BC Health: Organised for Team-based Healthcare
Healthcare in British Columbia
British Columbia needs an efficient health system designed for the future, not a legacy system from the past. Our health system struggles to deliver team-based care because the underlying organisational model is obsolete. Although there are exceptions (e.g. acute care), healthcare is currently delivered by ad hoc teams of independent providers (e.g. doctors, physiotherapists, pharmacists) who work with fragmented information silos and struggle with obsolete technology (e.g. facsimile machines). The service model was designed for the days when patients rode horses into town looking for a shingle signifying a doctor’s office, and technology was ink on paper. We’ve added technology (e.g. “digitised the goat paths” with email) and expanded the scope of existing positions (e.g. made doctors responsible for data stewardship) to try to make the system work as a team but it was never designed to do so.
If we want team-based healthcare, we need a health system designed to provide it. Teams have positions, each with a clear role and responsibilities. Modern information and communication technology (e.g. cloud-based systems) enables us to reimagine our health system as a virtual team. Healthcare workers would know their role and have the expertise to meet the responsibilities for their position. They would also know the roles, responsibilities, and levels of expertise for other positions. Everyone would then practice to their full scope as members of a team organised to deliver in-person and virtual healthcare. In other words, they would know their job and they could count on others to do theirs.
To speed implementation, reduce risk, and permit benchmarking, we can base the new BC Health organisation on Ontario Health. Ontario Health serves as a pilot project, which is an effective strategy to manage risk and cost. We learn from mistakes, and the best mistakes to learn from are the ones made by others. We can use also use Ontario Health to evaluate and improve performance of our new health system.
Transformation will result in 76 fewer executive positions, free resources to expand the healthcare workforce, and improve its efficiency. A single, slim-downed executive function will make the health system more agile. Moving from 95 executives to 19 would free up $18M from salaries for reallocation to patient-facing services.
The objective of health system transformation is to improve healthcare, not return funds to the provincial treasury. Any savings from consolidation of executive and supporting services will be redirected to improve and expand patient-facing healthcare services. We need to improve healthcare, not “save money.”
Positions
President and Chief Executive Officer – The most important leadership position. Same as any large organisation.
Patient-facing Services
Executive Vice-President, Population Health. Responsible for Preventive Care and consistent, effective population-level health policy. One policy across BC Health, not one for each Health Authority, will improve system performance and reduce patient and staff frustration. Same as Population Health and Value-Based Health Systems position with Ontario Health. Consolidated across BC Health Authorities. Opportunity to improve care and lower cost.
Executive Vice-President, Emergency Care and Chief Ambulance Officer. Responsible for Emergency Care but not support services. Current position in BC Provincial Health Services Authority. Opportunity to improve care.
Executive Vice-President, Primary and Virtual Care. New BC Health position. Responsible for Primary, Urgent, and Virtual Care. Primary Care is a key focus for BC Health. Better care in the community means less need for, and better outcomes from, Acute Care. Virtual Care will be ramped up to increase reach to patients and to healthcare workers. Healthcare will be pushed out to where and when it’s needed by patients. Virtual systems and processes will enable new strategies to recruit, develop, and retain healthcare workers. Opportunity to improve care.
Executive Vice-President, Acute Care. Responsible for Acute Care and Intensive Care. Reports include Chief of Medicine, Chief Nursing Officer, and Chief Allied Health Officer (Pharmacy, Social Work, Physiotherapy, Occupational Health, Lab and other Technology). Same as Ontario Health. Consolidated across BC Health Authorities. Opportunity to improve care.
Executive Vice-President, Long-term Care. Responsible for Long-term Care. Consolidated across BC Health Authorities. Opportunity to improve care.
Vice-President, Indigenous Health. Coordinates healthcare with First Nations Health Authority, a health services organization with another order of government. Consolidated across BC Health Authorities. Opportunity to improve care.
Regional Lead, North
Regional Lead, South
Regional Lead, Greater Vancouver
Regional Lead, Vancouver Island. New Positions. Ensures that BC Health understands and responds to unique regional needs. Ontario Health calls them the “front doors” to communities and people across the province. Opportunity to improve care.
Support Services
Vice-President, Clinical Institutes and Quality Programs. Evidence-informed clinical standards and practices that are consistent across the province. One set of practice standards, not one for each Health Authority. Same as Ontario Health. Consolidated across BC Health Authorities. Opportunity to improve care and lower cost.
Vice-President, Planning, Transformation, and Chief Health System Architect. New BC Health position responsible for organisational change. Responsible for design, integration and alignment of BC Health services with objectives and outcomes, and for performance measures that ensure BC Health is accountable to patients, staff, and the public. Expanded role for Health System Performance and Support position with Ontario Health. Opportunity to improve care and reduce cost.
Vice-President, Information Management and Technology Services, and Chief Information Officer. Virtual teams need virtual systems. Secure, reliable, and efficient information, communication, and medical technology is critical to healthcare service delivery by a virtual healthcare team. Expanded role for Digital Excellence in Health position with Ontario Health. Opportunity to improve care.
Vice-President, Finance and Chief Financial Officer – Same as any large organisation. Consolidated across BC Health Authorities. Opportunity to improve efficiency and reduce cost.
Vice-President, Human Resources – Healthcare is delivered by people. Works with executives and managers responsible for health service delivery to advance plans and strategies to recruit, retain, and develop the healthcare workforce to meet current and future needs. Consolidated across BC Health Authorities. Opportunity to improve care.
Vice-President, Real Property and Facilities Management. New position responsible for healthcare facility strategy. Healthcare facilities are specialised and expensive. Funds spent on unnecessary overhead are funds not spent on patient care. Provides shared, standardised facilities that enable safe and efficient delivery of services by healthcare teams. Opportunity to improve care and reduce cost.
Vice-President, Communications and Engagement. Responsible for informing patients, staff, and the public about BC Health services, performance, and plans. Same as Ontario Health. Consolidated across BC Health Authorities. Opportunity to reduce cost.
Legal Counsel – Same as any large organisation, including Ontario Health and BC Provincial Health Services Authority.
Road Map
Transformation of the provincial healthcare system is a massive project that will take time, resources, and leadership. A gated approach manages risk.
Gate: Obtain approval for Opportunity Evaluation
Phase I – Opportunity Evaluation
Create BC Health Project Team. Hire Project Director, BC Health. Chief Health System Architect, and Project Manager. Staff Communications.
Freeze hiring by Health Authorities of executives, managers and support services staff. Hiring of these positions requires approval of Project Director, BC Health.
Develop transformation plan and budget. Consult with Ontario Health to develop plan and budget for transformation.
Gate: Obtain approval for Transformation Project
Phase II – Deliver Transformation Project
Project Status and Outlook
If you made it through this post, congratulations! Organisation design is tough sledding, and I don’t have a to story bring it to life. Once we have a single leadership team and a team-based organisation in place, we can deliver team-based healthcare. The next post will show how we can address the crisis in primary care, relatively quickly. A bold claim, I know.
We now have:
Performance Measures and Improved Accountability to Patients and Healthcare Workers
Improving Primary Care with improved Information Management
A New Day in Primary Care (story)
Streamlining the Health Organisation
Putting the Pieces Together (story)
BC Health: Organised for Team-based Healthcare
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