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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