Primary Care Quality Improvement Whakakotahi Hutt Union Community

Primary Care Quality Improvement Whakakotahi Hutt Union & Community Health Services The Health Quality & Safety Commission

Session description • Overview of Whakakotahi • HUCHS Diabetes improvement project: – Why diabetes – Useful tools – Key learnings • Question time

Whakakotahi – ‘to be as one’ • Partnering with primary care teams to work on smallscale improvement projects • Projects chosen by providers • Alignment with System Level Measures Framework and district improvement plans • Accreditaton and MOPS requirements

Whakakotahi • Focus on: – EQUITY – INTEGRATION – CONSUMER ENGAGEMENT

Finding Answers: http: //www. solvingdisparities. org/tools/roadmap.

The story so far. . . December 2016 – 3 projects selected: – Papakura Marae Medical Clinic – gout – Nelson Marlborough Health & 3 general practices plus. . . –post stent management – Hutt Union & Community Health Service (HUCHS) – diabetes 1 September 2017 – Expressions of interest process closed for 2018 projects

Central Law of Improvement “ Every system is perfectly designed to deliver the results it produces. ” Langley, G. J. , Moen, R. D. , Nolan, K. M. , Nolan, T. W. , Norman, C. L. , & Provost, L. P. (2009). The improvement guide: a practical approach to enhancing organizational performance.

Improvement Science “The rationalism of science and the messiness of practice do not have to be incompatible. Improvement science can give practitioners the tools to plan, implement, evaluate, and embed new approaches more effectively into practice. ” Marshall, M. , Baker, M. , Rafi, I. , & Howe, A. (2014). What can science contribute to quality improvement in general practice? . Br J Gen Pract, 64(622), 254 -256.

Langley et al. The Improvement Guide 1996

Hutt Union & Community Health Service and Te Awakairangi Health Network Diabetes Improvement Project

Hutt Union & Community Health Service (HUCHS) • 7000 enrolled patients • 2 clinic sites – Pomare and Petone • 87% high needs

Te Awakairangi Health Network (Te. AHN) • Primary Health Organisation in the Hutt Valley • 118, 00 enrolled population • 20 practices over 22 sites • Check us out on

Why focus on diabetes?

How did Whakakotahi help us? • Learning theory of quality improvement • Scholarships to Ko Awatea Quality Improvement Facilitators programme • Great support on tap • Learning and using improvement science tools

Fishbone diagram

Affinity tool

Process Mapping

DRIVER DIAGRAM: HUCHS Diabetes Improvement Project AIM PRIMARY DRIVERS SECONDARY DRIVERS • • Clear pathways for patients with diabetes Effective diabetes management processes Individualised patient management plans Improved integration between providers To reduce the average Hba 1 c by 10% in HUCHS patients with diabetes by 31 December 2017 Reduce financial barriers Barriers to access Provide culturally appropriate services Clinic access Patient knowledge Patient empowerment Patient engagement Community & Whanau partnerships • • • • • • CHANGE IDEAS Regular data and feedback to providers Flow chart showing pathway for new and existing patients with diabetes Individualised patient management plans Standardise prescribing of diabetes medication Review patients on pioglitazone after 6 months with no significant reduction in Hba 1 c Increased insulin initiations Map external and internal diabetes services and agree referal and feedback processes Pharmacy data re pick up of meds Divert portion of disability allowance to pay for clinic visits and medications Check all eligible allowances are being paid Increase staff knowledge and awareness of cultural issues Use of interpreters Offer extended clinic hours Transport plans for patients as needed Develop education sessions and programmes based on patient feedback Print out Hba 1 c chart for each patient Implement Manage My Health patient portal Focus on the positive Holistic approach – put people in the picture Patient, whanau and community feedback and co-design Sharing patient stories HUCHS facebook page Patient info sheet Exercise Programme

Prioritisation Matrix

Testing change ideas: Plan Do Study Act

Te Kete Hauora - Patient Co-Design

Whakakotahi started Pharmacist started Progress to date – Average Hba 1 c Cohort 1

Whakakotahi started Pharmacist started Progress to date – % Patients with Hba 1 c <65

What we have learned? Communication is key Patient co-design rocks Co-leading has made it possible for us Needs whole team engaged and involved in leadership including doctors, nurses, administrators, community workers, etc • Needs commitment, time and energy • Takes a lot of resource so sustainability is a challenge • • Contact Details Sally Nicholl : sally@huchs. org. nz Sandy Bhawan: sandy. b@teahn. org. nz

Find out more at: https: //www. hqsc. govt. nz/our-programmes/primary-care/