The New Zealand Productivity Commission has endorsed the Canterbury Health System approach to alliancing in its More Effective Social Services report released this month.

The report praises how the Canterbury Health System has transformed over the past decade, particularly through alliancing under the Canterbury Clinical Network, and its efforts to create people centred health care along with the technology and systems to support and enable staff to do the right thing.

The report acknowledges Canterbury’s goal of coordinating services for people with complex needs to help ensure they experience seamless care that improves overall health outcomes. It also quotes a case study commissioned by the World Bank earlier this year to identify what is transferable from Canterbury to other health systems seeking to develop "People Centred Health Care".

The World Bank report looks at how having meaningful engagement with health professionals, community leaders, and patients has been the backbone of developing and driving change in Canterbury – and has also helped manage the significant disruptions of the Canterbury quakes.

The World Bank's review of the health service alliance model used in Canterbury concluded:

Alliances applied to health services in New Zealand are a distinctive model. The approach [uses] alliancing as a mechanism for achieving consensus on integrated service development, particularly in areas where the system is complex, and there are a number of different parties, professions and organisations which need to work together…the priority is effective service design, which can then be implemented with whatever contractual mechanism is appropriate.

The alliance contract is an agreement to participate in good faith with the other parties to the alliance. … The importance of clear scope definition and relationships of mutual respect appear to be widely recognized, and the value of alliance coaching and facilitation to help participants through difficult relationships and complex issues is generally agreed. Alliances have demonstrably been successful in facilitating clinically led service design in a number of areas. But the value of imposing alliances upon reluctant parties is controversial, with arguments and some anecdotal evidence on both sides of the issue.

Alliances can bring risks, including risk of failure and wasting [resources] and time. To some extent alliances can bring risks of diluted accountability, but these risks have generally been managed by DHBs in health alliances, and in many respects alliances can be seen as a tool for helping DHBs to manage risks by involving a range of stakeholders in the challenge of designing sustainable services.

David Meates, CEO of the Canterbury District Health Board, says “Ensuring we are managing acute demand appropriately through better linkages between primary and secondary care and identifying opportunities for capacity development have all contributed to improving patient care. We’ve done this through seeing the value and potential for improvements by creating strong alliances across professional and organisational boundaries.”

Meates points out that key strategies to achieving people-centred health care in Canterbury have involved new ways of working and having the technology to back it up. Information technology systems like HealthPathways have enabled Canterbury to provide better care.  

“It’s great to see other major organisations recognise our journey of transformation and supporting our way of thinking. Much of what we do isn’t unique to Canterbury but how we seek to do it in a seamless joined up process organised around our patients and our communities is envied by colleagues in other health systems.”

Sources:

• CDHB CEO Update, 28 September 2015.
• Love, T. (forthcoming). Case study: people centred health care in Canterbury, New Zealand. Final Report. July 2015. Sapere Research Group. Washington, United States: World Bank.