British Columbia’s Future


Looming challenges threatening some of our top sectors have forced British Columbians to confront a number of questions. Will traffic gridlock shut down Lower Mainland transportation? Will we have to remember our credit cards when we visit the hospital? Will B.C. still have a forestry industry after all the beetle-killed trees are harvested? We don’t have the luxury of taking decades to convene research panels and strike policy committees. These are issues that are knocking on our door right now, demanding immediate resolution. When all the excitement dies down post-Olympics, we will be living in a province that looks very different from the one we inhabit today. BCBusiness asked experts from a broad spectrum of disciplines to give us a glimpse into what BC.’s economy will look like in 2011. Two days after Jane discovers a lump in her breast, an urgent mammogram confirms a possible malignancy. Jane’s GP refers her to a “patient navigator” who will guide her through the complex logistics of cancer care. As well as scheduling everything from her biopsy to treatment appointments, Jane’s navigator will be a consistent source of information and emotional support, easing her long journey from diagnosis to recovery. By 2011, patient navigators, nurse practitioners and physicians’ assistants (newly trained paramedics providing a broad range of diagnostic and therapeutic services delegated by physicians) will join other professionals in B.C.’s health-care system, leaving our fast-dwindling pool of doctors and RNs to work where they are needed most. While better use of overstretched health professionals is only one small component of extensive change we can expect by 2011, it will have a huge impact on patient care, especially since our incidence of cancer alone is expected to jump 20 per cent over the next five years. As this issue of BCBusiness went to press, British Columbians were lining up to participate in the government’ s Conversation on Health, aimed at eliciting public views on health care. If nothing else, the exercise sparked emotional debate between those who favour jumping the queue and staunch defenders of equal access. While the outcome is unlikely to have much impact on B.C.’s ambitious plans for major systemic improvement by 2015, the initiative allows government to take the provincial pulse, especially on our tolerance for gradual private-sector creep. When Vancouver’s newest urgent-care clinic caved under government pressure in early December and agreed to bill through the public insurance system, it seemed that Victoria had finally drawn a line in the sand. Most of the leaders in health planning, administration, nursing and medicine interviewed for this piece expect that in five years, B.C. will have a more efficient, robust public system, topped up as needed with new private facilities that conform with the Canada Health Act. Post-Olympics, B.C. will be a model of disease prevention, health experts say. A major catalyst for this philosophical shift was Victoria’s retooling of our health-care system in 2001 from 52 to six regional health authorities. While still extremely cumbersome, B.C.’s current cradle-to-grave model ensures that administrations are not just responsible for running hospitals, but for keeping people healthy and out of hospital. By 2011, we can also expect innovations in managing chronic ailments, such as heart disease, that currently take a major bite out of our health budget and can only intensify, given our aging population. In 2011, when a GP informs a patient that he suffers from type 2 diabetes, it’s likely she will walk him down the hall to a nurse practitioner who will review his self-care strategies, schedule follow-up tests, demonstrate how to transmit his blood glucose readings to the office via his home PC and encourage him to join a practice-based peer-support group. This patient-centred approach should be bolstered by a new multidisciplinary home-support team that includes GPs, nurses and rehabilitation professionals, aimed at reducing preventable complications and easing pressure on emergency departments and hospital beds. As B.C. shifts from what Gavin Stuart, dean of the UBC faculty of medicine, describes as “a medical system to a health system,” we can also expect to reap further benefits from the health ministry’s long-term investment in technology. By 2011, 90 per cent of B.C.’s GPs will keep electronic health records and will be integrated with their regional health authority systems. Completely seamless data access throughout the province is stalled until stakeholders resolve a slew of privacy issues. However, the staged introduction of these electronic health records over the next five years will mean better patient care, a reduction in potentially serious prescription errors and costly duplication of tests, better access to specialists and diagnostic services, and more efficient movement of patients through the system. Over the long term, Health Canada plans to implement a nationwide health-information network using the latest information and communications technologies. Here in B.C., pilot projects are in the works across all six health regions, and in five years these communication improvements will eliminate most existing distance barriers to specialist care. On the labour front, it’s worth noting that 25 to 30 per cent of B.C.’s health-care administrators will be eligible for retirement by 2011, creating yet another HR problem for a system already facing a shortage of physicians, nurses and rehabilitation professionals. On the positive side, the organizational challenges in health care and the opportunity to make a difference, combined with competitive salaries, are attracting new MBAs disillusioned with the public sector. Vibrant new collaboration between business, administrators and health disciplines is a heady combination. Margaret MacDiarmid, president of the BC Medical Association, who describes herself as “an unabashed optimist,” says physicians are excited to be part of a team influencing future health policy. “I don’t like to use jargon, but I would say this is a tipping point, a moment in time when I think we can achieve some extremely positive change.”