Capital Coast Palliative Care Forum

Waikato Experience of Developing a District Palliative

Care Strategy

Jan Hewitt

Background

• NZ Cancer Control Taskforce

• Midland – regional approach to planning services

• How it was at the time

• January – July 2005

• Strategy endorsed August 2005

Six Month Project

• Strategic blueprint reflects views & expectations of the district

• Gold standard - attain best practice standards and outcomes

• Integrated & planned service delivery model approach

• Good linkages with & between providers• Awareness of services

Project Methodology

• Steering Group

• Stocktake

• HNA

• Patient mapping

• Comparison with National strategies

• Literature review – internal & external

Project Methodology

• Models of best practice

• Agree common definitions

• SWOT analysis

• Site visits

• Expert Peer Review

Project Communication

• Steering Group – minimum monthly• Face to face meetings• Allowed service providers to present• Documentation / information• Monthly reports to CEO & Board• Project Manager weekly CEO updates• Strategic Project Steering Group Report• Community Health Forums

Pitfalls• Individual agendas• People getting stuck and not be able to move to

next stage in project• Time constraints• People want to restart process• Primary Engagement • Hard work - requires effort & commitment• Logo & Title• Money & Contracts–become the focus

4 Key Result Areas

• Integrated & collaborative care

• Patient focus on improved access and equity of services

• Workforce & resource development

• Quality Systems

What worked well

• Strong executive leadership

• Project management

• GP Liaison

• Getting everyone to the table

• GP Peer Support Groups

• Have a plan – parameters set

• Real inclusion of all stakeholders

What worked well

• Have a common language / definition

• Keep the Plan and language to a level that everyone can understand

• Regular brief presentations as you progress – the end plan is not a surprise

• Build on what you have

• The Plan is a start of the journey

What worked well

• Manage expectations

• Work between meetings is most valuable

• Stick to the timeframe, but allow time to develop

• Have more than a Plan define how you are going to keep momentum and the way forward

• Establish a Palliative Care Network

The Decision Matrix Grid Showing Prioritisation of Palliative Care Recommendations (Nov. 2005)

Low

Low

High

High

1 2 3 4 5 6

6

5

4

3

2

1

4.6

2.1

1.33.43.3 2.2

4.1 a-c

1.1b 2.4

2.3

2.54.1b

1.1 a 1.4 4.5

2.6d

4.2

1.1 To establish PC Network

1.2 PC approach & inform public

1.3 Formal links between services & providers

1.4 PC clinical leadership

2.1 Culturally appropriate PC

2.2 Patient journey & processes

2.3 Improve rural access

2.4 Strengthen links with GP

2.5 Specialist PC links to resthomes

2.6 Assessment single point of entry

2.7 Clinical pathways - Liverpool

2.8 Specialist PC resources

3.1 Practice PC approach

3.2 Adequate trained PC staff

3.3 Adequate Hospice inpatient beds

3.4 Adequate, safe equipment

4.1 Culture CQI best practice care

4.2 Transition pathway child-adult

4.3 To establish baseline data & KPIs

4.4 National initiatives

4.5 Review DSL PC admin function

4.6 Review PC service specifications

Impact of Intervention

Am

enab

ili t

y fo

r In

terv

enti

on

1.2 a

1.1c

2.8 2.6 a-c

2.7

4.4

4.3

3.1

3.2

1.1 c

Palliative Care Network

• Formalises relationship between generalist & specialists

• Don’t try to get everyone to the table

• Work with those that make things happen

• Operational responsibility to implement and monitor the Plan

Palliative Care Network

• Terms of reference

• Tools to prioritise Strategy recommendations

• Annual action plan with responsibilities

• Monthly reporting mini projects

• Annual report on progress - celebrate