‘Culture' at heart of SDHB strategy

Taking the health pulse . . . The SDHB says patient and public feedback is vital to determine how...
Taking the health pulse . . . The SDHB says patient and public feedback is vital to determine how best to be ‘‘efficient, responsive and innovative'' and deliver ‘‘high-quality, high-value health care'' given budget constraints. PHOTO: GERARD O'BRIEN
There is a misconception about the Southern District Health Board's patient feedback sessions and the board's long-term task, Commissioner Kathy Grant and the Commissioner Team write.

The ODT claimed in a recent editorial (20.2.16) that: ‘‘There will be many in the South who feel the SDHB's appointment of a UK firm, April Strategy, to run patient feedback sessions next month and help the board find its ‘vision, values, and behaviour', is too much to stomach. Most members of the public and health users would think they have made their views plain enough in recent years, without needing to hire overseas consultants to facilitate more information-gathering.''

In itself, this assertion is questionable enough: the response to the feedback sessions and online survey indicates many patients and staff do wish to share their experiences, and we are delighted to provide the opportunity for them to do so.

But behind this comment is a deeper misconception, and we would like to offer ODT readers a broader explanation of why this is important for the health services for our region. When we were appointed to govern the Southern DHB, our perspective went far beyond fixing a budget deficit.

Our task was, is, to reposition the SDHB on a sustainable footing for the long term. The SDHB has a significant challenge - to provide as much high-quality, high-value healthcare as possible with constrained resources. It needs to make each dollar go a long way, and to do this it needs to be efficient, responsive, innovative - and have a very clear idea of what our patients truly place value on. These are the fundamental elements of a high-performing health system, and cutting costs would make no long-term difference if they were not addressed.

Fortunately, we have a huge basis of evidence to draw upon. The Institute for Healthcare Improvement (www.ihi.org) and the Healthcare Advisory Board (www.advisory.com) are among the health benchmark and research groups that look at what transforms healthcare organisations' performance. Their recommendations are not new to the SDHB, with local and senior clinicians already engaging with these important, and increasingly mainstream, ideas.

These include, in (very brief) summary:

●If you focus on quality and safety you will take cost out of the system.

●In most poorly performing health systems there is considerable waste. This has financial implications for the system and time (and therefore often financial cost) for the patient.

●To take waste out of the system you must create a culture where the patient is the focus of the decision-making. In most poorly performing systems most participants believe they have the patient as their most important consideration, but their behaviour suggests otherwise.

●Placing a sustained focus on quality, safety and putting the patient first requires a strong clinical engagement culture.

●Clinical engagement in top-performing organisations occurs when there is a strong set of values that determine: expectations of each other, responsibility for both decisions and outcomes, and where clinicians drive much of the decision-making process.

Interested readers may want to look into the case studies found at www.kingsfund.org.uk, ‘‘Medical Engagement: A journey not an event'', to further understand why ‘‘culture'' sits at the very heart of our strategy.

When we started sharing our thinking within the SDHB, we were aware that this might be interpreted as in last week's ODT editorial. Instead we got almost universal nodding in agreement. We were told about issues with the internal culture, practices that did not put the patient first and the absence of agreed expectations between the various parts of the system.

It was what the literature already identified as at the core of poorly performing health systems. Little of this is malicious or intentional, but about good people working in a poor system.

The ODT editorial recognises the generally positive view that people have of our health service and that is undeniably true, and we are grateful for the many outstanding staff members who contribute to this. But our staff themselves have told us it can be better.

So the culture work is designed not to write a mission statement and go back to what we were doing before, nor is it simply a patient satisfaction survey. Rather it puts the participants of the system in the same room to discuss their expectations of each other.

We don't yet know what it will reveal; the literature suggests it will probably range from clinical and managerial staff feeling misunderstood and unsupported through to patients feeling that the system does not put them at the heart of how it is organised.

These issues directly relate to an organisation's culture and top-performing health organisations address them in order to take waste out of what they do.

So why use an overseas consultant? When we spoke with other DHBs which had embarked on a similar journey - including Auckland, Counties Manakau, Northland and Waitemata - they gave the same advice: start broad, with an organisation and community-wide engagement process and build from that. And work with Tim Keogh, of April Strategy.

They described using him to facilitate this work as the best decision they made, and the participants' feedback reinforced that. Further, his work has a strong emphasis on preparing staff to take on and continue the work - critical if we are to succeed.

Paying some air fares to get him here is the only difference from a New Zealand consultant, and he is clearly one of the best in the business. We want to do this right, and we owe it to the people of Southern New Zealand to invest properly in this process to give it the very best chance of success.

It is the alternative - failing to change our culture - that is truly ‘‘too much to stomach''.

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