From the Transformational Change panel discussion. Presented by David Grayson, Head of Otolaryngology Head & Neck Surgery, Counties Manukau Health, at HINZ 2014, 11 November 2014, 2.15pm, Plenary Room

1. Co-designing a care
connectome in a region
Dr David Grayson
Counties Manukau Digital Health Board
Date: Created by:

2. Reality check
No conflicts of interest to declare
Acknowledgements
CMH Chair and Board
CEO Geraint Martin
Director Ko Awatea Jonothan Gray
IBM Ann Hicks, Paul Grundy & Ben
Tulloch
HINZ Liz Schoff, Kim Mundell

3. Monstrous transformaciones of men into bestes be made thro
charmes of wicches. Higden 1432

4. E pluribus unum
Convergence
Digital natives
Regional interdependencies
Rapid shifts
Horizontal and vertical progress
The most interesting and powerful
thing about digital is not technology at
all. It’s mindset, attitude and culture.
Dave Briggs
WorkSmart
Source: Guardian Weekly

5. Connectome
It is not the amount of knowledge that
makes a brain. It is not even the
distribution of knowledge. It is the
interconnectedness.
James Gleick
The Information

6. Platform for change
Description: Collaborative quality improvement programmes are an
established approach for get ting results at scale. Counties Manukau Health
(CMH) in Auckland, New Zealand is building improvement capability locally,
regionally and nationally through sequential collaboratives. This emulates
the idea of the PDSA ramp and is recommended for organizations seeking
rapid large scale improvement
NATIONAL COLLABORATIVE TO PREVENT CLAB RESULTS
Run Chart
CLAB Rate per 1,000 Line Days
Period January 2012 to July 2013
Median 0.2
Learning Session 2
Median 2.3
3.5
3
2.5
2
1.5
1
0.5
0
Jan-12
Baseline
Mar-12
Feb-12
May-12
Apr-12
Jul-12
Aug-12
Jun-12
Oct-12
Sep-12
Nov-12
Jan-13
Dec- 12
Mar-13
Feb-13
May-13
Apr-13
Jul-13
Jun-13
Rate per 1,000 line days
Start Up
Jan to
March
2012
Learning Session 3
Learning Session 1
Nov 2011
Learning Session 1 – Nov 2011
BUILDING IMPROVEMENT
CAPABILITY WITH A
COLLABORATIVE RAMP
AIM: TO BUILD IMPROVEMENT CAPABILITY
WITH OUR NETWORKS AT PACE AND AT SCALE.
120
110
100
90
Notes
Analysis
6.50
6.00
5.50
5.00
4.50
David Grayson
1.050
1.000
0.950
0.900
10250
9750
9250
8750
8250
7750
7250
6750
Improvement networks curator, Ko Awatea
David.Grayson@middlemore.co.nz
@sasanof
Diana Dowdle
Delivery Manager, Ko Awatea
Diana.Dowdle@middlemore.co.nz
@DianaDowdle
Days between Dot Days
UCL = 196
Mean
Suzanne Proudfoot
(t-chart)
Projects & Campaign Manager, Ko Awatea
Suzanne.Proudfoot@middlemore.co.nz
@SuzanneFPr
Brandon Bennet t
Ko Awatea Faculty, Ko Awatea
Improvement .science@gmail.com
@BrandonB_ ISC
Actions: In 3 years CMH, through its improvement and innovation
centre, Ko Awatea, has involved 219 teams in a ramp of collaboratives
and campaigns all using the model for improvement in their work. This
supplements a number of training activities run in conjunction with the IHI
(see Ko Awatea Capability model). The focus on improvement has resulted
in the spread of improvement as a contagion through our networks.
» Bet ter patient
experience
» Decreased hospital
stay
» Reduction in patient
harm
» 10 Non consecutive
months CLAB free
» 10 -15 Lives saved
» Between $1.6 and
$2.3 million saved
» 219 teams from health, education
and social sectors trained in the
model for improvement
» 20,0 0 0 Days Campaign and Beyond
20,0 0 0 Days Campaign involved
13 and 16 collaborative teams as
‘collaboratives of collaboratives’
» 20,0 0 0 Days Campaign returned
23,0 60 well and healthy days to the
people of CMH
Mean
300
250
200
150
100
50
7.0%
6.5%
6.0%
5.5%
5.0%
4.5%
4.0%
» Beyond 20,0 0 0 Days Campaign
saved more bed days, increased
access to community based
suppor t , improved ef ciency and
reduced costs
» Target CLAB Zero reduced national
CLAB rate from 3.32/10 0 0 line days
to 0.37/10 0 0 line days
RAMP OF COLLABORATIVES
0.850
Jul 2009
Oct 2009
Jan 2010
Apr 2010
Jul 2010
Oct 2010
Jan 2011
Apr 2011
Jul 2011
Oct 2011
Jan 2012
Apr 2012
Jul 2012
Oct 2012
Jan 2013
Apr 2013
Jul 2013
Oct 2013
Jan 2014
Apr 2014
Jul 2014
Oct 2014
Occupancy Rate
9am Occupancy Rate
(Adjusted u-chart)
4.00
Jul-09
Oct-09
Jan-10
Apr-10
Jul-10
Oct-10
Jan-11
Apr-11
Jul-11
Oct-11
Jan-12
Apr-12
Jul-12
Oct-12
Jan-13
Apr-13
Jul-13
Oct-13
Jan-14
Apr-14
Jul-14
Oct-14
Days
Average Length Of Stay
(Xbar graph/XbarS)
UCL
LCL
0
29/06/2009
16/06/2010
04/08/2010
12/01/2011
01/03/2011
26/05/2011
13/06/2011
21/06/2011
15/08/2011
27/02/2012
27/06/2012
10/07/2012
23/07/2012
04/09/2012
14/09/2012
22/05/2013
03/02/2014
07/04/2014
30/07/2014
Days bewteen Dot Days
Date of Dot Day
CL = 13
LCL = 0
Norovirus outbreak and
ward 24 closed for
renovations
UCL
CL
LCL
6250
Jul 2009
Oct 2009
Jan 2010
Apr 2010
Jul 2010
Oct 2010
Jan 2011
Apr 2011
Jul 2011
Oct 2011
Jan 2012
Apr 2012
Jul 2012
Oct 2012
Jan 2013
Apr 2013
Jul 2013
Oct 2013
Jan 2014
Apr 2014
Jul 2014
Oct 2014
Total EC Presentations
Monthly EC Presentations
(growth ImR)
UCL
Mean
LCL
80
Jul 2009
Oct 2009
Jan 2010
Apr 2010
Jul 2010
Oct 2010
Jan 2011
Apr 2011
Jul 2011
Oct 2011
Jan 2012
Apr 2012
Jul 2012
Oct 2012
Jan 2013
Apr 2013
Jul 2013
Oct 2013
Jan 2014
Apr 2014
Jul 2014
Oct 2014
Average Daily Admissions
Admissions
(Xbar / XBarS)
Beyond
20,000
D
a
ys
Campaign
D
a
shboard
July
2
0
14
3.5%
Jul 2009
Oct 2009
Jan 2010
Apr 2010
Jul 2010
Oct 2010
Jan 2011
Apr 2011
Jul 2011
Oct 2011
Jan 2012
Apr 2012
Jul 2012
Oct 2012
Jan 2013
Apr 2013
Jul 2013
Oct 2013
Jan 2014
Apr 2014
Jul 2014
Oct 2014
% Patients readmitted
Readmissions
(P Chart)
UCL
LCL
WHOLE SYSTEM MEASURES
KO AWATEA CAPABILITY MODEL (WILL, IDEAS & EXECUTION)
Rate reduction from 3.32/1,000 to 0.4/1,000 line days over 22 months
RESULTS SUMMARY
@KoAwatea
@TeamHQi
“By having a bet ter
understanding about
my condition and the
suppor t I need to stay
well, I can take charge
of my own health”
Shannon and
Gina Wetere,
Patient and whaanau
“A family approach
to care ensures
bet ter outcomes
for the patient ”
Dr Jennifer
Njenga – GP
Strategy
Leadership
Capability
The transformation to a patient centric
model will require more than
technology – it requires innovation
and a shift to more open, collaborative
and integrated systems.
Madhav Ragam
IBM Asia Pacific

7. Team HQi
Building a collaborative, trusting global
network of individuals and
organisations committed to the public
good of healthcare improvement.
Combining activated, knowledgeable
patients with smart connected
networks of support helping them
help themselves.
We need to move healthcare toward
the same interoperability approach
used by Facebook, Amazon, Google,
Apple app store and most non-healthcare
industries.
John Halamka
Geekdoctor.blogspot.com

8. Keep in touch
@sasanof
@KoAwatea
@TeamHQi