counties manukau district health board hospital advisory

Counties Manukau District Health Board – Hospital Advisory Committee Agenda

Counties Manukau District Health Board Hospital Advisory Committee Meeting Agenda Wednesday, 9 September 2015 at 9.00am – 12.30pm, Room 101, Ko Awatea, Middlemore Hospital, Hospital Road, Otahuhu, Auckland Time Item

9.00 – 9.15am 1. Welcome

9.15– 9.25am 2. Governance 2.1 Attendance & Apologies 2.2 Disclosure of Interests/Specific Interests 2.3 Confirmation of Public Minutes (29 July 2015) 2.4 Action Items Register Public

9.25 –10.00am

10.00 –10.10am 10.10 – 10.20am 10.20 – 10.30am 10.30 – 10.40am 10.40 – 10.50am 10.50 – 11.00am 11.00 – 11.05am 11.05 – 11.15am 11.15 – 11.25am

3. Director of Hospital Services Report (Phillip Balmer) 3.1 Executive Summary 3.2 Balanced Scorecard 3.3 Financial Summary 3.4 Hospital Health Target Overview 3.5 Human Resources 3.6 Actions Arising Responses 3.7 Balanced Scorecard Definitions 3.8 Mental Health (Tess Ahern) 3.9 Women’s Health & Kidz First (Nettie Knetsch) 3.10 Director of Midwifery report (Thelma Thompson) 3.11 Surgery and Ambulatory Care (Gillian Cossey) 3.12 Adult Rehabilitation/ Health of Older People (Dana Ralph-Smith) 3.13 Medicine, Acute Care & Clinical Support (Brad Healey) 3.14 Facilities (Phillip Balmer) 3.15 Director of Allied Health Report (Martin Chadwick) 3.16 Director of Nursing Report (Denise Kivell)

Morning Tea Break 11.40 – 11.50am 4. Quality Assurance

4.1 Inpatient Experience Report #9 (Dr David Hughes) 11.50 – 11.55am 5. Resolution to Exclude the Public

11.55 – 12.10am

12.10 – 12.20am 12.20 – 12.25am 12.25 – 12.30am

6. Confidential Items 6.1 Patient Experience & Safety Report/S&AE Report 14-15/HQSC Quarterly

Patient Experience Survey Results (Dr David Hughes) 6.2 Risk Register/Risk Report (Dr David Hughes) 6.3 Confirmation of Confidential Minutes (29 July 2015) 6.4 Action Item Register Confidential

Next Meeting: 21 October 2015

Meeting Room 101, Ko Awatea, Middlemore Hospital, Otahuhu

Counties Manukau District Health Board – Hospital Advisory Committee 9 September 2015 2

BOARD MEMBER ATTENDANCE SCHEDULE – HAC 2015

Name

Jan 11 Feb 24 Mar Apr 6 May 17 June 29 July August 9 Sept 21 Oct Nov 2 Dec

Lee Mathias (Chair)

No

Mee

ting

No

Mee

ting

No

Mee

ting

No

Mee

ting

Wendy Lai

Arthur Anae

X X

Colleen Brown

Sandra Alofivae

Lyn Murphy (Committee Chair)

David Collings

Kathy Maxwell

X

George Ngatai

Dianne Glenn

Reece Autagavaia

* Attended part meeting only


BOARD MEMBERS’ DISCLOSURE OF INTERESTS

9 September 2015 Member Disclosure of Interest

Dr Lee Mathias • Chair Health Promotion Agency

• Chairman, Unitec • Deputy Chair, Auckland District Health Board • Director, Health Innovation Hub • Director, healthAlliance NZ Ltd • Director, New Zealand Health Partners Ltd • External Advisor, National Health Committee • Director, Pictor Limited • Advisory Chair, Company of Women Limited • Director, John Seabrook Holdings Limited • MD, Lee Mathias Limited • Trustee, Lee Mathias Family Trust • Trustee, Awamoana Family Trust • Trustee, Mathias Martin Family Trust

Wendy Lai, Deputy Chair • Board Member and Partner at Deloitte • Board Member Te Papa Tongarewa, the Museum of

New Zealand • Chair, Ziera Shoes • Board Member, Avanti Finance

Arthur Anae

• Councillor, Auckland Council • Member The John Walker ‘Find Your Field of

Dreams’ Colleen Brown • Chair, Disability Connect (Auckland Metropolitan

Area) • Member of Advisory Committee for Disability

Programme Manukau Institute of Technology • Member NZ Down Syndrome Association • Husband, Determination Referee for Department of

Building and Housing • Chair IIMuch Trust • Director, Charlie Starling Production Ltd • Member, Auckland Council Disability Advisory Panel

Dr Lyn Murphy • Senior lecturer in management and leadership at Manukau Institute of Technology

• Member, ACT NZ • Director, Bizness Synergy Training Ltd • Director, Synergex Holdings Ltd • Associate Editor NZ Journal of Applied Business


Research • Member Franklin Local Board

Sandra Alofivae

• Member, Fonua Ola Board • Board Member, Pasefika Futures • Board Member, Housing New Zealand

David Collings

• Chair, Howick Local Board of Auckland Council • Member Auckland Council Southern Initiative

Kathy Maxwell • Director, Kathy the Chemist Ltd • Regional Pharmacy Advisory Group, Propharma

(Pharmacy Retailing (NZ) Ltd) • Editorial Advisory Board, New Zealand Formulary • Member Pharmaceutical Society of NZ • Trustee, Maxwell Family Trust • Member Manukau Locality Leadership Group,

CMDHB • Board Member, Pharmacy Guild of New Zealand

Dianne Glenn • Member – NZ Institute of Directors • Member – District Licensing Committee of Auckland

Council • Life Member – Business and Professional Women

Franklin • Member – UN Women Aotearoa/NZ • Vice President – Friends of Auckland Botanic

Gardens and Member of the Friends Trust • Life Member – Ambury Park Centre for Riding

Therapy Inc. • CMDHB Representative - Franklin Health

Forum/Franklin Locality Clinical Partnership • Vice President, National Council of Women of New

Zealand • Member, Auckland Disabled Women’s Group • Member, Pacific Women’s Watch (NZ) Limited • Justice of the Peace

George Ngatai • Arthritis NZ – Kaiwhakahaere • Chair Safer Aotearoa Family Violence Prevention

Network • Director Transitioning Out Aotearoa • Director BDO Marketing • Board Member, Manurewa Marae • Conservation Volunteers New Zealand • Maori Gout Action Group • Nga Ngaru Rautahi o Aotearoa Board


Reece Autagavaia • Member, Pacific Lawyers’ Association

• Member, Labour Party • Member, Auckland Council Pacific People’s Advisory

Panel • Member, Tangata o le Moana Steering Group • Employed by Tamaki Legal • Board Member, Governance Board, Fatugatiti Aoga

Amata Preschool


HOSPITAL ADVISORY COMMITTEE MEMBERS’ REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 9 September 2015 Director having interest Interest in Particulars of interest Disclosure date Board Action Wendy Lai

HBL – Food & Laundry & FPSC Programme

Ms Lai declared a specific interest in regard to Deloitte providing support to HBL in the food and laundry and FPSC Programme. Deloitte has mainly been providing Oracle implementation resources to FPSC. Ms Lai is not directly involved with this work.

12 February 2014

That Ms Lai’s specific interest be noted and that the Committee agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

Wendy Lai

Te Pou Matakana Deloitte is currently working with Te Pou Matakana (TPM) which is a subsidiary of Waipereira Trust. TPM has been awarded the contract as the Commissioner for Whaanau Ora services for North Island Maori.

7 May 2014 That Ms Lai’s specific interest be noted and that the Committee agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

Sandra Alofivae

Board Member, Pacific Futures Board

7 May 2014 That Ms Alofivae’s specific interest be noted and that the Committee agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

Lyn Murphy

MIT Dr Murphy is a lecturer at MIT. 17 June 2015 That Dr Murphy’s specific interest be noted and that the Committee agree that she may remain in the room and participate in any deliberations, but be excluded from chairing any items in relation to MIT and any voting.

Counties Manukau District Health Board – Hospital Advisory Committee Agenda 9 September 2015 7

Minutes of Counties Manukau District Health Board Hospital Advisory Committee Held on Wednesday, 29 July 2015 at 9.00 – 12.30pm, Room 101, Ko Awatea, Middlemore Hospital, Hospital Road, Otahuhu, Auckland Present: Dr Lee Mathias (Board Chair), Dr Lyn Murphy (Committee Chair), Ms Wendy Lai, Ms

Sandra Alofivae, Ms Colleen Brown, Mr George Ngatai, Ms Dianne Glenn, Mr David Collings, Apulu Reece Autagavaia, Anae Arthur Anae.

In attendance: Mr Geraint Martin (Chief Executive), Dr Gloria Johnson (Chief Medical Officer), Ms

Margaret White (Deputy Chief Financial Officer, Hospital Services), Mr Phillip Balmer (Director Hospital Services), Ms Denise Kivell (Director of Nursing), Ms Claire Green & Mr Simon Kerr (attending for Mr Martin Chadwick) and Ms Dinah Nicholas (Minute Taker). Ms Karen Dady (Business Support) and Mr Jarred Williamson (Eastern Courier) attended the public section of this meeting.

Apologies: Mr Martin Chadwick (Director Allied Health), Ms Kathy Maxwell , Ms Wendy Lai

(arriving late) and Ms Colleen Brown (leaving early). 1. Welcome

The Chair welcomed everyone to the meeting. 2. Governance

2.1 Attendance & Apologies Noted.

2.2 Disclosure of Interest/Specific Interests Noted with no amendments.

2.3 Acronyms Noted.

2.4 Confirmation of Public Minutes – 17 June 2015 Resolution That the Public Minutes of the Counties Manukau District Health Board Hospital Advisory Committee meeting held on Wednesday 17 June 2015 were taken as read and confirmed as a true and accurate record. Moved: Mr David Collings Seconded: Ms Dianne Glenn Carried: Unanimously

2.5 Action Item Register Public Noted.


3. Nursing Report

3.1 Nursing in CM Health (Ms Denise Kivell) Ms Denise Kivell presented a deep dive into all aspects of Nursing and Midwifery at Counties Manukau Health.

(Ms Wendy Lai arrived 9.32am)

Ms Kivell undertook to come back to the Committee with the number of male nurses currently employed at Counties Manukau Health.

4. For Discussion/Endorsement

4.1 Annual Leave Presentation (Ms Beth Bundy)

Nursing and Support are the two highest workforce groups - 40% up on the Counties Manukau Health average. SMO’s have significantly reduced from 18% to 15% over the last 2 quarters. There has been a small but significant shift in the Management/Administration group going from 4.5% to 5.5%. Counties Manukau Health average for all staff is on par with the Auckland region however, is 30% greater than our similar sized DHB’s.

Some actions being undertaken to address high annual leave balances are: • Traffic Light Reports for Managers • Audit & reconciliations of leave applications • Leave planning requirement for clinical staff • Leave management workshops • HR Toolkit and Leave Policy • Sick Leave Reviews

Ms Bundy undertook to review annual leave usage by blocks of two weeks to see if there are any issues arising from the practice of taking two weeks annual leave altogether.

4.2 Perioperative Clinical Information System Business Case (Mr Phillip Balmer)

Over the last 4 years CM Health has been actively working to procure a fully integrated PCIMS that manages the surgical patient’s journey from assessment and placement on to the surgical waiting list to the completion of the procedure and discharge home or to the ward. The successful vendor chosen from this process is Precept Health Ltd. The Northern region CEO/CMO group have endorsed our proposal to proceed to a contract with Precept on 16 January 2015.

Ms Lai commented that she would have liked to see the documentation point out a stronger case for why we are doing this – just because we can doesn’t mean we should. Mr Balmer confirmed that we have the busiest theatre facility in Australasia doing acute surgery with very complex care so the need for very good monitoring and the ability to identify clients quickly and easily is needed. This is very much an electronic health record, clinical recording of metrics around clinical performance.


Resolution That the Hospital Advisory Committee: Note this paper was approved by ELT on 23 June 2015. Endorse the purchase a Perioperative Clinical Information System (PCIMS) and implement over three years which includes: o the implementation of Intraop-operative module o the partnership agreement to develop and implement the Pre-operative module in

2015/16, o the partnership agreement to develop and implement the PACU and Pain modules

with Precept Health Ltd 2016/17 – 2017/18 years. Endorse the preferred option of phasing the project over the next three financial years at a total cost of $3.2M ($2,868,000 for the system & $375k for IPS and selection). Note that CMH Asset and Capital has already approved & allocated $1,443,000 to this project over the past 3 years. Note the Project requests the following additional funding of$1.8M: o 2015/16 – $500,000 (prioritised in 2015/16 FY) o 2016/17 - $800,000 (subject to capital prioritisation) o 2017/18 - $500,000 (subject to capital prioritisation)

Note that the project has regional support from the CIOs, CEOs and CMO Groups to proceed with a different vendor to that of ADHB and WDHB.

Note that the business case will be subject to NHITB approval. Note that the project has investigated the opportunity provided through the Regional PAS/ EHR project to assess whether the recommended Vendor (EPIC) could provide a solution. This solution does not meet the clinical requirements of CMH and is not a cost effective option to implement as a stand-alone application. It has been agreed by the regional CEOs/ CMO group as not being suitable for CMH at present. Note that the project will link with the following projects: o eReferrals o eMedication o Project Swift

Note that the Project will phase the introduction of the system to the business: o 2015 – 16 Implementation of the Intraop module & development of the Preop

module o 2016- 17 Implementation of the Preop module & development & implementation of

the PACU (Post Anaesthetic Care Unit)& Pain Modules to Middlemore Hospital o 2017-18 Implementation of the PACU & Pain Modules to Manukau Surgery Centre Endorse this paper go forward to the Board meeting this afternoon for final approval.

Moved: Ms Sandra Alofivae Seconded: Dr Lee Mathias Carried: Unanimously


5. Director of Hospital Services Report (Mr Phillip Balmer)

June was a very busy month with higher than expected EC volumes and inpatient discharges. All health targets were achieved. There was continued high performance in meeting national Quality & Safety Commission quality markers. This month’s report shows up to date financials and scorecard data (June). An area of ongoing focus is the % of clinical summaries authorised <7 days of creation. It is important that this information is signed off and transmitted to GPs as soon as possible. % of patients to discharge lounge or home by 1100am sitting at 16% v target of 30% - we are working to support ongoing improvement in this area. Project Swift will assist by enabling staff to undertake tasks electronically and therefore quicker. Faster Cancer Treatment – will be hitting this target 9 months earlier that the target date. Elective/Acute WIES – WIES activity was up 1% on contract (1% acute and 1% elective) but remains on contract YTD at 3% favourable (4% acute, (1)% elective). Ms Lai asked that as we are now coming to the end of the 14/15 year, whether there are any similarities in terms of WIES volumes with ADHB & WDHB and where they ended up for the year in terms of WIES numbers and whether there are any trends. Mr Balmer confirmed that for our elective WIES we had a quite deliberate strategy this year to do as much as we could efficiently as possible. Plus, the MoH gave us additional funds to achieve additional electives. We wanted to achieve all the elective bariatric surgery - which we did and all elective targets. We are right on the number for elective WIES. The increase in acute WIES we are seeing is reflecting the fact that a lot of people are being turned around so the ones who are being admitted are sicker. Our notional cost per discharge, as per the Health Roundtable, was one of the lowest so that does ask the question whether we are capturing accurately all the information about complexity. Mr Balmer to undertake a deep dive into two examples/areas of concern in this area - go right back to look at the coding and anything else that equals the price we get at the end and report back to the Committee. Ms Lai noted that Counties Manukau Health had employed an additional (47) FTE which were unbudgeted but had been funded externally (additionally). Mr Balmer is to provide a breakdown showing what this FTE is doing and what the outcomes will be (ie) clinical research. Ms Lai also noted that our annualised voluntary turnover is tracking upwards (page 56). Mr Balmer confirmed that the GM HR confirmed yesterday at ELT that our voluntary turnover is the lowest in the history of Counties Manukau Health so he would need to undertake some further analysis on this graph. Ms White undertook to look at an 18month period and report back to the Committee. 5.1 Mental Health (Mr Phillip Balmer)

Good to see a reduction in suicides reflected however, this is still a worry for Maaori youth. The need to focus on youth, Maaori and the broader access to specialist mental health


services has been highlighted and is part of the focus of the new Integrated Mental Health & Addiction Leadership Group. Work is underway on developing an At Risk programme for Child & Youth because there is a whole group that need intervention by a whole team of people, not just health. ARI focuses not just on the individual but on the whole family. Further information on this should be available in the next few months. In terms of health services planning, we should be thinking about this in terms of need, understanding the changing models of care/changing demands, the different demographics we have, staffing issues etc. Mr Balmer to bring back a package of information on this new programme.

5.2 Women’s Health & Kidz First (Mr Phillip Balmer) EC attendances 25,817 YTD, an 8.8% increase which is quite significant. The distribution of births continues to shift towards Middlemore with the 3 community units down by 103 births YTD. Mr Balmer to track how many babies are born with recognisable disabilities to see if there have been any trends over time and how we support them proactively as not all families are aware of the services available to them and report back. The MCIS (Maternity Clinical Information System) was rolled out in October 2014. At the end of June 2015, 2700 women at booking were recorded in the system and 110 births. (Ms Colleen Brown departed at 11.33am)

5.3 Director of Midwifery (Ms Thelma Thompson) The report was taken as read.

5.4 Surgical Services & Ambulatory Care (Ms Gillian Cossey) Some scorecard data missing from the report: o Theatre session utilisation 97.4% v target of 95% o Elective theatre turnaround times 14.6mins v target of 15mins o Elective cancellations 4% v target of 5%. The Manukau Super Clinic Volunteers were Runners Up in the 2015 Minister of Health Volunteer Awards.

Dr Mathias noted that the Acutes and Elective volumes for children balanced each other out (-16.2% and 16%). Ms Cossey undertook to look into the figures to find the answer why and report back. Mr Martin noted the sad passing of Mr Geoff Coldham on 21 July. Geoff spent the last 25 years at Middlemore, 15 of those as a very dedicated surgeon, developing highly specialised skills in spinal surgery and showing a deep passion for this specialty area. He will forever be a part of Middlemore history and memories.

5.5 Adult Rehabilitation & Health of Older People (Ms Dana Ralph-Smith)

Commenced rolling out supported discharge through the POAC winter coordination service since 15 June with 140-150 patients through this process.


Looking at rolling out supported discharge for stroke right through the whole Counties catchment. The pilot was just through the Mangere/Otara area.

5.6 Medicine, Acute Care & Clinical Support (Mr Brad Healey)

Total EC volumes 9195 – 2.2% higher than this time last year and 1.8% higher than last month with an average daily volume of 295. Occupancy of the medical wards remains high. The Surgical Assessment pilot commenced 29 June. Recently instituted is a daily Front Door Triage meeting where patients are reviewed who presented the previous day who have had more than 3 presentations in the previous 12 months. Health targets – CT target hit, continuing to work on MRI/Colonoscopy and FCT. Production planning is playing a big part in this but still some way to go. Angiography and Angioplasty have an intervention rate set by the MoH. We argued a year ago that we didn’t think the rate had been set at the appropriate level, we thought it should have been set at a lower level given the nature of our population and the fact that we didn’t have waiting lists etc. The Ministry did not agree with us. We still hold that view and are confident we don’t have a chunk of unmet need out there so we are set to have another conversation with them again shortly. Mr Martin advised he will talk to Dawn Kelly to see whether we have any other services that may fall into this category and report back. Echo waiting list is probably the one we are concerned about with the wait list continuing to grow due to ongoing recruitment issues and increasing demand – currently 1517, up 7 from last month. There is active work underway in three areas: (1) recruiting sonographers and we are training our own here which is a good thing for our DHB, our challenge will be keeping them; (2) production planning has been started for the next 12 months but until this is landed we won’t know how big the problem is in terms of the difference between the ability to meet the demand or what the capacity is; and (3) looking into ‘limited’ clinics which means the number of patients that can go through the clinics can be doubled. A ‘limited’ clinic reduces the amount of time for some patients that they have to spend in the clinic.

5.7 Facilities Report (Mr Phillip Balmer)

Good to see our patient satisfaction results reflecting an improvement in the perception of the cleanliness in the hospital and also the standard of the cleaning staff with their recent certification, National Certificate in Cleaning. PORTAL (portable real-time task assignment link) went live on18 July. The system assists the Orderly coordinators to locate and dispatch teams closer to the job requests. It also allows us to track response times. The uptake from the orderlies has been positive. Mr Balmer to give an update in three months on progress with this new system. Stage 2 of the EAM implementation is now live. This includes full capex, disposal and purchasing modules. Integration with Oracle and healthAlliance has been migrated to production.


The Train Station entrance modifications have been signed off. Mr Balmer to advise start and finish dates.

5.8 Director of Allied Health Report (Ms Claire Green & Mr Simon Kerr)

The Allied Health celebration has been set for 14 October with a workforce expo in the morning for high school students to highlight the many professions accessible within this workforce group and an awards event in the afternoon.

5.9 Director of Nursing Report (Ms Denise Kivell)

The report was taken as read.

6. Inpatient Experience Survey (Dr David Hughes)

This survey reports on cleanliness and hygiene. Next month’s survey will focus on ethnic populations and how they experience the care that we provide and an annual report wrap up of the year’s surveys. The surveys are available on the CM Health website under Patient & Whaanau Centred Care.

7. Resolution to Exclude the Public Individual reasons to exclude the public were noted. Resolution That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000, the public now be excluded from the meeting as detailed in the above paper. Moved: Anae Arthur Anae Seconded: Dr Lee Mathias Carried: Unanimously

12.13pm Public Excluded session. 12.38pm Open meeting resumed. The meeting closed at 12.39pm. The next meeting of the Hospital Advisory Committee will be Wednesday, 9 September 2015 at Ko Awatea, Middlemore Hospital. The Minutes of the meeting of the Counties Manukau District Health Board Hospital Advisory Committee held on Wednesday, 29 July 2015 are approved. Signed as a true and correct record on Wednesday, 9 September 2015. (Moved /Seconded ) Chair 9 September 2015 Dr Lyn Murphy Date

Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.


Hospital Advisory Committee Meeting – Action Items Register – 9 September 2015 DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

13.8.2014 3.1 Director’s Report - Health & Safety Hazard

Register to be tabled when compiled by OH&S. Pending Mr Balmer

10.9.2014 3.0 Orthopaedics –Mr Balmer to provide a copy of the NZ Orthopaedic Association projection report.

Pending Mr Balmer The NZ Orthopaedic Association has advised that this report has not yet been publically released.

17.6.2015 3.1 Allied Health Drilldown - report back on any collaboration/working together models and programmes including regional.

21 October Mr Chadwick

17.6.2015 4.0 Mr Balmer to give some thought as to what other services the Committee would visit such as Renal.

9 September Mr Balmer Refer Item 3.6 Director’s Report this month.

17.6.2015 4.0 Tertiary Adjuster – Mr Balmer provided an update on the tertiary adjuster at the 17 June HAC meeting and will report back on progress in 6 months’ time.

2 December Mr Balmer

17.06.2015 Director’s Report – ensure all graphs in this report are shown as control charts with upper and lower control limits going forward.

9 September Mr Balmer This activity is in progress and will occur over the proceeding months.

29.7.2015 3.1 Nursing – Ms Kivell to confirm the number of male nurses currently employed at CM Health.

9 September Ms Kivell Refer Item 3.6 Director’s Report this month

29.7.2015 4.1 Annual Leave – review annual leave usage by blocks of 2 weeks to see if there are any issues from the practice of taking 2 weeks leave altogether.

21 October

Ms Bundy

29.7.2015 5.0 Director’s Report – undertake a deep dive into 2 examples/areas of concern in relation to Elective/Acute WIES and report back. CMH had employed an additional 47 FTE which were unbudgeted but had been funded externally (additionally). Mr Balmer to provide a

21 October 9 September

Mr Balmer/Ms White Mr Balmer/Ms White

Analysis in progress.

Refer Item 3.6 Director’s Report this month.

Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.


DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

breakdown showing what this FTE is doing and what the outcomes will be (ie) clinical research. Annualised Voluntary Turnover increasing (page 56) – undertake further analysis over an 18month period and report back on the increase.

21 October

Mr Balmer/Ms Bundy

29.7.2015 5.1 Mental Health – information on the new At Risk Programme for Child & Youth.


29.7.2015 5.2 Women’s Health – track how many babies are been born with recognisable disabilities to see if there have been any trends over time and also how we support them proactively as not all families are aware of the services available to them.


29.7.2015 5.4 Surgical Services Ms Cossey to look into why the Acute & Elective volumes for children balanced each other out (page 96).


29.7.2015 5.6 Medicine –Angiography & Angioplasty have intervention rates set by MoH that we feel are set at inappropriate levels. Mr Martin to see whether we have any other services that may fall into the same category.

21 October Mr Martin

29.7.2015 5.7 Facilities – report back on how the new PORTAL system is working. Train Station entrance modifications – confirm start and finish dates.

21 October 9 September

Mr Balmer Mr Balmer

Refer Item 3.6 Director’s Report this month.


Counties Manukau District Health Board Hospital Advisory Committee

Hospital Services Report

Recommendation It is recommended that the Hospital Advisory Committee receive the Hospital Services Report covering activity in July 2015.

Prepared and submitted by: Phillip Balmer, Director Hospital Services Additional acronyms and abbreviations used in this report

ALOS Average Length of Stay ARHOP Adult Rehabilitation / Health of Older People Division ARRC Aged Related Residential Care CGS Community Geriatric Service CHF Congestive Heart Failure CLAB Central Line Associated Bacteraemia CND Clinical Nurse Director CSSD Central Sterile Supply Department CT/ FNA Computerized Tomography / Free Needle Aspiration (biopsy) DHB District Health Board DNA /DNR Did Not Attend Did Not Respond DOSA Day of Surgery Admission EAM Enterprise Asset Management EC Emergency Care FCT Faster Cancer Treatment FSA First Specialist Assessment GDD Goal Discharge Date hA healthAlliance HBL Health Benefits Ltd HBT Home-based Treatment HCA Health Care Assistant IP&C Infection Prevention and Control KF Kidz First KPI Key Performance Indicator LMC Lead Maternity Carer LOS Length of Stay MAU Medical Assessment Unit (short stay areas) MCIS Maternity Clinical Information System MECA Multi –Employer Collective Agreement MH/MH&H Mental Health/Mental Health and Addictions


MHSOP Mental Health Services Older people MSC Manukau Super Clinic MRI Magnetic Resonance Image MRT Medical Radiologic Technologist MSOP Musculoskeletal Outpatient Physiotherapy NASC Needs Assessment / Service Coordination NMMG National Maternity Monitoring Group NNU Neonatal Unit NPWT Negative Pressure Wound Therapy NZNO New Zealand Nurses Organisation ODA/ODP Operating Department Assistant/Operating Department Practitioner ORL Otorhinolaryngology (Ear Nose Throat) POAC Primary Options Acute Care PSA Public Service Association PSH Practising Sustainable Healthcare PWCC Patient/ Whaanau Centred Care RMO Registered Medical Officer RN Registered Nurse SACS Surgical & Ambulatory Care Services SAU Surgical Assessment Unit SIR Standardised Intervention Rates SMO Senior Medical Officer TIA Transient Ischemic Attack WH Women’s Health WIES Weighted Inlier Equivalent Separations


3.1 Executive Summary

Month in review: July Hospital services performed strongly during the first month of 2015/16 amidst continued ED volume pressure unprecedented in recent times. The key challenge for our people remains sustained focus on delivery of business as usual activity across the organisation. Our financial performance reflects increased volumes versus budget and a number of timing related matters that were planned. Underlying financial and risk management is actively managed across our services with a diverse portfolio of change initiatives inflight to improve patient outcomes and deliver savings. All our national health targets were met. The following report provides a overview of this performance in more detail. Activity summary

EC presentations EC volumes in July 2015 were a record 10,244 presentations - 7% higher than this time last year and 11% higher than last month. The average daily EC volume was 320 presentations.

EC discharges against contract actual versus projected for 2015/16 - as agreed with the Funder EC discharge volumes in July 2015 were a record 10,226 discharges. Despite exceptionally high volumes of patients and issues with staffing due to problems in recruitment and sickness, EC achieved the six hour LOS target in July 2015 and saw sustained improvements in the KPI’s for antibiotic times for patients in sepsis and time to analgesia.

July 2015 contracted volumes have continued to grow at a rate greater than expected and as seen in previous years. We are delivering a range of initiatives with the community teams and primary care to curb this demand growth and more effectively improve patient outcomes.

Volumes Month: July YTD Act Bud/ Contract Var Act Bud/ Contract Var Emergency Care Presentations (against last year) 10,244 9,561 7% 10,244 9,561 7%

Discharges (against contract) 10,226 9,694 5% 10,226 9,694 5%

N.B. Presentations refer to all people entering EC, while Discharges only include those that are admitted/ treated and includes a growth assumption on last year volumes (excludes a small number of cases that leave unseen, or are transferred).


WIES volumes actual versus projected for 2015/16 - as forecast (see below). July month WIES volumes (shown below) are as per the forecast/ funder agreement; (18)% for Acute and (9)% for Electives; overall WIES volumes including Acute Arranged Services - 2% above agreement.

Month: July-2015 YTD: July-2015 This Year

Funder Agreement

% Var to Last Year This Year

Funder Agreement

% Var to Last Year

Acute Services WIES 4,865 5,907 -18% 4,865 5,907 -18% *Acute Arranged Services WIES 1,377 1,377 Elective Services WIES 1,474 1,622 -9% 1,489 1,622 -8% Total WIES 7,716 7,529 2% 7,731 7,529 3% *N.B. A change in MoH elective reporting, effective 1 July 2015 requires that Acute Arranged surgical activity be recognised as elective activity. DSU are currently implementing these changes to take effect in August. In the interim, Acute Arranged activities have been explicitly reported. In addition, the introduction of WIES15 coding is forecast to reduce the overall level of surgical case weights as compared to 2015-16 contract, which was based on WIES14 coding.

Patient volumes actual versus 2014/15 patient volumes (see below) July:

• WIES volumes are on target against last year (Acute 1%, AA Services 9%, elective (9)%).

• Patient discharge volumes are up 4% on last year (Acute 6%; AA Services 9%, elective (8)%), reflecting 356 more patients discharged for the month (Acute 325, AA Services 159 and elective (128) discharges).

Month: July-2015 YTD: July-2015 This Year Last Year % Var to Last

Year This Year Last Year % Var to Last Year

Acute Services WIES 4,865 4,800 1% 4,865 4,800 1% Patients 6,114 5,789 6% 6,114 5,789 6% Acute Arranged Services WIES 1,377 1,260 9% 1,377 1,260 9% Patients 1,863 1,704 9% 1,863 1,704 9% Elective Services WIES 1,474 1,626 -9% 1,489 1,626 -8% Patients 1,407 1,535 -8% 1,482 1,535 -7% Total WIES 7,716 7,685 0% 7,731 7,685 1% Patients 9,384 9,028 4% 9,405 9,028 4%


3.2 Balanced Scorecard (See definitions in Appendix A)

HOSPITAL SERVICES BALANCED SCORECARD

July 2015

NOTES

* performance is against 2013/14 actual~ YTD figures not applicable, or reliant on further work to establish a data set# YTD records Baseline (2013 audit) results∆ ESPI interim results subject to change^ Ambulatory Sensitive Hospitalisation rates and targets data from MoH - rates are standardised (100% national average). Data reported March/Sept

NATIONAL HEALTH TARGETS - hospital

month result trend Def

YTD Jul-15 Target Var Actual Target VarEmergency Care - 6 hour LOS target 95.7% 95% 0.7% 95.0% 95% -0.0% 28

% Cancer Treatment (ADHB Radiotherapy) in 4 weeks 100% 100% 0.0% 100% 100% 0.0% 30

Elective Access - discharges Not Available 100% 100% -100.0%% smokers receive smokefree advice -Total 95% >95% 0.0% 95% >95% 0.0% 77

BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCES

month result trend Def

YTD Jul-15 Target Var Actual Target VarTotal Caseweight 7,716 7,529 2% 7,716 7,529 2% 1

Acute Caseweight 6,242 5,907 6% 6,242 5,907 6% 2

Elective Caseweight 1,474 1,622 -9% 1,474 1,622 -9% 3

Total Discharges * 9,384 9,028 4% 9,384 9,028 4% 4

Budgeted FTEs 5,609 5,881 4.6% 5,609 5,881 4.6% 6

Operating Costs ($000) 24,406 24,020 -1.6% 24,406 24,020 -1.6% 7

Personnel Costs ($000) 45,481 46,282 1.7% 45,481 46,282 1.7% 8

Financial Result Total ($000) 162 224 -$62 162 224 -$62 9

Outpatient FSA Volumes* 6,609 7,898 -16% 6,609 7,898 -16% 10

Outpatient Follow Up Volumes* 20,251 23,509 -14% 20,251 23,509 -14% 11

Virtual FSAs (GP consult and nonpatient appointments) 208 295 -29% 208 295 -29% 12

Reduce clinical outsourcing ($000) 1,325 1,429 $105 1,325 1,429 $105 13

HR metrics

YTD Jul-15 Target Var Actual Target VarExcess Annual Leave dollars ($000) - estimated cost for excess 2884 $932 1,952-$ ~ 5

Adult Rehab / Health of Older People 51 $45 6-$ ~Medicine/ Acute Care and Clinical Support 640 $304 336-$ ~

Surgical/ Ambulatory Care 1300 $293 1,008-$ ~Mental Health 250 $132 118-$ ~

Kidz First/ Women's Health 644 $158 486-$ ~

% Staff Annual Leave >2 years 12.7% 5.0% -7.7% 11.6% 5.0% -6.6% 14

Adult Rehab / Health of Older People 5.6% 5.0% -0.6% 6.2% 5.0% -1.2%Medicine/ Acute Care and Clinical Support 10.5% 5.0% -5.5% 9.6% 5.0% -4.6%

Surgical/ Ambulatory Care 22.2% 5.0% -17.2% 10.7% 5.0% -5.7%Mental Health 9.4% 5.0% -4.4% 8.7% 5.0% -3.7%

Kidz First/ Women's Health 20.4% 5.0% -15.4% 17.2% 5.0% -12.2%% Staff Turnover (YTD no. voluntary turnovers by average headcount) 0.8% 2.0% 1.2% 9.5% 10.0% 0.5% 15

% Sick Leave 2.9% 2.8% -0.1% 2.9% 2.8% -0.1% 16

Workplace Injury Per 1,000,000 hours 1.92 10.50 8.58 7.55 10.50 2.95 17

Where employees report a secondary identity Maaori, Pacific and Asian have been prioritised in that order. Var VarWorkforce Diversity - Leader data 2014 workforce population workforce population 19

Maaori Not Available 16% 16% -16%Pacific Not Available 23% 23% -23%Asian Not Available 23% 23% -23%

NZ European / non-specified/ other Not Available 38% 38% -38%

Ensu

ring

Fina

ncia

l Sus

tain

abili

tyEn

ablin

g Hi

gh P

erfo

rmin

g Pe

ople

Year to date

Year to date

Average last 12 months

Jul-15 Jul-14

Year



July 2015

NOTES


IMPROVED QUALITY, SAFETY AND EXPERIENCE OF CARE

NB data reported from Feb15 to align with patient safety report YTD Target Var Target Var% e-medication reconciliation -high risk patients within 48hrs 71% 80% -9% 71.0% 80% 0.09 20

% Serious Pressure Injuries rate / 100 Patients 0.7% <3.5% 2.8% 0.7% <3.5% 2.8% 21

Falls causing major harm rate / 1,000 bed days 0.00 0.00 -0.00 0.00 0.0 -0.00 22

Rate of adverse events rate / 1,000 bed days (Dec 14) 47.20 tbc 47.20 23

CLAB rate / 1,000 line days 0.00 0.0 0.0 0.00 0.0 0.00 24

Rate of S. aureus bacteraemia rate / 1,000 bed days 0.14 0.0 -0.14 0.14 0.0 -0.14 25

Q1 15/16 Target Var baseline Target Var% Operations - all 3 parts of the Surgical Safety Checklist used # Quarterly data 90% 90% -90% 26

% 75+ years assessed for the risk of falling # Quarterly data 90% 90% -90% 27

% 75+ years assessed for falls risk with falls intervention plans # Quarterly data 90% 90% -90% 27a

YTD Jul-15 Target Var Actual Target Var% Radiotherapy commences in 4 weeks - National Health Target 100% 100% 0% 100% 100% 0% 30

% Chemotherapy commences in 4 weeks – National Health Target 100% 100% 0% 100% 100% 0% 31

% MRI scans completed within 6 weeks from referral - MOH IDP 45% 80% -35% 55% 80% -25% 33

% CT scans completed within 6 weeks from referral - MOH IDP 92% 90% 2% 71% 90% -19% 34

% urgent diagnostic colonoscopy within 14 days - MOH IDP 100.0% 75% 25% 75.4% 75% 0% 37

% diagnostic colonoscopy patients within 42 days - MOH IDP 43.3% 60% -17% 28.1% 60% -32% 38

% surveillance colonoscopy patients within 84 days - MOH IDP 79% 60% 19% 88.4% 60% 28% 39

% cardiac STEMI-PCI (angiography) <120mins - Northern Region 80% 80.0% 0% 82% 80.0% 2% 41

% Coronary Angiography within 90days - MOH IDP (1mth arrears) 100% 85.0% 15% 100.0% 85.0% 15%

ESPI 2: No. patients waiting >4 mths for FSA - Elective ∆ 0 0 0 0 0 0 42

ESPI 5: No. patients waiting >4 mths treatment - Elective ∆ 0 0 0 0 0 0 43

Radiology - Inpatient radiology completion times <24hrs 93% 95% -2% 92% 95% -3% 35

Radiology- Emergency Care radiology completion times <2 hrs 95% 95% 0% 95% 95% 0% 36

Acute Surgery Priority Score - delay for surgery 83% 80% 3% 83% 80% 3% 44

Q1 Target Var Actual Target VarFaster Cancer Treatment - % high suspicion first cancer treatment within 62 days - MOH FCT + target by 2016 67% 85% -18% 57% 85% -28% 45

Faster Cancer Treatment - % confirmed diagnosis first cancer treatment within 31 days - MOH FCT + 86% na 90% na 46

% Radiology results reported within 24 hours 60% 75% -15% 59% 75% -16% 47

YTD Jul-15 Target Var Actual Target VarAverage Length of Stay - Acute Inpatient - MOH IDP 2.57 2.98 0.41 2.57 2.98 0.41 50

Average Length of Stay - Acute Arranged/ Elective - MOH IDP 1.83 1.37 -0.46 1.83 1.37 -0.46 51

MMH % patients to discharge lounge or home by 1100hrs 16.8% 30% -13% 17% 30% -13%Acute Readmissions within 7 days - Total 3.0% 2.89% 0.1% 3% 2.89% 0.1% 52

Acute Readmissions within 28 days - Total - MOH IDP 6.1% 7.6% 1.4% 6.1% 8% 1.4% 53

Acute Readmissions within 28 days - 75+ years - MOH IDP 9.0% 11.85% 2.8% 9.0% 11.85% 2.8% 54

EC Presentations - 75+ year olds (5% reduction on 2013) 1,080 807 -273 1,080 7,263 6183 55

% clinical summaries (meddocs) authorised <7 days of creation 72% 95% -23% 72% 95% -23% 56

% of patient outliers - not on home ward <5% 5.2% 5.0% -0.2% 5.2% 5.0% -0.2% 58

Year to date

YearQUARTERLY REPORTING

Syst

em In

tegr

atio

n (E

ffec

tive)

Tim

ely

Firs

t, Do

No

Harm

(Saf

ety)

Year to date

YearHealth Quality and Safety QSM - QUARTERLY AUDIT REPORTING

Year to date



July 2015

NOTES


Q4 Target Var Actual Target Var

% Eligible stroke patients thrombolysed - Northern Region 6.1% 6.0% 0.1% 6.5% 6.0% 0.5% 59

% DHB Mental Health Services - children/ youth (0-19years) seen by 3 weeks for non-urgent mental health - MOH IDP 78.3% 75.0% 3.3% NA 75.0% #VALUE! 48

Mental Health access rate - clients seen in last 12 months as % of population (0-19 Years) 3.62% 3.15% 0.5% NA 3.15% #VALUE! 49a

Mental Health access rate - clients seen in last 12 months as % of population (20-64 Years) 3.88% 3.15% 0.7% NA 3.15% #VALUE! 49b

Mental Health access rate - clients seen in last 12 months as % of population (64+ Years) 2.55% 2.70% -0.2% NA 2.70% #VALUE! 49c

Ambulatory Sensitive Hospitalisation rates - MOH IDP ^ 2015/16 Q10-4 years - Total Quarterly data 101% 60

0-4 years - Maaori Quarterly data 118%0-4 years - Pacific Quarterly data 118%0-74 years - Total Quarterly data 114% 60a

0-74 years- Maaori Quarterly data 119%0-74 years- Pacific Quarterly data 119%

YTD Jul-15 Target Var Actual Target VarOutpatient - First Specialist : Follow-up Clinic ratio 33% 34% 1% 33% 34% 1% 61

Outpatient - DNA rates - Maaori 11% 10% -1% 11% 10% -1% 62

Outpatient - DNA rates - Pacific 9% 10% 1% 9% 10% 1% 62a

Theatre List Utilisation 85.3% 83.4% 2% 85.3% 83.4% 2% 63

Day of Surgery Admissions (DOSA) 91% 90% 1% 91% 90% 1% 65

Day Case Rate (Elective/ Arranged) 61.2% 65% -4% 61.2% 65% -4% 66

% Medical Assessment patients with LOS < 28 hours 99% 65% 34% 99% 65% 34% 68

No. Hospital bed days occupied (against forecast open beds) 20,838 21,448 3% 20,838 205,148 884% 73

No. Length of Stay outliers (LOS >10 days)* 273 296 8% 273 296 8% 74

YTD Jul-15 Target Var Actual Target VarPatient Experience Survey (rated very good/ excellent) 77% 90% -13% 77% 90% -13% 75

Better Health Outcomes For All

YTD Jul-15 Target Var Actual Target Var% Infants Exclusively Breastfed at discharge - Total 89.0% 75% 14% 89.0% 75% 14% 76

% Infants Exclusively Breastfed at discharge - Maaori 79.0% 75% 4% 79.0% 75% 4%% Infants Exclusively Breastfed at discharge - Pacific 85.0% 75% 10% 85.0% 75% 10%

% smokers receive smokefree advice - Maaori 95% 95% 0% 95% 95% 0% 77

% smokers receive smokefree advice - Pacific 95% 95% 0% 95% 95% 0%

% Women (45-60yrs)with Breastscreen in 24months - Total 2411 2213 198 69.8% 70% 0% 78

% Women (45-60yrs)with Breastscreen in 24months - Maaori 223 261 -38 67.6% 70% -2%% Women (45-60yrs)with Breastscreen in 24months - Pacific 443 392 51 78.7% 70% 9%

(n = 215) Year to date (n = 215)

Year to date

Year to date

Patie

nt

Wha

anau

Ef

ficie

ntSy

stem

Inte

grat

ion

(Eff

ectiv

e)

QUARTERLY REPORTINGYear

% Screened in last 24 monthsVolumes Screened

Equi

ty


3.3 Financial Summary Best value for public health system resources

The Provider Arm produced a $162k surplus for the month, reporting an unfavourable result against budget of $(63)k for July 2015. This contributes to the consolidated DHB variance of $21k favourable to budget for the month.

Unfavourable revenue timing differences and a continuing demand for Clinical support services (radiology, labs and drugs) were mitigated by existing vacancies across the services and a high uptake of annual leave for the July school holidays.

Implementation of DHS Change Projects and Benefits for the current financial year have been initiated and are being tracked and reported on a monthly basis using the Daptiv software tool.

Financial Performance

Fig 1

Variance Result:

XX F = favourable variance to budget, (XX) U = unfavourable to budget

Actual Budget Variance Comparative Actual Budget Variance

$(000) $(000) $(000)Variance to Prev Mnth $(000) $(000) $(000)

Income

Government Revenue 4,666 4,650 16 F 4,666 4,650 16 F

Patient/Consumer Sourced 1,368 1,600 (232) U 1,368 1,600 (232) U

Other Income 1,978 2,266 (288) U 1,978 2,266 (288) U

Funder Payments 62,036 62,010 26 F 62,036 62,010 26 FTotal Income 70,048 70,527 (479) U 70,048 70,527 (479) U

Expenditure

Personnel 45,481 46,282 802 F 45,481 46,282 802 F

Outsourced Personnel 1,197 805 (392) U 1,197 805 (392) U

Outsourced Clinical 1,325 1,429 105 F 1,325 1,429 105 F

Outsourced Other 2,714 2,730 16 F 2,714 2,730 16 F

Clinical Supplies (excluding Depreciation) 9,172 8,795 (377) U 9,172 8,795 (377) U

Other Expenses 5,009 5,184 174 F 5,009 5,184 174 FTotal Expenditure (excl Depreciation, Interest and Capital Charge) 64,898 65,225 328 F 64,898 65,225 328 F

Earnings before Depreciation, Interest and Capital Charge 5,150 5,301 (151) U 5,150 5,301 (151) U

Depreciation 2,680 2,730 50 F 2,680 2,730 50 F

Interest 1,059 1,097 38 F 1,059 1,097 38 F

Capital Charge 1,250 1,250 0 F 1,250 1,250 0 F

Total Depreciation, Interest and Capital Charge 4,989 5,077 88 F

4,989 5,077 88 F

Net Surplus/(Deficit) Provider 162 224 (63) U 162 224 (63) U

Month Year to DateConsolidated Statement of Financial PerformanceJuly 2015


Financial Performance

Fig 2

Fig 3



Clinical

Women & Child Health (5,480) (5,486) 7 F (5,480) (5,486) 7 F

Medical & Clinical Support (18,035) (18,008) (27) U (18,035) (18,008) (27) U

ARHOP (3,509) (3,519) 9 F (3,509) (3,519) 9 F

Mental Health (5,515) (5,551) 36 F (5,515) (5,551) 36 F

Surgical & Ambulatory (13,432) (13,625) 193 F (13,432) (13,625) 193 F

Middlemore Central (410) (420) 10 F (410) (420) 10 FTotal Clinical (46,382) (46,610) 228 F (46,382) (46,610) 228 F

Non-ClinicalCorporate (incl Provider Arm Revenue from Funder) 56,441 56,670 (228) U 56,441 56,670 (228) U

HBL (173) (173) 0 F (173) (173) 0 F

Health Alliance (2,529) (2,528) (1) U (2,529) (2,528) (1) U

Facilities Services (3,818) (3,718) (100) U (3,818) (3,718) (100) U

Integrated Care (2,188) (2,107) (81) U (2,188) (2,107) (81) U

Innovations Hub & Ko Awatea (1,191) (1,309) 118 F (1,191) (1,309) 118 FTotal Non-Clinical 46,543 46,834 (291) U 46,543 46,834 (291) U

Net Surplus/(Deficit) Provider 162 224 (63) U 162 224 (63) U

Month Year to Date

Performance Summary by DirectorateJuly 2015



Medical Personnel 14,720 14,891 170 F 14,720 14,891 170 F

Nursing Personnel 16,854 17,231 377 F 16,854 17,231 377 F

Allied Health Personnel 6,712 6,896 184 F 6,712 6,896 184 F

Support Personnel 2,166 2,099 (66) U 2,166 2,099 (66) U

Management/Administration Personnel 5,028 5,165 136 F 5,028 5,165 136 F

Total (before Outsourced Personnel) 45,481 46,282 802 F 45,481 46,282 802 F

Outsourced Medical 597 371 (226) U 597 371 (226) U

Outsourced Nursing 120 45 (76) U 120 45 (76) U

Outsourced Allied Health 17 31 15 F 17 31 15 F

Outsourced Support 23 27 4 F 23 27 4 F

Outsourced Mangement/Admin 441 331 (109) U 441 331 (109) UTotal Outsourced Personnel 1,197 805 (392) U 1,197 805 (392) UTotal Personnel 46,678 47,087 410 F 46,678 47,087 410 F

Month Year to Date

Personnel Costs By Professional GroupJuly 2015


Fig 4

Fig 5


FTE FTE FTEVariance to Prev Mnth FTE FTE FTE

Medical Personnel 756 808 52 F 756 808 52 F

Nursing Personnel 2,503 2,614 111 F 2,503 2,614 111 F

Allied Health Personnel 1,077 1,134 57 F 1,077 1,134 57 F

Support Personnel 481 491 10 F 481 491 10 F

Management/Administration Personnel 792 835 43 F 792 835 43 F

Total (before Outsourced Personnel) 5,609 5,881 272 F 5,609 5,881 272 F

Outsourced Medical 22 13 (8) U 22 13 (8) U

Outsourced Nursing 11 4 (7) U 11 4 (7) U

Outsourced Allied Health 1 2 1 F 1 2 1 F

Outsourced Support 4 5 1 F 4 5 1 F

Outsourced Mangement/Admin 54 41 (13) U 54 41 (13) UTotal Outsourced Personnel 92 66 (26) U 92 66 (26) UTotal Personnel 5,701 5,947 246 F 5,701 5,947 246 F

Month Year to Date

FTE By Professional GroupJuly 2015


FTE FTE FTEVariance to Prev Mnth FTE FTE FTE

ClinicalWomen & Child Health 621 611 (10) U 621 611 (10) UMedical & Clinical Support 1,541 1,621 80 F 1,541 1,621 80 FARHOP 493 520 27 F 493 520 27 FMental Health 624 689 65 F 624 689 65 FSurgical & Ambulatory 1,337 1,401 64 F 1,337 1,401 64 FMiddlemore Central 59 57 (2) U 59 57 (2) UTotal Clinical 4,676 4,900 224 F 4,676 4,900 224 F

Non-ClinicalCorporate (incl Provider Arm Revenue from Funder) 112 112 (0) U 112 112 (0) UFacilities Services 448 465 18 F 448 465 18 FIntegrated Care 326 335 9 F 326 335 9 FInnovations Hub & Ko Awatea 139 134 (5) U 139 134 (5) UTotal Non-Clinical 1,025 1,047 22 F 1,025 1,047 22 F

Net Surplus/(Deficit) Provider 5,701 5,947 246 F 5,701 5,947 246 F

FTE by DirectorateJuly 2015 (including Outsourcing)

Month Year to Date


Financial Performance Trends


Month Result

Major variances for the Provider Arm Statement of Financial Performance (Fig. 1) follow:

Revenue is $(479)k unfavourable for the month of July. The main drivers for the current month’s variance are: • Government Revenue – revenue received on budget. • Patient/Consumer Sourced $(232)k; Lower Non-resident billings for the month $(162)k (offset by bad

debts); Patient Co-Payments $(63)k; other $(7)k. • Other Income $(288)k; The July favourable variance includes Interest received $251k; donation revenue

$(208)k; kA revenue phasing $(120)k; Non-Clinical DHS Benefit target savings mitigated in other areas $(133)k; Integrated Care offset by cost $(86)k; other $8k.

• Funder Payments $26k Variation in revenue phasing from Funder for contracts outside base funding. i.e.: 20k days and localities.

Expenditure – Total expenditure is favourable by $328k. Major variances are explained below:

• Personnel costs Personnel costs are $802k favourable for the month reflecting high vacancies across the organisation in all personnel categories (mainly nursing) that are partially covered by bureau, overtime and casual staff. A favourable annual leave variance (leave taken exceeds leave accrued) during July school holidays due to flat phasing of the budget has contributed to the favourable variance. Note that the Personnel cost variance above includes costs incurred in delivering additional unbudgeted revenue of $94k (fig 6).

• Outsourced Costs are $(271)k unfavourable for July (includes personnel, clinical and other). • Outsourcing to cover key vacancies (eg Mental Health) is offset by outsourced surgical volume

reduction due to contracts not finalised with private providers until end of July. • Clinical Support $(59)k. Additional outsourcing of MRI and CT scans to meet MOH targets. • Medicine, $(64)k. Outsourced gastro colonoscopies required to meet MOH targets. • Surgical, $117k. Outsourced surgical contracts not finalised with private providers. • Mental Health $(162)k. Vacancies covered by locums. • Kidz First and Womens Health $(80)k. Utilisation of external bureau to cover vacancies, skill mix issues

and orientation. • Other $(23)k. • Note that the Outsourced cost variance above includes costs incurred in delivering additional

unbudgeted revenue of $19k (fig 6).

• Clinical Supplies $(377)k unfavourable for the month. • Clinical Support, $(256)k. Blood product overspends due to high cost procedures in July and an

increase in lab volumes testing kits – Microbiology +16%, histology +14%. • ARHOP, $(81)k. Community continence, ostomy and burns garments overspends. • Other $(40)k.

• Other expenses are $174k favourable for July explained mainly by Ko Awatea uncommitted activity $127k;

Integrated Care $57k; Other $(10)k.

• Depreciation, Interest and Capital Charge costs are $88k favourable due to; CMDHB level of borrowings lower than budget delivering a $38k favourable interest cost variance for the month. Depreciation $50k favourable variance due to a reduction in cost based on a review of asset base.


Full Time Equivalents FTE (Fig 4 & 5)

Total FTE (including outsourced) for July is 5,701 which is 246 FTE favourable to budget. Major variances as follows:

• Vacancies net of overtime, internal bureau, outsourced FTE and casual FTE are 144FTE • Funded projects (not in budget) (21)FTE – localities and 20k days projects (ie: cancer care, breast

feeding advocates, KF Gateway project etc). • Net annual leave and other leave 186FTE – staff taking holiday during July school break (leave taken

higher than budget). • Sick and study leave (47)FTE requiring cover. • Other (16)FTE


3.4 Hospital Health Targets Overview Overview of the Hospital - National Health Targets

National Target Target Description July Result

95% of hospital patients who smoke and are seen by a health practitioner in a public hospital are offered brief advice and support to quit smoking

(Unconfirmed) Achieved 95%

95% of patients will be admitted, discharged, or transferred from an emergency department within six hours

Achieved 95.65%

85% of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks by July 2016, increasing to 90% by June 2017

Treatment commenced within 62 Days: ☐ 72%

The volume of elective surgery will be increased by an average of 4,000 dischargers per year.

Achieved 108%


3.5 Human Resources Human Resource metrics are provided to outline performance for Annual Leave Balances, Sick Leave and Turnover rates. Below are the 13 month trend graphs to July 2015 (Sick Leave to June 15).

0%

1%

2%

3%

4%

5%

Sick Leave as Percentage of Total Paid Hours

Sick Leave Sick Leave LY UCL Average LCL

8.0%8.2%8.4%8.6%8.8%9.0%9.2%9.4%9.6%9.8%

Annualised CMDHB Voluntary Turnover

Turnover Turnover LY UCL Average LCL


8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

Percentage of CMDHB Workforce with Annual Leave Balances> 2 Years' Equivalent

> 2 Years > 2 Years LY UCL Average LCL


3.6 Action Item Responses Open actions

Date Item Action Status

17.06.2015 1 Mr Balmer to give some thought as to what other services the committee could visit such as renal.

Response provided below

29.07.2015 2 CMH had employed an additional (47) FTE which were unbudgeted but had been funded externally (additionally). Mr Balmer is to provide a breakdown showing what this FTE is doing and what the outcomes will be (ie) clinical research.


29.07.2015 3 Work is underway on developing an At Risk programme for Child & Youth because there is a whole group that need intervention by a team of people, not just health. Mr Balmer to bring back a package of information on this new programme.


29.07.2015 4 Mr Balmer to track how many babies are born with recognisable disabilities and how do we support them proactively as not all families are aware of the services available to them.


29.07.2015 5 Dr Mathias noted that the Acutes and Elective volumes for children balanced each other out (-16.2% and 16%) – page 96. Ms Cossey undertook to look into the figures to find the answer why and report back.


29.07.2015 6 Ms Kivell undertook to come back to the Committee with the number of male nurses currently employed at CMH.


29.7.2015 7 Train Station entrance modifications – confirm start and finish dates.


1. Service visits Response: Medicine • Renal • Patient Information Services • Radiology - a visit to the existing lab could also be undertaken in the near future, followed by

a visit to the new lab so in order for Committee members to see the improvements made Surgical & Ambulatory Care • General Surgery Wards on level four • Outpatient, Breast, and Colorectal Clinics • Bariatric Education Session • Surgical Assessment Unit • Orthopaedics • Critical Care, and theatres to discuss the Spinal Cord Impairment work • Manukau SuperClinic Middlemore Central


2. Additional 47 FTE Response:

Funded FTE for the month of June 2015

By Directorate Internal

Reallocation New

Money Total ARHOP 9.2 9.2

Beyond 20k bed days 9.2 9.2 Clinical Support 3.8 0.4 4.2

20k Bed Days 3.8 3.8 Pharmacy UoA 0.4 0.4

Kidz First 10.7 0.5 11.2 ASD - Home Care 1.4 1.4 CCREP 0.5 0.5 Mana Kidz 7.53 7.53 Research 1.8 1.8

Medicine 11.4 2.5 13.9 20k Bed Days 4.4 4.4 Cancer Care 1.7 1.7 Education 1.8 1.8 Localities 1.7 1.7 Other 1.8 1.8 Renal 2.5 2.5

Mental Health 5.8 5.8

Youth Forensic Specialist Community Service & Maternal Mental Health Funding 5.8 5.8 Womens Health 2.9 2.9

Breast Feeding Advocates 2.9 2.9 Grand Total 43.8 3.4 47.2

3. At Risk Programme for Child & Youth Response: A specific ARI programme for Child & Youth is not being developed, rather the existing ARI programme will have initiatives focused in these Child and Youth areas. Child Health: Development of the programme to support children with complex health needs. A pilot is currently being worked up with CM Health paediatricians to begin work with a small number of practices with children with bronchiectasis. Complex Households: An initial working group has met to discuss the development of an intersectoral approach to supporting families to build resilience and wellness. Current work focusses on identifying the barriers to access.


4. Babies Born with Disabilities Response: How many children are born with disabilities: Unfortunately there currently is no ‘disability’ database/register available locally, regionally or nationally. The NZ Child and Youth Epi Service (Dr Liz Craig et al) does compile some indicative disability numbers every three years in their ‘The Health of Children and Young People with Chronic Conditions and Disabilities in the Northern DHBs’ report. The last report was issued in 2013, so we expect the next report to be a 2016 report using 2012-15 data but this has not been confirmed as yet.

We can report on some conditions e.g. congenital anomalies from the NZ Births, Deaths, and Marriages register. This register reports everything from minor (e.g. tongue tie) to major (e.g. babies with Down Syndrome, Central Nervous System Malformations) known at birth so search criteria would need to be specific.

For many conditions, such as Cerebral Palsy, the NZ Child and Youth Epi Service has had to use inpatient coding data to develop a national data set and then compare DHBs. The challenge is this data has a high degree of variation and may underestimate/ overestimate the prevalence of conditions that are managed in the outpatient and community setting. There is no national outpatient coding and we do not routinely use our CMH Kidz First outpatient coding to look at ‘disability rates’.

The question of ‘how many children are born with disabilities’ is complex as the majority although genetic/ in utero/ developmental in aetiology, won’t be apparent for months or years.

How do we support them proactively if they have disabilities:

The level of support and services available for babies/children with disabilities varies significantly. For example, for a baby in the Neonatal Unit or under Neonatal Care of the ward, the family will receive support and advice from the Neonatologist, Allied Health, and Social Work, and referrals will be made to services in the community. These community services include Child Development, Outpatient services, support groups, and referral to the Needs Assessment and Service Coordination Service (Taikura).

There is also the definition of ‘disability’ to consider. The Ministry of Health Disability Support Services criterion has very few disability sub-classifications in the first year of life. NASC interprets their guidelines as ‘needs of a baby with disability’ that are not in excess of the care of a normal baby. Issues such as feeding tubes/home oxygen according to NASC are personal health issues and not a disability. It does not matter even if the infant has severe HIE or other Neurological conditions and will progress to spastic quadriplegia. These families get personal health carer support and Family Options until NASC consider this a disability.

5. Acute & Elective Volumes Response: A question was raised regarding the paediatric volumes for the year ended 30 June 2015. The report to June 30 had shown that surgical acute volumes for children had decreased by 16.2% whilst the surgical elective volumes for children had increased by 16%. It was commented that it seemed a strange coincidence that these numbers were so similar.


An updated report from Health Information and Informatics has now confirmed final figures for the year showing a decrease of 17% in acute paediatric WIES and an increase of 21% in elective paediatric WIES as seen in the tables below:

There has been a similar change in the surgical discharges for paediatrics as follows: Year ended 30/6/15: a) Acute discharges 2,088 versus contract 2,157 – a decrease of 3.2%. b) Elective discharges 1,736 versus contract 1,504 – an increase of 15.4% In comparing the year ended 30/6/15 with the previous year, we also note: - A decrease in the length of stay in Kidz First Surgery wards from 2.37 to 2.05 - Occupancy in Kidz First Surgery has remained similar at 89% Feedback from the paediatric surgical teams is that the reduction in acute WIES and discharges is due to the fact that we are seeing fewer children with severe and long term burns and plastic procedures. As a result we have been able to carry out more short stay elective procedures and utilise the freed up theatre and bed capacity to address the increased demand for procedures such as tonsils and adenoids.

% Var To Contract Volume-28%-32%-30%-12%-20%-11%-13%-11%

-9%-8%-1%

-27%-17%

June 133 182Acute Total 1840 2211

April 167 182May 187 188

February 151 170March 171 188

December 168 188January 163 188

October 165 188November 145 182

August 128 188September 127 182

Admit Type Group Fiscal Period Name PUC Volume Contract Volume

Acute

July 136 188

% Var To

Contract Volume

49%24%21%23%49%10%34%

3%-20%

-3%37%24%21%Elective Total 1137 940

May 120 88June 100 81

March 67 84April 77 79

January 82 61February 78 75

November 124 83December 76 69

95 78October 101 82

Elective

July 116 78August 102 82

September

Admit Type Group

Fiscal Period

NamePUC Volume Contract Volume


6. Male Nurses Response: Overall data from the 2015 Workforce report is as follows: The numbers for Nurse/HCA is approximately 390 males to 3015 female staff (headcount of 3407); although this number is changing constantly with the recruitment process, the percentage is fairly consistent. Gender The health profession has always had a very high proportion of females in the workforce and this continues to be true at CM Health with more females than males in all workforce groups except medical. Across CM Health, we have a total split of 77% females to 23% males, which is aligned with the national average of 79% females and 21% males.

GENDER

ALLIED HEALTH

CORPORATE NON-CLINICAL SUPPORT

MEDICAL MIDWIFERY NURSING TECHNICAL

Female 85% 87% 59% 45% 100% 88% 74% Male 15% 13% 41% 55% 0% 12% 26%

Table 13: Workforce by Gender

7. Train Station Entrance Modifications Response: The Galbraith Entrance preliminary and develop design documentation is due for issue. Forecast for construction is 20/10/15 – 29/01/2016.


3.7 Balanced Scorecard Definitions HEALTH ADVISORY COMMITTEE SCORECARD NOTES AND DESCRIPTIONS 1 Total Case weight – DSS – This is the total MOH funded WIES for the month and year to date, from the

front page of the most recent Redbook WIES reporting. 2 Acute Case weight – DSS - This is the total ACUTE MOH funded WIES for the month and year to date,

from the front page of the most recent Redbook WIES reporting. 3

Elective Case weight –DSS - This is the total ELECTIVE MOH funded WIES for the month and year to date, from the front page of the most recent Redbook WIES reporting.

4

Total Discharges –DSS - Total number of patients discharged for the month and year to date, from the front page of the most recent Redbook reporting. There is no target/ funder agreement given for this measure, so last year’s actual is used as the target.

5 removed 6 Budgeted FTE –Finance - FFARs FTE actual and budget by month and YTD, as reported in the Provider

Arm. 7 Operating Costs ($000) – Finance – FFARs actual and budget by month and YTD, as reported in the

Provider Arm. All expenditure less staff/personnel costs plus 8000-xxxxx internal allocations. 8 Personnel Costs ($000) – Finance – FFARs actual & budget by month & YTD, as reported in the Provider

Arm. 9 Financial Result – total $m (negative is contribution) – Finance – FFARs actual and budget by month and

YTD, as reported in the Provider Arm $m. 10 Outpatient FSA Volumes – DSS – The total number of outpatient type of ‘New Patient’ for the month

and year to date. There is no target/ funder agreement for this measure, so last year’s actual is used as the target.

11

Outpatient Follow Up Volumes –DSS – The total number of outpatient type of ‘Follow-up’ for the month and year to date. There is no target/ funder agreement for this measure, last year’s actual is the target.

12 Virtual FSAs –DSS – volumes of outpatient events for PUC codes M00010 Virtual Medical Firsts and S00011 Virtual Surgical Firsts against contract. To show ‘Increase from baseline by 10%’, a baseline to be provided. Currently using the contract for the year.

13 Reduce clinical outsourcing – Finance. Spend on clinical service outsource against budget

14 Accrued Annual Leave (Rate based measures of staff with high annual leave balances within the DHB) HR - Excessive leave is considered to be those employees with an annual leave balance in excess of 2 years’ worth of their current annual entitlement. Factors in FTEs. Numerator: A count of the number of employees with an excessive annual leave balance as defined above. Denominator: A count of the number of employees with an annual leave balance.

15 Staff Turnover (A rate based measure of staff turnover within the DHB) – HR – Numerator: The number of employees who cease employment due to voluntary resignation during the period. Denominator: The total headcount of employees at the beginning of the period.

16 Sick Leave (A rate based measure of paid and unpaid sick leave hours taken by employees within the DHB) –HR - Measure the proportion of DHB employees’ paid and unpaid hours that are lost to sick leave. Provides an indication of relative effectiveness in maintaining healthy staff and managing absenteeism in the DHB. Does not measure all forms of absenteeism. Numerator: The total number of paid and unpaid sick leave hours taken by DHB employees during the reporting period. Denominator: The total number of DHB paid hours during the reporting period.

17 Incidences of days lost due to staff injuries per 1,000,000 hours worked – HR


Measures the proportion of DHB employees who have days lost due to workplace injuries or illness. Injuries or illness associated with the workplace contribute towards lost work hours.

18 Mandatory Training Completed < 3 months:– B Watson - HR This measure is under development 19 Workforce Diversity – HR 20 Patient Safety e-MR within 48hrs per 100 patients –MMC Aligns with monthly patient safety report 21 Patient Safety Rate of patients with hospital acquired pressure injuries per 100 patients – MMC

Aligns with monthly patient safety report 22 Patient Safety Rate of all falls in hospital causing major harm per 1,000 bed days. All inpatients

including satellite facilities such as Franklin Memorial –MMC Aligns with monthly patient safety report 23 Patient Safety Adverse Drug events per 1000 bed days – MM. Aligns with monthly patient safety report 24 Patient Safety Rate of CLAB in patient that had a central line that is not related to an infection at

another site expressed as per 1000 central line days – MMC Aligns with monthly patient safety report 25 Patient Safety Rate of Staph. Aureus Bacteria infection per 1,000 bed days – MMC

Aligns with monthly patient safety report 26 Quality Safety Marker, HQSC. % Operations with all 3 Surgical Safety Checklist complete

A baseline audit completed in Q1, 2013 had CMH at 86% –MMC 27 Patient Safety % patients 75+ years old (55+ years old for Maaori and Pacific) assessed for risk of falling

– Ko Awatea/ Regional Plan 27a Patient Safety % patients assessed for falls who have falls intervention plan – Ko Awatea/ Regional Plan 28 National Health Target. Numerator: number of patient presentations to the Emergency Department

with an Emergency Department length of stay of less than six hours from the time of presentation to the time of admission, transfer and discharge. Denominator: total number of patient presentations to the Emergency Department.

29 Seen by inpatient team <3 hours –DSS - 3 hours rule calculation is based on “If a patient is discharged from EC with a discharge description as "Admit to Ward" and the difference between EC DTTM of Arrival and IP Admit DTTM or if EC DTTM of Arrival to EC Discharge DTTM is >180 M then they fail the 3 hour rule or else they pass . 1 being fail and 0 being pass, No Triage mins logic has been included into this”

30 National Health Target: Percentage of radiotherapy patients receiving treatment within 4 weeks from date of decision to treat. Waiting time for treatment is from date of First Specialist Assessment to the beginning of treatment. The goal is that no one should wait longer than 4 weeks due to reasons of capacity constraint. Patients who wait due to clinical considerations or by their own choice are omitted

31 National Health Target: Percentage of chemotherapy patients receiving treatment within 4 weeks from date of decision to treat. Waiting time for treatment is from date of First Specialist Assessment to the beginning of treatment. The goal is that no one should wait longer than 4 weeks due to reasons of capacity constraint. Patients who wait due to clinical considerations or by their own choice are omitted

32 Medical Assessment Unit - seen by SMO within 4 hours: This measure is being developed 33 MOH Indicator of DHB Performance. 80% of accepted referrals for MRI scans will receive their scan

within than 6 weeks (42 days). Overall patient event numbers (Community and Outpatient Referrals) – including planned patient events; Waiting times (Community and Outpatient Referrals) – excluding planned patient events; Monthly activity and demand (Community and Outpatient Referrals) – excluding planned patient events.

34

MOH Indicator of DHB Performance. 90% of accepted referrals for CT scans will receive their scan within than 6 weeks (42 days). Overall patient event numbers (Community and Outpatient Referrals) – including planned patient events; Waiting times (Community and Outpatient Referrals) – excluding planned patient events; Monthly activity and demand (Community and Outpatient Referrals) – excluding planned patient events.


35 Radiology - Inpatient Radiology times within 24 hours: 36 Radiology - EC radiology times <2 hours :– P Hewitt – Radiology 37 MOH Indicator of DHB Performance. 50% of people accepted for an urgent diagnostic colonoscopy will

receive their procedure within two weeks (14 days) 38

MOH Indicator of DHB Performance. 50% of people accepted for a diagnostic colonoscopy will receive their procedure within 6 weeks (42 days)

39

MOH Indicator of DHB Performance. 50% of people waiting for a surveillance or follow-up colonoscopy will wait no longer than 12 weeks (84 days) beyond the planned date

40

Laboratory - Test turnaround time (TAT) – Labs This measure is being developed

41 Northern Region Target. Proportion of percutaneous coronary interventions (PCIs) carried out within the recommended 90 minute guideline in emergency cardiac care, specifically in the treatment of ST segment elevation myocardial infarction (STEMI). Measure is Door to Balloon, that is, from the arrival of the patient to when they receive a balloon angioplasty (inflation of balloon in a blocked coronary artery)

42

Ministry of Health Elective Service Performance Indicator (ESPI). Number of patients currently waiting longer than five months (150 days) from date of referral for their First Specialist Assessment. ESPI 2.

43

Ministry of Health Elective Service Performance Indicator (ESPI). Number of patients currently waiting longer than 5 months (150 days) for Treatment – elective. ESPI 5.

44 Surgical Acute Priority Score -delay for surgery. Theatre Central MMC [definition to be added] 45 Faster Cancer Treatment – MOH target The maximum target length of time taken for a patient

referred with a high-suspicion of cancer (that is, person presents with clinical features typical of cancer, or has less typical signs and symptoms but the triaging clinician suspects there is a high probability of cancer), to receive their first treatment (or other management) for cancer.

46 Faster Cancer Treatment – MOH target The maximum target length of time a patient should have to wait from date of decision-to-treat to receive their first treatment (or other management) for cancer. The 31 day indicator includes all patients who receive their first cancer treatment, irrespective of how they were initially referred.

47 Radiology % radiology results reported within 24 hours [definition to be added] 48 Mental Health national target, Indicator of DHB Performance. % child/ youth seen by 3 weeks for non-

urgent mental health services – The wait time will be counted from the time the referral is received for a person who has not been seen for at least a year (or not at all) to the time of the first face to face contact with a mental health or addiction professional.

49 a.b.c

Mental Health national Access rates - CMDHB domiciled unique clients seen by MH in preceding 12 months as % of population (0-19years, 20-64years and over 65 years)

50

MOH, Annual Plan Indicator of DHB Performance. ALOS – Acute Inpatient – DSS ALOS for Admit type Acute Inpatients across all services.

51 MOH, Annual Plan Indicator of DHB Performance. ALOS – Elective Surgery– DSS ALOS for Admit type Elective, Arranged and Waiting List Inpatients across all services.

52 Acute Readmissions within 7 days – Total – DSS 53 MOH, Annual Plan Indicator of DHB Performance. Acute Readmissions within 28 days – Total –DSS 54 MOH, Annual Plan Indicator of DHB Performance. Acute Readmissions within 28 days – 75+ years–DSS 55 Annual Plan % EC admissions – 75+ years – DSS 56 Discharge Information % transcribed clinical summaries authorised within 7 days for document created,

that is, authorised to be published in Concerto and sent out to GPs and patients. 57 % patients with Goal Discharge Date (EDD/ CSD) within 24hours of admission:


This measure is being developed 58 Patient outliers (patients admitted to a ward different from that which they are meant to be in. For

example, a medical patient placed in a surgical ward due to the lack of beds) Numerator: patient outliers in ARHOP, Medical and Surgical adult inpatients, excluding EC/ Short Stay. Denominator: occupancy in Medical, Surgical and ARHOP services only.

59 Northern Region Health Plan Target. Eligible stroke patients, that is, only patients with ischaemic stroke.

60 MOH, Indicator of DHB Performance. Hospitalisations of children aged 0 - 4 years old resulting from diseases sensitive to prophylactic or therapeutic interventions that are deliverable in a primary health care setting. The baseline national rate is expressed as 100% and DHB performance is reported against the national rate.

60a MOH, Indicator of DHB Performance. Hospitalisations of people aged 0 - 74 years old resulting from diseases sensitive to prophylactic or therapeutic interventions that are deliverable in a primary health care setting. The baseline national rate is expressed as 100% and DHB performance is reported against the national rate.

61 FSA/Follow up ratio – DSS – Using the OP measures from measure 4, the number of new patients divided by the number of follow-up appointments for the time period. There is no target; the previous year is the variance.

62 Outpatient DNA rates – Maaori –– DSS – All DNA’s for all hospitals for Maaori ethnicity divided by all outpatient appointments at all hospitals for Maaori ethnicity patients.

62a Outpatient DNA rates – Pacific – DSS – All DNA’s for all hospitals for Pacific ethnicity divided by all outpatient appointments at all hospitals for Pacific ethnicity patients.

63 MOH, Annual Plan Indicator of DHB Performance Theatre List Utilisation – DSS – from Report Manager Actual operating minutes vs. resourced operating minutes for all CMDHB theatres. https://nthreports.healthcare.huarahi.health.govt.nz/Reports/Pages/SearchResults.aspx?SearchText=theatre%20utilisation&ViewMode=List

64 Theatre Session Utilisation – DSS – also from reporting manager, 65 MOH, Annual Plan Indicator of DHB Performance Day of Surgery Admissions (DOSA) – DSS –

Percentage of all elective discharges (excluding day surgery) where the surgical procedures take place on the day of admission.

66 MOH, Annual Plan Indicator of DHB Performance Day Case Rate (Elective/Arranged) –DSS – Percentage of all elective discharges that have the same admission and discharge date.

67 removed 68 % MAU patients with LOS <28 hours – DSS – the time a patient spent in MSSU/SSMED during stay in EC 69 % Community NASC referrals via e-referrals and assessed within 48hours. (Part of e-referral project).

This measure is being developed, 70 % patients discharged and with District Nursing / Home Help within 24hours

This measure is being developed, 71 % FSA Referrals received electronically - This is a part of Regional e-referral project.

Baseline data is currently being collected 72 Nursing Hours per patient days: MMC. This measure is being developed as part of the McKesson 73 Hospital beds occupied – DSS – number of inpatient bed days for the month and year to date.

Target for month does not include Neonates and Critical Care as no forecast capacity 74 LOS outliers – DSS – count of encounters with a LOS >10 days, excluding burns, spinal, long stay psych

and long stay geriatrics. 75 National HQSC MCC - patient experience survey which all DHBs are expected to implement in 2014/15. 76 MOH, Annual Plan Indicator of DHB Performance - Kidz First/ Women's Health - Infants who are

https://nthreports.healthcare.huarahi.health.govt.nz/Reports/Pages/SearchResults.aspx?SearchText=theatre%20utilisation&ViewMode=List

https://nthreports.healthcare.huarahi.health.govt.nz/Reports/Pages/SearchResults.aspx?SearchText=theatre%20utilisation&ViewMode=List


exclusively breastfed upon discharge from Middlemore Baby Friendly Hospital Initiative Maternity facilities only. Excludes the three primary maternity units.

77 National health target. SmokeFree team - Percentage of identified smokers who have been identified through diagnostic coding as having received advice to quit.


3.8 Mental Health

Service Overview

Mental Health is managed by General Manager Tess Ahern, with Clinical Director Peter Watson and Clinical Nurse Director Anne Brebner.

Performance

Activity Summary

Note – Actual Bed days exceeding the target is shown as negative as this implies over-crowding. The budget is 85% occupancy rate of the available beds.

Highlights

Whole of System integration The Whole of System integration co-design phase, which is focussed on gathering experiences and ideas from a locality and cultural focus, is nearing completion. In addition to hearing feedback about the current system and what is working well or not working well, we have extended the conversations to encourage ‘greenfield thinking’ – asking stakeholders to consider how they would design a mental health and addictions system to best meet our populations’ needs. The greenfield discussions ask stakeholders to consider a future state without being constrained by consideration of existing approaches to service delivery and system design.

To date (end of July) there have been 25 co-design and greenfield sessions, engaging with almost 350 stakeholders ranging from service users, family/whaanau, primary and community care providers, NGOs, and secondary/specialist services. Ideas emerging from the co-design discussions have included:

• a shared suite or hub of services based within each community, utilising shared I.T; • clear information and support about how to navigate the system, enabling people to get

what they need; • ensuring that the system was based on a strong understanding of the needs of the different

populations within Counties Manukau; • creating and maintaining a system where relationships between providers is key; • user-driven and individualised, with information choice for service users; • interventions and activity that makes a real difference; and • creating a system where mental health and addition is at the core, alongside physical health

needs.

The remaining co-design and greenfield sessions will be completed in August. The ideas and feedback will be a key element of working towards an implementation plan by December 2015.

Volumes

ActBud /

Contract Var % var ActBud /

Contract Var % var

INPATIENT Bed daysTiaho Mai 1,499 1,326 -173 -13% 18,011 16,133 -1,878 -12%

Tamaki Oranga 582 540 -42 -8% 6,538 6,570 32 0%

Koropiko - MHSOP 370 383 13 3% 4,907 4,654 -253 -5%Service Access No. of unique CMDHB domiciled clients seen over 12 months

19,143 16,041 3,102 19% N/A N/A N/A

Mental Health Volumes (Bed days and Service Access)June '15 Year to date


Acute Pathway Update On 11 August it will be the first anniversary of the reconfiguration of the adult acute services that saw the development of the Intake and Acute Assessment and Home Based Treatment (HBT) Services. This service reconfiguration is being evaluated. During the week of 20 – 24 July a representative from the evaluation team interviewed several staff members from across the HBT and Intake services; however, not all of the interviews were able to be completed and the final meetings are due to occur in August.

The first year of operation has seen a refinement of the use of tools such as the electronic whiteboard. The Clinical Team Co-Coordinators’ have worked very hard to embed the new processes and some adjustments have been made as time has progressed. The Acute Adult Services have developed and implemented a capacity management tool which was endorsed by the Clinical Governance group on 16 July. The tool will be published in Objective. The daily communication plan has been extended into the weekends with a video conference occurring at 8.30am on Saturday and Sunday mornings (commenced on 25 and 26 July). The video conference meeting links up the community acute services with the inpatient unit and EC, and facilitates planning for the day across the continuum. The primary objective of the capacity management tool is to ensure that all parts of the acute service have capacity to respond. It promotes early identification of stress points to facilitate active planning. It is based on the Middlemore Central Capacity Planning Tool but has been modified to fit Mental Health Services.

Acute Mental Health Inpatient Unit Detailed Business Case Update The Concept Design phase is being finalised and identified caveats will be documented. Joanne Evans (Integrated Project Management) has been contracted by Facilities to undertake the SIM role for this project and will focus on the decant facilities requirements. Clinical services have identified potential alternative spaces for those that will be lost during the decanting phase of the project and that will not be accommodated within the Ward 22 option.

The Developed Design phase of planning is now underway with the reference groups providing feedback on each room. The reference groups are Pacific, Māori, Service User, Family/Whanaau and Clinical Services. Each of the reference groups have an identified lead and the leads meet with the Service Manager and Capital Project Co-Ordinator to ensure the feedback is occurring within the required timeframes. There is very good engagement with the reference groups and this process seems to be effective. Other stakeholders (such as Pharmacy) are consulted with as appropriate.

Psychiatric Liaison Team and Psychology in Physical Health review The review report by Dr Charles Hornabrook and Dr Jo Soldan was presented in April. A steering group has been established and is meeting regularly to consider and implement the recommendations of the review.

The chosen methodology is to establish working parties to map current and future patient pathways by early September. This will be followed by the development of a model of care, and then the development of a proposal for change. It is anticipated that the implementation phase will be next year.

The steering group has determined four streams of people receiving services from psychiatric liaison and/or psychology at CMH:

• People who present to the EC department with an acute psychiatric issue • People who are admitted to general hospital wards for medical or surgical conditions with

additional known or suspected mental disorders • People who are admitted to general hospital wards for medical or surgical conditions where

it is recognized that they have psychological or adjustment issues impacting on their health outcomes (these may also be outpatients)


• People who are admitted to general hospital wards or being seen or referred to outpatients where a significant cognitive impairment is suspected

The communication strategy includes monthly updates with the stake holders. Stakeholders have also been invited and are participating in the working groups.

Keyworker Review The first phase of the Keyworker review is now complete with the release of the final Decision Document to staff, unions, and primary care colleagues. Lasting for 11 months, this phase has focussed on comprehensive consultation processes involving direct or survey feedback from over 300 staff and service users, and 43 primary care staff. This was a pleasing level of engagement indicating a high degree of interest and positive morale around the review.

The next phase will involve implementation of the Decision Document led by a new implementation steering group. The focus will be on adoption of the revised job descriptions and the recommendations over the coming months. It is hoped that implementation of the new job descriptions will be in November. A ‘lessons learned’ report will be provided from the first phase to inform the second phase as well as other mental health initiatives.


Scorecard

Service Scorecard

Mental Health SCORECARD

July 2015


Def

Jul-15 Target Var Actual Target VarMedical staff locum Costs (in $000s) $164 $144 -$20 $164 $144 20-$ Overtime costs(in $000s) $151 $86 65-$ $151 $86 65-$

Jul-15 Target Var Actual Target Var% Staff with Annual Leave > 2 years 9.4% 5.0% -4.4% 8.7% 5% -3.7% 14

% Staff Turnover 9.8% 2.0% -7.8% 10.1% 10% -0.1% 15

% Sick Leave 3.8% 2.8% -1.0% 3.4% 2.8% -0.6% 16

Workplace Injury Per 1,000,000 hours 0 10.50 10.50 3.75 10.50 6.75 17


Jul-15 Target Var Actual Target VarNo. of Seclusion events - (Rolling 12 months in development) 172 125 -47

Jul-15 Target Var Actual Target VarShorter wait times for non urgent mental health and addiction Services (%< 3week wait)

0-19 years 78.26% 80% -1.74% 48

20-64 years 87.70% 80% 7.70%65+ years 90.20% 80% 10.20%

overall 84.39% 80% 4.39%

Jul-15 Target Var Actual Target VarMental Health Access rate - unique clients seen by all MH services ((PRIMHD reporting services include AoD and NGO services) 12 months as a % of population

0-19 years 3.62% 3.15% 0.47% ~ 49a

20-64 years 3.88% 3.15% 0.73% ~ 49b

65+ years 2.55% 2.70% -0.15% ~ 49c

Readmissions within 28 days - Total 9.62% 12.00% 2.38% 9.62% 12.00% 2.38%

Jul-15 Target Var Actual Target VarOccupancy - Tiaho Mai acute mental health unit target is <85% 96.8% 85% 11.8% 96.8% 85% 11.8%No of Patient LOS (Tiaho Mai inpatient) < 5 days 12 tbc 12 tbc

Jul-15 Target Var Actual Target VarPP7-Relapse Prevention Plan - Maaori 96.7% 95.0% 1.7% 96.7% 95% 1.70%PP7-Relapse Prevention Plan - Pacific 93.3% 95.0% -1.7% 93.3% 95% -1.7%

BETTER HEALTH OUTCOMES FOR ALL

Jul-15 Target Var Actual Target VarAccess rate - No. CM domiciled unique clients seen by MH services (PRIMHD) 12 months as a % of population - Maori 7.07% 6.0% 1.07%

~Access rate - No. CM domiciled unique clients seen by all MH services (PRIMHD) 12 months as a % of population - Total 3.66% 3.1% 0.56%

~

Ensu

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Fina

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Enab

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High

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12 month average

Year to date

Tim

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Year to date

Equi

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Year

Effic

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Year

Year

Patie

nt

Wha

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Ce

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re

Firs

t, Do

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(Saf

ety) Year to date

Syst

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ive)


Scorecard Commentary

Medical Locum cost There has been an increase in locum costs as a result of extra shifts being covered to fill gaps on the registrar roster

Overtime costs There has been a gradual reduction in overtime costs as vacancies have been filled in Intake and Assessment and HBT. Overtime in Tiaho Mai and Tamaki Oranga has been utilised to support management of ongoing high occupancy and sick leave cover.

0-19 Waiting time – Three weeks There has been a real focus on improving the percentage of young people seen within three weeks of referral and there is ongoing improvement to meet the 80% target. At the same time there has been an increase in the number of young people accessing the service with 277 more being seen over and above the MoH target.


Financial Results

Statement of financial performance

Actual Budget Var Var % Actual Budget Var Var %REVENUE

6 3 2 70% Government Revenue 6 3 2 70%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%6 77 (71) (92)% Other Income 6 77 (71) (92)%

31 0 31 0% Funder Payments 31 0 31 0%42 80 (37) (47)% Total Revenue 42 80 (37) (47)%

EXPENDITURE5,116 5,337 221 4% Staff Costs 5,116 5,337 221 4%

192 30 (162) (538)% Outsourced Costs 192 30 (162) (538)%13 16 3 16% Clinical Costs 13 16 3 16%

208 215 8 3% Infrastructure Costs 208 215 8 3%28 33 4 (13)% Internal Allocations 28 33 4 (13)%

5,558 5,631 73 1% Total Expenditure 5,558 5,631 73 1%(5,515) (5,551) 36 1% Net Result (5,515) (5,551) 36 1%

FTE60 81 22 27% Medical 60 81 22 27%

305 325 20 6% Nursing 305 325 20 6%196 223 28 12% Allied Health 196 223 28 12%

55 58 3 5% Management/Admin 55 58 3 5%616 688 72 10% FTE Total 616 688 72 10%

STATEMENT OF FINANCIAL PERFORMANCE - MENTAL HEALTH

Month to Date Year to Date

($000's) ($000's)

Jul-15

-5,800

-5,750

-5,700

-5,650

-5,600

-5,550

-5,500

-5,450

-5,400

-5,350

-5,300

-5,250

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

100

200

300

400

500

600

700

800

Mon

thly

resu

lt $0

00's

Monthly Operating Costs

Result Budget

4,700

4,800

4,900

5,000

5,100

5,200

5,300

5,400

5,500

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

* Jun14 - outsourcing $270k unfav -locum medical staff; YTD allocation of vehicle transfer costs $170k unfav


Commentary on major financial variances

Quality

Safety

Mental Health Acute 28 day Readmission rates and Use of Seclusion - Refer to BSC

Timeliness

Waiting times for non-urgent mental health and addiction Services - Refer to BSC

Efficiency

Mental Health Acute Inpatient services –Tiaho Mai Occupancy remains high; there were 79 admissions and 79 discharges in July. Unfortunately there were ten instances where individuals were bought to the unit “over capacity” in July as compared with seven in June. The longest wait time for a bed was 24 hours and the shortest wait time was one hour 12 minutes. Of the “over census” numbers, four were from The Cottage, three from ICT, two from Manukau, and one from Awhinatia.

Month YTD

Total Variance: $36 $36

Revenue: $(37) $(37)

Salaries & Wages: $221 $221

Outsourced: $(162) $(162)

Clinical Supplies: $3 $3

Infra-Structure: $8 $8

Internal Allocations: $4 $4

Locum Medical staff $(164)k for the month and YTD partly off-set by the favourable variance in Medical Staff salaries ($106k)

STATEMENT OF FINANCIAL PERFORMANCE - MENTAL HEALTHJul-15

Acute demand management costs remain high in July this has been off-set by vacancies in the community. The vacancies have resulted in underspends in community Nursing of $50k and Allied Health of $84k for the month and YTD

Medical staff is underspent by $106k for the month and YTD . There is a national shortage of psychiatrists and therefore locums, mainly from overseas are contracted to provide services (refer outsourced services below).Underspend in community Nursing of $50k and Allied Health of $84k for the month and YTD.

Year end Forecast variance to Budget $0


Average Length of Stay – Tiaho Mai The average length of stay slightly reduced in July following the sharp increase in June that related to complexity and comorbidity rather than acuity. A higher number of service users with complex needs such as a serious mental illness and medical and intellectual disabilities complicated by psychosocial issues were admitted than usual. The length of stay for these people is longer because it takes longer to stabilise the syndrome (rather than one illness) and often accommodation and community supports take some time to organise.

Mental Health Services for Older People (MHSOP) Occupancy has reduced in July and is currently sitting at 75% which is the lowest that it has been in the past two years. This is in alignment with a reduced referral rate to the community teams. This is highly unusual and it is not known what the factors are that has led to either the reduction in referral rates or admission rates.

70%

80%

90%

100%

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

Occupancy of Tiaho Mai Target Range 2013/14 2014/15

0

5

10

15

20

25

30


Average Length of Stay - Tiaho Mai Target Range 2013/14 2014/15


Effectiveness

Adult Community Service: Seven Day Post Discharge Contact Currently the number of clients seen within seven days of discharge from the inpatient unit (not including day of discharge) is 88%. We expect this number to slightly increase once we are able to count the end of month discharges that were seen in early August. Last month we achieved 96% and we expect to be close to that figure.

70%

80%

90%

100%


Occupancy of Koropiko Ward Target Range 2013/14 2014/15

70%

80%

90%

100%


PostDischarge Contact This Team/Service

2013/14 2014/15 Target


Child and Youth Service: Clients not seen last 90 days Steady progress has been made towards decreasing the number of clients not seen within 90 days. The service set the target of 95% of clients to be seen within 90 days. The service now has 1,532 open referrals, 56 of these have not been seen, this equates to 96.36% of open referrals having been seen within 90 days. The data issues relating to the provision of reports that track clients who have not been seen has been rectified. Staff are working together more effectively to match demand and capacity. The service is committed to continue to reduce the number of clients reported as not being seen within 90 days.

Patient and Whaanau Centred Care

Cassandra Laskey (Professional Leader Consumer and Family/Whaanau Centred Care, Mental Health Services, CMH) was invited to present learnings from the CMH Mental Health Service Development with our Australian counterparts in July. At the request of Mission Australia and Mid-North NSW Mental Health and Wellbeing Services, Ms Laskey provided a number of presentations and facilitated discussion groups in Sydney and the Mid-North NSW district. The visit was organised and hosted by Mission Australia and well-attended by groups and individuals totalling around 120 attendees over the week - varying from ministerial, national and state-wide leadership to local level frontline staff, service users, and family/carer representatives.

In addition to the learnings from the almost ten years of CMH Peer Support workforce development, there was much interest in the establishment of the Integrated MH&A Leadership Group; the localities integration agenda and co-design consultation; funding streams and management of the CHAMP, Te Arawhiriwhiri and AOD Collaboratives and the DRIVE consumer network.

There was a considerable engagement around some similar challenges experienced in NSW with establishing and growing the peer workforce, defining the agenda and action plans for collaboratives, and integration of the primary care business model with a public health model to enable seamless access and appropriate service delivery. This is sure to be an on-going conversation and collegial relationship with the NSW Mid-North district.


3.9 Women’s Health and Kidz First

Service Overview

Kidz First and Women’s Health is managed by General Manager Nettie Knetsch, with Clinical Director (Kidz First) Dr Wendy Walker, Clinical Director (Women’s Health) Dr Sarah Tout, Director of Midwifery Thelma Thompson, and Clinical Nurse Director Michelle Nicholson-Burr.

Performance

Kidz First Activity Summary

*Contract figures for WIES and outpatients are based on 2014-2015 volume, not agreed 2015-2016 volume

Volumes

ActBud /

Contract Var % var

INPATIENT (WIES)Kidz First EC 80 83 -3 -3.6%Paed Medicine 403 350 53 15.1%Paed ICU 2 5 -3 -60.0%NNU - Unit 268 218 50 22.9%NNU Womens health 114 54 60 111.1%Kidz First Surgical - acute 118 188 -70 -37.2%Kidz First Surgical - Elective 73 78 -5 -6.4%Total Kidz First WIES 1,058 976 82 8.4%INPATIENT (CASES)Kidz First EC 285 329 -44 -13.4%Paed Medicine 647 637 10 1.6%Paed ICU 4 4 0 0.0%NNU - Unit 73 73 0 0.0%NNU Womens health 271 102 169 165.7%Kidz First Surgical - acute 147 145 2 1.4%Kidz First Surgical - elective 119 165 -46 -27.9%Total Kidz First CASES 1,546 1,455 91 6.3%EC AttendancesEC Attendances 2,588 2,575 13 0.5%OUTPATIENTSFSA's 139 171 -32 -18.7%Follow-ups 242 282 -40 -14.2%Chart Reviews (Doc) one mo in arrear

49 92 -43 -46.7%

Nurse-led clinic (CNS clinic follow up)

42 58 -16 -27.6%

Virtual FSA 59 53 6 11.3%Total Kidz First Outpatients 531 656 -125 -19.1%

Contract = Last year actuals

Jul-15Kidz First Volumes (WIES and CASES)


Women’s Health Activity Summary

*Contract figures for WIES and outpatients are based on 2014-2015 volume, not agreed 2015-2016 volume

Volumes

ActBud /

Contract Var % var

INPATIENT (WIES)WH Gynae - acute 129 125 4 3%WH Gynae - elective 131 173 -42 -24%

Inpatient maternity care primary maternity facility (W02020)

N/A N/A #VALUE! #VALUE!

WH secondary (W10001) 556 503 53 11%Total Women's Health WIES 816 801 15 2%Births/ DeliveriesBotany M 22 30 -8 -27%Papakura M 22 30 -8 -27%Pukekohe M 24 16 8 50%Total Community Units 68 76 -8 -11%MMH 565 552 13 2%Total 633 628 5 1%INPATIENT (CASES)WH Gynae - acute 242 214 28 13%WH Gynae - elective (private) 0 0 0 #DIV/0!WH Gynae - elective 135 130 5 4%Total WH CASES 377 344 33 10%OUTPATIENTSGynae FSA's 202 294 -92 -31%Gynae Follow-ups 252 267 -15 -6%Gynae Virtual 24 6 18 300%Nurse-led clinic 81 87 -6 -7%Urodynamics 10 15 -5 -33%Obstetric Outpatient 1st S/B Doctors

259 285 -26 -9%

Obstetric Outpatient F/U S/B Doctors

279 329 -50 -15%

Colposcopy 149 213 -64 -30%Colposcopy HC 14 23 -9 -38%Colposcopy HC in OT 8 7 1 13%Gynae HC 37 65 -28 -43%Total WH Outpatients 1,315 1,591 -276 -17%

Women's HealthVolumes (WIES and CASES)Jul-15




Highlights

In July 2015 there were 565 births at MMH and 68 at the three community units, a total of 633 births for the month. The month of July had five more births than July 2014.

Target figures used for WIES and outpatient volumes for July 2015 scorecard are 2014-2015 contracted volume figures not 2015-2016 agreed contracted figures. The Casemix team is planning to implement 2015-2016 agreed contracted figures from August 2015 reporting. We will provide comments on variances in the August report.

Acute discharges are up by 28 and electives are up by five. Gynaecology is meeting the four months waiting time for FSAs as well as the time to procedure. As Gynaecology procedures are now increasingly occurring in the Outpatient setting we have decreased the elective WIES for the 15/16 year to reflect that change.

Although the discharge volume from Kidz First Neonatal Unit is similar to July 2014, the acuity in the Unit was much higher which is reflected in the length of stay for the month and the provisional WIES data. WIES is expected to be 50 more than last July 2014 and ALOS for NNU babies in July 2015 was 17.3 versus 9.2 in 2014.

Kidz First Inpatients saw the start of winter with similar volumes to winter 2014 which is still the highest since 2002. Emergency Care presentations were up by 13 for the month and that number is the highest since 2002 as well.

Outpatient volumes across Kidz First and Women’s Health are lower partially due to the agreed volumes not being populated as yet but also due to high annual leave hours taken during the school holidays as part of our annual leave planning and an unexpected high DNA rate in Kidz First Outpatients in July 2015 (13% vs 8% last year for FSAs).

Both Kidz First and Women’s Health completed their Quality Frameworks for the 15/16 year and these have been circulated to the teams.

Two articles were provided for the 2014/15 CMH Quality Accounts, one from Kidz first on Hypoxic Ischaemic Encephalopathy identifying the total number of babies admitted to the neonatal unit at Middlemore Hospital with hypoxic ischaemic encephalopathy (HIE) peaked in 2012 at 16 cases then declined significantly over the last two years with only four babies admitted with HIE in 2014. All of these four babies were over 36weeks gestation and were cooled.

The second article from Women’s Health showcased Maternity Services as the first service at CMH to go onto an electronic health record. This article discussed that by the end of June 2015 over 600

500

550

600

650

700

750

# of Births


health professionals have been trained, that 2,785 women were recorded in the system by the end of June, and that it is expected that by November 2015 all maternity women will have an electronic record for their booking and registration, labour and birth, and inpatient postnatal period.

Emerging Issues • Our Decision Support team has upgraded to their new Casemix and costing system. A new

set of reports were published since March 2015. Although the formats of the reports are similar, the presentations and how the data is categorised on the new report sets are very different from previous reports. Therefore, some data is no longer available since March 2015. We continue to work with the Decision Support team on clarification and troubleshooting the variance in volumes on the reports.

• Number of births for women in the MCIS increased significantly in July 2015. With the increasing number of women in the system and hence increasing number of women requiring secondary obstetric care, we continue to encounter new issues with the structure and layout of clinical information, particularly for the SMO group. Weekly user meetings continue with particular focus on the information flow for medical teams. CMH continues to take a leadership role in the development and implementation of the MCIS for the region and indeed the country. We are still awaiting the sign off of the national contract between MoH and Clevermed (Vendor of MCIS/BadgerNet).


Scorecards

Kidz First Scorecard

July 2015


Jul-15 Target Var. Actual Target Var.% Staff with Annual Leave > 2 years 20.9% 5% -15.9% 14.2% 5% -9.2% 12

% Staff Turnover 11.9% 2% -9.9% 15.6% 10.0% -5.6% 13

% Sick leave 3.3% 3% -0.3% 2.9% 3.0% 0.1% 14

Workplace injury per 1,000,000 hours 0 10.50 10.50 0.00 10.50 10.50 15

Mandatory training completed <3months U/DJul-15 Target Var. Actual Target Var.

Nursing Sick leave hours taken in FTEs (inc unpaid sick) - onestaff 6.23 7.98 1.75Performance reviews completed - onestaff 56% 57% -1.0%Study (both internal & external) leave taken FTE RN - onestaff 2.67 3.16 0.49

Quarterly REPORTING Jul-15 June-14 Var. Actual Target Var.% of 12 hour shifts Quarterly KF Surg only 0% 28% 28% ~ 0% of 12 hour shifts Quarterly KF Medg only 2% 26% 24% ~ 0


Jul-15 Target Var. Actual Target Var.Neonatal Rate of medication errors/1000 bed days 2.0% 5.0 4.98 ~ 0.00 20

Neonatal Care CLAB rate per 1000 line days 0.0% 0.0 0.0 ~ 0.00 21

CLAB insertion bundle compliance - NNU 100.0%CLAB prevention maintenance bundle compliance- NNU 92.0%Emergency trolley checks (compliance with checking) 88% 100% -12% ~ 100%Hand hygiene (compliance with checking) 92% 100% -8% ~ 100%Medication Chart 0% 0% 0%Documentation 0% 0% 0%Recognising and responding to clinical deterioration 0% 0% 0%Safe sleep - audits completed (tbc) 98% N/A ~ N/AFamily Violence Prevention # staff trained 2 TBC 2Health & Safety audit (Bi monthly) NA 100% 1.00 1.00

Jul-15 Target Var. Actual Target Var.ED 6 hour target - National Health target (Kidz First EC) 97% 95% 2% 95% -95% 41

ESPI 2 - No. waiting >4 months for FSA - Elective 0 0 0 0 0 41

ESPI 5 - No. waiting > 4 months for treatment - Elective 0 0 0 0 0 42

Jul-15 Target Var. Actual Target Var.NBHS number babies screened prior to discharge from hospital sites 84% 90% -6%NBHS number babies screened @ 12 weeks from birth 98% 95% 3%

Jul-15 Target Var. Actual Target Var.% transcribed clinic letters authorised >7 days of created 84.6% 75.0% 9.6% 83% 54

Readmission Rate (KF med) within 7 days 6.0% 7.0% 1.0% 0.0%Readmission Rate (KF med) within 7 days (Maaori) 7.0% 7.0% 0.0% 0.0%Readmission Rate (KF med) within 7 days (Pacific) 6.0% 7.0% 1.0% 0.0%

Readmission Rate (Level 1,2, 3) within 28 days (one month in arrear ) 7.7% 13.6% 5.9% 0.0%Readmission Rate (all Neonates) within 28 days (one month in arrear ) 3.9% 7.0% 3.1% 0.0%Admission Rate Babies in the first year of life (Total) 21% 20% -1.0% 0.0%

Admission Rate Babies in the first year of life (Maaori) 27% 23% -4.0% 0.0%Admission Rate Babies in the first year of life (Pacific) 27% 25% -2.0% 0.0%

ALOS (raw) - Kidz First - Surgical - Surgical Floor 2.0 2.6 0.6 0.0ALOS (raw)- Kidz First Medicine - KF Wards 2.7 3.2 0.5 0.0ALOS (raw)- Kidz First Medicine - EC Short Stay (hrs) 4.6 7.4 2.8 0.0ALOS (raw) - Kidz First - Neonatal Unit discharge only - - investigating data integrity 17.3 9.2 -8.1 0.0ALOS (raw)- Kidz First - Neonates including WH - - investigating data integrity 4.8 5.4 0.6 0.0

Year to date

KIDZ FIRST SCORECARD

Year

Year to date

Firs

t, Do

No

Harm

(Saf

ety)

Year to date

12 month average

Tim

ely

Year

Enab

ling

High

Per

form

ing

Peop

leSy

stem

Inte

grat

ion

(Eff

ectiv

e)

QUARTERLY REPORTING

data not available


Kidz First Scorecard Commentary

Other than the very high occupancy in the Neonatal Unit no significant variances were observed in the month of July. Neonatal Unit is resourced for 92% of 28 cots which is 26 cots. In July we averaged 28 cots per day resulting in the occupancy of 114%. The actual physical capacity of the Neonatal Unit is 38 cots so from a physical space perspective we can accommodate higher volumes. However, the staffing required for increased volumes remains challenging as the acuity and nursing requirements for these babies fluctuate from day to day.

July 2015KIDZ FIRST SCORECARD

Jul-15 Target Var. Actual Target Var.Outpatient DNA - FSA 13.0% 8.0% -5.0% 0.0%Outpatient DNA - Follow up 12.0% 15.0% 3.0% 0.0%Outpatient DNA - Maaori 16.0% <10% <10%Outpatient DNA - Pacific 18.0% <10% <10%Nurse Hours per Patient Day - KF Med 5.24 6.84 1.60 0.00Nurse Hours per Patient Day - KF Surg 4.84 4.6 -0.24 0.00Nurse Hours per Patient Day- Neonatal 9.86 12.54 2.68 0.00% Resourced Occupancy - Kidz First Medical (against 14/15) 90.0% 84.6% -5.4% 0.0%% Resourced Occupancy - Kidz First Surgical (against 14/15) 73.0% 71.7% -1.3% 0.0%% Resourced Occupancy- Neonatal (against 14/15) 114.0% 93.7% -20.3% 0.0%

Jul-15 Target Var. Actual Target Var.Patient Experience Survey results (Excellent, very good and good) 100% 90% 10% 100% 90% -10.0%


Jul-15 Target Var. Actual Target Var.Percentage of 'eligible' inpatients are referred to AWHI 89.0% 100.0% 11.0%

Year

n = 2 Year to date (n =2 )

Year

Equi

tyPa

tient

W

haan

au

Effic

ient


Women’s Health Scorecard

July 2015


Jul-15 Target Var. Actual Target Var.% Staff with Annual Leave > 2 years 20.1% 5.0% -15% 20.1% 5.0% -15.1% 12

% Staff Turnover 8.4% 2.0% -6% 6.8% 10.0% 3.2% 13

% Sick leave 3.7% 2.8% -1% 2.9% 2.8% -0.1% 14

Workplace injury per 1,000,000 hours 0.0% 10.50 10.50 5.33 10.50 5.17 15

Mandatory training completed <3monthsJul-15 Target Var. Actual Target Var.

Sick leave hrs. taken FTEs Nursing/Midwifery inc unpaid 8.72 8.13 -0.59 Study leave hours taken FTEs in Nursing/Midwifery 6.87 5.52 -1.35 Orientation hours taken FTEs in Nursing / Midwifery 4.40 2.85 -1.55 Performance reviews completed per annum 57% 79% -22%

Quarterly REPORTING Jul-15 June-14 Var. Actual Target Var.% of 12 hour shifts - - GCU 1% 0%% of 12 hour shifts - - Botany Maternity 1% 0%% of 12 hour shifts - - Papakura Maternity 37% 33%% of 12 hour shifts - - Pukekohe Maternity 17% 18%


Jul-15 Target Var. Actual Target Var.Emergency trolley checks (days checked) 86% 100% -14% naHand hygiene (compliance with checks) 87% 100% ~ 100%Medication Chart 0% 0% 0%Documentation 0% 0% 0%Recognising and responding to clinical deterioration 0% 0% 0%Safe Sleep audits completed (tbc) NA na naFamily Violence Prevention # staff trained 22 TBC 2Health & Safety audit (bi-monthly) NA 100% #VALUE! 1.00Total Caesarean Percentage 25.8% 23.9% -1.87% 0.0%

Caesarean - elective number 74 58 85 0 Caesarean - acute number 89 92 -3 0

Instrumental Deliveries 39 38 1Inductions of labour % (one month in arrear) 29% 24% -5% 28% 23% -5%Inductions of labour - number compared to last year (one month in arrear) 138 153 15 1704 1705 1

# of Women in Diabetes in Pregnancy

# of Women receiving Ferinject

Jul-15 Target Var. Actual Target Var.ED 6 hour target - National Health target (Gynae) 92% 95% -3% 0% 41

ESPI 2 - No. waiting >4 months for FSA - Elective 0 0 0 0 0 41

ESPI 5 - No. waiting > 4 months for treatment - Elective 0 0.00 0 0.00 0 42

Jul-15 Target Var. Actual Target Var.% transcribed clinic letters authorised <7 days created 85.2% 95.0% -9.80% 88.4% 54

Average Length of Stay Gynaecology - MMH 1.57 1.71 0.14 0.00Average Length of StayGynaecology - MSC Inpatients 0.69 0.74 0.05 0.00Average Length of Stay Obstetric (DHB Mat) (1 mo in arrear) 2.09 2.28 0.19 2.20 2.31 0.11Average Length of Stay Obstetric (Ind. Mat) (1 mo in arrear) 2.10 2.33 0.23 2.20 2.33 0.13Average Length of Stay Vaginal Deliveries overall 1.93 1.87 -0.06 0.00

Maaori - 1st time mothers 2.26 2.73 0.47 0.00Pacific - 1st time mothers 2.07 2.37 0.30 0.00

WOMEN'S HEALTH SCORECARD

Firs

t, Do

No

Harm

(Saf

ety)

Tim

ely

Syst

em In

tegr

atio

n (E

ffec

tive) Year to date

Year to date

Year

Enab

ling

High

Per

form

ing

Peop

le

12 month average

Year to date

data not available

no data available


Women’s Health Scorecard Commentary

Some of the data for July is not available due to the change-over to BadgerNet and reports still being set up, as well as waiting for the roll-out of the Care Compass for Women’s Health which will report on the safety measures much more accurately.

July 2015

WOMEN'S HEALTH SCORECARD

Jul-15 Target Var. Actual Target Var.FSA / FUP ratio - Gynae 1:1.46 1:1.1 ~ ~DNA - Midwifery Antenatal clinics - First 14% 17% 3% 0%DNA - Midwifery Antenatal clinic - Follow up 15% 17% 2% 0%DNA - Doctor Antenatal clinics- FSA 12% 9% -3% 0%DNA - Doctor Antenatal clinics - Follow up 16% 13% -3% 0%

Outpatient DNA - Maaori (Gynae) 13% 10% -3% 10% 10%Outpatient DNA - Pacific (Gynae) 12% 10% -2% 10% 10%Outpatient DNA - Maaori (Obst) 26% 10% -16% 10% 10%Outpatient DNA - Pacific (Obst) 18% 10% -8% 10% 10%

% Resourced Occupancy (avg of 9am & 9pm) Jul-14 June 15YTDGynaecology Ward 79.9% 78% -2% 0%

Maternity Ward - Maternity (45 beds) (lodgers included) 78.7% 81% 2% 0%Maternity Ward - Nursery (30 beds) (lodgers included ) 90.2% 87% -3% 0%

Botany Maternity Unit (lodgers included) 92.6% 95% 3% 0%Papakura Maternity Unit (lodgers included) 66.7% 90% 23% 0%

Pukekohe Maternity Unit (lodgers included) 76.8% 82% 5% 0%

Def

Jul-15 Target Var. Actual Target Var.Nursing Hours per Patient Day (not including HCA)at MMH

NHPPD - Maternity Ward North (including nursery PD) 5.49 6.99 1.50 0.00NHPPD - Maternity Ward South (including nursery PD ) 5.95 6.16 0.21 0.00

Nursing Hours per Patient Day - Gynae 5.43 5.05 -0.38 0.00

Jul-15 Target Var. Actual Target Var.Patient Experience Survey Resposnes - How would you rate your overall care 93% 90% 3% 93% 90% 3% 74

(Excellent, very good and good)


Jul-15 Target Var. Actual Target Var.% Infants Exclusively Breastfed Discharge MMH - Total 89.0% 75% 14.0% 85.0% 75% 10.0% 75

% Infants Exclusively Breastfed Discharge MMH - Maaori 79.0% 75% 4.0% 83.0% 75% 8.0%% Infants Exclusively Breastfed Discharge MMH - Pacific 85.0% 75% 10.0% 81.0% 75% 6.0%Note: this data is for babies discharged on Healthware., therefore this data is incomplete. Badgernet reports were not available.

Equi

tyPa

tient

/ W

hana

u Ce

ntre

d Ef

ficie

nt

Calendar Year to date (BFHI)

Year

n = 23 Year to date (n =41)

Year to date


Financial Results

Kidz First Statement of financial performance

From 1 July 2015, Public Health Nursing, Hearing and Vision Team, and Health Promotion teams were moved from Kidz First to Integrated Care. FTEs, financials, and volumes for these RCs are no longer included under Kidz First.


14 12 2 13% Government Revenue 0 0%0 0 0 0% Patient/Consumer Sourced 0 0%

121 126 (4) (4)% Other Income 0 #DIV/0!32 32 0 0% Funder Payments 0 #DIV/0!

167 169 (3) (2)% Total Revenue 0 #DIV/0!

EXPENDITURE2,314 2,373 59 2% Staff Costs 0 #DIV/0!

60 20 (40) (200)% Outsourced Costs 0 #DIV/0!182 172 (10) (6)% Clinical Costs 0 #DIV/0!

69 61 (7) (12)% Infrastructure Costs 0 #DIV/0!(9) (7) 2 28% Internal Allocations 0 #DIV/0!

2,615 2,619 4 0% Total Expenditure 0 #DIV/0!(2,449) (2,450) 1 0% Net Result 0 #DIV/0!

FTE46 44 (3) (6)% Medical 0 #DIV/0!

163 161 (2) (1)% Nursing 0 #DIV/0!44 48 4 9% Allied Health 0 #DIV/0!18 21 2 11% Management/Admin 0 #DIV/0!

272 274 2 1% FTE Total 0 #DIV/0!

STATEMENT OF FINANCIAL PERFORMANCE - KIDZ FIRSTJul-15


($000's)($000's)

-3,500

-3,000

-2,500

-2,000

-1,500

-1,000

-500

-

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

100

200

300

400

500

600

700

800

900

1,000

Mon

thly

resu

lt $0

00's


Result

-

500

1,000

1,500

2,000

2,500

3,000

3,500

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget


Kidz First commentary on major financial variances

Month YTD


Revenue: $3 $3



Clinical Supplies: $(10) $(10)

Infra-Structure: $(7) $(7)

Internal Allocation: $2 $2

The year end forecast is for the division to meet budget.

Revenue for projects is recovered on a monthly basis. Additional costs for various projects (not budgeted) are offset against additional revenue.

Jul-15

$0

Current Month: $(3)k for cleaning at community hubs, $(4)K for saving target

Year end Forecast variance to Budget

Current Month: $(10)k for high early winter volumes in conjunction with very high acuity in both KF medical/surgical floor and NNC contributed to very high clinical supply costs.

STATEMENT OF FINANCIAL PERFORMANCE - KIDZ FIRST

Additional costs for various projects (not budgeted) are offset against project revenue from the funder, i.e. MM Clinical Trials Research, ASD, and Mana Kidz. Annual leave has been well managed over the school holiday period (July 2015).Current Month:Medical - $25k - high annual leave uptake over school holiday period.Nursing- $(27)k - good annual leave management over school holidays. Various projects offset against additional revenues (not budgeted). Very high acuity and volume in NNC contributed to very high nursing costs. Allied Health- $51k - Good annual leave management over school holidays, additional costs for various projects (not budgeted) are offset against additional project revenue. Clerical - $11k - on track; high annual leave uptake over school holiday period.

Current Month:Government Revenue: ACC $1KOther Income: MM Clinical Trials $25K. NBHS $(12)K, MoE $(3)K, misc $5

Current Month:$(20)k for external bureau, $(4)k for University of Auckland, $(15)k for ASD - multi disciplinary consultation

Kidz First reported a $1k favourable variance for July.


Women’s Health Statement of financial performance


61 74 (13) (18)% Government Revenue 61 74 (13) (18)%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%

16 0 16 0% Other Income 16 0 16 0%0 0 0 0% Funder Payments 0 0 0 0%

77 74 3 4% Total Revenue 77 74 3 4%


102 62 (40) (66)% Outsourced Costs 102 62 (40) (66)%155 137 (18) (13)% Clinical Costs 155 137 (18) (13)%121 114 (7) (7)% Infrastructure Costs 121 114 (7) (7)%

30 49 19 (40)% Internal Allocations 30 49 19 (40)%3,108 3,111 3 0% Total Expenditure 3,108 3,111 3 0%

(3,031) (3,037) 6 0% Net Result (3,031) (3,037) 6 0%

FTE45 44 (0) (1)% Medical 45 44 (0) (1)%

248 247 (1) (0)% Nursing 248 247 (1) (0)%5 5 (1) (14)% Allied Health 5 5 (1) (14)%

48 45 (3) (8)% Management/Admin 48 45 (3) (8)%342 335 (7) (2)% FTE Total 342 335 (7) (2)%

Jul-15STATEMENT OF FINANCIAL PERFORMANCE - WOMENS HEALTH


($000's) ($000's)

-3,300

-3,200

-3,100

-3,000

-2,900

-2,800

-2,700

-2,600

-2,500

Mon

thly

resu

lt $0

00's

Monthly Net Result

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Women’s Health commentary on major financial variances

Month YTD


Revenue: $(3) $(3)





Internal Allocation: $19 $19



Current Month:Additional revenue for various projects (not budgeted) are offset against costs, Maternity Review Board $39k, $(19)k overspend on pharmacy.

Current Month:$(25)k for Neonatal Alloimmune Thrombocytopenia (NAIT) patient

$0

Current Month:$(5)k for clinic room rental$(9)k for saving target

STATEMENT OF FINANCIAL PERFORMANCE - WOMENS HEALTH

Additional costs for various projects (not budgeted) are offset against additional revenue.Current Month:Other Income: clinic room rental $6K, Colposcopy revenue down by $(14)K

Jul-15

Additional costs for various projects (not budgeted) are offset against additional revenues, i.e. Ccrep Research Current Month:Medical- $30k - good annual leave management over school holidaysNursing/Midwives- $40k - good annual leave management over school holidays. Internal bureaus (12.60)FTE and OT (2.72)FTE employed due to Midwifery vacancies of 15 FTE.Allied Health- $(12)k - (3)FTE offset by additional revenues for Breastfeeding Advocates. (1)FTE - offset by additional revenues for UoA research Clerical - $(9)k - (1)FTE offset by additional revenues from the maternity review board. High use of casuals for MCIS roll-out and vacancies.

The division reported a favourable variance of $6k for the month. Good annual leave management over the school holidays was offset by high sick leave hours taken and high # of watches on the maternity ward.July 2015 deliveries are 5 births down against last year's actual (delivery numbers at MMH were up by 13 and community units down by 8). However, WIES continues to be up by 4% reflecting the increasing complexity in Maternity.

Current Month:$(22)k for External Bureaus to offset MW / Nursing vacancies and skill mix issues, and orientation of 20 new graduate midwives$(9)K for temp admin to cover parental leave$(13)K for for AUT MDES (Midwifery Development) - not budgeted - proposal to be funded by Maternity Review Board


Quality

The Women’s Health Quality Framework for 2015/16 has been developed and endorsed by the Women’s Health Divisional Committee. The Kidz First Quality Framework for 2015/16 has been developed and will be signed off by the Clinical Leaders’ meeting in August.

Safety

Safe Sleep A Safe Sleep Audit comprising 10 women and babies was undertaken at the end of July on Maternity Wards North and South utilising the Care Compass and Regional Safe Sleep Observational Audit tool.

CLAB (Neonatal Unit) Compliance

CLAB insertion bundle compliance - NNU July 2015 100%

CLAB prevention maintenance bundle compliance- NNU July 2015 92%

Timeliness

Six Hour and ESPI Targets

Measures Result

Six Hour Target – 95% of EC presentations are seen/admitted/discharged. This measures LOS for initial specialties

Paediatric Medicine: 97% for the month Gynaecology: 94 % for the month Gynaecology missed the target for the month mainly due to some patients staying over 6 hrs in EC during the afternoon and night shift. We will be working with EC and the O&G team to understand why these delays occurred.

4 months FSA Kidz First outpatient Meeting target.

4months FSA Women’s Health Gynaecology outpatients and procedures

Meeting target.

Planned Expired Appointments trend

Current strategies outlined in the June update remain in place and have already resulted in a decrease to 536 Expired Appointments.


Efficiency

Management of Incidents As a quality and safety measure and following on from issues raised at both Access Holders meetings and the Maternity Quality and Safety Governance Group it was proposed to put together an information folder to help facilitate and improve the reporting of incidents from self-employed lead maternity carer (LMC) midwives. This is currently being developed and will be distributed throughout CMH maternity facilities.

Equity

Equity Result

New Born Hearing screening

15/165 Screens in hospital = 532 15/16 Screens in clinic = 87 Total = 619 (total births is 633 – however, the screening numbers include twins and also babies born in 14/15). We have employed two more screeners as part of the strategy to increase the number of babies screened in hospital rather than following discharge. We are also extending the screening hours.


Patient Satisfaction Result

Complaints / Compliments activity

July 2015 Complaints: KF= Two complaints received - both minor. WH= Three complaints received – two minor and one not specified. Compliments: KF= Nil compliments received. WH= Six compliments received.


3.10 Director of Midwifery

MOH Maternity Quality and Safety Programme

The purpose of the programme is for health professionals and consumer stakeholders to work collaboratively to monitor and improve maternity care. The Maternity Quality and Safety Annual Report has been submitted to the MOH and following review by the National Maternity Monitoring Group (NMMG). This will be placed on the CMH website.

The key priorities for the 2015-16 work plan are decided upon following consideration of national and local priorities and information. The key priorities are:

• Improve health professional and consumer involvement; • Implementation of the Maternity Clinical Information System (MCIS); • Early engagement and improve the management of first trimester care; • Early identification and treatment of women with anaemia; • Review number and rational for induction of labour and caesarean section; • Improve screening for mental health issues; • Increase number of women who receive influenza and pertussis vaccination; • Increase the number of maternity health professionals who receive the influenza

vaccination; • Provide accessible acceptable contraception; • Improve practice to decrease third and fourth degree perineal tears; • Implement MOH ‘guidance for healthy weight gain in pregnancy’; and • Implementation and service development to follow the National Maternity Diabetes

guidelines.

Virtual Tours of Maternity Facilities The aim of the virtual tours are to provide consumers with evidence to promote low risk women to utilise and birth in the primary birthing units, encourage women to register with a lead maternity carer early in their pregnancy, and describe service provision and orientation to each of the maternity facilities. The six minute virtual tours of Botany, Papakura, and Pukekohe Primary Birthing Units and Middlemore Hospital’s maternity facilities are now in the final stage of review and will be released on the maternity webpages in late August/early September 2015. This will be the first edition with a two month feedback time for changes to be made in October. Women’s Health Research Showcase On 29 July a presentation was arranged and facilitated by Dr Graham Parry, Obstetric Consultant. Dr Parry chairs the Women’s Health Research committee. The presentations (listed below) highlighted just some of the research currently underway in Women’s Health. Many health practitioners and consumers are contributing to local, national and international studies. We thank the range of presenters including midwives, medical, and academics who contributed to an excellent morning.


Speakers

Graham Parry Welcome and housekeeping

Lesley McCowan/Kara Okesene-Gafa HUMBA

Pip Walker Management of endometrial hyperplasia

Heather Donald Evaluation of the Midwifery Development and Education Unit in Birthing and Assessment

Kieran Dempster-Rivett Mirena in IHC

Alec Ekeroma Diabetes study

Jenny Kruger Pelvic Floor Research

Annabel Farry Comparison of outcomes of similar cohorts of primary maternity women who present in labour at Primary Birthing Units and Birthing and Assessment Middlemore Hospital

Lesley Ansell Shoulder dytocia

Caroline Crowther GEMS/Target

Jenny Kruger Pelvic Floor Research

Robin Cronin Maternal sleep survey in CMH Brian Spurrett Fellowships The objective of the Brian Spurrett Fellowship is to provide support to doctors, nurses, and midwives actively working in reproductive health in the Pacific to undertake short-term training in an Australian or New Zealand institution. Since 2009 Women’s Health has provided training for two Pacifica midwives with this fellowship annually. Their programmes of four to six weeks are individually planned to suit their clinical objectives and professional working environment. This can involve primary health care, Kidz First placements, and sessions at the AUT School of Midwifery. Two Fijian midwives commenced their programme on 20 July 2015.


3.11 Surgical and Ambulatory Care

Service Overview

Surgical and Ambulatory Care is led by General Manager Gillian Cossey, with Clinical Director - Surgery Mr Wilbur Farmilo, Clinical Director - Critical Care Tony Williams, Clinical Nurse Director - Surgery Jacqui Wynne-Jones, and Clinical Nurse Director - Acute and Critical Care Annie Fogarty.

Performance Activity Summary July was a quieter month for electives in Surgical and Ambulatory Care, due to school holidays and several SMO conferences. The Acute workload was busier, especially in Orthopaedics. There were seven Spinal Cord Impairment patients (two Counties, two Waitemata, one Auckland, and two Waikato) plus 22 other acute spine admissions with 10 patients going forward to surgery. The acute surgical wards were busy with many outlier patients due to the hospital being full. Ward 34 East accommodated 504 medicine patients in July. Several areas have been impacted by vacancies and staff sickness; however, teams are working well together to maintain professional and safe patient care.

Planning for the new See and Treat Unit continues with renovations progressing well. Some additional SMO staff have already been recruited, with work underway for nursing staff.

Financial results were $193k favourable for the month due partly to very low levels of outsourcing. (which was financially beneficial but resulted in two Urology cases breaching the 120 elective waiting time target). As always, it is a very fine balancing act to achieve all monthly objectives.

Operational Volumes /Inpatient Summary (WIES)

Surgical Volumes (WIES – Acute and Elective) Volumes Jul-15 Year to date Actual Bud/

Contract Var %var Actual Bud/

Contract Var % var

ACUTES - Adults 1,735 1,696 39 2.3% 1735 1,696 39 2.3% - Children 126 159 - 33 - 20.7% 126 159 - 33 -20.7%

1,862 1,856 6 0.3% 1,862 1,856 6 0.3% ELECTIVES - Adults 1,216 1,217 - 1 - 0.1% 1,216 1,217 - 1 - 0.1% - Children 79 85 - 5 - 6.1% 79 85 - 5 -6.1%

1,296 1,302 - 6 - 0.5% 1,296 1,302 - 6 - 0.5% COMBINED TOTAL

- Adults 2,952 2,914 38 1.3% 2,952 2,914 38 1.3% - Children 206 244 - 38 -15.7% 206 244 - 38 - 15.7% TOTAL 3,157 3,157 0 0.0% 3,157 3,157 0 0.0%


A summary of the months results shows: • Acutes WIES 0.33% higher than contract for the month. • Electives WIES 0.47% below contract for the month. • Overall WIES on contract for the month. Please note: that these comparisons are on the

basis of comparing contracts in WIES 14 with actuals in WIES 15. • Compared with 14/15 financial year: Acute WIES 4.16% lower and Electives 10.51% lower.

Overall 6.87% lower than the last financial year.

Operational Volumes / Inpatient Summary (Discharges)

Surgical Volumes (Discharges – Acute and Elective) Volumes Jul-15 Year to date Actual Bud/

Contract Var %var Actual Bud/

Contract Var % var

ACUTES - Adults 1,456 1,319 137 10.4% 1,456 1,319 137 10.4% - Children 147 182 - 35 -19.3% 147 182 - 35 - 19.3%

1,603 1,501 102 6.8% 1,603 1,501 102 6.8% ELECTIVES - Adults 1,127 1,032 95 9.2% 1,127 1,032 95 9.2% - Children 117 133 - 16 - 11.8% 117 133 - 16 - 11.8%

1,244 1,165 79 6.8% 1,244 1,165 79 6.8% COMBINED TOTAL

- Adults 2,583 2,351 232 9.9% 2,583 2,351 232 9.9% - Children 264 315 - 51 -16.1% 264 315 - 51 - 16.1% TOTAL 2,847 2,666 181 6.8% 2,847 2,666 181 6.8%

A summary of the months results shows: • Acute discharges were higher than contract by 102 patients or 6.8%. • Elective discharges higher than anticipated contracted levels by 79 patients or 6.8% • Overall monthly patient discharges are 181 over contract. • In comparison with that of last financial year acute discharges are higher by 68 patients but

electives are lower by 103. • For the month we subcontracted six patients against a target of 43 patients. During the

corresponding month of the previous year we subcontracted 37 patients to private providers.

• Elective base contract for the month excludes Gynae but includes additional elective work. • Note: Adjustment has been made for uncoded hip and knee patients operated and

discharged during the month but no adjustment has been made for waiting list patients done on acute arranged lists.


Outpatient Summary (visits first and follow up) for the month, and YTD:

• For the month, FSAs are 23.2% lower than contract and Follow ups are 14.7% lower than contract.

Jul-15 Year todate Actual Contract Var % Actual Contract Var % FSA’s 2,146 2,795 - 649 - 23.2% 2,146 2,795 - 649 - 23.2% Follow ups 5,981 7,014 - 1,033 - 14.7% 5,981 7,014 - 1,033 - 14.7% Total 8,127 9,809 - 1,682 - 17.2% 8,127 9,809 - 1,682 - 17.2%

Highlights • Leah Hodgkinson, Pharmacist with the Complex Pain Team has been nominated for ‘Young

Pharmacist of the Year’. • Burn Unit House Officer Awards - Congratulations to Dr Anna Lee and Dr Bryan Bae on being

jointly awarded the title of ‘House Officer of the Month’ for July 2015. They have been nominated by senior staff who felt they deserved recognition for “…the excellent team work between them and support for each other, in addition to their excellence in patient care, and delightful attitudes”.

• High productivity in Orthopaedics in July despite a very sad time due to the tragic loss of a colleague and skilled surgeon. Orthopaedic acutes exceeded contract by 14.3% and electives by 8.1%, with no outsourcing.

• A very successful service planning day was held by General Surgery. • The Surgical Assessment Unit is working well and the RMOs are enjoying having a dedicated

space in the Emergency Care Department. • Recycling in MMH theatres is going extremely well, with great commitment from the teams.

Emerging Issues

1. Anaesthetic Technicians Resignations We have six vacancies, severely depleting our ability to provide technician resource.

Mitigation for AT shortage

Short term: o Recruitment of Registered ATs – we are persistently advertising for ATs, ODAs, ODPs both

in NZ and internationally. o Recruitment of RNs with anaesthetic assistant experience/qualifications in progress both in

NZ and the UK. o Existing ATs are volunteering overtime and working on RDOs. This is unsustainable in

medium term. There is no duress put on the ATs to do this and sick leave is being monitored.


Medium term: o Training – we are planning an intake in Sept/Oct of four trainees (supernumerary for nine

months) – short listing at the moment, it is likely there will be RNs applying, although these RNs are from within CMH Operating Theatre –if they are successful there may be implications elsewhere. We have six vacancies, but the current AT Educator team and preceptors advise six new trainees in September would contribute to preceptor-fatigue and one of our three Educators has stepped down from 18 September 2015.

o Requesting to have the service size and flexibility to train more than we need to avoid the peaks and troughs.

Long term: o Bonding our home-grown ATs – this is being explored with HR – incentivising them to stay,

and/or dis-incentivising to leave. o Influencing/activating as able in the broad range of regulatory bodies, associations,

advisory groups, HWFNZ that exists with AT workforce,. o Watching brief on the NZ Nursing Council Registered Nurse Assistant to the Anaesthetist

(RNAA) pilot. Currently targeted at smaller, provincial hospitals, but certainly has potential for us.

2. Building Lifts The time taken to repair lifts when they breakdown is frequently unacceptable. Service contracts to be reviewed to ensure timely and efficient service from the lift suppliers.

3. Equipment warranties There will be rising costs for the maintenance of equipment in the Harley Gray building as units roll out of their 24 month extended comprehensive warranty periods. CSSD will need to remain compliant with the new AUS/NZ 4187 standards and equipment will need to be serviced by the manufacturer wherever possible. Maintenance contracts will need to be budgeted.

4. Parking on Middlemore Site The opening of the See and Treat unit in Galbraith building in September will bring more patients onto the MMH site. Various transport options need to be considered.


Scorecard

Service Scorecard


• Pleasing increase in Day Case Surgery Rate to 67%. • 225 General Surgical patients went through the Discharge Lounge in July (compared to 203

in June). • Outpatient DNA rates were higher in July due to school holidays and bad weather.

Surgical and Ambulatory Care SCORECARD

July 2015


Def

Jul-15 Target Var Actual Target VarTotal Caseweight (Provider view) 3,157 3,157 -0.0% 3,157 3,157 -0.0% 1

Elective Caseweight 1,296 1,302 -0.5% 1,296 1,302 -0.5% 3

Acute Caseweight 1,862 1,856 0.3% 1,862 1,856 0.3% 2

Elective Surgical Discharges 1,244 1,165 6.8% 1,244 1,165 6.8% 4

Outpatient FSA Volumes 2,146 2,795 -23% 2,146 2,795 -23% 10

Outpatient Follow Up Volumes 5,981 7,014 -14.7% 5,981 7,014 -15% 11

Virtual FSAs -(GP consult and nonpatient appointments) 68 110 -42 68 110 -42 12

Reduce clinical outsourcing ($000) 33 185 152 33 185 152 13

Jul-15 Target Var Actual Target Var% Staff with Annual Leave > 2 years 22.2% 5.0% -17.2% 10.7% 5.0% -9.2% 14

% Staff Turnover 9.8% 2.0% -7.8% 12.2% 10.0% 2.7% 15

% Sick Leave 3.1% 2.8% -0.30% 2.7% 2.8% 0.0% 16

Work Place Injury per 1,000,000 hours 0.00 10.50 10.50 8.51 10.50 -1.26 17


Jul-15 Target Var Actual Target VarHand Hygiene compliance rate (based on Gold Audit) - Ward 11 79% 80% -1% 79% 80% 3%Pressure Injuries / 100 patients 0% 0% 0% 0% 0% 0%Falls causing major harm / 1000 bed days 0% 0% 0% 0% 0% 0% 22

Severe Pressure Injury (ungradeable) per 1000 bed days 0% 0% 0% 0% 0% 0%Surgical Site Surveillance for Major joints- Confirmed HQSC data for Q1 & Q2

Antibiotics given 0-60mins before "knife to skin" 96% 95% 1% 98% 95% 3%2 grams or more Cefazolin given 98% 100% -2% 99% 100% -1%

Appropriate skin preparation 98% 100% -2% 98% 100% -2%% Operations - all 3 parts of Surgical Safety Checklist used 90% 90% 0% 92% 90% 1%CLAB rate/ 1000 line days 0% 0% -0% 0% 0% 0% 24

Rate of S. aureus bacteraemia per 1000 bed days 0% 0% -0% 0% 0% 0% 25

VTE - number of SACS re-admissions due to VTE 6 0 -6 103 0 103

Jul-15 Target Var Actual Target VarPre-operative Length of Stay Days (from admit to surgery) 0.35 1.00 0.65 0.35 1.0 0.65ESPI 2 No. patients waiting >150 days for FSA - Elective (Surgical Services incl Gynae) 0 0 0 0 0 0 42

ESPI 5 No. patients waiting >150 days Treatment - Elective (Surgical Services incl Gynae) 0 0 0 0 0 0 43

ESPI 2 No. patients waiting >120 days for FSA - Elective (Surgical Services incl Gynae)-Target 0 by 31/12/14 1 0 -1 1 0 -1ESPI 5 No. patients waiting >120 days Treatment - Elective (Surgical Services incl Gynae) -Target 0 by 31/12/14 4 0 -4 4 0 -4

Jul-15 Target Var Actual Target VarAverage Length of Stay - Acute Inpatient incl Burns 3.85 3.80 -0.05 3.85 3.8 -0.05 50

Average Length of Stay - Acute Inpatient excl: Burns 3.78 3.80 0.02 3.78 3.8 0.02Average Length of Stay - Electives 1.34 1.50 0.16 1.34 1.5 0.16 51

Acute Readmissions within 7 days - Total N/a 3.43 N/a N/a 3.43 N/a 52

Number of patients referred to POAC N/a 10 N/a N/a 60 N/a

Jul-15 Target Var Actual Target VarTheatre list utilisation - % used MMH/MSC (MOH OS5) 85.3% 85.0% 0.3% 85.3% 85% 0.3%Theatre session utilisation - % used MMH/MSC 97.5% 95.0% 3% 97.5% 95.0% 3%Elective Theatre turnaround times- Mins (MMH/MSC) 15.3 15 -0.3 15.3 15 -0.3 Elective cancellations - Day of surgery as % of all Elective (all reasons)- SACS only 9.0% 5.0% -4.0% 9.0% 5% -4.0%Day of Surgery Admissions (DOSA) 96.1% 90.0% 6.1% 96.1% 90% 6.1% 65

Day Case Rate (Elective/ Arranged) -Subspecialties in SACS only Adults/kids 67.0% 65.0% 2.0% 67.0% 65% 2.0% 66

MMH % patients discharged to discharge lounge or home by 1100hrs 12.1% 30.0% -17.9% 12.1% 30% -17.9%Ratio FSA/FU clinic ratio 35.9% 31.0% 4.9% 35.9% 31% 4.9% 61

Outpatient DNA rates - overall- Surgical Services only 8.1% 10.0% 1.9% 8.1% 10% 1.9% 62

Outpatient DNA rates - Maori (FSA) - Surgical Services only 13.7% 10.0% -3.7% 13.7% 10% -3.7% 62

Outpatient DNA rates - Pacific (FSA)- Surgical Services only 12.3% 10.0% -2.3% 12.3% 10% -2.3% 62

Jul-15 Target Var Actual Target VarPatient Experience Survey (n=106) 82% 92% -10.0% 82% 92% -10% 74


Jul-15 Target Var Actual Target Var% of hospitalised smokers receiving smokefree advice & support -Total (Surgical) 93% 95% -2.0% 93% 95% -2.0% 77

Year

Year to date (n=106)

Year

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Financial Results



752 644 108 17%Government Revenu 752 644 108 17%784 800 (16) (2)%ent/Consumer Sour 784 800 (16) (2)%518 514 4 1% Other Income 518 514 4 1%

1,216 1,216 0 0% Funder Payments 1,216 1,216 0 0%3,270 3,174 96 3% Total Revenue 3,270 3,174 96 3%


335 452 117 26% Outsourced Costs 335 452 117 26%3,037 3,060 24 1% Clinical Costs 3,037 3,060 24 1%

533 455 (78) (17)% nfrastructure Costs 533 455 (78) (17)%707 602 (104) 17% Internal Allocations 707 602 (104) 17%

16,702 16,800 98 1% Total Expenditure 16,702 16,800 98 1%13,432 13,625 193 1% Net Result 13,432 13,625 193 1%

FTE272 287 16 6% Medical 272 287 16 6%752 793 42 5% Nursing 752 793 42 5%111 115 4 4% Allied Health 111 115 4 4%

76 67 (9) (13)% Support 76 67 (9) (13)%124 127 3 3%Management/Admi 124 127 3 3%

1,334 1,390 56 4% FTE Total 1,334 1,390 56 4%

**April:Unpaid days accrual for the Easter period,adjusted in May.

($000's) ($000's)

STATEMENT OF FINANCIAL PERFORMANCE - SURGICAL & AMBULATORY

Month to Date Year to DateJul-15

02,0004,0006,0008,000

10,00012,00014,00016,00018,000

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Quality

Safety • A DVT/PE project has been initiated in Orthopaedics, with detailed analysis in progress,

project team identified and meetings commenced. • Care Compass is being trialled on Ward 34 North. • The first Perioperative / Mortality meeting was held in July. • Limb lifting tracks were installed in Theatre 4 (the Burns theatre).

Month YTD


Revenue: $96 $96


Outsourced: $117 $117


Infra-Structure/Internal Allocations: $(182) $(182)

Jul-15

Clinical outsourcing of patients to private providers totalled $33k against a target of $185k resulting in a $152k favourable variance. Private subcontracting has been low because contracts with private providers were not finalised until the end of the third week of July. This has compromised our ability to meet ESPI targets and we had a breach of two patients for July. For the month we also had a favourable variance of $14k in Interim care costs paid to private rest home providers.

STATEMENT OF FINANCIAL PERFORMANCE - SURGICAL & AMBULATORY

Government Revenue: Elective ACC Revenue was $109k favourable for the month. Revenue exceeded expectations in Orthopaedics, Plastics and Hands .Patient/Consumer Sourced: Private patients $(16)k adverse for the month. We invoiced $784k of Tahitian burns Revenue during the month compared with our flexed budget of $800k. With reduced Acutes, we plan to bring in some elective reconstructive burns patients from Tahiti for the financial year to ensure that we work towards achieving target revenue of $2.1M by year end.Other Income $3k favourable for the month due to additional Revenue from Urology and Plastics as a result of SMO 's carrying out work in other Auckland DHB's)Funder Payments: Funder revenue for elective work on budget for the month.

The Division had a favourable variance of $193k for the month. Detailed explanation for the months variance is given below. MoH outputs for the month were on contract . This was based on 85% coding of patient charts. There was an increase in Acute workload of 0.33% or 6 WIES and a reduction in Electives of 6 WIES or 0.47% compared to contract.

Medical $(97)k unfavourable for the MTH - Primarily reflects the salary change in SMO Step with was effective from 1st July plus leave revaluation which has resulted . This has been set off against SMO vacancies due to pending job sizing finalisation. Registrars and House Officers comprised $(50)k of this unfavourable variance . The mix of RMO's for the various surgical runs coupled with vacancies and the leave transfers on rotation have had an unfavourable impact on the Division. Nursing $200k favourable for the MTH -Favourable variance for the month represents mainly leave taken exceeding leave accrued. Accrual made for pending MECA settlement which is in line with the budget . Some changes in skill mix of staff which is partly offset by bureau nursing costs.Allied Health $61k favourable for MTH - Favourable variance due to vacancies 6.9 FTE. These have remained unfilled as a result of the lack of skilled staff and the time lag for recruitment. Support Staff $(39)k unfavourable for the MTH - This is due to Interpreter redundancy $20k phased cut in Interpreter cost of $13k that has not materialised due to the project still being in the planning stage and a Revenue reduction of $7k. The demand on the service has grown rapidly and servicing these demands has resulted in more casual interpreters being recruited to meet expectation. This is reflected in the numbers of FTE over budget.Management Admin $15k fav for the MTH - 5.4 FTE vacancies in the Division.

Clinical Supplies were favourable by $24k for the month which is consistent with outputs achieved. Some variation in the mix of work undertaken has resulted in the favourable Variance.



Infrastructure costs were cut for the 15/16 budget on the basis that savings would be achieved in Inventory Management, Bedding and linen, Stationery and supplies and Telecommunication costs. However some of these savings did not materialise. The unfavourable variance comprises laundry bedding and Linen $(25)k, Stock Adj Account $(20)k, Telecom $(6)k, Printing and Stationery $(13)k. There was also an $(81)k adverse variance in Pharmacy costs and $(14)k in Transfer costs for Cancer coordinators (to be transferred in August).


Timeliness ESPI 2: No patients will wait more than 120 days for their First Specialist Assessment (FSA): CMH compliance with the 120 day MOH ESPI 2 target for June is confirmed with no breaches reported by MOH in the final June data.

Internal ESPI results for July have identified two ESPI 2 breaches – one in Plastics and one in Dermatology. This result will be reflected in the September release of MOH data.

There are no red flags at present to indicate further deterioration in this position for the August result at month end.

ESPI 5: Patients given a commitment to treatment will be treated within 120 days: CMH achieved the MOH ESPI 5 target for June for the first time since December 2014 with no ESPI 5 Patients waiting greater than 120 days.

However, there will be four ESPI 5 breaches for July– two in Plastics and two in Urology. Urology breaches are due to the time gap of 3+ weeks between the end of the outsourcing contract and the implementation of the replacement contract. CMDHB Waiting Time Tracking 15/16

Surgical and Ambulatory Care Services Number Patients Waiting >120 days 31-Jul 31-Aug 30-Sep 31-Oct 30-Nov 31-Dec 31-Jan 28-Feb 31-Mar 30-Apr 31-May 30-Jun FSA ESPI 2 1 For Treatment ESPI 5 4

Organisational CMDHB Number Patients Waiting >120 days 31-Jul 31-Aug 30-Sep 31-Oct 30-Nov 31-Dec 31-Jan 28-Feb 31-Mar 30-Apr 31-May 30-Jun FSA ESPI 2 2 For Treatment ESPI 5 4

ESPI 5 Eligible Patients Waiting 120+ days for treatment Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 General Surgery 0 0 0 0 0 0 0 0 ORL 0 0 6 14 1 0 0 0 Ophthalmology 0 0 0 0 0 0 0 0 Orthopaedics 0 0 0 0 1 1 0 0 Plastic Surgery 0 1 2 0 3 2 0 2 Urology 0 0 0 0 0 0 0 2 SACS total 0 1 8 14 5 3 0 4 Gynaecology 0 0 0 0 0 0 0 0 Cardiology 0 0 0 0 0 0 0 0 CMH total 0 1 8 14 5 3 0 4

The Complex Pain Team The Complex Pain team continues to facilitate timely discharge of patients with complex and difficult to treat pain.

Efficiency • Development of an Acute Theatre Dashboard in Concerto is progressing well. • Weekly reporting on greater than 10 day stayers is ensuring a tighter focus in achieving

GDDs and reducing LOS. • Significant advances have been made with the T-Doc tracking system in CSSD. Almost 4,000

instruments have been databased and photographed, combining to make hundreds of sets.


The tracking system is operational for testing purposes and some staff have been able to trial it. Official training from Getinge is planned for August.

• In CSSD all turnaround times have been maintained with no significant delays. Fast track items have been provided within the three hour turnaround time specified. Loan sets coming in, although some at late notice, have also been completed on time.

Effectiveness • Collaboration continues between Orthopaedics and Eastern Locality on hip and knee

readiness for surgery. • An education session was facilitated with surgical registrars around the wound care team,

wound management, and NPWT.

Patient and Whaanau Centred Care • General Surgery has formed a group dedicated to Pastoral Care within the Department (led

by the Service Manager and Senior Doctors). Guidelines have been developed with a focus on physical and mental well-being and inclusion.

• There were 145 Compliments received for the surgical department this month 79 for MMH and 66 for MSC. Many great comments such as the following received from a Plastics patient: “I wish to express my appreciation of service at Middlemore recently. In July I was referred to your Plastics Unit by Mercy Hospital for treatment after dog bites to my face. At a time when staff were very busy with emergencies I was efficiently and pleasantly dealt with by all of the reception personnel and triage. The surgical work was carried out by Mr Patel (I forget the name of his assistant at the time). I cannot commend more highly his friendly, yet efficient and professional manner and also that of his female assistant. He fully informed me of the whole procedure before attending the wound and routinely during it. He found time to see that I was fully briefed about how to care for the wound after and provided full notes for a follow up (I travelled to France that next day and required advice for a French GP on these requirements). Incidentally, the French GP who removed the sutures remarked on both the notes provided and about the outstanding job done by Mr Patel. I have had medical treatment in several countries and am 66 years old so feel that I have some grounds on which to say that the work of your hospital and the Plastics team that I experienced justifies this note of praise. I would be grateful if you were able to pass my gratitude on to the staff involved by whatever means you may.

• General Surgery CNMs have worked with the CND to formulate guidelines for the management of long-staying patients on the wards. These include the early involvement of psych liaison and the use of supportive activities, plus close involvement of the family.


3.12 Adult Rehabilitation and Health of Older People

Service Overview Adult Rehabilitation and Health of Older People (ARHOP) is led by General Manager Dana Ralph-Smith, with Clinical Director Dr Peter Gow, and Lyn Cooper Clinical Nurse Director (ARHOP). In addition, to support the Health of Older People contracted services, Dr Kathy Peri is Clinical Nurse Director.

Performance Activity Summary

Inpatient summary

Outpatient Summary

Month Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Added 82 93 109 77 89 85 89 80 114 81 105 80 115 Seen 21 85 70 63 85 72 72 63 55 73 79 99 84 Return to GP 0 0 0 1 0 1 0 1 0 0 0 0 0 Removed Other 12 11 9 8 20 5 11 27 17 15 29 26 16 TOWL 123 115 143 145 126 137 141 132 178 177 175 123 151 Waiting > 120 days 9 12 17 17 16 22 27 12 4 6 10 8 6 Waiting > 90 days 16 17 22 21 23 33 33 16 8 18 21 15 16 Waiting > 60 days 43 41 26 29 39 48 30 21 From January 2015 the Ministry of Health requested visibility of patients seen/treated within 120 days. Waitlist timeframes for AT&R are not reported to the Ministry however the parameters have been changed to provide consistency with other services.

Highlights/Challenges

Influenza has played a big part on Ward 5 this month with staff and patients alike. At our peak we had 10 Influenza positive patients but to date no cross infection.

140 patients have received short term Home and Community Support Services since 15 June to facilitate discharge support needs from hospital or community. Primary Options for Acute Care (POAC) has been used to coordinate these services through the short term Home Care Support Services Providers (HCSS). The reablement team and locality coordinators are also working alongside to identify where functional retraining is required or speciality assessments and services in the community. Some next steps identified to improve services include working with POAC and short term providers to set up shared care access by 1 September 2015 and continue utilising the electronic referral and patient information set up on POAC website.

Volumes

ActBud /

Contract Var % var ActBud /

Contract Var % var

INPATIENT AT&R 1,936 2,102 -166 -8% 1,936 2,102 -166 -8%

Spinal 456 410 46 11% 456 410 46 11%

Stroke Rehabilitation 342 382 -40 -10% 342 382 -40 -10%

Acute Care for the Elderly 367 336 31 9% 367 336 31 9%

ARHOP Volumes (Bed days and Contacts)July '15 Year to date


Scorecard

Notes: 1. Enabling high performing people data not completed at time of reporting 2. Patient Experience Survey Data not completed at the time of reporting

Adult Rehabilitation and Health of Older People SCORECARD

July 2015


Def

Jul-15 Target Var Actual Target VarSpinal Inpatient ACC Revenue(in '000s) 537 439 97 537 439 97 Non-acute Rehabilitation ACC Revenue(in '000s) 321 300 21 321 300 21

Jul-15 Target Var Actual Target Var% Staff with Annual Leave > 2 years (1) 5.6% 5.0% -0.6% 6.2% 5.0% -1.2% 14

% Staff Turnover 0.6% 2.0% 1.4% 9.9% 10.0% 0.1% 15

% Sick Leave 2.9% 2.8% -0.1% 2.9% 2.8% -0.1% 16

Workplace Injury Per 1,000,000 hours 10.46 10.50 0.04 8.64 10.50 1.86 17


Jul-15 Target Var Actual Target VarFalls - % of falls assessments done in first 6 hours (2) 94% 100% -6.0% 94% 92% 2%Falls - % of Interventions completed 94% 100% -6.0% 94% 84% 11%Pressure Injuries - % of assessments done in first 6 hours 94% 100% -6.3% 94% 86% 8%Pressure Injuries - % of interventions completed 90% 100% -10.0% 94% 93% 1%Reduce over ride rate of Pyxis on ATR wards decrease medication errors to 15% 14% 15% 1% 14% 15% -1%

Jul-15 Target Var Actual Target Var

Stroke discharges - CVD risk profile, medications and 3 month follow-up100% 90% 10% 100% 90% 10.0%

Proportion of referrals managed via e-referrals across all Services (ARHOP) 10% 50% -40% 10% 26% -16%

Access to Outpatient specialist services -volumes of Geriatric A&R Hotline Calls 29 29 0 29 45 -16

QUARTERLY REPORTING

Jun-15 Target Var12 month

Ave Target Var% NASC referral to assessment - high complex within 5 days urgent < 24 hrs (or less), (new measure 2014/15) (3) 29% 75% -46% 29% 75% -46%% NASC referral to assessment - low complex clients <15 days (new measure 2014/15) (5) 70% 75% -5% 70% 75% -5%

Jul-15 Jul-14 Var Actual Target VarReduce number of patient 75’s or older LOS > 10 days in AT&R wards by 2% (4) 58 25 33 58 39 19 50.8Reducing direct admissions from GPs to ATR wards by 5% 28 27 1 28 24 4

% of Estimated Discharge date set following assessmentn in ARHOP 98% 97% 1% 98% 92% 6%Avoidable presentations to EC from Aged Residential Care Facilities (ARRC) 18 13 5 18 15 -3MMH % patients discharged to discharge lounge or home by 1100hrs 36% 38% -2% 36% 34% 2%Rehabilitation 7 day Readmissions rate 0.00% 0.0% 0% 0.0% 0.40% 0%Acute Readmission within 28 days - Total for Rehabilitation beds 3.0% 5.6% -3% 3.0% 7% -4% 53

QUARTERLY REPORTING Q3 Target Var Actual Target Var% +65years with long term HBSS - comprehensive clinical assessment &care plan 87% 75% 12% 87% 75% 12%Reported one quarter in arrears - Due after 20-10-15

Jul-15 Target Var Actual Target VarPatient Experience Survey 50% 90% -40% 50% 90% -40%


Jul-15July 14 Target Var Actual Target Var

Number of Spinal Rehabilitation Outreach Clinic days - (new measure 2014/15) 6 4 2 6 4 2 47

Year to date

Year to date

Equi

ty

Year to date

Syst

em In

tegr

atio

n (E

ffect

ive)

Year to date

Effic

ient

Year to date

`

Patie

nt

Wha

anau

Ce

ntre

d Ca

re n = 4 Year to date (n= 4)

Ensu

ring

Fina

ncia

l Su

stai

nabi

lity Year to date

Enab

ling

High

Pe

rfor

min

g Pe

ople 12 month average

Firs

t, Do

No

Harm

(S

afet

y)

Year to date

Tim

ely



1. The Division is continuing to monitor and manage high annual leave balances. Sick Leave rates also continue to be monitored and managed.

2. Falls, Pressure Injuries, and Medication assessments and intervention rates continue to be monitored and incidents investigated and reviewed by senior clinical and management team.

3. In addition to timeliness of assessments and number of current clients on InterRAI there is also a comprehensive Needs Assessment and Service Coordination (NASC) performance dashboard that has been developed and reviewed and refined monthly.

4. Further work to identify and improve service coordination across the organisation for complex older people with delirium and or dementia as a focussed process improvement has been agreed across mental health for older people, geriatrics, and emergency care acute general medicine.

Please refer to details below for further details on the key results.


Financial Results Statement of financial performance


514 390 125 32% Government Revenue 514 390 125 32%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%

47 33 14 44% Other Income 47 33 14 44%85 168 (83) (49)% Funder Payments 85 168 (83) (49)%

646 590 56 9% Total Revenue 646 590 56 9%


305 292 (13) (4)% Outsourced Costs 305 292 (13) (4)%428 347 (81) (23)% Clinical Costs 428 347 (81) (23)%111 109 (2) (2)% Infrastructure Costs 111 109 (2) (2)%

56 50 (6) 12% Internal Allocations 56 50 (6) 12%4,156 4,109 (47) (1)% Total Expenditure 4,156 4,109 (47) (1)%

(3,509) (3,519) 9 0% Net Result (3,509) (3,519) 9 0%

FTE 36 30 (5) (17)% Medical 36 30 (5) (17)%

197 208 12 6% Nursing 197 208 12 6%224 240 16 7% Allied Health 224 240 16 7%


STATEMENT OF FINANCIAL PERFORMANCE - ARHOP


($000's) ($000's)

Jul-15

-5,000

-4,500

-4,000

-3,500

-3,000

-2,500

-2,000

-1,500

-1,000

-500

-

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

200

400

600

800

1,000

1,200

1,400

Mon

thly

resu

lt $0

00's


Result Budget

2,000

2,500

3,000

3,500

4,000

4,500

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget



Quality

Safety

Pressure injuries There were nine pressure injuries recorded during the month of July, of which six were acquired during the ARHOP ward admissions.

Falls incidents There were 28 recorded falls in July; this is a decrease from 35 recorded falls last month. Of these there were three falls with harm, decreased from 11 during the month of June.

Medication errors incidents There were ten medication errors reported for July. This is consistent with the medication errors reported for June.

Staff Influenza Vaccination Update 74% of the ARHOP workforce has had their 2015 Influenza vaccination; this falls 11% short of the Counties Manukau Health uptake goal for 2015 of 85%.

Health & Safety Bi-Monthly Audits Audit Compliance based on ARHOP Division records of audits completed and received from services. All Operations Managers and Service Manager have attended the recent training provided by Occupational Health regarding new legislation and new responsibilities.

Timeliness

Acute Allied Health Outpatients Waitlist Activity Includes: Cardiac Rehabilitation, Physiotherapy Hyperventilation Service, Multidisciplinary Clinic, Occupational Therapist, Physiotherapist & Rheumatology Nurse Specialist (MORRSA), Musculoskeletal Outpatients (MSOP), Occupational Therapy Rheumatology, Pulmonary Rehab (Howick, Otara, Middlemore Hospital, Pukekohe), Women’s Health Gynaecology, Women’s Health Obstetric

Month YTD


Revenue: $56 $56





Internal Allocations: $(6) $(6)

The July month result reflects the positive affect of InterRai revenue and personnel costs below budget for Nursing and Allied; offset partly by Clinical Supplies overspend as detailed below. Overall (as indicated in the charts) there has been a reduction in costs from the previous period with the transfer of the Community RCs to the Localities GMs.

The favourable variance for the month is mainly due to InterRai revenue.

Medical Staffing is over budget $(29)k for the month mainly due to SMO requirements. The recruiting of staff at a lower level in Nursing has resulted in an underspend of $62k. The Allied Health vacancies, 9.8FTE and recruiting staff at a lower level wherever possible has resulted in a favourable variance of $21k for the month.

STATEMENT OF FINANCIAL PERFORMANCE - ARHOPJul-15

The main variances: Community Ostomy $(36)k overspend for the month and YTD, Patient Consumables (Burns Garments) $(35)k overspend for the month and YTD that is recoverable through the ACC pathway, Community Continence $(17)k overspend for the month and YTD. 2015/16 budget reflects reduced useage of clinical supplies.




Musculoskeletal Outpatients (MSOP) is making progress to reduce waiting list; in July it was reduced by approximately 50 patients. Positive change has been attributed to reducing initial appointments for post-operative patients to 30 minutes.

Cardio-respiratory Physiotherapy – Hyperventilation Services waiting list is high but stable. The service has increased the numbers of places in group classes in an attempt to reduce load. Staff are also currently investigating phone triage option to prioritise list.

Month Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Added 513 471 502 538 380 384 284 430 508 455 440 433 449 Seen 368 220 387 332 364 290 242 299 397 322 389 385 403 Removed Other 67 94 105 105 112 51 87 109 153 100 103 99 131 TOWL 819 830 865 928 846 908 881 941 907 958 925 891 863 Waiting > 150 days 10 17 16 31 36 51 75 97 81 80 67 51 40 Waiting > 120 days 31 22 45 41 32 63 63 58 61 38 28 37 25 Waiting > 90 days 65 97 62 79 94 110 113 113 85 66 111 101 62 Waiting > 60 days 148 120 147 159 115 140 The waiting list data is a reported as a point in time reflecting the number of patients waiting at the time the reported is generated. The reports are set to run in the early hours of the first of each month. Logically last month waiting plus added during the month less the seen and removed should give the numbers waiting for following month, however due to the lag in entering referrals and to a lesser extent removing patients, there will be always be a slight variance in this figure.

Efficiency

Needs Assessment and Services for Older People (NASC) Work continues on developing and implementing the new locality multidisciplinary model aligned to the At Risk Individual Programme, Reablement and Health Care Home, and developing pathways to align to community central model of coordinated intake and triage. The inpatient NASC team and NASC and Home Health Care Administration team decision document outlining the final structure has been sent out to the teams. Planning is underway for transition of these teams and recruitment to new roles throughout August.

0

100

200

300

400

500

600

700

800

900

1000

1100

Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15

Added

Removed Other

Seen

Total on Waiting List

Waiting > 90 days

Waiting > 120 days

Waiting > 150 days

Acute Allied Health Outpatient Waitlist Activity


Effectiveness

Dementia Pathway Implementation (Memory Team) The Memory Team is continually refining their processes. This month has seen the identification and assessment of the different documentation used to ensure consistency and minimise duplication. A process is underway looking at current data collection in relation to its use, collection method, and value to the team and Organisation.

The Community Stroke Early Supported Discharge Work has commenced on reviewing the Early Support Discharge (ESD) and Community Based Rehabilitation Team (CBRT) processes to combine the two teams into one seamless service. In the combined team the level of support patients receive will be determined by need, with early discharge continuing to be an option when the home environment and supports are appropriate. The aim of combining these two services is to ensure the delivery of early discharge options with timely rehabilitation support without loss in service continuity or rehabilitation gain. Recruitment has commenced to the additional approved roles; it is expected that it will take a further two months for all roles to be recruited and the full service delivery options to be available. In the interim cover options are being accessed from the inpatient team.

Community Geriatric Service (CGS) team An important component of the Systems Integration/Locality development is to provide additional Geriatrician support to primary care practices and aged residential care. The CGS team provided support to three primary care practices and six residential care providers during the month of July. 34 aged residential care facility staff attended the July education forum which was focused on pain management in arthritis.

Target: <100 Emergency Care presentations from residential facilities per month

<15 Potentially Avoidable Admissions

• July 2015 saw 112 Aged Related Residential Care (ARRC) Clients present to Emergency Care. Of these, 14 presentations were falls related and 18 were potentially avoidable admissions.

The National Spinal Strategy and Counties Manukau Health Spinal Service There have been 83 patients through the Acute Spinal Service since 1 July 2014.

Work continues with Burwood Spinal Unit on the development of a consistent approach to service delivery to meet the objectives of the New Zealand Spinal Cord Impairment Action Plan. Further progress has been made on the collection of information to capture the patient experience, inpatient questions have been shared, goal will be to align these as much as possible and share learning. The second patient stakeholder group has been held at Auckland Spinal Rehabilitation Unit, high level of enthusiasm of participants to contribute ideas to service improvement and planning, terms of reference for group are being developed.

The Fracture Liaison Service The Fracture Liaison Service Coordinator commenced in July after some delays to recruit. The new coordinator will work 0.6FTE. The focus over the first phase will be establishing assessment and treatment protocols, measurement and reporting.


Adult Rehabilitation and Health of Older People is aware that early patient experience data is starting to be reported and will be reviewing this data once refined to divisional/ward level. The process on the wards for collecting email addresses to promote better access to the survey will be reviewed. ARHOP will continue to work with the Patient Experience Team to develop a process for collecting the patient experience data via portable computer device, while patients/families are on the wards or during outpatient follow up appointments.


At the Auckland Spinal Rehabilitation Unit further progress has been made on the collection of information to capture the patient experience, inpatient questions have been shared, goal will be to align these as much as possible and share learning.

There were two compliments received during the month of July; one for Ward 5 complimenting staff and the second to staff at the Auckland Spinal Unit on behalf of His Royal Highness, Prince Harry for hosting him during his visit.


3.13 Medicine, Acute Care, and Clinical Support

Service Overview

The Division of Medicine, Acute Care and Clinical Support service is led by General Manager Brad Healey, with Clinical Directors/Heads Dr Carl Eagleton (Medicine), Dr Vanessa Thornton (Emergency Care), Dr Ross Boswell (Laboratory), Dr Sally Urry (Radiology & Breastscreen), Dr Mary Christie (Histopathology), and Clil Nurse Directors To’a Fereti and Annie Fogarty.nica

Performance Activity Summary

Volumes Month YTD Budget/ Contract

Last YTD

Act Bud /

Contract Var Act Bud /

Contract Var Forecast Act

Inpatient (WIES) Adult Acute Care 502 446 56 502 446 56 3,984 387 Adult Medical Care 2,423 2,197 226 2,423 2,197 226 24,155 2,262 Total 2,925 2,643 282 2,925 2,643 282 28,139 2,649 Inpatient (cases) Contract = Last year actuals

Adult Acute Care 1,353 1,246 107 1,353 1,246 107 15,085 872 Adult Medical Care 2,690 2,509 181 2,690 2,509 181 26,963 2,467 Total 4,043 3,755 288 4,043 3,755 288 42,048 3,339 Medicine O/P Procedural (contract) 323 654 (331) 323 654 (331) 6,285 364 FSA’s 1,168 1,247 (79) 1,168 1,247 (79) 15,435 1,235 Follow up’s 3,289 3,331 (42) 3,289 3,331 (42) 39,588 3,124 Emergency Care Presentations (against last year) 10,244 9,561 683 10,244 9,561 683 109,454 9,561

Breast Screening No. of screens 2,412 2,213 199 2,412 2,213 199 26,556 2,418


WIES The overall monthly WIES result reflects a 10% increase compared to contract and a 5% increase compared to last year. The results for General Medicine in July showed an 8% increase in WIES compared to contract and a 3% increase compared to last year.1

Cases This month we saw 7% or 151 more cases than this time last year, with a 2% increase in the ALOS compared to last year. General Medicine (inpatients) saw 8% or 135 more cases compared to last year and a 4% increase in the ALOS.2

Renal Volumes Continued increase above contract. Total 105 patients over in-centre capacity YTD including 32 in-centre dialysis patients outsourced, 24 patients in the Western Campus Prefab, and 49 patients on evening shifts in AMC and in Rito MSC. If numbers continue to grow at this rate an additional evening shift in-house, with additional staff, will need to be implemented.

Outpatients Data for July shows that FSA’s were 79 below contract and 20% lower than the same month last year. Follow-ups were 1% below contract for the month and 3% below the volumes compared to July last year. Education and management volumes remain higher than contract (+105%). Day patient procedural monthly volumes are now showing +14% variation to contract and volumes are 1% lower than last financial year.

Emergency Care In July 2015 there were 10,244 presentations to Emergency Care, an increase of 7% over last year. The volumes into early August have continued to be higher than in previous years and the graph below highlights that volumes are higher than previous years.

1 Source Total Inpatient WIES for Current fiscal period – Medical Service Book Run 2 2 Source Acute Care/Medicine Services ALOS and Cases for current fiscal period– Cherie Nouwens

2104

2046

2041 21

0220

1219

7821

1621

22 2143 22

0620

70 2102

2087

2055

2126

1902

2037

2012

1993 20

3021

0320

6520

6521

30 2156

2138

2297

2281

2282 23

20 2345 23

94 2437 2447

1,400

1,600

1,800

2,000

2,200

2,400

2,600

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52

Prese

ntatio

ns

Week

Weekly EC Presentations by Calendar Year

2011 2012 2013 2014 2015 UCL


A graph of average daily EC presentations is shown below:

Breast screening The service volumes for July were 9% above the monthly target.

Radiology July activity was slightly ahead of the same time last year primarily due to increased MRI scans from outsourcing and increased theatre volumes. Internal production of MRI scans is lower due to the reduced service hours as a result of vacancies in the MRI MRT team.


Laboratory Overall Laboratory workload increased by 6.1% compared to July 2014. With the exception of Histology, whose volumes fell slightly from the very high levels experienced in the last few months, July was the busiest month experienced by the remaining departments. A combination of sick leave, high workload and instrument problems impacted on Microbiology TATs. Other departments, despite the high workload, were not significantly affected by sick leave and had no major instrument failures.

Highlights

Emergency Care Despite exceptionally high volumes of patients and issues with staffing due to delays in recruitment and sickness we achieved the six hour LOS target in July 2015 and saw sustained improvements in our KPIs for antibiotic times for patients in sepsis and time to analgesia.

Medicine The Medical Assessment Unit continues to function well with the key benefits of co-location with EC in a single facility providing operational efficiencies. We are continuing to review our performance over this period to understand and quantify the benefits.

We are continuing to work on discharge templates for some conditions, e.g. TIA, pneumonia, CHF. There were 87 nurse facilitated discharges (weekday and weekend) in July which is significantly higher than in July last year.

We are continuing to work to increase the number of patients discharged by Medicine from hospital before 11am. In July 2015 over 17% of inpatients were discharged from the inpatient wards before 11am, and over 47% of the Medical Assessment patients were discharged from Medical Assessment before 11am.

The daily number of general medicine patients with a LOS of > 10 days continues to respond to the daily round up of the patients and regular twice weekly meeting with the Charge Nurses.

Cancer A regional and local planning process continues for the local provision of chemotherapy services. A regional working group has been established to ensure a consistent approach where required.

As part of the government’s 2014 budget initiatives funding was established to develop cancer psychological and social work roles. Recruitment is underway to establish two positions each for Psychology and Social Work. This is a very positive development and will significantly enhance the quality of care for cancer patients.

Medicine Outpatients An additional 8,348 patients were seen in the 12 months ended 30 June 2015 compared to the previous year in module 7/7a. Total combined FU and FSA attended at 7 and 7a for 2014-2015 was 55931 compared with 47583 in 2014. This has been influenced by better utilisation of clinic rooms from 65% to around 97% and ensuring all available slots are filled.

Pharmacy There were two finalists from Middlemore Hospital Pharmacy at this year’s Pharmacy Awards.

Emerging Issues

Cardiology With the Cardiac Catheter Laboratory closing for three weeks during the image intensifier replacement, this will place further pressure on the Standardised intervention rates (SIRs) for angiography and angioplasty. Unfortunately we have not met the national target for SIRs for quarter four. Although there are currently no barriers to accessing the Cardiac Catheter Laboratory and there are no delays in the system, this SIR result reflects the need of our population.


We are currently in the early stages of developing a regional process to deliver a plan for Cardiology services. Amongst other things, the plan will address the timing of the CMH second Cathlab (expected to be 2017/18) and workforce planning.

Gastroenterology Capacity Significant effort continues to be invested to grow our capacity from both a workforce and facilities perspective. Initiatives underway include growing the medical and nursing workforce (we have one new Fellow starting in August and recruitment continues for SMOs), General Surgery providing increased resource with three surgeons undertaking gastro lists, and the Gastroenterologists being released from providing General Medicine cover (December 2015). In addition we are planning for the introduction of Nurse Endoscopy (we have one nurse currently on the pathway) who we hope will be ready to commence the training programme in mid-2016.

From a facilities perspective we plan to have increased theatre capacity available at MHP in rooms 25 and 26 from September. This will enable two additional lists in room 26 when Urology moves in early September and either six or eight lists in room 25. Refurbishment of room 25 is necessary in order for the gastro scopes to be cleaned and dried to standard. The extent of the refurbishment is currently being planned.

The National Bowel Screening programme is likely to roll out from 2017. CMH is participating in national and regional meetings on this over the next month. We are also contributing to the regional work that is being undertaken to review options to further develop bowel investigation service provision.

Respiratory Pressure has increased on SMO follow up volumes with 296 overdue. A re-balancing of FSA: Follow up clinic slots has been completed to manage this, with close monitoring of the impact on FSA waiting times – this took effect from late July. Possible additional custom clinics may be required to manage the backlog, incurring additional cost – this will be monitored closely.

Laboratory In Infection Prevention & Control (IP&C) the sustained incidence of carbapenemase resistant organisms (CRO) is causing concern. Most are patients who have had contact with overseas health services e.g. India and Thailand. These organisms have a tendency to having major resistance profiles and the aim is to prevent these profiles from integrating with local organisms. Local CROs are also occurring but with less extreme antibiotic resistance profiles. IP&C is intensively monitoring any known cases and requesting area decontamination of environments. Improved cleaning in Emergency Care department is being investigated to reduce the risk of contamination and cross transmission.


Scorecard Service Scorecard Month

July 2015


Def

Jul-15 Target Var Actual Target VarTotal Caseweight 2,896 2,637 10% 2,896 2,637 10% 1

Elective Caseweight 52 48 8% 52 48 8% 2

Acute Caseweight (includes ICU) 2,844 2,588 10% 2,844 2,588 10% 3

Outpatient FSA Volumes 1,400 1,718 -19% 1,400 1,718 -19% 4

Outpatient Follow Up Volumes 7,229 7,353 -2% 7,229 7,353 -2% 5

Virtual FSAs 116 145 -20% 116 145 -20% 10

Jul-15 Target Var Actual Target Var% Staff with Annual Leave > 2 years 10.5% 5.0% -5.5% 9.6% 5.0% -4.6% 11

% Staff Turnover 8.7% 2.0% -6.7% 6.2% 10.0% 3.8% 13

% Sick Leave 3.1% 2.8% -0.3% 2.8% 2.8% 0.0% 14

Workplace Injury Per 1,000,000 hours 0 10.50 10.50 4.60 10.50 5.90 15


Jul-15 Target Var Actual Target Var% electronic medication reconciliation completed for high risk patients within 48hrs 71.0% 80.0% -9% 80.0% -80.0% 21

% Severe Pressure Injuries Per 100 Patients 0.0% 3.5% 3.5% 22

No. Falls causing major harm 0 0.0 0 0.0 0 23

Jul-15 Target Var Actual Target Var% MRI scans completed within 6 weeks from acceptance of referral 45% 80% -35% 55% 80% -25% 34

% CT scans completed within 6 weeks from acceptance of referral 92% 90% 2% 71% 90% -19% 35

Radiology - Inpatient radiology times < 24hours 93% 95% -2% 92% 95% -3% 36

Radiology EC radiology times < 2 hours 95% 95% 0% 95% 95% 0% 37

% diagnostic colonoscopy patients receive the procedure within 14 days 100.0% 60% 40% 75.4% 60.0% 15% 38

% diagnostic colonoscopy patients receive the procedure within 42 days 43.3% 60% -17% 28.1% 60.0% -32% 39

% surveillance colonscopy patients receive their procedure within 84 days of planned 79% 60% 19.4% 88.4% 60.0% 28.4% 40

% cardiac STEMI - PCI (angiography) within 120 mins - Northern Region Target 80% 80% 0.0% 81.9% 80.0% 1.9% 41

ESPI 2: No. patients waiting >5 mths for FSA - Elective ~ 0 0 0 0 -3 42

Medical Assessment – Triage3-5 patients seen by SMO within 60 min 67min 60min 3min 60 60 46

Laboratory -Test turnaround time (TAT) within 60mins average of results YTD 49

Potassium 96% 90% 6% 96% 90% 6% 50

Haemoglobin 99.3% 98% 1% 97.8% 98% 0% 51

PT/INR 99% 98% 1% 99% 98% 1% 52

Troponin 1 for EC 94% 90% 4% 93% 90% 3% 53

Histology - All - 5 working days 84% 90% -6% 90% -90% 54

-Breast - 3 working days 100% 100% 0% 100% -100% 55

-Non gynae FNAs - 5 working days 98% 100% -2% 100% -100% 56

Blood Bank - antibody screen within 4 hours 92% 90% 2% 90% -90% 57

Microbiology 90% -90%CSF cell count <30mins 82% 95% -13% 90% -90% 58

ESBL screens <2days 95% 90% 5% 95% -95% 59

CDT (C. diff Toxin) <25hrs 94% 90% 4% 90% -90% 60

UCHM (Urine Chemistry) <60mins 86% 90% -4% 95% -95% 61

Door to Cathlab suspected Acute Coronary Syndrome < 3 days (median time) 81% 70% 11% 84% 70% 14% 63

General Medince - Seen By Time (minutes)1st Time to be seen Triage 1 & 2 patients (median time) 26.00 <30mins 4.0 <30mins 30.0 64

1st Time to be seen Triage 3 - 5 patients (median time) 81.00 <60mins -21.0 <60mins 60.0 65

2nd Time to be seen Triage 1 & 2 patients (median time) 35.50 <30mins -4 mins <30mins 30.0 66

2nd Time to be seen Triage 3-5 patients (median time) 50.00 <60mins 10.0 <60mins 60.0 67

Year to date

Tim

ely

Medicine, Acute and Clinical Support Scorecard

Year to date

12 month average

Year to date

Ensu

ring

Fina

ncia

l Su

stai

nabi

lity

Enab

ling

High

Pe

rfor

min

g Pe

ople

Firs

t, Do

No

Harm

(S

afet

y)



Gastroenterology Gastroenterology’s performance against national MoH targets for colonoscopy (note that the targets have increased for the 15/16 year):

• 75% of P1s (urgent) will have their procedure within two weeks (14 days) • 65% of P2s (routine) waiting for a diagnostic colonoscopy will receive their procedure within

six weeks (42 days) • 65% of patients requiring surveillance colonoscopy will receive it within 84 days of the due

date

Colonoscopy

Feb March April May June July

P1 88% 100% 82% 96% 100% 100% P2 27% 33% 32% 38% 47% 40% Surveillance 89% 69% 69% 82% 60% 66%

QUARTERLY REPORTING Q1 Target Var Actual Target VarFaster Cancer Treatment - % high suspicion first cancer treatment within 62 days - MOH FCT + 67.0% 85% -28% 56.8% 85% -28% 68

Faster Cancer Treatment - %confirmed diagnosis first cancer treatment within 31 days - MOH

86.3% na 90.0% na 69

% radiology results reported within 24 hours 60.0% 75% -15% 59.0% 75% -16% 70

Jul-15 Target Var Actual Target VarAverage Length of Stay - Acute 2.3 2.59 0.29 2.3 2.59 0.29 71

Average Length of Stay - Acute Arranged / Elective 1.9 3.30 1.00 1.92 3.3 1.38 72

Acute Readmissions within 7 days - Total 4.7% 3.0% -1.7% 4.7% 4.4% -0.3% 73

Acute Readmissions within 28 days - 75+ - MOH IDP 12.9% 10.0% -2.9% 12.9% 14% 1% 75

% transcribed clinical summaries (meddocs)authorised <7 days of creation 95% 95% 0% 70.7% 95% -24% 76

% of patients on home wards in General Medicine 52.1% >75% -23% 80

% of Outliers on non-medicine wards 7.9% 0.0% -7.9% 5% 0.0% 81

QUARTERLY REPORTING Q4 Target Var Actual Target Var% eligible stroke patients thrombolysed - Northern Region Target 6.1% 6% 0.1% 7% 6% 0.5% 84

Stroke patients on stroke pathway 81.0% 80% 1.0% 70% 80% -10.0% 85

Jul-15 Target Var Actual Target Var% Discharges from transit lounge or home by 1100hrs 17.5% 30% -12.5% 30% -30% 89

% MA short stay patients discharged home from Medical Assessment 85% 80% 5.0% 80% 90

% of patients < 28 hrs discharged from inpatient wards 13.5% <10% -3.5% <10% 93

94

Implement Home First Renal policy - (increase CAPD & HD rate) 45% 50% -5.0% 50% -50.0% 95

Jul-15 Target Var Actual Target VarPatient experience Survey data - month (n=48) and YTD (N=48) 75% 90% -15.0% 75% 90% -15.0%Implementation of Advance Care Planning - number of conversations 589 218 372 5,135 2616 2512 95


Jul-15 Target Var Actual Target Var% Women with Breastscreen in last 24 months - total 2411 2213 +198 69.8% 70.0% 0% 98

% Women with Breastscreen in last 24 months - Maaori 223 261 -38 67.6% 70.0% -1% 99

% Women with Breastscreen in last 24 months - Pacific 443 392 +51 78.7% 70% 8% 100

Tim

ely

YearSy

stem

Inte

grat

ion

(Effe

ctiv

e)Ef

ficie

nt

Volumes Screened

Equi

ty

Year to date

Patie

nt W

haan

au

Cent

red

Care

Year to date

Year

Year

% Screened in last 24 Months


Waiting List

Feb March April May June July

Colons 1179 1081 948 871 807 736

The above tables show: 1. P1 and Surveillance targets have been met 2. A decrease in the P2 target for July due to annual leave reducing productivity 3. A reduction in the colon waiting list of 443 patients since February (38%)

Faster Cancer Treatment – 85% high suspicion first cancer treatment within 62 days • 72% of patients commenced treatment within 62 days in July. • 85.5% of patients receiving treatment within 31 days of decision to treat.

We have planned to meet the indicator by 30 September 2015 (with a requirement by MoH to meet the indicator by 30 June 2016).

Our plan reflects the following:

(i) Establishment in March 2015 of FCT programme with leadership from the CEO and support from ELT and Ko Awatea

(ii) Establishment of project workstreams to address the issues identified from comprehensive process mapping and data analysis.

(iii) Involvement of key FCT project members with regional FCT working group and liaison with MoH as appropriate

Acute Stroke Care – 80% of patients with stroke are admitted to the stroke unit/under an organised stroke pathway

• 81% achieved for quarter four. • A plan is in place to maintain and improve this level with collaboration from the inpatient

and community rehab teams and Emergency Care

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

CM Health FCT Performance

62-Day progess

62-Day Target

Plannnedachievement


Radiology – Diagnostic Access Targets CT: We achieved 92% in July against the target of 95%. Monitoring of the waiting list and adherence to the indicator remains challenging with weekly fluctuations in demand. There is also variation in demand in the types of procedures with increases in CT colonography, CT cardiac angiography and CT guided interventional procedures. The scheduling and staff rostering requires weekly alteration according to the type of demand.

There is a significant challenge ahead with addressing the CT cardiac angiography referrals with a backlog developed as a result of equipment downtime (and postponement of three sessions of scanning) and increased demand. Our plan to address this involves additional sessions being undertaken, however this issue will negatively impact the indicator through August and September.

MRI: In July 45% of elective patients were scanned within six weeks compared with 40% in June. In-house production was down due to loss of an MRI trained MRT which reduced service capacity. Outsourcing continues to help mitigate the impact of reduced capacity.

Percentage of Radiology reports completed within 24hrs: A combination of less SMO leave, use of digital dictation (rather than the poor performing voice recognition) and re-introduction of out of hours reporting improved the July result to 60%. Focus on the poor performance of the PACS and voice recognition continues with network and device monitoring now in place across the three Auckland DHB’s. Results of this monitoring should become available in August.

In-patient and EC patient completion times: Overall the performance against the targets remains consistent. However, in July there was additional in-hospital demand in MRI, Ultrasound, CT and General x-rays. This reduced the individual modality performance

Laboratory Despite the record test volumes the laboratory overall performed well, meeting most performance targets. Microbiology failed to meet two of four targets, largely due to high levels of sick leave, high workload and instrument problems. Histology reporting TAT slipped slightly from June, but were still significantly improved from the low levels in late 2014.


Financial Results Medicine statement of financial performance



57 66 (9) (14)% Other Income 57 66 (9) (14)%107 74 33 44% Funder Payments 107 74 33 44%

319 417 (98) (24)% Total Revenue 319 417 (98) (24)%


272 208 (64) (31)% Outsourced Costs 272 208 (64) (31)%1,368 1,387 20 1% Clinical Costs 1,368 1,387 20 1%

258 259 1 0% Infrastructure Costs 258 259 1 0%646 724 77 (11)% Internal Allocations 646 724 77 (11)%


FTE153 166 13 8% Medical 153 166 13 8%407 423 16 4% Nursing 407 423 16 4%

50 51 1 2% Allied Health 50 51 1 2%43 44 1 2% Management/Admin 43 44 1 2%

653 684 31 5% FTE Total 653 684 31 5%

STATEMENT OF FINANCIAL PERFORMANCE - MEDICINE


($000's) ($000's)

Jul-15

-8,600

-8,400

-8,200

-8,000

-7,800

-7,600

-7,400

-7,200

-7,000

Mon

thly

resu

lt $0

00's

Monthly Net Result

Series3 Series4

-

800

1,600

2,400

3,200

4,000

Mon

thly

resu

lt $0

00's


Series3 Series1

4,600

4,800

5,000

5,200

5,400

5,600

5,800

6,000

6,200

6,400

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Series3 Series4


Medicine commentary on major financial variances

Month YTD


Revenue: $(98) $(98)


Current Mth:-


Current Mth:-




Current Mth:-$26k - PCT Drugs underspent: Clinical Haematology due to Velcade 11% under 14/15 average

$30k - Rheumatology Rituximab drug volumes down 29%

$(64)k - Outsourced colonoscopies to meet MOH targets

$157k - Net Annual leave favourable due to school holidays in July.$(65)k - Unbudgeted positions funded externally (offset by revenue) - (9.5)FTE

Jul-15

Other income: $(11)k - Misc Funder Payments: $33k - 20k Funding for Better Breathing project. ($27k revenue still to come)

Government Revenue: $(120)k - Lower PCT revenue for the month due to timing of claims processed. Part offset by lower PCT drug spend below.

The division reported a $39k favourable variance against budget for the month.This is mostly due to savings in staffing costs due to high annual leave uptake during the school holidays.Medicine WIES volumes were 1.5% up on contract for July.

Current Month:-

$166k - Vacancies 17.4 FTE's$(155)k - additional duties offset by vacancies

STATEMENT OF FINANCIAL PERFORMANCE - MEDICINE

The year end forecast is for the division to meet budget

$0Year end Forecast variance to Budget

$21k - Gastro - due lower number of Influximab doses (5% lower than last 12 month average)


Clinical Support statement of financial performance




801 758 42 6% Total Revenue 801 758 42 6%


500 441 (59) (13)% Outsourced Costs 500 441 (59) (13)%3,222 2,966 (256) (9)% Clinical Costs 3,222 2,966 (256) (9)%

247 260 13 5% Infrastructure Costs 247 260 13 5%(1,670) (1,644) 26 2% Internal Allocations (1,670) (1,644) 26 2%

7,128 7,003 (125) (2)% Total Expenditure 7,128 7,003 (125) (2)%(6,328) (6,245) (83) (1)% Net Result (6,328) (6,245) (83) (1)%

FTE70 78 8 10% Medical 70 78 8 10%39 41 2 5% Nursing 39 41 2 5%

299 311 12 4% Allied Health 299 311 12 4%0 1 1 100% Support 0 1 1 100%


STATEMENT OF FINANCIAL PERFORMANCE - CLINICAL SUPPORT


($000's)

Jul-15

($000's)

-6,400

-6,200

-6,000

-5,800

-5,600

-5,400

-5,200

-5,000

-4,800

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

1,000

2,000

3,000

Mon

thly

resu

lt $0

00's


Result Budget

2,000

4,000

6,000

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget


Clinical Support commentary on major financial variances

Month YTD

Total Variance: $(83) $(83)

Revenue: $42 $42






Current month:-$20k - Annual leave taken higher than accrued due to school holidays in July$(25)k - Unbudgeted Allied Health salary provision$198k - Vacancies - Lab 6.7fte, BScreen 3.4fte, Pat Info 4.6 fte (incls 1fte delayed recruitment of newly approved position), Rad 19fte (incls 6.2 fte Sonographers due to national shortage and 5.5fte newly approved positions not yet filled).$(35)k - Radiology additional sessions $20k u, Lab penals/OT to address 6% volume increase $15k u.$(2)k - Externall funded positions - Patient info 0.5 fte funded by the Gateway project$(5)k - Microbiology unbudgeted Winter positions, 2 FTE started in Mid Jul15

Current month:-$(77)k - Additional outsourced MRI scans to meet MOH target by Oct15.$16k - Savings Lab sendaway tests

Current month:- $(158)k - Blood products overspend mainly due to high cost procedures.$(92)k - Labs - testing kits due to volume increase of 16% in Microbiology and 14% in Histology.



STATEMENT OF FINANCIAL PERFORMANCE - CLINICAL SUPPORTJul-15

Current month:-The division was $(83)k unfavourable for the month of July.

This was mainly due to an overspend in the Laboratory service, driven by high volumes resulting in overspends in bloods & clinical supplies.These were partly offset by savings from staffing costs, due to a high uptake of annual leave for July school holidays.


Acute Care statement of financial performance

Jul-15


0 0 0 0% Government Revenue 0 0 0 0%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%4 0 4 0% Other Income 4 0 4 0%0 0 0 0% Funder Payments 0 0 0 0%4 0 4 0% Total Revenue 4 0 4 0%


19 23 4 16% Outsourced Costs 19 23 4 16%265 246 (19) (8)% Clinical Costs 265 246 (19) (8)%138 122 (16) (14)% Infrastructure Costs 138 122 (16) (14)%112 86 (26) 30% Internal Allocations 112 86 (26) 30%


FTE 56 55 (1) (2)% Medical 56 55 (1) (2)%

213 224 11 5% Nursing 213 224 11 5%0 1 1 100% Allied Health 0 1 1 100%0 1 1 100% Support 0 1 1 100%


STATEMENT OF FINANCIAL PERFORMANCE - ACUTE CARE


($000's) ($000's)

-3,400

-3,300

-3,200

-3,100

-3,000

-2,900

-2,800

-2,700

-2,600

-2,500

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

100

200

300

400

500

600

Mon

thly

resu

lt $0

00's


Result Budget

-

500

1,000

1,500

2,000

2,500

3,000

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget


Acute Care commentary on major financial variances

Jul-15Month YTD


Revenue: $4 $4


Outsourced Costs: $4 $4



Internal Allocations: $(26) $(26)

This variance is mostly due to savings in staffing costs due to high annual leave taken over the July school holidays.This is partly offset by overspends in clinical supplies driven by high volumes in EC.

STATEMENT OF FINANCIAL PERFORMANCE - ACUTE CARE

The year end forecast was for the division to meet budget.

The division was on budget with a small favourable variance of $17k for the month of July.

Current month:-


Year to date:-

Volumes in EC were 7% higher than this time last year (10,244 presentations vs last year 9,561).

$71k - favourable variance due mostly to annual leave taken higher than accrued due to school holidays in July.


Quality Safety

Improvement in management of IV peripheral catheters A suite of bedside measures to reduce patient harm relating to peripheral IV catheters, including the Visual Infusion Phlebitis (VIP) score (a tool to measure / assess peripheral IV sites ) has been introduced. A process to ensure confirmed peripheral IV catheter related bacteraemia are investigated and reported via the CMH incident reporting system has been endorsed by the Infection control committee.

Management of patients with electronic monitoring devices The management of patients who are under Corrections has resulted in an undertaking by the Security Service to provide a policy/guideline for staff.

The use of social media to raise concerns

The increase in the use of social media as a way for patients and family to communicate with others and to raise their personal issues is an increasing phenomenon. We need to ensure that our staff are sufficiently supported to deal with any concerns about their personal information or images that may be shared on social media sites. Any staff who become aware that material has been posted on social media in relation to care that has been provided to a patient, either by the DHB or by them personally, should refrain from adding comment themselves, but should contact their Divisional Quality and Risk manager. This matter was raised at a recent HSQC panel discussion and this approach endorsed.

Renal outpatient falls working group

The renal outpatient falls working group have finalised an intervention tool, created a falls patient information leaflet, and developed a falls package. Following consultation with the renal operational group, PDSA cycles will be initiated in AMC.

Falls working group

A prompt list has been designed to guide managers in the appropriate assessment of fall incidents in the organisation and a trial and implementation process is to be discussed.

Efficiency

Gastroenterology

Systems and Processes: • Referrals Management – Work continues to refine and streamline referrals. As part of the

Nurse Endoscopy training, a nurse will start to triage surveillance referrals from September. • Procedure session Utilisations - increased to 92% for July. • For June lists utilisation was 100%. Lists are booked to the regionally agreed limit of 12

points, eight for a training list (two per week) and 10 for a list with acutes.

Production Planning: • Production plans are updated weekly. Review of production plans now includes the

increased MoH targets of 75% for P1s (colonoscopy within 14 days), 65% for P2s (colonoscopy within 42 days) and 65% for surveillance (within 84 days of due date).

• The production planning tool is being used in CT and over the past month has been rolled out of MRI. The tool is providing a much greater level of detail than previously available to allow us to forecast what activity is required to meet demand. The ability for MRI production to flex is more limited than for CT due to less available capacity.

CTC:

The graph below shows CTC verses Colonoscopy over the last two years.


Percentage of CTC versus Colonoscopy

Note: Data is sourced from Decision Support and may differ from data within Radiology and Gastroenterology.

• A plan to increase the rate of CTCs done from the current rate to 25% of all colon procedures is underway.

• Based on Decision Support monthly data for June, PUC colonoscopies versus CTC, 22% of all colon procedures were CTCs.

Data also demonstrates that the number of CTC to colonoscopy has increased in the last two years

Effectiveness

Renal Outsourcing of a managed service to provide in-centre haemodialysis:

• Contract negotiations between CMH and Diaverum continue. • Service set-up to commence on signing of the contract with a tentative go-live date of late

January.

Feet for Life To reduce the burden of foot disease in renal patients and reduce ALOS and amputations:

• Continued funding for podiatrist in the renal units approved. • Project has been accepted as a finalist in the International Health Excellence award at APAC.

Diabetes - Inpatient Care for People with Diabetes To reduce the length of stay and readmissions for patients with diabetes in CMH who are inpatients:

• All systems for managing in patients are in place


Renal Improvements in Live Organ Donation:

This is a four year project, with $1.8m funding from the MoH • Community Engagement- Phase ll Market Research. Company doing work through August

and findings will be presented to the Steering Group in September. • Pre-dialysis evaluation completed- development of questionnaire for patients now delayed. • Web site to be improved based on feedback from patients and will include patient story

videos along with patient blogs. • Resource material to be reviewed and updated based on feedback from focus groups. Focus

groups not well attended so groups to be phoned re feedback. • Business cases for ongoing funding for FTE and resource material when the project is

completed underway.


Advanced Care Planning To implement Advanced Care Planning (ACP) in the Renal Service in order to have documented plans for treatment choices available:

• NP intern has had 16 first conversations, with four new signed off plans • NP intern also developing guidelines on how to implement ACPs with Tongan patients

BreastScreen Breast Screen Aotearoa (BSA) is carrying out a Tracer project, and will interview two Māori women from each lead provider who have used our service over the last month and the staff who have been involved in their screening and assessment processes. They plan to interview the first BSCM candidate on 17 August and another in October. The aim of this project is to understand and improve the experience for Maori women in BSA.


3.14 Facilities

Service Overview

The Facilities division includes Clinical Engineering, Equipment and Assets Services, Non-Clinical Support Services, Engineering and Facilities. The General Manager is Greg Simpson.

Performance

Activity Summary • Regional Furniture tender is progressing with healthAlliance and shortlisted to two vendors.

The Tender has progressed with trials with specific furniture. Scoring is scheduled for mid-August 2015. Occupational health and Infection control is involved in the process.

• Implementation of the Enterprise Asset Management (EAM) process has now progressed to implement the Oracle project modules and interface. Changes to the CAPEX process has been well received by Asset and Capital.

• Food Services working towards implementation of the new food service involving set up of website to enable user friendly documentation for Task Manager Meal Information (TMMI) ward users, TMMI training, making changes as TMMI is gradually rolled out.

• CSB Laboratory: Tender and consent documents have been issued. Tenders closed on 10 Aug 2015 and next step is shortlisting and engagement of possible vendors.

Highlights

• The highlight for July 2015 was the graduation ceremony. 205 cleaners currently employed at CMH have graduated with the NZQA National Certificate in Cleaning and Caretaking. CMH is the first DHB to have the first cleaner to qualify nationally and we are the only DHB to have over 100 participants.

• We are currently in discussions with recruitment for a possible scholarship programme for

year two students on the New Zealand Diploma of Engineering programme (NZDE) to specialise in Clinical Engineering.

• Training underway for sample wards with Ward Information System (WIMS) diet codes transcribed to the new national diet codes being ordered via TMMI. Certain installations for B Pods (new food heating and handling system) have been completed in the Kitchen by Engineering.


• CSB Phase 2 -The building services design for the CSB Project recently achieved an Association of Consulting Engineers ACENZ Innovate Gold Award of Excellence, one of three given across the entire country and the only one for a building. The award is in addition to the Excellence Award given earlier by the NZ Property Council.

Emerging Issues • Additional copper/silver ionisation plant temporarily installed at EHB domestic hot water to

boost legionella control levels. Installation redesigned and alterations in progress to give better flows through the ionisation unit.


Financial Results



0 0 0 0% Government Revenue 0 0 0 0%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%


52 43 9 22% Total Revenue 52 43 9 22%

EXPENDITURE1,956 1,920 (36) (2)% Staff Costs 1,956 1,920 (36) (2)%

19 0 (19) 0% Outsourced Costs 19 0 (19) 0%34 29 (5) (18)% Clinical Costs 34 29 (5) (18)%

1,861 1,812 (49) (3)% Infrastructure Costs 1,861 1,812 (49) (3)%0 0 0 0% Internal Allocations 0 0 0 0%

3,870 3,761 (109) (3)% Total Expenditure 3,870 3,761 (109) (3)%(3,818) (3,718) (100) (3)% Net Result (3,818) (3,718) (100) (3)%

FTE17 18 1 7% Allied Health 17 18 1 7%

406 422 16 4% Support 406 422 16 4%24 26 2 7% Management/Admin 24 26 2 7%

446 465 19 4% FTE Total 446 465 19 4%

**Jun14: Recovery of motor vehicle lease costs

**Jun14: Recovery of motor vehicle lease costs

STATEMENT OF FINANCIAL PERFORMANCE - FACILITIES


($000's)

Jul-15

($000's)

-4,400-4,300-4,200-4,100-4,000-3,900-3,800-3,700-3,600-3,500-3,400

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

500

1,000

1,500

2,000

2,500

Mon

thly

resu

lt $0

00's


Result Budget

-

500

1,000

1,500

2,000

2,500

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget



Quality

Safety • We are currently working through the difficulties with the implementation of the new food

service particularly with regard to patients requiring modified texture diets and exclusion diets.

• Matariki: Minor alterations continue in the toilets to resolve the health and safety issue of doors hitting people when opened, and cosmetic changes to toilets to repair cracked pans.

• Programme work for removal of asbestos backed vinyl tiles in Galbraith basement is underway.

Timeliness • Jobs are completed within acceptable timeframes (resource dependant) and any major

delays are indicated to the services. Strategic and consultancy services have been deliberate due to senior members having to focus on day to day operational tasks and equipment maintenance.

Efficiency • Meal deliveries to the wards have improved this month with adjustment to the new

implementation.

Month YTD

Total Variance: $(100) $(100)

Revenue: $9 $9

Salaries & Wages: $(36) $(36)





STATEMENT OF FINANCIAL PERFORMANCE - FACILITIES

Total Employee Costs were $(36)k unfavourable for the month:Current month:-Clinical Engineering - 3 FTEs vacancies to be filled.Non Clinical Support - 2 FTEs vacancies to be filled.Cleaners $(5)k and Orderlies $(31)k - additional cleaning and orderly service requests due to increasing clinical demand - spinal patients in ICU and in ALBU and Discharge Lounge, high use of in-house casual pool staff to cover vacancies, annual leave, sick leave taken, and new staff training.'In-house' casual staff are being managed within the service.

Overall, the Division was $(100)k unfavourable for the month.This is due to higher clinical demand in cleaning and orderly services and ongoing requirements of Facilities R&M.

Jul-15

Outsourced staff costs were unfavourable due to covering vacancies in Clinical Engineering, sick leave cover in Engineering, helpdesk and maternity leave cover in Facilities Management.



Current month:-Infra-Structure Costs $(49)k unfavourable including R&M (account 5151 - 5159) $(117)k; partly offset by favourable variances in Utilities $16k, MV Leases, Fuel, Registration and R&M $31k.

$0


Effectiveness • Portable Real-time Task Assignment Link (PORTAL) has gone live and is in a staged roll out.

The staffs have been fully supportive of the initiative. Further roll out of the system will include EC, Radiology, Maternity, and Theatres.

• Build projects of Mental Health, Plastics See and Treat, and CSB laboratory equipment is underway. Selection and purchase of equipment included in the design are at different stages of completion to support the construction process.

• Replace indicator Anaesthetic Gas Scavenge (AGS) run lights in Burns Unit with long life LED’s. AGS has been running unnecessarily causing premature failure of exhaust fan in Burns Unit.


3.15 Director Allied Health Report Allied Health Directorate Development Ongoing focus work of the Directorate continues to be:

• He Pou Oranga Service Re-Design Framework subsumed by community integration work. o Currently nine Allied Health Assistants working through level three Careerforce training

as pilot group. We aim to have their training completed by the end of the year to support this work, with plans to expand this training in 2016.

• Launching and imbedding the Allied Health Initiative for Education and Development (AHIED) o Inaugural Allied Health Grand Round is planned for 30 September 2015 and will be live

streamed to the external sites, as well as video-recorded and available on Southnet. We aim to have a monthly Allied Health Grand Round.

o Dr Sarah Mitchell from NHS Scotland has accepted an invitation to present the Allied Health focus session as part of APAC 2015.

• Undertaking a stocktake and establishing a strategic direction for Allied Health research. • Working closely with our tertiary partners to improve the diversity of the AH trainees and

ultimately CMH workforce. o Allied Health Expo has been arranged for the morning of 14 October 2015 as part of the

Allied Health Celebration. Local high school children as part of the health academies will be invited to learn about a range of Allied Health careers.

Allied Health Celebration The fifth Allied Health Celebration will be held on 14 October 2015 in Ko Awatea from 12 - 3pm with keynote speaker Michael Bishop. Nominations will open at the end of August and there will be more communication about this to all staff through Daily Dose. Again this year we are planning to hold an Allied Health Careers Showcase for local school students and staff to come along and find out more about Allied Health careers. This will be held on 14 October 2015 from 9am -12pm in Ko Awatea. Other work PSA Bargaining small group ongoing. Whilst there has been agreement on the majority of issues there are still a few minor outstanding matters that are unique to Auckland.


3.16 Director of Nursing Report Nursing Strategic Action In early 2014 a collaborative team led by Clinical Nurse Director, Jacqui Wynne-Jones, created the Patient Safety Leadership Walk Rounds. In the Leadership Walk Rounds, a team of six CMH staff visits a ward or unit to discuss patient safety. In July, the group visited the Medical Assessment Unit of Emergency Care. The group this month included the Chief Medical Office, Laboratory Clinical Head, General Manager SCC, Manager MMC, OCHS manager, Patient Care Advisor, and Quality & Safety staff interviewed staff about how safe they believed the unit was and interviewed a number of patients to gather their perceptions of how safe they felt in this area. On this day, Helen Bevan – Chief Transformation Officer of NHS Improving Quality was also attending to support the initiative. In late July, the Minister of Health announced that the Government is committing $846,000 to support an additional 20 nurse practitioner trainees in 2016. Recognising the value of Nurse Practitioners as highly educated and experienced, and a key part of our health workforce, due to their advanced skills and prescribing authority, Nurse Practitioners are a growing resource in primary care. In the announcement, the Minister stated “They can provide a wide range of assessments and treatment for patients, and they also play an important role in providing care closer to home, particularly in regional or remote areas. The Government is supporting an additional 20 nurse practitioner trainees in 2016. We want to see more patients getting the care they need away from hospitals. To support this we need to further harness the skills of our workforce.” The University of Auckland and Massey University will provide a new education programme for the 20 trainees. It will offer more supervised practice time and require employer support to ensure graduates can practise in their advanced roles as soon as they qualify and register as nurse practitioners. Most recent data provided to the Nursing Council reported CMH attained 92% compliance with Professional Development/ Review Plans (PDRP) for nursing staff. Counties also acts as an accredited agent for several Aged Care related Units and Primary health organisations. There is ongoing discussion with national DON group, Tertiary providers and Occupational Health and safety regarding the requirements and responsibility for student immunisation/ vaccination status. The current arrangements are unclear, particularly regarding follow up with pre-placement students. The current regional student contract identifies a requirement for screening for Hepatitis B; Varicella zoster; Mumps; Rubella and Morbilli, (and Pertussis, where they may be working with neonates and vulnerable infants). There is a recommendation for immunisation for students, but it is currently at cost to them. Pre-employment screening is mandatory for staff, immunisation is recommended for all staff, and offered at no cost for staff. Working through these issues with the wider sector will continue. HSQC have been in communication with DHBs regarding consideration for national investment in reducing harm from Pressure Area/Injury and for Deteriorating Patients. A process of sector engagement and consultation is now underway. There have been an increase number of reported issues related to the new Food Services arrangements with staff/ patient complaints centred on the ordering processes, the quality of the meals, and the delivery time of the trolleys. A number of remedial actions and communications with Medirest / Compass are ongoing as this comprehensive change process is implemented. A consultation process is currently underway to consider the impact of a transfer of reporting lines and staff at Pukekohe/ Franklin to the Locality team for operational management.


Sustainable Nursing workforce Nursing recruitment at CMH remains high, at the end of July, there were 118FTE recruit-able vacancies listed – a decrease from the 129FTE in June. Data reports on skill mix and ward staff composition are provided to Service and Clinical Leads to inform discussions on workforce mix and planning. The upgrade of One Staff (electronic rostering system), is about to take place. This upgrade fixes a number of bugs in the system and will not significantly change how staff members use the One Staff application. The upgrade will also enable the introduction of a new web scheduling tool to view and manage rosters, and introduces an acuity tool that measures and assigns workload across the inpatient wards. The new Web Scheduling tool will enable staff to view rosters electronically from a PC, tablet, iPhone or iPad anywhere, with a correct log on. This will enable staff to apply for shift requests including view who to swap with, apply for annual leave, and see what other shifts are available in their work area. The Assignment and Workload tool enables nursing staff to accurately capture their shift workload on the ward and provides visibility of how this workload is distributed across the ward, service, division and hospital wide. Medical Wards 2, 33 East and 33 North are first to implement this new system and are excited by the opportunity it provides for capturing the workload of the wards. A pilot in Emergency Care is about to commence that will test the development of a pathway for Enrolled Nurses into EC. This follows a successful EN clinical Placement. Emergency Care is considering review of the Model of Care in the Assessment Area to incorporate EN scope. Workforce – Bureau The organisation-wide focus on quantifying the drivers and variation in current rates of use of internal nurse pools and bureau resources continues. July use of Bureau was stable against June 15, despite high ward nurse vacancy and the seasonal increases in unplanned leave. However, compared to July 14, there has been a significant increase in hours for both RN/RW (1,804 more hours), and HCA (5,293), with HCA watches increased by 3,596 hours on 12 months ago reflecting the winter use of the Delirium Risk and Falls risk tools. Given the demand, the proportion of hours provided by external bureau further increased from 14% to 28% of the total (although for Registered Nurses this is more stable than HCA rates). Some of the July stability may be attributed to Bureau staff choosing not to work during school holidays, even when the service demand was higher. Within this, most areas managed rosters to ensure staff could take annual leave for school holidays, and annual leave for nursing was the highest amount since summer. Primarily, the ongoing growth in bureau hours can be attributed to the greater use of HCA watches, in particular on surgical wards this month. For July, watches comprise 35% of all HCA FTE used, and in Medical Wards this is at 68% and Surgical at 58% of HCA use. In July, there was an average of 320 hours of watches per day, up from average 300 hrs in June. Within this, Medicine achieved a reduction in the average from 146 hours to 114 hours, while Surgical increased from 123 hours to 147 hours each day.


Monthly per ward reporting is helping to highlight variation and improve accountability. This is helping services to review current practice and test options. The challenge remains to sustain constraint into winter, and address the drivers of the increase arising over the last 12-18months. Highlights from Services The Surgical Assessment area in Emergency Care is working well, since opening in late June. Feedback from the surgeons and unit staff is positive and the evaluation of the new model will commence after winter peak. The winter initiative in Kidz First of a PM Shift Co-ordinator is working extremely well, with positive feedback from all stakeholders at the first post implementation review meeting. The Clinical Nurse Director – KF/ Women’s Health recently attended the 18th Annual Cook Islands Health Conference to present a paper on the I.N.F.A.N.T.S. Programme. This follows the work undertaken from our pacific development Unit in Fiji which appears to be making a difference in health outcomes for young children. The Kidz First Surgical CNS’s are now case managing the long term Rheumatic Fever (RF) children alongside Dr Ross Nicholson. This is a great learning opportunity for them to work closely with the patients alongside the SMO and learn valuable assessment/ diagnostic skills. A recent audit by Dr Nicholson has identified a 50% reduction in RF admissions for the first 6 months of this year compared to the same period last year. The Kidz First Medical CNS has commenced work on a bronchiolitis and asthma action plan for discharge in consultation with SMO’s. ARHOP Ward 5 visited by Waitemata DHB Consultants eager to learn about the Acute Care of Elderly (ACE) model of care, and the “How-to Guide” for ACE model is currently being completed. In recent weeks, there has been an increase in bed occupancy, particularly for Ward 4 with medical outliers admitted and discharged within 24hours. Although the winter demand has increased, patient flow to AT&R is being managed in a timely manner. ARHOP has achieved a decrease in the use of watches, with Ward 4 only requiring 26 watch shifts compared to 70 in April as a consequence of a number of other strategies being used. A new bed alarm has recently been demonstrated, that may be more effective than the current ‘invis-beam’ system. Mental Health and Addictions are responding to the changing needs and treatment regimens for community and Tamaki Oranga clients. High numbers of people on Injection therapy (IMI) are creating the need for community teams to review how these clients are best served. Some teams are running highly successful IMI clinics, using Sensory Modulation as the method to help distract ensure this is done in a calm and therapeutic manner as possible. Awhinitia team are finding the high numbers of clients on the wait list for Cognitive therapy is a strain on resource, mitigation strategies are being investigated. Stepping up the recruitment of Registered and Enrolled nurses for Mental Health and Addiction is currently a top priority. Recently a contingent of nurses attended the Te Ao Māramatanga , NZ College of Mental Health Nurses conference at Te Papa , Wellington. Anne Brebner Clinical Nurse Director reported back “I felt very proud of their presentations, their professionalism and how they represented Counties Manukau Health”.

Inpatient Experience – One Year On Our patient experience survey started with 51 completed responses in July 2014, and we now have over 2,030 responses!

These numbers are hard to ignore.

Every location now has its own patient experience data. You can use this data to understand what is important to YOUR patients, and to see how your location compares overall.

Have you logged in yet?

Service leaders can easily log in and see how our patients are experiencing our care, in real time. Staff who have accessed the portal tell us that it gives them an important insight into what matters for their patients. They are overwhelmed by the amount of positive feedback (not surprising, given 80% of our patients rate our care as very good or excellent). The data and patient comments have been used as a talking point in staff meetings to raise awareness, commend, motivate and occasionally remind us of how and where we can improve.

We want to encourage all staff to use the portal. We ask that all staff actively engage with the Patient Experience survey, and the survey results. To do this, simply go to https://cx.myexperience.health.nz/cmdhb

Enter your email address and password and click Log In.

If you have forgotten your password, you can reset it off the log in page.

If you require access to the portal or need further information please contact:

Lyndee Allan, Consumer Feedback Coordinator. [email protected], Ext: 9469, or mobile: 021 2424860

We would like to share your stories.

We would also like to understand any changes that staff may make as a result of our findings. Please let us know:

How you are using this information;

What actions you are taking as a result of this feedback; and

If you notice any changes as a result of these actions.

Please contact Lyndee Allen (contact details above) with your stories.

David Hughes Deputy Chief Medical Officer

WHAT MATTERS TO OUR PATIENTS?

Counties Manukau Health Inpatient Experience Report no.9 August 2015:1

Communication is the aspect of our care most patients (55%) say makes a difference to the quality of their care and treatment.

“[Staff] were not very helpful when I asked questions in regards to my pain or advised how my tests went. I was placed in isolation but wasn't told why.” (Rated good)

How are we doing on communication?

10 67

Poor Moderate Very good

Being treated with compassion, dignity and respect makes a difference to the quality of care and treatment for nearly half our patients (44%).

“I felt listened to. If I asked any foolish questions I was not aware of it as all answers were given respectfully.” (Rated very good)

How are we doing with dignity and respect?

6 81


More than one in three of our patients (39%) rate having confidence in their care and treatment as one of the things that makes the most difference.

“They were very competent and professional and compassionate.” (Rated excellent)

How are we doing with confidence?

6 81


Our inpatients are asked to choose the three things that matter most to their care and treatment.

112

https://cx.myexperience.health.nz/cmdhb

mailto:[email protected]

Rated overall care excellent “The nursing staff were a standout, they were so authentic and kind, really easy to have a chat to while they were doing things they needed to do.”

”As a support person staying with a child needing surgery, I felt like I was welcome. I appreciated the bed and the meals and the way nurses always did their stuff in my presence. The nurses took time to explain things. The playroom in the Surgery ward of Kidz First was great and the staff very supportive. There was a lot of empathy.”

Rated overall care very good: “I was really impressed with the care I received for my surgery. I was very nervous and had no Idea what was ahead having thoughts of just another public hospital [but] to my surprise it was amazing!! The care was second to none, [from] the nursing care on my arrival right through to theatre staff and then staff on the ward.”

“Meals better than expected. Attention greater than anticipated. Linen was nice and fresh and comfortable bed. Nice outlook.”

Rated overall care good “My surgeon has been fantastic, she has been giving me follow up phone calls to check how things are going. Without this I think I would have gone into panic with some of the things that have come up for me after surgery. I understand how busy everyone in hospitals are and that they try to give the best care possible, it would have made life much easier if I had been given more info on what to expect when I got home, especially since I had to go through this with not much help.”

Rated overall care fair “Tell patients visitors to keep as quiet as possible. There are people recovering or sleeping.”

Rated overall care poor “[One of the nurses] was unreasonable and I was left feeling bullied and victimized.”

“I took an hour and 2 trains to go to

Auckland Hospital because I did NOT want to go back [to Middlemore]… I was even willing to say to the staff at Auckland hospital that I was homeless, just so I wouldn't have to be transferred to Middlemore if I was admitted.”

How have we done? Over the past twelve months we have asked our patients to rate us on 12 dimensions which are related to effective care and treatment.

Overall, all but one of the dimensions has improved in ratings. If we look a little closer, however, we can see cleanliness is the only dimension which has improved consistently each quarter. As our ratings are likely to become more consistent as more patients take part in the survey, our focus should remain on seeking constant improvement so that our ratings do not slip backwards.

DIMENSION

JUL – SEP 2014

OCT – DEC 2014

JAN – MAR 2015

APR – JUN 2015

TREND CHANGE

+.5 Communication 7.4 8 7.7 7.9

+.2 Compassion, dignity & respect

8.4 8.7 8.4 8.6

+.4 Confidence in care 8.1 8.7 8.5 8.5

+.7 Consistent care in

hospital 7.4 8.1 8.1 8.1

+.2

Information 7.6 7.9 7.7 7.8

+.6 Pain and nausea 7.9 8.5 8.2 8.5

+.9 Cleanliness 7.3 7.8 7.8 8.2

+.3 Involvement in

decisions 7.7 8.2 8.1 8

-.7 Coordination of care

7.4 7.6 7.3 6.7

+.6 Food and dietary

needs 3.9 4.8 4.6 4.7

+.3 Support of whānau 8 9.3 7.7 8.3

+1.1 Cultural needs 6.8 7.6 7.2 7.9

Overall care and treatment ratings, rated very good and excellent (%)

78 76

84 82 82 78

83 83 79 81 80

70

80

90

100

Very good/excellent

PATIENT VOICES

Counties Manukau Health Inpatient Experience Report no.9 August 2015:2 113

What we are doing well Our patients are asked at the end of the Patient Experience survey if they would like to offer a general comment on what was good about their hospital stay. In total, 1361 patients, or 67% per cent of all respondents, chose to comment.

The percentages in this section relate to these 1361 respondents. Note that patients often comment on more than one thing, which means percentages may exceed 100%.

QUICK WINS

REMEMBER THAT EVERY INTERACTION MATTERS

Our patients are asking us to remember that every interaction matters. Often, one negative interaction can overshadow what is otherwise a positive experience.

In particular, our patients are asking that we:

Treat them respectfully, and with care and compassion;

Introduce ourselves and welcome them;

Reassure them;

Show them they matter by being proactive, checking on them, taking an interest in their well-being;

Support them (through good information and communication) to make decisions;

Listen to them, and respect their views, beliefs and decisions;

Value their privacy and dignity;

Value other patients’ privacy and dignity by talking quietly about their condition and treatment both to the patient and to others.

CONTINUE WITH ACTS OF KINDNESS

Many of our patients talk about moments of kindness, and the difference that a kind act can make to their stay in hospital. Some regret that they were not in a position to thank the person at the time. Although it may seem at times that small acts of kindness go unappreciated, our patients assure us that they do notice, and that it does make a difference.

Counties Manukau Health Inpatient Experience Report no.9 August 2015:3

77

More than three-quarters (77%) of patients said that the best thing about their stay in hospital was the care shown to them by the staff. A word frequency analysis shows that the words most often used to describe staff and the care they recieved are: friendly (17%); helpful (14%); excellent (16%); caring (12%); amazing (7%); professional (6%); and kind (5%).

“The nurses in my ward were amazing. They were particularly attentive and very empathetic and caring without over-stepping. I have been a patient in many hospitals over the years and this was my first admission to Middlemore and I have to say I’ve never had such great nurses and they made my stay a whole lot more bearable.”

“I found everyone to be really polite and professional. They were not only concerned about my physical comfort but also about my emotional well being, which was nice.”

Our outstanding staff

8

A positive experience

Nearly one in ten patients who commented about what was good wanted to say how positive the experience was. Many of these had feared going to hospital, but realised their fears were unfounded.

“I just found the whole experience to be one of total excellence. People go into hospital full of fear of the unknown - as I was initially - we put our lives and trust into people we do not know and come out the other end wondering what all the fuss was about...”

“Everything was excellent and above my high expectations.”

6

Confidence in care received

Six per cent of patients commented that they were extremely confident they had received the best care possible. Some said they felt staff went above and beyond the call of duty to attend to their needs

“There has never been a time that I have been admitted to Middlemore Hospital that I have not been amazed at the great effort made in thorough investigations and excellent treatment and most of the care.”

Other

Other patient comments related to the high standard of the amenities and facilities (5%), getting good information (2%), good communication (2%), being treated with dignity and respect (2%), getting consisten care (2%), nice food (2%), and fast, efficient service with no waiting time (2%).

114

QUICK WINS

Counties Manukau Health Inpatient Experience Report no.9 August 2015: 4

Patient suggestions for improvement Not surprisingly, our patients are far more specific with their ideas about what can be improved, than they are about what was good. In total, 987 patients chose to share their ideas for improvement.

The percentages in this section relate to these 987 respondents. Note that patients often comment on more than one thing, which means percentages may exceed 100%.

21

One in every five patients who commented chose to talk about how they didn’t enjoy the food on offer. Specifically, they felt the food quality was poor (e.g. bread was mouldy), the taste wasn’t enjoyable, the food was not suitable for their diet (e.g. vegetarian, gluten intolerant), the food was cold when it was delivered, or they were not given a choice of food options.

Food and dietary needs

14 Coordination at time of discharge

Coordination of care between home, hospital and other services, as well as service at the time of discharge, was commented on by 14% of patients. Some were sent home with no information about how to manage their care or condition, others did not receive follow-up contact or information that was promised. Most comments about discharge, however, related to lengthy waiting times (some up to 8 hours) in the discharge lounge, not understanding the discharge process (and not having it explained), or being able to leave but having to wait for an hour or more for a wheelchair.

14 Noise and visitors

Some patients felt that the overall level of noise on their ward was not conducive to rest and recovery. Specifically, the noise came from machines that were not responded to, other patients (and their televisions and radios), and staff conversations (particularly at night). Six percent of those who offered suggestions for improvement felt that the level of noise generated by other patients’ visitors, particularly children, was unacceptable. Many commented on the noise generated by visitors late at night or the early hours of the morning (e.g. 1am – 4am), and that visitors would often prevent patients from using facilities, such as bathrooms or toilets.

Staff interaction

Some patients felt that staff were rushed, unhelpful, stressed, unresponsive, rough or just plain rude. Many put this down to understaffing and the pressure on staff to look after a lot of people. Often, these negative interactions overshadowed what was otherwise a positive experience for many patients, and some cases affected their confidence in the care and treatment.

Other

Other patient suggestions for improvement included improving the facilities and amenities (10%), higher standards of cleanliness and hygiene (9%), better communication (6%), more information about their care and treatment (5%), to treat patients with dignity and respect (5%), improve waiting times to see staff (3%), and improve privacy, particularly when patients can overhear private conversations.

Whilst some patient ideas for improvement require larger, institutional change, there are still a number of quick and easy ways that we can respond to this patient feedback:

Make sure that patients understand they have a choice of food options, and their options are communicated to the kitchens;

Try and keep noise at night to a minimum, particularly staff conversations;

Respond to call bells and alarms in a timely manner;

Ensure that patients and their visitors are aware of visiting rules. Sometimes our patients may need a gentle reminder that only one whānau or family support person is able to stay overnight.

Ensure that visitors know the location of the public bathrooms.

Explain discharge plans and give patients the information in written form. Include information on what to expect and any signs and symptoms to look out for, along with contact details of whom to contact;

Keep patients informed of how long they might need to wait in the discharge lounge. For many patients, not knowing how long they will have to wait is much worse than the waiting.

Ensure that enough wheelchairs are available in the discharge lounge, so that patients don’t have to wait for one to be delivered.

115


Counties Manukau District Health Board 5.0 Resolution to Exclude the Public Resolution: That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General Subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

6.1 Patient Experience & Safety Report

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982).

[NZPH&D Act 2000 Schedule 3, S32 (a)]

Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S9(2)(a)]

6.2 Risk Register That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982). [NZPH&D Act 2000 Schedule 3, S32(a)]

Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S9(2)(i)]

6.3 Minutes of HAC meeting 29 July 2015 with public excluded

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982). [NZPH&D Act 2000 Schedule 3, S32(a)]

Confirmation of Minutes For the reasons given in the previous meeting.

6.4 Action Items Register Confidential

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982). [NZPH&D Act 2000 Schedule 3, S32(a)]

Action Items Register For the reasons given in the previous meeting.

counties manukau district health board hospital advisory

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