Supporting Healthy, Thriving Communities. That’s the Bay of Plenty District Health Board’s Mission.
The Bay of Plenty District Health Board is on an evolutionary journey to reach their next level of potential. The Tauranga, New Zealand-based organisation aspires to be the best they can be as a “living, breathing, growing organisation,” and as such, is rethinking the way healthcare organisations can meet operational challenges while riding the waves of change.
One of 20 DHBs in the country, BOPDHB serves a population of approximately 240,000 for the major population centres of Tauranga, Katikati, Te Puke, Whakatāne, Kawerau, and Ōpōtiki. Demographically speaking, 32 per cent of those in the district are aged 25 or younger, residents over 65 make up 19 per cent and are expected to grow to 24 per cent in the next five years. A quarter of the population are native New Zealanders (Māori) with 18 Iwi (tribal groups) in the district.
Compared to other regions of New Zealand, the residents of the Bay of Plenty area have better health, and in general, good access to health and disability support services. BOPDHB’s drive to provide excellence in care is fuelled by innovations in the way they conceptualise and create new approaches to service.
Pete Chandler is both the BOPDHB’s Chief Operating Officer and the Executive Lead of the BOP Health System Evolution. As such, he has a unique perspective on the changes necessary to ensure that BOPDHB will exist to care for the health and wellbeing of the area’s people for generations to come.
Three years ago, the DHB set out to identify areas of advancement and found four significant areas of focus that were important to address. “Our first one was Māori health, then developing our organisational culture, starting to address aspirations around a more connected healthcare system, and rethinking our approach to clinical governance and quality,” he explained.
“We've worked in each of those areas and laid some new foundations. During that time, we realised that our world is changing rapidly in many ways. Not just a demographic change and population growth, but also when it comes to the expectations of what patients are looking for out of their healthcare system along with our changing workforce expectations too. With pressures on all fronts we determined we couldn't keep working as we had in the past and we needed to rethink how we operate as an organization. We've called this exploration work ‘charting a course to our next level’ because essentially it's a journey of discovery.”
That passage set Chandler and his teams on a listening tour, asking the community and members from all aspects of the organisation four key questions. “How are we doing through your view of the world? What's the most important thing you think we should be focusing on? What gets in our way from achieving our full potential together? What are things that we should stop doing or do differently to make life easier?
“It's been thrilling,” he revealed. “To have the time to ask those questions and really listen to what people say has given us gold. They've given us their honest and true feelings about what they love, what restrains them, what holds them back, and they're giving that through stories of lived experiences.
“We heard from managers and leaders that you often don't get the time — or maybe we just don't make the time — to truly hear, looking deeply into the heart of the organisation to know where we are here in 2019, not where we think we might be. We've got a set of goals from that which has given us probably years worth of things to focus on. We've had to distill that down to find the next steps for us. It's been a pretty awesome way to discover.
“That journey resulted in a new, sharper focus on specific changes we want to make in how we provide care as part of our integrated healthcare strategy. We are commencing a comprehensive redesign of our mental health and addiction system across multiple service providers across the Bay of Plenty, bringing together multi-sectional services involved in child health and wellbeing, and our business redesign includes systems, processes, and IT solutions. We've got a much broader view of the components of what we want our business to look and feel like, and what our people are looking for in the new world of work,” Chandler noted.
Leading an Evolution of Heart and Mind
The BOPDHB is deeply committed to reducing the disparity in health status between Māori and non-Māori populations. Said Chandler, “We need to be creative in how we design the health system of the future and maybe sometimes put aside what we think we know as managers and leaders, and actually go and ask some questions.
“We assume older people will struggle with technology if we develop telehealth in rural communities, but actually it is often older people that are asking us, ‘Please can I have my appointment on Skype or FaceTime? It’s just too hard for me to get to your hospital,’” he said.
“Māori have a very different view of health and wellbeing, which in many aspects is far more aligned to what we hear in our wider patient populations with an increasing shift away from traditional medical models of healthcare. ‘Treat me as a person, not a diagnosis. It's not all about your whole hospital system and your appointments. Actually hear me as a person. See me as the unique individual I am, and take the time to understand my needs,’” he stressed.
The district is bringing together the skills and abilities of their clinical workforce with the indigenous wisdom and aspirations of Māori communities to work together and create a new future.”
BOPDHB has an excellent track record of improvement and quality performance. Over the last two years significant achievements have been made in the development of ambulatory acute models of care, which means that bed numbers have not increased in 10 years, despite very significant activity growth. These successes are motivators for their drive to take “a fresh … evolutionary approach” to the next phase of transformation.
“Our system performs well. But that depends on how you're measuring and assessing it,” Chandler admitted. “We tend to measure success on things that the system of the day prioritises. Whilst these are usually sound and important, they don’t always connect with what our communities, especially rural and Maori communities, see as their priorities.
“As we move forward in a changing world we need to be asking ourselves questions that go beyond traditional performance indicators. How do our people feel about working for us in this thing we've called our organisation? How did our community see us? Are they seeing that we're working with them or doing (things) to them? What real things can we do to make a difference where something isn't necessarily measured as a target for improvement or a marker for success in normal terms, but can make a huge difference in the community?
“What we have in our health system is something that originated in a different age for a different context, and it's very hard to change that but an imperative that we do.” BOPDHB found that doing better by trying harder within the same paradigm may not be the first, best approach to change.
He pointed to “did not arrive” (DNA) rates for hospital appointment attendance. “It can be difficult for people in rural communities, particularly if poverty is an aspect in that community, where there's no public transport; people might not have access to a car, communication might be difficult … in those cases trying harder to remind people to attend doesn't help. It doesn't fix things.
“We've realised we need to do it differently and are trialling taking some specific outpatient clinics out into our rural communities, working with willing hospital staff who were prepared to travel and hold clinics in the heart of a small community. From a 30 to 40 per cent DNA rate at the hospital we've moved close to 100 per cent attendance rate,” he said. “These may only affect small numbers of people and don't show in statistics, but they make a huge difference for those who previously struggled to access the care they needed and are some of the things we can do differently that perhaps matter the most.”