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Header image 'The Indicator'
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 Ten of The Indicator

In this issue:

From the Programme

 
“The objective is not to be a leader or a follower, but a guide. A good guide doesn’t stop at helping people change their beliefs or behaviours. Our work isn’t done until we’ve helped them accomplish their goals.”
Adam Grant, Think Again

As the COVID-19 pandemic continues to increase the pressure on our Aotearoa New Zealand health system, the call for transformative action is getting louder. It is a call echoed through our KPI Programme team’s engagement with the mental health and addiction workforce and will be a key area of focus as we ramp up Programme activities for 2021.

Government inquiries such as He Ara Oranga and the Health and Disability System Review have repeatedly emphasised the need for system wide decisive actions that achieve better, more equitable wellbeing outcomes for people, whānau and communities. In each inquiry it has been highlighted that while several valuable initiatives already exist across Aotearoa, a lack of integration and collective momentum has limited our ability to achieve the desired improvements. 

Although we understand that new sector policies can provide direction for addressing the systems complex challenges, one of the cornerstones of their effectiveness relies on our workforces’ ability to leverage existing capability and resources to translate policies into action, and create meaningful ways to measure their impact to continually improve services for people with mental health and addiction needs.

To transform current practices and re-orient our workforce to address these challenges, there is a need to harness and strengthen the use of data and research as a method for driving evidence-based improvements in the quality of our mental health and addiction system. 

This year the team will be putting their attention on how they can be effective ‘guides’. To figure out how we can equip the sector to align existing initiatives and resources to improve the application of evidence in service delivery and grow our workforces’ collective commitment to learning and adapting at pace.

In this issue of The Indicator, we are sharing resources from our November 2020 forums, including stories from three District Health Boards (DHBs) who have been using data to influence changes in practice that are improving outcomes for tāngata whai ora. This issue also includes some different perspectives about the work still to be done to improve the engagement of family, whānau and friends when people receive care in inpatient settings.

As a team, we remain excited to be working with you all in 2021 to keep realising the full utility of benchmarking – because we know that together, we can drive continuous improvement and the equity of health outcomes.

Noho ora mai

The KPI Programme team

Showcasing our November 2020 KPI Programme forums


In late November 2020, 102 people joined via Zoom to engage in the Adult, and Child and Youth stream KPI Programme forums. The forums were attended by people from across the sector, including DHBs, NGOs, consumer advisors, tāngata whai ora, whānau and the Ministry of Health.

Building on the focus of the June 2020 forums, participants explored the PRIMHD data collected through the COVID-19 alert levels to draw out insights about practice changes during the lockdown and reflect on what learnings they would like to take forward.

Participants were inspired by stories of change from three DHBs, as well as first-hand experiences of whānau navigating the care of their rangatahi.

The forums also created excitement about the future with a presentation from Wild Bamboo of the new KPI Programme data visualisation tool due to be released in March, and work from rangatahi on service design that meets their needs.

Post the forum, the KPI Programme team have continued to receive requests for the material shared, so we have included these resources below.

Once again, a sincere thank you to everyone who attended and contributed to the delivery of our November 2020 forums. We really look forward to releasing our schedule for forums in 2021 in the next issue of The Indicator – including our face-to-face events.
 

November 2020 KPI Programme forum resources

 
Our Key Performance Indicators… learning through benchmarking
Access the data presentations from each stream by clicking on the links below:
Using data to improve outcomes
Waikato DHB, Waitematā DHB and Southern DHB share their stories about how they have used data and KPIs to improve service experiences and wellbeing outcomes for tāngata whai ora. Click the image above to watch (13 minutes).
Learning from whānau experiences of our child and adolescent mental health services
Watch Georgina Te Amo’s powerful story of supporting her daughter through child and adolescent mental health services, and the lessons they have learnt about what works and what doesn’t along the way. Click the image above to watch (29 minutes).

Watch out for Issue 11 of The Indicator in mid-March where we will be launching our new KPI Programme website and data visualisation tool.

The importance of ‘getting it right’ when measuring engagement with family/whānau – Johnnie Potiki

Johnnie Potiki, Consumer Advisor at the Mental Health, Addictions, and Intellectual Disability Directorate for Southern DHB shares his recent reflections on the importance of getting it right as we seek to measure family/whānau engagement and its value for tāngata whai ora when accessing mental health services.  

Family/whānau engagement can make a real difference for people who access mental health services. However, it is my view that we also need to think about what the right language might be for family/whānau engagement.
As one of the newest indicators for the KPI Programme, it is important we keep working to uncover how to measure family/whānau engagement accurately so we can understand if it makes a difference for tāngata whai ora, or whether our ambitions around the indicator are because we want to be politically correct.

To do this, we need a way to better understand what “good” whānau engagement looks like. To be able to tell this story in a way that highlights its value, supported by evidence and data.

I believe mental health services actively engage with whānau when a person is in crisis and at discharge. However, the problem as I see it is that we do not know how to accurately measure every whānau contact. Without accurate measurement and consistent recording of each contact, it is hard to build an evidence base that whānau engagement is making a positive difference.

To support this, I would welcome a change in the language we use when talking about family/whānau engagement. Speaking about including a friend of the patient in our everyday language, (the wording used in the new Mental Health Act Guidelines 2020) is a change in the right direction. A move that would be further strengthened by a prioritisation from the Ministry of Health to include collection of tāngata whai ora, family/whānau/friend when presenting in crisis and at discharge.

There are known gaps in the PRIMHD collection. For example, crisis interventions and inpatient admissions with family/whānau/friend of tāngata whai ora which are not currently reliably included in the PRIMHD data.

From my perspective, it would be good to include a contact purpose along the lines of ‘discharge planning’ with the added dimension given by a new second tier ‘family/whānau involved’ value. Perhaps, a derived performance indicator could examine the last recorded activity to establish whether family/whānau involved.

The upcoming changes to NCAMP in July will enable better collection of family/whānau engagement in PRIMHD. These are much anticipated as they will offer an opportunity to gather evidence that will help our sector determine whether family/whānau engagement during crisis inpatient admissions and discharge planning improves outcomes for tāngata whai ora.

Prioritising support networks in crisis and discharge contacts led by the mental health leadership will also make this happen, as we strengthen our practices around engaging family, whānau or friends where appropriate as support networks for a person with mental health needs.

The question is - how can we measure the quality and value for individual tāngata whai ora and whānau versus just counting the numbers or ticking boxes. This is our challenge.

Looking for a way to measure tāngata whai ora and whānau experiences of service?


Mārama Real-Time Feedback (RTF) is a consumer satisfaction survey for tāngata whai ora and whānau to find out about their experience of the services they receive in the district health board (DHB) and non-government organisation (NGO) mental health and addiction sector.

In 2020, Mārama Real-Time Feedback launched consumer satisfaction surveys that are available online without the use of a tablet.

To find out more, click here.

Collaborate with us to create the 28-day readmission data visualisation


One of the key takeaways from our stakeholder engagement sessions in 2020 was the importance of context: that a standalone number isn’t as valuable as knowing the full story.

In preparing the data for the full acute inpatient suite of KPIs, we have observed some interesting patterns, but we would like to check what they mean. For example, do they represent data entry errors, conflicting interpretations of codes, variable business practices, genuine differences in service – or some combination? 

Here is what we’ve noticed:
 

28-day readmission (discharges since 1 January 2019)

  • High proportion of readmissions occur on the first day after inpatient discharge
    • Nationally, 10 per cent of 28-day readmissions occur on Day 1 (and 17 per cent occur on Days 1 and 2 combined)
    • Ten DHBs have 20+ per cent of their 28-day readmissions occur on Days 1 and 2
    • Six DHBs have 10+ per cent of all readmissions occur on Days 1 and 2
  • Across the board, 75 per cent of Day 1 readmissions are into the same team as the original inpatient discharge 
  • Excluding Day 1 and Day 2 readmissions changes the 28-day readmission rate by over 4 percent at five DHBs.
We’re wondering…
  • Could some of these be data entry errors, for example an accidental discharge by someone who doesn’t have access/permission to undo the discharge, and so creates a new referral in the IT system to re-activate the client record? 
  • Should some of the 25 per cent of inpatient discharges almost immediately readmitted into another team or organisation have had DT or DW end codes to indicate a transfer?
Length of stay (referrals started and ended since 1 January 2020)
  • Frequency and duration of leave (T37) in acute inpatient referrals are quite variable across DHBs
    • In four DHBs, 1 per cent (or fewer) of nights in an acute inpatient referral are spent on leave; in other DHBs, up to 29 per cent of nights in acute inpatient referrals are reported as leave
    • In five DHBs, fewer than 10 per cent of acute inpatient referrals include any leave nights at all; in other DHBs, up to 71 per cent of acute inpatient referrals include at least one night of leave.
       
  • Variable patterns of sub-acute inpatient (T04) bednights delivered in acute inpatient referrals
    • 16 DHBs report no sub-acute bednights against acute inpatient referrals, whereas 3 DHBs do deliver sub-acute bednights against acute inpatient referrals
    • At one DHB, 21 per cent of all nights in acute inpatient referrals are sub-acute inpatient bednights (and 29 per cent of all acute inpatient referrals included at least one sub-acute bednight).
We’re wondering…
  • Are leave patterns just quite different between DHBs, or do these patterns represent different data entry practices for when tāngata whai ora are not present in a bed? 
  • Do some DHBs regularly deliver sub-acute inpatient support as part of the acute inpatient referral while others transfer to a different sub-acute team to provide that step-down support if required?

Next steps


Before we progress the development of the data visualisation for 28-day readmission we would love to collect more perspectives about the above patterns and why they might exist.

So, we have set up a virtual Zoom meeting on Friday 12 March 2021 at 1pm for anyone from our sector who may be interested in collaborating with us to investigate and draw out the right context for this KPI. To register, please see the event details below.   

Upcoming events… don’t miss your chance to engage in critical conversations this March

12 March 2021
KPI Programme – Investigate 28-day readmission data (via Zoom)


The KPI Programme team are hosting a Zoom meeting on Friday 12 March 2021 for anyone working in DHB mental health and addiction services who would be interested in contributing to the investigation and ongoing development of the data visualisation tool for 28-day readmission. 

During this one hour meeting you will discuss national and local data patterns relating to 28-day readmissions with Technical Data Analyst, Jillian Pennington, and explore how data collection practices may be influencing local results. 

To register for this meeting, please click here.
After registering, you will receive a confirmation email containing information about joining the meeting.

Note - If you would like to investigate patterns occurring in your local data before the meeting, please email us at info@mhakpi.health.nz to request a copy of the deidentified raw datasets with specific ReferralIds for you to cross-reference. 

18 and 19 March 2021
National Youth Forensic Forum (via Zoom)


The Canterbury Youth Forensic team in collaboration with Werry Workforce Whāraurau are holding a National Youth Forensic Forum online on 18 March from 12:30pm – 4:30pm, continuing 19 March from 8:30am – 1:00pm.
 
To read more about the programme for the forum and register to attend, please click here.
We hope you have enjoyed this first issue of the mental health and addictions KPI newsletter The Indicator for 2021. 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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