Overview Fraser Health

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


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


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


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


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


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


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


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


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


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


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


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


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


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


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

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