1) Canterbury, New Zealand faced an unsustainable future healthcare demand that required a hospital twice the size, 20% more GPs, and 40% more aged care beds. 2) Leaders developed a vision of integrated care called Vision 2020 and implemented tools like lean process improvement and population health management to rethink care delivery. 3) By reducing waste like wait times and focusing funding on high-value services, Canterbury improved outcomes, shifted care to the community, and flattened healthcare demand curves, saving the need for billions in new facilities.

1. Canterbury, New Zealand’s quest
for integrated care
Nicholas Timmins, The King’s Fund
September 2013

4. Vision 2020
If nothing changed, Canterbury would need....
a hospital twice the size
20 per cent more GPs
2,000 more aged residential beds (40% increase).
This was neither affordable nor achievable.

5. Tools for re-thinking
Vision 2020
Xceler8
One system, one budget
The Health Services Plan

7. ‘When you first talk to doctors about using lean, they say ‘Hang on a
minute, we are not making cars or baked beans here ... these are
real people.
‘But a core part of lean is thinking about it from the product’s
perspective. You don’t want them stacked up in a pile, or falling off the
production line, or having defects. And that is even more important
from the patient’s point of view ….
‘Being in a pile waiting is not good. Falling off the production line is not
good. Having a defect is not good.
‘So we came up with the idea of not wasting the time of the product …
that if we valued the patient’s time as the most important thing,
we would start to get results.’
– Dr Nigel Millar, Chief Medical Officer

8. More tools…
Showcase 2009
Xcelr8
Collabor8
Particip8

9. So what else mattered?
First: The vision
Second: The tools
Third: The money

10. How did the money change?
1. Ideas that saved patient time got funded
2. Price/volume schedule scrapped
3. Alliance contracting
‘The biggest waste we have in the heath system is patient time
… removing waiting time can make far better use of the existing
resource … We are convinced that 30 per cent of what we do is
wastage.’
– David Meates, Chief Executive, Canterbury District Health Board

11. So what has happened as a result?
Hospital/GP/
community interface:
– Health Pathways
– ADMS
– CREST
– ERMS
– Electronic shared record
– Falls management
– Medication management
Within the hospital:
– Efficient radiology
– Surgical assessment unit
– Medical assessment unit
– Demand predictor
– Improved pharmacy
management

12. Was it just the earthquake?

13. Was it just the earthquake?
No.
The earthquake accelerated some things.
But none of that would have happened – or at the speed
it did – without the huge amount of groundwork that
had already been laid.

14. So what is the outcome of all this?
Canterbury has
always had a low
standardised acute
medical admission
rate – but it has
improved.

15. Acute medical length of stay versus readmission rate

16. Acute surgery

17. Elective surgery

18. Hospital bed occupancy, 2012

19. Emergency department attendances, 60–80 year olds

20. Emergency department attendances, 80 years +

21. Primary care activity …. is UP
Pipelle biopsy
2007 all 104 done in hospital
2012 711 procedures, 47% in primary care
Spirometry
2007 All done in hospital
2012 1,500 of them (22%) performed in primary care
Skin lesions
2007 1,142 publicly funded procedures, all in hospital
2012 5,711 procedures, 39% in primary care

22. Use of the most costly social care … is DOWN

23. As is aged residential care spend

24. What this has not done
Aside from a loss of beds from the earthquake, this has
not shrunk the hospital base.
‘What we are doing is flattening the demand
curve. In some areas we have actually reduced it,
and over future years that is billions of dollars in
capital that does not have to be spent.’
– David Meates, Chief Executive, Canterbury District Health Board

25. Conclusions
Has the Canterbury heath system been transformed? No.
Is it transforming? Yes.
Is what it is doing transformational? Certainly…
But in Canterbury – as everywhere else – there is still a
way to go.

26. Find out more:
www.kingsfund.org.uk/canterbury