NURSING WORKSHOP Wellington 29 November 2013 The Changing Nature of Healthcare Chai Chuah

Context A Health system that has served New Zealanders well Small country punching above our weight globally Adventurous, bold and creative Can do better for some – equity of access and quality Facing similar challenges to other developed countries

International Perspectives

Challenges 500, , 4,000p, 6,000dg, 13,000diag

Direction of travel for the NZ Health system

Shifting the focus of healthcare Prevention Detection Treatment A health system that works with you, for you

The Health system - more than the science … it’s relational Partnerships Communication Listening andEquality hearing Respect and trust Involvement Patient experience Families/whanau Clinicians Frontline staff Communities Carers GPs Nurses

Health with Other Determinants Well Being Health services Education Housing & Transport Employment

Framework for change Health Services Policy/reg/funding/ incentives Business models Enablers Models of care Where everything comes together

Enablers IT Capital Workforce Devices Perfect alignment- biggest impact on outcome

Quality – remains the driver for change

Mid-Staffordshire – a valuable lesson Meeting the targets but missing the point … Financial reporting came top of the agenda – safety issues came down the list Uncaring behaviours became the norm Clashes of egos and ethos were part of the culture On the flip side … Simple and easy to understand standards of care Openness, transparency, candour and patient voice Accountability – where everyone knows what ‘good looks like’

Quality – must be predictable and measurable Strong financial reporting is one measure of a well-functioning system – but it is not the only measure Real, sustainable, active improvement depends far more on learning and growth than on rules and regulations A culture of continual learning helps everyone to grow. In such a culture, measurement is not a threat

Quality driving disruptive innovations Motor vehicles – US, Japanese, Korean Retail industry – Department stores, Warehouse Health - cardiac surgery/intervention cardiology, POCT Incentives Process Structure Resources allocation Capacity & capability Success criteria & threshold

What stands in the way Innovations often collide with walls of professional and organisational resistance … Reinforced by outdated protocols, practices, beliefs, and traditional roles that may have served us well in the past but no longer do so.

Leadership – the Leaders We Need Those who are motivated to achieve the common good who have the qualities required to gain willing followers in a particular culture, at a historical moment when leadership becomes essential to meet the challenges of that time and place – Michael Maccoby

Christensen & Maccoby Intuitive Empirical Predictive Craft Industrial Knowledge

In summary Quality improvement is more about patient experience and behaviours than $. However managing our finances/resources is very much part of the quality agenda. Keep the targets in focus but don’t lose sight of the people in front of us We are moving beyond the success story to a measurement story – we need to demonstrate the impact on the quality of care The door needs to be open – information on impacts, quality and safety will be shared and judged by the New Zealand public As leaders we have an important role to play – to invite patients to trust us, talk to us and become co-producers of their care We are in the health business – and that makes it personal

Conclusion Our collective responsibility To ensure continued quality improvement and equitable access to services. As leaders and influencers, we need to know that what we do collectively has measurable impact on the quality of care for patients and their experience of the health system.

Keep talking, keep listening, keep the door open The science of health is incomplete without the compassion of care. He aha te mea nui He tangata, He tangata, He tangata