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Health care system performs well, but faces challenges

Health care system performs well, but faces equity, workforce and financial challenges

The latest snapshot of the quality of New Zealand’s health care shows a health system that continues to perform well in the face of a number of challenges.

A Window on the Quality of New Zealand’s Health Care 2018, published today, is the fourth Window report released by the Health Quality & Safety Commission.

The Commission’s director of health quality intelligence, Richard Hamblin, says New Zealanders have a good health system compared with overseas, despite less being spent on health care here than in most similar countries.

However, he says, it is also a system facing both long-term and new challenges.

‘Our health system does remarkable things on a daily basis and has shown improvement in a range of specific safety issues in the last five years. However, New Zealand has made less progress in tackling long-standing issues, like equity and unwarranted variation.’

‘We found clear evidence of inequities across access, treatment, patient experience and outcomes for patients of different ethnicities, age groups and income levels in New Zealand. High quality health care recognises and meets greater need, and in doing so, can reduce health inequity.

‘We believe that our health care system can perform better at each stage of the patient journey, to deliver more equitable health outcomes for New Zealanders.’

Mr Hamblin says these issues are not new - ‘We can’t just continue to do what we’ve been doing and ignore our lack of progress in important areas like equity.’

While the system has generally been performing well based on the ‘lagging indicators’ [1] considered in the Window to date, this year’s Window has a deliberate focus on identifying potential ‘early warning signals’ for the future safety and sustainability of the health system.

This new step involved considering more ‘leading indicators’, including looking at a wide range of information and assessing the strength of evidence of issues.

‘There are emerging early indicators that raise concern around increasing financial stress, workforce wellbeing and increasingly complex safety issues,’ Mr Hamblin says.

‘Up until budget 2018, there had been no real increase in funding for a number of years. We looked internationally, and we saw an increasing gap between expenditure on the New Zealand health care system and that of other similar countries. We are also concerned about continuing district health board deficits.

‘In terms of the health workforce, we are seeing early warnings signals that raise concern for staff wellbeing, including evidence of bullying.’

The Window recommends rethinking the current approach to health system oversight, suggesting two new approaches to help address emerging challenges and improve the quality of our services and system.

The first involves building on existing approaches, to encourage focused monitoring of service quality in a true partnership between national agencies and providers.

‘In this model, government, through the Ministry of Health, would set high-level system goals. Local health providers, working with staff and their local populations, would identify local priorities, which would contribute to the high-level goals.’

He says the thinking behind the Commission’s quality and safety markers and the Ministry of Health’s system level measures framework could be the basis for a more positive, partnership approach to system oversight.

The second involves developing a mechanism for spotting and addressing potential problems early, by bringing together national agencies to systematically share intelligence, evaluate the significance of emerging signals, and collaborate in effective and appropriate responses to solve problems.
Click here for a list of frequently asked questions about A Window on the Quality of New Zealand’s Health Care 2018.

[1] ‘Lagging indicators’ tell us about how the system was performing six to 18 months ago, when the data was collected - not about how the system is performing now, or how it will perform in the future. Lagging indicators often measure an outcome that has completed.

‘Leading indicators’ tell us more about what is happening now, or how we are tracking towards an anticipated outcome. Leading indicators provide us with greater opportunity to intervene to change an unwanted outcome, such as patient harm, before it happens.

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