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COMMUNITY CONSULTATION

SUMMARY REPORT

HEALTH SERVICE DELIVERY at the

VICTORIAN COMMUNITY HEALTH CENTRE OF KASLO

May 2013

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COMMUNITY CONSULTATION SUMMARY REPORT

HEALTH SERVICE DELIVERY

at the VICTORIAN COMMUNITY HEALTH CENTRE OF KASLO

Table of Contents

Executive Summary Page 3

Background Page 4 Consultation Design / Consultation Process Page 5 Focus Group Summary Page 7

Future State Workshop Summary Page 8 Next Steps Page 9

Appendices

Appendix A: Public Service Announcement March 14, 2013 Page 10

Appendix B: Focus Group Questions Page 12 Appendix C: Focus Group Summary Package Page 13 Appendix D: Workshop Invitation Page 21

Appendix E: Workshop Agenda Page 22 Appendix F: Workshop Discussion Summary Page 23

Appendix G: Workshop Participant List Page 27 Appendix H: Steering Committee Membership Page 28

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Executive Summary

An extensive community consultation process took place in the Kaslo area in the spring of 2013 to explore stakeholder interests in service delivery at the Victorian Community Health Centre (VCHC) of Kaslo. Interior Health, the Village of Kaslo and the Regional District of Central Kootenay supported this process. The concept of broad community consultation stemmed from work that began in the fall of 2012 after Interior Health proposed a plan to address frequent service delivery challenges at VCHC due to difficulties in securing stable physician and nursing coverage. The plan incorporated a reduction in Emergency Department hours of service from 24/7 coverage to weekday daytime service. There was widespread concern with a potential reduction in emergency department hours. The Kaslo and Area Health Care Work Group was formed to pursue discussions with Interior Health. Together it was

determined a community consultation process was critical to engage various stakeholders and members of the public in discussions around health-care services and service delivery, which would assist in developing a sustainable plan for the future. A Steering Committee was formed to design the consultation process which included two Kaslo community members and a number of Interior Health staff. Interior Health also engaged the services of two consultants: Linda Tarrant, an expert in collaborative strategic planning, and Dr. John Ross, a Canadian expert on rural emergency care. The consultation process involved over 260 people in focus group sessions, meetings and a workshop that were held during March and April 2013 in Kaslo, the Lardeau Valley and Nelson. The process produced valuable insight into community challenges, priorities and areas of potential service improvement. Over the coming months Interior Health will undertake a planning process using all of the information gathered, as well as a report on emergency service delivery options prepared by Dr. Ross. The objective is to develop a community health centre model that is sustainable in terms of fiscal and human resources, meets the health needs of area residents and can be used as a potential guide for other small and remote sites experiencing similar service delivery challenges. Interior Health recognizes the importance of ongoing community engagement and will keep the Kaslo and Area Health Care Work Group informed and involved as progress is made. It is expected the model will be

brought back to this group for discussion and feedback in the fall of 2013.

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Background

Kaslo is a relatively isolated community in the Kootenay Boundary, approximately 70 kilometres north of Nelson (one hour travel time). The village population is approximately 1,025 (2011), however the area population is closer to 2,500 when including the surrounding smaller communities. The Victorian Community Health Centre (VCHC) of Kaslo provides a variety of primary health-care services

and operates a 24/7 Emergency Department (ED). Physicians provide daytime ED coverage from their onsite offices and after-hours on-call service, supported by RNs who staff the attached 20-bed residential care facility. Kaslo is allocated funding for 2.0 physicians FTE (full time equivalent) which has typically been a mixture of physicians on contract and locums. While this is considered adequate to meet the primary health-care needs of the population, 2.0 FTE is not considered sustainable for 24/7 ED coverage. The ED is a low volume site, reporting a total of 1,003 unscheduled visits in 2011/12. VCHC experienced recurring human resource challenges in 2012 (physician and nursing) which led to a significant number of service interruptions (where the facility was either on diversion to Kootenay Lake Hospital in Nelson due to the lack of physician coverage, or where an RN was on call but not on site at VCHC). During the spring and summer of 2012 several discussions occurred with the Kaslo physicians regarding their inability to provide ongoing 24/7 ED coverage due to workload concerns. Interior Health formed a working group to examine the best way to provide quality emergency care to area residents. Discussions were informed by a thorough review of ED volumes, patient acuity and transport statistics. Emergency Services and Primary Care It was determined that a weekday ED service, together with a robust primary care service model, would be the most appropriate means to provide consistent and reliable care to the community. In order to address concerns about the reduced access to emergency services, and the need for enhanced transport services, Interior Health worked with BC Ambulance Service (BCAS) to develop a proposal to introduce Advanced Care Attendants (ACAs) at VCHC who would combine the skill set of paramedics and nursing aides. They would perform as IH staff while on duty at VCHC, and be released to BCAS to respond to 911 and ambulance transfer duties as an employee of BCAS. On September 13, 2012 senior Interior Health staff held a meeting with Kaslo Mayor Greg Lay and Regional District of Central Kootenay (RDCK) Director Andy Shadrack to outline current staffing challenges and plans to reduce Emergency Department (ED) hours at VCHC from 24/7 to daytime weekday service, effective October 1, 2013. VCHC staff was informed the same day, and a community-wide public meeting was held that night. The community was clearly concerned with the plan to reduce ED hours of service and felt Interior Health should have engaged the community in discussions much earlier. The Kaslo and Area Health Care Work Group was formed with community representatives selected by Mayor Lay and RDCK Director Shadrack. Working with Dr. Alan Stewart, IH Senior Medical Director, Community and Residential Services (now Executive Medical Director) and Linda Basran, Community Area Director, IH East, the group determined that a community consultation process was critical to engage various stakeholders and members of the public in discussions that would assist Interior Health in developing a sustainable model of primary and emergency care. A Consultation Steering Committee was formed to oversee the design and implementation of the consultation process. (See Appendix H: Steering Committee Membership)

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Consultation Design

The Consultation Steering Committee met in Kaslo on March 11, 2013 to plan and design the consultation process. Two guiding principles were agreed upon:

1. opportunities for stakeholder and community-wide input should be maximized 2. the consultation discussion should include the delivery of emergency and primary care services

An extensive consultation process was developed that included several community-wide and stakeholder focus groups, a transportation-focused meeting, and a follow-up workshop. Six questions were developed to ensure community priorities in both emergency and primary care areas would emerge. It was envisioned that the outcomes of the Kaslo consultation process could assist Interior Health in the development of a new model of care, one that could potentially be used as a guide in other small, rural sites

experiencing similar service delivery challenges. Consultation Process

Eight two-hour focus groups were held Sunday March 24th through Tuesday March 26th attracting approximately 220 people. Specific sessions were held for:

elected officials and business representatives

residents of the Lardeau Valley at the north end of Kootenay Lake

VCHC staff and physicians The other five sessions were community-wide; area residents were able to attend more than one session. Members of the public were notified by a Public Service Announcement to area media (see Appendix A), an ad in the Pennywise publication, posters at VCHC, e-mail and telephone. In addition to attending the eight focus groups, Dr. Ross met individually with a number of VCHC staff and physicians, and participated in a meeting with BCAS personnel, IH Transport Services and members of the Interior Health High Acuity Response Team (HART) based in Trail. All focus groups began with an introduction by Maggie Winters of the Kaslo and Area Healthcare Work Group, an overview of the consultative process by Linda Tarrant and comments from Dr. John Ross on his experience redesigning rural emergency care in Nova Scotia. Participants then broke into small groups to discuss a variety of topics such as expectations for local health services, access to those services, current challenges and future service sustainability. (See Appendix B: Focus Group Questions) All discussion points were gathered in written format on flip chart paper and posted on the walls at each session. A dotmocracy exercise enabled participants to identify areas they felt critical to the success of developing sustainable health services in the area.

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Focus Group in Lardeau Valley Community Hall Focus Group in Kaslo Legion Hall

March 24, 2013 March 25, 2013

Dotmocracy Exercise

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Focus Group Summary

All written responses to the focus group questions were transferred word-for-word into electronic format and organized into themes. (See Appendix C: Focus Group Consultation Summary Package) Six major themes emerged:

1. Access to 24 hour emergency care

a. Strong interest in seeing stable 24/7 emergency service b. Interest in exploring different staffing models i.e. physician accessible via telephone c. Readiness to explore integration with BCAS, with off-site physicians

2. Quality and continuity of primary care

a. Clinic hours should expand to improve physician access b. Need for collaboration with alternative health-care providers c. Area residents need more information on clinic services, health promotion and disease

prevention d. Suggestions that lab and diagnostic imaging services be more accessible

3. VCHC and staff training/education

a. Increase training for advanced clinical skills, make it ongoing b. Increase training on communications and customer service c. Consider how to use other health-care professionals d. Review staffing patterns

4. Community Engagement

a. Need to build trust and relationships b. Community wants to be involved in planning and decision making

5. Transportation

a. Need for improved ambulance service – include Lardeau Valley b. Need for Advanced Care Paramedics c. Improve HART access to Kaslo d. Need for more transportation options

6. Use of technology

a. More teleconference and video conference options with doctors and specialists b. More information should be on the VCHC webpage on the Interior Health website

c. Lardeau Valley residents should be eligible for more telephone consults

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Future State Workshop Summary

A day-long workshop was held on Monday April 22nd in Kaslo to pursue further discussion on the six major themes identified in the focus groups. Participants were selected to ensure a cross section of community interests, VCHC service areas, partners such as BCAS and physicians, and key IH staff. Forty-one participants were invited; 40 were able to attend. (See Appendix G: Workshop Participant List) After presentations from the consultants and Interior Health, participants self-selected into small groups according to their interests, moving between groups as they wished. Participants were asked to identify challenges, think creatively and develop suggestions to assist in developing consistent, quality health-care services in Kaslo. (See Appendix E: Workshop Agenda) The six groups then reported back presenting their suggestions to enhance both primary and emergency care services at VCHC. A number of valuable ideas were brought forward. (See Appendix F: Workshop

Discussion Summary)

Future State Workshop April 22, 2013

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Next Steps Over the next several months Interior Health will undertake a planning process informed by the information

gathered through community consultation, and a report from Dr. John Ross on emergency service delivery. The objective is to develop a community health centre model that is sustainable in terms of fiscal and human

resources, meets the health needs of area residents and can be used as a potential guide for other small and remote sites experiencing similar challenges. Interior Health recognizes the importance of ongoing community engagement and will keep the Kaslo and Area Health Care Work Group informed and involved as progress is made.

It is expected the model will be brought back to the Kaslo and Area Health Care Work Group for discussion and feedback in the fall of 2013.

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APPENDIX A

PUBLIC SERVICE ANNOUNCEMENT

For Immediate Release | March 14, 2013

Kaslo Community Consultation Sessions

KASLO – Interior Health will hold a number of community consultation sessions March 24 th through March 26th to engage area residents in productive dialogue around sustainable health-care services associated with the Kaslo Victorian Community Health Centre.

Area residents are invited to attend the sessions outlined below: Sunday March 24th North Kootenay Lake residents Lardeau Valley Community Hall in Meadow Creek 5 p.m. – 7 p.m. Please pre-register to ensure adequate seating is available. Phone: 250-366-4452 Monday March 25th Tuesday March 26th Kaslo Legion Hall Kaslo Legion Hall 10 a.m. – 12 p.m. 7:30 a.m. – 9:30 a.m. 12:30 p.m. – 2:30 p.m. 10 a.m. – 12 p.m. 7 p.m. – 9 p.m. 2 p.m. – 4 p.m. Please pre-register: E-mail: kaslofocusgroup@gmail.com Phone: 250-353-2083 Focus groups will also be held with elected officials, physicians and health centre staff. “We are pleased to see the community consultation process moving forward,” said Dr. Alan Stewart, Senior Medical Director for Community and Residential Services. “This is a terrific opportunity to learn from the community, our physicians and staff about their priorities, their values and how we can best meet Kaslo’s health-care needs given the ongoing human resource challenges we are facing.”

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Linda Tarrant, an expert in collaborative strategic planning, will facilitate the focus group discussions. Dr. John Ross, a Canadian expert on rural emergency care, will also consult with health-care professionals and assist Interior Health in developing a sustainable model of emergency care. Kaslo residents Maggie Winters and Maggie Crowe have been instrumental in designing the consultation process which will include a full-day workshop in April when elected officials, community representatives, physicians and Interior Health staff will come together to clarify priorities and develop suggestions for sustainable health-care services in Kaslo. “Our goal is to provide Kaslo residents with consistent, sustainable, quality care,” said Stewart. “We look forward to the focus group discussions and how they will inform our decisions moving forward.”

The community will be kept informed and involved as the consultation process unfolds.

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APPENDIX B

Community Consultations: Victorian Community Health Centre of Kaslo

External Focus Group Questions

1. Identify 2-3 key expectations that you have for health services in Kaslo and area.

2. Thinking of how you and/or your family have accessed both scheduled and unscheduled health services of VCHCK in the past, what worked well? What could be improved?

3. There are challenges to keeping the health centre open 24/7. How do you think we could best address those challenges?

4. How can we improve the community’s understanding of how to best access primary care and

emergency services?

5. What are your main concerns about changes to future health services? 6. After all of the comments that you have heard, what factors will be key to the success of developing

sustainable health services in this area?

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APPENDIX C

CONSULTATION SUMMARIES KASLO AND AREA

FOCUS GROUPS MARCH 24 – 26, 2013

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APPENDIX C

Question #1

Identify 2-3 key expectations that you have for health services in Kaslo and area.

Theme 1: Services delivered locally (58 responses)

Lab/x-ray (14); more frequent, mobile service

Specialists come to Kaslo

Alternate/complementary providers; NP. PA, working with doctors

Ability to stay in the community for services: Home care, palliative, extended care

Theme 2: Emergency room coverage (50) Does not have to be an MD; skilled, qualified personnel, NP, paramedic; revisit Nurse First Call, nurse

call doctor; Dr. on call or on site – doctor does not need to be the gatekeeper,

Stable, reliable hours

24 hours – we are isolated, remote and nothing less will do (20 responses but only one specified that a doctor needed to be on site)

Theme 3: Continuity of care (39) Be able to see the same doctor, develop a personal relationship

Continuity of doctors

Access to care sooner, in person or by phone or technology

Evening & weekend clinics; reasonable times for clinics, be able to see a doctor in 2-3 days

Better communication between doctors and alternative care providers

Theme 4: Training & Education (22) Increase training of staff; we need high quality, competent staff

Cross training for greater efficiency

Educate the public – prevention, nutrition, know the limitations of the Centre, when to use ED Theme 5: Community & Interior Health (22)

Enhance two-way communication between the community and the health system; listen to the community and act on our suggestions; transparent dialogue

Fewer administrators; big bureaucracy; spend money on services not admin

Need local leadership, autonomy and funding control

Need an effective network of regional services; better coordination; stable health services

Theme 6: Transportation/Ambulance/First Responders (18)

Need reliable public transportation; medical services bus NKL to Kaslo

Need well trained ambulance staff, more/improved services Integrate ambulance services with the rest of the health-care services

Better communication between community, emergency, fire, police, first responders

Use telehealth/video to access expanded services

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APPENDIX C

Question #2

Thinking of how you and/or your family have accessed both scheduled and unscheduled health services of VCHCK in the past, what worked well? what could be improved?

What’s working well:

Access to male and female physicians

Physicians available to discuss test results over the phone Team work at VCHC, including physiotherapist

Teleconferences and videoconferences with other health care providers outside of Kaslo

Community Pharmacist now providing more services

What could be improved? Theme 1: Clinic/physician access (37/163 comments)

Extend clinic hours/ walk-in clinic hours (takes too long to see a physician)

Physicians are pulled from clinic appointments to the ED, patients are left waiting when they had a scheduled appointment

Reception staff could benefit from additional training in scheduling, customer service as they are the ones deciding on urgency when someone needs to see a physician

Should be greater flexibility in terms of who patients can see for follow-up appointments (use nurses more)

More x-ray service (can nurses be trained to do x-rays?)

Theme 2: Transportation (12 comments)

Need assurance ambulance is always available

BCAS needs to know their way around

First responders need better training and equipment HART in Trail is too far away

Need medical services bus serving north end of lake and even Nelson/Trail

Theme 3: Lab concerns (11 comments)

Appointment cancellations without notice are a problem

Logistics around lab processes should be looked into (requisitions & results)

Better access needed (can nurses take blood samples?)

Theme 4: Consistency of care (6 comments)

Need consistent coverage to build relationships

Different doctors have different ideas about care plans/treatment – leads to conflicts Consistency would allow for more telephone consults

Theme 5: Communications (4 comments) Phone book listing for VCHCK needs to be easier to find

More local info needs to be provided regarding services available such as baby clinics, flu shots etc. – front desk staff need more information too

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APPENDIX C

Question #3:

There are challenges to keeping the Health Centre open 24/7. How do you think we could best address those challenges?

Theme 1: Staff Professional Development (34 out of 230 comments)

Leverage staff already in Kaslo by providing targeted additional training. Use all health-care professionals including community Pharmacist to their full scope of practice

Enhance paramedic training and roles

Training should also focus on team development, relationships, communication

Offer incentives for local people to be trained in the helping professions; bursaries Theme 2: Use technology (21)

Provide dynamic web page with up-to-date information; e-mail notices of important issues; better communication with the public (9)

Teleconferencing to connect remote physician with Health Centre staff when needed – establish protocols and liability managed; consider a sister hospital elsewhere in a different time zone to reduce problem of night call

Consider linking Lardeau Valley, others for regular teleclinics and follow-up (see theme 3) Theme 3: More community-based input and design of Health Centre services (18)

Understand the specific rural area; try to keep people close to home

Create and deliver services specific to the needs of the community

More evening or weekend clinics to reduce ED demand (9)

Consider providing a small residence for part-time, casual, and locum staff Theme 4: Add a Nurse Practitioner to the Health Centre staff (12) Theme 5: Simplify employee contracts (8)

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APPENDIX C

Question #4:

How can we improve the community’s understanding of how to best access primary care and emergency services?

Theme 1: People want more information about what’s available (87)

Many people understand the difference between the clinic and ER Improve understanding with posters, local press, BC nurse line, update web site, newsletter from IH

Fact sheets to homes re: hours, services available & phone numbers

Theme 2: Need to repair trust (7)

Better communication between health centre & community & IH and everyone

Lots of work to build trust, with IH and doctors

Confidentiality

Theme 3: Integrate services and use technology (7)

Need a regional ombudsman to help navigate the system Better coordination between local and distant providers Satellite services, more authority to support staff, regional doctor field calls from RNs & others

a) use internet for appointments (Skype)

b) better referral to alternative services by doctors

Theme 4: Access to doctor and clinics (6)

Use doctors in expanded hours, not emerg Primary care and doctors appointments more available People know how to use emerg but if we can’t see a doctor for 6 weeks, we go to emerg No one knows about the Rapid Access clinic

Other interesting comments about using local volunteers and 911 operators:

Need maps of rural roads, fire numbers, names of first responders Encourage people to know how to use fire numbers and access first responders More training for 911 and dispatchers – know our geography

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APPENDIX C

Question #5:

What are your main concerns about changes to future health services?

Theme 1: Positive comments about the future

We want a coordinated team (docs, nurse, admin, EMS, holistic medicine) - client/patient centered – not MD focused. Teamwork is key.

More access to primary care, prevention and staying healthy.

We want to maintain/grow home care.

Changes are good as long as they improve our services.

We want confidence in the system to provide our medical needs. Theme 2: Patient quality and accessibility of care in Kaslo (102 comments)

Aging population requires access to care; baby boomers overwhelming our taxed system.

Losing our ER – closure of services

Not now having a ―golden hour‖ for stroke care

Not having enough home care (nursing, housekeeping, socialization & palliative care)

Loss of chronic care services It is too far to go to Nelson, Trail, Kelowna and Vancouver. Transportation is costly and a hardship on

an ill person. We pay the same for benefits and get less access to care? Theme 3: IHA/Communication and trust (110).

Will IH listen? Fear that our public input may fall on deaf ears.

Need a higher level of transparency (reporting) and accountability (commitment).

Need annual reporting process? There are concerns about government in power, priorities, oppositions, relationship between

gov/IH/unions and health-care stakeholders being open and accurate.

Can IHA cull its overlarge bureaucracy? Admin must be streamlined.

Theme 4: Staff and paramedics, recruitment, retaining and respect of staff (40)

We want money to go into training, not admin.

Lack of reliable ambulance service, ―paramedic pay is abysmal!!‖ RNs and staff are working part time now, not being hired full time, is IH really saving money in the long

run?

Already we have volunteers doing work that skilled employees should be doing.

Theme 5: Keeping and attracting seniors, families and industry (27)

Our seniors will leave the community in the future due to the current and future condition of services.

The current care needs to be maintained and or improved so that people want to stay living here from cradle to grave; industry won’t come without services

Young families are not wanting to and will not want to move to our community without an ED.

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APPENDIX C

Question #6:

After all of the comments that you have heard, what factors will be key to the success of developing sustainable health services in this area? Note: Each participant in each focus group was given three dots to identify their top priorities. The numbers in parentheses represent the total number of dots that each theme received. Theme 1: Need for dedicated staff to be working to their full scope of practice (130)

nurse practitioners

doctors who understand the community paramedics

full time nurses/doctors who are happy and want to work here

Theme 2: Be willing to try new ways (65)

Be creative, innovative, look at new ways of doing things, open to new alternatives, let go of the past

be open to different staffing patterns, be flexible

break down barriers to silos, use alternative care providers

Theme 3: Sustainable funding (64)

Put the funds into patient care not administration

incentive programs for doctors and staff

restore programs that have been cut or reduced (home care)

keep services in Kaslo, stable ER Theme 4: Community Involvement/Education (60)

keep the community involved in decision-making affecting our services

good communication, inform us of up-coming changes, collaboration

emphasize prevention and education about how to best use services (ED)

Theme 5: Training/Education (46)

continuous professional development train medical staff

train home care staff Other comments: a. We need to work together better, teamwork b. We need to work more cooperatively with IH – they need to listen to us, respect us, honest communication c. We need good transportation & ambulance service d. We need to use technology to deliver better care

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APPENDIX C

At the end of each focus group session participants were asked to note anything that had not previously arisen in the conversation.

Question #7: One last thing you’d like to say…

Theme 1: Quality and access to care (29)

We need more services: home support, extended care, transportation, respite, short term acute, end of life, lab services in Meadow Creek

Longer clinic hours – evenings and weekends

Real food, bought locally, exercise Coordinated bookings, follow-up care

Shorter wait time for specialists

Doctors make house calls

Theme 2: Be willing to change and work together (25)

Current model doesn’t work, need a shared vision, short and long-term plan

Distinguish our area for excellent health care; package Kaslo to attract people of all ages

Integrate traditional and alternative/holistic medicine

Too much administration

Is the money going to the right place Need to work together with unions, IH, listen to the community, not a heavy hand of control

Doctors need to treat us with respect, come and stay in the community

Theme 3: Staff scope & training (11) Expand scope of service, cross-train

Less part-time, more money

Staff need more training to do more things (nurses do x-rays), NP

Theme 4: Community involvement (14)

We care; the future of Kaslo depends on our health services

We want to be involved in budgeting, local control in decision-making

Reduce administration and put it into care

Help us find what’s available

We want to look after ourselves and stay healthy

Other comments:

We should be creative about using space in the centre - don't just use it for one thing A 72 year old gentleman thought he should pay more because he needs more service

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APPENDIX D

INVITATION

You are invited to attend a

FUTURE STATE WORKSHOP

To discuss health-care service delivery options for the

Kaslo Victorian Community Health Centre

APRIL 22, 2013 8 a.m. – 3:30 p.m.

Kaslo Golf & Country Club 418 Pine St.

250-353-2262

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APPENDIX E

AGENDA

Kaslo Victorian Community Health Centre FUTURE STATE WORKSHOP

April 22, 2013 8:00 Coffee and networking 8:30 Welcome and introductions Maggie Winters

Kaslo and Area Healthcare Work Group & Karen Cairns IH Community Engagement Lead

Outline of consultation process & participation Linda Tarrant, Consultant Summary: Focus Groups & Individual interviews Dr. John Ross, Consultant

& Linda Tarrant Review Major Themes & Recommendations Group

Q & A Group Observations/Insights

10:15 Break 10:30 Review “Charting The Course” Karen Omelchuk & decision-making principles IH Director Health System Planning

11:00 Breakout sessions Group

Identify options for sustainable service delivery Barriers/How to overcome them? Short-term wins (within our control & resources) Longer-term solutions: process & who needs to be engaged?

12:00 Lunch 12:45 Continue breakout sessions Group 1:15 Report out: (10-15 min/group) Linda Tarrant

Each theme group reports

Q & A and comments from all participants

Priority options identified in large group 3:30 Next steps, closing remarks, thanks to all Dianne Kostachuk

IH Director, Strategic Initiatives

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APPENDIX F

WORKSHOP DISCUSSION SUMMARY

APRIL 22, 2013

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APPENDIX F

24 hour Emergency Care Foundational Work

Reassess staffing and utilization of nurses (including the number of full time nursing positions), in both emergency and residential care

Examine night staffing rotations to determine the best configuration of available resources

Implement practice and training sessions to optimize the care of high acuity patients and engage in team building

Explore options for physician call, how to provide nurses with appropriate physician support Longer Term

Provide advanced training for BCAS and nurses (including Nurse 1st Call)

Explore potential for a Nurse Practitioner

Maximize use of technology to communicate with physicians

Develop a new name/description for small EDs to reduce restrictions created by the term ―Emergency Department‖

Quality and Continuity of Primary Care Foundational Work

Improve communication around available VCHC services (i.e. urgent access clinic)

Stabilize the group of physicians providing service in Kaslo Increase training for clinic reception staff

Explore options that maximize office efficiency and effective team work (best provider for specific task)

Evaluate and consider adjusting the primary care clinic hours of operation and system of scheduling Longer Term

Explore alternatives that optimize physician contracts

Explore options for providing outreach service (lab) at the north end of the lake Investigate option of using a Nurse Practitioner or alternative care providers

Consider establishing nurse or physician-led group education sessions (public health, chronic disease and disease prevention)

Health Centre and Staff

Foundational Work Set up better internal communication

Implement a team-building process, framed by the staff, to include: a) monthly education strategy (use technology, simulator) to improve confidence and competence b) monthly strategy/operations meetings to address operational and site issues, and improve

teamwork across the site c) develop a strategy that will build on the enthusiasm of team members for quality improvement

Discuss opportunities for physician-led monthly teaching/learning sessions (with PHC Nurse partner) in the emergency department; a focused approach to teams learning and working together

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APPENDIX F

Health Centre and Staff cont’d Longer Term

Investigate a strategy for staff to enhance skills by doing a ―work exchange‖ with staff in larger emergency centres

Engage with local education leaders to develop a strategy to engage high school students in a health career (a ―grow your own‖ approach)

Investigate opportunity to develop a regional casual float pool among neighbouring communities

Seek opportunities for increased use of UBC physician ―rounds‖ (available on-line, via video?)

Community Engagement and Interior Health Foundational Work

Make it easier to find Kaslo information on Interior Health website and in the phone directory

Offer IH ―Living Well‖ columns to the local papers Include Lardeau Valley LINKS and the Village of Kaslo on IH e-mail distribution list to facilitate posting

of relevant IH news on their websites

Expand information in the annual IH Health Services Guide regarding using EDs

Kootenay Boundary Connected Communities – determine Kaslo representation on this group

Include community representatives on physician recruitment panels (Note: community representatives now participate on physician interview panels; this is a direct outcome of the Kaslo and Area Health Care Work Group)

Establish ongoing Kaslo community/IH liaison (Note: Ongoing liaison continues to be the Kaslo and Area Health Care Work Group)

Longer Term

Explore funding options to assist IH in communicating with communities (ex. advertising dollars)

Transportation and Ambulance Foundational Work

BCAS to explore 9-1-1 geo-mapping of community to minimize response times

Health Connections Bus (establish local working group to improve coordination of BC Transit bus service with local health-care services—to involve the community, IH and BC Transit)

Explore opportunity to integrate local paramedics into VCHC operations (rationale: retention of part time paramedic by offering regular work; providing cost-effective nursing assistance to VCHC staff; improve availability of paramedics to respond to 911 community responses; opportunity to develop clinical skills). Precedence already set in Kelowna/Kamloops and in rural communities in Alberta and Nova Scotia. Requires MOU between BCAS and IHA for release of paramedic to attend to 911.

BCAS public engagement opportunities (Open Houses, speaking to community groups about 9-1-1 services, including the new helicopter program based in Kamloops )

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APPENDIX F

Transportation and Ambulance cont’d Longer Term

Increase access to Critical Care Responders - supported by BCAS helicopter/ Interior Health High Acuity Response Team (HART). Include early deployment and rendezvous protocols for critical patients.

Establish and implement BCAS bypass protocols for emergency patients (supported by early deployment of BCAS helicopter and HART rendezvous protocols)

Explore advanced scope of practice for local paramedics and VCHC staff to support the short term management of emergency/critical care patients

Investigate possible use of the residential bus/school bus to connect rural residents with health-care services

Explore volunteer driver program such as Kootenay Ride Share to connect rural residents with health-care services

Background information

Annual cost to hire one dedicated paramedic crew 24/7: $600,000 Recruitment challenges – difficult to compete with the oil fields when Primary Care Paramedics

(PCPs) earn $2/hour when on call

Challenges in skills maintenance/competencies in rural areas

Technology Foundational Work

Facilitate connecting with other health professionals on-line via telehealth, Skype etc.

Move VCHC video conferencing equipment to a more accessible location in the building

Explore potential for dedicated Interior Health space in the Lardeau Valley to provide on-line services and web-based clinics

Longer Term

Investigate an interactive website for VCHC with current information on available services, which doctors are working, who is on call, educational courses

Explore the potential to book appointments and obtain test results on-line (lab work for example)

Explore the option of a 1-800 phone number with recorded messages (tap into the existing 1-800 number in Nelson?)

Use webinars for community and personal education at the convenience of the user

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APPENDIX G FUTURE STATE WORKSHOP PARTICIPANT LIST

Andy Shadrack, RDCK Director

Brent Hobbs, IH Director, Patient Transport

Chris Mason, BCAS Superintendent

Danielle Newson, VCHC Public Health Nurse

Deb Borsos, VCHC Lab Services

Dianne Kostachuk, IH Director Strategic Initiatives, Community Integrated Health Services (CIHS)

Dr. Fen Smit

Dr. Lauren Rodgers

Dr. Annemarie de Koker

Elizabeth Scarlett, VCHC Physiotherapist

Georgie Humphries, VCHC RN

Greg Lay, Mayor of Kaslo

Heather Cook, IH Chief of Professional Practice & Nursing

Heather Gates, community representative

Ingrid Hampf, IH Acute Health Service Administrator, Kootenay Boundary

Jane Ballantyne, community representative North Kootenay Lake Community Services Society

Jessie Renzie, VCHC RN

Karen Omelchuk, IH Director Health System Planning

Kaslo Consultation Steering Committee

Kate O’Keefe, North Kootenay Lake resident

Larry Badry, BCAS Kaslo Unit Chief

Lorna Staten, IH Human Resources

Mark Anderson, IH Manager Lab Operations

Mary Ballon, community representative

Molly Seminoff, community representative

Rhonda Addison, VCHC RN

Sandra Morrow, IH Residential Services Manager

Terri Domin, IH Administrator, CIHS

Thalia Vesterback, IH Diagnostic Imaging Director

Therese Rosner, IH Manager, Administrative Services, CIHS

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APPENDIX H KASLO CONSULTATION STEERING COMMITTEE

Catherine Anderson VCHC administrative staff

Linda Basran IH Community Integrated Health Services (CIHS) Area Director

Dr. Curtis Bell Community Medical Director

Karen Cairns IH Community Engagement Lead

Nicola Candy Clinical Lead, VCHC Residential and Emergency

Maggie Crowe Kaslo resident, retired nurse

Suzanne McCombs IH Site Manager- Kaslo, Nakusp, New Denver, Edgewood

Dr. Michael Purdon Executive Medical Director, Community & Residential

Dr. John Ross Physician consultant, Rural Emergency Care

Dr. Fen Smit Kaslo physician

Dr. Alan Stewart Executive Medical Director, Acute Services

Linda Tarrant Healthcare consultant and facilitator

Cheryl Whittleton Acting CIHS Administrator, Kootenay Boundary

Maggie Winters Kaslo resident, retired nurse