Overcoming federation and fragmentation through the development of a regional intersectoral, interorganisational, community activated collaborative model – An Australian example

Delivering person and family centred health and care services in a federated and fragmented system is a wicked problem, which requires a whole of community and system response. The West Moreton Care Collaboratives project in Australia has developed and implemented a values-based, intersectoral, interorganisational, community centred Collaborative model; using a solution focused, inclusive, codesigned action plan to create sustainable change. The Australian health system reflects Australia’s federated political model, where different levels of government are responsible for different areas of health and social care. Inevitably, the human experience of health and social care needs does not fit with this siloed and simplistic system. Federation leads to fragmentation in service delivery and funding streams. Australians can experience lengthy delays in accessing the care they need whilst bureaucratic processes decide which level of government will fund their services. Furthermore, fragmentation creates gaps in care which particularly affect our most vulnerable citizens, including people living with disability, older people and those approaching the end of life. West Moreton is located approximately 50 km west of Brisbane in Queensland, Australia and covers an area of almost 10,000km2. The significant challenges for the region include the expected 113% increase in population by 2036, and its very poor socioeconomic and health indicators. The West Moreton Care Collaboratives project was established in 2018 with the first Collaborative addressing Care at the End of Life. Our Older Persons Care Collaborative commenced in 2021. These Collaboratives welcome stakeholders (individual and organisational) from across the spectrum of health and social care, and most importantly, people living in the community of West Moreton. Our model is flexible, agile and has a community focused approach to governance and participation. The Care Collaboratives are auspiced through the University of Southern Queensland, and modestly funded to sustain a small team that provides governance and project management functions. The Care Collaboratives codesign and collectively endorse action plans using various codesign tools, such as World Café methodology. Funding opportunities are identified to implement the action plans, with project partners drawn from the Collaborative stakeholders. One of our key learnings from early in the Care Collaboratives project was that our community is proficient at creating their own solutions when they identify gaps in care. However, these solutions can be underutilised if they are not connected to the people who need them. The Care Collaboratives now play a vital role in connecting service providers with community groups to ensure their resources reach as many people as possible. The West Moreton Care Collaboratives have leveled the playing field for community stakeholders in creating collaborative service solutions which meet their needs, whilst activating community to be self-supporting. This presentation will describe the evolution of the Care Collaboratives to date, their benefits, challenges and outcomes in filling gaps in care. It is hoped this presentation will encourage our international colleagues that progress and sustainable improvement can be made through creative, collaborative models, even when the system appears to be stacked against you.