How New Zealand’s Whakarongorau Aotearoa is improving equity in healthcare

When Andrew Slater was 15 years old and working as an ambulance cadet, he witnessed the disparities in New Zealand’s healthcare system firsthand. Today, as the CEO of Whakarongorau Aotearoa (New Zealand Telehealth Services), he leads an organization whose mission is to provide the 5 million citizens of New Zealand equal access to care, and to improve health outcomes for Māori, Pacific people, and those living in disadvantaged communities.

Whakarongorau Aotearoa is a government- and private sector–funded social enterprise, owned by ProCare and Pegasus, two of New Zealand’s primary health organizations. Under its government contracts, Whakarongorau Aotearoa provides free virtual health, mental health, and social services 24 hours a day, seven days a week through its call centers and remote staff. The organization’s services are supported by clinical teams of registered nurses, mental health nurses, psychologists, doctors, and paramedics, among other care providers.

The COVID-19 pandemic, even in a country such as New Zealand that has been able to limit spread through lockdowns and closed borders, has generated new challenges and opportunities for Slater. Whakarongorau Aotearoa’s call volume for the year ending June 30, 2021, increased by 92%. The organization’s call center teams fielded 2.5 million contacts over that period, connecting with more than 950,000 people across the country. To manage this unprecedented surge in demand, Slater has added and trained staff rapidly, enabling Whakarongorau Aotearoa to serve more people across New Zealand and creating the chance to offer meaningful job opportunities.

The organization’s trajectory has surprised but heartened Slater, who at 38 is New Zealand’s youngest health sector CEO. Before being appointed Whakarongorau Aotearoa’s first chief executive in 2015, he worked in transformation, strategy, and human resources both for St John New Zealand ambulance services and for Vigil Monitoring, a care delivery platform. He now lives in Auckland with his partner, Nigel, and has maintained his knowledge of potato farming from his youth in rural New Zealand. Slater spoke to strategy+business recently about his experience leading a telehealth firm during a pandemic, and how Whakarongorau Aotearoa is innovating as the healthcare landscape evolves.

S+B: Your company changed its name in March of 2021, from Homecare Medical to Whakarongorau Aotearoa. Can you explain the significance of this rebranding initiative?

SLATER: Our previous name reflected how the shell entity started 20 years ago, when there were three doctors driving around Auckland treating patients in their homes and one nurse on the telephone. But today, we don’t go into people’s homes; we provide telehealth services. So in 2016, we started to reconsider what we should call ourselves. It took five years to do it, because we’d keep getting distracted by responding to health disasters and putting the rebrand on hold.

As part of our rebranding initiative, we had a series of conversations with the Māori Language Commission, in which they mentioned an ancient word, whakarongorua, which means “to listen with great intent and purpose.” That’s what ignited and created our new brand—we found something that captured our spirit and our purpose. I’ve seen lots of organizations rebrand based on what they aspire to be, but we wanted our brand to reflect what we are. The people in the communities we serve tell us that it takes courage to pick up the phone and talk about their symptoms, their sexual harm, and their mental health, among other things, and what we need to do is have a sympathetic ear.

S+B: What are some of the ways that you’ve worked to further your mission of improving access to health services for diverse communities?

SLATER: We’ve established some demanding equity goals for the organization that affect everyone’s job, from finance to frontline staff to leaders. To meet these goals, we’ve had to look anew at the way we do things. For example, we used to make service updates at 1:00 in the morning, when we had the least number of people working at the call center. This enabled us to limit the impact on our staff. However, we had to rewire our thinking, because this was also the time when the most at-risk populations would call us.

We also made a decision a few years back that to provide equitable access to healthcare, we would only codesign patient experience strategies with Māori—New Zealand’s indigenous peoples. In the past, we’d form focus groups in which we’d have a European person, an Asian person, a Māori, a person of Pacific Island descent, someone representing the disability community, and so on. When we decided to experiment with only codesigning with Māori, we found that service satisfaction for Māori leapfrogged non-Māori, and that engagement from non-Māori went up as well. Realizing firsthand that what works for Māori works for everyone was an eye-opener.

S+B: How do you build trust with the people using your services, and how do you know if you are succeeding?

SLATER: You have to be really good at saying “I’m sorry.” We don’t get it right every day. And if we thought we did, we’d be fooling ourselves. It’s OK to be vulnerable and say that we didn’t quite do as good a job at this as we should have, and this is how we can do better. You also have to be honest with your people. I always say to my team that if something doesn’t feel right, we can only do two things as leaders—we can either give context to why something is the way it is, or we can change it. Otherwise, we’re not living our values as an organization.

When we started the organization, we interviewed about a thousand New Zealanders about how they wanted us to behave. And largely, that data drove our core values. Our service users are most concerned with quality, and that’s what motivates us. At the same time, the challenge in a digital environment is that you have so much data, you can actually end up with the wrong measures. You can hit the target but miss the point because the point gets lost in the mountains of data. We’ve tried to strip back some of our reporting to the essentials. How many people waited longer than 20 minutes yesterday to speak to someone? Why did that happen?

My dad often asks if I’ve spent his taxpayer dollars responsibly this week. The key issue for me is that for every dollar that I don’t spend funding an hour of frontline clinician time, a person has not been served as a result. Everything we do has to be about helping us connect with more people or in some way making a difference. To that end, we look at opportunities every single day to improve the service that we deliver. And when we think about making improvements, we start by asking: what does a failed service user experience look like? Perhaps it’s a lack of clinical safety, or not building rapport with the service user, or not giving the service user access to a care provider in a suitable time frame, or people hanging up because of terrible hold music.

We can then make improvements to get to the heart of providing better and more accessible health services. I try to make sure that we are always thinking about the people that we’re connecting with. We care a lot about evidence and research, and we have a passion for data. But we also care about doing a good job and doing the right thing. I can say today that I’m getting more compliments than complaints, which is a good thing for a contact center.

S+B: Where have you seen the biggest spike in demand for your services in recent months?

SLATER: Whakarongorau Aotearoa is the most accessible part of New Zealand’s government-funded health system. We’re available 24 hours a day, seven days a week from the service user’s home, across all our clinical domains. The demand that we see reflects what’s happening in society. For example, during the pandemic, access to primary care has been harder to come by in many cases, and that’s driven increases in calls from people needing basic clinical advice.

At the same time, because sexual harm is talked about much more today in our communities and in society, we’re also seeing growth in demand for our sexual harm services, as people reach out for support. It’s the same with mental health. As society grows to accept that it’s OK to not be OK, and that it’s OK to ask for help, we’ve seen massive demand increases in these areas, as well. Suicide prevention, of course, remains a high priority for us.

S+B: How do you see your services evolving as digital technology evolves? Are there key technologies you think might reshape the industry or disrupt your space?

SLATER: Globally, the pandemic has driven the normalization of telehealth. There’s been this huge adoption of technology, especially virtual consults. One of the big issues about healthcare systems globally is that the clinical management partnership has deteriorated in a lot of institutions. But pre-COVID, more than three-quarters of our organization worked from home, so we’ve had a lot of experience supporting clinicians working remotely to deliver virtual medicine.

During COVID, we’ve also introduced some great innovations. For example, when people call Healthline, they now have the option of sending an image of their symptom (for example, injury, rash, or wound), if the clinician they are talking with identifies that it would be useful in assessing the situation. A link is sent to the caller via text message, and clicking on it opens a web page in their internet browser. The caller can then upload a photo which is instantly shared with the clinician assisting them. The addition of the image upload as a tool for clinicians has resulted in a 9% decrease in referrals to urgent and emergency care since it was introduced in October 2020.

We brought forward a virtual desktop system upgrade, allowing the COVID and vaccination workforce to connect any device from any connection to leverage our platforms from anywhere. Many of our staff work from their homes, and they’re based all over the country. Others work in our contact centers. A project that usually takes six months, we had up and running in less than two weeks. It has been scaled since then, as more resources have come on board.

I also think that moving forward, we will see more clinical disciplines virtualized. For example, the biggest enablement that technology can offer will be the augmentation of clinicians’ work. For me, healthcare will always be a human helping another human, and I don’t think we can ever lose that human-to-human interaction. But we have a shortage of great clinicians, and so I am interested in technology that enables them to do the things they do best more effectively. For example, how can we automatically create notes using AI? How can we take out steps in our processes? For instance, how do we get those notes to appear automatically on staff devices so service users don’t need to tell their story multiple times? In other words, how do we take out the friction points along the journey so we can focus more resources on the solutions? I think this is the kind of innovation that’s going to be really interesting for healthcare.

Of course, at the same time, the challenge with technology every day is that I have this enormous burden—keeping millions of people’s patient records highly confidential and as secure as I possibly can. I need to be able to go to bed every night knowing that I’m using every bit of technology that I can to protect those records and protect that perimeter. And unfortunately, there has been a huge increase in attempted cyberattacks on our infrastructure.

S+B: What are some of the other challenges you’ve faced, particularly as the pandemic has unfolded?

SLATER: We’ve had to build the capacity to manage our COVID outbreak response—we had to scale really quickly. This has meant building an operating model that can quadruple capacity on the front line if there’s an increase in COVID cases in the community. We’re also responsible for the surge capacity necessary for contact tracing, which could require us to expand our staff manyfold in a week’s time. Five years ago, when we started the service and I became founding CEO, we had 150 staff. Pre-COVID, we had a staff of 450, and now we’re at 3,000. At one point, we needed to hire about 1,500 new staff to support New Zealand’s vaccination rollout. [As of October 26, 2021, 69% of the country’s eligible population was fully vaccinated.]

My worst days in COVID were early on, when the morning disc jockeys on the radio were calling in on our lines to see whether we’d answer the phone by the end of the show, because the sudden spike in demand from COVID was slowing our operations down. There’s nothing more distressing for a chief executive than hearing that on your way into work.

S+B: How did you scale up your staff quickly?

SLATER: Finding solutions during the pandemic was a reminder of the value of working with people that you trust. For example, someone I knew also knew the CEO of a travel agency who had just served his staff redundancy notices because the border was closing, and travel was plummeting. We both trusted this one person and he connected us. And within 24 hours, more than 600 of his call center staff had been trained and were answering our calls.

The relationships you can develop with other organizations and how you partner to broaden your capabilities is the future. As an example, I look at the work we’re doing with our Māori health provider network. We have iwi [Māori tribal]-led partner contact centers in the North Island towns of Kaikohe and Rotorua, and a Māori health provider in Hawke’s Bay. Working in partnership with these groups means more than 800 people were given employment. In other cases, we’re giving people their first job. We help them write a CV, and we put them through an interview process. Some are 17- and 18-year-old parents who had dropped out of school, who may have perceived their job opportunities as limited.

We trained them and made them into the best contact and vaccine workforce in the world—and we’re able to offer services to many more homes. All that engagement grew out of partnerships. We could have just gone to a temp agency, probably paid 10% more, and not gotten that community outcome that we did.

S+B: What are some of the strategies you’ve used to develop your workers and keep them engaged?

SLATER: Some of our most innovative work has had nothing to do with technology. It’s about how we value our people, how we reward them and recognize them, and how we keep their spirits up. For example, to help build staff loyalty, we wrote a letter to a couple of well-known New Zealanders, asking them to make a selfie video thanking our staff. Then those videos went viral, and soon the prime minister and other famous people from all over the globe connected with New Zealand were sending me videos to share with my team. We’ve come through the pandemic with staff engagement in the top 5% globally for health organizations.

We have a native plant here in New Zealand called the toetoe that’s been used to fish deep in the water by Māori since before European settlement. I like to ask, how do we toetoe people out from the depths and help them grow? We aim to identify our strongest talent with a few simple questions that we ask every leader: Who on your team could do your job if you got hit by a bus today? Who could do it in a year’s time? And who could do it in three years’ time? They can’t choose the same person for all three scenarios. And then we think about what the people they have named need in those time frames to be successful. We have an in-house leadership development program where we are relentless in upskilling; we make sure all our leaders know and can operate our management systems so they appreciate and understand how prescribed we need to be about keeping it all flowing.

Too often, organizations spend so much energy building mechanisms, processes, and procedures that end up actually creating or reinforcing distrust. To earn the trust of your employees, you need to be transparent and honest, give context, and change things. At the heart of this issue of trust is the fact that we’re accountable, as leaders, for reinforcing the reality that we want other people to enforce. If everybody, for the rest of the month, told you that the sky had turned pink, you would eventually doubt your own perspective. It is in these “pink sky moments” that we need to help reinforce what’s best; to help our staff with the reality of reinforcing trust through our own actions.

S+B: What will happen to your workforce in the post-pandemic world—do you have plans to redeploy them?

SLATER: We have this amazing workforce that is, frankly, knocking it out of the park. Come hell or high water, I will try to find a way to keep this workforce involved with supporting communities to solve problems. There are many mega-problems in the New Zealand health and social sectors that a remote virtual workforce that’s engaged and connects with the community can be harnessed to address. We are also starting to have some discussions with some of the telcos and other organizations that traditionally have used outsourced contact centers, as another means to redeploy our workers down the road. It is my hope that corporate New Zealand will bring contact centers home.