Implementing Integrated Care 29 Aug 2017 Dunedin, New Zealand

Symposium Report

Table of Contents

Introduction ...... 1 Proceedings ...... 1 Opening Remarks ...... 1 Session 1: A Brief Introduction of CHeST ...... 2 Session 2: Keynote speakers ...... 4 Session 3: Panel discussion ...... 6 Closing remarks ...... 6 Feedback ...... 7 Annex 1: Participants ...... 8 Annex 2: Symposium Programme ...... 12

Introduction The 1st annual symposium of The Centre for Health Systems and Technology (CHeST) took place at the Hunter Centre, University of Otago, Dunedin, 29 August 2017. The theme of the symposium was Implementing Integrated Care .

The conference had following objectives: • to showcase the Centre’s activities and progress • to highlight issues on implementing integrated health care in New Zealand, and • to identify research gaps and opportunities in integrated care.

Over 40 participants attended, and included academics and researchers from different centres, departments, and schools of Otago University; health authorities, managers and experts from District Health Boards (DHBs) and various non- governmental organisations.

Proceedings

Opening Remarks The opening session was addressed by Associate Professor Joanne Baxter, who welcomed all the Conference attendees on behalf of CHeST and on behalf of people of Ng āi Tahu.

Professor Robin Gauld spoke next giving a brief description of the selection of symposium theme Implementing Integrated Care, and the symposium programme. He mentioned that the symposium was a landmark event for CHeST as its first public showing after becoming an official research theme of the University of Otago. He then highlighted that today’s health system is becoming more complex, needing a multi-faceted capacity to respond. CHeST has recently been recognised as a University theme, and its intention is to address this complexity by working collectively across schools and departments in the University. He emphasised

1 that one of the focus areas of CHeST is implementing integrated care research, which is an important issue globally and nationally. By addressing the implementation question of integrated care, we bring interface between primary and secondary care, among different departments in hospitals, patients and systems. He then briefly outlined the proceeding of symposium programme.

Session 1: A Brief Introduction of CHeST The CHeST Theme Leaders, Professor Robin Gauld, Professor Tim Stokes, Associate Professor Joanne Baxter, and Associate Professor Sarah Derrett jointly presented this session.

CHeST Co-Director Professor Tim Stokes opened the presentation giving a brief overview, including the history and rationale of initiating the CHeST research theme, linkage of the research theme with the existing New Zealand Health Research Strategy, aims and key research themes of the Centre, and planned activities for coming years. He highlighted the key principles and priorities of New Zealand Health Research Strategy, explained that the strategy has a strong focus on funding and building research capacity, and how CHeST’s work aligns with the strategy. He highlighted that CheST, which is projected to grow and develop even wider connections, consists of departments and schools from both of the Otago Business School and Division of Health Sciences.

“There is a lack of research specifically aimed at translating research findings into policy and practice. Health services research, implementation research, behavioural studies, evaluation and technology assessments have received relatively little investment. New Zealand currently has limited capacities in these areas.” – New Zealand Health Strategy 2017- 2027

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“We come together within the Centre’s five broad research themes, but we are not replicating silos, these [themes] are interrelated.” – Professor Tim Stokes

Following Professor Stokes’ talk, each of the theme leaders gave a brief outline of each of the five CHeST themes. He briefly highlighted that theme health care and health service delivery focuses on evaluating new ways of delivering health services for acute and chronic health conditions across the primary-community-secondary care interface. He also described existing research projects under this theme.

Professor Robin Gauld then presented about the theme, Health System Architecture, Management, and Performance , which focuses on system design and balance, new models of care, the redesign of current models, service-specific issues, and health service specific issues, e.g. health pathways and methods for performance assessment. He gave some examples of past (and ongoing) research projects, including a scorecard for health system performance.

“We never build a house without an overall design (Architecture). The health care system frequently seems to exist without such overall design.” – Professor Robin Gauld

Associate Professor Sarah Derrett spoke about the theme Health Quality, Safety, and Community Engagement, which focuses on quality, safety, patient centred services, health and disability services, preventing adverse events and improving outcomes, and community engagement. She noted that although CHeST is located at the University of Otago, it works closely with external partners, such as the Southern District Community Health Council and Clinical Council. She gave an example of a current project focused on paediatric patient and wh ānau experiences, pathways and quality improvement strategies in Otago.

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Associate Professor Joanne Baxter gave a brief overview of the theme Health Workforce, which focuses on health workforce intelligence, equity and diversity of the health workforce, new roles and scopes of practice, and M āori health workforce development.

On behalf of Professor Stephen MacDonnell, Professor Stokes introduced the theme Health Technology which focuses on the development, deployment, adoption and use of smart informatics and analytics in health service delivery and uptake.

Session 2: Keynote speakers This session featured three keynote speakers. John MacDonald, Independent Chair, Mental Health and Addictions Network, Alliance South spoke about the Stepped Care model. His presentation Integrated Care in the Real World covered the following: • What is integrated care? • Stepped Care Model and challenges.

He underlined that the Stepped Care Model is a person-focused model of care where the whole system works as one team in a fully co-ordinated and integrated manner. The Stepped Care system helps people know where and how to get the right health services at the right time and the right place, in a stigma-free setting. He stressed that the model is intended to provide care to patients closer to their home and addresses quality of care. He highlighted that one of the biggest challenges are the ‘silos’ in the health system and lack of coordination across different providers. Additionally, a lack of trust and communication among different parts in the system, a changing DHB structure, and equitable access to people across different parts of the region are other challenges.

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Professor Marshall Chin, Richard Parrillo Family Professor of Healthcare Ethics in the Department of Medicine, University of Chicago was the second keynote speaker and gave a presentation entitled Integrated Care Models and Policies in the U.S . His presentation focused on a model of integrated care in the U.S., including the drivers (clinical and financial), examples, and challenges of integrated care.

Associate Professor Joanne Baxter, Associate Dean for M āori Health, University of Otago was the final keynote speaker and gave a presentation on Māori Health Workforce Development – impacts, challenges, and opportunities for the health sector . She highlighted that there is a smaller proportion of Māori health professionals compared to the proportion of Māori in New Zealand’s population. She said in 2010 only 4% of students across the Division of Health Sciences were Māori. The Māori Health Workforce Development Unit, led by Associate Professor Baxter, has a goal for across the Division of Health Sciences to reach 20% of the students being M āori by 2020. The Unit has a number of initiatives that are making a real difference including: the Outreach and Recruitment programme for Year 9-13 students, the Foundation Year Scholarship Programme, a Māori HSFY Support Programme, and the Māori Health Sciences Degree Support Programme. There is now an increased number of M āori students passing HSFY papers and gaining entry into Health Professional degrees compared with previous years. She also highlighted challenges to sustaining the momentum of increasing Māori student numbers, and ensuring the necessary funding supports.

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Session 3: Panel discussion Profession Robin Gauld facilitated the session and provided opportunities for the participants and speakers to discuss the issues of integrated care, research gaps, and implementation challenges. Dr Neil Houston a general practitioner from NHS Scotland, and leader of the successful Scottish primary care patient safety programme, also joined the panel members together with the keynote speakers and the CHeST theme leaders. Key issues discussed: • What are the key challenges of implementing integrated care? • What we are doing? • What are the existing research and research gaps?

The main challenges of implementing integrated care that emerged from the discussions were equity of care, the complexity of bringing different perspectives together, lack of a leadership role, and scaling up of small projects happening around the world.

Closing remarks Professor Gauld gave the closing address, thanking all the participants for their time and interest. He reiterated that the symposium was called to bring together academics and practitioners to discuss and find solutions to the challenges of implementing integrated care. He concluded with a hope to hold a further symposium in the coming year.

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Feedback We asked participants to complete an online evaluation form; a summary of the feedback is provided below. The event received an overwhelmingly positive response from participants. In particular, they appreciated bringing together researchers and practitioners, opportunities to get an overview of CHeST, networking, the range of topics offered at the symposium, discussion opportunities, and the panel discussion.

“Best. Folk attempting to spread out from the academic environment to the implementing people.”

“Bringing everyone together; getting an overview of CHeST and meeting the main investigators; getting a feel for future research opportunities.”

“The easy approach, opportunities for questions, giving a clear description of CHeST activities.”

There was also constructive criticisms provided including room layout, and need for a bigger room/larger venue, and a desire for some workshop sessions.

“You will probably have to consider a larger venue next time.”

“Some workshops for the participants to engage at the next session. Maybe a presentation then small group work also a larger room with cafe style table settings.”

Some of the topics participants thought to see included at future symposium are as below:

• Leadership – creating environments for change • More case studies of the implementation of integration • An example of the Stepped Care Model working really well and what are the elements for this? • Details about Integrated Care in action • Integration and connection of services and systems is going to be very important going forward; perhaps something on co-design? • Lean thinking and integration; supply chain management in healthcare • A planning session to consider future collaborations between CHeST streams • New Zealand examples of integrated care implementation • Scoping what is already being done in this regard from members.

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Annex 1: Participants Participant name Designation Organisation /Department Email address Contact phone/Cell 1 Michelle O’Brien Alliance Support Manager Southern DHB Michelle.O'[email protected] 03 476 9779 027 788 1118 2 Nancy T odd District Manager – Māori Southern DHB [email protected] Health Directorate [email protected] 3 David Jaggard Unit Manager Community Alcohol and [email protected] 03 476 9764 Drug Service, Southern DHB 4 Tony Braam RN Com munity Alcohol and anthony.braam @southerndhb.govt.nz 03 476 9792 Drug Service, Southern DHB 5 Louise Travers General Manager Mental Health Addictions and [email protected] 03 214 7230 Intellectual Disability 027 290 1339 Directorate, Southern DHB 6 Prue Muschamp Charge Nurse Manager Early Southern DHB [email protected] 03 470 9945 Intervention in Psychosis 027 232 4122 Service 7 Gary Reed Clinical Director Southern DHB [email protected] 03 419 0516 027 228 5778 8 Dr Lincoln C. Wood Senior Lecturer Department of Management, [email protected] 03 470 3582 University of Otago 9 Adeel Akmal PhD Candidate Department of Management, [email protected] University of Otago 10 Prof essor David Professor Department of Economics, [email protected] 03 479 8653 Fielding University of Otago 11 Jodie Black Training Advisor Human Reso urce Division, [email protected] 03 479 9260 University of Otago 12 Prof essor Leigh Hale Dean, School of School of Physiotherapy, [email protected] 03 479 5425 Physiotherapy University of Otago 13 Kathryn McAuley Assistant Research Fellow Department of General [email protected] 03 479 4134 Practice and Rural Health, University of Otago

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Participant name Designation Organisat ion /Department Email address Contact phone/Cell 14 Claire Amos Assistant Research Fellow Department of General [email protected] Practice and Rural Health, University of Otago 15 Georgina Richardson Assistant Research Fellow Department of General [email protected] Practice and Rural Health, University of Otago 16 Dr Carol Atmore Foxley Fellow Department of General [email protected] 03 479 7443 Practice and Rural Health, 021 242 9477 University of Otago 17 Dr Fiona Doolan - Senior Research Fellow Department of General fiona.doolan [email protected] 03 479 9816 Noble Practice and Rural Health, University of Otago 18 Dr Shar on Leitch General Practitioner, Department of General [email protected] 03 479 7430 Senior Research Fellow Practice and Rural Health

19 Kristina Aluzaite Assistant Research Fellow, Department of Medicine, [email protected] Science Communication University of Otago Coordinator 20 Dr Jack Dummer Consultant and Senior Department of Medicine, [email protected] 03 474 0999 Lecturer in Respiratory University of Otago Medicine 21 Dr Shyamala Nada - Senior Research Fellow Depart ment of Preventive and shyamala.nada [email protected] 03 479 8518 Raja Social Medicine, University of Otago 22 Dr Daniela Aldabe Research Fellow Injury Preventio n Research [email protected] 03 479 7233 Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago

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Participant name Designation Organisat ion /Department Email address Contact phone/Cell 23 Dr Trudy Sullivan Lecturer in Health Economics Department of Preventive [email protected] 03 479 8087 and Social Medicine, 027 445 4363 University of Otago 24 Dr Judith Sligo Research Preventive and Social [email protected] 03 479 7223 Fellow/Professional Practice Medicine, University of Otago Fellow 25 Josh Ward Student Department of Preventive [email protected] and Social Medicine, University of Otago 26 Pauline Dawson Professional Practice Fellow , Departm ent of Women's & [email protected] Clinical Research Midwife Children's Health, University of Otago 27 Eeva -Katri Kumpula PhD student School of Pharmacy, [email protected] 03 479 7321 University of Otago 28 Prof essor Carlo Marra Dean of the School of School of Pharmacy, [email protected] 03 479 5044 Pharmacy University of Otago 29 Margaret Perley Operations Manager Student Health Services, [email protected] 03 479 8460, University of Otago 021 279 8460 30 Katherine Martin Student Health Services, [email protected] University of Otago 31 Richard Mooney Student Health Services, [email protected] University of Otago 32 Dr Bret Dougherty Student Health Services, [email protected] University of Otago 33 Hester Cheong Web Marketing Co - Executive Education, [email protected] ordinator, Executive University of Otago Programmes 34 Dr David Post CEO SIGMAGEN [email protected] +49 160 150 9806 +49 7545 784118

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Participant name Designation Organisat ion /Department Email address Contact phone/Cell 35 Ray Anton Chief Executive Officer Clutha Health First, 3 -7 [email protected] 03 419 0500 , Charlotte St Balclutha 027 229 9960 36 Kerry Hand MIRAMARE Needs [email protected] Assessment & Service Co- ordination, Mental Health 37 Tanya Ris sman Dunedin Central Community Link, Ministry of Social Development 38 Heidi Robertson Health & Disability Dunedin Central Community [email protected] 03 955 6657 Coordinator, Southern Link, Ministry of Social Region Development 39 John MacDonald Independent Chair Tourism Macs Ltd [email protected] 40 Professor Marshall Richard Parrillo Family Department of Medicine, [email protected] Chin Professor of Healthcare University of Chicago Ethics 41 Professor Robin Gauld Dean & Pro -Vice Chancellor Otago Business School, [email protected] (Commerce) University of Otago 42 Associate Professor Associate Professor , Health Department of Preventive [email protected] Sarah Derrett Systems & Public Policy and Social Medicine, University of Otago 43 Professor Tim Stokes Head of Department Department of General [email protected] Practice and Rural Health 44 Associate Professor Associate Professor and Dunedin School of Med icine, [email protected] Joanne Baxter Associate Dean (Māori) University of Otago 45 Dr Gagan Gurung Post -doctoral Fellow Dean’s Office, School of [email protected] Business, University of Otago

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Annex 2: Symposium Programme

Tuesday 29 August 2017

12:30 pm to 12:40 Registration pm

12:40 pm to 12:50 Mihi Whakatau pm

Centre for Health Systems and Technology (CHeST): A brief introduction

Professor Robin Gauld

Professor Tim Stokes 12:50 pm to 1:30pm Associate Professor Sarah Derrett

Associate Professor Joanne Baxter

Professor Stephen MacDonell

Keynote Address:

1:30 pm to 2:10 pm John MacDonald

Integrating Care in the Real World

Keynote Address:

2:10 pm to 2:50 pm Professor Marshall Chin

Integrated Care Models and Policies in the U.S.

2:50 pm to 3:20 pm Afternoon tea

Keynote Address:

Associate Professor Joanne Baxter 3:20 pm to 4:00 pm Māori Health Workforce Development – impacts, challenges and opportunities for the health sector

Panel discussion 4:00 pm to 4:50 pm Keynote speakers, CHeST theme leaders, Dr Neil Houston

4:50 pm to 5:00 pm Closing

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