Goals, Objectives, Strategies and Results

Government Strategic Goals		Ministry Mission To guide and enhance the province's health services to ensure British Columbians are supported in their efforts to maintain and improve their health.
		Ministry Goals		Ministry Objectives		Key Strategies		Performance Measures
Safe, healthy communities and a sustainable environment. A supportive social fabric.		1. Improved Health and Wellness for British Columbians.		1. Individuals are supported in their efforts to stay healthy and make healthy lifestyle choices.		– Implement ActNow BC to promote healthy living –Support healthy childhood development – Provide access to health information and advice – Collaborate on Canadian Public Health Strategy		a) Smoking rates b) Obesity rates
				2. Protection of the public from preventable disease, illness and injury.		– Strengthen core public health services – Coordinate response to major public health risks and collaborate on new Public Health Network – Reduce inequalities in health status		a) Immunization rates for children and elderly b) Aboriginal infant mortality rates
		2. High Quality Patient Care.		1. Timely access to appropriate health services by the appropriate provider in the appropriate setting.		– Enhance primary care – Increase community health services – Increase assisted living environments – Effectively manage acute care services – Develop assessment tools to prioritize access		Access to: a) Residential care b) Chemotherapy and Radiotherapy c) Hospital admission from Emergency Departments
				2. Patient-centred care tailored to meet the specific health needs of patients and patient sub-populations.		– Better care for those with extensive needs – Better care for those which chronic conditions – Better care for those at the end of life – Ensure clinical services are organized and delivered safely, effectively and at a high quality		a) Diabetes test rates b) Congestive heart failure treatment c) More choice in end-of-life care
				3. Improved integration of health care providers, processes and systems to allow patients to move seamlessly through the system.		– Provide a full continuum of mental health and addiction services within each health authority – Provide integrated youth addictions programs – Improve ambulance service integration with the health authorities – Develop an electronic health record		Coordinated mental health treatment (30-day follow-up)
		3. A Sustainable, Affordable, Publicly- Funded Health System.		1. Effective vision, leadership, direction and support for the health system.		– Provide clear strategic direction and measurable expectations – Develop best practice guidelines, standards, benchmarks, protocols – Provide appropriate legislative, regulatory and policy frameworks – Support HA's to plan for investments in facilities and equipment to meet future needs – Provide timely, accurate information – Support health research for improvement		Health Authorities' rating of ministry leadership, direction and support — survey
				2. Strategic investments in information management and technology to improve patient care and system integration.		– Enable province-wide integration of clinically required person specific data – Improve access through increased use of technology and information systems – Improve data availability and quality – Expand public access to information through web applications		Electronic health record development
				3. Optimum human resource development to ensure there are enough, and the right mix of, health professionals.		– Develop Health Human Resource action plans – Work with partners to provide education and training opportunities – Integrate nurse practitioners into the system – Create safe, positive work environments that attract and retain talented people		Health human resource action plan
				4. Sound business practices to manage within the available budget while meeting the priority needs of the population.		– Implement performance agreements with Health Authorities – Manage the MSP and PharmaCare programs – Use planning and projection tools and models to inform decision-making and focus resources – Monitor, evaluate, and report publicly on health system performance and the health of the population		Actual health expenditures do not exceed health budget

British Columbians are supported in their pursuit of better health through health protection and promotion and disease prevention activities.

British Columbians in general are among the healthiest people in the world, and we want to support their healthy lifestyles while also providing support to those in the population who do not enjoy good health or are at risk of diminishing health. Many citizens are at risk from factors such as poor dietary habits, obesity, inactivity, injuries, tobacco use and problematic substance use.

An ounce of prevention is worth a pound of cure. Services such as health promotion and protection, and chronic disease prevention and management, are important to maintaining and improving health outcomes while containing overall health system costs. If we can keep people healthy and out of the health care system, we win on two fronts: people have a better quality of life, and scarce resources can be freed up for non-preventable illness.

Key strategies include:

• Working with health authority partners and other government ministries and organizations to develop and implement ActNow BC, a program to promote healthy lifestyles and prevent disease by providing people with the information, resources and support they need to make healthy lifestyle decisions. Specifically, ActNow BC will promote physical activity, healthy eating, living tobacco free and making healthy choices during pregnancy.
• Supporting healthy childhood development through programs to identify problems with hearing, vision or dental health for children before they reach Grade 1, and providing the supports and services necessary to address their needs.
• Addressing elementary students' physical activity levels and providing them with information on healthy lifestyles through the Action Schools! BC program.
• Providing British Columbians 24 hour-a-day access to health information, advice and resources to assist their self-care and self-management by expanding the BC NurseLine and other components of the BC HealthGuide program.
• Working with the federal government and other provinces to develop a pan-Canadian Public Health Strategy, which will set goals and targets for improving the health status of Canadians.

Performance Measures:

B.C.'s Provincial Health Officer publishes an annual report on the health and well-being of the population. The report contains 91 indicators of broad and long-term health outcomes and is a valuable resource for the ministry to track and evaluate the overall health of the population and the impact of health system strategies. The annual reports can be found at http://www.healthservices.gov.bc.ca/pho.

The ministry has chosen to track two indicators also found in the Provincial Health Officer's report: smoking rates (age 15+) and population Body Mass Index (age 18+). These indicators will help assess the effectiveness of programs to encourage tobacco reduction, physical activity and healthy eating.

Long-term targets have been set in accordance with the ActNow BC initiative. For smoking rates, the target is to continue B.C.'s downward trend of tobacco use by a further 10 per cent — from the 2003 prevalence rate (latest data) of 16 per cent to 14.4 per cent of the population by 2010. For Body Mass Index, the target is to reduce by 20 per cent the proportion of the B.C. population currently classified as obese or overweight from the 2003 prevalence rate of 42.3 per cent to 33.9 per cent of the B.C. population by 2010.

The second major approach to keeping people healthy is through providing effective public health services to prevent illness and disability. The ministry and its partners play an important role in monitoring and protecting the health of the population. Legislation, regulation and monitoring of food, air and water quality lay the foundation for communities and citizens to live in healthy and safe environments. Immunization programs and infectious disease and injury prevention and control measures also help to improve population health, prevent illness and reduce health care costs.

Key Strategies:

• Protect health by implementing core public health prevention and protection programs, including immunization programs, infectious disease and injury prevention and control measures, monitoring and regulating water and environmental safety, reproductive health, food security and health emergency management.
• Develop coordinated system-wide approaches for responding to major public health risks, emergencies or epidemics (e.g., SARS, West Nile, influenza, meningitis, and natural and/or accidental disasters), and collaborate with other provinces through participation in a new Public Health Network.
• Reduce inequalities in health with a focus on Aboriginal peoples, low-income individuals, and women, children and seniors.

Performance Measures:

One important element of effective public health is immunization, particularly for infants and the vulnerable elderly. To this end, we will measure both the percentage of two-year-olds with up-to-date immunizations, and the percentage of residents of care facilities who get influenza vaccinations for flu season.

Also, the ministry will judge efforts to improve the health status of Aboriginal peoples by tracking post-neonatal infant mortality rates, and comparing them to the general population. Over the past decade the gap between the Status Indian neonatal (<28 days) infant mortality rate and the rate in the general population has been virtually eliminated. However, a gap does still remain in the post-neonatal group (28–364 days of age); accordingly, the ministry will focus on improvements in the post-neonatal subset of infant mortality rates.

Patients receive appropriate, effective, quality care at the right time in the right setting. Health services are planned, managed and delivered in concert with patient needs.

All British Columbians should be able to access health services when they need them, be that for a visit to a family doctor, prescription drug therapy, emergency treatment, elective surgery or ongoing care. The ministry and its partners have been working diligently over the past three years to ensure hospitals, community services and health professionals are used in the most efficient and effective way possible so that people get the right type of care in the right type of setting that will lead to the best health outcome. The key approaches have been to ensure there is an adequate supply of key providers, to increase the range and availability of services provided in the community, and to ensure that our hospitals are used effectively to provide emergency and acute care, such as surgery or cancer treatment.

Our strategies will continue to support those key approaches and include:

• Investing strategically across the continuum of prevention, primary care, acute care and post-acute home care and rehabilitation in order to maximize access in key areas of need for British Columbians, including the areas identified by First Ministers in developing their Ten Year Plan to Strengthen Health Care, 2004 (cancer, heart, diagnostics, joint replacements and sight restoration).
• Enhancing primary care to serve as an effective first point of contact in the health system for individuals and families.
• Utilizing the BC HealthGuide program, particularly BC NurseLine, to provide access to health information and advice 24 hours a day, 7 days a week.
• Increasing the range of community health support, including providing more intensive home care, to enable timely discharge from hospital once a patient's need for acute care has ended.
• Increasing the range of supportive living environments and community care options, including home care, for elderly and disabled individuals so they can remain as independent as possible in their own homes and communities.
• Developing and implementing evidence-based clinical assessment tools for prioritizing access to care, and renewing the surgical registry.
• Protecting British Columbians from catastrophic prescription drug costs through the Fair PharmaCare program, and collaborating with other provinces on a National Pharmaceutical Strategy.

Performance Measures:

Measuring access to appropriate care is currently hindered by a number of factors, including the absence of reliable waiting time data and a lack of accepted clinical assessment tools to prioritize access to care based on medical need. As part of the First Ministers' Ten Year Plan to Strengthen Health Care, each province and territory has agreed to establish comparable indicators of access to health care professionals and diagnostic and treatment procedures. In 2005/06, British Columbia will be actively participating in developing these access indicators, which will be used as indicators in future service plans.

In the meantime, we will track the following indicators to determine our progress in creating the right balance between care provided in the hospital and care provided in the community, and in providing timely access to needed health services:

a) Timely access to residential care — the percentage of community based clients admitted to a residential care facility within 30 days of approval.

This indicator tracks the percentage of seniors and people with disabilities who enter residential care within 30 days of being approved through assessment. Clients approved for residential care have complex needs that require close attention. Improving access to this level of care leads to better outcomes and use of resources.

b) Waiting times for key services: Radiotherapy and Chemotherapy.

Monitoring cancer wait times helps ensure patients' cancers are treated as early as possible to achieve the best possible outcomes.

c) Waiting times for key services: Hospital admission from the emergency department.

A hospital admission can either be planned, such as scheduled surgery, or unplanned. This measure focuses on unexpected hospital admissions that occur through hospital emergency departments. Many people are appropriately treated and released from emergency departments, but some people require an extended course of treatment and must be admitted to hospital. Measuring the amount of time from the decision to admit a patient from an emergency department to when the patient is admitted to an inpatient bed provides an indication of access to appropriate levels of care.

When people use the health care system we must ensure the care they receive is centred on their needs and will lead to the best health outcomes. This means delivering services that are evidence-based and reflect best practice. Since one size does not fit all in health service delivery, the ministry is working with health authorities and physicians to design and deliver customized care that addresses the unique needs of specific patient sub-populations. To begin, the focus is on coordinating care for patients with extensive needs, proactively managing patients with chronic diseases and providing better care for the dying. Implementing a patient-centred approach for these populations can improve quality of life and health outcomes for patients and provide better use of health services.

Key strategies include:

• Providing targeted services for patients who have extensive health care needs to more effectively manage their contact with health care services.
• Increasing the emphasis on more effective management of patients with chronic diseases to prevent or slow disease progression. Areas of focus will include diabetes, congestive heart failure, kidney disease, chronic obstructive pulmonary disease, osteo and rheumatoid arthritis and dementia.
• Expanding end-of-life care services to provide dying people with greater choice and access to services.
• Ensuring clinical services are organized and delivered safely and at a high quality by reviewing safety issues and developing guidelines, best practices and performance measures.

Performance Measures:

Measures under this objective centre on improving chronic disease management, focusing specifically on the treatment of congestive heart failure and diabetes. Improvement targets have been set in accordance with best practices in treating these chronic conditions.

We have also included an indicator to help us track improvement in the availability of more palliative care choices for those at the end of life.

a) Use by physicians of appropriate drug therapies to treat congestive heart failure (CHF), measured by the percentage of patients suffering from CHF who are prescribed
  a) ACE inhibitors; b) Beta blockers.

ACE inhibitor and Beta blocker drugs are recognized for their importance in treating patients suffering from congestive heart failure. Targets have been set in consultation with the Chronic Disease Collaborative, a collection of physicians working to implement best practices for chronic disease management.

b) Improved management of diabetes measured by the percentage of patients with diabetes who undergo at least two A_1C tests per year.

Diabetes is one of the most common chronic diseases. It affects about five per cent of British Columbians and is steadily increasing in prevalence. By taking two A_1C tests per year, patients and their physicians can be aware of abnormalities faster, and lower complication rates. This means a healthier life for the patient and a reduced impact on the health system.

c) Decrease in percentage of natural deaths occurring in hospital.

As part of a comprehensive plan to improve end-of-life care, we will monitor the number of natural deaths that occur in hospital. A decrease in the rate will serve as a proxy measure for improvements in the availability of a range of appropriate non-hospital choices for end-of-life care. It is recognized, however, that some deaths appropriately occur in a hospital setting. Accordingly, a long-term target has not yet been set as the ministry continues to work with its partners to research and develop best practices for end-of-life care.

The health care system is very complex. The diversity of health care needs across the province means the system is always caring for unique patients through different caregivers, in different settings, every day. The ministry and its partners will be working to improve the integration of those services so care can be provided in the most coordinated and seamless manner possible to the benefit of patients and health care providers.

Under this objective, particular attention is being focused on mental health and addiction services. People with mental illness or substance misuse disorders often must access various providers to receive care, and too many times end up in hospital emergency rooms. The ministry and its partners are working to ensure services, from child and youth to adult programs, are integrated and available within patients' home communities to improve and simplify the patient experience with the health system and maximize efficiency.

Better integration will also help up us realize maximum value from the various resources available in the system. For instance, the B.C. Ambulance Service is an important provincial resource with the potential to support and enhance services provided by health authorities, if we can work to better coordinate and integrate the services each provides.

Key strategies include:

• Providing a full continuum of mental health and addiction services within each health authority, which better integrates primary, secondary, community and tertiary care and is integrated within the larger care networks.
• Specifically addressing the need to provide integrated programs for youth addictions, including both detox and outreach programs.
• Working with other government ministries to ensure services are integrated and accessible for those suffering from mental illness and/or substance misuse.
• Enhancing patient care by enabling province-wide integration of and access to clinically required, person-specific data, while protecting personal privacy (electronic health record).
• Improving ambulance service integration with health authorities to maximize resources and provide best care to patients.

Performance Measure:

We will measure the continuity of care in mental health services by tracking the percentage of persons hospitalized for a mental health diagnosis who receive community or physician follow-up within 30 days of discharge. A high rate of community or physician follow-up reduces the chances that a mental health client will suffer a relapse and have to be readmitted to hospital. It also indicates strong communication between discharge planners, community services and family physicians.

The public health system is affordable, efficient and accountable, with governors, providers and patients taking responsibility for the provision and use of services.

The ministry's strategic direction for the health system must be well articulated and communicated to the public and to those who deliver services to the public. The ministry is committed to leading and fostering a culture in which health system activities are evidence-based, well planned and understood, and in which accountability structures exist to ensure strategic directions guide service delivery activities. Further, the ministry must support its service delivery partners (health authorities and health professionals) to achieve the strategic priorities of the health system. It does so by supporting health research activities and the development of best practices for service delivery, and developing legislative, regulatory and policy frameworks to manage the health system and protect public health.

Key strategies include:

• Translating health care needs into clear strategic direction and measurable expectations that will guide operational management and delivery of health services.
• Facilitating the delivery of health services by partners through the development and use of best practice guidelines, standards, benchmarks and protocols.
• Providing legislative, regulatory and policy frameworks to ensure policy direction is clear and consistent and allows services to be delivered appropriately and cost-effectively.
• Supporting health authorities in planning for investments in facilities and equipment to ensure the health system has the capacity to meet the population's health needs.
• Providing strategic communication support to ensure accurate information is available in a timely and coordinated manner.
• Supporting health research and creating opportunities for health partners to share knowledge and best practices to facilitate continuous improvement in service delivery.

Performance Measure:

Health authorities' ratings of the clarity, timeliness and usefulness of government direction in guiding service delivery.

Asking health authorities, through a survey, to rate the ministry's effectiveness in providing strong leadership will give a better understanding of whether the ministry is performing one of its central functions well.

Making the right investments in information management systems and new technologies will support the health system in meeting the goals and objectives set out in this service plan. Technology can improve system integration and efficiency, improve access to services across the province, assist managers and practitioners to make evidence-based decisions, and help citizens access valuable health information in a timely and convenient manner. The ministry is working to realize the potential in each of these areas.

Key strategies include:

• Enhancing patient care by enabling province-wide integration of and access to clinically-required, person-specific data, while protecting personal privacy (electronic health record).
• Improving access to services, in all geographic areas of the province, through the increased use of technology and information systems (e.g., telehealth).
• Improving the clinical and management utility of health data for decision-making through broadened availability of quality data and analysis.
• Expanding public access to health services and health information through web-based applications.

Performance Measure:

The ministry is developing an Electronic Health Record (EHR). It is a cornerstone of government's comprehensive strategy to deliver faster and more effective treatment to patients. Enabling care providers to access clinical information, such as patient medication profiles, lab and other testing results, using web-based technology is a high priority.

It is not feasible to produce an overall performance measure for the entire EHR initiative because it consists of many substantial and complex sub-projects. However, the ministry's Information Resource Management Plan, which is published and updated annually, tracks progress in the development of the major components of the EHR. For details on the project, please see the plan at http://www.gov.bc.ca/health/.

To be sustainable the system must have enough, and the right mix of, health professionals to provide services today and in the future. The system must ensure health workers are employed in the most efficient and effective manner, and that their work environments are supportive of them delivering high quality services. Therefore, this objective also focuses on improving workplace wellness, both in the Ministry of Health Services and the broader health system.

Key strategies include:

• Developing Health Human Resource plans to ensure an adequate supply and appropriate mix of health professionals.
• Working with the Ministry of Advanced Education and health system partners to implement human resource plans, including increasing education and training opportunities and successfully managing the medical school expansion.
• Addressing succession planning needs through initiatives to develop future leaders capable of managing the increasingly complex health system.
• Integrating nurse practitioners into B.C.'s health system.
• Creating safe, positive work environments that attract and retain talented people.
• Implementing a human resource plan for the ministry that supports employee wellness and assists the ministry in meeting its strategic goals.

Performance Measure:

The First Ministers' Ten Year Plan to Strengthen Health Care included a commitment by all jurisdictions to increase the supply of health professionals based on provincial needs, and to make their action plans public, including targets for the training, recruitment and retention of professionals, by December 31, 2005. British Columbia is in the process of developing its health human resource action plan and will incorporate key elements of it into future service plans to measure performance.

The ministry is committed to working with its partners to manage the health system efficiently to ensure resources are spent where they will have the best outcome. The ministry monitors and evaluates the delivery of services and the health of the population and works with its partners to ensure services delivered in the system meet the needs of the public. As part of a commitment to continuous improvement and evidence-based decision-making, the ministry uses its evaluations of health system performance to inform strategic direction and facilitate course correction where warranted.

Key strategies include:

• Developing and implementing three-year performance agreements with health authorities to detail responsibilities and expectations for service delivery.
• Providing three-year funding commitments to health authorities, updated annually, to enable them to plan and act with certainty.
• Effectively managing the Medical Services Plan and PharmaCare programs to ensure needed medical and pharmaceutical services are available and sustainable.
• Working with health authorities and other system partners to ensure their services and outcomes are aligned with government direction and policy.
• Working with system partners to ensure overall health system costs remain affordable and within budget.
• Monitoring and reporting publicly on health system performance and the health of the British Columbia population.
• Embedding sound management practices within the ministry, including structured performance planning and monitoring.
• Using planning and projection tools and models, and risk management processes, to inform decision-making and focus resources.
• Utilizing strategic partnerships and innovative approaches to improve services to the public within the available fiscal resources.

Performance Measure:

We will monitor and report on the health system's ability to manage within its budget. Staying within the budget provides a high-level indication of whether the health system is on a sustainable path.