Doing things her way--the pacific way: establishing o successful health business providing services to Pacific people and others on Auckland's North Shore has been an exercise in determination and commitment for Niuean nurse Dahlia Naepi.

Thinking outside the square. Stepping out of her comfort zone. The love and support of family. Seeking good advice. Rowing her own boat. Valuing education. Doing it her way--the Pacific way. These are all recurring motifs in Dahlia Naepi's story, a story that's taken her from Niue to Fiji and back, to New Zealand; from enrolled nurse to winner of the Pacific Blue Business Person of the Year at this years annual Pacific Business Trust awards.

It has been a long, sometimes lonely, always challenging and ultimately rewarding journey for Naepi: from nurse at Niue Hospital in the late 1970s, to founder and general manager of Pasifika Integrated Health Care (PIHC), based on Auckland's North Shore, to award winner. Her journey began in Niue, one often children, her father a strict "no nonsense" school teacher who instilled in his children a desire for education. Naepi learned that lesson welt. She won a scholarship to Fiji to study nursing, qualifying as a Fiji-trained nurse after three years, followed by a one-year internship. She returned to Niue in 1977 and worked at Niue Hospital for a year before leaving to begin a life in New Zealand.

Bridging programme

In 1979, she married a fellow Niuean in New Zealand, Vene Naepi, and they had two sons and two daughters. Her nursing career in New Zealand began as an enrolled nurse in paediatrics at Auckland Hospital for five years, followed by the bridging programme at Manukau Polytechnic. As a registered nurse, Naepi worked at National Women's Hospital, then Middtemore Hospital working night duty part-time, while supporting her young family.

In 1988, she became a public health nurse (PHN) based at Auckland Hospital, the first Pacific PHN. As a PHN, she undertook further study in a range of areas: diabetes education, by distance learning through Deakin University; health management; adult teaching; and the first year of a theology degree. She also worked in a dual rote as a PHN and district nurse for Pacific clients.

'Some really sad situations'

After nine years as a PHN, Naepi left to establish a Pacific Island home care service for those with disabilities, as a two-year pilot project under a mainstream provider. "This is where I deeply felt for our Pacific older people. I saw some realty sad situations."

And that is when the idea to begin her own service, doing things differently, began to develop. The project ended in 2000, Naepi took voluntary redundancy and then took a job coordinating the Pacific Island cervical screening programme with Pasifika Health Care in West Auckland.

While working as a PHN, then in care of older Pacific people and in cervical screening, Naepi saw many gaps in services that needed addressing. But nurses were not encouraged to think outside the square or to question the status quo. "Those things were a 'no no' in case you might get a warning or the sack or colleagues might make life difficult for you. Nurses were too scared to step outside their comfort zones." But Naepi was not going to let fear stop her. "While working in cervical screening, I was quietly working on putting together ideas of how to go it alone. I was tired to being told how to do things. I was sick of not being able to do things my way, the Pacific way."

Sounding out friends and colleagues about her plans, many told her she would have no hope as a Pacific person, let alone a Pacific woman, and that there was no need for the services she envisaged on the North Shore--quality services for Pacific people.

Undeterred, she decided to venture forth, selling her home to do so. "One day I came home to my husband and said 'Sell the house.' He said: 'Are you crazy?' and I replied: 'Yes, I think I am!" But her husband accepted her directive philosophically, saying "if we all go down the chute, we all go down together, and if we all climb the mountain, we art climb together."

Originally, two nursing colleagues and two friends in allied health fields wanted to work with her. "But we all had different ideas about business and what it would involve and different visions."

Naepi was adamant she wanted to run her services on a business model but she knew little about business--"the word business is not in the nursing language. I wanted my own model to improve health care for Pacific people and I wanted to row my own boat. I had motivation and vision and I didn't want to waste my time with those who didn't get the vision."

So she sought the best business, legal, management and employment advice she could and urges anyone contemplating starting a business to do the same.

But her business plan did not guarantee immediate success--Naepi waited for nine months for her first contract. Her two nursing colleagues left because there was no money coming in. But her patience and determination paid off and, after nine months, an Accident Compensation Corporation (ACC) contract set her business on its successful path.

Naepi did not lose her nerve during the anxious nine months' wait. "I'm a very determined person and I've never failed at anything I have tried, so I dug my toes in."

That first contract was for community nursing and home-based rehabilitation services for people with disabilities. It was for all the community, not just Pacific people. From that first contract, PIHC now provides this service to 400 clients, Auckland-wide, except south Auckland. Family carers and support workers assist with personal cares and household management and support the clients towards regaining personal independence. This service has been PIHC's core business for the last five years.

Primary health care services

Since working as a PHN, primary care has been Naepi's focus. Reading and hearing that Pacific people's poor health statistics were not changing motivated her to start some primary health care services on the North Shore. This began with group education and promotion sessions about PIHC's disability services. "What we discovered was that the Pacific community on the North Shore had a much bigger problem and that was lack of health information, with people being left to find things out for themselves." In 2004, PIHC received its first health education and promotion funding. It established an outreach clinic to gauge the community's need and this has mushroomed to four outreach clinics a fortnight, with up to 200 people attending the clinics every fortnight, which are open to "anyone and everyone"

The business employs three community health nurses, all Pacific nurses with New Zealand registration. The range of services offered includes lifestyle programmes to prevent cardiovascular disease, including smoking cessation, exercise and nutrition. There is also an outreach nursing service. These programmes have been funded by Waitemata District Health Board as two-year pilot projects and Procare Primary Health Organisation will continue funding them. PIHC is also involved in a pilot project providing cultural support services at North Shore Hospital.

Within the last couple of months, PIHC has established a new company, Pasifika Integrated Family Medical Centre, a general practice, part-owned by the doctor and part-owned by PIHC. "The initiative was for the doctor to have some ownership of the business and also to give him the autonomy to operate efficiently and effectively with the support of the PHO," Neapi explains. But establishing the general practice was not straight forward. "There were huge barriers but I took the risk."

The risk has paid off, as within two weeks of opening its doors, the medical centre had 500 clients from all walks of life. "It's a reflection of what is happening on the North Shore."

Naepi won't be resting on her laurels--establishing an award-winning business which generates $2 million a year and employs 200 people in less than seven years. Plans are underway to establish a pharmacy and physiotherapy practice close to the medical centre.

So what has been the key to her success? "My husband and four children have been the strength behind the success. Then come the stakeholders and all my advisers and, most importantly, the community who are our clients, friends and families."

One daughter is a fourth-year medical student, a son is doing physiotherapy. Both will work for PIHC once they've finished their studies. Her other son works as PIHC's financial manager and is completing his MBA.

Naepi's biggest reward has been seeing the services she has established being used. "I believe I am making a change for our people--making little changes in my backyard, the North Shore." It's a far cry from those who told her there was no need for and "no hope" of establishing such services on the North Shore.

She is also delighted to see the PIHC workforce develop and strengthen as a result of good training. All support workers must undergo training. A sound infrastructure with quality management systems has meant high quality standards.

Delegation a key to success

Naepi sees delegation as a key to success. "I don't know everything so I have gone looking for the best advice available. I have also employed a human resource manager and a manager for our primary health contracts."

Her own determination and a strongly-held belief that there is a perfect time for everything,--"including a Pacific nurse with radical views"--have been pivotal to PIHC's growth. "I was determined not to fail, but I wouldn't have been afraid to pick myself up and start again as a DHB employee, if it hadn't worked out. I looked outside the square and took a calculated risk. I have a different way of looking at things and use both my cultural and professional background in my work."

A mischievous sense of humour and her self-confessed skills as a "notorious negotiator" have also been important attributes.

'Humbled and honoured'

She was "humbled and honoured" to win the Pacific Business Person of the Year Award. "I have always seen myself as a worker who goes quietly on, like most nurses do. I was overwhelmed with joy on winning the award, not only for myself and my family, but also for those people out there who supported us during our six-year struggle."

Her advice to nurses considering establishing a business is to stay focused, get good advice, take all advice as welt meant but only use what is appropriate, and always be grateful for what assistance you get. "As nurses we have strived to attain a place in society equal to other professions. But often we have failed to stop and observe whether there are other areas we can venture into and stilt safely deliver the best care to the population in need. If you don't give it a try, you'll regret it all your life."

* Dahlia Naepi gave a presentation on PIHC at NZNO's primary health care conference in Auckland earlier this month.

By co-editor Teresa O'connor