Wednesday, April 23, 2014

Health Pathways for the ACT



On Monday 7 April I attended a joint workshop with ACT Health an ACT Medicare Local on Health Pathways. Eleanor Kerdo and Katrina, a consumer representative with HCCA, also participated.

Leanne Wells (CEO, ACT Medicare Local) formally opened the workshop and provided a brief  introduction of healthpathways, stating that it is an important collaboration between ACT Health and ACTML. Health pathways is a powerful platform to improve services and outcomes for consumers and they see it as an opportunity to develop pathways that put the patient at the centre of care and aspects of the system that need to be improved and enhanced. 

Rosemary O’Donnell (Executive Director Division of Medicine, ACT Health)  reflected on initial introduction to healthpathways as an exciting opportunity. She sees that this is a framework to enhance the patient journey through the system so that it is as seamless as possible. Rosemary commented that there is a large volume of medical services, including people living with chronic disease, and see that there are opportunities for improvement.

Ian Anderson – Streamliners NZ – Canterbury Health System, was the facilitator for the day. 

The idea of HealthPathways grew out of necessity in Christchurch, NZ. Christchurch is similar to Canberra: urban population of 400,000 people, one major tertiary hospital, catchment of 500,000.
In 2006 the Canterbury District Health Board introduced a new approach to working on problems. This involved new language and terminology, and collaborative approach across the system. By 2010 the new approach was starting to reveal results and improvements which resulted in better outcomes for patients. In 2011 Hunter New England asked about their work and they adopted aspects of their ways of working. They have shared their experience with other Australian districts. There are now 12 entities (Medicare Locals and & Local Hospital Networks) in Australia using elements of Health Pathways and six entities in NZ. In total about 10 million patients across Australia and NZ are part of this.


Three main themes:
  • The environment and creating fertile ground for collaboration and service improvement
  • The detail of service improvement, running work groups and getting change
  • The pathways: these are enablers of service change. They reduce variation in the system and improve outcomes
Ultimately this is all about improving services. In order to achieve sustainable change you need all three of these elements. Thee Canterbury story is a classic demonstration of what is possible when managers have a vision and trust clinicians to be involved in bringing about change.

There was a presentation from Carolyn Gullery, the General Manager of Planning and Funding for Canterbury health system, who was one of the prime drivers of change. This was the presentation she made at the ACI in 2013. (20 min video). It is not online but there is a long video (over an hour) online.

Gullery describes the burning platform, with 1 in 5 people over the age of 65, and by 2020 this will grow to be 1 in 3. There is growing demand, with increased admissions to hospital and increased waiting times. If there was not change there would be a need for many more GPs, another tertiary hospital, another 6000 people in the workforce, and another 2000 nursing home beds. Obviously unachievable and not sustainable.

Graphic of Canterbury health system: Connected system, shared vision. One of the elements that appeals to me is that the work was based on a premise that you shouldn’t be in a hospital if you don’t need to be there. A key measure is not to waste people’s time, both patients and clinical staff. At the core of their work is the belief that most people do the right thing if the system enables them.

A collaborative way of working and it was led by clinicians. They had to bring about a big change. They could not wait for incremental change. 

The full story of the transformation as well as the journey they took is available online on the Kings Fund website.

Executive Director

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