Abstract
Background: In 2007 the Canterbury Health System embarked on transformation to build an integrated health and social care system based on trust that engaged in a community of common interests in co-designing and stewarding the system. Measured in 2020 the model was demonstrably successful delivering measurably improved outcomes including a reduction in hospitalisation, reduction in the need for long term residential care and a reduction in inequity. The collective impact model developed in Canterbury has influenced approaches adopted in many other health and social care systems in five countries. Although Canterbury remains the broadest implementation of the model encompassing health, social care, mental health, education, and justice key learnings have proven to be transferable.
Approach: We implemented a collective impact model that emphasised shared systemic understanding, problem-solving, and collective ownership. The approach engaged a diverse group of stakeholders, including those affected by the system and those working within it, to build trust relationships and facilitate shared decision-making. Our approach included adaptive leadership and a co-designed outcomes framework that engaged the whole system in shared measurable objectives and collective reinvestment. The emphasis was on contributing to a shared outcome rather than seeking to attribute specific outcomes to specific initiatives.
Results: The outcome was enhanced system-level agility and coordination through improved communication shared decision-making and real-time feedback mechanisms. This resulted in a community mobilized towards common outcomes, with a clear understanding of each participant's role in achieving these outcomes. Additionally, the way of working enabled local system design and reinvestment, promoting globally recognized good practices tailored to local needs. With clear measurable outcomes such as reduced hospitalisations, reduced demand for long term residential care and reduction in inequity.
Implications: The model success demonstrates the importance of building trust and collective ownership in systemic change. It illustrates how open and transparent use of exploratory data analysis and predictive analytics such as Lightfoot signals fromnoise and co-owned coordination models such as HealthPathways contribute to building trust in a whole of system and provide the platform for agile responses that are adaptable in crisis. This different approach to system improvement enables rapid implementation of new models of care in a framework of continuous improvement. The lessons learned highlight the value of inclusive and co-designed approaches coupled with adaptive commissioning and simplified funding models support in achieving sustainable systemic improvements.