An interview with Professor Jonathon Gray
When Professor Jonathan Gray moved to New Zealand three years ago he had one aim in mind – to create an environment where it was easier to make the changes needed to deliver healthcare that really met the needs of the people.
Following the successful implementation of a challenging healthcare improvement programme in Wales, he was keen to see if he could take that learning and make a difference both locally in Counties Manakau District Health Board and nationally across New Zealand.
His remit was clear; to create a state of the art centre for innovation and learning that would support staff at Counties Manakau Health and other District Health Boards in developing and delivering best healthcare.
“I really wanted to make an impact right on ground level, in the heart of the communities, where it really matters,” said Professor Gray. “Healthcare systems worldwide are struggling to cope with rising patient demand and Counties Manakau, which serves a growing and ageing population, is no exception.
“There was an urgent need for transformational change to the way healthcare was designed and delivered, the system could not survive as it was.
“It became obvious that we had to make it easier for healthcare staff on the frontline to do the right things and produce sustainable change that would improve the quality and safety of care for patients, as well as reducing costs and pressures on the system.”
The journey began in June 2011 with the launch of Ko Awatea in Middlemore Hospital, south Auckland, a dynamic educational centre which enables individuals to meet, share ideas, carry out research, and access the latest information on healthcare quality improvement.
It is run in partnership with the University of Auckland, Manuaka Institute of Technology and Auckland University of Technology and has the capacity for over 800 people to use its facilities every day – a target which was met in its first year.
On a local level it acts as a continuous support to staff at Counties Manakau helping them to deliver innovative programmes which are making a real difference to patient care.
With a population of more than 500,000, the multicultural area which the district health board serves has many challenges including poverty, poor housing, alcohol and drug misuse, and high levels of obesity and diabetes.
In addition to this, the healthcare system is facing issues with increased demands, waiting times and financial restraint.
There was a real need to deliver healthcare services in a different way and which better met the needs of people by providing the right care at the right time and in the right place.
For example, the 20,000 Days campaign which reduced hospital demand and returned more than 23,000 days back to patients to be at home with their families, days that would have otherwise been spent in hospital, was a big success.
By providing appropriate care closer to home, it also enabled the district health board to continue delivering specialist care to those who really need to be in hospital.
There are currently 41 other improvement projects ongoing in the system and Ko Awatea provides support to each one, not least, ensuring staff learn the skills necessary to deliver the changes.
“I knew that if we could build capacity and capability we would start to see a difference,” said Professor Gray.
“The 20,000 Days campaign is a great example of how working with the community has spread change rapidly and made a real difference to the quality of life of patients.
“It just shows that with the right kind of skills, commitment and improvement science, small revolutions can result in big change.
“Now we have a team of clinicians, patients and their families mobilised towards a common aim of keeping people well in the community and avoiding hospital admission wherever possible.”
On a national level, Ko Awatea has been working with all district health boards across New Zealand delivering programmes aimed at preventing central line associated bacteraemia (infections) in patients in intensive care units.
The national approach to reducing infections in this area has led to sustainable improvement and better patient outcomes.
And in just three years, Ko Awatea has stamped its reputation on the international stage by bringing together healthcare professionals from across Asia Pacific to share and learn improvement best practice at The Asia Pacific (APAC) Healthcare Improvement Forum.
It has also developed strong international relationships with many international systems, not least the Institute for Healthcare Improvement in the USA, Victoria in Australia and Public Health Wales the UK.
“Ko Awatea is the catalyst for us to produce systematic sustainable change locally and to be the place the region, New Zealand and other countries look to for innovation and solutions to the challenges we face,” said Professor Gray.
“Ko Awatea means first light in Maori and it encapsulates the very thinking and drive behind the innovative approach to healthcare that we are taking; when dawn is breaking and a new day is about to begin, anything is possible.
“And this is our mantra, it’s about inspiring healthcare staff to come up with new ways of working and equipping and supporting them to deliver those changes.
“It’s about building will, which develops into ideas and then executing the changes. There is a real energy and can do spirit among everyone involved and we’ve shown that by bringing people together you can drive improvement locally, nationally and internationally.”
Whilst it’s important to celebrate the successes, Professor Gray is under no illusion that there is still much more work to be done and a key focus for Ko Awatea is to develop the next generation of healthcare leaders.
Ko Awatea works closely with local schools to enable young people to learn about healthcare with the aim of building a group who would lead the service in 2040.
And it hopes to expand its services by expand a student chapter and a series of academies to educate youngsters in improvement skills.
“We have laid the foundations but more challenges are coming and we have to ensure we equip the next generation of leaders with the skills to meet these challenges head on,” said Professor Gray.
“We want to attract more young people to train and understand their role in providing solutions for the future of healthcare provision and do this we need build on our reputation as being the leaders of healthcare improvement.”
Professor Gray is also looking continue to build networks locally, nationally and internationally as well as developing a think tank to support and influence government policy.
“We maybe small but we have big ambitions and we want to build an active network across Asia Pacific by bringing the best people together to accelerate learning,” he said.
“For the first time we are all speaking a common language about improvement and we have passed over some meaningful change to our community.
“There is still so much more to do but what we have created is a reusable network of skilled, passionate and committed health professionals who have the knowledge to bring about sustainable change across the health sector.
“This is a momentum game and we want to continue climbing towards our goal of being the best healthcare system in the Australasia by December 2015.”