Peace River Regional District REPORT

Transcription

1 Peace River Regional District REPORT To: Chair and Directors Date: July 18, 2012 From: Faye Salisbury, Corporate Officer Subject: Attendance at Northern Health Board / Executive Meeting on June 18, 2012 RECOMMENDATION(S): That the Regional Board refer discussion on regional medical issues to a Committee of the Whole meeting. BACKGROUND/RATIONALE: The Board extended an invitation to the Board of Northern Health, during the North Central Local Government Association s AGM in 100 Mile House, to come to this area and have discussion with the Directors of the Peace River Regional District on the following list of topics: How are community needs determined Hospital future viability morale Disposal of assets Recruitment of professional and support staff attitude towards recruiting Local access to medical service What is the commitment Quality of Service A two hour session was provided by Northern Health at its June 18, 2012 Executive meeting in the board room of the new Fort St. John Hospital. Although Northern Health is not responsible for ambulance service, the shortage of ambulance services in small communities was a primary topic of discussion. Mr. Michael MacDougal, Executive President and President of the Emergency and Health Services Commission was present in the meeting to hear the Directors concerns. Dr. Charles Jago, Board Chair and Cathy Ulrich, CEO elaborated on an in-depth PowerPoint presentation which addressed most of the topics the Board wished to discuss. Opportunity was given for questions throughout the presentation. Those present, expressed appreciation for the opportunity to speak directly with the Executive and Board of Northern Health. The notes of the meeting and PowerPoint presentation are attached to this report. Subsequent to the meeting, the Regional Directors mentioned, that since the shortage of medical service personnel remains a critical issue in the region s smaller communities; that they meet to provide their respective community s data and suggest solutions for a presentation to the Minister of Health. STRATEGIC PLAN RELEVANCE: No. 2 on Corporate Priorities FINANCIAL CONSIDERATION(S): OTHER CONSIDERATION(S): Staff Initials: Dept. Head: CAO: Page 1 of 1

2 NOTES OF MEETING with the NORTHERN HEALTH BOARD / EXECUTIVE DATE: June 18, 2012 TIME: PLACE: PRESENT: 10 a.m. Fort St. John Hospital Board Room Peace River Regional Hospital District Directors Director Goodings Director Hadland Director Christensen Director Jarvis Director Caisley Director Schembri Absent Director Anderson Director Ackerman Director Hiebert Director Bernier Director Fynn Director Nichols Staff Fred Banham, Chief Administrative Officer Faye Salisbury, Corporate Officer Sheila DeCosta, Secretary Legislative Services, Recorder Northern Health Board Dr Charles Jago, Board Chair Dale Bumstead, Board Member Kate O Neil, Board Member Gordon Milne, Board Member Cameron McIntyre, Board Member Sharon Hartwell, Board Member Barbara Caldwell, Board Member Gary Townsend, Board Member Deborah Shannon, Board Member Northern Health Executive Cathy Ulrich, CEO Fraser Bell, VP Planning, Quality & Information Mark De Croos, Chief Financial Officer, VP Finance Desa Chipman, Executive Assistant CEO & Board Betty Morris, NE Chief Operating Officer Dr. Sean Ebert, Chair Medical Advisory Committee Dr. Susan MacDonald, Interim VP Medicine Dr. Becky Temple, NE Medical Director Steve Raper, Director or Communications Guests Provincial Health Services Authority Michael MacDougall, Executive Vice President & President, Emergency and Health Services Commission Darwin Sauer, Chief Communications Officer 1

3 The purpose of the meeting is for Northern Health representatives to dialogue with the directors of the Peace River Regional Hospital District about topics of particular and common concern throughout the region. Board Chair Dr. Charles Jago called the meeting to order at 10:03 a.m. and introductions were made around the table. Through an in-depth Powerpoint presentation, (attached) Dr. Jago and Cathy Ulrich, CEO elaborated on the following: Health Authority Structure in BC; Northern Health Board Member appointments and structure; Northern Health Strategic Plan, four areas of focus; Board Structure and accountability; Meeting structure, schedule, agenda, community consultation, education Performance Planning and Priorities; Role of the Audit and Finance Committee; Medical Advisory Committee Governance and Management Relations; Board and Community Consultations Role of the Ministry of Health and its development of the Population Needs Based Funding formula; Staff recruitment, retention, safety, long service awards; Population needs health approach; and Consistent policy and quality framework across the North. The following discussion took place during the presentation: Cathy Ulrich We are in the process of mapping where all the industrial camps are, and will be able to share that information with you in the fall. The Northern Health Strategic Plan is designed for the northern rural population; fifteen hundred staff were engaged in the Strategic Plan process. Staff vacancies are trending down because of the health professional education in the north. We still have problems recruiting for the specialty areas. Chair Jago - Board Structure appointment process: through the Board Resourcing and Development Office of BC ultimately appointed by the Minister, we have a high functioning board; want people to bring their regional perspectives to bear, keeping the whole perspective. Dr. Jago - We have commissioned a consultant to look at economic development in the region, something that no other health authority has done to determine what challenges we might face. Since 1985, the population has fundamentally not changed. We can discern emerging trends, but we don t have much of a basis to obtain more provincial funding because of the overall population size. Dr. Jago -The Board sets the agenda for Board meetings, not management. Dr Jago - Board and Community Consultations we invest a considerable amount of time meeting with communities, this is really important to us. We are not accountable to communities, but to the provincial government. The Northern Health strategic plan aligns with the Ministry of Health agenda. We need to balance the provincial mandate and apply it to the regional needs. Cathy Ulrich - our funding is based on a population needs based funding formula. We are a younger population and substantially different than the other health authorities. We do get very small amounts for targeted specific purposes. Physician, pharmacare funding, BC Ambulance funding is all taken off the top then the rest comes to the health authorities through the funding formula. 2

4 Dr. Jago turned the floor over to special guest, Michael McDougal, Executive Vice President and President, Emergency and Health Services Commission, who explained that about 1 ½ years ago the government moved the emergency health services commission into the Provincial Health Services Authority. The PHSA Board oversees the commission. This has put a focus on patient quality. The Ambulance Service has been moved under the Facilities Bargaining Association in the Health Sector. The following discussion ensued: Fred Banham, CAO Peace River Regional and Hospital District - BC Ambulance in northern BC is broken. I have been meeting for over 15 years to get better service up here. The private sector is so much ahead of you. We have a huge population up here that is not counted because they fly in for 2 weeks and out for 2 weeks. BC Ambulance looks at BC Stats info e.g.: HH 1100 people, but there are actually 3 4 thousand there. It is a big problem, how we transport medical emergencies in the north. We need to come up with a different model, because the one we have does not work. Michael MacDougall - I think you are right; we are interested in partnering with the private sector. We are trying to take a new approach to make sure transporting patients isn t so fragmented. Fred Banham - The big part of the problem is distance up here. Taking patients from the local clinic to another community takes the ambulance crew out of the community for most of the day. Dr. Jago - Certainly the issue is around emergency services on the non-census population. We are doing the research on camps now. What impact do they have on our services? We are not there yet in having that understanding. We have to review how the funding formula accounts for Northern Issues. It is on our agenda to report to the Peace River Regional District on that in October. Cathy Ulrich - We will share the information on the industrial development and camp component study with BC Ambulance and PHSA as well Michael MacDougall - we would really like that information, so we can make better transport decisions. Director Goodings Thank you for this opportunity to talk about BC Ambulance service even though it is not Northern Health s responsibility. Can we allow the communities to speak up at this table? Many of our problems are outside of incorporated municipalities. Director Anderson - One of my large issues with BC Ambulance is that we only have two responders in our community. We are still waiting over 1 to 1 ½ hours to get the ambulance to respond. Why can t we have ambulance drivers as we used to? I don t understand why you take an ambulance out of a community. The fire department staff are not first responders. We have to make the rules a little bit different. We have had two deaths in the last 6 months waiting for ambulances. Some have driven to Fort St. John to meet the ambulance from there. The communication just isn t there, it is just terrible. Michael MacDougall that is what I was trying to refer to a flexible model. Dr. Jago - Anyone may express your opinions to our board in this session. Cathy Ulrich - We really want this to be pertinent Director Goodings - The mayor of Chetwynd is meeting with you later today, he also has similar issues Director Caisley Tumbler Ridge has the same sort of problems, I would like to invite Michael to a regional district meeting and to a meeting in Tumbler Ridge as well. Major issues, safety, no coverage, long distances. One of the concerns I have for Tumbler Ridge is that we have done a lot of very good work with Northern Health in trying to present the overall situation in our community and what is required. Most of our problems are with the Ministry of Health, maybe that is where we should be dealing with it. We are in a critical situation with Dr. C. Helm relative to the urgency of inadequate coverage. As far as the present time is concerned, our population is 27 hundred not 24 hundred, and will increase to over 4 thousand. There is major land development, and we are 3

5 seeking to provide necessary housing. The population could increase to 8 to 10 thousand over the coming years. A tremendous amount of information to prove the point has already been done. Northern Health also pursuing a master plan to 2035, we thank you for that. That sounds great for the long term, but what about now? A plan to carry us through till then is an absolute must. The plan in our community right now is simply not working. We don t have adequate health services related to the heavy industrial development, we can t offer the health services required to keep them safe. When is it our priority to start to have the kinds of services that we require? In two to five years other priorities will come up. Blair Lekstrom agrees that the small communities are not being treated fairly. It is a matter of trying to find out what the next step is to move us to a higher priority. As a director of the regional district representing Tumbler Ridge, I ask you what in your opinion is my next step? As a director of the Peace River Regional District overall, what is my next step relative to the changes we are requesting to move us up in the priority line to get us where we have to go. We need to cut to the chase on it. What is my next step? Cathy Ulrich -The master plan will be done this year. In that will be recommendations for next steps, I am expecting recommendations for higher levels of service and staffing level increases. There will be opportunity this year. In terms of your question, we really do struggle with the physician recruitment issue. Fred Banham - Can you elaborate on your model with physicians? Cathy Ulrich - Fee for service physicians like Dr. Helm (his own private practice, his business). The other is a contracted physician. Some communities have established a non-profit society working with physicians. Some physicians want a turn-key operation and no worry about the business aspects. The studies done by Northern Health suggest that Tumbler Ridge s population could grow to seven thousand over the next ten to fifteen years. Dr. Jago - Our own survey confirms what you are telling us, that was part of the driver behind the master plan. You should be talking to us, we want to work with you to solve those issues. You should also be talking to the Minister and the Deputy when they are available at UBCM etc. In terms of the companies, I am not saying that we couldn t partner with them in providing service. You could tell them that. Barb Caldwell - My husband used to operate in private BC licenced ambulance service, I can tell you how to get a hold of that. Director Anderson - I understand private providers can attend, but not transfer. Michael MacDougall - The only licenced one is in Kitimat. Director Schembri - I don t like to bring a problem to the table without some idea of a solution. I can t come up with a great idea for a solution. I think it lies outside of what we are dealing with currently. We are not moving forward in this. The growth is going to bring forward a lot of problems. I appreciate Michael saying a flexible model is being looked at. It is a provincial problem as well. What you are doing is such an honourable thing, but we have to keep the face of the patient at the forefront. However we can work with you and with Northern Health to get to how Health care can work together to find a solution. Dr. Jago - Partnering with communities is what we started in Fort St. John two years ago. Fundamentally it takes a new model and finding ways of working together. It is, frankly, the way we have to go. Director Schembri 700 million dollars to Northern Health is the smallest budget in the province, that makes my heart palpitate. A question was asked about what the protocols were for sending out ambulance in bad weather conditions in the outer regions. Michael MacDougall - We have sent out four wheel drive ambulances, but they run quite a bit rougher and are hard on patients. We factor what the vehicle needs are for that particular community. 4

6 Director Anderson - We have visiting physicians come in. We now have a medical services working group involving First Nations and industry. I believe this could become a model. We haven t involved Northern Health yet; we want to get some things going first. Cathy Ulrich - Fort St. James and Burns Lake are coming up with ideas too. It is a lot easier when there is a partnership. Michael MacDougall - There was a historical arrangement for involving fire department in Kitimat. Director Hadland - Area C is pretty satisfied with the level of service they get from Northern Health here. The ambulance service is different. He provided two examples where there was a dispatch issue with Kamloops, the communication fell apart. I think it needs to be de-centralized out of Kamloops. Michael MacDougall - Dispatch should not be a barrier. Director Anderson - They refuse to use our mapping. Fred Banham - The biggest problem is Kamloops doesn t have room for all the different regions maps. We do provide lap maps for the operators, but with the revolving door it brings a whole other issue. Director Goodings gave an example associated with the changed route to Cecil Lake. This issue needs to be looked at. Director Anderson spoke of the recent tragedy in Hudson s Hope. The Doctor who was scheduled to come, did not show up. That was a particular bad day in Hudson s Hope as we had no lab techs for 3-4 days. That is a bit of a catch 22. It is a dysfunctional set up at times. Dr. Becky Temple - The doctors that come from Fort St. John are not employees of Northern Health. They have more than enough work in Fort St. John already, including babies to deliver. Betty Morris explained that on that day the doctor was booked, but no patient appointments were scheduled. It was one of those really bad situations. Director Christensen - Is ambulance funding based on population as well? Is Site C being taken into consideration? What are the plans going forward being able to deal with that? How do we improve the services? Industry wants to build a helipad here, but there seems to be no desire for that. Michael MacDougall funding is based on call volumes. The number of ambulances is not the biggest factor. It is the staffing ability. eg: staff get trained and then find work with industry. We are trying to find a way to plan for the growth especially in this area of the province. It is a big challenge. It is about resourcing at the end of the day. We are trying to do the best we can with the resources available. Dr. Jago - There is a link between the quality and availability of social services and the ability of industry to grow. It is very difficult to convince the province proactively. We are doing our best to make factual arguments in order to prepare. You also need to maintain the level of services elsewhere at the same time. Director Christensen We at this table all know that Site C will probably be going ahead. Director Fynn - Compliments on your facility here. Pouce Coupe is at the other end of the scale, we have lost Pouce Coupe Care Home. Peace River Haven will be shutting down in the next 2-3 days. The future of it is undetermined at this point; Pouce Coupe would like to be involved in all the steps. Please do not leave us out of the loop. Cathy Ulrich We are undertaking a planning process. Peace River Haven is not suitable for complex care, but possibly for something in between. Part of the planning involves a cost analysis on the renovations required; then we will engage folks like yourself in that process. We are optimistic at this point. When we have infrastructure that could be adapted for use for seniors, we will take a look at that. Dr. Jago - If we will be disposing of the FSJ hospital we will contact the City of Fort St. John with that. 5

7 Director Jarvis - I think this has been good discussion today and a lot of health care work has been done. I often get the idea that there are other jurisdictions, particularly lawmakers that create greater difficulties in crossing over, e.g.: volunteers taking part in solving some of these problems and yet still be able to stay dedicated to their jobs. Are there areas that you have seen with legalities regarding volunteers, unions etc.? It would be good to be able to use the tremendous talents without the liability. Cathy Ulrich - There is an issue with the union sector if volunteers take on their members duties. We do have a lot of volunteers working within Northern Health. Michael MacDougall It is the same in BC Ambulance. Director Anderson - How are you made aware of new camps coming on? Those huge camps are all over out there. Cathy Ulrich Often through the Environmental Health Officers, we become informed. The medical health officer is involved in follow-up. Director Anderson - Is there ever a time we can access Board members? Cathy Ulrich - You can talk to them any time and they will bring the issues forward to the Board table. Director Anderson Priorities need to be determined in communities people in communities feel their priorities are not getting addressed. Cathy Ulrich - the fall joint planning session with the Regional Hospital District is to get those issues on the table. We have created that opportunity for that engagement. Take advantage of it. Director Anderson - So we will do that as a board, the Peace River Regional Hospital District Board only deals with capital. Cathy Ulrich - When you come to that fall meeting come to the afternoon meeting with the Peace River Regional District hat on to bring these issues forward. When Northern Health sets its overall priorities, it is designed for the region but flexible enough that the Chief Operating Officer in the Northeast can design the priorities for the Northeast. Director Goodings - We need to do something around the messaging e.g.: that the Fort St. John hospital has not pre-empted other facilities services for their community. Do not call this a regional hospital. Cathy Ulrich - We are trying to get our minds around a whole lot of issues here and want to work together on this. Thank you to the Peace River Regional District directors for raising your questions. Director Goodings Thank you for the opportunity and extended time we have had for this discussion. The meeting adjourned at 12:05 p.m. 6

8 Northern Health Presentation to: Peace River Regional District Board June 18, 2012 Dr Charles Jago, Board Chair Cathy Ulrich, President & CEO

9 Map of Health Authority Structure in BC The Provincial Health Services Authority (PHSA) delivers province wide services such as Cancer, Renal, BC Women s and Children s Hospital etc. 2

10 Map of Northern Health Northern Health is comprised of three Health Service Delivery er Areas: Northwest, Northern Interior & Northeast 3

11 Northeast Pouce Coupe 4

12 Northern Health Board Members 5

13 Northern Health Board Members Northeast Dale Bumstead Dawson Creek Barbara Caldwell Pouce Coupe Kathleen O Neil Charlie Lake Northern Interior Charles Jago Prince George Gordon Milne Vanderhoof Deborah Shannon Prince George Gary Townsend Quesnel Northwest Sharon Hartwell Telkwa Cameron McIntyre Prince Rupert 1 Vacant position 1. The Board Resourcing and Development Office of BC (BRDO) recommends Board appointments: a. Over 300 provincial agencies b. Based on merit c. Recommends names to the Minister of fhealth 2. Interested in Board appointments: a. Apply directly to the BRDO b. Inform the NH Board who will forward name to the BRDO 3. NH Board works with the BRDO to fill vacancies: a. Full slate of core competencies b. Equal representation from 3 HSDAs c. Gender balance d. At least 1 director of Aboriginal heritage 6

14 NH Strategic Plan Through the efforts of our dedicated staff and physicians, in partnership with communities and organizations, we provide exceptional health services for Northerners. The Northern way of caring 7

15 Strategic Plan Four Areas of Focus Integrated Accessible Health Services Northern people will have access to integrated health services, built on a foundation of primary health care A Focus on Our People Northern Health will create a dynamic work environment that engages, retains and attracts staff and physicians A Population Health Approach Northern Health will lead initiatives that improve the health of the people we serve High Quality Services Northern Health will ensure quality in all aspects of the organization 8

16 Board Structure Audit & Finance Committee Planning, Performance and Priorities Committee Board of Directors President & Chief Executive Officer Executive Team VPs COO NW COO NI COO NE - CMHO NH Medical Advisory Committee (NH MAC) Governance and Management Rlti Relations Employees Committee 3 Committees Board holds the CEO responsible for Committee work plans support the implementing the strategic directions Strategic Plan Chair of the NH MAC attends all Board hires the CEO Board meetings 9

17 Board Meeting Structure Board meetings held 6 times per year in Feb, Apr, Jun, Jul, Oct & Dec. Annual 2 day planning session in the fall, usually adjacent to 1-day Board meeting in October with first planning day held jointly with the RHD chairs 2 meetings in Prince George plus 1 in each HSDA July meeting is an abbreviated in camera session held by teleconference or videoconference The typical Board meeting agenda includes Day 1 (full day) 1 hour Board only session followed by an in camera session Luncheon with Regional Hospital District representatives Public session in the afternoon followed by public presentations. Community roundtable in the late afternoon with community stakeholder groups Day 2 (half day) Conclude in camera session and discuss public presentations Board education session Facility tour 10

18 Performance Planning & Priorities To assist the Board in fulfilling its oversight responsibilities by providing advice to the Board in the following areas: Measure performance to goals and targets set out in: Strategic Plan Annual Service Plan Government Letter of Expectations (GLE) Planning for the future e.g. Industrial Development Study, population and utilization projections, CIHI indicators, patient safety and quality indicators, patient and staff complaints Human Resource Plan Information Technology Plan Aboriginal Health Plan Communications Strategy Quality improvement goals Risk Management Analysis Medical staff bylaws and rules Physician appointment to the Medical Staff - credentials and privileges 11

19 Audit & Finance Committee To assist the Board in fulfilling its oversight responsibilities by providing advice to the Board in the following areas: Financial performance - operating and capital Budget development Internal controls Internal Audit External audit Capital Project reporting and monitoring Information Technology Project reporting and monitoring Insurance Investments Foundations & Auxiliaries Risk Management 12

20 Governance & Management Relations Comprised of the Board Chair, the Chairs of Board Committees, plus two Directors To assist the Board in fulfilling its oversight responsibilities by providing advice to the Board in the following areas: Develop Board agendas Annual Report Community Consultation Board composition, continuity, and renewal Board education Board policy Legislative compliance CEO performance planning, compensation, and succession planning Government relations: Province, Regional Hospital Districts, Municipalities First Nations Health Council Minister and Ministry of Health 13

21 Medical Advisory Committee NH Medical Advisory Committee (MAC) Northwest Medical Advisory Committee Northern Interior Medical Advisory Committee Northeast Medical Advisory Committee NH MAC Chair attends the NH Board meeting NH MAC Chair reports to the Board & CEO on the deliberations, motions, recommendations and decisions of the NHMAC with a particular focus on quality of care 14

22 Board & Community Consultations Spring RHD Meeting Fall RHD Meeting Annual Attendance at NCLGA Annual Attendance at UBCM RHD working lunches at Board meetings Community Roundtable at Board meetings Community Consultations 2004 Health 2006 Cancer 2007 Mental Health & Addictions 2008 Strategic Plan 2009 Primary Care 2011 Men s Health 15

23 Strategic Planning Context: Understand the regional and community context Understand trends and evidence Understand the government mandate and agenda Alignment of the Strategic Plan with Government s mandate Develop and implement mission, vision and values Hold organization accountable to deliver the Strategic Plan, Budget Management Plan and Capital Plan Provide guidance to management Seek transparency for those external to the organization whenever possible 16

24 Role of Ministry of Health Government Letter of Expectation An annual agreement between the NH Board and the Minister of Health that sets out the accountabilities, roles and responsibilities of both parties with respect to the planning, administration, delivery and monitoring of health services Innovation and Change Agenda Ministry of Health Ministry vision, goals and 16 Key Result Areas (KRA) inform the Health Authority s deliverables and performance measures from government s point of view There is an ongoing need to balance the provincial direction with Northern priorities and needs 17

25 Population Needs Based Funding (PNBF) The Ministry of Health developed PNBF as a means to allocate funding to the Health Authorities based on the relative needs of the population. The Health Authorities population is separated into funding categories for demographic factors such as age, gender, and social economic factors such as aboriginal and low income. In general, a young healthy male would require less healthcare than a elderly female on income assistance. Therefore, per capita funding is weighted more for the elderly female. Adjustments are made for inter-region patient flows, remoteness, and complexity. In addition to PNBF, Health Authorities receive restricted grant funding from Ministry of Health targeted for specific purposes. The Ministry of Health provides capital funding: Regional Hospital Districts and local donors contribute significantly to NH s capital needs. 18

26 CEO and Management Lead development of a Service Plan and Operational Plan that is shaped by the Northern Health Strategic Plan and the Ministry of Health Strategic Plan. Operational Planning is informed by community consultations and the northern and rural context of service delivery. The Operational Plan drives the: Budget Management Plan Capital Plan Human Resource Plan IMIT Plan Aboriginal Health Plan Assessment of organizational risk is undertaken through an Integrated Risk Management process. 19

27 Integrated Accessible Health Services Northern people will have access to integrated health services, built on a foundation of primary health care Examples: Decentralized management of service delivery Centralized management of regional services (e.g. Finance, Human Resources) Partnership with physicians and communities to recruit and retain primary care physicians Develop and coordinate a multidisciplinary team approach between physicians and community services Construct a new hospital in Fort St. John and planning the redevelopment of the inpatient wing in Dawson Creek which will support secondary care and specialty services (e.g. surgery, psychiatry, cancer care) 20

28 A Focus on Our People Northern Health will create a dynamic work environment that engages, retains and attracts staff and physicians. Examples: Conducted three employee engagement surveys with statistically significant improvements in results between surveys Partnerships with UNBC and community colleges to educate people from the North in the North Working with Joint Occupational Health & Safety committees to focus on staff safety in the workplace (e.g. patient care lifts installation and coaching at Rotary Manor) Celebrating and recognizing staff and physician contributions (e.g. 10-year anniversary of NH, Length of Service recognition) 21

29 A Population Health Approach Northern Health will lead initiatives that improve the health of the people we serve Examples: Road Health: a multi-sectoral collaboration with a focus on reducing vehicle crashes and fatalities (e.g. NH, ICBC, RCMP, Highways, Logging Industry) Men s Health: a program to improve the health outcomes of men living in the North Partnering with communities: Northern Health and eleven municipalities across the North are working together on healthier community initiatives 22

30 High-Quality Services Northern Health will ensure quality in all aspects of the organization Examples: Established 5 clinical programs focused on quality with leadership provided by a physician and a clinical lead in each of: Perinatal Care Surgical Services Critical Care Mental Health & Addictions Elder Services Engagement of clinical representatives from across the region on a program council Established a Patient Care Quality Office that supports local management in complaint investigation and follow-up Memorandum of Understanding with UNBC to facilitate research, evaluation and knowledge translation into service planning and delivery 23

31 Organizational Structure The organization is committed to a structure where service delivery decisions are made as close to the site where the service is rendered as possible within a consistent policy and quality framework across the North. 24