Background: Fraser Health opened Urgent and Primary Care Centres (UPCC) to provide patients with an alternative to care for urgent, non-emergency health concerns requiring medical attention within 12-24 hours. Registered Nurses (RN) hold a unique role at the UPCCs by triaging patients for urgency and suitability to receive care at the UPCC. Initially, triaging was completed based on the nurse’s clinical judgement/discretion; however, the subjective nature of this approach resulted in variabilities in accessing UPCC services throughout the UPCCs. This highlighted the need to standardize triage and care processes. In the fall of 2022, a digital triaging tool called Clear Triage was introduced to provide consistency in access to UPCC services within and across all Fraser Health UPCCs. This triaging tool was to complement the use of nursing judgement for triaging patients. There were two streams of introduction/implementation for Clear Triage. Six existing UPCCs rolled out Clear Triage as a new process, while one new site was introduced to Clear Triage as part of their orientation to the UPCC site at the time of opening. Subsequent assessment of Clear Triage revealed mixed feedback from the Registered Nurses (RN) and Client Care Coordinators (CCC) regarding the tool’s efficacy. The following quality improvement study aimed to explore what drives the nurses’ satisfaction with Clear Triage use in Fraser Health’s UPCCs? The findings of this study will support future implementation of Clear Triage and optimize its use within UPCCs at Fraser Health.

Methods: This study used a qualitative phenomenology approach to explore the nurses’ experience with Clear Triage. Urgent Care RNs and CCCs were invited to participate in the study. The study sample contained at least one representative from each UPCC site. The RNs and CCCs enrolled in the study had varying levels of nursing and triaging experience. Semi-structured interviews using Microsoft Teams were completed as part of the data collection process. De-identified transcripts were uploaded to NVivo and analyzed via inductive coding and thematic analysis.

Results: The findings reveal that the interplay between user characteristics and the clinical task environment is key in driving the user’s satisfaction with Clear Triage use. Users become particularly dissatisfied when their needs, triaging tools’ capacity, and tasks fail to align. The respondents suggested that this could be exacerbated when Clear Triage implementation was rolled out with a unilateral exercise of power. In response, the users may pursue compensatory behaviours, which could drive further variation within the clinical task environment. Contextualized through the implementation of a digital triaging tool, the study highlights the complexities and variations inherent within a health system when attempting care delivery standardization.

Conclusion: In the case of Clear Triage, encouraging its use and user satisfaction may benefit from a careful assessment of how well the health technology aligns with user characteristics, tasks, and the clinical environment. The role of power dynamics and the subtle ways in which they influence the effectiveness and successful implementation of health technologies are explored. Recommendations to improve Clear Triage through engaging with the Clear Triage vendor about modifying the application, developing a formal orientation plan for the tool’s use, providing a direct feedback mechanism for the end-users, clarifying the expected use of allied health services and its alignment within Clear Triage dispositions are discussed.

Background: In response to the 2022-2023 mpox outbreak in Canada, vaccinations were offered to individuals at increased risk for mpox, including gay, bisexual, or other men who have sex with men (GBMSM). While most studies to date have examined individual-level factors associated with vaccine uptake, given the patterning of vaccine uptake along social gradients and the gap between intention to vaccinate and actual vaccine uptake, there is a need to examine structural, environmental, and systemic facilitators and barriers to mpox vaccine uptake.

Methods: Semi-structured interviews were conducted with health care and community workers from BC and Ontario between April – July 2024. Data were analyzed using an interpretive descriptive approach. Participants were asked about their perceptions of the facilitators and barriers to the 2022-2023 mpox vaccination campaign as well as their personal beliefs about vaccines overall. National Advisory Committee on Immunization mpox guidance statements and provincial immunization and communicable disease guidelines were referenced to contextualize and verify interview data.

Results: Fourteen health and community worker interviews were conducted. Nine categories of environmental, systemic and structural facilitators and barriers to mpox vaccination uptake were identified. These encompass historic and ongoing influences, including the COVID-19 pandemic and the HIV/AIDS epidemic; mass media representations of mpox; health organization partnerships with community organizations; vaccination clinic design; operational and logistical factors; labour policies; healthcare system cultural competence; confusing or unclear vaccine information and eligibility criteria; and the use of targeted and diverse immunization promotion
strategies.

Conclusion: To ensure equitable access to immunization programs, environmental, structural, and systemic factors that contribute to social gradients in vaccine uptake must be further examined and addressed.

Background: Since British Columbia (BC) declared the opioid crisis a public health emergency in 2016, the devastating impact of unregulated drugs has led to the loss of over 12,000 lives among British Columbians. The PharmaCare-funded Methadone Maintenance Payment Program was introduced in 2001 to increase pharmacy participation in providing methadone treatment to individuals with opioid use disorder. The program incentivizes pharmacies through an interaction fee for each methadone dispensation involving direct interaction with the patient. However, concerns persist about the generosity of compensation, incentives offered by pharmacies, and the presence of inconsistencies and inequities. This capstone project examined the effectiveness, fairness, and sustainability of the Methadone Maintenance Payment Program in BC.

Methods: This project employed a qualitative study design that explores the experiences and perceptions of pharmacy remuneration for clinical services related to opioid agonist treatment (OAT). Semi-structured, one-on-one interviews were conducted with consenting community pharmacists, policymakers, pharmacy operators/owners/managers, OAT prescriber, addictions medicine educator, and health authority representatives.

Results: The analysis of the qualitative data yielded three themes:

1. Outdated PharmaCare Policies: The participants noted that the context of the opioid crisis has evolved significantly since the methadone interaction fees were implemented more than two decades ago. They noted that pharmacy participation is sufficient in urban BC, yet access remains a challenge in rural and remote BC. Additionally, pharmacy interaction for new OAT medications lacks proper reimbursement.
2. PharmaCare Facilitating Inappropriate Practices: Participants voiced concern on how the current reimbursement model facilitates poor pharmacy practice. The current design enables unscrupulous billing practices, provision of prohibited patient incentives, and poor service quality
3. Future Considerations for Reimagining the Reimbursement Model: Participants highlighted factors to be considered when redesigning the pharmacy remuneration model for OAT. These considerations include patient-centered care, vulnerability of patient population, contingency management, changes since the COVID-19 pandemic, pharmacy business operations, direct reimbursement for pharmacists, and emerging harm reduction and risk mitigation strategies. They also noted that expanded scope of services and roles for pharmacists with appropriate reimbursement would improve the quality of services.

Conclusion: The findings from this study reaffirm existing concerns about the flaws within the current PharmaCare’s Methadone Maintenance Payment Program and the Frequency of Dispensing policy. A shift towards value-based compensation model, using meaningful metrics and performance indicators, is recommended to promote quality-driven services and patient outcomes. Revisiting PharmaCare’s Frequency of Dispensing policy, exploring the integration of contingency management, and adapting to emerging harm reduction options will be crucial in the rapidly evolving landscape of the unregulated drug crisis. Expanding the clinical roles of pharmacists, with specialized education and training, can enhance wraparound care for patients, and an improved reimbursement model will be essential to support these services. Moreover, involving individuals who access OAT services or engage in drug use in the decision-making process is essential. This approach ensures the implementation of policy changes that not only align with patient needs but also thoroughly consider potential consequences, particularly within this vulnerable population.

Background: The emergence of cloud adoption is leading to a new era of technological advancements in the information technology (IT) industry and communication technologies. While cloud computing has garnered growing interest from global organizations, its adoption and implementation is a complex endeavour. Especially within the healthcare industry, this shift has given rise to healthcare cloud platforms with the potential to transform traditional healthcare models. To gain a comprehensive understanding of the critical factors influencing cloud computing in healthcare, this study conducted a literature review and expert interviews, aiming to identify key considerations and challenges in implementing cloud computing in healthcare environments.

Objectives: The research aims to evaluate the utilization and impact of cloud adoption in the Canadian healthcare system, focusing on the Provincial Health Services Authority (PHSA) within British Columbia, employing a qualitative analysis framework. The specific objectives include exploring the current state of cloud adoption in PHSA, examining advantages and challenges in cloud adoption, and exploring the future prospects of cloud computing in PHSA and healthcare to inform decision-making and promoting innovative healthcare practices.

Methods: A qualitative study was conducted through semi-structured interviews with stakeholders from within PHSA, specifically selected for their expertise in various aspects of cloud technology, including supply, implementation, adoption, design, operations, security, and innovation in healthcare. Recruitment methods included employing snowball sampling through the PHSA network and conducting interviews via Microsoft Teams. The interviews focused extensively on exploring the current state of cloud computing in PHSA and discussing the numerous advantages, inherent challenges, and the anticipated future use of cloud technology within healthcare industry.

Results: Between May and August 2023, interviews with 12 individuals were conducted who collectively shared a vision of a cloud-enabled application ecosystem driven by data innovation, data management, scalability, accessibility, agility, collaboration, security, and the goal of improving patient outcomes. In its early stages of cloud adoption, PHSA strategically utilizes Amazon Web Services and Microsoft’s Azure for cloud infrastructure development, leading to enhanced efficiency and data accessibility. The successful implementation of cloud initiatives like CareConnect, Health Gateway, ImmsBC, Zoom for Healthcare, PRISM, PANDA and Pixalere reflects PHSA’s commitment to an efficient healthcare system through cloud-based innovation, driven by dedicated clinicians, analysts, technology experts, and consultants embodying PHSA’s core values of innovation and exemplary service. Key barriers identified included expenses associated with cloud adoption, the financial models of capital versus operational expenditure, concerns related to security and privacy, resource constraints (shortages in the skills and misaligned pay scales) for implementing cloud technologies in healthcare, and the absence of interoperability standards and centralized organizational regulations.

Conclusion: The application of various cloud technologies in healthcare varies based on organizational contexts and existing infrastructure, with the COVID-19 pandemic significantly accelerating their adoption for tasks like clinician collaboration and remote healthcare delivery. To foster a robust cloud ecosystem, future efforts should promote interoperability by focusing on organizational shifts which are supported by provincial-wide initiatives. These findings provide valuable insights for decision-makers and stakeholders seeking to harness the potential of cloud computing in healthcare, paving the way for future innovations and improved healthcare practices in Canada.

Study Objectives: The goal of this study was to identify and quantify the impacts of rurality, remoteness, and northernness on healthcare delivery costs in Canada to inform funding allocation decisions.
Data: The study combined data from four main public sources: 1) the Canadian Institute for Health Information healthcare indicator and contextual data; 2) Statistics Canada geolocation data for all healthcare facilities; 3) Statistics Canada index of remoteness for all communities; and 4) Canadian health organization financial statements.

Methods: Multiple linear regression analyses were employed to build effect size models estimating the impacts of rurality, remoteness, and northernness on cost per capita and cost of a standard hospital stay across Canada. Additional correlated variables were included to improve model strength and predictive capabilities. The estimated effects were then compared against BC’s Population Needs-Based Funding model to identify opportunities to improve funding mechanisms to account for these cost drivers.

Results: While it was challenging to identify strong correlations with rurality, both remoteness and northernness were positively correlated with the cost of a standard
hospital stay. Due to data limitations, estimates of cost per capita were less reliable.

Conclusion: The findings highlight the need for more tailored and equitable funding models to ensure healthcare services are adequately resourced and accessible to all Canadians, regardless of their geographic location. Future research should continue to explore these relationships and refine funding models to address the inequitable health outcomes that persist in remote and northern regions.

Purpose: The project explores operating room time allocation through the examination of factors incorporated in resource allocation methodology models, and by comparing the processes and practices for applying the results of RAM modelling in health authorities in B.C. Further, the project sought to determine if the methodology is achieving its intended outcomes such as meeting Ministry of Health objectives and key results, such as reducing surgical wait lists. Additionally, the project explored the variation between health authority allocation practices in B.C., to those outside B.C.

Methods: The study aimed to understand operating room time allocation methods, processes and practices across B.C. through 1) an operations research literature review, 2) stakeholder interviews, and 3) survey method.

Results: The key findings reveal the complexity of operating room time allocation methods, which require a delicate balance of stakeholder priorities and competing objectives. Despite a single private entity providing resource allocation modelling for most health authorities, significant heterogeneity in allocation methods exist. A deeper grasp of current methods is required to determine if this represents the optimal approach for managing surgical wait lists.

Introduction: In British Columbia (BC), long-term care (LTC) pharmacy services are split between two providers: contracted community pharmacies and health authorities. The BC Ministry of Health is exploring updates to Plan B, which funds contracted community pharmacies. However, there is limited information to guide this work, with a lack of clarity in the types, breadth and extent of pharmacy services provided, as well as the differences between the two service providers. The hypothesis is that the two providers are different, assuming that health authority providers have increased types and standardization of pharmacy services and more rigorous protocols. This capstone project seeks to test the hypothesis, address information gaps, and explore LTC pharmacy services and associated influencing factors. The findings of this project can help to inform the approach and foci of future LTC pharmacy policy changes.

Methodology: Data for this project were collected through semi-structured interviews with key informants, supplemented by a scoping and analysis of the gray literature. The key informants were pharmacy service provider representatives from community pharmacies and health authorities that spanned the geographies of BC. Questions were a mix of written responses obtained by email and verbal responses from the interview component. Interviews were conducted one-on-one, recorded and transcribed via Zoom, with consent from each representative. Transcriptions were then coded through NVivo software, and analyzed for integration into the final report.

Results: There were 9 respondents interviewed for this capstone. The combination of the gray literature and interview analyses yielded the following key findings:

1) Required pharmacy services are generally consistent across providers. Most services are listed under the HPA Bylaws Schedule F Part 3 Residential Care Facilities and Homes Standards of Practice, while several others are outlined in accreditation standards. Despite consistency in types of services provided, there was a high degree of variability in how services were provided. This includes differences in time spent on services, resource availability and use, standards and procedures followed, reimbursement models, governance structures, and other operational differences. Further differences were as influenced by site-specific operations and preferences.

3) There are multiple accountability and quality measures already in place. This includes accreditation requirements and organization-specific requirements.

4) LTC pharmacy practice has changed over the years, which influences the financial sustainability of the current capitation fee model. Some relevant changes include drug distribution requirement differences as well as loss in historical income streams, such as generic rebates that have become banned.

5) The LTC practice setting is complex and both community pharmacy and health authority providers are heavily integrated into service provision to LTC residents. There are also linkages between health authority and community pharmacy operations through hybrid models that arose from historical factors and contextual influences.

Conclusion: Plan B policy work cannot be solely focused on service type, frequency, fees, nor required services alone, as this would ignore numerous nuances and services that are invaluable to LTC. In addition to considering other factors (i.e., history, governance, resources), health administrators also need to include extensive consultation and collaboration with both community pharmacy providers to determine which pharmacy services are of value to LTC residents, operators, providers and the Ministry. As well, the two providers are currently integrated at various operational points in practice; changes that influence one provider will likely affect the other. Therefore, the two providers should not be treated as separate, and changes should support standardization across providers.

Artificial intelligence (AI) is revolutionizing healthcare by addressing increasing demands on public health systems, yet its integration remains misunderstood, requiring urgent policy development. As populations age and global challenges rise, AI’s strategic implementation is crucial, particularly in complex health systems like in British Columbia.

The digitization of medical records has enabled big data to enhance treatment effectiveness and system efficiency. Despite historical interoperability issues, advancements now allow for better data utilization. Big data analytics improve quality management in industries such as manufacturing (Lee et al., 2018) and healthcare, offering predictive insights and real-time monitoring to enhance patient care and system integration (Groves et al., 2013). AI adoption in healthcare faces challenges, including low technological literacy among senior clinicians and informed consent complexities. AI tools like support vector machines and artificial neural networks require careful consideration of patient consent, distinguishing between AI as a tool versus a procedure. Legal precedents highlight the importance of offering AI-enhanced
treatments and ensuring informed consent.

Provincial health ministries can strategically integrate AI by focusing on specific use-cases, improving care coordination and system efficiency. The purpose of this report is to produce general strategic recommendations around AI and develop a strategic approach for a specific AI-use case to contribute to the wider development of a broader AI strategy for the Primary Care Division (PCD). Through the development of strategic approaches to specific use cases, the aim is to develop a wider Divisional strategy which can inform the Ministry of Health (MoH) overall strategy for AI. To achieve this, this report was supported by a comprehensive literature review as well as consultation with senior leaders from the MoH.

Multiple research studies, reports, and human rights cases depict clear evidence of systemic racism in British Columbia (BC) health care services (Allan & Smylie, 2015; Boyer, 2017; Browne et al., 2016; Muise, 2019, Turpel-Lafond, 2020). Within the literature, large bodies of research show that Indigenous people have poor health outcomes, highlighting how racism leads to decreased access, poorer treatment, and limitation of access to treatment and services (Allan & Smylie, 2015; Brown et al., 2011; Phillips-Beck et al., 2020). Measuring health outcomes of Indigenous people has been recommended for both provincial and federal levels of government. Canadian Institute for Health Information (CIHI) has developed a framework, Measuring Cultural Safety in Health Systems, to measure cultural safety (CIHI, 2021). The framework supports identifying problems, making practice changes and ultimately improving the BC health care system (CIHI, 2021). At Providence Health Care (PHC), there was an opportunity to apply the CIHI Measuring Cultural Safety in Health Systems framework with a team that had experience developing the framework. The application of the CIHI framework requires significant adaptability and agility to align with and meet the requirements, services and abilities of any organization. This project aimed to identify the process, success factors, and practical challenges faced in achieving the goal of developing cultural safety indicators at a health care organization using the CIHI framework. Analysis of the process, methods and experiences of those involved were used to identify recommendations for strategies and processes for PHC and other organizations to employ in developing cultural safety indicators. Using a thematic approach, analysis from the semi-structured interviews highlighted core success conditions within the categories of “People,” “Health Care Organization,” and “Data” in the development of
cultural safety indicators. The success of this project involves the collaboration of individuals with diverse knowledge, organizational commitment, including having the
time and space to attend to the work, and various aspects of data. These included the use of existing data, indicators that are actionable, and the use of the CIHI framework to support development. This work is necessary to address the health inequities Indigenous populations experience in the health care system.