Value and high performance

Te whāinga hua me te tika o ngā mahi

Possibly one of the most important and achievable gains we can make in the performance of the system will come from making smarter and more transparent use of information. As an integral part of a performance framework based on health outcomes and equity of health outcomes, this improved use of information will bring immediate benefits at the point of care and also in the longer term. It will also help the system as a whole to more purposefully target high-need priority populations.

This theme recognises that we need to make better use of our funding, better directing it to where needs are greatest, and that we could achieve this by taking a health investment approach with a long-term mindset. We are already doing well in terms of quality and safety. Strengthening relationships with key agencies, such as HQSC and ACC, will allow us to do even better.

The New Zealand Productivity Commission’s recommendations on More Effective Social Services recognise that improving social outcomes depends critically on the involvement and capability of not only government agencies but also non-governmental organisations (NGOs) and the wider community sector.

What do we want in five years?

  • There is a greater focus on health outcomes, equity and results that really matter to the public across the health system. The accountabilities of health organisations have been reoriented to reflect this focus.
  • Service users have a more prominent role in shaping improvements to system performance.
  • The performance and planning system supports the strategic direction.
  • Funding supports providers to improve their service:
    1. changes to funding processes improve access to universal services for high-need priority populations
    2. providers use a health investment approach
    3. funding, incentives and payment streams for primary care support its role in the system
    4. commissioning of services and payment approaches focus on equity of health outcomes
    5. purchasing from NGOs and commissioning at the local level are improved to better support NGO performance and sustainability.
  • Services at all levels of the system are providing high-quality care as a result of ongoing programmes of monitoring and improvement.

The actions below are intended to be carried out within a five-year timeframe, with the first steps starting in 2016/17 and indicated with an asterisk (*).

Improve performance and outcomes

Action 13

* Enable people to be partners in the search for value.

  1. The Ministry, working with the HQSC, will develop and implement measures of service user experience. These measures could build on the HQSC’s existing work with online surveys of patient experience.
  2. Develop more transparent, robust and meaningful public reporting of performance information, including patient safety data.

Action 14

* Develop and implement a monitoring framework focused on health outcomes, with involvement from the health and disability system, service users and the wider social sector. The framework will reflect the links between people and priority groups, their needs and outcomes of services and will shift the focus from inputs to outcomes. This work will build on the Integrated Performance and Incentive Framework and results-based accountability and aims to increase equity of health outcomes, quality and value.

Action 15

* Work with the system to develop a performance management approach that makes use of streamlined reporting at all levels, to make the whole system publicly transparent. This will draw on service user experience results as well as quality and safety information (developed through action 13a and action 19), and operate within the outcomes framework (developed through action 14). It will involve approaching planning, monitoring and continuous improvement in a tight–loose–tight way (ie, setting specific target outcomes, making service delivery options flexible and being tight on achieving health and equity outcomes) and supporting innovation.

Action 16

Maintain the direction set by the Strategy.

  1. * Monitor and report publicly on progress on the Strategy, well coordinated with the monitoring and public reporting of associated strategies and periodically evaluate progress (years 5 and 9).
  2. * Review, refine and renew roadmap actions each year.
  3. * Establish a Strategy Leadership Group with representation from across the system, to advise the Director-General of Health on the Strategy’s progress, implementation and refinement.

Align funding

Action 17

Align funding better across the system with a rolling programme focused on getting the best value from health investment (including incentives where relevant to support Strategy direction).

  1. * Explore possible means for improving access to health services for those most in need through financial support.
  2. * Embed the partnership approach between the Ministry of Health, The Treasury and DHBs for major capital expenditure, providing additional support from people with expertise in major capital expenditure to strengthen governance, planning and delivery.
  3. * Improve commissioning by using a wider range of service delivery models, expanding the use of contracting for health and equity of health outcomes and building capability to lift the quality of commissioning (as the New Zealand Productivity Commission recommended in its review of More Effective Social Services).
  4. Review funding, contracting and accountability arrangements for primary maternity and Well Child / Tamariki Ora services to better support access to, and integration of, health and social services for children, families and whānau with complex needs.
  5. Increase joint commissioning across the health and social sectors and quality improvement in youth services.
  6. Improve commissioning models for NGOs to enable streamlined and flexible contracting that supports providers to be sustainable.
  7. Where appropriate, improve consistency between services funded by health and those funded by ACC, the ministries of Justice and Social Development and the Department of Corrections.
  8. Agree on information technology project funding priorities, with input from across the system.
  9. Build capability across health and social service providers, especially those delivering services to priority groups and the most vulnerable, to promote sustainable options and choice within communities.

Target investments

Action 18

Continue to develop the application of the social investment approach to health investment with DHBs. This approach could be used to target high-need priority populations in order to improve overall health outcomes and improve equity, while developing and spreading better practices. This approach will increase knowledge about population segmentation, drive collaboration, build skills in developing investment cases in the system, improve visibility of value for money and build on the New Zealand Productivity Commission’s recommendations around a learning system.

  1. * Develop the techniques, standards and guidance for health investment cases.
  2. Trial the approach by targeting services for population segments for whom the potential health and fiscal returns are highest. Funding will be awarded on the basis of the strongest investment cases for a three- to five-year period so that NGO providers can have longer-term contracts where relevant.
  3. Review results and learnings and, if appropriate, extend the approach throughout the country for the selected population outcome and segment, and/or other outcomes and population segments.

Improve quality and safety

Action 19

Continuously improve system quality and safety. The Ministry of Health will achieve this by:

  1. * partnering with other organisations on quality and safety initiatives in primary and rest home care
  2. * working with ACC and HQSC to strengthen initiatives to reduce patient harm, focusing on services with the highest potential to make gains for patients
  3. * working with ACC and HQSC to analyse and share data on patient safety and treatment injury, making continuous improvements to solutions to the problems identified
  4. * reviewing and streamlining annual reporting to include relevant quality performance reporting.
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