2003/04 Annual Service Plan Report -- Ministry of Health Services

As steward of the health system, the ministry provides leadership and support to health authorities and other partners in delivering quality health services to the public. The ministry's stewardship objectives and strategies are designed to assist our service delivery partners fulfill the objectives and strategies listed in the previous section, and ensure the health system is redesigned in accordance with government's strategic direction. Stewardship strategies are organized under three objectives, which represent the main components of effective stewardship: Strategic Direction, Support to Partners, and Monitoring, Evaluation and Course Correction.

Each stewardship objective contributes to all three goals of the ministry. That is, effective stewardship by the ministry will contribute to a system with improved health and wellness for British Columbians, and high quality patient care that is sustainable and affordable.

The core business of Stewardship is where the functions of the former Ministry of Health Planning have been integrated with the Ministry of Health Services. This section reports our progress on performance measures from the 2003/04 – 2005/06 Service Plans for both the Ministries of Health Services and Health Planning. The format of this report follows the amalgamation of strategies from the two ministries as presented in the Ministry of Health Services 2004/05 – 2006/07 Service Plan. Each strategy and performance measure includes a notation indicating its origin (Health Services, Health Planning, or both). Performance measures that were discontinued following the amalgamation are included in this report and noted as such.

Unlike the previous sections of this report, most performance measures in this section are qualitative. Therefore, performance reporting is primarily based on detailing the ministry's progress in implementing its stewardship strategies.

Objective 1: Direction

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. 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 has undertaken several strategies to meet the objective of providing clear strategic direction for the health system. The following pages outline each of the strategies and report on the progress to date in meeting the performance expectations in the 2003/04 – 2005/06 Service Plan.

04/05 MOHS Strategy 1: Translate health care needs into clear strategic direction and measurable expectations that will guide operational management and delivery of health services.

03/04 Source: MOHS Strategy 1; MOHP Strategy 1.

To be effective the health system needs to be planned, well managed, responsive to patient and public needs and accountable to the public. We need to focus on the changing and diverse needs of British Columbians, and develop short and long-term strategies to ensure those needs are met. Those strategies must then be communicated and well understood by all stakeholders in the system, and accountability measures must be in place to ensure the delivery of services meets patient needs.

Performance Measure: Partners' ratings of the clarity, timeliness and usefulness of government direction in guiding service delivery (03/04 MOHS PM 1).

Rationale: As the ministry strives to provide clear and timely direction to those who deliver health services, it is also important to receive feedback from the recipients of that direction. Working together will help identify strengths and gaps, and inform our efforts to clarify and improve our strategic direction and communication with our service delivery partners. To begin, we are developing and implementing a survey seeking the opinions of senior health authority personnel. This assessment tool will provide a comparable, clear measure of the ministry's performance over time.

Progress: The ministry is working with BC STATS to develop a survey and process, with implementation expected in 2004/05.

Performance Measure: Mid and long-term direction setting plans for the health sector completed. (03/04 MOHP PM 1).

Target 03/04: Health care system directional plan developed and service plan aligned with directional plan.

Actual 03/04: Analytical foundations complete, directional plan development underway.

Rationale: The health system is a multi-faceted, complex system. Planning for a social program as large as the health system occurs on many levels, in many places, and involves numerous health care partners, stakeholders and organizations. To ensure all components of the system are working toward the same goals, the ministry is developing an overall directional plan. The plan will detail the major strategies government will pursue to sustain and improve the publicly funded health system.

Progress: The ministry has completed the foundational work for the directional plan, including a comprehensive review of the health system and input from national and international experts. The long-term directional plan will be published in 2004/05.

04/05 MOHS Strategy 2: Facilitate the delivery of health services by partners through the development and use of best practice guidelines/standards and protocols.

03/04 Source: MOHS Strategy 3; MOHP Strategy 2.

Effective stewardship requires that the ministry not only provide strategic direction through broad planning, but also operational support through the research of best practices in service delivery. Scanning other health systems for best practices and incorporating them in BC can improve patient care and outcomes. The ministry works with professional groups, such as physicians and other health professionals, to research and develop best-practice guidelines, standards and protocols for use across the system.

Performance Measure: Strategic clinical practice guidelines in priority areas developed and implemented. (03/04 MOHS PM 3, MOHP PM 2).

Target 03/04: Develop and implement guidelines for palliative care, post-stay acute care, assisted living, hypertension, asthma, and depression.

Actual 03/04: Palliative care, assisted living, hypertension and asthma guidelines are developed and implemented. The depression guideline will be approved in early 2004/05.

Rationale: Best practice guidelines are an important and growing component of providing quality care. By researching the best outcomes and methods of delivering care across the world, and implementing those practices in BC, we can help ensure BC's patients are getting the best possible care.

Progress: In BC, guidelines and protocols are developed under the direction of the Guidelines and Protocols Advisory Committee (GPAC), jointly sponsored by the BC Medical Association and the Ministry of Health Services. BC has an active and successful program. Other guidelines approved in 2003/04 include: Diagnosis and Management of Sore Throat, Heart Failure Care, Evaluation of Chest Pain for Acute Coronary Syndromes, and a revision of the Diabetes Care guideline.

04/05 MOHS Strategy 3: Protect public health by articulating expectations for core public health prevention and protection activities including standards for their delivery.

03/04 Source: MOHP Strategy 4.

The goal of public health programs and initiatives is to protect health and prevent disease, injury, premature death and disability, and to improve population health. Public health functions encompass programs in four areas — health improvement, prevention of disease, disability and injury, environmental health and emergency health management — delivered using the public health strategies of health promotion, health protection, preventive services, assessment of population health and surveillance of disease.

The ministry is currently leading the development of core functions for public health. These will be mandatory public health programs and services that health authorities will be required to provide for the populations they serve.

Performance Measure: Priority programs developed for prevention and protection. (03/04: MOHP PM 4).

Target 03/04: Core programs delivery expectations and performance measures finalized.

Actual 03/04: Consultations completed, Core Public Health Functions Framework drafted.

Rationale: The ministry is working with health authorities to develop a set of public health core functions. These will include mandatory, legislated, long-term programs representing the minimum level of public health services that health authorities will be required to provide to their regions and communities. Each program will have clear goals, measurable objectives and an evidentiary base that illustrates effectiveness in protecting and improving people's health and preventing disease, disability and/or injury. The programs will also be supported through identification of best practices and national and international benchmarks. The identification and implementation of public health core functions will help ensure public health capacity within the health authorities remains focused on the most critical areas (i.e., those areas of public health with the greatest potential for positive impact).

Progress: The ministry has worked with health authorities, major professional councils and public health organizations to develop a Framework for Core Programs and Services in Public Health. Consultations were held throughout 2003, with a large stakeholder workshop in October 2003 to finalize the framework. Next steps include examining scientific and academic research on public health programs in BC and other jurisdictions, and developing core program performance expectations. Preliminary performance expectations have been developed for some core programs and included in the 2004/05 performance agreements between the ministry and health authorities.

04/05 MOHS Strategy 4: Enhance the quality and accountability of self regulated health care professionals in British Columbia by developing a regulatory framework to support and guide their work.

03/04 Source: MOHP Strategy 5.

Regulated health professions in BC have the privilege and responsibility to govern themselves in the public interest. Enhanced quality and accountability mechanisms are needed in response to emerging technology, new research, changing practice standards and higher public expectations for accountability of individual health professionals.

Performance Measure: Improved governance and accountability framework developed for the health professions. (03/04: MOHP PM 5).

Target 03/04: Health Professions Act (HPA) amended to clarify accountability and governance expectations for all colleges.

Actual 03/04: Health Professions Amendment Act, 2003 (Bill 62) and Health Professions Amendment Act (No. 2), 2003 (Bill 81) passed in Fall 2003.

Rationale: Effective self-regulation in the future will not be feasible without comprehensive, modernized legislation. There are currently 10 statutes regulating 24 professions, based on an exclusive scope of practice model. The province is working toward an umbrella regulatory framework under a single statute using a shared scope of practice/reserved actions model. This new framework will provide consistency and fairness in requirements relating to governance structures and transparency, registration processes, and inquiry and discipline matters. It will also facilitate development of common jurisprudence, counter perceptions of "hierarchy" among professions, enhance interdisciplinary practice, increase accessibility and consumer choice, and improve cost effectiveness.

Progress: Some provisions of Bill 62 were brought into force in December 2003. Most of the remaining provisions will be brought into force in 2004. Bill 81 will be brought into force by the end of 2004/05.

04/05 MOHS Strategy 5: Develop coordinated system-wide approaches for responding to major public health risks and epidemics (e.g., SARS, West Nile, meningitis and influenza outbreaks; childhood immunizations).

03/04 Source: MOHP Strategy 3.

The outbreak of SARS in 2003 demonstrated the importance of preparation, coordination and communication among health care partners and stakeholders to minimize the impact of communicable disease. Monitoring population health status and detecting and responding to outbreaks of disease and other health-related issues are key functions of the ministry and its partners.

Progress: BC has a solid track record in disease control and prevention. Key to this success is the BC Centre for Disease Control (BCCDC) — Canada's only comprehensive centre for disease control. The BCCDC has enabled BC to play a major national role in the coordinated, effective and rapid response to public health issues.

The SARS outbreak and response demonstrated the effectiveness of BC's health system in handling an urgent public health concern. In British Columbia, an alert was published and disseminated throughout the health system by BCCDC, and infection control precautions were immediately initiated for the first suspected case of SARS. The health system was able to mobilize staff and coordinate efforts quickly to respond in a number of key areas, including communications, surveillance, infection control, diagnosis and emergency management.

BC is taking a coordinated approach to controlling West Nile Virus, and planning has been underway for its likely arrival. The Ministry of Health Services is working with the Provincial Health Officer, the BCCDC, health authorities, local governments, and other ministries to plan appropriate mosquito control measures within each area's sphere of jurisdiction and responsibility.

Objective 2: Support to Partners

The ministry supports its service delivery partners (health authorities and health professionals) in achieving the strategic priorities of the health system. We develop provincial plans for the future supply and effective use of health care professionals, equipment, technology and facilities to ensure the health system has the capacity to meet the population's health needs. The ministry also supports health research and the development of best practices for service delivery, and develops legislative, regulatory and policy frameworks to manage the health system and protect public health and safety.

The ministry has undertaken several strategies to support its partners. The following pages outline each of the strategies and report on the progress to date in meeting the performance expectations in the 2003/04 – 2005/06 Service Plan.

04/05 MOHS Strategy 6: Make data accessible, with due attention to quality, security and privacy protection, to support evidence-based planning of patient care and clinical decision-making by partners (e.g., Electronic Health Record; CDM registries; inter-provincial/national data collection standards and registries).

03/04 Source: MOHS Strategy 4.

Decisions in the health care system should be based on evidence. The ministry is working with its partners to develop and strengthen data and information systems to build capacity for evidence-based strategic planning and decision-making. Following the Health CIO Council's publications of the Strategic Plan for Health Information Management in BC, and the Framework for Electronic Health Record for British Columbians, the province launched a number of key EHR projects, many of which were the result of collaboration between the ministry and the six health authorities, as well as collaboration at the federal and inter-provincial levels. Key EHR projects included the development of an electronic medical summary system, diagnostic imaging services, EHR architecture, and strategies for enabling movement of clinical messages (broker), physician involvement in electronic access to clinical information, uniquely identifying patients, and improving the uptake of the PharmaNet system and the Provider Registry by the health authorities.

Performance Measure: Clients' and partners' ratings of data availability and usefulness in supporting planning and service delivery. (03/04: MOHS PM 4).

Rationale: Similar to the performance measure on government strategic direction and feedback, the ministry also wants to receive feedback from the health authorities on the usefulness of data supplied by the ministry. This feedback will help improve the way data is used to support decision-making in the health system.

Progress: The ministry is working with BC STATS to develop a survey and process, with implementation expected in 2004/05.

04/05 MOHS Strategy 7: Provide legislative, regulatory and policy frameworks to ensure policy direction is clear and consistent and that services are delivered appropriately and cost-effectively.

03/04 Source: MOHS Strategy 5; MOHP Strategy 6.

A core function of government is to provide the legislative governance framework for the health system. The ministry regularly assesses the need for new or amended legislation, regulation or policy to ensure the system operates in the public interest.

Performance Measure: Percentage of regulatory requirements reduced. (03/04: MOHP PM 6; MOHS PM 5).

Rationale: Government made a New Era commitment to reduce regulatory requirements by one-third across government. The ministry has been working to reduce regulatory requirements in the health sector to streamline and update the overall legislative framework and reflect an outcome-based approach. This work has been undertaken while recognizing the need to preserve those regulations which are essential to the protection of public health and safety.

Progress: The ministry continued its efforts during 2003/04 to reduce the regulatory burden in the health sector. Major regulatory reviews resulted in the reduction of 213 requirements, while 133 new requirements were enacted for a net reduction of 80. Significant streamlining related to health professional governance and statutory amendments is expected to achieve a further reduction of 10 per cent in 2004/05.

Performance Measure: Establishment of a regulatory framework to ensure appropriate utilization of the private sector in the provision of health care. (03/04: MOHP PM 7).

Target 03/04: Policy framework implemented.

Actual 03/04: Policy framework implemented.

Progress: The ministry developed a Patient Service Delivery Policy Framework to ensure appropriate use of private sector services in the provision of health care. The policy specifies parameters for when health authorities may purchase clinical services from private providers. The policy ensures this occurs only in situations that comply with the Canada Health Act, and only if government's criteria of patient benefit, value for money, and accountability have been met. Health authorities must comply with the policy when purchasing clinical services from private sector providers, and report all such arrangements in their annual Health Service Redesign Plans.

04/05 MOHS Strategy 8: Ensure the health care system has the capacity to meet the population's health needs by developing provincial plans for the supply and effective use of health care professionals, facilities, and infrastructure.

03/04 Source: MOHP Strategy 7.

The ministry has made a commitment to include longer-term planning in the management of the health system. This focus provides an opportunity to identify strategies that will effect systemic change in the health system for the long-term. Also, by involving health authorities in developing plans for health facilities and medical equipment, we can ensure capital funding is used in the best manner to meet the population's current and future needs.

Performance Measure: Health Human Resource, IT, and Capital plans developed. (03/04: MOHP PM 8).

Target 03/04: Health Human Resource Plan updated. Capital asset management planning process implemented. Hospital facilities, Intermediate and Long-term Care facilities, and Medical Machinery, Equipment and Technology plans developed.

Actual 03/04: On track — see progress section for details.

Rationale: Health human resource, information technology and capital planning all benefit from a province-wide perspective. Accordingly, the ministry is involved with health authorities and other partners (e.g., Ministry of Advanced Education, universities and colleges, Government of Canada) to ensure planning in these fundamental areas is integrated and coordinated to maximize benefits from investments and strategies.

Progress: Health human resource planning has focused on the education, recruitment and retention of physicians, nurses and other health professionals to ensure all regions of the province have appropriate care providers to meet patients' needs. Highlights include: almost 2,000 new education spaces for care aids, licensed practical nurses, registered nurses and midwives over the past three years, including 693 new places in 2003/04; expansion of medical school spaces from 128 to 224 by 2005; and establishment of a loan forgiveness program for medical, nursing, midwifery and pharmacy students who work in rural communities after graduation.

A new capital asset management planning process is in place. The Capital Asset Management Framework and multi-year budgeting process require provincial public sector agencies to submit annual capital asset management plans. This information is integral to the capital planning process and facilitates capital investment being targeted to support the ministry's service plan objectives. In this regard, the ministry has been focusing on three sectors of the health care system — hospital facilities, community care facilities, and equipment. For more information on capital planning and investments, please see page 82.

Information technology planning focused on provincial strategies for electronically linking patient and diagnostic information to improve care delivery, quality of clinical decision-making and efficiency. Highlights include developing an electronic medical summary system, diagnostic imaging services, EHR architecture, and strategies for enabling movement of clinical messages (broker), physician involvement in electronic access to clinical information, uniquely identifying patients, and improving the uptake of PharmaNet system and the Provider Registry by the health authorities.

04/05 MOHS Strategy 9: Support health research and create opportunities for health partners to share knowledge and best practices to facilitate continuous improvement in service delivery.

03/04 Source: MOHP Strategy 10.

Research, evaluation and information management are essential to enhancing our capacity to share knowledge and best practices to continually improve BC's health system. The Michael Smith Foundation for Health Research has a provincial mandate to help build BC's capacity for excellent health research. The foundation has a mandate to fund biomedical, clinical, population health and health services research.

In 2003/04, the province provided a $24 million grant to the foundation to support research to enhance the effectiveness of health care reforms and to continue to recruit and retain excellent health researchers. The grant is intended to fund rigorous evaluations of the impacts of key policy changes in the health system. The ministry and the health authorities have identified the following priority areas for research activity: acute care redesign, chronic disease management, home and community care, health human resources, specific populations and mental health services.

Objective 3: Monitoring and Evaluation

The ministry monitors and evaluates the delivery of services and the health of BC's population to ensure services meet patients' and the public's needs. 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 intervention and facilitate course correction if required.

The section contains the strategies and performance measures the ministry has adopted to enhance its monitoring and evaluation functions.

04/05 MOHS Strategy 10: Develop an effective monitoring and evaluation framework for services provided by health authorities and other system partners (e.g., health professions).

03/04 Source: MOHS Strategy 8.

Monitoring and evaluating the level, quality and impact of services delivered to the public by the ministry's partners is critical to ensuring the public receives value for health expenditures. The ministry must ensure patients are able to access appropriate services that meet their needs, while at the same time ensuring limited health funding is spent efficiently. To that end, the ministry has developed an accountability and performance monitoring framework for services delivered by health authorities. In 2002, for the first time in Canada, the ministry established performance agreements with each health authority that outlined expectations and performance targets. These performance agreements continue to be renewed annually, with modifications and improvements being incorporated as experience is gained.

Performance Measure: Health authority compliance with the performance agreement. (03/04: MOHS PM 7).

Target 03/04: 6/6 Health authorities will be in compliance.

Actual 03/04: On Track.

Rationale: Performance agreements set out direction and expectations for each health authority for health system governance and health service delivery. They contain specific targets for system performance improvements in key areas, such as emergency services, surgical services, mental health services, home and community care, public/population health, Aboriginal health, and support and administrative services. Each of these targeted improvements support achievement of the ministry's service plan goals and objectives.

Progress: Each health authority committed to a performance agreement for 2003/04. The ministry liaised with health authorities and monitored progress during the year. The ministry will publish a report on health authority performance for 2003/04 in January 2005, when final health system data is available for the 2003/04 fiscal year.

04/05 MOHS Strategy 11: Monitor financial status to ensure overall health system costs stay within budget.

03/04 Source: MOHS Strategy 9.

BC's health services budget has continued to grow — the ministry's budget for 2003/04 was over $10.5 billion and health spending consumed approximately 42 per cent of all government spending. It is important this funding is used wisely to provide the best care and achieve the best outcomes for patients — and that all parts of the system manage within their allocated budgets. The ministry monitors financial status throughout the year so any problems can be identified and addressed, and ensures overall costs remain within its budget.

Performance Measure: Overall health system financial status (actual expenses compared to budgeted expenses at year end) (03/04: MOHS PM 9).

Target 03/04: Expenses do not exceed budget.

Actual 03/04: Expenses did not exceed budget.

Progress: Overall health system expenses were under budget for 2003/04. For more details, please see the Resource Section on page 79.

04/05 MOHS Strategy 12: Monitor and report publicly on the health of the British Columbia population.

03/04 Source: MOHP Strategy 11.

Monitoring the health status of the population is essential for assessing the effectiveness of health programs and services. Health status is influenced by a number of factors including the social, economic and physical environment, personal health practices, individual capacity and coping skills, human biology, early childhood development, health services and gender and culture. While many of these factors lie beyond the jurisdiction of the health system, surveillance and assessment of population health assists government and the ministry address issues or trends and develop healthy public policy.

Performance Measure: Report annually on population health status or a significant health issue. (03/04: MOHP PM 9).

Target 03/04: Annual Report produced.

Actual 03/04: Report produced.

Rationale: The Provincial Health Officer (PHO) reports publicly each year on the health of the population. The PHO is the senior medical health officer for British Columbia and provides independent advice to the Minister of Health Services and the ministry on public health issues and population health.

Progress: In November 2003, the PHO released A Report on the Health and Well Being of People in British Columbia, Provincial Health Officer's Annual Report 2002. The Provincial Health Officer also released:

A Review of Infant Mortality in BC: Opportunities for Prevention. A Report of the Provincial Health Officer, October 2003;
An Ounce of Prevention — A Public Health Rationale for the School as a Setting for Health Promotion: A Report of the Provincial Health Officer, October 2003; and
Prevention of Falls and Injuries Among the Elderly, A Special Report from the Office of the Provincial Health Officer, January 2004.

These reports can be found on the ministry's Website at: www.healthservices.gov.bc.ca/pho.

Report on Results

Core Business: Stewardship

Goal 1: High Quality Patient Care

Goal 2: Improved Health and Wellness for British Columbians

Goal 3: A Sustainable, Affordable Health Care System

Objective 1: Direction

Objective 2: Support to Partners

Objective 3: Monitoring and Evaluation