Sustainability and Excellence

After getting a lot of feedback from you asking the same question, I promised that I’d discuss how the work we’re proposing and the changes we have ahead of us contribute to the bigger picture. I’ve spent much of the last month pulling together a framework that, I think, helps put a lot of our work in context. Today’s blog will hopefully give you that context and a better sense of the journey ahead.

Firstly, it’s important to reiterate why change is necessary. As I’ve mentioned, the demand on the health system is both growing and changing. The reality is that if we don’t change the way we work, Middlemore will eventually seize up and we’ll simply run out of beds. And our most valuable resource, our workforce, will get burnt out. Patient care will inevitably suffer.

This clearly isn’t an option. We can’t just sit back and wait for this to eventuate, especially when we know that often hospital isn’t the right place for some people to be treated because modern medicine has made alternatives at home possible. In fact, hospital is a very expensive way of providing some services which could be provided in the community. And there’s a lot more we can do to build up primary and community care so that people can be looked after at home.

The bottom line is that we need to design a sustainable health system that is fit for purpose. By ‘sustainable’, I mean sustainability both in the way it works (that people are treated in the right place and at the right time) and in terms of the environment. We need to move to a system that allows staff the time to practise at the top of their skills and get maximum job satisfaction. In other words, a system that allows staff the time to care.

At the heart of this is the issue of excellence. We already have many examples of excellence at CMDHB but we want to expand on these so that excellence is universal. Our quest for excellence will, of course, be underpinned by the Triple Aim: to ensure we address issues of population health such as health inequalities, to continue to improve the patient experience and to reduce cost per case.

We’ve talked previously about wanting to be the best healthcare system in the Asia/Pacific region by 2015. This isn’t just a vague hope but in order to achieve it, we do need to set ourselves some clear benchmarks by which we can measure our progress. As such, we’ve been mapping out a four year journey – called Achieving the Balance: Delivering Sustainability and Excellence – and it’s this framework that I am outlining today.

Essentially over the next four years as we move through this period of change, all of our work as an organisation will be aligned with our strategic objectives of either Sustainability or Excellence. Under these objectives come a range of strategic interventions. And finally at the third tier down, there are the various ‘executable strategies’ or work programmes we’ll be delivering to make this change happen.

For the visual among us, it looks like this:


  1. Establishment of four community localities and devolution of services to locality clinical partnerships
  2. Reducing demand on the system

Executable strategies include:

  • 20,000 Bed Days
  • Six Hours is Ours
  • Primary Options in Acute Care

3. Maintaining financial sustainability (capital and operational)

4. Building capacity/organisational sustainability

Executable strategies include:

  • Workforce development
  • Change Management
  • Financial Strategy
  • Clinical Leadership

5. Ensuring environmental sustainability

6. Working with DHB partners in the region


  1. Patient Experience

Executable strategies include:

  • Zero Patient Harm (Patient and Whaanau Centred Care, Quality Improvement and Patient Safety)

2. Value For Money

Executable strategies include:

  • Thriving in Difficult Times

3. Population Health

Executable strategies include:

  • Services and Programmes
  • Health Equity
  • Whaanau Ora

The leads for each executable strategy will be announced in the weeks to come. There is currently also a stock take happening of the various work programmes already underway at CMDHB so that we can make sure what we are doing aligns with our overall strategic objectives. We are also looking at streamlining decision making so we don’t waste your time and precious health dollars in duplicating work.

No doubt as we progress there will be more added to the list above as it’s very important that everything we do aligns to either Sustainability or Excellence going forward.

The other thing I want to note is that communication around this issue is vital. Major transformation programmes fail because of poor project management and poor communication. Aware of that, we are putting a lot of effort into ensuring we have top quality project management and getting our communications right. This blog is just the start of a major communications exercise involving staff, staff organisations such as unions, patients and the wider community. There will be a series of communications coming that will keep you informed as we go.

Finally, after all this talk about sustainability, I’d like to share an announcement that comes as a direct result of your feedback on my earlier blog post – Going Green.

In the coming weeks, a paper will be put to the board with the aim of us entering into a programme to become the first certified sustainable hospital in Australasia, led by Dr David Galler and Greg Simpson. Closer to the time, I’ll be blogging with David so he can tell us more about it but for the moment I want to let you know that this milestone, to consider such an undertaking and to bring it before the board for their consideration, is a direct result of your feedback on my blog and your clear enthusiasm for us to pursue environmental sustainability.

Your feedback really is making a difference and creating change. As I said last week, please use this blog as an opportunity to start those conversations and keep making that change happen.



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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