Josh Koko Podcast

This is a podcast episode where the hosts interview Josh Koko, who is the equity partner lead for Te Whātua Ora Improve and the innovation team at Te Toka Tūmai. Josh talks about his interests, including spending time with his family and his love for cars. He also mentions that he currently drives a new electric Mustang. Josh shares his journey in the health industry, coming from a family with a background in nursing. He discusses his role at Te Toka Tūmai and the challenges he faces as a minority in a Crown-led organization. He also talks about the importance of incorporating Māori frameworks and kaupapa models in his work. Overall, the episode focuses on Josh's personal and professional experiences. Kia ora and welcome to the Innovate or Medicaid podcast, the show where we talk to health industry insiders about how they have used innovation to get the health system off life support. Hosted by Jen P. Waka Waka and Tui Tony, join us as we explore and celebrate innovation and improvement within Te Whātua Ora. Let's get into the heart of it. Today we're talking to Josh Koko. He is currently the equity lead, equity partner lead for Te Whātua Ora Improve and the innovation team at Te Toka Tūmai. Kia ora Josh and welcome to the first episode of Innovate or Medicaid. Kia ora, tā mihi nui, kia koutou. Hi everyone who's listening. Ko Joshua Koko tōku ingoa, ko Ngāti Kahungunu ahau. My name's Joshua. Like Tony said, I'm the equity partner here at Te Toka Tūmai, specifically working with performance improvement or Te Whātua Ora Improve and our design studio whānau, āramanawa at 160. So kia ora, thanks for having me. Welcome. Cool. Okay, let's get into the questions. Kia ora tātou, nau mai haere mai Josh. Ko Jennifer Fletcher tōku ingoa and I'd just like to welcome you to our first podcast. I'm an improvement program manager here at SI&I or Performance Improvement as you mentioned. So yeah, welcome. And kia ora everybody. Ko Tony tāku ingoa. I'm one of the project managers in Te Whātua Ora Improve and excited to bring this first episode to you all. So let's kick it off. First question. Josh, tell us what you do for fun. I don't know, it's been a long time since I've sat down and actually dissected what is fun and what is not. I kind of think that hopefully there's an element of fun in everything that I do and there's not a specific kind of time set aside just to have in quote marks fun. More specifically, I guess the way I kind of fill my cup up is hanging out with my whānau. I've got three sisters. They're all married. They all have multiple tamariki. I've got 10 nieces and nephews at the moment and that brood is obviously growing. So yeah, it's cool just to hang out with them and kind of puts things into perspective really. I don't have any kids of my own and so being able to kind of hang out with my nieces and nephews and watch them grow up and be an influence in their life, I think that's kind of fun. On a more surface level, I'm really into cars as much as that is believable or not, but I've always loved cars. There's something about the freedom. When I was 15, I got my learners, which I think is the youngest you can get it and within a year, I had my whatever the next stage was restricted and then onto my full license. So for my 16th birthday, me and my dad together built a Mini Cooper GT 1975 from scratch. We had three mini bodies or kind of cars that we bought and we scrapped them to make one. At the time, it was M&M blue with chocolate in the middle. So the boys at school had a good time teasing the shit out of me. Once after school, I came out to find my Mini had been lifted onto the bottom step of the gym stairs into the gymnasium, but it turns out that a Mini's a lot heavier than what they thought. So I was able to drive away, but that Mini didn't last very long. Not when you squeeze five or six, you know, first 15 island boys into the back of it and try and drive to McDonald's on a rainy day. Can you tell us what you're driving now? Maybe I should. Yes. I have a new Mustang Mark E. It's the electric Mustang and I love it. It's 200 and something odd kilowatts and 400 odd brake horsepower. So you really get that push into the back of the seat when you put your foot down and I'm not adding any extra greenhouse gas. Guilty free. Well, not quite. I mean, you think about what went into it to actually make it. I'm sure the overall output, you know, whatever it costs. But there's always an opportunity cost for everything, right? Nothing in this world is for free and we're never guaranteed anything either. So we've got to take those chances when we can and find your passion, find your fun. And that's part of the reason why I work at Te Toka Tūmai is because I get to do bits of that all the time. And it's not easy, but what worth it? What things are worth it if they're easy, right? Nice. Then that brings us quite nicely onto our next question. I'm good at the segue. Yeah. That's a great, great segue. Can you tell us briefly about your journey in health? Yeah. So I come from a big whakapapa actually of wanting to do good or change for good. My great grandmother, Emma Mitchell, was one of the first Māori nurses in Wairoa. My grandmother on my mother's side was a matron at Napier Hospital. For a long time, my mother was a nurse. She started out her career as a nurse. She's retired now, but she was in preschool education. I have two aunts that were on my dad's side, was the matron of Hawke's Bay Hospital, so Hastings. Another one who worked at Whakatāne, in Whakatāne as the matron there. By the time she was, what do they call them, the head nurse, the charge nurse, they didn't call them matrons anymore. It's very antiquated. I'd be considered a matron, I think. And then now my sister's a nurse too at Waitematā. So there's a lot of either teachers or nurses in our family. Things have changed with nursing over the years. It used to be considered a vocation. There's a calling, and that's just an excuse to pay women less occasionally. Or women-dominated kind of fields. We always have this way of describing it as being a calling or being something that they should just do because it's in their nature. In their nature, obviously, but it's in all of our natures to be caring for each other. And sure, I do it for a paycheck, but I also do it for other reasons. Nice. And so how did you come to be working at Te Toka Tūmā? Because I understand you were working at Eke Pānuku before this, is that right? Yes. I was the principal advisor at Eke Pānuku for Māori engagement. Prior to that, I worked at Te Whānau Waipareira for a number of years. Where else was I? Oh, it's a bit of a blur, to be honest. And now you're at Te Toka Tūmā. And now I'm at Te Toka Tūmā, yes. So actually, how I got to come here, it's a really long and strange story, but I saw someone I knew who I'd been to university with at a funeral of all things at a tangi. And I sort of clocked him across the room, and he saw me, and basically, we need to have a conversation. And that person was Anthony Hawke, who was the head of the Māori directorate here at Te Toka Tūmā for a while. Now works back at Te Whātau Ora, I think. So yeah, we had a conversation, asked me to apply for a role that was going, and I did so. And ultimately, kind of, yeah, it was successful. And how long have you been working here for? Coming up three years. Yeah. Yes. Yeah, and it's taken pretty much three years to work out, to be clear about what my purpose is, what my role is, how I can add value, and to realise the worth that I bring, you know, because it's hard sometimes when you're, you know, a minority in a, well, especially a Crown-led organisation. So Josh, just before we start talking about your current mahi, can you talk to us a bit? You've been in a couple of different industries. It'd be great to hear from a Te Ao Māori perspective, what frameworks or kaupapa models for that particular work did you use, and how do you think you could apply it in this current setting? Yeah, well, I mean, I guess the first and the original one is the framework, you know, that we all, from our tūpuna, about whakawhanaungatanga, about building relationships, about our, you know, being tika and pono. I think Te Ao Māori offers, and our whakapapa offers such complete lessons already within our DNA, already within our experience that we bring to the mahi that we do, if we're being authentic to who we are, because everyone's on their, on a different journey of self-discovery as well, and there's no one way to be Māori. You know, I was listening to my nephew talk on the weekend about how him playing basketball, and he was up against these other Māori kids, and he referred to them as being better Māoris than him. And I was like, oh, so what does that actually mean? You know, trying to unpack some of that, and what it came down to was that these kids were visibly Māori, whereas my nephew has whakapapa from, you know, Pākehā as well as Māori, and he's blonde, and therefore his experience of being Māori is different to those kids that already present and look Māori. But I said to him that his experience is no more or less valid because he can whakapapa, and that's all that, that's all that it is. It's, you know, whether you acknowledge that or not, your whakapapa can't be erased. I'm just wondering how... Oh, right, sorry. Back on track with the Māori, right? The Māori you're talking about. Well, I guess there's whanetapa whā, which is, you know, the ones that everyone really knows about. But whatever kaupapa you're doing, if it's built for, by and with Māori, then it's a model that you can use and apply. So it doesn't necessarily need to be something that's in a textbook, because that's not how, that's not how mātauranga is kind of shared, right? So for me, I guess if you want to talk about something that's more structured in terms of a model, it was around the final water model of small, achievable chunks of change over a period of time with the right resource and tied into the right support. So the step changes to improvement, which I guess would be waterfall agile. I don't know how you would define those, but, you know, they're achievable, recognisable outcomes that build as a staircase over time to a larger overall change. And I think that's always sat with me quite well, that if we can give people the opportunity to achieve small things, then those larger things that they want to achieve then become a whole lot less scary and easier to reach. That's how I've approached my life, kind of in little chunks. And, you know, I'm enrolled right now in my Masters, which will be my third postgrad. I never thought that I would do tertiary education. It wasn't for me, but it all started with taking one course, and that one course turned into something else. And then you get the kind of the realisation that you can actually do this, that it is possible. So thinking about that, I wonder if you could, you know, talking about those models and frameworks, I wonder if you could tell us a little bit about the mahi around the Rehua project, programme, and, you know, how have you used some of those models in the Rehua programme of work, or just about the Rehua? Well, Rehua is actually just a work stream that falls outside of, that is complementary to the He Atawhitia programme of work, which is an indigenous response to the healthcare changes that are going on. Rehua in particular is one of four. There's one for quality kiwisa, there's one for kaimahi Maori experience, and then there's another channel for sort of evaluation and research. Rehua is one of those. Rehua is based on the highest, Rehua, the highest star in the heavens of Matariki, and it's about what is, you know, what do we have a moe moe aro vision for, and what are the steps that we need to do to get there, but also realising that we cannot be hamstrung by the fact that this vision might be so idealistic, or it might be so, yeah, what's that word? Yeah, the word I'm looking for, the, utopia, might be a utopia of perfection, but there's no, there's actually no such thing. That doesn't mean that you can't stop striving for it, though, and that's what Rehua is about. It's how do we empower the, our partners to become better partners in the way they relate to Maori, and the way they relate to Tiriti, and the way they relate to each other and themselves, and I think that's what I think we miss sometimes at work, where we think that the only, the only way to be at work is our work persona, and then there's a home persona, and we divide those two things. We kind of discount some of the EQ, emotional intelligence that we have to better fit within what we think is required from a work situation, whereas what I've learned throughout my career is that the more vulnerable I am, the more real I am in my the more real I am in my experience, and sharing that with others, it gives them the permission to do the same, and that we create better relationships through that, and at times where work has been hard, or I don't think like, I don't think that I'm getting anywhere, just by vocalizing that insecurity is enough to be able to allow other people to help you, and creating those connections, and those relationships are what get us all to be better in our work environment, but also in our approach to one another. I know that's a decent answer. Yeah, and that's a key part of the He Ara Whiri model, isn't it? Correct. Yes, going through those phases. And acknowledging that it's part and parcel of the process, that those feelings of insecurity, of vulnerability, of uncomfortableness, like being uncomfortable is uncomfortable, but it's not going to kill you, right? So you can sit in it, and you can be uncomfortable, and that will lead to better outcomes if you acknowledge that these things are real, and that it's part and parcel of the process of change, and the process of improvement. Yeah. Is rengawa mostly for staff who tangata tiriti, or is it for everybody? Yeah, I mean, Māori is for everyone. Tikanga Māori or Te Ao Māori is available for everyone to find what they need out of it. That's the gift that tangata whenua give to Aotearoa, and it's up to us whether we want to participate in that or not. However, rehua, I think, just going back to your question, Jen, rehua is designed to be whatever it needs to be for the people who want to use it. So if it's for tangata tiriti and they need to be empowered to be better partners, or to form better relationships, then they can use it in that way. Rehua is about empowering change in the context of which the change is required, in the hands of the people who need to do the change. So what I mean by that is it's not always up to Māori to be the catalysts for change. I can support and offer guidance, but I can't be responsible for the entire thing, because there's not enough of us. But there are plenty of people who see and value Te Ao Māori and tikanga Māori and tiriti as the way forward as a nation, and they want to be part of that change. And so how do we empower them, you know, as much or as little as they want to be part of that. So that, you know, it's quite lofty, but rehua is a lofty goal, right? Like, if we're not aiming for the stars, what are we doing? Nice. Yeah, that's really... I get quite passionate about it all the time. Yeah, it's really, really good, Josh, and thanks for sharing. And I guess you're kind of, with that idea, it can be used, it sounds like, in lots of different situations. And when people are learning a new skill, or when they're developing a new relationship, there's kind of lots of different parts where it could be applied. And is there any examples where you can think it has been used, you know, over the last 12 months? Rehua in particular? Yeah. Oh, I mean, with our work colleagues in Aramanawa, it's easy to see. The reason why we started Rehua within performance improvement, Aramanawa Innovation and Design Studio, and our executive services team, which includes EPMI, which is our project management office, is because those teams already were quite advanced in terms of their relative understanding of te ao Māori, of the understanding of Te Tiriti, and in their equity journey. So there's a big whakapapa already of performance improvement in Aramanawa in particular, leading equity change, because they have influence across the various directorates, and they're able to role model, you know, the right behaviour, I guess. So that's the reason why we, that Rehua was started here. And Aramanawa in particular have been champions of Rehua from the beginning, so from when He Atawhiria in particular was introduced, and they've been some of my biggest supports and advocates for pushing the development further. So, you know, I take my hat off to Emma and the team there, especially to Nick and Jodie and Robin as well. And have you found any lessons learnt so far? Yeah. You can't take things so personally. Not everything is a fight. I think, you know, Ed's told me in my first three months that I was here, and I wish I'd listened to him sooner, but he pulled me aside one day and he was like, you know, mate, not everything is a fight. Not everything is about being combative. Not everything is about, you know, trying to educate people or, you know, like, you don't have to always take that on. And so over time I've learnt that often a response to what I'm doing is not about me or the work that I'm doing or Te Ao Māori in particular. It's about that person's relationship with their own sense of self, their own lack of connection or, you know, like it's really got nothing to do with me. It's really just playing on someone else's insecurities. And I think once you take the self and the ego out of it, it's a lot less painful, because the work that we do, especially in advocacy and in empowering and uplifting others, is that we give a lot of our own selves in that, and you do need to, but you can't forget that, um, you can't forget to hold some of that for yourself and to protect yourself. Like, what are the protective factors that you need to be able to operate in an environment like this, which ensure that you're able to give when you can to the best that you can. Nice. Okay. Put a stop at the comma, didn't I? Yeah, no, no. It's really good, Josh. It's really good. Yeah, yeah. Really, really. It's, um, no, it's really good insights and, um, I'm just loving hearing about it all. Um, and so we just wondered if you could share your top tips for dealing with racist colleagues. Yeah. Well, the first is that it's not about you. So you've got to take the personal stuff out of it, um, which is really hard to do. And like, if you lose it sometimes, or if you need it, you know, you need to hide under the blankets and have a, have a bit of a tangi or a cry. Yeah. All completely valid because it's rough sometimes. Um, however, what I've learned is that I need to trust my, my work colleagues to be the ones that actually do that for me, because it's not my responsibility to, um, police non-Māori or these race or, you know, it doesn't have to be non-Māori, but these racist attitudes, it's not my job to police that all the time. And sometimes empowering other people to do that for you or to be that for you. Um, it, you know, I remember, I won't say their name, but I remember in a hui, um, a charge nurse at the time we were talking about, you know, discrimination, things that happen on the wards and, you know, like my mother, she was a, an, uh, an older Pākehā lady with blonde hair and a bob and et cetera, just like my mum. Uh, so yeah, just want to, you know, create that link there. Not talking out of turn, I know what I'm talking about. Anyway, she pipes up and she goes, oh, oh, that would never happen on my ward. And I was, I was, I could feel it, you know, that little thing you get in the pit of your stomach that starts to come up and you're like, oh, I'm going to rip shreds off this. You know, like it was, it was a visceral response because it's not for you. Like, obviously you don't see it because you're not anyway. And I was about to, and someone else of a similar demographic was like, well, maybe if you watched a few of those videos, you'd know what you're talking about and just shut this woman down. And I was like, okay, maybe not the most mana enhancing way to do things, but I'm glad I wasn't the angry Māori in the room again. And it sounds like the rehua work and empowering staff to have those sorts of conversations in a meaningful way, in a way that is mana enhancing. Yeah, totally. And part of that is being able to draw on my own experiences and the experiences of people around me. I don't know what it's like to be a Māori wāhine in these positions, but I do know what it's like to be takatāpui and Māori tāne in these positions. But what I need to do is ask more questions and go, okay, what was your experience like? How can we better support you? What does a rehua look like from your perspective, Jen? Because that's all we need to do is facilitate better conversations and better relationships with each other, and the change will come out of that. If our intentions are good going in that we want to be mana enhancing, that we want to work towards improving the system as a whole. As long as your intentions are good, I think ultimately it will succeed, because it has to. And taking people through that uncomfortableness. The discomfort. The discomfort. And supporting them through that to walk alongside them to improve their awareness. It's trite, and we have Whakatauki left, right and centre, but we're all in this together, right? Ultimately, the improvement that we make for Māori health outcome ultimately benefits all of us. I don't need to get into the politics of it all, but... We'll save that for another time. Yeah, well, maybe one that's not working. At the end of the day, what am I in this for? It's not for me. I'm going to be fine. My family are going to be fine. It's for those people that don't have a voice, that aren't heard. How can I make room for them, or the people who advocate on their behalf? How can we make decision-making tables more open to other perspectives and minority voices? How can we promote Wāhine Māori? Because they're the ones that, when you look at things over time, Wāhine Māori are the ones that are leading it. They're the first call you hear on the marae. Um, so, yeah. I don't know, I think that was one. Yeah, that's great. That's great. Yeah, I appreciate that, George. Great explanation of how... Not too many um's and ah's. I did all the um's and ah's today, don't worry. But I think the future will be brighter for, not just Māori, like you say, but for all, with this type of work that you're doing. I mean, I think there's also a deeper conversation to have from your perspective. Maybe you don't need to discuss this right now, but like, I understand, you know, you haven't told me so much, but I'm guessing that your experience of Māori models of health care or Māori participation have not necessarily led to the outcomes that you were looking for. And I'm guessing that sometimes the, I don't know, the... I'm not putting words in your mouth, but this is what I've perceived, and you can tell me whether or not I'm wrong. No, I mean, my use of Māori models of health have been varied. They're particularly useful in policy writing for things like designing a service. But when it comes to the nitty-gritty of what the likes of, say, ELT want, when they're talking about metrics and KPIs... Yeah, it's very hard to put a number on things. ...that are, you know, gained from, you could say, you know, Te Whare Tapa Whā. It's a little bit harder to translate that into a KPI, so to speak, unless you're just talking about more sort of qualitative, unless you can flip that into some kind of metric, then, you know, people want something that's a bit tangible in this situation. But that's the hard thing, right? Sometimes you can't define something as esoteric as Mātauranga Māori occasionally into a specific numeral or, you know, quantitative setting. And I think that's going to be the biggest challenge, is how do you do that well, so that not only Māori colleagues, but also non-Māori, you know, agree, buy into this kaupapa? The question is, should it be Māori's job to translate that for Pākehā, or should it be Pākehā's job to translate it for themselves? Don't know the answer to that. No, I wasn't expecting that. But it's everybody's responsibility. Yes. Do you think? If they're looking after our people, yes. Kaupai, cool. Anyway, shall we do a final, would you like to have some final words? Oh, I don't know, I think I've talked a lot. Wrap it up? That's okay, we can just cut this part out. Yeah, yeah, we'll cut it out, we'll cut it out, we've got a straight recording. Thanks, Josh, I really appreciated your time and your intriguing conversation about the mahi you've done, and so looking forward to how this is going to, you know, translate into our practice as well. Looking forward to developing more as an improvement practitioner with Rehua. I think that's going to give us that cutting edge that we, you know, haven't had in the past. And looking forward to, you know, navigating all the different levels of... Complexity. Complexity, thank you, that's the word I was going to say. Not to put words in your mouth, but... Yeah, yeah, yeah, you got it, you got it. Any final words from you? Yeah, kia ora, Josh. Thanks so much for sharing your insights and joining us on our inaugural Innovate for Medicaid podcast. I go for Medicaid all the time. Available on all streaming platforms. You heard it here, guys. Yeah, and I think it is, you know, it's topical and exciting to see how we can do things differently, and so thanks for sharing. Well, we've done things a certain way for the last 200 odd years, and how's that helped? Yeah. Let's try something new. Yeah, absolutely. Nice. Well, that was my last word, anyway. Okay, nice. Cool, guys, thanks for having me. Um, yeah. Nice.