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QUALITY FORUM 2012Applying a BC First Nations lens to quality in
health care
Presented by:Joe Gallagher, CEO
March 8th , 2012: Four Seasons Hotel, Vancouver
British Columbia First Nations
26 Cultural Groups32 Aboriginal Languages203 Bands (or First Nations)3 Provincial First Nations Organizations
BC Assembly of First Nations First Nations Summit Union of BC Indian Chiefs
OUR POPULATION
• First Nations population suffered a major collapse in the late 19th century.
• PHO report estimates that the FN population of 250,000 in mid 1700’s was reduced to 23,000 by 1929.
OUR POPULATION
• Aboriginal Population in BC is 197, 070
• Registered status First Nations population is 127, 675
• 60, 505 (47%) registered status First Nations people live on reserve
OUR POPULATION
Fraser Interior Northern Vancouver Coastal Vancouver Island
On Reserve and on Crown Land 4489 14720 18464 8962 13870
Off Reserve 3873 13678 28169 6254 15169
2,500
7,500
12,500
17,500
22,500
27,500
32,500
37,500
42,500
47,500
On and Off-Reserve Status Population by HA Region
203 BC First Nations communities
Regional Health Authorities (Provincial)
137 Community Health Centres (Federal / FNs)
CURRENT FIRST NATIONS HEALTH SERVICE DELIVERY
A BRIEF HISTORY OF FIRST NATION HEALTH DEVELOPMENTS IN BC
• 2005: Leadership Accord & New Relationship & Transformative Change Accord (TCA)
• 2006: TCA: First Nations Health Plan
• 2007: Tripartite First Nations Health Plan. FNHC established
A BRIEF HISTORY OF FIRST NATION HEALTH DEVELOPMENTS IN BC
• 2008 - 2011: Gathering Wisdom for a Shared Journey
• 2012: FN Health Society becomes interim First Nations Health Authority.
• Transition phase to become the new FNHA 2013-2015
The health and wellbeing of my people depends on how well I work with each and every one of you in this room.
Gathering Wisdom 2011
1- Community Driven, Nation Based
2- Increase First Nations Decision-
Making and Control
3- Improve Services
4- Foster Meaningful Collaboration and Partnership
5- Develop Human & Economic Capacity
6- Be Without Prejudice to First Nations Interests
7- Function at a High Operational Standard
What does this all mean for `quality and safety` in First Nations patient care in BC?
• Definitions must come from First Nations themselves…
• We can and should create space for this dialogue to happen
• Dialogue needs to occur between PROVIDERS of care and RECEIVERS of care on what quality and safety means
Example of Model of Care: South Central Foundation, Anchorage, Alaska
NUKA MODEL of CARE:• Relationships are key to health care• Patient care should be integrated• Same day access for primary care• CUSTOMER-OWNERS are partners in their own health
care• Customers must have ample opportunity to offer
advice and feedback
How SCF implements the Nuka Model
• Create a culture where training and re-training is valued• Create a comprehensive induction process around the
Nuka model• Have primary care teams that are without hierarchy –
everyone on the team is equal• Have `talking rooms`- not consulting rooms• Customer-owners choose their team – and make
changes if unhappy• Leaders share and constantly LIVE the vision
Creating the Space to talk about Quality
• iFNHA / FNIH, BC Patient Safety and Quality Council and Province working together
• Utilizing Regional Tables who partner with Regional Health Authorities
• Working with First Nations Health Directors and their patients, clients and communities
PATIENT SAFETY & QUALITY COUNCILQUALITY MATRIX
Acceptability Appropriateness Accessibility Safety Effectiveness
PREVENTION Culturally acceptable
services, respectful
of FN values,
traditions, teachings
and cultural practices
Cultural appropriateness
of health professionals
and organizations
and the services they provide for
FNs
Geographic factors (rural, remote, on & off reserve)
FN Health Literacy (across
jurisdictions)
Cultural safety for FN clients
Cultural safety for workers & practition-
ers
Equity of outcome for FN patients who have
higher rates of most
illnesses and conditions
The outcomes
are not the same if
access and experience is not the same
TREATMENT
LIVING WITH ILLNESS OR DISABILITY
COPING WITH END OF LIFE
Cultural Competency Factors‘Cultural Competency’ in health may been defined in two main forms:
– An individual focus on the COMPETENCY of PEOPLE:• Health professionals and practitioners, Nurses,
Managers, Governors, Health Workers
– An institutional focus on the COMPETENCY of ORGANIZATIONS including:• Policies, practices, strategies, plans, service delivery
mechanisms, systems, processes, forms, partnerships and relationships, communications etc
Cultural Competency FactorsA Culturally responsive health system
Is a combination of
Culturally competent staff / workforce
+
Culturally safe clients
+
Culturally appropriate systems & processes operated by institutions within the system
Cultural Competency at South Central Foundation
• RAISE PROGRAM - opportunities for native youth 14 – 19 to get on-the-job work experience in the context of Alaska Native cultural values
• TRADITIONAL HEALING CLINIC ON SITE – provide service and teach other health workers
• FAMILY WELLNESS WARRIORS – promote wellness through cultural and traditional methods
• ORIENTATION OF NEW STAFF – incorporates Nuka model, values, traditions and ongoing learning
TAKING RESPONSIBILITY / RECIPROCAL ACCOUNTABILITY
Embed cultural competency programs and initiatives within organizations
Individual workers, employees and practitioners take responsibility for their own learning
First Nations take responsibility for helping others to understand their perspectives in health
Tripartite Partners can create the space for these dialogues to happen at all levels
In conclusion…
The environment is right for partnership and collaboration at all levels
First Nations have been clear that they must define and govern their own health
First Nations health leaders are committed to service improvement; to better health experiences for their community members and to better health outcomes
THANK YOU