1. Preconditions of chronic disease March 2018
The Royal Society
Preconditions of chronic disease
March 2018

2. Our system Queensland Population 4.7 million 8 times size of UK
Decentralised population
Public Health System
Health budget - $16.55bn ( )
Circa 80,000 staff
182 hospitals
Activity
1in 5 Queenslanders are admitted to a public hospital
~1.8m Emergency Department presentations
~3.4m Outpatient appointments
141,000 elective surgeries
45,000 babies delivered
The Royal Society
March 2018

3. Sustainable healthcare
The challenge
The primary cause of death is chronic disease with cardiovascular disease and cancer being the primary cause of death.
Understanding the complexity of providing long term care is contingent of all pieces of the system working collaboratively.
Partners in healthcare
Availability and accessibility to GPs impacts experience. GPs are able to be the connecter for patients, providing early intervention, education and ongoing disease management.
Primary Healthcare Networks
Queensland has 31 PHNs, the PHNs were created to provide efficient and effective delivery of medical services for patients, particularly those at risk of poor health outcomes to ensure the patient can get the right care in the right place at the right time.
Our patients are presenting to hospitals with more complex conditions and despite a seemingly universal healthcare system we know that the experience, wait times and outcomes for patients can be impacted by location.

4. The challenge is growing
“Each year on average, about one in five Queenslanders is being admitted to a Queensland Hospital and this is growing. Our health systems are under pressure – hospital admissions are growing at an additional 70,000 every year and emergency department presentations by an additional 50,000 each year”
Dr Jeanette Young, Chief Health Officer, 2016
It’s a challenge but if we keep doing what we have always done we may not achieve the outcomes need.

5. Barriers to affordable care
In Queensland we still have:
Significant unexplained variation in care/cost vs outcome
Significant variation in health status for some population groups e.g. Indigenous, rural and remote, socio economically disadvantaged
Rising consumer expectations
Increasing rates of obesity and chronic illness
Workforce demographics
Unsustainable growth in cost

6. We need to think differently
Linkages and interactions between stakeholders can improve access to services and provide an improved experience for patients, carers, families and the community. The Institute for Healthcare Improvement (IHI) promote systems thinking within the Triple Aim framework.
It is like a three legged stool though, if any one area is short the likelihood is that it will fall over. We need to create genuine partnerships to improve health outcomes for Queenslanders.
Institute for healthcare Improvement, 2012

7. Systems thinking supports change
Getting patients to hospital in only part of the challenge, the system is at capacity, we don’t turn people away at the front door so we need to start to think differently about the cost of providing care and the potential consequences of only doing that within a hospital system with limited resources. Value based care supports clinical decision making based upon not only the presenting problem but also on the potential consequences and expected outcomes for patients.
Improving patient experience and access to care by reducing Hospital Acquired Complications, January 2018, Systems Performance Branch

8. Embedding new ways of thinking
The triple aim model supports new ways of thinking to better identify problems and solutions further upstream and outside of acute health care. Patients can expect less complex and much more coordinated care and the burden of illness will decrease. This model relies upon all providers collaborating to support the patient through all parts of the system. Importantly its means that all elements of the system need to collaborate and form strategic alliances, recognising that funding and resources may not be equal but the relationships and alliances should be.
The Royal Society
March 2018

9. What do we need for the future?
We need a system that:
cultivates innovation, research, service improvement, and seeks innovative service delivery models
Provides meaningful collaboration between all stakeholders
Enables patients with shared decision making
Ensures our workforce is fit for the future
Innovate and explore new ways of working
Focus on the patient
Systems thinking
The Royal Society
March 2018

10. The challenge ahead Our system needs to support transformation.
Leaders need to empower staff and support innovation and find new ways of doing things more efficiently.
We need to support performance and create meaningful measures to deliver system improvements.
As you meet this afternoon, discuss the challenges but focus on the opportunity. By bringing together the insights from this group we may better understand the destination but also how to get there.
The Royal Society
March 2018