Health Care Home (HCH) 101

Learning Objective: To gain an understanding of what HCH is and how the HCH model can make positive change in your practice for the benefit of your staff and patients. 


What is HCH? 

The Health Care Home model of care provides a framework for true patient centred care. It is a nationwide general practice model that supports primary care to deliver a better patient experience, improved quality of care, benefits for clinicians and greater practice efficiency. HCH introduces change to improve access for patients and to keep general practice sustainable, through a process of continuous improvement. 


Why implement HCH? 

Healthcare is a continually evolving landscape particularly in the past few years with a worldwide pandemic, virtual care becoming an essential service and the Health Reforms. How we provide care to our communities is changing and staff burnout is at the forefront of everyone’s mind.  On top of this, the population in the Southern region of New Zealand is ageing. An ageing population leads to patients presenting with increased complexity and morbidity. By 2036 we expect to see a 73% increase in the number of GP consultations required to service our 65+ population. Health Care Home is not a one size fits all solution to these problems, but it can be a step in the right direction for delivering efficient and timely patient centred care and preventing staff burnout. Health Care Home aims to improve patient access, better manage long-term conditions, use technology as appropriate and apply LEAN processes to improve work and patient flow. 


Rhonda Reid (General Manager, Gore Health) discusses the benefits of HCH.


Who does what? 




Fully support the implementation of HCH within the practice. 


Be open to change and working in new ways. 

Play an active role in HCH e.g. become a Huddle or Portal champion. 


Be open to change and working in new ways. 

Play an active role in HCH e.g. CLIC and improving practice processes. 

General Practitioners 

Critical that GPs are onboard and are actively participating in HCH. 


Engage staff around the benefits of HCH. 

Create a change team responsible for implementing HCH. 


Engage staff and owners around the benefits of HCH. 

Support general practice through the HCH journey. 


What do we work on? 

Throughout HCH you will work across 4 domains: 

1.  Urgent and Unplanned Care 

2.  Proactive Care 

3.  Routine and Preventative Care 

4.  Business Efficiency 

In practical terms this means engaging in continuous improvement projects through the Practice. Areas within these Domains that are often focused on in Year 1 are: same day access and defining the need for GP triage. Long term conditions management through WellSouth’s CLIC program. Activating patients onto a patient portal and using the portal to improve communication with patients.  Huddles and visual management tools to improve cohesion and efficiency in the practice.

While making these improvements we ask you to regularly seek feedback from patients and staff, and use this information to make informed decisions.  In Year 2 practices work on projects important to their patient populations. This may be working more closely with SDHB around developing a care plan for COPD patients or developing a wellness program to run in your local community. 


HCH Timeline 

Year 1: 

Attend HCH workshops to develop ideas and relationships important to HCH. 

Develop a year 1 implementation plan which will guide your work in the first year of HCH. 

Work on the projects as outlined in your Year 1 plan, developing a culture of continuous improvement and evidence-based decision making within your practice. 

You will have support from the HCH team and wider WellSouth network. 


Year 2: 

Develop a year 2 implementation plan with a focus on projects important to your practice and your patients. 

Continued support from the HCH and WellSouth teams. 

At the end of year 2 you may become a certified Health Care Home. 



Be sure to keep patients informed of changes along the way, especially changes impacting how patients interact with the practice. It may be a good idea to create a leaflet or short video explaining Health Care Home and the benefits that it will bring to patients. 


Helpful Tips 

Health Care Home will not be successful unless the whole practice team is onboard. 

A cross functional change team made up of GPs, Nurses, and administrators will ensure all areas of the business are considered when implementing change. 

For some projects e.g. increasing portal numbers, it is a good idea to have a dedicated champion. This person will be a subject matter expert and drive the change within the practice.