-By Jo-Ann Jacobson
The International Foundation for Integrated Care is immersed in a conversation about “….people-centred and integrated care as a fundamental design feature that can support health system strengthening in all countries of the world.”¹
In Aotearoa we believe that being ‘engaged’ in the community and having the ability to assess community readiness for collaboration and change is a critical success factor for health and social service agencies engaging in an integrated care model. It is not just the importance of engaging and empowering people in the design and delivery of integrated care interventions, but how the active role of whānau, the wider community and community groups play a key part in making change happen.
Sustaining that change is how we achieve systemic lifestyle change.
New Zealand’s Whānau Ora model of care is supported by a coalition of 6 government agencies working in a Collective Impact Alliance framework to create meaningful outcomes for whānau and a positive return on economic and social investment for whānau, community, funders and providers.
This approach is focused on weaving services with and around whānau to create the best possible outcomes for both whānau and their community. It requires both the sharing of care and data to inform a shared conversation with whānau at the centre.
And yet we are still foiled by the age-old argument of who owns the data about you and me and for what purposes it can be used based on who captured it and why?
Often the ‘protections’ offered by agencies holding data about you and I are artificial ‘barriers’ and the information can end up being ‘protected’ from the individual whom the information is actually about. For example: how well do you know your own health records and everything that is held in a government agency file about you? I know I don’t!
How can you and I be at the centre of our care (NZ Health Strategy attached) if we don’t have access to the information our service providers hold about us.
Aren’t you and I best suited to decide what data we should share with whom to get the ‘best’ outcomes for ourselves and our whānau?
What is missing from the diagram below?
Whilst this is a great start I feel like I am being ‘done to’ rather than my chosing who to ‘engage with’….
Putting You and Me in the Driving Seat
Whānau Tahi Connected Care is a key ICT enabler to the Counties Manukau Health, Ko Awatea Planned Proactive Care programme, a key work stream of the Manāaki Hauora programme “enabling whānau self-management”.
Manāaki Hauora incorporates a collection of workstreams focused on building capacity and capability in individuals with long term conditions to play an active role in their care (as a key member of their care team) where their aspirations are given top priority.
The Manāaki Hauora programme evidences:
“Self-management support can improve quality of life, clinical outcomes, and self-confidence for people with long-term physical and mental health conditions.
Helping people to manage their own health has benefit for individual clinicians and healthcare teams, as well as for patients and health care organisations.
Self-management support also represents better value for health care providers than the traditional disease-focused approach to care.”
The Whānau Tahi platform supports practitioners, professionals and community workers from Health, Iwi, and Social Services sectors (Education, Housing, MBIE, Justice) to collaborate around a single whānau-centric personalised plan, to help and support whānau ‘get well, live well, stay well’ and become self-determining in all aspects of their physical, spiritual and economic well-being no matter what their circumstance or age, all with an eye on quantifying the ‘social return on investment’.
Whānau Tahi is considered by the ‘International Foundation for Integrated Care’ to be a pioneer in combining health and social information connecting whānau, providers, and funders to enable and empower whānau-centric, self-directed care for transformative, aspirational and generational whānau change.
We are guided by our whakataukī: “Ma te huruhuru ka rere te Manu” (“without feathers, the bird cannot fly”).
For further information:
Manāaki Hauora – Enabling Self-management Support
Ministry of Health – New Zealand Health Strategy – Future Direction
¹International Foundation for Integrated Care Conference Dublin 2017