regional profile : vancouver island health authority.the ministry supports government’s vision of...

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September 2010

Regional Profile

Vancouver Island H ealth Authority

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Health Service Redesign British Columbia (BC) is committed to providing a health care system where high quality health care is available to everyone – where services are timely, affordable and sustainable, for today and future generations. Since 2001, when Government streamlined 52 health regions with competing or overlapping mandates into six health authorities, the Province has been able to maximize the resources available for direct patient care. Five regional health authorities now have responsibility for planning and delivering local health services, such as public health, mental health, residential, and home and hospital care. The Provincial Health Services Authority (PHSA) oversees provincial and highly-specialized health services, such as the BC Cancer Agency (BCCA). Government spending in the Ministry of Health Services (the Ministry) in 2009/10 reached $13.92 billion1, an increase of 61 percent from $8.65 billion in 2000/01.2 Strategic investments, based on best practices and innovative approaches to local challenges, are improving health authorities’ ability to provide more responsive, higher-quality care to meet patients’ need. As BC moves forward into the 21st

century, and individuals take a central role as a true partner in health care, lifestyle choices and ability to prevent and manage disease will be the foundation of keeping our population healthy and our health care system sustainable.

Vision and Mission The Ministry supports Government’s vision of a world class public health care system with a mandate to guide and enhance the Province’s health services to ensure British Columbians are supported in their efforts to maintain and improve their health. To ensure our publicly funded health care system is sustainable in the future, it is crucial that we as British Columbians all take a proactive role in the care of our health. The BC health system is one of our most valued social programs — virtually every person in the province will access some level of health care or health service at some point in their lives. The Ministry will continue to work in close collaboration with the Ministry of Healthy Living and Sport to encourage healthy lifestyles and support British Columbians in all areas of our great province. The Vancouver Island Health Authority (VIHA) is committed to being accountable to the public they serve and involving the people of the islands they serve to maintain and improve health delivery. They are committed to informing the public about how they plan to deliver services to meet the needs of their communities, as well as reporting on the services and resources provided to meet those needs. In particular, VIHA has increased funding to create five Assertive Community Treatment teams, and enhance supports and services for homeless people. From May through November 2008, VIHA recruited 59 physicians and two midwives.3

In June 2007, VIHA publicly released its People Plan, which outlines a strategy and framework to address and manage the risks that drive human resource planning to ensure they have the appropriate number and type of staff, now and into the future. The plan was updated in June 2009.

Overview and Demographic Profile VIHA provides a full range of health services to approximately 751,000 residents of Vancouver Island, the Gulf and Discovery Islands and to mainland residents located adjacent to the Mount Waddington and Campbell River areas.

1 2009/10 BC Public Accounts. Consolidated Revenue Fund Supplementary Schedule (2010). <http://www.fin.gov.bc.ca/ocg/pa/09_10/pa09_10.htm>. 2 Ministry of Health Services 2008/09 Annual Service Plan Report. <http://www.bcbudget.gov.bc.ca/Annual_Reports/2008_2009/hs/hs.pdf>. 3 News Release, Doctor Recruitment Strategy Gets Results, November 25, 2008 <http://www.viha.ca/NR/rdonlyres/1C29606E-CA26-4B57-A9D5-E38414D1E873/0/nr_bg_doctors_recruitment_strategy_nov08.pdf>.

http://www.fin.gov.bc.ca/ocg/pa/09_10/pa09_10.htm�

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Slightly below the average provincial population growth, VIHA is expected to gain approximately an annual rate of 1 percent of population growth in the next 10 years.1

However, VIHA’s proportion of seniors is estimated at 18.4 percent of its general population, which is higher than the provincial average of 14.8 percent in 2008. In the next 25 years, VIHA’s senior population will continue to lead the Province with the largest percentage of senior population amongst all health authorities. By 2036, the seniors’ population will account for nearly 27.7 percent of VIHA’s total population, likely due to the number of soon-to-be seniors who are now moving into the VIHA region. Compared to demographic profiles of other health authorities, VIHA has the highest percentage of people who are 75 years and older, at 8.9 percent in 2010. The provincial average is 7.0 percent. VIHA’s population of people over 75 is also projected to increase.

Aboriginal Population First Nations people make up 5.8 percent of the region’s population.2

There are 50 First Nations bands in VIHA, 4 Tribal Councils, and 1 umbrella health organization serving the majority of First Nations people (the Inter-Tribal Health Authority).

1 PEOPLE 34 Population Data, BC STATS, BC Ministry of Citizens’ Services. 2 Regional Profiles of First Nations Communities, First Nations Health Council 2009, quoting Stats Canada 2006 Census data.

21%

19% 19% 19% 19% 19% 19% 18%

62% 61%60%

58% 56%54% 54% 54%

18%

20%22%

24%25% 27% 28% 28%

0%

10%

20%

30%

40%

50%

60%

70%

2008 2012 2016 2020 2024 2028 2032 2036

Vancouver Island Health Authority Population Growth 2008-2036

% of Population

Source: PEOPLE 34 population data, 2010, BC Stats

Age 20-64

Age 65 years and over

Age 19 years and under

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Overview of Organizational Structure VIHA is governed by a board of directors and led by an executive team. Under the leadership of the executive team, VIHA staff, and senior leaders are working together toward the goal of a fully integrated organization. As a result, VIHA’s organization model establishes authority-wide programs and re-affirms VIHA’s commitment to providing the highest quality of care to patients, residents and clients. The model:

• provides authority-wide co-management of clinical portfolios; • highlights quality and safety as the key drivers to our system; • operationalizes a “plan regionally-deliver locally” philosophy; • embraces unique community needs; • provides a distributive management model; • facilitates more devolved decision making, close to the front line; • empowers clinicians to be involved in decision making; • simplifies decision making; • clarifies roles, responsibilities and accountabilities; • fosters a closer link between primary and secondary care; and • provides an effective foundation for clinical teaching and research.

The executive team oversees the two main organizational structures through which VIHA operates and delivers its services. These structures are Integrated Health Services, and Capital Services (which is discussed in its own section later in the profile). VIHA employs more than 17,000 health care professionals, technicians, and support staff to provide excellent care and service to people living within our region. Approximately 1,700 physicians work within VIHA.1

VIHA employs approximately 4,000 nurses, 250 medical technologists, 200 occupational therapists, 100 pharmacists, 200 physiotherapists, and 150 social workers.2

Financial Information VIHA reported total operating expenditures of $1,756.5 million3 in 2009/10, an increase of 40.7 percent from $1,248.0 million4

in 2002/03.

1 Vancouver Island Health Authority Website: <http://www.viha.ca/about_viha>. 2 Health Sector Compensation Information System, Difficult to fill vacancy Survey Report for 2009/10 Quarter 3. 3 Vancouver Island Health Authority., 2009/10 Audited Financial Statements: <http://www.viha.ca>. 4 Vancouver Island Health Authority., 2003/04 Audited Financial Statements: <http://www.viha.ca>.

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Acute Care Acute Care Facilities1

Victoria General Hospital 1 Hospital Way, Victoria, BC, V8Z 6R5 Provides services including:

Queen Alexandra Centre for Children’s Health 2400 Arbutus Road, Victoria, BC, V8N 1V7 Provides services including:

• Emergency Services • Maternity/Neonatal Services • Sexual Assault Nurse

Examiner • Breast Health • Pediatric Intensive Care Unit • Neonatal Intensive Care Unit • Adult/Pediatric

Rehabilitation • Aboriginal Health

• Respiratory Rehabilitation • Nuclear Medicine • Cancer Care Services • Asthma Clinic Services • Trauma Centre • Laboratory Services • Imaging/Diagnostics • Pharmacy Services

• Tertiary Child Services • Mental Health Services • Visually Impaired Services • Neuromuscular Pediatrics • Complex Developmental

Services

• Autism Intervention • Spina Bifida Services • Swallowing Disorders • Behavioural Condition

Assessment Services

Nanaimo Regional General Hospital 1200 Dufferin Crescent, Nanaimo, BC, V9S 2B7 Provides services including:

West Coast General Hospital 3949 Port Alberni Highway, Port Alberni, BC, V9Y 7L1 Provides services including:

• Emergency Services • General Surgery • Maternity and Neonatal

Services • Cancer Care Services • Pharmacy Services

• Nuclear Medicine • Cardiography • Laboratory Services • Rehabilitation • Imaging/Diagnostics • Pediatric Unit

• Emergency Services • General Surgery • Pharmacy Services • Laboratory Services • Adult Intensive Care

Services

• Mental Health Services • Aboriginal Health • Imaging/Diagnostics • Rehabilitation Services • Ambulatory Services

Lady Minto/ Gulf Islands Hospital 135 Crofton Road, Saltspring Island, BC, V8K 1T1 Provides services including:

Saanich Peninsula Hospital 2166 Mt. Newton X Road, Saanichton, BC, V8M 2B2 Provides services including:

• Emergency Services • Cancer Care Services • Mental Health Services • Maternity Services

• Rehabilitation • Laboratory Services • Imaging/Diagnostics

• Emergency Services • Palliative Care • Pharmacy Services • Rehabilitation Services

• Imaging/Diagnostics • Ambulatory Services • Aboriginal Health • Laboratory Services

Cowichan District Hospital 3045 Gibbins Road, Duncan, BC, V9L 1E5 Provides services including:

Royal Jubilee Hospital 1952 Bay Street, Victoria, BC, V8R 1J8 Provides services including:

• Emergency Services • Imaging/Diagnostics • General Surgery • Adult Intensive Care

Services • Mental Health Services • Ambulatory Services • Dialysis Services

• Rehabilitation Services • Pharmacy Services • Aboriginal Health • Maternity/Neonatal

Services • Lipid Clinic Services • Laboratory Services • Diabetes Clinic Services

• Emergency Services • Heart Health • Adult Intensive Care Unit • Nuclear Medicine • Burn Unit Services • Imaging/Diagnostics • Pulmonary Function

Laboratory

• Cancer Care • Mental Health Services • Adult Asthma Clinic • Sleep Laboratory • Aboriginal Health • Respiratory Rehabilitation • Pharmacy Services

1 For a complete listing of health care facilities and services offered in VIHA, please see the VIHA website at: <http://www.viha.ca/finding_care/facilities/>.

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St. Joseph’s General Hospital 2137 Comox Avenue, Comox, BC, V9M 1P2 Provides services including:

Campbell River and District General Hospital 375 - 2nd Avenue, Campbell River, BC, V9W 3V1 Provides services including:

• Emergency Services • General Surgery • Mental Health Services • Ambulatory Services • Laboratory Services • Adult Intensive Care

Services • Maternity/Neonatal Services • Pharmacy Services

• Rehabilitation Services • Aboriginal Health • Cancer Care Services • Respiratory Services • Diabetes Clinic Services • Telemetry Services • Imaging/Diagnostics

• Emergency Services • General Surgery • Cancer Care Services • Maternity/Neonatal Services • Ambulatory Services • Pharmacy Services

• Imaging/Diagnostics • Telemetry Services • Mental Health Services • Laboratory Services • Rehabilitation Services • Adult Intensive Care

Services

Port Hardy Hospital 9120 Granville Street, Port Hardy, BC, V0N 2P0 Provides services including:

Port McNeill and District Hospital 2750 Kingcome Place, Port McNeill, BC, V0N 2R0 Provides services including:

• Emergency Services • Ambulatory Services • Aboriginal Health

• Imaging/Diagnostics • Laboratory Services • Adult Physiotherapy

• Emergency Services • Ambulatory Services • Aboriginal Health • Low-Risk Obstetrics

• Imaging/Diagnostics • Laboratory Services • Adult Physiotherapy

Cormorant Island Health Centre 49 School Road, Alert Bay, BC, V0N 1A0 Provides services including:

Tofino General Hospital 261 Neill Street, PO Box 190, Tofino, BC, V0R 2Z0 Provides services including:

• Emergency Services • Aboriginal Health

• Laboratory Services

• Emergency Services • Ambulatory Services • Diabetes Rehabilitation

• Imaging/Diagnostics • Laboratory Services • Adult Rehabilitation

Financial Information

VIHA Acute Care Sector Expenditures ($ millions)

Actual 2006/071 Budget 2009/102 Incremental increase over 2006/07 % Increase

758.9 904.5 145.6 19.2% 1 Information provided by VIHA (August 2009). 2

Vancouver Island Health Authority Service Plan 2009/10 – 2011/12 (September 2009). <http://www.viha.ca>.

Accomplishments and Initiatives VIHA’s successes in the area of acute care over the past year include: • opening six “Hurry up Beds” at Royal Jubilee Hospital to provide temporary accommodation for inpatients

holding in the emergency department; • VIHA approval of a plan to build two new state-of-the-art acute care hospitals in Campbell River and the

Comox Valley; • opening of a new pediatric ambulatory health clinic at Nanaimo Regional General Hospital, with support from

Child Health BC; • initiating Therapy Response Teams at Royal Jubilee Hospital and Nanaimo Regional General Hospital to

provide enhanced rehabilitation services to elderly patients; and • implementing the Pathways patient flow tool. VIHA implemented a Regional Trauma Plan, which is dedicated to providing quality trauma care across VIHA. Future strategies for improving acute care in VIHA include: • participate in the creation of a Clinical Care Management System that includes the development and

implementation of a provincially-standardized set of clinical guidelines and standards for specific focus areas

http://www.fraserhealth.ca/HealthInfo/HospitalServices/EmergencyDepartment/�

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(stroke, congestive heart failure, surgical checklist, surgical site infection, sepsis, venous thrombo-embolism, and medication reconciliation);

• support the BC Patient Safety and Quality Council’s Health Quality Network to develop baseline measures for these seven guidelines; and

• reduce hospital/facility acquired infection rates by continuing to plan and implement Infection Prevention and Control strategies, including hand hygiene audits and creating a Methicillin-Resistant Staphylococcus Aureus (MRSA) policy and antibiotic use guidelines.

Modeling and optimization: • VIHA will continue to develop simulation and optimization models (including Lean Design methodologies)

to inform decision-making with respect to patient/client flow in acute care and residential care services. Priority areas are: residential care, emergency departments, and Computed Tomography (CT) wait lists.

• VIHA will review the effectiveness of Patient Location and Bed Management system tools and extend their use to other sites (this information management project will track a patient’s location within acute care and identify when a bed becomes available).

• VIHA will be implementing a Bed Allocation Methodology at Nanaimo Regional General Hospital and Cowichan District Hospital and will continue with the implementation and evaluation of the Bed Allocation Methodology to ensure the most appropriate mix of medical and surgical beds.

VIHA is participating in the Provincial Wait Times Strategy, including full implementation and utilization of a Surgical Patient Registry to more efficiently manage surgical services. VIHA is implementing a Joint Replacement Clinic to identify patients with joint problems who can be diverted from surgery through alternative treatment options. VIHA will work with the BC Cancer Agency to carry out a public awareness campaign to promote screening mammography, particularly in areas where participation is lower than target rates. The operating and central supplies reprocessing rooms at Saanich Peninsula Hospital are being upgraded in 2010. Capital Projects Examples of capital investments that are completed or underway for the South, Central and North Island are: South Island • In 2008, VIHA completed construction of a $1 million new High Acuity Neurosciences Unit at Victoria

General Hospital to improve care for surgical and unstable stroke patients. • In July 2008, construction started on the new 500 bed patient care centre at Royal Jubilee Hospital. The new

patient care centre is being built, financed and maintained through a public-private partnership (P3) between VIHA and ISL Health. The new facility will replace the aging infrastructure and patient rooms currently in use at Royal Jubilee Hospital and will be completed in late 2010 with patient occupancy Spring 2011. The new facility will provide modern patient care and is made up of over 80 percent single bedrooms. Other elements of the project include: upgrades to the power plant; critical program relocation; parking; medical equipment procurement and other site improvements. The total project cost is $348.6 million and cost shared with Government ($222.4 million), VIHA ($18.5 million), and the Capital Regional Hospital District ($107.7 million).

• In November 2008, VIHA formally opened the $1.3 million Geriatric Outpatient Clinic at Royal Jubilee Hospital as part of an initiative to decrease patient flow through emergency departments.

• Construction of an $18.8 million relocation and expansion of the Victoria General Hospital Emergency Department is was completed in September 2009.

• Redevelopment of Saanich Peninsula Hospital Operating Rooms and Central Sterilization Room is currently in the design stage.

• A $900,000 new echocardiography laboratory at Royal Jubilee Hospital has significantly enhanced response times from echocardiography services.

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• VIHA invested $3.2 million to renovate and move laboratory services at Royal Jubilee Hospital, and purchased $1.3 million worth of state-of-the-art urological equipment.

• Royal Jubilee Hospital and Victoria General Hospital have added two new gamma cameras to improve access to diagnostic services and increase the number of medical exams performed by this equipment at a cost of $1.2 million.

Central Island • Pharmacy redevelopment at Cowichan District Hospital in Duncan was completed in Spring 2010. • A Master Site Development Plan for the Cowichan District Hospital is underway. • Installation of a new CT scanner at West Coast General Hospital in Port Alberni was completed in September

2009. Nanaimo Regional General Hospital: • A $46.3 million expansion has been announced which will double the size of the emergency department,

increase treatment rooms from 24 to 41, add a Psychiatric Emergency Service and Psychiatric Intensive Care Unit and a Renal Dialysis Centre. The facility infrastructure requirements for the Renal Dialysis Centre were completed in 2008 at a cost of $4.5 million.

• A Master Site Development Plan for the Nanaimo Regional General Hospital is underway. • A new Pediatric Ambulatory Care Unit, completed in Spring 2009, will provide diagnostic and treatment

programs for children and youth resulting in fewer trips to Vancouver for the children and families living in the Central and North Island communities. Child Health NC provided $1.5 million to fund the facilities.

• Palliative Care Unit renovations costing $2.8 million were completed in November 2008. • In September 2007, the brand new $16 million perinatal wing was officially opened. The new centre provides

family centred maternity care, including 15 labour/birthing rooms and a Level 2 special care nursery. • A $23 million new surgical facility opened in 2005. It has eight fully equipped modern operating theatres

(with two shelled in for future expansion), increased space for post-anesthetic recovery and more space for surgical day care.

North Island • An estimated $2.3 million expansion of the Cumberland Community Dialysis Unit is under construction and

is scheduled to complete in Spring 2012. • Eleven new complex care beds in Port Hardy were completed in July 2009. • Clinical services were expanded at Campbell River Hospital to include speech pathology and social work. In

addition, a new secure observation room was opened in the emergency department. • St. Joseph’s Hospital in Comox added an $800,000 gamma camera, as part of its newly renovated nuclear

medicine suite. • Planning is underway for significant capital investment to improve hospital based services for residents of

the North Island with the VIHA Board’s approval of a plan to build two new acute care hospitals in Campbell River and the Comox Valley. VIHA’s analysis of potential locations for the proposed new hospital in the Comox Valley is underway.

Island-Wide Capital Projects • Women across Vancouver Island, including those living in North Island communities, now have access to

faster, more accurate breast cancer screening and diagnosis with the installation of eight state-of-the art digital mammography machines in 2008, at a cost of approximately $3 million.

• VIHA and the provincial government have invested $7 million to build and renovate facilities at Royal Jubilee and Victoria General Hospitals to provide training space for students in the Island Medical Program. Construction is underway to renovate facilities for student training space in Nanaimo, with planning underway in Duncan, Comox and Campbell River as part of the Affiliated Regional Centres in the Island Medical Program.

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• VIHA and GE Healthcare signed an agreement that allows VIHA to purchase 48 new ultrasound systems over the next 8 years. The new systems will be placed in all major VIHA sites from Saltspring Island to Port Hardy, with an additional seven units to be used in mobile ultrasound clinics.

Innovative Changes to Improve Acute Care Activity Based Funding To provide a greater focus on achieving the First Minister’s Meeting (FMM) targets for hip and knee joint replacement surgeries and cataract surgeries, in 2008/09 the province introduced an activity based funding model based on the volume of these priority surgery cases performed. The activity based funding model for these priority surgeries was subsequently revised so that in 2009/10 and 2010/11 a portion of the funding is directly tied to achievement of specific wait time performance targets. Other Innovative Initiatives: • Emergency Department Streaming at NRGH – Funded through the 2008/09 Transformation Fund, this project

involved a significant redesign to the flow of ambulatory patients designed to shorten wait times within the emergency department (ED). This project successfully improved patient flow within the ED and reduced wait times to physician assessment for ambulatory patients by between 24-39 percent, depending on the daily variation.1

• Bed Allocation Methodology (BAM) – This project allocated the acute care bed base in the most appropriate way across programs at three large acute care sites (Royal Jubilee, Victoria General and Nanaimo Regional General Hospitals) to regain and maximize existing capacity. In combination with enhanced discharge planning, BAM maximizes off-patient service and increases program accountability for patient flow.

• Lean Design and 6 Sigma for Lab Services – Funded through the 2007/08 Health Innovation Fund (HIF), this project engaged in Lean Design and 6 Sigma research to improve the efficiency of the laboratory at Victoria General Hospital, and enable shorter, more reliable lab turnaround times, particularly for the ED.

The Care Delivery Model Redesign Project is designed to ensure the right people are in the right position, doing the right work. So far, the redesign has been initiated in: Campbell River Hospital; Yucalta Lodge; West Coast General Hospital; Nanaimo Regional General Hospital; Cowichan District Hospital; and components of the Royal Jubilee Hospital. VIHA is also helping to pioneer a similar approach in BC’s Fraser, Interior and Northern Health Authorities.

The second phase of the Tele-Pathology project is underway with linkages to Central and North Island laboratories expected by December 2009. The Tele-Thoracic project has seen 146 patients and there are plans to expand telehealth services to Port Alice, Gold River, Tofino and Saltspring Island over the next year.

Initiating a Laboratory-based Diabetes Recall Program that is inclusive for Aboriginal communities. In Port Alberni, over 700 patients were enrolled in the first two years of the program. The program has also been initiated in the Duncan corridor, where over 100 patients were enrolled in the first month including patients from Chemainus, Ladysmith, Duncan, Ts’ewultun and Stz’minus.2

Working with Aboriginal Liaison and the Ministry of Advanced Education to assess training opportunities for local residents in Mount Waddington to work in Medical Imaging.

Emergency Departments • In 2006, VIHA invested $1.4 million in initiatives specifically designed to improve ED waits, including

a physical space reconfiguration at Nanaimo Regional General Hospital, improving laboratory and diagnostic imaging turnaround times, creating an outpatient IV antibiotics clinic at Royal Jubilee Hospital, and implementing card swipe technology for ED physicians, that enable registered nurses to log-on to an electronic triage and tracking system.

1 Corporate Clinical Care and Professional Practice Branch, Ministry of Health Services. 2 <http://www.viha.ca/about_viha/news/news_releases/WCGH_diabetes_monitoring_2yrs.htm>.

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• In Fall 2006, VIHA established an urgent access cardiology clinic at Nanaimo Regional General Hospital, which allows emergency physicians to discharge patients from the ED if they can be assessed by an internist within 72 hours.

• In August 2007, VIHA received seed funding from Health Innovation Fund for several projects to help improve ED flow. VIHA is continuing to provide funding for several of the projects including:

o Information Technology Solutions to improve patient care and to trigger timely and accurate patient

reassessments in EDs. In 2008/2009 FirstNet patient tracking software was implemented in the main sites on the Island, and it is now being expanded to facilities on the Central Island.

o Creating Comprehensive Geriatric Outpatient Services to help provide services for seniors in Nanaimo and Greater Victoria.

• In 2009, VIHA undertook a number of strategic initiatives such as a Wellness and Safety program for staff in

all EDs, and improved Seniors Care in the region. • In late 2008 and early 2009, Patient Streaming was implemented at 4 hospitals (Cowichan, Victoria General,

Royal Jubilee and Nanaimo Regional General Hospitals). VIHA will continue to implement provincial emergency department patient access strategies to reduce emergency department congestion, building on the early successes associated with the patient streaming projects.

• The new ED at Victoria General Hospital officially opened September 15, 2009, and planning continues for an enhanced ED at Nanaimo Regional General Hospital.

• VIHA has implemented a number of innovative projects aimed at reducing ED congestion, including an Advanced Access and Discharge Unit, comprehensive Geriatric Outpatient Services and several projects related to bed allocation, surgical smoothing, streaming and ED flow. These initiatives, as well as targeted reductions in inpatient length of stay, are all part of a whole system approach to reduce ED congestion and improve patient care.

• ED managers at Nanaimo Regional General Hospital, Victoria General Hospital, Royal Jubilee Hospital, Cowichan District Hospital, Campbell River and District General Hospital, West Coast General Hospital and St. Joseph’s General Hospital regularly receive management reports with their own patient experience survey results.

Wait Times and Access In BC, a patient requiring surgery or treatment that is not an emergency is placed on a wait list. Individuals requiring emergency surgery do not go on a wait list; they receive treatment without delay. Doctors and hospitals use wait lists to manage patients who are booked for non-emergency medical procedures and the resources required to perform those procedures. While it is usual to speak of “the” wait list for a procedure, there is currently no single wait list for British Columbians. Rather, each surgeon maintains their own wait list. If the surgeon decides to treat a patient surgically, an operating room booking package is completed and sent to the hospital and the patient is booked for surgery. While a patient is waiting for surgery, the surgeon remains responsible for determining if the patient still requires surgery, monitoring if their condition changes, and the patient’s relative priority to other patients on the surgeon’s wait list. Reducing wait times and improving access are one of the key priority areas of the Ministry. BC has developed a comprehensive and proactive Wait Times and Surgical Access Strategy. First Ministers’ Meeting Targets In September 2004, Federal First Ministers (FMM) committed to improving access and reducing wait times in five priority areas where wait times are longer than medically acceptable. The five priority areas identified at the FMM are: cancer (curative radiotherapy); cardiac (coronary artery bypass graft surgery); sight restoration

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(cataract surgery); orthopedics (hip and knee joint replacement surgery and hip fracture fixation); and diagnostic services (cervical cancer screening and screening mammography). Wait Time Reporting via the Surgical Patient Registry Improved management of wait lists, by using an electronic Surgical Patient Registry (SPR), is a key element of the Ministry’s Wait Times and Surgical Access Strategy. The SPR is a provincial information system that collects data for all elective and emergency surgeries1

performed on an adult in a public facility in BC. The SPR provides data regarding the types of procedures, number of patients waiting, wait times, and number of cases completed for each type of surgery. For most procedures, wait list data is available by site and by surgeon.

The SPR improves the quality of wait time data allowing active management of wait lists, and is fed by an automatic nightly download of operating room booking data from hospital computer systems. Wait times for procedures performed are currently measured and reported by the median wait time (the time when 50 percent of patients have received their surgery and 50 percent are still waiting). Wait times are calculated by measuring the time between when a patient is booked for surgery and completion of the procedure. This wait times data is reported publicly via the Ministry Wait Times Website. A new version of the website will be available in Fall 2010. The new website will report on additional procedures, provide patient education, and report 90th

percentile wait times. For updates to the data, please see the current website at: http://www.health.gov.bc.ca/cpa/mediasite/waitlist/median.html.

VIHA Median Wait Times (Weeks) For Patients on the Surgical Wait Registry &

(Elective Surgeries Completed From Wait Lists) Fiscal Year

Wait Times / Cases

All Surgeries Cataracts CABG

Hip Replacements

Knee Replacements

2009/10 Wait Times 6.3

(40,701) 6.6

(9,031) 2.4 (93)

13.1 (856)

15.6 (1,192) Cases


(51,527) 7.7

(9,394) 3.3

(142) 12.3 (887)

17.7 (1,349) Cases


(51,633) 10.0

(8,534) 4.8

(186) 14.8 (886)

23.7 (1,200) Cases


(52,254) 9.3

(8,633) 6.4

(155) 18.1 (857)

31.1 (1,264) Cases


(46,173) 9.0

(6,867) 6.4

(165) 23.0 (797)

47.9 (1,072) Cases


(41,816) 10.1

(6,014) 5.0

(170) 28.9 (745)

39.1 (765) Cases


(43,445) 11.1

(6,260) 7.0

(248) 24.9 (643)

36.0 (687) Cases


(42,609) 10.3

(5,592) 9.0

(235) 23.4 (505)

29.9 (580) Cases


(36,424) 10.0

(5,087) 10.1 (210)

26.1 (380)

35.4 (402) Cases

1 Exception: cardiac surgery data are collected by the BC Cardiac Registry.

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Sources: Coronary artery bypass graft (CABG): BC Cardiac Registry, April 6 2009 and July 18 2009, Provincial Health Services Authority. Total Number of CABG Surgeries and Median Waiting Time in weeks for elective surgeries received at Royal Columbian Hospital, Fraser Health Authority. All others: SWIFT, Standard Monthly Report, March 2008 and June 2009, Health Information Support Branch, HSPD. SWT, Standard Monthly Report, May 2010, Health Information Support Branch, HSPD. Note: all surgeries (total aggregated inpatient surgical cases) should not be compared over time as different definitions are used to determine surgical cases. This does not affect specific procedures. Diagnostic Imaging Between 2001/02 and 2009/10, VIHA saw the number of Magnetic Resonance Imaging (MRI) exams increase from 7,185 to 18,526 (a 158 percent increase) and the number of Computed Tomography (CT) scans performed increase from 39,628 to 94,957 (a 140 percent increase).1

VIHA has 18 public medical imaging sites employing 5 MRI scanners and 11 CT scanners,2

and 8 new digital mammography scanners (among other general medical imaging equipment).

1 HAMIS/OASIS, as of July 30, 2010, Management Information Branch, Health System Planning Division, Ministry of Health Services 2 Ministry of Health Services. Capital Services Branch. “Location of CT scanners, MRI scanners and PET/CT scanners in BC”. Victoria, BC. March 2010.

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Capital Projects Examples of capital investments that are completed or underway are: • A new scanner was purchased for Victoria General Hospital in 2007. In 2008, two new CT scanners were

installed at Royal Jubilee and Victoria General Hospitals. New scanners were also purchased for hospitals in Duncan, Campbell River, Comox and Port Alberni.

Home and Community Care The home and community care sector provides a range of publicly subsidized clinical and support services focused on individuals living in their own homes, and in other home-like settings through to, and including, the end of life. Services may be similar to those found in the acute or primary health system, including clinical nursing care, rehabilitation therapy, personal care and social work, or they may be unique to the community setting, such as case management, assisted living, home support, adult day services, and residential care services. The goals of home and community care services are:

• To support individuals to remain independent in their community to the greatest degree possible; • To facilitate clients’ transitions through the entire health care system; • To enable choice, dignity and quality of life, and • To provide caregivers with information, tools and support they need to be successful in their role.

Although most home and community care services are available to adults of all ages, the majority of clients are seniors, aged 65 and older. In addition, home care nursing, community rehabilitation and hospice palliative care services may be provided to children and youth under age 19 when needed, and often in collaboration with other provincial programs. Services provided will depend on the goals, abilities and circumstances of individuals, their network of support, clinical conditions, functional status, cultural influences and the range of resources available

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000V

IHA

Exa

ms

Year

VIHA: Magnetic Resonance Imaging (MRI) Exams and Computed Tomography (CT) Exams

MRI Exams

CT Exams

HAMIS/OASIS, as of July 30, 2010

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in the community (for example, transportation, recreation and housing). Home and community care services were provided to more than 124,200 British Columbians in 2008/09.1

Since 2001, BC has implemented a number of major initiatives to support ongoing improvement in home and community care services, including expanded home health options, innovative pilot initiatives such as integrated health networks, introduction of assisted living services and the BC Palliative Care Benefits Program upgrading of residential care and hospice facilities, and implementation of standardized assessment tools across the province. VIHA Home and Community Care provides health care and support services for people served by VIHA. VIHA’s focus is to maximize client wellness and their ability to care for themselves. Services for eligible clients are delivered by teams of health care professionals in a variety of settings, and may include:

• nursing; • physiotherapy and occupational therapy; • nutrition; • social work; • case management; • home support; • end of life care; • adult day programs; • community clinics; • assisted living; • residential care; • short term residential care for caregiver relief; and • hospice care.

In VIHA, the total number of home and community care units/beds increased from 4,956 in 2001, to 6,420 in March 2010, due to net gains in residential beds of 273, assisted living units of 1,065 and supportive housing units with home support of 126.2

Financial Information VIHA Home and Community Care Sector Expenditures ($ millions)



Vancouver Island Health Authority Service Plan 2009/10 – 2011/12 (September 2009): <http://www.viha.ca>.

Accomplishments and Initiatives VIHA is implementing the following strategies to improve seniors’ health and quality of life: • developing a three-year implementation plan for VIHA’s Seniors Service Excellence Strategy with the vision

of healthy seniors, age friendly communities, and seamless service; • continuing implementation and evaluation of the Seniors at Risk Integrated Health Network (SARIN)

demonstration project, in partnership with the Ministry, which proactively meets the needs of senior in the community at risk of admission to acute or residential care, while improving their health and maintaining their independence as long as possible;

1 CC Data WareHouse, HCC Client Counts and Service Volumes Fiscal Years 2001/2002 to 2008/2009 (CERTS 2009-0700), Management Information Branch, Health System Planning Division, MoHS, November 2009. 2 HCC 5000 Beds Project March 31, 2010 Update, Ministry of Health Services.

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• continuing to implement the new Community of Care Information System (CCIS) to improve care coordination. The CCIS is part of VIHA’s integrated electronic health record system and will allow VIHA staff to share information across the continuum of care;

• aligning VIHA’s End of Life Strategy with Ministry priorities to provide people with greater choice and access to services such as hospice and home-based palliative care as they near the end of life;

• conducting a needs assessment for seniors health to catalogue existing services and identify gaps, as a foundation for the development of the Seniors Health Plan that will integrate and align services for seniors across the health authority;

• implementing Telehomecare – an in-home monitoring system that monitors health failure patients who live in the Greater Victoria area to manage their health care from their own homes. Telehomecare enables rapid detection of problems and allows patients to self-manage their care;

• offering Geriatric Outpatient Services to reduce acute care episodes and length of stay in acute care; • partnering with the BC Alzheimer’s Society and family physicians to support patients diagnosed with early

dementia and their caregivers as part of the Dementia Strategy; • completing implementation of Falls Prevention Plan tools across all VIHA operated sites and sharing the tools

with all contracted service providers; • providing Integrated Primary Health Care Network evaluation and services for at-risk seniors in the South

Island with multiple chronic conditions, including persistent mental illness; and • continuing to enhance home care services based on an ongoing assessment of need. Centre for Excellence for Seniors Care One of the priorities identified in VIHA’s 2008/09 - 2010/11 Health Service Plan is creating a vision for the Centre of Excellence for Seniors Care. In pursuing this strategy, VIHA has:

• continued to increase complex care and assisted living capacity; VIHA exceeded its commitment under the 5,000 bed initiative;

• partnered with the University of Victoria’s Centre on Aging to conduct research that will inform innovative and enhanced service delivery into the future;

• continued to implement the Residential Assessment Instrument, which is a comprehensive, standardized and validated assessment tool designed to assess the care needs of clients in residential care facilities.

Home Health Services • In October 2007, VIHA awarded a contract for home support services to Beacon Community Services, a

not-for-profit agency which currently provides home support services to approximately 1,300 clients in Saanich, the Saanich Peninsula and the Southern Gulf Island areas.1

• VIHA has increased a number of home-based services, including home support services, as residential care and assisted living capacity is added.

• VIHA has improved access to services through the implementation of patient flow initiatives, including: enhanced community supports; enhanced Quick Response Teams to provide support in EDs; development of home and community care and primary care partnerships; and the development of access standards for urgent respite beds.

End-Of-Life Care Services In VIHA, all residents have access to end-of-life care services in the community to support them and their families as end of life approaches. Services may be delivered at home, in supported housing and assisted living residences, residential care facilities, and hospices. VIHA has an end-of-life care plan with a vision to build primary care capacity for clients, with access to specialized palliative care services when needed. Hospice societies exist throughout VIHA, and Victoria Hospice

1 News Release: VIHA Awards Contract for Renewed Home Support Services, October 4, 2007 <http://www.viha.ca/NR/rdonlyres/7719B4A1-3A78-4DB4-B1B8-0B0D8CAE7A3D/0/nr_home_support_contract_awarded.pdf>

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offers care and support to palliative clients in South Vancouver Island. VIHA has academic partnerships with the University of Victoria for end-of-life care teaching and research. VIHA operates 28 publicly-subsidized hospice care beds (March 2010). The table below shows how many people died in VIHA in 2009, and where they died.

HSDA/HA VANCOUVER ISLAND HEALTH AUTHORITY- NATURAL DEATHS 2009

Quarters 1, 2, 3, and 4 (Calendar Year) 1 Home Home Res Inst Res Inst Hospice Hospice Hospital Hospital Total

South Vancouver Island 571 18.3% 899 28.8% 399 12.8% 1,202 38.5% 3,124 Central Vancouver Island 403 17.5% 630 27.3% 53 2.3% 1,178 51.1% 2,307 North Vancouver Island 217 24.5% 151 17.1% 4 0.5% 486 55.0% 884 VIHA Total 1,191 18.9% 1,680 26.6% 456 7.2% 2,866 45.4% 6,315 BC Total 4,537 15.3% 7,162 24.1% 3,291 11.1% 14,139 47.5% 29,744 Innovative Changes to Improve Home and Community Care • Increased Home Care Access - Funded through the 2008/09 Transformation Fund, this project improved access to

home care by funding additional care hours. Mental Health and Substance Use Mental health is a vital part of a person’s overall wellbeing. Mental health problems and disorders, including substance use, are widespread throughout all sections of society. One in five British Columbians aged 15 to 64, or approximately 624,000 people2, will experience some form of mental health disorder, including substance use disorder, this year.3

Symptoms of mental illness may be mild, moderate, or severe, and may emerge at different times throughout a person’s life. However, these disorders are treatable and can often be minimized by early intervention. The Province of BC is committed to a comprehensive, integrated, evidence-based system of mental health and substance use services. These services focus on health promotion, prevention, treatment and recovery, and support individuals’ and families’ resiliency and self-care. VIHA provides services that cover the full spectrum of prevention, treatment and ongoing care for people with mental health and substance use disorders, including specialized programs for young adults, seniors, homeless individuals and those with mental disabilities. Financial Information

VIHA Mental Health & Substance Use Sector Expenditures ($ millions)




1 CeRTS No. 2009 – 789. Ministry of Health Services, HSIM/IT. March 4, 2010. 2 Applying this prevalence rate to BC’s 2008 population age 15 to less than 65. Data source: Population estimates (1986-2007) and projections (2008-2036) by BC STATS, Service BC, Ministry of Labour and Citizens’ Services, PEOPLE 33, Population estimate for 2007/08 3 Mental Health and Addictions Branch, Ministry of Health Services

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Mental Health Beds Community mental health beds are provided through three main housing programs: community residential care, family care homes, and supported housing. In addition, people with mental health issues can access resources such as rental subsidies, BC Housing health services, community crisis stabilization units, and emergency shelter or short stay crisis residential beds. Community Mental Health and Substance Use Bed Inventory Mental Health Facility Types VIHA BC Total Mental Health - Community Residential Care 148 1,421 Mental Health - Family Care Homes 65 171 Mental Health - Rental Subsidy 498 606 Mental Health - Community Crisis Stabilization Units 0 64 Mental Health - Emergency Shelters 65 136 Mental Health - Crisis Residential Care (Short Stay Crisis Stabilization) 29 74 BC Housing Health Services Program 237 2,509 Mental Health - Supported Housing - Supported Independent Living (SIL) 5 1,901 Mental Health - Supported Housing - Scattered Supported Apartments 95 305 Mental Health - Supported Housing - Clustered/Block Apartments 189 602 Mental Health - Supported Housing - Congregate Housing 49 285 Mental Health - Supported Housing - Group Homes 37 463 Mental Health - Supported Housing - Supported Hotels 0 125 Mental Health Beds Total 1,417 8,662 Substance Use - Adult Residential Treatment 7 247 Substance Use - Adult Support Recovery 43 403 Substance Use - Youth Residential Treatment 0 62 Substance Use - Youth Support Recovery 7 12 Substance Use - Adult Detox (withdrawal management) - Community Based 54 192 Substance Use - Youth Detox (withdrawal management) - Community Based 7 24 Substance Use - Youth Detox (withdrawal management) - Family Care Homes 7 15 Substance Use - Sobering and Assessment Beds 25 25 Substance Use - Low Barrier Housing 275 1,228 Substance Use - Supported Housing - Supported Independent Living (SIL) 0 70 Substance Use - Supported Housing - Scattered Supported Apartments 0 210 Substance Use - Supported Housing - Clustered/Block Apartments 0 30 Substance Use - Supported Housing - Congregated Housing 0 0 Substance Use - Supported Housing - Dedicated Sites 0 22 Substance Use - Supported Housing - Group Homes 1 10 Substance Use - Supported Housing - Supported Hotels 0 0 Substance Use - Supported Housing - Youth 0 0 Substance Use Beds Total 426 2,550 BC Total (Mental Health Beds + Substance Use Beds) 1 1,843 11,212 1

The Community Mental Health and Substance use Bed Inventory is based on the Mental Health and Substance Use Community Residential Beds and Units Survey reported by health authorities as of March 31, 2010.

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Accomplishments and Initiatives To support mental health and substance use plans, VIHA operates a number of innovative programs across Vancouver Island, including the following: • Continue implementation of VIHA’s Mental Health and Substance Use Services Plan to address mental health

and substance use in VIHA and focuses on: • Coordination with municipalities, non-government organizations and government to provide services to

people who have the greatest need/ are at the highest risk; • Better follow-up of acute care patients on discharge, and continued development of community-based

services; • Continue to invest in services, particularly in Central and North Island, to achieve a more even

distribution of resources; and • Implementation of the Riverview Redevelopment Plan including establishment of tertiary care facilities,

assertive community treatment teams, and Community Intensive Supported Living units, as provincial funds are made available.

• Health promotion programs, especially for youth and for the prevention of addictions; • Early Psychosis Intervention programs, which identify, rapidly assess and treat youth experiencing the onset

of schizophrenia and bipolar disorder; • Shared Care initiatives, which provide consultation with physicians for managing chronic diseases and

dementia; • 24-hour Crisis Response Network in Central and North Island; • Integrated Mobile Crisis Response Teams in the South Island, which enable clinicians and police officers to

work as an integrated team to respond to community emergencies; • Comprehensive new website to provide information on mental health and substance use services

<http://www.viha.ca/mhas/>; • Partnership with Our Place, a 45 one-bed shelter providing a continuum of supports to the homeless in

Victoria, which opened in late 2007; • Educational and clinical improvement programs to better manage suicidal behaviour among clients with

mental health and substance use issues; • Operation of a Geriatric Psychiatry Outreach Team, and redesign of the Elderly Outreach Service and

Victoria Innovative Senior Treatment Approach; • Expansion of Clearview Detox in Nanaimo from 8 to 12 beds, to provide medically-supervised detox for

people in the Central/North Island area; and • Provided $7.6 million funding to create Assertive Community Treatment teams, and enhance supports and

services for homeless people in Victoria. Youth Substance Use Services VIHA completed strategic planning for substance use services for youth in August 2005. The focus of this strategic planning is on preventing and treating problematic substance use and creating a regional network of youth substance use services. As of June 2008, VIHA has added 18 youth residential recovery beds and 8 youth detoxification beds and has enhanced early intervention and community-based outpatient services associated with crystal methamphetamine. Riverview Hospital Redevelopment Project In May 2002, the Government committed $138 million in capital funding to build new facilities or renovate existing facilities to replace the outdated buildings at Riverview Hospital. As a result, the health authorities are building a range of new tertiary and specialized residential treatment facilities in communities across the province. The new facilities provide supportive, more home-like environments and facilitate important ties to the community, making rehabilitation and reintegration easier.

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The VIHA beds are located at:

• Seven Oaks in Victoria – 26 tertiary rehabilitation; 27 adult rehabilitation beds opening in 2012; • Sandringham in Victoria – 25 tertiary rehabilitation and 21 specialized residential beds; • St. Joseph’s Hospital in Comox – 4 tertiary acute beds; • Lodge on 4th

• New Horizons in Campbell River – 6 specialized residential beds, and in Ladysmith – 12 specialized residential beds;

• Cowichan Lodge – 24 older rehabilitation beds opening in 2012. Community Intensive Supported Living VIHA is in the process of adding Community Intensive Supported Living units with 24/7 mental health and substance use support services. To date, 30 Community Intensive Supported Living clients have been opened at Tillicum Apartments in Victoria. Consultation, Assessment and Treatment Services VIHA provides specialized consultation, assessment and treatment services upon referral from the community based treatment teams. Services provided include housing specifically designed to provide a safe, supportive drug and alcohol free environment for people unable to participate in community treatment without transitional housing. Services also include withdrawal management (“detox”), post-acute withdrawal and supportive recovery where individual or group treatment is provided in the community as a transition out of residential treatment. Withdrawal Management Services (Detox) Detox can be provided in a variety of settings, depending on the severity, complexity and risk to the person going through detox. Withdrawal management is not a location or a bed; rather, it is a process which can take place in the community, in peoples’ homes, in community-based crisis/stabilization beds, in dedicated community-based medical withdrawal management facilities, and in acute care settings. Specialized substance use services on southern Vancouver Island include Medical Detox, which provides physician/nurse support for patients who are withdrawing from substances that carry significant medical risk, such as withdrawal from alcohol. Innovative Changes to Improve Mental Health and Substance Use Services Enhanced Mental Health and Addiction Services – Funded through the 2008/09 Transformation Fund, the Enhanced Mental Health and Addictions Services project targeted access to mental health services with a special focus on moving patients from hospital emergency departments to care environments and services that meet their needs more appropriately. Capital Projects Examples of capital investments that are completed or underway are: • The addition of 21 new community medical detox and stabilization beds at Eric Martin Pavilion in Victoria

was completed in December 2008. The $1.7 million project is part of VIHA’s $7.6 million in initiatives stemming from the Mayor’s Task Force on Homelessness.

• Planning is underway to accommodate 24 older adult rehabilitation beds at Cowichan Lodge and 27 adult rehabilitation beds as Seven Oaks Lodge.

Primary Health Care Primary health care involves health care providers working in teams to provide a range of everyday health services on a regular, ongoing basis to help people stay healthy and prevent injury, manage illness or disease, and cope with the end of life.

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VIHA is working towards establishing a comprehensive primary health care system, with a key focus on chronic disease management as its strategic priority for the next five years. This system will help VIHA provide more effective health care to communities across the health authority, and focus its attention on areas where the need is greatest. Accomplishments and Initiatives A comprehensive Primary Health Care Strategy and Chronic Disease Management Plan were developed in June 2006 to expand and integrate primary health care access across VIHA. The initiatives below outline how VIHA plans to provide a range of services to meet patients’ health care and chronic disease management needs: • Deliver co-terminus, integrated primary care, home and community care, and community mental health and

substance abuse services equitably across the health authority; • Work with ten communities in Mt. Waddington, Cowichan Valley and Saanich/Sidney with primary and

community care networks to help increase the quality of care provided and reduce hospital admissions; • Build on existing physician partnership model by aligning clinicians with primary care physicians and adopt

the Ministry’s Care Management Strategy when finalized; and • Develop a plan to spread the learning from the seniors patient flow work in Nanaimo throughout the health

authority to prevent and reduce alternate level of care and improve the flow of patients through the system. VIHA has identified the following strategies to expand and integrate primary health care access: 1. Improve chronic disease management by developing and sustaining Integrated Health Networks: groups of

resources formally working together to provide the best support to complex, high needs patients and their family physicians.

2. Continue to support physician practices to deliver efficient and effective primary health care and chronic disease management through: continued use and enhancement of our Practice Support Program; development of the South Island Collaborative Care program (for improved patient management and monitoring); and continued standardization of core services to improve diabetes and nutrition management for high-risk clients.

3. Work with local municipal and community partners to develop multi-disciplinary Primary Health Care Centres in Sooke, Ladysmith, Port Alberni and Parksville. An Expression of Interest was recently advertised to develop a Primary Health Care Centre in Oceanside.

4. Assess the feasibility of sending discharge summary reports to family physicians within 24 hours of a patient’s discharge from hospital and develop a phased implementation plan.

Primary Health Care Organizations VIHA manages four Primary Health Care Organizations. These organizations are a point of contact between a patient and the health care system, offering patient access to a team of care providers while meeting the particular needs of communities.

• Ladysmith Community Health Centre; • Health Point Care Centre; • Comox Valley Nursing Centre; and • Port McNeill Primary Health Care Practice.

The Primary Health Care Organization model uses an interdisciplinary approach to care and provides the first point of contact between a patient and the health care system. It focuses on ensuring patients meet with the right care provider at the right time, and that health services are available for extended hours. VIHA has established three Assertive Community Treatment Teams and two Outreach Teams, which link people to services, agencies and housing.

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Integrated Health Networks are offered for participating physicians and their patients in Campbell River, Parksville/Oceanside, Nanaimo, Port Alberni, Victoria and Sooke. Primary Health Care and Chronic Disease Management Programs • Adult Diabetes Education Centres – VIHA’s Adult Diabetes Education Centres provide educational programs

to adults with diabetes (and their families) to support them in managing diabetes. • Comox Valley Nursing Centre – a community based nursing service in Courtenay offers direct access to

registered nurses in the areas of drop-in services, booked appointments, administration and clinical support, and community development.

• Health Point Care Centre – Offers integrated services to adults over the age of 70 living in the community and their family caregivers who reside in Greater Victoria.

• Ladysmith Community Health Centre – A team of Physicians, Nurses and Clinical Office Assistants working together to provide primary health care and urgent care at Ladysmith.

• Nutrition Services – Nutrition Services develops nutrition guidelines and standards for nutrition care within VIHA. Registered Dietitians provide nutritional care for patients in acute care, outpatient care, home care and long term care settings.

Primary Mental Health Task Force VIHA created a Primary Mental Health Care Task Force and network of health providers and other key partners inside and outside the health authority. The aim of this initiative is to determine priorities for improvement and to gain common understanding of the issues. VIHA Service Delivery Frameworks Service frameworks are an approach to integrated health planning. This project will develop service delivery frameworks for VIHA’s chronic disease management priorities. One focus of service delivery frameworks is to identify gaps in care and make recommendations for change. Another is to follow the patient’s journey through the health care system over the course of an illness. The service frameworks provide an opportunity to recommend service delivery redesign options to improve patient outcomes, facilitate quality care and promote optimal use of health services within VIHA’s geographic boundaries. Innovative Changes to Improve Primary Health Care: • Development of Integrated Primary Health Care Networks for At-Risk Seniors – Funded through the 2007/08

HIF, the Integrated Primary Health Care Network for At-Risk Seniors (in the Victoria-Hillside Corridor) provides services for seniors with multiple chronic conditions, including persistent mental illness. Current facilities at Aberdeen Hospital and Hillside Seniors Centre serve as a hub for centralized intake, assessment and referral of patients. Network services consist of blended primary and specialized health care located both within the hub and within the community.

• Development of Integrated Primary Health Care Networks for Chronic Disease Management Comorbidity – Also funded through HIF, this project created three Integrated Primary Health Care Networks in urban centres to address chronic disease management (CDM) among individuals living with multiple comorbidities. The model leverages existing fee-for-service physician offices in the communities and realigns VIHA single disease clinics (i.e. diabetes education services, nutritional services, kidney care services, heart health services, and other locally delivered VIHA programs) to form comprehensive treatment and support networks for people living with multiple comorbidities.

• Heart Function Clinic – the Heart Function Clinic supports patients living with chronic heart failure, through a physician directed nurse case management model. The clinic helps patients and families to manage their heart health to the best of their ability by providing education, risk factor reduction, medical management through a nurse case management service, multidisciplinary heart function clinic visits, providing exercise rehabilitation or guidance, referring or linking patients to other services, and respectful discussions of advanced directive and end-of-life care. The intent of the Clinic is to assist patients to manage their care more effectively and to reduce their reliance on the health care providers.

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• Laboratory-based Approach to Support Patients with Diabetes – the VIHA Laboratory has developed and now facilitates a Diabetic Recall Program that collaborates with the physician offices and Diabetes Educators in several VIHA communities including First Nations. A process of recall, notification, monitoring, reporting, and data collection has been developed to ensure haemoglobin A1C testing guidelines are being met.

Capital Projects Examples of capital investments that are completed or underway are: • Through funding from HIF, VIHA is creating Primary Health Care Centres in areas not usually serviced with

primary care in Sooke, Port Alberni and Oceanside. As well, innovative primary health care projects are taking place in Victoria, Nanaimo and the Comox Valley.

• In March 2008, VIHA purchased a building in downtown Victoria (941 Pandora) for community health services to provide integrated primary health care for the hard-to-serve, high-risk and homeless populations.

Population and Public Health Population health is an approach to planning and delivering health services that recognizes the importance of broad determinants such as shelter, education, food and income on improving people’s health. Understanding the health determinants of a population is important in preventing illness, disability and injury. Population health strives to identify populations in need or at high risk, and to design services that meet their needs. High-risk populations identified in VIHA include: the downtown/hard-to-serve, the mentally ill and addicted, the frail elderly, the chronically ill, Aboriginal populations and rural and remote populations. The Public and Population Health Observatory was established in October 2003 as part of the portfolio of the Chief Medical Health Officer. Its mandate is to ensure that VIHA has an appropriate, timely and valid population health information to monitor health status, respond to health problems, and support planning, implementation, and evaluation of health services and programs in VIHA. VIHA’s focus on improving population health includes: • providing good public health prevention, protection and environmental programs that target issues such as

food safety, clean air, water quality, infection control and communicable disease prevention; • promoting healthy lifestyles that target high-risk situations and behaviours, such as: healthy choices during

pregnancy, safe sex and alcohol and risk-related trauma in youth; and • healthy child and youth development. Financial Information

VIHA Population Health and Wellness Sector Expenditures ($ millions)


52.4 58.3 5.9 11.2% 1 Information provided by VIHA. (August 2009). 2


Accomplishments and Initiatives Public Health provides a wide range of health education and disease prevention initiatives to promote health and prevent illness. In 2010/11 VIHA will focus on the following strategies to promote healthy living: • Implement a continuous improvement plan for core public health programs through standardized,

evidence-based prevention programs linked to clear and measurable population level health outcomes;

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• Complete review of Population Health and Wellness Programs to recommend program shifts and redirection in accordance with the direction provided by the Ministry.

• Support Healthy Communities Collaborative Initiative by developing partnerships with municipalities to improve the overall health and wellbeing of people and communities.

• Decrease tobacco use among VIHA residents by monitoring and enforcing all tobacco related legislation and creating and implementing strategies that target high-use groups.

• Implemented VIHA’s Smoke-Free Premises policy. • Implement the Pan-Canadian surveillance solution, Panorama, to manage core public health functions,

including immunizations, communicable disease management, and epidemic/pandemic surveillance management. VIHA will implement additional modules specific to BC and the Yukon, to support family and environmental health.

In 2009, VIHA developed Performance Improvement Documents for Health Emergency Management, Air Quality and Food Security. Health Human Resource Planning Health Match BC supports health authorities with out-of-province recruitment both within Canada and internationally. Through Health Match BC, job opportunities across the province are efficiently and effectively marketed to targeted professionals in other provinces and abroad. Between 1999 and 2010, Health Match BC has recruited more than 1,700 physicians. About 80 percent were recruited for communities outside the Lower Mainland. Family Physicians make up the single largest group, but a wide range of other specialists also have been recruited. In the current calendar year (to June 30th) more than 300 physicians were referred to positions throughout the province, with 126 matched so far, potentially making this their most successful year to date. Additionally, more than 700 registered nurses and 50 hospital pharmacists have been recruited from outside BC. Recently, Health Match BC began targeting other allied health professionals, including physiotherapists, medical laboratory technologists and radiation technologists. Internationally educated health professionals are provided with assistance with licensing and immigration matters, including Provincial Nominee Program applications to ensure speedy processing. It also manages the new BC Care Aide and Community Home Worker Registry established this year to protect vulnerable patients and encourage improved educational standards. Health Match BC is coordinating its activities with health employers, educational institutions and communities throughout the province.1

International recruitment is more successful as a result of the implementation of Skills Connect for Immigrants - Health which assists internationally educated health professionals with credential assessment, skills enhancement and workplace integration. Several initiatives are also underway to reduce licensing barriers. This includes piloting an assessment centre for internationally educated nurses to enable competency-based assessment, a great improvement over the existing paper-based credential review process. All health authorities are contributing to the expansion of health education programs by helping students fulfill practice education requirements. Between 2001/02 and 2010/11, over 6,500 education spaces have been added to health programs (nursing, medical and allied health) across BC.2

The number of nursing spaces has more than doubled (over 4,000 additional spaces since 2001) through the creation of 25 new nursing programs around the province, including three new 3-year accelerated Bachelor of Science in Nursing programs, resulting in over 17,000 credentials being awarded. 1,101 new education seats have been created for allied health professionals with new programs planned outside the Lower Mainland, for example, in Prince George and Victoria.

1 Health Human Resources Branch, Ministry of Health Services, August 2010. 2 All education statistics provided by the Ministry of Advanced Education.

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All health authorities are also contributing to the expansion and distribution of medical education programs for physicians. Since 2004, the medical school has doubled the number of first-year seats for undergraduate MD students to 256, and distributed their training to the North and the Island. Another medical education program is due to open in the Okanagan in 2011/12, and by 2015 there will be over 1,000 Canadian medical students in training at any one time in BC. Growth in postgraduate medical education (residencies) has kept pace with the undergraduate expansion. BC has also doubled the number of first-year residencies for Canadian medical graduates to 256, and tripled the number for international medical graduates to 18. By 2015, the there will be over 1,200 residents in training at any one time, and by 2020 the Province every year will have 300 new physicians ready for independent practice. Accomplishments and Initiatives VIHA has developed a comprehensive Human Resources Strategy to address our greatest organizational risk: ensuring we have the necessary complement of health professionals today and into the future. On January 24, 2008, VIHA publicly released its People Plan. The plan outlines a strategy and framework to address and manage the risks that drive human resource planning in an environment of significant and rapid change. VIHA’s People Plan focuses on six key projects:

• Recruitment and Retention Strategies • STAR – Scheduling Transformation and Redesign • Care Delivery Model Redesign • Workforce Planning • Continuous Learning • Work Life Support Strategies

This ensures that VIHA has the appropriate number and type of staff, now and into the future. In May 2008, VIHA purchased property in Tofino that will be used as housing for medical and nursing staff in the area. This purchase is part of VIHA’s People Plan goal to encourage staff recruitment and retention in rural and remote locations. VIHA continually strives to provide the best quality patient care. The Care Delivery Model Redesign - part of the People Plan - aims to ensure the right people are in the right positions doing the right work. During 2008, coordinators engaged health care teams at selected sites to research how health providers are using their time, assess individual challenges, and redesign their health care teams for the benefit of patients and staff. With input from a widely representative task force, consultants have helped VIHA to develop a five year Continuous Learning Directional and Infrastructure Plan. This plan includes succession and career planning, key to filling VIHA’s future leadership needs. The Scheduling Transformation and Redesign Project is a new staff scheduling system has established four centralized staffing service centres in Victoria (two) and up Island in Campbell River and Nanaimo. VIHA program areas and departments are being connected to one of these four centres for their staffing needs. The new system will help VIHA to meet its baseline staffing goals by having shifts filled efficiently with less use of overtime; stable and predictable staffing levels and use of knowledgeable staffing services specialists. In 2010/11 VIHA will focus focused on the following strategies to promote HHR: • Continue to plan and implement System-Wide Initiatives to:

• Redesign care delivery models to better meet the needs of the patient/client population and make full use

of staff skills, allowing more time for direct care, assessment and teaching;

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• Improve staff and physician safety in the workplace, including promoting awareness of and adherence to safe practices in order to reduce injury;

• Enhance workforce planning model to incorporate innovations in service delivery, the type of providers required, and projected improvements in provider health;

• Maintain a focus on and evaluate strategic recruitment and retention including the potential for expanding and enhancing certain flexible work arrangements; and

• Promote a continuous learning culture and work with the Ministry and our education partners to ensure staff have the skills and competencies to provide safe, high quality care, and are able to respond to changing health system and population health needs.

Physician and Nurse Practitioner Recruitment To support physician recruitment, VIHA has partnered with the University of Victoria’s Island Medical Program. This program supports the training of new physicians through mentorship opportunities with local physicians and experience working in mid-size, rural and coastal communities. • In June 2008, VIHA developed a Physician Resource Plan (the Plan) which includes targeted recruitment and

retention strategies and the redesign of care delivery models to support physicians. The Plan also includes projects to implement workforce planning, utilization, and physician forecasting, as well as projects to increase the supply of both general practitioners and specialists. The Plan has been implemented and is being regularly reviewed and refreshed. In the future, the Physician Resource Plan will integrate with VIHA’s People Plan, taking into account the potential impact on other health care provider resources and operations when physician numbers are increased.

• VIHA recently dedicated 2.5 Full Time Equivalent (FTE) positions to physician recruitment. • For 2008/09 VIHA recruited 42 family physicians and 41 specialists for a total of 83. In addition, two

midwives were recruited. As of June 2010, VIHA had filled 15 of the 16 allocated Family Physicians for BC (FP4BC) positions.1

• Nurse Practioner positions first appeared in VIHA in 2005. As of 2009 there are sixteen Nurse Practitioners, working in primary health care settings in Victoria, Nanaimo, Courtenay, Campbell River, Port Hardy and the Gulf Islands. VIHA is exploring opportunities to expand the role and availability of nurse practitioners to ease the burden on family physicians and provide education and preventative health care services.

Communities that continue to be eligible for the FP4BC program include Gabriola Island, Qualicum, Port McNeil and Tofino.

2

• Going forward, recruitment will focus on improving electronic marketing of VIHA opportunities, targeted niche marketing to Island Medical Program students and UBC residents as well as improving community engagement with the goal of having communities partner with VIHA in developing recruitment strategies.

Nurse Recruitment VIHA is working to attract new nurses, and now hires more nurses than leave each year. Included in nurse-hire initiatives is a program aimed at new graduates: all nursing students who graduated from Vancouver Island Schools of Nursing in 2008 were offered the New Grad transition program which includes full time temporary employment in the first year with VIHA. Many nursing students transition from the program into a full-time position. • VIHA hired a record number of graduating nurses in 2008, offering full-time temporary employment to

approximately 200 graduating nurses, both on-island and off-island. • VIHA also introduced a Specialty Sponsorship Program for nurses that pay the nurses’ regular salaries, plus

full tuition and book expenses, while they are studying for certification in specialties that are facing shortages.

1 Family Physicians for BC Program, Ministry of Health Services, June 2010. 2 <http://www.viha.ca/professional_practice/practice/nurse_practitioners>.

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Other Initiatives • VIHA received funding from the BC Health Education Foundation, for an additional 377 Resident Care

Attendant seats on the island. The graduates of this program will support the developments in the provincial 5,000 Bed initiatives.

• Through extended medical, VIHA is now funding any staff member who wishes to quit smoking. VIHA staff that wish to quit smoking can access up to $300 in smoking cessation aids.

• As part of VIHA’s commitment to maintain a safe and healthy work environment for staff and visitors to VIHA facilities, all VIHA owned, operated or leased facilities went smoke-free on March 1, 2008. Special exemptions are given for palliative, long-term care and mental health facilities, recognizing their special circumstances.

• VIHA invested $1.2 million in 2005 to purchase new safety-engineered needles and other sharps and to educate staff about how to avoid exposure to blood borne disease.

Capital Projects Examples of capital investments that are completed or underway are: • Student Training Space: VIHA and the provincial government have invested $7 million to build and renovate

facilities at Royal Jubilee and Victoria General hospitals to provide training space for students in the Island Medical Program. Construction is underway to renovate facilities for student training space in Nanaimo, with planning in Duncan, Comox and Campbell River as part of the Affiliated Regional Centres in the Island Medical Program.

Corporate Services Corporate and Strategic Services is a collection of portfolios which oversee the delivery of all non-clinical services in VIHA, including:

• Communications • Finance • People and Organizational Development • Information Management/Information Technology • Planning • Professional Practice and Nursing • Public and Environmental Health

Each is headed by a member of the VIHA executive team. In collaboration with the Ministry, the executive team establishes performance objectives regarding the delivery of health care, and works to ensure those goals are met or exceeded. Financial Information

VIHA Corporate Sector Expenditures ($ millions)




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Accomplishments and Initiatives 2010/11 Initiatives include:

• Achieve administrative cost savings through shared services organization and consolidation; o Participate in the shared services organization to achieve cost efficiencies; o Achieve a balanced budget through administrative efficiencies, increasing revenues and reconfiguring

services;

• Implement LEAN management principles as a common approach to process improvements; o Roll-out LEAN education and training by providing on-line curriculum and advanced practitioner

training; o Apply LEAN methodology to advance and support our four System-Wide Initiatives and to improve

overtime, sick time, disability duration, injury rates, staff scheduling, and timekeeping;

• Care Delivery Model Redesign (CDMR); o Continue to redesign how we deliver care on all medical and rehabilitation inpatient units to better meet

patient needs at the same time as optimizing staff models; o Royal Jubilee Hospital respiratory and rehabilitation therapy staff will participate in CDMR initiatives in

preparation for moving to the new Royal Jubilee Hospital Patient Care Centre;

• Deliver high performance governance, leadership and management skills; o Sustain annual planning cycle that includes several management and leadership forums ensuring that

leaders at all levels are kept informed about organization-wide strategies and activities; o Continue our focus on four System-Wide Initiatives that align staff across the organization towards

transforming, sustaining and continually improving quality of care and care delivery, and by addressing the barriers, risks and challenges faced in these areas;

• Work with the Ministry to develop plans to reduce green house gas emissions and continue to develop effective environmental management systems;

• Maintain a reliable information infrastructure by upgrading and replacing assets to ensure appropriate controls and continuity of operations; and

• Implement a Stakeholder/Community Engagement Plan that enhances collaborative dialogue and community outreach with external stakeholders.

Green Healthcare • The new Patient Care Centre, due to open at the Royal Jubilee Hospital site in 2011, aims to be the first acute

care facility in Canada - and the largest health care building - to achieve gold status under the Leadership in Energy and Environmental Design program.

• VIHA champions energy conservation through improving its hot water/boiler systems; reclaiming heat from waste laundry water; retrofitting lights to low mercury/high efficiency; and replacing windows. A partnership with BC Hydro energy management program is already resulting in significant energy savings.

• VIHA recycles. Through regular waste audits the health authority creatively recycles as much as possible, i.e. printer cartridges, cooking oil, mercury from fluorescent tubing and even used linens that we donate to third world countries.

• VIHA regularly composts all lawn and garden waste where community facilities allow. Kitchen wastes are composted in Nanaimo, Port Alberni, Duncan, Parksville, Qualicum and Victoria. Grease traps have been installed in all South Island food preparation kitchens, with the last site completed this year.

• VIHA promotes “travel smart” options such as walking, bicycling, using transit, ride sharing and carpools for staff.

Telehealth • VIHA has signed a First Nations Telehealth Partnership Agreement, the first of its kind in the Province of BC,

with the Inter Tribal Health Authority

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• A goal of VIHA’s IM/IT strategy is to use Telehealth to enhance patient access to specialty services and provide clinical support in remote/rural areas.

• Some initiatives for 2008/09: Targeted educational information on the Internet, including telemonitoring and personal health records to support chronic disease management. VIHA will introduce videoconferencing and collaboration services to support the development of virtual communities, improving communications and supporting safety as we engage with our colleagues across VIHA’s diverse geography.

Health Connections Program • VIHA provides an operating grant to Wheels for Wellness, a non-profit society that provides door-to-door

transportation on Vancouver Island for over 800 patients per month for trips that are over 75 kilometres (one way). From 2007 to 2008, Wheels for Wellness has transported over 20,000 patients. Wheels for Wellness does not provide services from other islands.1

Patient Care Quality Review Program In 2008, Government introduced the Patient Care Quality Review Board Act, requiring each health authority to establish a central Patient Care Quality Office (PCQO) to receive, investigate and respond to patient care quality complaints. The Act also created independent Patient Care Quality Review Boards to review complaints that had been addressed but not resolved by a PCQO. Following a review, the Boards can make recommendations to the health authorities and/or Minister for quality improvement. In 2009/10, there were a total of 5,824 care quality complaints submitted to health authority Patient Care Quality Offices (PCQO) across BC, including 1,619 to VIHA alone (27.7 percent of the total). The top three issues brought forward by complainants all arose in the acute care sector, and were reported as attitude and conduct, deficiencies in care, and care (all other issues). The Patient Care Quality Review Boards completed an independent review of 53 complaints in 2009/10, including 10 not resolved by VIHA’s PCQO. Six of these 10 cases resulted in 9 recommendations for quality improvement to VIHA. (The Boards made a total of 102 recommendations to the health authorities and two to the Minister in 2009/10.) 2

In response to those recommendations, VIHA made a number of changes, including:

• Island-wide protocol developed regarding family physician follow-up; • Island-wide centralized information system regarding bookings for medical imaging; and • Improved communication with staff regarding PCQO role and functions.

1 Wheels For Wellness Website: <http://www.wheelsforwellness.com>. 2 Patient Care Quality Review Boards’ Annual Report 2009/10 <http://www.health.gov.bc.ca/library/publications/year/2010/PCQRB_AnnualReport_0910.pdf>.

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GENERAL CONTACTS

Vancouver Island Health Authority: Telephone: 877 370-8699 (toll-free in BC)

http://www.viha.ca

Telephone: 250 370-8699 Email: [email protected] Patient Care Quality Office: Telephone: 877 977-5797 (toll-free in BC)

http://www.viha.ca/patientcarequalityoffice/

Telephone: 250 370-8323 Email: [email protected] BC Health Guide / BC Nurseline: Telephone: 8-1-1 (toll-free in BC)

http://www.healthlinkbc.ca

Telephone: 7-1-1 Deaf and hearing impaired (toll-free in BC) Email: [email protected] Dietitian Services at HealthLink BC: Telephone: 8-1-1 (toll-free in BC)

http://www.healthlinkbc.ca/dietitian/

Telephone: 7-1-1 Deaf and hearing impaired (toll-free in BC) Email: [email protected] Quit Now BC: Telephone: 877 455-2233 (toll-free in BC)

http://www.quitnow.ca/

Email: [email protected]

SOURCE: All data provided by the Vancouver Island Health Authority and the Ministry of Health Services

The numbers in this document reflect the latest available data as of printing. Please note data changes daily as the planning and delivery of health care services progresses.