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Promoting Health – A pathway. The Health Promoting Practices Quality Framework  11 July 2011
Health Promoting Practices and ProCare Health’s Strategy -Nicola Young, Project Sponsor ,[object Object],[object Object],[object Object],[object Object],[object Object]
How will HPP help practices and patients? ,[object Object],[object Object],[object Object]
Benefits of HPP ,[object Object],[object Object],[object Object],[object Object]
The Health Promoting Practices Framework  –  Kate Bukowski, Project Manager
WHAT is Health Promoting Practices based on?  – Dr Karen Parkes, GP  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Integration (not silos)
Why and How ?....  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
WHY for the practices… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
WHY for patients…
WHY for clinicians…
How to do it -community links
HOW to improve our practice systems….
HOW to improve our individual relationships
A Practice Nurse’s Perspective on Health Promoting Practice  – Kathy Neilson (RN) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How Health Promoting Practice has worked in Mangere  ,[object Object],[object Object]
Where to from here - Kate Bukowski, Project Manager ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Kate Bukowski Health Promoting Practices Presentation

Editor's Notes

  1. Clinicians will be less busy hrough having a healthier population who are presenting less for preventable illnesses and who are more engaged in community services who can assist them (i.e. Breast Screen, Plunket Nurses, Maori and Pacific community organisations, refugee and migrant services)
  2.   The Health Promoting Practices Quality Framework is based on the Health Promoting Settings philosophy that focuses on Health Promotion in Primary Health Care is about: Reaching the whole population Educating populations to improve health literacy self-management, health information, Social Marketing, health education and skill development Supporting practices to have healthy workplaces Supporting practices to be involved in community action
  3. Historically health promotion grown from work done overseas, arose from departments of Public Health but introduced concepts that penetrated into general practice and our individual relationships with patients Influenced by the Chronic care movement which is driving patient centeredness PCMH Now New Zealand tackling its own version Government initiatives in health Better Sooner More Convenient contracts with focus on prevention of hospital admissions, and shared social service/health contracts like Early Years service Hubs Whanau Ora contracts – initial direction related to ethnicity but the concepts about wrap around health apply to all new Zealanders. It links in with MSD and focuses on services talking to one another. Working between disciplines in general practice means lifting your gaze form what presents in front of you to the bigger picture.
  4. These silos could have lots of different names Funding ones could be MSD, Ministry of Health, NGOs Pro-cares ones could be practice teams, health promotion team, quality team, practice engagement team. Community labels could be schools, health services, police, social services, General practice could have patients, receptionists, nurses, doctors, management, community health workers, We are all now being encouraged to lift up our eyes from our head down bums up approach to the work that walks in our doors and think how we can all do it better – working smarter not harder. In some ways we are going back to the roots of general practice when GPs and their nurses were spending a lot of time in the communities that they lived & worked in.
  5. Its not new
  6. Capitation funding allows us to consider taking care of the patient and keeping them well, its in our interetss that they don’t get sick! Payment for performance and outcomes (PPP) Increased programme funding (CCM, Care+, Palliative Care, A2D) Business models, workforce crisis & sustainable general practice Cornerstone accreditation
  7. Current services fit most but not all, We are all so busy getting through our workload that General practice teams have been known to think if not to say that their lives would be so much easier if it wasn’t for the patients!! Whole person care focuses' on what the patient needs and creates holes the right size & shape for each person Our patients are individuals who will seek help from various sources and it may not be the service that can provide them what they need, if we make our holes and job descriptions flexible then the person who is their point of contact will know what to do next and where to send them. It may be a teacher seeing a child with school sores talking to the public health nurse who sends the family to the free marae clinic a group of practice nurses setting up a screening programme for non accidental injury for children so that staff know what t to ask and what to do next in a busy A&M, a GP referring a young mum to the new support group set up by the Early Years Service Hub that came to talk to the practice last week, a health care assistant accompanying a patient downstairs to their mammogram after organising transport to get them to the clinic a community health worker supporting a new patient to the practice in negotiating the seemingly impossible task of enrolling and setting up an AP to pay off a debt and providing information on a local budgeting service a woman attending a health expo having a heart risk check at the stand run by 2 local general practices and discovering she had a BP of 190/110 and total cholesterol of 7 and says she will get it checked at the marae clinic next week. After encouraging health promotion ways of working in our practice ALL of these are examples are ones that I have seen in our practice recently and could easily have stopped with no further action if staff had not been flexible and patient centred –hopefully these individuals all have had better outcomes because of this.
  8. HP helps to have a plan for those complicated ‘heart sink’ patients, they may be the ones that don’t come often but when they do EVERYTHING in their lives is a mess and health is the least of their problems. Practice teams often feel powerless trying to make inroads into their health issues Instead of trying to ignore the other issues health promotion concepts can provide some responses once we have opened Pandora's box – This means clinicians have the skills and the resources they can use once wider issue are identified (alcohol, mental illness, domestic violence, debt), once patients are dealing with these THEN we can get them to think about their cholesterol. Creates opportunities for achieving CME & PDRP requirements. Revving up those with flagging interest in their work. Practice teams working in the BSMC contracts included doctors ready to retire under the weight of paperwork but are now rearing to go on Teamwork approaches value individual skills and allow people to get on with what they are good at.
  9. How can we also develop our relationships with the alien world outside the practice to help them and us provide better care Although this is about community it is still about individual relationships with people in the community. Community Health workers can be a bridge between practices and communities Health promotion encourages the concept of a two way process = practice -> to community + community -> practice. Leading to an exchange of knowledge about services. Leading to influencing one another’s practice and better outcomes for the individuals we see Knowing what is out there in the community helps you deal with Pandora’s box. Using the powerful influence that medical practitioners can have on the community we can advocate on our patients behalf. We may consider taking our services out into the community or putting our patients in touch with the correct community services General practice has a part to play influencing Population Health,Community initiatives and Healthy Public Policy. This is truly the alien world but all basically built on fostering individual relationships. How about considering saying to your patient “I met this guy who has been offering a men’s health support group and we encouraged him to come and do some work at the local marae, he has made an inspiring personal journey improving his own health and he tells some great funny stories how about I get him to give you a call’ compare this to” here’s a leaflet on a service in town, not quite sure what they do but it might be good, give them a call”
  10. Systems – creating time and space to plan and think. Identifying a leader important. Idea is to create facilitated change from within The facilitated Pro-Care audit tool is going to provide a way to asses where things are at now With HPPQF tool kits to suggest practical steps to take The practice then identifies what they want to work on and using the HPPQF resources identifies how they want to proceed Ideally the process will involve the whole team – reception, nurse Doctor, HCAs, CSAs. IT utilisation harnessing the power of computers especially with Dr info development of systems that identify and fix the leaky buckets (funding and outcomes) Planning, action & review – PDSA cycles but led by practice teams doing what they feel is important. Improved practice health – create healthy workplaces.
  11. This slide is to highlight improved understanding of people who at times seem to inhabit different worlds from us. Its about the relationship between patients and practice staff, between doctors/nurses/reecptionsists, between practice and ProCare/PHO o rbetween Procare departments of health promotion and practice support, and even more alien to us but very important for our patients our relationships with the wider community and other service providers or funders. For our patients we can work on improved Health literacy – more information, not less, in a variety of forms, appropriate to patients. Clinical teams can develop combined care planning designed with the patient using a patient centred approach, what are they ready to deal with now? Encouragement of patient self management is the only way forward when you consider how little time we spend beside our patients on their journey to health – they are largely on their own and we have to work with their issues to guide them to better outcomes The therapeutic relationship begins with the Avatar concept of “I see you” meaning not only see you, but hear you & understand you. .