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Social Rehab Reviews: Towards the next generation of
services
Dylan Cross
Category Manager Social Rehabilitation
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Acknowledgements
Gill Hall, Manager Rehabilitation Programmes, ACC
Nic Johnson, Category Advisor, Social Rehabilitation, ACC
Jane Kelley, Head of Insurance Risk Management, ACC
Kim Allen and Sarah Carne, Senior Research Advisors, ACC
Alice Kan and Karen Connell, UMR
Corrine de Bonnaire and Jane Falloon, Research NZ
Jo Fadyl, AUT
Dr. Maree Dyson, Dyson Consulting Group
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Social Rehabilitation
The aim of ACCs social rehab services is to:
Provide support that allows a client to maximise their
independence / participation
Continuously improve the quality of service and outcomes for
clients with sustainable growth in liabilities.
Services worth nearly $300 million per annum:
Home and community support services
Inpatient non-acute rehabilitation
Residential Support
Social rehabilitation assessments
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Non Acute Rehabilitation (NAR)
Fast Stream rehab
20 district health boards and 4 trust hospitals
Predominantly older people (50% over 85)
Mostly post-fall injuries (fractures, soft tissue,
reconditioning)
~ 4,000 clients per annum
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Residential Support (RSS)
Slow stream rehab and home for life
Most commonly have a traumatic brain injury
Wide mix of ages
106 suppliers
~700 clients
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Social Rehab Assessments (SRA)
Identify client needs and develop options to support rehab
8 main assessment types, 57 suppliers
Mix of ages and injury types
~ 10,000 clients per annum
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Research Questions
For these services:
What is the local and international context? Who are our
clients, when and why?
What service gaps exist?
What is the state of the provider market?
What are international trends?
How are they performing for clients, staff, providers and other
stakeholders?
What is working well?
What is not working so well?
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The Reviews
Literature reviews & qualitative research:
Clients (54 case studies) and their support people/whanau;
ACC staff (23 in individual or mini group settings, 10 focus
groups)
Providers (44 individual, 5 focus groups)
Other stakeholders (12 individuals).
Client selection structured to achieve a range of
perspectives
Interviews transcribed and thematically analysed
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Themes
Positive client feedback about providers and ACC staff
Regional Variation
Services working well where relationships well cultivated
Single points of contact
Consistency of staff
Collegial relationship
Integration and flexibility of services a challenge
ACCs contracting model built around services, not clients
Injury (ACC) / illness (Ministry of Health) funding streams
Processes administratively heavy for staff and providers
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Non Acute Rehabilitation
Strengths
Communication skills of providers excellent
Providers generally seen as knowledgeable and honest
Clients individual needs and priorities often recognised
Positive relationships in some regions led to:
Effective rehab planning
Timely decisions
Efficient process
Smooth transitions
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Non Acute Rehabilitation
Opportunities for Improvement
Resourcing / workforce pressures
Group or self-directed therapy
Easier administration (especially for complex clients)
Availability of services for under 65s
Build of trust and understanding between ACC and hospital
staff
Work underway to improve process and relationships
Improvements in goal planning
Realistic, person-centred, SMART
Better access to intermediate care
Pilot underway
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Residential Support Services
Strengths
Match of client to facility, dignity-enhancing approach
Relationships & mutual respect between providers and ACC
Person-centred decision making and planning
Transitions working reasonably well
Active supports and client input into activities frequently
mentioned
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Residential Support Services
Opportunities for improvement
Contract needs greater clarity
ACC staff: How are providers rehabbing clients, managing risks,
providing fulfilling environment?
Providers: What are the requirements of us?
Improving quality of service, particularly smaller regions
Challenges around workforce and availability of right facility
for each client
Client-centred goal planning and monitoring of progress
Assessing clients on their potential rather than their needs
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Social Rehab Assessments
Strengths
Service valued highly by ACC staff
Assessors had excellent communication, client-centred
approach
Clients kept informed by ACC about expectations, rationale for
decisions and any delays in the process
Processes and templates for simpler assessment types generally
working well
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Social Rehab Assessments
Opportunities for improvement
Templates changes to allow for professional judgement and reduce
repetition
Referral timeframes affected by provision of clinical
information from public hospitals
Routine feedback and training mechanisms for assessors
Contracting fatigue opportunity to address referral disparities
through future redesign
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Assessment (Needs)
Services (Facility/Community)
Delivery (Timing)
Outcomes (Client)
Shared assessment
Service Providers & Services
Multidisciplinary approach Co-ordinated service delivery
Right service, right time, right place
Shared outcome Return to work Return to/maximise
independence
Return to school
client impact
Smooth rehabilitation pathway One touch Clear plan
Clear expectations and outcomes
Community Facility
New Directions
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Future Model
Non Acute Rehab Break barrier
between inpatient +
community
Outcome-focussed,
flexible approach to
rehab (packages)
Gradual integration
of community
provider market
where natural
efficiencies exist
Assessments Closer integration
with Ministry of
Health
Interoperability of
assessment
approaches
Move towards more
effective limited
vendor design
Residential More clarity about
objectives,
requirements,
pricing
Continuum of
service
Consolidation of
market where
possible
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Thank you
Feedback
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+64-4-816-7356
