National Shared Care Planning Programme (NSCPP) Evaluation Phase II

Abstract

This report summarises the findings of the evaluation that the National Institute for Health Innovation has completed in respect to Phase 2 of the National Shared Care Planning Programme (NSCCP). More detailed analysis and data is contained in Section 4 of this report and the Discussion in Section 5. This programme has been an exceptionally challenging one. Shared Care is inherently complex and there are few exemplars in New Zealand or offshore. Add in the element of goal focused planning and it is arguable that exemplars are not to be found at all (at least in terms of significant multi-provider health systems). The Key Findings below that summarise this report should be read in this context. They should not be read as implying criticisms of the Programme team, the vendor or any of the user community. It was always recognised that this would be challenging and that things would not always go well first time. The provision of this evaluation presents an opportunity to take a breath, to understand what has worked well, what worked less well and to more confidently plot the next step forward. The evaluation team does not make specific recommendations, (though many of these observations lend themselves to deriving forward paths); this is the role of the Steering Group and the Programme management. However the evaluation team is ready, willing and able to contribute to making next stage of this programme as successful and as effective as it certainly needs to be. Key Findings 1. Uptake has been slow and the numbers of participants are relatively small. Even among this user community, there are relatively few that are using the system to anything like its full capability and this has inhibited the quantitative aspects of the evaluation. Nevertheless there is evidence from the datasets and from feedback from participants, that implemented effectively, this Shared Care Planning approach will enable better communication between the members of a patient’s care team; will better engage patients; will reduce presentations to ED and unplanned admissions; will increase medication adherence and will ease a patient’s path through the health system. Although it may be too long a bow to suggest, purely based on the evaluation evidence, that it will directly improve health outcomes, the findings from the outcome methodology do suggest that it will be possible to identify positive health outcomes once enrolled numbers have grown. 2. Uptake has been less than planned for many reasons, all of which need to be addressed before a mass deployment is undertaken: a. To date the approach has based on rapid learning cycles, with constant change. This may be acceptable to committed champions; it will not support mass deployment. Therefore the system and the implementation approach needs to be stabilised and commoditised. b. The complexities of shared care demand that all determinants of success need to be aligned. It is not sufficient to introduce enabling technology; to have strong leadership, governance and programme management; to identify and recruit champions and/or to listen to feedback from evaluators. Other dimensions not sufficiently focused on to date also demand attention. For example, workforce development, the understanding of the importance of new roles and their introduction, the alignment of contribution and reward through the introduction of new funding models and the need to really understand patient perspectives, have all been variously identified by those consulted by the evaluation team as key factors needing greater attention. c. There is a general view, expressed by many, though not all respondents, that the strategy for successful mass deployment has not yet been fully derived. The asynchronous nature of shared care is a challenge and others are struggling (incidentally, this is acknowledged by the Canterbury programme leaders in the recent related review of CCMS). It is clear that this needs to be addressed and a consensus between all stakeholders needs to be agreed before the next stage can be planned and implemented. d. The technology is coming good, but aspects of usability, integration and performance continue to need to be addressed (see related evaluation report of CCMS). e. The wholehearted involvement of patients and their families is vital and currently is the least successful part of the Programme. The requirements of patients need to be clear and the related CCMS functionality needs to be available and usable. f. Workflow should be configurable, but also flexible to cater for the ever changing environment synonymous with modern healthcare. 3. There are a number of characteristics that differentiate the more successful sites from the less successful ones: a. The identification and appointment of a Care Coordinator is seen as essential. b. Where the implementation has been structured, with a collective understanding of the potential, the benefits and the dependencies of the system (the inputs and the outputs), the level of success increases. c. The introduction of SCP implies a new way of working, but has commonly been implemented on top of an existing way of working. Where more careful thought has been put into taking advantage of the opportunity offered by the implementation of SCP, successful use of the system was greater. d. Where there is commitment from the whole of a practice to embrace the system and where training and support is consistent and readily available, it is more likely to prove sustainable. e. The commitment needs to be strong; very often under pressure this initiative is seen as expendable. Only when it becomes the part of the day-to-day, hour by hour routine of the care team and the patients, will it become truly sustainable. 4. There seems to be confusion around the target patient cohort. Perhaps as this programme started with a focus on patients qualifying for CarePlus, it has proven difficult for some to accept that it has the potential to serve the entire population, in the provision of case management and the use of a patient portal.