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Counties Manukau District Health Board – Hospital Advisory Committee Agenda
Counties Manukau District Health Board Hospital Advisory Committee Meeting Agenda Wednesday, 29 July 2015 at 9.00am – 12.30pm, Room 101, Ko Awatea, Middlemore Hospital, Hospital Road, Otahuhu, Auckland Time Item Page No
9.00am – 9.10am 1. Welcome
9.10am – 9.15am 2. Governance 2.1 Attendance & Apologies 2.2 Disclosure of Interests/Specific Interests 2.3 Acronyms 2.4 Confirmation of Public Minutes - 17 June 2015 2.5 Action Item Register Public
2 3-6 7 8-12 13
9.15am – 9.45am
3. Nursing Report 3.1 Nursing in CM Health (Denise Kivell)
14-21
9.45am – 10.00am
10.00am – 10.10am
4. For Discussion/Endorsement 4.1 Annual Leave Presentation (Beth Bundy) 4.2 Perioperative Clinical Information System Business Case (Phillip Balmer)
- 22-33
10.10am – 10.20am Morning Tea Break
10.20am –10.35am
10.35am – 10.45am 10.45am – 10.55am 10.55am – 11.05am 11.05am – 11.15am 11.15am – 11.25am 11.25am – 11.35am 11.35am – 11.40am 11.40am – 11.45am 11.45am – 11.55am
5. Director of Hospital Services Report (Phillip Balmer) 5.01) Executive Summary 5.02) Balanced Scorecard 5.03) Financial Summary 5.04) Hospital Activity Overview 5.05) Actions Arising Responses 5.06) Balanced Scorecard Definitions 5.1 Mental Health (Phillip Balmer) 5.2 Women’s Health & Kidz First (Phillip Balmer) 5.3 Director of Midwifery report (Thelma Thompson) 5.4 Surgery and Ambulatory Care (Gillian Cossey) 5.5 Adult Rehabilitation/ Health of Older People (Dana Ralph-Smith) 5.6 Medicine, Acute Care & Clinical Support (Brad Healey) 5.7 Facilities (Phillip Balmer) 5.8 Director of Allied Health Report (Phillip Balmer) 5.9 Director of Nursing Report (Denise Kivell)
34-35 36-39 40-42 43-52 53-56 57 58-62 63-76 77-93 94-95 96-108 109-117 118-137 138-141 142-143 144-147
6. Resolution to Exclude the Public 148-149
11.55am – 12.05pm 12.05pm – 12.15pm 12.15pm – 12.25pm 12.25pm – 12.28pm 12.28pm – 12.30pm
7. Confidential Items 7.1 Patient Safety Report/S&AE Report (Dr David Hughes) 7.2 Risk Register/Report (Dr David Hughes) 7.3 Maternity Security Review Reports (Phillip Balmer) 7.4 Confirmation of Confidential Minutes - 17 June 2015 7.5 Action Item Register Confidential
150-185 186-195 196-206 207-213 214
Next Meeting: 9th September 2015, Ko Awatea
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BOARD MEMBER ATTENDANCE SCHEDULE – HAC 2015 Name
Jan 11 Feb 24 Mar Apr 6 May 17 June 29 July August 9 Sept 21 Oct Nov 2 Dec
Lee Mathias (Chair)
No
Mee
ting
No
Mee
ting
No
Mee
ting
No
Mee
ting
Wendy Lai
Arthur Anae
X X
Colleen Brown
Sandra Alofivae
Lyn Murphy (Committee Chair)
David Collings
Kathy Maxwell
George Ngatai
Dianne Glenn
Reece Autagavaia
* Attended part meeting only
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BOARD MEMBERS’ DISCLOSURE OF INTERESTS
29 July 2015 Member Disclosure of Interest
Dr Lee Mathias • Chair Health Promotion Agency
• Chairman, Unitec • Deputy Chair, Auckland District Health Board • Director, Health Innovation Hub • Director, healthAlliance NZ Ltd • Director, New Zealand Health Partners Ltd • External Advisor, National Health Committee • Director, Pictor Limited • Director, iAC Limited • Advisory Chair, Company of Women Limited • Director, John Seabrook Holdings Limited • MD, Lee Mathias Limited • Trustee, Lee Mathias Family Trust • Trustee, Awamoana Family Trust • Trustee, Mathias Martin Family Trust
Wendy Lai, Deputy Chair • Board Member and Partner at Deloitte • Board Member Te Papa Tongarewa, the Museum of
New Zealand • Chair, Ziera Shoes • Board Member, Avanti Finance
Arthur Anae
• Councillor, Auckland Council • Member The John Walker ‘Find Your Field of
Dreams’ Colleen Brown • Chair, Disability Connect (Auckland Metropolitan
Area) • Member of Advisory Committee for Disability
Programme Manukau Institute of Technology • Member NZ Down Syndrome Association • Husband, Determination Referee for Department of
Building and Housing • Chair IIMuch Trust • Director, Charlie Starling Production Ltd • Member, Auckland Council Disability Advisory Panel
Dr Lyn Murphy • Senior lecturer in management and leadership at Manukau Institute of Technology
• Member, ACT NZ • Director, Bizness Synergy Training Ltd
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• Director, Synergex Holdings Ltd • Associate Editor NZ Journal of Applied Business
Research • Member Franklin Local Board
Sandra Alofivae
• Member, Fonua Ola Board • Board Member, Pasefika Futures • Board Member, Housing New Zealand
David Collings
• Chair, Howick Local Board of Auckland Council • Member Auckland Council Southern Initiative
Kathy Maxwell • Director, Kathy the Chemist Ltd • Regional Pharmacy Advisory Group, Propharma
(Pharmacy Retailing (NZ) Ltd) • Editorial Advisory Board, New Zealand Formulary • Member Pharmaceutical Society of NZ • Trustee, Maxwell Family Trust • Member Manukau Locality Leadership Group,
CMDHB • Board Member, Pharmacy Guild of New Zealand
Dianne Glenn • Member – NZ Institute of Directors • Member – District Licensing Committee of Auckland
Council • Life Member – Business and Professional Women
Franklin • Member – UN Women Aotearoa/NZ • Vice President – Friends of Auckland Botanic
Gardens and Member of the Friends Trust • Life Member – Ambury Park Centre for Riding
Therapy Inc. • CMDHB Representative - Franklin Health
Forum/Franklin Locality Clinical Partnership • Vice President, National Council of Women of New
Zealand • Member, Auckland Disabled Women’s Group • Member, Pacific Women’s Watch (NZ) Limited • Justice of the Peace
George Ngatai • Arthritis NZ – Kaiwhakahaere • Chair Safer Aotearoa Family Violence Prevention
Network • Director Transitioning Out Aotearoa • Director BDO Marketing • Board Member, Manurewa Marae • Conservation Volunteers New Zealand • Maori Gout Action Group • Nga Ngaru Rautahi o Aotearoa Board
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Reece Autagavaia • Member, Pacific Lawyers’ Association
• Member, Labour Party • Member, Auckland Council Pacific People’s Advisory
Panel • Member, Tangata o le Moana Steering Group • Employed by Tamaki Legal • Board Member, Governance Board, Fatugatiti Aoga
Amata Preschool
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HOSPITAL ADVISORY COMMITTEE MEMBERS’ REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 29th July 2015 Director having interest Interest in Particulars of interest Disclosure date Board Action Wendy Lai
HBL – Food & Laundry & FPSC Programme
Ms Lai declared a specific interest in regard to Deloitte providing support to HBL in the food and laundry and FPSC Programme. Deloitte has mainly been providing Oracle implementation resources to FPSC. Ms Lai is not directly involved with this work.
12 February 2014
That Ms Lai’s specific interest be noted and that the Committee agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.
Wendy Lai
Te Pou Matakana Deloitte is currently working with Te Pou Matakana (TPM) which is a subsidiary of Waipereira Trust. TPM has been awarded the contract as the Commissioner for Whaanau Ora services for North Island Maori.
7th May 2014 That Ms Lai’s specific interest be noted and that the Committee agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.
Sandra Alofivae
Board Member, Pacific Futures Board
7th May 2014 That Ms Alofivae’s specific interest be noted and that the Committee agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.
Lyn Murphy
MIT Dr Murphy is a lecturer at MIT. 17th June 2015 That Dr Murphy’s specific interest be noted and that the Committee agree that she may remain in the room and participate in any deliberations, but be excluded from chairing any items in relation to MIT and any voting.
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Glossary
ACC Accident Compensation Commission ADU Assessment and Diagnostic Unit ARDS Auckland Regional Dental Service CADS Community Alcohol, Drug and Addictions Service CAMHS Child, Adolescent Mental Health Service CNM Charge Nurse Manager CT Computerised Tomography CW&F Child, Women and Family service DNA Did not attend ESPI Elective Services Performance Indicators FSA First Specialist Assessment (outpatients) FTE Full Time Equivalent ICU Intensive Care Unit MHSG Mental Health service group MoH Ministry of Health MTD Month To Date MOSS Medical Officer Special Scale OHBC Oral health business case ORL Otorhinolaryngology (ear, nose, and throat) PACU Post-operative Acute Care Unit PHO Primary Health Organisation PoC Point of Care SCBU Special care baby unit SMO Senior Medical Officer SSU Sterile Services Unit TLA Territorial Locality Areas WIES Weighted Inlier Equivalent Separations YTD Year To Date
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Minutes of the meeting of the Counties Manukau District Health Board
Hospital Advisory Committee Wednesday, 17 June 2015
held at the Innovation Lab, Ko Awatea, Middlemore Hospital
commencing 9.00am
COMMITTEE MEMBERS PRESENT: Dr Lee Mathias (Board Chair) Dr Lyn Murphy (Committee Chair) Ms Wendy Lai Ms Sandra Alofivae Ms Colleen Brown Ms Kathy Maxwell Mr George Ngatai Ms Dianne Glenn Mr David Collings Apulu Reece Autagavaia
ALSO PRESENT: Mr Geraint Martin (Chief Executive) Mr Martin Chadwick (Director Allied Health)
Dr Gloria Johnson (Chief Medical Officer) Ms Margaret White (Deputy Chief Financial Officer, Hospital Services) Mr Phillip Balmer (Director Hospital Services) Ms Toa Fereti (Clinical Nurse Director) attending for Ms Denise Kivell Ms Samantha Smith (Manukau Courier) and Mr Neville Shortland attended the public section of this meeting.
APOLOGIES: Apologies were received and accepted from Anae Arthur Anae, Ms Denise Kivell, (Director of Nursing) and Dr Lee Mathias (for leaving between 10.30-12pm).
WELCOME The Chair opened the meeting and shared some reflections on the tour of the Cancer Tumour Room with Mr Brad Healey this morning.
2.2 DISCLOSURE OF INTERESTS The Disclosures of Interest were noted with no amendments. 2.2 SPECIFIC INTERESTS The Committee noted Dr Lyn Murphy’s interest in regards to Item 6.3 on this agenda as a Lecturer at MIT. The Committee agreed that Dr Murphy would step down as Chair for this item and Mr David Collings would chair.
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2.3 ACRONYMS The acronym list was noted. 2.4 CONFIRMATION OF PUBLIC MINUTES Confirmation of the Public Minutes of the Counties Manukau Health Hospital Advisory Committee meeting held 6 May 2015. Resolution (Moved Ms Wendy Lai/Seconded Mr George Ngatai) That the public minutes of the Counties Manukau Health Hospital Advisory Committee meeting held 6 May 2015 be approved. Carried 2.5 PUBLIC ACTION ITEMS REGISTER The following items were verbally updated at the meeting: Orthopaedics Mr Martin confirmed that he met with Phillip Balmer & Wilbur
Farmilo yesterday to review progress and can confirm we are addressing the issues of unmet need and meeting our waiting time targets. Mr Balmer confirmed that the NZ Orthopaedic Association report on projections would be forthcoming to the next HAC meeting. This item to remain on the Action Item Register.
Tertiary Adjuster Mr Balmer gave the Committee an update on the tertiary adjuster and will report back on progress in another six months’ time (2nd December). This item to remain on the Action Item Register.
Resolution (Moved Dr Lyn Murphy/Seconded Dr Lee Mathias) That the Public Action Items Register of the Counties Manukau Health Hospital Advisory Committee be received. Carried (Dr Lee Mathias departed at 10.25am) 3.0 ALLIED HEALTH Mr Chadwick took the Committee through his presentation. A copy of the presentation is available on the CM Health website. 3.1 Drill Down into Allied Health • 40-odd professional groups fall under Allied Health. On their own they are usually small
professional groups. At CM Health they make up 22% of overall clinical staff. • Constraints:
o Sonographers – vacancy rate currently around 40%. Working with HWNZ on a programme running through the University of Auckland - hope to see graduates in six months’ time.
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o Anaesthetic Technicians – have become very engrained in our Model of Care to assist anaesthetists.
o Physio/OTs. In response to a question about how we can get more Maaori into pharmacy roles in Allied Health, Mr Chadwick confirmed that we currently have within Allied Health at CM Health 9% Maaori but not necessarily in pharmacy. The Health Could Be 4 You programme, Health academies and Health Expo are helping and we are just now starting to see some benefits from those programmes. Mr Collings suggested that the Southern Initiative could be another pipeline who could assist in getting more Maaori & Pacific students into health. Ms Lai commented that there has been a common theme in the today’s discussions around collaboration and working together. Mr Martin advised this is an area that he is currently looking at (ie) completing the rehabilitation model for the region the funding for which will come in part from ACC; the better public service area of pooling resources to get better value (ie) Mangere area. Margie Apa, Director Strategic Development is already thinking in this space. In relation to digitising, Mr Martin advised he has recently met with Ko Awatea to talk about how we set up a process to capture all the great work that is going on (ie) Ko Awatea currently provide all the e–learning for 8 DHBs and are also working in the social services and education fields in terms of building up capacity around the change processes we have developed here. Mr Martin confirmed that he would come back with an update in 2 months’ time. 4.0 DIRECTOR’S REPORT The section of the Director’s Report was taken as read. • Balanced Scorecard (page 46) – The Committee asked Mr Balmer to send their
congratulations to the teams involved in the Better Health Outcomes For All results for breastfeeding, smokefree advice and breastscreening as these targets are difficult to reach.
• Financial Summary (page 53) – YTD unfavourable revenue variances include $116k MIT, AUT
and Unitech training courses revenue deficit. Mr Chadwick advised he assumed this was just a timing issue. Margaret White to clarify at the next HAC meeting.
• Annual Leave Balances – The Committee asked for the GM Human Resources to attend the next HAC meeting to give an update in this area in relation to health & safety issues and confirm that we are doing all the things we should be doing in this area, that we are not necessarily higher or lower regionally and how much of an outlier we are in relation to other 3 regional DHBs.
• Mr Balmer to give some thought as to what other services the Committee could visit (ie) Renal. 4.1 Mental Health This section of the report was taken as read. • P&WCC Innovation & Excellence Awards (page 75) - The Committee asked Mr Balmer to pass
on their congratulations to Kitty Ko as winner of both the Judges and People’s Choice Awards for the poster she designed with staff from Affinity Services.
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4.2 Women’s Health & Kidz First This section of the report was taken as read. 4.3 Director of Midwifery Report This section of the report was taken as read. 4.4 Surgery & Ambulatory Care This section of the report was taken as read. 4.5 Adult Rehabilitation/Health of Older People This section of the report was taken as read. • Staff Influenza Vaccinations (page 112) – the Committee noted that only 27% of the ARHoP
workforce had received an influenza vaccination. Mr Balmer advised that that was an April report and as at 10th June the figures were: o Doctors 70% o Allied Health 65% o Nursing 64% o Midwifery 42% (were 35% last year) o Other 56%
• National Spinal Strategy and CM Health Spinal Service (page 114) – we have received more
spinal injuries that expected, almost double, coming from older people having spinal injuries from falls, motor vehicle and mountain bike accidents with certain regions seeing higher injury rates. Australia is also seeing a similar trend. The spinal unit is being reconfigured while we wait on further discussions in the Auckland region.
• Acute Allied Health Outpatient Waitlist Activity Graph (page 113) – it was noted that this graph is increasing. Mr Balmer advised that the numbers waiting for a longer period are decreasing, the numbers being added to the list are increasing and the numbers being seen are increasing. This tells us we are providing a greater level of service than last year and the demand is growing. As we transition to community based teams and an earlier supported discharge the demand on Allied Health will grow. The question as we do that is, are we ready for it and how do we know we are responding and people are not missing out.
Mr Balmer to ensure all graphs in the Director’s Report in future are shown as Control Charts with upper and lower control limits. 4.6 Medicine, Acute Care & Clinical Support This section of the report was taken as read. • Gastroenterology (page 119) – it was noted that the department continues to outsource
colonoscopies to reach the MoH targets and as a consequence other procedures are waiting longer which is clinically unsafe (ie) the wait time for a gastroscopy can be up to 40 weeks. Mr Martin advised that this item is on the Board agenda later today for discussion and confirmed that we will hit our targets by the end of this calendar year, it was originally planned to hit them by the end of this financial year however, it was decided to push it out slightly but they will be met by year end as it means better services for our patients.
(Dr Lee Mathias returned 11.30am)
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4.7 Non-Clinical Support Services This section of the report was taken as read. 4.8 Director of Nursing Report This section of the report was taken as read. 4.9 National Health Indicators – Radiology Progress Report This section of the report was taken as read. Resolution (Moved Dr Lyn Murphy/Dr Lee Mathias) That the Director of Hospital Services report be received. Carried 5.0 RESOLUTION TO EXCLUDE THE PUBLIC Individual reasons to exclude the public were noted. Resolution (Moved Ms Wendy Lai/Seconded Ms Dianne Glenn) That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000 the public now be excluded from the meeting as detailed in the above paper. Carried 12.03pm Public excluded session. 12.35pm Open meeting resumed. The meeting concluded at 12.36pm. The minutes of the Counties Manukau Hospital Advisory Committee meeting held on Wednesday, 17 June 2015 be approved. (Moved /Seconded ) Chair Dr Lyn Murphy Date
Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.
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Hospital Advisory Committee Meeting – Action Items Register – 29 July 2015
DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE
13.8.2014 3.1 Director’s Report Health & Safety Hazard Register to be tabled when compiled by OH&S.
Pending
Mr Balmer
10.9.2014 3.0 Orthopaedics –Mr Balmer to provide a copy of the NZ Orthopaedic Association projection report.
17 June/ 29 July
Mr Balmer 6.5.15 Mr Balmer advised this report was now available and would be presented at the 17
June HAC meeting.
3.12.2014 3.0 Acute Spinal Unit – spinal, burns & plastics are not classified as ‘tertiary’. In discussion with MoH & ACC around the acute levy paid to DHBs for complex acute care.
17 June
Mr Balmer
Mr Balmer provided a presentation on the Tertiary Adjuster at the 17th June HAC meeting.
25.3.2015 3.7 Drill down into Nursing 29 July Ms Kivell
17.6.2015 3.1 Allied Health Drilldown - report back on collaboration/working together models/ programmes including regional.
9 September Mr Martin
17.6.2015 4.0 Mr Balmer to give some thought as to what other services the Committee would visit such as Renal
29 July Mr Balmer Verbal update to be provided by Mr Balmer at today’s meeting.
17.6.2015 4.0 Tertiary Adjuster – Mr Balmer provided an update on the tertiary adjuster at the 17 June HAC meeting and will report back on progress in 6 months’ time.
2 December Mr Balmer
17.6.2015 4.02 Director’s Report – Balanced Scorecard – Annual leave update from the GM HR.
29 July Ms Beth Bundy
17.6.2015 4.03 Director’s Report – Financial Summary - YTD unfavourable revenue variances were noted including $116k MIT, AUT & Unitech training courses revenue deficit. Ms White to clarify at the next HAC meeting.
29 July Ms White This has been confirmed as a revenue timing issue.
HAC: 29th July 2015
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Counties Manukau District Health Board Nursing in Counties Manukau Health - Drill-down
Including Workforce Profile, Strategic Direction and Opportunities ___________________________________________________________________________
Recommendation It is recommended that the Hospital Advisory Committee note the report from the Director of Nursing. For the Drilldown on Nursing, here is some background information that will be further explored and referred to in the presentation, and creates opportunity for more discussion. Every Day at CM Health (on average…)
Definition – a Registered Nurse Nurses work with individuals, whaanau/ families and communities to provide:
• health education, • prevent illness, • and care for health consumers across the life-span.
Nurses also work in research, education, management and policy roles. Nursing Council of New Zealand Council of New Zealand
HAC: 29th July 2015
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Leadership & Performance
Profile – CM Health Nursing & Midwifery
Headcount & FTE
Workplaces
Note: Nursing Includes Enrolled Nurse but excludes Healthcare Assistants/ Hospital Aides Includes a calculated FTE for Bureau/ Casual roles
HAC: 29th July 2015
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Age Band profile
Largest numbers of Nurses are aged 30-39years. Average age of Nurses is 41.9 years, and Midwives is 45.2 years. Ethnic profile
HAC: 29th July 2015
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Compared to national data, have more staff identify as Asian or Pasifika. Now have more Nurses identify as Asian than any other group. Tenure / service at CM Health profile
Largest numbers of Nurses have worked at CM Health for 5-7 Years (16% or 419 staff) FTE profile
HAC: 29th July 2015
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Majority of Nurses and Midwives work 0.8-0.9FTE (39% of Nurses and 44% of Midwives). Senior Nurses more likely to work 1.0FTE (55%). Overall, 39% of Nurses are employed in 1.0FTE roles, 37% are employed in 0.8-0.9FTE roles and 24% less than 0.8FTE roles Roster Shifts 1,700 Nurses, Midwives & HCA are rostered to work per weekday
- 1,140 for a ‘am/ day’ shift 7am-3pm - Including Nursing staff in clinics, theatre, community etc - (444 for a weekend am shift)
- 330 for a ‘pm’ shift 3pm- 11pm (280 at weekend) - 235 for a night shift 11pm-7am
Also have 150 Clinical Nurse Specialists, Speciality Nurses across all clinical services 4 Nurse Practitioners Current Recruitment Recruit-able vacancy At the end of June, there were 129FTE Nursing/ Midwifery vacancy being advertised/ able to be recruited to. This is an increase from 93FTE in April 2015 New Starts In the 12 months from June 2014:
412 new Nurses – RN/ EN, Midwives and Snr Nurses commenced 382 in Directorate Hospital Services, of these:
Step 1: 126 Step 2-4: 60 Step 5: 136 (inc 50 to Bureau) Snr Nurses: 54 Enrolled Nurse: 6
Salary Band numbers by all Nursing/ Midwifery contracted FTE
HAC: 29th July 2015
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Graph represents the monthly contracted FTE by pay-scale steps from July 2013- May 2015. New Grads are represented in green and Senior Nurse in light blue. Students Opportunities Pipeline activity – Ko Awatea Health Science Academy, Volunteers programme and joint appointments with Tertiary providers. Undergraduate Nursing Programmes
• Bachelor of Nursing (BN), • Bachelor of Nursing Pacific (BNP) (MIT) • Diploma of Enrolled Nursing (DEN).
Big Day Out – offered for all MIT Y1 Nursing Students. A Welcome to CM Health (180 students over 2x4hr sessions).
• Includes a confidentiality agreement, orientate to Middlemore Hospital, visit a Clinical setting, complete challenges and a presentation on expectations of Students Professionalism.
Semester 1 2015, CM Health support 554 Nursing Student placements in:
• 337 MIT (plus the Big Day Out event) • 22 University of Auckland (UoA) • 12 Unitec • + 1 from AUT, Northtec and London Southbank University.
Dedicated Education Units These provide a • Medicine (Ward 2 – Cardiology, Ward 32 and Wards 33N/E – Gen Medicine, and Medical
Assessment Unit (MAU)) • ARHOP (Wards 4/5 HOP, and Wards 23/24 - Rehab) • Surgical (Ward 9 – Gen Surgery, Wards 10/11 – acute Orthopaedic, and Manukau Surgery
Centre (1st Floor & 2nd Floor elective surgical) • Mental Health (Ward 35 Koropiko/ MSHOP, Psych Liaison, Tiaho Mai) • Age Related Residential Care (Howick Baptist Hospital) • Perioperative Care DEU (Inter-professional Pilot with MIT Nursing and UoA 4th Year Medical
Students - being evaluated; Research commencing). • Potential for further units – eg Kidz First and primary care New Grad employment 119 New Grads at CM Health (largest total since Sept 2013). Jan 2015 Intake: total 67 graduates (4 Maaori, 10 Pacific) May 2015 Intake: total 14 graduates (3 Pacific) Enrolled Nurse opportunities 77 currently employed, expanding models and pipeline, including Emergency Care, Theatre and National Burns Unit and existing roles in ARHOP. Postgraduate Education Funding and Access Ko Awatea provide a range of in-service programmes accessed by Nursing staff, and mandatory (welcome day, annual updates, medication and resuscitation training) sessions – accessed via e-
HAC: 29th July 2015
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learning (LEARN), CTEC services, and also ongoing Improvement Science, Foundations of management and other programmes and workshops. There are 267 currently enrolled in HWNZ funded post-grad programmes
• 32 Masters, • 74 Post Grad Diploma • 157 Post-Grad Certificate
Via Auckland University, AUT, Massey and Whitirea Polytech Bureau Services Bureau are used for a variety of reasons, including known vacancies, unplanned leave (Sick, ACC, Jury, Bereavement), Special 1:1 Nursing, and some short-term roles. HCA staff are now predominantly being used for 1:1 watches (currently this is >50% of bureau HCA wok) Registered staff must have 2 years acute clinical experience in a variety of clinical settings, and most have more than 5 years. HCA staff must all be NZQA level 4 and above. Middlemore Central coordinate/ review all requests, and allocate Bureau to most areas (except Theatres), and from short-term projects. Women’s Health & Mental health schedule their own service pool. Permanent Bureau: Resource Team
• Registered Nurses and Health Care Assistants - permanent employees of CMDHB. • All resource staff are able to work in most areas of the hospital, and are rostered as other
permanent staff. CM Health Casual Bureau
• Middlemore Central is responsible for additional staff as casual workers. • Currently +/-120 Registered Nurses, 40 Midwives and 150 Health Care Assistants.
CM Health Service - specific Bureau
• Mental Health, Women's Health, MHSOP, Kidz First and Home & Community services. • Service specific ‘Bureau’ that enable staff to choose to work ‘casual hours’.
External Agencies
• Geneva (preferred provider contract) • Also use Medac, Medoc, and Zeal to provide additional capacity • External Agency nurses cannot be assigned to Isolation (eg MRSA/ ESBL) patients. • In June = 8FTE RN (12% of total) and 33FTE HCA (30% of total).
All internal Bureau staff complete a Nursing Council portfolio and have an annual appraisal, CM Health pays for annual practicing certificate costs. Internal casual Bureau staff receives an 8% loading in lieu of annual leave, and do not receive same entitlements as permanent staff. All bureau have a general orientation to CM Health, Internal bureau are provided with CM Health Uniform, computer/ e-learning access. Team are encouraged to participate in workplace training - 2 paid study days per year, and able to attend any courses offered by CM Health at no cost. A Sustainable Nursing workforce In the last year, we have developed and are providing integrated reporting of trends monthly for
Recruitment overview Leave and overtime rates Nursing Costs – including overtime, bureau
HAC: 29th July 2015
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Bureau utilisation (internal pool, watches/ specials & external) Roster Smoothing, Coaching/ mentors and training occurs in all services. Linkage with McKesson Upgrade and Modules is providing opportunity ongoing information and reports on hospital service activity.
Assignment & Workload Manager, Web Scheduler and Report Links to use of NHPPD for allocation/ deployment of rosters Benchmarking – internal, regional and with McKesson partners
Nursing is contributing to
HAC: 29th July 2015
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Counties Manukau District Health Board Perioperative Clinical Information System (PCIMS)
Business Case Sign off Recommendations It is recommended that the Hospital Advisory Committee: • Note this paper was approved by ELT on 23 June 2015. • Endorse the purchase a Perioperative Clinical Information System (PCIMS) and implement over
three years which includes: o the implementation of Intraop-operative module o the partnership agreement to develop and implement the Pre-operative module in
2015/16, o the partnership agreement to develop and implement the PACU and Pain modules with
Precept Health Ltd 2016/17 – 2017/18 years. • Endorse the preferred option of phasing the project over the next three financial years at a total
cost of $3.2M ($2,868,000 for the system & $375k for IPS and selection). • Note that CMH Asset and Capital has already approved & allocated $1,443,000 to this project
over the past 3 years. • Note the Project requests the following additional funding of$1.8M:
o 2015/16 – $500,000 (prioritised in 2015/16 FY) o 2016/17 - $800,000 (subject to capital prioritisation) o 2017/18 - $500,000 (subject to capital prioritisation)
• Note that the project has regional support from the CIOs, CEOs and CMO Groups to proceed with a different vendor to that of ADHB and WDHB.
• Note that the business case will be subject to NHITB approval. • Note that the project has investigated the opportunity provided through the Regional PAS/ EHR
project to assess whether the recommended Vendor (EPIC) could provide a solution. This solution does not meet the clinical requirements of CMH and is not a cost effective option to implement as a stand-alone application. It has been agreed by the regional CEOs/ CMO group as not being suitable for CMH at present.
• Note that the project will link with the following projects: o eReferrals o eMedication o Project Swift
• Note that the Project will phase the introduction of the system to the business o 2015 – 16 Implementation of the Intraop module & development of the Preop module o 2016- 17 Implementation of the Preop module & development & implementation of the
PACU (Post Anaesthetic Care Unit)& Pain Modules to Middlemore Hospital o 2017-18 Implementation of the PACU & Pain Modules to Manukau Surgery Centre
Prepared and submitted by: Phillip Balmer and Jenny Pooley, Project Manager on behalf of Surgical Services
This paper has been through HMT/P&CLT/CGG/ISGG ISGG Infrastructure Committee Asset & Capital Committee Regional CIO
Oct 14/ Feb 15 March 15/ May 15 April 15 Jan/ Feb 15
HAC: 29th July 2015
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Regional CEO/ CMO ELT HAC CMH Board NHITB
Jan 15 June 23rd July 29th July 29th To follow- Sept 15
Financial Implications Yes Finance have been consulted
Yes
HR Implications Yes HR have been consulted Preliminary 1. Purpose The purpose of this paper is to provide the Hospital Advisory Committee with an overall business case cost for the implementation of a Perioperative Clinical Information System (PCIMS) for CMH provided by Precept Health Ltd and seek endorsement to proceed. 2. Executive Summary Request for Procurement Process: Over the past 4 years CMH has been actively working to procure a fully integrated PCIMS that manages the surgical patient’s journey from assessment and placement on to the surgical waiting list to the completion of the procedure and discharge home or to the ward. The scope of the project also includes pain management and audit modules. CMH has led a robust, staged process (refer appendix 1) over the past few years to ensure that it achieves implementing an appropriate system that facilitates the flow of patient information and fulfills the clinical and business drivers (refer appendix 2) of CMH in particular, but also the wider region. The successful vendor chosen from this process is Precept Health Ltd. They are a NZ owned and operated company that are commercially successful both in New Zealand and internationally. They currently provide a national cardiology database across NZ and have multiple sites in Europe and Asia with ICU and PCIMS implemented. The company has demonstrated a strong and clear roadmap for product development and an overall growth strategy. They are currently undertaking a company re-structure to support this development. Regional Endorsement: The Northern region CEO/ CMO group endorsed the CMH proposal to proceed to a contract with Precept on January 16th, 2015 (refer appendix 3), with the proviso that CMH would explore the availability of an anaesthetic module as part of a Regional EHR, given the current plan to proceed to an implementation planning study (IPS) with EPIC for a Regional Patient Administration System (PAS)/Electronic Health Record (EHR).Extensive discussions with EPIC and health services in the US and UK have established that whilst EPIC does have an anaesthetic module it is not recommended that this module is implemented as a stand-alone system, or in advance of the EPIC EHR product. Alignment with Other CMH Projects: This project strongly aligns with the Project Swift initiatives of Point of Care and Orchestration of Care. The PCIMS Project aims to ensure relevant information is easily accessible and recordable at the point of care and across secondary care settings in order to improve patient health outcomes and reduce staff efforts. It will assist clinical staff with contextualised and personalised patient information that is accessible through devices at any point of care in patient’s surgical journey, requiring minimal duplication of data entry. It will also improve workflow for clinicians through automation of processes and a reduction in manual tasks required to facilitate care. The Project will also link with Medchart, ePrescibing and eReferrals to identify opportunities for alignment and mutual benefit. In addition, the project has ensured that this architecture is NIP
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(National Infrastructure Project)ready i.e. the systems architecture has been designed to meet NIP requirements however at this stage the project has been advised NIP will not be ready for any migration of applications for the next 12months as it is currently in the startup phase. Implementation timeline: CMH will directly procure the Intraoperative module from Precept. This process will include configuration of the system to meet CMH requirements. The development of pre-operative, post-operative and pain modules will be completed through an agile type design process which will involve CMH clinicians partnering with Precept to deliver a system that meets a wider market audience and also CMH requirements. 2015 – 16 Implement the Intra module to Middlemore and Manukau Surgery Centre.
Develop and implement the Preop Module 2016 – 17 Develop & implement the Post Anaesthetic Care Unit Module (PACU) and Pain
Modules at Middlemore 2017 – 18 Implement the PACU and Pain Modules at Manukau Surgery Centre Financial Impact:
• The total capital cost for this system is $3.2M ($2,868,000 for the system & $375k for IPS and selection).
• This equates to a further $1.8M over the next three years as $1,443,000 has already been approved through the Asset & Capital Committee.
• Operational costs equate to $212,605 per annum in year three. This equates to an increase in operational costs of $67k (year 1), $183k (year 2 i.e. an increase of $116k)), $213k (year 3 i.e. an increase of $30k))
These costs will be offset by a reduction in maintenance and licences fees and through other avenues such as a percentage of return on sales of the new modules. CMH has sought advice through the NZ Health Innovation Hub and the Ministry of Business, Innovation and Employment (MBIE) on how this process can best be managed. 3. Background CMH has led a robust procurement process for a PCIMS over the past 4 years. This process has included two comprehensive RFPs. The initial RFP looked to identify a provider of a PCIMS through direct procurement however after completing a high level Implementation Planning Study CMH withdrew from further contract negotiations as the vendor changed their pricing model making it operational unaffordable(in excess of $3.6M capital costs and $670k per annum operational costs). As a result of this process CMH learnt a number of valuable lessons, including that there were very few, if any, providers of a fully integrated perioperative clinical information system available in the Asia Pacific region and that the majority of existing systems were designed to be purchased as standalone modules, which few hospitals are able to afford due to the initial financial commitment to deliver the full suite of perioperative modules from any one vendor. This impacted on the flow and integration of data across the modules in a PCIMS. Consequently CMH elected to engage in discussions with the New Zealand Health Innovation Hub to investigate a partnership with a vendor who would be willing to consider working with CMH to develop a system that would meet the functional requirements of CMH and be a marketable solution to the local and international market. A market assessment by NZHIH had identified 4 possible vendors for inclusion in this process including GE, Dräger, Precept Health Ltd and Safer Sleep. Three of these vendors (GE, Precept and Safer Sleep) accepted the opportunity to participate in a Closed Competitive Dialogue Process.
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The successful vendor chosen from this process was Precept Health Ltd. They are a NZ owned and operated company that are commercially successful both in New Zealand and internationally. They currently provide a national cardiology database across NZ and have multiple sites in Europe and Asia with ICU and Anaesthetic Information Management Systems implemented. The company demonstrated a strong and clear roadmap for product development and an overall growth strategy. They are currently undertaking a company re-structure to support this development. The Precept product has proven integration with other CMH vendors (e.g. Carefusion and Orion and also has sites that integrate with the Zeus Anaesthetic machine). They do not have a working example of their perioperative system in Australasia and have therefore identified this as an opportunity to work with CMH to develop a product that is marketable in this region. They also have an ICU system (which WDHB are currently working with Precept to implement) and are keen to explore the opportunity of introducing an IT solution for Emergency Care. They have expressed an interest in developing CMH as a demonstration site for their products for the Asia Pacific market. Several other DHBs, including Northland DHB, have expressed interest in observing the development of this product for future opportunities. NDHB would like to provide clinical input to the CMH implementation and is also interested in Precept’s ICU system as a future option. CMH has since undertaken a high level implementation planning study to confirm cost with both healthAlliance and Precept Health Ltd. ISGG have been provided with an update of the process and requested regional support be re-confirmed as the initial regional support (refer appendix 4) to proceed was given in late 2012. Regional Approvals: The Northern region CEO/ CMO group endorsed the CMH proposal to proceed to a contract with Precept on January 16th, 2015 with the proviso that CMH would explore the availability of an anaesthetic module as part of a Regional EHR, given the current plan to proceed to an implementation planning study (IPS) with EPIC for a Regional Patient Administration System (PAS)/Electronic Health Record (EHR). Extensive discussions with EPIC and health services in the US and UK have established that whilst EPIC does have an anaesthetic module it is not recommended that this module is implemented as a stand-alone system, or in advance of the epic EHR product. The Regional PAS/ EHR Project may deliver a regional solution for the northern region over the next 5 - 10 years. However, given that CMH is to follow ADHB in the implementation of the PAS/EHR and that the PCIMS was not part of the original scope of the project and, if added, is likely to be at a later stage of the implementation, it is unlikely that this project will deliver a PCIMS to CMH within the next 5 years. The Northern region CIOs have also endorsed the proposal to proceed with Precept. Alignment with Other Projects: Project Swift The business case identifies significant opportunities for improving patient care aligning with several Project Swift workstreams. The system will enable the integration of information and workflow management to support the whole of system. It will enable clinicians to track patients through their journey and ensure that information is available real time. It will enable new ways of working; provide opportunities for monitoring clinical indicators, further research and audit to identify opportunities for improvement in patient care. eReferrals In the future the eReferrals project could potentially provide opportunities to develop pathways for patient information required for the preoperative health questionnaire assessments reducing duplication of effort by the patient, GPs and Hospital Clinicians. Access to patient information that
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has already been gathered from Primary Care through the eReferral may be able to be used to assist in streamlining patient care and in identifying those who require more complex care. ePrescribing WDHB are currently trialling ePrescribing in the non acute setting and any implications of the national roll out of this application will need to be considered by this project. The use of electronic signatures will also be explored for prescribing controlled medication in the intraoperative setting. This will be subject to a waiver from the MoH and requires further clarification as the new modules are developed. National Infrastructure Project (NIP) The design is NIP ready in that CMH and healthAlliance will have consulted with the NIP programmer team to ensure that the requirements are noted and documented. This will ensure the project will follow NIP requirements for infrastructure to facilitate ease of migration later and the servers are being placed in the recommended zones that are consistent with the NIP zoning system. 4. Proposal Implement the PCIMS over the next three financial years noting there is a 15% contingency applied across the project to allow for possible cost increases in hardware or changes in technology requirements and other development costs.
Yrs. Description Spend to date
Avail Capex $
2014/15
Additional Funding
Total $ excl. spend to date
Total Cost of Project over
6yrs 1 15/16 – Intraop &
Preop $375,000 $1,068,000 $500,000
2. 16/17 – PACU & Pain MMH
$800,000
3. 17/18 – PACU & Pain MSC
$500,000
$1,800,000 $2,868,000 $3,243,000 The staging of the business case to ensure that the Intraoperative and Pre-operative components are delivered in the first year will ensure that CMH maximizes the benefits of implementing this system. Ongoing development of the Pain Modules and PACU modules will complete the system and provide further opportunities for CMH to work collaboratively with a vendor to design a system that truly meets the clinicians’ requirements and can be marketed to a wider Asia Pacific audience. Recommendation: It is therefore recommended that CMH invest in a PCIM System over the next three financial years at a total cost of $3.2M (includes the Precept costs plus those spent to date for the IPS and site visits). This equates to a further $1.8M over the next three years as $1,443,000 has already been approved through the Asset & Capital Committee.
• Funds that have already been allocated and approved total $1,443,000 (Spend to date equates to $375k therefore remaining capex available = $1,068,000)
• 2015/16 - $500k for the 2015/16 year enabling implementation of the Intraop and Pre-op Modules (this amount has been prioritised in the 2015/16 planning round)
• 2016/17 - $800k to enable the development and implementation of the PACU and Pain modules at Middlemore.
• 2017/18 - $500k to enable the implementation of the PACU and Pain modules at Manukau Surgery Centre.
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• An increase in operational costs of $67k (year 1), $183k (year 2 i.e. an increase of $116k)), $213k (year 3 i.e. an increase of $30k))
This will enable the implementation of the intraoperative module and development of the Pre-operative module. The project team will gather the requirements for the Post-operative and Pain modules as the initial work is completed.
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Appendix One – Detailed Process This process has included a number of steps including: 1. An EIO in 2011 resulting in a closed RFP with the five selected vendors. 2. A regional Closed RFP process, led by CMH with these selected vendors
o Regional scoring based on regionally agreed criteria o Shortlisted to 3 preferred vendors by four regional DHBs o Product demonstrations and a split decision in preferred candidate o Withdrawal of ADHB and WDHB from the regional process given both DHBs have
significant level of sunken investment in current systems (refer appendix 2 for email of support from regional CEOs and CMOs)
o Withdrawal of NDHB due to financial constraints o Approval for CMH to proceed with the selection of a preferred vendor and site visits. o High level IPS with preferred Supplier, Medtel, resulting in a business decision to not
proceed with a commercial agreement given the significant increase in ongoing operating costs, implementation costs and concern regarding the company’s change in management structure and direction of the company.
3. A further assessment of the incumbent provider (Safer Sleep) at ADHB and WDHB, to assess further developments in the product and alignment with CMH requirements (Oct/ Nov 2013)
o CMH Clinicians continued to have significant concerns regarding the lack of a coordinated product development roadmap and demonstrated product advancement from the time of the initial product demonstration through to November 2013. The lack of flow of patient data from one module to another and significant amount of changes that would be required to support CMH processes also remained a concern. CMH provided Safer Sleep with a list of areas of concerns as part of this process which Safer Sleep tentatively agreed to work towards. However CMH was concerned about a perceived lack of responsiveness in the past to suggested changes by clinicians who work with the system in private.
4. Engagement and discussions with the NZ Health Innovation Hub (NZHIH) to assess the market for options to develop a partnership to co-develop an end to end PCIMS was also undertaken at the conclusion of the discussions with Safer Sleep
o CMH learnt a valuable lesson through the RFP process that there were very few affordable providers of a fully integrated perioperative clinical information system. Most systems are designed to be purchased as standalone modules and few hospitals were able to afford the initial financial commitment to deliver the full suite of perioperative modules from any one vendor. This impacted on the flow and integration of data across the modules in a PCIMS. CMH also learnt that a system that was significantly customised to CMH requirements would substantially increase the implementation and ongoing operational costs and made a conscious decision to ensure that any systems’ requirements would be beneficial to the overall product development and would reduce customisation to the CMH environment.
o As a result of this learning the Department of Anaesthesia and Pain elected to partner with the NZ Innovation Hub to identify potential vendors who would be willing to consider working with CMH to develop a system that would meet the functional requirements of both CMH and the international market.
o As a result of the work of the NZHIH, four vendors were engaged in initial discussions regarding the possibility of working together to co-develop a solution that was more tailored to the Asia Pacific market.
o After further discussions three vendors indicated they would be interested in pursuing a partnership. All vendors were informed that after advice from MBIE CMH would be required to run a closed competitive RFP.
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5. A Closed Competitive Dialogue process (CCDP) has been undertaken over the last 6 months.
ADHB and WDHB were not re-engaged in this process as they were undertaking an upgrade of their current system and it did not seem likely that they would be seeking a new provider of a PCIMS. o Advice was sought from the CMH Senior Legal Advisor to ensure a fair and transparent
process was adhered to. In response to this advice, CMH has a well documented process and outcomes from each meeting undertaken throughout. In addition there were several participants included in the evaluation panel who had not previously been involved in any EOI and RFP. This included the CEO and Analyst for the NZHIH, representatives from healthAlliance Procurement and IT teams and two clinicians.
o The CCDP included the submission of an initial partnership proposal, face to face meeting with each vendor, product demonstrations and the submission of a final proposal which included reference sites to contact. All steps in the process have been documented and proposal scored against agreed criteria.
o The outcome of the CCDP was to select Precept Health Ltd; a New Zealand based IT Company.
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Appendix 2 – Clinical Drivers & Benefits It is acknowledged that a PCIMS is a significant capital investment by CMH in information technology to support clinical practice and will be a critical enabler of the new clinical processes within the new theatre complex and beyond. Installing a PCIMS will enable and improve continuity of care and reduce clinical risks by: • Increased patient contact – currently information is entered manually and sometimes
retrospectively as there are a significant number of tasks to complete when anaesthetising a patient. The application extracts physiological data from the Anaesthetic machine and automatically loads it into the electronic record. The Anaesthetist can then add in medications, airway information, lines inserted etc. to provide a comprehensive record. Touch screens ensure the entering of data is quick and easy. A recent study1 by McLellan et al confirmed with progressive use of an automated anaesthetic record keeping system that these systems can significantly reduce the time taken to record patient relevant data supporting more patient contact time.
• Patient safety – In a review of literature of Anaesthetic Information Systems Chau et al (2011)2 stated that the major advantage of collecting data through the Anaesthesia Information Management System is that data that is consistent, legible and reliable. Multiple studies have shown that information technology can reduce the frequency of different types of errors and the frequency of associated adverse events. While the system records the physiological data the Anaesthetist is able to focus on the clinical tasks of providing the anaesthesia. The system will also have the ability to document alerts or make clinical comments that are relevant to the perioperative journey to reduce risks associated with ‘hidden’ information (e.g. previous anaesthetics at other hospitals or alerts that are documented within hand written notes). Opportunities also exist to monitor medication usage and potentially wastage, aligning this with departmental protocols (based on research and best practice guidelines) to ensure consistent management of certain anaesthetic events and potentially reducing adverse events.
• Communication – the availability of information across the perioperative journey will reduce the risks of the transfer of care from the preadmission or pre-operative assessment Anaesthetist to the procedural Anaesthetist. The information will be available at a local level i.e. within CMH Hospitals, at a regional level and have the potential to be used via a national clinical data repository. For example if the patient has a difficult airway to manage this will be documented as an alert within the system so the next time a patient has a surgical procedure this will be displayed on the patient record. The system will ensure that preadmission assessment information is readily available and provide opportunities for a more comprehensive assessment of acute patients.
• Pathway compliance, key performance indicators and adverse event monitoring – the collection detailed clinical data provides opportunities to implement clinical pathways, monitor adherence to agreed protocols undertake research and audit3,4. CMH are currently unable to produce meaningful clinical data to support reporting on pathway compliance or other clinical indicators. Opportunities exist to belong to the Australasian Council of Healthcare Standards Clinical Indicator Programme which will allow the Department to monitor the quality of clinical practice against other Healthcare organisations and international agreed best practice guidelines. In addition the quality of clinical data available through an electronic system is consistently
1 Benefits Measurement from the Use of an Automated Anaesthetic Record Keeping System (AARK) Sue McLellan1, Mary Galvin2, David McMaugh1 2 Using Real Time Clinical Decision Support to Improve Performance on Perioperative Quality and Process Measures; Chau, A; Ehrenfeld, J; Anaesthesiology Ckin 29 (2011) 57 - 69 3 Ehrenfeld J M, Anaesthesia Information Management Systems, Clinical and Operational Impact; Anaesthesiology News August 2010 4 Ehrenfeld J M, Anaesthesia Information Management Systems, Clinical and Operational Impact; Anaesthesiology News August 2010
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higher and more reliable assisting clinicians in understanding potentially causes of adverse events and therefore providing more opportunities to improve practice.
• Accuracy, completeness and legibility of the clinical record – practices vary across the service continuum in relation to the accuracy, legibility and completeness of data recorded in the paper form. A system that provides real time recording of physiological data which interfaces with the Patient Administration System and other key clinical applications and has mandatory fields will ensure that information is accurate and complete. The system will be designed to collect relevant clinical data and the more the Anaesthetist inputs into the system the more useful that data will be for the patient in the future and also when looking to review clinical outcomes etc.
• Decision support – Opportunities exist to introduce clinical alerts and decision making tools with
the collection of real time clinical data. It is acknowledged that this is still in the early development phase for most perioperative systems however there are significant opportunities to improve patient care and implement best practice5,6. It will also provide the Management team with robust data to base workload reports (e.g. the number of procedures with Anaesthetist support, the number of acute patients requiring a complete anaesthetic pre=op review) and theatre utilisation information and other key performance measures.
This project aims to achieve the following key objectives in alignment with the overall National Health IT Board eHealth vision:
Objective Deliverable 1. To provide a fully integrated electronic
clinical record of the patient’s surgical peri-operative episode of care including post-operative pain management.
An integrated electronic clinical record that pulls and stores identified relevant clinical information from other applications for the:
• Anaesthetic Preadmission • Intraoperative phase • Post-operative phases • Acute pain management phase
2. To provide opportunities for the patient to become more involved in the collection of their health information across the surgical continuum
Provide a patient portal to allow them to • complete an online health questionnaire • Confirm health information for current health status • access educational information • Reduce duplication of serial information collection
from the patient for different surgery episodes 3. To enhance patient safety through the
availability of clinical information across the perioperative journey and enable safe transfer of care (preadmission phase, intra-operative phase, post-operative phase, including acute pain management).
An integrated electronic clinical record that pulls and stores identified relevant clinical information from other applications for the:
• Anaesthetic Preadmission • Intraoperative phase • Post-operative phases • Acute pain management phase
4. To enhance patient safety through the collection and availability of clinical data to support clinical decision making, research and audit.
Installation of the Clinical Audit and Reporting Module to provide the clinical reporting and audit Real time capture of biophysical and drug administration data
5. Streamline administrative processes required to support the patient’s perioperative journey
Ensures quality of health information is complete and comprehensive
Reduces waste and duplication of personnel and processes due to incomplete information
Reduces ordering, retrieval, storage and transport of clinical records
One point of entry into system for anaesthetists
5 Ehrenfeld J M, Anaesthesia Information Management Systems, Clinical and Operational Impact; Anaesthesiology News August 2010 6 Wanderer J p, Sandberg W S, Ehrenfeld J M; Real Time Alerts and Reminders Using Information Systems; Anaesthesiology Clinics 2011,29:3
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Appendix 3 – Regional CEO/ CMO Draft Minutes January 16th, 2015 From: Sarah Prentice (NRA) Sent: 15 March 2015 13:20 To: Gloria Johnson (CMDHB) Subject: FW: Draft PCIMS Minutes for review Perioperative Clinical Information System Paper was taken as read. Justin Dimech and Helen Frith joined the meeting with key discussion points including:
• Note that CMH has been through the process twice to select a preferred vendor. This has involved Safer Sleep in both cases and in both instances this application has not meet the requirements
• Noted that accepting the preferred vendor Precept, will result in a second system in the region. • Noted that the paper describes the process and the rationale for this recommendation • Noted that subsequent to the paper being drafted, the preferred vendor recommendation for the
PAS/EHR IPS has been made which will now also need to take into consideration • Noted that the preferred vendor has both a theatre management and an anaesthetic module which
were out of scope for the Wicked Project and hence were not demonstrated or evaluated. • Agreed that CMH needs to pause and consider the option of obtaining a perioperative system as
part of a fully integrated EHR. There is an urgent need to evaluate whether the modules could meet the needs, whether they could be implemented as stand-alone modules, whether they could be implemented in CMH in advance of the HER, what the implications are for ADHB and WDHB who are currently utilising Safer Sleep etc.
• Noted that Precept’s ICU system is currently not implemented in NZ but have not discussed roll out to ICU. If doing site visits might pay to look at this modules also
• Agreed that Gloria Johnson would work with Wicked Project team to organise a demonstration and/or potential sites visit/s (possibly Cambridge or an Australian site) in the next fortnight to determine whether this is a preferred option or whether to continue with the recommendation to implement the Precept Health solution at CMH
• Noted the concern that CMH is currently in negotiations with Precept for an implementation by Easter and that a solution will need to be in place in advance of an EHR implementation
• Noted that CMH may also need to consider an interim solution if the EHR modules cannot be implemented on the current platform. Once potential option may be Precept’s Intraoperative module which is an off the shelf project that requires no development as an interim step until EHR implemented. This module is currently in around 100 sites internationally.
• Noted that the capex under the current recommendation is around $1.4m and will require NHITB sign off. CMH will need to signal to Precept that it will need to ensure that all likely questions/concerns from NHITB will need to be covered off in the request to NHTB for approval to progress and hence this may impact the current timeline
The CEO/CMO Forum:
• Endorsed the CMH recommendation to select Precept Health as the preferred supplier of a Perioperative Clinical Information Management System, subject to the review of the EHR modules
• Agreed that CMH should aim to complete the analysis of EHR models (and if required an interim solution) over the next 2 weeks and bring an updated paper toe CEOs/CMOs for sign off. Noted that this could potentially be done via email/conference call to avoid further delays to the process.
Actions
• Gloria Johnson/Wicked Project team to organise demonstration/site visits for relevant EHR modules to assess their ability to meet CMH’s requirements for PCIMS
• CMH to progress work to evaluate EHR modules as a potential PCIMS evaluation and bring an updated paper to CEOs/CMOs for endorsement following the completion of this analysis
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Appendix 4 – Regional CEO/ CMO Support 2012 From: Carolyn McElroy (ADHB) On Behalf Of Ailsa Claire (ADHB) Sent: Friday, 21 December 2012 14:39 To: '[email protected]'; '[email protected]'; Dale Bramley (WDHB); Andrew Brant (WDHB); Geraint Martin (CMDHB); Gloria Johnson (CMDHB) Cc: Ailsa Claire (ADHB) Subject: FW: Peri-Operative Information Systems Hi colleagues I hope the information below reflects what we have decided and can use for communicating a decision to your relevant teams. Please cascade as appropriate. We, CEOs and CMOs for the Northern Region DHBs, are committed to the alignment and standardisation of our processes and information systems to enable regional collaboration and improve the quality and efficiency of the services we deliver to our population. Collectively we have an enormous body of experience and expertise that presents us with the potential to improve health care delivery for our population as well as for New Zealand and beyond. Collaboration, alignment and trust between our organisations at all levels will allow us to share information and resources, learn from each other, and collectively target and share innovations. We acknowledge that in some exceptional circumstances sunken investment in processes and systems may be such that full regional alignment is neither practical nor affordable. Where such circumstances occur we will assess the validity to continue on separate paths by exception only. This does however not detract from our commitment that we expect all staff to strive for regional collaboration and alignment as much and as early as possible. Recently the regional CEOs and CMOs have reviewed the proposed way forward for our investment in Peri-Operative Clinical Information systems. We acknowledge that Waitemata DHB and Auckland DHB have an existing solution that is deeply embedded in their clinical process. Nevertheless a regional selection process has identified that an alternative solution will support the emerging needs of Counties Manukau and Northland DHBs better. In reviewing the situation, we have concluded that the cost and clinical process implications to force full regional alignment at this point in time is not in the interest of our patients and hence we have agreed that for the time being we will support investment in two information system solutions in this area moving forward. To minimise variation across New Zealand, the National Health IT Board has suggested that the Northern Region share the outcomes of our selection process and recommend that the two solutions that will be used in the Northern Region become the two preferred options available to all DHBs in NZ. We will engage in further discussions with the National Health IT Board to this effect. Kind regards, Ailsa Claire Carolyn McElroy - Executive Assistant Chief Executive Office Auckland District Health Board Level 4 Building 15, Greenlane Clinical Centre P: 09 630 9943 ext 26601 M: 021 555 423 F: 09 638 0347 (int) 26647 [email protected]
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5.0 Hospital Services Report
Recommendation It is recommended that the Hospital Advisory Committee receive the Hospital Services Report covering activity in June 2015 as follows: Prepared and submitted by: Phillip Balmer, Director Hospital Services Additional Acronym and abbreviations used in this report
ALOS Average Length of Stay ARHOP Adult Rehabilitation / Health of Older People Division ARRC Aged Related Residential Care ASRU Auckland Spinal Rehabilitation Unit AT&R Assessment Treatment and Rehabilitation AUT Auckland University of Technology BFHI Baby Friendly Hospital Initiative BSC Balanced Score Card CEO Chief Executive Officer CGS Community Geriatric Service CLAB Central Line Associated Bacteraemia CT/ FNA Computerized Tomography / Free Needle Aspiration (biopsy) DHB District Health Board DNA /DNR Did Not Attend Did Not Respond DOSA Day of Surgery Admission DRES Delivery Redesign Elective Services DSS Decision Support Service (within Health Intelligence & Informatics Ko Awatea) EAM Enterprise Asset Management EC Emergency Care e-MR Electronic Medication Reconciliation ETT Exercise Tolerance Test GP General Practitioner hA healthAlliance HBL Health Benefits Ltd HBT Home-based Team ISMP Institute for Safe Medication Practices KPI Key Performance Indicator LMC Lead Maternity Carer MAU Medical Assessment Unit (short stay areas) MECA Multi -Employer Collective Agreement MHSOP Mental Health Services Older people MIT Manukau Institute of Technology MORRSA Multidisciplinary clinic- Occupational Therapy, Physiotherapy & Nurse Specialist.
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MSC Manukau Super Clinic MRI Magnetic Resonance Image MRO Multi-Resistant Organisms MRSA Methicillin-resistant Staphylococcus aureus MSOP Musculoskeletal Outpatient Physiotherapy NASC Needs Assessment / Service Coordination NEQIP National Endoscopy Quality Improvement Programme NNU Neonatal Unit NZNO New Zealand Nurses Organisation ORL Otorhinolaryngology (Ear Nose Throat) PER Partnership in Evaluation towards Recovery (mental health service) POAC Primary Options Acute Care PSA Public Service Association PSH Practising Sustainable Healthcare PWCC Patient/ Whaanau Centred Care RAC Referral and Appointment Centre REAMHS Research, Evaluation and Audit - Mental Health Services RIS PAC Radiology Information System / Picture Archive & Communication RMO Registered Medical Officer SACS Surgical & Ambulatory Care Services STEMI- PCI ST segment elevation myocardial infarction (STEMI) - Percutaneous coronary
interventions (PCI). SUDI Sudden Unexplained Death of Infant TADU Theatre Admission/ Discharge Unit WH Women’s Health
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5.01 Executive Summary
Month in review: June
June was a very busy month with higher than expected EC volumes and inpatient discharges.
Elective casemix was complex, attributable in part to the work done to achieve the bariatric surgery goal of 158 operations.
All health targets were achieved
Diagnostic waiting time indicators and faster cancer waiting times were improved.
Bed occupancy was reduced as compared with forecast.
Budgets were achieved despite significant unfavourable variance in clinical support with increased outsourcing with diagnostics and gastroenterology.
Year in review: Achievements for 14/15
All Health Targets were achieved for every quarter and for the full year
Best Value for Health System Resources
• The Hospital Directorate achieved a $765k favourable result as compared with budget;
• EC Patient demand grew by 4.4%, or 4639 presentations which is equal to an additional 13 patients per day;
• Inpatient demand grew from 13/14 to 14/15 by 1,225 discharges in total and 1,537 acute discharges. This equates to 3.4 additional discharges per day and 4.2 additional acute discharges;
• The acute Wies went up by 4% from 0.78 Wies/ inpatient discharge to 0.8 Wies/ discharge;
• Despite the increased demand and complexity, we have seen only a 1.1% increase in the average Nurse Cost per Resourced Bed, which mirrors the nearly 1% increase in average occupancy. This is also achieved in part because of the focus on using internal redeployment to cover staff sickness rather than external bureau. Internal redeployment for example in June 15 as compared with June 14 has increased by 44% or 54 FTE.
• The increase in patient numbers has been managed with exactly the same number of resourced beds on average per month (i.e 719 beds) as compared with 13/14 which reflects the fact that while occupancy has increased resourced beds have not. The gap between occupied and resourced beds has reduced on an average of 6 beds per month.
• Goals to reduce outsourced volumes and improve net IDF volumes were largely achieved. Outsourced surgical elective volumes were reduced by 692 patients or 34.7% compared with the corresponding 13/14 financial year and the net IDF outflow was reduced by $4M.
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Improved Quality, Safety and Experience of Care
Safety
• Continued high performance in meeting national Quality and Safety Commission Quality Markers as shown below.
• Ongoing maintenance of care assessment and planning designed to minimise falls risk. • Ongoing performance in the completion of surgical safety checklist and significant
improvement in the three process measures to reduce the surgical site infection. • Hand Hygiene standards maintained in the five gold audit areas and Counties, unlike many
DHBs includes EC. • Retirement of the CLAB measure to make way for the medication safety measure
N.B. Medication Safety is a new measure this quarter. Counties is one of four DHBs that have implemented the electronic medication reconciliation tool. We introduced a quality and safety marker for medication safety in September 2014. It focuses on the task of medication reconciliation – a process by which health care professionals ensure all medicines a patient is taking are known and reviewed to ensure they are appropriate and safe. Doing this reduces the risk of medicines with potentially dangerous interactions being prescribed. A key first step to allow medication reconciliation to be done routinely and in a more straightforward manner is the introduction of an electronic system, known as electronic medication reconciliation (eMR). There is a national programme to roll out eMR throughout the country.
Patient experience
Counties continues to perform well when compared with the rest of the country on the patient experience measures. We are working on areas to improve this result.
HAC: 29th July 2015
38
Activity summary Emergency Care (EC) presentations June had 199 additional presentations (average seven per day) as compared with budget. YTD there have been 4,639 additional presentations as compared with budget or a 4.4% increase.
EC discharges against contract actual versus projected for 2014/15 - as agreed with the Funder Emergency care volumes in June 2015 were 9,195 presentations - 2.2% higher than this time last year and 1.8% higher than last month. Average daily volumes were 295. Results against the MoH 6 hour target were 96.0% for the month. YTD 14/15 contracted volumes have continued to grow at a rate greater than expected and as seen in previous years. We are progressing a range of initiatives with the community teams and primary care to curb this demand growth and more effectively improve patient outcomes.
Volumes Month: June YTD
Act Bud / Contract
Var Act Bud / Contract
Var
Emergency Care
Presentations (against last year) 9,195 8,996 2% 109,454 104,815 4%
Discharges (against contract) 9,119 9,053 1% 109,045 106,309 3%
N.B. Presentations refer to all people entering EC, while Discharges only include those that are admitted/ treated and includes a growth assumption on last year volumes (excludes a small number of cases that leave unseen, or are transferred).
WIES volumes actual versus projected for 2014/15 - as forecast (see below). June month WIES volumes (shown below) are as per the forecast/ funded agreement; 0.2% above for Acute and 5% above for Electives.
YTD WIES volumes are 3% higher than funded agreement (4% higher for Acutes and equal for Electives).
Month YTD
This YearFunder
Agreement
% Var To Funder
Agreement This YearFunder
Agreement
% Var To Funder
Agreement Acute ServicesWies 5,502 5,492 0% 68,572 66,165 4%
Elective Wies 1,552 1,472 5% 18,056 18,097 0%
TotalWies 7,053 6,964 1% 86,628 84,262 3%
Jun-15Jun-15
HAC: 29th July 2015
39
Patient volumes actual versus 2013/14 patient volumes (see below)
June:
• WIES volumes are up by 1% against last year (Acute 2%, elective 1%).
• Patient discharge volumes are on target against last year (Acute 0%; elective 1%), reflecting 24 more patients discharged for the month (Acute 8 and elective 16 discharges).
YTD:
• WIES volumes are up 2% on last year’s actuals (Acute up by 2%, elective down by (2)%);
• Patient discharge volumes are up 1% or 1,225 discharges on last year (Acute up 2% or 1,537 discharges; elective down (2)% or (312) discharges).
Month June-2015 YTD June-2015
This Year Last Year% Var to Last Year This Year Last Year
% Var to Last Year
Acute Services - WIES 5,521 5,414 2% 68,783 66,457 4% - Patients 7,173 7,165 0% 86,470 84,933 2%Elective Services - WIES 1,488 1,550 -4% 17,855 18,232 -2% - Patients 1,446 1,430 1% 16,888 17,200 -2%Total - WIES 7,009 6,965 1% 86,638 84,688 2% - Patients 8,619 8,595 0% 103,358 102,133 1%
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40
5.02 Balanced Scorecard (See definitions in Appendix A)
HOSPITAL SERVICES BALANCED SCORECARD
June 2015
NOTES
* performance is against 2013/14 actual~ YTD figures not applicable, or reliant on further work to establish a data set# YTD records Baseline (2013 audit) results∆ ESPI interim results subject to change^ Ambulatory Sensitive Hospitalisation rates and targets data from MoH - rates are standardised (100% national average). Data reported March/Sept
NATIONAL HEALTH TARGETS - hospital
month result trend Def
YTD Jun-15 Target Var Actual Target VarEmergency Care - 6 hour LOS target 96.0% 95% 1.0% 95.9% 95% 0.9% 28
% Cancer Treatment (ADHB Radiotherapy) in 4 weeks 100% 100% 0.0% 100% 100% 0.0% 30
Elective Access - discharges 106.3% 100% 6.3% 106.8% 100% 6.8%% smokers receive smokefree advice -Total 95% >95% 0.0% 95% >95% 0.0% 77
BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCES
month result trend Def
YTD Jun-15 Target Var Actual Target VarTotal Caseweight 7,009 6,964 1% 86,444 84,262 3% 1
Acute Caseweight 5,521 5,492 1% 68,783 66,165 4% 2
Elective Caseweight 1,488 1,472 1% 17,661 18,097 -2% 3
Total Discharges * 8,619 8,595 0% 103,131 102,133 1% 4
Budgeted FTEs 5,915 5,768 -2.5% 5,766 5,757 -0.2% 6
Operating Costs ($000) 26,055 23,603 -10.4% 296,553 279,066 -6.3% 7
Personnel Costs ($000) 51,228 45,742 -12.0% 538,330 539,636 0.2% 8
Financial Result Total ($000) -522 -1,164 $642 -6,239 -7,004 $765 9
Outpatient FSA Volumes* 6,890 7,739 -11% 90,076 91,754 -2% 10
Outpatient Follow Up Volumes* 20,477 21,453 -5% 257,753 261,651 -1% 11
Virtual FSAs (GP consult and nonpatient appointments) 195 240 -19% 3,362 2,885 17% 12
Reduce clinical outsourcing ($000) 1,905 1,151 -$754 17,867 14,701 -$3,165 13
HR metrics
YTD Jun-15 Target Var Actual Target VarExcess Annual Leave dollars ($000) - estimated cost for excess $2,884 $1,095 1,789-$ ~ 5
Adult Rehab / Health of Older People $51 $40 11-$ ~Medicine/ Acute Care and Clinical Support $640 $320 320-$ ~
Surgical/ Ambulatory Care $1,300 $411 889-$ ~Mental Health $250 $130 120-$ ~
Kidz First/ Women's Health $644 $194 450-$ ~
% Staff Annual Leave >2 years 5.0% 5.0% 5.0% 5.0% 14
Adult Rehab / Health of Older People 6.4% 5.0% -1.4% 3.3% 5.0% 1.7%Medicine/ Acute Care and Clinical Support 10.0% 5.0% -5.0% 9.6% 5.0% -4.6%
Surgical/ Ambulatory Care 15.8% 5.0% -10.8% 9.6% 5.0% -4.6%Mental Health 9.6% 5.0% -4.6% 8.7% 5.0% -3.7%
Kidz First/ Women's Health 16.6% 5.0% -11.6% 16.9% 5.0% -11.9%% Staff Turnover (YTD no. voluntary turnovers by average headcount) 0.8% 2.0% 1.2% 9.5% 10.0% 0.5% 15
% Sick Leave 2.8% 2.8% 2.8% 2.8% 16
Workplace Injury Per 1,000,000 hours 10.50 10.50 10.50 10.50 17
Where employees report a secondary identity Maaori, Pacific and Asian have been prioritised in that order. Var VarWorkforce Diversity - Leader data 2014 workforce population workforce population 19
Maaori 7% 16% -9% 6% 16% -10%Pacific 12% 23% -11% 9% 23% -15%Asian 28% 23% 5% 28% 23% 5%
NZ European / non-specified/ other 53% 38% 15% 57% 38% 19%
Ensu
ring
Fina
ncia
l Sus
tain
abili
tyEn
ablin
g Hi
gh P
erfo
rmin
g Pe
ople
Year to date
Year to date
Average last 12 months
Jun-15 Jun-14
Year
HAC: 29th July 2015
41
HOSPITAL SERVICES BALANCED SCORECARD
June 2015
NOTES
* performance is against 2013/14 actual~ YTD figures not applicable, or reliant on further work to establish a data set# YTD records Baseline (2013 audit) results∆ ESPI interim results subject to change^ Ambulatory Sensitive Hospitalisation rates and targets data from MoH - rates are standardised (100% national average). Data reported March/Sept
IMPROVED QUALITY, SAFETY AND EXPERIENCE OF CARE
NB data reported from Feb15 to align with patient safety report YTD Target Var Target Var% e-medication reconciliation -high risk patients within 48hrs 75% 80% -5% 67.0% 80% 0.13 20
% Serious Pressure Injuries rate / 100 Patients 0.0% <3.5% 3.5% 0.4% <3.5% 3.1% 21
Falls causing major harm rate / 1,000 bed days 0.08 0.00 -0.08 0.10 0.0 -0.10 22
Rate of adverse events rate / 1,000 bed days (Dec 14) 47.20 tbc 23
CLAB rate / 1,000 line days 5.20 0.0 -5.2 1.90 0.0 -1.90 24
Rate of S. aureus bacteraemia rate / 1,000 bed days 0.08 0.0 -0.08 0.04 0.0 -0.04 25
Q1 14/15 Target Var baseline Target Var% Operations - all 3 parts of the Surgical Safety Checklist used # 91% 90% 1% 86% 90% -4% 26
% 75+ years assessed for the risk of falling # 94% 90% 4% 97% 90% 7% 27
% 75+ years assessed for falls risk with falls intervention plans # 94% 90% 4% 92% 90% 2% 27a
YTD Jun-15 Target Var Actual Target Var% Radiotherapy commences in 4 weeks - National Health Target 100% 100% 0% 100% 100% 0% 30
% Chemotherapy commences in 4 weeks – National Health Target 100% 100% 0% 100% 100% 0% 31
% MRI scans completed within 6 weeks from referral - MOH IDP 40% 80% -40% 55% 80% -25% 33
% CT scans completed within 6 weeks from referral - MOH IDP 77% 90% -13% 71% 90% -19% 34
% urgent diagnostic colonoscopy within 14 days - MOH IDP 100% 75% 25% 75% 75% 0% 37
% diagnostic colonoscopy patients within 42 days - MOH IDP 43% 60% -17% 28% 60% -32% 38
% surveillance colonoscopy patients within 84 days - MOH IDP 79% 60% 19% 88% 60% 28% 39
% cardiac STEMI-PCI (angiography) <120mins - Northern Region 85% 80.0% 5% 82% 80.0% 2% 41
% Coronary Angiography within 90days - MOH IDP (1mth arrears) 100% 85.0% 15% 98.5% 85.0% 14%
ESPI 2: No. patients waiting >4 mths for FSA - Elective ∆ 0 0 0 0 0 0 42
ESPI 5: No. patients waiting >4 mths treatment - Elective ∆ 0 0 0 0 0 0 43
Radiology - Inpatient radiology completion times <24hrs 93% 95% -2% 92% 95% -3% 35
Radiology- Emergency Care radiology completion times <2 hrs 95% 95% 0% 95% 95% 0% 36
Acute Surgery Priority Score - delay for surgery 84% 80% 4% 80% 80% 0% 44
Q1 Target Var Actual Target VarFaster Cancer Treatment - % high suspicion first cancer treatment within 62 days - MOH FCT + target by 2016 78% 85% -7% 57% 85% -28% 45
Faster Cancer Treatment - % confirmed diagnosis first cancer treatment within 31 days - MOH FCT + 83% na 90% na 46
% Radiology results reported within 24 hours 52% 75% -23% 59% 75% -16% 47
YTD Jun-15 Target Var Actual Target VarAverage Length of Stay - Acute Inpatient - MOH IDP 2.69 2.98 0.29 2.64 2.98 0.34 50
Average Length of Stay - Acute Arranged/ Elective - MOH IDP 1.9 1.37 -0.53 1.65 1.37 -0.28 51
MMH % patients to discharge lounge or home by 1100hrs 16.0% 30% -14% 17% 30% -13%Acute Readmissions within 7 days - Total 2.6% 2.89% -0.3% 3.2% 2.89% 0.3% 52
Acute Readmissions within 28 days - Total - MOH IDP 5.6% 7.6% 2.0% 7.3% 8% 0.3% 53
Acute Readmissions within 28 days - 75+ years - MOH IDP 8.5% 11.85% 3.4% 10.7% 11.85% 1.2% 54
EC Presentations - 75+ year olds (5% reduction on 2013) 949 807 -142 11,130 7,263 -3867 55
% clinical summaries (meddocs) authorised <7 days of creation 73% 95% -22% 72% 95% -23% 56
% of patient outliers - not on home ward <5% 3.5% 5.0% 1.5% 4.2% 5.0% 0.8% 58
Health Quality and Safety QSM - QUARTERLY AUDIT REPORTING
Year to date
QUARTERLY REPORTING
Syst
em In
tegr
atio
n (E
ffec
tive)
Tim
ely
Firs
t, Do
No
Harm
(Saf
ety)
Year to date
Year
Year to date
Year
HAC: 29th July 2015
42
HOSPITAL SERVICES BALANCED SCORECARD
June 2015
NOTES
* performance is against 2013/14 actual~ YTD figures not applicable, or reliant on further work to establish a data set# YTD records Baseline (2013 audit) results∆ ESPI interim results subject to change^ Ambulatory Sensitive Hospitalisation rates and targets data from MoH - rates are standardised (100% national average). Data reported March/Sept
Q4 Target Var Actual Target Var
% Eligible stroke patients thrombolysed - Northern Region 6.1% 6.0% 0.1% 7.0% 6.0% 1.0% 59
% DHB Mental Health Services - children/ youth (0-19years) seen by 3 weeks for non-urgent mental health - MOH IDP 77.2% 75.0% 2.2% NA 75.0% #VALUE! 48
Mental Health access rate - clients seen in last 12 months as % of population (0-19 Years) 3.69% 3.15% 0.5% NA 3.15% #VALUE! 49a
Mental Health access rate - clients seen in last 12 months as % of population (20-64 Years) 3.94% 3.15% 0.8% NA 3.15% #VALUE! 49b
Mental Health access rate - clients seen in last 12 months as % of population (64+ Years) 2.61% 2.70% -0.1% NA 2.70% #VALUE! 49c
Ambulatory Sensitive Hospitalisation rates - MOH IDP ^ 2014/15 Q40-4 years - Total 102% 101% 1.0% 60
0-4 years - Maaori 113% 118% -5.0%0-4 years - Pacific 150% 118% 32.0%0-74 years - Total 119% 114% 5.0% 60a
0-74 years- Maaori 190% 119% 71.0%0-74 years- Pacific 182% 119% 63.0%
YTD Jun-15 Target Var Actual Target VarOutpatient - First Specialist : Follow-up Clinic ratio 34% 36% 2% 35% 35% 0% 61
Outpatient - DNA rates - Maaori 12% 10% -2% 11% 10% -1% 62
Outpatient - DNA rates - Pacific 9% 10% 1% 8% 10% 2% 62a
Theatre List Utilisation 86.9% 90.2% -3% 84.6% 87.7% -3% 63
Day of Surgery Admissions (DOSA) 92% 90% 2% 91% 90% 1% 65
Day Case Rate (Elective/ Arranged) 61.4% 65% -4% 60.3% 65% -5% 66
% Medical Assessment patients with LOS < 28 hours 99% 65% 34% 99% 65% 34% 68
No. Hospital bed days occupied (against forecast open beds) 19,908 21,448 8% 239,057 205,148 -14% 73
No. Length of Stay outliers (LOS >10 days)* 258 265 3% 3,330 3,380 2% 74
YTD Jun-15 Target Var Actual Target VarPatient Experience Survey (rated very good/ excellent) 81% 90% -9% 80% 90% -10% 75
Better Health Outcomes For All
YTD Jun-15 Target Var Actual Target Var% Infants Exclusively Breastfed at discharge - Total 88.0% 75% 13% 83.0% 75% 8% 76
% Infants Exclusively Breastfed at discharge - Maaori 84.0% 75% 9% 82.0% 75% 7%% Infants Exclusively Breastfed at discharge - Pacific 86.0% 75% 11% 80.0% 75% 5%
% smokers receive smokefree advice - Maaori 95% 95% 0% 95% 95% 0% 77
% smokers receive smokefree advice - Pacific 94% 95% -1% 95% 95% 0%
% Women (45-60yrs)with Breastscreen in 24months - Total 2416 2160 256 70% 70% 0% 78
% Women (45-60yrs)with Breastscreen in 24months - Maaori 240 253 -13 69% 70% -1%% Women (45-60yrs)with Breastscreen in 24months - Pacific 475 378 97 77.8% 70% 8%
% Screened in last 24 monthsVolumes Screened
Equi
ty
Year to date
Year to date
Patie
nt
Wha
anau
Ef
ficie
ntSy
stem
Inte
grat
ion
(Eff
ectiv
e)
QUARTERLY REPORTINGYear
(n = 192) Year to date (n = 2060)
HAC: 29th July 2015
43
5.03 Financial Summary Best value for public health system resources
The Provider Arm produced a $1.2m deficit for the month, reporting a favourable result against budget of $642k for June 2015. This contributes to the consolidated DHB variance of $2.8M favourable to budget for the month.
Volumes in Emergency Care for the month of June were 9,119 discharges versus 8,891 last year, 3% higher than previous year. Inpatient volumes were up <1% on last year, driven by acute <1% and 1% elective volumes. WIES activity was up 1% on contract (1% acute and 1% elective) but remains on contract YTD at 3% favourable (4% acute, (1)% elective).
Demand for Clinical Support services (radiology, labs and drugs) and Medical Services (renal and gastro) have increased significantly this financial year. This is reflected in the divisions’ performance at year end.
The delayed uptake for healthAlliance procurement and HBL Laundry contributed to the cost pressures within the DHB. Deployment of nursing and bed projects have ensured YTD delivery to budget despite the level of acute demand (vs contract/budget).
The YTD result includes a favourable $4M CMH final IDF wash-up as advised by MoH ($1.035M IDF inflow revenue was recognised in May).
Note that YTD revenue also includes $912k IDF revenue for Spinal Cord Impairment (SCI) acute spines, reflecting the MOH proposal for a supplementary payment in additional WIES. This has been confirmed by MOH. We have treated 35 CMH SCI’s at an estimated cost of $400-450K.
The year end result includes a number of year-end adjustments to recognise actuarial adjustments reviewed as at 30 June.
HAC: 29th July 2015
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Financial Performance
Fig 1
Variance Result:
XX F = favourable variance to budget, (XX) U = unfavourable to budget
Actual Budget Variance Comparative Actual Budget Variance
$(000) $(000) $(000)Variance to Prev Mnth $(000) $(000) $(000)
Income
Government Revenue 7,726 4,264 3,462 F 57,478 51,975 5,503 F
Patient/Consumer Sourced 746 700 46 F 9,507 8,703 804 F
Other Income 3,039 2,062 977 F 23,989 21,227 2,763 F
Funder Payments 65,250 60,816 4,434 F 737,669 729,794 7,875 FTotal Income 76,761 67,842 8,919 F 828,643 811,698 16,945 F
Expenditure
Personnel 51,228 45,742 (5,486) U 538,330 539,636 1,306 F
Outsourced Personnel 2,001 889 (1,112) U 16,699 10,603 (6,096) U
Outsourced Clinical 2,138 1,296 (842) U 20,500 16,440 (4,060) U
Outsourced Other 2,993 2,372 (622) U 30,921 28,507 (2,413) U
Clinical Supplies (excluding Depreciation) 13,653 8,191 (5,462) U 109,873 97,145 (12,728) U
Other Expenses 1,371 5,296 3,924 F 60,747 63,715 2,967 FTotal Expenditure (excl Depreciation, Interest and Capital Charge) 73,385 63,786 (9,600) U 777,070 756,047 (21,023) U
Earnings before Depreciation, Interest and Capital Charge 3,376 4,057 (681) U 51,573 55,651 (4,078) U
Depreciation 975 2,846 1,871 F 30,033 34,157 4,124 F
Interest 954 1,280 326 F 12,506 15,364 2,858 F
Capital Charge 1,969 1,095 (875) U 15,273 13,134 (2,139) U
Total Depreciation, Interest and Capital Charge 3,898 5,221 1,323 F
57,812 62,656 4,843 F
Net Surplus/(Deficit) Provider (522) (1,164) 642 F (6,239) (7,004) 765 F
Month Year to DateConsolidated Statement of Financial PerformanceJune 2015
HAC: 29th July 2015
45
Financial Performance
Fig 2
Fig 3
Actual Budget Variance Comparative Actual Budget Variance
$(000) $(000) $(000)Variance to Prev Mnth $(000) $(000) $(000)
Clinical
Women & Child Health (6,045) (5,689) (357) U (67,473) (67,698) 224 F
Medical & Clinical Support (17,559) (17,009) (550) U (205,927) (203,689) (2,238) U
ARHOP (4,487) (4,550) 63 F (53,648) (54,579) 931 F
Mental Health (5,655) (5,662) 7 F (67,591) (68,118) 527 F
Surgical & Ambulatory (15,678) (15,952) 274 F (181,849) (184,937) 3,087 F
Director of Nursing (248) (17) (231) U (226) (204) (21) U
Middlemore Central (374) (342) (33) U (4,312) (4,127) (185) UTotal Clinical (50,046) (49,220) (826) U (581,025) (583,351) 2,326 F
Non-ClinicalCorporate (incl Provider Arm Revenue from Funder) 56,884 53,438 3,447 F 646,924 642,069 4,855 F
HBL (668) 87 (755) U (2,347) 286 (2,633) U
Health Alliance - 472 (472) U - 5,000 (5,000) U
Facilities Services (4,296) (4,018) (278) U (47,139) (47,843) 704 F
Integrated Care (848) (805) (43) U (9,155) (9,665) 510 F
Innovations Hub & Ko Awatea (1,548) (1,119) (429) U (13,497) (13,500) 3 FTotal Non-Clinical 49,524 48,056 1,468 F 574,786 576,347 (1,561) U
Net Surplus/(Deficit) Provider (522) (1,164) 642 F (6,239) (7,004) 765 F
Month Year to Date
Performance Summary by DirectorateJune 2015
Actual Budget Variance Comparative Actual Budget Variance
$(000) $(000) $(000)Variance to Prev Mnth $(000) $(000) $(000)
Medical Personnel 18,436 15,034 (3,402) U 173,447 175,382 1,935 F
Nursing Personnel 18,647 16,952 (1,696) U 205,726 200,875 (4,851) U
Allied Health Personnel 6,547 6,712 165 F 77,148 80,088 2,940 F
Support Personnel 2,244 2,071 (173) U 24,829 24,193 (636) U
Management/Administration Personnel 5,354 4,974 (380) U 57,181 59,099 1,918 F
Total (before Outsourced Personnel) 51,228 45,742 (5,486) U 538,330 539,636 1,306 F
Outsourced Medical 1,159 443 (717) U 8,863 5,299 (3,564) U
Outsourced Nursing 222 48 (174) U 1,957 481 (1,476) U
Outsourced Allied Health (63) 70 134 F 522 844 322 F
Outsourced Support (121) 37 159 F 368 452 84 F
Outsourced Mangement/Admin 805 291 (514) U 4,989 3,527 (1,462) UTotal Outsourced Personnel 2,001 889 (1,112) U 16,699 10,603 (6,096) UTotal Personnel 53,230 46,631 (6,598) U 555,029 550,240 (4,790) U
Month Year to Date
Personnel Costs By Professional GroupJune 2015
HAC: 29th July 2015
46
Fig 4
Fig 5
Actual Budget Variance Comparative Actual Budget Variance
FTE FTE FTEVariance to Prev Mnth FTE FTE FTE
Medical Personnel 794 787 (6) U 775 788 13 F
Nursing Personnel 2,699 2,549 (151) U 2,631 2,541 (90) U
Allied Health Personnel 1,106 1,121 15 F 1,089 1,124 35 F
Support Personnel 499 482 (17) U 485 475 (10) U
Management/Administration Personnel 816 828 12 F 785 828 43 F
Total (before Outsourced Personnel) 5,915 5,768 (147) U 5,766 5,757 (9) U
Outsourced Medical 42 16 (26) U 27 16 (11) U
Outsourced Nursing 20 4 (15) U 14 4 (11) U
Outsourced Allied Health (5) 5 10 F 3 5 2 F
Outsourced Support (23) 7 31 F 6 7 1 F
Outsourced Mangement/Admin 99 36 (63) U 51 36 (15) UTotal Outsourced Personnel 132 69 (64) U 101 68 (33) UTotal Personnel 6,047 5,836 (210) U 5,867 5,825 (42) U
Month Year to Date
FTE By Professional GroupJune 2015
Actual Budget Variance Comparative Actual Budget Variance
FTE FTE FTEVariance to Prev Mnth FTE FTE FTE
ClinicalWomen & Child Health 733 676 (57) U 710 677 (34) UMedical & Clinical Support 1,645 1,569 (76) U 1,600 1,562 (38) UARHOP 640 644 5 F 637 646 9 FMental Health 654 684 30 F 660 684 24 FSurgical & Ambulatory 1,420 1,384 (36) U 1,397 1,384 (13) UDirector of Nursing 14 13 (1) U 13 13 (0) UMiddlemore Central 56 48 (8) U 51 48 (3) UTotal Clinical 5,161 5,018 (143) U 5,067 5,014 (54) U
Non-ClinicalCorporate (incl Provider Arm Revenue from Funder) 91 106 14 F 93 105 12 FFacilities Services 464 459 (5) U 453 452 (1) UIntegrated Care 138 113 (24) U 115 114 (1) UInnovations Hub & Ko Awatea 193 140 (53) U 139 140 1 FTotal Non-Clinical 886 818 (68) U 800 811 11 F
Net Surplus/(Deficit) Provider 6,047 5,836 (210) U 5,867 5,825 (42) U
FTE by DirectorateJune 2015 (including Outsourcing)
Month Year to Date
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47
Financial Performance Trends
HAC: 29th July 2015
48
Month Result
Major variances for the Provider Arm Statement of Financial Performance (Fig. 1) follow:
Revenue is $8.9M favourable for the month of June. The main drivers for the current month’s variance are:
• Government Revenue $3.5M; CTA Nursing timing of revenue to budget $(13)k, ACC revenue phasing reflects a $(122)k variance for the month (YTD $19k); Outsourced Gastro MoH funding $35k; integrated Care (offset by costs) $3.2M; PCT revenue $337k; other $25k.
• Patient/Consumer Sourced $46k; Tahitian burns $(150)k; Non-resident additional billings for the month $151k (offset by bad debts); other $45k.
• Other Income $977k; The June favourable variance includes donation revenue $(464)k; Pharmac rebate received $386k and Mana Kidz Research $199k. The balance of $856k, is attributable to additional income received for interest, MH Youth Forensic and Maternal MH, Surgical external services, and 20k days funding.
• Funder Payments $4.4M; Variation in revenue phasing from Funder for contracts outside base funding. ie: 20k days, localities and net IDF washup $4M.
Expenditure – Total expenditure is unfavourable by $(9.6)M. Major variances are explained below:
• Personnel costs Personnel costs are $(5.5)M unfavourable for June.
Key variances include unrealised Practicing Sustainable Health Care procurement savings for the month $(353)k. A measure of these costs has been offset by planned management of vacancies and annual leave.
Medical Personnel costs for the month, $(3.4)M, actuarial revaluation $(381)k; and existing vacancies.
Nursing personnel costs for the month $(1.7)M; Reflects target savings that have not been met due to the level of clinical demand within the hospital $(263)k. The main drivers for the balance of the nursing cost overspend are year-end actuarial adjustments, nursing course fee overspend and bureau usage costs. Please refer to Director of Nursing report for update on the Sustainable Nursing Workforce Strategy.
Note that the Personnel cost variance above includes costs incurred in delivering additional unbudgeted revenue of $331k.
• Outsourced Costs are $(2.6)M unfavourable for June (includes personnel, clinical and other). Outsourcing to cover key vacancies (eg Mental Health) and clinical services where we are short on specialist capacity (mainly gastro services and kA outsourced contracts), $(1.1)M for the month.
Clinical Support $(219)k. Additional outsourcing of MRI and CT scans to meet MOH targets and labs overspends to meet volume demand. Medicine, $(403)k. Outsourced gastro colonoscopies required to meet MOH targets.
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Surgical, $(462)k. Outsourced surgical procedures continue to maintain MoH ESPI 120 day targets. Mental Health $(214)k. Vacancies covered by locums. Non-Clinical Outsourcing, $(119)k. Pacific Health outsourced costs, offset by revenue. HBL, $(613)k. National Procurement, FPSC, write off of Linen/Laundry business case costs $(630)k. Integrated Care, $(162)k. Additional outsourcing costs offset by revenue. Ko Awatea, $(447)k. kA outsourced contract work to June 2015.
Clinical Supplies $(5.5)M unfavourable for the month. Unrealised procurement savings across the services $(708)k are partially offset in other cost and revenue areas. Integrated Care, $(2.96)M, costs offset by revenue. Clinical Support, $(507)k. Volume increase in Labs, Pharms and radiology based on surgical services volumes. Surgical Services, $(214)k. Unfavourable variance was driven by an increase of acute and elective WIES in excess of budget for the month. ARHOP, $(65)k. Community continence, ostomy and bandages & dressing overspends. Non-Clinical year-end adjustment to inventory, $(900)k. Other, minor underspends across divisions, $(154)k.
• Other expenses are $4M favourable for June explained by delayed target laundry procurement savings across the services $(143)k; Utilities overspend $(85)k; Bad Debts offset by revenue $(120)k; R&M Overspend $(221)k; rent received $(123)k; minor equipment purchases $(141)k; Consultants $(128)k mainly kA additional course fees.
• Depreciation, Interest and Capital Charge costs are $1.3m favourable due to; CMDHB level of borrowings lower than budget delivering a $297k favourable interest cost variance for the month. Capital Charge unfavourable variance of $(875)k reflects the actual cost of capital charged by MoH against budget YTD. Depreciation $1.8m favourable variance due to a reduction in cost based on a review of asset base.
Year-to-date Result
The YTD result is $765k favourable to budget, with volumes tracking at 103% of base contract (Actual 86,638 WIES vs Contract 84,262 WIES). YTD key variances are detailed below.
Revenue YTD is $17M favourable in June 2015. Positive revenue variances include:
• $4.2M Integrated Care additional revenue, offset by cost • $388k MoH unbudgeted contracts incl Radiology Service Improvement Initiative • $351k CTA phased revenue • $1.0M PCT revenue (offset by pharmacy overspends). • $453k Gastro MoH funding for outsourced procedures to meet MoH targets. • $2.4m Increase in Non-Resident billings (offset 80% by Bad Debt provision). • $1.8m Interest income received over budget (reflecting cash holdings higher than budget). • $254k Bad Debt recovery • $1.7M Other income offset by cost
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• $7.9m Funder payments for contracts outside base funding, offset by expenditure – includes IDF inflow washup 2014/15 $4M and SCI Acute Spines (35 spines YTD) $912k.
• $774k Other
YTD unfavourable revenue variances include:
• $(683)k Personal Health revenue variance for breast screening (offset in full in cost savings). • $(792)k Smokefree funding not received (offset by expense) • $(1.7)m YTD reduction in private patients revenue including Tahitian burns patients. • $(1.1)M Donations short fall.
Expenditure YTD is $(21)M unfavourable to budget, representing $1.3M personnel costs and $(22.3)M other expenses. Major variances to June are:
• Personnel costs $1.3M, (9)FTE (excludes outsourced) – Reflects a deliberate strategy to balance overall 2014/15 budget expectations. The favourable variance is primarily driven by a high level of vacancies (236FTE YTD) that exist across the organisation (representing 4.1% of budget FTE). This is partially offset with unrealised Practicing Sustainable Health Care procurement savings year to date, $(3.7)m.
• Outsourced services $(12.6)M – primarily reflects cover provided for vacancies $(6)M (offsets favourable personnel costs); Corporate Services $(2.4)M including expensing of unbudgeted HBL Linen project costs; Lab sendaways and surgical outsourcing services $(4)M.
• Clinical Supplies $(12.7)M – Delayed target procurement savings across the services of $(7.8)m are partially offset in other cost and revenue areas. Clinical Support drug overspend $(1.3)M partially funded by revenue; labs volume increases mainly in microbiology and bloods $(1.5)m; radiology supply variance in shunts/stents and treatment disposables $(470)k. Medicine, $307k mainly due to a reduced cath lab volumes. Surgical Services are $1.7m favourable due to reduced ACC elective work performed, absence of Tahitian Burns patients and achievement of a level of procurement savings (partly offsetting $7.8m YTD provider arm target). Strategies are in place to reduce elective volume over production based on previous year which has lead to lower YTD clinical supply costs. Clinical Engineering underspends $407k for Clinical Equipment R&M. ARHOP community continence, ostomy and dressings $(538)k. Integrated care, offset by revenue $(2.5)M. Non-Clinical year-end inventory adjustment $(900)k. Other $(106)k.
The above variance includes clinical supply costs incurred in delivering additional unbudgeted revenue: Pharmaceutical Cancer Treatment $1M and Non Residents $726k (calculated as 30% of additional Non-resident revenue). Spinal implants costs are estimated at $420k YTD.
• Other Expenses 3M – primarily reflects Facilities savings $616k in patient meals, repairs and maintenance and utilities; Integrated Care YTD underspend $1.2M (offset against unfavourable revenue); Bad debts $(2)M (offset by Non-Resident revenue); unrealised laundry procurement savings $(1)M; Ko Awatea $386k corporate training cost underspend; Corporate Records software costs $(360)k; ARHOP R&M $(347)k; office expenses overspend $(229)k.
• Depreciation, Interest and Capital Charge $4.8M favourable YTD.
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FTE - Full Time Equivalents FTE
Total FTE (including outsourced) for June is 6,047 which is (210) FTE unfavourable to budget and 118FTE lower than last month.
The June FTE variance reflects high levels of vacancies, 216 FTE within the services due to the absence of available skilled workforce within some specialities. Cover has been provided in overtime (51)FTE, bureau (85)FTE, casuals (57)FTE and external outsourcing (132)FTE.
Planned and unplanned leave during the month are: annual leave (111)FTE, sick leave (42)FTE and study leave (12)FTE. Other miscellaneous movements for the month were 76FTE.
CMH have employed an additional (47)FTE, which are unbudgeted but have been funded externally.
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2014/15 Practising Sustainability Healthcare Programme
The approved 2014/15 DAP includes a commitment to Provider Arm target savings of $23m for FY 2014/15. This sits within a $37.7m whole of DHB savings plan. The unfavourable YTD variance is balanced by offsets and mitigations outlined below:
hA/HBL procurement savings targets (primarily clinical supplies) YTD savings reflect value spend in areas monitored under the Procurement strategies. This reflects a mix of price and volume variances. These savings plans are reported in more detail in the Practising Sustainable Healthcare (PSHC) monthly report. hA/HBL procurement is now expected to deliver savings of $5.5m (originally $8.1m), resulting in a variance to target of $2.6m. This variance will be mitigated by continued management of discretionary expenditure and FTE.
PSHC Savings Summary - Provider Arm Variance Comparative
YTD June 2015 $(000)Variance to
Target
Revenue / Expenditure initiatives
hA/HBL procurement savings targets (primarily clinical supplies) (2,569) U
HBL Linen & Laundry savings plan (2,013) U
Reduce surgical outsourcing (services) (2,000) U
Reduce Bed Day demand (clinical supplies & personnel) (1,000) U
Clinical staffing skill mix realignment (4,828) U
Management & Admin Review 456 F
Other initiatives (1,158) U
Total Provider Savings Variance (13,112) U
Offset and Mitigation
New Revenue - IDF inflow washup 2014/15, non resident billings 14,464 F
Personnel Costs - planned management of vacancies and annual leave, net of locums and bureau staff
83 F
Outsourced Personnel (0) U
Outsourced Clinical (2,060) U
Outsourced Corporate - hA and HBL additional services post budget (2,622) U
Outsourced Corporate - Other 208 F
Clinical Supplies (6,691) U
Other Expenses 5,651 F
Depreciation, interest and capital charge 4,843 F
Net Surplus/(Deficit) Provider 765 F
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5.04 Hospital Activity Overview Overview of the Hospital - National Health Targets All graphs demonstrate consistent performance in meeting national health targets.
SmokeFree Support for hospitalised Smokers – Target 95% are identified and offered support.
Achieved: June quarter, YTD result 95%
Emergency Care Department – Length of Stay – Target 95% are seen and admitted or discharged within 6 hours.
Achieved: June result 96.0%
Achieving the 6 hour target remains a challenge with the on-going increase in patient volumes as shown.
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Elective Discharges – Target 100% of additional agreed elective discharges are delivered to achieve Ministry of Health national annual increase of 4,000 additional elective discharges (not WiES).
Achieved: June YTD result 106.8%
FY2014/15 Counties Manukau National Health target is 16,200 Elective Discharges. N.B. Current target is <120 days (from 31/12/2014). The data below is from National Elective Services reporting and has some time delay, compared to internal reporting in the Balanced Scorecards. Adjusted data is provided through the month.
2104
2046
2041
2102
2012
1978
2116
2122 21
4322
0620
70 2102
2087
2055
2126
1902
2037
2012
1993 20
3021
0320
6520
6521
30 2156
2138
2297
2281
1400
1600
1800
2000
2200
2400
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Pres
enta
tions
Week
Weekly EC Presentations by Calendar Year
2011 2012 2013 2014 2015 UCL
80%
85%
90%
95%
100%
105%
110%
115%
120%
Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15WIES 101.4% 99.4% 101.2% 100.3% 100.6% 101.30% 100.60% 100.5% 98.4% 96.9% 96.6% 99.8%Discharges 112.3% 110.1% 112.8% 113.5% 112.9% 112.80% 112.20% 111.4% 108.7% 107.1% 106.4% 106.8%FSA 100.5% 108.4% 107.4% 109.2% 107.1% 108.60% 109.10% 108.5% 107.5% 106.3% 104.9% 104.2%Target 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
YTD Elective Delivery vs Targets
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Number of patients waiting more than four, five months for Treatment or an FSA
Report Run Date: 25/06/2015 - data subject to change
Patients given a commitment to treatment but not treated within FOUR months.
2014 07 2014 08 2014 09 2014 10 2014 11 2014 12 2015 01 2015 02 2015 03 2015 04 2015 05 2015 06229 207 188 156 85 0 0 14 9 19 19 46192 143 99 68 24 0 0 8 14 5 3 8120 89 73 64 62 4 62 90 79 7 11 66176 119 80 35 6 0 9 15 11 16 21 181
2,248 2,007 1,665 1,624 1,015 128 598 611 330 263 243 623
Patients given a commitment to treatment but not treated within FIVE months.
2014 07 2014 08 2014 09 2014 10 2014 11 2014 12 2015 01 2015 02 2015 03 2015 04 2015 05 2016 0613 27 18 15 15 0 0 0 1 3 7 72 3 0 2 0 0 0 0 0 0 0 0
34 10 9 10 9 3 3 14 22 4 1 813 15 6 3 2 0 0 2 4 5 8 19
189 343 301 357 187 60 91 171 62 44 64 86
Patients waiting longer than FOUR months for their first specialist assessment (FSA).
2014 07 2014 08 2014 09 2014 10 2014 11 2014 12 2015 01 2015 02 2015 03 2015 04 2015 05 2015 06639 599 479 451 179 0 0 0 0 0 0185 129 39 6 21 0 1 0 0 0 0162 111 63 51 19 0 9 8 13 4 4 7
682 388 314 156 76 0 17 22 38 73 90
3,668 2,952 2,551 2,334 1,630 50 552 650 262 261 189
Patients waiting longer than FIVE months for their first specialist assessment (FSA).
2014 07 2014 08 2014 09 2014 10 2014 11 2014 12 2015 01 2015 02 2015 03 2015 04 2015 05 2015 0618 5 25 20 19 0 0 0 0 0 00 0 2 0 0 0 0 0 0 0 0
12 11 4 7 5 0 0 0 0 2 0 01 0 0 0 1 0 0 0 0 12 36
166 182 108 177 168 8 12 104 35 44 40
AucklandCounties ManukauNorthland
AucklandCounties ManukauNorthland
Waitemata
National Total:
National Total:
AucklandCounties ManukauNorthlandWaitemata
Waitemata
National Total:
AucklandCounties ManukauNorthlandWaitemata
National Total:
0
50
100
150
200
250
Regional ESPI - Treatment over 120 Days
Auckland Counties Manukau Northland Waitemata
05
10152025303540
Regional ESPI - Treatment over 150 Days
Auckland Counties Manukau Northland Waitemata
0100200300400500600700800
Regional ESPI - FSA over 120 Days
Auckland Counties Manukau Northland Waitemata
05
10152025303540
Regional ESPI - FSA over 150 Days
Auckland Counties Manukau Northland Waitemata
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Human Resources: Human Resource metrics are provided to outline performance for Annual Leave Balances, Sick Leave and Turnover rates. Below are the 13 month trend graphs to June 2015 (Sick Leave is to May 15).
0%
1%
2%
3%
4%
5%
Sick Leave as Percentage of Total Paid Hours
Sick Leave Sick Leave LY UCL Average LCL
8.0%8.2%8.4%8.6%8.8%9.0%9.2%9.4%9.6%9.8%
Annualised CMDHB Voluntary Turnover
Turnover Turnover LY UCL Average LCL
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
Percentage of CMDHB Workforce with Annual Leave Balances> 2 Years' Equivalent
> 2 Years > 2 Years LY UCL Average LCL
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5.05 Action arising responses Open actions
17/06/15 Mr Balmer to give some thought as to what other services the committee could visit such as renal.
Verbal update to be provided by Mr Balmer.
17/06/15 The committee asked Mr Balmer to pass on their congratulations to Kitty Ko as winner of the Judges and People’s choice Awards for the poster she designed with staff from Affinity Services.
Completed
17/16/15 The committee asked Mr Balmer to send their congratulations to the teams involved in the “Better Health Outcomes For All” for breast-feeding, Smokefree advice and breast-screening as these targets are difficult to reach.
Completed
17/06/15 Mr Balmer to ensure all graphs in the directors report in the future are shown as control charts with upper and lower control limits.
This activity is in progress and will occur over the proceeding months.
Confidential Actions
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5.06 Balanced Scorecard Definitions HEALTH ADVISORY COMMITTEE SCORECARD NOTES AND DESCRIPTIONS 1 Total Case weight – DSS – This is the total MOH funded WIES for the month and year to date, from the
front page of the most recent Redbook WIES reporting. 2 Acute Case weight – DSS - This is the total ACUTE MOH funded WIES for the month and year to date,
from the front page of the most recent Redbook WIES reporting. 3
Elective Case weight –DSS - This is the total ELECTIVE MOH funded WIES for the month and year to date, from the front page of the most recent Redbook WIES reporting.
4
Total Discharges –DSS - Total number of patients discharged for the month and year to date, from the front page of the most recent Redbook reporting. There is no target/ funder agreement given for this measure, so last year’s actual is used as the target.
5 removed 6 Budgeted FTE –Finance - FFARs FTE actual and budget by month and YTD, as reported in the Provider
Arm. 7 Operating Costs ($000) – Finance – FFARs actual and budget by month and YTD, as reported in the
Provider Arm. All expenditure less staff/personnel costs plus 8000-xxxxx internal allocations. 8 Personnel Costs ($000) – Finance – FFARs actual & budget by month & YTD, as reported in the Provider
Arm. 9 Financial Result – total $m (negative is contribution) – Finance – FFARs actual and budget by month and
YTD, as reported in the Provider Arm $m. 10 Outpatient FSA Volumes – DSS – The total number of outpatient type of ‘New Patient’ for the month
and year to date. There is no target/ funder agreement for this measure, so last year’s actual is used as the target.
11
Outpatient Follow Up Volumes –DSS – The total number of outpatient type of ‘Follow-up’ for the month and year to date. There is no target/ funder agreement for this measure, last year’s actual is the target.
12 Virtual FSAs –DSS – volumes of outpatient events for PUC codes M00010 Virtual Medical Firsts and S00011 Virtual Surgical Firsts against contract. To show ‘Increase from baseline by 10%’, a baseline to be provided. Currently using the contract for the year.
13 Reduce clinical outsourcing – Finance. Spend on clinical service outsource against budget
14 Accrued Annual Leave (Rate based measures of staff with high annual leave balances within the DHB) HR - Excessive leave is considered to be those employees with an annual leave balance in excess of 2 years’ worth of their current annual entitlement. Factors in FTEs. Numerator: A count of the number of employees with an excessive annual leave balance as defined above. Denominator: A count of the number of employees with an annual leave balance.
15 Staff Turnover (A rate based measure of staff turnover within the DHB) – HR – Numerator: The number of employees who cease employment due to voluntary resignation during the period. Denominator: The total headcount of employees at the beginning of the period.
16 Sick Leave (A rate based measure of paid and unpaid sick leave hours taken by employees within the DHB) –HR - Measure the proportion of DHB employees’ paid and unpaid hours that are lost to sick leave. Provides an indication of relative effectiveness in maintaining healthy staff and managing absenteeism in the DHB. Does not measure all forms of absenteeism. Numerator: The total number of paid and unpaid sick leave hours taken by DHB employees during the reporting period. Denominator: The total number of DHB paid hours during the reporting period.
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17 Incidences of days lost due to staff injuries per 1,000,000 hours worked – HR Measures the proportion of DHB employees who have days lost due to workplace injuries or illness. Injuries or illness associated with the workplace contribute towards lost work hours.
18 Mandatory Training Completed < 3 months:– B Watson - HR This measure is under development 19 Workforce Diversity – HR 20 Patient Safety e-MR within 48hrs per 100 patients –MMC Aligns with monthly patient safety report 21 Patient Safety Rate of patients with hospital acquired pressure injuries per 100 patients – MMC
Aligns with monthly patient safety report 22 Patient Safety Rate of all falls in hospital causing major harm per 1,000 bed days. All inpatients
including satellite facilities such as Franklin Memorial –MMC Aligns with monthly patient safety report 23 Patient Safety Adverse Drug events per 1000 bed days – MM. Aligns with monthly patient safety report 24 Patient Safety Rate of CLAB in patient that had a central line that is not related to an infection at
another site expressed as per 1000 central line days – MMC Aligns with monthly patient safety report 25 Patient Safety Rate of Staph. Aureus Bacteria infection per 1,000 bed days – MMC
Aligns with monthly patient safety report 26 Quality Safety Marker, HQSC. % Operations with all 3 Surgical Safety Checklist complete
A baseline audit completed in Q1, 2013 had CM Health at 86% –MMC 27 Patient Safety % patients 75+ years old (55+ years old for Maaori and Pacific) assessed for risk of falling
– Ko Awatea/ Regional Plan 27a Patient Safety % patients assessed for falls who have falls intervention plan – Ko Awatea/ Regional Plan 28 National Health Target. Numerator: number of patient presentations to the Emergency Department
with an Emergency Department length of stay of less than six hours from the time of presentation to the time of admission, transfer and discharge. Denominator: total number of patient presentations to the Emergency Department.
29 Seen by inpatient team <3 hours –DSS - 3 hours rule calculation is based on “If a patient is discharged from EC with a discharge description as "Admit to Ward" and the difference between EC DTTM of Arrival and IP Admit DTTM or if EC DTTM of Arrival to EC Discharge DTTM is >180 M then they fail the 3 hour rule or else they pass . 1 being fail and 0 being pass, No Triage mins logic has been included into this”
30 National Health Target: Percentage of radiotherapy patients receiving treatment within 4 weeks from date of decision to treat. Waiting time for treatment is from date of First Specialist Assessment to the beginning of treatment. The goal is that no one should wait longer than 4 weeks due to reasons of capacity constraint. Patients who wait due to clinical considerations or by their own choice are omitted
31 National Health Target: Percentage of chemotherapy patients receiving treatment within 4 weeks from date of decision to treat. Waiting time for treatment is from date of First Specialist Assessment to the beginning of treatment. The goal is that no one should wait longer than 4 weeks due to reasons of capacity constraint. Patients who wait due to clinical considerations or by their own choice are omitted
32 Medical Assessment Unit - seen by SMO within 4 hours: This measure is being developed 33 MOH Indicator of DHB Performance. 80% of accepted referrals for MRI scans will receive their scan
within than 6 weeks (42 days). Overall patient event numbers (Community and Outpatient Referrals) – including planned patient events; Waiting times (Community and Outpatient Referrals) – excluding planned patient events; Monthly activity and demand (Community and Outpatient Referrals) – excluding planned patient events.
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34
MOH Indicator of DHB Performance. 90% of accepted referrals for CT scans will receive their scan within than 6 weeks (42 days). Overall patient event numbers (Community and Outpatient Referrals) – including planned patient events; Waiting times (Community and Outpatient Referrals) – excluding planned patient events; Monthly activity and demand (Community and Outpatient Referrals) – excluding planned patient events.
35 Radiology - Inpatient Radiology times within 24 hours: 36 Radiology - EC radiology times <2 hours :– P Hewitt – Radiology 37 MOH Indicator of DHB Performance. 50% of people accepted for an urgent diagnostic colonoscopy will
receive their procedure within two weeks (14 days) 38
MOH Indicator of DHB Performance. 50% of people accepted for a diagnostic colonoscopy will receive their procedure within 6 weeks (42 days)
39
MOH Indicator of DHB Performance. 50% of people waiting for a surveillance or follow-up colonoscopy will wait no longer than 12 weeks (84 days) beyond the planned date
40
Laboratory - Test turnaround time (TAT) – Labs This measure is being developed
41 Northern Region Target. Proportion of percutaneous coronary interventions (PCIs) carried out within the recommended 90 minute guideline in emergency cardiac care, specifically in the treatment of ST segment elevation myocardial infarction (STEMI). Measure is Door to Balloon, that is, from the arrival of the patient to when they receive a balloon angioplasty (inflation of balloon in a blocked coronary artery)
42
Ministry of Health Elective Service Performance Indicator (ESPI). Number of patients currently waiting longer than five months (150 days) from date of referral for their First Specialist Assessment. ESPI 2.
43
Ministry of Health Elective Service Performance Indicator (ESPI). Number of patients currently waiting longer than 5 months (150 days) for Treatment – elective. ESPI 5.
44 Surgical Acute Priority Score -delay for surgery. Theatre Central MMC [definition to be added] 45 Faster Cancer Treatment – MOH target The maximum target length of time taken for a patient
referred with a high-suspicion of cancer (that is, person presents with clinical features typical of cancer, or has less typical signs and symptoms but the triaging clinician suspects there is a high probability of cancer), to receive their first treatment (or other management) for cancer.
46 Faster Cancer Treatment – MOH target The maximum target length of time a patient should have to wait from date of decision-to-treat to receive their first treatment (or other management) for cancer. The 31 day indicator includes all patients who receive their first cancer treatment, irrespective of how they were initially referred.
47 Radiology % radiology results reported within 24 hours [definition to be added] 48 Mental Health national target, Indicator of DHB Performance. % child/ youth seen by 3 weeks for non-
urgent mental health services – The wait time will be counted from the time the referral is received for a person who has not been seen for at least a year (or not at all) to the time of the first face to face contact with a mental health or addiction professional.
49 a.b.c
Mental Health national Access rates - CMDHB domiciled unique clients seen by MH in preceding 12 months as % of population (0-19years, 20-64years and over 65 years)
50
MOH, Annual Plan Indicator of DHB Performance. ALOS – Acute Inpatient – DSS ALOS for Admit type Acute Inpatients across all services.
51 MOH, Annual Plan Indicator of DHB Performance. ALOS – Elective Surgery– DSS ALOS for Admit type Elective, Arranged and Waiting List Inpatients across all services.
52 Acute Readmissions within 7 days – Total – DSS
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53 MOH, Annual Plan Indicator of DHB Performance. Acute Readmissions within 28 days – Total –DSS 54 MOH, Annual Plan Indicator of DHB Performance. Acute Readmissions within 28 days – 75+ years–DSS 55 Annual Plan % EC admissions – 75+ years – DSS 56 Discharge Information % transcribed clinical summaries authorised within 7 days for document created,
that is, authorised to be published in Concerto and sent out to GPs and patients. 57 % patients with Goal Discharge Date (EDD/ CSD) within 24hours of admission:
This measure is being developed 58 Patient outliers (patients admitted to a ward different from that which they are meant to be in. For
example, a medical patient placed in a surgical ward due to the lack of beds) Numerator: patient outliers in ARHOP, Medical and Surgical adult inpatients, excluding EC/ Short Stay. Denominator: occupancy in Medical, Surgical and ARHOP services only.
59 Northern Region Health Plan Target. Eligible stroke patients, that is, only patients with ischaemic stroke.
60 MOH, Indicator of DHB Performance. Hospitalisations of children aged 0 - 4 years old resulting from diseases sensitive to prophylactic or therapeutic interventions that are deliverable in a primary health care setting. The baseline national rate is expressed as 100% and DHB performance is reported against the national rate.
60a MOH, Indicator of DHB Performance. Hospitalisations of people aged 0 - 74 years old resulting from diseases sensitive to prophylactic or therapeutic interventions that are deliverable in a primary health care setting. The baseline national rate is expressed as 100% and DHB performance is reported against the national rate.
61 FSA/Follow up ratio – DSS – Using the OP measures from measure 4, the number of new patients divided by the number of follow-up appointments for the time period. There is no target; the previous year is the variance.
62 Outpatient DNA rates – Maaori –– DSS – All DNA’s for all hospitals for Maaori ethnicity divided by all outpatient appointments at all hospitals for Maaori ethnicity patients.
62a Outpatient DNA rates – Pacific – DSS – All DNA’s for all hospitals for Pacific ethnicity divided by all outpatient appointments at all hospitals for Pacific ethnicity patients.
63 MOH, Annual Plan Indicator of DHB Performance Theatre List Utilisation – DSS – from Report Manager Actual operating minutes vs. resourced operating minutes for all CMDHB theatres. https://nthreports.healthcare.huarahi.health.govt.nz/Reports/Pages/SearchResults.aspx?SearchText=theatre%20utilisation&ViewMode=List
64 Theatre Session Utilisation – DSS – also from reporting manager, 65 MOH, Annual Plan Indicator of DHB Performance Day of Surgery Admissions (DOSA) – DSS –
Percentage of all elective discharges (excluding day surgery) where the surgical procedures take place on the day of admission.
66 MOH, Annual Plan Indicator of DHB Performance Day Case Rate (Elective/Arranged) –DSS – Percentage of all elective discharges that have the same admission and discharge date.
67 removed 68 % MAU patients with LOS <28 hours – DSS – the time a patient spent in MSSU/SSMED during stay in EC 69 % Community NASC referrals via e-referrals and assessed within 48hours. (Part of e-referral project).
This measure is being developed, 70 % patients discharged and with District Nursing / Home Help within 24hours
This measure is being developed, 71 % FSA Referrals received electronically - This is a part of Regional e-referral project.
Baseline data is currently being collected
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72 Nursing Hours per patient days: MMC. This measure is being developed as part of the McKesson 73 Hospital beds occupied – DSS – number of inpatient bed days for the month and year to date.
Target for month does not include Neonates and Critical Care as no forecast capacity 74 LOS outliers – DSS – count of encounters with a LOS >10 days, excluding burns, spinal, long stay psych
and long stay geriatrics. 75
National HQSC MCC - patient experience survey which all DHBs are expected to implement in 2014/15.
76 MOH, Annual Plan Indicator of DHB Performance - Kidz First/ Women's Health - Infants who are exclusively breastfed upon discharge from Middlemore Baby Friendly Hospital Initiative Maternity facilities only. Excludes the three primary maternity units.
77 National health target. SmokeFree team - Percentage of identified smokers who have been identified through diagnostic coding as having received advice to quit.
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5.1 Mental Health
Performance
Activity Summary
Highlights
• MH&A submitted an entry into the Ko Awatea International Excellence in Health Improvement Awards 2015; under the Award for Citizens at the Centre of Service Re-Design and Delivery section. Our entry was entitled The Real Change Agents - Citizens at the Heart of Service Redesign and highlighted the redesign of the new acute mental health inpatient unit through a co-design methodology embedded within the project management framework. Of particular focus was the engagement with our Maori and Pacific service-users and their families/whaanau, to reflect the experiences of the highest Maaori and Pacific populations of all New Zealand District Health Boards.
• Keyworker Review: The Proposal for Change document has been released to all mental health staff and the consultation period has opened. Three question and answer sessions have been held with 55 staff and nine primary care staff attending. A survey tool has also been made available for feedback. Two unions (APEX and PSA) have been actively involved.
Feedback closes on 10 July following which the Project Group will consider responses before releasing the final Decision document and change management plan on 10 August.
Volumes
ActBud /
Contract Var % var ActBud /
Contract Var % var
INPATIENT Bed daysTiaho Mai 1,499 1,326 -173 -13% 18,011 16,133 -1,878 -12%
Tamaki Oranga 582 540 -42 -8% 6,538 6,570 32 0%
Koropiko - MHSOP 370 383 13 3% 4,907 4,654 -253 -5%Service Access No. of unique CMDHB domiciled clients seen over 12 months
19,143 16,041 3,102 19% N/A N/A N/A
Note - Actual Bed days exceeding the target is shown as negative as this implies over-crowding. The budgetis 85% occupancy rate of the available beds
Mental Health Volumes (Bed days and Service Access)June '15 Year to date
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Emerging Issues
Medical Staffing:
The shortage of permanent SMOs employed in the Provider Arm has been identified risk for some time. Over the 14/15 years this has fluctuated however the service has ended the year in a positive position with just over 45 SMOs permanently employed in CMH MH services.
The Psychiatry registrar workforce over the last 12 months has been relatively settled with good numbers (low vacancies) and some issues with the new acute pathway largely managed. However with the current six month run commencing with 6.5 FTE shortfall in CMH the situation has changed significantly. The after-hours rosters are being managed mostly internally with RMOs and SMOs undertaking additional shifts.
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Scorecard
Service Scorecard
Scorecard Commentary • Medical Locum costs : There has been an increase in locum costs as a result of extra
shifts being covered to fill gaps on the registrar roster
• Overtime costs: There has been a gradual reduction in overtime costs as vacancies have been filled in Intake and Assessment & HBT. Overtime in Tiaho Mai has been utilised to support management of ongoing high occupancy and sick leave cover.
• Access rates: Access for >65 years has increased by .06% since January 2015.
Mental Health SCORECARD
June 2015
BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCES
Def
Jun-15 Target Var Actual Target VarMedical staff locum Costs (in $000s) $189 $144 -$45 $1,948 $1,727 221-$ Overtime costs(in $000s) $126 $86 40-$ $1,729 $1,032 697-$
Jun-15 Target Var Actual Target Var% Staff with Annual Leave > 2 years 9.6% 5.0% -4.6% 8.7% 5% -3.7% 14
% Staff Turnover 0.8% 2.0% 1.2% 9.8% 10% 0.2% 15
% Sick Leave 2.8% 2.8% 2.8% 2.8% 16
Workplace Injury Per 1,000,000 hours 10.50 10.50 10.50 10.50 17
IMPROVED QUALITY, SAFETY AND EXPERIENCE OF CARE
Jun-15 Target Var Actual Target VarNo. of Seclusion events - (Rolling 12 months in development) 177 125 -52
Jun-15 Target Var Actual Target VarShorter wait times for non urgent mental health and addiction Services (%< 3week wait)
0-19 years 77.18% 75% 2.18% 48
20-64 years 87.38% 80% 7.38%65+ years 88.49% 80% 8.49%
overall 83.63% 78% 5.53%
Jun-15 Target Var Actual Target VarMental Health Access rate - unique clients seen by all MH services ((PRIMHD reporting services include AoD and NGO services) 12 months as a % of population
0-19 years 3.69% 3.15% 0.54% ~ 49a
20-64 years 3.94% 3.15% 0.79% ~ 49b
65+ years 2.61% 2.70% -0.09% ~ 49c
Readmissions within 28 days - Total 13.85% 12.00% -1.85% 12.78% 12.00% -0.78%
Jun-15 Target Var Actual Target VarOccupancy - Tiaho Mai acute mental health unit target is <85% 96.1% 85% 11.1% 95.1% 85% 10.1%No of Patient LOS (Tiaho Mai inpatient) < 5 days 4 tbc 198 tbc
Jun-15 Target Var Actual Target VarPP7-Relapse Prevention Plan - Maaori 95.7% 95.0% 0.7% 95.3% 95% 0.29%PP7-Relapse Prevention Plan - Pacific 97.2% 95.0% 2.2% 96.3% 95% 1.3%
BETTER HEALTH OUTCOMES FOR ALL
Jun-15 Target Var Actual Target VarAccess rate - No. CM domiciled unique clients seen by MH services (PRIMHD) 12 months as a % of population - Maori 7.18% 6.0% 1.18%
~Access rate - No. CM domiciled unique clients seen by all MH services (PRIMHD) 12 months as a % of population - Total 3.72% 3.1% 0.62%
~
Equi
ty
Year
Effic
ient
Year
Year
Patie
nt
Wha
anau
Ce
ntre
d Ca
re
Firs
t, Do
N
o Ha
rm
(Saf
ety) Year to date
Syst
em In
tegr
atio
n (E
ffect
ive)
Year to date
Tim
ely
Year to date
Ensu
ring
Fina
ncia
l Su
stai
nabi
lity Year to date
Enab
ling
High
Pe
rfor
min
g Pe
ople
12 month average
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Financial Results
Statement of financial performance
Actual Budget Var Var % Actual Budget Var Var %REVENUE
6 3 2 66% Government Revenue 81 40 41 101%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%
104 6 98 1,564% Other Income 111 75 36 48%64 0 64 0% Funder Payments 423 0 423 0%
174 10 164 1,707% Total Revenue 616 116 501 433%
EXPENDITURE5,339 5,371 32 1% Staff Costs 62,343 64,622 2,279 4%
231 17 (214) (1,283)% Outsourced Costs 2,481 201 (2,280) (1,137)%24 17 (6) (35)% Clinical Costs 175 209 33 16%
267 236 (32) (13)% Infrastructure Costs 2,890 2,829 (62) (2)%(32) 31 63 (203)% Internal Allocations 317 373 56 (15)%
5,829 5,672 (158) (3)% Total Expenditure 68,207 68,233 26 0%(5,655) (5,662) 7 0% Net Result (67,591) (68,118) 527 1%
FTE62 80 18 23% Medical 68 80 13 16%
330 322 (8) (3)% Nursing 327 322 (6) (2)%199 223 25 11% Allied Health 201 223 22 10%
54 58 4 8% Management/Admin 54 58 4 7%644 683 39 6% FTE Total 651 683 33 5%
STATEMENT OF FINANCIAL PERFORMANCE - MENTAL HEALTH
Month to Date Year to Date
($000's) ($000's)
Jun-15
-5,800
-5,750
-5,700
-5,650
-5,600
-5,550
-5,500
-5,450
-5,400
-5,350
-5,300
-5,250
Mon
thly
resu
lt $0
00's
Monthly Net Result
Result Budget
-
100
200
300
400
500
600
700
800
900
Mon
thly
resu
lt $0
00's
Monthly Operating Costs
Result Budget
4,700
4,800
4,900
5,000
5,100
5,200
5,300
5,400
5,500
Mon
thly
resu
lt $0
00's
Monthly Staff Costs
Result Budget
* Jun14 - outsourcing $270k unfav -locum medical staff; YTD allocation of vehicle transfer costs $170k unfav
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Commentary on major financial variances
Quality
Safety
Mental Health Acute 28 day Readmission rates and Use of Seclusion - Refer to BSC
Timeliness
Waiting times for non-urgent mental health and addiction Services - Refer to BSC
Efficiency
Mental Health Acute Inpatient services – Tiaho Mai Occupancy remains high although there were short periods in June where the unit had 2+ beds available for admissions.
Month YTD
Total Variance: $7 $527
Revenue: $164 $501
Salaries & Wages: $32 $2,279
Outsourced: $(214) $(2,280)
Clinical Supplies: $(6) $33
Infra-Structure: $(32) $(62)
Internal Allocations: $63 $56
Locum Medical staff $(189)k for the month $(1,946)k YTD partly off-set by the YTD favourable variance in Medical Staff salaries (YTD $1,562k); Admin Clerical mainly for MHSOP Community $(13)k overspend for month (YTD $(194)k overspend ) mainly for Child & Youth.
STATEMENT OF FINANCIAL PERFORMANCE - MENTAL HEALTHJun-15
Acute demand management costs remain high in June this has been off-set by vacancies in the community. The vacancies have resulted in underspends in Allied Health of $352k for the month (YTD $1,367k underspend).
Mainly Youth Forensic Specialist Community Service & Maternal Mental Health Funding, $64k for the month (YTD $423k)
Medical staff is overspent by $139k for the month (YTD $1,562k underspend). There is a national shortage of psychiatrists and therefore locums, mainly from overseas are contracted to provide services (refer outsourced services below). Acute demand management has mainly resulted in an overspend in Nursing of $(199)k for the month (YTD $(896)k overspend). Vacancies in the community have resulted in underspends in Allied Health of $352k for the month(YTD $1,367k underspend).
Year end Forecast variance to Budget
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Average Length of Stay – Tiaho Mai The sharp increase in average length of stay relates to complexity and comorbidity rather than acuity. A higher number of service users with complex needs such as a serious mental illness and medical and intellectual disabilities complicated by psychosocial issues were admitted than usual. The length of stay for these people is longer because it takes longer to stabilise the syndrome (rather than one illness) and often accommodation and community supports take some time to organise.
Length of Stay > 35 days Tiaho Mai The increase in length of stay greater than 35 days reflects the increase in the average length of stay and occurs for similar reasons. There appears to be a significant waiting time for supported accommodation which impacts on this group.
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Mental Health Services for Older People (MHSOP) Occupancy in June has been the lowest this year. Of the people admitted 50% have experienced an illness that is organic in nature and 50% functional in nature. (Organic = dementia/delirium Functional = psychiatric illness)
Adult Community Service: Clinician Contacts The clinician contacts have remained fairly stable over the past 12 months, with slight decreases during the summer and Easter holiday periods. On average there were 19,059 contacts per month, with an average caseload of 3164 clients over the reporting year.
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Child and Youth Service: Clinician Contacts Clinician contacts for 2014/15 are significantly higher than the previous year with the exception of the Christmas / New Year school break and Easter periods.
Effectiveness
Adult Community Service: 7 Day Post Discharge Contact The overall average for clients to be seen by a community mental health service within seven days of discharge from the inpatient unit was 88.6% (in June they achieved 96%). The national target is 90% and although we are slightly below this figure for the year, we believe that the actual number of clients who were seen throughout the year was just above 90%. Due to the reconfiguration of the acute community pathway, there had been some data reporting issues which had misrepresented the clinical contacts. This issue was rectified for the most recent report. Of note, the primary reasons for clients reported as not seen upon discharge: clients transferred to another DHB, discharged to their ‘home country’, difficulty in contacting/ locating the client following discharge or discharged to the general hospital for a physical health issue and then re-admitted to the mental health inpatient unit (and therefore not seen by community clinicians).
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Child and Youth Service - not seen last 90 days The service has committed to the following actions to decrease the number of clients being reported as having not been seen within 90 days:
1. Set a target of 95%: Continue to undertake case reviews and improve case management so that 95% of clients are seen in the last 90days.
2. Clean up the data following the identification of “test files” that needed to be removed by the Health Alliance Data Warehouse.
3. Create an accurate dash board to monitor against target.
Patient and Whaanau Centred Care
Family Initiative at Te Rawhiti The family initiative has developed from a wish to not only provide family members with accurate information about mental illness and how they can support their loved one but also the evidence that clients who have the support and involvement of ‘significant others’ in their treatment tend to have fewer hospital admissions and improved recovery. Over the year they have established regular monthly “support and information” evenings – as well as general discussions topics covered have included Problem solving, Communication, Minimizing the potential for relapse and Taking care of yourself when supporting a loved one with a mental Illness. A number of staff have participated in the groups – either supporting family members to attend or being there as the “topic expert”. With each of these topics they have produced an information booklet for families to use as a resource. So far 20 families attend reasonably regularly and we are looking at ways to encourage others to come. In July they hope to have the first meeting of the family Reference Group with a focus on developing Post cards and looking at ways of supporting other families to join the group.
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Whole of System Integration and Co-design
The programme of work to develop ‘whole of system’ integration for mental health and addictions is being informed by a comprehensive process of co-design engagement. The co-design process involves a wide range of stakeholders including service users, family/whaanau, primary care, NGO providers, secondary/specialist mental health and addictions, and broader community partners. Engagement is taking place with a focus on the four CM Health localities, ensuring the opportunity to hear and understand what is important for each of those communities. People are being encouraged to share ideas and experiences around what is working well, areas for improvement and the issues and challenges that need to be addressed. By the end of June 2015, 19 co-design engagement sessions had been held. Additional sessions will be held in July and early August, with an opportunity to also contribute via an on-line survey.
The feedback from the co-design process will be crucial in informing the development of the integration implementation plan for the period 2015 – 2020, with the Integrated Mental Health and Addictions Leadership Group leading and overseeing the development of the plan. The plan will reflect the importance of continuing to focus on meeting the needs of our population with the most severe and enduring mental health needs whilst also enabling early intervention in the life course and in the course of an illness or addiction. The plan will also recognise the importance supporting both the physical and mental well-being of our population.
Themes emerging from the co-design process focus strongly around the importance of good communication (with consumers/family/whaanau and between providers), joined-up care, access to information, and care that respects and empowers individuals and their family/whaanau.
Mental Health Services “Big Dot” - 25% reduction in Counties Manukau suicide rate in 5 years
Official suicide data is released from the Ministry of Health after determination and aggregation by the Coroner’s office in annual reports typically three years retrospectively. The latest annual data available is from 2012. The implementation of a systematic multisectorial postvention response lead by the DHB to suspected suicide deaths in collaboration with the Coroner’s office has enabled the determination of the number of suspected suicide deaths of people who were open to MH services or had been open to our services within the year prior to their death. This indicates many suicide deaths are amongst people accessing specialist MH services and gives the opportunity to focus on care delivery issues identified through the systematic review of these serious incidents. In addition it appears that young people and Maori are the least likely to have had contact with our services and provides useful direction to what groups may be the focus of efforts to enhance access to MH services.
The baseline suicide data for the 12/13 year based on suspected suicides known to service is not available as the data was not reported in that way. In 13/14 the Coroner confirmed that there were a total of 48 suspected suicide deaths in CM. Our postvention response team received information on 42 deaths. In 14/15 we have received postvention information on
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44 suspected CM suspected suicide deaths. We await confirmation from the Coroner on their total numbers for this past year.
We are able to report that in 13/14 there were 18 suspected suicide deaths of people known to specialist mental health services. In the 14/15 year this has dropped to 13 suspected suicide deaths representing a decrease of 5 (28%). Once again the concern is the high numbers of Maori and youth (aged less than 25 years) deaths accounting for a total of 45% and 34% of all suspected suicide deaths in Counties respectively. There appears to be an increase in suspected deaths in people who are not known to specialist MH services.
The decrease in deaths may be a random fluctuation – however there has been significant efforts put in by the provider arm to the new Serious Incident Review processes including SIR triage, London Protocol reviews, senior leadership group ratification of review recommendations and remedial actions, and use of Mortality and Morbidity meetings to more widely engage the clinicians in the findings and quality improvement activities that follow the reviews.
The need to focus on youth, Maori and the broader access to specialist MH services has been highlighted and is part of the focus of the new Integrated MH&A leadership group.
PP6 Access Rates
This MoH performance measure provides a view on the whole of population access to specialist MH&A services. This includes all CM who access any of the following services: CM provider arm specialist MH services, regional specialist MH and/or A services (e.g. specialist AoD, Forensics) and NGO services (both MH&A). What is evident is the increase in access to these services for the CM population. Of concern in this space is that nearly 1 in 10 adult Maori now resident in CM are accessing a specialist MH&A service.
The current challenge is how to ensure adequate access to specialist services while enabling and supporting specialist services to enhance the capability and capacity of the primary care level services to provide MH&A services. This is being undertaken through integration initiatives, IT developments and the work on enabling specialist clinicians and services to report on non NHI defined clinical consultation to other providers.
Psychiatric Liaison Team and Physical Health Psychology review
In April of this year, the review report by Dr Charles Hornabrook and Dr Jo Soldan was presented. A steering group has been established and is meeting regularly to consider and implement the recommendations of the review.
The chosen methodology is to establish working parties to map current and future patient pathways. This will be followed by the development of a model of care, and then the development of a proposal for change. It is anticipated that the implementation phase will be next year.
There will be four working groups:
1. Acute mental health / AoD presentations in E.D. 2. Co-morbid mental health / physical health presentations 3. Patients with health management and psychological issues 4. Patients who present with cognitive impairment
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For each of these groups, about three patient clusters have been identified for mapping. The mapping of patient pathways will be across wards, inpatient and community services, and age groupings. The unions have recently been provided with an update.
The Acute Inpatient Unit Rebuild Project- June 2015
The acute inpatient new build project has continued to progress through the ‘preliminary design’ phase. This phase is due to close in the next two weeks with the ‘detailed design’ phase due to begin middle of July. Two significant tasks have occurred this month - the architectural peer review process and the subsequent changes to the design as a result of the feedback.
The feedback provided from the peer reviewer was, in the main, positive but there were some challenges to the design team. These challenges were to four major areas within the design that have now been improved. The four areas were:
• Low Stimulus Area: This area is now separate from the entrances and has more natural light
• Clinical operations area: No longer a centralised staff area but a hybrid model of both central area and the inclusion of smaller interaction spaces
• Judicial/Whare/Heart of the building: This is now in the centre of the building and is connected to the therapeutic mall area with a café and recreation space
• Flexible bed management- These are now clearly defined with bedrooms attached allowing for different configurations to provide flexibility in care delivery inclusive of access to a lounge, courtyard and dining space
Previous design: Current design:
Architectural Peer Review has been concluded by Mungo Smith (MAPP Architecture). The project team will receive formal peer review report this month.
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Integrated Care Adult 2014/15 achievements on reflection
Throughout the past 12 months there has been a range of activities and initiatives where the Adult Community teams have increased their engagement with primary care. Some of these are listed below:
ARI (At Risk Individuals) A presentation was given to the Adult Integrated Care Clinical Governance group, with opportunities provided for clinicians and managers to participate in the steering group. With the inclusion of mental health into the second phase of the ARI program, this provides us with the opportunity to ensure that clients who are identified as having complex health issues (in addition to mental health needs) are able to have a more proactive, planned engagement and support from primary care along with other health providers.
Development of the Non-urgent pathway Since the implementation in August 2014 of the Intake and Acute Assessment team (I&AA), there has been a small group of clinicians working alongside I&AA to further assess and determine the appropriate clinical pathway for all non-urgent referrals coming to the adult services. Further development of this team will occur once the outcomes from the Keyworker/ Primary Care Liaison roles have been confirmed. Feedback received to date has been mostly positive with teams reporting a decrease in non-urgent referrals coming into the service (meaning an increase in suitable referrals) and primary care indicating that there has been an increase in responsiveness to their queries. The clinical head who works in the non-urgent pathway has endeavoured to increase the interface between mental health services and the various locality groups. This has occurred sporadically during 14/15 and will be a key focus for the coming 12 months.
Manaaki Hauora, Supporting Wellness Campaign (Self-Management Support) This is lead and supported by Ko Awatea has commenced in Mental Health with identified staff from both Faleola and The Cottage participating. The project leads receive coaching support in order to progress and incorporate the learnings from the Manaaki Hauora sessions provided by Ko Awatea into the specific project which has been developed. The Cottage project has been gifted the name from the Faleola Matua: Folau I Lagi-Ma (Journey to Wellness) The aim is to: support 100 clients from the Mangere Healthcare practice with long term conditions to understand their health conditions and integrated this information into their daily lives by identifying meaningful health & activity related goals which they can achieve within a 6-12 week period by December 2015.
Shared Care – Clozapine As part of improving the integration between primary and specialist services and as identified in Rising to the Challenge Development plan, work has occurred throughout the year to implement the shared care model which enables primary care management of clients prescribed clozapine. Initially the rollout was focused on one of the CMHC’s with a substantial amount of work undertaken by the Team Manager and identified clinicians. Specific protocols have been developed and this project has now been expanded to all of the adult community teams. Although the numbers of clients utilising this pathway remains small, we expect this to increase as we develop stronger linkages with the Localities and have more staff working within primary care facilities.
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Matters arising
Child and Youth not seen in 90 days The identification of 33“test files” has been completed and process is in progress to have these removed. In the interim the data analyst team have provided the graph below which indicates the 33 “test files” that need to be removed by the Health Alliance Data Warehouse Business intelligence Team and progress against our target of 95% which (with the “ test files” removed) is now being met.
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5.2 Women’s Health and Kidz First
Performance
Activity Summary
Volumes
ActBud /
Contract Var % var ActBud /
Contract Var % var
INPATIENT (WIES)Kidz First EC 76 79 -3 -3.8% 920 806 114 14.14%Paed Medicine 342 262 80 30.5% 3,305 2,923 382 13.07%Paed ICU 11 4 7 175.0% 47 30 17 56.67%NNU - Unit 151 225 -74 -32.9% 2,509 2,482 23 0.93%NNU Womens health 42 42 0 0.0% 537 518 19 3.67%Kidz First Surgical - acute 141 182 -41 -22.5% 1,810 2,211 -401 -18.14%Kidz First Surgical - Elective 98 81 17 21.0% 1,122 940 182 19.36%Total Kidz First WIES 861 875 -14 -1.6% 10,250 9,910 340 3.43%INPATIENT (CASES)Kidz First EC 261 311 -50 -16.1% 3,231 3,221 10 0.31%Paed Medicine 558 519 39 7.5% 5,776 5,601 175 3.12%Paed ICU 5 2 3 150.0% 31 28 3 10.71%NNU - Unit 52 66 -14 -21.2% 818 786 32 4.07%NNU Womens health 140 125 15 12.0% 1,339 1,392 -53 -3.81%Kidz First Surgical - acute 149 139 10 7.2% 2,088 2,157 -69 -3.20%Kidz First Surgical - elective 143 132 11 8.3% 1,736 1,504 232 15.43%Total Kidz First CASES 1,308 1,294 14 1.1% 15,019 14,689 330 2.25%EC AttendancesEC Attendances 2,330 2,178 152 7.0% 25,817 23,722 2,095 8.83%OUTPATIENTSFSA's 145 148 -3 -2.0% 1,993 1,986 7 0.35%Follow-ups 248 251 -3 -1.2% 3,116 3,232 -116 -3.59%Chart Reviews (Doc) one mo in arrear
65 53 12 22.6% 904 873 31 3.55%
Nurse-led clinic (CNS clinic follow up)
38 31 7 22.6% 508 391 117 29.92%
Virtual FSA 39 9 30 333.3% 547 396 151 38.13%Total Kidz First Outpatients 535 492 43 8.7% 7,068 6,878 190 2.76%
Jun-15 Year to dateKidz First Volumes (WIES and CASES)
Contract = Last year actuals
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Highlights
In June 2015 there were 499 births at MMH and 63 at the 3 community units, a total of 562 births for the month. Although the month of June had 97 fewer births than June 2014, YTD there are only 121 less births than YTD 2014 so small change overall. At year end 14/15 there were 7253 births against 7374 in 13/14 (-2%). The distribution of births continued to shift towards MMH with MMH seeing 18 less births YTD (- 0.28%) and the 3 Community Units down by 103 YTD (-10.55%). The overall number of births at the Community Units for 14/15 is 873 against 976 in 13/14 and 1095 in 12/13.
Gynaecology Acute WIES YTD is up by 89 but the elective WIES is down by 78. Acute discharges YTD are up by 89 and electives are down by 42. Gynaecology is meeting the 4 months waiting time for FSAs as well as the time to procedure. As Gynaecology procedures
Volumes
ActBud /
Contract Var % var ActBud /
Contract Var % var
INPATIENT (WIES)WH Gynae - acute 124 106 18 17% 1,639 1,550 89 6%WH Gynae - elective 129 120 9 8% 1,572 1,650 -78 -5%WH Primary Unit (W02020) 0 #DIV/0! 0 #DIV/0!WH secondary (W10001) 501 527 -26 -5% 6,349 6,097 252 4%Total Women's Health WIES 754 753 1 0% 9,560 9,297 263 3%Births/ DeliveriesTotal 562 659 -97 -15% 7,253 7,374 -121 -2%INPATIENT (CASES)WH Gynae - acute 236 221 15 7% 3,054 3,015 39 1%WH Gynae - elective 144 126 18 14% 1,690 1,732 -42 -2%Total WH CASES 380 347 33 10% 4,744 4,747 -3 0%OUTPATIENTSGynae FSA's 200 263 -63 -24% 2,727 3,150 -423 -13%Gynae Follow-ups 205 251 -46 -18% 2,837 3,012 -175 -6%Gynae Virtual 36 4 32 800% 392 48 344 717%Nurse-led clinic 53 81 -28 -35% 1,217 957 260 27%Colposcopy 175 213 -38 -18% 2,215 2,556 -341 -13%Colposcopy HC 11 22 -11 -50% 206 264 -58 -22%Colposcopy HC in OT 11 7 4 57% 79 84 -5 -6%Gynae HC 68 65 3 5% 709 780 -71 -9%Total WH Outpatients 759 906 -147 -16% 10,382 10,851 -469 -4%
Women's HealthVolumes (WIES and CASES)Jun-15 Year to date
Contract = Last year actuals
data no longer available
500
550
600
650
700
750
# of Births
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are now increasingly occurring in the Outpatient setting we have decreased the elective WIES for the 15/16 year to reflect that change.
Kidz First Neonates volumes continue with similar discharges and WIES compared to last year - only 27 up YTD June. WIES in Neonates is now stabilising in line with discharges. Discharges from the Neonatal YTD are up by 32 as well. The Unit has settled well in its new location and no issues have been identified with the transport of babies or women from Birthing and Assessment to the Neonatal Unit and the new Theatres. The dedicated orderlies, the bed moving equipment and the ‘shuttles’ (transport equipment attached to the heat tables) have all contributed to this safe transition.
Kidz First Inpatients experienced an early winter peak with inpatient admissions in June being high as well presentations to Kidz First Emergency Care being high again in June. YTD Kidz First Medicine has seen an increase of 175 discharges but 382 WIES indicating the complexity and acuity for those children admitted. Emergency Care presentations YTD are up by 2095 – the annual total is now almost 26000 for the 14/15 year (increase of 9%).
As part of the Maternity Quality Work Plan 2014/15 a working group has been established to review and update the maternity webpages on CMH internet site and develop virtual tours of the maternity facilities. The aim of the virtual tours are to provide consumers with evidence to promote low risk women to utilise and birth in the primary birthing units, encourage women to register with a lead maternity carer early in their pregnancy, describe service provision and orientation to each of the maternity facilities. Three meetings have been held between the working group and Ko Awatea’s Multi-Media Development Team to develop the six minute virtual tours. Filming of each of the facilities occurred in June in preparation for a planned release date of August.
A working group comprising Women’s Health senior clinical and management staff, Public Health Physician, Maternity Quality and Safety Programme Co-ordinator, Director of Midwifery, Service Development Manager Maternity Services and the Clinical Quality and Risk Manager have developed, with input from key stakeholders, the third edition of the Maternity Quality and Safety Programme Annual Report 2014/15 in preparation for submission to the Ministry of Health by mid July 2015. This MQSP Annual Report provides: a summary of the aims and objectives for Counties Manukau maternity service and MQSP in 2014/15; summarises the salient issues relating to maternity service delivery, provides data analysis on the maternity services provided within the Counties region and an evaluation in accordance with the National Maternity Clinical Indicators; describes the quality improvement actions undertaken in 2014/15 and outlines the planned actions for 2015/16. Once approved by the Deputy Director General Sector Capability and Implementation, this report will be published on the internet with an executive summary written in lay terms for consumers.
CMH rolled out the Maternity Clinical Information System (MCIS) in October 2014. We chose a ‘soft’ launch to ensure that we could implement the transition from paper clinical records to an electronic record in a controlled way and address any software and business process changes as quickly as possible. The soft launch started with a small group of women registering their pregnancy with the DHB community midwifery services and increased that group over time and now has started entering registrations/bookings for women who have a self-employed midwife as their Lead Maternity Carer.
At the end of June 2700 women at booking were recorded in the system and 110 births.
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To date over 600 Users have been trained including:
• 100% community midwives, case loading team, maternity ward staff
• 99% birthing and assessment (including RMO and SMO staff) and primary unit core staff
• 100% Admin and business support staff
• 125 LMC’s (98%) with more planned over the next few weeks
• Numerous allied health staff, including social worker, dieticians, physicians, pain team etc.
• Nearly all the Neonatal Unit SMOs, CNSs
• Nearly all of the Anaesthetic Department for read only access
• Still to train – physios, student midwives, newborn hearing screeners
The Kidz First finalised credentialing report was submitted to the Chief Medical Officer and the Director of Hospital Services on 15 May and distributed to the paediatric SMOs. An action plan is currently being developed to progress implementing the recommendations. In accordance with one of the recommendations of the credentialing report a meeting will be arranged with the credentialing panel in a year’s time to report on the changes made.
Emerging Issues
• We are expecting the number of births for women in the MCIS to increase significantly from July onwards. With the increasing number of women in the system and hence increasing number of women requiring secondary obstetric care we have started to encounter issues with the structure and lay out of the clinical information for the SMO group. This is a particular issue and risk for complex/high risk women during labour and birth. A small working group (including SMOs, Registrar, B&A and Maternity Ward midwives, Community Units and Community Midwife Representatives) has been set up and meets weekly to agree on new documentation methods and mitigation plans to ensure correct information is available at all times.
• For Kidz First Medicine inpatients we are reviewing which children/admissions are incurring a higher WIES. Anecdotally, our paediatricians are noticing an increase in complexity and acuity but we are investigating whether we can reconcile this with the coding and WIES. In addition, we have now seen another month with a significant increase in presentations to Kidz First EC. There were 152 more presentations for the month on last year. YTD there have been 2095 more presentations than the same period 2014. This is almost 6 children more per day. The increased numbers are particularly occurring after hours (i.e. after 5 pm till midnight). With the introduction of the free under 13 GP visits from 1 July 2015 we will be monitoring the impact of this on the Kidz First Emergency Care presentations.
81
Scorecards
Women’s Health Scorecard
June 2015
BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCES
Def
Jun-15 Target Var. Actual Target Var.Deliveries TOTAL 562 659 -97 7253 7374 -121
Deliveries at MMH 499 568 -69 6380 6398 -18Deliveries at Primary birthing units 63 91 -28 873 976 -103
Gynae Acute WIES 124 106 18 1639 1550 89 3
Gynae Elective WIES (Private) 7 0 7 72 0 72 2
Gynae Elective WIES 122 120 2 1500 1650 -150 2
Gynae Acute - Discharges 236 221 15 3054 3015 39Gynae Elective - Discharges 144 126 18 1690 1732 -42Maternity WIES - Secondary Facility (W10001) 501 527 -26 6,349 6097 252 1
Outpatient Gynae First 200 263 -63 2727 3150 -423Outpatient Gynae Follow-up 205 251 -46 2837 3012 -175Gynae nurse-led clinic 53 81 -28 1217 957 260Gynae SMO VFSA 36 4 32 392 48 344Obstetric Outpatient FSAs S/B Doctors 240 242 -2 3044 2908 136Obstetric Outpatient F/U S/B Doctors 284 333 -49 3449 3929 -480
Obstetric SMO VFSA N/ADHB Community Midwives Antenatal visits (two month in arrear and running total for the
1,472 1,444 28 17,928 18,188 -260
DHB Community Midwives Postnatal visits (two month in arrear and running total for the past 12 months)
702 1,162 -460 12,274 19,255 -6,981
WOMEN'S HEALTH SCORECARD
Ensu
ring
Fina
ncia
l Sus
tain
abili
ty
Year to date
Jun-15 Target Var. Actual Target Var.% Staff with Annual Leave > 2 years 21.0% 5.0% -16.0% 20.4% 5.0% -15.4% 12
% Staff Turnover 1.1% 2.0% 0.9% 9.9% 10.0% 0.1% 13
% Sick leave 2.8% 2.8% 2.9% 2.8% -0.1% 14
Workplace injury per 1,000,000 hours 0.00 10.50 10.50 10.57 10.50 -0.07 15
Mandatory training completed <3monthsJun-15 Target Var. Actual Target Var.
Sick leave hrs. taken FTEs Nursing/Midwifery inc unpaid 6.69 7.56 0.87Study leave hours taken FTEs in Nursing/Midwifery 6.77 3.23 -3.54 Orientation hours taken FTEs in Nursing / Midwifery 4.05 3.66 -0.39 Performance reviews completed per annum 56% 71% -15%
BI-ANNUAL REPORTING Jun-15 Mar-15 Var. Actual Target Var.% of 12 hour shifts 28% 24%
Enab
ling
High
Per
form
ing
Peop
le
12 month average
Year
IMPROVED QUALITY, SAFETY AND EXPERIENCE OF CARE
Jun-15 Target Var. Actual Target Var.Emergency trolley checks (days checked) 78% 100% -22% naHand hygiene (compliance with checks) 80% 100% ~ 100%Safe Sleep audits completed (tbc) 0% na naFamily Violence Prevention # staff trained nil TBC 18Total Caesarean Percentage 22.4% 22.5% 0.04% 22.9% 22.8% -0.2%
Caesarean - elective number 66 45 85 679 591 88 Caesarean - acute number 60 103 -43 984 1087 -103
Inductions of labour % (one month in arrear) 28% 22% -6% 24% 23% -1%Inductions of labour - number compared to last year (one month in arrear) 171 140 -31 1566 1552 -14
Firs
t, Do
No
Harm
(Saf
ety)
Year to date
Jun-15 Target Var. Actual Target Var.ED 6 hour target - National Health target (Gynae) 95% 95% 0% 97% 95% 2% 41
ESPI 2 - No. waiting >4 months for FSA - Elective 0 0 0 0 0 41
ESPI 5 - No. waiting > 4 months for treatment - Elective 0 0.00 0 0.00 0 42
Tim
ely
Year to date
Jun-15 Target Var. Actual Target Var.% transcribed clinic letters authorised <7 days created 89.3% 95.0% -6% 54
Average Length of Stay Gynaecology - MMH 1.51 1.80 0.29 1.59 1.67 0.08Average Length of StayGynaecology - MSC Inpatients 0.70 0.83 0.13 0.76 0.85 0.09Average Length of Stay Obstetric (DHB Mat) (1 mo in arrear) 2.09 2.28 0.19 2.20 2.31 0.11Average Length of Stay Obstetric (Ind. Mat) (1 mo in arrear) 2.10 2.33 0.23 2.20 2.33 0.13Average Length of Stay Vaginal Deliveries overall 1.93 1.87 -0.06 2.02 1.97 -0.05
Maaori - 1st time mothers 2.26 2.73 0.47 2.21 2.56 0.35Pacific - 1st time mothers 2.07 2.37 0.30 2.59 2.46 -0.13
Complex Needs WomenSyst
em In
tegr
atio
n (E
ffec
tive)
Year to date
82
Women’s Health Scorecard Commentary
• Gynaecology Outpatient and Colposcopy Volumes YTD the trend to increased Virtual FSAs has continued which explains the decrease in actual FSAs. Gynaecology services have worked in conjunction with primary care on excellent referral and management pathways (i.e. menorrhagia). Follow-ups are now also increasingly provided through Nurse Led clinics. Colposcopy volumes for the year are down by 13%. There are no women on the waiting list and all women are seen within the appropriate timeframes. The reduction in volumes could be partially due to lower cervical screening numbers but also the impact of the HPV vaccination programme. • Caesarean Section rate
The CS rate for June 2015 is 22.4% (year end 13/14 was 23%). The mix of acute and elective CS has remained the same as the previous year (66% acute and 34% electives). YTD the CS rate is 22.9 % which is the same as YTD 2014.
• Community Midwifery Antenatal and Postnatal visits
The accuracy of the data for these visits remains an issue for the service and is now compounded by the roll-out of the Maternity Clinical Information System (MCIS) with data now coming from iPiMs, Healthware and the MCIS. At the end of June there were 2700 women recorded in MCIS. We are working with our Decision Support colleagues on re-aligning the data sources and recalculate the numbers.
Jun-15 Target Var. Actual Target Var.FSA / FUP ratio - Gynae 1:1.025 1:1.048 ~ 1:1.04 1:1 ~DNA - Midwifery Antenatal clinics - First 10% 13% 3% 14% 14% 0%DNA - Midwifery Antenatal clinic - Follow up 16% 12% -4% 15% 15% 0%DNA - Doctor Antenatal clinics- FSA 11% 13% 2% 13% 15% 2%DNA - Doctor Antenatal clinics - Follow up 12% 12% 0% 14% 13% -1%
Outpatient DNA - Maaori (Gynae) 11% 10% -1% 15% 10% -5%Outpatient DNA - Pacific (Gynae) 9% 10% 1% 12% 10% -2%Outpatient DNA - Maaori (Obst) 26% 10% -16% 27% 10% -17%Outpatient DNA - Pacific (Obst) 15% 10% -5% 16% 10% -6%
% Resourced Occupancy (avg of 9am & 9pm) June 14YTDGynaecology Ward 79.4% 86% 7% 86% 92% 6%
Maternity Ward - Maternity (45 beds) (lodgers included) 70.4% 76% 6% 79% 78% 0%Maternity Ward - Nursery (30 beds) (lodgers included ) 75.1% 84% 9% 81% 86% 5%
Botany Maternity Unit (lodgers included) 80.8% 84% 3% 90% 94% 4%Papakura Maternity Unit (lodgers included) 71.7% 91% 19% 75% 82% 7%Pukekohe Maternity Unit (lodgers included) 59.6% 83% 23% 71% 74% 3%
Def
Jun-15 Target Var. Actual Target Var.Nursing Hours per Patient Day (not including HCA)at MMH
NHPPD - Maternity Ward North (including nursery PD) 6.22 6.65 0.43 6.11 5.50 -0.61 NHPPD - Maternity Ward South (including nursery PD ) 6.62 6.42 -0.20 5.72 5.50 -0.22
Nursing Hours per Patient Day - Gynae 5.41 5.23 -0.18 5.20 5.63 0.43
Effic
ient
Year
Year to date
Jun-15 Target Var. Actual Target Var.Patient Experience Survey Resposnes - How would you rate your overall care 91% 90% 1% 91% 90% 1% 74
(Excellent, very good and good)
Better Health Outcomes For All
Jun-15 Target Var. Actual Target Var.% Infants Exclusively Breastfed Discharge MMH - Total 88.0% 75% 13.0% 83.0% 75% 8.0% 75
% Infants Exclusively Breastfed Discharge MMH - Maaori 84.0% 75% 9.0% 82.0% 75% 7.0%% Infants Exclusively Breastfed Discharge MMH - Pacific 86.0% 75% 11.0% 80.0% 75% 5.0%Note: this data is for babies discharged on Healthware. Badgernet reports were not available.
Equi
tyPa
tient
/ W
hana
u Ce
ntre
d
Year to date
n = 46 Year (n =441 )
83
Kidz First Scorecard
June 2015
BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCES
Def
Jun-15 Target Var. Actual Target Var.Gen Paeds Outpatients FSAs 145 148 -2% 1,993 1,986 0% 4
Gen Paeds Outpatients Follow Ups 248 251 -1% 3,116 3,232 -4% 5
Gen Paeds Virtual FSAs 39 9 333% 547 396 38% 11
KF Surgical Ward discharges 172 161 7% 2,429 2,392 2%KF Surgical Ward WIES 178 157 13% 2,285 2,465 -7%KF Medical Ward + Short Stay Discharges 558 519 8% 5,776 5,601 3%KF Medical Ward + Short Stay WIES 342 262 31% 3,305 2,923 13%
Neonatal Care Discharges - Neonatal Unit 52 66 -21% 818 786 4%Neonatal Care Discharges - WH Neonatal 140 125 12% 1,339 1,392 -4%Neonatal Care WIES - Neonatal Unit 151 225 -33% 2,509 2,482 1%Neonatal Care WIES - WH Neonatal 42 42 0% 537 518 4%
EC Attendances <15 years 2,330 2,178 7% 25,817 23,722 9%
KIDZ FIRST SCORECARD En
surin
g Fi
nanc
ial S
usta
inab
ility
Year to date
May-15 Target Var. Actual Target Var.% Staff with Annual Leave > 2 years 14.1% 5% -9.1% 13.6% 5% -8.6% 12
% Staff Turnover 1.3% 2% 0.8% 11.2% 10.0% -1.2% 13
% Sick leave 3% 3.0% 3.6% 3.0% -0.6% 14
Workplace injury per 1,000,000 hours 0 10.50 10.50 8.80 10.50 1.70 15
Mandatory training completed <3months U/DJun-15 Target Var. Actual Target Var.
Nursing Sick leave hours taken in FTEs (inc unpaid sick) - onestaff 9.63 7.63 -2.00Performance reviews completed - onestaff 52% 61% -9.0%Study (both internal & external) leave taken FTE RN - onestaff 2.80 8.19 5.39
Bi-Annual REPORTING Jun-15 Mar-15 Var. Actual Target Var.% of 12 hour shifts Quarterly 30% 39% 9% ~
Year
12 month average
Enab
ling
High
Per
form
ing
Peop
le
IMPROVED QUALITY, SAFETY AND EXPERIENCE OF CARE
Jun-15 Target Var. Actual Target Var.Neonatal Rate of medication errors/1000 bed days 7.0% 5.0 4.93 ~ 0.00 20
Neonatal Care CLAB rate per 1000 line days 0.0% 0.0 0.0 ~ 0.00 21
Emergency trolley checks (compliance with checking) 0% 100% -100% ~ 100%Hand hygiene (compliance with checking) 0% 100% -100% ~ 100%Safe sleep - audits completed (tbc) 97% N/A #VALUE! ~ N/AFamily Violence Prevention # staff trained nil TBC 92Expired Planned Appointments KF outpatients 553Fi
rst,
Do N
o Ha
rm (S
afet
y) Year to date
Jun-15 Target Var. Actual Target Var.ED 6 hour target - National Health target (Kidz First EC) 98% 95% 3% 98% 95% 3% 41
Q3 Target Var. Actual Target Var.NBHS number babies screened prior to discharge from hospital sites 93% 90% 3% 95.5%NBHS number babies screened @ 12 weeks from birth 108% 95% 13%B4SC checks meets MoH target 100% 100% 100% 100%
Year
Year to date
Tim
ely
QUARTERLY REPORTING - Next report in Apr 2015 for YTD March 2015
Jun-15 Target Var. Actual Target Var.% transcribed clinic letters authorised >7 days of created 82.7% 75.0% 7.7% 54
Readmission Rate (KF med) within 7 days 5.0% 6.9% 1.9% 6.2% 5.9% -0.3%Readmission Rate (KF med) within 7 days (Maaori) 4.0% 8.1% 4.1% 8.8% 5.6% -3.2%Readmission Rate (KF med) within 7 days (Pacific) 5.0% 5.7% 0.7% 5.1% 5.7% 0.6%
Readmission Rate (Level 1,2, 3) within 28 days (one month in arrear ) 3.7% 12.0% 8.3% 8.0% 7.9% -0.1%Readmission Rate (all Neonates) within 28 days (one month in arrear ) 7.5% 8.1% 0.6% 7.7% 6.2% -1.5%Admission Rate Babies in the first year of life (Total) 25% 22% -3.0% 22% 21% -1.0%
Admission Rate Babies in the first year of life (Maaori) 31% 28% -3.0% 27% 25% -2.0%Admission Rate Babies in the first year of life (Pacific) 30% 29% -1.0% 29% 27% -2.0%
ALOS (raw) - Kidz First - Surgical - Surgical Floor 2.4 2.7 0.2 2.05 2.38 0.3ALOS (raw)- Kidz First Medicine - KF Wards 2.9 3.1 0.2 2.7 2.7 0.0ALOS (raw)- Kidz First Medicine - EC Short Stay (hrs) 4.6 5.2 0.7 4.6 4.8 0.2ALOS (raw) - Kidz First - Neonatal Unit discharge only - - investigating data integrity 11.9 13.9 2.0 12.4 11.8 -0.5 ALOS (raw)- Kidz First - Neonates including WH - - investigating data integrity 8.7 6.7 -2.0 10.9 6.2 -4.7
Year to date
Syst
em In
tegr
atio
n (E
ffec
tive)
84
Kidz First Scorecard Commentary
• Expired Planned Appointments (all Follow-Ups) Kidz First Outpatients We are working with the new GP Liaison, Dr Christine McIntosh, and the ARI team to develop options for ARI for Paediatric Outpatients to reduce the Expired Planned Appointments. Initial work has already resulted in a decrease of the expired appointments to 553 (from 704 in May 2015). The work includes reviewing all new referrals as well as reviewing follow-ups with a view whether the child could have been referred back to the GP or be appropriate for an ARI process. The Expired Planned Appointments have also been highlighted in the credentialing report as an urgent issue to address. A paper is being prepared for ELT outlining the issues and potential solutions and implications of those solutions. In the meantime, we also continue with increased follow-up clinics only before the busy acute winter workload commences. • Kidz First Outpatient Volumes Kidz First Outpatient FSA and Follow-up volumes are slightly down for the month and YTD. This is a result of extended sick leave and sabbatical leave during the period Jan- April 3015. Volumes have stabilised in June 2015. To offset these small decreases, the volumes for the Nurse-led clinics are up by 117 as they are now following up a lot more children after they have had their FSA with a paediatrician. Our continued work with the Virtual FSAs is also showing good progress with the VFSAs up by 151. The majority of referrals for Kidz First Outpatients are now e-referrals which is a fantastic development but does require more time for paediatricians to do the grading and liaise electronically with GPs for further information and clarification of referrals. We expect that, over time, the quality of the information on the e-referral will avoid further clarification and information
Jun-15 Target Var. Actual Target Var.Outpatient DNA - FSA 8.0% 8.0% 0.0% 8.00% 10% 2.0%Outpatient DNA - Follow up 11.0% 15.0% 4.0% 13.0% 16% 3.0%Outpatient DNA - Maaori 16.0% <10% 16.00% <10%Outpatient DNA - Pacific 13.0% <10% 14.00% <10%Nurse Hours per Patient Day - KF Med 5.44 6.22 0.78 5.89 6.00 0.11Nurse Hours per Patient Day - KF Surg 4.95 5.21 0.26 4.98 4.80 -0.18 Nurse Hours per Patient Day- Neonatal 11.23 10.9 -0.33 11.89 9.67 -2.22 % Resourced Occupancy - Kidz First Medical (against 13/14) 93.0% 85.8% -7.2% 91.0% 77.5% -13.5%% Resourced Occupancy - Kidz First Surgical (against 13/14) 89.0% 76.7% -12.3% 89.0% 73.9% -15.1%% Resourced Occupancy- Neonatal (against 13/14) 100.0% 93.8% -6.2% 99.0% 89.0% -10.0%
Year
Effic
ient
Jun-15 Target Var. Actual Target Var.Patient Experience Survey results (Excellent, very good and good) 75% 90% -15% 90% 90% 0.0%
Better Health Outcomes For All
Jun-15 Target Var. Actual Target Var.Percentage of 'eligible' inpatients are referred to AWHI 90.0% 100.0% 10.0%
Year
n = 8 Year (n =70 )
Equi
tyPa
tient
W
haan
au
Cent
red
Care
85
Financial Results
Kidz First Statement of financial performance
Actual Budget Var Var % Actual Budget Var Var %REVENUE
74 72 2 3% Government Revenue 860 860 (0) (0)%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%
439 113 326 288% Other Income 2,121 1,358 763 56%65 63 1 2% Funder Payments 779 761 18 2%
578 248 329 133% Total Revenue 3,759 2,979 781 26%
EXPENDITURE3,023 2,612 (410) (16)% Staff Costs 31,802 31,408 (394) (1)%
96 18 (78) (423)% Outsourced Costs 694 220 (474) (215)%259 172 (87) (51)% Clinical Costs 2,236 2,015 (220) (11)%134 90 (44) (49)% Infrastructure Costs 1,112 1,064 (48) (4)%(65) (23) 42 178% Internal Allocations (864) (280) 584 208%
3,447 2,869 (578) (20)% Total Expenditure 34,981 34,429 (552) (2)%(2,869) (2,621) (249) (9)% Net Result (31,221) (31,450) 229 1%
FTE47 43 (4) (8)% Medical 43 42 (1) (3)%
214 192 (22) (12)% Nursing 207 194 (12) (6)%73 68 (5) (8)% Allied Health 69 68 (1) (2)%28 29 1 2% Management/Admin 28 29 1 4%
363 333 (30) (9)% FTE Total 347 333 (14) (4)%
($000's)
STATEMENT OF FINANCIAL PERFORMANCE - KIDZ FIRSTJun-15
Month to Date Year to Date
($000's)
-3,500
-3,000
-2,500
-2,000
-1,500
-1,000
-500
-
Mon
thly
resu
lt $0
00's
Monthly Net Result
Result Budget
-
100
200
300
400
500
600
700
800
900
1,000
Mon
thly
resu
lt $0
00's
Monthly Operating Costs
Result Budget
-
500
1,000
1,500
2,000
2,500
3,000
3,500
Mon
thly
resu
lt $0
00's
Monthly Staff Costs
Result Budget
86
Kidz First Commentary on major financial variances
Month YTD
Total Variance: $(249) $229
Revenue: $329 $781
Revenue for projects is recovered on a monthly basis. Additional costs for various projects (not budgeted) are offset against additional revenue.
Jun-15STATEMENT OF FINANCIAL PERFORMANCE - KIDZ FIRST
Current Month:Government Revenue: ACC $2KOther Income: ASD $11k, CCREP $24K ,UoA $4K, Turuki & NRA $4K, Ministry of Education $20K, NBHS $42K, Manakidz Research $199K, misc $3K,
Year to Date:Government Revenue: ACC $(2)k (code correction for ACC refund)Other Income: ASD $132k, Rheumatic Fever Research $22K, CCREP $170K , UoA $35k, F&P $16K, Turuki & NRA $48K, ADHB $12K, Donations $33K, mana kidz $246k, MoE equity fund $37k, Cyfs $8K
Kidz First reported a $249k unfavourable variance for June, YTD $229k favourableNZNO and AH CPI Sal increase accrual had been adjusted in June 2015. High early winter volumes in conjunctions with very high acuity in both KF medical floor and NNC contributed very high nursing and clinical supply consumable costs. June WIES and YTD WIES for Kidz First Medical up by 27% and 12% respectively. However, discharges only up YTD by 3% reflecting complexity of inpatient cases this year.
Salaries & Wages: $(410) $(394)
Outsourced: $(78) $(474)
Clinical Supplies: $(87) $(220)Current Month: $(87)k for High early winter volumes in conjunctions with very high acuity in both KF medical floor and NNC contributed very high nursing and clinical supply costs
Year to date:In Dec 2014, We were notified that $103k for NNC inventory was incorrectly coded to a balance sheet account. The whole amount was transferred to NNC RC in Dec 2014. In addition, NNC had high admission of Level 3 babies in Dec 2014 that required high use of clinical supplies. $(126)k clinical supply demand for Home care nursing team for medically fragile patients continue.
Additional costs for various projects (not budgeted) are offset against additional revenue/internal allocations from the funder, i.e. Ccrep Research, ASD, and Mana Kidz. Annual leave has been well managed over the school holiday periods (end of Sept 2014/early Oct 2014, Dec 2014 and Jan 2015).Current Month:Medical - $(28)k - Annual Leave accrual is more than leave hours taken and accruals for additional duties/expense claims related to 2014-2015 financial years had been put thruNursing- $(197)k - Annual Leave accrual is more than leave hours taken and various projects off set against additional revenues (not budgeted). NZNO CPI Sal increase accrual had been adjusted in June 2015. High early winter volumes in conjunctions with very high acuity in both KF medical floor and NNC contributed very high nursing costs. Mana kidz research related nursing costs ad been accruedAllied Health- $(186)k - Annual Leave accrual is more than leave hours taken and additional costs for various projects (not budgeted) are offset against additional revenue/internal allocations. AH CPI Sal increase accrual had been adjusted in June 2015. Mana kidz research related nursing costs ad been accruedClerical - $1k - on track; operation manager budgeted under nursing but coded to Clerical, a cost transferred for gateway administrator was changed to AH from Clerical
Year to date:Medical - $113k - AL leave management over school holidays and $(30)k ACC refund to an employee in Aug 2014.Nursing- $(429)k - Additional costs for various projects (not budgeted (5.2) FTE at $(43)k) are offset against additional revenue. High levels of sick leave and ACC leave continue within the service. Unpredictable NICU volumes (acuity and occupancy), ongoing since Sept 2013, as well as vacancies/ skill mix issues, has driven cost increases year to date. Mana kidz research related nursing costs ad been accruedAllied Health- $(167)k - Additional costs for various projects (not budgeted 3.65 FTE at $18K). Mana kidz research related nursing costs ad been accruedClerical - $90k - on track; operation manager budgeted under nursing but coded to Clerical.
Current Month:$(38)k for external bureau, $(5)k for University of Auckland, $(27)k for ASD - multi displinary consultation, $(3)k team building consultation
Year to date:$(210)k for external bureau, $(38)k for University of Auckland (additional duties budgeted under 2xxx series), $(24)k for temp clerical, $(42)for locum$(33)k for secondment from ADHB clinicians for Centre for Youth, $(114)k for ASD - multidisplinary consultation/parental leave cover for Child development team $(21)k team building consultation
87
Kidz First Savings initiatives
Kidz First year end position is $228K favourable reflecting tight management of staff costs (leave management, overtime etc.) as well as management of clinical supply costs, linen and other non - clinical supplies.
Infra-Structure: $(44) $(48)
Internal Allocation: $42 $584
$228
Current Month: $(42)k for accrual for beraphone purchase
Year to date: We were notified that $28k for NNC was incorrectly coded to a balance sheet account. The whole amount was transferred to NNC RC in Dec 2014.
Year end Forecast variance to Budget
Current Month:Additional revenue for various projects (not budgeted) are offset against costs, ManaKidz $46kYear to date:Additional revenue for various projects (not budgeted) are offset against costs, ManaKidz $494k $13k less pharmacy transactions and $8k less MRI transactions
88
Women’s Health Statement of financial performance
Actual Budget Var Var % Actual Budget Var Var %REVENUE
60 74 (14) 0% Government Revenue 792 891 (99) (11)%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%
41 3 39 1,554% Other Income 265 30 235 782%7 6 0 6% Funder Payments 79 75 4 6%
108 83 25 30% Total Revenue 1,135 996 140 14%
EXPENDITURE2,879 2,762 (117) (4)% Staff Costs 32,984 32,619 (365) (1)%
88 65 (23) (35)% Outsourced Costs 1,137 785 (352) (45)%144 143 (1) (1)% Clinical Costs 1,636 1,677 41 2%148 132 (17) (13)% Infrastructure Costs 1,498 1,579 81 5%
24 49 24 (50)% Internal Allocations 133 583 450 (77)%3,284 3,151 (133) (4)% Total Expenditure 37,387 37,243 (144) (0)%
(3,176) (3,068) (108) (4)% Net Result (36,252) (36,248) (4) (0)%
FTE45 44 (0) (1)% Medical 46 44 (1) (3)%
248 247 (1) (0)% Nursing 254 247 (8) (3)%5 5 (1) (14)% Allied Health 6 5 (1) (26)%
48 45 (3) (8)% Management/Admin 50 45 (5) (11)%361 341 (20) (6)% FTE Total 356 341 (15) (5)%
Jun-15STATEMENT OF FINANCIAL PERFORMANCE - WOMENS HEALTH
Month to Date Year to Date
($000's) ($000's)
-3,500
-3,000
-2,500
-2,000
-1,500
-1,000
-500
-
Mon
thly
resu
lt $0
00's
Monthly Net Result
Result
-
100
200
300
400
500
600
700
800
900
1,000
Mon
thly
resu
lt $0
00's
Monthly Operating Costs
Result Budget
-
500
1,000
1,500
2,000
2,500
3,000
3,500
Mon
thly
resu
lt $0
00's
Monthly Staff Costs
Result Budget
89
Women’s Health Commentary on major financial variances
Month YTD
Total Variance: $(108) $(4)
STATEMENT OF FINANCIAL PERFORMANCE - WOMENS HEALTHJun-15
The division reported an unfavourable variance of $(108)k for the month. Mostly due to 10 FTE of new grad midwives commencing in early May 2015. They will be in orientation until 3rd week of June 2015. June 2015 deliveries are 98 births down against last year's actual (delivery numbers at MMH were down by 69 and community units down by 29). YTD Births are down by 122 (1.64%). However, WIES continues to be up by 4% reflecting the increasing complexity in Maternity. NZNO and AH CPI Sal increase accrual had been adjusted in June 2015. The new volume reports from casemix require further review and reconciliation as they vary from previous months reports. In addition, colposocopy numbers, and therefore, revenues had been unexpectedly low. Colposcopy is fee for services. There are no women on the waiting list but our volumes had decreased by 13% YTD. We are investigating with Primary Care what is happening to the overall cervical screening programme. We are expecting a small decrease in colposcopy due to the HPV programme implementation, however, this does not fully account for the 13% decrease.
Revenue: $25 $140
Salaries & Wages: $(117) $(365)
Additional costs for various projects (not budgeted) are offset against additional revenue.Current Month:Other Income: AUT student days $18K, clinic room rental $6K, Colposcopy revenue down by $(10)K, UoA $6.5K, $1K misc. revYear to Date:Other Income: AUT student days $88K, safe sleep $14K, clinic room rental $70K, UoA $32K and miscellaneous $46K, Colposcopy revenue down by $(105)K
Additional costs for various projects (not budgeted) are offset against additional revenues, i.e. Ccrep Research
Current Month:Medical- $(16)k unfavourable - Annual Leave accrual is more than leave hours taken and accruals for additional duties/expense claims related to 2014-2015 financial years had been put thruNursing/Midwives- $(43)k unfavourable; as detailed below. NZNO CPI Sal increase accrual had been adjusted in June 2015. Annual Leave accrual is more than leave hours taken - $88k Internal bureaus (12.04)FTE and $7K for OT (0.85)FTE due to Midwifery vacancies of 18 FTE, skill mix, high sick leave. Allied Health- $(10)k unfav costs, (3)FTE - offset by additional revenues for Breastfeeding Advocates. (1)FTE - offset by additional revenues for Breastfeeding Advocates AH CPI Sal increase accrual had been adjusted in June 2015. Annual Leave accrual is more than leave hours takenClerical - $(47)k unfavourable additional costs, (1)FTE offset by additional revenues from the maternity review board. High use of casuals for MCIS roll-out and vacancies. Code for a service manager was changed from Senior nurse account to Clerical account and costs transferred, budget sits under senior nurses account.
Year to Date:Medical- $207k favourable-Annual leave managementNursing/Midwives- $(51)k unfavourable; as detailed below. NZNO and AH CPI Sal increase accrual had been adjusted in June 2015.- unexpected high volume and high acuity in NNC resulting in more NNC graduates on Maternity Ward.-high sick, study leave, ACC and orientationAllied Health- $(117)k unfavourable costs, (3)FTE - offset by additional revenues for Breastfeeding Advocates. (1)FTE - offset by additional revenues for Breastfeeding Advocates from April 2015Clerical - $(404)k unfavourable additional costs, (1)FTE offset by additional revenues from the maternity review board. High use of casuals for MCIS roll-out. In addition, code for a service manager was changed from Senior nurse account to Clerical account and costs transferred, budget sits under senior nurses account.
Outsourced: $(23) $(352)
Clinical Supplies: $(1) $41
Current Month:On Track
Year to Date:$(74)k for urgent delivery of mattress, replacement for bodily fluid contamination at ALBU and Botany.$(56)k for ultrasound, urodynamics and ecomed service agreement$99K for lower patient / disposable consumable - tighter stock management in each are to reduce waste and overstocking$60k for lower ambulance usage. Less use of patient consumables in community unit and lower spend due to reducing birth numbers.
Current Month:$(23)k for External Bureaus to offset MW / Nursing vacancies and skill mix issues, and orientation of 20 new graduate midwives$(7)K for temp admin to cover parental leave
Year to Date:$(311)k for External Bureaus to offset MW / Nursing vacancies and skill mix issues$(11) K for locum usage$(50)k for AUT MDES (Midwifery Development) - not budgeted - proposal to be funded by Maternity Review Board. 2015-2016 funding has been accepted$16k favourable for UoA clinical services due to Long term injury of UoA Faculty staff member$11K favourable for secondary ultrasound scan
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Women’s Health Savings initiatives
Women’s Health year end position is $4K over which is a good result considering the additional costs of absorbing 20 new graduate midwives who all required six weeks orientation and additional study days.
Quality
Safety
• SUDI
Representatives from Counties Manukau Health Kidz First and Women’s Health attended a face to face regional meeting to implement the SUDI Action Plan on 3 July 2015. Discussion included determining the targets for safe sleep devices, the number of safe sleep enablers being delivered within each of the Northern regional district health boards , the criteria for referral of safe sleep enablers, and measures to identify vulnerable children. Safe Sleep Audits in hospital are also part of the top 5 Safety Measures that will be implemented from August onwards.
• CLAB (Neonatal Unit) Compliance
CLAB insertion bundle compliance - NNU 90%
CLAB prevention maintenance bundle compliance- NNU 94%
• Risk Register items
1. Shortage of Midwives at MMH resulting in skill mix issues particularly on Maternity Ward Tuesday 5 May 12 New Graduate Midwives commenced practice with CMH. This will offset the immediate vacancies and reliance on bureau staff but will not address the ongoing skill mix issues as these new staff will take their initial 15 months new graduate programme to become more experienced. However, growing our workforce through training new midwives remains the correct strategy long term as
Infra-Structure: $(17) $81
Internal Allocation: $24 $450
Year end Forecast variance to Budget
Current Month:Additional revenue for various projects (not budgeted) are offset against costs, i.e. BFA $11k, Safe Sleep $7k, Maternity Review Board $38k, $(24)k overspent on pharmacyYear to Date:Additional revenue for various projects (not budgeted) are offset against costs, i.e. BFA $132k, Safe Sleep $96k, Cancer Care $24k, Maternity Review Board $308k, $66k favourable for MRI usage, $(178)k more pharmacy expenses
$(4)
Current Month:$(13)k for equipment hire for broken urodynamics and ecomed $(6)k for laundry and linen
Year to Date:$76k for less printing, stationeries and office suppliers$22k no MVT/Fuel transfer (budget but no $ actual allocation)$44k lower rent costs$(40)k MMF funded project expenses and/or one-off purchases and less spending on other misc expenses$(18)k higher taxi usage for patient transfer for clinic appts and due to lack of CMDHB cars for comm activities
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we are not expecting experienced midwives from other DHBs to make a move to Auckland. Support for new midwives remains in place through: the Midwifery Education Service (joint programme with AUT) in Birthing and Assessment; Midwifery First year of Practice programme; LMC coordination roles, Midwife Educators and Senior Midwife support 24/7.
2. Planned Expired Appointments (see earlier in report)
3. New risk entered for MCIS highlighting the issues mentioned earlier in the report with the SMO workforce experiencing difficulties in navigating and finding the relevant clinical information quickly in the new system
Timeliness
• Six Hour and ESPI Targets
Measures Result Six Hour Target – 95% of EC presentations are seen/admitted/discharged. This measures LOS for initial specialties
Paediatric Medicine: 97.5% for the month and YTD 97.5% Gynaecology: 95.1 % for the month and YTD 94.6% - we continue to work with the junior staff in ensuring patients in EC are seen in a timely manner. In WH there are two acute areas: Birthing and Assessment (maternity EC) and EC for early pregnancy and Gynaecology referrals. In particular, after hours it is a fine balance to meet timeframes for both areas. Performance improved significantly in May and June.
4 months FSA Kidz First outpatient Meeting target. 4months FSA Women’s Health Gynaecology outpatients and procedures
Meeting target.
Efficiency
• Management of Incidents
In addition to the standard weekly/fortnightly Incident Review meetings held in Kidz First and Women’s Health, quarterly incidents reports for April to June 2015 have been developed. These reports present data for historical trends and each quarter for the current financial year for: actual severity of incidents; classification of incident by service; falls; employee incidents; equipment/staffing issues; care service provision; and medication errors. These reports provide an excellent overview and assists in identifying trends that can then be addressed and mitigated accordingly. These reports will be presented at the Women’s Health and Kidz First Incident Review meetings respectively in July.
• Length of Stay
Measures Result ALOS Kidz First Surgical Floor Actual YTD 2.05 vs. 2.38 for 2013/14 ALOS Kidz First Medical - - KF Wards Actual YTD 2.7 vs. 2.7 for 2013/14 ALOS Neonatal Care 12.4 vs. 11.8 for 2013/14
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Effectiveness
• MQSP Report
A working group comprising Women’s Health: Public Health Physician, Maternity Quality and Safety Programme Co-ordinator, Director of Midwifery, Service Development Manager Maternity Services and the Clinical Quality and Risk Manager have developed with input from key stakeholders the third edition of the Maternity Quality and Safety Programme Annual Report 2014/15 in preparation for submission to the Ministry of Health on 30 June 2015. This MQSP Annual Report provides: a summary of the aims and objectives for Counties Manukau maternity service and MQSP in 2014/15; summarises the salient issues relating to maternity service delivery, provides data analysis on the maternity services provided within the Counties region and an evaluation in accordance with the National Maternity Clinical Indicators; describes the quality improvement actions undertaken in 2014/15 and outlines the planned actions for 2015/16. Once approved by the Deputy Director General Sector Capability and Implementation, this report will be published on the internet with an executive summary written in lay terms for consumers.
• Certification
Corrective Action for Standard 1.3.10.2 completed. Guideline published and communicated to core and LMC midwives: ‘Transfer of Women and Babies to a Counties Manukau Primary Birthing Unit in the Postnatal Period’
• Projects
Effective Result Menorrhagia/PID/Hyperemesis pathways Pilot underway. Good participation from GP practices
Obstetric clinics in Mangere and Otara SMO Obstetric clinic for Otara has commenced in August with positive feedback from both the women and the SMO/Registrar. Awaiting internet connection at Mangere before the SMO clinic can commence
Contraception pathways
Part of Maternity Project Board work stream and reporting. We are currently working on making the option of vasectomy a sustainable option (funded) as part of the tubal ligation volumes – i.e. couples will have the choice for the male to have a vasectomy rather than the female having a TL. A presentation to HAC made was made in May.
Patient and Whaanau Centred Care
Patient Satisfaction Result
Complaints / Compliments activity
June 2015 Complaints: KF= Three complaints received –all minor WH= Three complaints received – 2 minor and 1 not
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specified. Compliments: KF= nil compliments received WH= Nine compliments received.
Equity
Equity Result New Born Hearing screening (quarterly) 14/15 Screens in hospital = 6925
14/15 Screens in clinic = 921
Total = 7846 (total births is 7253 – however, the screening numbers include twins and also babies born in 13/14 that had their clinic screen some weeks later in 14/15).
B4 school checks (quarterly) The combined Vision and Hearing and Nursing assessment services achieved an excellent result for 14/15 year:
100% coverage overall
100% coverage for Q5
Total checks completed: 8044 target is 8026
Q5 checks completed: 3532 target is 3532
HPV Vaccinations On track for 2015
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5.3 Director of Midwifery - Hospital report DHB Midwifery Leaders Forum During the meeting on the 19th June 2015 the Registrar General of Births, Deaths and Marriages, Jeff Montgomery discussed their Birth registration on line project and birth of a child life event. They are utilising the programme RealMe® which allows someone to securely prove their identity online. One aim is to enable the information to prepopulate other forms required for life events to prevent duplication. The next phase is for their website to include information and links of other relevant websites, for example, health promotional information. Also included in the next phase of the project is to enable digital birth certificates with access through different IT devices. Sue Calvert, Midwifery Advisor of the Midwifery Council of NZ, came and discussed The plan of auditing components of midwifery recertification and the planned review of the midwifery competencies, overseas midwifery requirements and the Midwifery First Year of Practice Programme. National Diabetes Guidelines The Screening, Diagnosis and Management of Gestational Diabetes in New Zealand: A clinical practice guideline was published December 2014 on the MOH website. Counties Manukau health is commencing the changes in practice as of the 1st July 2015. This includes screening and then referral onto the appropriate clinical pathway. This has been well communicated to all health practitioners. The changes will be audited and reviewed as part of the Maternity Quality and Safety Work Plan 15/16. MOH Maternity Quality and Safety Programme The purpose of the programme is for health professionals and consumer stakeholders to work collaboratively to monitor and improve maternity care. As part of the programme a working group in collaboration with Ko Awatea’s Multimedia Team was established to develop virtual tours of the maternity facilities. The aim of the virtual tours are to describe service provision and support orientation to each of the maternity facilities, encourage women to register with a lead maternity carer early in their pregnancy and provide consumers with evidence to promote low risk women to utilise and birth in the primary birthing units. Filming of the three Primary Birthing Units and Middlemore Maternity areas occurred in June 2015 with production happening in July 2015 in preparation for a planned release the end of August 2015. Everyone involved has embraced this project with enthusiasm and their contributions have been greatly appreciated. The Maternity Quality and Safety Annual Report is a requirement as part of the National Programme and reviewed by the National Maternity Monitoring Group (NMMG). The report will be sent through to the MOH to be forwarded to the NMMG on the 17th July 2105. Media Campaign to Encourage Early Engagement The social media campaign continues with the media company Waking Giants meeting with the maternity consumer panel in June 2015 to discuss further developments of the content regarding why it is important for mother and baby to engage early for pregnancy care. They also reviewed the concepts for proposed video “SuperSuga” for The Coconet TV and Social Media. Here is the link to the video launched on the 30th June 2015: http://wakinggiants.co.nz/a-fresh-take-on-pregnancy-care/
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The next stage is to engage with community groups and also survey women about their journey toward finding a midwife in Counties. Any feedback from both health professionals and the public is always welcome. This work has been led by Amanda Hinks, Maternity Service Development Manager, as part of the Maternity Care Review Action Plan. Point of Care Measurements for Safety As part of CM Health’s Point of Care Measurements for Safety Project, Women’s Health have ranked the top five point of care measurements for safety to be:
1. Clinical documentation; 2. Medication charts; 3. Violence intervention programme; 4. Recognising and responding to clinical deterioration; and 5. Safe Sleep.
Women’s Health further reviewed these five measurements against the United Kingdom’s Maternity Safety Thermometer, as well as the Northern Regional Safe Sleep Audit Toll and piloted the tools. Botany, Papakura and Pukekohe Birthing Units, Maternity North and South, and Community Midwifery will all be included in the audit process. This work is led by Lesa Freeman, Clinical Quality and Risk Manager, Kidz First and Women's Health.
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5.4 Surgery and Ambulatory Care
Service Overview
Surgical and Ambulatory Care is managed by Gillian Cossey, General Manager with Mr Wilbur Farmilo Clinical Director - Surgery, Tony Williams Clinical Director - Critical Care, Jacqui Wynne-Jones Clinical Nurse Director Surgery, and Annie Fogarty Clinical Nurse Director Acute & Critical Care.
Performance
Activity Summary The Division of Surgical Services worked hard in June to achieve a good month and a great end of year result. At June 30 we had achieved all our goals and objectives and met all the MoH targets. We had no elective patients waiting more than 120 days for FSA or treatment (a tremendous result given that we have struggled to meet this since 31 December due to various capacity and financial constraints). We achieved our Bariatric target of 158 procedures, thanks to the hard work and dedication of the team over the last few weeks of the year (one SMO alone completed 83 bariatric operations). Our elective discharges were 107% of the Health Target. Most importantly, the quality of care to our patients has not diminished, as can be seen by the excellent 0% results for falls, pressure injuries, CLAB and rate of S. aureus bacteraemia per 1000 bed days. Another great achievement was the positive financial variance of $3.087 million for the year, a very satisfying end to a challenging year. Sincere thanks go to the whole SAC team without whose passion, hard work and goodwill these results would not have been achieved. Operational Volumes /Inpatient Summary (WIES)
Volumes
Actual Bud
/Contract Var % var Actual
Bud /Contract
Var % var
ACUTES - Adults 1,984 1,798 186 10.3% 22,606 21,876 730 3.3% - Children 179 182 3- -1.7% 1,852 2,211 - 358 -16.2%
2,163 1,980 183 9.2% 24,458 24,087 372 1.5%ELECTIVES - Adults 1,326 1,282 44 3.4% 14,756 14,906 - 150 -1.0% - Children 116 81 35 43.2% 1,091 940 151 16.0%
1,442 1,363 79 5.8% 15,846 15,846 - 0.0%COMBINED TOTAL - Adults 3,310 3,080 230 7.5% 37,361 36,782 580 1.6% - Children 295 263 32 12.2% 2,943 3,151 - 208 -6.6%TOTAL 3,605 3,343 262 7.8% 40,304 39,933 372 0.9%
Year to dateSurgical Volumes (WIES - Acute and Elective)
Jun-15
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A summary of the months results shows: • Acutes WIES 9.24% higher than contract for the month (1.54% ahead of contract
YTD). • Electives WIES 5.80% above contract for the month with the targeted budgeted
WIES contract achieved for the 14/15 financial year. • Overall WIES 7.84% or 262 WIES higher than Contract for the month and 372 WIES
or 0.93% higher than contract for the financial year. • Compared with 13/14 financial year: Acute WIES 2.41% higher and Electives 1.17%
lower. Overall 0.97% higher than the last financial year.
Operational Volumes / Inpatient Summary (Discharges)
A summary of the months results shows:
• Acutes discharges below contacted levels by 330 patients or 19.6% (YTD 1162 pts or 5.67% lower than contract). The reason for the discrepancy between WIES and discharges is that the average WIES per patient was 7.64% higher than that budgeted which resulted in higher WIES obtained for a lower number of patients treated
• Elective discharges lower than anticipated contacted levels by 26 patients or 2.09% (YTD 223 pts or 1.62% higher than contract).
• Overall monthly patient discharges are 356 below contract while YTD we are under contract by 929 discharges.
• In comparison with that of last financial year acute discharges are higher by 110 patients but Electives are lower by 269. Overall YTD therefore we are 159 discharges or 0.47% lower than contract for the year.
• For the 12 months to June 15 we subcontracted 1375 Elective patients to external providers compared with our budget of 945 patients for the same period. For the corresponding period last year we had subcontracted 1995 patients. Therefore subcontracting has dropped by 620 patients or 31% over this period in comparison with the corresponding period last year. However 72 of the 1375 patients were subcontracted to a Private provider due to MSC theatre refurbishment with CMDHB Surgeons/Anaesthetists. If we make an adjustment for this forced reduction in
Volumes
Actual Bud
/Contract Var % var Actual
Bud /Contract
Var % var
ACUTES - Adults 1,212 1,473 261- -17.7% 17,330 17,917 - 587 -3.3% - Children 143 213 70- -32.8% 2,015 2,590 - 575 -22.2%
1,355 1,685 330- -19.6% 19,345 20,507 - 1,162 -5.7%ELECTIVES - Adults 1,028 1,100 72- -6.6% 12,929 12,794 135 1.1% - Children 182 136 46 34.3% 1,672 1,574 98 6.2%
1,210 1,236 26- -2.1% 14,601 14,368 233 1.6%COMBINED TOTAL - Adults 2,240 2,573 333- -12.9% 30,259 30,711 - 452 -1.5% - Children 325 348 23- -6.7% 3,687 4,164 - 477 -11.5%TOTAL 2,565 2,921 356- -12.2% 33,946 34,875 - 929 -2.7%
Overall WIES/case 1.187 1.145 3.69%
Jun-15 Year to dateSurgical Volumes (Discharges - Acute and Elective)
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capacity at MSC then subcontracting has dropped by 692 patients or 34.7% compared with the corresponding 13/14 financial year.
• Substantial Elective work was done internally towards maintaining target of 120 day waiting time for February 2015. However even with the lost capacity the Division was able to maintain its ESPI targets and No patients are outstanding as at the end of the financial year for either ESPI 2 or ESPI 5. This is a major achievement considering that we had reduced subcontracting by nearly 35% during this period as well
• Elective base contract for the month excludes Gynae but includes additional elective work.
• NOTE: Adjustment has been made for Uncoded Hip and knee patients operated and discharged during the month but no adjustment has been made for Waiting list patients done on Acute Arranged lists
Outpatient Summary (visits first and follow up) for the month, and YTD:
• FSA's for month 0.16% higher than contract for the month and 4.53% higher than contract for the year.
• Follow ups are 1.39% lower than contract for month (3.98% below contract YTD)
Highlights
• Zero elective patients waiting >120 days for FSA or treatment. • Bariatric contract of 158 surgeries achieved. • Manukau SuperClinic volunteers were runners-up in the 2015 Minister of Health
Volunteer Awards. • Excellent patient safety results for the month. • 24 Spinal operations done – 9 acute, 15 elective. • Senior Ortho nurses provided training for orderlies and theatre nurses in the safe
moving and handling of spinal patients. The Support Manager for Non-clinical Support Services wrote: “I would like to bring to your attention the great work that your team have been doing with regards to delivering training around lifts and turns in theatre. This has been so encouraging for us as Orderlies as we have never had a training programme/process that can be signed off as competent from a clinical perspective”.
• ORL credentialling successfully completed on 26 June. • Rotation of EC SMO workforce up to Critical Care for a six month period commenced
in June. • 100% of all Health and Safety audits completed. • For the first time ever, six joint replacements were done on an all-day theatre list at
Middlemore Hospital. Orthopaedic surgeon wrote: “I would like to write this letter
Actual Contract Var % Actual Contract Var % Contract Forecast Actuals
FSA's 4,874 4,866 8 0.2% 29,571 28,289 1,282 4.5% 29,072 29,072 37,022
Follow ups 13,282 13,469 187- -1.4% 76,652 79,826 3,174- -4.0% 54,146 54,146 76,057 Total 18,156 18,335 179- -1.0% 106,223 108,115 1,892- -1.8% 83,218 83,218 113,079
Jun-15 Year to date Full year
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to congratulate the superb effort of the Theatre Staff at Middlemore Hospital in running busy elective lists. Earlier this year there was a lot of ceremony about trying to achieve a list that had five joint replacements on it. This was achieved at the Manukau SuperClinic easily. The Registrar did each of the cases with my supervision. Last week at Middlemore Hospital site we got through six joint replacements by 4.50pm with the Registrar doing five of these. Admittedly one case was bilateral. However this represents a fantastic achievement by the personnel involved in the theatre as well as in the preop and postoperative areas. I would like to take this opportunity to congratulate the members of the teams involved who get through such a large volume of work efficiently and with aplomb”.
Emerging Issues Anaesthetic Technician Shortage: We have experienced a spike in resignations in the last two months. The departures have been for ‘legitimate’ reasons, as below. However, anecdote and feedback from Charge Techs is that other institutions don’t have the work load Counties does and other institutions are offering a higher step in salary. There are currently 50 Registered AT vacancies across NZ, with all hospitals vying for the same pool of staff. We have had no results from overseas recruitment attempts. All ATs are apparently completing exit surveys. There are now six unfilled and upcoming vacant positions. Mitigation: Advertising has commenced to take on Trainee Anaesthetic Technicians in September rather than continuing to try to find Registered ATs, both via the trainee route and RN route. There have been three enquiries from nurses. Meanwhile Morstaff Agency has been contracted to supply temporary staff, but there are insufficient to meet our requirements.
Ophthalmology Volumes: At the end of June 2015 there were 3351 overdue follow up appointments for Ophthalmology with the longest overdue appointment being 14 months. There is another 2266 patients due an appointment in the next four weeks. Ophthalmology has become a service managing chronic disease with Glaucoma, Diabetes and Macular Degeneration all requiring intensive monitoring, treatment with laser and intravitreal injections. The patients requiring intensive monitoring have priority for appointments – early June there were 90 urgent appointments required in the next 4 weeks with all clinics fully booked. These patients are on top of the 2266 due an appointment in the next 4 weeks and will have the highest priority. Mitigation: Locum SMOs are appointed wherever possible. One CNS has been appointed to this new role. Another will be appointed in the next few weeks.
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Ongoing discussions with the School of Ophthalmology at ADHB and Localities regarding the training of Optometrists.
ORL Volumes: Demand for FSAs continues to rise – see graph:
Mitigation: Discussions with Clinical Director and Clinical Head on reasons for this and actions required.
Short-term Shortage of Spinal SMOs: Due to staff paternal leave and sick leave, plus an unfilled vacancy, there will be only two spinal surgeons to cover the majority of the elective spinal cases during July, August and September. Mitigation: Leave cover has been arranged and recruitment continues
Shortage of Critical Care Nurses: There are currently 5 vacancies, with 5 more expected between August and September. Nine nurses will be on parental leave in the coming months. Mitigation: ICU will be reduced to 11 resourced beds (instead of 13). HDU will remain with six resourced beds. A Dedicated Education Unit project is being organised in collaboration with Acute Care to increase training requirements and ensure appropriate trained registered nurses in the future plus some flexibility in the workforce.
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Scorecard
Service Scorecard
Surgical and Ambulatory Care SCORECARD
June 2015
BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCES
Def
Jun-15 Target Var Actual Target VarTotal Caseweight (Provider view) 3,605 3,498 3.1% 40,304 39,933 0.9% 1
Elective Caseweight 1,442 1,452 -0.7% 15,846 15,846 0.0% 3
Acute Caseweight 2,163 2,046 5.7% 24,458 24,087 1.5% 2
Elective Surgical Discharges 1,210 1,321 -8.4% 14,601 14,368 1.6% 4
Outpatient FSA Volumes 4,874 4,866 0% 29,571 28,289 5% 10
Outpatient Follow Up Volumes 13,282 13,469 -1.4% 76,652 79,826 -4% 11
Virtual FSAs -(GP consult and nonpatient appointments) 126 94 32 1,444 1,119 325 12
Reduce clinical outsourcing ($000) 617 128 -489 4,413 2,400 -2,013 13
Jun-15 Target Var Actual Target Var% Staff with Annual Leave > 2 years 15.8% 5.0% -10.8% 9.6% 5.0% -9.2% 14
% Staff Turnover 0.5% 2.0% 1.5% 8.8% 10.0% 2.7% 15
% Sick Leave 2.8% 2.80% 2.8% 0.0% 16
Work Place Injury per 1,000,000 hours 10.50 10.50 10.50 -1.26 17
IMPROVED QUALITY, SAFETY AND EXPERIENCE OF CARE
Jun-15 Target Var Actual Target VarHand Hygiene compliance rate (based on Gold Audit) - Ward 11 79% 80% -1% 78% 80% 3%Pressure Injuries / 100 patients 0% 0% 0% 0% 0% 0%Falls causing major harm / 1000 bed days 0% 0% 0% 0% 0% 0% 22
Severe Pressure Injury (ungradeable) per 1000 bed days 0% 0% 0% 0% 0% 0%Surgical Site Surveillance for Major joints
Antibiotics given 0-60mins before "knife to skin" 92% 95% -3% 88% 95% -7%2 grams or more Cefazolin given 99% 100% -1% 95% 100% -5%
Appropriate skin preparation 99% 100% -1% 93% 100% -7%% Operations - all 3 parts of Surgical Safety Checklist used 90% 90% 0% 92% 90% 1%CLAB rate/ 1000 line days 0% 0% -0% 0% 0% 0% 24
Rate of S. aureus bacteraemia per 1000 bed days 0% 0% -0% 0% 0% 0% 25
VTE - number of SACS re-admissions due to VTE 6 0 -6 103 0 103
Jun-15 Target Var Actual Target VarPre-operative Length of Stay Days (from admit to surgery) 0.38 1.00 0.62 0.43 1.0 0.57ESPI 2 No. patients waiting >150 days for FSA - Elective (Surgical Services incl Gynae) 0 0 0 0 0 0 42
ESPI 5 No. patients waiting >150 days Treatment - Elective (Surgical Services incl Gynae) 0 0 0 0 0 0 43
ESPI 2 No. patients waiting >120 days for FSA - Elective (Surgical Services incl Gynae)-Target 0 by 31/12/14 0 0 0 0 0 0ESPI 5 No. patients waiting >120 days Treatment - Elective (Surgical Services incl Gynae) -Target 0 by 31/12/14 0 0 0 0 0 0
Jun-15 Target Var Actual Target VarAverage Length of Stay - Acute Inpatient incl Burns 4.20 3.80 -0.40 4.04 3.8 -0.24 50
Average Length of Stay - Acute Inpatient excl: Burns 4.14 3.80 -0.34 3.97 3.8 -0.17 Average Length of Stay - Electives 1.17 1.50 0.33 1.18 1.5 0.32 51
Acute Readmissions within 7 days - Total N/a 3.43 N/a 3.17 3.43 0.26 52
Number of patients referred to POAC N/a 10 N/a 57 60 -3
Jun-15 Target Var Actual Target VarTheatre list utilisation - % used MMH/MSC (MOH OS5) 86.9% 85.0% 1.9% 90.2% 85% 5.2%Theatre session utilisation - % used MMH/MSC N/a 95.0% N/a 95.6% 95% 1%Elective Theatre turnaround times- Mins (MMH/MSC) N/a 15 N/a 15.2 15 -0.2 Elective cancellations - Day of surgery as % of all Elective (all reasons)- SACS only N/a 5.0% N/a 6.9% 5% -1.9%Day of Surgery Admissions (DOSA) 97.9% 90.0% 7.9% 94.9% 90% 4.9% 65
Day Case Rate (Elective/ Arranged) -Subspecialties in SACS only Adults/kids 58.9% 65.0% -6.1% 61.0% 65% -4.0% 66
MMH % patients discharged to discharge lounge or home by 1100hrs 17.9% 30.0% -12.1% 18.3% 30% -11.7%Ratio FSA/FU clinic ratio 34.7% 31.0% 3.7% 38.6% 31% 7.6% 61
Outpatient DNA rates - overall- Surgical Services only 7.6% 10.0% 2.4% 7.8% 10% 2.2% 62
Outpatient DNA rates - Maori (FSA) - Surgical Services only 14.6% 10.0% -4.6% 12.4% 10% -2.4% 62
Outpatient DNA rates - Pacific (FSA)- Surgical Services only 11.2% 10.0% -1.2% 11.4% 10% -1.4% 62
Jun-15 Target Var Actual Target VarPatient Experience Survey (n=96) 84% 92% -8.0% 81% 92% -11% 74
BETTER HEALTH OUTCOMES FOR ALL
Jun-15 Target Var Actual Target Var% of hospitalised smokers receiving smokefree advice & support -Total (Surgical) 94% 95% -1.0% 95% 95% -0.3% 77
Year
Year to date (n=1062)
Year
Enab
ling
High
Pe
rfor
min
g Pe
ople
Firs
t, Do
No
Harm
(Saf
ety)
Equi
tySy
stem
Inte
grat
ion
(Eff
ectiv
e)Ti
mel
yEf
ficie
nt
Patie
nt
Wha
anau
Ce
ntre
d ca
re
Ensu
ring
Fina
ncia
l Su
stai
nabi
lity
Year to date
Year to date
Year to date
12 month average
Year to date
HAC: 29th July 2015
102
Scorecard Commentary
• Patient Safety results for June were excellent. • Surgical Site Surveillance results show May confirmed data and are pleasing. • Theatre list utilisation (OS5) of 86.9% represents the total of Middlemore and
Manukau combined. The actual results for the year ended 30 June were 88.9% overall for Middlemore for the year and 92.6% for Manukau for the year (a pleasing result against the MoH target of 85%).
• The day case rate appears to have dropped to 58.9%. However, there needs to be data showing the number of procedures that have been moved out of a theatre into a procedure room (eg. Avastin injections), as these procedures may not all be counted in the equation. This data will be reported in next month’s report.
• The DNA rate for Maaori for FSA has increased slightly. However a new process has been instigated at Manukau SuperClinic in June which involves sending a text message to those who DNA. A report on the impact of this will be organised.
• The data on theatre session utilisation, turnaround times and cancellations is not available this month due to the unfilled vacancy in the role of theatre scheduler and report writer.
HAC: 29th July 2015
103
Financial Results
Statement of financial performance
Actual Budget Var Var % Actual Budget Var Var %REVENUE
778 629 149 0 Government Revenue 6,454 7,151 (697) (10)%0 150 (150) (100)% Patient/Consumer Sourced 415 2,100 (1,685) (80)%
577 515 62 12% Other Income 2,847 2,638 209 8%1,320 1,035 286 28% Funder Payments 12,790 12,418 373 3%2,675 2,328 347 15% Total Revenue 22,507 24,307 (1,800) (7)%
EXPENDITURE12,466 13,157 691 5% Staff Costs 144,365 149,777 5,412 4%
850 388 (462) (119)% Outsourced Costs 8,150 5,509 (2,641) (48)%3,692 3,478 (214) (6)% Clinical Costs 37,796 39,499 1,703 4%
642 572 (70) (12)% Infrastructure Costs 6,469 6,676 207 3%703 685 (18) 3% Internal Allocations 7,575 7,782 207 (3)%
18,353 18,280 (73) (0)% Total Expenditure 204,356 209,243 4,887 2%15,678 15,952 274 2% Net Result 181,849 184,937 3,087 2%
FTE282 287 5 2% Medical 279 287 8 3%816 776 (41) (5)% Nursing 794 776 (18) (2)%121 116 (5) (4)% Allied Health 113 116 4 3%
80 67 (13) (19)% Support 74 67 (7) (10)%129 127 (3) (2)% Management/Admin 124 127 2 2%
1,428 1,373 (56) (4)% FTE Total 1,383 1,373 (10) (1)%
**April:Unpaid days accrual for the Easter period,adjusted in May.
($000's) ($000's)
STATEMENT OF FINANCIAL PERFORMANCE - SURGICAL & AMBULATORY
Month to Date Year to DateJun-15
12,50013,00013,50014,00014,50015,00015,50016,00016,50017,000
Mon
thly
res
ult $
000'
s
Monthly Net Result
Result Budget
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
Mon
thly
res
ult $
000'
s
Monthly Operating Costs
Result Budget
9,500
10,000
10,500
11,000
11,500
12,000
12,500
13,000
13,500
Mon
thly
res
ult $
000'
s
Monthly Staff Costs
Result Budget
HAC: 29th July 2015
104
Commentary on major financial variances
Month YTD
Total Variance: $274 $3,087
Revenue: $347 $(1,800)
Salaries & Wages: $691 $5,412
Outsourced: $(462) $(2,641)
Clinical Supplies: $(214) $1,703
Infra-Structure/Internal Allocati $(88) $413
Unfavourable variance on Clinical Supplies for the month is $214k . YTD the Variance is favourable by $1.703k. Months unfavourable variance is mainly due to increased Acute and Elective WIES in excess of budget. YTD favourable variance is due to lower ACC work and reduced Tahitian patients treated together with procurement savings as a result of favourable prices obtained on contract renewals.
Achieved and exceeded the forecast
Year end Forecast variance to Budget $3M favourable
UnFavourable for the month mainly due to accruals for software maintenance fees, repairs and maintenance at MSC and a provision for stock adjustment of $44k on account of damaged stock at MSC due to flood . Some set off by savings under cleaning supplies, bedding and linen, consultant fees and lower vac suction rentals.Ytd Fav variance of $207k mainly due to savings in MRI $199k.
Jun-15
Clinical outsourcing of patients to private providers totalled $617k against a target of $128k resulting in a $(489)k unfavourable variance. YTD the variance was $(2.013M) adverse. A proportion of this variance is due to unfilled SMO's vacancies which has hampered the internal CMDHB outputs. Private subcontracting has therefore been a deliberate strategy to meet ESPI targets. For the month we also had a $(90)k unfavourable variance on external nursing bureau costs to supplement staffing needs to ensure adequate care was provided for the extra Acute patient workload on wards. The corresponding YTD Variance is $(500)k adverse which is set off in part by a favourable YTD Nursing variance of $63k. There is also a $(80)k adverse variance for the month (YTD $(225)k) on SMO costs paid to Auckland University due to an SMO taking up a university appointment during the year and the appointment of a SMO to be a Clinical head at MSC and deputy CD for the Division .These adverse variances were partly set off by a reversal of provision for anaesthetic techncian locums which was underspent at
STATEMENT OF FINANCIAL PERFORMANCE - SURGICAL & AMBULATORY
Government Revenue: Elective ACC Revenue was $149k favourable for the month and ($688k) unfavourable for the year. The revenue was much lower than target mainly in Plastics and hands due to priority being given to operating MoH patients. There is limited Capacity for reatment of ACC patients especially with the reduction in Outsourcing. In comparison with the previous year we have reduced outsourcing by 35%.Patient/Consumer Sourced: Private patients $(150)k adverse for the month (YTD $(1,684)k) due to a reduction in Acute Tahitian burns patients accessing treatment. However the plan is to bring in some elective reconstructive burns patients from Tahiti for the next financial year to ensure that we work towards achieving target.Other Income $62k favourable for the month YTD $209k favourable mainly due to additional Revenue from Urology and Plastics as a result of SMO 's carrying out work in other Auckland DHB's)Funder Payments: Funder revenue for elective work $285k fav on budget for the month, YTD $372k favourable due to bariatric contract being achieved
The Division had a favourable variance of $274k for the month. Detailed explanation for the months variance is given below. Year todate the result is $3.087M favourable.MoH outputs for the month were higher than contract by 262 WIES or 7.84% . This was based on 85% coding of patient charts. There was an increase in Acute workload of 9.24% or 183 WIES and an increase in Electives of 79 WIES or 5.80% compared to contract. The highlights for the Division as a whole for the financial year are as follows: *There were no patients waiting in excess of 120 days for FSA or treatment on either ESPI 2 or ESPI 5 *The Provider Elective contract was met inspite of reduced subcontracting and reduced theatre capacity due to four MSC theatres being refurbished * The Division also completed its Moh Bariatric target and surpassed both the Hip and Knee and Cataract targets *The Acute WIES target was exceeded but there will be some recoding to Electives for patients with a Waiting list entries who were treated either as an Acute or Acute Arranged for the same condition as indicated on the Wait list *FSA's were higher than target by 4.5% while the Division reduced follow ups by 4% *The Division achieved its forecast financial target by delivering a positive result of $3.1 M
Medical $815k favourable for the MTH and $3,767k fav YTD - Primarily reflects SMO vacancies due to pending job sizing finalisation. RMO's and House Officers account for $1.7M of the Ytd favourable variance. The mix of RMO's for the various surgical runs coupled with vacancies and the leave transfers on rotation have had a favourable impact on the Division. Nursing $232k unfavourable for the MTH (fav $63k YTD) - Un -Favourable variance for the month represents mainly leave taken exceeding leave accrued and accrual for pending MECA settlement which is higher than the budget . YTD favourable variance mainly due to vacancies and changes in skill mix of staff which is partly offset by bureau nursing costs.Allied Health $105k favourable for MTH ($997k fav YTD) - Favourable variance due to vacancies 8.5 FTE. These have remained unfilled as a result of the lack of skilled staff and the time lag for recruitment. Support Staff on budget for the MTH ($152k fav YTD) 2.8 FTE of SSU staff in the process of being recruited .Note: that the Division holds the budget for the entire organisation providing interpreting services as and when required. The demand on the service has grown rapidly and servicing these demands has resulted in more casual interpreters being recruited to meet expectation.Management Admin $3k fav for the MTH ($431k fav YTD) - 8 FTE vacancies in the Division .Month and YTD variances due to savings in lag time on unfilled
i
HAC: 29th July 2015
105
Savings initiatives
• Complex Pain: - The formalities of recruitment underway for 0.2 each of CNS, Psychologist,
Pharmacist (likely the original 20,000 Days and Beyond 20,000 Days will be successful in this recruitment).
- Have met with Health Information and Intelligence to explore data/analysis regarding quantify cost savings, bed days, pharmacy, reducing presentations to EC for management of complex pain.
- Engaged re better capture of Treatment Related Injuries (ACC). - Engaged re better capture of ACC patients in general (some success with
retrospective claims for Anaesthetic Preassessment FSA for ACC pts. - New Capex IT request for Laptop to enable on-the-go clinical documentation
during Complex Pain round. - Daptiv training and experimenting underway.
• See and Treat Unit:
- The refurbishment of old TADU has commenced, due for completion mid-September.
- ATR submitted for a fixed term appointment of a MOSS to test the model of care.
- Successful meeting held with GP Liaison and Chari of Vocational Committee of GPs re GP training.
• Navigation:
- Meeting held to discuss her work with Patient Navigators (ref. Seattle model). - Meeting held with Team Leader Interpreters, Service Manager and HR to discuss
structure of project and way forward. - Daptiv training done with all three and General Manager. - PID document being drafted. - ATR submitted for six month fixed term backfill position to release Interpreters
Team Leader for this project.
• Day Case Surgery: - Each Surgical Service is currently reviewing day case surgery rates and checking
what is being done in procedure rooms as opposed to theatre. - Clinical Director is reviewing DRGs and potential day cases.
Quality
Safety
• Compliments numbers (120) continue to outweigh the number of complaints (21).
• SAC Smokefree provisional results for June were 94%.
• Surgical services achieved 100% compliance in the June Health and Safety Audits.
• No SAC 3 or 4 Pressure injuries recorded again this month.
• 20 Surgical Trigger Tools chart reviews are completed now twice a month.
• Five Pulmonary Embolus case reviews completed for VTE Committee.
HAC: 29th July 2015
106
• Two weekly auditing for Opioid harm are being completed as part of the HQSC collaborative.
• 10 Controlled documents were reviewed and updated this month in Objective.
• Orthopaedic SSSI data is continuing to improve each month.
• There was a Leadership Walk Round on Ward 8 on 25 June. All participants said they would be happy “to have their Granny nursed on that ward”. Patients said they all feel safe on the ward and they spoke very highly of the dedication of the nurses.
• The monthly occupancy continues to increase in the Perioperative Care Unit at Manukau Surgery Centre. The majority of the increase comes from General Surgery patients. Unstable patients are monitored by skilled senior nurses, with oversight from Anaesthetic SMOs.
Timeliness
• There has been a reduction in the number of patients on the General Surgery wards who have a length of stay over 10 days. From an average of 25-30 at any one time, we have reduced the number to 15 in the last week of June 2015 and the number continues to fall.
• E-grading is working well in ORL and the time taken to complete grading is significantly decreased compared to paper referrals.
• Elective Waiting times
ESPI 2: No patients will wait more than 120 days for their First Specialist Assessment (FSA) ESPI 5: Patients given a commitment to treatment will be treated within 120 days
Services continue to have done well in June with no breaches in preliminary results for the EPSI 2 and ESPI 5 requirement for patients to receive FSA and treatment within 120 days. This result will be reflected in the August release of MOH data. There are no red flags at present to indicate deterioration in this position for the July 15 result at month end.
0
10
20
30
40
50
60
January February March April May June
PCU Monthly Occupancy 2015
HAC: 29th July 2015
107
CMDHB Waiting Time Tracking 14/15 >120 days
SACS Divisional Results
Efficiency • The CNS for Soft-tissue Infection and Cellulitis is very efficient in her review and
follow up of patients with abscesses and cellulitis. Optimisation of TADU and early discharge of these patients saved 28 bed days in June.
Effectiveness • The Wound Care Nurse Consultant held Education sessions education sessions
Manukau SuperClinic, lectured at East Health Symposium, lectured at ARRC nursing education, met with Gerontology CNSs, delivered education to District nurses. Introduction to the service and the Complex Wound Clinic, as well as the referral process via the services Health point page. As a result an increase on referrals and phone queries around complex wounds.
ESPI 5 Eligible Patients Waiting 120+ days for treatment
Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15General Surgery 0 0 0 0 0 0 0 0 0 0 0 0
ORL 50 62 52 46 8 0 0 6 14 1 0 0Ophthalmology 150 64 32 14 6 0 0 0 0 0 0 0
Orthopaedics 49 36 9 19 0 0 0 0 0 1 1 0Plastic Surgery 10 17 14 13 6 0 1 2 0 3 2 0
Urology 1 1 0 0 0 0 0 0 0 0 0 0
SACS total 260 180 107 92 20 0 1 8 14 5 3 0Gynaecology 29 38 26 29 11 0 0 0 0 0 0 0Cardiology 0 0 0 0 0 0 0 0 0 0 0 0
CMH total 289 218 133 121 31 0 1 8 14 5 3 0
HAC: 29th July 2015
108
• The Clinical Nurse Specialists have very effective roles in patient education and integration with Localities:
- CNS Bariatrics - a plan for focus groups in GPs practises for preoperative Bariatric patients, with a view to providing therapy to aid self-management and reduce cancellations on day of surgery.
- CNS Colorectal - has developed pamphlets for patients and is developing an e-learning package of education, for all nurses.
- CNS Skin Lesions - helping set up the One Stop Shop for skin lesions in Galbraith, working with the GPwSI. Liaise with the community, GPs and practise nurses, around the Melanoma patients. Melanoma education, for Community Health professionals, and patients. Liaises with practise nurses, and GPs, around complex management plans for melanoma patients.
- CNS Reconstructive surgery - developed Breast reconstruction awareness day, education, awareness and access. A collaborative effort with plastic surgeons and GPs. Bra Day meeting for women. Education for nursing students provided at Auckland University. In-services for Ward staff, District Nurses, and the lymphodema team.
- CNS Cleft and Palate - strong links with community based home care nurses, speech therapists, health workers and social workers Communication with GPs by phone. Works with other DHBs for maternity services, speech therapy and MDT. Out-reach clinic in Whangarei for the region. Teaching sessions at all DHB maternity units and to University midwives.
Patient and Whaanau Centred Care
• There were 120 Compliments received for the surgical department this month 70 for MMH and 50 for MSC. Many great comments such as: - “Lovely nurses, treated with respect, dignity, happy, cheerful” - “all staff treated me with empathy and respect” - “very professional, quick, efficient with care” - Special praise for the National Burns Unit “Thank the Burns unit each and
every one of you from the cleaner through to the surgeons. A most valuable and worthy unit. I appreciate the super care shown to myself and partner. With loving thanks.”
050
100150200250300
Oct
Nov
Dec Jan
Feb
Mar Ap
rM
ay Jun
Jul
Aug
Sep
Oct
Nov
Dec Jan
Feb
Mar Ap
rM
ay Jun
Jul
Aug
Sep
Oct
Nov
Dec Jan
Feb
Mar Ap
rM
ay Jun
Jul
Aug
Sep
Oct
Nov
Dec Jan
Feb
Mar Ap
rM
ayJu
ne
2011 2012 2013 2014 2015
Wound Care Service Wound/Cellulitis Patient Input
# N/R# F/U
HAC: 29th July 2015
109
5.5 Adult Rehabilitation and Health of Older People
Performance
Activity Summary
Inpatient summary
Outpatient Summary
Note: From January 2015 the Ministry of Health requested visibility of patients seen/treated within 120 days. Waitlist timeframes for AT&R are not reported to the Ministry however the parameters have been changed to provide consistency with other services.
Highlights
• Inpatient hospital services began referring to the Primary Options for Acute Care (POAC) Winter Coordination Service from 15 June 2015. Two weeks on from the implementation date, referrals for clients currently receiving short term home based support services are now starting to be sent out by POAC to the localities coordinators for review and identification of further needs; including specialist support equipment or general practitioner follow up. We continue to work with the inpatient teams, localities teams and POAC to identify opportunities to streamline the process as queries arise.
• Sign off received for full funding of business case to increase Early Supportive Discharge (ESD) service for stroke to all of Counties Manukau Health Community areas as part of 20,000 bed days initiative. Further recruitment of additional roles has commenced as outlined in the business case (Appendix A) recruitment to roles commenced.
• Work has also commenced in July to combine ESD and Community Based Rehabilitation Team (CBRT) teams into one seamless service delivering support to community based patients as an option for earlier discharge from hospital and on-going active rehabilitation.
Volumes
ActBud /
Contract Var % var ActBud /
Contract Var % var
INPATIENT AT&R 1,670 1,874 -204 -11% 21,427 22,019 -592 -3%
Spinal 482 423 59 14% 5,479 5,207 272 5%
Stroke Rehabilitation 292 379 -87 -23% 3,901 4,046 -145 -4%
Acute Care for the Elderly 421 345 76 22% 3,794 3,688 106 3%
ARHOP Volumes (Bed days and Contacts)June '15 Year to date
Month Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15Added 79 82 93 109 77 89 85 89 80 114 81 105 80Seen 103 81 85 70 63 85 72 72 63 55 73 79 99Return to GP 0 0 0 0 1 0 1 0 1 0 0 0 0Removed Other 11 12 11 9 8 20 5 11 27 17 15 29 26
TOWL 142 123 115 143 145 126 137 141 132 178 177 175 123Waiting > 120 days 14 9 12 17 17 16 22 27 12 4 6 10 8Waiting > 90 days 23 16 17 22 21 23 33 33 16 8 18 21 15Waiting > 60 days 43 41 26 29 39 48 30
HAC: 29th July 2015
110
Scorecard Service Scorecard
Note: Enabling high performing people data not available at time of reporting
Adult Rehabilitation and Health of Older People SCORECARD
June 2015
BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCES
Def
Jun-15 Target Var Actual Target VarSpinal Inpatient ACC Revenue(in '000s) 204 308 -104 4,193 4,350 -157 Non-acute Rehabilitation ACC Revenue(in '000s) 156 200 -44 3,262 3,000 262
Jun-15 Target Var Actual Target Var% Staff with Annual Leave > 2 years (1) 6.4% 5.0% -1.4% 3.3% 5.0% 1.7% 14
% Staff Turnover 0.4% 2.0% 1.6% 10.7% 10.0% -0.7% 15
% Sick Leave 2.8% 2.8% 3.1% 2.8% -0.3% 16
Workplace Injury Per 1,000,000 hours 10.50 10.50 18.40 10.50 -7.90 17
IMPROVED QUALITY, SAFETY AND EXPERIENCE OF CARE
Jun-15 Target Var Actual Target VarFalls - % of falls assessments done in first 6 hours (2) 90% 100% -10.0% 91% 92% -1%Falls - % of Interventions completed 92% 100% -8.0% 92% 84% 9%Pressure Injuries - % of assessments done in first 6 hours 95% 100% -5.0% 97% 86% 11%Pressure Injuries - % of interventions completed 100% 100% 0.0% 96% 93% 3%Reduce over ride rate of Pyxis on ATR wards decrease medication errors to 15% 13% 15% 2% 15% 15% 0%
Jun-15 Target Var Actual Target Var
Stroke discharges - CVD risk profile, medications and 3 month follow-up100% 90% 10% 100% 90% 10.0%
Proportion of referrals managed via e-referrals across all Services (ARHOP) 31% 50% -19% 26% ~ ~
Access to Outpatient specialist services -volumes of Geriatric A&R Hotline Calls 28 29 -1 18 ~ ~
QUARTERLY REPORTING
May-15 Target Var12 month
Ave Target Var% NASC referral to assessment - high complex within 5 days urgent < 24 hrs (or less), (new measure 2014/15) (3) 29% 75% -46% 29% 75% -46%% NASC referral to assessment - low complex clients <15 days (new measure 2014/15) (5) 70% 75% -5% 72% 75% -3%
Jun-15Jun-14 (less %) Var Actual Target Var
Reduce number of patient 75’s or older LOS > 10 days in AT&R wards by 2% (4) 58 50 8 57 55 2 50.8Reducing direct admissions from GPs to ATR wards by 5% 13 28 -15 24 30 -5
% of Estimated Discharge date set following assessmentn in ARHOP 100% 75% 25% 91% 75% 16%Avoidable presentations to EC from Aged Residential Care Facilities (ARRC) 17 11 6 15 15 0MMH % patients discharged to discharge lounge or home by 1100hrs 29% 30% -1% 34% 30% 4%Rehabilitation 7 day Readmissions rate 0.00% ~ ~ 0.0% ~ ~Acute Readmission within 28 days - Total for Rehabilitation beds 0.8% 7.8% -7% 7.0% 10% -3% 53
QUARTERLY REPORTING Q2 Target Var Actual Target Var
% +65years with long term HBSS - comprehensive clinical assessment &care plan 81% 75% 6% 79% 75% 4%Reported one quarter in arrears - Due after 20-07-15
Jun-15 Target Var Actual Target VarPatient Experience Survey 100% 90% 10% 97% 90% 7%
Better Health Outcomes For All
Jun-15June 14 Target Var Actual Target Var
Number of Spinal Rehabilitation Outreach Clinic days - (new measure 2014/15) 3 5 -2 46 38 8 47
Ensu
ring
Fina
ncia
l Su
stai
nabi
lity Year to date
Enab
ling
High
Pe
rfor
min
g Pe
ople 12 month average
Equi
ty
Year to date
Syst
em In
tegr
atio
n (E
ffect
ive)
Year to date
Effic
ient
Year to date
`
Patie
nt
Wha
anau
Ce
ntre
d Ca
re n = 2 Year to date (n=34)
Tim
ely
Year to date
Year to date
Firs
t, Do
No
Harm
(S
afet
y)
Year to date
HAC: 29th July 2015
111
Scorecard Commentary
• The Division is continuing to monitor and manage high annual leave balances. Sick Leave rates also continue to be monitored and managed.
• Falls, Pressure Injuries and Medication assessments and intervention rates continue to be monitored and incidents investigated and reviewed by senior clinical and management team
• In addition to timeliness of assessments and number of current clients on InterRAI there is also a comprehensive Needs Assessment and Service Coordination (NASC) performance dashboard that has been developed and reviewed and refined monthly.
• Further work to identify and improve service coordination across the organisation for complex older people with delirium and or dementia as a focussed process improvement has been agreed across mental health for older people, geriatrics and emergency care acute general medicine.
HAC: 29th July 2015
112
Financial Results
Statement of financial performance
Actual Budget Var Var % Actual Budget Var Var %REVENUE
344 358 (14) (4)% Government Revenue 4,458 4,297 161 4%1 0 1 251% Patient/Consumer Sourced 5 3 2 71%
144 49 95 194% Other Income 507 589 (82) (14)%162 168 (6) (3)% Funder Payments 2,133 2,017 116 6%652 576 76 13% Total Revenue 7,102 6,906 196 3%
EXPENDITURE4,146 4,091 (54) (1)% Staff Costs 47,416 49,036 1,620 3%
198 355 158 44% Outsourced Costs 4,162 4,261 98 2%553 488 (65) (13)% Clinical Costs 6,395 5,857 (538) (9)%171 132 (39) (30)% Infrastructure Costs 1,929 1,581 (348) (22)%
71 59 (12) 20% Internal Allocations 847 750 (97) 13%5,139 5,125 (13) (0)% Total Expenditure 60,750 61,485 735 1%
(4,487) (4,550) 63 1% Net Result (53,648) (54,579) 931 2%
FTE 33 30 (3) (9)% Medical 31 30 (0) (1)%
267 260 (7) (3)% Nursing 271 261 (10) (4)%288 294 5 2% Allied Health 281 295 14 5%
53 55 2 4% Management/Admin 50 55 5 9%641 639 (2) (0)% FTE Total 632 641 9 1%
STATEMENT OF FINANCIAL PERFORMANCE - ARHOP
Month to Date Year to Date
($000's) ($000's)
Jun-15
-4,800
-4,700
-4,600
-4,500
-4,400
-4,300
-4,200
-4,100
-4,000
Mon
thly
resu
lt $0
00's
Monthly Net Result
Result Budget
850
900
950
1,000
1,050
1,100
1,150
1,200
1,250
Mon
thly
resu
lt $0
00's
Monthly Operating Costs
Result Budget
2,000
2,500
3,000
3,500
4,000
4,500
Mon
thly
resu
lt $0
00's
Monthly Staff Costs
Result Budget
HAC: 29th July 2015
113
Commentary on major financial variances
Savings initiatives
• Have commenced Primary Options for Acute Care (POAC) winter coordination services as highlighted to facilitate (bed savings) timely discharge.
• Have set up reporting to review and ensure ACC clients are being identified (with CM Health ACC Team) and billed accordingly.
• Have identified overdue continence assessments and are in process of catch up and ensuring correct allocations.
• Researching if virtual supports for self-management exercises verses face to face clinics in outpatient’s allied health (vestibular patients) vestibular are better and save time.
Month YTD
Total Variance: $63 $931
Revenue: $76 $196
Salaries & Wages: $(54) $1,620
Outsourced: $158 $98
Clinical Supplies: $(65) $(538)
Infra-Structure: $(39) $(348)
Internal Allocations: $(12) $(97)
The June month result reflects personnel costs below budget for Allied and Admin; offset partly by Clinical Supplies and Infrastructure costs overspend as detailed below.
The favourable variance YTD is mainly due to Beyond 20k Bed days Funding.
Medical Staffing is over budget $107k for the month (YTD underspend $279k) mainly due to RMOs seniority level being less than budgeted. The recruiting of staff at a lower level in Nursing has resulted in a YTD underspend of $130k. This month's client acuity mainly in Ward 5, Spinal Ward & Pukekohe Geriatric Ward have resulted in an overspend of $(57)k. The Allied Health vacancies, 13.5FTE and recruiting staff at a lower level wherever possible has resulted in a favourable variance of $106k (YTD underspend $972k). Admin vacancies and recruiting at lower levels has resulted in a favourable variance of $3k for the month (YTD under spend $238k).
YTD Underspend mainly due to lower Home Aids costs.
STATEMENT OF FINANCIAL PERFORMANCE - ARHOPJun-15
The main variances: Community Continence $3k overspend for the month (YTD $(117)k overspend), Patient Consumables (Burns Garments) $(11)k overrspend for the month (YTD overspend $(114)k) that is recoverable through the ACC pathway, Community Ostomy $(3)k underspend for the month (YTD $(107)k overspend), Inpatients and Community Bandages & Dressings $(33)k overspend for the month (YTD $122k overspend) and Clinical Equipment Minor Purchases $1k overerspend for the month (YTD $(57)k overspend). 2014/15 budget reflects reduced useage of clinical supplies.
Mainly due to Deferred Maintenance-Ward 23 (YTD $(163)k overspend) and MOH Project Manager Secondment costs in Spinal $(47)k YTD.
Mainly due to Drugs dispensing to client, YTD $(147)k overspend
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Quality
Safety
• Pressure injuries: There were two pressure injuries recorded during the month of June, both were acquired during ARHOP ward admissions.
• Falls incidents: There were 35 recorded falls in June; this is an increase from 33 recorded falls last month. Of these there were 11 falls with harm, an increase from eight during the month of May.
• Medication errors incidents: There were ten medication errors reported for June. This is a decrease from fifteen medication errors reported for May. Investigations and corrective actions are underway to address both the individual and systemic issues involved in this exceptionally high number of incidents.
• Staff Influenza Vaccination Update: 73% of the ARHOP workforce has had their 2015 Influenza vaccination; this 12% short of the Counties Manukau Health uptake goal for 2015 of 85%.
• Health & Safety Bi-Monthly Audits – Audit Compliance based on ARHOP Division records of audits completed and received from services. All Operations Managers and Service Manager have attended the recent training provided by Occupational Health regarding new legislation and new responsibilities.
Timeliness
Acute Allied Health Outpatient Waitlist Activity The priority 2 target for musculoskeletal patients continues to be an issue with a vacancy in the team contributing to it remaining high. Referrals continue to exceed the ability to manage the demand. The hyperventilation service has been doing some phone triaging and reviewing the patients on the waitlist which has reduced the waitlist by 15% from last month.
Note:
1. Of the 51 patients waiting greater than 150 days, five are Priority 1, all of which are Hyperventilation Services patients. Two patients missed their appointments and the remaining three have been contacted by the service.
2. The waiting list data is a reported as a point in time reflecting the number of patients waiting at the time the reported is generated. The reports are set to run in the early hours of the first of each month. Logically last month waiting plus added during the month less the seen and removed should give the numbers waiting for following month, however due to the lag in entering referrals and to a lesser extent removing patients, there will be always be a slight variance in this figure.
Month Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15Added 418 513 417 502 538 380 384 284 430 508 455 440 433Seen 273 368 220 387 332 364 290 242 299 397 322 389 385Removed Other 104 67 94 94 105 112 51 87 109 153 100 103 99
Total on Waiting List 818 819 830 865 928 846 908 881 941 907 958 925 891Waiting > 150 days 10 10 17 16 31 36 51 75 97 81 80 67 51Waiting > 120 days 18 31 22 45 41 32 63 63 58 61 38 28 37Waiting > 90 days 79 65 97 62 79 94 110 113 113 85 66 111 101Waiting > 60 days 148 120 147 159 115
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Efficiency
Needs Assessment and Services for Older People (NASC) Work continues on developing and implementing the new locality multidisciplinary model aligned to the At Risk Individual Programme and developing pathways to align to community central model. A proposal has been sent out to teams for consultation on alignment of the inpatient NASC team and NASC and Home Health Care Administration teams. A decision on the final structure of these teams will be developed based on feedback received and is planned to be finalised in mid-July.
Effectiveness
Acute Care for the Elderly (ACE) This project is now complete, the model is now stable and outcomes are routinely being delivered at a consistent level. Length of stay gains are being delivered for ACE to Adult Treatment and Rehabilitation (AT&R) patients in particular and readmissions and institutionalisation rates remain lower than the baseline.
Dementia Pathway Implementation (Memory Team) The Memory Team is continually refining their processes. Definition of the criteria for keeping cases open or closing them has been confirmed and the team is applying this definition to current cases. It is expected that the number of open cases will significantly close in the coming months with options of discharge, handing over to the General Practitioner (GP) or Alzheimers Auckland Charitable Trust (AACT).
Business planning for 2015/2016 has been completed with the following focus areas identified; locality model of care, measurements and reporting and projects and publicity.
One team member is presenting at the Australasian Society for the Study of Brain Impairment, (INS/ASBBI) Conference in Australia during the first week of July.
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The Community Stroke Early Supported Discharge Approval received as part of the 20,000 days project for a permanent doubling of the pilot Full Time Equivalent (FTE). With this change the scope of the Early Supportive Discharge service (ESD) will increase to the whole of Counties Manukau Health Community areas, including FTE being allocated to Franklin to provide an extended service as part of their existing community based services. The ESD/Community Based Rehabilitation Team (CBRT) service delivery model will be revised, combining the ESD and CBRT teams to deliver one seamless service. The level of support patients receive will be determined by need with early discharge being an option when home environment and supports are appropriate. The aim of combining these two services is to ensure the delivery of early discharge options with timely rehabilitation support without loss in service continuity or rehabilitation gain. Currently patients may experience a gap in rehabilitation support of up to three weeks from time of discharge from inpatient stay, when referred solely to CBRT, the revised model will diminish this wait time. In addition combining the teams will remove the transitional barrier between the two community based services. It is expected that through this model change a reduction in combined service length of service will be possible.
Community Geriatric Service (CGS) team An important component of the Systems Integration/Locality development is to provide additional Geriatrician support to primary care practices and aged residential care. The CGS team provided support to three GP practices and five residential care providers during the month of June. 28 aged residential care facility staff attended the June education forum; which was focused on Respiratory Diseases and Palliative care in Chronic Obstructive Pulmonary Disease (COPD) residents. Year to date, 338 aged residential care facility staff have attended the Educations Sessions provided by the CGS team.
Target <100 Emergency Care presentations from residential facilities per month
• June 2015 saw 109 Aged Related Residential Care (ARRC) Clients present to Emergency Care. Of these, 9 presentations were falls related and 17 were potentially avoidable admissions.
The National Spinal Strategy and Counties Manukau Health Spinal Service There have been 76 patients through the Acute Spinal Service since 1 July 2014, with a continuing high number of complete and incomplete cervical injuries.
Work continues with Canterbury District Health Board and Burwood Spinal Unit on a consistent approach to service delivery, collaboration on patient experience has been the main focus this month with sharing of information to develop a better approach to receiving and utilising patient feedback. Patient forum has been held at ASRU using agreed areas for questioning. Initial meeting of stakeholder group has been held.
Patient and Whaanau Centred Care
Adult Rehabilitation and Health of Older People is aware that early patient experience data is starting to be reported and will be reviewing this data once refined to divisional/ward level. The process on the wards for collecting email addresses to promote better access to the survey will be reviewed. ARHOP will continue to work with the Patient Experience Team to develop a process for collecting the patient experience data via portable computer
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device, while patients/families are on the wards or during outpatient follow up appointments.
Work continues with Canterbury District Health Board and Burwood Spinal Unit on a consistent approach to service delivery, collaboration on patient experience has been the main focus this month with sharing of information to develop a better approach to receiving and utilising patient feedback.
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5.6 Medicine, Acute Care, and Clinical Support
June 2015
Performance
Activity Summary
Volumes Month YTD Budget/ Contract
Last YTD
Act Bud / Contract
Var Act Bud / Contract
Var Forecast Act
Inpatient (WIES) Adult Acute Care 472 416 56 5,588 4,799 789 3,984 4,057 Adult Medical Care 1,924 1,957 (33) 24,016 24,051 (35) 24,155 23,396 Total 2,396 2,373 23 29,604 28,850 754 28,139 27,453 Inpatient (cases) Contract = Last year actuals
Adult Acute Care 1,236 1,322 (86) 15,085 14,933 152 11,560 11,560 Adult Medical Care 2,288 2,231 57 26,963 27,003 (40) 25,838 25,838 Total 3,524 3,553 (29) 42,048 41,936 112 37,398 37,398 Medicine O/P Procedural (contract) 607 417 190 6,343 6,397 (54) 6,285 5,859
FSA’s 1,297 1,178 119 16,578 14,103 2,475 15,435 15,435 Follow up’s 3,141 3,095 46 38,796 37,145 1,651 39,588 39,588 Emergency Care Presentations (against last year) 9,195 8,996 199 109,454 104,815 4,639 104,815 104,815
Breast Screening No. of screens 2,416 2,160 256 26,543 25,920 623 25,920 25,548 Wies: The overall monthly wies result reflects a 7% decrease compared to contract and a 1% decrease compared to last year. The results for General Medicine in June showed a 7% decrease in wies compared to contract and a 4% decrease compared to last year. (Source Total Inpatient Wies for Current fiscal period – Medical Service Book Run 2)
Cases: This month we saw 3% or 59 more cases than this time last year, with a 5% increase in the ALOS compared to last year. General Medicine (inpatients) saw 6% or 94 less cases compared to last year and a 4% increase in the ALOS. – (Source Acute Care/Medicine Services ALOS and Cases for current fiscal period– Cherie Nouwens) Renal Volumes: Continued increase above contract. 32 in-centre dialysis patients outsourced. 24 patients in the Western Campus Prefab, with 43 patients on evening shifts in AMC and in Rito MSC, totalling 99 patients over in-centre capacity for the year to date. However, in-centre growth has slowed with the implementation of the “Home and Kidney First” policy, which is channelling more patients to home dialysis options.
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Outpatients: Data for June shows that FSA’s were 119 above contract but 8% lower than the same month last year. YTD FSA's are 18% higher than contract but there is no significant difference compared to last year’s total volume. Follow-ups were 1% above contract for the month and similar volumes compared to the same month last year. YTD follow-ups are 4% higher than contract and in line with the volumes for last year. (Previously this was tracking below contract and last year). Education and management volumes remain higher YTD (8 % higher than the same time last year and 164% higher than contract). Day patient procedural total annual volumes are now showing +13% variation to contract and volumes are 6 % higher than last financial year. Emergency Care: Total EC volume 9195 – 2.2% higher than this time last year and 1.8% higher than last month. Average daily volume of 295.
Breast screening: The service volumes for June were above the monthly target and 2% above YTD budget. Radiology: June activity was ahead of the same time last year due to the additional weekend sessions performed in CT and Ultrasound and outsourcing of MRI and CT scans. These increases were offset by lower volumes of general x-rays. Laboratory: Overall laboratory workload increased by 5.9% compared to June 2014 and a total of 6.9% for the year. With the exception of Histology (19.7%) and Microbiology (14.3%) increases for the year were in line with previous years.
Highlights
Emergency Care Achieved the 95% target for the month and the quarter. The Surgical Assessment unit opened on the 29th of June 2015. Medicine We have also instituted a daily front door triage meeting, supported by gen med and EC clinicians, where we review the patients who presented the previous day who have had more than 3 presentations in the previous 12 months. Attending the meeting are representatives from VHIU and localities.
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Average Daily EC Presentations
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Radiology Acute Radiology Hub The Acute Radiology Hub refurbishment was completed ahead of time in the Emergency Department. This includes a CT scanning room, Radiologist reporting office, an out of hours Ultrasound scanning room, improved waiting areas and a widened corridor. The CT scanner was installed in the last week of June and during July the MRT’s and Radiologists will receive training on the new equipment. The Radiology and Emergency teams are excited about this collaboration which will ensure that Emergency patients will receive their Radiology within the Emergency Department improving patient safety, time to diagnosis and assisting meet the 6hr target set by the MOH. Patient Information The long- awaited upgrade of Provation was successfully completed on 21/06/2015. The project was managed well by the hA Project Manager, John Lahood and he continued to co-ordinate the resolution of post go-live issues. The staff have taken a few days to adapt to the new system, and John has ensured support was provided as required to resolve the change management issues that have been identified. The new meal ordering system, TMMI (Task Manager Meal Information) which integrates with the Compass IT system went live, and the staggered roll-out to the wards commenced in June. In general the staff have adapted to the new system/processes well, and ongoing support is being provided by staff from the Clinical Systems Support Team, Dieticians and main kitchen. The roll-out is expected to be completed by 20/07/2015. A project tasked with changing the way the procedure waiting lists are managed to meet the Ministry of Health reporting requirements, has been completed. This was a “business as usual” project which included moving all procedures for the following services from “First Specialist Appointment” waiting lists to “Procedure” waiting lists:
• Respiratory • Cardiology • Audiology • Ophthalmology • ORL • Plastic Surgery • Gynaecology • Urology • General Surgery
The Gastroenterology Service procedures were previously managed via an inpatient waiting list and have now been converted to an outpatient procedure waiting list. This involved a large amount of data migration which was successfully completed on 03/07/2015. A number of teams have worked very closely together this project, including staff at MSC, the Clinical
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Systems Support Team, the healthAlliance Database Analyst and DHB staff in the affected specialties. CM Health is now compliant with the MOH reporting requirements. Pharmacy Three abstracts on pharmacy lead initiatives were accepted for oral presentation at the 2015 New Zealand Hospital Pharmacist Conference held in Napier in August. Four posters were also accepted. The oral presentations will be on the Hospital Pharmacy Residency programme set up here as a New Zealand first, a health literacy study on cardiac patients and the education resources and electronic tool for surgical pharmacist training. Another abstract was accepted for oral presentation at the Federation of International Pharmacy held in Dusseldorf in Germany in September. The initiative shared at this conference is the improvement made in timely pharmaceutical care delivery in elderly care wards at Middlemore. Emerging Issues
Cardiology Standardised intervention rates (SIRs) – Angiography and Angioplasty Unfortunately we have not met the national target for SIRs for Angiography and angioplasty for quarter 4. There are currently no barriers to accessing the Cardiac Catheter Laboratory and there are no delays in the system, this SIR result reflects the need of our population. All other wait targets have been met. There have been several communications with the MOH indicating that we do not agree with the target set, however we were advised there had been no acceptance of a reduced rate.
ECHO Wait lists continue to grow in echoes due to ongoing recruitment issues and increasing demand. The Echo wait list is currently 1517 (up 7 last month).
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Gastroenterology Capacity The department is still challenged with the need to increase capacity in order to meet growing demand and achieve MoH targets. The lack of capacity has contributed to CMDHB not being able to meet the target of 60% of P2 (non-urgent) patients have their colonoscopy within 42 days. The target has also increased to 65% from 1 July, which will be more difficult to achieve.
A capacity issue for the future is the roll out of the National Bowel Screening programme, tentatively set to commence in 2017. CMH does not have capacity currently to manage the volumes of colonoscopies which will result from the screening programme, and will need to make plans on how to achieve this. Any planning will need to be done in collaboration with the regional Gastroenterology Group on managing the screening programme.
Lack of workforce is a major issue for the service, and recruiting new staff continues. Modelling of growth and volume management has established that there are four SMOs and/or fellows needed in the next couple of years. For the immediate needs, General Surgery is providing SMOs to do additional gastro lists from July and there is a new fellow due to start in Gastroenterology on the 20th of August. From December, the Gastroenterologists who currently provide cover in General Medicine, will come off the cover for 12 months thus providing significantly additional scoping capacity.
It is planned to have an additional four lists at MHP from September and a further six from December, with the provision of the additional General Surgeons and Gastroenterologists’. This will require some alterations to rooms 25 and 26 to accommodate the additional volumes. Plans on how to best manage the refurbishment without too much disruption to services and at a reasonable cost are currently being explored.
Additional scopes to manage the lists in room 25 at MHP have been procured. The equipment to clean and dry the scopes has been approved, but put on hold until the plans for the refurbishment can be agreed upon. BreastScreen Service Delivery and Funding Model Reviews BreastScreen Aotearoa advised programme managers at a meeting this month that a summary of outcomes of the Service Delivery Review and the results of the consultation will be released in July. Proposals regarding MRT outputs are not going to be progressed and it is therefore anticipated that there will be limited impact resulting from this review on BSCM.
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Scorecard
Service Scorecard Month
June 2015
BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCES
Def
Jun-15 Target Var Actual Target VarTotal Caseweight 2,396 2,374 1% 29,604 28,849 3% 1
Elective Caseweight 35 33 6% 431 478 -10% 2
Acute Caseweight (includes ICU) 2,361 2,341 1% 29,173 28,371 3% 3
Outpatient FSA Volumes 1,627 1,711 -5% 19,955 20,104 -1% 4
Outpatient Follow Up Volumes 6,886 6,756 2% 83,076 79,920 4% 5
Virtual FSAs 100 119 -16% 1,523 1,433 6% 10
Jun-15 Target Var Actual Target Var% Staff with Annual Leave > 2 years 10.2% 5.0% -5.2% 9.6% 5.0% -4.6% 11
% Staff Turnover 0.4% 2.0% 1.6% 9.1% 10.0% 0.9% 13
% Sick Leave 2.8% 2.8% 2.8% 2.8% 14
Workplace Injury Per 1,000,000 hours 9.05 10.50 1.45 12.01 10.50 -1.51 15
IMPROVED QUALITY, SAFETY AND EXPERIENCE OF CARE
Jun-15 Target Var Actual Target Var% electronic medication reconciliation completed for high risk patients within 48hrs 80.0% -80% 80.0% -80.0% 21
% Severe Pressure Injuries Per 100 Patients 3.5% 3.5% 22
No. Falls causing major harm 0.0 #VALUE! 0.0 0 23
Jun-15 Target Var Actual Target Var% MRI scans completed within 6 weeks from acceptance of referral 40% 80% -40% 55% 80% -25% 34
% CT scans completed within 6 weeks from acceptance of referral 77% 90% -13% 71% 90% -19% 35
Radiology - Inpatient radiology times < 24hours 93% 95% -2% 92% 95% -3% 36
Radiology EC radiology times < 2 hours 95% 95% 0% 95% 95% 0% 37
% diagnostic colonoscopy patients receive the procedure within 14 days 100.0% 60% 40% 75.4% 60.0% 15% 38
% diagnostic colonscopy patients receive the procedure within 42 days 43.4% 60% -17% 28.1% 60.0% -32% 39
% surveillance colonscopy patients receive their procedure within 84 days of planned 79% 60% 19.4% 88.4% 60.0% 28.4% 40
% cardiac STEMI - PCI (angiography) within 120 mins - Northern Region Target 85% 80% 5.0% 81.9% 80.0% 1.9% 41
ESPI 2: No. patients waiting >5 mths for FSA - Elective ~ 0 0 0 0 -3 42
Medical Assessment – Triage3-5 patients seen by SMO within 60 min 57min 60min 3min 60 60 46
Laboratory -Test turnaround time (TAT) within 60mins average of results YTD 49
Potassium 98% 90% 8% 96% 90% 6% 50
Haemoglobin 99.2% 98% 1% 97.8% 98% 0% 51
PT/INR 98% 98% 0% 99% 98% 1% 52
Troponin 1 for EC 96% 90% 5% 93% 90% 3% 53
Histology - All - 5 working days 89% 90% -1% 90% -90% 54
-Breast - 3 working days 100% 100% 0% 100% -100% 55
-Non gynae FNAs - 5 working days 96% 100% -4% 100% -100% 56
Blood Bank - antibody screen within 4 hours 92% 90% 2% 90% -90% 57
Microbiology 90% -90%CSF cell count <30mins 87% 95% -8% 90% -90% 58
ESBL screens <2days 93% 90% 3% 95% -95% 59
CDT (C. diff Toxin) <25hrs 93% 90% 3% 90% -90% 60
UCHM (Urine Chemistry) <60mins 92% 90% 2% 95% -95% 61
Door to Cathlab suspected Acute Coronary Syndrome < 3 days (median time) 86% 70% 16% 84% 70% 14% 63
General Medince - Seen By Time (minutes)1st Time to be seen Triage 1 & 2 patients (median time) 24.00 <30mins 6.0 <30mins 30.0 64
1st Time to be seen Triage 3 - 5 patients (median time) 67.00 <60mins -7.0 <60mins 60.0 65
2nd Time to be seen Triage 1 & 2 patients (median time) 64.51 <30mins -4 mins <30mins 30.0 66
2nd Time to be seen Triage 3-5 patients (median time) 74.86 <60mins -14.9 <60mins 60.0 67
QUARTERLY REPORTING Q1 Target Var Actual Target VarFaster Cancer Treatment - % high suspicion first cancer treatment within 62 days - MOH FCT + 78.2% 85% -28% 56.8% 85% -28% 68
Faster Cancer Treatment - %confirmed diagnosis first cancer treatment within 31 days - MOH
83.3% na 90.0% na 69
% radiology results reported within 24 hours 52.0% 75% -23% 59.0% 75% -16% 70
Year to date
Tim
ely
Medicine, Acute and Clinical Support Scorecard
Year to date
12 month average
Year to date
Ensu
ring
Fina
ncia
l Su
stai
nabi
lity
Enab
ling
High
Pe
rfor
min
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Firs
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Jun-15 Target Var Actual Target VarAverage Length of Stay - Acute 3.1 2.59 -0.51 2.21 2.59 0.38 71
Average Length of Stay - Acute Arranged / Elective 1.9 3.30 1.00 1.97 3.3 1.33 72
Acute Readmissions within 7 days - Total 5.8% 3.0% -2.8% 4.3% 4.4% 0.1% 73
Acute Readmissions within 28 days - 75+ - MOH IDP 13.0% 10.0% -3.0% 13.2% 14% 1% 75
% transcribed clinical summaries (meddocs)authorised <7 days of creation 95% 95% 0% 70.7% 95% -24% 76
% of patients on home wards in General Medicine 57.9% >75% -17% 80
% of Outliers on non-medicine wards 5.2% 0.0% -5.2% 5% 0.0% 81
QUARTERLY REPORTING Q1 Target Var Actual Target Var% eligible stroke patients thrombolysed - Northern Region Target 6.1% 6% 0.1% 7% 6% 0.5% 84
Stroke patients on stroke pathway 81.0% 80% 1.0% 70% 80% -10.0% 85
Jun-15 Target Var Actual Target Var% Discharges from transit lounge or home by 1100hrs 9.9% 30% -20.1% 30% -30% 89
% MA short stay patients discharged home from Medical Assessment 85% 80% 5.0% 80% 90
% of patients < 28 hrs discharged from inpatient wards 10.2% <10% -0.2% <10% 93
94
Implement Home First Renal policy - (increase CAPD & HD rate) 46% 50% -4.0% 50% -50.0% 95
Jun-15 Target Var Actual Target VarPatient experience Survey data - month (n=40) and YTD (N=452) 90% -90.0% 79% 90% -11.0%Implementation of Advance Care Planning - number of conversations 431 218 213 5,135 2623 2512 95
BETTER HEALTH OUTCOMES FOR ALL
Jun-15 Target Var Actual Target Var% Women with Breastscreen in last 24 months - total 2416 2160 +256 70.1% 70.0% 0% 98
% Women with Breastscreen in last 24 months - Maaori 240 253 -13 68.8% 70.0% -1% 99
% Women with Breastscreen in last 24 months - Pacific 475 378 +97 77.8% 70% 8% 100
Volumes Screened
Equi
ty
Year to date
Patie
nt W
haan
au
Cent
red
Care
Year to date
Year
Year
% Screened in last 24 Months
Syst
em In
tegr
atio
n (E
ffect
ive)
Effic
ient
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Scorecard Commentary
Gastroenterology - Performance against MoH targets for colonoscopy: • 60% of P1s (urgent) will have their procedure within two weeks (14 days) • 60% of P2s (routine) waiting for a diagnostic colonoscopy will receive their
procedure within six weeks (42 days) • 60% of patients requiring surveillance colonoscopy will receive it within 84 days of
the due date
Colonoscopy:
Target Feb March April May 28 June
P1 60% 88.5% 100% 81.8% 96.2% 100.0%
P2 60% 10.6% 21.8% 33.4% 47.1% 48%
Surveillance 60% 88.6% 69.0% 69.1% 81.5% 60.0%
Waiting List:
Feb March April May 28 June
Colons (includes
top & tail) 1,169 1061 921 831 773
The above tables show:
1. An ongoing improvement against the P2 target 2. P1 and Surveillance targets have been met 3. A reduction in the colon waiting list of 434 patients since February (37%)
These targets increase to 75% for P1s, 65% for P2s and Surveillance from 1 July 2015. We are currently reviewing our production plan to assess the impact of these changes. For all procedures in Gastroenterology the waiting times are as follows as of 30 June:
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Renal - Home Haemodialysis and Peritoneal Dialysis
• Home therapies is currently 45%, an increase from last month of 2% towards the 50% target
• The Acute Peritoneal Dialysis Clinic has had 7 patients since opening in May • Whilst home dialysis and transplant numbers are slowly increasing, in-centre dialysis
growth has slowed down, presumably in part due increasing home therapies and transplant
Faster Cancer Treatment – 85% high suspicion first cancer treatment within 62 days
• 71.8% of patients commenced treatment within 62 days in May. • 85.5% of patients receiving treatment within 31 days of decision to treat.
We have planned to meet the indicator by 30 September 2015 (with a requirement by MoH to meet the indicator by 30 June 2016). Our plan reflects the following:
• Establishment of project workstreams to address the issues identified from comprehensive process mapping and data analysis.
• Involvement of key FCT project members with regional FCT working group and liaison with MoH as appropriate
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
CM Health FCT Performance
62-Day progess
62-Day Target
Plannnedachievement
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Acute Stroke Care – 80% of patients with stroke are admitted to the stroke unit/under an organised stroke pathway
• 81% achieved for quarter four – the first time this has been attained. • A plan is in place to maintain and improve this level with collaboration from the
inpatient and community rehab teams and Emergency Care Radiology - Diagnostic Access Targets CT There has been a steady improvement in the indicator week on week with the June result showing 77%. The forecasting model shows that the indicator will be met during July provided the additional production is maintained. The number of patients waiting over 6 weeks has reduced from a high of 343 in May to 29 at end of June. This is a significant achievement during the latter part of 14/15. With the additional capacity as a result of the acute CT implementation the waiting times should be further minimised and the indicator maintained. MRI The final June result was 40%, significantly below the 80% indicator. Despite this the overall numbers of patients on the waiting list has reduced from a peak of 999 to 881 through May and June. The acute demand has increased from 44 to 48 a week through the same periods. Consistent outsourcing has been arranged which will lift production above demand and reduce the waiting time for patients. The indicator will start to improve once the proportion of patients waiting under 6 weeks exceeds that over 6 weeks. This is planned to happen mid-July. Percentage of Radiology reports completed within 24hrs The year end result was 59% completed within 24hrs. This measure is largely influenced by the high volumes of general x-rays needing to be reported which is influenced by the Radiologist FTE available. Through the 3rd and 4th quarters of 14/15 Radiologist FTE dipped to approx. 5FTE vacancies below budget. This was exacerbated by reducing the high annual leave balances of some Radiologists. Recruitment and return of Radiologists from maternity leave will raise the FTE to budget by September. An exacerbating factor is the general poor performance of the Agfa Impax system which Radiologists use to provide results for procedures. Whilst significant work has been undertaken to identify the root cause, it is thought that the most effective way is to upgrade the regional system. This will not be finalised until December 2015. Histology Turnaround Times Despite the high volumes in Histology there was a significant improvement in reporting TATs with 89% (target 90%) reported within 5 working days. The challenge for the department will be to sustain the improved times.
Northern Region DHB TAT KPI’s for EC requests for Haemoglobin, Potassium, Troponin and CSF Cell Count all indicate CMH Laboratory performs extremely well compared to the other Northern Region DHB laboratories.
HAC: 29th July 2015
128
Financial Results
Statement of financial performance
Actual Budget Var Var % Actual Budget Var Var %REVENUE
595 222 373 168% Government Revenue 4,210 2,669 1,541 58%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%
156 69 86 125% Other Income 1,259 857 402 47%140 74 65 88% Funder Payments 1,678 893 785 88%
891 366 525 143% Total Revenue 7,147 4,419 2,728 62%
EXPENDITURE5,868 5,752 (116) (2)% Staff Costs 70,369 69,372 (997) (1)%
800 398 (401) (101)% Outsourced Costs 6,362 4,863 (1,499) (31)%1,355 1,364 9 1% Clinical Costs 16,087 16,394 307 2%
270 251 (20) (8)% Infrastructure Costs 3,065 3,002 (63) (2)%746 617 (129) 21% Internal Allocations 8,568 7,748 (819) 11%
9,038 8,382 (656) (8)% Total Expenditure 104,451 101,380 (3,071) (3)%(8,147) (8,016) (132) (2)% Net Result (97,304) (96,961) (343) (0)%
FTE165 155 (11) (7)% Medical 162 156 (5) (3)%457 407 (50) (12)% Nursing 440 409 (31) (8)%
50 47 (4) (8)% Allied Health 50 47 (3) (7)%43 40 (3) (8)% Management/Admin 42 40 (2) (6)%
715 648 (67) (10)% FTE Total 694 652 (42) (7)%
STATEMENT OF FINANCIAL PERFORMANCE - MEDICINE
Month to Date Year to Date
($000's) ($000's)
Jun-15
-8,600
-8,400
-8,200
-8,000
-7,800
-7,600
-7,400
-7,200
-7,000
Mon
thly
res
ult $
000'
s
Monthly Net Result
Result Budget
-
800
1,600
2,400
3,200
4,000
Mon
thly
res
ult $
000'
s
Monthly Operating Costs
Result Budget
4,800
5,000
5,200
5,400
5,600
5,800
6,000
6,200
6,400
Mon
thly
res
ult $
000'
s
Monthly Staff Costs
Result Budget
HAC: 29th July 2015
129
Month YTD
Total Variance: $(132) $(343)
Revenue: $525 $2,728
Salaries & Wages: $(116) $(997)
Current Mth:-
Outsourced: $(401) $(1,499)
Current Mth:-
Clinical Supplies: $9 $307
Infra-Structure: $(20) $(63)
Internal Allocations: $(129) $(819)
$(49)k - Misc Drug overspends$(96)k - Rheumatology - Rituximab used to treat more patients in 1415.
$(31)k - Palliative SMO cover - cover provided by Hospice doctors
Current Mth:-
$49k - Savings in Continence products mainly in the Cath Lab due to YTD volumes down 4% on 13/14
$174k - Renal Fluids - savings in CAPD part offset by higher spend in Home Dialysis. Savings now levelling off as CAPD volumes increase as planned.
$(104)k - PCT Drugs overspent: Clinical Haematology due to - Rituximab 32% over 13/14 average - Velcade 5% over 13/14 average
Government Revenue: $1,024k - PCT revenue (Funder payment) to fund increased drug costs. See drug overspend below$500k - MOH funding for additional outsourced colonoscopies - see Outsourced below$19k - Renal - MOH Funding for Donor Liaison coordinator Renal Transplant
Other income: $200k - Renal Transplant recoveries $40k - Respiratory Salary recoveries for Clinical Lead in Regional Lung Cancer Project - paid by NRA$47k - Renal SMO salary recoveries $114k - Other includes Cancer Fast Tracker Funding $24k, SMO reimbursement from UOA $25k, higher UOA clinical teaching recoveries $26k, misc $39k
Funder Payments: $784k - cost recoveries for unbudgeted project positions - (20k and Localities) 6.1 FTE plus outsourced podiatrists
$(20)k - Gastro - due higher number of Influximab doses (93% higher than last 12 month average)
$(72)k - Podiatry costs for Renal and Diabetes - funded by 20k beddays project
$659k - Vacancies 8.6 FTE average
$(404)k - MOH funded outsourced colonoscopies to meet MOH targets
$(85)k - Additional outsourced sleep study clinics - ADHB Lab closed due to staff shortages. Savings offset in IDF's
Year to date:-
$3k - Other savings
$(1,161)k - Additional outsourced colonoscopy procedures as included in the forecast. Part offset by MOH funding of $500k.
$(150)k - Higher Outsourced Nursing bureau due to shortage in Internal bureau
$(35)k - YTD adjustment to Nursing salary provision
Year to date:-$(63)k - Overspends in Medical waste and Outsourced maintenance - maintenance of Renal dialysis homes
$(140)k - Additional unbudgeted Nursing salary provision
$(1,129)k - Unbudgeted positions funded externally (offset by revenue) - (11.5)FTE
Jun-15
Year to date:-
Other income: $15k - Renal Transplant salary recoveries from CCREP$40k - Respiratory salary recoveries for Clinical Lead in Regional Lung Cancer Project - paid by NRA$31k - Clinical Haematology - reimbursement from Samoan government for patient on chemotherapy
Funder Payments: $65k - Salary recoveries for unbudgeted project positions, 6.1 FTE
Government Revenue: $337k - Higher PCT revenue for the month is due to timing of claims processed. Offsets higher PCT drug spend for the month$36k - Gastro- MOH funding partly offsets additional costs of outsourced Colonoscopies - see Outsourced costs below
The division reported a $(132)k unfavourable variance against budget for the month and $(343)k unfavourable variance year to date.
The year end result is $343k unfavourable against budget ($48k unfavourable against the March forecast overspend of $295k). The overspend is due to forecast additional outsourced gastro volumes to be completed by June 2015 in order to meet MOH targets.
Medicine WIES volumes were 1.7% down on contract for June and 0.1% down on contract for the year.
Current Month:-
$178k - Release of Renal outsourcing provision to cover Renal overpend as a result of the delay in the opening of the outsource dialysis facility.
$(70)k - RMO back pay - offset by provision accrued at Corporate level
Year to date:-
$(224)k - Annual leave taken lower than accrued possibly due to school holidays falling in July.
$(317)k - unfavourable kiwisaver/super
$57k - Vacancies 8.4 FTE's
$(92)k - Unbudgeted positions funded externally (offset by revenue) - (13.9)FTE
STATEMENT OF FINANCIAL PERFORMANCE - MEDICINE
The year end result is that the division is $343k unfavourable against budget. Volume increases in renal, gastro and drugs has driven the higher costs.
Year to date:-
$(343)
Year to date:-
Year end Forecast variance to Budget
$197k - Cancer Care Revenue to offset unbudgeted staffing costs.
$(954)k - PCT Drugs overspend, Chemotherapy volumes 12% and Rituximab doses up 9% on 13/14 average
$19k - Misc savings
$65k - Savings patient consumables mainly in Cath Lab due to volumes down 4% on 13/14
$83k - 1415 Revenue received from DON for 3xDEU nurses working in wards
HAC: 29th July 2015
130
Jun-15
Actual Budget Var Var % Actual Budget Var Var %REVENUE
(1) 0 (1) 0% Government Revenue 7 0 7 0%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%4 0 4 0% Other Income 25 0 25 0%0 0 0 0% Funder Payments 0 0 0 0%3 0 3 0% Total Revenue 32 0 32 0%
EXPENDITURE2,779 2,728 (51) (2)% Staff Costs 31,514 31,620 106 0%
18 23 5 20% Outsourced Costs 301 270 (31) (11)%272 233 (39) (17)% Clinical Costs 2,864 2,801 (63) (2)%139 122 (17) (14)% Infrastructure Costs 1,487 1,465 (22) (1)%
89 88 (1) 1% Internal Allocations 1,072 1,018 (54) 5%3,297 3,194 (103) (3)% Total Expenditure 37,238 37,175 (63) (0)%
(3,294) (3,194) (100) (3)% Net Result (37,206) (37,175) (32) (0)%
FTE 61 54 (7) (14)% Medical 55 54 (1) (2)%
225 217 (8) (4)% Nursing 210 204 (5) (3)%0 1 1 100% Allied Health 0 1 1 100%0 1 1 100% Support 0 1 1 100%
47 51 5 9% Management/Admin 47 51 5 9%333 323 (9) (3)% FTE Total 311 310 (0) (0)%
STATEMENT OF FINANCIAL PERFORMANCE - ACUTE CARE
Month to Date Year to Date
($000's) ($000's)
-3,400
-3,300
-3,200
-3,100
-3,000
-2,900
-2,800
-2,700
-2,600
-2,500
Mon
thly
resu
lt $0
00's
Monthly Net Result
Result Budget
-
100
200
300
400
500
600
Mon
thly
resu
lt $0
00's
Monthly Operating Costs
Result Budget
2,100
2,200
2,300
2,400
2,500
2,600
2,700
2,800
2,900
Mon
thly
resu
lt $0
00's
Monthly Staff Costs
Result Budget
HAC: 29th July 2015
131
Jun-15Month YTD
Total Variance: $(100) $(32)
Revenue: $3 $32
Salaries & Wages: $(51) $106
Outsourced Costs: $5 $(31)
Clinical Supplies: $(39) $(63)
Infra-Structure: $(17) $(22)
Internal Allocations: $(1) $(54)
$58k - Admin staff - savings due mostly to delays in the recruitment of MAU ward clerks.
STATEMENT OF FINANCIAL PERFORMANCE - ACUTE CARE
Volumes for EC in the month of June were 2.2% higher than this time last year (9,195 presentations vs last year 8,996). Overall year end volumes are 4.4% above last year (109,454 presentations vs last year 104,815).
$(51)k - ovespend mostly due to Medical staff annual leave taken lower than accrued possibly due to school holidays in July
The year end result is a small unfavourable variance of $32k despite a 4.4% increase in volumes over last year. This was able to be achieved due to savings from the delay in the recruitment of MAU staff in the early months partly offsetting overspends in the later half of the year.
Overspends for drugs and MRI driven by increased volumes in EC - 4.4% above this time last year.
Overall the division came in on budget. The year end forecast was for the division to meet budget plus a measure of target savings (total expected cost savings $1.1m). The divisions inability to meet the expected cost savings target is driven by record volumes in EC, with a 4.4% increase on last year.
Overall the division was $(100)k unfavourable for the month and on budget with a small $32k unfavourable variance for the year.The currrent month variance is mostly due to low annual leave taken over the month of June in anticipation of school holidays falling in July.
Current month:-
Year end Forecast variance to Budget $67
Year to date:-
Year to date:-$70k - Medical staff - due mostly to salary variations.$(55)k - Nursing staff overspend
$33k - misc.
Year to date:-$(63)k - Misc overspend in clinical supplies driven by aprrox 4.4% volume increase over this time last year.
HAC: 29th July 2015
132
Actual Budget Var Var % Actual Budget Var Var %REVENUE
584 489 95 0 Government Revenue 5,807 5,808 (0) (0)%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%
636 170 466 274% Other Income 3,190 2,041 1,149 56%23 0 23 0% Funder Payments 440 0 440 0%
1,243 659 584 89% Total Revenue 9,438 7,849 1,589 20%
EXPENDITURE4,876 4,633 (244) (5)% Staff Costs 55,885 55,406 (479) (1)%
586 367 (219) (60)% Outsourced Costs 5,086 4,358 (728) (17)%3,207 2,699 (507) (19)% Clinical Costs 36,077 32,886 (3,191) (10)%
320 291 (29) (10)% Infrastructure Costs 3,511 3,484 (27) (1)%(1,629) (1,532) 97 6% Internal Allocations (19,705) (18,731) 974 5%
7,360 6,458 (902) (14)% Total Expenditure 80,854 77,403 (3,451) (4)%(6,117) (5,799) (318) (5)% Net Result (71,416) (69,554) (1,863) (3)%
FTE73 76 4 5% Medical 73 76 3 5%36 40 4 9% Nursing 40 40 1 2%
306 306 0 0% Allied Health 310 308 (2) (1)%161 168 8 4% Management/Admin 159 168 9 5%575 591 15 3% FTE Total 582 593 11 2%
STATEMENT OF FINANCIAL PERFORMANCE - CLINICAL SUPPORT
Month to Date Year to Date
($000's)
Jun-15
($000's)
-6,400
-6,200
-6,000
-5,800
-5,600
-5,400
-5,200
-5,000
-4,800
Mon
thly
resu
lt $0
00's
Monthly Net Result
Result Budget
-
1,000
2,000
3,000
Mon
thly
resu
lt $0
00's
Monthly Operating Costs
Result Budget
2,000
4,000
6,000
Mon
thly
resu
lt $0
00's
Monthly Staff Costs
Result Budget
HAC: 29th July 2015
133
Month YTD
Total Variance: $(318) $(1,863)
Current month:-
Revenue: $584 $1,589
Current Month:-
Salaries & Wages: $(244) $(479)
Current Mth:-
Outsourced: $(219) $(728)
Clinical Supplies: $(507) $(3,191)
Infra-Structure: $(29) $(27)
Internal Allocations: $97 $974
Other income: $386k - Pharmac Rebate FY14/15 accrued in June$61k - Radiology scans - ADHB referrals higher than expected$18k - Miscellaneous
Year to date:-Government Revenue: $(185)k - Ring fenced Breast Screen revenue $205k u and MOH Fellowship revenue $20k f.$185k - Rad MOH revenue for Rad Service Improvement project $180k
Other income: $282k- Radiology - Scans referrals from ADHB $339k - Lab tests for other DHBs & CCRep$519k - Pharmacy Revenue including Pharmac Rebate FY14/15 of $453k.$9k - Miscellaneous
Funder Payments:$182k - Patient info NPF project funding offset by consultant cost$190k - cost reimbursement for 2.7 FTE unbudgeted Pharmacists - SMOOTH project$69k - cost reimbursement for 1 FTE unbudgeted Pharmacists - Locality
Funder Payments:-$23k - Unbudgeted Pharmacists 2.7 FTE funded by 20k bed days project, 1FTE - Locality
STATEMENT OF FINANCIAL PERFORMANCE - CLINICAL SUPPORT
Government Revenue: $95k - Breast Screen Revenue - volumes 12% above the screening target $44k f, Ring fenced Breast Screen revenue $66k f, Radiology ACC Revenue shortfall of $14k u.
Jun-15
The division was $(318)k unfavourable for the month of Jun. The main drivers were volume increases, resulting in overspends in clinical supplies and staffing costs for Radiology and Laboratory, and additional MRI & CT volumes to meet MOH targets.
Year to date:-The year end result for the division was a $(1,863)k overspent due to increased demand for Laboratory and Radiology services.
Labs was $(1,594)k unfavourable against budget for the year with an average 7.0% increase in volumes overall with some areas experiencing up to 14.3% increase in volumes on this time last year.Radiology was $(1,320)k unfavourable against budget due to increased demand from Vascular Surgery, PET CT scans and MRI Scans. Outsourcing increased in the last quarter to allow installation of the new MRI 3T scanner and also to address waitlists in order to meet MOH targets.
The year end result is an unfavourable variance of $(1,853) against budget. An increase in volumes across the clinical services, particularly in Radiology and Laboratory has driven high overspends for the year. As forecast in March, this continued for the balance of the year. Target savings for the division, $1.5m.
Year end Forecast variance to Budget $(1,998)
Current month:$156k - Drug cost recoveries - offsets drug overspend above $(59)k - Miscellaneous - incls year end washup of corp overhead allocation to Breast Screen. Offset by upside in Corporate.
Year to date:$1,292k - Drug cost recoveries - offsets drug overspend above$(386)k - Radiology MRI costs - internal recovery below budget due to limited capacity$64k - Internal recoveries for unbudgeted positions $17k - Radiology salary recovery from SWIFT $28k - Patient Info - 0.5 fte funded by Gateway $39k - Lab Recoveries from Breast Screen $4k - Miscellaneous
$(23)k - Unbudgeted 2.7 fte Pharmacists funded by SMOOTH project; 1 fte funded by Localities (offset by revenue)$91k - Vacancies - Radiology 3.91 fte, Labs 0.68fte & Breaset Screen 0.35fte $(91) k - Radiology additional reads / sessions to cover vacancies due to national and international shortage of Sonographers.$(42)k - OT mainly in Radiology and Labs to cope with volume, both services experience an increase of 6% as compared to Jun14.$(100)k - Annual leave taken lower than accrued possibly due to school holidays due in July$(76)k - Unbudgeted Allied Health salary provision
Current month:-$(95)k - Additional outsourced MRI scans to meet MOH target - per forecast$(72)k - Outsourced CT Scans to address waitlist and meet MOH target $(55)k - labs sendaway tests including $36k u overspend in NZ blood services referred testing due to 5.9% volume increase compared to Jun14.
Current month:- $(128)k - Drug overspend driven by demand across the organisation and recovered through internal charging: - $(138)k - PCT drugs overspend partly funded by revenue $10k - Miscellaneous underspend$(83)k - Blood products overspend mainly due to high cost procedures.$(113)k - Labs - testing kits due to volume increase of 28% in Microbiology and 16% in Histology.$(61)k - Rad - Catheters, Shunts & Stents driven by 12% increase in Surgical Services demand for ANG procedures$(19)k - Chemicals overspend driven by 16% volume increase in Histology$(31)k - Equipment repairs & maintenance - Histology $16k u and Microbiology $15k u.$(10)k - Radiology - replacement of lead aprons, which are replaced on an as-needed basis$(62)k - Miscellaneous overspend in other clinical supplies & and disposable, mainly driven by volume increase in Radiology and Labs.
Year to date:-$(261)k - Labs sendaway tests overspend due to volume increase of 7.0%$(217)k - Radiology PET CT scans volumes $145k u and additional outsourced CT scans in Jun15 to meet MOH target $72k u.$(340)k - Radiology MRI scans volumes higher than budgeted including $230k additional scans to meet MOH target as advised in Mar forecast.$53k - Breastscreen outsourcing underspend$37k - Miscellaneous underspend
Year to date:-Pharmacy:-$(1,314)k - Drugs overspend driven by demand across the organisation & recovered through internal charging:- $(1,340)k - PCT drugs partly funded by revenue $(118)k - Infections driven by Surgical Services volumes $179k - Nutrition underspend driven by Medicine $(35)k - Miscellaneous overspendLabs:- $(531)k - Lab blood products driven by high cost patients in ICU, EC & Dialysis. Part offset by a $135k rebate. $(961)k - Lab testing kits & other clinical supplies - volumes up by 7% for the yearRadiology:- $(153)k - Shunts & stents - driven by Surgical Services vascular surgery, ANG vol up 14% for the year $(195)k - Catheters - driven by Surgical Services vascular surgery, ANG vol up 14% for the year $(122)k - Dressings - driven by increased demand - total volumes up 3.8% and ANG volumes up 14% compare to last year$85k - Miscellaneous savings
$(72)k - Miscellaneous overspend including annual leave taken lower than accrued and additional sessions / OT in Labs/Rad to address volume growth.
$(14k) - RMO backpay - offsets provision at Corporate level
Year to date:-$(275)k - Unbudgeted funded positions (3.7fte) offset by project revenue and Staff costs offset by SWIFT funding
$(76)k - Unbudgeted Allied Health Staff salary provision$(42)k - OT in Jun15, mainly in Radiology and Labs to cope with volume
HAC: 29th July 2015
134
Commentary on major financial variances
The year end result for the division is a $2.2 million unfavourable variance against budget compared with a $2 million favorable year end forecast. The breakdown of the variance:
• Acute Care – on budget despite a 4.4% increase on volume • Medicine - $343k unfavourable due primarily to additional outsourced gastro
volumes to reduce waiting lists • Clinical Support - $1 million unfavourable drivers by significant growth in Radiology
(CT, MRI & Vacular Surgery) and Laboratory volumes (average volume growth 7% with some areas experiencing up to 14.3%)
Quality
Safety
Taking a whole picture view of staff and patient safety Dr Carl Eagleton (clinical head, internal medicine) facilitated a discussion with members of the legal team, and mental health, adult rehabilitation clinicians and medical and nursing staff relating to Applications under the Protection of Personal and Property Rights Act 1988 (PPPR). This was initiated because there is a concern that the process is unclear, not easy to follow and contributes to unnecessary length of stay. The meeting recommended improvement of the administration process for the applications of the PPPR; this work could be facilitated by the Quality and Risk team but will need liaison with relevant stake holders.
Renal outpatient working group In response to patient concerns that there is a lack of clarity about the different dialysis units, and the need to have simple information about the renal service available for the patients, the Nursing renal working group have started work on an improved patient information leaflet to give to their patients; this will include basic information about facilities, schedules and transportation, and messages about patients’ rights and responsibilities. The group continues to address fall risk in the outpatient service: further PDSAs will focus on refining the intervention tool, addressing the process of spreading the change, developing education roll out and embedding change in practice. A planned service roll-out is anticipated for August.
Gastroenterology infliximab working group There are frequent complaints from our patients and staff that the process for Infliximab infusions could be better. This working group has been established to streamline and embed a process that will ensure staff and patients follow a standard process to access, receive and re-book for infliximab treatment. The ward clerk and charge nurse manager are supporting work on mapping the current process.
Falls working group A meeting was arranged with the Risk pro reporting team and clinical staff to discuss the problem of inaccurate risk assessment and severity scoring of fall incidents in the organisation. The improvement opportunity was to redesign the electronic system to automatically populate some of the matrix fields. However, this option was not achievable
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135
and instead a prompt list has been designed to guide appropriate assessment of fall incidents. This has been distributed to all managers.
Infection control focus Two instances of peripheral IV line infection (one the subject of an internal review and one a MOH request for feedback for an ACC treatment injury) highlighted the need for robust organisational processes in place for the management of the peripheral IV lines. The suite of improvement measures that have been implemented include the roll out of the the visual infusion phlebitis (VIP) score and a management plan to assist in the early detection of peripheral IV-related complications. As there was no standard process for the investigation of peripheral IV catheter-related bacteraemia, a process has been developed using the CMH incident reporting system and working with infection control clinicians and the IV team to ensure all confirmed peripheral IV catheter related bacteraemia are investigated.
Timeliness
Efficiency Rotation to promote staff flexibility Discussions with Acute Care Clinical Director and Clinical Heads of EC and CCC have confirmed that a rotation of EC SMO Workforce up to CCC for a six month period will start in June 2015. Similarly Critical Care and Acute Care are working together to increase training requirements to ensure that appropriately trained registered nurses will allow some flexibility in the workforce in future. Gastroenterology Systems and Processes
• Referrals Management – The audit of individual SMO referral grading times has been undertaken in order to streamline and enable faster grading of referrals.
• Procedure session Utilisations - was 79.26% due sessions being vacant to leave and ward cover and which were unable to be covered within the current staffing resources of Gastroenterologists or General Surgeons. Cancelled lists will be covered in the future by General Surgeons if they are available or the new fellow starting in August.
• For June lists utilisation was 98.56%. Lists are booked to the regionally agreed limit of 12 points, 8 for a training list (2 per week) and 10 for a list with acutes.
Production Planning: • Production plans are updated weekly. • Review of production plans will now include the increased MoH targets of 75% for
P1s (colonoscopy within 14 days), 65% for P2s (colonoscopy within 42 days) and 65% for surveillance (within 84 days of due date).
• Increasing the rate of CTCs done from the current 13.4% to 25%. IT System:
• Provation IT system upgrade go-live was actioned June 22nd.
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136
Radiology Performance Improvement Project Production Planning The forecasting tool for MRI and CT scanning is being incorporated into the overall production planning tool in Radiology. The familiarization of this tool with front line staff is on-going and several staff within Radiology have been identified to utilise the tool on an on-going basis. The CT production planning group is meeting weekly and the MRI group starts in July. This process has resulted in greater understanding by frontline staff how to manage more efficiently the resource we have available. Faster Cancer Treatment times Radiology is developing a group involving Radiology, Surgical and Cancer staff to review the management of FCT patients within Radiology. This project will focus on both the flow of the initial patient referral and further imaging referrals with an aim to streamline processes and reduce the time for diagnostic imaging to occur. It should be noted, however, that the main issue for timeliness of diagnostic imaging is related to capacity on the scanners. Discharge Lounge
There was large numbers of medicine patients discharged through the discharge lounge in June. 359 went to the lounge compared with 330 last month. However the percentage of patients out of the ward by 11.00am remains static – up 1%. Emphasis to working to a Goal Discharge Date (GDD) has been made this month however medical ward rounding continues to be a barrier to early discharge as often timely arrival to wards is inconsistent and after 11am which delays early discharge. SMO cover at ward rounds is vital and necessary for early discharges to occur. Radiology CT colonography 89% of CT colonography procedures were completed within 6 weeks in June. Despite this a small backlog had developed and focus on reducing the wait times for this will result in more procedures being performed in July. An initiative to reduce the Did Not Attend rate for patients referred for a CT colonography has resulted in 0% DNA’s through May and June. This will assist in maximising the utilisation of the available CT scanning time allocated for this procedure.
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Effectiveness
Breastscreen Breastscreen are about to carry out a survey with GPs to measure satisfaction with our service using Survey Monkey for the first time, previous surveys have been carried out by mail.
Renal Outsourcing of a managed service to provide in-centre haemodialysis:
• Contract negotiations between CMDHB and Diaverum continue- nearing completion • Diaverum to sign lease contract for facility at 10 Waddon Place when service
contract signed-off. • Service set-up to commence on signing of the contract with a tentative go-live date
of late November. Feet for Life - To reduce the burden of foot disease in renal patients and reduce ALOS and amputations-
• Re-education on the care package continues in Scott Dialysis as there has only been 50% compliance
• “How to Guide Book” on project is now completed. Diabetes - Inpatient Care for People with Diabetes: To reduce the length of stay and readmissions for patients with diabetes in CMDHB who are inpatients-
• All systems for managing in patients are in place. Patient and Whaanau Centred Care
Renal Improvements in Live Organ Donation: This is a four year project, with $1.8m funding from the MoH-
• Community Engagement- Phase ll Market Research, contract now signed but work will not commence until late July.
• Pre-dialysis evaluation completed- questionnaire for patients now under development.
• Web site to be improved based on feedback from patients. • Resource material to be reviewed and updated based on feedback from focus
groups. • Business cases for ongoing funding for fte and resource material when the project is
completed underway. Advanced Care Planning: To implement Advanced Care Planning (ACP) in the Renal Service in order to have documented plans for treatment choices available-
• NP intern has had 12 first conversations, with 5 new signed off plans • NP intern also developing guidelines on how to implement ACPs with Tongan
patients
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5.7 Facilities
Service Overview
The Facilities division includes Clinical Engineering, Equipment and Assets Services, Non-Clinical Support Services, and Engineering and Facilities. The General Manager is Greg Simpson.
Performance
Activity Summary • The regional furniture tender is progressing with healthAlliance. Four vendors have
been shortlisted and will be further evaluated over the coming weeks.
• Stage 2 of the EAM implementation is now live; this includes full capex, disposal, and purchasing modules. Integration with Oracle and healthAlliance has been migrated to production.
• Build projects of Mental Health, Plastics See and Treat and CSB laboratory equipment is underway. Selection and purchase of equipment included in the design are at different stages of completion to support the construction process.
• We have sourced an ITO to assist us in getting all our security staff level 3 NZQA qualified.
Highlights • Work continues with the Manukau Institute of Technology to develop a Clinical
Engineering Course. It is anticipated that the first student intake for the course will be early 2016.
• Morale amongst cleaning staff is high with their National Certificate in Cleaning and Caretaking Graduation Ceremony taking place on 17 July 2015.
Emerging Issues • Substantial costs as a result of an aging vehicle fleet are anticipated. Options are
currently being considered.
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Financial Results
Statement of financial performance
Actual Budget Var Var % Actual Budget Var Var %REVENUE
0 0 0 0% Government Revenue 0 0 0 0%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%
25 33 (8) (23)% Other Income 404 392 12 3%0 0 0 0% Funder Payments 0 0 0 0%
25 33 (8) (23)% Total Revenue 404 392 12 3%
EXPENDITURE1,943 1,862 (81) (4)% Staff Costs 22,132 21,867 (264) (1)%
12 0 (12) 0% Outsourced Costs 66 0 (66) 0%61 55 (6) (11)% Clinical Costs 252 659 407 62%
2,305 2,133 (172) (8)% Infrastructure Costs 25,093 25,709 616 2%0 0 0 0% Internal Allocations 0 0 0 0%
4,321 4,050 (271) (7)% Total Expenditure 47,543 48,235 693 1%(4,296) (4,018) (278) (7)% Net Result (47,139) (47,843) 704 1%
FTE16 19 3 13% Allied Health 16 19 3 17%
421 414 (7) (2)% Support 411 407 (4) (1)%25 26 1 3% Management/Admin 25 26 0 1%
462 459 (3) (1)% FTE Total 452 452 (1) (0)%
**Jun14: Recovery of motor vehicle lease costs
**Jun14: Recovery of motor vehicle lease costs
($000's)
STATEMENT OF FINANCIAL PERFORMANCE - FACILITIES
Month to Date Year to Date
($000's)
Jun-15
-4,400-4,300-4,200-4,100-4,000-3,900-3,800-3,700-3,600-3,500-3,400
Mon
thly
resu
lt $0
00's
Monthly Net Result
Result Budget
-
500
1,000
1,500
2,000
2,500
Mon
thly
resu
lt $0
00's
Monthly Operating Costs
Result Budget
-
500
1,000
1,500
2,000
2,500
Mon
thly
resu
lt $0
00's
Monthly Staff Costs
Result Budget
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Commentary on major financial variances
Quality
Safety • We are working closely with the Infection Control team on the use of the two
current Bioquell machines, and currently planning the operation of an additional three Bioquell machines that are due to arrive no later than September 2015. We are also working with infection control on Hand Hygiene, and addressing results from the Inpatient Survey.
• Work is being done to ensure safety is a high priority for meals served to compromised patients e.g. dysphagia, food allergies.
• The total number of security incidents for June was 139. This demonstrates a downward trend compared to the past six months and this time last year which is pleasing.
Month YTD
Total Variance: $(278) $704
Revenue: $(8) $12
Salaries & Wages: $(81) $(264)
Outsourced: $(12) $(66)
Clinical Supplies: $(6) $407
Infra-Structure: $(172) $616
Internal Allocations: $0 $0
Year end Forecast variance to Budget
The year end forecast is for the division to meet budget plus expected cost savings for the year (target savings $537k). An expected savings on utilities and food services will be realised balance of year.
Current month:-Infra-Structure Costs $(172)k unfavourable including R&M (account 5151 - 5159) $(122)k; Utilities $(84)k; MV Leases, Fuel, Regn and R&M $26k; and Postage Courier Freight $(14)k.Year to date:- Favourable variance $616k YTD including F&G Nutritional Supplements $78k; Patient Meals Outsourced $505k; Laundry Bedding & Linen $75k; Security Services Outsourced $(269)k; R&M (account 5151 - 5159) $(1,399)k; Utilities $1,243k; MV Leases $110k; MV Fuel $222k; Expenses Recoveries $64k and Postage Courier Freight $(137)k.
$704
Clinical Supplies were $(6)k unfavourable due to higher usage of medical gases, year to date favourable mainly due to Clinical Equipment R&M $419k year to date.
STATEMENT OF FINANCIAL PERFORMANCE - FACILITIES
Total Employee Costs were $(81)k unfavourable for the month:Current month:-Clinical Engineering $13k - 3 FTEs vacancies to be filled.Non Clinical Support $13k - 2 FTEs vacancies to be filled.Cleaners $(28)k and Orderlies $(82)k - additional cleaning and orderly service requests for infection control outbreaks, spinal patients in ICU and in ALBU and Discharge Lounge, (8.3)FTEs; high use of in-house casual pool staff to cover vacancies, annual leave, sick leave taken, and new staff training.Security officers $(14)k - high use of overtime and in-house casual pool staff to cover sick leave and annual leave taken and high penal costs for stat holidays, offset by 1 vacancy position not yet filled.Maintenance Supervisors & Engineers $29k due to 7.25 FTEs vacancies in Engineering. 'In-house' casual staff are being managed within the service.
Year to date:- Unfavourable variance $(264)k YTD including high vacancies in Clinical Engineering $385k, Non Clinical Support $120k, and Maintenance Supervisors & Engineers $648k. This is offset by unfavourable variances for Cleaners $(454)k and Orderlies $(941)k due to additional cleaning and orderly service requests for infection control outbreaks, spinal patients in ICU and in ALBU and Discharge Lounge, (8.3)FTEs; new staff training, and unfavourable variance for Security Officers $(116)k.
Favourable variance year to date due to rebate payments to Food Services for MSC Café.
Overall, the Division was $(278)k unfavourable for the month, $704k favourable year to date.Lower employee costs due to high vacancies, provision release of clincial equipment R&M costs and reduced cost for utilities have been the main drivers for the favourable variance year to date.
Jun-15
Outsourced staff costs were unfavourable due to covering vacancies in Clinical Engineering, sick leave cover in Engineering, helpdesk and maternity leave cover in Facilities Management.
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Timeliness • All jobs are being completed within acceptable timeframes (resource dependant)
and major delays are indicated to services.
Efficiency • Efficiency is reviewed regularly and resources are upskilled and/or redeployed as
required.
• We are currently experiencing our busiest time with an average of 307 presentations to EC daily. The recruitment carried out during March and May for Cleaners and Orderlies has paid off with our pool of casual staff at an all-time high. All shifts are fully covered as a result of the pre-planning and recruitment undertaken earlier this year.
Effectiveness • Regular meetings with Theatre and ICU managers are held to ensure appropriate
ongoing training is provided to orderlies in order to meet patient requirements.
• PORTAL (Portable Real-time Task Assignment Link) will go live on 18 July 2015. The system assists the Orderlies coordinator to locate and dispatch teams closer to job requests. The uptake from the staff has been positive.
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5.8 Director Allied Health Report Strategic Development He Pou Oranga (AH Enabling Localities Project) continues with a focus on how to better align the AH workforce to population health needs within the community.
• This work has now substantively been subsumed by the community integration work and the streams of work on reablement, restorative care and community central. As a part of the research being conducted into this process, formal interviews are being conducted with staff who participated in the Home Healthcare Redesign work to gauge the effectiveness of the approach taken.
Allied Health Workforce The Sonography project continues to be progressed through the NRA with preparation for the second training cohort about to begin. At a local level there continues to be a strong focus on recruitment and retention initiatives. A recent meeting with Health Workforce New Zealand (HWNZ) was concerning as they had highlighted the withdrawal of funding for the 12 week intensive training block. While this was always the intention in progressing towards self-sustainability of the programme, it is not there currently and would benefit from support for another 1-2 years. We will continue to actively work with HWNZ to this end. The stability of training Anaesthetic Technicians continues to be an issue and is being addressed with AUT. The national body has been working with members to identify options for sustainability and stability of the workforce to meet a growing demand for services. While there is no concrete proposal, there is potential to work towards a stepped training programme which would provide for training to enable the advanced scopes that have been approved for the profession. Work is underway with MIT to establish a programme for Clinical Engineers given that there is currently no programme in NZ. It is based on the NZDE course currently going through a Targeted Review of Qualifications (TRoQ) process lead by NZQA. The tertiary service providers were hoping that the TRoQ review would have been completed by the end of Feb/March 2015 where after MIT would have made an application to add the four (4) specialisation modules, as defined by the National Clinical Engineering Managers Forum (NCEMF) to the NZDE curriculum to form a National CE qualification. There is support from Weltec and Otago Polytechnic who expressed a keen interest in such a course and indicated that they would like to collaborate. This is important to note as it circumvents some of the issues that have been encountered with sonography insofar as the programme is being designed to be delivered in a modular fashion, and via multiple providers. Other workforces such as Occupational Therapy and Physiotherapy are stable, but are struggling to recruit to experienced roles. Allied Health Directorate Development Realigning of the Associate Director Allied Health role to Whole of System roles has been completed. This has been articulated in a strategic intent document for the AH Directorate for the coming year. Focus work of the Directorate continues to be:
• Facilitate the ongoing roll-out of the He Pou Oragna Service Re-Design Framework
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• Launching and imbedding the Allied Health Initiative for Education and Development (AHIED)
• Undertaking a stocktake and establishing a strategic direction for Allied Health research
• Working closely with our tertiary partners to improve the diversity of the AH trainees and ultimately CMH workforce
As a part of this, and arising from the recent UK study tour, work has been initiated on what a whole of system approach could look like for musculoskeletal service provision. The Scottish NHS has been very generous in sharing their experiences and expertise given that they are over two years into this journey and are now realising some very real benefits to the whole of system. Other non-related pieces of work underway:
• Confirming the Allied Health Celebration Day for the 14th October. A workforce expo is being planned for in the morning for high school students to highlight the many professions accessible within this workforce grouping. The awards event is to be held in the afternoon.
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Director of Nursing Report Nursing Strategic Action An additional intake of fourteen New Graduate Nurses commenced in May, ahead of the winter. This sees the largest cohort of New Grads at CM Health since 2013. There are now 119FTE new graduates working across all areas of the hospital and community. There are more reports from across Acute Care, Surgical, Mental Health, Theatres and Maternity that recruitment is challenging and recognition that developing New Grads within our system is the best way forward to attaining high quality and committed staff. At the end of June there were 129FTE recruit-able vacancies listed - an increase from 93FTE in April 2015. The CM Health mental health “Safe Practice, Effective Communication (SPEC) programme, an update of the Calming and Restraint training has been nationally recognised as the most up to date in NZ. As a result, CM Health has been asked to support Canterbury and Nelson Marlborough DHB with an update of their trainers, and this saw their Workforce Manager and Associate DON attend a recent 4 day training programme with us. Work continues on the Certification Corrective Action to improve handover from EC to wards, with a cross service working group and support from Ko Awatea improvement advisor. A number of quick wins are being focused on with PDSA cycles and valuable evidence is being gathered. The Director of Nursing is Lead for saving initiative on ward Linen Use and Processes, with a focus on linen for Beds, which comprise >60% of general Linen costs. In June, the Director of Nursing hosted a successful workshop provided by the Global Nursing Executive Advisory Board on Critical Thinking for Senior Nurses. There was positive feedback from staff, and this session has triggered challenging of current teaching programmes/ curriculum content. Many wards and service areas have enjoyed participating in the Matariki and Pasifika week celebrations, with wonderful decoration of areas, and acknowledgement of our diversity. Sustainable Nursing workforce Data reports provided to Service and Clinical Leads are increasingly being used in discussions on workforce mix and planning. Several areas have begun to trial new models and test options for more effective resource use. The Nursing Hours per Patient Day (NHPPD) work continues to support rollout of the McKesson AWM tool in Medicine wards underway, and confirmation of data for Surgical and ARHOP areas well advanced. All CNM’s have been actively engaged with the development and sign-off of the categories of care, required within the module as part of the tool, and training of nursing staff to use the tool occurred through June. The AWM module will record the acuity of each patient on each shift, and eventually this will allow the ward, Middlemore Central and the wider hospital team to have an overview of the workload within each ward. This will assist with determining staffing level requirements and support re-deployment of nurses between areas as required.
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Workforce – Bureau: The organisation-wide focus on quantifying the drivers and variation in current rates of use of internal nurse pools and bureau resources continues. June service activity, higher ward nurse vacancy and the seasonal increase in unplanned leave has contributed to in a further increase in the bureau Nursing FTE and hours provided via both the internal nursing pool and external bureau. Given the demand, the proportion of hours provided by external bureau increased from 11% to 14% of the total. HCA use is more complex, with a slight decrease in total FTE and hours of HCA internal pool and bureau in June, with a minor overall reduction from a May peak. However, this remains substantially higher than in June 2014, and is primarily driven by growth in the use of 1:1 patient watches to prevent patient harm/ injury during admissions. Additionally, in the last 2 months, there has been use of Bureau HCA staff by Non-Clinical Support and Corporate for designated short term work requirements. Monthly per ward reporting is helping to highlight variation and improve accountability. This is helping services to review current practice and test options. The challenge remains to sustain constraint into winter, and address the drivers of the increase arising over the last 12-18months. Workforce Diversity: The Nurse Leader Maaori Health/ Te Kaahui Ora participated with the NETP interview process to ensure a maaori cultural perspective for interviews where there was maaori participation. From ACE, Recruitment identified all student nurses who identified as maaori, and chose CM Health as their first or second preferred choice of placement. There were 18 maaori nurses, who were all reviewed for New Graduates roles. Following shortlisting, this narrowed to five general and two mental health applicants who were interviewed. Positions will be confirmed following State exam results in late July. There is also a new maaori facilitator working within Recruitment. Highlights from Services Medicine and EC continue to develop the nurse facilitated discharge models, to support Adult Short Stay, including more formal use of MDT rounds and discharge templates for some conditions. In addition, a focus daily review and twice weekly CNM follow up on the ward patients with LOS >10 days is achieving positive results. As winter volumes begin, there is steady increase in the daily volumes through the Discharge Lounge at Middlemore, and the Winter Plan for bed allocation is in place from 29 June. Kidz First has 4 pm shift (1500-2330hrs) coordinators working to support winter workloads across Paediatric EC and wards, until October. However, it has been more challenging to recruit nurses for KidzFirst Medical ward winter staffing. Mental Health has a number of service re-configurations and developments underway, intended to strengthen Nursing practice, ensure quality care and promote expertise. The CNS at Whirinaki is currently being supported to complete Nurse Practitioner requirements, with plan to submit to Nursing Council in April 2016. There is a review of the community Key Worker review, the use of Tamaki Oranga and the role of the Psychiatric Liaison Team across CM Health also underway. Mental Health had a positive response from the community teams to recent update on Intramuscular Injectable Medicines. This was provided in conjunction with two pharmaceutical
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companies, and provided opportunity for sharing of practice across teams. Further support will be provided to CMHC champions to maintain expertise in teams. Maaori Health - recently attended the Te Arai Palliative Care and End of Life Conference at the University of Auckland, School of Population Health. As a group, they presented recent work of the Pae Herenga ‘Te Arai Palliative Care Research Study Group’ to develop the use of digital story telling on the ‘End of life’ experiences from a Te Ao Maaori perspective. Pae Herenga is an investigation of traditional whanau end of life cultural care customs. The study uses a qualitative and kaupapa Maori approach. Pae Herenga is strengths-based study aimed to support whanau who have lost their traditional end of life care customs (tikanga). Pae Herenga will also support palliative care services to increase their knowledge and understanding of Maori end of life needs. This is aligned with Advanced Care Planning and was well received by the 200 attendees. This work has since been launched in London under Professor Merryn Gott and will be made available as a resource. Profile – Clinical Nurse Specialists: Surgical and Ambulatory Services
The CNS roles in Surgical and Ambulatory Care are leading the way to support greater integration with Localities. In addition to supporting individual patient care, via Nurse Led clinics and contributing to outpatient and ward services, all speciality CNS’s provide education sessions and resources for Nurses and community/ primary services, and for Undergraduate student programmes. Several are also involved in standardising procurement within their area of expertise and innovative service examples include:
Wound Nurse Consultant – Information on the service and the Complex Wound Clinic, as well as the referral process for the services are available via the HealthPoint page. There has been a steady increase on referrals and phone queries on management of complex wounds from community. Work is underway on a proposal to transition the clinical management of ambulatory patients with non-complex wound care needs, to General Practices, rather than the current model using District Nursing teams. This proposal will include development of an education competency package for Practise Nurses, to assess and treat these non-complex wound cases. The Consultant Nurse is on the national PHARMAC Expert Group, and leads local savings initiatives valued at $500k to date.
CNS Bariatrics – a plan is being worked on to have Focus Groups to be delivered in General Practices for pre-operative Bariatric patients, with a view to providing input that will aid self- management and reduce cancellations on day of surgery.
CNS Colorectal - has developed information/ education pamphlets for patients and is now developing an e-learning package for Nurses across primary and secondary settings.
CNS Skin Lesions – This role will be central to the provision of a One-Stop Shop for skin lesions, using a ‘see and treat’ approach with GPwSI from facility in Galbraith building. The CNS role is key liaison point for community, GPs and Practice Nurses regarding management of complex patients with Melanoma, including melanoma education for health professionals and patients.
CNS Reconstructive Surgery – Provides the Breast Reconstruction awareness day, providing education, awareness and access for health professionals as a collaborative effort with the Plastic Surgeons and GPs. Supports a regular ‘Bra Day meeting’ for Counties women.
CNS Cleft and Palate – Service has strong links with community-based home care nurses, Speech Language Therapists, health workers and Social Workers and provides contact for GPs by phone. This role also works closely with other regional DHBs maternity services, speech therapy and MDT and provides an Out- reach Clinic in Whangarei. Teaching sessions are provided at all DHB maternity units and to University midwifery students.
CNS Spinal Cord Injury (orthopaedics) – Contributing to development of best practise pathways for the Spinal Cord Impairment Centre. Also provides liaison for referring regional DHBs; and links to Kaleidoscope peer support service who talk with patients about life after spinal surgery.
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CNS Chronic Pain - this role is currently being advertised, but service has strong links with the At Risk Individuals (ARI) Advisory team and with Community Alcohol and Drug addictions group. Role supports clinics delivered at Pukekohe Medical Centre.
CNS Acute Pain - Advice, support, and education provided to Maternity services, as well as acute inpatient wards. Support for inpatients with CAD group and with Hospice coordination after-discharge care. CNS Prescribing will strengthen the role, and potentially free up Anaesthetists.
Ophthalmology – are currently interviewing for 2 CNS roles to deliver Nurse-led Outpatient Clinics to relieve pressure of referral volumes on Ophthalmologists. These roles have the potential to reinvent the service.
CNS Uro-dynamics -provides nurse led clinics, with flexible cystoscopy clinics and prostate surveillance clinics are being developed. As a part of the Advanced Nursing Practise process, the CNS developed bladder diaries for use by patients to support enhanced self-management. CNS has recently contributed to the regional collaboration for Urology Policy/ Procedure/ Guideline development work that has now been published in an academic journal.
Other Surgical / Ambulatory CNS roles include CNS Vascular, CNS Well-Managed Pain, and CNS ORL Head & Neck. All CNS staff are line managed via Service Managers, with a Professional link to the Division Clinical Nurse Director.
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Counties Manukau District Health Board 6.0 Resolution to Exclude the Public Resolution: That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:
General Subject of items to be considered
Reason for passing this resolution in relation to each item
Ground(s) under Clause 32 for passing this resolution
7.1 Patient Safety Report
That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982).
[NZPH&D Act 2000 Schedule 3, S32 (a)]
Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S9(2)(a)]
7.2 Risk Register That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982). [NZPH&D Act 2000 Schedule 3, S32(a)]
Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S9(2)(i)]
7.3 Maternity Security Review Reports
That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982). [NZPH&D Act 2000 Schedule 3, S32(a)]
Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S9(2)(i)]
7.4 Minutes of HAC meeting 17 June 2015 with public excluded
That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982). [NZPH&D Act 2000 Schedule 3, S32(a)]
Confirmation of Minutes For the reasons given in the previous meeting.
149
7.5 Action Items Register Confidential
That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982). [NZPH&D Act 2000 Schedule 3, S32(a)]
Action Items Register For the reasons given in the previous meeting.