Category: Health

Source: Health Quality and Safety Commission – Press Release/Statement:

Headline: Dr Lynne Maher on co-design

Partners in Care

Dr Lynne Maher presented at the Health Quality & Safety Commission’s Let’s talk forum on 8 March 2018. Lynne is the Director of Innovation at Ko Awatea, Counties Manukau Health, Honorary Associate Professor of Nursing at the University of Auckland, and has led the co-design movement across New Zealand.

She began by asking the audience how many people had ever accessed the health service for themselves or their families – not surprisingly, everybody in the room had. She then asked how many people would describe their experiences as ‘excellent service’? Only about ten people in the room put their hands up. Lynne saw this as an opportunity to learn about integrating the voice of consumers into the design of improved services.

“The response of consumers is a key component of co-design, to create a feedback loop for the design and development of health services,” she said.

“Generally, when consumer voices are integrated into the design of health services, research has shown a number of benefits. For example, patients are more able to take their medications correctly and feel more confident and empowered in their own health care management, which can reduce access to health care services.”

She said that when considering co-design, many mainly focus on working with patients and families. However, co-design is actually about working with everybody who is involved in or impacted by the health care process.

“It is important to understand staff perspective and there is a significant amount of research that demonstrates when staff feel fulfilled and able to work in a positive way, this translates into patients and family/whānau having a more positive experience.”

What is co-design?

Co-design is a process where a challenge or an opportunity is identified. A range of people who have experience and expertise in delivering or receiving services are engaged. The experiences they have are shared and captured with specific attention to how they feel at each step and any ideas they may have for improvement.

We are also capturing consumer experiences that may not have been good. We are gathering ideas for improvement, asking those intricately involved in the care: “How did it make you feel?” and also what ideas they have to improve the service.

Co-design enables us to:

• explore experiences, which helps us to better understand the root cause of the problem – people feel more engaged with the solution if they understand the problem
• engage and build partnerships between staff and consumers from the start
• better utilise all of the expertise available to us, especially from consumers and staff.

Lynne emphasised the importance of considering appropriate combinations of tools to capture experiences. Surveys provide excellent high-level understanding. This can be enhanced by even a short face-to-face discussion which provides much more depth about the experience.

“This storytelling also be very cathartic – people like to feel listened to – it can be therapeutic for patients to tell their story to get it off their chest and feel heard.”

She said capturing the evocative emotions from interviews with patients was key and could reveal subtexts.

In co-design, we are particularly listening for words that depict emotion: ‘In reception I was scared, but by the time the nurse came to talk to me I felt more comfortable’.

The data we capture helps us to map the care journey from multiple perspectives.

“The maps visually represent the story.

“Co-design is about turning experience into action and this results in improvement. It helps to draw out what is happening.”

She said this is a positive way to enable healing and build confidence and competence in health care services.

“Co-design helps to create a health service that can truly be known as world class.”

The Commission is committed to using co-design; a tool which is integral to its programmes.

You can find out more about co-design here: www.hqsc.govt.nz/partners-in-care/work-programmes/co-design/.

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Source: Health Quality and Safety Commission – Press Release/Statement:

Headline: The ripple effect

Partners in Care

Ngāti Kahu Ki Whaingaroa, Te Aitanga-a-Māhaki

Te Rina Ruru’s life changed the morning her brother Ray had a car accident which left him with a traumatic brain injury. She was 16 at the time and struggled to cope. Te Rina shared her story at the Health Quality & Safety Commission’s Let’s talk forum on 8–9 March in Wellington.

“I remember walking into the hospital, the corridors were dark and there was a sense of foreboding in the air. Our beautiful brother lay peacefully in a silent room. We didn’t understand what the doctor was talking about. To us he looked perfect. Despite what he looked like on the outside, the real injury was inside,” recalls Te Rina.

“They called it a traumatic brain injury, but no one sat us down and explained what that meant.”

The family had no idea what to expect in the coming months; Ray spent three months in hospital and five months in rehabilitation.

At the rehabilitation unit, the whānau didn’t want to leave Ray alone, as he had been hit by other patients in the night and left too long without basic cares. So they juggled their lives, from work and studying to child care and being with Ray at the centre. However, there were real concerns about their own safety from other patients who would be physically and sexually abusive towards them when they visited. The whānau were left to manage alone so they made the difficult decision to take Ray home.

Home brought new and unforeseen challenges. Ray is a 6’3” 120 kg wheel-chair bound, non-verbal man. He slept in the lounge and her mother in a Lay-Z-Boy beside him, with her sister and two children in one room and Te Rina in the other. They shared Ray’s 24/7 care, with various home-based support workers coming into help.

Te Rina says her mother was under immense pressure; while worrying about her son, she was also trying to keep the family afloat, trying to maintain the mortgage payments, feed the whānau, support them and navigate the health system.

They were labelled ‘a difficult family’ because they demanded a high standard of care for Ray.

“Was it too much to ask,” says Te Rina “to ask for care workers to be trained in washing and caring for my brother and for counselling support for the children and my mother?”

The family’s focus shifted to Ray’s needs and as a result everyone’s lives were impacted. They all tried to carry on, but were struggling under the pressure.

After the accident everything changed. Her brother was her biggest support and suddenly she had to be his – it was like the floor had been pulled out from beneath her.

Te Rina struggled under the pressure and turned to self-harm as a way to cope.

“One night it got really bad – I was home alone and all I could do was think, my brother was different, my mother was different, I felt so alone. I walked into the kitchen, opened the draw and grabbed the biggest butcher knife I could. I was drenched in blood on the kitchen floor. I knew I couldn’t do anything else… I knew I couldn’t do that to my family, they had been through enough.”

Instead, her response has been to learn as much as she can about the health system, even going to university to study.

She has also become an advocate for whānau going through the impact of living with a family member’s trauma. Her family established the Brain Injury Support Network to support family/whānau going through similar trauma, and started a new initiative, Camp Unity for children and young people working through trauma and low self-esteem to build healing communities.

Te Rina’s dedication to her brother and whānau shows through the ongoing care of her brother at home. Her plea is for more support for family/whānau as they are adjusting to their loved one being a changed person with new and challenging demands, which are not just emotional, but can significantly change the dynamic of the family through the ongoing dedication of time, resources, 24/7 availability and care.

As a family they didn’t get counselling or advice on how to help each other or the larger whānau network.

“Ray’s daughter would visit every fortnight and one day my mum and I were sitting talking to her about how we could all go camping,” says Te Rina.

“I looked down and saw scars on her arms and legs.”

Te Rina had many thoughts racing through her head: ’has my beautiful niece been going through this alone?’ ‘Is this my fault?’ “I felt like our world was shattered again.”
It took Te Rina a while to realise she wasn’t that 16-year-old any more. Over the last ten years she has met many children who were self-harming. There were so many other families and so many other children who were or still are battling with the same challenges.

This led her to establish Camp Unity, alongside friend and counsellor Char Rain, to support children and young people experiencing self-harm and trauma.

Te Rina talks about ‘the ripple effect’.

“People don’t really talk about the ripple effect, the effect of trauma across the whole whānau, like the ripples in a pond. This was the inspiration to create Camp Unity which brings vulnerable children together in a safe and secure environment where they are free to be themselves.

They have made it their mission to empower every child to have a voice. Camp Unity develops strength and unity and forms healthy relationships, teaching children to understand their individuality and develop their self-worth.

“They arrived broken, they were totally different, and now they can’t wait for the next camp.”

Te Rina challenged delegates at the forum to think about the consumers and family/whānau going through their services right now. She asked “What can you do to alleviate some of the burdens of the health system right now so that, instead of fighting the health system they can heal with each other?”

She ended to a standing ovation.

More information about the Brain Injury Support Network and Camp Unity is available at www.facebook.com/NZBrainInjurySupportNetwork and www.facebook.com/CampUnity01.

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Source: Health Quality and Safety Commission – Press Release/Statement:

Headline: A day in the life of the Toiora exercise class

Primary Care

Many elements combined make the Toiora exercise class for people with diabetes an excellent example of the Whakakotahi primary care improvement challenge in action.

Above all, the core element has been the community of people who have come together to co-design the class and take part over its inaugural 12 weeks.

Named after the healthy lifestyle component of Tā Mason Durie’s model for health promotion, Toiora was co-designed by Te Kete Hauora – the patient advisory group developed by Hutt Union & Community Health Service’s (HUCHS) Whakakotahi project team – and is led by Colleen Dunne, a Hutt Valley DHB physiotherapist, along with Te Kete Hauora members Patria Tamaka, Hine Chase and Mere Te Paki.

Dunne brings her physiotherapy expertise to Toiora, encouraging the group to push themselves without exceeding their own limits or causing injury as they do a combination of aerobic, resistance, balance and flexibility exercises. The exercise programme aligns with the American College of Sports Medicine (ACSM) guidelines for physical activity for Type 2 diabetes, Diabetes New Zealand and the Ministry of Health Quality Standards for Diabetes Care Toolkit 2014.

All participants were required to receive medical clearance before beginning the class and on commencement were provided with an information sheet on physical activity benefits and precautions, a home exercise programme, physical activity recording sheet and a Toiora t-shirt.

HUCHS manager Sally Nicholl says one of the points of difference with Toiora was that no-one went into the group cold. “Everyone knew someone else there, whether it was a member of the HUCHS team or a family member, and people would travel together to the class.

“There were pre-existing relationships to build on, whereas if we had done this ‘normally’ we would have been advertising via Facebook and promotion in the HUCHS waiting room. We might have got the numbers but I don’t think we would have had the retention that we’ve had.”

Through the co-design element feedback from the group was gathered week by week, class by class, so that the class could change as it progressed. Before classes began there was also a pre-assessment and interviews to openly address personal goals and any concerns.

Some snippets from an interim summary of feedback included:

• “It’s good to be in a group knowing that everyone’s on the same journey – kia ora.”
• “(I) memorised parts of the class to be able to do some at home.”
• “Music this week a bit too fast to catch up – good mixture would be good and a bit slow, to cater for older people.”
• “Takes my breath away, ka pai.”
• “Great camaraderie.”
• “Getting harder but loving it.”
• “Not so puffed today.”
• “Woohoo!!!”

And the longest comment: “The combined approach from the multidisciplinary team/nurses/community/management has been an amazing help in managing my chronic disease. I think this has to be the approach despite the resource heaviness or demand. I don’t think it (would) be successful with a solo clinician.”

As Colleen Dunne says: “Numbers matter when they translate into a better quality of life”. She is passionate about the approach used in Toiora.

“This has been a perfect marriage between evidence-based practice and community facilitation of self-management through a support group.

“The main ingredients are education, recognition and reassurance on concerns and goals, demonstration and empowerment in (group members’) ability to adapt management to their individual needs.

“Chronic illness exercise classes are not a new thing but it’s the practicalities of the individuals and what they want to do that really helps them to keep going. Those practicalities are just as relevant as the statistics and theories.”

“There’s no doubt an exercise prescription for a patient population is different. You have to consider what other things people might have going on, including in terms of comorbidities.

“We already know that the trends in exercise, and diet, in chronic health demographics have been poor. Collaboration between patient, health, government and community is a must and I think it should be easy to achieve.

“We have the community leisure facilities, we have instructors, we have health care practitioners who can and do share their knowledge, we have community nurses who can monitor progress and who have patients who can take part. I believe we just need more cohesion between these public systems and people with the passion to drive it.”

Colleen says the Toiora participants started to connect the classes to results when they began to see objective changes to their blood sugar levels pre and post class, and noticing they were able to participate for longer throughout the class.

“It’s been great that lots of the group have been doing the exercises at home too and carrying this into their day-to-day lives with whānau, fono and family. It was a toss-up between varying the exercises each week to keep it interesting, versus sticking to a template. I opted to keep it quite similar so people could hopefully pick up the habit.

“Group members were integral to decisions such as the timing of a long break over the Christmas/New Year, the types of exercises completed, designing the t-shirts and choosing the music.

“They really were the masters of their own destiny when it came to our weekly sessions. The regular recording and acknowledgement of feedback and responses to this on a weekly basis gave participants added confidence and trust (in the process) and ensured the class was something they enjoyed.

“In terms of my own practice I’m now convinced that providing written feedback will be something I continue with all my patients to provide back to me. It did seem like a hassle at first when there are other clinical duties, but the all-round benefits and input into shaping future ideas are absolutely worth it.”

Colleen moved from Ireland to New Zealand five years ago, and having a father with diabetes has given her additional insights.

“My dad knows all about Toiora and he messages me from Ireland to ask how it’s going.

“My wish would be for all diabetics to be given a wristband activity tracker in addition to the blood sugar monitors they currently receive. Exercise tracking would provide objective and relevant prognostic information and makes it easier for patients to monitor and comply with an exercise programme. We need to throw everything at this.”

This prompted a conversation about breakfast choices, accommodating preferences (a marmite versus vegemite debate ensued!), the importance of regular eating through the day and not skipping meals, and drinks and snacks. One of the shared messages was to avoid the mindset of being “on a diet”, which can create feelings of restriction and deprivation.

What next for this Whakakotahi initiative?

With the completion of the cycle of 12 sessions, the next steps for Toiora include a collective debrief and the opportunity for group members to continue co-designing and planning a future path. There will also be an evaluation undertaken by an external team.

Ideas under consideration include continuing with the group for a longer period and starting a new class with new participants at HUCHS’ other clinic in Petone.

HUCHS manager Sally Nicholls highlighted another possible direction.

“An inspiring idea raised within the group has been the idea of mentoring, and that’s new. They were saying ‘we could bring along new people and be their support people’. Imagine if that happened and everyone involved brought along two new people.”

Mere Te Paki, HUCHS community health worker, is clear on the kaupapa of any further Toiora work.

“It needs to be owned by the community. It’s about strengthening relationships.”

These ideas showcase the beauty of co-designed quality improvement initiatives that are community-based, consumer-centred and that exercise the power of word-of-mouth promotion. Consumer engagement that works.

A story in pictures

 

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Source: Health Quality and Safety Commission – Press Release/Statement:

Headline: Call for nominations for two members to join the Child and Youth Mortality Review Committee

Child & Youth Mortality Review Committee

The Health Quality & Safety Commission Board is seeking two members to join the Child and Youth Mortality Review Committee.

Nominations close at 5pm on Monday, 9 April 2018

The Child and Youth Mortality Review Committee is a mortality review committee established under Section 59e of the New Zealand Public Health and Disability Act 2000. The Committee is required to review and report on child and youth mortality and morbidity from 28 days up to 25 years as directed by the Commission Board, for the purposes of improving care quality and safety, and saving lives.

Collectively, the committee will have the following expertise:

• One member will have relevant consumer experience and will provide a consumer perspective and be well networked to consumer groups.

The other members will have expertise which includes:

• knowledge of mortality review systems
• knowledge of issues affecting children and youth
• knowledge and /or experience of the impact these mortalities have on families/whānau
• knowledge of epidemiology, research and health systems
• cultural expertise.

There are currently two positions available. The Commission welcomes all applications from interested parties, including community paediatricians, particularly those who offer experience in some of the following areas:

• child and youth expertise
• Māori, Pacific peoples and immigrant populations cultural expertise
• an interest in youth mental health and suicide
• injury prevention research expertise
• knowledge of developmental paediatrics.

The member will:

• work strategically
• have credibility in relevant communities
• be drawn from a range of disciplines and contexts including people representing Māori and Pacific peoples’ interests.

The member will also have:

• wide professional or cultural networks
• strong personal integrity and ethical behaviour
• commitment to the issues at the heart of the Committee’s business
• critical appraisal skills
• highly developed written and oral skills
• broad life experience
• respect of peers
• appropriate clinical or professional experience
• the ability to engage with the other members of the Committee and contribute constructively.

If you would like to nominate any suitable candidates, please email Dez McCormack.

If you would like to apply directly, without nomination, please complete the application form and provide your current curriculum vitae by email to Dez McCormack.

Nominations close on Monday 9 April 2018 at 5pm.

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Source: Health Quality and Safety Commission – Press Release/Statement:

Headline: Expressions of Interest: Consumer representative for the Mental Health and Addiction Quality Improvement Programme Leadership Group

Mental Health & Addiction Quality Improvement

Do you want to use your own mental health and/or addiction experience to work with the Health Quality & Safety Commission? 

We are seeking expressions of interest for the consumer position in the Commission’s Mental Health and Addiction (MHA) Quality Improvement Programme (QIP) Leadership Group. This group has a diversity of senior sector leaders as members and provides advice and direction to the Commission on this programme and its projects.

Key purpose of the Leadership Group

1. Provide sector leadership in the development and implementation of the MHA quality improvement programme and achieving improved outcomes.
2. Proactively support effective relationships between the MHA sector and the Commission.
3. Provide advice and make recommendations to the Commission that are informed by evidence and international, national and local knowledge, and focused on strategies to improve mental health and addiction services.
4. Share information that supports a national approach to MHA quality and safety improvements.
5. Foster an integrated approach to improving the quality and safety of health and disability services with other Commission programmes.

What is expected of the consumer representative role?

Members of the Leadership Group have well-established networks and the ability to consult widely. Full day face-to-face meetings are held at least quarterly in Wellington or Auckland, with occasional teleconferences at other times and decisions by e-mail, if required.

The consumer representative will:

• provide advice from a mental health and/or addiction consumer perspective, and be able to represent your own views from lived experience and represent the relevant views of your consumer community
• provide advice and review materials from the Commission’s MHA programme, working collaboratively with other LG members, and other agencies when required
• promote the work of the Commission and the Mental Health and Addiction Quality Improvement Programme with local, regional and national consumer groups and health providers
• support and promote consumer leadership capability development in the health and disability sector
• provide strategic guidance and support to enhance collaboration between consumer groups, health providers and government agencies.

Selection criteria

Candidates will be selected according to the following criteria:

• demonstrated experience as a consumer representative
• established or developing networks with local, regional and national consumer and community groups
• ability to use personal mental health and/or addiction health experiences and those of others to support better design and delivery of health and disability services
• knowledge about the mental health and addiction/disability services in New Zealand
• experience working in advisory groups
• prior knowledge/experience in co-design and/or quality improvement.

How to submit an Expression of Interest

Read and complete the attached Expression of Interest form, and email it to info@hqsc.govt.nz by 5pm Friday 23rd March 2018.

All candidates will be notified of the outcome of their Expression of Interest within one week of the closing date. Short-listed candidates will be then be offered a telephone interview and the successful candidates will be notified within a week of the telephone interview date. 

For further information please contact:
Shaun McNeil, National Consumer Engagement Advisor – Mental Health and Addiction.
shaun.mcneil@hqsc.govt.nz
04 912 0306
021 933 681

Approximate Timeline

Application closing date	5pm, Friday 23 March 2018
You will be notified by	Friday 30 March 2018
Shortlist telephone interviews during	first full week April 2018
Successful candidates chosen for recommendation to the Chair, by	Friday 13 April 2018
Orientation of successful candidates	to be advised
MHA QIP Leadership Group meetings 2018	Wednesday 30th May (29 August, 28 November)

 

 

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