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Hūtia te rito o te harakeke,
Kei whea te komako e kō?
Ka rere ki uta, ka rere ki tai.
Kī mai koe ki a au, he aha te mea nui o te ao?
Māku e kī atu,
He tangata! He tangata! He tangata!
If you pluck out the flax shoot,
where will the bellbird sing?
It will fly inland, it will fly seawards.
If you ask me, what is the most important thing in the world?
I will reply,
People! People! People!

Kia ora and welcome to Issue Six of
The Indicator

In this issue, we look at:

From the Programme

Continuous improvement is one of the cornerstones of the KPI Programme. It is the practice of continuously re-examining and improving the way we deliver mental health and addiction services across Aotearoa to achieve better outcomes for tāngata whai ora, whānau and communities.

Through the Programme, DHBs and their NGO partners have been equipped to make continuous improvement a practice using benchmarking to uncover service problems; and leverage shared learning and collective focus to find new ways to improve service quality.

For more than 10 years, the KPI Programme has worked alongside the sector to put attention on the right challenges and build a knowledge base through which the Ministry of Health and services across Aotearoa can monitor their progress against sector priorities.

The continual improvement of our mental health and addiction system, as well as suicide prevention, remain priorities for our Government and all New Zealanders. To help monitor sector progress, the Ministry of Health have asked all DHBs to start reporting their acute inpatient post discharge community care, or as we commonly know it – 7 day follow up, in their Quarterly Reports from 20 October 2020.

To find out more about why the Ministry has asked DHBs to report on their 7 day follow up performance and increase the visibility of this measure, the KPI Programme talked with Barry Welsh, Principal Advisor Strategy and Policy from the Mental Health Directorate at the Ministry of Health. Barry shared his key insights which are included in this issue, along with how the KPI Programme will be supporting DHBs to meet their reporting requirements.

Finally, a quick reminder as we head into the last quarter of 2020, to keep an eye on our website for further details of the November KPI Programme forums.

Insights from the Ministry of Health – Why we’re asking all DHBs to report on 7 day follow up performance in their quarterly reporting

KPI Programme Lead Sima Clarke met with Barry Welsh from the Ministry of Health to find out more about the Ministry’s requirement for DHBs to report acute inpatient post discharge community care (7 day follow up) in DHB quarterly reporting (2020/21).

Here is a summary of Barry’s key insights:


Can you share some of the rationale behind the Ministry’s decision to require all DHBs to report on 7 day follow up performance from 20 October 2020?

We are very aware that the days after discharge from an acute inpatient service are a very vulnerable time for people. What we know is that follow up within 7 days is important for the prevention of suicide, self-harm, and other negative outcomes such as readmission. If we can improve 7 day follow up rates, we can improve outcomes for the people who use acute mental health services.

Because of this the Ministry has included 7 day follow up in the reporting requirements of DHB non-financial monitoring framework and performance measures.

Our vision is that the reporting requirement is seen as a quality improvement process rather than a compliance exercise. We recognise that sometimes measures are perceived as “I have to do this because the Ministry said I had too”. However, we [the Ministry] hope it will be taken in the spirit in which it is intended, which is to improve outcomes for tāngata whai ora.

Will this measure evolve further?

Yes. Our hope is that by quarter two or quarter three we will have NGOs reporting against 7 day follow up as well. It is important to understand this is a developmental measure, which means there are no targets at this stage.

What does the Ministry expect from the KPI Programme to support this?

The KPI Programme is integral to the effectiveness of this measure. The Programme already has a focus on using data to provide insights and benchmarking performance to identify who is doing what well and then sharing the learning to create momentum for collective continuous improvement.

Given the existing data infrastructure of the KPI Programme and to support DHBs with their reporting requirements, we will be directing DHBs to the Programme’s acute inpatient post discharge community care (7 day follow up) data.

What are the three key things our DHBs need to know right now?

  • The new measure is MHO7 – Improving the health status of people with severe mental illness through improved acute inpatient post discharge community care.
  • It is to be reported from 20 October 2020.
  • It is a developmental measure, not a compliance measure.

We are here to help with acute inpatient post-discharge community care (7 day follow up) data for October 2020

We want to ensure all DHBs have access to the acute inpatient post-discharge community care (7 day follow up) data for the financial year 2020/21. Our work is continuing on the rebuild of the new KPI Programme data visualisation dashboard, so our intrepid information analyst, Sandra Baxendine has manually produced a report focused on the most recent 7 day follow up results for all DHBs.

You can read the report here

The report includes all information DHBs will need to report to the Ministry by 20 October 2020. DHBs can also  request the raw data from the KPI Programme team by emailing a special request to

If you have been into the secure section of the KPI Programme website recently, you may have noticed that the data for the financial year 2020/21 has not been updated. This is a result of the work being undertaken to rebuild the Programme’s data visualisation dashboard. The first data visualisations in production are related to 7 day follow up and will be previewed at our November 2020 KPI Programme forums. 
Read more about the evidence behind acute inpatient post discharge community care (aka 7 day follow up) here

Moving forensic outcomes to measures – making a difference for Māori in our forensic mental health services

Consumer Advisors Johnnie Potiki (Southland DHB) and Dean Rangihuna (Canterbury DHB) reflect on the principles and actions that make real a difference for Māori in forensic services and have kindly shared their learnings below.  

One of the most effective ways we can make a difference for Māori in our forensic mental health services is to deliver care that prioritises the five principles of the Tiriti of Waitangi as they apply to the Ministry of Health’s Te Tiriti o Waitangi Framework.  

The principles are:
  • Tino Rangatiratanga: Māori self-determination and mana motuhake in design delivery and monitoring of services
  • Equity: Equitable outcomes for Māori
  • Active Participation: Acting to the fullest extent practicable to achieve equitable health outcomes for Māori
  • Options: Providing for properly resourced kaupapa Māori health and disability services
  • Partnership: Working in partnership with Māori in governance, design delivery and monitoring of health and disability services.
In the context of forensic services, it is important there is a comprehensive cultural assessment for all Māori tāngata whai ora (Tino Rangatiratanga) who appear before the judicial process for the review of their Compulsory Treatment Order or Mental Health Act conditions.

The cultural assessment can include a holistic Māori framework, such as Te Whare Tapa Whā (options) and can be complemented using Hua Oranga outcomes framework to measure the outcomes from a cultural perspective (equity). This equips us to consider cultural factors in the process to determine if we are making a difference.

By ensuring the protection of our tāngata whai ora to have the cultural assessment alongside the clinical assessment (options), we can provide a formulation of care that recognises cultural rights and cultural safety (partnership) in the judicial process.

If we were to follow all the principles above, all people who are in forensic services would have a holistic cultural assessment based on the Te Whare Tapa Whā model and outcomes that are measured by a kaupapa Māori outcomes framework such as Hua Oranga. Doing this allows us to pay genuine respect to Whakamaua: Māori Health Action Plan 2020-2025 and work towards achieving better wellbeing outcomes for our tāngata whai ora. 

Save the date - KPI Programme end of year forums

It’s confirmed. In November 2020 we will be ‘Zoom-ing’ again to progress our benchmarking conversations and share service learnings.

More information is coming soon... but we know how fast diaries can fill up, so do register early by clicking on the links below for the forum(s) you would like to attend.

Keep an eye out for more detail about the different ways you can contribute to these events. You can also email the team at if you have any questions, suggestions or need support. 

Child & Youth forum

Tuesday 24 November 2020
9.30am to 12.30pm via Zoom
Register here

Adult forum

Thursday 26 November 2020
9.30am to 12.30pm via Zoom
Register here
We hope you are enjoying the mental health and addiction KPI newsletter, The Indicator. If you’d like to showcase your KPI stories, share the great work of your teams or even write a brief opinion piece, we’d love to hear from you
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