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Perspectives is the quarterly newsletter of the New Brunswick Health Council

In this issue...

Stéphane Robichaud
CEO of the NBHC

Message from the CEO

On March 11, 2008, the following statement was used to announce the creation of the New Brunswick Health Council. This was the same day as the announcement that there would be two Regional Health Authorities rather than eight, and that a new shared services agency would be created. Understandably, the public attention was mainly on the creation of the two health authorities - or the dismantling of the eight previous health authorities, depending on your point of view. 

The health care system must be trusted by New Brunswickers. It must be open and transparent, while delivering the best and most efficient care possible. New Brunswickers have a right to be aware of what decisions are being made, to be part of the decision-making process, to be aware of what dollars are being spent and what outcomes are being delivered by the health system.

To achieve this end, the Government of New Brunswick will be establishing the New Brunswick Health Council to promote and improve health system performance through a dual mandate.

The statement is as valid in 2016 as it was eight years ago. From some perspectives, a lot of work has been done since the 2008 reform. Within the public health services sector, there have been several attempts at leveraging opportunities provided by the new structure for improving health service quality.  Although the financial context served as the main driver for this reform, addressing the “working as a system” challenge was the main driver for reducing the number of Regional Health Authorities. 

From the perspective of the NBHC, when it comes to measuring population health or health service quality, there has been a significant amount of new information produced. The evaluation work that accompanied the gathering of this information provides context for establishing provincial priorities and an improved understanding of gaps in health service quality within the province.

However, from the perspective of the health care system, there are just as many shortfalls in “working as a system” today as before the March 2008 announcement.  Many are quick to jump to the structure for these shortfalls. There is no more value at blaming the structure, than there is in expecting that a new structure would, in itself, fix the health care system. As mentioned in NBHC reports, the challenge resides in the execution. The opportunities for improvement are in transparent and accountable interactions between governance and operations.

Since 2008, there has been no reason to doubt that those leading the governance and operations functions have done so with the belief that their actions were in the best interest of the New Brunswick population. But more can be done, by the NBHC and by all stakeholders, to achieve the vision laid out in the 2008 statement. What if, today, New Brunswickers were aware of what decisions were being made, were part of the decision-making process, and were aware of what dollars were being spent and what outcomes were being delivered by the health system?  Wouldn’t we have a better health system?
 

Recognizing and focusing on population health priorities


The NBHC has just released its latest population health information, reporting once again that New Brunswickers are among the unhealthiest when compared to all other provinces in Canada.

“The proportion of the population with a chronic condition is growing and chronic conditions are appearing in younger age groups.  The current trend is that a growing proportion of people are developing additional conditions as they age,” says Stéphane Robichaud, CEO of the NBHC.  “The demographic trends have not taken the system by surprise; they have been expected and should have been better taken into account during planning efforts.”

According to our population health model, we know that health behaviours have a 40% influence on how long or how well we will live. We also know that the health services that we count on to stay healthy only have a 10% influence on how long or how well we live, but those services account for 41% of the entire provincial government budget.

The more unhealthy we become, the more we will need expensive health services, including long-term care. The need for these services is projected to grow, but the tax base needed to fund them (as influenced by the availability of a young, healthy and productive workforce) may not be there.

This can also have significant implications for other government services as the money needed to fund the health services will have to come from reducing funding of other services, such as education, roads, tourism, environment and social service programs.

Adopting healthier behaviours at all ages is key as it can help prevent the appearance of chronic health conditions early in life, as well as avoid complications for those who already have chronic diseases. Having all health service providers supporting timely access to health services and preventative services is also key.

The NBHC has developed population health snapshots that compare New Brunswick to the Canadian average and also include rankings for each of the seven provincial health zones. The tool also offers a top ten list of chronic conditions for each targeted population and the top ten reasons for hospital admissions. This information, including the report titled Recognizing and Focusing on Population Health Priorities, can be found at www.nbhc.ca/population-health-snapshot.
Did you know?
 
Based on the population health model generally recognized in the province, health services only have a 10% influence in determining the health of the population. However, these health services represent 41% of our entire provincial budget.

Influence of health determinants on population health
  • Health services: 10%
  • Health behaviours: 40%
  • Social and economic factors: 40%
  • Physical environment: 10%

Register for New Brunswick’s first national Patient and Family Centred Care conference!


Presented by Horizon Health Network, November 7 and 8, 2016 in Moncton, New Brunswick

The Experience Conference will foster inspirational and thought-provoking dialogue, promote best practices, as well as inspire participants to move forward in the quest to provide exceptional care to every person every day.

Register today to be among the health care leaders and decision-makers discussing innovations in patient and family centred care, quality and patient safety and patient engagement.

Early Bird Registration – save when you register before July 30, 2016.

Visit http://www.pfccexperience.ca/ for more information.

Did you know?
 
14.5% of citizens receiving home care services said that more could be done to help them stay at home. On what could be done, the top three responses were:

1. More hours of service such as weeknights and weekends
2. More home support services such as yard work or food delivery
3. More equipment such as wheelchairs and shower handles

Update on our surveys


Home care survey

The NBHC has released the results of its most recent survey regarding home care services in New Brunswick. For the first time, comparisons can be made between survey results (2015 and 2012) to see if any improvements have been made.

This year again, satisfaction remains high. In terms of the services received, 95.1% of respondents were satisfied with the Extra-Mural Program, and 88.7% indicated they were satisfied with services received from home care agencies or home support workers, results similar to those of 2012. However, unmet needs are a growing concern, as 14.5% of respondents have reported in 2015 that more could be done to help them stay at home (compared to 11.4% in 2012), such as more hours of service on weeknights or on weekends.

These survey results are based on citizens across New Brunswick who have recently received home care services funded entirely or partially by the provincial government. It is worth noting that citizens who are not receiving home care services, but who should be, are not included in this survey. More research in this area could help identify to what extent publicly funded home care services are not meeting the needs of citizens.

Home support services funded entirely or partially by the Department of Social Development have a key role to play in keeping people at home once citizens start receiving the different services available.

To see the complete results, the NBHC encourages New Brunswickers to visit its website. An interactive map will help citizens locate the results at the provincial level and by community. The map can be found here.

Hospital/Acute care survey

Our survey on hospital services is ongoing. It is designed to measure several factors related to the quality of the services delivered during the overall hospital stay, from admission to discharge, from the patient’s point of view.

Medical, surgical and maternity patients, 18 years of age or older with at least one overnight stay, discharged from acute care hospital facilities in New Brunswick between December 1, 2015 and March 31, 2016 could be selected to participate in this survey. Patients selected to participate in the mail-out survey will receive a personalized letter and a bilingual survey questionnaire to fill out at home. The survey is voluntary, but it’s very important for the NBHC to hear from citizens to see if any improvements have been made to services over the past three years.

The results of the survey will be made public on the NBHC’s website and New Brunswickers will be able to see how each hospital in the province was rated by patients. Previous survey results are currently available at http://www.nbhc.ca/surveys/acutecare
Did you know?
 
Overall, home care services are highly valued in New Brunswick. The 2015 edition of the NBHC's Home Care Survey shows that 95% of citizens receiving services from the Extra-Mural Program rate the services favourably, and that 89% of citizens getting help from home support workers rate the services favourably.

Brief on youth mental health


At the beginning of the New Year, the NBHC published a brief regarding the need to improve the state of youth mental health in the province. It outlines the improvement of protective factors and the concept of resilience as a potential avenue to improve youth mental health.

Data shows that many young New Brunswickers have mental health issues. As some geographic areas in the province perform well, part of the solution is to learn from those areas and to set clear and common performance targets that all stakeholders can aim for.
 
Many factors contribute to the mental health problems that New Brunswick youth face. It’s important to effectively manage risk factors, but also to give more attention to promoting protective factors and building resilience. Key protective factors to work on include ensuring youth know where they can get help, increasing their feelings of belonging at school and of being treated fairly in the community, and ensuring they get enough sleep. Some of these factors can be addressed by the family, others by schools, the community and other public services.

The brief also includes the NBHC’s analysis on youth resilience by looking at 12 questions on protective factors from the 2012-2013 edition of the New Brunswick Student Wellness Survey for Grades 6 to 12, which could be used to spark discussions on this topic. When schools participate in the survey, we can produce information at the school or local level, which is used to support change in many communities.  We invite you to read the document here.

Did you know?

New Brunswick ranks among the worst in Canada on key population health indicators:
  • The percentage of the population who perceive their health as "very good" or "excellent" (last out of 10 provinces)
  • The percentage of the population who rate their mental health as "very good" or "excellent" (last out of 10 provinces)
  • The level of disability as measured by pain or discomfort preventing activities (9th out of 10 provinces)
The NBHC has been established as an independent organization that measures, monitors and evaluates New Brunswick’s health care system performance and population health, and that engages citizens in the improvement of health service quality.
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