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Counties Manukau District Health – Hospital Advisory Committee Agenda

Counties Manukau District Health Board

Hospital Advisory Committee Meeting Agenda

Wednesday, 7 May 2014 at 9.00am – 12.30pm, Innovation Lab, Ko Awatea, Middlemore

Hospital, Hospital Road, Otahuhu, Auckland

Time Item Page No

9.00am – 9.05am 1. Welcome

9.05am – 9.15am 2. Governance

2.1 Attendance & Apologies

2.2 Disclosure of Interests/Specific Interests

2.3 Acronyms

2.4 Confirmation of Minutes (9 April 2014)

2.5 Action Item Register

1-4

5

6-18

19-20

9.15am – 10.00am 3.1 Director of Hospital Services Report – Phillip Balmer

1) Executive Summary

2) Balanced Scorecard

3) Financial Summary

4) Surgery and Ambulatory Care

5) Adult Rehabilitation/ Health of Older People

6) Medicine, Acute Care & Diagnostics

7) Women’s Health & Kidz First

8) Mental Health

9) Non-Clinical Support Services

Director of Allied Health report

Director of Nursing report

Appendix A

21-26

27-30

31-35

36-44

45-51

52-66

67-75

76-82

82-86

87-88

89-90

91-94

10.00am – 10.15am Morning Tea

10.15am – 10.45am

10.45am – 11.15pm

4. Presentations

4.1 Health of Older People & Rehabilitation Services –

Dana Ralph-Smith, GM ARHoP & Lynda Irvine, GM

Manukau Locality

4.2 Falls Group, Dr David Hughes

95-132

133-146

5. Resolution to Exclude the Public 147-148

11.15pm – 11.45pm

11.45pm – 12.5pm

6. Confidential Items

6.1 Patient Safety Report/Quality Safety Markers– Dr David

Hughes & Mr David Holland, CD Infection Services

6.2 Confirmation of Minutes (9 April 2014)

149-188

189-197

Next Meeting: 11 June 2014, Ko Awatea Innovation Lab

Agenda for Hospital Advisory Committee

BOARD MEMBER ATTENDANCE SCHEDULE – HAC 2014 Name

Jan 12 Feb 5 Mar 9 Apr 7 May 11 Jun 2 Jul 13 Aug 10 Sept 1 Oct 5 Nov 3 Dec

Lee Mathias (Chair)

No

Me

eti

ng

� � �

Wendy Lai

� � �

Arthur Anae

� � X

Colleen Brown

�* � X

Sandra Alofivae

� X �

Lyn Murphy

� � �

David Collings

� � X

Kathy Maxwell

� � �

George Ngatai

X � �

Dianne Glenn

� � �

Reece Autagavaia

� � �

* Attended part meeting only

1

BOARD MEMBERS’

DISCLOSURE OF INTERESTS

7 May 2014

Member Disclosure of Interest

Dr Lee Mathias, Chair • MD Lee Mathias Limited

• Trustee, Lee Mathias Family Trust

• Trustee, Awamoana Family Trust

• Chair Health Promotion Agency

• Deputy Chair Auckland District Health Board

• Director, Pictor Limited

• Director, iAC Limited

• Advisory Chair, Company of Women Limited

• Director, John Seabrook Holdings Limited

Wendy Lai, Deputy Chair • Board member and partner at Deloitte

• Board member Te Papa Tongarewa, the Museum of

New Zealand

Arthur Anae

• Councillor, Auckland Council

• Board Member Phobic Trust

• Member The John Walker ‘Find Your Field of

Dreams’

• Chairman, NZ Good Samaritan Heart Mission to

Samoa Trust

Colleen Brown • Chair Parent and Family Resource Centre Board

(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, Early Childhood Education Taskforce for

COMET

• Member, Manurewa Advisory Group

• Member, Child Advocacy Group – Manukau

• MSD Member, Auckland Social Policy Forum,

Auckland Council

• Deputy Chair, Auckland City Council Disability

Strategic Advisory Group

• Chair ECE Implementation Team Auckland South

2

Dr Lyn Murphy • Member, International Society for

Pharmacoeconomics and Outcomes Research

(ISPOR).

• Member of the New Zealand Association of Clinical

Research (NZACRes)

• Senior lecturer in management and leadership at

Manukau Institute of Technology

• Member, ACT NZ

• Director, Bizness Synergy Training Ltd

• Director, Synergex Holdings Ltd

• Associate Editor NZ Journal of Applied Business

Research

• Member Franklin Local Board

Sandra Alofivae

• Chair of the Auckland South Community Response

Forum (MSD appointment)

• MSD Member, Auckland Social Policy Forum,

Auckland Council

• Member, Fonua Ola Board

• Appointed to the Ministerial Forum on Alcohol

Advertising & Sponsorship

• Board Member, Pacifica Futures

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

• Maxwell Family Trust Share in Orion House leased

to Orion Health through Oyster Management Ltd

• Member Manukau Locality Leadership Group,

CMDHB

Dianne Glenn • Member – NZ Institute of Directors

• Member – District Licensing Committee of Auckland

Council

• Member – Auckland Conservation Board

• Life Member – Business and Professional Women

Franklin

• President – National Council of Women

Papakura/Franklin Branch

• Member – UN Women Aotearoa/NZ

• Vice President – Friends of Auckland Botanic

Gardens and Member of the Friends Trust

• Member – Friends of Regional Parks

• Life Member – Ambury Park Centre for Riding

Therapy Inc.

3

• CMDHB Representative - Franklin Health

Forum/Franklin Locality Clinical Partnership

George Ngatai • Arthritis NZ – Kaiwhakahaere

• Chair Safer Aotearoa Family Violence Prevention

Network

• Director Transitioning Out Aotearoa

• Director BDO Marketing

• Board Member, Manurewa Marae

Reece Autagavaia • Executive Member, Pacific Lawyers’ Association

• Member, Labour Party

4

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 7th

May

2014

Director having

interest

Interest in Particulars of interest Disclosure

date

Board Action

Wendy Lai

HBL – Food & Laundry &

FPSC Programme

Ms Lai declared a specific interest

in regard to Deloitte providing

support to HBL in the food and

laundry and FPSC Programme.

Deloitte has mainly been

providing Oracle implementation

resources to FPSC. Ms Lai is not

directly involved with this work

12 February 2014

That Ms Lai’s specific

interest be noted and

that the Board agree

that she may remain in

the room and participate

in any deliberations, but

be excluded from any

voting.

5

Glossary ACC Accident Compensation Commission

ADU Assessment and Diagnostic Unit

ARDS Auckland Regional Dental Service

BT Business Transformation

CADS Community Alcohol, Drug and Addictions Service

CAMHS Child, Adolescent Mental Health Service

CNM Charge Nurse Manager

CT Computerised Tomography

CW&F Child, Women and Family service

DNA Did not attend

ESPI Elective Services Performance Indicators

FSA First Specialist Assessment (outpatients)

FTE Full Time Equivalent

ICU Intensive Care Unit

iFOBT Immuno Faecal Occult Blood Test

MHSG Mental Health service group

MoH Ministry of Health

MTD Month To Date

MOSS Medical Officer Special Scale

OHBC Oral health business case

ORL Otorhinolaryngology (ear, nose, and throat)

PACU Post-operative Acute Care Unit

PHO Primary Health Organisation

PoC Point of Care

SCBU Special care baby unit

SMO Senior Medical Officer

SSU Sterile Services Unit

TLA Territorial Locality Areas

WIES Weighted Inlier Equivalent Separations

YTD Year To Date

6

Minutes of the meeting of the Counties Manukau Health

Hospital Advisory Committee

Wednesday 9 April 2014

held at the Innovation Lab, Ko Awatea, Middlemore Hospital

commencing 9.00am

COMMITTEE MEMBERS PRESENT:

Dr Lee Mathias (Board Chair)

Dr Lyn Murphy (Committee Chair)

Ms Wendy Lai

Ms Kathy Maxwell

Mr George Ngatai

Ms Dianne Glenn

Ms Sandra Alofivae

Apulu Reece Autagavaia

ALSO PRESENT:

Mr Geraint Martin (Chief Executive)

Mr Phillip Balmer (Director, Hospital Services)

Ms Margaret White (Deputy Chief Financial Officer, Hospital)

Mr Martin Chadwick (Director Allied Health)

Ms Denise Kivell (Director of Nursing)

Dr Gloria Johnson (Chief Medical Officer)

APOLOGIES: Apologies were received and accepted from Anae Arthur Anae, Ms Colleen

Brown and Mr David Collings.

WELCOME Ms Sandra Alofivae opened the meeting with a prayer.

2.2 DISCLOSURE OF INTERESTS

The Committee noted Dr Lee Mathias will sit on the Board of healthAlliance as from the

beginning of May 2014.

2.2 SPECIFIC INTERESTS

There were no additional specific interests to note with regard to the agenda for this

meeting.

2.3 ACRONYMS

The acronym list was noted.

7

2.4 CONFIRMATION OF PREVIOUS MINUTES

Confirmation of the Minutes of the Counties Manukau Health Hospital Advisory Committee

meeting held 5 March 2014.

Resolution (Moved Mr George Ngatai/Seconded Ms Wendy Lai)

That the minutes of the Counties Manukau Health Hospital Advisory Committee meeting

held 5 March 2014 be approved.

Carried

3.1 DIRECTOR OF HOSPITAL SERVICES REPORT

Mr Phillip Balmer took the committee through his report.

The main issues of note were:

• Financials – overall the month result for the Provider Arm was a net surplus of $2,753k,

a $19k favourable variance. YTD the Provider Arm had a $469k favourable variance.

• WIES volumes are <1% above contract for the month. This volume is driven by acutes

being up on contract by 5% and electives down by 10%. Discharge volumes are 4% up

on last year with both elective and acute volumes showing a 4% increase on last year.

• FTEs – Nursing is reporting an unfavourable variance of 48FTE for February of which

approximately 22 are unbudgeted. Support staff unfavourable variance of 27FTE

reflects additional cleaning and orderly service requests as well as casual security staff to

cover for high incidence of sick and annual leave – this was offset by favourable

infrastructure costs in Medical Waste Removal and Patient Meals. Management and

Administration staff are below budget by 15FTE which represents vacancies yet to be

filled across the organisation. Future reports will separate out any positions funded

post-budget.

• Management/Administration below 15FTE – we take every opportunity to

rethink/challenge positions but we need to make sure we don’t compromise care and

we keep things safe. As we change how we work, all vacant positions will be reviewed.

• Breast screen coverage target - 70% women 45-69 years screened in the last 24 months.

Achieved 70% (including Maaori 68% and Pacific 73.1%). Ms Brown noted the problems

for disabled women to access these services – facilities are often quite difficult (ie)

tables too high, the mobile Breast screen unit has steep steps. She also inquired

whether we track data on disabled women for these services. Mr Balmer undertook to

talk to the services providing these services as there is a requirement for us to look at

every service and put a disability lense over that service. We need to constantly ask and

reassess.

• ESPI 2 & 5 Targets (FSAs and Treatment). Ms Lai asked if the Director’s report next

month could include a report of trends in the last month to give assurance that the wait

8

times are decreasing and whether the interventions that we have put in place are

working/are not working and if so, what initiatives are underway to correct.

Mr Balmer undertook to add onto the end of the scorecard, a YTD trend line alongside

the numbers and more detailed narrative around each.

• Quality – Hand Hygiene (Target 100%). Ms Brown asked why some centres are not

reporting on hand hygiene. Mr Balmer advised that some are struggling to capture data

but we would like to see it included in the next report. Hand Hygiene is measured by

trained auditors who do snap audits to a timeline. We don’t have enough auditors to

audit all centres so we pick the areas where we can get the most gains. We can do a

blitz in an area if that is needed.

• Echocardiograms – The service has agreed that they will increase their staff to an

additional sonographer to meet the demand. They are also looking at evening sessions

as well as day sessions. They have a number of clear plans to bring this back into line.

• Colonoscopy Nurse Training. This was discussed at the national DoNs meeting last week

and people want to get on board. Working groups have been formed and endorsed to

support credentialing. CMH is ready to do, have a couple of nurses keen to participate.

Need to get the clinical team on board, Head of Gastro is supportive of the idea but is

concerned that it is not a quick solution to the problem – going to take time to set up a

training programme, get people through the training and employ them. It is not of a

scale that will solve the pressing problem we have at the moment however, it will help

solve the problem with the non-urgent colonoscopies. We could include GPs to make it

work, particularly for surveillance colonoscopies.

• Home Health Care (HHC). Ms Lai commented that the HHC contacts across all localities

were down for the month yet staff costs were up. Mr Balmer advised that we have

thought carefully about what people need when they require home support - some

require quite complex assessments, others need a more modified version. That has

meant that the type of assessment has changed and the time to provide those

assessments has increased. For patients with complex needs we were asked to provide

an Inter-Rai assessment for them for which there was additional funding from the

Ministry to catch up on those assessments. The team has been doing more work on the

weekends to get those assessments up to date.

Mr Balmer undertook to take a more detailed look at the HHC nursing and provide

feedback. This is an area that is going to become more complex so we need a good

handle on the costs, what is economically efficient.

The Committee requested a presentation from the Health of Older People Service

around the HHC, NASC assessments, Inter-Rai assessments at the next meeting.

• Mental Health Adult Community Service – clinician contacts. There was a 5% reduction

in clinician contacts for the month of February (16351 v 17219 January). This was

attributed to the number of clinical staff who took annual leave in the month and

particularly to support the HCC IT platform upgrade on 7 February, as well as fewer

working days in the month. The contact numbers are expected to increase during

March.

9

Mr Balmer advised that there are national KPIs and within those there are target

timeframes in terms of access and response and we track well. Over holiday periods

demand for various types of acute services decrease. We need to be sensitive to the

fact that our leave and our ability to have locum support mat impact on our delivery. Mr

Balmer also confirmed that the fluctuations are something that can be looked at more

closely and if we move to contacts by clinician FTE that might be a better indicator.

The Committee asked that the Mental Health team come and talk through the drivers in

mental health (severity, social determinants, episodic v chronic etc).

Dr Mathias commented that the new national depression initiative advertisement is on

television, targeting rural. The next target area is likely to be maternity.

Ms Denise Kivell gave the Committee an overview of the ACE programme:

• The ACE Nursing Programme is an entry point/a portal where new graduates can apply

to go on a nurse entry to practice programme. CMH have partnerships with primary,

aged and plunket across the sector. The new graduates enter through one portal and

choose a DHB (have 3 choices), we interview them and then they will get one letter so

this stops multiple letters going out and us waiting a month for the graduate to advise

that they’ve taken a job with another DHB. ACE is a programme that goes right

throughout the country. The new graduates come to us with a practising certificate and

undertake a one year dedicated induction programme.

The report was received.

(Moved Dr Lyn Murphy/Seconded Ms Sandra Alofivae)

3.2 NATIONAL MATERNITY CARE INFORMATION SYSTEM

The paper was taken as read.

Ms Maxwell requested that the XP comments in the paper need to be updated.

The paper was received.

(Moved Ms Dianne Glenn/Seconded Ms Kathy Maxwell)

4. RESOLUTION TO EXCLUDE THE PUBLIC

Resolution (Moved Apulu Reece Autagavaia/Seconded Ms Dianne Glenn)

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:

10

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

5.1. Patient 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, S.32 (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

S.9 (2) (a)]

5.2. Non-Resident

Revenue Processes

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


not be in the public interest because

of the greater need to enable the

Board to carry out, without prejudice

or disadvantage, commercial

activities.


S9(2)(i)]

Carried

10.20am –11.21am Public excluded session.

11.21am Open meeting resumed.

6. PRESENTATION

6.1 Acute Care – What ‘Good’ Looks Like

Dr Vanessa Thornton, Clinical Director Emergency Care, Dr Jeffrey Garrett, Clinical Director

Medicine and Dr Carl Eagleton, Clinical Director General Medicine took the Committee

through the presentation. A copy of the presentation is attached to the minutes.

The main issues of note were:

• CMH key issues:

• Population Growth – 50% increase 2001 to 2026

• Ageing -172% increase in over 65s

11

• Increased burden of chronic disease

• Increased inpatient demand: 291 (42%) more beds 2005 -2025

• Workforce issues

• Modern Models of Care to lead CMDHB into the future

• Key model of care drivers

• Increasing people requiring long term care

• Short length of stay (but high admission rate)

• To reduce rate of growth of inpatient beds

• “Upstream models”

• “Whole of Society” integration across the continuum

• Secondary Care medicine supporting primary care and other services ( e.g. surgery,

ED)

• Medical Continuum of Care

� Keep acute medical services at MMH to 2025

� Close working relationship between General Medicine and Medical Subspecialty

services

� Continuum of care

• Primary care

• CCM programmes

• Ambulatory care

• Acute care management

� Committed to reducing inpatient bed utilisation

• evidence-based strategies

• improvements in efficiency

• improved capture and analysis of MMH data

• innovation

• Strong commitment to use of specialist nurses

• Primary care

• Community based secondary care

• Specialist nurses working across the secondary-primary interface

• Improved efficiency of ambulatory care

• Performance against prioritisation criteria

• Improved access to subacute care clinics

• Medical Planning Unit (oncology services),

• CT/MRI/Ultrasound service MSC

• Specialist and multidisciplinary clinics at Manukau Campus

• What ‘Good’ Looks Like (Emergency Care)

1st Hour

• TC1 patients seen immediately

• TC2 patients seen in 10 minutes

• Nursing assessment in 15 minutes

• All patients seen by a doctor within one hour of arrival

2nd Hour

• EC patients referred to inpatient speciality teams

• Specialty teams advised patient requires review

• All speciality patients seen in one hour by decision making doctor

12

4th Hour

• Bed allocated and bed available (in one hour of allocation)

• Ward nurse to request hand over within one hour of bed allocation

• Standardised (exception) handover

5th Hour

• Patient transferred to short stay

• Patient discharged with discharge papers

• Patient admitted to inpatient ward

• No inpatients boarding in acute EC or in short stay wards

• Over the last 14 years there has been an unprecedented and sustained increase in

patient presentations to ED.

• Existing research shows between 15-40% of patients in ED have had contact with their

GP prior to coming to ED.

• 25% self-presenting patients had contacted with GP prior to presenting to ED. Most

common reason for self-presenting is the belief that they are acutely ill.

• 30% attended out of hours because their GP service was closed.

• Cost did not feature as a reason for attendance.

The Chair thanked the Drs Thornton, Eagleton and Garrett for an informative presentation.

Ms Sandra Alofivae closed the meeting with a prayer.

Meeting concluded at 12.25pm.

The minutes of the Counties Manukau Hospital Advisory Committee meeting held on

Wednesday 9th April 2014 be approved.

(Moved /Seconded )

Chair

Dr Lyn Murphy Date

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

the following month.

19

Hospital Advisory Committee Meeting – Action Items Register – 7th May 2014

DATE ITEM ACTION DUE

DATE

RESPONSIBILITY COMME

NTS/UP

DATES

COMPLETE

��

5.3.2014

3.0

Director Hospital Services Report

Presentation on renal services and

issues including information on

current clinical studies

TBC

Mr Phillip Balmer

9.4.2014

3.1

Director Hospital Services Reports

Health of Older Peoples Service

presentation (Home Health Care,

NASC assessments, Inter-Rai

assessments)

May

Mr Phillip Balmer

��

9.4.2014

3.1

Director Hospital Services Reports

Mental Health Service attend HAC to

talk through the drivers in mental

health (severity, social determinants,

episodic v chronic etc)

TBC

Mr Phillip Balmer

9.4.2014

5.1.

Patient Safety Report

Falls Group to feedback on progress

they are making

May

Dr Gloria Johnson

��

9.4.2014

5.1.

Patient Safety Report

CD Infection Services to report on

the Quality Safety Markers

May

Dr Gloria Johnson

��


7 May 2014

21


Hospital Services Report

Recommendation

It is recommended that the Hospital Advisory Committee receive the Hospital Services Report

covering activity in March 2014 as follows:

Prepared and submitted by: Phillip Balmer, Director Hospital Services

Counties Manukau Health - Hospital Services .................................................................................... 22

1 Executive Summary .................................................................................................................. 22

2 BALANCED SCORECARD – N.B. Some measures under development ..................................... 27

2.1 Elective Wait Time target trends (150 days and 120 days) – to March 2014 .................... 30

3 FINANCIAL SUMMARY Best value for public health system resources – ................................. 31

3.1 Detailed FTE Analysis ......................................................................................................... 35

4 Surgery and Ambulatory Care .................................................................................................. 36

5 Adult Rehabilitation / Health of Older People (ARHOP) .......................................................... 45

6 Medicine, Acute Care and Diagnostics .................................................................................... 52

7 Women’s Health and Kidz First ................................................................................................ 67

8 Mental Health .......................................................................................................................... 76

9 Non Clinical Support Services .................................................................................................. 82

Director of Allied Health - report ......................................................................................................... 87

Director of Nursing - report ................................................................................................................. 89

Appendix A – Scorecard Glossary - in development ............................................................................. 91


7 May 2014

22

Counties Manukau Health - Hospital Services

1 Executive Summary

We have seen real focus from services over the month of March on strategic and service planning

with significant progress made. Clinical leaders and managers are involved in the following planning

responsibilities including:

1 Completing the annual plan;

2 Developing the service specific goals and plans related to the triple aim, to realise the health

service and organisational goal of being the best healthcare provider by 2015;

3 Developing service specific measures and scorecards that provide clarity on whether these

goals are being realised and improvements are being made;

4 Reviewing and improving the service goals for improving the acute patient journey;

5 Finalising the action plans associated with realising the triple aim goals for 2014/15 including

balancing the budget, whole of system service redesign, and improving the care continuum for

the “At Risk Individual”.

1.1 Activity summary

a) WIES volumes actual versus projected as agreed with the Funder

YTD WIES volumes are 3% above funded agreement (2% for Acutes and 5% for Electives).

MTD WIES volumes are 1.8% above contract for the month (1% for Acutes and 3% for Electives).

This Elective over-delivery is being driven by requirements of the Elective wait-time (ESPI) targets, in

part funded with additional Ministry of Health funding to deliver an additional 110 discharges.

against funder agreement 2013/14

Acute ServicesThis Yr Act

Funder agreement

% Var to funder

agreementThis Yr Act

Funder agreement

% Var to funder

agreement

- WIES 4,798 4,734 1% 44,674 43,806 2%

Elective Services - WIES 1,594 1,543 3% 13,271 12,590 5%

TOTAL (includes other DHB's) - WIES 6,392 6,277 2% 57,945 56,396 3%

CMDHB-Provider Arm Volume Summary - March 14

TOTAL - all patientsMonth March 14 YTD March 14

b) Patient discharge volumes actual versus 12/13 patient discharge volumes.

YTD patient discharges are 3.9% up on last year (Electives up 4.2% and Acutes, 3.8%);

MTD patient discharges are up 4% on last year (Electives down 1% and Acutes 5%).


7 May 2014

23

against 2012/13 year

Acute ServicesThis Yr Act Last Yr Act

% Var to Last Yr

This Yr Act Last Yr Act% Var to Last Yr

- WIES 4,798 4,702 2% 44,674 43,203 3% - Patients 5,996 5,709 5% 53,045 51,113 4%Elective Services - WIES 1,594 1,571 1% 13,271 13,402 -1% - Patients 1,293 1,304 -1% 12,545 12,043 4%TOTAL (includes other DHB's) - WIES 6,392 6,273 2% 57,945 56,605 2% - Patients 7,289 7,013 4% 65,590 63,156 4%

CMDHB-Provider Arm Volume Summary - March 14

TOTAL - all patientsMonth March 14 YTD March 14

c) Emergency Care (EC) presentations actual versus 12/13 presentations (see below).

YTD EC presentations are up 4% on last year and MTD up 3.5% on last year. YTD EC patient

discharges are 4.2% up on last year and MTD 3.9%.

EMERGENCY CARE

Volumes Month March 14 YTD March 14

This Yr Act agreement Var % var to

Last Yr

This Yr

Act agreement Var

% var to

Last Yr

Presentations

(against last year) 8,864 8,520 344 4.0% 78,775 76,137 2,638 3.5%

Discharges

(against contract) 8,810 8,459 351 4.2% 78,765 75,801 2,964 3.9%

Presentations refers to all people entering Emergency Care, while Discharges only include those are

those that treated (excludes a small number of cases that leave unseen, or are transferred).

1.2 Financials

The Provider Arm produced a $14k favourable variance for the month, maintaining a favourable year

to date variance of $481k. Revenue is favourable by $888k due to high billings for non-residents,

(significantly offset by bad debt provision) as well as additional revenue for some projects (partially

offset by cost). Expenses before depreciation, interest and capital charge are unfavourable by $1m

and are explained by the following:

a) Personnel costs $(400)k

Medical Personnel Costs are $546k favourable due to existing vacancies within the organisation,

partially offset by outsourced costs.

Nursing Personnel Costs are $(74)k. Course fees have been accrued for the month to reflect the

actual expected year to date spend of $(223)k, compensating for the delayed claims for study fees in

February.

Allied Health Personnel Costs are $(205)k adverse for the month (YTD $650k) as FTE increased to

support clinical volumes in pharmacy, radiology and laboratory.

Support costs are $(220)k unfavourable for the month. A high usage of in-house casual pool staff in

March for cleaners, orderlies and security, to cover the high incidence of annual leave, sick leave and

vacancies $(125)k. An increased demand of interpreter services across the hospital services has seen

an increased cost against budget of $(93)k for the month. The trend is expected to continue for the

balance of the year.


7 May 2014

24

Management Administration costs are $(446)k unfavourable for the month. A low level of annual

leave has been taken during the month in anticipation of the Easter/School holidays in April; this is

reflected as a higher accrual during March versus annual leave taken. This is expected to be offset

by leave planned for April. Ko Awatea are $(142)k unfavourable due to an AUT $(60)k contract cost

miscoded plus management and admin staff funded from other areas of kA business $(40)k.

b) Outsourced $(689)k

Outsourcing of surgical volumes continues in order to maintain the ESPI (Elective Service

Performance Indicator) targets $(377)k. Health Alliance and Health Benefits Ltd cost variances

against contract will continue for the balance of the year $(196)k.

c) Clinical Supplies $(53)k

Ambulance services $(141)k, inventory purchasing reduction $214k and drug overspends $(113)k are

the drivers for the clinical supplies variance for March.

d) Other Expenses $266k

Depreciation, interest and capital charge are $141k favourable. Capitalisation of CSB interest

($300k) (partially offset by capital charge and depreciation) has delivered this favourable cost

variance for the month, together with savings achieved across the services ie: patient meals $79k,

Laundry/Linen $125k, mobile phones $94k, corporate training $147k.

The breakdown of overall variances for the CMDHB group are summarised below:

Month YTD

Hospital Provider $(6)k $270 k

Integrated Care $(30)k $648 k

Ko Awatea $81 k $34 k

HBL $(31)k $(471)k

Total Provider $14k $481 k

CMDHB Funder $95 k $456 k

CMDHB Governance $(106)k $(616)k

Total CMDHB $2k $322k

1.3 FTEs

As shown in the table below we were 173.16 FTE over budget. The reasons for the variance are

summarised below.

FTE variance – hospital services for the month of March

Net Annual Leave (accrued - taken) (187.36)

Stat days in lieu (1.06)

Unpaid days accrual 0.00

Funded FTE (81.91)

Vacancies 151.94

Transfers in and out (2.40)

Overtime/Bureau/Casuals (73.03)

Other 20.66

TOTAL (173.16)


7 May 2014

25

Accrued leave: Provider Arm FTE has been largely affected by a low level of annual leave taken in

March with many staff anticipating increased leave over the Easter/School holiday period in April.

Funded FTE: There have been 81.94 additional funded FTE that have been supported by the Ministry

of Health or DHB following the development of the budget.

Vacancies: There has been a favourable variance for 151.94 FTE, partly offset by 73 FTE for

overtime/ bureau/ casuals over the month reflecting heavy clinical demand in March.

Please refer to Detailed FTE Variance Report – section 3.1.

1.4 Highlights

The new Medical Assessment Unit has opened, and the official opening ceremony of the Harley Gray

building facilities held, with the Minister of Health attending. There have also been events to mark

the closing of the Galbraith Theatres after many years of service. Since the Medical Assessment Unit

opened on 31 March, there has been a positive impact on improving the National Health target

Emergency Care 6 hour Length of Stay results, in spite of high Emergency Care presentations.

The Winter Plan final document will be circulated in mid April, subject to sign-off of the specific

winter initiatives. Rapid development of a Discharge/ Transit lounge concept is occurring, to

facilitate timely patient care, using the Goal Discharge Date process to promote preparations for

discharge, and enabling new admissions to move from Emergency Care.

The Influenza working group comprising Infectious Diseases, Laboratory, Emergency Care, Intensive

Care, OCHS and Middlemore Central has convened for the winter and will monitor Flu incidence and

presentations. The annual Staff vaccination campaign is underway, with over 2,000 staff already

vaccinated in March. In conjunction with Human Resources team and unions, agreement has been

reached that staff in high risk areas who are not vaccinated will wear masks to reduce flu

transmission.

An Emergency Planning exercise occurred on 28 March with a simulation exercise of a helicopter

crashing and burning on the top of the Edmund Hilary building. It was a very worthwhile exercise,

with all teams able to practice emergency plans and evacuation procedures, together with great

teamwork and communication skills.

The hospital has sustained achievement of the Smoke Free national health target at 95%, and

exceeded the quarterly target for Elective access, Emergency Care LOS and Cancer Treatment

results. Easter Hot Cross Buns were provided to staff on 16th April to acknowledge and thank them

for work in recent months. The National Burns Centre is preparing to celebrate 12months CLAB-

free, which is a notable milestone for the team.

1.5 Emerging issues

Winter Planning has commenced including initiatives to reduce acute demand, capacity plan, and

strengthen links with community providers including primary care.

Elective volumes (operations and outpatient visits) remain high with limited progress in reducing

wait times in preparation for the new ESPI 2 and 5 targets of 120 days from December. We also

have some Specialist sick leave arising and planned sabbatical leave in some services and so options

are being considered as to how to best progress production planning to meet the ESPI targets in

2014/15.

HBL Food and Linen/ laundry service contracts are nearing finalisation however; as yet we are not in

a position to fully understand their impact.

The Tahitian Burns contract volumes / revenue is down, with some concern that this may be due to

these patients going to alternative services in Australia and this is being investigated. We are also


7 May 2014

26

currently in negotiations with the Ministry of Health/ ACC to secure the future funding agreement

for the Auckland Spinal Rehabilitation Unit as there is currently a shortfall on revenue per surgical

patient.

We will be implementing the new approval process for recruitment in April, which will include clear

FTE and budget information for all cost centre managers; as well as sign-off from the Directorate

Professional Leaders.


7 May 2014

27

2 BALANCED SCORECARD – N.B. Some measures under development

(See definitions in Appendix A)

HOSPITAL ADVISORY COMMITTEE

SCORECARD

March 2014

BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCES

Def

Mar-13 Mar-14 Target Var Actual Target Var

Total Caseweight 6,273 6,371 6,277 1% 57,769 56,396 2% 1

Acute Caseweight 4,702 4,778 4,734 1% 44,657 43,806 2% 2

Elective Caseweight 1,571 1,593 1,543 3% 13,112 12,590 4% 3

Elective Surgical Discharges (excludes uncoded / target is 12/13) 1,304 1,293 1,304 -1% 12,545 12,043 4% 4

Outpatient - total volumes 30,565 29,818 28,266 5% 275,791 252,447 9% 5

Budgeted FTEs 5,775 5,795 5,622 -3% 5,634 5,535 -2% 6

Operating Costs ($000) 22,486 22,818 22,344 -2% 204,407 198,094 -3% 7

Personnel Costs ($000) 41,947 43,635 43,236 -1% 384,776 386,431 0% 8

Financial Result Total $m -0.2 -0.5 -0.6 3% -0.4 -0.8 58% 9

Outpatient FSA Volumes 7,705 7,274 -6% 71,526 70,324 2% 10

Outpatient Follow Up Volumes 25,743 25,385 -1% 230,191 225,272 2% 11

Virtual FSAs 261 155 188 -18% 2,137 1,310 63% 12

Reduce clinical outsourcing ($000) 2,200 1,688 1,331 -27% 15,133 13,147 -15% 13


% Staff with Annual Leave > 2 years 12.20% 10.6% 5.0% -5.6% 14

ARHOP 8.3% 6.1% 5.0% -1.1%

MACS 12.4% 9.3% 5.0% -4.3%

SACS 12.8% 12.8% 5.0% -7.8%

Mental Health 9.1% 7.7% 5.0% -2.7%

KFWH 16.2% 15.6% 5.0% -10.6%

% Staff Turnover 1.0% 0.9% 2.0% 1.1% 9.1% 10.0% 0.9% 15

% Sick Leave 2.9% 3.1% 3.0% -0.1% 3.1% 3.0% -0.1% 16

Workplace Injury Per 1,000,000 hours 8.99 6.89 13.2% 10.5% -2.7% 17

Mandatory Training Completed < 3 months U/D 18

QUARTERLY REPORTING Q1 2014 Var

Workforce Diversity - Leader data January 2014 workforce population 19

Maori 5.2% 16% 11%

Pacific 9.5% 23% 14%

Asian 26.3% 22% -4%

Other 59.0% 38% -21%

IMPROVED QUALITY, SAFETY AND EXPERIENCE OF CARE

NB data reported from February 14 to align with patient safety report Mar-13 Mar-14 Target Var Actual Target Var

% e-medication reconciliation -high risk patients within 48hrs admission 7.0% 57.2% 20

% Serious Pressure Injuries Per 100 Patients 0.0% 0.0% 3.5% 3.5% < 3.5% 21

Falls causing major harm per 1,000 bed days 0.13 0.08 0.00 -0.08 22

Rate of adverse drugs events per 1,000 bed days 51.3 22.22 23

CLAB rate per 1,000 line days 0.0 5.36 0.0 -5.36 0.00 24

Rate of S. aureus bacteraemia per 1000 bed days 0.088 0.084 0.0 -0.08 0.00 25

% Operations - all 3 parts of the Surgical Safety Checklist used (quarterly audit)- HQSC

QSM n/a 93.0% 95.0% 2.0% 93.0% 95.0% 2.0% 26

QUARTERLY REPORTING Q1 2013 Q1 2014 Target Var 2013 Target Var

% patients 75+ assessed for the risk of falling 98.0% 96.0% 90.0% 6.0% 98.0% 90.0% 8.0% 27

% patients assessed for falls who have falls intervention plans 85.0% 84.0% U/D 9.0% 27a

Year to date

Month

Month Year to date

Year to date

Month

En

ab

lin

g H

igh

Pe

rfo

rmin

g P

eo

ple

YearFirs

t, D

o N

o H

arm

(S

afe

ty)

Quarter

En

suri

ng

Fin

an

cia

l S

ust

ain

ab

ilit

y


7 May 2014

28


SCORECARD

March 2014


ED 6 hour target - National Health Target 96% 94.4% 95% -0.6% 95.4% 95% 0.4% 28

Seen By inpatient team < 3 hours 54% 49% 53% 29

% patients receive care within 4 weeks – Radiotherapy -National Health Target 100% 100% 100% 0.0% 100% 100% 0.0% 30

% patients receive care within 4 weeks – Chemotherapy - National Health Target 100% 100% 100% 0.0% 100% 100% 0.0% 31

Medical Assessment Unit - seen by SMO within 4 hours U/D 32

% MRI scans completed within 6 weeks from acceptance of referral - MOH IDP 69% 77% 75% 2.7% 75% -100.0% 33

% CT scans completed within 6 weeks from acceptance of referral - MOH IDP 91% 73% 85% -14.1% 85% -100.0% 34

Inpatient radiology times < 24hours U/D 35

EC radiology times < 2 hours U/D 36

% diagnostic colonoscopy patients receive procedure within 14 days - MOH IDP 40% 67.3% 50% 17.3% 50.0% 37

% diagnostic colonscopy patients receive procedure within 42 days - MOH IDP 26% 25.4% 50% -24.6% 50.0% 38

% surveillance colonscopy patients receive procedure within 84 days - MOH IDP 97.0% 98.1% 50.0% 48.1% 50.0% 39

Test turnaround time (TAT) - Labs U/D 40

Time to PCI for STEMI within 90 mins - Northern Region Target 97.0% 95.0% 80.0% 15.0% 80.0% -80.0% 41

Number of patients waiting > 5 months for their FSA - Elective - MOH ESPI 117 2 0 -2 25 0 -25 42

Number patients waiting > 5 months for inpatient treatment - Elective - MOH ESPI 49 6 0 -6 26 0 -26 43

Acute Priority Score delay for surgery 88% 79% 80% -1.0% 79% 80% -1% 44

QUARTERLY REPORTING Q1 Q2 Target Var Actual Target Var

Faster Cancer Treatment - % patients with a high suspicion of cancer receive first cancer

treatment within 62 days 51.4% 58.8% U/D 53.8% U/D 45

Faster Cancer Treatment % patients with a confirmed diagnosis of cancer receive first

cancer treatment within 31 days of decision to treat 76.4% 80.1% U/D 78.0% U/D 46

% Radiology results reported within 24 hours 54.0% 66.0% 75.0% -12.0% 59.9% 75.0% -20% 47


% children and youth (0-19) seen by 3 weeks for non-urgent mental health services – DHB

Mental Health teams - MOH IDP 75.0% -75.0% 75.0% -75.0% 48

Access rate - No. of CMDHB domiciled unique clients seen by MH services in the

preceding 12 months as a % of population (0-19 Years) n/a 3.06% 3.07% -0.0% 3.07% -3.1% 49a


preceding 12 months as a % of population (20-64 Years) n/a 3.76% 3.07% 0.7% 3.07% -3.1% 49b


preceding 12 months as a % of population (65+ population) n/a 2.57% 2.80% -0.2% 2.8% -2.8% 49c

ALOS - Acute Inpatient - MOH IDP 2.78 2.81 4.31 0.3 2.94 4.31 -32% 50

ALOS - Acute Arranged and Elective Surgery - MOH IDP 1.51 1.44 3.21 0.6 1.52 3.21 -53% 51

Acute Readmissions within 7 days - Total 2.7% 3.1% 3% 52

Acute Readmissions within 28 days - Total - MOH IDP 6.7% 5.9% 5% -0.9% 7.1% 5% -2.1% 53

Acute Readmissions within 28 days - 75+ - MOH IDP 10.3% 8.0% 11.80% 3.8% 11.2% 11.80% -5% 54

EC admissions - 75+ year olds 850 815 55

% transcribed clinical summaries authorised within 7 days of creation U/D 56

% patients with EDD/CSD within 24 hours of admission U/D 57

% of patient outliers - not on home ward 1.1% 1.1% U/D 1.9% 58

QUARTERLY REPORTING Q1 Q2 Target Var Actual Target Var

% eligible stroke patients thrombolysed 8.2% 6.5% 6.0% 0.5% 7.3% 6.0% 1.3% 59

ASH rates 0-4years - Total - MOH IDP 104% 84% -20% 60

ASH rates 0-4years - Maaori - MOH IDP 125% 84% -41%

ASH rates 0-4 years - Pacific - MOH IDP 138% 84% -54%

ASH rates 0-74 years - Total - MOH IDP 120% 116% -4% 60a

ASH rates 0-74 years- Maaori - MOH IDP 211% 116% -95%

ASH rates 0-74 years- Pacific - MOH IDP 186% 116% -70%

Sy

ste

m I

nte

gra

tio

n (

Eff

ect

ive

)

Month Year to date

Tim

ely

Year

Month

Quarter

Year to date

Quarter Year


7 May 2014

29


SCORECARD

March 2014


FSA/ FUP ratio 30% 29% 31% 2% 31% 31% 0% 61

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

Outpatient DNA rates - Pacific 9% 9% 10% 1% 10% 10% 0% 62a

Theatre List Utilisation 89% 85% 85% 0% 89% 88% 1% 63

Theatre Session Utilisation U/D 85% 64

Day of Surgery Admissions (DOSA) 88% 92% 90% 2% 91% 90% 1% 65

Day Case Rate (Elective/ Arranged) 60.2% 60.0% 65% -5% 63.2% 65% -2% 66

% patients discharged to transit lounge or home by 1100hrs 14% 14% 30% -16% 15% 30% -15% 67

% MAU patients with LOS < 28 hours 87% 93% 65% -28% 90% 65% -25% 68

% community NASC referrals managed via e-referrals and assessed within 48 hours U/D 69

% patients discharged with District Nursing home help within 24 hours U/D 70

% of FSA referrals received electronically U/D 71

Nursing Hours Per Patient Day U/D 72

Hospital beds occupied 22,897 23,889 22,073 -8% 207,228 183,339 13% 73

no.LOS outliers (LOS >10 days) 235 252 U/D 7% 2,336 2,409 -3% 74


Patient Experience Survey (to be reported from August 2014) 75

Better Health Outcomes For All


% Infants Exclusively Breastfed At Discharge from Hospital - Total 77% >75% 2% >75% 76

% Infants Exclusively Breastfed At Discharge from Hospital - Maaori 78% >75% 3% >75%

% Infants Exclusively Breastfed At Discharge from Hospital - Pacific 73% >75% -2% >75%

% of hospitalised smokers receiving smokefree advice -Total National Health Target 97% 96% >95% 1% 96% >95% 1% 77

% of hospitalised smokers receiving smokefree advice - Maaori 97% 95% >95% 0 95% >95% 0

% of hospitalised smokers receiving smokefree advice - Pacific 95% 96% >95% 1% 96% >95% 1%

Eff

icie

nt

Pa

tie

nt

Wh

aa

na

u

Ce

ntr

ed

Ca

reE

qu

ity

Month

Year

Year

Month

Month

Year


7 May 2014

30

2.1 Elective Wait Time target trends (150 days and 120 days) – to March 2014

Report Run Date: 14/04/2014 - data subject to chang e

Patients given a commitment to treatment but not tr eated within FOUR months.

2013 07 2013 08 2013 09 2013 10 2013 11 2013 12 2014 01 2014 02 2014 03225 202 218 222 157 294 350 356 284

107 162 191 209 157 195 263 240 305

155 186 124 103 114 109 119 153 206

163 175 217 193 162 209 296 241 358

2,256 2,222 2,399 2,344 2,034 2,662 3,625 3,202 3,270

Patients given a commitment to treatment but not tr eated within FIVE months.

2013 07 2013 08 2013 09 2013 10 2013 11 2013 12 2014 01 2014 02 2014 03

14 28 29 35 30 37 54 57 320 1 2 1 4 2 5 5 6 March Orthopaedics and Plastics

14 28 4 9 6 8 7 10 48

23 24 24 22 20 27 24 22 48351 379 248 319 282 351 681 628 393

Patients waiting longer than FOUR months for their first specialist assessment (FSA).

2013 07 2013 08 2013 09 2013 10 2013 11 2013 12 2014 01 2014 02 2014 03559 470 449 431 521 575 737 558

211 173 177 348 276 240 391 283 339

171 242 262 267 269 327 491 373 386

763 902 1,009 1,222 958 1,204 1,242 1,111 8315,045 5,093 5,143 5,705 5,068 6,032 7,494 6,261 2,683

Patients waiting longer than FIVE months for their first specialist assessment (FSA).

2013 07 2013 08 2013 09 2013 10 2013 11 2013 12 2014 01 2014 02 2014 0324 15 21 12 15 85 53 30

0 0 0 2 0 0 19 2 2 March Plastics12 9 12 6 12 8 32 9 9

14 29 15 0 0 24 87 11 18518 475 460 326 242 570 792 375 57

Number of patients waiting more than four, five mon ths for Treatment or an FSA

National Total:

Auckland

NorthlandWaitemata

Counties Manukau

Waitemata

Counties Manukau

National Total:

Auckland

Northland

National Total:

Auckland

NorthlandWaitemata

Counties Manukau

AucklandCounties ManukauNorthlandWaitemata

National Total:

Regional ESPI - Treatment over 120 Days

0

500

1,000

1,500

2013 07

2013 08

2013 09

2013 10

2013 11

2013 12

2014 01

2014 02

2014 03

Auckland

CountiesManukau

Northland

Waitemata

Regional ESPI - Treatment over 150 Days

0

50

100

150

200

2013 07

2013 08

2013 09

2013 10

2013 11

2013 12

2014 01

2014 02

2014 03

Auckland

CountiesManukau

Northland

Waitemata

Regional ESPI - FSA over 120 Days

0

500

1,000

1,500

2013 07

2013 08

2013 09

2013 10

2013 11

2013

12

2014

01

2014 02

2014 03

Auckland

CountiesManukau

Northland

Waitemata

Regional ESPI - FSA over 150 Days

0

50

100

150

200

2013 07

2013 08

2013

09

2013 10

2013 11

2013 12

2014 01

2014 02

2014

03

Auckland

CountiesManukau

Northland

Waitemata


7 May 2014

31

3 FINANCIAL SUMMARY Best value for public health system resources –

Month Ended: March-14

Division: Provider Arm

Actual Budget Var Var % Actual Budget Var Var %

REVENUE

3,995 4,081 (86) (2)% Government Revenue 35,184 36,377 (1,192) (3)%

1,006 755 251 33% Patient/Consumer Sourced 8,238 6,644 1,594 24%

2,213 1,754 460 26% Other Income 15,969 15,415 554 4%

58,702 58,440 262 0% Funder Payments 529,441 525,269 4,172 1%

65,916 65,029 888 1% Total Revenue 588,833 583,706 5,127 1%

EXPENDITURE

43,635 43,236 (400) (1)% Staff Costs 384,776 386,431 1,655 0%

5,141 4,453 (689) (15)% Outsourced Costs 48,149 41,232 (6,917) (17)%

9,150 9,097 (53) (1)% Clinical Costs 80,137 78,733 (1,404) (2)%

8,528 8,794 266 3% Infrastructure Costs 76,174 78,143 1,969 3%

(1) (0.3) 0 103% Internal Allocations (53) (2) 51 2,262%

66,454 65,579 (874) (1)% Total Expenditure 589,183 584,537 (4,646) (1)%

(537) (551) 14 2% Net Result (350) (832) 481 58%

5,795 5,622 (173) (3)% FTE 5,634 5,535 (99) (2)%

** April: Unpaid days accrual for Easter period, increased activity and outsourcing to meet 5 mnth waiting time target

**May13: Increased activity to meet 5mnth waiting time target

CMDHB Provider

Month to Date Year to Date

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

Monthly Net Result

-5,000

-4,000

-3,000

-2,000

-1,000

-

1,000

2,000

3,000

4,000

Mar-13Apr-13

May-13Jun-13

Jul-13Aug-13

Sep-13Oct-13

Nov-13Dec-13

Jan-14Feb-14

Mar-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget

Monthly Operating Costs

18,000

19,000

20,000

21,000

22,000

23,000

24,000

Mar

-13

Apr-1

3

May-1

3

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

Jan-

14

Feb-1

4

Mar

-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget

Monthly Staff Costs

38,000

39,000

40,000

41,000

42,000

43,000

44,000

45,000

46,000

Mar-1

3

Apr-1

3

May

-13

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

Jan-

14

Feb-1

4

Mar-1

4

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


7 May 2014

32

Mar-14 YTD

Total Variance: $14 $481

Revenue: $888 $5,127

Salaries & Wages: $(400) $1,655

Outsourced: $(689) $(6,917)

Clinical Supplies: $(53) $(1,404)

Infra-Structure: $266 $1,969

Internal Allocations: $0 $51

Outsourced Costs are $(689)k unfavourable, represented by:

Non-Clinical

- HBL phased increased cost for FPSC project $(31)k.

- hA increased costs have not been fully recognised in the budget phase $(165)k.

- Pacific Health $(109)k offset by revenue

Clinical

- Private procedures increased volumes continue in Surgical Services to maintain the ESPI (Elective Service Performance Indicator) targets $(377)k.

Other Expenses are $266k favourable for March. An increase in non-resident billings has increased the bad debt provision resulting in an unfavourable variance of

$(370)k.

Savings achieved across the services for the month are:

- Patient meals $79k

- Laundry, Bedding and Linen $125k

- Mobile phones $94k

- Corporate training $147k

Depreciation, Interest and Capital Charge costs are $141k favourable due to;

- Buildings & Plant Depreciation variance due to phasing $(108)k

- Other equipment depreciation charge increase $(32)k

- The level of borrowings is lower than budgeted. This combined with the capitalisation of the CSB project has delivered a $423k favourable interest cost variance for

the month

- Capital Charge unfavourable variance of $(125)k reflects the actual cost of capital charged by MoH.

Year end Forecast variance to Budget

Financial Commentary - Provider Arm

Management Administration costs are $(446)k unfavourable for the month. A low level of annual leave has been taken during the month in anticipation of the

Easter/School holidays in April; this is reflected as a higher accrual during March versus annual leave taken. This is expected to be offset by leave planned for April.

Ko Awatea are $(142)k unfavourable due to an AUT $(60)k contract cost miscoded plus management and admin staff funded from other areas of kA business $(40)k.

Support costs are $(220)k unfavourable for the month. A high usage of in-house casual pool staff was evident in March for cleaners, orderlies and security, to cover

the high incidence of annual leave, sick leave and vacancies $(125)k. An increased demand of interpreter services across the hospital services has seen an increased

cost against budget of $(93)k for the month. The trend is expected to continue for the balance of the year.

$372

Clinical Supplies are $(53)k unfavourable for the month, explained as follows:

- Ambulance Services $(141)k – There has been a delay in charges being processed through the system for payment – invoices were bought up to date in March

resulting in a large unfavourable variance for the month. Variance YTD $(172)k reflects an increase in costs year on year. A detailed analysis of usage indicating the

drivers of the increase has been requested.

- Surgical & Ambulatory $214k – 60% consumption of stock piled inventory and reduced elective ACC and Tahitian burns cases has contributed to lower usage of

clinical supplies.

- Clinical Support - $(113)k overspend on organisational wide demand for drugs. This will be recovered through internal sources.

CMDHB Provider

Medical Personnel Costs are $546k favourable due to existing vacancies within the organisation, partially offset by outsourced costs.

Nursing Personnel Costs are $(74)k. Course fees have been accrued for the month to reflect the actual expected year to date spend of $(223)k, compensating for the

delayed claims for study fees in February.

Allied Health Personnel Costs are $(205)k adverse for the month (YTD $650k). Clinical support volumes in pharmacy, radiology and laboratory were affected by cost

increases due to:

- Pharmacy $(45)k – unbudgeted positions for 20k bed days 6.7fte, offset by funding.

- Radiology $(53)k – additional SMO sessions and film reads to address volume growth

- Laboratory $(37)k – overtime and penal rates due to increased volumes as a result of dialysis patient profiling in March.

- MRT $(30)k, weekend overtime ultrasound sessions to address the waiting list.

- Physiotherapists $(40)k – overtime and professional membership costs provided for March.

Revenue is $888k favourable for the month of March ($5.1m YTD). The main drivers for the current month’s variance are:

- Non-residents income is $456k favourable against budget reflecting YTD trend ($2.3m) and the additional hA resource assigned to this area. This is partially offset

by doubtful debts $(370)k.

- Miscellaneous recoveries favourable $377k ($1.8m YTD) – revenue for additional projects across the services, offset by related cost of the project.

- ACC $164k ($225k YTD) - despite the reduction of elective ACC cases (due to prioritisation of MoH patients for ESPI wait time targets) during the month, the ACC

team have implemented review processes to capture unidentified ACC cases. Under the new audit programme, 20 cases were identified.

- CTA $154k ($(348)k YTD) recognises a YTD revenue catch-up during March. CTA YTD reflects the contract variation being less than budget.

- Disability Support Contract $(208)k ($(3)k YTD) recognises a YTD revenue correction.

The Provider Arm produced $14k favourable variance for the month, thus still maintaining a favourable year to date variance of $481k due to the capitalisation of

CSB interest.

WIES volumes: MTD are 1.8% above contract for the month. This volume is driven by Acute being up on contract by 1.3% and electives up by 3.31% (Actual

6,392wies, contract 6,277wies)

WIES volumes: YTD are 2.3% up on contract, with Acute up 3.4% and Electives down <1% (Actual 57,945wies, contract 56,396wies)


7 May 2014

33

Mar-14

Key: Trend Arrows;

Shows improvement Shows deterioration Shows no change from previous month

Target Achieved (A), Target Not Achieved (NA)

Balancing Excellence and Sustainability

��

��

Financial "Best Value" Service Result Target Variance Comment & Action Plan

Operating ExpensesProvider 22,818 22,344 (475)

Surgical & Ambulatory 5,017 4,912 (106)

Medicine 2,591 2,546 (44)

Acute Care 429 452 22

Clinical Support 1,919 1,910 (9)

Women's Health 398 393 (5)

Kidz First 154 260 106

ARHOP 980 1,028 48

Mental Health 416 321 (94)

Facilities 1,940 2,080 140

Middlemore Central 21 40 19

Ko Awatea 359 561 202

Non-Clinical 8,594 7,840 (754)

Personnel CostsProvider 43,635 43,236 (400)

Surgical & Ambulatory 11,980 12,756 775

Medicine 5,796 5,533 (263)

Acute Care 2,205 2,257 52

Clinical Support 4,531 4,231 (300)

Women's Health 2,635 2,588 (47)

Kidz First 2,603 2,427 (176)

ARHOP 3,808 3,870 62

Mental Health 5,207 5,367 160

Facilities 1,791 1,643 (148)

Middlemore Central 317 314 (4)

Ko Awatea 1,010 965 (45)

Non-Clinical 1,749 1,284 (466)

��

��

NA

NA

Reduction in course costs and consultants fees for the month.

Hotel Services Supervisors $22k f included 3 FTEs vacancies in Non Clinical Support to be replaced not yet

filled; Cleaners $69k u and Orderlies $83k u due to additional cleaning and orderly service requests (eg,

additional 4.2 FTEs orderly in ALBU), high usage of in-house casual pool staff (56.51 FTEs - 14.3% of cleaners

and 33.3% of orderlies rostered hours) covering vacancies (including 12 FTEs cleaning and 10.2 FTEs orderly

CSB increase), annual leave and sick leave taken; Security Officers $3k f due to 4 FTEs vacancies (2

replacement and 2 CSB increase) to be filled.

Course fees in DON are fav $124k for the month due to a delay in claims being made in February. Integrated

care are carrying high vacancies particularly in HR fav +$169k. Gratuities and long service leave has an

increased provision based on previous years actual calculation by AON $(30)k.

Summary YTD: Gratuities and long service leave provisioning $(478)k, DON personnel +$60)k, Integrated Care

Vacancies $1m.

Outsourced $16k (F), Clinical Supplies $23k (F), Infra-structure supplies $15k (F) partly off-set by internal

transfer-chargeS $5k (A)

Outsourced Medical staffing overspent $129k (locum cover for SMO vacancies) partly set off by the

underspend in vehicle related expenses ($6k) and in deferred maintenance ($8k)

Maintenance of FTE vacancies to offset lower revenue.

The main reason for the underspend in the month is the savings in nursing costs due to the closure of Ward

24 ($87k). Medical Staffing is under budget ($8k) mainly due to RMOs seniorty level being less than

budgeted. Overspend in Home Health care nursing ($16k)

Underspend in Salaries; Medical $134k, Allied Health $12k and Admn $12k. Medical Staffing salaries

underspend is off-set by locum medical costs ($129k) included in operating expenses under outsourced

services

Main variance drivers in operating expenses are hA and HBL cost variation to contract $(196)k, increase in

bad debts (directly attributable to the increase of Non-Resident billings) $(370)k, Capital charge $(125)k and

interest expense due to capitalisation of interest for the CSB building $423k

Operating expenses are influenced by the increased volumes in the larger services for March.

The personnel cost variance reflects SMO vacancies offset by a low level of annual leave taken during the

month resulting in a high annual leave accrual.

Medical costs are favourable due to vacancies in SMO/RMO positions as well as the impact of the mix of

Registrars and House Officers on rotation . Nursing is favourable due to existing vacancies currently being

filled.

$130k u - unbudgeted funded positions offset by revenue

$25k u - unbudgeted RMO overallocation - 3fte

$20k u - Renal night shifts

$50k u - high RMO WRE charges

$38k u - miscellaneous

Medical -($5K UnFav) - Junior doctor annual leave transfers.

Nursing/Midwifery- ($9K fav) mostly due to vacancies despite high level of sick leave, education leave,

orientations and ACC leave in March 2014.

Allied Heatlh - ($11K unfav) offset against additional revenue.

Clerical ($40K unfav) - increased # of MW clinics in addition to data cleasing to prepare for MCIS

implementation.

Outsourcing costs continue to be the major contributor of the adverse variance in March (subcontracting

CMDHB patients to private providers). A level of outsourcing is required balance of year to meet ESPI targets.

Miscellaneous overspends for drugs & infrasture

$26k f - Medical staff - $20k f due to timing of WRE claims.

$12k f - nursing - misc savings

$14k f - ward clerk vacancies in EC

$37k u - Pharmacy - 6.7fte unbudgeted - 20k bed days. Offset by funding.

$53k u - Rad SMO additional sessions and film reads to address the volume growth.

$30k u - MRT overtime & penals for weekend ultrasound sessions to address the waiting list.

Currently waitlist 10 wks vs target 6 wks.

$37k u - Lab over time & penal due to March Dialysis patient profiling.

$117k u - annual leave accrued higher than taken. Expect high annual leave taken during Easter & school

holidays in April.

$26k u - misc

Internal allocations and revenues offset additional costs

Medical -$(53)K Unfav - additional costs for various projects (not budgeted) are offset against additional

revenues; junior doctor annual leave transfers have had an unfav impact.

Nursing/Midwifery- $(94)K unfav - additional costs for various projects (not budgeted) are offset against

additional revenues. High sick leave, education leave, orientations and ACC leave have had a negative impact,

as well as the NICU move to the Harley Gray Building in Feb 2014.

Allied Health - $(4)K unfav additional costs for various projects (not budgeted) are offset against additional

revenues

Clerical $(24)K unfav - additional costs for various projects (not budgeted) are offset against additional

revenues

Including Patient Meals Outsourced $81k f; Cleaning Supplies $12k f; Non Medical Waste Removal $17k u;

Security Services R&M in Engineering $16k u; R&M (account 5151 - 5159) $26k f; Utilities Water $15k f; MV

Fuel $12k f varies month to month. Balance offsets overspend in employer costs.


7 May 2014

34

Mar-14

Key: Trend Arrows;

Shows improvement Shows deterioration Shows no change from previous month

Target Achieved (A), Target Not Achieved (NA)

Balancing Excellence and Sustainability

��

��

FTE's

Provider 5,795 5,622 (173)

Surgical & Ambulatory 1,403 1,397 (6)

Medicine 694 640 (54)

Acute Care 294 276 (18)

Clincal Support 588 574 (14)

Women's Health 354 335 (19)

Kidz First 363 318 (44)

ARHOP 638 624 (14)

Mental Health 670 674 4

Facilities 436 421 (15)

Middlemore Central 48 49 1

Ko Awatea 121 119 (2)

Non-Clinical 186 195 10

Maintenance of FTE vacancies to offset lower revenue

NA��

Cleaners 10.1 FTEs u and Orderlies 13.36 FTEs u due to additional cleaning and orderly service requests (eg,

additional 4.2 FTEs orderly in ALBU), high usage of in-house casual pool staff (56.51 FTEs - 14.3% of cleaners

and 33.3% of orderlies rostered hours) covering vacancies (including 12 FTEs cleaning and 10.2 FTEs orderly

CSB increase), annual leave and sick leave taken, annual leave accrued (14.78 FTEs for Cleaners and 8.43 FTEs

for Orderlies); Security Officers 1.3 FTEs f due to 4 FTEs vacancies (2 replacement and 2 CSB increase) to be

filled; Hotel Services Supervisors 3 FTEs vacancies in Non Clinical Support to be replaced not yet filled;

Engineering 4 FTEs vacancies (1 replacement and 3 CSB increase) to be filled; and Facilities Projects 2 FTEs

vacancies to be replaced not yet filled.

Favourable variance in FTE reflects existing vacancies in the non-clincal services.

The personnel cost variance mainly reflects a low level of annual leave taken during the month resulting in

a high annual leave FTE accrual.

Mainly due to casual Interpreter staff over budget (2FTE) and positions in other services where costs have

been transferred but the FTE remain in our service (4FTE).

Medical Staffing shows a vacancy rate of 5.1 FTE which is covered by locums.

6.7 u - Pharmacy unbudgeted - 20k bed days. Offset by funding

13 u - annual leave accrued higher than taken. Expect high annual leave taken during Easter and school

holidays in April.

5.7 f - Misc vacancies across the services

Medical - 3.46 FTE (unfav) from Junior doctor rotation and higher AL accrual FTEs than AL taken FTEs.

Nurse/Midwifery - 37.46 FTE (unFav) - 12 FTE offset against additional revenues, sick 8.01, Study 6.43,

orientation 1.96, ACC 0.67, OT 1.57, Specials/Watch 7.89,

Allied Health - 6.16 (unfav) offset against additional revenues

Clerical - 1.77 (unfav) - 1.5 offset against additional revenues.

20.1 u - unbudgeted funded positions offset by revenue

3.0 u - RMO overallocation

4.1 u - additional nursing for Renal night shifts

27.2 u - includes annual leave taken lower than accrued

- requires further investigation

Medical - 3 FTE (unfav) from junior doctor rotation and 1.7 FTE over-apointment of Jr Doc

Nurse/Midwifery - 8.49 fTE (unfav), sick 6.91, Study 6.71, orientation 4.95, ACC 0.85, OT 3.62, Specials/Watch

0.35,

Allied Health - 1.73 (unfav) offset against additional revenues

Clerical - 6.05 (unfav) - 5.5 FTE for additional Midwifery clinics and readiness for MCIS implementation.

Nursing FTEs - Mainly higher acuity in Wd 4 (3.8 FTEs), Wd 5 (3.7 FTEs), Wd 23 (6.6 FTES), HHC Community

(3.2 FTEs) and conversion of 10 Long stay Beds to AT&R in Puke (6.5 FTEs) off-set by the favourable variance in

Wd 24 (13.9 FTEs). Of the 14.1 FTEs over budget due to high acuity in Wds 23, 4 and 5, 10.1 FTEs are HCAs.

4.2 u - Medical - 1.1fte u - $'s tranf to ICU, 3.1fte u mostly due to low annual leave taken in March. Expect

high annual leave during Easter/school holidays in April.

14.2 u - Nursing - 6.3fte u low annual leave taken in March, 7.9fte over recruitment in preparation for the

early opening of MAU.

0.5 f - Admin vacancies


7 May 2014

35

3.1 Detailed FTE Analysis

Mar-14Personnel Comment

Provider Funder

MEDICAL PERSONNEL Mar-14 Mar-14

Net Annual Leave (accrued - taken) (12.09) 0.00

Stat days in lieu (1.13) 0.00

Unpaid days accrual 0.00 0.00

Funded FTE (12.72) 0.00

Vacancies 27.12 0.00

Transfers in and out (2.18) 0.00

Overtime/Bureau/Casuals (0.60) 0.00

Other (provide detail) 6.45 (0.12)

TOTAL MEDICAL PERSONNEL 4.86 (0.12)

NURSING PERSONNEL


Stat days in lieu 0.00 0.00


Funded FTE (32.04) 0.00


Transfers in and out (0.70) 0.00


Other (provide detail) 12.95 (0.28)

TOTAL NURSING PERSONNEL (136.81) (0.28)

ALLIED HEALTH PERSONNEL




Funded FTE (20.65) 0.00


Transfers in and out 0.00 0.00


Other (provide detail) 10.97 0.95

TOTAL ALLIED HEALTH PERSONNEL (13.98) 0.95

SUPPORT PERSONNEL




Funded FTE 0.00 0.00

Vacancies 9.00 0.00



Other (provide detail) (9.49) 0.00

TOTAL SUPPORT PERSONNEL (27.41) 0.00

MANAGEMENT/ADMIN PERSONNEL




Funded FTE (16.50) 0.00




Other (provide detail) (0.21) 1.06

TOTAL MANAGEMENT/ADMIN PERSONNEL 0.19 1.06

TOTAL VARIANCE (PER FFARS) (173.16) 1.61

Summary


Result of accrued leave exceeding leave taken, School holidays , Easter &

ANZAC in April. This represents a challenge re smoothing of AL.

Stat days in lieu (1.06) 0.00 Adjustment from February - Waitangi Day

Unpaid days accrual 0.00 0.00 Refer other (below)

Funded FTE (81.91) 0.00 Positions employed for specific projects outside BAU

Vacancies 151.94 0.00 MH 51.1, SACS 42.1 - vacancies carried across the services

Transfers in and out (2.40) 0.00 Should eliminate on consol

Overtime/Bureau/Casuals (73.03) 0.00 Mainly nursing cover during the month - under investigation

Other (provide detail) 20.66 1.61

Further analysis required re unpaid days accrual. Includes ARHOP 13.9 Partial

closure of ward 24, part offset by early opening of MAU 7.2.

TOTAL MANAGEMENT/ADMIN PERSONNEL (173.16) 1.61

FTE Variance

Detailed FTE ReconciliationWORK IN PROGRESS


7 May 2014

36

4 Surgery and Ambulatory Care

4.1 SERVICE PERFORMANCE

4.1.1 National Health targets

Elective Access

Target Elective Discharges = 15,635

(N.B. Includes DHB of domicile)

Elective Service Performance

Indicators (ESPI Targets) - 2 & 5

Target- 0 patients waiting>150 days

for FSA or Treatment

Elective Discharge Volume

WIES result – 102.5%

YTD discharge result –112.5%

ESPI

ESPI 2: FSA = 2 (plastics)

ESPI 5: Treatment = 5 (plastics/ orthopaedics)

4.1.2 Activity summary – at 14.04.14

Surgical volumes (WIES)

Volumes MAR'14 Year to date

Actual Contract Variance % Actual Contract Variance %

ACUTES

- Adults 1866 1714 152 8.89% 15933 15147 785 5.19%

- Children 181 186 (-5) (-2.95%) 1559 1645 (-86) (-5.21%)

Total 2047 1900 147 7.73% 17492 16792 700 4.17%

ELECTIVES

- Adults 1321 1249 72 5.77% 10901 10377 524 5.05%

- Children 67 95 (-28) (-29.60%) 716 785 (-69) (-8.85%)

Total 1388 1344 44 3.27% 11617 11162 454 4.07%

TOTALS

Adults 3187 2963 224 7.58% 26834 25525 1,309 5.13%

Children 247 281 (-34) (-11.96%) 2275 2430 (-155) (-6.38%)

TOTAL 3435 3244 191 5.88% 29108 27954 1,154 4.13%

Inpatient summary (WIES) The month and YTD activity is shown in the table above. In summary:

• Acutes: 7.73 % in excess of contract for month 4.17 % above contract YTD

• Electives: 3.27 % higher than contract for the month and 4.07% higher than contract YTD

NOTE: Elective base contract for the month excludes Gynae but includes additional elective work.

Adjustments made for uncoded hip and knee patients operated and discharged during the month

but no adjustment has been made for Waiting list patients completed on Acute Arranged lists.

Outpatient Summary (Visits First and follow up) for the month

MAR'14 Year to date

Actual Contract Variance % Actual Contract Variance %

FSA's 3,199 2,733 466 17.05% 27,680 23,095 4,585 19.85%

Follow ups 6,735 6,152 583 9.48% 57,546 53,989 3,557 6.59%

TOTAL 9,934 8,885 1,049 11.81% 85,226 77,084 8,142 10.56%


7 May 2014

37

4.2 FINANCIAL: Best value for public health system resources


Division: Surgical & Ambulatory


REVENUE

407 616 (209) (34)% Government Revenue 4,584 5,146 (561) (11)%

(3) 200 (203) (102)% Patient/Consumer Sourced 1,006 1,650 (644) (39)%

109 328 (219) (67)% Other Income 2,019 2,494 (475) (19)%

938 991 (53) (5)% Funder Payments 9,046 8,230 816 10%

1,451 2,134 (684) (32)% Total Revenue 16,655 17,520 (865) (5)%

EXPENDITURE

11,980 12,756 775 6% Staff Costs 103,378 106,969 3,590 3%

644 378 (266) (70)% Outsourced Costs 7,551 4,803 (2,747) (57)%

3,121 3,335 214 6% Clinical Costs 27,686 27,590 (96) (0)%

575 571 (4) (1)% Infrastructure Costs 4,719 4,955 236 5%

677 627 (49) 8% Internal Allocations 5,606 5,261 (345) 7%

16,998 17,667 670 4% Total Expenditure 148,939 149,578 638 0%

(15,547) (15,533) (14) (0)% Net Result (132,284) (132,058) (226) (0)%

1,403 1,397 (6) (0)% FTE 1,355 1,316 (38) (3)%

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

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

CMDHB Provider


Monthly Net Result

-18,000

-16,000

-14,000

-12,000

-10,000

-8,000

-6,000

-4,000

-2,000

-

Mar-13Apr-13

May-13Jun-13

Jul-13Aug-13

Sep-13Oct-13

Nov-13Dec-13

Jan-14Feb-14

Mar-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Mar

-13

Apr-1

3

May

-13

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

Jan-

14

Feb-1

4

Mar

-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget

Monthly Staff Costs

9,500

10,000

10,500

11,000

11,500

12,000

12,500

13,000

Mar

-13

Apr-1

3

May-1

3

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

Jan-

14

Feb-

14

Mar

-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


7 May 2014

38

Mar-14 YTD

Total Variance: $(14) $(226)

Revenue: $(684) $(865)

Salaries & Wages: $775 $3,590

Outsourced: $(266) $(2,747)

Clinical Supplies: $214 $(96)

Infra-Structure/Internal Allocations: $(54) $(109)

CMDHB Provider

Government Revenue: Elective ACC Revenue was $(208)k unfavourable for the month ($(574k) YTD). The month's revenue has been adversely affected by the continued need

to prioritise MoH patients to enable acute wait times and ESPI wait times to be met.

Patient/Consumer Sourced: Private patients $(203)k adverse for the month, $(673)k YTD. The main reason for this variance is that we have had no acute Tahitian burns patients

during this summer. This variance will continue to grow if we do not receive any Private Patients this financial year.

Other Income $(219)k unfav for the month and $(498)k unfav year to date. This is due to a timing issue relating to revenue receiveable on the Delivery Redesign of Elective

Services (DRES) project which will be invoiced for by 30th June 2014.

Funder Payments: There is also a further $(52)K unfavourable variance on the transfer of Internal Provider Revenue from the funder for Elective work due to phasing.

The Division had an unfavourable variance of $(14)k for the month and $(226)k YTD. Detailed explanation for the months variance is given below.

MoH outputs for the month exceeded contracted WIES by 5.9% or 191 WIES . This was based on 90% coding of patient charts. There was an increase in acutes of 7.7% or 147

WIES coupled with an increase in electives of 3.3% (44 WIES). Year to date we are 700 WIES or 4.17% over contract for acutes while electives are 454 WIES or 4.07% favourable

Financial Commentary - Surgical & Ambulatory

Outsourced costs on subcontracting $(377)k MTD ($(2.33)m YTD) - Outsourcing elective patients has been essential to meet and maintain ESPI (Elective Service Performance

Indicator) targets. This has been compounded by the closure of elective theatres at MSC in order to open the CSB theatres in February. A level of outsourcing is required balance

of year to meet ESPI targets. It is important to view this overrun in conjunction with the favourble variances as a result of vacancies under the Salaried staff as Elective work

needs to be carried out either internally at CMDHB or externally by subcontracting in order to meet Moh targets

Medical $655k MTH ($2.730m YTD) Primarily reflects SMO vacancies ($297k MTD, $1125k YTD). The Registars are also favourable by $130k for the month ($791k YTD). The mix

of Registrars for the run and the leave transfers on rotation have had a favourable affect on the Division.

Nursing $195k MTH ($358k YTD) Correction in March due to adverse impact of unfavourable variance in January together with time lag in filling vacancies.

Allied Health $(18)k MTH ($342k YTD) Months adverse variance due to accrual of stat days for non rostered anaesthetic technicians. Year to date reflects vacancies that have

not been filled either as a result of the lack of skilled staff and the time lag for recruitment. However this has to be viewed in conjunction with the outsourced costs of Allied

Health personnel which amounts to $(79)k adverse.

Support Staff $(93)k MTH ($(187)k YTD) This is due to a provision made for annual leave to Interpreter Staff that converted from IEA to MECA not being credited with correct

annual leave by payroll which was picked up during a routine audit. Also important to note that the Division holds the budget for the entire organisation providing interpreting

services as and when required. The demand on the service has grown rapidly and servicing these demands has resulted in more casual interpreters being recruited to meet

expectation. This variance is set to continue for the year. 2014/15 budget expectation is that demand will reduce to current years budget level.

Management Admin $36k MTH ($346k YTD) This has occurred due to non-filling of vacancies on time and also better management of leave. A budget reduction has been made

in 2014/15 to reflect currect activity.

The variance on Clinical Supplies for the month of $214k favourable is due to use of stockpiled inventory in CSB in January. We have now clawed back 60% of January overspend

based on outputs remaining at normalised levels.While the drop in Elective ACC and Tahitian burns revenue has contributed to the lower clinical supplies usage, Acute workload

is now running at around 5% higher than last financial year. (Clinical services have plans in place to manage elective demand ie: acceptance of patients in line with capacity - the

benefit will be realised from July 2014).

Year end Forecast variance to Budget $0

Overspend for the month mainly due to Pharmacy costs exceeding budget by $61k. Main reasons are the purchase of Botox for kids and Mirena Intrauterine devices. Year

todate overspend on pharmacy costs mainly due to increased outputs (Acute and Elective) set off in part by savings in non clincal costs

Current Year end Forecast is for a breakeven. This is dependant on the capitalisation of costs for the CSB planning phase . A schedule of costs has been prepared and awaiting

confirmation by corporate.

4.3 QUALITY: Goal to improve the quality safety and experience of care

4.3.1 SAFETY First Do No Harm

• CLAB Prevention – Plans are underway to celebrate 12 months with CLAB free in the National

Burns Centre.

• Falls Prevention – There were 28 falls were reported, none with serious harm, 9 resulting in

minor harm (lacerations or soft injuries).

• Pressure Injury Prevention: There were no Severity 3/4 Pressure Injuries.

• Surgical Site Surveillance: CM Health is compliant with the recommendations from the HQSC

but need to closely monitor the timing and documentation of prophylactic antibiotics prior to

knife to skin. Action meetings with Infection Control and Anaesthetics have ensured that

updates to the Anaesthetic Theatre form will assist to increase compliance rates.


7 May 2014

39

• MRO Screening – A renewed focus in surgical wards on screening for MRO with 24hours of

admission has addressed a recent decline.

• Other activity A Combined Surgical/Medical Morbidity and Mortality Meeting occurred 13

March. The Surgical Quality Facilitator co-facilitated Root Cause Analysis Training for 25

participants (including SMO, clinical heads, and Clinical Nurse Directors) on 20 March with

positive feedback received.

• Ventilator Associated Pneumonia (VAP) – Critical Care continues to work on implementation of

the VAP bundle compliance in both clinical documents and observed practice towards a goal of

100%.

4.3.2 TIMELINESS: “Every Hour Counts” if we are to achieve quality and safety outcomes”

• Elective Service Performance Indicators (ESPI Targets) - 2 & 5 ESPI 2 Compliance: Green if 0 patients, Yellow if greater than 0 patients and less than 0.39%, Red if 0.4% or

higher. Penalties are incurred when you have three red combined ESPIs in a row.

× ESPI 2: No patients wait more than 150 days for their First Specialist Assessment (FSA) – Two

Breaches


7 May 2014

40

The Hand Service had two patients breach for FSA. All other services achieved the 150 day target for

FSA assessments. General Surgery, Urology and Gynaecology, along with some of the small medical

services, achieved or maintained the 120 day timeline for FSA.

ESPI 5 Compliance: Green if 0 patients, Yellow if greater than 0 patients and less than 0.99%, Red if 0.4% or

higher. Penalties are incurred when you have three red combined ESPIs in a row.

× ESPI 5: All Patients are treated within 150 days – Five Breaches

At the end of March, five patients breached the 150 day waiting time for Treatment – one in Plastic

and four in Orthopaedics. This will give a sixth consecutive yellow result for Plastic and a second for

Orthopaedics. The Plastic case was a complex two surgeon Cranio-facial case and was booked, but

had to be cancelled at the last minute as both surgeons were required to do urgent two-man facial

free flap surgery on a young patient under acute care.

In Orthopaedics, Elective lists continue to be impacted by or cancelled due to the need to treat acute

patients in a clinically appropriate timeframe. Six acute patients were transferred to elective

operating lists in March with a total of 1250 minutes of acute operating transferred onto elective

lists. This number of minutes would have been sufficient to meet the elective demand and avoid

150 day breaches for March. All other services achieved the 150 day target for treatment.

The concern is that April will be an even more challenging month than March with the impact of

Easter, Anzac Day and the school holidays. The surgical services are working to create sufficient

buffer to manage acute cases without impacting on capacity for elective cases. Regionally, there are

77 cases for FSA and 120 cases for Treatment exceeding the 150 days target.

• SACS Results for target of no patients waiting >120 days for FSA / Treatment by Dec 2014:

Patients

Waiting >120

days

31

-Ju

l

31

-Au

g

30

-Se

p

31

-Oct

30

-No

v

31

-De

c

31

-Ja

n

28

-Fe

b

31

-Ma

r

30

-Ap

r

31

-Ma

y

30

-Ju

n

FSA 152 112 111 251 190 183 348 254 313

For Treatment 201 207 271 322 232 317 369 316 389

Good progress is being made towards achieving wait times less than 120 Days by December 2014, at

the end of March, there are 313 patients waiting 120+ for FSA and 389 patients waiting 120+ days

for treatment – the increase in total treatment numbers is due to the FSA activity in November,

following the October spike in referred cases. There were fewer clinics in February with 19 working

days.

Acute Services Theatre CapPlan is beginning to produce new useful reports of timeliness for the

teams. The first report on Acute Wait Times to Theatre showed some delays in the ‘urgent’ Priority

1 and 2 cases. Work continues with clinicians to understand and improve the data and reporting

formats, including development of information on average wait time for acute surgery. Clinical

feedback from General Surgery Clinical Head is that the delays are often due to patients needing to

be stabilised in Emergency Care before going to theatre and is clinically appropriate. For example,

for clinical reasons some patients with swelling may be booked later in the week once the swelling

has gone down. Some patients also elect to have the acute arranged operation when it better suits

them, and we are working through options as to whether these patients should simply be booked a

day later. The following tables show the number of patients per priority score for acute surgery and

the numbers that were completed within the targeted time frame for the priority.

Surgical Services Acute Priority Score - Mar 2014


7 May 2014

41

Priority Operation

in time

Operation

overtime Total

% In

Time

1 20 Mins 3 3 6 50%

2 1 hour 17 11 28 61%

3 6 hours 97 22 119 82%

4 24 hours 542 166 708 77%

5 48 hours 55 11 66 83%

6 7 days 59 7 66 89%

Total 773 220 993 78%

Obstetrics Acute Priority Score - Mar 2014

Priority Operation

in time

Operation

overtime Total

% In

Time

1 30 Mins 52 5 57 91%

2 1 hour 52 16 68 76%

3 2 hours 12 2 14 86%

4 24 hours 9 9 100%

5 48 hours 0

6 7 days 0

Total 125 23 148 84%

4.3.3 EFFICIENCY Avoiding waste, including waste of equipment, supplies, ideas and energy

Surgical Services monitor a number of efficiency measures including:

� Theatre list utilisation (Elective) - 84.85% (MoH target 85%)

� Middlemore 89.91%

The acute volumes were over contract by 7.7% (147 WIES) and elective volumes by 3.3% (44 WIES),

and this has impacted services in a number of ways. In Theatres, acute case caused the cancellation

of some elective lists, which in Orthopaedics and Plastic resulted in some long waiting elective

patients not meeting the 150 day timeframe for treatment. On the wards, the impact was increased

outliers plus several very complex patients requiring a high amount of nursing time and referrals to

the Patients at Risk (PAR) Team in March were especially high. Planning is underway to ensure we

have sufficient buffer to deal with the backlog as well as the increased acute demand.

Theatre Admission Discharge Unit – continues to focus on increasing utilisation and supporting the

targets.

MMH 144354 actual minutes

160560 resourced minutes


7 May 2014

42

TADU Monthly Utilisation

0

100

200

300

400

500

600

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

201220122012201220122012201220122012201220122012201320132013201320132013201320132013201320132013201420142015

Pre-Op

Post-Op

Clinics

The Clinical Nurse Director and Quality team are developing plans for the rollout of Goal Discharge

Dates for all surgical wards. The documentation is already in place to support this, and a toolkit of

training resources will be established for staff.

Plastics (Ward 35N) has made improvements to ALOS for acute adult patients; achieving a 33%

reduction from last year, by applying a good understanding of patient flow, accessing POAC and

other services available to support patients to be discharged. This has occurred despite challenges

with high occupancy and (orthopaedic) outliers on the ward due to more acute and elective cases.

Outpatient Services A number of initiatives and services improvements are being to positively effect

outpatient service efficiency and effectiveness. These include:

e-Grading of outpatient referrals became available to services on 17 March, with Rheumatology and

ORL services selected to test the system. Primary Care referrers can now select the local category

streaming the referral direct to relevant sub-specialty triage team. From the first week of e-Grading,

it is clear that the referrals are being graded faster. Feedback from clinicians using the system is that

it is more efficient, saves time and provides better quality grading as the access to the electronic

information is easy and information can be sent back to the referrer. Minor process changes have

been made to ensure the processing in The Referrals and Appointment Centre (RACs) supports an

efficient process and these changes have been made quickly. The plan for roll out to other services

will continue with Ophthalmology, General Medicine, Infectious Diseases, Dermatology and

Respiratory commencing in April and Endocrine/ Diabetes following that.

The Outpatient “Did Not Attend” (DNA) rate continues to reduce, following work to understand the

drivers of this issue. This will be closely monitored via division scorecards, and further service

improvements initiatives are being developed.


7 May 2014

43

Ophthalmology pre-admission process trial for Cataract procedures has been successful and will

now be rolled out as a standard process. The team completes pre-admission at the specialist initial

appointment where the decision to treat is made to reduce pre-admission appointments. A nurse-

led “stable Glaucoma” clinic is in place 2 sessions per week, and an ophthalmic technician is

completing further training to expand this capacity for stable glaucoma management. The service

has an established a training programme for Nurse-led ear clinics and the third RN has now

completed the credentialing process. An Optometrist will be providing a “stable Diabetic Review 4 &

5” follow-up clinic alongside an SMO to better manage volumes.

Hand Therapy/ Plastics Work to address the current demand for hand FSA and elective procedures

includes the Hand Therapy allied health team now reviewing all patients who can be treated

conservatively, prior to FSA. Work is also underway with GP liaison to improve the quality of hand

referrals and to ensure patients referred for FSA appointments with a Hand Specialist have

considered and do want surgical treatment; a recent local review suggests up to 10 % do not want

surgery even if this is only solution.

Skin Cancer lesion cases outsourcing using the General Practitioners with Special Interest (GPwSI)

scheme is going well with 54 referrals for March. Specific initiatives are underway to improve the

training and supervision of the GPs to expand their role further.

4.3.4 EFFECTIVENESS: Providing services based on scientific knowledge to all who could benefit,

and refraining from providing services to those not likely to benefit.

DRES Programme:

In line with the DRES programme plan, work is progressing on a number of fronts

• Primary Secondary Interface Redesign The ORL Service continues to develop a number of

pathway redesigns, having reviewed Canterbury Health Pathway as a template. ORL is

developing clinical pathways for Epistaxis, Chronic Sinusitis, Hoarseness, Thyroid, Neck Lumps

and Otitis Media. Regional Agreement has been achieved and currently investigating linking the

pathways to the e-Referral template.

• Orthopaedic Pathway redesign Orthopaedics continues Pathway redesign from Canterbury

Health Pathway Baseline, with GP Liaison for Orthopaedics leading a focus on feet and ankle

pathways, and shoulders pathway for redesign.

• General Surgery Pathway Redesign The Varicose Veins pathway is continuing to be developed

and a pathway for Bariatrics is on a national schedule.

• Plastic Pathways Redesign Waitemata DHB has employed a Clinical Nurse Specialist (Breast) as

part of meeting clinical standards. A contract between WDHB and CM Health’s Clinicians has

been agreed for work to be undertaken by CM Health staff in the new Elective Services Centre

and WDHB.

• Regional Urology Pathway the newly appointed Urology Clinical Nurse Specialist is making a

positive impact, and provided an excellent presentation on Urodynamics at the Medical Grand

Round on 20 March.

• Enhanced Recovery After Surgery (ERAS) A Chinese delegation of 20 visited Manukau Surgical

Centre on 27 March to gain knowledge on CM Health’s Enhanced Recovery after Surgery (ERAS)

programme. This was very successful, giving both parties the opportunity to discuss their

understanding and key points for successful integration. A Nurses lunchtime forum has added 4


7 May 2014

44

more members to ERAS monthly teleconference. The Clinical lead for Orthopaedic ERAS

Collaborative has presented findings of their work to date.

20,000 Days Collaborative Programmes:

‘Well Managed Pain’ (WMP): The Well Managed Pain team presented to the 20,000 Days sponsors

27 March for continued funding of this programme. There was good feedback and suggestions on

how to effectively measure the outcomes of the work.

Wound Care Service Education sessions for hospital, Primary Care and community teams such as

hospice continue, and promote access to the Complex Wound Clinic. The Clinical Nurse Specialist

has submitted expression of interest for the National Wound Product Advisory Group to PHARMAC.

4.3.5 PATIENT AND WHANAU CENTRED CARE: Providing care that is respectful of and responsive

to individual patient preferences, needs, and values and ensuring that patient values guide

all clinical decisions.

Staff training and research: Renee Greaves, Patient and Whaanau Advisor, attended the General

Surgery Quality Forum and spoke about issues which affect patients experience.

Ward 35N will be working in partnership with Ko Awatea on a “Patient and staff experience” project

related to the emerging body of evidence suggesting that experiential and behavioural aspects of

care can impact on safety. For example, by highlighting empathy and compassion as core values and

then working to understand the actual experience of described by patients who receive care and by

staff who deliver care could provide new insights for improvement.

Patient Whaanau-centred Care Masterclass: Two surgical service projects with a focus on the

inclusion of patients input to service delivery improvement have started. One involves the ERAS

colorectal pathway, the other is in PACU at Manukau Surgery Centre and involves discharge pain

relief. Critical Care is setting up a regular coffee morning for patients’ families, in order to have

discussions on what is done well and what could be better.

Complaints/ compliments: are tracked monthly with strengths and gaps noted, analysed and acted

on. There were 45 compliments and 50 complaints.

Surgical Services Incidents Complaints & Compliments

Jan 2009 - current

0

50

100

150

200

250

300

350

400

450

Apr-0

9

Jul-0

9

Oct-

09

Jan-10

Apr-1

0

Jul-1

0

Oct-

10

Jan-11

Apr-1

1

Jul-1

1

Oct-

11

Jan-12

Apr-1

2

Jul-1

2

Oct-

12

Jan-13

Apr-1

3

Jul-1

3

Oct-

13

Jan-14

Year/Month

Num

ber lo

gged

Incidents

Compliments

Complaints


7 May 2014

45

5 Adult Rehabilitation / Health of Older People (ARHOP)


5.1.1 Activity summary

Middlemore Rehabilitation Services

Health of older people (wards 4&5) focus on acute geriatric care, Rehabilitation (wards 23&24)

provide longer term (typically over 20days) in patient rehabilitation for adults and older people.

In March, 168 patients were admitted with 97 patients admitted (58%) directly from Emergency

Care. Of the admissions, 43% were admitted to Health of Older Persons Services (wards 4 and 5),

21% were admitted to Geriatric Rehabilitation services (Ward 24), and 17% were admitted to the

Rehabilitation (Ward 23). The AT&R team are currently reviewing current Rehabilitation admission

criteria, protocols and utilisation of various models and roles, including the Clinical Nurse Specialist

roles to maximise bed management and the access to rehabilitation expertise across the whole of

system.

Discharges from ARHOP – Health of Older People and Rehabilitation services

Average Length of Stay -Health of Older People (wards4&5), and Rehabilitation wards (wards23&24)

Auckland Spinal Rehabilitation Unit (ASRU) Activity –

March inpatient volumes at the Spinal Unit remained high at 95.5% with 509 bed days utilised (see

graph). Clinical Teams explore all options to enable timely discharge and are actively managing

patients to their goal discharge date. As the unit only has 20 beds, delays can quickly impact on bed

availability for new admissions and percentage of clients meeting their estimated discharge dates

(EDD), which are currently sitting at 87.5%.

Ward 24 Closed

in Jan/Feb


7 May 2014

46

Two patients with extended stays and delays to discharge; one due to non-resident (Tuvalu) funding

arrangements, and one with concurrent medical and personal health and disability support needs,

needing to access support via Taikura Trust.

Auckland Spinal Rehabilitation Unit bed days by funder

Note that ‘private’ refers to non-residents or private insurance patients with prior approval and

admission billed via revenue team with funding often via NZAID for non resident cases from Pacific

Islands.

Outpatient and Community Services – clinics continue to focus on community provision; with

Middlemore based clinics for Bone Density, C.A.R.E, Day clinic, and Falls & Osteoporosis; together

with regular clinics at Botany, Franklin Hospital, Manukau, Pakuranga Medical Centre, PROC bone

density, Pukekohe Family Health, Pukekohe Hospital, Tuakau Health Centre and Waiuku Health

Centre. Outpatient Allied Health sessions are provided at all satellite sites.

Needs Assessment and Service Coordination (NASC) – 305 referrals received during March, with

average contacts per month since February 2013 at 1,476. Average duration of contacts is 59mins

and 48% of contacts are for service co-ordinations.

0

500

1000

1500

2000

2500

July

Au

gust

Se

pte

mb

er

Oct

ob

er

No

vem

be

r

De

cem

ber

Jan

ua

ry

Feb

rua

ry

Ma

rch

Ap

ril

Ma

y

Jun

e

July

Au

gust

Se

pte

mb

er

Oct

ob

er

No

vem

be

r

De

cem

ber

Jan

ua

ry

Feb

rua

ry

Ma

rch

Ap

ril

Ma

y

Jun

e

2013 2014

Co

nta

cts

NASC Contacts

NASC Contacts

Mean

LCL

UCL

The Ministry of Health has provided $425k to deliver more Home Based Support Services (HBSS)

assessments (volumes) and services, and using this additional funding, during February and March,

the NASC service completed an additional 120 assessments and service co-ordinations for non-

complex clients. This work was completed on weekends and was very productive.

Community Geriatrics Services – there were a total of 161 contacts, with the average contact

duration 59mins. 41% of contacts were First Contact Type, 47% of contacts were at a Rest Home or

Private Hospital location, 70% of contacts were by a nurse and 57% were for Assessment. SMO

contacts have returned to usual levels following a decrease in February for medical staff on

conference and annual leave. The contacts provide management options and support to ensure the

patient can be managed in the community where appropriate.


7 May 2014

47

5.2 FINANCIAL: Best value for public health system resources


Division: ARHOP


REVENUE

307 338 (31) (9)% Government Revenue 3,088 3,038 50 2%

0 5 (5) (100)% Patient/Consumer Sourced 6 44 (38) (86)%

28 29 (1) (2)% Other Income 136 258 (122) (47)%

194 168 26 15% Funder Payments 2,008 1,513 495 33%

529 539 (11) (2)% Total Revenue 5,239 4,853 385 8%

EXPENDITURE

3,808 3,870 62 2% Staff Costs 34,664 35,202 539 2%

325 341 16 5% Outsourced Costs 3,099 3,069 (30) (1)%

466 489 23 5% Clinical Costs 4,553 4,399 (154) (3)%

119 134 15 11% Infrastructure Costs 1,241 1,210 (31) (3)%

68 64 (5) 7% Internal Allocations 582 519 (63) 12%


(4,259) (4,359) 100 2% Net Result (38,901) (39,547) 647 2%

638 624 (14) (2)% FTE 629 627 (2) (0)%

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

CMDHB Provider


Monthly Net Result

-4,800

-4,600

-4,400

-4,200

-4,000

-3,800

-3,600

Mar-13Apr-13

May-13Jun-13

Jul-13Aug-13

Sep-13Oct-13

Nov-13Dec-13

Jan-14Feb-14

Mar-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


-

200

400

600

800

1,000

1,200

1,400

Mar

-13

Apr-1

3

May

-13

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-13

Dec-1

3

Jan-

14

Feb-1

4

Mar

-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget

Monthly Staff Costs

2,000

2,500

3,000

3,500

4,000

4,500

Mar-1

3

Apr-1

3

May

-13

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

Jan-

14

Feb-1

4

Mar-1

4

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


7 May 2014

48

Mar-14 YTD


Revenue: $(11) $385

Salaries & Wages: $62 $539

Outsourced: $16 $(30)


Infra-Structure: $15 $(31)

Internal Allocations: $(5) $(63)

The year end forecast has been upgraded due to the closure of Ward 24 for refurbishment with no additional community services being put in place as a result.

The main variances YTD are Community Continence ($77k) and Ostomy supplies ($63k). 2014/15 budget reflects reduced useage of clinical supplies.


The main reason for the favourable variance is the closure of Ward 24 for renovation ($100k for the month and $466k YTD). Medical Staffing is under budget ($8k

for the month and $193k YTD) mainly due to RMOs seniorty level being less than budgeted.

YTD favourable variance is mainly due to the Funder cost reimbursement relating to the conversion of 10 long stay to AT&R beds in Pukekohe and Dementia Project

$478k off-set by out-patient ACC and Non-Resident revenue below budget $(95k).

Revenue for the 2014-15 budget has been increased by $250k for the spinal inpatient/ACC revenue on current year's budget.

The main reason for the underspend in the month is the savings in nursing costs due to the closure of Ward 24 ($87k for the month and $441k YTD). Medical

Staffing is under budget ($8k for the month and $193k YTD) mainly due to RMOs seniorty level being less than budgeted. YTD overspend in Home Health care

nursing ($16k for the month and $315k YTD) and the Allied Health vacancies and recruiting staff at a lower level wherever possible has resulted in a favourable

variance of $280k YTD.

CMDHB ProviderFinancial Commentary - ARHOP


5.3.1 SAFETY First, Do No Harm

• Pressure injuries: 2 pressure injuries in March; both acquired during present admission. This is

consistent with February.

• Falls incidents: There were 44 recorded falls in March, an increase from 35 in February. Of

these 11 falls were with minor harm.

• Medication errors incidents: There were 7 medication errors reported for the month of March.

This is an increase from zero recorded in February.

5.3.2 TIMELINESS: “Every Hour Counts” if we are to achieve quality and safety outcomes

Needs Assessment and Services for Older People (NASC) Regional discussions continue on

implementation and reporting against proposed new nationally consistent timeliness measures (10

days or less referral to services for complex clients and 30 days or less for non-complex). NASC will

be trialling greater use of administrators to support service co-ordination and diary management

roles, and a multi-disciplinary approach to referrals and reviews to improve response times. This will

initially be piloted in the Eastern Locality. The interRAI rollout continues with 63.8% (2432/3809) of

clients receiving Home Based Support services (HBSS) now having received an InterRAI assessment.

Waitlist - Allied Health Outpatients - The outpatient physiotherapy clinic waitlists in Women’s

Health and Musculoskeletal are still higher than service averages. Extra resource has been shifted

into Women’s Health to achieve the high priority 2 waiting times of 19 weeks over the coming

months. All other services are operating close to waiting time targets.


7 May 2014

49

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

Added 490

Seen 336

Return to GP 0

Removed Other 114

TOWL 752

Waiting > 150 days 38



0

100

200

300

400

500

600

700

800

Added

Seen

Return to GP

Removed Other

TOWL

Waiting > 150 days

Waiting > 120 days

Waiting > 90 days

Acute Allied Health Outpatient Waitlist Activity

Waitlists – Community Allied Health - The wait lists for allied health at Home Health Care remain

high, particularly for Occupational Therapy. There has been a reduction in Papakura and Howick

bases. Contacts increased for all teams in March, and consequently lists have reduced slightly.

The Allied Health Locality redesign project with Papakura Home Health Care is helping to reduce the

numbers, as well as analysing the possible bottlenecks in the process. Refer to the Director Allied

Health report for details on this redesign process.

Previous

Month Total

Orakau

(Otara/

Mangere)

Papakura

(Manukau)

Pukekohe

(Franklin)

Howick

(Eastern)

Waiting list Dietetics 24 12 6 3 3 0

Contacts Dietetics 83 104 40 25 21 18

Waiting list Occ Therapy 240 217 101 70 7 39

Contacts Occ Therapy 255 327 105 86 42 94

Waiting list Physiotherapy 112 105 1 44 5 55

Contacts Physio 254 333 102 73 117 41


Community Nursing Wound Care Project – Data is being collected with clinical review identifying

the need for Home Health Care to concentrate on the management of chronic wounds and

increased self-care. New documentation formats are being tested, with new products and their use

to be launched at a District Nurse Education study session in May

5.3.4 EFFECTIVENESS Providing services based on scientific knowledge to all who could benefit,


Community Geriatric Service team – The Community Geriatric Service (CGS) team provided

continuing education support to six GP practices during March and had 41 attendees for Aged

Related Residential Care (ARRC) nursing education sessions. Prescribing rate for Vitamin D for the

month of March was 92%. While there has been an increase in EC presentations from Residential

Care, the number of potentially avoidable presentations remains low.


7 May 2014

50

20,000 Days Collaborative Programmes;

• The Community Stroke Early Supportive Discharge – Supporting Life after Stroke team has

actively worked with 23 patients since pilot commencement. Early Length of Stay (LOS) data is

indicating that patients have achieved the target of a reduction in LOS of 4 days. Comparison of

patient outcomes for this pilot is the next step. The team presented an update to the 20,000

days campaign sponsors for Year 2 funding, with initial feedback exceptionally positive.

• Dementia Pathway Implementation (Memory Team) – service now has 222 clients, with 7% of

referrals directly from General Practice. Of these, only 14% had received a diagnosis compared

to 40% from other sources. Twenty cases are ready for allocation to Alzheimer’s Auckland Trust,

enabling the Memory Team to take on new referrals and create a throughput in the pathway.

Preparation work has been completed to align the Memory Team Care Plan with e-Shared Care

Plan, and a trial will commence in June at a GP Practice in Manurewa – Manukau Locality.

• Acute Care for the Elderly (ACE) for over 85year olds: Testing inter-rater reliability of the Needs

Identification tool in Emergency Care has been successful, and the care plan has been modified

to reduce duplication. The daily multidisciplinary team huddle is working well with Goal

discharge dates being set for all patients. There is a positive impact of the combined average

Length of Stay (LoS) for these patients from a high level of 25 days to the lowest ever of 10 days.

Information about the ACE initiative is on the intranet. The team presented an update to the

20,000 days campaign sponsors for Year 2 funding.

Reduction in Combined LOS for acute geriatric patients going to rehabilitation


7 May 2014

51

• Fracture Liaison (older people) Service – the inpatient ortho-geriatric team continues to identify

inpatients at risk of fractures and proactively manage their care to reduce their risk. Funding for

a part-time clinical co-ordinator role is being finalised, with the aim to have the role commenced

by June 2014. The role will work alongside the Fracture Clinic, to identify any ambulatory

patients who will benefit from primary prevention input.

• Delirium (CAM Tool) Roll Out (hospital care) – Completion of the NHS Sustainability

questionnaire has indicated that collaborative has good potential to be expanded. The team will

liaise with Zero Patient Harm leads to include delirium management in the monthly ward audits.

The intranet site has been completed and the CAM forms finalised.

Regional and National Service Developments:

• InterRAI Long Term Care Facility Rollout (LTCF) – over 54% of Counties Aged Related Residential

Care facilities have now completed staff training in use of the nationally mandated ‘InterRAI’

assessment and care planning system. This puts the service ahead of the regional target of 32%

by June 2014 for the rollout of InterRAI.

• Elder Abuse and Neglect (EAN) development – The Violence Intervention Programme (VIP)

Team has appointed an Elder Abuse and Neglect Coordinator and are working on the EAN policy

and procedure implementation planning. The procedure is in its final draft and is being

circulated for comments and recommendations to be finalized by May for the Clinical

Governance Group approval. Development of a half day staff Training Package continues, and

relevant Service Managers engaged to develop the training implementation plan.

• Auckland Spinal Rehabilitation Unit (ASRU) Spinal Pathways – The inpatient rehabilitation

Spinal Unit pathway development continues and work on the Shared Care Plan will form part of

the National Spinal Strategy action plan. The shared care plan will be piloted with 10 clients by

September 2014.

The National Spinal Strategy - The National Spinal Strategy Action Plan has been received. Work

has commenced to undertake the large body of preparatory work to see CM Health establish an

integrated acute and rehabilitation spinal service for the upper North Island by 1 July 2014 in

collaboration with EC, ICU and Orthopaedics.

• CM Health is focusing on the impact of acute surgical intervention, and will also be trialling the

shared care plan. The ASRU in conjunction with Burwood Spinal Unit will focus on consistency of

referrals management and the rehabilitation phase of the patient journey.

5.3.5 PATIENT AND WHANAU CENTRED CARE Providing care that is respectful of and responsive

to individual patient preferences, needs, and values and ensuring that patient values guide

all clinical decisions

• Facilities Environment Improvements: The Rehabilitation (ward 24) refurbishment and en-suite

development is complete and the ward re-opened on 17 March following a blessing. The

Auckland Spinal Rehabilitation Unit ward refurbishment and Motel Unit improvements were also

complete on 17 March, with a few minor remedial repairs to be rectified.

• Complaints/ compliments: Eleven Complaints were received in month, 5 for NASC, 2 for AT&R/

outpatients and 1 each for Home Health Care, ward 4, Pukekohe Hospital, Spinal outpatients.

They related to a range of issues including Delay in Access, Attitude, Communication and

Incorrect Details. Six of these have been investigated and closed, with the remainder still

underway. Two compliments were received – for Ward 4 and for Howick District Nursing.


7 May 2014

52

6 Medicine, Acute Care and Diagnostics


6.1.1 National Health targets

Shorter stays in the Emergency Department

95% of patients wait < 6 hours to be admitted,

discharged or transferred from an emergency

department.

6 hour target

Month result – 94.4%

Quarter result – 95.3%

Shorter waits for cancer treatment

All patients needing radiation treatment will

commence treatment within four weeks

Cancer wait target

Month result – 100%

Quarter result – 100%

6.1.2 Activity summary – at 14.04.14

Medicine volumes (WIES and CASES)

Volumes MAR'14 Year to date

Act Bud /

Contract Var % var Act

Bud /

Contract Var % var

EMERGENCY CARE

Presentations

(against last year) 8,864 8,520 344 4.0% 78,775 76,137 2,638 3.5%

Discharges

(against contract) 8,810 8,459 351 4.2% 78,765 75,801 2,964 3.9%

INPATIENT (WIES)

Adult Acute Care 328 336 (8) (2.4%) 2,962 2,958 4 0.1%

Adult Medical Care 1,867 1,925 (58) (3.0%) 17,722 18,373 (651) (3.5%)

TOTAL 2,195 2,261 (66) 2.9%) 20,684 21,331 (647) (3.0%)

INPATIENT (CASES) Contract = Last year actuals

Adult Acute Care 1,016 992 24 2.4% 8,655 8,132 523 6.4%

Adult Medical Care 2,209 2,114 95 4.5% 19,503 19,485 18 0.1%

Total 3,225 3,106 119 3.8% 28,158 27,617 541 2.0%

Emergency Care: Continuing high volumes, with a 4.0% increase on presentations last year. There

are significant swings in daily volumes from 245 to 324. Average daily patient volume in March was

285.

Inpatients: the month WIES result reflects a 3% increase to contract, but a 2% decrease to last year.

Gastroenterology reflected an 18% increase compared to last year. In March, 1% or 30 cases more

than this time last year, with an ALOS less than last year at 3.0 days compared to 3.1 days.

Gastroenterology saw 67 more cases than last year.

Outpatient Volumes were 14.8% above contract and 6.8% higher than last year. FSA’s were 24.2 %

above contract with increases in FSA’s across a number of areas, but most notably again in

Respiratory. Follow-ups were 4.9% above contract but only 1.7% higher than last year. Breast

screening volumes for March were above target, and are now above YTD targets.


7 May 2014

53

6.2 FINANCIAL RESULTS: Best value for public health system resources


Division: Acute Care


REVENUE

0 0 0 0% Government Revenue 8 0 8 0%

0 0 0 0% Patient/Consumer Sourced 0 0 0 0%

0 4 (4) (94)% Other Income 2 36 (34) (94)%

0 0 0 0% Funder Payments 0 0 0 0%

0 4 (4) (94)% Total Revenue 10 36 (26) (72)%

EXPENDITURE

2,205 2,257 52 2% Staff Costs 21,625 21,131 (493) (2)%

18 23 5 21% Outsourced Costs 285 203 (82) (41)%

228 226 (2) (1)% Clinical Costs 2,179 2,036 (143) (7)%

105 119 13 11% Infrastructure Costs 1,052 1,067 16 1%

78 84 6 (8)% Internal Allocations 749 724 (25) 3%

2,635 2,709 74 3% Total Expenditure 25,890 25,161 (728) (3)%

(2,634) (2,705) 70 3% Net Result (25,879) (25,125) (754) (3)%

294 276 (18) (6)% FTE 300 283 (17) (6)%

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

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

CMDHB Provider


Monthly Net Result

-3,500

-3,000

-2,500

-2,000

-1,500

-1,000

-500

-

Mar-13Apr-13

May-13Jun-13

Jul-13Aug-13

Sep-13Oct-13

Nov-13Dec-13

Jan-14Feb-14

Mar-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


-

100

200

300

400

500

600

Mar

-13

Apr-1

3

May-1

3

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

Jan-

14

Feb-1

4

Mar

-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget

Monthly Staff Costs

-

500

1,000

1,500

2,000

2,500

3,000

Mar

-13

Apr-1

3

May-1

3

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

Jan-

14

Feb-1

4

Mar

-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


7 May 2014

54

Mar-14 YTD

Total Variance: $70 $(754)

Revenue: $(4) $(26)

Salaries & Wages: $52 $(493)

Outsourced Costs: $5 $(82)

Clinical Supplies: $(2) $(143)

Infra-Structure: $13 $16

Internal Allocations: $6 $(25)

YTD overspend is across all expense categories but mostly treatment disposables. This is driven by a YTD volume increase of 4% above contract and 3% above this

time last year.

$52k f MTD

$25k f - Medical staff - includes $20k favourable due to timing of Work Related Expenses

$12k f - nursing - miscellaneous savings

$14k f - ward clerk vacancies in EC

$(493)k YTD

$(395)k u - Medical - includes approx $179k unbudgeted winter initiative costs transferred back to the service from the DHS budget and $216k u due to additional

SMO/Moss in EC to address increased volumes.

$(117)k u - Nursing due mainly to AOU/MSS open additional unbudgeted weekends / nights to address increased volumes in EC.

Overall the division is $70k favourable for the month due to miscellaneous savings across all expense categories..

YTD EC is $(754)k u (3%). This includes approx $(179)k u for the winter initiative costs transferred back to the service from DHS budget. The balance is due to

additional overspends in medical staffing, nursing and clinical supplies driven by increased volumes in EC (4% above contract YTD). Strategies are currently being

explored to manage volumes and bring the year end forecast back in line with budget.

Financial Commentary - Acute Care

Year end Forecast variance to Budget $(224)

The year end forecast for the division is $(224)k unfavourable against budget at year end. The division is currently $(754)k u YTD but we are currently investigating

strategies to bring this back in line with budget.

CMDHB Provider


7 May 2014

55


Division: Medicine


REVENUE

241 222 19 8% Government Revenue 2,109 2,002 108 5%


222 62 160 258% Other Income 1,480 583 897 154%

190 74 115 155% Funder Payments 1,500 670 830 124%

652 359 293 82% Total Revenue 5,089 3,254 1,835 56%

EXPENDITURE

5,796 5,533 (263) (5)% Staff Costs 51,962 49,842 (2,120) (4)%

322 324 2 1% Outsourced Costs 2,726 2,678 (48) (2)%

1,280 1,293 14 1% Clinical Costs 11,453 11,538 85 1%

275 253 (22) (9)% Infrastructure Costs 2,241 2,279 39 2%

714 675 (38) 6% Internal Allocations 5,802 5,917 115 (2)%

8,387 8,079 (308) (4)% Total Expenditure 74,183 72,254 (1,929) (3)%

(7,735) (7,721) (14) (0)% Net Result (69,094) (69,000) (94) (0)%

694 640 (54) (9)% FTE 686 635 (51) (8)%

CMDHB Provider


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

Monthly Net Result

-8,500

-8,000

-7,500

-7,000

-6,500

-6,000

Mar-13Apr-13

May-13Jun-13

Jul-13Aug-13

Sep-13Oct-13

Nov-13Dec-13

Jan-14Feb-14

Mar-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


-

800

1,600

2,400

3,200

Mar

-13

Apr-1

3

May

-13

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

Jan-

14

Feb-1

4

Mar

-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget

Monthly Staff Costs

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Mar-1

3

Apr-1

3

May

-13

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

Jan-

14

Feb-1

4

Mar-1

4

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


7 May 2014

56

Mar-14 YTD

Total Variance: (14) (94)

Revenue: 293 1,835

Government Revenue: $95k f - additional PCT revenue (Funder payment)

Salaries & Wages: (263) (2,120)

Current Mth:-

Outsourced: 2 (48)

Clinical Supplies: 14 85

Infra-Structure: (22) 39

Internal Allocations: (38) 115

Despite the unbudgeted costs for winter intiatives, over allocation of RMO's and the unbudgeted Renal growth, the division will is expected to recover the majority

of these additional costs by year end. This is due partly to savings from vacancies incurred in the early half of the year as well as the icodextrin refund partly

relating to prior year.


The year end forecast is expected to be an unfavourable variance of $(94)k.

Year to date:-

$133k f - Salary recoveries for unbudgeted Cancer Care Coordinator positions, offset against unbudgeter salary positions.

$17k u - misc

YTD the division is $94k unfavourable.

Other Income: $425k f - refund for Icodextrin (renal fluids) overcharge. Partly relates to the current financial year; $425k f - refund for Icodextrin (renal fluids)

overcharge. Partly relates to the current financial year.

Funder Payments: $1190k f - cost recoveries for unbudgeted project positions; $125k f - Other miscellaneious recoveries

$245k f - Savings due to vacancies at the beginning of the year. Now mostly filled.

$25k u - unbudgeted RMO overallocation - 3FTE

$260k u - unbudgeted winter initiative transferred from DoHS budget

$20k u - nursing costs to staff additional Renal night shifts to address unbudgeted renal growth

Year to date:-

$1239k u - unbudgeted funded positions (offset by revenue & internal allocations)

$50k u - high RMO WRE charges from NORTH - possibly due to timing/over allocation of RMO's. Awaiting explanation from NORTH

The division was slightly over budget for the month ($14ku variance). Overspends in staffing were driven by higher net annual leave. These were mostly offset by

higher revenue received for funded projects.

$38k u - Misc - including lower annual leave taken than accrued

$178k u - higher RMO WRE charges from NORTH - possibly due to timing/over allocation of RMO's. Awaiting explanation from NORTH

$213k u - Increased kiwisaver cost, mainly in Nursing due to the increase of staff joining the programme.

$305k u - unbudgeted RMO overallocation

$234k u - nursing costs to staff additional Renal night shifts to address unbudgeted renal growth

Volumes are down on contract by 2.9% for the month, however, caseloads are up by 4.5%. The increase in patient volumes has increased the monthly costs for the

service, as detailed below.

Current Month:-

(94)

$ 64k f - Other savings

Year to date:-

Mainly in Pacemakers due to higher stock levels carried forward from 12/13

$130k u - unbudgeted funded positions (offset by revenue)

CMDHB ProviderFinancial Commentary - Medicine

Year to date:-

Funder Payments: $131k f -cost recoveries for unbudgeted project positions - 18.6 ftes; $53k f - 2 x instalments for Fast Tracker

cancer position funded by NRA - contract now finalised

$12k f - misc

Other income: $72k f - Greenlane clinics session by Cardiologist - backbilling; $25k f - SMO secondment to CCREP from Nov13.

Agreement on price now finalised.


7 May 2014

57


Division: Clinical Support


REVENUE

435 462 (27) (6)% Government Revenue 4,077 4,208 (131) (3)%


439 131 308 234% Other Income 1,976 1,181 795 67%

37 0 37 0% Funder Payments 291 0 291 0%

911 593 318 54% Total Revenue 6,344 5,389 955 18%

EXPENDITURE

4,531 4,231 (300) (7)% Staff Costs 39,862 39,276 (586) (1)%

477 537 60 11% Outsourced Costs 4,662 4,831 169 3%

2,848 2,653 (195) (7)% Clinical Costs 24,186 23,123 (1,063) (5)%


(1,671) (1,549) 122 8% Internal Allocations (13,851) (13,302) 549 4%

6,450 6,141 (309) (5)% Total Expenditure 57,223 56,371 (852) (2)%

(5,539) (5,548) 9 0% Net Result (50,879) (50,982) 103 0%

588 574 (14) (2)% FTE 566 576 9 2%

($000's)

CMDHB Provider


($000's)

Monthly Net Result

-7,000

-6,000

-5,000

-4,000

-3,000

-2,000

-1,000

-

Mar-13Apr-13

May-13Jun-13

Jul-13Aug-13

Sep-13Oct-13

Nov-13Dec-13

Jan-14Feb-14

Mar-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


-

1,000

2,000

3,000

Mar-1

3

Apr-1

3

May-1

3

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

Jan-

14

Feb-1

4

Mar-1

4

Mo

nth

ly r

esu

lt $

00

0's

Result Budget

Monthly Staff Costs

-

2,000

4,000

6,000

Mar-1

3

Apr-1

3

May-1

3

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

Jan-

14

Feb-1

4

Mar-1

4

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


7 May 2014

58

Mar-14 YTD


Revenue: $318 $955

Salaries & Wages: $(300) $(586)

Outsourced: $60 $169

Clinical Supplies: $(195) $(1,063)



Year to date:-

Other Income: $331k f - Breast Screen film read revenue from Southland DHB; $300k f - Year to date revenue accrual for charges to ADHB for Radiology and use of CMH

facility

Funder Payments: $291k f - cost reimbursement for 6.7fte unbudgeted Pharmacists - 20k bed days

Government Revenue: $140k f - Increased Radiology ACC revenue due to better reporting to capture ACC cost data.

$(107)k u - misc

Current month:-

$(117)k u - annual leave taken lower than accrued in March. Expect high annual leave taken during Easter/school holidays in April.

$(37)k u - Pharmacy - 6.7fte unbudgeted - 20k bed days. Offset by funding

$(53)k u - Radiology - SMO additional sessions and film reads to address the volume growth

$(30)k u - MRT overtime/penals for two weekend Ultrasound sessions to address the waiting list. Currently waiting 10 wks vs clinical internal target of 6 wks. Ideally,

one additional weekend session per month is required to meet current demand.

$(37)k u - Lab over time/penals due to increased volumes as result of Dialysis patient profiling in March.

$(26)k u - miscellaneous

Year to date:-

$(291)k u - Pharmacy 6.7fte unbudgeted - 20k bed days. Offset by funding

$(45)k u - Unbudgeted winter initiative costs transferred from DoHS budget - Radiology 1.4 fte Winter Initiative

$(152)k u - Radiology SMO - additional sessions and film reads to address volume increase

$(80)k u - Radiology - RMOs allocated more senior than budgeted

$(30)k u - MRT overtime/penal for two weekend Ultrasound sessions to address waiting list. Currently waiting 10 wks vs clinical internal target of 6 wks. Ideally, one

additional weekend session per month is required to meet current demand.

$(64)k u - Lab Allied staff penals/overtime to address volume growth

$(76)k f - Misc vacancies across the services

The division is on budget for the current month due mostly to a year to date revenue accrual for Radiology charges to ADHB for CMDHB domicile patients treated under

the tertiary contract $300k.

This has been partly offset by low annual leave taken in March, Radiology SMO additional sessions/film reads & Sonographers on weekend Ultrasound sessions to

address the waiting list (currently at 10 wks vs internal target 6 wks).

Labs overtime/penals were also over due to March Dialysis patient profiling.

Year to date savings is mostly due to Pharmacy & Patient Information vacancies, partly offset by an overspend by Labs driven by volume growth.

Current month:-

Other Income: $300k f - Year to date revenue accrual for charges to ADHB for Radiology and use of CMH facility

Funder Payments: $37k f - cost reimbursement for 6.7fte unbudgeted Pharmacists - 20k bed days

$(19)k u - misc

CMDHB ProviderFinancial Commentary - Clinical Support

At year end the division is expected to be slightly favourable with a $94k favourable variance at year end.

Current month:-

$26k f - Lab sendaway tests savings

$23k f - Outsourced CT savings

Year to date:-

$151k f - Lab sendaway test savings

$18k f - misc

Current month:-

$(113)k u - Drugs overspend driven by demand across the organisation & recovered through internal charging: -

$104k u - PCT drug due to Haematology Chemotherapy volumes up 11.6% from last year. Velcade usage 50% higher than last years average. Partly offset by PCT

revenue. The forecast expectation is volumes will continue at the current level for 2013/14.

$(25)k u - Labs blood products due to three high cost patients in HDU & Ward 33N

$(21)k u - Radiology shunts & stents driven by vascular surgery.

$(36)k u - misc

Year to date:-

$(450)k u - Drugs overspend driven by demand across the organisation & recovered through internal charging:-

$(232)k u - Infections driven by Surgical Services volume increase - 6% Wies, 5% electives YTD

$(227)k u - Anaesthetic drugs driven by Surgical Services volume increase

$126k f - Labs - blood products savings due to less high costs patients (unpredictable volumes).

$(83)k u - Labs - winter initiatives reversed from DoHS

$(151)k u - Labs - increased costs due to some Biochemistry sendaway tests now completed in house. Offset by reduced outsource costs.

$(261)k u - Microbiology testing kits - volumes up 14% from last year driven by Medicine

$(145)k u - Lab equipment maintenance due to expired warranty.

$(56)k u - Radiology shunts & stents driven by vascular surgery

$(43)k u - misc


Year to date:-

$488k f - Drug cost recoveries - offsets drug overspend

$22k f - MRI cost recoveries

$39k f - misc savings

Current month:-

$117k f - Drug cost recoveries - offsets drug overspend


7 May 2014

59



• Zero Patient Harm activities and audits continue, with the use of the display boards in in-patient

areas. Feedback to frontline staff on audit results and staff involvement is ensuring continued

improvements to improving patient care and safety.

• Central line-associated bacteraemia the established protocols to reduce infection from line

sites, already in established use, are being introduced into the Medical wards in April.

• Falls Prevention – There were 34 falls on medicine wards for March up from 32 falls in February,

However falls with harm reduced from 12 falls in February to 2 in March.

• Medication Reconciliation –83% of all high risk patients has medication reconciliation initiated

and completed during their hospital stay. Overall, 66% (2020 of 3054) admissions and transfers

from adult medical, surgical and rehab wards had a validated medication history by a

pharmacist, 42% within 48 hours. In March, 43% of high risk patients received discharge

medication management service (SMOOTH) prior to discharge.

• Pressure Injury Prevention The focus is on preparing for the annual wound care coach day and

audits, and on finalising pathways for equipment. Two medical wards are use of trialling a skin

integrity assessment sticker to prompt assessment when a patient is admitted.

Other Activity

Training in Root Cause Analysis on 20 March was attended by participants with a variety of roles.

Three division Quality Managers supported the lead presenter by facilitating the case-based

sessions. Participants can now assist with SSE investigations where appropriate.


The Ministry of Health will work with DHBs to reduce waiting times; in particular:

A. Reducing waiting times for radiation and chemotherapy treatment and ensuring Faster Cancer

diagnosis;

� Achieved 100%: All radiation and chemotherapy commenced within 28 days for patients

ready for treatment.

B. Faster Cancer Treatment Indicator performance Currently for the 12month average (Target is

70%)

• 59.9% of eligible patients commencing treatment within 62 days

� 76.8% of eligible patients receiving treatment within 31 days of decision to treat.

Mar-2013

(Met/Total cases)

Jun-2013

(Met/Total cases)

Sep-2013

(Met/Total cases)

Dec-2013

(Met/Total cases)

Rolling 12-month

average

(Met/Total cases)

62-day indicator 66.7% (130/195) 61.5%

(131/213)

51.1%

(91/178)

58.8%

(50/85)

59.9%

(402/671)

31-day indicator 77.2%

(156/202)

74.4%

(169/227)

76.4%

(165/216)

80.1%

(125/156)

76.8%

(615/801)

The Project Plan for the Cancer Treatment target has been developed and finalised, with final

information from Ministry of Health required regarding the target details. Service-level

communication is underway across all services providing cancer assessment and care. A monthly


7 May 2014

60

tumour stream performance reports is being finalised and reporting data from ADHB cancer services

is being developed. The ‘High suspicion of cancer’ and “needing to be seen at FSA within 2 weeks”

flags are being created in the Patient Information System to capture eligible patients at referral

grading.

C. Developmental targets for reducing waiting times for important diagnostic tests (such as CT

scans, MRI scans, angiograms and colonoscopies). Targets for Diagnostic Indicators (test or

procedures)

As these are new indicators; compliance will be phased in over a number of years to allow for DHBs

to set up reporting and monitoring frameworks and work toward any required service improvements.

Because they are new areas of reporting the thresholds for colonoscopy, CT and MRI will be reviewed

after at least 6 months of data collection.

Colonoscopy by June 2015 - 95% of people should receive:

* Urgent colonoscopies within 14 days

* Non urgent colonoscopies within 42 days

* Surveillance colonoscopies no later than 84 days beyond a planned date

Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) by June 2015 - 95% of

patients should receive their CT or MRI scan and have it reported on within 42 days unless it is a

planned procedure.

Coronary Angiography by June 2015 - 95% of patients accepted for elective coronary angiography

should receive their procedure within three months (90 days).

Colonoscopy - by June 2014, 50% of people should receive:

Urgent diagnostic colonoscopies:

� Achieved: results 67.3% (from 64.6% in Feb).

Non-urgent colonoscopies:

× Not achieved: results are 25.4%.

Surveillance/Follow-up colonoscopy:

� Achieved: results 98.1%

Commentary: The priority two waitlist continues to grow and strategies for managing this continue

to be progressed. The business case for increased resources (FTE and facilities) to manage volumes,

and the use of outsourcing will continue. Funding is in place for 250 colonoscopies to be outsourced

up to June 2014. The Ministry of Health initially provided additional funding for 256 colonoscopies

to be outsourced, and have notified there is now further funding for an additional 234 colonoscopies

to be outsourced before June 30. Nationally, only four DHBs are achieving the P2 target and we are

working hard to be one of them.

Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) – in 2013/14,

× CT Scan - 85% within 42 days - Not Achieved 73%

� MRI Scan - 75% within 42 days – Achieved 77%

Commentary - Overall volumes are 6% higher than the same time last year. In March, particularly

general x-rays and ultrasound were busier with more general x-rays performed on community

patients at Middlemore radiology department following tightening of Access to Diagnostics funds for

Primary Care. Additional weekend ultrasound sessions were run to contain growth in the ultrasound

waiting list and this resulted in an additional 362 patients scanned.


7 May 2014

61

There has been a noticeable increase in the waiting list for CT scanning. This appears to be related

to the cumulative impact of ‘specified appointments’. These appointments are given to, for

example, oncology patients who require a staging scan every 6 months. With the growth in

repatriated tertiary funded patients to CM Health in the last few years, these ‘specified

appointments’ are becoming due and are now counted on the waiting list.

Additional MRI and CT scanning began 1 April at Middlemore Crescent site. There has been

favourable feedback from patients on the free car-parking, improved environment and quicker

turnaround time for the patients. Staff are managing any confusion by patients regarding where to

attend appointments and will complete the examination at either site.

Coronary angiography in 2013/14,

Greater than 75% of ACS patients have their angiogram within 72 hours.

� >84% of ACS patients had their angiogram within 72 hours in February (see graph

below).

Greater than 80% of High risk ACS patients have their PCI procedure within 120 minutes.

� Achieved: >92% of STEMI patients have their PCI procedure within 120 minutes in

February (see graph below).

Greater than 90% of accepted referrals for elective coronary angiography will receive their procedure

within 3 months (90 days).

� Achieved: 95% of elective angiography within 3 months in March.

Data taken from ANZAC – QI database (data to January 2014)


7 May 2014

62

Other access and wait time targets

Cardiology Echo Wait Times

× The outpatient wait list increased by 34, with 914 patients waiting for a standard

transthoracic Echo.

Commentary: Cardiology Echo wait times continue to grow, with difficulty recruiting to a vacant

maternity leave position. The service continues to work on efficiency gains, Saturday lists and

training of the trainee sonographer but referral volume continues. Productivity was also affected by

the Xcelera install and equipment trial completed in March and the team are now bedding in the

new systems and resolving a number of issues. Trials for the second replacement ultrasound

machine have now been completed.

Breast screen coverage target 70% women 45-69 years screened in the last 24 months.

� Achieved: 70% (including Maori 68.0% + Pacific 73.1%)

The service met all screening targets during March and is exceeding year to date targets for the total

eligible population and Pacific women. The service is working hard to achieve Maori screening

volumes by June.

BSCM Screening Coverage

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Jul-0

8

Nov

-08

Mar

-09

Jul-0

9

Nov

-09

Mar

-10

Jul-1

0

Nov

-10

Mar

-11

Jul-1

1

Nov

-11

Mar

-12

Jul-1

2

Nov

-12

Mar

-13

Jul-1

3

Nov

-13

Months

Cov

erag

e Maori Coverage

Pacific Coverage

All Coverage

Additional information re access to Breastscreen Services for women with disabilities:

It is a requirement of the BreastScreen National Policy and Quality Guidelines that all sites are

accessible for women with disabilities, and services are audited against these standards. At the time

of making appointments, the service identifies women with a disability, and can schedule additional

time, recommend the best clinic, and discuss any special requirements.

There is a wheelchair hoist on the mobile screening unit, although wherever possible, the service

prefers to screen women who require wheelchairs at the fixed sites, as there is more room

available. The mammography machines can now be adjusted in height and position, so there is less

difficulty with the equipment being too high etc. The service do screen a reasonable number of

women with disabilities, unfortunately this information is not tracked in our data system. The team

make every effort to support women with information and often a support person/ carer will be

encouraged to attend.

Laboratory – Targets for Tests are based on the following requests required urgently (within 60min)

- 90 percentile of four indicative tests Potassium (K), Haemoglobin, PT/INR and Troponin I (TNI) for

Emergency Care within 60 minutes.

� The laboratory is meeting these targets and most cases exceeding the target,


7 May 2014

63

Emergency Care – more than 95% of EC presentations are admitted or discharged in less than six

hours.

� Not Achieved: 94%

Overall month EC volumes reflect the seasonal pattern, but remained higher than March 2013 (up

139), and follows the pattern of previous years. Total EC presentation numbers increased markedly

on February (up 838). The second and fourth week in the month saw in excess of 2000 Emergency

Care presentations and there was wide day-to-day variation:

– The daily range was 256 – 342 presentations/ day; with average 286 presentations/ day – up

from average of 282 in February, and average on Mondays was 319 presentations. Seven days

were over 300 EC presentations, including all five Mondays in the month

Hospital occupancy has remained high – with a number of factors contributing to waitlist breaches,

and one Dot Days recorded. Ward 24 (rehab) reopened in mid month, and new facilities in Harley

Gray are operational.

Monthly EC 6hr LOS Percentage Pass

96

.8%

96

.5%

95

.9%

97

.7%

97

.0%

97

.0% 97

.8%

97

.4%

97

.0%

97

.1%

97

.5%

97

.4%

96

.1% 9

7.2

%

96

.4%

95

.5%

97

.1%

96

.6%

96

.8% 97

.6%

96

.5%

97

.2%

96

.8%

97

.4%

96

.8%

95

.7%

96

.4%

95

.6%

96

.3%

96

.5%

95

.9% 9

7.2

%

97

.0%

96

.3%

95

.4% 96

.4%

96

.2% 97

.1%

95

.6%

95

.9%

96

.6%

95

.5%

95

.6%

95

.9%

95

.2%

94

.6%

70

60

76

26

81

88

74

24

74

63

74

07 7

58

9

74

90

68

35

76

47

75

02

75

84

75

25

81

08

82

08

78

06 7

99

9

73

13

76

61

77

23

73

41

77

03

77

06 78

86

81

42

84

50 86

06

82

15

77

59

74

69 7

67

7

75

18

70

84

79

27

75

66

78

15 8

02

4

88

68

85

91

82

79

81

13

78

22

79

40

78

72

72

28

80

66

80%

85%

90%

95%

100%

Jun

10

Sep

10

Dec

10

Mar

11

Jun

11

Sep

11

Dec

11

Mar

12

Jun

12

Sep

12

Dec

12

Mar

13

Jun

13

Sep

13

Dec

13

Mar

14

Month

Pa

ss %

6000

7000

8000

9000

10000

% pas s Mean LCL UCL Target UCL

The new Medical Assessment is fully operational from Monday 31 March, bringing current areas:

AOU (Adult Observation Unit), Adult Short Stay (monitored patients) and Medical Short Stay

together on the ground floor of the Harley Gray Building. The 42 bed Medical Assessment improves

the acute flow of medical patients, and includes

– 8 beds for patients with low risk chest pain requiring cardiac monitoring,

– 13 beds assessment area for medical patients directly referred by GP’s or from Emergency Care

– 21 beds short stay area for patients staying less than 28 hours.

Next steps

A communication campaign about wise choices related to winter wellness and what to do when you

are acutely unwell and the related options.

Pilot a Discharge/ Transition Lounge to reduce time for transfer to inpatient setting during the

morning when patients are presenting to EC.

Winter planning is well underway; with new initiatives to be trialled including more focus on patients

with a LOS >10 days and more nurse-led discharges during the week, discharging earlier in the day

and use of a Discharge/ Transit Ward is currently being discussed. Currently the Acute and Post


7 May 2014

64

Acute Clinical Nurse Specialists (APAC) focus on turning medicine admissions around at the “front

door” and commencing early discharge planning for patients on presentation, which reduces

capacity to address long stay patient needs.

There is a suggestion that there may be locality nurses available to work in EC functioning in a similar

way to the APAC nurses, and be more knowledgeable or have relationships with services available in

the community.

Increasing access to specialist appointments; all out-patients accepted for services are provided

this service within 150 days and from December 2014 within 120 days

� Achieved

Commentary All medical services achieved the targets this month. The total number of patients on

the waiting list for an FSA has decreased by 107 patients from last month. There has also been a

decrease in patients waiting >90 days by 169 patients (a 50% decrease from last month) across all

services but most noticeably Respiratory and Sleep. The patients waiting >120 days have also

reduced.


• Gastroenterology – The department is continuing to work on efficiencies utilising the National

Endoscopy Quality Improvement Programme (NEQIP) methodology and tools, along with the

Gastroenterology Service Improvement Project. The main focus is on developing a robust

referrals management process, to reduce delays to diagnosis and treatment. A new referrals

clerk position and referrals process will be managed centrally in the Gastro department to

increase efficiency and timeliness. Production planning continues with the FSA production plans

now available.

• Medical Wards the average “Seen by” times for General Medicine remain under 60 minutes for

Triage Category 3-5, which is much improved since the roster changes made in December 2013.

The SMART model aims to see all patients referred to general medicine be seen within 60

minutes using the SMART Model. The graph below shows the trend in time to be seen by

general medicine.

0:20

0:40

1:00

1:20

1:40

2:00

Jul-1

2

Aug

-12

Sep

-12

Oct

-12

Nov

-12

Dec

-12

Jan-

13

Feb

-13

Mar

-13

Apr

-13

May

-13

Jun-

13

Jul-1

3

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun-

14

Average Time from Gen Med Referral to Gen Med Seen by

Gen Med Patients (baseline)

SMARTed Patients Only

• The Renal Service upgraded Clinical Vision database continues to be implemented in the Renal

Service, along with an additional application for management of transplant patients, Graft


7 May 2014

65

Vision. The upgraded system will allow for clinical and management reporting and provide more

real time data and reduce the need for manual data entry.

The Renal Haemodialysis Facility Procurement Project is continuing. Comparisons and cost

analysis between options of providing the facility ourselves or utilising space at MMH and a

supplier providing the facility and service have been explored and a paper with analysis of

findings, comparisons and recommendations will be completed and presented to ELT and then

the Board.

• Radiology – There was a major outage of the network connecting CM Health to ADHB during

March, which significantly impacted on the RIS and PACS creating delays in imaging, cancellation

of patient appointments and backlogs in reporting. There has been a long period of catch up

and reports. The business case for replacement of the current Agfa enterprise image viewer has

been endorsed to proceed.

• Cardiology The Telemetry system remains operational despite being unsupported by vendor

with no significant issues in March. Clinical Engineering team have additional spare parts to

extend the systems longevity and a failure shutdown plan is in place. The final costing

information is being complied by health Alliance working alongside the vendors. The business

case is in the process but a final recommendation requires organisation direction on the use of

WiFi.



Enhancing Cancer Multidisciplinary Meetings (MDM) – The first MDM videoconference facility will

go live in early May 2014. Work continues to establish baseline MDM performance in terms of

clinical participation and volume of patients presented, and this is aligned with the Ministry of

Health MDM guidance document to establish a consistent process and structure.

20,000 Days Collaborative Programmes

• Healthy Hearts Seven programme graduates/current participants completed

Round the Bays – 8.4 km walk. The team presented an update to the 20,000

days campaign sponsors for Year 2 funding, and continues to work with Ko

Awatea on data and measures methodology. Use of space at Fitness Plus has

been confirmed to undertake exercise assessments.

• Better Breathing and VHIU - the Business case for sustainable funding has been developed

between the respiratory service and Locality General Managers. This case has been submitted

via the Localities leadership as an integrated approach. Work on the ‘how to’ guide continues as

part of the 20000 Days collaborative.

• SMOOTH project has progressed significantly with work on spread and improving the use of the

checklist for high risk discharges in medical, surgical and ATR. Further development is currently

on hold, pending funding decisions. Over 44% of high risk patients from adult medical and

surgical services are receiving a discharge medicines management service. The “How to Guide”

has been completed and published, and there is interest from other DHBs in this initiative.

• SMART project- The model of care has been rolled out to all 15 general medical teams covering

all week days admitting teams till 10pm. The SMART model is operating with the Medical

Assessment Unit and further improvement test cycles are currently underway to increase the


7 May 2014

66

coverage of patients seen. The SMART project presented an update to the 20,000 days

campaign sponsors for Year 2 funding, and also at the last CEO’s staff forum.

• Inpatient Care for People with Diabetes work continues with the development of Guidelines,

Frequent flyer data, and revised Care Plans. The Insulin prescription guidance is being rolled out

in wards, and a Handover data base created, with new Alerts/flags for patients identified as

having diabetes to make them identifiable when inpatients. Resources prototype for review by

the team. Podiatrists have been appointed, have referral criteria, and are working on guideline.

Diabetes Type 1 cases are being seen by dietician whilst inpatient. The team presented an

update to the 20,000 days campaign sponsors for Year 2 funding.

• Feet for Life (Renal) work required on the change packages identified and now being tested in

Rito Dialysis unit, and to start in Scott Building Dialysis unit in May. Podiatrist has now seen 67

high risk patients. The team presented an update to the 20,000 days campaign sponsors for

Year 2 funding.

6.3.5 PATIENT and WHANAU CENTRED CARE Providing care that is respectful of and responsive to

individual patient preferences, needs, and values and ensuring that patient values guide all

clinical decisions

• Advance Care Planning Funding for 2014/15 has been secured and the project plan is being

updated to move the project into business as usual over the next 12 months. A ‘Conversations

that Count’ day on 16 April, has helped raise awareness across CM Health about this approach.

A qualitative research project on patient and family/whaanau experience of the ACP pathway is

going through the Ethics process before commencement in May 2014. In excess of 450 Advance

Care Planning patient conversations occur per month, and 70 DHB and locality staff have been

trained at level 2 with further training opportunities in April and June 2014. Work has

commenced to introduce Advanced Care Planning to the Renal Service in order to have a

documented plan for treatment choices in a patients’ clinical record. To date, 126 patients have

discussed ACP, and 47 signed off plans are complete

• Renal “Home and Kidney First” The treatment criteria and a patient letter explaining the new

policy are under development. The current percentage is 41%, (against target 50% of patients),

which is a drop from last month. This is due to a number of patients having to have interim in-

centre haemodialysis or receiving, happily renal transplants in the month.

• The renal live donor project for Ministry of Health continues with the recent website launch-

www.kidneydonor.org.nz Engagement with Stakeholders at the first community engagement

event was very successful on 25 March, with the Minister of Health launching the new resource

material.

• Bereavement Care referrals This initiative provides an opportunity for responding to concerns

raised by families about their experiences when a loved one dies in hospital, and to identify how

practices can be improved when working with dying patients and their families. Concerns may

be resolved by phone calls, letters and meetings. In March there was one family meeting; the

key issue concerned communication related to end-of-life care.

• Complaints/ Compliments


7 May 2014

67

7 Women’s Health and Kidz First

7.1 SERVICE PERFORMANCE 7.1.1 Activity summary – at 14.04.14

Inpatient Cases /Discharges:

Kidz First Inpatient WIES /Births/Outpatients Inpatient Cases /Discharges:

Women’s Health Inpatient WIES /Births/Outpatients Inpatient Cases /Discharges:

Inpatients

Kidz First Medicine / EC/ NNU WIES remain very similar to last year. Discharges are up slightly.

Volume

Contract Last YTD

WIES Act Contract Variance % variance Act Contract Variance % variance Forecast Act

KF EC 65 67 -2 -3% 661 655 6 1% 867 847 Pead Medicine 190 191 -1 -1% 2266 2292 -26 -1% 3000 2936Pead ICU 0 5 -5 -100% 22 19 3 16% 25 37NICU - Unit 177 225 -48 -21% 1978 1754 224 13% 2668NICU-WH 48 32 16 50% 422 343 79 23% 484 KF Surgical Acute 181 186 -5 -3% 1559 1645 -86 -5% 2018 2018KF Surgical Elective 66 95 -29 -31% 701 785 -84 -11% 1086 1086

Total KF (WIES) 727 801 -74 -9% 7609 7493 116 2% 9896 10076

Contract Last YTD

OUTPATIENT Act Contract Variance % variance Act Contract Variance % variance Forecast Act

KF FSA 161 175 -14 -8% 1516 1372 144 10% 1700 1849KF FU 277 259 18 7% 2401 2243 158 7% 3060 2851Virtual FSA 6 40 -34 -85% 294 328 -34 -10% 400 429 Total KF Outpatient 444 474 -30 -6% 4211 3943 268 7% 650 638

Discharges

Discharges Act Contract Variance % variance Act Contract Variance % variance

KF EC 248 247 1 0% 2387 2402 -15 -1%Pead Medicine 383 398 -15 -4% 4265 4171 94 2%Pead ICU 0 4 -4 -100% 25 34 -9 -26%NICU - Unit 62 74 -12 -16% 574 540 34 6%NICU-WH 96 91 5 5% 1028 893 135 15% KF Surgical Acute 199 190 9 5% 1590 1546 44 3%KF Surgical Elective 108 133 -25 -19% 1075 1230 -155 -13%

Total KF (Discharges) 1096 1137 -41 -4% 10944 10816 128 1%

Month YTD

2900

Month YTD

Month YTD

Volume

Contract Last YTD

WIES Act Contract Variance % variance Act Contract Variance % variance Forecast Act

WH Gynae Acute 136 120 16 13% 1192 1167 25 2% 1550 1444WH Gynae Elective 142 148 -6 -4% 1180 1116 64 6% 1500 1638WH Primary Unit (WIES equivalent) 192 181 11 6% 1709 1769 -60 -3% NA 2316WH Secondary 575 505 70 14% 4531 4717 -186 -4% 1500 1638

Total WH (WIES) 1045 954 91 29% 8612 8769 -157 -2% 4550 7036Births (Deliveries) 630 630 0 0% 5462 6012 -550 -9% 7894 7894

Contract Last YTD

OUTPATIENT Act Contract Variance % variance Act Contract Variance % variance Forecast Act

Gynae FSA 238 213 25 12% 2167 1828 339 19% 2500 2655Gynae FU 265 234 31 13% 2208 2229 -21 -1% 3000 2778Gynae VFSA 28 23 5 22% 248 157 91 58% N/A 226 Colp 199 208

-9 -4% 1854 1,875

-21 -1% 2500 2656

Colp HC 15 22 -7 -32% 147 199

-52 -26% 265 268

Colp HC in OT 4 7 -3 -43% 61 64 -3 -5% 85 109 Gynae HC 67 54 13 24% 587 488 99 20% 650 638

Discharges

Discharges Act Contract Variance % variance Act Contract Variance % variance

WH Gynae Acute 285 243 42 17% 2248 2166 82 4%WH Gynae Elective 170 157 13 8% 1287 1236 51 4%Total WH (Discharged) 455 400 55 26% 3535 3402 133 4%

Month YTD

Month YTD

Month YTD


7 May 2014

68

Kidz First Surgical Inpatient acute WIES continues to be low (YTD 5 % down). However, acute

discharges are up for the month and YTD up by 3% suggesting a different casemix to last year.

Volumes vary significantly with children with severe burns (low volume but high WIES) this year has

seen fewer children with severe burns. Kidz First Surgical elective WIES and Discharges both

continue to be down

Kidz First Neonatal WIES for babies discharged from the Neonatal Unit in March was down.

However, for babies discharged from both the Neonatal Unit and the postnatal floor attracting a

Neonatal WIES, the YTD WIES volume remains significantly higher (up 13%). Discharges from the

Unit are up by 6% only which is reflecting the very high acuity we have seen over the first 3 months

of 13/14 and again in January and February 2014.

Maternity

The decreasing trend in birthing volumes YTD has continued, however, in March 2014 the same

number of births occurred as March 2013 (630 for the month). For the month, there were 23 more

births at Middlemore but 23 less at the 3 community units. YTD the community units are down by

107.

While discharges are down, there is a much smaller decrease in WIES or WIES equivalent from both

Middlemore (4%) and the 3 Community Units (3%) reflecting the higher clinical complexity and

acuity reported from the maternity areas.

Births per month at CM Health facilities

July 2011 to June 2014

500

550

600

650

700

750

800

July

Septe

mber

Novem

ber

Janu

ary

Mar

chM

ayJu

ly

Septe

mber

Novem

ber

Janu

ary

Mar

chM

ayJu

ly

Septe

mber

Novem

ber

Janu

ary

Mar

chM

ay

Births

year mean

The Caesarean rate for March 2014 is 24.29% and the YTD rate is now 22.87%. The absolute

volumes are down on last year (1,249 in 13/14 against 1,277 in 12/13) but with the drop in actual

birth volumes the rate has increased.

Gynaecology WIES and discharges continue to be up for both acutes and electives.

Outpatient volumes across Kidz First and Women’s Health (Gynaecology) are up for FSAs, and also

up for Follow up clinic in Kidz First. This reflects the ongoing pressure of children with

developmental/ behavioural/ disability conditions requiring longer term management in secondary

care. Lower Gynaecology Follow up clinic volume continues to reflect the excellent work in working

with Primary Care in reducing unnecessary appointments.


7 May 2014

69



Division: Kidz First


REVENUE



126 115 11 10% Other Income 1,287 1,036 251 24%

73 33 41 124% Funder Payments 659 294 365 124%

216 148 69 46% Total Revenue 1,979 1,331 648 49%

EXPENDITURE

2,603 2,427 (176) (7)% Staff Costs 23,282 22,494 (788) (4)%

10 24 15 60% Outsourced Costs 378 220 (158) (72)%

180 165 (15) (9)% Clinical Costs 1,508 1,528 20 1%

71 84 12 15% Infrastructure Costs 756 812 56 7%

(107) (13) 94 712% Internal Allocations (874) (119) 755 637%


(2,541) (2,540) (1) (0)% Net Result (23,072) (23,605) 533 2%

363 318 (44) (14)% FTE 348 322 (26) (8)%


($000's)

CMDHB Provider

($000's)

Monthly Net Result

-3,500

-3,000

-2,500

-2,000

-1,500

-1,000

-500

-

Mar-13Apr-13

May-13Jun-13

Jul-13Aug-13

Sep-13Oct-13

Nov-13Dec-13

Jan-14Feb-14

Mar-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


-

100

200

300

400

500

600

700

800

900

1,000

Mar

-13

Apr-1

3

May

-13

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-13

Jan-

14

Feb-1

4

Mar

-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget

Monthly Staff Costs

-

500

1,000

1,500

2,000

2,500

3,000

3,500

Mar

-13

Apr-1

3

May

-13

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

Jan-

14

Feb-1

4

Mar

-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


7 May 2014

70

Mar-14 YTD

Total Variance: $(1) $533

Revenue: $69 $648


Outsourced: $15 $(158)

Clinical Supplies: $(15) $20


Internal Allocation: $94 $755


$94k MTD

Additional revenue for various projects (not budgeted) are offset against costs, i.e.Gateway $37K, ManaKidz $69K

$755k YTD

Additional revenue for various projects (not budgeted) are offset against costs, i.e.Gateway $333K, ManaKidz $464K

Additional costs for various projects (not budgeted) are offset against additional revenues/internal allocations from the funder, i.e. Gateway, Alternative Education,

Ccrep Research, ASD, and Mana kidz. NICU was moved from Galbraith to Harley Gray Building and KF Cpod in Mid Feb 2014. Operating NICU in 2 locations are

incurring unbudgeted costs. In addition, NICU experienced a higher level of acuity level 3 babies in March 2014 who required a high number of specials. High sick

leave, education leave, orientations and ACC leave in March 2014 have had a negative impact.

$(176)k MTD

Medical - $(53)K unfav (Junior doctor rotation transactions in March 2014)

Nursing- $(94)K unfav (mostly due to NICU move to HGB and KF C-pod and additional costs for various projects (not budgeted) offset against additional revenues)

Allied Health- $(4)K unfav additional costs for various projects (not budgeted) offset against additional revenues)

Clerical - $(24)K unfav costs offset by additional revenues

$(788)k YTD

Medical- $159K fav (partial off set against locum costs)

Nursing- $(806)K unfav (costs offset by additional revenues. High sick, study, orientation and additional duties for NICU move)

Allied Health - $(55)K unfav costs offset by additional revenues

Clerical - $(86)K unfav costs offset by additional revenues

Additional costs for various projects (not budgeted) are offset against additional revenues.

$69k MTD

Funder Payments: Alternative Education $31K, Ccrep Research $10K

Government Revenue: ACC $16K

Other Income: ASD $10k

$648k YTD

Funder Payments: Alternative Education $284K, Ccrep Research $100K

Government Revenue: ACC $32K

Other Income: ASD $97K, Health Promoting Schools $72K and misc revenue (i.e. various small research funds and one-off revenues)

On Track for the month of March 2014

$(158)k YTD

$(26)K for University additional duties (budgeted under doctors salary account)

$(66)K for External Bureaus to address nursing vacancies and skill mix issues in KF inpatients (mostly in NICU)

$(10)K for Admin Casual

$(51)K for research costs - offset against additional revenue

$(15)k MTD

This is mostly due to high acuity and higher number of level 3 babies in NICU in March 2014

$20k YTD

Less activity in KF surgical and KF medical has impacted favourably on clinical supplies due to lower consumption.

CMDHB Provider

Kidz First Medicine /EC/ICU Inpatient WIES remains very similar to last year. Volumes for the service are on track YTD; WIES YTD actual 7609, contract 7488. Close

monitoring of NICU volumes has been enforced in the service to mitigate potential cost over runs.

Due to Level 3 NICU in Harley Gray and Level 2 NICU in KFMed C-pod, we have additional FTEs until end of May 2014

We are anticipating increased costs in NICU but the service will meet the 2013-14 budget.

Revenue for projects are recovered on a monthly basis. Lower volumes in KF Medical and KF Surgical has assisted in maintaining this level of favourable variances.

Financial Commentary - Kidz First

$114

On Track for the month of March 2014

$56k YTD

Savings have been made in bedding and linen due to reduced volumes in KF surgical and KF medical for the year.

2014-2015 Bedding and Linen budget has been reduced by $39K against 2013-2014 budget to reflect lower contract prices.


7 May 2014

71


Division: Women's Health


REVENUE



42 3 39 1,565% Other Income 225 23 203 902%


48 9 39 453% Total Revenue 290 78 212 271%

EXPENDITURE

2,635 2,588 (47) (2)% Staff Costs 23,772 23,931 159 1%

127 67 (61) (91)% Outsourced Costs 1,032 602 (430) (71)%

135 146 11 7% Clinical Costs 1,208 1,264 56 4%


26 46 20 (43)% Internal Allocations 277 410 133 (32)%

3,033 2,981 (52) (2)% Total Expenditure 27,372 27,422 50 0%

(2,985) (2,972) (13) (0)% Net Result (27,082) (27,344) 262 1%

354 335 (19) (6)% FTE 349 335 (14) (4)%

CMDHB Provider


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

Monthly Net Result

-3,500

-3,000

-2,500

-2,000

-1,500

-1,000

-500

-

Jul-13Aug-13

Sep-13Oct-13

Nov-13Dec-13

Jan-14Feb-14

Mar-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


-

100

200

300

400

500

600

700

800

900

1,000

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

Jan-

14

Feb-1

4

Mar-1

4

Mo

nth

ly r

esu

lt $

00

0's

Result Budget

Monthly Staff Costs

-

500

1,000

1,500

2,000

2,500

3,000

3,500

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-13

Dec-1

3

Jan-

14

Feb-1

4

Mar-1

4

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


7 May 2014

72

Mar-14 YTD

Total Variance: $(13) $262

Revenue: $39 $212

Salaries & Wages: $(47) $159

Outsourced: $(61) $(430)

Clinical Supplies: $11 $56


Internal Allocation: $20 $133

On Track for the month of March 2014.

$131k YTD

Savings have been made in bedding and linen due to reduced volumes of deliveries.

2014-2015 Bedding and Linen budget had been reduced by $47K against 2013-2014 budget to reflect lower contract prices.

The expectation is to meet budget for 2013/14 with a small favourable variance.


$20k MTD

Additional revenue for various projects (not budgeted) are offset against costs, i.e. BFA ($11K), Safe Sleep ($7K)

$133k YTD

Additional revenue for various projects (not budgeted) are offset against costs, i.e.BFA ($96K), Safe Sleep ($64K)

$11K MTD: on track

$56k YTD: Lower use of clinical supplies due to reduced volumes of deliveries.

$116

Financial Commentary - Women's Health

Additional costs for various projects (not budgeted) are offset against additional revenues, i.e. Ccrep Research,MoH complex Care course .

High sick leave, education leave, orientations and ACC leave in March 2014 have had a negative impact.

$(47)k MTD

Medical- $(5)k unfav junior doctor annual leave transfers

Nursing/Midwives- $9K fav (despite of high sick, study, orientation, costs offset by additional revenue). Increased costs are anticipated due to 5 graduate midwives

commencing in February with another 10-15 due to commence in May 2014.

Allied Health- $(11)K unfav costs offset by additional revenues

Clerical - $(40)K unfav mostly due to increased number of MW clinics and preparing for MCIS implementation for WH and KF costs offset by additional revenues.

$159k YTD

Medical- $342k fav (less experienced junior doctors and discontinuation of weekend day and night payments for SMOs)

Nursing/Midwives- $151K fav (mostly due to MW vacancies partially offset against high sick, study, orientation, additional duties for NICU move)

Allied Health - $(63)K unfav (offset by additional BFA revenues)

Clerical - $(224)K unfav mostly due to increased # of MW clinics and preparing for MCIS implementation

KPI's for the service are on track against contract, although deliveries are 9% down YTD against last year's actual. March 2014 delivery numbers are similar year on

year. Delivery numbers at MMH were up by 23 and community units down by 23 for the month.

$(61)k MTD

$(2)K for colposcopy sessions

$(47)K for External Bureaus to offset MW / Nursing vacancies and skill mix issues

$(20)K for AUT MDES (Midwifery Development) - not budgeted - proposal to be funded by Maternity Review Board.

$(430)k YTD

$(16)K for colposcopy sessions

$(330) for External Bureaus to offset MW / Nursing vacancies and skill mix issues. Note that 5 graduate midwives commenced in February with another 10-15 due to

commence in May 2014. While there will be supernumerary during their 6 week orientation they will offset the vacancies and stablise MW/RN FTEs in 2014 15.

$(6)K for Admin Casual

$(127)K for AUT MDES (Midwifery Development) - not budgeted - proposal to be funded by Maternity Review Board.

CMDHB Provider

Additional costs for various projects (not budgeted) are offset against additional revenue.

$39k MTD

Other Income: MoH complex Care course $10K, AUT student days $15K, safe sleep $4K, clinic room rental $5K and miscellaneous $5K for the month of March 2014

$212k YTD:

Other Income: MoH complex Care course $30K, AUT student days $49K, clinic room rental $41K, safe sleep $47K, and miscelleaneous $6K (tech skills, research)


7 May 2014

73



The safety measures for the Kidz First and Women’s Health service are shown in the table below

which include the following:

• Safety measures ward based audits associated with emergency trolley, hand hygiene, fall

prevention/intervention, MRO screening, pressure injury assessment/intervention continue.

• Safe Sleep and Violence intervention - educational programme are being rolled out.

• CLAB Prevention insertion and maintenance bundle compliance is monitored.

• Surgical Site Infection Caesar wound infection surveillance as part of the SSI programme is slow

to gain traction. Surveillance forms completed for Jan 2014 was 29%. Community midwifery

completion was 85% but Ward only 41%. Further work is required for the Wards and Theatre to

improve the completion of forms.

• Winter Flu staff vaccination Strategies are in place to ensure uptake of flu vaccination,

particularly for areas such as midwifery and neonatal care. Strategies include peer vaccinators

and public health nursing staff providing on-site vaccination for maternity and neonatal areas

over the Easter holidays.

Safety Service

- = no data available in report system

KF

Me

dic

al

KF

Surg

ica

l

NN

U

GC

U

ALB

U

Ma

t. N

ort

h

Ma

t. S

ou

th

Pa

pa

kura

Bo

tan

y

Pu

keko

he

Emergency Trolley checks – target 100% 93 94 83 97 74 70 55 84 100 -

Hand Hygiene – target 100% 93 - - - - - - - - -

Falls prevention assessment - target 100% - -

Falls intervention – target 100% - -

Safety Service

- = no data available in report system

KF

Me

dic

al

KF

Su

rgic

al

NN

U

GC

U

ALB

U

Ma

t. N

ort

h

Ma

t. S

ou

th

MRO screening – target 100% 95 45 0 85 37 -

Pressure Injury Assessment - target 100% 80 100 - - - 100 80

Pressure Injury Intervention - target 100% 100 75 20 - - 80

BPEWS/PUP/MEWS tool –

target 100%

100

CLAB Prevention -

insertion bundle - target 100%

100

CLAB prevention-

maintenance bundle- target 100%

93

Note: Women’s Health and Kidz First are focussing on the above patient safety measures on each

ward and putting in place processes to ensure ward audits that are completed are entered on the

data reporting system. This is over and above the organisational hand hygiene sentinel (7) site audits

completed by Gold Standard auditors in February, June and October each year.


7 May 2014

74


Timely Measures Result

Six Hour EC LOS Target – 95% of EC

presentations are seen/ admitted/

discharged within 6hrs

� Achieved

Paediatric Medicine: 99.2%

Gynaecology : 97 %

FSA <150 Days - Kidz First outpatients � Achieved (NB 2 Paediatric breaches noted in other

reporting)

FSA <150 Days - Women’s Health

Gynaecology

� Achieved


Efficiency Measures Result

ALOS Kidz First Surgical Actual YTD 2.40 vs. 2.43 for 2012/13

ALOS Neonatal Care Actual YTD 11.70 vs. 12.4 for 2012/13

Compliance with NCNZ (Nursing Council

New Zealand) competency requirement

– quarterly report

Compliance for Oct – Dec 2013 Q2 was

Women’s Health = 93.9%

Kidz First = 90%



Effectiveness Actions

(Right care right place right time)

Result/ Progress

Clinical Pathways Development:

Menorrhagia/ PID/ Hyperemesis

Contraception

Pilot underway

Maternity Project Board workstream

Locality Development :

Obstetric clinics in Mangere / Otara

locality

SMO Obstetric clinics have not commenced as yet

7.3.5 EQUITY

Equity Actions

(Better outcomes for all campaign)

Result/ Progress

New Born Hearing screening

90% target.

YTD March percentage coverage is 95% - this includes children

screened at hospital and outpatient clinics (for those who

have missed their hospital screen)

B4 school checks Overall for quarter 3: 70% (target was 75%).

Hearing Initial Screen: 1051, Rescreened: 113

Vision Initial Screen: 1055, Rescreened: 62

Increase LMC access / market share

At Birth

At registration (target 51%)

YTD March 2014 = 58%

March 2014 = 50%

Prevention and screening measures commentary:

Rheumatic Fever Review of actual cases of Acute Rheumatic Fever (ARF) continues, with timeframes

for notifications of ARF to Auckland Regional Public Health being monitored. A regional discussion

on treatment options is to occur in early April. The biggest challenge is adherence by family and

children to antibiotics (i.e. completing the 5 or 10 day course). The Auckland-wide Housing Initiative

(AWHI) Hospital referral process was initiated in March – with 18 referrals during the month,

community AWHI referrals were over 60 for month.


7 May 2014

75

Rheumatic Fever Improvement targets – managed by Locality General Managers, General Manager

Kidz First and Women’s Health and Ko Awatea.

Targets:

• All Rheumatic Fever patients managed by Home Health Care will receive their monthly injection

within the 5 day tolerance time frame.

• There will be nil medication errors for this population.

The Rheumatic Fever Liaison Nurse will commence in April, and will complete a root cause analysis

of missed treatments. The Community Support Worker role and responsibilities and the Did Not

Attend process are being reviewed to achieve consistency. Text messaging patients seen in the

community has made good progress and will continue to be tested on a small group of patients

across two Localities. Good feedback from patients has been received with a slight reduction in

missed injections. The Patient Experience Programme has used a questionnaire to identify issues

with overall positive feedback, and a focus group will discuss the points raised. A High School will

further this work with their students and their parents. A questionnaire for patients who do not

attend regularly is being developed to try and identify issues.

HPV vaccinations are on track for meeting the MoH target coverage for girls in the 2014 school year.

Exclusive breastfeeding rates at discharge from hospital (BFHI target is > 75%) were Middlemore

Hospital Overall = 77% (Maaori = 78%, Pacific = 73%)



clinical decisions

Patient and whaanau/fono centred care

Increase postnatal Length of Stay for 40% of

women with high needs

March YTD = 2.73 days for first time mothers

(target 2.6 ALOS)

• Complaints / Compliments Kidz First – one complaint received and has been resolved, six

compliments and two concern/suggestion. Women’s Health – five complaints received, both

awaiting resolution, with 27 compliments received.


7 May 2014

76

8 Mental Health


8.1.1 National targets - Mental Health 3 Key Performance measures:

PP6 is Total access rates for all ethnicities to Mental Health service by age group;

PP7 is Proportion of clients with an up to date RPP plan;

PP8 is shorter waits for non urgent Mental Health and Addiction Services;

PP6 National Total access rates for all ethnicities to Mental Health service by age group

Measure Actual

Mar

Target Variance Action

PP61 Number of Unique

Clients –Maori 0-19

4.19% 4.45% (0.26)% Cultural capability remains a focus; high

deprivation populations (Papakura, Mangere

and Manurewa) need a targeted approach. A

key focus is implementation of school based

services and locality/ community alignments.


Clients – Total 0-19

3.06% 3.07% (0.01)% Client/clinician contacts have increased. May

indicate more intensive care provided to the

same client group for extended periods.

Actions underway include:

Team managers paper review of clients,

Progress care bundles (clinical pathways)

implementation, and development of

electronic job planning HCC.


Clients –Maori 20-64

8.20% 7.75% 0.45%


Clients – Total 20-64

3.76% 3.07% 0.69%


Clients – Maori 65+

2.80% 2.80%


Clients – Total 65+

2.57% 2.80% (0.23)% Referral rates have been slowly increasing over

the past few months.

PP7 is Proportion of clients with an up to date RPP plan

Measure Actual

Feb

Actual

Mar

Target Variance Action

PP7 Proportion of clients

with an up to date RPP

plan (Adult community)

90.4% 95.6% 95% 0.6% Very pleasing result plans to maintain this

include clinical governance embedding a

quality and clinical relevance approach to

RPPs.

Child / Adoles.

Community MHS

90.4% 96.9% 95% 1.9%


7 May 2014

77



Division: Mental Health


REVENUE



4 10 (6) (60)% Other Income 44 90 (46) (51)%


7 13 (6) (45)% Total Revenue 74 121 (46) (38)%

EXPENDITURE

5,207 5,367 160 3% Staff Costs 45,329 47,141 1,812 4%

156 31 (125) (410)% Outsourced Costs 1,709 275 (1,434) (522)%

16 17 1 6% Clinical Costs 140 156 16 10%


30 33 4 (11)% Internal Allocations 281 297 16 (5)%


(5,627) (5,675) 48 1% Net Result (49,391) (49,920) 528 1%

670 674 4 1% FTE 641 674 32 5%

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

CMDHB Provider


Monthly Net Result

-5,900

-5,800

-5,700

-5,600

-5,500

-5,400

-5,300

-5,200

-5,100

-5,000

-4,900

Mar-13

Apr-13

May-13Jun-13

Jul-13Aug-13

Sep-13Oct-1

3Nov-13

Dec-13Jan-14

Feb-14Mar-1

4

Mon

thly

resu

lt $

000's

Result Budget


-

100

200

300

400

500

600

700

800

Mar

-13

Apr-1

3

May

-13

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-

13

Nov-1

3

Dec-1

3

Jan-

14

Feb-

14

Mar

-14

Mo

nth

ly r

esu

lt $

000's

Result Budget

Monthly Staff Costs

4,200

4,400

4,600

4,800

5,000

5,200

5,400

5,600

Mar

-13

Apr-1

3

May

-13

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-

13

Nov-1

3

Dec-1

3

Jan-

14

Feb-

14

Mar

-14

Mo

nth

ly r

esu

lt $

000's

Result Budget


7 May 2014

78

Mar-14 YTD


Revenue: $(6) $(46)

Salaries & Wages: $160 $1,812

Outsourced: $(125) $(1,434)

Clinical Supplies: $1 $16




The favourable variance is mainly driven by vacancies in the Community.

The main items of underspends are vehicle related expenses ($6k for the month and $116k YTD) and deferred maintenance ($47k YTD). As the community vacancies

are filled and the service gears to provide services to the clients in their locality, the monthly underspend in vehicle related expenses will reduce.

The financials are tracking well against budget. Though the acute demand management costs remain high, this has been more than off-set by the vacancies in

community. The vacancies in the community have resulted in underspends in Nursing , Allied Health and Admin ($25k for the month and $903k YTD) and also

vehicle related expenses ($9k for the month and $116k YTD) off set by overspend in Medical Staff ( $583k YTD). The service has made good progress in reducing

overtime costs- $96k for March 14 as against $154k in the corresponding month of March 13.

Medical staff is underspent by $134k for the month and $907k YTD. There is a national shortage of psychiatrists and therefore locums, mainly from overseas are

contracted to provide services (ref outsourced services below). The vacancies in the community have resulted in underspends in Nursing , Allied Health and Admin

($25k for the month and $903k YTD).

The main reason for the variance is the spend in Locum Medical staff (129k for the month and $1490k YTD). This is partially off-set by the favourable variance in

Medical Staff salaries ($134k for the month and $907k YTD).

CMDHB ProviderFinancial Commentary - Mental Health


Framework for Change update Over the past month work streams have continued to meet to

prepare for implementation of the new adult acute pathway and its components. There have been

delays to implementation, mainly due to progressing requirements regarding rosters, and person

descriptions. The requisite work has been completed and will be presented at the next PSA meeting.

Acute Pathway- Three day testing of the pathway is planned, to check the new processes (such as

triage), and the roles for health professional and coordinator. The testing is scheduled for early April.

Mental Health Short Stay - A business case was presented to ELT for staffing, with 2 staff seconded

to support the establishment of the Short Stay concept. It is expected that an appraisal of the

environment will be undertaken and a suitable location for MH Short Stay will be undertaken. In

conjunction with Emergency Care, the initial focus will be on the service users with mental health

problems that present at Emergency Care for physical concerns such as self harm.

Supported Discharge Team- the clinicians recruited to this team are continuing to support service

users on discharge from Tiaho Mai. The 6 month secondment for Pacific role has commenced, with

the Maori role re-advertised.


Mental Health Acute 28 Day Readmission rate –

There were only 4 clients readmitted to Tiaho Mai within 7 days of their discharge. These

readmissions were due to a relapse of mental illness due to a variety of factors including substance

misuse and medication compliance.


7 May 2014

79

8.3.2 TIMELINESS: Every Hour Counts” if we are to achieve quality and safety outcomes

PP8 National Shorter waits for non-urgent mental health and addiction services: Mental Health

Provider Arm - <= 3 weeks

Total Target

2013/2014

Actual

2013/2014

Quarter 1

Actual

2013/2014

Quarter 2

Actual

2013/2014

Quarter 3

Variance

0 – 19 years 75% 76.05% 75.3% 72.93% (2.07)% Rollout of point of entry

urgent response being

trialled to reduce waiting

time. 20 – 64 years 80% 87.48% 87.9% 87.54% 7.54%

65 + years 80% 88.33% 89.1% 88.59% 8.59%

Total 78.1% 83.95% 83.4% 82.21% 2.21%


Adult Inpatient Services – Tiaho Mai: Occupancy remains at or near 100%, and does not capture the

over-census use. Fourteen clients waited from between 50 minutes and 17 hours to be admitted,

with the majority waiting 2 – 5 hours. Wait times have been able to be reduced by the Supported

Discharge clinician providing quick service to those being discharged. The over- census numbers

result in both the community teams and Tiaho Mai staff remaining with clients to address acuity

factors that are challenging to manage in spaces not designed for acute psychiatric interventions.


7 May 2014

80

Length of Stay The average length of inpatient stay has increased in March, but is consistently better

than 12 months ago. Recently, a number of clients with high acuity and poor response to treatment

have required Mental Health ICU for relatively long periods, while further treatment options are

explored.

Eight clients discharged in March with a length of stay of greater than 35 days. However, 10 clients

remain with a length of stay greater than 35 days. Some clients are waiting for supported discharge,

with delays to access mental health residential rehabilitation options leading to longer stays in

hospital. Wait times for mental health community residential rehabilitation facilities have been 3 – 4

months or longer. In order to improve the throughput of the residential rehab beds, a clinical review

is underway of people currently in the service and their future plans. All clients are having updated

Needs Assessment completed. Mental Health services do work closely with NGO providers and

community clinical teams on these cases and the proposed ‘whole of system’ approach will make a

positive difference.

Mental Health Services for Older People (MHSOP) Occupancy rate has reduced in comparison to

February but remains higher than the average occupancy. This is the fifth month where the

occupancy rate has been at 95% or higher. However acuity in the ward reduced in March.

Adult community Service: Clinician contacts - there was an increase in clinician contacts during

March, with an increase from 16,506 in February to 18,512 in March. This is consistent with the

historical pattern, with February having only 19 working days. Contacts remain higher than in

2012/13.


7 May 2014

81

Child and Youth Service: Clinician contacts – Significant increase in clinician contacts during the

month of March, reflecting communicating the expectation clinicians plan for 3 face to face contacts

per day, and in line with increases in previous years at this time.



7 Day Post Discharge Contact 82.35 % of clients were seen within 7 days of discharge from Tiaho

Mai. This is expected to increase when data from the first week in April is included. (Note: February

was 76.2%, but increased to 85.71% when early March data was included). All managers continue to

actively monitor this KPI.


7 May 2014

82



clinical decisions

Patient and Whaanau Experience programme The Professional Leader Peer Support is sponsoring a

Peer Support Specialist and service user from The Cottage to participate in the CMH Patient and

Whaanau Experience Programme facilitated by Lynne Maher of Ko Awatea. The focus is now on

sustainability of the projects and capture of the patient experience. The Cottage project will be

capturing the experience of participating in a WRAP (Wellness Recovery Action Planning)

programme and its impact on the service user’s experience and wellbeing.

The Cottage group will present a ‘snap shot’ of their work in early April. The service user involved

continues to be excited about the work and it is evidently helping her to overcome previous anxiety

regarding participation in community activities, with the added benefit to our service in having her

share her experience and feedback with us in a meaningful ‘real-time’ context. She is already

making plans to join and participate in other group activities in her community.

Family Advisor Focus this month has been on the development of methodology to gather feedback

from family/whaanau on their experience of clinical appointments, including counting family

members who came with a Service User to a clinical appointment, and developing an Experience

Questionnaire for family members to complete in the community Mental Health Clinic Waiting

Rooms.

9 Non Clinical Support Services


9.1.1 Orderlies Services

Increased demand given an unusually high month for sick leave, and additional orderlies allocated to

Theatres, and ALBU resulting in full deployment of casual pool and overtime hours. Currently the

Orderly Manager is reviewing the scheduling and roster matrix.

The Task Manager (tool used to deploy orderlies around the hospital) upgrade and reports have

been delayed due to the Windows 7.1 upgrade. When completed, this will provide us with much

needed information on labour utilisation, peak periods, etc.


7 May 2014

83

9.1.2 Cleaning Services:

The opening of Theatres in February the Medical Assessment Unit in March has meant an extremely

busy and exciting time, drawing up new cleaning duty lists, and recruiting staff into these new areas,

while being mindful of fiscal constraints. All cleaners have settled successfully into their new

environments. Victorian Standard Cleaning Audits results are still at an all-time high in the Satellite

sites, and most areas in Middlemore Hospital. The Operations Manager, Cleaning is working with

those individuals and areas that need closer monitoring. Glow Bug Audits are proving to be another

good initiative in our pursuit to maximise infection control, once again those areas and individuals

that require closer monitoring are being worked on. Team Leaders are providing extra training

where needed.


7 May 2014

84

Victorian Standard Audit Results –March 2014

9.1.3 FOOD SERVICE

Patient Survey Results

Quality of Meals Overall Impression of

Food Service?

% response rates

Month Wards

Surveyed

Breakfast Lunch Dinner

VG&G Satis VG&G Satis VG&G Satis VG&G Satis

Dec Tiaho Mai 70 30 72 18 61 23 65% 21%

Jan Surgical MMH 53 44 59 31 55 39 51% 41%

Feb Surgical MSC 66 31 60 17 66 29 77% 14%

Feb Maty & GCU 58 21 58 32 62 32 71% 23%

Feb 8&9, 34N&E 61 23 66 20 66 22 71% 17%

Mar Medical 54 44 57 38 55 35 55% 31%

9.1.4 CLINICAL ENGINEERING AND EQUIPMENT

Difficulty in recruiting technical personnel is exacerbating challenges with annual equipment fitness

checks and volume growth. Will increase liaison with Auckland DHB to investigate shared capacity

and other (albeit limited) market resources, in addition, to ongoing work with MIT to develop

training program for qualifications in Clinical Engineering. This is both a local and national issue.


7 May 2014

85



Division: Facilities Service


REVENUE



25 13 12 93% Other Income 356 214 142 67%


25 13 12 93% Total Revenue 356 214 142 67%

EXPENDITURE

1,791 1,643 (148) (9)% Staff Costs 15,496 14,573 (922) (6)%

4 0 (4) 0% Outsourced Costs 10 0 (10) 0%

53 54 2 3% Clinical Costs 497 428 (69) (16)%

1,883 2,026 143 7% Infrastructure Costs 17,710 18,533 823 4%

0 0 0 0% Internal Allocations 0 0 0 0%


(3,706) (3,711) 4 0% Net Result (33,357) (33,321) (36) (0)%

436 421 (15) (4)% FTE 420 400 (20) (5)%

Year to Date

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

CMDHB Provider

Month to Date

Monthly Net Result

-4,000

-3,900

-3,800

-3,700

-3,600

-3,500

-3,400

-3,300

-3,200

-3,100

Mar-13Apr-13

May-13Jun-13

Jul-13Aug-13

Sep-13Oct-13

Nov-13Dec-13

Jan-14Feb-14

Mar-14

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


-

500

1,000

1,500

2,000

2,500

Mar-1

3

Apr-1

3

May-1

3

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

Jan-

14

Feb-1

4

Mar-1

4

Mo

nth

ly r

esu

lt $

00

0's

Result Budget

Monthly Staff Costs

-

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

Mar-1

3

Apr-1

3

May-1

3

Jun-

13

Jul-1

3

Aug-1

3

Sep-1

3

Oct-13

Nov-1

3

Dec-1

3

Jan-

14

Feb-1

4

Mar-1

4

Mo

nth

ly r

esu

lt $

00

0's

Result Budget


7 May 2014

86

Mar-14 YTD

Total Variance: $4 $(36)

Revenue: $12 $142


Outsourced: $(4) $(10)




Non Clinical Supplies $143k f including Patient Meals Outsourced $81k f; Cleaning Supplies $12k f; Non Medical Waste Removal $(17)k u; Security Services R&M in

Engineering $(16)k u; R&M (account 5151 - 5159) $26k f; Utilities Water $15k f; MV Fuel $12k f varies month to month. The favourable variance offsets the salare

and wage exposure.

$(50)Year end Forecast variance to Budget

Medirest extended food services contract savings $19k per month.

Overall the Division was $4k favourable and $(36)k unfavourable YTD.

$922k unfavourable YTD employee costs in Support was due to an increase in clinical demands for cleaners and orderlies, particularly for the Winter Plan.

Additional Security Officers costs of $170k were a direct result of a payroll adjustment made to leave balances for shift leave and stat in Lieu not credited since

2008.

Financial Commentary - Facilities Service

Year end forecast is anticipating $50k unfavourable in R&M due to urgent additional work required for Acute Hub and Manukau cladding investigations - achieving

net saving of $150k (versus the $200k budgeted for 13/14).

Clinical Equipment R&M - varies month to month.

CMDHB Provider

Total Employee Costs were $(148)k u for the month including employee costs in Support of $(125)k u - $22k f in Hotel Services Supervisors due to 3 FTEs vacancies in

Non Clinical Support to be replaced not yet filled; Cleaners $(69)k u and Orderlies $83k u due to additional cleaning and orderly service requests (eg, additional 4.2

FTEs orderly in ALBU), high usage of in-house casual pool staff (56.51 FTEs - 14.3% of cleaners and 33.3% of orderlies rostered hours) covering vacancies (including

12 FTEs cleaning and 10.2 FTEs orderly CSB increase), annual leave and sick leave taken; Security Officers $3k f due to 4 FTEs vacancies (2 replacement and 2 CSB

increase) to be filled. 'In-house' casual staff are being managed within the service.


7 May 2014

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Director of Allied Health - report

Recommendation

It is recommended that: the Hospital Advisory Committee note the report from the Director of Allied

Health.

Prepared and submitted by Martin Chadwick – Director Allied Health

Strategic issues

He Pou Oranga – the Allied Health Enabling Localities Project continues; with a focus on how to

better align the Allied Health workforce to population health needs within the community, and an

appropriate skill mix for effectiveness and efficiency of care delivery. Tasks that could be more

effectively shared across disciplines have been identified, and work is now underway to develop the

workforce competencies that will need to be in place to allow this to occur safely. The result will be

a workforce that is more flexible, as well as implementing a development pipeline that will allow for

less experienced staff to expedite their learning in this area to reach a similar level to experienced

staff in a time compressed manner.

The methodology used within He Pou Oranga has been developed further for use within the broader

Home Healthcare team at Papakura, and linking in with representatives from key NGO’s and several

Practice Nurses are also participating throughout the process. Key lessons learnt have allowed for

the timeframes to be compressed markedly, with the bulk of the change process occurring over a 6

week period. The change framework is based on the key methodologies of Appreciative Inquiry,

Experience Based Design and pulling on the key principles of the Calderdale Framework.

Over four sessions, the group have affirmed what the key activities that are working well within the

team, a high level process map of the current way of working with input from patients and using

patient stories. This led to a session of re-design where over 100 change ideas were generated.

These ideas were clarified and grouped under the key components of the patient journey of referral,

screening, intervention and transition.

Key outcomes to date have been the recognition of the need to redesign the referral process to put

in place as many forcing functions as possible. This is to ensure the correct information is received

to make the right clinical decision in partnership with the patient and the primary care team. If this

is done correctly, the entire screening process (which is time intensive) is to a large part negated,

minimizing wait lists.

Intervention was also reviewed and it has been recognised that there is the ability to reshape care to

ensure it is what the patient wants, and is delivered in the most convenient and efficient way. This

has led to the intention to provide a range of interventions from telephone advice, to clinics either at

the base or in the community setting, and the traditional home-based visit.

Discharge as a term has been superseded by the term transition, recognising that there is only ever a

transition of care, and that this occurs with the full knowledge and participation of the patient and

the primary care team.


7 May 2014

88

Lastly, but potentially very powerfully symbolically, the team raised the issue as to changing their

name, as in the future state, Home Healthcare Team does not accurately capture and represent the

work they do.

The outcome of this work is now being translated into a project methodology with defined

components of change and associated timelines.

Allied Health Workforce development

The Sonography project continues to be progressed through the Northern Regional Alliance. Various

teething issues continue to be identified and worked through in turn.

The stability of training Anaesthetic Technicians continues to be an issue. No progress with AUT

over this period and this will be progressed further over the next period. Leadership for the

workforce has been clarified with a leadership role (Professional Leader) job description being

drafted for advertising.

The defined allied health career pathway within Counties Manukau Health continues to progress

with a process being agreed to work through staff to determine how they would fall within the titles

“Advanced Clinician” and “Advanced Practitioner” as provided for in the PSA MECA, as well as

Clinical Specialty roles. A communication plan has been drafted and is going out to staff over the

month of May before embarking on a process to change and align job titles.

Health Excellence Framework

The Health Excellence Framework roll-out continues building on the operational profile. The first

draft document has been submitted to ELT in April. Through this process clarity is being sought to

capture the opportunities for improvement for the organisation.


7 May 2014

89


Director of Nursing - report

Recommendation

It is recommended that: the Hospital Advisory Committee note the report from the Director of

Nursing.

Prepared and submitted by Denise Kivell Director of Nursing

Nursing Strategic issues

Key themes from the recent DHB Director of Nurses meeting were a need for strong communication

focus. Updates received from Human Resource General Manager’s work-plans indicated there are

several cross-over areas of work such as workforce retention and recruitment initiatives.

The DHB DONs are in the process of supporting a recommendation from the MOH Cancer

Programme to adopt the Australian e-learning based assessment and chemotherapy administration

course referred to as eviQ. Currently, the six cancer centres have a variety of training courses with

variation in standards and content.

Workforce

The approaches taken to build effective working relationships with Professional Nurse Advisors and

organisers from NZNO showed diversity through out the DHBs. CM Health has a established a strong

positive relationship which was acknowledged.

Nursing Council report 2012/13 indicated from 50,060 registered nurses; proceeding on registration

status were dealt with for 75 cases of competence, 72 for health reason and 34 as part of complaint

procedures.

Nurse prescribers await the changes in the Medicines Act in July 2014, of note is that all future Nurse

Practitioners will be prescribers. Many pieces of legislation require alignment and PHARMAC are

currently consulting on funding prescription from Diabetic Nurse Prescribers as occurred in the pilot.

The DON chairs the NZ Nurse Executives meetings with the last meeting focused on workforce

planning. Dr Graeme Benny, the new Director of Health Workforce New Zealand (HWNZ) indicated

his focus was on ‘management and leadership” within the nursing sector and to empower and

encourage the profession to operate more at the top end of the scope of practice rather than at the

bottom end.

Work is continuing on increasing the number of new graduates across the sector whilst balancing

the need for managing vacancies. The DON is currently working with and meeting all Charge Nurse

Managers (CNM) to challenge current nursing models and strengthening the case for taking on our

graduates. Flexibility of the interpretation of the contract is being investigated along with a

template to assist the visibility of the ward/unit make up.

Nursing Practice issues

Discussions are underway with Vocera –a voice activated phone system currently used successfully

in the Critical Care Complex, to investigate the possibility of the tool addressing two nursing issues:


7 May 2014

90

Timely response to telemetry calls and efficient tracking/locating of nurses within a ward/unit. The

system relies on WIFI compatibility.

Early campaign results for the annual influenza vaccinations are positive with Mental Health

committed to raise their ranking. Nurses have increased peer vaccinators numbers from 34 giving

1000 vaccinations last year, to 90 in 2014. The role allows 24/7 coverage and enables staff to get

vaccinations in their areas of practice.

Regional DON attended a teleconference discussing the procurement process to proceed to one

uniform provider. At this stage, CM Health and WDHB would like to rollover the current contracts

and be observers of the process. The associated non-productive clinical time and difficulty of

landing this work should not to be underestimated.

Patent and Whaanau centred care work

Positive results continue from the “co design workshops” now called Capturing Patient Experience.

Eighteen pieces of work are building capacity under leadership of Lynne Maher, Director of

Innovation, Ko Awatea. Dr Peter Gow reported a positive and helpful meeting with the Community

Panel on discussions around the whole of system Health of Older People strategy. Actively seeking

patient/consumer engagement is now more evident in many programmes of work. Monthly PWCC

Board meeting continue, with feedback sought from all work programmes, the programme board

endorsed the proposed presentation to Executive Leadership and DHB Board.


7 May 2014

91

Appendix A – Scorecard Glossary - in development

HEALTH ADVISORY COMMITTEE

SCORECARD NOTES AND DESCRIPTIONS

1 Total Caseweight – C Nouwens – 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 Caseweight – C Nouwens – 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 Caseweight – C Nouwens – 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

Elective Surgical Discharges (excludes uncoded) – C Nouwens – DSS

Total number of elective patients discharged from Adults Surgical Care and Kidz First Surgical.

There is no target given for this measure, so last years actual is used as the target.

5 Outpatient - total volumes – C Nouwens – DSS collated board report.

TBA if required as duplicates the FSA/ F/Up data below

6 Budgeted FTE – Finance – 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 and budget by month and 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. (Negative reflects surplus position).

10 Outpatient FSA Volumes – C Nouwens – DSS – The total number of outpatient type of ‘New Patient’ for the month

and year to date.

Contracts are not calculated in this way, so target is blank. Previous year volumes are used to calculate the Var.

In the Year section, the previous year volumes are used as the target also.

11

Outpatient Follow Up Volumes – C Nouwens – DSS – The total number of outpatient type of ‘Follow-up’ for the

month and year to date. Contracts are not calculated in this way, so target is blank. Previous year volumes are used

to calculate the Var. In the Year section, the previous year volumes are used as the target also.

12 Virtual FSAs – C Nouwens – DSS – volumes of outpatient events for PUC codes M00010 Virtual Medical Firsts and

S00011 Virtual Surgical Firsts against contract. If the intention of this is to show ‘Increase from baseline by 10%’ then

a baseline will have 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 excessive annual leave balances within the DHB) – B

Watson - 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) – B Watson - 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) – B

Watson - 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 – B Watson – 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 – B Watson – HR

Quarterly / Annual snapshot


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92

20 Patient Safety eMR within 48hrs per 100 patients – E Currie – MMC

Aligns with monthly patient safety report 21 Patient Safety Rate of patients with hospital acquired pressure injuries per 100 patients – E Currie – 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 – E Currie – MMC


23 Patient Safety Adverse Drug events per 1000 bed days – E Currie – MMC

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 – E Currie – MMC


25 Patient Safety Rate of S Aureus Bact per 1000 bed days – E Currie – MMC


26 Quality Safety Marker, HQSC. % Operations with all 3 Surgical Safety Checklist complete.

A baseline audit completed in Q1, 2013 had CM Health at 86% – E Currie - MMC

27 Patient Safety % patients 75+ years old (55+ years old for Maaori and Pacific) assessed for risk of falling – Ko Awatea

ZPH/ Regional Plan - M Cope 27a Patient Safety % patients assessed for falls who have falls intervention plan – Ko Awatea ZPH / Regional Plan - M

Cope 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 – C Thomas – 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 from the results.

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 from the results.

32 Medical Assessment Unit - seen by SMO within 4 hours:

This measure is being developed

33 MOH Developmental measure, MOH Indicator of DHB Performance. 75% 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 Developmental measure, MOH Indicator of DHB Performance. 85% 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: This measure is being developed

36 Radiology - EC radiology times <2 hours :– P Hewitt – Radiology – under development

37 MOH Developmental measure, 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 Developmental measure, MOH Indicator of DHB Performance. 50% of people accepted for a diagnostic

colonoscopy will receive their procedure within six weeks (42 days)


7 May 2014

93

39

MOH Developmental measure, MOH Indicator of DHB Performance. 50% of people waiting for a surveillance or

follow-up colonoscopy will wait no longer than twelve weeks (84 days) beyond the planned date

40

Laboratory - Test turnaround time (TAT) – Labs

41 Northern Region Target. Proportion of percutaneous coronary interventions (PCIs) carried out within the

recommended 90 minute guideline in emergency cardiac care (ECC), 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

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 – C Thomas

[definition to be added]

48 Mental Health national target, Indicator of DHB Performance. % child/ youth seen by 3 weeks for non urgent

mental health services – The wait time will be counted from the time the referral is received for a person who has not

been seen for at least a year (or not at all) to the time of the first face to face contact with a mental health or

addiction professional.

49

a.b.c

Mental Health national Access rates - CMDHB domiciled unique clients seen by MH in preceding 12 months as % of

population (0-19years, 20-64years and over 65 years)

50

MOH, Annual Plan Indicator of DHB Performance. ALOS – Acute Inpatient – C Nouwens – DSS – ALOS for Admit type

Acute Inpatients across all services.

51 MOH, Annual Plan Indicator of DHB Performance. ALOS – Elective Surgery – C Nouwens – DSS – ALOS for Admit type

Elective, Arranged and Waiting List Inpatients across all services.

52

Acute Readmissions within 7 days – Total – M Ng – DSS

53 MOH, Annual Plan Indicator of DHB Performance. Acute Readmissions within 28 days – Total – M Ng – DSS

54 MOH, Annual Plan Indicator of DHB Performance. Acute Readmissions within 28 days – 75+ years– M Ng – DSS

55 Annual Plan % EC admissions – 75+ years - C Thomas – 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.

Data collection only started from November 2013.

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. Counties Manukau Ambulatory Sensitive Hospitalisations (ASH) rates vs.

National rate. 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.


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94

60a MOH, Indicator of DHB Performance. Counties Manukau Ambulatory Sensitive Hospitalisations (ASH) rates vs.

National rate. 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.

61 FSA/FUP ratio – C Nouwens – 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 as such, so I’ve used the figure for the

previous year to determine the variance.

62 Outpatient DNA rates – Maaori – C Nouwens – 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 – C Nouwens – 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 – C Nouwens – DSS – from Report Manager

Actual operating minutes vs. resourced operating minutes for all CMDHB theatres. : https://nth-reports.healthcare.huarahi.health.govt.nz/Reports/Pages/SearchResults.aspx?SearchText=theatre%20utilisation&ViewMode=List

64 Theatre Session Utilisation – C Nouwens – DSS – also from reporting manager,

Report currently broken, waiting for fix.

65 MOH, Annual Plan Indicator of DHB Performance Day of Surgery Admissions (DOSA) – N Raj – 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) – N Raj – DSS – Percentage of all

elective discharges that have the same admission and discharge date.

67 Inpatient Services % patients discharged to discharge lounge or home by 1100hrs. Including Manukau Super Clinic.

68 % MAU patients with LOS <28 hours – C Thomas – DSS – the time a patient spent in MSSU/SSMED during stay in EC

69 % Community NASC referrals via e-referrals and assessed within 48hours. This is a part of e-referral project.

Baseline data being collected will start reporting to this in the 2014/15 financial year.

70 % patients discharged and with District Nursing / Home Help within 24hours

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

Baseline data is currently being collected and will start reporting to this in the 2014/15 financial year.

72

Nursing Hours per patient days: This measure is being developed

73 Hospital beds occupied – C Nouwens – 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 – C Nouwens – DSS – count of encounters with a LOS >10 days, excluding burns, spinal, long stay psych

and long stay geriatrics.

75

National HQSC patient experience survey which all DHBs are expected to implement in 2014/15.

Project nearing completion - To be nationally reported from August 2014.

76 MOH, Annual Plan Indicator of DHB Performance 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. Percentage of identified smokers who have been identified through diagnostic coding as

having received advice to quit. Amendments to data source mean the reported results differ from that sent to the

hospital. We are working to resolve this issue ASAP.

Whole of Systems Planning Health of Older People and

Rehabilitation Services

95

What are we trying to achieve?

• Review whole of system with an integrated team to identify further opportunities for improvement in quality of care, (efficiencies and effectiveness)

• We have a challenge to develop capacity and capability at pace to address the needs of Older People through community services and optimise the use of our acute and whole of continuum models

• Key Strategy is Triple Aim of Patient Experience/ Quality and Safety, Population Health and Equity and Best Value of Public Health Resources

96

Initiatives to Date- ARHOP Community Based Rehabilitation

• Home and Community Based Stroke Rehabilitation Community Geriatric Services (in collaboration with localities) 20000 days initiatives

• 2012-2013 (phase one) • Hip Fracture pathway • Delirium Care

• 2013-2014 (phase two)

• Early Supported Discharge of Stroke • Dementia Care in localities • Acute Care for the Elderly (ACE)

In reach rehabilitation Pukekohe AT&R development Rapid Response Franklin Locality

97

HOP Medical Programme

98

Overview- Acute Care for Elderly (ACE) Comprehensive Geriatric Assessment model for >85 acute medical patients Geriatrician led care Comprehensive MDT model Early rehab input to prevent functional decline Acute and rehabilitation in single unit Focus on frailty, high needs, “non-medical” complexity

99

EC Presentation or community admit

Acute Geriatric Unit (Save 410 days, 0.5

per patient from better organisation of

care)

Transfer to Rehabilitation (180

days saved by removing transition)

Rehabilitation (270 days saved from early

intervention)

5% increase in patients alive and at home in 12

months

Acute Geriatric Unit – System Wide Savings

Discharge

Return Home (5% increase)

Residential Care or Private Hospital (save 7500 residential care

and PH days)

2% Reduction readmissions (100 days)

Better patient Outcomes 1. Reduced

institutionalisation 2. Reduction in death and

deterioration 3. Experience better

cognition

100

Acute to Rehab Length of Stay

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Leng

th o

f Sta

y (D

ays)

Months

ACE to AT&R Length of Stay

Acute to Rehab LoS

Pre ACE Average

ACE Starts

19.2 Days

101

Current Measures

7-Day Readmissions • 19 readmits since May – 7 in December (5.8%)

Institutionalisation • 24 changed level of care (7.4% , down from 14%)

ACE Length of Stay

• 8.7 Days (soft target of 7)

102

Memory Service (20000 days) Aim to support people with Dementia, their families and

carers, to live independently as long as possible with best possible health and mental wellbeing within the bounds of their condition.

Predicted Savings Anticipate 2% bed day savings (acute) Average delay in admission to residential care

estimated at 6 months (reduced residential care demand)

103

What have we learnt?

First time diagnosis is often Severe or Mixed Dementia at younger age than expected Complex co morbidities Complex family and social situations High levels of carer stress Confusion and family tension Education and carer support important

104

In reach rehabilitation ( during 24 refurbishment Dec-March 2014) The in-reach team has picked up 15 patients from

the AT&R waiting list. 7 of these patients have been discharged directly

home from acute services without admission to AT&R.

The team have identified that the discharge co-ordination for these patients seems to be missing once a patient has been referred to AT&R.

Our PT/OT in-reach team assess the patient together and then bring in Social work in order to discharge the patient home.

105

Community Geriatric Services

Community Geriatric Services • ‘Both our Erin Park CGS pilot and the ARCHUS

study have demonstrated that there is a 50% reduction in Average LOS for the patients who were admitted from ARRC facilities to Acute Services. This benefit is in direct correlation to the CGS support to ARRC facilities.’ Dr Shankar Sankaran Clinical Head Community Geriatric Services

106

Pukekohe Hospital Development Aim Aim To develop an assessment, treatment and rehabilitation model of care at

Pukekohe Hospital for residents of Franklin.

Outcomes Patient and family experience feedback has been excellent (closer to home and

family support) Pilot ended in June 2013 with the utilisation of these beds becoming business as

usual. 80% occupancy with an ALOS 15 days. Reduced admissions to MMH rehab services Allowed capacity to develop and test the ACE model on the MMH site

107

Outcome to June 2013 and Jan 2014

Percentage of patients admitted to AT&R MMH from the Pukekohe/Franklin/Papakura domicile

0%

5%

10%

15%

20%

25%

July

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Febr

uary

Mar

ch

Apr

il

May

June

July

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Febr

uary

Mar

ch

Apr

il

May

June

2011 2012 2013

%

% of pts admitted Target

Percentage Occupancy of 10 AT&R Beds at Pukekohe Hospital

0%10%20%30%40%50%60%70%80%90%

100%

Janu

ary

Febr

uary

Mar

ch

Apr

il

May

June

July

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Febr

uary

Mar

ch

Apr

il

May

June

July

2012 2013

%

% Occupancy

Target

Pukekohe Rehab & Care Unit Jan-14

Occupancy 73%

Average Length of Stay 19.2

Admissions 19

Discharges 19

Percentage of Middlemore/ ATR from Franklin 7%

108

Rapid Response Franklin Locality Aim Aim To develop a service that will respond rapidly to residents* within the

Franklin Locality to reduce avoidable presentations to Emergency Care (EC) by 4% and to

support earlier discharge into their community. (* For residents aged 16+, excluding Maternity and Mental Health patients) Measures To date (Feb 2014) 60 patients have been referred to the Rapid Response

Service These will be hard dollars bed day and ED savings. The pilot is to be evaluated for sustainability and effectiveness in June

2014. Currently the service is a proof on concept before spread is engaged.

109

Stroke Programme

110

Stroke Pathway

Acute Early Supported

Discharge

Acute Rehab

Rehab

CBRT

CBRT

Stroke onset

Current

Proposed

Discharge home

Discharge home Figure 1: Proposed Pathway

111

Stroke Community Based Rehabilitation Total Client referrals over time 2005- 95 2006-88 2008-100 2009-252 (30% from acute services) 2010-298 (66% from acute services) 2011-308 (40% from acute services) 2012- 306 (38% from acute services) Average Length of Stay with Community Based Rehabilitation

(CBRT) 2012 = <65yrs – 17 weeks = >65 yrs – 9 weeks = Total – 12 Weeks Entry and Exit criteria monitored

112

Early Supported Discharge Stroke February 2014 : Current Overview (20000 days)

19 patients participated in SLAS pilot since Sept 2013 3 patients were direct admissions from Acute

Services All patients referred to Ward 23 Pilot capacity of one new patient per week Achieved > 4 day reduction in ALOS for all patients

except initial two trial patients Aggregated the data based on FIM score Research supports this model for moderate stroke

patients which equates to 40% of the stroke population

Favourable early data

113

Supporting Life After Stroke Inpatient Length of Stay for

Patients with FIM score >/=80

Total Inpatient Length of Stay(Individuals chart)

UCL

LCL

0

5

10

15

20

25

30

35

40

45

50

1 2 3 4 5 6 7 8 91

01

11

21

31

41

51

61

71

81

92

02

12

22

32

42

52

62

72

82

93

13

23

33

43

53

63

73

83

94

04

14

24

34

44

54

64

74

84

95

0

Days

Individual patients discharged from July 2012

ESD starts

Mean = 26.4 days

114

Time between discharge from hospital and first visit at home(Individuals chart)

UCL

LCL0

10

20

30

40

50

60

70

80

90

1 2 3 4 5 6 7 8 91

01

11

21

31

41

51

71

81

92

02

22

32

42

52

62

72

82

93

03

13

23

33

43

53

63

73

83

94

04

14

24

34

44

54

64

74

84

95

05

15

25

35

45

55

65

75

85

96

06

16

26

36

46

56

66

76

86

97

0

Individual patients discharged from July 2012

Day

s

115

Ortho-geriatric and General Surgery Programme

116

Hip Fracture Care

Improved organisation of post-surgical care. • Including better patient information, weekend physiotherapy, early transfer to

rehabilitation, better discharge planning from rehabilitation

Reduction of Total LoS (across rehab and acute) of 1 day per patient, saving 250 days per year

Acute LoS has reduced by 1.5 days since the start of the early transfer process in Jan 2012 • The saved days in acute have been incurred by rehabilitation • More patients are accessing rehabilitation (up to 60% from 40%)

Early results show improved functional gains for patients from 7 day physiotherapy

117

Delirium Management Aim and Savings (20000 days) CAM (Confusion Assessment Method) tool for 5

consecutive days from admission and patients will have the delirium pathway

implemented and documented Savings (being quantified via 20000 days)

• standardised clinical delirium identification and

management • reduced falls and increase the effectiveness of the use of

“watches” • improving patient and family experience.

118

Successful standardised clinical pathway implementation on the pilot ward where: • 100 % MDT staff received Delirium education. • 100% CAM assessment completed on admission. • 79-90% CAM documentation completion all shifts. • 81- 100% CAM documentation accuracy. • Improved compliance with intervention package from 38% to 89%.

Outcome (20000 days)

Audit Result of CAM Usage on Ward 4

0%

90%

75%75%

100%100%100%100%100%100%

0%

20%

40%

60%

80%

100%

120%

May-12

Sep-12

Sep-12

Oct-12

Nov-12

Feb-13

Mar-13

Mar-13

May-13

Jun-13

Date/Time/Period

CA

M u

sed

CAM usedMedian

119

Where to from here?

Data review of 75 years and older across the whole of system (hospital and community service delivery systems) • At Risk Individuals System Redesign and

Implementation

Acute Hospital redesign (Dr Ian Sturgess NHS experience) • Identify the process measures, balance measures

and outcome measures that reflect the performance of the integrated system

120

Whole of System Integration of At Risk Individuals Proactively identify Older

Peopl who we can support to avoid acute hospital presentations or admissions

Identify the data (total numbers) Currently population data suggests about 22,000 over 75yrs

What service needs (pathways)

Identify improvements in STEEP areas

At Risk Older People

Screening/triage PathwaysIdentify the group and data

Total Number of over 75s in population

How many by locality?

How many known to NASC and type

of service provided (eg

HBSS or ARRC

How many known to POAC (primary

care referrals)

How many know to POAC

(secondary care referrals)

Bright tool screening questions

InterRAI assessment5 screening questions

ARI clinical criteria

Dementia Pathway

Falls- National Imperative

Polypharmacy

Secondary Prevention Stroke

Pathway

Palliative Care(advance care

planning

Arthritis (under Musculoskeletal

WOS work)

Predictive Tool – End of Life

121

Process Measures What’s wrong with me?

• Specialist seen by times and clinical decision making at time/day of arrival

What’s going to happen? • Timely and effective service interventions and decision-making • Board and Ward rounds

What needs to happen so I can go home? • All patients have clinical criteria for discharge

When am I likely to go home • Estimated Discharge Dates vs Actual Discharge Dates (look at the

variances to identify barriers and waste in the system) • Monitor 75 and older patients with LOS greater than 14 days

122

Time and Day of Arrival to ED >75s

0

20

40

60

80

100

120

140

160

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

123

Total Hospital Length of Stay >75 years

Number of over 75 year old patients with total LOS > 14 days

02468

10

1/0

6/2

01

3

6/0

6/2

01

3

11

/0

6/2

01

3

14

/0

6/2

01

3

19

/0

6/2

01

3

23

/0

6/2

01

3

27

/0

6/2

01

3

1/0

7/2

01

3

4/0

7/2

01

3

9/0

7/2

01

3

14

/0

7/2

01

3

18

/0

7/2

01

3

23

/0

7/2

01

3

26

/0

7/2

01

3

31

/0

7/2

01

3

3/0

8/2

01

3

7/0

8/2

01

3

12

/0

8/2

01

3

15

/0

8/2

01

3

19

/0

8/2

01

3

22

/0

8/2

01

3

26

/0

8/2

01

3

29

/0

8/2

01

3

2/0

9/2

01

3

5/0

9/2

01

3

13

/0

9/2

01

3

16

/0

9/2

01

3

19

/0

9/2

01

3

24

/0

9/2

01

3

27

/0

9/2

01

3

1/1

0/2

01

3

7/1

0/2

01

3

11

/1

0/2

01

3

16

/1

0/2

01

3

21

/1

0/2

01

3

24

/1

0/2

01

3

30

/1

0/2

01

3

4/1

1/2

01

3

7/1

1/2

01

3

11

/1

1/2

01

3

14

/1

1/2

01

3

18

/1

1/2

01

3

22

/1

1/2

01

3

26

/1

1/2

01

3

1/1

2/2

01

3

4/1

2/2

01

3

10

/1

2/2

01

3

13

/1

2/2

01

3

19

/1

2/2

01

3

24

/1

2/2

01

3

3/0

1/2

01

4

8/0

1/2

01

4

11

/0

1/2

01

4

15

/0

1/2

01

4

20

/0

1/2

01

4

24

/0

1/2

01

4

30

/0

1/2

01

4

Number of stranded patients

124

Discharges across the hospital >75 years

Number of discharged patients

050

100150200250

04

/0

2/2

01

31

1/0

2/2

01

31

8/0

2/2

01

32

5/0

2/2

01

30

4/0

3/2

01

31

1/0

3/2

01

31

8/0

3/2

01

32

5/0

3/2

01

30

1/0

4/2

01

30

8/0

4/2

01

31

5/0

4/2

01

32

2/0

4/2

01

32

9/0

4/2

01

30

6/0

5/2

01

31

3/0

5/2

01

32

0/0

5/2

01

32

7/0

5/2

01

30

3/0

6/2

01

31

0/0

6/2

01

31

7/0

6/2

01

32

4/0

6/2

01

30

1/0

7/2

01

30

8/0

7/2

01

31

5/0

7/2

01

32

2/0

7/2

01

32

9/0

7/2

01

30

5/0

8/2

01

31

2/0

8/2

01

31

9/0

8/2

01

32

6/0

8/2

01

30

2/0

9/2

01

30

9/0

9/2

01

31

6/0

9/2

01

32

3/0

9/2

01

33

0/0

9/2

01

30

7/1

0/2

01

31

4/1

0/2

01

32

1/1

0/2

01

32

8/1

0/2

01

30

4/1

1/2

01

31

1/1

1/2

01

31

8/1

1/2

01

32

5/1

1/2

01

30

2/1

2/2

01

30

9/1

2/2

01

31

6/1

2/2

01

32

3/1

2/2

01

33

0/1

2/2

01

30

6/0

1/2

01

41

3/0

1/2

01

42

0/0

1/2

01

42

7/0

1/2

01

4


125

Discharges across the hospital >75 years


0

200

400

600

800

1000

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


126

Balance Measures

Readmissions • 7 day and 28 day

Institutionalisation Mortality

127

Outcome Measures-Harm

128

Outcome Measures

Patient Experience Tool Community Support Services needs following

discharge Functional outcomes

129

Continue to improve Patient & Family Engagement in Health and Health Care K Carman et al Health Affairs 2013

130

What matters to the Older Person? (from Age Concern) Social Connectedness (Spiritual Self Care) Abuse (financial and psychological) –expectations of family on

inheritance Eyesight, hearing, teeth and toes Carer support – Age Concern are seeing older people neglect

their own health taking care of spouse and disabled adult children (impact of dementia)

Cost of access of multiple appointments Language cultural differences (meeting the needs of ‘cultural

and linguistically diverse backgrounds’) Identify sources of information about health systems, clinical

conditions and social services (chemist?) Digital divide- use of technology –’what am I going to do

when the banks phase out cheque book?’

131

Thank you! Questions?

132

HAC Meeting

An update from the Falls Group

133

Why Falls matter

• Falls everyone’s business • HQSC – National focus – patient safety • Extended length of stay + $$ • 20-30% of elderly patients die within 12

months post hip # • Patients & Families – In Hosp fall = Poor duty

of care • At CMH, 70-80 patients fall per month, 20 are

injured, 2 are seriously harmed. 134

What have we been doing?

Where are we now?

135

Focus on accurate risk assessment

Since Fall Score Is implemented on the 15 June 2012

020406080

100120140160180200

00-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 00-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 00-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90

Score 0 - 24 Score 25 - 44 Score 45+

Nu

mb

er

of

Falls

No Yes

Incident Month/Year (All) Division (All) Service (All) Department/Unit/Ward (All) Person Classif ication IN-PATIENT

Sum of Count of File ID

Fall Risk Score Is Person Age Aggregate (Aggregated)

Injury Incurred

136

Number of FallsC Chart

UCL

LCL

0

20

40

60

80

100

120

140Ja

n-12

Feb-

12M

ar-1

2A

pr-1

2M

ay-1

2Ju

n-12

Jul-1

2A

ug-1

2S

ep-1

2O

ct-1

2N

ov-1

2D

ec-1

2Ja

n-13

Feb-

13M

ar-1

3A

pr-1

3M

ay-1

3Ju

n-13

Jul-1

3A

ug-1

3S

ep-1

3O

ct-1

3N

ov-1

3D

ec-1

3Ja

n-14

Feb-

14M

ar-1

4A

pr-1

4M

ay-1

4

Count

137

Number of patients who fellC Chart

UCL

LCL

0

20

40

60

80

100

120

140Ja

n-12

Feb-

12M

ar-1

2A

pr-1

2M

ay-1

2Ju

n-12

Jul-1

2A

ug-1

2S

ep-1

2O

ct-1

2N

ov-1

2D

ec-1

2Ja

n-13

Feb-

13M

ar-1

3A

pr-1

3M

ay-1

3Ju

n-13

Jul-1

3A

ug-1

3S

ep-1

3O

ct-1

3N

ov-1

3D

ec-1

3Ja

n-14

Feb-

14M

ar-1

4A

pr-1

4M

ay-1

4

Count

138

% of falls resulting in a SAC1-2 injuryP Chart

UCL

LCL0%1%2%3%4%5%6%7%8%9%

10%Ja

n-12

Feb-

12M

ar-1

2A

pr-1

2M

ay-1

2Ju

n-12

Jul-1

2A

ug-1

2S

ep-1

2O

ct-1

2N

ov-1

2D

ec-1

2Ja

n-13

Feb-

13M

ar-1

3A

pr-1

3M

ay-1

3Ju

n-13

Jul-1

3A

ug-1

3S

ep-1

3O

ct-1

3N

ov-1

3D

ec-1

3Ja

n-14

Feb-

14M

ar-1

4A

pr-1

4M

ay-1

4

Percent

139

Falls per 1000 beddaysU Chart

UCL

LCL

00.5

11.5

22.5

33.5

44.5

5Ja

n-12

Feb-

12M

ar-1

2A

pr-1

2M

ay-1

2Ju

n-12

Jul-1

2A

ug-1

2S

ep-1

2O

ct-1

2N

ov-1

2D

ec-1

2Ja

n-13

Feb-

13M

ar-1

3A

pr-1

3M

ay-1

3Ju

n-13

Jul-1

3A

ug-1

3S

ep-1

3O

ct-1

3N

ov-1

3D

ec-1

3Ja

n-14

Feb-

14M

ar-1

4A

pr-1

4M

ay-1

4

Rate

140

SAC1-3 Falls per 1000 beddaysU Chart

UCL

LCL0

0.1

0.2

0.3

0.4

0.5

0.6

0.7Ja

n-12

Feb-

12M

ar-1

2A

pr-1

2M

ay-1

2Ju

n-12

Jul-1

2A

ug-1

2S

ep-1

2O

ct-1

2N

ov-1

2D

ec-1

2Ja

n-13

Feb-

13M

ar-1

3A

pr-1

3M

ay-1

3Ju

n-13

Jul-1

3A

ug-1

3S

ep-1

3O

ct-1

3N

ov-1

3D

ec-1

3Ja

n-14

Feb-

14M

ar-1

4A

pr-1

4M

ay-1

4

Rate

141

Overview of the Falls Dashboard

142

What’s next?

143

Questions?

146

147


Hospital Advisory Committee Meeting – 7th

May 2014

5.0 Resolution to Exclude the Public

Resolution:

That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ

Public Health and Disability Act 2000 the public now be excluded from the meeting for

consideration of the following items, for the reasons and grounds set out below:

General Subject of

items to be considered

Reason for passing this resolution in

relation to each item

Ground(s) under Clause 32 for

passing this resolution

6.1. Patient Safety

Report/Quality Safety

Markers

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, S.32 (a)]

Privacy


not be in the public interest because of

the greater need to protect the privacy

of natural persons, including that of

deceased natural persons.


S.9 (2) (a)]

6.2. Minutes of HAC

meeting 9th

April

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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