Well Health Trust

The Health Ministry’s drive to reduce the number of PHOs in New Zealand in 2009 has seen them fall from 80 to 32. $25 million dollars of primary health care funding was reconfigured so frontline health services could improve. The success of the PHOs downsizing (PHOmosis) can be measured on a number of levels: financial savings, health targets, and last but not least – health outcomes.

HCA’s national hui was just the forum to hear a provider perspective of their journey along the bumpy road to effective Primary health care.  Well Health Trust Chief Executive Justine Thorpe shared the drivers, lessons and what to look for when you are working in the business of health. While taking into account the values of: social justice, community leadership and accessible models of health care for the vulnerable.

South East City PHO and Porirua Plus were small PHOs (with a registered population of under 20,000 independently or even as a merged PHO). Whilst they were small and committed to serving their community populations the two PHOs had distinctly different ways of working and supporting their communities. A quick merger (approximately 6 weeks) has presented a number of lessons and victories for the new Well Health Trust…

Kaupapa

“One of the victories is that our members didn’t get subsumed into something that wasn’t aligned. We have increased our diversity. Through ethically managed community-based engagement and innovation we continue to make a difference to our vulnerable communities.”

Values alignment and collective support is a sustainable platform for staying alive in an increasingly difficult environment. The values and our kaupapa is what sustains and builds our relationships.

Representation at the decision making table

Justine was HCA’s representative on the PHO Service Agreement Protocol (PSAAP) group. “PSAAP is the national contract negotiation point for the national PHO agreement.”

Although small in representation the voice for the vulnerable was at the table where it counted.  Justine says her role on PSAAP was strengthened by her HCA involvement. Through HCA she was able to network with HCAs other PHOs over email. She says it boosted her confidence and more importantly it gave her the mandate to represent HCAs kaupapa at a national level.

Change management

“Investigating change management concepts and reflecting on experience is extremely important when making change. “SECPHO and Porirua Plus were already working well. But we had to merge and do it quickly over about a six week period”. There were implications…

‘Change management should be about allowing it to happen not forcing it. But if we wanted to be standing at the end we had to do it quickly.” We got stuck a bit during the ‘ storming stage’ of Bruce Tuckman’s model of group development – ‘but our previous relationship held us together.”

‘Each of us had different ways of doing things and we both had to re-think and re-work everything including the governance and control’.

Relationships

“Through the PSSAP process we got HCA got the group to reconsider and acknowledge the importance of relationships in a process where merging or collaboration is required. You really have to let relationships grow and develop before you start making these changes”

“We got agreement to allow the PHOs time to consider their future and consult with their community. The outcome is that Capital and Coast DHB now has four from seven PHOs noting that one PHO now spans across two DHBs.”

Key relationships have been woven throughout the change process, relationships with DHB stakeholders was pivotal “It reflects the value that the DHB has placed on the role of community-led primary health care and is a credit to them,’ Justine said.