1 Fanau Ola Implementing Fanau Ola to accelerate health gain and improve wellbeing for Pacific families
2 Profile of Pacific People in Counties Manukau117,780 => 23% CM Health population (2013) 38,300 => 58% of Mangere population (2011) 23,990 => 65% of Otara population (2011) 158,300 => Projected Estimate of Pacific 2026 73% NZDep06 decile 9 and 10 (2006 census) ………Current health outcomes
3 Life Expectancy Gap
4 HAKAMANA Pacific Fanau Ola Fanau-Centred Patient CareFANAU OLA has been developed using the HAKAMANA Integrated System of Transformative Design
5 simultaneously ‘verbs’ and ‘nouns’, processes and outcomes.HAKAMANA - Breathe… HAKAMANA is informed by the sounds and words of the ancient Oceanic / Polynesian / Maori language I – O – E – A – U simultaneously ‘verbs’ and ‘nouns’, processes and outcomes. These sounds communicate states: of relationship, creativity and potentiality, of constancy on the one hand of dynamic change on the other that embody transformative processes
6 HAKAMANA I O E A U UI IO AU OE EA
7 I O E A U HAKAMANA TIKI HONO RERE HAKA TUPU hui nui tui pio tio UI IOhau kau rau koe hoe moe AU OE EA hea mea pea Fanau Ola System - CMDHB - Wolfgramm - Sept 2015
8 HAKAMANA – FANAU OLA THE INTENTION THE OutcomeTo design a healthcare solution for Pacific patients (with complex health needs and who have multiple socio-economic challenges) that includes their fanau / family members as important members of their circle of care; and provide quality patient and fanau-centric care to achieve better health outcomes THE Outcome The design, development and implementation of a Fanau Ola Support Service with an evaluation that shows a decline and reduction over time in secondary service utilisations (hospital admissions, emergency care presentations), and improved quality of life for Pacific patients and fanau
9 HAKAMANA Titiro I Vision Kotahi O Relate E Activate Rawa A AchieveValues & Principles of engagement Titiro I Vision Kotahi O Relate Rewa E Activate Rawa A Achieve Tupu U Sustain Aroha / Care & Compassion Values; Wairua; Ethics; Concepts Share Vision; Co-create ethical space UI IO Rangatiratanga Leadership Puawaitanga; Share; Open Opportunities Sustain Benefits; Enable Leadership Tikanga / Ethical Integrity Whanaungatanga Connect; Collaborate Whakapono; Respect; Genuine Partnerships Co-create / co-design / plan / strategise OE AU MAURI / Mana & Life force Reflect; Reorient; Mediate Fail in Safety; Evaluate; Learn; Whole of Systems Solutions Achieve Intentional Excellence Manaakitanga / Generosity Guardianship; Activate; Support; Implement; Real Engagement; Meaningful participation Provide / Operationalise / Deliver EA Fanau Ola System - CMDHB - Wolfgramm - Sept 2015
10 HAKAMANA encompasses …HA – the breathe of life - connects all living things KA – the fire that burns within us – energy to transform MA – the presence of all of one’s ‘light’, knowledge of self NA – our relationships - respectful kinship HAKA – the ‘dance of life and energy’ – animation / activation MANA – the power, strength and authority, leadership HAKAMANA – the creative process of realising one’s power
11 HAKAMANA – Co-design, Activate, TransformJourney Vision / Values / Ethics Conceptualise / Engage Titiro I Vision Kotahi O Relate Rewa E Activate Rawa A Achieve Tupu U Sustain Lead / Share UI IO Design Concepts Achieve Outcomes Sustain Benefits Share success Co-Design / Define Strategise / Plan Strengthen teams Connect Collaborate Realise Outcomes AU OE Reflect / Learn Measure / Analyse Quality Improvement Activate / Implement Integrate Operations Roles / Responsibilities EA Evaluate / Learn
12 Vision: Fanau Ola for Pacific familiesFanau will be… healthy in body, mind and spirit, educated, socially strong, and content. Fanau will have… the courage and will to live, the skills and abilities to plan and pursue their own futures. Fanau Ola System - CMDHB - Wolfgramm - Sept 2015
13 Fanau Ola Ancient Pacific words – expressing many sounds of creation;‘ha’ the ‘breath of life’ and ‘wa’ inferring ‘time and space’ combine to form the sound ‘fa’, a number - signifying foundations of family life ‘na’, interweaving family relationships with each other ‘u’, manifesting the realisation of the family’s potential ‘o’, animating the family space of creativity ‘la’, embracing the warmth of the sun as families grow Fanau Ola System - CMDHB - Wolfgramm - Sept 2015
14 …Moui lelei …Soifua Maloloina … Oraanga Meitaki …Fanau Ola Ancient Pacific words – used across the Pacific Ocean FA … NA … U O … LA Fanau - Fanau Being born; bringing forth; children; grandchildren; siblings; extended family (Maori …whanau ora) Ola - Being alive; healthy; nourished with food; healed from illness; refreshed; successful …Moui lelei …Soifua Maloloina … Oraanga Meitaki …
15 Fanau Ola & Whānau Ora Fanau Ola Whānau Ora Approach Māori WhānauKaupapa Whānau Te Ao Māori Tinana Hinengaro Manawa Wairua Tangata Whenua Rawa /Tiriti o Waitangi Rangatiratanga Māori Whānau Fanau Ola Vision Fanau Pacific Cultures Body Mind Heart Spirit Context Resources Leadership Pasifika Fanau Approach Current Health Profiles Pacific Heritage Culture Language Better Health Outcomes for All Families
16 Fanau Ola encompasses Fanau Ola encompassesVISION Fanau Futures / Goals / Plans SOCIAL Relationships / Caring Connections CULTURE Worldview / Tradition / Language BODY Physical Health / Conditions / Risks SPIRIT Spirituality / Beliefs / Religion HEART Emotional Wellbeing / Love / Support MIND Learning / Intellect / Education / Skills RESOURCES Resources / Housing / Income / Technology CONTEXT Environment / Community / Systems LEADERSHIP Leadership & Guidance Skills / Fanau Champions
17 Achieving a Balance at Counties Manukau Health Pacific Health - Whole of Systems SupportBest Value for Resources
18 Implementation The FANAU OLA System is implemented in five interlinked phases: Scoping, Strategy, Design & Planning Training & Development Organisational & Service Deployment Digital Activation Developmental Evaluation & Follow-Up
19 Fanau Ola System DevelopmentConsolidate Fanau Ola Approach Consultation / Presentations / Refinement Fanau Ola Training Referrals Systems Guidelines / Protocols / Quality Control Fanau Ola Toolkit Design / Development Assessments / Reflections link to indicators / outcomes Baselines / Targets weekly / monthly / quarterly tracking and monitoring Monitoring and evaluation Administration / Management support Strategic linkages / relationships – internal / external
20 How we help Fanau move from (and through)secondary to primary and community care
21 Fanau Ola Toolkit DevelopmentInformation materials (pamphlets / presentations) Consent/Enrol forms (Inpatient = Primary Client / Fanau Champion / Adults / Parents) Primary Client - Initial Fanau Ola Assessment (as inpatient) Fanau Genogram / Identification of Fanau Champion Discharge Summary Notation (PIMS – Notify Primary Care / ARI Coordinator) Fanau Ola Assessment / Reflections Demographic details GP / Hospital / Clinics Body / Physical Heart and Mind – Mental Health and Emotional Wellbeing Resources – Housing / Income / Transport Culture / Language and Spirituality / Religion / Church Fanau Vision and Leadership – Goals Fanau Ola Plans (one for Primary Client; one for Fanau; others as needed) Referrals System Ongoing learning / monitoring / evaluation Fanau Ola Sustainability Plan – Provide Fanau Mgmt Education / Health Lit Toolkit Note: Fanau have ownership of their Fanau Ola Assessments and Plans Fanau Ola Advocates support and facilitate their Fanau Ola Journey
22 Referrals into Fanau Ola ProgrammeMain Points of Entry Daily List (Patients admitted in previous 24 hours) Very High Intensive Users (VHIU) Team Emergency Department Internal Referrals (e.g. Hospital Wards / ED) Pacific Cardiac Programme Other
23 Centralised Referral SystemAll Referrals Centralised Triage process by Fanau Ola Senior Team Considerations for triage include: Number of Hospital Admissions Number of Emergency Care Presentations Number of DNA Condition (e.g. excl dialysis patients) Age (with careful consideration of newborn to 18 yrs) ‘Red Flags’ Allocate to Fanau Ola Advocates
24 Fanau Ola Advocacy and Integrated Support1. IP / Fanau Engagement Consent Enrolment 2. IP / Fanau Assessment Analysis Planning 3. IP / Fanau Support Services Care 4. IP / Fanau Evaluation Learning Success 5. IP / Fanau Sustainability Strategy
25 Impact Measures / Outcomes Activating GeneratingFanau Ola Journey Fanau grow through … Fanau Ola Journey Impact Measures / Outcomes Timeline Fanau Ola Phases Deliverables Indicators - Focus Outcomes / Benefits Phase One Searching Dreaming Week 1 Greet / Engage / Consent / Enrol Primary Client engaged; Consent; Initial Fanau Ola Assessment; Notes on Discharge Summary Fanau Champion identified; Fanau Consent Forms signed Primary Client / Fanau Champions engaged; Primary Client and Fanau Consents Inspired - Fanau are encouraged and inspired to participate in Fanau Ola Journey Phase Two Reflecting Planning Week 2-3 Assess / Reflect / Analyse / Plan Comprehensive Assessments; Fanau / Fanau Member Plans Fanau plans provide vision, strategies, implementation steps, activities, measures Optimistic - Fanau have a clear understanding of their situation and are engaged in planning Phase Three Activating Generating Week 3-4 Implement Plan / Support / Connect Pacific Patient and Fanau-Centred Support, Services and Care Access to and support received from Fanau Ola centred services Energised - Fanau access a range of quality Fanau Ola centred culturally appropriate support /services /care Phase Four Learning Succeeding Monthly / Quarterly Fanau Ola Evaluation Fanau Ola Indicators measured / Fanau Ola Plan updates Comprehensive range of Fanau Ola indicators move in right direction Animated - Fanau experience positive health, social, economic, educational outcomes. Phase Five Thriving Sustainably Month 10-11 Co-create Fanau Ola Sustainability Strategy Fanau Ola Sustainability Strategy Fanau Ola Sustainability Strategy completed Uplifted - Fanau are empowered; have the skills to plan and pursue own futures.
26 Links to indicators 1. National / Regional / Local – Indicators / Outcomes Heart disease / Diabetes – checks / assessments Smoking – cessation support provided Maternal health – LMC enrolment / antenatal care / smoking Child health – new born enrolments / immunisations / B4 School Checks / rheumatic fever swabs and support Youth – mental health / support to stop smoking, suicide prevention Cancer – screening rates (breast / cervical) Housing – healthy housing; insulation rates Health of older people – engagement in services Emergency Care - EC presentations; hospital admissions 2. Fanau Ola Indicators - Cultural / Spiritual / Leadership / Vision …
27 3311 Pacific Patients 13,755 Fanau MembersThe story so far… Period: 1 July 2013 – 30 June 2015 3311 Pacific Patients 13,755 Fanau Members
28 Clients and Fanau Members
29 Evaluation of Fanau Ola Support ServicePopulation Health Team CMH data analysis Compare PCST (Jul-Dec 2012) with FO (Jul-Dec 2013) Compare FO (Jul-Dec 2013) with FO (Mar-Aug 2014) Interviews – FO team; other CMH Pacific Perspectives Independent research group In-depth case studies (nine) Patient experience Literature review Documentary / discharge summary analysis
30 Patient profile – complexity / multiple health conditionsCharlson Co-Morbidity Index Score = 4-9 [very severe > 3]
31 Case studies - highlightsThe role of family as main carers and supporters Understanding and navigating complex health and social systems The impact of health beliefs and attitudes and previous experiences of health services
32 Public Health Evaluation: FindingsReductions in secondary service utilisation following intervention by both Pacific Cultural Support Team and Fanau Ola Support Service Reductions over time in secondary service utilisation prior to enrolment in Fanau Ola Support Service
33 Number of hospitalisations and bed days per patient for the PCST ≥5 cohort and Fanau Ola Support Service Jul-Dec 13 cohort in the six months before and after the intervention
34 Number of EC attendances per patient for the PCST ≥5 and Fanau Ola Support Service Jul-Dec 2013 cohorts in the six months before and after the intervention
35 Number of hospitalisations, bed days and average length of stay to CM Health facilities for the PCST ≥5 cohort and the Fanau Ola Support Service Jul-Dec13 cohort six months before and six months after the intervention, all admission types
36 Number and Percentage of patient who died within three months and six months of been seen by the Fanau Ola Support Service or the Pacific Cultural Support Team Cohort Died at 3 Months (%) Died at 6 Months Number of cases FO Jul-Dec 2013 8 (2.5%) 10 (3.1%) 321 PCST Jul-Dec 2012 21 (9.8%) 28 (13.0%) 217
37 Table 25 Number of emergency care attendances, hospitalisations and bed days at CM Health facilities for the Jul-Dec 13 and Mar-Aug 14 Fanau Ola Support Service cohorts six months before the intervention Utilisation Fanau Ola Support Service Jul-Dec 2013 Total Jul-Dec 2013 per patient Mar-Aug 2014 Total Mar-Aug 2014 per patient Percentage difference between cohorts ED attendances 723 2.25 1205 1.66 -36% Hospitalisations 582 1.81 834 1.15 -58% Bed days 2,017 6.28 2,339 3.22 -95%
38 Real life is what counts…MANAAKI Fanau Living and Working Hand in Hand
39 Strategic Alignment Healthy Pacific 2020Achieving a Balance: Patient & Whānau Centred Care; System Integration Pacific Plan: Healthy Pacific People 2020 Goal 2: Implement Fanau Ola Service Delivery across the whole of system Spread and improve Fanau Ola approaches for those Pacific patients for whom family based support is critical to recovery and living well with disease
40 WHOLE OF SYSTEMS - FANAU OLA APPROACH contributing to achieving health equityHealthy Services Services need to be patient & fanau-centric System / programmes / services needs to be dynamic and responsive to fanau – rather than have services that are difficult for patients to access / engage with / afford Need for greater integration across system (secondary / primary / community) with improved transparency (e.g. between hospital, GP, community, fanau/patient)
41 WHOLE OF SYSTEMS - FANAU OLA APPROACH contributing to achieving health equityHealthy Services Need to support Fanau to engage Fanau-centric services at appropriate times e.g. Primary Care Contracts: At Risk Individual (ARI) Integrated Services Agreements (ISA) Every moment with Pacific patient / fanau can be a learning interaction -> opportunities to increase health literacy
42 Change the trajectory …Evidence shows that enhanced and integrated care that incorporates system-level improvements including kind and respectful engagement; informed consent; identification of ‘family health champions; and comprehensive assessment, planning, and support processes, including targeted interventions and rehabilitation has the potential to change the ill-health trajectory of VCHN patients and families.
43 Fanau Ola Smart Path SystemFanau Ola Systems integration with Smart Path Healthcare Technology Patient Portal – Interactive Pathways Staff & Carers invited & permitted Data & Info shared through the Cloud Insight supports decision-making
44 Scale Up with OLA Integrated CarePACIFIC Auckland Region DHBs; NZ-Wide Pacific Islands MĀORI CMDHB, Auckland Region DHBs, NZ-Wide INDIGENOUS USA / Canada; Small Islands Developing States; Global INTERSECTORAL
45 Opportunities for CollaborationIf you would like develop an OLA Integrated Care Approach for your healthcare situation, contact Tania Wolfgramm to discuss your needs
46 Contributing to achieving Fanau Ola OutcomesPasifika fanau will be healthy in body, mind and spirit, educated, socially strong, and content. Pasifika fanau will have the courage and will to live, the skills and abilities to plan and pursue their own futures.
47 Fanau Ola A beautiful and powerful bird, farsighted and keen of eye,flying across the oceans in search of new vistas, as the sun rises on the horizon, bringing light, warmth and life into the world. The bird is Pasifika Fanau, their spirit, heart, mana and dignity. They weave strong relationships with each other and their communities. They are empowered to pursue their vision of a brighter future, as they seek to experience greater wellbeing, balance and harmony in their lives.
48 FANAU OLA – This document was prepared and presented by: Tania Wolfgramm Cultural Development Executive Fanau Ola / Whānau Ora Systems Architect Wikuki Kingi, Tohunga, QSM Pou Kapua - Creatrix Aotearoa New Zealand For further information about FANAU OLA / WHĀNAU ORA Contact Tania Wolfgramm, OLA Integrated Care Architect Tel: The FANAU OLA System has been designed developed, and deployed by Tania Wolfgramm, The HAKAMANA System of Transformative Design, Development & Transformation is Copyright © Tania Wolfgramm / Pou Kapua – Creatrix LINKS Photos are and images are courtesy Pou Kapua Creations; IDESIGN; Google Images