Ko Awatea draws upon multiple evidence-based methodologies in its work with individuals and teams across CM Health. Our approach to improvement is based upon the Model for Improvement, which focuses on three key questions:
Underpinned by the Plan, Do, Study, Act approach (PDSA), these questions are put into action by testing in situ and is informed by quantitative and qualitative data. Changes are tested on a small scale, building up over time with the aim of small changes creating a large effect.
The lifecycle of improvement spans across six stages; each stage representing a stage of the improvement journey and is made up of a range of change and improvement methodologies. At the heart of each stage is the need of those delivering and accessing care services.
1. Understand the current system and problem/opportunity for improvement
The diagnostic stage involves assessments to understand the issues and the context they sit within. Both have their place and indeed both can be used together. In complex environments with multiple stakeholders, all with their own perspective on what is happening, it may simply start with facilitating a common agreement on the nature of the problem to be addressed. The conclusions from this stage informs the design stage of the improvement framework.
2. Design changes to deliver desired improvements, clearly identifying the theory of change
A number of contextual and cultural factors are taken into account when designing a change package, including the nature and urgency of the issue and available resources. In designing changes, we draw from the evidence base and any relevant clinical and care guidelines.
Co-design is part of a process that enables those who deliver services and those who receive services to create improvements together, where each person or group is considered to have equally important views. All stakeholders are able to contribute ideas from their own perspectives and experience, leading to a more in-depth understanding of the current process and increased ability to create the most effective improvements for the future.
3. Implement the change with a focus on testing
We take every opportunity to test changes before implementing at scale and we collect relevant data to verify if the change has led to the anticipated improvements. An understanding of how human systems respond to planned change complements practical skills in quality improvement. We also recognise the need to look at the programme infrastructure to co-ordinate and support implementation and the value of project management approaches to effective management of the implementation process.
4. Evaluate to understand
Evaluation is built into improvement cycles through the use of outcome, process and balancing measures. These measures can be quantitative and qualitative. We promote approaches that support ongoing reflection and consideration of why change did or didn’t lead to improvement. Further, understanding what aspects of the change intervention led to success, including the impact of any local cultural and contextual issues, is key for knowing how to replicate changes elsewhere.
5. Embed and sustain successful change
Quality control, leadership, local ownership, and motivational techniques are fundamental to sustaining the changes that lead to improvement.
6. Spread the learning
Leadership and role modelling facilitate the spread of improvement along with social movement and network theory. There is a need for learnings to be captured and success shared through relevant communication channels.
Movement across the stages is not necessarily linear. Instead, progress from one stage to the next is dictated by continual assessment and agreement of the stakeholders’ readiness through open and honest dialogue, coaching and support. Indeed, there may be times when the best approach is to start again.
To deliver on our strategic direction, together with supporting the business with clinically led service improvements, we have created three structured portfolios that integrate related programme and project delivery activities. Based upon best practice portfolio management, these activities will help design and deliver synergies, more effectively allocate resources, link strategic and tactical activities, and benefits realisation.
a) Acute Flow
Takes a whole of system approach to improving how care is provided and patients move through acute care pathways. This includes improvements to Emergency Department processes, more efficient management of beds, proactive discharge planning and optimisation of transition of patients into community based services.
b) Ambulatory Flow
Focuses on improving patient care in non-acute settings, including improving management and remodelling of Outpatient Management processes across a range of services, and planning for the next steps for the Enhanced Model of Planned Proactive Care with Primary Care providers.
Review and delivery of a number of clinically led initiatives to reduce variation in line with best practice, and ensure that resources are used efficiently in order to better utilise clinician time, ensure consistent outcomes for patients as well as reduce costs for services.
Deliveres a number of initiatives in non-clinical or ‘back office’ areas, including workforce management and payroll opportunities, procurement and contracting efficiencies, promotion of environmental sustainability, and ensuring clinical coding processes are optimised and revenue from Inter District Flows are managed effectively.
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