Your health - Our mission Votre santé - Notre mission Canadian Forces Health Services Presentation to UNDE National Executive 23 April 2009

Your health - Our mission Votre santé - Notre mission Scope CFHS System Primary Care System Challenges Initiatives Statistics Conclusion/Questions

Your health - Our mission Votre santé - Notre mission CFHS System Director General through CMP, responsible and accountable to the CDS for the management, and administration of the CF health system Commander generate and sustain combat-ready health services units and individuals This includes the professional development, training, and preparation of health care personnel in order to meet their operational roles. Surgeon General setting of clinical policies delineation of clinical scopes of practice determination of clinical and professional content for CF courses interface between CF and external health care organizations

Your health - Our mission Votre santé - Notre mission CF H Svcs Gp HQ

Your health - Our mission Votre santé - Notre mission JTFNorth JTFPacific JTFWest JTFCentral JTFEast JTFAtlantic CF H Svcs C Ottawa CMEDCFEME 1 Cdn Fd Hosp 1 Dent U CF HS Trg Ctr Borden 1 H Svcs Gp 4 H Svcs Gp CF H Svcs Gp HQ CF H Svcs Gp CF A HSSS

Your health - Our mission Votre santé - Notre mission CF H Svcs Gp - Personnel 6331 positions (not people!) –Military 2717 Regular Force 1382 Reserve Force 283 Primary Reserve List –Public Servants 1469 –Calian contracted 480 (operational exigencies) –(of note: in 2007 >560 Calian employees)

Your health - Our mission Votre santé - Notre mission Largely a Primary Care System CF clinical specialists limited to those essential to deployed care Purchase many specialist services from civilian system Has pros and cons for care of seriously wounded from Afghanistan Highly unlikely to return to a system of military hospitals

Your health - Our mission Votre santé - Notre mission CF H Services Challenges

Your health - Our mission Votre santé - Notre mission CF H Services Challenges Governance disconnects Managing expectations Well-intentioned constructive criticism Deployment of electronic health record, and exploiting it for performance management

Your health - Our mission Votre santé - Notre mission HSS to JTF Afghanistan – Kandahar Role 3 MMU transition to US (CENTCOM) leadership CF H Services Challenges

Your health - Our mission Votre santé - Notre mission Attraction & Retention – Competition for limited HR pool; exacerbated by high op tempo Education and credentialing creep Progressive rising bar on entry to practice requirements Maintenance of operational clinical skills when not deployed – CF H Services Challenges

Your health - Our mission Votre santé - Notre mission Full Integration of Reserves at the Gp Level Synchronization of Reserve trg, (IBTS, pre-deployment, indiv) leading to enhanced interoperability and maximizing economies of effort within the Gp CF H Services Challenges

Your health - Our mission Votre santé - Notre mission Initiatives UMCC – HQ level LMRC – chain of command has provided clear direction HR(Civ) – COS professional interaction Clinic Manager’s Symposium

Your health - Our mission Votre santé - Notre mission Statistics Since 2006 to early-2009 –143 Calian employees have transferred into the PS –Dental Assistants, Clinical Psychologists, Social Workers, Physiotherapist, Medical Assistant, Pharmacy Technician, Pharmacist –What is missing: from this pool: clinicians –Excellent employment pool for the PS

Your health - Our mission Votre santé - Notre mission OP RESTORE Overall, CFDS RESTORE will be adding a total of FTE of public service positions, more than doubling the number of PS positions in the Dental Branch.

Your health - Our mission Votre santé - Notre mission Dental Branch – OP RESTORE New positions created: HSPHS 6 – 81.8 EG AS and CR DE Total 179.8

Your health - Our mission Votre santé - Notre mission QUESTIONS

Your health - Our mission Votre santé - Notre mission OP RESTORE – MOOSE JAW CFDS RESTORE will be adjusting its manning at CFB Moose Jaw to ensure the correct number of clinical providers and support staff required to support a patient population of between patients, be consistent with the Clinic Model, and to conform with the approved new provider-patient ratios described in the RESTORE document. The military and civilian establishment of every single clinic was closely scrutinized to ensure ALL clinics were treated equitably and established to appropriate levels.

Your health - Our mission Votre santé - Notre mission OP RESTORE – MOOSE JAW In particular for 1 Dent Unit Det Moose Jaw, the following changes to civilian establishment are planned : A CR3 position is being created to fill the role of receptionist. The 0.4 DE2 dentist position is being moved to another base, as the 1 military dental captain has the capacity to provide all of the necessary dental treatment. This position has never been filled, partly because no dentist was willing to work in the DE2 classification and partly because the clinic was not busy enough to require the extra dentist. The EG-05 dental hygienist position is being adjusted to 0.8 FTE, as hygienests are expected to serve a patient population of 800. Including the patients in Dundurn, Det Moose Jaw only has about 620 active charts, and many of those are of students who are too busy to make full use of the dental facility. 620/800 =.775, so with 0.8 FTE there is extra capacity. The 0.2 FTE will be transferred to another base. The HS-PHS6 position of 0.8 FTE is being adjusted to 0.6 FTE, providing the dentist with a total of 1.6 FTE of dental assistant support. The remaining FTE will be transferred to another base.