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

Establishing the Strategic Directions

This board clearly articulated its commitment to integrating care and services across the region, and understands the need to demonstrate quality care. Although members express divergent opinions on some issues, this is both normal and healthy and facilitates genuine discussion. Encouragement is offered to consider having affiliate organizations represented at the board level.

Inglewood Lodge and Private Hospital, (Inglewood Care Centre) has seen a major change in its clientele and is successfully adapting to changing needs across the region. Leadership is very positive about the growing interaction and integration at the regional level, and also shows enthusiasm for developing partnerships for long term and geriatric care. There is support for finding solutions through collaboration and co-operation.

Community needs are well known, including those which are still outstanding. for example, the issues of homelessness and clients with HIV/AIDS and how these needs are being addressed through planning activities. The board liaises with two aboriginal communities in the region. However, having these represented at the board level has proved unsuccessful thus far.

Community health profiles are completed every two years through extensive community consultation. There are five population advisory committees in place to advise the board on a quarterly basis. Public forums are held annually and four times each year, the public has opportunity to make presentations at the board meetings. 

Mission, vision and values have been combined into one “purpose statement”. In order to test the values which emphasize team work and quality, and are the foundation of the statement, group sessions with physicians, staff, and the public were held. The statement was recently introduced, is readily visible across the region and available in brochures and posters. Although staff are aware of NSHR’s new direction, this may not have reached the front lines, and the statement needs to be more widely communicated.

Strategic directions have resulted from numerous reviews of the organization over the last two years. Five strategic directions or goals are in place. It is suggested that time lines be attached to the goals to facilitate review and evaluation of progress regarding their implementation. ILPH’s (Inglewood Care Centre)  strategic plan fits well with NSHR’s strategic directions. There is much evidence of team work, physician and staff involvement, and a strong commitment to quality care and service. Managing risk is a component of the overall quality improvement process.

The board has established a human relations committee and states that this will not interfere with management activities. It is suggested that the board review the work of this committee in one year to determine its relevance and whether any overlap with management is occurring.

Partnerships are established with the North Vancouver district, the various colleges and universities, and with the B.C. Housing. NSHR has a municipal and school board liaison group. There is also liaison with the Ministry for Children and Family, First Nations, and other agencies and organizations including affiliate organizations. The board fully supports community development of programs and has demonstrated this by approving the community development worker role.

The board has demonstrated its support for quality monitoring and improvement by approving a staff position dedicated to being a resource across the region. The board has also embraced the concept of the balanced scored card to facilitate tracking and trending in all programs and departments. Opportunities for improvement that are related to governance were identified during the self-assessment process, and the board intends to develop some indicators to monitor performance. Education on developing and applying indicators would be of benefit to the board and all levels of staff, and encouragement is offered to secure this education for all.

Recommendations:

4. The board is very cognizant of the organization’s historical difficulties, and is recognized for its efforts to promote NSHR as a caring, values driven organization. The board is also attempting to encourage accountability downward. Currently, there is an active ethics committee but the board has little knowledge of its functions and no involvement in its deliberations. For the board to meet its ethical accountabilities, a review of the existing committee and membership is required. It is, therefore, recommended that the board review options for this committee, and develop, implement and approve a specific process for dealing with ethics issues at the board level. (See Draft Standards for Comprehensive Health Services, 1997, Establishing the Strategic Directions, 6, 6.2.)
   
5. The board has established a quality improvement committee and the framework for a process across the region is formulated but not yet fully implemented. The board will receive reports from the board quality committee and it appears that the process for providing feedback to the front line has yet to be developed. Many teams are demonstrating good quality improvement efforts and require specific feedback. It is, therefore, recommended that the necessary processes, including fiscal, human and education resources be implemented across the region to support NSHR’s quality improvement program and framework. (See Draft Standards for Comprehensive Health Services, 1997, Establishing the Strategic Directions, 12-13.1.)
   
6. The implications of research proposals and projects are reviewed by the B.C. Health Care Risk Management body. Although there is effective management of risks at the front line, the board appears to have confined itself to issues which might become legal matters. An element of quality improvement requires that processes rated high risk, high volume or problem prone receive priority attention. The board must assume accountability for quality and risk and is encouraged to become proactive in this regard. It is, therefore, recommended that a risk management process be developed and implemented to ensure that the board receives reports on risk related issues, including any corrective planning done or in process. This way, the board will not only assure itself that risk is managed, it can also be prepared for action and follow up. (See Draft Standards for Comprehensive Health Services. 1997, Establishing the Strategic Directions, 14, 14.1.)