Participants of the Gemba workshop – 27, 28, 29 April 2011

Rere atu, rere mai,

taku manu e rere ki tua, rere ki kō,

kia whetūrangitia e

• As we take up new challenges plant your feet strongly upon mother earth with eyes towards the stars for light and inspiration

Proposed future state;

• High level future state developed during the Gemba three day workshop for people in South Taranaki.

What was our goal?

• The goal was to design future services that can be provided by an appropriate range of skilled staff, making good use of technology and equipment in the best locations for patients.

How we did itWe designed a future state around four elements;• Prevention and screening• Assessment, triage, emergency• Diagnostics & specialist assessment • Treatment rehab and follow up

Prevention and screening

Integrated Care Centre

•Community support / resource for Maori/mental Health/CAMHs (non-clinical)•Enhancing community facilitating/identification•ie. of kaiawhina/etc•Enhanced MDT processes•Free up 2⁰ educators to work across entire community

•Whole community approach•Annual strategy & planning•Hub & spoke•Expansion of outreach•Programmed engagement•Whanau Ora Assessments•Extensive holistic approach defining risk factors across health/social streams

Investigate delivery models in other similar areas

•Database•Back office functions

Recalls Admin / clinical Scheduling•Focus on Targets through joint planning

Main aim:•Screening•Prevention•Early intervention

Utilise existing & effective

initiatives/programmes & enhance them

Available daily•Bookings•Records•Meds•Results•IBA•Radiology

Prime2-tier transfer system

Bypass protocolTransit lounge

Appropriate staffing

Procedural

24/7A & M plus

Base hospitalDental health

A&D

Does this need to be open during working hours?

Must have I2 lead ability combined with TK4 until St John have training, equipment & funding to do this

1⁰ facilityCo-paymentsVoucher system / LCF fee

24/7

Dr on sit

e – 0800 2200

Dr on call –

2200 0800

Healthline

F2F / Phone

111 Community/Kai awhinaTriage

Protocol-

driven transfe

r

(non-doctor)

On call (dedicated South Taranaki)Crisis MH on call & support

Security Mental health help line

Assessment, triage, emergency

Diagnostics & specialist assessment

All together-Pooling resources- One IT Site critical

All together-Pooling resources- One IT Site critical

Orientation•Where in Hawera <->Base?

•Health professional•Patient

•Navigator•Community

Mobile•Echo? (car, lease

clinic, increased FTE)•Lab screening

Support•Telemedicine (in patient

names, laptops, video)•E-mail

•Phone call•Standardized template “R”

•Increased / intensified local one programme

Specialist•1x Cardio, 1x Ortho etc

•Onsite visits by all•“One local champion”

specialist•Education & support of

local

Radiology• Easier accessibility

•Onsite U/S - plain film•Mobile U/S?

•Mobile CT / MRI (future)

Everyone together

Labs•Onsite 8-5 (already there)

•Collection•POCT (after 1pm weekends)

•Reduction in staffing cost

Main Requirements•Recruitment•Retention•Training

Main Requirements•Recruitment•Retention•Training

FSA

Treatment rehab and follow upHawera Health Base (South Heath Integrated)

Community Team

Rehabilitation/Intermediary Care(@ home or residential care)

Day Procedure Unit •Nurse lead•Blood transfusion•Ex ECGs

OP clinics – increase

Oral health

Mental health•Up skill to crisis trained

Public Health

Diagnostic primary•Paeds•Respiratory•Diabetes

Daytime Crisis Team•1x member South Gen Team •1x staff CPT (to cover general)•After Hours Crisis Team•Rostered staff (x2) based in Stratford

Resources needed:Staff•Mental health •Up-skilled/multi-skilled, more mobile

More allied health ( physio, OT, social worker, geriatrician)•Restorative/Intermediate Care team (Splice-related)Transport

Maternity (currently

under review)

Minor procedures: bumps, scopes, local anesthetics,

Mobile bus – enhance

Complex care managers

A&M•Observation/assessment beds

(numbers ?)

GPs

Psychiatric nurse within Intermediary Care team

Maori Advocacy •Support?•Intervention?

Need to be linked to screening / preventionearly intervention

Need a central hub

Common themes• Mobile services

• Central hub and spoke

• Pooling resources

• One IT site/system

• Building single team focus

• Recruitment, retention, training

Key Enablers• Transport• Policy & Governance• IT – shared information• Funding• Workforce• Health literacy/education• Facilities

• Meet with Hawera Hospital staff

• Meet with GPs• Develop proposal• Community

consultation

Where to from here?

Rere atu, rere mai,

taku manu e rere ki tua, rere ki kō,

kia whetūrangitia e

• As we take up new challenges plant your feet strongly upon mother earth with eyes towards the stars for light and inspiration