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Grassroots change is needed at our nation’s DHBs



Focus on Emergency Department waiting times ratings not enough

Real, grassroots change is needed at our nation’s DHBs and hospitals, says Kaizen Institute NZ CEO Danie Vermeulen

AUCKLAND, Wednesday 25TH November, 2009 - In May of this year, Minister of Health Tony Ryall set new standards for Emergency Department waiting times in the nation’s hospitals. Figures released this week show that limited real improvement has been made. No DHB managed to meet the minister’s target of 95 percent of patients admitted to a ward, discharged or transferred within six hours.

However, while Ministry targets provide some focus, they are only helpful in comparing “slices” of the DHBs’ performances, says Kaizen New Zealand CEO Danie Vermeulen. “The targets only paint part of the picture,” he says, “and merely identify the symptoms of the wider problem.”

Across the board, holistic change is Vermeulen’s prescription for the DHBs. “There is still room for “window-dressing” target numbers without fully recognising wider up-steam and down-stream impacts,” he says, “and while focusing on these few magic numbers, other important – and in this case life or death – issues may be missed.” For instance problems extend far outside of the emergency room, as the minister has admitted. Vermeulen suggests a change in the way DHBs think about the ED. “ED is not a silo or a function – it is part of a value stream that extends throughout the hospital.”

Hospitals and health boards in New Zealand and elsewhere have attempted to implement generic solutions and theories adopted from elsewhere or from management ‘gurus’. But this “copy and paste” solutions is ineffective, says Vermeulen. “It is the nurses, doctors, administrators and others who work at the “ground level” who are best suited to identify the root causes of New Zealand’s healthcare issues and challenges and to come up with the best solutions.”

Attempts at improvement from the top can only go so far. In order to create meaningful grassroots change, says Vermeulen, DHBs should develop their own holistic strategic framework and adopt the principle of ‘Kaizen’: “everyday, everywhere improvement by everyone.” This means more than simply asking hospital staff what they think once in a while at a focus group. “They should be deliberately taught, supported and encouraged to look for, define and implement their own continuous improvement,” Vermeulen says. “For solutions to be relevant and sustainable, they must be accepted, owned and implemented by those who know best - the people who deal every day with real patients in the waiting rooms, wards, theatres, rehabilitation programs, and administrative offices.” He notes that this involvement should not just be limited to staff, but should include patients, people across functions and across DHBs, and suppliers.

Vermeulen argues that in order to create a culture change, DHBs need a clear strategic framework. “This means a healthy mix of quality, delivery and cost measurements and relevant training and support so that DHBs can develop and continuously improve their own creative and sustainable solutions to the real problems,” he says. “This is the best investment that the Government and senior management can make in New Zealand’s healthcare, and will equip DHBs’ own experienced staff to set their own best practice standards.”

In order to meet the ministry’s targets, focusing merely on the targets is, to Vermeulen, not enough. “Holistic change from within will take a bit longer, but it will be real, sustainable and efficient.”

About KAIZEN Institute NZ

Established in 2006, KINZ focuses on the key areas of quality, costs, logistic, staff motivation, safety, technology and environment within an organisation to make it more streamlined and efficient by eliminating waste and providing a business process improvement framework.

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