Current State of Health Centre Operations
Getting familiar with the ‘current state’ of your health organization can help you to be an informed leader.
Health Directors have identified that the following “core elements” of health management will support new Health Directors to get a solid grasp of how the health organization is structured and how it is functioning.
You are encouraged to consider these core elements as directional signage for navigating the systems, processes and guidelines that define how the organization operates, makes decisions and manages its resources.
As you review each of the core elements, take note of strengths and areas that may benefit from more attention and focus.
If you discover areas that may benefit from more focus and attention (e.g., reports are not up-to-date or the organization has a consistently identified unmet wellness need), note them down. You don’t need to solve the issues immediately, however, they should be tracked for follow-up.
A “Notes” section has been included at the back of this Orientation Guidebook for you to keep track of things you might like to come back to later.
You don’t need to know these core elements of health management in detail, but you will be well positioned if you recognize their importance, know the highlights about each AND where you can go to get more information if needed.
The core elements can be organized into four groupings of related topics. The following pages will delve into each of these elements in greater detail.
Planning and Evaluation
Programs and Service Delivery
Quality & Safety
Human Resources
Planning and Evaluation
The Planning and Evaluation core elements are helpful for setting the direction of the health organization as it navigates ever-changing conditions.
Community Health Plan and Strategic Plan
The Community Health Plan is a valuable resource that identifies health organization priorities. Some communities may have a separate health strategic plan, however, for most communities, the Community Health Plan serves as the health strategic plan.
The Community Health Plan sets the direction for the health organization and is typically informed by a community engagement process and takes into consideration current health trends as well as partnership opportunities with other health providers. It reflects the community’s health and wellness vision, priorities, goals, objectives and its plan for monitoring and evaluating progress and sharing the results of health and wellness service delivery. Some may also include a budget.
Communities may have two versions of the Community Health Plan: a community facing version (high level and easy to read) and a technical version (more detailed).
Having the Community Health Plan at your fingertips will help you to navigate your health organization’s journey in a community-informed way.
Health organizations typically use a Community Health Plan to guide the delivery of health services. If the health organization has a contribution agreement with the FNHA, a Community Health Plan may be one of the requirements to maintain funding. If your health organization does not have a current Community Health Plan or you are unable to locate one, consult with your FNHA Funding Advisor. For communities without FNHA funding agreements (e.g., self-governing communities or communities whose health funds flow through an umbrella organization), you may reach out to an FNHA Funding Advisor to discuss ways to locate a copy of your funding agreement and/ or a copy of your Community Health Plan if one has been developed.
Check this box when you have obtained a copy of your health organization’s latest Community Health Plan or when you have connected with your FNHA Funding Advisor about the Community Health Plan.
Helpful Resources & Links
First Nations Health Authority (2019), Health and Wellness Planning: A Toolkit for BC First Nations:
To learn more about Community Health Plan development, access the “Community Health and Wellness Planning” resources on the First Nations Health Directors Association Website:
Reach out to a fellow Health Director
Operational Planning (Annual Work Plans)
Operational plans, sometimes known as ‘work plans’ are completed annually to support program and service planning for the upcoming fiscal year. Operational plans can include setting annual goals, setting objectives, planning activities to achieve the objectives, identifying who is responsible to carry out the activities, identifying success indicators, and identifying associated costs. When developing work plans, programs and services are encouraged to review the Community Health Plan to ensure that planned activities support the strategic priorities. Health Directors review and approve annual operational plans, and when doing so ensure that there is an adequate budget to carry out the identified activities.
Not all health organizations consistently complete annual operational plans.
Does your health organization complete annual operational plans (work plans)? ________________
If yes, check this box when you have accessed copies of the latest operational plans (work plans) for the programs and services of your health organization.
As the Health Director, you are encouraged to develop your own operational plan for the first year in your position. Operational plans can take many different forms. Below is an example of a Health Director operational plan for one goal.
Helpful Resources & Links
FNHDA “Funding and Financial Management and Budgeting Guidebook”
Reach out to a fellow Health Director
Operational Reporting (Internal)
Organizations that develop operational plans (annual work plans) typically have an established written reporting structure to give formal progress updates to the Health Director. Reports can include information such as celebrations & successes, program participation statistics, identified barriers for achieving goals and next steps for the upcoming reporting period.
Operational reporting can occur monthly, quarterly or semi-annually.
In many health organizations, Health Directors are required to provide operational reports to their supervisor and/ or to report directly to the organization’s governing body. Operational reports from program areas are then used to develop the health organization’s overall operational report.
Does your organization require regular operational reporting? (Circle)
Yes No
If “Yes” how often are operational reports required to be submitted? ______________________
If “Yes”, check this box when you have accessed copies of the latest work plans.
Capital Planning
Capital planning is a finance term that refers to the intentional planning for the purchase, upgrade or replacement of major equipment or building structures.
Some health organizations renew their 5-Year Capital Plan each year. The FNHA does not require communities to submit a 5-year capital plan, however, it may be a requirement for the financial audit or Indigenous Service Canada (if your building is a Nation/ Band owned building).
Maintaining an up-to-date capital list helps with accurately prioritizing the timing and budgeting for capital expenditures.
Capital planning may be done together with others in your organization, such as your public works or finance departments.
Check this box when you have obtained a copy of your health organization or community Capital Plan.
Check this box when you have accessed the most recent building assessment reports for your health organization (including special reports such as seismic assessments).
From time-to-time the FNHA supports health organizations to conduct building assessments to assist with capital planning. The FNHA Health Infrastructure and Development team is a resource to support health organizations with planning next steps to repair and replace items which may be identified through the capital planning process.
If your organization does not have a Capital Plan developed, you can reach out to the FNHA Health Infrastructure and Development team for assistance to get one started.
The FNHA has an intake process when a capital need is identified. The Health Infrastructure team can be reached at to discuss your requirements. They are also a resource for emergency operations and maintenance repairs to health buildings.
What are some of the most urgent capital items in need of purchase, upgrade and/ or replacement for your organization and their estimated costs?
Helpful Resources & Links
FNHA Health Infrastructure and Development –
FNHDA “Funding and Financial Management and Budgeting Guidebook”
Reach out to a fellow Health Director
Emergency Management Planning
Emergency preparedness planning allows teams to come together to plan and to practice their response to emergency scenarios. This results in quicker, more effective responses to actual emergencies—increasing the likelihood of safe outcomes for staff and clients.
Examples of emergency plans include:
Fire Manual
Emergency Response Plan
Communicable Disease Control Plan (Pandemic Plan)
Code White Policy
Suicide Prevention and Intervention Response Policy
At the service-delivery level, identifying your local health centre standard practices for managing day-to-day urgent needs (e.g., fire planning, injury in the workplace, emergency medical situations in the health centre) will support you to safely care for staff and community members in unexpected situations.
Emergency preparedness planning also involves collaboration and coordination with other organizations such as the Nation/ Band, first responders, local municipality, neighbouring communities, regional health authority, First Nations Health Authority, First Nations’ Emergency Services Society, Emergency Support Services, etc.
As part of your orientation, you are encouraged to locate the emergency management planning resources that exist within your health organization.
Check when you obtain a copy of your Fire Manual for your health organization.
Check when you obtain a copy of your Emergency Response Plan for your health organization.
Check when you obtain a copy of your Communicable Disease Control Plan (Pandemic Plan) for your health organization.
A valuable resource for you to learn more about emergency management is the FNHDA “Emergency Management Planning Guidebook”. Contact the FNHDA Team for this resource.
Health organizations, being closely connected with the communities they serve, may form part of the Nation/ Band emergency preparedness plans. Making connections with the Emergency Management Department or Emergency Management Coordinator(s) at the community you work with will help ensure your health organization has considered all aspects of emergency management planning.
Essential contacts related to emergency management may include:
911 or local emergency lines (police, fire department, ambulance)
Emergency Management Department or Emergency Management Coordinator(s) for the community that you work with
Your FNHA Region emergency management contacts
Regional Health Authority emergency management contacts
Provincial Emergency Service contacts (Emergency Support Services, Canadian Red Cross, etc.)
Emergency Management BC
Be sure to add all essential contacts related to emergency management to your Key Partners contact lists on pages 76 – 79.
See the “Emergency Management Planning Guidebook” for more information regarding Emergency Management Planning.
Helpful Resources & Links
FNHDA “Emergency Management Planning Guidebook”
First Nations Health Authority (2025), Communicable Disease Control:
Reach out to a fellow Health Director
Communication Plan
Maintaining strong connections with staff, community, health organization partners, and funders is supported by regular, planned communication from the health organization.
Many health organizations have developed a communication plan that outlines:
Who to communicate with (e.g., staff, community, partner organizations, funder, etc.)
What to communicate about (e.g., health organization updates, required reporting, etc.)
Why to communicate (e.g., the desired outcome of the communication strategy)
When to communicate (e.g., annual, monthly, weekly, etc.)
How to communicate (e.g., website, email, social media, in-person, closed-circuit television, local radio station, etc.)
Check this box when you have obtained a copy of the Communication Plan.
If a communication plan does not exist, explore how information from the health organization is communicated and determine who (if anyone) are the designated point-persons for disseminating communication on behalf of the health organization. Build on existing communication pathways. Where they do not exist, consider ways to establish regular, clear concise communication pathways.
What are the main ways that your health organization shares information with the following:
Staff: ________________________________________________
Community Members:________________________________________________
Partner Organizations:________________________________________________
Funders:________________________________________________
Other Relevant Plans and Reports
Each health organization may have access to additional plans and/ or reports that provide valuable insights to inform a better understanding the current state of affairs. Examples of such plans and reports include Comprehensive Community Plans, strategic plans from other Nation departments or community organizations, needs assessments, regional health survey data, findings and recommendations from inquiries.
What other relevant plans and reports are available to inform your understanding of the current situation?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Funding, Financial Management and Budgeting
Learning the current financial state of your health organization requires an investment of time and collaboration with others who are more familiar with your health organization’s finances. Arranging time with your Finance Manager and the FNHA Funding Advisor can be an efficient and effective way to learn the particulars of your health organization’s financial situation. As appropriate for your health organization, get to know your auditors (if your health organization does an annual audit).
Your Finance Manager is: ________________________________________
Finance Manager Contact Information: _____________________________________________________
Your FNHA Funding Advisor is: ___________________________________
FNHA Funding Advisor Contact Information: ________________________________________________
Your Auditing Firm Representative is: ____________________________
Auditing Firm Representative Contact Information: __________________________________________
The FNHDA has produced a “Funding and Financial Management and Budgeting Guidebook” that can be a helpful resource to have on hand. If you do not have a copy, reach out to the FNHDA Team.
There are several documents that will be helpful to review as you become oriented to your health organization’s finances.
Obtain a copy of your Annual Budget.
Obtain a copy of the last fiscal end-of-year financial statements.
Copies of contribution agreements and funding arrangements with FNHA and other agencies (e.g., Indigenous Services Canada, Ministry for Children & Families, special grants, etc.)
Obtain a copy of the finance policies.
Here are some questions that can start to get you more familiar with the current state of your financial situation:
When does the financial year start? (Usually it is April 1st): _______________________________
When does the financial year end? (Usually it is March 31st): ____________________________
What period is the health organization currently operating in? _____________________________
(Typically, there are 13 periods in a year)
Does the Health Director receive financial statements? ________________________________
Who produces financial statements for the Health Director? ____________________________
Are program leaders responsible for their program budgets? ____________________________
Do program leaders receive copies of their financial statements for their areas of responsibility? ______________________________________________________________________
How often are financial statements produced and distributed? _________________________
Has the annual budget been approved? _______________________________________________
Who approves the annual budget? ____________________________________________________
What is your role in the creation of the annual budget? __________________________________
What is the current financial position of the health organization? (check one)
Surplus (more income than expenses)
Deficit (operating at a loss – more expenses than income)
What are the revenue (funding) sources for your organization? _____________________________
____________________________________________________________________________________
____________________________________________________________________________________
Is your organization compliant with the contribution and funding agreements (e.g., are the narrative and financial reporting requirements up-to-date)? __________________________________________________
Are any contribution or funding agreements coming up for renewal in the next year? _____________________
Your FNHA Funding Advisor is a valuable resource for helping you determine if you are compliant with FNHA contribution and funding agreements.
Remember that if you identify shortfalls (e.g., non-compliance due to outstanding reports), you don’t need to address these right away, simply note them and consider addressing them in your first year work plan.
Staying compliant with your contribution and funding agreements places your organization in a favourable position for new funding opportunities should they become available.
Every Health Director comes with their own level of comfort and experience working with finances.
For Health Directors with less experience, there may be value in securing mentorship support to learn how to manage this part of your role. Some employers have supported their Health Director with formalized mentorship relationships—bridging this area of development until the Health Directors were comfortable doing it on their own.
Reviewing and becoming familiar with the finance policies and procedures for your health organization improves oversight and your understanding of operations. Connecting with your Finance Manager will help you to learn the internal finance activities for processing invoices, payroll and cheque requisitions, etc.
Helpful Resources & Links
FNHDA “Funding and Financial Management and Budgeting Guidebook”
First Nations Health Authority (2025), Funding Arrangements:
First Nations Health Authority, Reporting Requirements Guide:
Reach out to a fellow Health Director
Evaluation
Evaluations provide an opportunity to pause and reflect on how a health organization has been operating over a defined period. Generally, evaluations are guided by a few questions that the health organization would like answered, e.g., “Did we do what we said we would do?”, “Are our services accessible to our community members?” Evaluations include a review of written materials as well as connecting with staff, leadership, program clients, community members, Elders, youth and partner organizations who answer the evaluation questions.
Evaluation can take many forms.
One form of evaluation are annual program and service reviews of how the program performed relative to the goals as set out in the operational plan. These evaluations are typically done by the team around the time of setting the operational plan for the upcoming year. The information gathered during the review can inform Annual Report submissions from the program area.
Formal evaluations such as a program evaluation or a 5-year health centre evaluation cover a multi-year period and in many cases are performed by a person from outside the health organization in order to provide objectivity. They include a written summary of the evaluation findings along with recommended follow up actions.
Evaluation reports can be lengthy. If you don’t have time to read the whole report, focus on the executive summary and recommendations.
Your contribution agreement with the FNHA may require that your health organization complete an evaluation of Health Services every 5 years. If your health organization has not done one within the past 5 years, or you are unable to locate one, consult with your FNHA Funding Advisor. Review your contribution agreement with the FNHA to confirm the requirements related to 5-Year evaluation.
Check this box when you have obtained a copy of the last 5-Year Evaluation or confirmed that it is not required.
5-Year Evaluations can be a great place to find past information about your health organization. It may be worthwhile to locate copies of all past 5-Year Evaluations.
Helpful Resources & Links
First Nations Health Authority (2019), Health and Wellness Planning: A Toolkit for BC First Nations:
Reach out to a fellow Health Director
Programs and Service Delivery
The Program and Service Delivery core elements are helpful for understanding how your health organization is structured and the assets available to support health programs and services delivery.
Organizational Chart
A great place to start understanding the organizational structure is to review the current version of the organizational chart. Even if it is not completely up to date, it can serve as a place to begin to understand the program structure (and associated staff) and to document revisions that may be required to update it.
Check this box when you have the latest copy of the organizational chart.
Programs and Services
Health organizations offer a variety of health programs and services.
Health programs are structured initiatives that focus on specific desired health impacts over time —typically with goals, activities, desired outcomes and measurable success indicators.
Services are the direct actions or activities that address immediate needs.
Programs can have services embedded within them.
The types of programs and services offered by your health organization will depend on your community’s health and wellness priorities and the funding it receives from the FNHA, other funders, and in some cases own source revenue. The programs and services offered are unique to each community.
Your health organization will also have access to programs and services delivered by FNHA (e.g., environmental health services).
The FNHA produces a ‘programs and services’ guide that is updated every few years. It can be a helpful resource to help you understand more about expectations related to the delivery of FNHA funded programs and services. It can also help you learn more about the programs and services offered by the FNHA. The ‘programs and services’ guide is sometimes referred to as the program ‘compendium’.
The organization chart can provide some insight into how programs and services funded by the FNHA are arranged within your health organization.
If your health organization manages patient medical transportation services, take time to learn how this program generally operates as community members often ask about this program.
Another area to become familiar with is the FNHA Health Benefits program. Knowing who is eligible for this program and how community members can access it through FNHA will help you better support clients.
The FNHA offers support for Urban and Away from Home (UAH) First Nations people. Being familiar with the support they offer will be useful when you receive questions about how UAH First Nations people can be supported. Some health organizations offer support to UAH members.
What programs and services is your health organization responsible for providing?
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
What supports does your health organization offer to Urban and Away from Home members?
______________________________________________________________________________________________________________________________________________________________________________________
As you get more settled in your role, there may be a need for further program development due to new funding or community need. When this time comes, there is a valuable resource available to Health Directors called the “Program Development and Implementation Handbook” that can help to get you started. This resource can be accessed by contacting the FNHDA Team at .
Helpful Resources & Links
FNHDA “Program Development and Implementation Handbook”
First Nations Health Authority (2025), Health Benefits Program:
First Nations Health Authority (July 14, 2023), Programs and Services (2023/2024):
Reach out to a fellow Health Director
Organization Tangible Assets
Every organization has tangible assets (also known as capital assets) that they either own or lease. Knowing the organization’s tangible assets can give you insight into the organization’s scope of responsibility. Examples of tangible assets include the land and buildings where programs and services are delivered, staff housing, vehicles, and clinical information systems.
List some of the tangible assets that your organization owns or leases:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Work together with your finance manager to understand the tangible assets of your organization that support program and service delivery including their life expectancy and maintenance requirements.
Helpful Resources & Links
FNHDA “Funding and Financial Management and Budgeting Guidebook”
Quality & Safety
The Quality and Safety core elements are valuable for supporting the safe delivery of services that meet the ever-changing health care needs of community members.
Models and Frameworks Used
Models and frameworks are tools for creating a shared understanding of a concept such as an organizational structure, an approach to health service delivery or the organization’s values and beliefs. Typically, these models are graphic images accompanied by written text that describes the model or framework.
An example of a model is the FNHA First Nations Perspective on Health and Wellness,pictured here:
What (if any) frameworks or models does your organization use?
________________________________________________
________________________________________________
________________________________________________
Committee Structure Within Your Organization
Committees are ongoing meetings of designated people within an organization coming together for a defined purpose.
The details of the committee structure such as the purpose, committee members, frequency of meetings, quorum, committee responsibilities, etc. are often outlined in a Terms of Reference.
Each health organization has a unique committee structure while some health organizations have no committees at all.
Examples of some common committees include:
Occupational Health and Safety Committee
Quality Committee
Program Advisory Committee
Cultural Advisory Committee
Nursing or Health Professionals Committee
Infection Prevention and Control Committee
Accreditation Committee
What committees exist within your organization?
The Health Director may also be involved in external working groups and committees, see page 73 for more details.
Policies and Procedures
Policies and procedures are valuable resources for defining the expectations related to the day-to-day operations of the health organization. Some general areas that policies and procedures are commonly seen in health organizations include:
Administration
Health and Safety
Human Resources
Finance
Clinical Practice
Infection Prevention and Control
Governance
What policies and procedures have been developed for your health organization?
_________________________________
_________________________________
_________________________________
_________________________________
Some health organizations are required to adhere to the policies and procedures of other entities (e.g., Nation/ Band, British Columbia Centre for Disease Control, etc.)
What other policies and procedures is your health organization required to follow?
_________________________________
_________________________________
Helpful Resources & Links
FNHDA “Policy Making Guidebook”
Reach out to a fellow Health Director
Quality Improvement
Quality improvement can be defined as the continuous and ongoing efforts of a health organization to provide health services in a better way.
Every health organization has its own approach to quality improvement.
A starting place for making improvements is to be open to hearing about what improvements can be made. Opportunities for improvement can be identified through feedback from community members and staff, from system reviews and audits, or simply from observations in the work environment.
The health organization then responds by taking intentional steps learn more about the challenging situation, consider solutions, try them, learn from what went well, and then implement a new approach.
The First Nations Health Authority has developed the “BC First Nations Perspective on Quality” and the “First Nations Pathway for Quality Improvement” resources which provide valuable information about quality and a First Nation informed approach to quality improvement. This may be a valuable resource if quality improvement is a newer concept for you.
What model for quality improvement has your health organization adopted (if any)? ____________________________
Staff tend to forget the many quality improvement successes that they have implemented in the day-to-day business of health organization operations. From a strengths-based perspective, there is value in shining a light on these successes to acknowledge the progress that has been made by the health organization.
What are some recent quality improvement initiatives that your health organization can celebrate?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Many health organizations strive to meet the national accreditation standards. The premise of accreditation is to enhance quality and safety in health organizations. (More on accreditation below on page 46).
Helpful Resources & Links
First Nations Health Authority, BC First Nations Perspective on Quality:
First Nations Health Authority, First Nations Pathways for Quality Improvement:
First Nations Health Authority (2025), Community Accreditation and Quality Improvement:
Reach out to a fellow Health Director
Risk Management
Hazards, Harm and Risk Control Planning
Risk management is the work that the health organization does to reduce or eliminate the likelihood of harm coming to staff, clients, or the health organization.
Harm can come in many forms such as physical injury, psychological trauma, loss of health organization assets or health organization reputation.
To reduce the potential for harm, health organizations can proactively try to identify hazards in the work environment. Hazards are things that have the potential to cause harm.
Once hazards have been identified, the health organization can create a risk control plan to remove or reduce the potential that harm will come to staff, clients or the organization. Focus on the hazards that are more likely to happen and/ or could cause the greatest harm.
Has your organization developed a Risk Management Plan by identifying hazards and putting controls in place?
Obtain a copy of your health organization’s Risk Management Plan.
An important part of risk management is becoming aware of unusual incidents that either caused harm or fortunately did not cause harm and were a near miss. Incident reporting is a non-punitive reporting process that allows for the documentation and tracking of unusual incidents.
Incident Reporting
Incident Reporting raises awareness of hazards and allows for the organization to put in place control measures to reduce the risk of harm or eliminate it entirely.
Check this box when you have obtained a copy of your Risk Management, Incident Reporting, and Disclosure of Harmful Incident policies.
It is important for you to understand what your role is should an incident occur that results in an adverse outcome.
What is your role for following up with reported incidents?
________________________________________________________________________________________
Where is documentation associated with reported incidents stored so that others do not have access to it?
________________________________________________________________________________________
Insurance
As the Health Director, it is important for you to be aware of the insurance coverage for your health organization, when to submit a claim, what information is needed to submit a claim, and who submits the claim on behalf of your health organization.
Check this box when you have confirmed that your health organization has an active insurance policy and you have received a copy of the policy.
When should a claim be submitted?
________________________________________________________________________________________
What information is needed to submit a claim?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Who submits claims on behalf of your health organization?
________________________________________________________________________________________
Accreditation
Increasingly more BC First Nations health organizations are taking the journey of becoming ‘accredited’. Being ‘accredited’ means that a health organization has demonstrated that it meets national standards for health centre operations as set by a national accrediting body such as Accreditation Canada or Canadian Accreditation Council. As part of becoming accredited, health organizations invite outside surveyors to do an on-site survey approximately every four years. The health organization receives a report and letter outlining the results of the site visit and any required follow-up activities.
Becoming an accredited organization is voluntary.
Is your health organization accredited or has it been accredited in the past? YES NO
Who (if anyone) has been designated as the Accreditation Champion or Accreditation Lead? _____________________________________
If your organization is accredited:
Obtain a copy of the last site visit report and any subsequent letters from the accrediting body.
When does the accredited period expire? __________________________________
It is common to have time-sensitive deadlines for meeting outstanding items identified during the last site visit – these would be outlined in the accreditation report and letters about the site visit from the accrediting body.
Are there any conditions for being accredited (e.g., follow-up reports or a follow-up site visit)?
_________________________________________________________________________________________
If you do not know the answers to this question, reach out to the accrediting body to introduce yourself and learn about your organization’s accredited status.
Helpful Resources & Links
First Nations Health Authority (2025), Community Accreditation and Quality Improvement:
Reach out to a fellow Health Director
Cultural Safety and Humility
Cultural safety is an ongoing process that supports people to feel safe and respected when accessing services at your health organization or working for your health organization. It applies to both staff and clients.
Some ways to embody cultural safety include the following:
Listen in a non-judgemental way
Be interested in learning about and from other people
Share your culture and background with others
Encourage others to share about their cultures as they feel comfortable
Experience other cultures rather than only reading about them (upon invitation)
Open meetings in a good way (e.g., prayer, singing, drumming)
Invite Elders and Knowledge Keepers to meetings/ events when possible
Incorporate land acknowledgements as appropriate
Encourage your staff to uphold cultural safety with clients and other staff
Actively participate in cultural safety training
Co-develop policies with Elders and Knowledge Keepers
Cultural humility is an ongoing process of self-reflection, self-development and willingness to learn from other people. Humbly acknowledging that you as a person are willing to learn and grow will support cultural safety within your health organization.
Another part of cultural safety involves the use of a trauma-informed approach. Trauma informed care realizes that trauma impacts the lives of people including many of whom access programs and services at your health organization. By looking for and recognizing signs of trauma, the health organization team can provide services to meet the needs of community members in a holistic and compassionate way, avoiding possible re-traumatization.
Listed below are several key documents that have informed the need for greater cultural safety and humility in healthcare systems. An online internet search can locate these documents.
In Plain Sight – Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care, Addressing Racism Review, Summary Report, November 2020
Reclaiming Power and Place – The Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls, National Inquiry into Missing and Murdered Indigenous Women and Girls, 2019
Truth and Reconciliation Commission of Canada Calls to Action, Truth and Reconciliation Commission of Canda, 2015
United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), United Nations, September 2007
Declaration on the Rights of Indigenous Peoples Act (DRIPA), November 2019
British Columbia Cultural Safety and Humility Standard, Health Standards Organization (HSO), 2022
Respecting the rights of First Nations people related to the ownership, control, access and possession (OCAP) of their community information is yet another way to ensure a culturally safe and humble approach is incorporated into health organization service delivery. OCAP principles highlight the importance of First Nations communities having control over how data is collected and ownership and control over how the data can be utilized. To learn more about OCAP, access information available on the First Nations Information Governance Center: .
Identify three (3) ways that you will incorporate a culturally safe and humble approach in your work as a Health Director:
____________________________________________________________________________________
____________________________________________________________________________________
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Social Determinants of Health
The social determinants of health will overlap with all aspects of the work you do. A broader understanding of the importance of the social determinants of health is reflected in the First Nations Health Council (FNHC) 10-Year Strategy on the Social Determinants of Health: A Framework for the Future. This document defines the Social Determinants of Health as follows:
“Culture, language and ceremony
Self-determination genetics
Income and social status
Early childhood development
Personal health practices and coping skills
Physical environment
Education
Employment and working conditions
Gender
Social support networks
Social inclusion
Access to health services”
Our understanding of the social determinants of health highlights that the health status of an individual and community is the outcome of many variables outside health service delivery alone. Working collaboratively with partner organizations will achieve greater gains than working in isolation as a health organization. For more information on the social determinants of health and how Health Directors can address them, see the FNHDA “Social Determinants of Health Guidebook”.
Helpful Resources & Links
FNHDA “Social Determinants of Health Guidebook”
First Nations Health Council (2025), Our Approach:
First Nations Health Council (2023), 10-Year Strategy on the Social Determinants of Health: A Framework for the Future:
First Nations Health Authority (2025), Social Determinants of Health Strategy:
Reach out to a fellow Health Director
Human Resources
The Human Resources core elements are essential for understanding and working with the legal requirements of employers, creating structures to support staff and proactively planning for stability within the health organization.
Human Resources
Human resources are the people who deliver the programs and services of your health organization. Building a solid relationship with your health organization staff is an essential part of health centre operations—so much so that an entire section of this Orientation Guidebook has been dedicated to the topic (see page 60).
The term ‘human resources’ can also refer to the structures within the health organization that support the hiring, management and development of staff. This section of the Orientation Guidebook focuses more on the current state of human resource structures.
Every health organization manages the elements of human resources supports in their own unique ways. In some health organizations, the Health Director manages all aspects of human resources. In others it is shared with staff such as program leaders and the Finance Manager. In yet other situations there are dedicated human resources positions such as a Human Resources Officer. Human resources infrastructure can help create clarity, consistency, and safety in the work environment.
Who in your health organization is responsible for supporting the functions of human resources?
___________________________________________________________________________________________
Employment law governs the employer-employee relations of all health organizations. Which law will depend upon whether your health organization is provincially or federally regulated.
Federally regulated health organizations follow the Canada Labour Code.
Provincially regulated health organizations follow the BC Employment Standards Act.
It is important to confirm which legislation your health organization follows.
Which human resources legislation(s) regulates your health organization? (If you have service delivery sites on and off reserve, you may fall under one or both regulations).
___________________________________________________________________________________________
___________________________________________________________________________________________
Become knowledgeable about employment law to ensure that your health organization is adhering to the legislation.
If employment law is new to you, familiarize yourself with the legislation that is applicable to your work environment.
Check this box when you have accessed the latest copy of the employment law relevant to your health organization.
Another important consideration for your work environment is to determine if there is a collective agreement in place (i.e., unionized). Most health organizations are non-union; some are fully unionized and others are hybrid with some positions unionized and others that are not.
If there is a collective agreement in place, this prescribes much of the working relationship between employees and the employer. You are expected to follow the collective agreement, so do familiarize yourself with it. Deviation from the collective agreement may result in a grievance (violation of the employee’s rights under the collective agreement) from an employee.
Are there collective agreements in place at your health organization? Yes No
If yes, who is included as part of the collective agreement(s)?
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Check when you have obtained a copy of the collective agreements (or confirmed that no collective agreements are in place).
It is important to note that collective agreements expire and must be renegotiated. As a Health Director, you (or another designated person) will need to be prepared to negotiate on behalf of your health organization.
If you have a collective agreement in place, when does it expire? _____________________________
Human resources policies and procedures are developed within the context of the local health organization. They support transparency and consistent practice related to human resource-related matters. Some examples of human resource policies and procedures include hiring practices, succession planning, orientation and onboarding, code of conduct, conflict of interest, respectful workplace, dress code, conflict of interest, performance reviews, performance management, termination and resignation, exit interviews, timesheets and expense reimbursement and training, etc.
Each health organization will have its own human resource policies that may be tailored to local cultural practices (e.g., death protocols; bereavement leave; cultural leave; etc.)
What human resources policies and procedures has your organization established?
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One area that is relevant to you right now is your health organization’s orientation procedures and practices.
What resources (policy, procedure, checklist) are available to support you and your staff to become oriented to your health organization?
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Identify what areas of the orientation process work well, and what areas could be further developed. Jot these down as they may come in handy when your health organization would like to review and revise the orientation and onboarding procedures.
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The final area addressed in this section is job descriptions.
Job descriptions help to organize staff positions within an organization. They will typically include the job title, job purpose, scope of job duties and responsibilities, required and preferred qualifications, working conditions and who positions report to.
Job descriptions help the teams to understand employee roles within the organization. They can also be used to establish fair compensation using industry standards.
Job descriptions are reviewed and revised when positions become vacant and job postings are developed to recruit new staff. Some organizations conduct a review and update of job descriptions alongside annual employee performance evaluations.
Obtain copies of all your health organization’s employee job descriptions.
Are any of your health organization employee job descriptions missing? YES NO
When were your health organization’s job descriptions last updated? __________________________
Helpful Resources & Links
First Nations Health Directors Association (2018), First Nations Health Directors Job Description and Hiring Toolkit:
Government of British Columbia (January 28, 2025), Employment Standards Act [RSBC 1996] Chapter 113:
Government of Canada (December 15, 2024), Canada Labour Code (R.S.C., 1985, c. L-2):
Reach out to a fellow Health Director
Succession Planning
Succession planning is planning for future staff turnover within the organization (e.g., resignations, retirements). Succession planning involves identifying positions within your health organization that are critical for maintaining continuity of essential services to the community. The health organization will then identify team members who show an interest in and the potential to assume those positions with additional skill development. Succession planning essentially involves the training and development of staff to pass job roles to another employee or group of employees when positions become vacant.
One strategy of succession planning is to incorporate cross-training so that one or several people are always capable of stepping in to take care of the core functions of every position. This allows the health organization to continue functioning if someone is out of office. E.g., the Community Health Nurse could take on an Administrator In-Charge role when the Health Director is working off-site.
Succession planning provides the opportunity for existing staff to advance their careers while staying with the health organization and lessens gaps in service delivery and leadership.
Check off this box when you have the latest copy of the Succession Plan or confirmed that one does not exist.
Helpful Resources & Links
Reach out to a fellow Health Director
Reach out to a human resources advisor
