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Northern Health Goals for 2006 2007


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Title: Northern Health Goals for 2006 2007

Northern Health Goals for 2006 / 2007
  • North Central Municipal Association
  • Annual Health Meeting
  • February 10th, 2006

  • Overview
  • Jeff Burghardt, Chair

Strategic Goals
  • 2004 - 2008

Primary Goal Better Health The health of all
people in northern British Columbia will improve
during the period 2004 2008
Northern Healths Strategic Goals
Successes !
  • Recruitment adds capacity. 12 more surgeries
    for northerners in 2005/06.
  • NH completes in first accreditation Survey at age
    3 and receives a full-term award with only 4
    mandated actions!
  • NH Medical Staff, Board, and Management are
    recognized as having the best alignment among all
    Health Authorities!
  • Our communities are mostly supportive of our
    work, and take time to say so!
  • After 15 years and 3 false starts, the people of
    Masset will have a new hospital and health

Successes !
  • NH has the lowest OT hours/RN of all Health
  • NH is seen by as a  BC leader in medical
    IT, nursing recruitment, in Inter-RAI
    development, in chronic disease management among
  • This recognition fosters growth and pride and
    identity for our staff!

Goal 1Responsiveness
Northern Health will be responsive to the people
and communities it serves and will seek
partnerships with communities in achieving better
health for northern people.
  • RoadHealth and Crossroads Conference
  • Dr. D. Bowering

  • Northern Health Motor Vehicle Crash Task Force
  • ICBC
  • Worksafe BC
  • Trucksafe
  • RCMP
  • Coroners Service
  • Ministry of Transportation
  • BC Ambulance Service

4 Pillars of Crash Reduction Strategy
  • Education- seat belt use, helmets, speed, child
    safety seats
  • Enforcement- targeted enforcement by RCMP DOT
  • Engineering- signage, speed, road design, rumble
  • Engagement- public, communities, industry,
    health care professionals, First Responders,
    policy makers, all levels of government

  • Crash Reduction Conference held in Prince George
    October 18 19, 2005
  • Conference Goals
  • Deliver on a Northern Health Strategic Plan
    objective to follow up on motor vehicle injury
    reduction initiatives in the North
  • Identify initial collaborative strategies /
    opportunities to reduce injuries from MVAs
  • Raise public awareness of MVAs as an important
    public health issue.

Post Conference Activities
  • Secure funding to support small community
    initiatives across region.
  • Continue NH involvement in Trucksafe and other
    industry initiatives.
  • Continue with quarterly Task Force meetings,
    communications and inter-agency data exchange.
  • Implement strategic plan developed at
  • Progress Report
  • Jan 2006 release of grant information RFP
  • Feb 2006 proposal deadline
  • March 2006 funding flows out, projects begin
  • Follow up- once projects are approved, projects
    will be followed to completion- projects posted
    on website- newsletter developed- a logo and
    slogan developed to brand RoadHealth-
    promotions synchronized between RCMP, ICBC, WCB
    and RoadHealth

Goal 2High Quality Health Services
Residents and visitors to northern British
Columbia will have access to high quality health
services in an appropriate setting.
  • Surgical Services
  • - Dr. D. Butcher

  • Obstetrical care is a major area of clinical risk
    for Northern Health and a source of the majority
    of our litigation.
  • Obstetrical care is critical to meeting service
    delivery mandate for communities.
  • MORE OB is a total obstetrical Quality
    Improvement Program developed and run by SOGC.
  • 3-year program with commitment of gt80 of
    clinical staff involved obstetrical care (MDs,
    RNs, and midwives).
  • Focus on interdisciplinary learning, self
    evaluation and ongoing practice audit and
    critical incident review learn from near

  • Northern Health is pilot for BC in Health
    Authority wide implementation.
  • Implemented in Alberta province wide, many
    Ontario hospitals.
  • Funding for NHH implementation provided through
    BC Reproductive Care Program.
  • Added value knowledge gained in the use of QA
    and QI tools and processes by NH clinical staff,
    and culture of clinical quality improvement will
    be transferable to other clinical program areas.

Fed/Prov Surgical Wait Time Standards
  • Surgery to remove cataracts within 16 weeks for
    patients who are at high risk.
  • Three additional wait-time benchmarks for cardiac
    bypass patients that will provide treatment
    within two weeks to 26 weeks, depending on the
    severity of the case.
  • Hip fracture treatment within 48 hours.
  • Hip replacements within 26 weeks.
  • Knee replacements within 26 weeks.

Wait List Data
  • Work is ongoing to clean and manage surgical wait
  • Working with the PHSA and Ministry of Health in
    the Surgical Services Project
  • Gathering data to verify existing lists for
    orthopaedic surgeries eventually 14 surgical
    categories to be included
  • Validating patients on lists still requiring
  • Consulting with surgeons
  • OR efficiency through Arthroplasty Collaborative
  • Developing resource efficiency through
    Arthroplasty Collaborative
  • Predicting future needs through modeling
  • Access concerns if capacity growth is restricted
    to Vancouver

NH Hip Replacements
NH Knee Replacements
Home and Community Care
  • Complex Care Beds, Assisted Living Units to 2015

Home and Community Care Priority Projects
  • Prince Rupert Campus of Care upgrade of
    existing capacity to standard for complex care
    and increase by 7 beds and 15 assisted living
  • Terrace Campus of Care upgrade of existing
    capacity to standard for complex care and expand
    by 36 complex care beds, 8 respite/palliative
    care beds and Adult Day Centre.
  • Fort St. James addition of 6 complex care beds.
  • Prince George Campus of Care New 87 bed complex
    care facility with 49 Assisted Living Units.
  • Quesnel Complex Care Facility replace existing
    40-bed Baker Lodge facility to improve standards
    through expansion and renovation of Dunrovin
    Manor, an additional 35 assisted living units,
    plus an increase of 5 respite/palliative care
  • Fort St. John Complex Care Facility upgrade
    existing capacity at North Peace Care Centre to
    standard through renovations and increase by 18
    beds, plus 24 assisted living units.
  • Dawson Creek Complex Care Facility Assisted
    Living replace two substandard facilities
    (Pouce Coupe Care Home and Peace River Haven) on
    Rotary Manor site. Additional 15 beds of complex
    care and 26 beds of assisted living.

Complex Care Project Estimates
Note Prince George project (87 Beds) will be
contracted to a service provider
Northern Residential Care Issues
  • Northern Health operates all but one residential
    care facility in Region.
  • Scale Issues
  • 1 facility per community
  • Shared staff with hospital
  • Shared services with hospital
  • Additional capacity per community lt20 Beds.
  • Not attractive to private operators.
  • Concurred project development over next few
    years will require collaboration / consultation
    between Northern Health and RHDs.

Next Steps
  • Pre-design site studies complete or in progress.
  • NH Capital Budget confirmation from Provincial
  • Consultation with each RHD on capital plans and
  • Confirmation of funding model / timelines for
    each project.

Goal 3Integration
We will create a single health care organization
to better meet individual needs through
integrating services and resources.
  • Physician Connect
  • - Malcolm Maxwell
  • Northern Health Connections
  • - Sean Hardiman
  • Primary Care
  • - Malcolm Maxwell

Physician Connect
  • Driven by health mandate needs
  • Chronic disease management (CDM) Initiatives
  • Telehealth
  • Clinical, Education and Administrative
  • Integrated Clinical and Decision Support Systems
  • Patient centered
  • Open Architecture
  • Scaleable
  • Secure
  • Support for Medical / Professional Education
  • On-going education / training of health care
  • Electronic Health Record

Physician Connect
  • Northern Health Wide Area Network
  • Physician office connected through Physician
    Connect project
  • Physicians connected to WAN in all communities
    where bandwidth allows
  • Standardizes security
  • Supports telehealth and electronic data transfer
  • Provides e-mail services
  • Reduces technology and information isolation
  • Northern Health Physicians are largest users of
    EMRs in BC
  • 65 NH MD offices use EMRs
  • Provincial average 9
  • Majority use home-grown product MOIS
  • Strong link between local leadership and clinical
    use of EMRs
  • NH MDs engaged in practice and clinical
    improvement using EMRs
  • Northern Health providing clinical decision
    support to all clinicians on a pilot basis.
  • NH wide subscription to Up-to-date Online

Northern Health Connections
  • Extensive consultation process for ground
    transportation service locations involving
    community groups, Health Watch groups, seniors
    groups, local government, and regional district
    members in communities throughout the North

Key Consultation Findings
  • Cost sensitivity is a major issue for senior
    citizens, persons with a disability, non-status
    First Nations, and those on low or fixed incomes.
    Costs to patients should be as close to nil as
  • Respecting existing referral patterns is of key
    importance to communities, especially in the
  • A desire exists to support transportation within
    the region that does not result in a reduction of
    health care services in the community.

Program Services - Status
  • Ground Transportation (contracts signed)
  • Long Distance
  • Fort St. John - Prince George (twice weekly)
  • Prince Rupert - Prince George (twice weekly)
  • Prince George Vancouver (twice weekly)
  • Fort Nelson to Grande Prairie, AB (once weekly)
  • Short Distance (Phase I)
  • Burns Lake Prince George
  • Burns Lake Smithers
  • Houston Terrace
  • Valemount Prince George
  • Valemount Kamloops
  • Terrace Kitimat (BC Transit Partnership)
  • Short Distance (Phase II)
  • RFP release in March 2006

Ground Transportation Long Distance Coach
Improving Primary Care
  • Ministry data show care for people with diabetes
    could be enhanced
  • Using MSP and Pharmacare data, research shows
    that few patients were receiving optimal medical
    diabetes care at the primary care level in
  • Northern HA 28
  • Interior HA 32
  • Fraser HA 35
  • Vancouver/Coastal HA 38
  • Vancouver Island HA 38
  • Achieving optimal diabetes care requires
    significant and complex changes across BCs
    health care
  • delivery system

Proxy Measures for Improved health Outcomes
decrease morbidity and mortality
  • A 10 mm Hg reduction in BP will yield
  • 11 reduction in all-cause mortality
  • 11 reduction in MI
  • 15 reduction in heart failure
  • A 1.0 reduction in HbA1C will yield
  • 17 reduction in all-cause mortality
  • 18 reduction in MI
  • 15 reduction in stroke
  • 35 reduction in microvascular endpoints (renal
    failure and amputation).

The Quality Improvement Collaborative Model
  • Identify best practice clinical practice
  • Look at gap in care
  • Set targets for improvement
  • Redesigning the system
  • Collaboratives
  • CHF
  • Diabetes

NHA CDM Quality Improvement Participation
  • 63 of GPs in NHA are involved in Chronic
    Disease Initiatives and/or using the CDM Toolkit
  • 119 general practitioners (out of 245 GPs in NH)
    in 19 communities with NH system support
  • gt100 physician office staff, NHA staff and
    community members are working together in quality
    improvement teams
  • 17 of BC GPs are on the CDM toolkit
  • The North is leading British Columbia

Why Prevention? Decrease Incidence of diabetes
Diabetes Systolic Blood Pressure
Completion Rate
Observations lt 130 / 80
Diabetes A1C
Completion Rate
Observations lt 7.0
Diabetes LDL
Completion Rate
Observations lt 2.5
Diabetes Micro-Albumin Screening
Completion Rate
Observations lt 2.8
Diabetes Lower Extremity Exam and Self -
Lower Extremity Exam
Self Management
DiabetesSystolic Blood Pressure Dr. Sear/BCMA
Completion Rate
Observations lt 130 / 80
DiabetesA1C Dr. Sear/BCMA
Observations lt 7.0
Completion Rate
DiabetesSelf Management Dr. Sear/BCMA
Keys to success in Primary Care
  • Building new relationships
  • Champion Physicians
  • NHA Primary Health Care and Chronic Disease
    Management coordinators to support and facilitate
  • Education
  • IT Support
  • Physician connectivity project
  • Bursary to physicians to support IT needs for
  • Personnel IT support for physician and teams
  • NHA clinical staff participation with physicians
    in quality improvement initiatives

In 5 years.
  • 90of NH physicians will be on the CDM toolkit
    (or equivalent)
  • of diabetics receiving guideline based care will
    be increased to 90 (quality care)
  • of diabetics with outcomes within best practice
    range will be 70(improved health outcomes)
  • Number of predicted new diabetics will decrease
    by 10( prevention and risk reduction)
  • LOTS of WORK to DO..

Goal 4Work Life
Northern Health staff and medical staff members
will enjoy a high quality of work life including
significant opportunity for learning.
  • Respect In the Work Place
  • Injury Prevention Program
  • Malcolm Maxwell

(No Transcript)
Respect in the Workplace
  • Policy covers all employees, medical staff and
    volunteers and contractors
  • Establishes respectful work environment free from
    discrimination, harassment and
  • Promotes understanding of diversity
  • Fosters courteous and respectful interactions
  • Recognizes right of all people to be treated with
  • All staff receive
  • Basic training in dealing with disrespectful
  • Process to pursue complaint informally and
  • Supervisors receive training on fostering
    positive environment and guidance on dealing with
  • Optional dispute resolution processes

Respect in the Workplace
  • Dispute resolution
  • Informal process
  • Formal process
  • Does not displace collective agreement or
    regulatory processes
  • Commenced formal implementation in Spring 2005
  • To date training as follows
  • Combined Number of Staff Trained 1,239
  • Staff Sessions 60
  • Manager Sessions 17
  • Respect in the Workplace Inquiries 36
  • Respect in the Workplace Facilitated Meetings
  • Formal Investigations - 4

Injury Prevention Program
  • NH Board intends to ensure workplace accidents
    are declining
  • NH has implemented worksite assessments and
    established safety committees at each site
  • Northern Health has implemented a comprehensive
    data tracking system that provides database of
    incidents and causes
  • We have invested capital dollars on lifts,
    equipment redesign and workplace modifications
  • People still have injuries due to lack of
    understanding of practical and safe work
  • Pilot project has demonstrated on-the-floor
    training with skilled ergonomists
    /physiotherapists makes a big difference

Injury Prevention Program
  • In past year 51 of reported injuries and 83 of
    time loss injuries were musculoskeletal injuries
    (MSI) and 91 of total days lost were MSI
  • Estimated MSI compensation and medical costs were
  • NH planning to add person team to each HSDA to
    work with staff to reduce MSI compensation costs
  • We project a 25 reduction in MSI compensation
    costs after two years, and an additional 25
    after the third year

Goal 5Academic Health Care
Northern Health will work with partners to expand
the teaching of the health professions and to
support research within northern British Columbia.
  • Northern Medical Program
  • Nursing Recruitment
  • Potential Laboratory Program - CNC
  • Malcolm Maxwell

Medical Education
  • The second year class is now in place
  • By 2010 there will be 126 medical students
    training in the north.
  • Plans are under development with Northern Medical
    Program for Fort St John Dawson Creek, and
    Northwest sites for clinical clerkships in
    September 2006
  • The intention remains to have a wide range of
    clinical training opportunities for third and
    fourth year medical students throughout northern

Developments in Physio, Lab Tech, and Combined
Tech Programs
  • Community partners (UNBC, NH, CNC, Northern
    Medical Society and others) have been working to
    develop a Medical Lab Technician course at CNC
    which will be assessed within the provincial
  • Why this is important to patient care in Northern
  • 18.6 of NH Med Lab Techs are eligible to retire
    in 5 years
  • In some of our harder to recruit areas such as
    the NE, it is 24.
  • In subsequent years, these proportions will
  • 100 of vacant Med Lab Techs are hard to fill
    vacant 3 months or longer - and we need to bring
    staff from other provinces to fill jobs.

Human Resource Issues - Physicians
We are attracting more physicians.
Nurse Recruiting
  • UNBC / College of New Caledonia (CNC) BScN
    program in Prince George expands by 32 additional
    seats annual intake grows to around 140 students
    in 3 sites.
  • CNC/ UNBC BScN program in Quesnel continues with
    an annual intake of 24. First graduates to
    receive their degrees in May, 2007.
  • NWCC/ UNBC / NWCC BScN program begins in Terrace
    in September 2005 with a projected intake of 18
  • 84 (58) of UNBC Nursing Graduates in 2005 have
    accepted positions with the NHA.

Nurse Recruiting
  • Success in reducing nursing difficult to fill

Clinical experience for undergraduate nurses
Nurse mentoring
Goal 6Sustainability
Northern Health will operate within the public
and private revenues available to it without
depleting the financial, physical or human
resources required for the future.
  • Northern Health will finish 2005/06 with a
    balanced budget
  • We are making gradual but steady progress in
    meeting our needs for physicians and nurses. We
    have concerns about other disciplines in
    laboratory technology.
  • Many of our facilities require upgrading or
    replacement. Capital projects will be a major
    challenge over the next 5 10 years.

Cancer Consultation Process
  • 33 Focus Group and Community Meetings to be held
    in 16 Communities in Northern BC
  • March 2nd through to March 25th
  • Consult the public in three ways
  • Community Meetings
  • Focus Groups People who have experienced living
    with cancer or supporting someone else living
    with cancer.
  • Consultation Comment Forms www.northerncancercare
  • GoalHow can we design a comprehensive and
    integrated cancer care system that best meets the
    unique needs of the people of Northern BC?

What would be the requirements for a Northern
Cancer Centre?
  • Community Support
  • People in the north must be consulted and must be
    prepared to accept different referral routes for
  • Physician Support
  • Medical staff would need to be actively involved
    in the development of a northern cancer centre,
    providing both advice and input.
  • There must also be a willingness to reconsider
    historical referral patterns and to work with
    cancer care staff to ensure a highly integrated
    system of cancer care throughout Northern BC.
  • Agency Support
  • Support from the MOH, NHA and the BCCA would need
    to be in place for it to succeed. In turn, they
    would need to know there is guaranteed funding to
    cover capital costs and ongoing operational costs
    of the centre, as well as the host hospital.

What would be the requirements for a Northern
Cancer Centre?
  • Expansion of Existing Infrastructure
  • A decision would need to be made to enhance and
    expand existing surgical supports.
  • Long term plan to train oncology professionals
    needs to be put in place right away.

Current Status
  • Northern Cancer Control Strategy in Northern BC
  • The Northern Cancer Control Strategy is being
  • Designed to address all aspects of cancer care
  • Prevention and detection
  • Ongoing treatment
  • Palliative Care
  • End of Life Care