Giving voice to what supports prevention in the Queensland public health system

The telehealth program, Virtual outpatient integration for Care Delivery (VOICeD), allows a person with chronic disease to see several healthcare providers at one telehealth appointment.

Queensland Health, with system science support from the Prevention Centre, has used VOICeD as a case study for the project to understand existing activities and future opportunities for prevention in the Queensland public health system.

The VOICeD model was recently piloted in the Cairns and Hinterland Hospital and Health Service to integrate diabetes, renal and cardiac care for people with diabetes. The model is being adapted for other types of care.

An evaluation showed that VOICeD had improved equity of access and the patient experience. It had also reduced healthcare use and created system efficiency.

Dr Brent Knack, Coordinator of the Queensland Diabetes Clinical Network, said VOICeD was an ideal case study as its model of care could be translated to other prevention settings.

“It holds a really great potential for primary and mostly secondary prevention,” he said.

Investigator Dr Ray Maher, from the Centre for Policy Futures, The University of Queensland, said the project team created a systems model of VOICeD that was informed by a document review, key informant interviews and participatory workshops with a range of people from Queensland Health.

The model maps many factors that constrain and enable VOICeD at different levels of the system, and identifies ‘leverage points’ to improve outcomes most effectively.

Dr Maher said the model integrates views from many different perspectives into a “shared understanding of how VOICeD sits within Queensland Health ecosystem”.

He said the model is divided into five subsystems that could support change for prevention: patient-centred care; finance and funding; innovation; sustainability of programs and champions.

“It highlights what factors work together to make VOICeD possible and those lessons can be shared with other parts of the system,” Dr Maher said.

Dr Knack said the participatory workshops provided a rare opportunity for Queensland Health staff to take time out to re-observe the health system and how it works.

“The systems analysis of the barriers and enablers in our current environment has the potential to inform the way we do business, and to show how we can leverage different subsystems to deliver change and improvement in prevention.”

The project team is now working on a second case study that will focus on type 2 diabetes, and explore how prevention can work better to address a Queensland Health priority.

This part of the project is using a virtual crowdsourcing challenge to ask the broader Queensland Health workforce to help identify how the system could better support the prevention of type 2 diabetes.

It will also include focus groups, participatory workshops and interviews to gain a range of perspectives to further refine a systems model.

The findings from the analysis of VOICeD will inform the second case study of type 2 diabetes, and collectively will help the project team identify new subsystems, leverage points and critical factors that more broadly support chronic disease prevention within Queensland Health.  

Dr Knack said he had two broad hopes for what the project would achieve.

“The first is that we can communicate effectively what we’ve found when taking the time to really re-observe the system and the way it functions in that prevention space,” he said.

“The second is that we can leverage that information all the way from the policy environment to frontline delivery to very softly and almost quietly improve the prevention approach, and become more responsive to system enablers alternative to the prevalent activity-based drivers.”