Working across the whole health sector, both in Counties Manukau and greater Auckland, is becoming increasingly important. This week Ray Naden, the independent chair of the Greater Auckland Integrated Health Network (GAIHN), introduces us to GAIHN and how its work will enhance what we are doing at CMDHB going forward.
I’ll be back next week.
Too many people in greater Auckland end up in hospital unnecessarily. Unfortunately this is not an occasional problem – Aucklanders are admitted to hospital acutely about 20% more frequently than New Zealanders in other metropolitan district health boards. This is equivalent to about 15,000 admissions and 40,000 acute hospital days each year in CMDHB. Of course this situation incurs great expense and means that our hospitals are often operating at capacity. More importantly, these events are disruptive for patients and their families, and many of these admissions are avoidable.
The Greater Auckland Integrated Health Network (GAIHN) is an alliance of the three Auckland DHBs (CMDHB, Auckland DHB and Waitemata DHB) alongside three Primary Health Organisations (Auckland, East Health and ProCare which together cover about 1.1 million people). What makes this collaborative alliance possible is that, regardless of where in greater Auckland we operate, we share a common goal to improve healthcare with a focus on acute events which lead to avoidable hospitalisations.
Of course, improving healthcare is not just about what we do to people but also what we do for people. GAIHN’s emphasis is on better integrating care so that patients are seen by the right person, in the right place, at the right time. To this end, GAIHN has three workstreams:
- Targeting patients at high risk of acute hospitalisation with intensive integrated care to anticipate and prevent acute events
- Better response in the community to acute events likely to lead to unplanned hospitalisation
- Integrating the key support systems and services (enablers) required to prevent or better manage acute events
Workstream 1 is initially implementing a process for identifying high risk patients. In recent months, volunteer GPs have been advised of the patients enrolled with their practise who are at the highest risk of a future acute admission. The doctors have confirmed that the predictive risk tool is identifying the right patients, enabling the GPs and their health professional colleagues to intervene earlier and better integrate the various activities and services the patient requires. By doing so, our hope is to keep high risk patients well and at home. Hospital can be an unfamiliar and unsettling experience for patients. The more they can stay in their own environment at home, the more they will feel well, confident and empowered to better manage their own health.
Workstream 2, however, acknowledges that not all acute events can be prevented. For these events, what we can do is respond better in the community setting (such as the GP or an Accident and Emergency Clinic) rather than always resorting to hospital for treatment. GAIHN is exploring a range of options such as extending Primary Options for Acute Care (which is already being utilised in Counties Manukau) and a process whereby St John can take acute patients to an after-hours clinic or their Primary “Medical Home” rather than always to ED. We are also exploring more accessible and consistent triage advice for patients in the community and also better ways to respond to acute events for people in Aged Residential Care.
Finally, many people who are at risk of ending up in hospital have complex problems and require a range of care and treatment. But what we often find is that care is not integrated so that staff are making decisions without fully understanding what is going on in the patient’s other conditions or their treatment plans. Workstream 3 is looking at integrating the enablers to assist health professionals to better manage or prevent acute events. This includes developing agreed clinical pathways on how to treat certain conditions and then linking these to the electronic referrals, access to diagnostics and other specialist services, and shared care plans so that multidisciplinary teams can easily establish a patient’s whole story. Wouldn’t it be great if, when someone comes into contact with the health system in five years (or sooner!), we could say ‘This is Mrs Jones and this is her shared care plan. This chronic care nurse is her primary care coordinator. This cardiologist is involved and these people are looking after her diabetes. And here’s her self-care plan detailing what she does at home.’? I think that would be wonderful, most importantly for Mrs Jones and her family.
GAIHN is very much about fostering collaborative initiatives between our members, to design globally and to implement locally. There is already a lot of innovative work happening in Counties Manukau which GAIHN is supporting, both locally and in collaborative initiatives across the three DHBs and our PHOs. Together I believe we can not only achieve better outcomes for our patients but also create a more satisfying environment in which we do that work.
Ray Naden, Independent Chair of GAIHN