Achieving the Balance

In my two blog posts earlier this week I hinted at making a big announcement today about some major strategic changes CMDHB will be undertaking. I’m excited to be sharing news of these significant yet positive changes with you all.

Over the last few years we’ve talked a lot about the impact of ageing and of chronic disease, and how, unless we begin to change the health status of the population, we’ll find ourselves facing a level of demand which will be very difficult to cope with. Already, you’ll be aware of more patients, a hospital operating over capacity and undesirable pressure on you and your colleagues.

In response to the rising demand, we’ve tried a whole variety of initiatives such as Let’s Beat Diabetes. They’ve had a positive effect however what’s increasingly clear, especially in recent weeks, is that the demand is rising faster than we predicted. Recent work has identified that, in order to have a balanced health system that works, we have to reduce demand by the equivalent of 20,000 bed days from 2013 onwards.

The challenge is very much here and now.

In response, we’re launching a series of major strategic projects under the banner ‘Achieving the Balance’. This will mobilize major change across CMDHB in collaboration with our partner organisations.

Achieving the Balance will have four components:

  • Thriving in Difficult Times 2

Thriving in Difficult Times was launched with the aim of saving $10 million by improving quality and reducing waste. In fact, we saved closer to $22 million – a massive achievement by all involved. This success has demonstrated to me how much potential there is to save money by further improving quality and reducing waste. So a second wave of this initiative – Thriving in Difficult Times 2 – will be launched next month with the aim of saving over $20 million in the next 12 months. If we can achieve this target, the pressure to save money by cutting budgets will ease.

  • 10 Wicked Issues

As I hope you’ve read in earlier blog posts, I’ve asked staff to identify the top 10 wicked issues facing the organisation. Through Ko Awatea, we will begin to address these issues of concern. This will enable us to keep control of the current situation and improve our day to day operation.

  • Saving 20,000 Bed Days

Saving 20,000 Bed Days will be a coordinated drive to identify how we can reduce hospital usage by 20,000 bed days over the next two years. This means a 5% reduction in bed days – a significant challenge which will require substantial involvement by all staff.

  • The Development of Counties Manukau into Localities

Counties Manukau can be divided into six very distinct areas, each of which has a very different health profile. With strong clinical leadership and our partner organisations, we will be developing these six localities to ensure our investment in each meets the needs of that area.

Achieving the Balance represents major change for CMDHB. Saving 20,000 Bed Days and Locality Development are key strategic projects that will significantly change the way healthcare is delivered in Counties Manukau. We need to change from our current system, where people easily default to the hospital for care that could be provided just as well in primary or community care, to one where people are kept at home as long as possible. Only then will the hospital be able to do what it does best – provide the specialist treatment it’s designed for rather than also coping with patients who could be better treated elsewhere. Secondary care is a very expensive and inefficient way of providing community and chronic care.

As daunting a prospect as this might seem, the biggest risk in fact lies in doing nothing or by making small but ultimately insignificant changes. Making the hospital marginally more efficient will not be enough to meet the level of demand we know is coming. Bold change is required.

Achieving the Balance will challenge us hugely and it is probably one of the most complicated and toughest organisational challenges any healthcare system will face. This is why we’ve spent time creating the capacity in the organisation to deal with change – Ko Awatea is our ‘strategic brain’ to tackle challenges using innovation and the best thinking internationally while Middlemore Central is enabling us to manage the hospital in a more coordinated and sophisticated way than ever before.

In order for Achieving the Balance to succeed, we need the input of all staff and strong clinical leadership to help redesign how clinical services work. CMDHB will also be working closely with patients and primary care.

Achieving the Balance will begin to be implemented from the end of the month. Already we have begun to work on the detail – there was a great meeting with clinicians last Tuesday identifying the workstreams for Thriving in Difficult Times 2.

Challenging and demanding times are undoubtedly ahead of us but hopefully you share my excitement and enthusiasm. This is a rare opportunity to for us all to create positive change and design what the future will look like.



Author: Geraint Martin

Geraint Martin was appointed Chief Executive Officer of Counties Manukau DHB in December 2006. It is one of the largest District Health Boards in New Zealand and services a population of half a million. He has significant experience over 30 years in national policy & in managing both primary and secondary care . Previously, he was Director of Health and Social Care Strategy at the Welsh Government .He authored a radical 10 year strategy of reform, including the successful “Saving 1000 lives” Campaign.Until 2004, he was CEO at Kettering General Hospital & had held senior positions in London & Birmingham.He has worked closely with clinicians in improving clinical standards,patient safety,chronic disease management & managing acute care to reduce hospital demand.In NZ, He has promoted clinical quality and leadership as central to improving patientcare. This has led to a significant increases in productivity and access, whilst maintaining financial balance. CMH has completed in 2014 a $500 m capital redevelopment programme, the largest in New Zealand. A central part of this is the establishment of Ko Awatea,the Centre for Innovation and Research which will underpin CMH as one of the the leading health systems in Australasia.In 2008, he chaired the Ministerial Review of Emergency Care in New Zealand, and in 2013 was an member of the Expert Advisory Panel on Health Sector Performance. Geraint has an MSc in Health Policy from Birmingham University .His post-graduate work has focused on health economics and Corporate Strategy . He is adjunct Professor of Healthcare Management at AUT and Victoria University, Wellington Elected in 2006 as a Companion of the Institute of Healthcare Management, previously he was an Associate Fellow at Birmingham University.He is is Chair of the Auckland Philharmonia Orchestra, a member of the Institute of Directors, on the Board of the NZ Institute of Health Management & previously the Board of The NZ Health Quality and Safety Commission.

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