Tiers of Service
Defining the Tiers of Service framework and approach
System planning for children's health services is a major area of focus for Child Health BC and its collaborators.
Children's health services are provided by community based providers including family physicians, pediatricians, nurses, speech language pathologists, therapists and more. Regional health promotion and prevention services as well as clinics may be available to children as well. BC Children's Hospital has a major role to play as BC's only children's hospital. Our relatively small population spread across the vast geography of the province necessitates us working together in a planned manner.
The Tiers of Service framework provides a tool which can then be used to define and plan this system of service. Tier of Service provides a common language and methodology for defining and planning child and youth health services in BC.
The Tiers of Service framework:
- Recognizes that health services, while important, are one of several factors that contribute to child and youth well-being overall.
- Is informed by a review of frameworks / tools in other jurisdictions around the world.
- Allows system planning for clinical services, knowledge sharing/training and quality improvement/research. The responsibilities and requirements for each of these three areas are defined within the Tiers framework.
Six Tiers of Service Defined
Having learned from other jurisdictions, and based on some historical approaches in BC, we embarked on the Tiers journey starting off with defining four tiers of service. Quickly, once we started to move forward with planning here in our own BC context, we recognized that the system's resources were better delineated with six tiers. Therefore we now have six tiers: 1A and 1B, 2, 3A and 3B, 4 as shown in the attached diagram.
Each one of these tiers is important and each tier has unique roles that it plays. The system as a whole functions best when all the Tiers know and accomplish their responsibilities and fulfill their requirements. Each tier of service relies on the next and, together, services for children are strengthened.
Using the Tiers approach for system planning.
Child Health BC is leading the use of the Tiers of Service approach to system planning for children's health in BC. How does this happen?
Creation of a series of modules: For each of the major areas of health services — such as emergency care, pediatric medicine, pediatric surgery, intensive care services — a Tiers of Service module has been or is being created. Each module has three parts. Part one is called "Setting the Stage" and this presents data and literature used to create the module. Part two is called "tiers in brief for system planning" and provides a high level overview of key aspects to the module. Part three is called "tiers in full for operational planning" and provides tremendous detail regarding the (1) clinical service, (2) knowledge sharing/training and (3) quality improvement/research responsibilities and requirements.
Self-assessment based on the modules: Once a module is finalized and accepted by the key partners in the province, a self-assessment is completed. Child Health BC works with our health authority partners as necessary to get this work completed.
System planning and service planning based on the self-assessment results: Using the self-assessment analysis, provincial, regional and local planning is undertaken with significant efforts by our health authorities' collaborators, facilitated by Child Health BC.
Tiers of Service Framework and Approach summarizes these concepts in a one page document.
BC's Child Health Tiers of Service Modules
Tiers at a Glance provides an overview of Children's Health Care Services. It provides the highlights of all of the Tiers of Service modules that have been completed an are under development.
On the left side bar menu, you will find the Tiers of Service modules that have been completed.
Also under development are: Laboratory medicine for children, Children’s subspecialty medicine (multiple sub-specialites), Children’s critical care, Child Development and Rehabilitation, Child and Youth mental health. Contact Child Health BC if you would like more information about the status of these modules.