Recommendation # 27:

HC should ensure that nurses working in remote First Nation (FN) communities successfully complete the Department’s mandatory training courses.

HC recognizes that training is very important. Going forward, HC will strengthen its efforts to meet mandatory training requirements for its nurses and establish processes to monitor compliance and completion rates.

One of the challenges in meeting these requirements has been the significant vacancy and turnover rates in nursing.  The first order of priority has been to assign adequate level of nurses in all Nursing Stations.  HC’s Nurse Recruitment and Retention Strategy is striving to augment and stabilize its nursing workforce in efforts to address these shortages.

HC will work to balance its training needs and service to communities, ensuring that training does not result in a loss of services in a community.

Deliverables:

• Recruitment Strategy including streamlined application process, marketing campaign and the creation of a Nurse Resource pool. 

Expected Completion Date: March 2016.

• List of mandatory training courses in each Region delivering clinical care.

Expected Completion Date: May 2015.

·         Report on Regional mandatory training efforts.

Expected Completion Date: June and October 2015.

• National Education Policy for HC nurses to articulate roles and responsibilities, monitoring and reporting on compliance and completion rates.

Expected Completion Date: May 2015.

·         Regional Education Action Plans to address training compliance and completion rates.

Expected Completion Date: September 2015.

HC is implementing the Nurse Recruitment & Retention Strategy approved in the Fall 2013.  Three key initiatives are being implemented within this strategy that support HC’s response to the recommendation.  A marketing campaign was launched in February 2015 with a streamlined application tool, over 500 nursing applications have been received to date. The establishment of a Centre of Excellence for the development of a centralised nurse resource pool is underway. Status: On track to meet target.

Formal meetings were held with each Regional Executive to review the National Education Mandatory Training policy and confirm consistent application of the five core courses as follows: Advanced Cardiac Life Support (ACLS); Trauma Support; Paediatric Advanced Life Support (PALS); Controlled Substances; and, Immunization.

Status: Completed, May 2015. 

A standardized process to collect reports on regional mandatory training is being developed in collaboration with HC Regions.

Status: On track to meet target.

National Education Policy on Mandatory Training for HC Employed Nurses Delivering Clinical Care has been developed and approved by S/ADM, FNIHB.

Status: Completed, May 2015.

A standard approach to designing and reporting has been finalized and Regional Education Plan development is underway.

 Status: On track to meet target. 

Recommendation # 37:

HC should ensure that its nurses are provided with appropriate supporting mechanisms that allow them to provide essential health services that are outside their legislated scope of practice.

HC agrees that nurses need appropriate supporting mechanisms to perform their important duties and a number of mechanisms are already in place.  

HC will continue to strengthen and formalize its management and risk control framework for clinical care.  Elements of this framework include:

• Clinical guidelines, standards and accreditation;
• First Nations and Inuit (FNIHB) Drug Formulary and Drug Classification System;
• Mandatory Nursing Training Courses;
• Formalized access to physicians and nurse practitioners when the situation requires interventions outside the nurses’ legislated scope of practice;
• Appropriate medical delegation mechanisms;
• Nurse registration; and,

·         Work with the provinces and the nurse regulatory bodies to explore potential strategies to support nurses working in remote and isolated First Nations communities.

Deliverables:

• Engagement Strategies on supporting nurses scope of practice for each region where clinical care is available.

Expected Completion Date: September 2015

·         Joint regional working sessions to develop a working paper that will identify and operationalize solutions for each region to support HC nurses to work within their scope of practice.

Expected Completion Date: September 2015.

·         Clinical Practice Guidelines updated and web-enabled.

Expected Completion Date:  June 2016.

• Accreditation Plan presented to senior management.

Expected Completion Date:  September 2017.

·         Documentation detailing physician access arrangements.

Expected Completion Date: May 2015.

Regional discussions on the development of engagement strategies for supporting nurses scope of practice are underway.

Status: On track to meet target.

Regional discussions on the development of a working paper to identify solutions for nurses to work within their scope of practice are underway.

Status: On track to meet target.  

The work on the revisions to the Clinical Practice Guidelines is underway. A Governance Structure is in place to provide oversight of the review schedule for the revisions. 

Status: On track to meet target.

HC is in the process of developing an Accreditation Strategy that will help to identify and overcome barriers to the uptake of accreditation by nursing stations, community health centres and treatment centres.  This work will be guided by a Task Group comprised of Regional Accreditation Managers and representatives from the National Native Alcohol and Drug Abuse Program and Clinical and Client Care, with secretariat support by the Quality Improvement Accreditation Program. The planning and implementation  work will require close collaboration and engagement with First Nations communities where clinical care is delivered.  Building on the work that has already been done, a presentation to Senior Management is targeted for September 2015. 

Status: On track to meet target.

Meetings were held with regions to review physician and NP coverage. The inventory has been completed and will be used to support future discussions related to needs of clinical care.  

Status: Completed, May 2015.

Recommendation # 53:

HC should work with FN communities to ensure that nursing stations are inspected on a regular basis and that deficiencies related to health and safety requirement or building codes are addressed in a timely manner.

HC will continue to work with FNs to ensure that buildings are inspected on a regular basis and that deficiencies are addressed in a timely manner. In particular, HC will standardize procedures to ensure Facility Condition Reports (FCR) are systemically shared with building owners. HC will also make more explicit the requirements and timelines for routine inspections and corresponding repairs, by including relevant requirements in the Capital Contribution Protocol. 

Deliverables:

• Process changed to reflect systematic sharing of FCRs with FN communities.

Expected Completion Date:  May 2015.

• Regional national tracking system implemented for inspections and completion of major repairs and deficiencies identified in FCR's.

Expected Completion Date:  June 2015.

• Updated Framework for FNIHB’s Capital Planning and Management Framework.

Expected Completion Date:  September 2015.

Following a January 22, 2015, Capital Program Review Reporting Committee meeting, Regions now ensure FCR findings are formally communicated to First Nations via written letter as well as the sharing of FCRs.

Status: Completed and Implemented: January 2015.

An excel file is being set-up with the Regions for the Regional national tracking system to track and monitor inspections done and follow-up when deficiencies are delayed. Systems will be regionally based and reported with a National roll up.

Status: On track to be completed and implemented: June 2015.

The framework is being updated and will include specific guidelines regarding the conduct and sharing of FCRs with building owners. The FCR will be the basis for joint planning with the First Nations building owners for maintenance and renovation projects.

Status: On track to be completed and implemented: September 2015.

Recommendation #56:

HC should work with FN communities to ensure that new nursing stations are built according to applicable building codes.

Ensuring buildings are to code is a priority for HC.  HC has a longstanding process to require an attestation by an architect or engineer to provide assurance that the construction is completed and is compliant with the applicable building codes.  To increase clarity, going forward, HC will make adjustments to the process to ensure that the scope of this attestation is clear for all parties involved in a construction project.

Deliverables:

• Updated Capital Protocol document to clarify the requirements of attestations.

Expected Completion Date:  April 2015.

• Communication to all Facility Management Staff regarding attestation requirements.

Expected Completion Date:  May 2015.

The capital protocol document has been updated to clarify the requirement of attestations.  The changes clarify that HC will only release the final payment associated with any infrastructure or capital project once the recipient can provide proper documentation that a project or the work is complete and it meets applicable codes, laws or standards as referenced in the Agreement.  The protocol specifies the type attestations from industry professionals that will be accepted.

HC has undertaken changes to its process and tools to support better coordination and engagement with its First Nations partners. On the basis of these, engagement at the regional level will be improved.

Status: Completed and Implemented: April  2015.

A communiqué to facility management staff has been sent with specific expectations on how attestations are to be addressed in the Protocol document and how facility management staff are to use attestations from industry professionals in the project delivery process.

Status: Complete, communications sent out in May 2015.

Recommendation #64:

HC should work with FN communities to ensure that nursing stations are capable of providing HC’s essential health services.

Allocating nursing resources to support delivery of health services in a safe, supportive and culturally appropriate manner is a priority for HC. In collaboration with First Nations, HC will review the clinical care complement in an effort to progressively move towards the creation of inter-professional teams where possible to support the delivery of essential services in a culturally appropriate, safe and effective manner.

Deliverables:

• Mapping of current models of care. 

Expected Completion Date: October 2015.

• List of potential nursing stations to move toward inter-professional models of care. 

Expected Completion Date:  December 2015.

• Feasibility study of selected sites vis-à-vis implementation of inter professional  models of care

Expected Completion Date: December 2016.

HC has initiated the analysis and data collection and will engage with First Nations communities to advance this initiative.

The Nursing Station reporting template (NSRT) will provide data for this deliverable. Discussions on mapping and reporting are underway.

Status: On track to meet target.

The NSRT will collect information on current models of care and plans for moving towards an Inter-professional care model. The NSRT will be sent to regions in June, data analysis will be done in Summer 2015, with a report anticipated in Fall 2015.

Status: On track to meet target.  

Feasibility study for implementation of Inter-professional models of care will be undertaken once NSRT data has been analysed and the report completed.

Status: On track to meet target.

Recommendation # 65:

HC should work with FN to communicate what services are provided at each nursing station.

HC, in collaboration with FNs, will provide a list of all Clinical Care services offered at each nursing station for communication to community members.

Deliverables:

• Each nursing station will provide an overview of the health services offered.

Expected Completion Date:  September 2015.

• Develop communication products to increase community members understanding of services available.

Expected Completion Date:  December 2015.

Initial discussions undertaken for the development of an overview of the health services offered in each nursing station. This will be done in in collaboration between the Regions and First Nations communities.

Status: on track to meet target.    

Further discussions are needed with Regional Nursing Operations on the communication products. This will be done once the overview report is final in Fall 2015.

Status: On track to meet target.  

Recommendation # 81:

HC should work with FN communities and Aboriginal Affairs and Northern Development Canada (AANDC) to facilitate the registration of FN individuals.

HC will ensure that information materials about the Indian Registry process are available in all nursing stations and will continue to work with partners to improve the availability of information in health facilities.

Deliverables: 

• Registration forms and brochures available in HC operated centres.

Expected Completion Date:  September 2015.

·         Letter to First Nations partners to encourage them to display registration information in community hall centres.

Expected Completion Date: September 2015.

HC is working in collaboration with AANDC and will print and circulate registration forms to HC operated nursing stations and other facilities.

Status: On track to meet target.

Regions are also collaborating with AANDC on communications products for First Nations partners to encourage them to display registration information in community centres.

Status: On track to meet target.

Recommendation #91:

HC should maintain sufficient documentation to comply with TBS 2009 directive on recordkeeping and demonstrate that MT benefits are administered in accordance with 2005 MT policy framework.

HC’s goal is to ensure that eligible clients receive timely coverage for medical transportation in accordance with the provision of Medical Transportation (MT) Framework.  At the same time, the department is making efforts to adapt its processes to avoid undue burden for clients and health care professionals.  As part of this effort, HC will modify its current guidelines to better align with current operating practices related to assertion of medical needs and confirmation of attendance. 

As recommended, HC will disseminate to its staff clear instructions on the processing and retaining of transitional records necessary for the adjudications of benefits.

Deliverables: 

• New Medical Transportation Operational Guidelines introduced and integrated into regional operational manuals on the administration of MT benefits.

Expected Completion Date: April 2015.

• Regional Guidelines on Document Retention Policies sent to NIHB Regional offices.

Expected Completion Date: April 2015.

HC has addressed these two action items by developing administrative guidelines for documenting medical referrals, justification of non-medical escorts, confirmation of attendance, availability of local services and retention of transitory administrative documents.  The guidelines were disseminated via email at the end of April.

Status: completed April 2015.

Recommendation # 107:

When allocating nursing staff levels and other support, HC should work with FN communities, and take into account their health.

HC will work with FN communities to better integrate clinical care with culturally-appropriate community health planning as a means to ensure that HC’s services are further aligned with other health services under the control of the First Nation community.

HC is funding a number of community-based programs that aim to respond to community needs in the areas of mental health, maternal and child health, public health and home and community care in addition to Clinical Care.  These community-based programs are funded to support community health needs and are most of the time managed by the communities themselves. 

The allocation of nursing resources is complex, and depending on the community, different approaches are required.  The allocation process takes into account population size, the geographic location, accessibility of other health care services and other specific operational considerations as identified with the communities.  As recommended, HC will enhance its practices through the community health planning process.

Deliverables:

• Redesigned Health Plan Guide.

Expected Completion Date: June 2016

• Toolkit to share models and lessons learned to support collaboration.

Expected Completion Date: September 2016.

Discussions are underway on the redesign of the Health Plan Guide.

Status: On track to meet target.  

Work has begun on the redesign of the health planning process which will include elements to aid recipients to identify how clinical and client care will be managed in their community.

HC will engage with First Nations in a manner consistent with its Engagement Protocol to ensure that the redesign fits community needs.

Status: On track to be completed and implemented June 2016.

Recommendation # 116:

HC should work with FN communities, provinces, and health service providers to ensure that FNs living in remote communities have comparable access to Clinical and Client Care (CCC) services as other provincial residents living in similar geographic locations.

HC’s priority is to support First Nation communities receiving health services and benefits that are responsive to their needs and improve their health status.

HC will work with FN communities to build health service delivery models for remote and isolated communities, which will better respond to the community’s needs and contribute to ensure FN have comparable access to Health Services.

Deliverables: 

• Clinical Care Access report presented to Senior Management that will analyze access and associated issues.

Expected Completion Date: July 2016

• Report to identify best practices in enhancing access to culturally appropriate clinical care

Expected Completion Date: April 2017

Discussions are underway within HC on the development of a Clinical Care Access report. 

Status: On track to meet target.  

HC is presently designing an approach to serve as the basis for engagement with First Nations communities and others to meet this requirement.

Status: On track to meet target.

Recommendation # 130:

Working with FN organizations and communities, and the provinces, HC should play a key role in establishing effective coordinating mechanisms with a mandate of responding to priority health issues and related inter-jurisdictional challenges.

Management Response:

HC is committed to working with partners to better coordinate its actions and effective interventions where possible.  HC will continue to work with FN organizations and communities, and the provinces to explore opportunities for enhanced integration and coordination of health services based on joint priorities.  This being said, these partnerships, due to their multi-lateral nature, can take time to develop.  This should in no way be an indication that they are not productive or effective.  In fact, experience to date has demonstrated that some of the strongest and most productive relationships require a significant start-up phase to lay the foundation for future collaboration.

Deliverables:

• Document that highlights key initiatives and progress underway on service integration and coordination with partners.

Expected Completion Date: March 2016

·         Identification of challenges and opportunities in clinical care delivery in Ontario and Manitoba. 

Expected Completion Date: November 2015

HC will continue to be actively engaged in trilateral tables.

HC has engaged the Trilateral First Nations Senior Health Officials Committee (TFNHSOC) in Ontario as it relates to nurse recruitment and training.

Status: On track to meet target.

HC continues to work with FN and provincial partners to identity challenges and opportunities through participation in various internal and inter-jurisdictional tables. 

Status: On track to meet target.