Value and high performance

Te whāinga hua me te tika o ngā mahi

This theme is about:

  • delivering better outcomes relating to people’s experience of care, health status and best-value use of resources
  • striving for equitable health outcomes for all New Zealand population groups
  • measuring performance well and using information openly to drive learning and decision-making that will lead to better performance
  • building a culture of performance and quality improvement that values the different contributions the public and health workforce can make to improving services and systems
  • having an integrated operating model that makes responsibilities clear across the system
  • using investment approaches to address complex health and social issues.

Why is it important?

New Zealand’s health system performs well, but it can and must do better. It is important to get the best value we can from services, so that New Zealanders receive high-quality services that are affordable and sustainable. If we cut out waste in the delivery of services, we can then deliver better and more extensive services within the resources available. We need to draw on the skills, professionalism and commitment of the health workforce so that we continue to make improvements.

‘[We need] greater accountability of the system to those who experience poorer health outcomes and who continue to be underserved by the system.’
–Pacific community group

To deliver value, we must focus on the results that matter most. Our approach needs to take account of the full range of influences on health outcomes, including economic factors, human and technological resources, service users’ experience, service quality, health behaviours, the physical environment and social factors.

We can make information work much harder for us. Better and more visible information about real-time health results, including patients’ experience of care, can help us improve at the front line and at a national level. We want to build a culture of transparency and openness, using high-quality outcome indicators, to build the public’s trust and confidence.

The Triple Aim framework (below) provides a system approach to improving services. It can help us balance our goals across the three aims of the framework. One of its aims is improved health and equity for all populations.

The New Zealand Triple Aim framework

Diagram of a triangle with individual, population, and system each written inside one side. On the outside of the triangle's sides are Improved quality, safety and experience of care, Improved health and equity for all populations, and Best value for public health system resource.
Source: Health Quality & Safety Commission

New Zealand’s health system needs to do better for the population groups that do not enjoy the same health as New Zealanders as a whole. These groups include Māori and Pacific peoples, some Asian subgroups, refugees, migrants and people with disabilities. To achieve this, our focus must be on removing the infrastructural, financial, physical and other barriers to delivering high-quality health services, both within the health sector and between it and other sectors. Sometimes, improving the health of these  groups will involve tailoring services so they are available in more accessible places or at more suitable times, or are delivered in more culturally appropriate ways.

‘Health care providers must ensure the services that they deliver are efficient, of high quality and delivered safely. There must also be a focus on continuous improvement in performance.’
–Health regulatory authority

We need to be clear about which agency or organisation is accountable and responsible for what. This is particularly important if we want to provide integrated care. Our operating model must describe the role and purpose of all participants in the system and, equally importantly, our way of working. We need to define the processes and culture that allow us to work as one team, and identify the skills, resources and information that build the processes and culture we need.

Failures in the quality and safety of health services are costly to individual people, their families and whānau, and to the system. We need to promote a culture of quality and safety improvement across our health services so that those services minimise patient harm and achieve the best possible health outcomes.

New Zealand has outstanding and internationally recognised research teams, working in and with the health system, who contribute to innovations that can improve performance and safety. Our achievements include developing knowledge and improving practice in relation to asthma and cot death, making links between housing and health, using cooling caps for premature infants, and developing decision support tools for heart disease.

But in general we need to get better and faster at sharing the best new ideas and evidence  and putting them to work throughout the system. Such improvements will help us avoid unwarranted variations in the quality, safety and sustainability of services, and will also mean that effort is not wasted when regions or organisations independently develop solutions to common problems. This can be achieved if we take the learnings from successful initiatives and apply them systematically to areas in need of improvement.

Improving value for money so that better health outcomes are achieved using the same resources is vital in the face of changing health needs and growing expectations. Working with others across government is one way to achieve this.

Another way to improve value for money is to realise the potential for the health system to make more use of investment approaches. By adopting a more holistic perspective on social value and costs – that is, taking an investment approach – we can make better decisions and better-informed trade-offs.

PHARMAC’s approach to managing pharmaceutical spending is world leading. New Zealand has one of the highest proportions of generic medicines by volume – third out of 26 OECD countries. In 2014/15, spending on medicines managed by PHARMAC was $795 million, but PHARMAC estimates that without the savings it has achieved on the cost of medicines since 2004, these medicines would instead have cost almost $2 billion.

Source: PHARMAC Annual Report 2014/15

What great could look like in 2026

This is our vision for value and high performance in 2026.

  • The health system provides high-quality, accessible health services that help people live well, stay well, get well, at the lowest cost it can and within the resources available.
  • The system uses its resources skilfully so that services reach people who need them. As a result, people trust the system and it is more sustainable both financially and clinically.
  • All New Zealanders enjoy good health, and population groups that were previously disadvantaged, such as Māori, Pacific peoples and people with disabilities, experience a clear lift in health outcomes.
  • All involved in delivering and supporting services strive for excellence and improvement, supported by evidence, research and analysis.
  • The health system minimises harm to people, by openly tracking harm when it occurs, and learning from mistakes, so that the system as a whole can improve.
  • The health system has an operating model that clarifies relevant policies, legislation, regulations, guidelines, standards, roles and responsibilities, funding arrangements, systems and processes, and strategic direction. The model allows all parts of the system to play their roles effectively and efficiently.
  • Funding approaches consider a range of ‘bottom lines’ as part of the system’s commitment to a social investment approach.
  • The health system constantly monitors its performance and scans the environment to check that it is functioning well, maintaining its strategic direction and responding to changes.
  • Health and injury services are more consistent in the experience they provide to people.

The word map below displays some of the words people working in the health system use when describing what a high-performing system could look like.

A word map developed from Strategy workshops held during May–June 2015

The biggest words in this word map are health, people, system, equity, need, needs, want, care, followed by many more.

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