Govt announces a single national health board

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Kyanar

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#2699299 28-Apr-2021 17:54

BlinkyBill:

Umm, the question was how many, and the answer is 16.

I was going to point out that health funding and administration was different between NZ and AU, but the question seemed to be seeking a simple answer.

The question was overly simplistic and for all intents and purposes the answer is zero not 16, because Queensland's Hospital and Health Boards are not District Health Boards. They're glorified facilities, finance and HR management teams really.

neb

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#2699887 29-Apr-2021 23:11

freitasm:
Press release:

Putting a greater emphasis on primary healthcare and ensuring fairer access for all New Zealanders are two of the main drivers of health sector reforms announced today by Health Minister Andrew Little.

I was to learn later in life that we tend to meet any new situation by reorganizing; and what a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency, and demoralization.

Allegedly but almost certainly not Gaius Petronius Arbiter, c.60 AD.

neb

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#2699888 29-Apr-2021 23:13

antonknee:
Can't help but think this is a good thing. The DHBs ostensibly are meant to ensure healthcare is appropriately delivered for their local communities but they seem highly ineffective.

So instead we're going to move everything into one gigantic government department, because we know how effective those are.

tdgeek

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#2699949 30-Apr-2021 07:37

neb:
antonknee:

Can't help but think this is a good thing. The DHBs ostensibly are meant to ensure healthcare is appropriately delivered for their local communities but they seem highly ineffective.

So instead we're going to move everything into one gigantic government department, because we know how effective those are.

Will MP's and their subordinates be taking over from the current 20 DHB head offices? id have thought the 20 DHB head offices are amalgamating to one DHB head office. The MoH obviously has an input to the 20 DHB's they will now have an input to "one" DHB, thereby reducing duplication, fragmentation, and having one set of goals. The 20 H.O's will now be regional management hubs. Seems fine to me

BlinkyBill

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#2699966 30-Apr-2021 08:31

neb:
antonknee:

Can't help but think this is a good thing. The DHBs ostensibly are meant to ensure healthcare is appropriately delivered for their local communities but they seem highly ineffective.

So instead we're going to move everything into one gigantic government department, because we know how effective those are.

As I posted earlier in this thread: the problem is the 20 DHB’s plan independently, have their own processes and systems, and their own variants of tools. There is, for example the apocryphal story of DHB’s paying 20 different prices for the same can of Milo.

The Min Health has to wrangle all of this by reconciling budgets, 20 times, and setting health targets, 20 times.

Patients/citizens get different standards of service because of where they live: DHB ‘A’ is great at colorectal surgery and DHB ‘B’ is very bad at it. Money is spent trying to get DHB ‘B’ up to speed with good care.

The objective of the reforms is to standardise everything by planning once and flowing those plans out/down. This should mean everyone gets the same standard of care AND money from terrible inefficiencies are able to be relocated to the front-line.

But this is not a cost-saving exercise, indeed it will require investment, so net funding increase.

frankv

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#2699979 30-Apr-2021 09:21

BlinkyBill:

The Min Health has to wrangle all of this by reconciling budgets, 20 times, and setting health targets, 20 times.

FWIW, the MoH targets are nonsense, and the DHBs have all set up processes to meet those targets in a somewhat rational way.

For example, MoH has a target

https://www.health.govt.nz/system/files/documents/publications/targeting-emergencies-health-target.pdf

Shorter Stays in Emergency Departments: 95% of patients will be admitted, discharged or transferred from an Emergency Department within six hours.

Really, there is no medical benefit from a shorter ED stay, and sometimes this is completely contrary to good medical practice. Nevertheless, it is an MoH target on which funding depends, and therefore hospital management insists on. So, how to achieve this without spending any money (which is always a requirement)?

Example 1: a patient with a suspected heart attack needs to have troponin blood tests taken 6 hours apart. The first blood test doesn't get taken immediately, and it takes a while to get the results back from the lab. What should the doctor do with this patient after 6 hours? Admit them to a ward? Discharge them? Transfer them to another hospital?

The only medically correct answer is to admit them, but there's little actual point in transferring care of the patient from ED to a ward doctor. So every hospital has a "ward" which is in fact part of ED. This "ward" may resemble a waiting room with chairs and no beds at all (but with a nurse supervising). Or it may not exist at all physically... a patient in an ED bed stays where they are, looked after by the same doctors and nurses, but is "admitted" to the virtual ward. If they have actually had a heart attack, they're then transferred to an actual ward.

Example 2: a patient with suspected but not immediately dangerous illness or injury that doesn't immediately need lab results or x-rays (e.g. headache, D&V, stomach pains, mental health) presents at ED. Their problem may resolve itself in a few to a dozen hours. The trick here is to *not* treat them. They will be sat in the waiting room, under the gaze of a nurse. Treatment only officially starts when they are officially triaged, so choosing to let someone sit in the waiting room is *not* defined as triage. If they take a turn for the worse, or if they've been there long enough to suggest that it won't resolve itself, they're then triaged and the 6 hour clock starts. And 6 hours later, if there's no change they're "admitted" as above.

Example 3: a patient inadvertently stays in ED for more than 6 hours. No problem... retrospectively "adjust" the triage or discharge time.

Lego

Shop now for Lego sets and other gifts (affiliate link).

BlinkyBill

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#2700035 30-Apr-2021 11:23

I didn’t say they were any good or made sense, I just said they did it and it takes time/effort/bureaucracy/money. I do know they did it primarily because different DHB’s achieved different outcomes for the same process/procedure, and the targets were/are an attempt to bring DHB performance up to a standard.

I’m afraid I don’t know anything about ED best practice.

neb

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#2700038 30-Apr-2021 11:29

BlinkyBill:
But this is not a cost-saving exercise, indeed it will require investment, so net funding increase.

There's an episode of Yes Minister that ends up like this isn't there? "The Economy Drive" I think.

neb

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#2700041 30-Apr-2021 11:33

frankv:
FWIW, the MoH targets are nonsense, and the DHBs have all set up processes to meet those targets in a somewhat rational way.

In other words they're examples of Goodhart's Law in action.

jonherries

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#2700215 30-Apr-2021 18:35

neb:
frankv:
FWIW, the MoH targets are nonsense, and the DHBs have all set up processes to meet those targets in a somewhat rational way.

In other words they're examples of Goodhart's Law in action.

This is the reason I use Geekzone - Goodharts law - so obvious but didn't know about it…

Jon

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