<ul><li>CDHB Vision 2020 requires </li></ul><ul><li>Increased focus on supporting people /whanau to take greater responsib...
<ul><li>Progressed by work groups. </li></ul><ul><li>Clinicians meet with a blank whiteboard.  </li></ul><ul><li>Common co...
<ul><li>Clinical leadership  </li></ul><ul><li>Applying generic processes  </li></ul><ul><li>Building credibility through ...
<ul><li>General practitioners have identified: </li></ul><ul><ul><li>Variable level of understanding of the access criteri...
<ul><li>Patient management & referral pathways agreed by our specialists and GPs  (but referencing international best prac...
<ul><li>Not locally “reinvented” protocols or  pathways </li></ul><ul><li>Leverage from the best of breed </li></ul><ul><l...
 
 
 
 
 
<ul><li>We now have 215 pathways with 55 under development and 34,000 page views in July </li></ul>HealthPathways Statistics
 
 
Feedback about HealthPathways <ul><li>Referrers </li></ul><ul><ul><li>Equity of access </li></ul></ul><ul><ul><li>Reduced ...
<ul><li>Healthpathways </li></ul><ul><li>Like a chart in the ships bridge, memory jogger </li></ul><ul><li>Joint developme...
Our Journey <ul><li>To date: </li></ul><ul><ul><li>200 pathways ‘on the map’ </li></ul></ul><ul><ul><li>Electronic referra...
Electronic Referral  The other side of the coin
 
 
 
 
 
 
 
 
 
 
 
 
 
Benefits of ERMS for General Practice <ul><li>One click send  </li></ul><ul><li>Addresses managed </li></ul><ul><li>Forms ...
Benefits of ERMS to the  Whole System <ul><li>ONE SYSTEM, traffic monitored, jams reported, alternate routes provided, res...
<ul><li>Plastics: </li></ul><ul><ul><li>Was:  ESPI non compliant –9 month wait-list </li></ul></ul><ul><ul><ul><li>GP trai...
<ul><li>Women’s Health: </li></ul><ul><ul><li>Was:  Large unmanaged number of referrals was &quot;mystery shopped&quot; an...
<ul><li>Central tenet of transformation  </li></ul><ul><li>is that local clinical leadership and extensive engagement in s...
Panel Discussion – Q&A <ul><li>Discussion prompters: </li></ul><ul><ul><li>People, people, people </li></ul></ul><ul><ul><...
<ul><li>Functions: </li></ul><ul><ul><li>Plan and facilitate clinical work groups </li></ul></ul><ul><ul><li>Drive the pro...
<ul><li>Meets every month. </li></ul><ul><li>Comprises: </li></ul><ul><ul><li>DHB CEO (Chair) </li></ul></ul><ul><ul><li>I...
<ul><li>Commitment to a 'whole of system' transformation programme (min 50% of focus) </li></ul><ul><li>Commitment to shif...
<ul><li>Commitment to a 'whole of system' transformation programme  </li></ul><ul><li>Commitment to support change to 'ena...
<ul><li>Commitment to a 'whole of system' transformation programme  </li></ul><ul><li>Commitment to support change to 'ena...
Implementation <ul><li>Development>transition>sustained implementation </li></ul><ul><li>CISO </li></ul><ul><li>Service De...
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The Canterbury Initiative

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David Kerr, The Canterbury Initiative

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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
  • The Canterbury Initiative

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

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