21 district health boards - southern dhb...update for boards and ceos - the quarter in review |...

Update for boards aNd Ceos oCtober 2009 For the QUArter ending 30 SePteMBer 2009

www.dhbnz.org.nz

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The Quarter In Review

Goal 1: Improve Service Quality and Effectiveness

Goal 2: Increase Value for Money and Productivity

Goal 3: Future Workforce – Achieve a Flexible and Sustainable Workforce

Goal 4: Information and Capital

Goal 5: Build Confidence through DHB Collective Action

Financial Overview

21 District Health Boards

Update for Boards and CEOs - The Quarter in Review | October 2009

1.

21 District Health Boards Activity

Quarterly Report to Boards and CEOs - publication dates

District Health Boards (DHBs) work collectively – locally, regionally and nationally. Successful collaboration

improves performance and efficiency, and creates better outcomes.

District Health Boards New Zealand (DHBNZ) is the Association of the 21 DHBs. DHBNZ acts in DHBs’ collective

interests and helps DHBs meet their obligations under the New Zealand Public Health and Disability Act 2000.

The Association supports the Chairs’ Board of Governance, Executive Committee, and the Chief Executive

Group. DHBNZ facilitates and organises national collective work programmes as agreed by the 21 DHBs

through the Strategic Plan and Annual Plan.

DHBs make their own decisions and are accountable to the Minister. DHBNZ has no ability to direct them.

October > 1st quarter

February > 2nd quarter

April > 3rd quarter

July > The Year in Review


The Quarter in Review For the period ending 30 September 2009

The release of the Ministerial Review Group’s report in mid-August was a key focus in the quarter, with the

21 DHBs working closely together to provide a timely response to the report’s recommendations. We were

well placed to do this, having met with the Review Group several times earlier in the year and having provided

a 21 DHBs’ view on many of the key issues. Chairs and CEOs led the development of a 21 DHBs’ response

to the MRG report, with DHBNZ coordinating this process, and it is pleasing that we were able to provide this

response within the tight timeframe required. The Minister announced an initial set of decisions in response to

the MRG report in October, focusing on the swift establishment of a National Health Board as a unit within the

Ministry of Health and the steps to be taken towards developing a National Shared Services Agency. The details

of these are now being worked through and DHBs are eager to engage with the new structures and processes

as much as possible.

Our relationship with the Minister’s office has continued to grow, with regular meetings between the Minister

and Peter Glensor as Chair of the Chairs’ Boards of Governance for the 21 DHBs. These meetings offer valuable

opportunities to discuss key health issues and highlight areas of collaborative activity underway by the 21 DHBs.

Priorities in the quarter have included progress on specific work programmes under each of the five strategic

Goals, and ongoing discussions with the Ministry of Health and other agencies on issues of common interest.

We have made considerable progress during the quarter in all areas of strategic priority. Highlights include:

• Improve service quality and effectiveness: Successful engagement with all parties to the Pharmacy

Agreement consultation led to the development of final recommendations from DHB representatives and

GMs P&F, which were presented to the CEOs’ October meeting. Phase 1 of the Pharmacy Funding Project

was also completed, providing a base for further collective progress on future Pharmacy service and funding

models, and there was further work to align Health of Older People (HOP) activity. Joint work occurred on

the Cancer Control Strategy implementation, CVD-Diabetes Quality Improvement Plan and Environmental

Support Services.

• Increase value for money and productivity: Provisional savings of $11 million were delivered from Health

Procurement activity in the quarter, including $7 million of baseline savings from work on Project45. The total

finalised figure is likely to reach $15 million. Procurement plans were received from most DHBs, and these

are being used by the Procurement Taskforce to identify collective procurement opportunities for Project45.

Development of the Health Procurement Strategy progressed, with a proposed strategy to be presented to

CEOs for approval during the second quarter. Other Goal 2 activity included the initiation of DHB-level public

reporting in September to help the public understand how DHBs are performing against key indicators, and

a survey of back-office functions.

• Achieve a flexible and sustainable workforce: Alignment of employment relations with the Future

Workforce goals has continued, with a collaborative strategy put in place in July and reviewed in September.

This enables a whole-sector approach to employment relations, while supporting the 21 DHBs’ priorities

in recruitment and retention in the health and disability sector workforce. An update was published to the

Register of Settlements, which will help highlight the financial implications of settlement commitments.

Joint work included co-ordination of the DHB/CTAB medical workforce roadshow and continuing promotion

and development of the Healthcareers brand, including production of collateral material, and production of

the Just the Job TV programme.

2.


• Information and Capital: DHBs have also provided input into the establishment of a national IT clinical

leadership group sponsored by HISAC and set up to address the clinical safety issues of eDischarges.

Engagement on capital issues continued via the National Capital Committee in the quarter, with DHB input

required in coming months into the new national capital processes being developed.

• Build confidence through DHB collective action: DHBs were able to respond swiftly to the MRG

recommendations in the quarter, providing a collective response on to the Minister on key recommendations.

A number of DHBs also provided individual responses on the recommendations. Other Goal 5 activity in

the quarter included streamlining of groups and processes; a refresh of Lead CEO roles; progress towards

developing DAP Assumptions for 2010/11 to respond appropriately to forecasts of an extremely tight fiscal

environment; and ongoing effective governance of the DHBNZ entity, with a focus on tightening financial

controls, sustaining staff and facilitating access to good quality information.

Delivery of the Annual Plan is achieved via a partnership between Lead CEOs and DHBNZ’s CEO, and this

activity is described in more detail in the tables included here. We are pleased to report that most initiatives

were on-track in the quarter.

Work is tracked using a ‘traffic light’ system:

the work has been delivered in the quarter

the work is on track in the quarter

the work is experiencing delays and/or other issues in the quarter, and it may not be

delivered to the original timeframe

the work will not be delivered in the quarter

Work not started or being scoped.

On the financial front, a surplus of $83 thousand was achieved on the year-to-date (as at 30 September),

and billing stood at about 20 percent of the DHB share of the annual plan. A summary of DHBNZ financial

information is included.

We would like to acknowledge the ongoing contribution DHBs are making to the collaborative activity underway,

and we welcome feedback on any aspect of this report.

Peter Glensor Garry Smith Julian Inch

Chair, Chairs’ Board of Governance Chair, CEO Group CEO, DHBNZ

Chair, CEO Management Board

3.

October 2009

4.

Goal 1: Improve Service Quality and Effectiveness UPDATE FOR BOARDS AnD cEOs – THE QUARTER In REVIEW

DHBs benefit from Goal 1 activity by working collectively to create

national service improvement and change, supported by national service

agreements. Work delivered in the past quarter includes development of

a more consistent and streamlined approach to performance monitoring.

Regular reporting to monthly SIG/ GM P&F network meetings ensured the

information flow was maintained. Specific activities included continuing

consultation on the Pharmacy base dispensing fee agreement; responding

to Ministry of Health activity to accelerate implementation of the

Primary Health Care activity; greater alignment of Health of Older People

(HOP) activity; and progress with key pieces of work, including greater

engagement with PHARMAC. DHBs via Lead CEOs are reviewing the

priorities for Goal 1 in light of changing Ministerial and MOH priorities.

Achievements included:

• Progress with the Pharmacy Agreement consultation – five pharmacy

agents are participating, with PHARMAC as an observer; Sector Services

and Audit & Compliance involved as required. Relationships were

greatly improved; the process involved robust discussion to understand

each other’s position and improved involvement of DHBs with regional

GM representatives. The CEOs’ October meeting received final

recommendations from DHB representatives and GMs P&F.

• ARC Service Review – a contractor was selected to manage the review

process, under auspices of joint DHB-sector leadership and Steering

Group.

• Joint work including Cancer Control Strategy Implementation, CVD-

Diabetes Quality Improvement Plan and Environmental Support

Services.

Issues arising included reduced Ministry commitment to the joint Primary

Health Care Implementation Work Programme because of the Ministry’s

focus on new arrangements for Primary Care via an EOI process. The

Ministry has been engaged through GM P&F Network and SIG meetings,

particularly on Primary Care.

Development of a more consistent and

streamlined approach to performance

monitoring.

“

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Lead Chairs: Lynette Stewart, Peter Glensor

Lead CEOs: Geraint Martin, Craig Climo

DHBNZ CEO: Julian Inch

DHBNZ Manager: Janice Donaldson

5.

Work coming up in the next quarter will focus on:

• concluding consultation on the base Pharmacy Agreement

• completing Phase 1 of the Pharmacy Funding Project, which will lay the

foundation for further collective progress on future Pharmacy service

and funding models

• working on developing a more integrated collective picture in Health of

Older People area

• prioritising Cancer Control strategic directions

• Supporting DHBs with Primary Care accelerated change activity.

Goal 1: improve serviCe qUality aNd effeCtiveNess



6.

improviNG serviCe qUality & effeCtiveNess

• Primary Health: better, sooner, more convenient Primary Health delivering on the Primary Health Care Strategy

and a Quality Improvement focus.

• Services for long-term clients and chronic disease: a coordinated prioritised approach across services.

Coordinated Nationally Status Budget Due Date Delivered Nationally

Coordinate DHB views and provide input to MOH policy work, and support DHBs in delivering the PHCS.

Underbudget

Quarterly Limited activity, as MOH was internally focused on Primary Care EOI development, with limited DHB engagement. MOH attended GM P&F and Portfolio Manager meetings to provide briefings.

Integrate with and make full use of the PHO Performance Programme and the provider-arm performance programme.

Effective internal relationships between programmes to support improved information flows to DHBs and PHOs. A more consistent and streamlined approach to performance monitoring was developed, which will reduce duplication. It also provides a focused health sector continuum for indicators within the two programmes.

Deliver against other priority areas in progress including Maternity, Termination of Pregnancy, Environmental Support Services, Pharmacy, CVD-Diabetes, Cancer, and HOP.

• Maternity: MOH has not released results of consultation on plan and intended directions.

• Terminations of Pregnancy: draft document post survey went to the Steering Group in August and a final version will go to GMs P&F in November.

• Environmental Support Services: joint MOH-DHB work programme on track, including implementation of new Equipment & Modification Services Improvement Programme, which has six work streams under way, all reporting to the Steering Group’s monthly meetings:

i. Programme planning and co-ordinationii. Complex housing modificationsiii. Prioritisation of servicesiv. Equipment purchasing and provisionv. Service quality and outcomesvi. Assessor accreditation

• Pharmacy: - Funding Project framed with sector, PHARMAC, Sector Services. Increased

activity with PHARMAC: Forecasting, Pharmacy Incentive Options, Wholesale Uplift Fee, Special Foods, Brandswitches, longer-term budget setting, Rebates policy revision

- Community Pharmaceutical Budget-setting principles with MOH- Actioning Medicines NZ workshop took place on 14 August, led by

Minister Dunne.

• CVD-Diabetes Quality Improvement Plan: Lead GMs P&F assisted MOH & PHARMAC implement agreed work plan, e.g., implementation of CVD Guidelines; Acute Coronary Syndrome Pilot in Wairarapa DHB with two other DHBs to be invited as pilot sites; improving stroke services with five DHBs; updating guidelines and service specifications, e.g., Retinal Screening, Type 1 Diabetes, Diabetes Guidelines

• PHO Governance and Innovations Funding: contracts in place and being monitored, with evaluations to be completed by December 2009 and April 2010 respectively.

Development of relationships between regional lead GMs, Primary Care, and peak bodies.

Primary Sector Partnership Group was not proceeded with as Joint MOH-DHB Work Programme was reframed with a change in MOH priorities. However, Primary Care Engagement plan was signed off by GMs P&F and is being implemented.


7.

NatioNal serviCes

• Rolling three-year strategic direction maintained across all national services.

• Rolling three-year strategic direction maintained across all national services.

• Reduce clinical and systems risk.


Ensure a programme of regular engagement with DHBs is in place via GMs Planning & Funding.

Underbudget

Quarterly • Reported to monthly SIG/GM P&F Network meetings.

• Portfolio Manager meetings and work groups progressed agreed service activity.

Ensure agreed process for addition and removal of contract areas from National Services.

30 Sept 09 • Agreed national service agreements: ARC, Combined Dental Agreement, Community Pharmaceutical Budget

• PHO, S88 Immunisation: will be maintained but may change as result of EOI/Business Case process for new arrangements. PSAAP process maintained with full PSAAP meeting and regular facilitator meetings held.

• Pharmacy: interim base pharmacy agreement, with DHBs able to enter into new local or regional arrangements at any times, with national consistency where required to support PHARMAC, Audit & Compliance and Sector Services.

• Pharmacy Agreement consultation underway; four meetings with sector agents held in quarter with four DHB Lead GM P&F representatives, and PHARMAC attending as observer

• Specialist, Radiologist, Anaesthetist S88 Notices: worked to quantify financial expenditure; sought MOH support for approach to Minister to undertake consultation.

Evaluation completed and documented following each contract round.

Quarterly • Completed post-contract round: ARC, PHO/S88 Immunisation and fed into next contract round and DAP Planning Assumptions.

• Pharmacy agreement process evaluation to be completed next quarter.

Ensure delivery of ARC Audit Effectiveness & Efficiency Project.

31 Dec 09 12 DHBs agreed to participate in pilot surveillance/contractual audit. Evaluation will follow in December 2009 quarter.

New activity and/or opportunities Laboratory Agreement stock take completed. GMs P&F opted not to progress to Community Laboratory Schedule Review as not seen as a priority.


Help DHBs, clinicians and managers assess effectiveness of current clinical networks at local, regional and national levels.

Underbudget

An initial stocktake of clinical networks has been carried out and discussed by CEOs but further work in this area has been delayed. Priorities for Goal 1 activity are being reviewed in light of changes to Ministerial and MOH priorities.

Identify opportunities and key actions required.

Use Future Workforce network to reveal differences in expectations and confirm commitment to delivery of partnership agreements.


Ensure all DHBs are active and delivering required improvements.

Underbudget

Quarterly The National Healthcare Incident Management Programme completed its programme of training DHBs on the draft national policy. The programme has also completed the development of draft specifications for a national IT management system for the Ministry of Health.

Evaluate and document lessons for the Learning Sector.

Quarterly The programme’s close-out report includes an evaluation of the programme and lessons learnt.

CliNiCal Networks

NatioNal patieNt safety

October 2009

8.

Goal 2: Increase Value for Money and Productivity UPDATE FOR BOARDS AnD cEOs – THE QUARTER In REVIEW

DHBs benefit from Goal 2 activity by developing ways to consistently

measure and monitor their work, increase productivity and make health

dollars work more effectively.

Value delivered to DHBs from health procurement in the past quarter

included a provisional cost savings result from Project45 activity of $11

million (minimum), of which $7 million is baseline savings. An update

tracking savings by type (Baseline and Other) is provided to CEOs each

month and will be provided to Boards each quarter. Drafting of the

Health Procurement Strategy began in the quarter and will be put to CEOs

for endorsement in November.

Activity by the PHO Performance Programme continues to enable DHBs

to measure and monitor PHO outputs against a standard set of indicators

that align with health targets and priorities. A significant development in

the quarter was the initiation of DHB-level public reporting in September

to help the public understand how DHBs are performing on key indicators.

DHBs were able to provide commentary to sit alongside the information,

and this will be progressively added to each six months. The Programme

also provided PHO and Practice-level monthly reports on cervical screening

and influenza vaccinations, and continued strengthening its engagement

with the sector via the representation and expertise on its Governance

Group and Advisory Group.

Joint work in the quarter included participation in the Value For Money

Steering Group, and engagement with the Ministry of Health on identifying

and implementing tools to support a learning sector.


• health procurement savings in the quarter and the introduction of a

process to keep CEOs informed each month of savings as these emerge.

• completion of the preparatory work for the Health Procurement Strategy,

with recruitment of the team required to deliver the Strategy and approval

of key project documentation.

• agreement on a coding standard for products and related procurement data.

• clarification of the approach and priorities for a provider-arm performance

programme across hospital services, and preparation of a project plan for

the development of productivity measures. DHB representatives met in

Provisional cost savings from Project45 activity

of $11 million’.

Initiation of DHB-level public reporting on

key indicators.

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Lead Chairs: Gregor Coster, Peter Glensor

Lead CEOs: John Peters, Phil Cammish


DHBNZ Managers: John Allan, Kevin Broughton,

Serena Curtis-Lemuelu

9.

Wellington during the quarter to formulate and refine the approach,

and this work will be developed further in the coming months.

• PHO Performance Programme initiated public reporting of DHB-level data

via the DHBNZ website to assist the public and other organisations to

understand how DHBs are performing on key indicators.

• a survey of support service (back-office) functions identified considerable

gaps and provides a starting point for programme planning to further align

and amalgamate support functions across DHBs.

Coming up:

• Health Procurement – collective procurement opportunities for Project45

will be identified, now that most DHBs’ procurement plans have been

received. A draft Health Procurement Strategy will go to CEOs for

approval on 30 November 2009.

• Support services – a draft programme brief has been prepared to develop

preferred options for managing back-office functions. Options for an

implementation plan will be investigated in the next quarter.

• The new Value for Money steering group will be confirmed in the next

quarter, with representation expected from senior DHB and MOH staff.

The group will hold its first meeting before Christmas.

• A provider-arm performance programme proposal is being worked

on with DHB Chief Operating Officers (COOs). This includes the

development of a range of performance measures and an IT platform

to support collaborative COO activity.

Goal 2: Increase Value for Money and ProductIVIty


10.

performaNCe improvemeNt

redUCe waitiNG

• Sustainable performance improvement and reduction in negative variance through benchmarking and incentive

arrangements across a set of selected primary health and provider-arm measures.

• Reduce waiting by building capability in patient flow and improved scheduling.


Develop and review PHO Performance Programme.

Underbudget

30 June 2010

Public reporting of DHB-level performance against key indicators began in September and will be updated regularly. DHBs were able to provide commentary to sit alongside the information.

The Programme also provided PHO and Practice-level monthly reports on cervical screening and influenza vaccinations.

Build, deliver and maintain a provider-arm performance programme across hospital services to increase service value and decrease variance.

June 2010

31 August 2009

A workshop was held with sector experts in July to identify programme approach and priorities. A Programme Plan is being developed and expected to be confirmed in early November.

Draft Statement of Commitment on DHB hospital quality and productivity was developed but not progressed because of other priorities. This will be progressed in the next quarter.

Oversee development of productivity measures that can be applied across DHBs.

June 2010 A project plan for the development of productivity measures was prepared. This will be implemented when the programme plan is confirmed.

Joint activity Quarterly Ministry participation in Value for Money Steering Group.


Create opportunities to promote patient flow and scheduling tools such as Optimising the Patient Journey (OPJ) and Productive Ward.

Underbudget

March 2010 Work continued on developing options to give DHBs ready access to relevant information on relevant tools and methodologies.

Identify and support clinical networks.

No activity in this quarter

health proCUremeNt

• Sustainable gains in provider-arm of 5 percent ($45M) in savings, standardisation and capability improvement.


Create opportunities to promote patient flow and scheduling tools such as Optimising the Patient Journey (OPJ) and Productive Ward.

Underbudget

30 June 2010 • Savings categorised as Baseline and Other (includes cash releasing, cost avoided and cost increase avoided).

• Provisional total of $11m savings (incl. $7m baseline savings) reported by DHBs as at end September. Final report for the quarter likely to be circa $15m.

Identify and agree information standards, including codification, for products and related procurement data.

December 2009 • Coding standard identified, work to complete base product listing underway.• Implementation across all DHBs will be progressive, commencing January 2010.

Facilitate the sharing of DHB procurement plans and usage information.

Quarterly The majority of DHBs’ procurement plans have been received – currently being used by the Procurement Task force to identify collective procurement opportunities for Project45. The procurement plans will be made available online to Procurement Managers and approved others during November.

Develop an implementation plan for the changes in DHB skills resulting from the Health Procurement Strategy.

May 2010 Will follow the finalisation of the Health Procurement Strategy in March 2010.

Develop a training programme for DHB Health Procurement professionals that delivers on the capability requirements of the Health Procurement Strategy.

May 2010 Will follow the finalisation of the Health Procurement Strategy in March 2010.



Develop a Health Procurement Strategy after DHB and sector consultation.

March 2010 • Proposed Health Procurement Strategy to CEOs for approval 30 November 09.• Approval of detailed Strategy by CEOs in March 2010.

Develop performance metrics to monitor progress of the Health Procurement Strategy.

High level – 30 November 09

Final set - March 2010

Demonstrates that the gains articulated in the Health Procurement Strategy are being realised.

Lead and implement the Health Procurement Strategy, including management of change.

Lead development of the Strategy to March 2010;Lead Implementation of the Strategy from April 2010.

• [Note: Health Procurement’s lead role will be influenced by the Minister’s more detailed plans for the establishment of the NHB and the National SharedServices Agency.]

• During the quarter the Strategy Project team was recruited, key project documentation approved by the Steering Group (Project Brief, Project Plan, Communications Plan and Risk Register); an RFP issued for the provision of specialist advice including Change Leadership and Organisational Design, and two strategy development workshops were held with DHB Procurement Managers and CFO/COO representatives.

11.

baCk-offiCe fUNCtioNs

• Focus back-office functions on priorities and align collective groups.


Determine framework to identify and assess improvements to back-office functions.

Underbudget

31 Aug 09 This work was late getting started but is now underway. A framework is being developed in conjunction with an expert group which had its first meeting scheduled in October. Care has been taken to ensure the expert group included a wide range of expertise and this initiative will proceed in Q2.

Obtain 21 CEOs’ agreement on Statement of Commitment on back-office functions and stakeholder responsibilities.

Aug 09 24 August CEOs reviewed Statement of Commitment; signed off a set of milestones and deferred sign-off on the rest of the document in favour of proceeding with the programme.

Survey DHB progress on improving efficiency of back-office functions and identify opportunities to further align and amalgamate support functions across DHBs.

Aug 09 A survey was completed. It identified the main joint DHB activity, along with similar activity elsewhere in NZ and in the Australian health sector as well as any areas where there was currently no activity in the NZ health sector. The survey showed considerable gaps in current activities and provides a starting point for programme planning. A report was completed and presented to the Steering Group.

Develop preferred option for management of back-office functions and implementation plan.

Dec 09 A draft Programme Brief has been prepared and will be reviewed by the expert group at its meeting in October. The expert group will identify options for review and implementation plan.

learNiNG seCtor

• A learning sector that has capability and capacity to innovate and improve productivity.


Collect and disperse local initiatives. Quarterly Options for collection and dissemination were being developed as part of the development of the provider arm performance programme. Information is likely to be collected and made available on a dedicated website.

Develop and implement the national Learning Sector Action Plan.

A start was made on developing the infrastructure – website technology – needed to implement the Plan.

Maintain effective networks in sector.

Started developing support for professional groups including development of websites for each group to facilitate information sharing. Websites will be up and running in next quarter.

Work with MOH to identify and implement tools required to support a learning sector.

DHBs and MOH have participated in VfM steering group and are continuing to work towards developing a joint approach to this activity.

Engage with biannual Health Innovation Awards and Innovations Conferences.

May 2010 No activity in this quarter.

October 2009

12.

Goal 3: Future Workforce – Achieve a Flexible and Sustainable Workforce

DHBs benefit from Goal 3 activity by the growing alignment of employment

relations activity and workforce planning and development, and collective

action to build an effective employment relations environment.

Value delivered to DHBs in the past quarter has included greater alignment

of employment relations with the Future Workforce goals, with the

collaborative strategy put in place in July and reviewed in September.

This enables a whole-of-sector approach to employment relations, while

supporting the DHBs’ priorities in recruitment and retention in the health

and disability sector workforce. The Register of Settlements was updated

in the quarter to help highlight the financial implications of settlement

commitments. Joint work delivered in the quarter included coordination

of the DHB/CTAB medical workforce roadshow, and providing training

support to the Ministry of Education on bargaining strategy development.

Issues arising include a delayed start to joint DHB/Ministry of Health

workforce projects on elective theatres workforce, barriers to innovation,

primary health workforce, and clinical executive leadership development,

due to lack of clarity on government direction and changes to sector

workforce structures. Work is underway to regain momentum in these areas.


• continuing promotion and development of the Healthcareers brand,

including the Inzone bus tour, development of marketing collateral for

DHBs to use with local schools, and production of the Just the Job

TV programme

• a detailed employment relations environmental scan to inform decision

making on strategy and operational ER issues

• 21 DHBs roadshow on the medical workforce. Findings from this will

be developed as a basis for advice to the Minister on the question of a

single employer and other related issues

• HWIP – development and rollout across DHBs of nursing and medical

workforce ANZSCO codes, which is already improving the quality of data

• a successful ACE recruitment round

• advice to the Minister on midwifery workforce requirements going forward

Greater alignment of employment

relations with Future Workforce goals

“

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Lead Chairs: Suzanne Win; Peter Glensor

Lead CEOs: Cathy Cooney, Karen Roach


DHBNZ Managers: Marilyn Rimmer, Steve Aburn

13.

• workforce advice to ER bargaining strategy for medical physicists,

medical radiation therapists and medical laboratory worker negotiations

• negotiation and communications strategies developed for a number of

upcoming negotiations.

Coming up:

Activity in the next quarter will include further development of the Register

of Settlements to ensure the financial impact of negotiation outcomes are

apparent, and significant activity around the medical workforce in developing a

DHB sector response to RMO Commission recommendations.

Key project work will include completion of the Nurse Practitioner Facilitation

innovations round; joint guidelines (DHB and all Regulatory Authorities) for

management of health practitioner competency issues; and advice to the

Ministry on revision of criteria for the government’s voluntary bonding scheme.

Goal 3: fUtUre workforCe – aChieve a flexible aNd sUstaiNable workforCe



14.

workforCe sUpply

• Identify requirements and secure supply of key health and disability workforces

• Position health and disability sector as the career destination of choice

• Develop a single source for workforce information and analysis (HWIP)


Healthcareers Brand Underbudget

06/10 • Resource packs containing posters, DVD and leaflets were distributed to all DHBs.

• Posters promoting Healthcareers and uptake of science subjects as a lead-in to clinical careers were sent to all secondary schools.

• The Inzone careers bus (with Healthcareers information) continued progress in the South Island

• Social media (Facebook, Twitter) continued to be developed in conjunction with the Healthcareers website.

• A collaborative international health recruitment proposal was supported in principle by the Minister.

• A collaborative approach was developed to target recruitment of RMOs at the British Medical Journal Expo in Birmingham, UK (in October).

• A programme dedicated to Healthcareers was produced as part of Just the Job series in July to go to air in December.

Maori workforce capability: support Maori workforce champions.

Ongoing Formed a connected approach by linking Future Workforce Group to delivery of Ministry of Health-funded Maori Healthcareers project (Kia Ora Hauora) and Maori nursing leadership project.

Pacific workforce capability Ongoing Awaiting clarification of the impact on Workforce activity of changes to the Pacific development fund.

Standardised planning toolkit 10/09 Reprioritised due to increased forecast work.

ANZSCO Implementation: Agree on the interpretation and usage of ANZSCO coding and implement this within DHBs.

Ongoing Worked with sector groups on clarifying nursing and medical workforce codes. This is now being rolled out across all DHBs and the data quality improvement is already noticeable.

Medical Workforce Ongoing • Original deliverables have been reprioritised because the medical roadshow has taken priority.

• Chairs and CEOs agreed to a 21 DHBs roadshow in August, which was successfully completed. Findings from roadshow and a follow-up workshop will be further developed as a basis for advice to the Minister on the question of a single employer and related issues. This is a platform for ongoing sector development work for this workforce. This project has taken priority over other aspects of work plan activity for the medical workforce

• The ACE 2009 recruitment round was successfully completed.

Nursing & Midwifery Workforce Ongoing • Completed a project on macro overview of workforce in HWIP. A draft report from this will be released in October, which for the first time will give a clearer overview of the workforce in New Zealand.

• Advice was forwarded to the Minister on workforce supply requirement for midwives for next 10 years. The report makes recommendations to remedy a small but persistent undersupply based on current student numbers.

• The Maori and Pacific student nurses report is now published and will form the basis for new work this year. We hope to pilot a rollout of specifications of good practice in one DHB and one tertiary education provider. This work is at a very early stage.

• Made submissions to the Nurses Council consultation process for enrolled nurses on the potential utility to the sector of a generalist second-tier nurse role.

• The Nurse Practitioner Facilitation Project set up 12 innovation pilots due for completion in the 2nd quarter. We have had excellent feedback from the Ministry of Health on the leadership shown by the strategy group on this project and the successful delivery of the project.

• Three demonstration sites are now under way and on track to deliver to their objectives as part of the safe staffing healthy workplace.


15.

Allied/Technical • Three workforces for analysis of future need and workforce forecasts have been tentatively identified.

• Dental therapy careers were profiled to undergraduate student nurses.

• We have offered to support DHB innovations.

• Projects on operating theatre innovation; transition to practice for allied health have been scoped.

• Continuing progress on the development of clinical scientist advanced practice role for medical laboratory workers.

Frontline Support Ongoing • Work with Careerforce on a training framework for care and support workers continues. Draft on the Careerforce website website.

• Engaged with the age care sector and NGOs, and continuing with the rollout of workforce information.

• Development of an overarching draft workforce strategy for health of older people.

Operating Theatres: staffing for 20 new elective surgery theatres.

The scope for this is still to be confirmed by the Ministry of Health.

• Workforce innovation through increased service flexibility, more career choices, new ways of working and new roles


HRANZ competency notification: produce recommendations for DHBs and HRAs to help streamline competency notification issues.

Underbudget

Feb 2010 This project is on track to deliver on due date. This is the first 21 DHB and 16 regulatory authority joint project and will deliver streamlined guidelines for DHBs and regulatory authorities to use where there are competency notifications.

Barriers to Innovation: work with Regulatory Authorities and Colleges to identify innovation pathways.

Waiting for the Ministry of Health to signal when they are ready to have joint scope. We have informally provided advice on barriers to allied health workforce.

Joint activity (other) Work on progressing the Workforce response to primary health models of care is on hold pending the EOI project outcomes for primary health.

workforCe iNNovatioN

workforCe reteNtioN aNd prodUCtivity


Voluntary Bonding: Support implementation and review of criteria for hard-to-staff specialties and localities.

Underbudget

Quarterly This Ministry–led project is setting up a group to give advice on criteria around hard-to-staff specialities and localities. The Ministry has engaged a review of initial implementation which is due in November and DHBs have been asked to help build the criteria.

Staff Engagement Survey: Coordinate/progress implementation of a single staff survey for all DHBs.

Ongoing Good progress has been made on this. A paper is to be prepared for CEOs.

Culturally safe workplaces: Gather information on current safety training and practice.

Dec 2009 This work has been reprioritised. The Maori champions workforce will need to be involved in this.

Clinical leadership models: share effective existing clinical leadership models and consider how to enhance these.

March 2010 Scoping work for this project has now started.

• Identify requirements and secure supply of key health and disability workforces

• Position health and disability sector as the career destination of choice

• Develop a single source for workforce information and analysis (HWIP)



Monitor ER environment, develop ER policies and processes, provide ER support to DHBs, and develop initiatives to build ER capability within DHBs.

Underbudget

Ongoing

Quarterly review

July 2009

October 2009

Jan 2010

• HSRA work plan agreed and in place. Key projects in place to deliver on Government priorities (e.g. quit smoking, oral health, ED).

• Detailed environmental scan in place from 1 July, and updated in September. The next iteration is due in January. This initiative enables informed decision making on strategy and operational ER issues.

• New ER portfolio structure reviewed and endorsed.

• ER processes reviewed and amended to reflect new structure (e.g. bargaining team membership and mandate, spokespeople roles, etc).

• DHB ER capability supported by provision of training to DHBs in the four regions on bargaining strategy development. Developing of bargaining skills training is being scoped.

New activity Exploration of a bargaining framework with CTU unions has begun. This has the potential to reduce both time and resources required for bargaining.

16.

employmeNt relatioNs eNviroNmeNt

• Building an effective employment relations environment

Online learning: sharing best practice and using up-to-date, accessible education techniques to develop a collaborative online learning module available for use by DHBs.

May 2010 Early discussions are continuing to identify how this project can add most value.

Develop common principles to be applied to partnership arrangements, develop measures to assess value derived from partnership initiatives.

June 10 Exploration of a bargaining framework with CTU unions has begun. This has the potential to reduce both time and resources required for bargaining.

employmeNt relatioNs delivery

• Effective employment relations delivery


Develop an ER strategy and negotiation strategies aligned to workforce goals and DHB priorities.

Under budget

Quarterly • A collaborative strategy consistent with Government goals and workforce priorities was put in place in July and reviewed in September. This enables a consistent whole-of-sector approach to employment relations.

• Negotiation strategies have been developed for South Island clerical workers, MRTs (APEX), laboratory workers (MLWU), service and food workers (SFWU). Strategies are being developed for RMOs (RDA), nurses and midwives (NZNO), RTs (APEX), and SMOs (ASMS).

Deliver a national work plan of collective bargaining and support initiatives to achieve workforce-specific goals.

Ongoing • A national work plan of negotiations has been developed and is being implemented. Detailed plans for each set of negotiations and other activity are being developed as required on an ongoing basis. These are informed by workforce priorities.

• The project plan for locum management was updated in the quarter. A summary of existing commitments has been developed to inform DHB decisions and this will be updated as new financial commitments are entered into. At the end of the quarter no additional commitments had been entered.

• Input provided into the DAP planning process which will also help DHBs identify existing and potential financial commitments.

Provide a summary of financial commitments.

Quarterly Started developing support for professional groups including development of websites for each group to facilitate information sharing. Websites will be up and running in next quarter.

New activity Training support provided to the Ministry of Education on bargaining strategy development.

October 2009

17.

Goal 4: Information and capital UPDATE FOR BOARDS AnD cEOs – THE QUARTER In REVIEW

DHBs benefit from Goal 4 activity by having a collective voice on information

strategy and capital, and greater alignment of DHB activities to maximise

value. This work requires a visible focus and progress to support service

and quality development.

Gains made in the quarter include the eDischarges clinical group progressing

work based on what was previously done in the GP to GP Transfer initiative.

As well, primary and secondary clinicians met in Wellington to lead the

revision of the clinical user requirements of the eDischarges functions.

DHBs have engaged on capital issues through the National Capital

Committee during the quarter and will continue to do so until new capital

arrangements are in place, as described by the Minister in October 2009.

DHBs will need to make early representations to ensure input and

involvement with the new national capital process.


• DHB input into the establishment of a national IT clinical leadership group

with representation from doctors, nurses and allied health workforces.

This group was set up to address clinical safety issues of eDischarges.

It is sponsored by HISAC and chaired by HISAC’s Chair.

• Clear linkage between some of the Information Systems work related

to safe medications management with events priorities; for example,

prescribing e-medication charts.

• Maintained DHB engagement on capital issues, pending Ministerial

decisions on the Ministerial Review Committee Report.

Maintained DHB engagement on

capital issues pending MRG decisions.

“

”

Lead Chairs: Bob Francis, Peter Glensor

Lead CEOs: Chai Chuah, Brian Rousseau



Deliverable Status Budget Due Date Work achieved in the quarter

Develop proposed approach to management of capital requirements.

No budget assigned

Quarterly DHBs have continued to engage through the National Capital Committee. Further development of this work is awaiting Ministerial decisions about the Ministerial Review Committee recommendations (which occurred in October 2009).

Seek MOH attention to DHB issues and proposed solutions.

Quarterly As above – all activity in the quarter occurred via engagement with the National Capital Committee.

18.

iNformatioN systems


Agreement on joint DHB/MOH workplan, including timeframes for:

• agreement on resourcing

• establishing joint governance function

• signing off joint approach to developing and adopting a consistent national health record and information architecture

• signing off business plan by DHBs and MOH

• establishing joint implementation group for each priority

• completing rollout of agreed priorities in 21 DHBs.

No budget assigned

June 09: agreement on resourcing

Aug 09: establishing joint function

Nov 09: signing off joint approach to health record and architecture

Dec 09: signing off business plan

Dec 09: establishing joint implementation group for each priority

June 2012: completing rollout of priorities.

• Resourcing: DHBs have provided input into the establishment of a national IT clinical leadership group with regards to participation by secondary care clinicians. One-off funding was received from HISAC and discussions in progress about MOH contribution.

• Joint governance function is being developed for the national IT clinical leadership group.

• Progress on other IT deliverables put on hold pending outcome and decisions on Ministerial Review Committee (MRG) Report.

• Completing rollout of agreed priorities: good progress was made at a national level during the quarter on clinical leadership for priorities related to transfer of care; for example, GP to GP transfer, and eDischarges. Draft clinical user requirements for GP to GP transfer were issued for comment by the sector during the quarter. A national clinical workshop will be held in November to draft a revised national clinical user requirement for eDischarges, leveraging off the GP to GP work done to date.

• Some of the information systems work related to safe medications management is now firmly linked with the events priorities; for example, prescribing an e-medication chart.

New activity and/or opportunities New opportunities for progress on IT issues will arise as a result of Ministerial decisions on the MRG Report.

Capital arraNGemeNts

• Agreed framework for management of capital requirements on a three year rolling horizon.

• Focus on delivering improvements in information systems consistent with a nationally agreed Health Information Strategy.

• Secure Government investment in sector-led change.

New opportunities for progress on IT issues will arise as a result of Ministerial decisions on the MRG Report.

October 2009

19.

DHBs benefit from Goal 5 activity by the coordination of collaborative work

among DHBs and with government agencies such as the Ministry of Health

on issues of common interest. This promotes a planned approach which

avoids duplication and encourages effective engagement with individuals

and organisations most able to influence the success of collective activity.

Providing a timely 21 DHBs’ response to the Ministerial Review Group

(MRG) recommendations was a priority in the quarter. DHBs were

well positioned to do this, having had several opportunities earlier in

the year to meet with members of the Ministerial Review Group to

discuss key health issues. The Minister released the MRG Report in

August and requested feedback within a short timeframe. A group of

Chairs and CEOs led the development of a collective DHB response to

the recommendations, with the process facilitated by DHBNZ, and this

response was provided to the Minister within the required timeframe.

A number of DHBs also made individual responses directly to the Minister,

in addition to their involvement and support for the collective response.

In October, the Minister announced several key decisions about the MRG

recommendations, including the establishment of a National Health Board

and progress towards a national shared services agency.

The relationship with the Minister’s office continued to develop during

the quarter, with regular meetings taking place between the Minister

and Peter Glensor as the Chair of the Chairs’ Board of Governance for

the 21 DHBs. These meetings provide valuable opportunities to build

awareness of and support for areas of collaborative 21 DHBs’ activity.

Links with professional groups were strengthened in the quarter through

engagement on the MRG, and the building of involvement by portfolios.

The DHBNZ entity continued to be managed effectively, with a focus

on sustaining staff, tightening financial controls, attracting and capturing

external revenue, facilitating access to good quality information, and

improving the IT platform as a collaborative mechanism for DHBs.


• lead roles refreshed and DHB groups reviewed and streamlined

• process put in place to engage with the Ministry on new areas of work

and requests from the Minister

• 21 DHBs’ messages delivered via media engagement, no-surprises

Goal 5: Build confidence through DHB collective Action

21 DHBs provide timely response to Minister on MRG recommendations.

“

”

Lead Chairs: Peter Glensor

Lead CEOs: Garry Smith


DHBNZ Managers: Cushla Managh, John Allan

20.

practice with the Minister’s office and ongoing contact with the DHB

communications network

• application of DAP Assumptions by DHBs reviewed and DAP Assumptions

for 2010/11 developed. A model of DHB expenditure has been developed

and this will be used to build future expenditure scenarios.

• SOI Guidelines refreshed for 2010/11

• final report on NPP prices completed and reviewed by CEOs at October meeting

• service specifications being developed during the quarter and signed off

in conjunction with the Ministry

• issues identified and escalated as required, and the DHBNZ entity

governed effectively.

Goal 5: bUild CoNfideNCe throUGh dhb ColleCtive aCtioN




Include representatives from key stakeholders in groups overseeing activity of relevance to these stakeholders.

On budget

Quarterly Expertise from 21 DHBs and wider stakeholder networks involved in all priority areas.

Develop an agreed schedule of meetings with the Minister and MOH.

31 July 09 Schedule of meetings with the Minister and MOH developed.

Ensure stakeholder engagement and communication plans are in place overall and for each portfolio.

Quarterly • Existing communications plans across priorities were being reviewed and refreshed in the quarter. No-surprises practice maintained with key stakeholders.

• Improvements in IT platform being implemented to support purposeful engagement with stakeholders.

21.

JoiNed Up ColleCtive aCtivity


Produce an integrated workplan and develop processes to manage it, escalate issues, and review its effectiveness.

On budget

31 July 09 • Work being delivered through the 21 DHBs collective work plan.

• Agreement reached on the value to be delivered by effective application of collective principles.

• A template developed to report on the work plan.

• Process developed to identify and investigate new opportunities and areas of work.

Establish and maintain lead roles, portfolios and steering groups across all priorities.

30 Sept 09 Lead roles established and confirmed. DHB groups reviewed and streamlined.

Use collective decision-making principles for joint DHB-MOH decisions and DHB regional decisions.

Quarterly Process in place to engage with MOH on new areas of work and requests from Minister – using DHBs’ network and avoiding duplication.

Develop processes and tools to deliver 21 DHBs’ decisions and messages.

Quarterly • 21 DHB’s messages delivered via media engagement, no-surprises practice with the Minister’s office and ongoing contact with DHB communications network.

• Confirmation of Lead CEO spokesperson roles.

effeCtive seCtor relatioNships

• Purposeful engagement with stakeholders able to assist delivery of collective strategies and objectives.

• Sector-wide integrated workplan describing national, regional and MOH activity to avoid duplication and ensure good

management and resourcing of activity that the sector has agreed is essential.

• Collective Way of Working defined and implemented across 21 DHBs, with appropriate connections to MOH

decision-making.

effeCtive aCCoUNtability arraNGemeNts

• Maintain sector buy-in to a streamlined accountability and reporting framework.

• DAP Assumptions maintained three years ahead plus one year review.

• Maintain national pricing and service frameworks, and achieve sector buy-in to a streamlined performance

framework.

• Provision of prioritisation tools.


22.


Ensure Issues Register is in place across CEOs’ Group and MOH.

Not started.

30 Sept 09 Issues Register established for CEO Group but not being used yet on a regular basis.

Include issues management as standing item on agendas.

30 Sept 09 Issues included as standing item on agendas. This will be reviewed to ensure it is useful.


Govern the DHBNZ entity. On budget

Quarterly DHBNZ being governed effectively – regular meetings of CEO Management Board.

Ensure a Risks Register is in place for DHBNZ.

30 Sept 09 Processes to identify and manage risks yet to be completed.

Develop processes and satisfaction measures to evaluate DHBNZ effectiveness.

Q3 This has occurred informally through processes to facilitate 21 DHB input into the Ministerial Review Group, for example, but this will happen formally in the third quarter.


Maintain a set of DAP Assumption information.

On budget

Quarterly • A draft set of DAP assumption information was developed to assist DHBs and will be submitted to CEOs at their November meeting.

• Developed a DHB expenditure model that will enable future scenario building and modelling future funding and expenditure scenarios. This will assist DHB and sector planning in the coming period of severe fiscal constraint.

Develop a consistent understanding of the use of the Prioritisation Framework (PBMA) by all DHBs, MOH and other relevant parties.

Quarterly Started using the DHB Accountability Group to develop a consistent understanding amongst DHBs of this issue. Engagement with MoH and other relevant parties will occur.

Provide expert advice into Ministry-led annual accountability review.

Quarterly • Participated in Ministry planning and workshop in August.• SOI Guidelines were refreshed for 2010/11. • Proposal for DHBs to use the same set of Output classes in 2010/11 DAPs

developed and submitted to CEOs for decision. Refreshed.

Ensure delivery of NPP prices and work programme as agreed by the sector.

Nov 2009 • Final report completed and to be discussed by CEOs at October meeting.• Revised national contract template developed and sent out for consultation.

Identify levels of use and compliance with nationwide service framework.

Quarterly • Service specifications continued to be developed and signed off in conjunction with Ministry.

• Continued to identify levels of use and compliance.

issUes maNaGemeNt

effeCtive CoordiNatioN

• Clear escalation and management of issues and risks at national level.

• Effective facilitation, coordination and management of work the 21 DHBs undertake together.

October 2009

Financial Overview for period ending 30 September 2009

Annual PlanThe DHBNZ 2009/10 Annual Plan includes total revenue of $13.52 million, comprising $9.97 million DHB revenue and $3.55 million third party revenue. The Annual Plan has been used to determine the budget for 2009/10 and is made up as follows:

Financial Overview

23.

UPDATE FOR BOARDS AnD cEOs – THE QUARTER In REVIEW

Statement of Financial PerformanceA surplus of $83k has been achieved in the year to date as at 30 September.

Goal DHB Revenue $’000

Third Party Revenue$’000

1 Improve Service Quality and Effectiveness $1,355 $740

2 Increase Value for Money and Productivity $3,041 $1,200

3 Future Workforce $4,124 $1,610

4 Information and Capital $0 $0

5 DHB Collection $1,450 $0

TOTAL DHBNZ $9,970 $3,550

Statement of Financial Performancefor the period ending September 2009

Actual Budget Variance

YDT YDT YDT

$ $ $

Income

Membership Levies 67,500 67,500 0

Facilitation Revenue 154,387 154,387 0

Project Revenue 2,215,195 2,270,614 (441,357)

Services Revenue 2,215,195 2,270,614 (55,418)

Interest Income 6,649 9,520 (2,871)

Rental Income 15,061 10,041 5,020

Other Income 0 0 0

Total Income 2,904,936 3,399,561 (494,625)

Expenses

Chairs’ Support 74,584 75,147 562

CEO Group Support 56,098 59,905 3,807

Portfolio Facilitation 82,014 129,758 47,744

Projects/Services/Admin Costs 2,608,786 2,979,572 370,785

Total Expenses 2,821,483 3,244,381 422,898

Net Profit / (Loss) 83,453 155,180 (71,727)

Projects and ProgrammesThe net result specifically for project activity as at 30 September is a surplus of $66k.

DHB RevenueThe total Annual Plan budget for DHB revenue for 2009/10 is $9.97 million, including levies. DHB revenue is tracking to budget year to date.

Third Party RevenueThe budget for third party revenue is $3.55 million. To date savings of $72k have been achieved against third party contracts. Additional third party revenue of $741k has been carried over from 2008/09 for project activity in 2009/10.

CashflowThe cash position in September recorded a closing balance of $1.1 million. Monthly payments have been received from 19 DHBs. The receipt of these payments has had a positive effect on cash flow and will help to ensure the cash position is maintained throughout 2009/10. Third-party contract revenue received has also impacted favourably on the cash position.

InvoicingInvoices for quarter one billing against the 2009/10 annual plan will be issued in November.

24.

fiNaNCial overview


21 district health boards - southern dhb...update for boards and ceos - the quarter in review |...

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