The Canterbury Clinical Network Alliance in a health context The Canterbury Clinical Network

In 2007 Canterbury’s health system was fragmented We had: Growing admissions and waiting times Growing demand for aged residential care. General practice was isolated.

Building a Platform – A Shared Vision The answer was about a: Connected and integrated system Centred fundamentally around people (at the centre of everything we do) That aims not to waste – key measure of success is on time not wasted.

Shared Objective: Canterbury’s Three Strategic Goals The development of services that support people/whānau to stay well and take increased responsibility for their own health and wellbeing. People take greater responsibility for their own health. The development of primary care and community services to support people/whānau in a community-based setting and provide a point of ongoing continuity, which for most people will be general practice. People stay well in their own homes and communities. The freeing-up of hospital based specialist resources to be responsive to episodic events and the provision of complex care and support and specialist advice to primary care. People receive timely and appropriate complex care.

Getting the best outcomes possible within the resources we have. Removing barriers and perverse incentives created by contracts and organisational boundaries by planning and working collaboratively across the public, private and NGO sectors. Getting the best outcomes possible within the resources we have. One health system, one budget. The key measure of success at every point in the system is reducing the time people waste waiting. Right care, right place, right time, delivered by the right person. It's about people. The DHB's role is to buy the right thing for the population. Clinicians are enabled to do the right thing the right way. Focus on leadership. Understand and respond to the needs of populations. Use information to plan and drive service improvement. Make decisions based on where services are best provided: What is best for the patient? What is best for the system? Take a 'whole of system' approach. ‘Single system’ approach focused on patients A focus on ongoing improvement Ability to evolve Open and transparent information sharing Strong relationships and high levels of trust between multiple parties Joint decision-making High accountability for agreed outcomes and common performance targets Low level of bureaucracy

A way of working based on trust Clinicians are trusted Care pathways are re- designed Funding and resources are rearranged to support The person is in the middle Adaptive leadership in action.

Alliance Partners

Key Ingredients - Making the Alliance Work Some kind of structure, programme office coordination, clarity through clear processes Need to give genuine devolution of decision rights to service level alliances - permission Participants need to see early gains: create momentum Other investment - Time to make it work. Commitment seen in terms of people time Leadership across the system - display alliance principles Need to be clear about what success looks like and how going to monitor making a difference Confidence if it’s the right thing to do the funding will follow Independent Chairpeople and facilitation across alliance groups Person at the centre.

Alignment is Key Market context was one of the most important factors differentiating alliances. More highly aligned alliances had more extensive histories of collaboration established more credibility in the local community were more effective at balancing collaborative initiatives against competitive interests took more active approaches to build consensus among stakeholders regarding alliance initiatives successfully utilised small decision-making bodies to foster this consensus. Leadership credibility, leadership stability, and trust were important facilitators of alignment for all alliances, regardless of the level of alignment. These factors intersect and overlap in a multitude of ways to influence stakeholder alignment.

Alliance Charter Agreement to agree: The scope, activities and objectives of the alliance; How decision rights will be allocated across different parties, and how the process for joint decision-making will work; Principles for working together; The roles and responsibilities of an alliance leadership team; Arrangements for joining and leaving the alliance; and Dispute resolution.

The role of the DHB Statutory accountability for coverage of health services in a district: cannot contract out of this. Funder (mostly). DHBs contract for services in accordance with the decisions made by the alliance. DHBs responsible for maintaining commercial transparency of procurement. DHBs can choose not to respect alliance decisions, but the threshold for doing so would have to be very high. Membership across service level alliances – alignment with national, regional and local priorities, no surprises, resource expectations.

Shared Orientation Shared measurable objectives, direction and attribution. Understanding that we all contribute in a complex system . Mobilized towards common outcome and articulate your part in shared contribution to achieve those outcomes. Aim for global system maxima. Not local efficiency. Balancing the needs of the person with the needs of the population.

System Level Measures Aligned to our Outcomes Framework

System Integration Enablers

We need the whole system to be working for the whole system to work