Examining the pros and cons of telehealth
Dr Fiona Graham, of the University of Otago’s rehabilitation and teaching unit, worked on the telehealth project with Morgan Curry and Lena Sutherland, alongside the South Island CDS working group.
Telehealth can be an effective option to provide care for families accessing child disability services, but a hybrid approach works best, a telehealth project analysis has revealed.
The project is one of several South Island Alliance Child Development Services (CDS) innovations, examining quality of care and new ways of working. Telehealth is the use of digital communication technologies to deliver healthcare remotely, via cloud-based video conferencing services such as Zoom.
Dr Fiona Graham, of the University of Otago’s rehabilitation and teaching unit, worked on the project with Morgan Curry and Lena Sutherland, alongside the South Island CDS telehealth working group.
“We wanted to take a close look at the best parts of practice using telehealth, unpack the subtleties, and see if there were any lessons to be learned,” says Dr Graham. “We were pretty sure it could work for some families and that it probably wouldn’t work in other situations – but we weren’t clear about what those situations were.”
One of the first components of the study was asking therapists if they felt like their organisation supported the use of telehealth. Did they feel adequately trained? Was it viewed positively by their professional culture? “This is really important in the context of delivering telehealth, as people are unlikely to adopt a new method of working if they don’t feel it’s a valued, recognised legitimate practice, or don’t feel confident enough in their own skills.”
A range of methods were used to gain qualitative and quantitative information for the project, including a two-hour training workshop, and interviews with both clinicians and families.
The training workshop was created by the project team and was attended by many clinicians across the South Island. The event included self-funded international research from Mindy Silva, of Nelson Marlborough CDS, and high-quality engagement with Māori, presented by two academic scholars from the University of Otago – Anna Tiatia Fa’atoese Latu and Arianna Nisa-Waller.
The final component of the project was a set of interviews with clinicians who had their case notes audited, as well as feedback from families who received telehealth. Dr Graham, who was contracted to assist with the study, says this part of the process was “really enlightening”.
“It was fantastic because for both clinicians and families, telehealth generally worked really well for them – but they also all talked about its limits and when it doesn’t work. So, this is what we need to address or to take on board as we design better services that are better suited to telehealth.”
Analysis of evidence-based practice telehealth showed some issues with limited resources and limited training. “Although we provided a workshop, clinicians wanted more support to be able to take that initial step into telehealth. Something more comprehensive than our two-hour introductory session seems to be warranted.”
While some of the obvious advantages of telehealth included increased convenience, flexibility and less travel time, one advantage was more unexpected – the therapist was able to gain much clearer insight into the families’ real life when using telehealth.
“Quite a few therapists as well as families mentioned that when using telehealth, the behaviour of the child and the family routine wasn’t interrupted by them being there in-person. For example, seeing the mum with the headset on and the phone in her hand as she’s going through her normal routine with their child, is very insightful for the therapist.”
Other feedback included that while telehealth sessions are more convenient, some of the “gloss” is off, compared to child-direct hands-on therapy. “One of the comments was that apart from saving travel time, it’s just more fun and easier to catch-up with someone in person.”
Working mothers were also positive about the ease of scheduling a telehealth session over an in-person consultation. Some families talked about both positive and negative aspects of telehealth but said overall it made no difference to the level of outcome achieved for themselves. “Aside from the differences in telehealth compared to in-person service delivery, families and therapists valued telehealth because of the difference it made to other people – enabling more families to access services.”
One of the downsides of telehealth is when a child’s behaviour is particularly challenging, or the family is going through a stressful phase. “During peak times of stress, in-person can be better.”
In cases where a family’s contact with their child’s therapist was largely via telehealth, they all said it worked because they trusted the therapist and had already met them in-person at one point. “This was deeply felt by the caregivers and even the clinicians said they felt it worked better with an in-person contact initially – and we did not interview anyone who had not had that.”
Both the therapists and families described exemplary care during telehealth sessions. In particular, high levels of family engagement in problem solving, and sophisticated communication skills by the therapist. “Many families commented on how well the therapist listened to them and understood them. So how therapy is delivered definitely matters, particularly how the therapist engages.”
Dr Graham says the project was the ‘perfect marriage’ between interested and curious clinicians, and the advantage of academic skills to frame the project and findings to peer review standards, while also distilling findings that are applicable locally. “For me, the level of engagement from all the stakeholders in this project has been absolutely instrumental in its success.”
Project SEARCH internships a success
Bella Lammers, Project SEARCH intern at The Champion Centre.
Bella Lammers attended The Champion Centre as a baby almost two decades ago – today, she is working there as part of a one-year internship programme.
Project SEARCH is designed to give high school leavers with learning disabilities the work experience and skills they need to enter the workforce. Bella is over halfway through her 10-week internship at The Champion Centre and is a valuable member of the team, says Executive Director, Wendy Entwistle.
“We have staff who have worked here for a long time and they remember Bella when she was little,” she says. “We are really enjoying having her back here – not only because of the work she does, but Bella is a friendly, cheerful person to be around.”
Located at Burwood Hospital, The Champion Centre provides multi-disciplinary early intervention services to infants and young children with significant disabilities.
Bella’s tasks include setting up and clearing away morning tea trollies, stacking and unstacking the dishwasher, cleaning equipment and toys from the playroom, as well as sorting out the linen. This also frees up time for other staff members, so they can focus more on their roles.
Based on an international school-to-work transition programme, Project SEARCH is a collaborative model supported by a host business (Canterbury DHB), and supporting partners (CCS Disability Action, Riccarton High School, Enabling Good Lives) who form the steering committee. The interns participate in an hour of classroom instruction each morning at a Burwood-based classroom, before attending their internship roles. A skills trainer assists with job-skills training at the internship site.
Bella, 19, works every week day from 10am-2pm, catching the bus from home in Rolleston at 6.30am. She is very dedicated to the job and says she loves the friendly atmosphere. “Everyone talks to me, and they miss me when I’m not here.”
The internships are mainly based at Burwood Hospital and students generally complete three 10-week internship rotations within the nine-month period. This provides an opportunity to learn what type of work best suits their interests and areas of aptitude.
Jacob Levington during his internship at the Child Development Service.
Jacob Levington is currently completing the programme’s first off-site internship for 2020-2021, at the Child Development Service (CDS), based at Montreal House.
His tasks include administration, laminating patient files, shredding and recycling, cleaning, sanitising and packing away toys, setting up and restocking the food court, as well as laundry orders and car washing.
Jacob says he enjoys learning new skills and the social aspect of the role. “I love the staff, they are awesome,” he says. “Admin is my favourite, because I love paperwork. I’m so happy to come here and I’ve made lots of good friends.”
Demarnia Lloyd-Harris, Jacob’s Skills Trainer, says he was chosen as the intern for CDS because he was curious about the organisation and how everything worked. “Jacob is quite independent and confident in new situations, so it’s working really well. This is the third year of Project SEARCH and there are huge untapped capabilities in these young people.”
CDS Therapy Assistant Debbie Hodgson says Jacob also joins in with their after-work social activities and they have been “very lucky” to have him. “I’m dreading when Jacob leaves as he has been so helpful. He is so capable and has exceeded our expectations. He comes in and checks his schedule and gets on with things. If he needs help, he has the initiative to ask. We have faith in what he does, particularly the cleaning of our toys, which is very important in this current environment.”
Empowering breastfeeding mothers across the West Coast
Raewyn Johnson (top left) and some of the Mum4Mums at Reefton – Rose, Ayla and Christine – along with Susan Barnett, of West Coast DHB (far right).
For the past 15 years, the Mum4Mum Peer Counselling programme has been providing breastfeeding mothers across the West Coast with support, encouragement and guidance.
Breastfeeding advocate Raewyn Johnson has been there since the beginning. As one of the first two West Coast PHO employees in 2007, Raewyn and a former colleague – both lactation consultants – were contracted to provide breastfeeding support. After tweaking the La Leche League breastfeeding counsellor programme to fit the local community, they named it Mum4Mum.
Today, Raewyn job-shares with her colleague Erin, covering different areas of the West Coast to provide lactation consultancy services, education and support. They also train women in their communities to become Mum4Mum Breastfeeding Supporters.
The programme works by training mothers to empower and support other mothers on their breastfeeding journey. “We now have over 200 Mum4Mums on the West Coast and across New Zealand, who are helping other mums with the knowledge they’ve gained during their training and their own personal experience, and it just works so beautifully,” says Raewyn.
Mum4Mums can meet with parents to talk about breastfeeding before or after the baby is born. They have a wide range of personal experience, including older first-time parents, teenage parents, twin breastfeeding, as well as problems such as sore nipples, engorgement, or mastitis.
Raewyn Johnson, breastfeeding advocate, West Coast Primary Health Organisation.
Raewyn originally trained as a registered nurse and completed Plunket training prior to having her own children, who are now adults. “I breastfed both my babies, and with my first daughter I had cracked nipples, multiple bouts of mastitis and multiple doses of antibiotics, so I have real empathy for women who are struggling with breastfeeding – which is one of the reasons I was inspired to go further into the field of maternal health.”
The trained volunteers are included in the West Coast Breastfeeding Handbook, which is full of information about breastfeeding, alongside the list of Mum4Mum Breastfeeding Supporters. “The mothers who wish to have their names in the book provide a photo, contact details and a blurb about themselves and their breastfeeding experience, so that a mother looking through the book can choose who to contact for support and advice.”
The two-hour training classes are run over eight weeks and the Mum4Mum volunteers graduate with a certificate. “Some mums have gone on to use the certificate when applying for jobs, which is fabulous, and another mum went on to complete her childbirth educator certificate and now teaches antenatal education.”
Quarterly reports on the Mum4Mum Peer Counselling Programme prove the service is working. Not only are many mothers being supported, but a 2015 evaluation of the service showed 100% of the trained volunteers felt more confident with their own breastfeeding after completing the course.
“A significant number of them breastfed for longer than they thought they would as well, which is really positive. It’s really important we continue training these mums, as some of them who trained 13 or 15 years ago are still supporting women, and a lot of the work is also done by the newest mums as they are the ones with the little babies who are still going to the coffee groups and playgroups.”
The evolution of Whare Manaaki o te Tai Poutini
Eli-Ana Maiava
Eli-Ana Maiava created Whare Manaaki – a Kaupapa Māori community space for Mawhera (Greymouth) locals – knowing that a similar space was a valuable support system for her when she was a new mother. “My life was literally saved by a community space when I was living in the Hutt Valley,” she says.
“I had been experiencing some quite traumatic mental health issues and the scariest thing for me at the time was to be home alone with my baby. So, I could go there and be around other people, have a conversation and a cup of tea while someone held my baby.”
After moving to Mawhera from Wellington three years ago to connect with her iwi and Māori whakapapa, Eli’s aim was to work specifically for improving wellbeing of Māori on the West Coast, where her whānau are from. This led to a role in Community and Public Health (CPH) as Hauora Māori Health Promoter, when she noticed a gap in the community and decided to create Whare Manaaki.
What started out as a parenting programme, grew into a kaupapa Māori space for the entire community, offering a range of programmes to meet a variety of needs. Eli’s 20-year background of early childhood teaching, as well as mentoring, management, and a master’s degree in adult education was useful in creating and leading the programmes.
She also carried out research by interviewing 20 whānau on the West Coast about what their needs were and what barriers stood in the way of them being met. “How do we ensure our babies have good lives, with solid parenting? It’s about making sure that their whānau have their basic needs met so they have the capacity to then actively and intentionally think about the way they’re interacting and caring for their tamariki. That can be challenging when they’ve got a lot of stress hanging over their heads. We decided that a culturally safe, warm and inviting space where you can bring your family was the best way to support Māori parenting here on the Coast.”
“Māma or whānau can drop in for kai, community dinners or a cup of tea, and we’ve got plenty of resources for the tamariki to play with…”
The programmes range from gardening groups and breakfast clubs, to pepi and whānau coffee groups, and community Kapa Haka. “Māma or whānau can drop in for kai, community dinners or a cup of tea, and we’ve got plenty of resources for the tamariki to play with. We also do a Te Reo Māori playgroup where we do a bit of a song and a book reading session, to encourage use of Te Reo.”
An antenatal group is being developed and a Friday night rangatahi hangout programme has just started. Teenagers can come in off the street, have some kai, play some games and “just chill out together – there’s nowhere else for them to hang out on a Friday night.”
Community kai at Whare Manaaki
Staff at Whare Manaaki are currently working with other agencies to run a Safe Woman, Safe Family group, for women affected by violence in their lives, as victims or offenders. “We’ve also got a lunch programme where people can come and make kai and take it away for work or school, so that they’ve got full bellies. We offer everything with no judgement, we’ve got a pataka (pantry), vegetable garden and a freezer full of food to share with anyone. We’ve also got a community cupboard full of blankets and shoes and children’s clothes – people can help themselves.”
Eli, a mother of four tamariki aged 4 to 13 years, has resigned from her CPH role so she can dedicate more time to Whare Manaaki, which has grown exponentially. “There is just so much need, interest and support for it in the community. I’m not doing it alone, it’s part of a bigger collective and a community-led space and we all do our bit. It just took someone to take that first step and provide a space, and everyone else is filling it with all of these wonderful things.”
Eli is also a part of the South Island Alliance, Te Pā Harakeke/Nurturing Care in the First 1000 Days steering group, which is currently creating its framework principles for health services. “It goes back to well whānau and parents create well children, so looking a bit wider than just the children’s needs – what are the family’s needs in relation to doing well with that child?”
She says her ultimate goal in life is to raise wonderfully kind, confident and independent children. “And because I think collectively, like Māori tend to, I know that I can’t create those things for my children without them being surrounded by those things outside of our home as well. Ultimately, it’s about creating the environment I want my tamariki and other tamariki to grow up in, that’s going to instil a positive sense of identity and collective thinking around sharing of resources and wellbeing. That’s what I want in any project that I’m involved in, is to help create a better world for our tamariki.”
Step forward in quality improvement project for children with Type 1 diabetes
The five South Island DHBs have implemented a management database as part of a quality improvement project for children with Type 1 diabetes. Supported by the South Island Alliance Child Heath Service Level Alliance, the Diabetes Patient Management System (DPMS) collects patient data and provides benchmarking for Australasian quality improvement reporting.
Dr Martin de Bock, Paediatric Endocrinologist for Canterbury DHB and West Coast DHB, says the system also helps with collecting data for workforce planning. “This is really important as we think about our diabetes services and what we’re likely to see in the future, so that we can plan for it appropriately. Without the data, you can’t measure that. So, this is an easy, designed-for-purpose model that allows us to carry out that forecasting.”
With a five-year national roll-out plan, the long-term goal is to ensure equitable care for all New Zealanders with type 1 diabetes, he says. “Wherever you live in the country, we want to make sure you can access timely, equitable care and still get the outcomes and support you deserve, no matter which DHB you belong to.”
Ben Wheeler, Chair of the paediatric type 1 diabetes working group, says benchmarking allows both staff and patients at each DHB to advocate for areas where there may be needed. “After asthma, type 1 diabetes is the most common chronic illness in childhood, so it’s an important illness to focus on, as most units haven’t had a diabetes database that has allowed the opportunity for benchmarking before. This will allow us to see how we’re doing, celebrate any successes, and begin standardising activities across DHBs, so that we’re all working towards the same goal – we’re really pleased with the progress we’ve made so far.”
Stephanie Read, Child Health Regional Programme Facilitator, South Island Alliance, says it took a dedicated working group, support from each of the South Island DHB IT teams and engagement from all the clinicians involved to get the database up and running in each DHB. “Ultimately, this will support the provision of consistent services to children with type 1 diabetes and their families across the South Island.”
WCTO QI Steering Group Member Profile: Lydia Mains
After recognising a gap for mothers-to-be who needed extra support beyond the Well Child Tamariki Ora (WCTO) programme, Motueka Pūkenga Kaiwhakahaere Nurse Manager Lydia Mains created the Tūhono Service.
The kaupapa Māori programme, for young Māori parents in Waikawa and Motueka needing intensive and personalised support to nurture their babies, aims to strengthen connections and fill any gaps as early on as possible.
“We work closely with these women as they head into parenthood. They may not have family support or a secure relationship, or they may have had a traumatic childhood themselves. They could also have a mental health or addiction issue. It’s about early intervention, so their babies have the best start to life possible.”
Lydia and the team provide home visits to the parents, developing close, trusting relationships with them. “We provide support for any challenges they may be facing, so they can be the best parent possible and focus on enjoying their babies. To start with, we help them choose a midwife and look at any other needs they may have, such as finding suitable accommodation. You can’t address the need until you organise the chaos in their lives, while they’re in survival mode.”
Lydia followed her passion for Māori health, family and whānau throughout her career, after graduating with a nursing degree in 2000 and completing a post-grad qualification in WCTO. After working in Māori and sexual health in Nelson for a few years, Lydia became a WCTO nurse for Motueka, where she formed strong community connections.
In 2014, she began a role with Te Piki Oranga, a kaupapa Māori primary health provider for Te Tau Ihu o Te Waka a Maui (the top of the South) as a Māori community health nurse. A year later, Lydia was promoted to nurse manager, leading a multidisciplinary team working with referrals for vulnerable Māori. “It’s a real privilege to be working with whānau on such a holistic level,” she says.
Lydia developed the Tūhono Service last year after funding for the programme was approved by the Ministry of Health. “Navigating the health system can be hard and scary, so we support them to access these services independently. If they are feeling anxious about anything, they can just call or text their navigator for a debrief, comfort or just reassurance that they’re doing the right thing.”
The service also aims to connect them with their Māoritanga. “This can have a really positive effect on their health and wellbeing. Not only does it provide a sense of belonging and help them feel more connected to their culture, but they also want their children to grow up knowing where they came from.”
Watching the mother’s self-esteem and confidence grow is amazing, Lydia says. “It’s so rewarding to be able to be a consistent person in their lives. We want them to have access to high quality care, so they can reflect back and feel well supported – and have a positive outlook for the next stage.”
Lydia, who has a 19-year-old daughter, joined the South Island WCTO Quality Improvement Steering Group in 2019. Her extensive experience and wealth of knowledge is an asset to the team. “I really enjoy working with likeminded people, as we bring our own specialties to the table and collectively find solutions to any issues we’ve identified. It’s great that whenever I find any gaps or see how something could be done better through my nursing manager role, I can take those queries to a higher level and focus on making those improvements.”
Michael McIlhone Steps Down From WCTO Quality Improvement Group
Michael McIlhone, has chaired the WCTO QI group for the last three years.
Following over three years chairing the Well Child Tamariki Ora (WCTO) Quality Improvement (QI) steering group, Michael McIlhone is officially stepping down from the role. “It’s been a real privilege and thoroughly enjoyable,” he says. “I take pride in the collective and meaningful work that the South Island WCTO has completed during this time.”
With a new WCTO QI facilitator taking over the role earlier this year, Michael felt it was an opportune time for new thinking and leadership. “Three years is a good time to evaluate my effectiveness and relevance to the group. Our previous facilitator, Anna Foaese, has done fantastic work over the years and I equally appreciate the enthusiastic and different perspective that our new facilitator, Marijke Dryfout, has brought with her.”
He says the voice of the consumer and Māori is imperative for WCTO QI, which has been well- served and represented over the past few years. While Michael resigned as chair earlier this year, he has been guiding and supporting the group over the COVID-19 response, until a new chair is appointed.
He says chairing the group is a juggling act between individual DHB priorities and the overall needs of whānau and pepi across the South Island. “There’s still plenty of work to be done on adapting, adopting and not reinventing the wheel if it’s already been done somewhere else. Over the years, I have enjoyed the collaboration and willingness of everyone from the South Island to contribute and learn from each other.”
Michael has an impressive 40-year nursing background and was appointed in his current role as Director of Nursing for Pegasus Health in November 2014. He also sits on several other committees and health care working groups, including the South Island Mental Health and Addictions Service Level Alliance, Nurse Executives of New Zealand, Health Practitioners Disciplinary Tribunal, Kaikoura Health Te Ha o Te Ora facility Clinical Leadership Group, Canterbury Clinical Network Leadership Team and the Canterbury Infection Prevention Control Executive Committee.
Facilitating Change At The South Island Child Protection Forum
Canterbury DHB paediatric radiologist Kimberley Thomson presents at the annual South Island Child Protection Forum, held in Christchurch in February.
Every day, there is an average of around 40 family violence episodes in Canterbury alone – and 61% of those cases involve at least one child under the age of 18, living with the perpetrator or victim.
While police, health professionals, social workers and other dedicated staff are committed to ensuring the safety of families and whānau, organisations don’t often get the chance to get together and talk about what’s working and what isn’t.
The annual South Island Child Health Alliance Child Protection Forum was created to provide this opportunity. On 18 February, a range of paediatricians, family violence intervention coordinators, Oranga Tamariki liaison staff and other interested professionals from across the South Island met in Christchurch, to share best practice and hear from experts in child protection.
The forum was chaired by Canterbury DHB paediatrician Clare Doocey, who gave a presentation on the challenges for agencies and staff working in this field, titled When does it go wrong? Other speakers included Leanne McSkimming, director of Canterbury District Integrated Safety Response to Family Violence, as well as Helen Fraser, the Ministry of Health Violence Intervention Programme (VIP) portfolio manager, who spoke about the challenges, changes and future of the programme.
Kimberley Thomson, a Canterbury DHB paediatric radiologist, presented on Dating fractures in cases of suspected child abuse.The event provided a chance to network and spark discussion, says Pene Kingsford, Clinical Manager of the Child Safety Service. “I think it’s a great opportunity for us to meet, collaborate, listen and talk about our processes, thoughts and ideas – that’s how we upskill and facilitate change.”
West Coast Dhb Leads The Way With Safe Sleep Policy Audit
The most common cause of death in the first year of life is Sudden Unexpected Death in Infancy (SUDI). Nearly half of these deaths are due to accidental suffocation or strangulation in bed and many could have been prevented if the babies were put to sleep safely.
A graph showing causes of death for infants under one year old. Source: Numerator: NZ Mortality Review Database.
To help reduce these deaths, South Island DHBs adopted a Safe Sleep Policy for infants, from birth to six months. An audit tool was also developed to measure implementation of the policy and support any improvements – and West Coast DHB is leading the way.
West Coast DHB was the first South Island DHB to complete its three month audit of the policy’s implementation. The DHB provides information and models the best safe sleeping practices to young families, as well as smoking cessation advice and breastfeeding support. Resources such as safe beds and pepi pods are also discussed.
The policy ensures DHB health professionals have the necessary skills and resources to provide safe sleeping arrangements within its facilities; and consistent verbal and written advice about safe sleeping. This includes auditing between five and 10 infants every three months in both maternity and paediatric units, ensuring all relevant documentation is current, and that staff are well trained in supporting safe sleep.
Safe sleep is about ensuring baby sleeps on their back, on a firm surface with their face clear of anything that can make it hard to breathe, and in their own bed for every sleep. Babies also develop best and have lower risk of still birth or death if the pregnancy was smoke-free and if the home environment is kept smoke-free after birth.
West Coast DHB Acting Clinical Midwifery Manager Linda Monk says staff are very supportive of the audits and it’s a great way of making sure safe sleep is a high priority. “One of the reasons it’s working so well is that we’ve delegated someone to carry the audits out.”
The South Island Safe Sleep Policy Audit Working Group was established by the South Island Child Health Service Level Alliance (CH SLA) to develop the audit tools. The Safe Sleep Policy was endorsed by all the South Island DHB CEOs and implemented across the South Island.
The group has gained a significant amount of knowledge from the tool, says South Island Safe Sleep Policy Audit Working Group Chair, Dr Nick Baker. “It’s been excellent to see DHBs implement the policy and audit safe sleep practices. The results of the audit will help support improvement and effectiveness of the policy. Parents and caregivers have a right to know about keeping babies safe from preventable death, and the policy and audits are a powerful tool to help make safe care routine care – every baby, every sleep.”
WCTO Profile Michael McIlhone Chair Of The Well Child Tamariki Ora Quality Improvement Steering Group
Chair of the Well Child Tamariki Ora Quality Improvement steering group, Michael McIlhone.
Throughout Michael McIlhone’s 37 year nursing career, a strong focus on women and children’s health has been a reoccurring theme.
After becoming a registered nurse at the Christchurch Hospital School of Nursing in 1981, his first role was in the emergency department, before putting on a backpack and exploring the world. After his return to Christchurch and the Emergency Department, this was followed by some work in the surgical area and the STD clinic. A public health nurse position followed shortly after.
In 1988, Michael then moved into neonatal care, which led to a 20-year career in neonates that took him to Saudi Arabia – where he married his wife Elaine – then to Oxford (UK), Auckland, back to Saudi Arabia and then London again, and finally, home to Christchurch in 1994.
In 2008, Michael became the Nursing Director for Women and Children’s Health in Christchurch, including an 18-month secondment to Planning and Funding. He was appointed in his current role as Director of Nursing for Pegasus Health in November 2014. “Women and children’s health are an obvious and well-suited combination and my interest evolved from looking after sick children and babies in acute care, and blossomed over my 20 years working in neonates. I became interested in the child development side of things and it really opened my eyes to think – where do these children end up?”
So when Michael was asked to join the Well Child Tamariki Ora (WCTO) Quality Improvement steering group over two years ago, he says the decision was easy. “Equity is what drives me. This was an opportunity for me to champion women and children’s health and to have input into the development of services, ensuring there is a balance of care provided – equity of resources, equity of access, and equity of positive outcomes.”
Michael also sits on a number of other committees and health care working groups, including the South Island Mental Health Service Level Alliance, Clinical Informatics Leadership Team, Canterbury Clinical Network Leadership Team and recently the Canterbury Suicide Prevention Governance Group. This helps him link the systems together, he says. “I’m working with groups of people I either knew of or had professional relationships with, and my background gives me the ability to understand and contribute to the conversations being held around the table.”
He says the WCTO group is made up of people who truly believe in the work they are doing. “The members are all very committed and also well connected to their local communities. And our project manager, Anna Foaese, does a wonderful job. She gets the right people together and has a real insight on what needs to be done. She is great at project management, but is always keen to listen and learn.”
The role of chair is about governance and strategic thinking, with a good understanding of what’s going on, Michael says. “But it’s such a highly functioning group that I don’t have to do that much – I feel like I take just as much as I give.”
Ensuring the consumer and Maori are driving the conversation is also vital. “It’s so important to listen to their insight/experience/wisdom and take their advice, and this needs to take place in the form of a partnership in the initial stages of planning. We are all working towards a common goal, so the more we look at the system to ensure the best fit, work together and share ideas, the more the community will benefit.”
The five South Island DHBs have implemented a management database as part of a quality improvement project for children with Type 1 diabetes. Supported by the South Island Alliance Child Heath Service Level Alliance, the Diabetes Patient Management System (DPMS) collects patient data and provides benchmarking for Australasian quality improvement reporting.
After recognising a gap for mothers-to-be who needed extra support beyond the Well Child Tamariki Ora (WCTO) programme, Motueka Pūkenga Kaiwhakahaere Nurse Manager Lydia Mains created the Tūhono Service.
