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Agenda
HAUORA TAIRĀWHITI BOARD
Tuesday, 27 November 2018, Boardroom, Corporate Offices, Hauora Tairāwhiti
9.00am Karakia
9.05am WAKA Award to Hauora Tairāwhiti Groundskeeper
9.10am Patient Story (discussion)
9.30am Meet and Greet (Dr Anne Kolbe, Acting Chief Medical Officer)
Page
APOLOGIES
1.1. As advised
INTERESTS 2.1 Committee Members’ schedule of interests for review 3 2.2 Conflicts in relation to Agenda items n/a
PREVIOUS MEETING 3.1 Previous Minutes for approval: 30/10/2018 6 3.2 Matters Arising n/a
ACTION ITEMS 4.1 Actions from previous meeting 9
CORRESPONDENCE 5.0 Nil n/a
PATIENT QUALITY & SAFETY 6.0 Nil n/a
REPORTS 7.1 Performance Dashboard 10 7.2 Chair’s Report 12 7.3 Te Waiora o Nukutaimemeha Chair’s report 13 7.4 Chief Executive’s Report 14 7.5 Finance Report 37 • Organisational Performance Graphs 41 7.6 Board Sub-Committee Reports 42
INFORMATION ITEMS 8.1 Nil n/a
DECISION ITEMS 9.1 Speaking Up for Safety and the Promoting Professional Accountability Programme 43 9.2 Hauora Tairāwhiti (draft) Plastic Free Strategy 47
Hauora Tairāwhiti
GENERAL BUSINESS 10.0 Nil n/a
RESOLUTION TO EXCLUDE THE PUBLIC RESOLVED that: In accordance with the provisions of Schedule 3, of the NZ Public Health and Disability Act 2000, that the public be excluded from the next part of the proceedings of this meeting.
The reason for passing this resolution and the grounds on which the resolution is based, together with the particular interest or interests protected by the Official Information Act 1982 which would be prejudiced by the holding of the whole or the relevant part of the proceedings of the meeting in public areas are as follows:
11.1-2 12.1
As shown on resolution to exclude the public in Minutes.
13.1-3 Negotiations or Commercial Activities – The disclosure of that information would not be in the public interest because of the greater need to enable Hauora Tairāwhiti to carry on, without prejudice or disadvantage, negotiations or activities. [OIA 1982 S.9 (2) (j) & (i)]
Ground(s) under Clause 32 for passing this resolution: That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32(a)]
PREVIOUS IN COMMITTEE MEETING 11.1 Previous Minutes for approval: 30/10/2018 55 11.2 Action Items (nil) 57
IN COMMITTEE REPORTS FROM HAUORA TAIRĀWHITI ADVISORY COMMITTEES 12.1 For noting and/or adoption 58
INFORMATION ITEMS 13.1 Mental Health Issues Update 59 13.2 Manaaki Tairāwhiti 100 13.3 Request for Deficit Support (letter) 104
DECISION ITEMS 14.0 Nil n/a
STAFFING & GOVERNANCE 15.0 Committee report tabled
DATE OF NEXT MEETING: Tuesday, 18 December 2018
Hauora Tairāwhiti
Member Interest Declared RoleDavid Scott Three Rivers Medical Centre Wife an employee
Treescape Farm Partnership Partner in BusinessTreescape Consultancy Business ConsultantTe Kuri a Tuatae Marae TrusteeEast Coast Rural Support Trust Rural Support Co-ordinatorGisborne District Council Civil Defence Shift Volunteer/Media Liaison OfficerGisborne Herald Casual non-paid columnistMiddle Mount Company Ltd DirectorCONNEXT Charitable Trust Trustee
Geoff Milner Ngati Hine Health Trust Chief ExecutiveTerenga Paraoa Lmited DirectorManaia PHO Limited DirectorTairāwhiti Laundry Services Limited DirectorTairāwhiti Laundry Services Limited Director
Gavin Murphy Tlab Limited DirectorEastland Community Trust Chief ExecutiveTe Ahi o Maui Limited Partnership DirectorPersonal friend of the Minister of HealthActivate Tairāwhiti Limited DirectorEastland Development Fund Limited DirectorWET Gisborne Limited Director
Prudence Younger New Zealand Community Trust Regional Advisory Group
Chair
CONNEXT Charitable Trust ChairForest Industry Contractors Assoc Chief ExecutivePublic Impressions Limited Director
Kathy Sheldrake Motu Trails Charitable Trust ChairRehette Stoltz Gisborne District Council Deputy Mayor
Sport Gisborne Tairāwhiti TrusteeTairāwhiti Positive Aging Trust TrusteeE Tu Elgin Community Group MemberHusband employed by Hauora Tairāwhiti Deon Stoltz (Senior Medical Officer)Deon Stoltz Medical Services DirectorArt in Public Places TrusteeManaaki Tairāwhiti Governance Group memberSunshine Service Managment Team memberGisborne Walking & Cycling Trust TrusteeTairawhiti Laundry Services Limited DirectorTe Ha 1769 Sestercentennial Trust. Trustee
Hiki Pihema Hauora Tairāwhiti Team Leader, DietitiansDietitians Board Board Member Otago University Supervisor, Dietetics ProgrammeNgati Porou Hauora Dietitian via Hauora Tairāwhiti roleDietitians NZ MemberTe Runanganui o Ngati Porou Registered BeneficiaryTe Whaihanga ki Uawa MemberElgin Rangatahi Oral Health Project Daughter is Co-OrdinatingNational Heart Foundation Daughter is Nutrition Advisor
Na Raihania Whanau Trusts TrusteeHawkes’ Bay DHB Iwi Relationship Board MemberTRONPnui Board Trustee
Brian Wilson B & P Wilson Family Trust TrusteeGisborne District Council CouncillorYMCA PresidentGisborne Surf Lifesaving Charitable Trust TrusteeTLab Director
Board Members’ Register of Interests3
Josh Wharehinga Gisborne District Council CouncillorTe Wananga o Aotearoa Board memberGisborne Intermediate School Board memberMother employed by Hauora Tairāwhiti Maraea Cookson (Cultural Response Team)Ex Partner employed by Hauora Tairāwhiti Richelle Tarsau (Children’s Ward)Aotearoa Scholarships Trust TrusteeHorouta Waka Hoe Waka Ama Club Board member
Meredith Akuhata-Brown Gisborne District Council CouncillorCampion College Board memberTairawhiti Youth Workers Collective MemberPapawhariki Inc Board memberGisborne Herald Casual unpaid columnist
Jim Green (Chief Executive) Health Partnerships Limited (CE Sponsor – Food Services Programme)
Appointed by National CEs. First responsibility is to Hauora Tairāwhiti but there may be an occasion when this conflicts with the national programme.
Chief Executive Representative, Midland Alliance Leadership Team (Midland Health Network Trust)
Potential conflict exists in relation to decisions made by the Midland ALT which conflict with the interests of Hauora Tairāwhiti.
Director, HealthShare Limited Appointed by Hauora Tairāwhiti. First responsibility is to Hauora Tairāwhiti but there may be an occasion where this conflicts with the needs of HSL.
Wife employed by Tūranga Health as Tamariki Ora Nurse and Team Coordinator for Tamariki Ora
Potential conflict exists over decisions related to funding of services provided by Tūranga Health affecting the employment status of his wife.
Son is employed as a Medical Registrar at Waikato DHB.
Potential conflict regarding decisions on terms and conditions of employment for Medical Registrars.
Daughter in-law is currently working in a community Pharmacy in the Waikato.
Potential conflict regarding my involvement with the national Community Pharmacy Agreement which could impact on her employment.
Manaaki Tairāwhiti Decisions at Manaaki Tairāwhiti may conflict with those in my role as CE of Hauora Tairāwhiti. The management is that decisions around funding are required to come back to Hauora Tairāwhiti.
National Oracle Solution Executive Steering Committee as CE representative
A possible conflict of interest arises for me in this role as opposed to my role as CE of Hauora Tairāwhiti. Management of the possible conflict can be effected by the fact that I have a responsibility to Hauora Tairāwhiti and the Midland Region ahead of the commitment to the NOS programme.
Member, National BiPartite Action Group Appointed by National CEs. First responsibility is to Hauora Tairāwhiti but there may be an occasion when this conflicts with the group programme.
Pay Equity Workstream Co-Lead, Employment Relations Strategy Group (ERSG),
Appointed by National CEs. First responsibility is to Hauora Tairāwhiti but there may be an occasion when this conflicts with the work programme.
Holiday's Act Lead Appointed by National CEs. First responsibility is to Hauora Tairāwhiti but there may be an occasion when this conflicts with the work programme.
(Vacant) Chief Medical Officer
0 0
Management Attendees
4
Serita Karauria (Acting DoN) Nil 0
Craig Green (Chief Financial Officer)
Chamber of Commerce (Mentor) Possible conflict if mentored party is providing services to Hauora Tairāwhiti.
Mother employee of Compass Medirest Food Services
A conflict of interest exists in relation to negotiations with Compass Medirest Food services Tairāwhiti conflict where it affects or could affect staffing.
Nicola Ehau (Planning, Funding & Population Health)
Husband an employee of the Health Quality & Safety Commission
Low likelihood of conflict.
Manaaki Tairāwhiti Decisions at Manaaki Tairāwhiti may interest with those in my role as GM Planning & Funding in Hauora Tairāwhiti. The management is that decisions around funding require to come back to Hauora Tairāwhiti.
Fraser Hopkins (Communications)
Nil 0
Lynsey Bartlett (Surgical Services)
Company Director: Yesteryear Limos Low likelihood of conflicts.
Alternate Director, HealthShare Limited Appointed by Hauora Tairāwhiti. First responsibility is to Hauora Tairāwhiti but there may be an occasion where this conflicts with the needs of HSL.
5
Minutes
Hauora Tairāwhiti Board 30 October 2018, commencing 9.30am at Hinerupe Marae, Te Araroa
Present David Scott (Board Chair) Meredith Akuhata-Brown Kathy Sheldrake Na Raihania Hiki Pihema Geoff Milner Gavin Murphy
Attending
Jim Green (Chief Executive) Craig Green (Chief Financial Officer) Nicola Ehau (Group Manager, Planning, Funding & Population Health Joyce O’Donnell (Minutes)
Mihi Whakatau Karakia Na Raihania The Board were welcomed by Kararaina Ngatai-Melbourne (Hinerupe Marae Secretary) and Marae rangatahi
Item 1: Apologies Prue Younger, Brian Wilson, Josh Wharehinga, Rehette Stoltz
Item 2: Interests 5.1 Changes to Register Nil 5.2 Conflicts Related to Any Item on the Agenda Hiki Pihema – Item 7.1 Staffing & Governance Report
RESOLUTION TO EXCLUDE THE PUBLIC RESOLVED that: In accordance with the provisions of Schedule 3, of the NZ Public Health and Disability Act 2000, that the public be excluded from the next part of the proceedings of this meeting. The reason for passing this resolution and the grounds on which the resolution is based, together with the particular interest or interests protected by the Official Information Act 1982 which would be prejudiced by the holding of the whole or the relevant part of the proceedings of the meeting in public areas are as follows: 3.1-2 As shown on resolution to exclude the public in Minutes.
5.1 6.1-2 7.1
Negotiations or Commercial Activities – The disclosure of that information would not be in the public interest because of the greater need to enable Hauora Tairāwhiti to carry on, without prejudice or disadvantage, negotiations or activities.
1
6
[OIA 1982 S.9 (2) (j) & (i)]
Ground(s) under Clause 32 for passing this resolution: That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32(a)] 3.1 Previous Minutes for approval 26.6.18 3.2 Action Items 4.1 Sub Committee Reports 5.1 Information Items (nil) 6.1 Decision Items ( nil) 7.1 Staffing & Governance Report The meeting moved into In Committee. The Chief Executive, Financial Accountant, Communications Manager and the Minute Secretary were invited to remain for facilitation of Board discussion and recording. Public Included Minutes cont:
Item 8.1: Minutes of Previous Meeting ADOPTED
The public minutes of the Tairāwhiti District Health Board meeting held on 25 September 2018 confirmed as a true and accurate record.
Item 8.2: Matters Arising from Minutes Nil Item 9: Action Items Noted
Item 10: Correspondence Nil
Item 11: Patient Safety & Quality Nil
Item 12: Reports 12.1 Performance Dashboard Noted 12.2 Chair’s Report Noted. Agreed that Dr Gerry Devlin (Cardiologist) and Dr Bruce Duncan (Medical
Officer of Health) be invited to meet with the Board in 2019. 12.3 TWON Report Noted
2
7
12.4 Chief Executive’s Report Noted and the Chief Executive elaborated throughout. In addition to the report the
Chief Executive verbally reported: • A recent surge is being experienced in Emergency Department attendances
and admissions to hospital which could be interpreted as a delayed Winter peak or second onslaught of the winter flu.
• The CT scanner has been decommissioned to facilitate the installation of the new scanner. Mitigation strategies and processes are in place to avoid disruption to care.
• Representatives leading the Health & Disability System Review will be in Tairāwhiti on either 28 or 29 November. Discussions will centre on key system changes; planning & accountability frameworks; and the uniqueness of the Tairāwhiti district – its opportunities and challenges.
• The Chair and Chief Executive will appear before the Health Select Committee on 12 December.
12.5 Finance Report Noted and the Chief Financial Officer spoke to the report. The Board discussed the
implication of the deficit support and where that would be applied. 12.6 Board Sub-Committee reports Noted
Item 13 Information Items 13.1 Minister of Health re Letter of Comfort 2017/18 financial year Noted.
Item 14 Decision Items Nil Item 15 General Business Nil
Meeting closed: 11.16am Date of Next Meeting: 27 November 2018
………………………………………….. ………………………………………. Chair Date
3
8
Action Items HAUORA TAIRĀWHITI BOARD
Item Description Who Deadline
Carried over Indici Collective paper for Tairāwhiti General Practitioners to
highlight the benefits of an integrated electronic health record. • John Macaskill-Smith’s proposal was discussed at Te
Reo Rautaki (Strategic focus group incorporating primary care representatives) and it was agreed in principle to use proposal as a basis to further discussions with primary care (GP) stakeholders.
John Mackaskill Smith/ Jim Green
Feb 2018
Ambulatory Sensitive Hospitalisation (ASH) 45-64 Rate Increase
An update to the ASH 45-64 report in a year to gauge progress. • Carried over as scheduled
Nicola July 2019
Finance Report Consolidated Financial Performance Summary table – confirm what the year to date budget was last year. • Carry over
CFO Oct
30 October 2018
Nil
9
Oct-18 Oct-18
Ethnicity This Month Target Last Month 3 Month Average
Māori 95.8% 96.2% 95.8%
Total Pop 95.1% 95.9% 95.3%
Total Pop 100% ≥ 90% 100% 89%
Māori 84% 84% 82%
Total Pop 86% 85% 84%
Māori 80% 81% 81%
Total Pop 83% 83% 83%
Māori 95% 97% 96%
Total Pop 95% 97% 96%
Ethnicity This Month* Target Last Month 6 Month Average
Māori 95% 94% 90%
Total Pop 94% 94% 92%
Ethnicity Total This Month Monthly Target YTD Year to Date
Target
Māori 90 85 305 326
Total Pop 230 224 869 859
Ethnicity This Month Target Last Month 3 Month Average
9 ≤ 6 7 8
1 3 1
14 11 13
1 6 5
Māori 92% 92% 92%
Total Pop 91% 94% 93%
This Month Target Last Month 3 Month Average
82% ≥ 80% 85% 85%
1,023 ≤ 836 1,030 1035
2.60 ≤ 3.21 days 2.50 2.57
1,720 ≤ 1,523 1,598 1,670
69% ≤ 70% 67% 68%
*Target number of discharges and number of ED attendances is based on 5% reduction from 2015/16 year and displayed as 1/12 of that amount
This Month Target Last Month 3 Month Average
97 93 105
356 331 354
This Month Target 3 Month Average YTD Average
% 3.7% ≤ 6.1% 4.4% 4.2%
# 38 N/A 43.7 37.5
% 4.6% ≤ 7.8% 5.3% 6.4%
# 7 N/A 8.3 9.7
# of Enrolled Patients# of Māori
Enrolled
PHO % of enrolled
population
9,109 8,125 19%
38,960 16,630 89%
102% 108%
Ethnicity 12 months to 30 June 2018 Target Last Year (June 17)
Māori 7,205 8,135
Total Pop 6,479 7,631Māori 6,271 5,922Total Pop 3,992 4,197
Key
≤ Less Than or equal to ≥ Greater than or equal to
43%
PHO Enrolments (Oct-Dec 2018)
Severity Assessment Code 1 and 2 Events
Complaints
Number of Medication Events
≥ 95%
12 Month Trend
≥ 95%
12 Month Trend
≥ 90%
≥ 95%
12 Month Trend
* only available on 8th of the Month following service.
Hauora Tairāwhiti
Health Targets
Indicator
Shorter Stays in Emergency Departments
Shorter waits for Cancer Treatment - 62 day
target
Increased Immunisation
(8 Months) ≥ 95%
≤ 6,512
Percentage of Triage 4-5 attendances
Primary Care
Better help for Smokers to Quit - Secondary
Care
Better help for
Smokers to Quit**Maternity *Currently only Hospital Maternity Dept
Stats
≥ 90%
Raising Healthy Kids*
Improved Access to Elective Surgery
Indicator
Patient Falls
Patient Safety and Quality - Hospital
12 Month Trend
N/A
Number of Emergency Department Attendances*
12 Month Trend
Surgical Events
45-64
81%
12 Month Trend
PHO
Hospital Events
Indicator
Bed Utilisation
Number of discharges*
Average Length Stay (days)
≤ 3,490
Indicator
Number of Acute Surgeries
Total Number of Surgeries
12 Month Trend
Acute Readmission
Rate
Total Population
75+ population
N/A
Ngāti Porou Hauora
Midlands Health Network - Tairāwhiti
Percentage of Tairāwhiti Population enrolled in a PHO Percentage of Tairāwhiti Māori Population enrolled in a PHO
Percentage of PHO Population who are Māori
Ambulatory Sensitive Hospitalisations per 100,000 population 2018 Year
Age Group
00-04
Acute Readmission Rate
Indicator
7,253 6,330 6,053
7,320 6,738 6,479
4,031 4,197
2,163
4,280 4,164 3,992
0
2,000
4,000
6,000
8,000
12 to 03/17 12 m to 06/17 12 m to 09/17 12 m to 12/17 12 m to 03/18 12 m to 06/18
Ambulatory sensitive hospitalisations per 100,000 population
0-4 year olds -Total Pop 45-64 year olds - Total Pop
10
Oct-18 Oct-18
Indicator Ethnicity This Month Target Last Month 3 Month Average
Māori 87% 84% 85%
Total Pop 85% 83% 84%
Māori 260 276 295
Total Pop 564 581 592
Māori 17% 22% 20%
Total Pop 12% 13% 12%
2013/14 2014/15 2015/16 2016/17 2017/18 2018/19
5 6 2 1 4 0
12 months to June
2018Target
12 months to March
2018
Last year
12 m to June 2017
82% 71% 78%
70% 56% 69%
*Waiting times are sourced through National reporting (PP8), which reflect activity in the previously reported quarter.
Sep-18 Target Aug-18 3 Month Average
Computed Tomography (CT) < 42 days 94% ≥ 95% 93% 94%
Magnetic Resonance Imaging (MRI) < 42 days 93% ≥ 90% 92% 93%
Urgent Colonoscopy < 14 days 100% ≥ 90% 100% 100%
Non Urgent Colonoscopy < 42 days 56% ≥ 70% 64% 66%
Surveillance Colonoscopy < 84 days 68% ≥ 70% 75% 74%
This Month Target Last Month 3 Month Average
10% ≤ 10% 4% 6%
2 ≤ 7.6 1 1* Data won't be available till 12/11/2018.
Month Actual Month Budget Last Month Actual YTD Actual YTD Budget YTD Variance
$16,514 $16,175 $16,677 $66,091 $64,694 $1,397
$17,068 $17,050 $17,563 $68,522 $67,589 $933
($554) ($876) ($886) ($2,431) ($2,895) $464
($771) ($870) ($841) ($2,787) ($2,893) $106
$248 $0 ($51) $357 $0 $357
($31) ($6) $6 ($1) ($2) $1
Staff Injury (per 1m hours worked)
Diagnostic Waiting Times * 1 month behind due to data being collated Nationally
12 Month Trend
Immunisation at 2 years
First Specialist Assessments
Missed Appointments
Finance ($'000)
Consolidated Revenue
Consolidated Expenditure
Consolidated Result
Provider Result
Funder Result
≤10%
Governance Result
Trend
Patient Safety and Quality - Community
12 Month Trend
Hauora Tairāwhiti
≥ 95%
N/A
Rheumatic Fever Hospitalisations (Financial Year, First episode hospitalisation numbers)
Non-urgent Mental Health & Addiction waiting times for Child and Youth 0-19 (data reported Quarterly*)
Indicator
Mental Health waiting times (< 3 weeks)
Addiction Services Waiting times (< 3 weeks)≥ 80% < 3 Weeks
Indicator
Human Resources
Indicator
Staff Turnover
12 Month Trend
Indicator
Trend
$12
$160
$109
$357
$34 $31
$26
$1 $275 $376
$7
$106
-$466
-$1,175
-$2,016
-$2,787
$321
$567
$142 $464
($3,200)
($2,800)
($2,400)
($2,000)
($1,600)
($1,200)
($800)
($400)
$0
$400
$800
Jul-
18
Au
g-1
8
Sep
-18
Oct
-18
No
v-1
8
Dec
-18
Jan
-19
Feb
-19
Mar
-19
Ap
r-1
9
May
-19
Jun
-19
Re
sult
($
00
0's
)
Hauora Tairāwhiti Financial Performance 2018 /19
Funder variance Governance varianceProvider variance Provider ActualConsolidated Variance
Funder and Governance Budgets are set to zero. Provider Budget is set to a deficit of $2.023m The new Provider Variance reflects the difference between Actual and Budgetted results while Provider Actual reflects net actual result.
11
Chair’s Report – November 2018
- The October Board meeting was held in Te Araroa to provide an opportunity for the locals to have a say. Unfortunately, no locals were able to attend but we were hosted by the young people from Te Kura Kaupapa Māori O Kawakawa Mai Tawhiti , Hicks Bay. As well as being amply provided with kai, we were able to have a good discussion with the Rangatahi . On a positive note, we were able to hear of some of the wishes and desires from the Rangatahi which Planning, Funding & Population Health can follow up.
- The Hon Anne Tolley MP for East Cape brought the opposition health team to the Hospital for a
visit. Anne, Michael Woodhouse (spokesperson for Health), Dr Shane Reti and Nicky Wagner visited Kahikatea the new Medical Day Unit and the newly installed CT in the Radiology Department. The team were very interested in both venues and asked many questions. Michael said that they were using the time in opposition to find out from DHBs the sorts of things that would make life easier in “DHB land”. As well as being surprised at some of our innovative approaches, they also remarked that Hauora Tairāwhiti clearly “punches above its weight”.
Recommendation That the Board notes the report. David Scott, MNZM, JP Chair Hauora Tairāwhiti
12
Te Waiora o Nukutaimemeha November 2018 Report
Tēnā tātau e te Poari Matua
Te Waiora o Nukutaimemeha cancelled its monthly October hui to help support attendance at the South Central Foundation (Nuka) conference 23 -24 October in Hawkes Bay. Three Te Waiora o Nukutaimemeha members attended. The Nuka conference was attended by 350 attendees.
Southcentral Foundation’s Nuka System of Care (Nuka) is a relationship-based, customer-owned approach to transforming health care, improving outcomes and reducing costs. In FY 2015, SCF’s income was US$240 million, 5% of SCF’s income was through grants, 49% through third-party payments and 43% through a grant with the Indian Health Service. They serve a population in excess of 55 000 over an area of 107 400 sq miles.
They receive customer and staff satisfaction rates in excess of 90%. Half of their employees are Native Alaskan.
The relationship building with their customer owners was their key plank policy which was in effect about understanding their story and what wider impacts led them to illness.
Web search: slides.nuka.com Conference Code: nukanz Password: Amorangi
Next steps: Te Waiora o Nukutaimemeha participants will provide a report and present to the Board in the new year.
I runga I ngā manaakitanga o te Atua. Na Raihania Tiamana, Te Waiora o Nukutaimemeha
13
Chief Executive’s Report October 2018
Health Targets
Better Help for Smokers to Quit
For the month of October we offered support to 91% of smokers admitted to hospital. With some results still to be checked, we are not managing to reach the 95% target. The Chief Executive has followed up directly with areas where there have been people missed for advice. The main area has been in the Emergency Department and this may have been related to the record numbers of people coming through in the month. In all cases the records have been reviewed and Charge Nurse Managers have followed up directly with teams to ensure this aspect of care is being carried out.
Faster Cancer Treatment (FCT) 62-day pathway – 100% (6 out of 6). Of the six people with newly treated cancer this month: Two people had skin cancer and were treated initially in primary care – they may be removed onto the 31 day pathway once the Cancer Nurse tracker has reviewed them. One person had lung cancer – they presented to ED with cough and a weight loss history of 3-4 months. They proceeded quickly through to diagnosis and chemotherapy. One person had a gynaecological cancer – they were seen within three days of referral receipt, had biopsy one day later and had surgery in Auckland 21 days later. One person had a Head and Neck cancer – they were seen within seven days of referral receipt. A complex round of biopsies and scans ensued to ensure correct diagnosis and treatment. One person with sarcoma was referred urgently to Waikato Maxillofacial department by their dentist – presenting after one week of swelling in the mouth. Treated surgically within 55 days.
31 day pathway – 50% (2 out of 4). A further four people received treatment in October who had not entered the pathway on the High Suspicion of Cancer (HSCAN) referral: One person had a lung tumour found incidentally during bowel screening. Early stage. Unfortunately the person had a stroke during their inpatient stay and was not able to have treatment for the cancer immediately. This has now stabilised and the person has received radiotherapy. One person with breast cancer detected during screening chose to delay surgery to fit in with personal arrangements. One person with lower Gastro-intestinal cancer detected on treatment for diverticulitis was reluctant to return for treatment. The Surgical CNC visited at home and negotiated attendance and treatment. One person with a gynaecological cancer was not deemed HSCAN on referral.
Elective Production Elective surgical discharges are above target at 101.1%. 10 discharges ahead of a target of 859. Case weights are currently sitting at 96.9%. This is -35.2 CWDs behind the target of 1138.8. First Specialist Assessments (FSA) is ahead at 107.6%. 166 FSAs ahead of a target of 2168.
Elective Services Performance Indicators (ESPI) remains non-compliant at an organisational level in ESPI 2 – First Specialist Assessments and ESPI 5 – Time to treatment. An exemption is in place for Orthopaedics. Specialities requiring close monitoring and additional sessions to mitigate risk of non-compliance include Dental, ENT, Gynaecology, Neurology, and Urology.
Emergency Department 6 Hours ED achieved the ED target of 95% this month coming in at 95.1%. This result is pleasing particularly in light of the high volume of ED presentations this month which are a five year high and are the highest this year to date. They have surpassed the winter months and reflect flu like illnesses in the community. Primary care has reported a similar peak in demand.
14
1000110012001300140015001600170018001900
July
August
September
October
Novem
ber
Decem
ber
January
February
March
April
May
June
Emergency Department Presentations by Month
2014-2015 2015-2016 2016-2017 2017-2018 2018-2019
0
100
200
300
400
500
600
700
800
July
August
September
October
Novem
ber
Decem
ber
January
February
March
April
May
June
Triage 1-3
Triage 1-3 2013-2014 Triage 1-3 2014-2015Triage 1-3 2015-2016 Triage 1-3 2016-2017Triage 1-3 2017-2018 Triage 1-3 2018-2019
0
200
400
600
800
1000
1200
1400
July
August
September
October
Novem
ber
December
January
February
March
April
May
June
Triage 4-5
Triage 4-5 2012-2013 Triage 4-5 2013-2014 Triage 4-5 2014-2015Triage 4-5 2015-2016 Triage 4-5 2016-2017 Triage 4-5 2017-2018Triage 4-5 2018-2019
15
Immunisation October Figures 8 months - Overall is 86%, (↑1% ) Māori 84% (≈) and an overall decline rate of 7.8%(13 children) (↓1.2%) 2 years - Overall is 85% (↑2%) Māori 87% (↑3%) and an overall decline rate of 10.6% (↓0.5%)(20 children) 5 years – Overall is 93% (≈) Māori 93% (≈) and an overall decline rate of 3.1% (↑0.1 %)(6 children) The decline rate for the 8mth and 5 yr looks as if the rate is finally on the decline. We are still waiting on the enquiry report for the Samoa incident. Outreach immunisation service has had many discussions with families concerning the safety of the NZ vaccination programme. Presently discussing the possibility of vaccinating children in the Emergency Department as well as the Paediatric Out Patient Department, as well as increasing immunisation conversation and vaccinating in Planet Sunshine. Raising Healthy Kids 89% for total population and for Māori only 75%, against the target of 95%. The indicator varies as the year progresses and the current results do not provide cause for concern. Financial Oct 18
Actual Oct 18
Var YTD Var
Sep 18 Actual
Sep 18 Var
Provider ($771k) $98k $106k ($840k) ($368k) Governance ($25k) ($25k) $1k $5k ($5k) Funder $248k $248k $357k ($51k) ($51k) Consolidated ($553k) $321k $464k ($886k) ($424k) The management accounts result to October includes $160k of the non-specific expense accrual. The Provider Arm operating result for the month was a deficit of ($771k) – positive variance of $98k. This is a better result than the ($368k) variance of last month and continues the better start to the year being on budget year to date although total expenditure is up 7.3% or $2,521. While staff costs were under budget they are 9.2% up on last year, although this drops to 5.2% if the effect of the Cleaning, Orderly and Security staff transfer is removed. The nurses’ salary increases are now in place, the lump sum has been paid and the back pay was paid on November 14. The salary costs for this work group are inflated by an accrual for the 6% increase now in place at this time and similarly for the other like staff groups currently in bargaining. Staff costs were underspent for the month by $238k, and as noted above, while significantly up on last year this is mainly related to the change in cost centres and the higher than usual salary increases. Outsourced staff cost increased in the month, medical ($102k) over budget, and overall up 26.3% on last year to date. Reliance is high on locum staff for orthopaedics and psychiatry, with the former in catch up mode and the latter having recruited to vacancies although there is now a further resignation. Between insourced and outsourced staff we remain ahead of budget though. Clinical supplies costs are up 8.4% on last year with now similar overall acute throughput but a boost in electives combined with notable additional cost in medication (26.5% up on cancer drugs) and air ambulance costs (up 30.1% on last year). The Funder arm result was a surplus of $249k – positive variance $248k and year to date $357k – positive variance $357k. There was a further deterioration in IDFs for the month as Waikato DHB adjusted their estimates negatively again this month. Comparisons to 2017/18 (YTD)
Result Actual Variance 2017/18 ($1,682k) ($2,155k) 2018/19 ($2,431k) $464k
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The better than budget result this year has improved this month after the shock of the IDF change for Waikato DHB last month. Result Drivers Provider Revenue • Over budget for the month by $81k with YTD $127K ahead of budget. Health Workforce NZ receipts are
over this month $3k making YTD under ($17k). ACC income under budget ($13k) for the month making YTD ($89k). Some of this is delayed processing of claims. Patient and consumer sourced being under budget for month by ($7k).
Expenditure • Underspent $17k for the month compared with overspend of ($414k) last month, YTD overspend ($21k) • Staff costs were underspent by $238k for the month. The leave liability decreased from last month by
$111k. Medical Staff were under spent $246k. Nursing staff costs were over budget by $(146k), affected by the throughput. Allied Health was $88k under budget, Support under by $35k. Sick leave was 1.7% for the month, down from 3.3% last month. Sick leave is down on last year when it was 2.9% in October 2017. That will be very different in November however.
• Paid FTE was up 24 for the month. There were 736 FTE paid for the month. This includes the transferred staff and net of these the figure is 701, which compares to 664 last September.
• Outsourced services were overspent ($96k) for the month. This is $370k more than last year. Recruitment and cover remains problematic in psychiatry and orthopaedics, but improving.
• Clinical supplies were overspent by ($175k) for the month. Usage of blood was $3k under for the month. Cancer treatment costs were overspent by ($44k) and are ($151k) or 26.5% higher than last year. Air transport expenditure was ($49k) over for the month and is $191k higher than year to date last year. Patient transport and lodging is overspent YTD by ($46k) and is 8.6% more than last year.
• Infrastructure and non-clinical supplies costs were underspent $49k for the month. The non-specific accrual is $160k.
Winter 2018 is proving different. There is a distinctive tail seen in October with high utilisation of ED and an increase of admissions. It is certainly different than last year also with a sharper peak in admissions. The effect has flowed on into November with the signalled pressure on beds early in the month which has fortunately dissipated somewhat since. Influenza A has been a feature of this with conformed cases in the community and for hospital staff. There was an event team set up early in November to monitor and respond to what had the signs of being an influx. This however has not developed further.
At the same time, surgery is geared up considerably in Orthopaedics to catch up on people waiting for surgery, and to address the people who have been waiting for a first assessment. Lead by the Nurse Practitioner, a team are working through the people who are waiting in order to review their status and to ensure we prioritise action. We need to be sure on what the needs of each individual are so that we get maximum benefit out of our capacity. We are identifying instances where no follow up is required and this is also ensuring services are targeted.
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General medicine admissions are similar to last year and appear to be setting a new plateau, albeit at a higher overall level than in the past. The start of the registrars in December will deliver up a changed dynamic, although it will take time to see this effect given the expected reduction in acute admissions at that time of the year in any case.
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Paediatric medicine acute admissions October results shows a correction to previous years as we enter summer months and is still trending downward overall.
General Surgery is up again on last month and slightly up on this time last year.
19
Orthopaedic admissions show a sharp correction in admissions similar to the pattern across the years.
October ED admissions are up again to just above the trend line and are higher than this time last year.
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Governance and Administration Revenue • On budget for the month. Expenditure • Overspent ($25k) for the month and under $1k YTD. • Staff costs under budget $6k for the month and on budget YTD. • Non staff expenses are over budget ($31k) for the month, with adjustments in the month for accruals in
audit fees and HealthShare. • Democracy costs are $9k under budget and under budget $12k YTD.
Funder
Revenue • Positive $440k for the month, mainly pay equity and Te Kūwatawata for which there is offsetting
expenditure. Expenditure • Overspent ($192k) for the month, includes offsetting expenditure for pay equity and Te Kūwatawata. There
was a further $160k deterioration in the IDF position with Waikato DHB. Older Peoples’ services were underspent by $50k despite high loading.
Better Outcomes for People For a period of time we have struggled to achieve the national target for people to receive a falls risk assessment. Our focus on this has not been in meeting the target per se, but to realise the full implications of the benefits that routine screening for falls risk and for then planning action to eliminate that risk will have for people in hospital. There has been a view that part of the problem has bene turning actual assessments and plans into documentation which can verify what is actually happening in what is actually a routine part of nursing practise. This is why these latest figures are significant, alongside the improved performance in terms of the audit, there is now much more confidence that people are being kept safe during their stay in hospital. When this is added to all the control measures that are actually put in place as a result of the assessments we are continually improving the scale at which we can achieve our goal of zero falls for people in hospital. Process Marker National
Threshold Oct-Dec
2017 April-June
2018 July-Sept
2018 Percentage of patients aged 75 and over (Māori and Pacific Islanders 55 and over) that are given a falls risk assessment.
90% 88% 76.4% 91.7%
Percentages of patients assessed as being at risk have an individualised care plan which addresses their falls risk.
N/A 87% 73.6% 83.7%
Inter Professional Education Programme The latest report from the Inter Professional Education programme is attached to this report to provide an update on this highly successful adjunct to our efforts to secure the future workforce of Tairawhiti. It was pleasing to note that in the new starters to Hauora Tairawhiti there were people who had completed time in Tairawhiti as part of the programme. Their experiences were a definite factor in choosing Tairawhiti as a place to start their careers.
Accountability Annual Plan 2018/19 Final plan was submitted to MoH on 1 November. No feedback as yet on timeframe for approval.
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Primary & Community Health Services Community Pharmacy We are now going through the due diligence process for 2 new pharmacy providers. Once completed, and if no concerns are raised, we will enter into a new Pharmacy Provider Agreement with both providers. We have also started the development process for a new pharmacy provider policy, and are currently working with the DHB Communications Manager on communicating with community pharmacies on the new providers and policy development. Changes to Very Low Cost Access (VLCA) Funding The VLCA fund will be discontinued from 30 November 2018. This funding will be used to support the new primary health care initiatives that take effect from 1 December 2018, as agreed by PHOs/DHB agreement group, to reduce co-payments for people with a community services card or provide free access to those under 14. The negotiated changes will result in a net gain in capitation funding provided to VLCA practices. An estimated $18 million net increase per annum will be available to support the almost 300 VLCA practices nationally. Benefits locally can be applied in the manner chosen by PHOs and practices, with application to cost pressures a common use. Exiting School Based Services Agreement We will be exiting this agreement 31 December 2018 as the provider no longer wishes to provide the service. There are options to reconfigure the service and make it more targeted which will be pursued. Primary Health Care and Chronic Conditions Annual Plan Café Invitations have been sent out to stakeholders for the Annual Plan Primary Health Care Café Thursday 15th November and the Chronic Health Care Café Thursday 6th December. A post report of both cafés will be provided to governance. Zostavax Underpayments DHB General Managers Planning &Funding have recently agreed to compensate Zostavax (shingles vaccine) underpayments to general practices that did not claim for Zostavax and Influenza vaccinations administered on the same day for the period 1 April 2018 to 3 June 2018 at the rate of $15.00 (GST Exclusive). Claims are subject to verification via DHBs before payment can be authorised. As there is no national payment process in place for this service, we will be organising this with individual PHOs. It is expected that this will cost the DHB between $8,000 to $12,000.
Child, Youth and Population Health Maternal and Infant Health: Antenatal education services Currently, the Service Manager for Women, Children and Youth services and Maternity Manager are reviewing proposals to find a new provider to deliver antenatal education services locally for the DHB-based programme. Tūranga Health offers an antenatal programme within its other services, which it offers to the pregnant mums who access the range of their services. One of the key benefits of the Tūranga Health programme is that it enables connection to their Tamariki Ora services following Lead Maternity Carer (LMC) handover, and also engages with Māmā and Pēpi support services. The change in service provider for the DHB service has given us an opportunity to review our antenatal education services overall, what we have in place, our available resourcing and where there are other programmes that are not directly funded by the DHB. We’ve also looked at the programmes provided by other DHBs within Midlands. Currently all DHBs, aside from Hauora Tairāwhiti, fund the Hapū Wānanga programme, delivered by either a combination of LMCs and/or hospital-based midwives. This was launched out of Waikato, and as the name suggests, embodies the Māori world view and practices, and has successfully increased Māori
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participation in these programmes while still retaining the clinical requirements expected of an antenatal education programme. Rheumatic Fever – Healthy Homes Initiative A review of the recent case of the child diagnosed with rheumatic fever has been completed. The review involved the Planning & Funding Portfolio Manager, Medical Officer of Health - Communicable Diseases, Public Health Well Child Nursing Manager and Tūranga Health Rheumatic Fever Elimination Programme Coordinator. In addition, all cases back to 2017/18, were collated, to look for any commonalities that we could learn from in order to improve the programme delivery. Wahakura and Weavers – A Working Model In late October we met with weavers from across the Tairāwhiti district. Those invited were specifically experienced weavers of wahakura. It was an excellent meeting, gauging their interest and ability to engage with health services to support the Mokopuna Ora - Safe Sleeping Services. Feedback from weavers was varied. All who attended were interested in being involved as a weaver of wahakura and a few expressed interest in teaching hapū māmā to weave their own wahakura. Discussions involving the tikanga of raranga were shared and highlighted the depth of the weaving capacity within Tairāwhiti. We will continue to work with the weavers by presenting a model of delivery where they can be engaged in production and supply, and in supporting the programme to identify potential weavers from those who attend wānanga. Adolescent Dental Services – Ngāti Porou Hauora We have been working closely with Ngāti Porou Hauora since July to provide a dental service to adolescents on the coast. The absence of a dentist has made this difficult to achieve. However, we have brokered a relationship between NPH and a charitable dental trust based in Waikato, Revive a Smile, who have undertaken short-term intervention dental services by means of their mobile unit in places like Northland and the Far North, with significant success. Although there are still outstanding treatments for adolescents on the coast, a follow-up service is likely to be provided February 2019 for the new school year, if not this side of Christmas. It is important to note that a complaint from Tolaga Bay Area School principal has been submitted to Hauora Tairāwhiti regarding the lack of adolescent services to their students. Efforts are in place to bring the provider and the school parties together to resolve the shortfall in service. The complaint highlights that there are inconsistencies in adolescents’ utilisation of dental services across the district, with just over 45% not enrolled, or not utilising services. This is of significant concern, and a joint group from Planning and Funding, Dental Services, Women Children and Youth Services has been set up to focus on this need.
Mental Health, Alcohol and other Drugs AOD Review Implementation Plan to Establish a Collaborative Leadership Group After discussion with the Group Manager, Medical and Mental Health, it was decided that, since there is now a Portfolio Manager installed, there is no longer a need to establish a collaborative leadership group. Lead a Comprehensive Response to Methamphetamine • Team identified, and now actively recruiting and including it with the alcohol and other drugs (AOD) detox. • Multi-Purpose Residential Hub kaupapa. • Midlands planning - Hamilton, 10 Dec 2018. Suicide Prevention and Postvention. This role has now been filled. Eating disorders The inpatient component of this service has moved from Auckland to Waikato. Issues around costs/funding are presently being sorted.
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Mental Health and Addiction Wash ups • There seems to be a move to dispose of the wash up clause among national DHBs, except within the
Midland region. • Reporting for the Midlands database is developing, giving a good insight into Mental Health services and
activities. Te Kūwatawata There is a risk with the resignation of Dr Kopua as Clinical Lead for the project. We are looking to understand who will be replacing her, and what mitigations have been put in place in the meantime to ensure the continuing success of the project. Health of Older People and Disability Support Services Home and Community Support Services Registration of Interest (ROI). While there was a delay, the tender has now been submitted to GETS. The procurement timeline was updated and the Evaluation Panel members advised. The Project Manager is responding to the recommended actions listed in the Probity Audit review. Advance Care Planning (ACP) • A Level 1 ACP workshop was held in October, and 12 people attended. • A train the trainer workshop was also held in October, with 6 people being trained to provide ACP L1
training. Workshops are being planned for next year. • A national ACP administration training guide has been produced. Whānau Falls Prevention • Sport Gisborne is offering to support the East Coast provider in setting up Strength and Balance
Programmes. • East Coast In-Home Strength and Balance numbers are steady. • Met with the urban strength and balance provider to look at increasing the volumes of those participating
in the In-Home Strength and Balance Programme. It was identified that the problem was that they were not capturing all the people they were providing a service to.
• The number of people referred to the fracture liaison service has slowed. This was checked against the number of people with fragility fractures presenting to the Emergency Department, and the number appears to be correct. The Falls Nurse is now engaging with general practice to determine if any of their patient population is missing out on this service.
Needs Assessment Support Coordination (NASC) • Workload has been high. NASC are not able to meet all MoH timeframes, and referrals are carefully
prioritised. • Some annual reviews are several months overdue due to workload. • Manager is working with inpatient wards to get clinical information from nursing staff rather than OTs, as
OTs are unable to support discharge to permanent aged care facilities. • Manager has met with the new physician/geriatrician.
Population Health October has been a busy month overall, with good systems in place to enable staff to meet the outcomes in the Population Health Plan. These include project planning, identifying the key Medical Officer of Health sponsors across all projects, team lead/s and identifying other team members for input. A regular peer review process is in place to ensure collegial and management input is transparent. This will become evident in future reporting styles, as we further develop the systems and it beds in to business as usual
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Matters of Note for October: • All staff have completed Stage 2 of the Writing Course. • 2 Population Health staff have completed CIMS Level 4 training. • Successful completion of IANZ Accreditation by HPO. • Offer and acceptance of employment for Health Promotion Advisor-Suicide Prevention/Postvention. • Acceptance of 2 presentations for IHUPE International Indigenous Conference Rotorua in April 2019. Tobacco Control Smokefree Outdoor Spaces (draft) policy Empowering community groups such as Taki Tahi Toa Mano (Tairāwhiti Smokefree Coalition) and Ease -Up Sidelines to put forward submissions to council’s Long Term Plan regarding Smokefree Outdoor spaces has finally come to fruition. Council has also agreed to work with Taki Tahi Toa Mano to progress Smokefree CBD once the Smokefree Outdoor Spaces policy has been ratified. Ease up Sidelines Ease up Sidelines steering group is working with Poverty Bay Rugby Union to encourage clubs to review their policies around sideline behaviour. The aim is to see less risky sideline behaviour when the rugby season starts in 2019. Ka Pai Kaiti Trust • Rongomataane (Kaiti community vegetable gardens x 4). Donation of plants and seedlings from various
community groups has been overwhelming, with lots of community interest and volunteer support workers to assist with the preparation of the gardens and planting.
• Waiting for confirmation from Dunblane Retirement Village to proceed with a community garden on site. IUHPE - World Indigenous Health Promotion Conference Rotorua The senior health promotion advisor submitted two abstracts on behalf of Ka Pai Kaiti and the Population Health team and both abstracts have been accepted. Reform of the Residential Tenancies Act 1986 Response provided to the consultation document on behalf of the Population Health/Public Health team. Physical Activity and Nutrition Toi Ora – Healthy Lifestyles and Aē to Wai Project plan peer reviewed and agreed to support and advocate for longer term and ongoing drinking water safety initiatives with iwi, hapū and local stakeholders to develop regular drinking water testing for marae and kohanga reo in our rural communities and their whānau whānui. The two communities for this project are Tokomaru Bay and Te Karaka. Healthy Workplaces • Eastland Group - Presentation of WorkWell completed, and explored the Mates in Tairāwhiti Suicide
Prevention Programme. • Advisor support for Downer Transport has resulted in an increase of information submitted for bronze
accreditation. A request from Downer WorkWell leader to use the WorkWell logo for their touch team uniforms.
• Mental wellbeing initiative at Ovation completed as part of their Bronze Accreditation Action Plan. • Gisborne Tairāwhiti Rugby League to organise promotions of Ease Up Side Lines at the finals of rugby
league.
Mahi Tahi Rangatahi • Youth project plan peer reviewed. The aim is to rekindle the relationship the whakapapa rangatahi have to
our taiao, our whenua, our awa. This will be done by supporting, facilitating and working collaboratively with our two local kura kaupapa Māori through putaiao and hauora classes, introducing the aspects of population health, environmental health, and mental health through a Māori worldview approach.
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• Youth Sexual Health Resource Project Plan peer reviewed. Develop resources that would incorporate a Māori worldview through utilising purakau. Local kaumatua, kuia and other people identified hold a vast amount of knowledge in relation to this kaupapa, and knowledge that is specific to our district and will be incorporated.
Alcohol and Other Drugs (Ease Up Sidelines) YMP Waka Ama. In 2017/18 30 rangatahi were involved in the sport through this club and in 2018/19 season we currently have 42 rangatahi. This year has seen the implementation of a tuakana/teina programme, where the tuakana (J19 girls) are heavily involved in mentoring/training/coaching the younger teams. These tuakana (girls aged between 15-17) are present at all team training sessions in order to develop teina, role model. Sexual and Reproductive Health The health and wellbeing of our whakapapa • Re-establishing and building new relationships with key stakeholders – Qmunity, Family Planning, Hauiti
Hauora, Ngāti Porou Hauora, Te Whaariki Takapou and the Aids Foundation. • Project plan being established that supports places of education in Tairāwhiti to develop a diversity
inclusive policy. • Refreshing the Sexual and Reproductive Health Plan and 2018 Te Tairāwhiti Youth Survey to ensure all
youth activity is informed and includes youth mental health. 2018 Te Tairāwhiti Youth Survey to be presented back to youth by Dec 2018.
Hauora space at local festivals • Aids foundation donated 5000 condoms and 10,000 condom wallets to Hauora Tairāwhiti for upcoming
festivals. • Rhythm and Vines Hauora Village Project Plan approved by Pop Health team. Planning committee for
Hauora village at Rhythm and Vines established, and providing resources and advisory to R&V event manager.
Health Protection • The Water Safety Plan for Te Karaka was resubmitted and approved. • Smokefree education visits were continued in preparation for our CPO in November. • Radiation training was held for the Health Protection team, members of the Gisborne fire service and
visiting Health Protection Officers from Hawkes Bay. • Coordinated Incident Management Systems (CIMS) training was held and attended and completed by 4 Te
Puna Waiora staff. • Planning is in place for Rhythm and Vines response and monitoring. Health Protection staff will monitor
host responsibility (alcohol), drinking water, sanitary service and waste. Alcohol Licensing • Special license for Ormond Community fundraiser fête was opposed, due to Public Health’s outlook on
alcohol in school grounds. View is that schools act as role models for children, families and communities. The application was withdrawn.
• R&V – Public Health have opposed the special licence under Sec 105 (a) of the Sale and Supply of Alcohol Act 2012, and under the Gisborne District Local Alcohol Policy, which states that non-licensed premises will not be issued a Special Licence beyond 2 a.m. Their application is until 5 a.m. on 1 Jan 2019. This will go to a District Licensing Committee hearing on 20 November.
Communicable Disease • Norovirus Type 2 outbreak at Beetham Lifestyle Village. A total of 22 people were infected, including 1
staff member. The outbreak status was lifted 23/10/2018, 48hrs after the last reported case.
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Tairāwhiti Interprofessional Education
Programme
Te Hōtaka Ranga Ngaio-Maha o te Tairāwhiti
Rongopai Marae – Joint noho Marae March 2018
End of Year Report 2018
CE Report Attachment: 27
Tairāwhiti Interprofessional Education Programme 7th Year and End of Year Report 2018
1
Table of Contents 1. EXECUTIVE SUMMARY .......................................................................................................................... 2
2. REVIEW OF BUSINESS CASE AND OBJECTIVES ...................................................................................... 3
a. Focused immediate objectives met in 2018 ................................................................................. 3
b. An evaluation process to assess impact on longer term health objectives .................................. 4
c. Long term Goals and Objectives ................................................................................................... 4
3. IMPLEMENTATION ................................................................................................................................ 5
a. Highlights ...................................................................................................................................... 5
b. Issues ............................................................................................................................................. 6
c. Lessons learnt ............................................................................................................................... 6
4. PLAN FOR 2019 ..................................................................................................................................... 7
Appendix 1: Quantitative TIPE student feedback ......................................................................................... 8
Appendix 2: TIPE Publications in reverse order 2018 – 2012 ....................................................................... 9
28
Tairāwhiti Interprofessional Education Programme 7th Year and End of Year Report 2018
2
1. EXECUTIVE SUMMARY The Tairāwhiti Interprofessional Education Programme (TIPE) has been running successfully for
seven years. A total of 459 students from 11 disciplines have now completed the programme. This
year saw the following significant developments:
During 2018:
The programme hosted 70 students (5 x 5 week blocks over the academic year) during 2018.
However TIPE experienced several last minute issues. In some cases clinical providers were
unexpectedly not able to host students. A small number of student had to withdraw
because of significant personal reasons.
Nineteen students were hosted in Wairoa. This was the 5th year of successfully having
students at Wairoa (85 students over 5 years, 19 in 2018). Optimum number of students per
block at Wairoa continues to be 5
We have included Speech Language Therapy (SLT) Massey University and Para medicine AUT
students in block 5 at Hauora Tairāwhiti and one Para medicine student at Wairoa.
There have been significant local staffing changes. With 11 disciplines now involved with the
programme, and several resignations in the previous year, the staffing model has changed.
The local staffing model now incorporates an Academic Programme Leader, Deputy
Programme Leader (both part time) and a fulltime Programme Administrator based in
Tairāwhiti, with a small part time appointment in Wairoa.
Staff in Tairāwhiti 2018:
Academic programme leader – Dr Patrick McHugh
Deputy Academic programme leader – Natasha Ashworth
Programme administrator – Rose Schwass
Wairoa professional practice fellow (PPF) – Blocks 1, 2 & 4 Sonya Smith; Block 5 – Janie
Thomas
The experience offered by the Interprofessional Programme continues to be unique for the students
and the majority of student feedback is positive about all components of the programme.
The Hauora Māori learning and experience has been a highlight during 2018.
Wairoa is also popular with IPE students. The inclusion of Para medicine and Dental students in
Wairoa during 2018 has given more flexibility for the future.
The Tairāwhiti team continue collaborating with the Whakatane RHIP programme during 2018 with
two joint Noho Marae. The first was organised by TIPE. Students and staff from both programmes
attended a noho marae at Rongopai Marae in March which was reported in the Gisborne Herald. In
early September the Whakatane RHIP programme organised a reciprocal noho marae at Pāhāōa
Marae at Te Kaha.
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Tairāwhiti Interprofessional Education Programme 7th Year and End of Year Report 2018
3
Another 3 years (2019 – 2021) funding from HWNZ has been approved. Contracts have been
organised for both the TIPE and RHIP programmes. The TIPE programme at Tairāwhiti and Wairoa
will continue to follow a similar format during 2019 with 5 blocks of students scheduled, aiming to
host 70-80 students from eleven disciplines over the year.
2. REVIEW OF BUSINESS CASE AND OBJECTIVES
a. Focused immediate objectives met in 2018
Rural immersion for an increased number of students – 459 students over 7 years
Dent Diet Med Nurs Oral Health
OT Pharm Physio Social Work
SLT Para medicine
Total
2018 TIPE student
8 10 14 10 3 5 13 3 0 70
Total TIPE 2012-2018
Tairāwhiti 58 59 65 55 11 15 53 53 2 1 2 374 Wairoa 2 0 21 22 7 7 24 0 1 0 1 85 Total 60 59 86 77 18 22 77 53 3 1 3 459
o 2018 - aimed for and achieved another 70 student placements (including 19 at Wairoa over 4 blocks)
Exposure to interprofessional care, including chronic care management o students from a wide range of different health professional disciplines continue to learn
together and share flatting-style accommodation together o The community education projects (where students work in interprofessional groups)
are a special part of the TIPE programme and offer the students an opportunity to work on and with local community groups
o Students work together in clinical workplaces, in their home disciplines and with each other in an integrated programme of learning
o Changes in several degree curricula and pressure on some clinical providers has put increased challenges on the logistics of meeting the planned student numbers during 2018. Opportunities arose during the year to overcome this challenge by working with two new disciplines. There are ongoing opportunities to continue with both disciplines in 2019.
The first Speech Language Therapy student joined block 5. This addition to TIPE came about as a result of a request to be involved with the programme from Massey University.
Three Para medicine students from AUT joined block 5 in Tairāwhiti and Wairoa. AUT had previously sent students to the Whakatane programme and expressed an interest in also being a part of TIPE.
o Skills and knowledge from Tui Te Ora, Hauora Tairāwhiti have been introduced to improve the learning experience around Chronic Care Management for the students.
o The students continue to consider the interdisciplinary learning from each other and the living together as a highlight and unique aspect of the programme.
Exposure to working with a rural Māori community.
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Tairāwhiti Interprofessional Education Programme 7th Year and End of Year Report 2018
4
Due to unavoidable staff changes, the programme administrator has been able to take the opportunitiy to organise and co-ordinate a refreshed and enhanced multi-faceted programme – all positively acclaimed by successive student groups: o A new Kaumatua was introduced into the TIPE programme to enhance and support the
noho marae, learning around tikanga and support for the poroporoaki. o Every group of students attends a noho marae in the first week of their rotation – the
kaumatua and an experienced hauroa Maori expert continue to enhance the learning on the marae asa significant start to the beginning of each block.
o Students from each block have the opportunity to attend kaumatua days in Tairāwhiti and Wairoa, this gives them the opportunity to meet and discuss with members of the local Māori community and offer health advice
o A Wairua classroom session, an introduction to the Mahi a Atua programme, and opportunity to participate in waka ama on the Wairoa river, teaching sessions about Māori Health Strategy, Māori Health Models, and Whanau Ora, are other important learning activities that further strengthen the focus on tikanga and hauora Māori.
o TIPE students now have the opportunity to join Te Reo classes whilst they are based in Gisborne.
b. An evaluation process to assess impact on longer term health objectives
Qualitative data from Focus Groups
o These were conducted at the end of 4 blocks (2-5) and included a visit by University of
Otago Education Advisor in August who met with and interviewed a sample of clinical
providers in Gisborne. The focus groups provide in depth data to complement the end
of block questionnaire data and continue to be invaluable to continue developing and
fine tuning the programme.
Quantitative data from Questionnaires (see attached Appendix 1)
o The end of block student questionnaire was refined in 2018. Highlights over the six
years from the students’ perspective continue to be :
Overall high satisfaction of the programme and willingness to recommend the
programme to other students
Excellent opportunity for in depth Interprofessional learning, particularly due to
the living together
A highlight in 2018 has been the improvement in meeting the learning
objectives for long term conditions management.
o The Longitudinal study of the 2015 cohort of all eligible students (TIPE and non-TIPE) to
follow the students from 2015 to 2018 was established at the end of 2014 with 587
students from 7 disciplines completing an initial survey (86% response rate). The
students are currently being asked to complete their fifth and final survey. Good
response rates continue to be achieved. The 2016 TIPE students were added to the
study at the beginning of 2016, these students are currently being canvassed for their
fourth survey. There are many challenges keeping the new graduates interested in and
completing the survey each year.
c. Long term Goals and Objectives
The long term goals are:
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Tairāwhiti Interprofessional Education Programme 7th Year and End of Year Report 2018
5
• to increase the number, capacity and geographic spread of rural training opportunities, specifically placements, for health professional students;
• to contribute to the improvement of health practitioner to population ratio in rural areas through improved recruitment and retention; and
• to reduce inequalities in population health status It is difficult methodologically to explicitly link programme outcomes to these overarching long term objectives. However, we are collecting what data is possible:
The Longitudinal study is being conducted as above
The 2012 cohort have completed a follow-up survey with an 84.6% response rate– being 5 years since they attended TIPE. Eight of these students were also part of a qualitative interview. Results from these interviews were presents at the All Together Better Health IX Conference in Auckland in September.
The 2013 cohort completed the ‘5 year on’ survey in 2018. The results from the 2012 and 2013 surveys have been combined as in-depth report. 20 of the respondents indicated they would be happy to be available for an interview. The intention for 2019 is to conduct the interviews of the 2013 cohort and also survey the 2014 cohort.
Efforts to maintain communication with students who have graduated from the IPE Pilot 2012-2014 via the Facebook group is still in place. Students report enjoying hearing about the latest developments in IPE and activities that current students are experiencing
To date, 36 TIPE students have returned to work or take up an internship position in either Gisborne or Wairoa. A lack of available new graduate positions has meant that some students who would have wished to, have been unable to return to the area to work.
3. IMPLEMENTATION
a. Highlights
2018 has been another year of consolidation, but with several new challenges for both
Tairāwhiti and Wairoa.
Student feedback continues to be invaluable to on-going programme development
o Onsite living continues to be a very significant and effective informal teaching
environment.
o In most instances students arrive for TIPE with clear expectations of what the
programme will entail
o The interface between Hauora Māori learning earlier in their respective degree
programmes, and the learning that eventuates from being in the Tairāwhiti region is
valuable for the students
o The warmth of the hospitality and support offered by the Tairāwhiti team continues to
be positively talked about by the students.
o Students thrive on the many local activities they have been involved with throughout
the programme in both Tairāwhiti and Wairoa
A change to payment for DHB departments was implemented to reflect the number of students
hosted and contribution given to the TIPE programme. This has been well received by the
individual departments.
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Tairāwhiti Interprofessional Education Programme 7th Year and End of Year Report 2018
6
The benefit to the local communities of the Community Education Projects continues to be
significant to the point that clinical providers with many projects being successfully used in an
on-going manner by the providers.
The total number of peer reviewed publications reporting results from TIPE is now 2 book
chapters and 9 journal articles. Staff continue to present at conferences in NZ and
internationally and attract considerable interest. Several presentations were particularly well
attended at the international All Together Better Health IX Conference held in Auckland in
September 2018.
b. Issues
TIPE has experienced significantly more challenges balancing the individual requirements of
Clinical Providers, changes to curriculum dates and student availability during 2018.
o Staff changes required new dental clinical providers to be recruited at the beginning of
2018. The programme is grateful to the new practices stepping up at short notice -
there is fine-tuning to be done to ensure that requirements of the practices, students
and patients are all being met.
o Hauora Tairāwhiti Physio department have expressed concern at being overburdened
and reluctant to accommodate as many or any physio students going forward. The
pharmacy department is also currently short staffed. Plans are in place to address these
challenges.
c. Lessons learnt
• 12 students per block and 5 blocks per year continue to be a maximum for Tairāwhiti
• 4 blocks per year of 5 students is ideal for Wairoa, 3 students in Wairoa has been shown to be
too small.
• Increasing the number of disciplines to 11 has allowed more flexibility and inter professional
experiences particularly in Wairoa, however some disciplines are concerned that this is limiting
their students participating in the programme.
• There is an ongoing need to communicate closely and respond to the needs of all the providers,
DHB and communities that the students are hosted within.
• The power of word of mouth feedback from previous IPE students to encourage and inform new
IPE students cannot be overestimated. Word of mouth remains powerful in helping the students
have realistic and accurate expectations of what they can expect from TIPE.
• The scheduling of blocks with clinical placements in the different professional programmes
continues to be complex and time consuming
• Communication between UOW, Tairāwhiti & providers is essential – increased education has
been introduced to help all staff at clinical workplaces understand what they should be doing
when hosting students
• When students had improved information and clearer expectations before attending the
programme their overall satisfaction with the programme was significantly higher, new methods
of doing this are constantly being looked at and developed
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Tairāwhiti Interprofessional Education Programme 7th Year and End of Year Report 2018
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4. PLAN FOR 2019 • Five blocks are scheduled for 2019 – total 70-80 students
o 12 students, total 60 students at Tairāwhiti
o 4 or 5 students at 4 blocks in Wairoa
• Five main disciplines of students continue plus some Occupational Therapy, Oral Health,
Physio, Para medicine, Speech Language Therapy and Social Work students.
• The Tairāwhiti team will look for ways to continue and increase collaboration with the
Whakatane RHIP programme. The 2018 combined noho Maraes has been highly
successful
• Further fine tune programme and balance of components will continue – ensuring
student learning expectations are balanced with meeting the learning outcomes of the
programme
• Continue to ensure benefits to the local community are realized
Teaching staff plan for 2019
• Dr Patrick McHugh has decided to step down as the Programme Leader at the end of
2018. Patrick has been involved with the TIPE as the Academic Programme Leader right
from its inception and has contributed to the programme significantly. We are grateful
to Patrick for giving a substantial amount of notice, which is allowing us to put in place a
seamless succession plan.
• For block 5 and 2019 Sonya Smith is unable to be the Wairoa Professional Practice
Fellow (PPF) due to increased work commitments and her secondment to be Wairoa
Hospital Manager. Janie Thomas a midwife originally from Wairoa was able to take over
the responsibilities of the Wairoa PPF role. It is hoped that she will continue in this role
from 1st February to October 31st in 2019.
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Tairāwhiti Interprofessional Education Programme 7th Year and End of Year Report 2018
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Appendix 1: Quantitative TIPE student feedback
Student end of block feedback – quantitative survey (1 means strongly agree – 5 means strongly disagree) Mean
2018
Average of all blocks 2013-
2018, N=409
3a)I enjoyed taking part in the TIPE programme 1.21 1.28
3b)I would recommend the programme to other students 1.31 1.42
3c)I felt included as part of the Tairawhiti community 1.37 1.38
4d)I have a better understanding of how to incorporate Maori
health and customs into my practice
1.58 1.52
4e)I am more confident that I can provide care to Maori patients 1.59 1.50
4f)a better understanding of the impact of whanau ora on
healthcare provision
1.65 1.57
4g) I have become more confident in practicing in rural
health
1.98 1.59
4i) I have become more knowledgeable about the barriers
to health care in rural areas
1.50 1.38
5a) My skills in communicating with other health and social
care professionals improved through learning with students from
other healthcare professions
1.38 1.48
5b) Learning with students from other healthcare professions
is more beneficial to improving teamwork skills than learning only
with peers
1.36 1.34
CCMa)My collaboration with other disciplines when I organise
care for people with chronic conditions in the future will have
1.82 1.82
N=66
CCMb) My ability to work collaboratively with other disciplines to
organise care for people with chronic conditions
1.73 1.73
N=66
CCMc) My referral habits to other disciplines when planning care
for people with chronic conditions
1.86 1.86
N=66
6a) I had sufficient opportunity to practice my clinical skills 2.19 2.18
6b) The clinical teachers were sensitive and responsive to
patients and their relatives
1.79 1.45
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Tairāwhiti Interprofessional Education Programme 7th Year and End of Year Report 2018
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Appendix 2: TIPE Publications in reverse order 2018 – 2012 Authors Title
PUBLISHED IN PEER REVIEWED JOURNALS, BOOKS
Journal article Gallagher P, McKinlay E, Pullon S, & McHugh P
Student perceptions of cultural immersion during an Interprofessional programme. Journal of Interprofessional Care. 2018 (early on line) 10.1080/13561820.2018.1538105
Book Chapter Pullon S, Darlow B, McKinlay E.
Building evaluation into the development of IPE initiatives. Chapter 8. In; (eds) Dawn Forman, Marion Jones and Jill Thistlethwaite, Leading Research and Evaluation in Interprofessional Education and Collaborative Practice. 2016 DOI 10.1057/978-1-137-53744-7_8 Palgrave McMillan pp.145-166
Case Study in Book Chapter
Pullon S, McKinlay E, Gallagher P, Gray L, Skinner M, McHugh P.
Interprofessional education in a rural clinical setting: a quick start innovation for final year health professional students – case study. Chapter 14. In Harden, R (ed) Routledge International Handbook of Medical Education. Edited by Khalid Bin Abdulrahman, Ronald Harden, Stewart Mennin. Aug, 2015. 978-0-415-81573-4
Journal Article Pelham K, Skinner M, McHugh P, Pullon S
Interprofessional education in a rural community: the perspectives of the community workplace providers. Journal of Primary Health Care 2016; 8(3): 210-219
Journal Article McKinlay E, Gallagher P, Wilson C, Gray L, McHugh P, Pullon S
Social learning, shared accommodation and interprofessional education: ‘I think those conversations that you have at the dinner table …’ Journal of Interprofessional Education and Practice. 2016; 5:1-6
Journal Article Pullon S, Wilson C, Gallagher P, Skinner M, McKinlay E, Gray L, McHugh P
Transition to practice: can rural interprofessional education make a difference? A cohort study. BMC Medical Education 2016; 16:154. DOI 10.1186/s12909-016-0674-5
Journal Article Crawford R, Gallagher P, McKinlay E, Harding T, Pullon S
Interprofessional undergraduate students talk about nurses and nursing: A qualitative study. Nurse Education Today 2016; 39:7-11 doi: 10.1016/j.nedt.2015.12.021. Early on line 27.1.16
Journal Article Foster-Page L, Gray L, Gallagher P, McKinlay E, Rich A.
Untangling the web of influences of Dental Students participation in Interprofessional Programmes. Journal of Dental Education June 2016 DOI 10.1016/j.xjep.2016.07.001
Journal Article McKinlay EM, Gallagher PA, Gray LA, Wilson CL, Pullon SRH
Sixteen Months “From square one”: the process of forming an interprofessional clinical teaching team. Journal of Research in Interprofessional Practice and Education, 2015.5(2)
Journal Article Gallagher P, Pullon S, Skinner M, McHugh P, McKinlay E, Gray L.
An interprofessional community education project as a socially accountable assessment. Journal of Interprofessional Care. Jan, 2015. DOI:10.3109/13561820.2015.1004040
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Hauora Tairāwhiti Board
Title: SUMMARY FINANCIAL REPORT
Prepared By: Craig Green, GM Finance
Date: Friday, 9 November 2018
Information Item
1. GM FINANCE COMMENTSFinancial Performance Result and Overview The DHB has a Board approved $9.5 million deficit budget for the 2018/19 financial year. The DHB result for the period ending 31 October 2018 is $322k favourable to budget with a deficit of $554k for the month.
For the month, the: • Provider Arm is $ 98k favourable • Funder Arm is $249k favourable, and • Governance Arm is $ 25k adverse
Provider Arm: For the month, the Provider Arm’s favourable variance of $98k driven by: • Revenue: $81k favourable for the month (patient transport/accommodation $65k and cervical screening
$22k) • Expenditure: $17k favourable. Key variances:
o Personnel costs: $238k favourable o Outsourced Services: $95k adverse (Medical personnel adverse $102k)o Clinical Supplies: $175k adverse (Implants/Prosthesis $33k adverse; Pharms $59k
Air Ambulance $49k, Patient Transport & Lodging $16k)
Funder Arm: For the month, the Funder Arm’s favourable variance of $249k driven by: • Revenue: $440k favourable; MoH subcontracts $414k, ACC $24k• Expenditure: $192k adverse; driven by:
o Personal Health: $183k adverse; IDF Outflows $143k, Child protection $19k, price adjusters $131koffset by favourable spend Travel/Accommodation $43k, Primary Care $14k, rural support $20kTravel & Accommodation $143k
o Mental Health: $33k unfavourable; kaupapa Māori $61k offset by minor mental healthexpenditure $38k
2. CONSOLIDATED FINANCIAL PERFORMANCE SUMMARY
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3. STATEMENT OF FINANCIAL PERFORMANCE – CONSOLIDATED
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4. FINANCIAL POSITION - SUMMARY The financial position as at October 2018 is below. This indicates a weak balance sheet, with $17.3m in negative working capital and a net worth of $46.6m.
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5. CASH FLOW POSITION
Cash Position The cash balance was in debit by $3,625k with the DHB pool at month end; being $644k adverse to forecast debit balance of $4,268k. Operating cash was $2,108k favourable to forecast; Investing in capital equipment $75k adverse to budget and Financing in-line with expectations. The DHBs swift balance debit highpoint was 31 October 2018, at $3,625k.
Inwards: Inward cash was $1,821k favourable to forecast, 2017/18 Quarter 4 Elective and Ambulatory Initiative $1,254k, $205k favourable in Pharmac rebate; $247k favourable in MoH side contracts.
Outwards: Operating Cash outflow favourable $282k to forecast; with lower than expected payroll costs $326k, IDFs of $338k, GST of $42k offset by payments to suppliers of $382k and non-DHB providers $37k.
Capital Expenditure: $75k adverse to budget.
Outlook: Closing cash projected $3,846k cash negative in November; net cash expected to be $222k negative.
6. CAPITAL EXPENDITURE (CAPEX) Depreciation funded capital expenditure planned for the 2018/19 year is $2.821m. The table below summarises performance against budget (depreciation funded and Carry Forward from prior year) for the month and year-to-date.
A total of $317k spent on CAPEX during the month of October 2018 and is favourable year-to-date to the revised linear budget by $115k.
Actual Budget Var Actual Budget VarOpening cash (4,000) (2,611) (1,389) (1,597) (1,597) 0Operating 694 (1,414) 2,108 (330) (1,049) 719Investing (318) (243) (75) (1,698) (1,623) (75)Financing 0 0 0 0 0 0Closing cash (3,625) (4,268) 644 (3,625) (4,268) 644Closing cash Balance in NZHP Swift account (3,625) (3,625)
$'000s Month YTD
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7. PERFORMANCE GRAPHS
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Hauora Tairāwhiti Board Sub-Committee Reports
AGENDA ITEM
AGED & DISABILITY SUPPORT ADVISORY COMMITTEE
Open Forum meeting – no decision items
COMMUNITY & PUBLIC HEALTH ADVISORY COMMITTEE
Open Forum meeting – no decision items
HOSPITAL ADVISORY COMMITTEE 20.11.18
No public included decision items.
FINANCE, AUDIT & IT COMMITTEE 20.11.18
No public included decision items.
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Information Item
EXECUTIVE SUMMARY Hauora Tairāwhiti wishes to develop quality and safety within the organisation and promote a culture of openness and fairness for staff. There are acknowledged issues with inappropriate behaviour some of which may be considered bullying in the organisation, and clear opportunities for further improvements in quality of care and esprit de corps.
The Cognitive Institute programmes of Speaking up for Safety (SUFS) and the Promoting Professional Accountability programme (PPA) are designed to support delivery of the improvements sought at Hauora Tairāwhiti. As well regarded and already instituted programmes in Aotearoa, Hauora Tairāwhiti, in conjunction with site unions and staff, institutes the programmes, are introducing the Institute’s programmes of SUFS and PPA commencing early 2019. More information on the SUFS and PPA programmes is attached.
BACKGROUND Inappropriate behaviour, bullying, and harassment are endemic in health services in Aotearoa and internationally. There is a dynamic in the way people work, the demands of roles and the historical tolerance of poor behaviour that has created a culture that is counter-productive to the working environment, contributes to distress at work, increases sick leave and, most importantly, leads to poor outcomes in care.
At Hauora Tairāwhiti the recent ASMS Survey of their members identified bullying as a significant factor in the work life of Senior Medical Staff, most often between medical staff. The bi-annual staff engagement survey consistently shows bullying to be a behaviour staff want more action on to eliminate. Although attention has been applied to this through the development and promulgation of our WAKA values, training in the control of bullying, including policy review and a no tolerance approach, the problem still features.
Meanwhile, there are reported and anecdotal stories of missed opportunities for early intervention or prevention of incidents that affect care or the operation of services through staff not speaking up. There is a competency and then a feeling of safety required for staff to consistently look for opportunities to make improvements and the license to identify and report when circumstances are, or could, lead to poor outcomes. Even without the issue of bullying there is consistent evidence that continuing to develop a safe and just culture environment for staff to report brings benefits in outcomes for people, an improved working environment and improved productivity.
Hauora Tairāwhiti has already invested time, energy and resources in these over the years. Key in these has been our development and use of the WAKA values and these must remain the cornerstone of our culture as an organisation.
Hauora Tairāwhiti BoardTitle: Speaking Up For Safety and the Promoting Professional Accountability
Programme
Prepared By: Jenny Roy, People & Development
Date: Tuesday, 20 November 2018
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The Cognitive Institute’s programmes, in particular Speaking Up for Safety, will contribute to underpinning the WAKA values - everyone is in the WAKA together operating in a spirit of support and togetherness to enrich the experience for staff and patients alike. The Cognitive Institute’s programmes is comprehensive, co-ordinated, well researched, has been implemented in Aotearoa and Australia, is supported by health unions and provides for involvement of all staff, with a single mode of application regardless of the part of the organisation or the employee. Outcomes: Over the three years of the programme, building on immediate benefits to be realised in improved quality of service delivery from the SUFS component, it is expected the following benefits will accrue:
• Improvements in indices of outcomes for people receiving care e.g. infection rates, falls, returns to theatre
• Improved staff satisfaction • Lowered rates of sick leave • Reduced investigation and disciplinary action on inert-staff disputes • Improved productivity • Cost savings to cover the cost of the programme
Programme Costs The cost of both programme components is approximately AUD $94,750 plus additional costs related to travel, food, releasing staff etc. Since the programme is not commencing until 2019, the expenditure will be spread across at least the 2018/19 and 2019/20 years. Promoting Professional Accountability Programme – Board’s Commitment The programme’s success is dependent on the commitment from the whole organisation – from Board down – to the programme, as well as the joint commitment of the site unions, to supplement managements activities in securing engagement and buy-in from staff. Cognitive Institute will present the briefing on professional accountability (PPA) and its impact on a culture of safety and patient outcomes to the Board on the 18th of February at which time they will outline the role of the Board to a ‘no blink’ commitment required for success of the programme. The dates set aside for this is the 18th February directly after the Hospital Advisory Committee meeting. Board members not on HAC are being asked to commit their time to attending that session as well.
RECOMMENDATIONS That the following recommendations are adopted: 1. Note the information 2. That the Board gives their commitment to attend the PPA briefing with Dr O’Brien (Cognitive Institute)
on 18 February (commencing as an adjunct to the HAC meeting).
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Hauora Tairāwhiti BoardTitle: Hauora Tairāwhiti (draft) Plastic Free Strategy
Prepared By: H. Barber GMIS
Date: Tuesday, 13 November 2018
Decision Item
BACKGROUND
The effects and problems associated with plastic waste and the environment are now well established and documented.
Hauora Tairāwhiti as a large service industry organisation produces a large volume of plastic waste, and while there is some effort to recycling of this waste, with the recent exit of major recyclers, China in particular, the ability to have the plastic re-cycled is decreasing. Recycling, however, does not remove plastic from the environment, and in order to achieve this removal, other measures are required.
PROPOSAL
The volume of plastic waste Hauora Tairāwhiti produces is related to the volume of these items we acquire either as part of a purchase, or supplied as an incidental with goods and services delivered by third party providers.
It is suggested that Hauora Tairāwhiti cannot operate in an environmental vacuum, and that, as part of the wider concept of Health, Hauora Tairāwhiti should formally adopt a “plastic free” strategy and progress this with specific, measurable and reportable activities to reduce our level of plastic waste.
While there is no documented volume of all the plastic waste produced by Hauora Tairāwhiti, it is large and encompasses a wide variety of items. A quick scan through any department or office will quickly build a surprisingly long list. While some items are short life single use disposables (e.g. plastic cutlery, waste bags, food containers, and medical disposables) others are items with much longer “lives” (e.g. computers, chairs, office equipment).
Any strategy to meaningfully reduce the volume Hauora Tairāwhiti produces will require implementing changes to either replace items with non-plastic alternatives, or where there is no alternative, reduce the volume used through a change in workflow processes and practises. The arrangements will be different depending upon the item, its necessity, and its alternatives.
Effecting these changes will require a range of activities including but not limited to; changes to local policy and practises; incorporation of “plastic free” into supply agreements and purchasing decisions; and making changes to workflows and practises and procedures where plastic items are currently in use. To be most effective, these considerations and actions should be implemented at all levels in the organisation (and not simplistically the obligation of Purchasing), and they would need to become an ingrained part of normal everyday considerations and practise.
Different items will be subject to different methods of reduction. Variation in effort and duration will be required. It is suggested that the strategy can be graduated, with a number of “quick wins” changes that
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could be implemented almost immediately commencing an early effective decrease of the volume of plastic waste while the more complex changes are worked up. It is noted that while in some cases the efforts and costs associated with plastic waste reduction will be negligible, the adoption of a “plastic free” strategy will engender cost and effort. It is suggested that this cost and effort however should be viewed in the larger framework of environmental health at local, national and global level rather than a narrowly focussed organisational level.
RECOMMENDATIONS
That the Board adopt the following recommendations: 1. That the draft Strategy attached is reviewed and either approved if appropriate or feedback provided
to enable finalisation. 2. That subsequent to the Board adoption of the Strategy, management implement measures and
activities to see it successfully implemented, including formal reporting of appropriate measures and progress to the Board.
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Hauora Tairāwhiti Plastic Free Strategy Version 1.0 Oct 2018 HP Barber GMIS.
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Rationale Many of the effects and problems associated with plastic waste and the impact on the environment are now well established and documented. Outside of these there remain as yet unknown and unquantified negative impacts on the environment from the growing amounts of plastic waste. As an organisation recognising the influence of the environment on Health, Hauora Tairāwhiti should make material efforts to contribute to a decrease in plastic waste. Hauora Tairāwhiti produces a large volume of plastic waste, and while there has been some historical effort to recycling of this waste, with the recent exit of major recyclers, China in particular, the ability to have the plastic re-cycled is decreasing. Moreover, recycling does not remove plastic from the environment but rather redistributes it. In order to achieve removal measures other than recycling are required.
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A “Plastic Free” Strategy Goal By and large plastic enters the organisation either as specific items purchased for use, or as an accompaniment of other items. Many items are totally comprised of plastic, while others contain plastic componentry. Plastic as an accompanying item in the form of packaging represent a significant volume. In order to decrease the volume, a variety of measures will need to be utilised. While a numeric goal such as “reduction of plastic waste by 10% per annum” is easily stated, it perforce implies a system of measurement, both of a starting point and at subsequent waypoints. It focuses on quantifying the bottom line rather than addressing the inputs which create the bottom line. An optional goal, and one aligning to continuous quality improvement ethos would be “Hauora Tairāwhiti will continually reduce the amount of plastic we use or receive”. This goal puts the onus of activity (and thinking) on decreasing the amount of plastic flowing into the organisation, and leaving the bottom line simply as a result by which our success is measured. It also engenders an ongoing process as opposed to a time bound initiative, and should help realise a change in behaviour and thinking.
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Structure and Processes In order to implement and progress the Strategy, a small group will be formed comprising those with an interest and/or involvement in the various processes and procedures which include dealing with plastic. This will include representation from:
• Product Evaluation • Purchasing • Supplier management • Communications • Senior Management
Activity will include:
• The drafting of a Plastic Free Policy • A stocktake of plastic within the organisation • Plans for early interventions and activities • Staff engagement and Communications • Development of longer terms plans as understanding develops
Plastic Free Policy A Plastic Free Policy will need to be formulated and approved through normal processes. Steps to reduce plastic may involve relationship arrangements with third party suppliers; material costs; political issues etc. Ensuring a comprehensive policy that encompasses all these aspects of reducing plastic will be important to operationalise the Strategy. Stocktake An initial stocktake to identify the type and volume of plastic entering the organisation will be completed. The stocktake will seek to answer such questions as the following:
• What are the items? • Where do they come from? • How do they get into the organisation – direct purchase? incidental? • What is its need? • Is there an alternative product?
Plans for Early Interventions From the Stocktake plans would be formulated identifying actions that could be taken immediately and with immediate effect. These will be important to show commitment and intent, and demonstrate achievability and success. Plans and activities for decreasing the plastic inflow would be prepared and submitted to Te Kāhui Whakahaere for review and approval, with recognition that some plans and activities, due either to their implications, may need to be considered by the Board. Staff Engagement and Communications While a measure of success may be gained through simple directives, wider and deeper success will be gained through attitudinal and behavioural change – particular if the Strategy is to have a multiplying effect
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outside of the organisation. Ensuring buy-in and commitment from staff will require understanding of the Strategy and its purpose, and generating enthusiasm for its prosecution. The organisation will need to demonstrate the commitment it is making, and it should be visible not only within the walls of the organisation, but to all our health partners, suppliers, and the Public. An Engagement & Communications Plan will be an important and integral part of the Strategy. Longer Term Plans The development and implementation of the early plans and their outcomes will inform the medium and longer term activities needed to address the more complex issues. As we become more conversant with the issues around reducing plastic we expect to be able to bring more influence to bear on a wider scope.
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