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What Does A Functioning Healthcare System Look Like? – Expert Q&A
Amid ongoing news coverage of medical staff shortages and drastic changes to Te Whatu Ora leadership, the SMC asked experts to provide an overview of what public healthcare systems need in order to thrive.
Professor Robin Gauld, Co-Director, Centre for Health Systems and Technology, University of Otago, comments:
What does a functioning healthcare system look like?
“This would be a good example of what is called practising operational excellence. This means that there are clear systems and processes throughout the system that are evident and known to all. Strong clinical leadership is fundamental to developing operational excellence in healthcare along with the support of those skilled in facilitating operational excellence. Many other highly complex industries such as airlines have a strong focus on this. There are good health systems globally that also embed this focus and are shown to perform significantly better than those who don’t.”
What kind of benchmarks exist to measure how well a country’s healthcare system is doing and how does New Zealand’s healthcare system compare?
“We mostly use routine data collected at the national level to measure performance; mostly this does not look at granular issues such as how well local services perform although we can do this as we have a lot of data. The key to this is building a reliable set of indicators which highlight relevant performance and outcome areas.
“New Zealand does reasonably well by global standards on quality of care and efficiency of service delivery but we do very poorly on access and equity.”
Has there been any research around the NHS’ long standing crisis that is now informing how other countries manage their own healthcare systems?
“Organisations such as the King’s Fund, the Nuffield Trust and the Health Foundation in the UK have done work on this. There is a strong set of recommendations around building integrated health systems with a solid patient voice and clinical leadership.
“We have done this historically quite well in New Zealand; indeed, the UK looks at NZ as an example. We called this model an ‘alliance’. The alliance model is based on bringing together healthcare professionals and leaders from across the entire health sector, getting them around the table together, sharing resources and building whole-of-system approaches to care design, funding and delivery.
“Alliances basically came apart from the late 2010s and mean we presently do not have a mechanism for whole system planning. Hospitals and primary care are treated separately and there is no joined up planning mechanism. It means that the system is fragmented and this is both inefficient and complicates what is already a complex system.”
No conflict of interest.
Professor Rhema Vaithianathan, School of Social Sciences and Public Policy, Auckland University of Technology, comments:
What does a functioning healthcare system look like?
“Looking at the basic system that delivers health care, what I am concerned with is are:
- universality (i.e., Are people who would most benefit from health care able to do so?);
- efficiency (Are administrative costs minimised? Is technology being used to bring down costs of care? Are professionals spending time on the highest value care?);
- innovative capacity (Level of digitisation and integration of health care records; Are we ready for machine learning and artificial intelligence applications?);
- trust (Are there systems to ensure that citizens can and do trust the advice of health care providers?); and
- localised decision-making (Are doctors, nurses and clinicians who see a way to do some things better able to get it done?)”
What kind of benchmarks exist to measure how well a country’s healthcare system is doing and how does NZ’s healthcare system compare?
“The Commonwealth Fund produces a range of studies that compare health care systems.
“Research that compares New Zealand is from the 2023 Kings Fund report. We see that the NHS is really in trouble – but actually, the NZ system is pretty okay on most of those metrics – except maybe some concerningly high levels of GPs saying they will quit and ageing out.”
What else would you like to highlight on this topic?
“I have long advocated that we move away from using the term ‘financial deficits’ or ‘living beyond its means’ to describe the health care system.These are not accurate statements about how health care funding works. All it does is stress the frontline and there is absolutely nothing that anyone can do about the majority of the costs of care which are for acute patients. It was brought in to try and encourage the system to reduce costs – and it has done its dash. We should change the nomenclature. There are much better methods for understanding health system efficiency and Governments should use that for extracting efficiencies.”
No conflicts of interest declared.
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