Improving care across services

20 November 2017

On Thursday, I joined the team working with Manaaki Tairāwhiti, looking at the system and process issues we have providing care for people in our district. By care, I mean across the whole health and social sector, not just in Government agencies.

We have the assistance of two highly experienced process coaches from the State Services Commission. They are working with representatives from Government agencies, NGOs and iwi authorities to process map the actual encounters of people using systems.

The team are documenting the steps to find common ways in which we can improve the experience for people – both those seeking and providing support – and identify where we can work smarter.

Hauora Tairāwhiti is represented in this process by Judi Murphy. Judi has considerable experience working to streamline processes, most recently with the Maternity Clinical Information System.

Manaaki Tairāwhiti members have been invited to see first-hand what the team members have been seeing. This is so that when reports and recommendations are generated at the end of the 10-week process, we will be more cognisant of the points being made.

On Thursday I started the day with the Social Work Team as they prepared to review the previous 24-hour ds of Emergency Department (ED) presentations. The Team are looking for further actions for children, elderly and those that would benefit from referral to the joint triage process in the community. We then spent time in ED cross-referencing and ensuring appropriate referrals had been made, augmenting the work the ED staff do and acknowledging the pace of care required in ED may prevent additional referral areas.

Next was a visit to the daily Triage meeting held with representatives of the Police Whangaia Ngā Pā Harakeke team and various community agencies including Corrections, ACC and iwi providers. The principal focus is to look at Police callouts in the previous 24 hours. The focus is on ensuring there is full background information so the best possible support is in place to prevent further instances.

Of late health has not been a part of this process and we are considering how we can once again join in, so we can contribute to more effective participation

Next, I travelled to the Work and Income office where I observed a member of staff with one of their clients discussing updates on his allowance. I was grateful to both people for allowing me to observe and to go even further by asking questions. Even in that one observation, I could see the parallels necessary with health.

Finally, I spent an instructive and constructive hour at the base for this initiative - Gisborne Police Station. For each process area, the team have observed they are developing a summary of the findings and then producing a map of the integrated way in which we work in Tairāwhiti – or more importantly, the lack of integration on many occasions.

The impact on people requiring services is usually lower effectiveness, confusion and frustration, resulting in poor outcomes and re-working - all things that have no benefits whatsoever.

I am looking forward to what the findings from the first 10 weeks of study will be. I want to see actions that can be put in place and I know there will be a call for a sustained process, as it is unlikely all the learnings can be generated from a short piece of work on systems that have been in place for many years.


I will bring the conclusions and actions to you as they will be relevant for us all.

I a tātau e mahi pai ana, ka whai painga tātau katoa. Have a good week everyone.