Wellbeing model

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Background[edit | edit source]

The K'aute Wellbeing model is being developed, and aims to describe a future state way of working across KPT.

This article will show some key collateral generated as part of this work, to provide a more accessible and standardised knowledge base for reference.

The Wellbeing model has three components:

  1. A multidisciplinary holistic model of care
  2. Integrated operating model
  3. Enabling digital and data.

Multidisciplinary holistic model of care[edit | edit source]

Integrated operating model[edit | edit source]

An integrated operating model demands alignment of systems of record and workflow. An initial draft model is shown below:

flowchart LR subgraph AA[Holistic needs assessment] direction LR dom1[Domain] dom2[Domain] dom3[Domain] a1[Question] a2[Question] a3[Question] a4[Question] end subgraph BB[Alofa/Goal plan] direction TB b1[Goal] b2[Goal] b3(Goal) end subgraph CC[Actions] direction TB c1[Action] c2[Action] c3[Action] c4[Action] end subgraph SC[Service catalogue] subgraph SI[Internal] direction TB sc1[Service] sc2[Service] sc3[Service] end subgraph EI[External] direction TB sc4[Service] sc5[Service] sc6[Service] end subgraph PW[Pathways] pw1[Internal pathway] pw2[Internal pathway] pw3[Internal pathway] pw4[External referral] end end subgraph AP[Work with client/aiga] direction LR ap1[Update progress] ap2[Structured review] ap3[Complete/amend plan] end dom1-.->a1 dom1-.->a2 dom2-.->a3 dom3-.->a4 AA-.->BB b1-.->c1 b2-.->c2 b3-.->c3 b3-.->c4 c1-.->sc1 c2-.->sc2 c3-.->sc3 c4-.->sc6 sc1-.->pw1 sc2-.->pw2 sc3-.->pw3 sc6-.->pw4 pw1-.->AP pw2-.->AP pw3-.->AP pw4-.->AP

Following sections describe the above model in more detail, and make links to capabilities of enabling digital/data at the same time.

Holistic needs assessment[vague][edit | edit source]

The 'holistic needs assessment' is intended to capture all goals, strengths and/or needs of the client/family.[1]

Kotahi has a facility for an over-arching assessment/goal plan process and we are intending to use it for this purpose.[2] The Kotahi assessment process is structured hierarchically:

  1. Domains
  2. Outcome areas
  3. Outcome

Users can freely configure the above for their purposes - for example, define their own domains and outcome areas.

An assessment process can then be configured allowing questions or prompts to be set, which align with the above.

Completion of this results in a score being captured against each domain, and overall. This is intended to capture complexity and help with prioritisation of resource.[3]

Alofa/Goal plan[edit | edit source]

A process of setting out goals is then carried out - these should link directly to findings from the assessment talanoa process.

In Kotahi, the first phase is framed as 'aspirations' and describe what the client/aiga want to work on. An aspiration can be any kind of statement, phrased in any language or way the client/aiga wish. These are then broken down into more specific goals which require linking to:

  • Services
  • Domain
  • Outcome area
  • Outcome.

Actions[edit | edit source]

The next level is defining specific actions which will contribute to the achievement of the goal. In Kotahi this requires a simple definition of the required action, start/stop dates and nomination of the responsible person.

The responsible person can be either:

  • the client, or
  • a staff member.[4]

Additionally, whanau/aiga members can be linked to achievement of a goal if, for example, it requires family support or the goal is relevant to others.

Service catalogue[edit | edit source]

A service catalogue is:

...an organized and curated collection of business and information technology services within an enterprise. Service catalogs are knowledge management tools which designate subject matter experts (SMEs) who answer questions and requests related to the listed service. Services in the catalog are usually very repeatable and have controlled inputs, outputs, and procedures.

The development of a dynamic service catalogue enables us to easily:

  • identify whether client/aiga goals can be met internally or externally
  • define standardised pathways for internal referrals
  • clarify external services we can access and referral process.

Updating plan[edit | edit source]

The status of agreed actions can be modified and updated at any time. Since this plan sits as an 'umbrella' across teams and services, anyone can access it and contribute to it.

Kotahi assessment, showing change from initial assessment.

Formal review of the assessment can be done on two further occasions.[5] Each of these subsequent reviews are a chance to reassess the client/aiga against the domain scores generated in the initial assessment. The score differences are then presented and visualised, so that progress can be measured.

Data capture[edit | edit source]

Using the above approach in Kotahi enables us to catch every data point along this journey. While client/aiga assessment is quantified and presented/visualised within Kotahi itself,[6] access to the raw data will enable us to use and present this data in a range of different ways.

Standardised usage of NHI in Kotahi permits us to link to Indici data, where relevant and appropriate.

Enabling digital and data[edit | edit source]

The Wellbeing model will be enabled by effective use of digital and data. Please refer to content on the K'aute data model which zooms in on that component.

Digital and data is only one component of the overall model.

References[edit | edit source]

  1. As a reference point, akin to a MAST Assessment.
  2. Note this is a relatively new feature, but it is designed to allow assessment and planning to be done outside of the service/contract context, and allows allocation of actions to stakeholders for completing goals.
  3. A special reporting facility is also enabled, showing summary data of assessments completed and progress against goals. This data is also available to us in raw format, so we can use in other ways or integrate with other data as needed.
  4. Specific staff members can be set and made responsible for completion of an action.
  5. Nominally defined as a mid-point assessment, and one on completion.
  6. Additionally a summary report facility is available for admin users.