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

1. NURSING WORKSHOPWellington 29 November 2013The Changing Nature of HealthcareChai Chuah

2. 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

3. International Perspectives

4. Challenges 500,000. 2. 648, 4,000p, 6,000dg, 13,000diag

5. Direction of travel for the NZ Health system

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

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

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

9. Framework for change Health Services Where everything comes together

10. Enablers Enablers Perfect alignment- biggest impact on outcome

11. Quality – remains the driver for change

12. 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’

13. 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

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

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stands in the way • Innovations often collide with walls of professional and organisational resistance … Reinforced by outdated protocols, practices, beliefs, and traditional roles that may have served us well in the past but no longer do so.

16. 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

17. Christensen & Maccoby Intuitive Empirical Predictive Knowledge Industrial Craft

18. 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

19. 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.

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