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Building better systems on strong relationships: A co-design case study of a local initiative


Paul Cooper ,

Central Primary Health Care Organisation, NZ
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Beth McPherson,

MidCentral District Health Board, NZ
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Leanne Bell,

MidCentral District Health Board, NZ
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Deborah Davies

MidCentral District Health Board, NZ
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In 2012, a small team made up of experienced acute care clinicians was established, and based in the local Primary Health Care Organisation. The challenge was to address specified health targets focused on nurturing excellence in acute care delivery within the General Practice Team environment.

Our primary focus was to build energy and enthusiasm for acute care, increase capability and capacity in practice by working with multiple teams in a co-design, integrative fashion. Foundational work involved identifying the willing who understood the aim and the shared vision, and who had the passion to engage in this new way of working.

Building relationships with the primary health care providers was pivotal - the point of difference involved working in partnership to identify the challenges and opportunities. Being responsive, transparent and honest in a timely fashion was critical. This approach was underpinned by co-design and quality improvement principles. This enabled ongoing trust and confidence in the processes being tested.

Over time as relationships built and confidence grew, the focus changed from targeted initiatives to a whole of systems approach. The building blocks had been laid in the form of individual acute care packages such as standing orders, acute knowledge and skills education programme and intravenous training. Other packages were developed as the need was identified in partnership with the teams involved.

As acute care delivery in the community became more embedded, and the strategic focus shifted to move acute care closer to the health home, another key programme aimed at avoiding unnecessary admissions to hospital evolved. The key aims were:

• To reduce the escalation of care from community to hospital

• To implement specific acute clinical pathways

• To support innovation and responsiveness

• To support a quality improvement approach to acute care which was systematic, focused and reflexive

Our small team acted as a conduit between primary and secondary providers, linking the services together and enabling new connections. The team’s methodology was simple but effective - having the right people at the table, working within their environments to develop effective systems with an overarching focus on integration across the health care continuum.

The presentation will highlight the journey with our key partners, our successes and our challenges. It will depict the evolution of our programme of work from targeted acute care packages, to the development of the Primary Options for Acute Care programme and the introduction of a primary Early Warning Score. It will demonstrate the challenges and highlights of our approach as we continue to move acute care forward for our people in the Manawatu, Tararua, and Horowhenua districts.

How to Cite: Cooper P, McPherson B, Bell L, Davies D. Building better systems on strong relationships: A co-design case study of a local initiative. International Journal of Integrated Care. 2017;17(3):A154. DOI:
Published on 11 Jul 2017.


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