December 19, 2022
A few days at Digital Health Week in Rotorua earlier this month got me thinking about the potential of NZ’s health system. Not all of It good.
As Rob Campbell pointed out during his keynote address, in many ways the health system suffers from an abundance.
An abundance of systems that don’t speak to each other, an abundance of deteriorating facilities, an abundance of sick people, an abundance of overworked and overwhelmed staff, and an abundance of process built on abundant layers of bureaucracy. Rob painted a stark picture of today’s health system leaving few people in doubt that change is needed.
That change, which started earlier this year, is the Pae Ora health reforms. Pae Ora (or Healthy Futures) is the legislative framework on which the health system will be re-oriented and, where necessary, rebuilt to support wellness before treating sickness.
A key pillar of the framework is that equity matters for everyone. Or put another way, the system will provide the greatest support where ever there is the greatest need. We see this in nature all the time. Our own bodies direct their resources to where they are most needed. Commonly this is a reactive response, a reflex. Under these new reforms, support will become increasingly proactive, taking the form of prevention by providing low-cost access to community programs delivered locally.
I attended the Equity workshop at Digital Health Week (facilitated by Alex Kemp) and heard from numerous people who had directly experienced, witnessed, and helped to address entrenched inequities that prevented people accessing care. These were small, tactical examples where local initiatives had made a huge difference in people's lives. They all had good potential.
That evening Stuart Bloomfield talked about the importance of evaluation and drawing a clear line of sight between these initiatives and the outcomes that Te Whatu Ora, Te Aka Whai Ora and Manatu Hauora are seeking. Before these initiatives can achieve their potential, they must prove their potential. Everyone has a part to play here, and it starts well in advance of evaluation. It goes all the way back to design, or more accurately, co-design.
Co-design was a major theme of the week. I attended a presentation from Sense Medical accompanied by Ben Duffus from Te Whatu Ora Hawkes Bay who championed the need for clinicians to be involved in the design of solutions that clinicians use. It made sense to me and it has clearly made a big difference to clinicians, judging by the feedback from hospital staff.
Spritely spoke about our experience of co-design as well. When we wanted to make telemonitoring easy to access and simple to use for people that had little or no experience with touchscreens, we invited people with no experience of touchscreens to co-design the product. As a result, almost anyone can use our touchscreen system for remote patient monitoring.
I heard from a whole range of other communities including the disabled, the marginalized and the isolated. The message was clear – “Involve us in the design of programs that try to help us.”
Co-design goes beyond just user experience and program delivery. I heard from St John about the importance of co-designing outcomes with Te Whatu Ora to make sure we measure the things that will support pilots to become programs that become permanent parts of the health sector.
In the short time St John’s Community Hypertension Program (known as Manaaki Mamao) has been running they have been able to demonstrate the following outcomes
1. GPs will refer their patients to a telemonitoring service run by a trusted healthcare provider
2. Maori and Pasifika patients will embrace and engage with the service
3. The service does make a positive difference to the health of patients by reducing blood pressure
St John can show that Manaaki Mamao patients experience a reduction in systolic blood pressure after 8 weeks in the program. It is known that a reduction in systolic blood pressure of 5mmHg reduces heart attack and stroke risk by 10%.
This evaluation based on co-designed outcomes shows that Manaaki Mamao is actively increasing life expectancy for Maori and Pasifika. This perfectly aligns with the goals of Pae Ora and more recently Te Pae Tata. Further evaluation of the program is planned and I look forward to sharing more about that when information becomes available.
This is what I think Stuart was referring to when he said we must draw a line of sight between the initiatives we undertake and the outcomes we want the broader health system to achieve. When we do that, we create alignment across the health sector and direct our resources to where they are most needed. Making a positive change in people’s lives by improving equity of access to healthcare.
That, in my mind is the great potential of the health system that I observed during Digital Health Week in Rotorua earlier this month. To make a change. As Rob Campbell noted, not to make a change would be a great waste of potential.