PERFORMANCE IMPROVEMENT FRAMEWORK

1 PERFORMANCE IMPROVEMENT FRAMEWORK . Review for Manat Hauora, the Ministry of Health December 2017. Lead Reviewers' Acknowledgement We undertook this PIF Review for the Ministry of Health in two phases. In 2016 we developed a draft Four-year Excellence Horizon for use by the new Executive Leadership Team at the Ministry as it embarked on significant organisational change and implementation of the New Zealand Health Strategy. We conducted the full PIF Review in 2017 when we also updated and confirmed the Four-year Excellence Horizon. For both phases we interviewed Ministers, many Ministry staff, central agency officials, officials from other social sector agencies, stakeholders and representatives of health professionals and of customers of the New Zealand Health and Disability System. We thank them for sharing their insights about good work that is occurring, challenges facing the health system and the Ministry, and opportunities for the Ministry to improve its PERFORMANCE . We were impressed with the passion and commitment of staff and stakeholders to ensure all New Zealanders achieve excellent health and wellbeing.

2 We acknowledge the support of Helen Moody from State Services Commission and thank Ministry staff who provided logistical support for the many interviews and meetings. Potential conflicts of interest were managed appropriately. Published December 2017. ISBN 978-0-478-43485-9. Web address: Crown copyright . This copyright work is licensed under the Creative Commons Attribution- NonCommercial-NoDerivatives International licence. In essence, you are free to copy and distribute the work (including in other media and formats) for non-commercial purposes, as long as you attribute the work to the Crown, do not adapt the work and abide by the other licence terms. To view a copy of this licence, visit Attribution to the Crown should be in written form and not by reproduction of any such emblem, logo or Coat of Arms. Contents Agency's response ..2. Central agencies' overview ..6. Four-year Excellence Horizon ..8. Summary of ratings ..28. Agency context ..30. Results section ..33. Organisational management section.

3 54. Appendix A: Background to this PIF Appendix B: List of interviews ..81. Appendix C: PERFORMANCE IMPROVEMENT FRAMEWORK ..82. PERFORMANCE IMPROVEMENT FRAMEWORK Review for Ministry of Health December 2017 1. Agency's response Introduction The Ministry is grateful to the lead reviewers, and to all the external stakeholders and staff members who contributed to the review, for the guidance provided on how the Ministry can meet the challenge ahead of it. We support the direction of travel the review has outlined for the Ministry's organisational IMPROVEMENT areas including leadership development and people capability, system PERFORMANCE management and relationships. We are committed to continuing our organisational development with insights from experts and our stakeholders, including those who presented in the review. It is pleasing to note that in the months since the PIF process began in 2016, the Ministry has progressed in a number of areas highlighted by the review as being of importance.

4 We are also pleased that the review recognises the Ministry's achievements in delivering on the Government's priorities and delivering value across our core business. For example, in setting a clear direction for our Health and Disability System to 2026 through the New Zealand Health Strategy and in the achievement of Better Public Services results. We clearly note the areas where the review has identified that significant progress can, and needs to be made and are committed to addressing them to ensure a strong, stable Ministry and health system. Current context Health systems across the globe are facing intense pressures for change stemming from rising costs, epidemiologic and demographic shifts, growing consumer expectations, new and disruptive technologies and increasing globalisation. The focus of that change is about people the power of the person and their family/wh nau to engage and participate in healthcare. With this change comes opportunity, especially as technology is quickly changing what is possible in healthcare and is placing tools to enable greater participation in the hands of consumers.

5 It is an opportunity to shift mind-sets toward wellbeing rather than health, to introduce greater convenience, flexibility, self-direction and personalised experiences. It is an opportunity to create an environment where one can choose a patient-provider relationship where he or she participates as an equal and responsible partner, equipped with the knowledge and tools to do so. The Ministry recognises that many of our current systems of providing healthcare cannot deliver this radically different future of anywhere, anytime' care, and that we need to work with the sector to update traditional responses and practices. We are committed to transforming our health system and know we need to keep lifting our own PERFORMANCE to lead this change. The Ministry embraces this PERFORMANCE challenge at the heart of the review. We will continue to invest in becoming a learning organisation that is able to adapt to the unpredictable at pace, and can help the sector do the same, recognising that there is a balance to be struck between making strategic changes to prepare the sector for the future and maintaining ongoing access to safe and improving services.

6 PERFORMANCE IMPROVEMENT FRAMEWORK Review for Ministry of Health December 2017 2. What we will do Our focus will be on the following IMPROVEMENT areas: Better directing investment to address inequity and improve people's lives Transforming the Health and Disability System for future sustainability. Better directing investment to address inequity and improve people's lives One of our key challenges is to change our mind-set from illness to health and wellbeing. It is a big shift for many and it requires us to approach health and wellbeing by looking broadly across the whole of a person's life (a life course approach) and involving people and their family/wh nau in directing the support they receive (self-determination). A life course approach looks across an individual's, a cohort's or generational life experiences for insights into patterns of health and disease, while recognising that both past and present experiences are shaped by the wider social, economic and cultural context. This approach helps identify chains of risk that can be broken and times of intervention that may be especially effective.

7 Particularly during key life transitions ( starting school, starting work and retirement), we need to provide not just safety nets but springboards, which can alter life course trajectories with significant and lasting implications for a person's subsequent health and wellbeing. There needs to be a continued emphasis on not just what the health system can do for individuals and communities, but what individuals and communities can do for themselves and those around them. Self-determination is key to deriving the most benefit possible from the resources available to support people in leading their lives with as much independence and fulfilment as possible. Supports will have markedly different worth to different people depending on their values and circumstances. Building our understanding of the effectiveness of our investments and impact on wider social outcomes will allow us to maximise the health sector's contribution to the overall wellbeing of individuals and family/wh nau. To further build the evidence base about what works best we are: strengthening our measurement of return on investment, which will be used to better understand who is at risk of experiencing poor health outcomes and the relative value of health investments continuing to enhance our co-design and our analytical capability to improve understanding of health and social drivers and indicators, to enhance delivery of services and policy advice to the Government developing analytical and research networks across government, including with the Health Research Council and Statistics New Zealand to inform decision-making and prioritisation of investment programmes within health and at a cross-sectoral level.

8 PERFORMANCE IMPROVEMENT FRAMEWORK Review for Ministry of Health December 2017 3. Transforming the Health and Disability System for future sustainability To support wellbeing effectively requires, in many cases, a range of social and economic services that are well integrated across organisational, sector, and other boundaries. As the review identifies, the Ministry's challenge is to become more skilled and active in engaging with its partners, ranging from families and community groups, through to health practitioners, District Health Boards (DHBs) and other government agencies. We are also seeking to develop better communication with people to build our understanding of their needs and wishes, and to share more of our plans and priorities. We will work better with other sectors, organisations, and with people to design and provide the integrated interventions people need. Stakeholder engagement and outreach is a priority for 2017 and the future. Key actions through which we are taking this issue forward are.

9 Increasing our engagement and taking a stronger leadership role across both the wider public and private sectors to develop shared understanding, commitment, and systems and processes to more effectively advise Ministers and address common challenges further engagement with users of the Health and Disability System, additional to existing mechanisms such as our New Zealand Health Strategy workshops, to grow our understanding of customer experiences, needs and visions for a collaborative health sector initiating increased regular structured engagement with DHB Chairs, Chief Executives, senior managers and clinical leaders to listen to their views and share what we have been doing investing in our communications platforms and channels so that we can communicate better how the Ministry operates and how we deliver value to New Zealanders, and be more responsive to public input via channels that the public want to communicate through. The system also needs leaders beyond the Ministry who are receptive to innovation, and adept at building and maintaining partnerships and alliances.

10 The Ministry's role is to provide some of that leadership, including to help develop, connect, and support clinical and non- clinical champions, throughout the system. The environment in which these leaders work must support and incentivise them. To address this we are taking a number of steps. We are developing, a new approach to system PERFORMANCE that has a strong outcomes focus, draws on a broad range of user experience results and supports innovation. In time, this FRAMEWORK will re-shape how we plan for the delivery of health services. We agree with the reviewers' comments that more can be done to introduce technologies and integrated information systems that support richer information sharing for targeted customer-centred care and improved quality and safety. Our key action in this regard is the establishment of a national electronic health record, accessible through the patient portal network, health providers and mobile applications. PERFORMANCE IMPROVEMENT FRAMEWORK Review for Ministry of Health December 2017 4.