Taumarunui integrated health care model

Meeting the needs of the north Ruapehu district is a priority for the Waikato District Health Board.

The north Ruapehu district includes Taumarunui town (where Taumarunui Hospital is located) and the wider rural communities, south as far as Mt Ruapehu.

What is the integrated health care model?

The purpose of the model is to:

  1. Engage collaboratively to provide integrated care for our people
  2. Make the best use of valuable health resources
  3. Work together around common goals.

General principles:

  • Every door is the right door
  • The right care provided at the right place by the right person at the right time
  • Reduce health inequalities
  • Collaboration and integration
  • Best use of health care workforce

The episodes of care of particular interest are:

  • Planned discharge date
  • Joined up care planning
  • Pathways for commonalities

Background - the challenges

Taumarunui integrated health care modelFactors influencing the vulnerability of heath service delivery in the Taumarunui district are:

  • An ageing workforce
  • Difficulties in attracting and retaining a healthcare workforce
  • Increasing demands for services
  • Increasingly fragmented services which are inefficient and waste resource
  • High inter hospital transfer rates.

Taumarunui is geographically isolated, has an ageing population, a high proportion of Maori and a high proportion of people living in low socio-economic areas. In the past there has been a lack of general practitioners within the area, forcing a reliance on the hospital as the provider of primary and low level secondary care.

A report commissioned in 2011 indicated that an appropriate vision for Taumarunui was that of integrated and co-located workforces.

Taumarunui integrated health care modelA three-day workshop held in Taumarunui in June 2012 involved a number of interested parties who agreed to develop a comprehensive local health plan to ensure local services were aware of what each was doing in the community and how they could work together in a more sustainable way.

The workshop agreed on the following key points:

  • The solution(s) must work for all people in the Taumarunui district community
  • Barriers to access are reduced or eliminated where possible
  • An integrated model is preferred which works across all providers
  • A solutions focus is the approach to moving forward
  • ‘No door is the wrong door’ approach in accessing services or care.

Taumarunui integrated health care modelStrong feedback was received that there was a need to work differently, however the option of a single employer and / or a combined workforce and the option to locate services physically together were not supported.

Building trust within the community and goodwill to work together is our key requirement; therefore the option of a single workforce and co-locating services has been set aside in favour of a fully integrated model.

Governance and workstreams

Following the 2012 workshop a governance group was established to oversee the work and the journey towards integration.

The governance group comprises representatives of local providers, the mayor and local councillors, and Waikato DHB, and other co-opted members as appropriate.

The work streams established are:

  • Service integration
  • Tele medicine links
  • Workforce
  • Data integrity
  • Local directory / communications
  • Midwifery
  • Transport

Where we are at

1 Year AgoBy (mid 2013)Current & Beyond
  • Poor understanding of the current local services available.
  • Lack of interaction between key health providers.
  • Lack of understanding of services, roles and responsibilities.
  • No existing systems or processes to support integration across health services / providers.
  • No integrated care planning across health services that are working with the same individuals and whanau.
  • Lack of understanding / general knowledge about Whanau Ora.
  • Added value that each service can provide not recognised or utilised to potential.
  • Workstream project manager in place.
  • Service directory - paper and electronic copies.
  • Integrated Health Workforce & Services Group.
  • Established relationship between hospital, community, pharmacy and other key health providers.
  • Improved understanding between providers about what they provide.
  • Two integrated pathways developed - Respiratory and Pharmacy.
  • First integrated training session planned.
  • Developing multidisciplinary environment.
  • GPs and hospital doctors meeting.
  • Emerging referral process to improve patient experience / journey.
  • Web based directory.
  • Joined up IT systems as and when available.
  • Generic patient pathway between key services.
  • Reduced ED / acute presentations.
  • Multidisciplinary shared care planning for complex patients.
  • Agreed referral processes between services.
  • Annual training calendar for all local providers.
  • Integrated orientation / induction programme across services / providers.
  • Local initiatives to attract workforce to the area / joint appointments.
  • Integrated care pathways across health and social services.

Update to the board

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