Coordinated and accessible services

As part of Northern Health’s focus on primary and community care, interprofessional teams are starting to work closely with family doctors and nurse practitioners across the region. Depending on what a community needs, and the services available, these teams can include primary care nurses, mental health clinicians, physiotherapists, occupational therapists, social workers, pharmacists and other health care providers. Working in collaboration with primary care providers, these teams support care for patients and their families, working towards improving quality of services and health outcomes for residents in the north.

Northwest 

Steps have been taken to move public health, mental health and addictions, and home care services into one primary care program that will better meet the needs of patients.

A new intensive case management team, based in Terrace, is helping people with mental illness or substance use problems. The team works together with other healthcare providers across the northwest to help with client care planning and coordination. 

An opioid substitution treatment clinic opened in Terrace in September 2016. This community service supports patients in their journey through addictions therapy. 

The urology surgical program at Mills Memorial Hospital in Terrace is now able to surgically remove kidney stones using a new laser-based technology. Previously, patients had to travel to Prince George or Vancouver to receive this care. 

Terraceview Lodge (in Terrace) began minor renovations to increase its bed count from 95 to 99 beds. 

At Bulkley Valley District Hospital in Smithers:

• Staff are working to upgrade the main X-ray unit to digital radiography by late 2017.
• Northern Health is also working with the Bulkley Valley Healthcare and Hospital Foundation on ways to fundraise to bring CT services (machine that takes pictures inside the body) to the hospital.
• The updates for the maternity area (caring for pregnant women and their newborns), also supported by the foundation, are almost finished. The four new single room labour, delivery, recovery, and postpartum suites will be ready by mid-2017. 

At the Houston Primary Care Clinic, a family doctor and a nurse practitioner are providing primary care services close to home. Northern Health is actively looking for another doctor to join them.

Prince Rupert has opened an Opioid Substitute Treatment program, which offers virtual care, helping patients through addictions therapy in their home community so that they do not have to travel out-of-town for services. 

Mountainview Lodge (residential and community care) in Kitimat has hired a recreation therapist to provide therapeutic programming (recreation and leisure activities for patients).

Kitimat’s community oncology (cancer) clinic has moved to a larger space in the hospital. The clinic now has three more registered nurses helping patients, and who are also finishing their chemotherapy nursing certification. When they are certified, chemotherapy service will be re-started in Kitimat. 

Northern Interior 

Northern Health is working together with BC Housing, City of Quesnel and local groups to better help clients with mental health and addiction issues and homeless people. BC Housing is going to build a new 30 unit transitional housing facility which will have support recovery beds, crisis beds and transitional housing units.

In Mackenzie, the primary care team has moved into their renovated space next to the doctor clinic. The local baby circuit continues to be popular with young moms and is an excellent example of the benefits of interprofessional care. 

Primary care interprofessional teams are working well together with doctors in Fraser Lake, Fort St. James and Vanderhoof. The teams in Fort St James and Vanderhoof also include community paramedics which has helped to further support people living at home and in community. 

A new Palliative Care room (for end-of-life care) in Vanderhoof was opened at Stuart Nechako Manor in partnership with the Omineca Hospice Care Society. This will help people and their families who need end-of-life care. 

Northern Health is working on a Northern Shared Care Psychiatry Collaboration with the northern Divisions of Family Practice and Doctors of BC. This collaboration is about giving more help to people who have mental health and substance use issues and it will look at how primary care teams (which include health providers like doctors, nurses, mental health and social workers) and specialist services can best work together. 

With the announcement of Prince George Foundry, which is part of a provincial project, Northern Health is working together with other partners to open a special centre for young people (aged 12-24). This centre will bring together different services in one place, including primary care, mental health, and substance use care, social services, and youth and family peer supports. 

Two doctors have joined the primary care clinic at Lakes District Hospital and Health Centre in Burns Lake; they will work with the interprofessional team and nurse practitioners to deliver high-quality to local residents. Also, the Burns Lake Sustainability Project (for primary care) to find and keep doctors in Burns Lake is meeting its goals. Two Practice Ready Assessment - BC doctors have signed up to work in Burns Lake in summer 2017. Four family doctors have been recruited for Vanderhoof and Fraser Lake. All positions for chief of staff and deputy chief of staff (doctors in leadership positions) are filled in the region. 

There is continued support for Carrier Sekani Family Services to provide monthly community visits and telehealth sessions to isolated and remote Indigenous communities. 

Northeast 

Northeast staff continue work on providing primary care (person and family-centred care) for local residents. There are now interprofessional teams in each community. Staff are also being trained to help patients with several health needs so they only have to make one appointment, instead of going to visit different health care providers. Northern Health is also partnering with doctors as part of primary care.

The medical leadership team in the northeast is now complete, with all chief of staff and deputy chief of staff positions filled in the region. Specialist doctor vacancies are almost all filled, and several Northern Medical Program postgraduate and undergraduate learners have been recruited.

The northeast Aboriginal Health Improvement Committee has coordinated the following:

• The Aboriginal Patient Liaison at Fort St John hospital has put together an Aboriginal Community Health resources guide. This booklet will be available online, in emergency departments, health clinics, and from Aboriginal Patient Liaisons. It includes information about services in:

• Blueberry River First Nations
• Doig River First Nations
• Fort Nelson First Nation
• Halfway River First Nation
• Kelly Lake
• Prophet River First Nation
• Saulteau First Nation
• West Moberly First Nations

• The committee has printed patient information cards for northeast Indigenous communities (listed above). This card is a communication tool for Indigenous people who need to go to the hospital, and is especially helpful if there is a language barrier. The card will also help address concerns from recent Aboriginal patient satisfaction surveys, which noted that patients often have to retell their story to over and over when they try to get care outside of their communities.
   
• Naloxone training (treating opioid overdose) has been done in partnership with Indigenous communities.

Work has taken place to support and strengthen the health care team in Chetwynd through team building activities. The primary health care services delivered at the clinic in Chetwynd have helped in hiring two more doctors and fill other community health care positions. Northern Health has partnered with the District of Chetwynd to make sure that local residents have the right information about current health care services.

The Dawson Creek Health Committee is focused on recruiting and keeping health care professionals in the community. Members include mayor and council, doctors, community leaders, non-profit organizations, a Northern Health representative, and others. The group wants to start a non-profit society to help with affordable housing for locum doctors (who visit temporarily), health students and those new to town. The committee is also putting together a ‘Welcome to our community’ package for all new health care providers (including family activities, housing and dining options etc.).

A community cancer care consultation took place in Fort Nelson in December 2016 and the consultation has been shared with the Northern Rockies Regional Municipality, doctors and nurses.

The Nurse Practitioner (NP) program continues to work on its four goals established in 2015. 

a) Northern Health support to nurse practitioners 
b) Respect and understanding of the nurse practitioner role by other staff 
c) Making sure that Northern Health has a stable nurse practitioner work force 
d) Becoming leaders in B.C. on the work that nurse practitioners do in a health authority 

Achievements over the past year include:

• Developed an orientation plan for all new nurse practitioner hires (to help them learn about Northern Health and their new job)
• Having a mentorship program for new hires for their first year of work (connecting with an experienced NP who can offer support and advice).
• Defined the recruitment plan (to hire more NPs), including visits to three universities that offer the NP program: University of British Columbia (UBC); University of Victoria (UVIC); and University of Northern British Columbia (UNBC). The plan also includes attending the annual BC Coalition of Nursing Association conference to help with recruitment.

Milestones:

• Development of relationships with health directors and site managers at the places where nurse practitioners work.
• Ongoing recruitment to vacant positions
• Providing support and mentorship to new provisional Nurse Practitioners (who do not have their license yet). This helps them with finishing their Objective Structured Clinical Examination, so they can get their license.

Northern Health nurse practitioners who got awards in 2016 for their work from the Association of Registered Nurses of British Columbia included:

• Erin Wilson, Excellence in Nursing Practice
• Tracey Day, Excellence in Nursing Advocacy

Indigenous Health supports Northern Health’s commitment to partner with Indigenous peoples and to build a health system that honours diversity and provides culturally safe services. 

The following points show the activities and accomplishments for each priority of the Indigenous Health Operational Plan for the past year (2016-2017). 

1. Implement the Northern First Nations Health and Wellness Plan and related activities

• Partnered with the First Nations Health Authority (FNHA) to work together on four important areas: Mental Wellness and Substance Use, Primary Care, Cultural Safety, and Population and Public Health.
• Partnered with FNHA to have Mobile Support Teams available to help people with mental wellness and substance use. These teams give support, education, and crisis response in Indigenous communities close to Dease Lake, Fort St. John, and Quesnel (Phase 1).
• Partnered with FNHA to have a Mobile Primary Care Team that brings community-based primary care services to four Tsimshian communities (in Northwest BC).
• Partnered with FNHA on a nurse practitioner project to support the work of 14 nurse practitioners serving Indigenous communities.
• Started an Employee Aboriginal Self-Identification initiative in October 2016 that invited all Northern Health staff to self-identify as Aboriginal or non-Aboriginal. This will help us measure how well our workforce at Northern Health reflects the communities of northern BC, and also show any changes over time.
• Partnered with the FNHA to fund 12 Post-Secondary Student Awards, totaling $8,500, for Indigenous students studying in a health-related discipline at a northern BC university or college.

2. Enhance cultural competency and safety in all Northern Health programs and services

• Supported 10 Aboriginal Patient Liaisons (staff), located across the north, to help Indigenous patients and families to get the quality, culturally safe health care services they need.
• Worked with Northern Health staff to participate in the San’yas Indigenous Cultural Safety training. Approximately 35 per cent of staff have done the training.
• Hosted a third annual gathering of all Aboriginal Health Improvement Committees (AHICs) in May 2016; the event’s theme was ‘Growing Cultural Safety’. The gathering brought together community health teams, service providers, and Northern Health staff from across northern BC to share knowledge, reflect on practice, think about possibilities and make even better partnerships.
• Supported the AHICs to continue to develop local cultural resources and to keep doing patient and/or process mapping initiatives.
• Started a webinar series that introduces the eight AHICs across northern BC. The webinars also give information about their communities and cultures, and the local cultural resources that are available.
• Helped Northern Health to participate in a FNHA social media campaign to help people learn more about cultural humility and safety. Activities included promotion through social media, intranet, newsletters, a presentation to Northern Health leaders and several staff teams. Several Aboriginal Patient Liaisons are promoting the campaign in their work places, and the Northern Health executive committee and various staff groups have also made pledges.
• Participated on a number of Northern Health committees and working groups to support culturally safe content and approaches.

3. Undertake knowledge translation activities and initiatives

Developed information materials to: 1) help Indigenous peoples’ get the health services that they need, and 2) support Northern Health staff and health care providers in giving culturally safe care. In 2016-2017 we sent out the following:

• New Indigenous Health website – This website gives information on and is a place to learn more about Indigenous Health for Northern Health leaders and staff, as well as for Indigenous community members and organizations.
• Cultural Safety: Respect and Dignity in Relationships (Indigenous Peoples and the Health Care System) – This five minute animated video introduces cultural safety in a way that is easy to understand. It invites health care providers to help make the health system more culturally safe for Indigenous people and families.
  Cultural Safety: Respect and Dignity in Relationships – This booklet goes with the animated video on cultural safety (bullet above).    
• Sacred Spaces and Gathering Places in Northern Health – This booklet lists the spaces available in Northern Health buildings and grounds for family and community members to gather. It gives contact information for local Aboriginal Patient Liaisons and a regional Spiritual Health Manager.
• What to do with Questions, Concerns and Complaints – This booklet provides clear steps for patients to get their questions, concerns and complaints heard by the health care system. The booklet was updated this year to include information about how to make informal complaints. This report is about the AHIC Gathering held in May 2016.

4. Support and implement evaluation strategies

• An outside evaluation of the Aboriginal Patient Liaison program was started.
• Supported the use of information that Indigenous patients share about their experiences with the health system. This information is collected by Northern Health to help improve health care and service.

5. Undertake administration and program management

• Funded 13 IMAGINE Grants for community projects that support Indigenous peoples’ wellness.
• Partnered with FNHA to fund 31 community-based wellness projects across the north through the Northern Indigenous Community Wellness Funding Awards.

Building on several years of planning, Northern Health has started to put a new approach to care into place across the north. Primary and community care services in the northern region are changing so that services become centred around a person’s health-care needs and their family. The goal is to improve quality of services and health outcomes for patients in the north. 

Northern Health worked with patients, family doctors and other primary care providers, and the First Nations Health Authority in planning for these primary and community care changes. 

In this past year, new interprofessional teams have been formed in various communities. These are teams of different healthcare professionals who help coordinate, plan and provide care. The teams include doctors and/or nurse practitioners to support patients and their families. They can also include primary care nurses, mental health clinicians, physiotherapists, pharmacists, social workers, and other health care providers. 

Healthcare staff at Northern Health are also being trained to help patients with several health needs so that they only have to make one appointment, instead of having to visit several health care providers at different appointments. 

This new approach to providing care also includes the development of a central health record that will keep track of the care that a patient receives over time (instead of having several different electronic and/or paper records). This will help improve patient follow-up and also give health care providers quicker access to patient information in an emergency.

Indigenous communities

Northern Health has partnered with the First Nations Health Authority to help bring mobile support teams to various communities. This includes Mobile Support Teams to help residents in more remote areas with mental wellness and substance use. Mobile Primary Care Teams are now also visiting several communities and delivering primary care services.

Cardiac and stroke care

• Created information booklets to help cardiac patients (and their families) understand what they need to do when they are ready to go home after getting care at a hospital outside the Northern Health region
• Created one form for staff to use for cardiac care referrals (outside the Northern Health region) and updated patient transfer forms to help improve service for patients
• Provided extra education to staff so that they can better support and care for stroke and other patients who need rehabilitation services in the north.

Kidney care

• The Tele-Kidney Care program offers telehealth (appointments by videoconference) to patients across the north. This helps people stay at home instead of travelling out-of-town for an appointment. A recent survey of patients who use telehealth services shows that this has saved patients (and their families) both time and money because they don’t have to pay for travel or take as much time off work.
• Chronic Kidney Disease registration went up by 13 per cent over last year. When patients with kidney disease are diagnosed earlier, they can start regular follow-ups and education sooner, and maybe slow down the progression of their disease. Sometimes, they can even slow down the start of dialysis or not have to do it all.
• Quality improvement meetings have started, with nephrologists (kidney specialists) and the kidney care team working on how to improve patient care.

HIV and Hepatitis C care

• As part of the provincial STOP HIV/AIDS initiatives, $1.59 million has been given to eight community agencies. This will provide HIV education and supports throughout the north, including 23 Indigenous communities.
• A new team is helping to better support people in the north living with HIV and Hepatitis C, including those living in Indigenous communities. This team includes a pharmacist, social worker, nurse practitioner consultant, dietician, and nurse manager.

Cancer care

• The Northern Cancer Strategy plan was completed in 2016. This strategy is focused on improving cancer care in the North for the next five years.
  • Northern Health Cancer Care Patient and Family Counselling is a new service that provides psychosocial care (information and emotional support) for cancer patients outside of Prince George. This includes patients at Community Oncology Network clinics in the north).
  • Staff are working on a project to improve the care that cancer patients get after they finish treatment. This project includes collecting information on cancer cases and people who have survived cancer.  
• The Northwest Breast Diagnostic Program (screening for breast cancer) was started in January 2017 as a pilot test. Information on patients screened in the program will be compared to those who are not.
• New processes for colorectal cancer screening and diagnosis will help improve care for patients.      

Chronic pain 

• Patients shared their experiences and challenges in getting care for pain in our region. Their stories are helping to improve pain care in the north. 
  • A number of self-management BC chronic pain workshops were scheduled in communities across northern BC.
  • A directory of chronic pain service providers and resources was completed for Prince George and for Vanderhoof.    

Working with First Nations Health Authority

• Northern Health met with the First Nations Health Authority (FHNA) to find out how the regional chronic disease programs in the north can give more support to patients by working with local health care providers. In the Northwest, the clinical practice consultant is already working with FHNA to bring chronic disease education and support to local patients.