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Tiers of Service

Systematic approach to 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?

The primary goal of the framework is to establish a unified understanding and a common language for describing clinical services. The overarching objective is to enhance the coordination of services, ensuring a comprehensive approach that optimally meets the diverse needs of our patients.  

Ensuring access to the right care 

Ensuring that patients and their families can easily access the right level of care is essential. Understanding how clinical services fit within clinical networks and the broader health system is key to ensuring equitable distribution and access. 

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 proposed 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 collaborating 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, and moves up to Tier 6, which entails high-complexity subspecialized services requiring coordination among multiple specialty teams often found in only a few hospitals.  

The framework extends across the entirety of clinical services within hospitals, including vital areas such as emergency, critical care, medical imaging, pharmacy, lab & pathology, and more.  

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This tiered approach ensures a detailed 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 application, benefits, and how it enhances health care coordination across clinical services in B.C. 

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. 

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. 

 

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 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, PHSA intends to broaden the application of Tiers of Service to encompass all clinical services within hospitals, including critical areas like emergency care, 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 aids in shaping decisions regarding capital planning, redevelopment, and coordinated service expansion. It serves as a guiding structure, ensuring informed and cohesive strategies across BC's health care landscape.

Provincial working groups will be established for each clinical service, tasked to define modules that outline tier-specific clinical scope, responsibilities, workforce, equipment and space requirements, along with interdependent services. These groups will include key partners from across B.C., encompassing various disciplines, geographic areas, and experiences (15–20 people). Given the ever-evolving landscape of clinical innovations and evolving models of care, these modules will be regularly refreshed every three years or more frequently as needed to accurately reflect the dynamics of hospital-based clinical services.  

By offering a common language to describe clinical services, the Tiers of Service framework guides our system. It ensures an understanding of each hospital's clinical service scope, confirms whether the hospitals meet responsibilities and requirements, and identifies interdependent clinical services.   


Hospitals may occasionally be required to provide services outside of their planned tier (for example, in rural and remote areas). Higher-tiered services play a role in supporting other sites through clear clinical relationships and networks that provide clinical advice, assisting with: 


  • Developing clinical guidelines  
  • Making training and educational opportunities available  
  • Participating in collaborative care arrangements  
  • Providing clinical services such as outreach clinics (face-to-face or virtual) 
  • Participating in clinical review meetings
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. 

For any questions, please reach out to: TiersofService@phsa.ca   


Tiers of Service took shape in British Columbia through population-focused clinical services like BC Cancer, Child Health BC, Perinatal Services BC, and Trauma Services BC, among others. Clinicians and health care leaders formed provincial working groups to define service and operational requirements to better serve their particular patient groups. This collaborative effort fostered discussions that encompassed care pathways, resource allocation, and clinical responsibilities that were essential across different care settings. These discussions aimed to ensure comprehensive planning and effective coordination within their clinical service in support of patients. 

This service planning approach gained momentum for its effectiveness, prompting more clinical services to adopt it. As demand grew, Tiers of Service became widely embraced as a framework that could address system-wide challenges. Its adoption reflects a shared understanding of the benefits it brings to effective service delivery. 

Today, the Tiers of Service framework draws on the learnings gathered from clinical services that adopted a similar approach within B.C. and around the world. It extends its reach to encompass all clinical services, aiming to establish a unified provincial framework that illustrates how each clinical service fits into both clinical networks and the broader health system. 


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