Enhancing systematic service planning for B.C. hospitals.
The Tiers of Service framework is a planning tool that details the interconnections between various clinical services, their distinct levels (i.e. tiers), and the resources needed to facilitate collaboration within hospitals and health centres.
Tiers of Service represents a collaborative approach to service planning for British Columbia’s hospital system. This initiative establishes a unified understanding and a shared language for describing clinical services across diverse hospitals and health centres—from rural and remote communities to urban settings.
The framework’s overarching objective is to enhance service coordination and planning, to effectively address the diverse needs of patients, now and in the future.
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 more than 50 clinical services — in areas such as critical care, medical imaging, pharmacy, laboratory medicine and more. The Tiers of Service framework is a tool to enhance equitable service access by helping us better understand how services are distributed across the province and how services fit within clinical networks.
The establishment of the provincial Tiers of Service framework is being led by PHSA, in partnership with the Ministry of Health, health authorities and provincial partners. Insights from Tiers of Service will inform decision-making related to system investments, 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 system in the future.
As health systems worldwide face unprecedented resource challenges, planning hospital services thoughtfully and in a coordinated manner has become more important than ever.
The six tiers provide a common language to clearly define clinical services at every hospital and health centre across B.C.
Tier 1 represents the broad, comprehensive services found in many hospitals. Each level is increasingly specialized up to Tier 6, which entails highly complex, subspecialized services requiring coordination among multiple specialty teams often found in only a few hospitals.
The Tiers of Service framework unifies 50+ distinct clinical services into a cohesive structure. Each clinical service — such as emergency, maternal/fetal and stroke — is outlined in a ‘module’ that defines its specific scope, minimum workforce requirements, networked supports and interdependent services in up to six tiers. Modules are developed under the guidance of B.C.'s clinicians and leaders, with contributions from provincial partners within each clinical service area.
Module development is completed or underway for a growing number of clinical service areas.
Each module will be integrated into the Tiers of Service framework, by detailing how the clinical services connect to each other, and fit within clinical networks and the broader health system.
Given the dynamic nature of clinical innovations and models of care, engagement with clinicians and partners will continue over time to regularly update modules and ensure the framework remains responsive to the evolving health-care landscape.
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.
Explore the FAQs below for quick answers to common queries about the Tiers of Service framework.
The framework draws inspiration from work in B.C. and other areas around the world, notably
New South Wales where a similar approach has been in use since the mid-1980s. Comparable planning frameworks have been used in regions such as Australia, the U.K., Scotland, Ireland and Dubai. Western Australia, for instance, has used its clinical services framework for decades as a foundational tool for health system planning, including integrating new technologies, considering workforce and infrastructure requirements, and creating long-term plans.
Tiers of Service approaches have already been used in B.C. for specific clinical service areas. The success of Tiers of Service for specialized service and operational planning within programs (e.g. BC Cancer, Trauma Services BC, Child Health BC, and Perinatal Services BC) underscores its value. Building on what has been learned, B.C.’s provincial framework will encompass more than 50 clinical services for all ages within hospitals.
Initially, the Tiers of Service framework is being developed for hospital inpatient and outpatient services because evidence from other jurisdictions suggests this methodology is particularly well-suited to hospital and health centre settings. Rather than encompassing all clinical services within hospitals, the framework focuses on those most commonly provided and/or most likely to have clinical interdependencies.
The Tiers of Service framework plays a distinct yet complementary role to patient classification levels or acuity tools (such as Emergency Canadian Triage and Acuity Scale guidelines, Maternal/Neonatal Daily Classification Tools, the Mental Health Stepped Care Model and so on).
Patient classification levels/acuity tools categorize patients based on their presentation at the time of the assessment (supporting care planning, communication, and decisions to escalate care). Patients may require transfer to a higher-tier service for more specialized, definitive or higher-level care.
In contrast, the Tiers of Service categorizes clinical services into levels (tiers) based on scope of service, the resources needed to deliver care (such as workforce requirements), and interdependencies with other services. Each tier sets the minimum expectation for service delivery at that level.
In a nutshell, patient classification levels/acuity tools focus on characterizing individual patient needs, while the Tiers of Service framework concentrates on the overarching organization of hospital-based services.
The initial output of the Tiers of Service framework will be a tiered map of clinical services and their locations, offering valuable insights into how services are distributed across the province. Mapping will be a participatory process involving health system leaders and professionals across B.C.
This hospital-mapping exercise will serve as a key reference for the Ministry of Health, health authorities, and provincial partners to support service planning and decision-making, alongside other important factors such as population growth and clinical service utilization rates.
Clinical service planning requires a commitment to confront systemic racism and redress the impacts of colonialism, ensuring Indigenous peoples’ right to culturally safe, racism-free health care, as outlined in the Declaration on the Rights of Indigenous Peoples Action Plan.
Tiers of Service is currently in its initial planning stage, developing 50+ clinical service modules that will be integrated into the provincial framework.
From the outset of this work, provincial partners such as First Nations Health Authority, Rural Coordination Centre of BC, and PHSA Indigenous Health have been involved in crafting the framework’s guiding principles and foundational assumptions.
Importantly, the framework’s clinical service modules incorporate Indigenous-specific requirements — such as creating welcoming environments, accommodating chosen supports, and providing cultural competency training for providers. These elements are guided by foundational calls to action and are integrated alongside education/training and research. Flexibility is built into the modules, allowing service providers to adapt to local conditions and incorporate virtual care where appropriate.
Once the modules are integrated and approved for use, clinical service planning using the Tiers of Service framework should involve collaboration between the local health authorities or government health planners, and Indigenous partners and communities. This approach aims to improve access to culturally safe and appropriate services for all citizens in B.C.
