Crisis-Management Lessons From a New Zealand Health-Care System

I n 2011, a magnitude 6.3 earthquake struck the New Zealand city of Christchurch, killing 185 people and causing thousands of injuries. Despite the damage that CDHB’s facilities sustained, it remained operational and delivered care in the aftermath of the natural disaster. This was possible due partly to steps that CDHB had taken to begin digitizing its care infrastructure the year prior. In 2010, CDHB adopted an internal integrated health system that connected its various facilities to deliver more coordinated care.

But the disaster also uncovered problems in this nascent digital system. Despite greater digital integration across facilities, patient information remained siloed and was often inaccessible to clinical staff when they needed it. “It was a ‘never again’ moment,” recalls Stella Ward, chief digital officer at CDHB. “We must make sure we have digital systems that support our delivery of care.”

As a result, CDHB implemented a range of new information systems across primary care, hospitals, and community care, starting with HealthOne, an internal integrated infrastructure for patient health records available to clinical staff. “It freed up patients in terms of not having to tell their story multiple times,” says Ward. “If they had an X-ray or a lab test in one setting and were going to see a specialist in another setting, they didn’t have to redo those tests because the information was on their record.”

The organization then focused on how digital infrastructure could help its employees by empowering them to take charge of their own experience at work. CDHB deployed a new staff portal powered by ServiceNow, which allows employees to request leave, update bank accounts, send questions to the HR team, and look at duty rosters, among other capabilities.

CDHB also built functionality on top of this platform to support the workflow of orderlies—hospital attendants who assist medical staff and transport patients, equipment, and supplies. “Orderlies are fundamental to the way our hospital works,” says Ward. “We provided them with an app they can use on a mobile device to make sure they’re the most efficient they could be in supporting our hospitals.”

In the years that followed, CDHB continued upgrading its digital infrastructure, setting it up to weather the next crisis. It migrated applications to the cloud, developed a disaster-recovery plan to ensure access to information in case servers went down, and built out functionality to improve its processes.

In 2019, CDHB faced another system shock with the mass shootings at two mosques in Christchurch, which killed 51 people and injured many others. Thanks to its ongoing digital transformation, CDHB was well equipped to treat those impacted by the shootings.

“During such a surge into the emergency department, having digital workflows in place and access to information meant the system could respond to the demand,” says Ward. “Information that was captured across the acute response was available to all disciplines, so trauma patients could be reallocated to the 24-hour surgery, while those in need of long-term care could be transferred.”

M ore than a year later, in February 2020, the COVID-19 pandemic hit the shores of New Zealand, and CDHB had to adapt to the challenges it posed. “For us, it was the unknown in terms of the volume of people who would test positive,” says Ward. “We had to seriously think about our ICU capacity and plan to have the same outbreak and level of demand that other countries had.”

Acting swiftly, CDHB updated its digital clinical systems, adding case definitions, processes, and pathways around COVID-19—including how to assess patients infected with the novel coronavirus and determine whether they require hospital care or self-isolation at home, as well as information about where people can go to get tested and treated. Updating these workflows meant that CDHB’s network of medical practitioners could better prioritize care for critically infected patients and avoid a surge in demand for intensive-care resources.

Additionally, the organization supported community-based assessment centers for COVID-19 testing and hotels for managed isolation, using existing information systems to support those facilities. “We were able to deploy that rapidly because of our investment in infrastructure, platforms, and mobility,” says Ward.

Dealing with a new disease also meant CDHB had to deliver its non-coronavirus care differently. Its hospitals and primary care facilities used digital referral systems to direct non–COVID-19 patients to specialists rather than have them come into clinics for assessment, and implemented e-prescriptions to avoid the need for in-person, paper-based scripts. They also embraced telehealth, expanding its use from rural communities and far-flung areas to the entire region so patients could receive care without being exposed to an at-risk environment.

Due to CDHB’s preexisting digital infrastructure, it was able to streamline its workflows, reduce friction in the patient experience, and effectively deliver care in the face of yet another crisis. “If COVID-19 has proven anything, it’s that digital workflows are essential to an organization’s resiliency,” says Mitch Young, senior vice president for Asia Pacific and Japan at ServiceNow. “Businesses that were digitally transformed ahead of the pandemic were able to get on with work, while others were left scrambling to implement workarounds, putting other parts of their business on hold while figuring out how to keep the basics going.”

A s New Zealand worked toward eliminating the novel coronavirus, the country moved through its COVID-19 alert-level system, from lockdown at Alert Level 4 to relaxed restrictions at Alert Level 1. Upon reaching Alert Level 1 in June 2020, businesses reopened and employees returned to work. (New Zealand experienced a new outbreak in August 2020 and has since raised its alert levels.)

CDHB used its internal digital systems to aid its employees as it adapted to these phases. Its online staff portal served as both an HR management system and as a platform for training and upskilling, providing information on how to use online communication apps for meetings and collaboration, maintain health and well-being while working from home, and use personal protective equipment, as well as what support was available to staff who needed to isolate. “We had to ensure our infrastructure can support as many people as possible to work remotely, and that appropriate security, tokens, and two-factor authentication processes were in place for that,” says Ward.

For an essential organization such as CDHB, ensuring that its staff returned to work safely was of the utmost importance. It again used its digital platforms to help employees in this transition, offering virtual health assessments for vulnerable health-care workers to determine whether they should come back to the office or continue remote work.

“Companies are shifting their attention from survival to recovery in a changed environment,” says Young. “Every process has been tested during the pandemic, and leaders are looking to digital workflows to future-proof every step—from recruiting and onboarding new employees virtually to emergency response and return-to-work preparations.”

Though New Zealand’s response to COVID-19 is unique within the landscape of the pandemic, the story of CDHB’s digital transformation journey illustrates how digital platforms and workflows can help companies build resilience and better respond to outside pressures, both now and in the future.

“The pandemic taught us that the technology direction around telehealth and remote care is possible,” says Ward. “Another thing we learned is the importance of equity of access and making sure the digital divide is a consideration for any health response, and providing systems for the future that leave no one behind.”

Aside from continuing with flexible, remote work options for select staff and virtual health consults and remote monitoring for patients, CDHB will keep building on its digital-first approach, ensuring a seamless experience for both patients and clinicians while making mobility and access to information core components of its systems.

“I don’t think Canterbury needs to continue to experience disasters, but we can’t be complacent either,” says Ward. “We must always be prepared for another emergency or crisis.”