When is transformation not transformation?

We keep hearing about transformation but at this point in the journey, I can't see it. We still refer to primary and secondary care as if they are not connected. Within the hospitals, we continue to do things the same way as before. Silos exist to bat away change and we separate workforces in the system into some kind of hierarchy with importance placed heavily on doctors, and then nurses, and then the rest of us. (Here's the obligatory disclaimer that I work in the health sector)

To me, transformational change in the health sector is about us all working towards ensuring the patients we serve are well cared for and that they can access what they need close to home as possible and in a timely manner.

This relies in us working as a fully integrated system where we rely on each other to do 'our thing'. It is where those in hospitals work collegially and collaboratively with other services and community providers, whether they be NGO, pharmacy or other. It is where those in the community trust those in the hospital to have the correct resources and attitudes to supporting them to support patients.

It means having an integrated patient information management system so that wherever a patient may be, there is good access to their health record.

It means multi disciplinary teams made up of hospital and community providers so there is a lined up and transparent way of supporting our patients.

It means hospital specialist staff (medical and non medical) going to where patients are instead of expecting them to always travel to the hospital. 

Ultimately transformational change needs to be driven bottom up, with support, as it us these folk who do the Mahi every day and know where our failings are.

It is my firm belief that top down transformational change doesn't work. I've seen it fail once those driving the change become distracted and take their 'foot off the pedal'.

It's not going to be easy but I do still have faith that we can do it.

The reason behind the move from the DHB system was to flip health care provision.  If we don't have transformational change, what was the point?