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Goals, Objectives, Strategies and Performance Measures

Goal 1: Improved Health and Wellness for British Columbians

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

Objective 1.1: Individuals are supported in their efforts to stay healthy and make healthy lifestyle choices

British Columbians in general are among the healthiest people in the world. We want to support the excellent health status of the majority of our citizens while also helping those in the population who do not enjoy good health or are at risk of diminishing health from factors such as poor dietary habits, obesity, inactivity, injuries, tobacco use and problematic substance use. Services such as health promotion and protection, and chronic disease prevention and management, are important to maintaining and improving health outcomes while containing overall health system costs.

Strategies

  • Supporting ActNow BC to encourage healthy and active living. The Ministry and health authorities will promote healthy lifestyles and prevent disease by providing people with information, resources and support to make healthy lifestyle decisions.
  • Reducing tobacco use through B.C.’s Tobacco Control Strategy which includes school-based programming, public education, protection from second hand smoke, support for cessation, and legislation and regulation. The Ministry will also continue to offer stop-smoking programs such as QuitNow.ca, QuitNow by Phone, and Kick the Nic, which are available 24/7 to all British Columbians, with translation services available in 130 languages.
  • Partnering with the Ministry of Education in the following Healthy Schools Initiatives: supporting elementary students to increase their physical activity levels through Action Schools! BC; increasing fruit and vegetable consumption through the School Fruit and Vegetable Snack Program; supporting the elimination of unhealthy food and beverage sales in B.C. schools; and supporting the reduction of tobacco use among students.
  • Supporting healthy childhood development through programs to identify problems with hearing, vision or dental health for children before they reach Grade 1, and providing the supports and services necessary to address their needs.
  • Providing British Columbians 24 hour-a-day access to health information, advice and resources to assist their self-care and self-management through the BC NurseLine and other components of the BC HealthGuide program.

Performance Measure 1: Tobacco use rates

Performance Measure 2003
Baseline		 2007/08
Forecast		 2008/09
Target		 2009/10
Target		 2010/11
Target
Tobacco use rates (age 15 and over). 16% 15% Decrease toward 2010 target of 14.4% Decrease toward 2010 target of 14.4% 14.4%
Data Source:  Canadian Tobacco Use Monitoring Survey.

Tobacco use kills over 6,000 British Columbians each year,5 and costs the B.C. economy approximately $2.3 billion every year.6 Cigarette smoking is the primary risk factor for diseases of the circulatory system, cancers and respiratory diseases, and passive smoke kills up to140 people in B.C. each year.7 Accordingly, reducing smoking rates is a key priority for government. Smoking reduction targets were set in 2004 as part of the ActNow BC initiative. The target is to continue B.C.’s downward trend of tobacco use by a further 10 per cent from the 2003 prevalence rate of 16 per cent to 14.4 per cent of the population by 2010.

Objective 1.2: Protection of the public from preventable disease, illness and injury

The second major approach to keeping people healthy is through providing effective public health services to prevent illness and disability. The Ministry plays an important role in monitoring and protecting the health of the population. Legislation, regulation and monitoring of food, air and water quality lay the foundation for communities and citizens to live in healthy and safe environments. Immunization programs and infectious disease and injury prevention and control measures also help to improve population health, prevent illness and reduce health care costs.

Strategies

  • Protecting health by implementing core public health programs, including immunization programs, infectious disease and injury prevention and control measures, monitoring and regulating water and environmental safety, reproductive health, food security and health emergency management.
  • Preparing and responding in a co-ordinated system-wide manner to major public health risks, emergencies or epidemics (e.g., West Nile virus, pandemic influenza, meningitis outbreaks, and natural or accidental emergencies). Work with other provinces and the federal government to protect British Columbians through the Canadian Pandemic Influenza Plan.

Performance Tracking

The Provincial Health Officer develops a number of reports (annual and special) on the overall health of British Columbians and on specific topics such as immunization, child health, women’s health, food safety and air and water quality. Provincial Health Officer Reports can be found at www.health.gov.bc.ca/pho.

Objective 1.3: Improved health status for the Aboriginal population

As a group, Aboriginal British Columbians do not enjoy the same health status as the rest of the province’s population. The Ministry, in support of the Government’s New Relationship with First Nations and the Transformative Change Accord will continue to work with First Nations to improve health and eliminate the gap in health status between First Nations and the rest of the British Columbia population. The Ministry will continue to work on the priorities identified in the First Nations Health Plan developed by the First Nations Leadership Council and the Government of British Columbia in 2006.

Strategies

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

Performance Tracking

Monitoring and reporting on health outcomes and the health status of First Nations people is a key component of the First Nations Health Plan. The Health Plan identifies a number of performance indicators that will be used to measure the effectiveness of programs in closing the health gap between First Nations and other British Columbians. Measures identified in the First Nations Health Plan include life expectancy, mortality rates, infant mortality rates, youth suicide rates, diabetes rates, childhood obesity prevalence, and the number of practicing, certified First Nations health care professionals. A copy of the Transformative Change Accord: First Nations Health Plan, which includes descriptions and targets for each of these measures, can be found at www.health.gov.bc.ca/library/publications/year/2006//first_nations_health_implementation_plan.pdf.

The Provincial Health Officer will issue an Aboriginal health status report, including indicators from the First Nations Health Plan, every five years with interim updates produced every two years. These reports will be available at www.health.gov.bc.ca/pho.

Goal 2: High Quality Patient Care

Patients receive appropriate, effective, quality care at the right time in the right setting. Health services are planned, managed and delivered in concert with patient needs.

Objective 2.1: Timely access to appropriate health services by the appropriate provider in the appropriate setting

All British Columbians should be able to access appropriate health services when they need them, be that for a visit to a family doctor, prescription drug therapy, emergency treatment, elective surgery or ongoing care. The Ministry has been working diligently to ensure hospitals, community services and health professionals are used in the most efficient and effective way possible so that people get the right type of care in the right type of setting that will lead to the best health outcome.

Strategies

  • Increasing the range of supportive living environments and community care options, across the spectrum from home care to residential facility care, for the elderly and persons with disabilities so they can remain as independent as possible in their own homes and communities while also having the full support of residential care if their health conditions require the highest level of care. Part of this strategy is completing the commitment to build 5,000 net-new residential care, assisted living and supportive housing with care beds by December 2008.
  • Reducing wait times in key surgical and medical areas, including cardiac treatment, diagnostic imaging, joint replacements, cancer services and sight restoration.
  • Implementing a surgical patient registry to give patients more control over their surgical options, provide surgeons and health authorities with better management tools, and improve public reporting of wait times.
  • Improving waiting times in emergency departments by introducing innovative services such as fast track units and urgent care centres that work in conjunction with hospital emergency departments across B.C.
  • Increasing the availability of care from multidisciplinary primary health care teams to provide effective first point of contact care and a more integrated, patient-centred experience that focuses on supporting the role of patients in staying healthy and managing their conditions, particularly for those with chronic diseases.
  • Providing British Columbians access to prescription drug therapy through the PharmaCare program, and co-leading the development of a National Pharmaceuticals Strategy to provide access to catastrophic drug coverage, accelerate access to breakthrough drugs, strengthen the national evaluation of drug safety and effectiveness, and pursue national purchasing strategies to obtain drugs and vaccines at the best price possible.

The Ministry is tracking access indicators for hip and knee replacement surgeries and cancer treatment — two priority areas identified by First Ministers in the 2004 Ten-Year Plan to Strengthen Health Care.

Performance Measure 2: Waiting times for surgery

Performance Measure 2006/07
Baseline		 2007/08
Forecast		 2008/09
Target		 2009/10
Target		 2010/11
Target
Waiting times for surgery:
a) Percentage of hip replacement cases completed within 26 weeks.		 52% completed with 26 weeks Increase towards 90% within 26 weeks Increase towards 90% within 26 weeks 90% within 26 weeks >90% within 26 weeks
b) Percentage of knee replacement cases completed within 26 weeks. 49% completed with 26 weeks Increase towards 90% within 26 weeks Increase towards 90% within 26 weeks 90% within 26 weeks >90% within 26 weeks
Data Source:  Knowledge Management and Technology Division, B.C. Ministry of Health.

Demand for hip and knee replacement surgeries has been rising sharply as the population ages and new surgical techniques and technology makes replacement surgeries available to more people. Between 2000/01 and 2006/07 the number of knee replacements increased by approximately 121 per cent and hip replacements increased by approximately 61 per cent in British Columbia.

In the 2004 Ten-Year Plan to Strengthen Health Care, First Ministers committed to establish benchmarks in priority areas and to set multi-year targets against these benchmarks. The benchmark of completion within 26 weeks has been established for hip and knee replacement. The Ministry is making significant efforts to improve access to these services and has established a target to complete 90 per cent of hip and knee replacement surgeries within 26 weeks by 2010.

Performance Measure 3: Waiting times for cancer treatment

Performance Measure Benchmark1 2007/08
Forecast		 2008/09
Target		 2009/10
Target		 Long-Term
Target
Waiting times for cancer treatment:
a) Percentage of patients who receive radiotherapy within four weeks.		 90% 90% within four weeks Maintain at or above 90% within four weeks Maintain at or above 90% within four weeks Maintain at or above 90% within four weeks
b) Percentage of patients who receive chemotherapy within two weeks. 90% 90% within two weeks 90% within two weeks 90% within two weeks 90% within two weeks
Data Sources:  Radiotherapy: Provincial Radiation Therapy Program, BC Cancer Agency (BCCA). Data for this measure is from the BCCA scheduling system. Not all patients are captured because the most urgent patients never show up on the scheduling system as they receive treatment immediately. Chemotherapy: Provincial Systemic Therapy Program and Communities Oncology Network, BCCA. Data involves all existing BCCA centres and does not include all hospitals in B.C.
1   The radiotherapy benchmark was developed in accordance with the First Ministers’ Ten-Year Plan to Strengthen Health Care, September 2004.

The Ministry is tracking access to radiation therapy and chemotherapy as they are principal treatments in cancer care. Ensuring treatment is available and provided in a timely manner is important to achieving the best health outcomes for patients. The national benchmark for radiotherapy is to receive treatment within four weeks of being ready to treat. A national benchmark for chemotherapy has not been established; however the Ministry and BC Cancer Agency have established receiving treatment within two weeks of being ready to treat as a provincial benchmark.

British Columbia’s performance in delivering timely access to cancer care has been good, with access to both radiotherapy and chemotherapy being provided within the benchmarks at or over 90 per cent of the time. However, access to cancer treatment remains an important performance indicator for the Ministry as demand for radiotherapy and chemotherapy is growing as the B.C. population ages and the prevalence and incidence of cancer increases. The Ministry will need to continue to focus on maintaining timely access to cancer care in the face of the rising demand.

Objective 2.2: Patient-centred care to meet the specific health needs of patients and specific patient groups

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

Strategies

  • Increasing the emphasis on effective management for patients with chronic diseases to prevent or slow disease progression. In line with B.C.’s Primary Health Care Charter, the key area of focus is working with physicians and other health providers to provide care according to best practice guidelines in the areas of diabetes, congestive heart failure, kidney disease, chronic obstructive pulmonary disease, osteo and rheumatoid arthritis and dementia.
  • Expanding end-of-life care services, including hospice and home-based palliative care, to provide dying people with greater choice and access to services.
  • Ensuring the quality and safety of health services across the continuum of care by reviewing safety issues and by developing and implementing safety guidelines, best practices and initiatives.

Performance Measure 4: Chronic disease management (diabetes)

Performance Measure 2007/08
Forecast		 2008/09
Target		 2009/10
Target		 2010/11
Target
Percentage of patients with diabetes who
undergo at least two A1C tests per year. 		50% 55% 60% 65%
Data Source:  Medical Services Division, Ministry of Health.

The Ministry’s performance measure centres on improving chronic disease management, focusing specifically on the treatment of diabetes. Diabetes is one of the most common chronic diseases. It affects about five per cent of British Columbians and is steadily increasing in prevalence.

This indicator measures improved management of diabetes through the percentage of patients with diabetes who undergo the recommended best practice of at least two hemoglobin A1C tests per year. The hemoglobin A1C test is a simple lab test used in the management of diabetes that shows the average amount of sugar (glucose) that has been in a person’s blood over the previous three months. The A1C test shows if a person’s blood sugar is close to normal or too high, and is recommended as part of best practice care for diabetes because it allows patients and their physicians to be aware of abnormalities faster and take action to lower complication rates. Improved management of diabetes means a healthier life for the patient and a reduced impact on the health system.

Objective 2.3: Improved integration of health service providers, processes and systems to allow patients to move seamlessly through the system

The health system is very complex. The diversity of health needs across the province means the system is always caring for unique patients through different caregivers, in different settings, every day. While we have made good progress, the Ministry will continue to work to improve the integration of those services so care can be provided in the most co-ordinated and seamless manner possible, which benefits both patients and health service providers. The Ministry will also work to improve collaboration and co-ordination with other provincial government ministries and with agencies outside the traditional health system. Co-ordinated action and improved integration will allow government to provide better support services for persons with disabilities, special needs, children at risk and seniors.

Under this objective, the Ministry has a particular focus on mental health and addiction services. People with mental illness or substance use disorders often must access various providers to receive care and support services. The Ministry is working to ensure services, from child and youth to adult programs, are integrated to ensure appropriate care and supports are available to those in need.

Strategies

  • Providing a full continuum of high quality mental health and addiction services within each health authority, which better integrates primary, secondary, community and tertiary care and is integrated within the larger care networks.
  • Working with other ministries, BC Housing, health authorities and other partners to better address the housing and service needs of those with mental illness and addictions.
  • Enhancing services for people with dementia, including Alzheimer’s disease. Targeted improvements include earlier assessment, clinical guidelines to improve treatment, and better integration of services.
  • Expanding drug and alcohol treatment for at-risk and addicted people who are seeking help.
  • Specifically addressing the need to provide integrated programs for youth addictions, including both detoxification and outreach programs. Particular focus will be placed on contributing to government’s integrated approach to addressing crystal meth use in British Columbia.
  • Working with other government ministries to ensure programs and services are integrated to achieve maximum benefit for those in need, including people with mental illness and/or substance use disorders who access employment and income assistance programs, are involved in the corrections system or require services related to a dual diagnosis of mental illness and developmental disability.

Performance Measure 5: Co-ordinate mental health treatment

Performance Measure 2007/08
Forecast		 2008/09
Target		 2009/10
Target		 2010/11
Target
Number of people with a mental disorder and/or substance addiction receiving housing with supports. Baseline to be set by end of 2007/08 Increase over previous year Increase over previous year 20% increase over 2007/08
Data Source:  Knowledge Management and Technology Division, B.C. Ministry of Health.

People with severe mental illness and/or substance use disorders benefit from access to safe, secure and affordable housing that is co-ordinated with a range of appropriate support services to treat their conditions. This indicator measures the Ministry’s progress in improving the co-ordination and availability of housing and support services for those with mental illness and/or substance use disorders. Health authorities provide assessment, treatment and a range of health services, which are co-ordinated and integrated with other providers responsible for housing and other social supports.

This performance measure is new for 2008/09. A baseline will be determined by the end of 2007/08, with the Ministry working toward a 20 per cent increase in the availability of housing with supports by 2010/11. Housing with support services encompasses those who can live independently while receiving supports as well as those who require a structured residential or family care home environment.

Goal 3: A Sustainable, Affordable, Publicly Funded Health System

The public health system is affordable, efficient and accountable, with governors, providers and patients taking responsibility for the provision and use of services.

Objective 3.1: Optimum human resource development to ensure there are enough, and the right mix of, health professionals

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

Strategies

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

Objective 3.2: Strategic investments in information management and technology to improve patient care and system integration

Making the right investments in information management systems and new technologies will support the health system in meeting the goals and objectives set out in this service plan. Technology can improve system integration and efficiency, improve access to services across the province, assist managers and practitioners to make evidence-based decisions, and help the public access valuable health information in a timely and convenient manner.

The Ministry is working to realize the potential in each of these areas through implementation of B.C.’s eHealth Strategy. eHealth represents a major step in transforming the health system into a seamless continuum of care, supported by a seamless web of health information. It is also a powerful tool to allow providers to apply the highest standards and best practices to improve the quality and safety of services for British Columbians.

Strategies

  • Enhancing patient care by implementing a secure electronic health record system across the province which will allow medical practitioners to easily access information (such as test results or medication histories) that will assist treatment while protecting personal privacy.
  • Working with the British Columbia Medical Association and the College of Physicians and Surgeons to co-ordinate, facilitate and support information technology planning and implementation for physicians, including supporting the use of electronic medical record systems by physicians.
  • Expanding telehealth to improve rural and remote residents’ access to health services and specialists.
  • Improving the availability of quality data and analysis to assist clinical and management decision-making.
  • Expanding public access to health services and health information through web-based applications.

Performance Measure 6: Electronic medical record system implementations

Performance Measure 2007/08
Forecast		 2008/09
Target		 2009/10
Target		 2010/11
Target
Percentage of physicians implementing
electronic medical record systems.1		 Program introduced and
systems made available
to physicians		 20% 45% 70%
1   Electronic medical record systems implemented through a voluntary program funded by the Ministry/B.C. Medical Association Agreement.

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

Objective 3.3: Sound business practices to ensure sustainability of the publicly funded health system

The Ministry is committed to managing the health system efficiently to ensure resources are spent where they will have the best outcome. The Ministry monitors and evaluates the delivery of services and the health of the population and works to ensure services delivered in the system meet the needs of the public. As part of a commitment to continuous improvement, the Ministry uses its evaluations of health system performance to inform strategic direction and facilitate course correction where warranted. It also uses this information, along with population demographic and health need projections, to plan investments in the health system’s physical infrastructure.

Strategies

  • Providing legislative, regulatory and policy frameworks to ensure policy direction is clear and consistent and allows services to be delivered appropriately and cost-effectively.
  • Planning and making strategic capital investments to renew the health system’s infrastructure, including facilities, equipment and information technology.
  • Supporting the B.C. Energy Plan – A Vision for Clean Energy Leadership by implementing Green Health Care initiatives to make hospital and health authority operations carbon neutral by 2010.
  • Monitoring and reporting publicly on health system performance and the health of the British Columbia population.
  • Investing in health research and innovation to improve service delivery and treatments for major health care challenges. For example, the Province is providing $30 million to the new Terry Fox Research Institute, a national organization for cancer research headquartered in B.C.
  • Working with system partners to ensure overall health system costs remain affordable and within budget, and utilizing strategic partnerships and innovative approaches to improve services to the public within the available fiscal resources.
5  Selected Vital Statistics and Health Status Indicators, Annual Report 2004; Table 42 — Smoking-Attributable Mortality British Columbia 2004, page 109.
6  The Cost of Substance Abuse in Canada 2002, Canadian Centre on Substance Abuse.
7  Knowledge Management and Technology Division, Ministry of Health 2006.
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