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Counties Manukau District Health Board – Hospital Advisory Committee Agenda

Counties Manukau District Health Board Hospital Advisory Committee Meeting Agenda

Wednesday, 10 February 2016 at 9.00am – 12.30pm, Room 101, Ko Awatea, Middlemore Hospital, Hospital Road, Otahuhu, Auckland

Time Item

9.00 – 9.10am 1. Welcome

9.10 – 9.20am 2. Governance 2.1 Attendance & Apologies 2.2 Disclosure of Interests/Specific Interests 2.3 Confirmation of Public Minutes (2 December 2015) 2.4 Action Items Register Public

9.20 – 9.40am

9.40 – 9.50am

9.50 – 10.00am 10.00 – 10.10am 10.10 – 10.25am

3. Hospital Services Report (Phillip Balmer) 3.1 Executive Summary 3.2 Balanced Scorecard & Definitions 3.3 Financial Summary (Margaret White) 3.4 Hospital Health Target Overview 3.5 Human Resources 3.6 Actions Arising Responses 3.6.1 Update on ACC funding meeting 21.12.15 (Verbal) 3.7 Women’s Health & Kidz First (Nettie Knetsch) 3.8 Director of Midwifery (no report this month) 3.9 Surgery and Ambulatory Care (Gillian Cossey) 3.10 Adult Rehabilitation/ Health of Older People (Phillip Balmer) 3.11 Medicine, Acute Care & Clinical Support (Brad Healey) 3.11.1 Intragram Increase/Changes in Practice (Verbal)

Morning Tea Break

10.35 – 10.45am 10.45 – 10.55am 10.55 – 11.05am

3. Hospital Services Report (continued) 3.12 Facilities (no report this month) 3.13 Director of Allied Health Report (Martin Chadwick) 3.14 Director of Nursing Report (Denise Kivell) 3.15 Mental Health (Tess Ahern)

11.05 – 11.30am 11.30 – 11.50am

4. Presentations 4.1 Mental Health Suicide Prevention (Peter Watson/Tess Ahern) 4.2 ACC Treatment Injury Project (Jo Parker Dennis)

5. Resolution to Exclude the Public

11.50 – 12.00pm

12.00 – 12.10pm 12.10 – 12.25pm

12.25 – 12.28pm 12.28 – 12.30pm

6. Confidential Items 6.1 Patient Experience & Safety Report/Quality & Safety Markers July-

September 2015 (Dr David Hughes) 6.2 Risk Register/Risk Report (Dr David Hughes) 6.3 Occupational Immunity, Screening & Vaccination - Policy/Procedure

(Denise Kivell) 6.4 Confirmation of Confidential Minutes (2 December 2015) 6.5 Action Item Register Confidential

Next Meeting: 23 March 2016

Meeting Room 101, Ko Awatea, Middlemore Hospital, Otahuhu

Counties Manukau District Health Board – Hospital Advisory Committee 10 February 2016

BOARD MEMBER ATTENDANCE SCHEDULE – HAC 2016

Name

Jan 10 Feb 23 Mar Apr 4 May 15 June 27 July August 7 Sept 19 Oct 30 Nov 2 Dec

Lee Mathias (Chair)

No

Me

eti

ng

No

Me

eti

ng

No

Me

eti

ng

No

Me

eti

ng

Wendy Lai

Arthur Anae

Colleen Brown

Sandra Alofivae

Lyn Murphy (Committee Chair)

David Collings

Kathy Maxwell

George Ngatai

Dianne Glenn

Reece Autagavaia

* Attended part meeting only


BOARD MEMBERS’ DISCLOSURE OF INTERESTS

10 February 2016 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

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 Partner, 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 Sandra Alofivae

Member, Fonua Ola Board

Board Member, Pasifika Futures

Director, Housing New Zealand

Member, Ministerial Advisory Council for Pacific Island Affairs


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 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

George Ngatai 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

Transitioning Out Aotearoa (provides services & back office support to Huakina Development Trust and provides GP services to their people).

Chair, Restorative Practices NZ. 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.

Vice President, National Council of Women of New Zealand

Member, Auckland Disabled Women’s Group

Member, Pacific Women’s Watch (NZ)

Justice of the Peace


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

Trustee of Epiphany Pacific Trust


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 10 February 2016

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.


Minutes of Counties Manukau District Health Board Hospital Advisory Committee

Held on Wednesday, 2 December 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, Mr

George Ngatai, Ms Dianne Glenn, Apulu Reece Autagavaia, Ms Sandra Alofivae, Ms Colleen Brown, Anae Arthur Anae and Ms Kathy Maxwell.

In attendance: Mr Geraint Martin (Chief Executive), Ms Margaret White (Deputy Chief Financial

Officer, Hospital Services), Mr Martin Chadwick (Director Allied Health), Mr Phillip Balmer (Director Hospital Services, Dr Gloria Johnson, Ms Denise Kivell (Director of Nursing) and Ms Dinah Nicholas (Minute Taker).

Apologies: Mr David Collings, Ms Wendy Lai & Anae Arthur Anae (for lateness). 1. Welcome

The Chair welcomed everyone to the meeting.

2. Governance

2.1 Attendance & Apologies

Noted.

2.2 Disclosure of Interest/Specific Interests

The Committee noted Dr Mathias is no longer Advisory Chair of the Company of Women Limited and Mr George Ngatai is no longer a member of Arthritis NZ and is Chair of Restorative Practices NZ.

2.3 Confirmation of Public Minutes (21 October 2015) Resolution That the Public Minutes of the Counties Manukau District Health Board Hospital Advisory Committee meeting held on Wednesday 21 October 2015 were taken as read and confirmed as a true and accurate record. Moved: Dr Lyn Murphy Seconded: Dr Lee Mathias Carried: Unanimously

2.4 Action Item Register Public It was noted that Item 3.1 Allied Health Drilldown can be removed from the Register as this item has been covered in previous reports.


3. Hospital Services Report

3.1 Executive Summary Winter - the winter demand has now started to trend down allowing bed capacity planning for Winter 2016. Europe and Asia have signalled they are expecting a bad winter in terms of flu/bird flu. Statistically we are long overdue for a flu epidemic as our winters have been relatively mild. Mr Balmer confirmed he will present the 2016 Winter Plan at the 10 February HAC meeting. Immunisations – it appears we still have some groups, midwives in particular, that are still not on board. The Waikato DHB approach that you must wear a mask hasn’t worked. Some initiatives/approaches underway here are:

To include a KPI for each Manager that we see an improvement of 10% in influenza vaccination rates.

We need to be a lot more deliberate when we on-board new staff and have changed our policy which now says you will be vaccinated when you are employed.

For existing staff, our reflections are that it appears to be the same staff year on year refusing vaccination therefore we need to be checking (1) that they haven’t been vaccinated by their GP and that we are recording that and (2) if they haven’t, then possibly we need to look at the high risk areas and insist that they are vaccinated.

There is no reason we can’t make vaccination compulsory in our Access Agreement with LMCs and bureau staff. Canterbury and Auckland DHBs have improved their rates in midwifery vaccinations – we need to learn from what they have done. Ms Kivell confirmed that there is work underway on an Immunity Screening & Vaccination Policy & Procedure which will cover students, contractors, staff etc. It has been socialised with the national schools of nursing, HAI (hospital acquired infection group at the MoH), unions and professional bodies to get consistency across the country. This will come to ELT and the Board for approval when completed. Faster Cancer treatment times continue to gain momentum. There is continued focus on increasing our elective surgical WIES in conjunction with balancing higher inpatient summary discharges YTD vs planned. Financials are on track. Hospital Services are progressing to plan with their portfolio of clinical and operational change projects now established and beginning to deliver planned outcomes and benefits. This includes a major focus on strengthening the integration of these initiatives with those underway in the community. Further updates on these will be provided in the Director’s Report in February.

3.2 Balanced Scorecard % of eligible stroke patients thrombolysed (page 23) – we are doing a lot of work to increase access and are now sitting at 12.5% (target 6%). We have also recognised the need for access to a second cardiac Cath suite and as part of our infrastructure planning we are looking at an additional suite. The key is to get good outcomes for patients who present with complications.


Patient satisfaction is sitting at 85% (page 23). Food is still a concern but feedback is improving. Hospital beds occupied (page 23) – based on the numbers presented or admitted, YTD 7% less beds that this time last year. Standardised hospital mortality rate – Middlemore site (acute site) is 86 which is very good; Pukekohe Hospital is higher than 100 but that is because we have hospice and palliative care beds there. According to MoH, we sit nationally at 1 but that includes all our facilities and it is from 2013 data plus the Ministry measure 30 days mortality in the community as well, not just within the hospital. Mr Martin explained however, that you can’t read too much into one set of figures, for example, MSC would be 2. Some of the programmes currently underway should help us to continue improving in this area (ie) refresh of the Patient at Risk Team, standardising and improving the in-hospital care of sepsis and the End of Life Care programme. Mr Balmer noted that we have the second lowest coded deaths out of any of the HRT numbers which says that we are not documenting well enough when someone is recognised at end of life and for palliative care. When you code someone to palliative care it enables you to move them from your unexpected deaths which improve your figures.

3.3 Financial Summary The end of winter saw a dramatic decrease in EC volumes – 9,041 discharges against 9,028 last year. Inpatient volumes were 4% below last year driven by acute (2%) and elective (11%) volumes. Elective WIES performance was down on contract due to a move in the 15/16 year to a new WIES counting model – WIES 15 (total WIES value for surgical cases has dropped, medical cases has increased). This will roll itself through. Our contract was set in WIES14, but our coded results are now in WIES15; next year our contract will be set in WIES15 and the coding will be in WIES15. This doesn’t change every year and we will meet contract. YTD for our elective discharge target, we are 17 cases ahead of total contract. Last year we were over-performing against our elective target, this year we are trying very hard to keep it as close to on contract as possible. The MoH have to date only flagged concern around bariatric surgery which seems to be the only area they appear concerned about at the moment. Demand on clinical support services (Radiology, blood, labs & drugs) remains with year to date cost pressures in blood demand due to increased use of Intragram as an antibody for patients who are immune deficient. With the See and Treat Unit opening, there is no dedicated elective theatre access for Gastro and General Surgery at MSC. This will expand our capacity to meet current and future demand and reduce the budget overrun associated with outsourcing to private. We have had very high spinal and orthopaedic volumes which are being managed and will continue to be managed. The organisation challenge this year is to increase IDF inflows and reduce the level of outflows to other district health boards. YTD ahead by 148 WIES ($700k worth of activity).


Financial pressure points remain clinical support (bloods, histology, cleaners/orderlies), high locum costs for selected clinical services for ongoing vacancies and to a lesser degree high nursing costs and MECA settlement which was higher than budgeted. A number of unbudgeted costs have been absorbed and despite those, we have come in very close and in a favourable position. The balance of year focus remains on plan and we will achieve budgeted position for the Provider Arm.

3.4 Health Targets Noted.

3.5 Human Resources It was noted that the Voluntary Employee Turnover by Reason of Leaving graph (page 39) shows a higher number of staff resigning in October due to ‘personal/health’ reasons than the previous quarter. Mr Balmer to ask HR to provide a break-down of the reasons for the resignations and provide this in his next report.

3.6 Action Items Arising Tertiary Adjuster – Mr Balmer advised that there is a meeting with ACC scheduled for 21 December around them funding the gap earlier between what it costs us to deliver care and what we get funded. A further update on this will be provided in the Director’s Report in February.

(Anae Arthur Anae arrived at 9.45am)

3.7 Mental Health (Phillip Balmer) Suicide rates – it was good to see a reduction of 25% in CM Health suicide rates in five years. It was noted (page 42) that young people and Maaori are the least likely to have contact with our Mental Health services however, the figures on page 47 show otherwise with access rates for Maaori sitting at 7.31% (target 6%) and non-Maaori at 3.74% (target 3.1%). Ms Ahern to provide some information in the next Mental Health report that will explain this discrepancy. Seclusion and restraint minimisation – October saw one week where there were no incidents in Tiaho Mai. It is estimated that this is the first time in over two years that this has occurred. Staff are motivated to continue to work towards reducing and eliminating seclusion and restraint. The Committee agreed to send a note of thanks to the team from the Board. ARI update – development of Phase Two includes development of mental health capability within primary care working alongside the Mental Health team. Hospital Psychiatric Liaison Service - there is a significant piece of work currently underway to look at having one team rather than small teams of psychologists embedded across multiple directorates. The preferred direction of travel is to have one psychiatric service working in ED and another that works across the hospital as one team. This will see a much more cohesive service for the hospital that will deliver higher quality care for patients.


October readmission rates within 28 days are down to 8.22% (target 12%). (Ms Wendy Lai arrived at 10.15am) 3.8 Women’s Health & Kidz First (Nettie Knetsch)

September & October saw some gynaecology procedures outsourced in order to maintain the 120 day waiting time target. Despite utilising all available lists, gynaecology had 12 women at risk of breaching the waiting time. Analysis of all lists identified that the increasing obesity of our population is resulting in increased time required for procedures which means few women per operating list. In collaboration with Surgical Services, a reconfiguration of theatres has allowed for additional lists and the Surgical Bus has been utilised to capacity in order to adhere to the 4-month waiting time. Annual leave balances greater than two years in Women’s Health remains static at 20% (target 5%) and Kidz First 15.5% (target 5%). It was noted that there have been discussions about offering annual leave pay-out to these staff. Ms Knetsch was asked to come back to the Committee with a plan to address the leave situation once a process of assessing current leave patterns and leave planning for the next 12-months has been undertaken. Youth Report – Dr Simon Denny, Youth Health Physician presented at the Paediatric Society conference last week. There are some really pleasing things happening in youth overall – their educational attainment, smoking rates, less risk taking behaviour, teenage pregnancy going down but there are still concerning areas in our district around Maaori young males and their suicide rates for example. It was agreed to invite Dr Denny & Mr Pete Watson to a HAC meeting in the New Year to give an update in this area. Rotovirus – introduction of the rotovirus vaccine has seen rates drop significantly, an easy vaccine for babies. Ms Knetsch to follow up on some PR for this. Ms Maxwell asked if we had a public health campaign organised on food poisoning and campylobacter etc. As we head into summer, the need to be vigilant with food cooking (ie) chicken, become ever more important. Mr Balmer advised that in the Top 10 admissions into ED, the 3rd highest presentations are gastro-related problems and undertook to check whether something is being planning. It was noted that approx. one in five babies born in Counties are admitted into hospital in their first year of life – this is higher than the rest of the country. Most admissions are respiratory-related from poor housing. These rates dropped a couple of years ago to around 19-20% but are now back up to 27% for Maaori and Pacific 29% which is concerning. Engagement in the first 12 weeks is going up month on month. Ms Knetsch to provide information on the number of women presenting with unbooked births in her next report.

3.9 Director of Midwifery Report (Thelma Thompson) The Maternity Quality & Safety Annual Report has received a positive review by the National Maternity Monitoring Group. The 14/15 report was launched on 25 November at Ko Awatea and covers the continued progress and initiatives undertaken in the past


year to improve maternity care for our women, their babies and whaanau. It also outlines planned priorities for 15/16. The immunisation rates for Midwives is still a concern. Dr Mathias advised that the Board expectation for next year would be that this group will be at the same level or better than the other professional groups. Dr Mathias also noted that it appears there is a culture in the Lambie Drive Community midwifery team that is perhaps not as conducive to how we would like to be perceived in the community as we might want it to be. Ms Thompson advised that they are currently recruiting for a new Manager for this team but she will follow this up.

3.10 Surgery & Ambulatory Care (Gillian Cossey) Two new units opened onsite at Middlemore in October – the Sir William Manchester Plastic Surgery See & Treat Unit and the Woundcare Suite. The month saw a lot of activity including trying to reduce over-production, reducing outsourcing, managing to budget, increasing IDF revenue (doing more work for other people) and increasing ACC revenue by doing more ACC cases. The counter to that, when you look at the health targets, is that when we are measured by the DHB of domicile (only Counties patients), the fact that we are doing work for other DHBs is not counted, the way the target is measured goes against us. Quality – October saw 100% achievement in all three areas of surgical site surveillance for major joints. The month also saw no CLAB, no falls causing major harm and no pressure injuries. Spinal – the number of spinal cord impairment (SCI) cases has brought in a lot more work. We anticipated for a year that we would do 52 cases, we have done 86 and on top of that, because we are now recognised as the centre of excellence for spines, all our general spinal work has increased. We are now attracting a lot of spines from the other DHBs. Ophthalmology – this area is still a real concern. The elective requirement for FSA in October and November were not achieved due entirely to sheer volumes and staffing problems.

To mitigate the staffing issues, one SMO has been appointed who starts 18 January and we have interviewed a second SMO from the UK which looks promising. A joint appointment has also been made with ADHB of a Glaucoma SMO who will start in January, working 2 days for Counties and 3 days for Auckland. We have also advertised for a Fixed Term SMO for maternity leave cover and have locums covering.

To mitigate volumes- o ADHB have set up an Ophthalmology training scheme (for Glaucoma). We will

have 2 Optometrists attending the next course that begins after Easter. o We are meeting with Ko Awatea and Workforce NZ on 11 December where we

will be asking them for training money to set up more training courses as South Auckland needs its own. The training will be for health professionals who are trained in one specialty to give them extra skills in another area. WFNZ have indicated in the past that they are supportive.

o As the number of follow-up appointments grows phenomenally, the need to look at additional clinical facilities becomes important as MSC has no more clinic space. There are rooms available in Cavendish Drive and the service is looking at putting some equipment and technicians in there to run additional clinics.


Co-morbidity of our patients is slowing theatres down. As the patients are getting bigger and more complicated, this will impact on our capacity going forward. Bariatric surgery – Mr Martin advised that Professor Sir Peter Gluckman has done a cost benefit analysis that shows there is a very positive return on investment in terms of the impact bariatric surgery has in reducing diabetes. Bariatric surgery is the only known cure for diabetes. Ms Cossey advised that Greenstone Films are currently making a documentary at Middlemore, filming some of our bariatric patients showing their journey through the hospital and how the surgery has changed their lives. This should be shown in the New Year and could increase awareness and demand for the hospital. Mr Martin noted that there are clear criteria for bariatric surgery in the public system by which you get access and we have to maintain that however, the likelihood is that we could see an increase in those people who are eligible through the public system and we will have to consider how we will handle that before it happens. There is also the issue of follow-up plastic surgery for these patients. We currently do 5 times more bariatric surgery than any other DHB and there is a case for doing more surgery however, that would have to take into account the diversion of resources from other conditions as we don’t have the surgeons, nurses, anaesthetists, dieticians etc to meet the unmet need. Mr Balmer to ask Dr Andrew Connolly, who has published some research in this area, to provide a summary abstract on bariatric surgery for the next HAC meeting. Health targets – In response to a question in relation to hitting targets quarter on quarter, Mr Martin reiterated that whilst it is always a matter of balance, it is not acceptable that we miss targets on quarter but hit them at the end of the year. We have to maintain them on a level basis throughout the year. What has become very clear this year is the balancing we are having to do is becoming more and more complicated. The first quarter of this year reflects that we are just getting the balance right and this needs to be sustainable and clinically sensible .

3.11 Adult Rehabilitation & Health of Older People (Dana Ralph-Smith) The McKesson Workload tool is currently being rolled out. This is a whole of system planning tool across ICU, orthopaedics and spinal. There is work underway with ACC to look at opportunities for whole of system planning and reablement in the community and what that could look like in terms of aligning services with the current reablement health service we have started.

3.12 Medicine, Acute Care & Clinical Support (Brad Healey) Live organ donor funding – members of the Live Door Project team met yesterday with the MoH to discuss what the Ministry’s requirements were for developing a plan to make it a sustainable service. $96k is needed and a business case will be submitted by March 2016. There is no guarantee of the funding but it is the start of a positive conversation with the Ministry about the benefits of Counties doing this in the context of not just for the Counties population but the wider population.


Breastscreening future funding - BreastScreen Aotearoa recently carried out a funding review. The Ministry have just confirmed that the current funding for 16/17 will be rolled over. Health targets

FCT – we continue to make good progress although there is more work to do. Now sitting at 84% (target 85%).

CT – February 2015 was 55%, October 85%, last week up to 90% for the week. Confident we will hit this target by Christmas.

MRI – February 2015 was 49%, October 51%, last week up to 74%. Part of the reason is that the waiting list is coming down rapidly due to the outsourcing. Confident we will hit 85% target by Christmas. From a production planning perspective, we are in much better control of the waiting list, we can now analyse every week and be much more proactive than reactive.

Gastro – still a challenge but every effort is being put into hitting this target.

Diagnostics – challenges financially with labs and radiology. A Diagnostic User Group has been set up to look at variation. There is a lot of effort going in over the next six months and will report back on the outcome.

The Chair commented that we are not capturing research or other innovation that is occurring within the hospital in the HAC meetings very well and asked Mr Healey to feed into the deep dive she has asked Mr Balmer to undertake into clinical research and innovation within the hospital. This report is to come to a meeting in the New Year.

3.13 Facilities The report was taken as read.

3.14 Director of Allied Health Report (Martin Chadwick) Taken as read.

3.15 Director of Nursing Report Nursing vacancies remain high. There is work underway with the new Recruitment Manager.

4. Quality Assurance 4.1 Inpatient Experience Reports #11 and 12 (Dr David Hughes)

Report No. 11 focuses on Coordination of Care between hospital and other services, including discharge. The context for this report is that this was the issue that our patients rate us lowest on and has been a piece of work that has been undertaken in the hospital to improve. Through the report there are some excellent examples of coordinated care between hospital and community but also a number of situations that are far from ideal. There are strong messages in the report for staff around coordination of care and certainly for the hospital that is particularly around both written and verbal communication that we give patients as they ready themselves for discharge. There are pieces of work in play which will hopefully improve this rating in future (ie) Heads of Department (SMOs) are regularly reviewing the discharge summaries written by their House Officers; Dr Hughes has met with the new House Officers and given them a clear message around the importance of the electronic discharge summary in terms of patient safety and


coordination of care. We are also looking at ways the SMOs can see how well and timely their House Officers are completing the electronic discharges as a routine dashboard. It is reassuring to see that since May this measure ‘how well people are prepared for discharge’ has improved month on month (18% to 10%). Ms Maxwell asked if there was any work underway to review the discharge summary to ensure it is fit for purpose from the patient’s perspective. Dr Johnson confirmed that the current discharge summary is for more than one purpose so different sections do need to meet different purposes and have different kinds of jargon in them however, it could be time to look at developing a project jointly with the Patient & Whaanau Centred Care Board looking at the whole process of discharge, not just the discharge summary, to ensure that patients feel confident when they walk out the door they know what they need to know. It was agreed that Ms Kivell will work with Dr Hughes to coordinate work in this area and report back on progress early in the New Year. Response rates for the surveys is currently sitting at 2.5% of discharges. We are not capturing responses from the elderly but are looking at how to transfer a modified version of the survey to an iPad and capture it closer to discharge. WDHB do their survey during the admission rather than 2 weeks after which is our procedure. In terms of how we break into the patients who have English as a second language is more difficult however, we are making steady progress with obtaining more email addresses. Predominantly, the major way of inviting people into the survey is by SMS which has a very low response rate. Dr Hughes to come back to the Committee with a plan on how to increase the response rates for the Inpatient Experience Survey.

5. 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: Dr Lee Mathias Seconded: Ms Kathy Maxwell Carried: Unanimously

11.50am Public Excluded session. 12.50pm Open meeting resumed. The meeting closed at 12.50pm. The next meeting of the Hospital Advisory Committee will be Wednesday, 10 February 2016 at Ko Awatea, Middlemore Hospital. The Minutes of the meeting of the Counties Manukau District Health Board Hospital Advisory Committee held on Wednesday, 2 December 2015 are approved.


Signed as a true and correct record on Wednesday, 10 February 2016. (Moved : /Seconded: ) Chair 10 February 2016 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 – 10 February 2016 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. 4 May Mr Balmer

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

Pending Mr Balmer Still awaiting public release by the NZ Orthopaedic Association – a copy will be presented to the Committee when available.

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.

10 February Ms Bundy See Item 3.6 on this agenda.

29.7.2015 5.0 Director’s Report Annualised Voluntary Turnover increasing (page 56) – undertake further analysis over an 18month period and report back on the increase.


9.9.2015 3.6 Board Visit - arrange a visit to the Spinal Rehabilitation Unit.

Date TBC Mr Balmer Assigned to Board Secretary to arrange.

21.10.15 5.3 Financial Summary - run a report tracking leave for 12-months (including CME, study leave, annual leave) to show (1) the leave and the smoothing of the leave and are we effective in doing that and (2) better co-ordination of leave.

Date TBC Ms White

2.12.2015 3.1 Director’s Report – 2016 Winter Plan to be presented

10 February Mr Balmer See Item 3.6 on this agenda.

2.12.2015 3.3 Financials – update on the clinical and operational change projects for Hospital Services – outcomes and benefits.

10 February Ms White See Item 3.6 on this agenda.

2.12.2015 3.5 HR – provide a breakdown of the reasons for the resignations in the graph on page 39 (Voluntary Employee Turnover by Reason of Leaving)




DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

2.12.2015 3.6 Action Items Responses – provide an update on the meeting with ACC (21 December) in relation to them funding earlier the gap between what it costs us to deliver care and what we get funded.

10 February Mr Balmer A verbal update to be given at this meeting- See Item 3.6 on this agenda

2.12.2015 3.7 Mental Health - Page 42 notes that young people and Maaori are the least likely to have contact with our Mental Health services however, the figures on page 47 show otherwise with access rates for Maaori sitting at 7.31% (target 6%) and non-Maaori at 3.74% (target 3.1%). Ms Ahern to provide some information in the next Mental Health report that will explain this discrepancy.

10 February Ms Ahern See Item 3.6 on this agenda.

2.12.2015 3.8 Women’s Health – plan to address the annual leave balances greater than 2years in Women’s Health & Kidz First. Dr Simon Denny and Mr Pete Watson to present/provide an update on the great things happening in Youth overall. Check into whether a public health campaign is being organised on food poisoning etc as we head into summer. Provide information on the number of women presenting with unbooked births.

10 February Date TBC 10 February 10 February

Ms Knetsch Mr Balmer/Ms Knetsch Mr Balmer Ms Knetsch

See Item 3.6 on this agenda.



2.12.2015 3.10 Surgery & Ambulatory Care – Dr Andrew MacCormick to present on Bariatric surgery.

23 March Mr Balmer/Ms Cossey

2.12.2015 3.12 Medicine – Deep dive into clinical research and innovation within the hospital.

10 February Mr Balmer/Mr Healey




DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

2.12.2015 4.1 Quality – review the whole process of discharge, not just the discharge summary, to ensure that patients feel confident when they leave the hospital that they know what they need to know. Plan on how to increase response rates for the Inpatient Experience Survey.

Date TBC Date TBC

Ms Kivell/Dr Hughes Dr Hughes

2.12.2015 6.1 Mental Health – Suicide prevention strategy presentation

10 February Ms Ahern Refer Item 3.3 on this agenda.

Assigned from 16.12.15 ARF meeting

Personnel/Staff Costs – mostly sitting as red with only two lines showing as positive, primarily on Outsourced. Ms White to review and update and report back to HAC on Outsourcing.

10 February Ms White Refer Item 3.3 on this agenda.

Assigned from 16.12.15 ARF meeting

Intragram has increased by 38%. Provide details on changes in practice.

10 February Ms White A verbal update to be given at this meeting by GM Medicine -See Item 3.6 on this agenda.


3.1 Hospital Services Report

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

Prepared and submitted by: Phillip Balmer, Director Hospital Services

Glossary

EC Emergency Care MRI Magnetic Resonance Image MTD Month To Date WIES Weighted Inlier Equivalent Separations YTD Year To Date

Executive Summary

Month in review: December Hospital Services had a strong finish to 2015 across all core service areas. December reflected on-going increased volume growth in EC which continues the trend seen throughout 2015. Despite this pressure, our teams continued to deliver on budget financially and meet our national targets.

It is pleasing to report that for the first time, CM Health exceeded the MRI national heath target with the result of 87% for December vs. a target of 80%. This is the first time we have met this target, and is in line with the predicted timeframe. Going forward we believe we will be able to sustain this performance, and is a credit to all staff involved.

The learning’s from winter 2015 have been reviewed and planning for winter 2016 is now well advanced. Some investment initiatives made in 2015 have paid dividends regarding decreasing demand and increasing capacity including increased usage of our discharge lounge, improved theatre utilisation, enhanced community initiatives; increased nurse led discharges particularly on weekends, and reduced ward admissions due to our surgical and medical assessment units.

2016 will present some demand and capacity challenges which we are actively mitigating including the mandatory refurbishment of the Scott Building. We also have some large scale infrastructure projects planned for delivery in mid-2016 including the new Harley Gray laboratory which will provide our community with a leading facility of its kind in New Zealand, further enhancing our patient and staff experience.

Activity Summary

EC presentations MTD EC Presentations in December were 9286, 2.8% higher than last year and 1.5% higher than in November. Daily average volumes fell to 298, still higher than in previous years, but a welcome reduction from the winter volumes.


Fig. 1: Weekly EC Presentations

EC discharges

YTD EC discharges are 4.5% up on last year.

Volumes – December 2015 Month YTD

Act Bud /

Contract % Var Act

Bud / Contract

% Var

Emergency Care

Presentations 9,286 9,030 2.8% 58,208 55,682 4.5%

Discharges 9,350 9,188 2% 58,065 56,371 3%

Note: 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 planned for 2015/16 - as forecast December month WIES volumes (shown below) are as per the forecast/funder agreement; 4% for Acute and 5% for Electives.

YTD WIES Elective volumes are exactly as planned with 0% variance (see below table).

December 2015 Month YTD

This Year Funder

Agreement % Var to Contract

This Year Funder

Agreement % Var to Contract

Acute Services

WIES 5,648 5,431 4% 35,773 34,712 3%

Elective Services

WIES 1,290 1,233 5% 8,978 9,013 0%

Total WIES 6,939 6,664 4% 44,751 43,725 2%

2152

2147

2033

1400

1600

1800

2000

2200

2400

2600

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

Pres

enta

tions

Week

Weekly EC Presentations by Calendar Year

2012 2013 2014 2015 2016 UCL


Fig. 2: Acute Services - WIES

Fig. 3: Elective Services WIES

N.B. The forecast impact of changes to the WIES calculations from WIES 14 to WIES 15 based on 14/15 activity for our population was an overall decrease of 0.7% WIES ((2)% decrease for elective surgical services and an increase of 1.8% for medicine).

WIES and Discharge volumes actual versus last year WIES overall 2% up on last year due to a 3% greater than predicted demand in acute WIES particularly in November and December (see table below).

December:

MTD patient discharge volumes are very similar to last year with a 2% increase in acutes and a (6)% reduction in electives.

YTD patient discharge volumes are similar to last years’ volumes (Acute 2%; Elective (9)%).

MTD WIES volumes compared to last year show a (3)% decrease (Acute 1%; Elective (16)%) in part reflecting the change to WIES 2015 coding and in the new model of care for the see and treat clinics. YTD WIES volumes show a 0% variance against last year (Acute 2%; Elective (8)%).

4800

5000

5200

5400

5600

5800

6000

6200

6400

WIE

S

Control Chart of Acute WIES

FY2016 Contract

Upper Cl

Lower Cl

FY2016 Volume

1100

1200

1300

1400

1500

1600

1700

1800

WIE

S

Control Chart of Elective WIES - Contract adjusted to WIES15, Acutal WIES15

FY2016 Contract

Upper Cl

Lower Cl

FY2016 Volume


December 2015 Month YTD

This Year Last Year % Var to Last Year

This Year Last Year % Var

Acute Services

WIES 5,648 5,603 1% 35,773 35,098 2%

Patients 7,183 7,076 2% 44,696 43,864 2%

Elective Services

WIES 1,290 1,539 -16% 8,978 9,756 -8%

Patients 1,228 1,303 -6% 8,438 9,266 -9%

Total Services WIES 6,939 7,142 -3% 44,751 44,853 0% Patients 8,411 8,379 0% 53,134 53,130 0%


3.2 Balanced Scorecard

December 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 - hospitalmonth result

trend Def

YTD Dec-15 Target Var Actual Target Var

Emergency Care - 6 hour LOS target 96% 95% 1% 95% 95% 0% 28

% Cancer Treatment (ADHB Radiotherapy) in 4 weeks 100% 100% 0% 100% 100% 0% 30

% smokers receive smokefree advice -Total 96% >95% 1% 95% >95% 0% 77

BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCES

month result

trend Def

YTDDec-15 Target Var Actual Target Var

Total Caseweight 6,746 7,084 -5% 44,291 44,292 -0% 1

Acute Caseweight 5,512 5,606 -2% 35,584 34,957 2% 2

Elective Caseweight 1,234 1,478 -17% 8,707 9,334 -7% 3

Total Discharges * 8,264 8,263 0% 52,192 52,191 0% 4

Budgeted FTEs 5,788 5,850 1% 5,791 5,864 1% 6

Operating Costs ($000) 25,227 23,744 -6% 152,388 146,187 -4% 7

Personnel Costs ($000) 47,029 46,646 -1% 272,299 274,232 1% 8

Financial Result Total ($000) -1,259 -1,265 $6 -3,081 -3,410 $329 9

Outpatient FSA Volumes 3,669 3,915 -6% 25,148 26,503 -5% 10

Outpatient Follow Up Volumes 9,437 10,652 -11% 61,632 67,004 -8% 11

Virtual FSAs (GP consult and nonpatient appointments) 174 197 -12% 1,689 1,765 -4% 12

Reduce clinical outsourcing ($000) 1,701 1,689 -$12 10,742 9,956 -$786 13

HR metrics


Excess Annual Leave dollars ($000) - estimated cost for excess $2,906 $1,025 1,881-$ ~ 5

Adult Rehab / Health of Older People $46 $55 9$ ~Medicine/ Acute Care and Clinical Support $655 $385 270-$ ~

Surgical/ Ambulatory Care $1,289 $427 862-$ ~

Mental Health $8 $5 3-$ ~Kidz First/ Women's Health $659 $153 506-$ ~

% Staff Annual Leave >2 years 11.5% 5.0% -7% 11.9% 5.0% -7% 14

Adult Rehab / Health of Older People 4.2% 5.0% 1% 5.2% 5.0% -0%Medicine/ Acute Care and Clinical Support 8.5% 5.0% -4% 9.9% 5.0% -5%

Surgical/ Ambulatory Care 15.1% 5.0% -10% 15.3% 5.0% -10%

Mental Health 7.6% 5.0% -3% 8.3% 5.0% -3%Kidz First/ Women's Health 21.6% 5.0% -17% 19.0% 5.0% -14%

% Staff Turnover (YTD no. voluntary turnovers by average headcount) 0.7% 2.0% 1% 9.8% 10.0% 0% 15

% Sick Leave 2.7% 2.8% 0% 2.9% 2.8% -0% 16

Workplace Injury Per 1,000,000 hours 4.32 10.50 6 17.16 10.50 -7 17

Where employees report a secondary identity Maaori, Pacific and Asian have been

prioritised in that order. Var Var

Workforce Diversity - Leader data 2014 workforce population workforce population 19

Maaori 7.2% 16% -9% 7% 16% -9%Pacific 11.8% 23% -11% 11% 23% -12%

Asian 28.4% 23% 5% 28% 23% 5%NZ European / non-specified/ other 52.7% 38% 15% 54% 38% 16%

HOSPITAL SERVICES BALANCED SCORECARD

Year

Ensu

rin

g Fi

nan

cial

Su

stai

nab

ilit

yEn

abli

ng

Hig

h P

erf

orm

ing

Pe

op

le

Year to date

Year to date

Average last 12 months

Dec-15 Dec-14


IMPROVED QUALITY, SAFETY AND EXPERIENCE OF CARE

NB data reported from Feb15 to align with patient safety report YTD Var Target Var

% e-medication reconciliation -high risk patients within 48hrs 67% 80% -13% 69.0% 80% 11% 20

% Serious Pressure Injuries rate / 100 Patients 1.7% <3.5% 2% 2.6% <3.5% 1% 21

Falls causing major harm rate / 1,000 bed days 0.00 0.00 0 0.00 0.0 0 22

Rate of adverse events rate / 1,000 bed days (Mar 2015) 33.37 tbc - 23

CLAB rate / 1,000 line days 0.00 0.0 0.0 1.27 0.0 -1 24

Rate of S. aureus bacteraemia rate / 1,000 bed days 0.00 0.0 0 0.07 0.0 0 25

Q1 15/16 Target Var baseline Target Var

% 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


% 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 87% 80% 7% 54% 80% -26% 33

% CT scans completed within 6 weeks from referral - MOH IDP 93% 90% 3% 90% 90% 0% 34

% urgent diagnostic colonoscopy within 14 days - MOH IDP 91% 75% 16% 87% 75% 12% 37

% diagnostic colonoscopy patients within 42 days - MOH IDP 39% 60% -21% 40% 60% -20% 38

% surveillance colonoscopy patients within 84 days - MOH IDP 96% 60% 36% 79% 60% 19% 39

% cardiac STEMI-PCI (angiography) <120mins - Northern Region 60% 80% -20% 76% 80% -4% 41

% Coronary Angiography within 90days - MOH IDP (1mth arrears) 98% 95% 3% 98.0% 95% 3%

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% 93% 95% -2% 35

Radiology- Emergency Care radiology completion times <2 hrs 96% 95% 1% 96% 95% 1% 36

Q1 Target Var Actual Target Var

Faster Cancer Treatment - % high suspicion first cancer treatment

within 62 days - MOH FCT + target by 2016 81% 85% -4% 74% 85% -11% 45

Faster Cancer Treatment - % confirmed diagnosis first cancer

treatment within 31 days - MOH FCT + 91% na 89% na 46

% Radiology results reported within 24 hours 51% 75% -24% 54% 75% -21% 47


Average Length of Stay - Acute Inpatient - MOH IDP 2.56 2.98 0 2.62 2.98 0 50

Average Length of Stay - Acute Arranged/ Elective - MOH IDP 1.73 1.37 0 1.8 1.37 0 51

MMH % patients to discharge lounge or home by 1100hrs 15.6% 30% -14% 16.9% 30% -13%

Acute Readmissions within 7 days - Total 2.9% 2.89% 0% 3% 2.89% 0% 52

Acute Readmissions within 28 days - Total - MOH IDP 6.4% 7.6% 1% 7.1% 8% 0% 53

Acute Readmissions within 28 days - 75+ years - MOH IDP 10.7% 11.85% 1% 11.9% 11.85% 0% 54

EC Presentations - 75+ year olds (5% reduction on 2013) 967 807 -160 6,274 7,263 989 55

% clinical summaries (meddocs) authorised <7 days of creation 78% 95% -17% 73% 95% -22% 56

% of patient outliers - not on home ward <5% 2.1% 5.0% 3% 4.3% 5.4% 1% 58

Dec-15 Target Var Actual Target Var

% Eligible stroke patients thrombolysed - Northern Region9% 6.0% 3% 10% 6.0% 4% 59

% DHB Mental Health Services - children/ youth (0-19years) seen

by 3 weeks for non-urgent mental health - MOH IDP 80.5% 75.0% 6% NA 75.0% #VALUE! 48

Mental Health access rate - clients seen in last 12 months as % of

population (0-19 Years) 3.96% 3.15% 1% NA 3.15% #VALUE! 49a


population (20-64 Years) 3.86% 3.15% 1% NA 3.15% #VALUE! 49b


population (64+ Years) 2.60% 2.70% -0% NA 2.70% #VALUE! 49c

Ambulatory Sensitive Hospitalisation rates - MOH IDP ^ 2015/16 Q1

0-4 years - Total 6 month data 101% 60

0-4 years - Maaori 6 month data 118%

0-4 years - Pacific 6 month data 118%

0-74 years - Total 6 month data 114% 60a

0-74 years- Maaori 6 month data 119%

0-74 years- Pacific 6 month data 119%

Syst

em

Inte

grat

ion

(Ef

fect

ive

)

Year to date

Year

Dec-15

QUARTERLY REPORTING

QUARTERLY REPORTINGYear

Tim

ely

Firs

t, D

o N

o H

arm

(Sa

fety

)

Year to date

YearHealth Quality and Safety QSM - QUARTERLY AUDIT REPORTING

Year to date



Outpatient - First Specialist : Follow-up Clinic ratio 33% 35% 2% 35% 36% 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 87.6% 83.4% 4% 87.5% 83.4% 4% 63

Day of Surgery Admissions (DOSA) 92% 90% 2% 91% 90% 1% 65

Day Case Rate (Elective/ Arranged) 74.8% 65% 10% 73.5% 65% 8% 66

% Medical Assessment patients with LOS < 28 hours 77% 65% 12% 83% 65% 18% 68

No. Hospital bed days occupied (against forecast open beds) 18,606 20,425 10% 121,207 129,634 7% 73

No. Length of Stay outliers (LOS >10 days)* 289 315 9% 1,698 1,769 4% 74


Patient Experience Survey (rated very good/ excellent) 76% 90% -14% 80% 90% -10% 75

BETTER HEALTH OUTCOMES FOR ALL


% smokers receive smokefree advice - Maaori 96% 95% 1% 95% 95% 0% 77

% smokers receive smokefree advice - Pacific 96% 95% 1% 95% 95% 0%

% Women (45-60yrs)with Breastscreen in 24months - Total 1,960 2213 -253 68% 70% -2% 78

% Women (45-60yrs)with Breastscreen in 24months - Maaori 215 261 -46 66% 70% -4%

% Women (45-60yrs)with Breastscreen in 24months - Pacific 336 392 -56 79% 70% 9%

(n = 142) Year to date (n = 911)

Year to date

Year to date

Pat

ien

t

Wh

aan

au

Effi

cie

nt

% Screened in last 24 monthsVolumes Screened

Equ

ity


HOSPITAL 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 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.

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


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 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.


3.3 Financial Summary Best value for public health system resources

Glossary

ALBU Assessment, Labour, and Birthing Unit ARHOP Adult Rehabilitation and Health of Older People DHS Director Hospital Services FTE Full Time Equivalent hA healthAlliance HBL Health Benefits Ltd ICU Intensive Care Unit IDF Inter District Flow MoH Ministry of Health MRI Magnetic Resonance Image R&M Repairs and Maintenance SAU Surgical Assessment Unit WIES Weighted Inlier Equivalent Separations YTD Year to Date

Executive Summary

The Provider Arm produced a $5K favourable result against budget for December 2015. This contributes to the consolidated DHB variance of $19k favourable to budget for the month.

Demand on Clinical Support services (radiology, labs, bloods and drugs) continue with year-to-date cost pressures in blood demand due to an increased use of Intragram (as an antibody for patients who are immune deficient). An Intragram review is currently underway regarding the appropriate use, drivers and trends for increased usage. A verbal update will be provided to HAC and a report completed once key clinical personnel return from annual leave.

High microbiology and histology testing volumes in Labs have continued during the December period reflecting demand pressures with high volumes of cancer patients and infections.

The Surgical Assessment Unit in Acute Care has remained open in December to assist with surgical patient volume management, with efficiency outcomes for the patient. The unbudgeted costs balance of year will be offset against costs avoided in the back of the hospital.

Facilities management costs to support clinical services (ALBU, spinal, discharge lounge) and urgent R&M costs have continued into December.

December cost variances were mitigated by additional revenue received for ACC, interest revenue and one-off favourable to budget activity in other areas.

Note that the YTD cost variance includes costs associated with the delivery of additional $965K of unbudgeted revenue ($470k is new revenue to CM Health (funded externally i.e. Middlemore Clinical Trials)). Additionally, the hospital provider arm has delivered $690K of WIES activity above budget YTD which has not been reflected in hospital provider revenue.

Nursing Update Nursing costs for December reflect cover provided and penal rates paid during the holiday period despite the high uptake of annual leave during the same period.

Overtime continues to trend downwards when compared to previous year.

Significant effort has been made to redeploy staff to cover sick leave, additional shifts etc rather than using bureau staff. This initiative has shown continuous improvement over the past 12 months.


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 5,527 4,308 1,219 F h 29,760 27,060 2,699 F

Patient/Consumer Sourced 1,239 925 314 F i 7,009 6,227 783 F

Other Income 1,971 1,882 90 F i 12,145 11,665 480 F

Funder Payments 62,259 62,010 249 F h 372,692 372,056 636 F

Total Income 70,997 69,125 1,872 F h 421,606 417,008 4,598 F

Expenditure

Personnel 47,029 46,646 (382) U i 272,299 274,232 1,932 F

Outsourced Personnel 1,346 815 (531) U h 8,791 4,846 (3,944) U

Outsourced Clinical 1,701 1,689 (12) U h 10,742 9,956 (787) U

Outsourced Other 2,395 2,730 335 F h 15,731 16,381 650 F

Clinical Supplies (excluding Depreciation) 8,688 8,176 (512) U i 54,814 53,062 (1,751) U

Other Expenses 5,807 5,256 (551) U i 31,143 31,480 337 FTotal Expenditure (excl Depreciation,

Interest and Capital Charge) 66,967 65,313 (1,654) Ui

393,520 389,957 (3,563) U

Earnings before Depreciation, Interest and

Capital Charge 4,030 3,812 218 Fi

28,086 27,051 1,034 F

Depreciation 2,622 2,730 108 F h 16,147 16,378 232 F

Interest 1,059 1,097 38 F i 6,286 6,583 297 F

Capital Charge 1,609 1,250 (359) U i 8,734 7,500 (1,234) U

Total Depreciation, Interest and Capital

Charge 5,290 5,077 (213) Uh

31,167 30,461 (706) U

Net Surplus/(Deficit) Provider (1,259) (1,265) 5 F i (3,081) (3,410) 329 F

Month Year to Date

Consolidated Statement of Financial

Performance

December 2015


Fig 2

Fig 3


$(000) $(000) $(000)

Variance to

Prev Mnth $(000) $(000) $(000)

Clinical

Women & Child Health (5,556) (5,528) (28) U i (32,185) (32,040) (145) U

Medical & Clinical Support (18,853) (18,524) (330) U h (108,321) (106,171) (2,150) U

ARHOP (3,462) (3,470) 8 F h (21,088) (21,160) 71 F

Mental Health (5,750) (5,716) (34) U i (33,944) (34,133) 189 F

Surgical & Ambulatory (14,364) (14,186) (178) U i (87,662) (88,741) 1,079 F

Middlemore Central (435) (428) (7) U i (2,400) (2,470) 70 F

Total Clinical (48,421) (47,852) (569) U i (285,600) (284,715) (886) U

Non-ClinicalCorporate (incl Provider Arm Revenue from

Funder) 57,057 56,585 473 Fh

341,124 339,944 1,180 F

HBL (173) (173) (0) U h (1,131) (1,038) (93) U

Health Alliance (2,208) (2,528) 321 F h (14,546) (15,170) 625 F

Facilities Services (4,102) (3,886) (216) U i (23,209) (22,169) (1,040) U

Integrated Care (2,104) (2,095) (9) U i (12,409) (12,642) 232 F

Innovations Hub & Ko Awatea (1,309) (1,315) 6 F h (7,309) (7,619) 310 F

Total Non-Clinical 47,161 46,587 574 F h 282,519 281,305 1,215 F

Net Surplus/(Deficit) Provider (1,259) (1,265) 5 F i (3,081) (3,410) 329 F

Month Year to Date

Performance Summary by Directorate

December 2015


$(000) $(000) $(000)

Variance to

Prev Mnth $(000) $(000) $(000)

Medical Personnel 15,034 14,937 (98) U i 87,290 88,254 963 F

Nursing Personnel 17,811 17,450 (360) U i 103,033 102,687 (346) U

Allied Health Personnel 6,696 7,020 324 F i 39,299 40,854 1,555 F

Support Personnel 2,282 2,094 (188) U i 12,989 12,143 (846) U

Management/Administration Personnel 5,206 5,146 (60) U i 29,687 30,294 607 F

Total (before Outsourced Personnel) 47,029 46,646 (382) U i 272,299 274,232 1,932 F

Outsourced Medical 502 371 (131) U h 4,363 2,227 (2,135) U

Outsourced Nursing 317 46 (271) U h 1,684 273 (1,410) U

Outsourced Allied Health 77 31 (46) U i 184 189 5 F

Outsourced Support 40 27 (13) U i 207 160 (47) U

Outsourced Mangement/Admin 410 340 (70) U h 2,353 1,996 (357) U

Total Outsourced Personnel 1,346 815 (531) U h 8,791 4,846 (3,944) U

Total Personnel 48,375 47,461 (913) U i 281,090 279,078 (2,012) U

Month Year to Date

Personnel Costs By Professional Group

December 2015


Fig 4

Fig 5

Fig 6


FTE FTE FTE

Variance to

Prev Mnth FTE FTE FTE

Medical Personnel 804 803 (1) U i 776 807 30 F

Nursing Personnel 2,626 2,583 (43) U h 2,623 2,601 (22) U

Allied Health Personnel 1,082 1,147 65 F h 1,093 1,136 43 F

Support Personnel 488 485 (3) U h 499 488 (11) U

Management/Administration Personnel 789 833 44 F h 800 834 34 F

Total (before Outsourced Personnel) 5,788 5,850 62 F h 5,791 5,864 74 F

Outsourced Medical 18 13 (5) U h 32 16 (15) U

Outsourced Nursing 28 4 (24) U h 30 5 (25) U

Outsourced Allied Health 6 2 (4) U i 3 3 0 F

Outsourced Support 8 5 (3) U i 8 6 (2) U

Outsourced Mangement/Admin 50 42 (9) U h 58 49 (9) U

Total Outsourced Personnel 110 67 (43) U h 130 79 (51) U

Total Personnel 5,898 5,917 18 F h 5,921 5,944 23 F

Month Year to Date

FTE By Professional Group

December 2015


FTE FTE FTE

Variance to

Prev Mnth FTE FTE FTE

Clinical

Women & Child Health 635 603 (32) U i 631 610 (22) U

Medical & Clinical Support 1,645 1,606 (40) U h 1,612 1,613 1 F

ARHOP 513 516 4 F h 513 518 5 F

Mental Health 650 696 47 F h 656 696 39 F

Surgical & Ambulatory 1,362 1,395 34 F h 1,391 1,398 6 F

Middlemore Central 50 57 7 F h 53 57 4 F

Total Clinical 4,854 4,874 19 F h 4,856 4,890 34 F

Non-ClinicalCorporate (incl Provider Arm Revenue from

Funder) 110 113 3 Fi

113 119 6 F

Facilities Services 462 461 (1) U h 464 463 (0) U

Integrated Care 340 334 (6) U h 345 335 (10) U

Innovations Hub & Ko Awatea 132 134 2 F h 143 135 (8) U

Total Non-Clinical 1,044 1,043 (1) U h 1,065 1,053 (11) U

Net Surplus/(Deficit) Provider 5,898 5,917 18 F h 5,921 5,944 23 F

FTE by Directorate

December 2015 (including Outsourcing)

Month Year to Date


$(000) $(000) $(000)

Variance to

Prev Mnth $(000) $(000) $(000)

FTE 25 - (25) n 25 - (25)

Revenue to fund projects (154) - 154 F i (965) - 965 F

Employee Costs 125 - (125) U h 826 - (826) U

Outsourced Services 19 - (19) U n 129 - (129) U

Clinical Supplies - - 0 F n - - 0 F

Infrastructure & Non Clinical Costs (5) - 5 F h (27) - 27 F

Net Income (Cost) (15) - 15 F h (37) - 37 F

Month Year to Date

Project Cost Funded by Project Revenue

December 2015


Financial Performance Trends


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

Revenue is $1.8M favourable for the month of December. The main drivers for the current month’s variance are:

Government Revenue $1.2M; MoH revenue compensation for capital cost increase $325k (offset by capital cost); ACC arrears initiative $857k;

Patient/Consumer Sourced $314k; Non-resident additional billings $402k (offset by bad debts); No Tahitian burns presentations in December $(125)k; other $37k.

Other Income $90k; Interest received $166k; Donation revenue shortfall $(68)k reflects budget phasing variance due to timing of claims. A review of outstanding projects/claims is currently underway. Other $(8)k.

Funder Payments $249k from Funder (internal transfers) for contracts outside base funding i.e. 20k days and localities.

Note that revenue includes additional unbudgeted project revenue (offset by cost) of $154k, of which $78k is new revenue to CM Health (fig 6).

Expenditure – Total expenditure is unfavourable by $(1.6)M. Major variances are explained below:

Personnel costs

Personnel costs are $(382)k unfavourable for the month reflecting a provision leave revaluation ($230K) and higher clinical demand in cleaning and orderly services (discharge lounge, ICU, SAU). A high uptake of annual leave taken during December was largely offset by penal rates and overtime paid to cover shifts.

A level of vacancies exist across the organisation in all personnel categories (mainly nursing) that are partially covered by bureau, overtime and casual staff. December actual FTE are inflated by stat payroll accruals, this is a timing issue and will reverse January/February.

Note that the Personnel cost variance above includes costs incurred in delivering additional unbudgeted Provider revenue of $125k, 25FTE (fig 6).

Outsourced Costs are $(209)k unfavourable for December (includes personnel, clinical and other).

Outsourcing to cover key vacancies (eg Mental Health) and to meet MoH targets (eg gastro, renal, MRI); partly offset by hA YTD cost benefit and savings in other expenses.

Note that the Outsourced cost variance above includes costs incurred in delivering additional unbudgeted revenue of $19k (fig 6) and supporting schedule.

Clinical Supplies $(512)k unfavourable for the month.

Clinical Support $(387)k. Blood products variance is driven by haematology, surgical, renal and burns patients $(84)k, radiology stock up $(40)k, savings not achieved $(34)k, Testing kit costs increases were driven by a 1% increase in volume and Christmas period stock up $(72)k; other diagnostic cost increases in reagents, catheters and other diagnostic supplies $(63)k; Drug overspend driven by demand across the organisation $(89); other $(5)k

Surgical $(151)k. Overspend driven by increased outputs compared with December phasing.

Other $26k.

Other expenses are $(551)k unfavourable for December explained by bad debts $(319)k (offset by non-resident income); Corporate credit card prepayment $(67)k, DHS unbudgeted initiatives: contribution to “Doctors as Leaders” programme $(38)k and discharge lounge development $(35)k; other $38k.


The corporate credit card (referred to above) is used for travel, accommodation, and training for the whole of the Provider Arm as well as general corporate expenses (these expenses are coded to the relevant RC)

Depreciation, Interest and Capital Charge costs are $(213)k unfavourable due to;

CM Health level of borrowings lower than budget delivering a $38k favourable interest cost variance for the month. Depreciation $108k favourable, due to a reduction in cost based on a review of asset base. Additional cost of capital $(359)k driven by an increase in equity due to a revaluation of land. This cost increase will continue balance of year (total additional cost $3.3m).

Full Time Equivalents FTE (Fig 4 & 5) Total FTE (including outsourced) for December is 5,898FTE which is 18FTE favourable to budget. Major variances as follows:

Vacancies net of overtime, internal bureau, outsourced FTE and casual FTE are 54FTE

Funded projects (not in budget) (22)FTE – localities and 20k days projects (ie: cancer care, breast feeding advocates, Kidz First Gateway project etc).

Net annual leave and other leave 100FTE – annual leave taken higher than budget.

Unplanned and study leave (40)FTE requiring cover.

Other (19)FTE – includes nursing orientation, ACC, stat days and budget phasing.

Women and Child Health – (32) FTE variance was driven by unplanned leave (15.64)FTE and stat days paid in lieu (16.14)FTE that were recognised during the Christmas/New Year period.

Medical and Clinical Support – (40)FTE variance was driven mainly by (22.8)FTE additional FTE specific to strategic and MoH projects as follows: SMART 1.5FTE, Labs 0.3FTE, over allocation of House Officers 3FTE, gastro additional 3.2FTE, SAU 12.8FTE, other 2FTE. In addition (13)FTE were funded but not budgeted for projects i.e. localities, 20k days, renal, and DEU.

Year-to-date Result The YTD result is $329k favourable to budget, with volumes tracking ahead of target (Actual 44,540 WIES vs Contract 43,725 WIES). YTD key variances are detailed below.

Revenue YTD is $4.6M favourable to budget in December 2015. Positive revenue variances include:

$250k IDF Revenue recognised due to favourable WIES volumes in September.

$1.2M Additional Capital Cost (based on increase in equity following land revaluation).

$1.9M ACC revenue – implementation of ACC Elective Audit programme and Treatment Injury revenue.

$1.2M Interest received

$157k Additional rental payments received for new lease for Middlemore Clinical Trials.

$636k Funder payments for contracts outside base funding offset by expenditure i.e. 20k days.

$700k Non-resident billings lower than budget.

$158k Bad Debts recovered.

$105k Tahitian burns patient revenue.

$151k Other.

YTD unfavourable revenue variances include:

$(919)k Lower Integrated Care revenue to match lower costs incurred.

$(723)k donations shortfall. Middlemore Foundation confirmed forecast donation contribution to CM Health at $2M compared to FY budget $2.5M.


$(215)k Ko Awatea revenue phasing offset by cost.

Note that revenue includes additional YTD unbudgeted project revenue (offset by cost) of $965k, of which $470k is new revenue to CM Health (fig 6).

Expenditure YTD is $(3.6)M unfavourable to budget, representing $1.9M personnel costs and $(5.5)M other expenses. Major variances to November are:

Personnel costs $1.9M, 74FTE (excludes outsourced) – reflecting vacancies across the organisation (201FTE) in all personnel categories (mainly nursing). Offsetting factors include bureau, overtime and casual staff, as well as a provision for leave revaluation and higher clinical demand in cleaning and orderly services (discharge lounge, ICU, SAU).

Note that the Personnel cost variance above includes costs incurred in delivering additional YTD unbudgeted revenue of $826k, 25FTE. (fig 6).

Outsourced services $(4)M – primarily reflects Outsourcing to cover key vacancies (eg Mental Health) and to meet MoH targets (mainly in surgical, gastro and radiology); partly offset by personnel costs and savings in other expenses.

Note that the Outsourced cost variance above includes costs incurred in delivering additional YTD unbudgeted revenue of $129k (fig 6) and supporting schedule.

Clinical Supplies $(1.7)M – reflects continuing demand for Clinical support services (radiology, labs, bloods and drugs) and record volumes YTD through Emergency Care. The main drivers YTD are; blood products $(558)k driven by increased use of Intragram for patients who are immune deficient; testing kits overspend $(728)k driven by volume increases within the hospital environment (5% increase overall); other lab increases due to volumes $(295)k.

Other Expenses $337k – primarily reflects Ko Awatea uncommitted cost activity; Integrated Care cost savings (offset by revenue) and QBE insurance claim on Clinical Services Building $386k (offset against cost). The favourable variances have been part offset by bad debts (offset by non-resident additional revenue) and professional fee overspends.

Depreciation, Interest and Capital Charge $(706)k unfavourable YTD – Additional cost of capital $(1.2)M driven by an increase in equity due to a revaluation of land. This cost increase will continue balance of year (total additional cost $3.3m).

Divisional Result (exceptions only)

Women and Child Health – Dec $(28)k, YTD $(145)k Kidz First – Dec $0.4k; YTD $125k; Favourable variance in Kidz First due to lower Kidz First medical and surgical volumes and neonates.

Womens Health – Dec $(28)k; YTD $(270)k; Womens Health result reflects costs associated with high sick, ACC, study, orientation and annual leave cover.

Medical and Clinical Support – Dec $(330)k, YTD $(2.2)M Acute Care –Dec $(144)k, YTD $(356)k; The current month variance is due to the unbudgeted cost of keeping the Surgical Assessment Unit open beyond the original planned winter period - forecast at $100k per month.

Clinical Support – Dec $(279)k, YTD $(1.47)M; Increased demand continued in clinical support services during the month of December as demand for histology and microbiology lab services continue.

Medicine – Dec $94k, YTD $(322)k; The unfavourable YTD variance in Medicine is driven by additional volumes in Gastro to meet MoH targets. This is partly offset by savings in the delay of opening the Diaverum dialysis facility.


Mental Health –Dec $(34)k, YTD $189k A national shortage of experienced staff has lead to vacancies in Mental Health that are partly offset by cover provided by locums (at a premium cost).

Surgical –Dec $(178)k, YTD $1.1M The Surgical favourable variance is a direct result of additional ACC revenue due to the implementation of the ACC Audit programme and vacancies within the service (part offset by bureau).

Corporate Provider –Dec $473k, YTD $1.2M The Corporate YTD variance is explained by: QBE insurance claim on CSB $386k (offset against cost), interest received $1.2M; IDF revenue recognised $250k; Additional ACC received $1.3M; leave revaluation provision $(700)k; shortfall in donations and non-resident revenue $(813)k with the balance a contribution to savings not achieved.

Facilities Services – Dec $(216)k, YTD $(1)M The unfavourable variance in Facilities is due to higher clinical demand in cleaning and orderly services (ALBU, spinal, discharge lounge, EC) and ongoing one-off requirements of Facilities R&M. A review is underway to improve efficiencies within cleaning and orderly costs.


Supporting Schedule: Outsourced and Personnel Costs for the month of December 2015

CMH Provider Arm - Analysis of Mth and YTD Outsourced Personnel for FRC and HAC

For the month of December 2015

Division

3120:

Medical

Personnel

3202:

Nursing

Personnel

3302:

Allied

Health

Personnel

3402:

Support

Personnel

3502:

Manageme

nt/Administ

ration

Personnel

Outsourced

Total

2002:

Medical

Personnel

2202:

Nursing

Personnel

2402:

Allied

Health

Personnel

2602:

Support

Personnel

2802:

Manageme

nt/Administ

ration

Personnel

Personnel

Total Grand Total Commentary

Clinical Support (321) (321) (37,599) (10,062) 113,985 416 5,207 71,947 71,626 Not Material

Acute Care 8,600 (6,914) 1,686 10,752 (147,934) 3,123 2,123 9,401 (122,535) (120,849)

Outsourced nursing to address vacancy/sick cover & volumes

in EC 4.5% higher than this time last year.

NB:-Nursing personnel includes $133k unbudgeted SAU staff.

ARHOP 7,192 (40,380) (48,027) 0 (81,215) 33,064 (9,969) 10,771 (21,867) 11,999 (69,216)

Bureau nursing is not budgeted. High annual leave covered by

bureau nursing. Overall YTD nursing cost is marginally

favourable. Allied Health relates to a backlog of invoices part

of which is reimbursed by the funder. YTD is favourable.

Mental Health (245,665) 305 4,842 (6,338) (10,122) (256,978) 180,598 (64,961) 208,345 (18,811) 305,171 48,193 There are 8-10 SMO vacancies on average fi l led by locums.

Middlemore Central 12,402 (28,632) 10,099 (6,131) (6,131) Not Material

Surgical & Ambulatory 156,126 (119,743) 0 (11,371) 25,012 (7,620) (4,879) 65,778 (209) (24,245) 28,825 53,837

Main Variances in Outsourced Nursing and Anaes Techns

being set off against Fav Variances in Permanent Nursing and

Allied health lines (2202/2402). Also Outputs 2.3% ahead of

Target together with Additional Revenue for ACC and burns

patients

Women & Child Health (32,624) (54,216) 0 (86,840) (31,618) (34,123) 15,247 (13,267) (63,761) (150,601)

$37K Doc - jr doc change over$17K for KF and $40K for WH

offset against additional revenues.

$30K nurses 3 pays in Dec 2015 - should show fav variance in

Jan 2016.

$10K MCIS cost implementation.

$15high ACC and sick leave under WH.

Division of Medicine (25,758) (27,466) (53,224) (42,343) 30,415 (29,877) (14,204) (56,009) (109,233)

Medical $(15)k due to Gastro budget reduction.

$(10)k - Mainly Sleep studies due to increased volumes

(business case to increase budget with GM)

Nursing $(27)k due to insufficient internal cover - see offset

savings in Nursing staff costs $30k; Unbudgeted positions

fuded externally 12.3FTE $(107)k

Grand Total (132,129) (248,735) (43,185) (17,709) (10,122) (451,880) 117,636 (270,145) 387,372 2,330 (67,687) 169,506 (282,374)

Outsourced Personnel


Supporting Schedule: Outsourced and Personnel Costs YTD to December 2015

Variance : Outsourced and Personnel Costs YTD as at December 2015

YTD to December 2015

Grand Total

Division

3120:

Medical

Personnel

3202:

Nursing

Personnel

3302:

Allied

Health

Personnel

3402:

Support

Personnel

3502:

Manageme

nt/Administ

ration

Personnel

Outsourced

Total

2002:

Medical

Personnel

2202:

Nursing

Personnel

2402:

Allied

Health

Personnel

2602:

Support

Personnel

2802:

Manageme

nt/Administ

ration

Personnel

Personnel

Total Grand Total Commentary

Clinical Support (12,915) (12,915) (37,788) (120,956) 330,589 8,369 109,796 290,010 277,095

Vacancies in radiology $406k; savings in breast screening,

patient info and Pharms $316k; Penals in labs to address

increased volumes $(174K); Allied Health and Integrated case

costs $(258)k.

Acute Care 5,280 (115,509) (110,229) 76,227 (110,466) 18,068 12,120 4,169 118 (110,111)

Outsourced nursing to address vacancy/sick cover & volumes

in EC 4.5% higher than this time last year.

NB:-Nursing personnel includes $133k unbudgeted SAU staff.

ARHOP (15,502) (222,609) 34,940 (24,114) (227,285) (15,707) 240,105 362,936 2,158 589,492 362,207Bureau nursing is not budgeted. Offset by the positive

variance in nursing personnel

Mental Health (1,456,193) 56,272 145 (35,154) (51,487) (1,486,417) 1,129,157 42,048 766,841 21,087 1,959,133 472,716There are 8-10 SMO vacancies on average fi l led in by locums.

Middlemore Central 78,746 (107,699) 41,769 12,816 12,816 Not Material

Surgical & Ambulatory 61,031 (601,443) (130) (61,995) (602,537) 443,913 177,125 360,509 (102,068) 291,331 1,170,810 568,273

Main Variances in Outsourced Nursing and Anaes Techns

being set off against Fav Variances in Permanent Nursing and

Allied health lines (2202/2402). Also Outputs 2.3% ahead of

Target together with Additional Revenue for ACC and burns

patients

Women & Child Health (138,475) (284,708) (34,773) (457,956) 195,560 (117,544) 83,993 (71,609) 90,400 (367,556)

$95K for KF and $240K for WH offset against additional

revenues.

$60K MCIS cost implementation

$25K high ACC and sick leave under WH

Division of Medicine (598,519) (115,826) (714,345) (313,518) 215,138 (148,311) (75,356) (322,047) (1,036,392)

$(530)k medical due to outsourcing Gastro colons and

gastroscopies in order to achieve MOH targets - partly due to

the delay in the opening of the MSC theatres until end Sep15.

Outsourced nursing due to insufficient internal cover $(116)k,

offset savings in Nursing staff costs $215k; unbudgeted

positions funded exernaly $12.3FTE $(571)k.

Grand Total (2,142,378) (1,296,738) 34,955 (97,149) (110,374) (3,611,684) 1,556,590 217,751 1,774,625 (81,579) 323,345 3,790,732 179,048

Outsourced Personnel


Supporting Schedule: Outsourced Clinical Services Costs for the month and YTD to December 2015

Variance : Outsourced Clinical services MTD and YTD as at December 2015

Division

Month of

December

2015

YTD to

December

2015

Clinical Support (142,472) (588,142)

Acute Care 0 0

ARHOP (1,645) (63,087)

Mental Health (3,899) (16,415)

Middlemore Central (211) (1,773)

Surgical & Ambulatory (15,070) (143,960)

Women & Child Health (7,739) (137,443)

Division of Medicine 61,548 41,440

Grand Total (109,488) (909,380)

Unfav variance of $157k in private Outsourcing of

patients (Mainly Opthalmology- due to SMO

sickness/Vacancies) Set off by favourable Variance

in Interim Care Pvt hospital costs.

$75K for AUT MDES (Midwifery Development

education services) funded by Maternity Review

Board.

$27K additional night duties budgeted within

personnel costs.

$40K funded by MoH Autistic Spectrum Disorder

funding (used a contractor until a position is fi l led).

Outsourced Clinical Services

$(562)k Outsourced MRI to meet MOH target. Met in

December.

Forecast $6k unfav per month Jan-Jun due to price

variation.

$(105)k - PET CT due to higher demand Incls target

saving of $100pa.

$78k - misc savings incl lab sendaways.


3.4 Hospital Health Targets Overview

National Target Target Description December 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

Achieved

97%

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

Achieved

95%

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:

Not achieved

68%

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

Achieved

100%


3.5 Human Resources (HR)

HR metrics are provided to outline performance for Annual Leave Balances, Sick Leave and Turnover rates. Below are the 12 month trend graphs to December 2015 (Sick Leave and Annual Leave % Paid to November 15).

0%

1%

2%

3%

4%

5%

6%

Sick Leave as Percentage of Total Paid Hours

Sick Leave Sick Leave LY UCL Average LCL

7.0%

7.5%

8.0%

8.5%

9.0%

9.5%

10.0%

10.5%

11.0%

Annualised CMDHB Voluntary Turnover (Hospital Directorate Only)

Turnover Turnover LY UCL Average LCL

7%8%9%

10%11%12%13%14%15%

Percentage of CMDHB Workforce with Annual Leave Balances > 2 Years' Equivalent (Hospital Directorate Only)

> 2 Years > 2 Years LY UCL Average LCL


-5.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Annual Leave Paid as Percentage of Total Paid Hours December 2014 to November 2015

AL Paid % AL Paid % LY UCL Average LCL


3.6 Actions Arising Glossary CNS Clinical Nurse Specialist CT Computerized Tomography EC Emergency Care FTE Full Time Equivalent HR Human Resources MCIS Maternity Clinical Information System MRI Magnetic Resonance Image POAC Primary Options for Acute Care SMO Senior Medical Officer

Responses Action: 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 (HAC meeting held 29 July 2015). Response: Currently we are unable to report on annual leave in a way that would enable this reporting and analysis. Human Resources instead began to look at a view of those employees who had taken the statutory requirement of three weeks within a 12 month period. Whilst looking at this extract from the past 12 months ending 31 December 2015, we found that only 48% of employees that had taken annual leave had taken three weeks or more, regardless of whether this was three weeks consecutively or accumulated leave. With 52% of employees within the Hospital Directorate taking less than three weeks leave or no leave (15%) at all, this is an area that needs further investigation and analysis. There are a number of projects underway regarding annual leave usage and liabilities which all need to be taken into account and considered when completing this further analysis and formulating a targeted approach going forward.

Action: Director’s Report – Annualised Voluntary Turnover increasing (page 56) – undertake further analysis over an 18 month period and report back on the increase (HAC meeting held 29 July 2015). Response: Annualised voluntary turnover has increased from 9.28% to 9.83% between December 2014 and December 2015, a very insignificant increase and still within acceptable limits. The graph mentioned has been updated to show an 18 month timeframe as previously requested.

Action: HR – provide a breakdown of the reasons for the resignations in the graph on page 39 (Voluntary Employee Turnover by Reason of Leaving) (HAC meeting held 2 December 2015). Response: The graph concerned has been updated in this month’s report (refer Item 3.5) as the Personal/Health category was incorrectly showing additional categories.

Action: Director’s Report – 2016 Winter Plan to be presented (HAC meeting held 2 December 2015). Response: An overview of the key conclusions and learning’s from winter 2015 are described below:

1. There was on-going growth in EC demand of 4.9% that created significant pressure on EC for the winter of 2015. This then, in turn, impacted on Medicine where average occupancy was greater than 95% capacity from June to September, and 44 days where EC failed the six-hour target.


2. This created significant pressure on beds with the greatest number of Dot Days since 2012, increased congestion at the front of the hospital with more patients waiting for beds in EC at 0700, and increased medical readmissions and delayed transfers from the short stay units.

3. Significant gains have been made with initiatives to reduce demand across localities (especially Franklin) and services; however, there is further opportunity for improvement particularly in the Manukau and Mangere locations.

4. Significant gains have been made in improving access to diagnostic testing (particularly CT and MRI); however, further work is required particularly for access to cardiology echo tests.

5. Significant gains have been made through initiatives to manage the increasing acute demand across the hospital and to mitigate demand for beds including:

a. increased utilisation of the short stay units including the Medical Assessment Unit and the Surgical Assessment Unit;

b. improved patient flow with early discharge through the Discharge Lounge, and nurse facilitated discharges;

c. timely access to acute theatre; d. >90% of Accelerated Care of the Elderly (ACE) patients were transferred directly,

under the care of the ACE team; e. the Front Door / community central projects have resulted in a more coordinated

transfer from the EC and hospital back to the community and resulted in a reduced readmissions and EC reattendance rate;

f. the enhanced POAC, reablement initiatives were well used and maintained our admission rates at low levels.

Planning is underway to ensure we are prepared for winter 16/17 including:

1. FTE resource allocation to keep pace with the growth in demand in EC. The most recent addition is to EC medical staffing levels at night time so that we can maintain a 9/9/5 SMO roster every day of the week. Nursing in the acute areas of EC has remained static, although additional nursing staff have been added in the short stay areas. We are working on growing our staff bureau to provide greater responsiveness to cover seasonal and daily fluctuations in demand and the skills associated.

2. We need to maintain the on-going adjustment in the allocation of beds between services specifically to meet seasonal demand patterns.

3. We need to invest in expanding community capacity to improve integration between primary and secondary/tertiary services such as the chronic care CNS’s working with practice nurses in the enhanced healthcare home model.

4. We need to expand the community-based rehabilitation model of care (reablement) for a range of conditions.

Action: Financials – update on the clinical and operational change projects for Hospital Services – outcomes and benefits (HAC meeting held 2 December 2015) Response: We are reviewing progress against the current year plan as part of the 2016/17 budget process and will provide on-going updates to the Hospital Advisory Committee. For this meeting, Jo Parker Dennis will present on the progress made with the ACC Treatment Injury project.

Action: Action Items Responses – provide an update on the meeting with ACC (21 December) in relation to them funding earlier the gap between what it costs us to deliver care and what we get funded (HAC meeting held 2 December 2015). Response: Verbal update to be provided by the Director Hospital Services and Deputy Chief Financial Officer during this meeting.


Action: Mental Health – Page 42 notes that young people and Maaori are the least likely to have contact with our Mental Health services however, the figures on page 47 show otherwise with access rates for Maaori sitting at 7.31% (target 6%) and non-Maaori at 3.74% (target 3.1%). Ms Ahern to provide some information in the next Mental Health report that will explain this discrepancy (HAC meeting held 2 December 2015). Response: Information indicates many of the young people and Maaori who have committed suicide have not accessed mental health services prior to their suicide. We need to understand how we can work with families and communities so these young people can seek support from services instead of taking their lives. The 7.31% access rate for Maaori is for the percentage of adults who are Maaori who have accessed mental health services.

Action: Women’s Health – Plan to address the annual leave balances greater than 2 years in Women’s Health & Kidz First. Response: The Women’s Health and Kidz First Division are working with HR, the Director of Nursing, and Finance on paying out annual leave balances for those staff where a historical leave balance has been built up (long term ACC leave, parental leave, decrease in FTE etc.). We have already processed 12 applications and will work through reviewing the remaining staff with leave balances greater than two years over January and February. This is in addition to on-going leave management plans to ensure staff do not build up balances in excess of two years.

Action: Women’s Health – Rotovirus – introduction of the Rotovirus vaccine has seen rates drop significantly, an easy vaccine for babies. Ms Knetsch to follow up on some PR for this. Response: From 1 July 2014, infants younger than 15 weeks of age became eligible free of charge for the rotavirus vaccination, RotaTeq.

The RotaTeq vaccine is given orally at six weeks, three months, and five months of age. The first dose must be given before 15 weeks of age (i.e. by 14 weeks and six days old at the latest). The vaccine cannot be given to infants older than eight months old (i.e. by eight months and zero days old).

Infants born from 19 March 2014 onwards will be under 15 weeks of age when the vaccine is introduced on 1 July. They can still be vaccinated against rotavirus but may have only a brief window in which to be vaccinated as they must receive the first dose before they are 15 weeks old.

There is insufficient safety data available for infants receiving a first dose after 15 weeks of age. An infant who has not had their first dose before 15 weeks of age is no longer eligible to be vaccinated against rotavirus.

The graph below reflects all children aged 0-4 discharged from Kidz First with Rotaviral Enteritis as principal or secondary diagnoses between 1 July 2013 and 31 December 2015.


Since the introduction of the vaccine the incidence of Rotavirus has decreased particularly from January 2015 onwards – which is in line with the completion of the third dose for children eligible from 1 July 2014. The small spike in November and December had seven children under two years; hence no vaccination and two younger babies with incomplete vaccinations due to their age. In summary, the introduction of the Rotavirus vaccine has seen hospital admissions for the 0-1 age group decrease significantly.

Action: Women’s Health – Check into whether a public health campaign is being organised on food poisoning etc as we head into summer (HAC meeting held 2 December 2015). Response: The Ministry of Primary Industries now cover food safety and there hasn't been a 'public campaign' like the historical ' Clean, Cook, Cover, Chill' promotion for some years. They have material under http://www.foodsmart.govt.nz but people need to go there to find it rather than an awareness raising campaign.

Action: Women’s Health – Information on the number of women presenting with unbooked births (HAC meeting held 2 December 2015). Response: Due to the additional work required for the Maternity Clinical Information System (MCIS), the midwife specialist who used to prepare the unbooked women report had to allocate her time to MCIS referrals and grading. We have now appointed an additional resource and anticipate to have the unbooked women report available again in Feb/March 2016. Anecdotally, the numbers have remained static to 14/15 with 30 unbooked women per month of which some 23 – 25 are truly unbooked as others have booked with other facilities/districts and then present at birth at Middlemore Hospital.

Action: Medicine – Deep dive into clinical research and innovation within the hospital. Response: A summary of research undertaken at CM Health in the 2015 calendar year is provided in item 3.6.1. A comprehensive Annual Research Report is currently in development and will be provided to the Hospital Advisory Committee later in the year.

Action: At the 21 October Hospital Advisory Committee meeting the Board Chair requested clarification from the Medicine General Manager of the name (“Toto Ora”) that had been given to the new Haemodialysis Unit being developed with Diaverum.

0

5

10

15

20

Jul-

13

Sep

-13

No

v-1

3

Jan

-14

Mar

-14

May

-14

Jul-

14

Sep

-14

No

v-1

4

Jan

-15

Mar

-15

May

-15

Jul-

15

Sep

-15

No

v-1

5

Dis

char

ges

Discharge Date

Rotaviral enteritis - Jul 13 to Dec 15

Discharges

Linear (Discharges)

http://www.foodsmart.govt.nz/


Response: CM Health has entered into an agreement with Diaverum to establish a new haemodialysis unit to be located in the Mangere Town Centre. The new unit will be operational in February 2016. Under the terms of the contract the name of the unit is to be jointly agreed by Diaverum and CM Health. The name Toto Ora was arrived at after a consultation process involving the Mangere-Otara Locality leadership team, Mangere Integrated Community Health network, Peter Sykes, Tony Spelman, Zoe Wilson, Su’a William Sio, and Lydia Sosene. Toto Ora has been described as a statement about the end result of the work of the unit (i.e. healthy blood). During the consultation process an alternative name was suggested “He Whare Horoc Toto”. Subsequent to the 21 October Hospital Advisory Committee meeting, the General Manager of Medicine has sought advice from the General Managers of Maori Health (Riki Nia Nia) and Mangere-Otara Locality (Sarah Marshall) as to the process that was followed to arrive at the name Toto Ora. Kaumatua for CM Health, Whitiora Cooper and Matua met with Tony Spelman in December to discuss the process and the name. Feedback from the meeting was that they would defer to the community leaders opinion and agree with the Toto Ora name. This name is supported by the General Manager of Maori Health.

Action: Intragram has increased by 38% - Ms White to provide details on changes in practice and report back through HAC (AR&F meeting held 16 December) Response: The General Manager Medicine will provide a verbal update at the time of his report.


3.6.1 Research Summary Purpose The purpose of this paper is to provide a summary of the research activity undertaken at CM Health during the 2015 calendar year. A comprehensive Research Annual Report sponsored by the Director Hospital Services is currently in development and is expected to be provided to the Hospital Advisory Committee mid-2016. Research Activity Research within CM Health has experienced a steady increase over the past few years, from 127 research projects in 2010 to 260 research projects in 2015. The majority of research activity during the past five years has been in the areas of Medicine, Surgical and Ambulatory Care, and Women’s Health. Departments such as Anaesthetics, Emergency Care, General Surgery, Intensive Care, and Plastic and Reconstructive Surgery have had an increase in the number of research projects over the past five years. Table 1 below provides a brief background on number of studies registered in various divisions at CM Health. Of the 260 projects registered in 2015, 86 were clinical audits and 174 were research projects. Amongst the research projects, most of the studies were observational studies (33%) and clinical audits (33%), followed by clinical trials (18%), then qualitative research (10%). Mixed methods study design was also utilized (5%).

Table 1: Summary of study types and sources of financial support in 2015

n (%)

Study type Clinical trials Qualitative Observational Clinical audits Mixed methods

48 (18) 26 (10) 87 (33) 86 (33) 13 (5)

Services Involved ARHOP* Surgical and Ambulatory Care Women’s Health Kidz First Medicine Mental Health Other**

13 (5) 75 (29) 8 (3) 25 (10) 109 (41) 14 (5) 16 (6)

* Adult Rehabilitation and Health of Older People ** Ko Awatea, Nursing, Allied Health

CM Health and TUPU Research funds contributes to the research culture at the DHB. Applications and selections have been confirmed for 2015 TUPU submissions. Further details of the TUPU fund recipients are as follows:

Project Grant Elizabeth Nevill: Effect of breathing support during delayed cord clamping for preterm infants. Funding Amount: $27, 000 Jon Mathy: Incisional antibiotic prophylaxis in skin cancer surgery. Funding amount granted: $26, 000


Tanith Alexander: Body Composition of healthy term babies born at Middlemore Hospital. Funding amount granted: $25, 000

Maataatupu (Emerging fund) Sarah Candy: An exploration of the reasons why people do not complete Pulmonary Rehabilitation; The who and the why? Funding Amount granted: $5, 500 Reugeb Miller: Plasma Ropivacaine Levels following Local Infiltration Analgesia (LIA) for Total Knee Arthroplasty (TKA) Funding Amount granted: $10, 000 Rebecca Maloney: Vestibular rehabilitation pilot study Funding Amount granted: $3,940 Martin Chadwick: Managing Change: the porosity of professional boundaries Funding Amount granted: $1000

Pirrara Fund Marie Young: Patient experiences of ACP in CMH Funding amount granted: $1500

To capture research better, and in order to improve research process efficiency, a lot of progress has been made in 2015 which includes the following:

On-line Registration process The CM Health Research Office is working on the implementation of an on-line registration process whereby Researchers will be able to register their research/audit and obtain approvals on-line. This is currently in the ‘testing’ stage and it is expected that the platform will go live in February 2016.

The CMH audit approval process This policy was revised to make the process much easier and feasible for auditors.

Research Office Website A revision of the CM Health Research webpage is in progress.

Workshops Presentations are delivered every month in CM Health departments/services on how to conduct research and research approval processes. In future the plan is to conduct more workshops related to research.

Research Committee The Research Committee meets monthly to discuss research strategy, processes, and initiatives. This committee is made up of various heads of services and includes representation from Pacific & Maori health (15 members).

CM Health Research aims to contribute to a Research week in June of each year where presentations are delivered and posters are presented by those who have registered their research in the previous year. The focus of the research week is presentations, posters, and workshops. As part of research week, an awards ceremony will be held and awards will be presented for various categories. Women’s Health held a research morning in July 2015 at which eleven researchers presented their projects.


Studies registered in 2015 Adult Rehabilitation and Health of Older People

Mudge Suzie. Living well with a long-term neurological condition - phase II

Kumar Sunil. A Double-Blind, Randomized, Single-Dose Study to Assess the Safety and Efficacy of FX006 for the Treatment of Pain in Patients with Osteoarthritis of the Knee

Slark Julia. The association hyperuricaemia and gout with stroke and the risk factors for cardiovascular diseases: an observational study among stroke survivors in South and East Auckland

Li Ogilvie Vickie. An investigation of the efficacy of the Nijmegen Questionnaire for hyperventilation syndrome in adults using mixed research methods

Anderson Anneka. An exploration of whanau experiences of recurrent acute rheumatic fever and rheumatic heart disease in Tamaki Makaurau

Gough Deirdre. Can an Early Supported Discharge Service for Stroke be successful in a NZ context?

Bagrie Emma. Prevalence of traditional and non traditional cardiovascular disease risk factors and inflammation in a 5 year cohort of patients with rheumatoid arthritis and incidence of acute coronary syndrome

Park So-Jung. EPOA and it's barriers in geriatric population

Tian Ng Wan. Validation of the Test of Masticating and Swallowing Solids (TOMASS)

Gupta Rajiv. A Phase 2, Multicentre, Open Label Extension (OLE0 Study with ABT122 in Active Psoriatic Arthritis subjects who have completed a preceding study M14197 Phase 2 Randomised Controlled Trial (RCT)

Candy Sarah. An exploration of the reasons why people do not complete Pulmonary Rehabilitation; The who and the why?

Adiga Subramanya. Audit of secondary prevention in stroke inpatient rehabilitaion cohort

Kidz First

Bergin Peter. Incidence study of status epilepticus in the greater auckland region

Clements Joanne. Weaning heated humidified high flow nasal cannula (HHHFNC) versus continuous positive airway pressure (CPAP): A randomised control trial - CHiPS Study

Petousis-Harris Helen. Pertussis Immunisation in Pregnacy-Infant Outcomes (PIPIO)

Petousis-Harris Helen. Effectiveness of Pertussis Immunisation in Children (EPIC) Study

Hill Andrew. Trampolining season: An audit of trampoline related injuries

Neutze Jocelyn Bell's Palsy in Children: a Retrospective Chart Review

Hou David. "hPOD The hPOD Study: A randomised trial of oral dextrose gel for prevention of hypoglycaemia in at risk newborn babies"

Jones Hannah Investigating Maori and Polynesian children with autoimmune neurological disease in New Zealand: A parallel study of anti-N-Methyl-D-Aspartate Receptor Encephalitis and Sydenham’s Chorea

Alsweiler Jane. The use of point of care testing for the measurement of blood glucose concentrations in babies at-risk of neonatal hypoglycaemia

Hill Andrew. A retrospective study of trampoline related injuries in children in CMDHB over the last 15 years

Bergin Peter. EpiNet First: A series of 5 pragmatic randomised controlled trials comparing the effectiveness of levetiracetam, lamotrigine, carbamazepine, and sodium valproate for previously untreated epilepsy

Lawton Bev. SAMM Kids: Assessment of Infant Outcome from Severe Acute Maternal Morbidity (SAMM) Events

Leaunae Esther . The effects of play on hospital related anxiety in medically ill school-age children in hospital

Schibler Andreas. High Flow Nasal Cannula Treatment for Viral Bronchiolitis, a Randomised Controlled Trial to investigate a Reduction in Tertiary Hospital Admission

Alsweiler Jane. Local clinical leaders to implement a national guideline in babies on postnatal wards: a cluster-randomised, blinded, controlled, trial.


Meyer Michael . PHASE 3, Randomized, Doubleblind, Placebocontrolled Study Evaluating the Efficacy and Safety of a Human Monoclonal Antibody, REGN2222, for the Prevention of Medically attended RSV Infection in Preterm Infants

Cloete Elza. Pulse oximetry for the detection of congenital heart disease in newborn infants: a study assessing feasibility of a national screening programme

Alexander Tanith. Body composition of healthy term babies born at Middlemore Hospital

Thornton Vanessa. What brought you to EC today? EC utilisation by paediatric population at Middlemore Hospital

Nevill Elizabeth. Effect of breathing support during delayed cord clamping for preterm infants

Cluett Emma. Exploring the role of an individualised healthcare transition document for young people with disabilities transitioning from Paediatric services to Primary Care

Eichler Nick. Can expanded school health services reduce hospitalisations for preventable skin sepsis in school-aged children (school years 1-8)?

Lennon Diana. Are we winning? Serious Staphylococcal and Streptococcal infections in children

Lennon Diana. Are we winning: Post streptococcal glomerulonephritis in children?

Trenholme Adrian. Survey of SUDI-Related Infant Care Practices in Maaori and Pacific Families in CMDHB 2015-2016

Medicine

Herath Samantha. RCT comparing the diagnostic yield of radial endo-bronchial ultra-sound (R-EBUS) guided biopsy when using a thick USS probe Vs. a thin USS probe, in patients with parenchymal lung lesion (PPL), suspected of lung cancer.

Maikoo Raj. Long term follow up of patients with infantile haemangiomas treated with propranolol in CMDHB.

Herath Samantha. Randomised controlled trial comparing the diagnostioc yielld of radial endo-bronchial ultra-sound (R-EBUS) guided biopsy when using a thick USS probe Vs a thin USS probe, in patients with parenchymal lung lesion (PPL), suspected of lung cancer. (R-EBUST2)

Broadbent Elizabeth. Using technology to support patients with COPD

Blakiston Mathew. Comparison of Cooked Meat broth, Thioglycolate broth, and the BacT/Alert blood culture system for microbial recovery from periprosthetic joint tissues

Kenealy Tim. Current scenario of diabetes mellitus in Counties Manukau: A population-based retrospective database analysis

Mannan Shaheen. The prescribing patter of intravenous proton pump inhibitor (PPI) in older adults with upper gastrointestinal bleeding (UGIB) - continuous versus intermittant dosing

Denmark Sarah. Nursing Documentation in New Zealand's Acute Wards: Meeting Accreditation Standards

Kumar Sunil. A randomised, doubleblind and active controlled study of DS5565 in subjects with pain associated with fibromyalgia

Kumar Sunil. An open-lable extension study of DS-5565 for 52 weeks in pain associated with fibromyalgia

Jackson Sharon A phase 3, randomised, double-blind, multicenter study comparing oral MLN9708 plus lenalidomide and dexamethasone versus placebo plus lenalidomide and dexamethasone in adults patients with newly diagnosed multiple myeloma

Kumar Sunil Phase 3B/4 randomised safety endpoint study of 2 doses of tofacitinib in comparision to a tumor necrosis factor inhibitor in subjects with rheumatoid arthritis

Lal Dinesh. Outcomes of CTc performed at MMH radiology department

Tai Joyce. Post operative vascular complications in unrecognised obstructive sleep apnoea: an observational cohort study in moderate to high risk patients undergoing non-cardiac surgery

Blakiston Matthew. Evaluation of the potential clinical impact of rapid direct identification of S.aureus from positive blood cultures using the Staphylococcus QuickFISH assay

Bassett-Clark Debbie. How do patients decide which prescription medicines to Collect? A qualitative study of non-adherent patients in the Emergency Dept (ED) at Counties Manukau Health (CMH)

Bourke Sandra. The association of diffuse idiopathic skeletal hyperostosis with diabetes, gout and increased body mass index in a cohort of CMDHB patients; a preliminary audit


Taylor Elizabeth. Intrapleural catheters for malignant pleural effusions: Demonstrating use at Middlemore hospital and comparing outcomes before and after intrapleural catheters available

Baker John. Phase 3 Multi Center, Double Blind, Randomized, Placebo Controlled, Parallel Group Evaluation of the Efficacy, Safety, and Tolerability of Bococizumab (PF 04950615), in Reducing the Occurrence of Major Cardiovascular Events In High Risk Subjects – SPIRE -

Kumar Sunil. Phase 2, Multicenter, Open-Label Extension (OLE) Study with ABT-122 in Rheumatoid Arthritis Subjects Who Have Completed the Preceding M12-963 Phase 2 Randomized Controlled Trial (RCT)

Chalmet Kristin. Clinical Valiation of the Use of Different Samples in the Diagnosis of Prostate Cancer using Multiple RNA Biomarker Amplicon Sequencing (RBAS)

Olgra Ravinder. Using adenoma detection as a quality indicator in colonscopy: a multicentre ANZ audit

Street Catherine. Establishing need of cardiology patients for medicines information following discharge from hospitals

Herath Sam. Assessing the feasibility of performing a novel Cryo-biopsy procedure for diagnosis of Peripheral Pulmonary Lesions (PPL), suspected of lung cancer at Middlemore Hospital; with the view of commencing a multi centre RCT

Kueh Shaw-Hua. An Audit of Echocardiographic Referrals For Investigation of Infective Endocarditis at Middlemore Hospital – Can we do better?

O’Dochartaigh Conor Sleep Targeted Ventilation for Respiratory Insufficiencies

Ogra Ravinder. Endoscopic management of leaks post laparoscopic sleeve gastrectomy at Middlemore Hospital

Lal Dinesh. Colorectal Cancer Diagnosed in Midlemore Hospital - Patient demographics; delay in diagnosis and reasons; presenting symptoms; outcomes

Park Louise. A systematic review and meta analysis of first-pass success rates for Emergency Department intubation

Millar James. Hospital associated venous thromboembolism (VTE) project

Abbott William Prediction of Serious Liver Inflammation in Chronic Hepatitis B Virus Infection

Wong Conroy. A Phase 2b, Randomized, DoubleBlind, PlaceboControlled MultiCenter Study Evaluating Antiviral Effects, Pharmacokinetics, Safety, and Tolerability of GS5806 in Hospitalized Adults with Respiratory Syncytial Virus (RSV) Infection

Jones Stuart. Sleep Targeted Ventilation for Respiratory Insufficiencies

Walls Genevieve. Pilot randomised controlled trial of meropenem versus piperacillin-tazobactam for definitive treatment of of bloodstream infections due to ceftriazxone non-susceptible Escherichia coli and Klebiella species

Waterworth Susan. Does nursing leadership style effect nursing retention in emergency care at counties manukau

Luey Christopher. Prosthetic Joint Infection in Australia and New Zealand Observational Study

Ahmed Engin. Audit of quality of recovery of patients undergoing small incision sternoplasty (short title)

Tunnage Bronwyn. Paramedic response to acute stroke; investigating current practice and outcomes

Walls Genevieve. CAMERA2-Combination antiobiotic therapy for methicillin ressistant staphylococcus aureus infection - and investigator-initiated, multi-centre, paralle group, open labelled randomised controlled trial

Lucas-Roxburg Rebecca. Human papillomavirus associated oropharyngeal squamous cell carcinoma in New Zealand

Sutton T. Inpatient Focussed Echo Study

Miller Reuben. Blood ropivacaine levels following high volume local infiltration analgesia for total knee arthroplasty – A pharmacokinetic study to determine the incidence of clinical and sub-clinical local anaesthetic toxicity

Cheuk Chan Wing. Diabetes prevalence and quality improvement study in the Auckland metro region phase 2

Bergin Colleen. Cephalic Arch Stenosis; risk factors for development and analysis of outcomes following angioplasty


Jackson Sharon A Randomized, Multicentre, Openlabel, Phase 3 Study of the Bruton's Tyrosine Kinase Inhibitor Ibrutinib in Combination with Obinutuzumab versus Chlorambucil in combination with Obinutuzumab in subjects with treatment-naïve Chronic Lymphocytic Leukemia or

Kazemi Alex. "PATCH": Anti-Fibrinolytics for Traumatic Coagulopathy and Haemorrhage

Benschop Jackie. Is the family pet a risk for multidrug resistant bacterial infections

Wilson Andrew Post Dural Puncture Headache (PDHP) audit

Gupta Rajiv. A Phase 2 study to investigate the Safety, Tolerability and Efficacy of ABT122 in subjects with active Psoriatic Arthritis who have an inadequate response to Methotrexate

Hereath Samantha. Randomised controlled trial comparing the diagnostic yield of Cryo-biopsy via Radial Endo-Bronchial Ultra-Sound guide sheath Vs. CT guided transthoracic biopsy in patients with parenchymal pulmonary lesions. (CT-CROP)

Sykes Graeme. Adult Massive Transfusion Protocol (MTP) Audit

Kool Bridget. Investigating the prevalence of diabetic retinopathy among the Pacific population in South Auckland, New Zealand

Wijayaratna Sasini. Investigating Clinical outcomes in Type 2 Diabetes Patients Diagnosed in Youth in the Auckland Region, in comparison to their Type 1 Counterparts

Daly Barbara. Trends in the Community Management of Diabetes by Primary Health Care Nurses in Auckland

Royle Gordon. A Phase 3b, Prospective, Randomized, Open-label, Blind Evaluator (PROBE) Study evaluating the efficacy and safety of (LMW) Heparin/Edoxaban Versus Dalteparin in Venous Thromboembolism associated with Cancer

Gupta Rajiv. A Phase 2, Multicenter, OpenLabel Extension (OLE0 Study with ABT122 in Active Psoriatic Arthritis subjects who have completed a preceding study M14197 phase 2 randomized controlled trial (RCT)

Ogra Ravinder. A Phase 2, Double-blind, Randomized, Placebo-Controlled, Multicenter Study Evaluating the Safety and Efficacy of GS-5745 in subjects with Moderately to Severely active Crohn's Disease

Ogra Ravinder. A combine Phase 2/3, DoubleBlind, Randomized, PlaceboControlled, Induction and Maintenance Study Evaluating the Safety and Efficacy of GS5745 in subjects with moderately to severely active Ulcerative Colitis

Davies-Colley Susie The role of the Nurse Educator in challenging times

Song Rima 'TARGET' The Augmented versus Routine approach to Giving Energy Trial: a randomised controlled trial

Iosua Epenesa. The prevalence of human papillomavirus (HPV) infections in squamous cell carcinomas of the head and neck in an Auckland, NZ cohort

Khwaounjoo Prashannata A Phase IB/II, open label, multicenter study of INC280 administered orally in combination with gefitinib in adult patients with EGFR mutated, c-MET-amplified non-small cell lung cancer who have progressed after EGFR inhibitor treatment

Nilakant Kaushik. Airway Intervention Readiness survey for Australia and New Zealand - reporting technical, personnel, equipment and system approaches to airway care across the Australian and New Zealand Emergency Departments

McBride Stephen. Adult Septic Arthritis in South Auckland – the ASASA study

Boys Sylvia. Audit of abnormal blood test presentations to the emergency department, incidence, appropriateness, disposition

Nair Arun. PAEAN - Preventing Adverse Outcomes of Neonatal Hypoxic Ischaemic Encephalopathy with Erythropoietin: A Phase III Randomised Placebo Controlled Multicentre Clinical Trial

Marshall Mark. Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS)

McGhee Charles. Keratoconus - clinical characteristics, incidence, prevalence and severity amongst the NZ population - The Ark Study: Part 1

Looi Jen-Li. Clinical Outcomes of Apical Ballooning Syndrome in Auckland, New Zealand

Morpeth Susan. Carbapenem-resistant organisms at Middlemore Hospital

Lightfoot Nicholas. Assessing the burden of long term opiate use after joint replacement surgery

MacCormick Andrew. Prospective validation of APPEND clinical prediction tool


Dawkins Paul. "A Randomised, Doubleblind, Double Dummy, Chronic Dosing (56 week) Placebo controlled,Parallel Group, Multicentre, Phase III Study to Evaluate the Efficacy and Safety of 3 Doses of Benralizumab (MEDI563) in Patients with Moderate to Very Severe Chronic Ob"

Yee Seow Min. The impact of pacemaker implantation in older people with falls

Wong Conroy A research study to find out if the study drug, reslizumab, is safe and can help people with uncontrolled asthma.

Rosen Ian. A Phase 3, Randomized, Double-blind, Placebo-controlled, Parallel-group, Multicenter Study to Evaluate the Net Clinical Benefit of Sotagliflozin as Adjunct to Insulin Therapy in Type 1 Diabetes

O'Dochartaigh Conor. FG3019 therapy in patients with Idiopathic Pulmonary Fibrosis

Garcia Hoyos Vanessa. Sending Copies of Health Psychology Letters to Patients

Saydoon Mustafa. The use of new age adjusted D-dimer cut-off values to improve test specificity

Saydoon Mustafa. Comparing the microarray and standard karyotyping results on patients diagnosed with Myelodysplastic syndrome with normal karyotype

Taylor Elisabeth. Reliability of the Epworth Sleepiness Store

Ansell Gareth. Audit of preoperative blood ordering in general surgery at Counties-Manukau District Health Board and development of a blood ordering schedule

Kim Tae Yeb. Illness perception and stress in patients with inflammatory dermatoses, focussing on psoriasis, treated with narrow band ultraviolet light (nUVB)

Shaikh Nusratnaaz. Community Integration in ABI: Conceptualisation and Measurement

Le Comte Lyndsay. Improving End of Life Care

Rome Keith. Cutaneous foot manifestations in systemic and cutaneous Iupus erythematosus

Collingwood Andrew. Comparison of the impact of three calculation methodologies used routinely for the measurement of lung volume parameters

Patrick Alasdair Endobarrier stent therapy for treating obesity

Blakiston Mathew. Retrospective review of the diagnostic performance of pleural fluid adenosine deaminase (pfADA) for Tuberculous pleuritis in a low incidence setting

Branch Rebecca. Audit of orthogeriatric patients for acute surgery returned to ward from theatre without surgery

Kerr Andrew. Audit of frality assessment too

Smith Joshua. Liver abscesses at Middlemore Hospital

Stubbs Michael . Auditing ethnic variations in acute coronary syndrome management in patients admitted to hospital, not referred for coronary angiography

Branch Rebecca. Audit of orthogeriatric patients for acute surgery returned to ward from theatre without surgery

Dalbeth Nicola. A randomized controlled trial of intensive urate-lowering therapy for bone erosion in tophaceous gout

Jensen-Lesatele Victoria. Samoan People's experiences of cardiovascular disease pathways of care

Chung Shanee. Audit of Elderly AML treatment in Auckland Region over the 5 year period between 2011 and 2015.

Bowker Sarah. How often does routine checking of LFTs and INR, at the completion of N-acetyl cysteine treatment for acute single paracetamol ingestions, change management

Egan Richard. Spiritual care and kidney disease in NZ: Perspectives from Pacific Patients

Green Geoff. Self-directed rehabilitation RCT after stroke: a practical, low cost programme. The Taking Charge after Stroke (TaCAS) Study

Peat Briar. Duration of benzathine penicillin prophylaxis for rheumatic fever

Peat Briar. Inpatient management rheumatic fever and rheumatic heart disease in adult medicine at CMDHB 2005-2015

Wong Conroy. Anti-inflammatory effects of oral and transdermal Clonidine in bronchiectasis

Dunlop Jo. Qualitative and Quantitative Analysis of Antibiotic Stability tests for Balance Peritoneal dialysate solution for up to 7 days

Blacklock. Hilary. A phase III study of Pomalidomide and low dose Dexamethasone with or without Pembrolizumab (MK3475) in refractory or relapsed and refractory Multiple Myeloma (rrMM). (KEYNOTE 183)


Horwood Fiona. A Randomized, Double-Blind, Multi-Centre, Parallel-Group Study to assess the efficacy and safety of PT010 relative to PT003 and PT009 on COPD Exacerbations over a 52 week treatment period in subjects with moderate to very severe COPD

Hwang Euna. Gentamicin prescribing practices at CMDHB

Kerr Andrew. Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS)

Kerr Andrew. Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS)

Mental Health

Aguilera Lucho. The experience of participants in therapeutic story telling groups / te roopu pakiwaitara who live with severe mental illness in the community: a qualitative descriptive study

Petousis-Harris Helen. Pertussis Immunisation in Pregnancy Safefy Study (PIPS study) - Whole population data linking

Armstrong-Barrington Pixie. Treatment barriers for Maori with Social Anxiety: A Maori Perspective

Nes Paula. Views and experiences of adult mental health staff use of the electronic clinical record system 'Health Care Community' (HCC) for mental health and addiction services

Rajendra Kaberi . Recovery for South Asian people accessing mental health services in New Zealand

Muthukumaraswamy Suresh. A randomised, double blind, active placebo-controlled crossover trial of an N-Methyl-D-Aspartate antagonist for patients with treatment resistant depression

Wyllie Allan. Evaluation of Collaborative Mental Health and Addictions Credentialing Programme for Primary Care Nurses

Wyllie Allan. Assessment of mental health and addiction guidelines on the Ministry of Health website

Mitchell Jessica . Substance use rates of clients with First Episode Psychosis: A clinical audit

Wahanui Katrina. Clinical Audit of section 29 compulsory treatment orders indefinite that are applied to Maaori service users at Counties Manukau Mental Health and Addiction Services

Woolston Jude. Housing needs of mental health clients in Counties Manukau

Jastrzebska Joanna. Informed consent regarding pharmacological treatment in maternal mental health: Discussions with patients and medical records. An audit of medical records against best practice guidance

Russell Kathryn . Audit of the number of medical procedures on children with major paediatric burns and audit of any documentd pain management practices used during procedures - A serial case review

Fisher Mark. A Review of Delivery of Electro-Convulsive Therapy (ECT) around NZ

Armstrong-Barrington Pixie. Treatment Barriers for Maori with Social Anxiety: A Maori Perspective

Surgical and Ambulatory Care

Ekeroma Tracy. Incidence and subsequent management of UTIs in patients at Auckland spinal rehabilitaion unit 2013-2014: An audit

Gower Corinne. A study of 'active performance mangement' and DHB delivery of elective health services

Latif Rozanna. Laparoscopic Inguinal Hernia Repair Using a Self-Fixating ProgripTM Mesh – A Review

Koh Kong. Retrospective review comparing patella tendon re-rupture following primary repair vs primary repair with suture and wire augmentation

Hill Andrew. A study of sustained lignocaine release from polymeric films suitable for intraperitoneal drug delivery following surgery

Ross Marla. Impact of the time to definitive management on outcomes in "Mangled Limbs"

Bond Kirsten. The use of continuous positive airway pressure in the treatment of severe asthma

Patel Alpesh. Immediate Cooling and Emergency Decompression

Shanmuganathan Priya. Anaesthetic high risk obstetric clinic audit

Mathy Jonathan. Comparison of mortality rates in melanoma affecting Asians, Maori and Pacific Islanders to other ethic groups

Dakin Steven. Physical activity and amblyopipa

Locke Michelle. Individual risk of surgical site infection: Validating the breast reconstruction risk assessment acore

Le Cocq Heather. Outcomes of operative fixation of PIPJ dorsal fracture subluxations

Jaung Rebekah. Management of acute diveritculitis: a survery of New Zealand surgeons


Watts Carolyn . Whanau Health Literacy (pilot programme)

Kersten Paula. OATS - Outcomes After Trauma Study

Robinson De Wit Jessica . The effect of high protein diets on weight loss and lean muscle mass in patients awaiting bariatric surgery

Williams Anthony. 'PATCH': Anti-fibrinlytics for Taumatic Coagulopathy and Haemorrhage

Wu Scott. Evaluation of Fracture of Neck of Femur Pathway Effectiveness

Paulin Alison Augmentative and Alternative Communication in New Zealand Intensive Care Units: Experiences of Healthcare Professionals

Dunbar Rod Interactions of human immune cells with melanoma and the normal components of skin

Lo Victoria. Flexor Sheath Tenosynovitis: Is our current empiric antibiotic regimen appropriate?

Ncube Simono. Impact on the organisation and patient from delayed surgical intervention of fracture malleolus

Baker Kael. Traumatic Dislocation of the Proximal Tibia-Fibula Joint - A Stable Case Study

Moazzam Amber. A pilot study to evaluate the safety and tolerability of RepaiRx in donor site healing

Chen Joseph. Surgical Experience as a predictor of inadequate excision of BCC

Rajan Smitha. Study to analyse the impact of neck of humerus fractures on the quality of life in older people

Pondicherry Ashwini. Rehabilitation post primary flexor pollicis longus (FPL) tendon repair. A pilot study comparing immobilisation versus early active mobilisation after primary FPL primary repair

Minogue Febe. To close or not to close: A retrospective look at 1 year of hand infections in Middlemore Hospital

Godwin Timothy. Systematic review and metaanalysis of use of tranexamic acid in arthroplasty without LMWH chemical prophylaxis

Byers Stacey. Individual practitioner labour epidural numbers: changing over time?

Godwin Timothy. Systematic review and metaanalysis of use of tranexamic acid in arthroplasty without LMWH chemical prophylaxis

Sorhage Alexandra. Establishment of the New Zealand Cerebral Palsy (CP) Register

Mathy Jon. An evaluation of clinical and histologic factors associated with melanoma patients treated at the Auckland Plastic Surgery unit

Mathy Jon. An audit of the characteristics of intermediate and malignant tumours of bone and soft tissue presented to the Middlemore Sarcome Unit stored in the NZ Bone and Soft Tissue Tumour Registry between 2010 and 2014

Kareem Ahmed. A retrospective study to investigate the outcomes of rehabilitation in elderly population following a spinal cord injury

Lightfoot Nicholas. ELQullS: Emergency Laparotomy Quality Improvement Interventional Study

Malins William. What proportion of patients undergoing post-mastectomy implant-based breast reconstruction at the CMDHB Plastic Surgery department go on to receive adjuvant radiation therapy? And in such patients, what are the reconstruction-related complication rates?

Paul Sunita. Audit of quality of medical admissions of ortho-geriatric patients at Middlemore Hospital (2015)

Locke Michelle. Changes in dermal stem cell populations following fat grafting in irradiated skin and scars

Morton Emily. Introduction of recycling in operating theatres

Seneviratne Isuru. Audit in Inhalational burn injury with risk stratification tool

Yu Fiona. Exploring the impact of 12-hour shifts on nurse fatigue in ICU

Loughnan Alice. Adult Emergency Cricothyroidotomy survery on practice and training

Song Rima. Local Assessment of Management in Burn Patients (LAMiNAR) - Prospective Observational International Multicenter Cohort Study

Burgess Gordon. Retrospective study of outcomes following weber C ankle fracture fixation

Duplan Kate. Documentation of Cardiopulmonary Resuscitation Decisions in a NZ Hospital

Lin Peny. Acute Spinal Cord Injury and Time to Decompression

Padigos Junel. Involvement of registered nurses in antimicrobial stewardship programs in New Zealand Hospitals


Cheng Paul. Le Forte III distraction at the Auckland Craniofacial Unit - risks & benefits (including respiratory outcomes)

Locke Michelle. Effectiveness of 'See and Treat' unit for treatment of skin cancer at CMDHB

Chen Jonathan. Prognostic factors determining outcomes following renal replacement therapy in the ICU at MMH

Thorne Charlotte. Detecting Hypothermia in the Post Anaesthesia Care Unit: A comparison of Axilla and Tympanic Thermometers

Kazemi Alex. End-of-life practices in intensive care units around the world - The ETHICUS II study

Chand Sunetra . Building resilient teams through formal learning and critical care instu simulation

Larsen Catherine. Intraoperative documentation of the surgical swab, instrument and needle count

Murry Deborah. Health Professionals Attitudes Toward the Active Treatment of the Patient with a Major Burn Injury following Self Immolation

MacCormick Andrew. Life Cycle Assessment of laparoscopic cholecystectomy surgery

Patel Reena. Nurse concern as an alert to patient danger in the absence of an emergency activation score

Takerei Susan. Patient and family initiated call for concern

Wood Tania. A survey of staff perceptions of Middlemore Hospital Patient at Risk (PAR) team

Hill Andrew. A retrospective review of outcome data for patients who have undergone Laparoscopic Ventral Hernia Repair (LVHR) over a three year period (2011-2014) in the Counties Manukau District Health Board (CMDHB) region

MacCormick Andrew. Life Cycle Assessment of laparoscopic sleeve gastrectomy

MacCormick Andrew. Quantifying weight regain following sleeve gastrectomy

Balhorn Joshua. Long term followup of outcome following anterior delomous at Middlemore hospital

Sheikh Laila. Audit of biliary related disease in Middlemore Hospital

Patel Depak. Necrotising Fasiitis of the upper limb: an Auckland experience

Peat Briar. Access to same day appointments in primary care in the Counties Manukau Health Region

Horsley Carl. A prelimimary evaluation of a programme to implement resilient healthcare principles into the critical care complex

Miller Reuben. Plasma Ropivacaine Levels following local infiltration analgesia (LIA) for Total Knee Arthroplasty (TKA)

Mathy Jon. Incisional antibiotic prophylaxis in skin cancer surgery

Kong Koh Chuan. Why do we revise contemporary primary total knee joint replacement? A multicentre audit

Morton Randall. Patient-based outcomes following Sialendoscopy

Locke Michelle. Enhanced Recovery After Surgery (ERAS) in Free Flap Breast Reconstruction

Women’s Health

Boyd Nicola. Tubo-ovarian abscess management and outcomes in South Auckland

Baker Philip. Nutritional Intervention Preconception and during Pregnancy to maintain healthy glucosE metabolism and offspRing health

Cox Julie. How can the model of can for obstetric critical care women be improved at Counties, Manukau?

Crezee Ineke. Are spoken card discharge instructions in community languages useful for patients who do not have English as their preferred language of medical care?

McIntosh Christine. Safe Sleep Calculator for use in midwifery in the immediate post-natal period to identify and address SUDI risk in Counties Manukau

McAra-Couper Judith. Accessible, Affordable, Appropriate and Quality Maternity Care. Pasifika women accessing primary Maternity Care.

Van der Merwe Anna. Management of Mid trimester miscarriage and PPROM (Preterm pre labour rupture of membranes)

Others

Hughes David. Self reported patient safety competence of first year House Officers (interns) at Middlemore Hospital

Ryan Jacqueline . Care Compass


Morton Randall. A retrospective evaluation of the effectiveness of handovers on after-hour patient transfers between Manukau Surgery Centre and Middlemore Hospital

Cross Fraser. Monitoring Therapy Outcomes in Dual Disability: Goal Attainment Scaling in a NZ outpatient setting

Jacobs Stephen. A pragmatic leadership development programme for selected academically high achieving early career nurses


3.7 Women’s Health and Kidz First

Glossary

BFHI Baby Friendly Hospital Initiative CNS Clinical Nurse Specialist EC Emergency Care FSA First Specialist Assessment ICU Intensive Care Unit MCIS Maternity Clinical Information System NNU Neonatal Unit WIES Weighted Inlier Equivalent Separations YTD Year to date

Service Overview

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

Performance

Kidz First Activity Summary

Volumes

Act

Bud /

Contract Var % var Act

Bud /

Contract Var % var

INPATIENT (WIES)

Kidz First EC 81 68 13 19.1% 455 480 -25 -5.21%

Paed Medicine 205 192 13 6.8% 1,883 1,709 174 10.18%

Paed ICU 7 0 7 21 15 6 40.00%

NNU - Unit 192 202 -10 -5.0% 1,266 1,402 -136 -9.70%

NNU Womens health 47 40 7 17.5% 322 246 76 30.89%

Kidz First Surgical - acute 168 185 -17 -9.2% 1,033 894 139 15.55%

Kidz First Surgical - Elective 76 65 11 16.9% 512 564 -52 -9.22%

Total Kidz First WIES 776 752 24 3.2% 5,492 5,310 182 3.43%

INPATIENT (CASES)

Kidz First EC 287 238 49 20.6% 1,617 1,693 -76 -4.49%

Paed Medicine 362 401 -39 -9.7% 3,125 3,313 -188 -5.67%

Paed ICU 2 0 2 16 16 0 0.00%

NNU - Unit 67 66 1 1.5% 409 428 -19 -4.44%

NNU Womens health 117 99 18 18.2% 694 625 69 11.04%

Kidz First Surgical - acute 204 192 12 6.3% 1,089 1,012 77 7.61%

Kidz First Surgical - elective 116 121 -5 -4.1% 775 936 -161 -17.20%

Total Kidz First CASES 1,155 1,117 38 3.4% 7,725 8,023 -298 -3.71%

EC Attendances

EC Attendances 2,005 1,981 24 1.2% 13,964 13,721 243 1.77%

OUTPATIENTS

FSA's 130 159 -29 -18.2% 998 1,022 -24 -2.35%

Follow-ups 276 198 78 39.4% 1,631 1,565 66 4.22%

Chart Reviews (Doc) one mo

in arrear64 93 -29 -31.2% 429 446 -17 -3.81%

Nurse-led clinic (CNS clinic

follow up)47 44 3 6.8% 344 287 57 19.86%

Virtual FSA 16 48 -32 -66.7% 289 263 26 9.89%

Total Kidz First Outpatients 533 542 -9 -1.7% 3,691 3,583 108 3.01%

Dec-15 Year to date

Kidz First Volumes (WIES and CASES)

Contract = Last year actuals


Women’s Health (WH) Activity Summary

KF Community and Support Services Volume Last Year

YTD

Data

source

Act Contract (or

last Yr's

actual)

Var Act Contract (or last

Yr's actual)

Var Act

Child Protection

Doc FSA PIMS 4 4 0 50 56 -6 109

Doc FU PIMS 0 0 0 10 2 8 1

Child protection Register Reviews (RN) KK 816 252 564 4725 3077 1,648 N/A

Vulnerable Women Register Revies (SW-

Contacts and Diaries)

KK N/A N/A N/A 106 N/A N/A N/A

CP ALERTS KK 108 N/A N/A 856 N/A N/A N/A

Contacts and Diaries (only for CN) C&D N/A 24 N/A 106 73 33 136

Children in Care

Health Appointments attendend gateway 39 23 16 221 199 22 N/A

ISAs uploaded gateway 21 76 -55 169 344 -175 N/A

Number of Clients in Post review gateway 12 56 -44 99 268 -169 N/A

Centre for Youth

Alternative Education Contact and Diaries C&D 87 93 -6 1,030 1,155 -125 1,597

Regional Consultation Contacts and Diaries C&D 18 38 -20 230 268 -38 842

Specialist Adolescent Clinic Contacts and Diaries C&D 136 122 14 1,306 1,012 294 2,496

Play and Recreation

# of contacts 1870 1254 616 13371 9,052 4,319 17121

NBHS

NBH Screening in Hospital UNHS-40 PHN DB 447 N/A N/A 2938 N/A N/A 6135

NBH FSA Screening in clinic UNHS-40A PIMS 21 N/A N/A 298 N/A N/A N/A

NBH F/Ups Screening in clinic UNHS-40A PIMS 16 N/A N/A 164 N/A N/A N/A

Month YTD

Volumes

Act

Bud /


Bud /

Contract Var % var

INPATIENT (WIES)

WH Gynae - acute 143 121 22 18% 886 779 107 14%

WH Gynae - elective 0 0 0 0% 10 0 10

WH Gynae - elective 106 105 1 1% 760 765 -5 -1%

Inpatient maternity care primary

maternity facil ity (W02020)311 377 -66 -18% 2,183 2,229 -46 -2%

WH secondary (W10001) 501 561 -60 -11% 3,142 3,276 -134 -4%

Total Women's Health WIES 1,061 1,164 -103 -9% 6,981 7,049 -68 -1%

Births/ Deliveries

Botany M 22 22 0 0% 175 159 16 10%

Papakura M 18 21 -3 -14% 129 133 -4 -3%

Pukekohe M 20 28 -8 -29% 126 142 -16 -11%

Total Community Units 60 71 -11 -15% 430 434 -4 -1%

MMH 530 569 -39 -7% 3,237 3,269 -32 -1%

Total 590 640 -50 -8% 3,667 3,703 -36 -1%

INPATIENT (CASES)

WH Gynae - acute 257 232 25 11% 1,594 1,444 150 10%

WH Gynae - elective (private) 0 0 0 0% 18 0 18

WH Gynae - elective 113 95 18 19% 786 869 -83 -10%

Total WH CASES 370 327 43 13% 2,398 2,313 85 4%

OUTPATIENTS

Gynae FSA's 170 236 -66 -28% 865 937 -72 -8%

Gynae Follow-ups 187 239 -52 -22% 1,028 975 53 5%

Gynae Virtual 6 6 0 0% 186 143 43 30%

Nurse-led clinic 15 79 -64 -81% 347 725 -378 -52%

Urodynamics 13 11 2 18% 69 65 4 6%

Obstetric Outpatient 1st S/B

Doctors259 329 -70 -21% 1,543 1,605 -62 -4%

Obstetric Outpatient F/U S/B

Doctors242 315 -73 -23% 1,481 1,887 -406 -22%

Colposcopy 130 150 -20 -13% 933 1,102 -169 -15%

Colposcopy HC 17 13 4 31% 112 112 0 0%

Colposcopy HC in OT 3 3 0 0% 29 38 -9 -24%

Gynae HC 30 38 -8 -21% 288 358 -70 -20%

Total WH Outpatients 1,072 1,419 -347 -24% 6,881 7,947 -1,066 -13%

*target colp volumes are last years actual not contracted volume for 2015-2016

Women's HealthVolumes (WIES and CASES)

Dec-15 Year to date




Highlights

In December 2015, there were 530 births at Middlemore Hospital and 60 at the three community units; a total of 590 births for the month – 50 births less than December 2014.

For Gynaecology, acute discharges are up by 25 and electives are up by 18 for December. However, the YTD WIES for both acute and electives are up reflecting a slightly higher complexity.

Gynaecology Outpatients are on track YTD with the changes to the Nurse Led clinics reported in August 2015 continuing.

Kidz First Inpatients saw much lower discharge volumes in Dec 2015. Although discharges YTD have been lower over the six months (down 188 in Kidz First Medicine), the WIES continues to be higher (up 174) reflecting the increased acuity and improved coding. Kidz First introduced a coding/front sheet in May 2015. We have now reconciled the impact of the coding/front sheet and are confident that its introduction has resulted in the WIES now better reflecting the acuity on the ward. The increased acuity was particularly evident in October and continues to be reflected in an increased length of stay YTD (2.9 days vs. 2.7 days December 2014).

Emergency Care (EC) presentations were up for the month by 24. YTD presentations are up by 243 YTD.

Neonatal volumes remain stable and in line with decreased births. However, the acuity and complexity of the babies remains. Staffing for this acuity and complexity is challenging as it is unpredictable and can change quickly.

500

550

600

650

700

750

# of Births


December 2015


Dec-15 Target Var. Actual Target Var.

% Staff with Annual Leave > 2 years 21.3% 5% -16.3% 17.3% 5% -12.3% 12

% Staff Turnover 14.6% 2% -12.6% 23.8% 10.0% -13.8% 13

% Sick leave -- Oct 2015 results 2.0% 3% 1.0% 2.9% 3.0% 0.1% 14

Workplace injury per 1,000,000 hours -- Oct 2015 results 0.00 TBC - 10.59 10.50 -0.09 15

Dec-15 Last Yr Act Var. Actual Last Yr Act Var.

Nursing Sick leave hours taken in FTEs (inc unpaid sick) - onestaff 5.33 6.79 1.46 5.89 7.38

Performance reviews completed - onestaff - - 63% 69% -5.8%

Study (both internal & external) leave taken FTE RN - onestaff 2.14 2.00 -0.14 2.97 4.00 1.03

Quarterly REPORTING Dec-15 Nov-15 Var. Dec15YTD Target Var.

% of 12 hour shifts Quarterly KF Surg only 0% 0% 0% 1% 0%

% of 12 hour shifts Quarterly KF Medg only 0% 0% 0% 1% 0%

Compliance with NCNZ competency requirements (Qtrly)



Neonatal Rate of medication errors/1000 bed days per month 3.1% 5.0 4.97 N/A N/A 20

Neonatal Care CLAB rate per 1000 line days per month 0.0% 0.0 0.0 N/A N/A 21

CLAB insertion bundle compliance - NNU 100% 100% N/A N/A

CLAB prevention maintenance bundle compliance- NNU 95% 100% N/A N/A

Emergency trolley checks (compliance with checking) 97% 100% N/A N/A

Hand hygiene (compliance with checking) 90% 100% N/A N/A

Safe sleep - audits completed 82% 100% N/A N/A

OSH Audit 100% 100% N/A N/A


ED 6 hour target - National Health target (Kidz First EC) - Initial speciality 100% 95% 5% 98% 95% 3% 41

ESPI 2 - No. waiting >4 months for FSA - Elective 0 0 0 0 0 0 42


NBHS number babies screened prior to discharge from hospital sites 76% TBC N/A 80.1% TBC N/A

NBHS number babies screened @ 12 weeks from birth 90% TBC N/A 95.3% TBC N/A


% transcribed clinic letters authorised >7 days of created 86.8% 75.0% 11.8% 85.1% 75% 10.1% 54

Readmission Rate (KF med) within 7 days 3.9% 7.5% 3.6% 5.9% 6.2% 0.3%

Readmission Rate (KF med) within 7 days (Maaori) 3.3% 14.6% 11.3% 5.4% 8.9% 3.5%

Readmission Rate (KF med) within 7 days (Pacific) 2.8% 5.7% 3.0% 6.3% 5.2% -1.1%

Readmission Rate (Level 1,2, 3) within 28 days (one month in arrear ) 0.0% 6.7% 6.7% 10.7% 8.3% -2.4%

Readmission Rate (all Neonates) within 28 days (one month in arrear ) 1.8% 1.7% -0.1% 7.8% 7.5% -0.3%

Admission Rate Babies in the first year of life (Total) 24% 22% -2.0% 22% 22% 0.0%

Admission Rate Babies in the first year of life (Maaori) 28% 19% -9.0% 27% 27% 0.0%

Admission Rate Babies in the first year of life (Pacific) 33% 30% -3.0% 29% 29% 0.0%

ALOS (raw) - Kidz First - Surgical - Surgical Floor 1.9 2.0 0.1 2.24 2.05 -0.2

ALOS (raw)- Kidz First Medicine - KF Wards 2.4 2.6 0.2 2.9 2.7 -0.1

ALOS (raw)- Kidz First Medicine - EC Short Stay (hrs) 4.3 4.2 -0.1 4.7 4.6 -0.0

ALOS (raw) - Kidz First - Neonatal Unit discharge only 11.8 8.1 -3.7 12.7 12.4 -0.3

ALOS (raw)- Kidz First - Neonates including WH 5.4 4.7 -0.7 6.0 5.7 -0.3

Year to date

KIDZ FIRST SCORECARD

Year

Year to date

Year to date

12 month average

Tim

ely

Year

Enab

lin

g H

igh

Pe

rfo

rmin

g P

eo

ple

Firs

t, D

o N

o H

arm

(Sa

fety

)

QUARTERLY REPORTING

Syst

em

Inte

grat

ion

(Ef

fect

ive

)


.

Kidz First Scorecard Commentary

The safety measures’ reporting is now back on track by using the old database for most measures and the new weekly safe sleep audit tool (on five mothers and babies).

As previously reported, the target for patient experience survey performance was set on a different data set to what is currently used to measure performance. This discrepancy, and the small sample size reflected by the survey, is being addressed with the Patient Experience Coordinator. Patient Feedback forms continue to be used on the wards which enable the Charge Nurse Manager or Service Manager to promptly address issues or concerns raised.


Outpatient DNA - FSA 12.0% 9.0% -3.0% 10.00% 9% -1.0%

Outpatient DNA - Follow up 11.0% 15.0% 4.0% 12.0% 16% 4.0%

Outpatient DNA - Maaori 17.0% 14.0% -3.0% 15.00% 16.0% 1.0%

Outpatient DNA - Pacific 18.0% 16.0% -2.0% 16.00% 14.0% -2.0%

Nurse Hours per Patient Day - KF Med 6.73 7.40 0.67 5.59 5.89 0.30

Nurse Hours per Patient Day - KF Surg 6.03 6.35 0.32 5.16 4.98 -0.18

Nurse Hours per Patient Day- Neonatal 13.1 11.77 -1.33 11.63 11.89 0.26

% Resourced Occupancy - Kidz First Medical (against 14/15) 69.0% 78.8% 9.8% 81.0% 91.0% 10.0%

% Resourced Occupancy - Kidz First Surgical (against 14/15) 77.0% 71.2% -5.8% 80.0% 89.0% 9.0%

% Resourced Occupancy- Neonatal (against 14/15) 76.0% 88.1% 12.1% 88.0% 99.0% 11.0%


Patient Experience Survey results (Excellent, very good) 57% 90% -33% 56% 90% -34%



Percentage of 'eligible' inpatients are referred to AWHI 91.0% 100.0% 9.0% N/A N/A

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% Staff with Annual Leave > 2 years 21.8% 5.0% -17% 20.7% 5.0% -15.7% 12

% Staff Turnover 11.4% 2.0% -9% 10.4% 10.0% -0.4% 13

% Sick leave - Oct 2015 results 2.7% 2.8% 0% 2.9% 2.8% -0.1% 14

Workplace injury per 1,000,000 hours - Oct 2015 results 0.00 10.50 10.50 22.94 10.50 -12.44 15

Dec-15 Last yr act Var. Actual Last yr act Var.

Sick leave hrs. taken FTEs Nursing/Midwifery inc unpaid 6.12 7.06 0.94 8.44 7.11 -1.33

Study leave hours taken FTEs in Nursing/Midwifery 5.84 4.64 -1.20 6.53 5.43 -1.10

Orientation hours taken FTEs in Nursing / Midwifery 1.97 2.29 0.32 2.90 3.21 0.31

Performance reviews completed per annum - - 56% 83% -27%

Quarterly REPORTING Dec-15 Nov-15 Var. Actual Target Var.

% of 12 hour shifts - - GCU 0% 0% 0% 0% 0% -

% of 12 hour shifts - - Botany Maternity 0% 1% 1% 0% 0% -

% of 12 hour shifts - - Papakura Maternity 43% 45% 2% 42% 0% 1%

% of 12 hour shifts - - Pukekohe Maternity 14% 18% 4% 15% 0% 3%

Compliance with NCNZ competency requirements (Qtrly)IMPROVED QUALITY, SAFETY AND EXPERIENCE OF CARE


Emergency trolley checks (days checked) per month 98% 100% -2% N/A N/A

Hand hygiene (compliance with checks) per month nil 80% ~ N/A N/A

Safe Sleep audits completed 93% N/A N/A N/A

OSH Audit 100% 100% N/A N/A

Total Caesarean Percentage 23.1% 23.3% 0.23% 22.7% 22.7% 0.0%

Caesarean - elective number 64 62 85 388 339 49

Caesarean - acute number 72 87 -15 445 501 -56

Instrumental Deliveries 38 49 -11 256 252 4

Inductions of labour % (one month in arrear) 27% 22% -5% 27% 24% -3%

Inductions of labour - number compared to last year (one month in arrear) 157 125 -32 840 672 -168


ED 6 hour target - National Health target (Gynae) 88% 95% -7% 93% 95% -2% 41

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

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


% transcribed clinic letters authorised <7 days created 89.2% 95.0% -5.80% 86.5% 88.4% -1.90% 54

Average Length of Stay Gynaecology - MMH 1.48 1.80 0.32 1.55 1.59 0.04

Average Length of StayGynaecology - MSC Inpatients 0.74 0.80 0.06 0.83 0.76 -0.07

Average Length of Stay Obstetric (DHB Mat) (1 mo in arrear) 2.24 2.32 0.08 2.12 2.14 0.02

Average Length of Stay Obstetric (Ind. Mat) (1 mo in arrear) 2.00 2.14 0.14 2.09 2.20 0.11

Average Length of Stay Vaginal Deliveries overall 2.05 1.84 -0.21 2.06 2.07 0.01

Maaori - 1st time mothers 2.10 1.73 -0.37 2.45 2.21 -0.24

Pacific - 1st time mothers 2.35 2.38 0.03 2.39 2.61 0.22


FSA / FUP ratio - Gynae 1:1.1 1:1.1 ~ 1:1.20 1:1.1 ~

DNA - Midwifery Antenatal clinics - First 14% 14% 0% 14% 14% 0%

DNA - Midwifery Antenatal clinic - Follow up 14% 16% 2% 16% 15% -1%

DNA - Doctor Antenatal clinics- FSA 13% 15% 2% 13% 13% 0%

DNA - Doctor Antenatal clinics - Follow up 20% 14% -6% 20% 14% -6%

Outpatient DNA - Maaori (Gynae) 17% 10% -7% 16% 10% -6%

Outpatient DNA - Pacific (Gynae) 14% 10% -4% 14% 10% -4%

Outpatient DNA - Maaori (Obst) 29% 10% -19% 28% 10% -18%

Outpatient DNA - Pacific (Obst) 21% 10% -11% 20% 10% -10%

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WOMEN'S HEALTH SCORECARD

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Women’s Health Scorecard Commentary

The safety measures’ reporting is now back on track by using the old database for most measures and the new weekly safe sleep audit tool (on five mothers and babies).

We are investigating why the data on Hand Hygiene shows nil for the month. We are also in the process of identifying and training new Gold Hand Hygiene champions in Maternity who will be able to undertake the monthly audits more reliably.

Breastfeeding data is impacted by the change to MCIS reporting. We know from our BFHI data reporting that we are maintaining our 75% target.

The Gynaecology EC six hour target for the month was not reached. This was due to medical workforce issues (in particular with house officers); issues included high sick leave (ACC), three house officers resigning in early December, and the change-over of Registrars in early December.

The inpatient experience survey rating for December is 77% Excellent and Very good (total sample of 44 for the month). However, this is a small sample of the overall women/families using our services only. We continue to use the ward based Patient Feedback Forms (Happy/Unhappy forms) to allow immediate feedback for women/families on the wards/community maternity units so that issues and feedback can be addressed before women are discharged.

Update on MCIS Risk No. 706 Progress as at Wednesday, 13 January 2016

Following on from the November 2015 update:

Meeting MoH took place on 9 December outlining the pathway for the software and process development for 2016 with the first action being the Version 9.2 release in mid-February 2016. This release will mitigate some of the clinical safety issues (i.e. partogram in particular) but is not intended to mitigate and/or correct all issues identified.

MoH staff and DHB MCIS project and clinical staff are now meeting regularly to develop the overall process maps and software modification required to make the MCIS a clinically safe and user friendly programme. MoH has given us their commitment to have a fully functioning system by end of May 2016.

Department of Anaesthesia has completed their additional MCIS training of the current version and are involved in national user group meeting.

Def


% Resourced Occupancy (avg of 9am & 9pm) Dec-14 June 15YTD

Gynaecology Ward 83.7% 90.8% 7% 86.3% 85.5% -1%

Maternity Ward - Maternity (45 beds) (lodgers included) 77.0% 74.0% -3% 76.5% 78.8% 2%

Maternity Ward - Nursery (30 beds) (lodgers included ) 75.8% 81.7% 6% 82.9% 81.0% -2%

Botany Maternity Unit (lodgers included) 67.1% 95.7% 29% 84.9% 89.7% 5%

Papakura Maternity Unit (lodgers included) 66.1% 76.2% 10% 71.9% 75.3% 3%

Pukekohe Maternity Unit (lodgers included) 56.7% 80.2% 24% 68.3% 70.7% 2%

Nursing Hours per Patient Day (not including HCA)at MMH

NHPPD - Maternity Ward North (including nursery PD) 6.18 6.99 0.81 6.14 6.11 -0.03

NHPPD - Maternity Ward South (including nursery PD ) 5.77 6.16 0.39 5.89 5.72 -0.17

Nursing Hours per Patient Day - Gynae 5.28 5.05 -0.23 5.47 5.20 -0.27

#REF! Target Var. Actual Target Var.

Patient Experience Survey Responses - How would you rate your overall care 77% 90% -13% 77% 90% -13% 74

(Excellent and very good)

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The national Operational Governance Group (MoH and Early Adopter DHBs) has been set up and is meeting fortnightly.

All manual back-up systems remain in place to mitigate current clinical safety risks.

Risk Outcome Residual Consequence Rating: Moderate

Residual Risk Likelihood: Likely

Residual Level of Risk: 3 - Moderate risk

Risk File Status: Plan in Progress

http://mmhincrp01/rmproweb_riskregister/riskweb3.dll/FrmHome


3.9 Surgical and Ambulatory Care

Glossary

CLAB Central Line Associated Bacteraemia DRG Diagnostic Review Group FSA First Specialist Assessment SMO Senior Medical Officer WIES Weighted Inlier Equivalent Separations YTD Year to Date

Service Overview

Surgical and Ambulatory Care is managed by Gillian Cossey General Manager with Mr Wilbur Farmilo Clinical Director - Surgery, Catherine Simpson Clinical Director - Critical Care, Jacqui Wynne-Jones Clinical Nurse Director - Surgery, and Annie Fogerty Clinical Nurse Director - Acute & Critical Care.

Performance

Activity Summary

Operational Volumes /Inpatient Summary (WIES)

Surgical Volumes (WIES – Acute and Elective) Volumes Dec-15 Year to date

Actual Bud/

Contract Var %Var Actual

Bud/ Contract

Var % Var

ACUTES

- Adults 1,856 1,873 -16 -0.87% 10,922 10,792 130 1.20%

- Children 171 159 12 7.35% 1,037 945 92 9.78%

2,027 2,032 -5 -0.22% 11,959 11,737 222 1.89%

ELECTIVES

- Adults 1,047 1,020 28 2.73% 7,057 7,487 -430 -5.74%

- Children 76 71 5 6.90% 493 520 -27 -5.18%

1,123 1,090 33 3.00% 7,550 8,007 -457 -5.71% COMBINED TOTAL

- Adults 2,904 2,892 12 0.40% 17,979 18,279 -300 -1.64%

- Children 247 230 17 7.21% 1,530 1,465 65 4.47%

3,150 3,122 28 0.90% 19,509 19,744 -235 -1.19%

Acutes WIES 0.22% lower than contract for the month but 1.89% over contract YTD.

Electives WIES 3% higher than contract for the month but 5.71% behind contract YTD.

Overall 28 WIES higher than contract for month but 235 WIES below Contract YTD - please note that these comparisons are on the basis of comparing contracts in WIES 14 with actuals in WIES 15 which provides a lower WIES/case on a number of DRGs.


Operational Volumes / Inpatient Summary (Discharges)

Surgical Volumes (Discharges – Acute and Elective) Volumes December ‘15 Year to date

Act Bud/


Bud/ Contract

Var % var

ACUTES

Adults 1,531 1,453 78 5.34% 8,720 8,450 270 3.19%

Children 200 182 18 9.78% 1,084 1,081 3 .025%

Acutes Total 1,731 1,636 95 5.84% 9,804 9,532 272 2.86%

ELECTIVES

Adults 948 865 83 9.57% 6,528 6,341 187 2.95%

Children 116 111 5 4.44% 739 816 -77 -9.39%

Electives Total 1,064 976 88 8.99% 7,267 7,156 111 1.54% COMBINED TOTAL

Adults 2,479 2,318 160 6.92% 15,248 14,791 457 3.09%

Children 316 293 23 7.76% 1,823 1,897 -74 -3.90%

Total 2,795 2,612 183 7.04% 17,071 16,688 383 2.29%

Acute discharges higher than contract by 95 patients or 5.84% (YTD 272 discharges higher than contract 2.86%).

Elective discharges higher than anticipated contacted levels by 88 patients or 8.99% (YTD 111 patients ahead of contract or 1.54%).

Overall patient discharges are 183 higher than contract for month and 383 over contract YTD.

In comparison with that of last financial year acute discharges are higher by 310 patients but electives are lower by 418. Overall therefore 108 patients below corresponding six month period last year.

For the month we subcontracted 129 patients against a target of 60 patients (YTD 572 patients versus target of 397). During the last financial year we subcontracted 706 patients to private providers for the corresponding six month period. This effectively means that subcontracting has reduced by 19% compared with the previous year.

Elective base contract for the month excludes Gynae but includes additional elective work.

Note: Adjustment has been made for un-coded 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.

Spines There was a total of 42 spines for the month of December. Eight of these were acute Spinal Cord Impairment patients (seven ACC, one MoH). There were 25 Acute spine admissions with 17 patients going forward to surgery. Nine were Elective patients.


Outpatient Summary (visits first and follow-up) for the month, and YTD Dec-15 Year todate

Actual Contract Var % Actual Contract Var %

FSAs 2,294 2,221 73 3.29% 14,264 15,358 -1,094 -7.1%

Follow ups 5,658 6,725 -1,067 -15.87% 36,841 41,534 -4,693 -11.3%

Total 7,952 8,946 -994 -11.11% 51,105 56,892 -5,787 -10.2%

FSAs 3.29% higher than contract for the month but 7.1% below contract year YTD.

Follow ups are 15.87% below contract for month and 11.3% behind contract YTD.

Highlights

Alan Shackleton won the Emerging Project Manager of the Year award for his work on the Wound Care Suite Project.

The National Burn Centre won the Annual Hospital Smokefree Award for the “most consistent Smokefree best practice”.

The See and Treat Unit has been open for three months and has seen and treated 449 patients.

Two elective and two acute Tahitian Burn patients were treated during December.

6.1 FTE of Critical Nurses have been recruited from December;

Two Anaesthetic Technicians graduated from their Foundations of Management course in December.

Emerging Issues

The volumes of cancer cases are proving very challenging for the Faster Cancer Treatment times. There were 34 urgent breast cancer surgeries in December alone.

Due to staff shortages in Ophthalmology the service experienced 31 ESPI 2 breaches in December. Forecasts for January are indicating that increased subcontracting and the appointment of a new SMO will clear the backlog of patients waiting over 120 days for FSA. A newly recruited SMO will also commence in January.

Integrated Pain Service / Complex Pain Update

Derived Surgical Bed Day savings (based on $110 per surgical bed day) as of end December is $37,950.00 (345 bed days saved by the transdisciplinary teams care of 299 Complex Pain patients).

ACC revenue for treatment injury claims captured by ACC team in conjunction with Integrated Pain Service, as of end December $10,664.00.


SURGICAL AND AMBULATORY CARE SCORECARD

December 2015


Def


Total Caseweight (Provider view) 3,150 3,122 0.9% 19,509 19,744 -1.2% 1

Elective Caseweight 1,123 1,090 3.0% 7,550 8,007 -5.7% 3

Acute Caseweight 2,027 2,032 -0.2% 11,959 11,737 1.9% 2

Elective Surgical Discharges 1,064 976 9.0% 7,267 7,156 1.5% 4

Outpatient FSA Volumes 2,294 2,221 3.3% 14,264 15,358 -7.1% 10

Outpatient Follow Up Volumes 5,658 6,725 -15.9% 36,841 41,534 -11.3% 11

Virtual FSAs/Follow ups -(GP consult and nonpatient appointments) 110 85 25 674 703 -29 12

Reduce clinical outsourcing ($000) 249 222 -27 1,935 1,778 -157 13


% Staff with Annual Leave > 2 years 15.1% 5.0% -10.1% 15.3% 5.0% -10.3% 14

% Staff Turnover 9.1% 2.0% -7.1% 6.6% 10.0% 3.4% 15

% Sick Leave 2.9% 2.8% -0.1% 2.7% 2.8% 0.1% 16

Work Place Injury per 1,000,000 hours 0.00 10.50 10.50 16.22 10.50 10.50 17



Hand Hygiene compliance rate (based on Gold Audit) - Ward 11 72% 80% -8% 78% 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" 94% 95% -1% 97% 95% 2%

2 grams or more Cefazolin given 98% 100% -2% 99% 100% -1%

Appropriate skin preparation 100% 100% 0% 99% 100% -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 39 0 39


Pre-operative Length of Stay Days (from admit to surgery) 0.66 1.00 0.34 0.68 1.0 0.32

ESPI 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)31 0 -31 31 0 -31

ESPI 5 No. patients waiting >120 days Treatment - Elective (Surgical Services incl Gynae) 8 0 -8 8 0 -8


Average Length of Stay - Acute Inpatient incl Burns 3.77 3.80 0.03 3.84 3.8 -0.04 50

Average Length of Stay - Acute Inpatient excl: Burns 3.55 3.80 0.25 3.75 3.8 0.05

Average Length of Stay - Electives 1.40 1.50 0.10 1.41 1.5 0.09 51


Theatre list utilisation - % used MMH/MSC (MOH OS5) 87.6% 85.0% 2.6% 87.5% 85% 2.5%

Theatre session utilisation - % used MMH/MSC 85.5% 95.0% -9.5% 91.9% 95.0% -3.1%

Elective Theatre turnaround times- Mins (MSC only) 15.6 15 -0.6 14.6 15 0.4

Elective cancellations - Day of surgery as % of all Elective (all reasons)- SACS only 7.9% 5.0% -2.9% 8.0% 5% -3.0%

Day of Surgery Admissions (DOSA) 91.7% 90.0% 1.7% 91.3% 90% 1.3% 65

Day Case Rate (Elective/ Arranged) -Subspecialties in SACS only Adults/kids (New Calc

N/A) 74.8% 65.0% 9.8% 73.5% 65% 8.5% 66

MMH % patients discharged to discharge lounge or home by 1100hrs 14.3% 30.0% -15.7% 16.8% 30% -13.2%

Ratio FSA/FU clinic ratio 40.5% 31.0% 9.5% 38.7% 31% 7.7% 61

Outpatient DNA rates - overall- Surgical Services only 8.0% 10.0% 2.0% 7.9% 10% 2.1% 62

Outpatient DNA rates - Maori (FSA) - Surgical Services only 13.1% 10.0% -3.1% 13.9% 10% -3.9% 62

Outpatient DNA rates - Pacific (FSA)- Surgical Services only 11.3% 10.0% -1.3% 11.1% 10% -1.1% 62


Patient Experience Survey (rated very good/ excellent) 87% 92% -5.0% 85% 92% -8% 74



% of hospitalised smokers receiving smokefree advice & support -Total (Surgical) 96% 95% 1.0% 96% 95% 0.5% 77

Year

n=72 Year to date (N=463)

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Scorecard Commentary

Plus

Excellent patient safety results for falls, pressure injuries, CLAB and rate of S. aureus bacteraemia.

Day Case Surgery Rate has increased.

Average length of stay for acutes has improved.

Minus Still awaiting data to clarify where staff turnover has increased.

Data for surgical site surveillance in December shows a decline in antibiotic performance. We are awaiting details of the audit data for this.

Theatre utilisation data shows a decline in theatre utilisation. This appears to be partly as a result of the opening of the See & Treat Unit. A data review is being carried out to accurately measure the positive impact achieved by the See and Treat Unit. This unit has increased outputs and timeliness of local anaesthetic cases, thus greatly improving patient experience.

See and Treat Unit has now been open for three months:

o 449 patients treated and seen

o 101 FSA patients to date

o Referral to FSA: one patient waited 90 days, all others well under this target

o Procedures completed: October 142, November 189, December 118


3.10 Adult Rehabilitation and Health of Older People

Glossary

ARHOP Adult Rehabilitation and Health of Older People AT&R Assessment, Treatment and Rehabilitation Services

Service Overview

Adult Rehabilitation and Health of Older People (ARHOP) is managed by Dana Ralph-Smith General Manager, with Dr Peter Gow Clinical Director, 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 for the month and YTD activity

Outpatient Summary (Visits First and follow up) for the month Geriatrician Outpatient Clinics – December data not available at the time of reporting

Fig. 1: Health Older Person – AT&R Outpatient Waiting List Activity

1 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.

Volumes

Act

Bud /


Bud /

Contract Var % var

INPATIENT

AT&R 1,411 1,540 -129 -8% 10,208 11,600 -1,392 -12%

Spinal 419 437 -18 -4% 2,630 2,675 -45 -2%

Stroke Rehabilitation 470 353 117 33% 2,779 2,100 679 32%

Acute Care for the Elderly 290 186 104 56% 2,204 1,800 404 22%

ARHOP Volumes (Bed days and Contacts)

December '15 Year to date

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

Added 89 85 89 81 119 85 104 102 121 95 95 93 81

Seen 85 72 72 63 56 78 84 102 84 102 66 86 56

Return to GP 0 1 0 1 0 0 0 0 0 0 0 0 0

Removed Other 20 5 11 27 17 15 29 26 16 19 21 12 12

TOWL 126 137 141 132 178 177 175 123 151 131 137 133 151

Waiting > 120 days 16 22 27 12 4 6 10 8 6 6 10 9 13

Waiting > 90 days 23 33 33 16 8 18 21 15 16 11 16 16 18


Highlights

The ARHOP summer plan remained on target with closures going smoothly over the Christmas/New Year period and patient volumes being slightly lower than anticipated.

The Community Geriatric Services Team have been introduced to the “Discussion Document for Community Health Service Integration (Phase 1 – December 2015 – June 2016)”. The team will feedback through the options noted.

The McKesson Workload Tool trial has commence on wards 4, 5 and 23, the Spinal Ward is preparing for implementation, expected February 2016.

Emerging Issues

There appears to be delays for police checking required for Annual Practicing certificates (APC) for

new graduate recruits – this may cause delays for new starters in January.


Note: Enhancing high performing people and patient experience survey data not available at the time of reporting.

December 2015


Def


Spinal Inpatient ACC Revenue(in '000s) 859 447 412 3,210 2,789 421

Non-acute Rehabilitation ACC Revenue(in '000s) (1) 450 250 200 2,042 1,700 342


% Staff with Annual Leave > 2 years (2) 4.2% 5.0% 0.8% 5.2% 38.0% 32.8% 14

% Staff Turnover 0.6% 2.0% 1.4% 9.7% 10.0% 0.3% 15

% Sick Leave 2.0% 2.8% 0.8% 2.6% 2.8% 0.2% 16

Workplace Injury Per 1,000,000 hours 0.00 10.50 10.50 22.18 10.50 -11.68 17



Falls - % of falls assessments done in first 6 hours (3) 90% 100% -10.0% 91% 100% -9%

Falls - % of Interventions completed 100% 100% 0.0% 95% 100% -5%

Pressure Injuries - % of assessments done in first 6 hours 91% 100% -9.0% 95% 100% -5%

Pressure Injuries - % of interventions completed 96% 100% -4.0% 96% 100% -4%

Reduce over ride rate of Pyxis on ATR wards decrease medication errors to 15% 13% 15% -2% 14% 15% -1%


Proportion of referrals managed via e-referrals across Services (ARHOP) 38% 50% -12% 36% 50% -15%

Access to Outpatient specialist services -volumes of Geriatric A&R Hotline Calls 27 40 -13 36 40 -4

QUARTERLY REPORTING Sep-15 Target Var Actual Target Var

% NASC referral to assessment - high complex within 5 days urgent < 24 hrs (or less),

(new measure 2014/15) (4) 34% 75% -41% 29% 75% -46%

% NASC referral to assessment - low complex clients <15 days (new measure

2014/15) (4) 58% 75% -17% 59% 75% -16%

Dec-15 Dec-14 Var Actual Target VarMaintain number of patient 75’s or older LOS > 10 days in AT&R wards (2% reduction

on 2013/14) (4) 56 38 18 59 55 4 50.8

Maintain direct admissions from GPs to ATR wards (5% reduction on 2013/14) 23 34 -11 25 30 -5

% of Estimated Discharge date set following assessmentn in ARHOP 100% 100% 0% 99% 97% 2%

Avoidable presentations to EC from Aged Residential Care Facilities (ARRC) 17 18 -1 20 15 -5

MMH % patients discharged to discharge lounge or home by 1100hrs 34% 34% 0% 33% 34% -1%

Rehabilitation 7 day Readmissions rate 0.0% 0.8% -1% 0.2% 1% -0.8%

Acute Readmission within 28 days - Total for Rehabilitation beds 2.9% 5% -3% 3.7% 7% -3%

QUARTERLY REPORTING Q3 Target Var Actual Target Var

% +65years with long term HBSS - comprehensive clinical assessment &care plan 75% -75% 75% -75%Reported one quarter in arrears regional data due after 20th of the month


Patient Experience Survey 90% -90% 90% -90%


Dec-15 Dec-14 Var Actual Target Var

Number of Spinal Rehabilitation Outreach Clinic days - (new measure 2014/15) 5 2 3 30 22 8 47

ADULT REHABILITATION & HEALTH OF OLDER PEOPLE

SCORECARD

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12 month Average

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Revenue – The total ACC revenue shown in the scorecard is greater than the revenue recognised in ARHOP service. This is due to recognition differences for Non-acute Rehabilitation ACC revenue, Spinal Rehabilitation inpatient revenue and spinal outpatient revenue.

12 month leave planning has been undertaken across the division including minimum staffing levels.

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

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


3.11 Medicine, Acute Care, and Clinical Support

Glossary

ALOS Average Length of Stay CT Computerised Tomography EC Emergency Care FSA First Specialist Assessment MoH Ministry of Health MRI Magnetic Resonance Image WIES Weighted Inlier Equivalent Separations YTD Year to Date

Service Overview

The Division of Medicine, Acute Care and Clinical Support service is managed by Brad Healey General Manager, 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 Clinical Nurse Directors To’a Fereti and Annie Fogarty.

Performance

Activity Summary

Activity levels for December were in line with expectations. Volumes in Emergency Care (EC) were 2.8% higher than last year and Radiology and Laboratory volumes were also higher than December 2014. We have established a Diagnostic User Group to focus on growth in laboratory and Radiology.

Volumes

Month YTD Budget/ Contract

Last YTD

Act Bud /

Contract Var Act

Bud / Contract

Var Forecast Act

Inpatient (WIES)

Adult Acute Care 498 420 78 2,814 2,801 13 5,450 2,311

Adult Medical Care 1,975 1,872 103 13,328 12,709 619 23,626 12,823

Total 2,473 2,292 181 16,142 15,510 632 29,076 15,134

Inpatient (cases) Contract = Last year actuals Adult Acute Care 1,384 1,245 139 7,905 7,701 204 15,085 5,928

Adult Medical Care 2,142 2,214 (72) 14,117 14,166 (49) 26,963 14,062

Total 3,526 3,459 67 22,022 21,867 155 42,048 19,990

Medicine O/P

Procedural (contract) 484 606 (122) 4,182 3,720 462 6,285 2,712

FSA’s 1,251 1,514 (263) 9,177 10,222 (1,045) 16,578 8,497

Follow up’s 5,678 5,555 123 40,835 38,511 2,324 38,796 18,978

Emergency Care

Presentations (against last year)

9,286 9,030 256 58,208 55,682 2,526 109,454 55,683

Clinical Support*

Laboratory - Microbiology

27,401 25,875 1,526 203,175 182,198 20,977 293,394 182,198

Laboratory - Histology 29,422 31,935 (2,513) 192,842 164,400 28,442 326,350 164,400

Radiology 16,784 15,063 1,721 102,279 100,218 2,061 197,920 100,218 *Contract = Last Year’s actuals

Note: These volumes are Medicine only and exclude Acute Care. Hence these volumes differ to Balanced

Scorecard which includes Acute Care


Emergency Care – In December there were 9,286 presentations, 2.8% higher than last year and 1.5% higher than in November. The daily volumes fluctuated between 236 and 302 patients per day.

WIES – The overall monthly WIES result reflects a 5% increase compared to contract and a 4% increase compared to last year. The results for General Medicine in December showed a 1% increase in WIES compared to contract and a 1% increase compared to last year. (Source Total Inpatient WIES for Current fiscal period – Medical Service Book Run 2

Cases – This month we saw 0% or seven less cases than this time last year, with a 5% increase in the Average Length of Stay (ALOS) compared to last year. General Medicine (inpatients) saw 5% or 73 less cases compared to last year and a 4% increase in the ALOS. – (Source Acute Care/Medicine Services ALOS and Cases for current fiscal period–Run 0 Cherie Nouwens

Renal Volumes – Continued increase above contract. 32 in-centre dialysis patients outsourced. 24 patients in the Western Campus Prefab, with 43 patients on evening shifts in AMC and in Rito MSC, totalling 98 patients over in-centre capacity for the year to date.

Outpatients – Data for December shows that First Specialist Assessments (FSA) were 263 below volumes for December 2014 and 10% lower than the previous year to date volumes. Follow-ups were 123 above the monthly volumes for the previous year, and YTD follow-ups are 6% above the previous year.

Radiology – Significantly higher volumes compared with the same time last year, particularly in the general x-ray and CT modalities. Much of the growth in general x-ray volumes is driven by referrals from the community.

Laboratory – Overall laboratory workload for December has fallen, but not as much as expected. Test volumes were reduced from November and only 0.9% greater than December 14. While Haematology and Microbiology experienced reduced volumes they still remained 5% and 6% greater than last year. Despite a few instrument problems in Blood Bank, Haematology and Microbiology, the only impact on performance was in urine analysis.

Highlights

Renal CM Health renal transplants have topped the national transplant volumes with 24 since January. CM Health also provided five additional kidneys (from live CM Health donors) for transplants in non-CM Health recipients.

Laboratory IANZ surveillance audit was completed in the first week of December. There are two corrective action requests and 35 recommendations.

Of the two Corrective Action Requests, one is against equipment calibration intervals in relation to three-yearly spatial temperature checks on Microbiology thermo-regulated equipment. This was an oversight and will be addressed by the end of February (completion time is due to dependence on needing to external resources to undertake the work).

The second Corrective Action Request is against accommodation and environmental conditions in Histology, specifically the cutup room and offices and the separation of Non-Gynae Cytology from the remainder of Histology. A review of the risks of the space issues and a plan to address the inadequate accommodation is required. We are surprised this has been raised as a Corrective Action Request given we are already well advanced in our planning for the future location of Histology and Non-Gynae Cytology; we will be discussing this further with IANZ.

The remaining recommendations are currently being addressed and we will report back to IANZ in due course.


Emerging Issues

Renal

Over the past two months we have continued to explore options to address the space constraint

issues of AMC dialysis unit. A number of options have already been considered, with a new option of

extending the unit into adjacent space outside the building. This new option will take account of

future volume growth and we are currently updating our volume growth modelling to determine

how much extra capacity is needed. We expect to complete the business case for the recommended

solution by mid-February 2016.

The Ministry of Health (MoH) funded “Improvement in Live Organ Donor” project has been running

since June 2014 and has improved CM Health’s rate of not only live organ donation for kidney

transplant, but also improved overall kidney transplant rates from approximately six to seven per

annum to 18 per annum. A further meeting was held with the MoH to discuss ways to ensure that

the gains made from the project can continue with sustainable funding for the various initiatives. A

plan and business case is to be developed for MoH and should be ready for submission by

March/April 2016 once the evaluations of the project work-streams have been completed.


December 2015


Def


Total Caseweight 2,469 2,289 8% 16,123 15,479 4% 1

Elective Caseweight 55 38 45% 435 241 80% 2

Acute Caseweight (includes ICU) 2,415 2,251 7% 15,687 15,239 3% 3

Outpatient FSA Volumes 1,022 1,299 -21% 7,745 8,620 -10% 4

Outpatient Follow Up Volumes 3,179 3,112 2% 20,308 20,124 1% 5

Virtual FSAs 73 104 -30% 903 902 0% 10


% Staff with Annual Leave > 2 years 8.5% 5.0% -3.5% 9.9% 5.0% -4.9% 11

% Staff Turnover 8.4% 2.0% -6.4% 7.6% 10.0% 2.4% 13

% Sick Leave 2.6% 2.8% 0.2% 2.9% 2.8% -0.1% 14

Workplace Injury Per 1,000,000 hours 4.6 10.5 5.9 10.3 10.5 0.2 15



% electronic medication reconciliation completed for high risk patients within 48hrs 67.0% 80.0% -13% 69.0% 80.0% -11% 21

No. Falls causing major harm 7 0 7 42 0 42 23


% of patients admitted, discharged, transferred from ED within 6 hrs 96% 95% 1% 96% 95% 1% 33

% MRI scans completed within 6 weeks from acceptance of referral 87% 85% 2% 54% 85% -31% 34

% CT scans completed within 6 weeks from acceptance of referral 93% 95% -2% 90% 95% -5% 35

Radiology - Inpatient radiology times < 24hours 93% 95% -2% 93% 95% -2% 36

Radiology EC radiology times < 2 hours 96% 95% 1% 96% 95% 1% 37

P1 (urgent) % diagnostic colonoscopy patients receive the procedure within 14 days 91% 75% 16% 87% 75% 12% 38

P2 (routine)% diagnostic colonoscopy patients receive the procedure within 42 days 39% 65% -26% 40% 65% -25% 39

% surveillance colonscopy patients receive their procedure within 84 days of planned 96% 65% 31% 79% 65% 14% 40

% cardiac STEMI - PCI (angiography) within 120 mins - Northern Region Target 60% 80% -20% 76% 80% -4% 41

Medical Assessment – Triage3-5 patients seen by SMO within 60 min 63min 60min -3min 69.5min 60 -9.5min 46

Laboratory -Test turnaround time (TAT) within 60mins average of results YTD 49

Potassium 94% 90% 4% 94% 90% 4% 50

Haemoglobin 99% 98% 1% 99% 98% 1% 51

PT/INR 99% 98% 1% 99% 98% 1% 52

Troponin 1 for EC 94% 90% 4% 94% 90% 4% 53

Histology - All - 5 working days 90% 90% 0% 82.7% 90% -7% 54

-Breast - 3 working days 87% 100% -13% 89.1% 100% -11% 55

-Non gynae FNAs - 5 working days 100% 100% 0% 98.8% 100% -1% 56

Blood Bank - antibody screen within 4 hours 94% 90% 4% 93.2% 90% 3% 57

Microbiology

CSF cell count <30mins 89% 90% -1% 90.0% 90% 0% 58

ESBL screens <2days 96% 95% 1% 96.0% 95% 1% 59

CDT (C. diff Toxin) <25hrs 92% 90% 2% 92.0% 90% 2% 60

UCHM (Urine Chemistry) <60mins 86% 90% -4% 89.0% 90% -1% 61

Door to Cathlab suspected Acute Coronary Syndrome < 3 days (median time) 86% 70% 9% 81% 70% 11% 63

General Medince - Seen By Time (minutes)

1st Time to be seen Triage 1 & 2 patients (median time) 25min <30mins 5min 25.8min <30mins 4min 64

1st Time to be seen Triage 3 - 5 patients (median time) 72min <60mins 13min 81.5min <60mins 24min 65

2nd Time to be seen Triage 1 & 2 patients (median time) 46min <30mins 2min 41.1min <30mins 10min 66

2nd Time to be seen Triage 3-5 patients (median time) 50min <60mins 15min 52.5min <60mins 9min 67

MEDICINE, ACUTE AND CLINICAL SUPPORT SCORECARD

Year to date

Tim

ely

Year to date

12 month average

Year to date

Ensu

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Sust

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Enab

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CT - The CT result of 93% was below that expected due to a significant increase in demand in the weeks leading up to the Christmas break.

MRI – the indicator was exceeded with the result of 87% for December. This was despite demand above expected levels. Further reduction in outsourcing is occurring mid-January.

Percentage of Radiology reports completed within 24 hours – improved result on the previous month largely due to the resolution of the disruptive PACS issues reported last month. This resulted in an improvement of 9% on the general x-ray reporting turnaround.

Histology turnaround times for the first time in approximately two years achieved the 90% overall five working days reporting target. The challenge is to ensure systems remain robust enough to continue meeting the target. We are currently reviewing the Breast Screen data which was previously extracted manually is now extracted electronically to verify accuracy.

Urine Chemistry generally hovers close to the target and is dependent on the performance of the urine analyser. Maintaining this instrument in prime working order is very difficult due to the variability of samples being tested.

95% transcribed clinical summaries authorised in less than seven days of creation – performance against these indicators is circulated to Clinical Directors and Service Managers monthly. Performance against this target will be discussed at the Clinical Directors meeting in January 2016.

QUARTERLY REPORTING Q1 Target Var Actual Target VarFaster Cancer Treatment - % high suspicion first cancer treatment within 62 days - MOH FCT + 72% 85% -13% 72% 85% -13% 68

Faster Cancer Treatment - %confirmed diagnosis first cancer treatment within 31 days - MOH

FCT +82% N/A 87% N/A 69

% radiology results reported within 24 hours 59% 75% -16% 55% 75% -20% 70


Average Length of Stay - Acute 3.4days <3.5days 0.1 3.4days <3.5days 0.1 71

Acute Readmissions within 7 days - Total 6% 3% -3% 6% 3.0% -2.5% 73

Acute Readmissions within 28 days - 75+ - MOH IDP 15% 10% -5% 15% 10% -5% 75

% transcribed clinical summaries (meddocs)authorised <7 days of creation 78% 95% -17% 73% 95% -22% 76

% of patients on home wards in General Medicine 50.0% >75% -25% 48.1% >75% -26.9% 80

% of Outliers on non-medicine wards 2.3% 0.0% -2.3% 7.4% 0% -7.4% 81

QUARTERLY REPORTING Q4 Target Var Actual Target Var

% eligible stroke patients thrombolysed - Northern Region Target 9% 6% 2.9% 10% 6% 4.0% 84

Stroke patients on stroke pathway 80.0% 80% 0.0% 80% 80% 0.0% 85

Nov-15 Target Var Actual Target Var

% Discharges from transit lounge or home by 1100hrs 15% 30% -13.9% 19% 30% -11% 89

% MA short stay patients discharged home from Medical Assessment 76% 80% 4.4% 83% 80% 3% 90

% Discharged from Mau by 1100 43% 50.0% -6.5% 45.5% 50% -4.0% 91

% of patients < 28 hrs discharged from inpatient wards 11% <10% -1.3% 12.1% 10% -2.1% 93

94

Implement Home First Renal policy - (increase CAPD & HD rate) 44% 50% -5.7% 45% 50% -5.4% 95


Patient experience Survey data - month (n=23) and YTD (N=169) 90% -90.0% 90% -90.0%

Implementation of Advance Care Planning - number of conversations 433 262 +171 2,255 1,310 +945 95



% Women with Breastscreen in last 24 months - total 1,960 2,213 -253 68% 70% -2% 98

% Women with Breastscreen in last 24 months - Maaori 215 261 -46 66% 70% -3% 99

% Women with Breastscreen in last 24 months - Pacific 336 392 -56 79% 70% 6% 100

Effi

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Tim

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YearSy

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Volumes Screened

Equ

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Year to date

Pat

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Car

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Year

Year

% Screened in last 24 Months


3.13 Director Allied Health Report

Allied Health Directorate Development The Strategic Intent document for the Allied Health Directorate has been revisited to ensure alignment with the Strategic Direction of Counties Manukau Health. From this specific work has been clarification of the divisional responsibilities to be carried by the Associate Directors detailed below:

Professional Lead Locality Division

Claire Green Dietetics & Nutrition Franklin MAC&CS

Selena Donaldson Speech Language Therapy East ARHOP

Jill Grieve Speech Language Therapy Mangere-Otara Kidz First/WH

Simon Kerr Physiotherapy Mangere-Otara SACS & ARHOP

Haidee St John Occupational Therapy Manukau MH&A

Annelize de Wet Social Work MH&A

From this there has been clarifying of activity to be undertaken by the Directorate and how it aligns with the Counties Manukau Health Strategic Goals.


Other non-related pieces of work underway:

An offer was made to the PSA prior to Christmas to settle the Allied Health MECA. This was rejected by the members. Meetings with the Union have continued with an aim to enter into full bargaining again by February.

Prepared and submitted by Martin Chadwick Director Allied Health

Counties Manukau District Health Board – Hospital Advisory Committee 10 February.2016

3.14 Director of Nursing

Glossary

HCA Health Care Assistant NP Nurse Practitioner PHC Primary Health Care RM Registered Midwife RN Registered Nurse

Update

Nursing Strategic Action The Director of Nursing is working with Organisational Development in Ko Awatea to shape up a leadership course [Leading Quality Care] aimed at Charge Nurse Managers. We recognise the demands on this role are huge, so ensuring they are equipped with the right tool will be a help.

Did you know “At the heart of Counties Manukau DHB are Charge Nurse Managers who lead over 44% of our workforce, and are pivotal in touching a broad scope of people?” The aptitude needed to successfully manage and lead wards is forever increasing and challenging, and it is therefore vital for our nurse leaders to continually develop leadership practice while building and extending their capabilities. Leading Quality Care will be an interactive, practical and comprehensive programme designed to build leadership capability, and therefore influence and strengthen performance that is centred on quality care and patient outcomes in wards. To ensure the programme fits the needs of the organisation and further enables Charge Nurse Managers, we will be seeking input on programme design and content from staff in the New Year.

The festive season was busy, particularly for Medical wards and Emergency Care. The summer plan to close some beds and release staff for annual leave or re-deployment was implemented, although there were daily adjustments required. For Nursing, over 140 staff (HCA and RN/RM) worked shifts on wards outside their usual workplace, and nearly 450 staff worked shift on other wards within their divisions.

Sustainable Nursing workforce The One Staff (electronic rostering system) upgrade continues with the Assignment & Workload Manager Module implementation ongoing and now moving from acute area to Women’s Health, Mental Health and specialist units. There will be ongoing validation of the data and refinement of processes.

The use of Bureau was down overall (over 3,000hrs less than in November) with staff numbers reduced both in external agency HCA FTE, and in ‘internal’ RN FTE.

Despite current nurse vacancies (135 FTE) most areas have continued to manage rosters to ensure staff could take annual leave.

Patient and Whaanau Centred Care Consumer Council provided a comprehensive and impressive report on their inaugural year. A focus on being proactive rather than waiting for engagement is top of their 2016 intent list. Work is progressing on the Patient Experience week (7th March) which focuses on communication.

There has been on-going monitoring of the new food service contract implementation and operational changes. The transformation of the food services has been monumental and there is still some way to go to get our patient satisfaction with this element of their stay higher.

In mid-December, the Middlemore Patient Resource Centre “Whare Rapu Matauranga – Hauora” opened. The resource centre is at the entrance to the Edmund Hillary building before you go through the doors to the staff café. It has four computers and is currently staffed by volunteers to help

Counties Manukau District Health Board – Hospital Advisory Committee 10 February.2016

patients and family carers seek out information and resources. This has been funded by the Hector Trust, which has also funded some iPads for the ward environment.

Workforce Nationally, 20 nurses will be accepted into a pilot dedicated nurse practitioner training programme, which begins in 2016. Unfortunately three CM Health Nurses were unsuccessful in gaining full Nurse Practitioner Scholarships however Health Workforce NZ funding will assist, and it is planned to have the Respiratory NP intern join the cohort. CM Health currently has four expert nurses submitting their portfolios to Nursing Council. Three have secured NP roles if successful-one Primary Health Care (PHC) has been informed of limited options.

The New Graduate (NeTp) intake in January 2015 have completed their programme; this cohort had the largest number of PHC new graduates ever, as well as the first Occupational Health Nurse Graduate in NZ. The January 2016 intake has commenced; a report breaking down location and ethnicity will be submitted to the next HAC. The Nursing Council has notified us of our Professional development and NeTp Programme certification in March.

Highlights from Services Work to strengthen the integration between primary Health and secondary mental health services continues, with each community Mental Health Clinical Nurse Specialist developing alliances and networks in the Locality areas that will continue into 2016. Positive feedback from Justice services has been received on the amazing team work and new models of integrated care.

The Kidz First ward afternoon Coordinator Pilot held during winter 2015 is now being evaluated, with initial responses being positive. A Dedicated Education Unit for nursing students in Kidz First has been endorsed, and planning is underway. This will be a dual faculty unit with students from both University of Auckland and Manukau Institute of Technology Nursing Schools. This Dedicated Education Unit will aim to grow RNs with local paediatric experience and link to a commitment to three NeTp intakes per annum.


3.15 Mental Health

Glossary

DAO Duly Authorised Officer EC Emergency Care MH&A Mental Health and Addictions MHSOP Mental Health Services for Older People NGO Non-Government Organisation ToR Terms of Reference

Service Overview

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

Performance

Activity Summary

Mental Health Volumes (Bed days and Service Access)

Volumes December ‘15 Year to date

Act Bud/


Bud/ Contract

Var % var

INPATIENT Bed days

Tiaho Mai 1,496 1,370 -126 -9% 9,218 8,133 -1,085 -13%

Tamaki Oranga 604 558 -46 -8% 3,623 3,312 -311 -9%

Koropiko – MHSOP 376 395 19 5% 2,250 2,346 96 4%

Service Access No. of unique CMDHB domiciled clients seen over 12 months

19,564 16,125 3,439 21% N/A N/A N/A

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

Psychiatric Liaison and Psychology Proposal for Change The Proposal for Change – Outcome from the Psychiatric Liaison and Psychology Review was supported and approved by the Hospital Management Team on 13 November. The proposal made two recommendations:

i. Create an acute Psychiatry service in the Emergency Care (EC) incorporating existing Consult-Liaison Psychiatry resources and aligned to Acute Mental Health services;

ii. Establish a new hospital-wide Psychological Medicine Service incorporating existing resources from Consult-Liaison Psychiatry and Psychologists working in physical health. The degree of integration of these Psychologists into the new service will be flexible and dependent on a range of factors. The new multidisciplinary Psychological Medicine Service will be primarily accountable to the hospital, rather than Mental Health Services; have a shared cross-discipline leadership structure; and utilise a standardised referral and triage system that will match patient needs and demand to clinical skills and service delivery.

Two Terms of Reference (ToR) were finalised and disseminated in December, to enable work on the detailed design to begin early 2016:

i. Implementation Group for the Acute Psychiatry Service in EC

ii. Implementation Group for the Department of Psychological Medicine


The ToR’s outline the roles and responsibilities of the Implementation Groups, which are primarily to provide advice and feedback to the Mental Health and Hospital sponsors on the detailed design of the new service including the implementation plan with milestones, resources, and timeframes.

A series of questions and answers arising from the consultation workshops were published on the SouthNet/Hospital Psych Service website to keep staff informed of decisions and rationale.

An Expression of Interest for Clinical leadership for the implementation group of the Department of Psychological Medicine was distributed on 29 December. It is thought that an experienced psychiatrist or psychologist working alongside a dedicated project manager would be the most expedient way to implement the Proposal for change as outlined in the ToR.

Awake Overnight Nurse Pilot Background: Counties Manukau Mental Health Acute Services has identified the following issues regarding service delivery to acute presentations overnight.

Inconsistent service delivery

Increased demand – in part related to change of police practices (s109 assessments)

Waiting times

Isolated workers

On call staff being called out overnight which compromises day services

Inconsistent prioritisation processes when demand is high.

Change Concept: The six month trial of an awake, on duty Registered Nurse (Duly Authorised Officer) to replace current on-call system. The person in this role will work in close association with the on duty Registrar and provide the same function as the Intake and Acute Assessment service overnight. This service will include taking incoming calls and referrals, triaging the referrals, arranging and prioritising the assessments, providing clinical interventions, and arranging appropriate follow up as required by the service user. The awake on duty registered nurse (DAO) will be based at Middlemore Hospital within the EC.

Alignment to the psychiatric liaison review recommendations: While this pilot will be aligned directly with the Intake and Acute Assessment Team role and function, there will be close working relationships with both the Intake and Acute Assessment EC nurses and with the Middlemore Hospital Psychiatric Liaison Service.

At the completion of the ‘awake overnight nurse’ pilot, consideration will be given to the long term sustainability of this service. The service will align to Intake and Acute Assessment and in particular Intake and Acute Assessment EC and Police Watch-house based nurses.

Theories and Predictions as to how or why this idea will achieve an improvement:

1. This pilot would ensure that there is a consistent level of staffing and skill base rostered on duty to manage all incoming referrals to the Mental Health services between 12 midnight and 8am.

2. Waiting times and delays that currently exist due to on call DAO’s residing in a wide range of geographical locations will be reduced.

3. A rostered night nursing shift will ensure that registrars would not be working alone and potentially in isolation. This will have the effect of providing a more clinically supportive environment, especially for junior registrars.

4. The pilot will improve clinical safety by having additional staff available to attend initial assessments and contribute to clinical planning. (Two clinical heads are better than one)

5. The ‘awake overnight nurse’ will ensure a prompt response to the EC. This will increase the ability of the EC to meet its targets and reduce waiting times for service users and their family/whanau.


6. The ‘awake overnight nurse’ will ensure a prompt response in circumstances where the Police detain people under section 109 for assessment.

7. The pilot will provide a more consistent approach in service delivery across 24 hours. There will be an improvement in the standard process for entry to service, assessment and handover to the appropriate team for the morning shift.

8. The pilot will provide an opportunity to obtain an accurate measure of work-loads and the demand on overnight Mental Health Services.

Recruitment commenced for this pilot in December. In order to ensure that we have a baseline for this pilot the Clinical Team Coordinators within the acute community services have started collecting data of the number of times that the DAO’s are called out after midnight. In December there were seven instances where this occurred and a total of 82 overtime hours were claimed for this purpose. This data will continue to be collected as a baseline measurement to inform the efficacy of the pilot.

Integration On 30 November 2015 the Integrated Mental Health and Addictions (MH&A) Leadership Group hosted a session with key partner groups to discuss its vision, to share what had been heard throughout the co-design process, and to discuss ideas for what that could mean for the mental health and addictions sector in Counties Manukau. Participants included the collaborative and clinical governance groups representing consumers, MH&A Non-Government Organisation (NGO) providers, Kaupapa Maaori NGO providers, and primary and secondary mental health providers.

Attendees were supportive of the concepts and principles and eager to continue to work together to develop detailed proposals. The main ideas discussed were:

An alignment with the wider Counties Manukau locality approach, developing a mental health and addictions system that builds effective relationships focussed on primary care clusters. Named individuals from specialist MH&A will be connected to clusters/hubs, working in a way that moves past the traditional approach to referrals, enabling professionals and individuals to connect far more easily;

NGO partners will be a core component of local provision, ensuring that each locality has access to a range of services that are responsive to their needs. Alongside locality-focussed provision, will still remain the need for a number of specialist services, such as eating disorders or maternal mental health, which will be Counties-wide;

a focus will continue on people with severe and enduring mental health needs and extend to support the wider population with early intervention and easy access;

In addition to its connection to locality clusters, the MH&A workforce will have a significant mobile component, taking services into the community and engaging with partners such as schools, marae, and churches. Working closely with other sectors beyond health will be crucial in supporting the overall well-being of our communities;

A strong focus on building community resilience and providing education and coaching around self-management.

With this endorsement from key stakeholder groups, the next step will be to take the proposal to CM Health leadership for a mandate to work towards achieving the above.

Emerging Issues

Intake and Acute Assessment/Deportees During the latter months of 2015 a number of chartered flights arrived at Auckland airport from Australia with a number of New Zealand citizens who were being deported. The Intake and Acute Assessment team partnered with Primary Care and other agencies and NGOs to screen the deportees in order to ascertain their health requirements and, once identified, ensure that they are linked to the appropriate services. This has involved diverting staff from Intake and Acute


Assessment to the airport to join the staff from the other services. Of the number of deportees that arrived, a small number have had serious mental health needs identified, and some have refused this service. Intake and Acute Assessment does not have sufficient resources to continue with this practice of meeting every individual from every flight (whether charted or the usual international flight) as well as provide an acute service to Counties Manukau. The development of a Coordination role across CM Health in order to further streamline this process has been considered and Intake and Acute Assessment would support this approach. Intake and Acute Assessment services have been advised that a further 480 people are expected to be deported from Australia in 2016 by charter flights. This number does not include those who are arriving individually by usual international flights.



Overtime costs Overtime costs are driven by open vacancies that are currently being recruited for.

December 2015


Def


Medical staff locum Costs (in $000s) $244 $144 -$100 $1,445 $864 581-$

Overtime costs(in $000s) $145 $86 59-$ $965 $516 449-$


% Staff with Annual Leave > 2 years 7.6% 5.0% -2.6% 8.3% 5% -3.3% 14

% Staff Turnover 11.8% 2.0% -9.8% 8.0% 10% 2.0% 15

% Sick Leave 3.3% 2.8% -0.5% 3.4% 2.8% -0.6% 16

Workplace Injury Per 1,000,000 hours 11.55 10.50 -1.05 14.93 10.50 -4.43 17



No. of Seclusion events - (Rolling 12 months in development) ~ 206 125 -81


Shorter wait times for non urgent mental health and addiction Services (%< 3week

wait)

0-19 years 80.53% 80% 0.53% 48

20-64 years 88.58% 80% 8.58%

65+ years 91.36% 80% 11.36%

overall 85.66% 80% 5.66%


Mental 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 3.96% 3.15% 0.81% ~ 49a

20-64 years 3.86% 3.15% 0.71% ~ 49b

65+ years 2.60% 2.70% -0.10% ~ 49c

Readmissions within 28 days - Total 13.64% 12.00% -1.64% 12.11% 12.00% -0.11%


Occupancy - Tiaho Mai acute mental health unit target is <85% 92.8% 85% 7.8% 85% -85.0%

No of Patient LOS (Tiaho Mai inpatient) < 5 days 9 tbc 66 tbc


PP7-Relapse Prevention Plan - Maaori 97.4% 95.0% 2.4% 96.8% 95% 1.81%

PP7-Relapse Prevention Plan - Pacific 99.3% 95.0% 4.3% 96.0% 95% 1.0%



Access rate - No. CM domiciled unique clients seen by MH services (PRIMHD) 12

months as a % of population - Maori7.22% 6.0% 1.22%

~

Access rate - No. CM domiciled unique clients seen by all MH services (PRIMHD) 12

months as a % of population - Total3.75% 3.1% 0.65%

~

MENTAL HEALTH SCORECARD

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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 Occupational Immunity, Screening & Vaccination

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)]

6.4 Minutes of HAC meeting 2 December 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.


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

6.5 Action Item 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)]

Confirmation of Action Items Register For the reasons given in the previous meeting.

counties manukau district health board hospital advisory ... · 3.4 hospital health target overview...

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