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HOSPITAL ADVISORY COMMITTEE

Tuesday, 23 March 2009 – 2.00 pm

Board Room, First Floor, Dunedin Hospital

TIME INDEX

2.00 pm Welcome Apologies: Interests Registers

Hospital Advisory Committee Executive Management

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Minutes of Previous Meeting 2 2.15pm Presentation: Oncology Service Update Executive Reports: Chief Operating Officer’s Report 3 Chief Medical Officer’s Report 4 Chief Nursing & Midwifery Officer’s Report 5

Performance Reports: KPIs and Activity Report 6 Financial Report 7 Strategic Projects Report 8 Clinical Group Reports 9 Information Systems Report 10 Human Resources and Occupational Health

and Safety 11

Building and Property 12 Quality and Risk 13 Review of Action Sheet 14 General Business Next Meeting Acronyms 15

Closed Session:

RESOLUTION: That the Hospital Advisory Committee move into committee to consider the agenda items set out below.

The general subject of each matter to be considered while the public is excluded, the reason for passing this resolution in relation to each matter, and the specific grounds under section 34, Schedule 4 of the NZ Public Health and Disability Act 2000 for the passing of this resolution are as follows:

General subject: Reason for passing this resolution:

Grounds for passing the resolution:

1. Confidential Minutes of 23 February 2010

2. Procurement Report

3. Risk Register

4. Confidential Meeting Action Sheet

To allow activities to be carried on without prejudice or disadvantage

Commercial Sensitivity

S 34(a), Schedule 4, NZ Public Health and Disability Act 2000 – that the public conduct of this part of the meeting would be likely to result in the disclosure of information for which good reason for withholding exists under sections 9(2)(i) and 9(2)(j) of the Official Information Act 1982, that is, the withholding of the information is necessary to enable a Minister of the Crown or any Department or organisation holding the information to carry out, without prejudice or disadvantage, commercial activities and negotiations.

As at March 2010 Page 1

OTAGO DISTRICT HEALTH BOARD

HOSPITAL ADVISORY COMMITTEE

INTERESTS REGISTER

Board Member Date of Entry

Interest Disclosed Nature of Potential Interest with the Otago DHB

Richard John THOMSON (Chairman)

13.12.2001

23.09.2003

1. Thomson & Cessford Ltd (Managing Director) 2. Susanna Shaya Imports Ltd (Directors) 3. Hawksbury Community Living Trust (Chairperson &

Trustee) 4. HealthCare Otago Charitable Trust (Trustee)

1. Thomson & Cessford Ltd is the Company name for the Acquisitions Retail Chain. ODHB staff occasionally purchase goods for their departments from it.

2. Susanna Shaya Imports is a homeware importing Company. It has no dealings with the ODHB.

3. Hawksbury Trust runs residential homes for intellectually disabled adults in Otago and Canterbury. It does not have contracts with the ODHB.

4. Health Care Otago Charitable Trust regularly receives grant applications from staff and departments of the ODHB, as well as other community organisations.

John ADAMS 27.05.2003 24.02.2004 23.11.2004 22.04.2008 18.02.2010

1. Dunedin School of Medicine (Dean) 2. ODHB Mental Health Service (Staff Member) 3. Ashburn Hall Charitable Trust (Trustee) 4. NZ Institute of Rural Health (Trustee) 5. NZ Medical Council (Chair)

1. Possible conflicts between ODHB and University interests.

2. Possible differences in priorities and view between governance and employee.

3. The Ashburn Clinic is both a contractor to and provides similar services to the ODHB.

4. DHBs contract NZIRH to provide services. 5. At times, NZMC policy or opinion may conflict

with or be critical of ODHB policy. Maria Louise CARR 15.12.2007

07.02.2008 1. PACT (Chief Executive Officer) 2. Personal Advocacy Trust Board (Trustee)

1. Contracted to the Otago DHB to provide mental health services to Otago residents

Susan JOHNSTONE

16.12.2004

1. Southland District Health Board (Deputy Chair) 2. Otago Polytechnic (Council Member) 3. Shand Thomson Ltd (Principal) 4. Clutha Community Health Company Ltd (Accountant via

Shand Thomson; Consultant/Employee of Shand Thomson, Brian Dodds is Chairman)

5. Clutha Health Incorporated (Accountant via Shand Thomson, Consultant/Employee, of Shand Thomson, Brian Dodds is a Trustee;)

1. Governance representation for both DHBs. There will be issues that confront both DHBs that still require autonomous decisions.

2. OP places nursing trainees with ODHB 3. Shand Thomson is a Chartered Accountancy

practice. Clients can include general practitioners and pharmacists, and do include Otago Southern Region PHO, Clutha Community Health Co Ltd and Clutha Health Incorporated

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28.01.2008 16.12.2004

6. Shand Thomson Nominees Ltd; Shand Thomson Nominees (2005) Ltd; Abacus ST01 Ltd; Abacus ST02 Ltd, Abacus ST03 Ltd, Abacus ST04 Ltd; Abacus ST05 Ltd; Abacus ST06 Ltd; Abacus ST99 Ltd

7. Johnstone Afforestation Ltd (Director and Shareholder) Spouse: 8. Tuapeka Community Health Co Ltd

(Consultant/Accountant via Shand Thomson) 9. Tuapeka Health Incorporated (Consultant/Accountant

via Shand Thomson) 10. West Otago Health Ltd (Consultant/Accountant via

Shand Thomson) 11. Roxburgh & Districts Medical Services Trust Board

(Consultant/Accountant via Shand Thomson) 12. Wyndham Rest Home Incorporated

(Consultant/Accountant via Shand Thomson)

4. CCHC receives nearly all its funding from ODHB 5. CHI is the sole shareholder of CCHC 6. Corporate Trustee Companies for Shand

Thomson that potentially may be co trustees in trusts that hold shares in client companies that have contracts with ODHB – eg client pharmacy companies

7. Personal forestry investment. No conflict. 8-12. These entities all receive funding from ODHB

Judith MEDLICOTT 13.12.2001 23.11.2004

13.12.2001

11.05.2007 11.05.2007

1. Ashburn Hall Charitable Trust (Trustee) 2. Medlicotts, Lawyers (Partner) Daughter: 3. Senior Clinical Psychologist, Intellectual Disability

Service, Otago District Health Board Sons: 4. Elder son, Partner in Medlicotts 5. Younger son, General Practitioner, Island Bay,

Wellington.

1. Private Psychiatric Hospital which contracts with ODHB to provide care for patients. Strong professional links between staff of the two institutions.

2. Law firm which has some ODHB patients and staff as clients. These clients may require careful assessment or referral to another firm.

3. Is employed to provide psychological services to ODHB patients and others in Otago/Southland. Some are also clients of Medlicotts Lawyers.

4. Lawyer for Karori PHO, Wellington. PHO member is head of Pharmac.

5. Partner at Island Bay Medical Centre. No likely conflict.

Tahu POTIKI

15.12.2007 03.04.2008 24.11.2009

1. Arataki Associates (Director) 2. Southland District Health Board (Member) 3. Representative to Te Runanga o Ngai Tahu 4. Trustee of Ngai Tahu Charitable Trust 5. Board Member, Relationship Services NZ

1. Contracted to ODHB, funded provider in the past ie Araiteuru Whare Hauora Ltd

2. Governance representation for both DHBs. There will be issues that confront both DHBs that still require autonomous decisions.

3. & 4. Treaty Partner

Affiliated providers may contract to ODHB Te Runanga o Ngai Tahu has right of first refusal on disposal of property

5. No apparent conflict.

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Norma Jean RESTIEAUX

27.03.2008

28.04.2009

1. HealthCare Otago Charitable Trust (Trustee) 2. Dunedin Heart Unit Trust (Trustee) 3. National Heart Foundation, Scientific Advisory Group

(Chair)

1. Health Care Otago Charitable Trust regularly receives grant applications from staff and departments of the ODHB, as well as other community organisations.

2. Receives applications for support for research and study from ODHB staff.

3. Assessment and funding of research applications.

Marie-Louise ROSSON

17.04.2007 05.06.2007

1. Virgin Gold Ltd (Director) 2. The Otago Community Trust (Trustee) 3. Biosecurity Ministerial Advisory Committee (Member)

1. No actual or perceived conflict of interest with ODHB



M:\Interests Registers\HAC\2010\HACInterestRegister-February 2010.doc

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INTERESTS REGISTER FOR THE REGIONAL EXECUTIVE MANAGEMENT TEAM As at March 2010

Employee Name Date of Entry

Interest Disclosed Nature of Potential Interest with the Southland and Otago DHBs

John Adams 27.05.2003 24.02.2004 23.11.2004 22.04.2008 18.02.2010

1. Dunedin School of Medicine (Dean) 2. ODHB Mental Health Service (Staff Member) 3. Ashburn Hall Charitable Trust (Trustee) 4. NZ Institute of Rural Health (Trustee) 5. Medical Council of New Zealand (Chair)

1. Possible conflicts between ODHB and University interests.

2. Possible differences in priorities and view between governance and employee.

3. The Ashburn Clinic is both a contractor to and provides similar services to the ODHB.

4. DHBs contract NZIRH to provide services. 5. At times, NZMC policy or opinion may conflict with or be

critical of ODHB policy. Vivian Blake 23.04.2007

17.03.2008 08.02.2009

1. Close association (husband) with Project Manager, DHBNZ.

2. Executive Director on the Board of the Health Roundtable (HRT).

3. Executive Member of the RDA MoU. 4. New Zealand Benchmarking Group (Chair).

1. Portfolio includes DHB National Procurement Strategy 2. The HRT facilitates benchmarking activity for 103

Australasian hospitals. 3. The MoU Executive provides advice to DHBs and

considers strategies to improve the employment, recruitment and retention of Resident Medical Officers.

4. NZBG is the New Zealand Chapter of the Australasian Health Roundtable.

Richard Bunton 17.03.2004

1. Managing Director of Rockburn Wines Ltd. 2. Director of Mainland Cardiothoracic

Associates Ltd. 3. Director of the Southern Cardiothoracic

Institute Ltd. 4. Director of Wholehearted Ltd. 5. Member, Board of Cardiothoracic Surgery,

1. The only potential conflict would be if the ODHB decided to use this product for ODHB functions.

2. This company holds the ODHB contract for publicly funded Cardiac Surgery. Potential conflict exists in the renegotiation of this contract.

3. This company provides private cardiological services to Otago and Southland. A potential conflict would exist if

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23.02.2010

RACS. 6. Trustee, Dunedin Heart Unit Trust. 7. Chairman, Dunedin Basic Medical Sciences

Trust. 8. Otago Rugby Union (Director)

the ODHB were to contract with this company. 4. This company is one used for personal trading and apart

from issues raised in ‘2’ no conflict exists. 5. No conflict. 6. No conflict. 7. No conflict. 8. No conflict.

David Chrisp 01.06.2008 1. Officer of Southland and Otago District Health Boards.

1. Executive representation for both DHBs. There will be issues that confront both DHBs that still require autonomous decisions and the potential conflict is to ensure advice is offered without bias and in line with decision-making principles to be adopted by the virtual entity – Southern Alliance.

Robert Mackway-Jones

09.03.2007 28.08.2007

1. Officer of Southland and Otago District Health Boards.

2. Close association (wife) employed by SDHB Provider Arm.


2. Reporting line to Purchasing Team leader. Lexie O’Shea 01.07.2007

04.09.2009 1. Trustee, Gilmour Trust. 2. Officer of Southland and Otago District

Health Boards.

1. Southland DHB Trust. 2. Executive representation for both DHBs. There will be

issues that confront both DHBs that still require autonomous decisions and the potential conflict is to ensure advice is offered without bias and in line with the decision-making principles adopted by the virtual entity Southern Alliance.

Karyn Penno 21.12.2007 17.12.2009


2. Fusee Rouge Café, Cromwell (Owner).

1. Executive representation for both DHBs. There will be issues that confront both DHBs that still require autonomous decisions and the potential conflict is to ensure advice is offered without bias and in line with the decision-making principles adopted by the virtual entity Southern Alliance.

2. Nil.

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Brian Rousseau 23.07.2004 09.03.2007 16.12.2008 17.10.2008

1. Director of South Island Shared Services Agency Limited (SISSAL).

2. New Zealand Institute of Rural Health (NZIRH) (Trustee).

3. CEO, Southland and Otago DHBs. 4. Southern Health Welfare Trust (Trustee).

1. SISSAL is owned jointly by the SI DHBs, and conducts planning and funding work and provider arm project work for the DHBs.

2. Otago DHB is a founding sponsor of the NZIRH. DHBs contract NZIRH to provide services.


4. Southland DHB Trust. Leanne Samuel 01.07.2007

01.07.2007 01.07.2007 24.02.2009 29.10.2009

1. Southern Health Welfare Trust (Trustee). 2. Member of Community Trust of Southland

Health Scholarships Panel. 3. Member of Board of Studies at Southern

Institute of Technology. 4. Officer of Southland and Otago District

Health Boards. 5. Southland Medical Foundation Inc (Member)

1. Southland DHB Trust. 2. Nil. 3. Potential conflict if the DHB purchases services from this

organisation. 4. Executive representation for both DHBs. There will be

issues that confront both DHBs that still require autonomous decisions and the potential conflict is to ensure advice is offered without bias and in line with the decision-making principles adopted by the virtual entity Southern Alliance.

5. Southland trust. Grant Taylor 07.05.2007

14.10.2009 14.10.2009 14.10.2009 14.10.2009


2. Wife is employed by the University of Otago as a part time physiotherapy tutor and by Otago DHB as a part time physiotherapist.

3. Chair of the South Island CIOs. 4. Member of the National Connected Health

Board. 5. Member of the Safe Medication

Management Committee. 6. Member of the National Energy Project


2. Reporting line to Line Manager within Otago DHB Provider Arm.

3. Will lead SI regional strategies. 4. A focus on national connectivity and exposure to

strategies and vendors.

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5. Otago is looking to pilot E-Prescribing nationally. 6. No conflict.

Murray Fosbender 03.02.2010 1. Private Orthopaedic Surgeon, Queens Park Medical Centre. 2. Owner operator Dog Tail Farm, Deep water marine mussel farms limited.

1. Private / public contract accessed via Southern Cross Hospital 2. Nil.

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Minutes of the Hospital Advisory Committee, 23 February 2010 Page 1

Minutes of the Hospital Advisory Committee Meeting Held on Tuesday, 23 February 2010, commencing at 2.00 pm, in the Board Room, First Floor, Dunedin Hospital

Present: Mr R J Thomson Chairman Mrs S J Johnstone Dr J B Adams Dr J O Medlicott (until 4.55 pm)

Dr N J Restieaux Ms M L Rosson (from 2.15 pm)

In Attendance: Mrs V J Blake Chief Operating Officer Mr R W Bunton Chief Medical Officer (until 5.05 pm)

Mrs L Samuel Chief Nursing & Midwifery Officer Ms J Harvey Communications Officer

Ms J Kloosterman Board Secretary Mr G Paris Business Analyst

1.0 WELCOME

The Chairman welcomed everyone to the meeting.

2.0 APOLOGIES

Apologies were received from Ms M L Carr. An apology for lateness was received from Ms M L Rosson and apologies for an early departure were received from Dr J B Adams and Mrs L Samuel. Moved Mr R J Thomson, seconded Mrs S J Johnstone, that the apologies be accepted.

Carried

3.0 DECLARATION OF INTERESTS

The Chairman called for any adjustments or amendments to the Interest Registers. The following were notified: Action Point 445 Dr J B Adams - Chairman of the Medical Council of New Zealand to be added Dr N J Restieaux – Chair of Otago DHB Credentials Committee to be deleted Mr R W Bunton – Director of the Otago Rugby Union to be added The Committee congratulated Dr Adams on his appointment as Chair of the Medical Council.

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The Chairman asked if Committee members were aware of any agenda items with which they may have a potential conflict and reminded them of their responsibility to advise the meeting immediately should any potential conflict arise during discussions. Moved Mr R J Thomson, seconded Mrs S J Johnstone, that the Hospital Advisory Committee and Executive Interest Registers and the changes notified be noted.

Carried

4.0 MINUTES OF THE PREVIOUS MEETING

Moved Mrs S J Johnstone, seconded Dr J O Medlicott, that the minutes of the 24 November 2009 meeting of the Hospital Advisory Committee be approved and adopted as a true and correct record.

Carried

5.0 MATTERS ARISING

There were no items arising from the previous minutes that were not covered by the agenda or action sheet.

6.0 BRIDGING THE GAP Dr Christopher Jackson, Medical Oncologist, Southern Blood & Cancer Service, and Ms Chris Crane, Project Manager, joined the meeting to answer any questions members might have on the submissions summary and recommendations on Bridging the Gap – a partnership between patients, doctors and DHBs to enhance access to unfunded treatments (tab 14). The Chairman noted that this project started as a specific proposal for Oncology but became a consultation process around a principle, which had caused some confusion. He informed the Committee that, although the Southern Blood & Cancer Service operated across Otago and Southland, they were considering this proposal purely as a recommendation to the Otago Board.

Ms M L Rosson joined the meeting at 2.15 pm. During its deliberations on the proposed financial principles for the establishment of an oncology pilot, the Committee debated whether overhead charge recoveries should be retained by the service or applied to the institution. The Chairman explained that because overheads were calculated as an average, from a marginal perspective, passing these on to private patients on a pro rata basis could hypothetically result in a small “surplus” if it was found they did not need to be applied to facility costs. Dr Jackson advised that a model already existed in research to deal with this, ie for clinical trials. In response to a member’s question Dr Jackson said that the majority of patients accessing unfunded treatments would be existing public patients receiving a privately funded “top up”. It was agreed that the systems around income from private patients had to be transparent and guard against any perverse incentives to provide unnecessary

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additional treatments to potentially vulnerable people and that patients would need to be given good decision-making information. It was also noted that one of the issues raised during consultation was the potential to put pressure on the public system to expedite advancement of treatments, as occurred with Herceptin. In response to a question about evaluation parameters, Dr Jackson said it would be difficult to gauge the success of the pilot because during its life there would be times when it was dormant and others when it would be busy. He advised that New Zealand was behind other countries in introducing new drugs but as they became available through PHARMAC, private demand for them would drop off. Dr Jackson said that for him the evaluation parameters would be financial sustainability, ethical acceptability, and acceptability to staff and the community. Dr Jackson informed the Committee that before patients were offered an additional unfunded drug, it would need to be peer reviewed and go to the hospital costings group for approval. This would guard against treatments that were outside the mainstream and treatments that were not supported by other clinicians. It was agreed that the clinical decision to provide additional private treatment needed to be peer reviewed and cost recovery needed to be auditable. Action Points 446 Prior to the March Board meeting, management were asked to: Carry out more work on defining cost recovery and redraft principles 7 and 8

to make it explicit that charges would be on a cost recovery basis and as close to zero as possible;

Examine how a charitable trust might be used and its pros and cons.

Subject to the foregoing provisos, Mr R J Thomson moved, seconded Dr J B Adams, that the Hospital Advisory Committee: Note the report;

Recommend that the Board endorse the principles for the establishment of a pilot;

Recommend that the Board approve the utilisation of a charitable trust to advance the pilot;

Recommend that the Board endorse the pilot subject to Ministerial approval.

Carried

The Chairman thanked Dr Jackson and Ms Crane, and commented that the quality and value of the arguments presented by both sides during the consultation process had been remarkable.

7.0 EXECUTIVE REPORTS

The Committee considered the Executive Reports for January 2010 (tabs 3-5).

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Chief Operating Officer’s Report (tab 3) In presenting her monthly report, Mrs V J Blake, Chief Operating Officer, highlighted the following points. Reporting: The Clinical Group reports had been changed to align them with Southland

reporting and the presentation of volume data would be modified in future. Contract and Operational Performance: Total activity (including IDFs and adjustment for uncoded cases) was 7%

ahead of plan for January and on plan for the year to date.

Elective activity (including IDFs) was 12% ahead of plan for January and 2% ahead of plan for the year to date.

Financial Performance: The Provider Arm produced a positive variance against budget for January of

$449k and was positive against budget for the year to date by $1,298k.

Operational Performance:

The average length of stay crept up to 4.95 days during January against a target of 4.5 days.

There were some data issues with the Outpatient Did Not Attend (DNA) rate.

Staff turnover continued to improve and was 0.99% during January against a target of 1.2%.

The Emergency Department Triage Priority 2 was concerning at 62.3% during

January against a target of 80%. Staff Vacancy Report

A two-month view of the vacant positions being recruited to was circulated with the agenda (attachment A, tab 3).

There were no House Officer vacancies.

Value for Money (VfM) (Attachment B, tab 3) A progress report on VfM efficiencies was circulated with the agenda

(attachment B, tab 3). Mr G Paris, Business Analyst, advised that the VfM targets had been reviewed and the forecast had been revised down, as some of them had been found to be unrealistic.

Better Help for Smokers to Quit (Attachment C, tab 3) Establishment of a smoking room would cost $65k-$75k and was not included

on the capital plan.

There was a smoking area adjacent to Ward 1A that smokers were being redirected to and a lot of work was going into encouraging people to quit.

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Radiology IANZ The Radiology Service had obtained a good result from its annual surveillance

audit by International Accreditation New Zealand (IANZ).

Gastroenterology Services A significant amount of work had gone into increasing colonoscopy volumes,

internally and by outsourcing to Southland. Stroke Services A progress report provided by the Clinical Leader on Stroke Service

improvements was included in the Chief Operating Officer’s report. Action Point 447 Members asked that their appreciation be passed on to the Stroke Service and expressed a desire to be kept informed of future developments.

During discussion, members noted: That although overall performance was on target for the year, volumes for

Otago domiciled patients were not and IDF inflows were 32% ahead of plan year to date;

That the number of smokers in hospital entranceways had decreased. Chief Medical Officer’s Report (tab 4) The Chief Medical Officer’s report was taken as read. Chief Nursing & Midwifery Officer’s Report (tab 5) In presenting the Nursing & Midwifery Report, Mrs L Samuel, Chief Nursing & Midwifery Officer, highlighted the following items: The falls prevention project had been implemented across a number of floors

and one ward had achieved zero for January. This was a proactive quality project that would reduce the impact of injury, ACC claims and length of stay.

Frontline staff and at risk members of the public had been vaccinated in

anticipation of a second wave of H1N1. Seasonal influenza vaccination, including H1N1, would be actively promoted from 8 March.

Mrs L Samuel, Chief Nursing & Midwifery Officer, left the meeting at 3.30 pm.

8.0 PERFORMANCE REPORTS

The Committees considered the performance reports for January 2010 and noted the following points.

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KPIs and Activity Report (tab 6) The number of patients waiting greater than six months (KPI #12) had

increased but that was a usual trend during January.

Maternity volumes were not included in elective caseweights.

The areas that were over-delivering IDF electives were not under-delivering for Otago domiciled people, so IDFs were not driving elective under-delivery for Otago residents.

Financial Report (tab 7) In speaking to the financial report, Mr G Paris, Business Analyst, informed the Committee that the January result was a surplus of $4 million, which was favourable to budget by $450k. For the year to date there was a favourable variance to budget of $1.3m. Mr Paris outlined the major budget variances and answered members’ questions on these. It was agreed that the budget variances reported to the Committee could be changed to >$50k. Strategic Projects Report (tab 8) The strategic projects progress reports were taken as read. Clinical Group Reports (tab 9) The Committee reviewed the monthly Clinical Group reports and observed that the new format was more readable. Diagnostic & Support Services

Action Point 448 The Committee requested further information on the proposal to cease provision of a satellite physiotherapy clinic at Mosgiel and make changes to the Palmerston service.

Dr J B Adams left the meeting at 3.55 pm.

Emergency Medicine & Surgery Services Action Point 449 The Committee sought information on why the Orthopaedic Service was reluctant to provide its clinical threshold scoring tool to GPs so that they could determine the likelihood of a referral being successful, and whether this occurred in other DHBs.

Women’s Health, Children’s Health and Public Health Group Update

Members noted that the inadequacy of the NICU facility was likely to be highlighted again during the forthcoming accreditation audit.

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The Chairman advised that a communication had been received that funding for facility improvements would be available if the DHB improved its performance, so the DHB’s future was in its own hands.

Mrs L Samuel rejoined the meeting at 4.00 pm.

Information Group (tab 10) Members commented that the Information Group project reports were difficult to understand and reiterated their concerns about the projects being completed within budget. Action Point 450 The Committee requested:

That the Financial Team monitor the financial aspects of the Information Group projects closely, and

That future reports be less technical and focus more on the definition of outputs sought and progress against outputs.

Human Resources (tab 11)

The Committee noted the Human Resources Strategy update.

Building and Property Services (tab 12) The Chairman noted that the condition of the Physio Pool was deteriorating and commented that any capital work would have to be funded from attendance fees. Quality Improvement and Risk Management (tab 13) The Quality Improvement and Risk Management Report was noted. Moved Mr R J Thomson, seconded Ms M L Rosson, that the Executive and Operational Reports be noted.

Carried

9.0 ACTION SHEET The Committee reviewed the action sheet (tab 15). Information Services (Action Point 435-10/09) It was noted that the Committee had not been provided with a clear and budgeted implementation plan for Business Intelligence as requested. Moved Mr R J Thomson, seconded Ms M L Rosson, that the action sheet be noted.

Carried

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10.0 NEXT MEETING

Tuesday, 23 March 2010.

CONFIDENTIAL SESSION Moved Mrs S J Johnstone, seconded Ms M L Rosson, that the public be excluded from the meeting to consider the following agenda items:

General subject: Reason for passing this resolution:

Grounds for passing the resolution:

1. Confidential Minutes of 24 November 2009

2. Confidential Chief Operating Officer’s Report

3. Regional Procurement Report

4. Risk Register

5. Confidential Meeting Action Sheet

To allow activities to be carried on without prejudice or disadvantage

Commercial Sensitivity

S 34(a), Schedule 4, NZ Public Health and Disability Act 2000 – that the public conduct of this part of the meeting would be likely to result in the disclosure of information for which good reason for withholding exists under sections 9(2)(i) & (j) of the Official Information Act 1982, that is, the withholding of the information is necessary to enable a Minister of the Crown or any Department or organisation holding the information to carry out, without prejudice or disadvantage, commercial activities and negotiations.

Carried

The meeting closed at 5.25 pm. Certified as a true and correct record: Chairman: ___________________________ Date: ___________________________

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Chief Operating Officer’s HAC Report 1 Version 1 23rd March 2010

Chief Operating Officer’s Report February 2010 Recommendation That the Hospital Advisory Committee notes this report. Performance Contract Performance

Total activity for February (including IDFs and the adjustment for uncoded cases) is 13% behind plan and 2% behind year to date. Elective activity (including IDFs) is 14% behind plan for the month and 1% ahead of plan year to date. Acute activity (including IDFs) is 12% behind plan for the month and 3% behind plan year to date.

Acute IDF activity is 19% behind plan for February and 7% ahead of plan year to

date. Elective IDF activity is 2% behind plan for the month and 27% ahead of plan year to date.

Financial Performance

The Provider Arm produced a positive variance against budget for February of $453k. The year to date variance is positive by $1,751k.

Provider Arm revenue for February produced a positive variance against budget

by $509k and is positive by $2,431k year to date.

February expenses for the Provider Arm are negative against budget by $56k and negative by $679k year to date.

Operational Performance

There were 39 medical outlier bed days in February – the target is 30 bed days. The number of medical outlier bed days in February 2009 was 116

The readmission rate for February was 3.9% against a target of 4.5%. The

readmission rate for February 2009 was 3.4%.

Main Operation Theatre (MOT) utilisation in February was 89% against a target of 85%. The MOT utilisation rate in February 2009 was 86%.

The Staff turnover rate for February was 0.67% against a target of 1.2%. The

staff turnover rate for February 2009 was 0.87%.

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Operational Staff Vacancy Report Attached is a table outlining the number of FTE vacancies across the organisation as at 28th February 2010. This consolidated report includes the Joint Clinical Positions. (Attachment A). Caseweight Recovery Plan Attached is a spreadsheet outlining the caseweight activity along with a year end projection to achieve the DAP cwd target. Assuming all outsourcing can be achieved and all plans within the provider arm can proceed without interruption by staffing absences, infection outbreaks, industrial action or other unforseen events, we will achieve the target DAP caseweights by the end of June. (Attachment B). Most Supportive Employer The Otago District Health Board was one of four finalists in the New Zealand Army Territorial Force or Royal New Zealand Navy Reserve for the most supportive employer awards held on Wednesday 3rd March. Lieutenant-colonel Roger McElwain, commanding officer of the 4th Otago-Southland Battalion said the support of employers was invaluable because without it territorials and navy reservists would be unable to train. Employers were nominated by their employees. Ministry of Health Hospital Pharmacy Quality Audit Medicines Control undertook an audit of the Hospital Pharmacy on the 18th and 19th February on behalf of the Licensing Authority. The audit covered those parts of the Medicines Act and Regulations, Misuse of Drugs Act and Regulations and those Codes of Practice that relate to operation of a licensed pharmacy. The audit found that the Pharmacy met the licensing requirements. There were only ten audit points where the service did not fully meet requirements, each assessed by the auditors as low risk. The audit report has identified required actions to address the gaps. The service was congratulated by the auditors on the high quality of the service provided. MRT industrial action Otago District Health Board has received the following two strike notices from the union representing the Medical Radiation Technologists (MRTs): 1. Withdrawal of labour for all services between 1200 hours and 1400 hours on

Monday 15 March, Tuesday 16 March and Thursday 18 March. During this period the Radiology Department will be closed.

2. Withdrawal of labour for CT, MRI, DSA and Ultrasound during the following periods: 1700 hours Tuesday 16 March to 0800 hours Wednesday 17 March 1700 hours Wednesday 17 March to 0800 hours Thursday 18 March 1700 hours Thursday 18 March to 0800 hours Friday 19 March

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Contingency plans have been prepared with our focus being on minimising risk to patients and staff, as we manage demand and utilise available resources. The Employment Relations Act specifies a process for arranging cover with the union for “life preserving services” in situations where we are unable to allocate sufficient trained resource such as Emergency X-Ray, CT, MRI, Angiography and Ultrasound. However, some services during and prior to industrial action will need to be postponed. Patients have been contacted if their appointment has been effected. 53 patients have had radiology or mammography appointments rescheduled. 264 appointments will not be available if industrial action proceeds. Where possible procedures and appointments have been rearranged to enable continuation of patient activity for which there is no expected need for a radiological test during the period of industrial action. Provision of Physiotherapy Services at Mosgiel and Palmerston Satellite Sites The community (home based) physiotherapy service team has for some time provided clinic services at sites in Mosgiel and Palmerston. The position covering the Palmerston service is vacant, as a result of a resignation in November 2009, and the lease for the Mosgiel space is due to expire. A consultation process was initiated to explore alternative options to providing this service in the most cost effective way. As a result of this process, it has been determined that the Palmerston service should continue with a shift to provision of clinics twice a week. The service covers a wider geographical area with limited transport to Dunedin with no alternative provider available locally. It has also been decided that the referral criteria and the process for managing referrals is to be reviewed. With respect to the Mosgiel service, it has been identified that there is potential to improve linkage to primary care services in terms of devolution and development of physiotherapy (and some other allied health services) within the primary care sector. After consideration of the issues and feedback provided, an interim arrangement for the provision of a Mosgiel physiotherapy service has been agreed with the Taieri and Strath Taieri PHO on the following basis:

The PHO is providing the facility for the clinic (in the existing facility). Responsibility for provision of the service is being transferred to the physiotherapy

outpatient service. The rationale being to increase the operational and professional linkage with outpatient services and ensure alignment of referral process.

Development of access criteria to the Mosgiel clinic which ensures targeting in particular the >65 years of age patient and those where mobility limitations are a barrier to accessing the Dunedin based service. The criteria are being determined in consultation with therapists and referrers.

The Mosgiel clinic will be seen as a step in the treatment/rehabilitation process. It is recognised that the arrangement can only remain in place until the end of June when the single PHO is established. Prior to the end of June the following will be undertaken:

Establishment of referral criteria and evaluation of the impact upon patients who do not meet the criteria, patient numbers and resource required as well as the benefits to patients accessing the service.

Identify and progress options for an alternative service model which will require discussion with the PHO and potentially identification of a suitable facility.

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A small team has been established to implement the changes and evaluate the service consisting of GP Liaison, Clinical Coordinator Taieri and Strath Taieri PHO, Physiotherapy Professional Director and Unit Manager Allied Health Unit. Vivian Blake Chief Operating Officer Otago District Health Board 23rd March 2010

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Attachment A

Below is a summary of the open RFR forms as at the 28th February 2010 for the DHB. This report includes Joint Clinical (JC) positions.

Budget FTE

Specialist Medical Officer Made up of:

Jan 10 Vacant FTE

Feb 10 Vacant FTE

Status Report as at 28/02/10

Status report shows only the positions currently under offer and therefore do not tally against the open RFRs

JC

23.65 Anaesthesia 5.75 5.75 All 5.75 FTE vacancies have been appointed to with commencement dates between March and May 2010

2.70 Child & Family Mental Health 1.00 1.00 1.0 FTE commencing June 2010

2.20 Forensic Service 0.60 0.60 0.60 FTE expected to commence April 2010

9.00 General Medicine 2.00 1.00 1.00 FTE job offer currently underway

8.80 General Surgery 0.30 0.80 0.50 FTE appointed to February 2010 (RFR closed in March) 0.30 FTE to be closed off as no vacancy remaining.

0.90 Intellectual Disability Service 0.40 0.40 0.40 FTE expected to commence April 2010

0.50 Nephrology 0.50 0.50 0.50 FTE temporary contract (6 month) offered commencing April 2010 subject to registration processes

6.38 Obstetrics & Gynaecology 1.20 1.20 1.0 FTE commencing early April 2010. 0.2 FTE to be filled by increase in FTE of current staff

3.80 Ophthalmology 0.40 0.40 0.4 FTE expected to commence Jan 2011

2.30 Rheumatology 0.30 0.30 0.3 FTE expected to commence July 2010

0.55 School Dental Service 0.55 0.55 0.1 FTE is being subcontracted to Southland DHB

2.20 Adult Mental Health 1.80 1.30

1.51 Breast Care Services 1.50 1.50

3.40 Gastroenterology 1.30 1.30

1.00 Geriatric Services 1.00 0.30

2.00 Older Peoples Health 0.30 1.00

5.65 Haematology/Oncology 1.00 0

2.00 Neurosurgery 1.00 0

2.50 Public Health 1.10 1.00

9.16 Radiology 1.00 1.00

2.10 Rehabilitation Ward 0.90 0.90

2.30 Urology 0.30 0.30

Total SMO FTE 24.2 21.1

11.75 FTE

Staff Vacancy Report

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Budget FTE

Occupation Jan 10 Feb 10

2.60 MOSS 1.00 1.00

125.94 Registrars 5.25 4.25

95.67 Nurse Manager, Nurse Educator 3.10 4.10

702.55 Registered Nurse 25.74 29.625

97.63 Enrolled Nurses 1.30 1.30

5.11 Senior Midwives 0.60 0.60

26.91 Registered Midwives 1.06 0.66

92.35 Health Service Assistants 3.80 3.40

22.10 Dental Therapists 0.20 0.20

47.80 Occupational Therapists 0.50 2.00

8.97 Speech Therapists 1.00 0

19.30 Therapist Aids/Assistants 1.20 0.20

21.33 Other Therapists 0.70 0.70

29.76 Health Promotion Officers 3.25 2.75

15.61 Community Support Works 0 3.60

35.76 Psychologists 2.20 1.70

11.55 Social Workers 1.00 0

11.30 Pharmacists 0.10 0.10

75.87 MRTs & Sonographers 4.40 6.00

52.24 Technicians 2.25 0.55

7.44 Dietitians 1.50 1.50

7.47 Hearing/Vision testers 0.80 0

7.50 Scientific Officers and Research 1.00 1.00

7.60 Cooks 0.50 0.50

49.43 Kitchen Assistants 1.05 2.65

16.00 Security Patrolmen 3.20 3.20

4.12 Electricians 1.00 1.00

21.04 Sterile Supply Assistants 0 1.00

5.77 Executive 0.50 0.50

62.47 Managers 2.00 4.00

15.43 Supervisors 1.00 1.00

60.63 Professional Staff 2.00 2.80

226.44 Admin, Clerical & Secretarial Staff – Clinical

4.40 5.725

99.17 Admin, Clerical & Secretarial Staff – Non-Clinical

1.30 2.30

Grand Total 103.12 111.01

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Annual Year End Actual Plan Var Actual Plan Var Plan Projection

PUC Purchase Unit DescriptionD01.01 Inpatient Dental treatment (DRGs) 0 0 0% 0 0 0% 0 0.00M10.01 Cardiology - Inpatient Services (DRGs) 25.59 35.32 -38% 195.63 251.03 -28% 379.77 380.00S00.01 General Surgery - Inpatient Services (DRGs) 132.23 175.78 -33% 1396.71 1311.01 6% 2,014.12 2307.00S05.01 Anaesthesia 0 0.00 0% 0.71 0.00 100% - 1.00S15.01 Cardiothoracic - Inpatient Services (DRGs) 31.97 56.46 -77% 340.57 451.71 -33% 677.83 522.00S25.01 Ear, Nose and Throat - Inpatient Services (DRGs) 70.81 62.98 11% 556.28 450.97 19% 702.88 846.00S30.01 Gynaecology - Inpatient Services (DRGs) 39.72 48.02 -21% 374.01 343.89 8% 535.99 602.00S35.01 Neurosurgery - Inpatient Services (DRGs) 11.85 22.64 -91% 133.69 160.99 -20% 251.54 190.00S40.01 Ophthalmology - Inpatient Services (DRGs) 18.01 30.82 -71% 191.76 246.57 -29% 370.00 300.00S45.01 Orthopaedics - Inpatient Services (DRGs) 179.32 229.71 -28% 1360.66 1649.42 -21% 2,489.03 2217.00S55.01 Paediatric Surgical Services (DRGs) 3.39 6.69 0% 30.98 47.65 -54% 72.23 65.00S60.01 Plastic & Burns - Inpatient Services (DRGs) 15.33 0.00 100% 109.64 0.00 100% - 185.00S70.01 Urology - Inpatient Services (DRGs) 41.01 40.98 0% 340.77 296.03 13% 459.93 554.00S75.01 Vascular Surgery - Inpatient Services (DRGs) 0 0.00 0% 0 0.00 0% - 0.00

569.23 709.4 -25% 5,031.41 5,209.25 -4% 7,953.32 8,169.00


PUC Purchase Unit DescriptionD01.01 Inpatient Dental treatment (DRGs) 0.89 0.91 0% 13.47 7.36 45% 0 17.00M10.01 Cardiology - Inpatient Services (DRGs) 21.38 7.60 64% 168.76 61.28 64% 106.46 210.00S00.01 General Surgery - Inpatient Services (DRGs) 3.2 6.98 -118% 40.55 56.29 -39% 87.30 85.00S05.01 Anaesthesia 0 0.00 0% 0.00 0.00 0% 0.00 0.00S15.01 Cardiothoracic - Inpatient Services (DRGs) 0 0.80 0% 5.38 6.45 -20% 10.00 10.00S25.01 Ear, Nose and Throat - Inpatient Services (DRGs) 0.73 3.44 0% 8.34 27.77 -233% 43.06 15.00S30.01 Gynaecology - Inpatient Services (DRGs) 6.44 1.36 0% 24.31 10.94 55% 16.96 38.00S35.01 Neurosurgery - Inpatient Services (DRGs) 0 4.43 0% 22.1 35.70 -62% 55.37 50.00S40.01 Ophthalmology - Inpatient Services (DRGs) 4.73 3.22 32% 36.55 25.97 29% 40.28 48.00S45.01 Orthopaedics - Inpatient Services (DRGs) 5.17 4.18 0% 48.92 33.73 31% 52.31 75.00S55.01 Paediatric Surgical Services (DRGs) 3.91 2.65 32% 39.1 21.38 45% 33.16 55.00S60.01 Plastic & Burns - Inpatient Services (DRGs) 2.28 2.98 -31% 19.87 24.03 -21% 37.26 40.00S70.01 Urology - Inpatient Services (DRGs) 0 2.37 0% 14.51 19.09 -32% 29.61 30.00S75.01 Vascular Surgery - Inpatient Services (DRGs) 0 9.92 0 0 15

48.73 40.93 16% 451.78 330.00 27% 511.78 688.00


PUC Purchase Unit DescriptionD01.01 Inpatient Dental treatment (DRGs) 4.55 10.58 0% 49.02 84.67 0% 127.00 127.00M10.01 Cardiology - Inpatient Services (DRGs) 0 0.00 0% 0 0.00 0%S00.01 General Surgery - Inpatient Services (DRGs) 0 46.83 0% 0 374.67 0% 562.00 100.00S05.01 Anaesthesia 0 0.00 0% 0 0.00 0%S15.01 Cardiothoracic - Inpatient Services (DRGs) 0 0.00 0% 0 0.00 0% - S25.01 Ear, Nose and Throat - Inpatient Services (DRGs) 0 0.33 0% 28.93 2.67 0% 4.00 148.00S30.01 Gynaecology - Inpatient Services (DRGs) 0 0.00 0% 0 95.50 0% 143.25 0.00S35.01 Neurosurgery - Inpatient Services (DRGs) 0 11.94 0% 0 0.00 0% - S40.01 Ophthalmology - Inpatient Services (DRGs) 0 0.00 0% 0 0.00 0% - S45.01 Orthopaedics - Inpatient Services (DRGs) 5.11 0.00 0% 5.11 0.00 0% - 68.64S55.01 Paediatric Surgical Services (DRGs) 0 0.00 0% 0 0.00 0%S60.01 Plastic & Burns - Inpatient Services (DRGs) 0 0.00 0% 0 0.00 0% - S70.01 Urology - Inpatient Services (DRGs) 0 0.00 0% 0 0.00 0%

9.66 69.6875 0% 83.06 557.50 0% 836.25 443.64


PUC Purchase Unit DescriptionD01.01 Inpatient Dental treatment (DRGs) 5.44 11.50 0% 62.49 92.03 -47% 127.00 144.00M10.01 Cardiology - Inpatient Services (DRGs) 46.97 42.92 9% 364.39 312.31 14% 486.23 590.00S00.01 General Surgery - Inpatient Services (DRGs) 135.43 229.59 -70% 1437.26 1741.97 -21% 2663.42 2492.00S05.01 Anaesthesia 0 0.00 0% 0.71 0.00 100% 0.00 1.00S15.01 Cardiothoracic - Inpatient Services (DRGs) 31.97 57.26 -79% 345.95 458.16 -32% 687.83 532.00S25.01 Ear, Nose and Throat - Inpatient Services (DRGs) 71.54 66.75 7% 593.55 481.40 19% 749.94 1009.00S30.01 Gynaecology - Inpatient Services (DRGs) 46.16 49.38 -7% 398.32 450.33 -13% 696.20 640.00S35.01 Neurosurgery - Inpatient Services (DRGs) 11.85 39.00 -229% 155.79 196.69 -26% 306.91 240.00S40.01 Ophthalmology - Inpatient Services (DRGs) 22.74 34.04 -50% 228.31 272.54 -19% 410.28 348.00S45.01 Orthopaedics - Inpatient Services (DRGs) 189.6 233.90 -23% 1414.69 1683.15 -19% 2541.34 2360.64S55.01 Paediatric Surgical Services (DRGs) 7.3 9.34 -28% 70.08 69.03 2% 105.39 120.00S60.01 Plastic & Burns - Inpatient Services (DRGs) 17.61 2.98 83% 129.51 24.03 81% 37.26 225.00S70.01 Urology - Inpatient Services (DRGs) 41.01 43.34 -6% 355.28 315.12 11% 489.54 584.00

627.62 820.01 -31% 5,556.33 6,096.75 -10% 9,301.35 9,285.64 0%

Total Otago DHB Population viewFebruary Year to Date

Contracted Out CaseweightsFebruary Year to Date

February Year to Date

Provider Arm Caseweight ActivityFebruary Year to Date

IDF Outflow Caseweights

Attachment B

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1

Chief Medical Officer – February 2010 Recommendation That the Hospital Advisory Committee notes this report

Excerpts from the Monthly Quality Improvement Committee Report to the Clinical Board held on 24th February 2010. Safe Environment & Practices Group (SE&PG) Hazardous Substances & New Organism’s (HSNO) - The NZ Chemical Industry Council undertook an audit of the organisation during the week of 21 September 2009. The report notes that there has been good work done to date, however a qualified and experienced HSNO Coordinator should be employed for any further progress. Oversight of EQuIP 3.2.5 – three gaps have been identified: - (a) – there is an organisation-wide security policy: a draft security policy has been developed by the Security Service and is currently under review by the SE&PG. It will be sent out for wider consultation in mid-February 2010. - (c) – there is an organisation-wide violence and aggression prevention programme: Human Resources are working on this action. - (d) – service planning includes strategies for security management: this action will be looked at once the security policy has been developed. Lower Ground Floor Loading Dock - The loading dock area is now much improved and safer following the implementation of the new processes for goods arrival and dispatch and the refurbishments made to the compactor area. However damage is occurring to the clean dock with increased traffic, so the area and flow is to be reassessed. Restraint Minimisation Group Most of the restraint documents on MIDAS have been updated or withdrawn. Members of the group continue to work on this project. The De-escalation training is now part of mandatory training and a link is on the intranet so that updates can be done in the same manner as fire training refresher. Product Evaluation Committee Woundcare Contract: Group is to get together to go through the products on the new national contract and agree which products from each product class will be stocked in Otago and Southland. Woundcare product EXPO to be organised after that to make everyone aware of what is to be purchased and what is not. Infection Prevention and Control (IPC) Committee Hand Hygiene Project: The hand hygiene project is going well and so are the area audits. We recently attached gel onto beds which will make hand hygiene easier. “My 5 Moments of hand hygiene” will be promoted shortly at the upcoming IPC reps training days. This approach recommends health-care workers to clean their hands:

1. before touching a patient, 2. before clean/aseptic procedures, 3. after body fluid exposure/risk, 4. after touching a patient, and 5. after touching patient surroundings.

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Staff Influenza Vaccination Campaign: Vaccinations – will be reported through Staff Occupational Health as they are leading the campaign this year with continued support from the IPC team. Incident Review Committee Incident Trends from the September – December 2009 quarterly report: Total incidents reported have decreased slightly; Staff injuries have decreased with a corresponding decrease in severity; The Falls Project has made a positive impact on falls incidents; Staffing issues are up however the committee felt that more were being reported. Update of the Incident Management System: Ensuring the organisations policy and procedure is in line with the National Incident Management Policy is nearing completion; The incident brochure for patients and staff has now been finalised; The Incident Poster for wards/services has been finalised. It is expected that these will be displayed in every ward/service throughout the organisation. Hospital Transfusion Committee 1. Haemovigilance: Specimen labelling Dunedin Hospital: 13 month error rate: 5.4% specimens with one or more error; (slow upward increase). Re-bleed rate for the past 13 months is relatively stable at 1.9%. November 09 and January 2010 had marked increase. No wrong-blood-in-tube (WBIT) occurred during 2009, an excellent result. 13 month WBIT rate is <1: 3614 specimens. Adverse Events The updated reaction form has been introduced to ODHB. Good uptake noted. 2. Policy: Green form: under re-development to address all audit points. For test-run after EQuIP 4 audit. Warfarin reversal protocol reviewed. Aligned to Australasian guidelines. HTC review currently. 3. Audit: NZBS Anti-D Audit completed. Report underway.

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ODHB and SDHB audit of Prothrombinex-VF use and compliance to guidelines near completion. Overnight Transfusion Audit to commence in March 2010.

Emergency Planning

Fire Wardens: Building and Property have completed an up to date register of fire wardens throughout the organisation. There are approximately 400 within the DHB. A folder with the area each warden covers has been created and will be kept up to date. Kylie Machin has been recently appointed as a Fire and Security Coordinator and she will continue to work on this project with updating training for wardens.

Group Reports Emergency, Medicine and Surgery Group Incident Issues: It has been noted that there are an increasing number of incidents coming through the system that are related to staffing numbers on shifts compared with the need when patient numbers are high or patients are particularly acute. This may not reflect an increase in the actual number of such occurrences but rather an increase in reporting and attention given the establishment of the partnership work plan between the DHBs and the NZNO regarding safe staffing. The trends are being reported through the Joint Action Committee A further issue has arisen regarding the lack of familiarity of both junior and senior medical staff of the incident system, how to investigate incidents and how to manage the administration of the system to record findings and close incidents. Whilst training for junior staff could be established within the orientation for these staff, how to address the issue re senior staff needs consideration, particularly when the Open Disclosure Policy is implemented. Women’s Children and Public Health Services Patient / Client Satisfaction: The NICU 3 monthly survey has once again identified facilities as the main concern from families whilst complimenting the superb care from staff. A good response has been received by Primary Health to a survey of Early Childhood providers. Diagnostics and Support Services Group Infection Prevention & Control: The Infection Prevention & Control Programme is being updated and the Infection Prevention & Control Committee Terms of Reference are being reviewed. Certification & Accreditation: Diagnostics - International Accreditation New Zealand (IANZ) will be auditing Radiology in February 2010. Team or Quality Projects / Initiatives: Change to the scheduling of some ultrasound referrals is being evaluated as part of the modality review, with the expectation of increasing capacity within existing resources. In addition the referral process and criteria for abdominal and pelvic ultrasounds is being reviewed in conjunction with General Practitioner support. Clinical Support: The Community Occupational Therapy team wait list has 13 patients on it, continuing the trend of having less than 20 patients waiting. Infection Prevention & Control have completed an audit in CSSD and TSSU for compliance against AS/NZS 4187 Standard for cleaning, disinfection and sterilisation of instruments and medical equipment. The previous audit was completed in 2006 and the result of the current audit shows an increase of compliance in both departments, reflecting the substantial gains around the implementation of quality systems and the generic practice and those systems being maintained.

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Service Development & Support Services: - Vehicle utilisation is to be evaluated over a 5 week period utilising a Global Positioning System data capture, in conjunction with Southland DHB. The purpose is to enable review of both the allocation of vehicles across services and the general pool and ensure that leased vehicles are utilised effectively. - Implementation of the changes to Security Service rostering, following review of the service, commenced in December. Food Services: - A new staff café menu is being introduced, providing healthier options. The first stage is the new sandwich range, which includes vegetable wraps, low fat sandwiches and a variety of new breads. Risk Issues: Diagnostics - Following a mammography machine failure in Invercargill in January, the service was unable to screen for 6 days. This has impacted on the planned catch-up for Invercargill recall women and waitlist list numbers. The service has ceased inviting new women in the interim until all recall appointments have been made. The sustainability of the Breast Screening service and ability to meet contract volumes are a risk due to the ability to retain and recruit clinical staff. Active recruitment is ongoing and agencies are being contacted regarding the availability of locums. Wait time for non urgent abdominal and pelvic ultrasound and MRI. Modality reviews are underway in both specialties. A revised booking schedule is being evaluated for ultrasound and the referral pathway is being reviewed. Mental Health and Community Group Health and Safety Issues:

There are continuing issues regarding storage space for psychiatric records. The service business case for the outsourced storage of psychiatric records has been incorporated in the organisation-wide business case which has not been approved as yet. In the

Team or Quality Projects / Initiatives:

Development of Telephone Triage Guidelines.

District Nursing Handbook has been published and distributed to GPs.

Clinical Supervision – Review of process.

Administration of SAC 1 and SAC 2 incident processes are being centralised within Mental Health.

The Safe Environment Project is progressing well.

Clinical Director Appointments Dr Marion Poore, Clinical Director Public Health I am very pleased to announce the appointment of Marion Poore as Clinical Director Public Health. Marion Poore completed her undergraduate medical training at the University of Otago in Dunedin. She has specialist qualifications in both General Practice and Public Health Medicine. After working in several rural and urban Otago practices she moved to Pukekohe, South Auckland where she was a GP from 1986 to 1999. During this time she was active in primary care obstetrics, school health clinics, long stay geriatric care and palliative care and Police forensic examinations for victims of sexual assault. In 2000, she returned to Dunedin to complete specialist training as a public health physician and has worked at Public Health South since 2004. As well as day to day public health medicine practice she has been closely involved in planning and leading the health

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response to community wide disease outbreaks across both Otago and Southland, and developing a regional public health service with reorientation of the workplan to outcome focused practice. She currently leads a group of public health physicians in strengthening the national and local alcohol harm reduction programme. Marion sees the key public health issues as being:

threats from emerging communicable diseases including antibiotic resistance and healthcare associated infections;

reducing demand for health care services from chronic illness associated with tobacco, alcohol, physical inactivity / overweight and poor mental health;

health impacts from environmental issues such as declining water quality and air quality and their relationship to climate change;

improved co-ordination of health care services with integration across the spectrum of population health services, primary care services and hospital level services.

Dr Stephen Chalcroft, Clinical Director Rehabilitation and Older People’s Health I am also very pleased to announce the appointment of Stephen Chalcroft as Clinical Director for Rehabilitation and Older People’s Heath. Stephen completed his undergraduate training in Auckland. He has worked in Auckland and also previously at Wakari Hospital where he held the position of Clinical Director (Care of the Elderly). Stephen has an active interest in clinical audit and in the evidence-based approach to medicine. He is active in the Older Peoples’ Health Field of the Cochrane Collaboration. He has previously carried out detailed audit of the practice of “Swallowing Assessment” in conjunction with “Modified Barium Swallows” at Wakari Hospital (1994) and he completed a detailed observational survey (with partial audit) on a cohort of “Social Relief” at Wakari Hospital (1994). In Waitemata District Health Board (WDHB) he was involved in the development of an orthogeriatric service and was also involved in the “Stroke steering group” which worked towards a higher standard of organised stroke care (both for acute and rehabilitation services). Stephen is keen to develop a close linkage of rehabilitation to the acute stroke unit at Otago DHB. Stephen was involved in setting up standards for audit with regard to junior medical staff drug prescribing and had the only database in WDHB on error trends in prescribing on patient discharge from Assessment Treatment & Rehabilitation wards. Stephen has promoted better assessment processes for junior medical staff. Allied to this initiative is a plan to provide a specific syllabus for this group as an indication of the “core” activities that they should have completed at each stage of their training years and has taken an active interest in the problem of “handover” particularly as it relates to serious incidents and risk management. Stephen has an interest in the concept of advance directives and decision making around Do Not Attempt Resuscitation orders. He promoted a review in 2006 of assessments of “competency and testamentary capacity” within his service and commenced reviews of the use and misuse of EPOAs (Enduring Power of Attorneys) in his patient groups.

ePrescribing/eAdministration Pilot

Start Date: Jan-10

Target Date:

% Complete: 21

Projected Finish Date: Dec-10

Progress this month: The major effort within the pilot over the last reporting period has been in preparing, and

executing, the Implementation Planning Study (IPS) with our vendor. The purpose of an IPS

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is to collect all the information necessary to prepare an Implementation Plan for Med Chart

into the pilot area. Activity during the IPS included sessions with Clinical & Nursing Staff

from the pilot area, Nursing staff from the Emergency Department, Pharmacy staff,

Information Systems staff & Quality Service staff to ensure that a rounded perspective of all

the components that go into a solution are taken into account.

These sessions did highlight some issues for which we have not yet clearly identified

resolutions (e.g. Medical patients waiting in ED and Administration of Medications in ED)

and for which we need to concentrate on understanding so we deliver potential options back

to the areas concerned for consideration using the appropriate professional structures. The

IPS also highlighted the necessity to utilise previous implementation experience from

successful sites in Australasia which had been highlighted by the Project Board in their

February meeting.

A baseline audit of the computer hardware in the pilot area has highlighted a potential

shortage of equipment when we go-live, and for which we have already planned, &

budgeted for, additional devices.

A process mapping expert has mapped the Medication Administration & Acute Prescribing

processes to give the pilot a better understanding of the impact any potential changes

proposed would have on current process.

Participation in collaboration meetings with Safe Medication Management and other pilot

sites by the Clinical Leader & Project Manager has been undertaken and standards are

being developed out of this work.

Financial Status: Budget: The budget for this project is $642,244 as approved by the Board of Directors and funded by the Safe Medication Management Programme. Actual: Actual costs to date include Implementation Planning Study (50% on order). Variance: There is no variance to report against as the project costs are currently running to budget. Committed: The project has a committed expenditure of $26,087 against budget to date. Project Progress from Previous Months: Top Risks:

Administration of Medications in ED for admitted patients

Lack of ownership/knowledge within DHB regarding pilot, its aims and what is happening

Resolution: ED frequently have patients admitted

who are destined for Internal Medicine wards but cannot be directly sent to the ward so are held in ED. This requires the ED nurses to be trained to use the electronic system to administer those medications that the patient is due while in ED. This complicates the training approach by adding another 70 staff.

Pre-pilot consultation with Provider Arm, Clinical & Nursing governance

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Electronic Signatures waiver not

available by projected pilot go-live date (Jul-10)

layers to ensure knowledge is distributed and process is clearly understood. Additional consultation with unions representing potentially affected staff underway via Human Resources.

Escalation via Safe Medication Management who are handling the issue. Request CEO input to exert more understanding of the urgency of the issue at Ministry level if progress stalls.

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Regional Chief Nursing & Midwifery Officer HAC Report March 2010

Regional Chief Nursing & Midwifery Officer – March 2010 Recommendation That the Hospital Advisory Committee notes this report

Please note nursing KPI’s attached for your information and dashboard for your information. SAFE STAFFING / JAC ACTIVITY

SSHW/OJAC – National demonstration sites x3 pilots underway, and we will explore findings and their application for Otago from April 2010 – particularly around nursing production planning. Tools for gathering data that supports clinical decision making such as integrated rosters, patient acuity, patient forecasting activity etc are currently not developed or available in Otago for operational use by Charge nurses at this time. Such tools allow opportunity for efficiency gains, safe staffing and improved patient outcomes which are required for contemporaneous patient care in the immediate future. It is hoped that a new business intelligence suite of reports will assist with this requirement in the future.

CLINICAL PRACTICE / EDUCATION 2009 Year in Review (demonstrates work undertaken either directly or with significant

involvment by the Nurse Director team) Practice Improvements Falls – implemented program Emergency planning strengthening and CIMs training implemented. Early Warning Score System rolled out to clinical areas IV Guidelines updated Trachy response team implemented Workforce development Nurse Practitioner Development team and education undertaken Recruitment: NETP, CAP, Filtering, Interviews all ongoing and successful Mental Health New Grads new process with Te Pou worked through Teaching: Med School, Polytechnic, General Forums RN, RM ED: Clinical Nurse specialists appointments made ICU clinical associate charge nurse Secondary and Tertiary Midwifery Course-complex care commenced Knowledge Centre New Entry to Practice programs remain successful Clinical Training Agency programs over $500k led and facilitated Otago Clinical Skills Lab development Professional Development Recognition Program ongoing Acute &Critical Care Course delivered Library partnership with Auckland University and 12 other DHB’s going through MOH bid process for Nursing access to databases and online educational resources Resource Utilisation Safe Staffing Healthy Work Place: Fire Fighting, Relationship building with NZNO Gastro dept nursing review Day Hospital review 7B Cardio thoracic step down change in model of care District nursing review Nursing and Midwifery Leadership Credentialing process i.e. nursing council and CTA reviews completed successfully Group Manager and Nurse Director clinical governance engagement and communication around joint decision making and improvements occurring i.e. regular meetings Midwifery Director role in place but needs sorted definitively Competencies & performance issues: Eleven staff members actively managed

30

Regional Chief Nursing & Midwifery Officer HAC Report March 2010

Triumvirate input for service operations Human Resources usual recruitment/retention Relationship management HDC/SAC’s/Incidents: Lead/Input/Change in Practice Recommendation Support/Coaching/Mentoring/Mediation for various staff International Nurses/Midwives Day celebration National Reps on many committees Consultations for other DHB’s i.e. Southland Medical ward Organisation-wide activities supported or led H1N1 leadership Noro outbreak leadership Stroke Project Call Bell roll out of new system Bed Sides procurement Primary Care Nursing support for PHO nurses ED 6 hour target program Hand washing program Reward and recognition program Graseby IV device Transition Glucose meters transfer Emergency Equipment standardisation Seasonal vaccination delivered Restraint Models of Care SLT – 8th floor Baby Friendly Hospital implementation Allied Health Review

Leanne Samuel Regional Chief Nursing & Midwifery Officer

31

March 2010

STRATEGIC GOALS:

1.0 Nursing and Midwifery Workforce

High performing nursing and midwifery workforce able to effectively contributes to meeting the health needs of the community.

2.0 Nursing and Midwifery Practice/Professional Standards

Professional excellence and safety in Nursing and Midwifery practice delivering optimal frontline care and maximising the potential of the nursing workforce.

3.0 Nursing and Midwifery Resource Utilisation

Effectively deployed, managed and supported Nursing and Midwifery Resource able to meet the service needs.

4.0 Nursing and Midwifery Governance and Leadership

Clinical governance and leadership roles and responsibilities are upheld professionally and within the wider organisations structures and functions within the multidisciplinary and management teams

PROGRESS

KEY PROJECTS / ACTIVITY AREAS 2010

Sco

pin

g

Beh

ind

On

Tra

ck

Co

mp

lete

d

COMMENT

1.0 Workforce development

1.1 NETP and NETP expansion and MFYOP

Ongoing new cohorts started in February

1.2 PDRP uptake

1.3 CTA program access/uptake Waiting list for access to programs on both sites

1.4 Nurse Practitioner development program

Workshops planned in Otago and Southland DHB’s went very well increasing interest in NP roles

1.5 Access to course conference support Exploring Clinical Nurse specialist course conference support for Otago

1.6 Unregulated worker orientation/ education

O

S

1.7 Management and Leadership development for Senior nurses

Aligns to HR program and possibly CTA funding for nursing and midwifery. Ideally a local program for the region to be sourced in 2010 or 2011

2.0 Nursing and Midwifery Practice

2.1 Clearly demonstrated integration of Evidenced based practice

Needs ongoing evaluation

2.2 Contemporaneous models of care are delivered and evaluated continuously

As above-recent independent reviews held in Gastro- enterology (Otago) and Medical ward (Southland). Recommendations being actioned

2.3 Quality and HR processes and Policy, Procedure Alignment

Recruitment and retention strategies aligned, gaps identified; and approval processes complied with

2.4 Regulatory Compliance

Compliance Nursing and Midwifery councils of New Zealand re APCs, education programs etc

3.0 Nursing and Midwifery Resource Utilisation – this is in the context of production, planning, value for money initiatives, models of care development, clinical leadership, expert opinion, audit, culture, organisational systems/relationships, District Annual Plan delivery

3.1 Safe Staffing and Healthy Workplace

3.1.1 Patient Forecasting

-how many?

-what type?

-when?

-specific needs?

-required outcomes?

Project briefing and scoping yet to be undertaken, nor project management resource identified. Aligns to national SSHW demonstration site pilot work due for completion in April 2010.

Also aligns to Business Intelligence project roll out

Nursing and Midwifery Dashboard-OSDHBs

32

-cost?

3.1.2 Matching resources

-how many staff?

-what skill set required?

-where?

-with what resources?

-what is the available budget?

As above

3.1.3 Resource provision

-Right number of staff?

-Right type?

-Right skill mix?

-Right skills

-Right environment

-Right time?

-Right resources?

As above

3.1.4 Service Delivery

-Safe

-Effective

-Appropriate

-Timely

-Sustainable

-Flexible

-Responsive

Establishing targeted tool kit sourcing strategy for senior nurses use on a shift by shift basis

-Capacity planning tools (prospective)

-Integrated roster and bed management alignment electronically

-Business Intelligence reporting platform-live time

4.0 Nursing and Midwifery Governance and Leadership

4.1 Clinical Governance, clinical leadership on the ground

O

S

Clinical Governance review and structure in place SDHB Putting the patient first, OPJ, value for money related projects for ODHB

Projects/Practice Development Initiatives

Falls

S

O Falls material from Otago to be shared with Southland key groups

in Feb 1010

Early Warning Scores (Otago)/

Ups (Southland)

Evaluations of both sites progress underway

Clinical –Key performance indicators

Failure to rescue EWS (Otago) UPS (Southland) project being audited for improved rescue rates

Falls S

O

Being rolled out on a number of floors at Dunedin Hospital. Now being scoped for Southland Hospital

Pressure Injuries Not yet commenced

Health care associated infection

HAI data captured and reported via infection prevention and control

33

29.00

KEY PERFORMANCE INDICATORS

CLINICAL QUALITY Nov-08 Nov-09 Target Var Actual Target Var PERFORMANCE Nov-08 Nov-09 Target Var Actual Target Var

Specials & Watches (Hrs) 879.00 657.50 8334.00

NURSING FTE Feb-09 Feb-10 Target Var Actual Target Var NURSING FTE Feb-09 Feb-10 Target Var Actual Target Var

Nursing FTE (2) 638.0 649.3 725.1 75.9 728.0 725.1 (2.8) Nursing FTE - Child Health 41.3 45.6 48.4 2.8 52.9 48.4 (4.5)

% Sick Leave 3.2% 3.4% 3.0% (12.6%) 4.1% 3.0% (38.3%) Nursing/Midwifery FTE - QMMC 31.0 31.5 34.2 2.7 36.9 34.2 (2.7)

% Sick Leave - Child Health 4% 3.7% 3.0% (22.2%) 4.3% 3.0% (42.8%)

NURSING FTE Feb-09 Feb-10 Target Var Actual Target Var % Sick Leave - QMMC 1% 2.7% 3.0% 11.3% 3.6% 3.0% (19.7%)

Nursing FTE - Critical Care 77.1 76.6 85.3 8.7 86.8 85.3 (1.5)

Nursing FTE - Emergency Internal Medicine 69.1 72.3 80.4 8.2 80.8 80.4 (0.3)

Nursing FTE - Surgery 51.8 51.1 59.7 8.6 59.4 59.7 0.2

Nursing FTE - Oncology/Renal/Cardiology/Respiratory 65.1 65.2 72.4 7.2 72.6 72.4 (0.2)

Nursing FTE - Specialist Surgery 54.8 59.0 68.0 9.0 65.6 68.0 2.4

% Sick Leave - Critical Care 2.5% 3.3% 3.0% (8.8%) 4.4% 3.0% (45.8%)

% Sick Leave - Emergency Internal Medicine 4.3% 3.7% 3.0% (23.5%) 4.6% 3.0% (54.3%)

% Sick Leave - Surgery 4.1% 2.9% 3.0% 4.3% 4.3% 3.0% (42.4%)

% Sick Leave - Oncology/Renal/Cardiology/Respiratory 2.7% 4.0% 3.0% (32.4%) 4.0% 3.0% (34.8%)

% Sick Leave - Specialist Surgery 2.9% 2.4% 3.0% 20.8% 4.2% 3.0% (38.9%)

KEY

(1) Excludes ICU & Ward 7B(2) Includes all inpatient wards as well as ED, EPS, MOT, DSU, & ISIS Community Nursing(3) This figure differs from the organisational Balanced Scorecard as it is based on an average of 3 census periods per day

Month Year to date Month Year to date

N/A Not availableU/D Under Development

Feb-10

Prepared by The Reporting Team

34

44.00

KEY PERFORMANCE INDICATORS Month Year to date Month Year to date

CLINICAL QUALITY Feb-09 Feb-10 Target Var Actual Target Var DELIVERY QUALITY Feb-09 Feb-10 Target Var Actual Target Var

Readmission Rate 3.4% 3.9% 4.5% 14.3% 4.3% 4.5% 3.7%Overall Inpatient Satisfaction - Quarterly(Good & Very Good) -Quarter 2

97.65% 88.64% 90.0% (1.5%) 87.57% 90.00% (2.7%)

Unplanned Readmission to ICU (Surgery) 1 0 0 0 9 0 (9) Staff Turnover % (FTE Basis) 0.87% 0.67% 1.2% 43.9% 4.74% 9.60% 50.6%

Caesarean Section Rate 31.5% 39.5% 28.0% (40.9%) 32.9% 28.0% (17.5%) Sick Leave % 2.47% 2.83% 3% 5.7% 3.15% 3% (4.9%)

Hospital-Acquired S. Aureus Bloodstream Infections 0.10 0.05 0 (0.05) 0.09 0 (0.09) ED Triage - Priority 1 100% 100% 100% 0% 100% 100% 0%

Medical Outlier Days 116 39 30 (9) 940 240 (700) ED Triage - Priority 2 56.4% 64.0% 80% (20.0%) 60.2% 80% (24.7%)

Surgical Outlier Days 16 37 30 (7) 222 240 18 ED Triage - Priority 3 40.7% 52.1% 75% (31%) 39.0% 75% (48%)

Paediatric Admits to Adult Wards 9 27 0 (27) 141 0 (141) Average number of working days to resolve complaints 15 20 15 (32%) 19 15 (27%)

Outpatients Number Waiting > six months on the waiting list

192 137 0 -137 137 0 -137

InpatientsNumber Waiting > six months

190 225 0 -225 225 0 -225

PRODUCTIVITY Feb-09 Feb-10 Target Var Actual Target Var FINANCIAL PERFORMANCE Feb-09 Feb-10 Target Var Actual Target Var

ALOS Med_Surg Only 4.35 4.70 4.5 (4.5%) 4.84 4.5 (7.5%) WIES11A Caseweight Volumes (Based on month end coding) 2,208 2,331 2,742 (15.0%) 20,923 21,458 (2.5%)

Resourced Occupancy 87% NYA 85% NYA NYA 85% NYA Outpatient FSA Volumes 1,935 2,186 2,129 2.7% 15,024 15,636 (3.9%)

Elective Theatre Utilisation (MOT) 86% 89% 85% 4.7% 87% 85% 2.4% Outpatient FU Volumes 4,656 5,084 5,209 (2.4%) 39,648 38,817 2.1%

Day Surgery Utilisation (DSU) 80% 78% 85% (8.2%) 77% 85% (9.7%) Emergency Dept attendances 2,713 2,966 2,500 18.6% 24,102 20,000 20.5%

Elective Daycase Rate 75% 74% 77% (4.1%) 72% 77% (6.8%) FTEs 2,368 2,418 2,489 2.8% 2,408 2,493 3.4%

Outpatient DNA Rate FSAs 6.7% 6.9% 5% (38.0%) 8.1% 5% (62.1%) Number of staff with Annual Leave > 300 hours NR 97 0 (97) 97 0 (97)

Outpatient DNA Rate Follow Ups 7.7% 8.3% 5% (66.3%) 8.4% 5% (68.3%) Operating Result ($000, +ve is surplus) 1,048 3,290 2,837 453 13,723 11,971 1,752

Outpatient DNA Rate - Maori FSAs 15% 11% 5% (117%) 17% 5% (235.1%) Personnel Costs($000) 14,710 15,381 15,185 (196) 129,304 129,136 (168)

Outpatient DNA Rate - Maori Follow Ups 19% 17% 5% (231%) 17% 5% (230.6%) ACC Revenue ($000) 518 531 552 (21) 4,359 4,564 (205)

Overall Average Case Weight (WIES11A) 1.26 1.07 1.20 11.0% 1.19 1.20 0.7% DSS Revenue ($000) 541 547 574 (27) 4,454 4,593 (139)

NYA: Not yet available with new Patient Management System

NR: Comparison not required

Oct-09Feb-10

35

% of Emergency Department Patients Seen Within Specified Times as defined by the Australasian College for Emergency Medicine (KPI # 1)

0

25

50

75

100

Feb 09 Mar 09 Apr 09 May 09 Jun 09 Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10

Triage_1 Triage_2 Triage_3 Triage_4 Triage_5

Month : T1= 100% T2=64 % T3 = 52% T4= 61% T5= 96%Australia 1997 : T1=92% T2=69% T3=47% T4=64% T5=84%Targets : T1=100% T2=80% T3=75% T4=70% T5=70%

Specified times - Triage 1 - 1 min; Triage 2 - 10 mins; Triage 3 - 30 mins; Triage 4 - 1 hours; Triage 5 - 2 hrs.

Readmit Rate (KPI # 2)

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

5.0%

5.5%

6.0%

6.5%

7.0%


Rate Target Lower Upper

Target = 4.5 %February = 3.9 %

36

Average Length of Stay Med/Surg Only (KPI # 3)

3.5

3.6

3.7

3.8

3.9

4.0

4.1

4.2

4.3

4.4

4.5

4.6

4.7

4.8

4.9

5.0

5.1

5.2


Actual Target Lower Upper

Target = 4.5 DaysFebruary = 4.7 Days

Comment: Definition: Total days in hospital divided by the number of discharges (excludes ICU and CCU and all day cases) occurred in the month.

DNA Rate of Total FSA Appointments (KPI # 4)(Excludes Rural Clinics)

February 2010 7.2%

3.0%

3.5%

4.0%

4.5%

5.0%

5.5%

6.0%

6.5%

7.0%

7.5%

8.0%

8.5%

9.0%

9.5%

10.0%

Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10

0

20

40

60

80

100

120

140

160

180

200

220

DNA Rate No of DNA's

This graph represents the percentage of patients that did not attend their First Specialist Attendance within the Med/Surg groups

37

Percent Sick Leave Hours (KPI # 5)

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%


Percent lost time Target Lower Upper

Definition: Total sick hours paid during the month (excl ACC) over total hours paid during the month. Comment:

Target = 3%February = 2.8%

Total sick hours = 6273Total hours = 221,616

Overtime and Callback Hours (Electronic Timesheet Report KPI # 6)

0

500

1000

1500

2000

2500

3000

3500

4000

4500


Overtime Hours Callback Hours

125120

124 118

116

107

98

101

10199

90 103

Numbers in red represent vacancies

111

Page_C

38

Number of patients Waiting for treatment > than 6 months KPI # 7For 3 months to February 2010

0

10

20

30

40

50

60

70

Dec 09 11 25 35 7 0 16 19 3 46 33

Jan 10 22 28 39 17 0 15 31 3 51 29

Feb 10 9 3 44 18 2 18 25 3 66 37

Cardiac Surgery Cardiology ENT Gynaecology Neurosurgery Ophthalmology Orthopaedic Paediatric General Surgery Urology

Total Admissions during the month vs Total added to the Booking Lists during the month of February 2010 KPI # 8

0

20

40

60

80

100

120

140

160

Total Admits 20 53 113 45 8 48 87 5 71 72

Total Added 6 5 125 49 1 81 40 0 67 28

Cardiac Surgery Cardiology ENT Gynaecology Neurosurgery Ophthalmology Orthopaedic Paediatric General Surgery Urology

Page_D

39

Waiting > 6 Months (KPI # 9)Trend Line represents the Total of All Services

Stack represents only those Services with Volumes greater than 20

44 46 39 47 44 42 43 39 43 44 46 5166

3843

4243

33 40 32 40 39 34 3539

441915 25

26

24 18 2728 28 29 19

31

2528 20 14

5

10 9 8

2127

24 33

29

37

190

178172 170

162 162 164

184191

196 195

235

225

0

50

100

150

200

250


General Surgery ENT Orthopaedic Urology Total

Number of Patients on Active Review (KPI # 10) (Patients with a Staged/Planned Flag are excluded)

Stack represents only those services with volumes greater than 20

34 29 2741

55 5530 19 23 23 21 21 23

3025 25

2323 23

2322

40 38 39

7 4

109111

99

104102 94

8897

77 75 72

7563

121121

127

130133

121

106 120 10992 102

105

92

7 23 35

46

53

54

62 71

76 69

61

50

59

319332 335

362

380

362

325

237

315324

308305

272

0

50

100

150

200

250

300

350

400

450


General Surgery Cardiac Surgery ENT Orthopaedic Ophthalmology Total

Page_E

40

Waiting for FSA > 6 Months by Speciality (KPI # 11)(Excludes Rural Clinics Waiting)

0

10

20

30

40

50

Dec-09 12 0 0 0 2 0 27 4 0 0 0 0 13 5 2 1 0 1 6 6

Jan-10 39 0 0 0 4 0 29 2 0 2 1 2 16 7 4 0 0 6 9 17

Feb-10 39 0 0 1 6 0 28 4 0 3 0 6 24 3 3 0 0 0 0 20

Cardiology

Dermatology

Diabetes ENT Gastro Gen Med Gen SurgGynaecol

ogyHaematol

ogyNeurolog

yNeurosur

gOncology

Ophthalmology

Ortho Paeds Pain RenalRespirato

ryRheumat

ologyUrology

Waiting for FSA > 6 Months Totals (KPI # 12)(Excludes Rural Clinics Waiting)

0

100

200

300

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

11%

12%

13%

14%

15%

No Waiting > 6 Mths 192 157 144 131 114 370 186 102 82 92 79 138 137

Total Waiting 4816 4761 4916 4904 4847 2749 2357 3111 3098 2935 2808 2921 2666

% Waiting > 6 Mths 4% 3% 3% 3% 2% 13% 8% 3% 3% 3% 3% 5% 5%

Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10

Page_F

41

Number of patients Given Certainty and their Wait time for treatment (Includes Booked patients) at January 2010(Excludes patients with a staged or planned status) The numbers in Red indicate the number of booked patients

231

186

97

225

258

356342

0

50

100

150

200

250

300

350

400

450

500

0 1 2 3 4 5 >=6

Months Waiting

No

of

pat

ien

ts

Cardiothoracic Cardiology ENT Gynaecology Neurosurgery Paediatric General Surgery Ophthalmology Orthopaedics Total

74

86 64

38

17

3637

Number of patients Given Certainty and their Wait time for treatment (Includes Booked patients) at Dec 2009(Excludes patients with a staged or planned status) The numbers in Red indicate the number of booked patients

66

437399

272

228

116

195

0

50

100

150

200

250

300

350

400

450

500

0 1 2 3 4 5 >=6

Months Waiting

No

of

pat

ien

ts


35

43

54

1412

19

58

Number of patients Given Certainty and their Wait time for treatment (Includes Booked patients) at Nov 2009(Excludes patients with a staged or planned status) The numbers in Red indicate the number of booked patients

151

90 94

196

246273

254

0

50

100

150

200

250

300

350

400

450

500

0 1 2 3 4 5 >=6

Months Waiting

No

of

pat

ien

ts


27

4843

13 11

19

40

Number of patients Given Certainty and their Wait time for treatment (Includes Booked patients) at February 2010(Excludes patients with a staged or planned status) The numbers in Red indicate the number of booked patients

292

183

125

210

373

274 288

0

50

100

150

200

250

300

350

400

450

500

0 1 2 3 4 5 >=6

Months Waiting

No

of

pat

ien

ts


4339 37

25

24

33

46

42

Activity – February 2010 Recommendation That the Hospital Advisory Committee note the report.

The overall caseweight activity for Dunedin Hospital is 13% below plan based on the current coding and the assumption made for the uncoded cases. We are continuing to run our audit report that ensures that the admission type is correct at the time of extracting the report, This is run each day and fixed on a daily basis. All activity from 1 July has been submitted to the Ministry of Health, and is being submitted at least once a week. We have now also received compliance from the Ministry of Health for the submission of the Non admitted data, this will allow the Ambulatory Initiative Funding to be calculated. ED had a busy month with 2966 presentations of which 750 were admitted. Inpatients As mentioned above caseweight activity is 13% below plan for the month, this is not a good result for the month, this is partly due to phasing being based on 23- 25 working days, when February actually only has 20 working days. There are 86 cases uncoded for year to date, with an estimated caseweight value of 110, these have been included in the above numbers. Year to date we are 2% behind plan. Elective Surgical activity for Otago domiciled patients treated at Dunedin Hospital is below plan for February by 130 caseweights (related to phasing and some lists being dropped), and behind by 122 year to date, (this is predominantly related to Cardiac Surgery having only 1 surgeon for a period of time, and the impact of H1N1). Activity against the Health Target for elective services remains behind plan, this includes discharges for the DHB, for all those Otago domiciled patients treated at Dunedin Hospital, on the Surgical Bus, at Mercy Hospital and at other DHB’s. Below you will find a table that looks at Otago domiciled patients treated at other DHBs, this has been split into Elective and Acute admissions, and compares actuals against what is in the DAP. We are 46.81 below plan for February and below plan by 68.89 ytd.

43

DHB February Year to date

Actual Plan Actual Plan Dental - Acute 0.00 0.29 1.27 2.29 Dental - Elective 0.90 0.95 13.48 7.61 Anaesthesia - Acute 0.00 0.00 2.42 0.00 Internal Medicine - Acute 6.06 10.28 73.09 82.22 Endocrinology - Acute 0.00 0.03 0.44 0.26 Gastroenterology - Acute 0.00 2.53 2.93 20.27 Gastroenterology - Elective 0.00 0.02 0.88 0.20 Haematology - Acute 0.00 1.35 36.19 10.82 Neurology - Acute 0.00 0.51 6.28 4.11 Oncology - Acute 0.00 0.37 10.21 2.98 Infectious Diseases - Elective 0.00 0.15 0 1.17 Paediatric Oncology - Acute 0.00 5.38 5.92 43.06 Paediatric Medicine - Elective 0.35 0.00 0.35 0.00 Paediatric Medicine - Acute 0.19 2.18 16.31 17.44 Renal Medicine - Acute 0.00 1.11 3.22 8.86 Renal Medicine - Elective 0.00 2.14 13.98 17.10 Respiratory Medicine - Acute 0.00 3.82 5.91 30.60 Respiratory Medicine - Elective 0.00 0.44 5.13 3.49 Cardiology - Acute 13.06 3.19 75.42 25.51 Cardiology - Elective 21.38 7.92 168.77 63.36 Cardiothoracic - Acute 0.00 2.04 7.81 16.32 Cardiothoracic - Elective 0.00 0.83 5.38 6.67 Paediatric Cardiac - Acute 0.00 10.63 32.17 85.04 Paediatric Cardiac - Elective 0.00 6.26 25.16 50.05 General Surgery - Acute 1.19 12.16 47.93 97.30 General Surgery - Elective 3.21 7.27 40.56 58.20 ENT - Acute 0.00 0.11 2.37 0.85 ENT - Elective 0.74 3.59 8.35 28.71 Gynaecology - Acute 0.56 2.54 11.6 20.35 Gynaecology - Elective 6.44 1.41 24.32 11.31 Neurosurgery - Acute 7.48 3.48 53.05 27.87 Neurosurgery - Elective 0.00 4.61 22.1 36.91 Ophthalmology - Acute 0.79 0.49 5.29 3.95 Ophthalmology - Elective 4.74 3.36 36.55 26.85 Orthopaedics - Acute 4.79 13.14 50.97 105.11 Orthopaedics - Elective 5.18 4.36 48.93 34.88 Paediatric Surgery - Acute 0.00 1.73 6.2 13.82 Paediatric Surgery - Elective 3.92 2.76 39.01 22.10 Plastics - Acute 1.10 1.69 14.68 13.55 Plastics - Elective 2.28 3.11 19.87 24.84 Urology - Acute 0.00 0.39 2.07 3.08 Urology - Elective 0.00 2.47 14.51 19.74 Vascular Surgery - Acute 0.00 0.00 5.41 0.00 Vascular Surgery - Elective 0.00 0.00 9.92 0.00

NICU - Acute 8.67 8.73 73.43 69.87

93.03 139.84 1049.84 1118.73

44

Activity – February 2010 16/03/2010 3 Megan Boivin Version 2

There were 24 patients still in Hospital as at 1 March 2010, all with lengths of stay greater than 30 days, attached is a table that shows which services these patients are in, unfortunately due to the data quality issues we are unable to say what volume are ACC related. Service ACC Funded Bed Days MoH Funded Bed Days NICU 96 Psychogeriatrics 116 Physical Rehabilitation 186 446 Geriatrics 280 Cardiothoracic 81 Orthopaedics 34 Antenatal 38 Neurology 33 General Surgery 34 Renal 52 Total 186 days 1,210 days Maternity Caseweights delivered at Otago DHB are as below: Actual - February Plan - February Ytd Actual Ytd Plan

148.76 164.05 1,201.97 1,312.43 Megan Boivin Operations Manager 16 March 2010 Attachments

1. Contract Performance – Total coded caseweights summary – February 2010 2. Contract Performance – Acute & Elective includes IDFs – February 2010 3. Contract Performance – Coded Acute caseweights includes IDF – February 2010 4. Contract Performance – Coded Acute caseweights IDFs only – February 2010 5. Contract Performance – Coded Acute caseweights Otago patients only – February 2010 6. Contract Performance – Coded Elective caseweights includes IDFs – February 2010 7. Contract Performance – Coded Elective caseweights Otago patients only – February 2010 8. Contract Performance – Coded Elective caseweights IDFs only – February 2010 9. Monthly Phasing of Caseweight Activity 2009-10 10. Admissions from ED to inpatient wards 2004-10 11. Emergency Department Monthly Attendances 2004-10 12. Number of ED presentations by triage category

45

Description Monthly Volume

Budgeted Volume

Monthly Volume Variance

Actual YTD Volume

Budgeted YTD Volume

YTD Volume Variance

DAP Annual Volume 2009/10

2008/09 Actual Volume

Internal Medicine - Acute 196.89 240.33 (43.45) 1836.86 2139.75 (302.89) 3101.08 2764.53

Emergency Dept - Acute 86.93 83.33 3.60 488.59 666.63 (178.05) 1000.35 1118.88

Internal Medicine - Acute IDF 4.78 10.69 (5.91) 62.42 85.55 (23.13) 128.38 116.47

Cardiology - Acute 100.29 110.72 (10.43) 743.05 885.78 (142.73) 1329.20 1372.70

Cardiology - Acute IDF 36.14 42.50 (6.36) 302.93 322.11 (19.18) 492.11 450.56

Cardiology - Elective 25.59 35.32 (9.73) 195.63 251.03 (55.40) 379.77 375.31

Cardiology - Elective IDF 13.50 21.38 (7.88) 120.36 149.66 (29.30) 227.44 237.19

Endocrinology - Acute 2.03 0.61 1.42 6.44 4.26 2.18 6.70 6.08

Endocrinology - Acute IDF - 0.12 (0.12) 2.99 0.93 2.07 1.39 0.84

Endocrinology - Elective 0.48 - 0.48 3.49 - 3.49 - 4.68

Endocrinology - Elective IDF 1.48 0.33 1.15 3.89 2.65 1.23 3.98 3.95

Gastroenterology - Acute 21.46 25.03 (3.57) 203.89 200.23 3.66 300.46 291.67

Gastroenterology - Acute IDF 0.55 0.95 (0.40) 12.88 7.60 5.27 11.41 13.96

Gastroenterology - Elective 2.63 7.18 (4.55) 36.25 51.40 (15.16) 80.12 72.24

Gastroenterology - Elective IDF - 0.15 (0.15) 4.78 1.17 3.61 1.75 0.61

Haematology - Acute 40.11 23.19 16.93 238.67 185.51 53.17 278.37 253.68

Haematology - Acute IDF 1.85 2.76 (0.91) 49.12 22.04 27.07 33.08 102.95

Haematology - Elective - 1.34 (1.34) 15.53 10.70 4.83 16.06 22.28

Haematology - Elective IDF - 2.20 (2.20) 21.22 17.60 3.62 26.41 18.89

Neurology - Acute 22.00 16.20 5.80 185.92 121.50 64.42 186.30 197.89

Neurology - Acute IDF - 1.43 (1.43) 16.60 11.46 5.15 17.19 26.02

Neurology - Elective 9.14 6.02 3.12 45.08 43.47 1.61 65.46 54.71

Neurology - Elective IDF 1.03 1.76 (0.73) 12.30 14.11 (1.81) 21.17 19.88

Oncology - Acute 63.21 72.86 (9.65) 508.58 564.45 (55.88) 837.47 774.90

Oncology - Acute IDF 17.83 18.28 (0.45) 145.31 146.25 (0.94) 219.47 160.13

Oncology - Elective 1.70 3.49 (1.79) 34.67 27.90 6.77 41.87 35.28

Oncology - Elective IDF - 1.10 (1.10) 18.40 8.80 9.60 13.20 6.04

Paediatric Medical - Acute 41.17 39.12 2.05 450.77 443.41 7.36 642.29 611.67

Paediatric Medical - Acute IDF 3.13 2.25 0.88 10.68 17.99 (7.31) 26.99 47.65

Paediatric Medical - Elective 3.82 4.64 (0.82) 33.17 33.09 0.08 50.16 47.23

Paediatric Medical - Elective IDF - 0.49 (0.49) 2.13 3.48 (1.35) 5.28 6.04

Renal - Acute 16.40 27.96 (11.55) 174.65 223.64 (48.99) 335.60 318.47

Renal - Acute IDF 5.52 15.54 (10.01) 127.84 124.31 3.53 186.54 165.65

Renal - Elective 0.44 1.64 (1.20) 12.33 13.15 (0.83) 19.74 17.80

Renal - Elective IDF 1.40 0.40 1.01 15.53 3.17 12.35 4.76 5.04

Respiratory - Acute 41.07 64.14 (23.07) 583.25 494.02 89.23 750.59 743.75

Respiratory - Acute IDF 0.81 2.25 (1.44) 3.93 18.01 (14.08) 27.03 30.66

Respiratory - Elective 9.09 1.30 7.79 33.85 9.82 24.03 15.01 21.52

Respiratory - Elective IDF 1.33 0.21 1.12 2.40 1.71 0.69 2.57 0.53

Rheumatology - Acute 9.19 9.39 (0.20) 75.83 70.15 5.68 110.47 113.55

Rheumatology - Acute IDF - 0.65 (0.65) 21.62 5.23 16.39 7.85 21.71

Rheumatology - Elective 0.19 1.31 (1.12) 6.46 9.17 (2.70) 14.41 14.78

Rheumatology - Elective IDF - 0.06 (0.06) 0.73 0.52 0.21 0.78 3.17

General Surgery - Acute 159.94 251.66 (91.72) 1718.04 2013.31 (295.28) 3021.18 2823.48

General Surgery - Acute IDF 13.80 12.07 1.73 152.57 96.57 55.99 144.92 261.92

General Surgery - Elective 132.23 175.78 (43.55) 1396.71 1311.01 85.70 2014.12 2105.33

General Surgery - Elective IDF 14.50 13.02 1.48 155.88 89.46 66.42 141.55 211.35

Pain - Acute - - - 0.58 - 0.58 - -

Cardiothoracic - Acute 66.86 80.66 (13.80) 654.67 645.30 9.37 968.33 853.27

Cardiothoracic - Acute IDF 54.94 71.17 (16.23) 522.68 454.28 68.39 702.95 648.09

Cardiothoracic - Elective 31.97 56.46 (24.50) 340.57 451.71 (111.13) 677.83 789.05

Cardiothoracic - Elective IDF 23.08 29.95 (6.88) 171.67 179.72 (8.06) 299.54 481.25

ENT - Acute 10.82 12.55 (1.73) 97.33 100.37 (3.04) 150.62 139.45

ENT - Acute IDF 4.51 4.28 0.22 26.98 34.27 (7.30) 51.43 40.89

ENT - Elective 70.81 62.98 7.83 556.28 450.97 105.31 702.88 792.26

ENT - Elective IDF 2.15 6.61 (4.47) 68.57 47.34 21.23 73.79 76.23

Gynaecology - Acute 18.66 38.64 (19.97) 218.84 309.10 (90.27) 463.84 412.53

Gynaecology - Acute IDF 2.28 1.48 0.79 10.28 11.87 (1.59) 17.81 26.91

Gynaecology - Elective 39.72 48.02 (8.31) 374.01 343.89 30.12 535.99 554.76

COMPARISON SUMMARY OF ACTUAL VOLUMES AGAINST BUDGET

February 2010

46

Description Monthly Volume

Budgeted Volume

Monthly Volume Variance

Actual YTD Volume

Budgeted YTD Volume

YTD Volume Variance

DAP Annual Volume 2009/10

2008/09 Actual Volume

COMPARISON SUMMARY OF ACTUAL VOLUMES AGAINST BUDGET

February 2010

Gynaecology - Elective IDF 2.96 4.98 (2.02) 47.52 39.86 7.65 59.82 26.89

Neurosurgery - Acute 40.74 50.29 (9.55) 473.94 402.31 71.63 603.70 469.80

Neurosurgery - Acute IDF 30.73 18.06 12.67 208.97 144.49 64.48 216.82 301.34

Neurosurgery - Elective 11.85 22.64 (10.79) 133.69 160.99 (27.29) 251.54 188.81

Neurosurgery - Elective IDF 5.85 7.13 (1.28) 35.15 57.04 (21.89) 85.60 48.63

Ophthalmology - Acute 10.90 4.73 6.16 42.07 37.85 4.22 56.80 61.78

Ophthalmology - Acute IDF 4.65 1.07 3.58 34.97 7.48 27.49 11.76 34.45

Ophthalmology - Elective 18.01 30.82 (12.81) 191.76 246.57 (54.81) 370.00 275.83

Ophthalmology - Elective IDF 1.42 1.59 (0.17) 11.96 9.53 2.43 14.30 22.73

Orthopaedics - Acute 236.80 249.85 (13.05) 1829.15 1955.82 (126.67) 2955.22 2731.62

Orthopaedics - Acute IDF 10.37 16.40 (6.03) 126.14 131.17 (5.02) 196.83 158.26

Orthopaedics - Elective 179.32 229.71 (50.40) 1360.66 1649.42 (288.76) 2489.03 1715.58

Orthopaedics - Elective IDF 32.89 12.35 20.53 214.71 98.81 115.91 148.27 175.45

Paediatric Surgery - Acute 3.24 8.16 (4.92) 24.58 65.25 (40.66) 97.91 121.64

Paediatric Surgery - Acute IDF - 0.03 (0.03) 0.41 0.28 0.13 0.42 1.24

Paediatric Surgery - Elective 3.39 6.69 (3.30) 30.98 47.65 (16.67) 72.23 62.72

Paediatric Surgery - Elective IDF - 0.26 (0.26) - 1.83 (1.83) 2.78 -

Urology - Acute 18.64 11.97 6.67 142.60 89.75 52.85 137.61 155.88

Urology - Acute IDF 1.17 0.62 0.56 4.44 4.94 (0.50) 7.42 3.04

Urology - Elective 41.01 40.98 0.04 340.77 296.03 44.74 459.93 508.04

Urology - Elective IDF - 0.05 (0.05) 0.45 0.41 0.04 0.62 2.00

Neonatal - Acute 60.57 73.63 (13.06) 776.92 589.04 187.87 883.92 865.81

Neonatal - Acute IDF 3.19 19.59 (16.40) 79.95 156.70 (76.75) 235.15 282.00

Plastics - Acute 8.61 - 8.61 55.30 - 55.30 - -

Plastics - Acute IDF 15.33 - 15.33 109.64 - 109.64 - -

Plastics - Elective 1.10 - 1.10 12.90 - 12.90 - -

Plastics - Elective IDF 0.93 - 0.93 17.84 - 17.84 - -

Acute Costweights 1488.11 1737.22 (249.11) 13563.86 14010.98 (447.13) 20954.96 20097.77

Elective Costweights 685.00 840.36 (155.35) 6080.29 6134.85 (54.56) 9389.76 9004.08

Total Costweights 2173.11 2577.57 (404.46) 19644.15 20145.84 (501.69) 30344.72 29101.85

47

Service Name LevelImp. Req.

LevelImp. Req.

Level StatusImp. Req.

LevelImp. Req.





Cardiothoracic 1 of 1 0 1 0 1 0.0 % 0 0 0 14 25.0 % -12 10 83.3 % 0 9 0.0 % 0 X X X

Ear, Nose & Throat 1 of 1 0 32 0 30 2.7 % 0 0 0 29 2.6 % 0 2 0.0 % 0 25 2.2 % 0 58 100.0 % 0. %

General Surgery 1 of 1 0 30 0 4 0.0 % 0 0 0 38 4.1 % 0 1 0.0 % 0 25 2.7 % 0 46 100.0 % 0. %

Gynaecology 1 of 1 0 3 0 0 0.0 % 0 0 0 14 2.6 % 0 X 0.0 % 0 13 2.4 % 0 23 100.0 % 0. %

Neurosurgery 1 of 1 0 0 0 0 0.0 % 0 0 0 0 0.0 % 0 X 0.0 % 0 0 0.0 % 0 3 100.0 % 0. %

Ophthalmology 1 of 1 0 10 0 0 0.0 % 0 0 0 18 4.1 % 0 2 0.0 % 0 16 3.6 % 0 30 100.0 % 0. %

Orthopaedics 1 of 1 0 29 0 12 1.6 % 0 0 0 16 2.1 % 0 0 0.0 % 0 14 1.8 % 0 37 100.0 % 0. %

Paediatric Surgery X 0 X X 0 0.0 % 0 0 0 3 0.0 % 0 X 0.0 % 0 2 0.0 % 0 X X X

Plastics X 0 X X 0 0.0 % 0 0 0 5 0.0 % 0 X 0.0 % 0 3 0.0 % 0 11 100.0 % 0. %

Urology 1 of 1 0 10 0 0 0.0 % 0 0 0 28 4.2 % 0 0 0.0 % 0 10 1.5 % 0 41 100.0 % 0. %

Total 115 47 0 165 15 117 249

MoH Elective Services OnlineComparison of surgical services for January 2010

DHB Name: Otago

1.�DHB services that appropriately acknowledge

and process all patient referrals within ten working

days.

2.�Patients waiting longer than six months for their first specialist

assessment (FSA).

3.�Patients waiting without a commitment to

treatment whose priorities are higher than

the actual treatment threshold (aTT).

4.Clarity of treatment status.

5.Patients given a commitment to treatment but not treated within six

months.

6.�Patients in active review who have not

received a clinical assessment within the last

six months.

7.�Patients who have not been managed according to their assigned status

and who should have received treatment.

8.�The proportion of patients treated who

were prioritised using nationally recognised processes or tools.

Status Status Status

100.0 % 0.0 % 0.0 %

100.0 % 1.1 % 0.0 %

100.0 % 1.1 % 0.0 %

100.0 % 0.0 % 0.0 %

100.0 % 0.0 % 0.0 %

100.0 % 0.4 % 0.0 %

100.0 % 1.6 % 0.0 %

X 0.0 % 0.0 %

X 0.0 % 0.0 %

100.0 % 1.0 % 0.0 %

This report displays ESPI results for individual surgical services. The ESPI results do not include non-elective patients or elective patients awaiting planned and staged procedures. ESPIs 3, 7 and 8 assess surgical specialties where patients are prioritised using nationally recognised tools - including General Surgery from 01 January 08 and Vascular and Urology from 01 July 08. So, Medical specialties are currently excluded from the ESPI results. Please contact the Ministry of Health's Electives Team if you have any queries on the ESPI definitions (details on electives website). NZHIS's Analytical Services Team can assist with providing variations of this information e.g data for a particular DHB or period (details on the NZHIS website - http://www.nzhis.govt.nz/ ).

Data Warehouse Refresh Date: 06/Mar/2010

Report Run Date: 10/Mar/2010

48

Actual Planned Actual Planned

(CWDS) (CWDS) (CWDS) (CWDS) This mth Last mth This mth Last mth

ACUTE

MEDICAL 701 787 6273 6588 -11% -5% -5% -4%

SURGICAL 575 709 5257 5619 -19% -1% -6% -3%

TOTAL ACUTE 1277 1495 11530 12207 -15% -3% -6% -3%

ELECTIVE

MEDICAL 53 62 416 450 -15% 51% -7% -10%

SURGICAL 544 674 4835 4958 -19% 1% -2% -2%

TOTAL ELECTIVE 597 736 5251 5408 -19% 4% -3% -3%

IDF'S

MEDICAL - Acute 74 117 836 918 -37% 5% -9% -6%MEDICAL - Elective 18 28 201 203 -37% 106% -1% 5%

SURGICAL - Acute 124 125 1100 885 -1% 58% 24% 28%SURGICAL - Electives 84 76 724 524 10% -1% 38% 42%

TOTAL IDF'S 299 346 2862 2530 -14% 27% 13% 17%

Uncoded cases (86) 80 110

TOTAL 2,252 2,578 19,753 20,146 -13% 7% -2% 0%

Appendix 1

February 2010

Total Coded Caseweights Summary

CONTRACT PERFORMANCE(includes IDF's)

Var (%) Var (%)

February VarianceYear to Date Year to Date VarianceFebruary

49


SERVICE (CWDS) (CWDS) (CWDS) (CWDS) This mth Last mth This mth Last mth

Cardiology 176 210 1362 1609 -16% 1% -15% -15%Endocrinology 3 1 16 8 183% 94% 109% 89%Gastroenterology 25 33 258 260 -26% -10% -1% 3%Internal Medicine 202 251 1899 2225 -20% -12% -15% -15%Haematology 42 29 325 236 42% -8% 38% 37%Neurology 32 25 260 191 27% 40% 36% 35%Oncology 83 96 707 747 -14% 25% -5% -4%Renal Medicine 24 46 330 364 -48% -51% -9% -5%Respiratory 52 68 623 524 -23% -23% 19% 25%Rheumatology 9 11 105 85 -18% 60% 23% 29%Paediatric Medical 48 47 497 498 3% 10% 0% -1%NICU 64 93 857 746 -32% 8% 15% 21%Cardiothoracic 177 238 1690 1731 -26% 3% -2% 1%ENT 88 86 749 633 2% 11% 18% 26%Eyes 35 38 281 301 -8% -46% -7% -7%General Surgery 320 453 3423 3510 -29% -3% -2% 1%Neurosurgery 89 98 852 765 -9% -15% 11% 14%Orthopaedics 459 508 3531 3835 -10% 12% -8% -8%Gynaecology 64 93 651 705 -32% -23% -8% -4%Paediatric Surgery 7 15 56 115 -56% -84% -51% -51%Plastics 26 0 196 0Urology 61 54 488 391 13% 168% 25% 24%Emergency 87 83 489 667 4% 19% -27% -32%Uncoded Cases 80 110TOTAL 2,252 2,578 19,753 20,146 -13% 7% -2% 0%

Appendix 2

February 2010

Coded Caseweights - Acute & Elective


Var (%) Var (%)

February February VarianceYear to Date Year to Date Variance

50



Cardiology 136 153 1046 1208 -11% -9% -13% -13%

Endocrinology 2 1 9 5 180% -100% 82% 66%

Gastroenterology 22 26 217 208 -15% -18% 4% 7%

Internal Medicine 202 251 1899 2225 -20% -12% -15% -15%

Haematology 42 26 288 208 62% -2% 39% 35%

Neurology 22 18 203 133 25% 23% 52% 52%

Oncology 81 91 654 711 -11% 29% -8% -7%

Renal Medicine 22 43 302 348 -50% -49% -13% -9%

Respiratory 42 66 587 512 -37% -24% 15% 22%

Rheumatology 9 10 97 75 -9% 50% 29% 35%

Paediatric Medical 44 41 461 461 7% 6% 0% -1%

NICU 64 93 857 746 -32% 8% 15% 21%

Cardiothoracic 122 152 1177 1100 -20% 50% 7% 21%

ENT 15 17 124 135 -9% -4% -8% -7%

Eyes 16 6 77 45 168% -46% 70% 56%

General Surgery 174 264 1871 2110 -34% -20% -11% -8%

Neurosurgery 71 68 683 547 5% -13% 25% 28%

Orthopaedics 247 266 1955 2087 -7% 20% -6% -7%

Gynaecology 21 40 229 321 -48% -53% -29% -26%

Paediatric Surgery 3 8 25 66 -60% -78% -62% -62%

Urology 20 13 147 95 57% 155% 55% 56%

Plastics 10 0 68 0

Emergency 87 83 489 667 4% 19% -27% -32%

Uncoded Cases (63) 58 0 81 0

TOTAL 1,532 1,737 13,548 14,011 -12% 5% -3% -1%

Appendix 3

February 2010

Coded Caseweights - Acute


Var (%) Var (%)


51


SERVICE (CWDS) (CWDS) (CWDS) This mth Last mth This mth Last mth

Cardiology 36 43 303 322 -15% 41% -6% -5%Endocrinology 0 0 3 1 -100% -100% 223% 269%Gastroenterology 1 1 13 8 -42% 214% 69% 85%Internal Medicine 5 11 62 86 -55% 56% -27% -24%Haematology 2 3 49 22 -33% 197% 123% 145%Neurology 0 1 17 11 -100% -5% 45% 66%Oncology 18 18 145 146 -2% 13% -1% -6%Renal Medicine 6 16 128 124 -64% -56% 3% 12%Respiratory 1 2 4 18 -64% -100% -78% -80%Rheumatology 0 1 22 5 -100% -17% 313% 350%Paediatric Medical 3 2 11 18 39% -13% -41% -56%NICU 3 20 80 157 -84% -48% -49% -44%Cardiothoracic 55 71 523 454 -23% 122% 15% 22%ENT 5 4 27 34 5% 10% -21% -25%Eyes 5 1 35 7 0% 0% 367% 373%General Surgery 14 12 153 97 14% 75% 58% 60%Neurosurgery 31 18 209 144 70% 21% 45% 41%Orthopaedics 10 16 126 131 -37% -21% -4% -1%Gynaecology 2 1 10 12 54% -100% -13% -27%Paediatric Surgery 0 0 0 0 -100% -100% 46% 67%Plastics 1 0 13 0Urology 1 1 4 5 89% -100% -10% -24%TOTAL 197 242 1,937 1,804 -19% 29% 7% 11%

Appendix 4

February 2010


CONTRACT PERFORMANCE( IDF's only)

Var (%) Var (%)


52



Cardiology 100 111 743 886 -9% -20% -16% -16%Endocrinology 2 1 6 4 0% 0% 51% 21%Gastroenterology 21 25 204 200 -14% -27% 2% 4%Internal Medicine 197 240 1837 2140 -18% -15% -14% -14%Haematology 40 23 239 186 73% -26% 29% 22%Neurology 22 16 186 122 36% 28% 53% 51%Oncology 63 73 509 564 -13% 35% -10% -7%Renal Medicine 16 28 175 224 -41% -45% -22% -21%Respiratory 41 64 583 494 -36% -21% 18% 26%Rheumatology 9 9 76 70 -2% 60% 8% 11%Paediatric Medical 41 39 451 443 5% 7% 2% 1%NICU 61 74 777 589 -18% 22% 32% 39%Cardiothoracic 67 81 655 645 -17% 25% 1% 20%ENT 11 13 97 100 -14% -8% -3% -1%Eyes 11 5 42 38 130% -62% 11% -6%General Surgery 160 252 1718 2013 -36% -24% -15% -11%Neurosurgery 41 50 474 402 -19% -25% 18% 23%Orthopaedics 237 250 1829 1956 -5% 23% -6% -7%Gynaecology 19 39 219 309 -52% -51% -29% -26%Paediatric Surgery 3 8 25 65 -60% -78% -62% -63%Plastics 9 0 55 0Urology 19 12 143 90 56% 181% 59% 60%Emergency 87 83 489 667 4% 19% -27% -32%TOTAL 1,277 1,495 11,530 12,207 -15% -3% -6% -3%

Appendix 5

February 2010


CONTRACT PERFORMANCE(Otago Patients only)

Var (%) Var (%)


53



Cardiology 39 57 316 401 -31% 373% -21% -24%Endocrinology 1 0 7 3 190% 162% 163% 133%Gastroenterology 3 7 41 53 -64% 44% -22% -15%Haematology 0 4 37 28 -100% -50% 30% 48%Neurology 10 8 57 58 31% 94% 0% -5%Oncology 2 5 53 37 -63% -51% 45% 60%Paediatric Medical 4 5 35 37 -26% 75% -3% 0%Renal 2 2 28 16 -10% -100% 71% 81%Respiratory 10 2 36 12 590% 64% 214% 158%Rheumatology 0 1 7 10 -86% 854% -26% -16%Cardiothoracic 55 86 512 631 -36% -88% -19% -33%ENT 73 70 625 498 5% 19% 25% 35%Eyes 19 32 204 256 -40% -46% -20% -18%General Surgery 147 189 1553 1400 -22% 50% 11% 14%Neurosurgery 18 30 169 218 -41% -26% -23% -20%Orthopaedics 212 242 1575 1748 -12% -7% -10% -10%Gynaecology 43 53 422 384 -19% 22% 10% 14%Paediatric Surgery 3 7 31 49 -51% -100% -37% -35%Urology 41 41 341 296 0% 177% 15% 14%Plastics 16 127Uncoded Cases (23) 22 0 29 0TOTAL 720 840 6206 6135 -14% 12% 1% 2%

Appendix 6

February 2010

Coded Caseweights - Elective


Var (%) Var (%)


54



Cardiology 26 35 196 251 -28% 200% -22% -28%Endocrinology 0 0 3 0 0% 0% 0% 0%Gastroenterology 3 7 36 51 -63% 50% -29% -24%Haematology 0 1 16 11 -100% -86% 45% 66%Neurology 9 6 45 43 52% 165% 4% -4%Oncology 2 3 35 28 -51% -100% 24% 35%Paediatric Medical 4 5 33 33 -18% 94% 0% 3%Renal 0 2 12 13 -73% -100% -6% 1%Respiratory 9 1 34 10 601% 111% 245% 190%Rheumatology 0 1 6 9 0% 0% -30% -20%Cardiothoracic 32 56 341 452 -43% -94% -25% -45%ENT 71 63 556 451 12% 23% 23% 32%Eyes 18 31 192 247 -42% -50% -22% -19%General Surgery 132 176 1397 1311 -25% 56% 7% 10%Neurosurgery 12 23 134 161 -48% 26% -17% -12%Orthopaedics 179 230 1361 1649 -22% -6% -18% -17%Gynaecology 40 48 374 344 -17% 11% 9% 13%Paediatric Surgery 3 7 31 48 -49% -100% -35% -33%Urology 41 41 341 296 0% 179% 15% 14%Plastics 15 110TOTAL 597 736 5251 5408 -19% 4% -3% -3%

Appendix 7

February 2010


CONTRACT PERFORMANCE(Otago Patients only)

Var (%) Var (%)


55



Cardiology 14 21 120 150 0% 0% -20% -17%Endocrinology 0 0 3 3 45% 18% 32% 3%Gastroenterology 0 0 5 1 -100% -100% 310% 368%Haematology 0 2 21 18 -100% -29% 21% 38%Neurology 1 2 12 14 -42% 41% -13% -9%Oncology 0 1 18 9 -100% 104% 109% 139%Renal 1 0 16 3 253% -100% 390% 409%Respiratory 1 0 2 2 521% -100% 40% -29%Rheumatology 0 0 1 1 100% 100% 100% 100%Paediatric Medical 0 0 2 3 -100% -100% -39% -29%Cardiothoracic 23 30 172 180 0% 0% -4% -1%ENT 2 7 69 47 -67% -17% 45% 63%Eyes 1 2 12 10 0% 0% 25% 33%General Surgery 15 13 156 89 11% -100% 74% 82%Neurosurgery 6 7 35 57 -18% -62% -38% -41%Orthopaedics 33 12 215 99 166% -13% 117% 110%Gynaecology 3 5 48 40 -41% 72% 19% 24%Paediatric Surgery 0 0 0 2 -100% -100% -100% -100%Urology 0 0 0 0 -100% -100% 9% -36%Plastics 1 0 18 0TOTAL 102 104 925 727 -2% 17% 27% 32%

Appendix 8

February 2010


CONTRACT PERFORMANCE(IDF's Only)

Var (%) Var (%)


56

Acute Caseweight Delivery2009 - 10 (includes Maternity)

-

500.00

1,000.00

1,500.00

2,000.00

2,500.00

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Months

Cas

ewei

gh

ts

Plan

actual

Total Caseweight Delivery2009 - 10 (includes Maternity)

-

500.00

1,000.00

1,500.00

2,000.00

2,500.00

3,000.00


Months

Cas

ewei

gh

ts

Plan

actual

Elective Caseweight Delivery2009 - 10 (includes Maternity)

-100.00200.00300.00400.00500.00600.00700.00800.00900.00

1,000.00


Months

Cas

ewei

gh

ts

Plan

actual

Appendix 9

57

Appendix 10

Admissions from ED to Inpatient Wards 2005 - 2010

630

680

730

780

830

880

930

980

Jan-

05

Mar

-05

May

-05

Jul-0

5

Sep

-05

Nov

-05

Jan-

06

Mar

-06

May

-06

Jul-0

6

Sep

-06

Nov

-06

Jan-

07

Mar

-07

May

-07

Jul-0

7

Sep

-07

Nov

-07

Jan-

08

Mar

-08

May

-08

Jul-0

8

Sep

-08

Nov

-08

Jan-

09

Mar

-09

May

-09

Jul-0

9

Sep

-09

Nov

-09

Jan-

10

Ad

mis

sio

n n

um

ber

s

58

Appendix 11

Emergency Department Monthly Attendances 2005 - 2010

2600

2800

3000

3200

3400

3600

3800

Jan-

05

Mar

-05

May

-05

Jul-0

5

Sep

-05

Nov

-05

Jan-

06

Mar

-06

May

-06

Jul-0

6

Sep

-06

Nov

-06

Jan-

07

Mar

-07

May

-07

Jul-0

7

Sep

-07

Nov

-07

Jan-

08

Mar

-08

May

-08

Jul-0

8

Sep

-08

Nov

-08

Jan-

09

Mar

-09

May

-09

Jul-0

9

Sep

-09

Nov

-09

Jan-

10

Pa

tie

nt

att

en

da

nc

es

pe

r m

on

th

59

Appendix 12

ED : Presentations per Triage Category - 13 Month View

0

200

400

600

800

1000

1200

1400

1600

1800

Month

Pre

sen

tati

ons

Triage 1 15 12 9 12 10 12 13 14 11 21 11 8 17

Triage 2 339 405 376 384 385 369 455 367 340 401 387 321 358

Triage 3 945 1212 1043 1093 1075 1206 1276 1193 1214 1167 1047 1027 1013

Triage 4 1256 1579 1406 1309 1301 1344 1412 1358 1375 1219 1328 1363 1412

Triage 5 158 150 150 165 126 137 130 121 120 114 104 150 166

February 2009

March 2009 April 2009 May 2009 June 2009 July 2009 August 2009September

2009October

2009November

2009December

2009January 2010

February 2010

60

FINANCIAL REPORT

HAC Meeting Date: 24 March 2010 Financial Report as at: 28 February 2010 Report Prepared by: Grant Paris, Business Analysts Date: 10 March 2010

1. DHB Provider Summary Results

Annual

Actual Budget Variance Actual Budget Actual Budget Variance Budget$' 000 $' 000 $' 000 FTE FTE $' 000 $' 000 $' 000 $' 000

26,939 26,430 509 Revenue 212,258 209,827 2,431 315,642

(15,383) (15,185) (198) 2,418 2,417 Less Personnel Costs (129,307) (129,136) (171) (196,840)(447) (460) 13 Less Outsourced Cost (4,354) (3,843) (511) (5,700)

(4,064) (4,379) 315 Less Clinical Supplies (35,158) (35,473) 316 (53,464)(3,757) (3,569) (187) Less Non Clinical (29,720) (29,403) (316) (44,179)

3,288 2,837 451 2,418 2,417 Net Surplus / (Deficit) 13,720 11,971 1,749 15,460

453 211 243 374 384 Mental Health 839 358 480 80

2,835 2,627 208 2,044 2,033 Excluding Mental Health 12,881 11,613 1,268 15,380

Month Year to Date

Summary Comment: Februarys result is a surplus of $3.3m compared to a budgeted surplus of $2.8m, favourable to budget by $450k. Year to date a favourable variance to budget of $1.75m exists. The drivers of the variance are as follows;

Favourable revenue variance of $509k driven by; o Adjustment to the Mental Health wash-up calculation - $250k o Kiwisaver credits invoiced to the State Services Commission $118k. YTD $894k. o Additional Breast screening revenue $100k. o Revenue from Haemophilia pool $89k.

Offset partially by o PCT drug revenue $57k lower than budget. $821k unfavourable ytd offset by lower

pharmaceutical costs. o Pharmacy Outpatient revenue $129k down on budget.

Unfavourable Personnel costs driven by Nursing and Allied Health FTE being over budget (due

to vacancy factor budgeted)

Favourable Clinical Supplies variance of $315k driven by lower Pharmaceutical charges (offsetting above revenue variances).

Non Clinical Supplies were over budget for the month, driven by unfavourable variance in the

capital charge (favourable ytd)

61

FTE / Cap As evidenced from the table below, admin staff are within the approved cap. (NB Governance FTE included).

Object Object description Feb-10 Actual FTE Cap Approved Under / (Over) Cap2805 Executive 6.78 6.10 (0.68)

(1.81)(2.08)

(31.78)

2815 Managers 64.00 62.192822 Supervisors 12.76 10.682824 Professional staff 43.33 64.80 21.472830 Administrative, Clerical -Clinical 224.53 267.50 42.972832 Administrative, Clerical -Non-Clinical 102.43 70.65Grand Total 453.83 481.92 28.09

Financial FTE (worked hours) increased 7 from Jan10, the majority in Allied Health. As can be seen from the below chart, FTE is now on budget.

Provider Actual versus Budgeted FTE

2,200

2,250

2,300

2,350

2,400

2,450

2,500

2,550

Jul-0

7

Sep-0

7

Nov-0

7

Jan-

08

Mar

-08

May

-08

Jul-0

8

Sep-0

8

Nov-0

8

Jan-

09

Mar

-09

May

-09

Jul-0

9

Sep-0

9

Nov-0

9

Jan-

10

Mar

-10

May

-10

FT

E

Actual FTE

Budget FTE

Excl budgeted vacancies

Total FTE is 1FTE over budget as shown below, driven by Nursing FTE and Allied Health FTE. Both these staff types have large vacancy factors budgeted which drive their respective variances. If removed, both these staff types are within budget.

Staff Type FTE Movement Actual FTE Budget FTE Variance Average "Real" VarianceJun-09 to Feb-10 Feb-10 Feb-10 Feb10 FTE v Vacancies in Feb10 FTE v

09/10 Budget Budgeted 09/10 BudgetSMO (2.9)

(19.8) (8.3)

(5.2)

(0.7)

135.7 143.4 7.7 10.0 17.7 RMO 4.7 180.7 183.2 2.5 1.0 3.5 Nursing 14.2 1,041.0 1,021.2 22.0 2.3 Allied Health 9.0 486.2 477.9 30.0 21.7 Support 139.9 146.1 6.2 - 6.2 Mgmt / Admin 7.9 434.2 445.2 11.0 8.0 19.0

27.7 2,417.7 2,417.0 71.0 70.3

62

2. Revenue

The favourable monthly revenue variance of $509k and favourable ytd variance of $2,431k are driven by the following; Major Revenue Variances (<> $20k, mnthly or ytd) Monthly Variance

$000’sYTD Variance

$000’s

Favourable with Offsetting CostsKiwisaver State Services credit 118 894Pharmacy - Reimbursement Herceptin Drug costs 49 480Internal revenue received above budget for NASC / NIR, and ED Afterhours

36 329

Auckland DHB - Cardiac Procedures July09 - 311SDHB - Smokefree 23 276Public Health Revenue - HPV 46 273Mammography Volumes > budget ytd 100 164Non resident 2 153Haemophilia Funding 89 129SDHB - patient transport 11 77Pharmacy - Reimbursement Herceptin treatment costs 13 65Dental School invoicing > budget ytd 10 52SDHB - Southern Blood and Cancer (17)

(11) (52)(34) (118)

(144)(129) (169)

(6) (180)(21) (205)

(228)(57) (821)

(5) (1,917)

3

Total Major Revenue Variances with Offset Costs 480 3,206

Favourable with no cost offset in current yearDonations 66 403Public Health Revenue - prior year - 117West Coast - prior year contribution towards Oracle licence fee - 54Fixed Assets - Gain on Sale - 44 Total Major Favourable with no Cost Offset 66 618

Unfavourable with partial/full cost offsetSDHB - RMO clinics & SMO callCTA RevenueInterest Received 7Community Pharmacy - Outpatient ScripsOral Health Project (behind plan)ACC Revenue under budgeted volumes / price changesMental Health underspend (8 months to Feb10) 246Pharmacy - PCT Revenue (offset expenditure reduction)

Total Major Unfavourable with partial Cost Offset

Total Major Revenue Variances 541 1,907 The Mental Health wash-up calculation had a favourable impact this month as the calculation method was altered to net off the total FTE, whether or not the contract was paid on FTE or bed days. Previously only the FTE contracts had been included in this wash-up calculation, and historically these had vacancies leading to a larger wash-up.

63

3. Personnel Costs

Monthly Personnel-February 10

AnnualActual Budget Variance Actual Budget Variance BudgetFTE FTE FTE $' 000 $' 000 $' 000 $' 000

316.4 326.6 10.2 Medical Personnel (4,458) (4,388) (70) (56,964) 1,041.0 1,021.2 (19.8) Nursing Personnel (5,736) (5,525) (211) (72,258)

486.2 477.9 (8.3) Allied Health Personnel (2,434) (2,311) (123) (29,741) 139.9 146.1 6.2 Support Personnel (467) (490) 23 (6,365) 434.8 445.2 10.4 Management & Admin Personnel (1,785) (1,911) 126 (24,676)

2,418.2 2,417.0 (1.2) Direct Personnel (14,880)$ (14,625)$ (255)$ (190,004)$

Indirect Personnel (503)$ (560)$ 56$ (6,836)$

2,418.2 2,417.0 (1.2) Total Personnel (15,383)$ (15,185)$ (198)$ (196,840)$

Note: Indirect costs include course fees / membership fees/ recruitment / relocation / settlements

YTD Personnel - February 10

AnnualActual Budget Variance Actual Budget Variance BudgetFTE FTE FTE $' 000 $' 000 $' 000 $' 000

315.9 325.5 9.6 Medical Personnel (37,155) (37,290) 135 (56,964) 1,034.1 1,021.2 (12.8) Nursing Personnel (48,944) (47,529) (1,416) (72,258)

479.1 479.7 0.5 Allied Health Personnel (20,192) (19,349) (843) (29,741) 142.3 147.4 5.2 Support Personnel (4,063) (4,185) 122 (6,365) 436.9 447.3 10.5 Management & Admin Personnel (15,378) (16,233) 855 (24,676)

2,408.2 2,421.2 12.9 Direct Personnel (125,733)$ (124,586)$ (1,147)$ (190,004)$

Indirect Personnel (3,575)$ (4,550)$ 976$ (6,836)$

2,408.2 2,421.2 12.9 Total Personnel (129,308)$ (129,136)$ (171)$ (196,840)$

Month Month

Year to Date Year to Date

As shown above, personnel costs were $198k unfavourable for the month and $171k unfavourable for the year to date. Medical costs (direct) were $70k unfavourable in February and 10FTE favourable. Year to date direct costs are $135k under budget and 9.6FTE favourable.

o SMO direct costs are $35k unfavourable for the month and $585k favourable ytd. The major components of this monthly variance are;

$146k favourable – FTE under budget by 7FTE (YTD $1,112k and 6FTE). There will be

some offset against this favourable variance in outsourced costs. (Eg OBEs and Gynae.

Offset by $120k unfavourable allowances ($876k ytd). This is overstated by $60k due to an

incorrect Joint Clinical accrual. $57k unfavourable stat leave valuation. ($174k ytd)

o RMO direct costs are unfavourable for the month by approx $35k due to;

$73k favourable – FTE under budget by 8FTE (YTD $767k and 9FTE ) Offset by $45k unfavourable overtime ($531k ytd) $64k unfavourable leave taken to budget ($219k ytd)

64

Indirect Medical costs are $18k favourable for the month driven by course fees, recruitment and relocation costs. Year to date indirect medical costs are $353k under budget driven mainly by course fees ($324k).

Nursing costs (direct) are $211k over budget and 20FTE unfavourable in February. Year to date direct nursing costs are $1.4m over budget and 13FTE unfavourable (NB: if the vacancy factor was removed, the monthly costs would be $80k over budget and 2FTE favourable. YTD costs would be $350k over budget and 9FTE favourable)

The monthly unfavourable variance is driven by; $93k – 20 FTE over budget ($423k ytd) $25k –Stat leave not taken to budgeted levels. $40k – ACC payments under budgeted. ($257k ytd)

It is pleasing to note that both annual leave taken and overtime are on budget for the month. Both these areas are being managed closely as part of the financial recovery plan.

ODHB - Analysis of Overtime Hours (excl callback)

0

500

1,000

1,500

2,000

2,500

Jul-0

8

Aug-0

8

Sep-0

8

Oct-08

Nov-0

8

Dec-0

8

Jan-

09

Feb-0

9

Mar

-09

Apr-0

9

May

-09

Jun-

09

Jul-0

9

Aug-0

9

Sep-0

9

Oct-09

Nov-0

9

Dec-0

9

Jan-

10

Feb-1

0

ROSTER GAP

MAINTENANCE / PROJECT

COVER ILLNESS/INJURY

ACUITY OF WORKLOAD

PERSONNEL_GROUP NURSING PERSONNEL Group (All)

Sum of HRS

Month

DUTY_REASONCON

Indirect Nursing costs are $22k favourable for the month and $312k favourable year to date, driven mainly by course fees currently $36k under budget for the month and $272k under budget ytd. The majority of this variance however is a budget allocation for Nursing CTA spend for which revenue is received. Currently costs (which consists largely of FTE cover for ODHB staff and outside staff attending courses) are well under revenue being received.

Allied Health costs (direct) are $123k over budget and 8FTE unfavourable in February. Year to date direct allied health costs are $843k over budget and 0.5FTE favourable. (NB: If the vacancy factor was removed, ytd costs would be $446k under budget and 29.5 favourable)

This overrun in costs is consistent with the prior months of this year, although fluctuations in the size of the variance are depending largely on amounts of annual leave being taken. The major monthly variances are; o $18k unfavourable annual leave variance as less leave taken than budgeted ($157k ytd).

65

o $20k unfavourable variance due to 5 additional FTE over budget ($129k fad and 3 FTE fad ytd) o $18k allowances paid in excess of budget due to new MECA increases re call back not being

budgeted. YTD the impact of this is $155k unfavourable and we expect this variance to continue at this level ($200k unfavourable impact for the year)

o $36k overtime payments in excess of budget ($205k unfavourable ytd). o $11k unfavourable due to rates paid in excess of budget ($240k ytd). As mentioned previously,

this is due to the fact that some staff have gone up more than one step budgeted merit steps have been received that weren’t budgeted. interns / assistants that were budgeted no longer exist as they have moved up to the

next grade receiving significant increases. The low staff turnover has altered the staff mix that was used for budgeting.

Indirect Allied Health costs are favourable for the month by $17k and $135k ytd due to favourable variances in professional membership fees, training and recruitment costs. These are also favourable ytd however it is expected that professional fees may be on budget at year end, the variance representing a timing difference in when the costs are budgeted against when they are paid.

Support Personnel costs (direct) are favourable ytd by $122k due to FTE being favourable by 5FTE. Management / Admin costs (direct) are $126k under budget in February and 10FTE favourable. Year to date Management / Admin costs are $855k under budget and 10.5FTE favourable.

The monthly variance in direct costs is driven by o $39k driven by favourable rate variations ($478k ytd), due to budgeted increases being

higher than actuals o $38k favourable 9FTE variance ($397k and 11FTE ytd), o $32k reversal of backpay accrual.

On a year to date basis, the variance is also impacted favourably by $186k of prior period staffing costs transferred to the Balance Sheet for staff working on IPM and BI projects.

Indirect Management / Admin costs are $22k favourable for the month and $259k year to date driven by course fees and professional membership fees not spent to budget.

DAP assumption re wage growth As per the DAP assumptions, wages must be managed within the inflationary component of 2.6%.

66

4. Outsourced Costs

Outsourced costs are under budget by $13k in February as follows.

Description Feb 10 Variance

Fav/(Unfav) $000's

YTD Variance Fav/(Unfav)

$000's

YTD Variance as % YTD Budget

Medical Personnel (25) (223) (22%)Nursing Personnel 1 2 10%Allied Health Personnel 8 38 21%Support Personnel 5 38 24%Management/Administration Personnel 1 (2) (11%)Outsourced Clinical Services 28 (340) (16%)Outsourced Corporate / Governance Services (5) (25) (7%)

Total 13 (512) (13%)

o Outsourced Medical Personnel variance driven by Obstetrics and Gynaecology cover for vacant position. This locum position will be in position until late March when the vacancy is filled.

o On a ytd basis the Outsourced Clinical Services unfavourable variance is driven by ;

o University of Otago for subcontracting of HEHA contract invoiced back to Feb09 ($113k), offset by personnel costs.

o SDHB for 0.3FTE Midwifery Director invoiced from Dec08 ($56k) - offset by vacancy and

o Outsourced skin lesion procedures performed by general practitioners ($100k). Offset revenue received.

o Outsourced procedures to Mercy Hospital - $172k. This is made up of 61 ENT procedures @ $150k + $22k for 4 orthopaedic procedures (bunions and shoulder decompression)

5. Clinical Supplies

Clinical Supplies were $314k favourable in February and $315k favourable ytd.


Fav/(Unfav) $000's


$000's


Treatment Disposables (14) (549) (5%)Diagnostic Supplies & Other ClinicalSupplies

15 (12) (1%)

Instruments & Equipment 67 196 3%Patient Appliances (62) (23) (2%)Implants and Prostheses 93 (394) (9%)Pharmaceuticals 232 1,242 13%Other Clinical & Client Costs (17) (145) (20%)

Total 314 315 1%

67

Treatment Disposables The only material unfavourable outliers this month were both in blood products, Intragram which was $51k over budget and Novoseven for a SDHB haemophilia patient $83k, which is offset by revenue (invoice to haemophilia pool). Favourable variances across the board in other categories reduced this to an overall unfavourable variance of $14k for the month.

o Intragram – despite last month forecasting that the trend in Intragram usage was unlikely to

continue, Februarys expenditure continue to materially overrun budget. Patient presentations in February that drove this were;

o One of the acute Neurology cases who presented in January re-presented in Feb (very unusual for this to happen - less than one case per year) and received a further large dose.

o A second Neurology patient received treatment and is not expected to return. o One further case that has been using very large amounts is proving very difficult to

manage. This may continue for a few more months.

The department has now forecast that expenditure is likely to drop in March, however it is not known by how much. This impacts on savings forecast in the financial recovery plan, the forecast for Intragram now understated.

Instruments and Equipment is under budget by $67k for the month and $196k ytd. The favourable monthly variance is driven by continuing low clinical depreciation ($48k favourable), lower than average repairs and maintenance ($25k favourable) and minor purchases being down on budget by $19k. Depreciation was impacted by a change in the useful life of assets purchased in the current financial year from 5 years to 7 years as budgeted. The other two expenses by their nature are variable month to month. These favourable variances are offset by lease payments for the “Stealth” equipment used in Neurosurgery which is being rented at $5k per procedure. Purchase of this equipment would represents a significant saving to the DHB, however this has been postponed until the final structure of Neurosurgery is set for the South Island.

Implants and Prosthesis are favourable to budget by $93k in February ($394k unfavourable ytd), driven by:

o Hip and Knees favourable to budget by $78k (ytd $71k fav) due to lower than budgeted volumes. Additional elective hips and knees have been budgeted from Jan10 to June10. At the end of February there has been 243 hips and knee performed against a financial volume budget of 245. Section 10 provides an explanation of the forecasted variance for hips and knees

o Cardiac implants are on budget for the month however still $116k over budget ytd. Although a

portion of the ytd variance can be offset against revenue from other DHB’s, the variance is impacted on by the use of a high cost stent used in lieu of Cardiac surgery ($16k per stent). This procedure is performed by Cardiologists and may be used where the patient is not fit enough to undertake cardiac surgery and where the clinical outcomes may be acceptable or just as good through the implantation of the stent.

o Spinal plates and screws are over budget for the month by $45k ($408k over budget ytd.) YTD

this has been driven by an increase in Scoliosis, a catch up of spinal procedures, and an increase in high cost cervical spine procedures performed at the start of the financial year.

68

Pharmaceuticals were favourable to budget by $232k for the month ($1.2m ytd) The majority of this favourable variance ($900k) occurs within two cost centres

Pharmacy outpatient drugs Pharmacy production unit

A review of the Pharmacy Outpatient Unit shows a bigger movement in ytd costs to budget compared to revenue (ytd $280k revenue v $501k costs). The reason for this is simply due to revenue being under budgeted.

Cost Centre Descrip Account type Month Actuals

Month Budget

Month Variance

YTD Actual YTD Budget YTD Variance

Annual Budget

Pharmacy - Outpatient Drugs Revenue ($207) ($354) ($147) ($2,552) ($2,832) ($280) ($4,248)

($42) ($84)Expenses $266 $371 $105 $2,468 $2,970 $501 $4,454

Pharmacy - Outpatient Drugs Total $59 $17 $137 $222 $206 A review of the Pharmacy Production Unit shows a direct correlation between movements in revenue and movements in costs against budget. Herceptin revenue wasn’t budgeted for the 12 month Herceptin however this has been offset by a decrease in PCT revenue received compared to budget

Cost Centre Descrip Account type Month Actuals

Month Budget

Month Variance

YTD Actual YTD Budget YTD Variance

Annual Budget

Pharmacy - Production Revenue ($275) ($292) ($17) ($1,954) ($2,336) ($382) ($3,505)

($5)Expenses $351 $363 $12 $2,500 $2,904 $404 $4,356

Pharmacy - Outpatient Drugs Total $76 $71 $546 $568 $21 $852

6. Non Clinical

Non clinical costs are unfavourable by $187k in February and $317k year to date;


Fav/(Unfav) $000's


$000's


Hotel Services, Laundry & Cleaning 51 171 3%Facilities (40) (295) (3%)Transport 46 196 11%IT Systems & Telecommunications 47 (278) (6%)Interest & Financing Charges (215) 203 3%Professional Fees & Expenses (1) 196 28%Other Operating Expenses 3 (121) (6%)Budgeted Savings - VFM (78) (389) 100%

Total (187) (317) (1%) Hotel Services, Laundry and Cleaning favourable ytd variance of $171k continues to be driven by savings in patient meals ($149k) and cleaning supplies ($69k). Partially offsetting these is an unfavourable trend in laundry costs, exacerbated during the year by the H1N1 pandemic. Facilities unfavourable variance of $40k ($295 ytd) is driven by;

o Maintenance costs are $74k over budget for the month although $71k favourable ytd. The monthly overrun is due to deferred maintenance expenditure to repair the concrete spalling on the outside of the main ward block.

69

o Steam costs which are $63k unfavourable for the month ($403k ytd) due to a price increase of

over 70% (20% budgeted). A price fall is expected from April 2010 as Meridian Energy boiler upgrades are completed.

o Gas charges are $65k under budget for the month, the ytd variance being $43k favourable.

The monthly variance is to due to invoices being received for less than what was accrued. We still expect year end expenditure to be on budget as the budget was not phased to reflect winter usage.

o Electricity charges are lower than budgeted, both monthly and ytd. The budgeted consumption

increase of 3% does not appear to be eventuating at this stage and savings due to EECA (Energy Efficiency Contract) are being realised.

70

IT Systems and Telecommunications are favourable to budget by $47k (unfavourable $278k ytd) driven by;

o Operating Leases are only $7k over budget this month ($282k ytd) due to an overaccrual based on the last invoice received in December. Equipment has dropped off the leasing schedules reducing the monthly charge back to around $30k. An initial offer has been made to the leasing companies to buy out these leases at nominal value, as a high % of the fair market value of these has already been paid (in some cases exceeded). A counter offer has been received which is being negotiated.

o Maintenance Fees are $78k under budget this month ($11k over ytd), due to 3 one-off

adjustments / recharges to 3rd parties , being;

o recharge to SDHB for share of Oracle licensing o write back of accrual held for Pharmacy system, as actual invoice received less than

expected o reversal of old uncosted orders.

o Mobile phones charges ($55k over budget ytd) and line rentals ($81k over budget ytd). There

has been no movement on the review of this with our provider. We will have a follow up report in next months HAC.

o Data net work and Internet Fees are $161k favourable to budget ytd. This is a result of

invoicing SDHB for their share of data network charges, which were understated in the budget. Interest and Financing Charges as per last month a rolling YTD equity position has been used to calculate the monthly charge which is not how was budgeted. It is envisaged that this will avoid large wash-up calculations at year end and while this has created a $199k unfavourable variance for the month ($125k favourable ytd); the year end position will be the same. We have requested the methodology be changed and pending that, will calculate capital charges on this basis holding any difference as either a debtor or creditor. Other Operating Expenses ytd unfavourable variance of $120k is driven by $202k doubtful debts on non residents and increased postage charges. Partially offsetting these are savings in Corporate training, printing and stationery and minor equipment purchases. Budgeted Savings VFM –this will appear as a one line unachieved savings target, the value for money report identifying where the savings are actually occurring.

71

7. Financial Statements – February 2010

Current Month Year to Date Annual

Part 2: DHB provider Actual Budget Variance Variance Actual Budget Variance Variance Budget$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

Part 2.1: Statement of Financial Performance

REVENUE

Ministry of Health MoH - Personal Health 430 293 137 F 47% 2,778 2,342 437 F 19% 3,512 MoH - Mental Health - - 0 F n/m - - 0 F n/m - MoH - Public Health 509 559 (50) U (9%) 4,331 4,472 (140) U (3%) 6,707 MoH - Disability Support Services 547 574 (27) U (5%) 4,454 4,593 (139) U (3%) 6,889 MoH - Maori Health - - 0 F n/m - - 0 F n/m - Clinical Training Agency 406 440 (34) U (8%) 3,613 3,732 (118) U (3%) 5,472 Internal - DHB Funder to DHB Provider 22,903 22,797 105 F 0% 179,770 180,433 (663) U 0% 271,623Ministry of Health Total 24,794 24,663 131 F 1% 194,947 195,571 (624) U 0% 294,204

Other Government Other DHB's 364 309 55 F 18% 3,204 2,479 724 F 29% 3,719 Training Fees and Subsidies - 13 (13) U (100%) 77 103 (25) U (25%) 154 Accident Insurance 531 552 (21) U (4%) 4,359 4,564 (205) U (5%) 6,850 Other Government 451 326 124 F 38% 3,152 2,529 623 F 25% 3,835Other Government Total 1,345 1,200 145 F 12% 10,792 9,675 1,116 F 12% 14,559

Government and Crown Agency Total 26,139 25,863 276 F 1% 205,738 205,246 492 F 0% 308,763

Other Revenue Patient / Consumer Sourced 120 125 (5) U (4%) 1,105 1,013 92 F 9% 1,520 Other Income 680 442 238 F 54% 5,415 3,568 1,847 F 52% 5,359Other Revenue Total 800 567 233 F 41% 6,520 4,581 1,939 F 42% 6,879

REVENUE TOTAL 26,939 26,430 509 F 2% 212,258 209,827 2,431 F 1% 315,642

EXPENSES

Personnel Expenses Medical Personnel (4,828) (4,776) (52) U (1%) (39,928) (40,416) 488 F 1% (61,656) Nursing Personnel (5,797) (5,591) (206) U (4%) (49,260) (48,052) (1,208) U (3%) (73,045) Allied Health Personnel (2,474) (2,369) (105) U (4%) (20,550) (19,842) (708) U (4%) (30,484) Support Services Personnel (468) (494) 25 F 5% (4,072) (4,214) 143 F 3% (6,409) Management / Admin Personnel (1,813) (1,955) 142 F 7% (15,494) (16,612) 1,118 F 7% (25,247)Personnel Costs Total (15,381) (15,185) (196) U (1%) (129,304) (129,136) (168) U (0%) (196,840)

Outsourced Expenses Medical Personnel (129) (103) (25) U (25%) (1,215) (992) (223) U (22%) (1,418) Nursing Personnel (1) (3) 1 F 51% (18) (20) 2 F 9% (30) Allied Health Personnel (15) (23) 8 F 34% (145) (183) 38 F 21% (275) Support Personnel (13) (19) 5 F 29% (118) (156) 38 F 25% (234) Management / Administration Personnel (1) (2) 1 F 43% (20) (18) (2) U (11%) (26) Outsourced Clinical Services (235) (262) 28 F 11% (2,430) (2,090) (340) U (16%) (3,142) Outsourced Corporate / Governance Services (53) (48) (5) U (11%) (409) (384) (25) U (7%) (576) Outsourced Funder Services - - - n/m - - - n/m -Outsourced Services Total (447) (460) 13 F 3% (4,354) (3,843) (511) U (13%) (5,700)

Clinical Supplies Treatment Disposables (1,389) (1,375) (14) U (1%) (12,288) (11,739) (549) U (5%) (17,610) Diagnostic Supplies & Other Clinical Supplies (77) (92) 15 F 16% (817) (805) (12) U (1%) (1,203) Instruments & Equipment (818) (885) 67 F 8% (7,005) (7,201) 196 F 3% (10,777) Patient Appliances (188) (126) (62) U (49%) (1,125) (1,102) (23) U (2%) (1,653) Implants & Prosthesis (525) (618) 93 F 15% (4,733) (4,339) (394) U (9%) (6,788) Pharmaceuticals (959) (1,192) 232 F 19% (8,309) (9,551) 1,242 F 13% (14,327) Other Clinical Supplies (108) (90) (17) U (19%) (881) (736) (145) U (20%) (1,105)Clinical Supplies Total (4,064) (4,379) 315 F 7% (35,158) (35,473) 316 F 1% (53,464)

Infrastructure & Non Clinical Expenses Hotel Services, Laundry & Cleaning (661) (712) 51 F 7% (5,744) (5,915) 171 F 3% (8,873) Facilities (1,058) (1,018) (40) U (4%) (8,726) (8,431) (295) U (4%) (12,732) Transport (169) (216) 46 F 21% (1,531) (1,727) 196 F 11% (2,597) IT Systems & Telecommunications (542) (588) 47 F 8% (5,172) (4,895) (278) U (6%) (7,231) Interest & Financing Charges (990) (775) (215) U (28%) (5,903) (6,105) 203 F 3% (9,425) Professional Fees & Expenses (85) (84) (1) U (1%) (505) (701) 196 F 28% (1,053) Other Operating Expenses (252) (255) 3 F 1% (2,139) (2,018) (121) U (6%) (2,994) Subsidiaries & Joint Ventures - 78 (78) U 100% - 389 (389) U 100% 700Infrastructure & Non-Clinical Supplies Total (3,757) (3,569) (187) U (5%) (29,720) (29,403) (317) U (1%) (44,205)

Other Costs and Internal Allocations - - - n/m - - - n/m -

Total Expenses (23,649) (23,593) (56) U (0%) (198,536) (197,856) (679) U (0%) (300,208)

Net Surplus/ (Deficit) 3,290 2,837 453 F (16%) 13,723 11,971 1,751 F (15%) 15,434

72

Part 2.1 A: Supplementary Information to Statement of Financial Performance

Depreciation - Clinical Equipment (466) (511) 46 F 9% (3,815) (4,082) 267 F 7% (6,096) Depreciation - Non Res Buildings & Plant (336) (340) 3 F 1% (2,830) (2,725) (106) U (4%) (4,084) Depreciation - Motor Vehicles (1) (1) - (0%) (6) (6) - (0%) (9) Depreciation - Information Technology (276) (248) (28) U (11%) (2,091) (2,067) (25) U (1%) (2,985) Depreciation - Other Equipment (50) (38) (12) U (31%) (377) (320) (57) U (18%) (459) Total Depreciation (1,129) (1,138) 9 F 1% (9,120) (9,200) 80 F 1% (13,632) Interest Cost from Funder Loans - - - n/m - - - n/m - Interest Costs from CHFA (199) (209) 10 F 5% (1,722) (1,815) 93 F 5% (2,727) Financing Component of Operating Leases (69) (43) (26) U (61%) (377) (367) (10) U (3%) (529) Capital Charge (713) (514) (199) U (39%) (3,715) (3,841) 126 F 3% (6,048)

Part 1.2 : Full Time Equivalent Numbers Medical Personnel 316 327 316 326 326 Nursing Personnel 1,041 1,021 1,034 1,021 1,021 Allied Health Personnel 486 478 479 480 479 Support Personnel 140 146 142 147 147 Management / Administration Personnel 435 445 437 447 447 Total Full Time Equivalents (FTE's) 2,418 2,417 2,408 2,421 2,421

Mental Health

The table below shows a summary of the mental health result for February 2010.

AnnualActual Budget Variance Actual Budget Variance Budget$' 000 $' 000 $' 000 $' 000 $' 000 $' 000 $' 000

3,684 3,510 174 Revenue 27,635 28,071 (436) 42,110(2,256) (2,321) 65 Less Personnel Costs (19,098) (19,734) 636 (30,057)

(279) (315) 36 Less Other Costs (2,476) (2,674) 198 (4,014)1,149 874 276 Contribution Margin 6,062 5,663 398 8,039(696) (663) (33) Overhead Allocation (5,223) (5,305) 82 (7,959)

453 211 243 Net Surplus / (Deficit) 839 358 480 80

Month Year to Date

The table below shows the vacancies in each staff type.

Staff Type Month

FTEActual

MonthFTE

Budget

Variance Variance % to

BudgetMedical Personnel 29.6 37.2 7.6 20%Nursing Personnel 210.0 210.2 0.2 0%Allied Health Personnel 91.4 92.5 1.0 1%Support Personnel 0.0 - 0.0- Management/Administration P 42.8 44.4 1.6 4%Total FTE 373.9 384.3 10.3 3%

73

8. Capital

The following report shows major capital items planned and committed for the 2009/10 financial year and tracks expenditure against these assets. ODHB CAPITAL PLAN 2009/10MAJOR CAPITAL ASSETS 0

Major Asset (Yes/No) Yes

Major Asset Class Capital Description

Revised capex Plan

Capex Approved 2009

Capex Approved 2010

2009/10 Capital Expenditure

Funds Available to Commit

Building & Property 4th Floor Clin. Services BLDG- Respiratory Lab a 12,424 12,424 0 9,442 0Cath Lab renovation 661,800 0 661,847 683,282 (47)Community Alcohol and Drug - Relocation Fitout 400,000 0 0 41,181 400,000CSB-fire Alarm Upgrade Level(all) 44,500 44,500 0 0 0DSA Room Upgrade 600,000 0 0 0 600,000Dunstan Hospital Waste Water Plant 360,000 0 53,350 33,450 306,650Laboratory Redevelopment - Stage 2 123,883 123,883 0 34,247 0Laboratory Redevelopment - Stage 3 42,841 42,841 0 11,821 0NICU Upgrade 100,000 0 0 0 100,000Public Health South Relocation 48,106 48,106 0 40,879 0Security Services including Cameras 100,000 0 0 11,575 100,000Ward 10A layout alterations 178,000 0 177,952 7,180 48Ward Block- Cooling Towers 191,482 191,482 0 168,478 0

Building & Property Total 2,863,035 463,235 893,149 1,041,536 1,506,651Clinical Equipment Atherton Tangent Gorrilla Autoclave 3,941 3,941 0 0 0

Batch Washer Repairs 180,000 0 125,665 0 54,335Bucky Diagnost Ceiling Suspension System 157,000 157,000 0 157,000 0Camera light source tower x 2 200,000 0 147,685 147,685 52,315Cardiac Ultrasound Machine 150,000 0 0 0 150,000DSA Machine & Table-Mounted DSA Ultrasound M 2,200,000 0 0 0 2,200,000RFA System 225,000 0 224,226 0 774Treatment Planning System 165,000 0 165,000 0 0Ventilator 120,000 0 120,000 0 0

Clinical Equipment Total 3,400,941 160,941 782,576 304,685 2,457,424

Information Systems BEIMS Software 37,075 37,075 0 380 0Business Intelligence 763,781 290,091 0 216,908 473,690Cisco Call Manager Upgrade 200,000 0 22,011 20,482 177,990Cisco VG248-RF Digital Analog Converters 17,345 17,345 0 12,399 0Data - Protection 250,000 0 48,862 48,862 201,138Imaging Systems Storage 120,000 0 0 0 120,000Network - Upgrade & Expansion 500,000 0 186,718 95,440 313,282Network Core Uprade-Dn Hospital 17,656 17,656 0 0 0Patient Management System (IPM) 327,534 327,534 0 491,846 0Server Room 476,675 476,675 0 452,481 0Storage - Expansion 136,880 0 0 0 136,880Telecomms - Phone Upgrades 250,000 0 3,677 1,848 246,323MS Licensing Compliance 773,595 0 773,595 773,596 0PRA Compliance 68,440 0 0 7,669 68,440

Information Systems Total 3,938,981 1,166,376 1,034,863 2,121,910 1,737,742Grand Total 10,202,957 1,790,552 2,710,588 3,468,131 5,701,817

CHECK = zero 0MINOR CAPITAL ASSETS

Capital Description (All)

Major Asset Class Major Asset (Yes/No)

Revised Capex Plan

Capex Approved 2009

Capex Approved 2010



Building & Property No 683,999 535,999 15,794 399,009 132,206Clinical Equipment No 2,364,432 628,196 935,666 1,225,125 800,570Information Systems No 1,202,861 568,153 70,111 166,662 564,597Non Clinical Equipment No 628,005 103,895 83,866 88,807 440,244Grand Total 4,879,297 1,836,243 1,105,437 1,879,604 1,937,617

CHECK = zero 0CONTINGENCIES

Major Asset (Yes/No) (Multiple Items)

Major Asset Class Capital Description

Revised Capex Plan

Capex Approved 2009

Capex Approved 2010



Contingencies Contingency for 08/09 assets that missed the cut- 50,000 0 226,029 218,711 (176,029)Organisation-wide equipment 400,000 0 0 0 400,000Contingency Funds 1,179,294 0 317,319 168,444 861,975

Grand Total 1,629,294 0 543,348 387,155 1,085,946

CHECK = zero 0

Total excluding Funded & Donated Assets 16,711,548 3,626,795 4,359,372 5,734,889 8,725,381

CHECK = zero 0

74

9. Recovery Plan

A recovery plan was put in place as a result of the Dec09 forecast that forecast a year end deficit to budget of $1.3m at year end. The purpose of this was to focus management on areas where they believed they could have some impact on costs / revenue. A review of progress against the plan for January and February shows that we are currently ahead of the revised forecast (to break even) by $266k. This is tabled below.

Account Type Summary Classification YTD Revised

Forecast YTD

ActualsVariance

RevenueDonation assumption reviewed - expected to receive more 172 227 55Increase in pricing 83 122 39Forecast assumption revisited 110 34 (76)

(22)

(190) (178)

New contract for service 50 65 16Forecast assumption revisited re washup 8 208 199

Revenue Total 422 656 234Staff Costs Non appointment of positions 51 29

Review of all vocational groups course conference expenditure 12Overtime managementLeave mana

(111) (122) (12)gement

New Medical appointments 57 81 24Additional recruitment and relocation charges missed from ori

(233) (262) (29)

ginal forecast -Review of forecast miscellaneous salar

(22) (22)y items - - -

Staff Costs TotalOutsourced Costs Hi

(426) (474) (48)gher expenditure expected in next 6 months 22

Higher expenditure expected in next 3 months, then reduced

Outsourced Costs Total

Clinical SuppliesChange in depreciation methodology and inclusion of all char

(23) (1)

(44) (93) (49)(67) (94) (27)

ges 11Clinical supplies forecast aligned with volume activity

6Miscellaneous ad

(958) (947)

(512) (506)justments 41

Clinical Supplies Total 58Infrastructure and Non Clinic

(169) (128)(1,639) (1,581)

a Review of forecast assumptions 49Infrastructure and Non Clinical Supplies Total 49Grand Total 266

(570) (521)(570) (521)

(2,280) (2,014) The key unfavourable variances in the December forecast included:

$1.7m in nursing salaries where FTE exceed plan and leave is not being taken in line with plan (the leave component of $1m may be able to be mitigated)

$0.8m in allied health salaries where vacancy factors are not being met $0.6m (net) in implant and prosthesis costs due to volume and type of procedures $0.5m in coal costs following the closure of Ohai mines (this is reduced from April 2010) $0.6m in additional IT leasing costs where equipment coming off finance lease is being retained for use

Ongoing Actions that were identified to Mitigate Financial Risk

The 40 VFM projects within the provider-arm Finalisation of IT desktop business model (constrained by capital availability) Finalisation of energy project of Wakari (constrained by capital availability) NASC allocations for DSS utilisation Elective initiative delivery Discretionary expenditure budget restrictions (travel etc) Leave management & vacancy management

15Otago DHB HAC Meeting Financial Report v2 75

10. Contracts Database

CONTRACTS REGISTER - FEBRUARY 2010

NEW CONTRACTS ENTERED INTO FEBRUARY 2010

CONTRACT TYPE Expense ContractsProvider Name Description Signed by ExpiresOracle New Zealand LtdReplacement - supercedes prior contractual agreement

TOTAL CONTRACTUAL VALUE FEBRUARY 2010 = $176,215.88 TOTAL ANNUAL VALUE FEBRUARY 2010 = $176,215.88

CONTRACT TYPE Revenue ContractsProvider Name Description Signed by ExpiresClinical Training AgencyNew - no prior contractual agreementClutha Community Health Company LtdReplacement - supercedes prior contractual agreementMinistry Of Health - ChristchurchModified - variation of existing contractual agreementSouthern Cancer Network (Scn) - SissalReplacement - supercedes prior contractual agreement

University Of OtagoReplacement - supercedes prior contractual agreement

TOTAL CONTRACTUAL VALUE FEBRUARY 2010 = $1,382,498.06 TOTAL ANNUAL VALUE FEBRUARY 2010 = $957,320.00 x

23/12/2010ORACLE software update license and support Grant Taylor

Service Agreement Post Graduate Nursing Training Brian Rousseau 30/11/2010Contract for Provision of Outpatient Specialist Services between CCHCL and ODHB. Included services are: Asthma Educator, Endocrinology, Vivian Blake 30/06/2010

Agreement to allow the University access to Dunedin and Wakari Hospital premises and facilities to enable training of the University Dietrtic Students for 2010 Sonja Dillon 26/11/2010

Public Health Services Vivian Blake 30/06/2012ODHB to provide a Clinician to hold Joint Clinical Director - SCN role for 8 hrs a week as per agreement. Colleen Coop 27/03/2010

16 76

11. Budget Variances (excl personnel costs)

The following summary and detail tables show budget variances <> $50k and <>10% which also have no offsets.

Group name Revenue / Exp Variance Feb 10 YTD

Forecast Year End Forecast

Major Driver

Chief Operating Officer Revenue 728,765 828,765 Donations, cos t recoveriesExpenses g(16,313) (104,345) Le al Fees, Air Am bulance

Chief Operating Off icer To tal

Diagnos tic And Support Services Revenue Patient Co-

712,452 724,420

(51,701) (72,141) payments, Pharmac IncomeExpenses Reduct ion in dru262,672 316,370 gs wr it ten off , laboratory tests, and fuel

Diagnostic And Support Services Total 210,972 244,229

Emergency Medicine And Surgery Revenue 702,544 663,244Higher than expected Non resident income, Cardiac revenue from Auckland and back dated and current year PHO incom e.

Expenses

High levels of intragam use due to levels of acuity plus high lev els of theatre expenditure at start of year offset by c ardiology savings as budget set on high usage period in previous year

Emergency Medicine And Surgery Total

Finance Group Revenue 676,814 1,390,700 Kiwisaver Credit

ExpensesCoal - Solid Energy (monopoly) supply from W est Coast, previously O hai - additional f re ight.

Finance G roup To tal

Inform ation S ervices Group Revenue 54,225 69,225 O RACLE revenue billed to W CDHB for 2009/10 year

ExpensesAddit ional cos t to Jan 10 is the expens e on the PC lease rentals - expect savings on forecast of $160k

In formation S ervices Group Total

Mental Health And Community Services RevenueACC volum es under budget but increas ing, PA THS revenue recognised recently

Expenses O verf low to Asburn Hall les s than expectedMental Health And Community Services Total

W omens Child And Public Health Revenue 53,580 15,580Increased non res ident income offset part ia lly by increased doubtful debts

ExpensesLocum cover for SMO vacancy in Obs & G ynae, Sm ok efree expenses

(223,375) (338,294)479,169 324,950

(240,005) (383,909)436,809 1,006,791

(317,587) (406,448)(263,362) (337,223)

(415,939) (480,918)88,837 133,256

(327,101) (347,662)

(216,585) (112,310) (offsets revenue)W om ens Child And Pub lic Health Total

Grand Total 1

(163,005) (96,730)

17

,085,933 1,518,775 Detailed variances and explanations are tabled below. Some omissions and follow up still required.

77

Revenue Variances

Cost Centre

Cost Centre Descrip Object Object Descrip Sub Code

YTD Act $ Feb 10

YTD Budg $ Feb 10

Variance YTD Feb 10

Variance %

2009-10 Budget

Forecast for y.e June10

Variance from Budget

Forecast Year End variance

Comments

8000 Chief Operations Officer 1864 Other Income 00000 325,453 325,453 100% 325,453 325,453 325,4538000 Chief Operations Officer 1855 Donations 00000 403,313 403,313 100% 503,313 503,313 503,313 Forecast additional $100k on ytd actuals

5122 Pharmacy - Outpatient Drug 1724 Patient Co-Payments - PharmPCG 120,797 172,497 (51,701) (30%) (72,141) (72,141)258,746 186,605

Income down because patients are exempted from prescription charges on reaching 20 items for the year. New charging year starts in Feb 10.

5122 Pharmacy - Outpatient Drug 1916 Patient Co-Payments - Pharm00000 2,427,066 2,596,053 3,894,080 3,690,599Pharmac income down due to less prescriptions filled.

8140 Critical Care Service Reven 1714 Non-Residents 00000 61,974 61,974 100% 61,974 61,974 61,974

Levels of non-resident income uncertain. Forecast based on budget + current year variance.

8122 ED & Internal Medicine Ser

(168,987) (7%) (203,481) (203,481)

v 1714 Non-Residents 00000 92,042 24,667 67,375 273% 37,000 104,375 67,375 67,375

Levels of non-resident income uncertain. Forecast based on budget + current year variance.

8122 ED & Internal Medicine Serv 1694 Other Government AHR 102,524 102,524 100% 147,524 147,524 147,524 PHO After Hours Revenue8123 Oncology/Renal/Respiratory 1607 Auckland DHB 00000 311,386 311,386 100% 311,386 311,386 311,386 Cardiac cases8123 Oncology/Renal/Respiratory 1864 Other Income 00000 188,724 100,000 88,724 89% 150,000 216,724 66,724 66,724 Unbudgeted salary reimbursement8136 Specialist Surgery Service R 1637 Canterbury DHB 00000 24,050 96,000 144,000 36,075 Scoliosis now part of IDF8136 Specialist Surgery Service

(71,950) (75%) (107,925) (107,925)R 1643 Southland DHB 00000 163,349 216,000 324,000 245,024 Scoliosis now part of IDF

8136 Specialist Surgery Service (52,651) (24%) (78,976) (78,976)

R 1684 Accident Insurance ECS 101,212 195,840 293,760 199,132 Forecast = YTD variance + bud(94,628) (48%) (94,628) (94,628) get8136 Specialist Surgery Service R 1684 Accident Insurance TRS 1,289,790 1,000,000 1,500,000 1,789,790 Forecast = YTD variance + bud289,790 29% 289,790 289,790 get8230 Corporate Finance BA 1804 Interest 00000 415,714 560,000 840,000 623,5728230 Corporate Finance BA 1935 Funder - Public Health 00000 287,554 191,333 287,000 431,3318230 Corporate Finance BA 1955 Funder - Maori Health 00000 62,249 62,249 100% 93,374 93,374 93,3748230 Corporate Finance BA 1864 Other Income 00000 75,361 75,361 100% 75,361 75,361 75,3618230 Corporate Finance BA 1808 Kiwisaver - SSC Subsidies 00000 862,707 862,707 100% 1,294,061 1,294,061 1,294,061 Not bud

(144,286) (26%) (216,428) (216,428)96,221 50% 144,331 144,331

geted8231 Budget Reconciliation 1714 Non-Residents 00000 192,613 288,920 288,920 Bud(192,613) (100%) g rec cost centre. No actuals8231 Budget Reconciliation 1704 Private Patients 00000 82,827 124,240 124,240 Bud(82,827) (100%) g rec cost centre. No actuals

8244 Business Systems 1635 West Coast DHB 00000 54,225 54,225 100% 69,225 69,225 69,225

Oncharging for Oracle (prior period). Need to allow $15k for period Oct09 - Jun10. Partial expense offset 8244.5350.ORACL

8117 Group Manager Disability S 1684 Accident Insurance HBN 89,783 152,560 228,840 166,063

Difficult to gauge referrals for ACC contracts now as ACC pulling back in many areas.

8117 Group Manager Disability S 1684 Accident Insurance RAR 540,666 691,868 1,039,226 888,023

Difficult to gauge numbers of ACC patients to be admitted, and also ACC response for NAR and RAR contracts (both due for renewal during this financial year). ACC currently pulling back funding, and so likelhood is that we may go under expected revenue b

(62,777) (41%) (62,777) (62,777)

(151,203) (22%) (151,203) (151,203) y

3174 Psychological Medicine 1550 Clinical Training Agency 00000 162,746 440,233 660,350 280,120

Less revenue for CTA funded MH Registrar positions due to vacancies and 2 Registrars no longer eligible for funding. 2 new registrars may be eligible so revenue may increase by year end.include at $4.5k each from March

8024 Group Manager Intermedia

(277,487) (63%) (380,231) (380,231)

1694 MoH - Non Base Contracts 00000 75,528 75,528 100% 113,291 113,291 113,291

PATHS revenue invoice catch up. Not budgeted as not confirmed beyond 30 june 2009 at budr get time.

8114 Service Manager Womens 1714 Non-Residents 00000 53,580 53,580 100% 15,580 15,580 15,580

Non resident income not budgeted, less $38k Doubtful Debt, not specifically identified on the anal

18

ysis

78

Expense Variance

Cost Centre


YTD Act $ Feb 10

YTD Budg $ Feb 10

Variance YTD Feb 10

Variance %

2009-10 Budget




Comments

8000 Chief Operations Officer 5510 Consultants Fees 00000 (53,250) (79,990) (79,990)(69,563) (69,563) (104,345) (104,345) (104,345)(18,155) (101,379) 83,224 (152,069) (36,796) 115,273 115,273

53,250 100%8000 Chief Operations Officer 5515 Legal Fees FRAUD 100% Unbudgeted fees for Swann5121 Pharmacy - Production 4700 Pharmaceuticals STK 82% Cost of stock disposed off

5122 Pharmacy - Outpatient Drug 4700 Pharmaceuticals 00000 266,384 53% 378,140 378,140

The reduction in purchases for non-subsided drugs has reduced the internal charges to cost centres

5122 Pharmacy - Outpatient Dru

(237,572) (503,956) (755,934) (377,794)

g 4700 Pharmaceuticals INT 87,718 300,907 451,361 151,447

The reduction in purchases is related to decrease in the internal charges for non-subsided drugs

5122 Pharmacy - Outpatient Dru

(213,189) (71%) (299,914) (299,914)

g 4700 Pharmaceuticals OPD 467,374 16% 622,210 622,210Expecting average spend per month to be $317k for the period Mar10 to Jun10.

5076 Mammography Programme 3620 Laboratory Sendaway Tests 00000 21,745 108,412 125% 119,745 119,745

Invoices from SCL averaging $8k per month. The actual includes an accrual carried over from last year.

8112 Vehicle Management 5220 Fuel 00000 71,037 81,352 81,352

Expecting average spend per month to be $31k for the period Mar10 to Jun10. Reverse of accrual for $30k reduced Nov09 expenditure.

3300 Main Operating Theatre 4095 Perfusion Materials 00000 74,169 30% 111,767 111,767Slight reduction in cardiac surgery cases requiring perfusion.

3300 Main Operating Theatre 4115 Sutures 00000

Sutures are variable each month. Double order in July (occures in one month each year). Expenditure since then has only decreased slightly to below budget. Have estimated forecast at budget plus YTD variance.

3300 Main Operating Theatre 4120 Staples & Accessories 00000

There is a trend for a greater use of staplers. In 07/08 we spent $270k, last year we spent $350k and this year there is a further increase. There has been little price variation so this is not a factor. The trend towards increased stapler use is due to

3300 Main Operating Theatre 4190 Patient Consumables 00000

First full year usage of penevac. Budget based on 12mths to Oct 08 which included on $12k of penevac expenditure. Actuals to Feb 09 = $68k.

3300 Main Operating Theatre 4340 Clinical Equipment - Minor

(2,376,185) (2,843,559) (4,265,338) (3,643,128)

(86,667) (130,000) (10,255)

(200,297) (271,333) (26%) (407,000) (325,648)

(175,489) (249,658) (375,000) (263,233)

(473,643) (399,452) (74,191) (19%) (600,000) (674,191) (74,191) (74,191)

(291,215) (214,067) (77,148) (36%) (321,100) (436,823) (115,723) (115,723)

(247,119) (189,740) (57,379) (30%) (285,000) (370,679) (85,679) (85,679)

P 00000 94,579 55% 142,221 142,221

Coding of items now being made to correct object codes. Positive budget variance expecetd to run at consistent levels till end of year.

3300 Main Operating Theatre 4365 Clinical Equipment - Operati

(76,786) (171,365) (257,400) (115,179)

n00000Stealth hire. Forecast based on budget + YTD var.

3300 Main Operating Theatre 4590 Implants and Prostheses -

(87,810) (4,170) (83,640) (2006%) (6,270) (89,910) (83,640) (83,640)

O00000

The budget is insufficient for 09/10. The cost drivers in this code include shoulder surgery, hand surgery, foot surgery, thermal ablations (Gynae) and aneurysm clipping (neurosurgery). Some of these procedures are new to the DHB following employment of

3000 General Medicine Medical (240,934) (166,438) (74,496) (45%) (250,000) (324,496) (74,496) (74,496)

19

s 3105 Medical Fees for Service - S 00000 Sabbatical not taken(60,000) 60,000 100% (60,000) 60,000 60,000

79

Expense Variance (contd)

20

Cost Centre


YTD Act $ Feb 10

YTD Budg $ Feb 10

Variance YTD Feb 10

Variance %

2009-10 Budget




Comments

3308 General Surgery Treatment 4560 Shunts and Stents 00000 110,443 41% 135,333 135,333

Less endoluminal stents used than expected. Forecast that 2/3rds of budget will be expended by the end of the year.

3308 General Surgery Treatment 4565 Spinal plates and screws 00000

Variance based on actuals & monthly usage. At the start of the year a significant number of cervical spine procedures utilising expensive implants (up to $30k per procedure) were performed. In February expenditure increased again with some high cost neu

3410 Cardiac Theatre Consuma

(160,223) (270,667) (406,000) (270,667)

(174,085) (84,000) (90,085) (107%) (126,000) (261,127) (135,127) (135,127)

b 4510 Cardiac Implants 00000

Partly due to undertaking Auckland DHB cases. Has a revenue offset. Expenditure decreased to less than budget since Dec 09.

3511 Cardiology labs 4025 Catheters 00000 152,377 23% 152,377 152,377

Decrease in usage of bare metal stents due in part to cath suite outage in August 09. Up till end of Feb 297 bare metal stents inserted compared to 376 last year (i.e. 21% decrease)

3511 Cardiology labs 4140 Customized Procedure Pac

(317,500) (213,050) (104,450) (49%) (320,010) (424,460) (104,450) (104,450)

(516,705) (669,082) (1,005,000) (852,623)

k00000 100%

New use of procedure packs. Offset cost in sterilising and catheter code. Usage is $11,500 per month

3511 Cardiology labs 4550 Pacemakers 00000 122,170 20% 122,170 122,170

Budget was based on usage for 6 months up to December 08 which had high usage, overall cost for 08/09 was $800, therefore budget for 09/10 $100k higher. Volumes also down compared to last year, 104 pacemakers inserted till Feb compared to 120 last year.

3511 Cardiology labs 4700 Pharmaceuticals INT 59,970 60% 86,170 86,170

Due in part to cath suite outage in Aug 09, plus budget set based on Nov 08 extrpolated which was a high 5 month pharmacy period. Forecast based on YTD actuals plus $6k per month.

3652 Renal / Nephrology Unit 4700 Pharmaceuticals INT 56,278 52% 56,278 56,278

Dialysis unit pharmaceuticals highly sensitive to demand driven prescribing of high cost medicines, particularly post transplantation. To date these costs have not eventuated.

5030 Haemophiliac 4010 Blood - Intragam 00000

Further high cost month in February due to additional case plus ongoing treatment of 2 patients (very unusual). Forecast based on costs of $90k per month till end of year.

6461 Building & Property Service

(54,654) (54,654) (100,654) (100,654) (100,654)

(477,830) (600,000) (900,000) (777,830)

(40,030) (100,000) (150,200) (64,030)

(52,042) (108,320) (162,700) (106,422)

(870,651) (533,333) (337,318) (63%) (800,000) (1,230,651) (430,651) (430,651)

s 5162 Utilities - Electricity 00000 102,826 13% 143,191 143,191

Savings coming from the work we have done with EPCII. and electricity price increase budgeted too high


(715,779) (818,605) (1,311,523) (1,168,332)

s 5166 Utilities - Steam 00000Coal increase. Decrease expected from 1st April (as per RMJ)


(1,392,747) (990,135) (402,612) (41%) (1,487,240) (1,980,788) (493,548) (493,548)

5151 Maintenance - Carpentry DEFdeferred maintenance on concrete spalling

(120,943) (66,667) (54,276) (81%) (100,000) (154,276) (54,276) (54,276)s 80

21 Otago DHB HAC Meeting Financial Report v1

Expense Variance (contd)

Cost Centre


YTD Act $ Feb 10

YTD Budg $ Feb 10

Variance YTD Feb 10

Variance %

2009-10 Budget




Comments

8230 Corporate Finance BA 5530 Insurance 00000 (17,776) (94,460) (141,880) (65,196)76,684 81% 76,684 76,684 Prior years prepayments reversed.8230 Corporate Finance BA 5605 Other Equipment - Depreciat000008231 Budget Reconciliation 5045 Cleaning Supplies 00000 Prior years prepayments reversed.

6015 Telephone Services 5355 Telecommunications - Line

(376,037) (320,077) (55,960) (17%) (458,820) (514,780) (55,960) (55,960)(93,333) 93,333 100% (140,000) (140,000)

R00000

Possible over charging by Telecom and increased CDMA Data usage. Still investigating. Additional one off charges in Feb of $20k excluded in YTD extarpolation

6015 Telephone Services 5375 Telecommunications - Repa 00000Prior year costs in actuals, also $20k for PABX repairs budgeted in 8245-5330

8244 Business Systems 5340 Software Charges - Mainten

(136,361) (75,648) (60,713) (80%) (113,627) (194,542) (80,915) (80,915)

(156,116) (70,037) (86,079) (123%) (105,200) (190,246) (85,046) (85,046)aNASC Offset by NASC revenue

8245 IT Network 5320 Information Technology - Le

(135,933) (41,467) (94,465) (228%) (62,201) (197,345) (135,144) (135,144)

a00000

Expected to continue unless Thin Client spend affordable within current cost structure (no capital budget). Have reviewed current rentals and proposal to buyout existing rentals at a price less than FMV from IBM-GF based on rentals paid to date. Forecast

8245 IT Network 5330 Hardware - Repairs & Maint

(296,633) (296,633) (100%) (436,633) (436,633) (436,633)

e00000 61,945 92,418 92,418Less hardware repairs than expected. Offset in 6015.5330

8245 IT Network 5350 Telecommunications - Data 00000 158,358 24% 238,872 238,872

favourable variance due to backdated invoicing to SDHB. And miscoded expense in 8243.5350

2500 Acute Psychiatric 1A 3690 Outsourced Clinical Service

(5,037) (66,982) (100%) (101,054) (8,636)

(490,538) (648,896) (974,679) (735,807)

s00000 88,837 89% 133,256 133,256

Ashburn Clinic - bed demand running at 10 -12, budgeted at 50/mth. Year end forecast expected to be same as for first 6 months of year.

3036 Obs and Gynae Medical St

(11,163) (100,000) (150,000) (16,744)

a 3105 Medical Fees for Service - S 00000 100%Bill Clow , employed for 7 weeks during Jan/Feb/Mar covering vacancy.(216,585) (216,585) (112,310) (112,310) (112,310)

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Hand Hygiene Project

StatusCommentaryName % TasksComplete

To improve hand hygiene compliance among healthcare workers and thereby reduce the transmission of healthcare-acquired infections.�Goal 1: Culture change - adopt and promote behaviour which supports good hand hygiene practices.�Goal 2: Introduce and support a hand hygiene programme where all healthcare workers complete appropriate hand hygiene before and after every patient contact.�Goal 3: Monitor and evaluate outputs and outcomes of the hand hygiene programme.

Objectives

1. Implemented hand hygiene programme as per the national guidelines.�2. Development and delivery of a hand hygiene education package for staff.�3. System for ongoing monitoring, analysing and reporting of outputs and outcomes from the hand hygiene programme.

Deliverables

Delays in receiving prototype holder and product procurement may hold up implementation. Risks

Late

Gel placement on the ends of all beds occurred in January 10 in all wards except those previously identified as exceptions (Paeds, Queen Mary, NICU, ICU). Discussions are taking place in those areas as to the appropriate placement.��Audits of the non project wards are nearing completion. These have been delayed due to committments of IPC audit staff on the monovalence influenza vaccination programme and the seasonal influenza vaccination programme that commences next week. Once completed the results will be communicated to CNMs of those wards.��Education material is in development. Education commenced at the recent IPC rep days and a quiz to check understanding was tested on the IPC reps. Arrangements have been made for this to be loaded into EmployeeConnect for accessing and completing be all staff following training.

Project Management 59%

CompleteProject Startup 100%

CompleteProject Initiation 100%

CompleteRoll out and facility preparation 100%

LateBaseline Evaluation 96%

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Hand Hygiene Project


LateImplementation 87%

On timeLab Data 29%

LateLaunch strategy 78%

On timeFollow-up Evaluation 0%

Future task

Ongoing action planning & review cycle

0%

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Falls Prevention Project


1. Quantify the extent of the falls issue within the provider arm by 01/04/09�2. Implement a programme to reduce falls and harm from falls within the provider arm by 31/8/09�3. Reduce patient falls within the organisation by 50% by December 2009. This objective will be quantified during the course of the project

Objectives

A working group or working groups will be formed to complete the main tasks required to deliver the project objectives. In order to ensure appropriate representation, participating services will be identified by examining falls incident data. The working group(s) will have multidisciplinary representation.�The working group(s) will be assigned tasks by the project manager. The project manager reports to the project board, which will make decisions and set the overall framework for the project. The project board will report progress to the Clinical Board.�It is envisaged the working group(s) will undertake tasks relating to the delivery of the key products,.�Key Products �Current falls rate and location baseline �Falls rates benchmarking exercise �Developed interventions �Implemented interventions �Monitored programme of interventions

Deliverables

No new risks to report this periodRisks

On timeRoll out into additional areas is progressing well.Project Management 88%

CompleteReview Western Health (WH) Falls documentation and

100%

CompleteRe-consult with Professor Campbell School of Medicine

100%

CompleteUpdate admission assessment: 100%

CompleteFalls Assessment Risk Tool update 100%

CompleteDevelop baseline audit tool 100%

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2009 2010


1/3/10



CompleteBaseline audit of exiting practice Ward 6A

100%

CompleteChanges to Daily Care Plan 100%

CompleteForm Steering Group 100%

CompleteDevelop education resources 100%

CompletePre-meeting with 6A, 6B & 6C 100%

CompleteRun incident data for Ward 6A, 6B & 6C (3 month period)

100%

CompleteDevelop visual aids for pilot (monitoring charts etc)

100%

CompleteDeliver education to pilot site 6A, 6B & 6C

100%

CompleteRepeat education to pilot site 6A, 6B & 6C

100%

CompletePilot on Ward 6A, 6B & 6C 100%

CompleteRe audit 1 in 6A, 6B & 6C 100%

CompleteRe audit 2 in 6A, 6B & 6C 100%

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LateEvaluate pilot 95%

CompleteDevelop roll out plan 100%

CompleteRoll out 8th Floor 100%

On timeRoll out 7th Floor 80%

On timeRoll out 3rd Floor 95%

Future taskRoll out 4th Floor 30%

Future taskRoll out 5th Floor 30%

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2009 2010 2011 2012

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Otago Southland Oral Health Project


To implement re-oriented oral health services in Southland and Otago by February 2012. Objectives

9 new fixed clinics in Winton, Gore, Wakatipu, Wanaka, Alexandra, Cromwell, Balclutha, Mosgiel, Dunedin South & Oamaru�Provision of a hub clinic at the Faculty of Dentistry�Refurbishment of 2 clinics in Southland�Construction of 30+ mobile landing pads�Puchase of 7 new mobile dental units�Realignment of staffing ratios in Otago�Operational changes to accomodate the new model of care�Digital imaging and patient management system upgrade�Communication plan and public education

Deliverables

Some quality issues with the early mobile sites in Southland have been identified, and the response will be to put in place more robust quality check and handover processes to control contractor performance.��Electrical compliance issues have arisin with the mobile unit, and these are with the manufacturer for resolution. There may be 1 - 2 days lost production when the fix is implemented but otherwise there is no cost to the DHB or any safety risk to staff.��Due to an oversubscribed production schedule the commissioning of Otago's mobile units looked to be delayed until 2012. A process is currently underway to negotiate an earlier production slot for at least one of Otago's mobiles, and it is expected the outcome will be known in the next few weeks.

Risks

Late

Significant progress has been made on the design work for the new and refubished clinics, and it is anticipated the first construction will start in the next 2 months. Early mobile sites in Southland have been completed and several learnings from that process are being built into future sites. Both Otago and Southland are on track to meet Ministry of Health spending targets provided construction starts as planned.


CompleteCapex Approvals & Deeds 100%

On timeSouthland Mobile Procurement 41%

On timeOtago's first two mobile units have been ordered but comissioning will not occur until 2012. This will affect implementation of change and models of care.

Otago Mobile Procurement 1%

LateEarly sites have taken longer to develop than planned, mainly because of delays in Building Consent from the ICC. There have been some design and construction issues which are in the process of being resolved.

Mobile Pads Design & Procurement 8%

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Otago Southland Oral Health Project


On timeThis task is running behind while efforts are focused on the early mobile sites. This ground will be regained in Q3Refurbs 15%

LateThe task is tracking behind the original schedule however good progress is now being made. The schedule will be redrawn once more detailed information comes to hand

Fixed Clinics 8%

On timeThis task has been rescheduled following delays in the processChange Management 17%

On timeHealth promoter appointments have been rescheduled for April 2010Business Case Funded Appointments

12%

On timeThis task cannot proceed until DHB capital funding for the new system is confirmed, so it has been resheduled for the new financial year.

Patient Management System & Digital

6%

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OPJ2 Year of Care Project


Aims �- improved self management of patients with level 1 chronic conditions;�- reductions in admissions for patients with chronic conditions;�- reductions in ED attendances for people with chronic conditions;� by development of a methodology for the implementation of the 'Year of Care Integrated Model of Care, implementation to target (pilot) group of patients with one or more chronic conditions and monitoring and reporting on outcome measures for this group.

Objectives

PHO Population stratification into Type 1, 2 and 3.�Stocktake of 'As is', including analysis of admissions/ ED presentation data; Practice visit data; current care pathway; community/ support sector services.�Design of Year of Care model that has the patient as 'producer' of their own health.�Design of Year of Care Plans for Type 3.�Parallel design of Plans for Type 1 and 2.�Implementation of Year of Care model - to trial group of patients.

Deliverables

The resignation of the project owner (Dr Roy Morris) has taken effect and as yet no replacement has been allocated. Other members of the Project team are filling the gap currently and Anne Worsnop is attending meetings to mainitain a DHB input. ��Links with Secondary Care are being established and strengthened through the active participation of OPH and Community clinical management and the support and input of their Group Manager.��PHO restructuring may threaten the project however time frames are such that by the time any change in PHO structure takes effect the Project should be in its monitoring and evaluating phase.

Risks

Late

Implementation of Year of Care Wellness Planning has commenced at MHC and 61 patients have been through the initial Care Planning process. The first round of follow up appointments with these patients begins during March.��EARLi has been conducted on Level 3 Gordon Rd patients, who have been restratified on the basis of the results. 24 patients have been identified as medium to high risk of an emergency admission and these patients have been invited by letter to partake in Wellness Planning. Sessions are scheduled to start on 12 March 10. ��As yet we have been unable to obtain the current admission and ED presentation data from the hospital but this should not cause any delays in the project as long as we are able to obtain this by mid 2010 to enable analysis and monitoring of those patients on YoC Care Plans.


CompleteProject Startup 100%

CompleteProject Initiation 100%

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OPJ2 Year of Care Project


CompletePreparation 100%

CompleteImplementation of Year of Care Model for selected

100%

Late

As yet we have not sourced the hospital data since baseline data was obtained. This is due to limited availability of hospital reports. The current process is very manual and fairly time consuming. We will start getting the data required in the next 2 months and will then be sourcing it on a monthly basis until the end of the year.

Monitoring and Review (PDSA cycle)

15%

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DIAGNOSTIC & SUPPORT SERVICES UPDATE

HAC Meeting Date: 23 March 2010

Report Prepared By: Sonja Dillon, Group Manager Dr Chris Lovell-Smith, Clinical Director Kim Caffell, Nurse Director Lynda McCutcheon, Allied Health Director

Date Prepared: 8 March 2010

Recommendation

That the Committee receives and notes this report.

1. Service Summary

Preparation for provision of food services at Southland Hospital has continued, with the regional service to commence 1 April 2010.

Planning for Medical Radiation Technologist (MRT) industrial action in mid March is underway.

International Accreditation New Zealand (IANZ) undertook the annual surveillance audit of Radiology from 9th-11th February. IANZ issued no corrective actions, 10 strong recommendations and 24 recommendations. Auditors noted further improvement in staff morale.

Appointment and commencement of a Speech Language Therapist and a Dietitian have enabled services to re-establish some services that were curtailed due to staff shortages and commence quality initiatives.

The Ministry of Health undertook a legislative compliance audit of the Pharmacy department on 18th and 19th February. Overall, there was a positive result with no significant concerns from the auditors. The service was congratulated for the high quality of service provided.

A proposed restructure of the team leader roles in the Central Sterile Supply Department (CSSD) is currently under consultation with staff and unions. Feedback received indicates that the proposal is seen as a positive move for the service.

The Infection Prevention & Control team have been busy with the monovalent influenza vaccination campaign, Infection Prevention and Control representative training days and the Equip4 audit.

A decision on the proposal to cease provision of the satellite Physiotherapy clinic at Mosgiel and for changes to the Palmerston service was announced on 4th March 2010. The Palmerston service will now be provided utilising Community Physiotherapy staff with 2 sessions per week. The Mosgiel clinic will be provided utilising Community Physiotherapy staff at the current premises as a collaborative arrangement with the Taieri and Strath Taieri PHO until the end of June 2010. Evaluation of the service will be undertaken over the next few months.

2. Quality Initiatives

As a result of the new appointment schedule implemented in Ultrasound, the wait list for ‘B’ graded patients has reduced from 10-16 weeks to 4-6 weeks (the target wait time is 4 weeks). This means that more appointments for ‘C’ graded patients are available, demonstrated by a reduction in the number of ‘C’ grade patients waiting for an appointment to be scheduled.

Diagnostic & Support Services Update 91

In order to reduce the number of patients that do not attend appointments (DNAs), the Ultrasound service calls all patients to remind them of their appointments. This has reduced the number of DNAs, however is hugely time consuming. The Ultrasound review team are investigating the options available.

The Kaiarahi – Professional Advisor has been meeting with the Associate Professor and Associate Dean of Maori at the Dunedin Medical School to establish a relationship between the Medical School and the Maori Health Liaison Service. This year a Mihi whakatautau was held for all Maori medical students who are starting their first year and a session was held for fifth year medical students working in Paediatrics and Women’s Health to introduce them to the Kaiawhina.

An educational tool ‘What is ethnicity and what is not?’ is being developed to empower staff to feel confident in collecting ethnicity data.

A resource booklet for RMOs is being developed on Maori culture and Maori health in Otago. The booklet is being developed to widen awareness of Maori and Maori health issues in NZ and aid doctors in creating and maintaining culturally competent practice.

Statistics are being recorded by the Security service on areas that are found unlocked or insecure. This data will be analysed on a monthly basis and if any patterns are identified the departments will be notified that they may be at risk of theft or unauthorised access.

A change of practice has been agreed to by stakeholders that the use of red bag liners in infectious linen bags will cease. Currently, staff utilise any colour linen bag and identify it as infectious linen by using a red bag liner and labelling it ‘infectious linen’. From 22nd March, only red linen bags will be used for infectious linen. This simpler process will reduce error and save the organisation $13,000 annually.

3. Contract Performance

Actual Planned Variance Actual Prior

Year Actual Planned Variance

Actual Prior Year

Community Referred Radiology 4,096 2,762 1,334 3,952 29,653 28,605 1,048 31,100

ACC High Tech Imaging RVUs 501 649 (148) (309)

(120)

(101)

884 6,407 6,716 7,054

Breast Screening (Total women screened) 1,556 1,271 285 1,525 11,396 10,227 1,169 10,260

Age Group 45 - 49 359 318 41 346 2,795 2,556 239 2,170

Age Group 50 - 64 980 762 218 923 7,187 6,137 1,050 6,422

Age Group 65 - 69 217 191 26 256 1,414 1,534 1,668

Radiology Utilisation (ODHB patients) 5,626 5,453 173 5,453 47,236 47,337 47,337

Hospital Meal Equivalents 36,834 36,834 - 35,841 323,368 323,368 - 315,019

Physiotherapy Outpatients MOH 1,807 1,551 256 1,044 15,281 12,563 2,718 7,916

Physiotherapy Outpatients ACC 473 405 68 526 3,975 3,240 735 3,916

Month Year to Date

ACC High Tech Imaging – down for the month and year to date due to a low number of

referrals received.

Breast Screening – the service increased screening in February to mitigate the screening delays in January caused by equipment failure. 245 of the 1,556 women screened in February were new women to the programme.

Radiology Utilisation – down year to date due to the low number of referrals received during January.


4. Financial Performance – January 2010

AnnualActual Budget Variance Actual Budget Actual Budget Variance Budget$' 000 $' 000 $' 000 FTE FTE $' 000 $' 000 $' 000 $' 000

913 963 (50) Revenue 8,204 7,760 444 11,642 (1,811) (1,862) 51 367.89 373.96 Less Personnel Costs (15,354) (15,747) 393 (24,011)

(34) (45) 11 Less Outsourced Costs (249) (363) 114 (545) (693) (865) 172 Less Climical Costs (6,225) (6,852) 627 (10,267) (105) (156) 51 Less Infrastructure & Non Clinical Costs (976) (1,144) 168 (1,720)

(1,730) (1,965) 235 367.89 373.96 Net Surplus / (Deficit) (14,600) (16,346) 1,746 (24,901)

Year to DateMonth

AnnualActual Budget Variance Staff Type Actual Budget Variance Budget

FTE FTE FTE FTE FTE FTE FTE

22.97 23.75 0.78 Medical 22.28 23.76 1.48 23.77 14.03 13.66 (0.37) Nursing 13.73 13.66 (0.07) 13.66

165.82 164.97 (0.85) Allied Health 160.24 166.35 6.11 166.12 103.94 108.49 4.55 Support 100.81 104.77 3.96 109.76 61.13 63.09 1.96 Management/Administration 58.12 62.63 4.51 63.75

367.89 373.96 6.07 Total FTEs 355.18 371.17 15.99 377.06

Month Year to Date

Breast Screening income up on budget this month by $100k for the month. The actual includes

$58k for the backdated price increase. In February 2010 there were 1,556 screenings performed (February 2009 - 1,525 screenings).

$49k received in February for 12 months of Herceptin.

Radiology RMO overtime continues to be over budget – 1.21 FTE at a cost of $10k.

Radiology MRT overtime related to callbacks is over budget this month by 1.51 FTE at a cost of $14k.

Sick leave across all staff types was 7.67 FTE for the month, compared with budget of 13.53, FTE variance of 5.86.

Annual leave taken this month was up on budget by 2.69 FTE. The actual includes hours from the pay period ended 31 January 2010.

Fleet vehicle utilisation audit invoice for $27k incurred this month. The invoice covered the 40% plus set-up costs as per the contract.

Medical waste is over budget this month by $5k. Discussions are underway on developing longer term solutions for reducing medical waste.

Blood products (excluding Intragam) down on budget this month by $25k and $49k ytd.

Pharmacy Outpatients drug expenditure is down on budget this month by $105k. Outpatient income for the month is also down on budget by $97k.

Drug purchases for Pharmacy Inpatients and Pharmacy Production are down on budget this month by $127k.


Otago DHB HAC Meeting – 23 March 2010 Diagnostic & Support Services Update

5. Emerging Issues/Risks/Mitigation

Emerging risks for the Diagnostic & Support Services Group are: Risk Mitigation Sustainability of Breast Screening service and ability to meet contract volumes due to ability to retain and recruit clinical staff

Continue active recruitment and development of recruitment strategies with Human Resources. Subcontract services where feasible. Prioritise recall and high risk women as priority for scheduling.

Clinical equipment failure and inability to replace due to capital constraints.

High priority items within the capital plan are being progressed for purchase. Ongoing assessment of equipment status, ensure regular servicing and quality monitoring of equipment is in place.

Delay in diagnosis and treatment due to the wait time for non urgent abdominal and pelvic ultrasound and MRI

Modality reviews are underway in both specialties. A revised booking schedule is being trialled for ultrasound, with initial results indicating a benefit. The referral pathway for pelvic and abdominal ultrasound is being reviewed.

Southland Mammography cottage does not meet standards required by the National Screening Unit resulting in contractual non compliance.

Southland DHB aware of the issue and concept plans are under development.

Loss of ACC revenue through referral changes and ACC pricing changes

Monitor referral patterns and cost benefit of provision of ACC services. Ensure quality services provided in a timely manner.

Unable to meet financial savings or impact upon delivery of service if the implementation of the Regional Food Service does not meet project targets.

The project plan assumes completion of preparation prior to the transition date. Expenditure is being monitored against the business case.

MRT Industrial Action will impact upon wait times which may create delay in diagnosis and treatment.

All postponed referrals are being reviewed by Radiologists and given priority for rescheduling. Management of wait lists practice will continue to focus upon ensuring appropriate prioritisation and scheduling, along with communication to patients and referrers.

94

EMERGENCY, MEDICINE AND SURGERY GROUP UPDATE

HAC Meeting Date: 23 March 2010 Report Prepared By: Colleen Coop, Group Manager

Dr Shaun Costello; Prof Jean Claude Theis, Clinical Directors

Kim Caffell; Sharon Jones, Nurse Directors Date Prepared: 10 March 2010

Recommendation


1. Service Summary

Caseweight Recovery Programme: The results as at the end of February 2010 show that

the provider arm has provided 5,031 caseweights (cwd) against a year to date target of 5,209 cwd of elective surgical procedures (-4%). The projection based on theatre lists (including Saturday operating planned) and staffing predictions is that by the end of the year the provider arm will have produced 8,169 against a target of 7,953. As a whole, the District Health Board target is 9,301 (including Interdistrict flows). The current plan to achieve the projected gap is outsourcing. This plan includes outsourcing procedures to Southland and Mercy Hospital. Timaru is also currently being investigated for their capacity. So far definite agreement has been made with Southland for general surgery cases, and Mercy for a combination of surgical procedures. It is hoped that a significant amount of the required caseweight volume will be completed by Mercy. The projection therefore, assuming all outsourcing can be achieved and all plans within the provider arm can proceed without interruption by staffing absences, infection outbreaks, industrial action or other unforseen events, is that we will achieve the target District Annual Plan (DAP) caseweights by the end of June.

Emergency Department (ED): The ED Leadership Group has been convened to progress

the shorter stays in Emergency health target. The focus is to work on processes within the Emergency Department that can help meet the target. The result for this month was 81% of patients were seen and discharged/transferred within six hours, which is an improvement over previous months.

Gastroenterology Services: The Gastroenterology Board continues to meet weekly to

work through multiple issues regarding increased access to colonoscopies and strategic issues affecting the future development of the service.

Ophthalmology: As the department is now almost fully staffed medically, operating will

increase from the first half of the financial year, although our annual production of cataracts will be behind target at year end. To mitigate the size of the gap we are considering whether some operating lists can be cataract and consultant only to increase our throughput.

Orthopaedic Services: The orthopaedic service continues to experience extremely high

demand, both for elective and acute procedures. The demand is predicted to grow year on year, and planning will need to occur for how to manage this demand. Current staffing and operating lists will not be adequate to cope, and facility issues will compromise this further, as the main operating suite is running at capacity during normal working hours when all anaesthetist positions are full.

95

General Surgery/Urology: Planning for outsourcing of surgery continued through the

month with the first lists commencing late February. Patients are being referred to Southland DHB and to Mercy Hospital. We have also planned additional Saturday lists to meet provider arm targets. This has taken a lot of organisation with the workload being shared across the team. Preparation for Equip4 went well and resulted in an “excellence” rating for wound care from the assessors which is a great achievement.

Neurosurgery: Work continues on recruitment for neurosurgery however the model for the

South Island has not been finalised which has prevented finalisation of employment contracts. Locums will continue to fill the period until the final model of care is decided upon.

Cardiology / Respiratory / CCU: The incoming Siemens diagnostic unit in the cardiac

catheter laboratory is presently being commissioned with the full system undergoing testing with ‘live’ patients. To date the initialisation has gone well.

Endocrinology: At present an absent registrar is creating some delays in the service in

seeing patients. We have managed to source some additional resource in April which it is hoped will assist in managing the service back-log.

Oncology/Haematology/Southern Blood and Cancer Service: The MDU changed its

official title this month to the Oncology Day Unit to better reflect its principal activity and improve its association within the Oncology service. The Counsellor Service has been retitled from Patient & Family Support Service to Oncology/Haematology Counselling Service for the same reason.

Anaesthesia: We remain short staffed but expect to have all positions filled by May 2010.

Unfortunately in February vacancies of SMOs were compounded by five of our registrars sitting their exams which placed pressure on the department in covering their responsibilities.

Main Operating Theatre (MOT): We are still working through arrangements regarding

caesarean sections out of hours. There is not always the ability to provide notification of an impending emergency caesarean and when the acute theatre is already operational this has caused delays and staffing problems. Currently rostering for theatre nursing staff is being examined to identify whether the current complement is sufficient to deal with the increased activity demands in the main operating suite.


Internal Medicine: The services enjoyed a visit from United Kingdom (UK)-based Maggie

Scott, a Nurse Consultant in stroke management. It was interesting to understand how stroke management is undertaken in the UK where many of the services are in the community. Maggie also confirmed that all UK hospitals will be required to offer all-hours thrombolysis services from 1st April 2010. The Otago District Health Board is hoping to introduce thrombolysis from 6th April. The electronic prescribing pilot project is underway with an equipment audit and process mapping exercise being undertaken on the wards. Ward 8A met the Ministry 80% smoking cessation target for brief advice at the beginning of February which is an excellent achievement.

Oncology/Haematology/Southern Blood and Cancer Services (SB&CS): A fast track

process (ED to the ward) for neutropenic patients has been developed to improve our treatment of this cohort of patients. The introduction of respiratory gated radiation therapy for our lung patients is well underway with a couple of patients treated this month. This

96

system allows very large treatment doses to be delivered in small numbers, i.e. from 30 fractions to 3. The treatment time is longer but fewer appointments are required and outcomes for patients are much improved.

Renal Dialysis Unit: The unit received a commendation from the Equip4 auditors in their

report for its cohesive planning for patients. Cardiology (Diagnostics): The pilot for same day discharge of patients who have

undergone angiography/plasty has been initiated. The purpose of this pilot is to seek to improve the efficiency of the Day Stay Unit, to move to a more ambulatory model of care for this patient cohort and to increase day of procedure admission rates. Also pleasingly the unit returned a 100% result for offering brief intervention for smokers presenting at the unit this month.


Surgery Contract Volumes

Month Year to date

Actual Planned Variance

Actual Prior Year

Actual Planned

Variance

Actual Prior Year

Surgery_Group_ODHB_Acute CW

517.62 607.22 (89.60) 425.42 4620.74 4791.06 (170.31) 4551.29

Surgery_Group_ODHB Acute IDF CW

66.34 54.59 11.75 82.59 605.20 435.62 169.58 536.09

Surgery_Group_Elective CW 477.89 570.24 (92.34) 489.27 4141.05 4167.61 (26.56) 3637.61

Surgery_Group_Elective IDF CW

58.76 42.58 16.18 43.14 517.61 317.23 200.38 340.14

Surgery_Group_TOTAL CW 1120.61 1274.63 -154.02 1040.41 9884.61 9711.51 173.09 9065.12

Medicine Contract Volumes

Month Year to date


Actual Prior Year

Actual Planned

Variance

Actual PriorYear

ED_Medicine_Group_ODHB_Acute CW

635.27 728.83 (93.56) 756.80 5387.53 6009.57 (622.04) 5767.03

ED_Medicine_Group_ODHB Acute IDF CW

122.42 164.26 (41.84) 147.60 1230.09 1181.09 49.00 1137.31

ED_Medicine_Group_Elective CW

71.90 106.73 (34.82) 133.59 672.32 815.72 (143.40) 815.01

ED_Medicine_Group_Elective IDF CW

40.79 55.72 (14.93) 65.75 358.23 361.83 (3.60) 437.49

ED_Medicine_Group_TOTAL CW

870.38 1055.54 (185.16) 1103.74 7648.18 8368.22 (720.04) 8156.84


Actual Prior Year

Actual Planned

Variance

Actual Prior Year

Group FSA 492 434 58 456 3191 3152 39 3344

Group Follow Up 1440 1457 (17) 1374 10768 10560 208 10981

o A significant contributor to the medicine caseweight under delivery relates to the cath lab

being out of action for over a month last year. Although the service has resumed full activity despite the commissioning of the new laboratory it cannot make up this shortfall.

97

Activity Indicators

Feb

09 Mar

09April

09May

09June

09July

09Aug

09Sept

09Oct 09

Nov 09

Dec 09

Jan2010

Feb2010

Percentage of DSU theatre facility utilisation - Target 94% 96% 98% 99% 98% 93% 87% 89% 95% 96% 96% 91% 80% 94%Percentage of MOT theatre facility utilisation - Target 94% 98% 88% 95% 90% 73% 90% 95% 95% 89% 90% 95% 86% 83%Percentage of DSU Elective list utilisation Target – 90% 89% 89% 70% 81% 80% 79% 101% 83% 83% 75% 85% 72% 85%Percentage of MOT Elective list utilisation Target – 95% 98% 103% 94% 93% 100% 100% 94% 98% 101% 95% 100% 95% 101%Time spent in ED - % seen and discharged within 6 hours - Target - < 6 hours 75% 75% 76% 79% 74% 73% 70% 67% 72% 72% 74% 77% 81%

4. Financial Performance – January 2010

Annual


744 644 100 Revenue 5,919 5,077 841 7,658 (6,143) (6,139) (4) 822.06 834.49 Less Personnel Costs (51,494) (52,272) 778 (79,628)

(202) (207) 5 Less Outsourced Costs (2,188) (1,809) (378) (2,650) (2,428) (2,544) 116 Less Clinical Supplies (20,740) (20,559) (181) (31,150)

(496) (515) 18 Less Infrastructure & Other Costs (4,269) (4,311) 42 (6,471) (8,524) (8,760) 236 822.06 834.49 Net Surplus / (Deficit) (72,772) (73,874) 1,102 (112,241)

Month Year to Date

AnnualActual Budget Variance Staff Type Actual Budget Variance Budget


135.97 143.86 7.89 Medical 137.06 143.88 6.82 143.88 494.75 496.19 1.44 Nursing 490.64 496.19 5.55 496.19 77.45 81.91 4.46 Allied Health 78.45 82.06 3.61 82.02 7.78 7.61 (0.17) Support 7.46 7.61 0.15 7.61

106.11 104.92 (1.19) Management/Administration 105.44 105.89 0.45 105.74 822.06 834.49 12.43 Total FTEs 988.19 978.94 16.57 980.01

Month Year to Date

The overall operating deficit for the month was $8,524k against a projected deficit of $8,760k producing a $236k favourable result. Year to date the operating deficit is $72,772k against a projected deficit of $73,874k, resulting in a $1,102k favourable result. Significant variances are itemised as follows: Revenue $100k favourable: Additional income from the National Haemophilia Pool for high use of Novoseven in February. Personnel Costs ($4k) unfavourable: Medical Personnel $24k:

Vacancies still continue at approximately 10 FTE (9.9 FTE made up of 7.2 SMO FTE and 2.7 RMO FTE) contributing a $149k favourable impact. Offsetting this variance was higher than budgeted call backs, allowances, course and professional fees

Nursing Personnel ($46k) A combination of long service and parental leave taken, along with higher ACC and superannuation costs were the main factors in the variance for the month.

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HAC report – February 2010 Version 2 Group Manager – Dr Colleen Coop

Expenditure $139k favourable: Positive variances in implants and prosthesis ($105k favourable for the month, $341 negative YTD) and pharmaceuticals ($103k favourable for the month, $694k favourable YTD), offset by treatment disposables being $75k over for the month, with $412 over YTD) were the main drivers of the positive variance, a brief summary of each variance is as follows: Implants and prosthesis. The phasing of hips and knees additional electives for the second

half of the year has produced a $78k favourable variance in hips and knee implant expenditure for the month.

Pharmaceuticals. The main driver of the decrease in pharmaceuticals continues to be Oncology. Year to date Oncology drugs are $385k less than budget.

Treatment disposables. Continued high levels of intragam use due to high acuity patients ($51k over for the month and $331k over YTD), and high Novoseven use (offset by additional revenue) was offset by less than expected bare metal stent insertions.

5. Emerging issues/risks/mitigation

Current and emerging risks for the Emergency, Medicine and Surgery Group: Risk Mitigation Ability to meet elective surgical volumes

Close surgical list management to maximise lists, theatre productivity projects and outsourcing relationships with SDHB and Mercy Hospital. Timaru Hospital being explored. Otago Saturday operating lists confirmed for March and April

Facility Issues – theatres, Intensive Care Unit, outpatient areas especially Ear, Nose and Throat and the Gastroenterology Unit. Inadequate facilities do not comply with accreditation and certification standards, do not allow efficient delivery of volumes, and restrict strategic development as recruitment efforts result in staff who do not want to work in current facilities (especially gastroenterology)

Continue to focus on achieving DAP goals to promote ability to gain master-site capital funding

Lack of capital budget to replace mandatory items needed to provide services Major items of capital equipment are nearing their end of life and combined equate to more than the available capital – e.g. ED central monitoring station

Identify those that are absolutely required and maximise life span of the remainder Identify those at greatest risk for the upcoming capital plan, deferring those that are important for strategic growth (e.g. gastroenterological equipment)

High Attendance at ED – numbers above what the facility was designed for leading to over-crowding and long waits

Continue to educate public about alternatives to ED, streamline internal ED processes, utilise fast track system for minor injuries and work with inpatient services to allow them to pull patients to wards faster

Neurosurgeon Vacancy may compromise ability to provide service for lower South Island

Ongoing worldwide recruitment of both locum and permanent staff

Low numbers of colonoscopy offered in Otago area

Increase numbers within the Otago provider arm

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HAC report – February 2010

Emergency Medicine & Surgery Services Group APPENDIX ONE – Theatres Utilisation Report

February 2010 MOT & DSU ListsFull day lists

Jan Feb Mar Apr May JunACUTE Planned lists 35.0 39.0 37.0 36.5 37.0 48.5

Extra lists 3.5 3.5 3.0 2.0 5.5 3.0Unallocated lists 0.0 0.0 0.0 0.0 0.0 0.0Actual lists 38.5 42.5 40.0 38.5 42.5 51.5

CARD Planned lists 18.0 17.0 18.0 16.0 16.0 12.0Extra lists 0.0 0.0 0.0 0.0 0.0 0.0Unallocated lists 1.0 0.0 1.0 1.0 0.0 0.0Actual lists 17.0 17.0 17.0 15.0 16.0 12.0

ENT Planned lists 24.0 23.5 25.0 23.0 23.5 19.0Extra lists 0.5 0.0 1.0 1.0 0.0 2.0Unallocated lists 0.5 0.5 1.5 0.5 0.5 1.5Actual lists 24.0 23.0 24.5 23.5 23.0 19.5

EYES Planned lists 9.5 9.0 11.0 8.0 6.5 6.0Extra lists 0.0 0.0 0.0 0.0 0.0 0.0Unallocated lists 0.5 0.5 0.5 0.0 0.5 1.0Actual lists 9.0 8.5 10.5 8.0 6.0 5.0

GSURG Planned lists 42.0 39.0 40.0 36.5 40.5 34.5Extra lists 2.5 0.0 0.0 1.5 4.0 1.0Unallocated lists 0.5 2.0 1.0 1.0 0.5 2.0Actual lists 44.0 37.0 39.0 37.0 44.0 33.5

GYNAE Planned lists 13.0 13.0 13.0 11.5 13.0 9.5Extra lists 0.0 0.0 0.0 0.0 0.0 0.0Unallocated lists 1.0 0.5 1.0 0.0 0.5 3.0Actual lists 12.0 12.5 12.0 11.5 12.5 6.5

NEURO Planned lists 8.0 7.0 8.0 7.0 5.0 5.5Extra lists 1.0 0.0 0.0 0.5 0.0 1.0Unallocated lists 0.0 0.0 0.0 2.0 1.0 2.5Actual lists 9.0 7.0 8.0 5.5 4.0 4.0

ORTHO Planned lists 41.0 36.0 37.0 37.5 37.0 28.0Extra lists 0.0 0.0 1.0 1.0 0.0 0.5Unallocated lists 1.0 1.0 0.0 1.0 1.0 1.0Actual lists 40.0 35.0 38.0 37.5 36.0 27.5

PAEDS Planned lists 1.0 1.0 1.0 2.0 1.5 0.5Extra lists 0.0 0.0 0.0 0.0 0.0 0.0Unallocated lists 0.0 0.0 0.0 0.5 0.0 0.0Actual lists 1.0 1.0 1.0 1.5 1.5 0.5

URO Planned lists 6.5 9.0 10.5 8.5 7.5 6.5Extra lists 0.0 0.0 0.0 0.0 0.0 0.0Unallocated lists 1.5 0.0 0.5 0.0 0.0 0.5Actual lists 5.0 9.0 10.0 8.5 7.5 6.0

TOTAL Planned lists 203.5 196.5 204.0 190.5 197.0 170.0Extra lists 7.5 7.5 7.5 7.5 7.5 7.5Unallocated lists 11.5 11.5 11.5 11.5 11.5 11.5Actual lists 199.5 192.5 200.0 186.5 193.0 166.0

Description of terms used to describe lists Planned lists

Original scheduled lists entered into the theatre list schedule up to 18 months in advance

Extra lists Any lists that are provided to surgical services over and above the working schedule including lists that have been reinstated

Unallocated lists

Lists that are removed from the original schedule for any reason Reasons include: lack of anaesthesia resource, surgeon leave, theatre closed for maintenance

Actual lists Actual lists used by surgical services recorded in the theatre list schedule Actual lists = Planned lists + Extra lists – Unallocated lists

Version 2 Group Manager – Dr Colleen Coop 100

MENTAL HEALTH & COMMUNITY GROUP UPDATE

HAC Meeting Date: 15 March 2010 Report Prepared By: Heather Casey, Acting Group Manager, Mental

Health and Community Group Services, Cathy Tod, Acting Nurse Director, Adele Knowles, Nurse Director, Lynda McCutcheon, AH Director, James Knight, Clinical Director


Recommendation


1. Group Summary

Forensic inpatient services are the only area with significant nursing vacancies.

Senior Medical Officer vacancies are improving with all positions being under offer in the Mental Health and Intellectual Disability Services. There are still a number of vacant positions in Older Peoples Health and Specialist Rehabilitation.

There are no registrar vacancies within the group for the first time in many years.

Proposals for change documents released to staff for consultation. Affected services include Needs Assessment and Service Coordination and Mental Health Outpatient Groups.

The relocation of the Community Alcohol and Drug Service (CADs) from leased space to Wakari Hospital has been approved by the Board, however, there are a number of conditions regarding the proposed design that need to be reviewed prior to building work commencing.

Contingency planning is well underway within the Intellectual Disability Service for the ongoing management of the secure inpatient service during alterations to Ward 10A. These alterations are due to start 22nd March and will address current health and safety and compliance issues.

The District Nursing Service continues to manage a high workload due to the level of activity across hospital services and the nature of demand in the wider primary setting. The service recently recruited into 2.4 FTE RN vacancies, and received a large number of high quality applicants.

The reduction in nursing overtime down to budgeted levels continues. Close monitoring is being maintained. The decreased numbers of nursing vacancies impacts on the need for overtime.

ACC revenue has a positive variance 34K for February, mainly due to additional patients but also due to increasing controls around identification and billing of ACC patients.

Old files stored at Wakari Hospital – a proposal to manage storage and disposal is being developed.


Strategies have been put into place to minimize the use of vehicles to essential use only as per the recovery plan.

South Island Shared Services Agency Ltd (SISSAL) facilitated Models of Care for regional services commences this month.

ODHB Mental Health and Intellectual Disability services continues to work with SDHB Mental Health Services to identify regional opportunities for collaboration around operational issues.

101

The 2010 Service planning day is the 20th April. The Service Plan will use the Te Kokiri framework to develop strategies to progress in 2010 and 2011. Strategies will include further work on models of care around service provision.

Smokefree activities are progressing with the group, with a steady increase in the percentages of clinical staff participating in Quit Card training and recording of smoke free interventions.


No data obtainable

4. Financial Performance – October 2009

AnnualActual Budget Variance Actual Budget Actual Budget Variance Budget$' 000 $' 000 $' 000 FTE FTE $' 000 $' 000 $' 000 $' 000

(4,253) (4,064) 189 Revenue (31,817) (32,654) (837) (48,990) 3,680 3,765 85 626.43 647.91 Less Personnel Costs 30,674 31,831 1,157 48,493

29 50 21 Less Outsourced Costs 358 401 43 602 199 200 1 Less Clinical Costs 1,678 1,717 39 2,579 408 434 26 Less Infrastructure & Non Clinical Costs 3,532 3,688 156 5,537

63 385 322 626.43 647.91 Net Surplus / (Deficit) 4,425 4,983 558 8,221

Year to DateMonth

Month Year to Date AnnualActual Budget Variance Staff Type Actual Budget Variance BudgetFTE FTE FTE FTE FTE FTE FTE

37.15 46.99 9.84 Medical 36.66 46.27 9.60 46.28 380.84 384.57 3.73 Nursing 377.12 384.57 7.45 384.57 141.84 148.51 6.67 Allied Health 139.10 148.58 9.48 148.56

0.04 - (0.04) Support 0.04 - (0.04) - 66.56 67.84 1.28 Management/Administration 67.59 67.94 0.34 67.92

626.43 647.91 21.48 Total FTEs 620.51 647.35 26.84 647.33

The overall result for the month was favourable to budget by $322k

Revenue : $189k favourable to Budget

Internal Funding $246k favourable due to year to date FTE net off of Mental Health ring fenced funding and $40k revenue for new Court Liaison position. Other Government Revenue ($35k) unfavourable due to RMO Clinical Training Revenue $79k, ACC Revenue favourable $32k due to NAR volumes, other Crown Agencies favourable $12k. MoH DSS revenue is ($25k) unfavourable this month.

Personnel Costs : $85k favourable to Budget

Medical Personnel is Favourable $78k due to 9.60 FTE savings. Nursing Personnel is unfavourable ($41k) 7.45 FTE savings offset by ACC payouts, Parental Leave, HCA Backpays and Professional Fees. Overtime continues its recent trend to align with budget. Psychologist and Social Worker Personnel is $30k favourable due to 6.62 FTE savings. Therapies Personnel is $3k favourable due to 3.02 FTE savings offset by $4k rural DAO overtime. Other Allied is ($3k) unfavourable due to FTE overrun. Management and Administration Personnel is $18k favourable due to 0.34 FTE and Rate savings, with Sick leave and Professional Fee savings.

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Otago DHB HAC Meeting – 15 March 2010 Mental Health and Community Services Group

Expenses : $48k favourable to Budget

Transport is $18k favourable due $8k savings in Staff Travel Domestic and $9k DHB vehicle costs especially in the Community Teams. Pharmaceutical savings of $5k in Mental Health wards 9A and 9B. Patient Appliance overrun of $17k in Community Ostomy supplies which is currently under review ($18k) unfavourable YTD. Treatment Disposables favourable $9k due to $4k Community Dressing supplies and $5k Patient Consumables in ISIS and Community Rehab following continued volume reductions. Outsourced Clinical Services continues to be favourable $20k due to low overflow beds being required at Ashburn Clinic and savings in the rural Community Rehab clinics. $13k general savings across the Group in Facilities, IT and Other Operating Expenses.


Emerging risks for the Mental Health, Intellectual Disability, Older Peoples Health, Community and Specialist Rehabilitation services include: Risk Mitigation

Plan for removing airlock and other changes to Ward 10A (secure intellectual disability ward) requires reduced patient numbers while alterations occur to address current Health and Safety and compliance issues.

Contingency plan have been developed. Some patients to be accommodated short-term in other service wards.

Regular reviews have been implemented to ensure risks around patient relocation are effective.

The ongoing management of overtime in Mental Health and Intellectual Disability Services to maintain at budgeted levels.

Maintain identified criteria for overtime approval.

Close monitoring by management team and Business Analyst.

Continue to focus on vacancy management

File storage is creating a health and safety risk for staff when asked to access old files

Proposal for disposal of files stored for over 20 years is being finalised, this includes a process to identify the last clinical entry and ascertain from clinicians if access is likely to be required.

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WOMEN’S HEALTH, CHILDREN’S HEALTH & PUBLIC HEALTH GROUP UPDATE

HAC Meeting Date: 23 March 2010 Report Prepared By: Pip Stewart, Group Manager

Dr David Barker, Clinical Director Dr Alex Teare, Clinical Director Dr Marion Poore, Clinical Director Adele Knowles, Nurse Director Jenny Humphries, Midwifery Director Lynda McCutcheon, Allied Health Director


Recommendation

That the Hospital Advisory Committee receives and notes this report.

1. Service Summary

Overview Services prepared for, and participated in the EQuiP4 accreditation survey. Actions to contribute to the financial recovery plan for the Provider Arm continue to be implemented

across the Group. Smokefree The Better Help for Smokers to Quit projects continue in Otago and Southland Hospitals. At the end of

February 38.2 % of patients admitted to hospitals in Otago were provided with advice and support to quit which is an improvement from 26.6 % in January.

Smokefree signage has been replaced across Dunedin and Wakari hospital sites. Planning is underway for the relaunch of the revised Otago and Southland DHBs Smokefree policy in

mid March. Children’s Health The service continues to await the outcome of consideration of the Paediatric SMO jobsizing exercise

resubmitted to the COO. The jobsize exercise revealed a gap between the hours contracted and the hours worked by the Paediatricians.

Following the previous period of sustained increased demand, February NICU activity returned closer to planned. Occasional periods of higher demand necessitated the implementation of the bed cascade plan. Short term contingency planning around space on the 5th floor continues. Options have been identified; however indicative costs are greater than capital budget allocation.

The South Island Children’s Health planning project, led by SISSAL, continues. Public Health South (PHS) – Primary Services Implementation of the Community Oral Health project continues. Implementation of the 2010 school-based Human Papillomavirus Vaccination (HPV) programme is

under way. This year’s programme includes offering vaccination to year 8 girls and catch up of girls in years 9 -13 who have not previously been vaccinated.

The Otago Public Health Nursing team continue to provide the Before Schools Check programme. Recruitment continues for a replacement Dentist for the School Dental Service. Public Health South – Public Health Services Service delivery continues to be provided in accordance with the Public Health annual plan. A public health advisory was issued to the Dunedin, Mosgiel and surrounds communities in response to

the acute poor air quality during the Mt Allen fire. Public Health worked in partnership with the University, Dunedin City Council and the Police to promote

and support a safe tertiary orientation period. During “O” week, the three agencies involved in alcohol

104

regulation (Dunedin City Council, Police, Public Health South) carried out several evenings of monitoring in the student area.

Following the death of two dogs suspected of ingesting toxic algae from Silverstream near Mosgiel, water samples were taken and testing confirmed the presence of the alga responsible for the poisoning as being phormidium. Signs were erected by the Otago Regional Council to warn the public.

Women’s Health Following changes to anaesthesia service delivery, out of hours caesarean sections and other

procedures requiring anaesthesia continue to be undertaken in the main operating theatre. Previously these were done in the Queen Mary operating theatre. Additional midwifery staffing has been required on the night shift as a result of this change; the additional costs of this are unbudgeted. A business case seeking approval for the additional costs has been developed.

Preparation for the 2010 post graduate complex care midwifery course is underway. Three midwives successfully completed the inaugural course last year and a further two are scheduled to undertake the forthcoming course.


Preparation is underway for the Baby Friendly Hospital audit scheduled for the end of the year. Steady progress is being made by services towards the health target “Better Help for Smokers to Quit”. A new communication prompt tool has been introduced in the maternity service aimed at improving

communication amongst the multidisciplinary team.


Month Year to date


Actual Prior Year

Actual Planned

Variance

Actual PriorYear

Gynaecology FSA 128 152 (24) 93 1020 1091 (71) 1134

Gynaecology FU 134 134 (0) 114 1191 962 229 1018

Gynae surgery c/wts 64 93 (30) 73 651 705 (54) 670

Colposcopy 95 97 (2) 114 755 726 29 772

Terminations 25 39 (14) 36 258 276 (18) 309

Maternity – Births 147 151 (4) 167 1184 1208 (24) 1014 Paed FSA 131 130 1 137 927 924 3 947

Paed FUA 370 509 (139) 480 3200 3628 (428) 3817

Paed Acute Assess 136 70 66 63 1232 760 472 758

Paed medical c/wts 48 47 1 32 497 498 (1) 488

Paed surgery c/wts 7 15 (8) 15 56 115 (59) 140

NICU c/wts 64 93 (29) 112 857 746 111 764 Sexual Health FSA 159 218 (59) 153 1413 1767 (354) 1512

Sexual Health FUA 54 113 (59) 69 1705 2050 (345) 662

Contributing factors for the variance in activity are: Gynae FSA and FU below plan for month due to seniority of registrars and SMO leave requirements. Gynae caseweights behind plan due to dropped lists by Theatres due to anaesthesia vacancies. Paediatric follow – up appointments below plan for the month due to SMO leave requirements. NICU caseweights below plan associated with the timing and realisation of caseweight value. Sexual health volumes continue to below plan year to date. The reasons for this are unknown and given

that the majority of referrals are self referrals that require assessment and treatment at reasonably short notice. The service has distributed posters to some of the community services that our main at risk client group have connections with aiming to encourage engagement with the service.

105

4. Financial Performance – February 2010

Annual


753 722 31 Revenue 6,367 5,769 598 8,658 (1,955) (1,893) (62) 309.32 313.05 Less Personnel Costs (16,089) (16,108) 19 (24,627)

(111) (72) (39) Less Outsourced Costs (903) (580) (323) (870) (163) (192) 29 Less Clinical Supplies (1,687) (1,635) (53) (2,456) (202) (210) 9 Less Infrastructure and Other Costs (1,811) (1,728) (83) (2,597)

(1,678) (1,646) (32) 309.32 313.05 Net Surplus / (Deficit) (14,124) (14,281) 158 (21,892)

Year to DateMonth

Month Year to Date AnnualActual Budget Variance Staff Type Actual Budget Variance Budget


30.86 33.48 2.62 Medical 31.09 33.09 2.00 33.22 136.04 132.16 (3.88) Nursing 137.04 132.16 (4.88) 132.16

98.02 108.00 9.98 Allied Health 98.13 108.15 10.02 108.12 0.28 0.30 0.02 Support 0.30 0.30 (0.00) 0.30

44.12 39.11 (5.01) Management/Administration 38.87 39.29 0.42 39.28 309.32 313.05 3.73 Total FTEs 305.44 312.99 7.56 313.07

Women’s Health, Children’s Health and Public Health Group had an operating deficit of $1,678k for February 2010 against a budgeted deficit of 1,646k. This produced an unfavourable variance to budget of $32k with a favourable year to date (YTD) variance to budget of $158k. FTEs for February 2010 are under budget by 3.73.

The revenue variance is $31k over budget for February 2010. Negative variances in Public Health revenue for contracts that have finished ($49k) are offset by favourable variances in Other Government revenue for HPV (Human Papillomavirus). YTD revenue is $598k over budget, due mainly to revenue received for side contracts in the Public Health Service that were not included when the budget was set. These are offset by additional costs.

Expenses show an unfavourable variance of $62k for the month, YTD expenses are tracking $441k over budget.

Salaries are over budget by $42k for the month, YTD under budget by $19k. This is reflected in the 7.56 FTE favourable variance YTD.

o Medical Staff is unfavourable by $4k. However, the $46k favourable variance due to vacancies is offset by overtime ($18k), relocation costs ($6k) and annual leave taken less than budgeted ($11k).

o Nursing Staff is unfavourable by $38k for February 2010, $249k YTD, due mainly to FTE being over budget, partly offset by additional revenue in Primary Services Service.

o Allied Health staff is favourable by $27k for February 2010 and $211k YTD, due to vacancies in Public Health (partly offset by reduced revenue from Public Health contracts).

o Management Admin is unfavourable by $44k. This is due to a coding error that relates to Community Dental Health personnel costs. These costs should be capitalised and will be corrected in March 2010.

Outsourced expenses show a $38k unfavourable variance from budget for the month, YTD unfavourable variance of $323k being mostly locum cover for the senior medical staff vacancies and outsourced health promotion costs that are being provided by the University of Otago (budgeted in personnel costs).

Clinical supplies show a favourable variance of $29k for the month, driven by relatively lower acuity in February and the timing of Health Promotion purchases in Public Health. YTD shows an unfavourable variance of $53k.

106

Otago DHB HAC Meeting – 23 March 2010 Women’s Health, Children’s Health & Public Health Group Update

Infrastructure and non-clinical supplies show a favourable variance of $9k for the month. YTD shows an unfavourable variance of $83k driven mainly by the provision of doubtful debts in Women’s and Children’s Health of $134k.


Emerging risks for the women’s health, children’s health and public health group are: Risk Mitigation Administrative services continue to experience additional workloads as a result of iPM

Services continue to review and refine administrative process flows

NICU facility continues to be not compliant with Health and Disability Sector standards. This is likely to be highlighted again during the accreditation audit.

Contingency plan options for additional space continue to be explored on the 5th floor. Risks associated with delays in redevelopment highlighted with the DHB Board.

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Information Group Prepared by: Regional Chief Information Officer, Grant Taylor Recommendation That the Hospital Advisory Committee (HAC) notes this report. Summary Work on the E-Prescribing pilot has started and is going well. The project is strongly supported by clinical staff and there is a great feeling surrounding this work. The Healthviews (or iSoft clinical workstation) server was upgraded and feedback sought from clinical staff. Feedback indicated a vast improvement and the team will now work on the workflows to ensure the system is configured optimally. The IT team are heavily involved in the behind the scenes work to bring back office systems together. The work streams include financial and payroll systems as well as external websites and work on communication plans. More outages in the XT network have reduced our confidence in the network. We are working through the issues and providing workarounds with the local gen-i team. I have requested assurances and evidence that a solution is being worked through that will provide the resilience that we require. Project Highlights Healthviews A new virtual instance of the Healthviews server was created. This new environment is resourced well and once the new “hardware” was implemented testing from a selection of clinical staff concluded that the performance of the new server was much improved. The next steps for the team will involve working with clinical staff to configure the systems workflows appropriately and then plan to implement more functionality ultimately leading to changes in practice such as electronic acknowledgement of results and a platform for improved discharge information and then referrals. Healthviews along with iPM is one of our most important core clinical information systems and is used by the vast majority of clinical staff as well as being available to GP’s in the community. The XT Network Outages and issues with slowness and texting have continued to be an issue on the XT network. We have been working with the organisation and Telecom to cut phones over in critical area the legacy CDMA network. This has gone well and we will be monitoring Telecoms efforts to address the infrastructure issues they have that are affecting us. Our contract for mobile, data and voice expires in September this year. It has also highlighted the need for a disaster recovery plan for mobile and paging services – this will be developed.

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E-Prescribing At the June 2009 board meeting the Otago board approved the proposed pilot of E-Prescribing. This business case has been accepted by the safe medication management group and we will be the pilot site for E-Prescribing along with Taranaki. The plan and project documentation are being developed as well as extensive stakeholder meetings. Internal Medicine on the 8th Floor has been selected to lead the pilot. In February and early March meetings with all key stakeholders to kick off the pilot where held. This included IT, Clinicians, Nurses and management. The New Data Centre The New Data Centre, located under the Oncology building is complete! However due to supplier delay’s we are still awaiting the arrival of switches to then configure and start the migration out of the old data centre. Having the New Data Centre will remove significant risk from the organisation. This risk has been a constant battle to manage as we have had to work within restrictions on cooling, power and space. This has slowed down many projects as we have best tried to juggle resources and accommodate change. I am looking forward to the integrity the new environment will bring to our systems, the risk it will remove and the ability to implement projects. Business Intelligence Since getting the Ministers approval to proceed with the project an RFT process has completed and we have selected the vendor to work with to deliver the project. The gathering requirements phase is now complete and from here we need to prioritise what will be delivered. This will be a collaborative effort from IT, staff and management and will impact the overall design of the Business Intelligence environment. A more detailed report is available as part of this paper. The Public Records Act Compliance The REMT recommended a practical approach to achieving compliance with the focus of the required work being a stock take of what we currently do and a gap analysis to be completed against the Public Records Act. From there a work plan will be created to achieve compliance in the upcoming years. The worked commenced in February.

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Information Group Dashboard

STRATEGIC GOALS:

An IT informed organisation.

Alignment to the clinical needs of the organisation.

Efficiency gains through technology.

PROGRESS

PROJECT

Beh

ind

On

targ

et

Co

mp

lete

COMMENT

Healthviews Rebuild Rebuild of the Healthviews server and optimization of it.

New Data Centre The building of the Data Centre is complete and handed over from building and property. Delays in getting the switches have delayed the “Go Live”

Backoffice Merger Work Finance, Payroll, Website and Communications

Business Intelligence A more detailed report is available as part of this report.

E-Prescribing The project has started. Internal Medicine (8th floor) have been selected to lead the pilot. This project is funded by the Safe Medication Management Program.

Regional Travel Register Now in pilot with the shared services teams of IT, Finance, HR and Planning and Funding. The purpose is to track travel volumes and costs.

Thin Desktop Working up a pricing plan and technology options and dove tailing into a leased desktop return schedule. Pricing options now being considered and design for the deployment finalized.

Network Upgrade Core upgrade work started including improved performance for the Fraser Building and Waikari.

PRA Compliance Project brief completed and options reviewed. Project stating in February.

Healthviews A clinical working party has been established to review and reconfigure Healthviews. Enhancements have been negotiated and upgrades scheduled over the next few months.

Expense Claim System Due to budget constraints we are developing this in house.

Video Conferencing Looking at our options for MDM, Telemedicine, Education and Management Meetings. Regional solutions are being investigated. Selecting a Vendor.

E-Pharmacy Upgrade This may be postponed due to capital reprioritization.

E-Forms Development Development schedule complete and work is underway in Women’s Health and for BMI. May be postponed due to capital reprioritization.

Server Virtualization The roll out plan for servers has been developed and the project has started. 90% of all servers now run on a virtual platform. Upgrading to V4.0

Oracle Financials Upgrade Planning underway.

HRIS Development Single sign on and workflow development as well as e- recruitment.

Middleware Development Outsourcing and improving the integrity of our payroll middleware solution. Now in proto type.

DR and BCP Draft DR document completed and being reviewed. However some of this may be postponed due to capital reprioritization.

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Business Intelligence Project

Start Date:

24/08/09

Target Date:

% Complete:

Actual Finish Date:

Executive Summary:

The Business Intelligence (BI) project is a direct response to the reporting issues facing both the Otago and Southland Health Boards, with Otago in particular faced with the real risk of not being able to access the information needed to make business decisions. The BI project is about more than just reporting, it will provide real time information, that when enabled by the tools will allow:

Alerting Dashboards KPI’s and Forecasting information to better inform management.

While the immediate need in Otago is for accurate information out of iPM, the BI project is bigger than just the Patient Management System data. It will eventually deal with data from over 20 core systems, across both the Otago DHB and the Region, providing the ability to report across multiple systems, services, management levels and DHB’s. The BI strategy is a multiyear project, with the first five years of the project split into three phases:

Essential BI Phase: Data Warehouse Design and Development; Basic analytical Reports.

Extended BI Phase: Integrated and expanded Financial, Labs, Rads Data etc; further systems development.

Advanced BI Phase: Advanced Analytics, KPI’s, Dashboards, Data Mining

The project is currently in the Essential Phase, the primary objective is to concentrate on the design and development of the Data Warehouse, which will provide all the organisations information needs in a single repository. This design and development work is important to ensure the core design meets the demands of the following phases. This foundation will allow faster ad hoc development of information requests, as well as toolsets to allow users to more easily access data and to create their own reports.

Progress this month:

The first information deliverables have been decided and align with the Ministry ‘Health Targets’ that measure the DHB’s performance. The recommendation that ‘Shorter stays in emergency departments’ should be the first of the health targets to

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be delivered was ratified by the Project Board.

Work continuing on the overall design component of the project. Work on what the next information deliverables will be after the ‘Health Targets’ has already commenced.

The project budget has been re‐examined, ensuring that it aligns with the projects’ phasing to allow the Business Analysts to more effectively monitor progress.

The choice of the six ‘Health Targets’ as the first deliverables of the project is logical. It satisfies several of the criteria used in the evaluation process, namely it is a regional requirement, it has significant strategic value as they are stated objectives in the 2009/10 District Annual Plan, and is used as a measure of performance by the Ministry. Starting with the ‘shorter stays in emergency departments’ as the first of these will allow the near time monitoring of progress to ensure that the 2009/10 target of 80% of patients to be ‘admitted, discharged or transferred’ within the six hour timeframe is met. To date this monitoring has been conducted reactively, with no ability to easily analyse the factors that are influencing the wait times.

The high level design of this subject area is already underway, this will be presented at the next project board meeting. This can then be enhanced during workshops involving key stakeholders from the organisation, held to refine the requirements and scope of the information deliverable, as well as identify and resolve process and system issues. The design and development process will also be benchmarked, with accurate duration and effort to be incorporated into the overall and stage plans for final sign off at the next project board meeting.

Whilst the first of the health targets are being delivered, work on the overall design component of the project continues. One of the characteristics of a Business Intelligence project is that the design and development phases are parallel streams of work, with the design phase of a deliverable being conducted while the previous deliverable is being developed.

There has been no alteration in the overall amount of capital for the project, nor has the amount of capital available to the project for each financial year been increased. The new financials supplied by Finance have been attached to this report.

Financial Status:

Refer to Finance Section Project Progress from Previous Months:

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Top Risks:

Data Requirements Risk that the end user’s within the organisation will be unable to define their requirements. A change in mindset is needed from what they currently have, to thinking about what their objectives are and how to measure the success of them.

Regional Focus

Since the project is regional, there needs to be a sustained effort to ensure that a regional focus is maintained. It can be easy for this focus to slip, especially because this first data sources to be integrated are Otago DHB systems, leading to requirements that are too narrow in focus.

Internal project staff skills The skills needed for this project are very specific, there is a likelihood that members of the internal project team do not have the relevant skill level to undertake certain tasks.

Resolution:

A structured requirement gathering process is currently underway to avoid this. This process involves interviewing the end users and eliciting a set of requirements and priorities.

This risk should be negated by ensuring that

there is a Southland presence on the Project Board, as well as gathering their requirements during the initial discovery phase, even though these may not be delivered until later in the project.

A skill assessment is underway, comparing the

skills of the project team to a skills matrix. A plan will be put in place to breach any gaps, either through training or filling it by using Montage and ensuring a transfer of skills knowledge.

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Financial Report – Business Intelligence Project (BI) A detailed review of the BI financials has taken place this month by finance alongside the BI Project management team. The main outcome of these discussions was a forecast based on a phased resourcing schedule over the project life, that includes project to date actuals. A summary of this forecast is included below and shows that at this stage the project is forecast to come in $120k under the approved business case. Please note however that this represents unallocated contingency, which if all spent, will bring the project in on budget. Description Business

Case Feb-10

ForecastVariance

728 709 19

648 737 (89)215 0 0

Total Incremental Capital Costs 1591 1,446 146

Inhouse Personnel 817 842 (26)

TOTAL BI project 2408 2,288 120

FTEBusiness

Case Feb-10

ForecastVariance

Inhouse Personnel 3.20 3.06 0.14

Implementation (Consultants-Project Mgmt / Developers and Monitoring)

Hardware/Software

Contingency

Currently, the one area of identified financial risk, which hasn’t been scoped is the cost to the project of training and potential backfill for “Subject Matter Experts” from the business who will be used to verify the business rules. As each workpackage is delivered, different staff will be utilised however at this stage we are unsure of the;

commitment required whether or not they will require backfill and therefore represent a cost to the project.

Costs incurred will be met from the contingency or other savings. Contingency As at February10, allocations against the contingency are as follows Allocation of Contingency to Feb10 Business

Case Feb-10 Actuals

Variance

Contingency 215 215Business Analyst 43 (43)Project Initiation delay / Rates undercosted 46 (46)

Remaining Contingency /Unallocated 215 89 127

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As shown in the above table, $89k of the contingency has been allocated, the majority of this for consultant costs not in the original RFP. These have been incurred due to three reasons;

$46k – a combination of the hourly consultant rate being undercosted in the original Business Case combined with an extended project initiation phase and requirement to have the Montage Project Manager on site more than originally expected at this stage.

$43k - the requirement to have an outsourced “Business Analyst”, for a period of time prior to a staff member assuming this role. This position was not identified in the original RFP, however is now seen as a pivotal position bridging the gap between IT, Finance and the Business. This position will lead workshops and be the pivotal link that will drive the project through the business users.

FTE FTE forecast against the business case is as follows

FTE - InhouseBusiness

Case Feb-10

ForecastVariance

Project Manager - 0.66 (0.66)Bus Sys Manager 0.10 - 0.10BI Architect 0.60 - 0.60BI Technical Lead - 0.52 (0.52)BI Specialist - 0.71 (0.71)Report Writer / Analyst - 1 1.00 0.38 0.62Report Writer / Analyst - 2 1.50 0.38 1.12Business Analyst - 0.40 (0.40)TOTAL FTE Inhouse 3.20 3.06 0.14 As can be seen, there has been a reallocation of the FTE into different roles since the business case was approved. This reflects the 2 year gap since the preparation of the original business case, the forecast aligning more correctly to the RFP presented by Montage. Capital Spend The amount capitalised to date is shown below and is well within the current approved amount. Description Feb-10

PTD Actuals

Hardware/Software 137Implementation (Consultants-Project Mgmt / Developers and Monitoring) 64

Total Incremental Capital Costs 201

Inhouse Personnel 76

TOTAL BI project spend to date 277

Approved Capital Plan to Date (ODHB + SDHB) 1067

Capital Allocated to Date but not Spent 790

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Business Intelligence Project - Financials as at 28th February 2010

Description Business Case

Feb-10 Forecast

Variance

HardwareServers 80 104 (24)Storage 0 31 (31)

SoftwareSQL Server 290 306 (16)WhereScape RED 267 108 159Microsoft ( MSDN) Windows 0 10 (10)Performance Point 91 0 91Sharepoint 0 150 (150)

Hardware/Software Total 728 709 19

ImplementationProject Management 176 147 29Design and Development 220 310 (90)Report Writer 100 100 0Business Analyst 0 43 (43)Project Monitoring 113 100 13

Disbursements 39 37 2

Implementation Total 648 737 (89)

Contingency / UnallocatedContingency / unallocated 215

Remaining Contingency /Unallocated 215 0

Total Incremental Capital Costs 1591 1446 146

Personnel (in-house)Project Manager 0 190 (190)Bus Sys Manager 42 0 42BI Architect 232 0 232BI Technical Lead 0 158 (158)BI Specialist 0 222 (222)Report Writer / Analyst - 1 0 94 (94)Report Writer / Analyst - 2 542 75 467Business Analyst 0 104 (104)

Total Personnel ( in-house) 817 842 (26)

TOTAL BI project 2408 2,288 120

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Voice Gateways Project

Start Date:

Jun‐09

Target Date:

% Complete:

60

Projected Finish

Date:


Work on the physical installation of the Voice Gateway (VG) units has been completed & the

preferred configuration has been implemented and fully tested.

Migration of users to the solution has highlighted existing issues with the greater voice

network that are now the focus of our attention.

External engineers have extensively reviewed the voice network and identified faults that

may have caused performance issues on legacy and newer VOIP voice networks. These were

existing issues that have been uncovered and highlighted during the installation of the Voice

Gateways solution.

An external party was engaged to resolve these issues and this work was executed on

Thursday the 4th of March. Monitoring of the VOIP Network is being undertaken to ensure

that this work has the necessary positive effect on the IP Phones and also on the Voice

Gateways.

Work has been undertaken with a small group of departments to move their fax machines

onto the Voice Gateways, and alter a key setting on their fax machines, to trial a potential

solution to the issue as identified by a vendor. To date this has been effective and no

problems have been reported in the 3 week period since the changes were made.

A small test group of 10 users has also been migrated to the solution with no issues

reported since the work was undertaken on the 4th of March.

Should the changes to the VOIP Network improve the overall performance & reliability of

the Voice Gateways solution, to an acceptable level to the organisation, then we will

develop a cutover strategy in consultation with provider arm management to minimise the

impact on our staff & patients.

Financial Status:

Budget:

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The budget for this project is $341,597.20 as approved by the Board of Directors on the 4th of March 2009. Actual: Actual costs to date are the purchase of the forty (40) Voice Gateway devices and some partial implementation costs to have the equipment installed within the DHB framework. Variance: There is no variance to report against as the project costs are currently running to budget. Committed: The project has a committed capital expenditure of $337,095.26 against budget. Project Progress from Previous Months:

Top Risks:

Potential loss of core Call Parking functionality

Cooling capacity in PABX Room

Call functionality

Resolution:

Identified solution with Telecom and planned testing undertaken to ensure core functionality is maintained in VG solution

Mitigating risk by load balancing equipment cutover to reduce heat in room.

Training sheets are being created that identify the changes in functionality between the PABX system and the VG’s solution. Global emails and distribution of information prior to cutover will be utilised to ensure shared knowledge

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Human Resources – February 2010 Recommendation That the Hospital Advisory Committee note this report. Activity Human Resources Information Systems / Payroll Work has commenced identifying issues to resolve due to the pending merger of ODHB & SDHB eg a number of employees are paid from both sites which will require consolidation from 1 May. Payroll forms have been reviewed and suggestions from users forwarded to IT prior to introduction at SDHB. Recruitment Key work for recruitment during February included the following;

Agency negotiations successfully continuing from a regional perspective in preparation for One DHB. Most agencies rates are being cut substantially ensuring large savings regionally.

Commence negotiation of advertising deals across Southland and Otago.

Strategic work continuing to make impact and gain momentum; eg: Attracted 80 high quality applicants for a Medical Physicist position (most previously attracted was 2 a that level). Also, placed 5 candidates from talent pool in Otago Nursing area.

Southland Otago

Allied 1 1

Support/Management/Corporate/Admin 4 6

Nursing 12 15

New vacancies actively being recruited for

SMO 9 0

Total 26 22

Allied 3 10


Nursing 19 24

New vacancies from pre-February still actively being recruited SMO 9 17

Total 36 57

Allied 6 13


Nursing 18 15

Vacancies filled in February

SMO 3 0

Total 35 33

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Learning and Development Learning and development activity across both Otago and Southland DHBs is currently on hold. Incubator Programme Year two of the SDHB programme is well underway, with key planning activity undertaken during February and a series of student and teacher meetings held across participating schools. The first school session is scheduled for early March. Otago DHB is considering a pilot approach for 2010. The particular workforce group that had been identified in earlier discussions was that of MRT’s. One DHB: HR Transition Workstream The HR transition workstream is progressing well. Issues identified for resolution primarily relate to ensuring the seamless transition of staff from the existing organisations into the new entity. Input and advice is also being provided to other transition workstreams as required. Key issues being worked through by HR involve the actual transfer of staff, union engagement and ensuring technical requirements such as ACC partnership programmes, Kiwisaver obligations and employee immigration status are transferred without excessive paperwork being required. Good progress on these matters has been made and legal advice sort where necessary. Employment Relations South Island Clerical MECA PSA Document remains unsettled, no further notice of industrial action received since November 2009. PSA has joined with other CTU-Unions in looking at an alternative negotiation approach. Service & Food Workers MECA SFWU Document remains unsettled, no further notice of industrial action received since November 2009. SFWU has joined with other CTU-Unions in looking at an alternative negotiation approach. Southland DHB Clerical & Administrative CEA NZNO Document remains unsettled, NZNO has joined with other CTU-Unions in looking at an alternative negotiation approach. MRT MECA APEX Negotiations are continuing with little progress made. Notice of industrial action for March has been received by most DHBs, although some DHBs do appear to be targeted with greater levels of action than others. Southland Managers’ CEA APEX The parties met in October to commence negotiations. Still awaiting further dates to be set to continue discussions. Otago Food Services CEA AWUNZ Dates for the parties to begin discussions are yet to be determined. The bargaining strategy is awaiting signoff. AWU, which is a non-CTU union, is currently waiting to determine success of strategy adopted by CTU-Unions.

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Otago Drivers CEA AWUNZ Dates for the parties to begin discussions are yet to be determined. AWU, which is a non-CTU union, is currently waiting to determine success of strategy adopted by CTU-Unions. Otago Pharmacy CEA NDU Negotiations occurred on 24 November 2009. Dates to continue negotiations are yet to be set. The union is currently waiting to determine success of strategy adopted by CTU-Unions. RMO MECA RDA Union has initiated negotiations for 3 separate SECAs in the Auckland region, and a “rest of country” (including Otago-Southland) MECA. Dates are being arranged for Auckland DHB-RDA negotiations, but dates for the other negotiations, including the rest of country MECA, are yet to be set. Physicist MECA APEX Union has initiated negotiations for a renewed MECA covering the 6 DHBs providing Radiation Oncology Treatment. Negotiations occurred 16 and 17 February, further dates yet to be set. Nurses and Midwives MECA NZNO Union has initiated bargaining. NZNO has joined with other CTU-Unions in looking at an alternative negotiation approach. MERAS Midwives MERAS Union has initiated bargaining. MECA settlement is likely to be the same as the Nurses and Midwives. Occupational Health and Safety ACC Partnership Programme Kate Gaines has agreed to conduct the audit this year, which is scheduled to commence on Monday 18 October 2010. Kate conducted the audit in 2008. Work on the action plan developed following the 2009 audit continues. The current focus is on injury management. The revised WorkAon report form introduced in mid-December to improve compliance with time frame requirements of needs assessment and initial action plans for injured staff who are absent from work has shown significant improvement. Bi-monthly audits will continue. H1N1 (Swine Flu) Monovalent ’ Early Bird’ vaccination programme The target for front line health care workers in Dunedin has been exceeded for those receiving the first dose of the ‘Early Bird’ vaccination and the campaign continues with clinics now providing the second dose of the two dose course. Final figures will be collated across the regions to provide a national perspective. Early indication is that Otago is progressing extremely favourably with this campaign. Seasonal Influenza Vaccination The campaign will commence on 8 March. Full details of all clinic times are available on the front page of MIDAS and we are again fortunate to have Turners and Growers donating fresh fruit for the duration of the campaign. Marion Poore will hold an information session for staff on 2 March which focuses on how influenza is likely to affect us this season and to assist staff in making their decision about vaccination.

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One DHB Transition Workstream The local Occupational Health and Safety teams have operated as a shared service for the past two years and the forthcoming merger will see the consolidation of work that is well underway. Service delivery will continue unaffected with priority areas for further alignment identified as follows: - ACC Partnership Programme - H&S Structure - EAP - Pre-employment health screening - Legislative compliance - Employee Participation Agreement - Policies & procedures Injury Management Work-Related Accidents/Accidents to visitors, contractors etc on-site A total of 50 work-related (employee) or onsite (visitor, contractor or patient) were reported during February 2010. Twelve of these injures related to non-staff, as detailed below. There was one serious harm notification made to the Department of Labour (a staff member suffered a lower back injury). The number of physical assaults reported again indicates a wide spread of reporting as opposed to an increase in physical assaults in one area. A greater number of injuries to visitors, contractors and patients were reported this month than usual and are included in the category ‘other accidents by type’. This includes three visitors, six contractors, one student and two patient injuries. These were mostly minor injuries but included:

a bite injury to police officer escorting a patient (this will be followed up directly with the police); and

an out-patient who fell off equipment provided during physiotherapy. One verbal assault was reported but is not included in the monthly accident total as no actual physical injury occurs.

FEBRUARY 2010 ACCIDENT BY TYPE

58

04

17

25

005

1015202530

Patien

t hand

ling

Slip/tr

ip/fa

ll

Man

ual ha

ndling

Indu

stria

l han

dling

Restra

int

Assau

lt phy

sical

Oth

er

Near m

iss

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FEBRUARY 2010 INJURY BY TYPE

8

11

1

10 10 10

1

02468

1012

Back

pain

Hand/

arm/s

houl

der

Serio

us h

arm

Oth

er

Face/h

ead/

neck

Leg/

hip/kn

eeBur

n

Monthly Accident Total - Annual Comparison2009-2010

0

10

20

30

40

50

60

Feb-0

9

Apr-0

9

Jun-

09

Aug-0

9

Oct-09

Dec-09

Feb-1

0

Injury total

Serious harm

Blood, body fluid

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February 2010

Human Resources Dashboard

2009-2012 STRATEGIC GOALS:

1.0 Establish a recruitment infrastructure that enables and supports delivery of a strategic and proactive approach to recruitment, including improved efficiency, more effective selection outcomes and enhanced budget control

2.0 Cultivate and promote a positive, safe and healthy working environment

3.0 Develop an overarching regional framework for workforce development

4.0 Deliver human resources services that support managers in their management of workforce

PROGRESS

KEY PROJECTS / ACTIVITY AREAS 2009/2010

Sco

pin

g

Beh

ind

On

Tra

ck

Co

mp

lete

d

COMMENT

1.0 RECRUITMENT

1.1 Regional recruitment model √ Complete

1.1.6 Recruitment metrics reported √ Baseline data continues to be collected and reported for active recruitment process numbers. HRIS reporting scoping ongoing.

1.1.8 Implement e-recruitment platform module of HRIS

√ Progress occurring and on schedule. Timeline now to be ready for April 30.

1.2 Establish targeted sourcing strategy √ Regional advertising strategy proposal complete at SMO level. Networking focus continuing. First edition of Alumni newsletter due March. Talent pool now providing successful placements.

2.0 SAFE AND HEALTHY WORKING ENVIRONMENT

2.1 Engagement Survey √ Will not be delivered this 2009/10 due to financial constraints.

2.1 Review Exit interview √ Expanded to include electronic workflow of full exit procedure; deliverable therefore taking longer than anticipated to achieve.

2.3 Policy, Procedure Alignment √ Draft regional Health & Safety Policy released for consultation

2.3 HSNO Compliance √ Draft compliance audit report received; initial indications are that specific FTE will be required to manage HSNO responsibilities.

3.0 WORKFORCE DEVELOPMENT

3.1.1 Workforce Development Discussions √ No activity this month, currently on hold

3.1.2 Workforce Committee √ No activity this month, currently on hold

3.1.3 Community Engagement √

3.2.1 Incubator Pilot Programme √

3.2.2 Scholarship Programme Not yet commenced, currently on hold

3.2.3 Workforce Information √ Scoping activity as part of HRIS Project

3.4.1 Management and Leadership development

√ Deliverable timing under review, may roll over into 2010/11 plan

3.4.2 Clinical Governance √

3.4.3 Regional Framework √ Deliverable timing under review, may roll over into 2010/11 plan

4.0 HUMAN RESOURCES SERVICES

4.2 Complete Regional Policies √ Change management, disciplinary, harassment and leave management policies being worked up for consultation

HUMAN RESOURCES INFORMATION SYSTEMS

Implement Employee Connect in SDHB √

Introduce Electronic Filing √ Business case to support One DHB transition being worked up.

Payroll system upgrade √ On hold for ODHB & SDHB due to financial constraints.

Please note: the numbers in the left hand column correspond to the HR Strategic Plan

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Otago District Health Board - Provider 28 February 2010

FTE Summary by Group

Medical Nursing Support Allied Health Management/Admin Total

Actual Budget Variance % Var Actual Budget Variance % Var Actual Budget Variance % Var Actual Budget Variance % Var Actual Budget Variance % Var Actual Budget Variance % Var

Clinical Services

Emergency Medicine & Surgery 136.0 143.9 7.9 5% 494.8 496.3 1.6 0% 7.8 7.6 (0.2) (2%) 77.5 81.9 4.5 5% 106.1 104.9 (1.2) (1%) 822.1 834.6 12.6 2%

Mental Health & Community Services 37.2 47.0 9.8 21% 380.8 384.6 3.7 1% 0.0 - (0.0) 0% 141.8 148.5 6.7 4% 66.6 67.8 1.3 2% 626.4 647.9 21.5 3%

Womens, Child & Public Health 30.9 33.5 2.6 8% 136.0 132.2 (3.9) (3%) 0.3 0.3 0.0 7% 98.0 108.0 10.0 9% 44.1 39.1 (5.0) (13%) 309.3 313.1 3.7 1%

Budgeted Savings - (11.0) (11.0) 100% - (22.0) (22.0) 100% - - - 0% - (30.0) (30.0) 100% - (8.3) (8.3) 100% - (71.3) (71.3) 100%

Totals Clinical Services 204.0 213.3 9.4 4% 1,011.6 991.1 (20.6) (2%) 8.1 7.9 (0.2) (2%) 317.3 308.4 (8.9) (3%) 216.8 203.6 (13.2) (7%) 1,757.8 1,724.3 (33.5) (2%)

Clinical Support

Diagnostic & Support Services 23.0 23.8 0.8 3% 14.0 13.7 (0.4) (3%) 103.9 108.5 4.6 4% 165.8 165.0 (0.8) (1%) 61.1 63.1 2.0 3% 367.9 374.0 6.1 2%

Totals Clinical Support 23.0 23.8 0.8 3% 14.0 13.7 (0.4) (3%) 103.9 108.5 4.6 4% 165.8 165.0 (0.8) (1%) 61.1 63.1 2.0 3% 367.9 374.0 6.1 2%

Total Clinical & Clinical Support Services 227.0 237.1 10.1 4% 1,025.7 1,004.7 (20.9) (2%) 112.0 116.4 4.4 4% 483.1 473.4 (9.7) (2%) 277.9 266.6 (11.3) (4%) 2,125.7 2,098.2 (27.5) (1%)

Non Clinical Support

Finance/Corporate Services 89.5 89.5 0.0 0% 15.3 16.6 1.3 8% 27.9 29.7 1.8 6% 3.1 4.5 1.5 33% 156.8 178.6 21.7 12% 292.5 318.9 26.4 8%

Totals Non Clinical Support 89.5 89.5 0.0 0% 15.3 16.6 1.3 8% 27.9 29.7 1.8 6% 3.1 4.5 1.5 33% 156.8 178.6 21.7 12% 292.5 318.9 26.4 8%

316.4 326.6 10.2 3% 1,041.0 1,021.4 (19.6) (2%) 139.9 146.1 6.2 4% 486.2 477.9 (8.3) (2%) 434.8 445.2 10.5 2% 2,418.2 2,417.1 (1.1) (0%)

Personnel Costs Summary

Medical Nursing Allied Health Management/Admin Total

Actual Budget Variance % Var Actual Budget Variance % Var Actual Budget Variance % Var Actual Budget Variance % Var Actual Budget Variance % Var

Clinical Services & Support 4,052 4,047 (6) (0%) 5,675 5,456 (219) (4%) 355.0 373.3 18.2 5% 2,453.6 2,317.2 (136.4) (6%) 1,040.3 990.8 (49.5) (5%) 13,576.6 13,184.2 (392.4) (3%)

Non Clinical Support 776 730 (46) (6%) 122 135 13 9% 113.2 120.3 7.1 6% 20.7 52.0 31.3 60% 774.2 964.1 190.0 20% 1,806.1 2,000.7 194.6 10%

Total Personnel Costs ($'000) 4,828 4,776 (52) (1%) 5,797 5,591 (206) (4%) 468.3 493.6 25.3 5% 2,474.4 2,369.2 (105.2) (4%) 1,814.5 1,954.9 140.4 7% 15,382.7 15,185.0 (197.8) (1%)

Support

10/03/2010

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Otago and Southland – February 2010 16/03/2010 Manager – Warren Taylor Version 1

Regional Building and Property Services February 2010 1. General Overview 1.1 Regional Structure, Policies and Procedures

The regional Building and Property Services team is progressing well since the merge in December 2009. We have been utilising some of our Otago trades staff at Southland Hospital in the past month. This followed a cost analysis which showed that it is more financially viable to use internal staff at either site than to pay contractors. We will ensure that this process is managed and workloads do not increase while staff are working at other sites. We are also reviewing our policies and procedures to be consistent on all sites, which will make efficiencies and reduce costs. There are challenges in implementing these, and consultation with services will take time, but both organisations will see an improvement in our service. We have identified that approval from senior staff and budget holders to undertake work, access and services is a critical area to get right. This will ensure resources and funds are committed correctly.

1.2 BEIMS

BEIMS software is now fully running for all reactive and planned preventative maintenance in the region. We are continuing to transfer the asset data history for Southland DHB into BEIMS. This involves reformatting the information for consistency, and will be an ongoing process. We are also working on our KPI reporting. This will assist with the management of the teams, ensure that resources are correct and all work is undertaken in a timely manner. The financial component of BEIMS is yet to be implemented. This will link the work requests, purchase orders, receipting and invoices together to provide greater visibility and streamline our process.

1.3 Generator – Southland

The Southland Hospital Generator has proven to be unreliable, with various faults and incidences of total power loss, most recently in January 2010. The majority of time this month has been involved in planning to remove the Generator from service, and replace it with a temporary Generator. This was a difficult task, as there is only one Generator on the site, which resulted in periods where no essential backup was available. We are currently investigating the options, potentially in a regional approach, with the issues around the Dunedin Hospital Generators also being considered.

1.4 Flooring - Otago

During February we have been prioritising our flooring replacements for the rest of the financial year. Unfortunately we have received more requests than we have funding for, and it is becoming difficult to maintain a good standard. The success of the Queen Mary replacement of carpet with vinyl had a positive result, but this process is more expensive, which adds to the issue. In order to keep up with the flooring requests, we plan to revise the 2010/11 deferred maintenance programme. However this does put pressure on other items of plant and infrastructure, which could impact multiple departments if failure occurs.

2. Quality 2.1 Fire and Security Coordinator

There has been a huge increase in requests for Fire Training across the region, with Ad hoc training sessions and requests. The training itself differs for each site, for instance the Otago staff are trained in the use of Fire Extinguishers and Fire Hose Reels but the Southland staff are not. However Southland has a far better theory schedule and staff have a better understanding of Fire and Building Wardens. To make efficiencies and ensure the best use of resources we are reviewing the training content and schedule on both sites, which includes looking at regional online training. All training will be compliant and developed with the Fire Service.

2.1 Helensburgh House Data Hub - Otago Work commenced on the upgrade of the Helensburgh House Data Hub which serves the building. This job was prioritised as a deferred maintenance project to eliminate health and safety issues caused by falling objects, loose equipment and Ad hoc repairs and to strengthen the data infrastructure for the building. Running concurrently with this work is an upgrade of some of the telephone services which is being carried out by IT.

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3. Risk 3.1 Medical Electrical Areas

Preliminary work commenced this month reviewing our documentation around body and cardiac areas. There appears to be some holes in our system where verification checks by contractors should result in a reactive maintenance ticket being created. This issue appears to be regional, however we cannot confirm this for Southland because we are still establishing all documentation for the sites. An action plan is being developed to ensure that all work is completed.

3.2 Emergency Oxygen Cylinder Store - Otago

The current storage Oxygen cylinder storage capacity in the event of an emergency is 12 hours at average flow. The BOC gases recommendation of 24 hours at average flow, has highlighted that our capacity is inadequate and a risk. Design work has commenced to provide additional capacity of the BOC recommendation. This work will be forwarded to BOC to provide further engineering advice and preliminary costings.

4. Capital and Deferred Maintenance Project Status 4.1 Capital Projects

15 new capital projects have been submitted this month for Otago, with an estimated capital value of $46,357.00. In addition to this, the Dunedin School of Medicine has submitted a capital project for $12,000.00, which they will fund. 7 new capital projects have been submitted this month for Southland, with an estimated capital value of $14,700.00.

4.2 New Major Capital Projects Submitted (Greater than $10,000)

Location

Ota

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Du

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Kew

Lak

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/ Group Description of Project

Estimated or Quoted Total

Value

Medical School Alterations to old Glass Washing Room (B & P involved) $ 12,000.00

4.3 New Minor Capital Projects Submitted (Less than $10,000)

Location

Ota

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Kew

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/ Group Description of Project

Estimated or Quoted Total

Value

D & S S Kitchen Ward Block Lower Ground: Install New Oven $ 3,268.00

D & S S Staff Café: Removal and Installation of New Dishwasher $ 10,000.00

D & S S ISS Laundry Shift to Children’s Pavilion $ 4,644.00

D & S S New Data Outlets (x 4) $ 1,782.00

Diagnostic and Support Services – Total Requests: 4 Total Estimated Value: $ 19,694.00

E, M & S Oncology Ground Floor: New Data Outlet $ 594.00

E, M & S Cath Suite: Hang Door in Existing Opening $ 410.00

E, M & S Respiratory: New Data Outlet $ 486.00

E, M & S Oncology 1st Floor: New Data Outlets $ 2,020.00

Emergency, Medicine and Surgery – Total Requests: 4 Total Estimated Value: $ 3,510.00

Info Sys Dividing Wall to Create New PACS Project Office $ 6,500.00

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Info Sys Rewire Data Outlets to Radiology 1st Floor $ 7,500.00

Information Systems – Total Requests: 2 Total Estimated Value: $ 14,000.00

M H & C S Helensburgh House 4th Floor: Data Outlet $ 200.00

Mental Health and Community Services – Total Requests: 1 Total Estimated Value: $ 200.00

W, C & P H Dunedin and Wakari Hospitals: Smoke Free Signage $ 6,500.00

W, C & P H Children’s Pavilion Ground Floor: Install New Dishwasher $ 294.00

W, C & P H Children’s Pavilion Ground Floor: New Data Outlet $ 658.00

W, C & P H Vera Hayward Clinic: Install Door Bell $ 1,501.00

Women’s, Children’s and Public Health – Total Requests: 4 Total Estimated Value: $ 8,953.00

Corporate Remove Partition to Enlarge Board Room $ 2,500.00

Corporate (Chief Executive Officer) – Total Requests: 1 Total Estimated Value: $ 2,500.00

Medical Emergency Dept: Provide Hot Water Feed to Emergency Shower $ 1,500.00

Medical Emergency Dept: Mount Large EDIS Monitor $ 1,000.00

Medical Medical Imaging: Relocate Data Outlet for Printer $ 200.00

Medical Ultrasound Dept: Install Televisions $ 1,000.00

Medical Division – Total Requests: 4 Total Estimated Value: $ 3,700.00

Mental Health Change Room 220 into an Office (previously a Spotless job) $ 3,000.00

Mental Health Division – Total Requests: 1 Total Estimated Value: $ 3,000.00

Surgical Pharmacy: Change Dictation Bay into Pharmacy Cupboard $ 5,500.00

Surgical Division – Total Requests: 1 Total Estimated Value: $ 5,500.00

4.4 Capital Construction Project Summary

Location Status

Ota

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Capital Construction Projects

Pen

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Des

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Co

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MS

P

Update

Mental Health Acute Inpatient Ward On hold until funding confirmed. Corporate – Finance and Info Systems On hold until funding confirmed. Conference Facilities - Wakari On hold until funding confirmed. Staff Cafeteria - Dunedin On hold until funding confirmed. Staff Cafeteria - Wakari On hold until funding confirmed. Nursecall Upgrade Ward 10A Wakari Design work pending

Nursecall Upgrade Ward 11 Wakari Design work pending Hospital Management Building Refer to one page report.

CADS Relocation Quote sent to Client. Awaiting approval.

NICU Alterations Budget estimate sent to service. Awaiting feedback.

Hulme House Bathroom Upgrade Working drawings currently in progress

DSA Room Upgrade

Work has begun on a new Concept after it was decided that the initial concept does not meet the needs of the service.

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Nursecall – Queen Mary Preliminary drawings in progress

Bike Racks Quotes have been requested from external contractors.

Community Oral Health Project Refer to one page report Cardiology Catheter Suite Refurbishment Refer to one page report.

MRI Double door installation Prices received from Contractors – quote to be forwarded to Client for Capex application.

Gastro Cleaning Room Upgrade All work completed and handed back to service

Helensburgh House Data Room Upgrade Construction underway

Ward 10A Alterations Capex received – Building Consent Application in progress. Contractors have been notified.

4.5 Deferred Maintenance Projects

Location Status

Ota

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Deferred Projects P

end

ing

Des

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Co

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Update

Painting Projects Currently working on 3rd floors of the Ward Block.

Concrete Spalling Continue to make good progress on the repairs of the concrete spalling and the resealing of the exterior concrete.

CSB 4th Floor Domestic Hot Water - South Main

Large sections of pipe work are being replaced to this area. This work is about 98% completed.

EPC II Ward Block Lighting and Heating

Ward Block and Clinical Services Building are largely finished. Lights being progressed into other buildings on the Dunedin site. Waiting on more tubes from supplier.

Warren Taylor Regional Facilities and Site Development Manager

129

DESIGN REPORT

HOSPITAL MANAGEMENT BUILDING - SOUTHLAND


Concept design work has been undertaken around the initial scope presented and additional information provided

Concept has been submitted to the Regional Facilities & Site Development Manager to review & comment before a more detailed plan is developed.

Concept work completed to date will give a good indication of the number of occupants that can be accommodated in the refurbished building.

Financial Status:

Estimate yet to be established.

Project Description: The purpose of this project is to provide additional office space for several management and support functions for the DHB. The project will include:

Demolition of existing interior walls, floor coverings. Removal and replacement of existing asbestos roof. Internal partitions and suspended ceilings. Stopping, painting, and floor coverings. Lights, socket outlets, communications, fire protection, plumbing, drainage,

and HVAC plant, supply and extract ductwork. Replacement of window joinery as and where required.

Project Progress from Previous Month:

As built drawing has been completed. Concept work has commenced. The scope is yet to be confirmed. A design meeting to refine the office configuration, with the key stakeholders,

has been proposed.

Risk: Asbestos removal (existing roof

cladding) Clear communication during

design to ensure all needs are met by design.

Regional differences in project

development.

Resolution:

Must be built into planning and strict adherence to OSH procedures during demolition phase must be enforced.

Regular meetings with stakeholders and

clear scope of requirements. Refinement of regional project

development procedures and familiarity with site and personnel.

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PROGRESS REPORT - APPROVED CONSTRUCTION FOR THE COMMUNITY

ORAL HEALTH PROJECT – REGIONAL

START DATE:

TARGET FINISH

DATE:

% COMPLETE:

ACTUAL FINISH

DATE:

27 January 2010

Yet to be confirmed

Overall: 2%

Donovan: 95%

PROGRESS THIS MONTH:

The Building Consent for Donovan Primary School has finally been issued after protracted negotiations with the Invercargill City Council.

Construction has commenced and is due to be completed on 1st March. This delay has raised the question of how to avoid Building Consent if possible.

The quote to install the Electrical Cabinet and terminate services in Kurow has arrived and is being evaluated.

Design work is well advanced on the Fixed Clinics for Wanaka, Lumsden, Riverton, and the Mobile Site for Te Anau.

FINANCIAL STATUS:

Oral Health

Approved Cost

Actual Costs to Date

Construction Costs $ $ 43,632.20 Project Contingency $ $

TOTAL $ Yet to be advised $ 43,632.20 PROJECT DESCRIPTION:

This project includes the construction, relocation, refurbishment and replacement of various Dental Clinics.

PROJECT PROGRESS FROM LAST MONTH: Newfield Park Primary School, Invercargill - Building Consent has been issued, and construction has been completed. The construction included concrete work for driveways and cabinet foundation pad, and underground services such as water, drainage, power and data. Donovan Primary School, Invercargill - The Building Consent for Donovan school has not yet been issued, as the Invercargill City Council are working through drainage issues. The power cables are already in progress, as they are not part of the Building Consent.

RISKS AND RESOLUTIONS:

Remotely managing construction on non-DHB sites.

Robust communication with schools and other stakeholders.

Ensuring information is kept up to date.

Keeping updated information on sharepoint and hold regular design and construction meetings.

Undertaking construction work on school sites.

Signage and construction barriers to be installed to meet the requirements of each school / location.

Building and Property Services February 2010 Version 1

131

PROGRESS REPORT - CARDIOLOGY CATHETER SUITE - DUNEDIN

START DATE:

TARGET FINISH

DATE:

% COMPLETE:

ACTUAL FINISH

DATE:

14 September 2009

23 December 2009

99%

PROGRESS THIS MONTH:

Defects which were discovered since the room was occupied are being repaired. Work to be done out of hours to fit around Clinical need.

Investigation into vibration of extract duct have discovered a historic fault around air velocity. The ventilation design consultant is working on a solution which will be work additional to the contract.

The change over of the UPS power supply from the GE lab is being planned. A time and date is to be negotiated with the Cardiology service to undertake this work.

Final invoices (excluding retentions) will not be forwarded until the defects have been repaired.

FINANCIAL STATUS:

Catheter Suite

Approved Cost

Actual Costs to Date

Construction Costs $ 605,628.14 $ 588,394.82 Project Contingency $ 55,720.50 $ 52,211.25

TOTAL $ 661,348.64 $ 640,606.07 PROJECT DESCRIPTION:

Refurbishment of existing redundant Cardiology Catheter Suite, on the 7th Floor of the Ward Block.

PROJECT PROGRESS FROM LAST MONTH: The room is to be handed over to Siemens to install the Catheter machine. They are happy for the commissioning work to continue around them. Camfill Farr have tested and certified the ventilation to operating theatre standard. The ductwork, joinery, painting and floor coverings have been completed. The corridor ceilings have been reinstated. All of the support rooms have been returned to the Cardiology service. The Cardiology service has made additional requests which are being undertaken by Building and Property staff.

RISKS AND RESOLUTIONS:

Noise. Increased communication with all users of the adjacent areas.

Access. Signage and construction / dust barriers to be installed to construction area.

Traffic. Extra vigilance required by construction staff when entering and exiting site. Signage and barriers to be used.

Operational department adjacent to work site.

Close communication and cooperation with Cardiology department.

Building and Property Services February 2010 Version 1

132

Quality Improvement and Risk Management Page 1 of 2 09 March 2010

Quality Improvement and Risk Management March 2010 Report to the Hospital Advisory Committee

EquIP4 Accreditation and Certification Our accreditation and certification survey was held 22nd – 26th February 2010. 13 surveyors from QHNZ were onsite during the week completing both our certification audit and our first survey against the new EQuIP4 accreditation standards. Feedback from the survey team at the summation highlighted the positive work that is being done around the organisation with the organisation receiving an Extensive Achievement (EA) rating in four areas. In order to achieve an EA rating services must be able to demonstrate:

That they benchmark their performance against other organisations and / or Conduct research in that particular area and / or Have implemented advanced systems related to that area and / or Have achieved excellent outcomes in that area.

The four criteria for which we were awarded the EA rating were:

1.5.2 Infection Prevention and Control 1.5.3 Pressure Ulcer Prevention 1.5.5 Blood Management 2.5.1 Research.

Areas for improvement identified by the survey team included recommendations about: Standardising our processes Working more collaboratively across the organisation Improving the way we evaluate our systems and processes Improving the way we measure our performance.

The final certification result and report is expected back in approximately six weeks time and our EQuIP4 accreditation result and report is expected in approximately eight weeks time. Falls Prevention Project Roll out of the Falls project continues along expected timelines. The final evaluation and review of the documents included feedback from wards, nursing and allied health staff. The final versions are complete to be released onto MIDAS this week. This refining is imperative to have the best most functional document with this attention to detail leading to very high compliance in use of the document in audits. There was positive feedback about the project from the recent EQUIP 4 survey. A study day is planned for May to present the Falls programme and the Early Warning Scoring to all rural hospitals. Southland is also going to pick up the programme following our presentation of the programme to them in early February. Early Warning Scoring Systems Project Recognising when a patient's condition is deteriorating is a key aspect of patient safety and the use of early warning scoring systems (EWS) is integral to this. EWS comprises an early warning 'trigger' system, designed to identify adult patients at risk of developing critical illness at an early stage, and a protocol to use for those patients. The nursing team is leading this initiative. The new scoring charts have been delivered and education sessions have been well attended. The aim of this initiative is to decrease unplanned admissions to ICU by 20% and decrease cardiac arrest rates by 20% over 3 years. Hand Hygiene Project The national hand hygiene campaign, referred to as ‘Hand Hygiene New Zealand’, is part of the National Quality Improvement (NQIP) and Infection Prevention and Control

133

Quality Improvement and Risk Management Page 2 of 2 09 March 2010

Programmes. The programme is part of New Zealand’s response to the fact that harm caused to patients by infections contracted in the health care system are a significant problem worldwide. The project is being led in the Otago DHB by the Infection Prevention and Control team. This initiative is introducing the five moments of hand hygiene. This approach recommends health-care workers clean their Hands 1. before touching a patient, 2. before clean/aseptic procedures, 3. after body fluid exposure/risk, 4. after touching a patient, and 5. after touching patient surroundings. The team has completed the national baseline data measurements and hand gel has been installed on the ends of beds. Training has begun and was a feature of the Infection Prevention and Control Rep days held on 25th Feb and 2nd March. Putting the Patient First – our Quality Plan Despite our best efforts, healthcare is not yet as safe, reliable or patient-centred as we would like it to be. To be successful in providing high quality care to each patient, every time, we need to focus on continuously improving each of the dimensions that define healthcare quality. A quality plan is being developed to identify the initiatives we will undertake to achieve this. The six dimensions of healthcare that we are basing our plan on are: 1. Safe 2. Effective 3. Patient-centred 4. Timely 5. Efficient 6. Equitable The quality plan defines the activities that the organisation will undertake to improve patient safety and achieve the Ministry of Health targets. Initiatives in the plan include improving medication safety, reducing the number of patients who fall in hospital, reducing hospital-acquired infections and improving outcomes for stroke rehabilitation. The plan will have clearly stated outcome measures and timeframes so that we can measure whether or not we are making a difference. Quality Times Page 2 Audit Tools + Calendar - Global The amended global audit calendar and audit tools are almost completed and we expect to have them in MIDAS in March. The audit tools have had significant changes to layout, questions and instructions and now include a corrective action plan for services to implement and monitor. We expect the new tools and process will make auditing more effective for Services and will also allow a better organisation wide view of audit results. Quality Catherine Rae Regional Quality & Risk Manager 09 March 2010

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HOSPITAL ADVISORY COMMITTEE ACTION SHEET

As at February 2010

Action

Point No. SUBJECT ACTION REQUIRED BY STATUS EXPECTED

COMPLETION DATE

445-02/10 Interests Registers (Minute item 3.0)

Entries for Dr Adams, Dr Retieaux and Mr Bunton to be updated.

BS

Completed.

n/a

446-02/10 Bridging the Gap (Minute item 6.0)

Prior to the March Board meeting: Cost recovery to be further refined

and principles 7 and 8 to be redrafted;

Information to be provided on how a charitable trust might be used and its pros and cons.

COO Completed. Note a separate cost centre in DHB to be created instead of trust.

Complete

447-02/10 Stroke Service (Minute item 7.0)

Stroke Service to be advised of the committee’s appreciation and desire to be kept informed of future developments.

COO Letter sent to Dr Brendon Rae on 1st March 2010.

Complete

448-02/10 Physiotherapy (Minute item 8.0)

Further information to be provided on the proposal to cease provision of a satellite physiotherapy clinic at Mosgiel and make changes to the Palmerston service.

COO See Chief Operating Officers report. Tab 3.

Complete

449-02/10 Orthopaedics (Minute item 8.0)

Information to be provided on why the Orthopaedic Service is reluctant to provide its clinical threshold scoring tool to GPs so they can determine the likelihood of a referral being successful, and whether this occurs in other DHBs.

COO/CMO CPAC Scoring is available to General Practitioners.

Complete

450-02/10 Information Group Projects (Minute item 449)

Financial team to monitor the final aspects of Information Group projects closely;

Future project reports to be less technical and focus more on the definition of outputs sought and progress against outputs.

RCFO/BA

RCIO

Monitoring is ongoing Ongoing

Complete Complete

135

GLOSSARY OF ACRONYMS

A & D Alcohol and Drug

ACN Associate Charge Nurse

ADM Acute Demand Management

APEX Association of Professional & Executive Employees

ASMS Association of Salaried Medical Specialists

AT&R Assessment, Treatment & Rehabilitation

AWU Amalgamated Workers Union

BSA Breast Screen Aotearoa

BCP Business Continuity Plan

BU Business Unit

CAFMHS Children, Adolescent and Family Mental Health Services

Capex Capital Expenditure

CEA Collective Employment Agreement

CEO Chief Executive Officer

CFA Crown Funding Agreement; Crown Funding Agency

CFO Chief Financial Officer

CHFA Crown Health Funding Agency

CHS Community Health Services

CL Clinical Leader

CMO Chief Medical Officer

CMS Contract Management System

CNM Charge Nurse Manager

CNS Clinical Nurse Specialist

COHSL Central Otago Health Services Ltd

COO Chief Operating Officer

CPAC Clinical Priority Assessment Criteria

CP&FO Chief Planning & Funding Officer

CPG Clinical Practice Group

CPHAC Community and Public Health Advisory Committee

CQI Continuous Quality Improvement

CRC Community Rehabilitation Centre

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CSCC Community Service Coordination Centre

CSSD Central Sterile Supply Department

CT Computed Tomography

CTA Clinical Training Agency

DAP District Annual Plan

DHB District Health Board

DHBNZ District Health Boards New Zealand

DNA Did Not Attend

DOSA Day of Surgery Admission

DPA Disabled People’s Assembly

DR Disaster Recovery

DSA Digital Subtraction Angiography

DSAC Disability Support Advisory Committee

DSS Disability Support Services

DSU Day Surgery Unit

DTS Diabetes Test Strips

EAP Employment Assistance Programme

ECCT Emergency Care Coordination Team

ED Emergency Department

EDON Executive Director of Nursing

EEO Equal Employment Opportunity

EMR Electronic Medical Record

EN Enrolled Nurse

ENT Ear, Nose & Throat

EPS Emergency Psychiatric Services

EREL Employment Related Education Leave

ESPI Elective Services Performance Indicators

ETAT Expenditure to Attend Treatment

FF&E Furniture, Fixtures & Equipment

FSA First Specialist Assessment

FTE Full-time equivalent

FU Follow-up visit

HAC Hospital Advisory Committee

HBL Health Benefits Ltd

HCO HealthCare Otago (formerly the provider arm of the DHB)

HDU High Dependency Unit

HEICS Hospital Emergency Incident Command System

137

HHS Hospital & Health Service

HR Human Resources

HRIS Human Resources Information System

HSSIL Heart Surgery South Island Ltd

HWIS Health Workforce Information System

ICM Integrated Care Manager

ICU Intensive Care Unit

IDF’s Inter-district flows

IEA Individual Employment Agreement

IP Inpatient

IPA Independent Practitioners Association

IT Information Technology

JV Joint Venture

KPI Key Performance Indicator

MDU Medical Day Unit

MECA Multi-employer Collective Agreement

MERAS Midwifery Employee Representation and Advisory Services

MH Mental Health

MOH Ministry of Health

MOSS Medical Officer of Special Scale

MOT Main Operating Theatre

MOW Meals on Wheels

MRI Magnetic Resonance Imaging

MRSA Methicillin Resistant Staphylococcus Aureus (a “superbug”)

MRT Medical Radiation Technologists

MVS Meningococcal Vaccine Strategy

NASC Needs Assessment & Service Co-ordination

NCMHT North Community Mental Health Team

NGO Non-government organisation

NHI National Health Index

NHPPD Nursing hours per patient day

NICU Neonatal Intensive Care Unit

NIR National Immunisation Register

NSU National Screening Unit

NZBS New Zealand Blood Service

NZHIS NZ Health Information Service

NZNO New Zealand Nurses Organisation

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O & G Obstetrics & Gynaecology

ODHB Otago District Health Board

ODM Organisational Development Manager

OP Outpatient

OT Occupational Therapy

PACU Post Anaesthetic Care Unit

PACS Picture Archiving and Communications System

PAU Paediatric Assessment Unit

PBFF Population Based Funding Formula

PCA Primary Care Advisor

PCO Primary Care Organisation

PDP Professional Development Programme

PDF Portable Document Format

PETS Primary Emergency Triage Service

PH Public Health or Personal Health

PHO Primary Health Organisation

POP Plaster of Paris

PPM Planned Preventative Maintenance

PSA Public Sector Association

OBI On Board Imager

QIC Quality Improvement Committee

QSE Quality Services Enterprises

RDA Resident Doctors Association

RFI Request for Information

RFP Request for Proposal

RHMU Residual Health Management Unit

RIDSS Residential Intellectual Disability Secure Services

RIS Radiology Information System

RMO Resident Medical Officer

RN Registered Nurse

RT Radiation Therapist

SCL Southern Community Laboratories Inc

SCLOS Southern Community Laboratories Otago Southland Ltd

SCMHT South Community Mental Health Team

SDHB Southland District Health Board

SEAM Surgical Emergency Admission Management

SFWU Service & Food Workers Union

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SIPA South Island Pharmacy Association

SISSAL South Island Shared Service Agency Ltd

SLT Speech Language Therapy

SMO Senior Medical Officer

SOI Statement of Intent

TOTT Te Oranga Tonu Tanga

TPN Total Parenteral Nutrition

TSSU Theatre Sterile Supply Unit

VOCERA Wireless voice communication

VOIP Voice over internet protocol

WAP Workforce Action Plan

140

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