Māori responses to Covid-19 were unique, including this face mask by fashion designer Shona Tawhiao @tawhiao7 (Illustration: Miriama Grace-Smith)

Recipe for resilience: Te ao Māori and the Covid-19 response

Across Aotearoa, Māori responded to the unique needs of their communities during the peak of Covid-19. Two Māori organisations share the lessons from their success.

Hutia te rito o te harakeke 

Kei hea te kōmako e kō? 

Whakatairangitia, rere ki uta, rere ki tai; 

Ui mai ki ahau, 

He aha te mea nui o te ao?

Māku e kī atu, 

He tangata, he tangata, he tangata.

 

If you remove the central shoot of the flax bush 

Where will the bellbird find rest? 

Will it fly inland, fly out to sea, or fly aimlessly? 

If you were to ask me, what is the most important thing in the world? 

I will tell you, 

It is people, it is people, it is people.

Often only the last three lines of this famous whakataukī are used in isolation, but when we see it in its entirety, we can understand something more complex is happening. Northern kaumātua attribute this saying to a rangatira whose relatives married her off to secure peace, but who was prevented from having children. The whakataukī tells us the removal of the rito, or central shoot, means the harakeke, or flax, will not survive, will not flower, and the bellbird is robbed of nectar, and habitat, and will no longer sing and will wander, lost. Small actions create secondary consequences – a failure in one part has flow-on impacts in the wider system.

The last part of the whakataukī links the natural world to people and back again – both concepts are inextricably interconnected. The whakataukī recognises and describes a Māori worldview of the importance of whakapapa, and of people as both ancestors and descendants, and of our intrinsic whakapapa ties to the natural world. The future is built on the past and the nurturing we do now, in the present.

In the same way that the whakataukī loses deeper meaning when the context of the proverb is removed, we lose the bellbird’s song when its habitat is removed. As a fixed statement in isolation, “it is people, it is people, it is people” is grand yet lacks further resonance. Set within the context of the story of the harakeke and the bellbird’s song, it becomes a complex, dynamic interplay of ideas about the flow-on effects of actions within changing contexts, responsive to new and changing meanings and understandings. 

The whakataukī recognises that human beings and environments are inherently linked and that the connection between them is fluid and directly impacts the way in which both humans and environments behave. We need a richer understanding of local contexts to find solutions that work. There are lessons from the whakataukī itself but also, as we see here, lessons from the misunderstanding of the whakataukī.

Ngāti Ruanui iwi leader and Māori Party co-leader Debbie Ngarewa-Packer at a checkpoint in Patea, Taranaki, May 2020 (Photo: supplied)

In 2020, Aotearoa has seen an unprecedented series of collective efforts. The most visible was that of an entire population enduring a series of increasingly stringent restrictions on freedoms, contacts, communities and incomes in order to prevent further loss of life to the pandemic.

However, beneath this collective endeavour were dozens of other diverse efforts, small and large, performed to protect communities, hapū, whānau, and individuals. These efforts have involved organisations and individuals at every level, from government to iwi, marae, institutions, hospitals, communities, whānau, GP practices and neighbourhoods, working across the usual boundaries, barriers and teams with urgency and camaraderie. Covid-19 has brought us to a place where norms have been flipped and we have had to do things differently – and it has worked.

“Resilient healthcare” and its advocates (Jeffrey Braithwaite and Eric Hollnagel, for example) argue that a 21st-century healthcare system that is fit for purpose requires a paradigm shift to understanding healthcare systems not as linear production lines but as complex adaptive systems, where local contexts require local solutions developed in partnerships. These partnerships need to be characterised by trust and a collective sense of interdependence and shared purpose. The conditions of healthcare systems must be understood as uncertain, unpredictable and dynamic, and responses must therefore be flexible, relationship-based and adaptive. All of this we’ve seen during the response to Covid-19. And it is in the work of Māori providers that we have seen resilient healthcare most clearly and successfully in action. Two examples illustrate the use of a Māori worldview in response to Covid-19, and the importance and effectiveness of local solutions in local contexts: the responses of Turuki Healthcare, a primary care practice based in south Auckland, and of Māori groups in Te Rohe o Te Wairoa/Hawkes Bay region. They are among the many Māori and Pacific organisations and providers across the country who acted rapidly to assist their communities to meet the challenges of the pandemic.

Turuki Healthcare – a primary care provider in south Auckland

Turuki Healthcare is a multilingual kaupapa Māori health provider providing local whānau-based primary healthcare, wellness, pharmacy, parenting, domestic violence, mental health and social services to more than 11,000 enrolled patients in south Auckland.

“When the country went into level four lockdown, we had to change what we had been doing in general practice for 20 years, overnight,” said Renee Muru-Barnard, primary healthcare manager at Turuki. 

While many primary-care practices were forced to close their doors, “we had a commitment to stay open for whānau,” said CEO Te Puea Winiata. That meant a difficult calculus – protecting and treating whānau but not at the expense of workers’ own whānau. This meant providing personal protective equipment (PPE) and demanding stringent infection prevention and control procedures to protect the families of workers. 

Immediately, Turuki faced challenges: there was insufficient PPE and hand sanitiser for staff. Leadership improvised, purchasing their own PPE, even using painters’ overalls when PPE gear was unavailable. In general, it was felt that Māori providers could not wait for funders, so they provided out of their own funds and budgets. 

Sick people were assessed by phone, then swabbed in their cars by staff in full PPE, and brought into quarantined offices if required, which were then deep cleaned after every patient. “We were not set up for a virtual environment,” said Muru-Barnard. So leadership made bulk purchases of phones and laptops for staff to conduct proactive welfare checks on whānau. In the first two weeks, more than 2000 virtual consultations were conducted, checking in on whānau, conducting antenatal classes, communicating the impacts of Covid-19 and what people needed to know.

Turuki mobilised its relationships to assist its community. Drawing on existing relationships and partnerships in the Whānau Ora network – more than 70 across the North Island – Turuki partnered with others to provide an outreach service, distributing kai, heaters and supplies around the community to rapidly address the new and evolving needs of whānau/families in south Auckland. The whakamā (shame) of requiring food parcels soon gave way to necessity for many, and this was alleviated by wraparound support of food and care packages delivered to whānau confined at home by lockdown. 

(Photo: supplied)

“Māori providers have a nimbleness and an agility to mobilise and to turn a ship round on a penny very quickly,” said Te Puea. “There’s no other network like it.” 

As well as practice doors staying open, Turuki’s focus on older patients meant proactively calling kaumātua to check on their wellbeing, accommodation, food, and medications. This included home visits, food package deliveries and flu vaccinations. 

Turuki’s Te Ira team (who support whānau going through the justice system) were redeployed after the courts were shut down to manage a “pop-up” warehouse with pallets of donated goods and bulk-purchased kai to pack and deliver to thousands of whānau. The school-based health team pivoted to conducting whānau-welfare checks by phone.

Wānanga online resources mostly delivered via Facebook experienced massive growth, generating up to 365,000 views. Staff remain aware of the challenges ahead amid the massive economic fallout from Covid-19, such as mental health issues, domestic violence and drug use.

For Turuki, the positives from this experience included the emergence of new capabilities within the organisation and the capacity to be responsive to whānau, unshackled by service specifications that do not work; and permissive environments leading to some great innovation, making it a struggle to return to a previous way of working with funders.

How can Turuki do more of these things? The organisation is an ardent supporter of the establishment of a Māori Authority and local commissioning, giving it a greater say in where the money goes, creating a shorter pipeline from money source to provider to whānau.

“The model of two GPs and a receptionist has its place,” but a network that “holds people,” is needed, said Te Puea. 

“Primary health is moving towards needing scale, responsiveness and collaboration. A forum of shared learning and building trust between government agencies and community needs to be an ongoing focus.” She pointed to the need for Māori to be Māori, and have Māori solutions, a shared language and shared learning.

Read more about the Turuki response here.

Staff at Turuki Clinic used social media to inform patients (Photo: supplied)

Te Rohe o Te Wairoa, Hawke’s Bay, Ngāti Kahungunu and the response to Covid-19 between February and May 2020

Wairoa District comprises a large area stretching from Mahia through to Mohaka along the east coast of the North Island and inland to Waikaremoana, with multiple connections to the Tairāwhiti and Hawke’s Bay regions. Ngāti Kahungunu is the third largest iwi in Aotearoa and comprises six rohe (regions) from northern Wairoa to southern Wairarapa. During the rise of Covid-19 in Aotearoa New Zealand in March 2020 numerous iwi and hapū entities, community organisations and government and local-government departments mobilised to protect their entire community. 

“Intergenerational community teamwork” was the preeminent achievement of the response, according to Nigel How, chairman of Ngāti Kahungunu Wairoa Taiwhenua Incorporated, and Wairoa board member of Ngāti Kahungunu Iwi Incorporated. “In time of crisis our community survives because we work together to be responsive to need, creative in approaches and adaptable to changes.” 

One arm of the response was the Wairoa Community Welfare Food Hub. Between March 31 and May 28, the Food Hub distributed nearly 1,000 food parcels to nearly 3,000 people. The hub was focused on delivering aid to kaumātua with little or no external support, as well as whānau with pre-existing health conditions and other issues. 

It was a massive, networked and community-wide operation encompassing donations from the public, Whānau Ora, local businesses, farmers and the iwi organisations, delivering everything from hand-knitted socks to fruit, vegetables, baked goods, meat, fresh seafood, baby food, locally made honey, and Easter eggs. Multiple organisations provided money, transport, facilities, charge accounts, freezers and chilly bins, storage, laptops, and, most crucially, a team of volunteers to make it all happen. 

The shared values of duty to community, responsiveness, creativity and adaptability extended much further than the food response. “Our local funeral director, the police, our local hospital, our local doctor practice, social clubs and the numerous church congregations to name a few all played a vital role in our entire community effort,” How said.

L-R Valma Lambert (Kahungunu Executive), Te Paea Whakatope (Te Whare Maire), Craig Little (Mayor), Denise Eaglesome-Karekare (District Councillor/Kahui chair) having a break before food parcel deliveries to the whānau requiring assistance during the Covid-19 lockdown (Photo: supplied)

Denise Eaglesome-Karekare, chair of Te Wairoa Tapokorau Whanui Trust, Wairoa District Councillor, and former deputy mayor and manager of the Wairoa Young Achievers Trust, said: “What made our response outstanding was the natural ability of everyone to come together as a whole-of-community response. It didn’t matter if prior to Covid-19 that some of us didn’t have a relationship. This event made us think of those that were most vulnerable in our community and helped us put our differences aside and get on with the mahi that needed to be done. 

“Our willingness to work together came out of, I believe, a shared passion for our community and its people. We all want to see our whānau flourish in all aspects of their lives – health, education, employment, housing, for example. The whānaungatanga that developed has stayed strong ever since and would probably never have happened had it not been for Covid.”

Leon Symes, chair of Tātau Tātau o Te Wairoa Trust, the post-settlement governance entity (PSGE) on behalf of the iwi and hapū of Te Rohe o Te Wairoa, reached the same conclusion from his trust’s perspective. 

“Māori did well in the Covid-19 response because we have got those strong networks within communities that we could then leverage off. Our key strength is that connection into those community groups where the need is the most. 

“The level of trust between Māori entities existed from the outset. In a Māori sense sometimes it fluctuates but in a crisis they all come together. The whānau know that in certain circumstances we put our differences to one side and get on with what we need to do. The trust is there to begin with.”

For Symes, the Māori response and its success was because it was founded in the principles of te ao Māori, of manaaki, whānau, and aroha, rather than the hard guardrails of legislation or regulation. 

“We don’t have legislation and statutes, we have principles, values and mātauranga Māori that are not fixed in stone. That’s why we are more flexible. We operate on a values-based approach, not a traditional Western-based approach of authority. We are able to adapt and to quickly realise our roles and our abilities to provide support.

“It’s how we were raised from a young age: to look after manaaki, whānau, aroha, these principles. To make sure we look after those that are vulnerable. It’s not about the individualistic approach, that Western approach, It’s not about the ‘I’ – it’s about the ‘us’.”

Shayne Walker, chair of the Hawke’s Bay DHB, one of Aotearoa New Zealand’s five Māori DHB chairs, saw a similar picture of massive pan-community solidarity, the benefits of existing relationships and the community willingness to quickly develop new relationships, a collective, proactive approach and a focus on the needy that included finding those the system hadn’t seen before.

“We know that Māori have suffered greater inequalities in previous pandemics as well as general health outcomes, so we were clear from the start that we have to focus on Māori and Pasifica and our other disadvantaged communities,” Walker said.  “We have a good relationship here with Ngāti Kahungunu Iwi Incorporated, the pan-hapū, pan-tribal vehicle, but there are lots of treaty partners in our region, so it’s important that we engage with all of them.”

Hawke’s Bay DHB and Ngāti Kahungunu Iwi Incorporated worked together to use their organisational structures to get resources out to people in the community from the central Tihei Mauri Ora Emergency Response Centre to the local Taiwhenua hubs, which then distributed the food and care packages directly to people.

“Māori took a massive role in the response to Covid. We really worked hard to reach out across our community to our business sector and elsewhere for donations of kai and other resources. Then we made those distributions directly to the door, particularly to our pākeke, our elderly. We called them our whānau pounamu, our precious whānau, our vulnerable whānau.

“The benefits that have spun off from this are the extra relationships and opportunities. The registrations of a lot of our whānau that weren’t engaged before with our Māori and our DHB approaches. Even things like our pākehā pākeke receiving kai and health packs, saying, ‘I thought this was just for Māori’ and us being able to say that’s not how we operate. It’s for everybody and it’s for our community,” Walker said.

The biggest challenge was effective communication. “At times it was quite hard because we had to explain to our whānau that we have to take an epidemiological approach to this as well as a cultural approach. Some of those epidemiological, scientific and public-health communications were key.”

Austin King was part of the Wairoa Civil Defence response as a public-information management representative. He has connections to nearly all marae and hapū of the Wairoa District and is a community development officer of the Wairoa District Council. His perspective: “The Wairoa Covid-19 response presented various inter-organisation challenges, but this community’s ‘just do it if it’s safe to do so’ attitude really demonstrated the resilience of Wairoa and her people.  

“Our role as public information management representatives entailed delivering and disseminating key messages to our people – around the national, regional and local Covid-19 response,” he said. 

“Having strong whakapapa ties to this community – plus understanding intimately the fabric of the whānau who live in various smaller communities of Wairoa – our Civil Defence team was able to effectively communicate these messages between the agency and people.

“One important key for any pandemic response is effective communication. Local agency and grassroots champions were key respondents in disseminating key messages throughout this response. 

“During a time of unrest and uncertainty, these grassroots champions played a critical role in communicating these messages to whānau – ones that are able to get messages through to whānau on the ground.”

Over the course of the lockdown, as well as distributing food and care packs, Ngāti Kahungunu Iwi comms developed its own messaging and communications to inform and reassure whānau over issues such as tangihanga processes for deceased whānau, gatherings of different sizes over phases of lockdown, and with guidance on safe behaviours that do not violate tikanga, as lockdown levels changed and recommendations from government evolved quickly. Key messages were sent out by Facebook, email and the iwi website.

In Wairoa, Nigel How and the Wairoa Wellness Network panui developed regular newsletters for a wide range of contacts, emphasising community solidarity, the “tikanga of lockdown”, and regular stories of “The Nannies” – two local personalities and relatives of How’s aged 80 and 74. The Nannies’ adaptations to the tikanga of lockdown provided both light relief and examples in practice for the community to understand what was expected of them in terms of maintaining their bubbles while caring for kaumātua.

For Walker, effective governance and leadership were key to the district response. “The key is we saw this amazing Māori leadership and this amazing New Zealand leadership and spirit coming to the fore. The steady, collaborative and calm leadership around the region was very important. We came together when we needed to. It was like wartime conditions and the leadership and collaboration was outstanding and it was tested and we should celebrate that it worked really well for us.”

Social distanced B&E pie Nannies-style (Photo: supplied)

Wairoa born and bred Leona Karauria is a founding member of the Hawke’s Bay DHB Consumer Council, has a consumer healthcare advocacy background, and is owner of local internet service provider Wairoa Wireless Communications.  

One of her first priorities in the initial lockdown period was immediately contacting Sonya Smith, manager of the Wairoa Healthcare Centre. “We were facing immediate health challenges and there was an opportunity to put in place the best digital solutions. We immediately strengthened internet connectivity at the Rural Health Learning Centre and established remote and virtual environments in Tuai Lake Waikaremoana and Mahia Beach for online health consultations. We provided digital support and upgraded internet connectivity in the homes of clinicians and health workers to make sure they had reliable connections for virtual consultations. Our role was to repair and reconnect the relationship between the health consumer and the system that Covid-19 had fractured.

“We have built internet infrastructure in some of the most remote communities in Aotearoa New Zealand,” Karauria says. “Places no one would touch. They are rural, remote, highly disconnected, and many are predominantly Māori communities. But Covid-19 has shown us that what was once digitally challenging doesn’t have to be. Big corporations only provide a ‘one size fits all’ solution that excludes people in these communities. But we can fix the challenges and barriers of the system and provide digital equity. Local solutions can be better.

“Digital inequity existed before Covid-19, yet digital connectivity was the most important source of effective communication for everyone across the world, not just in Aotearoa New Zealand. With an uncertain future ahead of us, our government needs to invest effectively to improve digital inclusion for all vulnerable families and communities. In recent years I have seen barriers put in place that prevent or delay consumers having reasonable access to receiving generic healthcare services. Post-lockdown, I now have greater concerns that the system is compounding the barriers, making it even more difficult for a consumer to get reasonable, basic healthcare attention.”

Shared ideas have emerged about what has been learnt and the challenges of the future. “On the whole, everybody did an amazing job given the circumstances, but there are always ways we can learn to do things differently or better in parts,” Shayne Walker said. Of the extra relationships and opportunities that developed during the response, he asked:” “How do we not turn this off?”

Leon Symes agreed about the benefits of additional relationships. “We need to be making sure we’ve got those connections with communities. Knowing what our neighbours are doing. Knowing our people down the road.” He saw an opportunity for the future. “We’ve just been through a massive event. We need to pull together some of the learnings and put that within some kind of document or framework we can then pull out in the future. We need something that has a more values-based, caring approach. It was a unique situation that probably will be repeated again, and if we don’t learn from what we went through we’ll never truly provide a better response in the future.”

Read more about the Wairoa response here.

Digital communication was an essential part of keeping Ngāti Kahungunu communities informed (Image: supplied)

There are many other stories. Te Arawa Lakes Trust, with the support of NZ Police, Bay of Plenty Regional Council and the Rotorua Lakes Council, placed a rāhui (a temporary ritual prohibition) on the 14 Te Arawa Lakes in the Rotorua area over the 2020 Easter Weekend to encourage people to stay home and stay safe in response to the Covid-19 lockdown then in effect. Iwi in the far north and east cape, such as Te Whānau-ā-Apanui and Ngāti Porou, established checkpoints to protect rural communities. And  Te Puea Marae, whose namesake housed orphans of the 1918 pandemic at the Tūrangawaewae marae in Ngāruawāhia, is expanding to help house those made homeless by the effects of Covid-19

Te ao Māori, resilient healthcare and the Covid-19 response

Dynamic and successful Covid-19 responses from Māori and Pacific providers and a multiplicity of other healthcare services across the country have shown us that we can choose purposeful agility, explore diverse ideas for working in fast-changing contexts, and quickly adjust the way we do things. We have the ability to design responses that are fluid in the face of different needs and complexity. This is the central idea at the heart of “resilient healthcare”, an approach that embraces the complexity of healthcare and seeks to nurture systems that support the people within them as they navigate this dynamic reality.

The stories above – and those we have seen in many healthcare contexts – are characterised by a willingness and agility to cross typical boundaries between and within institutions. Some responders were given freedom to serve the emerging needs of local people and local communities, while at the same time serving boundaries, budgets, workstreams, schedules and timelines. Responsiveness, creativity and adaptability were underpinned not by role descriptions and mission statements, but by values of duty to community and those in need – by values of manaaki, whānau, and aroha. 

The whakataukī “hutia te rito…” above describes the interdependence of people with and within their environmental context. It calls us to recognise the whakapapa of the systems we work within. We need to first acknowledge and better understand this interdependence, including the daily norms, values and principles held implicit in the system, to enable our ability and agility to change when required.

The importance of context 

Often attempts to improve healthcare lead to interventions based on implementing singular “correct” solutions, enforced through regulations, policies and hierarchies. This approach can be seen in what are known as “pilot and scale” approaches, where solutions are tested in controlled conditions then scaled up throughout the system. The underlying assumption is that this single solution will work the same way wherever it is applied. However, we remain blind to differences and our knowledge is not granular enough to deal with the differences in context. Rather than asking “what works?”, we must instead ask “what works, for whom, in what respects, to what extent, in what contexts, and how?” One size does not fit all. 

As we saw in the whakataukī, our understanding is enriched when we make the context of the story and the relationships it contains visible. In healthcare, this means drawing on the knowledge and connections we see in local-scale responses and trusting in distributed models of leadership that devolve decision-making. We can be clear about overarching goals but must trust in the actions locally towards those ends, knowing that different contexts require different responses. This idea of “trust” is at odds with the audit and performance-management approaches that characterise public management and healthcare of the last 40 years, but it is what we have seen in the Covid-19 response and it has worked.

The Wairua roopu from the Turuki clinic prepping for level two (Photo: supplied)

Uncertain/dynamic conditions

Previous ways of working in healthcare were often built on assumptions that the future would be much like the past. However, Covid-19 has fundamentally challenged these assumptions, creating a dynamic and uncertain environment that is fundamentally mismatched to previous ways of working. The bureaucratic structures and controls that deliver certain types of efficiency may actually hamper us when conditions change or complexity increases. 

Change and increased complexity are most apparent with the challenges of Covid-19, but conditions in healthcare systems are always complex and dynamic. Overly rigid responses will regularly produce mismatches, conflicts and system failures, as conditions drift and resolve in uncertain and unpredictable ways. It is the people working in a system who produce safety and success, often despite the system. “Work-as-imagined” – the way those removed from the local situation assume healthcare is carried out – is often very different from “work-as-done” – what workers at the front line do to deliver the right healthcare to people despite the conditions they face.

Responding flexibly

In the Covid-19 response, increased freedom has been given for local solutions in local contexts. There are clear, simple overarching rules (bubbles, alert levels, and the companion levels for hospitals) and communities are trusted to adapt around these to meet the needs of their people and their everyday work. 

A flexible approach is consistent with ideas of system “resilience”: the ability to recognise and adjust performance when conditions are dynamic, complex and uncertain. The Covid-19 response was characterised by trust – high-level principles were established from above, and then teams were trusted to form around them at the micro level to come up with solutions and applications that suited their everyday work. With at least some of the shackles of compliance and funding loosened, teams at the frontline were given more leeway to do what was needed for their communities – and succeeded.

There are several important principles in building resilience:

  • Dealing with complexity in a system or a situation is easier and will have better results when we create a safe space for multiple viewpoints to be exchanged and shared. This diversity of understanding allows us to better appreciate the true nature of problems and find solutions that work for more people.
  • Flexible responses require us to work together across traditional system boundaries, e.g. community/DHB, patients/clinicians, healthcare providers/government.
  • There are coordination costs to this “teaming” in terms of time and money, which can be lessened when there are existing relationships to draw on.

Rather than being seen as a one-off project, there is a need for us to be open to continuous adjustment as conditions inevitably change. Hence the need to keep or nurture the different ways of working, trusting local people and communities to innovate.

In the examples from Turuki and from te rohe o te Wairoa, we see this in action. The foundations and precepts of resilient healthcare align with and resonate with the creative, collaborative principles of te ao Māori, and its collective, adaptive, flexible responses.

The Ngāti Kahungunu approach (Photo: supplied)

The role of people and their relationships 

New Zealand’s “team of five million” demonstrated why people and their relationships are a resilient health system’s greatest resource. The stories above demonstrate that whakapapa is crucial and that the prior existence of strong, trusting relationships between individuals, organisations or communities can produce a rapid and effective response to a threat like Covid-19.

Understanding safety as being about relationships as well as regulatory frameworks is important because resilient health systems recognise that safety is created from our human capacity for learning, growth and development though connection and collaboration. 

Māori health models, Te Wheke and Te Whare Tapa Whā, appreciate that our wellbeing is dependent on whanaungatanga – relationship and kinship – as well as our environment. The stories above demonstrate that responding to challenging events requires inclusive democratic dialogue. This kōrero must be guided by concern to address harms, meet needs, restore trust, and promote repair or healing for all those affected. The ultimate goal is the restoration of wellbeing and relationships, as well as understanding what happened. In terms of the whakataukī, restoration of proper care for the harakeke allows the plant to flourish and the bellbird’s song can return.

Building on what works

“Addressing failure” has been the organising idea in patient safety for a significant period, a model designed by other safety-critical industries like aviation or nuclear power. It focuses on ensuring “as few things go wrong as possible” and sees adverse outcomes or incidents as being due to non-compliance or failure, often corrected by further constraints or focusing on more rigid compliance. However, by only paying attention to rare failures, this deficit view of safety leaves the everyday work that staff, patients and whānau do to create successful health outcomes unseen and unvalued.

Newer models redefine safety as “making sure as much as possible goes right”. They seek to recognise, foster and build on success rather than mobilise around failure. Central to this approach is focus on the ways in which people come together to actively create safety every day. By understanding how successful work happens we can better understand rare failures as well as create the space for innovation. This paradigm shift could fundamentally change health-system design  from “addressing failure” to instead “nurturing the conditions for success”, by meeting the needs of the people within the system.

Resilient healthcare in action

New Zealand’s response to the dynamic and uncertain environment of Covid-19 has created the space for an adaptive approach that resonates with the creative, collaborative, relationship-centred principles of te ao Māori – not a new approach at all, but rather restoring what really matters.

We have seen a resilient healthcare system in action. We do not want to go back to “how it was” but are seeing and experiencing the previous structures and barriers beginning to reimpose themselves. The question becomes how do we foster governance and funding structures that harness the creativity and distributed leadership we saw during Covid-19, so we can nurture resilience in our health system? How do we invest in resilience rather than rely on individuals to create it?

We must invest in resilience, or we will once again be on the merry-go-round of rigid approaches that are mismatched to the local realities we face, creating events and inequitable outcomes that negatively impact our people and communities.

As Covid-19 remains a threat, the relationships and trust built continues to serve our communities well. This is evident both in the stories above and in the work of frontline clinical teams. Manaakitanga – the caring attitudes and willingness to support the mana of each member of our family, whānau, team or community – remains central to our response.

The question remains, how do we take care of this process – what Māori have known for a long time to be valuable, and which so obviously works? How do we take care of our people? How do we tend the harakeke responsibly and intelligently to provide the bellbird rest?

This content was created in paid partnership with the Health Quality and Safety Commission and was contributed to by the following:

Te Puea Winiata, Renee Muru-Barnard, and Dr Lily Fraser of Turuki Healthcare

From Wairoa and the rohe: 

Leona Karauria, founding member of Hawke’s Bay DHB Consumer Council, consumer healthcare advocate, and owner of Wairoa Wireless Communications 

Austin King, Te Wairoa Tapokorau Mai Tawhiti Trustee and Community Development Officer at Wairoa District Council 

Nigel How, Chairman of Ngāti Kahungunu Wairoa Taiwhenua Incorporated, and Wairoa Board Member of Ngāti Kahungunu Iwi Incorporated

Denise Eaglesome-Karekare, chair of Te Wairoa Tapokorau Whanui Trust, Wairoa District Councillor, previous Deputy Mayor for many years and manager of the Wairoa Young Achievers Trust

Leon Symes, chair of Tātau Tātau o Te Wairoa Trust

Shayne Walker, Chair of the Hawkes Bay District Health Board

Resilient Health Care group at the Health Quality & Safety Commission: Leona Dann, Carl Horsley, Carl Shuker, Iwona Stolarek, Caroline Tilah, Stephanie Turner, Jo Wailling, Huataki Whareaitu




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