One of the Biggest Issues we Face

Arguably one of the most important issues facing healthcare as we go forward is health literacy, a term which refers to a patient’s ability to be informed about, and understand, how to best manage their condition and the treatment they are receiving. I’ve blogged before about how health literacy is a major issue in our part of the world and you may remember the case of George, a patient whose story was highlighted through our 20,000 Days Campaign. George was admitted to hospital 28 times within the space of a year until he gained a better understanding of his condition and learnt how to look after himself, at which point he turned a corner and managed to reduce the number of times he ended up in hospital. Clearly in George’s case, the knowledge of how, and why, to manage his condition had a huge impact on his wellbeing, how much he benefited from the treatment we were providing and how much his treatment cost.

Whenever I’ve talked to secondary care clinicians about patients like George, they tell me that there may be odd cases of this happening. Primary care physicians, on the other hand, know of handfuls of cases of people like George who are not getting the best outcomes they could because of health literacy issues. Personally, I suspect the number of cases like George’s may well run into the thousands in South Auckland. To best serve such patients, I think we need to improve health literacy and our patients’ understanding of how to manage their condition at the same time as we provide high quality and safe patient care.

To assist with improving health literacy, we hosted a two-day symposium last week. CM Health staff, alongside representatives from Primary Health Organisations, patient interest groups and other support organisations, came together to discuss how we can achieve health literate organisations in Counties Manukau. What was of great interest to me was talking about how, in an era of chronic disease, we can better communicate with our patients so that they can make the right decisions for themselves and get the best benefit from the services we provide. I believe that CM Health has two tasks. The first is to ensure that patients who come to hospital are treated well and quickly, and I think we’re doing this increasingly well. The second, however, is more unchartered territory – that is ensuring patients stay well and at home as much as possible. It was interesting to have a conversation about this at the symposium and begin to explore ways in which improving health literacy might support this aim.

With the patient in mind, we are also lucky to have had Dr Neil Houston join us this week. Neil is a GP and National Clinical Lead for a Primary Care Safety Programme in Scotland. This programme, which has now spread to 1000 Scottish general practices, focuses on improving practices’ safety culture, improving the reliability of high risk processes and managing systems. It has helped practices improve their systems and safety culture, enhance their team work and allowed staff to become more efficient and less stressed as team members know what they’re meant to be doing and fewer things go wrong.

Neil was here to work with CM Health, ADHB and WDHB to help us identify lessons learned in Scotland and how we might develop them for our own local context. Earlier this week, he also launched our Primary Care Patient Safety Initiative which will focus on improving safety within general practice over the next 12 months. As part of this initiative, general practices are required to involve patients in the co-design of their systems. It is an extension of the Patient and Whaanau Centred Care work that is already underway in the hospital and another step in the journey of making sure that clinical quality is the only game in town.

I’ve talked a lot over the last year or so about the need for a new approach if we are to ensure that the health system is not overwhelmed in future, particularly in this era of chronic disease. If we consider the effective management of Type 2 Diabetes for example, half of New Zealand’s renal dialysis beds are already located in Counties Manukau and we expect this condition to become even more prevalent. Yet we cannot simply go on expanding our secondary care facilities to deal with these sorts of issues, issues which are best dealt with by the patient themselves and by primary care. Not only is it more effective for the patient to be looked after in the community where possible, it is also more cost-effective for the health system. It does, however, involve revisiting the roles played by both the patient and the practitioner. We need to bring new life to that relationship while also rebalancing it so that it is fit for purpose in the 21st century. Exciting times ahead…



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.

One thought on “One of the Biggest Issues we Face”

  1. I couldn’t agree more …. but I think that librarians can play a role too. I have worked as a Consumer Health Librarian in two different locations in Canada and in 2011 visited St. Michael’s Hospital in Toronto where their library manages the “patient education” library which is centrally located, making it easily accessible to patients. At that time it was staffed by librarians from the hospital’s library and student nurses who were doing their placements there.

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