Transformational Change: Easier said than done…so

what are the critical success factors?

Cathy O’MalleyCompass Health CEO

July 2011

Lots of Activity• Workforce challenges• Long Term conditions• Health of Older Persons• Acute Care and After Hours• Lots of Nursing development• Shared Records and other IM enablers• IFHC• Problem solving

IFHC Min Requirements• Range of services• Integration mechanisms:

– IT– Admin and management– Clinical Governance

• Maori Health and Whanau Ora• LTC Management• Pop Health approach• Workforce planning

Wairarapa IFHC• 40,000 population• 1 Masterton practice 23,000• Whole of system integration to goal• Joint planning• Proposal• Business risks• Policy requirements• Stalled

Tararua IFHC• General Practice lead• Community Hospital also part of mix• Private business• Amalgamated all but one practices• Joint IT• Devolved some services• Governance challenge• Nearly there

Feilding IFHC• 4 practices to co-locate• Range of other community, PHO and DHB

services• Community Trust involvement• Old Hospital site development

Otaki IFHC• 7500 population• 1 practice • Geographical isolation• Co-location already• Integration mechanisms• GP owned practice and facility• Joint governance being established

PNth IFHC• Many stalled co-location attempts• Large Radius site• Now working on integration and

governance

Horowhenua Case Study• 2009 all Horowhenua General Practices had closed books

• Horowhenua PHO purchased one practice (5,000 enrolled) – Practice situated at Horowhenua Health Centre – PHO Strategy developed for practice to become a health hub for

the district and more recently IFHC

• End of 2010 - 1500 people on waiting list

• All practices participated in providing casual acute visits – not good for patients (cost and no continuity of care)– not good for practices (time consuming and reactive, no pro-

active care planning)

Joint Problem: considered response

• DHB/PHO formulated a “Waiting List Practice” joint plan to: – Enrol all people who wanted access Primary Health Care (1500) – Resource put in place

• 1 FTE NP intern/0.2 GP/Practice Admin/Practice Management – Provide all required appointments – Establish health record for patients - relevant recalls – Establish care plan for people with high health risks – Referred patients to PHO/MCH/Maori health services if required – Establish new ways of working with MCH specialist services

within Horowhenua Health Centre (Mental Health, Child Health and Older persons)

What happened• As Waiting List Practice being implemented a practice within the

Horowhenua Health Centre “fell over” – 1700 enrolled • All 3 practices merged in April 2011 creating a general practice hub

at the Health Centre (8,000 enrolled)• Pressure off other local Practices which are now able to “open

books”

• Able to pick up Foxton Practice 2,400 patients when GP retried and no buyer available

• All Horowhenua people wishing to be enrolled with a general practice can now do so and be provided with high quality Primary Health care - Aim is no one will be “left behind”

Workforce

• Diversification of skills available within general practice • 3.2 GPs & 1 GP Registrar • 1 Nurse Practitioner & 2 Nurse Practitioner interns• 5 Practice Nurses & 1 New Graduate Practice Nurse • 1 Practice Manager and 3 Receptionists • Maori Provider - Whanau Ora Navigator aligned • PHO based Chronic Care Teams - Clinical Pharmacist, Chronic

Care Nurses, Dietician, Smoking Cessation, Physical activity educator , podiatrist, community cardiology service .... aligned

• MCH District Nurses – aligned • Scoping physician assistant role

• Leadership team established: Clinical Director, Nurse Leader, Practice Manager and Clinical Pharmacist

• New ways of working with specialist teams based at Horowhenua Health Centre established – Mental Health, Child Health and Older Persons

Key Success factors• Patient Focus• Clinical and Management Leadership• Vision• Courage• Based in Reality and Measurement• Respect for the providers challenge• Flexibility• Communication• Sharing risk

And for the long haul• Active planning• Monitoring progress• Diversifying workforce• Teamwork and team development• Confidence• Pushing boundaries

“Healthcare is a total system, is a monstrously complex organism….To ensure excellence in everything that affects patients and families is only a

dream, self evidently out of reach, if all we can do is lengthen the list of targets.

How many projects could possibly be enough?”

Virginia Mason

“So we who are ambitions, invoke transformation as the key to systemic

pervasive improvement…continual change through scientific design and

redesign……… everywhere all the time, and where excellence is the result”

The Way Forward• Some core systemic decisions about

base process and culture• Commitment• 5 Habits

– Vision and Values– Tight Specification and Planning– Infrastructure design and implementation– Measurement and Control (Publish)– Self Study