voluntary integrations
data collection)

Proportions of HSPs (via self-

integrations that have reporting, SAAs, and
achieved their expected outcome evaluation
outcomes data collection)

Percent of community
agencies that have
implemented HSPs (via SAAs)
community business
intelligence
# or proportion of HSPs
measuring the patient HSPs (via SAAs)
experience

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F. Issues and Gaps Roster

The Issues and Gaps Roster will allow the TC LHIN, as well as individual HSPs, to log, track and
monitor issues, gaps, and concerns as they arise throughout the coming three years. By
centralizing, and analyzing, issues and gaps, this tool supports organizations in mitigating issues
and ensuring they remain a priority for strategic discussion.

Discovery / Current-State Issues & Gaps - Scoring & Ranking

LEGEND — 0 = Low; 1 = Moderate; 2 = High
N.B. For Implementation Cost, 0 = High Cost, 1 = Moderate Cost, 2 = Low Cost

Qualitative Issue Analysis

Issue / Gap Issue / Gap Issue / Gap Imple- Quick Hit Strategic Total
ID Ease to Likelihood Urgency & Business
Description Category Sub-Category mentation Score Importance Score
Address of Success Importance Impact
Cost (Max 6) (Max 6) (Max 12)

Templates are far too cumbersome,

often 80-85 pages in length. Some
are simply not usable – they’re too Tools/
M5
long and have a lot of duplication
Methodology
Templates
0 2 1 3 1 2 3 6
and a lot of meaningless
information.
BUs are becoming too granular with Plan
M6
plan development.
Methodology
Requirements
0 1 1 2 1 2 3 5
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

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