LEADING FOR OUTCOMES: Health system change / Community primary care / Population health / CVD / Diabetes

Moving to healthcare based on population outcomes
Leading for Outcomes provides a framework for all who are involved in the health system, whether in actual health care delivery, administration or policy, to maintain focus on the overall results of our collective actions - on outcomes. Although this makes logical sense, it is not how we have always worked and it is still not how we work today.

The term 'outcome' here does not refer just to the immediate results of an action.
The concept of outcome in personal health care has tended to refer to the results for an individual of an intervention. For example the outcome of a surgical intervention may be restored capacity to some part of the body (or to the body as a whole).

When the term is used here it has a much broader application. The outcomes referred to may be for a whole population (for example, increased life expectancy for Māori and Pacific Islands men). In this case the activities that lead to such an outcome will be carried out by a wide range of people over a number of years. This long-term outcome then becomes the focus of not only individual or team actions but also the way our institutions are developed and activities funded.

Both at the individual and at the organisational level (and not just in the health sector) it is common to focus on the job at hand, on the output - we are often reluctant to step back and view the bigger picture and look at where our efforts might be heading.

In the health sector, institutional arrangements, such as price/volume funding approaches, have encouraged this way of working in hospitals. While there have been advantages to this, it hinders flexibility in delivering services with respect to desired outcomes and the overall picture comes to lack direction.

In general practice unconnected episodic care of patients on a 'fee-for-service' basis deals in outputs. The 'unit' of health care in this situation is the 10 or 15 minute consultation between GP and patient without reference to the characteristics of sub-groups within the wider practice population. This approach is not necessarily compatible with improving outcomes for the whole.

It is the aim of both Leading for Outcomes and the New Zealand Primary Health Care Strategy to change the way health care is delivered in community settings so that outcomes are improved for both individuals and groups of people.

Health care delivery and the organisational arrangements that support it must be explicitly shaped by the outcomes we seek to achieve - in the first instance by reducing outcome disparities through better preventing and managing long-term conditions among groups at greatest risk of ill-health in primary care/community settings.