Counties Manukau

Reducing bed days for Counties Manukau District Health Board

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Background to the Role

Counties Manukau District Health Board ('CMDHB') (6,000 employees, $1.46 billion revenue) is responsible for the funding of health and disability services and for the provision of hospital and related medical services for the circa 500,000 people of Counties Manukau.

The Business Need

The traditional model of care used by many DHBs is highly hospital and consultant centric, with poor service integration between secondary and the primary and community care sector. In light of the forecasted patient and demand growth in many regions, and the constrained funding environment, the result is that Middlemore runs out of beds in 2015 / 16. This needed to be addressed.

The Cranleigh Solution

In line with the Ministry of Health's established priorities, Cranleigh was engaged to develop the Business Case, under the Better Business Case Methodology, for improving community-based care in three Localities (East Auckland, Franklin and Manukau) within the Counties Manukau region.

The key to Cranleigh's approach was to combine analytical and advisory capabilities with an extensive and wide-ranging stakeholder engagement process. Cranleigh recognised that in developing a community health solution it was critical that the proposed solution was clinically led and was embraced and implementable within the community it served.

The key steps of the Cranleigh approach included:

Clinical engagement, leadership and locality governance forums and groups established between the key sectors and organisations (e.g. hospital, GPs and PHOs and other providers).

Establishment of work streams and programmes to determine and assess the feasibility and financial viability of opportunities to address issues.

Wide sector and community engagement with key clinical and non-clinical stakeholders including Maori and Pacific health providers, community workers, GPs and specific consultants (e.g. geriatricians, respiratory physicians etc.)

Securing locality and clinician endorsement of the new community services, initiatives and models of care and partnerships tested through a cost-benefit analysis that included key enablers (e.g. IT, coordinators and project managers).

Through this process, Cranleigh was able to develop a robust Business Case with demonstrable stakeholder buy-in for each locality. Each Business Case provided a compelling case for change which was commercially viable and optimised value for money in each region. Cranleigh's Business Cases were well received by the Ministry of Health and all three locality projects are currently in the implementation stage.