A note from BCACHC

Bowen Island Community Health Centre was initiated by a concerned group of community members to address the limited access to physicians on the island. It is amazing to hear of their successful efforts in raising $7.5 million.

We are all excited for Bowen Island CHC as it makes the final push in the construction of its purpose-built centre.

BCACHC would like to thank the Bowen Island Health Centre Foundation board members Tim Rhodes (President), Colleen O’Neil (VP) and Bowen Island CHC Suzanne Saatchi (Executive Director) for sharing their journey with us. You can read the interview in our blog and check out their website to learn more about their progress.

We wish Bowen Island every success in realizing its aspiration of providing residents with convenient access to healthcare services and its objective of establishing sustainable primary care and outreach services that cater to the distinctive healthcare needs of the community!

1. Why did your community decide to start a CHC?

The idea of the Community Health Centre (CHC) on Bowen Island was initiated by a concerned group of community members who formed the Bowen Island Health Centre Foundation. Their primary objective was to address the limited access to physicians on the island, which had reduced to one physician serving a population of 4,800 residents. This was particularly problematic for the island's population, which had a high proportion of families with young children and aging seniors, who were in greater need of healthcare services.

Initially, the Foundation sought support from government bodies and the Vancouver Coastal Health (VCH) authority, who cited Ministry of Health statistics indicating a substantial proportion of Bowen Islanders were attached to a family physician. However, this failed to capture the full picture of the community's healthcare needs, prompting the Foundation to conduct a community survey that focused on access. The results of the survey confirmed that the majority of island residents experienced difficulties accessing timely healthcare services, which resulted in frustration, fear, and anger.

The absence of a walk-in clinic or urgent care centre on the island meant that residents had to travel to the mainland via ferry, which often involved long wait times and the possibility of overnight stays. The economic and logistical challenges associated with accessing healthcare services had a significant impact on residents' healthcare decisions, which was not always in their best interests.

The Foundation also discovered that physicians and other healthcare providers faced barriers to providing services on the island, including the economic viability of small fee-for-service practices in a rural environment and the lack of appropriate space to provide services. Furthermore, there was no clear healthcare representation or advocacy for the needs of island residents.

Given the complexity of the challenges facing the island's healthcare system, the Foundation recognized that a systematic change was required. To this end, they engaged a consultant to develop potential solutions, and the CHC model emerged as the most viable option.

2. What gaps or improvements will the CHC address and who is impacted?

To address gaps in health care on the island, the CHC aims to: 

1. Create a sustainable Integrated Primary Care Team:

• Establish an Integrated Primary Care Team comprising Nurses, Social Workers, Mental Health Workers, and Community Health Workers.
• Provide team-based care, ensuring each team member works to the top of their scope.
• Address physical and emotional well-being of residents, as well as social determinants of health.
• Implement a salary (APP) model for physicians, removing the financial and administrative burdens associated with the Fee-for-Service payment model.
• Attach unattached patients.
• Retain capacity for same-day/urgent care for Bowen Island residents or visitors, regardless of attachment.
• Extend hours and provide after-hours on-call availability.
• Create access for all residents, including the Indigenous community.

2. Create a Community Health and Wellness Hub that includes Community Coordination and Development:

• Provide functional space for VCH outreach services, physician specialists, and visiting allied health professionals, such as VCH paediatric speech-language therapy.
• Create tenant space for co-location of complementary health services.
• Establish a full scope dentistry office as tenants, a first for the Island.
• Explore the interest of LifeLabs to co-locate in the space.
• Create an organizational structure to coordinate services between the primary care clinic, VCH, PCN, community NGOs, community paramedics, and municipal partners.
• Provide touch-down space for community non-governmental organizations for shared education and utility space to address social determinants of health.
• Create a unified voice in the community for education and advocacy to address social determinants of health.
• Create a unified voice in the community for education and advocacy to address social determinants of health.
• Empower the community to manage their own health.

3. What has the journey been like so far?

We take great pride in our successful fundraising efforts, which have resulted in a community of 4850 people contributing $7.5 million dollars. This achievement was made possible by the generosity of local volunteers who shared their experience, networks, and expertise. It is a testament to the power of engaged community members coming together to make a difference.

Despite our successes, we faced challenges along the way. The COVID-19 pandemic disrupted our plans just as we were gaining momentum, leading to construction delays and supply chain issues that continue to impact our ongoing costs. However, it also highlighted the health inequities and barriers to mental health and social services faced by residents of Bowen Island.

Our path to developing and funding a Community Health Centre (CHC) was well-mapped by the BC Association of Community Health Centres (BCACHC), but not all stakeholders in the process understood their roles. 

We faced high turnover among local health authority representatives and had to educate new leaders on their responsibilities. Similarly, our volunteer board experienced turnover due to the complex nature of the project, but we responded by creating a highly skilled board with specialized committees to ensure responsible management of the funds raised from Bowen Island residents.

Finally, unforeseen challenges, such as a municipal sewer infrastructure defect, further increased our construction costs by over half a million dollars. Nonetheless, we remain committed to our goal of creating a much-needed CHC for the community and are grateful for the support we have received every step of the way.

4. Who are your partners, supporters, and champions?

We have been fortunate to have strong partnerships and support throughout our journey. 

Experienced island residents who were knowledgeable about government relations provided guidance on approaching the government to obtain the initial million-dollar grant, which initiated the fundraising and planning process. Additionally, island champions connected us with affluent residents who believed in our cause and introduced us to local volunteer experts who generously shared their knowledge and time.

Our island has had committed physician champions, including Dr. Lloyd Purdy, who played a significant role in shaping our service model. Dr. Susanne Schloegl and Dr. Matt Blackwood have helped us identify gaps in services and barriers to care faced by their patients and suggested possible solutions.

The North Shore Division of Family Practice immediately recognized the importance of our goals and incorporated us into their PCN strategic plan for the region. They provided us with guidance to establish relationships with local First Nations and navigate stakeholders in our local Health Authority.

Local NGOs, including Caring Circle and the Bowen Island Community Foundation, supported us by sharing their local knowledge, funding research and surveys, and helping us find the right solutions.

Once local Health Authority leadership understood their role in the process, they designated a representative who facilitated connections with key VCH stakeholders as needed.

The Ministry of Health was a vital partner, providing guidance on the roles of individual PCN stakeholders and addressing funding concerns when our proposal submission stalled.

Finally, the BC Association of Community Health Centres (BCACHC) was instrumental in guiding us throughout the entire process, providing a pathway to a CHC and connecting us with appropriate Ministry resources and other CHCs.

5. How much time/money/other resources have the community and supporters contributed/committed?

We have been fortunate to achieve remarkable success in our fundraising endeavors, setting a record for Bowen Island in the process. Our community, which comprises 4,850 residents, has contributed $7.5 million to our cause, with 25% of households making contributions ranging from small monthly donations to one-time gifts in the millions. The unwavering support of our community has been a driving force behind our efforts, inspiring us to overcome challenges along the way.

In addition to the generous contributions of our community members, we have benefited from the tireless dedication of a committed group of volunteers. Our working board members have put in countless hours towards our mission, and we have also been fortunate to engage the expertise of local volunteers whenever needed. These community members have shared their knowledge in diverse areas, including building design and project management, clinical planning, primary care workflows, financial management, fundraising, land acquisition, technology, web development, communications, procurement, and recruitment.

Our journey began in 2014, and until the hiring of our Executive Director in 2021, all work was undertaken by volunteers. Despite our significant progress, we continue to maintain highly active working committees, with many community members continuing to contribute their time and energy towards our shared vision.

6. What would have/could have made the journey easier, or better

Our healthcare system is intricate and poses a challenge to navigate. The initial action taken by our new Executive Director was to educate us on the diverse decision makers in our health system, acquaint us with the stakeholders and elucidate their future funding relationships with us.

However, these stakeholders were also unaccustomed to the process. Community Health Centres (CHCs) fall under the Primary Care Networks (PCNs), which are relatively new and still endeavoring to establish their partnerships. Moreover, the Ministry of Health (MoH) and Health Authorities are progressively being requested to assume a larger role in primary care delivery, but they are also learning, as they are new players in this field. This resulted in a prolonged period to capture the attention and involvement of certain stakeholders. We had to persevere and utilize all available means to reach them.

Once we succeeded in making contact, we had to impart basic knowledge about CHCs as per the MoH mandate, the funding process, their role in that process, and why our small, community-based nonprofit was part of the conversation. Unfortunately, leadership turnovers were frequent, leading us to restart the process.

Fortunately, the Ministry of Health eventually intervened and clarified roles when necessary. Nonetheless, a briefing note outlining expectations and roles from government to government-funded organizations at the outset or even better yet -  a face-to-face meeting with government, PCN and non-profit kick-off meeting-  would have helped everyone start on the same page and facilitate the journey. We anticipate that this process will be more straightforward as more CHCs are funded and expectations are clarified.

7. What are your hopes and wishes for the CHC and your community?

Our aspiration for the Bowen Island community is to provide convenient access to healthcare services, enabling residents to receive care locally and alleviating the challenges and inconvenience associated with seeking care off Island. Our objective is to establish sustainable primary care and outreach services that cater to the distinctive healthcare needs of the community.

8. What is your advice for communities or groups looking to start a CHC?

Advice:

• Hire an executive director with experience and contacts in health care as early as possible.
• Find community and physician champions who can provide instant credibility with stakeholders.
• Leverage community expertise on boards and committees, but maintain control central to keep the focus.
• Start fundraising early or find fundraisers who can volunteer their time and share their connections.
• Stay optimistic and persistent throughout the process.
• Conduct a community survey early in the process.
• Network with donors and experts, and take up golf.
• Do not make assumptions; speak to community stakeholders to understand their concerns.

Community engagement:

• Allow the community to share their hopes and concerns through surveys and conversations.
• Be open and transparent throughout the process.
• Leverage community expertise on boards and committees.
• Involve local media and speak directly to stakeholders.
• Keep relationships strong with community organizations with a similar mandate.

Message to decision-makers:

• Do not underestimate what a community can achieve when they see the importance of a project.
• Provide adequate ongoing operational funding.
• Be willing to listen and be creative and open to new approaches.

 Biggest challenge for a startup CHC:

• Navigating the healthcare system itself.