Walgan Tilly Project: Chronic Care for Aboriginal People - NSW Health

Project overview

The Chronic Care for Aboriginal People (Walgan Tilly) Clinical Services Redesign project is the first Aboriginal Redesign project and was developed from a number of established NSW Health initiatives in an attempt to address the disparities in health care and improve access to and utilisation of chronic care services for Aboriginal people in NSW.

The Chronic Care for Aboriginal People project was named Walgan Tilly. Walgan is a Kamilaroi word meaning 'Aunty', a title of respect to Aboriginal women and 'Tilly' is short for the name Matilda. The project was given this name to help ensure that the focus of the project remained on the patient experience.

Goals

The main goals of the project were as follows:

Develop practical steps and real solutions to improving access to chronic disease services for Aboriginal families and communities.
Build working relationships between Aboriginal and chronic disease services.
Identify and share of best practice in meeting the needs of Aboriginal people with chronic disease.

Objectives

The high level objectives of the project as stated in the NSW Health work order were:

Understand and reduce health system barriers to access of mainstream chronic disease services for Aboriginal people in the community setting.
Develop effective systems between Area Health Service’s (AHS) Acute and Chronic Care teams, Aboriginal Medical Services (AMS) and the Aboriginal Vascular Health projects for the diagnosis and care of Aboriginal people with chronic conditions.
Provide development and support for implementation of evidence based strategies for Aboriginal communities that prevent chronic disease and/or reduce hospital admissions.

Method

The approach to undertaking this project was focused on the application of Redesign methodologies to review the patient journey of the Aboriginal person (aged 15 and over) who have, or are at risk of, chronic conditions and was underpinned by the principles of collaboration and partnership.

This was achieved through a structured approach that captured and analysed the 'as-is' environment through extensive stakeholder consultation and data collection activities, which was then used to inform the development of the recommended solutions (or the 'to-be' environment).

Phases

The project was comprised of three key phases:

Phase 1: Project planning and mobilisation
Phase 2: Diagnostic phase-understanding the ‘as-is’ environment
Phase 3: Solution design and implementation planning phase-designing the ‘to-be’ environment.

Progress to date

Over the course of the project, a number of milestones were achieved, these included:

23 proposed AHS and Justice Health solutions and implementation plans.
Six proposed state-wide solutions and implementation plans.
Development of Aboriginal Nation maps for each AHS and Justice Health.
A state-wide workshop was held in Sydney (with over 65 attendees) to facilitate the sharing of local and state-wide solutions, to agree the next steps and to build the commitment for change.
Solution design training workshop which provided skills transfer from NSW Health and PricewaterhouseCoopers (PwC) to over 35 AHS and Justice Health representatives.
A total of 12 validation workshops were held across the state, with a total of 206 attendees, with a minimum if one workshop per AHS.
A total of 11 local solution design workshops (AHS and Justice Health) were held across the state, with a total of 201 attendees
Three site visits for the purpose of in-depth data collection activities in a metropolitan, regional/rural and remote location, these sites were:
- Mt Druitt, SWAHS
- Casino, NCAHS
- Condobolin, GWAHS.
A total of 111 key informant interviews were undertaken, along with five expert interviews.
A total of 45 staff and patients were involved in five process mapping sessions.
Engagement of a total 34 patients and carers through interviews, the Patient Assessment of Chronic Illness care (PACIC) and process mapping.
A total of 84 survey responses to the online General Practitioner (GP) and general service provider surveys were received.
The Solution Design Training Workshop brought all the Areas together, which was most beneficial as it allowed us to do some networking and discuss
common issues and innovations being considered.
Development of a literature scan to provide a brief and practical review of good practice in the field of chronic care and self-management, both nationally and internationally.
The collection of 17 good practice exemplars of what has worked well/exemplars of best practice from the AHSs and Justice Health.
The development of a food for thought document which was developed to assist the AHSs and Justice Health with solution design.
Development of a Quantitative Data Supplement which addressed the Key Performance Indicators (KPIs) outlined in the work order request.
Skills transfer undertaken with the NSW Health project team and project representatives statewide.