Your 92-year-old mother needs a simple but urgent procedure. The only vehicle available to take her to the hospital is the region's only ambulance. The nearest hospital is over an hour away.
Now she faces a long night waiting for a check-up, before being transported back in the early morning.
This scenario paints a familiar picture in rural healthcare. Smaller health care facilities are not equipped to handle a range of procedures directly, which puts pressure on other services such as ambulances and emergency rooms to provide care. It's an inefficient use of resources, and it's a tough experience for patients.
Shifts in demographics, funding models, and increasing demand have combined to put emergency health services in regional areas under pressure. Hospital emergency rooms are stretched and every day, people are experiencing a diminished quality of care.
In an attempt to address these issues at the system level, we collaborated with a group of cross-sector stakeholders and Foresight Lane to establish a collective impact program for the Wimmera Southern Mallee emergency health services system.
We designed a two-day collective impact forum that brought together many of the organisations who deliver or utilise emergency services in the region.
The stakeholders all wanted the same thing——to improve the delivery of emergency medical services to the community.
The Victorian Department of Health was interested in distributing capability between different public providers to improve efficiency and efficacy. Individual hospitals were interested in relieving pressure on their emergency departments. Ambulance Victoria was interested in redesigning how they're managed between different emergency departments. And GP’s and Medicare locals were interested in redesigning referral pathways.
All of the stakeholders were working individually towards improving the emergency health system, yet they all faced similar obstructions. There were barriers to collaboration across the industry or organisational boundaries and a lack of a universal ‘system view’ which meant their ability to improve the system independently was limited.
Our aim was to enable the group to identify, design and implement one or more ways to relieve the pressure on emergency health services in the region.
We formed a Sponsor Team of 6–8 key stakeholders who worked with us to clarify the goals of the program.
These sponsors were senior executives or CEOs from numerous participating rural hospitals, Victorian Department of Health executives and members of the regional health strategy committee. We worked closely with our health strategy partners, Foresight Lane to ensure the group had the authority to effect change.
We met with the Sponsor Team three times over two months before our collective impact forum was scheduled. Together we co-designed the different layers of the event and refined our understanding of the impact we wanted to create.
Over the course of the two-month preparation process, we designed all layers of the collective impact event with our sponsor group.As we were asking over 40 individuals to donate two full days to the program, it was important that we meticulously designed the event to make the most of participant’s time and capabilities. Bringing together the right group of individuals for the event was critical.
We needed people with different points of view to ensure the group had a diverse, representative knowledge of various parts of the system. We needed individuals who were able to make decisions as well as individuals able to lead the implementation of any innovations we designed together.
It was important that our program of activities allowed participants to go on a journey, exchanging the right knowledge at the right time, to allow the group to identify gaps and opportunities.
We designed fit for purpose activities that helped participants to exchange information, build awareness, make decisions and identify opportunities.
We carefully orchestrated the timing and flow of activities throughout the event. The activities were sequenced to ensure participants gained a shared understanding of the system and contributed their particular requirements and challenges for consideration.
We knew that most of our participants were coming into our event cold, being relatively unaware of the goals of the program or the value of collective impact as an approach.
Our event was designed to ensure our participants did not give up or become distracted or distrustful of the process. We needed them to be inspired and to feel comfortable thinking and working in different ways.
Collective impact events produce a lot of new knowledge. While it is good that this knowledge exists experientially in the heads of participants, it is critical that work is photographed and captured after each activity so that it can be fed back in at key moments later in the program to provoke insights.
We captured all of the work and insights so they could be shared with and built upon by others after the event. The facilitation team had carefully planned this knowledge management process before the event.
Over the course of the two-day event, we had regular check-ins with our Sponsors, who as participants themselves, were tasked with feeding information and insights from the participant group back to the facilitation team.
Because we had designed the event in close collaboration with our sponsor team, the facilitation team was able to adapt, adjust and redesign the program and activities to take advantage of opportunities that arose on the day.
We kept the desired outcomes in sight while we adapted, rather than dogmatically sticking to our program.
The participants identified six major innovation opportunities and designed a vision, business case and implementation plan for each.
An important outcome was the agreement that a system-wide ‘air traffic control centre’ was needed to coordinate capability across healthcare providers, enabling Ambulance Victoria to make more informed decisions in emergency situations.
Beyond the individual opportunities that the group identified, the collective also realised that an ongoing, inter-organisational strategy group was needed. This resolution was conveyed to the existing regional health alliance, and their role and remit has now been broadened.
The Department of Health, the Medicare locals and the Regional Health Strategy Committee are playing an important role in attracting the funding required to launch Australia’s first integrated, public and private capability hub located in Horsham.
Another initiative from the form, the “Flick the Flu” campaign launched and saw over 500 preventative flu packs distributed to vulnerable members of the community. Twelve organisations are now participating in the Flick the Flu program across several regions.
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