How a Maori proverb contains the key to integrated care
Nurse leaders should consider how they can foster better relationships between health and social care staff to support patients, says New Zealand-based Kathryn Gibb
In Aotearoa, the Māori name for New Zealand, we enjoy the richness of our indigenous people, Māori, and their culture, woven into the fabric of our daily lives.
He aha o te mea nui o teao. He tāngata, he tāngata, he tāngata, means: what is the most important thing in the world? It is the people, it is the people, it is the people.
This Māori proverb is one that offers us much to reflect on in health, as we consider how we might place people at the centre of everything we do in order to achieve equitable health outcomes for all.
Here in Canterbury, in New Zealand’s South Island, we have been on a transformational journey towards an integrated health and social care system where health professionals from across the services work together in a connected system that revolves around the patients’ needs.
Much has been written about Canterbury’s journey over recent years, including a recent report by the King’s Fund in which it is suggested that health systems like the NHS can learn from Canterbury’s journey (Charles 2017). The technological innovations that have enabled our connected system, and the approach of our senior leadership to decision making that created a ‘one system, one budget’ alliancing approach, have been significant enablers of the successes that have been achieved.
However, what is an equally important enabler of these changes? He tāngata – it is the people. In Canterbury, we talk about ‘Agnes’ as our archetypal patient – how will our actions and decisions make things better for Agnes? For Agnes, an older woman with a chronic health condition living in her own home, it isn’t important which organisation employs the nurse, or who completes an assessment with Agnes in her home, or who supports Agnes to plan how her needs will be met on discharge from hospital. What is important to Agnes is that the people who support her work together seamlessly, as one system.
For our nursing leadership here, this has meant thinking about how we can support nurses from across our health system, across organisational boundaries, to build trust and understand the important roles played by colleagues across the system, and to come together around Agnes as a ‘virtual team’.
'These things take time, years in fact'
In reducing the growth rate of acute hospital admissions, we have increased the complexity of services being offered in the community. There is always more to be done, and never enough time in the day.
These things take time, years in fact; and they need a team of leaders who support and understand the value of relationships, and are prepared to support ways of working which enable this time spent together.
As the NHS considers how it will move forward over the next five years and beyond, I would encourage leaders to give thought how to foster relationships among the people across the system who will make things better for your Agnes.
What is the most important part of an integrated health and social care system? He tāngata, he tāngata, he tāngata.
Charles A (2017) Developing accountable care systems: lessons from Canterbury, New Zealand. The Kings Fund.
About the author
Kathryn Gibb is a nursing director older people, population health at Burwood Hospital, New Zealand