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Tiers of Service

Enhancing systematic service planning for B.C. hospitals.

The Tiers of Service framework details the interconnections between various clinical services, their distinct levels (i.e. tiers), and the necessary resources to facilitate seamless collaboration within hospitals and health centres.

What is the Tiers of Service framework?

Tiers of Service represents a systematic and collaborative approach to service planning within British Columbia's hospitals. This initiative establishes a unified understanding and a shared language for describing clinical services.  

The framework’s overarching objective is to enhance service coordination and planning, ensuring our ability to effectively address the diverse needs of patients, now and in the future. 

Ensuring access to the right care 

Understanding how clinical services interconnect is key to ensuring patients and their families can access the right level of care. Across B.C., hospitals and health centres provide access to more than 50 clinical services — in areas such as critical care, general surgery, medical imaging, pharmacy, emergency, lab and pathology, and more.  

Tiers of Service is one tool to help enhance equitable service distribution and access for patients, by describing how clinical services connect to each other and fit within clinical networks and the broader health system. 

Guiding decisions with Tiers of Service 

The establishment of the provincial Tiers of Service framework is being led by PHSA, in partnership with Ministry of Health, health authorities, and provincial partners. Tiers of Service will provide insights to inform decision-making related to capital planning, redevelopment, expansion of services, and more.  

Initially, the Tiers of Service framework is being developed for hospital inpatient and outpatient services, with the potential to expand beyond the hospital in subsequent phases. The aim is to foster a cohesive partnership among all clinical services across B.C., ensuring that they work together to serve the needs of our patients. 

Understanding the Tiers

Our process begins by partnering with clinicians and health-care leaders across the province to clearly define each clinical service through a common language, the six tiers. Tier 1 represents the broad, comprehensive services found in many hospitals, with increasing specialization up to Tier 6, which entails high-complexity subspecialized services requiring coordination among multiple specialty teams often found in only a few hospitals.  


This tiered approach enhances our shared understanding of the diverse clinical services within our hospitals and health centres, enabling us to customize our efforts to meet specific needs at every tier.  

Tiers of Service development & planning 

Define clinical services across six tiers to better understand the service scope, requirements and interconnections with other clinical services in B.C.  Over 50 clinical services are anticipated to take part in this exercise.  

Identify the clinical services offered at each hospital and health centre, specifying their respective tiers.  


Assess the alignment of services with population growth projections and clinical utilization data to ensure proper positioning and accessibility for patients and communities. 


Develop long-term strategies and system investments, addressing identified gaps through collaborative planning over multiple years with Ministry of Health and health authorities. This phase may include capital planning or redevelopment, as necessary. 

Frequently asked questions 

Explore the FAQs below for quick answers to common queries about the Tiers of Service framework. Get insights on its development, benefits, and how it enhances planning across clinical services in B.C. 

The Tiers of Service framework draws inspiration from work completed in B.C. and other jurisdictions, most notably New South Wales. Comparable planning frameworks have been utilized in regions like Queensland, Western Australia, and the United Kingdom since the mid-1980s. Western Australia, for instance, employs its clinical services framework as a foundational element in planning its health system, including for 10 years into the future, serving as a reference point for workforce and infrastructure requirements and integrating new technologies.  

The Tiers of Service framework will serve as a strategic guide, outlining how B.C. will deliver clinical services in upcoming years. It will act as a benchmark, aiding in identifying workforce and infrastructure needs. These valuable insights will pave the way for a sustainable health system that effectively meets the needs of patients and accommodates population growth, ensuring optimal healthcare outcomes. 

Tiers of Service is most effective as a tool to support hospital system and service planning when coupled with complementary methodologies. These include analyzing population growth projections, assessing clinical service utilization rates, studying referral patterns, addressing calls to action from foundational reports, and consulting with Indigenous peoples, patients, and communities.  

The Tiers of Service framework has previously been used in B.C. for specific service areas. The success of the Tiers of Service approach for specialized service planning within programs like BC Cancer, Trauma Services BC, Child Health BC, and Perinatal Services BC underscores its inherent value. Building upon these learnings, a provincial Tiers of Service framework is being developed to encompass all clinical services within hospitals, including vital areas like emergency, critical care, medical imaging, pharmacy, lab & pathology, and more.  

Previous Tiers of Service modules have included detailed requirements that expand beyond service delivery and support operational planning across many domains. These population or service-specific modules have been instrumental in identifying site-based, regional and provincial opportunities that have enhanced care delivery across B.C. It is important to note that the provincial approach to Tiers of Service does not invalidate these modules or the opportunities they've illuminated. Ongoing clinical service planning remains essential.  

Developing a provincial Tiers of Service framework encompassing all hospital-based clinical services facilitates a systemic approach. This framework offers one new tool to help make decisions regarding capital planning, redevelopment, and coordinated service expansion. It serves as a guiding structure, ensuring informed and cohesive strategies across B.C.'s health-care landscape. 

Initially, the Tiers of Service framework is proposed for hospital inpatient and outpatient services, with the potential to expand beyond the hospital in subsequent phases. Within the hospital setting, it is essential to emphasize that the Tiers of Service framework does not seek to encapsulate the entirety of clinical services. Instead, it delineates the most prevalent and commonly encountered clinical services. 

Each clinical service area under the Tiers of Service framework will have a dedicated "module" to outline its clinical scope, service requirements, and interdependencies. These modules are crafted by provincial working groups of expert clinicians and leaders, with input from partners across B.C.

Module development is underway for an initial group of "core" clinical services, which have many interdependencies with other clinical areas: emergency, pharmacy, critical care, medical imaging, surgery (anesthesia and operating suite), and lab and pathology. As phase 1 progresses, more provincial working groups will be established as additional clinical areas are invited to participate.
Given the ever-evolving landscape of clinical innovations and  models of care, modules will be regularly refreshed to accurately reflect the changing dynamics of hospital-based clinical services.  
The Tiers of Service framework and Patient Classification Levels/Acuity Tools (such as Emergency CTAS guidelines, Maternal/Neonatal Daily Classification Tools, Mental Health Stepped Care Model, etc.) serve distinct yet complementary roles in care delivery.  

Patient Classification Levels/Acuity Tools are designed to categorize patients based on their specific care requirements at any given time. These levels/tools support, care planning, communication and decisions to escalate care and transfer patients. Notably, these tools often remain consistent across the various tiers, although higher tiers may incorporate refinements specific to the subspecialty service. 

On the other hand, the Tiers of Service framework describes the clinical services available for patients at a specific level (i.e., tier of service), who is required to deliver these services, and what resources are essential to support care delivery. 

While Patient Classification Levels/Acuity Tools focus on characterizing individual patient needs, the Tiers of Service framework concentrates on the overarching organization of hospital-based services. Both are essential, each serving a specific role in ensuring efficient health care delivery. 

By offering a common language to describe clinical services, the Tiers of Service framework helps guide our long-term health system and service planning. It enhances our shared understanding of each hospital's clinical service scope, confirms whether the hospitals meet responsibilities and requirements, and identifies interdependent clinical services. 

SOURCE: Tiers of Service ( )
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