auckland district health board hospital advisory …...2011/02/02 · auckland district health...

Auckland District Health Board

Hospital Advisory Committee Meeting

Wednesday 2 February 2011

10.45am

A+ Trust Room

Clinical Education Centre

Level 5

Auckland City Hospital, Grafton

Hei Oranga Tika Mo Te Iti Me Te Rahi Healthy Communities, Quality Healthcare

Hospital Advisory Committee

For discussion with Board

HAC Meeting Date:

Feedback By:

DAP

RECOMMENDATIONS

1.

2.

NOTING

1.

2.

KPIs

RECOMMENDATIONS

1.

2.

NOTING

1.

2.

RISKS

RECOMMENDATIONS

1.

2.

NOTING

1.

2.

3.

4.


A c t i o n P o i n t s

MEETING DETAILS

Date and Time

Item Detail Responsibility Action

xx

xx

xx

xx

1

ATTENDANCE AND APOLOGIES

1

2

CONFLICTS OF INTEREST

3

Conf l ic ts o f In terest Quick Reference Guide

Under the NZ Public Health and Disability Act Board members must disclose all interests, and the full nature of the interest, as soon as practicable after the relevant facts come to his or her knowledge. An “interest” can include, but is not limited to:

Being a party to, or deriving a financial benefit from, a transaction. Having a financial interest in another party to a transaction. Being a director, member, official, partner or trustee of another party to a transaction or a

person who will or may derive a financial benefit from it. Being the parent, child, spouse or partner of another person or party who will or may derive a

financial benefit from the transaction. Being otherwise directly or indirectly interested in the transaction.

If the interest is so remote or insignificant that it cannot reasonably be regarded as likely to influence the Board member in carrying out duties under the Act then he or she may not be “interested in the transaction”. The Board should generally make this decision, not the individual concerned. Gifts and offers of hospitality or sponsorship could be perceived as influencing your activities as a Board member and are unlikely to be appropriate in any circumstances.

When a disclosure is made the Board member concerned must not take part in any deliberation or decision of the Board relating to the transaction, or be included in any quorum or decision, or sign any documents related to the transaction.

The disclosure must be recorded in the minutes of the next meeting and entered into the interests register.

The member can take part in deliberations (but not any decision) of the Board in relation to the transaction if the majority of other members of the Board permit the member to do so.

If this occurs, the minutes of the meeting must record the permission given and the majority’s reasons for doing so, along with what the member said during any deliberation of the Board relating to the transaction concerned.

IMPORTANT If in doubt – declare. Ensure the full nature of the interest is disclosed, not just the existence of the interest. This sheet provides summary information only - refer to clause 36, schedule 3 of the New Zealand Public Health and Disability Act 2000 and the Crown Entities Act 2004 for further information (available at www.legisaltion.govt.nz) and “Managing Conflicts of Interest – Guidance for Public Entities” (www.oag.govt.nz ).

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http://www.legisaltion.govt.nz/�

http://www.oag.govt.nz/�

Date: 26/01/2011

2.0 Board and Committee Interests Schedule HAC.doc Page 1 of 5

ADHB BOARD AND COMMITTEE (HAC) INTERESTS REGISTER

NAME OF BOARD

MEMBER ORGANISATION ROLE FINANCIAL

INTEREST NATURE OF INTEREST DATE OF LATEST

DISCLOSURE

Lester LEVY (Chair) 1. University of Auckland Business School

2. New Zealand Leadership Institute

3. Health Benefits Limited

4. Tonkin & Taylor

Professor of Leadership Chief Executive Deputy Chair Independent Chairman

28 October 2010

Jo AGNEW 1. Senior Lecturer Nursing, Auckland University

2. Casual Staff Nurse ADHB

Salary

Salary

21 April 2010

Peter AITKEN 1. Pharmacist

2. Pharmacy Care Systems Ltd

Pharmacy Locum

Shareholder/Director, Consultant

Hourly Fee

Medical Centre development and pharmacy lease

10 December 2010

Judith BASSETT 1. Nil 9 December 2010

7

Date: 26/01/2011

R

NAME OF BOARD

MEMBER ORGANISATION OLE FINANCIAL


DISCLOSURE

Susan BUCKLAND 1. Writing, editing and public relations services

2. Medical Council of NZ

3. Occupational Therapy Board

Self-employed

Professional Conduct Committee member

Professional Conduct Committee member

Fees

Hourly fee

Hourly fee

Writer, editor and public relations services

Lay member of PCC set up to hear complaints brought to Medical Council and to determine outcomes

Lay member of PCC to assess complaints and determine outcomes

7 August 2009

Dr Chris CHAMBERS 1. Employee, Auckland District Health Board

2. Wife employed by Starship Trauma Service

3. Clinical Senior Lecturer in Anaesthesia Auckland Clinical School

4. Associate, Epsom Anaesthetic Group

5. Member, ASMS

6. Shareholder, Ormiston Surgical

7. Surveyor Quality Healthcare NZ

12 December 2010

8

Date: 26/01/2011

R

NAME OF BOARD



DISCLOSURE

Rob COOPER 1. Ngati Hine Health Trust

2. James Henare Research Centre, University of Auckland

3. Whanau Ora Governance Group

4. National Health Board

5. Waitemata District Health Board

Chief Executive

Board Member

Chair

Member

Member

Salary

No fee

Fee (to Ngati Hine Health Trust



Management of a Health, Disabilities, Social & Education Services Trust

Advisory

Assists in the development of Government’s Whanau Ora policy

25 February 2011

Lee MATHIAS 1. Lee Mathias Limited

2. Iris Limited

3. Midwifery and Maternity Providers Organisation Limited

4. Pictor Limited

5. John Seabrook Holdings Limited

Managing Director

Director

Director

Shareholder, Director

Director

Governance Advisor

Fee

Fee

Fee paid to Lee Mathias Limited

Fee

No fee

Fee

Shareholder, director, independent directorships and healthcare services consulting

Director, company provides services to people with multiple physical disabilities especially

cerebral Palsy

Provider of business and professional services to

midwives and other maternity services providers

Biotech start-up focussing on diagnostic products

Estate of late husband

Provider of early childhood education services contracted to

13 December 2010

9

Date: 26/01/2011

6. AuPairlink Limited

7. NZ Midwifery Council

Council member

Fee

the MoE. Statutory Authroity

Robyn NORTHEY Self employed Contractor

Hope Foundation

Project management, service review, planning etc.

Board member

Fee

Nil

Some clients are contractors to ADHB

Research and Education into Aging in NZ, Deliver Seminars and awards scholarships

16 December 2010

Gwen TEPANIA-PALMER

1.

Ian WARD 1. Chair, Advisory Board, Healthvision Limited

2. Principal/Director C -4 Consulting Limited

Fee

Tender to National Shared Services

3 February 2010

Anne KOLBE 1. Private Paediatric Surgical Practice

2. Employee Communio NZ

3. Siggins Miller, Australia

4. Head, Auckland Clinical School, School of Medicine, University of Auckland

5. Husband: Employee University of Auckland

6. Risk and Audit Committee Whanganui District Health Board

7. Pharmac Board

8. South Island Neurosurgical Services Expert Panel

Director

Senior Consultant

Senior Consultant

Employee

Member

Member

Chair

Joint Owner

Contractor

Contractor

Salary

Fee

Fee

Fee

4 August 2010

10

Date: 26/01/2011

2.0 Board and Committee Interests Schedule HAC.doc Page 5 of 5

R

NAME OF BOARD



DISCLOSURE

Iain MARTIN 1. University of Auckland

2. Chair Peri-Operative Mortality Review Committee

Employee Salary 5 May 2010

11

3

CONFIRMATION OF MINUTES

- THURSDAY 2 DECEMBER 2010

13


M i n u t e s

MEETING DETAILS

Time and Date 10:45am, Wednesday, 2 December 2010

Venue Board Room, Level 5, Administration Suite, Auckland City Hospital, Grafton

1 ATTENDANCE AND APOLOGIES

The Chair declared the meeting open at 10:46am.

Committee Members

Dr Chris Chambers (Chair) Jo Agnew Susan Buckland Rob Cooper Dr Brian Fergus Dr Ian Scott Pat Snedden Rt Hon Bob Tizard Associate Professor Anne Kolbe Professor Iain Martin Farida Sultana Lynda Williams

In Attendance

Judith Bassett – New Board Member Robyn Northey – New Board Member

Management in Attendance

Garry Smith –Chief Executive Dr Denis Jury – Chief Planning & Funding Officer Dr Margaret Wilsher – Chief Medical Officer Brent Wiseman – Chief Financial Officer Greg Balla – Director Performance and Innovation Dr Clive Bensemann – Director of Mental Health Services Ngaire Buchanan – General Manager Operations Taima Campbell – Executive Director Nursing Margaret Dotchin - Nurse Director Fionnagh Dougan - GM Mental Health, Ambulatory, Cancer & Blood Services Paul Green – Manager Materials Management Janice Mueller – Director Allied Health Vivienne Rawlings – General Manager Human Resources Aroha Haggie –Maori Health Gains Manager Anna Schofield – Nurse Leader Mental Health Dr Barry Snow - Medical Director Adult Healthcare Service Group Ian Bell - Board Administrator

Apologies

Apologies had been received from Harry Burkhardt, Seiuli Dr Juliet Walker, Richard Aickin and Kay Hyman. An apology for lateness was recorded for Iain Martin.

Moved Chris Chambers; seconded Jo Agnew

That the apologies be sustained.

Carried

15

2 CONFLICTS OF INTEREST

There were no declarations of conflicts of interest for any item on the agenda.

3 CONFIRMATION OF MINUTES 3 NOVEMBER 2010

Moved Jo Agnew, seconded Lynda Williams

That the minutes of the Hospital Advisory Committee meeting held on 3 November 2010 be confirmed as a true and correct record.

Carried

There had been a joint meeting with Waitemata of CEOs, CMOs, CFOs, Margaret Dotchin and their COO seeking confirmation of elective volumes and to address the under purchase of acutes and non DRGs without wash-ups. The new reporting system had identified the top 3 and bottom 3 variations to plan however Waitemata were unprepared to talk at the detailed level. Discussions focused on patient referrals and care plans with the financials automatically following. Their CMO and Deputy CEO were charged with IDF management. ADHB had asked for an answer for the Board meeting today however no response had been received.

Iain Martin joined the meeting at 10:58am.

The data is generated nationally from one source. They had acknowledged the budgeting error for acutes that was $8m for the year and year to date $1.8m.

The Committee was yet to receive a report on how Counties Manukau is servicing ADHB’s population in relation to plastic surgery.

7.1 Reducing the Wait for Radiation Therapy

Fionnagh Dougan and the Clinical Director, Andrew Macann were in attendance and presented to the Committee providing a background and what the four week target meant.(Being from the decision to treat to treatment within 28 days). In 2007 there were 13 weeks waiting time and patients going to Australia with a number of equipment breakdowns. There had been a treatment planning improvement project to reduce planning by 7 days and the employment of an improvement specialist to analyse data and look at systems and processes. Two linear accelerators have been replaced to get more capacity and with recruitment (at the moment being fully staffed) and staff working more flexibly wait times have reduced. A capacity modelling tool was being used and the radiation oncologists were looking at clinical practice. The peaks in day stay have been moved and there were improved reporting systems which has result in a waiting time of 4 weeks now. There is support of colleagues in other DHBs and the private provider AOR was very flexible.

The team was congratulated on the results.

The high dose brachytherapy will be commissioned next year and needs a bunker which may initially be shared. More work needs to be done on tumour streams.

5.1 Operational Summary Report and Financials

The internal allocations from the Funder were favourable this month although not year to date. Elective services were unfavourable although there were a number of initiatives being undertaken and Greenlane coming on stream will make a difference so if there are delays in opening the facility this would increase stress on the organisation. A change in working day expectations has been implemented so that an undertaking that if a list is agreed it will be finished that day and this will be formally documented. Employee costs and FTE are favourable.

Better, Sooner, More Convenient was aimed at reducing acute demand growth which was a worldwide phenomenon. The stay in ED had been reduced by 26% and there had been a launch of a series of excellence programmes in ED. Patient flows in the hospital had improved so now the focus was on ED.

16

Pharmac are to become involved with the acquisition of devices and are in discussion with Health Benefits Limited about who would drive the contracts for those that are high volume with Pharmac handling other devices i.e., drug eluting stents. ADH, as a high end user, was keeping a watching brief and having a meeting with the Pharmac after Christmas.

Electives were 190 down. In the future suspensions for strike action would be commenced earlier. Production reporting was being revisited with comparative data used through the Health Roundtable with a mix of generic and specific measures. Treatment costs as a percentage of revenue reflected the budget based on reduced outsourcing and efficiency gains but there had still been considerable outsourcing. There had been higher use of ICDs and pacers in Cardiac and the clinical practice was being reviewed to see whether there had been a change in practice or whether this was a one-off. The Pain Service attempted to balance demand with ACC revenue but had had to do more public patients.

5.2 Operational Indicators Exception Report

There was a degree of variability on the access rate to Mental Health Services with Maori following the same trend. There was a kaupapa Maori service and overall access for Maori was above target. There was better staffing in community facilities and occupation at Te Whetu Tawera had dropped to 90% earlier in the year but was now up to 100% capacity. The data for Maori and Pacific Island KPIs was work in progress and the Cardiac presentation to the Maori Health Advisory Committee would go to the Steering Group. It was commented that people were advising that they were getting better access to treatment for strokes.

9 GENERAL BUSINESS

South Island Neurological Services

The changes in services in the South Island were noted with the question being whether there were any learning’s for ADHB.

Coroner

The Coroner addressing Mental Health deaths had been proactive with the press and not allowed name suppression for staff with findings critical of some aspects of care given but acknowledging that changes had been made.

NEXT MEETING

The meeting closed at 10:58 am

The next meeting is scheduled for 10:45am, Wednesday, 2 February 2011 A+ Trust Room Clinical Education Centre Level 5, Auckland City Hospital Grafton

CONFIRMED

CHAIR: DATE:

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4

ACTION POINTS

THURSDAY 2 DECEMBER 2010

19

Hospital Advisory Committee Action Points from the meeting on Thursday 2 December 2010

Item Detail Designated Action

3 Plastic Surgery: Report on how CM is servicing ADHB’s population Denis Jury Andrew Coe

21

5

OPERATIONAL

PERFORMANCE

5.1 OPERATIONAL SUMMARY REPORT

5.2 OPERATIONAL INDICATORS - EXCEPTION REPORT

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5.1 Summary Repor t

Overall Performance for the Month Summary of Provider Results ($000)

Actual Budget Variance Actual Budget Variance

Operational ( 68,842) ( 66,077) 2,764U ( 391,025) ( 384,760) 6,265U

( 366) 431U ( 91) 812U

( 4,282) ( 8,101) ( 3,407) 6,164U

Complementary 66 721

Functional 64,926 57,911 7,015F 387,710 386,796 914F

Ancilliary 64,560 57,976 6,583F 387,619 387,517 102F

Provider Net Surplus/(Deficit) 3,819F 2,757

$,000'sMonth YTD

In the table above we have set out the summary results of various sections which make up the Provider. Under the Functional heading are included areas, such as Finance, HR and IS which support the operational areas. Under the complementary heading are included areas such as Public Health, A+ Trust, Research and our Retail businesses. While the majority of variances at the total Provider Arm level are the same as at an operational level there are some key variances, such as the changes in the value of interest rate swap instruments and allowances for volume coding lag which are included in the ‘Provider’ section of Finance reports. With effect from 1 July 2010, MOH base contract income (Price Volume Schedule income) for both the ADHB population and IDF Funders is now held under Functional, and is not reported as it was formerly within the Operational group of services.

2

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5.1.1 PROVIDER OPERATING STATEMENT ProviderOperating Statement - Dec 2010 Actual Budget Variance Actual Budget Variance

Total IncomeInternal Allocations - Ex Funder 87,018 78,502 8,516F 512,579 510,371 2,208FMOH - Funding Subcontracts 2,662 2,994 332U 2,716U

229U

251U

134U

103U

2,122U 644U

2,378U 11,006U

34U 2,312U

433U

9U 9U

0U 0U

332U

4,898U 13,835U

8,791U

(4,282) (8,101) (3,407) 6,164U

15,074 17,790 Other Patient Care Revenue 2,904 2,721 183F 18,132 16,259 1,873F

Sales of Services & Products 4,327 4,556 27,451 26,845 606F

Clinical Training & Education Income 1,913 1,778 135F 9,775 10,026

Trust & Donation Income 294 428 3,678 2,606 1,072F

Financial Income 116 219 4,373 2,313 2,061F

Other Income 660 599 61F 3,289 3,193 96F

Profit on Disposal of Fixed Assets 38 0 38F 97 1 96F

Total Income 99,932 91,796 8,135F 594,448 589,404 5,044F

Operating Expenditure

Employee Costs 65,905 63,783 368,149 367,505

Direct Treatment Costs 20,108 17,731 117,295 106,289

Indirect Treatment Costs 3,290 3,256 21,800 19,488

Property, Equipment & Transportation Costs 4,014 4,090 76F 24,520 24,955 435F

Administration Costs 1,613 1,180 9,270 9,304 34F

Maintenance Programme 143 133 809 800

Indirect Service Billing 482 482 2,893 2,892

Loss on Sale of Fixed Assets ‐ 1 1F 341 8

Total Operating Expenditure 95,555 90,657 545,077 531,242

Operating Surplus/(Deficit) 4,377 1,139 3,237F 49,372 58,162

Non‐Operating Expenditure

Capital Charge 2,851 3,015 164F 17,223 18,164 941F

Depreciation 4,303 4,539 235F 26,236 27,150 914F

Finance Costs 1,504 1,687 183F 9,319 10,091 772F

Total :Non-Operating Expenditure 8,658 9,240 582F 52,778 55,405 2,627F

Total Surplus/(Deficit) 3,819F 2,757

Month Year to Date

Key variances (> $250,000) for December 2010 for the Provider were:- Month YTD Income $000 $000 1 Internal Allocations 8,516 F 2,208 F 2 MoH Subcontracts (332) U (2,716) U Costs 3 Employee Costs (2,122) U (644) U Direct Treatment Costs (2,378) U (11,006) U 4 Administration Costs (433) U 34 F 5 Non Operating Costs 582 F 2,627 F

3

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4

1 Patient Care Revenue Favourable Base Revenue driven by higher base contract variations, primarily being additional Heceptin Funding $4.2m and provision for FY11 IDF Wash up’s $2.8m. 2 MoH Sub Contracts Lower MoH Subcontract revenue $(1.6)m, driven by lower Herceptin funding (now in base revenue) $(4.2)m and lower Additional Elective revenue $(2.9)m as a result of lower volume delivery offset by higher Other MoH Subcontract Revenue $5.5m 3 Employee Costs Note – Payroll cut off for December accounts was 19 December for non-Nursing and 26 December for Nursing. This means the impact of Christmas leave on December accounts is minimal. The main impact will be in January accounts, and this should result in favourable Employee Costs for the month. FTE Table 1 – FTEs for Month (December 2010)

FTEs Budget

FTE Month

2010-11

Actual FTE

Month 2010-11

Total FTE

Variance

Operational

Variance

Savings Targets

not Achieve

d Adult Health 1,724 1,752 -29 -7 -22Wom, Child, Card, OR&A 2,481 2,463 18 18 0Operations 1,457 1,444 12 12 0MH,Amb, Ophth, Cancer & Blood 1,296 1,274 22 34 -12Other Operational 1 1 0 0 0Ancillary 961 980 -18 -18 0TOTAL 7,920 7,915 5 39 -34

FTE Table 2 – Cost per FTE

Provider Services – Staffing Variance

Month 2010/11 Budget Actual Variance %

Employee Costs ($M) 63.8 65.9 -3.33%FTE Numbers 7,919.9 7,915.0 0.06%Cost per FTE (Month) 8,054 8,327 -3.39%

YTD 2010/11 Budget Actual Variance %

Employee Costs ($M) 367.5 368.1 -0.18%FTE Numbers 7,915.7 7,846.6 0.87%Cost per FTE (Year to Date) 46,427 46,918 -1.06%

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Variances for employee costs were as follows:-

Portfolio Month

Total Variance

Month Savings

Targets not Achieved

Month Operational

Variance

Comments YTD Total

Variance

YTD Savings


YTD Operational

Variance

Comments

Adult Health $(219)k U $(128)k U $(91)k U Key drivers of monthly variance are (i) House Officers 16 FTE over budget due to an agreed approach with ARRMOS to over allocate in the December rotation on the basis there are normally a high number of withdrawals (which does not appear to have been the case for the December rotation); (ii) Savings targets variance due to summer Nursing MOC not achieved – budget assumption was 90% occupancy for summer, whereas December actual occupancy was 95%, reflecting high AED/acute admission volumes for the month.

$2,149k F $2,149k F YTD favourable Employee Costs reflects a high number of SMO vacancies, and low Staff Related Expenses due to CME/CNME write-offs following new year entitlements.

Wom, Child, Card, ORA (CWORAC)

$(1,169)k U $(332)k U $(837)k U Medical costs $490k UF, 20.2 FTE F. SMO and Registrar costs arise mainly from additional allowances eg some paid to cover short staffing, weekend contract work, 2nd on call payments etc. HOs costs are a reflection of the additional FTE which have been included in the current rotation (see above). Nursing $438k UF; 20.3 FTE UF. Although significantly over budget for the month the actual costs are $700k less than Dec 09.

$(1,959)k U $(1,959)k U Medical - overall $689k UF, 21.8 FTE F. Issues related to additional allowances paid re high workloads and trial of new initiatives related to optimising use of theatre time. Nursing $1.57m UF, 18.5 FTE UF. Issues re additional beds opened re new contracts, budget phasing incorrect re closeout of contracts, ward and ICU occupancy levels higher than budget and for Theatres – a reflecton of 27% increase in actual Theatre minutes over budget.

Operations $76k F $76k F Relatively small favourable variances spread widely over most services (total variance equated to 0.7% of month budget).

$1,310k F $1,310k F YTD favourable Employee Costs reflects i) a high number of SMO vacancies in Radiology and, ii) Technical FTE averaging 15 (2%) below budget, spread widely across most services, in part to offset against savings targets in Direct Treatment Costs.

MH, Amb, Ophth, Cancer & Blood

$359k F $56k U

$415k F MH, Ambulatory & Ophthalmology - $179k F favourable employee costs reflects the high level of medical, nursing and technical vacancies in Mental Health $288k F. This is offset by the unmet vacancy target in Ambulatory and Ophthalmology $56k U - the vacancy target budget assumption was based on the previous years actual vacancies which is currently not achieved. Cancer & Blood – $180k F employee cost variance reflects difficulty to recruit to specialist Medical, RT and Physics positions. Savings redirected to fund unbudgeted costs

$2,053k F $576k U

$2,629k F MH, Ambulatory & Ophthalmology - $1,299k F YTD favourable employee costs reflects the high level of medical, nursing and technical vacancies in Mental Health $1,826k F. This is offset by the unachieved vacancy target in Ambulatory $388k U and Ophthalmology $188k U. Cancer & Blood – $754k F employee cost variance reflects difficulty to recruit to specialist Medical, RT and Physics positions. Savings redirected to fund unbudgeted costs of outsourcing to meet the MOH 4 week target for radiation therapy. Please note comment

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of outsourcing to meet the MOH 4 week target for radiation therapy.

under 3rd party treatment costs.

Other Operational $1k U $1k U Month variance not material $(221)k U $(221)k U Variance reflects abnormal costs relating to MRT and MLWU strikes.

Ancillary Services $(1,176)k U Further provision for potential MECA settlements, increased long service and gratuity payments, and ACC liabilities.

$(3,976)k U Further provision has been made for potential MECA settlements $(2.2)M YTD, increased long service and gratuity payments $(0.8)M YTD, and ACC liabilities $(0.4)M YTD.

4 Direct Treatment Costs

The principal variances in direct treatment costs were as shown below:-

Variance Variance

Cost Month $M YTD $M Clinical Supplies (0.7) (3.3)Drugs (0.6) (1.7)Chemicals & Media (0.4) (1.6)Patient Appliances (0.3) (2.1)3rd Party Treatment Costs (0.3) (2.1)Interpreters (0.0) (0.2)Food (0.0) (0.1) (2.4) (11.0)

Variances rounded to nearest $100,000

Note – there are significant savings targets incorporated into the Direct Treatment Costs budget, and these account for the majority of the YTD unfavourable variance in Direct Treatment Costs - $8.0M of the total YTD $11.0 M variance. Progress is being made on various initiatives to achieve these savings.

Key variances for Clinical Supplies costs were as follows:-

Portfolio Month Total

Variance

Month Savings


Month Operational

Variance

Comments YTD Total

Variance

YTD Savings


YTD Operational

Variance

Comments


$(441)k U $(360)k U $(81)k U Clinical Supplies $440k UF Child Health $165k UF and ORA $292k UF but lower then Dec 09 by $64k. These costs are reflections of the activity levels in the services eg Theatre mins for month were 24% higher than budget

$(2,839)k U $(2,160)k U $(679)k U ORA $1.75m U. Child Health $842k U. All unachieved budget savings. Overall YTD Budget $1.8m lower than LY actual spend at YTD Dec 10. Comparing TY act with LY actual, TY is $977k higher than LY. Shortfall

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and the caseload was 16% higher than budget

mainly Catheters and other clinical supplies and mainly ORA reflecting increased theatre minutes ie Theatre mins for YTD Dec 10 were 27% higher than budget and the caseload was 23% higher than budget.

Operations $(97)k U $(22)k U $(75)k U Month variance is primarily operational in LabPlus, reflecting costs for new external contract i.e. costs are unbudgeted but fully funded.

$(295)k U $(229)k U $(66)k U Key YTD variance relates to target savings in Radiology and reflects actual volume of high cost interventional angio procedures being above YTD target.

Adult Health $(169)k U $(169)k U Month variance is spread across a number of services with main variances in Renal ($47k U), A+ Links ($35k U) & Gastro ($31k U), all reflecting the high volume activity during December.

$(271)k U $(271)k U YTD variance is primarily in Renal, and is activity related, reflecting actual volumes above YTD contract.

Key variances for Drugs costs were as follows:-


Variance

Month Savings


Month Operational

Variance

Comments YTD Total

Variance

YTD Savings


YTD Operational

Variance

Comments


$(259)k U $(45)k U $(214)k U Drugs - Child Health - Paed Med $253k UF - incl. Malignant $138k UF, Blood products $49k UF, and Anti infectives $28k UF. Mainly related to Haem/Onc treatments which is reflecting activity and changes in patient mix and size and different drugs in use. Analysis of the patients and drugs used is currently underway but $93k was spent on one drug alone for one patient.

$(1,287)k U $(270)k U $(1.0)M U Drugs $1.287m UF - $115k higher than LY actual. Mainly Paed Medical $822k U – re Bloods, Oncology and anti infective drugs.

Adult Health $(204)k U $(204)k U Month variance is spread across a number of services with main variances in Transplants ($56k U) and General Surgery ($39k U), reflecting the high volume activity during December.

$(416)k U $(416)k U YTD variance is spread across all services, reflecting total YTD volumes (WIES funded and non WIES funded) ahead of contract.

Key variances for Chemicals & Media costs were as follows:-


Variance

Month Savings


Month Operational

Variance

Comments YTD Total

Variance

YTD Savings


YTD Operational

Variance

Comments

Operations (LapbPlus)

$(400)k U $(400)k U Reflects full year budget 14% below 09/10 actuals. A combination of a reduction in test utilisation through the Non Schedule contract and/or price reductions for reagents is required to meet this budget target. i) The Non

$(1,393)k U $(1,393)k U Reflects full year budget 14% below 09/10 actuals. A combination of a reduction in test utilisation through the Non Schedule contract and/or price reductions for reagents is required to meet this budget target. i) The Non

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8

Schedule test volumes have grown rather than decreased (YTD 11% ahead of contract), but the service is looking at how non schedule tests can be reduced. ii) To date some price reduction for reagents has been achieved, but not at the level required to achieve the savings targets.

Schedule test volumes have grown rather than decreased (YTD 11% ahead of contract), but the service is looking at how non schedule tests can be reduced. ii) To date some price reduction for reagents has been achieved, but not at the level required to achieve the savings targets.

Key variances for Patient Appliances costs were as follows:-


Variance

Month Savings


Month Operational

Variance

Comments YTD Total

Variance

YTD Savings


YTD Operational

Variance

Comments


$(300)k U $(275)k U $(25)k U Implants Child Health $128k UF ( 1 Melody valve and the balance related to higher than average Orthopaedic surgical vols incl more spines than average). Cardiac $176k UF - Pacemaker vols are on budget but cost budget too low. ICD budget $ and vols were set close to the 0910 Dec ytd figures. Activity levels for 10-11 however are now equivalent to 0809 - higher than 0910

$(2,559)k U $(1,651)k U $(908)k U Implants $2.478m UF - Cardiac ICDs, Pacing and Valves $1.82m UF. This is $1.3m higher than the Dec YTD LY. Initial findings of the review indicate that pacemaker volumes are close to budget for 10-11. Pacemaker YTD costs are now $52k UF. At YTD Dec 10 ICD volumes are equivalent to 0809. The budget was set based on YTD Dec 10 which was only 2/3 of the 0809 position. Hence the challenge for the 10-11 cost overrun which is now $634k UF. Other Cardiac implant costs relate to valves etc. for CTSU procedures and they are $557k UF.

Adult Health $(94)k U $(94)k U Month variance is in Neurosurgery and is due to exceptionally high volumes for the service for the month.

$401k F $401k F YTD variance is primarily due to Orthopaedics, reflecting elective/joint replacement volumes behind YTD contract.

Key variances for 3rd Party Treatment costs were as follows:-


Variance

Month Savings


Month Operational

Variance

Comments YTD Total

Variance

YTD Savings


YTD Operational

Variance

Comments


$(12)k U $(12k) U Month variance not material $(1,637)k U $(1,637)k U Outsourcing $1.6M UF – Cardiac services - to manage patient waiting lists & ESPIs & overall patient targets. Budget assumption for Cardiac – all CTSU in house.

Operations $(158)k U $(108)k U $(50)k U Key variance is due to target savings not met: i) Budget includes assumption of reduced outsourced volumes for the new SSH MRI as well as a reduction in total demand (Concord project). The first target is being met - SSH

$(1,006)k U $(653)k U $(353)k U Key variance is due to target savings not met: i) Budget includes assumption of reduced outsourced volumes for the new SSH MRI as well as a reduction in total demand (Concord project). The first target is being met - SSH

31

9

MRI is now operational, reducing outsourced MRI volumes. For the second target, overall demand has not decreased – a clinical workshop has been organised for late January to look at managing overall demand. ii) LabPlus referred tests - budget assumes a 25% reduction in sendaways from 09/10 actuals. While savings to date are small, progress is being made in moving towards bringing several sendaway tests in-house – setup procedures and operational impact analysis are underway.

MRI is now operational, reducing outsourced MRI volumes. For the second target, overall demand has not decreased – a clinical workshop has been organised for late January to look at managing overall demand. ii) LabPlus referred tests - budget assumes a 25% reduction in sendaways from 09/10 actuals. While savings to date are small, progress is being made in moving towards bringing several sendaway tests in-house – setup procedures and operational impact analysis are underway.

MH, Amb, Ophth, Cancer & Blood

$(34)k U Month variance not material $(587)k U $(587)k U $(570)k U Cancer & Blood reflects the unbudgeted costs associated with the need to outsource to meet the 4 week MOH target for radiation Therapy. 2010/11 FTE savings will be used to offset these additional costs. In addition a project in place to secure regional DHB contribution to fully absorbed cancer costs not met by national pricing.

Adult Health $(142)k U $(142)k U Variance is in Orthopaedics ($186k U) which is currently outsourcing greater than monthly budget (budget is phased evenly over the year). Final expected total outsourcing for the year for the service is still to be agreed.

$38k F YTD variance not material

32

10

5 Administration Costs Variances for administration follows:-

Portfolio Variance Comments Ancillary Services $(726)k U Operational areas $(149)k UADHB Trust $(433)k U, HR

$(74)k U; Finance $(52)k U, CEO Functional $(191)k U Consolidation Entry $443k F

Operations $(77)k U A series of individually immaterial items spread widely over various services and accounts.

6 Non Operating Costs Non operating costs were $582k F to budget ($2.627m F year to date). As discussed in the Board paper in previous months:- Depreciation is lower than budget driven by the timing of capitalisation of capital projects Finance Costs are lower than budget driven by lower than planned interest rates and CHFA loans

not being drawn down. The Capital Charge is lower than budget driven by the revaluation of Land & Buildings

downwards at balance date.

Throughput – Acute Front Door Month Per

Day % Last

Month Per Day % Last

Year Per Day

Dec-10 Att per Day

Comparison to Last Month

Nov-10 Att per Day

Comparison to Last Year

Dec-09

Att per Day

APU 1,600 52 -2.7% 1,644 55 1.7% 1,574 51

AED 4,630 149 5.7% 4,380 146 14.7% 4,036 130

CED 2,620 85 -1.4% 2,658 89 -5.5% 2,772 89

AED. High growth persists: record high volumes, 15% higher than December 2009.

However the admission rate reduced back to 25% and the median LOS dropped after creeping up all year.

APU. Similar volumes to last month but a drop in both the median and average LOS, which indicates improved flow.

CED. Drops in both average and median LOS, indicating improved flow.

33

11

Throughput – by Admission Type Year to Date December 2010 (measured in wies)

Electives (wies) DHB Contract Actual Variance % of

completion

ADHB

7,754

6,266 -1,488 80.8%

CMDHB

2,764

2,424 -340 87.7%

WDHB

3,521

3,070 -451 87.2%

NLDHB

1,252

1,099 -153 87.7%

Other 1,985 1,877 -108 94.6%

17,276 14,736 -2,540 85.3%

Acutes (wies) DHB Contract Actual Variance % of

completion

ADHB

25,830

26,991 1,161 104.5%

CMDHB

6,293

6,191 -102 98.4%

WDHB

9,137

9,651 514 105.6%

NLDHB

2,337

2,386 49 102.1%

Other 3,676 3,817 141 103.8%

47,273 49,036 1,763 103.7%

Acute & Elective Combined (wies)

DHB Contract Actual Variance % of

completion

ADHB

33,584

33,257 -327 99.0%

CMDHB

9,057

8,615 -442 95.1%

WDHB

12,657

12,721 64 100.5%

NLDHB

3,589

3,485 -104 97.1%

Other 5,661 5,694 33 100.6%

64,549 63,772 -777 98.8%

34

Elective volumes are at 85% overall measured against the price volume schedule, and 81% for ADHB’s own population. In addition to this internal target ADHB has a health target to produce 11,149 elective discharges for its own population. This latter target is measured in patient numbers (discharges) rather than wies, it excludes work done in four specialties – dermatology, oral health, cardiology and paediatric cardiac and it includes work done for the ADHB population at other DHBs – the majority of this work being done at CMDHB. The target for the health target for YTD December was 5,293, against which actual outputs were 4,742 (90%). As noted in the Ministry Target slide elsewhere in this agenda contingency plans are in place to lift performance and achieve the year end target.

Electives - Number of Elective Discharges for the ADHB Population Undertaken by the ADHB provider and other DHBs - actual vs target July 2010 - June 2011 (excludes four specialties not part of

targets and includes outflows - mainly work done at CMDHB.

0

2,000

4,000

6,000

8,000

10,000

12,000

Jul-1

0

Aug

-10

Sep

-10

Oct

-10

Nov

-10

Dec

-10

Jan-

11

Feb

-11

Mar

-11

Apr

-11

May

-11

Jun-

11goal Ministry target phasing actual forecast MoH target

Throughput – Elective Service Performance Indicators The table overleaf shows ADHB’s level of compliance with two of the elective services performance indicators – ESPI 5 numbers of people waiting for surgery greater than six months and ESPI 6 numbers of patients waiting greater than six months for a clinical review. The target for ESPI 5 looks at Number of patients who have waited > 6 months in certainty of treatment status, who have yet to receive treatment. This is then expressed as a % of the total number treated over last 12 month period. To be compliant we must remain < 4%. As the table indicates as at 31 December we were 55 patients outside this compliance limit. The projection for January 31 is 151 patients outside the compliance limit. If the DHB remains non-compliant by 28 February this will trigger financial penalties of $3.7m. Work is ongoing with services to identify the numbers of long waiting patients by service which will be seen or otherwise removed from the waiting list by 28 February. Indicative numbers at 25th January suggest that there is a risk of remaining non-compliant, albeit closer to compliance than shown overleaf, and this will be remedied over the next five weeks.

12

35

ADHB: Surgical Elective Service Performance Indicator Summary:

ESPIs 5 and 6

Includes Data Entry up to end of 23/01/2011Health Service Group Specialty Level Status Limit

Imp.Req'd Level Status Limit



Imp.Req'd

Adult Health Cardiology 15 1.2% 52 0 107 55.2% 29 -78 13 0.9% 56 0 107 55.2% 29 -78Cardiothoracic 14 1.6% 36 0 0 0.0% 0 0 15 1.6% 37 0 0 0.0% 0 0General Surgery 115 5.1% 90 -25 0 0.0% 0 0 105 4.6% 92 -13 0 0.0% 0 0Neurosurgery 61 17.4% 14 -47 0 0.0% 0 0 72 19.6% 15 -57 0 0.0% 0 0ORL 36 6.5% 22 -14 0 0.0% 0 0 29 5.3% 22 -7 0 0.0% 0 0Orthopaedics 48 5.5% 35 -13 0 0.0% 0 0 62 7.0% 35 -27 0 0.0% 0 0Urology 57 5.3% 43 -14 0 0.0% 0 0 74 6.7% 44 -30 0 0.0% 0 0Vascular Service 1 0.4% 10 0 1 5.0% 3 0 2 0.7% 11 0 1 5.0% 3 0

Adult Health Services Total 332 5.3% 250 -82 1 4.5% 3 0 359 5.6% 256 -103 1 4.5% 3 0Ambulatory Health Ophthalmology 160 4.6% 140 -20 0 0.0% 0 0 196 5.4% 144 -52 0 0.0% 0 0

Oral Health Greenlane 22 1.5% 57 0 0 0.0% 0 0 33 2.3% 59 0 0 0.0% 0 0Ambulatory Health Services Total 182 3.7% 198 0 0 0.0% 0 0 229 4.5% 203 -26 0 0.0% 0 0Women & Children's Adult Congenital Medical Heart (ACHD) 2 3.9% 2 0 0 0.0% 0 0 3 5.4% 2 -1 0 0.0% 0 0

Adult Congenital Surgical 1 3.3% 1 0 0 0.0% 0 0 0 0.0% 1 0 0 0.0% 0 0ENT 99 8.0% 50 -49 0 0.0% 0 0 124 9.7% 51 -73 0 0.0% 0 0Gastroenterology Paediatric 6 3.4% 7 0 0 0.0% 0 0 5 2.8% 7 0 0 0.0% 0 0Gynaecology Inpatients 26 1.4% 73 0 0 0.0% 0 0 25 1.3% 76 0 0 0.0% 0 0Neuroservices 2 2.4% 3 0 0 0.0% 0 0 4 4.6% 4 0 0 0.0% 0 0Orthopaedics Paediatric 18 4.1% 18 0 0 0.0% 3 0 20 4.5% 18 -2 1 5.6% 3 0Paed Cardiology 2 1.4% 6 0 0 0.0% 0 0 4 2.6% 6 0 0 0.0% 0 0Paediatric CTSU 0 0.0% 8 0 0 0.0% 0 0 1 0.5% 8 0 0 0.0% 0 0Respiratory Paediatric 1 1.3% 3 0 0 0.0% 0 0 1 1.4% 3 0 0 0.0% 0 0Surgery Paediatric 43 4.1% 41 -2 0 0.0% 0 0 53 5.0% 42 -11 0 0.0% 0 0

Women & Children's Health Services Total 198 3.8% 210 0 0 0.0% 3 0 237 4.4% 216 -21 1 0.0% 3 0

ADHB Total 712 4.3% 657 -55 1 2.5% 6 0 825 4.9% 675 -150 2 5.0% 6 0

ESPI 5 - Certainty ESPI 6 - ActiveReviewDecember-10 January-11est

ESPI 5 - Certainty ESPI 6 - ActiveReview

Throughput – Contract Volumes Inpatient Volume Delivery & Mix The chart below shows the production recorded to December 2010. At the time the results were finalised, the coding was 95.4% complete with the average WIES per discharge being 0.8% higher than last year for the same period. Discharges are down by 0.1% from last year. Inpatient delivery to the most current Price Volume Schedule was 104.3% for the month and 99% YTD.

Actual Budget Variance Actual Budget VarianceWIES 10,600 10,384 216F 63,512 63,787 275UWIES Delivery per day 505 494 10F 588 494 94F

Month`

YTD

WIES Production & Delivery per working day

13

36

300

350

400

450

500

550

WIES per Working Day (excluding stat day - 1011 working year = 250 days)

2010/11 Plan 2010/11 Actual 2009/10 2008-09

Outpatient Delivery Below is a graph of outpatient activity in the same manner as for inpatient activity - output per working day. As well as being a useful indicator of productivity, outpatient activity is, in part, the 'feeder' activity for much of our elective 'production line'.

FSA= First Specialist Assessment Green Line= Average

Arrow= Target

B17. FSA per Working Day

240

260

280

300

320

340

360

380

Dec

-08

Feb-

09

Apr-0

9

Jun-

09

Aug-

09

Oct

-09

Dec

-09

Feb-

10

Apr-1

0

Jun-

10

Aug-

10

Oct

-10

Dec

-10

14

37

Cost Relationship Charts

50.0%

52.0%

54.0%

56.0%

58.0%

60.0%

62.0%

64.0%

% of Revenue

Employee Costs as % of Revenue (YTD)

Actual 2010‐11 Budget 2010‐11 Actual 2009‐10

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

22.0%

24.0%

26.0%

% of Revenue

Treatment Costs as % of Revenue (YTD)

2010‐11 Actual 2010/11 Budget 2009‐10 Actual

15

38

The principal areas which differed from budget for Dec YTD are:- In $,000’s

Act Bud Var

Adult Health 100,254 101,215 961F The variance is primarily driven by favourable employee costs, reflecting a number of Medical vacancies, and low Staff Related Expenses due to CME and CNME write-offs following new year entitlements.

Women, Child, Cardiac, ORA 165,142 157,761 7,380U Income $3.7m F. Mainly Non Resident income and Donations ahead of budget. Employee costs $2m U - mainly Nursing in Child Health and ORA reflecting high activity levels. $223k will be recovered in the final 6 months of the year through corrections to budget phasing. Medical costs in Cardiac also high. Treatment costs $9.6m UF. Mainly Drugs $1.3m UF (Bloods, Oncology and Cardiovascular drugs), Implants $2.6m UF ($1.8m UF from Cardiac - budget activity levels reflected Dec 10 YTD, however, actual vols for Dec 11 reflect the 0809 financial year), Clinical Supplies $2.8m UF (use of all supplies under investigation) and Outsourcing $1.6m UF - Cardiac Services - to manage patient wait lists & ESPIs. Bad debts also $953k UF.

Operations 82,707 80,712 1,995U The variance is primarily driven by unfavourable Direct Treatment Costs, the key variances being: i) outsourcing of MRIs $688k U (rate of variance is now reducing as new Starship MRI is fully operational), and ii) Chemicals & Media in LabPlus $1,363k U, for which the budget has a saving target requiring decreases in test utilisation and/or price for reagents. These unfavourable Direct Treatment Costs are partly offset by favourable Employee Costs achieved through vacancies. Ongoing mitigation strategies to achieve full year budget include vacancy management, annual leave management and tight management of discretionary expenditure.

Ambulatory & Ophthalmology 15,386 14,390 996U The unfavourable variance is primarily driven by 1) Employee costs $528K unfavourable mainly due to the unachieved target saving assumption, 2) Treatment cost $531K unfavourable driven by Immunology blood products $318K unfavourable and Oral Health clinical supplies $75k unfavourable, both of which are demand driven. Year to date volumes for Ambulatory inpatients are at 95% and Ambulatory outpatients are at 104% of budget and Ophthalmology inpatients are at 91% and Ophthalmology outpatients are at 101% of budget.

Cancer & Blood 31,477 32,838 1,361F Net cost $1,361K favourable to budget is due to 1) Adult PCT wash-up adjustment and higher demand for haemophilia blood product $661 KF, 2) medical, nursing and technical staff vacancies $754k fav, 3) savings from volume related drug costs offset by outsourcing costs (RT plus Bone Marrow Transplant (marrow retrieval)) in excess of budget $144k unfav. 4) $120K savings from depreciation costs ( budget phrasing);

ACH Others 412 112 299U Variance reflects abnormal costs relating to MRT and MLWU strikes.

Mental Health 42,769 44,800 2,031F The favourable variance is mainly driven by favourable employee costs made up of vacancies $1434k favourable and lower staff related expenses $424k favourable. The favourable staff related expenses variance is primarily caused by the level of vacancies, the reversal of expired CME entitlements and the timing of expenses.

Total Operational 438,146 431,828 6,318U

Health Service PortfolioYTD - Net Cost of Service ($ '000)

Comments

39

Act Bud Var

Complementary 832 (110) 941U The unfavourable variance is driven by a one off payment from the Alexandra Trust to Ronald McDonald House Trust Auckland for the provision of a facility for convalescing women and children $0.5m.

Functional 72,430 78,492 6,062F The favourable variance is driven by higher Interest on term deposits $1.3m, a realised gain on Interest Rate Swap instruments $2.1m, lower computer maintenance $0.3m & property maintenance $0.6m, a lower capital charge driven by the downward revaluation of land and buildings as at 30 June 10 $0.9m and lower finance costs due to CHFA loans of $10.5m not being drawn down and lower interest rates $0.8m.

Provider Arm - High Level Provisions 4,402 (2,241) 6,643U This responsibility centre holds budgets for overall Provider Arm provisions. It is unfavourable due to budgetary provisions for the receipt of Herceptin funding $(4.2), which is now paid as part of Internal revenue from the funder below, and outsourcing costs $0.9m. In addition there have been further increases in provisions for Meca settlements $(2.2)m and long service leave & gratuities $(0.7)m and ACC Costs $(0.4)m.

Consolidation Adjustments 235 (861) 1,097U The responsibility centre is used to eliminate intra provider transactions on consolidation

Net Cost of Service (Before Internal Transfers)

516,045 507,108 8,937U

Internal Revenue from Funder (512,579) (509,766) 2,813F This responsibility centre holds budgets for overall Provider Arm revenue.

Intra Provider Arm Revenue and Cost Transfers to Governance & Funder

(59) (99) 40U This responsibility centre holds budgets for service billing of revenue and costs within the Provider Arm.

Provider Arm Surplus/(Deficit) 3,407 (2,757) 6,164U

Health Service PortfolioYTD - Net Cost of Service ($ '000)

Comments

40

ProviderDec 2010

Act 1011 % of Rev Bud 1011 % of Rev Act 0910 % of Rev Var Budget% Var to

BudVar LY

RevenueMOH Base Funding 512,579 510,371 503,848 2,208 F 0.4%F 8,731 FMoH Sub-contracts 15,074 17,790 16,572

2,716 U 15.3%U 1,498 U1,873 F 11.5%F 1,542 F

251 U 2.5%U 1,131 U072 F 41.1%F 1,173 F

1,006 U 0.9%U 5,649 U27 U 0.0%U 653 F27 F 1.0%F 1,498 U

122 U 2.5%U 117 U451 U 1.0%U 1,446 U334 F 1.6%F 839 F644 U 0.2%U 7,218 U

11,006 U 10.4%U 2,287 U2,312 U 11.9%U 1,963 U

435 F 1.7%F 237 U2,316 U

9 U 1.1%U 407 F( 400) 0 F 0.0%F 400 U( 65) 0 U 0.0%U 2,957 U

94 332 U 4,041.0%U 246 U13,835 U 2.6%U 17,218 U8,791 U 15.1%F 5,982 U

2,284 U830 F

1,100 U

( 3,407) 6,164 U 223.6%U 7,081 U

Other Patient Care 18,132 16,259 16,591 545,785 544,420 537,010 1,365 F 0.3%F 8,775 F

Services & Products 27,451 26,845 25,704 606 F 2.3%F 1,746 FCTA 9,775 10,026 10,906 Trust & Donation Income 3,678 2,606 2,505 1,Other Income 7,760 5,507 7,086 2,252 F 40.9%F 673 F

594,448 589,404 583,212 5,044 F 0.9%F 11,236 FExpenditureEmployee Costs Medical 118,456 19.9% 117,450 19.9% 112,808 19.3% Nursing 118,803 20.0% 118,776 20.2% 119,456 20.5% Technical 61,119 10.3% 61,746 10.5% 59,621 10.2% 6 Hotel Services 4,956 0.8% 4,834 0.8% 4,839 0.8% Administration 44,602 7.5% 44,151 7.5% 43,156 7.4% Other 20,213 3.4% 20,547 3.5% 21,053 3.6%Total Employee Costs 368,149 61.9% 367,505 62.4% 360,932 61.9%Direct Treatment Costs 117,295 19.7% 106,289 18.0% 115,008 19.7%Indirect Treatment Costs 21,800 3.7% 19,488 3.3% 19,837 3.4%Prop, Equip. & Transpt 24,520 4.1% 24,955 4.2% 24,283 4.2%Administration Costs 9,270 1.6% 9,304 1.6% 6,954 1.2% 34 F 0.4%FMaintenance Programme 809 0.1% 800 0.1% 1,216 0.2%Building Compliance Costs - 0.0% - 0.0% -0.1%Indirect Service Billing 2,893 0.5% 2,892 0.5% 0.0%Loss on Sale of Fixed Assets 341 0.1% 8 0.0% 0.0%Total Operating Expenditure 545,077 91.7% 531,242 90.1% 527,859 90.5%Operating Surplus/(Deficit) 49,372 8.3% 58,162 9.9% 55,353 9.5%

Capital Charge 17,223 2.9% 18,164 3.1% 17,578 3.0% 941 F 5.2%F 355 FDepreciation 26,236 4.4% 27,150 4.6% 23,952 4.1% 914 F 3.4%FFinance Costs 9,319 1.6% 10,091 1.7% 10,149 1.7% 772 F 7.6%FTotal Non Operating Costs 52,778 8.9% 55,405 9.4% 51,679 8.9% 2,627 F 4.7%F

Net Surplus / (Deficit) -0.6% 2,757 0.5% 3,675 0.6%

YTD

41

5.2 Operat ions Ind icators Except ion Repor t

43

ADHB HAC KPI Report †MOH top 6

‡ IDP SOI HBIΦ Mental Health KPI set

December 2010

Indicator Frequency

Review date

KPI report page ref

Volume

B3. Acute WIES Volume - Auckland M Aug-10 1

B4. Elective WIES Volume - Auckland M Jan-10 1

B5. Total WIES Volume - Auckland M 1

B6. Non-DRG Revenue - Auckland M Mar-10 1

B7. Acute WIES Volume - IDF M Feb-09 2

B8. Elective WIES Volume -IDF M 2

B9. Total WIES Volume _IDF M Jan-10 2

B10. Non-DRG Revenue - IDF M Jan-10 2

B11. Acute WIES Volume -All DHBs M 3

B12. Elective WIES Volume -All DHBs M Jan-10 3

B13. Total WIES Volume - All DHBs M Jan-10 3

B14. Non-DRG Revenue - All DHBs M Jan-10 3

B30. Inpatient WIES Cumulative Variance to Contract - Acute/Elective by DHB M Apr-09 4

B31. Inpatient WIES Cumulative Variance to Contract - Total by DHB M Apr-09 4

B32. Inpatient WIES Cumulative Variance to Contract - Total all DHBs M Apr-09 4

B33. NON-DRG Revenue Cumulative Variance to Contract by DHB M Apr-09 4

B41. Mental Health Total Access - Rate M Dec-10 6

B41b. Mental Health Access Rate - Maori M Dec-10 6

B40. Mental Health Total Community Face-to-Face Appts. M Jan-10 12

B42. Mental Health Community New Referrals M 12

Productivity

B15. Acute WIES per Day M 5

B16. Elective WIES per Working Day M Jan-10 5

B17. FSA per Working Day M 5

A27. Inhouse Elective WIES through Theatre - Per day Q Q2

Length of Stay

A22. Raw Average Length of Stay - WIES funded patients (days) M 7

A61. Mental Health - Average Length of Stay (KPI Discharges) - Te Whetu Tawera M Aug-09 7 Φ

Elective Process and Waiting Times

A03. Elective Day of Surgery Admission (DOSA) Rate M 7

B61. Raw Elective Surgical daycase rate M 7

B50. % of chemotherapy patients attending FSA within 6 weeks of referral M 8

B51. (POP-10) % of chemotherapy patients receiving treatment within 6 weeks of FSA M 8 ‡

B52. % of radiation oncology patients attending FSA within 6 weeks of referral M 8

B56. % of patients who commence bone marrow transplant within 6 weeks of decision to treat. M 9

B57. % of haematology patients attending FSA within 6 weeks of referral M 9

B58. % of haematology patients receiving treatment within 6 weeks of FSA M 9

A65. (ESPI 8). Proportion of patients treated prioritised using nationally recognised processes or tools M Aug-10 10

B65. DOSA Rate - Neurosurgery M 10

A03b. Elective Day of Surgery Admission (DOSA) Rate - Maori Q Q1

A03d. Elective Day of Surgery Admission (DOSA) Rate - Pacific Island Q Q1

Acute Process

A56. Percentage of stroke patients cared for within the stroke unit - Total 6 monthly Jul-10 A56b. Percentage of stroke patients cared for within the stroke unit - Maori 6 monthly

A56d. Percentage of stroke patients cared for within the stroke unit - Pacific 6 monthly

B63. Mental Health percentage of people with relapse prevention plans M Jan-10

Cost

B34. Cost and revenue for WIES funded inpatient events -all services 6 monthly

B35. Cost and revenue for WIES funded inpatient events -child 6 monthly

B36. Cost and revenue for WIES funded inpatient events -adult 6 monthly

B37. Cost per WIES for WIES funded inpatients - all 6 monthly

Human Resources

F.12 % of Total Employee Turnover (Monthly) M 11

F.21 Lost Time Injury Frequency Rate M 11

45

HAC Exception Report December 2010

A06. Total volumes for AED Patients with Triage Category 2, (10 Minutes)While A06 (triage 2) is not an exception this month it is presented alongside the equivalent chart for triage 3 patients in order to illustrate the recent prevailing upward trend.

A08. Total Volumes for AED Patients with Triage Category 3, (30 Minutes)As noted in previous months, triage volumes across all categories of ED attendences continue to show an unexplained growth trend. As all categories have increased, this is not a change in triage practice, but genuine increase in higher acuity workload. This factor dispels the myth that increase ED volumes are only occuring in minor patients. Despite the increase in numbers, compliance has also been increasing in this group reflecting efforts to see the sickest patients first.

A63. (ESPI 5) Patients given a commitment to treatment but not treated within six monthsPatients waiting longer than 6 months have continued to increase through 2010, the Radiology strike exacerbated the situation, as has the opening of GCC theatres later than originally anticipated. Outsourcing is expected to impact the compliance level and formal recovery plans now being worked on by the services for completion 21st January.

.

A63. (ESPI 5) Patients given a committment to treatment but not treated within six months

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

Dec

-08

Feb-

09

Apr-0

9

Jun-

09

Aug-

09

Oct

-09

Dec

-09

Feb-

10

Apr-1

0

Jun-

10

Aug-

10

Oct

-10

Dec

-10

A06.Total Volumes for AED Patients with Triage Category 2, (10 Minutes)

650

700

750

800

850

900

950

Dec

-08

Feb-

09

Apr-0

9

Jun-

09

Aug-

09

Oct

-09

Dec

-09

Feb-

10

Apr-1

0

Jun-

10

Aug-

10

Oct

-10

Dec

-10

A08.Total Volumes for AED Patients with Triage Category 3, (30 Minutes)

1100

1200

1300

1400

1500

1600

1700

Dec

-08

Feb-

09

Apr-0

9

Jun-

09

Aug-

09

Oct

-09

Dec

-09

Feb-

10

Apr-1

0

Jun-

10

Aug-

10

Oct

-10

Dec

-10

46

6

IMPROVEMENT ACTIVITIES

6.1 DAP Projects Report

47

Te Runanga Ngati Whatua

Auckland District Health Board

District Annual Plan 2010 - 2011 22 June 2010

49

Priority and Developmental Work for 201011

Goal 1: Lift the health of people living in Auckland city High level strategy Objective Strategies to achieve objectives

1.1.1 Increase local access to culturally appropriate services for Maori, respecting their status as an indigenous people

1.1.1.1 Work with the successful primary care business cases and Maori providers within these arrangements to: – develop Integrated Family Health Centres/Whanau Ora Centres – develop specific activities that achieve Whanau Ora – develop indicator measures for Whanau Ora – develop a Whanau Ora approach for all services devolved

1.1.1.2 Implement the year one activities part of the cross DHB:MAPO Whanau Ora framework for 2010 - 2015

1.1.1.3 Provide leadership in the development of Maori health workforce development

1.1.2 Increase local access to culturally appropriate services for Pacific and other high needs groups

1.1.2.1 Integrate the Healthy Village Action Zone actions within the appropriate primary care business cases

1.1.2.2 Participate in determining indicator measures for Pacific health gain in the three regional primary care business cases

1.1.2.3 Host two Auckland DHB Pacific community leadership meetings to communicate the Auckland DHB Pacific Summit recommendations and the proposed plan

1.1.2.4 Implement the Pacific best practice guidelines and training at Auckland City Hospital in at least 4 identified clinical areas (orthopaedic outpatient, child diabetes, renal and cardiology services) where there is high Pacific use and high DNA rates

1.1.2.5 Complete the Healthy Village Action Zone evaluation

1.1 Reduce inequities in health status

1.1.3 Increase access to services for culturally and linguistically diverse populations

1.1.3.1 Cultural competency training focussed on culturally and linguistically diverse populations for all staff working in primary and secondary health services, with 50% of clinical staff completing at least two of the four on-line modules

1.1.3.2 Increase the uptake of the Primary Health Interpreting Pilot so that 100% of the non-English speaking population using general practices in Auckland city has access to an interpreter when using General Practice services

1.1.4 Support disabled people and improve their access to health care and support services

1.1.4.1 20% more clients over 65 are accepted into the Interim Funding Pool 1.1.4.2 Audit report completed on accessibility: specifically physical access, culture,

employment and advocacy 1.1.4.3 KPIs developed for reporting disability issues and incidents to DSAC along with

follow-up actions; for both provider audit and for Ministry of Health spot audit system

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High level strategy Objective Strategies to achieve objectives

1.2 Improve outcomes in priority areas

1.2a.1 Achieve immunisation targets

1.2a.1.1 Implement a 2010-11 Action Plan to achieve key objectives of Auckland DHB’s immunisation strategy including:

1.2a.1.2 Work with EOI (primary care) respondents on actions to improve immunisation rates to the 91% for Auckland DHB by ensuring that Immunisation Co-ordinator roles are maintained and their effectiveness maximised

1.2a.1.3 Work with other regional DHBs and our primary care partners to achieve a regional immunisation target of 90% of all 2 year olds fully immunised

1.2a Children and young people

1.2a.2 Improve the oral health of children

1.2a.2.1 Increase school dental clinics to six by June 2011 1.2a.2.2 Four new mobile clinics in total established by June 2011 1.2a.2.3 Reduce inequalities in the use of school dental services:

– improving access by taking services to pre-schools – enhancing oral health education – increasing early enrolment with a focus on Maori and Pacific populations

1.2b.1 Home-based support services and restorative homecare initiatives

1.2b.1.1 Introduce the funding methodology for home-based services by July 2010 1.2b.1.2 Work with primary care (EOI) respondents and primary care to align with

homecare services

1.2b Older people

1.2b.2 Quality improvement in residential care

1.2b.2.1 Work with related aged residential care partners to pilot the EDEN philosophy in at least three organisations

1.2b.2.2 25% reduction in overall number of complaints from residential care

1.2c Mental health and addictions

1.2c.1 Increase effectiveness across primary, secondary, tertiary services

1.2c.1.1 Continued development of the secondary to primary care shift to achieve target of 90% of mental health clients (achieved through extension of ProGRESS+)

1.2c.1.2 Expand primary mental health; implementation of online therapies, appointment of primary care employment support worker, appointment of CSW in primary care to provide psycho-education and psycho-social interventions; and service navigators/coordinators to manage movement through the system

1.2c.1.3 Complete the reconfiguration of Maori mental health services so that services are embedded in existing secondary care mental health structures

1.2c.1.4 Complete the reconfiguration of levels 3 and 4 residential rehabilitation; i.e. to contract for support hours that provide flexibility for consumers to get the level of service required, including residential support where needed

1.2c.1.5 Review and reconfigure the continuum of mental health services to focus on recovery and social inclusion using best practice and evidence based approaches

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1.2d.1 Strengthen community participation and action

1.2d.1.1 Ensure community participation at a locality level to input into the changes occurring in primary health care as part of the metro Auckland approach to long term conditions

1.2d.2 Integration of services across primary and secondary care

1.2d.2.1 Work with our primary care partners to develop care pathways across primary-secondary care for at least two common long term conditions (including diabetes)

1.2d.2.2 Increase the number of GPs using electronic referral systems to at least 10%

1.2d.3 Support and facilitate primary care teams to take a greater role in managing long term conditions

1.2d.3.1 Meet existing target re number of the eligible adult population having their CVD risk assessed

1.2d 3.2 At least 2 cardiac rehabilitation courses are run in the community 1.2d 3.3 At least 10% of retinal screening to be undertaken in the community

1.2d Long term conditions

1.2d.4 Support whanau and self resilience

1.2d.4.1 Pilot coaching services to support people with long term conditions in line with evidence base

1.2d.4.2 Work with our primary care partners to improve outcomes for Maori, Pacific people and other high need groups through a range of strategies that involve families and communities

1.2e Palliative care 1.2e.1 Enhance primary care approach to palliative care including more flexibility to meet patient needs

1.2e.1.1 Service redesign for palliative care agreed, and which aligns the specialist and generalist workforce

1.2e.1.2 Liverpool Care Pathway trial is evaluated with phase 2 undertaken according to the outcome

1.2e.1.3 Review of equipment services so that equipment provision becomes aligned and streamlined by June 2011

1.2e.1.4 ProCare palliative care pilot rolled out and evaluated with 2 other PHOs beginning the programme

More detail on some of these performance measures is included on page 36

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Goal 2: Performance improvement: sooner, better, more convenient High level strategy Objective Strategies to achieve objectives

2.1 Efficient and effective health care system

2.1a Primary health care 2.1a.1 Provide efficient and effective co-ordinated care in the neighbourhood

2.1a.1.1 Develop a comprehensive metro Auckland primary care plan in collaboration with DHBs and primary care

2.1b.1 Improve access and efficiency of service delivery

2.1b.1.1 Implement regional e-referrals, health event summaries and electronic outpatient letters

2.1b.1.2 Increase access to diagnostic radiology for primary care by providing community assessment for up to 4,500 procedures and improving access for 16,000 patients

2.1b.1.3 Shift minor surgery activity into the community, increasing more convenient primary care based treatments for skin cancer across the metro region from 513 to 1200 per year

2.1b.1.4 Implement a formalised network across Auckland, proving local access to urgent care that will be integrated with general practice services

2.1b.1.5 Improve access to primary care for palliative care clients by 15% 2.1b.1.6 Implement a clinically led “proof of concept” process to more effectively

manage the community pharmaceutical budget by facilitating appropriate prescribing and safe use of medicines. Target savings of $1.5m

2.1b Improve primary–secondary system efficiency

2.1b.2 Reduce acute demand 2.1b.2.1 Increase by 50% across the metro Auckland region the number of Primary Options for Acute Care (POAC) referrals (target of 12,500 patients managed in a community setting)

2.1c Improve quality of hospital care while improving productivity

2.1c Improve quality of

hospital care while improving productivity (cont)

2.1c.1 Improve service throughput and productivity

2.1c.1.1 Improve cardiac surgery throughput from an average of 17 to 20 bypass procedures per week. Complete implementation of the 10 project work streams (including formalising the private / public relationship and incentive schemes)

2.1c.1.2 Eliminate unnecessary follow ups to reduce follow up rate by 10% 2.1c.1.3 Improve performance against the Emergency Department six-hour measure

from 76% to 95% by implementing project solutions in the adult and children’s acute flow projects

2.1c.1.4 Improve adult operating room productivity by 6% by implementing the productive operating theatre programme/lean improvement programmes (UK NHS Productive Operating Theatre Programme)*

2.1c.1.5 Improve ward productivity by 3% by increasing the number of wards in Adults

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High level strategy Objective Strategies to achieve objectives and Mental Health services using Releasing Time to Care from 6 to 24

2.1c.1.6 Achieve a day of surgery (DOSA) rate of 60% for elective Neurosurgery 2.1c.1.7 Increase Starship Operating Room capacity and functionality by rebuilding the

Operating Room Suite, addressing patient flow issues and adding 2 operating rooms providing capacity for increasing volumes; construction planned to commence early 2011

2.1c.1.8 Improve the patient experience while improving productivity by implementing service improvement projects in: – General medicine – Orthopaedics – Radiology – Paediatrics general surgery – General surgery – Ophthalmology

2.1c.2 Improve mainstream effectiveness

2.1c.2.1 Activities to improve mainstream effectiveness, ensuring clinical safety and effectiveness for Maori and developing an understanding of iwi recommended approaches

2.1c.2.2 Review pathways of care focused on improving health outcomes and reducing inequalities for Maori

2.1c.2.3 Over the long term reduce Did not Attend rates (DNA) and failures to engage with treatment and follow up (reduce the Maori DNA rate from 9.6% to 9% in 2010-11)

2.1c.2.4 60% of discharge letters to Pacific people include another primary health care provider

2.1c.3 Improve relapse prevention planning in mental health

2.1c.3.1 Greater than 95 percent of long term mental health clients have up-to-date relapse plans by July 2011

2.1c.4 Hospitalised smokers given assistance to stop smoking

2.1c.4.1 90% of hospitalised smokers given help to quit via brief advice and intervention by June 2011

2.1c.4.2 450 pregnant women enrolled into smoking cessation programme per annum

2.1c.5 Reduce waiting times for oncology

2.1c.5.1 Radiation therapy will commence within four weeks from FSA, by December 2010

2.1c.5.2 Complete the northern region 2009–2019 strategic plan for sustainable delivery of radiation oncology

2.1c.5.3 Implement lung and bowel tumour stream models by June 2011

2.1c Improve quality of

hospital care while improving productivity (cont)

2.1c.6 Increase elective surgical discharges to 10,227

2.1c.6.1 The Plan re the development of Greenlane for full elective services on target with commissioning underway – Implement new model of care and workforce roles in the Greenlane Surgical

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High level strategy Objective Strategies to achieve objectives Centre

– Maintain past elective surgery improvement by including primary care in the referral pathways and patient management

– Outpatient waiting times referral to First Specialist Assessment decrease by 5% and reduce First Specialist Assessment to surgery waiting time

2.2 Improve leadership capability

2.2.1 Strengthen Clinical Leadership model

2.2.1.1 Refine, implement and monitor integrated governance model 2.2.1.2 Monitor and report against “In Good Hands” implementation

2.2.2 Improve Senior Leadership Team Performance

2.2.2.1 Develop and implement a Leadership programme focussed on leading improvement

2.2.2.2 Review clinical indicators and reporting framework to align with clinical governance requirements inclusive of primary care

2.3.1 Implement regional clinical networks

2.3.1.1 Provide leadership in cancer and cardiac clinical networks 2.3.1.2 Support the development of clinical networks to enable integration between

hospital and primary care

2.3 Improve Clinical Quality and Professional Governance

2.3.2 Accelerated quality improvement including reduction of avoidable variation and adverse events

2.3.2.1 Consolidate and continue to implement the NQIP projects: medication safety, infection, prevention and control, mortality review, incident management

2.3.2.2 Implement an Early Warning System for the physiologically unstable patients in all clinical areas

2.3.2.3 Improve the use of clinical resources including reducing waste and clinical variation, especially blood use and discharge process

2.3.2.4 20% reduction in unnecessary bed days due to improved processes for assessment and discharge for under 65s

2.3.2.5 Implement Senior Leadership Team ‘Walk-around’ safety programme i.e. growth and training in clinical leadership

2.3.2.6 Establish Consumer Council to increase consumer engagement in quality improvement

2.3.2.7 Evaluation against Health Excellence Framework 2.3.2.8 Continue roll out of Cornerstone accreditation across primary care 2.3.2.9 Improve the regional Clinical Alerts system in relation to improvement of the

national Medical Warning System

2.3.3 Improve research quality 2.3.3.1 Research strategy developed and approved by Board with annual report on activity

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2.4 Strengthen the health workforce

2.4.1 Ensure workforce capability is matched to service delivery current and future

2.4.1.1 Targeted recruitment of ‘hard to staff’ clinical roles / workforces 2.4.1.2 Implement/ continue Maori and Pacific workforce development programmes:

Rangatahi programme and the Scholarship programme 2.4.1.3 Increase the number of Maori and Pacific in the Auckland DHB workforce via

the Tamaki project (20 Maori and 20 Pacific for year 2010-11 with the 300 in total by 2015)

2.4.1.4 At least two Maori nurse graduates in each Auckland DHB NETP programme 2.4.1.5 Increase the number of Pacific people in the Auckland DHB health workforce

from 7.4% to 8%

2.5.1 Improve the resilience and availability of core IT systems

2.5.1.1 Implement the resilience improvement plan Phase 3 and 4 delivered on time 2.5.1.2 KPI reporting for end-to-end application performance in place 2.5.1.3 IMTS user satisfaction increases by >10% against previous year 2.5.1.4 Number of unplanned system outages reduced from >20 to <5 per month 2.5.1.5 Tier 1 system availability increases to >99.95%

2.5.2 Improve corporate records and knowledge management

2.5.2.1 Improve capability to manage corporate information – achieve level 1 with Public Records Act compliance

2.5.2.2 Management of Scanned Clinical Records (replace solution for management of scanned clinical records)

2.5 Information management

2.5.3 Improve data quality 2.5.3.1 Ministry of Health data quality targets met

2.6 Planning 2.6 Planning (cont)

2.6.1 Long term planning and change management

2.6.1.1 Undertake any Strategic Planning work as advised to meet Ministry of Health requirements and deadlines

2.6.1.2 Develop the Long Term Health Services Plan, encompassing a comprehensive blueprint for the development of integrated health services across Auckland DHB to the year 2030: – description of future models of care across the continuum of care – plan the shape, size, setting, and location for future services and inter district flow

patients – provide the strategic context for major future developments and business cases – develop workforce response to current and long term service plans via regional

and the national workforce planning – increase the focus on regional planning and collaboration with the regional primary

care business cases

2.6.1.3 Any potential service, funding or planning changes arising from the implementation of the National Health Board and the NZHD Amendment Bill are identified and responded to

* Refer to appendix 8

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Goal 3: Live within our means High level strategy Objective Strategies to achieve objectives

3.1 Break-even position maintained

3.1a Manage revenue 3.1a.1 Ensure revenue received for services provided

3.1a.1.1 Reconfigure renal services in response to Waitemata DHB repatriation and mange any associated risks

3.1a.1.2 Manage funding and other changes arising from the National Health Board and other Ministerial Review Group recommendations

3.1a.1.3 Participate in the national pricing process, particularly risk arising for 2011–12 paediatrics tertiary adjuster

3.1a.1.4 The impacts of any service reconfigurations are managed within Vote Health parameters

3.1b.1 Improve processes 3.1b.1.3 Align systems (national and regional) where shared services across the region or the country results in greater administration efficiency

3.1b.2 Manage labour resources

3.1b.2.1 Manage the FTE cap for management and administration staff 3.1b.2.2 Improve HR payroll processing and leave management 3.1b.2.3 Manage industrial relations (MECA) and assess draft proposals against outcomes

and against financial and sustainability risks

3.1b Cost management

3.1b.3 Enhance asset and supply chain management

3.1b.3.1 Asset Management Plan alignment with the Long Term Services Plan 3.1b.3.2 Leverage national /regional procurement initiatives 3.1b.3.3 Progress procurement strategy (national and regional) and supply chain processes

3.2 Sustainable balance sheet

3.2a Manage cash 3.2a.1 Sustainable cash management

3.2a.1.2 Cash/Financing Plan aligns with Asset Management and Long Term Services Plans

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Goal Level Summary

Group Pack Report Group/Committee: Hospital Advisory Committee

DAP Projects - total projects: 22

Goal

Num

ber

Started

Current Phase On Time On BudgetExpected Outcome

FinishedPost Implementation

Benefits

PlanDo/

Check Act Cancelled

Green

Orange

Red

Green

Orange

Red

Green

Orange

Red

Green

Orange

Red

Define

Measure

Analyse

Improve

Control

1 Lift the Health of the people in Auckland City 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0

2 Performance improvement 20 20 3 0 2 12 1 0 12 6 0 18 0 0 17 1 0 2 2 0 0

3 Live within our means 1 1 0 0 0 1 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0

Total # 22 22 3 0 2 13 1 0 13 6 0 19 0 0 18 1 0 3 3 0 0

Total % 100% 100% 14% 0% 9% 59% 5% 0% 59% 27% 0% 86% 0% 0% 82% 5% 0% 14% 14% 0% 0%

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Goal: 1 Lift the Health of the people in Auckland City

No Objectives have been entered for this committee or group against this goal.

There are no projects that have been marked as an exception

High Level Summary - total projects: 1

High Level Strategy

Num

ber

Started


Finished

Post Implementation Benefits

PlanDo/

Check Act Cancelled

Green

Orange

Red

Green

Orange

Red

Green

Orange

Red

Green

Orange

Red

Define

Measure

Analyse

Improve

Control

1.1 Reduce inequalities in health status 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1.2a Improve outcomes for children and young people 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1.2b Improve outcomes for older people 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1.2c Improve outcomes for mental health and addictions 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0

1.2d Improve outcomes for long term conditions 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1.2e Improve outcomes for Palliative care 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total # 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0

Total % 100% 100% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 100% 100% 0% 0%

Objectives

Exceptions

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Goal: 2 Performance improvement


High Level Strategy

Num

ber

Started


Finished


PlanDo/

Check Act Cancelled

Green

Orange

Red

Green

Orange

Red

Green

Orange

Red

Green

Orange

Red

Define

Measure

Analyse

Improve

Control

2.1a Efficient and effective Primary health care 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2.1b Improve primary–secondary system efficiency 3 3 1 0 0 2 0 0 2 1 0 3 0 0 2 1 0 0 0 0 0

2.1c Improve quality of hospital care while improving productivity 13 13 1 0 2 9 0 0 9 3 0 12 0 0 12 0 0 1 1 0 0

2.2 Improve leadership capability 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2.3 Improve Clinical Quality and Professional Governance 3 3 0 0 0 1 1 0 1 1 0 2 0 0 2 0 0 1 1 0 0

2.4 Strengthen the health workforce 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2.5 Information management 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2.6 Planning 1 1 1 0 0 0 0 0 0 1 0 1 0 0 1 0 0 0 0 0 0

Total # 20 20 3 0 2 12 1 0 12 6 0 18 0 0 17 1 0 2 2 0 0

Total % 100% 100% 15% 0% 10% 60% 5% 0% 60% 30% 0% 90% 0% 0% 85% 5% 0% 10% 10% 0% 0%

Objectives

Objective Objective Owner Comment

2.1c.1 Improve service throughput and productivity

Ngaire Buchanan (ADHB) There are 8 projects associated with this objective all at different stages. Cardiac surgery throughput, Emergency six hour measure, releasing time to care, increasing Starship OR capacity and the Service improvement projects are all under way. Eliminating unnecessary outpatient follow ups will be within the service improvement programme. TPOR (The Productive Operating Room) is working through the define stage with presentation to the senior leadership in February.

2.1c.2 Improve mainstream effectiveness

Ngaire Buchanan (ADHB) Being managed with Pacific Health Manager. To commence

2.1c.3 Improve relapse prevention planning in mental health

Fionnagh Dougan (ADHB) 97% of eligible clients had a relapse prevention plan documented in their notes this month. This percentage exceeds the MOH requirement.

2.1c.4 Hospitalised smokers given assistance to stop smoking

Taima Campbell (ADHB) League tables for services to compare performance developed. Data being analysed to determine best opportunities for improvement. Data confirms a correlation with frequency of offering brief advice and length of stay. Smokefree team to transfer to DoN line management on 1st Jan

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Legend: Red - , Orange - , Green -

2.1c.5 Reduce waiting times for oncology

Fionnagh Dougan (ADHB) The timeline for achieving the 4 week target has been revised and is now 31 December 2010. In anticipation all eligible patients referred for treatment to the regional service are being treated within 4 weeks.

2.1c.6 Increase elective surgical discharges to 10,227

Ngaire Buchanan (ADHB) Individual service workout plans agreed to for meeting contract, ministry targets and ESPI compliance. Outsourcing has commenced for Adult Orthopaedics with contracts for the remaining services requiring outsourcing have been signed off in principle. The GSU theatre build has had Board approval of the Ophthalmology clinic and Dialysis unit design. Refit of bathroom facilities to enable additional casemix to stay overnight has begun. Operationalisation of GSU is mixed with the key risk area of reliance on staff appointments. pected to be operational by the end of November. The status for operationalising the operating rooms at GSU is now well under way with equipment ordered, Staff appointments commenced and awaiting start dates. A number of key issues have been identified which are currently being worked through. The implementation plan has been agreed for the productivity gains at ACH. The first activity to commence are the Orthopaedic service lists which are planned to commence mid November.

Exceptions

Project Coverage PhaseOn Time

On Budget

Expected Outcome Sponsor Review

Adult 6-hour project

National Improve Emergency Department resourcing plan to respond to increased volumes being implemented with the new SMO roster commenced in December – this should further improve the % of patients discharged directly from ED within 6 hours over the next few months. Rapid Improvement Event to accelerate improvement and review current workstreams performance held with two initiatives identified for implementation to improve transfer of patients from ED to APU. ED service Excellence programme launched. Daily review of patients who stay longer than six hours in ED to be implemented in early 2011 to understand root causes and to inform further improvement activity to accelerate performance.

Skin Lesions Regional Improve Project experienced a set back, with the EOI process run to identify suitable Primary Care providers having to be withdrawn due to a process issue and re-issued.

Radiology Service Excellence

ADHB Improve Report turn-around time has continued to improve throughout Decemebr with 42% of reports completed within 24hours to meet quarter 1 target. Typing turn-around has also improved with continued focus on this over the next phase. Reporting backlog is now at an all time low as a result of change in reporting practice and increased visibility. DNA project has seen continued improved within ultrasound and will now be rolled out to other modalities.

Starship 6 hour project

National Improve There has been a slight improvement in the December results. Green belt projects have moved into the improve phase. Next focus is to increase the visibility of occupancy data and commence roll out of pilot projects in other area's

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Goal: 3 Live within our means

No Objectives have been entered for this committee or group against this goal.

There are no projects that have been marked as an exception


High Level Strategy

Num

ber

Started


Finished


PlanDo/

Check Act Cancelled

Green

Orange

Red

Green

Orange

Red

Green

Orange

Red

Green

Orange

Red

Define

Measure

Analyse

Improve

Control

3.1a Manage revenue to maintain break-even position 1 1 0 0 0 1 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0

3.1b Cost management to maintain break-even position 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

3.2a Manage cash for sustainable balance sheet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total # 1 1 0 0 0 1 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0

Total % 100% 100% 0% 0% 0% 100% 0% 0% 100% 0% 0% 100% 0% 0% 100% 0% 0% 0% 0% 0% 0%

Objectives

Exceptions

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7

PAPERS

7.1 HOSPITAL BASED MINISTRY TARGETS – NGAIRE BUCHANAN

65

Adult Acute Patient Flow, Actual vs Target, July 2009 - June 2011

0%

20%

40%

60%

80%

100%

Jul-2

009

Aug

-200

9

Sep

-200

9

Oct

-200

9

Nov

-200

9

Dec

-200

9

Jan-

2010

Feb

-201

0

Mar

-201

0

Apr

-201

0

May

-201

0

Jun-

2010

Jul-2

010

Aug

-201

0

Sep

-201

0

Oct

-201

0

Nov

-201

0

Dec

-201

0

Jan-

2011

Feb

-201

1

Mar

-201

1

Apr

-201

1

May

-201

1

Jun-

2011

Actual Goal MOH Target

Project: Adult Acute Patient FlowPrimary Objective: That at least 95% of patients will be admitted, discharged or transferred from Auckland Adult Emergency Department

within 6 hoursDate of Delivery: 30 June 2011Clinical Leads: Nurse Director Margaret Dotchin , Dr Tim ParkeProject Sponsor: Nurse Director Margaret DotchinSteering Group: Nurse Director Margaret Dotchin, General Manager Ngaire Buchanan, Dr Tim Parke, Dr Art Nahill, Dr Wayne Jones, Dr Andrew Old, Nurse Advisor

Mark Entwistle.

Project Risks / Comments:

Shorter Stays in ED health target performance for the 2nd quarter of the year for AED was 73% of patients stayed less than six hours in the ED compared to our goal of 95%. This represents a 2% increase on the previous quarter for AED. December has been a demanding month for AED, as attendances were very high, 5.7% more than last month and 16% increase on this time last year. A significant increase in trauma is demonstrated through a 69% increase in Triage 1 patients and 12% increase of triage 2 as compared with Dec 2009. Although the percentage of admissions has remained stable the increase in volume means that there has been a 5% rise in the number of patient requiring ward admissions. 50% of patients requiring ward beds were transferred out of ED within 2 hrs, this is an improvement of 37 minutes on this time last year. Emergency Department resourcing plan to respond to increased volumes being implemented with the new SMO roster commenced in December – this should further improve the % of patients discharged directly from ED within 6 hours over the next few months.Rapid Improvement Event to accelerate improvement and review current workstreams performance held with two initiatives identified for implementation to improve transfer of patients from ED to APU. ED service Excellence programme launched. Daily review of patients who stay longer than six hours in ED to be implemented in early 2011 to understand root causes and to inform further improvement activity to accelerate performance.

Recent and Current activities:1.Additional beds opened in

a)

November 2009 b)

January 20102.Improved Measurement systems to better identify clinical short

stay patients3.Reducing ward occupancy

a)

Expediting patient discharges from wards by the

introduction of daily ‘rapid rounds’

into General Medicine

wards

b)

Introduce Rapid Rounds into Orthopaedics.c)

Introduce daily ‘Whiteboard catch‐up’

meetings into

General Surgery

d)

Increase the number of weekend discharges in General

medicine and Orthopaedics. 66 Nurse Facilitated

discharges have been completed since the relaunch.

e)

Improve the volume and accuracy of estimated discharge

dates in Orthopaedics. Baseline performance identified

that approximately 6% of patients have EDD within 8

hours of arrival on wards

f) Remove delays associated with Taikura

Trust patients.

Workshops have been held with both Taikura

Trust team

and ACH teams.

4.Bed management CMS system enhancements releases (4a & b)5.Increased Operational management and daily exception reporting

6.

Improve triage processes in Emergency Department7.

Reduced transfer times between AED and APU8.

Reduced AED to Ward patient transfer times9.

Improved time to acknowledge bed requests10.

Improved scheduling of elective volumes

1a1a

22

3b3b

3d3d

3e3e

3f3f

4a4a

55

66 771b1b

3a3a 88

4b4b

99

1010

3c3c

67

0%

20%

40%

60%

80%

100%

Jul-

2009

Aug

-200

9

Sep

-200

9

Oct

-200

9

No

v-20

09

Dec

-200

9

Jan

-201

0

Feb

-201

0

Mar

-201

0

Ap

r-20

10

May

-201

0

Jun

-201

0

Jul-

2010

Aug

-201

0

Sep

-201

0

Oct

-201

0

No

v-20

10

Dec

-201

0

Jan

-201

1

Feb

-201

1

Mar

-201

1

Ap

r-20

11

May

-201

1

Jun

-201

1

Children's Acute Patient Flow, Actual vs Target, July 2009 - June 2011


Project: Children’s Acute Patient FlowPrimary Objective: That at least 95% of patients will be admitted, discharged or transferred from Auckland Children’s Emergency

Department within 6 hoursDate of Delivery: 30 June 2011Clinical Lead: Richard AickinProject Sponsor: Ngaire BuchananSteering Group: Ngaire Buchanan, Kay Hyman, Richard Aickin, Michael Shepherd, Janet Campbell, Stuart Dalziel

11 446a6a

22

55336b6b

6c6c

6d6d

Completed and current activities:1) Improved Measurement systems to better identify

clinical short stay patients

2) Development of weekly dashboard reporting for CED to

better track performance

3) Weekly communications of performance to ward level4) Development underway of daily reviews to identify

specific reasons for delays on a case‐by‐case basis

and to communicate findings with relevant teams

5) Development of ‘full hospital plan’

to improve

responsiveness when indicators of ‘bed block’

developing

6) Lean Six Sigma Green Belt projects recently commenced

to improve

a) Patient Transfers from CED to

a ward where a bed is

available

b) Bed turnaround time in ward

24B ‐

time to discharge

from Doctor’s clearance

c) Inter‐hospital Paediatric

transfers

d) Estimated Discharge Date

accuracy in Paediatric

Orthopaedics:

Project Risks / Comments:The number one issue remains transferring children from Children’s Emergency Department (CED) to inpatient wards. CED continues with good performance for those children discharged from the service (96%) but the result is pulled back by delays in inpatient transfers. The result improved during December as the intense pressure for inpatient beds reduced but December occupancy was still high (96%). There are a number of Process Improvement projects focussed on improving access to inpatient beds underway which will continue to deliver improvements over the next months.

68

Project: Improved access to elective surgeryPrimary Objective: Increase ADHB Elective Surgical Discharges from 10189 to 11149Date of Delivery: 30 June 2011Clinical Lead: Vanessa BeavisProject Sponsor: Ngaire BuchananSteering Group: Ngaire Buchanan, Dr Vanessa Beavis, Margaret Dotchin, Justin Kennedy‐

Good, Greg Balla (chair), Dr Judy Bent, Dr Margaret Wilsher, Fionnagh

Dougan, Ian Civil.

Risks / Comments: (Amber)Contingencies have been put in place to bring performance back on track. Individual service

workout plans agreed to for meeting contract, ministry targets and ESPI compliance. Outsourcing

has commenced for Adult Orthopaedics with contracts for the remaining services requiring

outsourcing planned. The phasing for elective surgery has been aligned to the planned activities

outlined on the right of the graph. The GSU theatre build is on track with the sterile supply unit

completed and operational. The status for operationalising

the operating rooms at GSU is under

way with equipment ordered, Staff recruitment commenced and awaiting start dates. There are a

number of key issues which have been identified needing to be worked through. The

implementation plan has been agreed for the productivity gains at ACH. The first activity to

commence were the Orthopaedic service lists which commenced in December.

Planned Activities:‐

1.

Outsourcing Orthopaedics, 2.

Production Lists ‐

Orthopaedics3.

GSU Theatre 14.

Outsourcing for General Surgery, ORL,

Neurosurgery, Gynaecology and Paediatric

Surgery

5.

Longer days at GSU6.

Additional (temporary) ophthalmology lists at

GSU

7.

Longer days at ACH

Electives - Number of Elective Discharges for the ADHB Population Undertaken by the ADHB provider and other DHBs - actual vs target July 2010 - June 2011 (excludes four specialties not part

of targets and includes outflows - mainly work done at CMDHB.

0

2,000

4,000

6,000

8,000

10,000

12,000

Jul-1

0

Aug

-10

Sep

-10

Oct

-10

No

v-10

Dec

-10

Jan-

11

Feb

-11

Mar

-11

Apr

-11

Ma

y-11

Jun-

11

goal Ministry target phasing actual forecast MoH target

1

2

3

4

5

67

69

Better help for smokers -% of hospitalised smokers provided advise and help to quit, Actual vs Target, June 2009 - Dec 2010

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Jun-

2009

Jul-2

009

Aug

-200

9

Sep

-200

9

Oct

-200

9

Nov

-200

9

Dec

-200

9

Jan-

2010

Feb

-201

0

Mar

-201

0

Apr

-201

0

May

-201

0

Jun-

2010

Jul-2

010

Aug

-201

0

Sep

-201

0

Oct

-201

0

Nov

-201

0

Dec

-201

0


Project: Better help for smokers to quit

Primary Objective : % of hospitalised smokers provided advice and help to quit

Date of Delivery: 80 % by 1/07/2010, 90% by 1/07/2011, 95% by 1/07/2012

Clinical Lead: Stephen Childs

Project Sponsor: Taima Campbell

Steering Group: Taima Campbell, Stephen Child, Jan Marshall, Anna Schofield, Anne Bannatyne, Paul Bohmer, Leani O’Connor, Cheryl Hamilton, Nicki

Jackson, Jim Kriechbaum, Kerry Hiini, Lyndsay Le Comte, Rachel Morris

Recent and Current activities:1. ABC Systems improvement, monitoring and feedback

a) Follow up with wards as a result of the audits to

improve ward performance. b) Feedback on service performance ongoingc) Audit of clinical coding completed results to be

discussed with Clinical Coding team in January. D) Analysis of health target by service undertaken to

determine focus of activities for 2011.

2. ABC training & Coaching a)

Ongoing promotion of MOODLE training. b) Further training needs to be determined by audit

findings.c) ABC and NRT staff coaching to continued) Promotion of ABC training to undergraduate health

programmes and tertiary institutes

3. Improved utilisation of NRT for withdrawal managementa) Promotion to medical staff on ABC and NRT planned

for February b) NRT Standing Order currently being simplified

4. Promotion & Communication a) ABC promotion ongoing. Recognise top performing

wards to continue in February

5. Research & Evaluationa) Research programme –

Discussions held in December

with the CTRU re development of a cessation research

strategy for ADHB

6. Governance & Leadershipa) Role and function of the ADHB Tobacco Control

Steering group to be completed by February.

7. ABC sustainability plana) to be developed to enable handover of ABC

programme to services by 2012.

Project Risks and CommentsBased on the results of recent audits there a need to improve medical staff engagement in asking

patients about their smoking and offering brief advice (doing the ABC). To this end the new intake

of registrars were briefed on the ABC at their orientation in early December and given ABC and NRT

lanyard cards and information sheets. An analysis of health target data by ward indicates that the

services with a shorter length of stay e.g. under 6 hours are less likely to record brief advice.

Emergency Medicine, General Surgery and General Medicine were identified as the areas with the

highest patient volumes and therefore where the greatest gains could be made towards meeting

the target. Consequently these services will be the focus for improvement. Work continues with

the Adult Emergency Dept. and the Admission and Planning Unit to

improve their results. Despite

the continued pressure in AED for events coded in December there

was a small increase in both the

numbers of smokers identified from 204 in November to 224 in December and brief advice

increased from 91 to 112 (44%‐50%).

11

22 33

44 55

66

77

70

0%10%20%30%40%50%60%70%80%90%

100%

Jun

-200

9

Jul-

2009

Aug

-200

9

Sep

-200

9

Oct

-200

9

No

v-20

09

Dec

-200

9

Jan

-201

0

Feb

-201

0

Mar

-201

0

Ap

r-20

10

May

-201

0

Jun

-201

0

Jul-

2010

Aug

-201

0

Sep

-201

0

Oct

-201

0

No

v-20

10

Dec

-201

0

Radiation Therapy - % patients commencing treatment within target,Actual vs Target, June 2009 - Dec 2010


Project: Shorter waits for Radiation TherapyPrimary Objective: That 100% of patients requiring radiation treatment will commence treatment within 6 weeks of their first

specialist assessment by 1 July 2010, and within 4 weeks by 31 December 2010 (Excludes D priority patients and Delay codes)Date of Delivery: 1 July 2010 (6 weeks), 31 December 2010 (4 weeks)Clinical Lead: Andrew MacannProject Sponsor: Fionnagh DouganSteering Group: Fionnagh Dougan, Andrew Macann, Margaret White,

Robyn DunninghamRadiation Oncology Wait times –

December 2010In December the service achieved 100% delivery to the 6

week target for patients in priority categories A,B & C

without a delay code and 100% to the 4 week target.

There has been a significant improvement in C‐Radical wait

times over the last three months October 4.2 wks,

Nov 4.1 wks and Dec 3.2 weeks.

Strategies to reduce wait times:1.

MV5 Linear Accelerator is now fully operational.

Extended hours: Extended hours have been

implemented for RT staff where this is an option

within the terms of their contract.

2.

Outsourcing: A short term agreement has been

agreed with ARO for provision of public capacity. A

short term / interim contract to outsource 3 pts per

week (up to a maximum of 5 per week) is agreed to

April 2011. A feasibility study is in progress to

determine a long term public/private arrangement.

3.

Aria project: A project is underway to develop a full

electronic record within ARIA. This will increase

treatment processes and better match demand to

capacity.

4.

A prototype weekly capacity modelling tool

is now

being used for future Linac capacity planning,

improved forecasting capability and management of

workload.

5.

Weekly “operational”

/ prioritisation meetings and

review of the wait list.

6.

Daily Waitlist reporting and remedial action plan.

Project Risks / Comments:The service expects to be 100% compliant to the 4 week target by

the end of December 2010.A number of improvements were implemented during that time, including

• Development of the capacity modelling tool now in prototype phase• Introduction of RT flexible working hours in June 2010 and ongoing• Outsourcing to ARO• Daily waitlist reporting• Improved forecasting capability• Continual prioritisation and review of waiting list• Commissioning of MV5 linear accelerator from 1st

November 2010.• A comprehensive and ongoing recruitment plan to attract RT staff

to the service. Full RT staffing

to budget is expected by December 2010.

114422

55

33

66

71

Reduce Cardiac Waiting List, Actual vs Target, Jan 2009 - Dec 2010

0

50

100

150

200

250

Jan-

2009

Feb

-200

9

Mar

-200

9

Apr

-200

9

May

-200

9

Jun-

2009

Jul-2

009

Aug

-200

9

Sep

-200

9

Oct

-200

9

Nov

-200

9

Dec

-200

9

Jan-

2010

Feb

-201

0

Mar

-201

0

Apr

-201

0

May

-201

0

Jun-

2010

Jul-2

010

Aug

-201

0

Sep

-201

0

Oct

-201

0

Nov

-201

0

Dec

-201

0


Project: Cardiac Bypass SurgeryPrimary Objectives: To enable timely access to cardiac bypass surgery the waiting list should be no greater than 80.

To support the national cardiac bypass intervention target, 916 bypass will be completed in 2009/10Date of Delivery: 31 December 2010Clinical Lead: Paget MilsomProject Sponsor: Garry Smith, Kay HymanSteering Group: Marian Hussey, Paget Milsom, Andrew McKee, Peter Ruygrok, Elizabeth Shaw, Pam McCormack, Greg Balla, Gordon Davies

1a1a

2a2a

3a3a

4a4a

55

1b1b

2b2b 2c2c3b3b 3c3c 3d3d3f3f

4b4b2e2e

Recent and Current activities:1 Initial drive for an improvement to the waiting list

a) Successful recruitment campaign for CVICU nurses

shortage

b) Outsource push to reduce the waiting list2 Improve measurement and reporting

a) The development of improved operational

measurement systems

b) The development of surgical clinical outcome reportingc) Ongoing improvement of CTSU Throughput Meeting

3 Improve co‐ordination and synchronisation between units to

improve utilisation and throughput:

a) Daily bed management meetingb) Development of online scheduling systemc) Development of ward load planning systemd) Development of the patient pathway management

system

e) Capacity plan model developed for CVICU and Ward 42f) Flex CVICU roster to optimise resource cover and reduce

cancellations

4 Reduce patient related cancellationsa) Initiation of pre‐admission process/clinicb) Review and refinement of the referral process to

achieve ‘full kit’

patient information5 Provide clinical leadership

a) Evaluate the position of ‘Cardiac Clinical Leader’

Project Risks / Comments:There are 45 patients on the waiting list as at the end of December 2010. YTD throughput is 10

patients less than planned as at end December. The shortfall in

YTD production relates directly to the

impact of the H1N1 ECMO patients and industrial action. It is unlikely that we will return to the YTD

production target until February as patients were understandably

reluctant to proceed with cardiac

surgery over the Christmas/New Year period.

72

8

FEEDBACK TO BOARD

8.1 Hospital Advisory Committee Feedback to Board

73

9

GENERAL BUSINESS

75

10

APPENDICES

10.1 Healthcare System Diagram

77

10.1 Heal thcare System Diagram

79


A g e n d a

MEETING DETAILS

Time and Date 10:45am – 12:15pm, Wednesday 2 February 2011

Venue A+ Trust Room, Clinical Education Centre, Level 5, Auckland City Hospital

Members Dr Chris Chambers (Chair), Jo Agnew, Peter Aitken, Judith Bassett, Susan Buckland, Rob Cooper, Lester Levy, Dr Lee Mathias, Robyn Northey, Gwen Tepania-Palmer, Ian Ward, Assoc Prof Anne Kolbe, Prof Iain Martin.

Apologies

In Attendance Garry Smith, Dr Denis Jury, Dr Margaret Wilsher, Brent Wiseman, Richard Aickin, Greg Balla, Ngaire Buchanan, Taima Campbell, Margaret Dotchin, Fionnagh Dougan, Paul Green, Janice Mueller, Vivienne Rawlings, Ian Bell.

COMMITTEE FUNCTIONS

To monitor the financial and operational performance of the hospitals and related services of the DHB, assess strategic issues relating to the provision of hospital services by or through the DHB and give the Board advice and recommendations on that monitoring and that assessment.

Item Page No

1 Attendance and Apologies 001

2 Conflicts of Interest 003

3 Confirmation of Minutes Thursday 2 December 2010 013

4 Action Points Thursday 2 December 2010 019

5 Operational Performance

5.1 Operational Summary Report and Financials 5.2 Operational Indicators Exception Report

023

6 Improvement Activities

6.1 DAP Projects Report

047

7 Papers

7.1 Hospital Based Ministry Targets – Ngaire Buchanan

065

8 Feedback to Board 073

9 General Business 075

10 Appendices

10.1 Healthcare System Diagram

077

Hospital Advisory Committee Agenda – Wednesday 2 February 2011 Page 1

Hospital Advisory Committee Agenda – Wednesday 2 February 2011 Page 2

NEXT MEETING

Time and Date: 10.45am, Wednesday 2 March 2011

Venue: Pohutukawa Room, Sorrento, One Tree Hill Domain, Epsom

Hei Oranga Tika Mo Te Iti Me Te Rahi Healthy Communities, Quality Healthcare

auckland district health board hospital advisory …...2011/02/02 · auckland district health...

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