2019-2025 Strategy - New Zealand Doctor
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2019–2025 Strategy
Contact Us CONTENTS
enquiries@thinkhauora.nz Foreword 2
www.thinkhauora.nz
Each rohe has an office out of which THINK
Te Rautaki - Strategic Context 4
Hauora staff operate. Contact details for Our Strategy of Weaving 6
these locality offices are as follows:
Our History 8
Palmerston North
200 Broadway Ave, Palmerston North 4410
Connecting Our Past and Future 10
PO Box 2075, Palmerston North 4410 Strategy Visualisation 12
Tel (06) 354 9107
Fax (06) 354 6107 W. Whānau Ora 14
Horowhenua E. Equity 18
62 Liverpool Street, Levin 5510 A. Access 20
PO Box 659, Levin 5510
Tel (06) 367 6433 V. Value 26
Fax (06) 367 6434
I. Innovation 32
Ōtaki
N. Networking 36
2 Aotaki Street, Ōtaki 5512
PO Box 659, Levin 5510 G. Growth 38
Tel (06) 364 8291
Fax (06) 367 6434
In Summary 40
Pahiatua Strategy At A Glance 42
3 Centre Street, Pahiatua 4910 Outcomes Framework 43
PO Box 2075, Palmerston North 4410
Tel 0800 766 255
References 44
Fax (06) 354 6107
COMMITMENT TO TE TIRITI O WAITANGI
We are committed to:
1. Recognising and respecting the Treaty of Waitangi (Te Tiriti O Waitangi) and the principles –
partnership, participation and protection
2. Acknowledging that the Treaty of Waitangi and principles underpin our strategy
3. Being responsive to Māori interests and ensuring these are protected
4. Implementing the Treaty of Waitangi and principles into the overall governance, planning and
THINK Hauora 2019–2025 Strategy delivery of the services
Unuhia te rito o te harakeke Remove the centre of the flaxbush
Kei hea te korimako e kō? Where then will the bellbird sing?
Whakatairangitia, rere ki uta, rere ki tai. It will fly inland and seawards aimlessly.
Kī mai koe ki ahau, You enquire of me,
He aha te mea nui o te ao? What is the greatest thing in this world
Māku e kī atu, he tangata, he tangata, I reply, it is people, it is people,
he tangata it is people
(Nā Meri Ngaroto o Te Aupouri) (Proverb by Meri Ngaroto of the Te Aupouri tribal nation)
THINK Hauora 2019–2025 Strategy 1
FOREWORD
Tēnā koutou and welcome to
THINK Hauora
This outward-looking focus has born the
2019–2025 Strategy and the concept of
“Wellbeing touches
For the last three years Central Primary
WEAVING. Our new strategy looks at how so much more than
the organisation can operate to weave
Health Organisation (PHO) has followed a
forward-thinking strategy, and a significant
connected systems and processes for the health alone”
betterment of the communities’ wellbeing.
amount of mahi has been directed at
improving services to our primary health This is not a change of direction but a
care provider network, implementing a natural extension of the journey we have
bold and extensive ICT programme and been on. To complement this new exciting
continuing to partner with MidCentral strategy, the Trust Board has taken the
District Health Board (DHB) to improve bold move to change the name of the
health outcomes for the communities we organisation to reflect the direction of
live in. travel. From July 2019 we will be known as
“THINK Hauora”. The vision is “Connecting
When developing the new strategy, Central
Communities for Wellbeing”.
PHO took a far reaching and outward-
looking approach. This recognises that Exciting times are here – now the new mahi
the wellbeing of people, whānau and begins.
communities is not just an issue of health
provision and health providers but involves
complex and inter-related connections,
systems, and organisations.
Wellbeing touches so much more than
health alone, and for us working to provide
health services it is necessary to look Dr Bruce Stewart
beyond our own borders and boundaries Chairman
and connect the dots. THINK Hauora Board
Recent experience in using collective impact July 2019
further highlights the need to work outside
of the isolation of health.
2 THINK Hauora 2019–2025 Strategy
“THINK Hauora links our Our journey began with developing a
strong foundation for primary health care
These partnerships connect on many levels.
Thus the concept of WEAVING has been
focuses of technology, across our rohe twenty years ago. created, both in its process and art, as a
framework for this strategy. Our new name
health, innovation, This six-year strategy continues to focus
on health care, however it is set within a
and branding, THINK Hauora, links our key
networks and knowledge” wider context, recognising the connections
focuses of Technology, Health, Innovation,
Networks and Knowledge. It calls to
between health and other aspects of
partnerships.
people’s lives. The strategy acknowledges
the environments in which we live and work, With that said it is important this THINK
and their significant impacts on the health Hauora strategy is viewed more widely than
and wellbeing of individuals and whānau an organisational strategy. This strategy
of the five distinct communities within belongs to our people, providers and
our rohe. This strategy aligns well to the partners – together we are committed to
Government’s Wellbeing Budget. connecting communities for wellbeing.
Over recent years we have deliberately
developed into a values-based network and
have proven that working collaboratively
with our contracted providers and
communities through engagement and co-
design is not only enjoyable but has created
a platform for excellence every day. Chiquita Hansen
We are committed to partnerships and are CEO
proud of our local alliances with Te Tihi o THINK Hauora
Ruahine and Raukawa Whānau Ora, and the July 2019
MidCentral District Health Board.
THINK Hauora 2019–2025 Strategy 3
TE RAUTAKI - STRATEGIC CONTEXT
Tūhonotia te hapori te ora – Connecting Communities for Wellbeing
The THINK Hauora strategy of Whānau Ora, equity, access, value, innovation, networking and growth is grounded by the
New Zealand Health Strategy, the New Zealand Māori Health Strategy and the MidCentral DHB Strategic Imperatives.
NZ Health Strategy NZ Māori Health Strategy MidCentral DHB Strategic Imperatives
Rautaki ā-Motu He Korowai Oranga Me Mahi
Te whāinga hua me te tika o ngā mahi
Value and high performance Achieve quality and excellence by design
Value and high performance
Closer to home Pae Ora Healthy futures for Māori Connect and transform primary, community and specialist care
One team Wai Ora Healthy environments Partner with people and whānau to support health and
wellbeing
Smart system Whānau Ora Healthy families
Achieve equity of outcomes across communities
People-powered Mauri Ora Healthy individuals
THINK Hauora Strategic Aims
W E A V I N G
Whānau Ora Equity Access Value Innovation Networking Growth
Achieving wellbeing People, community voice Easy, available, cross- Teams, technology, Quality improvement, Relationships, Sustainability, system
and data-driven sectors performance excellence, engagement partnerships, and alignment focus
collective impact
4 THINK Hauora 2019–2025 Strategy
OUR ROHE
The MidCentral district is made up of:
We have a population of
19% 21% 17% 25% 18%
182,110 0-14 years 15-29 years 30-44 years 45-64 years 65+ years
Trend
Five Manawatū
territorial local authority districts District
are covered by MidCentral DHB
30,300
which is estimated to rise 12%
to 186,040 by 2023/24 Horowhenua 71%
District
80%
32,500
As a district, we have a higher
proportion of Māori compared to 66%
the national average 69% Tararua
District
71%
Māori 20% 17,850
Kāpiti District Ōtaki Palmerston North 42%
Pasifika 3%
8,620 City 67%
Asian 9%
71% 87,300 76%
Other 68% 65% 18%
80% 62%
82%
Graphic adapted from: MidCentral DHB Strategy 2016
THINK Hauora 2019–2025 Strategy = Population = Deprivation = Home ownership = NCEA Level 2 5
OUR STRATEGY OF WEAVING
Unuhia te rito o te harakeke Preparation lays ground for our Weaving begins with planning,
future process and discipline
Kei hea te korimako e kō?
As we look to the future, we have chosen Te Whare Pora is the House of Weaving
Whakatairangitia, rere ki uta, weaving, both in its process and art, where Hineteiwaiwa as the Spirit of all Māori
rere ki tai. to provide a lens to view our strategic weaving presides.
direction and intention of ‘Connecting
Harakeke is a commonly used material used
Kī mai koe ki ahau, Communities for Wellbeing’. Weaving
for weaving. Depending on the intended
provides a blueprint for many things
He aha te mea nui o te ao? including purpose, preparation, foundation,
use of the harakeke, kairaranga/weavers
will select specific varieties based on the
Māku e kī atu, he tangata, rhythm, connectedness, prosperity and self-
pliability, colour and fibre quality. Included
determination.
he tangata, he tangata in the planning is ascertaining how many
Nā Meri Ngaroto o Te Aupouri As a network we are impacted, shaped and rau harakeke will be required. The outer
motivated by a wide range of strategies and leaves are then harvested and prepared in
policies. Our strategy weaves these into a accordance with custom. All of this requires
strategic document that will help shape the planning, patience and discipline. Weaving
Remove the centre of the
annual plans of the network partners. is yet to start.
flaxbush
This whakatauāki indicates that should the When weaving does begin, each whenu
Where then will the bellbird sing? rito (centre) of the harakeke be cut, the (warp strand) and aho (weft strand) is
harakeke will perish, resulting in far reaching woven in a deliberate fashion to form the
It will fly inland and seawards consequences. With the loss of the harakeke, papa, the foundation for the artform being
aimlessly. there is no kōrari stalk for the korimako created.
(kōmako) to perch upon, no nectar from the
You enquire of me, The whakatauāki speaks to the environment
stalk flower for the korimako to suckle on
for weaving; to kaitiaki as those responsible
What is the greatest thing in to sustain itself, and thus no song would be
for the guardianship of weaving, and to
this world heard. Although the proverb origins and
everyone overall.
purpose are unfamiliar to most, the adage
I reply, it is people, it is people, endures—we are urged to treasure and work
it is people respectfully with what we have now, while
being cognisant of the future.
Proverb by Meri Ngaroto of the
Te Aupouri tribal nation
6 THINK Hauora 2019–2025 Strategy
Pā
W Whānau is a crucial building block of society
and is symbolised by pū, a single harakeke and
core root base which holds the rito, flanked by
Pū the awhi rito or mātua (parents) which are then
surrounded by the tūpuna (grandparents). A
E cluster of harakeke is a pā.
Equitable conditions create the right
environments for harakeke to grow and create
strong foundations and ongoing sustainable
Awhi rito/mātua (parents)
A
thriving crops.
Rito (child) Access to harakeke was so desired that pā were
cultivated, named and treasured.
Tūpuna (grandparents) Values of suitability, durability, versatility
V
abound in this humble plant to the point that
tūpuna questioned how other nations could live
without it.
Innovative modern designs build on the
traditional materials, dyes, patterns and
I techniques maintained by Kaitiaki and
Kairaranga.
Networks of mutual benefit are formed by
interconnected, interdependent, synergetic
N
relationships between pū and pā.
Growth comes from the centre. The middle
shoot known as the rito or child is protected and
nurtured by the awhi rito or mātua (parents)
G
which are then surrounded by the tūpuna
(grandparents). The more mature outer leaves
generally used for weaving.
THINK Hauora 2019–2025 Strategy 7OUR HISTORY
In the early 2000s MidCentral District initiatives to address the health of older These ventures ensured a “The amalgamation of
Health Board’s (DHB) Primary Health Care people, creation of system enablers and continuity and access of four geographical PHOs
(PHC) Strategy enabled investment and plans to ensure high-quality care. Many care in line with its founding
growth across our rohe. Primary Health small general practices merged as Integrated vision of ‘working together, (Manawatū, Ōtaki,
Organisations (PHOs), management Family Health Centres to provide broader co- towards healthy and flourishing Tararua, Horowhenua)
support entity, Nursing Development ordinated care to their enrolled populations. communities’. followed, and Central
Team (known as Health Care Development PHO was formed”
The Central PHO Board and Alliance In 2016 a three-year Strategic
between 2007–2018) and cohorts of new
Leadership Team joined forces in 2013 Plan was developed with five
long-term condition staff emerged. Access,
and the alignment of annual plans on strategic aims: improve access and equity,
community participation, service co-
quality improvement, business intelligence, integrated care for priority populations,
ordination, infrastructure, integration and
specialist integration, and acute care began. partner with people, communities and
quality provided the framework for the DHB
providers, activate smart systems and
investment. The Central PHO Māori Health Team was
quality foundation for success. Central
instrumental in the development of Te
The Millennium marked a change — the PHO brought financial management and
Tihi o Ruahine Whānau Ora Alliance (Te
introduction of the Better Sooner More human resourcing capability in-house and
Tihi) in 2011. Nine Iwi, Hapū and Māori
Convenient 2010 policy, introduced by the commenced preparation for digital health
organisations are part of this Alliance.
Ministry of Health to improve primary health transformation and the transition of data
The Alliance works collectively to develop
care and integration commenced. The management in-house from 2019.
whānau-centred projects, innovations
amalgamation of four geographical PHOs
and processes. In 2017 Te Tihi established Te Ara Rau, primary mental health
(Manawatū, Ōtaki, Tararua, Horowhenua)
their own Charitable Trust and a new service, was co-designed in 2018 and this
followed, and Central PHO was formed
entity emerged. The relationship between model of care has been supported by
with a vision of ‘working together, towards
Central PHO and Te Tihi remains strong the 2019 Wellbeing Budget as part of the
healthy and flourishing communities’. A
with a Board-to-Board Memorandum Government’s response to the inquiry into
PHO-DHB Alliance Leadership Team was
of Partnership in place. Te Tihi provide mental health and addiction, He Ara Oranga.
developed to provide governance of the
ongoing Māori health leadership and
change and marked a new way of working in Today, THINK Hauora has a core staff of
stewardship to Central PHO.
partnership. 110, as well as 25 staff employed within
Central PHO acquired Horowhenua Horowhenua Community Practice. It
At this time, the rohe was served by 42
Community Practice in Levin in 2013. contracts through 29 General Practice Teams
general practice teams and 50 contracted
Soon after, Central PHO, together with Te and Integrated Family Health Centres, and
health providers. Priorities included
Rūnanga o Raukawa, opened Te Waiora 82 providers, for the health and wellbeing of
embracing a Whānau Ora approach and
Community Health Services in Foxton. over 182,110 people throughout the rohe.
the development of a Māori Health team,
THINK Hauora Board is made up of 13 representatives from across the provider network, Māori, Iwi and community. They are also members of the
8 Alliance Leadership Team alongside other system-wide representatives. THINK Hauora 2019–2025 StrategyTHINK Hauora 2019–2025 Strategy 9
CONNECTING OUR PAST AND FUTURE
Connecting our past and future We move forward, keeping our values Introducing our new vision
Our origin from four PHOs into one ‘central’
at the forefront
Tūhonotia te Hapori te Ora
PHO was translated through the physical
elements within the Central PHO logo. The
Trust
Tararua maunga; the Ruahine maunga, the Whakapono/Rangatiratanga Connecting Communities
Maintaining open and honest relationships
Manawatū awa; the Ōtaki waka prow; and
the Horowhenua waka stern represent each
for Wellbeing
community. The maunga symbolises the Respect
life-force giving rise to nurturing water— Whakaaro nui/Manaakitanga
common and unifying. The elements within Embracing diversity, uniqueness and ideas
the Central PHO logo carry meanings of
connected systems, health and wellbeing, Unity
community and continuity. Kōtahitanga
Our new strategic direction provides Valuing strengths and skills
an opportunity to reflect and to find an
identity which connects our origins with our Accountability
aspirations. He mana tō te kupu Central PHO logo
2010–2019
THINK Hauora is this new identity. THINK Working in a transparent and responsible
Hauora links Technology, Health, Innovation, manner
Networks and Knowledge to the wellbeing
of all. It calls to partnerships. This draws
Courage
inspiration from the prow of a waka drawing Ka tū te ihiihi/Whakamanawanui/Hautoa
all people forward into a shared future. It Participating with confidence and
speaks to equity. Awa is the system which enjoyment
connects people to land and people through THINK Hauora logo
time. It gives access to health-giving 2019–present
nourishment and ensuring growth. The logo
also evokes imagery of the rohe landscape:
mountains, hills, plains, rivers, and a wave
surge.
10 THINK Hauora 2019–2025 StrategyTHINK Hauora 2019–2025 Strategy 11
COMMUNITIES Horowhenua Ōtaki
COMMITMENT TO TE
TIRITI O WAITANGI
STRATEGIC AIMS
WHĀNAU ORA EQUITY ACCESS
Achieving wellbeing People, community voice Easy, available,
and data-driven cross-sectors
Tūhonotia te Hapori te Ora
• Positively support and influence cross- • Connect information and people to • Provide leadership for the inclusion of
KEY AREAS OF FOCUS
Connecting Communities
sector Whānau Ora and Wellbeing inform and transfer knowledge to develop bold political choices for health across all
policy setting and direction innovative ways to improve equity sectors
for Wellbeing
• Align activities and effort to the • Health intelligence provides quality • Develop a strong affinity between
Whānau Ora outcomes-based and context-based insights to support the Health Care Home, Iwi and Māori
framework and the Stats NZ Wellbeing decision-making to improve equitable providers and other community-based
indicators health outcomes health, social and specialist services
• Continue to drive the uptake and • Effective data stewardship and system • THINK Hauora will give effect to Te Awa–
utilisation of Ka Ao, Ka Awatea Māori interoperability will improve the access Digital Strategy by continuing to drive the
Health Strategic Framework and flow of information digital connectedness in our rohe
WHĀNAU ORA Rangatiratanga Hauoranga
OUTCOMES Self-Managing Living Healthy Lifestyles
Kōtahitanga
Whānau Cohesion
QUADRUPLE AIM Affordable care Excellent outcomesManawatū Tararua Palmerston North
VALUE INNOVATION NETWORKING GROWTH
Teams, technology, Quality improvement, Relationships, partnerships, Sustainability, system and
performance excellence, engagement collective impact alignment focus
• Establish locality-based teams across the • Recognise and celebrate our provider • Partner with people, community and • THINK Hauora will give effect to the
rohe to support whānau to meet their network achieving excellence every providers to collectively support our MidCentral DHB Health and Wellbeing
health and wellbeing needs day in improving health outcomes communities’ aspirations Locality and Cluster Plans
• Locality-based teams will be supported • Drive the implementation of the • Strive to become a trusted backbone • Diversify revenue streams to achieve
by technology that enables mobility, district’s ‘Quality Agenda Shared organisation that supports cross-sector primary health care clinical and
productivity, knowledge and safety Clinical Governance’ alliances within a collective impact financial sustainability
methodology
• THINK Hauora Outcomes Framework will • Achieving our local response to the • Cultivate innovative approaches
focus expectations on equity of outcomes Mental Health Inquiry ‘Realising • Partner with local, national and to primary health care workforce
and any related consumer and practice W.A.I.O.R.A - A Collective Voice’ international organisations to development to improve the
incentives across our communities Programme of Action improve our approach to research and experience of providing care
development
Tiaki Taiao Pukenga Rawa
Responsible Stewards of Living & Economic Security &
Natural Environments Wealth Creation
Tuakiritanga Pāporitanga
Participating in Te Ao Māori Participating in Society
Excellent experience for Excellent experience
those we serve for providersW Developing a Whānau Ora Whānau Ora Outcomes
approach to accelerate and Rangatiratanga
ensure equity of Māori health Self-Managing
outcomes
WHĀNAU ORA
Kōtahitanga
Whānau Cohesion
Whānau Ora Whānau Ora Outcomes
Achieving wellbeing
Whānau Ora ensures the collective capacity Seven priority areas have been Hauoranga
within all whānau to problem solve, to identified for concerted focus and Living Healthy
nurture each other and to realise aspirations. attention which will ensure whānau Lifestyles
Whānau is a crucial building block of flourish and on-going gains are made in
society. Whānau Ora is about working in Māori health.
Tuakiritanga
a way that recognises and builds on the
Participating in Te Ao
strengths and leadership with whānau, and
Māori
ensure whānau are supported to move in Positively support and
a positive and self-managing way of life. influence cross-sector
Whānau Ora and Wellbeing Tiaki Taiao
In essence, the inclusion of Whānau Ora Responsible Stewards
principles within the values and philosophy policy setting and direction of Living & Natural
of primary health care providers will ensure Environments
whānau-centred initiatives are embedded
into everyday practice. Whānau Ora is one
part of a systematic approach to Māori Pāporitanga
health and improving outcomes for Māori. Participating in Society
Pukenga Rawa
Economic Security &
Wealth Creation
Throughout the document you will see
this tohu. It indicates our key areas of
focus. The orange colour reflects
Ka Ao, Ka Awatea (see page 16).
Whānau ora tohu © Te Tihi
14 THINK Hauora 2019–2025 StrategyTe Puni Kōkiri Whānau Ora Stats NZ Wellbeing Indicators
Outcomes Framework
Empowering Whānau into the Future W
Health
Whānau are self-managing and
empowered leaders
Social connections Whānau Ora and the Wellbeing
Whānau are cohesive, resilient Indicators:
and nurturing
Indicators Aotearoa has worked alongside
Education, skills and Stats NZ to develop a source of measure for
Whānau are leading healthy training New Zealand’s wellbeing. These indicators
lifestyles go beyond economic measure to include
wellbeing and sustainable development.
Wellbeing looks at current wellbeing, future
Whānau are confidently wellbeing and trans-boundary impacts
Income
participating in Te Ao Māori (The (our impact on the rest of the world).
Māori World) The wellbeing indicators have a direct
relationship to the Whānau Ora Outcomes
Whānau are responsible stewards Environment Framework and to Treasury’s Living
of their living and natural Standards Framework.
environment
Align activities and effort to
Whānau are participating fully in the Whānau Ora outcomes-
society based framework and the Stats
NZ Wellbeing indicators
Whānau are economically secure
and successfully involved in
wealth creation
THINK Hauora 2019–2025 Strategy 15Ka Ao, Ka Awatea I N N OVAT I O N
The Whānau Ora Outcomes Framework
provides a tuarā (backbone) to the Māori Iwi and Integrated
Health Strategic Framework of our rohe, Māori Family
General Providers Health
Ka Ao, Ka Awatea. Four areas have been
TE REO WHAI PĀNGA TE MATATIKI Practices Centres
identified as a pathway to improving Primary
Whānau Input Resourcing Health Care
ori Health Str
whānau health: whānau input, resourcing, Marae,
Mā
Nursing
new ideas and scaling up solutions. Ka Ao, Churches, a
Kōhanga
Ao, K watea
Ka Awatea recognises the many partners
teg
Reo
delivering health services collectively to PATHWAY TO
ic Framework
Te Tihi
aA
contribute to both individual and community IMPROVING WHĀNAU
Raukawa
health. Sound relationships between WHĀNAU Whānau
partners, strengthened collaboration, HEALTH Ora
THINK
a
and effective communication systems
K
Hauora
are all pivotal to innovation and quality Community
TE AUAHATANGA TE WHAKAWHĀNUI
improvement in delivery of health services Pharmacy
New Ideas Scaling up Solutions
in our community. Manawhenua
MidCentral Hauora
Pae
DHB Ora
Continue to drive the uptake
QU
and utilisation of Ka Ao, Ka ALI T
Awatea Māori Health Strategic T Y I M P R OV E M E N
Framework
16 Diagrams adapted from: Ka Ao, Ka Awatea, 2017–2022, Māori Health Strategic Framework THINK Hauora 2019–2025 StrategyW THINK Hauora 2019–2025 Strategy 17
E
EQUITY
People, community voice
Driving equity of outcomes
through people, community
voice and data
THINK Hauora knows that pursuing health
equity requires both equal and equitable
opportunities for all social groups to be as
healthy as possible. This requires creating
“In Aotearoa New Zealand, people have
differences in health that are not only
avoidable, but are unfair and unjust. Equity
recognises different people with different
and data-driven the right environments and having a clear levels of advantage require different
focus on improving outcomes for those approaches and resources to get equitable
groups who have had fewer opportunities health outcomes.” 1
– particularly Māori and Pasifika. Achieving Ministry of Health’s definition of Equity 2019.
equity requires us to acknowledge that
different groups of people may benefit
from different approaches to achieve “Health equity, or equity in health implies
comparable or equitable outcomes. We that ideally everyone should have a fair
will partner alongside providers, whānau, opportunity to attain their full health
and community to use data to support potential and that no one should be
decision-making and drive innovation. This disadvantaged from achieving this
will contribute to equitable health outcomes potential.”
and lay the foundation to connecting World Health Organisation.
communities for wellbeing.
Connect information and
people to inform and transfer
knowledge to develop
innovative ways to improve
equity
1. Dr Bloomfield, Director-General of Health, states that ‘having a common understanding of equity is an essential
foundation for coordinated and collaborative effort to achieve equity in health and wellness. The definition fits the New
Zealand context and aligns with Te Tiriti o Waitangi obligations. It also reflects international equity literature and the World
18 Health Organisation’s definition of equity.’ THINK Hauora 2019–2025 StrategyHealth intelligence
Data management has transitioned in-house The THINK Hauora data warehouse will
over the last few years and has grown our enable a common lens across primary health
E
dynamic approach to health intelligence. care and support integration of multiple
Our health intelligence team is responsible data sources both within and outside of the
for capturing and utilising information health sector. Effective data stewardship
to support decision-making to improve and system interoperability will enable
the health of the population across our a focus on equity, adverse variation and
communities. Bringing our data in-house trends to move us from a reactive analysis
will strengthen our approach to improve (what has happened); to an informative
health outcomes and address equity at the analysis (why did it happen); to a predictive
forefront. analysis (what will happen).
THINK Hauora is passionate and committed
as a network to curate and use data,
Health intelligence provides
information, knowledge, and wisdom in co-
quality and context-based
operation with our health and social sectors.
insights to support decision-
This data will be enriched with consumer,
making to improve equitable
whānau and community voice, and will be
health outcomes
made available for consumers, whānau
and communities to inform their decision-
making. Effective data stewardship and
It is important that we propel our health system interoperability will
system forward by enabling the meaningful improve the access and flow of
flow of health and social information to drive information
equitable health outcome improvement.
THINK Hauora 2019–2025 Strategy The Manawatū River, image courtesy of Te Tihi 19A Ensuring access to health care is Five most pressing
social determinants
easy, available, cross-sectors of health to inflect to
drive equity
A strong primary health care system is Aligning health care with social services
central to improving the health of all will encourage clinicians to think in broader
New Zealanders and to reducing health terms about investment in health – and
ACCESS inequalities between different groups. In
2016, the Ministry updated the New Zealand
this greater alignment has the potential
to improve population health outcomes Housing
Easy, available, Health Strategy. The Health Strategy
highlights the need for:
while lowering spending on more expensive
traditional approaches. THINK Hauora is
cross-sectors • a shift from treatment to prevention,
committed to providing leadership for the
inclusion of bold political choices for health
improving consumers’ lives and
across all sectors, therefore cultivating, Food
supporting greater financial
naming and treasuring relationships.
sustainability
• overcoming inequities across the health
system to strive to deliver healthy Provide leadership for the
outcomes for every New Zealander inclusion of bold political
Economics
• a thorough understanding of how to
choices for health across all
access the appropriate health options
sectors
available
• creating customer-friendly services and
Interpersonal
removing barriers in order to achieve
equity
• the Ministry, health providers, other
government agencies, NGOs and
communities working together to Education
address the social determinants of
health
source: NZ Health Strategy 2016 Source: Engaging Patients in Ongoing Care
20 THINK Hauora 2019–2025 StrategyHealth Care Home
The Health Care Home model is a key
driver to improving access for increased
services closer to home, more proactive
care, improved self-management, improved
consumer experience, and better community
health and social service integration. Health
Care Home has four core domains:
• Ready access to urgent and unplanned
care
• Proactive care for those with more
complex needs
• Better routine and preventative care
A
• Improved business efficiency and
sustainability
The Health Care Home summary
characteristics described on page 22 are
supported by a national data set. They
focus general practice teams on diversifying
access, population health, long term
condition, and acute care management at a
practice and system level. These measures
are part of the THINK Hauora Outcomes
Framework on page 43.
All measures will be
reported through
an appropriate
equity lens
THINK Hauora 2019–2025 Strategy Image courtesy of Te Tihi 21Health Care Home
Summary Characteristics
Equity lens Health plans Prework Continuity of Information Affordability
care Technology systems
support
Same day access Access to care Patient wait Telephone Cultural needs Patient Fully Alternatives to Patient Proactive
and appointment during business times assessment engagement functional F2F consults experience planning
systems hours and treatment portal
(clinical triage)
Health literacy Call demand Appointment Extended Health records
monitored systems hours
Urgent and Routine and Business efficiency
Proactive care
unplanned care preventative care and sustainability
LEAN process Continuous Staff training Workflow Standardisation
in place quality
improvement
Risk Development Cultural Interdisciplinary Community Care co- Family Practice layout Reception F2F Workforce Clinical Extended
stratification of care plans consideration approach based ordination infrastructure and call free planning and leadership practice team
in care plans resources development
22 Source: Health Care Home, Model of care requirements, December 2018 THINK Hauora 2019–2025 Strategyf luences all aspects
a lth in of l
ife
H e
Our approach to Health Care
Home
Effective relationships and linkages
with Iwi and Māori providers along with
Individual Family Education Environment community-based health and social
Health Whānau Housing Economy services are paramount to achieving
Community Social support
Workplaces
the four domains of Health Care Home.
A
System connection with MidCentral
Transport
DHB specialist services is instrumental.
Recreation
The development of the new DHB
integrated service models and
Ma accompanying clusters have outlined
ny f l th
actor e to hea their commitment to support the
Source: New Zealand Health Strategy, Future direction s co ntrib ut Health Care Home programme across
our rohe, enabling a partnership
focussed on care delivery closer to
home.
Develop a strong affinity
between the Health Care
Community- Home, Iwi and Māori
Iwi and DHB
THINK based health providers and other
Māori specialist
Hauora and social community-based health,
providers services
service social and specialist
services
THINK Hauora 2019–2025 Strategy 23Digitise our consumers, Digital, data-enabled Inclusive information
families and whānau decisions stewardship and
experience Improve safety and outcomes, reduce management
individual and population inequity through
Improve access to information enabling Quality and trustworthiness of information
use of data for better insights, real-
greater involvement of people and whānau for all system participants with timely, safe
time decision-making, risk stratification,
MidCentral DHB Te Awa–Digital in wellness and planning, better and more and appropriate access to knowledge and
population wellness planning, analysis of
Health Strategy Objectives convenient access to services, easier information.
wellness outcomes to improve pathways,
The district’s Te Awa–Digital Strategy navigation and proactive, individualised
system performance analysis and reporting.
supports improved access and wellness and care.
achievement of the four Health Care
Home domains.
THINK Hauora will give
effect to Te Awa–Digital
Strategy by continuing
to drive the digital
Digitise our end-to-end Interconnected Stable, secure,
connectedness in our rohe processes communication and responsive and
Smoother, safer, more informed and
co-ordinated wellness journeys across
collaboration sustainable ICT services
organisational boundaries and between Greater level of communication, co- Ensure the integrity, continuity,
services with optimised workflow, and better ordination and teamwork amongst all interoperability and performance of
alignment of resource to demand. system participants. systems, rationalise applications, consolidate
infrastructure, automate, simplify and
digitise processes with continued co-
investment in innovation and emerging
technologies with a vibrant ecosystem of
industry partners.
24 THINK Hauora 2019–2025 StrategyRealising digital transition in our rohe
THINK Hauora will drive digital connectedness in our rohe.
The enablers IT Infrastructure Cloud-based PMS e-referrals Data warehouse Data stewardship and Influencing
governance national activity
Technology Telephony Shared electronic Collaborative clinical Self-service health
health record pathways intelligence System
transition Cyber-risk and
interoperability and
= enabling the
security MDT shared care plan Electronic discharge Monitoring consumer to
design
dashboards
READcodes to Patient portal DHB appointment shape service
SNOMED CT scheduling tool Data management delivery A
Clinical portal
Rohe ecosystem change
Underpinned by identity management to enable management of access and single sign on to all systems
Achieving = health
knowledge professionals co-
Health Reactive analysis–what has happened? Why did it happen? Predictive–what will happen? designing people-
intelligence centred services
transition in partnership
with other sectors
THINK Hauora 2019–2025 Strategy 25V
VALUE
Teams, technology,
Creating value through teams,
technology and performance
Locality-based teams
THINK Hauora will continue to partner
to develop suitable, durable and
versatile locality-based teams across our
communities. A key focus will be on self
care and the alignment of community health
teams and will be responsible for preventing
and managing long term conditions. The
Long Term Conditions Population to Last
Days of Life framework on page 28 will be
used to organise the long term condition
approach across the localities. THINK
Hauora long term conditions, mental health,
S e l f-
Management
Self-Testing
S el
f-Awareness
performance and social services.
acute care, population health programmes
Priorities for service alignment at a and resources will be aligned to the primary
locality level will be identified through the health care teams. A strong affinity between
aspirations and needs of the community. the Health Care Home, Iwi and Māori Self-Care
This will involve establishing new ways of providers and community-based health and Everyday life
working, reconfiguration of the workflow social services will be established. Effective
and identifying efficiencies and capacity processes and technology to work in
release to enable staff to work closely across collaboration with the specialist services will
primary, community, specialist and social be enhanced.
services. Technology will play a key role. Self care is the ability of individuals, whānau
and communities to promote health, prevent
The locality teams will align to six principles:
Establish locality-based teams disease, maintain health and to cope with
• People and whānau-centred across the rohe to support illness and disability with or without the
• Accessible and virtual whānau to meet their health support of a transdisciplinary primary health
and wellbeing needs care team.
• Comprehensive
• Co-ordinated
• Continuity and choice-enabled
• Accountable
Comprehensive primary health care teams
provide the foundation of the locality-based Source: WHO Consolidated Guideline on Self-Care
Interventions for Health, 2019
26 THINK Hauora 2019–2025 StrategyTransdisciplinary Primary Health Care Team
(Health Care Home)
People and whānau are leaders in their care
and are supported by their primary health care
team who they know and trust.
Strong affinity with
The team provides comprehensive health
Iwi and Māori providers and
care across the lifespan and co-ordinates community-based health
care to meet the health and wellbeing of the
community. and social services
People, whānau and their local
community are leaders who are actively
included in creating solutions for
achieving their health and wellbeing. V
People are able to access health and
wider sector services which promote
Aligned specialist health outcomes that are important to
district-wide services them. If required, support and guidance
from their primary health care teams will
contribute to this.
Collaboration between specialist services
and primary health care teams will be
enhanced to deliver comprehensive health
care.
People self-manage and access support virtually and
close to where they live, work and play
THINK Hauora 2019–2025 Strategy 27The Long Term Conditions Population Health to Last Days of Life
Well/at risk population
Self Care, health promotion and prevention, early detection and intervention, diagnosis and treatment
Diagnosed: mild complications or impact
Clinical and wellbeing indicators are within acceptable range
Predominantly general practice based with referral to Iwi and Māori and other health and social service providers
Diagnosed: mild complications or impact
Clinical and wellbeing indicators are not within acceptable range
Self-management support is required
Predominantly general practice based with referral to Iwi and Māori and other
health and social service providers
Moderate complexity, severity or impact
Structured co-ordinated care provided by a responsive
comprehensive PHC team, this may include Iwi and
Māori and other health and social service providers
High complexity severity or impact
Case management provided by teams as above
and in collaboration with specialist services
End stage
Integrated palliative care
28 THINK Hauora 2019–2025 StrategyEquity and innovation Security
Digital health initiatives and innovations are to be Establish cyber citizenship (one secure log in)
consumer-led
Technology
Build resilience in the new cyber world
Digital health initiatives in the district will
Enable interoperability in information systems to
be consumer-led and will encompass the
ensure a streamlined flow of information
models of care that provide for hauora. Robust governance, compliance and auditing that
Consumers will help co-design inclusive provides confidence in the use of information for
district information stewardship and Invest in health IT such as wearable devices, smart consumers and the workforce
security policies to support the quality watches, in-home digital support
domains and whānau ora outcomes. Contribute to national architecture design that
Technology will enable a connected up Introduce tools and services that simplify health and enables data translation to knowledge
environment where information is readily wellness for consumers, whānau and the workforce
shared to support timely, digital, decision
Tools and training to develop a skilled workforce
making and equity-based population
Digital health literacy for consumers, whānau and the conversant with health informatics
health investment decisions. Locality based
teams will be supported by technology
workforce V
that digitizes the consumer, whānau and
workforce experience and will change the
Knowledge and analytics
way we communicate and collaborate.
Processes will be automated wherever
Productivity and mobility
possible to enable the workforce to focus on Bidirectional data flows
activity that best uses their skills. Develop autonomous ICT infrastructure that is
secure and self-governing
Predictive population health data that drives equity-
based investment
Locality-based teams will be Introduce workforce efficiency supported by tools
supported by technology that and services that allow teleworking and cloud-based
enables mobility, productivity, Democratize data to enable evidence-based decision
anywhere, anytime collaboration
knowledge and safety making across the workforce
Replace manual processes with digital tools-based
Curated and centralised data repository to be
workflows
responsive to local health intelligence needs
Operate from anywhere, anytime, using any device
THINK Hauora 2019–2025 Strategy 29Performance
Our performance will be aligned with nau Ora & Quadruple A
WEAVING and will be reported at a locality W hā im
level within the THINK Hauora Outcomes
Framework on page 43.
The overarching THINK Hauora outcomes
re Home National Dat
encapsulate the Whānau Ora outcomes and h Ca a Se
the quadruple aim: H ealt t
• Affordable care
• Excellent outcomes
Quailty Domains
• Excellent experience for those we serve
• Excellent experience for providers
High levels of performance in aligning
health and social care will be achieved
em Level Measures
through engaging clinicians and system Syst
leaders in collecting and monitoring
performance data. A feedback loop on
key outcome measures will be used to
effect change and connect local quality Ka Awatea
improvement activities. Ka Ao,
The specific measures in the THINK Hauora
Outcomes Framework include Ka Ao, Ka
Awatea, System Level Measures, Quality THINK
Domains and the National Health Care
Home Domains (outlined on page 33). Hauora
WEAVING
30 THINK Hauora 2019–2025 StrategySystem Level Measures
Preventing and detecting disease early Ensuring patient-centred care System Level Measures are set by the
Ministry of Health and the Contributory
Measures are co-designed measurements
focusing on children, youth and high priority
Amenable mortality rates Patient experience of care populations.
All the measures and indicators will be set
annually and supported by agreed local
consumer and practice incentives.
This Outcomes Framework will foster high
Keeping children out of hospital Ensuring a healthy start trust outcome-based agreements across our
provider network.
V
Ambulatory sensitive hospitalisations (ASH) Proportion of babies who live in THINK Hauora Outcomes
0-4 years old smoke-free households Framework will focus
expectations on equity of
outcomes and any related
consumer and practice
incentives across our
communities
Using health resources effectively Youth are healthy, safe, and supported
Acute hospital bed days per capita Access to, and utilisation of, youth
appropriate health services
THINK Hauora 2019–2025 Strategy 31I
INNOVATION
Quality improvement,
Activating innovation,
improvement, engagement and
delivery of excellence
The THINK Hauora network will build on
our track record of co-designing innovative
approaches in response to the aspirations of
the communities we serve. Building on the
Central to the THINK Hauora quality
improvement approach has been the co-
designing of a district-wide Quality Agenda
Shared Clinical Governance Framework
excellence, engagement traditional through modern design. Over in collaboration with MidCentral DHB.
recent years we have deliberately developed Underpinning quality improvement are
into a values-based network and have engaged consumers, providers and system.
proven that working collaboratively with
our contracted providers and communities
through engagement and co-design is not Drive the implementation of
only enjoyable but has created a platform the district’s ‘Quality Agenda
for excellence every day. Shared Clinical Governance’
Recognise and celebrate our
provider network achieving
excellence every day in
improving health outcomes
32 THINK Hauora 2019–2025 StrategyQuality Domains
The quality domains and consumer, provider and system meanings depicted below are
incorporated into the THINK Hauora Outcomes Framework.
Domain Consumer/Whānau Meaning Provider Meaning System Meaning
Haumaru Our safety system is robust and will identify
My whānau and I will not be harmed by the The care our consumers receive does not
if things are going wrong. It looks after our
Safe health system. cause harm.
people (our population and our providers).
Whaihua My whānau and I receive the right The care provided is based on best
Our quality culture supports quality
treatment for conditions, and it contributes evidence and produces the desired
Effective improvement, innovation and research.
to improving health. outcome.
Arotahi kite My goals and preferences drive my
Joint decisions about our consumers’ We have an organised consumer voice
kiritaki wellbeing/care plan. My whānau and I are
care reflect the goals and preferences of across our rohe that ensures we partner
treated with respect and dignity. I am at
Consumer- the consumer and his or her whānau or with people and whānau to support health
the centre of all my care decisions. Nothing
centred caregivers. and wellbeing.
about me without me.
We deliver care to our consumers using Our models of care ensure health and
Māia The care my whānau and I receive from
available human, physical and financial social care alignment. Resources are
all practitioners is well co-ordinated and
resources efficiently, with no waste to the deployed to ensure best value for our
Efficient efforts are not duplicated.
system. community. I
I know how long I must wait to see my
Wā tōtika Our consumers can receive care within an
health care team for tests or treatments Our aligned system will ensure people
appropriate and acceptable time after the
Timely I need and why. I am confident this wait receive health care in a timely way.
need is identified.
time is safe and appropriate.
Our consumers have access to the services
they need regardless of their location, age,
Kia tōkeke ai We have strong and enduring health
No matter who I am or where I live, I can gender or socio-economic status. The
equity leadership across the rohe at all
Equitable access services that benefit me. treatment provided aims to ensure equity
levels.
of outcome so may be different to suit the
specific needs of the person.
THINK Hauora 2019–2025 Strategy 33The W.A.I.O.R.A Model Whānau Ora Resiliency and recovery
THINK Hauora is poised to work with Models of care such as Whānau Ora and Resiliency refers to the ability of individual
partners across the sectors to drive new whānau-focused initiatives have been and whānau to respond adaptively to life
innovative ways of realising the aspirations identified as offering significant potential events, human development stages and
of our five distinct communities. THINK benefit within the revitalisation/re-think of rites of passage.
Hauora through engagement with partners mental health.
has been at the forefront of working across
All together
sectors in co-designing improvements
across the system. A recent example
Access and availability Waiora/wellbeing is achieved using a
of partnering to collectively support Access to and availability of appropriate Whānau Ora, whole-of-system and cross-
community aspirations was our contribution wellbeing services that facilitate flourishing sectoral approach across all services
to the response in 2018 to the Government’s individuals, whānau and communities over and activities which have the potential
Inquiry into Mental Health and Addictions. the life course and along the wellbeing to contribute to flourishing individuals,
continuum. whānau/family, communities and
The key drivers for the Inquiry were
environments.
inequalities in mental health and addiction
outcomes, underfunding of mental health Identity and indigeneity The Wellbeing Budget 2019 is taking
and addiction services, and high suicide A strong and flourishing personal, cultural mental health seriously and has announced
rates. and community identity is considered within additional investment in strengthening and
the context of overall wellbeing. improving services.
Locally, we garnered our combined
strengths and used this Inquiry to provide
a collective and intersectoral, robust voice Opportunities Achieving our local response
on the specific changes needed to enable The focus for prevention, early intervention to the Mental Health Inquiry
improved and equitable outcomes. Our and health promotion at a wider system ‘Realising W.A.I.O.R.A - A
vision for the future direction, structure level is considered. Collective Voice’ Programme of
and delivery of mental health services is Action
harnessed in W.A.I.O.R.A.
34 THINK Hauora 2019–2025 StrategyAchieving Whānau Ora
THE W.A.I.O.R.A MODEL
Rangatiratanga
Self-Managing
Holistic wellbeing across the wellbeing continuum and life course with a focus on
flourishing individuals, whānau/family, communities and environments
Kōtahitanga
Whānau Cohesion
Hauoranga
Living Healthy
g › Re silienc
We l l b e i n
Lifestyles
e › P
re v e n t
i o n › Re c ove r y Tuakiritanga
W A A
Participating in Te Ao
I
Māori
Whānau
Ora
Access &
Availability Identity &
O R All Together Tiaki Taiao
Responsible Stewards
indigeneity Opportunities Resilience &
Recovery
of Living & Natural I
Environments
nfa nts Tamariki Children Rang
Pēpi I atahi
Youth
Pakeke Pāporitanga
Adults Kaumātua Older Persons Participating in Society
Pukenga Rawa
Economic Security &
Wealth Creation
THINK Hauora 2019–2025 Strategy Whānau ora tohu © Te Tihi 35N
NETWORKING
Relationships,
Enabling networking and
relationships to achieve
partnerships
Partnering with people, community
and providers to collectively support
communities’ aspirations is fundamental to
our success.
THINK Hauora believes that the people,
providers and communities we serve have
great strengths upon which to base change
strategies. Collective impact engages
partnerships, collective people, providers and communities as
partners in the capacity building process.
impact Partner with people, Collective Impact nurtures relationships and
community and providers to appreciates that relationships are key to
collectively support community everyone’s success.
aspirations
Strive to become a trusted
THINK Hauora strives to become a trusted backbone organisation that
backbone organisation that supports cross- supports cross-sector alliances
sector alliances within a collective impact within a collective impact
methodology. Synergistic relationships will methodology
be focused on the basis of mutual benefit.
This methodology recognises that issues
We are committed to building authentic and
faced by organisations and communities
strong partnerships locally, nationally and
are multi-faceted and require holistic
internationally. One aspect of this will be to
approaches. Many organisations and
continue to develop our approach to research
communities operate in fragmented,
and development as this is central to the
restrictive, and systems-driven
execution of our THINK Hauora strategy.
environments. Their efforts are often
isolated within categorical silos according
to funding streams, operational regulations,
Partner with local, national and
and disciplinary theories and methodologies.
international organisations
to improve our approach to
research and development
36 THINK Hauora 2019–2025 StrategyCollective Impact
Shared whānau and community aspirations drive our partners’ shared vision for change
Common Agenda including a common understanding of the joint approach
Diverse Voices • Responsive • Community Aspiration
Collecting data, measuring results consistently across all partners to facilitate insights and
Shared Measurement strategic learning
Alignment • Tracking Progress • Insights • Strategic Learning
A mutually-reinforcing plan of action with a focus on high leverage and loose/tight working
Mutually-Reinforcing Activities relationships
Weaving • System • Supportive • Centred
Consistent and open communication to partners and pathways for authentic engagement
Continuous Communication for whānau and communities
Trust • Transparency • Ongoing • Engagement
Creating and managing collective impact requires dedicated staff and skills to serve as the N
Backbone Support container for change for the entire initiative to coordinate participating organisations and
agencies
Facilitate • Convener • Co-ordinate • Movement
Source: Collective Impact: A Framework for Community Change, 2017
THINK Hauora 2019–2025 Strategy 37G
GROWTH
Sustainability, system
Driving sustainability through system and
alignment focus
THINK Hauora has contributed to the
MidCentral DHB Health and Wellbeing
Locality and Cluster Plans. These plans
are supported by an Integrated Service
Model and at the heart of the model is the
development of seven clusters supported
by enabler groups. The cluster arrangement
THINK Hauora is confident that the
elements of WEAVING outlined throughout
the strategy will demonstrably contribute
to the achievement of MidCentral’s four
strategic imperatives.
Looking to the future, THINK Hauora is
An engaged networked healthcare
workforce is vital to achieving this
strategy. THINK Hauora aspires to meet
the quadruple aim of affordable care,
excellent outcomes, excellent experience
for those we serve, and excellence for
providers. This includes fostering an
well-positioned to develop, investigate and
and alignment focus is a structure to enable MidCentral DHB
secure firm partnerships to diversify revenue
engaged networked healthcare workforce.
to organise services to achieve their four THINK Hauora is committed to cultivating
streams that enhance elements contained
strategic imperatives: innovating approaches to primary health
within this 2019–2025 Strategy. Work is
care workforce development to improve the
• Achieve quality and excellence by occurring in this arena. We have an exciting
experience of primary care.
design future ahead developing relationships
and forming new alliances. With the new An engaged workforce is vital to achieving
• Connect and transform primary,
initiatives on the horizon, THINK Hauora, in the goals of our strategy. At the core of
community and specialist care
partnership with the provider network, will workforce engagement is the experience
• Partner with people and whānau to strive to achieve primary health care clinical of joy and meaning in healthcare work;
support health and wellbeing and financial sustainability. the sense of accomplishment and purpose
• Achieve equity of outcomes across of contribution. THINK Hauora values
communities its workforce. Like the harakeke, growth
Diversify revenue streams and development of the THINK Hauora
to achieve primary health workforce is both protected and nurtured.
THINK Hauora will give effect care clinical and financial
to the MidCentral DHB Health sustainability
and Wellbeing Locality and Cultivate innovative
Cluster Plans approaches to primary health
care workforce development
to improve the experience of
providing care
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