Professional Documents
Culture Documents
Overview
Setting Priorities for the B.C. Health System
presentsthe strategic and operational priorities for
the delivery of health services across the province.
The plan is founded on avision of achieving
asustainable health system that supports people
tostay healthy and provides high quality publicly
funded health care services that meet their needs
when they aresick.
The plan builds upon on successes achieved
through the health sectors transformational
guiding framework, the Innovation and Change
Agenda, and is focused on delivering apatientcentred culture across all health sector services
andprograms, while incrementally improving
onthe quality of serviceoutcomes.
The strategies and priorities outlined in this
document are based on thoughtful analysis of
population health and service utilization data,
best practices from the research literature,
lessonslearned from B.C.s efforts over the last
fouryears todrive provincewide system change
and consultation with many key stakeholders.
Contents
EXECUTIVESUMMARY. . . . . . . . . . . . . . . . . . . . . . . . . 1
INTRODUCTION: Health SystemStrategy. . . . . . . . 7
KeyConcepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
STRATEGY IMPLEMENTATION
AND FUTURE DIRECTIONINB.C.. . . . . . . . . . . . . . 17
The Innovation and Change Agenda
(2009-2013) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
FutureDirection . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
HEALTHOUTCOMES. . . . . . . . . . . . . . . . . . . . . . . . . . 21
STRATEGY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Access andWaitTimes. . . . . . . . . . . . . . . . . . . . . . 25
Strategy2: AccountabilitytoDeliver
the Three-YearPlan. . . . . . . . . . . . . . . . . . . . . . . . . 34
Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
QUALITY AND A SUSTAINABLE SERVICE
DELIVERYSYSTEM. . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Priority1: Provide patient-centredcare. . . . . 27
Priority2: Implement targeted andeffective
primary prevention andhealth promotion
through aco-ordinated deliverysystem . . . . 27
Priority3: Implement aprovincial system
ofprimary and communitycare built around
inter-professional teamsandfunctions . . . . . 28
Strategy3:Quality . . . . . . . . . . . . . . . . . . . . . . . . . 36
Strategy4: Skilled Change
Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Strategy5: Health Human Resource
Strategy An Engaged, Skilled, Well-Led
andHealthyWorkforce. . . . . . . . . . . . . . . . . . . . . . 37
Strategy6: Information Management
andTechnology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Strategy7: Budget Management
andEfficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
CONCLUSION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
APPENDIX A:
Minister ofHealth MandateLetter. . . . . . . . . . . . . . . 40
ExecutiveSummary
Setting Priorities for the B.C. Health System proposes
that there is much that is effective in the current
health system, while recognizing there are some
persistent challenges that have been resistant
toany substantive and successful change over the
pastdecade.
Having clarified the meaning and scope ofseveral
terms, the paper takes stock ofaction taken todate.
Four years ago, B.C. implemented asector-wide
strategy called the Innovation and Change Agenda
totry todrive meaningful change across the
healthsystem.
The Innovation and Change Agenda was structured
under four keythemes:
1. Providing effective health promotion, prevention
and self-management toimprove the health and
wellness ofBritish Columbians.
2. Meeting the majority ofhealth needs with high
quality primary and community based health
care and supportservices.
3. Ensuring high quality hospital care services are
available whenneeded.
4. Improving innovation, productivity and
efficiency in the delivery ofhealthservices.
The key strength ofthe agenda was that it
established an overarching system-wide strategic
framework for co-ordinated action something
ENABLING
STRATEGIES
PRIORITIES
GOALS
Staying Healthy
Getting Better
Prevention and
Health Promotion
Access to Quality
Diagnostic Services
Primary and
Community Care
Clear Accountability
Health Human
Resources Strategy
Information Management
and Technology
Ensure Quality
Improve Access to
Specialist Services
Appropriate
Residential Care
Skilled Change
Management
Budget Management
and Efficiency
This focus will improve patient care and outcomes for these populations, drive asustainable budget,
andpotentially free up funds tobetter meet other patient needs in the health caresystem.
In support ofthese improved outcomes, and in response tothe second question, eight priority
areasforservice delivery action have been identified.
PRIORITY1:
PRIORITY3:
Provide patient-centredcare
PRIORITY2:
PRIORITY4:
PRIORITY5:
PRIORITY6:
PRIORITY7:
PRIORITY8:
STRATEGY1:
STRATEGY5:
A Shared PlanofAction
STRATEGY2:
AccountabilitytoDeliver
theThree-YearPlan
Establish aclear performance management
accountability framework built on public reporting.
Include role clarity and accountability mechanisms
for the Ministry ofHealth, health authorities,
physicians, nurses and allied health professional
and support staff focused on population and
patient needs. This framework will be hard wired
tohealth authority governance evaluation as well
as executive and staff performancereviews.
STRATEGY3:
Quality
Enable effective quality improvement capacity
across the health system strengthen quality
assurance toeffect meaningful improvements
inpatientoutcomes.
STRATEGY4:
Skilled ChangeManagement
Enable effective change management capacity
across the health system adequate change
management capacity is needed todrive
successfulchange.
STRATEGY6:
Information Management
andTechnology
Enable access totimely and high quality data and
information. Access tosystem data and information
drives successfulchange.
STRATEGY7:
Introduction:
Health SystemStrategy
The starting point for thinking about health
system priorities for the B.C. health system
is torecognize that British Columbians have
thousands ofsuccessful interactions with the health
care system every day, with multiple examples
ofexcellent results: high quality maternity care;
high quality acute, critical and trauma care services;
excellent cancer care and treatment; high quality
elective surgeries; high quality diagnostic services;
and ahighly trained health workforce. Citizens
ofB.C. enjoy some ofthe best health indicators
in the world, pointing tothe underlying strength
ofthe provinces social determinants ofhealth and
the quality ofits health caresystem.
It is also important torecognize that B.C. has made
meaningful progress across arange ofareas over
the past several years, including: putting in place
aproactive chronic disease prevention framework;
strengthening primary care and, in particular,
improving care and treatment for anumber
ofchronic conditions; improving patient flow
within and between hospitals and the community;
increasingthe use ofday surgeries; an increasing
focus on quality through strengthening clinical care
management, physician quality assurance, and the
establishment ofthe BC Patient Safety & Quality
Council and the Patient Safety Review Boards; and
improving productivity and cost management.
A health care system featuring huge bureaucracies, large institutions, formidable professional associations
andunions, well paid and educated administrators, with turnover of both ministers and senior health
ministry, and all nominally supervised by agoverning political party that has torespond tothe complex
Canadian public response toahealth system encumbered with so much national emotion and self
definition, results in asector thatis large, complex and notoriously difficulttomanage.
The conclusion is that THE HEALTH SYSTEM CANNOT BE CHANGED QUICKLY OR EASILY.
Northatlarge amounts of additional money will necessarily buy change. Notwithstanding the
difficulty ofmakingchange, there is astrong level of consensus thatthehealth system cannot
continue as delivered, administered, andfinanced.
Chronic Condition by Jeffrey Simpson(2012)
KeyConcepts
It is important tohave ashared understanding
ofseveral keyconcepts:
}} Who are populations andpatients?
}} What makes up the range ofhealth
serviceswithin the B.C. healthsystem?
}} Healthynon-users;
}} Why is sustainabilityanissue?
UNDERSTANDING POPULATIONS
ANDPATIENTS
}} Frail in residentialcare;and
}} Endoflife.
Getting Better
Understanding theRange
and Level ofHealthServices
Along with an understanding ofpopulation and patient health care needs, we also need ashared
understanding ofthe actual range ofhealth services that are provided in an attempt tomeet thoseneeds.
British Columbia provides arange ofpublicly funded services,including:
COMMUNITY
}} MaternityCare
}} Medical SpecialistServices
}} Communicable DiseasePrevention
DIAGNOSTIC AND PHARMACYSERVICES
}} InjuryPrevention
}} Pathology
}} EnvironmentalHealth
}} Diagnostic Imaging/Radiology
}} PublicHealth
}} Pharmaceuticals
}} EmergencyManagement
HOSPITAL
SPECIALTY POPULATIONHEALTH
ANDCARESERVICES
}} HospitalOutpatient
}} CancerCare
}} MentalHealth
}} SubstanceUse
}} AssistedLiving
}} Maternity
}} ResidentialCare
}} Ambulance
}} PalliativeCare
}} EmergencyDepartment
}} In Hospital MedicalCare
}} Anesthesia
}} Ambulatory ElectiveSurgical
}} In Patient ElectiveSurgical
}} TransplantSurgery
}} Trauma and EmergencySurgery
10
TERTIARYCARE
}} Treatment given in ahealth care centre that
includes highly trained specialists and often
advanced technology. Also referred toas acute
care, it is often associated with ahospital and
includes emergency, critical and intensive care
medical services. It can also include tertiary
prevention.
These health services are distributed geographically
across the health system. Thehealth system
through which these services are delivered includes
the organization ofpeople, institutions (public/
private), and the resources needed todeliver
health care services. Thedominant structures are
five regional health authorities, one Provincial
Health Services Authority, and the recently
added provincial First Nations Health Authority.
Theregional health authorities are sub-divided
into 62 geographic service areas categorized as
metro, urban/rural, rural or remote. This provides
amap from which tobetter understand the type
and quality ofhealth services delivered across the
different geographic regions ofBritishColumbia.
These entities have acomplex relationship with
quasi-autonomous physician practices and arange
ofprivate-pay health care serviceproviders.
Underpinning this organizational system are
critical considerations related towhat governance
and financing (public/private payer) mechanisms
might best optimize effective and efficient service
delivery. With these two elements (population/
patient and health services/geographic areas),
wenow have abasic matrix with which toanalyze
services. What is missing is ameans toevaluate the
connection between the two. This is where quality
comesintoplay.
11
Appropriateness
Accessibility
Safety
Acceptability
Optimal Use
of Resources
We need ahealth care system designed todeliver chronic care toan aging population. Thejourney of care
does not last afew days anymore; it often lasts years. Technology and drugs are important, but they should not
take precedence over hands-on care and good old-fashioned caring. OVER TIME, WE HAVE FOCUSED SO
HEAVILY ON INCREASING THE QUANTITY ANDSOPHISTICATION OF CARE THAT WE HAVE LOST
SIGHT OF THE BASICS namely, that we are treating people, not just bodies harbouring acollection of disease
andconditions.
The Path toHealth Care Reform: Policy andPolitics
by Andr Picard(2013)
12
13
15%
10%
55%
43.5%
42.1%
44.3%
40%
3.0%
2.7%
2.3%
0%
08/09
09/10
10/11
11/12
50%
45%
2.8%
4.9%
07/08
47.1%
6.3%
5.7%
6.4%
5%
43.7%
43.1%
47.0%
46.6%
45.8%
12/13
2.4%
13/14
14/15
35%
30%
15/16
Due tothese efforts, B.C. now compares well with other provinces, with the second lowest per capita
health spendinginCanada.
PER CAPITA HEALTH CARE SPENDING BY PROVINCIAL GOVERNMENT, 2011
$6,000
$5,077
$5,000
$4,528
$4,348
$4,266
$4,058
$4,033
$4,000
$3,972
$3,645
$3,604
$3,407
ONT
BC
QUE
$3,000
$2,000
$1,000
$NL
AB
SASK
MAN
PEI
NB
NS
14
Additionally, our province compares well against other Organisation for Economic Co-operation and
Development countries for life expectancy and per capita spending. British Columbia has one ofthe
longest life expectancies and is one ofthe lowest in per capita spending. As the figure below demonstrates,
spending more does not equate tobetterhealth.
LIFE EXPECTANCY AT BIRTH TOTAL POPULATION (2009)
AND PER CAPITA SPENDING (2010)
81.4
81.3
$8,233
81.4
81
80.9
80.8
80.4
$3,670
$3,604
$3,974
$3,758
$4,445
$3,022
Australia
B.C.
Sweden
France
Canada
New
Zealand
$3,433 78.2
U.K.
United
States
Sources: Organisation for Economic Co-operation and Development health data (June 30, 2011), International Profiles ofHealth Care Systems
(2012), TheCommonwealth Fund (November 2012), Statistics Canada (Canadian Vital Statistics, Birth and Death Databases and population estimates, CANSIM table 102-0512). Note: Canadian and B.C. birth data are for the 2006 2008 period. Frances birth data is estimated. Australias
per capita spending data is 2009. B.C.s per capita spending datais2011.
The challenge for B.C. will be tosustain these efforts in the context ofa health system that cannot be
changed quickly or easily acknowledging the need for decisions tobe made that may change the
waywedeliver, administer and finance healthcare.
Operational management is the basic day-today processes by which the health care system
produces its services and delivers them topatients.
These are both direct (service delivery) and indirect
(human resources, information technology, budget
and cost management). Continued efforts tolean
these processes reducing waste and improving
efficiencies can result in cost savings, deliver
short-term quality improvements, and are critical
underpinnings ofa sustainable health system in
BritishColumbia.
Strategy points tothe overarching efforts
tosuccessfully position the health system
toprovide both quality services and sustainability.
It can be described as the approach used by the
provincial health system tocreate value for its
population and patients. Strategy is often assumed
15
16
Strategy Implementation
and Future DirectioninB.C.
The Innovation and Change Agenda
(2009-2013)
Setting new priorities starts with understanding
where we are. Four years ago, B.C. implemented
asector-wide strategy called the Innovation
and Change Agenda totry todrive meaningful
change across the health system. TheInnovation
and Change Agenda is structured under four key
themes. Thefirst three are linked tomajor health
services delivery areas, and are underpinned by the
fourth strategic imperative:
1. Providing effective health promotion, prevention
and self-management toimprove the health and
wellness ofBritish Columbians.
2. Meeting the majority ofhealth needs with high
quality primary and community based health
care and supportservices.
3. Ensuring high quality hospital care services are
available whenneeded.
INTEGRATIONOFPRIMARY
AND COMMUNITYCARE
HEALTH PROMOTIONAND
PREVENTION OFCHRONICDISEASE
If left unrestrained, health spending could soon exceed realistic limits beyond what governments, social security
or family budgets can afford. The need torein in large fiscal deficits offers AN OPPORTUNITY TORETHINK THE
FINANCING AND DELIVERY MODELS OF HEALTH SYSTEMS. Long-term trends are equally challenging, with
changes in disease patterns forcing countries todeal with the rapidly changing structure of sicknesses, especially the
growing burden of non-communicable and ageing-related diseases. This will require investing inpreventing chronic
illnesses related tolifestyles as well as promoting integrated care and further innovation inhealthservices.
Angel Gurria, secretary general, Organisation for Economic Co-operation and Development
17
INNOVATION, PRODUCTIVITY
ANDEFFICIENCY
The ministry has pursued assertive expenditure
management through the use ofinnovative
strategies toincrease productivity and improve
efficiencies. Specific actionsinclude:
}} Lean process improvements toreducewaste.
}} Active management ofpharmaceutical and
laboratorycosts.
}} Consolidation ofback-office functions and
shared businessservices.
}} Activity-based financial incentives and patient
focusedfunding.
}} Information management/technology
solutions,including:
Implementation ofe-Health, developing
systems tomake health care information
accessible, supporting personal health and
health care decision-making, and health
system sustainability.
Development ofthe BC ServicesCard.
Strengths oftheInnovation
and ChangeAgenda
With the establishment ofthe Innovation and
Change Agenda, the provincial health system has
had aconsistent, overarching system-wide strategic
framework over four years something that had
not been attempted inthepast.
The Innovation and Change Agenda has laid down
the foundational elements ofseveral large system
strategies:
}} Healthy Families BC provides the foundation for
aprovincial chronic disease preventionstrategy;
}} The First Nations Health Authority is an
important foundation in closing the health gaps
between Aboriginal and non-Aboriginal British
Columbians;
18
Challenges oftheInnovation
and ChangeAgenda
Some ofthe key challenges for the agenda
were related tochange management and
the implementation ofthe strategy across
acomplex sector. Alignment and buy-in from
health authorities and other system partners
tothe provincial strategy has been partial and
incremental (highlighting the challenge ofbuilding
commitment toashared agenda across diffuse
interests and power dependencies) due tothe
limited capacity in the system todeliver systemwide strategic change in atimely manner. There
have also been persistent challenges in the
accessibility, quality, and availability ofdata for
performance management, monitoring and
outcomes measurement across the system. There is
still work todo before the benefitsofthe e-Health
strategy is fully realized in particular with regards
tothe use ofthe electronic medical/ health record
and health informationexchange.
As noted at the beginning ofthis paper, several
service areas remain stubbornly problematic and
resistant tosuccessful resolution despite significant
effort and some key populations continue tobe
more vulnerable and experience poorer health
and health outcomes. These challenges and gaps
provide an opportunity for reassessment and
fresh strategic efforts in setting ofpriorities for the
coming threeyears.
19
FutureDirection
The ministers mandate letter (June 2013)
states that the Minister ofHealth is responsible
for protecting and enhancing the health care
system while ensuring the best possible value for
taxpayers in the context ofsignificant demand
pressure. Itincludes two instructions regarding
the overall direction for the health system. One is
tocontinue the Innovation and Change Agenda by
driving change in the areas ofprimary care, home
and community care, hospitals, and prevention
(mandate letter, no. 4). Theother mandate direction
is torecommend tocabinet the new priorities
forthe health system toensure maximum value
for taxpayers while providing maximum benefit
forpatients (mandate letter,no.3).
Additional mandate deliverables focus on key
service areas prevention, utilization ofnurse
practitioners, mental health service improvement,
laboratory reform, addiction service expansion,
expanded end-of-life care services, and successful
labour negotiations.
20
HealthOutcomes
WHAT HEALTH OUTCOMES DO
WEWANTTOACHIEVE FORTHE
POPULATION ANDPATIENTS?
21
Healthy Non-Users
Maternity and Healthy Newborns
Healthy with minor episodic health needs
Major or Significant time limited health needs: Adults
Major or Significant time limited health needs: <18 yrs
Mental Health and Substance Use needs
Population with Cancer
Low Complex Chronic Conditions
Medium Complex Chronic Conditions
High Complex Chronic Conditions
Frail Population, living in the Community
Frail Population, living in Residential Care
Palliative Needs
All Population Segments
662
111
1,613
119
45
83
54
1,332
383
208
13
38
16
4,675
14%
2%
35%
3%
1%
2%
1%
28%
8%
4%
0%
1%
0%
100%
$
$
$
$
$
$
$
$
$
$
$
$
$
29
150
26
9
19
26
235
145
156
16
27
31
868
9%
$ 148
$ 199
$ 122
$
47
$ 100
$ 107
$ 520
$ 315
$ 311
$
17
$
50
$
41
$ 1,977
20%
$
$
$
$
$
$
$
$
$
$
$
$
$
5
11
51
8
94
28
221
207
251
24
44
27
970
10%
$
$
$
$
$
$
$
$
$
$
$
$
$
188
203
180
225
284
404
418
958
82
381
271
3,595
36%
$
$
$
$
$
Residential Care
People
(Thousands)
PharmaCare
Millions of Dollars
12 $
236
158
48
32
486
5%
Total Cost
(Millions)
$
17
$
7
$ 1,912
$
57
$ 1,994
20%
$
369
$
359
$
401
$
244
$
438
$
459
$ 1,380
$ 1,086
$ 1,928
$
305
$ 2,462
$
458
$ 9,889
100%
0%
4%
4%
4%
2%
4%
5%
14%
11%
19%
3%
25%
5%
100%
Selected publicly funded Health Care Services are based on Physician encounter billings, PharmaCare paid prescriptions, Hospitalizations, HCCcommununity
services (Home Support, Assisted Living, Adult Day Services, Home Care Professional Services), and Residential Care. Peopleare assigned to their highest health
care need in the year, and all their health care services in the year are counted in that final population segment, even if they occurred earlier in theyear.
22
96%
93%
End of Life
76%
69%
Cancer
45%
45%
Sever Disability
32%
31%
25%
19%
18%
Total
120%
0%
20%
FRAILSENIORS
British Columbias population is growing and
aging, with the fastest growing seniors population
in Canada. Thepopulation over 65 is expected
toincrease from about 14 per cent to24 per
cent ofthe total provincial population between
2006and2036.
Theaging ofthe population is important as the
likelihood that aperson will have at least one
40%
60%
80%
100%
120%
23
24
25
26
OUTCOMES
Based on this population and patient analysis, what
outcomes might B.C. want toachieve? This can be
framed in three propositions:
}} To improve health outcomes, as well as
patient and workforce satisfaction, we need
todrive apatient-centred culture across the
healthsector.
}} Any strategy going forward needs torequire that
we maintain and incrementally improve on what
is workingwell.
}} There are several population segments where
it is critical that we achieve system-wide
improvement both from apopulation wellness,
patient health and quality oflife perspective and
from abudget management perspective.
Six desired outcome areasstandout:
}} Effective chronic disease prevention through
universal and targeted population health
interventions that address all major risk factors
across the lifecycle.
}} Reducing hospitalization and the need for
residential care by preventing or slowing down
the onset offrailty. This can be achieved through
targeted secondary prevention, with aparticular
focus on better managing the development
from low tomoderate tocomplex chronic
conditions linked toaging/increased frailty
thatappear tohappen over afive-yearperiod.
}} Reducing hospitalizations through effective
secondary and tertiary prevention for mental
illness and addictions.
}} Increasing timely access toevidence-informed
care from specialists, diagnostic imaging,
andelectivesurgery.
}} Providing consistent quality ofcare for
residential care patients, with astrong focus
onquality ofcare for dementiapatients.
}} Effective and compassionate care for end-oflifepatients.
PRIORITY1:
Provide patient-centredcare
Patient-centred care will be the foundational driver
in the planning and implementation ofall strategic
actions in the health system strategy. Theprovince
will strive todeliver health care as aservice built
around the individual, not the provider and
administration. Wewill do this in collaboration with
our health workforce and with patients. This is not
an overnight change, but apromise ofa sustained
focus that will drive policy, service design, training,
service delivery, and service accountability systems
over the coming threeyears.
A first key action will be tostart toshift the culture
ofpublicly funded health care organizations in B.C.,
where required, from being provider/administratorcentred and/or overly disease-centred tobeing
PRIORITY2:
27
PRIORITY3:
28
A GP 4ME
2,100 family physicians have
registered for theprogram.
4,200 previously
29
PRIORITY4:
30
REBALANCEMD
PROVIDES complete care from initial
assessment and diagnosis topostoperative therapy andfollow-up.
PATIENT wait times tosee aspecialist
have been reduced from 6-20 months
tofiveweeks.
PRIORITY5:
PRIORITY6:
PRIORITY7:
31
32
PRIORITY8:
Strategy
WHAT STRATEGY WILL WE PURSUE TOGET
RESULTS? WHAT ENABLING FACTORS
DO WE NEED TOLEVERAGE AND WHAT
CONSTRAINTS DO WE NEED TOMITIGATE?
The most interesting question facing any
contemporary health system is not what needs
tochange, but why change has not occurred.
Crafting an effective strategy is acritical and
neglected element ofhealth system change efforts.
In practice, there are anumber ofkey elements
that, depending on how they are managed or
not managed, will either enable or constrain
changeefforts.
As noted earlier, it is often assumed that
astrategy is synonymous with aplan. A plan
supposes asequence ofevents that allows one
tomove with confidence from one situation
toanother. Astrategy implies the involvement and
dependence on others with different and possibly
opposing interests and concerns. Successfulchange
in the health system will require astrategy that
accounts for the diverse political, administrative
33
STRATEGY1:
A Shared PlanofAction
A critical enabler for successful health system
change is the development ofa compelling vision
and an inclusive and credible planofaction.
This paper proposes athree part focus for
thevision:
1. Supporting the health and well-being
ofB.C.citizens.
2. Delivering asystem ofresponsive and effective
health care services for patients acrossB.C.
3. Ensuring valueformoney.
Realizing this vision will require disciplined
engagement and collaboration between
government, communities, health authority
governance and administration, health
professionals, support staff, professional
associations and unions. This must be linked
tocascading operational and strategic plans at the
provincial and regional levels that are comprised
ofclearly aligned objectives, meaningful and
measurable deliverables, meaningful timelines,
change management processes, balanced
budget plans (mandate letter, nos. 1 & 2), and
accountabilities driven by population and patient
outcomes and identified service priorities.
Theaction plans must be grounded in regional
realities and provide adequate detail detailing how
we are responding tothe health needs ofthe 62
geographic service areas categorized as metro,
urban/rural, ruralorremote.
34
STRATEGY2:
AccountabilitytoDeliver
the Three-YearPlan
The successful implementation ofa three-year
plan requires aclear performance management
accountability framework built on public reporting.
Key actions focus on refreshing role clarity and
accountability mechanisms for the ministry,
health authorities, physicians, nurses, allied health
professionals, and support staff focused on
population and patientneeds:
MINISTRYOFHEALTH
}} Align the role, core functions and structure
ofthe ministry tostrengthen capacity tolead
effective policy development, quality assurance,
and co-ordination ofeffective strategic action
across the healthsector.
PHYSICIANS
}} Ensure physicians have aconstructive voice and
accountability in the provision ofhealth care in
each community and health care facility in B.C.
based on acommitment topopulation health,
the experience ofquality care for patients,
and aconcern for per capita cost (Triple Aim,
Institute for Healthcare Improvement).
}} Negotiate asystem with mutual and increased
accountability between physicians and health
authority administrators. Ensure physicians
are able toexert meaningful influence on
decisions in the regional health authority
system that affects patient care, while also
ensuring professional accountability tothe
healthauthority.
}} Collaborate with physicians towork more
effectively with other health care providers
as part ofhealth care teams through mutual
accountability.
}} Ensure effective engagement with government
and professional accountability on the
development and implementation ofpolicies
that promote positive change in population
and patient health and the best standard ofcare
forpatients.
}} Make alternative contractual arrangements with
family and specialist physicians apriority, linked
toimproved health care topatients.
NURSING AND ALLIED HEALTHSTAFF
}} Ensure nurses and allied health professionals
have aconstructive voice and accountability
in the provision ofhealth care in each
community and health care facility in B.C.
based on acommitment topopulation health,
the experience ofquality care for patients,
and aconcern for per capita cost (Triple Aim,
Institute for Healthcare Improvement).
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STRATEGY3: Quality
To realize effective clinical quality improvement,
we must leverage the BC Patient Safety and Quality
Council todrive clinical quality improvement across
thesystem:
}} Establish aguideline driven clinical care
management system toimprove the quality,
safety and consistency ofkey clinical services
and toimprove patient experience ofcare,
building on the work undertaken todate
inthisarea.
}} Identify 15 high-priority areas for system
improvement and implement five per year
forthe next threeyears.
}} Require each health authority tohave
aformalized and adequate clinical quality
improvement capacity linked tothe BC
Patient Safety and Quality Council that is
inclusive ofphysicians, nurses and allied
healthprofessionals.
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STRATEGY4:
Skilled ChangeManagement
The ministry will work with and require each
health authority todemonstrate effective change
management capacity across its system - ensuring
managers are adequately skilled in change
management and are putting adequate time into
change management action todrive successful,
timely and efficient change. Managementwill:
}} Develop shared change management
approaches and expertise across thesector;
}} Ensure timely, open communication and
engagement with the health workforce during
the change management process;and
}} Provide accurate information on change
management performance todecision-makers.
}} Evaluate each health authority on the adequacy
ofits change management in moving forward
on the system wide priorities and time frames
established by the government.
STRATEGY5:
STRATEGY6:
Information Management
andTechnology
The information management and information
technology (IM/IT) strategy for the health sector
outlines aplan ofaction torealize more accessible
information, toensure knowledgeable people, and
todrive better health outcomes. It will leverage
technology such as the eHealth infrastructure built
over the pastdecade.
Theplanwill:
}} Increase information flow and personal
access tohealth data toempower patients
tobe full partners in actively managing their
healthconcerns.
}} Ensure the provision oftimely access todata
anduse oftechnology tosupport actions
related tothe six priority patient outcome areas.
Thiswillinclude:
Expanding the capability for cooperation,
enabling referrals, improved wait time
management and improved exchange
ofpatient information across service areas
tosupport inter-professional care teams in
the delivery ofhigh quality patientcare.
Expanding telehealth tosupport: patients
with chronic diseases, mental illness and
substance abuse; access tospecialists; and
acute care services in remote serviceareas.
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STRATEGY7:
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Conclusion
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