Transcript WentWest Annual Report

Illawarra-Shoalhaven
Medicare Local
Primary Health Care Conference
22 November, 2014
Making Integrated Service Delivery a Reality
A Western Sydney Perspective
Di O’Halloran
Chair, Western Sydney Medicare Local (WentWest)
Member, WS LHD Board
Conjoint Professor, Dept of General Practice, UWS
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF - NOV 2014
Overview: Making Integrated
Service Delivery a Reality
Integrated care is patient centred care
Health as a Complex Adaptive System
PHNs’ role in Integrated patient centred care
How far down the reform road have we travelled?
Some Western Sydney Experiences
- A matter of principle
- HealthOne
- Local Community Partnerships
- Health Pathways
- Integrated Care Program
Words of Wisdom from elsewhere
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF NOV 2014
Delivering Integrated Services
is only possible if care is truly
patient centred
Care which imposes the patient’s perspective as the
organising principle of service delivery makes
redundant old supply-driven models of care provision...
.... Integrated care enables health and social care
provision that is flexible, personalised, and seamless
(Lloyd & Wait 2005)
PHN structure should ideally reflect their function
PHN’s role in the system should be for all not just some
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF NOV 2014
Regional Primary Health Care
Organisations’ Core Role?
To lead, support and manage the
transition of our fragmented, underresourced, inefficient and inequitable
PHC sector to achieve...
An integrated cost effective, equitable
and patient centred PHC system
forming the foundations of a Top
Down, Bottom Up Health System,
with Quality General Practice central
How ready is our health system for this
transition?
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF - NOV 2014
Health: a Complex Adaptive System
with Right and Wrong System Drivers
Health care vortex - Joachim Sturmberg - 2010
www.wentwest.com.au
How Far Have We Come in Reforming the
Health System to Deliver Integrated Care?
Analysis of Community Health Needs?
Agreed National Health System Vision?
National Health Values, Policy and Key Outcomes Framework?
High level National Primary Health Care Policy?
COAG PHC Strategic Framework
Bilateral State Health Plans?
Regional LHDs, MLs, LHD-ML partnerships, stakeholder collaborations
Strong, integrated PHC sector – Quality General Practice Central
Equitable, accessible quality care, esp. for those at risk
Empowered patients and communities
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF NOV 2014
A Western Sydney Perspective on
ML/PHN Roles and Integrated Care
WentWest – Western Sydney
Medicare Local and Regional
Training Provider – matched
boundaries with WS LHD
Local Area
Population
Auburn
76,519
Baulkham Hills - Central
75,684
Baulkham Hills- North
57,192
Baulkham Hills - South
43,611
Blacktown - North
100,096
Blacktown- South-East
97,379
Blacktown- South-West
102,322
Holroyd
100,122
Parramatta - Inner
47,750
Parramatta - North-East
46,387
Parramatta - North-West
36,611
Parramatta - South
36,683
Total
820,356
www.wentwest.com.au
WentWest:
Western Sydney Medicare Local
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF NOV 2014
WS ML Operating Principles
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Support the provision of person‐centred, integrated, coordinated care,
reflecting Medical Home principles
Enhance health literacy and self care capabilities for individuals, families and
communities
Design locally‐responsive and equitable services by working with local
communities and building on what already exists
Strengthen quality, scope, connectedness and capability in general practice
and primary health care
Promote innovation, integration and continuous improvement to increase
quality, safety and equity in all health care
Work across sectors to influence socio‐economic determinants of health
Integrate teaching and research into health service planning, delivery and
evaluation
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF NOV 2014
Regional PCO/PHN Leadership
at Three Levels
Regional
leadership
Programs and
Projects
Local Community
Partnerships
• Needs assessment
• Cross sector
coordination
• Responding to
diversity and
Closing the Gap
• “Smart
commissioning”
• GP & AHP capacity
building
• Innovative
solutions and
partnerships
• Health planning
and engagement
• Enabling
investments and
infrastructure
• Structuring
consumer
engagement
Building a “bottom up” approach supported by regional
leadership and a strong evidence base
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF NOV 2014
2012 WS ML-LHD
Partnership Matrix
Partnership
Health Service Priorities
Agreement
on Shared
Population Health
Priorities
Child and Family Health
Cross Service Enablers
HealthOne
Local Community Partnerships
Chronic and Complex Illness
e-Health, PCEHR
Aged Care
Health Pathways
Mental Health (inc. ATAPS, PIR, hs)
GP After Hours
Aboriginal Health
Intensive Practice support
+ Integrated Care Program
now incl. PCMH
REDE Framework
Research, Evaluation, Development and Education Framework
Think & behave as if we are one health system
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF - NOV
2014
Some Western Sydney
Experiences with Integrated Care
• HealthOne
• Local (LGA) Community Partnerships
• Health Pathways
• Diabetes Care
• NSW Integrated Care Program
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF NOV 2014
High priority, high risk groups
New integrated models of care
New service models including
Specialist support, outreach)
Targeted special services:
clinics, outreach, education
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‘Foundation’ service pathways
Population planning
Capability building
HealthOne
Patient centred,
integrated MoC for
high priority groups
Enrolment, Care Plan
Wrap around care
Development of targeted services,
special purpose clinics to meet id’d
needs of community, community
groups and GPs, and/or develop
intensive support/recruit to high risk
programs eg Connecting Care, HO
Review and/or audit of all usual community health service
business processes to enhance relationships, quality of
care and communication processes with general practice
Develop single point entry, common assessments.
Ongoing joint population and service planning processes
Development of e-connectivity, Health Pathways
Build General Practice quality. scope and capacity
Engage local community groups, NGOs, schools in planning
Support people in their own homes and communities
The ‘Universal Triangle’
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF - NOV 2014
HealthOne: Keys to
successful implementation
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Identify, invest in, professional leaders
Identify shared culture, values, priorities
Detailed local data analysis
Delegated responsibilities
Facilitated local strategic planning
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Dedicated GP Liaison Nurse positions
Progressive Model of Care development
Progressive Cross sector engagement
Referral and communication pathway
review against targets
• Build quality and capability
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Behave as if philosophy ...
www.wentwest.com.au
Local Community Partnerships
LGA Level
Local Level
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Community Health centre as
local Health hub
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Cross sector outreach services
to disadvantaged communities
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SHAPE – exercise, diet, nutrition
program – positive evaluations
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Multiple Refugee Health, CALD
initiatives
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Thrive at Five - Doonside
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ML, LHD, AMS, other sector
agencies, schools, local
councils, juvenile justice ...
Detailed Community profiles for
every LGA – support cross
sector planning and priority
setting
Expanding ML-initiated, schools
based program to lift AEDI levels
in disadvantaged schools
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF NOV 2014
Health Pathways
• Commenced 2013 with Diabetes Program
• GPs, Specialists, Allied Health, Consumers engaged
• Aim is link up electronic systems, develop patient portal
• 72 Pathways developed, 144 in development, but ...
• more important to ensure patient experience is consistently positive
• Requires continuing feedback, evaluation and improvement
• Pathway development process critical in breaking down professional
and service barriers
• Health Pathways: about more than efficiency and consistency, can
lead to significant clinical redesign, devolution, integrated care gains
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF NOV 2014
Integrated Care Program
• NSW Health Initiative
• WS one of three demonstrator sites
• WS LHD-ML partnership focussing on three Chronic Conditions with
high hospital utilisation
• Collaborative development of tiered evidence based Model of Care
• Difficulties significant and include:
- pimple on pumpkin syndrome
- generalist versus specialist emphasis
- appropriate investment in building GP capability
- achieving right core drivers for a Complex Adaptive System
• ML – strong emphasis on Patient Centred Medical Home principles
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF NOV 2014
Integrated Care: Critical success
factors (McKinsey)
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF NOV 2014
Overview: Making Integrated
Service Delivery a Reality
Integrated care is patient centred care
Health as a Complex Adaptive System
PHNs’ role in Integrated patient centred care
How far down the reform road have we travelled?
Some Western Sydney Experiences
- A matter of principle
- HealthOne
- Local Community Partnerships
- Health Pathways
- Integrated Care Program
.... and finally, a few Words of Wisdom from elsewhere
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF NOV 2014
“Find common cause with
partners and be prepared
to share sovereignty”
(Kings Fund 2013)
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF NOV 2014
Kings Fund: Top 16 needs to make
Integrated Care happen at Scale and Pace
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Find a common cause with partners and be prepared to share sovereignty
Develop a shared narrative to explain why integrated care matters
Develop a persuasive vision to describe what integrated care will achieve
Establish shared leadership
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Create time and space to develop understanding and new ways of working
Identify services & user groups where benefits from integrated care are the greatest
Build integrated care from the bottom up as well as the top down
Pool resources to enable commissioners & integrated teams to use resources flexibly
Recognise that there is no ‘best way’ of integrating care
Support and empower users to take more control over their health and well-being
Share information about users with the support of appropriate information governance
Use workforce effectively and be open to innovations in skill mix and staff substitution.
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Innovate in use of contracting & payment mechanisms, use of the independent sector
Set specific objectives and measure and evaluate progress towards these objectives
Be realistic about the costs of integrated care
Act on all these lessons together as part of a coherent strategy
www.wentwest.com.au
D O'HALLORAN- WENTWEST-IPHC REFORM CONF-MARCH 2014
Primary Care Trajectories
(From ‘GPs at the Deep End’: Glasgow)
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From pastoral to interventional care which alters natural history ..
From reactive care (focus on presenting complaint) to anticipatory care
(delay/prevent future problems)
From passive to active patients with increased agency, responsibility ...
From single episodes of care to sequences of care requiring continuity,
relationships and trust
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From individual to population care, including equity based on need
From pragmatism and good conscience to systematic efforts to
improve quality of care base on evidence and audit
From individual professional activities to teamwork
From local to wider team, involving colleagues from other agencies
From isolated local units ..to consideration of PHC as a whole system
From medical .. to social model of health and health care within
communities
From professionalism to participatory democracy
(General Practice) Leading all or some of the above
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Professor Graham Watt
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http://www.gla.ac.uk/researchinstitutes/healthwellbeing/research/generalpractice/
www.wentwest.com.au
deepend
D O'HALLORAN- ILLAWARRA phc coNF NOV 2014
Thank You
Questions?
Contact:
Di O’Halloran
[email protected]
Mobile: 0400 010 840
www.wentwest.com.au
D O'HALLORAN- ILLAWARRA phc coNF NOV 2014