Lessons from Study tour: Implications for Neighbourhood Healthcare Homes

Nurses Hui 16.4.15 Jenni Moore

Synthesis

Key elements

• My distillery slide

Support people to be healthier through

providing better care

Enhanced access

Enhanced access

Better patient

experience

Better patient

experience

Increased worker

satisfaction

Increased worker

satisfaction

Reduced costs

Patient engagement, activation and experience Work with patients on all aspects of how you relate. They must have a good experience

Work in a team, and make sure the patient knows the team: trust and relationships

Technology : Use all technology to enhance access for patients, enable remote work, and monitoring

Know your patients: stratify into high medium and low risk. Proactively manage medium and high, engage with low by email, phone, Skype etc. Appointment slots to reflect need. Post discharge follow up

Implement lean processes. Consider ‘the flow’, reduce waiting, use the right workforce to do the right work, team huddles to coordinate

Patient Centred Medical Home

What did we like and what didn’t we like

• Like:• Patient centred: involvement of patients in co-design,

prioritising patient experience • Acknowledgment of need to include social and

‘behavioural’ dimension- whole of person • Belief in need to link effectively with network of

providers • “improving health is a challenge that requires the

engagement of partners across the community to address the broader determinants of health “ (IHI org)

• Innovative use of technology

….Not so much

• Electronic tags• Gouging out of middle level nursing roles, -

replacing with lay workers• Still more work to be done in linking more

with external providers, but this is seen as essential

Paradigm shift

Today Future

Treating Sickness / Episodic Managing Populations

Fragmented Care Collaborative Care

Specialty Driven Primary Care Driven

Isolated Patient Files Integrated Electronic Records

Utilisation Management Evidence-Based Medicine

Fee for Service Shared Risk/Reward

Payment for Volume Payment for Value

Adversarial Payer-Provider Relations Cooperative Payer-Provider Relations

“Everyone For Themselves” Joint Contracting

Evidence

• Patient experience is positively associated with clinical effectiveness and patient safety

• Patients experiences should be included as one of the central pillars of quality in healthcare

• Clinicians should resist side-lining patients experience as too subjective, or mood oriented, divorced from the real work of measuring safety and effectiveness

Doyle, C.;Lennox, L.; Bell, D. 2012 “A systematic review of the evidence on the links between patient experience and clinical safety and effectiveness”

Evidence

• https://www.pcpcc.org/• Reduction in Emergency department

attendances• Reduction in Ambulatory Sensitive

Hospitalisations

So how does this line up with what we are doing in Northland?

Northland Health Services Plan

Integrated Urgent Health Care (IUHC)

Neighbourhood Health Care Homes (NHH)

Patient and Family Centred CareFit for LifeFirst 2000

Days

• Project manager for 12 months

• Andrew Miller Clinical Lead

• Rose and Chris sponsors

The NHH project

Neighbourhood Healthcare Homes

• A network of providers connected up with General Practice and including consumers to provide accessible, comprehensive, coordinated patient centred proactive care.

• Relationships between patients and the extended team, and within the extended team are central to success.

Aligns to IHI triple aim framework

Te Tiriti o Waitangi

Foundations of Primary Healthcare

• Excellent accessibility• Comprehensive• Coordinated• Continuity – relationship(Barbara Starfield)

• Compassion (Dr Harry Rea)

• Community (Ben Rosenstein)

Wagner’s Chronic Care Model

Elements of a Neighbourhood Healthcare Home

Painting a picture

• Intentional linking and issue management with consumer involvement

• Clarity around nursing roles and linkages , for the patients and the health providers

• Proactive management of medium and high need patients

• Accessibility for all: options

Difference is….

• More than lip service to ‘patient centered’• Co design : listening and acting• Leveraging off technological advances• Focus on relationships

Its not rocket science:

“I was dropped through the service and support gap in the hospital systems and it has yet to be determined how far I have fallen” (Patient complaint NDHB 2014)

“We are sick of falling through gaps. We are tired of organisational barriers and boundaries that delay or prevent our access to care. We do not accept being discharged from a service into a void. We want services to be seamless and care to be continuous”. (National Voices)

.

Why is this project needed?

• To improve equity of access to health services and health status

• Fragmented diagnosis and treatment as different parts of the system fail to communicate effectively

• Patients miss out on care• To develop a sustainable fit for purpose PHC system • To take advantage of technological change• Changing demographics and patterns of disease• Increased demand for quality care by patients• Patients not supported to manage their own health

• “The patients perspective is at the heart of any discussion about integrated care. Achieving integrated care requires those involved with planning and providing services to impose the patients perspective as the organising principle of service delivery”

• (Shaw et al cited on www.Kingsfund.org.UK)

Integrated care is centred around the needs of users

Your assistance

• Support the kaupapa: stronger primary care • Nurses are central to the change• Key potential expanded roles • You are leaders in the health system • Be the champion in your practice for NHH • Help get the right people involved, including

consumers