Unwrapping APAC

As those of you who attended will know, APAC was a resounding success. About 900 people from 16 countries gathered for two days to hear from some of the brightest healthcare thinkers in the world and the results were astounding. Participants not just from CMDHB, or Auckland, or New Zealand but from right across the Asia/Pacific region raved about the range of thought-provoking and inspiring speakers APAC brought together and there was almost a tangible sense of inspiration and energy in the room as we collectively grappled with, and untangled, some of the biggest challenges around quality improvement in healthcare in the world today.

The standard of the Forum was set with the first keynote speech from Maureen Bisognano, President of the Institute for Healthcare Improvement. She talked about the need to move from what she calls “what’s the matter medicine” to “what matters to you medicine” and shared compelling cases where this approach has made a real difference to the quality of care and experience patients receive. In one case, a hospital patient was involved in setting their goals with health professionals and reframed the conversation by writing simply “Heal this broken body. Cut grass.” Elsewhere at Toronto’s Mount Sinai Hospital, parents of babies in the Neonatal Intensive Care Unit (NICU) are encouraged to spend a minimum eight hours a day in NICU where they receive coaching, take a lead in care planning and are paired with ‘parent buddies’ who have had babies of their own in NICU. The end result is that parents are heavily involved in giving the best care that they can to their newborns and feel supported to continue doing so on their own when their baby is discharged. “The most important thing we can do, I think, is change the process so that we actually sit down and set goals with patients, not for patients,” Maureen said. “Patients with diabetes or heart disease have 5000 wakeful hours per year where they’re taking care of themselves,” she said. “Without sitting down and talking about what they want, I think we are really missing a huge opportunity and a huge asset in the system.”

The second keynote speech was from Sir Muir Gray, who challenged us all with the idea that “the future is like the harbour bridge or the Sky Tower – something we imagine, plan and build”. He reflected on the revolutions that have shaped modern healthcare and detailed the five problems which remain unsolved around the world: failure to prevent preventable disease, inequity, patient harm, waste of resources and unwarranted variation. He surmised that the future will see demand rise at the same time as resources will decrease and health’s carbon footprint will have to come down. The 21st Century, he said, is the century of the patient, focusing on care, prevention and harm, increasing value and networks.

Speaking first on Friday was Dr Harry Pert, a Rotorua GP and President of the Royal NZ College of General Practitioners. He talked about the history of the GP and how it has shaped this profession today. He also talked about the two different conceptual frameworks used in the patient-centred clinical method: disease (incorporating history, examination and diagnosis) and illness (ideas, expectations, feelings, effects on function and the patient’s unique experience of illness). “Both are important” and lead to an integrated understanding, he says. Dr Pert says we have to redesign the role of the GP and the hospital, and could draw on what’s happening in other industries, such as NASA and Toyota, to fuel “destination discussions about our planned and preferred future”.

Don Berwick was the final keynote speaker on day two and rounded out the Forum on a simply amazing note, discussing the ethics of healthcare improvement. He reflected on a personal experience from his work as a registrar in the 1970s, during which he grappled with the ethics of an oversight in healthcare delivery. It was an extremely powerful and moving story in which Don honestly shared details of the choices he made as a young registrar, and how they differ from the choices he would make today. Due to latent factors (such as stress, tiredness or workplace variations), unintentional errors in healthcare can happen but the key to improvement, he says, is in what health professionals choose to do about them afterwards. We have, he says, an ethical obligation to improve the system in which we work. “If we be healers, how can we conscience the fact that we do not act to prevent harm when we know the cause?”

I was extremely proud of all that APAC achieved and the stunning line-up of speakers who were brought together alongside people from across the healthcare sector throughout the Asia/Pacific region. I’m pretty convinced that some patients will not be harmed, and some patients who are currently utilising healthcare services will be supported to become more independent, as a result of the APAC Forum. I think that’s a fantastic return on investment. Thank you to all CMDHB staff who were able to make it and added their energy and ideas to the mix. If you couldn’t be there but are interested to hear more from some of these speakers or the many others who presented, I urge you to watch some of the Forum videos on the Ko Awatea website. I’m really keen to get all staff involved in this discussion about quality improvement and start to explore and apply some of the ideas APAC sparked.



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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