SECTION 2
Client Care and Service
Community Focused
Continuing Care
Emergency/Trauma
Maternal, Child & Youth
Medical Care
Mental Health
Palliative Care
Specialized Intensive Care
Surgical Care

SECTION 3
Support Services
Information Management
Human Resources
Physical Environment

SECTION 4
Leadership/Partnership
Strategic Directions
Implementing Strategic Directions

This is a strong team which benefits from having consumer representation. The team’s quality and risk management focus and integrated approach are key strengths. The new program management structure has moved reporting for most clinical services into three broad based areas: environmental health, community facilities licensing, and communicable disease control. Encouragement is offered to strengthen links to the new program management structure. There is also a strong primary care promotion and prevention initiative through community development and advisory groups. Occasionally, this has lead to going beyond legislated mandate and providing programs that improve the community.

There are strong links to other organizations who work in communities. Links with general practitioners are being strengthened through an open line to the medical officer of health, and communication boxes at the acute care sites. Information sheets outlining services available have been developed by the medical director. Consistency in programs and services is being promoted through partnering with other medical officers of health in the province, and with the cities of North Vancouver and West Vancouver. Issues identified through regulatory accountability are addressed as projects and opportunities to educate and support community needs.

Each of the three core areas has a central intake line and response varies according to need. Good strategies are in place to facilitate easy access to all regulatory areas. When needs are identified every effort is made to respond and examples include Hepatitis B immunization, smoke free communities, education programs for food handlers. and support for parents who care for HIV/AIDS children. Partnerships are formed to promote needed services, for example, working with a municipality to provide special housing in return for day care services, and bylaw regulations to support healthy behaviours such as no smoking.

Overall, informed consent is done well but can present a challenge in unusual circumstances such as the need for standing orders to quickly activate influenza immunization and prophylaxis in nursing homes. Although the team is fully aware of its regulatory function and authority, it also promotes a partnership approach with pre­schools, elderly care centres and restaurants.

Two full time community development workers are very active in involving communities at all levels, and recognition is given for the consensus building approach and respect shown for differing opinions. There is strong community support through volunteers and donations. There is every indication that integrated program structures will strengthen the individual community services and programs that are offered. There are no formal links with physicians except through administrative channels. However, interest appears high and these channels should be further pursued as opportunities exist at the primary care level.

The team reviews the latest evidence on population health approaches and when indicated will make changes. A decrease in the incidence of tuberculosis lead to a reduction of testing children. When evidence showed that health care workers are prime carriers for influenza into care centres, funding was successfully obtained to offer a free immunization program.

Good indicators are in use to monitor each aspect of programs and services provided within the three core areas. Improvements through quality initiatives are being sustained. Generally, risk is very well managed. First Nations, however, are not that receptive to regulatory functions and this is a potential risk issue, especially for day care facilities. Recognition is given for monitoring this and taking a balanced approach.

This interdisciplinary and knowledgeable team is working in a coordinated way to provide a wide range of programs and services for clients. The team has identified younger people with disabilities as a possible unmet need. Long term care is offered in the acute care setting and at four continuing care facilities. Community programs include geriatric outreach, emergency response, adult day centres, home support and congregate housing.

There is a central intake process in place for home care services. As yet there is no single entry point for long term care and each site maintains its own wait list. There is a residential facility assessment tool, and clients designated as “emergency’s receive priority for placement. Community health councils will interact with clients and families while they wait for a bed and will provide educational material to support them. Efforts are under way to minimize duplication in the assessment process and note is made of the tool currently being piloted to minimize duplication of assessment information.

Effort is made to ensure consistency in the quality of care and services. Following an examination of the region’s aging population two plans were developed, one for seniors services and one for long term care facilities. Clients and families were surveyed to determine level of satisfaction with admission processes with positive results. There is good orientation to facilities, units and routines. Clients are thoroughly assessed by the interdisciplinary team during the first few weeks, and a care conference is held within six weeks of admission.

Documentation is comprehensive and complete and includes informed consent. Issues of duplication of information are being addressed. Interdisciplinary collaboration is good at all sites and is strongest at Evergreen House because of the complex nature of its clients. Resident and family councils are well established, active and meet several times a year. Clients and families are encouraged to become involved in all aspects of care and service. Support is given to the plan to adopt an enhanced abilities approach to care planning for implementation across the region.

Recognition is given for the progress made in standardizing protocols and use of clinical practice guidelines. A clinical nursing group is working on pain management and wound management guidelines. Directors of care meet monthly to share and promote consistency in care processes for all sites. The quality and consistency of care for elderly clients on acute care services who are awaiting placement is a concern. This relates primarily to decreased staffing and increased acuity of these clients, and requires monitoring.

The team has prioritized wait list management and discharge planning as issues for improvement. An area currently being explored is improving alternative housing options. Quality improvement initiatives include the falls prevention program, infection control, and dementia care. Program management is also viewed as a quality improvement initiative. Indicators are in use and the intent to develop some wellness indicators is encouraged. A minimum data set of 30 quality indicators is used as part of the assessment process.

Risks are managed within the confines of client’s right to risk. The dysphasia protocol, for example, allows clients choice of diet even if it is considered a risk. Staff receive training for dealing with aggressive behaviors. Each client is assessed for possibility of elopement, and security has been increased in facilities where dementia is an identified concern.