1. Participants of the Gemba workshop – 27, 28, 29 April 2011

2. Rere atu, rere mai, taku manu e rere ki tua, rere ki kō, kia whetūrangitia e As we take up new challenges plant your feet strongly upon mother earth with eyes towards the stars for light and inspiration

3. Proposed future state; High level future state developed during the Gemba three day workshop for people in South Taranaki.

4. What was our goal? The goal was to design future services that can be provided by an appropriate range of skilled staff, making good use of technology and equipment in the best locations for patients.

5. How we did it We designed a future state around four elements; Prevention and screening Assessment, triage, emergency Diagnostics & specialist assessment Treatment rehab and follow up

6. Prevention and screening Integrated Care Centre Community support / resource for Maori/mental Health/CAMHs (non- clinical) Enhancing community facilitating/identification ie. of kaiawhina/etc Enhanced MDT processes Free up 2 educators to work across entire community Whole community approach Annual strategy & planning Hub & spoke Expansion of outreach Programmed engagement Whanau Ora Assessments Extensive holistic approach defining risk factors across health/social streams Investigate delivery models in other similar areas Database Back office functions Recalls Admin / clinical Scheduling Focus on Targets through joint planning Main aim: Screening Prevention Early intervention Utilise existing & effective initiatives/programmes & enhance them

7. Available daily Bookings Records Meds Results IBA Radiology Prime 2-tier transfer system Bypass protocol Transit lounge Appropriate staffing Procedural 24/7 A & M plus Base hospital Dental health A&D Does this need to be open during working hours? Must have I2 lead ability combined with TK4 until St John have training, equipment & funding to do this 1 facility Co-payments Voucher system / LCF fee 24/7 Dr on site – 0800 2200 Dr on call – 2200 0800 Healthline F2F / Phone 111 Community/Kai awhina Triage Protocol- driven transfer (non-doctor) On call (dedicated South Taranaki) Crisis MH on call & support Security Mental health help line Assessment, triage, emergency

8. Diagnostics & specialist assessment All together -Pooling resources - One IT Site critical All together -Pooling resources - One IT Site critical Orientation Where in Hawera Base? Health professional Patient Navigator Community Mobile Echo? (car, lease clinic, increased FTE) Lab screening Support Telemedicine (in patient names, laptops, video) E-mail Phone call Standardized template R Increased / intensified local one programme Specialist 1x Cardio, 1x Ortho etc Onsite visits by all One local champion specialist Education & support of local Radiology Easier accessibility Onsite U/S - plain film Mobile U/S? Mobile CT / MRI (future) Everyone together Labs Onsite 8-5 (already there) Collection POCT (after 1pm weekends) Reduction in staffing cost Main Requirements Recruitment Retention Training Main Requirements Recruitment Retention Training FSA

9. Treatment rehab and follow up Hawera Health Base (South Heath Integrated) Community Team Rehabilitation/Intermediary Care(@ home or residential care) Day Procedure Unit Nurse lead Blood transfusion Ex ECGs OP clinics – increase Oral health Mental health Up skill to crisis trained Public Health Diagnostic primary Paeds Respiratory Diabetes Daytime Crisis Team 1x member South Gen Team 1x staff CPT (to cover general) After Hours Crisis Team Rostered staff (x2) based in Stratford Resources needed: Staff Mental health Up-skilled/multi-skilled, more mobile More allied health ( physio, OT, social worker, geriatrician) Restorative/Intermediate Care team (Splice-related) Transport Maternity (currently under review) Minor procedures: bumps, scopes, local anesthetics, Mobile bus – enhance Complex care managers A&M Observation/assessment beds (numbers ?) GPs Psychiatric nurse within Intermediary Care team Maori Advocacy Support? Interventio n? Need to be linked to screening / prevention early intervention Need a central hub

10. Common themes Mobile services Central hub and spoke Pooling resources One IT site/system Building single team focus Recruitment, retention, training

11. Key Enablers Transport Policy & Governance IT – shared information Funding Workforce Health literacy/education Facilities

12. Meet with Hawera Hospital staff Meet with GPs Develop proposal Community consultation Where to from here?

13. Rere atu, rere mai, taku manu e rere ki tua, rere ki kō, kia whetūrangitia e As we take up new challenges plant your feet strongly upon mother earth with eyes towards the stars for light and inspiration