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HCH Model of Care Summary

The HCH Interactive Model of Care includes a vast set of resources to support the implementation of the model – this easy access approach to tool and resources supports change at scale and pace across our network

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1.1 Practice Sustainability

Review of practice sustainability promotes the application of a structured methodology to continuously improve quality and reduce waste in general practices.

2.1 Continuous Quality Improvement

Quality improvement (QI) is the framework we use to systematically improve the ways care is delivered to patients.

3.1 Desk Staff

Patient-oriented front desk staff encourage the reception service to focus on kanohi ki te kanohi (face to face) interactions with patients.

4.1 Workflow

Workflows for practice teams have been documented and are evaluated and modified on a regular basis.

4.2 Standardisation

Standardisation involves having an agreed set of equipment, storage place in each room and a processes to ensure consumables are replaced routinely.

4.3 Facility Infrastructure

Infrastructure has been designed to allow for HCH processes, including “off-stage” work and team space and maximise utilisation of clinical space.

5.1 Practice layout

A practice layout should enhance teamwork by allowing all staff to take calls, work on computers, process paperwork and easily interact with others.

6.1 Staff Training

The practice develops broader roles through training with a focus on Te Tiriti o Waitangi and cultural competency to enable consistent upskilling.

6.2 Workforce Planning & Development

Practice workforce plan emphasises the importance of regularly reviewing practice deployment and workforce plans.

6.3 Clinical & Cultural Leadership

Clinical and cultural leadership emphasises the importance of practice staff undertaking the leadership role.

6.4 Extended Practice Team

Extended practice team encourages the development of new/emerging roles in general practices in addition to traditional roles.

7.1 Same Day Access & Appointment Systems

This is about implementing a schedule that reserves slots each day with a focus on access for Maori and other priority patients.

7.2 Access to Care During Business Hours

Access during regular business hours is accomplished by providing a choice of options to improve response time.

7.3 Patient Wait Times

Patient wait times at the practice for scheduled appointments are managed in a culturally appropriate manner, that allows for high quality outcomes.

7.4 Clinical Phone Triage

Clinical Phone Triage is a core component of the Health Care Home model and is required to be implemented daily at the high traffic times.

8.1 Population Stratification

Population Stratification enables targeted primary care service delivery and helps reduce inequities in health outcomes.

9.1 Hauora / Wellness Plan

A Hauora Health Plan is a patient centred plan (either electronic or paper-based) that describes the care and support for patients.

9.2 Interdisciplinary Approach

An interdisciplinary approach allows the patient, their family and carers in any discussions about their condition, prognosis and care plan.

9.3 Community Health Networks

A Community Health Network is the central point for the delivery of effective and efficient health and social services.

9.4 Patients With Complex Needs

Māori and other priority patients have a Hauora coordinator / with whom they have established whānaungatanga (relationship).

10.1 Improving Health Equity

Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes.

11.1 Routine & Preventative Plan

Routine and Preventative Plan includes a whānau led approach that is routinely used at all points of care.

11.2 Prework

Prework should occur on an ongoing basis and involves reviewing the schedule of booked appointments a day or a few days in advance.

11.3 Continuity of Care and Whanaungatanga

Patients are encouraged to see their preferred GP and practice with whom they have established whanaungatanga (relationship).

11.4 Technology Enablers

Technology enablers supports all providers with a shared electronic health record and is integrated in all aspects of patient care.

11.5 Iwi and Social Services

Relationships with Māori Health and Social Service Providers are fully embedded in practice with two-way referrals occurring.

12.1 Affordability Systems

The practice has an approach and plan to affordability issues with focus on facilitating access for most patients, with focus for Māori and other priority patients.

12.2 Cultural Needs

Cross cultural practitioner- patient interactions are common and practitioners need to be competent in dealing with patients whose cultures differ.

13.1 Alternatives To In Person Consults

Alternatives to in-person consults includes systems determined by what is most suitable to the patient.

14.1 Fully Functional Portal

Patient portals are secure online sites where patients can access their health information and interact with their general practice.

15.1 Patient Engagement

Patient co-design emphasises the importance of engaging with consumers in developing and delivering health care services.

15.2 Patient Experience

Measuring patient experience within general practice helps to inform continuous improvement of service delivery.

16.1 Proactive Planning

Practice teams value patients’ time by proactive planning through daily meetings to plan the work for the day.

17.1 Health Literacy

Health literacy is about improving understanding of health information so that health messages can be understood and, hopefully, acted upon.

18.1 Call Demand Monitored

Call management is the art of having the right number of skilled people and supporting resources in place at the right times.

19.1 Appointment Systems

Flexible appointment systems enable the practice to offer flexibility in their appointment system to accommodate acute, semi acute, routine visits.

19.2 Extended Hours

Providing provision of services over extended hours ensures access to care for routine bookable appointments.

20.1 Health Records

Health records are available to clinicians involved in a patient’s care in a variety of settings.

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