southern primary & community care strategy...we will work with our communities and other...
TRANSCRIPT
SouthernPrimary&CommunityCareStrategy
Mihi
Karangaaturākingātangataotetaitonga;Neirāmātou,emihikauanakiākoutoutīpunakuaweheatu
kituaoPaerau.Tēnākoutoukatoa!
_______________________________
Wecalltoyou,thepeopleofthesouth;Wegreetandacknowledgeallofourancestorswhohave
passedbeyondtheveil.Greetingstoyouall!
3
Contents
► Overview 4
► Introduction 8
► Strategy 14
► Goal1– Consumers,whānauandcommunitiesareempoweredtodriveandowntheircare 16
► Goal2– Primaryandcommunitycareworksinpartnershiptoprovideholistic,team-basedcare 17
► Goal3– Secondaryandtertiarycareisintegratedintoprimaryandcommunitycaremodels 18
► Goal4– Thehealthsystemistechnologyenabled 19
► TransformingprimaryandcommunitycareforMāori 22
► Transformingprimaryandcommunitycareinruralcommunities 23
► ExecutingtheStrategy 25
► Appendix– PlanningFramework 27
4
Overview
5
Tēnākoutoukatoa,
WearepleasedtopresenttheSouthernPrimaryandCommunityCareStrategy,whichdescribesourvisionforprimaryandcommunitycareintheSouthernhealthsystem.Thisvisioncentresaroundourconsumers,theirwhānauandcommunities,andtheroletheSouthernhealthsystemneedstoplay in caringforandempoweringthemtolivewell,staywell,getwellanddiewell.Itreflectsthecallfromourcommunitiesforbetterintegratedservices,andfromourworkforcetostrengthenthecapacityandcapabilityofprimaryandcommunitycaretocontributetothewiderSouthernhealthsystem.
GiventhechallengesfacingtheSouthernhealthsystem,andthegenerationalopportunitythattherebuildofDunedinHospital presents,wehavedevelopedaboldandaspirationalPrimaryandCommunityCareStrategy.Fundamentally,wewanttofocusprimaryandcommunityservicesonfosteringwellness,reducinghealthinequities(particularlyforMāori),andprovidingtimely,holisticcareclosetopeople’shomes.Ouraspirationisthatconsumerswillexperienceprimaryandcommunitycarethatismoreresponsivetotheirneeds,isdeliveredbypractitionerswhoworkinpartnershipwiththem,andwhointurnarebettersupportedbyourhospitalservices.TodevelopaStrategythatreflectsthisaspiration,wehavebeenguidedbyfivequestions:
1. Whatcanconsumers,whānauandcommunitiesachieveforthemselves?
2. Whatcantechnologyhelpconsumersandtheworkforcetodomoreeffectively?
3. Howcancarebeprovidedclosertohome?
4. Howcanwedevelopamoreintegratedsystemofcareforourpopulation?
5. Howcanwedevelopthecultureandleadershipneededtodeliveronthisvision?
Thesequestionsareimportant,becausewerecognisethatfortoolongwehavetakenthecapabilitiesofourpopulation,whānau,andprimaryandcommunityservicesforgranted,andhavenotconsistentlyprioritisedinvestmentsandotheractionsthatcouldmostcost-effectivelyimproveaccessandoutcomes.
ThisStrategyhasbeendevelopedjointlybySouthernDistrictHealthBoardandWellSouthPrimaryHealthNetwork,withsupport fromtheUniversityofOtago,reflectingourcommitmenttoworkingtogethertoimprovethecontributionofprimaryandcommunitycaretothewiderSouthernhealthsystem.Itrecognisesourhistory,andthechallengeswefaceinrespondingtothechangingneedsofourcommunities,theincreasingpressuresonourhealthworkforce,andourresponsibilitytoprovideequitableaccesstoservicesacrossourlargeanddiversedistrict.
OurabilitytoimplementtheactionsunderpinningthisStrategywilldependonwhetherweareboldenoughandpreparedtomaketoughprioritisationdecisions.Wewillworkwithourcommunitiesandotherstakeholderstomaketheseprioritisationdecisions,whichwillrequireallofusto challengeourattitudes,beliefsandwaysofworking.WearecommittedtodoingourpartinchanginghowweoperateasleadersoftheSouthernhealthsystem,andlookforwardtoworkingwithyoutomakeapositivedifferencetoprimaryandcommunityservicesthatwecanallbeproudof.Mauriora!
Foreword
ChrisFlemingChiefExecutiveSouthernDHB
KathyGrantCommissionerSouthernDHB
Dr.DouglasHillChairWellSouthPHN
IanMacaraChiefExecutiveWellSouthPHN
6
TheSouthernPrimary&CommunityCareStrategyandActionPlan
WHY?
WHAT?
HOW?
NewZealandHealthStrategyAllNewZealanderslivewell,staywell,getwell
SouthIslandRegionStrategicDirectionAsustainableSouthIslandhealth&disabilitysystem,focusedonkeepingpeoplewellandprovidingequitableandtimelyaccesstosafe,
effective,highqualityservices,asclosetopeople’shomesaspossible
SouthernWayVisionBetterhealth,betterlives,WhānauOra
VisionforSouthernprimary&communitycareExcellentprimaryandcommunitycarethatempowerspeopleinourdiversecommunitiestolivewell,staywell,getwellanddiewell,through
integratedwaysofworking,rapidlearningandeffectiveuseoftechnology
Goal1.Consumers,whānauand
communitiesareempoweredtodriveandowntheircare
Goal2.Primaryandcommunitycare
worksinpartnershiptoprovideholistic,team-basedcare
Goal3.Secondaryandtertiarycareisintegratedintoprimaryandcommunitycaremodels
Goal4.Thehealthsystemistechnology-enabled
Empowerconsumers,whānauandcommunitiestoself-care
Develophealthcarehomes(HCHs)toenhanceaccesstoprimarycare
Createlocalitynetworkstobettercoordinatecare
Demonstration Communicationsandengagement Providersupport
Strengthenedgovernanceandleadership
Whole-systemhealthandbusinessintelligence
Buildingworkforcecapabilityandculture
Integratedtechnologysolutionsandcost-effectiveuseofcaretechnologies
Results-focusedfundingandcontracting
Caremodels
Supportinginfrastructure
Supportingadoption
HeKorowaiOrangaHealthyfuturesforMāori,‘PaeOra’
7
TableofkeydefinitionsTerm Definition
Primarycare Primarycarerelatestotheprofessionalhealthcareprovidedinthecommunity,usuallyfromageneralpractitioner(GP),practicenurse,pharmacistorotherhealthprofessionalworkingwithinageneralpractice
Communitycare Wide-rangingcareprovidedinacommunitysetting,fromsupportingconsumerstomanagelong-termconditions,totreatingthosewhoareseriouslyillwithcomplexconditions,muchofwhichtakesplaceinpeople’shomes
Secondarycare Careprovidedbyaspecialistorfacilityonreferralfromprimary care(usuallybyaGP),requiringmorespecialisedknowledge, skills,orequipmentthancanbeprovidedinprimarycare.Thiscanbeprovidedeitherbyvisiting specialists,orinDunedin,Invercargill,orsomeruralhospitalsintheSoutherndistrict
Tertiarycare Specialised care(investigationandtreatment)usuallyprovidedonreferralfromcliniciansinprimaryorsecondarycare byvisitingspecialists,orinDunedinHospital (withsomeservicesprovidedoutsidethedistricte.g.,highlyspecialisedpaediatriccareatStarshipHospitalinAuckland)
Multi-disciplinary Ateamcomprisedofpeoplefromacrossdisciplineswithinthehealthsector,supportingthedeliveryofholistichealthcare.Thiscouldinclude,forexample,GPs,PNs,DNs,pharmacists,healthcareassistants,alliedhealthandotherrelevantrepresentatives
Inter-disciplinary Ateamcomprised ofpeoplefromthehealthandsocialsector,supportingthedeliveryofholistichealthandsocialcare.Thiscouldinclude,forexample,multi-disciplinaryteams,plusrepresentativesfromMSD,Corrections,Housing,MinistryforVulnerableChildren,OrangaTamariki andotheragencies
Carecoordination Supportingthecoordinateddeliveryofconsumer/whānaucare,either withinoracrossproviders.ACareCoordinationCentre(CCC)willsupportthisfunctionacrossprimary,community,secondaryandtertiarycareintheSoutherndistrict
Stepped care Acaremodelapproachthatsegments populationsintoincreasinglevelsofhealth(andsocial)need,withdefinedcareresponsesmatchedtopopulationsegments.Thehigherthelevelofneed,themoreintensethecareresponse.
HealthCareHome(HCH) Ateam-basedmodelofcareby primarycarewithstrongstrategicandoperationalrelationshipswithcommunity,hospitalandspecialistservices,withtheintenttoprovidetherightlevelofproactive,comprehensiveandcontinuoushealthcaretopatients
Localitynetwork The strategicandoperationalnetworkofprovidersandservicesrequiredtoprovidetimely,responsivecaretodefinedpopulationsbasedonanagreedminimumlevelofcare,withsomelocalvariationforparticularhealthneedsandservicecontexts
Communitycarehub Thepotentialphysicalinfrastructure requiredtoenableintegratedwaysofworkingwithinlocalitynetworks,withmodificationofthescaleandscopeofthehubdeterminedbypopulationsizeandexistinginfrastructure
8
Introduction
9
DevelopmentoftheSouthernPrimary&CommunityCareStrategyandaccompanyingActionPlanhasbeenledbytheSouthernDistrictHealthBoard(DHB)andWellSouthPrimaryHealthNetwork(PHN),withsupportfromtheUniversityofOtago,reflectingeachorganisation’scriticalroleinshapinghealthcareintheSouthernhealthsystem,commitmenttocollaboration,anduniqueteachingandlearningenvironment.BothorganisationshaverecognisedtheDunedinHospitalrebuildasagenerationalopportunitytoredistributeinvestmentacrossthesystem,anddothingsdifferentlyinprimaryandcommunitycare- deliveringabroaderrangeofservicesthroughapproachesandsettingsthatareeffectiveandconvenientforconsumersandwhānau,andfosterprofessionalsatisfaction.
DevelopmentofthisStrategyhasrequiredadifferentwayofthinkingandactivelyengagingwithconsumers,whānau,iwi,tertiaryproviders,andrepresentativesfromacrossprimary,communityandsecondarycare.Thisapproachwillbemaintainedthroughimplementation,andextendedtoincludeengagementwithsocialandprivatesectors.
TheStrategyisalignedwiththegovernment’sprioritiesandpolicies,includingtheNewZealandHealthStrategyandHeKorowaiOranga.IthasbeendevelopedtoaddresstheuniqueneedsandcircumstancesofthediverseSoutherndistrict,NewZealand’slargestDHBarea,andwithover40%ofitspopulationlivingrurally.TheStrategyandaccompanyingActionPlanisstronglyevidence-based,buildinguponleadingexamplesofprimaryandcommunitycareinNewZealandandinternationally,andanalysisofdemographic,accessandoutcomedata.
TheStrategyrecognisesthatSouthernprimaryandcommunitycareperformswellinmanyrespects.Mostpeoplehavetimelyaccesstogoodqualitycareprovidedbyhard-workingandwell-intentionedhealthprovidersandpractitioners.However,thestrainonsomeservicesisapparent,andinotherinstances,careproviderscanimprovetheirresponsivenesstopopulationandindividualneeds.Trustingrelationshipsbetweenmanyprovidersarebrokenordonotexist,andinmanycasesaprovider- orservice-centricapproachistaken,ratherthanplanningwithconsumersandwhānauatthecentreofcare.
Inparticular,thereremainlongstandinginequitiesofaccessandoutcomesforMāori,ruralandremotepopulations.
Lookingtothefuture,changesindemographics,diseaseprevalenceandworkforcecapacitywillincreasethestrainonprimaryandcommunitycare,ifcurrentcaremodelspersist.Changinghowprimaryandcommunitycareprovidersinteract,theservicestheyarecapableofdelivering,andtheirrelationshipwithhospitalandspecialistservicesisfundamentaltomeetingtomorrow’schallenges.
Stakeholderengagement,researchonleadingmodelsofprimaryandcommunitycare,andanalyticsofaccessandoutcomesacrossthedistricthaveledtoafocuson:
► Empoweringconsumers,whānauandcommunities
► Strengtheningtheabilityofprimarycaretoprovideabroaderscopeofservicesclosetohome
► Integratingcareacrossprimary,communityandsecondarycare.
Theunderlyingdirectionisenablingprimaryandcommunitycaretofocusitselfonpopulationhealthandwellness,deliveringcareclosertohome,andbeingabletosuccessfullytransitionpeopleacrosscaresettings.Thiswillrequirechangestothewayinwhich:
► Consumerandwhānauneedsareinterpretedandmet
► Servicesareplanned,fundedandcontracted
► Providersandpractitionersinteractacrossprimary,secondaryandcommunitycare.
Thisdirectionisarticulatedthroughavisionandsetofstrategicgoals.TheaccompanyingActionPlansetsouttheheadlineactionsandsupportingactivitiesthatwillbeprogressedduringinitialphasesofexecutingtheStrategy.Throughimplementation,theSouthernhealthsystemwillbeone,collaboratingtohelpconsumersandwhānaulivewell,staywell,getwellanddiewell.
IntroducingtheSouthernPrimary&CommunityCareStrategyandActionPlan
10
DevelopingthePrimaryandCommunityCareStrategyandActionPlan
Literaturescan• Keynationalandinternationaltrendsin
contemporarymodelsofcare
Stakeholderfeedback• Engagedapprox.525consumersand
primary,communityandsecondarycarestakeholderstounderstandtheiraspirations
Analyticalprofile• Profileddemand,access,equityand
capacityacrossprimaryandcommunitycare,andrelevantinterfaceswithsecondarycareintheSoutherndistrict
Casestudies• 10relevantcasestudiesfromNZ,
Australia,theUSandUK• Innovativechangesinmodelsofcare
PlanningFramework• Collatedandanalysedkeythemesto
informStrategyandActionPlandevelopment
Strategy• Enhanceprimarycare• Team-basedwaysofworking• Integratingcareacrosssettings• IntegratedITsolutions• Virtualhealth• Home-basedcare(includingremote-
monitoring)• Localityapproachestocaredelivery
ActionPlanBeinginnovative,courageousandrapidlylearningasimplementationprogresses
Buildingacriticalmassofinter-lockedinitiativesthattogethertransformcare
delivery
OngoingengagementThisoccurredthroughouttheprocessatkeypoints,withaSteeringGroup,aWorkingGroup,consumers,andprimary,community,andsecondarycare
stakeholders
11
HowtheStrategyrelatestoothernational,regionalanddistrictstrategiesandplansNewZealandHealthStrategy(NZHS)
SouthernStrategicHealthPlan(SSHP)2015- 2025andImplementationPlan
54321 6
SouthernPrimaryandCommunityCareStrategy
SouthernWorkforceStrategyandActionPlan(June2018)
SouthernDigitalStrategy(June2018)
DunedinHospitalRebuild
DetailedServicesPlansA&B
IndicativeBusinessCase
DetailedBusinessCase(TBC)
SouthernStrategicServicesPlan
SouthIslandRegionalHealthServicesPlan
DevelopacoherentSouthernsystemof
care
BuildtheSouthernhealthsystemonafoundationofpopulationhealth,andprimary&community
care
Securesustainableaccesstospecialised
services
Strengthenclinicalleadership,engagement
andqualityimprovement
Optimisesystemcapabilityandcapacity
Livewithinourmeans
SouthernPrimaryandCommunityCareActionPlan
HeKorowaiOranga
12
1 2 3
4 5 6
Ageingandincreasingcomplexitysuggestsasignificantincreaseindemandforhealthcare
Consumersandwhānauexpectamoreconsistentcareexperience,inwhichtheyplayamoreactiverole
SignificantvariationintheSouthernhealthsystemintermsofaccess,experienceandoutcomes
SouthernasanationalhubforeducationandtrainingofhealthprofessionalscandesignlocalapproachestoaddressworkforceshortagesanddevelopmentneedsincludingbuildingtheMāorihealthworkforce
TherebuildofDunedinHospitalisamajoropportunitytooptimisethemixofservicesacrosssettings
Consumerswanttoreceivecareinnewways,supportingtheuseofnewservice,workforce,businessandfundingmodels
Challenges
Opp
ortunitie
s
…variationinmedical/surgicaldischargeratesbyenrolledgeneralpractice
populations,whichcan’tbeexplainedbyage,ethnicityor
deprivation
3-fold73%…increaseinGP
consultationsexpectedfor65+populationby2036undercurrentmodelsofcare
11+medicationsdispensedonaverageto
Southernersaged85+years(2014)
*cf.197inNelsonMarlborough&280inCanterbury
40%…ofSouthernGPsintendtoretireinthenext8
years
WecandobetterforthepeopleoftheSoutherndistrict…
Primaryandcommunity
care
Secondaryandtertiary
care
Self-care
>1/6…Olderpeoplelivewith3+chronicconditions
193…DHBalliedhealth
professionalsper100,000population*
*Darkershading=higherrateofuse
Māoriare3x morelikelytodiefor
amenablereasons
Publichealth
Individu
al
preven
tion
LTC
managem
ent
Avoidinghospital
admission
s
Hospitalcare
Reha
bilitation
Endoflife
494 …MāoriDHBemployeesper100,000Māoripopulation^
^cf.510inNelsonMarlborough&392inCanterbury
494
13
Ifwetakeanewapproach…Ifwemaintainthestatusquo…Weneedanewapproach…
Healthriskfactorssuchasobesitycontinuetoincreaseanddemandfortreatmentservicesgrows
Thereremainmanypointsofentrytothesystem,andhealthservicescontinuetooperatein‘silos’,withlimitedconnectionswithsocialservices
OurGP,nursingandalliedhealthworkforcestrugglestodelivertimelyaccesstoservices– creatingfurtherpressureonhospitals,andmakingprimaryandcommunitycarecareersunattractivetothenextgenerationoftheworkforce
Healthservicescontinuetobeprovidedintraditionalways,despitetechnologicaladvanceswhichcouldimproveaccess,qualityandefficiency
SouthernDHBstrugglestolivewithinitsavailablefunding,andDHBhospitalservicesconsumeanever-increasingshareofresources,limitinginvestmentopportunitiesinprimaryandcommunitycare
Hospitalcarecannotkeepupwithincreasingacutedemand,exacerbatedbyprimaryandcommunitycarecapacityshortages,andtheincreasingnumberofconsumerswithcomplexneedsandlong-termconditions
Newinitiativesarenotregularlymonitoredandadjusted,andscaledorstoppeddependingonperformance,resultingininefficientresourceuse
Consumers,whānauandcommunitiesunderstandhowtolivewell,andaresupportedbypreventivecareinthecommunity
Consumersandwhānauareabletoeasilynavigatethesystem,whichprovidescohesivecareacrossservices,settingsandorganisations,supportedbyintegratedsystemsandprocesses
Ourprimaryandcommunityworkforceisengagedandalignedthroughnewmodelsofcare,allowinghealthprofessionalstofocusonhigherskilledclinicalworkthroughnewwaysofworkingandsupportfromnewroles(e.g.healthcareassistants;clinicalpharmacists)
Newdigitaltechnologiessupportcommunityhealthliteracyandprovide‘virtual’linksbetweenconsumersandservices,supportingthedeliveryofcareinhomeandcommunitysettings
Investmentisplannedandprioritisedacrossthesystemtodriveanoptimalmixofcommunityandhospital-basedservices
Primaryandcommunitycareisdeliveredfromfit-for-purposefacilities,enablingteam-basedwaysofworking,andprovidingabroaderrangeofservicesinout-of-hospitalsettings,allowinghospitalcaretobefocusedonthosewiththehighestneeds
Acultureofcontinuousimprovementissupportedbythemonitoringandrapidevaluationofnewinitiatives,informedbyconsistentdataanduseofevidence-basedevaluationtools
2345678
Disjointedapproachesacrosssectorsresultinagrowinghealthinequitygap,particularlyforMāori
Joinedupapproachesacrosshealth,socialandeducationsectorsenablecollectiveactiontoaddressfactorsthatcontributetoinequityofaccessandoutcomes1
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TheStrategy
15
Thevisionforprimaryandcommunitycareis…
TheSouthernhealthsystemisbuiltonanoverarchingvision…
Betterhealth,betterlives,WhānauOra
Excellentprimaryandcommunitycarethatempowerspeopleinourdiversecommunitiestolivewell,staywell,getwellanddiewell,throughintegratedwaysofworking,rapidlearningandeffectiveuseoftechnology
Thestrategicgoalssupportingthisvisionare…
Primaryandcommunitycareworksinpartnershiptoprovide
holistic,team-basedcare
Secondaryandtertiarycareisintegratedintoprimaryandcommunitycaremodels
Thehealthsystemistechnology-enabled
Consumers,whānauandcommunitiesareempoweredto
driveandowntheircare
1 2 3 4
TheStrategy:Visionandstrategicgoals
16
Goal1.Consumers,whānauandcommunitiesareempoweredtodriveandowntheircare
Whatthiswillmean:
► Consumerswillbeinvolvedindesignandreviewofprimaryandcommunityhealthservices
► Consumerswithmorecomplexneedswillhavealeadcarercoordinatingservicesacrossthecareteamaccordingtoasharedcareplan
► Consumersandwhānauwill:
1. haveaccesstoculturally-appropriateservicestoimprovetheirhealthliteracy,andtheself-managementskillsofthosewithalong-termcondition(s)
2. haveasinglepointofonlinecontactthroughaportaltoaccesstheirhealthinformation,includingsharedcareplansconnected totheirhealthcarerecords;initialdiagnosis,triagingandcareoptions;andotherreliablehealth-relatedinformation
3. beabletoparticipateinpeergroupsofconsumers(e.g.viasocialmedia,communitymeetings,andprofessional-ledsessions)
4. beabletoshapetheimprovementofprimaryandcommunitycarethroughregularfeedbackmechanisms,andaccesstoproviderperformanceresults
► Consumers,whānauandcommunitieswillbesupportedtohavegreaterinvolvementincaringforothersthroughtechnologysupport, accesstotime- andskill-sharingvolunteeropportunities,enhancingsocialparticipationandresilience.
Southernconsumers,whānauandcommunitiesaresupportedtodrivetheirowncareandwellbeing,andtheoverallperformanceofSouthernprimaryandcommunitycare
17
Goal2.Primaryandcommunitycareworksinpartnershiptoprovideholistic,team-basedcare
Primaryandcommunitycareisworkinginpartnershiptoprovideholisticcaretailoredtoindividualneeds,throughteam-basedwaysofworkingacrosshome,clinicandcommunitysettings
Whatthiswillmean:► Primaryandcommunitycarewillbe:
1. abletoproactivelymatchresourceswithcareneedsthroughnewwaysofworking(e.g.extendedconsultations;extendedhours;team-basedcare;virtualhealth),andnewteamroles(e.g.healthcareassistant,healthcoach;clinicalpharmacist;alliedhealthprofessionals)basedonaHCHmodelofcare
2. usingdiagnosticandvirtualhealthtechnologiestoprovideefficientandconvenientcare3. usingwhole-systemcarepathwaystailoredtotheSoutherncontext4. organisedintointegratedmulti-disciplinaryteamswrappedaroundgeneralpractice,whichprovide24/7holisticandculturally-appropriatestepped
care,withteammembershipbasedonskillsandcapabilitiesratherthanprofessionaldemarcation5. deliveredthroughintegratedprimaryandcommunitycarehubs thatfostercloseralignmentofDHBandNGOcommunityservices,and- wherecost-
effective- ambulatorysecondarycareservicesfromDunedinandInvercargillhospitals6. abletoeffectivelyrespondtoacutecrises(e.g.paramedicsandPRIME-trainedpractitionersinruralcommunities;accesstocommunitydiagnostics;
clinicalobservationinacentreorhub)7. equippedwithenhancedaccesstoclinicaladvicefromsecondaryandtertiarycare8. abletoprovideanincreasedscopeofclinicalinterventionsthroughdefinedclinicalprotocols9. deliveredinwaysthatrecognisetheimportanceofTeAoMāori(theMāoriworldview),tereoMāori,andinsettingsthatrecognisetheimportanceof
culturalsafetyandfamiliarity(e.g.marae;integratedMāorihealthserviceclinics)10. engagedinteachingandlearning
► Primaryandcommunitycarewillbeattheheartofruralhospitalcareprovision.Withinadistrict-wideplanningframework,theywillbeabletoprovideanexpandedscopeofdiagnostics,andstep-up/-downcarefortheircatchmentpopulations,withaworkforcedevelopedtodeliverthismodelofcare,withcapacitymatchedtopopulationneeds
► PrimaryandcommunitycarewillbeplannedtorespondeffectivelytotheneedsofMāori,Pacifica,ruralandremotepopulationgroups
► Communitypharmacy,agedcare,mentalhealth&addictions,andpalliativecarecommunityproviderswillbefullyintegratedintoteam-basedcaremodels
► Effectiveintersectoralpartnershipswillbeeffectivelyaddressingthesocialdeterminantsofhealth,includingintroducinganexplicitHealthinAllPolicies(HiAP)componenttoallpublicsectorpolicydevelopmentprocesses.
18
Goal3.Secondaryandtertiarycareisintegratedintoprimaryandcommunitycaremodels
Whatthiswillmean:
► Secondaryandtertiarycarewill:
1. beactivesupportersofprimaryandcommunitycareteams,providingspecialistadvice,episodiccareforconsumerswithmorecomplexneedsvirtuallyandinclinic-basedsettings,andcontributingtothedevelopmentandimplementationofcarepathways
2. supportregulatedhealthcareprofessionalstoextendtheirscopesofpracticeandinter-professionalworking(e.g.developmentofnursepractitioner,GPandPNwithspecialinterestroles,andallied-nursinginter-professionalskills/competenciesforsharedtasks)
3. haveaclearunderstandingoftherangeofcommunityoptionsavailableforconsumers,andprioritisecommunitycarewhereclinicallyappropriate,includingstep-up/-downcare
4. haveasingleclearpointofaccessforprimaryandcommunitycareprovidersseekingrapidadvice
5. integratedteaching,learningandresearch
6. accommodatethedistinctneedsofruralcommunitiesthrough:
a) patient-determinedprimaryandcommunitycarebookings,andcoordinationofspecialistappointments*
b) localoutreachclinics(virtualorvisiting)
c) tailoringoutpatientclinicstotheneedsofMāori
d) preparednessforemergencytransferorretrieval
e) arrangementoftravelandaccommodationoptions.
Secondaryandtertiaryservicesjointheprimaryandcommunityteamtoprovidesupporttoenableconsumerswithcomplexneedstoaccesstimelycareclosetohome
*patient-determinedbookingswillbeacrossbothprimaryandsecondarycare,withprimarycarebookingsabletobeself-initiated,whilepatientsarepromptedtomakesecondarybookingsthroughaclearsinglepointofaccess
19
Goal4.Thehealthsystemistechnologyenabled
Whatthiswillmean:
► Everyconsumerwillhaveanelectronichealthrecord(EHR)accessibletothemandmembersoftheircareteam,accessiblefromanydevice,andwithaconsumer-nominatedleadcarerascustodian
► Thehealthworkforcewillusedigitalplatformsforprofessionaldevelopmentandfosteringofpeersupportnetworks
► AnintegratedsetoftechnologysolutionswillenableasinglepointofcontacttotheSouthernhealthsystem,sharedcareplanningandefficientadministration.Itwillsupporte-orderingandinstantcommunicationregardlessofdevice,reducingbarrierstoaccessandsupportingtheprimaryandcommunityworkforcetooperateatthetopoftheirscopes
► Virtualhealthtechnologiessupportingthedeliveryofvirtualconsultationsbytheprimary,community,secondaryandtertiarycareworkforce
► Clearlyspecifiedprocessesfordatacollection,analysis,andperformanceimprovementinitiativesdrivenbyinsights,withtheuseofAItoaugmenthumaninput
► Newtechnologiestosupporthome-basedcareandremotemonitoringwillbecommonplace,includingin-homesensorsforpeoplewith relevantphysicaland/orcognitiveneeds(e.g.heartdisease;dementia),withreal-timedatabeingcollectedandactedonbycareprofessionals
► Consumergenomicinformationandhealthdatafrombothhome-basedandwearabletechnologieswillbeincorporatedintotheconsumer’sEHR,informingdiscussionsanddecisionswiththeircareteam
► Wherefeasible,cost-effectiveemergingtechnologieswillbeinusebyconsumers(e.g.home-basedsupportforolderpeople)andbyproviders(e.g.communitypharmacy)
► Theintroductionofemergingtechnologieswillhaveaclearprocessforprioritisation,seedfunding,structuredadoption,andevaluation(includingreturnoninvestment)
► Southernwillbeafast-followerofnationalandotherregionaltrends,adoptingothers’provensolutionswherepossibleandinnovatingasrequired,dependingonneedsandtechnologytrends.
Technologysolutionsaresystematicallydeployedtosupportseamlesscareandcontinuousimprovementofprimaryandcommunitycare
20
Bringingitalltogether– theconsumerandwhānauexperience
Icangetasame-dayappointmentwhenmy
needsareurgent
Icangetholisticsupportfromarange
ofcarers
Consumer’shome
HCH
Hospital
Icanaccessallmyhealthinformationfromhome
includingcertifiedself-careresources
Icanaccesspeersupportgroupsonlineandinmy
community
Icanaccessreal-timeadvicefromhealth
professionals24/7byphone,emailorvideo
Homemonitoringandwraparoundsupportmakesmefeelsafeliving
athomewithadisabilityorsignificantlong-termcondition(s)
Ihaveatrustedcareproviderwhounderstandsmeandmy
whānau
Whenmyneedsarecomplex,mycarejourneyissmooth
andeasytounderstand
Icangetspecialisedassessmentandcare
closetohome
Icangetrapidaccessto
specialistcarewhenIreally
needit
Icanquicklyreturnhomeortomylocalhospitalthroughimprovedcommunicationandsupport
Ihaveaccesstoservicesinculturallysafesettings(e.g.
marae)
IcanfindtheinformationIneedtoseektherightcareat
therighttime
21
Primaryandcommunitycare► Primarycareadviceto,andcoordinated
caredeliveryalongside,communitycareproviders
► Step-upcareoptionsavailable► Socialcareincorporatedintoteamcare
models
Communityandsecondarycare► Streamlinedaccesstospecialistadvice
forcommunityproviders► Step-downcareoptionsavailable► Remotemonitoringandrapidresponse
Primaryandsecondarycare► Primarypractitionerwithspecialist
interestsroles► Rapidaccesstoclinicalspecialistadvice► Virtualandvisitingspecialistclinics
Primary,communityandsecondarycare► Multi- andinter-disciplinarycareteams► Sharedcareplansandcarecoordination
forpeoplewithmorecomplexneeds► HCHstopromoteteamcareand
consumeraccess► Whole-systemcarepathways► Integratedinformationtechnologies
Bringingitalltogether- integrationofprimary,communityandsecondarycareThedeliveryofbettercoordinatedwaysofworkingacrossprimary,communityandsecondarycarewillimproveefficiencyandconsumerexperience.Corecomponentsareshownbelow.
Primarycare
Communitycare
Secondarycare
22
TransformingprimaryandcommunitycareforMāoriWhilsttherehasbeenimprovementinMāorihealthoutcomesoverthepastthreedecades,thefactthatsignificantinequitiesremainisofgreatconcern.TransformingprimaryandcommunitycareforMāoriisthereforeapriorityinaddressingtheselong-termissues.WithinthecontextofthisStrategy,effortstoeliminatethesepersistentinequitieswillrequirefocusingonthesocialdeterminantsofhealth,liftingthecapabilityandperformanceofbothMāorihealthandmainstreamservices,andbuildingmoreeffectivewaysofworkingtheseservices.Thekeywaystoachievethiswillbeawillingnesstounderstandthosemeasuresthathaven’tworkedwellenough,andleadershipinrespectofapproachingandimplementingthosethatmay.Data,analysisandreportingwillbeusedtohelpdriveaconcertedfocusinthisregard.
AddressingthesocialdeterminantsofhealthwillincludeworkingwithhealthandsocialsectorsusingaHealthinAllPoliciesapproach,whichfocusesonaddressingthemajordeterminantsofhealthinequities.IwiwillbeactivelyengagedthroughthisprocesstohelpdesignandimplementeffectiveandinnovativeapproachesforconnectingwithMāoriwhānauandcommunities.
BuildingthecapabilityoftheMāoriprovidersectorwillinclude:
► StrengtheningthebreadthanddepthofdeliveryofcarefromMāorihealthclinicsthroughHCHdevelopment
► IntegrationofMāorihealthprovidersintolocalitynetworkssupportedbycarepathwaysalignedwiththesteppedcaremodel,allowingkaupapaMāorisupportforconsumerswithcomplexneeds
► Workforcedevelopment,includingincreasingMāoriparticipationandfosteringgreaterculturalinclusivity
► RecognisingtheroleofrongoāMāoriandothertraditionalMāorihealthcarepracticesincaremodels.
Liftingtheresponsivenessofmainstreamprimaryandcommunitycareserviceswillinclude:
► HCHmodelofcaredesigntoreducebarrierstoequityofaccessby(forexample)targetinghighriskpopulations,includingMāori, throughstratificationandsteppedcare
► LocalitynetworkmodelstoincludeexplicitkeyperformanceindicatorsforimprovingMāorihealthaccess,experienceandoutcomes
► Increasingworkforcecapability,particularlyinrelationtoculturalcompetency,andunderstandingandusingtereoMāoriandteaoMāorivalues.
Transparentequityanalysisandreportingwillinclude:
► HealthandbusinessintelligencetoquantifyandbenchmarkMāoriandnon-Māoriaccessandoutcomes
► LocalityhealthneedsandserviceprofileanalysistoincludeassessmentofcurrentandfutureMāorihealthneedsandservicegaps.
WithMāoriconsumerfeedbackspeakingclearlytofeelingsoflackofunderstandingandrespect(andconsequentlossofmana),geographicalisolationanddistancefromtheirtraditionalmethodsofhealthcare,effortstoaddresstheseissuesisvital.EnablingSouthernMāoritoregaintheiraspirationalhealthfocus,feelculturallysafeandrespected,andaccessprimaryandcommunityhealthserviceswithoutunduebarriersthroughtheHCHandimplementationofeffectivetechnologywillbegin(atleast)toaddresstheinequitiesinmeaningfulways.
23
Ruralmodelsofcarewillbeprogressivelybasedonadistrict-wideplanningframework,withtailoringfortheuniqueneedsofdifferentcommunities.TheplanningframeworkwillincludethetransformationofprimarycareintoHCHmodelsofcare,and,asappropriate,developmentofcommunitycarehubsthatco-locateabroaderrangeofservices.TherewillalsobeplanneddevelopmentofprimaryandcommunitycarepractitionerswithspecialintereststhatdelivercarefromandacrossHCHsandcommunitycarehubs.Ruralhospitalswillincreasinglyoperateinanintegratedwaywithprimaryandcommunityhealthservices,withmedicalstaffingbyruralhospitalmedicinespecialistswhoarepartoftheunifiedmedicalteamservingthecatchmentpopulation.Thiswillincludeensuringappropriatemedicalsupportforhealthcentresoperatinginmoreremotetowns.
Withineachlocality,deliveryofaminimumsetofserviceswillberequired,withfundingandcontractingarrangementstosupportbroadeningscopesofpractice,increasedaccesstocost-effectiveclinicaltechnologies,andlocallytailoredserviceinterventions.Therewillbeanexplicitfocusonreducingruralandremoteinequitiesrelatedtocost,transport,andotheraccessbarriers.Insomecases,morespecialisedserviceswilloperateacrossmultiplecommunitiesorHCHsinordertobecost-effective- whilestilldeliveringcareclosetohomeforconsumers.
Caremodelswillbebasedonasteppedcareapproach,supportedbycarepathways,sharedcareplanninganddelivery,EHRs,andotherkeyenablers.Thiswillnotonlysupporttheintegrationoftheruralhospitalwithotherprimarycareservices,butalsotheextensionofprimaryandcommunitycarethroughstrongerstrategicandoperationalconnectionswithlocalproviders,andlocalsupportservices(e.g.healthofolderpeople)andsocialcareservices(e.g.housing,MSD,education).
Aspartoftheprimaryandcommunityserviceforthecatchmentpopulation,theruralhospitalwillofferacutecareintegratedwithlocalprimarycareservices,extendeddiagnostics,andhavetheclinicalcapabilitytodelivercareatanappropriatelevelofacuity.
Theruralhospital’sclinicalcapabilitywillincreasewiththedistancefromabasehospital,andthesizeandstructureofitspopulation.
Otherconsiderationsindefiningtherangeofservicestobeofferedbyruralhospitalsinclude:
► Moderatelyspecialisedprocedurescouldbedeliveredlocally,suchaschemotherapyinfusionsunderthesupervisionoftheSouthernregionalbloodandcancerservice,minoroperationsforskinlesions,andinjectionsforwetmaculardegeneration(insomeinstances,HCHsmayprovidesomeoftheseservices)
► Expandeddiagnosticswouldsavetime,enhancelocalcare,andprovidevisitingorremotespecialistswithadditionalclinicalinformation.Electrocardiogramsfortestsofheartconditionsandspirometryforrespiratoryfunctioncouldbeavailable.Somelevelofimaging,suchasX-ray,CTscanning(wheretheworkforcepermits),andlesscomplexultrasoundisdesirable.Overtime,theabilitytoperformawiderrangeof‘scopes’islikely
► Closelocalmanagementofacutepresentations,alignedwithanintegratedEDnetworkacrossthedistrict,wouldreducetheneedfortransferandtransport,andensurepatientswhodoneedcarefromabasehospitalaresenttothecorrectdestination.RuralhospitalscouldofferprimarycareacutemanagementbackedupwithsupportfromInvercargillandDunedinhospitalEDs,closeon-siteintegrationwithStJohnparamediccapacity,andshort-stayobservation/assessmentbeds
► Dependingonlocalcircumstances,theacutecapabilityoftheruralhospitalcouldbecomplementedby:‘step-down’subacutecapacity,includingrehabilitationfollowinganacutemedicalorsurgicalinterventionatInvercargillandDunedinhospitals;agedresidentialcare;andprimarybirthing.Suchco-locationofservicescouldprovidethescaleneededtomeetclinicalandfinancialrequirements
► Anenhanced‘hospitalinthehome’communitynursingservicecouldprovideacute,sub-acuteandpost-acutecaretoadultsandchildrentoavoidtheneedforinpatientcareinarural(orbase)hospital
► Localityplanningwillalsoworkwithindistrict-wideparameterstodeterminetheavailabilityofspecialistclinics(visitingandvirtual)tomatchpopulationneeds.
Transformingprimaryandcommunitycareinruralcommunities
24
Wewillknowwe’vebeensuccessfulwhen…
Asaresultofconsumeraspirations,moreofourpopulationissupportedtoeffectivelyself-managetheirhealthandwellbeing
Wehaveimplementedproactiveriskstratificationandsteppedcaremodelsbasedonhealthandsocialneeds,includingcarecoordinationforpeoplewithcomplexconditions
Wehaveaplannedapproachtoworkforcedevelopmentthatisbasedonthedesiredmodelsofcare,newworkforcerolesandsystempriorities,andisstronglylinkedwitheducationandtrainingprovidersandprofessionalbodies
Wehavesignificantlyreducedinequitiesofaccessforruralandremotecommunities,Māoriandothervulnerablepopulations
Consumersandwhānausayitisquickerandeasiertogetthehealthcareandadvicetheyneedincommunitysettings
Ourinvestmentinprimaryandcommunitycarehassignificantlyreducedtherateofacutedemandforhospitalservices,andhasenabledagreaternumberofolderpeopletolivesafelyathome
Wewillbeabletosay…Ourpopulationhasequitableaccesstoprimaryandcommunitycare,andspecialistsupportwhenneeded
Ourhealthworkforceisworkingas‘oneteam’,withinanintegratedsystemofcare,andwithdeliverythroughteam-basedcare(includinghealthandbroadersocialservicerepresentation)
Wehavebettermatchedourworkforcecapacity,capabilityandmixtopopulationphysical,mental,andsocialneeds
Wehavebecomeanimbleandsustainablesystem,abletomakeeffectiveinvestmentdecisionsthatensureongoingimprovementinpopulationhealthoutcomesandcost-effectiveuseofresources
Ourconsumers,whānauandcommunitiesknowhowtolivewell,andareactivelyparticipatingincaringforthemselvesandothers
Virtualhealthcareapproacheshavebecomepervasiveacrossoursystem,supportingconsumerstogainfasterandmoreconvenientaccesstohealthinformation,adviceandcare
Strategicaspirationsandsuccessfactors
Ourprimaryandcommunitycareworkforceisculturallycompetent,andisaddressingtheneedsofMāoriinpartnershipwith(ratherthandependenton)Māoriandotherspecialisedcareproviders
PrimaryandcommunitycarerespondseffectivelytotheneedsofMāori
12
54
6
87
Ourprimaryandcommunitycareworkforceisculturallycompetent,andisaddressingtheneedsof,Pacificarural,remoteanddisabledpopulationgroupsinpartnershipwithspecialisedcareproviders
Primaryandcommunitycarerespondseffectivelytotheneedsofothervulnerablepopulationgroups(e.g.Pacifica,rural,remote,anddisabled)3
Wearerecognisedfortheresponsivedevelopmentofaworkforcematchedtopopulationneeds,andacommitmenttocontinuouslearning
Weareactivelyinvolvedintrainingourfutureworkforce,andresearchisactivelysupportedtoimprovehealthandoutcomes9
25
TheStrategydescribesourvisionandstrategicgoalsfortransformingprimaryandcommunitycareservices,withinthecontextoftheoverallSouthernhealthsystem.AnActionPlantodeliveronthevisionandgoalshasbeendeveloped.IndevelopingtheActionPlan,wehaveconsidered:► Howthesystemisbestconfigured► Theimportanceofconsumers,cliniciansandproviders
understandingtherationaleforchange,andsupportingitsdirection
► Howtobuildacriticalmassofinter-linkedactions► Actionsthatneedtobe:
► District-wide► Tailoredtolocalcommunityneeds► Targetedtospecificpopulationgroups
► LearningsfrompreviousplanningandactioninSouthern► Theexperiencesofotherhealthsystemsinimproving
primaryandcommunitycare.
ThreeactionareashavebeenidentifiedfordeliveringontheStrategy(seeright):caremodels;enablinginfrastructure;andsupportforadoption.TheseactionareasformthebasisoftheActionPlan.Theactionareaswillbeprogressedconcurrently,withsequencingofactivitiesandmilestones.Roll-outofnewcaremodelswillbeundertakenintranchestoenablemanageabledesign,adoptionandevaluation.
AroadmapforeachoftheactionareasfortheinitialphasesofexecutingtheStrategyhasbeendevelopedtoguideearlyprogressonachievingthevisionforprimaryandcommunitycareinSouthern(seethePrimary&CommunityCareActionPlan).
Governanceandleadership
DevelopHCHstoenhanceaccessto
primarycare
Empowerconsumers,whānauand
communitiestoself-care
Createlocalitynetworkstobettercoordinate
care
Workforcecapabilityandculture
Whole-systemhealthandbusinessintelligence
Fundingandcontracting
Caremodels
Enablinginfrastructure
Supportforadoption
Demonstration Communicationsandengagement
Providersupport
Informationandcaretechnologies
ExecutingtheStrategy:TheActionPlan
26
ExecutingtheStrategy:Ourcommitment
Alignincentives
Innovate
Innovateandbecourageous
Demonstrate
Evaluate
SpreadStopOperateasonesystem,makingthebestuseof
availableresources
Takeaninvestmentapproachthatprioritisesevidence-basedinterventionstoimprovelong-termoutcomes
Supportourpopulationtolivewellandself-care
Makealldecisionsinthebestinterestsofourpopulationandconsumers(usingthequadrupleaim)
Improveequityofoutcomes,particularlyforMāoriandruralcommunities
Makeourhealthsystemeasytouse
Movefromtraditionalwaysofworkingtobefit-for-the-future
Takeaprincipledapproach
Provideequitableaccesstoappropriate24/7careacrossthedistrict
Treateachotherwithtrustandrespect
Fundingandcontractingapproacheswill
progressivelyincentiviseprimary,communityandhospitalcaretowork
collaborativelytoachievetheoptimalmixofservicesacrosssettings,andto
improveaccess,outcomesandresourceuse
Utiliseoureducationpartnerstodevelopaworkforcematchedtopopulationneed
27
Appendix- Planningframework
28
Keynational,regionalandlocalstrategiesand
plans
Scanofinnovativemodelsofcareand
evidenceofwhatworks
Stakeholderengagementincluding
consumers
AnalyticalprofileoftheSoutherndistrict
AwiderangeofinformationinformedthedevelopmentoftheStrategyanditssupportingActionPlan.ThisinformationisincludedinthePlanningFrameworkthataccompaniestheStrategyandActionPlan.
Areviewofkeynational,regionalandlocalstrategiesandplanswasundertaken,withrelevantthemesfromthesedocumentsbeingusedtohelpidentifyfocusareasforStrategydevelopment.Inparticular,theNewZealandHealthStrategyandit’sfivepillars(‘people-powered’,‘closetohome’,‘valueandperformance’,‘oneteam’and‘smartsystem’)andtheHeKorowaiOrangaframework(overallaimof‘PaeOra’,supportedby‘WaiOra’,‘WhānauOra’,and‘MauriOra’)informedtheprioritiesoftheStrategy,alongsideserviceplanningworkundertakentoinformtheDunedinHospitalIndicativeBusinessCase.
Ascanoflocalandinternationalliteraturewasundertakentoidentifyinnovativemodelsofcareandevidenceforwhatworksinimprovingaccess,qualityandoutcomes,includinglearningsforhowtotransformmodelsofcareandsystemdesign.CasestudiesofinnovativecaremodelsfromNewZealand,Australia,theUnitedKingdomandtheUnitedStateswerealsodevelopedtoprovideapracticalsenseofwhatchangesotherlocalhealthsystemsandprovidersareundertaking.
AnanalyticalprofileoftheSoutherndistrictwasalsodeveloped,updatingrelevantpartsofthe2013SouthernHealthNeedsandServiceProfile.Theanalyticalprofileexamineddemographictrends,populationhealthriskfactors,andserviceuseacrossarangeofprimary,communityandhospitalservices.TheprofileinformedtheStrategyandActionPlanthroughsizingcurrentandfutureopportunitiesforimprovingsystemperformance,andmatchingcarewithpopulationneedsacrosstheSoutherndistrict.Asnapshotofkeyfindingsfromtheprofileisprovidedonpage34.
AkeypartofdevelopingtheStrategywasgainingtheperspectivesofstakeholdersonwhatismostimportantforfurtherdevelopingprimaryandcommunitycareinSouthern.Stakeholderengagementactivitiesincluded:
► Fourconsumerfocusgroups,with32participants
► Fourin-depthinterviewswithconsumerswithexistinghealthand/ordisabilityconditions
► Twowānangawithapproximately50Māoriconsumers
► Adirection-settingworkshopwithSouthernDHBCommissioners,WellSouthPHNBoard,SouthernDHBexecutiveteamandtheproject’sSteeringGroup
► Eightworkshopswithsectorrepresentatives
► Onlineforumforsectorrepresentatives,andfollow-upin-depthinterviews
► AroadshowoftheinitialstrategicthinkinginDunedin,InvercargillandCentralOtago,withmorethan300stakeholdersprovidingfeedback.
Keyinputs…
HowtheStrategywasdeveloped
29
TheNewZealandHealthStrategy(NZHS)andHeKorowaiOrangawereusedincombinationasakeyconceptualframeworkfortranslatingnationalandregionalaspirationsintolocalprioritiesforprimaryandcommunitycareinSouthern.
TheNZHSreflectsthegovernment’scommitmenttoaddressingthehealthsystemsustainabilitychallenge,andultimatelyshiftingtowardsabetterintegratedmodelofcarecentredonconsumersandtheirwhānau.It’svisionisthatallNew Zealanderslivewell,staywell,andgetwellinasystemthatispeople-powered,providesservicesclosertohome,isdesignedforvalueandhighperformance,andworksasoneteaminasmartsystem.
HeKorowaiOrangaisNewZealand’sMāoriHealthStrategy,settingtheoverarchingframeworkthatguidestheGovernmentandthehealthanddisabilitysectortoachievethebesthealthoutcomesforMāori.It’soverallaimisPaeOra,‘healthyfuturesforMāori’,recognisingthemultifacetedneedsofMāorithroughaholisticapproachandthreeinterconnectedelements:mauriora(healthyindividuals),whānauora(healthyfamilies),andwaiora(healthyenvironments).TheapproachreinforcestheneedtoensurethatMāoriareinvolvedinbothdecision-makingandservicedelivery.PaeOraguidedthinkingonhowtheStrategyneedstoaddresstheneedsofMāoriinSouthern.
TheNZHSandHeKorowaiOrangaprovidetheframeworkforarangeofmorespecificnationalstrategiesandplanssuchastheHealthyAgeingStrategy,PharmacyActionPlan,andtheMentalHealth&AddictionsServiceDevelopmentPlan.ThesestrategiesandplanswerealsoconsideredduringStrategydevelopment.
ThesocialservicessystemfunctionsreasonablywellformostNewZealanders…
…butthesystembadlyletsdownmanyofNewZealand’smostdisadvantagedpeople.
Thegovernment’ssocialinvestmentpolicyacknowledgesthattraditionalapproachesarenotmeetingtheneedsofthemostvulnerable– particularlychildrenandyouth.Inresponse,governmenthaschallengedagenciesto:• Prioritiseeffortsforimprovingthelivesofthemost
vulnerable• Takeadata- andevidence-ledapproachto
commissioningandcontractingforoutcomes• Joinupplanningandactionacrossagenciesand
sectorsincludingintegratedfundingandcontractingmodels
• Designnewmodelsofcarethatovercomebarrierstoaccessforpeoplewiththemostcomplexneeds
• Involveindividuals,whānauandcommunitiesinprioritysettingandservicedesign.
ThisthinkinghasbeenincorporatedintotheStrategythroughrecognisingthatsomemembersofourcommunitieswillrequiremoretime,effortandresourcesthanothers,tolifttheirhealthandsocialoutcomes.
Nationalstrategiesandplans
30
AllianceSouthisapartnershipbetweenSouthernDHBandWellSouthPHNtodrivecollaborationandprogressonkeyinitiativesacrosstheSouthernhealthsystem.TheAlliancehasdrivencollaborationandprogressthroughanumberofnetworksfocusedonparticularpartsoftheSouthernhealthsystem.Acrossthesenetworks,it’spriorityareasoffocushavebeen:careplanningandmanagementofcomplexconsumers,enablers,alocalityapproach,communication,andcareclosertohome.AllianceachievementsandlearningshavebeenfactoredintothedevelopmentoftheStrategyandActionPlan.
AnumberofstrategyandplanningdocumentshavebeendevelopedtoinformtherebuildofDunedinHospitalbusinesscaseprocess.Theseinclude:► AStrategicServicesPlan
► DetailedServicePlans(A&B)forDunedinHospitalservices
► AnIndicativeBusinessCasefortheHospitalrebuild
► Anumberofclinically-ledpositionpapersregardingpossiblefuturemodelsofcare.
ThesedocumentspointtothesignificantopportunitytherebuildpresentstoradicallyredesigncaremodelsbothwithintheDunedinHospitalsettingandinprimaryandcommunitycare.Fromastrategicperspective,theStrategicServicesPlanmadethefollowingrecommendationsrelatedtoprimaryandcommunitycare:
a) Activelysupportaggregationofgeneralpracticesintolargergroupingsandinvestinenhancedmodelsofprimarycare
b) Proactivelydeliverwell-organisedandconnectedprimarycarethroughthedevelopmentofleadershippositionsandnetworks
c) Considercomprehensivewraparoundservicesforhighlycomplexconsumers,includingpartnershipswithcommunityorhospital-basedpharmacy
d) Consideraclinically-ledreviewofhowHealthPathwaysaredetermined,marketedandutilised,andestablishnear-termprioritiesforfurtherexpansionofpathways.
TheStrategyandActionPlanhaveincorporatedthethinkingemergingfromthebusinesscaseprocess,whilealsoconsideringdistrict-wideissuesandopportunities,andtheparticularnuancesofSouthern’sdiversecommunities.
TheSouthernhealthsystemhasadoptedaQuadrupleAimframeworktoguideplanninganddecision-making.Thefourdimensionsoftheframeworkare:populationhealth;experienceofcare;costpercapita;andteachingandlearning.Thepurposeoftheframeworkistoensurethateachofthesedimensionsisconsideredsimultaneouslywhendecidingprioritiesandactions.TheframeworkhasbeenusedtohelpshapetheStrategyandActionPlan.
WithinthecontextoftheSouthernWay,theSouthernStrategicHealthPlandescribeshowhealthservicesinSouthernshouldevolvebetween2015and2025.Itdescribesasysteminwhichfamilydoctors,communityhealthanddisabilityproviders,andhospitalcareworktogetheraroundcommunityhealthanddisabilityneeds.ThePlanhassixpriorityareas,withthemostrelevantonesfortheStrategybeing:1. DevelopingacoherentSouthernsystemofcare2. Buildingthesystemonafoundationofpopulation
health,andprimaryandcommunitycare.
Localstrategiesandplans
31
Healthsystemsarefocusingonbetterintegratingcareacrossprofessions,servicesandsettings,withastrongfocusonmovinginvestment‘upstream’topreventionandstrengthenedprimaryandcommunitycaredelivery.Thereisalsoastrongemphasisonactiverehabilitationthatreducesriskofrecurrentacutepresentations,andend-of-lifecarethatprovidespeoplewithappropriatesupportstoenableadignifieddeath.Achievingthese outcomesrequiresprioritisingfutureinvestmentstowardspreventionandcommunity-basedmodelsofcare.
Rebalancingcapacitythroughreallocationacrossthesystem
Publichealth Individualprevention Long-termconditionmanagement
Avoidinghospitaladmissions
Hospitalcare Rehabilitation Endoflife
“Thecostofprovidinghealthservicesthroughthecurrentmodelisunsustainableinthelongterm.TheTreasuryestimatesthat, ifnothingweretochangeinthewaywefundanddeliverservices,governmenthealthspendingwouldrisefromabout7percentofGDPnow,toabout11percentofGDPin2060.Itisessentialthatwefindnewandsustainablewaystodeliverservices,investingresourcesinawaythatwillprovidethebestoutcomespossibleforpeoples’healthandwiderwellbeing.”
TheNewZealandHealthStrategy:FutureDirection(MinistryofHealth,2016)
Trendsinsystemdesign
32
► Simplifyingthesystemforbothconsumersandcarersthroughmechanismssuchasconsumerportals,singlepointsofaccess,andcarepathways
► Re-engineeringclinicalandbusinessprocessestostreamlineconsumerflow,releasingtimetocare
► Organisingservicesarounddefinedpopulations, includingonalocalitybasis.
Manyoftheseinnovativemodelsarenew.However,thereareearlysignsofsuccess,suchas:
► Improvedconsumersatisfactionwithaccessandexperienceofcare
► Improvedworkforcesatisfactionresultinginbetterrecruitmentandretention
► Increasedcapacitywithinprimaryandcommunitycareasevidencedbymoreconsumerinteractionswithinsimilarresources
► Someevidenceofreductionsin:
► Urgentcare
► Polypharmacy
► Acutehospitalisations
► Hospitalbed-days
► Entryintoaged-relatedresidentialcare.
TheseleadingpracticedesignfeaturesofcontemporarymodelsofcarehavebeenincorporatedintheStrategyandActionPlan.
InnovativecaremodelsareemerginginNewZealandandinternationally.Thesewerescannedtoseewhatothersystemshavebeingdoingoraretrialing,andtheirlessonsandlearnings.Somekeythemesemergedfromthescan,irrespectiveofjurisdictionorsystem.Thesethemesinclude:
► Activelyinvolvingconsumersandwhānauindeterminingcareneedsandapproaches
► Takingapopulationhealthfocusthatprioritiseswellness,prevention,healthliteracyandself-management
► Focusingonindividualsandpopulationsratherthanspecificconditionssuchasdiabetes,heartfailureordepression
► ReinforcingthepivotalroleofprimaryhealthcareinthehealthsystemthroughapproachessuchastheHCH
► Proactivelytargetingresourcestoindividualandpopulationneedsthroughriskstratification– ledfromprimaryhealthcare
► Buildingtheprimaryandcommunitycareworkforcethroughnewworkforceroles(e.g.,clinicalpharmacy;healthcoaches;kaiāwhina)andenablingpractitionerstoworkatthetopoftheirscopesofpractice
► Usingteam-basedapproachesforpeoplewithmorecomplexneeds,whichintegrateskillsandcapabilitiesfromacrossthehealthandsocialsectors
► Maximisingtheuseoftechnologytosupportconsumersandthewiderhealthandsocialcareteam
► Developingfit-for-purposefacilitiesthatenableintegratedwaysofworking
Trendsinmodelsofcare
33
Newandemergingtechnologiesarerapidlytransforminghowpeopleengagewitheachotherandtheservicestheyuse.Inhealthcare,thismeanshowpeopleaccesshealthinformation(includingtheirownrecords),howtheyengagewithservices,andthehealthchecks(likesimplediagnostics)theycandoforthemselves.Togetherthesetrends,andthefurtherpromiseofnewtechnologies,havethepotentialtoradicallychangeconsumerexperienceofcare.Thepromiseofthesetechnologiesisahealthsystemthatcanmoreefficientlyandeffectivelydeliverconsumer-centredcare,makingthebestuseofworkforceandinfrastructure.Someofthechangesthatnewtechnologypromisesareasfollows:
► Peoplearemoreactivelyinvolvedinmanagingtheirlifelonghealthandwellness.Theycandrivetheirhealthexperiencethroughuseoftoolslikewearabletechnologies,onlineaccesstotheirhealthandwellnessinformation,andgamesthatsupportmemoryfunction,painrelief,andself-managementoflong-termconditions
► Socialnetworkingmechanismsthatsupportpeer-to-peersharedexperiences,informationandmotivationalencouragement
► Encouragingastrengthenedrelationshipbetweenconsumersandthehealthworkforcethatenablesconsumerstobeco-producersoftheirwellness,withphysiciansasexpertadvisors
► Ataservicedeliverylevel,technologiessuchasclinicalanddecision-makingalgorithms,artificialintelligence(AI)diagnostics,andonlinepathwaysandservicedirectoriestosystematisecaredeliverysystemsandprocessesefficientlyandeffectively
► Peoplewithlong-termconditionsbeingabletomonitorclinicalmeasures(e.g.,temperature,bloodpressure)andrelaytheseinreal-timethroughsmartdevicestotheircareteam,withtheircareteambeingabletorespondwhenthereareclinicallymeaningfulchangesinaperson’shealthstatus.Thisfreesupbothconsumerandprovidertime
► The‘internetofthings’enablingsafeandeffectivehomemonitoringofpeoplewhohistoricallywouldhaveneededshort-termcareinahospitalsettingorlong-termcareinaresidentialsetting
Interested Interestinservice Notinterested
87% Makeanappointmentonlinetoseeadoctorororganiseahospitalservice/appointment 13%
83% Completedoctororhospitalregistrationdetailsonlinebeforeyourvisit 17%
74% Useanat–homediagnostictestkit(e.g.forstrepthroat,cholesterollevels)andsendtheinformationtoyourdoctor 26%
70% Communicateelectronicallywithadoctororotherhealthprofessional(e.g.email,text,socialmediasite) 30%
70% Orderprescriptiondrugrefillsusingmobileappsonyourphone 30%
66% Useadevicethatconnectstoyoursmartphone(e.g. temperature,bloodpressureorheartrate)andsendtheinformationtoyourdoctor 34%
61% Consultadoctorbyvideoonyourcomputerratherthanin-personinaclinic 39%
60% Sendaphotoofyourinjury/heathproblemtoadoctorusingyourcomputerormobiledevice 40%
Consumerinterestinusingnewtechnologies*
► Newrobotictechnologiesaremakingpossibleavastrangeofnewwaystoprovidecareanddeliversystemefficiencyimprovements.Thisincludesrobotsthatprovidecompanionshipforpeoplelivingalone,robotsthatsupportcaredelivery(e.g.helpingpeoplehavesafetransitionsoutofbedinagedcare),anddronesthatcandelivermedicinestoconsumers
► AIandmachinelearningofferthepromiseofanalysingvastamountsofdataquickly,improvinghealthandbusinessintelligence.
Newandemergingtechnologies
Seeformoreinformation:Healthcare:thecross-currentsofconvergencedeliverparticipatoryhealth:AsecondpaperintheHealthReimaginedseries,2017,EY.
34
ASouthernanalyticsprofilewasdevelopedtoinformprioritysettingfortheStrategy.ThisconsideredarangeofmeasuresacrossprimaryandcommunitycareintheSoutherndistrict,andalsobroadersystemmeasuresrelatedtouseofhospitalservices.Itshowsthatweperformwellonmanymeasures;however,thereremainsampleroomforimprovement,particularlyinthecontextofrisingdemandforservicesandemergingcapacityissues.Key findingsaresummarisedbelow.
Demographicchangewillbeunevenacrossthedistrict Urgentcaredemandisincreasing
Variationinaccessandoutcomesisevident Workforcecapacityissuesexist,andwillintensifyinthecontextofrisingdemand
Manysmall-scaleprimaryandcommunityprovidersexist,presentinganopportunityforconsolidationtobroadenthescaleandscopeofservicesUtilisationratesarehigherthanpeerdistrictsonsomekeymeasures
%populationchange2016-36
-50% 100%50%
%populationchange2016-36
-100% 400%200%
Totalpopulationgrowth 75+populationgrowth
56…morenon-admittedED
attendancesperdaythanin2013/14
…ofSouthernconsumersexperiencedanunmetprimarycareneedinthepast12months
29% 40%…ofSouthernGPs
intendedtoretireinthenext10yearsin2015
RuralGPvacancies
…percapita
Highestrateof…
In2016/17thereareapproximately…
…variationinmedical/surgicaldischargesbyenrolledgeneral
practicepopulations
3-fold 73%…increaseinGPconsultsfor65+populationwithcurrent
caremodelsby2036
11+medicationsaged85+years-
2014
*Darkershading=higherrateofuse
…highestagedresidentialcareuseof
peerDHBs
2nd
…increaseinnon-admittedEDattendancesatDunedin,
SouthlandandLakesHospitalsfrom2014- 2016
33%1
2
3
4
5
62nd…highestlowurgencyEDattendancerateof
peerDHBs
Southernanalyticsprofile:keyfindings
35
AwiderangeofstakeholderswereengagedduringthedevelopmentoftheStrategy,includingconsumers,healthprofessionals,non-governmentalorganisations(NGOs),andDHBandPHNstaff.Stakeholderssharedtheirperspectivesontheirexperienceofprimaryandcommunityservices,andopportunitiesforthefuture.AnumberofkeythemesemergedfromconversationswithSouthernstakeholders:
► Consumerscontinuetoexperiencebarrierstoaccessingservices,particularlythosewholiveinmoreruralsettings
► Consumersreportinconsistentexperiencesofcarefromsimilarproviders
► Māoriconsumerscontinuetoexperienceprejudiceanddisrespect,andwouldvaluegreateraccesstorongoāMāori/traditionalMāorimedicineandpractitioners
► OnesizedoesnotfitallforMāoriconsumers,andmanyfeelthatthecurrentmodelofcaredoesnotcatertotheirneeds
► Consumersdesiregreaterempowermentintheircare,andtheinformationandsupportneededtorealisethis
► Thereisageneralviewthathealthserviceshavebeenslowtoadapttochanginghealthneedsandconsumerpreferences
► Allstakeholdersareunitedintheirdesireforgreatersharingofclinicalinformationthroughmeanssuchasanelectronicheathrecord
► Thereisageneraldesiretodevelopamorecollaborativeandintegratedsystem,foundedonasharedpurposeandsetofvalues
► Whilegoodprogresshasbeenmadeonparticularserviceareas,thereremainsapressingneedtodescribetheoverarchingorganisationofcaredeliveryinprimaryandcommunitysettings,andtheirrelationshipwithhospitalservices
► Therearesignificantopportunitiestoimprovehowprimaryandcommunitycareprovidersandpractitionersworkintermsofclinicalandbusinessmodels
► Peopleareexcitedbythepromiseofnewtechnologies,andtheirabilitytoimproveaccesstoinformationandcare.
Usingtechnologytoenhancecurrentinteractions…
“HavingtodrivetoInvercargillfortwohoursforappointmentsthatcansometimesonlybe10minuteslongcanputyouatrisk.
I’dmuchpreferthis.”(Queenstown consumer)
Co-locatedservices…“IlikethisbutsomeservicescancostmoreattheGP– Iwenttohospitalforeyetestsanditwaswaycheaper,soaslongasthe
pricedoesn’tgoup…”(Dunedinconsumer)
“
”
Directionsettingworkshop
Wananga
Stakeholderperspectives
36
SteeringGroup,WorkingGroupandUniversityofOtagoThisprojectwasoverseenbyaSteeringGroupwithbroadrepresentationfromacrosstheSoutherndistrict.AWorkingGroupco-developedthedetailedactivitytablestosupportimplementationofthefirstthreeyearsoftheActionPlan.Toassistwithdemonstratingchange,theUniversityofOtagodevelopedfivecasestudiestosupportStrategyandActionPlandevelopment.
SteeringGroupTheSteeringGroupguideddevelopmentoftheStrategyandActionPlan,reviewingandprovidingfeedbackonkeydocumentation,meetingfive timesatkeypointsacrosstheproject.Membershipwasasfollows:
► ChrisFleming(SDHB,CEO)
► LisaGestro(SDHB,ExecutiveDirectorStrategy,PrimaryandCommunity)
► IanMacara(WSPHN,CEO)
► WendyFindlay(WSPHN,DON)
► ProfessorBarryTaylor(UniversityofOtago,DeanMedicalSchool)
► BronnieGrant(Consumerrepresentative)
► SueCrengle(Providerandiwirepresentative)
► KarlMetzler(RuralHospitalrepresentative)
► Dr.MurrayTilyard(GP)
► Dr.NigelMillar(SDHB,CMO)
WorkingGroupAWorkingGroupwasestablishedtosupportActionPlandevelopment,withrepresentationfromacrossprimary,communityandsecondarycare.Inparticular,thisgroupsupporteddevelopmentofthedetailedactivitytables.
UniversityofOtagoRepresentativesfromtheUniversityofOtagodevelopedfivecasestudiesaspartofthePlanningFramework,usedtosupportStrategyandActionPlandevelopment.
*LizDisney(SDHBEDP&F(Acting))wasaSteeringGroupmemberuntilleavinginOctober2017