A highly engaged clinical editor (CE) group, efficient page localisation process, and strong local champions who share the big picture have been instrumental in establishing Midland Region Community HealthPathways. The programme is a collaborative venture between five District Health Boards (DHBs) serving New Zealand’s central North Island – Bay of Plenty, Lakes, Hauora Tairāwhiti, Taranaki, and Waikato.
At the centre of this collaboration is shared services agency HealthShare, which partners with the Midland DHBs and local PHOs for service improvement and innovation in healthcare provision. Eight Primary Health Organisations (PHOs) cover this large area – the Eastern Bay Primary Health Alliance (EBPHA), Hauraki PHO, National Hauora Coalition, Ngāti Porou Hauora, Nga Mataapuna Oranga (NMO), Pinnacle, Rotorua Area Primary Health Services (RAPHS), and Western Bay PHO.
With this many local health systems and stakeholders in the mix, implementing HealthPathways was always going to be a challenge.
“When our HealthPathways journey began in late 2018, we knew our programme was going to span the biggest collective of District Health Boards in the country (five of New Zealand’s 20 districts). We weren’t even sure we could do it,” says HealthPathways Midland Region Programme Manager, Chris Scott.
Two years into the programme, it’s clear that the team have embedded HealthPathways into this complex environment by inspiring local champions as strong advocates.
Second birthday celebrations (left to right):
Dr Sheril-Ann Wilson (CE, Waikato), Jo Hollobon (Regional Coordinator), Dr Fiona Campbell (CE, Waikato), Chris Scott (Regional Programme Manager), Dr Mark Taylor (CE, Waikato), Dr Angela Fairweather (CE, Waikato)
A cohesive approach
“It took a lot of energy to get everyone onboard - basically a 12-month process. One of the key aspects that really helped was to acknowledge the importance of local champions as a force for change,” says Chris.
“We’re very fortunate to have active stakeholders who see the big picture, from the governance level through to our clinical editing team. Our general practice liaison teams (GPLs) also see the pathway work as vital,” says Chris.
“Our advocates helped spread the word within each DHB, and quickly understood the wider potential for our HealthPathways programme. As each local group embarked on pathway development, the process highlighted differences across our health system. We found the question of how to treat a particular condition could be asked as many as eight times in the patient journey through the PHOs and DHBs. When the champs saw variance, each working group took the queries back to their own DHBs, so they could work on the issue collectively.”
Using the pathway development process to bring about a more cohesive approach to health system change has also enabled smaller DHBs to take a bigger share in the overall benefits, says Chris, citing the example of the COVID-19 pathways and eReferrals, now being accessed by all users. Other successful projects such as improvements in local telehealth services also show that local practitioners share the overall concept and don’t view the pathways in isolation, says Chris.
“As we achieve more in the programme, the pathways are seen as a key chunk of the whole package. HealthPathways is the start point, and our clinical editors are very involved with service improvement.”
Minimal change approach maintains the pace
Right from the outset, a “minimal changes” approach to clinical editing has ensured stakeholder needs are met, while still maintaining content integrity and pace in the work programme.
“One of our key philosophies is that clinically, treatment should be similar across our wider region no matter where the patient is being treated. The COVID-19 resources are a fantastic example of that,” says Chris.
“We start from the premise that a Base clinical pathway shouldn’t need to be changed too much. When we localise it, we try to strike the right balance between being local, and not being too local. We encourage clinical editors (CEs) and senior medical officers (SMOs) to focus on the top level of pathway development, and to keep the really locally specific information for request pages.”
HealthPathways Midland Region Coordinator, Joanne (Jo) Hollobon plays a key role in making the process as simple as possible, as she works with the lead CE, SMO, or group for each page.
“I highlight differences in their drafts, send them out to all of the regions so that they can discuss with their subject matter experts, then leave them to have those discussions. They have some great debates!” she says.
“We’re pretty focused. To help maintain the momentum I do what I can to encourage the group to get each page over the line.”
The minimal changes approach was a key factor in the development of a suite of palliative care pages, which are now being used by seven hospices, all aged care facilities, and hospitals in the region including for e-referral.
“Working across five DHBs, we’ve managed to complete 27 pathways in about nine months, including request pages,” says Chris.
GPs champion the cause (left to right):
Dr Joe Bourne, Regional Clinical Lead Support, Bay of Plenty DHB; Dr Lisa Hughes, Clinical Editor, Lakes DHB; Dr Anna Meuli, Clinical Editor, Hauora Tairāwhiti DHB; Dr Jo Scott-Jones, Interim Chair, Regional Governance Group; Dr Chris Tolfield, Clinical Editor, Bay of Plenty DHB.
Access at the point of care
Another practical initiative has been to make access at the point of care as easy as possible.
“We recognised early on that ready access would be a key driver for engagement, and a user survey confirmed this. So we invested a lot of time into learning about how each PHO worked, and which systems our local practitioners used. We mapped out every DHB and PHO access point, then connected with IT departments and software vendors to integrate HealthPathways into every system we knew of in primary and secondary care,” says Chris.
“This included intranets, clinical applications, practice management systems such as Indici, patient management software, and decision support systems including BPAC. Whether at the main menu or a prompt, HealthPathways was there at go-live, within a single click, for everyone,” she says.
This is supported by customised guides for each PHO/DHB, with screenshots of each clinical system where HealthPathways access can be found.
“If a new user isn’t sure where to find HealthPathways, I can immediately give them the exact view for access from within their own practice environment, and I follow-up to see how they are going,” says Jo.
There are now two innovative ways to integrate HealthPathways into clinical workflows - the Pathway Link API and the App Launch API. See Introducing the new App Launch API and Introducing the Pathway Link API and if you’d like to know more, contact your community success manager.
Strong belief and big picture thinking
Two years on and the landscape looks very different to when they first embarked on their HealthPathways journey, says Chris.
“We started out wondering how we’d be able to effectively engage with thirteen direct stakeholders, five DHBs, eight PHOs, plus a large additional interest group. Now at the 24-month mark, we’re in a routine, our CEs are in a routine, and the value HealthPathways provides is being seen across our communities.”
Thinking about what advice they could offer for new HealthPathways teams, both Chris and Jo agreed that the key was a strong belief in what can be achieved.
“You’ve got to believe from the outset that it will make a difference,” says Chris.
“If you’re not convinced, others won’t follow. Now that our HealthPathways programme has gained its momentum, we can never stop the energy and drive. Before you know it, the pages you start off with will be up for review,” adds Jo.
Building local engagement
For tips and resources to help you build HealthPathways engagement in your area, see User Engagement Strategies in Online Help, or Engagement and Education - resources provided by members of the HealthPathways Community.
If you have any questions about the Midland Region Community HealthPathways Programme, please contact your lead writer.