HealthOne newsletter October 2007
HealthOne NSW Statewide Workshop: an outstanding success | Prevention: core business for HealthOne NSW Services | HealthOne NSW Services in focus: patient journey mapping – the Manilla experience | Australian Better Health Care InitiativeHealthOne NSW Statewide Workshop: an outstanding success
Ninety-six participants representing all 26 HealthOne NSW services and proposed services attended the HealthOne NSW statewide workshop held on 31 August 2007 at the Mercure Hotel in Sydney. The participants were drawn from the range of local community partners who have taken an active interest in the HealthOne NSW service. They included representatives from 5 local councils, 7 Divisions of General Practice and 8 Area Health Services.
The day was expertly facilitated by Julie McCrossin who ran a series of panel discussions with participation by the audience. At the end of each session there was an opportunity for reflection and further discussion at each table. The feedback from participants was that the format worked well with many appreciating a change from PowerPoint presentations to a more interactive learning experience.
Key themes which emerged through the day included:
• the importance of building relationships with partners to provide a firm foundation for service development
• managing some of the difficulties arising from the differences in cultures between public and private sector
• how to get the governance arrangements right, and developing them in tandem with the service model.
Another issue highlighted was shifting professional boundaries. The extended roles of nurses and other allied health professionals were noted to offer the opportunity to provide team care while freeing up GPs to be involved in integration activities such as case conferencing.
Janet Anderson, Director Inter-Government and Funding Strategies Branch, started the day with a reminder of the core characteristics of HealthOne NSW services, and the importance of ensuring that quality performance was a hallmark of the 'brand'. The key features of the model are:
1. GPs and community health staff working together as members of a multi-disciplinary team, with GPs providing clinical leadership
2. In a professionally satisfying and sustainable work environment that is organised and managed differently from either a conventional General Practice or a conventional Community Health Service
3. Providing coordinated and integrated services for a local community that encompass:
• Health promotion and illness prevention
• Early detection and early intervention
• Continuing care for people with chronic conditions
4. Including planned care for those who need it
5. Underpinned by integration of systems for client record keeping and information sharing
6. Providing a locale for clinical education and training, and research
7. With health care consumers and the local community as active participants in services planning and care delivery.
Session 1 focused on how to develop a service around the needs of the community. Panel members from Molong, Rylstone, Manilla, Jindabyne and Mt Druitt related their experiences including:
• using population data to map health needs and service utilisation, both current and projected
• community consultations to better understand the gaps and challenges of current service provision
• mapping patient journeys to gain insights into how patients move through and between services, and identifying how these journeys can be improved through integrated service delivery.
Challenges encountered in service planning included finding those people who were currently not accessing services but who would benefit from early intervention and better disease management. Working effectively with the different cultures was also seen as a challenge. Participants also noted the difficulty in making the time to undertake activities to facilitate integration.
Solutions included ensuring that the focus from the outset was on the people who needed health care, so all partners shared a common goal of improving services for that group. Prioritising integration and actively working on it was seen as critical to the process, and this should include getting clinicians together at an early stage to develop productive working relationships and break down any barriers and misconceptions about different roles.
Session 2 was about governance and how to make the governance arrangements work in reality. The importance of clinical governance as a mechanism for ensuring quality, risk management and professional development was highlighted. The corporate governance arrangements required to run the 'business' of HealthOne NSW services were also discussed. Emerging from a lively discussion of definitions was broad agreement that the term referred to a formal set of arrangements that ensured accountable decision-making in relation to the operation of the service.
For those services that had already started to address their governance arrangements, most emphasised the importance of building trusting relationships before tackling the details of how the arrangements would work in practice. The NSW Department of Health offered to explore ways of providing further assistance to emerging HealthOne NSW services in working on this critical issue.
Prevention: core business for HealthOne NSW Services
An essential component of the HealthOne NSW program is its emphasis on health promotion to minimise the impact of disease processes on individuals and the community. In 2004 it was estimated that 67% of all premature deaths were due to causes which could have been reduced or avoided by healthier lifestyles, earlier detection of disease or improved treatment (Report of the Chief Health Officer 2006, NSW Health). For the Aboriginal population, this figure rises to 76%. This is why it is so important for HealthOne NSW services to focus on this area of health as part of their core business. HealthOne NSW services need to engage with communities to develop a proactive approach to health.
HealthOne NSW services will provide an opportunity to develop personalised care, based on an assessment of genetic and lifestyle risk factors, to help individuals stay well. Such an approach is new to Australia but well established in a number of countries, so we know that focusing on prevention at a community as well as an individual level is a worthwhile investment. Many of the developing HealthOne NSW services will be the main health care provider in smaller towns and this presents a great opportunity to develop health promotion programs which reach the entire local population and make the best use of all the available resources.
Tobacco smoking, risky drinking of alcohol, inadequate physical activity and poor diet contribute significantly to the burden of disease. Smoking contributes to 6,500 deaths per year and more than 55,500 hospital admissions in NSW. Despite decreases in smoking prevalence over the last few decades 23% of men and 18% of women are current smokers and 9% of boys and 8% of girls aged 12-16 reported smoking in the previous week.
By focusing on health issues of local concern and actively engaging local community members in planning and implementation, the multidisciplinary teams in HealthOne NSW services will have the opportunity to reinforce healthy lifestyle messages across the community, promoting activities that will help people stay healthy longer.
For example, a focus on men's health issues or heart disease may take the form of a week-long intensive campaign to encourage men to take an interest in their health, and get screened for risk factors such as high cholesterol or high blood pressure. Tailored advice would then be provided and follow up sessions arranged. Such activities will necessarily extend well beyond the HealthOne NSW building and, depending on the campaign, may include activities in pubs, clubs, workplaces, pharmacies and schools.
How these important activities are undertaken will vary according to local circumstances, but what is essential is that disease prevention and health promotion will be core business for HealthOne NSW services.
Professor John Dwyer - Clinical Advisor to the HealthOne NSW program.
HealthOne NSW Services in focus: patient journey mapping - the Manilla experience
HealthOne NSW services must deliver care in a way that is different from conventional community health or GP services whilst also reducing duplication of, and improving, services for patients and their families.
Undertaking a clinical redesign process is challenging, especially where there are public and private partners involved. As indicated in the above article by Prof Dwyer, the HealthOne NSW program requires reorientating primary health care to incorporate strong health promotion, illness prevention and early intervention foci.
Many partners of developing HealthOne NSW services have been looking for practical information and advice about how to start this process.
Sarah Bradfield spoke to Paul Gorrick (General Manager, Peel Cluster HNEAHS) about the experience of the Manilla HealthOne NSW service partners in undertaking this process. This article provides an overview of the process at Manilla and the approach used for the clinical redesign process and developing the service model using patient journey mapping.
Mapping the Patient Journey at Manilla HealthOne NSW
"To begin the process, an initial meeting of clinical staff from Manilla Hospital and Community Health services was arranged and structured around four key questions:
1. What do we understand about integration?
2. What does it mean for us at Manilla?
3. What do our current service delivery methods and models look like now?
4. What would the service delivery methods look like when we move to integration?
Community health staff involvement in the diagnostic phase of the patient journey mapping was seen as critical to the success of the process. Early involvement of frontline clinical staff has encouraged ownership by the clinicians who will work in the HealthOne NSW service at Manilla and ensured that we were able to benefit from their practical clinical expertise.
The first meeting generated discussion and information about the way services are currently delivered and how integration could improve them. The discussions were underpinned by a focus on patient journeys and how to improve the experience of care for the patient. While it was clear that we all had different views of what integration meant, the discussion was productive and rich through the participation of the different professional groups represented.
A second meeting was arranged with senior planners, the Clinical Nurse Consultant and population health representatives from the HNEAHS. This meeting was used to discuss ideas generated by the clinical staff and how these could be developed into a HealthOne NSW service model. The group decided to take a disease-specific approach, considering such things as the needs of the patient, the available resources in the community and the patient journey across the lifespan.
Based on the demographics of the local population of Manilla the group chose to initially focus on airways diseases. This seemed a logical population health choice as we have higher than average rates of childhood asthma and an ageing population with corresponding prevalence of chronic obstructive pulmonary disease. Using an illness prevention, early intervention and health promotion framework, the team looked at the patient journey and experience of care for those who were already receiving services and those who may be at risk of developing a chronic disease but do not seek help. Key questions were asked including:
- If patients were not receiving services where would they be most likely to go for help and support? This included both health care and other social agencies such as non-government organisations.
- What are the opportunities for contact with health professionals in those settings?
- Are there agencies that we need to involve and partners within our HealthOne NSW service to engage people who are not currently seeking help?
An important outcome of this process was identification of non-traditional settings - like schools and day care facilities - where we might be able to offer community health clinics or health promotion campaigns to the target populations. It also demonstrated the importance of involving the non-government sector in our service mapping as they may be seeing people with health care needs that we don't know about yet.
This early work enabled the team to develop a draft service framework for people at risk of developing breathing disorders across the lifespan. The next steps will include further discussions and refinements with the clinical team of the HealthOne NSW service to see how this model might work in practice. "
For further information contact Paul Gorrick (General Manager, Peel Cluster, HNEAHS).
Australian Better Health Care Initiative
The Australian Better Health Care Initiative (ABHI) is a package of programs announced by the Council of Australian Governments in February 2006. It is jointly funded by the Commonwealth and State/Territory governments.
Under priority area 5: Improving Integration and Coordination of Care, the Australian Government has committed $28 million nationally to improve the integration of primary health care services. NSW Divisions of General Practice and the Alliance of NSW Divisions will receive approximately $9 million of these funds over a 3 year period.
Recognising the importance of leveraging off existing initiatives in each state/territory, the Australian Government Department of Health and Ageing has worked with both the Alliance of NSW Divisions and the NSW Department of Health in developing a proposal for how these funds will be used in this state.
It has been decided that the program will be managed by the Alliance through a statewide coordinator who will work with regionally based coordinators in the Divisions network. The role of the regional coordinators will include supporting multidisciplinary education and training and systems change in primary health care settings. This is likely to include, but extend beyond, HealthOne NSW services.
Divisions of General Practice have been invited to submit proposals to obtain funding under this program, and are being encouraged to work in consortia and consult with Area Health Services to determine the best local implementation plans.
The NSW Department of Health and Area Health Services are both represented on the Commonwealth-convened Working Group providing advice on this program. Further updates will be provided both on the HealthOne NSW website and through the HealthOne NSW newsletter as the program progresses.
Further information about recurrent funding for HealthOne NSW services
Written advice has now been provided to all Area Health Service Chief Executives in relation to the recurrent funding for HealthOne NSW services announced in the 2007/08 Budget. For Wave 1 and Wave 2 sites this will comprise $200,000 per year and $100,000 per year respectively, recurrent from 2007/08. For Wave 3 sites, it will be $100,000 recurrent from 2008/09 (irrespective of the outcome of the evaluation of proposals due at the end of November). This growth funding is to be spent on increasing community health capacity by providing extra non-medical clinical staff in HealthOne NSW services. HealthOne NSW partners are encouraged to work together to assess local community needs and any service gaps to determine how the additional funds can best be used.
HealthOne NSW evaluation: outcome of tender announced
The Department is pleased to announce that the successful tenderer for the HealthOne NSW program evaluation is the University of New South Wales Research Centre for Primary Health Care and Equity. Many HealthOne NSW partners will have previously worked with UNSW and will be aware of their extensive research experience in the primary care field. The Department and the Evaluation team are working together to consider the best ways to maintain active communication with the HealthOne NSW services. Watch this space for further details about the evaluation.
Team of consultants
There have been some changes to the Team of Consultants. As the University of New South Wales Research Centre is now involved in the evaluation of the HealthOne NSW program they are no longer available on the team of consultants. Westwood Spice will be engaged to provide an additional option for consultancy. Information on the services they can offer is available from the Program Team and will also be placed on the website.
Reminder to Wave 3 sites
Proposals from all Wave 3 sites are due at the NSW Department of Health by Thursday 29 November 2007. They should be emailed by COB to kim.white@doh.health.nsw.gov.au
The template has been sent to all Wave 3 site project leads. Please contact the HealthOne NSW program team if you have any questions or would like any further advice regarding the submission of a Wave 3 proposal.
Contact us
If you would like to contribute to the next newsletter or want to get in touch with us for any other reason please send an email to: healthonensw@doh.health.nsw.gov.au
This web page is managed and authorised by Inter-Government & Funding Strategies of the NSW Department of Health. Last updated: 30 March, 2009
