Case Studies

Air Ambulance Reference Group (for Ministry of Health and ACC)

The Air Ambulance Reference Group (AARG) was initiated by the Minister for ACC and Minister of Health in late 2006 to provide expert advice on a framework for the provision of air ambulance services for New Zealand. Monarch’s role was to provide project management and analytical support to the independent Chair, Mel Smith.

There have been previous reviews of the air ambulance sector over the last ten years, but there remained outstanding questions about the long-term sustainability of the current service delivery model that needed to be resolved. This review was aimed at addressing those questions and providing advice for the long-term direction for air ambulance services.

The membership of AARG was large and diverse, representing all parts of the air ambulance sector: clinicians, emergency helicopter operators (private and charitable trusts), road ambulance providers, district health boards, central and local government, and other emergency service providers. ACC and Ministry of Health also attended the meetings as funders and purchasers of the service. The diversity of the members required proactive relationship management to ensure that all members had the opportunity to contribute and have their views discussed.

The role involved working closely with the independent Chair as the project manager and facilitator to achieve the objective of the project, i.e. to provide expert advice to Ministers. Three workstreams were established to enable the wide scope to be canvassed and discussed with members from the wider Group. In addition, an Integration Team was established to align the work of the three workstreams.

Monarch consultants developed discussion documents for each workstream, Integration Team and full AARG meetings to aid the debate. Monarch worked with the Ministry of Health and ACC to commission two independent studies to provide information for the review. The final report was distributed to all AARG members and their feedback was reviewed and responded to at subsequent meetings and versions.

The final report outlined substantive and practical proposals to address the issues facing the sector. These focused on establishing a governance structure that would provide the strategic oversight that had been lacking and streamlining the Crown and ACC funding and contracting processes to minimise the transaction costs for all parties and ensuring a consistent approach to service specifications. A key challenge was that AARG’s scope was focused on the air ambulance portion, which is only a small part of the wider ambulance sector, which was facing similar challenges.

Feedback from those involved in the process was positive and members felt that they had been involved, listened to and their views considered. While not all members agreed with all parts of the final report, there was a consensus that it fairly represented the debate that had taken place over the 18 months of the project.

 

Inter-hospital Transfer: Air Ambulance Review (for District Health Boards New Zealand Inc)

The Inter-hospital Transfer: Air Ambulance (IHT-AA) project was initiated by District Health Boards New Zealand to address a number of inter-related issues and concerns relating to choice of service and the sustainability of the status quo. Chief Executives of District Health Boards (DHBs) wanted to manage the significant growth in demand for IHT-AA services, increasing costs and public expectations.

The objective was for DHBs to collectively define a safe, efficient, cost-effective and nationally integrated but regionally delivered IHT-AA service that meet patients needs, targeted population health outcomes. This project was complementary to the Air Ambulance Reference Group project and there was some dual membership of both groups, along with Monarch Consulting providing the project management and analytical support for both projects.

The project team members came from a number of DHBs, but represented all DHBs in that the service had to meet the needs of patients and DHBs throughout New Zealand. Members had to put aside ‘regional’ perspectives and provide input that would result in a better national service. Monarch Consulting’s role was to ensure that regional views were considered within the context of a desire for a nationally integrated but regionally delivered service.

The project was undertaken in two phases. The first phase involved developing a clear picture of the current service through a systematic data collection process, defining the purpose, scope and principles for the service design, and clearly understanding the patient’s needs of such a service. Monarch developed discussion documents to facilitate the debate about options for the future of the service, including providing a conceptual framework that enabled members to understand the components of the service and how these could best be delivered. The final report was drafted by Monarch and following a series of reviews, was presented to Chief Executives. The recommendations from this phase outlined proposed governance and management structures that would result in a national tender process based on an agreed service specification. The Chief Executives agreed in principle to all the recommendations, subject to further advice on particular aspects.

The second phase undertook the detailed planning to provide further advice. Some project team members from the first phase continued on into a further three workstreams that provided more detailed advice on the clinical resource implications, undertook financial analysis to validate the costs of the current service, identify potential cost savings and options for how a nationally tendered service could be equitably charged to DHBs throughout New Zealand. A detailed assessment of the risks and mitigations was undertaken, along with the development of a consultation and communications plan. Project planning ensured that teleconferences were used wherever possible and face-to-face meetings of separate and combined workstreams were kept to a minimum to manage costs and impacts on project team members.

The three workstreams developed separate preliminary reports for discussion by an Oversight Committee, comprising the Lead Chief Executive, the technical leads of each workstream, the DHBNZ programme manager and Monarch Consulting. The final report was consolidated by Monarch Consulting utilising the outputs from each workstream.

 

Procurement Advisory Services (Capital and Coast District Health Board)

Capital and Coast District Health Board (DHB) commissioned Monarch Consulting to provide procurement advisory services for management of the total tender process for the new Wellington Hospital Radiology and Cardiac Intervention suites from user requirements, ROI, RFP, Governance, analysis of responses, management of all responses and communication, selection of successful vendors, negotiation of terms and conditions and contract drafting through to management signoff and final execution of contracts.

This was a highly successful process with significant savings to the DHB which amounted to several million dollars on purchase price and ongoing life of the equipment maintenance and service savings.

Primary Response In Medical Emergency (PRIME) Training Review (Ministry of Health and ACC)

The Ministry of Health and ACC commissioned Monarch Consulting Limited and Research New Zealand Limited to jointly review the PRIME training programme. The Review, conducted in early 2008, was to assist the Ministry and ACC to continue to specify and contract for appropriate PRIME training. That is, training that develops and maintains the skills needed by PRIME practitioners to deliver safe, effective pre-hospital emergency care in rural areas.

A Project Advisory Group was established to serve as formal advisors and reviewers during the project, providing comment on the project plan, survey design and draft reports. Group members included representatives from ACC, Ministry of Health, ambulance services, and the primary care sector in each of the North and South Islands.

Monarch Consulting and Research NZ prepared a joint proposal to undertake this work. This approach provided a team that covered all the areas of expertise required for the project, including clinical experience and knowledge in pre-hospital emergency environments and in training clinical courses. A Principal Consultant and Project Manager was appointed to ensure the project team and activities was seamless and integrated.

The scope of the review included the clinical content of the PRIME courses, comparing it with other New Zealand and international training programmes, reviewing available international evidence on training interventions, reviewing the current operation, accessibility and effectiveness and making recommendations about the desired standards for practitioners participating in PRIME.

The review required extensive consultation on matters such as the desired standards with a number of clinical organizations, undertaking a literature review to identify the relevant evidence base and best practice information, and completing surveys of PRIME rural practitioners, trainers/coaches, medical staff; and completion of key informant interviews with ambulance and emergency department clinical directors and overseas educational educators delivering PRIME equivalent training.

 

Policy Advice and Implementation, and Regulation Development (for Department of Building and Housing)

The Department of Building and Housing have been undertaking substantial policy and regulatory projects for a number of years arising from the ‘leaky building’ problem, among other things. This has created resourcing issues to meet the legislated timeframes. Monarch Consulting has provided resources and expertise to fill the Department’s resource gap.

The new Building Act 2004 established the requirement for accreditation and certification processes for building consent authorities and for building systems and products. These were both substantial policy initiatives that required detailed analysis, extensive consultation and the development of regulations to put the policy into effect. Monarch undertook a number of roles: development of policy advice, preparation of Ministerial briefings and Cabinet papers, development of consultation documents and analysis of feedback. Monarch was responsible for the overall project management of these processes to ensure the timelines were achieved.

During this time, territorial authorities had to prepare themselves for the certification process to become ‘accredited building consent authorities’. An assistance package was developed by the Department to appoint ‘case advisors’ to work with specified territorial authorities to assist them in meeting the requirements and timeframe for certification. A Monarch consultant was one of the team of case advisors that provided operational and process support. Relationship management was a key aspect of this work to establish a rapport with the territorial authorities.

An in-depth technical knowledge and understanding of the wider policy matters and initiatives underway enabled Monarch to provide targeted support as and when required. This included the development of ‘plain English’ guideline documents, preparing specifications for tender processes and managing the process, providing urgent background papers for senior management.

 

Operational Review of the Accredited Employers Programme (for ACC)

The AEP Operational Review was a joint initiative of government agencies (ACC and the Department of Labour), the NZCTU and Business New Zealand. In October 2006 the NZCTU released an issues paper describing concerns about the performance of the AEP. Around that time, as part of continuous improvement planning, ACC had also initiated an internal review of AEP audit practices. In December 2006, discussions between ACC, the NZCTU and Business New Zealand concluded in an ‘in principle’ agreement to conduct a collaborative operational review of the AEP. The Department of Labour also subsequently agreed to participate in the Review.

The AEP Operational Review was formally established by the participants (with the consent of the Minister for ACC) as a joint initiative to develop advice, as appropriate, for the Review Steering Group, ACC Board, Department of Labour or the Minister for ACC. The focus of the Review was principally on operational issues and solutions.

Independent, professional Review project management support was provided through Monarch Consulting Limited. Monarch’s extensive project management experience contributed to the development of two key Review deliverables – an Interim Report, which outlined options with potential for early implementation, and a Final Report which addressed the balance of the Review’s work. Work undertaken to populate the reports included information gathering, options identification, and assessments to determine the operational viability of options.

The scope of the review included an analysis of ACC practices, identifying differences and issues with the ACC approach, and undertaking comprehensive surveys of AEP stakeholders, including AEP employers, AEP claimants and Unions.

The Review has drawn on information from a number of sources, including Review meetings and discussions, consultation with wider stakeholder groups and five surveys in total. Research New Zealand contributed to the development and implementation of three of the five surveys that informed this Review. Monarch was responsible for introducing the Review project, including early findings from project surveys, at a series of workshops for Accredited Employers and NZCTU delegates that were held in Auckland, Wellington and Christchurch. Consultative discussions were also held with third-party administrators (TPAs), and the ACC Consumer Outlook Group.