Meeting of the North West Regional Hospital District to be held Friday, May 17, 2019 commencing at 11:00 AM in the Regional District of Kitimat-Stikine Board Room, 1st Floor-4545 Lazelle Avenue, Terrace, B.C.
AGENDA
A. APPROVAL OF AGENDA:
B. CLOSED:
1. This Meeting be closed to the public as the subject matters being considered relate to 226 (1) of the Local Government Act and the following Sections of the Community Charter: 90(1)(i) the receipt of advice that is subject to solicitor- client privilege, including communications necessary for that purpose; 90(1)(j) information that is prohibited, or information that if it were presented in a document would be prohibited, from disclosure under section 21 of the Freedom of Information and Protection of Privacy Act; and 90(1)(k) negotiations and related discussions respecting the proposed provision of a municipal service that are at their preliminary stages and that, in the view of the council, could reasonably be expected to harm the interests of the municipality if they were held in public.
C. DELEGATIONS & GUESTS:
1. Rakel King Northwest Medical Health Officer Northern Health
Vaccinations
2. Katherine Puchala, Midwife 5 - 23
Midwifery
3. Ciro Panessa, Northwest Chief Operating Officer Michael Hoefer, Regional Director, Capital Planning and Support Services Northern Health
Northern Health Updates
D. PETITIONS:
E. ADOPTION OF MINUTES:
1. Minutes of the March 22, 2019, regular meeting of the North West Regional 25 - 28 Hospital District Board.
F. BUSINESS ARISING OUT OF MINUTES:
G. CORRESPONDENCE:
1. Letter from Lil Milani, Capital Accounting Coordinator, Northern Health, dated 29 - 48 April 25, 2019, re: Fourth Quarter 2018/19 Capital Status Reports.
Supplementary:
S-1. Letter from Cathy Ulrich, President and CEO, Northern Health, dated May 16, 49 - 50 2019, re: NCLGA Meeting, Williams Lake, May 7, 2019.
H. REPORTS:
1. Report from Administration, dated March 22, 2019, re: North West Regional 51 - 55 Hospital District; Directors’ Report – March 22, 2019 Board Meeting – with Follow-Up Action List.
2. Report from Administration dated May 7, 2019, re: Directors’ Report – 2019 57 - 88 Spring Joint Meeting with Northern Health and all Regional Hospital Districts.
Supplementary:
S-1. Report from Ernie Dusdal, Carlyle Shepherd & Co., dated May 17, 2019, re: 89 - 91 North West Regional Hospital District 2018 FInancial Statement.
S-2. Report from Administration, dated May 17, 2019, re: Renewal of the Joint 93 - 100 Northern Health and Regional Hospital Districts Memorandum of Understanding.
I. BYLAWS:
J. NEW BUSINESS:
1. Next Meeting Date: August 23, 2019
Supplementary:
Page 2 of 137 S-1. Office of the Seniors Advocate Appointment
S-2. UBCM Issues - Topics & Meeting Requests
N. RISE AND REPORT:
P. ADJOURNMENT:
Q. INFORMATION ONLY:
1. News Release from Northern Health dated April 18, 2019, re: Northern Health 101 - 102 Board Meeting Highlights: April 2019.
2. Letter to the Honourable Adrian Dix, Minister of Health, from Shane Brienen, 103 Mayor, District of Houston, re: Assisted Living Complex - Cottonwood Manor.
3. Proposal from University of British Columbia Faculty of Medicine, dated 105 - 133 September 14, 2018, re: Strategic Investment Fund Proposal Form.
4. Email from Eryn Collins, Regional Manager, Public Affairs & Media, and 135 Jessica Quinn, Regional Manager, Digital Communications and Public Engagement, Northern Health, dated April 25, 2019, re: Northern Health Facebook Groups for Communities - Terrace & Kitimat Pilot.
5. News Release from the Ministry of Health, dated May 9, 2019, re: One Month 137 In - Update on Measles Immunization Catch-up Program.
LUNCH WILL BE PROVIDED PLEASE RSVP ATTENDANCE Telephone: 1-800-663-3208 or 250-615-6100 Fax: 250-635-9222 Email [email protected]
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First Approved Version: April 14, 1997 Current Approved Version: December 10, 2018
MIDWIFERY SCOPE AND MODEL OF PRACTICE
Preamble
The midwifery scope and model of practice as defined in this document provides the broad boundaries of midwifery practice in British Columbia (BC). The College of Midwives of British Columbia (CMBC)’s Standards of Practice and associated policies detail the minimum requirements for safe practice of midwifery within the midwifery scope and model. The Competencies of Registered Midwives provide details of the skills and knowledge expected of a midwife in BC.
Midwifery Scope of Practice
According to the International Confederation of Midwives (ICM), a midwife is:
“a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice to during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in the mother and child, the accessing of medical care or other appropriate assistance when necessary and the carrying out of emergency measures when necessary.
The midwife has an important task in health counselling and education, not only for the woman but also within the family and the community. The work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.
A midwife may practise in any setting including the home, community, hospitals, clinics, or health units.”
The ICM definition of a midwife (last updated in 2005) has been consistently supported by the International Federation of Gynaecologists and Obstetricians (FIGO), and the World Health Organization (WHO) since 1972.
In BC, the Midwives Regulation limits the midwifery scope of practice as the practice of midwifery. Midwifery is defined as “the health profession in which a person provides the following services during normal pregnancy, labour, delivery and the postpartum period:
• assessment, monitoring and care for women, newborns and infants, including the carrying out of appropriate emergency measures when necessary; • counselling, supporting and advising women, including provision of advice and information regarding care for newborns and infants; • conducting internal examinations of women, performing episiotomies and amniotomies and repairing episiotomies and simple lacerations; • contraceptive services for women during the 3 months following a birth.”
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Midwifery Model of Practice The midwifery model of practice in British Columbia is autonomous, community-based primary care, and incorporates the principles of continuity of care, informed choice, choice of birth setting, collaboration, accountability, ethics and evidence-based practice.
AUTONOMOUS, COMMUNITY-BASED PRIMARY CARE Midwives are primary care providers in autonomous practice, with hospital privileges, within their communities. For each client, under their own responsibility, the midwife provides a continuum of midwifery services throughout pregnancy, labour and the postpartum period.
Midwives practice in a range of settings, including clinics, clients’ homes, hospitals, and other community-based settings. Midwifery care for labour, birth and early postpartum is provided in a setting chosen by the client and appropriate to their level of risk. In all settings, midwives remain responsible and accountable for the care they provide.
CONTINUITY OF CARE Midwives provide continuity of care. Continuity of care is delivered through the provision of midwifery care during pregnancy, labour, birth and the postpartum period, on a 24-hour on- call basis by a registrant or small group of registrants known to the client. Continuity of care is both a philosophy and a process that is facilitated through a partnership; ideally each client will meet and develop a relationship of trust with the midwife or midwives in the group before labour. A group practice must share a common philosophy and a consistent and coordinated approach to practice.
INFORMED CHOICE Midwives respect the rights of clients to make informed choices and facilitate this process by providing complete, relevant, objective information and their professional recommendations in a non-authoritarian, supportive manner. Having adequate time for discussion in the prenatal period is necessary to the successful facilitation of informed choice.
CHOICE OF BIRTH SETTING Midwives provide care in a variety of settings, including homes, hospitals and birth centres, where available. The birth setting is chosen by the client in consultation with the midwife. Midwives must acquire admitting and discharge midwifery hospital privileges in their local maternity units and, where available, privileges for birth centers. Midwives function within their scope of practice in both the home and hospital setting.
COLLABORATION Midwives consult and collaborate with other health care professionals to work safely within their scope of practice. In situations where transfer of care to a physician is required, the midwife may provide supportive care after transfer and may resume primary care if appropriate.
ETHICS, ACCOUNTABILITY AND EVIDENCE-BASED PRACTICE Midwives’ fundamental accountability is to the clients in their care. They are also accountable to their peers, their regulatory body, the health agencies where they practice and the public to for the provision of safe, competent, ethical practice informed by the CMBC Philosophy of Care and current evidence in perinatal care. Midwives develop and share midwifery knowledge, promoting and participating in research.
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References
Ministry of Health (2008). Health Professions Act: Midwives Regulation. Retrieved from: http://www.bclaws.ca/civix/document/id/lc/statreg/281_2008
International Confederation of Midwives (2018). ICM Definitions. Retrieved from: https://www.internationalmidwives.org/our-work/policy-and-practice/icm-definitions.html
Kilthei, Jane. (2017). The Safety of the BC Midwifery Model of Practice: A Literature Review. Unpublished paper.
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STANDARDS OF PRACTICE
The College of Midwives of British Columbia (CMBC) holds registrants to the following minimum standards to ensure safe and consistent practice and conduct within the midwifery scope and model in British Columbia. Additional polices with more detail on specific standards are referenced throughout.
STANDARD ONE The midwife shall be the primary care provider within the midwives’ scope1 of practice.
The midwife: 1.1 is an autonomous health care professional governed by the College of Midwives of British Columbia; and 1.2 practises within scope without supervision, and takes full responsibility for the care provided.
STANDARD TWO The midwife shall collaborate with other health professionals and, when the client’s risk status, condition or needs exceed the midwives’ scope of practice, shall consult2 with a physician or nurse practitioner.
The midwife: 2.1 provides the consultant with complete and accurate records and client information; 2.2 initiates physician consultation and transfer of primary care where appropriate and in accordance with CMBC policies; 2.3 makes use of professional, community and administrative resources that serve the interests of the client; and 2.4 is honest and acts with integrity at all times.
STANDARD THREE If primary care is transferred to a physician, the midwife may continue to counsel, support and advise3 the client.
The midwife: 3.1 in a supportive care role, shall work cooperatively within the midwife’s scope of practice with the primary care team; 3.2 documents clearly in the medical record when a transfer of care has taken place; and 3.3 provides supportive and/or primary care after the birth.
1 Refer to the Midwifery Model and Scope of Practice 2 Refer to the Indications for Discussion, Consultation and Transfer of Care 3 Refer to the Policy on Supportive Care
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STANDARD FOUR The midwife shall work in partnership with the client recognising individual and shared responsibilities.
The midwife: 4.1 develops a plan for care together with the client; 4.2 discusses the philosophy and scope of midwifery care with the client; 4.3 involves the client’s family accordingly; 4.4 respects the client’s value system; and 4.5 practises in a culturally safe and competent manner.
STANDARD FIVE The midwife shall uphold the client’s right to informed choice4 and consent.
The midwife: 5.1 shares relevant information with clients in a non-authoritarian, cooperative manner; 5.2 recognizes the client as the primary decision maker in their care; 5.3 encourages clients to actively participate in care and to make informed choices; 5.4 advocates for clients within their scope; 5.5 respects the client’s right to accept or decline treatments or procedures; and 5.6 advises the client of their professional standards and recommendations with respect to safe care.
STANDARD SIX The midwife shall provide continuity of care to the client.
The midwife: 6.1 provides comprehensive care during pregnancy, labour, birth, and postpartum5; 6.2 either individually or within an established group, provides care with 24 hour on- call availability; 6.3 either individually or within an established group, maintains a coordinated approach to clinical practice consistent with CMBC’s Philosophy of Care; 6.4 ensures, within reason, that no more than four6 primary care providers known to the client provide them with care during their pregnancy, and throughout labour, birth, and postpartum; 6.5 informs every client early in care of their on-call schedule and how care is organized and provided within their practice; and 6.6 endeavours to develop a relationship of therapeutic trust with each client.
4 Refer to the Policy on Informed Choice 5 Unless registered as Temporary (limited scope) or receives an exemption per the Policy on Alternate Practice Arrangements 6 Exemptions allowable per Policy on Alternate Practice Arrangements
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STANDARD SEVEN The midwife shall respect the client’s right to make informed choices about the setting for birth7 and shall provide care in all appropriate settings.
The midwife: 7.1 provides the client with the required information as the clinical situation evolves, including that related to safety, to make an informed choice about appropriate settings in which to give birth; 7.2 provides care in a variety of settings including hospitals, homes and alternate community-based locations8; 7.3 ensures a safe environment in which to give birth; and 7.4 notifies the appropriate agencies when any safety concerns arise.
STANDARD EIGHT The midwife shall ensure, within reason, that a second midwife or qualified second birth attendant who is currently certified in neonatal resuscitation and cardiopulmonary resuscitation assists at every birth.
The midwife: 8.1 ensures that a second midwife, or a qualified second attendant approved by CMBC, is present for every home or out of hospital birth; and 8.2 informs the client of the arrangements for a second midwife or qualified second birth attendant.
STANDARD NINE The midwife shall ensure that no act or omission places the client at unnecessary risk.
The midwife: 9.1 uses their knowledge, skills and judgement as well as local policies and protocols to plan and implement care; 9.2 provides on-going assessment and modifies planned care as required; 9.3 responds promptly and appropriately to emergency situations; 9.4 maintains access to appropriate equipment and supplies; 9.5 refers to another appropriate practitioner when their ability to practise safely is mentally or physically impaired; and 9.6 adheres to best practices related to infection prevention and control at all times.
STANDARD TEN The midwife shall maintain complete and accurate health care records9.
The midwife: 10.1 uses records that facilitate accurate communication of information to and from consultants and institutions; 10.2 reviews and updates records at each clinical contact with the client; 10.3 ensures prompt review and entry of screening and diagnostic test results, treatments and consultations into health care records;
7 Refer to the Indications for Planned Place of Birth and Policy on Hospital Privileges 8 Exemptions allowable as per the Policy on Alternative Practice Arrangements 9 Refer to the Policy on Record Content
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10.4 ensures that records are legible, signed and dated; 10.5 documents decisions and professional actions; 10.6 documents informed choice discussions and recommendations; 10.7 documents errors, incidents and complaints, reports to the appropriate authorities and initiates restorative actions; 10.8 documents contemporaneously; and 10.9 refers to part 7 of the CMBC Bylaws for additional requirements regarding client records.
STANDARD ELEVEN The midwife shall ensure confidentiality of information10 except with the client’s consent, or as required to be disclosed by law, or in extraordinary circumstances where the failure to disclose will result in immediate and grave harm to the client.
The midwife: 11.1 maintains, stores and disposes of records in accordance with the law; and 11.2 maintains, stores and disposes of records in a manner that protects the confidentiality of information.
STANDARD TWELVE The midwife shall be accountable to the client, the midwifery profession and the public for safe, competent and ethical care.
The midwife: 12.1 assumes responsibility for all care provided; 12.2 ensures that the results from all tests, treatments, consultations and referrals are followed up and acted upon in a timely manner; 12.3 never abandons a client in labour; 12.4 conducts themselves professionally and with integrity at all times, and never in a way that puts the profession of midwifery in disrepute; 12.5 disclosures appropriate information to the client related to any harm or injury they experience while receiving midwifery care; 12.6 informs the client as to complaint and review procedures established under the Act and the Bylaws; 12.7 participates in mortality and morbidity reporting and review processes as required by institutional policies and CMBC; and 12.8 complies with the quality assurance program as established by CMBC.
STANDARD THIRTEEN The midwife shall participate in ongoing education and evaluation of self, colleagues, and the community.
The midwife: 13.1 involves the client in evaluating midwifery practice and integrates the results of evaluation into practice; 13.2 adjusts clinical practice after review of current literature and appropriate education or training; 13.3 shares knowledge with colleagues and students and assists in developing
10 Refer to the Policy on Record Keeping, Storage and Retention
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mechanisms to promote this sharing; and 13.4 maintains current knowledge of academic and professional research based on developments that are directly related to midwifery practice.
STANDARD FOURTEEN The midwife shall critically assess research findings for use in practice and shall support research activities.
The midwife: 14.1 complies with bylaw 84 when engaged in any research activities; 14.2 identifies areas for research, shares research findings and incorporates these appropriately into practice; and 14.3 ensures that the research in which midwives participate meets acceptable standards of research methodology and design, and is consistent with CMBC’s Code of Ethics.
STANDARD FIFTEEN The midwife shall only prescribe, order or administer drugs and substances in the categories as set out in Schedules A and B of the Midwives Regulation and these shall be prescribed, ordered or administered in accordance with CMBC Standards.
STANDARD SIXTEEN The midwife shall only order, perform or collect samples for and interpret screening and diagnostic tests in accordance with CMBC’s Standards, Limits and Conditions for Ordering and Interpreting Screening and Diagnostic Tests.
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First Approved Version: January 27, 1997 Current Approved Version: September 25, 2017
COMPETENCIES OF REGISTERED MIDWIVES
Midwifery Education Programs approved by the Registration Committee of the College of Midwives of BC (CMBC) prepare their graduates to practice as general registrants in the full scope of practice in British Columbia. Such programs ensure that their graduates have acquired the midwifery knowledge and skills essential for practice in BC, while embracing the BC philosophy of midwifery care. The midwife, as a primary health care professional, must be able to provide responsive holistic care and advice during the antepartum, intrapartum and postpartum period.
Approved Midwifery Education Programs foster the development of sound practical skills based on and reinforced through clinical experience. Students are being prepared to assume roles in primary care, education, health promotion, and counselling related to childbearing and the transition to parenthood. Approved Programs provide opportunities to develop and use clinical judgement, critical thinking, communication, collaboration and research skills necessary to provide family-centred care throughout the childbearing cycle. Approved Programs assist students in developing sensitivity toward health issues related to childbearing from a global perspective.
These Competencies of Registered Midwives set out the expectations for what an entry-level midwife in British Columbia is expected to know and do. An entry-level midwife is someone who is qualified and meets the requirements to begin practicing as a midwife in BC without supervision requirements on their registration.
GENERAL COMPETENCIES
Midwives have the knowledge and skills necessary to:
1. provide responsive holistic care and advice before and during pregnancy, labour, birth and the postpartum; 2. provide care which responds to client diversity; 3. provide education, health promotion and counselling related to childbearing, transition to parenthood and family planning for the client, family and the community; 4. facilitate informed decision-making; 5. assist in planning for an appropriate place of birth; 6. provide primary care in a variety of settings including hospitals, clinics, health units, community health centres, birth centres or homes; 7. provide care in accordance with universal precautions and infection control best practices; 8. support and facilitate physiologic birth; 9. conduct births and care for the newborn on their own responsibility;
10. identify risk factors before and during pregnancy, during labour, birth and the postpartum period and take appropriate action; 11. order, perform and interpret results of screening and diagnostic tests according to CMBC
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Standards, Limits and Conditions for Ordering and Interpreting Screening and Diagnostic Tests; 12. identify abnormal conditions, recommend and initiate appropriate treatment and make referrals, as required; 13. provide objective information regarding the risks and benefits of and alternatives to obstetrical treatments and interventions; 14. use technology appropriately; 15. prescribe and administer drugs and substances according to Schedules A and B of the Midwives Regulation, CMBC Standards, Limits and Conditions for Prescribing, Ordering and Administering Drugs and CMBC Standards, Limits and Conditions for Prescribing, Ordering and Administering Controlled Substances; 16. establish and maintain comprehensive, relevant and confidential records; 17. carry out basic life support and other appropriate emergency measures when necessary; 18. interpret research findings and apply them to midwifery practice; and 19. practice in an ethical manner.
SPECIFIC COMPETENCIES
I. Antepartum Care
A. Midwives have knowledge of:
1. the importance and functions of pre-pregnancy counselling1; 2. general anatomy and physiology; 3. anatomy and physiology of the reproductive systems; 4. physical, emotional, sexual and social changes associated with pregnancy; 5. physical, emotional, sexual and social factors likely to influence pregnancy outcome; 6. selected aspects of genetics, embryology and fetal development; 7. nutritional requirements during pre-conception and pregnancy; 8. the physiology and management of common discomforts during pregnancy; 9. methods for diagnosing pregnancy, establishing due dates, assessing gestational age and assessing the progress of pregnancy; 10. screening and diagnostic tests that may be ordered during pregnancy; 11. drugs and substances that may be used during pregnancy, including their indications, contraindications and interactions; 12. complementary therapies which may be used during pregnancy; 13. environmental, occupational, genetic, biological and pharmacological hazards during pregnancy; 14. causes, recognition, treatment and management of abnormalities and variations of normal which may occur during pregnancy; and
1 Midwives Regulation restricts the provision of midwifery care to during pregnancy, labour, delivery and the postpartum period/
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15. sexually transmitted diseases, vaginal infections and their impact on pregnancy.
B. Midwives have the ability to:
1. obtain a comprehensive health history; 2. perform a complete physical examination; 3. confirm pregnancy; 4. assess general nutritional status and provide or recommend appropriate counselling; 5. manage common discomforts associated with pregnancy; 6. assess well-being and the progress of pregnancy; 7. assess for and respond appropriately to variations of normal and signs and symptoms of abnormal conditions; 8. obtain the necessary specimens to determine the presence of sexually transmitted infections, vaginal infections and cytological changes and use a microscope to examine specimens; 9. perform venipuncture and finger puncture; 10. order and interpret screening and diagnostic tests used in pregnancy; 11. provide information and resources regarding newborn behaviour, nutrition, feeding and care; 12. provide information and resources on the benefits and practice of breastfeeding; 13. prescribe, order and administer drugs and substances used in pregnancy; and 14. use appropriate complementary therapies.
II. Intrapartum Care
A. Midwives have knowledge of:
1. the process of labour, including the mechanisms of labour and birth; 2. anatomy as relevant to assessing fetal position and the progress of labour; 3. indicators of well-being; 4. requirements for a safe birthing environment; 5. comfort and support measures during labour and birth; 6. holistic approaches to facilitate labour and birth; 7. fetal health surveillance; 8. aseptic technique; 9. significance of ruptured membranes and methods of reducing risk of infection; 10. abnormalities of labour; 11. prevention, assessment and management of exhaustion and dehydration during labour; 12. techniques to protect the perineum, avoid episiotomy and minimize lacerations; 13. indications and procedure for episiotomy;
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14. indications and procedure for repair of lacerations or episiotomy; 15. care during the 3rd stage of labour; 16. prevention and treatment of hemorrhage; 17. drugs and substances which may be used during the intrapartum period, including their indications, contraindications and interactions; 18. complementary therapies which may be used during the intrapartum period; 19. screening and diagnostic tests that may be ordered during the intrapartum period; 20. obstetrical interventions used to assist labour; 21. obstetrical interventions used in emergency care; and 22. neonatal resuscitation, to the standard established for a primary care provider in Canada (includes successful completion of a provincially recognised neonatal resuscitation program).
B. Midwives have the ability to:
1. provide emotional and physical support during labour; 2. assess the onset and progress of labour and take appropriate actions according to: (i) frequency, duration and intensity of uterine contractions; (ii) fetal station, position, presentation, attitude and degree of moulding; (iii) condition of the cervix; 3. recognise abnormal labour patterns and identify the probable cause(s); 4. assess fetal heart tones by auscultation and electronic means including application of scalp electrodes; 5. determine the status of fetal membranes and perform amniotomy; 6. assess amniotic fluid; 7. recognise factors which could impede labour progress; 8. recognise a full bladder and catheterize; 9. assess the need for relief of pain and intervene using non-pharmacological and pharmacological measures as required; 10. give injections, insert an intravenous catheter and administer intravenous fluids and medications; 11. prescribe, order and administer drugs and substances used during the intrapartum; 12. administer inhalants; 13. order and interpret screening and diagnostic tests during the intrapartum period; 14. protect the perineum, avoid unnecessary episiotomy and minimize lacerations; 15. perform an episiotomy; 16. assist and support the spontaneous vaginal birth of the baby and placenta; 17. recognise signs of placental separation; 18. collect cord blood;
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19. examine the placenta, membranes and cord; 20. examine the perineal and vulval areas for lacerations, hematomas and abrasions and repair lacerations or episiotomy; 21. recognize and manage postpartum hemorrhage; 22. recognize signs of shock, initiate treatment and perform ongoing assessment; 23. perform immediate newborn assessment and care; 24. perform neonatal resuscitation to the standard established for a primary care provider in Canada; and 25. encourage and assist with the initiation of breastfeeding.
III. Postpartum Care
A. Midwives have knowledge of:
1. anatomy and physiology of the client during the postpartum period; 2. postpartum discomforts and their management; 3. methods to assess and manage postpartum complications; 4. screening and diagnostic tests that may be ordered during the postpartum period; 5. drugs and substances that may be used during the postpartum period, including their indications, contraindications and interactions; 6. emotional, psychosocial and sexual aspects of the postpartum period and early parenting; 7. nutritional requirements during the postpartum period; and 8. methods of birth control and family planning and their risks and benefits.
B. Midwives have the ability to:
1. assess health and monitor progress during the postpartum period; 2. assist the client to establish and maintain breastfeeding; 3. provide information and resources to the client and family regarding self-care, normal postpartum progress and signs and symptoms of common postpartum complications; 4. manage postpartum complications; 5. prescribe, order and administer drugs and substances used in the postpartum; 6. order and interpret screening and diagnostic tests in the postpartum; and 7. counsel the client and family in the choice and use of contraceptive methods;
IV. Care of the Newborn and Young Infant
A. Midwives have knowledge of:
1. anatomy and physiology of the newborn;
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2. methods of newborn assessment and gestational age assessment; 3. nutritional needs of the newborn and properties of breast milk and breast milk substitutes; 4. methods of infant feeding; 5. newborn screening methods and diagnostic testing; 6. growth and development of the newborn; 7. signs and symptoms of abnormal conditions in the newborn; 8. prophylactic medications commonly given to the newborn; 9. effects of drugs on the newborn; 10. safety needs of the newborn; and 11. issues related to circumcision.
B. Midwives have the ability to:
1. perform a newborn assessment and provide care at birth; 2. perform a comprehensive newborn exam; 3. perform a heel puncture to obtain samples; 4. administer immune globulins, vaccines and other medications to the newborn; 5. order and interpret screening and diagnostic tests for the newborn; 6. assess the ongoing well-being and development of the newborn in early infancy and make appropriate referrals as necessary; and 7. provide information and resources to the client and family regarding newborn growth, development, behaviour, nutrition, feeding and care, and immunizations.
V. Breastfeeding
A. Midwives have knowledge of:
1. anatomy and physiology of lactation; 2. health benefits of breastfeeding; 3. the normal breastfeeding process and necessary conditions and factors for its success; 4. emotional, social and psychological aspects of breastfeeding; 5. the influence of environmental, occupational, biological and pharmacological factors on breastfeeding; 6. stimulation and suppression of lactation; 7. drugs and substances that may be used during lactation, including their indications, contraindications and interactions; and 8. management of common breastfeeding problems, including breast infections.
B. Midwives have the ability to:
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1. assist the client to initiate and maintain breastfeeding; 2. use assistive devices and complementary therapies to support breastfeeding; 3. prescribe, order and administer drugs to support breastfeeding; and 4. identify special, unusual or abnormal situations and develop an appropriate plan of action.
VI. Education and Counselling
A. Midwives have knowledge of:
1. principles and processes of informed decision-making; 2. principles of adult education, communication and counselling; 3. theoretical approaches to prenatal and parenting education; 4. family theory; 5. grief and loss; 6. available community resources; 7. cultural influences on childbearing and child rearing; 8. the impact of life experiences on childbearing; 9. the role of midwives as preceptors for learners; and 10. principles of mentoring.
B. Midwives have the ability to:
1. provide objective information about care alternatives to facilitate informed decision making; 2. communicate effectively with the client, family, and their support people; 3. identify and respond to the client and family’s educational and counselling needs; 4. assist the client and family in planning and preparing for the birth experience and early parenting; 5. assess the emotional status of the client; 6. provide prenatal and parenting education; 7. respond sensitively to cultural differences in providing care to the client and family; 8. work with and in groups; and 9. support and evaluate student learning.
VII. Sexuality
A. Midwives have knowledge of:
1. physiological and psychosocial aspects of human sexuality; 2. physiological and psychosocial aspects of human fertility;
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3. human sexuality during the childbearing cycle; 4. infertility and its implications for midwifery care; and 5. counselling and resources for unexpected pregnancies.
B. Midwives have the ability to:
1. inform and advise on issues of human sexuality and make referrals where appropriate.
VIII. Collaboration with Other Caregivers
A. Midwives have knowledge of:
1. the role and responsibilities of other health care providers and their standards of practice; and 2. the process of team-building and engaging in partnerships.
B. Midwives have the ability to:
1. communicate effectively with other caregivers, facilitating referral, consultation and collaboration when appropriate.
IX. Professional, Legal and other Cornerstones of the Profession
A. Midwives have knowledge of:
1. current issues in midwifery at local, provincial, national and international levels; 2. the structures and processes of the Canadian health care system; 3. key historical developments in Canadian health care as they relate to midwifery; 4. selected health policies in the provincial, national and international context; 5. the process of policy analysis and policy development; 6. the politics of health care as it relates to health; 7. the history, philosophy and nature of the midwifery profession; 8. the structure and function of professional midwifery organizations; 9. regulations and processes governing midwifery in BC; 10. legal aspects of midwifery practice including, but not limited to, duties and responsibilities of the midwife, privacy and freedom of information, informed consent and informed choice and recording and reporting; 11. the College of Midwives Code of Ethics and ethical frameworks guiding midwifery practice; 12. frameworks and methods for assessing evidence for practice; and 13. entrepreneurial frameworks and midwifery practice management.
COMPETENCIES for SPECIALIZED PRACTICE:
Competencies of Registered Midwives Page 8 of 9 Midwifery Page 22 of 137 AGENDA ITEM C. 2.
Under the Midwives Regulation and the Bylaws for the College of Midwives of BC a BC general registered midwife may acquire additional certification through a certification course or program established by the quality assurance committee and approved by the board to practice in the following areas of specialized competency:
Certification of Competency required for: 1. contraceptive management: a. prescribing contraceptives2; b. fitting barrier methods and inserting intrauterine devices3 for contraception; 2. sexually transmitted infection management4; 3. induction or augmentation of labour in hospital for early rupture of membranes at term and/or for non-progressive labour and/or post-dates pregnancy where fetal assessment is reassuring and there are no indications for physician consultation or transfer of care5; 6 4. vacuum assisted birth in hospital ; 5. first surgical assist at cesarean sections in hospitals with cesarean capabilities7; 6. inserting acupuncture needles for pain relief in labour or the postpartum period8; and 7. epidural monitoring in hospital9.
The following areas for specialized practice have also been requested; further legislation or regulation amendments are required for: 8. providing well baby care up to one year; 9. providing sexual and reproductive health care throughout the life cycle; 10. evacuation of the uterus.
2 Framework for Certification in place - an approved certification program is in place. For more information, please contact CMBC. 3 Delegation of this act with specialized practice certification has been approved until the Midwives Regulation is amended to include Intrauterine Contraceptive Therapy as a Certification for Specialized Practice. An approved certification program is in place. For more information, please contact CMBC. 4 Framework for Certification in place - an approved certification program is in place. For more information, please contact CMBC. 5 Certification process is not yet in place. For more information, please contact CMBC. 6 Certification process is not yet in place. For more information, please contact CMBC. 7 Framework for Certification in place - an approved certification program is in place. For more information, please contact CMBC. 8 Framework for Certification in place - an approved certification program is in place. For more information, please contact CMBC. 9 Framework for Certification in place - an approved certification program is in place. For more information, please contact CMBC.
Competencies of Registered Midwives Page 9 of 9 Midwifery Page 23 of 137 Page 24 of 137 AGENDA ITEM E. 1.
Minutes of the Special Meeting of the North West Regional Hospital District held Friday, March 22, 2019, in the Regional District of Kitimat-Stikine Board Room, located at 4545 Lazelle Avenue, Terrace, B.C., commencing at 10:31 a.m.
Members Present:
Vice Chair Bidgood Presided
Mark Fisher Bulkley-Nechako Regional District Electoral Area A Rob Newell Bulkley-Nechako Regional District Electoral Area G Jonathan Van Barneveld Bulkley-Nechako Regional District District of Houston Taylor Bachrach Bulkley-Nechako Regional District Town of Smithers Brad Layton Bulkley Nechako Regional District Village of Telkwa Eric Nyce Kitimat-Stikine Regional District Electoral Area A Dean Paranich Kitimat-Stikine Regional District Electoral Area B Bruce Bidgood Kitimat-Stikine Regional District Electoral Area C Jeff Hammond Kitimat-Stikine Regional District Electoral Area E James Cordeiro Kitimat-Stikine Regional District City of Terrace Sean Bujtas Kitimat-Stikine Regional District City of Terrace Rob Goffinet Kitimat-Stikine Regional District District of Kitimat Gail Lowry Kitimat-Stikine Regional District District of New Hazelton Gina McKay Kitimat-Stikine Regional District District of Stewart Dennis Sterritt Kitimat-Stikine Regional District Village of Hazelton Willard Martin Kitimat-Stikine Regional District Nisga’a Nation Des Nobels North Coast Regional District Electoral Area A (attended electronically) Johanne Young North Coast Regional District Electoral Area D Evan Putterill North Coast Regional District Electoral Area E Barry Cunningham North Coast Regional District City of Prince Rupert Knut Bjorndal North Coast Regional District District of Port Edward (attended electronically) Doug Daugert North Coast Regional District Village of Port Clements Kris Olsen North Coast Regional District Village of Queen Charlotte (attended electronically)
Staff Present:
Yvonne Koerner Executive Director Lisa Teggarty Treasurer Megan Glover Recording Secretary
Also Present:
Margaret Jones Bricker Manager Annual Giving, Northern BC, BC Cancer Society Sandra Blackwell Annual Giving Coordinator, Northern BC, BC Cancer Society Dr. Jaco Fourie Medical Director, Northwest HSDA, Medical Lead Northern Health Cancer Care, Northern Health
Minutes of the March 22, 2019, regular meeting of the North West Regiona... Page 25 of 137 AGENDA ITEM E. 1. Members Absent with Apologies:
Dave Brocklebank Kitimat-Stikine Regional District Electoral Area F Tina Etzerza Kitimat-Stikine Regional District Electoral Area D Karl Bergman North Coast Regional District Electoral Area C Lee Brain North Coast Regional District City of Prince Rupert Barry Pages North Coast Regional District Village of Masset Dan Franzen North Coast Regional District District of Port Edward
Vice Chair Bidgood called the meeting to order at 10:31 a.m.
APPROVAL OF AGENDA:
R043-2019 MOVED by Director Cunningham/Director Lowry that the March 22, 2019 North West Regional Hospital District Meeting Agenda be accepted as presented. Carried.
IN-CAMERA:
R044-2019 MOVED by Director Hamond/Director Newell that the meeting move In-Camera. Carried.
The meeting moved in-camera at 10:34 a.m.
Director Martin arrived at 10:35 a.m.
The meeting moved out of camera at 10:40 a.m.
MINUTES:
Presented were the minutes of the February 22, 2019 Special Meeting of the North West Regional Hospital District.
R045-2019 MOVED by Director Nyce/Director Hammond that the minutes of the February 22, 2019 Special Meeting of the North West Regional Hospital District be adopted as presented. Carried.
REPORTS:
R046-2019 MOVED by Director Newell/Director Cunningham that the Report from Administration, dated January 25, 2019, regarding North West Regional Hospital District: Directors’ Report – January 25, 2019 Board Meeting – with Follow-up Action List be received. Carried.
Director Layton arrived at 10:43 a.m.
Margaret Jones Bricker and Sandra Blackwell arrived at 10:47 a.m.
Minutes of the March 22, 2019, regular meeting of the North West Regiona... Page 26 of 137 AGENDA ITEM E. 1. DELEGATIONS & GUESTS:
Kordyban Lodge, BC Cancer Society Margaret Jones Bricker, Manager Annual Giving, Northern BC Sandra Blackwell, Annual Giving Coordinator, Northern BC
Director Bjorndal arrived at 11:11 a.m.
Ron Poole arrived at 11:15 a.m.
Margaret Jones Bricker and Sandra Blackwell left at 11:17 a.m.
BYLAWS:
Introduced and presented for three readings and adoption was North West Regional Hospital District Budget Bylaw No. 116, 2019.
R047-2019 MOVED by Director Lowry/Director Layton that the North West Regional Hospital District Budget Bylaw No. 116, 2019 be read for a first and second time by title only and passed in its first and second reading. Carried.
R048-2019 MOVED by Director Layton/Director Newell that the North West Regional Hospital District Budget Bylaw No. 116, 2019 be read for a third time by title only and passed in its third reading. Carried.
R049-2019 MOVED by Director Lowry/Director Goffinet that the North West Regional Hospital District Budget Bylaw No. 116, 2019 be adopted. Carried.
NEW BUSINESS:
R050-2019 MOVED by Director Layton/Director Bujtas that the next regular meeting of the North West Regional Hospital District be held May 17, 2019. Carried.
The next meeting of the North West Regional Hospital District will be held May 17, 2019.
Dr. Jaco Fourie arrived at 11:26 a.m.
Topics for the North Central Local Government Association Meeting with Northern Health: • Mills Memorial Hospital Update • Population Health – Casual Factors • Imagine Grants – Complaints Regarding Process • Trauma Report 2008 • Emergency Medical Evacuations from the Nass Valley – BC Ambulance Service
DELEGATIONS & GUESTS:
Physician Recruitment Update, Northern Health Dr. Jaco Fourie, Medical Director, Northwest HSDA, Medical Lead Northern Health Cancer Care
Dr. Fourie left at 12:06 p.m.
Minutes of the March 22, 2019, regular meeting of the North West Regiona... Page 27 of 137 AGENDA ITEM E. 1.
INFORMATION:
R051-2019 MOVED by Director Layton/Director Cunningham that: 1) the News Release from Northern Health dated February 14, 2019, regarding Northern Health Board Meeting Highlights: Projects, Partnerships and Philanthropy; 2) the News Release form the Ministry of Transportation dated February 22, 2019 regarding Province Restoring Ferry Service to Coastal Communities; 3) the Letter to Chair and Board, Regional District of Kitimat-Stikine, from Arjun Singh, Union of BC Municipalities President, dated March 7, 2019, regarding Provincial Response to 2018 Resolutions; 4) News Article from the Terrace Standard dated March 13, 2019 regarding Doctor Recruiting Drive Showing Results; 5) the News Story from the Terrace Standard dated March 15, 2019, regarding Radiology Improvements Boost Regional Patient Care; 6) the News Release from the Ministry of Health dated March 20, 2019, regarding Province to Launch Catch-up Immunization Program to Protect Against Measles; and 7) the News Release from Northern Health dated March 21, 2019, regarding New Mobile Unit Takes Mental Health and Addictions Services on the Road be received as a block. Carried.
NEW BUSINESS:
R052-2019 MOVED by Director Putterill/Director Nobels that administration investigate the Capital Financing Agreement for the Masset Hospital. Carried.
ADJOURNMENT:
R053-2019 MOVED by Director Cunningham/Director Layton that the meeting be adjourned. Carried.
Vice Chair Bidgood adjourned the meeting at 12:26 p.m.
DULY APPROVED: CERTIFIED CORRECT:
______Chair Executive Director
Minutes of the March 22, 2019, regular meeting of the North West Regiona... Page 28 of 137 AGENDA ITEM G. 1. Northern Health: Finance Department 300-299 Victoria Street, Prince George, BC V2L 5B8 Telephone (250) 565-2300, Fax: (250) 565-2833, www.northernhealth.ca
April 25, 2019
Email: [email protected]
Yvonne Koerner Treasurer North West Regional Hospital District 300 – 4545 Lazelle Avenue Terrace, BC V8G 4E1
RE: Fourth Quarter 2018/19 Capital Status Reports
Dear Ms. Koerner:
Thank you for your continued support.
Enclosed please find capital status reports for the final quarter of our 2018/2019 year for the Building Integrity and the Minor Capital Grant(s).
We have also attached the Dashboards for projects currently in progress.
If you have any questions on the attached, please do not hesitate to contact our office via email at [email protected].
Sincerely,
Lil Milani
A. Lil Milani Capital Accounting Coordinator
Letter from Lil Milani, Capital Accounting Coordinator, Northern Health,... Page 29 of 137 Letter from Lil Milani, Capital Accounting Coordinator, Northern Health,...
Period Date: March 31,2019
Fund Budget Reconciliation FUNDING SOURCES MOH RHD Aux/ Opening Total Actual Committed Foundation Cash Expenditures (Spent) BI - Building Integrity $104,000 $69,333 $173,333 $61,565 $168,625 Budget Total: $104,000 $69,333 $173,333 $61,565 $168,625 Expense Total: $99,292 $69,333 $168,625
Variance: $4,708 $4,708 Capital Expenditures 2019 BI - Building Integrity Acropolis Manor N671940003 DDC & BOS Replacement $61,565 $61,565 61,565 Completed Count:: 1 Completed Total $61,565 $61,565 61,565 Stewart Health Centre N671990032 Propane Vapourizer Replacement $44,070 $7,768 $51,838 Ordered Count:: 1 Ordered Total $44,070 $7,768 $51,838 Mills Memorial Hospital N6719N0010 Cooling Coil Replacement $18,103 $18,103 18,103Tsf to Operating Houston D & T N6719N0008 Compressor #2 and valves for compressor $13,412 $13,412 13,412Tsf to Operating Count:: 2 Tsf to Operating Total $31,514 $31,514 31,514 Kitimat Hospital and Health Centre N6719N0027 Network Automation Engine (NAE) Unit $6,687 $6,687 Tsf to Op In Progress Bulkley Lodge N6719N0021 Controls Replacement Phase 1 $17,021 $17,021 2,269Tsf to Op In Progress Count:: 2Tsf to Op In Progress Total $23,708 $23,708 2,269 BI - Building Integrity Total $99,292 $69,333 $168,625 95,348
'Approved' Count:: 0 Count:: 6 Report Total $99,292 $69,333 $168,625 95,348 'On Hold' Count:: 0 'Ordered' Count:: 1 'Completed' Count:: 1 AGENDA ITEM G. 1. Page 30 of 137
Tuesday, April 09, 2019 Page 1 of 1 Letter from Lil Milani, Capital Accounting Coordinator, Northern Health,...
Period Date: March 31,2019
Fund Budget Reconciliation FUNDING SOURCES MOH RHD Aux/ Opening Total Actual Committed Foundation Cash Expenditures (Spent) BI - Building Integrity $180,000 $120,000 $104,602 $404,602 $0 $76,612 Budget Total: $180,000 $120,000 $104,602 $404,602 $0 $76,612 Expense Total: $76,612 $76,612
Variance: $103,388 $120,000 $104,602 $327,990 Capital Expenditures 2020 BI - Building Integrity Wrinch Memorial Hosp-New N6720N0001 Med Vacuum System $48,923 $48,923 Tsf to Op In Progress Mills Memorial Hospital N6720N0007 AC Unit Replacement $27,689 $27,689 Tsf to Op In Progress Count:: 2Tsf to Op In Progress Total $76,612 $76,612 BI - Building Integrity Total $76,612 $76,612
'Approved' Count:: 0 Count:: 2 Report Total $76,612 $76,612 'On Hold' Count:: 0 'Ordered' Count:: 0 'Completed' Count:: 0 AGENDA ITEM G. 1. Page 31 of 137
Tuesday, April 09, 2019 Page 1 of 1 Letter from Lil Milani, Capital Accounting Coordinator, Northern Health,...
Period Date: March 31,2019
Fund Budget Reconciliation FUNDING SOURCES MOH RHD Aux/ Opening Total Actual Committed Foundation Cash Expenditures (Spent) Minor Capital < $100,000 $842,941 $975,000 $654,510 $191,217 $2,663,668 $1,629,635 $2,581,532 Budget Total: $842,941 $975,000 $654,510 $191,217 $2,663,668 $1,629,635 $2,581,532 Expense Total: $760,808 $975,000 $654,507 $191,217 $2,581,532
Variance: $82,133 $3 $82,136 Capital Expenditures 2019 Minor Capital < $100,000 Bulkley Valley District Hospital N671990026 Ventilator $40,228 $40,228 40,228 Completed Bulkley Valley District Hospital N671990028 Tub $21,392 $21,392 21,392 Completed Bulkley Valley District Hospital N671990040 Monitor System - Temperature $19,407 $19,407 19,407 Completed Bulkley Valley District Hospital N671990042 Lift - Ceiling X3 (Rooms 311,318,342) $8,858 $15,900 $24,758 24,758 Completed Bulkley Valley District Hospital N671990058 Scrubber - Floor $8,490 $8,490 8,490 Completed Bulkley Valley District Hospital N671990061 Colonoscope $42,806 $42,806 42,806 Completed Bulkley Valley District Hospital N671990062 Gastroscope $35,195 $35,195 35,195 Completed Wrinch Memorial Hosp-New N671990004 Ultrasound - Portable $48,533 $48,533 48,533 Completed Wrinch Memorial Hosp-New N671990008 Reprocessor - Endoscope $40,679 $40,679 40,679 Completed Wrinch Memorial Hosp-New N671990013 Bed & Mattress X2 $12,905 $12,905 12,905 Completed Wrinch Memorial Hosp-New N671990017 Monitor - Patient $1,941 $23,753 $25,694 25,694 Completed Wrinch Memorial Hosp-New N671990025 Wound Therapy System (Activac) $23,727 $23,727 23,727 Completed Mills Memorial Hospital N671890061 Hood - Fume $18,121 $18,121 18,121 Completed Mills Memorial Hospital N671990001 Pump - Syringe X2 $10,774 $10,774 10,774 Completed Mills Memorial Hospital N671990007 Bed - Echo $8,641 $8,641 8,641 Completed Mills Memorial Hospital N671990011 Transducer X2 & Upgrade Kit X2 & Shear $31,454 $20,750 $52,204 52,204 Completed Mills Memorial Hospital N671990014 Analyzer - Coagulation $37,110 $37,110 37,110 Completed Mills Memorial Hospital N671990016 Analyzer - Microbiology $41,793 $41,793 41,793 Completed Mills Memorial Hospital N671990022 Lights - Operating (Major Room) $53,535 $53,535 53,535 Completed Mills Memorial Hospital N671990029 Cabinet - Warming $5,570 $5,570 5,570 Completed Mills Memorial Hospital N671990033 Table - Urology $51,547 $15,000 $66,547 66,547 Completed
Mills Memorial Hospital N671990034 Freezer - Plasma $13,254 $13,254 13,254 Completed AGENDA ITEM G. 1. Mills Memorial Hospital N671990039 Refrigerator $12,345 $12,345 12,345 Completed Mills Memorial Hospital N671990041 Microscope $49,072 $49,072 49,072 Completed Mills Memorial Hospital N671990043 Bike - Trainer $10,809 $10,809 10,809 Completed Mills Memorial Hospital N671990047 Scanner - Bladder $16,900 $16,900 16,900 Completed Mills Memorial Hospital N671990050 Laser - Ophthalmology $51,984 $51,984 51,984 Completed Mills Memorial Hospital N671990051 Ventilator $20,920 $20,920 20,920 Completed Northwest CHSS N671930001 Health Unit Renovation - Smithers $106,955 $106,955 106,955 Completed Northwest CHSS N671990030 Stretcher - Exam $7,050 $7,050 7,050 Completed Page 32 of 137 Kitimat Hospital and Health Centre N671890056 Video System - Surgical (Endoeye) $37,748 $37,748 37,748 Completed Kitimat Hospital and Health Centre N671990002 Beds & Mattresses X5 $36,541 $36,541 36,541 Completed Kitimat Hospital and Health Centre N671990010 Power Drill & Saw Module for OR $37,636 $37,636 37,636 Completed Kitimat Hospital and Health Centre N671990015 Pump - Infusion X6 $6,587 $25,872 $32,459 32,459 Completed Kitimat Hospital and Health Centre N671990018 Lift - Ceiling X6 $25,883 $32,000 $57,883 57,883 Completed Tuesday, April 09, 2019 Page 1 of 3 Letter from Lil Milani, Capital Accounting Coordinator, Northern Health,... Fund Budget Reconciliation FUNDING SOURCES Period Date: March 31,2019 MOH RHD Aux/ Opening Total Foundation Cash Expenditures to Date File Capital Expenditures Year(s): 2019 /Other /Deferred Status /Internal Kitimat Hospital and Health Centre N671990035 Power Drill and Saw Module $28,762 $28,762 28,762 Completed Kitimat Hospital and Health Centre N671990036 Lift - Hygiene $10,352 $10,352 10,352 Completed Kitimat Hospital and Health Centre N671990038 Stainer, Slide (Cytocentrifuge) $22,590 $22,590 22,590 Completed Kitimat Hospital and Health Centre N671990044 Lift - Ceilng X2 $17,337 $17,337 17,337 Completed Prince Rupert Regional Hospital N671990031 Bed - Bariatric $19 $21,768 $21,787 21,787 Completed Prince Rupert Regional Hospital N671990048 Colonoscope $42,806 $42,806 42,806 Completed Prince Rupert Regional Hospital N671990054 Scrubber - Floor $8,490 $8,490 8,490 Completed Prince Rupert Regional Hospital N671990071 Table - Exam $14,819 $14,819 14,819 Completed Bulkley Lodge N671990066 Lift - Floor $6,127 $6,127 6,127 Completed Terraceview Lodge N671990003 Oven - Retherm $10,218 $10,218 10,218 Completed Community Programs(NW) N671990037 Pump - Infusion X2 $9,079 $9,079 9,079 Completed Houston D & T N671990063 Dishwasher $7,303 $7,303 7,303 Completed Atlin N671990012 Echocardiograph System $19,664 $19,664 19,664 Completed Mountain View Lodge N671990019 Lift - Ceiling X4 $37,974 $37,974 37,974 Completed Haida Gwaii Hospital and Health C N671990020 Colposcope $11,156 $11,156 11,156 Completed Haida Gwaii Hospital and Health C N671990021 Cautery System $7,410 $7,410 7,410 Completed Haida Gwaii Hospital and Health C N671990046 Ventilator $20,765 $20,765 20,765 Completed Count:: 52 Completed Total $220,617 $733,980 $471,705 $1,426,302 1,426,302 Bulkley Valley District Hospital N671990027 Camera - Surgical $14,344 $14,344 Ordered Bulkley Valley District Hospital N671990053 Mattress - Air $7,026 $7,026 Ordered Bulkley Valley District Hospital N671990059 Microscope $74,956 $74,956 Ordered Bulkley Valley District Hospital N671990065 Analyzer - Chemistry $32,597 $32,597 Ordered Bulkley Valley District Hospital N671990067 Bed - Electric $6,741 $6,741 Ordered Bulkley Valley District Hospital N671990068 Bed - Electric X2 $11,637 $11,637 Ordered Mills Memorial Hospital N671990009 Ventilator $8,628 $8,628 8,628 Ordered Mills Memorial Hospital N671990023 Lights - Operating (Minor Room) $54,221 $54,221 53,535 Ordered Mills Memorial Hospital N671990024 Mattress $8,000 $8,000 Ordered Mills Memorial Hospital N671990072 Cart - Meal X2 $11,614 $37,406 $49,020 Ordered Mills Memorial Hospital N671990073 Videoscope - Uretero-Reno (TRIAL) $19,249 $19,249 Ordered Kitimat Hospital and Health Centre N671990060 Ventilator $4,814 $20,487 $25,301 Ordered Prince Rupert Regional Hospital N671990005 Analyzer - Blood Gas $23,727 $23,727 Ordered AGENDA ITEM G. 1. Prince Rupert Regional Hospital N671990049 Tower - Surgical Video (Trial) $80,888 $80,888 80,888 Ordered Prince Rupert Regional Hospital N671990057 Nasolaryngoscope & Video Camera $436 $21,629 $22,065 3,775 Ordered Prince Rupert Regional Hospital N671990064 C-Arm - Mini $91,673 $91,673 Ordered Northern Haida Gwaii Hospital and N671990052 Analyzer - Chemistry $74,807 $74,807 20,044 Ordered Bulkley Lodge N671990070 Dryer - Commercial $12,827 $12,827 8,487 Ordered Bulkley Lodge N6719N0012 Bath Tub $10,298 $21,477 $31,775 27,977 Ordered Houston D & T N671990055 Mattress $7,026 $7,026 Ordered Houston D & T N671990069 Nurse Call Bell Upgrade $7,936 $7,936 Ordered
Page 33 of 137 Count:: 21 Ordered Total $252,863 $234,278 $177,303 $664,444 203,333 Kitimat Hospital and Health Centre N671990006 Bed - Bariatric $6,741 $6,741 On Hold Count:: 1 On Hold Total $6,741 $6,741 Bulkley Valley District Hospital N6719N0013 Curtains, Hookless - for OR Daycare area $1,028 $5,500 $6,528 6,528Tsf to Operating Mills Memorial Hospital N6719N0001 Pumps (18/19 Pump Remediation) $111,106 $191,217 $302,323 302,323Tsf to Operating Tuesday, April 09, 2019 Page 2 of 3 Letter from Lil Milani, Capital Accounting Coordinator, Northern Health,... Fund Budget Reconciliation FUNDING SOURCES Period Date: March 31,2019 MOH RHD Aux/ Opening Total Foundation Cash Expenditures to Date File Capital Expenditures Year(s): 2019 /Other /Deferred Status /Internal Kitimat Hospital and Health Centre N6719N0019 Compressor - Air $9,686 $9,686 9,686Tsf to Operating Prince Rupert Regional Hospital N6719N0015 Add 2 cameras to current camera system $4,156 $4,156 4,156Tsf to Operating Northern Haida Gwaii Hospital and N6719N0005 MAH Nurse Call Replacement Design Pha $7,564 $7,564 7,564Tsf to Operating Bulkley Lodge N6719N0016 Freezer Renovation $5,059 $5,059 5,059Tsf to Operating Community Programs(NW) N6719N0017 New Door Hardware, Lock Changes, new k $5,998 $5,998 5,998Tsf to Operating Houston D & T N6719N0007 Interface (Coagulation Analyzer) $5,619 $5,619 5,619Tsf to Operating Count:: 8 Tsf to Operating Total $150,216 $5,500 $191,217 $346,933 346,933 Mills Memorial Hospital N671990045 Cart - Meal $0 Cancelled Mills Memorial Hospital N6719N0006 BacTALERT (240 bottles) $0 Cancelled Count:: 2 Cancelled Total $0 Bulkley Valley District Hospital N6719N0029 Replace Emergency Entrance Doors $19,070 $19,070 Tsf to Op In Progress Prince Rupert Regional Hospital N6719N0014 Security Upgrades - add 2 doors (ER Staff $5,391 $5,391 Tsf to Op In Progress Prince Rupert Regional Hospital N6719N0022 Hookless Curtains in Emergency $22,068 $22,068 12,337Tsf to Op In Progress Bulkley Lodge N6719N0009 Production/Storage area redesign $20,678 $20,678 Tsf to Op In Progress Bulkley Lodge N6719N0028 Flooring R&R Phase 1 $32,320 $32,320 1,178Tsf to Op In Progress Houston D & T N6719N0002 Replace Main Entrance Doors $37,585 $37,585 29,970Tsf to Op In Progress Count:: 6Tsf to Op In Progress Total $137,112 $137,112 43,485 Minor Capital < $100,000 Total $760,808 $975,000 $654,507 $191,217 $2,581,532 2,020,052
'Approved' Count:: 0 Count:: 90 Report Total $760,808 $975,000 $654,507 $191,217 $2,581,532 2,020,052 'On Hold' Count:: 1 'Ordered' Count:: 21 'Completed' Count:: 52 AGENDA ITEM G. 1. Page 34 of 137
Tuesday, April 09, 2019 Page 3 of 3 Letter from Lil Milani, Capital Accounting Coordinator, Northern Health,...
Period Date: March 31,2019
Fund Budget Reconciliation FUNDING SOURCES MOH RHD Aux/ Opening Total Actual Committed Foundation Cash Expenditures (Spent) Minor Capital < $100,000 $852,000 $975,000 $146,776 $188,619 $2,162,395 $193,162 $403,160 Budget Total: $852,000 $975,000 $146,776 $188,619 $2,162,395 $193,162 $403,160 Expense Total: $48,273 $95,955 $146,776 $112,156 $403,160
Variance: $803,727 $879,045 $76,463 $1,759,235 Capital Expenditures 2020 Minor Capital < $100,000 Bulkley Valley District Hospital N672090003 Pump - Infusion X3 $21,333 $21,333 Approved Mills Memorial Hospital N672090006 Warmer - Infant $35,252 $35,252 Approved Mills Memorial Hospital N672090007 Pump - Infusion X2 $288 $11,000 $11,288 Approved Mills Memorial Hospital N672090010 Cystoscope - Flexible $18,845 $18,845 Approved Mills Memorial Hospital N672090013 Ice and Water Station $7,407 $7,407 Approved Kitimat Hospital and Health Centre N672090012 Table - Exam $4,780 $10,000 $14,780 Approved Count:: 6 Approved Total $31,320 $77,585 $108,905 Bulkley Valley District Hospital N672090004 Call System $12,359 $12,359 Ordered Bulkley Valley District Hospital N672090005 Monitor - Fetal $2,351 $30,054 $32,405 Ordered Mills Memorial Hospital N671990056 Table - Xray $7,321 $7,321 7,321 Ordered Mills Memorial Hospital N672090002 Cart - Meal $24,510 $24,510 Ordered Mills Memorial Hospital N672090008 *TRIAL - Coblator $10,536 $10,536 Ordered Mills Memorial Hospital N672090009 *TRIAL - Stretchers X5 $37,737 $37,737 Ordered Kitimat Hospital and Health Centre N672090001 Steamer - Food $14,425 $14,425 14,425 Ordered Kitimat Hospital and Health Centre N672090011 Colonoscope $3,669 $39,137 $42,806 Ordered Count:: 8 Ordered Total $48,273 $64,635 $69,191 $182,099 21,746 Bulkley Valley District Hospital N6720N0002 Maternity A/C Project $98,014 $98,014 Tsf to Op In Progress Prince Rupert Regional Hospital N6720N0008 4th Floor Renos for IPT Space $14,142 $14,142 Tsf to Op In Progress Count:: 2Tsf to Op In Progress Total $112,156 $112,156 Minor Capital < $100,000 Total $48,273 $95,955 $146,776 $112,156 $403,160 21,746 AGENDA ITEM G. 1. 'Approved' Count:: 6 Count:: 16 Report Total $48,273 $95,955 $146,776 $112,156 $403,160 21,746 'On Hold' Count:: 0 'Ordered' Count:: 8 'Completed' Count:: 0 Page 35 of 137
Monday, April 29, 2019 Page 1 of 1 Project Detail AGENDA ITEM G. 1. Created By : Leah Joseph on Wednesday, April 24, 2019 Report Status as of : 4/24/2019 Project Activity for : Last Week (Last 7 Days) Upcoming Tasks for: Next Week (Next 7 Days)
EXECUTIVE SUMMARY
PROJECT PROFILE
Identification
Name: WRI - Boiler Upgrade Phase 3 Number: CAP-0163
Description: Phase 3 of the boiler replacement.
Classification
Type: Construction Business Priority:
Status: Executing Category: Cap - Routine Capital Priority: Refer to Evaluation Portfolio: Capital
Organization Owner Capital Planning and Support Services Project Owner Joseph , Leah
Status Update (Last Modified: 9/12/2018 1:13:26 PM) September 10, 2018 - On track and on budget, Contract awarded and waiting to confirm delivery and final schedule. So far no change to schedule and budget is on track. July 16, 2018 - Construction contract has been awarded and signed by Aqua North Plumbing Ltd. Construction will continue to the middle of October. May 22, 2018 - Tender package has been posted today for Phase 3. Mandatory site tour will be Wednesday May 30, 2018 and tender closing date is Wednesday June 6, 2018. March 12, 2018 - Have proposal from mechanical consultant. Will execute as quickly as possible and finalize design and issue tender. Prelimninary design completed as part of Phase 2.
Health Name Value Name Value Cost Project is on track in this area. Schedule Project is on track in this area. Overall Project Health Project is on track in this area. Scope Project is on track in this area. Quality Project is on track in this area.
Properties Name Value Name Value Funding Type Major Capital City Hazelton Cost Code (WIP) 5800.85.6719401 HSDA NW Project File Number N671940001
SCHEDULE SUMMARY
Schedule Details
Start Date: 3/1/2018 Baseline Start Date: Actual Effort To Date(hrs): 16.50 Planned Effort to Date(hrs): 4,485.00
End Date: 4/24/2019 Baseline End Date: % Complete: 0 % Expected % Complete: 100 %
Duration(days): 300 Baseline Duration(days):
Accomplishments
None for the selected period.
Letter fromPage: Lil Milani, 1 of 2 Capital Accounting Coordinator, Northern Health,... Page 36 of 137 Project Detail AGENDA ITEM G. 1. Created By : Leah Joseph on Wednesday, April 24, 2019 Report Status as of : 4/24/2019 Project Activity for : Last Week (Last 7 Days) Upcoming Tasks for: Next Week (Next 7 Days)
PROJECT DETAIL
FINANCIAL
Financial Plan: 2018.03.01 - Financial Plan [Approved] Year View: Fiscal
Total Total Grand 2018 2019 Total Funding $300,000.00 $0.00 $300,000.00
MOH - RCG $180,000.00 $0.00 $180,000.00
RHD $120,000.00 $0.00 $120,000.00
Budget $300,000.00 $0.00 $300,000.00
Capital $300,000.00 $0.00 $300,000.00
Construction $165,797.00 $0.00 $165,797.00
Construction Contingency $16,440.00 $0.00 $16,440.00
Mechanical Engineer $22,691.00 $0.00 $22,691.00
Other Costs $56,981.00 $0.00 $56,981.00
Project Contingency $27,615.00 $0.00 $27,615.00
Project Manager $10,476.00 $0.00 $10,476.00
Expenditures $90.38 $256,259.46 $256,349.84
Committed $0.00 $48,313.31 $48,313.31
Capital $0.00 $48,313.31 $48,313.31
Construction $0.00 $48,313.31 $48,313.31
Actual $90.38 $207,946.15 $208,036.53
Capital $90.38 $207,946.15 $208,036.53
Construction $90.38 $207,946.15 $208,036.53
Letter fromPage: Lil Milani, 2 of 2 Capital Accounting Coordinator, Northern Health,... Page 37 of 137 Project Detail AGENDA ITEM G. 1. Created By : Leah Joseph on Monday, April 29, 2019 Report Status as of : 4/29/2019 Project Activity for : Last Week (Last 7 Days) Upcoming Tasks for: Next Week (Next 7 Days)
EXECUTIVE SUMMARY
PROJECT PROFILE Identification
Name: NGH - Observation Room Number: CAP-0157
Description: Design and install new Observation Room in the Emergency Department.
Classification
Type: Construction Business Priority:
Status: Executing Category: Cap - Routine Capital Priority: Refer to Evaluation Portfolio: Capital
Organization Owner Capital Planning and Support Services Project Owner Joseph , Leah
Status Update (Last Modified: 4/23/2019 3:33:51 PM) April 23, 2019 1. Discussion with HSA regarding next steps in the community 2. Foll observation scope cannot be achieved
March 20, 2019 1. Next consultant meeting to be held when designer returns following three month medical leave of absence to office in April
February 25, 2019 1. Ciro, Heidi, Mike and Peter teleconference on Febrary 7, 2019 provided a debrief of their trip to HG at the end of January. 2. After reviewing schematic floorplan with Site Staff, Capital Planning instructed to structure a meeing in NHG to listen to local comments respecting alternate location for observation room. 3. on February 24, 2019 received notification that budget in capital plan for Observation Room (only) has been increased to $991,000. 4. Next consultant meeting to be held when designer returns following three month medical leave of absence to office in March.
Health Name Value Name Value Cost Project is on track in this area. Schedule Project is on track in this area. Overall Project Health Project is on track in this area. Scope Project is on track in this area. Quality Project is on track in this area.
Properties Name Value Name Value Funding Type Major Capital City Masset Cost Code (WIP) 5800.85.6718301 HSDA NW Project File Number N671830001 SCHEDULE SUMMARY
Schedule Details
Start Date: 2/26/2018 Baseline Start Date: Actual Effort To Date(hrs): 67.00 Planned Effort to Date(hrs): 0.00
End Date: 6/14/2019 Baseline End Date: % Complete: 13 % Expected % Complete: 95 %
Duration(days): 340 Baseline Duration(days):
Accomplishments
None for the selected period. Upcoming Tasks None for the selected period.
Letter fromPage: Lil Milani, 1 of 2 Capital Accounting Coordinator, Northern Health,... Page 38 of 137 Project Detail AGENDA ITEM G. 1. Created By : Leah Joseph on Monday, April 29, 2019 Report Status as of : 4/29/2019 Project Activity for : Last Week (Last 7 Days) Upcoming Tasks for: Next Week (Next 7 Days)
PROJECT DETAIL
FINANCIAL
Financial Plan: 2018.03.12 - Financial Plan [Approved] Year View: Fiscal
Total Total Total Grand 2018 2019 2020 Total Funding $510.00 $74,490.00 $916,000.00 $991,000.00
Internal Cash $510.00 $74,490.00 $183,699.00 $258,699.00
MOH - RCG $0.00 $0.00 $335,901.00 $335,901.00
RHD $0.00 $0.00 $396,400.00 $396,400.00
Budget $0.00 $991,000.00 $0.00 $991,000.00
Capital $0.00 $991,000.00 $0.00 $991,000.00
Architect $0.00 $110,431.00 $0.00 $110,431.00
Building Permit $0.00 $3,600.00 $0.00 $3,600.00
Construction $0.00 $529,380.00 $0.00 $529,380.00
Construction Contingency $0.00 $52,492.00 $0.00 $52,492.00
Electrical Engineer $0.00 $48,408.00 $0.00 $48,408.00
Hazardous Material $0.00 $58,493.00 $0.00 $58,493.00
Mechanical Engineer $0.00 $66,359.00 $0.00 $66,359.00
Project Contingency $0.00 $87,070.00 $0.00 $87,070.00
Project Manager $0.00 $34,767.00 $0.00 $34,767.00
Expenditures $510.42 $20,660.24 $830,267.34 $851,438.00
Committed $0.00 $0.00 $830,267.34 $830,267.34
Capital $0.00 $0.00 $830,267.34 $830,267.34
Construction $0.00 $0.00 $830,267.34 $830,267.34
Actual $510.42 $20,660.24 $0.00 $21,170.66
Capital $510.42 $20,660.24 $0.00 $21,170.66
Construction $510.42 $20,660.24 $0.00 $21,170.66
Letter fromPage: Lil Milani, 2 of 2 Capital Accounting Coordinator, Northern Health,... Page 39 of 137 Project Detail AGENDA ITEM G. 1. Created By : Leah Joseph on Wednesday, April 24, 2019 Report Status as of : 4/24/2019 Project Activity for : Last Week (Last 7 Days) Upcoming Tasks for: Next Week (Next 7 Days)
EXECUTIVE SUMMARY
PROJECT PROFILE
Identification
Name: MMH - CT Scanner Number: CAP-0210
Mills Memorial Hosptial 64 slice CT scanner replacement. The scanner provides critical diagnostic service to the NW. CT scans are instrumental in providing the current standard of care in an Description: acute care setting.
Classification
Type: Construction Business Priority:
Status: Executing Category: Cap - Priority Investment Priority: Refer to Evaluation Portfolio: Capital
Organization Owner Capital Planning and Support Services Project Owner Gustafson , Rebecca
Status Update (Last Modified: 4/23/2019 7:20:37 PM) April 23, 2010 - Capital Planning continues to work with the site to identify options that will minimize the cost and downtime March 25, 2019 - the project CPAF did not adequately address necessary construction or rental of an interim mobile CT during construction. these omissions have left the project significantly underfunded.
Health Name Value Name Value Project is significantly off track or at risk in this Cost Schedule Project is on track in this area. area. Project is significantly off track or at risk in this Overall Project Health Scope Project needs attention in this area. area. Quality Project is on track in this area.
Properties Name Value Name Value Funding Type Major Capital City Terrace Cost Code (WIP) 58001.85.6720502 HSDA NW Does this improve Information Project File Number N672050002 No Governance maturity? SCHEDULE SUMMARY
Schedule Details
Start Date: 3/13/2019 Baseline Start Date: Actual Effort To Date(hrs): 18.00 Planned Effort to Date(hrs): 0.00
End Date: 12/24/2019 Baseline End Date: % Complete: 0 % Expected % Complete: 13 %
Duration(days): 205 Baseline Duration(days):
Accomplishments
None for the selected period.
Exceptions
None for the selected period.
Upcoming Tasks None for the selected period.
Page: 1 of 2 Letter from Lil Milani, Capital Accounting Coordinator, Northern Health,... Page 40 of 137 Project Detail AGENDA ITEM G. 1. Created By : Leah Joseph on Wednesday, April 24, 2019 Report Status as of : 4/24/2019 Project Activity for : Last Week (Last 7 Days) Upcoming Tasks for: Next Week (Next 7 Days) PROJECT DETAIL
FINANCIAL
Financial Plan: 2019.03.13 - Financial Plan [Draft/Working Copy] Year View: Fiscal
Total Total Grand 2019 2020 Total Funding $1,876,000.00 $0.00 $1,876,000.00
Internal Cash $750,400.00 $0.00 $750,400.00
MOH - RCG $683,920.00 $0.00 $683,920.00
RHD $441,680.00 $0.00 $441,680.00
Budget $1,876,000.00 $0.00 $1,876,000.00
Capital $1,876,000.00 $0.00 $1,876,000.00
Equipment / Furnishing $1,348,125.00 $0.00 $1,348,125.00
Information Technology $10,785.00 $0.00 $10,785.00
Other Costs $287,125.00 $0.00 $287,125.00
Project Contingency $164,124.00 $0.00 $164,124.00
Project Manager $65,841.00 $0.00 $65,841.00
Expenditures $1,075.57 $1,710,800.43 $1,711,876.00
Committed $0.00 $1,710,800.43 $1,710,800.43
Capital $0.00 $1,710,800.43 $1,710,800.43
Construction $0.00 $1,710,800.43 $1,710,800.43
Actual $1,075.57 $0.00 $1,075.57
Capital $1,075.57 $0.00 $1,075.57
Construction $1,075.57 $0.00 $1,075.57
Page: 2 of 2 Letter from Lil Milani, Capital Accounting Coordinator, Northern Health,... Page 41 of 137 Project Detail AGENDA ITEM G. 1. Created By : Leah Joseph on Monday, April 29, 2019 Report Status as of : 4/29/2019 Project Activity for : Last Week (Last 7 Days) Upcoming Tasks for: Next Week (Next 7 Days)
EXECUTIVE SUMMARY
PROJECT PROFILE
Identification
Name: MMH - Building Business Case Number: CAP-0156
Description: Business Case work for the new Hospital in Terrace.
Classification
Type: Construction Business Priority:
Status: Executing Category: Cap - Priority Investment Priority: Refer to Evaluation Portfolio: Capital
Organization Owner Capital Planning and Support Services Project Owner Joseph , Leah
Status Update (Last Modified: 4/23/2019 7:18:41 PM) April 23, 2019 . project continues to await government funding approval. March 25, 2019. No change to project approval status. (Seven Sisters now has its own dashboard) Feb 28, 2019 - Awaiting government approval to proceed with procurement. RFQ for Seven Sisters constructors closed at the end of the month. XX submissions recieived Jan 30, 2019 - Awaiting government approval to proceed with procurement. RFQ issued for Seven Sisters constructors Dec 6, 2018 - Amendment #1 (Addressing PBC Peer Review Letter) submitted to MOH
NOV 22, 2018 - FINAL BUSINESS CASE SUBMITTED TO MINISTRY OF HEALTH - CAPITAL DIV (KIRK EATON AND MARK BELL REC'D) ------Nov 5, 2018 : Project Costs recevied; Business Plan draft ready for PBC Peer Reveiew and MoH review. DB identified as preferred procurement method. Plan to formally submit to Board and Gov't mid-November Oct 4, 2018 - Indicative design completed as at OCt 4. Costing to follow by end of Oct. Business Plan submission to Board continues on track for Nov 14, 2018. September 5, 2018 Work as outlined on Aug 10 continuing. Meeting held with Community Advisory group - RHD, FN, FNHA, City of Terrace
Health Name Value Name Value Cost Project needs attention in this area. Schedule Project needs attention in this area. Overall Project Health Project is on track in this area. Scope Project is on track in this area. Quality Project is on track in this area.
Properties Name Value Name Value Funding Type Major Capital City Terrace Cost Code (WIP) 5800.85.6718302 HSDA NW Project File Number N671830002 SCHEDULE SUMMARY
Schedule Details
Start Date: 5/2/2018 Baseline Start Date: Actual Effort To Date(hrs): 1,416.00 Planned Effort to Date(hrs): 4,650.00
End Date: 4/4/2019 Baseline End Date: % Complete: 95 % Expected % Complete: 100 %
Duration(days): 232 Baseline Duration(days):
Accomplishments
None for the selected period.
Upcoming Tasks None for the selected period.
Letter fromPage: Lil Milani, 1 of 2 Capital Accounting Coordinator, Northern Health,... Page 42 of 137 Project Detail AGENDA ITEM G. 1. Created By : Leah Joseph on Monday, April 29, 2019 Report Status as of : 4/29/2019 Project Activity for : Last Week (Last 7 Days) Upcoming Tasks for: Next Week (Next 7 Days)
PROJECT DETAIL
FINANCIAL
Financial Plan: 2018.10.22 - Financial Plan [Approved] Year View: Fiscal
Total Total Grand 2018 2019 Total Funding $3,500,000.00 $0.00 $3,500,000.00
RHD $3,500,000.00 $0.00 $3,500,000.00
Budget $3,500,000.00 $0.00 $3,500,000.00
Capital $3,500,000.00 $0.00 $3,500,000.00
Administration $30,255.00 $0.00 $30,255.00
Consulting Services $2,530,564.80 $0.00 $2,530,564.80
Project Contingency $229,428.20 $0.00 $229,428.20
Project Manager $709,752.00 $0.00 $709,752.00
Expenditures $28,275.40 $3,260,886.91 $3,289,162.31
Committed $0.00 $1,062,108.95 $1,062,108.95
Capital $0.00 $1,062,108.95 $1,062,108.95
Construction $0.00 $1,062,108.95 $1,062,108.95
Actual $28,275.40 $2,198,777.96 $2,227,053.36
Capital $28,275.40 $2,198,777.96 $2,227,053.36
Construction $28,275.40 $2,198,777.96 $2,227,053.36
Letter fromPage: Lil Milani, 2 of 2 Capital Accounting Coordinator, Northern Health,... Page 43 of 137 Project Detail AGENDA ITEM G. 1. Created By : Leah Joseph on Monday, April 29, 2019 Report Status as of : 4/29/2019 Project Activity for : Last Week (Last 7 Days) Upcoming Tasks for: Next Week (Next 7 Days)
EXECUTIVE SUMMARY
PROJECT PROFILE Identification Name: KIT - Fire Alarm System and Panel Upgrade Number: CAP-0162
Description: Updating the firel alarm system and panel.
Classification
Type: Construction Business Priority:
Status: Executing Category: Cap - Routine Capital Priority: Refer to Evaluation Portfolio: Capital
Organization Owner Capital Planning and Support Services Project Owner Joseph , Leah
Status Update (Last Modified: 4/18/2019 3:01:23 PM) April 18, 2019 - Completed testing of new system. A few deficiencies to wrap up by the end of the month. March 22, 2019 - Project is on track and on budget, likely to be complete next month. February 27, 2019 - Project is well on track close to completion. January 28, 2019 - Contractor has been on site working with Cindy. Project is on target. December 3, 2018 - Contractor has signed the contract. They did their inventor on site last week to order materials. Health Name Value Name Value Cost Project is on track in this area. Schedule Project is on track in this area. Overall Project Health Project is on track in this area. Scope Project is on track in this area. Quality Project is on track in this area.
Properties Name Value Name Value Funding Type Major Capital City Kitimat Cost Code (WIP) 5800.85.6719402 HSDA NW Project File Number N671940002 SCHEDULE SUMMARY
Schedule Details
Start Date: 3/1/2018 Baseline Start Date: Actual Effort To Date(hrs): 36.50 Planned Effort to Date(hrs): 4,500.00
End Date: 4/25/2019 Baseline End Date: % Complete: 95 % Expected % Complete: 100 %
Duration(days): 300 Baseline Duration(days):
PROJECT DETAIL
FINANCIAL
Financial Plan: 2019.04.29 - Financial Plan [Draft/Working Copy] Year View: Fiscal
Total Total Total Grand 2018 2019 2020 Total Funding $288,000.00 $0.00 $0.00 $288,000.00
MOH - RCG $172,800.00 $0.00 $0.00 $172,800.00
RHD $115,200.00 $0.00 $0.00 $115,200.00
Budget $277,338.00 $10,662.00 $0.00 $288,000.00
Capital $277,338.00 $10,662.00 $0.00 $288,000.00
Equipment / Furnishing $277,338.00 ($30,889.70) $0.00 $246,448.30
Project Contingency $0.00 $36,004.70 $0.00 $36,004.70
Project Manager $0.00 $5,547.00 $0.00 $5,547.00
Expenditures $0.00 $241,993.81 $10,001.49 $251,995.30
Committed $0.00 $0.00 $10,001.49 $10,001.49
Capital $0.00 $0.00 $10,001.49 $10,001.49
Construction $0.00 $0.00 $10,001.49 $10,001.49
Actual $0.00 $241,993.81 $0.00 $241,993.81
Capital $0.00 $241,993.81 $0.00 $241,993.81
Construction $0.00 $241,993.81 $0.00 $241,993.81
Page: 1 of 1 Letter from Lil Milani, Capital Accounting Coordinator, Northern Health,... Page 44 of 137 Project Detail AGENDA ITEM G. 1. Created By : Leah Joseph on Tuesday, April 23, 2019 Report Status as of : 4/23/2019 Project Activity for : Last Week (Last 7 Days) Upcoming Tasks for: Next Week (Next 7 Days)
EXECUTIVE SUMMARY
PROJECT PROFILE Identification
Name: BVH - CT Scan Room Number: CAP-0161
Description: Purchase and installation of a CT
Classification
Type: Construction Business Priority:
Status: Executing Category: Cap - Routine Capital Priority: Refer to Evaluation Portfolio: Capital
Organization Owner Capital Planning and Support Services Project Owner Joseph , Leah
Status Update (Last Modified: 4/23/2019 11:55:54 AM) April 23, 2019 - Vector is back to work on site. The delivery date has been adjusted due to the removal of the asbestos. Napp had to take a second trip to remove rubbish that was remaining. The schedule is already tight so will see if this also affects the delivery date of the CT machine. March 21, 2019 - Asbestos was encountered in the crawlspace, so work in the CT room has been on hold since. Napp started asbestos abatement on March 18, and should be wrapped up in the last week of March. This work may impact overall schedule, but Vector has yet to advise how much it will be impacted. February 27, 2019 - Project was awarded to Vector Projects Group. Held start up meeting last week. Mobilization and demolition started this week. Estimate project completion in May and first public patient in June. There will be a 3 week waiting period before first public patient. January 29, 2019 - Tender submissions came in last week and are very close. Currently reviewing the results and discussing next steps. All depends on separate price to be included or not. January 3, 2019 - Posted drawings for tender on Wednesday December 19, 2018. Will be having a mandatory site tour next week for contractors. December 3, 2018 - Council meeting was on November 27th. Cormac attended the meeting. The vote was 4-3 against the variance to not do the off site work. The council voted that NHA do the the work in which the Planning Department recommended. Right now this project is on hold.
Health Name Value Name Value Cost Project is on track in this area. Schedule Project needs attention in this area. Overall Project Health Project is on track in this area. Scope Project is on track in this area. Quality Project is on track in this area.
Properties Name Value Name Value Funding Type Major Capital City Smithers Cost Code (WIP) 5800.85.6719501 HSDA NW Project File Number N671950001 SCHEDULE SUMMARY
Schedule Details
Start Date: 2/22/2019 Baseline Start Date: Actual Effort To Date(hrs): 75.75 Planned Effort to Date(hrs): 0.00
End Date: 7/3/2019 Baseline End Date: % Complete: 36 % Expected % Complete: 38 %
Duration(days): 90 Baseline Duration(days):
Letter fromPage: Lil Milani, 1 of 2 Capital Accounting Coordinator, Northern Health,... Page 45 of 137 Project Detail AGENDA ITEM G. 1. Created By : Leah Joseph on Tuesday, April 23, 2019 Report Status as of : 4/23/2019 Project Activity for : Last Week (Last 7 Days) Upcoming Tasks for: Next Week (Next 7 Days)
PROJECT DETAIL
FINANCIAL
Financial Plan: 2018.03.08 - Financial Plan [Archived] Year View: Fiscal
Total Total Total Grand 2018 2019 2020 Total Funding $2,898,000.00 $0.00 $0.00 $2,898,000.00
FND/AUX/OTHER $1,750,000.00 $0.00 $0.00 $1,750,000.00
RHD $1,148,000.00 $0.00 $0.00 $1,148,000.00
Budget $2,898,000.00 $0.00 $0.00 $2,898,000.00
Capital $2,898,000.00 $0.00 $0.00 $2,898,000.00
Architect $161,360.00 $0.00 $0.00 $161,360.00
Building Permit $2,300.00 $0.00 $0.00 $2,300.00
Construction $978,245.00 $0.00 $0.00 $978,245.00
Construction Contingency $97,000.00 $0.00 $0.00 $97,000.00 Course of Construction $15,520.00 $0.00 $0.00 $15,520.00 Insurance Electrical Engineer $22,691.00 $0.00 $0.00 $22,691.00
Equipment / Furnishing $16,178.00 $0.00 $0.00 $16,178.00
Information Technology $107,850.00 $0.00 $0.00 $107,850.00
Mechanical Engineer $40,340.00 $0.00 $0.00 $40,340.00
Other Costs $1,051,538.00 $0.00 $0.00 $1,051,538.00
Project Contingency $280,610.00 $0.00 $0.00 $280,610.00
Project Manager $100,668.00 $0.00 $0.00 $100,668.00
Structural Engineer $23,700.00 $0.00 $0.00 $23,700.00
Expenditures $418.02 $629,395.12 $1,417,046.91 $2,046,860.05
Committed $0.00 $0.00 $1,417,046.91 $1,417,046.91
Capital $0.00 $0.00 $1,417,046.91 $1,417,046.91
Construction $0.00 $0.00 $1,417,046.91 $1,417,046.91
Actual $418.02 $629,395.12 $0.00 $629,813.14
Capital $418.02 $629,395.12 $0.00 $629,813.14
Construction $418.02 $629,395.12 $0.00 $629,813.14
Letter fromPage: Lil Milani, 2 of 2 Capital Accounting Coordinator, Northern Health,... Page 46 of 137 Project Detail AGENDA ITEM G. 1. Created By : Leah Joseph on Tuesday, April 23, 2019 Report Status as of : 4/23/2019 Project Activity for : Last Week (Last 7 Days) Upcoming Tasks for: Next Week (Next 7 Days)
EXECUTIVE SUMMARY
PROJECT PROFILE
Identification
Name: WRI - DI Xray and Portable Number: CAP-0217
The goal is to upgrade the X-ray room from CR (Computed Radiography) to Digital Radiography. This will mean replacing the entire tosrad system. Replacing the x-ray table/bed, wall bucky system, x-ray tube, ceiling tracks/guides. This project will also entail some room renovations that are past due to improve patient care and maintain confidentiality. These renovations include: Description: Installing a new control panel with new lead glass, removing several small walls to increase working space, rearranging old dark room so the space is usable and safe. There is currently very little usable space in the old dark room and there is also some old wiring that is exposed. The goal is to upgrade the portable machine at the same time as the stationary system so that we can retire completely the CR reader, cassettes and monitor. Having both systems the same brand would simplify education and training and would allow less confusion.
Classification
Type: Major Equipment Business Priority:
Status: Executing Category: Cap - Routine Capital Priority: Refer to Evaluation Portfolio: Capital
Organization Owner Capital Planning and Support Services Project Owner Gustafson , Rebecca
Status Update
Health Name Value Name Value Cost Project is on track in this area. Schedule Project is on track in this area. Overall Project Health Project is on track in this area. Scope Project is on track in this area. Quality Project is on track in this area.
Properties Name Value Name Value Funding Type Major Capital City Hazelton Cost Code (WIP) 58001.85.6720501 HSDA NW Does this improve Information Project File Number N672050001 No Governance maturity? SCHEDULE SUMMARY
Schedule Details
Start Date: 3/26/2019 Baseline Start Date: Actual Effort To Date(hrs): 0.00 Planned Effort to Date(hrs): 0.00 End Date: 12/31/2019 Baseline End Date: % Complete: 0 % Expected % Complete: 10 % Duration(days): 201 Baseline Duration(days):
Accomplishments
None for the selected period.
Exceptions
None for the selected period.
Upcoming Tasks None for the selected period. STATUS UPDATE SUMMARY
No new Status update for selected period.
Page: 1 of 2 Letter from Lil Milani, Capital Accounting Coordinator, Northern Health,... Page 47 of 137 Project Detail AGENDA ITEM G. 1. Created By : Leah Joseph on Tuesday, April 23, 2019 Report Status as of : 4/23/2019 Project Activity for : Last Week (Last 7 Days) Upcoming Tasks for: Next Week (Next 7 Days) PROJECT DETAIL
FINANCIAL
Financial Plan: 2019.03.26 - Financial Plan [Approved] Year View: Fiscal
Total Total Grand 2019 2020 Total Funding $910,000.00 $0.00 $910,000.00
Internal Cash $97,800.00 $0.00 $97,800.00
MOH - RCG $448,200.00 $0.00 $448,200.00
RHD $364,000.00 $0.00 $364,000.00
Budget $910,000.00 $0.00 $910,000.00
Capital $910,000.00 $0.00 $910,000.00
Administration $31,935.00 $0.00 $31,935.00
Building Permit $1,513.00 $0.00 $1,513.00
Construction $191,615.00 $0.00 $191,615.00
Construction Contingency $19,000.00 $0.00 $19,000.00
Electrical Engineer $17,649.00 $0.00 $17,649.00
Equipment / Furnishing $485,325.00 $0.00 $485,325.00
Hazardous Material $20,170.00 $0.00 $20,170.00
Mechanical Engineer $22,187.00 $0.00 $22,187.00
Other Costs $25,086.00 $0.00 $25,086.00
Project Contingency $79,686.00 $0.00 $79,686.00
Remediation $5,043.00 $0.00 $5,043.00
Structural Engineer $10,791.00 $0.00 $10,791.00
Expenditures $0.00 $806,271.00 $806,271.00
Committed $0.00 $806,271.00 $806,271.00
Capital $0.00 $806,271.00 $806,271.00
Construction $0.00 $806,271.00 $806,271.00
Page: 2 of 2 Letter from Lil Milani, Capital Accounting Coordinator, Northern Health,... Page 48 of 137 AGENDA ITEM G. S-1.
Board ft Administration Office #600 - 299 Victoria Street, northern health Prince George, BC V2L 568 the northern way of caring Telephone: (250) 565-2922 www.northernhealth.ca
May 16, 2019
Rob Newell, Vice Chair Northwest Regional Hospital District #300 -4545 Lazelle Avenue Terrace BC V8G 4E1 Via email: [email protected]
Dear Mr. Newell:
Re: NCLGA Meeting: Williams Lake, May 7, 2019
Thank you for taking the time to meet with Northern Health during the recent NCLGA meetings in Williams Lake. In addition, we appreciated your attendance at the Partnering for Healthy Communities workshop on Monday, May 6, 2019.
At our meeting we discussed the status of the Mills Memorial Hospital project and Master Planning progress at Bulkley Valley District Hospital. As you are aware the Business Plan to replace Mills Memorial Hospital was submitted in November 2018. We have worked with the Ministry of Health to finalize this Business Plan over the last several months. The Ministry of Health will communicate the next steps once approval of the Business Plan has been received. We have appreciated Yvonne Koerner, Executive Director, NW RHO participation on the Project Steering Committee as well as the NW RHD's participation on the Advisory Committee.
Master Planning is proceeding well for Bulkley Valley District Hospital. Staff, physicians, and managers in Smithers have been very engaged in the planning process. A briefing of the Smithers town council will be planned in the coming weeks. We expect to have the Master Planning process completed later in the fall 2019.
Another topic we discussed was the Trauma Report that the NW Regional Hospital District completed in 2008 and whether there is any value add in repeating such a study. Northern Health has made significant progress since 2008 in relation to Trauma Services so it is unlikely that repeating this study would add value at this time. In October 2018, Northern Health completed the second cycle of trauma accreditation with Accreditation Canada and was awarded 'Distinction in Trauma Services'. Further information about Northern Health's work in increasing the quality of trauma services across the North can be arranged in the future should the NW RHO be interested.
Letter from Cathy Ulrich, President and CEO, Northern Health, dated May ... Page 49 of 137 AGENDA ITEM G. S-1.
Page 2
It was important for us to hear about the challenges experienced in applying for Imagine Grants. We will discuss this feedback with the Population Health program area. We also appreciated the ideas you have regarding supporting seniors groups through this granting process. At the meeting, we discussed a provincial project called 'Raising the Profile' that focused on community-based seniors services. The link to information about this project is: http://www.seniorsraisingtheprofile.ca
Thank you once again for meeting with Northern Health.
Sincerely, 0:ft~~L.~ Cathy Ulrich, President and CEO Northern Health Authority
cc: Colleen Nyce, Chair, Northern Health Board Ciro Panessa, Chief Operating Officer, North West Mike Hoefer, Regional Director Capital Planning & Support Services Yvonne Koerner, Executive Director, North West Regional Hospital District
Letter from Cathy Ulrich, President and CEO, Northern Health, dated May ... Page 50 of 137 AGENDA ITEM H. 1.
Regional Hospital District Building for Health
North West Regional Hospital District: Directors' Report
Meeting Date: Friday, March 22, 2019 at 10:30 am
Place: Regional District of Kitimat-Stikine, Board Room, Terrace, BC
The following actions were taken at the March 22, 2019 Regular meeting of the North West Regional Hospital District Board.
In-Camera Meeting - separate report
Regular Meeting
Guests: Margaret Jones-Bricker Manager Annual Giving, Northern BC Canadian Cancer Society Topic: Kordyban Lodge - Peace of Mind Campaign • Located in Prince Goerge(PG) by the Cancer Centre for the North which is the only location in the region for radiology treatment. Chemotherapy is offered in 10 communities but patients needing radiation must travel to PG • The society works to provide support services and in PG this is accommodations • The lodge can house 36 people • 2009-2011-12 million was raised for the building • The cost to stay at the lodge is $54 per person per night. This includes meals and activities. Patients can be there for five - 6 weeks. The cost to a couple could be $4500 for the stay to have treatment. • In 2018 171 residents stayed at the lodge from Terrace and 48 residents from Kitimat. • The goal of the Peace of Mind Campaign is to raise $450,000 by January 2020. To date $95,000 has been raised. PRRD has donated $SOK per year for three years. Discussion: Traveling to the four cancer centers in the Province can be difficult for people in the North. Locations are in Victoria, Vancouver, Kelowna and Prince George. Has there been discussions on providing a "stage coach stop" service to help residents travel to these cancers? Currently there is the Northern Connector bus service.
Report from Administration, dated March 22, 2019, re: North West Regiona... Page 51 of 137 AGENDA ITEM H. 1.
Regional Hospital District Bw!dmg for Health
Dr. Jaco Fourie Medical Director, Northwest Health Service Delivery Area, Medical Lead Northern Health Cancer Center, Northern Health Topic: Recruitment Update • Thank you for support in dealing with the primary care crisis. In early 2018 Terrace 8FTE FP in a 21 FTE manpower plan. 10,000-12,000 people were without a physician. • Since the nlO family physicians have been recruited to Terrace and two new primary care clinics have opened up. • Recruitment efforts have benefited the whole region. o Hazelton - five physicians joined. (.SFTE each) Still looking for a .75FTE. o Smithers-two GPs departed, three recruited o Masset - one physician joined (.SFTE) o Prince Rupert - had been. advertising for almost a year for a GP/OB. Two Canadian Grads to start work this summer o Dease Lake - New physician starting in April • More work needs to be done. Focusing now on gaps in specialist services in the Northwest o Prince Rupert needs urology, ENT, obstetrical and orthopedic surgery support o Kitimat needs urology, ENT, pediatric and orthopedic surgery support o Terrace needs two pathologists, two pediatricians and a second ENT, urologist, orthopedic surgeon o Terrace NW Regional Psychiatry unit needs three psychiatrists. An example of the challenge is that there are 89 psychiatry positions posted for southern BC o Smithers needs two pediatricians and a radiologist • The $60,000 from NWRHD allowed Northern Health to offer a housing subside to on board physicians and this was a significant recruitment incentive. This money is now full spent. • Northern Health is now looking for new funds to be able to continue to provide this incentive • There is a desire to secure transitional housing in Smithers to offer the same incentive but funds from outside of NH would be required
Correspondence: None
Reports: H-1 Directors Report from January 25, 2019 Comments: The Seniors Advocate would be willing to come and give a presentation but has requested we provide a specific topic as the services offered are very broad. Discussion: • Concerns expressed over the lack of rural representation on this board • Director Bachrach reference a recent letter in the Interior newspapers regarding seniors issues. Here is the link. https://www.interior-news.com/opinion/broken-system-has priorities-upside-down-and- backwards/?fbclid=lwAR2a4GJB06cgpoVhllKVMYcY4UT YLtF19fM 610- hCo4ghE15m4HTMmhps • Recurring comments revolved around the need for more senior housing and in-home care • ED to arrange for a presentation at a future meeting.
Report from Administration, dated March 22, 2019, re: North West Regiona... Page 52 of 137 AGENDA ITEM H. 1.
Regional Hospital Dist:rict Bwldmg for He,1!th
Bylaw 116 - NWRHD 2019 Annual Budget Bylaw ist and 2nd Reading - Director Lowry/Director Layton 3rd Reading - Director Layton/Director Newell Adoption - Director Lowry/Director Goffinet
New Business:
NCLGA • Village of Queen Charlotte has a NCLGA resolution regarding the construction of belipads at hospital that support was requested for.
• Meeting with Northern Health at NCLGA-waiting for invite from NH with date and time options Suggested Topics: Mills Memorial Update Population Health - causal factors Image Grants - complaints regarding process Trauma report 2008 - should this be updated? Emergency medical evacuations from the Nass - BCAS
Agency Nursing • Question for NH for future meeting. Looking to understand why agency nurses are used instead hiring full time nurses. Have received complaints of this occurring
Masset Hospital • In order to build the Masset Hospital, the Village of Masset borrowed the money from MFA for 60% of the cost instead of the Province contributing 60%. Northern Health makes payments for the facility. This has created a situation where Masset has no more borrowing capacity. Motion: Refer staff to investigate the capital financing agreement for the Masset Hospital. {Director Puterill/Director Nobels)
• Next Meeting: May 17, 2019 Regular Meeting
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I Ems-» mzsm8 momzuS .5552 ~m._m=-$ m-zo<-H _:o_camn_S _m::m«< Hu¢m:-$ mmmzam Page 55 of 137 . . . 22-; N-zo<-Hm zen: < North West Regional Hospital District: Directors’ Report – 2019 Spring Joint Meeting with NH and all RHD’s Meeting Date: Monday April 16, 2019 Place: video-conference This meeting was attended by Vice- Chair Newell and Executive Director Koerner by video conference. This was the regular Spring Capital Planning Update session. Northern Health presentation attached to this report. 2018/2019 Capital Plan • Major Projects o Kitimat Fire Alarm System and Panel Upgrade – work started fall 2018 o Wrinch Boiler Upgrade – phase 3 in construction • Major Equipment> $100K o Smithers BVDH CT Suite o Smithers BVH Radiology Room #1 o Kitimat General Radiographic Room o Terrace MMH C-Arm o Terrace Portable X-Ray o Kitimat Phone System Replacement • Minor Equipment <$100K o Total spending in the NWRHD $2.471M, ($975K from NWRHD) • Regional IM/IT Projects are continuing. Master Planning Updates o Work continues the Mills Business Plan o Master planning starting for BVDH o Review provided of the processes followed for Master Planning Facility Condition Assessments • Updated values provided for all facilities • The lower the index the better condition of the facility 2019/2020 Capital Plan • Major Projects – list of all major projects in planning provided in slides. o MMH Chiller Replacement - critical equipment that cannot wait, can be moved to new facility o Masset NHG Observation Room – needed to meet Provincial Standards Report from Administration dated May 7, 2019, re: Directors’ Report – 20... Page 57 of 137 AGENDA ITEM H. 2. o Masset NHG Nurse Call System o Smithers BVDH Nurse Call System and Vocera • Major Equipment> $100K o Wrinch X-Ray replacement o MMH CT Suite – will be moved to new facility o BVDH Anesthetic Machine Replacement o Houston Radiology Room o BVDH Second Ultrasound o Kitimat Anesthetic Machine Replacement o PRR Radiopgraphic Unit Mobile • Minor Equipment <$100K o Total spending in the NWRHD $2.5M, ($1M from NWRHD) • Regional IM/IT Projects are continuing Other Presentations Delayed till October Face to Face Meeting in PG. MOU due to be renewed this fall. At NCLGA the CAOs will meet to review. Chairs will need to sign the MOU this fall at the Joint RHDs and NH Meeting. Next Joint Meetings: Fall October 21, 2019 Face to Face in Prince George, BC [Type text] [Type text] [Type text] Report from Administration dated May 7, 2019, re: Directors’ Report – 20... Page 58 of 137 Report from Administration dated May7,2019, re:Directors’ Report –20... 1 2 2018-2019 Capital Plan Update Agenda 2018 - 2019 Capital Projects Major Projects <$10M NH/RHD Administrator’s Meeting Carbon Neutral Capital Program (CNCP) October 15, 2018 Major Equipment >$100,000 IM/IT Major Projects Minor Capital <$100,000 Minor Building Integrity 3 4 Major Projects Major Projects McBride Hospital Robson Valley Ventilation RHD Community Project Budget RHD Funding FFGRHD McBride Robson Valley Ventilation $1,426,000 $360,400 Project Value: $1,426,000 FFGRHD Prince George UHNBC Electrical Supply Upgrade $4,500,000 $1,800,000 Fraser-Fort George RHD Funding: $360,400 UHNBC Inpatient Beds and Clinic FFGRHD Prince George $8,000,000 $3,200,000 Renovations Replace the antiquated ventilation system at McBride AGENDA ITEMH.2. FFGRHD Prince George UHNBC Maternal OR #4 $877,000 $350,800 Hospital and in the community health unit with a NWRHD Kitimat Fire Alarm System and Panel Upgrade $288,000 $115,200 newer system capable of meeting current code NWRHD Hazelton Wrinch Boiler Upgrade $300,000 $120,000 requirements for air exchange and providing better PRRHD Dawson Creek DCDH Sterilization Dept (MDR) $2,079,000 $831,600 temperature control. The new system should also SNRHD Fort St. James Primary Care Leasehold Improvement $2,000,000 $400,000 make use of heat recovery and variable speed drives PRRHD Fort St. John Medical Clinic 3rd Pod $2,050,000 $820,000 to significantly reduce energy expenditures. Page 59 of137 SNRHD Burns Lake The Pines Cafeteria Expansion $3,745,000 $1,084,000 Project Status: Nearing substantial completion. FFGRHD Prince George Phoenix Outpatient Lab Renovation $415,000 $166,000 Report from Administration dated May7,2019, re:Directors’ Report –20... 5 6 Major Projects Major Projects UHNBC Electrical Power System Reliability Upgrade UHNBC Inpatient Beds and Clinic Renovations Project Value: $4,500,000 Project Value: $8,000,000 Fraser-Fort George RHD Funding: $1,800,000 Fraser-Fort George RHD Funding: $3,200,000 As a result of two power failures at UHNBC a review Renovations to Level 2 to facilitate 27 Beds, Minor of the Hospital’s electrical distribution system was Renovations to Level 1 Clinics undertaken by an Electrical Engineer. The Project Status: Demolition and Abatement complete. Engineer’s report split this project into 5 Construction progress at 20% modifications to improve the reliability of the UHNBC electrical distribution system The work is addressed in modifications 1, 2 & 3 in the Engineers report (1334-E-1301 UHNBC electrical Power System) Project Status: Complete 7 8 Major Projects Major Projects UHNBC Maternal OR #4 KIT Fire Alarm System and Panel Upgrade Project Value: $288,000 Project Value: $877,000 Northwest RHD Funding: $115,200 AGENDA ITEMH.2. Fraser-Fort George RHD Funding: $350,800 Fire alarm and panel upgrade. Old system Renovations and equipment for a dedicated maternal OR including additional equipment storage space. end of life. Work to begin Fall 2018. Scheduled to be open in October 2018. Page 60 of137 Report from Administration dated May7,2019, re:Directors’ Report –20... 9 10 Major Projects Major Projects Wrinch Boiler Upgrade DCDH Sterilization Dept (MDR) Project Value: $2,079,000 Project Value: $300,000 Peace River RHD Funding: $831,600 Northwest RHD Funding: $120,000 The existing Medical Device Processing (MDR) department requires complete renovations to meet Third phase of boiler room upgrade to dual fuel and a the requirements current CSA Z314.8-08 and to back up heat source. address infection and safety risks identified following an infection prevention and control risk assessment. In construction. Project Status: Preparing final design.gn. 11 12 Major Projects Major Projects Fort St. James Primary Care Leasehold Improvement Fort St. John Medical Clinic 3rd Pod Project Value: $2,000,000 Project Value: $2,050,000 Peace River RHD Funding: $820,000 Stuart Nechako RHD Funding: $400,000 AGENDA ITEMH.2. Renovate the vacant pod of the existing Fort St John Leasehold improvement of Primary Care and Medical Medical Clinic to accommodate a third Medical Clinic Clinic. consisting of physician practice clinic and Project Status: Final design development awaiting cost interprofessional team spaces. consultant report prior to tender. Project Status: Architectural and Engineering design Page 61 of137 work underway. Anticipated to go to spring 2019. Report from Administration dated May7,2019, re:Directors’ Report –20... 13 14 Major Projects Major Projects The Pines Cafeteria Expansion Phoenix Outpatient Lab Renovation Project Value: $3,745,000 Project Value: $415,000 Stuart Nechako RHD Funding: $1,084,000 Fraser-Fort George RHD Funding: $166,000 A building extension to improve residents life/eating experience. Old existing eating area is substandard and Renovate outpatient laboratory at Phoenix Medical not suited for a number of patients in the facility. building. Increase Phlebotomy stations from 3 to 6. Project will provide sufficient space to accommodate Increase ECG bays from 1 to 2. Provide additional special needs patient requirements. seating for 20 outpatients. Current seating is for 8 and overflows into public hallway. Project Status: Substantial completion scheduled for March 2019. Project Status: Currently doing the move to allocate the necessary increase in space. 15 Carbon Neutral Capital Program 16 CNCP Projects (CNCP) Projects UHNBC Domestic Hot Water Upgrades Project value $1,026,791 RHD Community Project Budget RHD Funding Fraser-Fort George RHD funding $404,138 FFGRHD Prince George UHNBC Domestic Hot Water Upgrades 1,026,791 $404,138 AGENDA ITEMH.2. Hot water decoupling is to save energy (natural gas) by using right size smaller boiler. This will provide A provincial government initiative to achieve carbon significant energy savings particularly during neutrality in the public sector. summer months when heating the hospital is not required. Page 62 of137 Project Status: 90% completed. Final switchover to be completed on October 30, 2018. Report from Administration dated May7,2019, re:Directors’ Report –20... 17 18 Major Equipment (>$100,000) IM/IT Major Projects RHD Community Project Budget RHD Funding NWRHD Smithers BVDH CT Suite $2,898,000 $1,148,000 RHD Community Project Budget RHD Funding NWRHD Smithers BVDH Radiology Room #1 $900,000 $360,000 Regional REG Cerner Code & Hardware Upgrade $4,521,072 $1,808,429 NWRHD Kitimat General Radiographic Room $870,000 $348,000 Regional REG CeDaR (Clinical Data Repository) $1,525,000 - NWRHD Terrace MMH C-Arm $215,000 Regional REG PACS and Cardiology System Upgrade $3,393,223 $1,308,400 NWRHD Terrace MMH Portable X-Ray $213,000 $85,200 Automated Medication Dispensing Regional REG MySchedule Enhancements $193,400 - NRRHD Fort Nelson $145,000 $52,602 Cabinet CHR Mental Health/Home & Community FSJH X-ray Rad Rex Room #1 Regional REG $4,900,000 $1,960,000 PRRHD Fort St. John $635,000 $254,000 Care/Reporting Replacement Regional REG Clinical Interoperability $991,558 - SNRHD Fraser Lake X-Ray Replacement $562,000 $224,800 MySchedule – Smart Leave, Annual Regional REG $285,143 - FFGRHD Prince George Parkwood Reverse Osmosis $560,000 Vacations FFGRHD Prince George UHNBC C-Arm $279,000 $111,600 NWRHD Kitimat Phone System Replacement $326,000 $130,400 FFGRHD Prince George UHNBC Hematology Autoimmune $126,000 $50,400 Regional REG Secure Texting $788,668 - UHNBC Microbiology Blood Culture FFGRHD Prince George $145,000 $58,000 Analyzer FFGRHD Prince George UHNBC Microbiology Vitek 2XL $163,000 $65,200 Jubilee Lodge/UHNBC Rehab Nurse Call FFGRHD Prince George $321,000 $128,400 System 19 20 IM/IT Major Projects IM/IT Major Projects Cerner Code & Hardware Upgrade PACS and Cardiology System Upgrade Project Value: $3,393,223 Project Value: $4,521,072 RHD Funding: $1,308,400 RHD Funding: $1,808,429 AGENDA ITEMH.2. Upgrade of Agfa IMPAX version 6.3 to Agfa Enterprise Maintain lifecycle of Cerner Acute Care EMR technology platform. Move system to Kamloops Data Imaging, upgrade hardware, licensing and training. Center. Build greater flexibility, capability and Upgrade EchoPACS to Agfa Enterprise Imaging. ECG predictability of IM/IT human and financial resources Cardiology suite replacement with Agfa Enterprise platform. Project Status: In progress Page 63 of137 Project Status: In progress Report from Administration dated May7,2019, re:Directors’ Report –20... 21 22 IM/IT Major Projects IM/IT Major Projects Kitimat Phone System Community Health Record (Phase 3) Project Value: $4,900,000 Project Value: $326,000 RHD Funding: $1,960,000 Northwest RHD Funding: $130,400 To enable the new clinical team-based care service Upgrading old technology. model, as part of the Primary and Community Care initiative Design and configuration in October 2018. Installation to be complete by February 2019. To custom develop an innovative community Electronic Medical Record (EMR) system, and then implement, support and continuously improve it Project Status: In progress 23 24 IM/IT Major Projects IM/IT Major Projects Community Health Record MySchedule Enhancements, Smart Leave, Annual Vacation Project Value for Enhancements: $193,400 Project Value for Smart Leave, Annual Vacation AGENDA ITEMH.2. $285,143 RHD Funding: None Enhance functionality of the mySchedule application through the addition of Procura Uploads, Broadcast Module, Quick Dial Module, QD Unplanned Leaves Page 64 of137 (replaces EARL) and QD Working Alone Check in. Project Status: In progress Report from Administration dated May7,2019, re:Directors’ Report –20... 25 26 IM/IT Major Projects IM/IT Major Projects Clinical Interoperability CeDaR (Clinical Data Repository) Project Value: $991,558 Project Value: $1,525,000 RHD Funding: None RHD Funding: None This project covers the development of additional Northern Health Medical Office Information System standardized services to improve interoperability (MOIS) and Community Medical Office Information between Clinical Systems utilizing the Distribution System (CMOIS), integration to British Columbia platform "CDX" housed at Interior Health. Panorama. Plans for health records to be scanned into MOIS application and community transcribed Project Status: In progress documents (eg Home visits) to be scanned into MOIS. In progress 27 28 IM/IT Major Projects Secure Texting Minor Capital (<$100,000) Project Value: $788,668 RHD Total Funding RHD Funding Fraser-Fort George HD $2,807,500 $1,123,000 RHD Funding: None Stuart-Nechako RHD $440,000 $177,000 AGENDA ITEMH.2. Implement Secure Texting, Cerner Alerts and access Cariboo-Chilcotin RHD $473,000 $187,000 to integrated On Call Schedules for NH Healthcare Peace River RHD $1,400,000 $565,000 providers. To help reduce communication challenges Northern Rockies RHD $174,000 $70,000 being experienced by Physicians. Northwest RHD $2,471,000 $975,000 Project Status: In progress Page 65 of137 Report from Administration dated May7,2019, re:Directors’ Report –20... 29 30 Minor Building Integrity Questions? RHD Total Funding RHD Funding Fraser-Fort George HD $226,667 $90,667 Stuart-Nechako RHD $60,000 $24,000 Cariboo-Chilcotin RHD $53,333 $21,333 Peace River RHD $126,667 $50,667 Northern Rockies RHD $26,667 $10,667 Northwest RHD $173,333 $69,333 31 32 Agenda Master Planning Updates Major Projects Priority Investments AGENDA ITEMH.2. NH/RHD Administrator’s Meeting Master Planning Planning for Major Projects and Facility October 15, 2018 Replacements Page 66 of137 Report from Administration dated May7,2019, re:Directors’ Report –20... 33 34 Master Planning Master Planning Terrace: Mills Memorial Hospital Redevelopment Terrace: Mills Memorial Hospital Redevelopment • Government announced approval to proceed to • The project team continues to meet on a weekly business plan development on February 9, 2018 basis. • Capital Planning is working closely with Partnerships • Steering group continues to meet on a regular basis BC in this development. to review the project progress and provide direction. • User group and functional planning is complete. • The Community Advisory Committee has met twice. The intent is to keep the community and local First • Indicative design to inform cost in development. Nations informed of the project and receive input. • Business plan is underway with several draft iterations having been completed. 35 Master Planning 36 Master Planning UHNBC Phase 1 UHNBC Additional Bed Capacity • Development of improvement plans for surgical services, • The project has received Ministry approval including operating rooms, a post-anaesthetic recovery • Project budget is $8 million unit, pre-surgical screening, operating room booking, day • Think Space Architects has been engaged to prepare surgery, medical device reprocessing and surgical inpatient drawings and contract documents AGENDA ITEMH.2. accommodation • Scope includes: move Ultrasound to 4th Floor, redevelop o Cardiac care beds diagnostics and invasive cardiac Level 2 (oldest hospital building) into inpatient unit, move services Diabetes to Parkwood Mall and move Pain Clinic to new o Mental Health & Addiction Services includes re- space development of all mental health services within the • The move of Ultrasound to the 4th floor is complete hospital Page 67 of137 • Relocation of Diabetes & Pain Clinic is complete • Completion of a Cardiac Services Business Plan in • IDL. Inc. was selected as the General Contractor for the collaboration with Cardiac Services BC project and construction work commenced on June 6/2018. • Concept Plan was submitted to Government December Project currently is progressing as expected . 2017 • Project completion : March 2019 Report from Administration dated May7,2019, re:Directors’ Report –20... 37 Master Planning 38 Master Planning Fort St James: Stuart Lake Hospital Quesnel: GR Baker ED & ICU Redevelopment • Concept Plan submitted to Ministry of Health June 2018 • MOH approval given to proceed with Business Plan • October 9, 2018 approved to go to Business Plan finalization. Amendments are necessary stemming from unforeseen geotechnical and archaeological issues. Fort St James: Primary Care Redevelopment • Contract with PBC for assistance on procurement analysis • Pre-tender project estimates indicate original budget • MCS is conducting First Nations consultation process for estimate of $2M for tenant improvements (T/I’s) will fall short Northern Health and PBC will provide guidance respecting selection of a suitable development process • Tender issued – October ??th, closing November ??th • Project design and schedule have been adjusted to meet • Fixturing period (6 months) – commenced October 1, 2018 requirements of the Facility Program and to accommodate • Estimated T/I project completion – Spring / Summer 2019 archaeology and geotechnical issues. • Lease commencement - April 1, 2019 39 Master Planning 40 Master Planning Atlin Quesnel: GR Baker ED & ICU Redevelopment • Moving toward modular building for new health clinic • The Atlin Supportive Living Society has secured a donated • Geotechnical issues resulted in relocation and other changes to the ED+ICU addition site. The site appears suitable for NH’s portion of a development. The society has engaged an architect to AGENDA ITEMH.2. • First Nations consultation process is ongoing develop a site master plan which incorporates the health • The Steering Committee was established in May 2018 centre without compromising the society’s ability to develop other uses on the site at their cost • Schematic design work is approaching completion • Community and First Nations engagement is completed • Archaeological services were contracted to Stantec (Quesnel) • The intent is to issue the RFP in mid-Fall and award early to mid-January for start of construction in Spring 2019 Page 68 of137 • A Ground Penetrating Radar (GPR) survey is scheduled for October • Current project budget target is $500,000 to $1 Million Report from Administration dated May7,2019, re:Directors’ Report –20... 41 Master Planning Updates 42 Master Planning Updates Dawson Creek: Dawson Creek District Hospital Redevelopment Smithers: Bulkley Valley District Hospital Master Planning • Project has been approved by government on June 14, 2018 to proceed to business plan • RFP has been drafted for master planning consulting and • RFP awarded for facility advisor consultant to prepare a has been posted. RFP closes in November functional program and indicative design. Work is anticipated to start in September/October • RFP for quantity surveyors, geotechnical engineering and medical equipment are being prepared • Business Plan is anticipated to be complete Summer 2019 43 Master Planning Updates 44 Future Plans PRIMARY CARE INITIATIVES NH moving to a regularized Master Planning and Community Space Planning methodology Primary Care space planning work has been completed for the following communities: Establish trigger points where next steps are developed AGENDA ITEMH.2. Chetwynd - Implemented Develop smaller phased projects or Fort St James – In Progress Move into Concept Plan and with approvals, Business Planning Fort St. John – Partially Implemented Quesnel – Implemented Some examples of trigger points: Prince George – Urgent Primary Care Center Facility Condition Index Page 69 of137 Quesnel – Urgent Primary Care Center Cost and magnitude of project Applicable building functionality issues Standards such as CSA, Infection Control Report from Administration dated May7,2019, re:Directors’ Report –20... 45 Building Standards Affecting 46 Building Standards Affecting Health Care Facilities Health Care Facilities • CSA Z8000 - Canadian Health Care Facilities - • CSA Z317.13 - Infection Control During Construction Planning, Design and Construction • Issued 2003, Revised 2007, revised 2012 • Draft available in 2011/12 • Especially applies to renovations in an active hospital • Ministry would not adopt in interim • • Issued 2014, due for revision 2018-2020 107 pages • Within CSA Z8000 • British Columbia Building Codes • Heating and Ventilation, Fresh Air, recirculation • Current version, 2012, updated every 5 years • Electrical Standards such as generators, redundancy • WorkSafe BC of power • Ranges from overhead patient lifts and portable lifts • Single Patient Rooms with private washrooms to eye wash stations and flooring standards for non • Many other infection control issues slip, non grounding 47 Healthcare Regulations Affecting 48 Other Standards Affecting Northern Health Capital Projects Northern Health Capital Projects • BC Centre for Disease Control (BCCDC) • Nuclear Medicine – radiation safety, shielding for X-rays, containment of radiopharmaceuticals • Provincial Infection Control Network of British AGENDA ITEMH.2. Columbia (PicNET) • Diagnostic Accreditation Program standards • Pharmacy Standards • Laboratory • USP797- issued 2004, 2 revisions, 1 pending • Medical Imaging revision(2017) • Nuclear Medicine Page 70 of137 Report from Administration dated May7,2019, re:Directors’ Report –20... 49 Key Components of a Master 50 Concept Plan Program and a Master Plan A Master Program consists of the following: A Concept Plan contains the following: • Project Parameters • Functional and Physical Evaluation of the current facility and • A Project Rationale and context within the Health Authority space and the provincial mandate to deliver health care services to • Description each Service Component being planned. This residents includes: • Project Goals and Objectives Service delivery description (existing and proposed) • Delivery options for health care services Historic and projected workloads • A proposed solution to the need Description of space elements within each component and associated total space requirement of the component • Recommendations for future work • Cost estimates of solution +/- 25% A Master Plan consists of the following: • A facility layout solution at a block diagram level of detail • Cost Estimate (+/- 25%) 51 Business Plan 52 Glossary • Master Program = Identifies goals and objectives, service A Business Plan consists of the following: area, demographic impacts, current services, future services including block spaces and adjacencies • Explores the components of the Concept Plan in greater AGENDA ITEMH.2. detail including: • Master Plan = Represents the Master Program space needs in graphical fashion, with block functional areas, • Better assurance of project costs defines site spaces, layouts and access requirements • Options for procurement • Identifies ongoing cost of operations • Concept Planning = the Concept Plan identifies, at a high level, the need for the project and presents a proposed • Explores operational challenges to transition from old Page 71 of137 facility/services to new facility/service models solution. A Concept Plan describes the issues, outlines the needs, assesses cost, site logistics, and procurement • Cost estimates of solution +/- 15% options. Government uses the Concept Plan to inform approvals to proceed to a Business Plan. The Concept Plan is informed by a Master Program and Plan Report from Administration dated May7,2019, re:Directors’ Report –20... 53 54 The Capital Planning Process for Glossary Continued Facility Renewal • Business Plan = presents a detailed analysis of the project and includes service demands, service delivery, operational Identify Master Concept Ministry Business Ministry needs, financials, procurement, detailed space needs, site Design Construction Need Program Plan Approval Plan Approval requirements and other details upon which Government can •Identify need •Prepare facility •Prepare •Complete •Undertake for facility renewal funding detailed facility design construction of •Identify present replacement request for program new / renewed make an informed funding decision. and future •Determine Ministry capital development, facility •Commit funds needs in high equipment approval operational for planning level terms. needs and •Transition from The business plan results in an approval to proceed to processes and requirements existing and •Long term room by room operationalize planning •finalize costs space plans new facility procurement document 55 Master Program Process 56 Project Scheduling & Budgeting Month 1 2 3 4 5 6 7 8 9 10 11 RFP Process RFP Process Project Initiation Data Collection and Confirmation Project Data Collection Project Parameters Project AGENDA ITEMH.2. Definition Parameters Physical and Functional Facility Assessments Assessment Master Programming Master Programming Master Planning Master Planning Cost Estimating Costing Page 72 of137 Issue Concept Plan to Ministry Working Committee Meetings Steering Committee Meetings } } } } } } } } } } Month 1 2 3 4 5 6 7 8 9 10 11 Report from Administration dated May7,2019, re:Directors’ Report –20... 57 Project Governance 58 Project Governance - Continued Project Charter: a project charter will be developed which will act as a guiding document. The charter will define Liaison Committee: The Liaison Committee provides project goals, assumptions, scope and deliverables, project oversight and communication advice to the steering resources, roles and responsibilities of the participants, and a committee and project board. project process o Chaired by an government MLA, this committee consists of health authority, ministry of health and regional hospital Project Board: The project board provides direction and district members. oversight, financial and risk management to the steering committee and liaison committee. This structure is only used for major projects where priority investment funding >$10 M Working Group: The working group will work closely with the is used. project consultant, will provide input and direction to the NH Project Manager. The Working group will report to the steering committee Steering Committee: The Steering Committee will provide direction and oversight of the project, will accept final documents or provide direction to the Working Group for modifications 59 60 Questions? Facility Condition Assessments AGENDA ITEMH.2. NH/RHD Administrator’s Meeting October 15, 2018 Page 73 of137 Report from Administration dated May7,2019, re:Directors’ Report –20... 61 Cariboo RHD 62 Fraser Fort George RHD As of Oct 2 2018 Replacement As of Oct 2 2018 Facility Repairs/ Year Facility Building City FCI Value ($ Replacement Renewals ($ Millions) Constructed Repairs/ Year Millions) Building City FCI Value ($ Renewals Constructed Mackenzie Hospital Mackenzie 0.76 17.49 12.22 1988 Millions) ($ Millions) Storage Mackenzie 0.24 0.59 0.14 1995 Dunrovin Park Lodge Quesnel 0.37 25.96 9.62 1974 McBride and District Hospital McBride 0.59 11.57 6.80 1963 Alward Place Prince George 0.32 34.95 11.27 1975 Dunrovin Park Lodge Addition Quesnel 0.21 23.66 4.92 2007 Aspen 1 Independent Living Prince George 0.60 4.16 2.50 1965 Eileen Ramsay Memorial Clinic Quesnel 0.43 1.49 0.64 1954 Aspen 2 Independent Living Prince George 0.54 3.89 2.12 1964 G R Baker Memorial Hospital Quesnel 0.59 78.39 46.05 1954 Duplex Cottage Independent Living Prince George 0.56 0.74 0.41 1959 Fourplex Cottage Independent Living Prince George 0.69 1.23 0.84 1959 Gateway Residential Care Complex Care Prince George 0.03 46.84 1.44 2009 Gateway Residential Care Assisted Living Prince George 0.14 30.05 4.29 2009 Iris House Prince George 0.27 5.86 1.56 2002 JG Mackenzie Family Practice Centre Prince George 0.21 3.94 0.84 1996 Laurier Manor Prince George 0.22 10.45 2.29 2001 Learning & Development Centre Prince George 0.00 3.67 0.00 2015 Parkside Intermediate Care Home Prince George 0.42 13.10 5.44 1983 Project Parent North Prince George 0.29 0.59 0.17 1975 Rainbow Intermediate Care Home Prince George 0.50 8.01 4.01 1972 Spruceland Prince George 0.66 9.41 6.21 1955 University Hospital of Northern British Columbia Prince George 0.37 316.50 116.03 1958 Valemount D and T Centre Valemount 0.21 3.51 0.74 1978 63 Stuart Nechako RHD 64 Northern Rockies RHD As of Oct 2 2018 Facility As of Oct 2 2018 Replacement Facility Repairs/ Year Replacement Building City FCI Value ($ Repairs/ Year Renewals($ Constructed Building City FCI Value ($ Millions) Renewals($ Constructed Millions) Millions) Millions) Fort Nelson General Hospital Fort Nelson 0.56 28.10 15.67 1963 Burns Lake - The Pines Burns Lake 0.50 10.43 5.21 1992 AGENDA ITEMH.2. Lakes District Hospital and Health Centre Burns Lake 0.00 39.65 0.00 2015 Nurses Residence Burns Lake 0.46 0.83 0.38 1965 Stuart Lake Hospital Fort St. James 0.41 10.59 4.37 1972 Fraser Lake Community Health Centre Fraser Lake 0.62 6.06 3.77 1979 Southside Health and Wellness Centre Burns Lake 0.25 1.50 0.37 2003 Nurses Residence Vanderhoof 0.50 2.53 1.27 1935 Old Hospital - College of New Caledonia Vanderhoof 0.48 7.07 3.41 1940 St John Hospital Vanderhoof 0.48 26.47 12.61 1971 Stuart Nechako Manor Vanderhoof 0.11 18.67 2.03 2004 Page 74 of137 Report from Administration dated May7,2019, re:Directors’ Report –20... 65 Northwest RHD 66 Peace River As of Oct 2 2018 Facility Replacement Repairs/ Year Building City FCI Value ($ Renewals Constructed Millions) ($ Millions) As of Oct 2 2018 22 Tatcho Street Dease Lake 0.54 0.39 0.21 1979 Facility Replacement Year 23 Tatcho Street Dease Lake 0.38 0.35 0.13 1979 Repairs/ Building City FCI Value ($ Constructe 3rd Avenue Dease Lake 0.64 0.38 0.24 1982 Renewals Millions) d Stikine Health Centre Dease Lake 0.37 9.08 3.34 1994 ($ Millions) Hazelton Duplex Hazelton 0.26 0.35 0.09 1998 Chetwynd General Hospital Chetwynd 0.72 18.19 13.04 1971 Wrinch Memorial Hospital Hazelton 0.64 24.63 15.73 1977 Dawson Creek and District Hospital Dawson Creek 0.56 88.47 49.80 1960 Houston D and T Centre Houston 0.44 6.82 2.97 1982 Dawson Creek and District Hospital Service Kitimat General Hospital Kitimat 0.34 72.16 24.24 2002 Building Dawson Creek 0.24 8.34 1.99 1996 Kitimat Mixed Elder Care Kitimat 0.31 16.42 5.10 2002 Dawson Creek Mental Health Residence Dawson Creek 0.43 0.44 0.19 1968 Masset Assisted Living Masset 0.08 1.19 0.09 2008 Rotary Manor Dawson Creek 0.22 18.82 4.48 2002 Northern Haida Gwaii Hospital and Health Centre Masset 0.12 9.83 1.20 2008 Rotary Manor Addition Dawson Creek 0.16 15.75 2.44 2008 Duplex at 2208 and 2210 Dogwood Masset 0.40 0.50 0.20 1970 Fort St John Hospital Fort St John 0.13 195.12 24.43 2012 Acropolis Manor Prince Rupert 0.05 20.35 0.94 2011 Peace Villa Residential Care Fort St John 0.10 40.06 3.81 2012 Prince Rupert Regional Hospital Prince Rupert 0.44 54.98 24.10 1971 Hudson's Hope Health Centre Hudson's Hope 0.18 7.02 1.28 1997 Queen Charlotte Island Hospital Queen Charlotte City New Build Hospital - To be assessed Peace River Haven Pouce Coupe 0.75 12.84 9.70 1982 Bulkley Lodge Smithers 0.27 16.48 4.45 1978 Tumbler Ridge D and T Centre Tumbler Ridge 0.64 7.83 5.05 1983 Bulkley Valley District Hospital Smithers 0.73 30.81 22.44 1954 Stewart Health Centre Stewart 0.68 12.29 8.40 1993 Birchwood Place Terrace 0.17 1.70 0.28 1994 McConnell Estates Terrace 0.16 7.47 1.18 2002 Mills Memorial Hospital Terrace 0.55 57.94 31.67 1959 Seven Sisters Residential Mental Health Terrace 0.23 3.76 0.85 2000 Sleeping Beauty Medical Clinic Terrace 0.50 1.39 0.69 1960 Terraceview Lodge Terrace 0.44 18.32 8.11 1984 Terraceview Lodge New Addition Terrace 0.06 13.92 0.78 2009 67 68 Facility Condition Assessments (FCA) Facility Condition Index Provincial Capital Asset Management Definitions Framework (CAMF): • all ministries to establish and maintain an inventory of their facilities and their AGENDA ITEMH.2. physical condition In 2003: • Ministry of Health contracted VFA Inc. to complete a province- wide inventory and assessment of 500 health care facilities Page 75 of137 Assessments were completed in 2006 • Contract did not address need for re-assessments to ensure facility condition data reflects ongoing capital investments Report from Administration dated May7,2019, re:Directors’ Report –20... 69 70 New FCA Agreement New FCA Agreement (cont’d) • 2012 – Ministry of Health selected VFA • Physical assessments of • Hosting and maintaining Canada Corporation (VFA) as the approx. 500 health a secure database successful RFP proponent for facility facilities (3 million m2) system to provide the assessment service to: Ministry and Health • identify deficiencies; Authorities with data • The Agreement: • estimate work required to for: • was signed in July 2012 for a term of 5 years; update the infrastructure. • tracking and reporting • includes two 5-year options for renewal, at the sole • Assessments are facility physical discretion of the Ministry; performed by VFA teams condition • requires VFA to assess approx. 20% (based on m2) of of professionals: • identifying future capital health care facilities per year; • architects projects • requires VFA to assess all identified BC health care • professional engineers over the 5-year term. • quantity surveyors 71 72 Facility Condition Index (FCI) The Assessment Process HAs provide VFA The FCI is: drawings and reports • the numeric outcome of a facility assessment about specific facilities a minimum • an industry-standard indicator that measures the of 15 business days relative physical condition of a facility and its systems AGENDA ITEMH.2. prior to on site (mechanical, electrical, plumbing, etc.) at a specific arrival of the VFA team. point in time Physical assessment of facility FCI ratio: Total cost of facility systems repairs/renewals ($) Page 76 of137 System Facility replacement value ($) updates Report from Administration dated May7,2019, re:Directors’ Report –20... 73 74 FCI Example What does FCI mean? The lower the FCI value, Value of outstanding • the better condition that a facility is in, and renewal needs • the lesser the need for renovations or renewal funding $90,000 relative to the facility’s value. = 0.09 FCI $1,000,000 For health facilities, the target FCI of 0.10 (10%) Current value was recommended by VFA2. of building replacement1 1 Current Replacement Value is the total amount required to replace a facility to its optimal condition. 75 76 FCI does not capture all costs How to Use FCI Values FCI calculations do not include: FCI allows the Ministry and Health Authorities to: – compare the condition of facilities against industry-wide • taxes • consulting fees standards; • LEED improvements • asbestos removal AGENDA ITEMH.2. – compare similar facilities by their physical condition; • financing costs • site work – identify areas of facilities in the greatest need for • equipment or furniture • architectural fees updating, repair or replacement. • Inspection of systems • commissioning of systems Page 77 of137 Report from Administration dated May7,2019, re:Directors’ Report –20... 77 78 How to Use FCI Values (cont’d) Next Steps • FCI is only one component (related to facilities physical infrastructure) used in the process of • Once facilities have been assessed, Health making informed capital planning decision. Authorities use the FCI data, together with other relevant criteria, to plan and prioritize future capital • In capital planning, other conditions and criteria investments. other than the FCI value must be taken into • FCI data must be considered together with other consideration, such as: strategic criteria such as: facility functionality, • Is the facility providing the right services? market trends (e.g. available funding), demographic • Is the facility over or under capacity? needs. • Is the facility adaptable to current standards? A well maintained 1960 era hospital with a low FCI value is still designed to deliver care as if it’s 1960 79 80 Agenda 2019-2020 Capital Planning • Capital Funding Summary • 2019-20 Capital Plan Draft • Proposed Priority Investments AGENDA ITEMH.2. • Major Projects NH/RHD Administrator’s Meeting • IM/IT Major Projects October 15, 2018 • Major Equipment • Minor Equipment Page 78 of137 • Building Integrity Report from Administration dated May7,2019, re:Directors’ Report –20... 81 Capital Funding Summary 82 Priority Investments Concept Plans Submitted to the Ministry Northern Health Major Capital Funding - Notional 2019/20 2020/21 2021/22 Proposed MOH General Allocation 8,830,000 9,486,000 9,510,000 Community RHD Project Budget ($M) Standard Working Capital Allocation 4,500,000 4,500,000 4,500,000 RHD - estimated* 7,800,000 8,324,000 8,340,000 Terrace NWRHD MMH Redevelopment 379* Total Estimated Major Capital Funds 21,130,000 22,310,000 22,350,000 Dawson Creek PRHRD DCH Patient Care Replacement (Phase 1) 250 * STH Hospital Replacement and Primary *estimated slightly less than 40% as we do not request RHD funding on all projects ie. IMIT Fort St. James SNRHD 85 * Care Redevelopment Quesnel CCRHD GRB Facility Replacement 250 * Prince George FFRHD UHNBC Phase 1 Redevelopment** 600 * * Proposed Budget in Millions of Dollars, is as submitted in the Concept Plan and error estimate is +/- 25% , 19 times out of 20. Budget will be refined when approval is given to proceed to Business Plan development. ** Concept Plan in development and not as yet submitted. 83 Priority Investments 84 Major Projects Master Planning to Commence in Near Future Proposed Community RHD Project Budget ($)* Proposed Community RHD Project Budget ($M) Prince George FFGRHD UHNBC Echo-Cardiac Services Department Upgrade $ 3,273,000 Prince George FFGRHD UHN Redevelopment (remaining phases) 600 Terrace NWRHD MMH Chiller Replacement $ 947,000 NH NE/NW/NI NE Residential Care Beds and/or Dementia Care Option 130 * Dawson Creek PRRHD DCDH 2nd Floor Tub Room Renovation $ 338,500 Northern Haida AGENDA ITEMH.2. Additional projects/planning based on key metrics tbd. Gwaii NWRHD NHG Observation Room $ 991,000 Quesnel CCRHD GR Baker Kitchen Renovation $ 8,046,000 Chetwynd PRRHD Chetwynd Hospital Seclusion Room tbd Quesnel CCRHD GR Baker DDC Upgrade $ 190,000 Northern Haida Gwaii NWRHD NHGH Nurse Call System $ 300,000 Dawson Creek PRRHD DCDH Pharmacy Oncology Space Renovation tbd Page 79 of137 Quesnel CCRHD GR Baker Ventilation Upgrades – South Wing $ 1,493,000 Smithers NWRHD Bulkley Lodge Nurse Call System & Vocera $ 415,000 Fort St. John PRRHD FSJH Staff Parking Lot Expansion $ 750,000 ...list continued on next slide * Order of magnitude costing based on early Planning (Residential/ Dementia care) +/- 20%. Budgets and project priorities subject to change and develop in the Master Planning process. * Budgets and project priorities subject to change Report from Administration dated May7,2019, re:Directors’ Report –20... 85 Major Projects 86 Major Projects Proposed Community RHD Project Budget ($) $ 550,000 Proposed Prince George FFGRHD UHNBC Atrium Renovation Community RHD Project Budget ($) Kitimat NWRHD Kitimat Hospital DDC System $ 185,000 Prince Rupert NWRHD PRRH ER Triage Renovation $ 100,000 Fort St. John PRRHD FSJ Medical Clinic Parking lot (total or just repairs) Tbd Prince George FFGRHD UHNBC Transformer Replacement $ 1,767,000 Prince George FFGRHD UHNBC Ultrasound Air Conditioning $ 1,500,000 Hazelton NWRHD Wrinch ER Renovation Tbd Kitimat NWRHD Kitimat Hospital Washer $ 226,000 Prince George FFGRHD UHNBC Kitchen Upgrade Tbd McBride FFGRHD McBride – Nursing Renovation $ 358,000 Hazelton NWRHD Wrinch Vocera tbd Smithers NWRHD BVDH ER Triage Renovation $ 1,255,000 Smithers NWRHD Bulkley Lodge DDC Tbd Mackenzie FFGRHD Mackenzie – Primary Care Clinic Renovations Tbd Prince Rupert NWRHD Acropolis Manor DDC tbd Terrace NWRHD Terrace ICMT/Staffing Renovation $ 250,000 Smithers NWRHD BVDH Rooftop Air Handler tbd Vanderhoof SNRHD Oncology Clinic Renovation Tbd Smithers NWRHD BVDH Pharmacy Renovations $ 2,000,000 $ 205,000 Kitimat NWRHD Kitimat/Mountainview Lodge Vocera Long Term Care Beds and/or Enhanced Assisted Northwest NWRHD Living Units Tbd Quesnel CCRHD GR Baker Parking Lot Repaving $ 597,000 ...list continued on next slide * Budgets and project priorities subject to change * Budgets and project priorities subject to change 87 IM/IT Major Projects 88 IM/IT Major Projects Community RHD Project Proposed Community RHD Project Proposed Budget ($)* Budget ($)* Community Health Record – MH/HCC/Reporting Regional All (Phase 3) $ 4,900,000 Regional All E-mail Gateway Replacement $ 312,500 CritCare – Regional Critical Care Electronic Medical Regional All Cerner Code and Harware Upgrade $ 4,521,072 Regional All Record $ 2,700,000 Prince Rupert NWRHD PRRH Phone System $ 409,000 Dawson Creek PRRHD DCDH Phone System $ 430,000 Masset, Stikine, Regional Bedside Diagnostics and Specimen AGENDA ITEMH.2. Houston NWRHD Phone Systems $ 216,000 Regional All Collection Device Integration $ 750,000 Prince George FFGRHD UHNBC Phone System phase 1 $ 400,000 Quesnel CCRHD GR Baker Phone System $ 434,000 EmergCare – Regional Emergency/Trauma MatCare – Regional Maternity Electronic Medical Regional All Electronic Medical Record $ 3,260,000 Regional All Record $ 3,900,000 Regional All Northern Lights – Personal Health Record tbd Smithers NWRHD BVDH Phone System $ 257,000 SurgCare – Regional Surcial Electronic Medical Regional All CPOE Lite – Lab and Imaging Electronic Ordering $ 750,000 Regional All Record $ 750,000 Fraser Lake, Prince George FFGRHD UHNBC Phone System phase 2 $ 1,900,000 Granisle SNRHD Phone Systems $ 100,000 Page 80 of137 Regional All Medical Record Scanning Software $ 1,319,000 Regional All Mobility Management $ 200,000 Tumbler Ridge, Hudson's Hope PRRHD Phone Systems $ 116,000 Regional All Network Security $ 200,000 Regional All Endoworks tbd Regional All Clinical Media Management $ 900,000 ...list continued on next slide Regional All Workfore Timekeeper $ 1,860,000 * Budgets and project priorities subject to change * Budgets and project priorities subject to change Report from Administration dated May7,2019, re:Directors’ Report –20... 89 Major Equipment (>$100,000) 90 Major Equipment (>$100,000) Community RHD Project Proposed Community RHD Project Proposed Budget ($)* Budget ($)* Vanderhoof SNRHD SJH C-Arm Replacement $ 263,000 Valemount FFGRHD VMC General X-Ray and Portable X-Ray Replacement $ 672,000 Chetwynd PRRHD CHT X-Ray Replacement $ 769,000 Hudson’s Hope PRRHD HH X-Ray Replacement $ 350,000 Hazelton NWRHD Wrinch X-Ray Replacement $ 922,000 Houston NWRHD Houston Radiology Room $ 447,000 Quesnel CCRHD GR Baker X-Ray Replacement $ 851,000 Prince George FFGRHD UHN Pharmacy Tablet Packager Verifier $ 169,000 Fort St. John PRRHD FSJH SPECT CT Scanner Replacement $ 1,771,000 Dawson Creek PRRHD DCDH Automated Medication Dispensing Cabinet $ 122,000 Terrace NWRHD MMH CT Suite $ 2,200,000 Smithers NWRHD BVDH Second Ultrasound $ 595,000 Mackenzie FFGRHD MCK X-Ray Replacement $ 700,000 McBride FFGRHD MCB General X-Ray and Portable X-Ray $ 670,000 Fort St. John PRRHD FSJH Anesthetic Machine Replacement x 2 $ 310,000 Fort St. John PRRHD FSH Ultrasound Tbd Dawson Creek PRRHD DCDH Anesthetic Machine Replacement $ 155,000 Terrace NWRHD MMH Second Ultrasound Tbd Fort Nelson NRRHD FNH Anesthetic Machine Replacement $ 155,000 Prince George FFGRHD UHN – OR Video Towers Orthopedic $ 250,000 Smithers NWRHD BVDH Anesthetic Machine Replacement $ 170,000 Terrace NWRHD MMH Ultrasound Tbd Prince George FFGRHD UHN Sterile Processing Low Temp Sterilizer $ 242,000 ...list continued on next slide Hazelton NWRHD Wrinch Ultrasound Tbd ...list continued on next slide * Budgets and project priorities subject to change * Budgets and project priorities subject to change 91 Major Equipment (>$100,000) 92 Major Equipment (>$100,000) Community RHD Project Proposed Community RHD Project Proposed Budget ($) Budget ($) Quesnel CCRHD GRB Multipurpose Fluoroscopy $ 1,539,000 Smithers NWRHD BVH Vario S88 Microscope $ 140,000 Kitimat NWRHD KIT Anesthetic Unit $ 160,000 Prince George FFGRHD UHN General X-Ray Room $ 869,000 Prince George FFGRHD UHNBC – OR Video Towers General Surgery $ 400,000 Smithers NWRHD BVH OR Microscope $ 171,000 AGENDA ITEMH.2. Prince Rupert NWRHD PRR Radiographic Unit, Mobile $ 225,000 Prince George FFGRHD UHN Fluoroscopy Room $ 1,994,000 Quesnel CCRHG GRB Ultrasound $ 224,000 Prince Rupert NWRHD PRR Operating Room Boom System $ 250,000 PRR Radiographic/Fluoroscopic System, General Prince Rupert NWRHD Purpose $ 800,000 Prince George FFGRHD UHN Interventional Radiology Room $ 2,832,000 Quesnel CCRHD GRB Nurse Call System $ 145,000 Prince George FFGRHD Victoria Medical X-Ray Replacement $ 621,000 Stikine NWRHD Stikine – Rad Room tbd Prince George FFGRHD UHN Lab Services Chemistry Automation Project $ 2,792,000 Prince George FFGRHD UHN Nuclear Medicine $ 1,412,000 Smithers NWRHD BVH Anesthetic Machine $ 160,000 Page 81 of137 Prince George FFGRHD Gateway Vocera $ 167,000 ...list continued on next slide * Budgets and project priorities subject to change * Budgets and project priorities subject to change Report from Administration dated May7,2019, re:Directors’ Report –20... 93 Minor Equipment Allocations - 94 2018-19 Building Integrity Allocations Notional - Notional RHD Total Allocation RHD Portion RHD Total Allocation RHD Portion FFGRHD 2,882,000 1,152,000 SNRHD 455,000 182,000 RRGRHD 226,667 90,667 CCRHD 472,000 187,000 SNRHD 60,000 24,000 PRRHD 1,450,000 580,000 CCRHD 53,333 21,333 NRRHD 180,000 72,000 PRRHD 126,667 50,667 NWRHD 2,500,000 1,000,000 NRRHD 26,667 10,776 NWRHD 173,333 69,333 95 96 Questions? AGENDA ITEMH.2. Physician Recruitment Update Page 82 of137 April 17, 2018 - Spring Joint Meeting Northern Health and Regional Hospital Districts of Northern BC Prepared by: Kelly Giesbrecht, Regional Manager, Physician Recruitment for Dr. Ronald Chapman Report from Administration dated May7,2019, re:Directors’ Report –20... 201597 -2019 Physician Recruitment Plan 98 Retention and Recruitment Team z Alignment of Nurse Practitioner and Physician Recruitment z Transition Plan to bring NP recruitment into this department z Will work closely the NP Lead and team moving forward z Department Structure z Regional Manager, Physician/NP Recruitment z 3 HSDA specific Physician Recruiters / Candidate Relationship Developers (NE, NW, NI) z 2 Coordinators z Medical Staff Retention and Recruitment (Marketing, NP Recruitment) z Physician Recruitment Programs (IMG/PRA Programs, NMP Students, Residents) Retention99 and Recruitment Highlights Sources100 of Physician Supply for the North z Increasing focus on retention – Development and implementation of a Retention Plan Northern Health sources physicians through the – Stay Interviews and Exit Interviews following: z Maintaining focus on recruitment z For Family Practitioners – Comprehensive events strategy AGENDA ITEMH.2. – Foundation of excellence and collaboration with partners – Actively recruit from students and residents attending the Northern Medical Program z Developing an engagement and marketing plan – Practice Ready Assessment Program of BC (PRA-BC) – Implementation of a Client Relationship Management system – Provide a framework for our existing engagement work z Approximately 12 physicians annually – Use this framework to design and implement a marketing plan – The UBC International Medical Residency Program z Ongoing relationship building and collaboration z Approximately 10 physicians annually Page 83 of137 – Internal departments (HR, Physician Compensation, etc) z – External partner organizations (Health Match BC, MOH, etc) For Family Practitioners and Specialists: – Communities in Northern BC (Divisions of Family Practice, etc) – Use traditional recruitment activities (i.e. attending planned medical events) Report from Administration dated May7,2019, re:Directors’ Report –20... 101 2018 Events Planned 102 Northwest Recruitment Events Planned April 2018-March 2019 Northwest HSDA Current Postings & 2017/18 Fiscal Year Filled Positions Month Event Name And Recruitment In Progress By Community April Society of Rural Physicians Conference (St. John’s, NFLD) (Based on best available information April 10, 2018) Nurse Practitioner Association of Alberta (Edmonton, AB) Community Postings Filled (17/18) In Progress FTE in Practice Notes Family Practice Resident “Doc Talks” (Prince George, BC) * Atlin 0 Not recruiting May BC Rural Health Conference (Nanaimo, BC) Dease Lake 2 Canadian Association of Emergency Physicians Conference (Calgary, AB) Hazelton 3 1 Letter of Offer 4.5 6 candidates Northern Doctors Continuing Medical Education Event (Tumbler Ridge, BC) ** Houston 1 2.2 Family Practice Resident “Doc Talks” (Prince George, BC) * Kitimat 7 Northern Medical Program Students Year 4 Graduation (Prince George, BC) * Kitimat SP 1 June BC Nurse Practitioner Associates Conference (Nanaimo, BC) Masset 3 1 Letter of Offer 4 UBC CPD Practice Survival Skills Conference (Vancouver, BC) 18 Canadian Anesthesiologist Society Annual Meeting (Montreal, QC) Prince Rupert 1 6 September St. Paul’s Hospital Emergency Medicine Conference (Whister, BC) Prince Rupert SP 2 16.1 Family Practice Resident “Doc Talks” (Prince George, BC) * Smithers 1 1 October American Academy of Family Physicians Smithers SP 21 1 Canadian Society of Internal Medicine (Banff, AB) Stewart 11 Family Practice Resident “Doc Talks” (Prince George, BC) * Terrace 6 5 1 Letter of Offer 15.45 3 GP candidates November CFP Family Medical Forum (Toronto, ON) Terrace SP + GPA/GPO 44 23.85 2 OBG Candidates St. Paul's Hospital Conference for Primary Care Physicians (Vancouver, BC) V. of Queen Charlotte 1 4.5 Family Practice Resident “Doc Talks” (Prince George, BC) * TOTAL GPs 11 12 3 75.75 Northern Medical Program Year 1 Orientation Weekend (Prince George, BC) TOTAL SPs 6 7 30.85 * Events organized and supported by NH Physician Recruitment ** NH Continuing Medical Education event. 103 Northeast 104 Northern Interior Northeast HSDA Northern Interior HSDA Current Postings & 2017/18 Fiscal Year Filled Positions Current Vacancies & 2017/18 Fiscal Year Filled Positions And Recruitment In Progress By Community And Recruitment In Progress By Community (Based on best available information April 10, 2018) (Based on best available information April 10, 2018) Community Postings Filled (17/18) In Progress FTE in Practice Notes Community Postings Filled (17/18) In Progress FTE in Practice Notes Chetwynd 2 5 Burns Lake 3 7.5 Dawson Creek 5 21 Fort St. James 1 5 AGENDA ITEMH.2. 8 Dawson Creek SP 1 Fraser Lake 1 3.6 Fort Nelson 1 4 Mackenzie 2 5 Fort St. John 25 29 McBride 1 2.4 Fort St. John SP 4 1 Letter of Offer 12 Prince George 217 84.9 Hudson’s Hope 1 Prince George SP 18 10 3 Letters of Offer 112.51 7 candidates 23.35 Taylor Not recruiting Quesnel 1 Quesnel SP 1 5 1 candidate Tumbler Ridge 1 3 Valemount 3.5 TOTAL GPs 314 63 Vanderhoof 3 11.5 TOTAL SPs 41 20 TOTAL GPs 229 146.75 Page 84 of137 TOTAL SPs 19 10 3 117.51 Report from Administration dated May7,2019, re:Directors’ Report –20... 105 Nurse Practitioners 106 Thank you Northern Health Nurse Practitioners as of March 22, 2018 (Based on best available information) Contact Area / Region In Practice (FTE) Current Permanent Postings (FTE) z Kelly Giesbrecht Prince George 13.0 0.0 – Regional Manager Physician Recruitment Northern Interior 8.0 1.0 – Email: [email protected] Northeast 1.0 2.0 – Phone: 250.649.7244 Northwest 6.0 4.0 Flexible / Casual -- 2.0 TOTAL 28 9 107 108 The Issue z Enduring and serious transfer issues- sending seriously ill or injured patients to higher levels of care within Northern Health or outside the Health Authority z Concern of Northern Health, physicians, RHDs, and municipalities for several years AGENDA ITEMH.2. z Concerns have been escalating over the last year Page 85 of137 Northern Health Review of Patient Transfers NH Board and Regional Hospital District Planning Session Report from Administration dated May7,2019, re:Directors’ Report –20... 109 The North is Unique 110 The Provincial Context z Vast geography and greatest distances to the next level of care z Northern Health relies on access to some tertiary and quaternary services outside the north 111 Process 112 Issues z In order to provide a comprehensive review of the current z Findings validate our concerns: state, NH undertook the following processes over the last – The #1 Issue- Difficult transfers of the seriously ill or injured six months: to higher levels of care within Northern Health or elsewhere in the province – Undertook a review of all patient transfer issues – Aircraft is frequently not available due to plane diversion, AGENDA ITEMH.2. – Met with Prince George and Rural Physicians, Operational Leaders and Staff pilots ‘timing out’, poor understanding of northern geography and capabilities of the sites, sometimes weather – Used 2 years of data from the Patient Safety Learning System (PSLS) to validate the consultation findings – Ground Transport- Very few paramedics in the north have the qualifications/skills needed to safely accompany the – Developed a Patient Transfer Process Map very ill or injured to the next level of care. – Collected recent patient transfer stories to illustrate Page 86 of137 concerns Report from Administration dated May7,2019, re:Directors’ Report –20... 113 Issues Continued 114 Issues Continued z Findings validate our concerns cont’d: – Paramedic qualification issues mean physicians or nurses z Findings validate our concerns cont’d: are frequently required to leave their rural communities to – Paramedic qualification issues mean physicians or nurses are accompany the patient frequently required to leave their rural communities to accompany the patient – Leaves rural communities with reduced coverage (or with no coverage) – Leaves rural communities with reduced coverage (or with no coverage) – Challenges getting physicians and nurses back to their – Challenges getting physicians and nurses back to their home home communities (prolonging the period of time rural communities (prolonging the period of time rural communities communities are understaffed) are understaffed) 115What Are We Doing About This? Established116 a BCEHS and NH Working Group z Produced a draft report of key findings z Explore Telemedicine enabled consult calls to connect Transfer z After meeting with the Provincial Health Services CEO physicians and our rural physicians and nurses (esp. for relatively and Senior BC Emergency Health Services staff, we new grad physicians/nurses in rural communities) z Skill up the existing northern paramedic workforce within a research developed a collaborative action plan to address high AGENDA ITEMH.2. acuity patient transfer issues. project framework. z Educate BCEHS regarding our site level capabilities and distances to the next higher level of care z Educate BCEHS regarding Northern referral patterns and transportation routes. z Develop a communication pathway for BCEHS to consult and Page 87 of137 introduce policy and practice change to Health Authorities Report from Administration dated May7,2019, re:Directors’ Report –20... 117 Progress to Date 118Other Notable Actions to Improve Transport Times z The UHNBC Emergency Room physicians are testing a virtual connection project linking the regional hospital to physicians and z BCEHS implemented a low acuity air service (a charter plane) to nurses in the Robson Valley to support the care of the critically ill or enable low acuity transfers between Fort Nelson and Fort St. John. injured in these small sites until transport occurs. z BCEHS has established an “Auto Launch” response in the North z NH and BCEHS have met with UNBC Researchers to develop a East. This is the simultaneous dispatch of ground and air transport framework to set up and study the process of skilling up rural to respond to accident scenes. paramedics. z Auto launch compliments the Early Fixed Wing activation process. z BCEHS has advised NH that they have embedded our site capability z Early Fixed Wing Activation is an “on scene” alert to dispatch that and referral pattern information in their orientation for transfer transport to a higher level of care may be required. At the hospital physicians and staff. the ED physician decides within 30 minutes if this transfer to a z A communication pathway to ensure NH is aware and can prepare higher level of care should occur. The early notice allows for the for BCEHS transfer policy changes has been established aircraft and critical care paramedic team to be ready to respond immediately. 119 Questions? AGENDA ITEMH.2. Page 88 of137 l _.. AGENDA ITEM H. S-1. f~·~ SECOND FL 0 0 R CARLYLE SHEPHERD & CO. 4544 LAKELSE AVENUE ~ CHARTERED PROFESSIONAL ACCOUNTANTS I "s TERRACE BC V8G 1P8 INDEPENDENT AUDITOR'S REPORT TELEPHONE 250· 635-6126 FACSIMILE 250-635-2182 To the Board of Directors North West Regional Hospital District Opinion We have audited the financial statements of the North West Regional Hospital District, which comprise the statement of financial position as at December 31, 2018 and the statement of financial activities for the year then ended, and notes to the financial statements, including a summary of significant accounting policies. ::~: In our opinion, the accompanying financial statements present fairly, in all material respects, the financial position of the Regional Hospital District as at December 31, 2018 and the results of its operations for the year then ended in accordance with Canadian public sector accounting standards. Basis for opinion We conducted our audit in accordance with Canadian generally accepted auditing standards. We are independent of the Regional Hospital District in accordance with the ethical requirements that are relevant to our audit of the financial statements in Canada, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient '· .~· and appropriate to provide a basis for our opinion. Auditor's Responsibility for the Audit of the Financial Statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor's report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with Canadian generally accepted auditing standards will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements. As part of an audit in accordance with Canadian generally accepted auditing standards, we exercise professional judgement and maintain professional skepticism throughout the audit. Responsibilities of Management and Directors for the Financial Statements Management is responsible for the preparation and fair presentation of these financial statements in accordance with Canadian public sector accounting standards, and for such internal controls as management determines are necessary to enable the preparation of financial statements that are free of material misstatement, whether due to fraud or error. In preparing the financial statements, management is responsible for assessing the Regional Hospital District's ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless conditions exist that do not allow for the going concern basis to be used. The Board of Directors are responsible for overseeing the Regional Hospital District's financial reporting process. Terrace, BC May 17, 2019 Report from Ernie Dusdal, Carlyle Shepherd & Co., dated May 17, 2019, re... Page 89 of 137 COQUITLAM KITIMAT PRINCE RUPERT SMITHERS TERRACE AGENDA ITEM H. S-1. NORTH WEST REGIONAL HOSPITAL DISTRICT STATEMENT B STATEMENT OF FINANCIAL ACTIVITIES YEAR ENDED DECEMBER 31 Unaudited Audited Audited 2018 2018 2017 Budget Actual Actual $ $ $ REVENUE Tax Requisition 9,258,968 9,258,975 9,258,974 Grants in Lieu/Other Revenue 180,987 202,664 Interest 210,000 370 474 231,649 9,468,968 9,810,436 9,693,287 EXPENDITURE Grants to Health Facilities and Planning Studies 4,685,411 4,559, 158 4, 198,739 Debenture Debt Interest 1,441,275 1,371,543 1,037,561 Principal 1,545, 173 1,545, 173 . 1,158,589 Interest on Temporary Borrowing 20,000 12,330 119,707 Contingency 116, 164 Administration 175,000 144,975 159, 137 7,983,023 7,633,179 6,673,733 I. NET CHANGE IN FINANCIAL ACTIVITIES 1,485,945 2, 177,257 . 3,019,554 OPENING POSITION 17, 120,753 17,120,753 14,101,199 . CLOSING POSITION 18,606,698 19,298,010 17,120,753 . .•,. Report from Ernie Dusdal, Carlyle Shepherd & Co., dated May 17, 2019, re... Page 90 of 137 AGENDA ITEM H. S-1. NORTH WEST REGIONAL HOSPITAL DISTRICT STATEMENT A STATEMENT OF FINANCIAL POSITION --~ .·• DECEMBER 31 · .•. ·-··· FINANCIAL ASSETS 2018 2017 $ $ CASH 20,345,918 17,000,039 ACCOUNTS RECEIVABLE 406, 112 404,664 MUNICIPAL FINANCE AUTHORtTY DEBT RESERVE FUND 599,733 586,965 1-- 21,351 ;763 17,991,668 FINANCIAL LIABILITIES ACCOUNTS PAYABLE AND ACCRUED LIABILITIES 1,454,020 283,950 MUNICIPAL FINANCE AUTHORITY DEBT RESERVE FUND 599,733 586,965 LONG TERM DEBT (Note 2) . 32,085,615 34,177,401 34, 139,368 . 35,048 ~ 316 [.. NET FINANCIAL ASSETS/LIABILITIES (12,787,605) (17,056,648) FUTURE REVENUE REQUIREMENT FROM TAXPAYERS 32,085,615 34, 177,401 REGIONAL HOSPITAL DISTRICT POSITION 19,298,010 17,120,753 APPROVED BY THE BOARD ------Chair ------Treasurer Report from Ernie Dusdal, Carlyle Shepherd & Co., dated May 17, 2019, re... Page 91 of 137 Page 92 of 137 AGENDA ITEM H. S-2. TO: North West Regional Hospital Board FROM: Yvonne Koerner, Executive Director DATE: May 16, 2019 RE: Renewal of the Joint Northern Health and Regional Hospital Districts Memorandum of Understanding. The North West Regional Hospital District along with the four other Regional Hospital Districts within Northern Health Authority's boundaries have a Memorandum of Understanding (MOU) with Northern Health Authority. This agreement is renewed every two years. The Next renewal is scheduled for October 21, 2019 at the Joint Regional Hospital Districts and Northern Health Fall Meeting. An executive member will sign on behalf of the North West Regional Hospital District and there is need for a resolution from the Board to approve signing. On April 25, the 2017 MOU was circulated to the Board for review and no changes were requested. At NCLGA on May 9, 2019 the Administrators from three of the Regional Hospital District met to discuss the MOU and concluded that ·no changes were required at this time. A copy of the 2017 MOU is attached to this report. Recommendation: That the NWRHD Board authorize the Chair or a Vice-Chair to sign the 2019 renewal of the Memorandum of Understanding between Northern Health and the Regional Hospital Districts. Report from Administration, dated May 17, 2019, re: Renewal of the Joint... Page 93 of 137 AGENDA ITEM H. S-2. Memorandum of Understanding THIS UNDERSTANDING made as of the 7th day of October, 2003 and renewed, as amended, the 16th day of October, 2017. BETWEEN: NORTHERN HEALTH (hereinafter called "NH") OF THE FIRST PART AND: CARIBOO-CHILCOTIN REGIONAL HOSPITAL DISTRICT FRASER-FORT GEORGE REGIONAL HOSPITAL DISTRICT NORTH WEST REGIONAL HOSPITAL DISTRICT NORTHERN ROCKIES REGIONAL HOSPITAL DISTRICT PEACE RIVER REGIONAL HOSPITAL DISTRICT STUART-NECHAKO REGIONAL HOSPITAL DISTRICT (hereinafter called "RHDs") OF THE SECOND PART WHEREAS: A) NH is responsible for all health care services within the Northern British Columbia region comprising of Northwest, Northeast and Northern Interior Health Service Delivery Areas, and B) The RHDs are responsible, on a voluntary basis, for providing funding based on a cost-shared formula to NH for capital, including equipment and clinical information technology projects, within their respective service areas in accordance with the Hospital District Act. Intent: In order for the planning and funding of equipment, clinical information technology and capital projects to be effective and efficient while ensuring accountability, the parties agree with each other as follows: 1. Upon receiving the funding envelope from the province for Capital Improvement Projects, NH will allocate the capital funding for Minor Capital Projects and Equipment< $100K among the three Health Service Delivery Areas (HSDAs.) Each HSDA will contact its respective RHO to share the plan by community,. including identifying funding allocation by each community, for feedback. Report from Administration, dated May 17, 2019, re: Renewal of the Joint... Page 94 of 137 AGENDA ITEM H. S-2. NH-RHD Memorandum of Understanding Page2 2. Upon receiving the funding envelope from the province for Capital Improvement Projects, NH will present proposals at a meeting of the Chairs/Staff of all RH Os within the region to seek feedback and identify funding requirements. Capital Improvement Projects requiring RHO funding will be presented to the regional planning group before being presented to the NH Board for approval. 3. Capital equipment projects over $100,000 will be prioritized on an NH-wide basis and presented to the RHOs for feedback and to identify requirements prior to being presented to the NH Board for approval. 4. Capital Projects requiring debt servicing or other forms of funding by NH, not included above and which historically would receive RHO funding, will be presented to a meeting of the Chairs/Staff of all RH Os within the region to seek feedback and identify funding requirements prior to being presented to the NH Board for approval. 5. NH will provide three-year capital plans including construction, clinical information technology and equipment outlining funding requirements to the respective RHOs by November 1st of each year, recognizing that it will take time for NH to develop suitable plans integrated with service plans. 6. RHOs may examine widening the scope of projects that will be cost-shared under legislation, subject to RHO taxation limits. 7. NH will submit a summary of projects and/or equipment costing under $100K to the RH Os for their review, annually. NH will submit a summary of the projects and/or equipment costing over $1 OOK to the RH Os for reimbursement. RH Os reserve the right to request further detailed invoice copies. 8. For any project with an estimated cost greater than $1 million, including professional services, construction and equipment, the RHO may require the use of a Project Implementation and Accountability process (see Appendix 1.) 9. The disposal of NH capital assets and disposition of proceeds will follow the guidelines set out in Appendix 2. 10. Media releases announcing capital expenditures for which RHO funding is supplied will be jointly produced and released by NH and the RHO. 11. a) RH Os may provide funding for projects within their geographic boundaries and for clinical information technology and projects or equipment outside their boundaries where there is a greater service area and there is an agreement amongst benefiting RHOs and NH for cost-sharing such projects. b) Each RHO maintains the flexibility to negotiate independently with NH without prejudice and precedence for issues relating to the capital plan within the RHO boundary. . · 12. The parties agree to meet twice each year to discuss planning and funding of equipment and capital projects. NH agrees to schedule additional meetings with the individual RHO's to discuss specific capital projects and operational issues as the need arises. Originally adopted October 7, 2003; formally renewed October 16, 201.7 Report from Administration, dated May 17, 2019, re: Renewal of the Joint... Page 95 of 137 AGENDA ITEM H. S-2. NH-RHD Memorandum of Understanding Page3 a) Spring joint meetings will focus on the Capital Plan and business matters. b) Fall joint meetings will focus on preparation of the Capital Plan and feedback on strategic directions in preparation for the NH Board fall planning session. 13. The NH Board will provide opportunity for each RHO to meet annually with the NH Board when the Board is meeting in the RH D's jurisdiction~ The purpose of this meeting is: a) to discuss matters of mutual concern related to the Capital Plan, and b) to receive any other feedback and input. 14. RHDs will have opportunity to meet with NH's Board Chair and Chief Executive Officer during the course of the North Central Local Government Association (NCLGA) and Union of B.C. Municipalities (UBCM) events held each year to discuss the Capital Plan and related issues. 15. NH's Chief Operating Officers (COOs) from each HSDA will attend RHO meetings upon request for discussion of ad-hoc items to ensure timely communication of issues. 16. This agreement will be reviewed every two years by NH and RHDs to ensure the process is accountable and effective. Any party can terminate its participation by giving 90 days' notice in writing to all parties of its intent to do so. IN WITNESS WHEREOF the parties have executed this Memorandum of Understanding as of the day, month and year first above written. Chair, Cariboo-Chilcotin Regional Hospital District Chair, Fraser-Fort George Regional Hospital District Chair, Northern Rockies Regional Hospital District Chair, North West Regional Hospital District Chair, Peace River Regional Hospital District Chair, Stuart-Nechako Regional Hospital District Chair, Northern Health Originally adopted October 7, 2003; formally renewed October 16, 2017 Report from Administration, dated May 17, 2019, re: Renewal of the Joint... Page 96 of 137 AGENDA ITEM H. S-2. NH-RHO Memorandum of Understanding Page4 APPENDIX 1 NORTHERN HEALTH I REGIONAL HOSPITAL DISTRICT PROJECT IMPLEMENTATION AND ACCOUNTABILITY PROCESS POLICY Northern Health (NH) is responsible for Capital Projects and Regional Hospital Districts (RH Os) are responsible to the taxpayer and require accountability regarding Capital Projects from Health Authorities. NH has the expertise to implement projects and RH Os reserve the right to decide the amount of funding contribution to the projects. NH and RHDs agree that projects are to be developed using the following guidelines: PROJECTS OVER $1 MILLION Preliminary Planning Projects over $1 million should be included in the five-year prioritized major capital project plan, and be consistent with the facility role and service plan. Scope of Project Northern Health will develop the scope of the project with consultation from their stakeholders and user groups. A Project Brief will be presented to the RHO for approval in-principle. The RHO may wish to consider approval of planning funds at this stage. Project Brief includes: • Needs Assessment • Project description (including scope) • Location • Preliminary cost estimate Planning NH's formal request to the RHD will include the same project planning documentation as presented to NH's Board for their approval. It is anticipated this documentation will include: • Detailed Project Scope • Conceptual and schematic estimates • Project delivery time schedule • Strategic importance • Cost estimate • Recommended reporting schedule to the RHO • Other information applicable to the project Implementation Progress reports will be provided to the RHO on a regular basis, as agreed to with individual RHDs in compliance with the agreed scope of the project. Requests for funding will include actual monthly expenditures, budgetary status report and list of change orders and cannot exceed actual expenses incurred as reported on the status report. RHDs reserve the right to request invoices. Originally adopted October 7, 2003; formally renewed October 16, 2017 Report from Administration, dated May 17, 2019, re: Renewal of the Joint... Page 97 of 137 AGENDA ITEM H. S-2. NH-RHD Memorandum of Understanding Page5 Project Management If a project is likely to diverge from the original scope or implementation schedule, NH will inform the RHD in a timely manner, identifying the reasons for the variance, the financial implications, the time frame implications and impacts on the projected completion date. Failure to notify the RHD may jeopardize the RHD portion of incremental project funding. NH may make a request to the RHD for funding contributions for cost overruns; however, the RHD is not obligated to approve such requests. Any scope change or reallocation of project funds over 5% requires RHD consent. In the event that cost savings on the total project are generated, NH will contact the RHD and report the amount and provide an explanation. PROJECTS BETWEEN $100,000 AND $1 MILLION Northern Health to provide: • A Scope of Work for the project. This project brief will include an understanding of the need, priority, schematic design (if required), and order of magnitude budget. • NH will provide the RHD with an annual list of all proposed projects for the current fiscal year for their budget consideration and feedback. A five-year plan will also be provided at this time. • NH will, to the best of its abilities, complete all projects on time, on budget and within scope. • NH will attend the RHD Board meetings to provide updates on any or all projects, if requested. Reports to be provided by Northern Health: • Quarterly update to the RHD. This update includes a schedule describing the progress for each approved project from schematic design through to final completion of the project. It also provides the estimated construction timeframe and proposed completion date. This information is to be used in the planning of any opening ceremonies. • NH will advise the RHD immediately, in writing, of any project with the potential of significant changes to the scope of work or budget overrun, detailing the change and/or cost overrun. • NH may make a request to the RHD for funding contributions for cost overruns, however the RHD is not obligated to approve such requests. THE FOLLOWING WILL BE APPLICABLE TO ALL PROJECTS Public/Private Partnerships Should NH enter into public/private partnership with RHD involvement, a different project implementation approach and accountability process may be required, which will be decided in the initial planning stages. Originally adopted October 7, 2003; formally renewed October 16, 2017 Report from Administration, dated May 17, 2019, re: Renewal of the Joint... Page 98 of 137 AGENDA ITEM H. S-2. NH-RHD Memorandum of Understanding Page6 Completion NH and the RHD will arrange joint press releases in accordance with their Memorandum of Understanding. Media events, such as project approval, sod turning and facility openings, shall ensure recognition and include participation of funding partners. Report from Administration,Originally adopted Octoberdated 7,May 2003; 17, formally 2019, renewed re: RenewalOctober 16, 2017of the Joint... Page 99 of 137 AGENDA ITEM H. S-2. NH-RHD Memorandum of Understanding Page7 APPENDIX2 DISPOSAL OF NORTHERN HEAL TH CAPITAL ASSETS AND DISPOSITION OF PROCEEDS POLICY Northern Health (NH) will work with respective Regional Hospital Districts (RHOs) and in compliance with the Ministry of Health Capital Asset Management Plan in the disposal of NH capital assets and the disposition of proceeds as follows: 1. Disposal of Health Authority Capital Assets NH will consult with an RHO regarding disposal of capital assets, including equipment, land and buildings, with an initial capital cost over $500,000 that have been cost-shared by that RHO. The sale or disposal of the asset will be in accordance with Ministry of Health policy. In the event that an outstanding RHO debt remains on the property, NH will negotiate repayment through agreement with the RHO and/or the Ministry. Any "trade in allowance" or "proceeds of sale" of assets which the RHO has cost shared shall be applied to the purchase of the replacement asset or, if the asset is not to be replaced, NH will negotiate the use of the proceeds of the sale or disposal towards an item on the NH Capital Plan within the RHO. 2. Transferring Assets within RHO Boundaries When a major capital asset that a RHO has cost-shared is moved to another facility within the RHD boundaries, NH will consult with the RHO prior to transferring the asset from one facility to another. 3. Transferring Assets outside RHO Boundaries When a major capital asset that a RHO has cost-shared is moved to another facility outside the RHD, the RHO Board will be asked for their consent prior to transferring the asset. 4. Change to Function If NH plans to substantively change the function of a capital asset (facility or component thereof) that the RHO has cost-shared, NH will consult with that RHD prior to any such conversion. Examples include hospital conversion to complex care, complex care conversion to supportive housing. The RHD may wish to negotiate repayment of any outstanding debt and/or compensation. Emergency movement of equipment, making space available for care due to a catastrophic facility failure or other event, NH and the RHD agree: 1. that the RHD will be notified as soon as possible after the event starts; and 2. that consultation and consent will be discussed after the event. Report from Administration,Originally adopted Octoberdated 7,May 2003; 17, formally 2019, renewed re: RenewalOctober 16, 2017of the Joint... Page 100 of 137 AGENDA ITEM Q. 1. NEWS RELEASE For Immediate Release April 18, 2019 NH Board meeting highlights: April 2019 Northern Health's Board of Directors heard details of progress on implementation of the Northern First Nations Wellness Plan, and about an integrated approach to Adult Day Program services for seniors in the Bulkley Valley, at its most recent meeting in Smithers. NH Indigenous Health provided an update on a wide range of ongoing and new initiatives in partnership with the First Nations Health Authority, and northern First Nations communities across the region. Among the highlights are two programs offering undergraduate medical students the opportunity to visit and learn from northern First Nations communities through cultural exchange and sharing of local knowledge. "A key priority in the First Nations Health and Wellness Plan is to improve the cultural safety of NH services provided to Indigenous people," said Board Chair Colleen Nyce. "We thank all of our partners including the First Nations Health Authority and northern First Nations communities who are guiding this work across the spectrum of health services in the region." · While in the Bulkley Valley, Board members recognized improvements to local services including the implementation of a CT scanner in Smithers that will enhance the access to diagnostic testing in the Hazelton to Burns Lake corridor. The project would not have been possible without a major donation and support from the Bulkley Valley Hospital Foundation. Northern Health is targeting a late June 2019 start for the delivery of patient services. The Smithers Integrated Adult Day Program at Bulkley Lodge was the focus of a presentation highlighting efforts to improve access to a wider and more flexible range of services for seniors with care needs in the community while also providing respite forfamily caregivers. Over the years, the program has added staff and programming to operate seven days per week, with improved program flexibility and stability. 1.· "Increasing access to Adult Day Program services for seniors is an important f component of meeting the needs of an aging population," said Cathy Ulrich, t Northern Health CEO. "Health supports are only one piece of the puzzle, and we News Release from Northern Health dated April 18, 2019, re: Northern Hea... Page 101 of 137 AGENDA ITEM Q. 1. Page 2 continue to work in partnership with community partners to expand and enhance community services and supports to help seniors stay at home and in their communities." Other highlights from the April 2019 meeting include: • An overview of 2018 research projects reviewed and approved by the NH Research Review Committee; in all, 47 projects were approved in partnership and/or collaboration with University of Northern BC, UBC and the Northern Medical Program, and other organizations such as BC Cancer, other health authorities and the BC Academic Health Science Network • Enhancements to the North West Specialized Community Services Program for Mental Health and Substance Use, including the recently announced mobile Mental Health and Substance Use unit serving Terrace, Kitimat and the Hazelton area. The next regular meeting of the Northern Health Board of Directors will be held June 10, 2019 in Fort St. John. Media Contact: NH media line - 877-961-7724 News Release from Northern Health dated April 18, 2019, re: Northern Hea... Page 102 of 137 AGENDA ITEM Q. 2.I I ! April 10,2019 Honourable Adrian Drx Ministry of Health P,O. Box 9056 Stn Prov Govt Victoria, BC V8W 9E2 HL [email protected] To the Honourable Adrian Dix, RE: Assisted Living Complex - Cottonwood Manor Council for the District of Houston respectfullyreq4ests your support and consideration for the conversion of Cottonwood Manor, located in Houston, B.C., from an Assisted Living Complex to a Residential Care Facility. Currently, as an Assisted Living Complex, residents living in Cottonwood Manor do not have overnight care. This results in residents suffering falls throughout the night with no assistance until the next morning. After a number offalls, residents are considered living beyond their own ability according to the facility's policies and procedures and are forced to find other accommodations. However, with no space available in the Residential Care Facillty, the Houston Health Centre, or other long term care in surrounding communities, residents forced fo leave are faced with excessive wait times forcare. This puts uMecessary pressure on the health care system with increased calls to 911 and overloading of the already strained Emergency department ofthe Bulkley Valley Hospital in Smithers, B.C, Recently, Seniors Advocate Isobel Mackenzie stated "appropriate housing, sufficient income, adequate transportation, accessible health care and assistance with personal needs must all be available if seniors ;;ire to live safely and with dign,ity". The District of Houston recognizes an increasing senior population and the lack of care required to sufficiently meet the needs of its residents. Council for the District is requesting your support in converting Cottonwood Manor frorn an Assisted Living Complex to a Residential Care Facility. All rooms at Cottonwood Manor are capable of supporting the residential care model, and this conversion would assist in reducing wait times for seniors currently seeking care; Sincerely, ~~/?Af'/}U/'.- Shane Brienen Mayor cc: Minister Selina Robinson, Ministry of Municipal Affairs & Housing, [email protected] Isobel Mackenzie, Seniors Advocate, [email protected] MLA John Rustad, [email protected] North West Regional Hospital District Board, [email protected] Northern Health Authority; 4702 LazelleAvenue, Terrace BC VSG 1T2 Smithers Community Services Association, [email protected] BC Housing, [email protected] 3367 12th Stre0t PO Bt1x 370 Houston lJC VOJ lZO r 250.84£i.2238 F 250.845.3429 f [email protected] www.houston.ca Letter to the Honourable Adrian Dix, Minister of Health, from Shane Brie... Page 103 of 137 Page 104 of 137 AGENDA ITEM Q. 3. THE UNIVERSITY OF BRITISH COLUMBIA Faculty of Medicine Strategic Investment Fund Proposal - version 3 Strategic Investment Fund Proposal Form Applicant Information Primary Applicant Name Jan Dutz Title ·. Professor and Head Email address ... [email protected] Unit Dermatology and Skin Science Co-applicant(s) Name(s} & Unit(s) • Neil Kitson (Project Lead), Nathan Teegee (Dermatology Resident Lead), and Aaron Wong (Dermatology Residency Program Director), UBC Dermatology and Skin Science • John Pawlovich, UBC Dept. of Family Practice; Medical Director, Carrier-Sekani Family Services; Director, Rural Education Action Plan • Dan Horvat, Quality Improvement and Evaluation Lead, Rural Co ordination Centre, Doctors of BC • Travis Holyk, Executive Director Research, Primary Care and Strategic Services, Carrier-Sekani First Nation • Emma Palmatier, Community Health Representative, Lake Babine First Nation • Craig Mitton, Centre for Clinical Epidemiology and Evaluation 1 High-level Proposal Summary 1.1 Title Please provide a very brief title for your proposed project. Title I Telemedicine proof-of-concept model for a rural and remote dermatology service 1.2 Intended Outcome In one or two sentences, what value (benefits, outcomes, return on investment) will this project deliver? This does not have to be monetary, although it can be. There is room for further explanation in other sect;ons below. Value UBC Dermatology will test a new model of telemedicine designed to be clinically Proposition effective while drastically reducing costs and wait lists. To do this, a collaboration is September 14, 2018 Page 1of14 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 105 of 137 AGENDA ITEM Q. 3. THE UNIVERSITY OF BRITISH COLUMBIA Faculty of' Medicine Strategic Investment Fund Proposal - version 3 being forged with rural doctors and communities, including First Nations communities whose already limited access is aggravated by geography, poverty, and health care system mistrust. 1.3 Amount Requested Please indicate the amount of funding requested from the Strategic Investment Fund. There is room for budget details and assumptions in other sections below. Amount I $170,8s2 1.4 Primary Strategic Plan Connection Indicate one (or perhaps two) primary strategic plan objectives on which the proposed project is focused, and explain how the proposed project will advance it/them. You can find more information about the plan's objectives here: http://stratplan.med.ubc.ca/ Primary Partnership (This application is endorsed by the Partnership Pillar, Dr. Gurdeep Strategic Plan Parhar, Executive Associate Dean, Clinical Partnerships and Professionalism) Objective(s) "Shape practices and policies for improved care of the population across the province through collective system leadership." The goal of this project is to test a model of dermatology care that would improve access in rural and remote areas. The model has three parts: (1) to establish working relationships with rural doctors through community visits, (2) to establish secure telemedicine access to dermatologists for referring community doctors, and (3) to transfer dermatology knowledge and skills into the community. The collective leadership combines the UBC Dept. of Dermatology and Skin Science, the UBC Dept. of Family Practice, the Rural Education Action Plan, the Rural Co ordination Centre of Doctors of BC, Divisions of Family Practice in the test area proposed, and the health care administrations of Lake Babine and Carrier-Sekani First Nations, as well as the Centre for Clinical Epidemiology and Evaluation. 1.5 Secondary Strategic Plan Connection If there are secondary strategic plan objectives that will be advanced by this proposed project in addition to the primary objective(s), please list them here and explain the how the project will advance it/them. Secondary Pl. Support the establishment of mechanisms that formalize and simplify Strategic Plan connections across the system through the AHSN (Academic Health Objective(s) Science Network) and AHSCs. The model establishes working relationships between referring doctors and consulting dermatologists through community visits which should then lead to efficient use of telemedicine in the form of secure phone and video links. Community visits would then be reduced in frequency because they could not be sustained, particularly on the scale of a provincial service. Such relationships are expected to increase education in both directions. September 14, 2018 Page 2of14 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 106 of 137 AGENDA ITEM Q. 3. THE UNIVERSITY OF BRITISH COLUMBIA Faculty of Medicine Strategic Investment Fund Proposal - version 3 Pl. Engage with partners and populations to help reduce inequities in Indigenous health care and outcomes. Through collaboration with John Pawlovich of the Dept. of Family Practice, UBC Dermatology has provided care in the First Nations Communities of Takla Landing, Fort Babine, Tachet, Yekooche, Stella'ten, and Woyenne. At least 5 dermatology residents have been on such outreach visits, and more wish to participate in this "rural dermatology elective". We believe these existing community relationships form the basis for a realistic test of our "working relationships" model for indigenous people, and the participation of residents increases the probability of recruiting younger dermatologists to the program. Both Carrier-Sekani and Lake Babine First Nations are full partners in this application. Their collective experience in formulating surveys for their own populations together with associated data collection and analysis, will be available to us through Travis Holyk, Executive Director Research, Primary Care. and Strategic Services, Carrier-Sekani First Nation, and complements the expertise of our partners Craig Mitton at the Centre for Clinical Epidemiology and Evaluation, and Dan Horvat, Quality Improvement and Evaluation Lead, Rural Co-ordination Center of BC. P3. Develop shared agendas and accountabilities with sector partners to address core systemic issues A core systemic problem is lack of access to clinical services for patients in rural and remote areas. The partners in this project share an agenda to increase access to dermatology services and education for this population and their primary care doctors. We believe our model might be used easily by other disciplines to increase access and education using secure cell phone service with associated file transfer and video as appropriate. We attach letters of support from colleagues in Emergency Medicine, Gynaecology, and Pediatric Dermatology that confirm this potential. P4. Reinforce provincial capacity and rigour in health data analytics and quality improvement. The model includes measures of clinical outcome, service efficiency (waiting times etc.) as well as patient and referring doctor satisfaction. These can be continued as measures of QI and continuing clinical research. PS. Strengthen education and research through coordinated international focus and growth. With our colleagues in the Rural Co-ordination Centre, we have initiated a dermatology education collaboration with the Australian College of Rural and Remote Medicine, who in turn have a previously established collaboration with Dr. Jim Muir at the University of Queensland in Brisbane to develop on line educational material in dermatology for doctors in rural and remote areas of Australia. This is a national program and Dr. Muir is a Fellow of the Australasian College of Dermatologists. We now have access to these resources for 20 rural doctors in BCas a pilot project. We have begun experimenting with our own educational resources as a result and have made several demonstration videos. We expect this September 14, 2018 Page 3of14 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 107 of 137 AGENDA ITEM Q. 3. THE UNIVERSITY OF BRITISH COLUMBIA Faculty of Medicine Strategic Investment Fund Proposal - version 3 collaboration to grow to our mutual benefit both in education and educational research. R3. Embed and extend patient-oriented clinical research capacity. The embedding of patient-oriented assessments in our model lends itself to further clinical research; for example, the relative values of dermatology treatments could be assessed in a real-world rural setting. We are receiving guidance from Colleen McGavin, Patient Engagement Lead of the BC Support Unit of the CIHR Strategy for Patient Oriented Research. E2. Exploit disruptive innovation to enrich the learning experience and increase access. The disruptive technology is secure cell phone service that allows clinical phone conversation, text-messaging {SMS}, file transfer (MMS), and video chat. We believe the technology can also provide education at the so-called "point-of-care". This could be as simple as a link to one of our resources, to a practice guideline, or to an educational case on the site of our Australian collaborators. It can also involve transfer of videos, documents, and slide presentations although file sizes might pose practical problems, at least for now. ES. Develop a learning environment conducive to learner, trainee, staff & faculty development & mentorship. To expand teaching opportunities across residency and undergraduate medical education, resident physicians and medical students will have the chance to be involved in the tele-medicine experiences offered on both sides of the clinical encounter. The clinical experience would be treated and evaluated as full rotation, with goals, objectives and other metrics. Training residents to be familiar with this modality of care will also ensure its future continuity as more and more will incorporate this service into their future practices. The benefits to First Nations, remote or rural communities would be many-fold. September 14, 2018 Page 4of14 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 108 of 137 AGENDA ITEM Q. 3. ~ THE UNIVERSITY OF BRITISH COLUMBIA • Faculty of Medicine Strategic Investment Fund Proposal - version 3 2 Proposal Details (3 Page Limit) Please limit this section to three pages or fewer (including the existing titles and section descriptions). 2.1 Context (Opportunity/Problem) Describe the project context or background with emphasis on the problem it seeks to solve or the opportunity it seeks to seize. Background In rural and remote British Columbia "reasonable access" to dermatology services is limited by "financial or other barriers" contrary to the stated purpose of the Canada Health Act. Our goal is to create a model of effective care by telemedicine that would reduce such barriers by increasing access while reducing costs (including travel and other out-of-pocket costs for patients) and waiting times. 2.2 Project Description Describe the specific work that will be done (project scope}, and the deliverables that will be produced. Explain how that work and those deliverables will lead to achieving the intended outcome described in section 1.2. Scope & This is a two-year project. In Year 1 we will construct a working model and field test Deliverables it. In Year 2 we will collect data and, depending on results, make plans for a sustainable service. If warranted, we will consider the requirements for expansion to a provincial service. Description of model Technology supports our model of care but does not define it. The heart of the model is collaborative care at a distance: the primary doctor cares for the patient in the community with consultation and backup from consultants who are accessible. Technology and working human relationships make this model possible and easily available, education sustains it; as always, guided experience is the best teacher. Community visits are planned to be frequent when establishing working relationships and then to decrease as trust in the telemedicine and its providers increases. In our view, a permanent provincial travelling dermatology service cannot be imagined let alone sustained. Unmet need We are convinced that this model of care will fulfill an unmet need because an obvious demand exists. Dermatology manpower is currently focused on the south west corner of the province with the remainder of the geography under-served. Many if not all dermatologists have received requests to review photos sent from rural and remote practitioners and requests to discuss cases in real time. To our certain knowledge, that demand continues to this day and the lack of a working service frustrates clinicians on all sides. We did not create this project, the project came to us. The technology After considerable searching we were surprised to discover an existing Canadian engineered solution: BlackBerry BBM Enterprise with voice and video, an application that provides secure communication with the user's own cell phone. Voice, text, September 14, 2018 Page 5of14 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 109 of 137 AGENDA ITEM Q. 3. THE UNIVERSITY OF BRITISH COLUMBIA Faculty of Medicine Strategic Investment Fund Proposal - version 3 transferred images, and video chat are all encrypted and secured, and we believe the technology meets FIPPA standards. The solution is adaptable to multiple device platforms. Once installed, it is as easy to use as any phone, text, or video chat service. In addition, we use WebEx (used by PHSA) and Cisco Jabber (used by FNHA) and Polycom (used by Northern Health). Out of an abundance of caution we are working with the Office of the Information and Privacy Commissioner to create a Privacy Impact Assessment. We believe that having a number of communications channels available (including regular phone calls) makes the project more flexible for users. The evaluation We will measure outcomes with accepted standards such as the Dermatology Life Quality Index, the EQSD, Global Physician Assessments, waiting times, and measures of patient and referring doctor satisfaction. An important goal is building these measurements into office visits in a way that creates little extra work for doctors or staff. We will assess these outcomes relative to costs using standard economic evaluation tools, considering both government payer and societal perspectives. The formal evaluation activities will be led by experts based at the Centre for Clinical Epidemiology and Evaluation. A key challenge will be to find a suitable comparator for the model of care, but there are several possibilities including parallel communities not in the test area that will be examined in the first year of the project during which time the full evaluation design will be completed based on the 'on the ground' developments outlined herein. Conclusion We are not starting from scratch. We already have experience with the proposed model of care, including community visits and the use ofthe secure communications described. Neil Kitson will devote himself full-time to this project and to that end has established a telemedicine practice that will be central to the project and which can be joined by others and continued. Nathan Teegee has deep roots within participating communities (including his own, Takla Landing), was a health administrator for Carrier-Sekani Family.Services, and has a vested interest to see that that the project is successful and sustainable. John Pawlovich was a community GP in Fraser Lake for 12 years, and is now Medical Director for CSFS and attends his rural Indigenous patients through telemedicine and personal visits. The collective leadership thus has many connections to the test area that make this project possible. We believe that a permanent rural and remote travelling dermatology service is not a possibility for many obvious reasons; weather, road conditions, and consultant availability being some. What is possible is to develop relationships with rural communities, and then to provide education and collaborative care with community doctors who are supported by telemedicine. This proposal will position UBC Dermatology to be a leader in telemedicine development, evaluation and delivery. For greater certainty, we believe face-to-face consultation with dermatologists will always be required for some patients, but that a considerable proportion of office dermatology can and should be done by local practitioners with accessible help and associated education from UBC Dermatology. September 14, 2018 Page 6of14 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 110 of 137 AGENDA ITEM Q. 3. THE UNIVERSITY OF BRITISH COLUMBIA Faculty of Medicine Strategic Investment Fund Proposal - version 3 2.3 Duration Indicate the estimated duration of the project. Estimated start date Oct 1, 2018 Estimated completion date Sept 30, 2020 2.4 Schedule Milestones Identify the major milestones that you plan to meet along the way (e.g.: dates by which you expect to complete deliverables or scope elements). Embed in this milestone schedule dates you expect to report on progress and impact. Add rows to the table as needed. ... Milestone (deliverable or scope component) Completion Date • Year1 Working relationships Finalize participating communities and set schedule for dermatology visits 6 months Discuss and agree on nature of most effective education on such visits 6 months Establish rotation and staffing of community visits, including field trials 12 months Telemedicine Formalize secure telecommunications within the test area, including education 6 months and field trials (BlackBerry BBM Enterprise, WebEx, Jabber, and Polycom) Establish a telemedicine suite in the UBC/VGH Skin Care Centre for clinical use 6 months and teaching Establish workflow and fee for service billing standard 6 months Education Establish access for 20 rural doctors to Tele-Derm, the educational website of 3 months the Australian College of Rural and Remote Medicine Establish curriculum for primary care dermatology 12 months Establish secure website for educational resources 6 months Establish curriculum for telemedicine in UBC dermatology residency program, 3 months emphasizing protection of privacy and confidentiality Evaluation Establish means and methods of evaluation of care, including field trials and 6 months data collection Establish means and methods of evaluation of dermatology education in 12 months communities, including field trials Establish means and methods of evaluation on-line dermatology education, 12 months including field trials Establish means and methods of evaluation of the costs of this model of care, 6 months including out of pocket costs to patients Year2 Data collection start 12 months Data collection end 24 months Finance and sustainability working group start 12 months Preliminary data analysis 20 months Proposal for sustained model of care 22 months September 14, 2018 Page 7of14 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 111 of 137 AGENDA ITEM Q. 3. THE UNIVERSITY OF BRITISH COLUMBIA Faculty of Medicine Strategic Investment Fund Proposal - version 3 I • NITAOP will continue to fund consultant travel at this level. 3.2 Unit Responsibility and Human Resources Indicate which unit will be responsible for the project and any subsequent operational considerations. Indicate who will be responsible for ensuring successful delivery and contributing to the project. Add bullets as needed. U.nit Responsible Department of Dermatology and Skin Science Project Team' Resources • Jan Dutz • Neil Kitson 4 Other Considerations 4.1 Risks Describe any major risks associated with this project. Include consideration of impact on people of the organization. Add bullets as needed. • Lack of involvement by consultants. Our experience is that interest increases when there is a working model. Strategies to mitigate financial barriers exist in NITAOP, but there are other rewards in rural and remote practice that must be experienced to be appreciated. • Lack of interest in telemedicine. We doubt that this will be a problem because of the informal ad hoc demand that exists. Making the technology as easy as cell phones already in use is crucial, as is having a smooth workflow plan. • A major privacy breach. We believe this is unlikely through the secure communications channels we use, and is much more likely to occur through loss of improperly secured cell phones, failure to delete images from phones, and lack of ability to erase phones remotely. UBC IT has an excellent series of education modules showing how to mitigate all these risks. Within BBM Enterprise, the only error possible is sending a message to another doctor on the network by selecting an incorrect contact. Dialing errors are not possible. • The worst that could happen is that the model fails for unforeseen reasons. That is always the risk of conducting experiments and although very discouraging to those of us who are optimistic that the model will work, valuable information would be obtained from failure nonetheless. The only way to know is to do the experiment. 4.2 Key Success Factors Identify a few factors that you expect to be the keys to making this project successful. Add bullets as needed. Key Success Existing Relationships Factors Pediatric Dermatology September 14, 2018 Page 11of14 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 112 of 137 AGENDA ITEM Q. 3. THE UNIVERSITY OF BRITISH COLUMBIA Faculty of Medicine Strategic Investment Fund Proposal - version 3 We have close connections with pediatric dermatologists, and in particular Dr. Wingfield Rehmus, incoming Head of Dermatology at BC Children's Hospital. Both she and Dr. Joseph Lam, also a staff dermatologist at BCCH are interested in participating in this project. Emergency Medicine We have well-established relationships with Kendall Ho who has been an encouraging collaborator for years and a co-author with us to date on one paper and a number of abstracts. In addition, we already work closely with Jim Christenson who is very interested in our development of educational material for Emergency Medicine physicians as well as the potential fo consultant access. Vulvar Disease Clinic Leslie Sadownik, Head of the Vu Ivar Diseases Clinic has expressed support for this project, and sees it as a means of access to care for women in rural and remote areas. She has agreed to be one of our consultants in the project and we have a long-standing professional connection as she frequently attends our weekly Dermatology Rounds in the Skin Care Centre. The Rural Co-ordination Centre The Rural Coordination Centre of BC (RCCbc), in conjunction with the Rural Education Action Plan (REAP), seeks to improve rural health education and advocates for rural health in British Columbia. The Centre works to coordinate, facilitate and create new initiatives and projects to bridge gaps between existing rural resources, link the JSC, rural physicians, rural communities, and UBC, and to develop strong relationships between all the facets of rural health care work broadly through six areas of interest, including education REAP John Pawlovich is the Medical Director of the Rural Education Action Plan (REAP). This program supports the training needs of physicians in rural practice, provides undergraduate medical students and postgraduate residents with rural practice experience, and increases rural physician participation in the medical school selection process. REAP was established as a result of the Rural Practice Subsidiary Agreement (RSA), and is managed by the Joint Standing Committee on Rural Issues (JSC). Carrier-Sekani, Lake Babine First Nations Both are well known to the applicants. John Pawlovich has been providing primary care for over 5 years in these communities, in part by telemedicine, and previously provided care for members of these communities while a GP in Fraser Lake for 12 years. He is the Medical Director for Carrier-Sekani Family Services. Neil Kitson has been accompanying him for 3 years and has provided dermatology care in these locations and is known to community members. Communities As part of our outreach trial, clinics have been conducted in Smithers, Burns Lake, Fraser Lake, Fort St. James, Vanderhoof, Mackenzie, Quesnel, McBride, and September 14, 2018 Page 12of14 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 113 of 137 AGENDA ITEM Q. 3. ~ THE UNIVERSITY OF BRITISH COLUMBIA ~ Faculty of Medicine Strategic Investment Fund Proposal - version 3 Valemount, together with occasional CPD events as opportunity presented. We are known in these communities to local primary care doctors and it would be this group of communities, in parallel with First Nation Communities that would compose the test site. ACCRM The Australian College of Rural and Remote Medicine is accredited by the Australian Medical Council (AMC) for setting professional medical standards for training, assessment, certification and continuing professional development in the specialty of general practice. The College has an educational website for dermatology in general practice. Jim Muir is the Director ofthe Department of Dermatology at the Mater Hospital, South Brisbane. As the dermatologist for 'Telederm National', a website run by the Australian College of Rural and Remote Medicine, Jim also delivers dermatological care to all parts of Australia via the internet. Jim has a special interest in skin cancer and skin disease in the elderly. He is actively involved in medical education he regularly lectures on dermatology to other specialists, general practitioners, medical students, pharmacists and the general public. He is also a senior lecturer in dermatology at the University of Queensland, a moderator of the International Dermoscopy Society, Chair of the Brisbane Hospitals Dermatology Group. Evaluation Craig Mitton's research is focused on the application of health economics to impact health policy and to inform clinical practice. He has worked extensively with health authorities in numerous countries on the development and implementation of priority setting and resource allocation processes. He is the lead author on a book titled "The Priority Setting Toolkit: a guide to the use of economics in health care priority setting" and is the lead or co-author on more than 130 peer reviewed journal articles. In addition, he has delivered over 150 presentations across many different countries and regularly runs workshops and short courses on health economics and health care priority setting. In 2015, he was awarded a Killam Teaching Prize from the University of British Columbia. Dr. Mitton is a Professor in the School of Population and Public Health and Senior Scientist at the Centre for Clinical Epidemiology and Evaluation. Travis Halyk Executive Director Research, Primary Care and Strategic Services, Carrier-Sekani First Nation. His team is a leader in Indigenous research methods and ethics, and will assist in developing evaluation tools appropriate to indigenous patient's needs and complimentary to work currently being done on medical trust. Dan Horvat Clinical Associate Professor, Northern Medical Program, Department of Family Practice, University of BC; Associate Professor, University of Northern BC; September 14, 2018 Page 13of14 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 114 of 137 AGENDA ITEM Q. 3. - THE UNIVERSITY OF BRITISH COLUMBIA Faculty of Medicine Strategic Investment Fund Proposal - version 3 Quality Improvement and Evaluation Lead, Rural Coordination Center of BC; ' Member, The British Columbia Alliance on Tele health Policy and Research Patient-Oriented Research Colleen McGavin is our collaborator for patient-oriented research and has previously worked with Jan Dutz. The BC Support Unit was developed under the Strategy for Patient-Oriented Research (SPOR). It is supported by $80 million in funding over five years from both the federal and provincial governments, through the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research respectively, as well as several other BC partner organizations. It will provide services for researchers, patients, health care providers and health system decision makers, and facilitate initiatives identified as provincial priorities. The Unit, a multidisciplinary cluster of specialized personnel in research, policy and patient care, will engage patients to identify their needs and set priorities for research. It joins similar units in other province and regions of the country to create a pan-Canadian platform for sharing information and best practices. Along with partner organizations, a provincial hub based in Vancouver will serve stakeholders within the Vancouver region and provide province-wide services. Regional centre~ are being developed to be the first point of contact for stakeholders located outside of the Vancouver region. Gradually, the Unit will assist with patient engagement, research navigation, data access and use, knowledge translation, and training and capacity development. Our design for measurement of clinical outcomes in this project Will be influenced by the patients themselves. In collaboration with the BC Support Unit, we will obtain patient opinions about the outcomes that matter to them. We need two different approaches to obtain such opinions, because First Nations expectations might differ culturally from non-indigenous populations: obtaining frank opinions from the First Nations communities requires that they trust us. Fortunately, this collaboration includes those already have such trust. John Pawlovich has worked directly as Medical Director for Carrier-Sekani for 6 years and before that cared for indigenous people working as a GP in Fraser Lake. Travis Holyk is the director of research at Carrier-Sekani. Emma Palmantier is the Health Director for Lake Babine Nation. Nathan Teegee is a dermatology resident and member ofthe Takla Lake First Nation. He has worked as a Community Health Liaison and Primary Care Coordinator for Carrier-Sekani Family Services prior to medical school and has years of experience that can contribute to the project. Thus, we have established and trusted connections with the Indigenous communities in the test area. We will take similar approaches with the other non-indigenous communities involved in this project. We expect their opinions will be related to the difficulties of access to care based on practicalities such as travel and related costs. We will need to establish trust in these communities also, that we will listen to their opinions and that these will then be represented in measurements of clinical outcome. September 14, 2018 Page 14of14 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 115 of 137 AGENDA ITEM Q. 3. THE UNIVERSITY OF BRITISH COLUMBIA Faculty of Medicine Strategic Investment Fund Proposal - version 3 4.3 Ongoing Operational Requirements Describe any ongoing operational requirements that will exist once the project is complete, with a high /eve/ plan to fulfil them. Please note, these cannot be funded through the Strategic Investment Fund. Add b.ullets as needed. Operational Requirements • A continuing service will require an operational budget that will include technology and the usual costs of practice (medical office assistants, EMR etc.) plus travel expenses. If effectiveness and cost savings are shown, alternative funding for physicians' services could be considered. • Demonstrated cost savings may be re-invested in the development of a Telemedicine Suite at UBC Dermatology. Construction costs have already been obtained from UBC. • System administration. If the network becomes largerthanthis project, a professional administrator will be required. September 14, 2018 Page 15of14 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 116 of 137 AGENDA ITEM Q. 3. CARRIER SEKANI www .csfs.org FAMILY SERVICES Creating wellness together February 22, 2018 UBC Faculty of Medicine Strategic Investment Fund RE: Letter ofSupport for Telehealth Proof-of-Concept model for rural and remote dermatology service This letter is to confirm Carrier Sekani Family Services' (CSFS) support of the proposal to develop a proof-of-concept for rural dermatology service. As an organization CSFS is a leader in the implementation of Primary Care teams and Telehealth and we view this as an opportunity to increase capacity through a replicable model. CSFS prides itself on innovative and holistic service delivery and this proposal demonstrates a creative attempt to improve the way professionals deliver health care to Indigenous peoples in northern BC. We have established a relationship with Dr. Kitson through the clinics he has provided in CSFS communities and believe this project supports improved access to marginalized rural and remote populations. As an organization that is a leader in Indigenous research methods and ethics, specific contributions will include assisting in developing evaluation tools appropriate to indigenous patient's needs and complimentary to work we are currently doing on medical trust. We have been active participants in the development of this application and as such fully believe it will have direct benefit to the communities we serve. We look forward to strengthening our partnership with Dr. Kitson through continued efforts to transfer dermatology knowledge and skills into the community. ravis Halyk Executive Director Re arch, Primary Care and Strategic Services Head Office D ReplyTo: D ReplyTo: DReplyTo: Stellat'en First Nation 987 4th Avenue 240WestStewartStreet, P.O.Box 1219 #8 - 870 Highway 16 P.O. Box209 Prince George BC, V2L 3H7 VanderhoofBC, VOJ 3AO P.O.Box 1475 Fraser Lake BC,VOJ1SO Phone: 250.562.3591 Phone: 250.567.2900 Burns Lake BC,VOJ1EO Phone: 1.800,889.6855 Fax: 250.562.2272 Fax: 250.567.2975 Phone: 250.692.1800 Fax: 250.699.6855 Toll Free:1.800.889.6855 Toll Free:1.866.567.2333 Fax: 250.692.1877 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 117 of 137 AGENDA ITEM Q. 3. Lake Babine Nation 225 Sus Avenue TEL: (250)692-4700 PO BOX 879 FAX: (250) 692-4790 Burns Lake, BCVOJ 1 EO Feb 271ti, 2018 Dr. Jan Du t z and Dr. Nei I Kitson Dept. of Dermatology and Skin Science University of British Columbia 2329 West M all Vancouver, BC V6T 1Z4 Dear Dr. Dutz and Kit son RE: SUPPORT LETTER FOR THE RURAL DERMATOLOGY As Health Director for the Lake Babine Nation, I am pleased to partner with your department in the application for the UBC Strategic Investment Fund to improve access for our communities to dermatology services. We know Dr. Nathan Teegee and Dr. John Pawlovich very well, as he has been providing services to our community fo r a num ber of years, and we have supported Nat han in his education since he was in med ical school. . We are here to collaborate with you as a partner in this application and we will help you design pr act ical and cultu rally appropriate research methodologies that will suite our communities. We hope th is project is successfu I and we look forward to working wit h you and being the beneficiary of such a great project. Any questions regarding the Dermatology sup po rt, please contact Emma Palmantie r, Health Director directly tel/ fax: 250-692-4726, email:_ em ma.palm anti [email protected]. Sincerely yours, r-V~_:~- ~~9 BARBRA ERICKSON tOM, Acting Health Dire tor Cc: Chief Wilfred Adam VIA Email: wilf.adam @lakebabine .com Robert Szelecz, Executive Director VIA Email: Rob ert.Szelecz@ lakebabine.corn Emma Palmant er, Health Director VIA Email: emma.p almant i er@lakebabine. com Proposal from University of British Columbia Faculty of Medicine, dated ... Page 118 of 137 AGENDA ITEM Q. 3. UBC Research Institute Healthier lives through discovery Feb 20, 2018 Strategic Investment Fund Review panel Faculty of Medicine, UBC RE: Proposal for Telemedicine proof of concept model To whom it may concern, I am writing to provide my full support for the Telemedicine Proof of Concept submission to the second round of the FoM Strategic Investment Fund call for proposals. The proposed team of clinicians and researchers is set to examine critical issues with respect to telemedicine and has the potential for dramatic improvement in the lives of British Columbians in the North. As the co-Director (interim) of the Centre for Clinical Epidemiology and Evaluation (C2E2) it is my pleasure to commit to this project highly qualified research staff and trainees to assist Dr. Dutz and the team in the evaluation of this initiative. We will provide expertise both on clinical evaluation (i.e., outcomes assessment) and economic evaluation (i.e., assessment of costs in relation to outcomes). I have met with Dr. Dutz and team members and numerous occasions over the last several months and feel that there is an excellent fit between the objectives of this project (and the Dept. of Dermatology more broadly) and C2E2's mission of supporting high quality health services research for the purposes of impacting patient outcomes and health system transformation. At the Centre, we have expertise in health services, health economics, health policy, biostatistics and patient engagement and thus are well suited to support the project and the Dept of Dermatology through this work. Please contact me should there be any questions or if further information is required. Again, I am extremely positive about this project and the potential collaboration between C2E2 and the Dept of Dermatology. Sincerely, Craig Mitton, PhD Professor, School of Population and Public Health University of British Columbia Co-Director (interim), Centre for Clinical Epidemiology and Evaluation Vancouver Coastal Health Research Institute A joint venture in research between Vancouver Coastal Health and the University of British Columbia. VGH Research Pavilion, 7th Floor, 828 West IO'h Avenue, Vancouver, BC V5Z IM9 Tel: 604-875-5178, Fax: 604-875-5179 http://c2e2.vchri.ca Proposal from University of British Columbia Faculty of Medicine, dated ... Page 119 of 137 AGENDA ITEM Q. 3. [email protected] JPN3300 910 W10th Avenue www.BCEmergencyNetwork.ca I Vancouver, BC V6B 1M6 BC EMERGENCY 6048754111 x64128 MEDICINE NETWORK @BCEmergMedNtwrk February 13, 2018 Strategic Investment Fund Review Committee UBC Faculty of Medicine Vancouver, British Columbia RE: Funding Proposal for '(Telemedicine proof-of-concept model for a rural and remote dermatology service)' (Pl: Jan Dutz) Dear Reviewer: On behalf of the BC Emergency Medicine Network, I am writing to express my enthusiastic support for Dr Dutz and his team in the application for a UBC Faculty of Medicine Strategic Investment Fund Award titled: Telemedicine proof-of concept model for a rural and remote dermatology s As both the Executive Lead for the BC Emergency M ncy physician, I am enthusiastic about the delivery, especially in improving quality and C. This approach is helpful for patients to receive tim effective and well-timed team based care, and for ou The proposed project n of supporting, sharing and innovating to improve irectly aligns with the BC EMN's goals to suppor patient care and improve cost effectiveness of health ect can be translated to other disciplines in addition t The BC EM N is excited ating the educational dermatology videos produced throu on platform www.b er enc network.ca , which supports emergency departments and diagnostic treatment centres in BC. I have the utmost confidenc the team's ability to carry out this project successfully. The team has a proven track record of providing virtual visits in rural and remote communities and has already built strong relationships in the First Nations communities they will be working in. If given the opportunity to move forward, I will be delighted to participate and contribute fully in this initiative. Sincerely, Jim Christenson MD FRCPC Executive Lead, BC Emergency Medicine Network Professor and Head, Department of Emergency Medicine University of British Columbia Faculty of Medicine Proposal from University of British Columbia Faculty of Medicine, dated ... Page 120 of 137 AGENDA ITEM Q. 3. Vancouver lHealth Department of Gynecology Gordon and Leslie Diamond Centre- 6th floor Gynecology 2775 Laurel Street Vancouver, BC VSZ 1M9 February 15, 2018 In reply to: Telemedicine proof-of-concept model Dr. Jan Dutz, Professor and Head UBC Department of Dermatology and Skin Science UBC Skin Care Centre 835 West 10th Avenue Vancouver, BC V5Z 4E8 Dear Dr. Dutz: As Director of the BC Centre for Vulvar Health, I am writing to provide a strong letter of support for your Department's proposal regarding the use of telemedicine to support enhanced rural and remote dermatology service. In BC, one in five women will suffer from >3 months of significant vulvar symptoms. Women who have vulvar diseases are often too embarrassed to seek help from a health care provider, and if and when they seek help, they face numerous barriers to receive timely and effective care. Women in B.C. seek help from multiple health care providers: Family Doctors, Gynaecologists, Urologists, Alternative Medical Practitioners, even Emergency Room doctors. These clinicians may not be familiar with the range of common and rare medical conditions that can affect the vulva, and/or competent in performing an examination of the vulva and vagina - thus misdiagnosis is common. This situation results in multiple visits to other health care providers, and ultimately a delay in accurate diagnosis. Empiric treatment (initiation of treatment prior to determination of a firm diagnosis) of vulvar diseases is common but usually not helpful. Women will report years of symptoms before an accurate diagnosis is made, and effective treatment is started. Not surprisingly, the health care provided to these women in B.C. is often perceived as not helpful. Telephone: 604-875-4268 Fax: 604-875-4860 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 121 of 137 AGENDA ITEM Q. 3. Page 2 Re: Telemedicine Proposal Many women with chronic vulvar diseases also report a moderate or severe impairment of quality of life that is exacerbated by a delay in diagnosis. These women report adverse effects on their physical quality of life, daily living activities, body image, psychological health, sexual health, and their personal relationships. Some vulvar skin conditions are associated with an increased risk of developing vulvar cancer and a delay in diagnosis can affect their prognosis. There are ongoing challenges in providing high quality patient-centered care to women with. chronic and complex vulvar diseases. These include: a large demand for these services; lack of experts in the area ofvulvovaginal health; and a limited scope of health care provided to affected women. While the new Centre for Vulvar Health offers diagnostic and therapeutic services to all women in BC, many women are unable, for personal and financial reasons, to travel to Vancouver for expert assessment. This has resulted in clinicians seeking advice by emailing photos of their patients' vulvas to myself. Given the nature of the photos clearly it would be more acceptable for affected women, referring clinicians, as well as myself, that this consult was facilitated by a formal process that protected patient privacy. This telemedicine proposal aligns with one of the Centre's long-term goals - the development of online consultation service for physicians in rural and remote communities to support the early diagnosis and community follow up of uncomplicated chronic vulvar diseases. I strongly support the Department's proposal as I believe that it will provide a venue for clinicians; to seek access to expert advice, facilitate the early diagnosis of vulvar conditions, reduce the secondary psychosexual morbidity associated with these conditions, and allow women to receive this care in their communities. With respect, Dr. Leslie Ann Sadownik Associate Professor Department of Obstetrics and Gynaecology Associate Member Department of Dermatology and Skin Science Director, BC Centre for Vulvar Health cc Dr. Geoff Cundiff, Professor Health UBC Department of Obstetrics and Dermatology Proposal from University of British Columbia Faculty of Medicine, dated ... Page 122 of 137 AGENDA ITEM Q. 3. Australian College of Rural & Remote Medicine WORLD LEADERS IN RURAL PRACTICE 27 February 2018 Dr Neil Kitson University of British Columbia Sent via email: [email protected] Dear Neil Re: Support Letter to provide access to dermatology tele-medicine and education services to rural and remote communities The Australian College of Rural and Remote Medicine (ACRRM) wishes to express its support for the Strategic Investment Fund Proposal as submitted by Jan Dutz - Professor and Head, Department of Dermatology and Skin Science. The Austral ian College of Rural and Remote Medicine is accredited by the Australian Medical Council (AMC) for setting professional medical standards for training, assessment, certification and continuing professional development in the specialty of general practice. It is the only College in Australia dedicated to rural and remote medicine, and plays an important role in supporting junior doctors and medical students considering a career in rural medicine. It is committed to delivering sustainable, high-quality health services to rural and remote communities by providing quality education programs, innovative support, and strong representation for doctors who serve those communities. The College supports the proposal as it aims to provide access to dermatology tele-medicine and education services to rural and remote communities. The notion of providing support to rural and remote doctors to allow them to provide a greater scope of practice to their communities (especially to first peoples) fits well with the philosophy of ACRRM. ACRRM has been developing a close relationship with UBC in recent years and currently has a number of programs in development to formalise this relationship for the mutual benefit of both our membership bases. ACRRM Is already committed to providing free trial access for a limited number of UBC medical professionals to access the ACRRM Tele-Derm platform. Should this proposal go head we would look forward to expanding this arrangement to a wider range of medical professionals - and to a wider range of content. This proposal would allow UBC members to access not only Tele-Derm - but also other dermatology modules on eczema, skin surgery and downloadable clinical notes. Access would also include access to around 100 online modules on topics as diverse as retrieval medicine, palliative care, and radiology . Our online modules are largely written by rural doctors and always with the rural and remote context in mind. We believe this proposal could lead to the development of a great service for the benefit of rural and remote communities, and will help to forge a stronger relationship between our two organisations . Levsl 2, 410 Queen Street I GPO Box 260'1 Brisbane QI D 4001 i P Oi" 3!HH5 8200 I F 07 3105 8299 I E acrrm @acrrm.erg.au I v,ww. acrrm. crg.au l ABl'Jl Z Cii78. 08 ~ 848 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 123 of 137 AGENDA ITEM Q. 3. Northern Regionol Office Suite 200 • 177 Victoria St. Lheidli T'enneh Territory Prince George, BC V2L SK8 T 250.561.5425 First Nations Health Authority F 250.561.5369 Health through wellness www.fnha.ca August 27, 2018 Dr. Jan Dutz and Dr. Neil Kitson, Project Lead, UBC Department of Dermatology and Skin Science University of British Columbia 2329 West Mall, Vancouver BC V6T 1Z4 Request for letters of support for "Telemedicine proof-of-concept model for a rural and remote dermatology service" The First Nations Health Authority North Region is delighted to write this letter of support for the "Telemedicine proof-of-concept model for rural and remote dermatology services". Dermatology services are and have continued to be challenge to access in northern BC and First Nations living in rural and isolated locations have been further challenged by timely access and care to this much needed specialized service. The North region FNHA understands that this grant application was submitted to the UBC Faculty of Medicine Strategic Innovation Fund Feb 28, 2018. We are told it has been reviewed favorably, subjectto some revisions. We are pleased to povide an expression of interest for a project that has been developed to explore and promote a new model for provision of dermatology services; specifically, a combination oftelemedicine, education (transfer of knowledge and skills to rural doctors), and building relationships between dermatologists, First Nations and rural communities. Further to this our organization has a keen interest in working with partners to support and operationalize; 1. Primary care dermatology curriculum for rural practitioners. 2. Collaborative design; i.e., consultation on how proposed measurements of clinical effectiveness (e.g., Dermatology Life Quality Index) could be practically integrated into rural GP work flow in order to minimize work and align and integrate with the new Primary Care Networks being developed across the province. 1. Practical support for trial; e.g., helping to incorporate such measurements into EMRs (particularly MOIS), support in some form for telemedicine infrastructure (e.g., BlackBerry BBM Enterprise, Webex), and participation in evaluating UBC Dermatology education initiatives such as website development. Proposal from University of British Columbia Faculty of Medicine, dated ... Page 124 of 137 AGENDA ITEM Q. 3. First Nations Health Authority Health through wellness 2. Interest in the potential of scaling up this model to serve wider areas, depending on outcome. 3. Awareness that this model includes continuation of REAP funding to make possible dermatology resident rotations in rural and remote medicine. We believe these exposures to rural, remote, and indigenous communities is crucial to future dermatology care. 4. Awareness that this model inevitably exposes some NMP students to rural dermatology practice. 5. Awareness that alternative funding models might be considered for the proposed model of practice. FNHA is excited about the opportunity for cultural safe care and education for providers in this area of practice for integration/ connection and awareness with traditional practices for addressing skin concerns. Thank you and we look forward to a positive response for the selection of this project. Sincerely, Nicole Cross Regional Executive Director North Region First Nations Health Authority Proposal from University of British Columbia Faculty of Medicine, dated ... Page 125 of 137 AGENDA ITEM Q. 3. Medical Affairs -!11.. 600-299 Victoria Street, Prince George, BC V2L 588 ~~ northern health Tel: (250) 565-2154, Fax: (250) 565-2640, www.northernhealth.ca August 17, 2018 Dr. Jan Dutz and Dr. Neil Kitson Dept. of Dermatology and Skin Science University of British Columbia 2329 West Mall Vancouver, BC V6TIZ4 Dear Dr. Jan Dutz and Dr. Neil Kitson, Letter of support for "Telemedicine proof-of-concept model for a rural and remote dermatology service" Northern Health has been unsuccessful to recruit resident dermatologists for the past 5 years. The North is dependent on limited itinerant dermatology services and these are limited to only certain areas in the North. Timely access to dermatology services is a challenge for physicians and patients in the majority of Northern areas. This tele-dermatology services project is very timely project and would be trialing a new model for the provision of dermatology services. It combines telemedicine, education (transfer of knowledge and skills to rural doctors), and building relationships between dermatologists and rural communities. Northern Health understands this is a trail, and we believe if successful, this has the potential to be a model that could improve access to dermatology services for patients and physicians in the majority of areas in the North. Northern physicians will benefit from the development of a primary care dermatology curriculum that is based on the Australian model "Tele-Derm" Australian Model. This model is sponsored by the Australian College of Rural and Remote medicine and the Australasian College of Dermatologists. Northern Health would be interested in helping with designing the study in the following areas: a) Planning proposed measurements of clinical effectiveness (e.g., Dermatology Life Quality Index) and how these measures could be practically integrated into rural GP work flow in order to minimize work. b) How measurements can be incorporated into the EMR's especially MOIS. c) How EMR's can be used to help with the evaluation of this project. d) How NH could provide support in the form of Telehealth infrastructure and e) Feasibility of access to transcription services. Northern Health supports this application for funding and we hope the application will be considered favorably and look forward to working with all the stakeholders to implement this project. Sincerely, Dr. Ronald Chapman MD, FRCPC, MBBCH, MCH Vice President Medicine Northern Health Medical Administration Phone: 250-565-2154 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 126 of 137 AGENDA ITEM Q. 3. THE UNIVERSITY OF BRITISH COLUMBIA ~ UBCCPD Faculty of Medicine The Division of Division of Continuing Professional Development Continuing Professional Development • Faculty of Medicine The University of British Columbia City Square, 200ET-555 W 12th Ave Vancouver BC Canada V5Z 3X7 T 604.675.3777 F 604.675.3778 ubccpd.ca Online Dermatology Edu.cation UBC CPD Proposal for Online Course Development, Hosting & Maintenance Prepared by: Ms. Kate Campbell, MSc, Senior Instructional Designer, UBC Division of Continuing Professional Development (UBC CPD) Dr. Bob Bluman, MD, CCFP, FCFP, Executive Medical Director (UBC CPD) Prepared for: Dr. Neil Kitson, MD, PhD Date: May 24, 2018 Proposal from University of British Columbia Faculty of Medicine, dated ... Page 127 of 137 AGENDA ITEM Q. 3. AB UT TH PR J T BACKGROUND The UBC Faculty of Medicine's Division of Continuing Professional Development (UBC CPD) was requested by Dr. Neil Kitson to discuss opportunities to collaborate on developing an online dermatology education portal for healthcare practitioners in BC. The proposed on line portal would contain dermatology educational resources and activities to help better support primary care providers. Since 2011, the Shared Care funded BCConsultDerm has improved access to specialists through a secure on line system that allows family physicians to submit a digital photo and relevant information for viewing and assessment by a dermatologist. The specialist then provides diagnosis and treatment recommendations to the family physician. Despite BCConsultDerm's many successes, patients are still being referred to specialists with conditions that could be diagnosed and treated by primary care providers. This, coupled with a shortage of dermatologists, compounds the difficulty in accessing dermatological care in the Province. Limited access to dermatologist is not isolated to BC. Similar challenges exist in Australia where the Australian College of Rural and Remote Medicine (ACRRM) has developed an online resource called Tele-Derm (website link). This differs from the supports available in BC because in addition to access to consultation, family physicians are provided with resources, education cases, procedural videos, and an opportunity to further improve their knowledge of dermatology through participation in a designated 'case of the week' and discussion of current cases submitted for diagnosis by participating physicians in Australia. In order to further support family physicians in urban, remote, and isolated communities in BC, UBC CPD proposes a similar approach to Tele-Derm. The proposed on line portal will provide educational resources such as videos, interactive case studies, assessment quizzes, discussion forums, and printable check-lists. Content will be tailored to BC physicians by responding to local needs and providing local resources and contacts. UBC CPD offers a growing library of on line courses and resources that are very popular with BC healthcare providers as participants receive high quality, up-to-date, convenient, accessible and relevant CME from their homes, offices and mobile devices. UBC CPD participants have requested additional programs be delivered in this format, and recent literature shows that online learning can be as effective as in-person educational sessions. It also provides the opportunity to reach physicians in rural and remote communities. Program details, a proposed timeline, and budget are included in the following pages. UBC CPD I ONLINE DERMATOLOGY EDUCATION 11 PAGE Proposal from University of British Columbia Faculty of Medicine, dated ... Page 128 of 137 AGENDA ITEM Q. 3. B UT U PD The Division of Continuing Professional Development (UBC CPD) is a unit within the Faculty of Medicine at the University of British Columbia. UBC CPD partners and collaborates with local, provincial, and national health care organizations to design and deliver high-quality, evidence-based education that promotes practice improvement and enhances patient care. The strength of UBC CPD lies in its people and relationships the organization has developed across the Faculty of Medicine, the province, and the country. UBC CPD is a tremendously productive unit supporting many of the 12,000+ physicians across the province with their CPD needs. UBC CPD accredits hundreds of programs each year through our Accreditation office and the office continues to work toward developing and offering CPD for other health professions within the Faculty of Medicine and beyond. UBC CPD is a "one stop shop" for partners and stakeholders in CPD because the office can lead or get involved with all stages of an initiative-from conception, to curriculum design, to the development of a research, evaluation, and knowledge translation strategy, to the execution or implementation of educational programming. UBC CPD is nimble and responsive to learner needs. The office addresses these needs with high-quality, evidence-based, multi-modal education strategies. Our Vision To be leaders in health improvement through innovative continuing professional development. Our Mission To research, develop, implement, and evaluate continuing professional development {CPD) initiatives for physicians and other health professionals to optimize clinical practice and the delivery of patient care in order to improve health outcomes. As an academic unit, UBC CPD follows and contributes to best practices in CPD, including quality and practice improvement in BC and at national and international levels. UBC CPD I ONLINE DERMATOLOGY EDUCATION 2 I PAGE Proposal from University of British Columbia Faculty of Medicine, dated ... Page 129 of 137 AGENDA ITEM Q. 3. PR RA D T I LS The overall goal of the on line portal is to provide BC primary healthcare practitioners (including physicians, nurses, nurse practitioners, and pharmacists) with the knowledge and tools to improve diagnosis and treatment of skin conditions. Learning material and resources will be curated by an expert working group led by Dr. Neil Kitson. UBC CPD will assist by conducting an environmental scan for applicable content with Dr. Neil Kitson's guidance. UBC CPD will create the portal structure, develop activities based on content provided, optimize usability, customize LMS, and assist in marketing through email and on line campaigns as well as print marketing (such as postcards and/or flyers). ONLINE PORTAL STRUCTURE The proposed on line portal would be structured into sections based on content types; proposed sections may include: 1. Case Studies 2. Test your Knowledge (self-assessment/quizzes) 3. Dermoscopy Atlas 4. Surgical Corner 5. Video Gallery 6. Useful Links 7. Discussion Board 8. Take-Home I Printable Resources 9. Feedback I Evaluation Sections include a mix of visual (photography and video) and text content. Interactive multiple choice quiz questions for case studies and self-assessment quizzes may be developed to reinforce learning. Discussion boards may be monitored and content may be uploaded by designated subject matter experts. UBC CPD I ONLINE DERMATOLOGY EDUCATION 3 I PAGE Proposal from University of British Columbia Faculty of Medicine, dated ... Page 130 of 137 AGENDA ITEM Q. 3. I. Complete online portal containing 7-10 sections, available through elearning.ubccpd.ca; deliverables include: • Development of on line portal structure and instructional design support • Environmental scan for resources and content and assist with compiling resources (may be region-specific) • Development of up to 100 single question case studies @ Development of up to 10 self-assessment/quiz activities (10 questions each) e1> Photographic atlas of dermoscopy and dermatoscopy; maximum 100 items o Single page containing content, resources, and links specific to surgery • Video gallery containing embedded YouTube videos (up to 25 videos) <1> Single page containing curated list of useful links • Discussion board structure and ability for users to post topics • Ability for designated users/SM Es to monitor discussion boards and upload content; up to 5 users - training material will be provided e Downloadable resource package or production of 3-5 take-home single page PDFs e Ability for users to self-enroll 111 Online evaluation form and ability for users to submit feedback • Online hosting on UBC CPD Moodie Learning Management System (LMS). H. Analytics reports and summary of feedback evaluation data shared with collaborative group quarterly for 1 year post-launch Ill. 1 year post-launch maintenance, basic content editing, troubleshooting/learner support, course monitoring and issuing certificates UBC CPD I ONLINE DERMATOLOGY EDUCATION 4IPAGE Proposal from University of British Columbia Faculty of Medicine, dated ... Page 131 of 137 AGENDA ITEM Q. 3. PROPOSED TIMELINE AND SCHEDULE Working group meet and determine course structure and content needs; provide environmental scan parameters October • UBC CPD provide environmental scan results October~January • Workinggroupto collect a.nd develop content • Working group to. obtain permission to copy and/or adapt as necessary for all non-original work • All content delivered to UBC CPD; all text, video, photographs and links provided January-April • Development of on line portal in UBC CPD LMS "' Upload content (videos, cases, photographs) • Interactive elements prepared (cases studies and assessment too Is/quizzes) © Evaluation tool development April-June © Onlin~ portal soft launch oe User testing and working group review • Facilitation and compiling offeedbackby UBC CPD May-June • Revisions based on user feedback and working group review July • LAUNCH • UBCCPD team to.commence online maintenance including ongoing user tracking and troubleshooting activities, monitoring .evaluation feedback, marketing/advertising activities Post-launch • Ongoing discussion boards/Q&A area moderated by identified expert o Analytics and evaluation summary report sent to collaborative group October 2019, January 2020, April 2020, July 2020 • July 2020 annual costs due for ongoing maintenance, user tracking, troubleshooting, evaluation monitoring, certificate distribution, activities UBC CPD I ONLINE DERMATOLOGY EDUCATION SI PAGE Proposal from University of British Columbia Faculty of Medicine, dated ... Page 132 of 137 AGENDA ITEM Q. 3. BUDG Below is a summary of anticipated expenditures for the on line portal deyelopment and annual hosting, management, and maintenance. Working Group Material will be collected and provided in-kind by Dr. Neil Kitson; UBC 0 Leadership CPD leadership support provided in-kind Senior Instructional Designer, 100 hours @ $67 /hr; Junior Instructional Designer, 140 hours @ $45/hr; Research Assistant, 40 hours @ $45/hr UBC CPD online work includes but is not limited to: providing consultation to working course 14,800.00 group and reviewers, developing portal structure, uploading content, development developing support graphics and interactive elements {e.g. diagrams, illustrations, animations, self-assessment activities), conducting environmental scan, conducting usability testing and compiling results Physician reviewers Discussion board monitoring and input {ongoing throughout the year; approx. 5 hours per month) - 60hrs *156.38/hr -Doctors of BC Dermatologist 10,946.60 sessiona I rate.f or .Specia Iists. . PI anning committee invo Ivement -1Oh rs *156.38/hr Learning 500.00 Moodie platform customization Management System Marketing 500.00 Material development and distribution -flyers, email blasts, Activities advertisements, etc. Maintenance 2,000.00 Post-launch until July 2020, 40hrs per year general maintenance and {for 1 year post support from UBC CPD {external resource links, participant and launch) instructor tech support, issuing certificates of course completion, LMS hosting and upgrades, ongoing analytics); minor content revisions, amendments and additions, as required. Larger or more extensive revisions post-launch, would require a new agreement. Quarterly 800.00 Summary of ev.aluation data and analytics report shared with evaluation and collaborative group quarterly for.1 year post-launch; October 2019, analytics January 2020, April 2020, July 2020 reporting Subtotal 31,535.00 ----+---- Adm in 3,785.00 12% - direct and indirect costs ---- Total 35,320.00 UBC CPD I ONLINE DERMATOLOGY EDUCATION 6 I PAGE Proposal from University of British Columbia Faculty of Medicine, dated ... Page 133 of 137 Page 134 of 137 AGENDA ITEM Q. 4. Yvonne Koerner From: Collins, Eryn < [email protected]> Sent: Thursday, April 25, 2019 2:48 PM To: Communications Account Cc: Collins, Eryn; Quinn, Jessica Subject: NH Facebook groups for communities - Terrace & Kitimat pilot Good afternoon, We are writing to let you know about an exciting initiative the Northern Health communications team is undertaking as a pilot project, which will affect public communications for Terrace and Kitimat area!_ The NH Digital Communications and Public Engagement team's strategy includes expansion in our social media work to better reach people in communities. One of our goals in this strategy is to create online community forums, in the form of Facebook groups for communities. This will allow us to: 1. Better directly (and more quickly) reach members of the community (for the purposes of sharing emergent info, for example), 2. Hear back from them about community specific issues, 3. Engage directly with them to find solutions and offer our messaging/resources/etc. 4. Provide a space where community members can reach us directly and engage in health messaging. The Terrace/Kitimat group is live now here: https://facebook.com/groups/NHTerraceKitimat/. We encourage you to please join, and share with your local networks! NH Facebook groups for communities will be monitored 24/7 (as are Northern Health general social media pages), so that we can respond quickly and appropriately, and direct people to the best resources. This is a pilot project, so we will be working out some issues as we go, and welcome any of your feedback and questions at any time. Thanks in advance! Eryn Collins Jessica Quinn Regional Manager, Public Affairs & Media Regional Manager, Digital Communications Relations and Public Engagement Northern Health Northern Health Tel: 250.649.7542 Tel: 250-565-5641 Media Line: 877.961.7724 blog. northern health. ca f the northern way of caring The contents of this electronic mail transmission are PRIVILEGED, intended to be CONFIDENTIAL, and for the sole use of the designated recipient. If this message has been misdirected, or if a resend is desired, please contact the sending office as soon as possible. 1 Email from Eryn Collins, Regional Manager, Public Affairs & Media, and J... Page 135 of 137 Page 136 of 137 ÿÿÿ ÿÿ ! ÿ"#ÿ$$%"ÿ&'&ÿ(ÿ)0ÿ12ÿ3 4 AGENDA ITEM Q. 5. 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