FINAL REPORT
SMART – A preferred Vision for Redcliffe-Caboolture
1.
Background
Over
50 health care professionals met on April 17th at the
Redcliffe Convention center to develop a shared vision of the future.
The aim of this conference was underpinned by a need to create a single
intent that ‘pulled’ multiple realities held by limited stakeholders
into one vision that could:
1.
Facilitate growth in community building.
2.
Integrate and align effort towards a common purpose with a
beginning towards an integrated planning approach.
3.
Articulate an image of preferred Health Futures.
4.
Create an opportunity to develop relationships and possible
partnerships within a common cause.
The driving
reason to conduct such a session was due to limited levels of integrated
approaches to health planning by health professionals within the
Redcliffe and Caboolture Regions but other regions throughout Australia.
The intention was that this model of grassroots futures work could
become portable, allowing real transformation in health delivery
throughout the nation.
2.
Conference
Day
The
conference day was divided into the following stages.
1.
An opening presentation by Aboriginal Elder
Peter Bird. Bird's His
main point was that to develop a shared vision of the
future, we must acknowledge how settlement destroyed the health of
aboriginal peoples. Creating a future must begin with redressing past
grievances.
2.
The first session focused on creating health pasts. The three
main trends identified were: (1) less funds available and thus the move
from abundance to tough choices; (2) the development of community health
and (3) technological advances
3.
A keynote address by Sohail Inayatullah. He made the following
points. 1. Creating an integrated framework for health care is
foundational necessity given the overwhelming changes to health. Whether
it is genomics, cyberhealth, an aging population or
the rise of complementary medicine, traditional delivery systems
of health are being dramatically challenged. The economic reality of
globalization – more porous nations, privatization – force agencies
to do more with less. While daunting this is possible through
integrative visions and strategies. Four solutions were provided:
coordinate care; smart card; community care; and integrated system.
4.
Sectorial presentations from Ralph Smallhorn (General Practice),
John O'Brian (Queensland Health), Jeanette Evans (Blue Care); Darryl
Baker (Redcliffe City Council) and, Chantal de Vere (Natural Healing).
We briefly summarize their main points.
Ralph Smallhorn made the following points. 1. There
are not enough gps (or nurses). 2. We will see an increased number of
part time GPs. This is already evident in women GPs. 3. GPs should treat
only what others groups cannot. 4. GPs must work with other groups as to
create a multi-door integrated scenario of the future.
John O'Brian articulated Queensland Health's vision
for the future. This is:
Health is a lifetime investment, education as
consciousness of health choices
both in terms of life style and smart consumer, and
health as resource (a healthy population is cheaper to maintain). The
main future issue is the transition from health for children to health
for the aged.
Darryl Baker developed how the local council is
working in the health area. His talk focused on community capacity
building, as for example, the local library which has become a core
areas of learning and community building.
Jeanette Evans saw health a pivotal investment to our
future. While the demand for health for often insatiable and increased
aging made health care delivery even more difficult, advances in
technology (tele-health, for example) and the possibility of integration
offered some hope for the future.
Chantel De Vere pointed out how complementary
medicine was leading the way in many areas of health care, and, becoming
increasingly respectable. The presented numerous case studies - for
example, at Southern Cross University – to illustrate that the walls
between traditional and complementary medicine were breaking.
Next were six break-out groups. They were charged
with the task of developing a preferred vision. Points of agreement from
the disparate groups where developed in a collective visioning session.
3.
The Vision
VIRTUAL MULTIDOOR HEALTH/
VIRTUAL MULTI PERSONAL LIFE HEALTH PLAN/
HEALTH
FOR LIFE
S
Seamless Portals
M Multi-Tier
A Access
R Relations and
Community Building
T Trust/Respect/Ethics
The
following describes in more detail the vision:
·
Virtual
teams
·
Person-based,
holism
·
Prevention,
early intervention
·
Unique
ID number, card system, health points
·
Co-ordinate
life style interventions
·
Community
Care at the centre/core – person – trust
·
Funding
values shift towards wellness model
·
Smart
system – interactive – TV
·
Seamless
strategic alliances
·
Volunteerism
·
New
measurements
·
Smart
astute use of current resources
·
Shared
doable vision
·
Breaking
down barriers
·
Sustainablility
·
Client
focused
·
Federal
plus local
·
All
individuals accountable
·
Multiple
entry – suppliers
Some
of the social factors necessary for this vision included.
·
Ten
year funding cycle
·
From
greedy society to community
·
30
hour working week – improved connectedness/health
New
indicators were measure movement toward this vision, among them were: no
homeless and a comfortable death.
An
essential value behind this vision was: trust and respect.
To
move toward this vision, it was agreed that a pilot project was
necessary.
Further
next steps included:
Community
Information
·
Involvement
·
Focus
groups
·
funding
·
local
members, political buy-in
·
Media
involvement
These
communities needed to be: Physical and Virtual
Potential
users/suppliers needed to be assessed as well.
4.
Small Groups
What
follows are the reports from the small groups. They are the data,
information and values from which the group prepared a consensus vision.
1.
Red Group: Facilitator Philip Daffara. Vision 2101
Ensure
a wholistic continuous lifetime care plan is co-created for each
individual, encompassing Prevention, Empowerment and Sustainable
well-being.
To
achieve this Vision we the Redcliffe-Caboolture-Bribie community intend
to:
·
Develop
a web portal of all health service providers in the District to
integrate the sequential delivery of individual (care plan) based
services;
·
Build
community leadership and Ethics;
·
Promote
and provide incentives for the development and maintenance of care plans
using credits for preventative actions;
·
Promote
and facilitate the switch of restructuring of Federal and State funding
and reporting arrangements so that it moves with the Care Plan outcomes.
·
Develop
a system and Strategic Plan to measure the “Health” of the
community, the effectiveness of Strategic alliances and collaborative
partnerships to achieve the vision;
·
Facilitate
the planning of future health service needs with Local Governments (Redcliffe,
Caboolture and Kilcoy Councils) so that social infrastructure is
provided for new developments in accordance with the integrated Planning
Act.
·
Habitat
needs to sustain community health.
·
Empower
Minority and Mainstream communities and provide physical and cultural
space and freedom to allow them to improve their own health. Eg
Indigenous, Youth, Gay)
·
Promote
Life Education at schools and for the disadvantaged to increase the
awareness of the benefits if a lifetime Health Care Plan, responsibility
for their choices and the benefits of a holistic view.
·
Promote
the Investigation of the triple bottom line benefits of introducing a
Health Tax or excise on unhealthy products, to increase alternative
sources of funds; and investigate the impact of having Private Insurance
premium reductions if preventive actions are implemented in an
individual’s care plan.
Shared
values were:
Innovative,
tolerant, sensitive, compassionate, fulfilling, proactive, flexible,
Ethical, confidential, equitable, socially just, sustainable, viable,
responsive, mentors, sharing, honest, openly communicative, building
relationships.
2. Green Group. Facilitator. Eric Dommers.
Vision for Redcliffe Caboolture health system in 2012.
Structural
1.
There is alignment of all district service providers (health,
education, housing, employment, council etc), and all operate on a 10
year funding cycle. This
enables budgets to be designed with a view to reaping
savings/investments from prevention initiatives.
This has enabled local service providers to invest in both inter-organisational
integration initiatives, as well as primary prevention initiatives.
2.
Inter-organisational arrangements include Memoranda of
Understanding linking various service providers for both ‘population
groups’, and whole of population initiatives. All service providers
are fully accredited and are also academic institutions conducting
professional/vocational preparation and training courses. The focus of
these courses is on training service providers to be multi-disciplinary.
Health service providers have agreed on the use of best practice
protocols and guidelines for various disease entities.
3.
Primary care is still provided and co-ordinated by GPs. GP businesses are operated within a range of quasi-corporate
structures. The local
community still regards GPs as a first point of access, and no-one in
need is denied access (ie. some bulk billing arrangements are still in
place). GPs work with a
range of other primary care providers such as “St. Blues” to
co-ordinate the care of patients with complex needs.
4.
Structural efficiencies and a concomitant need for flexibility
have resulted in a wide range of strategic alliances and amalgamations
among health service providers. The
preventive arena has become a market, with payments available for locals
who are in danger of falling through the gaps in the safety net. A wide
range of service packages is available for at risk/marginalised
individuals.
5.
Service information is accessible through various home and
community media, and a key social education tool is ‘service
literacy’, and ‘health literacy’.
6.
All salaried employees work a maximum 30 hour week. This enables
people to have mote quality time with their families, and in supporting
their local community. Volunteering
is a strong community theme. The 30 hr working week has also increased
the levels of employment, and improved local health, and social
connectedness.
Scenario
Mrs.
Jones wakes in the morning, and tunes into her health information
channel. The monitor bids her good morning, bio-senses her health
status, makes a health service appointment with a local GP, and advises
her of the time of the appointment with the Mayne-Blue-QUT-Salvos Health
Service and tune up centre.
Mrs.
Jones’ estranged younger cousin Mary, is homeless, unemployed, and
physically and emotionally depressed.
She is identified as ‘at risk’ by the ‘Blue Salvos’
bounty group. Mary is offered a holistic and co-ordinated package of
services including temporary shelter, a shower, aromatherapy, ‘quality
listening’, a health check, and employment counselling.
The package is paid for by the ‘Upstream Health Investment
Fund’, which pays for the services from a ten year ‘prevention
contributions levy’ contributed by relevant local service providers on
the assumption that there will be a return on their investment through a
reduction in Mary’s estimated future
use of acute and emergency services. Mary’s QoL improves dramatically,
and she is now working as a volunteer for the local council.
3. Blue Group Facilitator.,
Steve Gould
Stated
Vision: ‘Relational Health’
To break down the barriers
through community/service provision, education, and sharing
by empowering that which leads
to seamless care in sustainable health environments
This vision was based upon
descriptive statements of what measures could be observed by
participants within their respective health care fields of work and is
based upon preliminary descriptors of meaningful outcomes/visions
previously mentioned.
Themes
No paper.
High levels of customer satisfaction (both internally
and externally).
Acceptance of “stay ins” as a right of choice to
remove oneself from the community.
Expedient access and processing of health clients
through the medical system by
multi
team approaches.
Layered assessment of health clients to target
interventions based upon primary vs
acute
care.
Empowered and informed communities to facilitate
targeted interventions based upon
primary
vs acute care.
Provision of alternative options to ‘first
choice’ medical interventions other than the GP
as the first point of contact.
Removal of barriers to local GPs which prevent locals
accessing their preferred GPs.
(This situation was due to long waiting lists.)
Increased access points to multiple health providers
within the existing health system by
community.
Increased usage of virtual technologies to alleviate
demands on health system.
Functional integrated planning for local health
community.
Developed partnerships and relationships within the
local health community.
Sharing of health clients and information to facilitate expedient service
to clients.
Partnered ‘funding generation’ activities.
Care providers as a vehicle of change via
communication and braking down the barriers.
Increased opportunities to be
involved in future visioning.
Shared values were:
·
Direction
or told what to do.
·
Learning
·
Sharing
·
Relationships
·
Purpose
·
Results
·
Influence
4.
Facilitator:Ivana
Milojevic, Preferred
Vision for the Future of Redcliffe-Caboolture Health.
Collaborative
Care 2020
·
Only
two levels of government in Australia: e.g. national (federal) and
regional
·
Movement
from the greedy society towards giving one. Cultural values are changed:
promotion of ‘old-fashion’ values of caring, tolerance, compromise.
Sense of community also back.
·
Health
system more integrated: ‘share-care’, collaborative approach,
collaborative action research planning, teamwork – ‘mobile working
teams’ (not necessarily in the same building). Mutual respect and
recognition crucial (instead of saying nurses or doctors or allied
health practitioners ‘are only good for …’). Everyone’s skills
are respected and valued. Also important to accept the limitations of
what service providers can offer.
·
Collaboration
between ‘mobile working teams’ through improved communication and
connection. There is enhanced communication and referral linkages
facilitated by unique ID number, client data record (similar to smart
cart), owned by client.
·
Client
and community are put in the middle – services are planned around them
and their needs.
·
Responsibility
goes back to people themselves who are in charge of their own health.
People are more responsible and accountable for their health. Affordable
and timely access to healthy lifestyle is improved. Focus on lifestyle
change and promotion of wellness. Focus on education (of children,
parents, health workers, community, society).
·
There
is an increased focus on prevention across community service providers.
Resources are re-distributed – there is a balanced placement of funds
on ‘prevention-early intervention-illness-palliative care’
continuum.
·
There
is life course approach to health – intervention at transitional
milestones (e.g. birth, starting school, adolescence, etc.). Services
working together around schools.
Recommendations
·
More
funding into community. Community based system.
·
More
aged care facility. More appropriate staff, nurses, allied health
practitioners, teachers-educators.
·
$
freed by money moving from (1) rearrangement in governance, (2) illness
end – prevention saving money in the long term
·
Land
development taking into account broader set of issues – e.g. public
spaces.
·
Development
of healthy food chain stores.
·
High
employment rate, reduced gap between rich and poor.
·
Euthanasia
debate over – replaced by palliative care [not generally agreed upon]
·
Emergence
of a ‘major computer virus’ – re-introduction of traditional games
among children, as subjects at school, etc.
5.
Faciltator. Marcus Bussey.
The vision had two dimensions – a wellness building
and wellness hug.
The Wellness
Building
This
definition of wellness as an essential social capital builds a 4 tiered
health system that is rooted in consciousness: education for Living.
It progresses through a Community health network of positive
relationships; moves to the physical centres of health and healing and
has at its summit the Spiritual “I”, that acknowledges that the role
of meditation and personal reflection is central to a well being.
This was
represented as a pyramid.
The
“Wellness Hub”
Represented
as a wheel with relationship at the centre.
This
idea places relationships at the centre of health, both personal and
professional.
A
sick person enters the health system through their own chosen modality.
This trusted professional acts as a guide.
She or he may or may not be a GP but they will be able to provide
clear pathways through an integrated system that includes home care,
library access, meals on wheels, mental health, specialist treatments,
etc…
Values
Shift
·
Sickness
to Health
·
Specialist
to Holistic
·
Isolation
to Integration
Key Ideas
·
Needs
Management for client based on personal relationship
·
Relationships
between client and workers
·
Information
Management Infrastructure (Computers)
·
Clear
Marketing of integrated services
·
Opportunities
for self referral
Outcomes
·
Relationships
leading to responsiveness to individual needs
·
Wellness
Vs Sickness resolved in favour of former
·
Value
structures for funding to change
·
Information
management – techno + humane
6.
Facilitator:
Patricia Kelly
Vision:
Client Focused Future
Features
·
One prime level of government
·
Tiered roles addressed staff shortages as professionals are supervising
and engaged in educating families.
·
Community and residential services integrated including transport services - to support well aged
·
A comfortable death -pain free, intervention if required, euthanasia not
illegal
·
Health maintenance and prevention of illness means that everyone
experiences wellness in all aspects, physical, mental, spiritual,
cultural.
·
It is a concerned community, with everyone accountable and responsible
·
No homeless, no pollution
·
Nuclear and extended families
·
Ethical decision making
·
Consensus based on trust. Competition has gone with changed funding
·
Competency testing for over 65s
·
More accountable – accurate, informed choice
o
May
not get the choice you want eg
if you are a smoker or a drinker you may
not get access to heart transplant
·
Better focussed
·
Discourse – turn problems
into challenges
-
At
a personal level only one person stated his preferred life in 2012
but others agreed. The elements were
3 days work, from 10- 4, twice the salary, a healthy person,
valued, resourced to meet individual and community needs
Drivers for change:
·
Funding – limited supply
·
Yearning for quality of life
·
Explosion of technology
·
Expansion of knowledge
The
Client focussed future was presented as a diagram with a virtual centre
at the core.
Coming
off this were these elements
1.
client focussed – in all dimensions
2.
trust
a.
professional respect
b.
re-evaluated roles – chosen core business, specialty areas
3.
one bucket of money
a.
shared accountability
b.
local government to take responsibility for health services
through negotiating and accountability
4.
community services
a.
minimal duplication
5.
consumer choice
a.
“health points” linked to…
b.
smart card,
c.
better marketed to population … linked to…
6.
information integration and transfer
a.
data bases all linked electronically
so no need for reassessment, hard to lie to system
7.
health
maintenance and illness prevention
8.
All These Changes Began With A Pilot Program In 2002/3with the
suggestion this might be North Lakes.
Additional information
Trust.
Service providers need to be non-territorial and recognise the
professionalism of others. This requires trust that has to be built
through discussion hence the pilot project. All agreed that competition
for limited funds creates much of the current tension between groups.
Integration, Including transport services
An
Alternative Scenario to the preferred vision was:
2012
Breakdown Scenario
·
No integration
·
Duplication of infrastructure leading to wastage and inefficiency
·
Under-resourcing
·
Low socio-economic groups leading to
third-world conditions and disasters in multiple areas, including
raised suicide rates.
·
Unrepresentative demographics with majority aged
·
Budget cuts leading to equity issues – not enough people to provide
services leading to
·
Burn-out
There was consensus that we are currently on this track
Facilitator
Comments
1.
Ivana Milojevic
Comment
General
agreement on the first part. ‘Other ideas’ show some contradictions
with the general vision or haven’t been more thoroughly explored, or
there was some disagreement among participants. E.g. there was a
contradiction between ‘more aged care facility’ (promoted by
palliative care nurse) and ‘no need for increased funding, instead,
redistribution of resources’ as well as ‘more balanced placement of
funds’ meaning more resources into prevention and less into
‘end-stage of illness’. Similarly, emergence of a ‘major computer
virus’ inconsistent with the development of electronic ID card. Also,
some ideas too broad, e.g. high employment rate or reduced gap between
rich and poor.
2.
Steve Gould
Reflections
Upon
assessment of events from Wednesday 17th April 2002, the
following questions remain unanswered:
·
Q:
How will GPs release themselves from traditions knowledge based
hierarchies?
·
Q:
How will future policy making impact upon how decisions are made?
·
Q:
How will future funding be dispersed and under what criteria?
·
Q:
What are the implications for future technologies upon industries that
are dependent upon existing health service provisions.
·
Q:
How will the shift towards self-diagnosing and self-dispensing
technologies impact upon current service deliveries?
·
Q:
Who are the future stakeholders?
·
Q:
What is the future role of Government entities? Regulation or
Socialistic Service provision?
·
Q:
Where is the ‘way forward’ manual?
Conflicts
to the Vision
Possible
barriers to ennobling the preferred Vision are:
·
Loss
of power bases.
·
Hoarding
of patient knowledge.
·
Impotence
of action.
·
Translation
into pragmatic languages.
·
Adherence
to existing health practices.
·
Espoused
rhetoric without behavioral transformation.
·
Limited
stakeholder ownership.
Future
Implications
Possible
implications are:
·
Diffusion
of traditional power bases, from GP to allied health practitioners.
·
Equity
and access to medical information.
·
Development
of ‘redundancy mentality’ within practitioners.
·
De-mystifying
the diagnostic processes through knowledge empowerment.
·
Developing
the evolution of alternative health intervention choices as acceptable
and valid.
·
Growth
in litigation behaviours within the community.
Future
Actions
To
continue with the momentum generated on the vision workshop, it is
crucial to follow up quickly with a series of activities to evolve the
endorsement of the vision by all stakeholders. This can be
achieved by:
1.
Plan
a series of workshops to develop ‘ownership’ of the vision. This can
be achieved through stakeholder assessment workshops.
2.
Develop
a ‘Values Statement’ for the Region to dovetail into the Vision.
3.
Explore
preferred scenarios for the Region
4.
Develop a Strategic and Operational plans to enable the
‘operationalisation’ of goals and strategies from the preferred
vision.
5.
Develop ‘meaningful measures’ that PULL the desired future
and act as feedback loops into future reflection workshops.
Patricia
Kelly
Comments:
·
The preferred scenario depends on an assumed computer literacy, which
seems unlikely in
for
the majority of this ageing population.
·
Any futures work with any of the groups or in the suggested pilot
project would benefit from time to air and discuss concerns and current
problems, possibly in separate groups and then come
coming
together with a summary of issues.
·
To do quality futures work the participants
may need to
more
work with the
Futures
ideas and concepts.