Abstract
This report was commissioned of Centre for Health Systems, Department of Preventive and Social Medicine, University of Otago by Ko Awatea Counties Manukau Health, Health New Zealand.
This report is an independent evaluation of a quality improvement initiative undertaken by Counties Manukau Health. The objectives of this report are to establish if improvement within the Counties Manukau healthcare system as a consequence of the initiative was evident, how any improvement was accomplished, and if any gaps remained. Three aspects of quality improvement were examined: Counties Manukau’s System Level Measures, the establishment of comparisons and gold standards for these measures; and a case study of healthcare organisations recognised for their work on quality improvement. A modified case study method was used to examine these.
Counties Manukau Health’s population and funding context is a significantly challenging one, requiring it to embark on an ambitious quality improvement response. It is clear from our findings that Counties Manukau Health has developed the cultural and quality improvement science approaches necessary to operate a quality improvement initiative largely in accordance with international best practice. It set ambitious targets and is the best performing of all its international comparators on three of its fifteen System Level Measures, is ahead of its peers on two of the fifteen, comparable on four, and is focusing improvement on five (one was unable to be compared).
Overall the findings indicate that Counties Manukau Health:
• has largely put in place the organisational and operational structures needed to be successful;
• uses accepted techniques to address buy-‐in and change management;
• has clearly articulated the cultural importance of quality improvement, and has situated its work in an existing supportive staff culture;
• has invested in Ko Awatea as an educational organisation, in a quality improvement method that works towards sustainable change and in being a learning organisation;
• has recognised the need to link the emotional motivations of staff, patients and families to quality improvement;
• works with appropriate processes and technologies to support quality improvement.
In the future, Counties Manukau Health may like to:
• refine and extend the use of system level measures;
• extend the quality improvement initiative and the use of quality improvement methods, including system level measures, into the wider social sector;
• ensure the quality improvement initiative addresses its own sustainability;
• ensure learning and innovation remain priorities.
Healthcare measurement is difficult because there is no universal method of comparison. As such, this evaluation is unable to determine if the goal set by Counties Manukau Health’s Chief Executive of being the best healthcare system in Australasia by December 2015 has been achieved. However, Counties Manukau Health has clearly put in place many of the strategies suggested by international best practice as being necessary to achieve such a goal. In this regard, we can confidently say that Counties Manukau Health is a leader, and one of the best at getting better.