Lines of business

NL Health Services implements measures that promote and protect population health and help prevent disease and injury. The primary initiatives in this line of business include population health assessment, surveillance and epidemiology; growth and development in the early years; health promotion; health protection; and disease and injury prevention.

Population health assessment, surveillance and epidemiology

Population health assessment, surveillance and epidemiology ensure programs and services are informed by population health data and respond effectively to current and evolving conditions that contribute to the public’s health and well-being. Population health assessment is the process of assessing the changing strengths, vulnerabilities, and needs of communities. Surveillance is the process of collecting health data to track diseases, the health status of populations, the determinants of health, and differences among populations. Assessment and health surveillance include the information collected to inform all public health work. They rely on the science of epidemiology, which focuses on describing health and disease in populations rather than in individuals. Epidemiology contributes information essential for understanding the determinants of health and for developing and evaluating public health programs.

Growth and development in the early years

Supporting growth and development in the early years incorporates programs and services to optimize the well-being of children, youth and families in a variety of settings (home, school, community) through the creation and reinforcement of supportive environments and practices during the preconception to early years of children’s development.

The major categories of service include but are not limited to:

• Maternal child health care
• Services to families of infants, preschool and school age children who have or are at risk of delayed development

Health promotion

Health promotion is the process of implementing a range of social and environmental interventions that enable people and communities to increase control over and to improve their health. Health promotion programs and services involve the work of many internal and external partners working together to focus on:

• Building healthy public policy (e.g., smoke-free policies)
• Strengthening community action (e.g., Regional Wellness Coalitions)
• Creating supportive environments (e.g., safe walking routes within communities)
• Supporting development of personals skills (e.g., child and family health programs)
• Re-orienting health services to focus on prevention and early intervention (e.g., through engaging the public and partnerships with community agencies, such as self-management programs and youth outreach services)
• Re-orienting health services to focus on population health as well as individual health outcomes (e.g., addressing the determinants of health and health inequities)
• Supporting health service delivery (e.g., Healthy Baby Clubs, Child Health Clinics)

Health promotion activities are integrated throughout all lines of business within NL Health Services.

Health protection

Health Protection involves the protection of individuals, groups and populations through expert advice and effective collaboration to prevent and mitigate the impact of infectious disease, environmental, chemical and radiological threats. Health protection involves using the latest evidence to advance knowledge and guide practice and uses surveillance data to monitor the health of the population. Health protection includes the regulatory framework, programs and services for the control of diseases and protection from public health threats. Health protection is delivered within the context of current legislation, where applicable.

The major categories of service include but are not limited to:

• Communicable disease prevention and control
• Environmental public health support
• Emergency preparedness and response

Disease and injury prevention

Many illnesses can either be prevented or delayed and injuries avoided. Prevention services offer early intervention and best available information to members of the public to prevent the onset of disease, illness and injury, and/or the deterioration of well-being. Actions include programs and services that are focused on eradicating, eliminating or minimizing the impacts of disease and disability. Programs and services vary depending on the incidence or potential for disease, illness or injury identified in specific areas.

The major categories of service include but are not limited to:

• Health surveillance
• Screening (e.g., breast, cervical, colorectal, and prostate)
• Noncommunicable disease and injury prevention
• Chronic disease prevention and management

NL Health Services provides broad ranging supportive care services across the continuum of care and lifespan within legislation, provincial guidelines, organizational policies, and resources. This includes the provision of residential care options, community-based support, special assistance and continuing care, home support, personal care home and nursing home care for individuals based on assessed needs. These services are provided in select locations and in some cases may be subject to clinical and/or financial assessment. There is occasionally a relationship with other Provincial Government agencies for subsidized funding to supplement programs. Supportive care promotes the safety, health and well-being of the individual by supporting the existing strengths of the individual, family and community. The main categories within this area are listed below:

Individual, family and community supportive services

Individual, family and community supportive services make up a considerable component of the work of the organization. These include:

• Services to clients with physical/development disabilities or other cognitive impairments
• Services to clients experiencing psychosocial concerns (e.g., disruption of family functioning, lack of social support, mental health or substance use concerns, violence)
• Adult protection services
• Home support services
• Health-care supplies and equipment (e.g., oxygen, ostomy supplies, bathing supports, and drug cards)
• Home care, respite, convalescent, and palliative/end-of-life care

Long-term care and residential services

Long-term care and residential services encompass an extensive range of the organization’s supports and partnerships including:

• Long-term care homes
• Seniors’ cottages and congregate living
• Protective community residences
• Personal care homes
• Alternate family care
• Cooperative Living
• Therapeutic residences
• Hostel accommodations

Rehabilitative services

The organization offers a variety of rehabilitative services for individuals following illness or injury. These services are offered in selected locations through a referral process and include:

• Post-acute nursing services both in clinic and home settings
• Rehabilitation services such as physiotherapy, occupational therapy, speech-language pathology, audiology and social work
• Rehabilitation centres and inpatient programs

Restorative care (inpatient post-acute) program

NL Health Services investigates, treats, rehabilitates and cares for individuals with illness or injury. The clinical intent is to apply interventions that will reduce the severity of an illness or injury, preserve and improve the health of the individual, provide comfort measures and to educate and inform patients. Additionally, we provide care at the beginning of life (newborn care) and at the end of life (palliative care).

Services are offered in a variety of locations throughout the province, depending on factors such as the level of care required (primary, secondary or tertiary), access to health professionals and access to appropriate facilities. Certain services are self-referred, while others require a referral from a health professional. These services are provided by multidisciplinary teams of health professionals, through a variety of inpatient and outpatient settings. The main categories within this area are listed below:

Primary health care

Primary health care is typically an individual’s first point of contact with the health-care system and can encompass a range of community-based services essential to maintaining and improving health and well-being throughout an individual’s lifespan. Both salaried and fee-for-service physicians and salaried nurse practitioners work within one of the organization’s facilities or operate their own independent offices to provide primary health care. There are also a growing number of primary health-care projects in which physicians, nurse practitioners, and other health professionals work in a coordinated manner to offer care.

Ambulatory care

Services include day procedures, surgical day care, endoscopic services, diagnostic and laboratory services, specialist clinics both regular (e.g., medical and surgical) and visiting (e.g., nephrology), diabetes education, cardio-pulmonary services, nutritional services and a variety of clinical support services.

Emergency care

Services consist of hospital emergency services including emergency room services and the monitoring of community-based, private provider and hospital-based emergency medical services. In addition, patient transport provides both ground and air transport of patients, conducted by both public and private operators and includes ambulance and client transport for medical services.

Medical services

Services include internal medicine, family medicine, psychiatry, pediatrics, obstetrics, nephrology, neurology, dermatology, medical oncology including chemotherapy, physiatry, gastroenterology, cardiology, intensive care, renal dialysis, and palliative care.

Mental health and addiction services

Services range from health promotion-based programs to diagnosis and treatment (inpatient, outpatient and residential) to follow-up services. There are strong links with community-based partners such as advocacy groups, self-help groups, employment and housing. Services are offered to those who are experiencing mental health problems, mental illness or difficulties with alcohol, drugs, gambling, or are affected by someone else’s use.

Surgical services

Services include anesthesiology, general surgery, orthopedics, urology, ophthalmology, otolaryngology, obstetrics and gynecology, colposcopy, vascular and dental.

Tertiary hospitals

Tertiary hospitals provide primary-, secondary- and tertiary-level services. These hospitals are academic health-care facilities that accept referrals and transfers from all parts of the province for both inpatient and outpatient services. The majority of these specialty services are listed in the footnote [1].

_
[1] Medical, surgical and radiation oncology; cardiac and critical care; specialized diagnostics – laboratory medicine, imaging, nuclear medicine, pathology; children and women’s health – specialty pediatrics, gynecology, obstetrics, pediatric critical care, perinatology; medicine – allergy & immunology, emergency medicine, endocrinology & metabolism, family medicine, gastroenterology, general internal medicine, geriatrics, hematology, nephrology, pharmacy, respirology, rheumatology; surgery – anesthesia and perioperative medicine, cardiac surgery, dentistry, general surgery, neurosurgery, ophthalmology, orthopedics, otolaryngology, plastic surgery, thoracic surgery, urology, vascular surgery; psychiatry – child/adolescent psychiatry, geriatric psychiatry, adult and general psychiatry, forensic psychiatry.

NL Health Services is dedicated to advancing research, education and knowledge dissemination. The organization will continue to utilize evidence-based practices to transform the health system into an efficient and effective model of service that positions NL Health Services as a leading Canadian health-care organization. The main categories within this area are listed below:

Education

The organization plays a key role in ensuring that the next generation of health professionals has opportunities to gain relevant educational experience. Education of the next generation of health-care providers is offered through affiliation agreements with numerous educational institutions within the province, across the country and further abroad. These arrangements enable students to study and participate in fieldwork experiences. Staff and physicians are encouraged to seek the best information and knowledge from multiple sources and to incorporate evidence into their practice. Continuing education for NL Health Services’ staff, physicians, volunteers, and advisors is offered throughout the organization in various formats. NL Health Services also partners with other government departments and community agencies to offer training to health professionals and the public. In addition, the Centre for Nursing Studies and Western Regional School of Nursing offer Practical Nursing, Bachelor of Science in Nursing and various continuing education programs.

Research and innovation

NL Health Services is committed to ensuring that the issues faced in daily practice bring about research and innovation to find creative health-care solutions. The Patient Research Centre provides for the coordination and implementation of clinical trials and all zones support applied health research projects. Research and innovation are collaborative endeavours and overall success depends upon partnerships with patients, staff, suppliers, the academic community, funding agencies, private enterprise, the technology sector, and many others that wish to improve the health and well-being of people in this province.

Planning and performance

The organization regularly assesses its performance as part of the strategic planning and accreditation processes, as well as through an array of planning, evaluation, and quality improvement frameworks and practices. By employing an integrated approach to quality and using data to measure outcomes, the organization is able to determine where to focus its efforts to transform service delivery and provide exemplary high quality care experiences and best possible outcomes for all Newfoundlanders and Labradorians.

Data and information services

Includes the delivery of a full range of information products and services in support of health system management including health analytics, data access, applied health research, evaluation, performance improvement, clinical efficiency, data and information management, business intelligence, decision support, and data quality and standards. Data and information services support health system management and transformation through information, obtained through health analytics, evaluation and business intelligence, as part of a comprehensive approach to supporting system transformation that also includes an emphasis on building capacity in the system for continuous quality improvement.

Digital health services 

Services include the delivery of information technology and eHealth services applied in the health-care system to provide quality care. A key area of service, eHealth, refers to all of the electronic, communication and technology tools used to share health and administrative information provided across NL Health Services. eHealth tools provide more accurate and reliable data and are designed to facilitate better sharing and interpretation of health information among health professionals involved in a person’s care regardless of location. In turn, improved access to this information supports improved health-care delivery, decision-making and policy development.

Major programs include but are not limited to:

• HEALTHe NL, the provincial electronic health record
• eDOCSNL, a program that supports the implementation, adoption and use of the provincial electronic medical record solution in participating health-care provider offices across the province
• Virtual care, a suite of services used to connect individuals to health-care providers who are not located in the same community, as well as to overcome other barriers to accessing in-person care. Services include telehealth, home-based telehealth, remote patient monitoring, telepathology, and virtual emergency room services, among others.

Transformation

NL Health Services is committed to transforming the provincial health-care system into a more sustainable and well-balanced system that meets the needs of the population now and in the future. A health transformation framework will outline the resources and supports for transformation including a health advisory council, transformation office, strategic health networks, and service integration teams.

Strategic Health Networks (SHNs) are inter-professional groups with a provincial scope and mandate to drive clinical and operational improvements in health outcomes and service delivery. SHNs bring people together, across professional groups and geographic locations or zones, to apply a provincial, strategic, and evidence-based lens to address identified issues and reduce unwanted variation in practices, processes, and outcomes and to support quality, consistency, and system sustainability.

Service Integration Teams (SITs) will be established to support programs that are delivered through a zone-based leadership model where SHNs are not in place. SITs will offer a mechanism for provincial coordination around operational issues, risk and quality improvement activities, implementation activities, and provide an avenue for zone counterparts to exchange information, problem-solve, discuss day-to-day operational issues, and collaborate on issues of mutual relevance.