HNA process

MPHN uses a supply and demand approach to determine gaps in service which results in identification, prioritisation and planning of strategies or programs to address the gaps identified. Planned commissioned services and programs in response to the identified health needs provide service utilisation data which informs effectiveness and efficiency of services and programs and which feeds back into the continuous review of health needs and gaps in service provision.

Understanding the quantity of the gap is one element, measured by supply and demand. Understanding the reason for the gap is another, MPHN take a consultative approach with community members, key stakeholders and health service providers to understand reasons why gaps exist and to co-design where applicable, solutions that address the root causes.

MPHN take a stepped approach, identifying demand by developing population profiles analysing demographic and health data which are then prioritised for the region and within local government areas. Prioritisation assists in identifying the most significant issues and where geographically they occur in higher prevalence. MPHN constantly looks for robust data sources to include in its HNA data review. MPHN preferences gold standard sources of information such as the Australian Institute of Health and Welfare (AIHW), Australian Bureau of Statistics (ABS), Public Health Information Development Unit (PHIDU) and New South Wales (NSW) Health data.

An exciting improvement to MPHN’s data analysis in relation to prioritisation of health issues and risk factors includes the development of automation through the Population Health Analytics (PHA) tool which ingests templates, in excess of 500 data points currently, of MPHN related health data and automatically calculates priority status based on a defined algorithm of benchmarking throughout the nation and variance to national averages. Within its LGA structure prioritisation of areas to concentrate on included taking into account magnitude of the difference compared with MPHN or state averages. This provides a transparent and robust methodology to data analysis.

Using service data as a measure of supply, MPHN maps where services are currently provided. Service supply can also include patient use of services data such as general practice data, Medicare Benefits Scheme (MBS) items and hospital usage rates. Workforce data is a critical piece of information that informs service gaps. Service mapping is undertaken in general practice and the community through MPHN staff regularly and at census points through the year. MPHN additionally use their commissioned service data to inform supply. Service use data is also prioritised using the MPHN automated Population Health Analytics tool.

Confirmation of potential gaps and why the gap exists are achieved by consultation with communities through several mechanisms. MPHN conducts a “Conversations on the Couch” tour of several places in the region annually to talk openly with communities about their issues. There is no defined agenda which is deliberate to ensure we are not influencing the issues that communities face. A minor change to the Conversations tour for this HNA includes changing from a week-long tour at one time point to a designated tour to areas at the end of each month for a period of six to eight months. This results in the same coverage but allows for additional conversations to occur in specific naturally occurring groups such as youth groups, men’s sheds, Country Women’s Association and local councils, broadening the scope of consultation in each of the chosen areas.

This HNA process will include a specific “Yarns on the Couch” conversation with Aboriginal and Torres Strait Islander people in four areas of the Murrumbidgee region. Held at local land councils or significant places where local people gather, this informal process built on the conversations on the couch will ensure a culturally safe and respectful mechanism for engagement to hear Aboriginal and Torres Strait Islander people’s voices.

HNA Live, now HNA mini, allows consumers and healthcare professionals of the region to let MPHN know in real time their concerns about emerging health issues. Information on issues, challenges or positive feedback for specific populations is sought by promotion of a month long activity of feedback. Twitter, Facebook and MPHN newsletters are used to promote the feature of the month to encourage the community to provide feedback

MPHN has added a community survey for this HNA. The survey seeks to gather information from communities about how they view their community. It also gathers information on self-reported health status and health challenges and capacity to access services. It is available with a cultural lens for Aboriginal and Torres Strait Islander people.

It is acknowledged that MPHN whilst capturing a broad range of stakeholders will need to continue to find solutions to engaging with people who normally don’t engage with health services, this includes but is not limited to people who are homeless, from culturally linguistic backgrounds and the prison population.

Targeted in depth projects are also undertaken, for example Community Led Planning projects are undertaken with two dedicated communities annually to work with community members to identify their needs and develop strategies led by the community to address them. This has been impacted by COVID-19 but remains an important strategy in working with regional communities and is partnered work with the MLHD to ensure that duplication of effort does not occur.

In addition promotion of the feedback mechanisms occurs through the Local Health Advisory Committees (LHACs). Consultation with various groups include the Murrumbidgee Aboriginal Health Consortium, the Youth Reference Group, the Shared Care Antenatal Group, the Murrumbidgee Mental Health Drug and Alcohol Alliance and the Murrumbidgee Aged Care Consortium also occur regularly to gather information on these groups specific needs. The insights of these groups are useful for identifying efficiency and effectiveness of current service delivery models and provide opportunities for improvement and identification of barriers to service access.

Clinical Councils are consulted to connect with healthcare providers, as a key stakeholder group it is important to understand the constraints and limitations of providers for health service delivery and to take into account their views related to health needs of their communities. MPHN consults with its current providers of commissioned services regularly and each have an opportunity to express issues with healthcare through regular contact with their portfolio manager. Primary care providers are regularly supported by primary care engagement officers in each of the four MPHN sectors. Information and issues gathered during support visits are captured and fed back to MPHNs HNA through MPHN’s customer relationship management system.

Consideration of both qualitative and quantitative analysis of health issues provides strong evidence for service and navigation investment to best meet what matters to communities.

MPHN analyses a range of sources related to geography, demography, health determinants and health status including risk factors. MPHN analyses the data at a Primary Health Network (PHN) level and

benchmarks to other PHNs across the nation. To determine locally where these domains are more relevant, MPHN uses LGA data. MPHN analysis of Statistical Area 3 (SA3) level information does not provide a good distribution within its boundaries and in particular is less able to be matched to MLHD service delivery and is rarely used. Local Health Advisory Committees additionally look to support their local communities within the LGA boundaries.

MPHN has developed a Population Health Analytics (PHA) tool to ingest publically available data. Data is ingested into the tool and is ranked comparing all 31 PHNs data. Data is ordered by PHN dependent on whether a lower or higher score is relevant. For example having less infant deaths is desirable so the ascending order would be by lower values, the higher the MPHN value is the worse the issue. Having more people exercising is desirable so this variable would be sorted by higher values. Ranking remains static in that a rank of one is always considered better than a ranking of 31 considered to be worse. In the MPHN view in the tool in addition to the rank score the variance to the national average and the NSW average is displayed if available. The tool preferentially sorts indicators by most significant variance to national data. This identifies which indicators we should be considering for activities to improve health. Where indicators fall in the bottom third of the nation, indicating worse standing they are considered for activity. Other indicators may be considered for continuing activity to maintain or improve their standings. Rank order is not the only consideration though, indicators are preferentially sorted by their variance to the National average.

To determine where MPHN activity should be focused, the PHA tool reports each indicator across all LGAs where information is available and displays the difference between the MPHN average or the NSW average.

The final action in the needs assessment is to incorporate all data and qualitative information collected in a triangulation methodology that brings together demand and supply to identify gaps, reasons for gaps, existing planned activities to determine where maintenance of existing service supply is required or where new activity would be required to address an unmet need.

MPHN has a community and person first philosophy, to support this MPHN organises its health needs assessment and activity workplans by population groups. The following groupings are used:

 Aboriginal and Torres Strait Islander people;  mothers, children and youth;  older persons and  population health including vulnerable populations who experience socio economic disadvantage.

Using these groupings allows synthesis of profiles, geographic, demographic and health to be analysed in conjunction with information from feedback and consultations to give an accurate representation of the entire MPHN and the 21 LGAs.

Prior to submission to the Commonwealth the last important actions for the compiled priority list is to validate the results with key stakeholders. Key stakeholders include identified staff from the MLHD as a major partner in the process and MPHN community. Refinement of priorities occurs based on validation feedback. Once this validation has been completed the HNA is provided to the Clinical Councils and the Community Advisory Committee of MPHN for their input into validation and endorsement for progression to the MPHN Board. Once endorsed MPHN’s Board considers the recommendations and approves submission to the Commonwealth.

This formal approach to reviewing the HNA is undertaken annually, however it is reviewed and updated continuously. MPHN take a reflective approach to reviewing its processes for HNA regularly to ensure they are fit for purpose and take opportunities to refine and improve and mature its implementation of the HNA.