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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;
• High level future state developed during the Gemba three day workshop for people in South Taranaki.
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 itWe designed a future state around four elements;• Prevention and screening• Assessment, triage, emergency• Diagnostics & specialist assessment • Treatment rehab and follow up
Prevention and screening
Integrated Care Centre
•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
•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
Investigate delivery models in other similar areas
•Database•Back office functions
Recalls Admin / clinical Scheduling•Focus on Targets through joint planning
Main aim:•Screening•Prevention•Early intervention
Utilise existing & effective
initiatives/programmes & enhance them
Available daily•Bookings•Records•Meds•Results•IBA•Radiology
Prime2-tier transfer system
Bypass protocolTransit lounge
Appropriate staffing
Procedural
24/7A & M plus
Base hospitalDental health
A&D
Does this need to be open during working hours?
Must have I2 lead ability combined with TK4 until St John have training, equipment & funding to do this
1⁰ facilityCo-paymentsVoucher system / LCF fee
24/7
Dr on sit
e – 0800 2200
Dr on call –
2200 0800
Healthline
F2F / Phone
111 Community/Kai awhinaTriage
Protocol-
driven transfe
r
(non-doctor)
On call (dedicated South Taranaki)Crisis MH on call & support
Security Mental health help line
Assessment, triage, emergency
Diagnostics & specialist assessment
All together-Pooling resources- One IT Site critical
All together-Pooling resources- One IT Site critical
Orientation•Where in Hawera <->Base?
•Health professional•Patient
•Navigator•Community
Mobile•Echo? (car, lease
clinic, increased FTE)•Lab screening
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
Radiology• Easier accessibility
•Onsite U/S - plain film•Mobile U/S?
•Mobile CT / MRI (future)
Everyone together
Labs•Onsite 8-5 (already there)
•Collection•POCT (after 1pm weekends)
•Reduction in staffing cost
Main Requirements•Recruitment•Retention•Training
Main Requirements•Recruitment•Retention•Training
FSA
Treatment rehab and follow upHawera Health Base (South Heath Integrated)
Community Team
Rehabilitation/Intermediary Care(@ home or residential care)
Day Procedure Unit •Nurse lead•Blood transfusion•Ex ECGs
OP clinics – increase
Oral health
Mental health•Up skill to crisis trained
Public Health
Diagnostic primary•Paeds•Respiratory•Diabetes
Daytime Crisis Team•1x member South Gen Team •1x staff CPT (to cover general)•After Hours Crisis Team•Rostered staff (x2) based in Stratford
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
Maternity (currently
under review)
Minor procedures: bumps, scopes, local anesthetics,
Mobile bus – enhance
Complex care managers
A&M•Observation/assessment beds
(numbers ?)
GPs
Psychiatric nurse within Intermediary Care team
Maori Advocacy •Support?•Intervention?
Need to be linked to screening / preventionearly intervention
Need a central hub
Common themes• Mobile services
• Central hub and spoke
• Pooling resources
• One IT site/system
• Building single team focus
• Recruitment, retention, training
Key Enablers• Transport• Policy & Governance• IT – shared information• Funding• Workforce• Health literacy/education• Facilities
• Meet with Hawera Hospital staff
• Meet with GPs• Develop proposal• Community
consultation
Where to from here?
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