Better Sooner More Convenient Primary Care - New Zealand Doctor

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• 10 Implementation plan 10.1 Project governance and management If either of Options C (devolution to PHO) or D (new joint entity) are chosen the two boards will establish a subcommittee led by the two chairs to oversee the change. The subcommittee will appoint an individual to take over the current PHO CEO and DHB community GM roles and will oversee the development and implementation of a change plan. The subcommittee will also establish a Project Office under the direction of the newly established combined PHO CEO/GM community role to ensure best practice project management of the intended changes, including: task sequencing and critical path development reporting communications planning financial monitoring HR and legal input. The advisory group that helped to create this business case will be maintained to advice on aspects of the change programme. The change programme will be governed using project alliancing principles, including: transparent information sharing shared risk/gain integrated operational management of the change alignment around a set of mutually agreed goals agreed decision making processes shared project values. These principles will be agreed in a heads of agreement or alliance contract between the PHO and the DHB. 10.2 Change management The key drivers for change are: Clinical sustainability: the current model of care in most health centres requires GP numbers we have not been able to achieve consistently on the Coast for at least five years, and leads to long waiting times for appointments (often > three weeks) and lack of continuity and consistency of care. Business case EoI V38 AC 25Feb10 Page 62
Limited integration of community services with primary care leading to lack of coordination and consistency of care and some duplication of services. Financial: primary care medical practices and community services owned by the DHB contribute significantly to the DHB overspend each financial year. Hospitals in Reefton and Buller together also contribute significantly to the DHB overspend each financial year. The barriers to change include: Some primary care providers are overworked and lack energy for change. GPs not having time to participate in planning workshops. Some health providers are comfortable working within the current model of care and do not see the need for change. There are concerns that changes in the current model of care may lead to a decrease in the quality of care. Some staff may be concerned about erosion of current terms and conditions of employment, and/or reduced support for professional development. Recruitment on the coast is difficult, whereas health professionals generally find it easy to get jobs elsewhere if they are not successful engaged in the new models of care. The key change management task is to communicate to the community and health providers the vision of Integrated Family Centres that provide better, quicker, more convenient health care. The Toolkit for Change produced by the primary health care strategy implementation work programme 19 , promotes the following steps when introducing change: “Building the case for change, establishing a sense of urgency and using emergent opportunities as a catalyst for change. Confirming the vision for the future desired state and achieving widespread ownership of the change / new vision. Early engagement with key stakeholders, particularly those likely to be opposed to change. It will be important to understand the perspectives of key stakeholders and reframe the message accordingly. Developing plans with short-term achievable objectives and also longer term objectives. The short term goals are a stepping stone to the larger vision and create momentum. Emphasising the win-win nature of the change, but also being transparent with regard to uncertainties. We note that the Toolkit for Change provides a very useful guide for change management in health, and that it will be used as a guide in implementing the change programme, particularly: Lewin‟s forcefield analysis, pg 17. Nilakant‟s change framework, pg 19. 19 <strong>Primary</strong> health care strategy implementation work programme. Toolkit for Change. MoH, DHBNZ. April 2009 Business case EoI V38 AC 25Feb10 Page 63
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Business Case Better, Sooner, More
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1 Caveats/status This business case
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Current situation By three years Wa
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staffed on a capacity model - in wh
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support from DHBs, specialist clini
Page 11 and 12: 10.4 Key milestones................
Page 13 and 14: Annual government health funding pe
Page 15 and 16: Ambulatory Sensitive Hospitalisatio
Page 17 and 18: The base populations of the three d
Page 19 and 20: Māori/Pacific Not Māori/Pacific D
Page 21 and 22: 4.7 West Coast region service deliv
Page 23 and 24: 5 Future model of care 5.1 The desi
Page 25 and 26: support them. Help with understandi
Page 27 and 28: LEVERS VISION Better, sooner, more
Page 29 and 30: providing the majority of care). Th
Page 31 and 32: The Community Health System Deliver
Page 33 and 34: To better integrate the support pro
Page 35 and 36: 5.5 Enablers A key aspect of this b
Page 37 and 38: Two rounds of meetings with front l
Page 39 and 40: While doctor-nurse substitution has
Page 41 and 42: Nick Goodwin, Kings Fund 14 , in hi
Page 43 and 44: Quality domains Each new initiative
Page 45 and 46: Preventative Acute LTC management R
Page 47 and 48: Preventative Acute LTC management R
Page 49 and 50: The core services are provided or p
Page 51 and 52: Total required FTEs for the Grey IF
Page 53 and 54: 7 Governance, Ownership & Managemen
Page 55 and 56: Option D: PHO/DHB jointly owned Pri
Page 57 and 58: The IFHS will need the ability to b
Page 59 and 60: Of note, a large proportion of the
Page 61: The DHB delegates decision making o
Page 65 and 66: 10.4 Key milestones The table below
Page 67 and 68: Expanded pharmacy roles Improving a
Page 69 and 70: Devolved community based services w
Page 71 and 72: Appendices Appendix One: Health Equ
Page 73 and 74: ongoing GP shortage creating an env
Page 75 and 76: 10. What are the unintended consequ
Page 77 and 78: It is common for people with an acu
Page 79 and 80: Outcome measures Indicator Baseline
Page 81 and 82: determine ratio of nurses and GPs t
Page 83 and 84: C. Extended role for pharmacists:
Page 85 and 86: 11 Engagement Working group who dev
Page 87 and 88: Appendix B: Acutely unwell adult pa
Page 89 and 90: 4 Objectives to implement nur
Page 91 and 92: Review Buller after hours arrangeme
Page 93 and 94: Year three Community education camp
Page 95 and 96: 13 Costs Budget considerations:
Page 97 and 98: established. This group now oversee
Page 99 and 100: Output measures Tobacco control / s
Page 101 and 102: Improving immunisation coverage - h
Page 103 and 104: Year three Continued joint plan
Page 105 and 106: extending health promotion activiti
Page 107 and 108: Immunisation Coverage Funder Provid
Page 109 and 110: The Community Health System Deliver
Page 111 and 112: Clinical care Practice self managem
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and increases in the numbers of pat
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Ambulatory Sensitive Hospitalisatio
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% CVD on lipid lowering drugs, beta
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Health navigators/ kaiawhina: chan
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Committee‟s objectives 41 of prov
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- lack of consistency of care betwe
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qualifications and skills. Where ca
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6 Deliverables / activities Impleme
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“With an aging population and an
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Differences between revenue generat
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Appendix Seven: Integration - Healt
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It is expected that HealthPathways
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Year two implement the process to
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Low uptake by primary and secondary
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Appendix Eight: Improved access to
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to easily access by telephone). Oth
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Year One - July 2010 to June 2011 T
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LECG 50 evaluated whether “the im
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Appendix Nine: Referred services 1.
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them by technical errors or lack of
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Identify patients that would benefi
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• Provision of patient specific m
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12 Organisational accountabilities
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emain under the care and management
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Service user pathways in an optimal
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Model for shared care pathways deve
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Implementation plan: to June 30 Dev
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Year two Review progress, outcome m
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10 Risk analysis Risk Probability I
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Appendix Eleven: Frail older people
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ehab and treatment programmes that
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Year one: Maintain and continue the
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Māori have a higher incidence of m
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11 Organisational accountabilities
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There are often vacancies for allie
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6 Deliverables / activities Program
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Professional development: Provide
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Mainstream arguments are concerned
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Appendix Thirteen: IFHCs - Faciliti
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A key possibility is that land at t
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This option is effectively a Greenf
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7 Westland IFHC Facilities options
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Year two Substantive-IFHC in Greymo
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12 Costs Capital costs Greymouth IF
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utilize MedTech, but via their own
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4 Objectives: To implement c
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Security An individual‟s health i
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8 Effect on inequalities The increa
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Appendix Fifteen: Project advisory
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