The Fono

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Alaska Experience Invaluable

The Fono CEO Tevita Funaki attended the 7th Annual Nuka System of Care (“Nuka”) Conference in Alaska from June 18-20. He presents his findings on a health system that focuses on holistic wellness built via a relationship-based model. 

Developed by Alaska’s Southcentral Foundation (SCF), the Nuka System of Care (“Nuka”) is recognised as one of the world’s leading models of health care redesign.

SCF provides medical, dental, behavioural, traditional and health care support services to more than 65,000 Alaska Native people.

Tevita Funaki, CEO of The Fono, was among a delegation of Pacific health providers attending the 7th Annual Nuka System of Care (“Nuka”) Conference, supported and coordinated by Pasifika Futures, the commissioning agency for Pacific Whanau Ora in New Zealand.

The Nuka system takes a relationship-based, customer-owned approach to transforming health care, improving outcomes and reducing costs.

The system of care places Alaska Native people in control as the ‘‘customer-owners’’ of the health care system, with a vision and mission focussing on physical, mental, emotional, and spiritual wellness and working together as a Native Community.

Together with operational principles based on relationships and core concepts, this redesigned system has fostered an innovative environment focussed on continuous quality improvement and value based system of care.

Tevita says there are many similarities with the New Zealand-based delegation and their Alaskan hosts.

“There are many differences between how the health system works in Alaska compared to New Zealand,” he says.

“For example, their model of funding is made up of both government and non-government funding including philanthropy, whereas ours in New Zealand is government-funded.”

Recognising that individuals are ultimately in control of their own lifestyle choices and health care decisions, Nuka focuses on understanding each customer-owner’s unique story, values and influencers in an effort to engage them in their care and support long-term behaviour change.

The focus on relationships extends beyond health care delivery. To ensure whole system transformation, each key work system was redesigned.

SCF’s leaders argue that its success cannot be attributed to a single part of the system. Instead, it requires continued effort across multiple dimensions (vision, values, the operating model for services, supporting infrastructure, and workforce development) to sustain high performance at scale and over time.
“Workforce development is a major drive,” says Tevita.

“Once they reach a certain level of qualification, the drive is on to take the next step up. There’s no thinking that you don’t need to learn more, because you always can.”

He adds it was noticeable how many of the key staff at SCF were women, with CEO Dr Katherine Gottlieb leading the way.

The conference comprised of 25 sessions with emphasis on leadership, integrated care, improvement, data and information management, behavioural health and workforce management.

Tevita believes Pacific health and community service providers can apply the learnings from Nuka to their approach.

“It’s said that because our Pacific providers comprise of people who identify themselves as Tongan, Cook Islanders, Samoan, Niuean, Tuvaluan, it makes it harder,” he says.

“But Nuka said it’s necessary to challenge things that are assumed. They have their different cultures, whether they’re Native American or Eskimo and they often fight.”

He adds that his experience in Alaska and at Harvard University has been invaluable in ensuring The Fono remain at the forefront of providing holistic care for all patients. 

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