Strategic funding case study – Palliative care services, a case study in co-operation
This case study outlines how strategic funding through contracting was the key to changing funder and provider behaviour.
A crisis in the organisation and delivery of palliative care services in the Bay of Plenty provided the Bay of Plenty District Health Board (BOPDHB) with a unique opportunity to use innovative service redesign and create new funding models to improve service continuity, co-ordination and effectiveness within available resources.
In March 2003, the BOPDHB set out to change the behaviour of palliative care providers to ensure services met local population needs.
Critical elements to be addressed were the competitive behaviour between providers in a contestable funding environment and the impact of that behaviour on the provision of services. Strategic funding through contracting was the key to changing provider behaviour.
Key features of this study are the ways in which evidence-based policy development, needs-based planning and ‘social-capital building’ methodologies were applied.
Case study background
A review by the BOPDHB found that palliative care was fragmented and disconnected.
Care providers were competing with each other and there were entrenched attitudes to care – community support versus health funds; hospital care versus palliative care; disability support care versus personal care.
Despite local capacity and capability there were gaps in care provision and a decision was made to establish a formal District Palliative Care Network (the network).
A steering group of palliative care stakeholders was organised to guide the project and the palliative care funding portfolio manager handled the relationships and determined the role of the network.
District Palliative Care Network
Key features of the network are:
- clear functions and responsibilities
- a structure that allows flexibility for delivering a range of services
- a culture that enables knowledge transfer and continuous learning
- partnerships between clinicians and managers
- care co-ordination and multidisciplinary team approaches
- connectedness – to communities, to providers, to patients, to funders, to systems of care.
Core elements of the network are that it is district-wide and has a single point of co-ordination for clients. It promotes services that are:
- equitable
- accessible
- locally acceptable
- consistent.
The network promotes capacity and capability-building. It monitors the provision and ensures continuity of care, evaluates progress and recommends improvements.
Having a single point of co-ordination strengthens the provision of community-based services through a district-wide palliative care team. The team collaborates between DHB provider community services, hospice domiciliary care and primary health care services.
Strategic funding
Strategic funding requires a number of components:
- Tools – use of health-needs information, evidence of effectiveness, sector knowledge, systems thinking
- Models – collaboration, knowledge-sharing and management
- Vehicles – sector self-organisation
- Assumptions – understand the assumptions on which current contracts are based and be explicit about the assumptions you make for any future funding redesign
- Marketing – engage the sector and understand marketing concepts and solutions
- Agency – understanding the role of a perfect agent – non-partisan
- What about ‘health sector intelligence’?
Results achieved
The BOPDHB review of palliative care services responded to an emerging issue and provided the board with an opportunity to plan the progressive local implementation of the New Zealand Palliative Care Strategy.
In doing so, it converted competition into co-operation and improved the quality of palliative care service provision.
It also accomplished change within available resources, promoted ‘networking’ to address ongoing learning and development and created a multi-disciplinary virtual team.
Above all, it organised a change in behaviour by palliative care providers, BOPDHB planners and funders, the BOPDHB board, the local hospice and communities of interest.
Where sector capacity and capability is constrained it is essential that:
- service design is based on need
- available expertise is given the mandate and support to do the job
- patient and community outcomes drive service design, not system-management processes
- sector self-organisation and growth is facilitated or micro-managed.
This case study was prepared (in May 2006) in association with Dr Sharon Kletchko, then Director of Planning and Service Development, Bay of Plenty District Health Board, and Faye Ryan, Manager, Population Health Improvement, Bay of Plenty District Health Board.
For more information contact:Dr Sharon Kletchko
General Manager Planning and Funding
Nelson Marlborough District Health Board
Faye Ryan
Manager Population Health Improvement
Bay of Plenty District Health Board
