Through the Systems Navigation Access and Partnership (SNAP) Project, Community Health Centre (CHC) grantees are working to advance systems navigation efforts to improve access and health across Canada. This blog explores the work of Prince George based CHC, Central Interior Native Health Society and the impact the funding has had in their community.

Question 1: Tell us a bit about your CHC, catchment area, and community that you serve.

Central Interior Native Health Society (CINHS) is a non-profit healthcare society based in Prince George, BC. We provide primary healthcare services, primarily supporting Indigenous Peoples and empowering clients who experience the deep impacts of colonization. Our services are inclusive, accessible, culturally safe, and holistic, fostering physical, spiritual, emotional, and cultural harmony.

CINHS prioritizes intake for clients experiencing homelessness, mental health or substance use challenges, Indigenous youth in ministry care, and Indigenous pregnant individuals without a primary care provider for labour and delivery. We aim to decolonize our organizational mindsets and practices, meeting clients where they are and challenging broader systems to provide client-centered care.

Our interdisciplinary team of approximately 35 staff includes nurses, social workers, counsellors, pharmacy technicians, Elders, and cultural and support staff, all working together to build on the strengths of all those we serve. We offer multiple programs, including a community health clinic, Natsoolyis’ cultural centre, a Trauma, Equity, and Advocacy (TEA) team, and a High Acuity Support Program (HASP), with elements of outreach services. Our core values of trust, respect, humour, and compassion guide our actions as we serve the North Central BC community.

CINHS is currently expanding to increase hours and services, continually establishing supportive relationships with other healthcare providers and Indigenous communities across the region. We regularly engage clients to inform our services, acknowledging the need to better understand the systems that support our providers in meeting client needs and achieving professional and organizational goals.

Question 2: Tell us about your SNAP Project.

The Systems Navigation Access and Partnership (SNAP) Project, funded by the TD Ready Commitment, aimed to improve systems navigation within our CHC and across the broader health and social service ecosystem. Our project focused on expanding our nursing services to address significant gaps in care, reduce wait times, and enhance the quality of service through nurse-led programming. By building RN capacity and implementing robust systems navigation tools and practices, we aimed to streamline care, improve client outcomes, and share our learnings with other CHCs across Canada.

Key components of our SNAP Project included:

• Expanding Outreach Services: We’ve increased our outreach efforts, providing more comprehensive and accessible care to our clients in need, meeting them where they are and collaborating with them as partners in their health journey.
• Enhanced Immunization Programs: We’ve solidified our immunization framework, ensuring that clients receive necessary vaccinations in a timely and efficient manner. This structured approach has eliminated previous issues of supply shortages, ensuring readiness and reliability, and emphasizing a trauma-informed, strengths-based approach.
• Medication Support Collaboration: Collaborating with the TEA team, we’ve enhanced our medication support services, ensuring clients have consistent and reliable access to their medications. This includes streamlined processes and improved coordination among healthcare providers, ensuring supports where clients need it most.
• Opioid Agonist Therapy (OAT) Capabilities: We are expanding our OAT services to ensure they do not rely on a single provider, thereby improving access and continuity of care, and integrating two-eyed seeing by combining Indigenous knowledge and Western practices.
• New Patient Intakes and Expanded Services: We are continually taking on new patients and expanding services such as STI and contraceptive management, high-risk TB screening, flu and COVID-19 boosters, and specialty population immunizations. Our planning includes the potential addition of Mpox vaccinations, always keeping client-centered care at the forefront.
• Group Medical Visits (GMVs): Initiatives like the perinatal GMV in collaboration with Natsoolyis’ have had their successes and challenges. We are also preparing to launch a diabetes GMV, which will offer comprehensive support and education for managing diabetes, fostering a relational approach and empowering clients.
• Annual Nursing Diabetes Visits: We have started conducting annual nursing diabetes visits, ensuring comprehensive care and follow-up for our clients with diabetes, incorporating their life goals and lived experiences into care plans.
• Improved Administrative Processes: We’ve revamped our ordering and stocking processes, ensuring that supplies are adequately managed and available when needed. This has greatly improved our efficiency and service delivery, ensuring we meet our clients’ needs effectively.
• Complex Wound and Frostbite Care: Increased competence and confidence in handling complex wounds and frostbite through enhanced training and new tools have been significant achievements. This includes establishing effective treatment protocols and ensuring high standards of care, always in collaboration with our clients.
• Expanded Roles and Training: We’ve carefully redefined roles, hired, and trained new graduates, and enhanced training programs. Notable certifications include TNCC and ENPC, and three of our nurses have completed their contraceptive management (CM) prescriber courses, supporting our commitment to two-eyed seeing and holistic care.
• Client Feedback and Arts-Based Engagement: We have led arts-based client feedback sessions and developed informational booklets, incorporating client input to improve our services, ensuring that our care is relational and strengths-based.

These initiatives under the SNAP Project aimed (and continue) to create a sustainable model for nurse-led, client-centered care. By enhancing our systems navigation capabilities, we strive to offer more timely and effective care, ultimately leading to better health outcomes for our communities. Sharing our experiences and learnings with other CHCs across Canada, we hope to contribute to broader improvements in healthcare delivery nationwide, always honoring the wisdom and strengths of our clients.

Question 3: Why was it important to expand the current Nursing services in order to have robust, high-quality nurse-led programming that met clients’ needs to reduce the extensive waitlist and streamline care?

Expanding our nursing services was crucial due to a significant shortage of clinic providers and an extensive waitlist. By developing high-quality nurse-led programming, we can provide same-day, drop-in, and outreach services, gradually reducing wait times and ensuring that those who are most in need, receive the support and services when needed. This approach allows us to utilize the full scope of nursing practice, ensuring clients receive timely, culturally safe, and trauma-informed care. It also alleviates the burden on other healthcare providers, streamlining care and improving overall service delivery.

Question 4: What has the impact of your SNAP project been?

The SNAP project has already made significant strides in improving access to care and enhancing the quality of services that RNs and our team’s doula provides. We have established and continue to expand our new nurse-led clinics for various health needs, including sexual health, immunizations, chronic conditions management, TB, and more. Additionally, our initiatives are starting to identify gaps in effective data collection so we can focus on RN-led data collection and evaluation. We have streamlined our administrative processes and improved training and competency among our nursing staff. These changes have resulted in more efficient care delivery and positive feedback from clients who appreciate the increased availability and quality of services.

Question 5: What have been the challenges around your respective SNAP Projects?

One of the main challenges has been managing the extensive changes and expansions within the existing capacity of our team. Ensuring that all staff are adequately trained and comfortable with new procedures has required a humanizing approach, time, and resources. Additionally, coordinating with various teams and managing the logistics of new programs has been complex. There have also been challenges in maintaining a high level of service while implementing these changes, especially given the high demand for care and the existing waitlist. Considering decolonizing data collection methods and Indigenizing evaluation approaches that center the experiences of our clients and our team, while empowering nurses’ voices in their own work, continues as a significant goal moving forward. This can often lead to challenging the status quo within our own organizational context.

Question 6: What impact do you hope your evaluation and increased support will leave for clients in the long term?

While we continue on this integral path, in the long term, we hope that ongoing RN-led evaluation and the increased support will lead to sustained improvements in access to care and client outcomes. By establishing robust nurse-led programs and eventually, enhanced effective systems navigation tools, we aim to create a more responsive and efficient healthcare environment. This will not only reduce wait times and improve the quality of care but also empower clients to take an active role in their health management. Ultimately, we hope to contribute to a healthier, more equitable community.

Question 7: How do you hope to continue to sustain your SNAP project? Would more funding allow for your project to continue?

This work continues and will continue to be a work in progress. We plan to sustain our SNAP project by continuously evaluating and refining our programs based on client feedback and strengthening our Nurse-led outcomes data collection and analysis. By building strong partnerships within the community and advocating for continued funding, we aim to secure the resources needed to maintain and expand our initiatives. Additional funding would be instrumental in further developing our nurse-led programs, enhancing training opportunities, and scaling successful practices to benefit more clients.