Yarning up the Indigenous

Navigator Model

Indigenous Health Services

Dean Johnson

Indigenous Health Coordinator

Population Health

Local Government Areas: Ipswich City Council, Scenic Rim Regional Council, Somerset Regional Council, Lockyer Valley Regional Council.

In 2011-12, the average life expectancy at birth for West Moreton residents was 80.7 years and in the period 2009-2011 there were 176 deaths per 100,000 people that were potentially avoidable.

Within West Moreton’s population approximately:• 71% of the population are overweight or obese • 38% of the population are obese • 19% of the population smoke daily • 14% of adults face a cost barrier to seeing a

medical specialist • 9% of adults face a cost barrier to filling a

prescription

WMHHS Population Profile

2012 =

252,000

2036 =

637,000

West Moreton's expected population increase is in excess of 150%, making West Moreton the fastest

growing hospital and health service in Queensland.

By comparison, Queensland as a whole is projected to increase approximately 60% in the same period.

Steady rise in activity…

Activity flowing through the health service has been steadily increasing,

driven by significant population growth and local health demographics.

Ipswich Hospital Emergency Department presentations January 2012 to August 2015

Presentations to

the Emergency

Department

alone have

increased by

over 20 percent

during the past

three years.

Improving Our Services

Over the past several years West Moreton has dramatically improved

the timeliness and manner in which our patients are able to access

healthcare.

Since November 2014, there have been no elective surgery patients

waiting longer than is clinically recommended – the first time in history.

The Specialist Outpatients Department reduced long

wait lists from over 5,387 patients waiting in July

2014, to just over 100 patients waiting in June 2015.

Patients are being cared for in a safer

manner, with the introduction of a 24

hour model of care.

The Greying Patient (and

provider)

The Lifestyle Epidemic

The Information Revolution The Blessing

and Curse of Clinical

Technology

The New Health Care Consumer

Five Disruptive Forces Affecting Health Care

What is our future of healthcare provision?

Status Quo? Innovative new models of care that are built around the patient.

Population Health Approach?

Alternative Innovation ?

Life expectancy at birth (years)

2005-2007 2010-2012

Change 2005-2007 to 2010-

2012

Indigenous Non-Indigenous Gap Indigenous Non-Indigenous Gap Indigenous Non-Indigenous Gap

Males

Qld 67.1 78.8 11.8 68.7 79.4 10.8 1.6 0.6 -1.0

NSW 68.3 78.8 10.5 70.5 79.8 9.3 2.2 1.0 -1.2

WA 64.5 79.2 14.7 65.0 80.1 15.1 0.5 0.9 0.4

NT 61.5 75.5 14.0 63.4 77.8 14.4 1.9 2.3 0.4

Aust (a) 65.7 78.9 13.1 67.4 79.8 12.4 1.7 0.9 -0.7

Females

Qld 72.7 82.7 10.0 74.4 83.0 8.6 1.7 0.3 -1.4

NSW 74.0 82.6 8.6 74.6 83.1 8.5 0.6 0.5 -0.1

WA 70.0 82.9 12.9 70.2 83.7 13.5 0.2 0.8 0.6

NT 69.4 81.0 11.6 68.7 83.1 14.4 -0.7 2.1 2.8

Aust (a) 71.7 82.7 11.0 72.3 83.2 10.9 0.6 0.5 -0.1

“Closing the Gap”: Queensland Indigenous Life Expectancy

Gap - What does it look like?

21%

15%

11%10%

7%

6%

6%

5%

5% 3%

11%

Cardiovascular disease

Diabetes mellitus

Mental disorders

Chronic respiratory disease

Intentional injuries

Malignant neoplasms

Unintentional injuries

Infectious and parasitic diseases

Neonatal causes

Acute respiratory infections

Other

COAG agreed the gap in life expectancy between

Indigenous and non-Indigenous Australians

must be closed. COAG agreed to a partnership

between all levels of government to work with

Indigenous Communities to achieve the target of

closing the gap on Indigenous disadvantage. COAG

committed to:

- Closing the life expectancy gap within a

generation;

- Halving the mortality gap for children under five

within a decade; and

- Halving the gap in reading, writing and numeracy

within a decade.

COAG has also agreed that States and Territories

will report transparently on the use of their

Commonwealth Grants Commission funding which

is on the basis of Indigenous need funding for

services to Indigenous people.

“Making Tracks towards closing the gap in health

outcomes for Indigenous Queenslanders by 2033”

“Making Tracks” provides a long term evidenced based

policy consistent with COAG’s Indigenous Reform

Agreement – to which the Queensland Government

remains committed. The framework articulates the vision

for “closing the gap in Indigenous disadvantage” by 2033

“Queensland Health Aboriginal and Torres Strait

Islander Cultural Capability Framework 2010 - 2033”:

Queensland Health shares the vision of closing the life

expectancy gap between Aboriginal and Torres Strait

Islander and other Queenslanders. To achieve this, we

need to ensure that our organisation is well positioned to

meet the needs of Aboriginal and Torres Strait Islander

peoples. This relies on much more than the provision of

clinical services. It also requires an organisation that

understands and respects cultural differences and needs,

and applies this understanding and respect in its

governance, policy, planning, infrastructure, funding,

standards, information systems, human resource

management, quality improvement, education, training and

every aspect of health service delivery.

The objective of the WMHHS Cultural Capability Plan is

to ensure that:

WMHHS is aligned with relevant National policies

and priorities for health.

All Aboriginal and Torres Strait Islander focussed

activities, services and processes across the

Organisation are working towards the same goals

Describes the relationships between strategic and

operational plans, translating into activities at the

frontline of health services.

The provision of health services locally has clear

priorities, supportive leadership and staff who work

both together and across each level of the health

system.

Effectively fulfilling our vision and addressing our

challenges, with all staff having have a clear

understanding of where we are heading, how we are

going to get there, and how day to-day role supports

the overall achievement of our goals.

WMHHS Cultural Capability Plan

Indigenous Health Services

Indigenous Navigator Model – “Coordination is

the Care”

All patients and their families must be treated with kindness, respect and dignity

and the way we experience care should be valued both from a clinical treatment

perspective and cultural appropriateness of service delivery.

• High Risk: People with complex, unstable and often co morbid conditions

who are at very high risk of hospitalisation and receive intensive care

coordination (5% of the population). Care Coordinators

• Medium Risk: People who are at high risk of hospitalisation who need help

managing their chronic condition through care navigation and self-

management support such as health coaching (15-35% of the population).

Navigators

• Low Risk: 70-80% of people with chronic conditions who are in control of

their condition and are able to self-manage with limited support. Health

Coaches

Numbulli Yalwa ProjectProgram ArtworkBy Ms Leanne Ruska, is called Yuggi-

linair Murra Murra meaning (Working Hand in Hand).

It represents Aboriginal and Torres Strait Islanders on their journey, depicting their inner spirit which gives strength to walk out into our communities and work with health professionals to give our community access to health care that helps patients maintain a healthier, longer and productive life.

Numbulli Yalwa Project

Health Service Planning – Through E-Shared Patient Files

• Improve planning and coordination of Aboriginal and

Torres Strait Islander primary health care services

across West Moreton

• Contribute to better long-term health outcomes for

Aboriginal and Torres Strait Islander patients

• Improve Aboriginal and Torres Strait Islander population

health reports across West Moreton

Numbulli Yalwa Project

Project Launch 19 August 2015

Partnership Walk Art work unveiling Nunukul Yuggera Aboriginal

Dancers

Bush Tucker Lunch QT, media release and radio Mabuiag Islander Dancers

West Moreton Hospital &

Health Service

Patient Care

Our

Communities

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