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Counties Manukau District Health Board – Hospital Advisory Committee Agenda

Counties Manukau District Health Board Hospital Advisory Committee Meeting Agenda Wednesday, 4 May 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 (23 March 2016) 2.4 Action Items Register Public

9.20 – 9.30am

9.30 – 9.40am 9.40 – 9.50am

9.50 – 10.00am 10.00 – 10.10am 10.10 – 10.20am 10.20 – 10.30am 10.30 – 10.40am 10.40 – 10.45am 10.45 – 10.55am 10.55 – 11.05am

3. Hospital Services Directorate Report (Phillip Balmer) 3.1 Executive Summary incl. Health Targets 3.1.1 Update on improvement to diagnostics tests - verbal 3.2 Balanced Scorecard & Definitions 3.3 Human Resources 3.4 Responses to Action Items 3.5 Financial Summary (Margaret White) 3.6 Mental Health (Tess Ahern) 3.7 Women’s Health & Kidz First (Nettie Knetsch) 3.8 Director of Midwifery Report (Thelma Thompson) 3.9 Surgical and Ambulatory Care (Gillian Cossey) 3.10 Adult Rehabilitation/Health of Older People (Dana Ralph-Smith) 3.11 Medicine, Acute Care & Clinical Support (Brad Healey) 3.12 Facilities (Phillip Balmer) 3.13 Director of Allied Health Report (Martin Chadwick) 3.14 Director of Nursing Report (Denise Kivell)

Morning Tea Break 11.15 – 11.45am 4. Presentation

4.1 See and Treat Unit

11.45 – 11.50am 11.50 – 11.55am 11.55 – 12.05pm

5. Quality 5.1 Inpatient Experience Survey No. 2/No. 3 (Dr David Hughes) 5.1.1 Review of Inpatient Experience Survey Response Rates – verbal 5.2 Review of Discharge Process – verbal (Denise Kivell)

6. Resolution to Exclude the Public

12.05 – 12.15pm

12.15 – 12.25pm 12.25 – 12.30pm

7. Confidential Items 7.1 Patient Experience & Safety Report/HQSC Q&SM Update October-December

2015/S&AE Report Q3 Jan-March 2016 (Dr David Hughes) 7.2 Risk Register/Risk Report (Dr David Hughes) 7.3 Confirmation of Confidential Minutes (23 March 2016)

Next Meeting:15 June 2016

Meeting Room 101, Ko Awatea, Middlemore Hospital, Otahuhu

Counties Manukau District Health Board – Hospital Advisory Committee 4 May 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

Mee

ting

No

Mee

ting

No

Mee

ting

No

Mee

ting

Wendy Lai

Arthur Anae

Colleen Brown

Sandra Alofivae

Lyn Murphy (Committee Chair)

David Collings

Kathy Maxwell

George Ngatai

X X

Dianne Glenn

Reece Autagavaia

* Attended part meeting only


BOARD MEMBERS’ DISCLOSURE OF INTERESTS

4 May 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 • Member, NZ Disability Strategy Reference Group

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

• Member, ACT NZ • Director, Bizness Synergy Training Ltd • Director, Synergex Holdings Ltd • Trustee, Synergex Trust • Member, International Society of Pharmacoeconomics

and Outcome Research (ISPOR NZ) • Member, New Zealand Association of Clinical Research

(NZACRes) • Member, Franklin Local Board • Senior Lecturer, AUT University School of Inter

professional health studies 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 • President – Friends of Auckland Botanic Gardens and

Chair 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 4 May 2016 Director having interest Interest in Particulars of interest Disclosure date Board Action


Minutes of Counties Manukau District Health Board Hospital Advisory Committee Held on Wednesday, 23 March 2016 at 9.00 – 12.30pm, Room 101, Ko Awatea, Middlemore Hospital, Hospital Road, Otahuhu, Auckland Present: Dr Lee Mathias (Board Chair), Dr Lyn Murphy (Committee Chair), Ms Wendy Lai, Ms

Dianne Glenn, Mr David Collings, Apulu Reece Autagavaia, Ms Sandra Alofivae, Ms Colleen Brown (Deputy Committee Chair), Anae Arthur Anae and Ms Kathy Maxwell.

In attendance: Mr Ron Pearson (for Mr Geraint Martin), Ms Margaret White (Deputy Chief

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

Apologies: Mr George Ngatai, Mr Geraint Martin, Mr Phillip Balmer, Dr Lyn Murphy (for

lateness) and Ms Denise Kivell (for lateness). 1. Welcome

In the absence of the Committee Chair, Ms Colleen Brown chaired the meeting and welcomed everyone in attendance.

2. Governance

2.1 Attendance & Apologies

Noted.

2.2 Disclosure of Interest/Specific Interests

The Disclosures of Interest were noted with no amendments. Ms Wendy Lai confirmed that her two Specific Interest entries could now be deleted.

2.3 Confirmation of Public Minutes (10 February 2016) Resolution That the Public Minutes of the Counties Manukau District Health Board Hospital Advisory Committee meeting held on Wednesday 10 February 2016 were taken as read and confirmed as a true and accurate record. Moved: Ms Dianne Glenn Seconded: Dr Lee Mathias Carried: Unanimously


2.4 Action Item Register Public

Noted.

3. Presentations

3.1 Department of General & Vascular Surgery Dr Andrew Connolly, Head of Department General Surgery & Ms Mary Burr, Service Manager General Surgery took the Committee through the presentation highlighting the following: • CM Health is the busiest combined elective and general surgical unit in the country

and the busiest acute hospital. All acute work is carried out on Middlemore site along with trauma and some complex elective surgery. Most elective surgery is done at Manukau Super Clinic however, Middlemore is doing an increasing amount of elective surgery in an effort to keep up with health target throughput, in particular the Faster Cancer Treatment target.

(Dr Lyn Murphy arrived at 9.20am) • Current hot topics:

o Surgical Assessment Unit – over winter W34E becomes a medical ward staffed by nurses who are multi-skilled across both medical and surgical. By putting patients in the SAU and observing them there as opposed to admitting them to a ward for observation, has seen an immediate improvement in the proportion of patients on the wards staying under 28hrs. Although the unit started as a pilot, there are good clinical reasons to keep it going.

(Ms Denise Kivell arrived at 9.35am) o Faster Cancer Treatment – this target come with frustrations. Last 12 months

452 breast cancers compared to five years ago under 300; 4-5 new bowel cancers per week all of which don’t need major operations but they do all need to go through MDT meetings, have decisions made etc. One of the nuances of the FCT rules is that a high number of our cancers are not captured. The FCT has a couple of different pieces: (1) from referral when we believe it is highly suspicious and of clinical importance (roughly 1/3rd of cancers fall here) and (2) from decision to treat until starting treatment (this makes up the rest). Patients are placed on the FCT list as soon as there are suspicions of having a cancer, not when they are ready for treatment. The FCT definition as it stands does not recognise other treatment that we consider essential prior to the patient’s cancer treatment (ie) a colostomy in order to treat bowel cancer or a heart valve replaced to make it safe to remove the cancer. The Ministry don’t see these as being definitive treatment. Nationally, we are all making the same statements to the Ministry around the definitions for the FCT target. General Surgery will continue to be at risk of not meeting the FCT times until the definitions are expanded. The Committee would like to see some progress in sorting out the Faster Cancer Treatment definitions and asked Dr Connolly to come back in six-months to provide an update on progress.

The Chair thanked Dr Connolly for his presentation.

(Ms Brown handed the meeting over to the Chair at 10.00am)


3.2 Bariatric Service – Can We Afford to Expand/Can We Afford Not To

Dr Andrew MacCormick, Surgeon General Surgery took the Committee through the presentation highlighting the following: • We have a world-leading unit at CM Health based on outcomes and research. • We have the biggest publically funded bariatric service in Australasia – up to 1500

patients and growing at around 150-160 per year. • We have a 60% success rate and the surgery brings lots of long term benefits for the

patient by improving co-morbidities, diabetes, high blood pressure, sleep apnoea, cholesterol etc.

• Some patients will regain weight after surgery, this is often diet and exercise related or lack of follow up care.

• Some GPs see bariatric surgery as a way for patients to ‘cheat’ in their weight loss and can be disinterested to offer referrals for the surgery.

• The service has no dedicated operating time allocated so has to compete for theatre space against FCT for example.

• Some areas for future expansion could include adolescents but this would need to be well structured; Type 1 Diabetes – surgery could help improve the diabetes but not necessarily cure it; and renal transplants.

• The funding stream is ring-fenced from the Ministry and runs out in two years. If stopped, we will have to look to fund the service from the current General Surgery budget.

• Follow-on reconstructive surgery sometimes required (ie) arms, thighs, stomachs is not funded. This costs around $20,000.

Dr MacCormick finished up by advising that his service is only dealing with the lapping water on the shore when there is a tsunami coming.

The Chair thanked Dr MacCormick for his presentation.

3.3 McKesson Tools – Matching Staffing to Demand Ms Dot McKeen, Manager Middlemore Central took the Committee through the presentation highlighting the following: • Care Capacity Demand Management (CCDM) – quality patient care, quality work

environment & best use of health resource. CCDM is based on five integrated elements:

1. Forecasting the work programme of the organisation 2. Matching resource to achieve the forecast 3. Putting resources in place 4. Delivering the service 5. Monitoring & responding to system variance

• Cap Plan forecasting tool is used every day and recalculates every morning at 7am. • Rostering is currently done via OneStaff – 85% of staff are on OneStaff, RMOs are not

currently as they are administered through the NRA. • New modules are being added to OneStaff that will allow greater flexibility for the

Charge Nurse/s and enable them to simplify the staffing and scheduling process and identify cost effective staffing.

The Chair thanked Ms McKeen for her presentation.


3.4 Cleveland Clinic Empathy Video

Ms Denise Kivell played the Cleveland Clinic’s Empathy video entitled ‘The Human Connection to Patient Care’. A link to the video is provided below: https://www.youtube.com/watch?v=cDDWvj_q-o8

4. Hospital Services Directorate Report 4.1 Executive Summary

Continual growth in volumes across Acute Care, Medicine & Clinical Support (notably Radiology and Microbiology) and the on-going challenge of dealing with peaks in demand that exceed production capacity remain emerging issues for the directorate. Elective WIES is 486 behind YTD contract. This includes 196 WIES (40%) differential due to the move from WIES 14 to WIES 15 (1 July 2016). We have been in discussion with the Ministry of Health to confirm an adjustment to the 15/16 elective target for this and have, yesterday, received confirmation they have accepted this. The balance of the unfavourable YTD variance will be delivered by the end of the year. YTD elective discharges remain on target. Future reporting – next HAC meeting will see a new reconfiguration of this report that clearly highlights our delivery against key strategic initiatives and priorities.

4.2 Balanced Scorecard The report was noted and taken as read.

4.3 Financial Summary The report was noted and taken as read.

4.4 Human Resources The report was noted and taken as read.

4.5 Action Item Responses The report was noted and taken as read.

4.6 Mental Health The report was noted and taken as read.

4.7 Women’s Health & Kidz First (Ms Nettie Knetsch) The Children’s Team launched yesterday at Clendon Park Primary School. They have received a flurry of referrals already and the service is working with the Child Youth & Maternity Integration Manager on how to manage and coordinate the current urgent demands as well as planning for the longer term resources that will be required for the Children’s Team. It was noted that there are four major current programmes - Healthy Families, Westpac/MMF project at Papakura with Education, the Social Investment Board (SIB) and the Children’s Team. Whilst the Children’s Team look good it is still separately funded which the SIB won’t be and whilst Healthy Families is good, it doesn’t deal with those most at risk. We need to ensure that we are evaluating which model is going to be the best one for the DHB to put its efforts into.

https://www.youtube.com/watch?v=cDDWvj_q-o8


The Committee asked Ms Knetsch to come back with some objective analysis of which model is the best spend from the DHB perspective and how quickly we could evaluate the outcomes. Dr Mathias noted that some items offered in the vending machines in the hospital are not acceptable and many would not comply with our own Healthy Food & Beverage Environment Policy. Ms White undertook to follow up with the Facilities General Manager and report back to the Committee.

4.8 Surgical & Ambulatory Care (Ms Gillian Cossey) ESPI targets – substantial elective work was done internally towards maintaining the 120 day waiting time target for January and as a result there were no patients breaching ESPI 2 (120 day FSA threshold) however, the backlog of patients as a result of low subcontracting numbers with private providers and annual leave of SMOs in Plastic resulted in 9 patients breaching ESPI 5 (120 day treatment threshold) for the month. There were also a further 3 patients that breached the ESP1 5 in Gynaecology. Ms Cossey advised that it is a constant challenge to keep the balance with all the demands, particularly the high profile Faster Cancer Treatment target as they have to put the cancer patients ahead of some of the others. The juggling act is getting harder and if acute volumes stay high they may have to think about some other strategies, for example, increase internal capacity, outsourcing. The service is finding the number of orthopaedic cases coming through and acute spines a surprise – 11 spines in 11 days. The service is stretched to capacity and having to cancel some electives as a result. They will now have to go back to the drawing board to see where they can recreate capacity for electives, looking at additional Saturday theatre sessions, asking staff to volunteer for overtime etc. Theatres at Middlemore are working 24/7, MSC is Monday – Friday and is under-utilised but to open on a Saturday has challenges around workforce and budget.

4.9 Adult Rehabilitation & Health of Older People The report was noted and taken as read.

4.10 Medicine, Acute Care & Clinical Support (Mr Brad Healey) It was noted that FSAs were up 732 YTD (page 119). Mr Healey to look into whether this is due to a phasing or budgeting issue or whether we are just not getting through the assessments. Intragam – The Committee asked Dr Johnson to see if the Regional Clinical Practice Committee could undertake a cost benefit analysis of the efficacy and efficiency of Intragam v what was used before.

4.11 Facilities Scott Building recladding – the highest risk to the recladding is the potential to have to close beds should the decay be found to be more extensive than expected and therefore requires a mitigation strategy.

4.12 Director of Allied Health (Mr Martin Chadwick) PSA Strike – informal meetings have continued with the PSA to find common ground for on-going bargaining with the rejection of the offer made to staff at the end of 2015. The PSA has undertaken to ballot staff for approval to take further industrial action. No strike


notices have been received to date and options continue to be explored to achieve resolution.

4.13 Director of Nursing (Denise Kivell) Nursing vacancies open for recruitment remains high with 169 FTE recruitable vacancies for registered and enrolled nurses and healthcare assistants. NETP – CM Health has the highest percentage of new graduates per head of nursing population in the country at 4.7%. It is getting harder to recruit nurses in Auckland due to the higher costs of living. The next Certification Audit is due to occur late April 2016. The national Directors of Mental Health Nursing group have agreed to utilise a nationally consistent training package for Safe Practice Effective Care developed at CM Health. This will achieve national consistency of training and delivery of pain-free patient restraint.

4.14 Director of Midwifery No report was submitted this month.

5. Quality 5.1 Inpatient Experience Survey (Dr David Hughes)

Report No. 1 for 2016 focusses on Compassion, Dignity and Respect. Almost half (44%) of our patients consider this to be one of the areas of care that makes the most difference to the quality of their care and treatment. The Committee asked that the Director of Human Resources provide a report back next month on how we are implementing the refreshed Values and how that will translate into behaviours.

6. 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 Lyn Murphy Seconded: Dr Lee Mathias Carried: Unanimously

12.22pm Public Excluded session. 12.50pm Open meeting resumed. The meeting closed at 12.51pm. The next meeting of the Hospital Advisory Committee will be Wednesday, 4 May 2016 at Ko Awatea, Middlemore Hospital.


The Minutes of the meeting of the Counties Manukau District Health Board Hospital Advisory Committee held on Wednesday, 23 March 2016 are approved. Signed as a true and correct record on Wednesday, 4 May 2016. (Moved : /Seconded: ) Chair 4 May 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 – 4 May 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/15 June

Mr Balmer

21.10.15 5.3 Financial Summary – undertake a deep dive into leave tracking 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.

4 May Ms White Refer Item 3.5 on this agenda.

2.12.2015 3.8 Women’s Health Dr Simon Denny and Mr Pete Watson to present/provide an update on Youth.

Date TBC

Mr Balmer/Ms Knetsch

Mental Health has been covered off in recent presentations to HAC. Dr Denny will present on Youth – date tbc.

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.

4 May 4 May

Ms Kivell/Dr Hughes Dr Hughes

Verbal update on this agenda. Verbal update on this agenda.

10.2.2016 2.4 Annual Leave – quarterly report showing, for those staff that have had annual leave paid out, their current leave balance, leave accrual and leave taken.

4 May Ms White Refer Item 3.5 on this agenda.

23.3.2016 3.1 FCT Definitions – the Committee would like to see some progress in sorting out the FCT definitions. Dr Connolly to come back in six-months with an update on progress.

7 September Dr Connolly

23.3.2016 4.7 Women’s Health – Ms Knetsch to provide some objective analysis on the 4 major programmes (HT, SIB, CT, Papakura) as to which will provide the DHB with the best spend and how quickly we

Ms Knetsch

This item has been transferred to CPHAC for report back purposes.

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


DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

can evaluate the outcomes. Vending machine items in the hospital do not comply with our Healthy Food & Beverage Policy. Ms White to follow up with the GM Facilities.

4 May

Ms White

Refer Item 3.5 on this agenda.

23.3.2016 4.10 Medicine – YTD FSAs are up – Mr Healey to look into whether this is due to a phasing or budgeting error or whether we are just not getting through the assessments. Intragam – Dr Johnson to talk to the regional Clinical Practice Committee about them undertaking a cost benefit analysis on the efficacy and efficiency of Intragam v what was used before.

4 May 4 May/15 June

Mr Healey Dr Johnson

Refer Item 3.5 on this agenda. Deferred as Dr Johnson on leave.

23.3.2016 Human Resources – report back on how we are implementing the refreshed Values and how this will translate into behaviours.

4 May Beth Bundy Refer item 3.5 on this agenda.

4.5.2016 Board Action Item

Extract from CE Report – Performance remains strong and we remain on course to achieve key targets for the 3rd year running. We will also ensure delivery of improvements to diagnostic tests. This will be reported at the next HAC meeting.

4 May Mr Balmer Verbal update 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 March 2016.

Prepared and submitted by: Phillip Balmer, Director Hospital Services Glossary EC Emergency Care MoH Ministry of Health MTD Month to date WIES Weighted Inlier Equivalent Separations YTD Year to date Executive Summary Month in review Hospital Services delivered a favourable result against budget and achieved our National Health Targets in March. A pre-winter surge in acute demand has placed additional pressure on our services, which is making frontline operations challenging for our people at all levels. Clinical and non-clinical leaders across the services are working very hard on planned initiatives to address the areas we need to strengthen to achieve our objectives by year-end. Our preparation for 2016/17 is now moving to mobilising a targeted programme of activities where we believe we can make the greatest gain to support delivery the Healthy Together 2020 strategy. Central to our progress year to date is the collaborative and integrated way Hospital Services is planning its future service provision through a whole-of-system approach. We are working together with our primary and community colleagues to deliver integrated initiatives as we head into winter and beyond. Despite the commitment and focus, we remain realistic about our capability to deliver large-scale change while prioritising quality of care with our current capacity. We need to create capacity across the system to enable the right patients, to be managed in the right place, at the right time, in an environment where volumes are expected to continue to rise. Activity Summary Emergency Care (EC) presentations MTD EC Presentations in March remained consistent with YTD trends of 5% higher than the same period last year. There were four incidences of “red dot days” (hospital occupancy >100%) driven by a record number of EC presentations for a March month (9,467 against previous year of 9,373 presentations).


WIES and Discharge volumes actual versus last year Overall WIES volumes were down 8% on contract for the month of March, and 1% ahead YTD (Fig 1 below). Acute: YTD Acute WIES and discharges remain consistently higher than the same period last year at 3% and 2% respectively (Fig 2 below), reflecting the sustained pressure on medical specialties in particular. In surgery acute demand was at new record levels with acute theatre minutes increasing by 16% at Middlemore Hospital compared to the previous March with the largest increase in Orthopaedics (12%) and Plastics (32%). Elective: Counties Manukau Health (CM Health) of Domicile elective discharges are 678 ahead or 104.9% YTD. At year end we are forecast to have a significant increase in discharges over last year. In contrast WIES volumes will be below last year volumes attributable in part to the impact of the change to WIES 15 from WIES 14. We have other volumes we can count to offset this gap. We are working hard to ensure the disruption caused in Orthopaedics due to a 7% increase in acute demand and surgeon sickness will be recovered by year end. The 2015/16 Elective Production Plan has been reworked to include additional Saturday lists, extra theatre productivity initiatives, and some increased outsourcing to ensure additional volume funding for Orthopaedics and General Surgery are realised.

Fig. 1: March 2016 WIES vs contract (incl skin lesions) March 2016 Month YTD This Year Funder

Agreement % Var to Contract

This Year Funder Agreement

% Var to Contract

Acute Services WIES 5,626 5,929 (5%) 52,622 51,021 3% Elective Services WIES 1,315 1,591 (17%) 12,273 13,229 (7%) Total WIES 6,941 7,520 (8%) 64,895 64,249 1%

Fig. 2: March 2016 WIES vs last year (excl skin lesions) March 2016 Month YTD This Year Last Year % Var to Last

Year This Year Last Year % Var

Acute Services WIES 5,626 5,717 (2%) 52,622 51,244 3% Discharges 7,264 7,311 (1%) 65,979 64,475 2% Elective Services WIES 1,315 1,568 (16%) 12,273 13,649 (10%) Discharges 1,246 1,304 (4%) 10,841 11,737 (8%) Total Services WIES 6,941 7,285 (5%) 64,895 64,893 0% Patients 8,510 8,615 (1%) 76,820 76,212 1%

Note: Changes to MoH criteria for Elective discharges mean that skin lesions are now counted as elective discharges. These were not counted in 2014/15, therefore 2015/16 volumes have been adjusted for comparison against the same period last year.


National Health Targets – Hospital performance The directorate continues to meet the National Health Targets.

National Target Target Description March 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 98%

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

Achieved 96%

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:

On track 70%

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

Achieved 104.9%

Note: Improved Access to Elective Surgery information reported one month in arrears so the confirmed result provided is for February 2016. Based on indicative results, CM Health will achieve 104% for March.


3.2 Balanced Scorecard

Hospital Services Balanced Scorecard

March 2016

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

BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCESmonth result

trend Def

YTD Mar-16 Target Var Actual Target VarTotal Caseweight 6,941 7,520 -8% 64,895 64,249 1% 1

Acute Caseweight 5,626 5,929 -5% 52,622 51,021 3% 2

Elective Caseweight 1,315 1,591 -17% 12,273 13,229 -7% 3

Total Discharges * 8,510 8,615 -1% 76,820 76,212 1% 4

Budgeted FTEs 5,988 5,832 -3% 5,821 5,855 1% 6

Operating Costs ($000) 26,131 24,782 -5% 227,914 219,144 -4% 7

Personnel Costs ($000) 48,132 48,163 0% 410,104 412,662 1% 8

Financial Result Total ($000) -3,471 -3,501 $30 -6,310 -6,877 $567 9

Outpatient FSA Volumes 4,362 4,815 -9% 38,009 39,104 -3% 10

Outpatient Follow Up Volumes 11,071 12,343 -10% 93,081 99,606 -7% 11

Virtual FSAs (GP consult and nonpatient appointments) 199 243 -18% 2,562 2,446 5% 12

Reduce clinical outsourcing ($000) 1,714 1,752 $38 16,087 14,961 -$1,126 13

HR metrics

YTD Mar-16 Target Var Actual Target VarExcess Annual Leave dollars ($000) - estimated cost for excess $2,987 $1,077 1,910-$ ~ 5

Adult Rehab / Health of Older People $49 $56 7$ ~Medicine/ Acute Care and Clinical Support $592 $305 287-$ ~

Surgical/ Ambulatory Care $1,240 $413 827-$ ~Mental Health $249 $148 101-$ ~

Kidz First/ Women's Health $687 $155 532-$ ~

% Staff Annual Leave >2 years 11.5% 5.0% -7% 12.0% 5.0% -7% 14

Adult Rehab / Health of Older People 4.4% 5.0% 1% 4.8% 5.0% 0%Medicine/ Acute Care and Clinical Support 9.7% 5.0% -5% 9.7% 5.0% -5%

Surgical/ Ambulatory Care 15.0% 5.0% -10% 15.3% 5.0% -10%Mental Health 8.4% 5.0% -3% 8.4% 5.0% -3%

Kidz First/ Women's Health 22.2% 5.0% -17% 20.4% 5.0% -15%% Staff Turnover (YTD no. voluntary turnovers by average headcount) 10.0% 2.0% -8% 9.6% 10.0% 0% 15

% Sick Leave 2.5% 2.8% 0% 2.7% 2.8% 0% 16

Workplace Injury Per 1,000,000 hours 13.35 10.50 -3 16.43 10.50 -6 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 12.0% 23% -11% 12% 23% -12%Asian 28.7% 23% 6% 28% 23% 5%

NZ European / non-specified/ other 52.1% 38% 14% 54% 38% 16%

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 69% 80% -11% 69% 80% 11% 20

% Serious Pressure Injuries rate / 100 Patients 2.1% 3.5% 1.4% 2.1% 3.5% 1.4% 21

Falls causing major harm rate / 1,000 bed days 0.18 0.00 -0 0.06 0.0 -0 22

Rate of adverse events / 1,000 bed days (Sept 2015) 86 na 61 na 23

CLAB rate / 1,000 line days 4.50 0.0 -4.5 1.90 0.0 -1.9 24

Rate of S. aureus bacteraemia rate / 1,000 bed days 0.00 0.0 0.0 0.06 0.0 -0.1 25

YTD Mar-16 Target Var Actual Target VarEmergency Care - 6 hour LOS target 96.4% 95% 1.4% 95.3% 95% 0.3% 28

% Radiotherapy commences in 4 weeks - National policy priority 100% 100% 0% 100% 100% 0% 30

% Chemotherapy commences in 4 weeks – National policy priority 100% 100% 0% 100% 100% 0% 31

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% MRI scans completed within 6 weeks from referral - MOH IDP 70% 80% -10% 65% 80% -15% 33

% CT scans completed within 6 weeks from referral - MOH IDP 96% 90% 6% 91% 90% 1% 34

% urgent diagnostic colonoscopy within 14 days - MOH IDP 73% 75% -2% 81% 75% 6% 37

% diagnostic colonoscopy patients within 42 days - MOH IDP 39% 60% -21% 38% 60% -22% 38

% surveillance colonoscopy patients within 84 days - MOH IDP 65% 60% 5% 93% 60% 33% 39

% cardiac STEMI-PCI (angiography) <120mins - Northern Region 77% 80% -3% 77% 80% -3% 41

% Coronary Angiography within 90days - MOH IDP (1mth arrears) 100% 95% 5% 99% 95% 4%

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 94% 95% -1% 95% 95% 0% 36

Q2 Target Var Actual Target VarFaster Cancer Treatment - % high suspicion first cancer treatment within 62 days - MOH FCT + target by 2016 74% 85% -11% 72% 85% -13% 45

Faster Cancer Treatment - % confirmed diagnosis first cancer treatment within 31 days - MOH FCT + 80% na 87% na 46

% Radiology results reported within 24 hours 64% 75% -11% 57% 75% -18% 47

YTD Mar-16 Target Var Actual Target VarAverage Length of Stay - Acute Inpatient - MOH IDP 2.76 2.98 0 2.62 2.98 0 50

Average Length of Stay - Acute Arranged/ Elective - MOH IDP 1.77 1.37 0 1.76 1.37 0 51

MMH % patients to discharge lounge or home by 1100hrs 14.8% 30% -15% 16.5% 30% -14%Acute Readmissions within 7 days - Total 2.7% 2.89% 0% 3% 2.89% 0% 52

Acute Readmissions within 28 days - Total - MOH IDP 5.9% 7.6% 2% 7.0% 8% -1% 53

Acute Readmissions within 28 days - 75+ years - MOH IDP 10.7% 11.85% 1% 12.0% 11.85% 0% 54

EC Presentations - 75+ year olds (5% reduction on 2013) 977 807 -170 9,024 7,263 -1761 55

% clinical summaries (meddocs) authorised <7 days of creation 72% 95% -23% 73% 95% -22% 56

% of patient outliers - not on home ward <5% 2.7% 5.0% 2% 3.7% 5.4% 2% 58

QUARTERLY REPORTINGMar-16 Target Var Actual Target Var

% Eligible stroke patients thrombolysed - Northern Region 11% 6.0% 5% 11% 6.0% 5% 59

% DHB Mental Health Services - children/ youth (0-19years) seen by 3 weeks for non-urgent mental health - MOH IDP 76.8% 75.0% 2% NA 75.0% #VALUE! 48

Mental Health access rate - clients seen in last 12 months as % of population (0-19 Years) 3.79% 3.15% 1% NA 3.15% #VALUE! 49a

Mental Health access rate - clients seen in last 12 months as % of population (20-64 Years) 3.78% 3.15% 1% NA 3.15% #VALUE! 49b

Mental Health access rate - clients seen in last 12 months as % of population (64+ Years) 2.49% 2.70% -0% NA 2.70% #VALUE! 49c

Ambulatory Sensitive Hospitalisation rates - MOH IDP ^ 2015/16 Q10-4 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%

YTD Mar-16 Target Var Actual Target VarOutpatient - First Specialist : Follow-up Clinic ratio 39% 43% 4% 41% 43% 2% 61

Outpatient - DNA rates - Maaori 12% 10% -2% 11% 10% -1% 62

Outpatient - DNA rates - Pacific 11% 10% -1% 9% 10% 1% 62a

Theatre List Utilisation 93.6% 83.4% 10% 88.5% 83.4% 5% 63

Day of Surgery Admissions (DOSA) 90% 90% 0% 91% 90% 1% 65

Day Case Rate (Elective/ Arranged) 75.0% 65% 10% 73.9% 65% 9% 66

% Medical Assessment patients with LOS < 28 hours 84% 65% 19% 83% 65% 18% 68

No. Hospital bed days occupied (against forecast open beds) 20,744 22,460 8% 179,808 193,252 7% 73

No. Length of Stay outliers (LOS >10 days)* 332 272 -18% 2,509 2,547 2% 74

YTD Mar-16 Target Var Actual Target VarPatient Experience Survey (rated very good/ excellent) 77% 90% -13% 79% 90% -11% 75

BETTER HEALTH OUTCOMES FOR ALL

YTD Mar-16 Target Var Actual Target Var% smokers receive smokefree advice -Total 98% >95% 3% 96% >95% 1% 77

% smokers receive smokefree advice - Maaori 98% 95% 3% 96% 95% 1% 77

% smokers receive smokefree advice - Pacific 97% 95% 2% 96% 95% 1%

% Women (45-60yrs)with Breastscreen in 24months - Total 2,185 2213 -28 67% 70% -3% 78

% Women (45-60yrs)with Breastscreen in 24months - Maaori 203 261 -58 66% 70% -4%% Women (45-60yrs)with Breastscreen in 24months - Pacific 349 392 -43 76% 70% 6%

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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. 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.

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


3.3 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 March 2016 (Sick Leave % Paid to February 16).

0%

1%

2%

3%

4%

5%

6%

Sick Leave as Percentage of Total Paid Hours (Hospital Directorate Only)

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


0%

4%

8%

12%

16%

20%

Annual Leave Paid as Percentage of Total Paid Hours March 2015 to February 2016

AL Paid % AL Paid % LY UCL Average LCL

0 10 20 30 40 50 60 70

Apr'15

May'15

Jun'15

Jul'15

Aug'15

Sep'15

Oct'15

Nov'15

Dec'15

Jan'16

Feb'16

Mar'16

Voluntary Employee Turnover by Reason for Leaving April 2015 to March 2016

Personal/Health To go Overseas Unknown Job in Public HealthJob in Private Health Retired Job Outside of Health Left DistrictEducation Job Dissatisfaction Unpaid Work


3.4 Responses to Action Items Actions and Responses HAC Meeting 21.10.15 - Financial Summary Undertake a deep dive into leave tracking 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. Human Resources and the Hospital Services Directorate are currently planning a number of initiatives to address leave management across the directorate. These initiatives focus on supporting our employees to take “time off” acknowledging the benefits this has on employee health, wellbeing and organisational productivity. The Hospital Services initiatives focus on three main areas. Firstly, dealing with legacy issues, particularity for employees with annual leave accrued over multiple years (majority being part-time employees). Secondarily, providing training and development to our line manager population on leave management and supporting all our managers with tools and techniques that will enable them to better plan and coordinate leave. Thirdly, increasing awareness of the importance of leave with employees and encouraging a conversation with their manager to proactively plan ahead. These initiatives will be supported by a number of performance measures to enable our services to monitor their progress. The plans will be shared with Hospital Management Team and Executive Leadership Team shortly, and will be presented to the Hospital Advisory Committee in Mid-2016. HAC Meeting 10.2.16 – Action Item Register Provide a quarterly report showing, for those staff that have had annual leave paid out, their current leave balance, leave accrual and leave taken. The information requested is provided in the table at the end of this report. Applications must meet the criteria outlined below for approval: • Be in ‘extraordinary’ circumstances • Must have more than two years balance (400 hours +) pro-rated • Must have taken a period of two weeks leave in a row during the previous 12 months • A substantial leave plan must be in place that is agreed, signed, and attached to the application

form (in consultation with Human Resources) • No prior cash ups taken • The amount that is able to be ken out must leave the ‘current’ years entitlement in place

(whatever leave they are entitled to in their agreement) • Must be approved and signed by their General Manager, Human Resources, Business Manager,

and Executive Leadership Team member. HAC Meeting 23.3.16 – Women’s Health Vending machine items in the hospital do not comply with our Healthy Food & Beverage Policy. Ms White to follow up with the GM Facilities. Current vending machine products comply with the current Metropolitan Auckland Policy.


The national DHB Health Food and Beverage Policy is still in draft – consultation/engagement is complete and the policy is being finalised with the feedback received. This policy will apply to all retail food in DHBs. The national policy will be completed by 1 July 2016; it will remove all confectionary and other snack items that do not comply. There will also be tighter parameters for beverages as well. The implementation plan for CM Health will be finalised when the policy is completed. The plan will be presented to the Executive Leadership Team and governance bodies in due course. It is anticipated that CM Health vending machines will be compliant around October/November of this year. This allows time to inform our current supplier and agree compliant products for the machines. HAC Meeting 23.03.16 - Medicine YTD FSAs are up – Mr Healey to look into whether this is due to a phasing or budgeting error or whether we are just not getting through the assessments. First Specialist Assessments were down in Respiratory (366), General Medicine (100), Dermatology (94), and Diabetes (68). This was due to a combination of annual and CME leave along with staff shortages in Respiratory (expect to complete recruitment in May) and Dermatology (additional resource commenced in March). HAC Meeting 23.3.16 – HR Report back on how we are implementing the refreshed Values and how this will translate into behaviours. Last year ELT approved a number of recommended actions to support a programme of work for the values refresh including the phases of launch, embed and sustain. Since the successful launch in 2015, we are now in the phase of embed and sustain, and a series of work streams are underway to build values into our everyday work. This report provides an overview of values activities being implemented across the organisation and how these will translate into behaviours. Work streams implemented The refreshed values are currently being implemented via the following work streams:

• Living our Values Campaigns • Patient Experience • Leadership Visibility • Values Based Recruitment • Reward and Recognition • Values Measurement • Wellness • Communications • Diversity


Work that has already been rolled out includes Living our Values Campaigns, Patient Experience improvement, increased leadership visibility and values based recruitment (VBR). These are summarised below. Living our Values Campaigns In order to support embedding and sustaining values, the Building Capability team have developed and will be delivering the following 4 hour interactive Living our Values sessions in 2016:

• 28 April • 09 August • 18 October • 01 November

These sessions began on 23 February, however due to poor attendance at this session we are focusing on increasing the communications for future sessions. In addition to this the team has been threading the values into a variety of existing training programmes. This includes the following sessions:

• Papakura Home Health Care/District Nurses • Patient Safety Training (all nurses attend this annually) • New graduate nurses (90 new graduates to date this year) • Bureau nurses • CM Health Welcome Day (approx. 30 new starters per month) • Foundations of Management • Undergraduate sessions on values and professionalism pre-placement • Patient Experience Week • Emerging Leaders Programme/ Leadership Academy

The team have been facilitating short 15 minutes ABC/ BUILD sessions at team meetings across the organisation and will continue to run these. These sessions demonstrate how we can use this model to challenge negative behaviours, reinforce positive behaviours, and provide constructive feedback. This programme of work reinforces behaviours linked to values: Excellent, Together Patient Experience – Silent Night Ear plugs are now available, for any patients who have trouble sleeping as a result of noise, on all wards. There will be an increased focus on promoting awareness and posters are being developed for wards to promote the ear plugs. A video was created and showcased during Patient Experience Week to demonstrate the importance of good communication within the hospital, and the impact this can have on someone’s day. To see the video, visit: https://vimeo.com/157497977 This programme reinforces behaviours linked to values: Kind, Together, Excellent, Valuing Everyone

https://vimeo.com/157497977


Leadership Visibility Patient Safety Leadership Walk Round dates for 2016 have been confirmed and will take place on the second and third Thursday of each month. A minimum of two ELT members will be attending each walk round to increase leadership visibility around the organisation. We are also looking at putting a process in place for ELT to blog about their experiences. This programme reinforces behaviours linked to values: Together, Valuing Everyone Values Based Recruitment

Values Based Recruitment (VBR) training provides information for hiring managers on designing values based recruitment tools, from attraction to selection, and practice of advanced values based interviewing skills. VBR training is available for hiring managers as part of the Foundations of Management and will be rolled out across services between March and May 2016. This programme reinforces behaviours linked to value: Excellent Work streams in progress The work streams that are currently in progress include reward and recognition, values measurement, wellness and communications. These are summarised below. Reward and Recognition Thank you cards have been designed. The template is available to all staff on Southnet to print and distribute throughout their departments. The card includes a statement “Thank you for living our values and making a difference” and has blank space for the employee to create a personalised message based on the particular behavior they observed in their colleague. The purpose of the card is to encourage staff to give feedback or compliments using the ABC/ BUILD framework by talking about the impact and putting it in context. This will ensure we are consistent in how we want staff to deliver compliments. The tear-off compliment poster has been trialed in select areas for feedback across each of the services in regards to its effectiveness in encouraging compliments to be given to reinforce values based behaviours. A communication accompanies this to encourage staff to give feedback using the ABC/ BUILD approach for contextual and constructive feedback. Feedback has been positive and we aim to roll this out to the wider organisation in April 2016. These programmes will reinforce behaviours linked to values: Excellent, Valuing Everyone Values Measurement We are currently in the process of identifying the most effective way to measure values and looking at how we can use and/or adapt the current patient experience survey questions. We are looking at ways in which we can assess how Values is being led at team level across the organisation. This will help us to inform future values based activities. This programme will reinforce behaviours linked to value: Excellent


Wellness CM Health is developing a Wellness strategy based on practices which focus on embedding a safe work environment. This includes building wellness and resilience across our people and making CM Health a happier and healthier place to work. In order to support this, we have undertaken a Wellness survey. Assessment of some early feedback suggests that stress and exercise are the top two areas for staff focus. A more formal analysis of the wellbeing survey will be undertaken, and a report will come to ELT. We are also looking at our high risk demographic areas and the respective issues employees may face in their personal and work lives. We are also doing some further analysis of other sources of data to assess staff wellness. This includes analysis of EAP usage. This programme of work will reinforce behaviours linked to values: Kind, Together, Valuing Everyone

Communications We are reviewing our communication strategy and how we promote positive values related stories through our current communication channels; HR4U, Connect + and Daily Dose. Some areas have shared examples of how they are promoting values and communication within teams. Loraine Elliot, Service Manager of Non- Clinical Support has established a values section to the team’s weekly management meetings. The purpose of creating a values agenda item is so that managers must relay actions and activity, which focus on delivering and/or embedding the value. This means that managers are having conscious conversations with their teams on what CM Health values means in everyday operational activity. We are looking at ways in which we can share these conversations with the wider organisation, test their effectiveness, and spread this initiative to embed these types of values based discussion into BAU. This programme of work will reinforce behaviours linked to values: Kind, Together Translating values into behaviours Through the workstreams we are integrating values into all areas of the business and our everyday activities and behaviours. Values is a programme of work involving transformational and cultural change, which is ongoing. The workstreams provide tools and techniques for managers and staff to reinforce positive behaviour and challenge poor behaviour. They focus on explicitly connecting everyday behaviours and personal interactions with patients, whanau and colleagues to the values. This enables us to continuously raise awareness, actively live and embed our values, and by doing so integrating values into the DNA of Counties Manukau Health. Next Steps • HR to continue to provide updates to HAC on the implementation of the work streams. • HAC to advise HR if they would like further information in relation to any of the work streams.


Division RC Name Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 15 Jan 16 Feb 16 Mar 16 Total Director of Nursing Total Director of Nursing 1 1 2 Facilities Cleaning MMH 1 1

General Engineering 1 1 Orderly MMH 1 1 Security Services 1 1 Telephone Exchange 1 1 Total Facilities 1 1 1 1 1 5

Kidz First NICU 6 6 Total Kidz First 6 6

Medicine, Acute Care & Clinical Support

Adult EC 3 1 1 5 Clinical Haematology 1 1 Dermatology 1 1 General Medicine 1 1 2 Medicine Administration 1 1 Radiology 1 1 Total Medicine 1 2 5 1 1 1 11

Mental Health Maternal Mental Health 1 1 Total Mental Health 1 1

Pacific Health Pacific Cultural Unit 1 1 Total Pacific Health 1 1

Primary Health & Community Services

Disability Support Services Governance 1 1 ICAH 1 1 Total Primary Health & Community 1 1 2

Surgical & Ambulatory Care

Anaesthesiology 1 3 1 5 Decontamination Sterilisations 1 1 2 Intensive Care Unit (ICU) 1 1 1 3 Operating Theatre 1 1 Orthopaedic Surgery 1 1 Total Surgical & Ambulatory Care 1 1 3 1 5 1 12

Women’s Health Assessment Labour & Birthing Unit 1 2 3 6 Continuity of Care 1 1 Total Women’s Health 1 1 2 3 7

Grand total 2 3 3 5 3 13 10 5 3 47


3.5 Financial Summary – Best value for public health system resources Glossary ACC Accident Compensation Corporation DHB District Health Board DRG Diagnosis Related Group FTE Full Time Equivalent ICU Intensive Care Unit MCIS Maternity Clinical Information System MECA Multi Employer Collective Agreement MoH Ministry of Health MRI Magnetic Resonance Image SAU Surgical Assessment Unit YTD Year to Date Commentary The Provider Arm produced a $30k favourable result against budget for March 2016. This contributes to the consolidated DHB variance of $77k favourable to budget for the month. Our acute DRG revenue reflects a YTD net increase in acutes for Counties of $2.8 M, together with an increase of acute inflow from other DHBs of $2.2M. Record acute theatre minutes in March, represented an increase of 13% on the previous year (orthopaedics 12% and plastics 32%). This meant elective volumes at Middlemore Hospital were cancelled with a reduction in (11%) for elective theatre minutes for orthopaedics. Elective volumes will be remedied by year end, requiring the need for a level of supplementary outsourcing and an ongoing focus in improving production. The increased acute demand has generated significant cost pressures on Clinical Support (radiology, labs, bloods and drugs), nursing and hotel services reflecting the “winter level” demand on the hospital. Our 2015/16 plan included assumptions regarding our ability to reduce demand for diagnostic services through the Diagnostic User Group. This initiative is progressing well under the clinical leadership of Medical and Surgical Heads of Department with analytical support from Health Intelligence. As previously reflected, we will not realise material reduction in demand until 2016/17. SWIFT business cases for eLaboratory, ePharmacy and iPM coming to Board in May will provide an essential enabler to these initiatives. Our 2015/16 budget also included material assumptions regarding nursing costs and procurement and supply chain savings. Despite nursing costs being higher than budget, actual cost per bed day has remained at less than the annual cost of MECA. McKesson Care Capacity Demand Management is now operational and will support improved ability to flex rosters as required to match patient acuity. Of note the recent MoH Hospital Quality and Productivity 2015 Calendar report highlighted that Counties benchmarked well against a range of metrics as shown below.


A number of initiatives are running ahead of target, these together with favourable interest revenue and the ACC Arrears programme continue to ensure month and year to date delivery on budget. While Clinical Support and Hotel services will continue to run unfavourable to budget for the reasons outlined above, the provider arm will deliver on budget for the year ended 30 June 2016. Noting the reliance on a number of one off gains during 2015/16, our 2016/17 planning is focused on working with primary care to substantially reduce demand for hospital based services while we also invest in programmes to improve the efficiency of hospital service delivery. Significant effort has also been deployed to accurately baseline budgets for clinical support and hotel services consistent with underlying clinical demand.


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 5,208 4,563 645 F 45,763 40,490 5,274 F

Patient/Consumer Sourced 969 989 (20) U 9,137 9,066 71 F

Other Income 2,328 1,883 446 F 17,730 17,289 441 F

Funder Payments 62,288 62,010 278 F 559,078 558,084 994 FTotal Income 70,793 69,445 1,348 F 631,708 624,928 6,780 F

Expenditure

Personnel 48,132 48,163 31 F 410,104 412,662 2,557 F

Outsourced Personnel 1,341 816 (525) U 12,584 7,293 (5,291) U

Outsourced Clinical 1,714 1,752 38 F 16,087 14,961 (1,126) U

Outsourced Other 2,607 2,730 124 F 23,550 24,572 1,022 F

Clinical Supplies (excluding Depreciation) 10,040 9,006 (1,034) U 82,125 79,058 (3,067) U

Other Expenses 5,110 5,401 291 F 46,290 47,568 1,278 FTotal Expenditure (excl Depreciation, Interest and Capital Charge) 68,945 67,869 (1,076) U 590,741 586,114 (4,627) U

Earnings before Depreciation, Interest and Capital Charge 1,848 1,576 272 F 40,967 38,815 2,153 F

Depreciation 2,651 2,730 79 F 24,357 24,568 211 F

Interest 1,059 1,097 38 F 9,361 9,874 514 F

Capital Charge 1,609 1,250 (359) U 13,560 11,250 (2,310) U

Total Depreciation, Interest and Capital Charge 5,319 5,077 (242) U

47,277 45,692 (1,585) U

Net Surplus/(Deficit) Provider (3,471) (3,501) 30 F (6,310) (6,877) 568 F

Month Year to DateConsolidated Statement of Financial PerformanceMarch 2016


Fig 2

Fig 3



Clinical

Women & Child Health (5,813) (5,600) (213) U (48,382) (48,021) (361) U

Medical & Clinical Support (19,003) (18,552) (451) U (162,589) (159,461) (3,129) U

ARHOP (3,513) (3,567) 54 F (31,347) (31,715) 368 F

Mental Health (5,747) (5,751) 4 F (50,877) (51,254) 376 F

Surgical & Ambulatory (16,072) (16,119) 47 F (132,668) (134,511) 1,843 F

Middlemore Central (420) (431) 11 F (3,594) (3,706) 112 FTotal Clinical (50,569) (50,021) (548) U (429,458) (428,668) (790) U

Non-ClinicalCorporate (incl Provider Arm Revenue from Funder) 57,122 56,554 568 F 511,602 509,791 1,811 F

HBL (173) (173) (0) U (1,650) (1,557) (93) U

Health Alliance (2,422) (2,528) 106 F (21,811) (22,756) 945 F

Facilities Services (4,354) (3,996) (357) U (35,933) (33,676) (2,257) U

Integrated Care (1,780) (2,005) 225 F (18,099) (18,614) 515 F

Innovations Hub & Ko Awatea (1,295) (1,332) 36 F (10,961) (11,398) 437 FTotal Non-Clinical 47,098 46,520 578 F 423,149 421,791 1,358 F

Net Surplus/(Deficit) Provider (3,471) (3,501) 30 F (6,310) (6,877) 568 F

Month Year to Date

Performance Summary by DirectorateMarch 2016



Medical Personnel 15,547 15,922 375 F 131,090 133,114 2,023 F

Nursing Personnel 18,046 17,777 (270) U 155,710 154,741 (968) U

Allied Health Personnel 6,984 7,050 66 F 58,989 61,330 2,341 F

Support Personnel 2,304 2,101 (203) U 19,563 18,083 (1,480) U

Management/Administration Personnel 5,251 5,313 63 F 44,752 45,393 642 F

Total (before Outsourced Personnel) 48,132 48,163 31 F 410,104 412,662 2,557 F

Outsourced Medical 730 371 (359) U 6,408 3,341 (3,067) U

Outsourced Nursing 187 46 (141) U 2,203 411 (1,792) U

Outsourced Allied Health 22 32 10 F 274 284 10 F

Outsourced Support 42 27 (16) U 299 240 (59) U

Outsourced Management/Admin 360 340 (19) U 3,400 3,017 (383) UTotal Outsourced Personnel 1,341 816 (525) U 12,584 7,293 (5,291) UTotal Personnel 49,473 48,979 (494) U 422,688 419,954 (2,734) U

Month Year to Date

Personnel Costs By Professional GroupMarch 2016


Fig 4

Fig 5

Fig 6


FTE FTE FTEVariance to Prev Mnth FTE FTE FTE

Medical Personnel 812 805 (8) U 781 806 25 F

Nursing Personnel 2,698 2,579 (119) U 2,646 2,594 (52) U

Allied Health Personnel 1,155 1,134 (21) U 1,093 1,136 43 F

Support Personnel 498 485 (13) U 501 487 (15) U

Management/Administration Personnel 826 830 4 F 800 833 33 F

Total (before Outsourced Personnel) 5,988 5,832 (156) U 5,821 5,855 34 F

Outsourced Medical 26 13 (13) U 26 13 (12) U

Outsourced Nursing 17 4 (13) U 22 4 (18) U

Outsourced Allied Health 2 2 1 F 2 2 0 F

Outsourced Support 8 5 (3) U 6 5 (1) U

Outsourced Management/Admin 44 42 (2) U 46 41 (5) UTotal Outsourced Personnel 97 67 (30) U 103 66 (36) UTotal Personnel 6,085 5,899 (186) U 5,924 5,921 (2) U

Month Year to Date

FTE By Professional GroupMarch 2016


FTE FTE FTEVariance to Prev Mnth FTE FTE FTE

ClinicalWomen & Child Health 628 603 (25) U 628 607 (21) UMedical & Clinical Support 1,678 1,589 (89) U 1,630 1,605 (25) UARHOP 537 517 (20) U 514 517 4 FMental Health 669 696 27 F 654 696 42 FSurgical & Ambulatory 1,434 1,395 (39) U 1,392 1,395 4 FMiddlemore Central 53 57 3 F 53 57 4 FTotal Clinical 4,999 4,858 (141) U 4,871 4,878 7 F

Non-ClinicalCorporate (incl Provider Arm Revenue from Funder) 116 113 (3) U 107 113 6 FFacilities Services 462 461 (1) U 467 463 (4) UIntegrated Care 357 332 (25) U 339 334 (5) UInnovations Hub & Ko Awatea 151 134 (17) U 140 134 (6) UTotal Non-Clinical 1,087 1,041 (45) U 1,053 1,044 (9) U

Net Surplus/(Deficit) Provider 6,085 5,899 (186) U 5,924 5,921 (2) U

FTE by DirectorateMarch 2016 (including Outsourcing)

Month Year to Date



FTE 25 - (25) 24 - (24)

Revenue to fund projects (176) - 176 F (1,304) - 1,304 F

Employee Costs 147 - (147) U 1,197 - (1,197) U

Outsourced Services 19 - (19) U 186 - (186) U

Clinical Supplies 5 - (5) U 50 - (50) U

Infrastructure & Non Clinical Costs 1 - (1) U 26 - (26) U

Net Income (Cost) (5) - 5 F 155 - (155) U

Month Year to Date

Project Cost Funded by Project RevenueMarch 2016


Financial Performance Trends


Month Result Major variances for the Provider Arm Statement of Financial Performance (Fig. 1) follow: Revenue is $1.3M favourable for the month of March. The main drivers for the current month’s variance are: • Government Revenue $645k; MoH revenue compensation for capital cost increase $325k (offset

by capital cost); ACC arrears initiative $262k; CTA revenue delay in invoicing $(214)k; funded gastro procedures $200k; other $72k.

• Patient/Consumer Sourced $(20)k; Non-resident favourable billings $20k (offset by bad debts); Patient co-payments $(50)k, other $10k.

• Other Income $446k; Interest received $75k; Donation revenue $343k reflects budget phasing variance due to timing of claims. A review of outstanding projects/claims is currently underway; other $28k.

• Funder Payments $278k 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 $176k, of which $85k is new revenue to CM Health (fig 6).

Expenditure – Total expenditure is unfavourable by $(1.3)M. Major variances are explained below: • Personnel costs

Personnel costs are $31k favourable for the month reflecting vacancies mainly in the Nursing and Allied Health Group’s. This includes a leave revaluation provision $(230)k and higher clinical demand in cleaning and orderly services (discharge lounge, ICU, SAU). A level of vacancies exist across the organisation in all personnel categories (including Allied Health) and are partially covered by bureau, overtime and casual staff. Note that the Personnel cost variance above includes $147k (25FTE) of costs incurred in delivering additional unbudgeted Provider revenue (fig 6) and ($695k) additional costs over budget for implementing MCIS (we expect to recover a significant portion of this via cash reimbursement or offset against birth fees).

• Outsourced Costs are $(364)k unfavourable for March (includes personnel, clinical and other). Outsourcing to cover key vacancies (e.g. Mental Health) and to meet MoH targets (e.g. gastro, renal, MRI). (N.B. Gastro will receive additional revenue if all targets are met for the last quarter); partly offset by healthAlliance YTD cost benefit and savings in other expenses. Note that the Outsourced cost variance above includes $19k of costs incurred in delivering additional unbudgeted revenue (fig 6).

• Clinical Supplies $(1)M unfavourable for the month. Clinical Support $(518)k. Drug overspend of $(289)k was driven by infection and cancer drugs (offset by PCT revenue); Blood costs $(119)k include high cost patients with Guillain-Barre Syndrome and antibody mediated vasculitis; Lab costs $(111)k were driven by a 3% volume increase (on March 2015). Surgical $(391)k. Overspend driven by high complexity and high volume acute work, particularly implant costs, $(260)k. Other $(91)k. Note that the Clinical Supplies cost variance above includes $5k of costs incurred in delivering additional unbudgeted revenue (fig 6).

• Other expenses are $291k favourable for March explained mainly by Integrated Care Expense Recoveries $431k (offset by revenue), R&M overspend $(176)k, Other $36k.

• Depreciation, Interest and Capital Charge costs are $(242)k unfavourable due to; CM Health level of borrowings lower than budget delivering a $38k favourable interest cost variance for the month. Depreciation $79k favourable. 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 March is 6,085FTE which is (186)FTE unfavourable to budget. Major variances as follows:

• Vacancies net of overtime, internal bureau, outsourced FTE and casual FTE are 13FTE • Funded projects (not in budget) (22)FTE – localities and 20k days projects (i.e. cancer care,

breast feeding advocates, KF Gateway project etc.). • Net annual leave and other leave (138)FTE – annual leave taken lower than budget. • Unplanned and study leave (54)FTE requiring cover. • Other 15FTE – includes nursing orientation, ACC, stat days, stat day credits and budget

phasing.


3.6 Mental Health Glossary ICT Intensive Community Team MH&A Mental Health and Addictions MHSOP Mental Health Services for Older People NGO Non Government Organisation Service Overview Mental Health is managed by Tess Ahern (General Manager) with Dr Peter Watson (Clinical Director) and Anne Brebner (Clinical Nurse Director). The Mental Health service is comprised of a number of services providing support to people with significant mental health issues and their family/whanau. Acute services are provided through home-based treatment or in a hospital or residential care facility, and services for patients with less severe concerns are provided within a community setting. The Division’s services are structured into three main groups: Inpatient, Mental Health Services for Older People (MHSOP), and Liaison; Adult Community Services; and Child and Youth Services. Performance Activity Summary

Mental Health Volumes (Bed Days and Service Access) March 16 YTD

Act Bud/ Contract Var % Var Act

Bud/ Contract Var % Var

Inpatient Bed Days Tiaho Mai 1,562 1,370 -192 -14% 13,734 12,155 -1,579 -13% Tamaki Oranga 593 558 -35 -6% 5,367 4,950 -417 -8% Koropiko – MHSOP 383 395 12 3% 3,410 3,506 96 3% Service Access No. of unique CMDHB domiciled clients seen over 12 months

19,203 16,125 3,078 19% N/A 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 Whirinaki Nurse Practitioner candidate has been endorsed and recommended as Nurse Practitioner. Background work has been done in preparation with Position description completed in readiness to transition into the new role. Whole of System Integration A paper setting out the direction and areas of focus for the whole of system integration agenda for Mental Health and Addictions (MH&A) has been provided to executive leadership within CM Health and to the Alliance Leadership Team. The outcome of those discussions was an agreement in principle and an endorsement of the high level direction. In addition, the paper was presented to


the CM Health Board on 23 March, with endorsement given to proceed with further work to develop our thinking and underpin the proposals with detailed analysis and assessment. Based on these discussions with the Board and executive leadership, the MH&A leadership team have been tasked with developing and submitting a detailed business case and implementation plan to take this agenda forward. Intensive Community Team – Supporting Women with High and Complex Needs The Intensive Community Team (ICT) and a Non-Government Organisation (NGO) Residential Rehabilitation provider have developed an initiative to support women with high and complex needs in the community. The ICT staff have been able to work and train with the Emerge NGO staff to put individual plans in place to support six women to remain in the community. The training provided to the NGO staff has included Behaviour management plans, Drug and alcohol training, and individual care plans and programmes to support the service user and the staff for better outcomes for these women. ICT Occupational therapists, Psychologists, and Registered Health professionals have all been a part of this project and have put time into ensuring they are getting the best support possible. The team are reviewing the progress weekly and have measurements in place so they are able to monitor progress and identify any issues as they arise.


Scorecard

Scorecard Commentary • There has been an increase in overtime in Tiaho Mai as a result of high acuity and occupancy,

and an increase in staff sick leave.

• Wait times for non-urgent 0-19 target: ongoing increase in referrals and caseloads means the demand to see 80% of new referrals within three weeks has not been achieved this month. There has also been an increase in the number of young people not seen within 90 days. Case reviews will be undertaken and transition planning will occur if clinically indicated in order to manage the workload so that these patients are seen within appropriate timeframes.

March 2016

BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCESDef

Mar-16 Target Var Actual Target VarMedical staff locum Costs (in $000s) $134 $144 $10 $2,119 $1,296 824-$ Overtime costs(in $000s) $185 $86 99-$ $1,496 $774 722-$

Mar-16 Target Var Actual Target Var% Staff with Annual Leave > 2 years 8.4% 5.0% -3.4% 8.4% 5% -3.4% 14

% Staff Turnover 12.5% 2.0% -10.5% 10.5% 10% -0.5% 15

% Sick Leave 3.2% 2.8% -0.4% 2.4% 2.8% 0.4% 16

Workplace Injury Per 1,000,000 hours 11.93 10.50 -1.43 13.11 10.50 -2.61 17


Mar-16 Target Var Actual Target VarNo. of Seclusion events - (Rolling 12 months in development) 231 125 -106 0

Mar-16 Target Var Actual Target VarShorter wait times for non urgent mental health and addiction Services (%< 3week wait)

0-19 years 76.80% 80% -3.20% 48

20-64 years 88.06% 80% 8.06%65+ years 94.04% 80% 14.04%

overall 84.28% 80% 4.28%

Mar-16 Target Var Actual Target VarMental Health Access rate - unique clients seen by all MH services ((PRIMHD reporting services include AoD and NGO services) 12 months as a % of population

0-19 years 3.79% 3.15% 0.64% ~ 49a

20-64 years 3.78% 3.15% 0.63% ~ 49b

65+ years 2.49% 2.70% -0.21% ~ 49c

Readmissions within 28 days - Total 14.71% 12.00% -2.71% 11.77% 12.00% 0.23%

Mar-16 Target Var Actual Target VarOccupancy - Tiaho Mai acute mental health unit target is <85% 94.8% 85% 9.8% 96.1% 85% 11.1%No of Patient LOS (Tiaho Mai inpatient) < 5 days 18 tbc 109 tbc

Mar-16 Target Var Actual Target VarPP7-Relapse Prevention Plan - Maaori 94.7% 95.0% -0.3% 96.6% 95% 1.55%PP7-Relapse Prevention Plan - Pacific 97.6% 95.0% 2.6% 96.0% 95% 1.0%


Mar-16 Target Var Actual Target VarAccess rate - No. CM domiciled unique clients seen by MH services (PRIMHD) 12 months as a % of population - Maori 6.90% 6.0% 0.90%

~Access rate - No. CM domiciled unique clients seen by all MH services (PRIMHD) 12 months as a % of population - Total 3.63% 3.1% 0.53%

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3.7 Women’s Health and Kidz First Glossary EC Emergency Care FSA First Specialist Assessment FTE Full Time Equivalent ICU Intensive Care Unit KF Kidz First MCIS Maternity Clinical Information System NNU Neo Natal Unit WIES Weighted Inlier Equivalent Separation YTD Year to Date Service Overview Women’s Health and Kidz First is managed by Nettie Knetsch (General Manager) with Dr Sarah Tout (Clinical Director Women’s Health), Dr Wendy Walker (Clinical Director Kidz First), Thelma Thompson (Director of Midwifery), and Michelle Nicholson-Burr (Clinical Nurse Director). The Division provides a comprehesive range of integrated services for women, children, and their families. These services are provided from a number of hospital and community settings. Performance Activity Summary Kidz First Volumes (WIES and Cases) March 16 YTD Act Bud/

Contract Var % Var Act Bud/

Contract Var % Var

Inpatient (WIES) Kidz First EC 70 81 -11 -13.6% 648 694 -46 -6.63% Paediatric Medicine 198 211 -13 -6.2 2,449 2,273 176 7.74% Paediatric ICU 1 2 -1 0.0% 17 19 -2 -10.53% NNU – Unit 219 298 -79 -26.5% 1,838 2,049 -211 -10.30% NNU – Women’s Health 46 42 4 9.5% 473 375 98 26.13% KF Surgical – acute 179 159 20 12.6% 1,574 1,407 167 11.87% KF – elective 111 93 18 19.4% 783 775 8 1.03% Total Kidz First WIES 824 886 -62 -7.0% 7,782 7,592 190 2.50% Inpatient (Cases) Contract = last year actuals Kidz First EC 244 286 -42 -14.7% 2,275 2,247 -152 -6.26% Paediatric Medicine 417 425 -8 -1.9% 4,285 4,435 -150 -3.38% Paediatric ICU 1 2 -1 0.0 17 20 -3 -15.00% NNU – Unit 64 72 -8 -11.1% 581 634 -53 -8.36% NNU – Women’s Health 103 121 -18 -14.9% 1,027 954 73 7.65% KF Surgical – acute 198 202 -4 -2.0% 1,651 1,598 53 3.32% KF – elective 166 106 60 56.6 1,211 1,282 -71 -5.54% Total Kidz First Cases 1,193 1,214 -21 -1.7% 11,047 11,350 -303 -2.67% EC Attendances EC Attendances 2,164 2,097 67 3.2 20,049 19,512 537 2.75% Table continued over page Continued from previous page


Kidz First Volumes (WIES and Cases) - continued March 16 YTD Act Bud/

Contract Var % Var Act Bud/ Contract Var % Var

Outpatients FSAs 177 202 -25 -12.4% 1,480 1,546 -66 -4.27% Follow-ups 274 291 -17 -5.8% 2,387 2,373 14 0.59% Chart Reviews (Doc) one month in arrears 74 89 -15 -16.9% 709 703 6 0.85%

Nurse-led clinic (CNS clinic follow up) 55 55 0 0.0% 496 412 84 20.39%

Virtual FSA 26 39 -13 -33.3% 442 387 55 14.21% Total KF Outpatients 606 676 -70 -10.4% 5,514 5,421 93 1.72% Kidz First Community and Support Services Volumes Last Year March 16 YTD YTD Act Bud/

Contract Var Act Bud/

Contract Var Act

Child Protection Doc First Specialist Assessment 3 4 -1 71 70 1 109 Doc Follow Up 0 0 0 11 2 9 1 Child Protection Register Reviews (RN) 277 368 -91 5,791 4,359 1,360 N/A Vulnerable Women Register Reviews (SW – Contacts and Diaries) 72 N/A N/A 277 N/A N/A N/A

CP Alerts 141 N/A N/A 1152 N/A N/A N/A Contacts and Diaries (only for CN) 10 20 N/A 164 142 22 136 Children in Care Health Appointments attended 27 14 13 299 246 53 N/A ISAs uploaded 30 9 21 270 392 -122 N/A Number of Clients in Post review 79 67 12 228 437 -209 N/A Centre for Youth Alternative Education Contact and Diaries 103 281 -178 1,227 1,606 -379 1,597

Regional Consultation Contacts and Diaries 44 58 -14 337 399 -62 842

Specialist Adolescent Clinic Contacts and Diaries 204 206 -2 1,804 1,579 225 2,496

Play and Recreation Number of contacts 1,978 2,540 -562 18,736 15,519 3,217 17,121 Child Development No. of contacts – child development 1,196 961 235 7,992 7,968 24 12,832 No. of contacts in clinics (SLT) 55 39 16 366 366 0 453 Home Care nursing No. of contacts – Home care nursing 1,033 1,215 -182 10,152 11,056 -904 12,009 No. of contacts - CSW 34 30 4 507 471 36 637 NBHS NBH Screening in Hospital UNHS-40 583 N/A N/A 4,428 N/A N/A 6,135 NBH FSA Screening in clinic UNHS-40A 46 N/A N/A 431 N/A N/A N/A NBH Follow Ups Screening in clinic UNHS-40A 24 N/A N/A 233 N/A N/A N/A


Women’s Health Volumes (WIES and Cases) March 16 YTD



Inpatient (WIES) WH Gynae – acute 141 146 -5 -3% 1,329 1,197 132 11% WH Gynae – elective 0 0 0 0% 10 0 10 0% WH Gynae - elective 100 137 -37 -27% 1,091 1,121 -30 -3% Inpatient maternity care primary maternity facility (W02020)

375 379 -4 -1% 3,289 3,321 -32 -1%

WH secondary (W10001) 511 532 -21 -4% 4,704 4,821 -117 -2% Total WH WIES 1,127 1,194 -67 -6% 10,423 10,460 -37 0% Births/Deliveries Contract = Last year actuals Botany M 37 27 10 37% 270 248 22 9% Papakura M 22 19 3 16% 198 194 4 2% Pukekohe M 30 27 1 3% 197 219 -22 -10% Total Community Units 89 75 14 19% 665 661 4 1% Middlemore Hospital 514 555 -41 -7% 4,758 4,804 -46 -1% Total 603 630 -27 -4% 5,243 5,465 -42 -1% Inpatient (Cases) Contract = Last year actuals WH Gynae - acute 267 299 -32 -11% 2,438 2,267 171 8% WH Gynae – elective (private) 0 0 0 0% 18 0 18 0%

WH Gynae – elective 106 156 -50 -32% 1,167 1,278 -111 -9% Total WH Cases 373 455 -82 -18% 3,623 3,545 78 2% Outpatients Gynae FSAs 240 313 -73 -23% 1,802 2,163 -361 -17% Gynae Follow Ups 257 314 -57 -18% 2,143 2,163 -20 -1% Gynae Virtual 32 33 -1 -3% 329 247 82 33% Nurse-led clinic 42 92 -50 -54% 450 1,078 -628 -58% Urodynamics 0 12 -12 -100% 86 99 -13 -13% Obstetric Outpatient 1st S/B Doctors 288 260 28 11% 2,280 2,339 -59 -3%

Obstetric Outpatient F/U S/B Doctors 260 291 -31 -11% 2,166 2,814 -648 -23%

Colposcopy 156 211 -55 -26% 1,389 1,698 -309 -18% Colposcopy HC 27 16 11 69% 174 159 15 9% Colposcopy HC in OT 0 6 -6 -100% 35 54 -19 -35% Gynae HC 62 68 -6 -9% 439 514 -75 -15% Total WH Outpatients 1,364 1,616 -252 -16% 11,293 13,328 -2,035 -15% Note – target Colposcopy volumes are last years actual not contracted volume for 2015/16

Highlights Volumes During March there were 514 births at Middlemore Hospital and 89 at the three community units; a total of 603 births for the month which is 27 births less than March 2015. Year to Date (YTD) there are 42 less births than YTD March 2015. The distribution of births YTD is 46 births less at Middlemore Hospital and four births more in the three community units. Births at Pukekohe are down by 10%, and births at Botany are up by 9%. Acute discharges for Gynaecology are down by 32 and Elective discharges are down by 50 for March. Acutes in Gynaecology remain higher both in WIES and discharges YTD, which is also reflected in the occupancy figures for the Gynaecology ward.


Obstetric Outpatient volumes are understated. Increasingly, and with the assistance of the Maternity Clinical Information System, Obstetric referrals are now triaged and managed through a Virtual First Specialist Assessment (FSA) process with the Obstetric Specialist providing advice and a management plan rather than seeing the patient in an Outpatient Clinic. It is anticipated that at least 1000 Virtual FSAs are now done annually; however, we cannot yet capture this activity in our current reporting systems. Further integration between MCIS and existing systems capturing Outpatient activity is needed for this reporting, and it is expected that this capability will be in place by the end of June 2016. Although discharges YTD have been lower over the nine months (down 152 in Kidz First Medicine), the WIES continues to be higher (up 175 YTD) reflecting the increased acuity and improved coding. Emergency Care presentations were up for the month by 67 and by 537 for the YTD. The increase may be due to the long weekend which historically results in attendance increases. Neonatal admissions increased significantly towards end of March 2016. This is not yet visible in the discharges or WIES for the month as these babies will not be discharged until April/May. The Unit experienced more than 100% capacity for the period 20 - 31 March, and had more level three babies (sickest and tiniest) than level two babies (note that the Neonatal Unit is budgeted for an average of one third being level three babies and two thirds being level two babies). Volumes in Kidz First Home Care Nursing reflect a different way of counting activity in 2015/16. Nurses have combined events rather than counting multiple short encounters. The overall Full Time Equivalent (FTE) and caseloads have remained the same so there is no reduction in activity but rather a different way of reporting. Security The baby security trial in Maternity has continued with several scenarios developed to test the validity of the system, and has proved very successful overall. The Business Case for full implementation will now be developed. Credentialing The Women’s Health Department of Obstetrics and Gynaecology completed service and individual SMO credentialing during March. The full report with recommendations is expected by mid-April. As per the recommendations from the Kidz First credentialing in March 2015, we have provided an update on progress to the external panel chair. The majority of the recommendations are in the implementation phase. Hand Hygiene It is pleasing to note that Kidz First Medical achieve the highest compliance rate of the eight CM Health sites audited for the March National gold standard hand hygiene audit. Emerging Issues The setting up of the first Children’s Team in Manurewa/Clendon continues to require a lot of engagement and release of senior paediatrician and nurse specialist time. In February, Lead Professional training also commenced for the Centre for Youth Health staff. The Division is working with the Child, Youth and Maternity Integration Manager on managing and coordinating the current urgent demands as well as planning the longer term resources required for the Children’s Team(s).


Scorecards

March 2016

BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCES

Mar-16 Target Var. Actual Target Var.Nursing Sick leave hours taken in FTEs (inc unpaid sick) - onestaff 6.27 5.65 -0.62 5.77 7.58Performance reviews completed - onestaff - - 47% 65% -18.0%Study (both internal & external) leave taken FTE RN - onestaff 5.34 5.12 -0.22 3.24 4.00 0.76

Quarterly REPORTING Mar-16 Feb-16 Var. Mar-16YTD Target Var.% of 12 hour shifts Quarterly KF Surg only 0% 0% 0% 0% 0%% of 12 hour shifts Quarterly KF Medg only 0% 0% 0% 0% 0%


Mar-16 Target Var. Actual Target Var.Neonatal Rate of medication errors/1000 bed days per month 1.4 5.0 3.6 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% 0% N/A N/ACLAB prevention maintenance bundle compliance- NNU 94% 100% -6% N/A N/AEmergency trolley checks (compliance with checking) 90% 100% -10% N/A N/AHand hygiene (compliance with checking) 95% 100% -5% N/A N/ASafe sleep - audits completed 83% 100% -17% N/A N/AOSH Audit (Bi-Monthly) N/A 100% N/A N/A

Mar-16 Target Var. Actual Target Var.ED 6 hour target - National Health target (Kidz First EC) - Initial speciality 98% 95% 3% 98% 95% 3% 41

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

Mar-16 Target Var. Actual Target Var.NBHS number babies screened prior to discharge from hospital sites 96% TBC N/A 86.0% TBC N/A

NBHS number babies screened @ 12 weeks from birth 92% TBC N/A 92.0% TBC N/A

Mar-16 Target Var. Actual Target Var.% transcribed clinic letters authorised >7 days of created 78.0% 75.0% 3.0% 84.6% 75% 9.6% 54

Readmission Rate (KF med) within 7 days 6.2% 7.0% 0.8% 5.9% 6.2% 0.3%Readmission Rate (KF med) within 7 days (Maaori) 6.0% 5.6% -0.4% 5.3% 8.9% 3.6%Readmission Rate (KF med) within 7 days (Pacific) 3.8% 3.6% -0.2% 5.7% 5.2% -0.5%

Readmission Rate (Level 1,2, 3) within 28 days (one month in arrear ) 18.2% 0.0% -18.2% 9.6% 8.3% -1.3%Readmission Rate (all Neonates) within 28 days (one month in arrear ) 9.8% 6.3% -3.5% 7.1% 7.5% 0.4%Admission Rate Babies in the first year of life (Total) 23% 20% -3.0% 22% 22% 0.0%

Admission Rate Babies in the first year of life (Maaori) 27% 20% -7.0% 27% 27% 0.0%Admission Rate Babies in the first year of life (Pacific) 30% 29% -1.0% 29% 29% 0.0%

ALOS (raw)- Kidz First - Surgical - Surgical Floor 2.2 1.9 -0.3 2.14 2.05 -0.1 ALOS (raw)- Kidz First Medicine - KF Wards 2.3 2.6 0.4 2.7 2.7 0.0ALOS (raw)- Kidz First Medicine - EC Short Stay (hrs) 4.8 4.3 -0.5 4.6 4.6 -0.0 ALOS (raw) - Kidz First - Neonatal Unit discharge only 13.4 14.9 1.5 12.7 11.5 -1.2 ALOS (raw)- Kidz First - Neonates including WH 6.4 6.7 0.3 6.0 5.7 -0.3

Mar-16 Target Var. Actual Target Var.Outpatient DNA - FSA 6.0% 7.0% 1.0% 9.0% 9.0% 0.0%Outpatient DNA - Follow up 11.0% 12.0% 1.0% 12.0% 16.0% 4.0%Outpatient DNA - Maaori 11.0% 13.0% 2.0% 15.0% 16.0% 1.0%Outpatient DNA - Pacific 14.0% 14.0% 0.0% 15.0% 14.0% -1.0%Nurse Hours per Patient Day - KF Med 6.53 5.54 -0.99 5.78 5.89 0.11Nurse Hours per Patient Day - KF Surg 4.99 5.09 0.10 5.26 4.98 -0.28 Nurse Hours per Patient Day- Neonatal 12.14 11.1 -1.04 11.64 11.89 0.25% Resourced Occupancy - Kidz First Medical (against 14/15) 78.0% 87.0% 9.0% 83.0% 91.0% 8.0%% Resourced Occupancy - Kidz First Surgical (against 14/15) 80.0% 86.1% 6.1% 82.0% 89.0% 7.0%% Resourced Occupancy- Neonatal (against 14/15) 83.0% 102.1% 19.1% 88.0% 99.0% 11.0%

Mar-16 Target Var. Actual Target Var.Patient Experience Survey results (Excellent, very good) 100% 76% 24% 63% 76% -13%


Mar-16 Target Var. Actual Target Var.Percentage of 'eligible' inpatients are referred to AWHI 100.0% 100.0% 0.0% N/A N/A

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BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCES

Mar-16 Target Var. Actual Target Var.Sick leave hrs. taken FTEs Nursing/Midwifery inc unpaid 9.11 5.41 -3.70 7.85 7.11 -0.74 Study leave hours taken FTEs in Nursing/Midwifery 4.08 5.31 1.23 5.21 5.43 0.22Orientation hours taken FTEs in Nursing / Midwifery 5.50 3.97 -1.53 3.23 3.21 -0.02 Performance reviews completed per annum - - 47% 65% -18%

Quarterly REPORTING Mar-16 Feb-16 Var. Actual Target Var.% of 12 hour shifts - - GCU 1% 1% 0% 0% 0% 0%% of 12 hour shifts - - Botany Maternity 1% 1% 0% 0% 0% 0%% of 12 hour shifts - - Papakura Maternity 35% 40% 5% 41% 0% -41%% of 12 hour shifts - - Pukekohe Maternity 19% 17% -2% 17% 0% -17%


Mar-16 Target Var. Actual Target Var.Emergency trolley checks (days checked) per month 84% 100% -16% N/A N/AHand hygiene (compliance with checks) per month 79% 80% -1% N/A N/ASafe Sleep audits completed 81% 100% -19% N/A N/AOSH Audit (Bi-Monthly) N/A 100% - N/A N/ATotal Caesarean Percentage 24.9% 22.4% -2.49% 23.2% 22.9% -0.3%

Caesarean - elective number 67 66 1 595 505 90 Caesarean - acute number 83 75 8 665 749 -84

Instrumental Deliveries 43 42 1 379 361 18Inductions of labour % (one month in arrear) 23% 22% -1% 26% 25% -1%Inductions of labour - number compared to last year (one month in arrear) 128 146 18 1291 1125 -166

Mar-16 Target Var. Actual Target Var.ED 6 hour target - National Health target (Gynae) 89% 95% -6% 91% 95% -4% 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 0 0 0 0 42

Mar-16 Target Var. Actual Target Var.% transcribed clinic letters authorised <7 days created 85.1% 95.0% -9.90% 86.7% 95.0% -8.30% 54

Average Length of Stay Gynaecology - MMH 1.64 1.45 -0.19 1.57 1.59 0.02Average Length of StayGynaecology - MSC Inpatients 0.97 1.21 0.24 0.78 0.76 -0.02 Average Length of Stay Obstetric (DHB Mat) (1 mo in arrear) 2.22 2.09 -0.13 2.13 2.14 0.01Average Length of Stay Obstetric (Ind. Mat) (1 mo in arrear) 2.09 2.15 0.06 2.05 2.20 0.15Average Length of Stay Vaginal Deliveries overall 2.09 1.96 -0.13 2.09 2.03 -0.06

Maaori - 1st time mothers 3.35 2.08 -1.27 2.63 2.21 -0.42 Pacific - 1st time mothers 3.50 2.53 -0.97 2.60 2.61 0.01

Mar-16 Target Var. Actual Target Var.FSA / FUP ratio - Gynae 1:1.07 1:1.1 ~ 1:1.19 1:1.1 ~DNA - Midwifery Antenatal clinics - First 12% 14% 2% 12% 14% 2%DNA - Midwifery Antenatal clinic - Follow up 14% 15% 1% 15% 15% 0%DNA - Doctor Antenatal clinics- FSA 11% 17% 6% 12% 13% 1%DNA - Doctor Antenatal clinics - Follow up 17% 15% -2% 19% 14% -5%

Outpatient DNA - Maaori (Gynae) 8% 10% 2% 14% 10% -4%Outpatient DNA - Pacific (Gynae) 9% 10% 1% 11% 10% -1%Outpatient DNA - Maaori (Obst) 25% 10% -15% 26% 10% -16%Outpatient DNA - Pacific (Obst) 17% 10% -7% 19% 10% -9%

% Resourced Occupancy (avg of 9am & 9pm) Mar-15 June 15YTDGynaecology Ward 94.4% 97.5% 3% 89.5% 85.5% -4%

Maternity Ward - Maternity (45 beds) (lodgers included) 77.0% 82.4% 5% 76.6% 78.8% 2%Maternity Ward - Nursery (30 beds) (lodgers included ) 77.8% 87.0% 9% 82.0% 81.0% -1%

Botany Maternity Unit (lodgers included) 73.3% 91.8% 19% 83.4% 89.7% 6%Papakura Maternity Unit (lodgers included) 80.9% 78.4% -2% 73.0% 75.3% 2%

Pukekohe Maternity Unit (lodgers included) 78.2% 80.2% 2% 65.8% 70.7% 5%Def

Mar-16 Target Var. Actual Target Var.Nursing Hours per Patient Day (not including HCA)at MMH

NHPPD - Maternity Ward North (including nursery PD) 6.33 6.21 -0.12 6.09 6.11 0.02NHPPD - Maternity Ward South (including nursery PD ) 6.51 5.23 -1.28 5.86 5.72 -0.14

Nursing Hours per Patient Day - Gynae 5.28 4.63 -0.65 5.34 5.20 -0.14

Mar-16 Target Var. Actual Target Var.Patient Experience Survey Responses - How would you rate your overall care 72% 79% -7% 76% 79% -3% 74

(Excellent and very good)

Women's Health ScorecardPa

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Women’s Health Scorecard Commentary

• The safety measures’ reporting continues using the existing organisational database for most measures and the new weekly safe sleep audit tool. The Safe Sleep measure is impacted by the timing of the education provided to the patient versus the time that the audit is undertaken (i.e. some women receive the education closer to discharge when the audit has already been completed). Education is one component of the overall Safe Sleep audit.

• Breastfeeding data is impacted by a change to MCIS reporting. Baby Friendly Hospital Initiative data confirms that the 75% target is being maintained.

• The Gynaecology Emergency Care six hour target increased in March but did not reach the 95% target. High sick leave (ACC) and parental leave continued across the Women’s Health junior medical workforce.

• Average Length of Stay for First Time Mothers (Maaori) is very high for March 2016. This is due to several women with severe complications having a length of stay of close to a month. Maaori and Pacific First Time Mothers (with a vaginal delivery) are now staying 2.6 days on average which is almost a day higher than three years ago.

• The inpatient experience survey rating for February is 72% for excellent and very good (total sample of 34 for the month). This remains still a small sample of the overall women/families using our services.


3.8 Director of Midwifery Midwifery Workforce The Midwifery Workforce Team, made up of seven self-employed Lead Maternity Carers (LMC) and seven employed staff are currently drafting the workforce plan for 2016/17. Workload demand and Resource available During the 2014/15 Christmas Holiday Season the culture and communication between the LMCs and employed staff on Birthing and Assessment deteriorated due to different expectations and increased workload. During this year the Midwifery Workforce team have worked on different strategies to prevent this occurring again. This included: • CM Health values discussed during clinical handovers, focussing on one value each shift as to

how we establish these as “who we are” and “how we work”. • A memo sent from myself with a clear message of expectations to both LMCs and employed.

This acknowledged the stress that can come with increased workload and decreased staff and LMCs over the holiday time and strategies of what to do to minimalize this.

• A Clinical Transfer of Responsibility Audit. “Clinical Transfer of Responsibility’ is the point of time when a woman moves from Primary care to Secondary when the management for her care moves from the LMC to the Secondary Medical team. This is guided by a national document, the Referral Guidelines (Ministry of Health 2010). The point of difference for maternity compared to medical and surgical areas is that this can happen at any time during an episode of care within the facility. For medical and surgical the management of care for any patient is under the Secondary Care team and CM Health staff from when they enter a CM Health facility compared with Maternity when a woman is cared for by a LMC or CM Health staff or both at any time the women is in the facility. Another point of difference is the LMC can choose to handover or choose to continue the midwifery care when a woman is under the ‘Clinical Responsibility’ of the Secondary Care Team. This is a challenge of allocating resources (midwifery staff) when the unit is busy, when requests come from a LMC for a CM Health midwife to take over care. The Birthing and Assessment Unit is the Emergency Care Unit for Women’s Health and there is no pattern to admissions or the number of women which are handed over from LMCs. The reason for this audit is that anecdotally one of the concerns raised by LMCs is the inability to handover when they would like to. The audit is designed to look at the frequency and the aspects of the ‘handover’ which assist in a smooth and timely transition of a woman from LMC to CM Health care. This audit was done with the assistance of a Ko Awatea Quality Improvement Advisor, Cindy Blackwell with the process of a data collection designed to achieve a better understanding of transfer of clinical responsibility as occurs in the Primary Maternity Notice, Section 88 (Ministry of Health 2012). The audit report will be available in April 2016.

The anecdotal feedback from LMCs and CM Health midwives was that the strategies acted upon assisted with the culture and communication between all health professionals over the 2015/16 Christmas Holiday time and still continue.


Midwifery Graduate Programme The next intake will occur on 2 May 2016. There are eight commencing employment with CM Health in addition to the five who commenced in January 2016. There are five self-employed LMC graduates also joining aspects of the programme. LMC Liaison Midwives Two 0.5 Full Time Equivalent positions have commenced reporting to the Service Development Manager Maternity Services. Donna Ritchie and Heather Muriwai, both midwives, are still carrying a small caseload as LMCs in the CM Health area. The purpose of this position is to work in partnership with LMCs, Localities, and CM Health employees to assist with the design and development of integrated maternity service provision and collaborative ways of working together. International Day of the Midwife – 5 May 2016 The theme of International Day of the Midwife 2016 is 'Women and Newborns: The Heart of Midwifery'. Planning on recognition and celebration of Midwifery and the women midwifery cares for is occurring. Maternity Quality and Safety Programme The Annual Report is due to the Ministry of Health by 30 June 2016. We are currently in the process of writing this. The presentation of this is planned for 12 October 2016. Dietary and Lifestyle management for pregnant women with HbA1c 41-49 As part of CM Health roll out of the National Maternity Diabetes Guidelines, Elaine Chong, CM Health Gestational Diabetes Dietician has run education sessions; 74 health professionals providing maternity care have attended to date.


3.9 Surgical and Ambulatory Care Glossary DRG Diagnosis Related Group ESPI Elective Services Patient Flow Indicators FSA First Specialist Assessment MSC Manukau SuperClinic TADU Theatre Admission and Discharge Unit 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), Dr Catherine Simpson (Clinical Director Critical Care), Jacqui Wynne-Jones (Clinical Nurse Director Surgery), and Annie Fogarty (Clinical Nurse Director Acute and Critical Care). The division provides expert multidisciplinary inpatient and outpatient care for the people of Counties Manukau, the greater Auckland regional, and nationally in some specific services. Specialities provided include Orthopaedics, Ophthalmology, Otolaryngology and Audiology, Plastic and Hand, General Surgery, and the National Burn Service. Services are provided across Middlemore Hospital and Manukau SuperClinic (MSC). Performance Activity Summary Operational Volumes/Inpatient Summary (WIES) Fig 1: Acute and Elective WIES Surgical Volumes (WIES – Acute and Elective) March 16 YTD Act Bud/


Contract Var % Var

Acutes Adults 2,165 2,198 -33 -1.51% 16,873 16,732 141 0.84% Children 172 159 13 8.36% 1,626 1,407 219 15.59% 2,338 2,357 -20 -0.84% 18,499 18,138 361 1.99% Electives Adults 1,086 1,339 -254 -18.84% 10,005 11,154 -1,149 -10.30% Children 106 93 13 14.10% 754 775 -20 -2.64% 1,192 1,432 -240 -16.79% 10,759 11,929 -1,170 -9.81% Combined total Adults 3,251 3,537 -287 -8.11% 26,878 27,886 1,008 3.62% Children 279 252 26 10.47% 2,381 2,182 199 9.21% 3,529 3,790 -260 -6.87% 29,258 30,068 -809 -2.69% The March Elective result has been adversely impacted by Acute workload which resulted in the cancellation of a number of Elective cases; this was not anticipated and not factored into the production plan flex for the month at the start of the financial year.


Overall output is 260 WIES below contract for the month, and 809 WIES below YTD. 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 Diagnosis Related Groups (DRGs). The approximate impact, based on National Minimum Dataset comparison, is 327 WIES. This means that our Elective contract for the year is overstated. When compared with the 2014/15 financial year, Acute WIES is over by 1.5%, Elective WIES is lower than contract by 7.72%, and overall lower by 2.1%. Operational Volumes/Inpatient Summary (Discharges) Surgical Volumes (Discharges – Acute and Elective) March 16 YTD



Acutes Adults 1,637 1,693 -56 -3.30% 13,346 13,057 289 2.22% Children 198 182 16 8.69% 1,645 1,610 35 2.16% 1,835 1,875 -40 -2.13% 14,991 14,667 324 2.21% Electives Adults 1,162 1,150 12 1.06% 9,482 9,490 -8 -0.08% Children 163 146 17 11.73% 1,161 1,215 -54 -4.45% 1,325 1,296 29 2.26% 10,643 10,705 -62 -0.58% Combined total Adults 2,799 2,843 -44 -1.53% 22,828 22,547 281 1.25% Children 361 328 33 10.04% 2,806 2,825 -19 -0.68% 3,160 3,171 -11 -0.32% 25,634 25,372 262 1.03% Acute discharges are lower than contract by 40 patients (YTD 324 discharges higher than contract). However, a significant number of very complex acute cases were carried out. Elective discharges are higher than anticipated contracted levels by 29 patients (YTD 62 patients behind contract). The reason for the discrepancy between WIES and discharges is based on the fact that we are comparing WIES 14 and WIES 15 for the contract and actuals respectively. This is predominantly under the General Surgery subspecialty. Overall patient discharges are 11 lower than contract for month but 262 over contract YTD. In comparison with the 2014/15 financial year, Acute discharges are higher by 385 patients; however, Electives are lower by 215. Overall we are 170 patients higher when compared with the corresponding nine month period last year. For the month we subcontracted 88 patients against a target of 68 patients (YTD 854 patients vs target of 607). During the last financial year we subcontracted 888 patients to private providers for the corresponding nine month period. This effectively means that subcontracting is still 3.8% behind the corresponding period of the previous financial year. Increased peaks in Acute workload has resulted in an unfavourable March ESPI 2 result (120 day FSA threshold). Both Orthopaedics and the organisation will receive a red ESPI 2 result for March. Additionally, the backlog of patients coupled with elective cancellations (due to Acute priority) and low subcontracting numbers with private providers resulted in twelve patients breaching ESPI 5 (120 days treatment threshold) for the month. Note that the Elective base contract for the month excludes Gynaecology but includes additional Elective work. Also note that an 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 that are treated on acute arranged lists. Outpatient Summary Outpatient Summary (Visits – First and Follow Up) March 16 YTD Act Contract Var % Var Act Contract Var % Var FSAs 2,522 2,682 -160 -5.97% 21,332 22,395 -1,063 -4.7% Follow Ups 6,545 7,376 -831 -11.27% 55,039 61,269 -6,230 -10.2% Total 9,067 10,058 -991 -9.85% 76,371 83,664 -7,293 -8.7% Highlights The Surgical teams managed a surge in Acute volumes during the month. Orthopaedics experienced the majority of the pressure with 12 Acute and 18 Elective spine operations carried out; of note, there were 11 Spinal Cord Impairment patients in as many days. There was also a surge in Acute hand cases. Theatre Admission and Discharge Unit (TADU) utilisation increased significantly in March. Emerging Issues It is becoming increasingly challenging to manage volumes and achieve Ministry of Health targets within the capacity constraints currently experienced (attributable to SMO sickness and leave, Anaesthetic Technician shortage, and outpatient clinics). A detailed plan is being finalised, and will be monitored weekly, to ensure all objectives are achieved for 30 June 2016.


Scorecard

Surgical and Ambulatory Care Scorecard

March 2016


Mar-16 Target Var Actual Target VarTotal Caseweight (Provider view) 3,529 3,790 -6.9% 29,258 26,278 11.3% 1

Elective Caseweight 1,192 1,432 -16.8% 10,759 10,497 2.5% 3

Acute Caseweight 2,338 2,357 -0.8% 18,499 15,781 17.2% 2

Elective Surgical Discharges 1,325 1,296 2.3% 10,643 9,409 13.1% 4

Outpatient FSA Volumes 2,522 2,682 -6.0% 21,332 19,713 8% 10

Outpatient Follow Up Volumes 6,545 7,376 -11.3% 55,039 53,893 2% 11

Virtual FSAs/Follow ups -(GP consult and nonpatient appointments) 97 95 2 967 958 9 12

Reduce clinical outsourcing ($000) 211 371 160 3,088 2,667 -421 13

Mar-16 Target Var Actual Target Var% Staff with Annual Leave > 2 years 15.0% 5.0% -10.0% 15.3% 5.0% -10.3% 14

% Staff Turnover 8.7% 2.0% -6.7% 9.1% 10.0% 0.9% 15

% Sick Leave 3.1% 2.8% -0.3% 2.9% 2.8% -0.1% 16

Work Place Injury per 1,000,000 hours 5.65 10.50 4.85 14.41 10.50 -3.91 17


Mar-16 Target Var Actual Target VarHand Hygiene compliance rate (based on Gold Audit) - Ward 11 67% 80% -13% 73% 80% -7%Pressure Injuries / 100 patients 0 0 0 0 0 0Falls 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 0Surgical Site Surveillance for Major joints-

Antibiotics given 0-60mins before "knife to skin" 97% 95% 2% 95% 95% 0%2 grams or more Cefazolin given 100% 100% 0% 99% 100% -1%

Appropriate skin preparation 98% 100% -2% 99% 100% -1%CLAB rate/ 1000 line days 0 0 0 1 0 1 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 2 0 -2 45 0 45

Mar-16 Target Var Actual Target VarPre-operative Length of Stay Days (from admit to surgery) 0.81 1.00 0.19 0.74 1.0 0.26ESPI 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)76 0 -76 76 0 -76

ESPI 5 No. patients waiting >120 days Treatment - Elective (Surgical Services incl Gynae) 12 0 -12 12 0 -12

Mar-16 Target Var Actual Target VarAverage Length of Stay - Acute Inpatient incl Burns 4.23 3.80 -0.43 3.88 3.8 -0.08 50

Average Length of Stay - Acute Inpatient excl: Burns 4.20 3.80 -0.40 3.79 3.8 0.01Average Length of Stay - Electives 1.24 1.50 0.26 1.39 1.5 0.11 51

Mar-16 Target Var Actual Target VarTheatre list utilisation - % used MMH/MSC (MOH OS5) 93.6% 85.0% 8.6% 88.5% 85% 3.5%Theatre session utilisation - % used MMH/MSC 98.2% 95.0% 3.2% 92.7% 95.0% -2.3%Elective Theatre turnaround times- Mins (MSC only) 13.6 15 1.4 14.5 15 0.5Elective cancellations - Day of surgery as % of all Elective (all reasons)- SACS only 8.9% 5.0% -3.9% 8.6% 5% -3.6%Day of Surgery Admissions (DOSA) 90.1% 90.0% 0.1% 90.9% 90% 0.9% 65

Day Case Rate (Elective/ Arranged) -Subspecialties in SACS only Adults/kids (New Calc 75.0% 65.0% 10.0% 73.9% 65% 8.9% 66

MMH % patients discharged to discharge lounge or home by 1100hrs 13.9% 30.0% -16.1% 16.3% 30% -13.7%Ratio FSA/FU clinic ratio 36.6% 31.0% 5.6% 36.4% 31% 5.4% 61

Outpatient DNA rates - overall- Surgical Services only 8.6% 10.0% 1.4% 8.0% 10% 2.0% 62

Outpatient DNA rates - Maori (FSA) - Surgical Services only 16.9% 10.0% -6.9% 14.8% 10% -4.8% 62

Outpatient DNA rates - Pacific (FSA)- Surgical Services only 11.3% 10.0% -1.3% 11.4% 10% -1.4% 62

Mar-16 Target Var Actual Target VarPatient Experience Survey (rated very good/ excellent) 75% 92% -17.0% 82% 92% -10% 74


Mar-16 Target Var Actual Target Var% of hospitalised smokers receiving smokefree advice & support -Total (Surgical) 96% 95% 1.0% 96% 95% 0.5% 77

Ensu

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Scorecard Commentary

It is pleasing to see improved results for both the staff turnover rate and Surgical Site Surveillance, as well as continued positive performance for Day of Surgery Admission and Day Case Rates. The increased complexity of Orthopaedic patients during the month is reflected both in the increased Acute Length of Stay metric, and ESPI 2 performance. The Hand Hygiene compliance rate for the month indicates increased focus and effort in this area is required in order to improve performance.


3.10 Adult Rehabilitation and Health of Older People Glossary ARHOP Adult Rehabilitation and Health of Older People ASRU Auckland Spinal Rehabilitation Unit AT&R Assessment, Treatment and Rehabilitation Services NASC Needs Assessment and Service Coordination YTD Year to Date 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). In addition, Dr Kathy Peri (Clinical Nurse Director) supports the Health of Older People contracted services. ARHOP incorporates services that do not require the resources of a general hospital (acute secondary care) but are generally not provided by the primary care team. The Division provides expertise in the areas of interdisciplinary rehabilitation, long-term care, and support services using an integrated and continuum-of-care approach. Performance Activity Summary Inpatient summary for the month and Year to Date (YTD) activity Fig 1: ARHOP Volumes (bed days and contacts)

ARHOP Volumes (Bed Days and Contacts) March 16 YTD Act Bud/


Contract Var % Var

Inpatient AT&R 1,656 1,693 -37 -2% 14,521 16,394 -1,873 -11% Spinal 502 539 -37 -7% 4,082 4,060 22 1% Stroke Rehabilitation 584 291 293 101% 4,446 2,987 1,459 49% Acute Care for Elderly 388 376 12 3% 3,330 2,696 634 24%

The variance in actual versus contracted Assessment, Treatment and Rehabilitation (AT&R) versus Stroke Rehabilitation volumes is due to the refinement of speciality coding to ensure the accurate capture of Stroke volumes.


Outpatient summary (Visits – First and Follow-up) for the month Geriatrician Outpatient Clinics Fig. 2: AT&R Outpatient Waiting List Activity

Clients waiting longer than 90 days are being reviewed by the Clinical Head of AT&R; additional clinics will be provided to catch up as required. Highlights McKesson Workload Tool Monthly meetings are held with Senior Executives and a representation from each service to track and update on Assignment and Workload Manager progress. Initial reports from each service are planned and the information from these reports is to be discussed at these meetings.

• The AT&R wards are using the daily allocation tool and each patient’s acuity is entered on each shift.

• Spinal Unit - core categories have been completed and work is being completed on the core coverage and Nursing Hours Per Patient.

• Web Scheduler education for ward staff is planned however, no dates have been confirmed at this stage.

Certification Audit All ARHOP teams are currently preparing for certification due to take place from 26 to 29 April 2016. Specialised Rehabilitation and Community Wellness business case The Specialised Rehabilitation and Community Wellbeing Strategic Assessment has been approved by the Executive Leadership Team and the Board. It will now be tabled with regional groups throughout April and May.

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Other quality and efficiency initiatives • The Dementia Pathway Implementation (Memory Team) and Stroke Services Quality

Improvement Project are both progressing well. • The Community Geriatric Service team continues to provide support to primary care

practices and residential care providers as part of the systems integration/locality development work.

• The database for the Fracture Liaison Service has experienced rapid growth since the service went live on 1 February. To date the service has identified 102 patients that meet the criteria.

Emerging Issues Reablement Work is continuing to support the identification and implementation of supported discharge reablement services. Meetings with Home and Community Support Providers to confirm their capacity and capability to support reablement have occurred throughout March. Auckland Spinal Rehabilitation Unit (ASRU) The ASRU has seen an increase in the number of newly injured patients, with 14 patients being acutely admitted during the month of March.


Scorecard

Adult Rehabilitation and Health of Older People Scorecard

March 2016


Mar-16 Target Var Actual Target VarSpinal Inpatient ACC Revenue(in '000s) 448 447 0 5,212 4,131 1,081 Non-acute Rehabilitation ACC Revenue(in '000s) (1) 755 250 505 3,911 2,450 1,461

Mar-16 Target Var Actual Target Var% Staff with Annual Leave > 2 years (2) 4.4% 5.0% 0.6% 4.8% 38.0% 33.2% 14

% Staff Turnover 12.0% 2.0% -10.0% 10.2% 10.0% -0.2% 15

% Sick Leave 2.3% 2.8% 0.5% 2.4% 2.8% 0.4% 16



Mar-16 Target Var Actual Target VarFalls - % of falls assessments done in first 6 hours (3) 83% 100% -17.0% 81% 100% -19%Falls - % of Interventions completed 93% 100% -7.0% 84% 100% -16%Pressure Injuries - % of assessments done in first 6 hours 95% 100% -5.0% 96% 100% -4%Pressure Injuries - % of interventions completed 100% 100% 0.0% 88% 100% -12%Reduce over ride rate of Pyxis on ATR wards decrease medication errors to 15% 14% 15% -1% 14% 15% -1%

Mar-16 Target Var Actual Target VarProportion of referrals managed via e-referrals across Services (ARHOP) (4) 45% 50% -5% 39% 50% -11%

Access to specialist services -volumes of Geriatric A&R Hotline Calls 36 37 -1 36 37 -1

QUARTERLY REPORTING Jan-16 Target Var Actual Target Var% NASC referral to assessment - high complex within 5 days urgent < 24 hrs (or less), (new measure 2014/15) (5) 28% 75% -47% 30% 75% -45%% NASC referral to assessment - low complex clients <15 days (new measure 2014/15) (5) 43% 75% -32% 56% 75% -19%

Mar-16 Mar-15 Var Actual Target VarMaintain number of patient 75’s or older LOS > 10 days in AT&R wards (2% reduction on 2013/14) 54 68 -14 54 55 -1 50.8Maintain direct admissions from GPs to ATR wards (5% reduction on 2013/14) 23 32 -9 23 25 -2% of Estimated Discharge date set following assessmentn in ARHOP 98% 100% -2% 99% 97% 2%Avoidable presentations to EC from Aged Residential Care Facilities (ARRC) 18 12 6 18 15 -3MMH % patients discharged to discharge lounge or home by 1100hrs 34% 37% -3% 33% 34% -1%Rehabilitation 7 day Readmissions rate 0.8% 0.0% 1% 0.3% 1% -0.3%Acute Readmission within 28 days - Total for Rehabilitation beds 6.5% 3.0% 3.5% 4.7% 7.0% -2.3%

QUARTERLY REPORTING Q3 Target Var Actual Target Var% +65years with long term HBSS - comprehensive clinical assessment &care plan 87% 75% 12% 87% 75% 12%Reported one quarter in arrears regional data due after 20th of the month

Mar-16 Target Var Actual Target VarPatient Experience Survey 80% 90% -10% 81% 90% -9%


Mar-16 Mar-15 Var Actual Target VarNumber of Spinal Rehabilitation Outreach Clinic days - (new measure 2014/15) 5 5 0 43 33 10 47

Year to date

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Scorecard Commentary • Annual Leave: 12 month leave planning continues across the division. • Falls, Pressure Injuries and Medication assessments and intervention rates continue to be

monitored and incidents investigated and reviewed by the senior clinical and management team.

• E-referrals: this measure is being reviewed to ensure it is only measuring General Practitioner referrals received (denominator) and number of General Practitioner referrals (numerator) as data corruption issues are suspected.

• NASC reporting of timeliness referrals to assessment: work is underway with Locality General Managers to improve this measure. This includes snapshot manual tracking of individual clients by National Health Index numbers, and Operations Managers reviewing work allocation and productivity across locality-based NASC team members.


3.11 Medicine, Acute Care, and Clinical Support Glossary ALOS Average Length of Stay ESPI Elective Services Patient Flow Indicators FSA First Specialist Assessment FTE Full Time Equivalent MSC Manukau SuperClinic PACS Picture Archiving and Communication System SAU Surgical Assessment Unit SMO Senior Medical Officer YTD Year to Date Service Overview Medicine, Acute Care, and Clinical Support 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 and BreastScreen), Dr Mary Christie (Histopathology), and Clinical Nurse Directors To’a Fereti and Annie Fogarty. The Medicine, Acute Care, and Clinical Support Division is responsible for the provision of emergency care, medical services, and subspecialties for the adult population, clinical support, and breastscreening services. Performance Activity Summary

March 16 YTD Budget/ Contract

Last YTD

Act

Bud/ Contract Var Act

Bud/ Contract Var Forecast Act

Inpatient (WIES) Adult Acute Care 471 425 46 4,219 4,051 168 5,450 4,064 Adult Medical Care 1,898 1,903 -5 18,992 18,078 914 23,626 18,240 Total 2,369 2,328 41 23,211 22,129 1,082 29,076 22,304 Inpatient (Cases) Contract = Last year actuals Adult Acute Care 1,446 1,412 34 12,493 12,309 184 15,085 11,334 Adult Medical Care 2,042 2,072 -30 19,751 19,449 302 26,963 20,494 Total 3,488 3,484 4 32,244 31,758 486 42,048 31,828 Medicine O/P Procedural (contract) 1,058 875 183 6,746 5,821 925 6,285 4,289 FSAs – see note 1,536 1,872 -336 13,982 15,201 -1,219 16,578 12,441 Follow Ups – see note 6,245 7,116 -871 52,560 55,364 -2,804 38,796 31,000 Emergency Care Contract = Last year actuals Presentations 9,775 9,373 402 86,779 82,569 4,210 109,454 82,571 Clinical Support Contract = Last year actuals Laboratory – Microbiology 28,297 27,758 539 283,771 258,990 24,781 354,275 258,990 Laboratory - Histology 37,800 33,426 4,374 286,480 242,274 44,206 350,777 242,274 Radiology 17,792 17,816 -24 152,202 148,892 3,310 197,920 148,892 Note: These volumes are for Medicine only and exclude Acute Care. These volumes differ from the Balanced Scorecard which includes Acute Care.


Emergency Care Volumes in March were exceptionally high (equivalent to winter 2014 volumes) with the daily average being 315 patients. The total volume for March was 9775 which is 4.3% higher than the previous year and 3.2% higher than February. The daily volume of self-referrals for Emergency Medicine fluctuated between 247 and 319, and those patients referred by their general practitioners were transferred directly from triage to either the Medical or Surgical Assessment Units. WIES The overall monthly WIES result reflects a 0.2% decrease compared to contract and no change compared to last year. The results for General Medicine in March showed a 4% decrease in WIES compared to contract and a 4% decrease compared to last year. Cases This month we saw 1% (30) fewer cases than this time last year, with a 6% increase in the Average Length of Stay (ALOS) compared to last year. General Medicine (inpatients) saw 5% (81) fewer cases compared to last year and a 12% increase in the ALOS. Renal Volumes There are 633 patients on dialysis; 176 of these are on peritoneal dialysis and 110 on home haemodialysis. The remaining 347 are on in-centre dialysis, with 96 of these patients dialysing at the new private facility, Toto Ora. There has been one renal transplant in March and one acute peritoneal dialysis patient trained. Outpatients Data for March shows that First Specialist Assessments (FSA) were 336 below target for the month and 8% lower than the previous for YTD volumes. Follow-ups were 871 below the monthly targeted volumes and YTD follow-ups are 5% below the previous YTD volumes. Lower monthly volumes in March than the previous year could in part be due to the early Easter break. Labs Overall laboratory workload for March is 2.8% greater than March 2015. With the exception of Blood Bank all the other departments experienced increases, with Chemistry, Haematology and Histology recording record test numbers. Radiology Activity was higher than the previous month across all modalities. This is, in part, a result of the increased Acute load experienced across the hospital as well as additional Elective activity such as weekend elective ultrasound lists. Highlights Renal The new Toto Ora haemodialysis unit opened for treatments on 2 February 2016 as planned. The new unit is a joint project with a private provider, Diaverum and is the first of this type of service in


New Zealand. The official opening of the Toto Ora unit by the Minister of Health was on 8 April 2016. Radiology – Sonographer Recruitment A USA based Sonographer has arrived and is being oriented. This represents the first overseas Sonographer that we have successfully employed. Another Sonographer has returned from Maternity leave, with a further Sonographer moving part-time from Auckland DHB in April. This will reduce the vacancy rate to approximately 30%. Leadership Sanjoy Nand, Pharmacy Services Manager is the recipient of 2016 CM Health Diversity Scholarship which is being used to support his acceptance into the 2016 Leadership New Zealand Programme. The Programme’s vision is “Enriching New Zealand through active leadership in a connected community”. The 2016 Programme has a cohort of 34 from different sectors and industries including Non-Government Organisations and private companies. Emerging Issues Respiratory There was continued pressure on FSA capacity which was managed through additional clinics during March. Additional clinics are planned for April and May in order to clear the backlog and prevent ESPI 2 (FSA 120 day target) breaches. This is partially impacted by higher than expected sleep referrals and reduced capacity due to an SMO vacancy. Haematology High referral demand, combined with significant follow-up waitlists, has led to significant pressure on outpatient clinics. Additional custom clinics are being investigated as a method for managing the current demand. A review of outpatient processes has commenced to establish potential improvements to manage this more effectively. Cardiology There is increasing pressure on Cardiology in a number of areas. Whilst some good progress has been made in areas such as reducing the Echo and follow-up waiting lists, there is a need to further assess the gap in demand and capacity. Plans are being developed to manage interim demand while the service awaits the additional Cath Lab and MRI scanner. Pharmacy CM Health uses the Ascribe pharmacy system for management of medicines supply, procurement and pharmacy related activities. Ascribe is a company based in the United Kingdom and was recently acquired by EMIS Health. EMIS Health have decided to pull out of the New Zealand and Australian markets and will no longer provide support to New Zealand from December 2017. Therefore, the Ascribe pharmacy system will need to be replaced before support is discontinued. CM Health intends to replace Ascribe with a system which has been adopted by Auckland and Northland DHBs. This will be included in the 2016/17 capital plan.


Histology Tracking System The Middlemore Hospital Histopathology laboratory is a participant in a Northern Region DHB project to implement a Histology Tracking System in each of the DHB laboratories. The specimen tracking system is an integrated package consisting of both operational software and hardware that uniquely identifies each patient sample and tracks the sample in real time through every processing step to ensure the right procedures are being performed on the right samples at the right time. The project is subject to significant delays with the projected go live for Middlemore Hospital being late 2016, compared with an original go live of March 2016. The delays are primarily due to:

• In phase one of the project it was identified that hA IS infrastructure and project costs had been significantly understated by $300k (of which $46k relates to CM Health). CM Health has approved additional capex to meet CM Health difference and other DHBs are working through the process of seeking additional capex.

• healthAlliance introducing a new database platform in June 2016 Agfa RIS & PACS Performance For some time we have had performance issues with the Radiology Picture Archiving and Communication System (PACS); CM Health is involved in a regional project to upgrade the PACS. There has been significant focus on addressing the performance issues and the issues are now largely resolved. We expect to upgrade the PACS in June 2016 and prior to this will be replacing the current enterprise viewer (i.e. the mechanism by which clinicians view images) which we expect to give significantly improved performance to clinicians on the wards and in clinics.


Scorecard

March 2016


Mar-16 Target Var Actual Target VarTotal Caseweight 2,372 2,323 2% 23,194 22,039 5% 1

Elective Caseweight 71 40 78% 529 333 59% 2

Acute Caseweight (includes ICU) 2,301 2,283 1% 22,664 21,705 4% 3

Outpatient FSA Volumes 1,360 1,608 -15% 12,018 12,848 -6% 4

Outpatient Follow Up Volumes 3,663 3,835 -4% 30,385 30,093 1% 5

Virtual FSAs 88 113 -22% 1,374 1,223 12% 10

Budgeted FTEs 1,661 1,585 -76 1,619 1,601 -18Personnel Costs ($000) 14,706 14,522 -184 124,032 123,072 -960Other Operating Costs ($000) 4,297 4,030 -267 38,557 36,389 -2168Financial Result Total ($000) 19,003 18,552 -451 162,589 159,461 -3128

Mar-16 Target Var Actual Target Var% Staff with Annual Leave > 2 years 8.2% 5.0% -3.2% 9.7% 5.0% -4.7% 11

% Staff Turnover 8.4% 2.0% -6.4% 8.7% 10.0% 1.3% 13

% Sick Leave 2.3% 2.8% 0.5% 2.7% 2.8% 0.1% 14



Mar-16 Target Var Actual Target Var% electronic medication reconciliation completed for high risk patients within 48hrs 69.0% 80.0% -11% 68.0% 80.0% -12% 21

No. Falls causing major harm 0 0 0 6 0 -6 23

Mar-16 Target Var Actual Target Var% of patients admitted, discharged, transferred from ED within 6 hrs 96% 95% 1% 95% 95% 1% 33

% MRI scans completed within 6 weeks from acceptance of referral 70% 85% -15% 65% 85% -20% 34

% CT scans completed within 6 weeks from acceptance of referral 96% 95% 1% 91% 95% -4% 35

Radiology - Inpatient radiology times < 24hours 93% 95% -2% 93% 95% -2% 36

Radiology EC radiology times < 2 hours 94% 95% -1% 95% 95% 0% 37

P1 (urgent) % diagnostic colonoscopy patients receive the procedure within 14 days 73% 75% -2% 81% 75% 6% 38

P2 (routine)% diagnostic colonoscopy patients receive the procedure within 42 days 39% 65% -26% 38% 65% -27% 39

% surveillance colonscopy patients receive their procedure within 84 days of planned date 65% 65% 0% 93% 65% 28% 40

% cardiac STEMI - PCI (angiography) within 120 mins - Northern Region Target 77% 80% -3% 77% 80% -3% 41

Medical Assessment – Triage3-5 patients seen by SMO within 60 min 82.9min 60min 22.9min 68.4min 60 8.4min 46

Laboratory -Test turnaround time (TAT) within 60mins 49

Potassium 98% 90% 8% 95% 90% 5% 50

Haemoglobin 98% 98% 0% 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 91% 90% 1% 90% 90% 0% 54

-Breast - 3 working days 92% 100% -8% 89% 100% -11% 55

-Non gynae FNAs - 5 working days 99% 100% -1% 98% 100% -2% 56

Blood Bank - antibody screen within 4 hours 91% 90% 1% 92% 90% 2% 57

Microbiology CSF cell count <30mins 93% 90% 3% 94.0% 90% 4% 58

ESBL screens <2days 92% 95% -3% 92.0% 95% -3% 59

CDT (C. diff Toxin) <25hrs 86% 90% -4% 90.0% 90% 0% 60

UCHM (Urine Chemistry) <60mins 84% 90% -6% 87.0% 90% -3% 61

Door to Cathlab suspected Acute Coronary Syndrome < 3 days (median time) 71% 70% 1% 77% 70% 7% 63

General Medince - Seen By Time (minutes)1st Time to be seen Triage 1 & 2 patients (median time) 53min <30mins 22.99 56.04 <30mins 26.0min 64

1st Time to be seen Triage 3 - 5 patients (median time) 91min <60mins 30.72 97.46 <60mins 37.5min 65

2nd Time to be seen Triage 1 & 2 patients (median time) 61min <30mins 30.50 56.17 <30mins 26.2min 66

2nd Time to be seen Triage 3-5 patients (median time) 64min <60mins 4.0 66.00 <60mins 6min 67

QUARTERLY REPORTING Q3 Target Var Actual Target VarFaster Cancer Treatment - % high suspicion first cancer treatment within 62 days - MOH FCT + 70% 85% -15% 71% 85% -14% 68

Faster Cancer Treatment - %confirmed diagnosis first cancer treatment within 31 days - MOH FCT + 90% N/A 87% N/A 69

% radiology results reported within 24 hours 68% 75% -7% 59% 75% -16% 70

average of results YTD

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Scorecard Commentary Financial Result The unfavourable variance for March of $451k and YTD $3,128k is largely driven by the increased demand for laboratory services (particularly Microbiology), blood products (including Intragam), and the cost of keeping the Surgical Assessment Unit (SAU) open beyond the original planned winter period. FTE The unfavourable FTE variance for March is largely due to 14 FTE unbudgeted but funded from external sources, 13.4 FTE nursing for the unbudgeted costs of keeping the SAU open beyond the winter period, five FTE over allocation of House Officers, and 44 FTE due to annual leave taken lower than accrued (a timing issue). FSA Volumes FSA’s were 172 below target for the month with YTD being in line with target. Lower monthly volumes in March are likely to be due to the early Easter break. Percentage of electronic medication reconciliation completed for high risk patients within 48 hours Performance for March was 69% against a target of 80%. There were 2976 admissions and transfers for all areas where electronic medicines reconciliation has been implemented (Adult Medicine, Adult Surgery including MSC wards, Care of the Elderly and Rehabilitation wards including Pukekohe and Franklin, Spinal Unit, and Gynaecology). Priority focus is on high risk patients; 94% had a documented medicine history carried out by a clinical pharmacist and 91% had a documented medicines reconciliation during their stay. 69% had this done within the first 48 hours of admission.

Mar-16 Target Var Actual Target VarAverage Length of Stay - Acute 3.4 <3.5days 0.1 3.4 <3.5days 0.1 71

Acute Readmissions within 28 days - 75+ - MOH IDP 14% 10% -4% 14% 10% -4% 75

% transcribed clinical summaries (meddocs)authorised <7 days of creation 72% 95% -23% 72% 95% -22% 76

% of patients on home wards in General Medicine 50.0% >75% -25% 47.3% >75% -27.7% 80

% of Outliers on non-medicine wards 4.8% 0.0% -4.8% 8.9% 0% -8.9% 81

QUARTERLY REPORTING Q3 Target Var Actual Target Var% eligible stroke patients thrombolysed - Northern Region Target 11% 6% 5.0% 11% 6% 4.8% 84

Stroke patients on stroke pathway 69.0% 80% -11.0% 77% 80% -3.0% 85

Mar-16 Target Var Actual Target Var% Discharges from transit lounge or home by 1100hrs 15% 30% -15.0% 15% 30% -15% 89

% MA short stay patients discharged home from Medical Assessment 84% 80% 3.5% 83% 80% 3% 90

% Discharged from Mau by 1100 45% 50.0% -5.0% 45.2% 50% -4.8% 91

% of patients < 28 hrs discharged from inpatient wards 10% <10% 0.3% 11.3% 10% 1.3% 93

Implement Home First Renal policy - (increase CAPD & HD rate) 45% 50% -4.8% 45% 50% -5.3% 95

Mar-16 Target Var Actual Target VarPatient experience Survey data - month (n=52) and YTD (N=348) 81% 90% -9.0% 80% 90% -10.0%Implementation of Advance Care Planning - number of conversations 400 262 +138 3,438 3,144 +294 95


Mar-16 Target Var Actual Target Var% Women with Breastscreen in last 24 months - total 2,185 2,213 -87 67% 70% -3% 98

% Women with Breastscreen in last 24 months - Maaori 203 261 -33 66% 70% -5% 99

% Women with Breastscreen in last 24 months - Pacific 349 392 -109 76% 70% 7% 100

% Screened in last 24 Months

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Year

Year


95% transcribed clinical summaries authorised in less than seven days of creation The Clinical Director and Service Managers continue to monitor performance against this measure and investigate reasons for variations in performance. Percentage discharged from Discharge Lounge or home by 1100 hours 15 % of patients were either sent to the Discharge Lounge or discharged home by 1100 hours against the target of 30%. Improvement in the measure is linked to the work we are doing to improve our processes in General Medicine and we expect it will be several months before we see an improvement. Implement Home First Renal Policy Home therapies, peritioneal, and home haemodialysis have remained stable at 45.2% against the target of 50% for March. Percentage of women with Breastscreen in last 24 months Volumes screened in March have been reduced due to MRT shortages. We have successfully recruited to the two vacant positions but it will take time to orientate and train the new staff so we are expecting volumes to be lower than planned for the next two months. We are concerned that our coverage rate has dropped more than seems attributable to the reduced volumes. We have discussed this with BSA and it appears that since June 2015 women who are screened and who live in either new or retired domicile codes may not be counted in coverage reports. We will continue to follow this up with BSA.


3.12 Facilities Glossary MSC Manukau SuperClinic Service Overview The Facilities division is managed by Greg Simpson (General Manager) with support from John Black (Manager Engineering and Facilities), Chester Buller (Manager Capital Works), Loraine Eliott (Manager Non-Clinical Support Services), Louis Havinga (Manager Clinical Engineering), and Roy Malto (Manager Assets and Equipment). Performance Activity Summary March was another busy month for Facilities with a significant, wide ranging portfolio of work. Despite the increase in demand for both clinical and non-clinical support services, the division has successfully progressed and or delivered a number of key initiatives for the organisation; some of which are highlighted below. It was pleasing to see the main entrance of the Galbraith building reopen after a period of construction to refresh the space. Work continues to meet the scheduled completion timeframe of early May. Good progress has been made on a number of hospital projects including the Acute Mental Health Inpatient Unit, Harley Gray Laboratory, extension of the Emergency Care Whanau Room, Manukau Super Clinic (MSC) car park extension, Discharge Lounge, Scott building External Refurbishment and Retail redevelopment, and concept work for both Critical Care and Paediatric Emergency Care. The Division has also been actively involved in the Long Term Investment Planning process. The ability to meet increasing demand within current capacity remains a concern for the division. Anticipated need for the year ahead is being carefully considered as part of the 2016/17 budget process currently underway. Highlights Enterprise Asset Management The division continues to lead this programme of work, and expects a positive result from Treasury in the current assessment process. A major component of this work will be to mobilise Hyperion which will provide an organisation-wide reporting mechanism and process for all assets. Food Services The rollout of the new food service model is now settling, and significant improvements at the patient interface have been made with increased training of Compass Food Service Assistants who assist patients at the bedside. The next key focus for the service will be the implementation of the ‘Steamplicity’ preparation model at MSC.


Security – baby tracking The Proof of Concept in testing baby tracking in Maternity has been largely successful. Solutions are currently being developed for issues that arose during testing with a view to implementing the system as soon as possible. Clinical Engineering The Clinical Engineering service continues to work closely with clinical services across the hospital to deliver innovative and fit-for-purpose solutions in a timely way. Of note, a solution developed using existing equipment within the Respiratory service mitigated the need to purchase new equipment avoiding expenditure of $80K, and has also successfully modified the existing bed mover fleet to enable the transportation of bariatric beds. Emerging Issues Clinical Engineering workforce Demand based on compliance testing and certification continues to exceed the Service’s capacity to deliver, with recruitment proving difficult as a result of workforce shortages experienced across Auckland. There has been an increased, concerted recruitment effort in this area, and national training through the Manukau Institute of Technology (initiated by CM Health and supported nationally) has commenced. Orderly and Cleaning Services Continued pressure on both the Orderly and Cleaning services has resulted in the service exceeding its budget. Non-Clinical Support is working with hospital services to address how their additional demand can be funded going forward. Initiatives such as the Orderly Tracking System are being rolled out and evaluated to enable the service to manage increasing demand within current capacity.


3.13 Director Allied Health The previous Allied Health Directorate report detailed the process the directorate has undergone to ensure work is aligned to the revised organisational strategy. This report will now report on progress against these change initiatives as well as any other risks or issues within the organisation relating to Allied Health. Allied Health Directorate Development Change Initiative Status Progress Allied Health Initiative for Education and Development (AHIED)

• Allied Health Grand Rounds continue. They are being live streamed via YouTube and are being recorded for accessibility at all hours for rostered staff. Presentations have been a mix of therapy staff, and scientific and technical staff. Feedback has been positive, broadening the understanding of the may AH professions.

• Project Initiation Document for a detailed learning needs analysis has been signed off. Interest has already been received as to how we could expand this concept beyond the DHB to the wider district. A paper has been accepted at the upcoming AH Conference detailing the process we are undertaking.

• Planning for the national biennial Allied Health Conference in May continues.

Model of Care (MOC) fit for purpose

• Planning continues for implementation of the career pathways within the organisation.

• Support continues for Community Central and central triaging.

Allied Health Workforce Diversity • Planning for a Diversity Workforce Hui for Allied Health has been signed off regionally.

• Planning is well underway for the AH workforce Expo which will provide a vehicle for a large number of high-school students to be exposed to the many AH professions. This is planned to be linked into an information evening for parents to gain support for potential career paths.

Allied Health Research Strategy • An initial audit of Allied Health research has been completed. This is now being validated to ensure that it encompasses the breadth of the Allied Health professions.

• Assisting with planning for the Research week to be held later in the year.

Other non-related pieces of work underway Since the previous report there has been considerable activity relating to planned industrial activity on the part of the PSA Union and members. This was a raft of partial strikes and full withdrawal of labour planned for the 8 April for four hours, and 24 hour withdrawal of labour on the 15 and 22 April. The three Auckland DHBs had applied for facilitation under the ERA which was accepted under urgency as was the facilitation date. Facilitation was ultimately successful with a signed Terms of


Settlement being achieved on the evening of 6 April. While this was a period of a high level of activity in preparation for the strike action it is a testament to the organisation that plans were in place and we were prepared for the action. A debt of thanks is owed through this period to all of the managers for the planning and to the coordination of activity through Middlemore Central. The focus has now shifted to rebuilding relationships with the PSA.


3.14 Director of Nursing Patient and Whaanau Centred Care The Patient Experience week was very successful, with a number of events across the hospital and community. The newly launched CM Health communication video focuses on the impact of the patient’s experience when and how “we” communicate and the difference “we” can make. In conjunction with the Patient Experience week, a regional forum was held for new and experienced consumer representatives to share their experiences, gain practical advice and tips on working with the DHBs and advise what the DHBs could be doing better. The intention of the workshop was to support the process of hearing patients and their family’s experience of health services, and provide a range of cultural and patient perspectives. Workshop topics included understanding the health and disability system in NZ, building confidence and “making sure you are heard”, and improving communication with and between consumer representatives. Certification All providers of healthcare services in New Zealand are required to be certified by the Ministry of Health under the Health and Disability Services (Safety) Act 2001 to meet the NZS8134:2008 Health and Disability Services Standard. Certification can be likened to a warrant of fitness that aims to ensure the hospital is providing safe, effective and appropriate care to the people of Counties Manukau. This is a check of our systems ‐ to make sure we have the basics right. Maintaining certification is an integral part of measuring and monitoring quality improvement. The DAA auditing team is large, usually between 20 – 30 auditors, including Technical Assessors who come from other NZ DHBs and will provide specialist clinical knowledge for the audit process. The audit week (26‐29

April) will focus on hospital services. A number of corrective actions for nursing have been progressed since the last audit; including processes for auditing and monitoring of documentation standards, clinical handover and patient safety initiatives. Savings initiative – linen The organisational working group continues to address standardisation of processes and systems, including trialling and endorsing lower cost options for sheets, blankets and linen bag use. These have been documented and communications with services are ongoing to adjust impress levels and use. Current utilisation levels and YTD expenditure for bed‐making items is showing no growth (0% variation on the FY2014/15 levels), despite annual increases in patient volumes, Emergency Care presentations and theatre minutes. Workforce The annual Nursing and Midwifery Awards celebration is scheduled for 12 May 2016, with Nigel Latta as the keynote speaker. There have been a large number of nominations for the award categories, signalling high calibre nursing and midwifery across Counties. The annual Influenza vaccination Campaign has started, with an increased number in peer vaccinators in most wards and units, along with the ‘pop up’ clinics at the main hospital sites, and a communication campaign underway.


Our Professional Development Recognition Programme has been accredited by the Nursing Council. Excellent engagement noted across the sector. A few minor recommendations have been actioned. Counties have adopted the Huarahi Whakatau Maori Professional Development Recognition Programme process as a choice for our Maaori Nursing staff. Sustainable Nursing workforce Nursing vacancies open for recruitment at CM Health remains high with 169FTE recruitable vacancies for Registered and Enrolled Nurses and Health Care Assistant roles, not including advertising for Bureau roles. This total includes 25 additional New Graduates starting in a May intake. The OneStaff (electronic rostering system) upgrade is nearly complete with the Assignment and Workload Manager Module implementation working with ward leaders and coordinators to fully validate and utilise the system. The use of Bureau was unsurprisingly up on last month by 2800hrs (16FTE) more than February, but mainly for Health Care Assistant use, but with small growth in external agency use. Some of this increase is driven by unusually high seasonal demand, as ward occupancy increases, and the capacity to redeploy staff to cover diminishes. There is still a shortfall in bureau to cover RN roster shortages, and all areas work hard to share and smooth rosters where possible. Patient watches requests were also higher overall again in March, with the largest use in Acute Medical, Orthopaedic and ARHOP wards, reflecting these busy/full wards in the month. Middlemore Central continues to recruit to internal bureau, particularly for Health Care Assistant roles. Ward areas continue to manage rosters to ensure staff could take annual leave, although this was lower total than in 2015, likely reflecting the busy hospital requirements. As anticipated, March saw higher than sick leave was slightly lower than last summer. Education hours were significantly higher, reflecting the resumption of post graduate and clinical training programmes. Highlights from Services • The new Kidz First Dedicated Education Unit working with students from Manukau Institute of

Technology and University of Auckland starting and receiving exceptional feedback. • The Kidz First Leadership Academy participants have a proposal for a Year Two Registered Nurse

role within the Kidz First Home Care Nursing team. Work is now in progress to scope the role alongside this “senior” team.

• Winter preparation will see a new supportive model with a number of ‘float’ nurses recruited and educated to be clinical coaches. This concept originated from Emergency Care and Critical Care working with the Nurse Educators. This model recognises the increasing complexity of ward based patients, and the need for ‘on the job’ coaching and skill development opportunities. The proposal will be tested this winter.

• Mental Health have appointed to a number of Senior Nurse leadership roles including CNM and ACNM roles, and in community with two Clinical Nurse Specialists and a Nurse Lead – primary and integrated care. Additionally the service have had their first Nurse Practitioner Intern successfully achieve in the field of Child and Youth –this is a NZ first.

• Mental Health Acute Services have a focus the process of re‐warranting Duly Authorised Officers underway. Being a legislated role, it is vital that we maintain currency and confidence with this process.

• The Clinical Nurse Director for Aged Residential Care is developing a research project for future funding on exploring the decision making process of nurses/GPs at the time of sending a


residential care resident to the Emergency Care department at Middlemore Hospital. Aged Residential Care resident Emergency presentations to Middlemore and hospitalisation remain steady at an average of 78 per month.

• The ARHOP team are actively supporting the Community Re‐enablement programme with weekly peer review meetings to discuss issues/ complex clients, and using telehealth to link with the Franklin re‐enablement team.

• The Kidz First INFANTS Programme Fiji (providing Neonatal Education Development Programme) has been redesigned for 2016, and this will see the two Nurse Educators stay in NZ and Observers visiting from Fiji for longer periods of time starting in May.

• Senior nursing leaders of Primary Health Organisations and the Surgical Clinical Nurse Specialists held a successful workshop on understanding roles and integration.

• Roll out of computers in medication room is on track‐emphasis is on changing practice Profile: Wound care team The Wound care team under the leadership of Alan Shackleton, Nurse Consultant, are championing improvements in wound management. Their aims are challenging:

• Provide support DHB wide with issues relating to complex wound care • Improve the wound care knowledge base of all Registered Nurses within CM Health • Empower the DHB’s Wound Care Coaches, enabling them to better support their local team • Oversee and manage the use of Negative Pressure Wound Therapy across the DHB • Oversee wound care products

Since its inception in September 2013, the e‐learning ‘Ko Awatea Learn’ Wound Care module has been completed by over 700 CM Health staff. There are 80‐90 Resource Nurses across wards and services in the DHB. Additional modules Pressure Injury prevention (August 2013) have been completed by over 400 staff, and Negative Pressure wound therapy (August 2014) has been completed by 157 staff. The Wound care course module has also been taken up by Hawkes Bay and Mid‐Central DHB. There is ongoing work to support additional resource nurses in our local aged‐related residential care facilities. Current work under the leadership of Karyn Sangster Chief Nurse Advisor Primary and Integrated Care is redirecting a percentage of wound care to Practice Nurses (70% of referrals for District Nursing are for wound care). In April the Wound care team hosted the MoH, ACC and the HSQC workshop on pressure injuries. The intent of the workshop was to showcase and remind us of the impact, cost and opportunities to reduce pressure injuries across the healthcare sector.

INPATIENT EXPERIENCE SURVEY Consistent and Coordinated Care This months’ report looks at consistent and coordinated care whilst in hospital.

Many of our patients experience our hospital system as confusing and confounding. Many are in an unfamiliar environment when they need to absorb information, technical terms and language that is often new to them – all whilst they are feeling poorly or under stress.

Our patient experience surveys show that, by and large, we are performing well at communicating with patients in ways they understand and at giving them the information they need to make decisions. Our job is made that much harder, however, if we are not all on the same page with the information and advice we communicate and if our staff and teams do not work together in ways that are consistent and coordinated.

Our patients are asking for more consistent and coordinated care, indeed, for one third of our patients, this is one of the top three things that matter most to their care and treatment. Too often patients report receiving conflicting advice about their care and treatment from different staff members within our services; nearly one in ten of our patients tell us that “often” one staff member will tell them one thing, and another will then tell them something different.

Our patients are telling that that good consistent and coordinated care is when:

They receive consistent advice and care between staff and teams;

All staff involved in their care are familiar with clinical notes and treatment plans;

Patients are “kept in the loop” with their condition and any plans;

They are treated consistently well;

Communication is regular, consistent and informative;

They are attended to promptly and our systems are coordinated and efficient;

Staff are consistently available and attentive; and Care is coordinated and thorough e.g. tests are carried out.

Some of our patients do not receive consistent or coordinated care, largely because of miscommunication or conflicting opinions, advice and information. This often leads to situations that are, at best, avoidable and at worst, dangerous. A number of patients also noted inefficiencies or delays due to a lack of coordination between staff and teams.

Our previous in-depth look at consistent and coordinated care was in February 2015. When we compare data between 2014 and 2015 we can see some improvements in our performance, most notably around how our patients rate us on how well doctors, nurses and midwives work together. In the year to January 2016, five percent more patients rated this as “excellent” (from 35% to 40%), and a smaller percentage rated it as either “fair” or “poor” (from 11% to 8%) than in the 12 months to January 2015. These results are statistically significant. These are good results, but there is still further work to be done.

David Hughes

Deputy Chief Medical Officer

WHAT MATTERS TO OUR PATIENTS?

Counties Manukau Health

Communication is the aspect of our care most patients (56%) say makes a difference to the quality of their care and treatment.

“My condition and subsequent treatments were explained to me verbally and also in a follow-up letter. This was the same for every step of the treatment process.” (Rated overall care very good)

How are we doing on communication?

68 10

Very good Poor

Being treated with compassion, dignity and respect makes a difference to the quality of care and treatment for nearly half (43%) our patients.

“Every staff member treated us as their equals and respected any decisions we made.” (Rated overall care excellent).

How are we doing with dignity and respect?

81 7

Very good Poor

More than one in three of our patients (37%) rate receiving consistent and coordinated care in hospital as one of the things that makes the most difference.

“Several tests were organised and acted on in a short time. The results were passed on efficiently.” (Rated overall care excellent)

How are we doing with consistent care?

81 6

Very good Poor

Our inpatients are asked to choose the three things that matter most to their care and treatment.

Counties Manukau Health Inpatient Experience Report no.2 March 2016:1

Rated overall care excellent

“The care I received … put me at ease and made me confident.”

“…Cleaners were just finishing off cleaning the area we were to stay in and it was spotless. They were caring for our needs as much as anyone else [was]….”

“My hospital stay could not have been better, and I would like to thank everyone involved with my stay. You should be very proud of the standards that you reach.”

“All the staff's friendliness, competence and empathy made the hospital procedure and after care a wonderfully calm and overall pleasant experience. All the staff we encountered seem to really enjoy their job!”

“Speed and comprehensiveness of care impressed me … while nurses were very, very busy at times, they were always calm, responsive and helpful.”

Rated overall care very good

“The whole team worked very well together to ensure I was very well looked after and my condition was always improving. They were striving for getting my health ready for discharge and home.”

“I had every confidence in the staff and they all explained what was to happen and why.”

“The care received by the nurses … was very good, they listened if you said something and responded accordingly and they were very helpful.”

Rated overall care good

“Positive: Only a very brief waiting time for my surgery. Negative: I found it very stressful that my I had to listen the entire day to the TV program of my bed neighbour. It impacted negatively on my recovery.”

Rated overall care fair or poor

“The toilet in our room was disgusting: faeces all over the toilet bowl & seat, urine sample pottles with urine in it left on the basin, the rubbish stunk. We were in hospital for 4 days and not once was it cleaned, we did tell the nurse but to no avail.”

OVERALL CARE AND TREATMENT Over 2200 patients completed our Inpatient Experience Survey in the 12 months to January 31, 2016. Overall, we are seeing some improvement in our ratings; in October 2015 our ‘excellent’ ratings reached a high of 52 percent and our combined “excellent” and “very good” ratings have averaged 80 percent over the past 12 months. Whilst these changes are not statistically significant, they are heading in the right direction.

Inpatient overall experience of care rating, Feb 2015 to Jan 2016 (%)

n=2230

Overall care and treatment ratings to January 31, 2016 (%)

Overall n= 2235; Medicine & Acute Care n=457; Surgical & Ambulatory Care n=1127; Women’s Health n=530. Note that the data from some divisions are too small to be included here (<100).

WHAT MATTERS TO PATIENTS The graph below ranks the dimensions of care in order of what matters most to patients and shows how we are doing on each of those dimensions. The percentages of patients who say that each dimension makes a difference are listed next to each.

Overall care and treatment ratings (%)

0%10%20%30%40%50%60%

44

41

46

43

36

39

37

35

12

12

11

14

5

5

5

5

2

3

2

4

Overall

Medicine & Acute Care


Women's Health

Excellent Very good Good Fair Poor

68

81

80

73

67

75

70

74

59

26

75

70

10

6

6

9

11

7

10

7

18

53

8

7

Communication (discuss care and treatment)

Treated with compassion, dignity and respect

Confidence in care

Consistent and coordinated care in hospital

Getting good information

Managing pain and nausea

Cleanliness and hygiene

Involvement in decisions

Co-ordination between hospital, home etc

Food and dietary needs

Enabling whaanau, family & friends support

Values, beliefs and cultural needs met

Very good Poor

PATIENT VOICES

ADHB Outpatient Experience Report no. 4 July 2014:2

Counties Manukau Health Inpatient Experience Report no.2 March 2016: 2

56%

43%

37%

37%

24%

22%

21%

18%

13%

10%

7%

4%

Matters %


FOCUS ON CONSISTENT AND COORDINATED CARE More than one-third of our inpatient respondents (37% or 967 patients) tell us that getting consistent and coordinated care whilst in hospital is important to them.

37 percent of our inpatients say that getting

consistent and coordinated care whilst in hospital makes the most difference to the

quality of their care and treatment

Consistent information

Nearly two-thirds of our patients tell us they are given consistent information by staff. Nearly one in ten, however, tell us that they are “often” given conflicting information by different staff members, e.g. one staff member will tell them one thing, and another will then tell them something different.

There is very little change in our performance on this measure between 2014 and 2015. The differences are not significant.

PERCENTAGE OF PATIENTS WHO SAY THEY WERE GIVEN CONFLICTING INFORMATION BY DIFFERENT STAFF MEMBERS

2014: n=1080; 2015: n=2084

How well staff work together

Statistically, we can see that there has been some improvement in how well doctors, nurses and midwives work together, with a higher percentage of patients rating this as “excellent”, and a smaller percentage rating it as either “fair” or “poor” in the year to January 2016 than they did in the previous 12 months to January 2015. There is little improvement, however, in how patients rate how well

other staff, (e.g. physiotherapists, radiographers, occupational therapists or dietitians), work together with other members their healthcare team. Although the excellent ratings for ‘other staff’ appear to have increased, the differences are not significant.

PATIENT RATINGS OF HOW WELL STAFF WORK TOGETHER

2014: Doctors, Nurses Midwives n=1148; Other staff n=750 2015: Doctors, Nurses Midwives n=2198; Other staff n=1391 *The differences are significant (p.<05)

64

64

10

9

2014

2015

No Yes, often

35

40

36

39

41

37

41

37

13

15

15

16

8

6

6

6

3

2

3

2

2014

2015

2014

2015


HOW ARE WE DOING?

Doctors, nurses

and midwives*

Other staff

RATINGS ON CONSISTENT AND COORDINATED CARE (FEB 2015 TO JAN 2016)

AVERAGE RATING

Overall: 8.1

AVERAGE RATING BY GENDER

Female: 8.0

Male: 8.2

AVERAGE RATING BY ETHNICITY

NZ European: 8.0

Maaori: 7.6

Pasifika: 8.0

Asian: 8.2

Other European: 8.2

AVERAGE RATING BY AGE

17 and under: 7.8

18 – 24: 7.9

25 – 44: 7.8

45 – 64: 8.2

65 – 74: 8.6

75+: 8.3

AVERAGE RATING BY DIVISION

Medicine and Acute Care: 8.2

Surgical and Ambulatory Care: 8.1

Women’s Health: 7.8


CONSISTENT AND COORDINATED CARE – PATIENT COMMENTS Overall, 802 patients have commented on consistent and coordinated care in the 12 months to February 2016. More than half (59%) of the comments were positive. Note that the percentage of respondents who commented negatively or positively are in brackets.

GOOD COMMUNICATION AND INFORMATION

BEHAVIOUR WE WANT TO SEE (21%)

Our patients appreciate it when they receive consistent communication, advice and care between staff and teams. Many of these patients talked about staff being “on the same page”, being familiar with care and treatment plans, repeating the same information and advice and a handover process that worked smoothly and ensured all staff were kept up to date.

“There was no backtracking [and] no one told me anything that was not repeated by others in a consistent manner. I was comforted by the flow through of the information supplied - totally consistent from go to whoa!”

CONSISTENCY BETWEEN STAFF AND TEAMS

BEHAVIOUR WE DON’T WANT TO SEE (16%)

Just over one in six of the patients who commented believed that they experienced poor communication between staff and teams, which often led to conflicting advice and information. When this happened, patients were left confused, frustrated and unsure whose advice or opinion they should trust.

“First day after my operation, one surgeon said I should mobilise and that I'd be going home the next day. Trying to walk was extremely painful. There was no way I could've gone home. Two days later another surgeon said I shouldn't mobilise and that I'd be staying in hospital for "quite a while".”

EFFICIENT, ORGANISED, CONSISTENT CARE 2,14


For one in six of our patients, the consistent and coordinated care they received meant they were attended to promptly, and systems worked well and were efficient.

“On admission - the moving from department to department was incredibly efficient I have never experienced this in a hospital before. Also there was no major time delay between stages.”


Some of our patients believe that a lack of consistent and coordinated care was inefficient or led to a delay in care or treatment or other situations that they believed were avoidable.

“We waited 5 hours [in A&E] to see a doctor when a ward bed was already assigned for us upstairs.”


One in 10 of our patients commented negatively about miscommunication which led to a lack of consistency. Most of these patients spoke of incidents that had occurred because of miscommunication between staff and teams. Some were annoying, such as having to repeat information, being nil by mouth for extended periods of time or being left with no idea as to what was happening. Others, however, were more serious, e.g. when prescribed medications conflicted with other health conditions or when allergies were not noted and the patient had an allergic reaction as a result.

“One nurse would tell me that I could have a drug, then there would be a shift change and the next nurse would say I couldn't.”


Patients who commented about good communication and information said that consistency is about being treated consistently well, getting good communication on a consistent basis, having their information and clinical notes available to others (and therefore not having to repeat themselves) and feeling as though they were “kept in the loop” in terms of their condition and any plans or information.

“I was totally informed every step of the way and really appreciated that. Everyone involved with my care knew what was what and I had total confidence in the staff.”

OTHER

BEHAVIOUR WE WANT TO SEE

Our patients also commented positively on:

Staff being consistently available and attentive e.g. attending bells promptly (4%)

Thorough, coordinated care e.g. tests ordered and carried out, patient advised of results (2%)

BEHAVIOUR WE DON’T WANT TO SEE

Patients commented negatively:

When they felt a lack of consistent and coordinated care was due to understaffing or under resourcing (4%)

When decisions or plans changed because of a lack of coordination (4%)

INPATIENT EXPERIENCE SURVEY Confidence and Trust Confidence and trust is at the heart of the clinician-patient relationship.

Most patients say they always have confidence and trust in staff at Counties Manukau Health (CM Health). However, at least one in four of our inpatients do not always feel this way.

An analysis of the results from our Inpatient Experience survey (April 2015) shows that there is a strong association (.730) between overall ratings and how confident patients feel about the quality of their care and treatment. What this means is that patients who have little confidence and trust in our care are much more likely to rate their overall experience of our services as poor. Similarly, those who had confidence and trust in our staff are much more likely to rate their overall care and treatment positively.

We rate well on confidence and trust. Three-quarters of our patients (76%) tell us they are always confident they get good care and treatment at CM Health, and more than three quarters tell us they always have confidence and trust in the staff treating them. Our performance on these measures, however, has not changed since 2014. There is clearly some room for improvement here.

Our patients tell us the following matter most to their feelings of confidence and trust:

Respectful and professional care. Patients are asking us to listen to them, share information with them, talk to them about their options and generally treat them as partners in their care. They tell us that their confidence and trust in their care and treatment is undermined when staff do not listen to them or are dismissive of their views.

Professional competence. Our patients want to see staff who are knowledgeable about their condition. Patients have confidence in their care and treatment when they are reassured that staff are competent and know what they are doing. Whilst our patients are not telling us they expect us to know everything, they do find it concerning when we don’t take time to read their case notes or don’t understand their medical history.

Manner: Our patients say they are more trusting of staff who show them kindness and compassion as they feel staff genuinely care about them. Patients express confidence in their care when staff are proactive, helpful and friendly. When we are abrupt, rushed, and lack empathy or treat our patients as though they are a hassle or a problem to be dealt with, they do not feel as if they matter to us or that we have their best interests at heart.

Our patients and their families and whaanau trust us to provide the right care and put enormous faith in our ability to do so. Ultimately their confidence and trust comes down to receiving professional and respectful care, feeling as though they are in competent hands and as though they genuinely matter to us.

David Hughes

Deputy Chief Medical Officer

WHAT MATTERS TO OUR PATIENTS?

Counties Manukau Health

Communication is the aspect of our care most patients (56%) say makes a difference to the quality of their care and treatment.

“My condition, care options and ongoing plans were discussed with me each morning. I was aware at all times of what was going on in regard to daily testing and the results.” (Rated overall care excellent)

How are we doing on communication?

69 9

Very good Poor

Being treated with compassion, dignity and respect makes a difference to the quality of care and treatment for nearly half (43%) our patients.

“my overall feeling is that I was valued...” (Rated overall care very good).

How are we doing with dignity and respect?

81 7

Very good Poor

More than one in three of our patients (37%) rate receiving consistent and coordinated care in hospital as one of the things that makes the most difference.

“It was obvious that great care was given to coordinate my care, this was shown by the handovers that were done at the shift changes.... (Rated overall care excellent)

How are we doing with consistent care?

81 6

Very good Poor

Our inpatients are asked to choose the three things that matter most to their care and treatment.

Counties Manukau Health Inpatient Experience Report no.3 April 2016:1

Rated overall care excellent

“I know [staff] are all very busy but while with me they acted and treated me like they had all the time in the world.”

“The dedication of the doctors and nurses made it possible for me to recover from my illness sooner than we thought.”

“…I was a little apprehensive, but procedures were so efficient, staff so kind and considerate, and my room so clean and comfortable I was able to relax and appreciate my good fortune to be the recipient of such superb care.”

“I found the whole experience very well co-ordinated and care excellent. Before surgery I found [it] surprisingly calming the way things were run between staff.”

“The care I received was outstanding from start to finish.”

Rated overall care very good

“The nurses on the ward that I was on were fantastic … always happy and positive very polite and made the stay less daunting :)”

“… even though the nurses were very busy during their shifts, I still received quality care, compassion and friendship from the staff. This made my … stay more comfortable and reassuring.”

“I love the fact that at Kidz First there are beds for the parents … and that there is food provided for the parents or caregivers.”

Rated overall care good

“The nurses were excellent but appeared overworked…There seemed to be excessive time delays throughout my stay waiting for doctors and/or tests and test results.”

Rated overall care fair or poor

“No information about my condition during the time I was in hospital and no results received since. Very worrying. All the doctor said to me was that he could confirm that I had an infection!!!! Not very helpful a month later when we still don't know what we are dealing with. My [GP] is in the dark as to how to manage my health so we are just trying what we can till the hospital eventually gives us the results of my biopsies!

OVERALL CARE AND TREATMENT More than 3000 patients have completed our Inpatient Experience Survey between 1 August 2014 and 29 February 2016. Looking back, we can see that although our “excellent” ratings have fluctuated over that time, the overall trend is heading upwards. During this same time period, however, our “very good” ratings have trended downwards. One of our challenges over the coming months will be to ensure that our “excellent” and “very good” ratings rise in tandem, rather than at the expense of each other.

Inpatient overall experience of care rating (very good and excellent), August 2014 to Feb 2016 (%)

n=3335

Overall care and treatment ratings March 2015 - Feb 2016 (%)

Overall n= 2304; Medicine & Acute Care n=474; Surgical & Ambulatory Care n=1151; Women’s Health n=555. Note that the data from some divisions are too small to be included here (<100).

WHAT MATTERS TO PATIENTS Overall care and treatment ratings (%)

0

10

20

30

40

50

60

Excellent Very Good

44

42

45

42

37

38

38

35

12

12

11

14

5

5

5

5

2

3

2

4

Overall

Medicine & Acute Care


Women's Health


69

82

72

80

67

75

69

74

59

26

75

71

9

6

9

6

10

7

11

7

18

53

8

8

Communication (discuss care and treatment)

Treated with compassion, dignity and respect

Consistent and coordinated care in hospital

Confidence in care

Getting good information

Managing pain and nausea

Cleanliness and hygiene

Involvement in decisions

Co-ordination between hospital, home etc

Food and dietary needs

Enabling whaanau, family & friends support

Values, beliefs and cultural needs met

Very good Poor

56%

43%

37%

36%

24%

22%

21%

18%

14%

10%

8%

4%

Matters %

PATIENT VOICES

ADHB Outpatient Experience Report no. 4 July 2014:2

Counties Manukau Health Inpatient Experience Report no.3 April 2016: 2


FOCUS ON CONFIDENCE AND TRUST IN CARE Over the past 12 months, more than one-third of our inpatient respondents (36% or 834 patients) have told us that having confidence and trust in their care whilst in hospital is important to them.

36 percent of our inpatients say that having confidence and trust in their care whilst in hospital makes the most difference to the

quality of their care and treatment

Confidence and trust in our staff

More than three-quarters of our patients told us they had confidence and trust in the staff who were treating them. Note that in 2015 the percentage of patients who told us they had no confidence in other members of their healthcare team (7%) was more than double that of those who told us they had no confidence in doctors and nurses/midwives (3% each).

There is very little change in our performance on this measure between 2014 and 2015. Note that the differences between staff groups are significant (<p.05), however the differences between years are not.

PERCENTAGE OF PATIENTS WHO SAY THEY HAD CONFIDENCE AND TRUST IN THE STAFF TREATING THEM

2014: Doctors n=1329; Nurses/Midwives n=1162; Other staff n=760. 2015: Doctors n=2202; Nurses/Midwives n=1851; Other staff n=1125.

Overall confidence

Overall, three-quarters of our patients (76%) told us they were always confident they were getting good care and treatment with CM Health.

Statistically, there has been no change on this measure between 2014 and 2015. Please see page 4 of this report for comments from our patients on behaviours and practices which drive confidence and trust in our care, and conversely, behaviours and practices which undermine it. Attending to these can drive improvements in how patients rate us on this measure.

PERCENTAGE OF PATIENTS WHO SAY THEY ARE CONFIDENT THEY WERE GETTING GOOD CARE AND TREATMENT

2014: 1365; 2015: 2282

82

81

75

76

78

78

3

3

3

3

6

7

2014

2015

2014

2015

2014

2015

Yes, always No

76

76

3

3

2014

2015

Yes, always No

HOW ARE WE DOING?

RATINGS ON CONFIDENCE AND TRUST (MARCH 2015 TO

FEB 2016)

AVERAGE RATING

Overall: 8.5

AVERAGE RATING BY GENDER

Female: 8.3

Male: 8.7

AVERAGE RATING BY ETHNICITY

NZ European: 8.4

Maaori: 8.6

Pasifika: 8.6

Asian: 8.2

Other European: 8.4

AVERAGE RATING BY AGE

17 and under: 7.5

18 – 24: 7.2

25 – 44: 8.3

45 – 64: 8.6

65 – 74: 8.9

75+: 8.8

AVERAGE RATING BY DIVISION

Medicine and Acute Care: 8.6

Surgical and Ambulatory Care: 8.5

Women’s Health: 8.3

Doctors

Nurses / Midwives

Other staff

Respectful and professional care




Patients want to be treated respectfully and professionally. This involves taking time with patients to listen, answer questions, and respect their point to view.

“The professional and caring attitude of the staff in handling my (often repeated) questions and quest for detail left me in no doubt as to their ability to provide the care and treatment I required.”


Patients do not want to be treated disrespectfully or unprofessionally. In particular, they are concerned when staff do not listen to them or are dismissive of their views.

“One of the doctors dealing with me rolled her eyes when I told her I had [a serious condition] when asked if I had any other conditions. I was made to feel like I was making things up. It was proven from the CT scan that I wasn't!”


Patients want to see staff that are knowledgeable about their condition and have a good understanding of the history of their case. They want to be reassured that staff are competent and know what they are doing. They want to know that they are getting the best treatment.

“Surgery staff discussed aspects of my previous surgeries which made me more comfortable that they knew my med history.”

“I felt like they knew what they were doing. Their confidence in their voices was evident. They were friendly and reassured me.”


Patients do not appreciate it when staff lack knowledge about their condition, care and treatment. They are concerned when staff have not taken the time to read their clinical notes and understand their medical history, particularly when they have serious allergies or need medication or treatment.

“Being told I had not been charted medication for an asthma attack … and having a nurse tell me to wait while I struggled to breathe left me no choice but to question the quality of my care.”

“A qualified nurse told me she could not put in a line for fluids as she did not feel confident doing it!!!”

Helpful, caring and friendly manner


Patients do not want to feel ignored, or treated with indifference. Patients rate their care and treatment poorly if they are made to feel as though they are a hassle or problem. They do not have confidence in their care and treatment if staff are unhelpful, unkind or no one appears to take responsibility for them, as they do not feel as if staff care enough about them to be giving them the best treatment.

“Everyone agreed I had a problem that needed fixing but no one seemed to really take responsibility for fixing it.”

I was repeatedly "forgotten" during my stay…the nursing staff consistently forgot to connect me to fluids when I was nil by mouth and my [blood pressure] kept dropping because of it. And[I] wasn't offered a blanket till my second night.


Patients want to feel cared about and as if they matter. They have confidence in their care and treatment when they feel that staff genuinely care about them. This is demonstrated when staff are proactive, helpful and friendly.

“Always being informed of what’s happening also friendly staff really helps to trust in them.”

“I had every confidence in the quality of my care and treatment because you could feel that the staff genuinely cared about you, it wasn't just a job to do for them, you felt their compassion and love for their job and the patients they worked with.”

OTHER

BEHAVIOUR WE WANT TO SEE

Patients also commented positively on:

Clear and direct information, e.g. about options (12%)

Consistent care and regular monitoring (8%)

Coordinated care and teamwork on wards and between different departments (6%)

BEHAVIOUR WE DON’T WANT TO SEE

Patients commented negatively when:

There was a lack of consistency or continuity in their care, e.g. with different doctors (6%)

Staff gave them conflicting information (4%)

Information was unclear, partial or lacking, or was not in layman’s terms (4%)


CONFIDENCE AND TRUST - PATIENT COMMENTS Overall, 862 patients commented on confidence in their care and treatment in the 12 months to March 2016. More than two-thirds (68%) of the comments were positive. Note that the percentage of respondents who commented negatively or positively are in brackets.

Knowledgeable about the patient and their condition


Counties Manukau District Health Board 6.0 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

7.1 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)]

7.2 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)]

7.3 Minutes of HAC meeting 23 March 2016 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.

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