Enhancing health and wellbeing in New Zealand children and young people
Quality Improvement cycles             Act              Plan                      Quality                   improvement   ...
Well-child/Tamariki Ora                  Draft Quality frameworkHealth Quality and Safety Commissionadapted the IHI Triple...
Quality initiatives in Child health in                New ZealandWell-child/Tamariki Ora quality framework•   Immunisation...
Improved health and equity across          populations
Improved health and equity across          populations• To improve  immunisation  coverage at 2 years  to 95% by July 2012...
The 2 year immunisation target               100%                            Coverage at 2 by Socioeconomic quintile      ...
Public reporting
ImmunisationCoverageToolkit
Best value for health system         resource
The B4 School Check is a universal-offer          Well-Child check              It aims to identify and              addre...
10.0%                                                                              20.0%                                  ...
The quality letter.• A Quality Improvement  process for the 4 year old  check.• Shared with providers and  DHB management•...
Quality improvement in action45.00%40.00%35.00%30.00%25.00%20.00%15.00%10.00% 5.00% 0.00%           01-July-2011          ...
Improved safety and quality experience    for child, family and communityImproving communityinvolvement and parentsatisfac...
Improved safety and quality experience    for child, family and community                    We developed a               ...
Improved safety and quality experience    for child, family and communityValidation of the Strengthsand DifficultiesQuesti...
SDQ validation• The SDQ is a behavioural and emotional  screen used in many countries and translated  into over 30 languag...
Conclusion• Reframing difficult problems within a QI  perspective can lead to rapid gains• A Quality Framework will ensure...
Dr. Pay Tuohy: Enhancing the Health & Wellbeing of Children & Young People in New Zealand
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Dr. Pay Tuohy: Enhancing the Health & Wellbeing of Children & Young People in New Zealand

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A presentation given at the CHA conference The Journey, in October 2012.

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Dr. Pay Tuohy: Enhancing the Health & Wellbeing of Children & Young People in New Zealand

  1. 1. Enhancing health and wellbeing in New Zealand children and young people
  2. 2. Quality Improvement cycles Act Plan Quality improvement actions Check Do SmallMaintaining the gains with steps ofStandards and QualityAssurance continuous improvement
  3. 3. Well-child/Tamariki Ora Draft Quality frameworkHealth Quality and Safety Commissionadapted the IHI Triple Aim for NZ.The three dimensions in the NewZealand adapted model are:• improved quality, safety and experience of care• improved health and equity for all populations• best value for public health system resources.The three sides of the WCTO triangleare:• improved safety and quality experience of child, family/and community• improved health and equity across populations• best value for health system resource
  4. 4. Quality initiatives in Child health in New ZealandWell-child/Tamariki Ora quality framework• Immunisation coverage target• B4School check quality initiative• Reducing rheumatic fever• Children’s Commissioners Compass• Development of clinical networks• QI for maternal and newborn screening• Maternity quality initiative
  5. 5. Improved health and equity across populations
  6. 6. Improved health and equity across populations• To improve immunisation coverage at 2 years to 95% by July 2012• To reduce ethnic and socio-demographic disparities in coverage
  7. 7. The 2 year immunisation target 100% Coverage at 2 by Socioeconomic quintile 95% 90% 85% 3% difference Total %Coverage (%) 80% Dep 1-2 % 75% Dep 3-4 % Dep 5-6 % 70% Dep 7-8 % 65% 10% difference Dep 9-10 % Dep Unavailable % 60% 55% 50% Sep-2011 Jun-2007 Jun-2008 Jun-2009 Jun-2010 Jun-2012 Dec-2010 Sep-2007 Dec-2007 Sep-2008 Dec-2008 Sep-2009 Dec-2009 Sep-2010 Mar-2008 Mar-2009 Mar-2010 Jun-2011 Mar-2012 Dec-2011 Mar-2011
  8. 8. Public reporting
  9. 9. ImmunisationCoverageToolkit
  10. 10. Best value for health system resource
  11. 11. The B4 School Check is a universal-offer Well-Child check It aims to identify and address any health, behavioural, social, or developmental concerns which could affect a child’s ability to get the most benefit from school.
  12. 12. 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 0.0% 10.0% 30.0% 50.0% 70.0% 90.0% 20.0% 40.0% 60.0% 80.0% 0.0% Auckland AucklandBay of Plenty Bay of Plenty Canterbury Canterbury Capital and… Capital and Coast Counties … Counties ManukauHawkes Bay Hawkes Bay Hutt Hutt Lakes Lakes Midcentral Midcentral Nelson… Nelson… Northland Northland Otago Otago South… South Canterbury Southland Southland Tairawhiti Tairawhiti % of PEDS Pathway A referred Taranaki Taranaki Waikato Waikato % of Decay Level 2 - 6 referred Wairarapa Wairarapa Waitemata Waitemata West Coast West Coast Whanganui Whanganui % of Extreme Obese Referred 100.0% 120.0% 20.0% 40.0% 60.0% 0.0% 80.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 0.0% AucklandBay of Plenty Auckland Canterbury Bay of Plenty Capital and… Canterbury Counties… Capital and… Hawkes Bay Counties… Hutt Hawkes Bay Lakes Hutt Lakes Midcentral When we started Midcentral Nelson… Nelson… Northland Northland Otago Otago South… South… Southland Southland Extreme Obese that are referred Tairawhiti Tairawhiti Taranaki Taranaki Waikato % of Abnormal SDQ scores referred Waikato Wairarapa Wairarapa Waitemata Waitemata West Coast West Coast Whanganui Whanganui
  13. 13. The quality letter.• A Quality Improvement process for the 4 year old check.• Shared with providers and DHB management• An opportunity to provide up to date information and share good practice• Provision of benchmarking information
  14. 14. Quality improvement in action45.00%40.00%35.00%30.00%25.00%20.00%15.00%10.00% 5.00% 0.00% 01-July-2011 01-January-2012 01-April-2012 01-July-2012 Lift the Lip % of 2-6 referred % of BMI>=21 referred PEDS % of pathway A referred SDQ-P abnormal that were referred
  15. 15. Improved safety and quality experience for child, family and communityImproving communityinvolvement and parentsatisfaction with theB4School check
  16. 16. Improved safety and quality experience for child, family and community We developed a relationship with Richard Taylor of Weta workshop to promote the B4School checks using the Wot- Wots.
  17. 17. Improved safety and quality experience for child, family and communityValidation of the Strengthsand DifficultiesQuestionnaire
  18. 18. SDQ validation• The SDQ is a behavioural and emotional screen used in many countries and translated into over 30 languages• Parents and early childhood teachers have told us that they were uncertain about he screen because it had not been tested on New Zealand children• Ministry of Health has contracted Auckland University of Technology to validate the SDQ on New Zealand children
  19. 19. Conclusion• Reframing difficult problems within a QI perspective can lead to rapid gains• A Quality Framework will ensure that all aspects of quality are considered and addressed• Once you have had success, your learning is generalisable to other areas• Improving quality doesn’t always save money, but it can increase efficiency

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