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Kia āta kōwhiri Choosing Wisely

The Choosing Wisely campaign seeks to reduce harm from unnecessary and low-value tests and treatment.

The Network and Te Tāhū Hauora completed scoping work that identified several key system issues that, if addressed, could enhance patient recovery.  These included: poor care coordination, difficulty navigating the health system, delays in accessing essential care, unwarranted variations in service delivery and inequity for Māori.

From March 2021 to June 2022, a national rehabilitation collaborative brought together 11 teams of rehabilitation clinicians from across Aotearoa New Zealand. Their projects aimed to identify and implement new initiatives that would remove barriers to achieving the best outcomes for patients with major trauma and to increase the quality improvement skills and knowledge of rehabilitation providers.  

A group of people stand posing for the camera in a conference room

Learning session two project teams from the national rehabilitation collaborative

The collaborative used the Institute of Healthcare Improvement’s breakthrough series collaborative model[1] as an evidence-based methodology to support the teams. Projects were co-designed with patients and used robust processes to identify key problem areas and explore change ideas that were measurable within their services. Details of the write-ups from learning sessions 1–4 can be found at the links below:

Participants from learning session one of the national rehabilitation collaborative sitting at tables around a room working together and talking.

Participants from learning session one of the national rehabilitation collaborative

The nine completed projects focused on traumatic brain injury, care coordination and patient experience, and several resulted in improved outcomes, including that:

  • clinical teams complete early cover notification to ACC, which assists in the allocation of patients to partnered and supported recovery streams
  • patients are referred to allied health earlier – during acute admission – to support early rehabilitation and proactive discharge planning
  • communication during transitions of care has been improved by allied health contributing to electronic discharge summaries
  • comprehensive discharge advice is provided for people with traumatic brain injury
  • waiting times for community services are reduced
  • a Whāia te Ora framework has been developed to support Māori through their rehabilitation. 

The projects have made impactful service changes that have enhanced the efficiency of care delivery at the local level, and some of the work has been scaled up and successfully implemented for the benefit of major trauma patients nationwide.

At the end of the project, teams displayed high levels of confidence in using quality improvement methodology, and all surveyed participants reported that the collaborative process had increased their knowledge of quality improvement science within trauma rehabilitation.

Local, regional and national networks were established during the collaborative, and several teams noted stronger working relationships across allied health and trauma services.

The collaborative approach successfully improved workforce capability in quality improvement. The teams implemented lasting service improvements that resulted in improved outcomes. Anticipated future impacts include more accurate screening for post-traumatic amnesia, incorporation of kaupapa Māori approaches into rehabilitation and improved allied health discharge documentation for people with major trauma.

The evaluation report and project case studies can found here.

References

[1] Institute for Healthcare Improvement. 2003. The Breakthrough Series: IHI’s collaborative model for achieving breakthrough improvement. IHI Innovation Series white paper. Boston, MA: IHI. URL: www.ihi.org.

Published: 26 May 2023 Modified: 19 Sep 2023