Provincial Health Services Authority: Lynda Cranston, President & CEO

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There are six health authorities in British Columbia. Five of them are regional and are generally responsible for the entire spectrum of health care within a specific geographic area. The sixth, Provincial Health Services Authority (PHSA), is the first health authority of its kind in Canada. PSHA is different in that it is responsible for assuring the quality and effectiveness of the kind of specialized health services that people might require regardless of where they live in the province.

PHSA, with approximately 11,000 employees, operates the BC Cancer Agency, BC Children’s Hospital & Sunny Hill Health Centre, Women’s Hospital and Health Centre, BC Transplant, BC Mental Health and Addiction Services, BC Centre for Disease Control, the BC Provincial Renal Agency and other province-wide services. Approximately 2,000 of those employees are involved in academic research making the organization one of the largest academic health centers in the country. Additionally, the authority plans or funds a number of other specialized programs, for instance, Cardiac Services BC, though the clinical care is delivered by the regional health authorities.

“We are often involved in bringing players together to look at provincial solutions and to deliver better care to people with respect to specialized services,” says Lynda Cranston, President and CEO.

Living Values

When PHSA was created, one of the primary goals was to “pull as much patient care out of every dollar possible,” according to Cranston. The individual agencies now under PHSA all had their own boards and executives, financial departments, and human resource departments. Consolidating these corporate services was one of the first orders of business. “We provide HR, finance, communication, quality assurance, and quality/safety services. With the efficiencies and savings we are able to achieve through consolidation, we’ve been able to redirect those dollars back into patient care,” Cranston says.

“‘Patients First’ is the lens through which we view everything,” she says. “History tells us that sometimes organizations tend to focus services according to what works for the providers rather than what works for the patients. We really do try to put patients first in everything we do.”

This means things like patient safety and quality of care remain high on the agenda. Emphasis is not only on documenting safety issues, but creating a system that allows the organization to continually improve on patient safety issues and shift to a culture that understands the issues, reports the issues, and makes changes in the system to achieve improvement.

To this end, the organization has customized its own LEAN program, tailored to improve healthcare and empower employees to improve their immediate work processes. They call this program imPROVE. The name is important because it embodies the five values of the organization: Patient’s First, Results Matter, Open to Possibilities, Best Value, and Improvements through Knowledge. The program has been going for two years now and in 2009, the organization will run approximately 30 different projects known as Rapid Process Improvement Weeks (RPIW). These are structured, dedicated times when staff members examine their work processes and work to develop more efficient, effective ways of doing things.

RPIWs are preceded by considerable data collection and preparation. The single week when the members of a specific department or job area are brought together to implement change has proven to be a powerful tool. In January, for instance, the group spent one week looking at the operating room schedule for prostrate cancer treatment at the BC Cancer Agency. The end result was that they were able to schedule one additional operating opportunity per day, achieving a significant improvement in access without increasing the number of staff already working on any given day.

“We are really committed to the imPROVE program as a major tool to help us redesign our systems and make them as efficient as possible,” says Cranston. “LEAN principles are all about taking waste out of the system and, in doing that, improving what we can provide to patients and empowering our staff.”

Appropriate Access to Care

This past summer PHSA opened a new cancer center in conjunction with a regional health authority hospital. It serves a fast-growing area of the province where there were increasing problems with access to treatment due to long driving distances. This much-needed cancer center will be followed by another new center which will serve northern B.C. bringing to six the total number to cancer centers.

Also high on the list of priorities is redeveloping the central Vancouver site of BC Children’s and B.C. Women’s hospitals. BC Children’s Hospital has a very active foundation supporting it that has already initiated a $200 million capital campaign to help support the redevelopment. Of those funds, $50 million will be used to increase pediatric capacity throughout the province so that every child does not have to travel to the Lower Mainland to receive appropriate care.

“We’re working with regional health authorities to help build up their pediatrics capacity in more remote areas,” says Cranston. “That’s really important to us.”

Human Resource Challenges

PHSA looks to the imPROVE programs to help meet the challenge of maintaining and recruiting staff, as well. The organization recently completed an employee health survey and the results were used to design enhanced mental health and wellness programs to support staff members. For example, PHSA created a web-based mental health assessment tool that assists staff in assessing mental health issues and in locating resources both within PHSA and in the community to help deal with these issues.

Depression in the workplace is a huge cost to the system, as well as to the individuals affected, and one initiative to combat this has been the creation of a self-help booklet by the mental health and addiction services specialists that is based on cognitive behavior therapy. “It is based on using skills, not pills,” says Cranston, “And it is actually helping people manage their situations more effectively.

Other employee initiatives include offering better access to wellness opportunities, such as yoga and exercise classes, and helping employees find better ways of coping with chronic pain. Another staff survey is in the works to determine additional opportunities to support. “We believe providing appropriate support systems for our employees is a priority,” says Cranston.

Open to Possibilities

The PHSA value that ties everything together is, Open to Possibilities. It epitomizes the recognition within health care that no single resource has a monopoly on good ideas or the best way of doing things.

That said, PHSA lives its values as a whole because they guide the organization’s attitudes and actions. “Our values provide a collective focus for how we approach our work,” says Cranston. “And, they inspire and encourage the behaviour that creates a dynamic and performance-oriented organization that serves all British Columbians.”

-by Tracy Million Simmons

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