Healthcare system, heal thyself

By Juha Saarinen

The $10 million Ko Awatea Centre, designed by Jasmax and fitted over repurposed parking space, is generating interest overseas. Photo / Juha Saarinen
The $10 million Ko Awatea Centre, designed by Jasmax and fitted over repurposed parking space, is generating interest overseas. Photo / Juha Saarinen

The Ko Awatea Centre in Middlemore aims to connect community healthcare with world-class innovation and ideas, writes Juha Saarinen

What do we as a society do to keep our healthcare system going, with a rising aged population and increasing costs?

Geraint Martin, the chief executive of Counties Manukau District Health Board, responsible for Middlemore Hospital, answers the question by ruling out building another hospital.

"Over the next 15 years, Counties Manukau will grow by the size of Hamilton," Martin says.

That means another 150,000 or so people, as Counties Manukau is the fastest-growing area in New Zealand. The area has the largest groupings of Maori, Pacific and Asians in the country, making it a uniquely multicultural place with roughly 15 per cent of New Zealand's population.

The growth hasn't translated to wealth for the area, however.

Though Manukau city centre looks spruced up and smart, driving around Middlemore Hospital's surroundings in Otahuhu show a part of New Zealand characterised by deprivation.

The police presence in the area is heavy and most shops and food outlets focus on cheap stuff, not quality.

As a result of socio-economic deprivation, many people in Counties Manukau are obese, have heart disease and diabetes.

Becoming more efficient at what we do isn't going to keep pace with population demands, Martin says. Instead, he says that as hospitals are very expensive places, keeping people well in their homes is a far better idea.

To this end, Martin and Professor Jonathan Gray, director, have been working to build the Ko Awatea Centre in Middlemore, which aims to connect community healthcare with world-class innovation and ideas.

The concept sprang out of health sustainability conferences over three years, Martin says, during which time he realised the expertise was already there in South Auckland, but was disconnected and compartmentalised.

Gray and Martin have worked together in Wales on a similar project, but believe Ko Awatea will go further and with better results than they saw overseas.

Ko Awatea opened on June 21 this year, and is aimed at bringing together the thinking and experience of healthcare professionals in an education and innovation centre. While this may seem like a common sense approach, Martin says Ko Awatea represents a break from how medical education has traditionally been done.

"The key thing is that they [medical students] learn together. It's about collective learning, and not meeting the first time over a sick patient," says Professor Gray.

Apart from Counties Manukau DHB, Ko Awatea will deliver education programmes with the University of Auckland, Manukau Institute of Technology, and AUT.

Internationally, Ko Awatea has partnered with the Institute of Healthcare Improvement (IHI) in Boston, with some of their lecturers already in place in South Auckland.

Setting up something like Ko Awatea isn't uncontroversial however. As fund raising executive Michelle Kidd candidly says, "someone on the waiting list for major surgery might look at Ko Awatea and say 'is this where the money for my operation is being spent?"'

However, Alex Smart, manager of Ko Awatea, is confident that Ko Awatea will not just work out better, but that the centre will in fact save on money compared to ad-hoc arrangements for education and training in the past, where universities had to shell out high rates for temporary lecture rooms for students.

Even though the Ko Awatea Centre is only just finding its feet and still has rooms to be fitted out, the $10 million building, designed by Jasmax and fitted over repurposed parking space, is generating interest overseas, Martin says.

"Australia and Asia-Pacific countries are showing a great deal of interest in Ko Awatea," Martin says, and adds with some pride that it has been asked to host the next regional health improvement conference.

As a measure of overseas interest Ko Awatea has generated in a short time, Martin proudly mentions the centre's new professor of emergency care, Greg Larkin, from Yale.

With something as fresh and innovative as Ko Awatea around, it will be possible not just to attract top healthcare professionals like Larkin, but also to retain them and to keep their ideas and thinking here, Gray says. Nevertheless, the key to Ko Awatea's success is how well it will attract local people. Martin says "NZ is very good at importing people" but at the same time, we can't do that to keep up with population growth, he adds.

Instead, the new healthcare professionals have to come from the local community. Right now, the work force at Middlemore, one of the country's biggest employers with 6000 staff isn't proportional to the demographics in South Auckland.

How do we get Pacific Islanders and Maori to consider a career in healthcare then? Martin says that traditionally, "we'd tell people to go down to Dunedin for three years, get a really big student loan and then come back." Given the socio-economic realities of South Auckland, he says it "ain't gonna happen". Instead, training local people has to take into account their need to earn while they learn to support their families, and foundation courses to plug holes in their education.

Succeeding in attracting locals to often well-paying jobs in the $70,000 a year range will have several beneficial side-effects beyond sheer economic ones, Martin believes. Having for instance a nurse in "every family in South Auckland" who you could ask for advice would improve health literacy something tremendous he says.

Could a concept like Ko Awatea become an export earner? Martin has no doubts that it will. Companies such as Fisher & Paykel Healthcare and Orion Healthcare both grew out of Middlemore he says. Both are enjoying international success currently.

There are over one hundred healthcare-related companies in South Auckland, and Martin says another twenty to thirty should be possible. "It's high-end, high-value stuff," Martin says.

The goal is to make the world look to South Auckland for answers on how to work together and develop systems to beat the complexity of modern healthcare.

"The rest of the world is facing exactly the same healthcare problems we are. Why don't we create innovation whereby we connect with industry, to create products and services, and build an export industry?" he asks.

- NZ Herald

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