hospital advisory committee 2013 9.45am library hospital...dec 11, 2013 · minutes of the hospital...
TRANSCRIPT
Hospital Advisory Committee
Wednesday 11 December 2013
9.45am
Marion Davis Library
Building 43
Auckland City Hospital
Grafton
Hei Oranga Tika Mo Te Iti Me Te Rahi
Healthy Communities, Quality Healthcare
AgendaHospital Advisory Committee
11 December 2013
Venue: Marion Davis Library, Building 43, Auckland City Hospital, Grafton Time: 9.45am Hospital Advisory Committee Members Judith Bassett (Chair) Jo Agnew Peter Aitken Doug Armstrong Dr Chris Chambers Assoc Prof Anne Kolbe Dr Lester Levy (Board Chair) Dr Lee Mathias (Deputy Chair) Robyn Northey Morris Pita Gwen Tepania‐Palmer Ian Ward
ADHB Management Ailsa Claire Chief Executive Officer Greg Balla Director Performance and Improvement Margaret Dotchin Chief Nursing Officer Fionnagh Dougan Director Provider Services Rosalie Percival Chief Financial Officer Vivienne Rawlings Chief Human Resources Officer Sue Waters Chief Health Professions Officer Dr Margaret Wilsher Chief Medical Officer ADHB Senior Staff Dr Richard Aickin Medical Director Starship and Child Health Services Dr Vanessa Beavis Director Perioperative Services & Clinical Support Clive Bensemann Clinical Director Mental Health & Addictions Dr Ian Civil Clinical Director Trauma Services Andrew Davies Performance Director Adult Services Karin Drummond General Manager Women’s Health Services Group Mark Fenwick Communications Manager Dr Sue Fleming Medical Director Women’s Health Services Group Jane Lees Nurse Director Adult Health Services Sarah Little Nurse Director Starship and Child Health Services Peter Lowry General Manager Cardiovascular and Regional Cancer
and Blood Services Dr Peter Ruygrok Director Cardiovascular Health Services Anna Schofield Nurse Director Mental Health & Addictions Marlene Skelton Corporate Business Manager Dr Barry Snow Medical Director Adult Health Services Dr Richard Sullivan Director Cancer & Blood Services Helen Wood General Manager Mental Health and Addictions (Other staff members who attend for a particular item are named at the start of the minute for that item)
Apologies
Register of Interests Does any member have an interest they have not previously disclosed? Does any member have an interest that may give rise to a conflict of interest with a matter on the agenda?
Agenda Please note that agenda item times are estimates only
9.45am 1 Attendance and Apologies
2 Conflicts of Interest
3 Confirmation of Minutes 30 October 2013 1
4 Action Points 30 October 2013 15
5 Provider Arm Performance Report 19
Auckland District Health Boards Hospital Advisory Committee 11 December 2013
5.1 Scorecard 21 5.2 Overall Provider Performance including Health Target Updates 27 5.3 Financial and Operational Performance 37
6 Health Services Group Updates 51 Children’s Health Services Group
Regional Cancer & Blood Health Services Group
Mental Health & Addictions Health Services Group
Cardiovascular Health Services Group
Operational & Clinical Support Services Group
Adult Health Services Group
Women’s Health Services Group
7 Summer Bed Plan 2013‐2014 99
8 Quality Updates 127 8.1 Compliment Report 129 8.2 Quality Overview 139
9 Resolution to Exclude the Public 149
Next Meeting
Wednesday 19 February 2014 at 9.30am Marion Davis Library, Building 43, Auckland City Hospital, Grafton
Hei Oranga Tika Mo Te Iti Me Te Rahi
Healthy Communities, Quality Healthcare
Attendance at Hospital Advisory Committee Meetings
Attendees 11 Decem
ber 2013
19 Feb
ruary 2014
2 April 2014
14 M
ay 2014
25 June 2014
6 August 2014
17 Sep
tember 2014
29 October 2014
10 Decem
ber 2014
Dr Lester Levy (Chair)
Jo Agnew
Peter Aitken
Doug Armstrong
Judith Bassett
Dr Chris Chambers
Assoc Prof Anne Kolbe
Dr Lee Mathias (Deputy Chair)
Robyn Northey
Morris Pita
Gwen Tepania‐Palmer
Ian Ward
x absent
# leave of absence
Conflicts of Interest Quick Reference Guide Under the NZ Public Health and Disability Act Board members must disclose all interests, and the full
nature of the interest, as soon as practicable after the relevant facts come to his or her knowledge.
An “interest” can include, but is not limited to:
Being a party to, or deriving a financial benefit from, a transaction
Having a financial interest in another party to a transaction
Being a director, member, official, partner or trustee of another party to a transaction or a
person who will or may derive a financial benefit from it
Being the parent, child, spouse or partner of another person or party who will or may derive a
financial benefit from the transaction
Being otherwise directly or indirectly interested in the transaction
If the interest is so remote or insignificant that it cannot reasonably be regarded as likely to
influence the Board member in carrying out duties under the Act then he or she may not be
“interested in the transaction”. The Board should generally make this decision, not the individual
concerned.
Gifts and offers of hospitality or sponsorship could be perceived as influencing your activities as a
Board member and are unlikely to be appropriate in any circumstances.
When a disclosure is made the Board member concerned must not take part in any deliberation
or decision of the Board relating to the transaction, or be included in any quorum or decision, or
sign any documents related to the transaction.
The disclosure must be recorded in the minutes of the next meeting and entered into the
interests register.
The member can take part in deliberations (but not any decision) of the Board in relation to the
transaction if the majority of other members of the Board permit the member to do so.
If this occurs, the minutes of the meeting must record the permission given and the majority’s
reasons for doing so, along with what the member said during any deliberation of the Board
relating to the transaction concerned.
IMPORTANT
If in doubt – declare.
Ensure the full nature of the interest is disclosed, not just the existence of the interest.
This sheet provides summary information only ‐ refer to clause 36, schedule 3 of the New Zealand
Public Health and Disability Act 2000 and the Crown Entities Act 2004 for further information
(available at www.legisaltion.govt.nz) and “Managing Conflicts of Interest – Guidance for Public
Entities” (www.oag.govt.nz ).
Register of Interests – Hospital Advisory Committee Board Member Organisation Latest
Disclosure
Judith BASSETT (Chair) Nil 9 Dec 2010
Jo AGNEW Professional Teaching Fellow ‐ School of Nursing, Auckland University Casual Staff Nurse ‐ ADHB
9 Sept 2011
Peter AITKEN Pharmacy Locum ‐ Pharmacist Shareholder/ Director, Consultant ‐ Pharmacy Care Systems Ltd Shareholder/ Director ‐ Pharmacy New Lynn Medical Centre
15 May 2013
Doug ARMSTRONG To be advised
Dr Chris CHAMBERS Employee ‐ ADHB Wife is an employee ‐ Starship Trauma Service Clinical Senior Lecturer in Anaesthesia ‐ Auckland Clinical School Member – ASMS Associate ‐ Epsom Anaesthetic Group Shareholder ‐ Ormiston Surgical
20 April 2011
Assoc Prof Anne KOLBE
Director – Private Paediatric Surgical Practice Senior Consultant ‐ Employee Communio NZ Senior Consultant ‐ Siggins Miller, Australia Employee ‐ Strategic Engagement, School of Medicine, University of Auckland Chair ‐ Risk and Audit Committee, Whanganui District Health Board Husband: Professor of Medicine
3 Aug 2012
Dr Lester LEVY (Board Chair)
Professor (Adjunct) of Leadership ‐ University of Auckland Business School Co‐Director ‐ New Zealand Leadership Institute Deputy Chair ‐ Health Benefits Limited Independent Chairman ‐ Tonkin & Taylor Chairman ‐ Waitemata District Health Board Chairman ‐ Auckland Transport
1 Nov 2012
Lee MATHIAS Managing Director ‐ Lee Mathias Limited Director ‐ Midwifery and Maternity Providers Organisation Limited Shareholder/Director ‐ Pictor Limited Director ‐ John Seabrook Holdings Limited Governance Advisor ‐ AuPairlink Limited Council Member ‐Midwifery Council of New Zealand Chair ‐ Health Promotion Agency Health Vision Limited Chair ‐ iAC IP Limited
20 Feb 2013
Robyn NORTHEY Self‐employed Contractor ‐ Project management, service review, planning etc. Board Member ‐ Hope Foundation Trustee ‐ A+ Charitable Trust
20 June 2012
Morris PITA To be advised
Gwen TEPANIA‐PALMER
Board Member ‐ Waitemata District Health Board Board Member ‐ Manaia PHO Chair ‐ Ngati Hine Health Trust Committee Member ‐ Te Taitokerau Whanau Ora Committee Member ‐ Lottery Northland Community Committee
11 Mar 2013
Ian WARD Principal/ Director ‐ C ‐4 Consulting Limited Board Member ‐ NZ Blood Service Advisor ‐ Francis Group Consulting
19 Jan 2012
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CONFIRMATION OF MINUTES
WEDNESDAY 30 October 2013
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MinutesMeeting of the Hospital Advisory Committee
Minutes of the Hospital Advisory Committee meeting held on Wednesday, 30 October 2013 in the
Marion Davis Library, Building 43, Auckland City Hospital, Grafton commencing at 9.30am
ADHB Board Members Present Judith Bassett (Chair) Jo Agnew Peter Aitken Susan Buckland Dr Chris Chambers Associate Professor Anne Kolbe Rob Cooper Dr Lester Levy Dr Lee Mathias Robyn Northey Gwen Tepania‐Palmer Ian Ward
ADHB Management Present Ailsa Claire Chief Executive Officer Greg Balla Director Performance and Improvement) Margaret Dotchin Chief Nursing Officer Fionnagh Dougan Director Provider Services Rosalie Percival Chief Financial Officer Vivienne Rawlings Chief Human Resources Officer Sue Waters Chief Health Professions Officer Dr Margaret Wilsher Chief Medical Officer Dr Richard Aickin Medical Director Starship and Child Health Services Clive Bensemann Clinical Director Andrew Davies Performance Director Adult Services Karin Drummond General Manager, Women’s Health Services Group Mark Fenwick Communications Manager Dr Sue Fleming Medical Director, Women’s Health Services Group Jane Lees Nurse Director Sarah Little Nurse Director Starship and Child Health Services Peter Lowry Interim General Manager Anna Schofield Nurse Director Marlene Skelton Corporate Business Manager Helen Wood General Manager, Mental Health and Addictions (Other staff members who attended for a particular item are named at the start of the minute for that item)
1 Apologies
Susan Buckland, Rob Cooper and Gwen Tepania‐Palmer
Resolution: Moved Jo Agnew/Seconded Chris Chambers
That the apologies be accepted
Carried
2 Conflicts of Interest
There were no declarations of conflicts of interest for any other items on the agenda.
3 Confirmation of Minutes 18 September 2013
There was further discussion on the following items but no requested changes to be made to
the minutes:
Adult Healthcare Services Group report (page 20)
Associate Professor Anne Kolbe commented that the latest budget shows a cost shift from ACC to the DHB with respect to spinal surgery. This is a sector wide issue for all DHBs and
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$200m has been injected into the budget to address the issue. Orthopaedics grew by $16m across the sectors. Spines are the biggest contributor to that cost.
She made the point that DHBs need to advise what other areas are affected, or have
experienced ACC funding becoming an issue for them. It is imperative that DHBs understand
their own data. If the National Health Committee chooses to address this issue then it will be
done nationally. It will take 12‐18 months to resolve and understand the problem.
There is currently a referral from Waitemata DHB submitted by Debbie Holdsworth and it
would be possible to add Auckland DHB to this referral.
Resolution: Moved Jo Agnew/Seconded Ian Ward
That the minutes of the Hospital Advisory Committee meeting held on 18 September 2013
be confirmed as a true and correct record.
Carried
4 Action Points 18 September 2013
The following comment was made with regard to action points.
Invitation to Murray Horn
Rosalie Percival ‐ Chief Financial Officer, advised that Board Members were invited to submit issues for discussion in order to formulate an invitation to Murray Horn to address the Board. To date none had been forthcoming. Clarification was required around what Board Members wished in regard to a visit by Murray Horn.
The Board Chair advised that he was happy to make the invitation and that it was a
conversation that was required rather than an agenda driven item.
The visit should occur during the “Board Only” discussion.
The item to be removed from the Action Points report in the meantime.
DNA Project
A new action to be recorded dealing with DNA. A progress report on DNA to be made to the
Board at its February 2014 meeting.
The Board Chair requested that some lateral thinking be applied to this issue and thought
that someone who is uninvolved in the issue, and who has a customer service background
should be consulted.
The Chief Executive concurred but added that she would like to see consideration of whether
some DNAs, for example a follow‐up appointment was seen as valuable by the patient.
The Board Chair wanted a less academic and theoretical approach to DNAs taken and for it to
run in parallel with other investigation being carried out.
It was advised that work was being done with those staff who are contacting these patients.
Feedback to date indicated that it was hard to get engagement with these patients. The
Counties Manukau District Health Board model appeared to be working well and their
process was being investigated.
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There were questions that required an answer such as:
The implications of missed appointments – Is it a problem or not? Are clients seeing no value for them in coming back?
Does the rate of DNAs affect the readmission rate? If not, then is it a real problem?
That the Action Point Report be amended accordingly.
5.1 Provider Arm Scorecard
Fionnagh Dougan ‐ Director Provider Services and Dr Margaret Wilsher ‐ Chief Medical
Officer, made some general comment in regard to the scorecard.
Patients are waiting longer for a follow‐up appointment. They then feel better and think they don’t need that appointment. We are contacting them and having to explain that we do require them to return
Advising that this is the first winter quarter where the acute patient flow target was met. Volumes have been high but there has been less flu due to a milder winter. She also noted the planning for acute flow work that was done prior to winter.
The Board Chair advised that he had asked Counties to apply their figure to the Auckland data. The result was spectacular, a huge amount of money has been saved along with cost avoidance of an additional 91 beds. Put simply, the avoidance of another ward build.
The Board felt that an article in E‐Nova should highlight this result and express the appreciation of both the Hospital Advisory Committee and the Board. A letter should go to all key clinical leaders thanking them as the result had been achieved in a difficult situation and over winter.
It was advised that the appointment of a flow manager had a big effect in achieving this result.
That the report be received.
5.2 Overall Provider Performance including Health Target Updates
The report was taken as read.
The Chief Executive commented in regard to Ministry of Health targets around shorter waits
for cancer treatment pointing out that the diagnosis ‐ to ‐ treatment target will be a
challenge for the cancer service. The new target will expose gaps in care pathways from
hospital to hospital. The concept of moving smoothly from diagnosis to treatment becomes
more complicated, as it now encompasses elapsed time between appointments.
Matters covered in discussion of the report and in response to questions included:
Associate Professor Anne Kolbe made the observation that the issue highlighted by the Chief Executive was a silo problem. We are a small country so how can we effectively connect good pieces of work so that they get legs nationally. We have yet to grasp how to translate knowledge and share it so that we are not all doing the same work.
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The Board Chair commented that casual benchmarking does not always work. It is
not always possible to effect a transfer successfully. We continually underestimate
the role that culture and language plays.
In answer to a question whether the volume of patients is increasing for Heart and
Diabetes and if there was a delay factor in diagnosis it was advised that an increase
was being seen across the western world and that there were numerous factors to
acknowledge at the pre diabetes stage that affected diagnosis.
Resolution: Moved Lee Mathias; seconded Robyn Northey
That the report be received.
Carried
5.3 Financial and Operational Performance
Rosalie Percival ‐ Chief Financial Officer, spoke to her report providing a brief overview of key
points.
The September results are showing an improvement over the prior two months. The focus
has been on lowering employee and clinical supply cost. There have been some one off costs
which are being looked at and relate to sustainability issues.
Matters covered in discussion of the report and in response to questions included:
An explanation of what constituted the outsourced staffing cost was requested. It
was advised that it was a combination of medical staffing and medical bureau cost. A
concern was expressed that external agencies should be the last port of call for
additional assistance and that it did not look like this was happening. A breakdown of
what formed this cost was requested.
The Board Chair asked how the Lab Transfer had proceeded and was advised by the
Chief Medical Officer, Margaret Wilsher, that it had been a quiet move providing an
encouraging start to the transfer attracting low media interest.
Lee Mathias commented that staff count was showing 26 favourable but that the
dollars were unfavourable This suggests that this area will be an on‐going challenge
for the Board, particularly as employees age and also move up the pay scales. She
suggested that, if not already in existence, that a long term plan be put in place along
with active management of this issue.
The Chief Financial Officer advised that the removal of the subsidy around Kiwi Saver
had seen a big uptake in Kiwi Saver by staff that would have an impact on overall
costs.
That the report be received.
6 Health Services Group Updates
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Women’s Healthcare Service Group
Karin Drummond ‐ General Manager, Women’s Health Services Group was in attendance to answer questions. Matters covered in discussion of the report and in response to questions included:
In answer to a question around sick leave data it was advised that targets have been set for addressing FTE management and that these were visible to all. Both excess and sick leave were being monitored to better understand the causes so countermeasures could be put in place. Quality improvements were being sought in both areas.
Jo Agnew noted that it was clear that nursing FTE was driving an over‐spend and asked what strategies were being employed to address this. Karin Drummond advised that it was difficult to reduce the workforce unless patient numbers dropped correspondingly. Therefore, pathways of care and rostering practice were being investigated to see what changes could be instituted that would improve flows and reduce cost.
Karin Drummond advised that an issue being investigated was how customary practice in hours worked had become preferential for some nursing staff. This is prevalent in those aged over 55.
Margaret Dotchin advised that there is a need to look at all issues around supporting an aging workforce. Understanding is required on how to bridge the current gap and to plan for the next ten years when younger staff would definitely be required. She felt the use of “Trendcare” would assist in turning this genesis around.
The Board Chair noted that if the industry model didn’t fit with the current context then the law needed changing and this should be advocated for now.
Child Healthcare Services Group
Fionnagh Dougan ‐ Director Provider Services introduced the new General Manager, Clinical Services, Starship and Child Health Services, Emma Maddren, who was welcomed to her first Auckland District Health Board meeting. Fionnagh Dougan introduced the report and summarised key points. She advised that:
Performance against target for shorter stays in ED were met or exceeded for 24 days in the month with the target at 97%. Beds had been able to be closed in October that would have been closed much later in the year
The ESPI 5 target, access to elective surgery, was moderately compliant with 9 children (1.05%) having waited longer than 5 months for surgery. There has been a Fellow covering surgery but there may be a point when there is need of external assistance.
Fionnagh advised that the Family Violence Screening target, while improving, remains below what it should be and that a reason for this is that staff are still not confident in having the required conversations with patients and family.
A financial variation in donation income was noted the mitigation being that it was an issue around timing with funding for major projects being received as projects are completed. The Chief Financial Officer, Rosalie Percival, added that the project for the Bone Marrow Unit is in a favourable position and will offset this. However,
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phasing of the budget next year needs looking at.
Matters covered in discussion of the report and in response to questions included:
The Board Chair congratulated the wider child health service for the recent rheumatic fever event which was a great initiative and showcased engaged kids within the community. Good media coverage had surrounded the event.
Lee Mathias raised the issue of recent talk back comment on cleanliness within Starship and was advised that this related to a situation that had occurred some years ago. Fionnagh Dougan advised that the situation is now aggressively monitored to ensure standards are met.
Richard Aiken advised that long stay patients bring a lot of personal belongings in with them and these situations need careful managing. He thought the best use of the building was being made. Some wards have had a lot of work done to them to keep them up to standard but that does not totally solve the problem of an aging building.
In answer to a question in regard to the life term of the building the Board was advised that short term mitigation strategies were constantly being put in place and that medium and long term strategies were currently being worked on. Fionnagh Dougan and Rosalie Percival advised that this situation had been included as part of the site master plan being developed. There had been engagement with other District Health Boards to determine volumes and a model nationally and at the same time a service description was being developed for a business plan.
The Board Chair advised that capital should not be regarded as a barrier. The Board was open to providing seed funding for resource to facilitate this. He encouraged staff to provide opportunities for engagement at all levels and commented that the Board would benefit from a timetable or milestone chart for delivery.
Richard Aiken concurred that the discussion does need elevation but he felt it must happen at time when there is sufficient information to engage well. In his opinion the current plan is the right one and the interim solution provides a good result. Clinical engagement is being used to get the information required to escalate the issue.
Action
That the Chief Financial Officer and Director Provider Services develop and place within the
site master plan a roadmap and milestones for the replacement of the Starship Building.
Regional Cancer and Blood Health Services Group
Fionnagh Dougan introduced the report and summarised key points. She advised that:
A new manager had been appointed to the service and would be starting in March of next year.
The Wait List is being closely monitored in order to achieve the 100% target.
The Chief Executive commented that the customer complaints target needed more consideration in how it was represented as while the District Health Board welcomed feedback, the three complaints received had placed the service in breach. Feedback should not be seen as a negative.
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Matters covered in discussion of the report and in response to questions included:
In answer to a question around excess annual leave of 12.73% it was advised that it had been accrued over a number of years and a plan had been put in place with the individuals concerned to reduce the level held.
In answer to a question around “unachieved savings” noted under clinical supplies it was advised that it was applicable to TPN and how it was utilised in the service and to a particular group of people for whom the cost of the ingredients had increased.
Fionnagh Dougan advised that the costs for TPN fell within the wider hospital budget and that new Pharmac rules applied to it. Costs had crept up and there were attempts being made to control and manage the situation.
Mental Health and Addictions Health Services Group
Helen Wood – General Manager, Mental Health and Addictions, Clive Bensemann – Clinical Director and Anna Schofield – Director of Nursing were in attendance to introduce the report and answer questions. Helen advised that the wait times and access continues to improve for the service. For the first time the full 8 week target had been met for clients in the 0‐19 age group with other age groups continuing to meet target. A major challenge nationally and locally was providing faster access to youth services. A three day rapid event had been planned for 5 – 7 November which will assist in the redesign of the service delivery model to enable the service to better meet targets and minimise pressure on clinical staff.
There had been a successful three day certification audit conducted for Mental Health
Services with auditors giving positive feedback on improvement in culture and environment,
particularly in intensive care in comparison to two years ago when the last certification was
undertaken.
Helen advised that an unfavourable financial position of $350,000 was being reversed and
had been reduced by 73%. This had been achieved by increased management of recruitment
and paying particular attention to skill mix issues.
Matters covered in discussion of the report and in response to questions included:
It was noted that Bureau utilisation was still above target. Anna advised that work was on going to address this situation.
In response to a request for more information in regard to the Child and family occupancy unit the Board were advised that the unit is classed as super regional and for children throughout the wider North Island. There was work being led by the National body to look at other opportunities for use of the facilities.
It was commented that the Kari Unit was still looking scruffy and something should be done to improve the situation. Helen Wood undertook to follow this up.
A request was made as to how many community support services houses exist within the community. It was agreed that a presentation in “Board Only” discussion time depicting a “Day in the Life” of a person living in such a community house would be beneficial to aid board members’ understanding. The Committee Chair also requested that options available for support to occupants be highlighted along with
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any other areas staff had a concern with.
Cardiovascular Healthcare Services Group
Peter Lowry ‐ Interim General Manager and Jane Lees –Nurse Director were in attendance to introduce the report and answer questions.
Peter Lowry advised that the referral rate in September for bypass surgery had been at a
record high. The service delivered volume over and above the planned production rate. This
high inpatient demand did result in some priority two patients being non‐compliant with
their target surgery timeframe for the month.
The service has an unfavourable result of $600,000 for the month which is attributable to
high clinical supplies cost, particularly blood products and a radiology service billing
overspend dues to high vascular radiology intervention procedures.
Matters covered in discussion of the report and in response to questions included:
Advising in response to a question around what financial strategies are in place to deliver a better result, that operating costs are being held through pursuing reduced prices for implants and consumables; managing staffing and leave more closely; and by following through on revenue gain strategies which were outlined on page 88 of the agenda.
Operational and Clinical Support Services Group
Fionnagh Dougan introduced the report and summarised key points. She advised that:
There is a need to review ultrasound vascular referral list and how those patients are
managed in order to control the wait list as the ultrasound is running at full capacity.
The Contact Centre fall‐back position is not sustainable as it relies on a small room within the
main building with four lines. This is being addressed as part of the current contact centre
business case development.
Matters covered in discussion of the report and in response to questions included:
A general concern with disaster recovery plans overall and a specific question around the national plan covering IT. The Chief Executive advised that there is a data centres proposal which covers all 44 centres nationally. This is a vulnerable area so backup systems are required. The other issue is around systems failing.
Linda Wakeling commented that if full redundancy occurred then the District Health Board could not manage the situation. The best of breed systems were coming to the end of their life and over the coming months a lot of work will be put into finding a way forward for end of life core systems and how they are replaced to enable new models of care to be instituted. The focus was on building a record around the patient and breaking away from the old models. Traditionally the sector had been good at starting new projects but the solutions are not supporting the clinical
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requirements on the ground.
In answer to a question on what the National IT Board saw as a priority the Chief Executive advised that New Zealand systems were somewhat unique as they were interoperable and if you changed one you affected others so clearly alternative solutions were required nationally.
Linda Wakeling advised that she was cautiously optimistic that there would be a decision in this financial year by the National IT Board of the direction to take.
Adult Health Services Group
Andrew Davies – Performance Director Adult Services introduced the report and summarised key points. Advising that the acute flow target of 95% was not met but that the result of 93.4% was extremely close. There had been some significant successes for the month with the ready for winter work streams delivering significant bed savings. There had been reduced cancellations and improved flow performance. The service had initiated the service excellence programme for health of older people. The operating model for the medical observation unit which was due to open in November had been developed
Issues requiring closer management and of concern were the continued challenges with non‐
urgent colonoscopy cases which were being addressed with additional lists to remove the
wait list backlog and the delay to the operating model and contracting for the National
Intestinal Failure Service. The collaborative approach on the latter issue, while slowing
progress, will result in a better agreement around service design.
There have been 33 bed closures over the last 2 month period leading to savings. These beds
can be opened up on a call back model. There is a continued drive to place a strong focus on
living within the service’s means.
Matters covered in discussion of the report and in response to questions included:
The comment was made that bed closures save nursing dollars but will the initiative actually affect the Senior Medical Officer budget? It was advised that unless a Senior Medical Officer is rostered then that Senior Medical Officer will be on leave. Registered Medical Officers are more difficult to manage because of their employment agreement.
Dissatisfaction was expressed with the first 3 months financial position. It was advised that orthopaedics has had long standing issues affecting it financially and is a fast growing area requiring careful management to effect a remediation.
The Chief Executive expressed concern over the management of the National Intestinal Failure Service. Associate Professor Ann Kolbe commented that the NHB has a series of programmes sitting waiting for review. At issue is how much is to be done and where will the funding come from. She voiced the opinion that she was not sure that the National Intestinal Failure Service would meet their materiality test. Auckland District Health Board should only undertake work which was endorsed. The Chief Financial Officer advised that agreement had yet to be reached between parties over what was required and how it should be paid for.
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Resolution: Moved Jo Agnew; seconded Lee Mathias
That the Health Services Updates be received
Carried
7 Quality Updates
The report was taken as read
Resolution: Moved Robyn Northey/Seconded Ian Ward
That the report be received
Carried
7.1 Compliment Report
The report was taken as read.
Resolution: Moved Lee Mathias/Seconded Peter Aitken
That the report be received.
Carried
7.2 Quality Overview
The report was taken as read
Resolution: Moved Robyn Northey/Seconded Ian Ward
That the report be received
Carried
8 Resolution to Exclude the Public
Moved Jo Agnew/Seconded Robyn Northey
That in accordance with the provisions of Clauses 32 and 33, Schedule 3, of the New Zealand Public Health and Disability Act 2000 (“Act”), the Hospital Advisory Committee resolve that 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 each item to be considered:
Reasons for passing this resolution in relation to each item:
Ground(s) under Clause 32 for the passing of this resolution
8.1 Confirmation of the Public Excluded Minutes of the 18 September 2013 Committee Meeting
Confirmation of Minutes As per resolution(s) from the open section of the minutes of the above meeting, in terms of the NZPH&D Act 2000.
That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official
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Auckland District Health Board Meeting of the Hospital Advisory Committee 30/11/2013
Information Act 1982 [NZPH&D Act 2000]
8.2 Health Group Service Update
Privacy of Persons To protect the privacy of natural persons, including that of deceased natural persons
[Official Information Act 1982 S9 (2) (a)]
That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000]
8.3 Items for consideration and recommendation to the Board:
Risk Report
Complaints Report
Privacy of Persons To protect the privacy of natural persons, including that of deceased natural persons
[Official Information Act 1982 S9 (2) (a)] Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities
[Official Information Act 1982 S.9 (2) (i)]
That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000]
Carried
The meeting closed at 12.40pm
Next Meeting
The next ordinary scheduled meeting will be held: 9.30 am, Wednesday, 11 December 2013 Marion Davis Library, Building 43, Park Road, Auckland City Hospital, Grafton Signed as a true and correct record of the Hospital Advisory Committee meeting held on Wednesday, 30 October 2013. _____________________________________________ Chair ___________________________ Date
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ACTION POINTS
WEDNESDAY 30 October 2013
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Auckland District Health BoardAction Point Report to HAC Meeting
Action Points from the HAC meeting on Wednesday 30 October
2013
Meeting and Item
Detail Designated to Action by
26 August 2013 Item 6
Report on the cost shift occurring with the adult component of ACC patients
Andrew Davies February 2014
September 2013 Item 5
That Auckland District Health Board be included in the submission made by Waitemata District Health Board to the National Health Committee referring the issue of spinal surgery within both District Health Boards.
Fionnagh Dougan Andrew Davies
Completed
26 August 2013 Item 6
Ethnicity Data/benchmarking data to be provided when the new national Cardio surgical Database is implemented
Fionnagh Dougan
Date to be advised when determined by MoH
June 2013 Item 4
A report on TrendCare was requested Fionnagh Dougan Margaret Dotchin
19 February 2014
30 October 2013 Item 4
A progress report to be provided on the management of DNAs.
Fionnagh Dougan
19 February 2014
17
18
5
PROVIDER ARM PERFORMANCE REPORT
5.1 Scorecard
5.2 Overall Provider Performance including
Health Target Updates
5.3 Financial and Operational Performance
19
20
5.1 Scorecard
21
22
Measure Actual Prev Period Commentary
% AED patients seen within triage time - triage category 2 (10 minutes) PR006 86.3% >= 80% 80.7%
% CED patients seen within triage time - triage category 2 (10 minutes) PR008 83.3% >= 80% 87.7%
Adverse events causing harm (SAC 1&2) per 1,000 bed days PR084 0.033 <= 0.06 0.401
Central line associated bacteraemia rate per 1,000 central line days PR087 0. <= 2 1.2
Healthcare-associated Staphylococcus aureus bacteraemia (per 1,000 bed days) * PR088 0.375 <= 0.2 0.145
Healthcare-associated bloodstream infections (per 1,000 bed days) - Adult * PR089 1.61 <= 1.6 1.54
Healthcare-associated bloodstream infections (per 1,000 bed days) - Child * PR090 1.95 <= 2.4 2.05
Falls with major harm (per 1,000 bed days) PR095 0.03 <= 0.09 0.183
Nosocomial pressure injury point prevalence (% of in-patients) PR097 4.7% <= 5% 4%
Healthcare-associated Clostridium difficile infection rate (per 10,000 beddays) * PR143 4.55 <= 4 3.89
% Hand Hygiene Compliance PR144 76.1% >= 70% 75.1%
(MOH-01) % All patients with ED stay < 6 hours PR017 95.5% >= 95% 94.4%
% Inpatients on Older Peoples Health waiting list for 4 days or less PR023 96.6% >= 80% 91.9%
HT2 Elective discharges cumulative variance from target PR035 1.02 >= 1 1
(ESPI-2) Patients waiting longer that 5 months for their FSA * PR038 0.002 <= 0 0.001
Target achieved.
We now have 5 data points and there is common cause variation around the central line.
The rate of healthcare-associated bloodstream infections in adult patients remains stable. However, there is special cause variation wtih 10 data points sitting above the centre line. The cause for this is not clear. The hand hygiene compliance rates for ADHB continue to improve and the CLAB initiaitves in the three ICU's has significantly reduced CLAB events. The HA-BSI data for the last 10 months will be reviewed to better understand why this special cause variation may be occuring.
Auckland DHB Provider ScorecardFor October 2013
Target
Despite high volumes the processes for managing acuity are working well.
Patie
nt S
afet
yB
ette
r Qua
lity
Car
e
There were no CLAB episodes in October.
The number of healthcare-associated S. aureus bacteraemia repisodes was high at 9 episodes in September. Looking at the cases 4 were device related vascular access 3, urinary catheter 1), 2 were associated with febrile neutropenia epsiodes, 1 was associated with a surgical site infection and the source was unknown in the other two patients. No for the increase in episodes during this month has been identified.
The majority of services are now consistently under five months for ESPI2 performance. We have occasional exceptions in services with specific subspecialty constraints and unforeseen delivery issues however services continue to build resilience through quick trouble shooting and escalation of these scenarios. Orthopaedics remains a challenge with a series of initiatives underway to reduce wait times for FSA. Spines in particular is a subspecialty constraint that is difficult to resolve but the service is working to address this.
23
Measure Actual Prev Period Commentary
Auckland DHB Provider ScorecardFor October 2013
Target
(ESPI-5) Patients given a commitment to treatment but not treated within 5 months * PR039 0.007 <= 0 0.006
Cardiac Bypass Surgery Waiting List PR042 45 <= 101 80
% Accepted referrals for elective coronary angiography treated within 3 months PR043 100% >= 85% 99.1%
% Urgent Diagnostic colonoscopy procedures treated < 14 days PR044 63.2% >= 50% 72.7%
% Non urgent colonoscopy procedures treated < 42 days PR045 31.3% >= 50% 27.8%
% Outpatients & community referred MRI completed < 6 weeks PR046 63.9% >= 75% 52.5%
% Outpatients & community referred CT completed < 6 weeks PR047 87.5% >= 85% 90%
Elective day of surgery admission (DOSA) rate PR048 64.1% >= 68% 63.4%
% Day Surgery Rate PR052 59.9% >= 70% 58.1%
Inhouse Elective WIES through theatre - per day PR053 111.56 >= 99 116.88
% DNA rate for outpatient appointments - All Ethnicities PR056 8.8% <= 9% 8.9%
% DNA rate for outpatient appointments - Maori PR057 17.1% <= 9% 17.3%
% DNA rate for outpatient appointments - Pacific PR058 17.5% <= 9% 17.8%
He Kamaka Waiora has commenced a process to remind Maori patients by phone of their planned appointments.
The proportion of patients admitted for surgery and discharged on the same day has changed little.
The production and operation planning process (POP) has allowed HSG's to focus on throughput.
KPI has increased from 31% in Sep 2012 and will continue to increase as the waiting list backlog is worked through
DOSA rates have remained stable over the last two years. Individual HSG's are exploring options to increase the number of patients admitted on the day of surgery.
We are currently working on a submission in response to the MoH RFP for additional funds to achieve the target.
The majority of services are now consistently under five months for ESPI5 performance. We have occasional exceptions in services with specific subspecialty constraints and unforeseen delivery issues, however services continue to build resilience through quick trouble shooting and escalation of these scenarios. Orthopaedics, Paediatric General Surgery and General surgery are a challenge. Each has constraints around particular subspecialty case mix types. As with ESPI2 services are working to address these through alternative pathways, the use of locums and effective list prioritisation to balance wait time, health target, and inter-district flow demands.
A low referral rate combined with strong production in October has brought the wait list down to 45. Historically November and December have provided a very high referral rate (average of 25 per week) that has caused us to become non compliant with the MoH upper limit. We are in a strong position this year to maintain a compliant wait list given our current position.
Bet
ter Q
ualit
y C
are
24
Measure Actual Prev Period Commentary
Auckland DHB Provider ScorecardFor October 2013
Target
We are working on piloting a collaborative approach which brings in the Pacific navigator/community health worker and, the scheduler (renegotiating appointments) and also reviving the health promotion messages on Pacific radio stations to improve health literacy amongst Pacific communities. This approach led to reductions in DNA rates for Pacific patients in Counties Manukau and Capital Coast DHBs.
25
Measure Actual Prev Period Commentary
Auckland DHB Provider ScorecardFor October 2013
Target
% Chemotherapy patients (Med Onc and Haem) attending FSA within 4 weeks of referral PR059 100% 78.7%
% Radiation oncology patients attending FSA within 4 weeks of referral PR064 100% 99.6%
% Cancer patients receiving radiation/chemo therapy treatment within 4 weeks of DTT PR070 100% 100%
Average LOS for WIES funded discharges (days) PR074 2.9 <= 3 2.96
28 Day Readmission Rate - Total * PR078 10.2% <= 6% 10.4%
Breastfeeding rate on discharge excluding NICU admissions * PR099 81.9% >= 80% 76.8%
Mental Health - 28 Day Readmission Rate (KPI Discharges) to Te Whetu Tawera * PR119 2.1% <= 10% 8.5%
Mental Health Average LOS (KPI Discharges) - Te Whetu Tawera PR120 25.3 <= 21 28
% Very good and excellent ratings for overall patient experience for inpatients (from physical healt PR154 83.1% >= 90% 83.8%
Number of CBU Outliers - Adult PR173 453 <= 0 543
% Patients cared for in a mixed gender room at midday - Adult PR175 18.2% <= 0% 20.9%
Mental Health % long-term clients with relapse prevention plans PR125 94.4% >= 95% 94.4%
% Hospitalised smokers offered advice and support to quit PR129 96.3% >= 95% 94.9%
Note: * indicates that the actual value shown is for a prior period, due to no data available for October.
The overall rating of "good" has increased from 8.6% to 10.9% from last month.
Work is currently being undertaken to better match the bed configuration on the patient administration system to the greater volume of surgical patients admitted. This will reduce the number of ward outliers.
Daily operational meeting to review and reduce the numbers of patients in mixed gender rooms.
Although not at target, this still represents a very positive step in the progress towards lowering average length of stay at TWT
Impr
oved
H
ealth
St
atus
Services have been made aware of this drop and are seeking to make this more business-as-usual rather than reactionary activity.
ADHB observed slightly above average readmission rates in Q1 which has continued in Oct but the observed level is within normal ranges and is not a statistically significant increase. Therefore we are monitoring the situation closely.
Bet
ter Q
ualit
y C
are
100%
100%
100%
26
5.2 Overall Provider Performance including Health Target Updates
27
28
Project: Adult Acute Patient FlowPrimary Objective: That at least 95% of patients will be admitted, discharged or transferred from Auckland Adult Emergency Department
within 6 hoursDate of Delivery: 30 June 2014Clinical Leads: Jane Lees , Dr Barry SnowProject Sponsor: Andrew DaviesSteering Group: Jane Lees, Andrew Davies, Dr Barry Snow, Dr Anil Nair,Dr Anthony Hardy, Dr Robyn Toomath, Dr Alex Ng, Sandi Milner, Sharee
Bartlett, Jo Mack
Improvements to date:•
Reviewed Medical / Nursing requirements for AED and approved business case for
resource increase to match increased workload.•
Charge nurse patient flow coordinator introduced•
Improved access to Radiology •
Streamlined documentation required for safe transfer •
Improved triage processes.•
58 Additional beds opened•
Winter Ward 31 General Medicine 10 additional beds•
Daily Rapid Rounds introduced •
Nurse Facilitated Discharging in General Medicine•
Improved Bed Management Communication via Estimated Discharge Dates, CMS
upgrades, improved visual management, more efficient bed management
meetings, earlier time of day discharging.•
Daily breech review meetings to understand root causes and implement short
term solutions.•
General Medicine model change•
Improve referral practices to allied health to support resource allocation and
prioritization of patients for discharge.•
Daily meeting implemented with Snr
nursing and management to review flow
blockages, current state of the hospital, plan of the day, staffing challenges and
priorities, and actions.•
Reallocate Allied resources to AED and APU to avoid admissions where possible•
Escalation plans put in place to Improve response times for service coordination.
Ongoing actions to improve current performance:•
Audit of the delays to treatment in the wards to identify all discharge delays.•
Brought the community team resources in for support when the number of
patients waiting was above the threshold.•
Increase focus with the medical teams on patient discharging and
sign on times for
acute patients. •
Utilized senior nursing teams to support proactive opening of flex beds based on
occupancy triggers.
Project Risks / Comments:•
Adults performance in Sept was 93%. This was largely driven by 5 low flow days linked to high volumes and high
occupancy.•
The accelerated work programme has been addressing these issues and has resulted in our flow remaining high for
winter.
Current improvements:•
Eliminating duplicated documentation between AED and inpatient medical teams•
Streamlining high volume patient pathways and developing team approach to acute flow management between ED
and IP specialties.•
Roster alignment to demand profiles•
Demand management in alignment with Health of Older People (HOP)
and District Annual Plan acute demand
initiatives•
Increased focus of the inpatient specialty teams via the introduction of acute flow measures into the daily and weekly
operational management team meetings.
Adult Acute Patient Flow, Actual vs Target, July 2012 - June 2014
0%
20%
40%
60%
80%
100%
120%
Jul-2
012
Aug
-201
2
Sep
-201
2
Oct
-201
2
Nov
-201
2
Dec
-201
2
Jan-
2013
Feb
-201
3
Mar
-201
3
Apr
-201
3
May
-201
3
Jun-
2013
Jul-2
013
Aug
-201
3
Sep
-201
3
Oct
-201
3
Nov
-201
3
Dec
-201
3
Jan-
2014
Feb
-201
4
Mar
-201
4
Apr
-201
4
May
-201
4
Jun-
2014
Actual Goal M OH Target
29
Project: Children’s Acute Patient FlowPrimary Objective: That at least 95% of patients will be admitted, discharged or transferred from Auckland Children’s Emergency
Department within 6 hoursDate of Delivery: 30 June 2014Clinical Lead: Richard AickinProject Sponsor: Emma MaddrenSteering Group Emma Maddren, Richard Aickin, Michael Shepherd, Anna‐Marie Grace
Project Risks /Comments:Performance remains consistent with October performance averaging at 97%. The Flow
Coordinator role continues to contribute to a greater quality child and family experience as
well as positively impact on the speed children are transferred from Children’s ED to the wards.
Improvements to date:•
Increased completion and accuracy of Estimate Discharge
Date (EDD’s) for current inpatients•
Improvement in the forecasting of short term occupancy
levels•
Changes to the registrar call back guidelines to improve
timeliness of patient review•
Capacity planning process implemented to ensure better
longer term planning•
Bed turnaround reviewed which has resulted in a reduction
of time taken to access a bed•
Cohorted
patients with low complexity and reduced staffing
for this group, freeing staff to care for increasing numbers
of higher acuity patients•
Rostered
additional senior staff onto periods of high
admissions, to improve decision‐making speed•
Increased the frequency of daily Ready To Go meetings to
two or three times a day to identify potential discharges•
Daily review of patients who can be safely cared for by their
DHB of domicile•
A Rapid Improvement Event was held at the end of August.
This led to process and communication improvements and. •
Increased liaison with CMDHB and WDHB.•
Opening up the Day Stay Unit for overnight patients•
Basing a House Officer in CED to review general surgical
admissions during the peak hours of 1600 –
midnight•
Agreement with WDHB that where appropriate, Auckland
children living on the border can be cared for at Waitakere•
Investigating different models for the management of semi
acute orthopaedic
patients – so avoiding the need for an
inpatient bed
Children's Acute Patient Flow, Actual vs Target, July 2012 - June 2014
0%
20%
40%
60%
80%
100%
120%
Jul-2
012
Aug
-201
2
Sep
-201
2
Oct
-201
2
Nov
-201
2
Dec
-201
2
Jan-
2013
Feb
-201
3
Mar
-201
3
Apr
-201
3
May
-201
3
Jun-
2013
Jul-2
013
Aug
-201
3
Sep
-201
3
Oct
-201
3
Nov
-201
3
Dec
-201
3
Jan-
2014
Feb
-201
4
Mar
-201
4
Apr
-201
4
May
-201
4
Jun-
2014
Actual Goal M OH Target
30
Project: Improved access to elective surgeryPrimary Objective: Increase ADHB Elective Surgical Discharges from
12,891 to 13,499Date of Delivery: 30 June 2014Clinical Lead: Vanessa Beavis, Ian CivilProject Sponsor: Fionnagh DouganSteering Group: Dr Vanessa Beavis, Greg Balla, Andrew Davies, Fionnagh Dougan, Ian
Civil.
Risks / Comments: Red
1.
We are at 101% YTD for ADHB Health Target Discharges due to high
volumes in
October
2.
ESPI wait time in control for all but two subspecialties. Orthopaedic
Spines and Paed
Surgery being resolved
3.
Acute volumes continue to outstrip PVS demand
Previous activities:
•
Four weekly production planning routines recommenced and
focused on mitigating Christmas impact to wait times
•
OR MOS commenced in Starship operating rooms•
New Production Co‐ordinator orientation underway•
Phase one of service sizing near completion for Orthopaedics•
Version one of 14/15 and 15/16 production plans complete•
Met with Cancer Services and some medical services to discuss
production planning support for those areas
Planned activities:
The productive operating room:•
‘Just in time’
use of consumables roll out to Level 8 ORs•
Analyse phase for PACU delays project on Level 9•
Replicating MOS meeting routines for Level 8•
Preparing for rapid improvement event 9‐13 December for CSSD
to reduce errors impacting operating rooms
•
‘Acutes
same day’
project launch for level 8Clinic performance:•
Broadened project team and reassigned sponsorship to Fionnagh
Dougan
•
Letter changes underway to improve patient experienceProduction planning:•
Discuss 14/15 and 15/16 production plan with services for
refinement
•
Ongoing surgery dashboard development –
first release by end of
this month
•
Roll out of weekly reporting process and packs to Ophthalmology•
New production co‐ordinator to work with General SurgeryPathways:•
Over the phone pre admit underway in Oral Health, Gen Surg,
Womens
•
ERAS initiative with Ministry of Health underway with
Orthopaedics to align existing Neck of Femur Fracture work with
national initiatives
08/10/13 update31
MoH
Target: Shorter waits for Cancer TreatmentPrimary Objective: That 100% of eligible patients requiring radiation treatment or chemotherapy will commence treatment
within 4 weeks of a decision to treat. Date of Delivery: 30 June 2014 (4 weeks)Clinical Lead: Giuseppe Sasso
(Rad
Onc), David Porter (Med Onc), Richard Doocey
(Haematology)Service Manager: Danah Cadman
Ongoing initiatives to maintain the 4 week target
Radiation Therapy:
An “Operational team” measures KPIs to prioritise the waitlist and analyse performance on a weekly basis. This is ongoing.
Waitlist report enables active monitoring and immediate remedial action if required. This is ongoing.
Chemotherapy:
Weekly meetings to coordinate clinician, nursing and Daystay workload. This is ongoing
Regular monitoring of clinic utilisation of FSA, F/Up and review clinics.
Clinic capacity is monitored weekly to ensure patients are scheduled by priority and length of wait time.
Cancer Nurse Co-ordinators:The cancer nurse co-coordinator positions have now been
appointed. Senior nurses have been recruited to address key initiatives across the patient pathway including MDMs, concurrent treatment, supportive care, access and equity. These initiatives directly support the national priority of Faster Cancer Treatment
The service is 100% compliant for October 2013
Key risks which may impact capacity to deliver to the target in the coming months:
Chemotherapy:Adherence to the 4 week target is being achieved by daily monitoring of wait times and detailed Daystay and clinic
scheduling to manage a sustained growth in referrals that is impacting day stay capacity and resources. Radiation Therapy: The commissioning of the new Radiation Therapy planning system has commenced. The system will be fully
implemented by January 2014, this will significantly increase planning capacity to continue to meet the 4 week target.
Radiation Therapy/Chemotherapy - % patients receiving treatment w ithin 4 weeks of DTT, Actual vs Target, July 2013 - June 2014
0%
20%
40%
60%
80%
100%
120%
Jul-2
013
Aug
-201
3
Sep
-201
3
Oct
-201
3
Nov
-201
3
Dec
-201
3
Jan-
2014
Feb
-201
4
Mar
-201
4
Apr
-201
4
May
-201
4
Jun-
2014
Actual Goal M OH Target
32
I have talked through issues with the MoH
and kineo
about the online study
programme and as a result the set up has been realigned to aas
it was with
the previous IT provider. This will improve on the pass rate.Immediate Actions to improve performance A.Maintain Focus on short stay/high volume areas to achieve •AED and APU are audited weekly. The problems in the intermediate
discharge planner have now been rectified and the % of Brief Advice given
to identified smokers is now back up to above 80%•We are seeking to overcome the rate of not identifying smokers by
introducing the same assessment and referral form in women’s health as in
adult health. The trial phase has passed and we are in the process of getting
the final proof correct with a view to a release this month with
supportive
training.•The maternity target of 90% of all pregnant women who smoke must
be
given brief advice and assistance to quit is still under review nationally. A
narrative report only has been supported and accepted for Quarter 1.B.Improve engagement of clinical workforce to achieve •Reports on events discharged and coded in the month to be available for
services and reported weekly to OMM and BoardC.Data collection systems and processes
to achieve•Weekly Pareto Chart of cumulative percent achievement for the month of
wards / areas emailed out from the CEO plus follow up weekly achievement
poster for each area.D. Communications –
planned activities•Poster campaign with weekly posters to let each area know how they are
doing•Weekly results are reported by ward / unit and accountable Manager.
Meetings with Nursing or Midwife Advisors are followed up and a
discussion
of percent achieved occurs.•E. Quarter 1 report – achieved•The detailed report was lauded and the Ministry is very satisfied with what
has been undertaken. The response was to ask for sustainability.
The main
factors for this are embedded processes (forms, self audits, reporting) and
electronic formats (mandatory report in EDS, whiteboard columns to have
cell portability), and CEO engagement.
CommentsAs at 22/11/13. 96.3% of hospitalised smokers were given brief advice to quit in
October 2013.
Project: Better help for smokers to quit
Objective : 95% of hospitalised smokers provided advice and help
to quit by 30/06/2014
Clinical Lead:
Stephen Child
Programme Sponsor:
Margaret Dotchin
Programme Manager Acting: Karen Stevens Steering Group:
Di Roud, Anna Schofield, Maggie O’Brien, Stephen Child, Rachel Mattison, Paul Bohmer, Arun
Kulkarni, Kristine Nicol, Anne‐Marie Pickering,
Karen Stevens, Kara Hamilton, Steven Stewart, Maree Wilton, Lisa
Croft, Alberto Bonini, Shalom Okesene, Graham Rivers, Jude Sprott, Berdie
Milner, Dominica
Horton, Pam Hewlett, Carol Ennis, Sangita
Shah, Denise Takinui, Matt Fribbens, Maxine Stead, Peter Ruygrok, George Laking.Achievements :ADHB achieved overall status of 95% in the 3 months July 2013 to
end
September 2013 inclusive. Better help for smokers -% of hospitalised smokers provided advice
and help to quit, Actual vs Target, Jan 2013-Jun 2014 and % of Maori hospitalized smokers offered advice and support to quit
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan-
2013
Feb
-201
3
Mar
-201
3
Apr
-201
3
May
-201
3
Jun-
2013
Jul-2
013
Aug
-201
3
Sep
-201
3
Oct
-201
3
Nov
-201
3
Dec
-201
3
Jan-
2014
Feb
-201
4
Mar
-201
4
Apr
-201
4
May
-201
4
Jun-
2014
Actual Goal M OH Target Actual - M aori
33
Project: Cardiac Bypass SurgeryPrimary Objectives: To enable timely access to cardiac bypass surgery the waiting list should be no greater than 101.
To support the national cardiac bypass intervention target, 1009 bypasses should be completed in 2013/2014Date of Delivery: 30 June 2014Clinical Lead: Peter RuygrokProject Sponsor: Peter LowrySteering Group: Paget Milsom, Andrew McKee, Peter Ruygrok, Elizabeth Shaw, Wendy Hoskin
Completed Improvement Activities:
Initiated pre‐admit process
Developed detailed operational reporting
Approved business case for CVICU bed capacity
Built capacity planning model for CVICU and Ward 42
Implemented enhanced recovery pathway in ICU
Releasing time to care foundation modules and Level 2
modules
CVICU\HDU merger
Business case approved across the service for the staffing of the
4th
theatre
Rapid Rounds ward 42
Elective pathway process established
Production planning process established
CPR surgical outcome database implemented
New electronic referral system implemented for national
urgency scoring tool
MOS ward meeting 31
Acute predict database implemented
Direct treatment cost project – savings being realised
.
Cardiology MOS system in place
Further improvements in progress:
Delay to discharge – ward 42 & CVICUTo reduce LOS for patients who are delayed during the discharge
process, reducing theatre cancellations• Surgical site infection reduction project• MOS system
To make use of the MOS system in an operational setting . This
will facilitate the use of data to make effective meetings
as well as assisting the service to determine its strategic
direction and scope of improvement work• EP service improvement project
This piece of work is aimed at getting the wait list for this service
under control through a critical review of process as well
as accurately measuring demand and capacity• Meals module RTC• Cardiac Monitoring project ward 31
Monthly PerformanceProduction during the month of October delivered 74 eligible BP procedures against a plan of 83. Due to lower than
anticipated eligible demand the capacity of the service was redirected to deliver 11 BP procedures to Midland and
Tahitian patients as well as completing 56 thoracic cases (against a plan of 42). Although the service is behind the
planned intervention rate the wait list has been reduced to 45 patients. Looking at the November to December 2012
period the service received on average 26 eligible BP referrals a week. Historically these high referral months
combined with a reduction in production capacity has caused the service to have a non compliant wait list through
January. Coming into this period with a low wait list will help
the service to prevent this scenario happening again.
ESPI performance remains positive with the service having maintained a wait list with zero patients waiting longer
than 4 months throughout the entire financial year so far. The service continues to recruit up to the approved models
of care in CVICU and ward 42.
Reduce Cardiac Waiting List, Actual vs Target, Jan 2012 - Jun 2014
0
20
40
60
80
100
120
Jan-
2013
Feb
-201
3
Mar
-201
3
Apr
-201
3
May
-201
3
Jun-
2013
Jul-2
013
Aug
-201
3
Sep
-201
3
Oct
-201
3
Nov
-201
3
Dec
-201
3
Jan-
2014
Feb
-201
4
Mar
-201
4
Apr
-201
4
May
-201
4
Jun-
2014
Actual Goal M OH Target
34
Project:
More Heart and Diabetes Checks
Primary Objectives: Increase the percentage of people in the eligible population group have a CVD risk assessment every 5 years
Date of Delivery: Overall goal is : 90% of eligible enrolled population will have had a cardiovascular risk assessment within the last five years by June 14.
Planning and Funding Manager: Carolyn Jones
Project Sponsor: Simon Bowen
Steering Group: Primary Care Clinical Advisory Team
Past activities:Previous goals of 60% of eligible enrolled population
screened by June 2012 and 75% screened by June
2013 have been achieved.
ADHB funds the license for an electronic clinical
decision support tool with Enigma. This is available for
all ADHB PHOs
(although is currently only actively
utilised by Auckland PHO and Procare).
Recent and Current activities:•New contracts for the 2013/14 year have been sent
to the PHOs
with a performance based focus, along
with some systems support funding . These will be
aligned with WDHB after June 2014.•Workplace CVDRA are being explored working with
CMDHB. •A proposal to offer free staff CVDRA screening in
2014 is in draft .•Acute Predict is in place in the cardiology wards and
it is envisaged that the licence to send the CVD risk
assessments back to primary care will be in place
shortly therefore these will be able to be captured. •Scoping for placement of Acute Predict in other
services is being done , namely the mental health
inpatient unit and the Diabetes Centre
Project Risks / Comments:•Auckland DHB has had some challenges collecting data for CVDRA.
Weekly extracts are sent to ADHB by the PHOs
which do not include some historical risk assessments and
some risk assessments which are recorded in other PMS systems. Therefore the weekly numbers are used as a guide only to see which trajectory ADHB ‘s performance is on. The
weekly numbers are estimated to be at least 8% lower than the monthly accurate (CPI) extract‐
when comparing with the monthly numbers.•The target for June 2014 is 90% of all eligible enrolled patients will have had a cardiovascular risk screen recorded within the
last 5 years. The target from the MOH is a
stepped target with the contract from the MOH stating a target of 75% (Jul‐
Sep) and 80%(Oct‐Dec) This increases to 90% from 01 January. In that respect we are on track with
quarter one results from the MOH showing that we are at 80%, currently third in the country. (CMDHB are on 80.6% and Wairarapa
are on 82%. ) •There is still a long way to go to reach 90% and the PHOs
are aware that there is a lot of work to do to achieve this target. Training nurses to do phlebotomy has been a big
push this year along with the support from the Long Term Condition Quality Coordinators who liaise with the PHOs
to identify poor performing practices and advise and
support all practices to ensure that they have a sustainable method of maintaining and improving the rate of CVDRA within practices in the future. 35
Project: Increased Immunisation Primary goal: That 85% of 8 months olds are fully immunised by July 2013 that 95% of 8 month olds are full immunised by December 2014. Date of Delivery: 1 July 2012 to 30 June 2013, and 1 July 2013 to 31 December 2014 Clinical Lead: Richard Aickin Project Sponsor: Richard Aickin Steering Group: Richard Aickin, Ruth Bijl, Leani Sandford, Lenka Robinson, Alison Leversha, IMAC, Auckland PHO, Public Health, Plunket, Commissioner for Children Office, Ministry of Health
• Activities1) review of immunisation guidelines to focus on
early engagement with parents
2) an online questionnaire looking at what assisted parents to immunise their child on time & what would have helped those who did not immunise on time
3) a joint RFP with WDHB for Outreach Immunisation and National Immunisation Register (NIR) Administration services, with the aim to improve co-ordination of services, improve coverage rates, minimise duplication of activity and, where possible, achieve cost savings.
4) Education sessions for Practice Nurses were held in November – the focus was newborn enrolment and PCV vaccine
5) Particular focus on GP practices with high Maori enrolment but low Maori coverage – one on one assistance is provided to promote recommended pre call and re call processes and clean data
6) A DVD to dispel common immunisation myths is being produced in partnership with IMAC for use with health professionals.
7) DVD launched as a resource at various forums and made available to health professionals. Key messages included clinical importance of on-time immunisation, premature infants, mild illnesses and pneumococcal vaccine myths.
Project Risks / Comments:ADHB's
coverage for target population at 30 September 2013 exceeded the 90% annual target by 4%. Maori immunisation rate at 8 months was 89%, Pacific 94%, Asian 97%, Other 91% and NZE 94%. Maori
coverage has increased significantly in the last quarter.Note: Data reported quarterly.
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5.3 Financial and Operational Performance
37
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Financial Performance Consolidated Statement of Financial Performance - October 2013
Provider Month YTD $000s Actual Budget Variance Actual Budget Variance
Income Government and Crown Agency sourced
7,044 6,471 574 F 27,828 26,539 1,289 F
Non-Government & Crown Agency Sourced
9,068 6,506 2,563 F 30,378 26,017 4,361 F
Inter-DHB & Internal Revenue 1,169 1,315 (146) U 5,089 5,389 (300) U
Internal Alloc DHB Provider 93,398 93,450 (53) U 376,500 376,574 (74) U
110,679 107,742 2,938 F 439,796 434,520 5,276 F Expenditure
Employee Costs 66,998 64,849 (2,149) U 261,550 258,337 (3,212) U
Outsourced Staff 1,611 1,480 (130) U 7,115 5,938 (1,177) U
Outsourced Clinical Services 2,327 2,014 (314) U 8,876 8,112 (764) U
Outsourced Other 3,128 2,952 (177) U 12,501 11,807 (694) U
Clinical Supplies 20,906 19,405 (1,501) U 79,998 78,180 (1,818) U Infrastructure & Non-Clinical Supplies
14,635 14,723 88 F 60,628 59,210 (1,418) U
Internal Allocations 874 874 () U 3,509 3,497 (12) U
Total Expenditure 110,480 106,297 (4,184) U 434,177 425,083 (9,095) U
Net Surplus / (Deficit) 199 1,445 (1,246) U 5,618 9,437 (3,819) U
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Consolidated Statement of Financial Performance - October 2013 Performance Summary by HSG
Provider Variance Month
Variance FTE
Month Variance
YTD Variance
FTE YTD
$000s $000’s # $000’s # Adult Health (1,380) U (34) U (1,319) U (32) U
Women's Health & Genetics (53) U (13) U (703) U (17) U
Child Health (766) U 9 F (1,510) U 9 F
Cardiac Services (23) U 15 F (362) U 21 F
Operations 393 F 7 F (177) U 11 F
Perioperative Services (511) U 33 F (699) U 31 F
Cancer & Blood Services 46 F 1 F 171 F 3 F
ACH Others 2 F 0 F 7 F 0 F
Mental Health 243 F 6 F (381) U 2 F
Ancillary Services 802 F 12 F 1,154 F 1 F
TOTAL (1,246) U 35 F (3,819) U 28 F
Consolidated Statement of Personnel By Professional Group - October 2013
Provider Actual
FTE Month
Variance FTE
Month Variance
Month
Actual FTE YTD
Variance FTE YTD
Variance YTD
# # $000’s # # $000’s
Medical Personnel 1,290 (17) U (1,216) U 1,281 (8) U (2,057) U
Nursing Personnel 3,360 27 F (700) U 3,362 28 F (1,263) U
Allied Health Personnel 1,759 26 F (374) U 1,745 38 F (68) U
Support Personnel 325 (10) U (58) U 323 (8) U (187) U
Management/ Administration Personnel
1,102 78 F 199 F 1,112 69 F 363 F
Total (before Outsourced Staff) 7,838 103 F (2,149) U 7,822 119 F (3,212) U
Outsourced staff 101 (69) U (130) U 123 (90) U (1,177) U
Total 7,939 35 F (2,280) U 7,945 28 F (4,389) U
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Month Result The Provider arm result for the month is $1.2M unfavourable. Total revenue is $2.9M favourable, driven by Research revenue $1.3M favourable
(partially offset by additional expenditure), Non Resident income $0.5M favourable (variable month to month, YTD $0.5M favourable) and a backdated washup for CTA revenue ($0.5M upside to budget).
Total expenditure is $4.2M unfavourable, driven by Personnel Costs $2.1M and Clinical Supplies $1.5M. Key drivers for Personnel Costs:
o Medical $1.2M comprising Registrars and House Officers 37 FTE over budget, and saving assumptions around average cost per FTE not being met
o Nursing $0.7M (3.2%) unfavourable, versus FTE 27 (0.7%) favourable – this is partly due to average cost per FTE assumptions not being met. In addition, with an annual budget of $263M small variations in phasing create a material variance - the year to date position is $1.3M (1.4%) unfavourable and is a more accurate reflection of the underlying variance due to average cost per FTE assumptions not being met.
YTD Result The YTD result is $3.8M unfavourable to budget. Overall volumes were reported at 98.5% of base contract, but the latest estimate based on up to date coding is now 99.1%. The bottom line unfavourable result is primarily driven by expenditure beyond budget. Comment on Key YTD Variances Revenue Provider arm revenue is $5.3M (1.2%) favourable for the YTD. The major variances are for non patient care revenue streams, as follows: Financial instrument revaluation $1.2M favourable – resulting from the increase in the
ten year bond rates. Donation income $1.1M unfavourable – a timing issue, with funding for major projects
being received as the projects are completed. CTA Revenue $1.1M favourable – backdated washup for the current contract term
agreed with HWFNZ Retail Revenue $0.6M favourable – partially offset by unfavourable cost of sales in
Infrastructure & Non Clinical Supplies costs. Non Resident Income $0.5M favourable – varies from month to month Research grants $2.2M favourable – partially offset by additional costs of $1.1M (spread
widely over expenditure categories) Other revenue streams are close to budget. Expenditure Provider arm expenditure is $9.1M (2.1%) unfavourable for the YTD, with the key variances being:
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Personnel Costs $3.2M (1.2%) unfavourable – primarily due to savings targets not met ($1.7M), particularly around cost per FTE in Medical and Nursing, as well as Medical FTE over budget for Registrars and House Officers (YTD 30 FTE over budget) .
Outsourced Services $2.6M (10.2%) unfavourable – hA IT costs $0.7M (timing - expected to meet budget for the year), LabPlus delay in planned repatriation of sendaway tests $0.4M (work programme now underway for repatriation of tests), Radiology CT/MRI $0.3M (savings dependent on implementing MRI and CT business cases), Outsourced Medical Personnel costs $0.8M – for costs of locums and cover, budget held under Personnel Costs – the use of all flexible staffing such as contractors, overtime and locums is under review.
Clinical Supplies $1.8M (2.3%) unfavourable – PCTs $0.3M unfavourable (subject to washup for IDF component), with the balance due to savings targets not achieved.
Infrastructure and Non Clinical Supplies $1.4M (2.4%) - Consultants Fees $1.0M covering a range of ‘invest to save’ projects including Clinical Engineering, sustainability review, risk management review, linen utilisation and a number of commercial contract reviews (these projects will deliver ongoing savings) and cost of sales for the additional Retail revenue $0.5M.
The mitigation strategies to improve the unfavourable YTD bottom line result and to bring the Provider to budget by year end are: Close management of staffing levels including usage of overtime, bureau, and other
outsourced staff Review of consultancy usage – this has highlighted a number of opportunities which are
being acted on Recruitment/vacancy management - all requests for replacement of FTE are reviewed
weekly by a senior management committee and alternative roles or skill-mix are considered
Management of annual leave and sick leave Review of high earning individuals Tight management of all discretionary expenditure Matching output to Funding levels. In 2012/13 the ADHB provider completed over $10M
worth of work that wasn’t paid for by funders. To prevent reoccurrence a quarterly review cycle will be implemented with key funders, ADHB & WDHB, to implement strategies to address this.
FTE Total September FTE at 7,939 are 35 below budget and 16 below last month.
Unfavourable variances are in Medical (21 above budget including outsourced FTE - due to Registrars and House Officer above budget) and Support (10 above budget, primarily in Orderlies and Kitchen Staff – note both of these services are favourable to bottom line budget).
13/14 Savings Programme The approved 2013/14 DAP and specifically Provider Arm savings of $59.9M is categorised as either Business as Usual savings ($25.4M) and Business Transformation savings ($34.5M). For HAC only business transformation is reported in this paper.
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Business Transformation Initiatives – progress update $8.3M savings reported for the period October year to date against budget of $8.5M resulting in an unfavourable variance of $185kU (last month $415kU).
The improvement from last month is mainly attributed to other savings (Adult, Womens, Childrens, Ancillary) that form part of an overall mitigation strategy adopted by services to help offset savings initiatives that are either not proceeding, not yet been implemented or expected savings are not being achieved. Key points; There is a steady upward trend since July (see table below).
July ($000’s) Aug ($000’s) Sept ($000’s) Oct ($000’s)
$1,252 $1,812 $2,513 $2,710
healthAlliance savings continues to track favourably against budget. healthAlliance continue to upgrade their 13/14 programme as new contracts and prices continue to be re-negotiated.
Adult - Reduce orthopaedic elective outsourcing – better than budget savings continues to be realised with a favourable variance of $281k. The service is expecting to achieve budget savings ($1.7M) from this initiative.
Womens - MOC review $184k favourable against budget. The FTE year to date savings are being realised plus other savings from Increased non-resident and fertility revenue within obstetrics has contributed to the better than budget result for October.
A number of initiatives are being addressed and savings have not been fully realised. These include; MOC for Gynae & Obstetrics, Change in Junior Doctor MOC, Reduction in Outpatient follow-ups. The Pharmacy utilisation work-stream is underway with savings expected to be realised in the months ahead. The clinical supplies which is to manage dispensing and stock control in wards is underway but due to the complexity of patient needs, savings are not being reported. Similar issues with the blood product project where no savings are reported in October. The service expect to offset some of the shortfall with private patient revenue.
Cardiac – favourable variance against budget with savings reported from cost/productivity efficiencies.
Mental Health - Review of model of care $141k unfavourable against budget. There are some timing factors but the service is expecting to meet its total target ($1.3M).
Ancillary Services - Infrastructure cost containment strategies is unfavourable against budget by $162k. Some initiatives are reporting additional savings (interest, retail and carpark revenue). While there are some timing factors in realization of savings the service expects to deliver against target.
Provider services - Revenue maximisation strategies. Better than budget non-resident and research/clinical trial revenue has resulted in a favourable variance of $121k.
Perioperative & Adult Services - Standardisation of clinical supplies/implants $59k favourable against budget.
Adult Acute Patient flow. $106k favourable against budget mainly attributed to other savings from the service to offset the acute patient flow initiative (budget $1.8M) which is not proceeding. The service will continue to bridge the gap with other savings opportunities (eg training revenue, non-residential price increase and other non-clinical infrastructure costs).
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Childrens Paediatric services review. $149k favourable against budget. Savings are being reported with FTEs being held below the reduced budget and savings reported above budget. The Paediatric tertiary service review/redesign to align with service specifications and funding. This will result in changes to billings for outsourced clinics to be implemented by Jan 14. ADHB population service redesign will result in closure of beds from October onwards. Paediatric out-sourcing is being maintained within existing budget by managing volumes in-house with better than budget savings reported to date. Vacancy savings is a key focus with an over-supply of Registrars and House Officers.
All Operational Services Reduce outpatient follow up activity – unfavourable variance $592k. Each service is undertaking an individual approach to managing outpatient activity. Some services report minor savings to date ($75k) and where shortfalls are forecast, the service is expected to bridge the gap with mitigation strategies.
All Operational Services Pharmacy utilisation project – unfavourable variance $252k. The gap is mainly due to minor savings reported in July and August. With enhanced reporting savings in pharmacy are now being recognised. Services forecast to be close to budget ($3.3M) and any shortfall will be mitigated with other savings.
All Operational Services Blood products project. Achieved savings against budget. Similar to the Pharmacy utilization project enhanced reporting in blood usage has resulted in savings being recognised. Services forecast to be close to budget and any shortfall will be mitigated with other savings.
Table 1: Business Transformation Savings October YTD ($000’s)
Key Actions Actual YTD
Budget YTD Var.
hA Regional Shared Service Initiatives 372 321 51
Adult Reduce Orthopaedics elective outsourcing 848 567 281
Womens MOC in delivery of Gynae&Obstetric services 485 301 184
Cardiac cost improvement and productivity efficiencies 886 886 ‐0
Mental Health Review MOC, skill mix and employee costs 0 141 ‐141
Ancillary/All Operations Infrastructure cost and revenue initiatives 856 1,018 ‐162
All Operations Revenue maximisation initiatives 1,520 1,399 121
Adult/Perioperative Standardisation of clinical supplies, implants 666 607 59
Adult Acute Patient Flow 320 214 106
Paediatric services review and redesign 1,169 1,020 149
Al Operations Reduce Outpatient follow‐up activity 75 667 ‐592
All Operations Concord Pharmacy Utilisation 748 1,000 ‐252
All Operations Concord blood products project further savings 344 334 10
Total $8,288 $8,473 ‐$185
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Volume Performance
1) Combined DRG and Non-DRG Activity (All DHBs) October 2013 Year to Date
$000s $000sHSG Service Cont Act Var Prog % Cont Act Var Prog %
AED, APU, DCCM, Air Ambulance 1,730 1,795 66 103.8% 6,767 7,071 305 104.5%Ambulatory Health Services 3,046 2,918 -128 95.8% 12,129 11,853 -276 97.7%Gen Med, A+ Links, ID, NASC 7,878 7,024 -854 89.2% 32,620 30,703 -1,917 94.1%Gen Surg, Trauma, Gastro, Resp 7,720 7,504 -216 97.2% 31,781 31,295 -486 98.5%Ophthalmology 2,654 2,845 191 107.2% 10,244 10,642 398 103.9%Orthopaedics Adult 4,405 3,935 -469 89.3% 17,481 15,471 -2,010 88.5%Rehab Plus 622 622 0 100.0% 2,488 2,488 0 100.0%Trans, Renal, Uro, ORL, Neuro 10,020 10,614 594 105.9% 41,220 42,333 1,113 102.7%
38,074 37,258 -816 97.9% 154,729 151,856 -2,873 98.1%
Cancer & Blood Service 7,599 7,510 -89 98.8% 30,651 30,259 -392 98.7%
Cardiac Service 10,627 10,694 66 100.6% 42,365 42,245 -120 99.7%
Child Health & Disability 652 652 0 100.0% 2,609 2,609 0 100.0%Medical & Community services 5,958 5,864 -95 98.4% 25,444 25,133 -311 98.8%Paediatric Cardiac & ICU's 3,627 2,959 -667 81.6% 14,618 13,244 -1,375 90.6%Surgical & Community services 4,977 4,479 -498 90.0% 19,085 18,225 -859 95.5%
15,215 13,954 -1,261 91.7% 61,756 59,211 -2,545 95.9%
Genetics 220 207 -13 94.1% 862 900 37 104.3%Womens Health 6,833 6,227 -606 91.1% 26,639 26,790 151 100.6%
7,054 6,435 -619 91.2% 27,501 27,689 188 100.7%
GCC, PAS, Elective, Interp 47 47 0 100.0% 188 188 0 100.0%
Operations 1,818 1,937 119 106.5% 7,220 7,757 538 107.4%
1,865 1,984 119 106.4% 7,407 7,945 538 107.3%
Mental Health & Addictions 43 43 0 100.0% 174 174 0 100.0%
Maori Health services 68 68 0 100.0% 273 273 0 100.0%
Pacific Health Services 32 32 0 100.0% 129 129 0 100.0%
The Auckland Regional Public Health Service 127 127 0 100.0% 509 509 0 100.0%
Funder 5,171 5,208 37 100.7% 20,683 20,835 152 100.7%
85,877 83,314 -2,564 97.0% 346,178 341,127 -5,051 98.5%
Children's Health Service
Women's Health Service
Women's Health Service Total
Children's Health Service Total
Adult Health Service
Adult Health Service Total
Operations and Clinical Support
Operations and Clinical Support Total
Grand Total
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2) Caseweight Activity for the YTD October 2013 (All DHBs)
HSG Service Con Act Var Con Act Var Prog % Con Act Var Con Act Var Prog % Con Act Var Con Act Var Prog %AED, APU, DCCM, Air Ambulance
963 1,044 80 4,485 4,859 374 108.3% 0 0 0 0 0 0 0.0% 963 1,044 80 4,485 4,859 374 108.3%
Ambulatory Health Services
330 338 8 1,538 1,573 35 102.3% 392 395 3 1,824 1,838 15 100.8% 722 733 11 3,361 3,411 50 101.5%
Gen Med, A+ Links, ID, NASC
3,930 3,536 -394 18,296 16,462 -1,834 90.0% 0 0 0 0 0 0 0.0% 3,930 3,536 -394 18,296 16,462 -1,834 90.0%
Gen Surg, Trauma, Gastro, Resp
3,798 3,667 -131 17,684 17,073 -610 96.5% 1,539 1,425 -114 7,166 6,633 -533 92.6% 5,338 5,092 -246 24,850 23,707 -1,143 95.4%
Ophthalmology 241 274 33 1,124 1,276 152 113.6% 1,110 1,011 -99 5,166 4,704 -461 91.1% 1,351 1,285 -66 6,289 5,980 -309 95.1%
Orthopaedics Adult 1,838 1,771 -67 8,556 8,243 -313 96.3% 1,593 1,139 -454 7,415 5,303 -2,112 71.5% 3,431 2,910 -521 15,971 13,547 -2,424 84.8%Trans, Renal, Uro, ORL, Neuro
3,601 3,777 176 16,764 17,583 819 104.9% 2,084 2,042 -42 9,700 9,506 -194 98.0% 5,685 5,819 134 26,464 27,089 625 102.4%
Adult Health Service Total 14,703 14,407 -296 68,446 67,070 -1,377 98.0% 6,717 6,011 -706 31,271 27,986 -3,285 89.5% 21,420 20,418 -1,001 99,717 95,056 -4,662 95.3%
Cancer & Bl Cancer and Blood services
2,062 1,893 -169 9,600 8,814 -786 91.8% 0 0 0 0 0 0 0.0% 2,062 1,893 -169 9,600 8,814 -786 91.8%
Cardiac ServCardiac Services 5,073 5,171 98 23,617 24,071 454 101.9% 3,328 3,080 -248 15,492 14,337 -1,155 92.5% 8,401 8,250 -150 39,109 38,408 -700 98.2%
Medical & Community services
3,750 3,560 -190 17,458 16,574 -884 94.9% 0 0 0 0 0 0 0.0% 3,750 3,560 -190 17,458 16,574 -884 94.9%
Paediatric Cardiac & ICU's
2,003 1,925 -77 9,323 8,964 -359 96.1% 844 661 -183 3,930 3,077 -852 78.3% 2,847 2,587 -260 13,253 12,041 -1,212 90.9%
Surgical & Community services
1,950 1,760 -190 9,079 8,194 -885 90.2% 1,620 1,526 -94 7,541 7,102 -439 94.2% 3,570 3,286 -284 16,620 15,296 -1,324 92.0%
Children's Health Service Total 7,703 7,246 -457 35,860 33,732 -2,129 94.1% 2,464 2,187 -277 11,471 10,180 -1,292 88.7% 10,167 9,432 -735 47,331 43,911 -3,420 92.8%
Women's HeWomens Health 3,265 3,338 73 15,201 15,541 340 102.2% 760 662 -98 3,538 3,084 -454 87.2% 4,025 4,001 -25 18,739 18,624 -114 99.4%
Grand Total 32,806 32,055 -751 152,725 149,228 -3,497 97.7% 13,269 11,940 -1,329 61,772 55,587 -6,185 90.0% 46,074 43,995 -2,080 214,496 204,814 -9,682 95.5%
$000s Case Weighted Volume $000s
Adult Health Service
Children's Health Service
Case Weighted Volume$000s
TotalElectiveAcuteCase Weighted
Volume
In light of the significantly lower WIES than last year there has been a lot of investigation into the impact of the WIES model. The WIES model changed boundaries significantly. Initial indications were that the impact would be a slightly higher level of WIES for ADHB. However, this has not occurred. The lower than expected WIES is due to a number of factors: While the number of cases over 10 WIES have increased, the average WIES for those cases has decreased by 8% A reduction in LOS (12,000 days or 8% for the first 4 months of the year), is leading to more cases discharged as low outliers and consequently
getting lower WIES. Fewer cases where the WIES has been increased, eg haematology, and more surgical discharges where it had been decreased. Acute
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YTD 97.7% of contract - There has been a 2.7% increase in acute discharges compared to the first four months of last year but a 3.3% decrease in average WIES, giving an overall 0.7% decrease in WIES/revenue compared to the same period last year. This is again up on last month reflecting a higher complexity. Acute medical discharges are 102% of last year but with an average length of stay 8% lower and average WIES 4.5% lower Acute surgical discharges are up 9.8% on last year but with an average length of stay 12% lower and average WIES 8% lower Acute obstetric/newborn discharges are down 4% but with an average length of stay 7% higher and an average WIES 2% higher. This is due to
complex neonates (41 discharges over 10 WIES, compared to 28 over the same period last year) Elective YTD 90.0% of contract - There has been a further deterioration against contract, although the discharges are 3.4% higher than the same period last year, with a 2.5% decrease in average WIES. There is an increase in throughput from last month, although a worsening contractual position, which is partly due to high contract phasing in the first part of the year.
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3) Non-DRG Activity (ALL DHBs)
October 2013 Year to Date$000s $000s
HSG Service Cont Act Var Prog % Cont Act Var Prog %AED, APU, DCCM, Air Ambulance 575 566 -9 98.4% 2,282 2,212 -70 97.0%Ambulatory Health Services 2,219 2,061 -158 92.9% 8,767 8,442 -325 96.3%Gen Med, A+ Links, ID, NASC 3,600 3,387 -214 94.1% 14,323 14,241 -82 99.4%Gen Surg, Trauma, Gastro, Resp 1,754 1,913 159 109.1% 6,932 7,588 657 109.5%Ophthalmology 1,003 1,278 274 127.3% 3,955 4,662 707 117.9%Orthopaedics Adult 383 527 144 137.6% 1,510 1,924 414 127.4%Rehab Plus 622 622 0 100.0% 2,488 2,488 0 100.0%Trans, Renal, Uro, ORL, Neuro 3,718 3,867 149 104.0% 14,756 15,244 488 103.3%
13,874 14,220 345 102.5% 55,012 56,801 1,788 103.3%
Cancer & Blood Service 5,307 5,495 187 103.5% 21,050 21,444 394 101.9%
Cardiac Service 822 952 130 115.9% 3,256 3,836 580 117.8%
Child Health & Disability 652 652 0 100.0% 2,609 2,609 0 100.0%Medical & Community services 2,017 2,098 82 104.0% 7,986 8,559 573 107.2%Paediatric Cardiac & ICU's 346 282 -64 81.6% 1,365 1,202 -163 88.1%Surgical & Community services 625 679 54 108.7% 2,464 2,930 465 118.9%
3,640 3,712 72 102.0% 14,424 15,300 876 106.1%
Genetics 220 207 -13 94.1% 862 900 37 104.3%Womens Health 2,000 1,915 -85 95.7% 7,900 8,165 265 103.4%
2,221 2,123 -98 95.6% 8,762 9,065 303 103.5%
GCC, PAS, Elective, Interp 47 47 0 100.0% 188 188 0 100.0%Operations 1,818 1,937 119 106.5% 7,220 7,757 538 107.4%
1,865 1,984 119 106.4% 7,407 7,945 538 107.3%
Mental Health & Addictions 43 43 0 100.0% 174 174 0 100.0%
Maori Health services 68 68 0 100.0% 273 273 0 100.0%
Pacific Health Services 32 32 0 100.0% 129 129 0 100.0%
The Auckland Regional Public Health Service 127 127 0 100.0% 509 509 0 100.0%
Funder 5,171 5,208 37 100.7% 20,683 20,835 152 100.7%
33,171 33,964 792 102.4% 131,682 136,313 4,631 103.5%
Children's Health Service
Children's Health Service Total
Women's Health Service
Women's Health Service Total
Grand Total
Operations and Clinical Support
Operations and Clinical Support Total
Adult Health Service
Adult Health Service Total
There is a new price volume schedule in place for October reporting which reflects changes
requested in the last quarter by other DHB funders. Overdelivery to contract is unchanged at 103.5% of plan, equating to $4.Mm over contract. Non DRG over delivery will not be funded other than IDF Renal and Oncology (Adult and Paediatric). Key areas over contract are:
o Follow Ups are now $2.4M over (representing 52% of the over delivery (up from 48% last month). This is partly due to reduced follow up volumes from WDHB: Cardiology – ($307k, up from $231k last month). The service is reviewing whether
pacemaker checks can be reduced to minimise the over performance General surgery ($388k) – up nearly 7% on last year at the same period (note WIES
discharges are up 4%). If the service is to achieve a reduction in follow ups as per the contract, then a different model of care may be required for post discharge management of patients.
Ophthalmology - $318k – while the change in acute management has now been adjusted in the PVS, over delivery has increased at a higher rate.
Vascular - $83k – a 22% reduction in contract compared to last year’s contract and actual.
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Adult and paediatric Orthopaedics - $681k due to an IT based volume counting issue
– underlying over delivery is much lower than this (minimal) o FSAs $0.4M – a drop in over delivery from last month which is likely to have been caused by
an increased budget.
o Other volumes ($1.9M):
Laboratories are contributing $578k to the over delivery. The contract has now been reduced, so part of the over delivery is due to reduced budget. The service is working on a pricing review and looking at further volume reductions.
Fertility – currently $212k over contract. This service has not had any material funding increase in 6 years and each year has to reduce access to meet contract.
The requirement for access to scopes for both diagnostic and therapeutic purposes is also increasing above population levels, particularly colonoscopy for bowel cancer patients. This is contributing $128k towards the over delivery.
Cancer treatment for adults and paediatrics is $231k over contract for Radiotherapy and $138k over for Chemotherapy.
Offsetting this is under delivery in renal dialysis modalities of $118k.
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6
HEALTH SERVICES GROUP UPDATES
Children’s Health Services Group
Regional Cancer & Blood Health
Services Group
Mental Health & Addictions Health
Services Group
Cardiovascular Health Services Group
Operational & Clinical Support Services
Group
Adult Health Services Group
Women’s Health Services Group
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Starship and Child Health Service Group Speaker: Emma Maddren, General Manager Clinical Services ‐ Starship and Child Health.
Service Overview Starship Children's Health is a dedicated paediatric healthcare service and major teaching centre,
providing family centred care to children and young people throughout New Zealand and the South
Pacific. Care is provided for children up to their 15th birthday. A comprehensive range of services are
provided; Newborn, Cardiac Inherited Diseases, Developmental Paediatrics, General Paediatrics,
Audiology, Anaesthesia, Paediatric and Congenital Cardiac Service, Child Consult Liaison Psychiatry,
Community Child Health & Disability Service, Dermatology, Diabetes and Endocrinology, Emergency, ENT,
ORL, Family Information Service, Family Options, Gastroenterology & Hepatology,
Haematology/Oncology, Home care, Immunology and Allergy, Infectious Diseases Service, Intensive Care
Unit (PICU), Metabolic Service, Nephrology, Neurosurgery, Orthopaedics, Palliative Care, Respiratory
Services, Rheumatology, Spine Service, Surgery and Urology, Te Puaruruhau (Child Protection). The leadership team is; Emma Maddren, General Manager, Richard Aickin, Medical Director and Sarah Little, Nurse Director.
Scorecard Oct-13 Measure Target
Central line associated bacteraemia rate per 1,000 central line days 0 0 3.85%
% Hand hygiene compliance 71% 80% 71%
Adverse events causing harm (SAC 1&2) per 1,000 bed days 0 0 0
MOH‐01 % all patients with ED stay < 6 hours 97.1% 95% 97.0%
(ESPI‐2) Patients waiting longer than 5 months for their FSA 0 0 0
HT2 Elective discharges cumulative variance from target 105.62% 0% 101.17%
(ESPI‐5) Patients given a commitment to treatment but not treated within 5 months 1.9% 0 1.7%
% DNA rate for outpatient appointments 10.0% 9% 10.0%
Elective day of surgery admission (DOSA) rate 52% 68% 45%
% Day Surgery Rate 66% 70% 65%
Inhouse Elective WIES through theatre ‐ per day 22.52 TBC 23.53
Customer Experience ‐ Inpatient Survey/Child & Family Satisfaction 78.4% 90% 77.6%
Customer satisfaction ‐ new complaints 3 TBC 3
28 Day Readmission Rate ‐ Total 8.4% 10% 8.9%
% adjusted theatre utilisation 75% 80% 78%
Average length of stay for WIES funded discharges (days) 2.27 <2.5 days 2.22
0.96 <1.5 days 0.88
P&L ‐ YTD Variance ‐ $000 $1,519 U 0 $744 U
Business Improvement Savings - YTD variance - $000 $231k F 0 $360 U
FTE Employed/Contracted ‐ Month Variance 9.14 F 0 9.0 F
Immunisation at 8 months 94% 85% 94%
Family Violence screening 40% 40% 40%
Excess annual leave ‐ Percentage of staff 9.3% 6% 10.4%
Excess annual leave ‐ $ 0.2M 0.04M
Staff turnover (% of voluntary turnover, annually) 10.5% 10% 9.7%
Staff turnover (% of voluntary turnover, <1 yr tenure) 6.9% 6% 8.3%
Actual Prev Period
Increased
Patient Safety
Better Quality Care
Improved
Health
Status
Engaged
Workforce
Economic
Sustainability
53
Scorecard Commentary
Health Targets Shorter Stays in ED performance against the target was 97% for the month.
Immunisation of 8 month olds performance against target was 94% for October (against an annual target of 90%). 90% of Maori babies and 96% of Pacific babies are fully immunised at this stage. There has been a steady but significant increase over the October period in both Maori and Pacific rates of immunisation, Maori by 1% and Pacific by 3%. Access to elective surgery continues to be actively managed. Child Health achieved the ESPI 2 (time to FSA) target and was moderately non‐compliant with the ESPI 5 (time to surgery) target. 12 children (1.5%) waited longer than five months for surgery.
Increased Patient Safety Hand hygiene performance remains at 71%. The next update on this target will be in December. An improvement campaign was launched in October with active clinical leadership and involvement.
Central Line Associated Bacteraemia (CLAB) events – There were no CLAB events in October. It has been 38 days since the last CLAB event.
Better Quality Care There were three new complaints received in October. The predominant theme around these complaints relates to the timeliness of services provided and the communication with patients and their family about their care. The leadership team are working with our staff to reinforce the importance of communication.
O ct-13
S ep-1
3
A u g- 13
Jul- 1
3
Jun- 1
3
M ay -13
A p r -13
M a r-13
F eb- 1
3
Ja n- 13
D e c- 12
N ov -12
Oc t- 12
Sep- 12
A ug -12
Jul- 1
2
Jun- 1
2
M ay- 1
2
A pr - 12
M ar -12
F eb- 1
2
Jan- 1
2
D ec- 1
1
N ov - 11
O c t-11
Sep- 11
A ug- 11
Jul -1
1
20
18
16
14
12
10
8
6
4
2
0
M onth & Y ear
Num
ber
of C
ompl
aint
s
_X=7.25
U C L=19.07
P ro je ct : Un t it le d ; W o rksh e e t : W o rksh e e t 1 ; RP
Ne w Compla int s by Mont h
54
Improved Health Status
Immunisation coverage at 8 months – Coverage for October at eight months was 94% which is 4% above the 2013/14 target of 90%. The Maori rate is 90% and the Pacific rate 96%. There has been a steady but significant increase over the October period in both Maori and Pacific rates (Maori by 1% and Pacific by 3%).
Coverage at two years declined by 1% to 94%. The rate for Maori is 89% and 96% for Pacific. Regular meetings will continue with the immunisation coordinators to maintain an emphasis on Maori immunisation rates.
Rheumatic Fever prevention – This programme is jointly funded by the Ministry of Health and ADHB and managed through a Service Alliance between ADHB and the four ADHB PHOs. The Community Child Health and Disability Service has reconfigured its current work plan to provide public health nurses from existing resources. In addition to swabbing and treating sore throats, public health nurses and community health workers are identifying and treating skin infections and will be referring families to the Auckland Wide Healthy Homes Initiative (AWHHI) for assistance with housing related issues. ADHB is also being funded for the provision of a free and open access “rapid response” programme of sore throat management outside of school times and for Maori, Pacific and ‘quintile 5’ children and young people aged 4‐19 years who can’t access a school‐based sore throat programme. This programme began on 1 October and is also managed through the Sore Throat Swabbing Service Alliance. We are working with our PHO’s, and Waitemata and Counties Manukau colleagues in planning the roll out of this service. ADHB submitted a four year Rheumatic Fever Prevention Plan to the Ministry of Health in October. The plan outlines how the programme will be delivered over the next four years and details the staffing and other resourcing which will be provided by the DHB. ADHB is implementing a sore throat swabbing programme in 16 schools over 2013/14. At the end of October there were nine schools providing the service. A further two schools will begin providing the service in November. A formal community‐based launch of the throat swabbing and rapid response programmes was held at Ruapotaka Marae on 25 October. This event was well attended by school, community, health and political leaders as well as parents and staff involved in the programmes. B4SC ‐ Ministry of health data for October shows that ADHB is only 1% under the year to date target. This represents a significant improvement in performance.
Engaged Workforce
Staff turnover increased to 10.5%, just above the organisational target in October.
Employees with excess annual leave are currently 9.3% of the workforce. Active management of annual leave has continued in October. Leave plans for the Christmas and New Year period are being developed in November with an expectation that leave taken will align with service requirements during this period.
55
Family Violence Screening This remains below target, though continues to be an improvement on previous months. A Project Manager is in place with a focus on clearly defining the issues, which are preventing achievement in this area. A proposal for change in approach will be an outcome of the process.
Strategic initiatives
Deliverable / Action STATUS
Business Case for additional theatre capacity Complete √ √ √ √
Level 6 redevelopment Completed √ √
Immunisation rates On track √ √
Rheumatic fever project On Track √ √ √
Child Health Clinical Service Plan Planning √ √ √ √ √
Starship facility plan Planning √ √ √ √
Development of National Intestinal Failure Service Planning √ √ √ √ √
Improved communication with home DHBs of long stay patients Planning √ √ √ √
Reduction in Follow Up appointments Progressing √ √
Bed modelling and summer capacity On Track √ √ √
Repatriating outsourced sleep studies Planning √ √ √
Increased Patient Safety ‐ Better Quality Care ‐ Economic Sustainability ‐ Improved Health Status ‐ Engaged Workforce
Key achievements in the month:
Children and their families waiting for less time in Children’s ED.
Formal community‐based launch of the throat swabbing and rapid response programmes.
Areas off track and remedial plans: Reduction of follow ups ‐ Medical Speciality services have committed to addressing this
and are working through 2 project based approval
Key issues / initiatives identified in coming months
Continued roll out of the community‐based Throat Swabbing Clinics and Rapid Response Programmes.
Commencement of the Starship theatres improvement project which will increase theatre utility and access.
Commencement of the refurbishment of wards 24A and 24B. This will provide a much needed refresh of the décor and improvement in the hygiene on level four to improve the patient and family experience.
Working with Waitemata DHB to improve the quality of care for children through standardised clinical pathways and referral criteria.
56
Financial results STATEMENT OF FINANCIAL PERFORMANCEChild Health Services Reporting Date Oct-13
($000s) MONTH YEAR TO DATEActual Budget Variance Actual Budget Variance
REVENUEGovernment and Crown Agency 770 702 68 F 3,092 2,810 282 F
Other Income 17,386 17,637 251 U 1,135 U
183 U 853 U
369 U 835 U
1 U 137 U
243 U
565 U 695 U
748 U 1,548 U
18 U
766 U 1,510 U
12.2 U 9.9 U
0.2 U
2.9 U
70,452 71,587
Total Revenue 18,156 18,340 73,543 74,397
EXPENDITUREPersonnel Personnel Costs 9,333 8,964 36,573 35,737
Outsourced Personnel 125 124 633 496
Outsourced Clinical Services 213 235 22 F 904 940 36 F
Clinical Supplies 2,312 2,069 8,224 8,344 119 F
Infrastructure & Non-Clinical Supplies 254 281 27 F 1,003 1,126 122 F
Total Expenditure 12,237 11,673 47,337 46,643
Contribution 5,919 6,667 26,206 27,754
Allocations 917 900 3,579 3,617 38 F
NET RESULT 5,002 5,767 22,627 24,137
Paid FTEMONTH (FTE) YEAR TO DATE ( FTE)
Actual Budget Variance Actual Budget Variance
Medical 225.4 213.2 223.2 213.2
Nursing 587.5 601.1 13.6 F 588.7 601.1 12.3 F
Allied Health 109.1 115.4 6.4 F 105.7 115.4 9.8 F
Support 0.0 0.0 0.0 F 0.0 0.0 0.0 F
Management/Administration 79.4 80.1 0.7 F 80.3 80.1
Total excluding outsourced FTEs 1,001.3 1,009.8 8.5 F 997.8 1,009.8 12.0 F
Total :Outsourced Services 4.9 5.5 0.6 F 8.4 5.5
Total including outsourced FTEs 1,006.2 1,015.3 9.1 F 1,006.2 1,015.3 9.1 F Comments on major financial variances The Child Health HSG was $766k U for the month and $1,510k U YTD (Oct). Inpatient activity for the month was 89% to contract and 93% YTD.
The Child Health HSG year to date financial performance has been impacted by the following key drivers:
Revenue
Donation income was below budget for the month $208k U leaving a YTD variance of $941k U. This is
mainly a timing issue with funding for major projects being received as the projects are completed.
Non‐resident income YTD $422k U to budget. This income stream is significantly dependent on
contractual income for Paediatric Cardiac with the Pacific Islands. Currently the Paediatric Cardiac
non resident income is $728k lower YTD than the same period last year. The volume of non resident
57
children in Paediatric Cardiac is being impacted by the numbers of New Zealand resident children who
are waiting for care. Non‐resident prices have been increased in October this will favourably impact
on the coming months’ revenue.
Costs Personnel Costs
Main drivers for the variance are:
SMO costs. This is the issue in the surgical area requiring unanticipated leave cover to ensure ESPI compliance.
Overallocation of JRMOs (16 FTE). Active management and review of all Registrar and House Office runs is currently underway by the General Manager and Medical Director.
Mitigations
These Medical cost overruns have been partially offset by savings made through vacancy management in Nursing and Allied Health.
Continued emphasis will be maintained on managing FTE and cost within budget. Active management of FTE includes
FTE reconciliation (actual‐budget) under review by Medical Director.
Rationalisation of all FTE pending approval and being sourced.
NoRTH proposed allocation for next rotation under review by Medical Director and Chief Resident.
Other costs
Continued low volume of high cost procedures has assisted in maintaining the financial
variance YTD. Overall inpatient activity which is less than contract has assisted in
achieving the balance of the variance.
58
Regional Cancer and Blood Healthcare Service Group Speaker: Fionnagh Dougan, Acting General Manager
Service Overview Cancer is a major health issue for New Zealanders. One in three New Zealanders will have some experience of cancer, either personally or through a relative or friend. Cancer is the country’s leading cause of death (29.8 percent) and a major cause of hospitalisation.
The ADHB Cancer and Blood Service provides active and supportive cancer care to the 1.5 million population of the greater Auckland region. This is currently achieved by seeing approximately 5000 new patients a year and 46000 patients in follow‐up/or on treatment assessment appointments. Clinical Leader, Richard Sullivan, Nurse Director Jane Lees, General Manager, Fionnagh Dougan.
Scorecard
Oct-13 Measure Target
Medication errors 13 0 7
% Hand hygiene compliance 79% 80% 79%
Adverse events causing harm (SAC 1&2) 1 0 1
% DNA rate for outpatient appointments 5% 9% 5%
Chemotherapy Wait Times <4 weeks 100% 100% 79%
Radiation therapy Wait Times <4 weeks 100% 100% 99.6%
Customer Experience ‐ Inpatient Survey 100% 90% 100%
Customer satisfaction ‐ new complaints 1 0 3
28 Day Readmission Rate ‐ Total 21.99% TBC 18.24%
Average length of stay for WIES funded discharges (days) ‐ Acute 4.48 TBC 4.03
P&L ‐ YTD Variance ‐ $000 46 F 0 172 F%
Business Improvement Savings - YTD variance - $000 0 0 0
FTE Employed/Contracted ‐ Month Variance 1.0 F 0 3.5 F
% Hospitalised smokers offered advice and support to quit 100% 95% 96%
Number of Clinical trials underway 37 TBD 37
BMT Autologous Waitlist Patients waiting >6 weeks 10 TBD 6
Excess annual leave ‐ Percentage of staff 12.20% 6% 13.10%
Excess annual leave ‐ $ $205,289 $220,422
Staff turnover (% of voluntary turnover, annually) 10.6% 10% 10.4%
Staff turnover (% of voluntary turnover, <1 yr tenure) 13.3% 6% 12.5%
Actual Prev Period
Increased
Patient Safety
Better Quality Care
Improved
Health Status
Engaged
Workforce
Economic
Sustainability
59
Scorecard Commentary
Health Targets Chemotherapy Target – The service delivered to target in October. Demand and capacity issues continue to require active management due to high variation in referrals. Oncology Daystay is treating at capacity with an average of 50+ patients per day (48‐84 depending on
the day of the week). In addition to the higher volume of patients, a high proportion of complex patients are currently being treated.
We have commenced a service review to address the prioritisation, flow and utilisation issues across the medical oncology pathway.
Radiation Therapy Target – The service delivered to target in October. A recent increase in referral volumes and treatment complexity is impacting capacity and which is being closely monitored and managed.
Increased Patient Safety
Adverse Events – There was one adverse event in October.
Medication Errors ‐ There is an increase in the number of medication errors in day stay. This is being addressed.
Hand hygiene – Results from the October Hand Hygiene audit show that service compliance remains at 79%
Better Quality Care Complaints – the service only received one complaint in October. This is a significant improvement on previous month’s results
Customer experience –All respondents rated the service very good or excellent.
Improved Health Status
Smoking Cessation Advice – All patients were offered advice in October.
BMT Autologous Waitlist Patients waiting > 6 weeks – The limiting factor for delivery BMT treatment in the desired timeframe continues to be physical space. Construction of the new ward begins in December 2013. Until this time, the service continues to negotiate with other BMT centres to ensure timely treatment.
Engaged Workforce
Employee turnover
Sick leave – The number of staff using more than sick leave allocation remains the same. Individual plans and monitoring are in place for staff taking regular sick leave.
60
Strategic initiatives
Key achievements in the month: October
• Continuing to meet the four week targets for Chemotherapy and Radiation therapy.
• BMT ward build fundraising commenced.
• Working closely with the Maori Health team regarding Maori DNA rate – Maori Health team contacting families and providing home visits when appropriate.
Areas off track and remedial plans:
• New BMT/ Haematology ward – building due to commence December 2013 ‐ delayed start, still due for completion in July 2013.
Key issues / initiatives identified in coming months
Issue Description
Day stay currently operating at or above capacity with a risk of failing to deliver to the chemotherapy treatment time target.
Medical oncology flow, clinic and day stay utilisation improvement project.
Review the role of senior nurses across the outpatient clinic and treatment areas
Ministry requirement to develop prospective data to report against the faster cancer treatment indicators.
Agree nationally consistent definitions.
Understand baseline number of cancer registrations that are referred to secondary services.
Develop automated faster cancer treatment data.
Radiotherapy Therapy waiting room upgrade
Dry July funds are being utilised to develop a patient and family friendly space.
Current technology limits radiation therapy capacity
Treatment Planning System upgrade – will be fully commissioned January 2014
Planning for next Linac upgrade (due 2015)
Delivery of the Cancer Nurse Coordinator projects across the tumour streams
Review the effectiveness of the current model and its ability to deliver
Identify where there are barriers to implementation
Consider alternative options if appropriate
61
Care of paediatric patients Review the clinical needs, the clinical environment and staff resources and skills required for this cohort of patients and their families
Financial results STATEMENT OF FINANCIAL PERFORMANCE
Cancer & Blood Services Reporting Date Oct-13
($000s) MONTH YEAR TO DATE
Actual Budget Varianc
e Actual Budget Varianc
e REVENUE
Government and Crown Agency
781 712 69 F 3,020 2,849 171 F
Other Income 7,678 7,696 19 U 31,10
7 31,056 52 F
Total Revenue 8,458 8,408 50 F 34,127 33,905 222 F
EXPENDITURE
Personnel
Personnel Costs 2,807 2,795 12 U 11,01
7 11,125 108 F
Outsourced Personnel 34 51 17 F 208 206 2 U
Outsourced Clinical Services 174 181 7 F 688 725 37 F
Clinical Supplies 2,848 2,748 100 U 11,54
6 11,082 464 U
Infrastructure & Non-Clinical Supplies
71 108 37 F 432 431 1 U
Total Expenditure 5,935 5,884 51 U 23,891 23,569 322 U
Contribution 2,523 2,525 1 U 10,236 10,336 100 U
Allocations 588 636 47 F 2,284 2,554 270 F
NET RESULT 1,935 1,889 46 F 7,953 7,782 171 F
Paid FTE
MONTH (FTE) YEAR TO
DATE ( FTE)
Actual Budget Varianc
e Actual Budget Varianc
e Medical 69.2 66.9 2.3 U 68.4 66.9 1.5 U
Nursing 140.6 137.7 2.8 U 138.7 137.7 0.9 U
Allied Health 75.1 79.0 4.0 F 75.2 79.0 3.8 F
Support 1.1 1.0 0.1 U 1.1 1.0 0.1 U
Management/Administration 11.7 14.0 2.3 F 11.9 14.0 2.1 F
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Total excluding outsourced FTEs 297.6 298.7 1.0 F 295.3 298.7 3.3 F
Total Outsourced Services 1.4 1.3 0.1 U 1.8 1.3 0.5 U
Total including outsourced FTEs 299.0 300.0 1.0 F 297.1 300.0 2.9 F
Comments on major financial variances
Month Result
The variance for the month is $46k favourable.
Revenue ‐ $50k favourable primarily due to Funding for Cancer Nurse Coordinators $78K F (budget
phasing) offset by lower demand for Haemophilia blood product $23k U and non resident fee $25k
U.
Expenditure ‐$51k unfavourable.
Employee costs – $12k unfavourable primarily due to unachieved target savings.
Clinical Supplies Costs ‐ $100k unfavourable due to overrun in PCT drug cost $230k U driven by
volume (subject to IDF wash up), Blood product unachieved target savings $33k U offset by savings
in Haemophilia blood product cost $62k F (demand driven) and savings in RT machine repair and
maintenance $103k F.
Outsourced Costs $24k favourable to budget due to savings in RT student stipend payment $17k F
(budget phasing).
Infrastructure & Non‐clinical supplies $37k favourable due to prior months cost adjustment for
projects funded Dry July $25k F.
Internal allocations $47k F ‐ relates to favourable research overhead recovery $60k F.
YTD Result
The result for the YTD is a favourable variance of $171k.
Revenue ‐ $222k favourable due to
i) Haemophilia blood products reimbursement driven by patient demand $76k F(offset by blood
product costs) and
ii) 2012‐13 funding for cancer nurse coordinators $64k F.
Expenditure ‐ $322k unfavourable.
Employee Cost $108k F reflects vacancies in technical and administration staff.
Clinical Supplies ‐ $464k unfavourable is primarily due to overrun in PCT drug cost $256k U (subject
to IDF wash up) , unachieved drug savings target $71k U, Haemophilia blood products (driven by
patient demand) , blood product unachieved savings target $56k U, unachieved savings in direct
63
treatment cost $48k U, depreciation $121k U and offset by savings clinical equipment minor
purchases $120k F.
Internal allocations $270k F due to savings in radiology service billings $95k F and favourable
variances in research overhead recovery $195k (budget phasing).
Summary
The service is currently experiencing a higher volume of referrals than recent months and greater clinical complexity.
64
Mental Health & Addictions HSG Speaker: Helen Wood, General Manager Mental Health & Addictions
Service Overview This HSG provides specialist community and inpatient mental health services to Auckland residents. It also provides a range of services at various levels: sub‐regional (adult inpatient rehabilitation & community psychotherapy), regional (youth forensics) and supra‐regional (child and youth acute inpatient & eating disorders). The HSG is managed by Helen Wood (GM), Clinical Director Dr Clive Bensemann and Director of Nursing Anna Schofield.
Scorecard
Oct‐13 Measure Target
Adverse events causing harm (SAC 1&2) per 1,000 bed days 2 TBC 1
Medication errors 6 TBC 4
Seclusion. All inpatient services ‐ Episodes of seclusion 4 TBC 2
Restraint. All services ‐ Incidents of Restraint 70 TBC 46
7 Day Follow Up post discharge. Adult ‐ All community Service 94% 95% 98%
28 Day readmission rate. Adult ‐ Te Whetu Tarewa 2.1% 10% 8.5%
Average Length of Stay ‐ Adult 25.3 21 28.0
Average Length of Stay ‐ Child & Youth 7.5 9.8
Average Length of Stay ‐ Older People 56.8 27.3
Waiting Times. 0 ‐ 19y All service: 3 wk Target 67% 80% 67%
Waiting Times. 0 ‐ 19y All service: 8 wk Target 95% 95% 95%
Waiting Times. 20 ‐ 64y All service: 3 wk Target 88% 80% 88%
Waiting Times. 20 ‐ 64y All service: 8 wk Target 96% 95% 96%
Waiting Times. 65y+ All service: 3 wk Target 67% 80% 67%
Waiting Times. 65y+ All service: 8 wk Target 93% 95% 93%
P&L ‐ YTD Variance ‐ $000 379 U 0 624 U
Business Improvement Savings - YTD variance - $000 306 U 0 135 U
FTE Employed/Contracted ‐ Month Variance 2.0 F 0 5.0 F
% Hospitalised smokers offered advice and support to quit 100% 95% 98%
% long‐term clients with relapse prevention plans 94% 95% 94%
Access. Maori ‐ 0 ‐ 19y 5.01% 3% 5.03%
Access. Maori ‐ 20 ‐ 64y 11.42% 3.3% 11.31%
Access. Maori ‐ 65y+ 4.18% TBC 4.18%
Access. Overall ‐ 0 ‐ 19y 2.85% 3% 2.81%
Access. Overall ‐ 20 ‐ 64y 3.83% 3.3% 3.80%
Access. Overall ‐ 65y+ 3.61% TBC 3.57%
Excess annual leave ‐ Percentage of staff 6.31% 6% 6.47%
Excess annual leave ‐ $ $0.12M $0.11M
Staff turnover (% of voluntary turnover, annually) 6.88% 10% 7.38%
Staff turnover (% of voluntary turnover, <1 yr tenure) 2.33% 6% 2.17%
Engaged
Workforce
Actual Prev Period
Increased
Patient Safety
Better Quality Care
Improved Health Status
Economic
Sustainability
65
Scorecard Commentary
Increased Patient Safety Seclusion & Restraint Seclusion and restraint episodes are up slightly in October, reflecting the usual monthly variation associated with client mix, acuity and occupancy. Year to date comparisons to end of October show seclusion down a third on last year, and restraint down 21% on last year. Medication Errors Medication errors related to administration/practice were up this month but remain at low levels over the year to date.
Better Quality Care 7 Day Follow Up Post Discharges This has slipped just under our DHB target this month but is above target at 97% for the year‐to‐date and well above the nationally set target of 90%. Services are reviewing the monthly exceptions. Average Length of Stay & Occupancy Although Te Whetu Tawera ALOS for October is above the 21d target, it continues to show sustained improvement and is the lowest monthly figure for last 12 months. This was achieved with occupancy just above the 90% target. Fraser McDonald Unit LOS was impacted by the discharge of some longer stay patients. Waiting Times Adult services continue to meet these higher targets but known issues remain for Child & Youth and Older Adult services. Both have dedicated projects in place around this but it will take at least six months to reach the new target s (to be achieved by the end of the financial year).
Improved Health Status Relapse Prevention Planning for Long Term Clients The monthly results have slipped just below the 95% target for the last 2 months and plans are in place to address this at service level. Access Access targets for the current FY are being met in all areas except the 0‐19 years overall group. Small gains are being made in this group each month and the addition of data captured via PRIMHD for Starship Hospital Consultation and Liaison service will contribute to some increase in access that has been occurring but has not been reported previously. The new service delivery model and pathways in Child and Adolescent mental health services once implemented will enable the development of a consult/ liaison function of the service to focus on increasing access. We are piloting a mechanism for capturing consult activity to primary care, schools and CYFs.
Engaged Workforce Bureau Utilisation/Overtime 3, 247 hours across 3 acute and 1 rehabilitation inpatient unit (total of137 beds). This compromised of:
Overtime RN 168.73 hrs/Overtime MHA 2 hrs
Bureau RN 393.63 hrs/Bureau & Zeal MHA 2,682.66 Drivers for the utilisation included
Vacancies within the nursing model at Te Whetu
66
Increased Observations due to risk to self/others 239.12 hours
Increased acuity Measures to reduce: Shift reviews by CNs and Daily & weekly reviews by ND/NA TWT recruited 3 MHA (skill mix change) Nov start (13.3 vacancies)
2 RNs Nov/Dec start (11.3 vacancies) 6 New Grads Feb start (5.3 vacancies)
We are working with Careers to source 5 yr plus RNs to strengthen skill mix. Staff Turnover, Accrued Annual Leave & Sick Leave: Staff Turnover, Accrued Annual Leave and Sick Leave are all down relative to last month.
Strategic initiatives Deliverable / Action STATUS
Reshape Child and Adolescent Mental Health Service referral
pathway to reduce wait times and improved access by 1st October
In progress √ √ √
Reconfigure clinical services to increase access rates for children and youth
In progress √ √ √ √
Explore and define possible primary care liaison role for youth and explore options to measure; focus on options to facilitate access for Māori.
Not started yet.
√ √
Map and plan implementation of a multi‐agency pathway that provides better value for money and removes duplication.
In progress √ √
Adopt a stepped care approach matched to specialist level of intervention delivered where young people are based;
In progress √ √ √
Contributions from Child and Adolescent Mental Health (CAMHS) and Alcohol and Other Drug (AOD) services towards the Prime Minister’s youth mental health programme
Due to start Sept Oct once MoH guidelines issued
√
Increase the rates of access to mental health services by using the work streams set up for service development.
In progress
√ √ √
Commission primary mental health service that meets key requirements for psychosocial model and stepped care
In progress √ √ √
Older People’s project will define options for integrating personal and mental health older people’s services. There will be a focus on Māori who experience age related problems at younger age.
In progress √ √
Complete older people’s project to understand options and potential requirement for reallocating funding to develop wrap around services for acute inpatient care.
In progress √ √
Contribute to the implementation plan for a dementia care pathway
√ √
Explore means to measure access in primary care for a range of mental health problems, especially high prevalence ones (P & F)
In progress √ √
Ensure links to Whānau Ora are made through specific project work.
Not started √
Undertake a project to ensure existing outcome measures are widely used including those from KPI project, across all ages and service environments.
In progress √ √ √ √
Increased Patient Safety ‐ Better Quality Care ‐ Economic Sustainability ‐ Improved Health Status ‐ Engaged Workforce
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Key achievements in the month: July and August Improving access rates The three day rapid improvement event with staff from the child and youth service has now occurred with agreements on how the “front Door” processes can be improved to improve access and waiting times alongside better managing workload burden felt by staff. See Highlights section for further detail Multi‐ Agency pathway Significant progress made with revising pathways and co‐ordination of care for young people with high and complex needs and multi ‐agency involvement. Clear set of actions and agreements met between ADHB, WDHB child and youth mental health teams and MSD (CYF). This includes strengthening some existing forums for care planning (e.g high and complex needs forum), implementing an escalation process if issues arise across agencies with timely access to packages and support, and improved follow up arrangements at points of transition. Adopt a stepped care approach matched to specialist level of intervention delivered where young people are based ADHB child and youth services “Direction” document is complete and awaiting Board sign off at CPHAC (27th Nov). The plan outlines key actions and steps for the next 3 years to change service model. Some actions have already started (e.g. work on multi‐agency pathways).
Key issues / initiatives identified in coming months Service improvement and productivity initiative in partnership with Unions A key focus for the division is strengthening our partnership with PSA to address and jointly resolve work place issues quickly. A joint strategic committee meets bi monthly to establish and oversee joint programs of improvement, have dialogue around issues that have not been resolved at local service level and find resolution. A key joint program is the productivity working group. It aims to work collaboratively in addressing a range of productivity issues across mental health services that relate to workload, managing increased demand for example. This first major joint project was an initiative in our child and youth mental health services (Kari Centre teams) where two key issues were of significant concern 1) staff feeling increasingly overwhelmed and distressed by the increase in referrals and workload and 2) a need for the service to improve access (more referrals) and waiting times (timeliness of first appointment – non urgent, within the 3 & 8 week national targets).
Working together the manager, clinical leader and PSA delegate set up a process for engaging the clinical teams in a service change process that would have direct impact on better meeting service users’ needs and staff needs. A core group were trained in the lean fundamentals tools and a rapid improvement event planned with support from John McTaggart The 3 day rapid improvement event occurred beginning of November with stunning effect. The team identified the main causes of delay and frustration as being: Duty Processes; Allocation process; Managing Capacity; Booking and scheduling of clinicians and rooms. A set of agreed actions, with implementation date of 3rd February, include:
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Key staff focused on duty system to provide phone consultation, acute assessments, rapid processing of referrals, face to face triage. Additional functions will include brief intervention/case management, and close liaison with community services.
Streamline process for allocation of clients with clearer matching to clinician expertise
Client bookings will be electronic with open diary system and starting an early evening clinic. Workforce pressures and recruitment The division implemented in July a tighter process for managing the flow along the recruitment pathway to stay within our budget and fte. Decision making priorities for recruitment firstly occur at Level 3 Ops Managers, who meet weekly to work together on a whole of service view of their priorities for recruitment. Priorities go forward to our Level 2 weekly sign off process. There are currently 26.8 fte that are sitting at level 3 that they have not progressed at this stage as a priority.
Level 2 meet weekly to review requests and go through a prioritisation process again. These then go on to organisational wide processes. The extended process of recruitment currently, while assisting to achieve other pressures, is of growing concern to the division. Delay has the potential impact of
Compromising clinical safety in teams with growing referrals, acuity and vacancies accumulating.
Delaying access to appropriate treatment with impact on either not meeting national waiting time targets in the community (thus increasing risk of relapse and further clinical deterioration) or delaying discharge from hospital bed.
Some are critical to have some cover in place during recruitment either via locum e.g. SMO or roster cover via more expensive options.
Many of these will take several months to recruit to so interim options are in place (locums, bureau or other team members trying to cover caseloads but that is not sustainable and has both financial and workforce costs).
Where teams have growing vacancies we are not able to get people off on leave or reduce leave in a timely way.
Buchanan Rehabilitation Centre Buchanan Rehabilitation Centre are finalising a Proposal for Change for early 2014. This is in response to the changing service user population which is increasing in complexity, younger with co‐existing mental health and addiction needs and more acute. The proposal identifies service and workforce areas that require strengthening to deliver effective care, treatment and rehabilitation to this group of 40 service users. The document proposes strengthening clinical leadership through establishment and strengthening of front line clinical leadership roles and clarity around scope of role for registered health professionals.
Mothers and Infant Acute responses A regional steering group including women’s health and consumer representative are working closely with the MoH to finalise the contracting processes and details for the enhancement of acute responses to mothers and infants. We are currently establishing 5 working groups to develop the model of care, establish 3 inpatient beds at CFU (including redesign of the unit), commission extended range of community support resources, recruit an additional 12.4 clinical staff across Auckland metro DHB and establish training and development. There is intense pressure from MoH for implementation at significant pace. The facilities changes and council sign‐off processes at CFU are the most challenging in terms of expected timeframes. The upgrade of CFU has been delayed due needing to revisit the design to accommodate the mother and infant beds. We are in the final stages of high level design for the unit and seeking increased pace from architects for this process. Facilities team have been helpful in trying to achieve this.
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Kari Centre Upgrade Kari centre leadership are putting a proposal to A+ trust to refurbish and enhance the environment making it more child and youth friendly Fraser McDonald Unit (FMU): Improving the Facility Co‐design workshops with service users and staff are planned for December. The key focus will be on obtaining feedback about the utility of the environment for staff, families and patients. A communication strategy is underway for FMU staff to improve engagement and clearly identify scope of project. This will include written information and be presented face to face where possible with a 24 hour workforce. We are seeking input (to be confirmed) from the contractor who worked on Bone Marrow Transport and Totara ward scoping/development. Existing project funds would be used to pay for this.
Upgrade of Regional Electronic Clinical notes system– HCC The regional mental health system HCC has been earmarked for upgrade for some time. This will help with:
Moving Mental Health and Addiction Services devices onto the new operating system (Windows 7) .The current version of HCC does not work under this operating system
Fix some outstanding bugs and add new functionality to improve workflow
The new version allowing us to extend our ability for shared records and service user direct access
Move the standalone Methdata system into HCC (CADS) It is some years since we upgraded the system. The database is a considerable size and HCC has around 3,000 users across the 3 DHBs. Because we are moving several versions in one step it will take approximately 4 days for safe reconfiguration/restart. We will put in place arrangements for access to clinical information as read only. As this is a big and complex piece of work we need to plan for this to be done safely which means we need to run the service at weekend level for an extended 4 day period. With this in mind we are anticipating doing this over an extended long weekend. It has been identified that the optimal timing for the upgrade would be 6th February‐9th February 2014. Performing the work over the long weekend, the 6th February is a public holiday, will mean the service reduction will only impact on service delivery by non‐acute staff on Friday 7th February. We expect that service levels will be similar to those we provide on a weekend or public holiday. With support from regional ER/HR colleagues we are liaising with all key unions. We will be requesting staff who are not essential for the delivery of acute services on the 7th February to take an annual leave day. We hope that in most instances staff will be agreeable because they understand the value in having a more efficient and effective clinical records system .We expect that many will welcome the opportunity for a long extended weekend during summer.
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Financial results CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Oct-13
Mental Health & Addictions Services
($000s) MONTH YEAR TO DATE Actual Budget Variance Actual Budget Variance REVENUE
Government & Crown Agency 8,130 8,108 22 F 32,437 32,433 4 F Other Income 21 22 2 U 132 90 42 F
Total Revenue 8,151 8,131 20 F 32,569 32,523 46 F EXPENDITURE
Personnel Costs 5,587 5,747 160 F 23,371 22,949 422 U Outsourced Services 152 101 51 U 666 405 261 U Clinical Supplies 67 62 4 U 250 252 2 F
Infrastructure & Non-Clinical Supplies
210 293 83 F 1,064 1,172 109 F
Total Expenditure 6,017 6,204 187 F 25,351 24,779 572 U Contribution 2,134 1,927 207 F 7,219 7,744 526 U Allocations 1,677 1,711 34 F 6,697 6,844 146 F NET RESULT 457 216 241 F 521 901 379 U Paid FTE MONTH (FTE) YEAR TO DATE ( FTE) Actual Budget Variance Actual Budget Variance
Medical 87.7 91.6 3.9 89.1 91.6 2.5 Nursing 282.4 296.2 13.8 285.9 296.2 10.3 Technical 271.5 271.8 0.3 270.7 271.8 1.1 Hotel Services 6.4 5.4 -1.1 6.1 5.4 -0.7 Administration 56.1 56.4 0.3 56.8 56.4 -0.5
Total excl outsourced FTEs 704.1 721.3 17.2 708.5 721.3 12.8 Total Outsourced Services 12.1 0.5 -11.6 11.3 0.5 -10.8
Total incl outsourced FTEs 716.2 721.8 5.6 719.9 721.8 2.0
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Comments on major financial variances Month The result for the month is a favourable variance of $241k. This is mainly driven by
Employee costs
Medical including outsourced $286k F‐ Primarily reversal of SMO jobsizing overprovision $409k F, 3.4 FTE vacancies $57k F, offset by skill mix savings not achieved $43k U, annual leave phasing $47k U and locum rate premiums, on‐call & cross cover allowances of $90k U.
Nursing including outsourced $15k U‐ primarily due to vacancies of 4.2 FTEs $37k F and allowances $9k U offset by annual leave phasing $61k U.
Allied $147k U‐ primarily due to phasing of annual leave and allowances $84k U, unachieved skill mix savings of $64k U, Kaiatawhai 2.8 FTEs transferred from Maori Health to Manawanui $19k U, offset by vacancies of 3.1 FTE $20k F.
Internal Allocations $34k F‐ Primarily Kaiatawhai 2.8 FTE transferred to Manawanui $19k F.
YTD The result for the YTD is an unfavourable variance of $379k. The main drivers of this month's unfavourable variance of $381k are
Employee costs
Medical including outsourced $186k U‐ Primarily locum rate premiums, on‐call allowances and locum rate premiums of $413k U, skill mix savings not achieved $172k U, timing of annual leave $151k U offset by 2.05 FTE vacancies $141k F and reversal of SMO job size overprovision $409k F.
Nursing including outsourced $100k U‐ primarily due to higher than budgeted allowances $82k U, annual leave phasing and overtime premium of $37k U, offset by vacancies of 0.6 FTEs $19k F.
Allied $318k U‐ primarily due to unachieved skill mix savings of $256k U, Kaiatawhai 2.8 FTEs transferred from Maori Health to Manawanui $61k U, phasing of annual leave and allowances $99k U, offset by vacancies of 3.9 FTE $98k F.
Infrastructure & non‐clinical supplies $109k F ‐ primarily due to reversal of over provision for rental opex for St Lukes $54k F.
Internal Allocations $146k F ‐ primarily due to Kaiatawhai FTEs transferred to Manawanui (see above Allied personnel costs) $78k F.
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Cardiovascular Healthcare Service Group Speaker: Peter Lowry, General Manager
Service Overview The Cardiovascular Healthcare service group comprises Cardiothoracic Surgery, Cardiology, Vascular Surgery, Organ Donation New Zealand, and Hearty Towers. Peter Ruygrok is the Clinical Leader, Jane Lees, Nurse Director and Peter Lowry the General Manager.
Scorecard
Oct‐13 Measure Target
Adverse events causing harm (SAC 1&2) per 1,000 bed days 0 0 0
Medication errors 25 0 13
% Hand hygiene compliance 75% 58%
Pressure areas injuries count for the month 3 14 14
Customer satisfaction ‐ new complaints 0 0 0
HT2 Elective discharges cumulative variance from target 101.60% 100% 108.59%
Theatre Cancellation % (unreplaced) 9% 14% 14%
Cardiac Bypass Surgery Waiting List 45 47 ‐ 99 80
Theatre Adjusted Utilisation 85% 80% 89%
Average Length of Stay for WIES funded discharges (days) ‐ Acute 6.4 TBC 5.02
Average Length of Stay for WIES funded discharges (days) ‐ Elective 5.65 TBC 4.51
P&L ‐ YTD Variance ‐ $000 362 U 0 339 U
Business Improvement Savings - YTD variance - $000 0 0 0
FTE Employed/Contracted ‐ Month Variance 20.72 F 0 20.49 F
% Hospitalised smokers offered advice and support to quit 100% 85% 100%
Vascular surgical wait list ‐ longest waiting pt (days) 115 150 140
Outpatient wait time for chest pain clinic patients (%compliant against 42 day target) 100% 70% 94%
CVD risk assessment 80% 83% 80%
Excess annual leave ‐ Percentage of staff 16.0% 6% 14.3%
Excess annual leave ‐ $ 471,000 425,000
Staff turnover (% of voluntary turnover, annually) 9% 10% 9%
Staff turnover (% of voluntary turnover, <1 yr tenure) 8.9% 6% 6.8%
Engaged
Workforce
Actual Prev Period
Increased
Patient Safety
Better Quality Care
Improved
Health Status
Economic
Sustainability
Scorecard Commentary
Health Targets
Cardiac Surgery Bypass waiting list
The service has maintained a wait list within the advised limits for the month of October. Demand has been slightly lower than forecast which should mean the service will be able to carry a low wait list number into the Christmas period.
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CVD Risk assessment ADHB achieved 80% for CVD screening and whilst this is less than target it was the 3rd highest result when compared with other DHBs across the country, CMDHB was 2nd with 80.6% and Wairarapa first with 82%.
Increased Patient Safety
October has been a very positive month for the service as we have been able to reduce the waiting list for cardiac surgery markedly. We have experienced low referral volumes which has allowed elective surgery to be brought forward thereby clearing the backlog of patients waiting beyond their target timeframe. The wait list is at a low level coming into what has historically been a very busy period for the service. This combined with a sustained surgical capacity should mean that we will maintain compliance through this period which is in contrast to what was achieved in January 2013 and 2012 where our waitlists were non compliant. We had 25 medication errors in October of which 6 were incorrect/unordered medications, 5 omissions and 4 extra dose/duplications. In terms of severity 1 was moderate, 7 minor and 17 minimal. We had 5 falls in October 4 minimal and 1 near miss. Two of the falls were in Ward 41 which is the vascular ward and they had up to 6 amputee patients in October which increases the risk of falls. We had 3 pressure injuries all of which occurred in CVICU/HDU. All were minor.
Better Quality Care
Theatre cancellation and utilisation reflect a very strong performance for CTSU throughout October, however Cardiology has had significant issues during the month. Room 2 has experienced ongoing outages of the X‐ray equipment due to the equipment being near the end of its lifecycle. We have been able to mitigate the issue through working longer days and using the Starship laboratory to ensure patients continue to be treated within timeframes. We are currently undergoing an RFP process to purchase replacement equipment.
Economic Sustainability
The Cardiovascular Health Services Group continues working towards ensuring our staffing model is complete. This allows us to continue to minimise theatre cancellations which in turn leads to greater productivity within normal hours and a reduced reliance on outsourcing and weekend work. This is demonstrated in October with low theatre cancellation rates, good production levels and relatively low level of weekend and outsourcing work required. We continue to improve the first to followup assessment ratio in cardiology. When compared with the rest of the Auckland region ADHB has the lowest ratio at 1 to 1.6. The average rate for the Northern region is 1 to 2.04. This is achieved through a continuing focus on discharging patients as soon as is clinically appropriate.
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Improved Health Status The positive performance in improved health status indicators has been maintained by the service through October. The EP service wait list remains the only metric of concern. The long waiting patients were all booked for October but have subsequently been delayed and rescheduled for both patient and hospital related reasons.
Engaged Workforce
Turnover in October remains within normal parameters and annual leave has also stayed static. Christmas rosters are being finalised across the HSG with planned reduction in the leave liability over the summer months.
Strategic initiatives
DAP initiatives Deliverable / Action STATUS
Bypass intervention rates 6.5 per 10,000 population (6.84 actual) On Track √ √
angiogram discharges rates 34.73 per 10,0000 (actual 35.58) On Track √ √
PCI (angioplasty) + Cardiac Surgery rates 18.90 per 10,000 (actual 19.22)
On Track √
100% patients receive elective angiogram < 90 days On Track √ √ √
Primary angioplasty “Door to balloon time” On Track √ √ √ √
Acute coronary syndrome diagnostic angiogram 70% (90%) On Track √ √ √
Increased Patient Safety ‐ Better Quality Care ‐ Economic Sustainability ‐ Improved Health Status ‐ Engaged Workforce
Regional Cardiac KPIs
Metric ADHB Region Average
Median Wait time FSA (weeks) 4.6 7.3
Ratio FSA:Fup 1:1.6 1:2.04
Median Wait time Angiography (weeks) 4.4 5.0
Bypass waiting list 44 (max of 101)
Key achievements in the month:
Patient flow is being maintained and within urgency timeframes.
Cathlab replacement approved and with procurement to progress
Business case for additional Hybrid OR approved and we are planning to run the procurement process through December.
Cardiac CT business case approved.
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Key issues / initiatives identified in coming months Continued focus on CVD risk screening targets, developing patient flow processes and managing financial performance.
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Financial Results
STATEMENT OF FINANCIAL PERFORMANCECardiac Services Reporting Date Oct-13
($000s) MONTH YEAR TO DATEActual Budget Variance Actual Budget Variance
REVENUEGovernment and Crown Agency 59 71 12 U
325 U 238 U
54 U 266 U
9 U
123 U 413 U
391 U 575 U
120 U 436 U
23 U 362 U
3.6 U
2.0 U 2.0 U
3.6 U 3.8 U
311 283 28 F
Other Income 11,741 11,240 501 F 45,446 44,824 621 F
Total Revenue 11,799 11,311 488 F 45,756 45,107 649 F
EXPENDITUREPersonnel Personnel Costs 5,181 4,855 19,570 19,333
Outsourced Personnel 77 23 359 93
Outsourced Clinical Services 300 291 904 1,164 260 F
Clinical Supplies 2,567 2,444 10,266 9,854
Infrastructure & Non-Clinical Supplies 23 143 120 F 493 574 81 F
Total Expenditure 8,148 7,756 31,593 31,017
Contribution 3,651 3,554 97 F 14,164 14,090 74 F
Allocations 1,000 880 3,977 3,541
NET RESULT 2,651 2,674 10,186 10,549
Paid FTEMONTH (FTE) YEAR TO DATE ( FTE)
Actual Budget Variance Actual Budget Variance Medical 88.8 85.2 84.1 85.2 1.1 F
Nursing 296.4 310.7 14.4 F 292.4 310.7 18.3 F
Allied Health 68.8 69.7 0.9 F 64.0 69.7 5.6 F
Support 3.0 1.0 3.0 1.0
Management/Administration 20.2 29.6 9.3 F 28.1 29.6 1.4 F
Total excluding outsourced FTEs 477.1 496.1 19.0 F 471.6 496.1 24.5 F Total Outsourced Services 3.6 0.0 3.8 0.0
Total including outsourced FTEs 480.7 496.1 15.4 F 475.4 496.1 20.7 F
Comments on major financial variances The results for October were $0.0M F ($0.4M U YTD). The key drivers of the YTD unfavourable result at Cardiac service level are
Clinical Supplies $0.4M U: The Cardiac cost improvement savings initiative is progressing
positively to budget. However clinical supplies overall are unfavourable as a result of the
costs of high acuity especially blood ($0.3M U). This is offset by favourable outsourcing and
other income initiatives.
Internal Allocations $0.4M U: The Radiology service billing is overspent ($0.3M U) due to
high vascular Radiology intervention procedures. This is offset by lower theatre minutes.
Note ‐ At ADHB level Radiology service billing and costs are breakeven to Budget.
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The key mitigation strategies to ensure an ongoing breakeven with budget position are:‐
Holding operating costs through pursuing reduced prices for implants and consumables,
managing outsourcing and continued tight management of FTE recruitment, annual leave
management and junior doctors. Savings for some clinical supplies will be significantly
higher than budgeted and these will flow through to the accounts later in the year.
Revenue strategies including an agreement with Waikato DHB for additional IDF revenue,
and investigating and improving the timing of revenue recognition/invoicing. If the coding
catch‐up is in line with previous history we would expect a further $0.4M revenue upside by
December relating to November volumes.
Business Improvement Savings – YTD Var
The Cardiac cost improvement savings initiative is progressing positively to budget with outsourcing
and clinical supply cost savings favourable for the year to date. The success of the Cardiac cost
improvements is covering the costs of delays in other projects, so overall we are still achieving
savings overall.
The successful procurement initiatives will result in further ongoing savings on implants and high
cost clinical supplies.
FTE Employed/Contracted – YTD Var
FTE remains favourable with CVICU recruiting into their model of care over the next couple of
months. Ward 42 also has FTE to recruit to get to their new model of care. The ward has a workplan
to harness opportunities to improve throughput beyond the staffing model.
The favourable FTE are not translating into favourable Personnel costs overall as the high vacancies
are resulting in higher costs due to low leave taken and high call‐back, overtime, fees for service and
other payments.
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Operations & Clinical Support Services
Speaker: Frank Tracey, General Manager
Service Overview This service delivery group is comprised of Daily Operations (including daily operations, transit, resource, bureau, volunteers & reception), Greenlane Clinical Centre (including Outpatient facilities, Patient Administration, Contact Centre & Interpreter services), Radiology, Laboratory, Clinical Engineering, Commercial Services, Nutrition, Emergency Management and Pharmacy. Frank Tracey is the General Manager in this area, working alongside the Director of Perioperative Services.
Scorecard
Oct-13 Measure Target
Surgical Checklist TBD 100% TBD
Medication errors 4 0% 7
Adverse events causing harm (SAC 1&2) 0 0 1
Customer satisfaction ‐ new complaints 13 0 11
% Outpatients & community referred MRI completed , 6 weeks 64% 75% 52%
% Outpatients & community referred CT completed , 6 weeks 88% 75% 90%
Ultrasound Waitlist ‐ 6 weeks 72% 75% 74%
P&L ‐ YTD Variance ‐ $000 876 U 0 862 U
Business Improvement Savings - YTD variance - $000 378 U 0 9 U
FTE Employed/Contracted ‐ Month Variance 41.79 F% 0 42.02 F%
% Hospitalised smokers offered advice and support to quit 94% 95% 93%
Excess annual leave ‐ Percentage of staff 8.3% 6% 8.1%
Excess annual leave ‐ $ 0.67M 0.65M
Staff turnover (% of voluntary turnover, annually) 8.5% 10% 8.3%
Staff turnover (% of voluntary turnover, <1 yr tenure) 7.2% 6% 8.0%
Better Quality Care
Improved
Health
Status
Engaged
Workforce
Economic
Sustainability
Actual Prev Period
Increased
Patient Safety
Scorecard Commentary
Health Targets
MRI Waitlist The MR waitlist is currently 200 patients. Compliance to the 6 week target for outpatient MRI is at 64%. Ultrasound Waitlist The ultrasound waitlist is increasing, currently at 1200. This represents a 300% increase since the start of the year. 6 week outpatient compliance is trending down and is now 72%. Improvement initiatives to optimise throughput are in place and the department is reviewing its processes and skill mix.
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CT Waitlist The CT waitlist is stable with 6 week compliance at 88%.
Increased Patient Safety
There were no SAC1 or SAC 2 events reported for the month of October. There were a total of 4
medication errors for October including adverse drug / allergic reaction, extra dose / duplication and
incorrect storage.
Better Quality Care
Customer experience: there have been 11 complaints for the month of September. These include
issues with clinic scheduling and clinic reception, Contact Centre, Orderly Services, Radiology and
Starship Anaesthesia. All complaints we reviewed by the senior team and improvements are being
made.
Engaged Workforce
Staff are being actively encouraged to take their leave which will allow for appropriate rest and recreation as well as assist the financial position.
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Strategic initiatives
Deliverable / Action STATUS
PC3 Lab business case On track. Plans
finalised and tied to Level 4
shell
√ √
Level 4 Lab shell Level 4 tender released,
closes 17 Jan 2014.
√
ADHB programme for DML project Transition Manager
working with the group.
√
√
√
Consolidate Nuclear Medicines scans at ACH Slow progress √
√
√
3rd MRI scan at GCC Very slow progress
√ √ √
GCC CT contract Slow progress √ √
HBL nutrition NBIO Behind schedule
√ √
HBL Laundry NBIO Behind schedule
√ √
WDHB/ADHB Contact Centre business case
The Project Team is working with healthAlliance who are refining the scope and cost of technology aspects associated with the business case. Once this information is available in the coming weeks we hope to be able to make a recommendation to the ADHB‐WDHB Collaboration Steering Group with respect to next steps.
In Progress √ √ √
ADHB E‐referrals Phase 2 Work in progress
√ √ √ √ √
MOJ ROI initiated Proposal underway, expectation of submission December
2013
√ √
WDHB/ADHB Clinical Engineering transition Plan implemented and on track
√
√
√
√
Clinical Planning Engineering review On track √ √ √ √
LabPlus performance improvement In progress, realising
improvement
√
√
√
√
Starship ORs Go ahead given to start, awaiting final timeline from contactor
√
√
√
√
√
Increased Patient Safety ‐ Better Quality Care ‐ Economic Sustainability ‐ Improved Health Status ‐ Engaged Workforce
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Clinical Engineering Highlights
GE along with CE staff members have successfully completed an exercise to upgrade the 291 Dash 4000 Physio Monitor fleet to software version 7.2 to help resolve on going issues such as monitors not communicating to Central Stations distorted ECG waveforms in the combination monitoring mode and the date intermittently reverting to 1993.
Staff continues to make significant savings for clinical areas by providing a wide range of technical services in‐house at an effective hourly rate up to 75% lower than the external market. The on‐going savings made by CE's in‐house procurement section also deserve recognition.
CE Management continues to promote regional collaboration with CMDHB eg two CE staff members (one from each of the ADHB and CMDHB) have just spent a week in the USA on a free operating table servicing course as a result of CMDHB CE Management's successful negotiations with the supplier.
Key Issues
Two further staff have tendered their resignations and will leave early next month for positions with the new CE Service at WDHB . This will leave a significant gap in the CE expertise available to service our customers in LabPlus and Anaesthesia/Theatre Services. Efforts are underway to train back up staff to provide continuity of service to these two key customers. However further instances of skilled CE staff moving to WDHB are likely over the next six months and this is a serious concern to CE Management at both ADHB and CMDHB
The CE service restructuring exercise following the loss of the WDHB contract continues to cause significant unrest and concern amongst staff members. Staff has provided feedback to Management, the Consultants (Deloitte) and the PSA, throughout the consultation period, to help achieve an appropriate outcome to this major exercise.
A potentially major issue has been identified with the new Philip's manual Defibrillators (XLT and MRx). The automatic analysing of some ECG arrhythmias in Monitor mode has proven to be inaccurate and could result in a clinical risk. The Resus Committee has been advised and this issue has been followed up with Philips to resolve before the fleet of existing Defibrillators is replaced.
There continues to be zero progress on the issue of the EAM database upgrade despite the efforts of CE Management and the findings of the Deloitte report.
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Key achievements in the month
Radiology
• Improvement in 6 week compliance for MR.
LabPLUS
Favourable variance against budget for October (248k F). Short and long term business transformation initiatives established to reduce deficit while
ensuring service quality is continued.
Business planning initiated and service excellence project on‐track. TOR developed for new formatted Operations and Performance Review meetings via the
service/business excellence programme.
AP project on track ‐ Tender for Level 4 shell build issued. The new tandem mass spec has been installed for the Newborn Screening programme.
Areas off track and remedial plans
Radiology
Ultrasound waitlist. Business case for improved capacity and backlog reduction in progress.
After hours capacity for Radiology. Remedial plan in development.
LabPlus
Budget YTD $508k unfavourable YTD – Business transformation and service/business excellence
plans in development and initiatives in place.
Multi‐lab LIS project with NDHB delayed until March 2014 – new plan in place.
New Lab ID number go‐live deferred until Feb 2014 – new plan in place.
Delays in tandem mass spec implementation in Chemical Pathology – unable to recruit suitably
qualified toxicologist, further interviews planned, however, instrument installed.
Key initiatives for the next 6 months
LabPLUS
Progress transformation initiatives including operating cost reduction
MOJ Coronial procurement project underway with proposal initiative being developed by
LabPLUS as the contract holder for the current National Forensic Pathology Service contract (due
for submission mid December). Perioperative CSSD – results from Smartfold instrument wrapping process are positive at present. Allied Health
AVERT (A Very Early Rehabilitation Trial) reached a major milestone of recruiting 150 patients.
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Financial results ‐ Operations and Clinical Support
STATEMENT OF FINANCIAL PERFORMANCEOperations & Clinical Support Services Reporting Date Oct-13
($000s) MONTH YEAR TO DATEActual Budget Variance Actual Budget Variance
REVENUEGovernment and Crown Agency 831 774 57 F 3,183 3,167 16 F
Other Income 3,592 3,635 14,475 14,676
Total Revenue 4,423 4,409 14 F 17,658 17,843
EXPENDITUREPersonnel Personnel Costs 10,250 10,178 39,750 40,396 646 F
Outsourced Personnel 195 264 69 F 951 1,054 103 F
Outsourced Clinical Services 834 596 3,241 2,443
Clinical Supplies 3,399 3,515 116 F 14,556 14,170
Infrastructure & Non-Clinical Supplies 2,649 2,757 107 F 10,989 11,009 20 F
Total Expenditure 17,328 17,310 69,488 69,073
Contribution (12,905) (12,901) (51,831) (51,230)
Allocations (8,463) (8,067) 396 F (33,340) (32,917) 423 F
NET RESULT (4,442) (4,834) 393 F (18,491) (18,313)
Paid FTEMONTH (FTE) YEAR TO DATE ( FTE)
Actual Budget Variance Actual Budget Variance Medical 119.2 125.0 5.8 F 118.7 125.0 6.3 F
Nursing 99.4 90.9 97.8 90.9
Allied Health 781.6 797.2 15.5 F 777.7 797.2 19.5 F
Support 177.8 168.4 177.2 168.4
Management/Administration 294.4 307.0 12.6 F 295.2 307.0 11.9 F
Total excluding outsourced FTEs 1,472.5 1,488.5 16.0 F 1,466.5 1,488.5 21.9 F Total :Outsourced Services 12.2 3.2 14.3 3.2
Total including outsourced FTEs 1,484.7 1,491.7 7.0 F 1,480.8 1,491.7 10.9 F
43 U 201 U
185 U
71 U
238 U 798 U
386 U
17 U 415 U
4 U 601 U
177 U
8.5 U 6.9 U
9.4 U 8.8 U
9.0 U 11.1 U
Comments on major financial variances ‐ Operations & Clinical Support YTD Result is $177 U. The key drivers of this result are:
Personnel Costs $646K F due to FTE being 22 below budget YTD. The vacancies are mainly in Allied Health and Pharmacy.
Outsourced Clinical Services were $798K U due to phasing of CT and MR project not being implemented until later in year ‐ $356K. Labplus budgeted savings for send away tests not achieved $289K. The cost per test and volume of tests were also higher than budget $205K. This was offset by MSS volumes being lower than budget.
Clinical Supplies unfavourable due to Radiology June invoices not accrued ‐ $250k and Labplus due to volumes and one off costs $242k. This was offset by savings in other areas.
Service billing F across all areas due to volume.
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Financial results – Perioperative Services STATEMENT OF FINANCIAL PERFORMANCEPerioperative Services Reporting Date Oct-13
($000s) MONTH YEAR TO DATEActual Budget Variance Actual Budget Variance
REVENUEGovernment and Crown Agency 244 189 55 F 914 755 159 F
Other Income 29 30 85 120
Total Revenue 273 219 55 F 1,000 875 124 F
EXPENDITUREPersonnel Personnel Costs 7,340 6,945 28,403 27,683
Outsourced Personnel 52 31 351 125
Outsourced Clinical Services 0 0 0 F 0 0
Clinical Supplies 3,551 3,378 13,442 13,619 177 F
Infrastructure & Non-Clinical Supplies 113 136 24 F 634 546
Total Expenditure 11,056 10,490 42,831 41,973
Contribution (10,783) (10,271) (41,831) (41,098)
Allocations 26 27 0 F 73 107 34 F
NET RESULT (10,809) (10,298) (41,903) (41,204)
Paid FTEMONTH (FTE) YEAR TO DATE ( FTE)
Actual Budget Variance Actual Budget Variance Medical 155.9 159.8 3.8 F 155.9 159.1 3.2 F
Nursing 387.6 407.2 19.6 F 391.1 406.6 15.5 F
Allied Health 99.1 102.8 3.8 F 97.2 102.7 5.5 F
Support 110.3 111.8 1.6 F 108.2 111.8 3.7 F
Management/Administration 20.4 28.6 8.2 F 20.1 28.6 8.5 F
Total excluding outsourced FTEs 773.3 810.2 36.9 F 772.5 808.8 36.4 F Total :Outsourced Services 3.5 1.3 6.5 1.3
Total including outsourced FTEs 776.7 811.5 34.8 F 779.0 810.1 31.2 F
1 U 34 U
395 U 720 U
21 U 227 U
173 U
88 U
566 U 858 U
511 U 733 U
511 U 699 U
2.2 U 5.2 U
0 F
Comments on major financial variances – Perioperative Services October month was $511k unfavourable to budget. The principal drivers of the variance were Medical Costs 278k and Clinical Supplies 173k October YTD is $699k unfavourable to budget. The principal drivers of this result are Revenue 124k F, Medical Costs 558k U, Nursing Costs 167k, Outsourced Clinical Services 227k U and Clinical Supplies 177k F. OR activity measured by theatre minutes for the period is 6.3% more than the same period last year, and theatre cases 4.8% more. Allowances paid to medical staff for this period are 294k unfavourable to budget and nursing bureau costs 193k unfavourable to budget. Additionally, the cost of Medical Locums was 168k unfavourable to budget. These additional unbudgeted costs reflect the amount of work performed out of hours which is an expensive mode of service delivery. Clinical Supplies are 177k favourable to budget, the main driver being the timing of clinical equipment depreciation providing a 234k favourable variance to budget. However, clinical supplies have absorbed a 1,233k
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target saving during this period which indicates that efficiency programmes in cost and inventory management are also working well Mitigation Strategy – review models of service delivery to ensure they are operating as approved and that they will provide services to be delivered within budget by June 2014. Specific strategies include a number of ERAS initiatives (enhanced recovery after surgery). Examples include the TAH gynaecological pilot (total abdominal hysterectomy), and a review of the obstetric and primary joint replacement pathways. These initiatives are designed to reduce length of stay, which will benefit ADHB as a whole, and improve productivity. Two further strategies to manage within the budget are encouraging the recycling of lists to optimise available theatre time, and review of excess annual leave with HR as part of roster planning for the balance of the year In addition to these short term initiatives, work has started on reviewing available operating room management information to ensure that theatres are operating as efficiently as possible. The objective is to highlight in a monthly report the key drivers of inefficiency that will enable management action to be taken to address these. It will be the positive outcomes from this work that will enable the Perioperative Service financial target savings in medical and nursing costs for 2013/14 of 1.3m and 2.1m to be successfully embedded into the organisation for 2014/15 and beyond.
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Adult Healthcare Service Group Speaker: Andrew Davies, Performance Director, Adult Healthcare Service Group
Service Overview The Adult HSG is responsible for the provision of emergency care, medical and surgical services and sub specialties for that adult population. The HSG leadership consists of Medical Director Barry Snow, Surgical Director Ian Civil, Nurse Director Jane Lees and Performance Director Andrew Davies. The services in the HSG are structured into 5 portfolios: GINOA – General Medicine, Infectious Diseases, NASC, Orthopaedics and A+ Links NUTRON – Neurology, Urology, Transplant, Renal, ORL, Neurosurgery Adult Emergency, APU, Critical Care, Air Ambulance General Surgery, Respiratory, Gastroenterology Ophthalmology and Ambulatory Services.
Scorecard Oct-13 Measure Target
Pressure areas ‐ inpatient acquired per 1,000 bed days 4.8% 0 3.9%
% Hand hygiene compliance 80% 80% 80%
Falls with major harm per 1,000 bed days 0.29 TBD 0.06
Adverse events causing harm (SAC 1&2) per 1,000 bed days 0.29 TBD 0.15
MOH‐01 % all patients with ED stay < 6 hours 95% 95% 93%
HT2 Elective discharges cumulative variance from target 101.7% 100% 101.2%
(ESPI‐2) Patients waiting longer than 5 months for their FSA 0.20% 0 0.20%
(ESPI‐5) Patients given a commitment to treatment but not treated within 5 months 1.6% 0 1.0%
% DNA rate for outpatient appointments 10% 9% 10%
Elective day of surgery admission (DOSA) rate 73% 68% 72%
% Day Surgery Rate 63% 70% 61%
Inhouse Elective WIES through theatre ‐ per day 66.52 TBD 61.59
% patients in mixed sex wards at midday 16.2% TBD 14.8%
Customer Experience ‐ Inpatient Survey 81% 90% 85%
Customer satisfaction ‐ new complaints 36 TBD 34
28 Day Readmission Rate ‐ Total 11.9% 10% 11.7%
% theatre cancellations 6.6% 10% 10.5%
% Urgent Diagnostic colonoscopy procedures treated < 14 days 63.2% 50% 73.0%
% Non‐urgent colonscopy procedures treated <42 days 31% 50% 28%
% adjusted theatre utilisation 86.1% 80% 85.0%
Average length of stay for WIES funded discharges (days) ‐ Acute 3.53 TBD 3.43
Average length of stay for WIES funded discharges (days) ‐ Elective 1.43 TBD 1.35
P&L ‐ YTD Variance ‐ $000 $1,319 U 0 $61 F
Business Improvement Savings - YTD variance - $000 $309 U 0 $161 U
FTE Employed/Contracted ‐ Month Variance 34.4 U 0 38.29 U
% Hospitalised smokers offered advice and support to quit 96% 95% 95%
Diabetes ‐ HBA1C management 74% 75% 74%
Excess annual leave ‐ Percentage of staff 14.6% 6% 13.7%
Excess annual leave ‐ $ $1.69M $1.67M
Staff turnover (% of voluntary turnover, annually) 8.2% 10% 8.5%
Staff turnover (% of voluntary turnover, <1 yr tenure) 2.5% 6% 3.7%
Actual Prev Period
Increased Patient
Safety
Better Quality Care
Improved
Health
Status
Engaged
Workforce
Economic
Sustainability
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Scorecard Commentary
Health Targets Acute Flow: The adult acute flow performance for October was back on target at 95%.
Smoking Cessation: Performance for October met the target at 96% and has recovered from the slight decline last month.
Elective Discharges: Adult discharges in October exceeded the revised discharge plan with Ophthalmology addressing their shortfall. The Adults services are now at 102% of plan YTD. In October the ESPI compliance to 5 months for FSA was moderately non compliant with 0.2% of patients waiting for greater than 5 months for FSA. These were primarily spine FSAs that were unable to be seen due to a decrease in our capacity. We were non compliant for Surgery with 1.6% of patients waiting greater than 5 months. While this was largely due to the orthopaedics capacity issues we also had number of General Surgery patients non compliant in the month due to a temporary capacity shortfall.
Increased Patient Safety Safety performance in the HSG is tracking at target levels. While the overall pressure injury result has increased slightly we had 0 grade 3 and 4 pressure injuries in the portfolio in October.
Better Quality Care Service sizing is progressing to support the improved timely access to electives. FSA and Surgery production issues are reviewed weekly and current challenges are focuses around the Orthopaedics service. Alternate models of care are being investigated to support the demand here. The DNA rate for appointments is slightly above target and is a focus of our outpatient performance projects. The colonoscopy wait times are improving. We have achieved the target for the urgent category but are a way off target for the non urgent. We are addressing this with additional lists running to get rid of the waitlist backlog. A recent initiative from the MoH may support funding for these additional colonoscopies.
Improved Health Status Smoking performance has returned to the levels of previous months with the additional focus in October.
Engaged Workforce Excess annual leave has increased in October and is a focus area for the service teams in the lead up to the summer holiday period. Leave plans for staff with excess leave is a priority for the teams.
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Strategic initiatives Deliverable / Action STATUS
Falls with Harm Programme (20% reduction) On Track √ √ √
Reduce pressure injuries (20% reduction) On Track √ √ √
Hand Hygiene On Track √ √ √
CLAB zero On Track √ √ √
Acute care management o Avoidable admissions – Alt to hospital care o Early discharge o Reduced admissions from ARRC o Escalation plan o One document between AED and IP teams
On Track √ √ √
Elective discharges per plan On Track √ √ √
Improved access to diagnostics (colonoscopy wait times reduction)
On track √
Reduce average LOS o Long stay patients o ERAS in Ortho / Gen surg
On Track
Rollout
√ √
Improve clinic flows and utilisation of resources via MOH projects
Rollout √ √
Behaviours of concern project On Track √ √
Intentional Rounding Rollout √ √
Bed modelling and summer plan Complete √ √
Adult savings programme o Acute Care programme o ACC and Non Res o Outsourcing reduction o DTC reduction in line with Concord programmes
On Track √
Establish Community dialysis centre On track √ √
Establish ARRC Cluster model Complete √ √
ARRC avoidable admissions On Track √ √ √
National intestinal failure service Delayed √ √
Pathway improvement for Glaucoma patients including Optometrists in care pathway
Initiating √ √ √
Development of Management Operating System (MOS) for service and ward level (L2, L3 and L4)
Rollout √
Implement a Nursing Management Operating System (MOS)
Complete √
Increased Patient Safety ‐ Better Quality Care ‐ Economic Sustainability ‐ Improved Health Status ‐ Engaged Workforce
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Key achievements in the month:
Summer plan modelling complete with additional 33 beds to be closed relative to last year. Contingencies for opening at short notice in place
Model of care changes for Totara ward implemented Revised financial analysis with Ngati Whatua o Orakei community health
services on the community haemodialysis to meet affordability Information session run for all charge nurses on financial management and
their controls to support living within our means
HDU occupancy has increased in line with expectations with medical patients now admitted
Areas off track and remedial plans: Continued challenges with the non urgent colonoscopy. This is being addressed
with additional lists to remove the waitlist backlog. Action will deliver over the next 3 months with potential funding support from the MoH.
Operating model and contracting for the National Intestinal Failure Service has been delayed. We are working with the NHB to progress this.
Development of the MOC for AED and APU. Workshop scheduled for Dec 4.
Key issues / initiatives identified in coming months Budget issues in Oct driven by FTE and cost per FTE. Mitigation plans developed
Open the medical observation unit on Level 6 (opened in Nov)
World pressure injury day – Joint venture with HSQC, and First do no harm
Focus on falls over bed rails
Further refinement of the escalation plan to include step down triggers
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Financial Results
STATEMENT OF FINANCIAL PERFORMANCEAdult Health Services Reporting Date Oct-13
($000s) MONTH YEAR TO DATEActual Budget Variance Actual Budget Variance
REVENUEGovernment and Crown Agency 2,198 2,222 24 U
17,444 797 U 69,549 1,187 U
1,427 283 U
4,681 482 U 18,826 238 U
499 40 U 2,043 100 U
23,457 1,246 U 93,754 1,694 U
17,367 1,098 U 71,948 996 U
4,386 281 U 17,620 323 U
12,981 1,380 U 54,328 1,319 U
431.4 7.1 U 431.3 9.1 U
1,204.4 27.0 U 1,207.7 20.4 U
5.0 1.2 U 5.0 1.2 U
2,029.3 28.3 U 2,030.2 23.6 U13.8 6.1 U 13.8 8.5 U
2,043.0 34.4 U 2,043.9 32.1 U
9,113 8,889 224 F
Other Income 38,773 38,601 172 F 157,287 156,812 475 F
Total Revenue 40,971 40,824 148 F 166,400 165,701 699 F
EXPENDITUREPersonnel Personnel Costs 18,241 70,736
Outsourced Personnel 322 356 34 F 1,710
Outsourced Clinical Services 437 477 40 F 1,794 1,908 114 F
Clinical Supplies 5,163 19,064
Infrastructure & Non-Clinical Supplies 539 2,143
Total Expenditure 24,703 95,448
Contribution 16,269 70,952
Allocations 4,667 17,943
NET RESULT 11,602 53,009
Paid FTEMONTH (FTE) YEAR TO DATE ( FTE)
Actual Budget Variance Actual Budget Variance Medical 438.5 440.4
Nursing 1,231.4 1,228.1
Allied Health 216.9 220.4 3.5 F 214.7 218.1 3.4 F
Support 6.2 6.2
Management/Administration 164.6 168.1 3.5 F 164.4 168.1 3.7 F
Total excluding outsourced FTEs 2,057.6 2,053.7 Total :Outsourced Services 19.8 22.3
Total including outsourced FTEs 2,077.4 2,076.0
Comments on major financial variances The YTD result is $1,319k U. Revenue YTD is $699k F from Non Resident $416k F and $524k F from CTA Training (additional 15% as agreed with HWNZ for the clinical training contract Aug‐Dec 2013.) ACC in OPH is $309k U. Total Expenditure YTD is $2,018k U. Mainly due to:
Personnel and Outsourced Personnel combined $1,470k U. As a result of Nursing $1,006k U, Medical $250k U and Admin $170k U. The Nursing variance is due to timing of implementation of a number of initiatives and reflects 20.54 FTE U. Medical $250k U is from FTE 9.1 U
Clinical Supplies are $238k U. Inventory adjustments account for $76k U the balance is due to high patient needs for blood and pharmaceuticals. DCCM and General Surgery both had high usage patients in October.
Infrastructure and Non‐Clinical Supplies are $100k U. This includes a Doubtful Debts provision of $280k U
Recovery strategies include increased annual leave during the summer period, continued increased revenue from ACC, Non Res and CTA and focus on decreasing cost per FTE with recruitment and roster management.
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Womens Healthcare Service Group Speaker: Karin Drummond, GM Women’s Healthcare Service
Service Overview The Women’s Health portfolio includes all Obstetric and Gynaecology services plus Fertility and Termination services. The team is contracted to provide primary, secondary and tertiary services. The Maternal Fetal Medicine group provide quaternary services and are contracted to lead the National Maternal Fetal Medicine network. The Northern Hub of the National Genetic service is also under the umbrella of the Women’s Healthcare Service Group. Dr. Sue Flemming is the Medical Director, Karin Drummond the General Manager and Maggie O’Brien the Midwifery Director.
Scorecard
Oct-13 Measure Target
Medication errors 3 0 6
Adverse events causing harm (SAC 1&2) 0 0 1
(ESPI‐1) Triage of new referrals 0 0 0
(ESPI‐2) Patients waiting longer than 5 months for their FSA 0 0 0
(ESPI‐5) Patients given a commitment to treatment but not treated within 5 months 0 0 0
HT2 Elective discharges cumulative variance from target 95.99% 0% 95.92%
% DNA rate for outpatient appointments 8% 9% 7%
Elective day of surgery admission (DOSA) rate 82% TBC 84%
% Day Surgery Rate 53% TBC 43%
Inhouse Elective WIES through theatre ‐ per day 7.13 TBC 7.81
Birthcare primary births (YTD) 103 150 81
Customer Experience ‐ Inpatient Survey 88% 90% 83%
Customer satisfaction ‐ new complaints 9 TBC 4
28 Day Readmission Rate ‐ Total 6.34% TBC 5.53%
Average length of stay for WIES funded discharges (days) ‐ Acute 1.84 TBC 2.1
Average length of stay for WIES funded discharges (days) ‐ Elective 1.19 TBC 1.47
P&L ‐ YTD Variance ‐ $000 397 F 0 203 F
Business Improvement Savings - YTD variance - $000 235 F 0 95 F
FTE Employed/Contracted ‐ Month Variance 16.9 U 0 18.1 U
% Hospitalised smokers offered advice and support to quit 95% 95% 95%
Breastfeeding rates 82% 75% 82%
Excess annual leave ‐ Percentage of staff 13.3% 6% 16.0%
Excess annual leave ‐ $ 0.44M 0.44M
Staff turnover (% of voluntary turnover, annually) 12.7% 10% 12.0%
Staff turnover (% of voluntary turnover, <1 yr tenure) 6.0% 6% 3.7%
Actual Prev Period
Increased
Patient
Safety
Better Quality Care
Improve
d Health
Status
Engaged
Workforce
Economic
Sustainability
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Scorecard Commentary
Health Targets Acute flow Gynaecology services met the 95% target Elective discharges Discharges in October were 95% of plan. The shortfall relates to the lack of minor cases required to fill lists and enable for full utilisation of operating rooms. It is expected that in the last 2 quarters demand will rise due to a 25% growth in referrals. Smoking Cessation We are meeting targets (improvement in capturing information on Healthware).
Increased Patient Safety There have been no adverse events for the month of October. There were 3 medication errors which did not result in patient harm.
Better Quality Care
We continue to meet ESPI targets. Primary birthing numbers continue to be below target, with most women choosing to birth at National Womens rather than at Birthcare. There were 9 new complaints for the month of October, of which the dominant themes were care and communication issues. All complaints are being reviewed weekly and where significant issues arise a formal review process is completed.
Improved Health Status
Women’s Health has continued to achieve full compliance to targets for this month.
Engaged Workforce
Progress is being made in reducing annual leave with all staff with leave greater than 5 weeks receiving formal letters to work with their managers to develop leave plans to address this. Staff turnover is slightly above target, a number of staff have reached retirement age or have left to travel.
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Strategic initiatives Work stream Objectives Progress Consolidation of Women’s Health improvement programme
Visibility of all improvement activity in women’s health Process to manage existing projects and prioritise new projects Improved allocation of resources
Projects are formally reviewed each month and most are on track to plan Mitigations are in place for those that are experiences delays or barriers
Mapping of Maternity Post‐Natal pathways
Develop a clear understanding of current the post‐natal pathways Identify opportunities to improve the service for women and management of resources / allocation of funding
Postnatal pathways work progressing to plan
Review of Women’s Acute pathways
Develop a clear understanding of acute maternity pathways Identify opportunities to improve the service for women and management of resources
This work is progressing in line with development of 180 day plans Clinical lead appointed to lead service improvements commences Jan 14
Development of Women’s Health Management Operating System
Deployment of strategy from visioning workshop; development of 180day plan Review of meetings to define purpose and structures / remove duplication Refinement of Women’s Health scorecard Increased awareness of priorities and performance across service
MOS meetings commenced Draft NW Health service and Future Direction document developed – in process of defining accurate measures
Strategic initiatives agreed through the ADHB/WDHB collaboration process Deliverable / Action STATUS Maternity Strategy establishes clear pathways for all
pregnant women On track √ √ √ √
Performance against the national maternity indicators is examined and changes put in place
On Track √ √ √
The number of primary births managed by Birthcare LMCs increases from 450 to at least 600.
In discussion
√ √
Services are better aligned to improve outcomes for teen and vulnerable pregnant women. This is achieved by connecting women, their families and services from pregnancy through the first years of the infant’s lives. Recommendations are to be implemented during 13/14.
Progressing
√ √ √
Referral pathways for gynaecology referrals to be revised On Track √ √ Increased Patient Safety ‐ Better Quality Care ‐ Economic Sustainability ‐ Improved Health Status ‐ Engaged Workforce
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Key achievements in the month
Recruitment into Clinical Lead position for fertility services
Completion of SMO workforce stocktake. This detailed analysis of where SMO resources are allocated has enabled a comparison between available resources and service demands. This will provide the basis for decisions around changes to SMO FTE and future recruitments.
Commencement of review of demand for EDU surgical sessions and potential changes to SMO schedules. The reduced demand for TOP’s opens up the possibility that EDU can be utilized as a centre for Women’s health day/outpatient procedures beyond just TOP.
Participating in regional project to improve Maternal Mental Health Services to Northern Region.
Areas off track and remedial plans
PHARMAC regulation of Mirena IUC poses risk to our ability to manage many common gynaecological problems and potentially pushes our patients toward more investigations and higher cost interventions. Local and regional approaches to managing this are being explored. Our heavy menstrual bleeding pathway will assist in managing this challenge.
Excess leave for SMO’s. A number of our SMO have excess leave and have been discouraged from taking this because the clinical services they provide are more difficult to cover. A more proactive approach to planning for leave will enable leave balances to be slowly reduced.
Key issues / initiatives identified in coming months We are continuing to progress work to strengthen gynaecological service delivery. Our pathways development is occurring in partnership with WDHB. We are also strengthening our links with CMDHB who have already established a menstrual disorders pathway with a view to making primary care to DHB pathways uniform across Auckland. We have commenced work measuring the expectations and values of women using our maternity services. This will help inform the work we plan to progress over coming months with redesign of maternity services across the region.
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Financial Results
STATEMENT OF FINANCIAL PERFORMANCEWomens Health Services Reporting Date Oct-13
($000s) MONTH YEAR TO DATEActual Budget Variance Actual Budget Variance
REVENUEGovernment and Crown Agency 319 193 126 F 980 770 210 F
Other Income 7,318 7,250 68 F 28,470 28,283 187 F
Total Revenue 7,636 7,442 194 F 29,450 29,053 397 F
EXPENDITUREPersonnel Personnel Costs 3,039 2,910 130 U 577 U
24 U 70 U
46 U 89 U
53 U 126 U
69 U
223 U 931 U
29 U 534 U
24 U 169 U
53 U 703 U
0.4 U
13.6 U 16.1 U
0.1 U 1.1 U
12.0 U 16.0 U1.2 U 0.9 U
13.2 U 16.9 U
12,171 11,595
Outsourced Personnel 92 68 342 271
Outsourced Clinical Services 57 10 129 40
Clinical Supplies 462 409 1,775 1,649
Infrastructure & Non-Clinical Supplies 80 110 30 F 510 441
Total Expenditure 3,730 3,507 14,927 13,996
Contribution 3,906 3,936 14,523 15,057
Allocations 690 667 2,843 2,675
NET RESULT 3,216 3,269 11,679 12,383
Paid FTEMONTH (FTE) YEAR TO DATE ( FTE)
Actual Budget Variance Actual Budget Variance
Medical 65.0 65.4 0.4 F 65.9 65.4
Nursing 252.3 238.7 254.9 238.7
Allied Health 16.6 17.8 1.2 F 16.1 17.8 1.7 F
Support 0.0 0.0 0.0 F 0.0 0.0 0.0 F
Management/Administration 33.6 33.6 34.7 33.6
Total excluding outsourced FTEs 367.5 355.5 371.5 355.5
Total :Outsourced Services 3.8 2.6 3.4 2.6
Total including outsourced FTEs 371.3 358.1 375.0 358.1 Comments on major financial variances The year to date result is $703k U. MOH base income is recognised at HSG level as per 2013/14 budget. YTD Oct CWD volumes are 99% of contract.
The key drivers of the YTD unfavorable result are:
Personnel costs and outsourced services $647k U, 17UF FTE. This reflects a variance to savings strategy which is based on reducing length of stay, converting inpatient episodes of care to outpatient procedures, and promoting primary birthing where applicable. To realize cost savings a reduction of 16 FTE across Midwifery / Nursing FTE have been built into WH budget. To date these savings have only been partially recognized. However there has been a reduction of 5 FTE (excluding senior nurses) from the previous October results. Work is on‐going to minimize overtime and external bureau with a steadily reducing payment /
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usage of both each month since July 2013.
Infrastructure costs – These are now F for the month reflecting reversal of provision for doubtful debts on one long overdue debt.
Mitigation The key mitigation strategies planned to reduce costs associated with the delivery of Gynae & Obstetric volumes are as follows:
Implementation of Early Recovery After Surgery (ERAS) for Caesarean sections to reduce Length of Stay.
Review Patient flow processes from referral to discharge and develop clinical pathways to maximize efficiencies and best practice care models.
Reduce epidural rate to comparable exemplar hospital (HRT benchmarks),
Implement word catheter as short stay procedure,
Progress gynaecological clinical pathways in collaboration with WDHB
Strengthen acute obstetric services clinical leadership to enable more efficient and effective management of acute care services including after hour cover and use of casual locums
Improvement of rostering practices to minimize use of overtime, bureau and locums
Job sizing for all SMO and reducing FTE where service size has reduced ( Epsom day unit)
These strategies are actively being scoped or are progressing, however due to the size and complexity of a number of these projects savings are not likely to flow until late 2013/14. It is recognized that WH is facing a significant challenge to meet proposed savings strategies. Reduction in FTE has not yet been achieved year to date as Models of care are set at 70% occupancy rates and to date occupancy in the postnatal wards has been an average of 85%.
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7
SUMMER BED PLAN 2013‐2014
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Summer Bed Plan 2013/2014
Recommendation
That the report be received.
From:Fionnagh Dougan (Director, Provider Services)
Executive Summary Every year the number of patients requiring inpatient beds reduces over the December and January holiday period. The Summer Bed Plan outlines our forecasted bed demand and resulting planned bed closures to enable ward areas to flex down staff and maximise leave over this period while maintaining occupancy levels to achieve patient flow and minimise outliers. Adult, Cardiac and Cancer, Women’s Health, and Starship are included in the Summer Bed Plan.
Background Our approach to creating the Summer Plan is outlined below:
Project resourced beds required at an aggregate level (e.g. Adult, Cardiac and Cancer) based on 5 year historical occupancy
Adjust (if necessary) for any significant changes to Elective Surgical plans which would either increase or decrease bed demand
In consultation with service leaders, identify required ward by ward bed levels based on historical service occupancy
Repeat #3 above until the target aggregate resourced bed requirement is met
Service leaders worked with ward staff to plan rosters in order to maximise leave
Support Services summer closure plans consolidated to identify additional risks or opportunities (Allied Health, Pharmacy, Clinics, Starship OR, GSU, Level 8, Level 9, Endoscopy)
The improved sophistication of our forecasting has enabled us to plan more bed closures and allocate staff leave in advance compared to previous years. For example, the 2013/14 Summer Bed Plan results in average additional closure of 33 beds in January and February across Adult, Cardiac and Cancer services is compared to last year. A summary of the planned bed level (green line) versus historical occupancy can be seen for Adult, Cardiac & Cancer in the chart below. We should also observe fewer outliers than previous years because the specific beds closed by ward are more closely matched to predicted service occupancy.
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Figure 1: Adult, Cardiac & Cancer Planned “Normal” Beds vs. Historical Occupancy
Risks The primary risks are that we have either significantly more or less bed demand than anticipated. In the case of having fewer patients than expected, normal escalation practices will allow additional staff leave. In the case of having more patients than expected, a mitigation plan has been developed outlining which ward areas will be reopened and in what order as well as who and how additional staff will be brought in to ensure safe staffing and patient flow. In Adult Health, the Stroke unit is to be relocated to Ward 81 to allow the full closure of Ward 63 for the holiday period. If we see more stroke patients than can be cared for in Ward 81 the decision to reopen a portion of Ward 63 may be made by the Adult Health Nurse Director with the Stroke Service leaders.
Auckland District Health Board Hospital Advisory Committee 11/12/13
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Summer Plan
2013/14
2013/14 The following pages outline the projected hospital occupancy and planned bed closures over the December & January period.
ADHB Bed Plan
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Table of Contents I. Adult Cardiac & Cancer Services – Overall Bed Plan ....................................................................... 3
Overall Plan ......................................................................................................................................... 3
Risks .................................................................................................................................................... 3
II. Adult Cardiac & Cancer Services - Ward by Ward Closures ............................................................ 3
Ward 31 ............................................................................................................................................... 3
Ward 41 ............................................................................................................................................... 4
Ward 42 ............................................................................................................................................... 4
Ward 71 ............................................................................................................................................... 4
Ward 72 ............................................................................................................................................... 4
Ward 7A .............................................................................................................................................. 4
Ward 73 ............................................................................................................................................... 4
Ward 74 ............................................................................................................................................... 5
Ward 61 ............................................................................................................................................... 5
Ward 76 ............................................................................................................................................... 5
Ward 78 ............................................................................................................................................... 5
Ward 62 ............................................................................................................................................... 5
Ward 64 ............................................................................................................................................... 5
Ward 65 ............................................................................................................................................... 5
Ward 66 ............................................................................................................................................... 6
Ward 67 ............................................................................................................................................... 6
Ward 68 ............................................................................................................................................... 6
Ward 75 ............................................................................................................................................... 6
Ward 77 ............................................................................................................................................... 6
Ward 81 ............................................................................................................................................... 6
Ward 83 ............................................................................................................................................... 6
Ward 63 ............................................................................................................................................... 7
Totara Ward ........................................................................................................................................ 7
Awatea ................................................................................................................................................ 7
Marino ................................................................................................................................................. 7
Rangitoto ............................................................................................................................................. 7
Remuera .............................................................................................................................................. 7
Rehab + Paua ...................................................................................................................................... 7
104
Rehab + Pounamu ............................................................................................................................... 7
III. Table – Day by Day Beds Adult Cardiac Cancer .......................................................................... 8
IV. Women’s Health ....................................................................................................................... 10
Ward 96 & 98 .................................................................................................................................... 10
Ward 97 ............................................................................................................................................. 11
Tamaki ............................................................................................................................................... 12
V. Starship Children’s Health ............................................................................................................. 13
Overall Plan ....................................................................................................................................... 13
Risks .................................................................................................................................................. 13
Starship Children’s Health Bed Numbers from 1st November 2013– 3 February 2014 .................... 14
VI. Staffing Process ......................................................................................................................... 15
VII. Allied Health .............................................................................................................................. 16
VIII. Pharmacy .................................................................................................................................. 16
IX. Appendix ................................................................................................................................... 17
Clinic schedule December 2013 – January 2014 ............................................................................... 17
Starship Operating Rooms ................................................................................................................ 18
Level 4 Theatre Schedule .................................................................................................................. 20
Level 8 ............................................................................................................................................... 21
Level 9 ............................................................................................................................................... 22
Endoscopy Department Schedule ..................................................................................................... 23
105
I. Adult Cardiac & Cancer Services – Overall Bed Plan
Overall Plan The Bed plan covers the period December 2013 to February 2014 when reduced capacity forecasted will enable ward areas to flex down bed requirements and staff through this period.
Risks The weekend period following New Year from Friday 3rd January 2014 – Monday 6th January 2014 has potential for our occupancy to reach over 100% based on the bed plan. Occupancy requirements to flex beds and staffing resource over this period will require to be monitored as per the escalation plan.
II. Adult Cardiac & Cancer Services - Ward by Ward Closures
Ward 31 ↓20 December 2013 Friday PM closes to 15 beds
↑12 January 2013 Sunday PM opens to 20 beds
↑3 February 2013 Monday AM fully opened
80%
90%
100%
110%
120%
130%
140%
150%
200
250
300
350
400
450
500
550
Sun
Mon Tu
eW
ed Thu Fri
Sat
Sun
Mon Tu
eW
ed Thu Fri
Sat
Sun
Mon Tu
eW
ed Thu Fri
Sat
Sun
Mon Tu
eW
ed Thu Fri
Sat
Sun
Mon Tu
eW
ed Thu Fri
Sat
Sun
Mon Tu
eW
ed Thu Fri
Sat
Sun
Mon Tu
eW
ed Thu Fri
Sat
Sun
Mon Tu
eW
ed Thu Fri
Sat
Sun
Mon Tu
eW
ed Thu Fri
1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031
Dec Jan
All Patients - Total Capacity 535 Beds (Noon Occupancy)(On wards: 31w, 31MED, 41, 42, 61, 62,63,64,65,66,67,68,71,72,73,74,75,76, 77,78,7A, 81,83)
2010/112011/122012/132008/092009/102013/14 Planned Beds% vs 2012/13
106
Ward 41 ↓20 December 2013 Friday PM closes to 20 beds
↓23 December 2013 Monday PM closes to 16 beds
↑13 January 2013 Monday AM opened to 20 beds
Ward 42 ↓23 December 2013 Monday PM closes to 25 beds
↑05 January 2013 Sunday PM opens to 30 beds
↑13 January 2013 Monday fully opened to 33 beds
Ward 71 ↓24 December 2013 Tuesday PM closes to 16 beds
↑06 January 2013 Monday AM fully opened to 24 beds
Ward 72 ↓20 December 2013 Friday PM closes to 16 beds
↑20 January 2013 Monday AM open to 20 beds
↑28 January 2013 Tuesday PM fully open to 24 beds
Ward 7A ↓ 09 December 2013 Friday PM ward closes
↑03 February 2014 Monday AM fully open 9 beds
Ward 73 ↓ 20 December 2013 Friday PM closes to 20 beds
↓ 24 December 2013 Tuesday PM closes to 15 beds
107
↑06 January 2013 Monday AM fully open to 24 beds
Ward 74 ↓ 20 December 2013 Friday closes to 19 beds
↓ 24 December 2013 Tuesday PM closes to 11 beds
↑13 January 2013 Monday AM fully open to 23 beds
Ward 61 ↓ 20 December 2013 Friday PM closes to 17 beds
↑06 January 2013 Monday AM fully open to 27 beds
Ward 76 ↓ 20 December 2013 Friday PM closes to 20 beds
↑13 January 2014 Monday AM fully open to 24 beds
Ward 78 No Closures
Ward 62 No Closures
Ward 64 ↓ 24 December 2013 Tuesday PM closes to 25 beds
↑27 December 2013 Friday AM fully open to 29 beds
Ward 65 ↓ 24 December 2013 Tuesday PM closes to 22 beds
↑27 December 2013 Friday AM fully open to 26 beds
108
Ward 66 ↓ 20 December 2013 Friday PM ward fully closes
↑06 January 2014 Monday AM fully open to 22 beds
Ward 67 ↓ 24 December 2013 Tuesday PM closes to 21 beds
↑27 December 2013 Friday AM fully open to 27 beds
↓ 6 January 2014 Monday AM closes to 19 beds
↑3 February 2014 Monday AM fully open to 27 beds
Ward 68 ↓ 24 December 2013 Tuesday PM closes to 21 beds
↑27 December 2013 Friday AM fully open to 25 beds
Ward 75 ↓ 24 December 2013 Tuesday PM closes to 23 beds
↑29 December 2013 Sunday AM fully open to 28 beds
Ward 77 ↓ 24 December 2013 Tuesday PM closes to 21 beds
↑29 December 2013 Sunday AM fully open to 26 beds
Ward 81 ↓ 24 December 2013 Tuesday PM closes to 14 beds
↑29 December 2013 Monday AM fully open to 22 beds
Ward 83 ↓ 20 December 2013 Friday PM closes to 18 beds
↑03 January 2014 Friday AM fully open to 22 beds
109
Ward 63 ↓ 09 December 2013 Monday PM closes to 16 beds
↓ 20 December 2013 Friday PM ward closes
↑3 February 2014 Monday AM ward opens to 18 beds
Totara Ward ↓ 24 December 2013 Tuesday PM closes to 10 beds
↑06 January 2014 Monday AM open to 15 beds
↑13 January 2014 Monday AM fully open to 24 resourced beds
Awatea ↓ 20 December 2013 Friday PM closes to 21 beds
↑06 January 2014 Monday AM fully open to 25 beds
Marino No Closures
Rangitoto ↓ 20 December 2013 Friday PM closes to 16 beds
↑06 January 2014 Monday AM fully open to 28 beds
Remuera No Closures
Rehab + Paua No Closures
Rehab + Pounamu No Closures
110
III. Table – Day by Day Beds Adult Cardiac Cancer
War
d 31
War
d 41
War
d 42
War
d 71
Ward 72, 7A W
ard
73
War
d 74
Wards 61,76, 78Wards 62,
64 Wards 65, 66, 67, 68Wards 75,
77Wards 81,
83 War
d 63
Total Plan31 41 42 71 72 7A 73 74 61 76 78 62 64 65 66 67 68 75 77 81 83 63
Normal 24 24 33 24 24 9 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 2401-Dec-13 Sun 24 24 33 24 24 9 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 24 53302-Dec-13 Mon 24 24 33 24 24 9 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 24 53303-Dec-13 Tue 24 24 33 24 24 9 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 24 53304-Dec-13 Wed 24 24 33 24 24 9 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 24 53305-Dec-13 Thu 24 24 33 24 24 9 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 24 53306-Dec-13 Fri 24 24 33 24 24 9 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 24 53307-Dec-13 Sat 24 24 33 24 24 9 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 24 53308-Dec-13 Sun 24 24 33 24 24 9 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 24 53309-Dec-13 Mon 24 24 33 24 24 9 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 24 53310-Dec-13 Tue 24 24 33 24 24 0 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 16 51611-Dec-13 Wed 24 24 33 24 24 0 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 16 51612-Dec-13 Thu 24 24 33 24 24 0 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 16 51613-Dec-13 Fri 24 24 33 24 24 0 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 16 51614-Dec-13 Sat 24 24 33 24 24 0 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 16 51615-Dec-13 Sun 24 24 33 24 24 0 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 16 51616-Dec-13 Mon 24 24 33 24 24 0 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 16 51617-Dec-13 Tue 24 24 33 24 24 0 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 16 51618-Dec-13 Wed 24 24 33 24 24 0 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 16 51619-Dec-13 Thu 24 24 33 24 24 0 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 16 51620-Dec-13 Fri 24 24 33 24 24 0 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 16 51621-Dec-13 Sat 15 20 33 24 16 0 20 19 17 20 26 20 29 26 0 27 25 28 26 22 18 0 43122-Dec-13 Sun 15 20 33 24 16 0 20 19 17 20 26 20 29 26 0 27 25 28 26 22 18 0 43123-Dec-13 Mon 15 20 33 24 16 0 20 19 17 20 26 20 29 26 0 27 25 28 26 22 18 0 43124-Dec-13 Tue 15 16 25 24 16 0 20 19 17 20 26 20 29 26 0 27 25 28 26 22 18 0 41925-Dec-13 Wed 15 16 25 16 16 0 15 11 17 20 26 20 25 22 0 23 21 23 21 14 18 0 36426-Dec-13 Thu 15 16 25 16 16 0 15 11 17 20 26 20 25 22 0 23 21 23 21 14 18 0 36427-Dec-13 Fri 15 16 25 16 16 0 15 11 17 20 26 20 29 26 0 27 25 23 21 14 18 0 38028-Dec-13 Sat 15 16 25 16 16 0 15 11 17 20 26 20 29 26 0 27 25 23 21 14 18 0 38029-Dec-13 Sun 15 16 25 16 16 0 15 11 17 20 26 20 29 26 0 27 25 28 26 22 18 0 39830-Dec-13 Mon 15 16 25 16 16 0 15 11 17 20 26 20 29 26 0 27 25 28 26 22 18 0 39831-Dec-13 Tue 15 16 25 16 16 0 15 11 17 20 26 20 29 26 0 27 25 28 26 22 18 0 39801-Jan-14 Wed 15 16 25 16 16 0 15 11 17 20 26 20 29 26 0 27 25 28 26 22 18 0 39802-Jan-14 Thu 15 16 25 16 16 0 15 11 17 20 26 20 29 26 0 27 25 28 26 22 18 0 39803-Jan-14 Fri 15 16 25 16 16 0 15 11 17 20 26 20 29 26 0 27 25 28 26 22 22 0 40204-Jan-14 Sat 15 16 25 16 16 0 15 11 17 20 26 20 29 26 0 27 25 28 26 22 22 0 40205-Jan-14 Sun 15 16 30 16 16 0 15 11 17 20 26 20 29 26 0 27 25 28 26 22 22 0 40706-Jan-14 Mon 15 16 30 24 16 0 24 11 27 20 26 20 29 26 22 19 25 28 26 22 22 0 44807-Jan-14 Tue 15 16 30 24 16 0 24 11 27 20 26 20 29 26 22 19 25 28 26 22 22 0 44808-Jan-14 Wed 15 16 30 24 16 0 24 11 27 20 26 20 29 26 22 19 25 28 26 22 22 0 44809-Jan-14 Thu 15 16 30 24 16 0 24 11 27 20 26 20 29 26 22 19 25 28 26 22 22 0 44810-Jan-14 Fri 15 16 30 24 16 0 24 11 27 20 26 20 29 26 22 19 25 28 26 22 22 0 44811-Jan-14 Sat 15 16 30 24 16 0 24 11 27 20 26 20 29 26 22 19 25 28 26 22 22 0 44812-Jan-14 Sun 20 16 30 24 16 0 24 11 27 20 26 20 29 26 22 19 25 28 26 22 22 0 45313-Jan-14 Mon 20 20 33 24 16 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 47614-Jan-14 Tue 20 20 33 24 16 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 47615-Jan-14 Wed 20 20 33 24 16 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 47616-Jan-14 Thu 20 20 33 24 16 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 47617-Jan-14 Fri 20 20 33 24 16 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 47618-Jan-14 Sat 20 20 33 24 16 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 47619-Jan-14 Sun 20 20 33 24 16 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 47620-Jan-14 Mon 20 20 33 24 20 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 48021-Jan-14 Tue 20 20 33 24 20 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 48022-Jan-14 Wed 20 20 33 24 20 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 48023-Jan-14 Thu 20 20 33 24 20 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 48024-Jan-14 Fri 20 20 33 24 20 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 48025-Jan-14 Sat 20 20 33 24 20 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 48026-Jan-14 Sun 20 20 33 24 20 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 48027-Jan-14 Mon 20 20 33 24 20 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 48028-Jan-14 Tue 20 20 33 24 24 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 48429-Jan-14 Wed 20 20 33 24 24 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 48430-Jan-14 Thu 20 20 33 24 24 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 48431-Jan-14 Fri 20 20 33 24 24 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 48401-Feb-14 Sat 20 20 33 24 24 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 48402-Feb-14 Sun 20 20 33 24 24 0 24 23 27 24 26 20 29 26 22 19 25 28 26 22 22 0 48403-Feb-14 Mon 24 20 33 24 24 9 24 23 27 24 26 20 29 26 22 27 25 28 26 22 22 18 523
111
Older Peoples Health Tota
ra
Aw Ma Rang Rem Totara
25 24 28 22 2425 24 28 22 24 01-Dec-13 Sun25 24 28 22 24 02-Dec-13 Mon25 24 28 22 24 03-Dec-13 Tue25 24 28 22 24 04-Dec-13 Wed25 24 28 22 24 05-Dec-13 Thu25 24 28 22 24 06-Dec-13 Fri25 24 28 22 24 07-Dec-13 Sat25 24 28 22 24 08-Dec-13 Sun25 24 28 22 24 09-Dec-13 Mon25 24 28 22 24 10-Dec-13 Tue25 24 28 22 24 11-Dec-13 Wed25 24 28 22 24 12-Dec-13 Thu25 24 28 22 24 13-Dec-13 Fri25 24 28 22 24 14-Dec-13 Sat25 24 28 22 24 15-Dec-13 Sun25 24 28 22 24 16-Dec-13 Mon25 24 28 22 24 17-Dec-13 Tue25 24 28 22 24 18-Dec-13 Wed25 24 28 22 24 19-Dec-13 Thu25 24 28 22 24 20-Dec-13 Fri21 24 16 22 24 21-Dec-13 Sat21 24 16 22 24 22-Dec-13 Sun21 24 16 22 24 23-Dec-13 Mon21 24 16 22 10 24-Dec-13 Tue21 24 16 22 10 25-Dec-13 Wed21 24 16 22 10 26-Dec-13 Thu21 24 16 22 10 27-Dec-13 Fri21 24 16 22 10 28-Dec-13 Sat21 24 16 22 10 29-Dec-13 Sun21 24 16 22 10 30-Dec-13 Mon21 24 16 22 10 31-Dec-13 Tue21 24 16 22 10 01-Jan-14 Wed21 24 16 22 10 02-Jan-14 Thu21 24 16 22 10 03-Jan-14 Fri21 24 16 22 10 04-Jan-14 Sat21 24 16 22 10 05-Jan-14 Sun25 24 28 22 15 06-Jan-14 Mon25 24 28 22 15 07-Jan-14 Tue25 24 28 22 15 08-Jan-14 Wed25 24 28 22 15 09-Jan-14 Thu25 24 28 22 15 10-Jan-14 Fri25 24 28 22 15 11-Jan-14 Sat25 24 28 22 15 12-Jan-14 Sun25 24 28 22 24 13-Jan-14 Mon25 24 28 22 24 14-Jan-14 Tue25 24 28 22 24 15-Jan-14 Wed25 24 28 22 24 16-Jan-14 Thu25 24 28 22 24 17-Jan-14 Fri25 24 28 22 24 18-Jan-14 Sat25 24 28 22 24 19-Jan-14 Sun25 24 28 22 24 20-Jan-14 Mon25 24 28 22 24 21-Jan-14 Tue25 24 28 22 24 22-Jan-14 Wed25 24 28 22 24 23-Jan-14 Thu25 24 28 22 24 24-Jan-14 Fri25 24 28 22 24 25-Jan-14 Sat25 24 28 22 24 26-Jan-14 Sun25 24 28 22 24 27-Jan-14 Mon25 24 28 22 24 28-Jan-14 Tue25 24 28 22 24 29-Jan-14 Wed25 24 28 22 24 30-Jan-14 Thu25 24 28 22 24 31-Jan-14 Fri25 24 28 22 24 01-Feb-14 Sat25 24 28 22 24 02-Feb-14 Sun25 24 28 22 24 03-Feb-14 Mon
112
IV. Women’s Health
Ward 96 & 98 Normal beds: Ward 96 – 21 beds, Ward 98 – 23 beds
Fully open – flex down if occupancy permits
0
5
10
15
20
25
30
35
40
45
50
1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031 1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829
Dec Jan Feb
Womens Health Occupants on 96 + 98
2010/112011/122012/13
113
Ward 97
Normally 22 beds
↓ 24 December 2013 Tuesday PM closes to 12 beds but flex down more if occupancy permits
↑13 January Monday AM fully open to 22 beds
0
5
10
15
20
25
1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031 1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829
Dec Jan Feb
Womens Health Occupants on 97
2010/112011/122012/13
114
Tamaki Normally 33 beds (39 physical beds)
↓ 24 December 2013 Tuesday PM closes to 27 beds but flex down more if occupancy permits
↑ 3 January Friday AM fully open to 33 beds
0
5
10
15
20
25
30
35
40
1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031 1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829
Dec Jan Feb
Womens Health Occpants on Tamaki
2010/11 2011/12 2012/13
115
V. Starship Children’s Health
Overall Plan The Bed plan covers the period from the beginning of November 2013 to 21 January 2014. There is reduced bed capacity (and flexibility) from the 1st November until mid December with the closure of ward 24B (relocation to 25A) for refurbishment. From mid December when reduced bed demand is forecasted we will match capacity with the forecasted demand. This will enable ward areas to flex down bed requirements and staff through this period.
Risks The second week of November is a risk with predicted occupancy is greater than available beds due to lost flexibility with Ward 25A. Contingency is planned with the potential utilisation of Ward 31 overnight for this period.
Unpredicted variation of seasonal patterns of illness and higher than expected presentations of non accidental injury (which are traditionally higher at this time of year) are potentially an unquantified risk. Occupancy requirements to flex beds and staffing resource if this occurs will require monitoring as per the escalation plan.
116
Starship Children’s Health Bed Numbers from 1st November 2013– 3 February 2014 Wards Beds 1 Nov –
20 December
21 -24 December
25 -26 December
27 -31 December
1-2 January
3 – 5 January
6 - 12 January
13 - 19 January
21 -31 January
27B 19 19 15 15 15 15 15 17 19 19 26A (4 IOA)
16 16 16 12 12 12 16 12 16 16
26B 22 22 12 16 16 12 12 18 22 22 25B 20 24 15 15 15 15 15 20 20 20 25A summer model
0-5 21 Closed Closed Closed Closed Closed Closed Closed closed
24A 25 25 20 16 20 14 20 20 25 25 24B 24 Closed 20 16 20 14 20 20 24 24 23B (4 IOA)
17 17 12 10 12 10 12 12 12 17
DSU Open Closed Closed Closed Closed Closed Open Open Open Total 143-
148 144 110 100 110 92 110 119 138 142
NICU 40 40 40 40 40 40 40 40 40 40 PICU 16 16 16 16 16 16 16 16 16 16 Total 199
-204 198 166 156 166 148 166 175 194 198
117
VI. Staffing Process
Page 1
Summer Plan Staffing Process Adult Health, Women & Children's Health
20th December 2013 – 31st January 2014
Duty Manager to assess occupancy of hospital and staffing resource required
Hospital Occupancy and resource needs allow Staff
to take ad hoc leave?YES
Duty Manager to inform Charge Nurse / Coordinator that leave
can be granted
Staff who have indicated preference for ad hoc leave
on staffing sheet to be contacted at earliest
opportunityE.g.; evening before a
morning shift.
NO
Duty Manager to redeploy staff to area
which requires resource
Note; Only those Staff Members who have indicated a preference for annual leave should be contacted. This does not mean the Staff member is automatically obliged to take leave ,
agreement requires to be sought from the Staff member by the Duty Manager or Charge Nurse on a case by case basis.
Should staffing resource be over the needs of Hospital Occupancy this will mean Staff will be deployed to an area where annual leave may have been granted.
Charge Nurses to inform Staff that ad hoc annual leave will be available based on occupancy of hospital.
Charge Nurses/ Coordinators to identify on staffing sheets those staff members prepared to take annual leave on a
day to day basis.Charge Nurses to liaise with Duty Manager prior to granting ad hoc leave to assess needs of Hospital
October 2013
118
VII. Allied Health
For Adult services, there will be reduced staffing for all Allied Health disciplines between 23/12- 13/01/2014 in line with the reduced bed numbers.
GCC physiotherapy outpatient service is closed 25/12/13 until 3/01/2014 reopening on 6/01/2014.
Allied Health services Ward 63 which will be closed throughout January. During this time the Ward 63 Allied Health staff will support OPH. Normal annual leave will be approved over this time to ensure an appropriate service can be maintained.
VIII. Pharmacy
Christmas 2013 Hours - Pharmacy
L6 inpatient PAPU ACH Retail GCC RetailMon 23rd open open open openTue 24th open open open openWed 25th closed closed open closedThu 26th closed open 8-1 open closedFri 27th open open open closedSat 28th open8-12 open 8-1 open closedSun 29th closed closed open closedMon 30th open open open closedTue 31st open open open closedWed 1st closed open 8-1 open closedThu 2nd closed open 8-1 open closedFri 3rd open open open openSat 4th open 8-12 closed open closedSun 5th closed closed open closed
119
IX. Appendix
Clinic schedule December 2013 – January 2014
Dec-Jan 2013 Mo Tu We Th Fr Mo Tu We Th Fr Mo Tu We Th Fr Mo Tu We Th Fr Mo Tu We Th Fr Mo TuACH 16 17 18 19 20 23 24 25 26 27 30 31 1 2 3 6 7 8 9 10 13 14 15 16 17 20 21Gen Surg openRespiratory closed acute service continuesCardiothoracic acutesORLGen MedHead and NeckNeurosurgeryImmunlogyInfect DiseasesLiver except transplant continues throughoutRenal except transplant continues throughoutGastroGCCRespiratoryGastroRenalLiverOral HealthDermatologyGen surgGastroRespiratoryCardiologyColposcopyEDUGynaeUrologyORLDiabetesRheumatologyEndocrinologyOpthamology Urgent and Acutes only daily (Totara ward on stats and weekends)Orthopaedics# # clinic & urgent FU 23 & 24 Dec # clinic AM 27/12 2 clinicsSexual HealthTARPSAnaes clinic Reduced service week 6th Jan/full service 13thSSHOrthopaedics#AudiologySSH OPDGen Paeds
120
Starship Operating Rooms
Starship Operating Rooms
Available Operating Rooms 23th Dec 13- 13th Jan 14
OR1 OR2 OR3 OR4 OR5 OR6 OTF Date Day am pm am pm am pm am pm am pm 16/12/2013 Mon Normal Acutes Acutes Normal Normal Normal Cardiac All Day 17/12/2013 Tue services Acutes Acutes services services Cardiac Cardiac Cardiac All Day 18/12/2013 Wed all week Acutes Acutes all week all week services Cardiac All Day 19/12/2013 Thu Acutes Acutes all week Cardiac All Day 20/12/2013 Fri Acutes Acutes Cardiac All Day 21/12/2013 Sat Acutes Acutes 22/12/2013 Sun Acutes Acutes 23/12/2013 Mon Acutes ONC Acutes Acutes Acutes Acutes Cardiac All Day 24/12/2013 Tue Acutes Acutes Acutes Acutes Acutes Acutes Cardiac All Day 25/12/2013 Wed Public Holiday Acutes Acutes Public Holiday Public Holiday Public Holiday Public Holiday Public Holiday 26/12/2013 Thu Public Holiday Acutes Acutes Public Holiday Public Holiday Public Holiday Public Holiday Public Holiday 27/12/2013 Fri Acutes Acutes Acutes Acutes Cardiac All Day 28/12/2013 Sat Acutes Acutes 29/12/2013 Sun Acutes Acutes 30/12/2013 Mon OTF ONC Acutes Acutes Acutes Acutes Cardiac 31/12/2013 Tue Acutes OTF Acutes Acutes Acutes Acutes Cardiac 1/01/2014 Wed Public Holiday Acutes Acutes Public Holiday Public Holiday Public Holiday Public Holiday Public Holiday 2/01/2014 Thu Public Holiday Acutes Acutes Public Holiday Public Holiday Public Holiday Public Holiday Public Holiday 3/01/2014 Fri Acutes Acutes Acutes Acutes Cardiac All Day 4/01/2014 Sat Acutes Acutes 5/01/2014 Sun Acutes Acutes 6/01/2014 Mon Elective ONC Acutes Acutes Elective Elective Cardiac All Day 7/01/2014 Tue Elective Elective Acutes Acutes Elective Elective Cardiac All Day 8/01/2014 Wed Acutes Acutes Elective Elective Elective Elective Cardiac All Day 9/01/2014 Thu ONC ONC Acutes Acutes Elective Elective Cardiac All Day 10/01/2014 Fri Acutes Acutes Elective Elective Acutes Acutes Cardiac All Day 11/01/2014 Sat Acutes Acutes 12/01/2014 Sun Acutes Acutes 13/01/2014 Mon Normal Normal Normal Normal Normal Normal Normal services services services services services services services
121
Week C Elective Services Jan 2014
OR1 OR 2
OR 3
OR 4
OR 5
OR6
OTF
Mon AM 06/01 PM Week C
Gastro ONC
Acutes All day
Closed Ortho Ortho
Closed Cardiac All Day
Tues AM 07/01 PM
Dental Respiratory
Acutes All Day
Gen Gen
Closed Closed Cardiac All Day
Wed AM 08/01 PM
Closed Acutes All Day
ORL ORL
Ortho Ortho
Closed Cardiac All Day
Thurs AM 09/01 PM
ONC ONC
Acutes All Day
Gen Gen
Closed Closed Cardiac All Day
Fri AM 10/01 PM
Closed Acutes All day
ORL ORL
Acutes All day
Closed Cardiac All Day
• Please note that the OR that the session is booked into may change according to annual cleaning maintenance
• Elective services are reduced this week and electives offered to a service may not equal normal schedules • Normal OR schedules resume Week D Jan 13th 2014 • No inservice Friday AM, start time is 0830 as per norm
122
Level 4 Theatre Schedule
SSTOR5 SSTOR6 OR Manager20-Dec Friday Normal service for ORL, Cardiac and PAED Cardiac
21-Dec Saturday Acute Acute 22-Dec Sunday Acute Acute23-Dec Monday AM ACHD CTSU CTSU CTSU ORL ORL CLOSED Cardiac Acutes
A 23-Dec Monday PM ACHD CTSU CTSU CTSU ORL ORL CLOSED Cardiac Acutes24-Dec Tuesday AM CTSU CTSU CTSU CTSU ORL ORL CARDIAC Cardiac Acutes24-Dec Tuesday PM Acute Acute Acute Acute CLOSED Acutes ORL ACUTES Cardiac Acutes25-Dec Wednesday Acute Public Holiday Acute26-Dec Thursday Acute Public Holiday Acute27-Dec Friday AM CTSU CTSU CLOSED CLOSED CLOSED Acutes ORL CLOSED Cardaic27-Dec Friday PM CTSU CTSU CLOSED CLOSED CLOSED Acutes ORL CLOSED Cardiac28-Dec Saturday AM Acute29-Dec Sunday PM Acute30-Dec Monday AM CLOSED CTSU CTSU CLOSED CLOSED Acutes ORL CLOSED Cardiac 30-Dec Monday PM CLOSED CTSU CTSU CLOSED CLOSED Acutes ORL CLOSED Cardiac 31-Dec Tuesday AM CLOSED CTSU CTSU CLOSED CLOSED Acutes ORL CLOSED Cardiac 31-Dec Tuesday PM CLOSED CTSU CTSU CLOSED CLOSED Acutes ORL CLOSED Cardiac
1-Jan Wednesday Acute Public Holiday Acute2-Jan Thursday Acute Public Holiday Acute3-Jan Friday AM CTSU CTSU CLOSED CLOSED CLOSED Acutes ORL Closed Cardiac 3-Jan Friday PM CTSU CTSU CLOSED CLOSED CLOSED Acutes ORL Closed Cardiac 4-Jan Saturday Acute5-Jan Sunday Acute6-Jan Monday AM CLOSED CTSU CTSU CTSU CLOSED ORL CLOSED Cardiac 6-Jan Monday PM CLOSED CTSU CTSU CTSU CLOSED ORL CLOSED Cardiac 7-Jan Tuesday AM CLOSED CTSU CTSU CTSU CLOSED ORL CLOSED Cardiac 7-Jan Tuesday PM CLOSED CTSU CTSU CTSU CLOSED ORL CLOSED Cardiac 8-Jan WednesdayAM CLOSED CTSU CTSU CTSU CLOSED ORL CLOSED Cardiac 8-Jan WednesdayPM CLOSED CTSU CTSU CTSU CLOSED ORL CLOSED Cardiac 9-Jan Thursday AM CLOSED CTSU CTSU CTSU CLOSED ORL CLOSED Cardiac 9-Jan Thursday PM CLOSED CTSU CTSU CTSU CLOSED ORL CLOSED Cardiac
10-Jan Friday AM CLOSED CTSU CTSU CTSU CLOSED ORL CLOSED Cardiac 10-Jan Friday PM CLOSED CTSU CTSU CTSU CLOSED ORL CLOSED Cardiac 11-Jan Saturday AM Acute12-Jan Sunday PM Acute13-Jan Monday AM13-Jan Monday PM
D 14-Jan Tuesday AM
Colour KeyWeekend Public Holid Closed Theatre Closed Theatre Open Normal Service
Normal service for PAED CARDIAC resumes MONDAY 3RD FEBRUARY
C
Normal service for CTSU and ORL resumes
123
Level 8
20-Dec Friday21-Dec Saturday TX Ortho Acute Acute22-Dec Sunday TX Ortho Acute Acute23-Dec Monday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives TX Closed Ortho Acute Acute Closed Closed Closed24-Dec Tuesday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives TX Closed Ortho Acute Acute Closed Closed Closed25-Dec Wednesday Closed Closed Closed Closed Closed Closed Closed Closed TX Closed Ortho Acute Acute Closed Closed Closed26-Dec Thursday Closed Closed Closed Closed Closed Closed Closed Closed TX Closed Ortho Acute Acute Closed Closed Closed27-Dec Friday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives TX Closed Ortho Acute Acute Closed Closed Closed28-Dec Saturday TX Ortho Acute Acute29-Dec Sunday TX Ortho Acute Acute30-Dec Monday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives TX Closed Ortho Acute Acute Closed Closed Closed31-Dec Tuesday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives TX Closed Ortho Acute Acute Closed Closed Closed
1-Jan Wednesday Closed Closed Closed Closed Closed Closed Closed Closed TX Closed Ortho Acute Acute Closed Closed Closed2-Jan Thursday Closed Closed Closed Closed Closed Closed Closed Closed TX Closed Ortho Acute Acute Closed Closed Closed3-Jan Friday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives TX Closed Ortho Acute Acute Closed Closed Closed4-Jan Saturday TX Ortho Acute Acute5-Jan Sunday TX Ortho Acute Acute6-Jan Monday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives Electives/TX Electives Ortho Acute Acute Closed Normal Service Normal Service7-Jan Tuesday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives Electives/TX Electives Ortho Acute Acute Closed Normal Service Normal Service8-Jan Wednesday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives Electives/TX Electives Ortho Acute Acute Closed Normal Service Normal Service9-Jan Thursday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives Electives/TX Electives Ortho Acute Acute Closed Normal Service Normal Service
10-Jan Friday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives Electives/TX Electives Ortho Acute Acute Closed Normal Service Normal Service11-Jan Saturday TX Ortho Acute Acute12-Jan Sunday TX Ortho Acute Acute13-Jan Monday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives Electives/TX Electives Ortho Acute Acute Closed Normal Service Normal Service14-Jan Tuesday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives Electives/TX Electives Ortho Acute Acute Closed Normal Service Normal Service15-Jan Wednesday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives Electives/TX Electives Ortho Acute Acute Closed Normal Service Normal Service16-Jan Thursday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives Electives/TX Electives Ortho Acute Acute Closed Normal Service Normal Service17-Jan Friday Electives Closed Electives Electives Electives Closed/ Bldg Closed/ Bldg Electives Electives/TX Electives Ortho Acute Acute Closed Normal Service Normal Service18-Jan Saturday TX Ortho Acute Acute19-Jan Sunday TX Ortho Acute Acute
C 20-Jan Monday
ORDA AACNormal services all week for all services
Resume normal services all week for all services
A8OR13A8OR09 A8OR10 A8OR11 A8OR12A8OR08Week Session A8OR07A8OR04 A8OR05 A8OR06A8OR02 A8OR03Operating Days A8OR01
D
A
B
C
124
Level 9
19-Dec Thursday AM Gynae19-Dec Thursday PM Gynae20-Dec Friday AM20-Dec Friday PM
Sat Saturday AcuteSun Sunday Acute
23-Dec Monday AM Whittaker (Onc) Closed Acute23-Dec Monday PM Whittaker (Onc) Closed Acute24-Dec Tuesday AM Acute24-Dec Tuesday PM Acute25-Dec Wednesday Closed Closed Closed Acute26-Dec Thursday Closed Closed Closed Acute27-Dec Friday AM Closed Closed Acute Closed27-Dec Friday PM Closed Closed Acute Closed
Sat Saturday AcuteSun Sunday Acute
30-Dec Monday AM Eva (Onc) Closed Acute30-Dec Monday PM Eva (Onc) Closed Acute31-Dec Tuesday AM Closed Closed31-Dec Tuesday PM Closed Closed Acute
1-Jan Wednesday Closed Closed Closed Acute2-Jan Thursday Closed Closed Closed Acute3-Jan Friday AM Closed Closed Acute3-Jan Friday PM Closed Closed Acute
Sat Saturday AcuteSun Sunday Acute
6-Jan Monday AM Tan (Onc) Closed Acute6-Jan Monday PM Tan (Onc) Closed Acute7-Jan Tuesday AM Eva (Onc) Closed Acute7-Jan Tuesday PM Eva (Onc) Closed Acute8-Jan Wednesday AM Closed Closed Acute8-Jan Wednesday PM Closed Closed Acute9-Jan Thursday AM Closed Closed Acute Gynae9-Jan Thursday PM Closed Closed Acute Gynae
10-Jan Friday AM Closed Closed LSCS x 3 Acute Normal Clinic (6)10-Jan Friday PM Closed Closed Acute
Sat SaturdaySun Sunday
D 13-Jan Monday AM
LSCS x 5
LSCS x 5
LSCS x 5
LSCS x 5
LSCS x 5
Week Operating days Session
B
C
A
Gynae Pre Admit Clinics
Maternity Pre-Admit Clinics
Resume normal services all week for all services
Normal services all week for all services
A9OR01 A9OR02 A9OR03 A9OR04Normal services all week for all servicesNormal services all week for all services
LSCS x 5
LSCS x 5
Super Clinic (15)
Normal Clinic (12)
Super Clinic (15)
Super Clinic (15)
LSCS x 5
LSCS x 5
Normal services all week for all services
LSCS x 5
125
Endoscopy Department Schedule
Endoscopy Department Schedule 20th December 2013 - 13th January 201420-Dec-13 Fri GCC Endoscopy ACH Endoscopy21-Dec-13 Sat Closed on call service22-Dec-13 Sun Closed on call service23-Dec-13 Mon Closed Full service24-Dec-13 Tue Closed Full service25-Dec-13 Wed Closed on call service26-Dec-13 Thu Closed on call service27-Dec-13 Fri Closed Acute list28-Dec-13 Sat Closed on call service29-Dec-13 Sun Closed on call service30-Dec-13 Mon Closed Acute list31-Dec-13 Tue Closed Acute list01-Jan-14 Wed Closed on call service02-Jan-14 Thu Closed on call service03-Jan-14 Fri Closed Acute list04-Jan-14 Sat Closed on call service05-Jan-14 Sun Closed on call service06-Jan-14 Mon Closed Full service07-Jan-14 Tue Closed Full service08-Jan-14 Wed Closed Full service09-Jan-14 Thu Closed Full service10-Jan-14 Fri Closed Full service11-Jan-14 Sat Closed on call service12-Jan-14 Sun Closed on call service13-Jan-14 Mon Full service Full service
On-call Gastro nurses phone 021 884 642On-call Gastro Reg phone 021 884 631
126
8
QUALITY UPDATES
8.1 Compliment Report
8.2 Quality Overview
127
128
8.1 Compliment Report
129
130
Confidential 05/12/2013 Page 1
ADHB Compliments - Weekly Report Compliments: November 2013
Date Received
Method Compliment From Patient or
Family of Patient
Description (Excerpts taken from patient comments)
Staff & Areas Notified Management Notified
4/11/2013 Email Patient’s relative (on behalf of patient)
The care for patient by the team at FMU is outstanding. Their kind, compassionate, firm and decisive care has made the incredibly difficult and challenging time manageable. Grateful that they could engage the services of a private physiotherapist.
Psychiatrist
Social Worker
Staff of Fraser Macdonald Unit
CMO
CNO
5/11/2013 Email Patient A big thank you to the ED for saving my life, I was glad that I came in for treatment for an allergic reaction as I had no idea that it would become life threatening. The team worked so well and quickly and my family (including my 9 month old baby) and I are very grateful to you all.
Staff of Emergency Department (Adult)
CMO
CNO
6/11/2013 Letter Patient The entire team in DCCM provided impeccable medical, nursing and auxiliary care, they are well staffed, have willing hearts and clever minds, they work in an entrenched team approach culture and they saved my husband’s life. A health professional stood out, her knowledge of physiology, anatomy and psychology is profound and my family wishes to commend her.
Staff of DCCM
Staff of Ward 76
Staff of Ward 78
Physiotherapist
CMO
CNO
7/11/2013 Email (copied to Hon Tony Ryall)
Patient Writing to congratulate Hon Tony Ryall for the wonderful health team and the wonderful procedure completed. The appointments which went very smoothly and I was looked after superbly. The whole experience was absolutely perfect. The surgeon and the support team that looked after me were just world class and I could not have asked for better care. At the clinic everyone whom I encountered that worked there were all amazing and took everything in their stride and were so professional. Well done and thank
Staff of Totara Ward CMO
CNO
131
Confidential Page 2 05/12/2013
Date Received
Method Compliment From Patient or
Family of Patient
Description (Excerpts taken from patient comments)
Staff & Areas Notified Management Notified
you. The operation has been an outstanding success.
7/11/2013 Letter Patient Sincerely thank you for all your dedicated care. It is indeed wonderful to have dedicated health professionals who care for you.
Staff of Ward 97
SMO – Med Oncology
Consultant - Gynaecology
Consultant - Anaesthetist
Staff Nurses
Pain Team
Women’s Physiotherapist
CMO
CNO
12/11/2013 Letter Anonymous Patient
Impressed with the care and service all staff provided when I was a patient. Pleasant receptionist at the ORDA made me feel calm; the theatre nurse kept an eye on me and the recovery was brilliant.
A big thank you to all the nurses in Ward 97, they were extremely professional, understanding. I cannot thank them enough for the wonderful job they did looking after me.
Fellow Women’s Health
Staff Nurse, Theatres Level 9, Women’s Health
Nurses - Ward 97
CMO
CNO
18/11/2013 Thank you note Patient To the delivery team who brought our little boy safely into the world. After 18 days in NICU we get to take baby home, thank you so much for your amazing work, care and support, we are incredibly thankful.
Staff of Ward 91
Staff of Labour & Birthing Suite.
Private Specialist
Cardiologist
Staff Nurse
CMO
CNO
19/11/2013 Letter Patient I was a patient in your ward and I want to express my admiration and appreciation for the wonderful treatment I received from the staff. I had developed a heart problem and I was transferred to Auckland City Hospital for monitoring, I never realised how hard nurses had to work. Unintentionally I was messy and troublesome patient but they looked after me as though I was a
Staff of Ward 63
Staff of Ward 34 CCU
CMO
CNO
132
Confidential Page 3 05/12/2013
Date Received
Method Compliment From Patient or
Family of Patient
Description (Excerpts taken from patient comments)
Staff & Areas Notified Management Notified
friend they had known from long time. You have a great team working for you. I am very grateful.
19/11/2013 Letter Patient I completed 37 radiation treatments at your hospital and would like you to know what fabulous staff you have working in this department. We drove to Warkworth each day to be greeting by receptionist who is the perfect person behind the desk, always helpful, cheerful and efficient. Well done Auckland City Hospital, we are so lucky to have a health system as we have in our country.
Staff of Oncology- Radiotherapy
Radiation Therapists
Receptionist
CMO
CNO
20/11/2013 Letter Patient’s mother My sincere and deepest thanks to all the staff that cared for my son during his stay. The care and respect he received during his stay was exceptional. As a mother and going through an unexpected and scary illness, I cannot express enough how frightening it is and the difference it makes for not only the patient but also their families when you receive such excellent treatment from the staff who were great to my son and the family, they were always friendly, chatty and helpful.
Staff of Ward 66
Staff of Ward 81
Staff Nurse
Neurologist
Clinical Nurse Manager
CMO
CNO
21/11/2013 Letter Patient When admitted to ED, initially the admission staff were a little sceptical as I wasn’t in obvious physical discomfort nor ill. However I was brought in which was great. I was promptly seen by a nurse who was polite, professional and friendly. The doctor was also very polite, professional, friendly and clearly genuinely cared about the wellbeing of patients.
Staff of Emergency Department
Emergency Doctor
ED Nurse
CMO
CNO
21/11/2013 Letter Patient Thanks to everyone who were involved in my operation and stay. Before the stay I could not imagine how difficult and important their role is, they were ready to help at any moment, giving important advices and explanations about health
Staff of Ward 41
Staff of Ward 42
Cardiothoracic Surgeon
Staff of Ward 48
CMO
CNO
Commercial Manager
133
Confidential 05/12/2013 Page 4
Date Received
Method Compliment From Patient or
Family of Patient
Description (Excerpts taken from patient comments)
Staff & Areas Notified Management Notified
and recovery. I was surprised how their personal approach to each patient made me feel much safer. Regarding cuisine, I was surprised how many choices were available.
Nutrition Services Manager
21/11/2013 Feedback Form Patient’s Father The outpatient team were helpful, professional at all times. The Paed Ortho Floater advised us throughout and was very professional, easy to deal with and clearly knowledgeable expert in his advice, overall the team was great.
Staff of Ortho Outpatients SSH
Paed Ortho Floater
CMO
Director, Child Health
22/11/2013 Feedback form Anonymous Patient relative
Would like to commend (orderly) for her service and caring nature throughout our stay would nominate her if you had an employee of the month/week. Also would like to commend Nurse for her excellent service, she would check on my daughter every hour. Staff nurses were very polite and caring. Thank you for your kind words and reassurance that my daughter would be in good hands when she moved to another level, it brought peace to my mind.
Staff of Ward 24B
Orderly
Staff Nurses
CMO
Director, Child Health
22/11/2013 Email Patient I could not fault the treatment/care given to me from all staff. I was sick but was comforted by the fact that I was looked after by professionals. The main observations in day to day goings in my room the main was the respect that each and every one if us was given. My heartfelt thanks to you all.
Staff of Emergency Department
Staff of APU
Staff of Ward 72
Staff of Ward 65
CMO
CNO
22/11/2013 Letter Patient (reply from Hon Tony Ryall)
Most satisfied with the care that the staff from both NSH & ACH provided.
Staff of Emergency Department
Staff of APU
Staff of Ward 77
Consultant
CMO
CNO
22/11/2013 Letter Patient Thank you for scheduling my operation, it seems to have been a success. I was very impressed with the excellent professionalism of through care. I found all the staff very pleasant and respectful. Please congratulate yourselves on your high
Staff of Totara Ward CMO
CNO
134
Confidential 05/12/2013 Page 5
Date Received
Method Compliment From Patient or
Family of Patient
Description (Excerpts taken from patient comments)
Staff & Areas Notified Management Notified
standards and excellent process.
22/11/2013 Thank you note Patient’s relative Thank you to all the people who work on ward 63 for the wonderful care given to our father/grandfather. He and the family were treated with kindness and compassion. We really appreciate the efforts of all to make his last days as pain free and comfortable as possible, kind regards and Bless you all- you are special people.
Staff of Ward 63 CMO
CNO
25/11/2013 Letter Patient I was an outpatient coming from South Island for an immediate operation on my eye. I arrived at 5:30pm and was immediately catered to by a team awaiting my arrival. I write to express my sincere thanks for the way in which my treatment was carried out by the three ophthalmologists involved and for the speed in which it was dealt to. Your aim to achieve the right mix of services for the people of Auckland city, while balancing the needs of people who live outside who need immediate medical attention was certainly in evidence in my case. Thanks you.
Ophthalmology team
Senior Medical Officer
Receptionist
CMO
CNO
25/11/2013 Email BTTS Coordinator (forwarded compliment from a patient)
Follow up phone call to son of deceased patient, he is gradually getting used to life without his mother. CN, Ward 65 was exceptional during his mothers’ final admission to ACH.
Coordinator BBTS
Nurse Specialist
CMO
CNO
26/11/2013 Thank you card Patient A huge thank you to the lovely midwife who took my call during the night and welcomed us to the unit. To all the staff that looked after us, you make a great team and we appreciate all your input
Midwife
Student Nurses
Consultant
Registrar
CMO
CNO
27/11/2013 Thank you note Patient’s relative This note is written in all sincerity. Please accept my warmest thanks for your kindness to my husband when he visited your clinic, he was unwell at the time and it was difficult for you, none the less you treated him with patience and courtesy. I
Senior Medical Officer CMO
CNO
135
Confidential Page 6 05/12/2013
Date Received
Method Compliment From Patient or
Family of Patient
Description (Excerpts taken from patient comments)
Staff & Areas Notified Management Notified
believe you and your team do a superb job, my praise and thanks to all.
28/11/2013 Letter Patient I was referred to Ophthalmology Dept. at Greenlane Clinical Centre. The consultant is very knowledgeable, skilful and kind. SMO did my cataract operations calmly and perfectly and now the visions in my eyes have recovered; now I can see the beautiful New Zealand.
Consultant CMO
CNO
136
Confidential Page 7 05/12/2013 Confidential Page 7 05/12/2013
137
138
8.2 Quality Overview
139
140
Report on
Re p or t
O ct obe r 2013
23
Auckland District Health Board : Executive Summary Patient Experience
Executive Summary Nutrition The report this month focuses on food. The hospital provides 3,000 meals each day and caters for 100 different dietary requirements. Nutrition Services points out that food choices and customs around meals are very personal. When sick, or on particular treatments or medications food may taste different and at home people may eat quite different types of food. Moreover, food in hospital is intentionally low in salt. Nonetheless, overall food ratings in the past year have not increased.
Rated food as very good or excellent (per cent)
• Of those who had food at hospital 44 per cent (43 per cent last October) rated it as good or very good. Over half, however, rated it as poor or fair.
• Over half of those (57 per cent) who had food did not always feel their dietary needs were being met.
• There appear to have been small gains in the percentage of people receiving assistance from staff to eat their meals. Over half of those who needed help to eat their meals either did not receive assistance (26 per cent, down from 30 per cent last year) or received it only sometimes (25 per cent, down from 29 per cent last year).
For those who identified food as one of the things that made the most difference to their care, and rated it negatively:
• 15 per cent commented that the food was bland • 12 per cent felt that the portion sizes were too small • 12 per cent wanted more fruit and vegetables • 11 per cent got incorrect orders. For some this was important as they had
allergies or cultural requirements that left them unable to eat their meals.
For those who identified food as one of the things that made the most difference to their care, and rated it positively:
• 42 per cent felt the food was generally good • 12 per cent felt that they were given good breakfast choices • 9 per cent felt that there was a good variety of food
It is noted, however, that the comments on food were not confined to observations on meals and nutrition. Patients appear to consider food to be an indicator of care and compassion. Hence in addition to the nutritional content of meals, they want:
• Incorrect orders corrected • Help if they are unable to eat their meals independently.
Remember:
• To make sure the Diet Colum on the ward whiteboard is up to date • That call back meals are available at any time of the day • If a patient is unhappy with meal services, to contact a menu processor
35 34 33 35 37 35 29
35 34 39 34 34
01020304050
TOP THREE Patients believe these things make the most difference to the quality of their care and treatment:
1 Communication (clear answers patients can understand)
48%
2 Feeling confident about the quality of their care and treatment
45%
3 Getting coordinated care 41%
PATIENT COMMENTS (on a 0-10 point scale where 0 is poor and 10 is excellent)
Rated food excellent (9-10) “There was a good choice on a daily menu.”
“I needed a diabetes diet and this was noted and adhered too.”
Rated Average (5-6) “I am a vegan and those needs were well met, however it was poorly prepared and on the whole tasteless.”
“I was always hungry, the serving sizes weren't big enough for me.”
“I kept being given meals containing meat despite being a vegetarian and the people bringing the food would run off before I could check to make sure I was able to eat my food which a couple times left me very unhappy due to how hungry I was. However the nurses were very good at sorting this out and I never went without food.”
Rated Poor (0-1) “The food was cold and soggy when delivered. I never had an option of fresh salad or vegetables with my main meal. The breakfast toast was limp and damp. Once my meal was delivered when I was asleep and when I woke up it had been sitting there for 30 minutes. Inedible. I had no fibre for three days and went home very constipated and feeling weak.”
ADHB Patient Experience Report no.23 October 2013: 1
141
PATIENTS’ VOICES
Rated overall care as excellent:
“The only thing was that the breakfast each day was delivered at about 8.45am each day and as a breast feeding mum I was absolutely starving by this time each morning. It would be great if breakfast came earlier or there was a snack area that patients could help themselves.”
“It was really useful having kitchen supplies for parents who were not prepared with food i.e. me and could make themselves some toast and a cup of tea.”
Rated overall care as good:
“RN wanted the beds emptied as quickly as possible before next intake of patients. Was taken to the Transition Lounge and waited until 2pm for a final IV antibiotic. Was advised that I could go to nearby shops for food & drink but I did not have any money with me so couldn't. I was given a coffee and one sandwich in the Transition Lounge.”
“The food was dumped in front of us and in front of others who could not manage themselves then taken away - people did not eat.”
Rated overall care as fair or poor:
“During my 3 visits to hospital I was between 16-18 weeks pregnant. A lot of the time I was kept nil my mouth at one point for over 36 hours waiting for an ultrasound, and at times wasn't even able to get IV fluids because there was no doctor around to chart it - which resulted in me feeling quite dehydrated.”
“When I was finally able to eat, I was offered either a ham or tuna sandwich, both of which carry higher risk of listeria and are not recommended foods to eat during pregnancy. I was treated without any respect by the nurses when I said that I couldn't eat that, and they said they'd never heard of anything so silly and why on earth couldn't I eat ham or tuna while pregnant (this happened twice with 2 different sets of nurses). In the end the only food I was able to get which was 'pregnancy-friendly' was toast.”
ADHB Patient Experience Report no.23 October 2013: 2
Nutrition The report this month focuses on food. Although patients had a lot to say about food, and it is an important part of healing, food does not appear to be strongly associated with overall patient experience ratings.
Nonetheless, good nutrition is an important part of healing. For some patients (6 per cent), their food and dietary needs made the most difference to their care and treatment.
Their comments suggest it is not just about food, but the attitude of staff who deliver meals, the willingness of staff to assist patients who need support to eat, and the responsiveness of staff to help patients who have missed meals, have been given incorrect meals, or who have other issues with the meal service that make a difference. Hence ratings appear to be as much about caring and compassion, as the content of the meals provided.
The ratings on food at ADHB suggest that patients would like meals that are not only nutritional, but tasty, varied and with lots of fresh fruit and vegetables.
Overall care and treatment In the past 12 months, almost 4,000 (3,923) patients have provided feedback about their experience via ADHB’s patient experience survey.
Almost half of ADHB patients (44 per cent) rate their overall care as excellent, and 84 per cent rate it as very good or excellent.
Overall care and treatment satisfaction by Health Service Group (%)
Overall n=3923
(Women’s Health n=966, Children’s Health n=822, Cardiac services n=223, Cancer and Blood n=141, Adult Health n=1771
Overall
Over the past 12 months the ratings have mainly ranged between 80% and 85%. On the whole, overall ratings have been improving from a low of 76% in April 2013. In September the overall rating was 84%.
Overall care and treatment rated very good and excellent (%)
2
0
0
1
2
2
4
4
1
5
4
4
12
6
4
14
10
11
39
39
29
40
39
39
43
51
65
41
46
44
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Adult HealthCancer & Blood
CardiacChildren's HealthWomen's Health
Overall
Poor Fair Good Very good Excellent
43 43 36 35 39 37 40 36 38
45 39 44
40
42 42 47 45 47 45 40 40 47 39 45 41 44
0
20
40
60
80
100
Sep-
12
Oct
-12
Nov
-12
Dec-
12
Jan-
13
Feb-
13
Mar
-13
Apr-
13
May
-13
Jun-
13
Jul-1
3
Aug-
13
Sep-
13
142
Focus area Patients who selected food as one of the things that made the most difference to their care were asked to rate how well ADHB performed on this dimension.
Overall, on an 11-point scale, where 0 is poor and 10 is excellent, most patients rated ADHB poorly. Almost two-thirds (63 per cent) rated the food and service as poor (rated 0-4). Twenty one per cent rated it as good (5-7) and 17 per cent as very good (8-10).
Rating (%)
n=373
“I am most grateful to be provided with food, however the sandwiches have not been good. If I'm being truthful they were awful (sorry)! One was salmon and cottage cheese mixed together (the texture is still in my memory). This time it was chicken and luncheon sausage mixed together. I didn't even try it. I had a chicken dinner with the tastiest gravy I had ever eaten! I would have loved a little more of the sauce not only because it was so nice, importantly my mouth was very dry after the anesthetic .Once again I'm sorry for sounding critical but this is a very honest account of my of my experience. A salad sandwich would be nice next time. Yogurt without sugar or artificial sweaters and natural fruit would help me to feel better.
20
12
13
11
7 10 5 6 8 4 5
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Rating
10
9
8
7
6
5
4
3
2
1
0
Food How are we doing? In the past 12 months one-quarter of patients (23 per cent) did not have hospital food. Around one third of all patients (35 per cent) and 46 per cent of those that had food rated it as good to very good. Over half of those who had food however, (57 per cent) rated it as poor (19 per cent) or fair (35 per cent).
How would you rate the hospital food (%) n=3964
Over half of the patients had dietary needs (57 per cent). One-quarter (28 per cent) of all patients (or 49 per cent of those with dietary needs) felt that their dietary needs were always met.
Did the food meet any dietary needs that you have (%) n=3049
Of those who needed help to eat their meals one quarter (26 per cent) felt that staff did not give them the help they needed to eat their meals. A further quarter (25 per cent) said they only got help they needed sometimes.
Did staff give you the help you needed to eat your meals (%) n=763
16
14
7
13
16
15
26
23
8
30
27
27
24
39
27
23
24
25
11
11
40
8
7
10
23 13
18 26 25 23
0% 20% 40% 60% 80% 100%
Adult HealthCancer & Blood
CardiacChildren's HealthWomen's Health
Overall
Poor Fair Good Very good Did not have any
10
8
6
11
8
9
20
28
13
22
19
20
29
23
40
26
26
28
42 41 41 41
47 43
0% 20% 40% 60% 80% 100%
Adult HealthCancer & Blood
CardiacChildren's HealthWomen's Health
Overall
No Sometimes Always Did not have needs
25
21
24
26
28
26
25
21
14
28
24
25
49
59
62
46
48
49
0% 20% 40% 60% 80% 100%
Adult HealthCancer & Blood
CardiacChildren's HealthWomen's Health
Overall
No Sometimes Always
ADHB Patient Experience Report no.23 October 2013: 3
143
What patients want Patients appear to look forward to their meals. Some are hungry at meal time and for others it appears to break up their day. Patients would like food that is:
• Tasty • Has fresh fruit and
vegetables , and • Is sufficient in portion
size.
They would also like:
• Incorrect orders to be corrected.
• Dietary requirements to be observed, respected and corrected when not
• Help if they are unable to eat their meals independently.
Recording patient diet needs
Remember to ensure the Diet Column on the Ward Whiteboard is up-to-date all the time and checked regularly. This information is used by the kitchen to get the right diet choices to the patient. Record in the whiteboard (as well as the clinical record) any special diet requirements including any food allergies. If urgent changes are required phone a menu processor on ext. 25657, 25659 to order a meal, or Fax a completed patient menu to ext. 25654.
Late Meals / Call-back Meals
A reminder that call-back meals are available at any time of the day. Hot dinner meals are available until 1900 hours. After that cold sandwich packs can be ordered on ext. 25657, 25659 until 2000 hours, when the kitchen closes. Duty Managers have access to the kitchen after hours, and can obtain cold meals or special feeds / formula.
Resolving problems
If a patient is unhappy with any aspect of their meal service please contact the Manager, Patient Meal Services ext. 22788, or a Food Supervisor on ext. 25658.
A closer look at: nutrition The survey invites patients to tell us what ADHB is doing well, and to give suggestions on anything we could do differently. Awareness of these issues can be used to help modify how we treat and care for our patients.
Almost four hundred people commented on the food and food service.
Improvements Over 300 patients (325) commented that the food needs to be improved.
The food was tasteless or bland (15%) “The food was unappetising. Everything tasted bland and there was the over-riding colour of brown. At no stage was there ever a piece of lettuce, tomato or cucumber on the plate. Salad was never even offered. I am not a fussy eater but all in my ward thought the food awful. Sorry to have to tell you this.”
The portion sizes were too small (12%) “The only time I was given fresh fruit it was a banana On the whole the food I would call "processed " rather than fresh and quantity always left me hungry.”
There needed to be more fruit vegetables and salads (12%) “Very little fresh - processed or pre-packed food including sometimes the egg and potato. I was desperate for some fresh and tasty and colourful food. The soup, apart from one adequate pumpkin soup, was thin, watery and clearly watered down packet soup. I think that food is super important in hospital for recovery. Lots of improvements could be made and so easily. What about some fresh fruit for breakfast and homemade vegetable soup for lunch!” The food orders were not correct (11%) “Half the time you don't get what you ask for anyway e.g. I consistently crossed out and wrote that I did not want breakfast and it still kept turning up”
• Allergies or requirements were not considered (10%)
• Meals were cold (8%) • The food lacked variety (7%) • The food was overcooked or dry
(7%) • The nutritional value was poor
(7%) • Generally inedible (6%) • Poor presentation (6%) • Disliked the breakfast e.g. toast
unappetising (5%) • Disliked the sandwiches (5%) • Lacked fibre (5%)
Strengths Some patients (76) gave positive feedback about the food.
The food was generally good (42%) “No complaints” “People always complaint about hospital food but I thought it was great, I have no complaints whatsoever. Well done chefs.” “I think the food provided was nutritious and healthy. Designed to be easily digested and help in the recovery of illness or injury. I am a vegetarian and would appreciate more variety for vegetarian meals but otherwise I think the food provided by Auckland Hospital is very good.”
Breakfast (12 %) Although many patients commented that the toast was cold and unpleasant to eat by the time it arrived on the ward, some patients commented that the breakfast options were good and the breakfast itself was nutritional. “Breakfast options were ok”. “I had breakfast and I felt it was a good nutritional meal and I really enjoyed it.”
There was good variety (9%) Some patients commented on the variety of food on offer. “I thought that in the main, the food was quite tasty, to me there was enough of it, and I liked that the main courses were varied. Before I left I was going to send a message to the kitchen that I was very pleased with the food, but unfortunately, I didn't get round to it!”
Enjoyed the lunch (8%) “Lunch meals were interesting and varied.”
Taste (5%) Although many commented that the food was bland and tasteless, some did not find it so.
“Food was tasty and served warm and good size of portion.”
Ice cream and jelly (5%) Although some patients noted that the ice cream had generally melted by the time it had arrived, others enjoyed it.
ADHB Patient Experience Report no23October 2013: 4
144
Noticeboard Patient Feedback “The care and treatment I received was excellent and I was always treated with respect. The staff were always friendly and helpful and I was very happy with the level of care I received”
Email addresses The Patient Experience survey is currently sent to in-patients that provide us with current email addresses. This means we need up to date email addresses for our patients.
You can help by making sure that:
Patient email addresses are collected and checked before discharge.
Email addresses are recorded accurately.
Let us know about the changes you are making We would like to hear how the Patient Experience reports are being used, and about any changes that are being made in response to this feedback.
We are particularly interested in hearing specific examples of changes you have made.
Please let us know at [email protected]
“Staff were excellent, compassionate, communicative and professional with an understanding and empathy which really helped me through some difficult patches”
“The care and treatment I received was excellent and I was always treated with respect. The staff were always friendly and helpful and I was very happy with the level of care I received.”
Admin Report
on
R e p or t
O ct ob e r 2 0 1 3
23 Auckland District Health Board
Patient Experience
ADHB Patient Experience Admin Report no.23 October 2013: 1
Executive Summary The October Patient Experience Report focuses on nutrition. This is the administrative report that gives background details such as the method used, the response rate and information about the respondents.
Response Rate A total of 26,871 patients discharged between 1 September 2011 and 31
October 2013 were sent an email containing a link to the survey.
One-quarter (26%) completed the survey, with 35 per cent completing or partially completing the survey.
Requests for contact A total of 12 per cent of the patients who participated in the survey between 1
September 2011 and 31 October 2013 requested ADHB contact them directly about their experience.
Complaints Formal complaints made up less than 1 per cent of the requests for contact.
Making the most difference Communication, having confidence in the quality of their care and treatment,
and getting consistent and coordinated care while in hospital, are the three things that patients say make the most difference to their hospital care and treatment.
Overall, these percentages have remained largely stable over the last few months.
Overall ADHB Care and Treatment The percentage of patients rating their overall care and treatment as very good
or excellent reached a high of 86 per cent in January 2013. The differences, although small, are significant.
82 84 84 84
83
80
86
82 80
76
85 84 84 84
70
75
80
85
90
95
100
Actual ADHB Target
145
ADHB Patient Experience Admin Report no.23 October 2013: 2
june 2013: 2
What makes a difference? Communication, having confidence in the quality of their care and treatment, and getting consistent and coordinated care while in hospital, are the three things that patients say make the most difference to their hospital care and treatment. Getting good information and being treated with dignity and respect is important to patients. Overall, these percentages have remained largely stable over the last few months.
The three things that make the most difference to care and treatment
How patients rate their care and treatment
Rating ADHB’s care and treatment Having identified the factors they consider make the most difference to their care and treatment, patients are then asked to rate ADHB’s performance on each of these dimensions, on an 11-point scale where 0 is `poor’ and 10 is `excellent’. The ratings have been grouped as Poor (0-4), Moderate (5-7) and Very Good (8-10)
Most patients rated ADHB’s performance as very good (between 8 and 10) on the dimensions they considered important to them. Most (81%) felt confident that they received good quality treatment and care, and indicated that they were treated with dignity and respect (81%). Similarly, most felt that whānau/family and friends were able to support them (80%), were involved in decisions about their health and care (74%) and that staff did everything they could to help manage their pain (72%).
Patients were most likely give a poor rating to food (56%) to the coordination of care between hospital, home, and other services (22%), the management of nausea (13%), and cleanliness (13%).
Rating ADHB’s performance
Communication (clear answers I could understand)
Feeling confident about the quality of my care and…
Getting consistent and coordinated care while in…
Getting good information
Being treated with dignity and respect
Cleanliness and hygiene
Being involved in decisions about my health and care
Managing pain
Co-ordination of care between the hospital, home…
Allowing whānau, family and friends to support me
Food and dietary needs
Managing nausea
Meeting my cultural needs
Other
49
45
41
37
35
20
21
17
10
8
6
3
1
2
Managing nausea
Food and dietary needs
Allowing whānau, family and friends to support me
Coordination of care between the hospital, home and…
Managing pain
Being involved in decisions about my health and care
Cleanliness and hygiene
Being treated with dignity and respect
Getting consistent and coordinated care while in…
Getting good information
Feeling confident about the quality of my care and…
Communication (clear answers I could understand)
13
56
6
22
9
7
13
5
7
9
4
7
24
23
15
23
19
19
21
14
25
25
15
22
64
22
80
55
72
74
66
81
68
66
81
71
Poor Moderate Very Good
Demographics Gender % (n=7494)
Ethnicity % (n=7028)
Age % (n=7368)
Disability % (n=7117)
Type of difficulties experienced % (n=2516)
Female
Male
58
42
NZ Euro
Māori
Pacific
Asian
Other Euro
Other
69
8
8
12
8
9
16 & under
17 - 24
25 - 44
45 - 64
65 - 79
80 years +
28
4
31
24
12
2
Long term
Under 6 months
While inhospital
No
12
19
9
60
Walking,lifting,bending
Using hands
Hearing
Learning/remembering
Seeing
Communicating/socialising
Other
74
17
8
14
7
11
21
146
ADHB Patient Experience Admin Report no.23 October 2013: 3
Administrative information About the Patient Experience Survey Patients and their whānau/families have unique perspectives on their care. When they share these perspectives and insights they can help those delivering health care services to identify ways of improving performance.
The ADHB In-Patient Experience Survey is online. An email containing a survey link is sent to patients between one and two weeks after they have been discharged from hospital. They are asked about their most recent experience in hospital. The survey is sent out weekly, kept open for three weeks, and the results are collated, analysed, and reported each month. Note, no reminders are sent.
Response rate A total of 26,871 patients discharged between 1 September 2011 and 31 October 2013 were sent an email containing a link to the survey. To date, one-quarter (26%) have completed the survey, with just over one-third (35%) completing or partially completing the survey.
Requests for ADHB to contact respondents Up until 31 October 2013, 12 percent of those who participated in the survey requested ADHB contact them directly about their experiences.
Complaints Contact
Requests Formal
Complaints
One percent of the requests for contact were formal complaints.
Some did not want to be contacted, but wanted to make suggestions to improve services, or let ADHB know of their experiences. Others just wanted to compliment ADHB.
12% 1%
(I would like) to talk through the circumstances and challenges of my experience a little more, to be able to provide feedback, and also potentially help ADHB to make helpful changes.”
For more information contact:
Sarah Devine, Quality Projects Facilitator, ADHB, 09 3074949 x 27941 [email protected] Alex Woodley, Point & Associates, 09 215 9663, [email protected]
29 27
29 27
24
27 26 25 27 27 27 26 26 27 28
26
22
37 39
37 35
33 33 35 34
36 36 36 34 34
37 36 34
30
Completes % Completes & partial completes %
147
148
9
PUBLIC EXCLUSION
149
150
Hospital Advisory CommitteeResolution to exclude the public from a meeting
Recommendation: That in accordance with the provisions of Clauses 32 and 33, Schedule 3, of the New Zealand Public Health and Disability Act 2000 (“Act”): 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 each item to be considered:
Reasons for passing this resolution in relation to each item:
Ground(s) under Clause 32 for the passing of this resolution
9.1 Confirmation of the Public Excluded Minutes of the Hospital Advisory Committee Meeting 30 October 2013
To enable the committee to carry on without prejudice or disadvantage commercial activities and negotiations: Official Information Act 1982 s.9(2)(i) and s.9(2)(j)
That the public conduct of the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under s 9 of the Official Information Act 1982.
9.2 Risk Report To enable the committee to carry on without prejudice or disadvantage commercial activities and negotiations: Official Information Act 1982 s.9(2)(i) and s.9(2)(j)
That the public conduct of the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under s 9 of the Official Information Act 1982.
9.3 Complaints Report To enable the committee to carry on without prejudice or disadvantage commercial activities and negotiations: Official Information Act 1982 s.9(2)(i) and s.9(2)(j)
That the public conduct of the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under s 9 of the Official Information Act 1982.
9.4 Productivity Model To enable the committee to carry on without prejudice or disadvantage commercial activities and negotiations: Official Information Act 1982 s.9(2)(i) and s.9(2)(j)
That the public conduct of the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under s 9 of the Official Information Act 1982.
9.5 Financial Report To enable the committee to carry on without prejudice or disadvantage commercial activities and negotiations: Official Information Act 1982 s.9(2)(i) and s.9(2)(j)
That the public conduct of the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under s 9 of the Official Information Act 1982.
151