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HOSPITAL ADVISORY
COMMITTEE (HAC)
MEETING
Wednesday 09th
April 2014
10.00am
Note:
• Public Excluded Session 10.00am to 11.00am
• Open meeting from 11.00am
A G E N D A
VENUE
Waitemata District Health Board
Boardroom
Level 1, 15 Shea Tce
Takapuna
Waitemata DHB, Hospital Advisory Committee Meeting 09/04/14 i
HOSPITAL ADVISORY COMMITTEE (HAC) MEETING
09th
April 2014
Venue: Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna Time: 10.00am
Committee Members
James Le Fevre – Committee Chair
Lester Levy – WDHB Chair
Max Abbott – WDHB Board Member
Pat Booth – WDHB Board Member
Sandra Coney – Deputy Committee Chair
Warren Flaunty – WDHB Board Member
Tony Norman – WDHB Deputy Chair
Morris Pita – WDHB Board Member
Christine Rankin – WDHB Board Member
Allison Roe – WDHB Board Member
Gwen Tepania-Palmer – WDHB Board Member
Hasan Bhally – Co-opted Member
Susanna Galea – Co-opted Member
Andrew Jones – Co-opted Member
WDHB Management
Dale Bramley – Chief Executive Officer
Robert Paine – Chief Financial Officer and Head of Corporate Services
Andrew Brant – Chief Medical Officer
Jocelyn Peach – Director of Nursing & Midwifery
Debbie Holdsworth – Director Funding
Phil Barnes – Director of Allied Health
Sam Bartrum – GM Human Resources
Paul Garbett – Board Secretary
Apologies: Phil Barnes
AGENDA
DISCLOSURE OF INTERESTS
• Does any member have an interest they have not previously disclosed?
• Does any member have an interest that might give rise to a conflict of interest with a matter on the
agenda?
PART I – Items to be considered in public meeting All recommendations / resolutions are subject to approval of the Board.
TIME 10.00a.m (please note agenda item times are estimates only and that the public excluded
session is from 10.00am-11.00am)
1. AGENDA ORDER AND TIMING
10.00am 2. RESOLUTION TO EXCLUDE THE PUBLIC ......................................................................................... 1
3. CONFIRMATION OF MINUTES
11.00am 3.1 Confirmation of Minutes of Hospital Advisory Committee Meeting (26/02/14) ........................... 2
4. ITEMS FOR CONSIDERATION AND RECOMMENDATION TO THE BOARD
5. PROVIDER REPORT
11.05am 5.1 Provider Arm Performance Report ............................................................................................. 12
6. CORPORATE REPORTS
11.50am 6.1 Clinical Leaders’ Report ............................................................................................................... 92
12.00pm 6.2 Human Resources Report ............................................................................................................ 96
7. INFORMATION PAPERS
12.05pm 7.1 Synthetic Cannabinoids.............................................................................................................. 105
12.15pm PRESENTATION: Awhina Prize Winning Presentation ‘Rekeketanga: A Uniquely Diverse Role’
(Dianna McGregor, Maori Nurse Specialist Gerontology, Waitemata DHB). This was the overall
award winner at the Awhina Awards.
Waitemata DHB, Hospital Advisory Committee Meeting 09/04/14 ii
REGISTER OF INTERESTS
Board/Committee
Member
Involvements with other organisations
Last Updated
Lester Levy Chair – Auckland District Health Board
Chairman – Auckland Transport
Deputy Chair – Health Benefits Limited
Independent Chairman – Tonkin & Taylor
Chief Executive – New Zealand Leadership Institute
Professor of Leadership – University of Auckland Business School
Trustee, Well Foundation (ex-officio member)
20/03/14
Max Abbott Pro Vice-Chancellor (North Shore) and Dean – Faculty of Health and
Environmental Sciences, Auckland University of Technology
Patron – Raeburn House
Advisor – Health Workforce New Zealand
Board Member, AUT Millennium Ownership Trust
Chair – Social Services Online Trust
Board member – Rotary National Science and Technology Forum
Trust
19/03/14
Sandra Coney Chair – Waitakere Ranges Local Board, Auckland Council 12/12/13
Pat Booth Consulting Editor – Fairfax Suburban Papers in Auckland 24/06/09
Warren Flaunty Member – Henderson - Massey and Rodney Local Boards, Auckland
Council
Trustee - West Auckland Hospice
Trustee (Vice President) - Waitakere Licensing Trust
Shareholder - EBOS Group
Shareholder – Pharmacy Brands Ltd
Director – Westgate Pharmacy Ltd
Chair – Three Harbours Health Foundation
Director - Trusts Community Foundation Ltd
12/12/13
James Le Fevre Registrar – Auckland City Hospital
Auckland Helicopter Emergency Medical Service Doctor
Member – Australian Society for Emergency Medicine, Hospital
Overcrowding Subcommittee
27/02/13
Anthony Norman –
Deputy Chair
Board Chair - Northland DHB
Director - Health Alliance NZ Ltd
Director - Health Alliance (FPSC) Ltd
Chair - DHB Shared Services Executive Committee
Trustee and Treasurer - Kerikeri International Piano Competition Trust
Partner - Mill Bay Haven, Mangonui (accommodation provider)
Member - representing the interests of 20 DHBs, of the following
committees: Health Sector Forum; Medication Safety Committee and
Health Sector Relationship Committee
23/01/14
Morris Pita Board Member – Auckland District Health Board
Owner/operator – Shea Pita and Associates Limited
Shareholder – Turuki Pharmacy Limited
Wife is member of the Northland District Health Board
13/12/13
Christine Rankin Member - Upper Harbour Local Board, Auckland Council
Director - The Transformational Leadership Company
CEO – Conservative Party
17/05/13
Allison Roe Member – Devonport-Takapuna Local Board, Auckland Council
Member – Board of Kaipara Medical Centre
Chairperson – Matakana Trail Trust
11/02/14
Waitemata DHB, Hospital Advisory Committee Meeting 09/04/14 iii
Board/Committee
Member
Involvements with other organisations
Last Updated
Gwen Tepania-
Palmer
Chairperson- Ngatihine Health Trust, Bay of Islands
Life Member – National Council Maori Nurses
Alumni – Massey University MBA
Director – Manaia Health PHO, Whangarei
Board Member – Auckland District Health Board
Committee Member – Lottery Northland Community Committee
11/03/13
Co-Opted
Members
Hasan Bhally Member – Association of Salaried Medical Specialists (ASMS)
Recipient of funding for research and advice - Pfizer Anti-Infectives
Recipient of funding for research and advice - Cubist Pharmaceuticals
08/05/12
Susanna Galea Member – New Zealand Medical Association
Member – Association of Salaried Medical Specialists (ASMS)
Member – Medical Protection Society
Associate Director – Centre for Addictions Research
31/03/14
Andrew Jones Member – Public Services Association (PSA)
Chair – Physiotherapy New Zealand Ethics Committee
08/05/12
Waitemata DHB Hospital Advisory Committee Meeting 09/04/14 iv
Waitemata District Health Board
Hospital Advisory Committee Member Attendance Schedule 2014
���� Attended the meeting
x Absent
* Attended part of the meeting only
# Absent on Board business
^ Leave of absence
NAME FEB APR MAY JULY AUG SEPT NOV DEC
Dr Lester Levy (Chair) ����
Max Abbott ����
Pat Booth ����
Sandra Coney ����
Warren Flaunty x
James Le Fevre
(Committee Chair) x
Tony Norman (Deputy Chair) ����
Morris Pita ����
Christine Rankin ����
Allison Roe ����
Gwen Tepania – Palmer ����
Co-opted members
Hasan Bhally ����
Susanna Galea ����
Andrew Jones x
Waitemata DHB, Hospital Advisory Committee Meeting 09/04/14
2 RESOLUTION TO EXCLUDE THE PUBLIC
Recommendation:
That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public
Health and Disability Act 2000:
The public now be excluded from the meeting for consideration of the following items, for the
reasons and grounds set out below:
General subject of
items to be considered
Reason for passing this resolution in
relation to each item
Ground(s) under Clause 32 for
passing this resolution
1. Confirmation of
Public Excluded
Minutes – Hospital
Advisory Committee
Meeting of 26/02/14
That the public conduct of the whole or the
relevant part of the proceedings of the
meeting would be likely to result in the
disclosure of information for which good
reason for withholding would exist, under
section 6, 7 or 9 (except section 9 (2) (g) (i))
of the Official Information Act 1982.
[NZPH&D Act 2000
Schedule 3, S.32 (a)]
Confirmation of Minutes
As per resolution(s) to exclude the public
from the open section of the minutes of
the above meeting, in terms of the
NZPH&D Act.
2. Quality Report That the public conduct of the whole or the
relevant part of the proceedings of the
meeting would be likely to result in the
disclosure of information for which good
reason for withholding would exist, under
section 6, 7 or 9 (except section 9 (2) (g) (i))
of the Official Information Act 1982.
[NZPH&D Act 2000
Schedule 3, S.32 (a)]
Privacy
The disclosure of information would not
be in the public interest because of the
greater need to protect the privacy of
natural persons, including that of
deceased natural persons.
[Official Information Act 1982
S.9 (2) (a)]
3. HR Update Report That the public conduct of the whole or the
relevant part of the proceedings of the
meeting would be likely to result in the
disclosure of information for which good
reason for withholding would exist, under
section 6, 7 or 9 (except section 9 (2) (g) (i))
of the Official Information Act 1982.
[NZPH&D Act 2000
Schedule 3, S.32 (a)]
Privacy
The disclosure of information would not
be in the public interest because of the
greater need to protect the privacy of
natural persons, including that of
deceased natural persons.
[Official Information Act 1982
S.9 (2) (a)]
Negotiations
The disclosure of information would not
be in the public interest because of the
greater need to enable the board to carry
on, without prejudice or disadvantage,
negotiations.
[Official Information Act 1982
S.9 (2) (j)]
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3.1 Confirmation of Minutes of the Hospital Advisory
Committee meeting held on 26th
February 2014
Recommendation:
That the Minutes of the Hospital Advisory Committee meeting held on 26
th February 2014
be approved.
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Waitemata District Health Board, Meeting of the Hospital Advisory Committee 09/02/14
Minutes of the meeting of the Waitemata District Health Board
Hospital Advisory Committee
Wednesday 26 February 2014
held at Waitemata District Health Board Boardroom, Level 1, 15 Shea Terrace,
Takapuna, commencing at 10.05a.m
PART I – Items considered in public meeting
COMMITTEE MEMBERS PRESENT:
Sandra Coney (Acting Committee Chair)
Lester Levy (Board Chair)
Max Abbott
Pat Booth
Tony Norman
Morris Pita
Christine Rankin
Allison Roe
Gwen Tepania-Palmer
Hasan Bhally (Co-opted member)
Susanna Galea (Co-opted member)
ALSO PRESENT: Dale Bramley (Chief Executive Officer)
Andrew Brant (Chief Medical Officer)
Robert Paine (Chief Financial Officer and Head of Corporate Services)
Jocelyn Peach (Director of Nursing and Midwifery)
Phil Barnes (Director of Allied Health)
Sam Bartrum (Director of Human Resources)
Debbie Eastwood (GM Medicine and Health of Older People Services)
Linda Harun (GM Child, Women and Family Services)
Jenny Parr (Associate Director of Nursing)
Paul Garbett (Board Secretary)
(Staff members who attended for a particular item are named at the
start of the minute for that item.)
PUBLIC AND MEDIA REPRESENTATIVES:
There were no public or media representatives present.
APOLOGIES: Resolution (Moved Sandra Coney/Seconded Gwen Tepania-Palmer)
That the apologies from James Le Fevre, Warren Flaunty and Andrew
Jones be received and accepted.
Carried
WELCOME: The Acting Committee Chair welcomed those present.
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DISCLOSURE OF INTERESTS
There were no additions or amendments to the Interests Register.
With regard to the agenda for this meeting, Lester Levy noted his standing interest in
matters relating to HBL.
1. AGENDA ORDER AND TIMING
Items were taken in the same order as listed in the agenda, with the public excluded
session being held first, from 10.08a.m until 10.57a.m. A section of the Provider Arm
Report (Mental Health and Addiction Services) was delayed and considered later in
the meeting after Item 6.1.
2. RESOLUTION TO EXCLUDE THE PUBLIC (agenda page 1)
Resolution (Moved Sandra Coney/Seconded Gwen Tepania-Palmer)
That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ
Public Health and Disability Act 2000:
The public now be excluded from the meeting for consideration of the following
items, for the reasons and grounds set out below:
General subject of
items to be considered
Reason for passing this resolution
in relation to each item
Ground(s) under Clause 32 for
passing this resolution
1. Confirmation of
Public Excluded
Minutes – Hospital
Advisory Committee
Meeting of 06/11/13
That the public conduct of the whole or
the relevant part of the proceedings of
the meeting would be likely to result in
the disclosure of information for which
good reason for withholding would
exist, under section 6, 7 or 9 (except
section 9 (2) (g) (i)) of the Official
Information Act 1982
[NZPH&D Act 2000, Schedule 3, S.32 a]
Confirmation of Minutes
As per resolution(s) to exclude the
public from the open section of
the minutes of that meeting, in
terms of the NZPH&D Act.
2. Quality Report That the public conduct of the whole or
the relevant part of the proceedings of
the meeting would be likely to result in
the disclosure of information for which
good reason for withholding would
exist, under section 6, 7 or 9 (except
section 9 (2) (g) (i)) of the Official
Information Act 1982.
[NZPH&D Act 2000, Schedule 3, S.32 a]
Privacy
The disclosure of information
would not be in the public
interest because of the greater
need to protect the privacy of
natural persons, including that of
deceased natural persons.
[Official Information Act 1982
S.9 (2) (a)]
3. Medication Safety
Report
That the public conduct of the whole or
the relevant part of the proceedings of
the meeting would be likely to result in
the disclosure of information for which
good reason for withholding would
exist, under section 6, 7 or 9 (except
section 9 (2) (g) (i)) of the Official
Information Act 1982.
[NZPH&D Act 2000 Schedule 3, S.32 a)]
Commercial Activities
The disclosure of information
would not be in the public
interest because of the greater
need to enable the Board to carry
out, without prejudice or
disadvantage, commercial
activities.
[Official Information Act 1982
S.9 (2) (i)]
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General subject of
items to be considered
Reason for passing this resolution
in relation to each item
Ground(s) under Clause 32 for
passing this resolution
4. HR Update Report That the public conduct of the whole or
the relevant part of the proceedings of
the meeting would be likely to result in
the disclosure of information for which
good reason for withholding would
exist, under section 6, 7 or 9 (except
section 9 (2) (g) (i)) of the Official
Information Act 1982.
[NZPH&D Act 2000 Schedule 3, S.32
(a)]
Privacy
The disclosure of information
would not be in the public
interest because of the greater
need to protect the privacy of
natural persons, including that of
deceased natural persons.
[Official Information Act 1982
S.9 (2) (a)]
Negotiations
The disclosure of information
would not be in the public
interest because of the greater
need to enable the board to carry
on, without prejudice or
disadvantage, negotiations.
[Official Information Act 1982
S.9 (2) (j)]
Carried
10.08a.m to 10.57a.m – public excluded session
10.57a.m – the Committee resumed in open session.
3. COMMITTEE MINUTES
3.1 Confirmation of the Minutes of the Meeting of the Hospital Advisory Committee
held on 12 December 2013 (agenda pages 2-14)
Resolution (Moved Sandra Coney/Seconded Christine Rankin)
That the minutes of the meeting of the Hospital Advisory Committee held on 12
December 2013 be approved.
Carried
Matters Arising
Disability and Way Finding Project – in answer to a question, Jocelyn Peach
confirmed that the parking spaces for disabled service users next to Ward 11 at
North Shore Hospital are as close to the Ward 11 entrance as they can be and the
closest feasible to the main entrance.
4. ITEMS FOR CONSIDERATION AND RECOMMENDATION TO THE BOARD
There were no decision items.
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5. PROVIDER ARM PERFORMANCE REPORT
5.1 Provider Arm Performance Report – December 2013 (agenda pages 15-96)
Executive Summary/Overview/Scorecard/Human Resources
Robert Paine (Chief Financial Officer and Head of Corporate Services) noted a
correction on page 18 of the agenda. The Provider Arm was $346,000 adverse to
budget at the half year point, not $346,000 positive to budget.
Matters covered in discussion and response to questions included:
• With the DNA results on page 18 of the agenda, it was confirmed that the
‘total’ figures include Maori and Pacific.
• In answer to a question, Cath Cronin advised that they don’t yet have a
estimate of what the cost of DNAs is to the organisation on an annual basis,
however that is being considered.
Medicine and Health of Older Peoples Services
Debbie Eastwood (General Manager, Medicine and Health of Older Peoples Services)
and Dr Jonathan Christiansen (Head of Division Medical) were present for this
section of the report.
Debbie Eastwood commented on the End of Life Care Programme as an area
identified as needing focus.
No questions were raised on this section of the report.
Child, Women and Family Services
Linda Harun (General Manager, Child, Women and Family Services) and Dr Meia
Schmidt-Uili (Clinical Director Child Health) were present for this section of the
report.
Matters highlighted included:
• Child Health Redesign continuing (pages 49-50 of the agenda), moving to a
single point of entry.
• Auckland DHB-Waitemata DHB Women’s Health Collaboration (pages 50-51 of
the agenda). The aim is to make sure that both Boards can deliver the very
best service by working together. Dale Bramley noted that maternity services
at Waitakere Hospital need upgrading and how to address that needs to be
established before other substantive change occurs.
In response to a question, the Committee was advised that the audit of Muriwai
Ward (page 30 of the agenda) is being undertaken by a multi-disciplinary team and
it is of no particular significance that the person leading facilitation of meetings with
families is a speech therapist. The focus of the audit is linking with families and
preparing them for discharge home of family members.
Linda Harun and Meia Schmidt-Uili were thanked by the Acting Committee Chair.
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Surgical and Ambulatory Services and Elective Surgery Centre
Cath Cronin (General Manager, Surgical and Ambulatory Services), John Cullen
(Head of Division Medical and Director ESC) and Mark Watson (Group Manager ESC)
were present for these sections of the report.
Matters highlighted included:
• Cath Cronin advised that two major areas of focus are looking at volumes and
increasing utilisation of the ESC, involving planning both for this year and next
year; and making sure that achieving ESPI 1,2 and 5 targets are on track.
• John Cullen advised that over the last few weeks the Elective Surgery Centre
had been achieving the number of procedures that it was contracted to do
and that issue is now sorted, although it will not be feasible to catch up on the
shortfall for the earlier months.
Matters covered in response to questions included:
• John Cullen advised that there had been changes in the way in which patients
are processed, to ensure they do come across to the ESC. The issue of
volumes has been sorted out for the current three operating theatres,
although to get the numbers needed for the fourth will be a challenge.
• Cath Cullen advised that with procurement they are continually working to
get the best price through healthAlliance and HBL. There is quite an advanced
programme with them and some good progress has been made.
Provider Arm Support Services
No issues were raised.
Mental Health and Addiction Services
Helen Wood (General Manager, Mental Health and Addiction Services) and Murray
Patton (Clinical Director Mental Health) were present for this section of the report.
Matters highlighted included:
• The high level of acute demand over the previous five months. There are
transition plans that should address that, but the system is under a lot of
pressure. There are short, medium and long term plans (including the high and
complex needs patients plan being considered by the Board later on 26
February). Over all of the Mental Health and Addictions Services there has
been an overwhelming increase in the numbers coming through the doors.
• The four day outage of HCC - Regional Mental Health clinical notes system
(pages 60-61 of the agenda) had highlighted the need for a more urgent
response in such cases from healthAlliance.
The Board Chair advised that he had spent three hours the previous Monday with
mental health staff members in the West. Some of the things that had stood out was
that staff members are very realistic about what is feasible; there is a quite refined
understanding about values; they are very constructive and thoughtful, but having
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to deal with a big workload. He had been very impressed and had spoken to the
Chief Executive about a few issues.
Matters covered in discussion and response to questions included:
• Synthetic cannabinoids – Murray Patton advised that where there are pre-
existing mental conditions, synthetic cannabinoids make these worse. There
are also a lot of examples where people with no history of prior mental health
issues use these substances and become acutely unwell. Helen Wood advised
that she has reinforced the need for staff to report every time that there is an
adverse effect identified from these products. The Acting Committee Chair
requested information on synthetic cannabinoids be reported to the
Committee.
• Murray Patton thanked the Board Chair for his visit to the west on the
previous Monday, as staff members had appreciated the opportunity to talk
with him. A lot of the work they do goes unnoticed and unreported. A lot of
their work is based in the local communities. There may be a need to think
about how to make their work more apparent to the Board in an ongoing way.
• The Acting Committee Chair requested that some visits to hospital facilities be
scheduled for Board members, particularly the new members, as at the start
of the last Board term. These might be relatively short, for example scheduled
before CPHAC meetings.
Provider Arm Performance Report – January 2014
This summary update had been tabled and distributed at the meeting.
The Chief Executive noted that financially the DHB remains on track to achieve a
surplus for 2013/14. He also acknowledged Cath Cronin for leading (with the support
of the other GMs) the work that had seen the major issue with ESPI 1 compliance
addressed and full compliance achieved. This had involved a huge amount of work in
every service and division, and also with the Booking and Scheduling team. The
Committee asked that the Board’s appreciation be included in the acknowledgement
that is taking place of this work.
Resolution (Moved Sandra Coney/Seconded Christine Rankin)
That the Provider Arm Performance report be received.
Carried
6. CORPORATE REPORTS
6.1 Clinical Leaders’ Report (agenda pages 97-101)
Phil Barnes (Director Allied Health) and Dr Jocelyn Peach (Director Nursing and
Midwifery) were present for this item.
Phil Barnes highlighted and/or updated aspects of his report, including:
• Collaboration between laboratory and pharmacy services as described on page 98
of the agenda.
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• Some Allied Health therapists have been using IPads and finding them much more
efficient.
• Development of the Therapy Assistant workforce – Waitemata DHB has the first
cohort of any DHB in New Zealand.
In response to questions, Phil Barnes advised:
• New Zealand is somewhat behind in terms of e-laboratory ordering and e-
radiology ordering. This is close to being resolved here.
• The idea of capturing some value from innovation in terms of copyright etc. is kept
in mind.
Jocelyn Peach highlighted and/or updated aspects of her report including:
• The CNM Leader Development Programme ‘Leading Quality Care’ (pages 109-110
of the agenda) being led by Jenny Parr and her team. Charge Nurse Managers are
really important in the organisation as they set standards, tone and quality, make
sure that things are done efficiently and effectively and have to manage both their
team and the public interface. Sometimes this demanding role leaves them tired or
exhausted and so Part 1 of the programme has been to build resilience for this
group. Those involved were excited with and committed to the programme.
• The Nursing Council of New Zealand audit of Professional Development and
Recognition Programme (page 100 of the agenda). This programme has been going
since the 1980s and over 65% of our nurses have competencies. 560 portfolios
were assessed last year.
• New graduate programme intake – in each of the three DHBs in the Auckland
region, between 70 and 76 new graduates had started the previous week.
Regionally 6.7% were Maori and 13% Pacific. For Waitemata DHB, 4% were Maori
and 6.8% Pacific. This year there had been a lower number of Maori applying. The
enthusiasm new graduates bring is always special and the aim is to try and keep
that going through their first year.
• An emergency planning exercise will run in April based on the hospital being
incapacitated and a regional response being required.
Resolution (Moved Sandra Coney/Seconded Gwen Tepania-Palmer)
That the report be received.
Carried
6.2 Human Resources (agenda pages 102-110)
Sam Bartrum (Director of Human Resources) introduced the report, highlighting:
• The project looking at running hospital services 24/7 – the first part of this is
to look at weekend services and that is getting underway.
• Values implementation is going very well, with a lot of work linking values with
behaviours.
• The scholarship programme – updating the information on page 106 of the
agenda, on 25 February 15 scholarships had been awarded to 15 students, all
Maori.
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• The successful joint bid from the three Auckland Region DHBs for the Pacific
Health Science Academy and Mentoring Programme (detailed on page 106 of
the agenda).
Matters covered in discussion and response to questions included:
• There had been a great uptake from staff in joining the new staff gymnasium,
with over 700 staff members signing up in the last week. Responsibility for the
gym had now been handed over to Occupational Health and Safety. The Board
Chair suggested that all Board members take the opportunity to look at the
gym.
• With regard to the recent scholarship selection process, there had been
enough applicants to require a quite rigorous selection process. Those
students who had earned the scholarships had prepared and studied and went
through an interview process. There had been a lot of whanau support visible
at the awards on 25 February.
• The Board Chair noted that the same affirmative action approach being taken
with the scholarships is also being taken by Auckland and Canterbury DHBs.
For other students who face financial difficulties there are quite a lot of
scholarships available around the country.
• In answer to a question from the Acting Committee Chair, the Committee was
advised that although the Board’s MOUs are with Ngati Whatua and the
Waipareira Trust, Ngati Whatua does take a leadership and co-ordination role
with other Maori in the District, such as Te Kawarau o Maki. Naida Glavish
could advise members about this. Also the DHB’s Maori workforce is open to
all Maori.
Resolution (Moved Pat Booth/Seconded Tony Norman)
That the report be received.
Carried
7. INFORMATION PAPERS
There were no information papers.
The Acting Committee Chair thanked those present.
The meeting concluded at 12.05p.m.
SIGNED AS A CORRECT RECORD OF THE WAITEMATA DISTRICT HEALTH BOARD HOSPITAL
ADVISORY COMMITTEE MEETING OF 26 FEBRUARY 2014
_____________________________________ ACTING COMMITTEE CHAIR
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Actions Arising and Carried Forward from
Meetings of the Hospital Advisory Committee
as at 1st
April 2014
Meeting Agenda
Ref
Topic Person
Responsible
Expected
Report
Back
Comment
HAC
12/12/13
5.1 Provider Arm Report:
- Child poverty – breakdown
of where located in the
Waitemata DHB area to be
provided for Board members.
Tim Jelleyman
Actioned. Sent to
HAC members on
11th
March 2014.
HAC
26/02/14
5.1 Provider Arm Report:
- Synthetic Cannabinoids –
information on this issue to
be reported to HAC
- Visits to hospitals facilities –
to be arranged for Board
members, particularly new
Board members.
Susanna Galea
Peta Molloy
HAC
09/02/14
Separate report
included on agenda.
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5.1 Provider Arm Performance Report – February 2014
Recommendation
That the report be received.
___________________________________________________________________________ Prepared by: Robert Paine (Chief Financial Officer) and Andrew Brant (Chief Medical Officer)
This report summarises the Provider arm performance for February 2014.
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Provider Arm Performance Report
Table of Contents
Glossary
Executive summary
Scorecard
Health Targets
Financial Performance
Human Resources
Divisional Reports
- Medicine and Health of Older People services
- Child, Women and Family services
- Mental Health and Addiction services
- Surgical and Ambulatory services
- Elective Surgery Centre
- Corporate Services Group
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Glossary ACC Accident Compensation Commission
ADU Assessment and Diagnostic Unit
ARDS Auckland Regional Dental Service
BT Business Transformation
CADS Community Alcohol, Drug and Addictions Service
CAMHS Child, Adolescent Mental Health Service
CNM Charge Nurse Manager
CLAB Central Line Associated Bacteraemia
CT Computerised Tomography
CW&F Child, Women and Family service
DNA Did not attend
ESPI Elective Services Performance Indicators
FSA First Specialist Assessment (outpatients)
FTE Full Time Equivalent
ICU Intensive Care Unit
iFOBT Immuno Faecal Occult Blood Test
MHSG Mental Health service group
MoH Ministry of Health
MTD Month To Date
MOSS Medical Officer Special Scale
NOF Neck of Femur
NSH North Shore Hospital
OHBC Oral health business case
ORL Otorhinolaryngology (ear, nose, and throat)
PACU Post-operative Acute Care Unit
PHO Primary Health Organisation
PoC Point of Care
SCBU Special care baby unit
SMO Senior Medical Officer
SSU Sterile Services Unit
TLA Territorial Locality Areas
WIES Weighted Inlier Equivalent Separations
WTH Waitakere Hospital
YTD Year To Date
Information to assist with understanding the scorecard:
For each measure the green bar reflects how well we are doing against the target for the period (ie. July 2013).
The progress green bar is weighted for each measure based on the degree of concern of any short fall in meeting
the target. The analysts within each service have provided an initial estimate of the weighting for each measure
based on prior performance; however this element of the scorecard is still work in progress for some of the
measures. For example, this weighting is noticeable for Elective Volumes where the scale is very sensitive so
that any variance is deemed to be significant. If performance is achieving or better than target, the bar will
display as a solid green line.
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Executive Summary / Overview
Overall assessment
Financial Performance
For the month of February, the Provider Arm had a surplus of $2.935m against a budgeted surplus of $2.919m
and is therefore slightly favourable by $16k.
The entire DHB result was also favourable to budget by $67k for the month.
Service Delivery
The health targets for better help for smokers to quit, shorter waits in emergency departments and elective
surgery were all met in December.
The overall Did Not Attend rate (DNA) for first specialist attendances was 11.9% in February, the highest rate
reported since September 2013. Maori and Pacific rates continue to be much higher than those for the total
population, especially for first specialist assessments.
Cath Cronin is the Lead GM for the DNA project for the Provider Arm. The project is tasked with understanding
why the DNA rate for our Maori and Pacific Island patients is disproportionately high in comparison with other
ethnic groups. Key areas of concern have been identified from questionnaire findings, data analysis and
literature review and recommendations are being developed to improve our services to both Pacific Island and
Maori patients and whanau.
The project lead, Lael Meredith is currently working with staff from the Provider Arm, Cultural Support Teams,
Planning and Funding, Business Support and Primary Care to improve reporting on DNAs and develop options,
which can be tested and implemented to improve engagement with Maori and Pacific patients and reduce DNA
rates. Details of patient and health provider questionnaire findings, data analysis and literature review have been
collated and are being socialised with project steering and working groups. Recommendations are being
developed for key areas identified. Initial findings are indicating that we will be in a position to identify areas to
improve our services to both Pacific Island and Maori patients and whanau.
ESPI2 and ESPI5, the MoH indicators for outpatient and inpatient waiting times, were both within the Ministry of
Health buffer range. From March we plan to have all services 100% compliant and will endeavour not to use the
MoH buffer.
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Scorecard
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Health Targets
Better Help For Smokers To Quit
Shorter Stays in Emergency Departments
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Emergency Department Presentations
1,000
1,200
1,400
1,600
1,800
2,000
2,200
2,400
2,600
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Pre
sen
tati
on
s
Calendar Weeks
WDHB ED Presentations
Calendar Years from 01 Jan 2008 to 09/03/2014
2008 2009 2010 2011 2012 Mean from Aug 2010 2013 2014
Improved Access to Elective Surgery
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Elective Performance
Zero patients waiting over 5 and over 4 Months
Specialty Compliant Non
Compliant
Non
compliance %
Specialty Comp
liant
Non Compliant Non
complianc
e %
ESPI2 10,529 15 0.18% ESPI2 9424 1120 10.62%
ESPI5 3,670 27 0.73% ESPI5 3407 290 7.84%
Specialty Compliant Non
Compliant
Non
compliance %
Compliant Non
Compliant
Non
compliance %
Specialty Compliant Non
Compliant
Non
compliance %
Anaesthesiology 91 0 0.00% 91 0 0.00% Cardiology 201 0 0.00%
Cardiology 1,130 2 0.18% 986 146 12.90% General Surgery 831 2 0.24%
Dermatology 58 0 0.00% 57 1 1.72% Gynaecology 532 1 0.19%
Diabetes 150 0 0.00% 140 10 6.67% Orthopaedic 973 18 1.82%
Endocrinology 247 0 0.00% 238 9 3.64% Otorhinolaryngology 746 5 0.67%
Gastro-Enterology 921 0 0.00% 776 145 15.74% Urology 387 1 0.26%
General Medicine 434 0 0.00% 390 44 10.14% Total 3670 27 0.73%
General Surgery 1,367 1 0.07% 1247 121 8.85%
Gynaecology 895 0 0.00% 813 82 9.16%
Haematology 79 0 0.00% 78 1 1.27%
Infectious Diseases 15 0 0.00% 15 0 0.00% Specialty Compliant Non
Compliant
Non
compliance %
Neurology 17 0 0.00% 17 0 0.00% Cardiology 192 9 4.48%
Oncology 20 0 0.00% 20 0 0.00% General Surgery 800 33 3.96%
Orthopaedic 1,723 11 0.65% 1465 269 15.51% Gynaecology 512 21 3.94%
Otorhinolaryngology 1,308 1 0.08% 1104 205 15.66% Orthopaedic 892 99 9.99%
Paediatric MED 923 0 0.00% 917 6 0.65% Otorhinolaryngology 659 92 12.25%
Renal Medicine 83 0 0.00% 83 0 0.00% Urology 352 36 9.28%
Respiratory Medicine 306 0 0.00% 282 24 7.84% Total 3407 290 7.84%
Rheumatology 212 0 0.00% 210 2 0.94%
Urology 550 0 0.00% 495 55 10.00%
Total 10,529 15 0.18% 9,424 1,120 10.62%
ESPI5 Summary (1% Compliance Buffer) - Compliant 4
months
ESPI Compliance Summary Report - 5 months ESPI Compliance Summary Report - 4 months
ESPI2 Summary (0.4% Compliance Buffer)
ESPI5 Summary (1% Compliance Buffer) - Compliant 5
months5 months 4 months
90% of outpatient referrals acknowledged and processed within 10 days
ESPI 1 Compliance Summary
Specialty Cases Authouris
ed In Time
Frame
ESPI 1
Compliance
Anaesthesiology 95 95 100.00%
Cardiology 516 505 97.87%
Dermatology 57 46 80.70%
Diabetes 235 231 98.30%
Endocrinology 192 181 94.27%
Gastro-Enterology 1033 996 96.42%
General Medicine 269 264 98.14%
General Surgery 615 582 94.63%
Gynaecology 416 404 97.12%
Haematology 157 151 96.18%
Infectious Diseases 26 26 100.00%
Neurology 23 20 86.96%
Oncology 52 52 100.00%
Orthopaedic 685 668 97.52%
Otorhinolaryngology 493 491 99.59%
Paediatric MED 398 393 98.74%
Renal Medicine 104 104 100.00%
Respiratory Medicine 242 242 100.00%
Rheumatology 130 129 99.23%
Urology 256 254 99.22%
Total 5,994 5,834 97.33%
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Financial Performance
All Services
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COMMENT ON MAJOR VARIANCES
Summary
The provider arm is $656k unfavourable to budget year to date, having reported a surplus of $2,130k against a
budgeted surplus of $2,786k. The year end forecast is a surplus of $1,112k, being $112k favourable to budget.
In the month of February the Provider Arm made a surplus of $2,935k which was $16k favourable to budget.
Revenue
The month’s revenue is $775k favourable to budget, which brings the YTD position to $4.052M favourable. The
main contributors to the monthly variance are $250k from the National Haemophilia Group, Slark Hyperbaric
billings of $88k, $170k of revenue from non-resident patients treated under the ACC contract and interest
earnings ahead of budget by $160k.
The YTD favourable variance consists of an additional $2.0M for the National Haemophilia Management Group
savings initiative, bank interest of $1.5M above budget and a positive variance of $277k from the car parks.
Additional funding has also been received; in Mental Health $260k to provide Adult MH respite in North and
Rodney, $446k in Radiology for the reduction of CT MRI waitlists, $1.25M for beds (short stay and older adults)
and the SLARK Hyperbaric Unit in MedHops. These are offset by a shortfall in non-resident revenue of $643k,
lower surgical services ACC revenue of $346k, and a shortfall of $516k in revenue from repatriation of patients
from Starship, lower than expected revenue in Forensics of $324k and in radiology of $248k.
Full year forecast revenue is $6.032M favourable. This arises from unbudgeted Hyperbaric revenue and ACC
volumes ahead of budget in MedHops $1.726M, additional $3.0M for the National Haemophilia Management
Group savings initiative, car park revenue in excess of budget in Hospital Ops $318k, Corporate revenue ahead
budget principally bank interest $557k. Offsetting this is a shortfall in funding for colposcopy, transfers from
Starship and dental revenue in CWF $1.335M.
Expenditure
Expenditure for the Provider arm was overall unfavourable for the month ($759k) and YTD ($4.709M). Within
this is an under spend in personnel costs for the month ($541k) which has increased the YTD underspend ($546k).
Staff costs year to date variances:
• Medical Personnel ($1.159M unfavourable) –The YTD overspend relates primarily to anaesthetic medical
costs incurred in surgical services in respect to cover in ESC. These costs have been budgeted in outsourced
services. In addition there have been $1.1M of unbudgeted professional membership costs. Offsetting
these overspends is a $1.372M underspend in allowances. In FTE terms the Provider Arm is over budget with
over recruiting of RMOs (17 FTE) and MOSS (6 FTE) being offset by under recruitment of SMOs (18 FTE).
• Nursing Personnel ($386k unfavourable) –In MedHops the favourable nursing spend variable of $216k was
lower than prior months due to recruitment in medical and ATR wards but the difficulty in recruiting to
nursing positions earlier in the year continues to have a favourable effect on the YTD result ($778k). Mental
Health Services has also experienced nursing staff cost underspends ($832k YTD) from positions previously
held vacant in advance of service reviews and better management of acuity in the inpatient units. Other
operating units have reported smaller favourable variances. These favourable variances are offset by
unfavourable variance in centralised nursing savings budgets ($2.633M).
• Allied Health Personnel ($470k favourable) – $470k of this variance arises in the CWF division as both the
Child Health and Regional Dental services delay recruiting into some budgeted positions. Child Health will
not fill roles until they are confirmed as part of their service redesign. Mental Health Services are $652k
favourable YTD due to vacancies in the community teams and annual leave taken in excess of planned.
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Offsetting these favourable variances is a $323k unfavourable variance in S&AS due to unmet savings plans
which are being achieved in other areas of expenditure.
• Support and Admin Personnel ($1.621M favourable) – The bulk of the underspend in Support staff costs
relates to vacancies in orderlies and cleaning staff ($984k) which are covered by the use of outsourced
agency casual staff. 26 FTE of vacancies across Corporate and Facilities Groups (Finance, HR, Quality,
Maintenance, Admin and CIO) have contributed a further $1.259M to the YTD underspend with $649k being
spent in outsourced staff to cover some of the positions. There was also $269k of savings from the ACC levy
reduction in central budgets. Offsetting this is $875k of overspend in MedHops and S&AS due to budgeted
savings being achieved in other areas.
Staff costs year end forecasts:
Forecast staff costs are $1.497M favourable. Substantial underspends in Mental Health Services ($3.061M), due
to positions being held ahead of service reviews, in CWF ($1.349M), due to difficulty in recruiting Child and
Women’s health SMO positions and the holding of dental therapist positions until new graduates become
available. These underspends will offset overspends in S&AS ($1.613M) due to the cost of Anaesthetists
budgeted under POC in ESC and unmet savings initiatives in Provider Support Services.
Non staff costs year to date variances:
Non staff costs were unfavourable by $5.255 YTD. Of this $1.053M related to overspends on outsourced services,
mainly related to the cost of non-medical agency staff ($4.043M) covering vacant positions on wards ($1.104M)
and support areas ($2.7373M finance, cleaners, orderlies, records, transcription and telephone operators).
Offsetting this are underspends on outsourced medical costs ($1.545M) and outsourced clinical services
($1.539M). The outsourced medical underspend arises from lower than planned POC in ESC ($823k) due to lower
volumes, a $1.585M underspend for Anaesthetists costs in ESC (not counted as FTE) which are incurred in staff
costs but budgeted in outsourced costs, offset by $467k of savings lines in SAS which are being achieved
elsewhere and $357k in unbudgeted costs of additional sessions in Mental Health, MedHops and S&AS. The
$1.539M outsourced clinical services underspend relates to a $1.160M underspend against corporate provisions,
$982k favourable variance against central savings initiatives and a $344k underspend in MedHops in the
Hyperbaric, Renal and Older Adults respite services offset by $720k due to Mental Health savings which have
been achieved elsewhere and $401k of unbudgeted CT/MRI outsourcing costs associated with wait list initiatives.
Outsourced services are forecast to be $2.429M overspent for the full year. Clinical services as a whole
contribute $2.107M to the under spend as vacancies are covered through bureau staff in MedHops and MHSG
and some savings planned for this area are achieved elsewhere. Provider Support is also $322k overspent due to
the use of outsourced cleaning and orderly staff .
The YTD $4.532 M unfavourable variances in clinical supplies cost arises in most divisions mainly due to savings of
$2.517M achieved elsewhere, a $1.766M overspend in implants and prosthesis driven by surgical throughput and
cardiac volumes ahead of plan. In addition there was a $1.540M volume-driven overspend in treatment
disposables (principally in Dental, Theatres and Radiology) offset by a $1.189M saving in instruments and
equipment due to the repatriation of the maintenance service from ADHB.
Clinical supplies costs are forecast to overspend by $5.209M in line with the year to date position as a result of
volume driven overspends in treatments consumables. Overspends will be managed through tighter controls
across the provider arm and favourable healthAlliance price negotiations.
The $329k favourable variance in Infrastructure costs relates to $2.499M of unmet savings from professional
services and general operating costs mitigated by other infrastructure underspends such as a $609k underspend
on outsourced cleaning, laundry and orderlies, $252k saving on utilities and maintenance, $762k saving on
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software charges and telecommunications costs and $1.265M interest saving from lower debt balances and
interest rates.
Infrastructure costs are forecast to underspend by $221k for the year. This is in line with the year to date position
and stems from tight control of central administration costs (such as legal expenses, telecoms and training) and
from better than expected interest income.
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Human Resources
Sick Leave
Trends
Current trending mirrors the summer/autumn period last year with sick leave levels starting to rise
February/March. The level is currently still within target.
Highlights/risks
While the levels are still below target the challenge will be to contain sick leave rates as we move into winter.
Planned Actions
Leave management training and continued support from HR Managers/Advisors in their business units to assist
managers pro-actively address instances of high sick leave within DHB policy and practice.
Staff flu vaccination programme commencing in March.
The staff gymnasium is now open and staff are being encouraged to use this facility as part of their wellbeing and
fitness programmes.
Overtime
Trends
Overtime is still above organisational target and increasing again, mirroring increase in sick leave rates over the
same reporting period.
Highlights/risks
Feb 2014 rate is higher than the previous two years and if upwards trend continues this would be a concern in
terms of potential budget impact into the last quarter of the financial year.
Planned Actions
Analysis of ‘red flag’ areas. Continued support from HR Managers/Advisors to managers in implementing
strategies to reduce overtime such as effective leave management and recruitment processes.
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Annual Leave Management (headcount)
Trends
Totals remaining relatively stable with the biggest changes being a decrease in the number of staff with 50-74
days balance but balanced by an increase of approximately 200 staff with up to 24 days.
Highlights/risks
As noted above there has been a decrease in staff with 50-74 days which will be a reflection of active leave
management planning. This needs to continue for both 50-74 days and 75+ days particularly as we move towards
winter where annual leave update is traditionally lower.
Planned Actions
Continued focus in business units of implementing pro-active leave management plans for employees with high
balances with support of HR Managers/Advisors
Staff Retention
Trends
Continued upwards trend in staff resignations within first six months from December 2013 but the level is still less
than previous year.
Highlights/risks
Should this level continue to rise we will need to undertake further analysis. While the current rates are of no
significant concern a continued increase in staff leaving within the first six months will need to responded to .
Planned Actions
Continue to analyse information from exit interviews and work with managers to address any specific concerns or
opportunities for improvement.
Work progressing over the next few months to embed the results of Our Values Your Values will include strategies
to monitor employee engagement. It has been decided to develop these processes within our Values work rather
than implement another stand alone survey. Some of this information has already been gathered through the
listening clinics with staff in the recent In Our Shoes sessions and will continue to develop as we progress.
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Turnover
Trends
Upwards trend from November 2013, but has since declined.
Highlights/risks
While the current rates are of no significant concern, monitoring of staff leaving within the first six months will
continue.
Planned Actions
Continue to analyse information from exit interviews and work with managers to address any specific concerns or
opportunities for improvement.
Work progressing over the next few months to embed the results of Our Values Your Values will include strategies
to monitor employee engagement. It has been decided to develop these processes within our Values work rather
than implement another stand alone survey. Some of this information has already been gathered through the
listening clinics with staff in the recent In Our Shoes sessions and will continue to develop as we progress.
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Medicine and Health of Older Peoples Services
Service Overview
This Division is responsible for the provision of emergency care, medical services and sub-specialties (including
cardiology, dermatology, diabetes, endocrinology, gastroenterology, haematology, infectious diseases, renal,
respiratory and rheumatology), and services for older people including assessment, treatment and rehabilitation
(A,T& R), mental health services, and home based support services.
The service is managed by Debbie Eastwood with the Heads of Department Dr Jonathan Christiansen, Medical,
Shirley Ross, Nursing and Tamzin Brott, Allied Health. The Clinical Directors are Dr Hamish Hart for Medicine, Dr
John Scott for Health of Older Adults, Dr Rob Butler for Psychiatry for the Older Adult, Dr Willem Landman for
Emergency Care, Dr Ali Jafer for Gastroenterology, Dr Rick Cutfield for Diabetes/Endocrinology, Dr Tony Scott for
Cardiology, Dr Hasan Bhally for Infection Diseases, Dr Janak De Zoysa for Renal, Dr Megan Cornere for
Respiratory, Dr Ross Henderson for Haematology, Dr Cathy Miller for Palliative, Dr Blair Wood for Dermatology
and Dr Michael Corkill for Rheumatology.
Scorecard
Health Targets Smokefree
The Medicine and Health of Older People Service (MHoP) achieved 95.8% for February against a target of 95%,
with the result for the organisation being 96.3%.
Shorter Stays In Emergency Departments
Shorter stays in ED performance for February was 95.99% for MHoP and 95.7% for the organisation. February has
been challenging for the North Shore ED both in terms of the volume of patients, and the high number of
presentations in short time periods (i.e. greater than 8 patients in 20 minutes which is monitored on a weekly
basis). The increase in ED presentations is demonstrated in the graph earlier in this report with YTD growth in ED
presentations at 4.3% and 6.8% for ADU.
We are working closely with all services to improve their response to ED when patients are referred to their
speciality. We are also monitoring the referral times from ED, i.e. <3 hours and > 3 hours in an effort to ensure
patients are being processed in a timely manner. This can become difficult when a large number of patients
present in a short time period. Bed availability, and therefore flow through ED and ADU, has been facilitated by
opening the Short Stay Ward. Year to date this financial year the utilisation of the short stay ward has been:
Surgical Services 58%, Medicine 38% and Gynaecology 8%. This area is used primarily for patients waiting for
theatre, patients waiting on diagnostic results and patients who are likely to be discharged within 48 hours. The
short stay ward has been open consistently (closed for some days over December only) this financial year.
The information below shows the year on year growth in ED presentations from 2011 along with the impact on
admissions.
% Growth For each Fiscal Year
Hospital Admit To Ward 2011 2012 2013 YTD 2014
YTD 2014 +
Forecast for
Mar-Jun
2012 2013
YTD 2014 +
Forecast for Mar-
Jun
Annual percentage growth
rate from 2011 to 2014WDHB No 70,447 77,673 79,583 54,854 82,281 10% 2% 3% 4%
Yes 27,250 27,255 28,693 20,170 30,255 0% 5% 5% 3%
WDHB % Admitted 28% 26% 26% 27% 27%
North Shore No 37,118 41,165 42,659 29,864 44,796 11% 4% 5% 5%
Yes 20,843 20,406 21,611 15,160 22,740 -2% 6% 5% 2%
North Shore % Admitted 36% 33% 34% 34% 34%
Waitakere No 33,329 36,508 36,924 24,990 37,485 10% 1% 2% 3%
Yes 6,407 6,849 7,082 5,010 7,515 7% 3% 6% 4%
Waitakere % Admitted 16% 16% 16% 17% 17%
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AT&R Wards and Length of Stay
The average length of stay (LOS) for the AT&R wards in February was 22.8 days against a target of 15.50 days.
There are a number of contributing factors to this long Length of Stay. The wards were at times during the
month closed to admissions on the advice of Infection Control and this was coupled with the fewest number of
discharges over the last 12 months (112 against an average of 148 per month). A significant factor was the
discharge of a cluster of complex patients that had much higher than average stays. The ALOS for these five
patients was 74.6 days. There are currently four patients with stays over 30 days awaiting Protection of Personal
and Property Rights (PPP&R) decisions. We are monitoring this delay currently.
Elective WIES & Discharges for Cardiology
WIES for elective cardiology is below contract for the month, however the number of discharges are 125.3%
ahead of target in February. We are planning to run additional elective lists in March and April to ensure we meet
both patient demand and our elective contract.
Complaints The number of complaints received in February was 33 for the month with a turnaround time of 19 days against a
target of 14. We also received 9 requests/inquiries/suggestions.
Other Key Measures Assessment & Diagnostic Unit (ADU) – time to be seen from triage (Medicine) % compliance to 60 minutes
Our result was 50% in February, a slight reduction from the previous two months. We are continuing to work on
understanding the root cause of the delays and as part of this we are reviewing the data related to the time when
the delays occur. The medical teams are also being mobilised to support admitting in ED/ADU when there are
surges in volumes as we have experienced on a number of occasions during February.
Acute readmission rate within 28 days
The analysis of the readmissions audit has been delayed due to the junior doctor’s exams. We are aiming to have
the analysis of the audit completed by the end of March. Whilst we will then need to review the results more
thoroughly, in the interim, one of the key features we have identified as an issue is the need to improve the
information going into Electronic Discharge Summary (EDS) information. The plan for the patient post discharge is
a critical component of the EDS which needs to be completed effectively. The Clinical Director Geriatrics and the
Chief Resident are working on developing EDS examples for junior medical staff to be used as training guides.
Quality
FAST quality improvement project - Managing pain on the medical wards
Wards 3 and 6 have been identified as the pilot wards for this initiative. Data has been collected through patient
and staff surveys and a medication chart audit. Preliminary results show that patients with pain receive analgesia
however they are not having their pain reassessed after administration. The steering group met on the 13th March
to formulate an education plan for improvement and initial findings will be ready for presentation to Clinical
Governance on 23rd March. The plan is to commence education and improvements from 7th April.
HQSC Markers
Falls
Fall audits across all wards in MHoP continue to indicate a steady improvement in the completion of a risk
assessment along with care planning within 8 hours of admission. We are focussing on implementing a package of
care for medium and high risk patients rather than focussing on individual falls prevention strategies. An for
example of this might be 15 minute checks being done in conjunction with a floor line bed and personal falls
alarm.
Hand Hygiene
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Gold auditor training is well underway and a further six nurses from our division are undertaking this opportunity
on 19 March. Once they have completed the training they will immediately be involved in hand hygiene audits,
along with being a resource in the ward and providing interactive education for the nurses on their wards. By
March every medical ward will have at least one member of staff trained as a gold auditor.
Friends & Family
The Friends and Family test in MHoP is progressing well with most of the wards now able to collect feedback daily
as they each have their own tablet. The Charge Nurse Managers are leading this project with Ward 2 currently
achieving the highest number of responses at 80 and ward 10 with 76.
Staff are beginning to understand the data and the value in collecting as many responses as possible to improve
the validity and therefore the value of the feedback from patients and their families.
Total responses collected for MHOP for February are 226.
� 193 inpatient responses (wards)
� 33 from ED
Overall MHOP has a net promoter score of 53%. This is made up of 71.8% promoter, 24.2% neutral and 4%
detractor. The scores are calculated using the underlying net promoter score methodology by analyzing
responses and categorizing them into promoters (would recommend), detractors (would not recommend) and
neutral (passive) responses. The proportion of detractors is then subtracted from the proportion of promoters to
provide an overall ‘net promoter’ score.
Human Resources Thirty three new graduate nurses, totalling 21.6 FTE, joined the MHoP service in February. These nurses are filling
budgeted vacancies across all the wards, Emergency Department and the Assessment & Diagnostic Unit.
The HOD Nursing is leading an education project in partnership with senior nurses from the AT&R wards to up
skill Ward 11 (isolation/infection control ward) nurses to be specifically focussed on the needs of the older adult
patient. We have identified over the past few months that a significant proportion of the patients who are on this
ward are >75 years of age and therefore require care that is appropriate for both their presenting medical
problem, but also their age related requirements.
We are currently advertising for a part time Dermatologist. This will enable us to provide a more appropriate level
of access for community patients via the outpatient service, along with improving the support to the inpatient
services.
The clinical nurse specialist review is progressing, with work groups now being set up to work on areas such as:
generic job description for speciality nurse and clinical nurse specialist, orientation, job planning process and
establishing key performance indicators.
Service Delivery Cardiology achieved 100% compliance with the MoH target of 85% of elective patients receiving their coronary
angiogram within 90 days.
Colonoscopy service delivery – as noted on the scorecard we achieved 55% compliance for the urgent
colonoscopies completed within 14 days. We have been focussing on our non-urgent gastroscopy waiting list
over the last 2 months.
Cardiology is meeting a compliance requirement of 85%, total number is 134 as at 24th February 2014. 100%
compliance for ESPI 5 but local target not achieved. Acceptable wait list is 100 with target 76. This is being
addressed as part of the NSH CVU initiative to increase throughput and session availability and results are not
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likely to be evidenced until financial calendar Q3 to 4 2014, depending on the availability of additional PCI
operator resource.
ESPI 1, ESPI 2 & ESPI 5
All specialties continue to be 100% compliant with the 5 month target (ESPI 2 & ESPI 5). There remains a
challenge for cardiology and gastroenterology in terms of ESPI2 compliance. Plans are underway in all services to
achieve 4 months wait times for ESPI2 by June 2014 (target date of October 2014 for Cardiology and
Gastroenterology). The recruitment of an additional Dermatologist will support this small service to sustain their
waiting list at 4 months as will the return of a Respiratory Physician from maternity leave.
The booking and scheduling function undertaken in the Patient Service Centre - Medicine continues to be
reviewed and a restructure of the current functions will be undertaken. This work will be supported by the Quality
team. The specific actions in February are:
• Referrals processes have been reengineered and embedded. • Capacity and demand work for the Patient Service Centre- Medicine staff has been completed. This work
will inform the restructure of this area. • Interviews for a Team Leader of this area are underway, however it is unlikely we will have a successful
appointment.
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Scorecard
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Waitemata DHB, Hospital Advisory Committee Meeting 09/04/2014
STRATEGIC INITIATIVES
Deliverable /Action On Target
Increase monitoring and review of waiting times by ethnicity for echocardiograms and
adopt new ways of working that will improve the use of current capacity and reduce
waiting times ����
Direct access for general practitioners to specialist nurse and /or doctor advice in renal,
diabetes, gerontology, dementia and cardiology – confirm current practice and
establish baseline Q1, identify any enablers or process changes required (e.g. processes
to ensure any advice provided is captured in clinical notes) Q2, implement changes
required Q3, direct access in place for identified specialties Q4
����
The Diabetes Centre will explore the option to extend the Mind the GAP (Glucose
Awareness Project) programme once the results of the pilot are known ����
Inpatient hospital services (31 services) will have a trained and resourced smokefree
lead to provide training and support to clinical staff. These leads will be supported and
resourced by the Waitemata DHB Smokefree Team with peer support and monthly
updates
����
Refresh the ABC activity recording form (ATM – Ask, Triage, Manage) in use at
Waitemata DHB ����
Having completed a comprehensive review of the current General Medicine model of
care, redesign the model of care and staffing for General Medicine inpatient services by
September 2013 x
Implement the new model of care by February 2014 x
Continue the development and implementation of clinical pathways which will ensure
standardisation and equity of care for patients in both ED & ADU – 5 pathways to be
reviewed and/or developed by June 2014 ����
Develop a workforce strategy plan for the ED by July 2013 with sign off and initial
implementation by December 2013 x
Implement a semi acute respiratory clinic by July 2013 for winter demand and evaluate
by December 2013 x
Provide LTC workforce education courses to primary health care practitioners –
ongoing ����
Implementation of an staff on-line training tool for thrombolysis staff ����
Use the findings of the Integrated Transition of Care Project to inform development by
October 2013 of a suite of interventions to improve the discharge management
process. Commence piloting the suite of interventions by January 2014. Use participant
feedback for iterative development and re-piloting to achieve a sustainable suite of
interventions by April 2014. Pilot evaluated to determine suitability for rollout across a
range of inpatient services by 30 June 2014
����
Implement the Ministry of Health Elder Abuse Guidelines ����
Deliver secondary preventative care for fragility sufferers (through identification,
investigation and intervention) to prevent hip fractures. This will be supported by the
Minimum data set (MDS) for hip fractures. (Service Level Agreement in progress) ����
Finalise and report the findings of clinical quality audit of Māori referrals for
angiography and angioplasty by September 2013, and develop a business case to
support implementation of recommendations as appropriate ����
Review older people services and clinical pathways ����
Ongoing provider arm services reviews ����
* include a � or a �
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Key achievements for month
• The District Nursing project has been shared with NZNO and will be launched with staff in
early March. We are now advertising for an enrolled nurse to join the Rodney team, which
is the pilot site for the new model of care. Meetings are also being arranged with our
internal nursing development team and Unitec in relationship to clinical placements for EN
students and new grad programme.
• The nine month cognitive Impairment pathway pilot commenced as planned on 4th
November 2013 and will run until 31st July 14. By the 31st March 14 the 12 GPs (6 GPs and
their Practice Nurses per ProCare and Waitemata PHOs) will each case find three 65+ year
old patients with previously undiagnosed dementia and 2 with previously undiagnosed
cognitive impairment and with their / their carer’s consent trial the pathway. Two meetings
have been held with clinical directors and key others to progress moving forwards with
memory clinic.
• The Febrile Neutropaenia pathway which was developed by one of our Registrars and our
Acute Care Physician with input from the Haematologists and the Infectious Disease
physicians has now being completed and is now up on General Medicine site.
• The Diabetes Centre will explore the option to extend the Mind the GAP (Glucose Awareness
Project) programme once the results of the pilot are known. The first year of the diabetes
audit provided an excellent picture of our admitted diabetic population. It also identified
opportunities for improvement. Further refinement of the audit process will ensure that the
state of diabetic care continues to improve. The audit also identified a need for
downloadable data from POCT blood glucose monitors. Nine new monitors were ordered in
January and a further six were provided free of charge for a three month period by the
suppliers. Staff training commenced in January for the first three services to trial the
monitors.
• Deliver secondary preventative care for fragility sufferers. A 0.5FTE CNS is currently
delivering a wrap-around service of assessment, treatment, education, and follow for up to
300 outpatients per year. She is supported by a consultant Endocrinologist. Patients are
identified from both the acute fracture clinic based in orthopaedic outpatients at North
Shore Hospital or referred from the ED with relatively straight forward injuries, i.e. they do
not require surgery. The work to date suggests that at least 300 patients at risk of fragility
present for an outpatient appointment each year. Of this group, we estimate that up to two
thirds will not be on appropriate osteoporosis prevention medication. This is our target
population. To enhance our DHB funded service, ACC want to discuss the possibility of a
funding partnership to increase the personnel resources for up to three years to further this
work stream.
Areas off track for month and remedial plans
• ED workforce strategy – the development of the best care bundles in the ED are continuing
to be developed, rolled out and evaluated. Changes to the medical workforce are on hold at
this stage.
• General Medicine roster – as noted in previous reports we are not progressing home
wards/general medicine roster. However we are working with the general medicine teams
to achieve a higher level of home warding at Waitakere Hospital.
• Respiratory semi acute clinic – this initiative has been put on hold as further discussion
between Respiratory and General Medicine has identified this is not a priority as there is
fast track access to a respiratory physician via the outpatient service.
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KEY ISSUES/INITIATIVES IDENTIFIED IN COMING MONTHS
• Telerehab Project –Funding for the tablets for this project has now been agreed and we are
waiting on a final quote before moving ahead and purchasing them. The professional and
clinical Leader for speech language therapy has picked up the lead for this project post the
allied health review. There is currently a focus on finalising the training, identifying the
project outcome measurements and setting training dates post the delivery of the
hardware.
• Ward 6 continues to be fully utilised to its full level of 35 beds, this is primarily to support
surgical patients (elective and acute). This has meant that the projected reduction in
medical bed demand and subsequent financial savings has been compromised. We have had
to ask staff to extend shifts, work overtime and on a number of occasions employ external
bureau to ensure safe nurse to patient ratios are maintained.
• The Regional RMO position request process is underway across the DHB; this work is being
coordinated by the Medical HoD, MHoP on behalf of the organisation.
• User groups have been set up to work on the detailed design for the Podium.
• A project manager has now started working on the business case for additional medical
beds.
• A post implementation review of the Additional Endoscopy Room business case will
commence in late March.
• Commissioning work is progressing to plan for the new community dialysis unit in Apollo
Drive. This unit will open in May 2014.
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Financial Results
COMMENT ON MAJOR FINANCIAL VARIANCES
The overall result for Medicine & Health of Older People was unfavourable by $565k for the month and year to
date $78k unfavourable.
Revenue
Revenue for the February is $41k favourable ($1,283k YTD favourable). ACC revenue in AT&R is $4k unfavourable
for the month; however it is $420k favourable YTD due to higher than budgeted bed day usage for ACC patients
this financial year. AT&R billings to ACC were lower during February as a result of high bed demand within North
Shore hospital which flowed into AT&R reducing beds available for ACC funded patients. There was a shortfall in
the community nursing ACC of $27k ($220k YTD) which is due to lower acuity work being performed by other
organisations contracted directly with ACC. The Slark Hyperbaric also contributed $101k for the month ($562k
YTD) in unbudgeted revenue which fully offset the costs related to this service; this includes $90k YTD revenue
from ACC funded treatments. Cardiology revenue is $214k unfavourable for the month (YTD $231k unfavourable)
due mainly to lower than contracted elective volumes due to leave over the holiday period. Research revenue is
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$5k unfavourable for the month ($22k YTD) however this is fully offset by favourable variances in costs. Additional
funding of $419k YTD has been received fully reimbursing the operating cost of Short Stay Ward YTD and
additional beds in Ward 6 to the end of December. However the Short Stay Ward has remained open for much of
January and February 2014.
Expenditure
Personnel costs overall are $543k unfavourable for February and $85k favourable YTD. Medical staff costs are
$207k unfavourable year to date and this is mainly due to unmet budgeted savings for the Emergency
Department workforce initiative which is now on hold. Unbudgeted medical costs for the Slark Hyperbaric Unit of
$210k YTD are also contributing to the unfavourable variance, however they are offset by revenue. RMO costs are
$449k favourable YTD primarily due to the actual paid allowances being lower than budgeted year to date. RMO
allowances are not being paid to the same extent as previous years due to the increasing number of doctors
available to fill rosters eliminating payment for additional hours, these are being reviewed as part of the forecast
and budget 14/15 build. Nursing staff costs are under spent by $778k year to date, with the main contributor
being vacancies primarily within the wards; this is at both North Shore and Waitakere Hospitals. Nursing staff are
recruited to budget now with only normal level of vacancies reflected in the service.
Contracted FTE for nursing in the division was 928 FTE at the end of June against a budget for 2013/14 financial
year of 1016 FTE (excluding bureau and unplanned leave FTE) therefore we started the year with approximately
88 FTE vacancies or 8.5% of total nursing FTE. Recruitment during the first eight months has increased contract
FTE by 63 to 991, reducing the vacancies to 2.5% of total nursing FTE. The opening of the Short Stay Ward to meet
bed demand has contributed $387k of additional nursing cost which has been fully reimbursed by revenue up
until December. Approximately 4.9% of our nursing spend over the first six months has been a combination of
internal and external bureau, this has been to cover a combination of vacancies and sick leave. Bureau usage to
date remains constant as high occupancy since the Christmas period led to use of temporary resources to top up
the reduced beds/FTE planned for summer.
FTE Staffing levels are below the agreed budget FTE for the division this month with contracted FTE 1686.52
against the budget of 1727.14. Vacancies are the main contributor to this. There has been a net increase of 10.6
contracted FTE across the division in January and February, mainly due to the latest intake of Graduate Nurses.
Other Expenditure
Outsourced Services are $125k unfavourable for the month and $434k unfavourable YTD. External nursing bureau
costs are $820k over budget YTD; however this is offset by the favourable variance in nursing personnel costs.
There were favourable variances for both medical fee for service and clinical services.
Clinical Supplies are unfavourable to budget $556k YTD. PCT drugs are under spent by $22k YTD (despite $173k
relating to under accrued costs from the 2012/13 financial year). Overall PCT costs now include use of these drugs
in Haematology and Rheumatology. Client related costs are over budget by $231k YTD. This is comprised of on-
going costs $85k of ADHB home haemodialysis support (which continues to incur cost due to the delay in the
build of the Apollo Drive Dialysis Unit which is part of the Renal Phase 2 business case) and Mental Health for
Older Adults Respite care over budget by $181k. Implantable Cardiac Defibrillators (ICDs) are over spent by $492k
YTD due to higher than budgeted volumes. This is under review, however all procedures have been audited and
are appropriate within regional guidelines. Further work analysing the volumes is underway. Other areas of over
spend include protective clothing, dressings, monitoring equipment and catheters. These costs will be closely
monitored over the next quarter to ensure any agreed price reductions are realised and where there is volume or
price increases we will seek to mitigated these over spends.
Infrastructure and non-clinical costs are unfavourable by $455k YTD with the most significant overspends coming
from budgeted revenue which has not yet been received, cleaning costs, printing, stationery and postage costs
and one off consulting costs from PwC relating to work in the division on identifying savings opportunities.
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Full Year Forecast
A high level forecast has been prepared for the service based on the January result predicting an over spend of
$1,216k against the budget.
Assumptions include the impact of savings plans, back pay estimates for Cardiology and Older Adults SMO’s,
outsourcing of colonoscopy and gastroscopy and achievement of elective volumes.
Areas of risk are continued high bed demand impacting on nursing and external bureau cost, receipt of additional
$250k funding budgeted but not yet received, extent of available funding from Ministry of Health to offset costs.
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Child, Women and Family Services
Service Overview
This Division is responsible for the provision of maternity, obstetrics, gynaecology and paediatric medicine
services for our community and the Auckland Regional Dental Service (ARDS) for metro-Auckland. Services are
provided within our hospitals, e.g. births and gynaecology surgery, and within our community, e.g. community
midwifery and mobile/transportable dental clinics. The division is managed by Linda Harun with Dr Tim Jelleyman
HOD Medical CWF, Emma Farmer HOD Midwifery; Marianne Cameron HOD Nursing, Ronelle Baker Allied Health
Lead, Dr Sathananthan Kanagaratnam Clinical Director ARDS, Dr Sue Belgrave Clinical Director Obstetrics, Dr Peter
van de Weijer Clinical Director Gynaecology and Dr Meia Schmidt-Uili Clinical Director Child Health. SCORECARD
Health Targets The service continued to deliver better than target on the better help for smokers to quit at 96%.
Elective volumes (gynaecology) are 104% of target overall and the volume delivered in ESC has increased over the
last few months to reach 99% of target YTD.
The service achieved 98% compliance with the 6 hour target in ED. Both Women’s and Children’s services
continue to review all breaches and are working with the ED to improve results.
The gynaecology breaches related largely to a shortage of beds to admit patients in a timely manner.
During February there were 881 children under 15-years who presented to the Waitakere Emergency
Department. During the month there were 18 breaches (paediatric) of the ED 6-hour target (98% compliance).
Each breach continues to be reviewed. These reviews demonstrated there were a number of contributing factors
that led to the breaches. These included:
• Patient acuity, where children required stabilisation in resuscitation prior to transfer to the ward
• Children who were following clinical pathways who required longer than 6-hours in the emergency
department before being discharged home
• Medical staff responding to high volumes of children through the department.
Quality The complaint turnaround time for the service was on target of 14 days. The Friends and Family Test is being trialled in maternity at North Shore and shows a high rate of promoter scores
on a relatively small sample size.
Human Resources The sick leave rate remains above target. The service has several staff on long term sick leave which are being
reviewed with the assistance of Well NZ.
Annual leave balances remain an issue for SMOs. Women’s Health has employed two new SMOs which will
enable existing staff to take their annual leave and should result in overall reduction of high leave balances.
Service Delivery Oral Health Arrears Target
Total arrears have continued to improve reaching overall regional rates of 6.7% and 6.1% for Maori. This has
resulted in volumes of treatments being 23% above the previous year.
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Theatre utilisation
Theatre utilisation remains lower than target largely due to late cancellations. The Women’s Health Service
continues to work with individual SMOs who do not meet the target in order to improve the theatre utilisation.
All theatre lists are reviewed two weeks from operating date to ensure they are fully booked.
Breastfeeding on discharge
Exclusive breastfeeding on discharge remains above target at 78%. This reflects well on the commitment of all
staff to maintain the BFHI status.
Births
Year to date births are slightly above target for the year to date.
Elective Caesarean Sections
The Women’s Health Service has commenced a normal birth project which specifically has the aim of promoting
normal birth. This project is being led by the Maternity Quality and Safety Midwife Co-ordinator. Along with this
project the service audits the Caesarean Section rate and reviews the clinical indications for Elective Caesarean
Sections.
Average length of stay
Length of stay in maternity and paediatrics is slightly below target for the month of February.
ESPI compliance
Both gynaecology and paediatrics are ESPI 2 compliant. The ESPI 2 target moving to 4 months raises some issues
for the Women’s Health Service in relation to the availability of additional clinic rooms and nursing staff. The
service is working closely with both outpatient CNM’s to ensure any available clinic room is booked in advance for
a gynaecology compliance clinic.
Gynaecology is ESPI 5 compliant.
Both Child and Women’s Health services are better than target in achieving ESPI 1 compliance, reaching 95%. The
services both have centralised triaging processes that enable close monitoring of processes. Child Health Services
is now booking and scheduling all paediatric clinics (this responsibility previously sat with Elective Services). The
paediatric booking clerks have been fully oriented into the service and the transfer of responsibility has resulted
in a reduction of clinic booking errors and improved wait list management.
Contracts WIES volumes
Gynaecology Elective WIES volumes remain slightly above target for the year and this is expected to continue
until June. The total WIES delivered in ESC is now close to target and this will be maintained. Gynaecology is
delivering increased total elective volumes to improve the overall elective volumes for the organisation.
Acute gynaecology volumes are close to target.
Maternity WIES volumes are higher than target reflecting the increased complexity of cases now that the DHB is
delivering the Gestational Diabetes service locally. Overall birth numbers are not higher but the numbers of
women requiring complex care has increased.
Paediatrics WIES volumes are now trending towards target. The volumes are always higher in winter and the
summer reduction in volume brings the overall volume down towards the annual target. Currently the service has
delivered 114% of target.
Neonatal WIES is 3% below WIES target reflecting a slight reduction in activity for this period.
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Transfers from Starship Hospital and Out of Area Admissions
There has been a decrease in transfers from Starship ED to Rangatira ward while the number of out of area
admissions has remained static. Discussions are continuing with Starship to streamline these processes and
reduce double handling whenever possible.
Non case weighted discharges
Child health services remain below target in FSA volumes. Paediatrics typically provide more of this volume in
summer and the total year to date volume will continue to improve in the next two months. In addition, there
may potentially be two factors that are influencing FSA volumes: 1) the centralisation of triage across both sites
leading to greater consistency in acceptance (or not) of referrals for assessment; and 2) an increase in virtual
FSAs.
FUP volumes are higher than target due largely to gynaecology volumes. These are being investigated to ensure
accuracy of data. All SMOs planned appointments are being reviewed to determine if a woman needs a FUP
appointment or can be discharged back to her GP.
Child Rehabilitation Activity
Rehabilitation Activity – Total Bed Days (In and Out of Area)
Overall MOH rehabilitation bed days utilised has seen a reduction over the past month. This is due to very low ‘in
area’ bed day utilisation this month (n=1). Decreased overall bed utilisation is also a result of the introduction of
strategies to manage the high volume (beyond contracted levels) of ‘out of area’ bed days. This includes the
delay of planned rehabilitation for some children.
Rehabilitation Referrals
The referrals from outside of the Auckland region have continued to be above target with referrals from Taranaki
and Waikato being the highest users of the service. The referrals from within the Auckland region significantly
reduced this month.
Rehabilitation Activity – ACC Bed Days
ACC volume has shown a spike in referrals resulting in a year to date delivery of 5% above the target.
The ACC contract is a fee for service and the DHB only receives revenue for referrals accepted and services
delivered.
Gateway Assessment Programme Referrals
There has been an increase in the number of referrals received to the Gateway Assessment programme this
month, but the monthly referral rate continues to be much lower than the anticipated volume of 32 per month.
A meeting has been scheduled with the CYF operations manager in late March to highlight concerns about the
low referral rate and identify strategies to improve this.
Assessments Completed
There were 22 completed Gateway assessments this month. This is a significant increase from previous months.
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Children Waiting Beyond Contracted Wait Times
At the end of February there are 42 children who have a completed referral waiting for a Gateway assessment.
This has been reduced each week with the number at 17th March being 26. To date, there are 21 Gateway
assessments scheduled during March.
Gateway referrals
Week
commencing No. of active
referrals Children waiting
beyond
contracted time
frame
Children waiting
beyond
contracted time
frame with
complete referrals
Children waiting
beyond
contracted time
frame with
scheduled appts
17th Feb 114 85 48 16
24th Feb 102 80 46 26
3rd Mar 96 84 42 21
10th Mar 84 75 37 16
17th Mar 70 60 26 14
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Scorecard
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Strategic Initiatives
Deliverable /Action On
Target
Implement Child Emergency Departments and Paediatric Wards immunisation
processes improvement plan
�
Ensure all cases of acute rheumatic fever are notified to the Medical Officer of Health
within 7 days of confirmed diagnosis by June 2014
�
Continue to deliver the hospital-based Family Violence prevention and intervention
programme. For 2013/14, this will include training for mental health social workers,
Auckland Regional Dental Service and on-going DHB generic training via Learning and
Development
�
Work with maternal mental health to implement universal screening for mental health
conditions in pregnancy
�
Progress training of DHB professionals to recognise signs of maltreatment in the
following key services: Child Health, Maternity, Alcohol and Other Drugs, Mental Health,
Sexual Health and Emergency Departments
�
Sign the CYF Schedule 2 (under the Memorandum of Understanding with Child, Youth
and Family Services, Police and DHBs for interagency collaboration for child protection),
which relates to Child, Youth and Family Services funded liaison social worker positions
in all DHBs
�
Policies and reporting systems in place to recognise and report child abuse and neglect �
High level accountability in place for clinicians to routinely screen for family violence as
part of assessing the well-being and safety of children and families
�
Develop and implement a policy to support maternal/perinatal mental health services
screening of pregnant and postpartum women who access provider arm services for
antenatal and post natal care
�
Publication of Annual Maternity and Clinical Reports for 2012 is published in August
2013 and for 2013 data, in August 2014
�
Develop a system for identifying whether children presenting to Child Health Services
are engaged with early childhood education and routinely provide information to
families/whānau on the benefits of early childhood education
�
* include a � or a �
Key achievements for month
� The immunisation processes improvement plan has been fully implemented in Rangatira ward.
� Public health nurses and social workers are opportunistically promoting early childhood
education attendance with families where there are pre-schoolers. Parents are also made aware
of the Before School Check and the process for arranging an appointment. Specifically, staff are
talking with parents about school readiness and provide information on how they can apply for
20-hours free early childhood education. The Waitakere Child & Family team continue to be
involved in the Success for Little People Initiative. The long term goal of this initiative is to
ensure that all 5-year olds living in West Auckland are enrolled in school, ready for school and
are attending every day with the support of their families
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OTHER HIGHLIGHTS Before School Check (Vision & Hearing Component)
There has been an increase in the number of screens completed this month, with the service now at
6% below the expected target.
The February 2014 report from the Ministry of Health indicates that Waitemata DHB has almost
reached the year to date target for Before School Checks and is the highest performing DHB in the
Northern region.
Rheumatic Fever Programme
School Based Swabbing Programme
The swabbing programme is operational in all five high risk schools within the Waitemata district. Of
note, 100% of children in all five schools have consented to participate in the programme. 491
swabs were taken this month and 16% (n=79) of children swabbed had a GAS+ result.
During February there has been a particular focus on updating school rolls. Also, each of the
thirteen schools in the Waitemata district that have been identified as moderate risk have been
allocated a public health nurse. Each school will receive an information pack on rheumatic fever and
advice on other available resources. The schools will be offered education sessions for staff and the
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broader community. These will be delivered after a short survey is completed, which ensures that
the sessions are tailored to each school community’s needs. It is anticipated that the education
sessions will be undertaken in partnership with NGOs, Maori and Pacific health providers with the
local community. Schools will also be shown the National Heart Foundation curriculum tool and
encouraged to use it. The plan is to utilise any up and coming school community events to deliver
education and promotion to these communities.
Auckland Wide Health Housing Initiative (AWHI)
A working group (across community and inpatient services) has been established to develop
pathways and processes for eligible children. All children on the bicillin programme are being
reviewed to determine whether they are eligible for referral to AWHI. To date, all eligible children
who have been identified through the school based swabbing programme have been referred.
Referrals to date are detailed in the graph below.
0
4
8
12
16
20
Child Health Referrals to AWHI (n)
Jan - Feb 2014
Auckland Regional Dental Service
Oral Health Arrears Target
A child is considered in arrears if they have not been examined within more than one month outside
their recall period. The Ministry of Health has a target of 10%. The arrears at Waitemata are
currently 8.3% and at Auckland 6.1%, compared to July 2013 where rates for Auckland were 20% and
Waitemata 18%. The results above differ to the scorecard reported result as arrears fluctuate daily
and reports change according to timing.
This graph demonstrates the improvements in arrears rates from October 2009 to February 2014.
The MoH target by June 2014 has been increased to 7% (93% children seen on time). All areas are on
track to achieve the new target by June 30.
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Child Health Redesign
Implementation of the recommendations identified in the Child Health Redesign continues. Key
achievements this month include:
Single Point of
Entry
� The entry pathway has been completed
� A meeting has been held with all team leaders and charge nurse managers to
discuss implementation
� Processes and systems that will support implementation are nearing completion
� The service is actively engaged in the e-referral project
� ‘Go Live’ has been scheduled for the 28th
April 2014
Care Co-ordination � Pre-evaluation questionnaires have been completed
� Initial feedback from clinicians participating in the pilot indicates that there are
significant benefits in the model (e.g. reduction in children lost to follow up) and
improved engagement with families
� A post-evaluation session has been booked for the end of March 2014
School Based
Services
� A stocktake of services provided within school has commenced
� The plan for transition the bicillin programme from Home Care to Child & Family is
progressing within identified time frames and a ‘bicillin champion’ has been
identified from the public health nursing team
� An in depth review of services provided to each secondary school is underway. This
involves the Clinical Nurse Specialist for Youth Health visiting each school with the
allocated public health nurse.
Clinical Pathways � Work continues on developing both the continence and ASD pathways
� Marinoto have agreed that the ASD pathway will work across both services and the
feasibility of developing a joint assessment clinic will be explored
� A working group has been convened to look at the development of an allergy
pathway (due to clinical interest)
Future Service
Framework
� Child Health IT Governance Group has been convened
� A process for defining the integrated teams has been determined and members of a
working group have been identified
ADHB-WDHB Women' Health Collaboration
The CD for Gynaecology and the Operations Manager for Women’s Health are on a collaborative
group working with ADHB and community GP’s to improve the clinical pathway for women referred
with abnormal uterine bleeding.
Midwifery Conference Presentations
Four presentations were accepted by the NZCOM conference committee from the community
midwifery team for presentation at the annual conference at the end of August. The theme for the
conference is “Midwifery relationships in bridging the gaps” and how the sectors of primary,
secondary and tertiary work together.
The presentations accepted are:
• Te Aka Ora (the WDHB model of care for supporting vulnerable women and families in
pregnancy);
• Diabetes in Pregnancy model of care at WDHB;
• Community Midwifery Liaison role;
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• Pacific Island interface with maternity services specifically the antenatal drop-in clinic at
West Fono and the engagement with Pacific Island churches.
Financial Results
COMMENT ON MAJOR FINANCIAL VARIANCES
Revenue
February Revenue continues to be earned at a lesser rate than budget because the budget assumed
additional revenue to reflect an increase in children being transferred from Starship to Rangitira
($63k per month, $500k unfavourable YTD). In addition the pricing error on Colposcopy also
continues, with a further $63k per month unfavourable variance.
Favourable offsets in February included additional IDFs passed on to Maternity ($92k), and a one-off
accounting adjustment of a release of prior year accruals.
The year end forecast assumes continuation of the Colposcopy and Starship unfavourable variances,
as well as a shortfall on Dental revenue from CMDHB for additional staff and Operational costs
oncharged under the SLA for the new service model.
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Personnel Costs
Medical – February saw continued favourable variances on medical costs, with a significant
underspend of $226k. This is due to a combination of SMO vacancies in Child Health and Women’s
Health, however recruitment into these roles is currently underway, and all but 1 FTE are expected
to be filled by the end of June 2014. Up to this time however the underspend is expected to
continue, and will result in unbudgeted locum costs being incurred to cover acute duties.
Nursing – Nursing costs for February were favourably affected by the reverse of an accounting
adjustment in January; however YTD the result is unaffected and is close to budget. There have
been high levels of vacancies through the year in Nursing, but these have been offset by incurring
higher penal rates and allowances than were originally anticipated. Recruitment of additional staff
will occur in the final months of the financial year in preparation for the winter Roster in Rangitira
ward and in the SCBUs, which has impacted on the small overspend forecast for year end.
Allied Health – Two savings initiatives have impacted on allied health recruitment, being the Child
Health redesign process still underway, and the delay of recruitment of Dental Therapists until the
New Grads were available in the New Year. A total of 22 FTE began work with the Dental service
over January and February.
Administration – The Administration budget includes a total $330k saving line which has impacted
unfavourably by $238k on the Administration performance to budget YTD. This has been offset by
vacancies from the prior year which took several months to fill, influencing the results favourably
earlier in the year.
Note: No vacancies for clinical positions are being held as a cost saving measure.
Other Direct Costs
Outsourced – unbudgeted locum costs incurred to cover SMO vacancies as noted above have
reached $210k for the YTD, and are expected to continue to grow as the vacancies will only be filled
in June 2014. In addition there has been a one-off cost of $87.5k relating to outsourced support for
savings initiative implementation.
Clinical Supplies – The Clinical supplies budget includes a savings target of $900k which will not be
achieved in this financial year. Other options to make savings are being investigated to mitigate this.
In addition to this are overspends within the Dental Service where treatment volumes have been
123% of prior years’ delivery, due to a combination of additional enrolment volumes and also due to
an increased focus on catching up on arrears. This is expected to continue throughout the
remainder of the financial year. The two variances together result in the full year forecast of $1.6m
overspent in this area.
Infrastructure – The change from NZ Post to DX Mail resulted in an increase in postage costs for
CWFS, YTD this has reached $72k, and this is expected to reach $104k by Year End.
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Mental Health and Addiction Services
Service Overview
This division provides specialist community and inpatient mental health services to Waitemata
residents. It is also provides community alcohol, drug and other addiction services, and forensic
services to the northern region. The group is managed by Helen Wood with Clinical Director Murray
Patton for Mental Health and Clinical Director Forensic Services, Jeremy Skipworth.
Scorecard
Health Targets Better help for smokers to Quit: 96%
The service continues to perform above target but is slightly lower this month. This is due to one
person, during the process of two transfers, being missed for a 2nd and 3rd set of questions about
their smoking status.
Shorter Waits in ED: 77%
High bed occupancy and acuity in both adult inpatient units continues to impact on timely access for
admission. One of the impacts of high occupancy is the flows back into the Emergency Department
and waiting times for admission after assessment has been completed and consequently some
extended stays in Assessment and Diagnostic unit (ADU) in NSH.
Quality Complaint response time: 17 days
The average number of days to close complaints was twice the rate of January (8 average days to
close). This is however attributable to one complaint, requiring a detailed investigation and response
which required review by CEO as well as the Board Chairman. It remained open from December
2013 to February 2014. There were 10 open complaints during the month of February, compared
with 8 in January 2014.
Seclusion in Adult Inpatient Units
The time in seclusion from previous reports has increased as has the number of episodes; the bulk of
this increase is related to the very challenging behaviours of three specific people i.e. 12 of the 16
seclusion episodes involved 3 people.
Acute Readmission within 28 days
The readmission rate remains high at 14% compared with National KPI targets of 10%. The period
reported on has seen high occupancy levels (99%). The level of pressure for beds resulted in a
number of early discharges, which is likely to have impacted on the readmission rate.
Human Resources Annual leave over 75 days.
Proactive leave planning is occurring with those people with extremely high annual leave
balances. There are 11 people with leave balance accrual of over 3 year’s entitlement. Some of
group took big periods of leave during January and February. We had a particular focus to get
people on holiday for the summer which has had a big impact. The service was also on
minimum staffing on 7th February to allow for the 4 days HCC upgrade. Annual leave taken has
been greater than annual leave earned for the past 3 months.
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Service Delivery – Productivity Occupancy and Average length of stay:
The waiting list for Forensic Services has reduced from an average of 14.5 during 2013 to an average
of 6.5 so far in 2014, and is currently at its lowest level in recent years with only two prisoners
waiting for admission. Although the commissioning of five additional beds in the Wellington Region
for Auckland patients has contributed to this dramatic improvement, the reduction has also been
the result of sustained efforts by clinicians across the service.
Occupancy continues to be very high for Adult acute units (at 99% for February and into March).
There is a constant review of people in beds, alternatives being found to enable new admissions.
Koromiko House provides contracted respite for the North Shore and Rodney areas. The occupancy
rate for February was 98.4%. Koromiko House (7 beds) has directly felt the impact of the pressure
both on Taharoto beds and the North Shore Emergency Department as Koromiko receives some
direct discharges from North Shore Hospital. During February the occupancy rate for Piri Pono (5
beds) was 56%. This is our newest community based acute residential service and is gradually
increasing its occupancy. Te Kotuku Ki Te Rangi (Respite West Auckland – 6 beds), Feb occupancy
rate was 73.21% Average length of stay is lower for February at 20 days. The data for January showed as 35 days.
This is due to a person being discharged to a high level community package of care who had been in
the unit for 584 days. Length of stay is calculated at the point of discharge.
Waiting Times/ Access Rates
All services are meeting national waiting time targets for non-urgent face to face
contact/assessment. Child and Youth services are making some progress to achieving the end
of year 3% access target.
The measure for access to youth alcohol and drug services still requires changing of the age
band – the band 0-19 reduces access level for the group where as it should be 12- 19yrs olds.
The regional target for access to Youth Alcohol and Drug Services for 2013/14 is 1% of the youth
population aged 12 – 18 years of age, increasing to 1.5% in 2014/15. Clients are included if they
receive at least one face to face contact. In the period 1 July 2013 to 31 January 2014 CADS saw new
217 clients aged 12 – 18 years and the Non-Government sector saw 26 clients in WDHB. The total
was 243 clients or 0.4% of the target population.
All other services are performing well against these measures.
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Scorecard
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Strategic Initiatives
No. Deliverable /Action – Prime Minister’s Youth Mental Health Project On
Target
1 Refine data collection systems and collect baseline data for the percentage of
youth discharged from CAMHS and Youth AOD services into primary care being
provided with follow-up care plans, and for consult-liaison sessions delivered by
secondary care to primary care, and set targets by June 2014. The impact of these
practices will be reviewed by June 2015
x
2 Establish baseline for youth access rates to specialist alcohol and drug services and
develop plan to meet the target of 1.5% x
3 Supporting families by developing services for children with parents with mental
illness and addictions by June 2014 and ensure access for the parents to parent
education (e.g. Triple P and Incredible Years) - ongoing. �
No. Deliverable /Action – Mental Health Service Development Plan On
Target
4 Complete a stock-take and gap analysis and develop a three year plan, based on it –
September 2013 completed
5 Collect baseline data for number of consult-liaison sessions delivered by secondary
care to primary care, and set targets by June 2014 On-going
6 Implement the GAIHN integrated care pathway for depression On Hold
7 Ensure links to Whānau ora are made through specific project work �
8 Establish a reporting mechanism to reflect employment status of service-users and
develop an integrated plan to increase opportunities for employment in alignment
with MSD services and welfare reforms (links to local and regional KPI work)
�
9 Meet the wait time targets for non-urgent mental health services �
10 Full implementation of Stepped Care across adult clinical services, and increased
access to talking therapies On-going
11 Establish an inter-agency steering group to develop a local suicide
prevention/postvention action plan
Starting Q4
12 Contribute the mental health perspective to a Maori clinical governance structure
With Maori
Health
13 Ongoing provider arm services reviews �
No. Deliverable /Action – Other On
Target
14 Work towards zero wait times for maternal mental health referrals from DHB
maternity services and lead maternity carers �
15 At least 200 DHB mental health and addiction service practitioners to complete
CALD cultural competency courses within the year 2013/14 �
* include a � or a �
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Key achievements for month
Deliverable /Action Prime Ministers Youth Mental Health Project
3. Supporting families by developing services for children with parents with mental illness and
addictions by June 2014 and ensure access for the parents to parent education
COPMIA stands for “Children of Parents with Mental Illness and/or addiction”. This group are at risk
of developing mental health/addiction problems in the future. Whilst NZ research is limited, the
literature identifies that 1 in 5 Australian young people live in families with a parent who has a
mental illness and it is known that children with depressed parents have a 3-fold increase in
depression, anxiety and substance dependence. Building resilience can make a difference for the
future of children who are identified as vulnerable. A stocktake of our local services in 2013
identified the following rates:
These numbers are likely to be an under-representation with adult services finding it challenging to
identify children and additionally those who may be vulnerable. Work is continuing with Child and
adolescent and Adult Services to raise awareness of COPMIA and link with current resources that
are available. Currently we are proposing that:
1. A suite of COPMIA resources be made available to all mental health services group staff.
2. A Child and Adolescent mental health service liaison clinician will be identified for each
adult community mental health team within Waitemata DHB (including Cultural services).
The liaison clinician can be accessed by the Adult Services Clinical Co-ordinator for each
team for consultation and advice when working with families.
3. Group programmes need to be purchased by the funder (as per ADHB contracts) to
promote the resilience and wellbeing of children and adolescents of Adult service users.
This proposal is in joint mental health funder and provider new investment priorities list.
4. Roles/staff in Adult Services and CADS need to be specified for the development and
implementation of COPMIA pathways and ongoing education of staff. This needs to be
developed via Clinical Governance team.
Mental Health Services Development Plan
5. Collect baseline data for number of consult-liaison sessions delivered by secondary care to
primary care, and set targets by June 2014. The Northern region has tested a mechanism for
collecting this data and will go to full implementation in Child and Youth services (including youth
AOD) from 1 April’14. We are leading the country in this work. Some adaptation and testing is
Adult Community Teams Clients who are Parents with
Children living with them
Marinoto Child and
Youth Clients who are living
with a parent with mental
illness
29%
71%
Parent
with
mental
illness Not
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required for Adult services (including CADS) before we can move to full implementation for all
services. We plan to focus on that next stage in the final quarter (April – June).
7. Ensure links to Whānau ora are made through specific project work. Clinical staff from Whitiki
Maurea and the Adult West community teams are starting to utilise the Whanau House facilities to
see consumers. More work however needs to be done to come to commonly agreed practical
approach for i) enhancing existing mental health contract work provided through whanau house
and our services and ii) having a common ground for tangata wha iti ora who are in common with
both services. Liaison work has been occurring from Whitiki Maurea staff.
8. Establish a reporting mechanism to reflect employment status of service-users and develop an
integrated plan to increase opportunities for employment in alignment with MSD services and
welfare reforms. Three very successful workshops have been held with all local NGO providers
with employment related contracts funded by ADHB and WDHB, Funding team, employment lead
for WDHB provision and GM Mental Health group WDHB. There is a high level of enthusiasm for
aligning our approaches, getter better value from contracts, strengthening network and
collaboration between contract providers and attempting to get better contract alignments with
MSD. A joint proposal from this group is going to Waitemata Stakeholder group (WSN) for support
for development and practical gains in this area (next step to having a coherent plan for getting
better outcomes for people in relation to staying in employment, returning to work, coming off
benefits or accessing training /education).
13. Ongoing provider arm services reviews
i) Review of Administration services – A full review of the MHSG group administration structure has
been completed. A six monthly review of the new structure is scheduled for May 2014.
Issues reported to date: Marinoto West have reported a negative impact due to the reduction of
1 FTE. However upon investigation it appears that the impact is connected to staff performance,
rather than the FTE reduction. The Mason Clinic was the highest area affected with the reduction of 5.63 FTE –, regular meetings
to discuss the impact of changes are assisting with implementation. No major issues have been
highlighted to date.
ii) Review of Acute community services
Work to date includes extensive consultation with staff who provide this service, review of
international literature and referencing local proposed changes in both CMDHB and ADHB. A
survey of the work distribution with regard to acuity demands has been completed across the five
community teams. The information will help develop the proposal for the Community Acute
Services Plan. This Acute Service Review has reached a point where a formal proposal will be
presented to staff in late March. Staff reports have identified ongoing stress in relation to
workload, particularly in the west HBT service. Meetings have been held with the service and a
transitional plan identified to manage workload prior to the implementation of proposed changes
following the acute services review. The roll out of the full Model post staff feedback is expected
to occur in May and June 2014. Some of the proposed changes to rosters and hours of operation
will still be taking place in June and July 2014.
15. At least 200 DHB mental health and addiction service practitioners to complete CALD cultural
competency courses within the year 2013/14. Good progress is being made given the range of
training practitioners need to do. For the year to date, 157 staff completed the course (as at 28
February 2014).
Areas off track for month and remedial plans
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1. Refine data collection systems and collect baseline data for the percentage of youth
discharged from CAMHS and Youth AOD services into primary care being provided with
follow-up care plans, and for consult-liaison sessions delivered by secondary care to primary
care, and set targets by June 2014. The impact of these practices will be reviewed by June
2015. Implementation of the guidelines is delayed due to the required guidelines not having
been published by the MoH and Werry Centre. The requirement by the MoH is to implement
these follow up transition guidelines. We anticipate receiving a full update from MoH on 11th
April. The tools to measure consult Liaison to primary care (GPs and Education) are being
established in the Northern region and due for full Child and Youth mental health and
addictions services roll out from 1 April.
2. Establish baseline for youth access rates to specialist alcohol and drug services and develop
plan to meet the target of 1.5%: current measurement is against 0-19 age group where the
target group is 12-19. Discussions are being held with MoH to rectify the definitions for this
group. Current reporting provides an inaccurate picture because of inclusion of 0-11 group in %
totals – implies lower access than is actually occurring for the group it is intended to target.
Other Highlights
Youth AOD exemplar services CADS was successful in the second round of tendering for a Ministry of Health “Youth Alcohol and
Drug Service Exemplar” Request for Proposals (RFP). This RFP was part of the Prime Minister’s Youth
Mental Health Project and aims to improve services to young people with substance abuse
problems. The proposal is targeted at improving the interface between CADS “Altered High” youth
service and primary care providers including general practitioners and school based health clinics. It
aims to increase the volume of young clients that can be supported in primary care as well as
increasing referrals to CADS “Altered High”. The Ministry targets the project in particular on Maori
and Pacific youth, living in low social economic areas. The RFP includes three full time staff. The
“Youth Alcohol and Drug Exemplar” initiative includes six projects in total nationwide (of whom
CADS is one). Results will be widely disseminated to stimulate the development of Youth Alcohol and
Drug Services in other DHBs.
Muslim Mental Health awareness and collaboration project
This project is underway to communicate with Imams to develop a clear pathway for community
mental health teams to access Muslim cultural support/ guidance. The project is led by a staff
member, Khalid Shah, and supported by Asian Mental Health Services and the Asian Mental Health
and Addiction Governance Group. The goal of the project is to increase Imams/ community leaders’
understanding of available mental health services, and their knowledge of how to access these
services. This has involved building relationships with Muslim community leaders/ Imams and
developing the content of mental health awareness workshops to be delivered at the local Mosques.
This work will support greater awareness of when and how to refer to WDHB services and to link
with support/ education activities that operate through Mosques and other Muslim social services.
Renewal of the Pacific Gambling Contract for Takanga A Fohe.
We received confirmation week of 17 March that our proposal to keep the contract as part of a full
open RFP process, was successful. In the RFP, the service asked for 5 clinical FTE and 2 Public Health
FTE. These were granted in full at the maximum price that the Ministry set in the RFP. MOH have
indicated that they would move to the contracting details in the month ahead. For now, Takanga A
Fohe are excited but mindful of the other services that have not been successful and the need for
the service to maintain good relationships with them.
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Facilities updates 1) Mason Clinic Refurbishment: Resource consents are being sought for the building of a unit on
land leased from Unitec for the purpose of decanting current patients of the forensic service and
enabling remedial works to proceed for our leaky buildings. An arborist report has been
received and soil report is pending. The panel reviews resulting from Expressions of Interest
(EOI’s) for Architect and Cost Consultant have been completed and requests for Proposals (RFP)
for three architect companies and Cost Consultants close 21 March. The design brief/outline
specification for the Tanekaha facility was approved at the December 2013 Steering Group
meeting and the architect that will be appointed as a result of the RFP will complete the concept
design options to the end of concept stage.
2) He Puna Waiora: An implementation plan identifying a range of current operational areas for
review and change has been finalised by the Steering Group. Working groups will be established
involving inpatient, community and NGO staff over the next two months. These groups will be
responsible for reviewing existing processes with the aim of making improvements/changes
which can be transferred to He Puna Waiora.
Communication strategies have been established between Carmel Collage and WDHB. A weekly
meeting occurs between the construction company and facilities manager of Carmel Collage and
these have been progressing well. Garth Whittaker, Helen Wood and Christine Allen (Principal)
will meet monthly commencing in March. There is a staff intranet site which has the live camera
linked to it and construction updates. The project sign board naming the project and all parties
involved has been approved by the CEO and will be erected on the building site shortly. A mail
drop for the residents and businesses of Shakespeare Road will occur week beginning 24 March.
The Communications team have been involved to develop the content. A presentation was given
to the Community Engagement forum last week.
A tree planting ceremony was held on the 26th March. Maggie Barry, National MP, Dr Dale
Bramley, CEO and Dr Lester Levy, Board Chairman attended together with Senior Management,
Lead Clinical Roles for Mental Health Services and some of our NGO partners.
Recruitment and Workforce
Child and Youth Teams: The Youth Consumer Advisor has been appointed and begun orientation.
She brings with her some previous experience in youth consumer roles and is also completing
studies in public health. Recruitment continues for a replacement Maternal Mental Health
Consultant and for a Child and Adolescent Consultant for Marinoto North. The SMO group are
pulling together to provide sufficient cover in the meantime. The recruitment for the new acute
perinatal community specialist roles is underway. This is a regional recruitment process. WDHB will
have an additional .6 SMO and 3.29 clinical fte. These roles will need to work flexibly and cover
weekend and some out of hours work as part of a regional process.
SMO Job Sizing for Adult, Child and Youth and Cultural Services: The service size has been agreed
and the process will be now to formally notify SMOs individually of the outcome of this process. For
Adult Services, the Service Clinical Director, Mike Ang, and Operations Manager, Don Mackinven will
formally notify all SMOs of their individual job size offer and will meet with them to go through their
work plans. A similar process will start with the other services. It has been agreed that where there
is a shortfall of hours, all existing staff will be offered new service size. Any new and additional fte
will need to be added over time as funding allows.
Key Issues Coming UP
Wiri Prison Impact for Forensic Services
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Waitemata DHB has provided the Ministry of Health with an analysis of anticipated demand when
the private prison is opened in Wiri next year. The prison will open in April 2015 for 960 male
prisoners. Although the Forensic Service anticipates the need to provide specialist mental health
services to these prisoners, the Ministry has yet to provide a commitment to the resources that will
enable this. In addition to a dedicated prison team (10fte) there will also be a need for between 5
and 10 additional inpatient beds. As these beds will not be available in the northern region in the
short term, we believe the Ministry will need to explore dedicated forensic beds elsewhere in the
country to serve this population until such time that they can be accommodated at the Mason Clinic.
MoH senior leadership (Cathy O’Malley) is visiting Mason Clinic on 11th April and this will be one of
the topic areas she is interested to discuss with us.
High and complex needs business case
The Board gave approval to develop a detailed business case for the provision of two community
residential options for around 16 people. We have started work with Funding and planning team
and aim to have business Board approval in May. This would free up bed capacity from those who
require a high level community option, not an acute bed. The total impact would aim to free up to
potentially 16 beds across both units. Consideration of service users at Mason Clinic needs to be
included so the full 16 beds may not be available solely to Adult Inpatient Units.
Increase in child and youth referrals in North Shore & Rodney
Marinoto North has reported a 25% increase in referrals as compared to February last year. This has
implications for meeting service demand and wait time targets. Analysis indicates that for the next
quarter Marinoto North will need to offer 400 Choice appointments but currently only has capacity
(staffing and facilities) to offer slightly more than 300. We are currently seeking solutions to address
this such as identifying alternate clinic space and anticipated filling of vacancies.
Understanding the nature of demand change is an important feature of finding solutions. Referrals
are a mix of new to service and those returning for a “top up” in Treatment. The choice and
partnership model allows for easy access, easy out and easy back to enable a more episodic
approach on an as needed (just in time) principle rather than families staying in treatment or on
caseload for long periods (“just in case” model). For the Marinoto North youth team (up to 18yrs or
still at high school), 30 referrals out of 75 in February were new to service. North Child team (up to
school year 8) 16 out of 36 referrals were new and Rodney (0-end high school /18yrs), 20 out of 39
were new.
The attached graph compares referral sources between February 2013 and February 2014, and
shows some increase in referrals from GPs, within WDHB, schools and self.
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Financial Results
Comment on Major Financial Variances
Revenue
The favourable revenue result of $247k YTD is driven by unbudgeted contracts signed after the
budget was set amounting to $279k YTD and $258k of additional revenue received because of a
delay in commissioning alternative services to the existing adult mental health respite and inpatient
sub-acute facilities. The revenue for the latter ceased in September as the community alternatives
are now up and running.
An unfavourable variance of $325k YTD arising due to reallocation of Forensic demographic funding
to Capital and Coast DHB to fund 5 Forensic beds partially reduces the positive impact of the
additional revenue referred to above. The full year impact will be $490k adverse.
All of these items are factored into the full year forecast position.
Personnel
Medical personnel expenditure is favourable to budget by $695k YTD because of a CME adjustment
($30k), better coverage on the registrar after hours on call roster ($209k) and vacancies. Vacancy
savings through the payroll are partially reduced by costs realised in outsourced services ($286k) due
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to employment of a locum and payment to the University of Auckland for shared employment
arrangements.
Favourable variances for the year to date in allied ($652k) and nursing ($832k) are also mainly driven
by vacancies. Positions not in scope for savings are actively being recruited to. The positive result in
nursing is to some extent attributable to improved acuity management on the inpatient units. $77k
of the variance is due to the remedial works at the Mason Clinic taking place later than planned in
the original business case.
Management/Admin is adverse $213k YTD due to delayed implementation of the administrative
review savings initiative and one off exit costs associated with the project. The project is now fully
implemented.
The full year forecast for all personnel groups reflects the position as at the end of February
incorporating known changes to staffing levels.
Other Direct Costs
The unfavourable variance of $833k YTD in outsourced services relates to unmet budget savings
($720k) and outsourced clinical staff budgeted for in personnel. These variances are partially
suppressed by an under-spend on forensic step down beds of $67k. Variances connected to unmet
budget savings and forensic step down beds are forecast to continue at the same rate for the
remainder of the year. Outsourced personnel costs are forecast to rise in the last four months of the
year due to employment of two additional locums in adult mental health and unbudgeted project
costs.
Notable explanations contributing to the $308k overspend on infrastructure and non-clinical
supplies and forecast year end result of $541k unfavourable are late billing (YTD $32k), security
services for watches in adult mental health (YTD $57k) and unmet budget savings (YTD $200k). In
addition, $67k of cost has been realised to conduct a relapse prevention in psychosis education
project, which is completely offset by additional revenue.
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Surgical and Ambulatory Services and Hospital Operations
This Division provides elective and acute surgery to our community encompassing surgical specialties
such as general surgery, orthopaedics, otorhinolaryngology and urology, and includes outpatient
clinics, operating theatres and pre and post-operative wards. ICU and radiology are with this service.
The service is managed by Cath Cronin. The Head of Division Medical is John Cullen, Head of Division
Nursing is Kate Gilmour, Head of Division Allied Health is Tamzin Brott.
The Group Manager of Hospital Operations is Leith Hart.
Headline News
We are very pleased to announce the appointment of Michael Rodgers as Chief of Surgery, Surgical
and Ambulatory Services. Mike is an Upper Gastrointestinal and General Surgeon who has worked
at Waitemata DHB for10 years. He has previous senior clinical roles including Clinical Director,
General Surgery at Waitemata.
Kate Gilmour has been permanently appointed to the Head of Division, Nursing Surgical and
Ambulatory Services. Kate has been acting in the role for the past 12 months and her achievements
have been well illustrated in this report over that time
Richard Harman has been appointed Clinical Director of General Surgery. Richard has been acting
CD for the last few months and is the lead surgeon for Breast Services and Breast Screen Waitemata
Northland.
Dale Shewan has been appointed as Operations Manager, Orthopaedic Surgery. Dale has relocated
from Tauranga. She brings great experience from similar roles in both the public and private sector
We welcome Mike, Kate, Richard and Dale to these senior clinical and professional leadership roles.
Scorecard
Health Target
Better help for smokers to quit is above target at 97.5%.
Elective Surgery Volumes
The Waitemata DHB Surgical Programme (S&AS, CW&F and ESC) remains on track to achieve
elective volumes to meet MoH target year to date. However it is important to note that we have a
very tight schedule to meet the 30 June Health Target.
ESC has achieved on average 81% of performance to surgical health discharge target from 30
September to 2 March. Surgical and Ambulatory Services is over delivering in a planned approach
and achieving on average 111% delivery to surgical health discharge target.
Radiology
For January the Radiology wait time indicator levels were 70% of patients received their CT scans
within 6 weeks and 21% received their MR scans within six weeks. These were down from 90% and
32% respectively for December. The target achievement levels set by the Ministry for these
indicators are 85% of CT scans within 6 weeks and 75% of MR scans. The January waiting times have
been impacted by the statutory holiday period and reduced booking capacity. The MR throughput
was further reduced by the build work underway for installation of the second MR scanner. The
contract with the Ministry of Health to reduce the tail of patients waiting longer than 21 weeks,
which was largely achieved through outsourcing, was completed in mid-January. It is expected the
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benefit of this additional Ministry funding on the wait times will be reflected in improved February
results.
ESPI 1, 2 and 5
We have achieved compliance for February and are on track for March. The majority of specialty
units are progressing well to 100% compliance for ESPI 2 and 5 for five month treatment times and
making inroads into the 4 month indicator.
Focussed work is continuing with both orthopaedic surgery and ORL. These units continue to be at
risk of non-compliance. This is largely attributed to specialty surgeons’ hours and clinical demand
that exceeds the specialty mix within a surgical unit. This is being addressed and we will align
population demand to Waitemata DHB service capability.
Quality
Twenty one compliments were received by surgical services in February.
The service received 16 complaints in February (12 received at the same time last year) and achieved
a complaint response rate of 18 days. The delay in the response rate was due to two complaints
that required some time to investigate and be responded to in writing. However both patients were
kept informed while their complaints were being investigated.
The new Informed Consent Policy and Consent to Treatment are now published as controlled
documents. The policy and form have been developed over a number of months with wide
consultation. The form is available and can be ordered through Oracle. The policy is the formally
approved policy considered interim for 8 months to allow additional feedback. Staff update and
training are currently being organised by their Managers with a particular focus on NSH and WTH
theatres.
Provider Arm Did Not Attend (DNA) Project
Cath Cronin is the Lead GM for the DNA project for the Provider Arm. The project is tasked to
complete a detailed review to understand why the DNA rate for our Maori and Pacific Island patients
is disproportionately high in comparison to other ethnic groups. The project lead, Lael Meredith is currently working with staff from the Provider Arm, Cultural
Support Teams, Planning and Funding, Business Support and Primary Care to improve reporting on
DNAs and develop options, which can be tested and implemented to improve engagement with
Maori and Pacific patients and reduce DNA rates. Details of patient and health provider questionnaire findings, data analysis and literature review
have been collated and are being socialised with project steering and working groups.
Recommendations are being developed for key areas identified. Initial findings are indicating that
we will be in a position to identify areas to improve our services to both Pacific Island and Maori
patients and whanau.
The February DNA rates for the provider arm are below: DNA Rate % - Feb 14 S&AS Medical CW&F ESC WDHB
FSA DNA Rate total 11.7% 12.2% 10.9% 14.8% 11.9%
Maori 32.3% 26.3% 22.1% 25.0% 27.0%
Pacific Island 25.0% 22.1% 18.4% 15.4% 21.3%
Follow Up DNA Rate
total 9.3% 9.2% 11.7% 7.8% 9.5%
Maori 24.0% 22.1% 17.9% 20.0% 21.9%
Pacific Island 17.9% 18.5% 27.5% 12.5% 20.0%
WDHB 10.0% 10.0% 11.4% 10.9% 10.3%
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Scorecard
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Service Delivery
Intensive Care/High Dependency Unit and Outreach
The patient and family experience project has commenced utilising a steering group and subgroups
for the four core areas: patient and family information, patient experience in ICU (patient
diaries/surveys), bereavement and long term follow-up, and follow-up post discharge from
ICU/HDU.
It is pleasing to be represented at the national Australia New Zealand Intensive Care Society
conference in Christchurch with a poster presentation from the Outreach Team Leader and a verbal
presentation from the Clinical Educator.
Surgical Wards
The surgical wards have all updated their quality plans which include the agreed quality and safety
markers falls, pressure injuries, hand hygiene and CLAB.
Quality Rep study days have commenced and had a focus on documentation this month which
included the redesigned Nursing documentation and a ward transfer form. The pilot is now well
underway.
Infection Control:
CLAB
• ICU/HDU - 166 CLAB free days
• WARD 8 - 475 CLAB free days
• Ward 4 - 560 CLAB free days
• Ward 7 - 254 CLAB free days
• Ward 9 - 259 CLAB free days
ESBL incidence and prevalence remains high.
Strategies continue:
• Admission and discharge screening
• Nursing ESBL patients on one half of each ward
• Appropriate signage has been put up to mark dedicated ESBL areas
• Information brochures/sheets have been updated/created to be given to patients and their
families
• Infection Control will map each ward’s ESBL positive patients by room to identify any areas that
need appropriate cleaning/decontamination - there has been clusters in D room opposite
communal toilets
The surgical wards have advertised and Ward 7 has appointed a 6/12 fixed term appointment of a
housekeeper from current resource to support and supplement the nursing, domestic and hostess
services. As part of a ward team the housekeeper is responsible for maintaining a safe and
comfortable environment, ensuring that all patients and visitors are welcomed and experience an
efficient, effective and comfortable service.
Hand Hygiene
• Bare Below the Elbows continues to be business as usual for the Surgical Wards
• Gold auditor training was completed this month which will enable those trained to be able to
intervene and educate/provide feedback on the spot to correct practices. It also enables them to
have the ability to communicate immediate feedback to staff for good hand hygiene practices
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• Hand hygiene compliance remains unsatisfactory – there will be discussion at upcoming General
Surgical and Orthopaedic business meetings to discuss barriers
• Healthcare Assistant training will be carried out to improve their practice and to empower them
to discuss good practice with their colleagues.
Falls
Falls risk assessments were completed for 97% of patients with a falls risk on the surgical wards.
Strategies have been implemented to increase completion within 8 hours of admission.
There has been one fall with fracture this month.
Friends and Family
Surgical and Ambulatory Services have a Net promoter score of 67% with a total of 1,913 responses.
Orthopaedic Early Recovery After Surgery (ERAS) Collaborative Project
Waitemata DHB clinical leads and project working groups have been established for both the acute
fractured neck of femur and elective hip/knee pathways as part of the National Orthopaedic
Collaborative project. Change concepts have been identified and driver diagrams developed as per
the framework and improvement methodology set out by the Ministry of Health. Members of the
project group are participating in the National Collaborative Learning Sessions and National WebEx
meetings provided by the Ministry.
ERAS interventions such as the standardised multimodal anaesthetic/analgesic and surgical
protocols are under development for both the acute and elective pathways. Change ideas are being
tested at the local level and education sessions are being provided across both the North Shore
Hospital and Elective Surgery Centre sites. Current patient information and staff documentation is
under review and will be adapted to include the ERAS principles. Data measures are being collected
and will demonstrate progress in ERAS compliance and outcome measures throughout the
implementation of ERAS.
Design Innovation
Ward 8 planning continues with the Concept Design due to be signed off mid-March 2014. The
design provides for 6 single bedrooms, 3 doubles and 4 four bed rooms. This includes two special
(bariatric) single rooms as well as a 4 bed high observation area (details to be confirmed). Once the
concept design has been agreed, an estimate of project costs will be obtained and planning will
progress to preliminary design, determining the exact location of each room within the ward.
The Project Team undertook a site visit to Greenlane Hospital Eye Ward to review room layouts and
staff base options and will be visiting Southern Cross in the next few weeks. In addition,
investigation continues into potential innovation to be utilised on the ward, working closely with IT
and Research and Innovation.
Leadership
The four Surgical Charge Nurse Managers attended the first cohort of the CNM Leader Development
Programme LEADING QUALITY. This programme will build leader capability, and therefore influence
and strengthen performance centred on quality care and patient outcomes in wards. Feedback and
insights from the first cohort will be utilised to evaluate the course for the second cohort.
Ward Productivity
The Surgical wards have had approximately 890 surgical cases through the surgical wards this
month; approximately 460 of these cases were acute.
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Theatres North Shore Hospital and Waitakere Hospital
The interim consent policy has just been released and is a major focus for the OR. An education
plan is being developed which includes FAQ sheet and drop in sessions with legal
representatives over the next 2 weeks to ensure all staff have a good understanding of the
changes to the policy.
February was another busy month for NSH theatres with an additional five sessions in addition
to planned sessions for both acute and elective surgery.
WTH surgical unit has been busy recruiting new staff to fill FTE vacancies. Orientation of the
new staff is now well underway.
Patient Service Centre
Surgical and Ambulatory Services Operational Team restructure is now complete and the
Patient Service Centre (previously Booking and Scheduling) has been established with a focus
on supporting the patient journey and patient experience (Everyone Matters). An initial test
stage for Patient Focussed Booking (PFB) commenced 10 March within orthopaedics. The first
stage of PFB process enables patients to be involved in negotiating their First Specialist
Appointment. Rollout of Patient Focussed Booking is planned over 2014.
Cancer Care Coordination Update
Huri Perry, our Clinical Nurse Specialist Maori Cancer Coordinator, has been welcomed to our team
with a Powhiri held at Waitakere. Waitemata Cancer Patient survey has been sent out to 441
patients, we have received back approximately 60%.
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Strategic Initiatives
Specific deliverables/actions to deliver improved performance will consider: On
Target
A fully functioning Cancer Care Co-ordination service employing clinical nurse
specialists across all tumour streams and including Māori and Pacific
navigators, Faster Cancer Treatment tracking, and a Clinical Lead for Cancer
Care, by 30 June 2014. Cancer nurse co-ordinators will be supported to attend
regional training and mentoring forums.
�
Use Faster Cancer Treatment data reported to the Ministry of Health as
baseline data for service improvements �
Design rapid reporting and telephone communication of results of diagnostic
scans and investigations
�
Re-designed cancer multi-disciplinary meetings consistent with national
standardised processes of access, documentation, communication and care
coordination, audit and reporting in place by 30 June 2014
�
Conduct a baseline survey of cancer patient experience � Collect ethnicity data for Māori and Pacific People at the key Faster Cancer
Tracking wait time indicators as baseline data for 2014/15 interventions to
reduce ethnic inequalities � Plan to deliver required elective surgical discharges for the Waitemata DHB
population in accordance with patients’ assigned priority and within the
appropriate waiting time
�
Ensure plan in place to meet and maintain ESPI compliance � Monitor patient outcomes including complication rate, readmission rate and
infection rates each month by ethnicity
�
Ensure improved Maori and Pacific access to bariatric surgery � Implement electronic referrals for eight elective procedures by 30 June 2014 �
Review numbers of follow ups to ensure match to clinical need with a plan to
discharge patient back to primary care
�
Audit current ultrasound utilisation and relevant back-up to better understand
possibility of incorporating both CT and CT angiogram within same
appointment for TIA patients
�
Implement new Outpatient Service model (staffing, booking & scheduling) � Maintain direct access for general practitioners to a full suite of diagnostic
imaging including X-rays, ultrasounds, fluoroscopy, mammography, nuclear
medicine, CT and MR with a focus on reducing waiting times for ultrasounds
(establish baseline Q1, reduction in waiting times by 30 June 2014)
�
Electronic referral templates, developed by a working group comprised of
primary and secondary clinicians, implemented by 31 December 2013 to
enhance general practitioner access to radiology services
�
Direct referrals by general practitioners to elective booking lists will be in place
for skin lesions, vasectomy, mirena insertions and ring pessaries (WDHB) –
confirm current practice and establish baseline Q1, identify any
enablers/process changes required Q2, implement changes required Q3,
direct referrals to identified booking lists in place Q4
�
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The Waitemata DHB chronic pain management service will work more closely
with general practices through improved availability for telephone and email
contact and by having regular, interactive workshops which will provide a
forum for specialist pain staff to share knowledge with primary care
practitioners to improve the community based management of patients with
chronic pain. The service will operate with a concept of “partnership in pain
management” between the patient, general practitioner and hospital
specialist service
�
Ensure viable elective services units within Provider Arm during 2013/14 � Ongoing provider arm services reviews �
MRI replacement �
* include a � or a �
Key achievements for month:
ESPI compliance achieved for second quarter (within MoH buffer) Surgical Health target on track for second quarter
Areas off track for month and remedial plans:
Risk areas are ESPI 1, 2 and 5. Focussed work underway as above in commentary
Key issues/initiatives identified in coming months • A focussed review of management of referrals is continuing with successful outcomes to
manage referral timelines, improving the patient experience and working to standardised
guidelines.
• Increased engagement with primary care is planned to increase quality of referrals with
complete patient information.
• Surgical pathway analysis is underway to measure surgical demand/capacity and treat all
patients within 4 months, achieved prior to December 2014 and to sustain this into FY16.
• Daily monitoring of performance to targets and financial management continues to ensure
health targets are met and any potential risks to achieving revenue are identified and resolved
including the additional 166 surgical discharges.
• Clinical Supplies Project continues to improve reporting and timely data on expenditure for
clinical supplies. NSH theatre inventory scanning of imprest items has commenced and the
receipting issues have now been rectified. The Inventory team are working to extend the
scanning to some additional sub Inventory store areas.
• The DNA project is well underway with a goal to have recommendations from our patients and
their families/carers, the provider arm, public health and community providers to ensure we
address this issue with a sustainable outcome of a DNA rate less than 10% for Maori and Pacific
Island populations.
• S&AS has received funding and has commenced the Enhanced Recovery After Surgery (ERAS) to
orthopaedic patients (hip/knee procedures and fractured neck of femur). This project is being
lead by Matt Walker, Michal Kluger and Teresa Wingate.
• Strategies are in place to contain our expenditure and to look for opportunities to continue to
realise savings initiatives within the service.
• Formalisation of appropriate financial processes between S&AS and ESC.
• Commence work to review ESC after 12 months in operation.
• Multiple avenues of work progressing with Cancer Treatment Times. A new indicator has been
agreed of treatment within 62 days from referral. An update will be included in the next report.
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Neck of Femur Fractures (#NOF)
The clinical team with a multidisciplinary focus over surgery, medicine and allied health have
developed the initial work focussed on patients with fractured NOF to a review of the patient
journey from admission to rehabilitation and discharge into the Ministry of Health supported
National Orthopaedic Enhanced Recovery After Surgery (ERAS) Collaborative Project. ERAS
pathways are clinically focused, cost effective, patient driven pathways, with an evidenced base in
improving quality outcomes, teams working across functional, organisational and professional
boundaries.
One important international indicator is the time to surgery in 24 and 48 hours. We are tracking well
within the 48 hour indicator but will continue to measure the time to surgery for 80% of patients
within 24 hours. We would expect 100% of medically fit patients to receive surgery within 48 hours.
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Financial Results
Surgical & Ambulatory Services
COMMENT ON MAJOR FINANCIAL VARIANCES (S&AS = Surgical & Ambulatory Services)
Summary
The February monthly result is $262k favourable and $626k favourable YTD. This is primarily due to
the extra patient activity (108% of plan), and the resulting revenue, being greater than the
underlying additional costs. During the same period the division has absorbed $2.6M of savings
initiatives, whilst $350k of costs relating to prior years have crystallised in the current year. It is
forecast that the current favourable variances offsetting ESC will continue, and move slightly higher,
however this will be directly impacted by ESC as improvements in ESC throughput will reduce
revenue recognition in S&AS.
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Revenue ($3,694k favourable YTD)
The MoH revenue variance YTD is $3.9M favourable, due to YTD elective wies volumes at 119% of
plan –effectively volumes done at NSH instead of ESC.
Included in the MoH revenue variance is an additional $445k unbudgeted MRI/CT volumes due to an
additional MoH funded initiative to reduce waiting times for imaging.
ACC revenue is $280k or 20% below budget YTD. This has improved substantially in the past two
months but is still well below where we would expect it to be. $55k has been recognised at ESC
instead of S&AS and we are doing further analysis on the Orthopaedics ACC Contract overall to
determine why revenue is less than expected YTD.
Expenditure
Medical personnel: ($936k unfavourable YTD)
The main driver is a change in the model of care in relation to anaesthetists’ resourcing of ESC.
Budget costs for anaesthesia are budgeted within ESC as an outsourced service cost. However with
the late change in approach the actual costs now fall into the medical personnel costs in S&AS. The
recharge to S&AS for these costs is recorded in the outsourced service costs line. YTD anaesthesia
SMO costs are $984k unfavourable because of this. Other medical costs are favourable by $48k –
across SMOs and RMOs. FTE are broadly in line with budget.
Nursing: ($168k favourable YTD)
Staffing is effectively at budget, with a small favourable variance. However nursing outsourced costs
are $306k unfavourable as noted below, resulting in a combined $138k unfavourable position.
However given the volumes in S&AS this is a good result.
Allied Health staff: ($495k unfavourable YTD)
The unfavourable $495k YTD variance is in contrast to the actual staffing situation in Allied Health,
which is 1.77 FTE favourable due to vacancies and maintaining disciplined rosters. However, a $424k
savings line, being part of S&AS’s $2m share of budget savings initiatives, to which S&AS is fully
committed and plans to deliver, is included in the Allied Health set of accounts. These savings
initiatives are being actively addressed in all divisions of S&AS and has been absorbed across the
division.
Admin staff: ($387k unfavourable YTD)
Similarly, the unfavourable YTD variance of $387k is created by a $237k YTD savings line in this cost
centre, with the actual planned staffing and costs broadly on budget. Some restructure impacts have
added some costs in this area for management where extra resource was required particularly in the
Patient Service Centre ($120k).
Outsourced personnel: ($497k favourable YTD)
As noted above, the accounting treatment for the anaesthetists working at ESC now reflected as a
credit on this cost line to the amount of $1,584k YTD. Offsetting this favourable (unbudgeted)
revenue is the savings initiative that is not currently being achieved based on the Ophthalmology
Service implementation ($466k unfavourable). Other unfavourable items include Package of Care
costs for surgeons of $183k doing unbudgeted work at WTH awaiting the start of ESC (first 2 weeks
of July) and other claims for some additional sessions; $306k of unbudgeted bureau nursing costs;
$38k of unbudgeted orthotic and hand therapist costs and $45k of unbudgeted Fee for Service Costs
for colonoscopies relating to the Bowel Screening Programme.
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Outsourced services: ($461k unfavourable YTD)
Radiology have incurred $364k unbudgeted costs for MRI and CT outsourced imaging requests
related to a MoH funded initiative to reduce imaging waiting times (this is reflected with $445k in
revenue to offset this cost). Additionally $113k of outsourced ultrasound work has impacted.
Clinical supplies: ($1,685k unfavourable YTD)
Inpatient activity is 108% of plan (acute + elective wies YTD) but expenditure is 110% which indicates
we are unfavourable with planned levels on a volume adjusted basis to the extent of about $250k.
Implant costs for joint replacements are high and will be investigated further.
Infrastructure: ($160k favourable YTD)
A number of items offset each other however the key item is a favourable stock adjustment ($145k).
Post implementation of the inventory scanning system in theatres, we are reviewing the outcomes
to ensure accuracy of our financial transactions.
S&AS and ESC Combined
The combined summary helps off-set some of the larger disparities created by the ratio of budgeted
volumes delivered between NSH and ESC theatres being different to those that have actually
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occurred in the first eight months of ESC’s operation. Overall inpatient activity is at YTD 100% of plan
across the two entities.
Overall YTD revenue is line with budget, with the exception of ACC which is $224k unfavourable.
Further analysis is occurring in this area.
Total YTD personnel expenditure is $1.4M unfavourable, however of the outsourced services the
staffing component is $1.4M favourable – so employee costs are essentially in line with budget.
YTD clinical supply costs are $1.3M unfavourable (5.7%). The main variances are in orthopaedic
implant costs and ESC treatment disposable costs. We will be further investigating the implant costs.
The net result is $173k favourable for February and YTD is $1.4M unfavourable. We envisage that
the remaining months will deliver at budget levels at a consolidated ESC/S&AS level, with a resulting
$1.4M unfavourable full year forecast.
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HOSPITAL OPERATIONS
Service Delivery/Key Issues Food and Nutrition Services
Recruitment and offer made for the vacant food contract manager position.
Laboratory
Regional RFI discussions held to discuss Real Time Temperature Monitoring System. This system will
be used for monitoring of fridges, freezers, incubators, room temperature and areas storing liquid
nitrogen, pharmaceutical storage and blood products.
Security
A pool vehicle was stolen from Waitakere site and vandalism was found to Healthwest building. The
Police are investigating both these issues.
There have been an increased number of calls to assist with aggressive patients.
High number of access cards being issued this month, mainly to house officers and new graduates.
Also over 1,000 access changes made to staff cards to allow access to the new gymnasium at NSH.
Crisis Intervention Training provided by security well received by participants this month, positive
feedback from CADS and new graduates.
Security staff completed 62 incident reports with 40 restraint events reported. One staff member off
for 2 days as a result of injury received during a restraint event.
Security Supervisor at Waitakere has resigned to take up the position of Waitemata DHB Fire
Training Officer, this position is currently being advertised.
Pharmacy
North Shore Hospital Inpatient and Outpatient Pharmacies, and Waitakere Inpatient Pharmacy, have
all fully attained the required audit criteria during the Pharmacy Quality Audit 4 by Medicines
Control, Ministry of Health.
Medication Safety Strategy reporting is now included in the HAC Quality report. Information about
the progress of the electronic Prescribing and Administration system (ePA), as well as the electronic
Medicine Reconciliation system (eMR) is included there. Of note, the eMR system will be available
to the Medical Wards at both Waitakere and North Shore Hospitals as from 3 March 2014, and the
clinical pharmacists will be incrementally increasing the number of medication histories recorded
electronically.
The use of the PHARMAC managed Hospital Medicines List (HML) which was initially introduced in
July 2013 and which is still in transition phase, is being consolidated. Most of the associated issues
have been resolved, and systems are being implemented proactively to ensure that information is
recorded on high-cost medicines that are likely to be audited by PHARMAC (e.g. infliximab).
Surgical Pathology
There is an issue with standard of air extraction in the laboratory. Temporary bench top extraction
units are being used to reduce the formalin fume levels. We are working with Facilities for a
permanent air extraction system.
An additional histology technician FTE is currently being recruited to keep up with volume growth.
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Clinical Engineering
An equipment service programme has been established for routine equipment inspection and
maintenance.
Planning is underway to expand the North Shore Hospital workshop space. This will improve
workflow and service efficiency, with all technicians working in one workshop.
The Waitakere Hospital workshop has been remodelled to accommodate additional staff who are
now on a monthly rotational schedule from North Shore Hospital. The rotation of technicians
through Waitakere Hospital will assist with the increasing workload demand at this site and also
allow staff to gain local knowledge and expertise, thus increasing our ability to cover for leave.
Traffic and Fleet
There is a Northern Region DHB project underway with regards to Fleet Management Services.
Initial scoping for this project is underway.
Staff parking at the main car park building is at capacity most days now by 09:00 A.M. There are still
a number of car parks available at the Shea Terrace staff car park, which has not yet reached
capacity. The reinstatement of the P.M. car park is working well.
The CEO has requested work be undertaken to look at options for more car parking availability.
Clinical Support Services
Operations Manager commenced early February, review currently being undertaken on internal
structure as there are three vacancies in the Management team. There are a significant number of
operational vacancies currently being covered by the outsourced labour force and a plan is being
developed to advertise and appoint to these vacancies.
A master roster is being developed, so this can be compared to the budget in order to contain costs
as we move away from the outsourced labour model. A review of each duty will be made before
recruitment commences to see if we can realise any efficiencies.
A meeting has taken place with Career Force who will be assisting with the Orderly NZQA
qualification and plan to undertake an assessment of staff in April, this should coincide with
recruiting the Training and Quality Manager position.
Training has been identified for the Service Development Coordinators as follows: leave
management and Hazardous Substance and New Organisms (HZNO) Training.
Introduction meetings have been carried out with all contractors including waste contractors (which
the Operations Manager is currently looking after until the Sustainability officer is recruited and
appointed).
Data analysis of Linen Product Catalogue continues for HBL project.
Fuji Xerox site audits have been completed with recommendations of 159 copiers being removed.
Relocations
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Highlight for the month has been receiving a considerable donation of furniture from the ANZ Bank.
This was arranged by the contract manager for Allied Pickfords. As at 24 February six truckloads of
furniture have been delivered to the North Shore campus.
One issue identified as part of decanting and migration is lack of storage space across the
organisation. This is mainly evident in forward refurbishment projects. There are regular requests to
store items for services as a result of refurbishment resulting in less space available. Options are
currently being explored how this issue can be resolved
Fixtures Fittings and Equipment (FF&E) Signage
Procurement – 90% is now completed for satellite renal unit.
FF&E costings are within the budget.
Logistic planning is underway for Podium project.
Strategic Initiatives
Specific deliverables/actions to deliver improved performance will consider: On Target
Laboratory testing review and cost savings �
Pharmaceutical cost savings �
Development of the Allied Health workforce strategy �
Implement Fleet Management policy for fleet vehicles completed
Development of business cases for in-sourcing services (e.g. orderlies) completed
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Financial Result
Comment on Major Financial Variances
The overall result for Hospital Operations is $535k unfavourable in the month, and $1.141M
unfavourable YTD
Revenue ($272k favourable YTD)
Car Park revenue is $277k favourable YTD reflecting the high number of patients and visitors as well
as the change in Tariffs from Jul-13. Asian Health unbudgeted income for CALD resources is $151k
favourable YTD, off set by unbudgeted other direct costs. Recharge to Inpatient services for
Outpatient pharmacy dispensing is $226k unfavourable YTD. This is due to changes in the
Community Pharmaceutical Schedule that has meant a reduction in the value recharged to Inpatient
services. Income from Auckland DHB for expenses incurred in joint Pacific Support service is $229k
favourable YTD.
Expenditure ($1,473k unfavourable YTD)
Personnel costs ($1,039k favourable YTD)
Nursing costs are $22k unfavourable YTD being Blood Transfusion Nurse in Laboratories offset by
budget in outsourced cost to NZ Blood. Support staff costs are $984k favourable YTD. This is
primarily due to the contracted FTE vacancy in Clinical Support - Cleaning and Orderly Services being
covered by agency casual staff. Management and Admin staff costs are $175k favourable YTD with
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vacancies to budget in Clinical Records and Clinical Transcription being offset by casual agency staff
in outsourced costs.
Clinical Engineering service has now been brought in-house with personnel costs being $246k
unfavourable YTD. This is offset by savings in Clinical Supplies where the budget for paying ADHB to
provide the service sits.
Other Direct costs ($2,512k unfavourable YTD)
Outsourced personnel costs for casual cleaning and orderly staff are $1,692k unfavourable YTD and
costs for casual admin staff are $425k unfavourable YTD. Asian Health unbudgeted expenses for
CALD resources are $143k unfavourable YTD off set by unbudgeted revenue. Activity related
variances in clinical supplies for Inpatient Pharmacy are $661k unfavourable YTD: Laboratories
including blood products are $231k unfavourable YTD and Outpatient Pharmacy is $50k
unfavourable YTD.
External storage costs for clinical records are $127k unfavourable YTD. Business Transformation plan
to develop records storage at NSH is progressing but savings will only materialise when we are no
longer retrieving from the external storage facility. Clinical Engineering service is now in-house,
resulting in savings in Clinical Supplies where the budget associated with paying ADHB for the service
is $308k favourable YTD.
Summary and Forecast Full Year:
The overall financial position for Hospital Operations is $1.1M unfavourable YTD and forecast to be
$2.0M unfavourable at year end. This is primarily due to activity related Clinical Supplies costs in
Pharmacy and Laboratories which are $942k unfavourable YTD, forecast to be $1,158k unfavourable
at year end. Also unfavourable due to savings plan initiatives embedded in Hospital Operations that
are either not materialising or savings show in other services being $341k unfavourable YTD and
$1,045k unfavourable at year end. These are being partly offset by favourable revenue from car park
activity which is $277k favourable YTD.
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Elective Surgical Centre
Service Overview
This new division provides elective surgical services to our community, working alongside the
Surgical & Ambulatory and Women & Child Health Services. It provides general surgery, orthopaedic
surgery, gynaecology and urology. It has its own outpatient clinic, operating theatres, CSSD and a
post-operative ward. The Director of the service is Dr John Cullen and it is managed by Mark
Watson.
Service Delivery Points of Interest for February:
• Volumes down in January but increased significantly in February
• Engaged with S&AS to move elective sessions over from NSH to vacant ESC theatre space
• Implementation of revised Booking and Scheduling process
• Commenced anaesthetic triage training for ESC Peri-operative Nurse Coordinators
• Internal operational processes working well within ESC
• Sharp increase in late finishes for some ESC sessions
• Consolidation of overall ESC theatre schedule with new, fulltime consultants starting.
• Final building defects continue to be identified and fixed in the lead up to the defect liability
period ending
Elective Surgery Volumes
January volume was below expectation and volumes continue to be below expectation year to date
due to SMO leave and our inability to backfill the vacant sessions. February picked up significantly,
however, and we saw the second largest volumes go through the facility since it opened. The overall
volumes, against expected production plans, remain a concern and we have now implemented a
change to the existing process to ensure that patient availability, timely anaesthetic triage/clearance
and adequate booking of patients to lists are all improved to rectify the problem. These changes will
also be adopted within the S&AS booking and scheduling process in time. This change is being driven
by ESC and we are working in conjunction with S&AS to remedy the above issues as soon as possible.
Overall, we remain concerned about the under utilisation of the ESC that is resulting in a continued
under delivery of patient volumes, and this remains in contrast to the over delivery in the
NSH/Waitakere theatres.
By the 18th March there had been a total of 2,125 patients treated year to date. As the graph shows,
there was a drop in volumes over January.
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Session Utilisation/Start & Finish Times
During February the ratio of actual sessions undertaken against planned session schedule was 88%,
with the average length of stay continuing at two days. Of these sessions, the actual utilisation of the
time allotted was 86%. Of note, 13 of the theatre sessions out of a total of 57 overran greater than
30 minutes in theatre. We have contacted the relevant surgeons to determine the reasons for this.
We have worked closely with S&AS to enable further utilisation of ESC theatre and bed space over
the coming months and have agreed to work towards full use of all four theatres, five days a week,
from July 2014 onwards. With the recent arrival of a number of new SMOs the current four weekly
theatre schedules of booked and regular operating lists have now been consolidated, allowing for far
better planning of resources and better utilisation of sessions. We now have 126 half day sessions
booked for regular operating out of a potential 160 over a four weekly cycle. The plan in place is to
look at increasing this to at least 145 sessions by July 2014.
It is essential that we have the ability to back fill, with both surgeons and anaesthetists, sessions
vacated by leave or CME, by either full time SMOs or locums.
Pre-Operative Assessment and Booking & Scheduling of ESC patients
ESC has revised the current booking and scheduling process, in collaboration with S&AS, to allow
tighter control over the management of the triaging, anaesthetic assessment and management of
waitlisted patients identified for surgery at ESC by the surgeon at their First Specialist Appointment
(FSA).
This new process has now been implemented and the anaesthetic department has commenced the
training of the Peri-operative Coordinators to undertake initial triaging of patients. Timeframes have
been put in place to ensure all patients receive anaesthetic clearance within 6 weeks of the referral
received. This will then allow the patients to be booked for surgery, up to four weeks prior to the
operating date, allowing much greater time to prepare the patients for the day of surgery and
providing a greater pool of patients to ensure full utilisation of the sessions. The process will take a
number of weeks to fully bed down, but will work in well with the reduced waiting time for surgery
implementation from five months to four months, from July 2014.
Defect Liability Period
Final building defects continue to be identified and fixed in the lead up to the defect liability period
ending at the end of May 2014. There are no major issues that have been identified at this stage that
causes us any concern.
Summary
Despite ongoing concerns over actual vs. budgeted volumes at ESC, assurances can be given that the
operational aspects of the facility are working very well and we have an outstanding team in place,
who work very hard to ensure that the hospital functions as efficiently as possible. Judging by the
feedback from our patients and SMOs, the consensus is that we are achieving a high level of
efficiency and productivity in the way we operate and this has not compromised the high quality of
the service in any way.
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Scorecard
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Strategic Initiatives
Deliverable /Action
Implement shorter journey and productivity models of care in ESC by 30 June 2014 � Implement remuneration package in ESC by 30 June 2014 � Implement PIPMS (Peri-operative Information Process Management System) system in
ESC by 30 June 2014
�
Ensure viable elective services units within ESC during 2013/14 � Primary Care access and streamline referral process pathways to the Elective Surgery
Centre (orthopaedics) in place by 31 December 2013
�
Implementation of new model of care for elective services delivery at the new surgery
centre
�
* include a � or a �
Key achievements for month:
• Implemented the new booking and scheduling process, led by ESC team
• Identified and rectified most defects prior to the defect liability period closing
• Created electronic access to key anaesthetic triage information, to assist
anaesthetists in a more timely assessment of their ESC patients
• Completed the new stock management process (Oracle Managed Inventory)
• Commenced the new registrar training programme with a general surgical session for
Lap Choles and basic suturing techniques
Areas off track for month and remedial plans:
• The overall anaesthetic assessing process needs to be finalised along with
anaesthetic/surgeon team – On-going discussions with the anaesthetic department
and S&AS
KEY ISSUES/INITIATIVES IDENTIFIED IN COMING MONTHS
Booking & Scheduling
The newly revised booking and scheduling process is now underway and we are working directly
with the managers of the Booking Clerks to ensure that it will allow ESC staff to have direct control
over the anaesthetic triage and pre-assessment of its patients, along with full overview of what is
being booked onto the operating lists, in sufficient time to allow for changes to be made. This is
progressing very well at the moment. ESC has now put on additional Pre-Anaesthetic Clinic (PAC)
sessions, using the spare space on the ward, to help cater for the increased demand.
Anaesthetic Teams/Triage and Pre-Assessment
There are now two lead anaesthetists for ESC whose role is to help develop rosters to improve
compliance to the surgeon/anaesthetist team combination, and to continue to develop the
anaesthetic pre-assessment process. As a result we expect to now see further improvements in the
team combination compliance and pre-assessment processes in upcoming months.
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Financial Results
COMMENT ON MAJOR FINANCIAL VARIANCES
Revenue
The MoH revenue variance YTD is $3.8M unfavourable, due to YTD elective wies volumes at 72% of
plan. Some YTD revenue associated with ACC and acute arranged cases has now been recognised in
ESC and total revenue is at 76% of budget, including these items. On a discharge basis relative to
planned cases, February is the best month since commencement at 88% of planned discharges, with
YTD discharges now at 74% of plan. YTD Average case weight per patient is marginally lower than
budget (1.48 v 1.52 or 97%).
Expenditure
Nursing: ($201k favourable YTD)
Nursing is holding 6 fte vacancies, whilst it is operating below planned levels. This has resulted in a
$201k favourable variance (plus a further $25k saving in bureau costs). However this is still at 92% of
budget as opposed to revenue at 76%.
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Admin staff: ($44k unfavourable YTD)
One senior nurse is classified as a manager compared to budget and this is the reason for the $44k
unfavourable variance.
Outsourced services: ($921k favourable YTD)
These expenses are primarily the Package of Care costs for surgeons and the Anaesthesia costs
charged by S&AS at close to budget levels. Surgeon Package of Care costs are $800k favourable (74%
of budget); and anaesthesia costs are $163k favourable (91% of budget). Overall this cost is at 80%
of budget, compared to revenue at 76% of budget.
Clinical supplies: ($388k favourable YTD)
Expenditure is $388k favourable at about 90% of budget compared to revenue at 76%. These costs
are generally variable except for depreciation of clinical equipment. After adjusting for depreciation
and reduced volumes, the YTD variance is approximately $500k unfavourable – primarily in
treatment disposable and diagnostic supply costs. With no history in ESC it is difficult to determine if
the budget is low or whether there are operational drivers to this outcome.
Infrastructure: ($283k favourable YTD)
Approximately $24k per month ($192k YTD) of infrastructure costs (software/electricity/water) are
not being charged to the ESC. Additionally a stock adjustment credit of $67k is reflected in this
result.
Summary
The February monthly result is $89k unfavourable and $2,032k unfavourable YTD. The month result
is the best to date, although it does pick up a net $160k of prior month revenue from ACC and acute
arranged cases, less some other un-accrued expenditure. The YTD position is primarily driven by
theatre utilisation and the resulting lower revenue, due to a variety of operational issues.
Expenditures are being held as much as is practical, however the key driver to improved results is
improved numbers of patients going through the facility. It is forecast that the current YTD position
will improve over the fourth quarter, which is assumed at 90% of planned revenue compared to YTD
76%, although the team will be focused on trying to deliver a higher level than that.
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Provider Arm Support Services
Corporate Services: Include offices of the Chief Executive Officer/Chief Financial Officer/Chief
Medical Officer/Director of Nursing/Director of Allied Health, Corporate Finance, Operational
Finance, Information Systems and Management, Facilities and Development, Quality, HR and Awhina
and Maori Services. It also includes outsourced healthAlliance services, HBL, Other affiliation costs
and financing costs. Robert Paine has overall financial responsibility for the Corporate Group.
During the current financial year, the management of Hospital Operations has been moved to
Surgical and Ambulatory Services, but in this month’s reporting the financial and scorecard data is
still shown as part of Provider Arm Support Services (financial data is also included in a separate
table in the Hospital Operations section).
Scorecard
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STRATEGIC INITIATIVES
Specific deliverables/actions to deliver improved performance will consider: On Target
Inventory management for clinical and non-clinical supplies �
Infrastructure costs/contracts and energy efficiency reviews and savings �
Commencement of new mental health facility He Puna Waiora, to replace Taharoto
Unit �
Mason Clinic remedial work �
Transfer of renal services: Phase II �
* include a ���� or a ����
Key achievements for month
• Work is progressing on the new facility He Puna Waiora with the next official event being
the tree planting ceremony on 26th of March 2014 by the local Member of Parliament.
• Weekly communication is occurring directly with Carmel College facility staff and bi- monthly
meetings between the General Manager Mental Health, project director and Carmel College
principal.
• Two options are being worked through for the new link between He Puna Waiora and the
renal centre. A recommendation will go to the project steering group in April 2014 and then
onto the CEO for approval.
• Work is progressing on the project implementation plan and the introduction of new
processes and procedures by the time the new facility is completed.
• Mason Clinic – Maui. The design of the building is able to be generally accommodated on
the leased land. Waitemata DHB are now responsible for the removal of the cabbage trees,
the resource consent is expected to be lodged in March with the remaining consent to be
lodged shortly thereafter. Unitec requested Waitemata provide alternative dog training
areas however this is outside of the leased area. Access to the Oakley Creek Group across
the land will be diverted based on consultations undertaken.
• Renal Community Building construction continues on programme with practical completion
due in April 2014 and the unit opening in May 2014. Hawkins Construction has been granted
an extension of time, however the programme has been adjusted to accommodate this and
we remain on track.
• The inventory management project is ready for pilot implementation at Emergency Dept at
North Shore Hospital and one Ward at either North Shore or Waitakere Hospital. This pilot
project will include rationalisation of all supplies made to each pilot sites with focus on
buying all supplies from a list of catalogued products from approved vendors and prices.
Based on the work so far it has been established that each area in hospital has different
ways of ordering and stocking clinical and non-clinical supplies. This pilot project is designed
to be implemented in partnership with Health Alliance. A steering group has been formed to
provide leadership to this project with membership of CFO, GM’s, Director of Nursing and
Group Manager Finance & Planning.
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CORPORATE SERVICES GROUP HIGHLIGHTS / ISSUES
Health Information Group
The electronic Ward Whiteboard (eWW) roll-out starts in April 2014 with some exciting new
functionality including Allied Health referring, booked procedures and pharmacy dispensing. Medical
and Surgical wards at both hospitals are expected to have ward whiteboards by the end of June
2014.
A cancer coordination information system is being developed to track key points in the cancer
pathway. Health Information Group is using an existing application, Soprano Workflow Engine, a
system already in use by Renal Medicine and community services.
A report has been developed to identify patients with diabetes who have just been admitted to
hospital. The report looks at a range of sources to identify likely diabetes diagnoses; clinical coding
of past admissions, Diabetes clinic appointments and retinal screening. This report shows the
patients and their last HBA1C result. The report will help the Diabetes Service to improve clinical
management of patients.
The National Orthopaedic Enhanced Recovery After Surgery (ERAS) Collaboration is underway to
improve the pathway for Hip and Knee Replacement and Neck of Femur Fracture patients. The
Health Intelligence Team has worked with the Project Manager to submit weekly reports to the
national group.
Paediatrics at WDHB is the first service to go live with eReferrals Phase 2 (featuring electronic
triaging) on Monday 17th March. As of this date, all eReferrals for Paediatric Medicine and
Paediatric Cardiology will be electronically triaged by Waitemata DHB clinicians and messages
related to the triage process will be sent back to the GP. The next service to go live will be
Cardiology, planned for the end of April 2014.
The Clinical Records, Coding and Transcription services are maintaining local and national service
levels and targets. This is being achieved under the pressure of continuing higher than previous
year’s volumes of work for all services.
Facilities & Development
Highlights/Issues
• Testing for legionella continues at NSH, WTH, Mason and Wilson Home. All testing to date has
failed to detect any incident of the disease.
• Minor capital projects relating to improved environmental workplaces continue to be processed
with the work completed in a timely manner, these projects include air conditioning, new
carpet and painting at NSH and WTH.
• Negotiations have concluded for the lease of premises at Hibiscus Coast. A cash incentive of
$275,000 from the landlord has been paid. Minor upgrades are anticipated to better utilise the
facility.
• 2 Lake Pupuke Drive is deemed a leaky building. The building is leased and accommodates the
Breast Screening service. The landlord has completed some critical remedial works in the last
quarter of 2013. The Service has advised they can agree to remain in the premises for a further
3 years only, during which time the Landlord will continue to remediate the building.
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• The ground lease at Hoani Whititi School for a concrete pad to house a transportable dental
unit remains outstanding. We are providing assistance to the School to enable this matter to
be concluded quickly.
• In December 2013, we were alerted to further leaking in the Community Health Building. The
building has been known to leak from 1995 on a sporadic basis. Various rooms were vacated.
Independent air tests undertaken found some rooms had high levels of bacteria and spores. All
rooms vacated have been cleaned and fumigated by specialist cleaners. Many of these leaks
originate from the roof and approval was granted in November to replace the roof. The roof
replacement is due to commence in March once Building Consent is received. Thereafter
further condition assessments can be carried out to assess any other leaks.
Major Capital Projects
• NSH KMU remedial works concluded in December 2013, the ward remained mostly operational
during the project works. Minor defects are being completed by the Contractor.
• Ward 8 refurbishment project was placed on hold by the CEO pending a full review of
Christchurch designs and philosophy. Workshops, User Group meetings including listening
events have been taking place in January to enable guiding principles to be established.
• Renal Phase II Community facility was handed over from the Landlord in late November. The
clinical fit out is progressing, with handover for operational commissioning in April 2014.
• NSH Gym is now completed and operational. Options are being considered for a location at
WTH.
• WTH Low Load Chiller project works was completed in December with operational
commissioning undertaken during January 2014.
Other
• Vacancies remain for an operations engineer and a project manager. These vacancies are now
impacting on the efficiencies of the team.
• Approval was granted to recruit to the Sustainability role and this role has been filled in March
2014.
• The project management role has been placed on hold again pending Facilities and
Development collaboration with ADHB.
• The Personal Assistant role vacancy will be filled in April
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Financial Results
Comment on Major Financial Variances
The overall result for Provider Support is $250k unfavourable for month and $653k favourable YTD
as at February 2014.
Revenue (Favourable $639k month, Favourable $2,878k YTD)
The favourable YTD position is largely due to $2.0M received in recognition of Pharmac savings, the
budget for which is included in other direct costs. Car Park revenue is favourable by $277k YTD
reflecting the higher number of patients / visitors and change in tariffs from Jul-13. In addition
Interest Receivable is favourable by $1.5M YTD while income from non-resident patients is
unfavourable by $644k YTD.
Expenditure (Unfavourable $889k month, Unfavourable $2,224k YTD)
Personnel Costs (Unfavourable $169k month, Unfavourable $893 YTD)
Budget savings not embedded in the services has a $3.6M YTD unfavourable variance in Provider
Support. These savings will be realised in the other Operating Groups. Support staff are favourable
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$1.5M YTD primarily due to the contracted FTE vacancy in Non-Clinical Support Cleaning and Orderly
Services being covered by agency casual staff. Management and Admin costs are favourable $1.4Mk
YTD with vacancies in Corporate Services and Hospital Operations partly offset by outsourced casual
staff.
Other Direct costs (Unfavourable $721k month, Unfavourable $1,332k YTD)
Budget savings not embedded in the services has a $2.7M YTD unfavourable variance in Other Direct
Costs. This is partly offset by $2.0M income received for Pharmac savings shown in Revenue.
Outsourced costs for casual staff in Hospital Operations are unfavourable by $2.1M YTD. Clinical
Supplies in Hospital Operations are unfavourable by $667k YTD being activity related costs in
Laboratories and Pharmacy. Non-clinical Supplies in Corporate Services are favourable by $2.3M YTD
primarily due to saving in interest and financing costs. Electricity costs are +$161k YTD being the
favourable pricing of new national contract.
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6.1 Clinical Leaders Report
Recommendation
That the report be received.
Prepared by: Dr Andrew Brant (Chief Medical Officer), Dr Jocelyn Peach (Director of Nursing and Midwifery) and Phil
Barnes (Director of Allied Health and Acting GM for Hospital Operations)
Glossary
SMOs - Senior Medical Officers’
RMOs - Resident Medical Officers’
AT - Anaesthetic Technicians
RATs - Registered Health Professionals
PICC - Peripherally Inserted Central Catheters
CCDM - Care Capacity Demand Management, tools and programme supported by the Safe Staffing Unit
FAST - Quality Improvement method used by Waitemata DHB
Medical staff
Clinical Leadership
Michael Rodgers has been appointed Chief of Surgery for the service. An upper gastrointestinal and general
surgeon, Michael has been with Waitemata for the last ten years. He has previously held senior leadership
positions as Clinical Director General Surgery and President of the NZ Association of General Surgeons.
Michael established liver resection at this hospital and improved the journey to elective theatre through
the shorter journey pilot.
Richard Harman has been appointed Clinical Director General Surgery. Richard has worked as a consultant
surgeon with special interest in breast and endocrine surgery at Waitemata DHB since 1998. He has
previously held the role of Clinical Director of General Surgery from 2003 to 2006 and more recently has
provided leadership and direction to the Department of General Surgery as acting Clinical Director. Richard
has a wealth of experience and knowledge which includes development of comprehensive breast surgical
services at Waitemata DHB and being lead surgeon for Breast Screen Waitemata Northland.
Interviews are underway in April for the Head of Division roles, Medical for the Child, Woman and Family
directorate.
Senior Medical Officers (SMOs)
New SMO appointments: Simon Young in orthopaedics; Jeffrey Reddy and Melanie Speer in anaesthesia,
and Andrew Howie psychiatrist.
Resident Medical Officers (RMOs)
Members of the MCNZ Education Committee will visit on 17-18th July for an accreditation visit. The
purpose is to ensure the education, training, supervision and facilities available meets the medical council
standards. The Medical Education and Training Unit and Mr Pat Alley, Clinical Director of Medical Training,
will be leading the preparation for the visit.
The New Zealand Medical Council (NZMC) is implementing changes to doctor’s training and education that
will improve patient safety and the performance of doctors. The changes are being phased in over the next
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two years. In March 2014 the Medical Council released the first change which is the New Zealand
Curriculum Framework for Prevocational Medical Training (NZCF). A staged implementation of the NZCF
will commence in November 2014 for those entering PGY1. Interns, Prevocational Educational Supervisors
and others involved in prevocational training will be able to use the learning outcomes in the NZCF as a
guide for training and educational programmes. Full implementation cannot occur until clinical attachments
have been accredited, which is scheduled for November 2015. The changes will have a significant impact on
training of our junior doctors in the DHB, and in particular supervision requirements of the SMOs. We will
be working with council this year to ensure that we provide appropriate environment for the new
curriculum.
In April 2014 we will submit to the regional RMO process our intentions for new RMO positions for 2015.
This is currently being worked through the services
GP open day
We held the first GP open event on February 25 in the evening. GPs were shown around the North Shore
facilities, including Emergency department, cardiology, and Elective Surgery Centre. This was followed by a
general question and answer session. It enabled the DHB to outline recent developments, and discuss
interface and integration issues. The event was very well received and has led to further opening of
channels of communication with our primary care colleagues to interact with the DHB. Further events are
planned, the next being in Waitakere Hospital. Future events may be centred on service themes.
Allied Health, Technical and Scientific staff
Anaesthetic Technicians
The core workforce involved in anaesthesia comprises medical practitioners (Anaesthetists), Nurses and
Anaesthetic Technicians (AT) and there is considerable variation nationally and internationally in the scope
of practice of each of these groups and therefore the skill mix within any perioperative environment.
Anaesthetic Technicians have existed in New Zealand since the early 1970’s, anecdotally having evolved
from a group of theatre orderlies who expressed an interest in assisting anaesthetists during surgery.
Training programmes were developed in the late 70’s and the role became formalised with strong support
from the College of Anaesthetists. There is now at least one AT in every operating theatre at WDHB.
The Waitemata DHB AT Department has been led by Julie Bromley since 1997 and around that time the
newly opened ICU was run by Anaesthetists, with their AT assistants. Thus it was recognised that AT skills
were readily transferable to emergency departments and ICU and in consequence ATs are now part of the
emergency resuscitation team, attending all adult resuscitation, trauma and medical emergency calls 24/7.
ATs were also found to be useful in assisting ward staff with difficult cannulations and during the RMO
strike of 2009 were asked to provide a formal hospital-wide cannulation service. Coincidentally, the rate of
line sepsis decreased significantly at that time.
In 2012 ATs became registered health professionals (RATs!) under the Health Practitioners Competence
Assurance Act 2003. Immediately prior to this, ATs were asked by HWNZ to pilot a scheme for the insertion
of Peripherally Inserted Central Catheters (PICC lines) to free up SMO time. This trial was very successful
and the AT led service demonstrated quicker referral-to-insertion time, reduction in procedure time and
significantly reduced failure rate. Now 95% of all PICC lines (average 15 per week) at WDHB are inserted by
RATS. It should be noted that a significant proportion of the RAT workforce is trained overseas (generally
UK) where their role as Operating Department Practitioners has a much wider scope than that outlined
above for New Zealand practitioners and gives an indication of the underutilised skills and potential of this
particular technical workforce.
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Laboratory Service
The Clinical Director of the service, Dr Ross Henderson has resigned from this position due to clinical
haematology workload pressures. Whilst Ross will continue to contribute to leadership of the service and
may return to his original role at some point in the future there is a need to secure clinical pathologist
support, at least in the interim. Preliminary discussions have occurred with LabPlus (ADHB) around the
possibility of a collaborative approach to the problem and possibly a joint appointment between ADHB and
WDHB. These initial discussions were very positive and gave rise to a number of possible options that are
currently being explored by the laboratory management team.
Allied Health Therapies
The Nutrition and Dietetics team is now at full complement following the appointment of Teresa Stanbrook
to the Professional Leader role and the morale of the service has significantly improved.
The allied health clinical governance group comprising professional and clinical leaders and senior
managers continues to meet and is developing into a vibrant forum for debate and decision making.
Dental Therapy
The Director of Allied Health, in conjunction with the Professional Leader Dental Therapy and Allied Health
Leader (CWF) are in the process of organising an auditor training course for up to 20 Dental Therapists and
service leaders to enable them to establish a formal and systematic peer review programme for the
Auckland Regional Dental Service.
Continuing Professional Development Fund
The CEO’s newly established professional development and training fund has been particularly well
received by the allied health, scientific and technical staffs as the majority of these professions have no
formal allocation of funds for continuing education and professional development. Processes are being
developed to ensure transparent and equitable distribution of the money within and between services and
the relevant professional groups.
Nursing and Midwifery
Activity using key priorities: Nursing and Midwifery
Provide a positive experience of care
Feedback to the senior nurses and midwives is planned in the next week from the ‘In Your Shoes’ event so
that learning can be applied to the next phase of patient experience work.
Deliver high quality care and measure impact
Quality programme
There has been good staff engagement in some key projects to improve the quality of professional care:
• A recent Nutrition and Hydration workshop involved 35 staff consisting of nurses, allied health staff
and the disability advisor, working very constructively together to identify the barriers to best
practice and key priorities to make improvements. Outstanding achievement was the work of the
registered nurse nutrition champion on Ward 7 and the Charge Nurse Manager who urgently
introduced ‘Protected Mealtimes’ with positive effect. This high priority work is ongoing.
• Pain Management Awareness FAST project, led by Shirley Ross, Head of Division Nursing is
addressing an important issue for patients in the inpatient setting.
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• Pressure Injury Prevent FAST project – led by Jeanette Bell, new Essentials of Care project assistant
working with Jenny Parr, Associate Director of Nursing.
• End of Life practice improvement – led by Tania Chalton which is engaging a number of champions
and is showing improvement.
The focus on quality improvement and safety is evident in all divisions. Each Head of Division for Nursing
and Midwifery is leading work on: documentation, medication safety, professional presentation and
essentials of care. The range of audit results shows improvement and increasing consistency in auditing
practices.
Build and strengthen professional leadership
• Charge Nurse Development Part 1 and Part 2
As reported previously, Part 1 of the Charge Nurse Managers development programme work commenced
with a two day workshop in March and the Part 2 cohort will commence in September 2014. The role of
Charge Nurse/Midwife Manager is important in an organisation as they set the culture at ward/unit level
which influences the direct care and the patient experience.
• Other senior nurse development
Leadership development of other senior nurse and midwife roles is underway as well.
Ensure we have the right staff, with the right skills in the right place
• Workforce planning Trendcare and CCDM [Care Capacity Demand Management]
Work continues to ensure we have a clear understanding of the acuity needs of patients and that there is
appropriate resource to meet these patients needs. This issue is becoming increasingly important to the
staff and their unions. We are engaging staff with the information that can be extracted from the
databases so that they can understand the importance of accuracy and consistency.
Support positive staff experience
Work continues to find ways to address staff experience of ‘everyone matters’. Ideas arose from ‘in your
shoes’. Plans to increase visibility, delivery on what they say is important to them in order to deliver quality
patient experience is underway.
Activity using key priorities: Emergency Systems Planning
The DHB annual exercise is planned for the beginning of April with good interagency emergency services
participation. There is increasing interest from residential aged care and primary care.
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6.2 Human Resources
Recommendation:
That the report be received.
Prepared by: Sam Bartrum (Director, Human Resources)
Executive Summary This report identifies some key areas that are occurring in Human Resources for the
month of March 2014.
Occupational Health & Safety WDHB Influenza Campaign
The 2014 Influenza campaign programme is underway with considerably more vaccinators
than last year. The target is to exceed 55% (2013) and the campaign’s aim is to access more
areas more often. The timetable is available on the OH&S website and there will be roving
as well as static vaccinators. There will be a communication programme to update staff
throughout the campaign.
Recruitment
No. Hires
(All permanent, fixed term, casual roles)
-
50
100
150
200
Feb-
13
Mar-1
3
Apr-13
May-
13
Jun-1
3
Jul-1
3
Aug-13
Sep-
13
Oct-1
3
Nov-13
Dec-1
3
Jan-1
4
Feb-
14
Cost per Hire ($)
(this includes advertising costs, relocation costs and
Monthly Recruitment Centre Running Costs)
-
200
400
600
800
1,000
Feb-
13
Mar-1
3
Apr-13
May-
13
Jun-1
3
Jul-1
3
Aug-13
Sep-
13
Oct-1
3
Nov-13
Dec-1
3
Jan-1
4
Feb-
14
Cost per Hire Cost per Hire Target ($)
Time to Hire (days)
(From candidate application to hire)
-
20
40
60
80
100
Feb-
13
Mar-1
3
Apr-13
May-
13
Jun-1
3
Jul-1
3
Aug-13
Sep-
13
Oct-1
3
Nov-13
Dec-1
3
Jan-1
4
Feb-
14
Time to Hire (days) Time to hire Target (days)
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KiwiHealth Jobs
Number of Jobs advertised by month and organisation
0
10
20
30
40
50
60
70
80
Northla
nd
Auckla
nd
Waite
mat
a
Counties M
anakau
Waik
ato
Bay of P
lenty
Tairaw
hiti
Taranak
i
Lake
s
Whanga
nui
Hawke
s Bay
Mid
Centra
l
Wai
rara
pa
Capita
l and C
oast
Hutt Valle
y
Nelson M
albro
ugh
Cante
rbury
South
Cante
rbury
West
Coas
t
South
ern
NZ Blo
od
Jan-14
Feb-14
At a glance – February 2014
Total number of visits: 38,388
Visits from:
UK
Australia
USA
Canada
Ireland
2732
1923
1414
566
291
Number of jobs posted
Clinical jobs
Non-clinical jobs
366
96
Key Highlights
• Total visits to the site remain steady; February had close to 40,000 visits to KHJ
which was consistent with January figures.
• There was an increase in traffic from Ireland and Canada – up 29% and 19%
respectively.
• Subscribers registered for job alerts continues to rise; 8,790 at the end of
February, up from 8,399 in January.
• The top 5 DHB referrals in February were Waitemata, Mid Central, Nelson
Marlborough, Waikato and South Canterbury DHBs.
Workforce Development
Values Implementation
The Best Care for Everyone programme continues to be a key focus for the workforce team.
A set of service standards and behaviours aligned to the values are completed and will be
launched as part of an organisational communication strategy in April. Phase 2 activity has
begun with a focus on values based recruitment workshops, In Your Shoes sessions for
SMOs, In your Shoes sessions for Maori, Asian and Pacific patient/client groups, leading to
the values, appraisal documentation and measurement of the patient and staff engagement.
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There is a strongly positive organisational response to the values programme and the rigour
of the processes and outputs is ensuring sustainable development and cultural change.
Allied Health Assistants Qualification
A successful graduation ceremony occurred for the Allied Health Therapy Assistants who
have completed the Level 3 National Certificate NZQA qualification. As Waitemata is the first
DHB to have a group complete the qualification, a representative group is facilitating a
workshop at the Allied Health Scientific and Technical Conference to be held late March
2014 at Health Waikato. The purpose is to share our journey and work with others both
regionally and nationally to grow this workforce.
Further work is occurring internally to work towards the enhanced use of the newly qualified
therapy assistants as part of the MDT.
Scholarship Programme
There was an award ceremony on 25th February for the 12 Māori students on the
Scholarship programme, and their Whānau. The purpose was to strengthen WDHB’s
connection with the students and their Whānau, whilst facilitating networking and
whanaungatanga among the students, Ngāti Whātua iwi members and the Waitemata DHB
staff who attended: He Kamaka Waiora Maori Health Gain team across Funding and
Planning and the provider arm, Director of HR, Workforce Development Manager, Pacific
Workforce Development Consultant, and Service Managers who interviewed the students on
the panels.
Outcomes included two students engaged with Dr Helen Wihongi around research, one
student engaged with Dr Sue Crengle around mentoring, one student engaged with John
Paterson and Sam Bartrum around employment opportunities as a new grad Podiatrist, and
all students in attendance received information about the WDHB My Career Path
programme.
Further work is being done to recruit a final three Physio and three Med Lab students for the
2014 Scholarship programme.
Māori Recruitment: Partnership with Ngāti Whātua o Ōrakei
Ngāti Whātua o Ōrākei have undergone some internal changes to the delivery of their
programmes. This has resulted in a shift of focus for them, and they now have a new team
named Whai Poutama who aim to facilitate employment for tertiary students of Ngāti
Whātua descent across all sectors.
Where links exist, Whai Poutama will register their students with the national Māori health
workforce development programme Kia Ora Hauora, and if eligible, support them to apply
for the Waitemata DHB Health Scholarship or the Whakatupu Hauora Scholarship.
Both the Kia Ora Hauora programme and the Scholarship programmes work with Waitemata
DHB to provide a facilitated employment process for students upon completion of their
qualification.
Pacific Health Science Academy & Mentoring Programme
We are actively working on the implementation plan and related immediate activities.
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A recruitment process for the role of Programme Manager – Health Science Academies is
underway. This role will be based at WDHB and will be responsible for the implementation
and delivery of the Health Science Academies.
The first regional governance meeting has just been held with good engagement from all
parties. This group will meet monthly during the initial set up phase and then quarterly after
that. The role of this group is to ensure contract targets are met and to facilitate action
within DHBs if barriers and issues are identified.
Internal Communications
Publications
The internal communications team published the following over the past two months:
• Healthlines – monthly 12 page staff magazine available online with 1200 printed copies
• Primary Care News – monthly magazine for Auckland GPs with contributions from
Waitemata, Auckland and Counties Manukau DHBs
• Waitemata Weekly – a weekly e-newsletter for all staff
• A Note from the CEO – a fortnightly message from the CEO to all staff
• Weekly health targets update – weekly update and commentary on health targets to all
staff
• Maintenance of StaffNet (WDHB’s intranet site), Awhina website, Waitemata DHB
external website and Waitemata DHB pages on Health Point
• A range of booklets and leaflets
Project/campaign work
The internal communications team provided communications advice and support to the
following projects/campaign in March:
• Community dialysis facility in Apollo Drive
• Waitakere Hospital maternity unit – planning for 50th anniversary celebrations [June
2014]
• ADCU [Assessment Diagnostic Cardiology Unit] name change communications
• CWF communications planning re changes to child health service
• ACP [advanced care planning] open day communications
• IPANZ public sector excellence awards – video / poster support
• Corporate orientation presentation update
• Values campaign
• Chapel project
• healthAlliance windows 7 rollout project
• MRI project including media activity re arrival of Philips magnet [28 March]
• He Puna Waiora [new mental health facility on Shakespeare Rd] tree planting ceremony
with media and local MP in attendance [26 March]
• 2014 flu campaign
• Establish research project with North Shore police intelligence unit and NSH ED
• Sustainability comms
• New fresh food options in NSH staff cafeteria
• Proofing various department newsletters
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Other support
March Health Heroes celebration.
Awhina Education & Learning
Education and Learning Governance at Waitemata DHB
The recently established Waitemata DHB Education and Learning Committee meets every six
weeks. Two meetings (5 February and 20 March) have been held to date. The committee is
chaired by Dr Jonathan Christiansen. It provides a central connection for education and
learning across the DHB. It aims to link learning and development with the provision of
clinical care in the services and provide advice and guidance to the senior management team
to support their decision-making.
The programme of work for the first six months is:
1. Complete establishment of the Education and Learning Committee
• Invite a primary care representative to join the core committee
• Establish a virtual consultative group to enable a broad group of staff to participate
in education and learning issues as they arise
• Get sign-off on the Terms of Reference.
2. Establish key sub-committees
• Professional development fund committee. This committee has an annual budget of
$250k. The first task for the committee is to establish criteria and an application
process for staff to apply to access funding
• Internal conferences, seminars and speaker series committee
• Education, Research, Conference and Learning Centre user group – working in
conjunction with Dr John Cullen
• Mandatory training committee.
3. Conduct stock-takes to establish a baseline of information
• The first stock-take the committee will conduct will focus on parties external to the
DHB who influence education and learning and service provided within WDHB. The
stock-take will look at the extent and impact of these external requirements.
Resident Doctors
Medical Council NZ (MCNZ) Accreditation Visit
The MCNZ will visit Waitemata DHB on 17-18 July for the accreditation site visit. This has
been reported on previously to HAC. Preparation for the visit is on track.
Resident doctor protected teaching time programme
Under their union agreement, resident doctors have two hours protected teaching time
each week. Waitemata DHB schedules this each Thursday from 12.30-2.30pm. Paging
behaviour was recognised as one of the key barriers to our DHB meeting this protected
teaching time requirement. There was a tendency for resident doctors to arrive and sign in
for the session and then respond to their pagers/leave to attend to ‘urgent calls’ during the
session. Given the regularity of this behaviour we recognized the need to address it. Two
things occurred as a result (i) leaving the sessions to answer pager calls has significantly
reduced and (ii) the frequency of calls has diminished. Resident doctors are now better at
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filtering urgent v non-urgent calls and actively managing this for themselves. Some of this
change in behaviour has been made possible by the new SmartPage system.
The resident doctor programme is a year-long programme designed to meet the MCNZ
curriculum requirements. It is structured into five teaching blocks underpinned by four
crucial elements: quality, clinical skills, inter-professional education and collaborative
practice, and safe prescribing. The programme is facilitated by in-house specialists and is as
follows:
Block Teaching topics e-Learning modules
Orientation
Week one
DHB values and welcome
Occupational health and safety
Cannulation
Medication chart
Infection, prevention and control
Catheterization
Fire Safety
Occupational H&S
Infection, Prevention &
Control
Informed Consent
Adult Medication Chart
Medication History
Survival Series
13 weeks
Supports early
expectations of
the role
Ward calls and handovers
Certifying death
Fluid management
Medication safety
Surgical do’s & don’ts
Pain relief
ABC of chest x-rays & working with the
radiology dept
Acute chest pain, acute shortness of
breath, oxygen therapy
Palliative care
Difficult conversations
Sepsis and antibiotic choice
Prescribing for the elderly
Peri-operative work up – from consent
to assessment
Electronic discharge summaries
Tramadol and Oxycodone
Medications in the Elderly
Gentamycin
Metroprolol
Consolidation
Part 1
13 weeks
Blends theory
and practice
Acute urology (skills, prostate exams &
review of catheterization)
LA, suturing, haemostasis & dressings
Delirium, depression & dementia
(cognitive testing)
Diabetes management (blood glucose
testing)
Gastrointestinal conditions (university
challenge style Q&A)
Arterial blood gases (punctures)
GI bleeding
Lumbar punctures
Chest drains (drain insertion &
removal)
Stroke (MDT management of stroke
patients)
Insulin
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Toxicology, drug overdose and
anaphylaxis
Quality, learning from our mistakes &
ACC
Consolidation
Part 2
14 weeks
Case
presentations &
reflective practice on
clinical scenarios
Keys to presenting & giving feedback
Nephrology
Respiratory
Gynecological
Infectious diseases
Nutrition & metabolism
Musculoskeletal
Haemopoietic
Psychiatric/drug and alcohol
Neurological
Domestic violence
Endocrine
ENT otorhinolaryngology
Circulatory
Dermatological
[the Healthcare Challenge
Team challenge for
interdisciplinary teams
occurs during this teaching
block]
Transition to
post-grad, year 2
8 weeks
Career direction and planning & next
steps
Preparing your CV and interview
preparation
Values – your career and the values
you hold
Moving and Handling
1:1 teaching and coaching skills
Medication safety
Skills for audit & research – developing
a research question
Communication/health literacy
Preparation for working in ICU and ED
Feedback and end of year round-up &
certification ceremony
We are currently midway through the ‘Consolidation – Part 1’ programme and detailed
planning is underway for ‘Consolidation – Part 2.’
The MCNZ has recently published an updated version of the curriculum for resident doctors
and a review of our programme against those requirements shows no adjustments to our
programme are required.
Charge Nurse Managers – leader development programme
The Leading Quality Care – leader development programme for CNMs is a seven day
programme delivered over 8 months. It’s a new programme that is being piloted for a group
of 13 charge nurse managers from Medical and Health of Older People Service and from
Surgical and Ambulatory Services. The first two days ran at the beginning of March.
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Following the first two days, charge nurse managers were asked to do two things: carry out
ward observations in their own wards/within their own teams; and form learning sets for the
duration of the programme. Members of the Learning and Development team have
facilitated the first sessions of each learning set to help them get established.
It’s too early for there to be significant shift in terms of leader behaviour but observations to
date are encouraging. CNM’s report that they are observing what’s happening in their
wards with new eyes, some of them are naming and challenging behaviour that
compromises quality care and others are using their learning about the Myers Briggs
personality profile to support and enhance their communication with others.
The programme has been designed in two parts. Part 1 focuses on strategies for leader
readiness and part 2 focuses on strategies for leading quality care.
e-Learning
Our Learning Technologies team has continued to work closely with subject matter experts
across our DHB to design and develop e-Learning courses for staff. See below for a
complete list of courses:
CODE: (*) edited; (+) redesigned; (-) not developed by Awhina; Blue text – new course in
development
Category Course
General 1. Nicotine Replacement Therapy
2. Smoking Cessation
3. Healthy Eating, Healthy Weight
Clinical Procedural
Skills
4. Thrombolysis
5. Central Venous Catheters (*)
Enteral Nutrition 6. Inter-Disciplinary Team(*)
7. Dysphagia and SLT
8. Medications
9. Nutritional assessment
10. Tube placement & Potential Issues with enteral feeding
11. Treatment
12. Monitoring
13. Discharge
14. Cultural & Ethical Safety(*)
Safe Use of Medicines 15. The Adult Medication Chart
16. Medication History
17. Tramadol
18. Gentamicin for Adults
19. Insulin
20. Heart Failure Medications
21. Medications for Older Adults
22. Buscopan
23. Metroprolol
24. Oxycodone
25. Gentamicin for neonates and paediatrics
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Category Course
26. Pharmacological management of
pain (+)
27. 3D’s: Dementia, Delirium and dehydration
Diversity 28. Disability Awareness
29. CALD programme (-)
30. Sharing information with Family/Whanau
Patient Safety 31. Informed Consent 2014(*)
32. SOAP - Clinical Documentation Notes
33. Good Clinical Research Practice
34. MHSOP
35. SCBU
Annual Updates 36. Level 3 CPR(*)
37. Fire Training (+)
38. Occupational Health and Safety Services
39. Privacy of Health Information
40. Infection Prevention & Control
Clinical (+)
41. Infection Prevention & Control non-clinical
42. ACLS Recertification Theory Test
43. Nursing Code of Conduct
44. Blood Culture Safety
Products 45. AMS Leader Training
46. Trendcare Pre-Testing
47. e-Prescribing
48. Stastrip Xpress
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7.1 Synthetic Cannabinoids
Recommendation
That the report be received.
Prepared by: Susanna Galea (Clinical Director CADS)
Purpose of this report
To inform the WDHB Hospital Advisory Committee on the concern related to harm from the use of
synthetic cannabinoids and the approach being taken on this issue.
What are they?
Synthetic cannabinoids, also referred to as ‘synthetics’, are substances that mimic the effects of
cannabis, although with significantly greater potency and efficacy. They are marketed as legal
substitutes for cannabis, sold in our local shops often at close accessible proximity to hospitals and
other treatment settings. ‘Synthetics’ usually consist of a chemical agent sprayed onto dried plant
material which is smoked (and sometimes consumed as ‘tea’). Common names include: Apocalypse,
Outbreak, Tai High, and Giggle (also, Kronic, Spice and K2- which are now banned).
The concern
The emergence and proliferation of synthetic cannabinoids within the NZ market, and globally, is of
great concern. Very little is known about the safety profile of these substances, however it is clear
that they have numerous adverse side effects. The evidence that is available is mainly anecdotal
(reported on social media/internet sites by users), and via case studies reported in the literature.
Frequent adverse effects reported through case reports and calls to the National Poisons Centre in
New Zealand, include: dependence, psychosis, hallucinations, anxiety, agitation, tremors, seizures,
drowsiness, tachycardia, hypertension, chest pain, tachypnoea and vomiting. Other less frequent
adverse events include: respiratory depression, loss of consciousness, rhabdomyolysis, acute tubular
necrosis and renal failure. All these reported effects had been severe enough to require medical
attention. Stopping use of synthetics can trigger withdrawal symptoms that can last a number of
weeks.
Although little is known about the prevalence of use of such substances in the general New Zealand
population the ‘synthetics’ industry is extensive and profitable, suggesting use is not insignificant.
Presentations at emergency departments, mental health and addiction units suggest an upward
trend in usage overall (however over the past few months some downward trends have been
observed also).
The most recent report by the Illicit Drug Monitoring System (IDMS), shows increasing trends over
the past few years – see figure below. Although the IDMS interviews frequent drug users these data
show that there was a trend for increasing use of these substances during this time which reflects
increased availability. The emergency department in Dunedin reported that 79 out of 1702
attendances over a 6 month period (April to September 2013), involved synthetic cannabinoids. The
National Poisons Unit reported an increase in number of calls related to synthetics, from October
2013 to November 2013; followed by an apparent reduction from November 2013 to January 2014.
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Over the past two years CADS has experienced an increasing demand to address health needs
related to use of synthetic cannabinoids. Cannabinoid presentations tend to be complex and can
utilise more health care time than other presentations. Anecdotal evidence suggests that about 40%
of people presenting at CADS report use of synthetics. It is unclear how many of these have
‘synthetic use’ as their main presenting complaint, however CADS is looking at ways to collect this
data into the future. Some CADS services are able to provide more detailed information. Medical
detoxification services have assessed 4-5 people a month for the past 8 months requesting support
to withdraw from synthetic cannabis and a large percentage of these clients have been admitted to
the inpatient unit. The Youth Service ‘Altered High’ reports 2-3 new referrals a week that have
‘synthetics’ use as the reason for referral.
A cross sectional audit of the CADS Altered High Youth Service conducted in 2011 found that 42% of
clients had used ‘synthetics’ and that 32% of these users had experienced problems as a result of
use including mood difficulties (16%), family arguments and conflict (16%), school problems (14%),
addiction/dependence (11%) and criminal or violent behaviour (9%).
Legal status
In July 2013, the New Zealand Government introduced the Psychoactive Substances Act to regulate
the availability of psychoactive substances and protect the health, and minimize harm to individuals
using these substances. New Zealand is leading in this approach to regulate availability – no product
will legally go on the market before it is deemed as low-risk. As synthetic cannabinoids are classed as
psychoactive substances, and are not listed under the Misuse of Drugs Act, they will be considered
by the Psychoactive Substances Act.
The Act stipulates that a product will only be approved for use if it poses a low risk of harm to
individuals. Before a product is approved for use, the degree of harm will need to be assessed. The
onus to prove low-risk lies with the manufacturer. As an intermediary step in the implementation of
the act, a number of synthetic cannabinoids were granted interim approval under the Psychoactive
Substances Act and are sold in New Zealand by retailers (see -http://www.health.govt.nz/our-
work/regulation-health-and-disability-system/psychoactive-substances/interim-product-approvals
for a full list of approved for sale products e.g. AB-Fubinaca, PB-22-F, CP-55244). The MoH will
revoke these approvals and recall the products if it judges, from reports of adverse effects, that a
product poses more than a low risk of harm to the user.
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The MoH is encouraging clinicians to report adverse events to the Centre for Adverse Reaction
Monitoring (CARM). Reporting of adverse effects plays a crucial role in the recall of products from
the market. CADS currently is promoting reporting of adverse effects to CARM across its various
services.
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