Performance Plan

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

British Columbians in general are among the healthiest people in the world. We want to support the excellent health status of the majority of our citizens while also helping those in the population who do not enjoy good health or are at risk of diminishing health from factors such as poor dietary habits, obesity, inactivity, injuries, tobacco use and problematic substance use. 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.

Providing British Columbians with self-care tools and resources can empower individuals and families to stay healthy and manage minor and chronic conditions safely, in collaboration with a health care professional where necessary. 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.

• Supporting ActNow BC to encourage healthy and active living. The Ministry and its health authority partners will promote healthy lifestyles and prevent disease by providing people with information, resources and support to make healthy lifestyle decisions. One example is a new centre at BC Children's Hospital to help reduce obesity in children and adolescents. The Centre for Healthy Weights: Shapedown BC will help families of children and adolescents who are dealing with obesity and will target changes in nutrition and physical activity levels for the entire family.
• Assisting people to stay healthy across their life-span through the development of a staying healthy framework. The framework complements the illness care components of the health system; provides a system-wide approach to staying healthy; and focuses on public health renewal, population health promotion, prevention services in primary care, and self-care.
• 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.
• Partnering with the Ministry of Education in the following Healthy Schools Initiatives: supporting elementary students to increase their physical activity levels through Action Schools! BC; increasing fruit and vegetable consumption through the School Fruit and Vegetable Snack Program; supporting the elimination of unhealthy food and beverage sales in B.C. schools; and supporting the reduction of tobacco use among students.
• Providing British Columbians 24 hour-a-day access to health information, advice and resources to assist their self-care and self-management through 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.

As part of its focus on healthy living, the Ministry will continue to track physical activity rates in British Columbia. For physical activity, the target is to increase by 20 per cent the proportion of the B.C. population currently classified as active or moderately active from the 2003 rate of per cent to 69.5 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.

• Protect health by implementing core public health 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.
• Continue to prepare and respond in a coordinated system-wide manner to major public health risks, emergencies or epidemics (e.g., West Nile virus, pandemic influenza, meningitis outbreaks, and natural or accidental emergencies). Work with other provinces and the federal government to reflect best practice implementation of the Canadian Pandemic Influenza Plan.

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

As part of promoting and protecting health, the Ministry and its partners are focusing on reducing inequalities in health status across the B.C. population. In particular, we are supporting the Government's New Relationship with First Nations and the Transformative Change Accord by working with First Nations to improve health and eliminate the gap in health status between First Nations and the rest of the British Columbia population. The First Nations Leadership Council and British Columbia have developed the First Nations Health Plan to identify priorities for action to close the health gap between First Nations and other British Columbians.

• Enable First Nations to take a leadership role in improving their health status and in providing input into health planning, as well as in reviewing health outcomes for First Nations people.
• Design and deliver health promotion and disease prevention programs designed for First Nations. The Minister of State for ActNow BC will work with First Nations communities, the National Collaborating Centre on Aboriginal Health and health authorities to develop a First Nations/Aboriginal specific ActNow BC program.
• Provide First Nations with improved access to quality, culturally appropriate health services. Priorities include a new health centre in Lytton, a new chronic disease management pilot program in the Northern Health Authority, improved mental health and addictions services, and new post-secondary educational opportunities to increase the number of trained First Nations health care professionals.
• Improve the collection of First Nations health status and health service information (data) and use it to improve health services and monitor and report on the health status of First Nations in British Columbia.

Monitoring and reporting on health outcomes and the health status of First Nations' people is a key component of the First Nations Health Plan. The Health Plan identifies a number of performance indicators that will be used to measure the effectiveness of programs in closing the health gap between First Nations and other British Columbians. Measures identified in the First Nations Health Plan include life expectancy, mortality rates, infant mortality rates, youth suicide rates, diabetes rates, childhood obesity prevalence, and the number of practicing, certified First Nations health care professionals. A copy of the First Nations Health plan, which includes descriptions and targets for each of these measures, can be found at http://www.health.gov.bc.ca/cpa/publications.

The Provincial Health Officer will issue an Aboriginal health status report, including indicators from the First Nations Health Plan, every five years with interim updates produced every two years. These reports will be available at: http://www.health.gov.bc.ca/pho. Meanwhile, the Ministry service plan will track life expectancy for Aboriginal people as an overarching indicator of Aboriginal health. Aboriginal life expectancy has been improving in recent years, but there is still a significant gap between life expectancy in the Aboriginal population and life expectancy for the rest of the B.C. population.

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 appropriate 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 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.

• Increasing the range of supportive living environments and community care options, across the spectrum from home care to residential facility care, for elderly and disabled individuals so they can remain as independent as possible in their own homes and communities while also having the full support of residential care if their health conditions require the highest level of care. Part of this strategy is completing the commitment to build 5,000 net new residential care, assisted living and supportive housing beds by December 2008.
• Reducing wait times in key surgical and medical areas, including cardiac treatment, diagnostic imaging, joint replacements, cancer services and sight restoration.
• Addressing emergency department congestion and improving the effectiveness and efficiency of emergency departments through initiatives both within and outside hospitals.
• Expanding primary care capacity and services delivered by doctors, nurse practitioners, pharmacists and other key professionals to provide effective first point of contact care and help keep people with chronic diseases as healthy as possible.
• Providing British Columbians access to prescription drug therapy through the PharmaCare program, and co-leading with the Federal Government the development of a National Pharmaceuticals Strategy to provide access to catastrophic drug coverage, accelerate access to breakthrough drugs, strengthen the national evaluation of drug safety and effectiveness, and pursue national purchasing strategies to obtain drugs and vaccines at the best price possible.

The Ministry is tracking a number of access indicators aligned with its key strategies, including access to cancer treatment, hip and knee replacement surgeries, and access to hospital services through the emergency department. Descriptions of the measures in each of these areas are provided below:

a) Timely access to cancer treatment — radiotherapy and chemotherapy.

Radiation therapy and chemotherapy are principal treatments in cancer care. Ensuring treatment is available and provided in a timely manner is important to achieving the best health outcomes for patients.

b) Timely access to surgical services — hip and knee replacement surgery.

Demand for hip and knee replacement surgeries has been rising sharply as the population ages and new surgical techniques and technology makes replacement surgeries available to more people. The Ministry is making significant efforts to improve access to these services and has established a target for 90 per cent of hip and knee replacements to be completed within 26 weeks by 2010.

c) Timely access to hospital 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.

B.C.'s health system is committed to providing top quality care and services. When people use the system we must ensure the care they receive is centred on their needs, safe, evidence-based and will lead to the best health outcomes. Since one size does not fit all in health service delivery, the Ministry is working with health authorities, physicians and other providers to design and deliver customized care that addresses the unique needs of patients or specific patient groups, such as those with chronic diseases. Implementing a quality focused, patient-centred approach can improve quality of life and health outcomes for patients and provide better use of health services.

• Increasing the emphasis on the effective management of patients with chronic diseases to prevent or slow disease progression. The primary areas of focus are diabetes, congestive heart failure, kidney disease, chronic obstructive pulmonary disease, osteo and rheumatoid arthritis and dementia.
• Expanding end-of-life care services, including hospice and home-based palliative care, to provide dying people with greater choice and access to services.
• Ensuring the quality and safety of health services across the continuum of care by reviewing safety issues and by developing and implementing safety guidelines, best practices and initiatives.

The Ministry is tracking two measures under this objective. The first measure centres on improving chronic disease management, focusing specifically on the treatment of diabetes. The second measure for this objective is an indicator of the availability of non-hospital care options for persons at the end of life.

a) Improved management of diabetes measured by the percentage of patients with diabetes who undergo at least two hemoglobin 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. The hemoglobin A_1C test is a simple lab test used in the management of diabetes that shows the average amount of sugar (glucose) that has been in a person's blood over the previous three months. The A_1C test shows if a person's blood sugar is close to normal or too high, and is recommended as part of best practice care for diabetes because it allows patients and their physicians to be aware of abnormalities faster and take action to lower complication rates. Improved management of diabetes means a healthier life for the patient and a reduced impact on the health system.

b) Availability of palliative care options as measured by the percentage of natural deaths occurring in settings outside hospital (home, residential care, hospice).

As part of a comprehensive plan to improve end-of-life care, the Ministry is monitoring the number of natural deaths that occur in settings outside hospital. An increase 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 research and develop best practices for end-of-life care.

The health system is very complex. The diversity of health needs across the province means the system is always caring for unique patients through different caregivers, in different settings, every day. While we have made good progress, the Ministry and its partners will continue to work to improve the integration of those services so care can be provided in the most coordinated and seamless manner possible, which benefits both patients and health service providers.

In addition, the Ministry is also committed to improved collaboration and coordination with other provincial government ministries and with agencies outside the traditional health system. Coordinated action and improved integration will allow government to provide better support services for persons with disabilities, special needs, children at risk and seniors.

Under this objective, the Ministry has a particular focus on mental health and addiction services. People with mental illness or substance misuse disorders often must access various providers to receive care and support services. The Ministry and its partners are working to ensure services, from child and youth to adult programs, are integrated and available within people's home communities to improve and simplify the patient experience, while ensuring the appropriate care and services are delivered.

• Providing a full continuum of high quality 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.
• Working with other ministries, BC Housing, health authorities and other partners to better address the housing and service needs of those with mental illness and addictions.
• Enhancing services for people with dementia, including Alzheimer's disease. Targeted improvements include earlier assessment, clinical guidelines to improve treatment, and better integration of services.
• Expanding drug and alcohol treatment for at-risk and addicted people who are seeking help.
• Specifically addressing the need to provide integrated programs for youth addictions, including both detoxification and outreach programs. Particular focus will be placed on contributing to government's integrated approach to addressing crystal meth use in British Columbia.
• Working with other government ministries to ensure initiatives, programs and services are integrated to achieve maximum benefit for those in need, including people suffering from mental illness and/or substance misuse, children with special needs, children and seniors at risk, and persons with disabilities.

The Ministry will measure the continuity of care in mental health services by tracking the percentage of persons hospitalized for a mental health or addictions 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 re-admitted 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.

British Columbia's health system is a valuable public resource that benefits all British Columbians. People value good health and a health system that will be there when they need it, both now and in the future.

The sustainability of the health system faces many challenges as the province's population grows and ages and as new and more expensive technologies and treatments are introduced. As Government works to make the health system sustainable, it is seeking the input of British Columbians. It has launched a Conversation on Health as a discussion among British Columbians on how to make British Columbia healthier, and how to improve and renew our health system while strengthening the Canada Health Act. The Conversation on Health engages British Columbians in finding ways to make the health system sustainable for the future. It allows government to hear what is important to British Columbians, what challenges are the most important to address, and what solutions are available to ensure good health and a sustainable health system in the long term.

• Engaging British Columbians in a conversation about the health system and solutions to make it sustainable into the future.
• Providing multiple opportunities and avenues for British Columbians to be heard during the Conversation on Health, including online discussions through a dedicated website, regional forums, email or regular mail, a toll-free telephone number and by contacting a local Member of the Legislative Assembly.
• Providing specific opportunities for input for government leaders, health professionals, and patients.
• Listening to British Columbians and reporting on what they have said.

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 and its partners are working to realize the potential in each of these areas through implementation of B.C.'s eHealth Strategy. eHealth represents a major step in transforming the health system into a seamless continuum of care, supported by a seamless web of health information. It is also a powerful tool to allow providers to apply the highest standards and best practices to improve the quality and safety of services for British Columbians. Further information on the eHealth strategy can be found at http://www.health.gov.bc.ca/cpa/publications. An overview of the Ministry's Information Resource Management Plan can also be found at the same website.

• Enhancing patient care by enabling province-wide integration of and access to clinically required, person-specific data, while protecting personal privacy (electronic health record).
• Working with the British Columbia Medical Association and the College of Physicians and Surgeons to co-ordinate, facilitate and support information technology planning and implementation for physicians, and develop and implement standardized systems of electronic medical records.
• Supporting the use of electronic medical record systems by physicians.
• Expanding telehealth to improve rural and remote residents' access to health services and specialists.
• Improving the availability of quality data and analysis to assist clinical and management decision-making.
• Expanding public access to health services and health information through web-based applications.

eHealth is about more than just information technology — it is about changing and modernizing clinical and business practices in the delivery of health services. It is important to ensure physicians and health professionals are engaged in the selection and implementation of new technology to modernize the delivery of health services in the province. Accordingly, the Ministry and British Columbia Medical Association are working together to expand the use of electronic medical record systems in physician offices. As a performance measure, the Ministry will track the number of physicians implementing electronic medical record systems through the Government/BC Medical Association incentive program.

Skilled and caring health professionals are the cornerstones of our health system. Thousands of British Columbians seek medical attention every day, confident they are in the care of competent professionals who hold themselves to the highest standards. To be sustainable the system must ensure it has enough, and the right mix of, health professionals to provide the services that will meet British Columbian's needs now and in the future. B.C. has made significant progress over the past five years in addressing our health human resource needs, but there is more work to be done.

• Working with the Ministry of Advanced Education and health system partners to implement human resource training plans, including increasing education and training opportunities and reviewing educational programs to ensure new graduates are ready to practice. Key initiatives include expanding B.C.'s medical school, with campuses in Victoria, Prince George and Kelowna, doubling of the number of post-graduate residency spaces to 256 by 2010, and investing in the continued recruitment, training, and retention of nurses.
• Recruiting foreign-trained doctors and nurses through an expanded B.C. Provincial Nominee Program, which allows applicants to gain permanent residence status more quickly and permanently practice in British Columbia.
• Integrating nurse practitioners into B.C.'s health system, and increasing the number of nurse practitioners graduating in the province, including new graduates at University of Northern B.C.
• Addressing succession planning needs through initiatives to develop future leaders capable of managing the increasingly complex health system.
• Creating safe, positive work environments that attract and retain talented people, and support employee wellness and quality of work life in the health sector.

A major focus and challenge for the province, and other jurisdictions around the world, is the availability and supply of nurses and other key allied health professionals. British Columbia's health human resource strategies include a number of targeted education, recruitment and retention strategies designed to ensure we have enough health professionals to meet health system needs. To assess the impact of these strategies on the supply of health professionals, the Ministry will track vacancy rates across the province. In 2007/08 the Ministry will work with health authorities to establish appropriate provincial reporting systems and vacancy rate baselines; future targets will then be developed based on that information.

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, the Ministry uses its evaluations of health system performance to inform strategic direction and facilitate course correction where warranted. It also uses this information, along with population demographic and health need projections, to plan investments in the health system's physical infrastructure.

• Providing legislative, regulatory and policy frameworks to ensure policy direction is clear and consistent and allows services to be delivered appropriately and cost-effectively.
• Working with health authorities and other partners to plan and manage strategic capital investments to renew the health system's infrastructure, including facilities, equipment and information technology.
• Monitoring and reporting publicly on health system performance and the health of the British Columbia population.
• Working with system partners to ensure overall health system costs remain affordable and within budget.
• Utilizing strategic partnerships and innovative approaches to improve services to the public within the available fiscal resources.