Abstract
Introduction
The Health Quality & Safety Commission, a New Zealand crown agency charged with quality improvement across the health sector has recently begun to work in primary care and needed to build sector relationships and its own understanding of the complexity of primary care.
Beginning in February 2017, the Commission used co-creation to develop, implement, evaluate and improve Whakakotahi, te reo Māori for ‘to be as one’, the Commission’s primary care improvement programme. The Commission was guided by sector experts, the improvement teams and an external formative evaluation to enable rapid learning and adaptation.
Whakakotahi aims to improve health outcomes with a focus on Māori health gains, equity and consumer experience in primary care. The theory of change primary drivers are: partnering with Māori, integration, enhanced sector leadership and quality improvement capability, alongside consumer co-design and reduced harm and variation, supported by our use of data and knowledge. The collaborative methodology was adapted to meet the specific needs of our people and context. Key to this were primary care stakeholders and consumers, particularly Māori, Pacific peoples and/or those living in low socio-economic environments experiencing inequitable health outcomes.
Discussion
Whakakotahi is small-scale but expanding each year with an increasing focus on equity. In 2019 all participating teams serve low socio-economic populations. The eight teams include four Iwi and Māori providers, and a Pacific provider.
Whakakotahi teams are having a positive impact. Whakakotahi has built quality improvement capability in the sector alongside promising gains in health outcomes and narrowing of equity gaps. Relationships and partnerships have been built to form the base for an enduring programme of work in primary care. The challenge now is to progress to scale and spread while maintaining the key factors that have made Whakakotahi a success particularly for populations experiencing inequitable health outcomes.
The co-creation approach and small-scale incremental learning means that Whakakotahi has been able to ‘fail small’, learn and respond with agility to the needs of the sector. This led to the formation of new partnerships both within the sector and with central agencies that draw on existing expertise. This has been a key factor in maintaining the cultural safety of the Commission team and the participating primary care teams, while supporting Iwi, Māori and Pacific peoples’ approaches to improvement.
Conclusions
Partnerships and relationships are key; expertise exists within the system to improve the system. Whakakotahi has worked alongside primary care improvement teams and other agencies to seek improved health outcomes, equity, integration and consumer co-design. The teams’ diverse cultural contexts are teaching us new ways of working. This bottom-up approach, co-created with the sector as partners, has generated some early wins, but the challenge of scale-up and spread remains.
Lessons:
• Start small, build knowledge incrementally.
• Partner with those with cultural expertise and lived experience of care – especially those most affected by inequitable health outcomes.
• Ensure engagement, relationship building up front.
• Listen, learn, adapt, respond to local context.
• Share improvement stories in various fora and media for impact.