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Shared problems, co-designed solutions
The first idea was a desire for a standardised discharge checklist to be co-de-
signed by consumers and clinicians. The second was to institute structured
questionnaires at discharge and post-discharge.
A common concern emerged that discharge processes tended to have a speed and
momentum that weren’t helpful to consumers and that didn’t match their needs
for clear directions on how to manage ongoing health issues and future rehabili-
tation. Clinicians were concerned that patients were “lost” to rehabilitation—they
fell through the gaps and disappeared after their initial phase of treatment.
Enabled by co-design, this introduced a tangible example of an area where the
clinical response needs “to get better at the things they’re not good at”.
Ultimately the common goal of transparency is to encourage a system of
public reporting that fosters learning and improvement in the work of clini-
cians and reassurance and trust for the consumers of their services. In parallel
the Commission is working with the registry holders and the Cardiac Network to
publish indicators of quality of care in ACS in a dartboard format, showing vari-
ation across the country on key agreed indicators, and tracking improvement
against agreed targets.
Adaptable, smart techniques to make transparency work
The use of existing registries and co-design is a transferable technique,
adaptable to other specialties and conditions with their own registries—to make
more data more public in ways consumers want and clinicians trust and can use to
improve services and address their patients’ needs. New Zealanders can’t choose
their providers, but they have a residual trust in their health care services; this
is an invaluable component of our unique social contract and one that increased
transparency can support. We continue to reach out to registry holders to talk
about making more of their data public in ways that can inform New Zealanders
and make our healthcare better.
Continued research into understanding the barriers to optimal
care is critical to improving health outcomes for all New
Zealanders. ANZACS-QI is a Ministry of Health funded web-
based quality improvement registry to which all hospitals
admitting patients with acute coronary syndromes are
required to register patients. The aim is to improve outcomes
for all, regardless of age, gender, location, socioeconomic
status or ethnicity. ANZACS-QI as a quality improvement
initiative helps us to identify evidence-practice gaps, and
assess the implementation of programmes to narrow those
gaps. Integral to the registry’s goals is transparency of
outcomes and development of indicators meaningful to New
Zealanders living with heart disease.
MB BCh BAO BA MD FRACP FCSANZ FESC
Associate Professor (Hon) in Medicine University of Auckland
Medical Director Heart Foundation
Clinical Leader New Zealand Cardiac Network
Carl Shuker is Principal Adviser,
Publications in the Health Quality
Intelligence team at the Health Quality
and Safety Commission New Zealand.
He is a researcher and writer with
special interests in transparency,
incentives and public reporting. He
was a digital editor at the British
Medical Journal for seven years before
returning to New Zealand as the 2013
Victoria University Writer in Residence.
He has a background in creative writing
and is an award-winning novelist with
four novels and short fiction published
in the US, UK and New Zealand.
About Carl Shuker
For more information see:
Shuker C, Bohm G, Hamblin R, et al. Progress in public reporting in New
Zealand since the Ombudsman's ruling, and an invitation. N Z Med J. 2017
Ministry of Health, Health Quality & Safety Commission. First annual update
on increasing transparency in New Zealand health care 28 June 2017.
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