Health Services Planning
The creation of Nova Scotia Health Authority in 2015 was much more than the rewriting of boundaries and a new organizational structure. It is recognition that we need to do better for Nova Scotians, and an extraordinary opportunity to reshape our health system to better the lives of Nova Scotians.
Together with the IWK Health Centre and the Department of Health and Wellness, we are leading an effort to develop and implement a multi-year plan that will result in new provincial approaches to a range of services that Nova Scotians rely on to care for them and help them be healthy. We’ve begun planning for several services that have been identified as initial priorities. They are:
- primary health care – as the foundation of our health system
- maternal and newborn health
- critical care
- cancer care
- emergency services
- surgical services
- mental health and addictions
Our goal is to use the best evidence and engage Nova Scotians in order to create an accessible health system that offers the right care, in the right place, at the right time.
How Are We Planning
Project teams involving staff and physicians have come together to lead this planning. A steering committee involving leaders from Nova Scotia Health Authority, IWK Health Centre and Department of Health and Wellness is providing oversight to this work.
Planning for each service requires that we develop three components: a program or care delivery model, a service delivery model and an operational model. Planning for all takes into account the relationships between services and supporting areas, such as laboratory and diagnostic imaging services, and how they rely and support each other.
A program or care delivery model… is basically “the what” and “the why” of the service. It is the big picture of what the goals and objectives of the service are, including what it intends to accomplish and what needs to be available to support that. At this stage of planning, it is critical to understand the health and health needs of patients and clients, and when they need to access services. Also occurring at this stage is an exploration of approaches used in other jurisdictions, not only those working well but those falling short. This evidence-informed approach will help determine what core services need to be made available.
A service delivery model… defines “the where” and at what level services will be offered to meet the service’s goals. This is also referred to as the siting and sizing stage of planning. During this stage, roles and responsibilities of different health care providers and groups of providers are defined. Questions to be answered during service delivery model planning include:
- Where will services be offered and how?
- What needs to be in place for these services to be delivered safely?
- What providers should be involved in offering this care?
- How will we know that outcomes are achieved?
An operational model… details the structure put in place to provide the service. This is the most detailed stage of planning and includes identifying leadership roles that are required to manage and oversee services. Other decisions include budgets, staffing patterns and hours of operation.
The design principles that underpinned planning of Nova Scotia Health Authority also guide our service planning.
These are based on nationally recognized “essential components of quality” for health care organizations and aligned with Accreditation Canada’s Dimensions of Quality and the Province of Nova Scotia’s Quality Framework. The principles are:
- safety - services must place a premium on patient safety
- population focus – services must be relevant to the group of people being served
- accessibility - services must be timely and equitable
- supportive of healthy workplace culture - services should respect employee wellness and recognize that a healthy workplace is an important element of the quality of care
- people centred - services must prioritize the perspective and experience of patients and clients and their families.
- continuity of services - services must be co-ordinated and seamless
- effectiveness/ efficiency/ sustainability - services must lead to the best possible results using the fewest resources feasible, for today and into
Meaningful engagement and real conversations with those whose lives we affect – whether employees, physicians, volunteers, patients, families, communities, leaders, residents – are essential to change. It is the way we build trust and make better, more widely supported decisions.
Nova Scotians have been surveyed and consulted in many health system initiatives:
- Talk About Health Public Engagement (Nova Scotia Health Authority, 2015-16)
- Minister of Health and Wellness’s What We Heard Report on District Health Authority Consolidation (Department of Health and Wellness, 2014)
- Mental Health and Addictions Strategy consultations (Department of Health and Wellness, 2011)
- Emergency Services Consultations (Department of Health and Wellness, 2010)
- Primary Health Care Consultations
- Community Health Board Health Plans
You’ve helped bring awareness to many factors we need to keep in mind as we plan provincial approaches to services, including:
- Nova Scotians want to access care as close to home as possible
- You want timely access to primary health care providers
- There are inequities in services across the province
- Certain population groups and communities have unique needs that have to be considered
- It should be easier for patients to transition between one service and another
We’ll keep listening to what is important to you as our planning moves forward and began recruiting for a Patient, Family and Public Advisory Council in August. These volunteers will come together this Fall to help bring a public lens to this planning and other Nova Scotia Health Authority priorities.
Questions & Answers
1. Why is this planning needed?
Nova Scotia Health Authority has a vision of a healthy Nova Scotia. We believe that Nova Scotians should and can be healthier, and that care providers, policy makers, communities and individuals all have an essential part in making that happen. We also know that if we want different results – a healthy Nova Scotia – we have to do things differently in the province. Collaborative planning for services with the IWK Health Centre and Department of Health and Wellness is an important part of that change.
2. What is health service planning?
Nova Scotia Health Authority, with our partners (IWK Health Centre and Department of Health and Wellness) is leading the development and implementation of a multi-year plan that will result in new provincial approaches to a range of services that Nova Scotians depend on to help them be healthy or stay healthy and support them when they are not.
This planning will create a solid foundation for continuous improvements to the health system over time. It will result in having the right providers providing the right services, in the right places at the right time, for the sake of healthy people and healthy communities into the future.
3. What services are in included in this planning?
In 2016-2017 planning will be focused on a number of priority services:
- primary health care - as the foundation of our health care system
- maternal and newborn care
- emergency services
- cancer care
- mental health and addictions
- surgical services
4. Why are these services a priority?
While all services are important, these areas are a priority for the first stages of our service planning. This multi-year plan will help create a strong foundation for ongoing improvements to our health system over time.
5. What about the other services that NSHA now has to deliver province-wide?
While we are initially placing some emphasis on these services, we also continue to complete the change from nine organizations to one. This involves exploring and planning for additional provincial approaches to service delivery and opportunities to enhance other services we offer including:
- continuing care (home care, long-term care)
- nutrition and food services
- pathology, laboratory medicine and diagnostic imaging services
- public health
6. What does this planning involve?
Over the next several months, work streams will develop and finalize draft program/care delivery models, service delivery models and operational models for each of the identified priority services. Specifically, this includes:
- articulating strategic goals and objectives
- identifying the needs and health status of Nova Scotians
- incorporating past work and evidence-based best practices
- defining a model that provides the right care, in the right place, at the right time
- operationalizing the revised inter-professional and collaborative service model
7. Will a similar approach be used to plan each service?
A joint steering committee with broad membership from across Nova Scotia Health Authority, IWK Health Centre and Department of Health and Wellness is overseeing the planning for a number of services, and a joint project management office is in place to co-ordinate and leverage resources and support. Each work stream is applying a similar planning framework. The teams are co-led by a program/service leader and physician leaders (where applicable) and have inter-professional representation.
8. Are there principles that are guiding this planning?
Planning for each service is building on the same fundamental design principles that have guided system transformation. These are based on nationally recognized standards and align with Accreditation Canada’s Dimensions of Quality and the Province of Nova Scotia’s Quality Framework. These quality principles include:
- population focus
- support for healthy workplace culture
- people-centred approach
- continuity of services
- effectiveness/ efficiency/ sustainability
9. Will this improve access to services or reduce wait lists?
Appropriate access to services is an important consideration of planning. We need to ensure that we have the right providers, providing the right services, in the right places and at the right time. This approach will help ensure access to quality services that are delivered efficiently and consistently across the province in order to improve health and deliver better results.
10. How long will this planning take?
Our planning builds on existing continuous improvement efforts. Like quality improvement, service planning requires ongoing research, monitoring and evaluation. This planning is a starting point for changes that are needed to improve both health and health services. There is no finish line. This work will be a significant priority and focus throughout this fiscal year. As teams move this work forward they will take the time needed to ensure that planning has been based on evidence and informed by stakeholders, and that it is the right approach to produce results, including improved health and a system that is stainable for future generations.
11. How will Nova Scotians be involved in service planning?
Provincial legislation (Health Authorities Act) requires that Nova Scotia Health Authority and IWK Health Centre develop a comprehensive and long-term engagement strategy; this will be incorporated into service planning. Delivering quality health services and improving health require the support and input of a wide range of care providers, patients, clients, community members and partners. Understanding the needs and experiences of patients and clients has always been a planning consideration and this will continue going forward. In their planning, our teams are considering:
- who needs to be involved in these teams or working groups to ensure many perspectives are represented
- who their stakeholders are and what information they need about services planning
- what information they need from their stakeholders and how can this be sought
- what other planning or engagement activities have been completed and how these results can factor into their planning
NSHA began recruiting for a new Patient, Family and Public Advisory Council in August. These volunteers will come together this fall to ensure a public lens is applied to planning for various priorities, including Health Services Planning.
12. Will community health boards be involved in this planning?
Nova Scotia’s 37 community health boards develop community health plans with input from their communities. These plans identify key issues, concerns or opportunities to improve health. The information and recommendations within their plans will be among the information sources from which planning teams can draw.
13. How can Nova Scotians learn more about this planning?
More information will be provided as service planning moves forward. Questions or ideas can be sent to firstname.lastname@example.org and information and updates will continue to be available on the Nova Scotia Health Authority website as planning progresses.