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David Kerr, The Canterbury Initiative

David Kerr, The Canterbury Initiative

Published in Health & Medicine
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  • Vision is a clinically led way of working which focuses on addressing and resolving the challenges that a changing population and workforce will have on health care delivery in Canterbury Clinical leadership: hospital clinicians, general practitioners and other clinicians working with managers and funders, Generic processes: which encourage clinicians to work together Whole of system: to ensure that incremental change is consistent with the Canterbury DHB vision, Evaluating results: against an outcomes framework
  • Vision is a clinically led way of working which focuses on addressing and resolving the challenges that a changing population and workforce will have on health care delivery in Canterbury Clinical leadership: hospital clinicians, general practitioners and other clinicians working with managers and funders, Generic processes: which encourage clinicians to work together Whole of system: to ensure that incremental change is consistent with the Canterbury DHB vision, Evaluating results: against an outcomes framework
  • Vision is a clinically led way of working which focuses on addressing and resolving the challenges that a changing population and workforce will have on health care delivery in Canterbury Clinical leadership: hospital clinicians, general practitioners and other clinicians working with managers and funders, Generic processes: which encourage clinicians to work together Whole of system: to ensure that incremental change is consistent with the Canterbury DHB vision, Evaluating results: against an outcomes framework
  • Vision is a clinically led way of working which focuses on addressing and resolving the challenges that a changing population and workforce will have on health care delivery in Canterbury Clinical leadership: hospital clinicians, general practitioners and other clinicians working with managers and funders, Generic processes: which encourage clinicians to work together Whole of system: to ensure that incremental change is consistent with the Canterbury DHB vision, Evaluating results: against an outcomes framework
  • Vision is a clinically led way of working which focuses on addressing and resolving the challenges that a changing population and workforce will have on health care delivery in Canterbury Clinical leadership: hospital clinicians, general practitioners and other clinicians working with managers and funders, Generic processes: which encourage clinicians to work together Whole of system: to ensure that incremental change is consistent with the Canterbury DHB vision, Evaluating results: against an outcomes framework
  • Vision is a clinically led way of working which focuses on addressing and resolving the challenges that a changing population and workforce will have on health care delivery in Canterbury Clinical leadership: hospital clinicians, general practitioners and other clinicians working with managers and funders, Generic processes: which encourage clinicians to work together Whole of system: to ensure that incremental change is consistent with the Canterbury DHB vision, Evaluating results: against an outcomes framework
  • Vision is a clinically led way of working which focuses on addressing and resolving the challenges that a changing population and workforce will have on health care delivery in Canterbury Clinical leadership: hospital clinicians, general practitioners and other clinicians working with managers and funders, Generic processes: which encourage clinicians to work together Whole of system: to ensure that incremental change is consistent with the Canterbury DHB vision, Evaluating results: against an outcomes framework
  • Vision is a clinically led way of working which focuses on addressing and resolving the challenges that a changing population and workforce will have on health care delivery in Canterbury Clinical leadership: hospital clinicians, general practitioners and other clinicians working with managers and funders, Generic processes: which encourage clinicians to work together Whole of system: to ensure that incremental change is consistent with the Canterbury DHB vision, Evaluating results: against an outcomes framework
  • Vision is a clinically led way of working which focuses on addressing and resolving the challenges that a changing population and workforce will have on health care delivery in Canterbury Clinical leadership: hospital clinicians, general practitioners and other clinicians working with managers and funders, Generic processes: which encourage clinicians to work together Whole of system: to ensure that incremental change is consistent with the Canterbury DHB vision, Evaluating results: against an outcomes framework
  • Vision is a clinically led way of working which focuses on addressing and resolving the challenges that a changing population and workforce will have on health care delivery in Canterbury Clinical leadership: hospital clinicians, general practitioners and other clinicians working with managers and funders, Generic processes: which encourage clinicians to work together Whole of system: to ensure that incremental change is consistent with the Canterbury DHB vision, Evaluating results: against an outcomes framework
  • Vision is a clinically led way of working which focuses on addressing and resolving the challenges that a changing population and workforce will have on health care delivery in Canterbury Clinical leadership: hospital clinicians, general practitioners and other clinicians working with managers and funders, Generic processes: which encourage clinicians to work together Whole of system: to ensure that incremental change is consistent with the Canterbury DHB vision, Evaluating results: against an outcomes framework
  • Vision is a clinically led way of working which focuses on addressing and resolving the challenges that a changing population and workforce will have on health care delivery in Canterbury Clinical leadership: hospital clinicians, general practitioners and other clinicians working with managers and funders, Generic processes: which encourage clinicians to work together Whole of system: to ensure that incremental change is consistent with the Canterbury DHB vision, Evaluating results: against an outcomes framework
  • Vision is a clinically led way of working which focuses on addressing and resolving the challenges that a changing population and workforce will have on health care delivery in Canterbury Clinical leadership: hospital clinicians, general practitioners and other clinicians working with managers and funders, Generic processes: which encourage clinicians to work together Whole of system: to ensure that incremental change is consistent with the Canterbury DHB vision, Evaluating results: against an outcomes framework
  • Vision is a clinically led way of working which focuses on addressing and resolving the challenges that a changing population and workforce will have on health care delivery in Canterbury Clinical leadership: hospital clinicians, general practitioners and other clinicians working with managers and funders, Generic processes: which encourage clinicians to work together Whole of system: to ensure that incremental change is consistent with the Canterbury DHB vision, Evaluating results: against an outcomes framework

Transcript

  • 1.
    • CDHB Vision 2020 requires
    • Increased focus on supporting people /whanau to take greater responsibility for their health
    • The development of primary health care and community services to support people/whanau in a community based setting
    • The release of secondary care based specialist services to be responsive to and support the provision of primary health care
  • 2.
    • Progressed by work groups.
    • Clinicians meet with a blank whiteboard.
    • Common concerns are identified, discussed and prioritised.
    • Nursing, allied health, management, and funders assist the work-stream as relevant.
    • Solutions are developed.
    • Information available on HealthPathways.
    • Clinicians work with colleagues.
    A Common Process
  • 3.
    • Clinical leadership
    • Applying generic processes
    • Building credibility through delivery of results
    • Working with a sense of urgency
    • Applying a whole of system approach
    • Delivering solutions through existing structures
    • Involving Planning and Funding
    • Evaluating results
    • Supporting change with quality communication and education, …. across the entire Canterbury health system.
    A Way of Working
  • 4.
    • General practitioners have identified:
      • Variable level of understanding of the access criteria and services available from hospital departments.
      • Lack of information on what clinical management to try before referral.
      • Restricted access to important investigations.
      • Concern at the variable number of follow ups.
      • Difficulty accessing updated, agreed clinical care pathways.
    • Hospital specialists have identified:
      • That some referrals do not meet minimum criteria or do not contain critical information required for accurate triage.
      • Concern that patients being discharged may not receive appropriate follow up.
      • An overwhelming increase in demand for their services.
    Issues we address
  • 5.
    • Patient management & referral pathways agreed by our specialists and GPs (but referencing international best practice)
    • Workable in our DHB environment
    • Continuously evolving:
      • Growing range of pathways
      • More professional groups using it
      • Expanding continuum of care
      • More patient information
      • Clever review & update systems
      • Localisation solution for other regions
    • Available on PDAs (offline & online) and on the web
    HealthPathways
  • 6.
    • Not locally “reinvented” protocols or pathways
    • Leverage from the best of breed
    • National or international pathways or protocols or guidelines
    • Localise them or link to them on site
  • 7.  
  • 8.  
  • 9.  
  • 10.  
  • 11.  
  • 12.
    • We now have 215 pathways with 55 under development and 34,000 page views in July
    HealthPathways Statistics
  • 13.  
  • 14.  
  • 15. Feedback about HealthPathways
    • Referrers
      • Equity of access
      • Reduced rejection rate
      • Reduced hospital follow-up
      • Current, agreed, CDHB practice
      • Expanded diagnostics/options
    • Specialists
      • Equity of access
      • Consistency of practice in dept
      • Best use of time
      • Training opportunities
      • Letters refer to HP
      • Reduced wait times
  • 16.
    • Healthpathways
    • Like a chart in the ships bridge, memory jogger
    • Joint development
    • Overt description of clinician discussions
    • Alternative options if not publicly available
    • Rich source of linkages eg NICE, NZGG
    • Potential for efficient management of 80%
  • 17. Our Journey
    • To date:
      • 200 pathways ‘on the map’
      • Electronic referral supports many (but not all) pathways
    • Future:
      • eReferral to support more pathways, referrers, and destinations
      • Referrer analysis, feedback, and education systems to be developed
      • Unmet need reporting and resource allocation ‘business rules’ to be developed
  • 18. Electronic Referral The other side of the coin
  • 19.  
  • 20.  
  • 21.  
  • 22.  
  • 23.  
  • 24.  
  • 25.  
  • 26.  
  • 27.  
  • 28.  
  • 29.  
  • 30.  
  • 31.  
  • 32. Benefits of ERMS for General Practice
    • One click send
    • Addresses managed
    • Forms managed
    • Electronic confirmation
    • Specialist’s information requirements met
    • Expands ‘non-hospital’ referral options
    • Evolving product to meet Canterbury needs
  • 33. Benefits of ERMS to the Whole System
    • ONE SYSTEM, traffic monitored, jams reported, alternate routes provided, resources shifted
    • Free-flow access to specialist assistance
    • Best route indicated real-time
    • Informed resource allocation
    • Optimised health outcomes within available resources
  • 34.
    • Plastics:
      • Was: ESPI non compliant –9 month wait-list
        • GP training at Burwood Outpatients
        • Subsidies to support GP delivery of low complexity and GP to GP referral mechanism established
      • Now: Compliant –all melanoma seen and treated in 4 weeks from referral
        • Additional 2,188 patients treated in Primary Care
        • Specialists focused on higher acuity
    • Child Health:
      • Was: Very long wait for patients with cough and asthma –up to six months
      • Now: with agreed pathways that General Practice and Child Health specialists follow alike, patients wait 2 months to see a specialist if required
      • Also good training tool and good level of concordance between Child Health specialists
    Measurable Impacts of CI Activity
  • 35.
    • Women’s Health:
      • Was: Large unmanaged number of referrals was "mystery shopped" and found great variability of service response
        • New Pathways agreed
        • GPs trained in pipelle biopsy and Mirena insertion
        • GPs given direct access to diagnostics
      • Now:
        • ESPI compliant
        • Reduced number of referrals
        • Higher rate of conversion to surgery
        • Virtual FSAs as a result of well "worked up" patients
        • Will be first Department to triage electronic referrals online
    Measurable Impacts of CI Activity
  • 36.
    • Central tenet of transformation
    • is that local clinical leadership and extensive engagement in service design and decision making is essential for change to happen.
    • IT supports the changes in the health service but first you need
    • strong clinical leadership, and deep understanding by clinicians that there is one health system and one bucket of money
  • 37. Panel Discussion – Q&A
    • Discussion prompters:
      • People, people, people
      • Don’t present a solution
      • Avalanche of requests
      • Soon presented with opposite to low hanging fruit (i.e. the insoluble problems)
      • Politics of envy
      • Underestimating the grind
      • Transitioning from development to operational
  • 38.
    • Functions:
      • Plan and facilitate clinical work groups
      • Drive the process with commitment
      • Explain and promote the process widely
      • Assess progress, and adjust the way of working
      • Work with clinical leaders formal and informal
      • Work with the HealthPathways team
      • Work in close partnership with the DHB GM Planning & Funding and CEO (scheduled fortnightly meetings)
      • Work with the PHO / general practice groups in the region
      • Work with the hospital general, operations and service managers
    Development Team
  • 39.
    • Meets every month.
    • Comprises:
      • DHB CEO (Chair)
      • Influential GPs and SMOs DHB
      • Planning & Funding Manager
      • Consumer
      • PHO CEOs
      • Hospital GMs
    Governance Group
  • 40.
    • Commitment to a 'whole of system' transformation programme (min 50% of focus)
    • Commitment to shift resources to 'enable' the pathways
    • Commitment to fortnightly meetings with the Transformation Facilitation Team
    DHB Planning & Funding
  • 41.
    • Commitment to a 'whole of system' transformation programme
    • Commitment to support change to 'enable' the pathways
    • Commitment to monthly meetings with the Transformation Facilitation Team
    Hospital GMs & Clinical Leaders
  • 42.
    • Commitment to a 'whole of system' transformation programme
    • Commitment to support change to 'enable' the pathways
    • Commitment to monthly meetings with the Transformation Facilitation Team
    PHO’s & General Practice Groups
  • 43. Implementation
    • Development>transition>sustained implementation
    • CISO
    • Service Development Groups
    • Service delivery ‘business as usual’
    • CD, service manager, GP liaison