Canterbury District Health Board (DHB) is a high-performing health care organisation that has focused its quality improvement work on integrating health and social care to tackle growing demand for hospital care from an ageing population.
The board serves just over 500,000 people and delivers care through 9,000 staff employed across a range of hospital, community, and primary care providers. While working within a framework set by the Minister of Health in Wellington, the DHB has greater freedom in how it uses its resources than NHS organisations typically have. The majority of the DHB’s members are elected locally, with a minority appointed by the minister.
Why did it take this approach?
Canterbury decided to focus on integrating health and social care because of concern that unless action was taken to stem growing demand for hospital care, increased hospital capacity would be needed, which was not affordable. The DHB’s leaders responded by developing a vision for the future based on the notion that there was ‘one system, one budget’, and that all those involved in the system needed to work together to improve care. This resulted in a commitment to build on the strengths of primary care in Canterbury and, particularly, to invest in services that would help avoid hospital admissions and facilitate early discharge where appropriate. These and many other initiatives enabled the DHB to stem the increase in hospital use. They also helped the system cope with the effects of the 2011 earthquake, which destroyed some of the hospital capacity in Christchurch.
Investing in staff
These results were achieved through sustained investment in providing staff and organisations under contract with the DHB with the skills needed to improve care and develop innovative models of provision. Training was provided for more than 1,000 staff in quality improvement methods such as Lean and Six Sigma. Arrangements were also made for some staff to visit other organisations that had used these methods (such as Air New Zealand and New Zealand Post). The training and visits proved important in building momentum and staff commitment to make the changes needed. Experts in process engineering were also engaged to support clinicians and managers to redesign care pathways and work flows in order to cut waste and improve performance.
The benefits of organisational stability
Canterbury’s improvement journey also benefited from organisational stability and continuity of leadership. The DHB’s achievements were recognised in a report from the New Zealand Auditor-General in 2013, which rated Canterbury’s management control for the previous financial year as ‘very good’ – one of only two district health boards to receive this top rating. Its financial information systems were described as good (no other health board did better), while Canterbury became the only health board, and one of only four per cent of all New Zealand public bodies, to be judged to have ‘very good’ service performance information.