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Participants of the Gemba workshop – 27, 28, 29 April 2011. Rere atu, rere mai, taku manu e rere ki tua, rere ki kō, kia whetūrangitia e As we take up new challenges plant your feet strongly upon mother earth with eyes towards the stars for light and inspiration. Proposed future state;.

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Presentation Transcript
slide2
Rere atu,

rere mai,

taku manu e rere ki tua,

rere ki kō,

kia whetūrangitia e

  • As we take up new challenges plant your feet strongly upon mother earth with eyes towards the stars for light and inspiration
proposed future state
Proposed future state;
  • High level future state developed during the Gemba three day workshop for people in South Taranaki.
what was our goal
What was our goal?
  • The goal was to design future services that can be provided by an appropriate range of skilled staff, making good use of technology and equipment in the best locations for patients.
how we did it
How we did it

We designed a future state around four elements;

  • Prevention and screening
  • Assessment, triage, emergency
  • Diagnostics & specialist assessment
  • Treatment rehab and follow up
prevention and screening
Prevention and screening
  • Main aim:
  • Screening
  • Prevention
  • Early intervention

Utilise existing & effective initiatives/programmes & enhance them

Investigate delivery models in other similar areas

  • Whole community approach
  • Annual strategy & planning
  • Hub & spoke
  • Expansion of outreach
  • Programmed engagement
  • Whanau Ora Assessments
  • Extensive holistic approach defining risk factors across health/social streams
  • Community support / resource for Maori/mental Health/CAMHs (non-clinical)
  • Enhancing community facilitating/identification
  • ie. of kaiawhina/etc
  • Enhanced MDT processes
  • Free up 2⁰ educators to work across entire community

Integrated Care Centre

  • Database
  • Back office functions
  • Recalls
  • Admin / clinical
  • Scheduling
  • Focus on Targets through joint planning
assessment triage emergency
Assessment, triage, emergency

Protocol-driven transfer (non-doctor)

Does this need to be open during working hours?

24/7

Dr on site – 0800 2200

Dr on call – 2200 0800

Healthline

F2F / Phone

111 Community/Kai awhina

Procedural

A & M plus

24/7

1⁰ facility

Co-payments

Voucher system / LCF fee

Must have I2 lead ability combined with TK4 until St John have training, equipment & funding to do this

Triage

Prime

2-tier transfer system

Bypass protocol

Transit lounge

Appropriate staffing

On call (dedicated South Taranaki)

Crisis MH on call & support

  • Available daily
  • Bookings
  • Records
  • Meds
  • Results
  • IBA
  • Radiology

Security

Mental health help line

Dental health

A&D

Base hospital

diagnostics specialist assessment
Diagnostics & specialist assessment

FSA

  • Orientation
  • Where in Hawera <->Base?
  • Health professional
  • Patient
  • Navigator
  • Community
  • Main Requirements
  • Recruitment
  • Retention
  • Training
  • Labs
  • Onsite 8-5 (already there)
  • Collection
  • POCT (after 1pm weekends)
  • Reduction in staffing cost
  • Mobile
  • Echo? (car, lease clinic, increased FTE)
  • Lab screening
  • Radiology
  • Easier accessibility
  • Onsite U/S - plain film
  • Mobile U/S?
  • Mobile CT / MRI (future)

All together

-Pooling resources

- One IT Site critical

  • Support
  • Telemedicine (in patient names, laptops, video)
  • E-mail
  • Phone call
  • Standardized template “R”
  • Increased / intensified local one programme
  • Specialist
  • 1x Cardio, 1x Ortho etc
  • Onsite visits by all
  • “One local champion” specialist
  • Education & support of local

Everyone together

treatment rehab and follow up
Treatment rehab and follow up
  • Maori Advocacy
  • Support?
  • Intervention?

Hawera Health Base

(South Heath Integrated)

Rehabilitation/Intermediary Care(@ home or residential care)

  • Day Procedure Unit
  • Nurse lead
  • Blood transfusion
  • Ex ECGs
  • A&M
  • Observation/assessment beds (numbers ?)

Need a central hub

Community Team

OP clinics – increase

Complex care managers

  • Daytime Crisis Team
  • 1x member South Gen Team
  • 1x staff CPT (to cover general)
  • After Hours Crisis Team
  • Rostered staff (x2) based in Stratford

GPs

Mobile bus – enhance

Public Health

Minor procedures: bumps, scopes, local anesthetics,

Oral health

  • Mental health
  • Up skill to crisis trained

Maternity (currently under review)

  • Resources needed:
  • Staff
  • Mental health
  • Up-skilled/multi-skilled, more mobile
  • More allied health ( physio, OT, social worker, geriatrician)
  • Restorative/Intermediate Care team (Splice-related)
  • Transport
  • Diagnostic primary
  • Paeds
  • Respiratory
  • Diabetes

Need to be linked to screening / prevention

early intervention

Psychiatric nurse within Intermediary Care team

common themes
Common themes
  • Mobile services
  • Central hub and spoke
  • Pooling resources
  • One IT site/system
  • Building single team focus
  • Recruitment, retention, training
key enablers
Key Enablers
  • Transport
  • Policy & Governance
  • IT – shared information
  • Funding
  • Workforce
  • Health literacy/education
  • Facilities
slide12
Meet with Hawera Hospital staff

Meet with GPs

Develop proposal

Community consultation

Where to from here?

slide13
Rere atu,

rere mai,

taku manu e rere ki tua,

rere ki kō,

kia whetūrangitia e

  • As we take up new challenges plant your feet strongly upon mother earth with eyes towards the stars for light and inspiration