Manaaki Mamao is extraordinary for several reasons.
Spritely has written this blog to highlight everything this progressive, innovative, and highly motivated St John team has achieved with Manaaki Mamao in the last 18 months, and some of the things they’re hoping to achieve in the next 18 months. Ka pai Hato Hone.
In 2021 Hato Hone St John began developing their 5-year strategy Manaaki Ora 2022-2027. Among their strategic aims were:
The leadership of St John, including the members of the ELT, and the Board committed to improving hauora Māori, health equity for all and community partnering. Further to this, Hato Hone St John defined their kaupapa (or purpose) as “to make life-changing differences with our communities.”
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Clear strategy and strong leadership from the top, empowered a group of Hato Hone employees in the Customers and Supporters team to do something extraordinary.
Alarmed by NZ research that showed Māori and Pasifika were 3x more likely than Pakeha to die within a year of having their first heart attack or stroke, the team set about creating a Te Ao Māori Population Health pilot to address this completely unjust and unnecessary inequity.
Strategic leadership from this newly established, multi-disciplinary team, enabled St John to grow their initial pilot into a local program that attracted funding from the Ministry of Health. This local program, which focused on South Auckland, became known as Manaaki Mamao.
Hato Hone has the ambition and the motivation to take this program nationwide and address health inequities in communities right around the country. But they can’t do it on their own. That's why St John is partnering with local hauora Māori providers, so they can help more high-risk patients avoid heart attacks and strokes.
St John’s clinical workforce has considerable experience when it comes to heart attacks and strokes. Many ambulance call outs are the result of cardiovascular emergencies. Hato Hone also educates and trains people about the risk of heart attack and stroke, how to mitigate those risks, how to recognise a cardiovascular emergency, and what to do if you are nearby at the time of a heart attack or stroke.
St John developed the Manaaki Mamao program in partnership with Turuki Healthcare, a hauora Māori provider in South Auckland. Turuki has many enrolled patients who struggle to manage high blood pressure despite being prescribed medication for the illness. Many of those patients are at high risk of heart attack or stroke due to their hypertension and statistically they are likely to have worse health outcomes in the event of a heart attack or stroke.
Now, thanks to the partnership with St John, the GPs at Turuki Healthcare can identify and refer high-risk patients to Hato Hone’s Manaaki Mamao program.
Manaaki Mamao means to provide care from a distance. The program, which was co-designed with Turuki Healthcare, can be customised for each patient by their GP. After being referred to the program, a clinician from Hato Hone gives the patient a call.
The clinician speaks to the patient over the phone to explain more about the program and gains their consent before enrolling them. Once they are enrolled, a St John representative visits them in their home to deliver the all-in-one telemonitoring system.
To enable simple remote connection, St John partnered with NZ company Spritely. Spritely is an award-winning health tech company and the creator of an easy-to-use touchscreen device with a wirelessly connected blood pressure machine that works right out of the box.
There is no set up required by the patient, no need to connect WiFi, and no Bluetooth pairing of devices. Video calls connect instantly, and messaging is already enabled without the need for any other applications. According to Jess Verdon from Hato Hone St John, “Spritely has created the simplest telemonitoring system for patients I have ever seen”.
The platform is clinically powerful as well. Clinician-friendly features including custom workflows, drag and drop forms, real-time alerts, quick notes and dashboard reporting, save clinicians time and keep patients safe. Data and documentation are also readily accessible with strict controls based on roles and permissions.
Once patients have received their system, St John clinicians can keep in close contact. Patients take their health vitals including blood pressure and heart rate every day. If readings are outside specified limits, then St John is alerted so a clinician can review the data and follow up accordingly, either with a message, a survey, or a video call.
As part of the program, clinicians set a target for each patient and aim to reduce their systolic BP by at least 5mmHg during the first 12 weeks. This is achieved through regular consultations, and relevant content that can be viewed on the tablet. The system supports educational videos such as nutritional lectures, coaching sessions, and exercise programs. Messages and surveys can be delivered in any language and clinicians can use interpreters during video calls.
As a result, patients feel engaged, they make changes to their lifestyle and improve their compliance with medication. Patients feel empowered as blood pressure comes down and everyone including whānau feel relieved as the risk of heart and stroke reduces.
For every 5mmHg reduction in systolic blood pressure the chance of a stroke or heart attack reduces by 10%.
Or, put another way, life expectancy increases.
Dolly, who features in the video below, says that the program has made a real difference in her life. Hato Hone’s Kaupapa is “to make life-changing differences within our communities”. The Manaaki Mamao team at St John is doing an amazing job delivering on the strategic aims of Manaaki Ora.
St John’s ambition over the next 2 years is to scale Manaaki Mamao to be a national service delivered locally through partnerships with many hauora Māori providers. By partnering with hauora Māori organisations around the country (including GPs, pharmacies, health promotion agencies, other health-focused NGOs and community leaders) they can develop local versions of their Te Ao Māori population health service and make a difference in communities where people who suffer heart attack and stroke have the worst mortality rates.
Hato Hone will also seek out partners that can contribute to the overall wellbeing of Manaaki Mamao patients. This might include organisations with expertise managing specific risks associated with cardiovascular disease. Organisations with expertise in nutrition, stress management, cognitive behavioural therapy and a host of other fields that could bring extra value to the program and better outcomes for patients by creating a healthy future.
As the service expands to more local communities there is also an ambition to expand to more hauora programs. Many patients with hypertension have co-morbities that could also benefit from remote patient monitoring. International research shows that telemonitoring can improve health outcomes for people that have diabetes and COPD (Chronic Obstructive Pulmonary Disorder) among other chronic illnesses. The service could even be developed to help people rehabilitate from certain surgeries or adverse events such as falls.
The great thing about this technology is that enables patient-led, clinician-managed care at scale. Clinicians from Hato Hone can focus on patient wellbeing and not be distracted or diverted by technology questions. When the system is this simple, clinicians don’t waste time providing tech support and patients feel empowered to take control of their own health, with support from whanau and carers. GPs and other people in the circle of care can be kept closely informed about patient progress leading to better treatment plans.
In the last 18 months Hato Hone St John has achieved a huge amount:
We could extrapolate from these achievements that the team (and its partners) has also contributed to increasing life expectancy for many participants of the program.
Hato Hone St John is leading the way when it comes health equity innovation. By developing strong partnerships, they have enabled new models of care using data and digital. By focusing on local communities and working with hauora Māori providers, they can extend care to the home for some of our most vulnerable people.
Now that the local South Auckland hypertension program is well established, we hope to see St John partnering with more Māori health providers, expanding into more communities and targeting a wider range of health inequities.