Thoughts, Impressions & Implications for Health Managers

1. Stephen McKernan – NZHIM Conference, June 2006 Thoughts, Impressions & Implications for Health Managers

2. Outline • Challenges for the sector • Improving our performance – what does this mean? • Focusing, maximising and sharing our resources • Where to next

3. Challenges for the Sector • Increasing public expectation • Competing demands and resource allocation – Population Based Funding, Future Funding Path • Workforce development • Preventing & managing chronic conditions • Continuing implementation of the Primary Health Care Strategy • Focussing on the “opportunity” rather than the “churn” • The productivity debate

4. How Do We Improve Our Performance & Productivity Understanding the inputs, their impact, and realising the potential

5. Knowledge production: Evidence-based, guidelines, protocols LegislativeFramework National Systems Performance Data Governance Arrangements IT, D/Support Tools Quality Framework Incentives Use of Guidelines Peer Review Patient Engagement Improving Quality A Systemic and Systematic Approach Source: Leatherman/ McCarthty, 2002

6. But…. Every Day In Counties Manukau • 5 people die • 1 of the 5 deaths is tobacco related • 3 people die < 75 years old, 2 of them from potentially preventable conditions • 20 babies are born, 1 is low birthweight, 1 has a teenage mother, and 4 of the babies will be admitted to hospital in their 1st year of life • 200 are admitted to a public hospital • 155 are <75 years old, 40 of them are children • 60 of the 155 have potentially preventable conditions • 2 are admitted for mental health conditions • 4,500 people consult their GP

7. Production per unit of effort Effectiveness of productive effort Shifting Our View of ‘Productivity’ “capacity to produce; quality or state of being productive; production per unit of effort; effectiveness of productive effort, esp. in industry” vs

8. So Where Do We Need to Make the Gains? • Inputs • PBFF funding • Expenditure • Compliance – guidelines, quality • Provider arm salaries & operating expenses AND • Integrated care initiatives • Intersectoral initiatives • Primary / secondary care initiatives & funding • Therefore = “Effectiveness of Productive Effort” • Improved health status for the community

9. Standardised Discharge Ratios 01/02 - 04/05

10. CMDHB Resident Procedure Rates 2001-2005 Angiography (age-std rate/100,000 ethnic-specific pop) Angioplasty

11. CMDHB Resident Procedure Rates 2001-2005 Cataract removal Cholecystectomy

12. CMDHB Resident Procedure Rates 2001-2005 Total Hip Joint Replacement Total Knee Joint Replacement

13. CCM Diabetes • 6,615 enrolments as at Feb 2006 • 44% Pacific, 22% Maori HbA1c Value Cholesterol level % on Statins

14. CMDHB Potentially Avoidable Hospitalisations 1997-2005 All ages

15. CMDHB Potentially Avoidable Hospitalisations 1997-2005 Children 0-14

16. Life Expectancy at Birth 1996-2004

17. Where To Now? • Challenge the way we’re working • Maintain a sense of urgency to deliver on our most important priorities • Maximise opportunities for national, regional and local collaboration and service planning • Continue the focus on reducing inequalities • Enable innovative approaches & a shared learning environment Shared Sector Vision & Achievements