Review of practice sustainability promotes the application of a structured methodology to continuously improve quality and reduce waste in general practices.
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HCH Model of Care Summary
What is Health Care Home?
The Health Care Home (HCH) is a model of care based around the general practice and designed to improve the quality and sustainability of services as well as the experience of both patients and staff.
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First introduced into New Zealand over a decade ago, it has now been incorporated into more than 300 general practices with many more picking up elements of the model of care. Healthcare Home has been refined and developed for our New Zealand context, with the most recently updated version of the model of care enhanced for equity, lived experience leadership and honours Te Tiriti o Waitangi.
The Health Care Home model shifts the traditional system of general practice from one that is mostly reactive, to a more proactive, team-based approach that focuses on the individual needs of the patient and their whānau. It is made up of a number of core elements, involving processes such as triaging patients to ensure urgent appointments are available to those who need them most; offering consultations by phone, video or email as well in person; and taking a proactive and partnership approach to care for people with long term conditions such as asthma and diabetes.
HCHs has been framed in the context of Te Tiriti o Waitangi, of Wai 2575, of Pae Ora and Whānau Ora, to ensure that the HCH enhanced model of care embraces Māori models of health and its domains related to Māori world views, delivering tangible benefits for Māori and other priority populations.
The patient journey video summarises an ideal experience of a metaphorical patient interacting with their Health Care Home.
The purpose is to bring the HCH model of care to life and to demonstrate how this model of care works for individual’s and whānau.
2.1 Continuous Quality Improvement
Quality improvement (QI) is the framework we use to systematically improve the ways care is delivered to patients.
3.1 Desk Staff
Patient-oriented front desk staff encourage the reception service to focus on kanohi ki te kanohi (face to face) interactions with patients.
4.1 Workflow
Workflows for practice teams have been documented and are evaluated and modified on a regular basis.
4.2 Standardisation
Standardisation involves having an agreed set of equipment, storage place in each room and a processes to ensure consumables are replaced routinely.
4.3 Facility Infrastructure
Infrastructure has been designed to allow for HCH processes, including “off-stage” work and team space and maximise utilisation of clinical space.
5.1 Practice layout
A practice layout should enhance teamwork by allowing all staff to take calls, work on computers, process paperwork and easily interact with others.
6.1 Staff Training
The practice develops broader roles through training with a focus on Te Tiriti o Waitangi and cultural competency to enable consistent upskilling.
6.2 Workforce Planning & Development
Practice workforce plan emphasises the importance of regularly reviewing practice deployment and workforce plans.
7.1 Same Day Access & Appointment Systems
This is about implementing a schedule that reserves slots each day with a focus on access for Maori and other priority patients.
7.2 Access to Care During Business Hours
Access during regular business hours is accomplished by providing a choice of options to improve response time.
8.1 Population Stratification
Population Stratification enables targeted primary care service delivery and helps reduce inequities in health outcomes.
9.1 Hauora / Wellness Plan
A Hauora Health Plan is a patient centred plan (either electronic or paper-based) that describes the care and support for patients.
9.2 Interdisciplinary Approach
An interdisciplinary approach allows the patient, their family and carers in any discussions about their condition, prognosis and care plan.
10.1 Improving Health Equity
Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes.
11.1 Routine & Preventative Plan
Routine and Preventative Plan includes a whānau led approach that is routinely used at all points of care.
11.2 Prework
Prework should occur on an ongoing basis and involves reviewing the schedule of booked appointments a day or a few days in advance.
11.3 Continuity of Care and Whanaungatanga
Patients are encouraged to see their preferred GP and practice with whom they have established whanaungatanga (relationship).
11.4 Technology Enablers
Technology enablers supports all providers with a shared electronic health record and is integrated in all aspects of patient care.
11.5 Iwi and Social Services
Relationships with Māori Health and Social Service Providers are fully embedded in practice with two-way referrals occurring.
12.1 Affordability Systems
The practice has an approach and plan to affordability issues with focus on facilitating access for most patients, with focus for Māori and other priority patients.
12.2 Cultural Needs
Cross cultural practitioner- patient interactions are common and practitioners need to be competent in dealing with patients whose cultures differ.
13.1 Alternatives To In Person Consults
Alternatives to in-person consults includes systems determined by what is most suitable to the patient.
14.1 Fully Functional Portal
Patient portals are secure online sites where patients can access their health information and interact with their general practice.
15.1 Patient Engagement
Patient co-design emphasises the importance of engaging with consumers in developing and delivering health care services.
15.2 Patient Experience
Measuring patient experience within general practice helps to inform continuous improvement of service delivery.
16.1 Proactive Planning
Practice teams value patients’ time by proactive planning through daily meetings to plan the work for the day.
17.1 Health Literacy
Health literacy is about improving understanding of health information so that health messages can be understood and, hopefully, acted upon.
18.1 Call Demand Monitored
Call management is the art of having the right number of skilled people and supporting resources in place at the right times.
19.1 Appointment Systems
Flexible appointment systems enable the practice to offer flexibility in their appointment system to accommodate acute, semi acute, routine visits.