Provincial Health Services Authority ANNUAL SERVICE PLAN REPORT
For more information on the Provincial Health Services Authority contact: Provincial Health Services Authority #700 1380 BURRARD STREET VANCOUVER, BC V6Z 2H3 or visit our website at www.phsa.ca
Board Chair s Message and Accountability Statement On behalf of the Board of Directors and the staff of the Provincial Health Service Authority (PHSA) and its agencies, I am pleased to present the PHSA Annual Service Plan Report. This report was prepared under my direction and in accordance with the Society Act and BC Reporting Principles. The development of the plan was guided by the Government s strategic priorities and strategic plan, and the Ministry of Health s goals, objectives and strategies. The Board is accountable for its contents and for ensuring that PHSA achieves the specific performance targets and objectives identified in this plan. In June 2014, the BC Government introduced the Taxpayer Accountability Principles, to ensure fiscal responsibility and transparency across government, including the health authorities. The Ministry routinely engages with the health authorities to ensure government direction on strategic and operational priorities is understood. This collaborative approach aligns with the requirements of the Taxpayer Accountability Principals, and has enabled the Ministry and health authorities to make significant progress on a number of action items in the fiscal year. PHSA plays a significant role in planning and ensuring accessibility, quality, efficiency and effectiveness of province-wide programs and services. Our provincial mandate and the focus of the care we provide means that the majority of our patients have complex, chronic conditions requiring highly specialized assessment and care, and that many of them live outside the Lower Mainland. We continue to work in partnership with the regional health authorities to improve access to evidence-informed practice closer to where people live. PHSA s Annual Service Plan Report highlights significant initiatives that are underway in accordance with our mandate. In we worked to address issues that span all areas of the province, including: Led the introduction of community paramedicine as part of the Rural and Remote Health Strategy in BC. Working collaboratively with the regional health authorities and Primary Care Networks, BC Emergency Health Services is developing care protocols that will keep people at home, out of emergency departments and avoid hospitalizations. Implemented the PHSA Indigenous Cultural Competency Training Program across PHSA with a focus on BC Emergency Health Services, BC Children s Hospital and BC Women s Hospital. Promoted innovative dialysis options and supportive strategies for chronic kidney disease patients to enhance quality of life and promote improved outcomes. Achieved efficiencies as the lead for Lower Mainland laboratory services. We believe that a high performing health system is one that uses its resources in the best way possible to improve health outcomes for patients. We are committed to look for ways to meet new demands for health care services while keeping health care sustainable through innovation. Through the PHSA, British Columbians have access to a comprehensive network of highly specialized agencies and services, providing the best possible tertiary care. PHSA has a number of dedicated people physicians, nurses, researchers, allied health professionals, administrative and support staff, students, volunteers and board of directors who work hard to deliver the very best. Through the commitment of these people we are able to deliver on our promise to the people we serve: Province-wide solutions. Better health. Wynne Powell Board Chair Annual Service Plan Report 3
Table of Contents Board Chair s Message and Accountability Statement... 3 Purpose of the Organization... 5 Strategic Direction and Context... 7 Strategic Direction... 7 Strategic Context... 7 Report on Performance... 8 Goals, Objectives, Strategies and Performance Results... 8 Financial Report... 17 Management Discussion and Analysis... 17 Resource Summary Table... 17 Major Capital Projects... 19 Appendix A: Health Authority Contact Information... 24 Appendix B: Hyperlinks to Additional Information (optional)... 24 Annual Service Plan Report 4
Purpose of the Organization Provincial Health Services Authority Provincial Health Services Authority (PHSA), established in December 2001, is responsible for select specialized and province-wide health care services in B.C. The first organization of its kind in the country, PHSA works with the five regional health authorities and the Ministry of Health to meet local and provincial health needs. PHSA does this by: Governing and managing ten agencies that plan and/or provide specialized health services on a province-wide basis: BC Cancer Agency, BC Centre for Disease Control, BC Children's Hospital & Sunny Hill Health Centre for Children, BC Mental Health & Substance Use Services, BC Provincial Renal Agency, BC Transplant, BC Women's Hospital & Health Centre, Perinatal Services BC, Cardiac Services and BC Emergency Health Services; Working in partnership with the First Nations Health Authority to ensure coordinated planning and service delivery efforts in support of the BC First Nations health and wellness objectives; Working with the five regional health authorities and the Ministry of Health to plan, coordinate and, in some cases, fund the delivery of highly specialized provincial services; and Leading and coordinating a number of priority provincial system improvement initiatives. PHSA plays a significant role in planning and ensuring accessibility, quality, efficiency and effectiveness of province-wide programs and services such as the BC Autism Network, the Childhood Screening and Hearing Program, the Thoracic Surgery Program, the Surgical Patient Registry, the Provincial Blood Coordinating Office, PHSA Laboratories, Provincial Infection Control Network (PICNet), the Provincial Language Service, Stroke Services BC, Trauma Services and Telehealth. Additionally, PHSA has responsibility for its Lower Mainland Consolidation (LMC) components. In collaboration with the Ministry of Health and the regional health authorities, PHSA also assumes a funded change leadership role and facilitates the development and enhancement of selected provincial programs to ensure that the changes required to achieve improved outcomes are effectively initiated, planned, implemented, monitored and evaluated. PHSA s relationship with the regional health authorities is a collaborative one. In some cases, we directly provide specialized care to their residents, often transferring responsibility back to local providers once specialized services are no longer required. We rely on the regional health authorities to deliver the specialized services we co-ordinate and we need to work closely with them to achieve integrated and coordinated care across the continuum. In our provincial coordination role, we work together to collaborate on system-wide change and health care reform using evidence and best practice research. Annual Service Plan Report 5
PHSA is also a research-intensive, academic health sciences organization with a mandate for: Basic and clinical research to inform health care and health service decision making; Multidisciplinary, integrated research programs supporting translational science; and Education and training of more than 4,000 students per year in the specialized health and human services provided by our agencies. PHSA currently has the largest health research enterprise in B.C. Research and development creates many benefits for patients, the health care system and society. It provides British Columbians with access to new discoveries and technologies, offers opportunities to deliver better and more effective heath care services, attracts the best and the brightest scientists and health care professionals to B.C. and produces economic benefits for British Columbia. Research is also key to system sustainability, providing the best possible evidence to inform decision-making and directing our scarce resources to those that represent the best value. Please visit our website for more information on PHSA services: http://www.phsa.ca/our-services PHSA operates under The Society Act and is accountable to the Ministry of Health through a twelve member Board of Directors appointed by the Minister of Health. The composition of the board is intended to be geographically representative of the population of British Columbia, with board members living in all regions of the province. As a public sector organization, the PHSA is mandated to meet the needs of the people we serve. The Governance policies and practices of the PHSA are compliant with the Governance and Disclosure Guidelines for Governing Boards of British Columbia Public Sector Organizations (Best Practice Guidelines) issued by the Board Resourcing and Development Office, Office of the Premier of British Columbia. These guidelines define how the Board carries out its duties of stewardship and accountability and are available on our website: http://www.phsa.ca/aboutphsa/phsaboard/corporategovernance.htm Annual Service Plan Report 6
Strategic Direction and Context Strategic Direction Provincial Health Services Authority Health authority planning follows the strategic direction for the health system as outlined in Setting Priorities for the B.C. Health System. Patient-centred care is a central facet of all health service delivery, as is a renewed focus on performance management and prioritizing cross sector actions to realize an overall improvement in the quality and sustainability of the B.C. health system: Improving quality of care for seniors with complex health issues and patients with mental illness and/or addictions while reducing hospitalizations Improving access to surgical services and procedures Improving delivery of rural health services The health authorities work collaboratively with the Ministry of Health and other system partners to implement actions identified in the health system policy discussion papers released in February 2015. Successfully achieving the Ministry s strategic vision will require close collaboration with partners, including health authorities, physicians and health care providers, unions, patients and other stakeholders, in shaping and implementing key areas of focus. This collaborative approach aligns with the Taxpayer Accountability Principles, which strengthen two-way communication between government and provincial public sector entities, promotes cost control and helps create a strong, accountable relationship between government and agencies. Recognizing that public sector organizations have both an ethical and fiduciary accountability to the taxpayer, enhanced performance management will ensure the delivery of patient-centred health services while promoting quality and containing costs. Strategic Context The health system in B.C. is a complex network of skilled professionals, organizations and groups that work together to provide value for patients, the public and taxpayers. The key challenge facing the health system is to deliver a high performing sustainable health system (from prevention to endof-life care) in the context of significant growth in demand. Although the B.C. health system effectively meets the majority of the population s health needs, it continues to be challenged by an increasing demand for health services. The most significant drivers of rising demand are the aging population, the increasing need to provide care to frail seniors, a rising burden of illness from chronic diseases, mental illness and cancer, and advances in technology and pharmaceuticals driving new costly procedures and treatments. The pressure is compounded by the need for new care delivery models by health professionals and health care workers, and the need to maintain and improve the health system s physical infrastructure (i.e. buildings and equipment). In the current economic climate it is even more important for the health system to find new and creative ways to ensure the resources available for health care services are used effectively and in ways that most benefit the people of B.C. Annual Service Plan Report 7
Report on Performance Provincial Health Services Authority In June 2014, the BC Government introduced the Taxpayer Accountability Principles, to ensure fiscal responsibility and transparency across government, including the health authorities. The Ministry routinely engages with the health authorities to ensure government direction on strategic and operational priorities is understood. This collaborative approach aligns with the requirements of the Taxpayer Accountability Principals, and has enabled the Ministry and health authorities to make significant progress on a number of action items in the fiscal year, including regular Ministry and health authority board Meetings, monthly meetings of the Deputy Minister and the health authority Chief Executive Officers, publication of health authority Codes of Conduct, and the development of 2015/16 Health Authority Mandate Letters. Goals, Objectives, Strategies and Performance Results Goal 1: Support the health and wellbeing of British Columbians Chronic disease is the largest cause of death and disability represents the largest proportion of the burden of disease, and drives a significant part of downstream health costs in B.C. Evidence suggests that, over time, a primary prevention and health promotion agenda can make progress in improving the overall health of the population. The Ministry of Health s focus in this area is built upon the current Healthy Families BC Strategy organized across seven intervention streams: healthy eating, physical activity, tobacco control, healthy early childhood development, building positive mental health promotion, building a culture of moderation for alcohol use and injury prevention. Objective 1.1: ed and effective primary prevention and health promotion PHSA embraces a broad definition of health, and in addition to providing specialized treatments for illness when it occurs, PHSA develops strategies to promote wellbeing and the highest quality of life, in alignment with Ministry goals. Working together with the Ministry of Health and the regional health authorities, PHSA has a role in developing health promotion and illness prevention strategies. PHSA is committed to improving the health of British Columbians by supporting the development of healthy communities, informing healthy public policy and providing information and tools that help individuals make healthier choices to prevent the onset of many chronic diseases and to assist those living with chronic disease to stay as healthy as possible. Our activities in these areas will focus on the life course, key settings and how to more explicitly apply the behavioural sciences to shift modifiable behaviour at the individual level for enough of the population to have a meaningful impact on overall health in the long term. Annual Service Plan Report 8
Strategies Continue to lead the operations of Panorama, a Pan-Canadian public health e-health system, to improve population health by supporting service delivery and enabling secure access to integrated public health data to support policy changes and measure the impact of public health interventions. Support initiatives that encourage individuals to lead healthier lives where they live, work, learn and play, and work with the Ministry of Health and the regional health authorities to coordinate physical activity and healthy eating programs in BC schools and healthy workplaces. Coordinate Population and Public Health across PHSA through an expanded mandate for the BC Centre for Disease Control. Through our formalized partnership with FNHA, PHSA will work to ensure coordinated planning and service delivery efforts in support of BC First Nations health and wellness objectives. Performance Measure 1: Breast Cancer Screening Performance Measure 2013/14 Baseline Actual 2015/16 2016/17 Percentage of women aged 50-69 participating in screening mammography once every two years 51.4% 53.5% 52.5% 55.5% 57.5% Data Source: Screening Mammography Program of BC, Provincial Health Services Authority. Discussion This performance measure tracks the proportion of women between 50 and 69 years of age, screened in the last 30 months. Real time changes in screening attendance would not be readily appreciated by this two-year rolling average measure. Over the last four fiscal years, the mammography participation rate declined slightly as public debate about the value of screening mammography continued with the publication of new articles on both sides of the debate. Participation has now stabilized since the provincial breast cancer screening policy update was announced in February 2014. PHSA will continue to maintain easy access to screening services. As of April 2015, all screening centers reported wait times less than eight weeks (the Ministry of Health Guidelines and Protocols Advisory Committee definition of reasonable access wait time for screening mammography is eight weeks). The international perspective on cancer screening has moved from providing simple promotional messages to supporting informed decision-making about screening. PHSA supports women s decision-making by including information about risks and benefits of screening with the new policy information. The impact of this approach on the decision to screen (i.e. participation rate) is not yet known. Further monitoring is needed when reviewing and establishing new targets. The Screening Mammography Program is planning a number of promotional/educational activities targeting primary care providers and women for the coming year with a focus on patient retention. Continued work focusing on developing solutions for women who cannot attend for screening as they Annual Service Plan Report 9
do not have a regular health care provider is underway with the Divisions of Family Practice and walk-in clinics. The Canadian Breast Cancer Foundation media campaign to promote the benefits of early detection by participating in screening mammography was launched in mid-july and will continue to the end of October. In February 2015, the first of three new digital mobile mammography vehicles was launched in BC with the other two planned for January 2016. This new digital service will improve patient experience through its thoughtful design and patient workflow, and decrease the number of rescreens required by reducing film handling errors such as film fogging and overexposure, contributing to improved quality outcomes and providing better value for patients. Goal 2: Deliver a system of responsive and effective health care services across British Columbia In a high functioning health system, patients with conditions requiring specialist services experience seamless and timely access to the services they need. A priority area for further improvement is the ability of family physicians to facilitate timely access to specialist levels of care for their patients when needed. Objective 2.1: Strengthened interface between primary and specialist care and treatment All British Columbians should be able to access appropriate health services when they need them. From the patient s perspective, a quality outcome means early and timely treatment that responds to their needs and is safe, evidence-informed and results in a fast and complete recovery or minimal complications related to their condition. Health care in general is moving away from the delivery of episodic care to embrace a more holistic view of the individual and the full continuum of care. Optimizing flow of information, services, and care to improve the patient experience across our systems and programs are key PHSA priorities.phsa and its agencies are committed to ensuring that hospitals, services and health professionals are utilized in the most efficient and effective way possible so people receive the right type of care in the right setting that is most likely to lead to the best health outcome. Strategies In collaboration with our health workforce and patients and families, we will strive to shift the culture of health care from disease-centred and provider-focused to being patient centred. Reorganize and leverage PHSA s provincial service streams for provincial system-wide improvements, including collaborating with the regional health authorities on developing provincial clinical standards, guidelines and data collection processes to improve care and outcomes for patients. As outlined in the Ministry of Health report entitled Improving Health Services of Individuals with Severe Addiction and Mental Illness, in collaboration with regional health authorizes lead Annual Service Plan Report 10
the development of a provincial service model to address the long-term care and treatment needs of a sub-population of patient with severe addiction and mental illness. Continue the implementation of the PHSA Indigenous Cultural Competency Training Program across PHSA with a focus on BC Emergency Health Services, BC Children s Hospital and BC Women s Hospital + Health Centre. Build on the award winning patient transfer strategy built by Vancouver Coastal Health and PHSA for adults requiring oncology care post-surgery. Continue to promote innovative dialysis options and supportive strategies for chronic kidney disease patients to enhance quality of life and promote improved outcomes. Through Child Health BC, collaborate with partners in the ministries, regional health authorities, the community and our academic partners to inform a child and youth service delivery plan based on an overarching health service delivery framework. In partnership with PHSA Aboriginal Health, create an Aboriginal Leader position in the BC Cancer Agency and collaborate to improve cancer services for Aboriginal Peoples across BC. Through BC Emergency Health Services, lead the introduction of community paramedicine as part of the Rural and Remote Health Strategy in BC. Working collaboratively with the regional health authorities and Primary Care Networks, we will develop care protocols that keep people at home, out of emergency departments and avoid hospitalizations. Objective 2.2: Timely Access to Quality Diagnostics The goal of the Ministry of Health objective is a high-functioning health system where patients with conditions requiring diagnostic services experience seamless, appropriate and timely access to the services they need. This provincial work is focused on laboratory reform and improved evidencebased access to imaging services. Access to evidence-informed diagnostic services is critical to seamless and timely care. As demand for diagnostic imaging and laboratory testing rises, continuous improvement in both quality and cost are important elements of a sustainable strategy for the health system. Strategies Continue to achieve efficiencies as the lead for Lower Mainland laboratory services. Collaborate with Vancouver Coastal Health as the lead agency for Diagnostic Imaging, in initiatives to increase access, reduce waitlists and improve quality and appropriateness. Annual Service Plan Report 11
Performance Measure 2: Independent Dialysis Performance Measure 2010/11 Baseline Actual 2015/16 2016/17 Percentage of dialysis patients on independent dialysis 31% 33% 32% 34% 35% Data Source: BC Renal Agency, Provincial Health Services Authority. Discussion This indicator is based on prevalent numbers of independent patients and does not capture those who started the year on independent therapies and left the program for a variety of reasons, such as death, moving out of province, return to dependent care, or transplantation. Hence, a substantial amount of activity is required to increase the percentage of independent dialysis patients. The target set by the BC Renal Agency (BCRA) and the renal network is an aggressive one, considering the significant barriers and drivers faced, as well as the annual attrition rate of patients on all forms of dialysis, including independent dialysis. Attrition for valid reasons, including transplant, death or change in status requiring more supervised treatment, is the nature of chronic conditions like kidney disease, and needs to be appreciated in target setting. Of note, BC remains well above the national average for independent dialysis. A review of the Canadian Organ Replacement Registry Report for 2014 shows that BC leads the country on this measure, as the percentage of patients on independent dialysis in other provinces varies from 8 to 25 per cent, with a Canadian average of 22 per cent. Using a multifaceted approach, BCRA and the renal programs were able to increase uptake and reduce attrition between 2010 and 2014. This past fiscal year saw a very slight drop in overall prevalence, a difference of only 0.2 per cent from 32.6 per cent to 32.4 per cent. We believe the independent dialysis prevalence rate has and will continue to be impacted by a number of factors, including an increase in transplant rates and the overall reduction in dialysis growth, leading to a corresponding reduction in independent dialysis uptake. These positive factors are being investigated and a shift in this metric to include patients who transition to transplant may better reflect overarching goals to improve kidney patient health outcomes and quality of life. Annual Service Plan Report 12
Performance Measure 3: Child and youth inpatient mental health services Performance Measure 2010/11 Baseline Percentage of children admitted to an inpatient psychiatric unit bed within 42 days Actual 2015/16 2016/17 49% 70% 100% 75% 77% Data Source: Child and Youth Mental Health Database, Provincial Health Services Authority. Discussion This performance measure tracks access to inpatient care for children with mental health concerns. Community-based child and youth mental health and substance use services are provided across the province by the Ministry of Children and Family Development. Some of the children, youth and their families served in the community need the specialized psychiatric services operated by BC Mental Health & Substance Use Services located at the BC Children s Hospital (BCCH) site in Vancouver. Although treatment is increasingly provided on an outpatient basis to enable the children and youth served to remain at home with their families, inpatient services are available for those who need them. In, the program exceeded their service plan target, admitting 100 per cent of Child Inpatient Psychiatry patients within 42 days of being waitlisted. Given the stable and exceptional performance throughout, this measure will be retired from the PHSA s Service Plan measures. Performance Measure 4: Complex pediatric surgeries Performance Measure 2010/11 Baseline Actual 2015/16 2016/17 Percentage of complex, nonemergency pediatric hip surgeries completed within established benchmark time frames 42% 60% 88% 70% 75% Data Source: BC Children s Hospital Database, Provincial Health Services Authority. Discussion This performance measure tracks the percentage of non-emergency pediatric complex hip surgeries completed within established benchmarks. The benchmark is based on urgency of care required in the pediatric care setting and is not comparable to adult hip surgery cases. Through expanded surgical activity and focused funding, combined with continuous efforts to foster innovation and efficiency, BC Children s Hospital has reduced wait times for all pediatric surgeries, including complex hip. The proportion of completed cases within benchmark timeframes for complex hip procedures improved from 77 per cent in 2013/14 to 88 per cent in. Annual Service Plan Report 13
Over the next three years, BC Children s Hospital plans to maintain achieved levels for surgical specialties. For complex hip procedures, we will continue to focus on completing cases exceeding established wait-time benchmarks. As we continue to work to eliminate the backlog of hip cases waiting beyond benchmark, our percentage of complex hip surgeries completed within benchmark will remain lower than usual and not reflect of the reduction of actual number of children on the waitlist. Performance Measure 5: Access to Maternity Care Performance Measure 2013/14 Baseline Actual 2015/16 2016/17 Percentage of patients in active labour admitted within 45 minutes 26% 35% 30% 45% 55% Data Source: BC Women s Hospital Database, Provincial Health Services Authority. Discussion The Assessment Room at BC Women s Hospital receives women with a variety of maternity-related conditions. Better patient outcomes and improved patient experience are achieved when a women in active labour is moved to the most appropriate location to deliver her baby in the most timely and efficient way. When a women in labour arrives at the Assessment Room she is triaged by a nurse, registered, undergoes a detailed assessment by the nurse, and seen by her doctor or midwife. Once assessments are complete and it is determined the women is in active labour, she is transferred to the labour and delivery suite or the single room maternity unit. The goal is to improve the efficiency of each of these activities so that a woman in active labour spends less than 45 minutes in the Assessment Room. The percentage of admission within 45 minutes for active labouring patients was 20 per cent in 2012/13 and 26 per cent in 2013/14. Continuous improvement initiatives will be applied to further improve patient flow. Goal 3: Ensure value for money A high performing health system is one that uses its resources in the best way possible to improve health outcomes for patients. Ensuring the health system has sufficient numbers and the right mix of health professionals is vital to providing the services that will meet British Columbians needs now and in the future. Health care providers must also be appropriately supported by leadership, information management systems, technologies and the physical infrastructure to deliver high quality services as efficiently as possible. Annual Service Plan Report 14
Objective 3.1: Provincial Health Services Authority Align workforce, infrastructure, information management and technology resources to achieve patient and service outcomes Skilled and caring health professionals are the cornerstone of our health system. Thousands of British Columbians seek medical attention every day, confident they are in the care of competent professionals who hold themselves to the highest standards. To be effective, we must also ensure that our human resources are appropriately supported by information management systems, technology and the physical infrastructure to deliver high quality services as efficiently as possible. Furthermore PHSA strives to create an environment that fosters health care innovation and discovery research that is translated into improved patient outcomes and population health. Strategies Continue and enhance PHSA s comprehensive workforce strategy focusing on employee engagement, specialized recruitment and retention initiatives, and supporting the development of leaders across the organization using the provincial leadership development programs and other strategies. Continue working to implement a team-based, inter-professional approach in the deployment of valuable health care professionals, particularly those in the nursing family, across care settings. Continue the emphasis on a team-based approach enabling registered nurses, nurse practitioners, and others to work to their optimal scope of practice, enhancing the workforce environment, the quality of care, and the patience experience. Continue the implementation of the Clinical & System Transformation (CST) Project to improve the quality and accessibility of patient information by creating an integrated health record for each patient based on a single identifier and using standardized processes. Continue to lead a strategy to integrate BC Emergency Health Services to better align with the Health Sector. Objective 3.2: Drive budget management, efficiency, collaboration and quality improvement to ensure sustainability of the publicly funded health system As stewards of taxpayers dollars, PHSA must prioritize limited resources to ensure we are providing the best value to the populations we serve. PHSA has implemented improve, a lean-based process improvement system. PHSA agencies and services look for essential value-added services, while minimizing ineffective or redundant efforts. Our limited resources will be utilized more efficiently, technology will be leveraged to a greater degree, and our processes will become more reflective of an integrated system that is focused on improving the patients experience while in our care. With respect to provincial business service delivery and coordination, PHSA, through its new mandate, also provides consolidated and standardized non-clinical business support services through Annual Service Plan Report 15
Health Shared Services BC. Strategies Review the mandate, governance, management and funding model of Health Shared Services BC to renew the approach for provincial health shared service delivery and to identify opportunities to create enhanced value to the health system. Continue to improve pricing methodology and customer service model. Performance Measure 6: Nursing overtime Performance Measure 2009/10 Baseline Nursing overtime hours as a percentage of productive nursing hours 2.24% (2010 calendar year) Actual 2015/16 2016/17 <= 3.3% 2.8% <= 3.3% <= 3.3% Data Source: Based on calendar year. Health Sector Compensation Information System (HSCIS). Health Employers Association of British Columbia (HEABC). Discussion This performance measure tracks how much nursing overtime is used. The core of health care is the people who provide the service: the nurses, physicians and other health professionals who care for our patients. As we deepen our understanding of a patient-centered care culture, we know that an essential element of providing care is the capacity and experience of our care providers, our staff. Enhancing their ability to provide effective, quality care in an engaging, supported and healthy environment is our focus. There are a multitude of factors that contribute to overtime for nurses. A detailed review of nursing areas is currently being conducted, looking at unit- based workforce metrics, including overtime, vacancies, relief needs and other criteria. This will assist in understanding and supporting the needs of the local workforce and leadership, especially in our many unique and specialized nursing areas, so that we can ensure a sustainable future workforce. Although PHSA annual overtime rate is showing slight upwards trending in last 3 years, the annual rate has continued to remain the lowest among B.C. health authorities. Annual Service Plan Report 16
Financial Report Management Discussion and Analysis The Provincial Health Services Authority (PHSA) had an operating budget of $2,780.4 million in. Actual expenditures for the fiscal year ending March 31, 2015 were $2,844.3 million. The higher than budgeted expenditures of $63.9 million were offset by higher than budgeted revenues of $64.5 million, resulting in a overall operating surplus of $0.6 million, or 0.02 per cent of the annual operating budget. The significant operating variances were: Total Revenue: The surplus of $64.5 million is primarily due to higher recoveries from other Health Authorities for services and materials, funding from the Ministry of Health received during the fiscal year offsetting expenditures incurred, higher MSP revenues for physician hours worked, and higher capital contributions offsetting amortization expenditures. Expenditures Corporate Sector: The deficit of $85.5 million is primarily due to higher Health Shared Services BC (HSSBC) expenditures and higher informational technology costs with offsetting recoveries from other Health Authorities, and ehealth expenditures with offsetting recoveries from the Ministry of Health. Expenditures Community Sector: The surplus of $12.4 million is primarily due to lower than anticipated payments under the Provincial Retinal Disease Treatment program (offset by lower funding from the Ministry of Health), and lower community dialysis expenditures. Expenditures Population Health & Wellness Sector: The surplus of $8.7 million is primarily due to lower referred out funding and lower uptake rates in cancer screening programs. PHSA Resource Summary Table ($ millions) OPERATING SUMMARY Provincial Government Sources Estimated Actual $ 2,614.4 $2,691.7 $77.3 Variance Non-Provincial Government Sources $166.0 $153.2 -$12.8 Total Revenue: $2,780.4 $2,844.9 $64.5 Acute Care $1,873.5 $1,865.7 $7.8 HCC Residential $1.7 $1.8 -$0.1 HCC Community $120.3 $107.9 $12.4 Mental Health & Substance Use $122.9 $130.1 -$7.2 Population Health & Wellness $193.5 $184.8 $8.7 Corporate $468.5 $554.0 -$85.5 Total Expenditures: $2,780.4 $2,844.3 -$63.9 Annual Service Plan Report 17
Surplus (Deficit) - $0.6 $0.6 CAPITAL SUMMARY Funded by Provincial Government $118.7 $133.7 -$15.0 Funded by Foundations, Regional Hospital Districts, and Other Non- Government Sources $59.9 $ 43.1 $ 16.8 Total Capital Spending $178.6 $176.8 $ 1.8 Annual Service Plan Report 18
Major Capital Projects from PHSA Service Plan Community Name (as applicable) Facility location (as applicable) Project Name Total Project Cost ($ million) Facility Projects Vancouver Children s & Women s Children s & Women s Redevelopment Phase 2 529.1 Vancouver Children s & Women s Children s & Women s Redevelopment Phase 1 68.7 Vancouver Children s & Women s Children s & Women s Energy Centre 29.7 Victoria BC Cancer Agency Radiation Therapy and Diagnostic Equipment 24.1 Vancouver BC Cancer Agency Radiation Therapy and Diagnostic Equipment 11.0 Coquitlam Forensic Psychiatric Forensic Psychiatric Hospital Flood Mitigation 9.0 Services Commission Vancouver Children s & Women s Children s & Women s Daycare Centre 6.7 Vancouver BC Cancer Agency Radiation Therapy and Diagnostic Equipment 5.7 (VERO) Victoria & Kelowna BC Cancer Agency Pharmacy Upgrades 4.7 Information Management/Information Technology Projects Various Communities Various Facilities Clinical & Systems Transformation 50.8 Kamloops Health Shared Services Provincial Data Centre 29.5 BC Kamloops Health Shared Services Provincial Data Centre Expansion 5.0 BC Various Communities Various Facilities Provincial Practitioner Credentialing and 3.5 Privileging Various Communities PHSA Labs Synoptic Reporting Lab System 2.2 Equipment Projects Various Communities BC Ambulance Service Ambulance Replacements 8.0 Various Communities BC Provincial Renal Home Hemodialysis Machines 3.8 Agency Various Communities BC Cancer Agency Screening Mammography Mobile Units 3.1 Children s and Women s Hospital Redevelopment The redevelopment of BC Children s Hospital and BC Women s Hospital, both agencies of the Provincial Health Services Authority, will be completed in three phases. The first phase included opening three additional neonatal intensive care unit (NICU) beds at BC Women s Hospital to help care for the province s most vulnerable patients. Those additional beds became part of the provincial network of NICU beds. First phase work also included: site preparations for the new hospital; constructing additional academic space for UBC; and constructing a new clinical support building. The second phase of the project consists of construction of a new 59,400 square metre (640,000 square foot) Teck Acute Care Centre (underway) and renovations to the BC Women s Assessment Room in the 1982 Building. The new Acute Care Centre is expected to be open for patients in fall 2017. The third phase includes a 10 bed expansion of single room maternity care, and relocation of Sunny Hill Health Centre for Children into renovated space in the 1982 Building at the Oak Street Annual Service Plan Report 19
campus. The Phase 3 business plan is expected to be brought to government in early 2016 with project completion planned for late 2019. For more information on the Children s and Women s Hospital Redevelopment project, please see the website at http://newcw.phsa.ca. Children s & Women s Energy Centre The Eco-Energy System project is a Government-approved initiative to deliver a low carbon energy plant on the BC Children s & Women s (C&W) campus capable of serving both C&W and Vancouver General Hospital (VGH), including establishment of a district energy system incorporating the sites existing legacy energy plants and an interconnecting steam line between the sites. The key goals of the project are to meet the Province s mandate to reduce greenhouse gas emissions by at least 33% by 2020 as per the provisions of the Greenhouse Gas Reduction s Act, reduce lifecycle costs and risks related to energy generation and satisfy the City of Vancouver s (CoV) rezoning condition allowing development of the C&W Teck Acute Care Centre (TACC). BC Cancer Centre Vancouver Island Centre Radiation Therapy and Diagnostic Equipment project This project replaced the aging and technologically obsolescent radiation therapy equipment at the BC Cancer Agency s Vancouver Island Centre. Primarily this included the replacement of six linear accelerators (used to deliver radiation therapy) and two CT-Simulators (used to image patients as part of the planning of radiation therapy), and associated supporting renovations and equipment. The project was consistent with the goal of supporting the health and well-being of British Columbians by providing access to up to date and reliable radiation therapy treatments for patients with cancer. BC Cancer Agency Vancouver Centre Radiation Therapy and Diagnostic Equipment project This project will replace three of radiation therapy s aging and technologically obsolescent linear accelerators (used to deliver radiation therapy) and associated supporting renovations and equipment at the BC Cancer Agency s Vancouver Centre. The project is consistent with the goal of supporting the health and well-being of British Columbians by providing access to up to date and reliable radiation therapy treatments for patients with cancer. Forensic Psychiatric Hospital Flood Mitigation The purpose of the Forensic Psychiatric Hospital Flood Mitigation project is to complete the design and construction of the flood protection works to protect the Forensic Psychiatric Hospital site and to maintain operations-in-place in the event of a severe flood event. Completion of this project will eliminate the costs and complexity of temporary flood protection for the facility and building and to mitigate the impacts to facility operations and finding temporary secure alternate facilities for staff and patients. Annual Service Plan Report 20
Children s & Women s Daycare Centre Provincial Health Services Authority The Dr. Djavad Mowfaghian Child Care Centre, a 692-sq.m. (7,450-sq.ft.) building, has space for 49 children, including 12 infants (under 17 months), 12 toddlers (18 to 36 months) and 25 preschoolers (30 months to five years), and was designed with specific areas for each of these age groups. It also features 933 sq.m. (10,043 sq.ft.) of outdoor space, landscaped for play. The Centre follows B.C. s Wood First Act and has achieved LEED Gold certification. This licensed child care centre is a unique partnership between the Provincial Health Services Authority and the YMCA of Greater Vancouver to provide care for BC Children s Hospital, Women s Hospital and Health Centre and PHSA employees who work at the Oak Street site. BC Cancer Agency Vancouver Centre Radiation Therapy and Diagnostic Equipment (VERO) The purpose of this project is to install an innovative radiation therapy machine (VERO) at the Vancouver Centre and commence an associated research program aimed at developing highly accurate and adaptive treatment modalities for patients with a variety of cancers (such as cancers of the pancreas or liver) that cannot be treated with conventional radiation therapy. BC Cancer Agency Pharmacy Upgrades The BC Cancer Agency s (BCCA) pharmacy upgrades project is required to meet the College of Pharmacists of BC requirements for IV chemotherapy preparation. These standards ensure the safety of both the medication being prepared in a sterile environment and the staff who are handling the hazardous medications. Over time, these standards have been strengthened significantly, and as a result, the pharmacy upgrades are required to ensure continued compliance and operations for IV chemotherapy preparation. Pharmacy upgrades are underway at the BCCA s Vancouver Island Centre (Victoria) and Sindi Ahluwalia Hawkins Centre for the Southern Interior (Kelowna). The PHSA is planning for pharmacy upgrade projects at other BCCA centres. Clinical and Systems Transformation Project The primary purpose of the Clinical and Systems Transformation (CST) Project is to establish a common standardized, integrated, end-to-end clinical information system and environment for the Provincial Health Services Authority, Vancouver Coastal Health Authority and Providence Health Care. The vision of this integrated system is One Person. One Record. Better Health. A single health record for each patient will promote high quality care and improve health outcomes throughout the region by ensuring clinicians have a greater level of accurate and consistent patient information. A single electronic health record per patient across the continuum of care (acute, ambulatory, and residential integrated with lab, medical imaging, health information, and pharmacy) will streamline Annual Service Plan Report 21
the care process, improve the safety and efficiency of patient care, and provide clinicians with a longitudinal view of a patient s medical history for better care decisions. Provincial Data Centre The Provincial Data Centre (KDC) project in Kamloops was an important step in the provincial shared services initiative for technology which was designed to provide a standardized platform for all Health Authority s clinical and business applications. The availability of the Kamloops Data Centre provided the opportunity for the Health Authorities to align their strategic initiatives and goals, including improved service delivery and reduced risk, operational and management costs. Additional benefits included centralizing the expansion of existing technologies and providing the ability to standardize technology platforms. Provincial Data Centre Expansion Health Authorities (HAs) store data at the Provincial Data Centre in Kamloops (KDC) and this service is managed by Health Shared Services BC (HSSBC) utilizing shared infrastructure. HSSBC highlighted to the HAs that the initial infrastructure capacity was close to being fully utilized and that HA projects would have needed 120% of the existing capacity when fully implemented. HSSBC indicated it needed an additional $5 million in capital funding to cover the cost of an expansion, including hardware acquisition, configuration and implementation. Provincial Practitioner Credentialing and Privileging The purpose of the project is to implement a single standard provincial web-based Practitioner Credentialing and Privileging Solution and related common business processes across all of the Health Authorities to ensure that members of Health Authorities medical staff have the requisite credentials and privileges to provide appropriate and safe care to patients, clients and their families. The project outcomes will contribute to the Cochrane Reports recommendations. It will also contribute to the Ministry of Health s key outcomes of sustaining high quality patient care through more efficient and effective services. Synoptic Reporting Lab System The Electronic Synoptic Pathology Reporting Initiative project covers all of the BC Health Authorities and is part of a wider national project that will advance the adoption of national standards through implementation of electronic synoptic pathology reporting tools across Canada. This project will invest into technology and processes to advance the depth and consistency of pathology information data gathering. This will be done in compliance with the College of American Pathologists cancer protocols. Practically, it is an online software application, capturing and editing discrete data fields which would replace the current, dictation-based method of synoptic reporting. This data would be electronically consolidated into a shared repository and automatically uploaded into the cancer registry. Fundamentally this is a quality and patient safety initiative. This Annual Service Plan Report 22
program would align BC with Canadian and International standards, support and enhance cancer diagnosis and treatment practices, reduce error rates, improve the performance of individuals, and the overall system and enable cancer research. BC Emergency Health Services Ambulance Replacements The current British Columbia Ambulance Service (BCAS) fleet consists of 518 ambulances and 64 support units. Based on an anticipated vehicle useful life of 7-8 years, 60-70 new ambulances are required to be procured every year through multi-year contracts in order to maintain the current age profile of the fleet. BC Provincial Renal Agency Home Hemodialysis Machines BC has the only province-wide independent hemodialysis program in Canada, with approximately 140 patients currently managing their hemodialysis care at home. Not only does home hemodialysis result in positive health outcomes and lifestyle benefits for patients, it makes financial sense. Through this initiative, the BC Renal Agency has realized a cost avoidance of approximately $1 million in operating dollars over the past five years. Additional financial benefits include global health system savings from reduced hospitalizations, as home hemodialysis patients spend an average of five fewer days in hospital per year than their facility-based peers. Based on the current number of patients on home hemodialysis, this equates to approximately 220 fewer hospital days per year. At a societal level, home hemodialysis patients have an increased ability to maintain employment. BC Cancer Agency Screening Mammography Mobile Units The BC Cancer Agency (BCCA) Screening Mammography Program has received funding to convert the three transport vehicles and equipment used to provide mobile screening mammograms for the Vancouver Island, Interior Kootenays and Northern Health/Lower Mainland regions to full selfcontained digital mammography vehicles. The purpose of the project is to provide a consistent, private, secure, high-quality patient experience for all women of BC regardless of their residence by conducting upgrades of the existing vehicles to a state of the art screening service. The new vehicles are equipped with a wheelchair lift, a spacious waiting area, a private examination room and are designed to fit on all BC Ferries. Conversion to the digital mammography vehicles will improve privacy and the patient experience, through its design and patient workflow, and decrease the number of re-screens required by reducing film handling errors such as film fogging and over-exposure. Annual Service Plan Report 23