So staggering were the improvements in health outcomes for an Alaskan community that Hawke's Bay District Health Board's general manager of Maori Health invited them to Hawke's Bay for a workshop.

Tracee Te Huia, general manager Maori health, said she visited the Alaskan community last year and was so "stunned" by the improvements the Southcentral Foundation Nuka System of Care had made that she believed much of their work could be replicated in Hawke's Bay.

"A lot of the issues the Alaskan community were facing are the same we have here; high rates of diabetes, increasing ED presentations, domestic violence, child abuse and high numbers of hospital admissions," she said.

"In 19 years they have completely changed the way health care works. ED presentations have dropped by over 36 per cent, primary care visits have dropped by 25per cent, diabetes and other chronic disease management has improved dramatically but most of all patients give them a big tick of 96-99 per cent for customer satisfaction - and so did their staff, at 93 per cent employee satisfaction."

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Ms Te Huia said it had been fascinating watching the workshop at the end of last year.

"As soon as you have a customer the whole thinking changes - it becomes about respect, sharing and empowering people to be in control of their own wellness," she says.

South Central Foundation chief executive Katherine Gottlieb agrees that by changing from patient to customer-focused health care the system moved in Alaska.

"Our community wanted same-day access to their primary health practitioner, better and cleaner health facilities, they wanted to see a drop in domestic violence and child abuse to name a few of the main items - and we have delivered", she says.