Case in Point

Sometimes, a picture tells a thousand words.

I’ve been reflecting recently on last week’s launch of our 20,000 Days campaign and the energy and buzz that event created. It was fantastic to see people from across the sector working together to generate ideas about how we might redesign the health system. What’s even better is that the enthusiasm generated at the launch has continued, as people really start thinking about redesigning the system to keep people well and at home, and ‘save’ 20,000 days in hospital.

One of the highlights for me from last week’s event was when Professor Harry Rea stood up holding a very large plastic bag that was simply bulging with boxes and pieces of foil. He explained that the contents of the bag, which you can see here, was the medication regime for just one patient.

This moment really illustrated to me, and to everyone in the room, the challenge that we have ahead of us.  In addition to the medications in the bag, this patient has had multiple outpatient appointments with different services as well as occasional admissions to hospital for problems associated with his long-term conditions.  I’ve asked our Chronic Care Pharmacist, Gray Maingay, to tell you more about the experience this person is having in the hands of our health system.

We visited this patient, who has multiple long-term conditions, at home last week. He had been given $3500 worth of medication, including $2500 of unused asthma inhalers, yet he had little understanding of what was required to manage his long-term conditions successfully. He was confused about his medication. He didn’t understand what he needed to do. His health literacy problems compounded this.

As a result, he had been into hospital a number of times. But because of the language barriers and cultural barriers, the messages in hospital were hard to understand.

By working with a great multi-disciplinary team from the hospital and in the community, we built a trusting relationship with this patient and really began to understand the barriers that led to his treatment failure. Integrating care across the sectors, and working with patients in their homes, makes a big difference to preventing avoidable admissions to hospital. If we work together in the community, we can be a fence at the top of the cliff rather than the ambulance at the bottom.

As Gray suggests, what had clearly happened in this case was that the system was too complex and as a result, this patient was plagued by poor communication, poor coordination, wasted resource and, ultimately, poor outcomes.  This is exactly why we have got to Achieve a Balance by developing localities and building our locality partnerships, and engaging with primary care to better integrate the way we work. This case is the perfect example of why the current system needs to be radically changed and why simply making it more efficient won’t solve the problems.

It is worth pointing out that the problems we are currently addressing are also commonly experienced by other health systems. As such, people around the world are talking about the work we are doing; how we are engaging with people to change how the system works; and how we are resourcing those at the front line with the skills, opportunities and power required to make change happen. This approach is very much leading the way internationally and is being followed closely. If you need proof, check out these two videos from friends overseas (please allow time for them to load). The first is from Maureen Bisognano, the President of the Institute for Healthcare Improvement (IHI) in Boston, while the second is from Dr Don Berwick, recently head of the Centers for Medicare and Medicaid in the USA. He is also the former President of the IHI and widely regarded as one of the most influential thinkers in healthcare worldwide. Their support of, and interest in, what we are doing is extremely exciting but also speaks volumes about the excellent work you are doing here at CMDHB to tackle these big challenges.

Have a great week,


PS: It hasn’t been a great week for my weight loss but MiddleNOmore participants are up to 103.8kg lost. Congratulations – it’s great to have passed the first 100kg milestone! Have you recorded your latest weight with Physiopac this week and contributed your loss to our total?


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.

2 thoughts on “Case in Point”

  1. Excellent blog and it really brought home to me why we need 20k! The waste of those medications is probably replicated thousands of times…

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