Overview Fraser Health


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Overview Fraser Health

  1. 1. The Fraser Health Strategic Plan FRASER HEALTH – AN OVERVIEW Fraser Health serves more than 1.46 million people, approximately one third of the total provincial population. It is a geographically large area, running East-West from Burnaby to Hope and North- Fraser Health is the largest and South from the Canada/US Border to Boston Bar. It is the fastest growing of the health authorities fastest growing health authority in and has almost doubled in size since 1981 Between 2004 and 2010, the population is expected to the province. increase by over 152,246 to 1.62 million. Fraser Health represents 22 municipalities and a large number of communities ranging in size from small rural communities such as Hope, to large, rapidly growing suburban centres such as Surrey. The wide-ranging size of communities and the distances between them create challenges for health service delivery from the perspective of quality of care, equity in access and efficiency. Exhibit 1: Population Proportions, Fraser Health by LHA, 2004 Exhibit 1 shows how the population is dispersed across Fraser Health. More detailed information is available in the Fraser Health Authority Profile, Tri Cities Langley 8% located on our web site (http://www.fraserhealth.ca/). The profile provides 14% a wealth of information, including expected population growth, socio- Maple Ridge economic indicators, current health status, and an overview of current 6% Surrey 23% health services in Fraser Health. The demand for health services in Fraser Health is expected to increase Burnaby and become more complex because of anticipated population growth 14% and demographic shifts (Exhibit 2). Currently, nearly 12% of the S Surrey/White New Rock population in Fraser Health is over 65 years old and the median age of Westminister 5% the population has been increasing steadily. By 2010, this is expected 4% Delta Mission to increase by 18% or 32,718 people – a significant increase because as Agassiz - Hope 7% 3% Harrison 1% people age, they typically require more health services and are more 1% Abbotsford Chilliwack 9% 5% likely to be affected by chronic diseases. January 2005 3
  2. 2. The Fraser Health Strategic Plan Exhibit 2: Age Breakdown for Fraser Health Communities When these population numbers are translated into Fraser Health Authority Age Structure 2003 & 2010 health issues, the potential impact on Fraser Health 800000 services can be seen. For example approximately: 716,106 700000 647,586 • 33,500 Fraser Health residents are living with 625,405 105,200 600000 562,754 78,849 diabetes 84,714 • 156,500 Fraser Health residents suffer from Population 62,825 500000 arthritis 400000 442,501 65+ • 68,000 Fraser Health residents live with a mental 433,788 375,325 20-64 255,494 290,278 368,750 0-19 illness 300000 36,276 41,228 • 78,500 Fraser Health residents live with heart 200000 disease 148,242 176,244 100000 • 5,100 residents are diagnosed with cancer 131,179 134,949 165,366 168,405 70,976 72,806 annually1. 0 2003 2010 2003 2010 2003 2010 • There is an opportunity to optimize early Fraser East Fraser North Fraser South childhood development for some of the 169,400 children and youth under the age of 19 (2010). Our population is very diverse, and there are a few sub-populations that are especially at risk for poor health outcomes. The Aboriginal population has been identified as a high priority for improving health status and access to health services. In Fraser Health, there are approximately 38,000 Aboriginal people2, with the highest number in Fraser South and the highest proportion of the population in Fraser East. There are large Asian, Indo Canadian, Korean, and Philippine populations in parts of Fraser Health. We acknowledge that existing health services are not always responsive and accessible to these groups, and recognize the importance of developing community specific strategies. For example, health services that are tailored to specific ethnic groups are urgently needed in particular communities, while initiatives aimed at populations suffering from chronic disease are a priority in others. 1 Based on 2001 data. 2 1996 Census data. Includes First Nations (Status and Non Status); Metis; Inuit. January 2005 4
  3. 3. The Fraser Health Strategic Plan As we focus on improving and equalizing health status across Fraser Health we have set goals to improve services to our mental health clients, to better manage and support individuals with chronic diseases, and address the particular health needs of our Aboriginal and culturally diverse population. A Typical Day in the Fraser Health System Fraser Health’s employees and partners provide a wide range of health care services in a number of locations, including hospitals, residential facilities, client homes, and community health centers, every day. Here is an example of the volume and types of services delivered during a day in Fraser Health. Everyday in Fraser Health… • 42 babies are born • 59 long term care assessments are performed by community case managers • 1052 Fraser Health residents visit the Emergency Department • 2395 patients occupy an acute care bed • 400 patients have surgery • 236 Fraser Health clients take part in activities at Adult Day Program Centres • 577 home care nursing visits occur • 7660 Fraser Health residents receive care in long term care facilities • 660 clients access mental health community services for treatment of mental health disorders and disease • 22 people die; including 6 from cancer, 4 from heart disease, 2 from stroke, and 1 from injury Not included in this typical day, are the many residents that go to other communities for services. For some people, this is because receiving care in another hospital is their preference, while others need specialized care that is only available in tertiary centres. Some go outside Fraser Health because services are not available locally or there is a very long wait time for local services. This is particularly true for people who need surgery and children who require hospital care. Exhibit 3 provides an overview of where Fraser Health residents receive care. January 2005 5
  4. 4. The Fraser Health Strategic Plan Exhibit 3: Where do Fraser Health residents receive Hospital Care? FHA Residents' Pattern of Use of Pediatric Medical and Surgical Services FHA Residents' Pattern of Use of Medical Services 2000/2001 2000/2001 12% 9% 5% 24% 67% 83% FHA Residents' Pattern of Use of Surgical Services (including surgical day care) 2000/2001 11% 19% 70% Fraser Hospitals Vancouver Hospitals Other Hospitals January 2005 6
  5. 5. The Fraser Health Strategic Plan Fraser Health is geographically large, so residents of the region may still need to travel within the authority to receive care if it is not offered in their local community. Exhibit 4 shows the major communities within Fraser Health. Exhibit 4 The scale of operations within Fraser Health, and its importance in the lives of every resident cannot be understated. We are working towards enhancing our ability to anticipate and respond to the needs of Fraser Health residents in order to better address existing service delivery challenges, while continuing to provide health services that residents rely on each day. January 2005 7
  6. 6. The Fraser Health Strategic Plan HEALTH CARE TRENDS There has been a decade of intense debate about health care in Canada. Nationally and internationally there is emerging consensus on the strategies that are necessary to build a sustainable, high quality health system. Strategies proposed include: Supporting individuals and communities in optimizing their health: Achieve a better balance between promoting disease and injury prevention and providing care to people who are injured or ill. Most recent reports on health reform emphasize a need to promote a population health agenda with a focus on keeping people well, before they get sick, and moving well upstream to ensure a healthy start among children aged 0-5. Focusing on improving quality, safety and access: Improve access to care by shortening wait lists for health services and Achieving a balance diagnostics, and removing barriers to access for vulnerable groups. A good health care system has four essential ingredients: health promotion, prevention, cure and care. These have different time Common approaches included new, more responsive models of frames, cost profiles and actions. service delivery and specialized service networks. Improved safety Health promotion: Focus on individual and community can occur through using technology to automate tasks or processes participation and control over determinants of health, knowledge of that are prone to error (e.g., physician order entry). health issues, choice about health care and building individual skills and resiliency. Increasing availability of community based services and Prevention: Focus on comprehensive, integrated strategies to supports: Expand the services covered by public health insurance reduce illness and injury in the whole population, results may not so that individuals do not have to bear the burden of catastrophic appear for years. health expenses. Reports included recommendations to increase Cure: Focus on evidence-based tests and treatments shown to be coverage for home and community care, palliative care and effective and to improve patients’ lives. prescription drug costs. The important contribution of informal Care: Focus on the appropriate care—such as chronic disease caregivers is also acknowledged, and several reports recommend management, home care, supportive housing, palliative care—for changes to reflect the need for caregiver support. people with illnesses and disabilities that can’t be prevented or cured. Managing cost drivers to achieve fiscal sustainability: Picture of Health, 2002 Regardless of whether expenditures are private, public, provincial or January 2005 8
  7. 7. The Fraser Health Strategic Plan federal, costs need to be managed and there must be evidence of value for resources spent on health care. Strategies include using alternatives to hospital care when clinically appropriate, evaluating outcomes, and assessing new treatment and technology for effectiveness. Increasing transparency and accountability: Build better accountability mechanisms into the health care system through systematic measurement, reporting to the public, greater local involvement and legal mechanisms such as contracts. Improving coordination and supply of health human resources: Optimize scarce health human resources by expanding scopes of practice, increasing collaboration between health providers, improving recruitment and retention, and aligning incentives with quality of care. Reforming primary care: Primary health care is widely recognized as the hub of an integrated health system. The key elements of primary health reform that have been identified are 24/7 availability; multi-disciplinary teams; and alternative remuneration models for health professionals. Making better use of technology and innovation: Technology offers the possibility of delivering better care by giving caregivers timely access to important information, and streamlining access to care for patients. Most health reform studies recommend investing in better information systems and the development of electronic health records; supporting the adoption of new technology; implementing strategies to assess the impact of new technology; and, support health research. These trends are described in greater detail in the National and International Health System Reviews: Trends and Directions section of the 3 BC Ministry of Health Planning Industry Analysis. 3 www.gov.bc.ca/healthplanning/ January 2005 9
  8. 8. The Fraser Health Strategic Plan A Picture of the Future A recently completed report from the UK described a vision of what the health system could look like if the above strategies were implemented. We have taken the liberty of adapting this vision to reflect Fraser Health issues and goals. Exhibit 5: A Vision for Health Services – The Long Term View4 Patients are at the heart of our vision of health service of the future. With When patients need to see their GP, or seek other forms of primary care, access to better information, they are involved fully in decisions—not just about they get appointments quickly with staff who are pro-active in identifying what treatment, but also about the prevention and management of illness. Health care is required and who is best placed to deal with it. Primary care delivers an service has moved beyond an ‘informed consent’ to an ‘informed choice’ increasingly wide range of care, including diagnosis, monitoring and help with approach. recovery. There is a focus on lifestyle, disease prevention and screening. The health authority is able to recruit and retain the staff that it requires Choices are explained in a clear, jargon-free way. More options are provided with the right levels of skills. No longer do chronic shortages among key staff for end of life care. groups act as a constraint on the timely delivery of care. Health care workers The majority of general and less specialized medical and surgical care has are highly valued and well motivated as a result of better working conditions moved out of large hospitals. Hospitals focus almost solely on specialist and the opportunity to develop their skills to take on new and more challenging treatments. There is a new ‘whole systems’ relationship between self-care, roles for which they are appropriately rewarded. primary, secondary, tertiary and social care. Modern and integrated information and communication technology (ICT) is Patients who need hospital care wait within reason—weeks not months, being used to full effect, joining up all levels of health care and in doing so days not weeks, hours not days and minutes not hours. They get the best delivering significant gains in efficiency. Repetitive requests for information are treatments with minimum variability in outcomes, supported by up-to-date and a thing of the past as health care professionals can readily access a patient’s effective use of technology. details through their Electronic Health Record. Electronic prescribing of drugs Patients leave hospital quickly when they are medically fit to do so and are has improved efficiency and safety. Patients book appointments at a time that transferred speedily to the most suitable setting. In many instances they will suits them and not the service. return home. If the need is there, they are supported by health care In this vision, patients receive consistently high quality care wherever and professionals and paid carers, allowing people to enjoy independent lives in whoever they are. It is appropriate, timely and in the right setting. Different their own homes for longer. If necessary they move to a high quality residential types of care are effectively integrated into a smooth, efficient, hassle-free placement of their choice, or another quality assisted living setting. service. People are increasingly taking responsibility for their own health and well-being. While it would take years to achieve this vision, it provides a clear goal. Together, Fraser Health and the population we serve must share the commitment to work toward a system that is as responsive, coordinated, and effective as this picture of the future. 4 Adapted from “Securing Our Future Health: Taking a Long Term View”, Derek Wanless, April 2002 January 2005 10
  9. 9. The Fraser Health Strategic Plan THE CASE FOR CHANGE There are significant opportunities to improve the quality of our health and make better use of the 42% of the provincial budget British Columbians spend on health care. In this section we present the argument for significant change from a quality, health status, worklife and financial perspective. Why Change? To Improve the Quality and Safety of the Health System British Columbians are concerned about the future of the health care system. They are concerned about Institute of Medicine their ability to access health care in a timely manner, the ability of the system to take care of their aging Round Table parents and relatives, and the ability of the system to provide the most advanced and effective treatment. People are also interested in how they can affect and improve their own health status. 3 categories of quality problems: One of the biggest challenges we face is equalizing the significant variation in health status and access to • overuse health services that exists within our communities in Fraser Health. We are developing strategies and • underuse targets to meet our goals for improving health care across communities, closing the gaps between • misuse communities, and continuously improving the quality of care. • Across Fraser Health, access to and use of health services varies widely. This is based on historical funding patterns rather than health needs. The use of hospitals varies widely, and there is a 25% difference in the rate of hospital use between the populations in Fraser Health communities. People with similar conditions stay in hospitals for different lengths of time, depending on the hospital in which they receive care. Fraser South is well below provincial targets for access to and use of residential and home care services. • Patients often remain in hospital beds when a different type of care would better meet their needs. About 400, or 20%, of Fraser Health’s hospital beds are used for people who require an alternative level of care (ALC). This is not only an January 2005 11
  10. 10. The Fraser Health Strategic Plan expensive way to provide care, but these patients often do not receive the right kind of care for their needs, which may include services such as rehabilitation or palliative care. • There is also wide variation in practice across Fraser Health. Between Fraser Health hospitals, there is a 30% difference in the rate of Caesarean- section deliveries. In 2001, residents of Fraser East were 60% more likely to be hospitalized for mental We are committed to illness than Fraser South residents and 40% more likely than Fraser North residents. providing seniors with increased choices to • We do not manage the health needs of one of our most vulnerable populations, frail seniors, enable seniors to live in very well. Care is often fragmented, crisis oriented, and choices limited or expensive. This is their own home and a large and growing population, one that needs special attention as we move forward. community safely. • A recent study on medication errors in the US5 found the error rate for the type of drug Keith Anderson, Vice distribution system used in most of our Fraser Health acute care sites is 11%. If the error rate President Health Planning & Systems is similar for the 44,000 medication doses administered daily in Fraser Health sites, the Development number of errors may be substantial. • The lack of an integrated waitlist management and scheduling system means that people in some communities wait longer for care than in other communities. 5 To Err is Human, Institute of Medicine, 2001. January 2005 12
  11. 11. The Fraser Health Strategic Plan Why Change? To Improve the Health of the Population Fraser Health has some of the best health status indicators in the province. Still, the averages hide significant problems with some population groups. • Status Indians in Fraser North have a life expectancy that is 13 years less than other Fraser Health residents. • Deaths related to smoking, alcohol and injuries are dramatically higher for Fraser Health Status Indians than for other residents. For example, Status Indians are four times more likely to die of injuries. • Teen pregnancy rates in some communities in Fraser Health are twice as high as the community with the lowest rate in the province. • Only half of the population most at risk for breast cancer and cervical cancer is screened regularly. • Fraser East 0-24 year olds are hospitalized for injuries nearly one and a half times more than other Fraser Health residents the same age. • Rates of obesity for men and women in Fraser Health are 50% higher than in BC’s healthiest communities. • Residents in Fraser East have higher rates of arthritis, diabetes and depression than the provincial average. Toward Better Health, Best in Health Care reflects our commitment to continually improving the health and health status of our population. We will intentionally work to raise health status in all of our communities to the best performance level within Fraser Health and British Columbia. January 2005 13
  12. 12. The Fraser Health Strategic Plan Why Change? To Improve the Health of Fraser Health Employees, Physicians, and Volunteers Fraser Health employees, physicians and volunteers provide excellent front “Be courageous – make the tough line care and support to the Fraser decisions now that will lead to long term sustainability” Health community every day. Our people are skilled, motivated Key message from Fraser Health physician leaders individuals who are dedicated to providing the best in health care. While working in health care continues to be rewarding, the work environment can be very challenging. Health human resources are under pressure in many areas, and one of the key reasons our health system needs to change is to create a healthier, more sustainable workplace. Shortages of Skilled Labour There is a shortage of key health professionals such as specialized nurses, physicians, pharmacists and therapists. Unfilled vacancies and overtime costs decrease our ability to provide the best care possible to our patients, clients and residents. Fraser Health’s current RN vacancy rate is 4.4%, therefore, we need to hire 350 RNs each year to replace normal voluntary resignations. Added to that, 33% of RNs are over 50 years of age and could retire in 2008 and 18% are over 55 years of age now and could retire immediately. There are currently 100 physician vacancies within Fraser Health. Workplace Absences Cumulatively, absenteeism because of illness or injury has a significant impact on day-to-day operations in Fraser Health. Fraser Health employees currently use approximately 12 sick days per year per full time equivalent. This equals a loss of 100 productive full time employees over the entire year for sick leave alone. Absences due to WCB and long-term disability claims place additional stress on our resources. January 2005 14
  13. 13. The Fraser Health Strategic Plan Morale Organizational change and budget pressures have been difficult for many, and have created a workplace that is often stressful. The challenges faced by the Fraser Health workforce are not unique. A recent national study of work environments surveyed workers in a variety of occupations, including health professionals, teachers, unskilled manual labour and service workers. Health professionals gave the lowest rating on a cluster of factors that related to a healthy and supportive work environment. This survey also showed that health care professionals ranked the lowest of all occupational groups on the four pillars of positive employment relationships: trust in their employer, commitment to their employer, workplace communication, and decision making influence. Health care workers have also had to deal with increasing vacancy rates and stress relating to increased overtime. In 2002, stress related disability claims were only slightly less than claims for back related injuries. Why Change? To Manage Fiscal Pressures Fiscal pressure will continue to be one of the most significant challenges facing Fraser Health. In 2004/05 Fraser Health received a budgeted grant of $1.4 billion (excluding funding from PHSA and MSP), or 18.4% of the $7.6 billion provincial budget allocated to health authorities. The current distribution of resources within Fraser Health is shown in Exhibit 6. January 2005 15
  14. 14. The Fraser Health Strategic Plan Exhibit 6: Overview of Distribution of Resources by Sector for Fiscal Year Approximately 70% of Fraser Health’s resources are currently 2004/05 (‘000s) spent on hospital and residential care facilities. While the strategies outlined in this Plan will shift this balance, it will take time to do so. In the future we expect we will make 2004-05 Expenses by Sector investments in technology and spend a greater proportion of ($000s) resources in the community to support independent living and Continuing Care reduce unnecessary hospitalization. Community $140,702 8.28% At the same time, as the provision of health care becomes more sophisticated, cost pressures continue to increase. Continuing Care • Drug costs, wage and benefit costs, and new Residential $309,793 18.22% technology costs have been rising. • Infrastructure that supports a number of health Acute $866,508 50.98% services, including hospitals and residential care Corporate/Support facilities, as well as medical equipment, is in urgent $195,712 need of upgrading and replacement. 11.51% • The aging and growth of the population will also drive Mental Health $108,575 operational costs up. An increase in the need for 6.39% Strategic chronic disease management and treatment services, Investments/DRP $27,245 Public Health $51,317 as well as assisted living and home support services 1.60% 3.02% is expected. • Shortage of skilled health care professionals leads to higher costs for overtime and sick leave. January 2005 16
  15. 15. The Fraser Health Strategic Plan Through investment in technology and redesign of how Exhibit 7: Summary of Cost Pressures services are delivered, we expect to make considerable gains in productivity. This will mitigate some of the cost pressures outlined above. For example, Fraser Health $ • Clinical service is exploring systems and tools that will streamline the $ redesign booking and scheduling of many services such as Drug costs • • Technology related diagnostic tests and surgical procedures to allow us to • Equipment costs productivity gain manage access to these services in a more efficient and • Aging population • Standardization equitable manner. Significant gains in productivity can • Addressing unmet towards best be made through implementation of these systems, demand practice freeing up resources to reduce waiting times and • Improving access • Appropriate • Patient/ family skillmix increase capacity. expectations • Substitution of subacute, hospice Exhibit 7 summarizes the cost pressures faced by Fraser Health and illustrates some of the strategies needed to address these pressures and maintain a sustainable health system. January 2005 17