NURSING WORKSHOPWellington 29 November 2013

The Changing Nature of Healthcare

Chai Chuah

Context• A Health system that has served New Zealanders

well

• Small country punching above our weight globally

• Adventurous, bold and creative

• Can do better for some – equity of access and quality

• Facing similar challenges to other developed countries

International Perspectives

Challenges

500,000. 2. 648, 4,000p, 6,000dg, 13,000diag

Direction of travel for the NZ Health system

Shifting the focus of healthcare

Prevention Detection Treatment

A health system that works with you, for you

The Health system - more than the science …

it’s relational

Partnerships Communication

Listening and Equality hearing

Respect and trust Involvement

Patient experience

Families/whanau

Clinicians

Frontline staffCommunities

Carers

GPsNurses

Health with Other Determinants

Well BeingHealth

services

Education

Housing &Transport

Employment

Framework for change

Health Services

Policy/reg/funding/

incentives

Businessmodels

Enablers

Models of care

Where everything comes together

Enablers

Enablers

IT

Capital

Workforce

Devices

Perfect alignment- biggest impact on outcome

Quality – remains the driver for change

Mid-Staffordshire – a valuable lesson Meeting the targets but missing the point …

Financial reporting came top of the agenda – safety issues came down the list

Uncaring behaviours became the norm

Clashes of egos and ethos were part of the culture

On the flip side …

Simple and easy to understand standards of care

Openness, transparency, candour and patient voice

Accountability – where everyone knows what ‘good looks like’

Quality – must be predictable and measurable

• Strong financial reporting is one measure of a well-functioning system – but it is not the only measure

• Real, sustainable, active improvement depends far more on learning and growth than on rules and regulations

• A culture of continual learning helps everyone to grow. In such a culture, measurement is not a threat

Quality driving disruptive innovations

• Motor vehicles – US, Japanese, Korean

• Retail industry – Department stores, Warehouse

• Health - cardiac surgery/intervention cardiology, POCT

Incentives Process

Structure

Resourcesallocation

Capacity & capability

Success criteria & threshold

What stands in the way• Innovations often collide with walls of

professional and organisational resistance … Reinforced by outdated protocols, practices, beliefs, and traditional roles that may have served us well in the past but no longer do so.

Leadership – the Leaders We Need• Those who are motivated to achieve the common

good who have the qualities required to gain willing followers in a particular culture, at a historical moment when leadership becomes essential to meet the challenges of that time and place – Michael Maccoby

Christensen & Maccoby

Intuitive Empirical Predictive

CraftIndustrialKnowledge

In summary • Quality improvement is more about patient experience and

behaviours than $. However managing our finances/resources is very much part of the quality agenda.

• Keep the targets in focus but don’t lose sight of the people in front of us

• We are moving beyond the success story to a measurement story – we need to demonstrate the impact on the quality of care

• The door needs to be open – information on impacts, quality and safety will be shared and judged by the New Zealand public

• As leaders we have an important role to play – to invite patients to trust us, talk to us and become co-producers of their care

• We are in the health business – and that makes it personal

Conclusion

Our collective responsibility

To ensure continued quality improvement and equitable access to services. As leaders and influencers, we need to know that what we do collectively has measurable impact on the quality of care for patients and their experience of the health system.

Keep talking, keep listening, keep the door open

The science of health is incomplete without the compassion of care. He aha te mea nui He tangata, He tangata, He tangata