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BC’s health authorities at 15: Big change pays off


It was 15 years ago, on December 12th, that Sindi Hawkins, the then B.C. Minister of Health Planning, stepped up to a microphone and announced a sweeping change in the delivery of patient care in British Columbia.

“A simpler, more accountable structure for delivering health services,” she said, and in a single bold move, the Government of British Columbia eliminated the existing 52 health authorities scattered across the length and breadth of the province and created one provincial and five regional health authorities to oversee delivery of specialized health care services such as heart, transplant, disease control, children and women’s health services.

Ms. Hawkins noted the previous model of health governance was one of the most complicated, expensive, and ineffectually managed health systems in the country.  “The combination of small rural community councils and large urban health boards created huge disparities,” she said, especially with regard to budgets and equitable access to care and delivery of quality service.

Well, on the 15th anniversary of her announcement, has the change in structure worked?  Has health care delivery improved?  Is service more accessible?  Accountable?  Better?

Let’s see.

In Vancouver Coastal Health (VCH), the move brought together 14 Aboriginal communities, four regional districts, and 12 municipalities — including Vancouver, Richmond, the North Shore, Sunshine Coast, Powell River, Bella Bella and Bella Coola.

Some changes over the 15 years — in the shape of new or redeveloped facilities — are obvious.  The redevelopment of Lions Gate and Richmond hospitals.  The Gordon and Leslie Diamond Health Care Centre, and Blusson Pavilion for spinal research at Vancouver General Hospital.  The new Richmond Community Care Clinic and replacement of Richmond Lions Manor.  Upgrades to Powell River and Sechelt hospitals.  The Djavad Mowafaghian Centre for Brain Health and — still to come — the Segal Wellness Centre at VGH, and a brand new St. Paul’s Hospital.

Walk around any VCH hospital or health facility and, again, some changes will be obvious.  Operating rooms with robotic surgery equipment.  A hip and knee surgical centre at UBC Hospital.  More and better patient-lifting equipment.  An array of high-tech equipment in emergency departments. Centres of Excellence for prostate and breast surgery.

Less obvious to many people perhaps, but no less important, is what’s happening on the streets in an area such as the Downtown Eastside.  That’s where you’ll find the Insite supervised injection site and five Assertive Community Treatment (ACT) teams working around-the-clock to address the challenges of providing care, treatment and support for individuals with mental illness or addictions or multiple complex needs.  ACT teams have reduced neighbourhood street disorder by more than 70 per cent and reduced violent offences by more than 35 per cent.

There is, of course, the sheer increase in numbers of people accessing health care in VCH.  In 15 years, the number of people using VCH Emergency Rooms has increased more than 50 per cent.  Health clinic visits?  Doubled, now with more than a million patient visits each year.

Hospital admissions?  Same-day care?  Hip and knee replacements?  CT scans and MRIs?  Cardiac surgeries?  Up, up, up, as you’d expect.

Accompanying these large increases are shifts in the type of services required today.  Go back 15 years, and nobody had ever heard of fentanyl, let alone naloxone.  Mental health has become a priority, while our aging population has led to greater efforts to combat Alzheimer’s disease, dementia, and all brain-function diseases.  We might be living longer, but have more complex needs.

Looking back at the 2001 announcement, has the change in structure worked?  Has health care delivery improved?  Is service more accessible?  Statistics and outcomes say yes, even with our expanding population.

Is the structure accountable?  Yes, and now includes online report cards and public forums with the VCH board across our service-delivery areas.

With VCH, it’s been 15 years of better use of tax dollars for patient care, and a more flexible approach to changes in what care is needed, where it’s needed, and when it’s needed, for the now over one million B.C. residents we serve.

With fewer health organizations, we have partnerships and progress like never before.  Academic hospitals like VGH, UBCH and St. Paul’s now work together, sharing creative ideas, staff and resources to improve patient outcomes.

That ‘better’ isn’t ‘perfect’ is much of what fuels VCH.  We must continue to support our elected leaders to further implement best practices from near and far and introduce new technologies and the privacy measures to support them. There is still much work to do around primary care and the system reforms it brings.

Health care is complex, demanding, and always under pressure.  If you visit, you’ll see the experiences shared by some of our staff on our 15-year journey.  It’s an impressive and moving testament to the remarkable work done by our 2,100 physicians, 14,300 full and part time staff, and the 3,000 volunteers who expertly respond to the complexity, demand, and patient needs each and every day. 

The website tells another story, too.  While it’s been 15 years, and much has changed in health care — and in VCH — the essentials of dedication, innovation, and the human touch remain constant. 

Kip Woodward is Chair of Vancouver Coastal Health. Read the original story in the Vancouver Sun.

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