HD-1

Orientation to Northern Health March 14, 2019 March 14, 2019 Outline HD-1

 NH Overview – Governance and Organizational Structure – Partnerships BC – Capital Planning Processes  Major Project Development Process  Procurement  Capital Project Operations  Capital Project Financial Tracking – NE Operations

March 14, 2019 HD-1 Northern Health

Demographics:  One of five geographic Health Authorities  Population: 289,974  Area: 592,116 sq km  2015 population of seniors 65+: 40,646 and is projected to grow to 72,454 in 2030

March 14, 2019 Northern Health Mandate HD-1

 Legislation: – Health Authorities Act – Hospitals Act – Public Health Act – School Act – Community Care and Assisted Living Act  Annual Mandate Letter – Government’s mandate to the Health Authority Boards outlining government’s priorities for the health system  Annual Service Plan and Budget Management Plan – reflect government priorities for the health system  Demographic and Health Status data and analysis  Community Health Profiles  Community consultation processes

March 14, 2019 HD-1 Northern Health Highlights

 Acute Care - 599 acute care beds – 1 regional hospital – 17 community hospitals – 9 diagnostic and treatment/community health centres  14 Long Term Care facilities: 1,106 beds – 13 long term care facilities and 10 acute care facilities providing long term care – 2 private long term care facilities (Prince George) – Assisted living facilities in 15 communities – MH&SU tertiary care units in , Terrace, and Prince George  Primary and Community Care/Services – Primary care services linked to interprofessional teams  4 Divisions of Family Practice with Hazelton linked to the provincial rural division – Specialized Mental Health & Substance Use services – Specialized services for the frail elderly and those living with complex chronic conditions – Public and Population Health – 10 community oncology clinics and 1 Regional Cancer Clinic (BC Cancer Agency/PHSA)

March 14, 2019 Health of the Population HD-1

Source: BC Vital Statistics VISTA Data Warehouse: Previous 5 Years Mortality: UCOD CS- 358. For: 2010,2011,2012,2013 and 2014. Accessed; February 2017. - The population has a poorer health status and a higher burden of illness - After adjusting for age, annual deaths occur at a rate 28% greater than the provincial average - Community Health Profiles available on the Community Health Information Portal: http://chip.northernhealth.ca/CommunityHealthInformationPortal/OtherTopics/HowHealthyAreWe.aspx

March 14, 2019 HD-1 Community Profile Criteria

Community Profile Population Criteria Catchment Population Criteria

Urban 50,000+ 100,000+

Rural Centre – Large Referral Base 10,000 to 50,000 20,000 to 100,000

Rural Centre – Smaller Referral 4,000 to 10,000 6,000 to 20,000 Base

1,000 to 4,000 Small Rural Centre Isolation and breadth of 2,000 to 8,000 catchment as significant factor

Rural Community:

1,000 to 3,000 2,000 to 5,000 Less Isolated Relatively close proximity to larger centre

500 to1,500 2,000 More Isolated Distant from larger centre

Catchment Community < 500 NA

March 14, 2019 First Nations Communities HD-1

• 17% of population is Indigenous • 35.6% of the BC First Nations population resides in the north • 54 First Nations communities, 9 Tribal Councils, • 17 distinct linguistic groups

March 14, 2019 HD-1 Tripartite Agreement

 The Northern Partnership Accord was signed in 2012 between the First Nations Health Council: Northern Regional Caucus, the First Nations Health Authority (FNHA) and Northern Health (NH).  This partnership is committed to ‘improving the health outcomes of First Nations residing in the northern region.’  Flowing from this formal partnership is the Northern First Nations Health Partnership Committee (NFNHPC) and the Northern First Nations Health and Wellness Plan – Priorities:  Cultural Safety  Primary Care  Mental Wellness  Population Health  Maternal and Child Health

March 14, 2019 HD-1 Commitment to Cultural Safety and Cultural Humility: July 2015

March 14, 2019 HD-1 Other Provincial Relationships

 Provincial Health Services Authority (PHSA) – Provincial Clinical Policy – e.g. Cardiac Services BC, Renal Services BC, Child Health BC, Perinatal Services BC, BC Centre for Disease Control – Provincial Clinical Service Delivery - e.g. BC Cancer, BC Emergency Health Services (Ambulance Service and Patient Transfer Network), Laboratory Agency – Provincial Commercial Services – Procurement & Supply Chain, Accounts Payable, Desktop Management Services, Kamloops Data Centre, Health Emergency Management (emergency preparedness and response) – Provincial Digital Health  Health Employers Association of BC (HEABC) – Bargaining agent for the employer  Labour Relations – Community Bargaining Association – Facilities Bargaining Association – Health Sciences Professionals Bargaining Association – Nurses Bargaining Association  Doctors of BC  Professional Colleges  Memorandum of Understanding with – Meditech Business Platform  BC Patient Safety & Quality Council (BPSQC)  Patient Care Quality Review Board (PCQRB) – governed by provincial legislation – Patient Care Quality Office (PCQO)

March 14, 2019 Northern Regional Hospital DistrictsHD-1

 Northern Rockies Regional Municipality/Northern Rockies Regional Hospital District  Peace River Regional Hospital District  Fraser Fort George Regional Hospital District  Cariboo Chilcotin Regional Hospital District  Stuart Nechako Regional Hospital District  North West Regional Hospital District

March 14, 2019 Northern Health Foundations HD-1

 Spirit of the North  Fort Nelson Hospital Foundation  Fort St. John Hospital Foundation  Dawson Creek Hospital Foundation  Chetwynd General Hospital Foundation  Health Centre Foundation  Bulkley Valley Healthcare and Hospital Foundation  REM Lee Hospital Foundation  Wrinch Memorial Foundation  General Hospital Foundation  North Coast Health Improvement Society  Hospital Auxiliaries present in most communities across the region

March 14, 2019 Governance – Northern Health BoardHD-1

Northern Health Medical Advisory Board Committee

Governance & Internal Audit Performance, Management Planning & Audit & Finance Relations Priorities Committee Committee Committee

President & Chief Executive Officer

March 14, 2019 NH Organizational StructureHD-1

Ministry of Health

NH Board of Directors

Northwest NH Executive Team Senior Leadership Team

Corporate NH Capital Planning Committee Capital (CPC) Planning

Northern Interior North East HSDA North West HSDA HSDA Capital Planning Capital Planning Capital Planning Working Group Working Group Working Group (CPWG) (CPWG) (CPWG)

RHDs and Funding Partners

March 14, 2019 Northeast (NE) HSDA HD-1 Senior Leadership Team

Angela De Smit Dr. Jong Kim Dr. Becky Temple Chief Operating Officer, NE Medical Health NE Medical Director NE HSDA Officer

Sherry Services Administrators Executive Assistant

Joanne Cozac Kendra Kiss HSA, North Peace HSA, South Peace

Specialized Services

Peter Martin Annette Weger Tracy McLellan HSA, Chetwynd & HSA, Fort Nelson Tumbler Ridge Director of Specialized Services, NE

March 14, 2019 Northeast (NE) Physician HD-1 Leadership

March 14, 2019 HD-1 Northeast HSDA Highlights

 Acute Care - 110 acute care beds – 4 community hospitals – 2 diagnostic and treatment/community health centres  Long Term Care facilities: 253 beds – 2 long term care facilities and 2 acute care facilities providing long term care – Assisted living facilities in 3 communities – MH&SU tertiary care unit located in Dawson Creek  Primary and Community Care/Services – Primary care services linked to interprofessional teams  1 Division of Family Practice for North Peace and 1 newly created Division of Family Practice for South Peace – Specialized Mental Health & Substance Use services – Specialized services for the frail elderly and those living with complex chronic conditions – Public and Population Health – 2 community oncology clinics

March 14, 2019 HD-1

March 14, 2019 Key Elements HD-1

 Centred on the person and family including cultural safety  Care plan that follows the patient across the system and over time  Embedded within a healthy community  Interprofessional team  Team includes Primary Care Nurse/s relationship with Primary Care provider/s  Community specialty services linked to Specialist physicians  Clear pathways to specialists and specialty services

March 14, 2019 Capital Projects HD-1

Project Year of Implementation Status

Business Plan under preparation DCDH Hospital Redevelopment

2018-2020 Project out to tender DCDH Medical Device Reprocessing Renovation Construction documents under 2018-2020 preparation Fort St. John Medical Clinic 3rd Pod

2019/20 Planning DCDH OR Cooling Replacement

Proposed DCDH 2nd Floor Tub Room Renovation

Proposed Chetwynd Seclusion Room

Proposed DCDH Pharmacy Oncology Renovation

Proposed Fort St. John Hospital Parking Lot

Proposed Fort St. John Medical Clinic Parking Lot

Proposed Tumbler Ridge Facility Redevelopment

Proposed Residential Care Beds

March 14, 2019 Major Equipment HD-1

Project Year of Implementation Status

2018/19 Complete Fort St. John X-Ray - Rad Rex Room

2019 Received Fort St. John Ultrasound

2019/20 Planning Chetwynd X-Ray Replacement

2019/20 Planning Fort St. John SPECT CT

Proposed Fort St. John Anesthetic Machines

Proposed DCDH Anesthetic Machine Hudson's Hope X-Ray Proposed

Proposed DCDH Automated Medication Dispensing Cabinet DCDH Phone System Proposed

Proposed Tumbler Ridge & Hudson's Hope Phone Systems

March 14, 2019 Peace River RHD Capital PurchasesHD-1 Minor Capital: • Various equipment such as: o Venilators o Centrifuges o Beds o Scrubbers o Tissue Removal System o Warmer – Infant o Laparoscope o Colonoscopes o Carts o Renovations o Infusion Pumps

March 14, 2019 Capital Planning ProcessesHD-1

Availability of Investment Availability of Capital Funding Proposals Alternatives

Capital Planning Capital Planning Inputs Outputs NH Stakeholder Strategic Priorities Improved Patient Wants and Needs Care

Clients Capital Planning Capital Plan Increased Access to Decision Process Implementation Care Employees Strengthened NH Capabilities Care Providers Health Services Redesign Plan Operational Efficiencies NH Board

New / Extended Ministry of Health Programs & Services

Regional Hospital Project Proposal New/Improved Critical Risk Districts Evaluation Facilities & Equip. Factors Criteria Other Funding New/Improved Agencies Information Systems

Communities Standards Financial Non-Financial Uncertainty Implementation Compliance Factors Factors Risk Risk NH's Improved Stakeholder Wants and Needs Relationships

Post-Implementation Review

(Actual vs. Planned Achievement)

March 14, 2019 Capital Planning Cycle HD-1

Capital Asset NH Board Management Approval of Plan Plan to MoH Capital Asset Management Audit & Finance Plan Meetings with Individual Comm. Review and RHDs Approval March April

MoH Funding Allocated February May Capital Plan Capital Plan Presentation to all Update to RHDs RHDs & Foundations

NH Executive January June Review and RHDs Approve Approval Approval Plan Cycle CAPITAL PLANNING CYCLE

RHDs Approve July Internal Budgets December RHDs Approve Provisional Budgets for Meetings with Next Calendar Year Individual RHDs Planning August November Cycle

CPWGs Submit Lists to Corporate Capital Planning October September

Corporate Capital Capital Planning Planning Prepares Working Groups Beginning of Consolidated NH Lists Identify Priorities Annual Cycle

March 14, 2019 Major Project DevelopmentHD-1

 The steps of a major project development are: – Community Space Plan – Master Plan and Functional Program – Procurement analysis (if required) – Procurement options and approvals by NH Board, Ministry of Health, Capital Planning Secretariat, Regional Hospital District – Schematic Design – Design Development and Working Drawings – Construction – Commissioning

March 14, 2019 Generic Facility Replacement >$50M HD-1 Approximate Timelines & Cash Flow Projection – Years 1 & 2

2% of Budget

Approval byTreasury Board

Cost Estimate 'D' of Order Magnitude Level INDETERMINANT PERIOD OF TIME Schematic ♦ Procurement Design Options Master Plan and Community Functional Program Space Plan

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Dec Jan Feb Mar

Year 1 Year 2

March 14, 2019 Generic Facility Replacement >$50M HD-1 Approximate Timelines & Cash Flow Projection – Years 3 & 4

8% of Budget

Cost Estimate ' B' 75% Budget Confidence

Cost Estmate 'C' 50% Budget Confidence ♦ Construction ♦ Drawings, Detailed Design Site Acquistion Development Schematic Design

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan

Year 3 Year 4

March 14, 2019 Generic Facility Replacement >$50M HD-1 Approximate Timelines & Cash Flow Projection – Years 5 thru 7

Year 5 Year 6 Year 7 30% of Budget 30% of Budget 30% of Budget

Approx 30 months, Commissioning Dependant on facility size

Cost Estimate 'A' 99% Confidence ♦ Tender, Award, Construction Construction Drawings, Site Acquistion

Apr May Jun Jul Aug Sep

Year 5 Year 6 Year 7

March 14, 2019 Traditional project ProcurementHD-1 i.e. design-build

Manage Project

Program Delivery Program Design Build Maintain Plan Facility Management Services

Finance Project

Own Building

Own Land

Public sector Private partner

March 14, 2019 Capital Project Operations HD-1  NH has staff which are responsible for planning and project operations: – Consultant contracts are tendered, quoted, taken from our shortlists depending on value of work:  Planning, architects, engineers, cost consultants firms are used – Construction contracts are tendered using Journal of Commerce, BC Bid, BC Construction Association bid repository.  Reporting using project dashboards to our board – Scope – Schedule – Quality – Budget – A project summary dashboard is also used for public meetings  Reporting using WebCaps to MOHS, Capital Services – Project approvals (Certificate of Approval) – Scope, Schedule, Budget, Funding Sources are reported quarterly – Cash Flow is now monitored tightly be government

March 14, 2019 Capital Project Financial TrackingHD-1

 Fiscal Year for Northern Health is April 1, 2019 to March 31, 2020  We produce Project Dashboards for 13 fiscal Periods per year – Scope – Schedule – Budget – Quality  Additionally, we produce project reports such as: – Review of actual spending by invoice at 20%, 80%, near completion for all major projects – Invoices to funding partners as required (MOHS, RHD, Auxiliary, Foundation)

March 14, 2019