20,000 Days

This week while I’m away, Diana Dowdle (Campaign Manager) and David Grayson (Clinical Lead) are telling us more about 20,000 Days – a CMDHB campaign to address rising demand on Middlemore Hospital and ensure that people are able to be treated in the community or at home where appropriate.


Around the world all health systems are struggling with rising patient demand and Middlemore Hospital, with our growing and ageing population, is no exception. In fact, thanks to Dr Gary Jackson (former Clinical Director of the Health Intelligence Unit), we know that we will run out of hospital beds by July 1 next year if acute admissions keep rising at their current rate. Just like when you strike traffic on the motorway and are reduced to driving at a snail’s pace, this situation would bring Middlemore to a near standstill, with all of our services blocked and patients unable to flow through the hospital.

Unfortunately, we can’t deal with this pressure by continuing to build a bigger hospital. It is simply too costly and would not provide a sustainable solution for years to come.

Instead, CMDHB’s answer is 20,000 Days, a whole-of-system approach aimed at ‘saving’ 20,000 bed days from the hospital system. The collaborative, involving professionals from across the health sector alongside members of our community, is about providing care in a different way. We want people to be treated as soon as possible and as well as possible in the right place, but this doesn’t always mean coming into hospital. It may mean that some people are treated at home or in the community by their family doctor or at an Accident and Medical Centre if appropriate, enabling Middlemore to continue looking after those people who need the specialist care a hospital can provide.

20,000 Days will be delivered through Ko Awatea and is modelled on international campaigns, including ‘Saving 100,000 Lives’ from America. There are five work streams – living well in the community, keeping at-risk people well in the community, rapid response in the community to acute events, co-ordinated and rapid care in Emergency Care, and safe and timely care for those who need in-hospital care. Phase One has eight specific intervention areas (which are primarily focussed on adult medical and surgical admissions as these areas generate the greatest pressure on the hospital):

  • Chronic Obstructive Pulmonary Disease
  • Congestive Cardiac Failure and Cardiovascular Disease
  • Health of Older Peoples including Frail Elderly
  • Cellulitis and Skin Infections
  • Perioperative Care
  • Transitions of Care
  • Predictive Risk Modelling
  • Very High Intensity Users Integrated Case Management

The time frame for these interventions is until July next year, with further phases being developed through this year so that collaborative improvement becomes business as usual going forward.

20,000 Days will be launched on May 3 in Ko Awatea with a learning session for the people who’ll be making change happen – health professionals from across the sector and members of the community. Our hope is that we can ‘save’ 20,000 bed days from the hospital and have no more than three ‘Dot Days’ (when the hospital is gridlocked) each year. We’ll be looking at our admissions, readmissions, length of stay and discharges data to monitor our progress.

We think it’s hugely positive that CMDHB is looking ahead and acknowledging that things need to change in order for us to manage the increasing demand on our services. 20,000 Days has the potential to make work less stressful for hospital staff; to make the hospital more efficient and safer for the patients that are here; and to keep our community in better health and at home. We know that you are committed to improving patient care and we look forward to your support of this campaign.

Diana Dowdle and David Grayson

(please respond to david.grayson@middlemore.co.nz)


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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