Pushing an open door

It’s been over two years since the first campaign (20,000 Days) began, initiated in response to increasing demands on resources across the system. It’s been a remarkable journey and while the 20,000 Days campaign was successful in giving back 23,060 healthy and well days to our community, Beyond 20,000 Days has continued to build on this success, with 16 collaborative teams working across the system to anticipate and prevent acute health problems, respond quickly and effectively in the community and provide timely and safe care to people admitted to hospital.

Both campaigns have had a profound effect on the patients and families involved. Patients like Mike, who joined the Healthy Hearts: Fit to Exercise programme, following a heart attack. Mike has now turned his life around. He is fitter, healthier and more confident. Earlier this year Mike completed Round the Bays with other Fit to Exercise participants.

And who can forget George from the first campaign, who with the help of the Very High Intensity User (VHIU) team went from 28 admissions in one year down to three admissions the following year.

The importance of these health and lifestyle gains for patients and their family/whaanau cannot be overstated

I’ve watched both campaigns closely – seen the data, heard the stories and personally visited some of the teams to see first- hand the difference their work is making. Both campaigns are rich in information and we need to start sharing this wider, so others can learn from it and apply it in their own work.

For this reason we enlisted the help of the Health Services Research Centre at the Victoria University of Wellington to carry out a comprehensive evaluation of the first 20,000 Days campaign. Not only to see why and under what circumstances the campaign worked, but to learn how we can improve for the next time.

The team from Victoria went through the campaign with a fine tooth comb, interviewing a number of people, both within and external to the organisation, sending out questionnaires and reviewing the campaign material.

The evaluation report landed on my desk last week, and I was very impressed with the findings. In fact 78% of people who were interviewed said it was the best thing CM Health had done in a long time! This amazing response not only re-enforced that 20,000 Days was successful, but proved we have found a collaborative approach and methodology that works, that gets results and can be used for other projects, campaigns and improvement work across the health system.

I’m joined by David Grayson, 20,000 Days Clinical Lead and Diana Dowdle, Campaign Manager to talk through some of the findings.

The time was right

“We can’t stay where we are and 20,000 Days is the vanguard for moving forward.” Professor Jonathon Gray, Director Ko Awatea

Looking back, the timing for the campaign was right as there was a growing need to curb the demand on our hospital and to improve the health of people living in our community. It was clear we needed to do things differently and 20,000 Days with its big, but achievable goal came along at the right time – a time when the CM Health culture was receptive and responsive to change. The campaign was also nested within a wider strategy to manage demand for hospital admissions and improve the care of people with long-term conditions.

13 motivated and committed collaborative teams signed up for the challenge, each with a burning issue or problem that needed to be tackled. While all of the teams had a unified purpose i.e. to give back to our community 20,000 healthy and well days, each collaborative group also had its own goal to work towards.

A first for CM Health

Over the course of the campaign, people have become more confident in their ability to test ideas and discover what will work for patients and improve quality care.”
Brandon Bennett, Senior Improvement Advisor

The driving force behind the campaign was the Model for Improvement, which for many was a relatively new concept. At the learning sessions all the teams were exposed to the methodology, including – Plan Do Study Act (PDSA) cycles and measurement for improvement. By the 2nd and 3rd learning sessions teams were confident in using the tools, with PDSA’s becoming part of the air they breathed. By using PDSAs to test theories or ideas, teams were able to decide, quite quickly whether an idea was worth taking to the next stage.

For the first time we began to fully explore how we could use data and measurement to show improvement. This information was presented in a series of dashboards and run charts – again, a relatively new concept for CM Health. Being able to show people what works and what doesn’t, backed up by data was a motivational tool for many of the teams.

The collaborative approach was also a great way of bringing people together and learning sessions were well attended, as people shared their successes and challenges and gained new skills and insights.

“20,000 Days shows really good collaboration by working across different teams.” Pamela Hill, Clinical Specialty Nurse and Team Co-ordinator, VHIU

Having the right people involved

Leadership was a key ingredient to the campaign’s success and we were fortunate to have support from Geraint, Jonathon Gray and others, who not only provided valuable advice and direction, but also participated in the work the groups were doing. This motivated the teams, and re-enforced what they were doing was valued.

Words aren’t enough to say how committed the teams were in the campaign – in fact if we could bottle the energy, commitment and enthusiasm we would have a highly sought after formula for success. It’s this team spirit that enabled teams to stay on track and while some of the teams may not have achieved the big improvements they were expecting, the opportunity to look at current processes and identify what can be improved was invaluable.

The outcomes

“Before I felt hopeless, now I have hope”

While the target for the campaign was met, the real rewards came in the improvements to patients and families lives. While hard to measure in a dollar sense, patients who participated in the programmes are staying out of hospital, feeling fitter and healthier, gaining more confidence and in some cases returning back to work.

It’s not just the patients who benefited from the campaign and we now have a growing force of quality improvement superheroes, who have the skills, and the expertise to spread improvement further.  

Lessons for next time

Choosing the right people to join the teams was important and we learnt that having a multi-disciplinary mix of people, who firstly wanted to participate, were motivated and committed, was key. What we are working on for the next campaign is closer involvement from some of our senior managers. Ideally, where appropriate we would like to have managers actively participate in the teams, so when it comes to the stage where teams are asking for permanent funding and support for the work, managers are more able to see the value of the work being done.

We also need to do more work on the costs involved with downstream change, as well as the potential size of impact (i.e. the number of days saved). With complex projects this can be quite hard, however it’s an exercise we need to undertake.

Everyone wants to use it

80% of respondents agreed/strongly agreed the Campaign made a contribution to building a culture of Quality Improvement

The 20,000 Days Campaign and Target CLAB Zero have been a catalyst for helping to spread the Model of Improvement wider and there are now more and more collaboratives, such as Beyond 20,000 Days, ERAS (Enhanced Recovery After Surgery), and Safety in Practice using the methodology to solve problems or help make decisions. Since we started 20,000 Days we have tripled the amount of work using the Model of Improvement and have built up the overall capability for change in our organisation. The benefit of the methodology is that you don’t need a campaign to use it. People are now beginning to use it in their everyday work – it’s been amazing to see such positive engagement.  

Feeling proud

We are incredibly proud of the work that has been done, and is continuing to be done, through a variety of improvement work taking place across the health sector. The 20,000 Days evaluation report provides a comprehensive profile of our work and confirms our strengths, weaknesses and what we can do better the next time.

We are also inspired by the interest the campaign is getting locally, nationally and overseas. Individuals and organisations are getting in touch from around the world to find out more about the work we are doing. With the collaborative ‘how to guides’ becoming a big hit, health professionals are starting to adopt and implement programmes in their own areas. This interest is incredibly rewarding to witness and a great accolade for the collaborative teams.

For more information about the campaign and to access the ‘how to guides’ click here

Geraint, David and Diana



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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