diagnostic and support services group july 2007 1. · pdf filediagnostic and support services...

Diagnostic and Support Services Group July 2007

1. Service Summary • Kingi Dirks, former Lead Social Worker with the Maori Health Liaison Service, started in her new role as Kaiarahi –

Cultural Advisor on Monday 23rd July 2007. Breast Care Services • Implementation of digital mammography has been successfully completed in Invercargill. Screening will resume for

the backlog of new women enrolled in the 45-49 year age group. • The mobile screening unit will recommence screening in Invercargill during the second week of August with the

locum Medical Radiation Technologist (MRT) screening recall women. • Following the conclusion of the MRT industrial action and staff returning from annual leave, screening activity has

improved at Dunedin Hospital. The first priority is catch up of screening women scheduled for recall. • Illness has impacted on the screening schedule for the Otago mobile screening unit, with the unit being delayed by

two weeks before moving to the Lakes district. Two MRTs are manning the unit to catch-up on recall women. • Dr Anusha Naidoo, the new Consultant, has gained accreditation with the National Screening Unit so can now

‘screen read’. This will greatly assist in reducing reporting times. Radiology • Meeting the new MRT employment agreement roster requirements is creating some difficulties, particularly in

terms of rostered sleep days. During the compilation of the roster a deficit of 0.4 FTE has been identified to cover these days.

• The ability of the service to meet clinical demand remains a concern. The wait time for non-urgent MRI referrals which is now at 45 weeks (target of 16 weeks), the wait time for non-urgent CT is 44 weeks (target of 12 weeks) and the wait time for B priority (semi-urgent) CT is 36 weeks (target of 4 weeks).

• Despite extra weekend screening, the Computed Tomography (CT) waiting list continues to grow, influenced by referral numbers and CT servicing issues.

• A new device called the ‘Outback Catheter’ was successfully used in DSA to ‘get through’ an occluded leg artery. Value of catheter is $3,456 but the alternative for the patient was surgery which would be at a greater cost to the organisation, but more importantly, to the patient in terms of recovery time.

Hotel Services • Strike notices were lifted by the Service & Food Workers Union during July. • Recycling started in the Dunedin Hospital staff café and at Wakari Hospital in early July with recycling bins being

placed in the Fraser Building in late July. A few issues were highlighted early on and initial responses were not as high as expected. Recycling bins will be placed in areas in the main ward block in August.

Therapies • Occupational Therapists are now performing, as part of their core service provision, pre-surgery home visits to

assess home support requirements prior to surgery for total hip, knees and spinal fusions. Early results show that this has streamlined the discharge process and planning and has increased awareness of any social factors that may impact on discharge. This service is complimentary to the service the Community Occupational Therapists provide after a patient has been discharged.

• Dietetic waiting times are currently being well managed with Paediatric and General Outpatient patients being seen within 6 weeks and Diabetes referrals attending follow up appointments within 4 weeks.

• All Therapies professions have current vacancies and this is directly impacting on wait times and ability to provide core services. Active recruitment of senior Physiotherapists is underway, with a consolidated recruitment strategy taking place between the Physiotherapy departments across the organisation.

Pharmacy • The sterile dispensing workload increased slightly in July, with a considerable increase in patients requiring Home

IV, the highest figure since March 2005. Infection Prevention and Control • An urgent glove recall was notified to the organisation at the end of July. This recall highlighted some gaps in the

recall process within the organisation. • The peripheral IV audit commenced on 25th July 2007 and a report will be tabled at the August IV Committee

meeting.

HAC report – July 2007 24/08/2007 Group Manager – Sonja Dillon

• The annual Infection Prevention and Control Programme has been signed off by both the Infection Control Committee and the Clinical Board.

• The draft Infection Control standards are currently out for consultation. 2. Contractual Performance

Actual Planned Variance Actual Prior Year Actual Planned Variance Actual Prior

Year

Community Referred Radiology 1,786 1,606 180 1,606 1,786 1,606 180 1,606

ACC High Tech Imaging 78 74 4 74 78 74 4 74

Breast Screening (Total women screened) 1,438 1,555 1,828 1,438 1,555 1,828

Age Group 45 - 49 247 389 220 247 389 220

Age Group 50 - 64 942 933 9 1,213 942 933 9 1,213

Age Group 65 - 69 249 233 16 395 249 233 16 395

Radiology Utilisation (ODHB patients) 6,514 5,562 952 5,562 6,514 5,562 952 5,562

Dietitian Clinics 173 259 137 173 259 137

Hospital Meal Equivalents 41,695 40,655 1,040 40,655 41,695 40,655 1,040 40,655

Physiotherapy Outpatients MOH 1,140 1,481 1,179 1,140 1,481 1,179

Physiotherapy Outpatients ACC 669 572 97 572 669 572 97 572

Month Year to Date

(117) (117)

(142) (142)

(86) (86)

(341) (341)

• Breast Screening activity was down in July compared to planned activity due to staff leave and sickness and the

implementation of digital mammography in Southland. • The Dietetics volumes are down as they have been adjusted to reflect the true nature of patient contacts.

Previously group sessions were counted as individual contacts. This variation will continue until the end of the financial year.

• Physiotherapy Outpatient MOH volumes are down due to inpatient cover. Physiotherapy Outpatient ACC volumes remain over target volumes.

3. Resource Management

Actual Budget Variance 06/07 Actual Vacancies Actual Budget Variance 06/07 Actual SMOs 9.44 9.90 0.46 12.92 1.60 9.44 9.90 0.46 12.92RMOs 13.54 11.00 11.91 0.00 13.54 11.00 11.91Nursing 12.70 13.29 0.59 12.92 0.00 12.70 13.29 0.59 12.92Allied Health 133.96 141.12 7.16 186.31 10.82 133.96 141.12 7.16 186.31Other 160.13 153.96 150.70 4.90 160.13 153.96 150.70Total 329.77 329.27 374.76 17.32 329.77 329.27 374.76

Year to Date FTE Month FTE

(2.54) (2.54)

(6.17) (6.17) (0.50) (0.50)

• The key gaps that remain are clinical and technical. • There are currently 3.25 FTE MRT vacancies in Breast Care Services and recruitment and retention issues mean

that there may be at least a further 2 FTE by the end of 2007. Vacancies are severely impacting on the service’s ability to meet activity levels. An action plan around recruitment and retention is under development.

• Vacancies for 9 FTE were approved for recruiting in July 2007. • The FTE includes 2.1 FTE medical staff associated with laboratory services that are not budgeted (cost is

recovered).


4. Financial Performance Net Result ($000)

Actual Budget Variance Actual Budget VarianceRevenue 1,068 940 128 1,068 940 128 Personnel (1,613) (1,566) (47) (1,613) (1,566) (47)

(980) (978) (2) (980) (978) (2) (1,525) (1,604) (1,525) (1,604)

ExpensesSurplus/(Deficit) 79 79

Month Year to Date

Revenue: $128k favourable variance for the month; • MOH - Personal Health $38k

• $32k – Breast Screening volume achieved for the month was 1,438 – budget was based on volume of 1248. The price increase in this year’s contract above budget. The budget has been spread evenly across the year while activity planning is phased.

• Internal Funding $25k • $32k – Outpatient Drugs from Funder – demand driven.

• Other DHB’s $43k • $43k – Drug Sales to SDHB for Cyto-toxic Drugs and Total Parental Nutritionals (TPNs) supplied. Southland

DHB were sourcing these from Baxter’s in prior months. • Other Income $28k

• $16k – Drug Sales to Private Patients mainly for Trastuzumab (marketed under tradename Herceptin). • $29k – Charge backs to SCL Otago Southland for Salaries and Utilities provided.

Personnel: ($47k) unfavourable variance for the month; • Medical Personnel Costs ($35k)

• ($16k) in Radiology Registrars as a result of overtime to cover non-compliant roster. • ($19) in Medical Salaries for 1 RMO and Joint Clinical Staff employed in Laboratories not budgeted for.

(Recovered from SCL Otago Southland) • Nursing Staff $30k

• $30k – Annual Leave Adjustment. • Allied Health ($20k)

• ($11k) – Back pay accrued for proposed settlement of MRT award negotiations above assumed budget increase.

• ($10k) – Allowances paid to MRTs and Sonographers for additional weekend sessions for CT and Ultrasounds. • Management & Administration ($23k)

• ($16k) – Administration & Clerical associated with additional (3.47) Ordinary FTE and (1.08) Overtime FTE in Radiology, as part of the work-round of the Easy-RIS implementation and arranging patient visits to external providers to assist in reducing waiting times.

• ($7k) – Additional sick leave taken by administration staff. Other Expenses: ($2k) unfavourable variance for the month; • Diagnostic Supplies $20k

• $12k – Sterilising Consumables are being ordered against Theatres cost centre code. Internal Transfer required.

• $10k – Contrast Media in DSA, CT & MRI, due to SMO being away reducing demand and downtime due to equipment servicing.

• Hotel Services Laundry & Cleaning $52k • $21k – Outsourced Cleaning overestimate of reactive cleans at June year end. • $24k – Food (all categories) savings made as contracts renegotiated from when budget set.

• IT Systems & Telecommunications $13k • $9k – IT Leases (non-financing) change in accounting for PC leases. They are now treated as a finance lease

whilst the budget was set assuming treatment as an operating lease (which does have a financial cost to the group). The budget for the IT expenditure is expected to be transferred out of the group for next month end to where the actual expenditure now lies in Corporate Overhead.

• Outsourced Clinical Services $15k • $13k - Additional Radiology Services budgeted to enable catch up and reduce waiting times. Large list done in

June, so no requirement in July. Budget will be utilised in future months. • Pharmaceuticals ($113k)

• $98k –Pharmaceuticals due to increase demand from Southland, Private Drug sales (Herceptin) and demand from Outpatients and internal charges to Wards.

Chris Lovell-Smith Sonja Dillon Kim Caffell Clinical Director Group Manager Nursing Director


Emergency Medicine & Surgery Services Group July 2007 1. Service Summary

• Whilst the budget results show a positive variance this is mainly contributed to by vacancies in staff groups

who are working hard to cover the gaps. Staff are to be commended for the huge efforts put on over our busy winter season, with fewer than staff than is ideal.

• It is noteworthy to mention that the Did Not Attend (DNA) rate for Urology Outpatients has reduced from 9.2% in July 2006 to 2.9% in July 2007. Since the introduction of the call reminder system, and as various technical issues with the system have been addressed and resolved over the past 5 months, the DNA rate has been reducing. The number of patients that respond to the call reminder and confirm their appointments has continued to rise, there are still those who actually confirm their time and then do not show up but on the whole the system is showing an impact on the DNA rates. Recently a further feature has been added for out of town patients (the system does not allow toll calls) with a text message sent to a cell phone number. This is a very recent innovation and as yet we are not confident on whether it will be beneficial for those who live in the rural areas. Despite this the benefits of the system are becoming known and several services wish to roll it out, which we will do, starting with Renal Services this month, and then Surgical Outpatients.

• A meeting was held with the Dean of Medical School to discuss a collaborative approach to Senior Medical Staff recruitment to increase joint clinical positions. Joint advertising for vacant positions will occur to promote the potential of these new roles. Work continues on ensuring patients are treated within the six month timeframe within the constraints of long wait waits for radiology and anaesthetic shortages.

• The Elective Services Performance Indicators (ESPIs) remain ‘green’ for all services in all key performance areas.

Emergency Department (ED) • It has once again been a busy month for the ED. Resourced occupancy has been high on the wards, coupled

with nurse and junior medical staffing shortages in ED, this continues to put pressure on the department. Despite these challenges there is much quality improvement activity including a review of clerical team orientation; regular monthly education sessions, improving the relationship with the Laboratory Services, equipment audits and internal Patient Flow subprojects have started.

• Junior medical staffing shortages in inpatient areas of the hospital also have been affecting the ED as patients can wait for long periods to be seen by service staff. Many patients have several problems, requiring multiple referrals to be made and long waits can ensue.

Internal Medicine • Inpatient wards are still actively recruiting for registered nurses with several vacancies. The two wards (8a and

8b) are more frequently exchanging staff between the wards which helps enormously with flexibility in operating the two wards and maximising how many beds can be opened.

Gastroenterology • Service cleaning equipment breakdowns continue to cause problems however the service is trialling new

machines. General Surgery • The job size was completed this month for General Surgery and Neurology and all consultants have ratified

the outcomes. We have now started work to identify the sub speciality mix for the additional staff and begin recruitment strategies.

• Shortages in nursing and registrar staffing has been challenging although no reduction in services has occurred. The service expects to be fully staffed with registrars next year.

HAC report – July 2007 24/08/2007

Group Manager – Dr Colleen Coop

Specialist Surgery: • Ophthalmology Department. The shortage of SMOs continues to impact on every aspect of the department.

There is an SMO who will be arriving in January 2008, which will improve our ability to deliver to the planned contract performance. Recruitment continues to be a priority. Following the College inspection it is expected that two training registrars will be removed from the service at the end of the year, a final report is pending.

• The orthopaedic acute demand continues to be high; patients have been accommodated across the floor and at time as outliers on the 4th floor. The demand for acute theatre time has at times had an impact on the length of stay for some patients, having to wait extended times for theatre. There continues to be a tension between acute and elective surgery at times.

Cardiothoracic Surgery • ESPIs presently remain green for the service. A Cardiothoracic Registrar has been appointed to the services

long standing vacancy and will commence 17th September 2007. • Two cardiac patients received their surgery this month under the surgical agreement with Waikato. Cardiology (Diagnostics) • The Cardiac Angiography Suite equipment sustained a prolonged outage from Thursday 19th July to Tuesday

31st July due to an intermittent fault which could not be isolated despite protracted effort by the engineer. Due to clinical risk, demand for in patient beds and to prevent stockpiling of acute coronary syndrome patients, angiography was undertaken at Mercy Hospital.

Respiratory Services • Interviews were held this month for the vacant Respiratory Specialist vacancy and an offer made for an

appointment in September 2008. • Plans for the Sleep Laboratory refurbishment were finalised this month with a tentative date for construction

given for August 2008. This upgrade will address the issues related to compliance. Cardiology / Respiratory /Coronary Care Unit (CCU) (Wards) 7A • The Lions Club donated four exercycles to the ward in July. These exercycles are of huge benefit in the

assisting of post surgical patients’ recovery and the ward was delighted to have accepted four rather than the single one expected.

7B • The CCU released 4 “closed” beds to ward 7C to enable the wards to merge thus allowing an economy of

scale to be achieved from a nursing resource and bed optimisation perspective. This was due to the need for 7C to close 4 acute beds due to nursing vacancies.

7C • An initiative was commenced this month reviewing the use of the Day Ward in 7C and the development of a

protocol seeking nurse led discharges of patients who have had inserted a coronary stent and the same day discharge of these patients. Presently it is customary for these patients to automatically stay overnight. The development of a protocol which allows for same day discharge has the potential to significantly reduce day case patients who require / progress to occupying in patient beds at short notice.

Renal Dialysis Unit • A rationalisation of peritoneal fluid suppliers and types for certain patients should allow for a small reduction in

the annual fluid supply costs from this month onwards. The exact saving cannot be predicted due to the dynamics of patient conditions but the saving should none the less be identifiable as the financial year progresses.

Endocrinology • Nil issues

HAC report – July 2007 24/08/2007


Oncology / Haematology • The potential benefits of the self administration of the drug pamidronate have been explored and protocols

developed which will allow patients to administer the medication at home at a time convenient to themselves. This will reduce the demand for bed time within the Medical Day Unit (MDU).

• Discussions have been held with the Surgical Services for the handing over of non-oncological patients presently receiving non cytotoxic infusions in the MDU back to their primary service. This is intended to reduce demand upon bed time and retain the MDU for its primary purpose of the delivery of cytotoxic agents.

• Development of both nurse and radiation therapist run “patient on treatment”(POT) clinics are now ready to roll. This allows POT clinics currently undertaken by nursing staff to be run by radiation therapists. This allows multiple benefits: such a model embraces the intended integrative and collaborative model of service delivery for oncology services, allows for double the current amount of POT clinic slots available and aids in recruitment and retention of both staff types.

• The steering group continues to meet fortnightly to progress the implementation of the Southern Blood and Cancer Service (SB&CS). A project facilitator has been appointed from Southland District Health Board (SDHB) to implement OraCare into SDHB to allow for a single electronic wait list to be formulated. The milestone for this to be operational is not yet determined but projected to be first week of October 2007

• The LiNAC installation is progressing to schedule with no major problems to date. Commissioning due tentatively for October 2007.

Anaesthesia • Registrar numbers are currently one down, Specialist numbers are severely depleted, with the roster now

down to 1 in 3 from 1 in 6. This is a critical issue for the running of our ICU and whilst contingency plans are being put in place, we recognise the huge efforts being made by the remaining SMO staff, and the extra shifts they are doing.

Day Surgery Unit (DSU) • Nil issues this month. Intensive Care Unit (ICU) • 63% of ICU admissions were acute and unplanned. • Patient mortality rate is <1% which is much improved after 3 months of a rate >10%. Post Anaesthesia Care Unit (PACU) • Late running lists are being addressed to try to decrease late cases which compromise other activities planned

for staff such as education. Pain Service • PACU discussing ways of managing some of the issues facing the Acute Pain Service (APS) particularly those

involving the education of nursing and medical staff. Main Operating theatre (MOT) • The majority of theatre lists have been well utilized, with the acute theatre consistently busy. • Unfortunately several lists have been dropped due to lack of anaesthetists, although nursing numbers are

good.

HAC report – July 2007 24/08/2007


2. Contractual Performance

2.1 Surgery Contract Volumes

Month Year to date

Actual Planned Variance Actual Prior

Year Actual Planned

Variance

Actual PriorYear

Surgery_Group_ODHB_Acute CW 432.65 483.20 (50.55) 441.64 6167.38 5872.00 295.38 6,218.68 Surgery_Group_ODHB Acute IDF CW 50.02 59.66 (9.64) 43.86 751.54 714.75 36.79 1,056.63 Surgery_Group_Elective CW 356.86 471.42 (114.56) 397.54 5565.22 5647.16 (81.94) 6,046.48 Surgery_Group_Elective IDF CW 40.15 37.62 2.53 38.33 602.17 458.80 143.37 574.77

Surgery_Group_TOTAL CW 879.69 1051.90 -172.21 921.37 13086.30 12692.71 393.59 13,896.57

Month Year to date


Year Actual Planned

Variance

Actual Prior Year

Group FSA 1021 1302 (281) 1068 12384 14170 (1,786) 14,318.00

Group Follow Up 3017 3619 (602) 3170 35883 38722 (2,839) 41,351.00

Group Other 1105 1108 (3) 816 12635 12694 (59) 11,631.00

• Cystoscopies are behind for the month by 15 procedures which is concern so early in the year. • Podiatry volumes have not adjusted for the reduced resources and will present a variance for the year • Specialist surgery services have not had a good start to the year. This was a result of the staff shortages

especially within Ophthalmology and Orthopaedics where there is also a registrar shortage. July is traditionally a slow month for orthopaedics due to conferences and annual leave.

2.2 Medicine Contract Volumes

Month Year to date

Actual Planned Variance Actual

Prior Year Actual Planned

Variance

Actual PriorYear

ED_Medicine_Group_ODHB_Acute CW 775.17 797.89 (22.72) 1075.50 9131.23 9457.00 (325.77) 8,543.92 ED_Medicine_Group_ODHB Acute IDF CW 98.63 119.99 (21.36) 120.00 1534.89 1412.56 122.33 1,429.06 ED_Medicine_Group_Elective CW 56.05 85.87 (29.82) 66.75 1057.19 953.00 104.19 3,095.04 ED_Medicine_Group_Elective IDF CW 15.26 58.14 (42.88) 66.43 570.31 654.82 (84.51) 559.57

ED_Medicine_Group_TOTAL CW 945.11 1061.89 (116.78) 1328.68 12293.62 12477.38 (183.76) 13,627.58


Year Actual Planned

Variance

Actual Prior Year

Group FSA 348 456 (108) 335 4800 5242 (442) 4,750.00

Group Follow Up 1246 1406 (160) 1177 16027 16202 (175) 15,847.00 • Endocrinology – SMOs have been on leave hence slight reduction in monthly throughput • Haematology - clinic performance on track given there is a 1.0FTE SMO vacancy thus a projected 30%

reduction in activity ( offset by RMO additional clinics) • Respiratory – Smoking cessation and COPD clinics are not being counted correctly. Reporting team are

investigating.

HAC report – July 2007 24/08/2007


• Internal Medicine First Specialist Assessments (FSAs): One consultant on leave this month so volume down slightly.

• Gastroenterology First Specialist Assessments (FSAs): One consultant on leave for a 2 week period during July affecting volume outputs. Will catch up over coming months.

• Gastroscopies down for month of July due to Consultant leave and a 0.5 nursing vacancy. This vacancy has now been filled.

• ED attendances high for month with service beginning to see increase in injury and winter related illnesses.

2.3 Elective Services and Theatre Performance Indicators

Jul 06

Aug 06

Sep 06

Oct06

Nov06

Dec06

Jan07

Feb07

Mar 07

Apr07

May 07

June07

July07

ESPI 2 (FSA) – Number people who have been seen within 6 months

1414 1711 1604 1709 1656 1202 1066 1481 1622 1362 1774 1471 1569ESPI 2 – % of people who have been seen within 6 months 94% 93% 94% 98% 96% 98% 95% 94% 95% 95% 94% 97% 97%ESPI 5 – Number of people who have received their treatment within 6 months 449 456 352 436 417 340 194 354 416 367 496 410 401ESPI 5 – % of people who have received their treatment within 6 months 86% 87% 87% 87% 92% 91% 89% 86% 89% 90% 90% 90% 92%Percentage of DSU theatre facility utilisation - Target 94% * * * * * * * * * * * * 88%Percentage of MOT theatre facility utilisation - Target 94% * * * * * * * * * * * * 76%Percentage of DSU Elective list utilisation Target – 90% * * * * * * * * * * * * 86%Percentage of MOT Elective list utilisation Target – 95% * * * * * * * * * * * * 96%

• Two new Key Performance Indicator has been introduced which we will be using to monitor theatre efficiency. The first one is a measure of theatre facility efficiency and measures the percentage of lists used against the lists available. The second is a measure of how efficiently the time within the lists allocations is used, that is the percentage of time spent on a surgical procedure as a proportion of the time available for the list.

3. Resource Management Month FTE Year to date FTE

Actual Budget Variance 06/07 Actual

Vacancies Actual Budget Variance

06/07 Actual

Staff Group Jul-07 Jul-07 Jul-07 Jul-06 Jul-07 Jul-07 Jul-07 Jul-06

SMO

73.04

90.16

17.12

75.81

16.2

73.04

90.16

17.12

75.81

RMO

111.37

116.66

5.29

112.28

5.0

111.37

116.66

5.29

112.28

Nursing

459.51

480.51

21.00

460.65

20.8

459.51

480.51

21.00

460.65

Allied Health

76.37

83.59

7.22

79.61

1.9

76.37

83.59

7.22

79.61

Support

0.04

-

(0.04)

9.34

0.2

0.04

-

(0.04)

9.34 Mgmt/Admin

99.39

103.42

4.03

105.82

1.5

99.39

103.42

4.03

105.82

Total

819.72

874.34

54.62

843.51 45.6

819.72

874.34

54.62

843.51

HAC report – July 2007 24/08/2007


• 1 ICU/Anaesthesia SMO in October and 1 ICU/Anaesthesia SMO in January. There is also a good likelihood of employing an anaesthesia specialist in February.

4. Financial Performance Net Result ($000) Month Year to date

Actual Budget Variance Actual Budget Variance Revenue

664

782

(118)

664

782

(118) Personnel

(5,851)

(6,147)

297

(5,851)

(6,147)

297 Expenses

(2,814)

(2,974)

160

(2,814)

(2,974)

160 Surplus/(Deficit)

(8,000)

(8,339)

339

(8,000)

(8,339)

339

Revenue ($118k) unfavourable: Revenue being below budget was driven from three areas:

• ($42k) – ACC income below budget • ($40k) – Budgeted Cardiac income for Waikato DHB not yet invoiced • ($10k) – No scoliosis clinics invoiced in the month.

Personnel Costs $297k favourable • Medical Personnel $208k

• $294k – FTE (excluding overtime) less than budget. SMO FTE was 17.37 and RMO FTE was 9.16 less than budget. Significant RMO vacancies were in General Medicine (approx 3.3 FTE) and General Surgery (approx 2.7 FTE).

• $41k – SMO professional membership fees less than budget. Corresponds with medical FTE being less than budget,

• ($85k) – Rates paid (including back pay accrual) greater than budget ($35k) – RMO overtime greater than budget. Significant overtime was incurred in the Emergency Department and Ophthalmology. The ED variance resulted from cover for annual and sick leave incurred for the month. The Ophthalmology was a result of additional RMO cover

•

required to Os working up to the vacant SMO positions to cover RMOs on training.

• Nursing r•

inuing vacancies from 06/07, an increase in

being less than budget • ($68k) – Rates paid (including back pay accrual) greater than budget

h•

• with expenditure levels for the last four months of 06/07

• 25k – IT leases. The accounting treatment of computer leases has now changed. They are now treated as a nance lease whilst the budget was set assuming treatment as an operating lease.

cover both RM Pe sonnel $75k

$102k – FTE (excluding overtime) under budget. Nursing FTE was 22.42 under budget for the month. Total nursing FTE for the month was 459.51 compared to an average in 06/07 of 461.01. The increase in the budget variance is a result of contthe nursing budget FTE for leave cover

• $47k – Allowances less than budget. Follow on effect of nursing FTE

Ot er costs $160k favourable:

$54k – Theatre expenditure. A combination of the low levels of joint procedures performed in the month and a continuation of underspend of certain theatre consumable items (blades, disposable instruments, implants and prosthesis) and pharmaceuticals has resulted in the decrease to budget $24k – Catheters. Actual expenditure is consistentwhere volume usage decreased compared to the start of the 06/07 financial year. The budget for 07/08 was set based on the trend of increased stent insertion. $fi

HAC report – July 2007 24/08/2007


HAC report – July 2007 24/08/2007


Dr Shaun Costello Clinical Director (Med)

Dr Colleen Coop Group Manager

Kim Caffell Nursing Director

Dr Bill Buchanan Clinical Director (Surgery)

Dr Colleen Coop Group Manager

Sharon Jones Nursing Director

HAC report – July 2007 24/08/2007


Emergency Medicine & Surgery Services Group APPENDIX ONE – Theatres Utilisation Report July 2007 MOT & DSU ListsFull day lists

Jul Aug Sep Oct Nov DecACUTE Planned lists 31.5 31.5 31 34 39.5 43.5

Extra lists 6 1 0 0 0 0Unallocated lists 0 0 0 0 0 0Actual lists 37.5 32.5 31 34 39.5 43.5

CARD Planned lists 16 16.5 14 15 15 12Extra lists 0 0 0 0 0 0Unallocated lists 3 1 3 5 0 0Actual lists 13 15.5 11 10 15 1

ENT Planned lists 24 24.5 22 26 23.5 17Extra lists 0 0 0 0 0 0Unallocated lists 2.5 1.5 0 1 1 0Actual lists 21.5 23 22 25 22.5 17

EYES Planned lists 9.5 10 9 11 9.5 6.5Extra lists 0.5 0 0 0 0 0Unallocated lists 2.5 0 3 0.5 0.5 0Actual lists 7.5 10 6 10.5 9 6.5

GSURG Planned lists 30.5 36.5 36.5 40.5 39.5 28.5Extra lists 12.5 6.5 0 0 0 0Unallocated lists 3 5 4 2 1 0Actual lists 40 38 32.5 38.5 38.5 28.5

GYNAE Planned lists 13 13.5 12 13 13 9Extra lists 0 0.5 0 0 0 0Unallocated lists 0 3 2 0 0 0Actual lists 13 11 10 13 13 9

NEURO Planned lists 6 9 8 10 8 6Extra lists 0 1 0 0 0 0Unallocated lists 1 3 0 1 0 0Actual lists 5 7 8 9 8 6

ORTHO Planned lists 34 40.5 36 40 40 27Extra lists 1 0 0 0 0 0Unallocated lists 13.5 5 3 3 0 0Actual lists 21.5 35.5 33 37 40 2

PAEDS Planned lists 0.5 2 1.5 1 2 0.5Extra lists 0 0 0 0 0 0Unallocated lists 0 0 0 0 0 0Actual lists 0.5 2 1.5 1 2 0.5

URO Planned lists 9 9.5 8.5 10 10 7.5Extra lists 0 0 0 0 0 0Unallocated lists 0 0 0 1 0 0Actual lists 9 9.5 8.5 9 10 7.5

TOTAL Planned lists 184 198 178.5 200.5 200 157.5Extra lists 10 4.5 0 0 0 0Unallocated lists 25.5 18.5 15 13.5 2.5 0Actual lists 168.5 184 163.5 187 197.5 157.5

2

7

Mental Health & Community Services July 2007 1. Service Summary Older Peoples Health • The inpatient areas within Older Peoples Health (OPH) continue to have high occupancy rates, particularly for

ACC patients. • We would like to welcome Dr Julie Mador as the new Clinical Leader for OPH. We would also like to thank Dr

Wendy Busby for her many years as Clinical Leader. • Nursing vacancies within the service continue to impact on service delivery. Active recruitment is ongoing

however a small number of beds have been closed to manage cover. • The Needs Assessment and Service Co-ordination (NASC) waiting times continue to be monitored to ensure

there is a reduction in the number of clients waiting. Both the number of clients and the waiting time has reduced significantly.

• The InterRAI electronic assessment tool pilot has been completed within OPH and NASC. A summary document including an evaluation and proposed recommendations is currently being written up for the Chief Operating Officer and Regional Planning and Funding Manager.

• The Otago Exercise Programme has commenced in OPH Service and Community Services as a falls prevention strategy. The programme currently has 9 clients.

• Dr Esther Abeln, Senior Medical Officer (SMO) has commenced within the Mental Health of Older People service.

Rehabilitation Service • Both the inpatient and community-based rehabilitation teams are being impacted by vacancies across the

service. • The provision of physiotherapy services, in particular, is being monitored due to numerous vacancies existing in

both the ward and community settings. All vacancies are being recruited to with some appointments made, however there are still vacant positions. Other vacancies include Speech Language Therapist and Senior Medical Officer (SMO) positions.

• Dr Lyle Gross (SMO) commences on 20th August 2007. • We are still awaiting feedback from a Request for Proposal submitted to ACC for an updated Active

Rehabilitation Contract for Moderate to Severe Traumatic Brain Injury. • The Occupational Therapy Disability workshop currently held in leased premises with an expired lease. The

current facility does not meet building compliance requirements for its function, so other options are being considered for this carpentry based rehabilitation activity.

Community Services • Heath Co-ordinator and GP Advisor positions are being implemented into the Community Service Co-ordination

Centre (CSCC) as part of the inter-agency Providing Access to Health Solutions (PATHS) programme, in conjunction with the Ministry of Social Development (MSD). The Health Co-ordinator has been appointed and GP Advisor Role is currently being recruited to. There was an official launch of the programme in early August.

• The Case Co-ordination function continues to be fully implemented into the CSCC to manage long term patients with chronic conditions who require complex treatment and support in the community. Feedback is being sought from clinical staff and General Practice as to the process for identifying patients for this programme.

Mental Health Services • The Facility Planning project has commenced within the Mental Health Service to review the models of care

required for future service provision. A Steering Committee has also been formed to oversee this project and the associated project to redesign an acute inpatient ward to be relocated to the Wakari Site. An in depth communication strategy is being developed to manage these projects.

• The ODHB Provider Arm Mental Health Service will work with Planning and Funding and the Blue Print Learning Centre to develop a Home-based Treatment Service concept. This will be a comprehensive project for the service over the next twelve months.

• Inpatient numbers continue to be high in July with most wards exceeding resourced occupancy levels, with some overflow. Solutions continue to be developed with external agencies to address issues with discharge planning from some wards.

• Overtime within Mental Health and Intellectual Disability Services this month is lower than usual.

HAC report – July 2007 24/08/2007 Group Manager – Elaine Chisnall

• Milburn Prison – active discussion and planning is occurring across specialist and relevant adult mental health teams, with the Department of Corrections. The prison now has a muster of 100 plus inmates. The Dunedin prison is scheduled to close mid August 2007.

• Locum Forensic Psychiatrists have been located to cover sabbatical leave, and a six month locum position has been secured from September 2007, however recruitment of a full time permanent forensic psychiatrist remains a challenge.

• For the month of July 85 bed days at Ashburn Clinic were outsourced to manage mental health service clients. • The Otago DHB Mental Health Requests for Proposal (RFP) process continues with the Provider Arm Mental

Health Service presenting a further proposal for new services as part of these RFPs. • A new Mental Health Target measuring the number of clients with completed Relapse Prevention Plans has

been released to be reported on quarterly. • The Mental Health services that are located in premises away from Dunedin and Wakari Hospital sites are

experiencing increased issues with computer response times. Strategies to increase network speed continue to be developed with the Chief Information Officer.

• The Mental Health service continues to be involved with the development of a suicide strategy action plan for the Otago DHB.

• A review document on the Provision of Forensic Services has been released. Otago DHB is required to develop and submit an Otago Regional Forensic Service Plan to the Ministry. Discussions are underway with Canterbury DHB regarding a South Island response.

• Information was co-ordinated from many areas of the service in response to the Ministry of Health’s Health of Offenders review.

• A review of the Mental Health NASC Service within the provider arm is continuing with a draft summary document due in August.

Miscellaneous • We welcome Adele Knowles as the new Nurse Director for Community, Rehabilitation and Older People’s Health

services. • All services within the group performed credibly during the recent accreditation and certification survey. The

results are a reflection on the enthusiastic and committed staff within the group. • Many staff within the Group are involved in the organisation wide Allied Health Review. • A proposal to implement a needlefree intravenous system within the organisation has been forwarded for

consideration by the Clinical Board. • Hon David Benson-Pope and his office staff have requested a site visit to Wakari Hospital in August to view the

proposed changes in facilities. The Group Manager is facilitating this visit. 2. Contractual Performance

Month Year to date

Actual Planned VarianceActual Prior

Year Actual Planned Variance Actual Prior

Year OPH – Inpatient - DSS 717 992 (275) 889 717 992 (275) 889OPH – Inpatient - ACC 300 225 75 239 300 225 75 239Rehab Inpatient –DSS 354 532* (178) 369 354 532* (178) 369Rehab Inpatient –ACC 209 225 (16) 233 209 225 (16) 233OPH – Outpatients 831 1,130 (299) 909 831 1,130 (299) 909Rehab – Outpatients 202 366 (164) 295 202 366 (164) 295Community Nursing 4,513 4,292 221 4,552 4,513 4,292 221 4,552Community Dom OT 329 394 (65) 379 329 394 (65) 379Comm. Dom Physio 418 662 (244) 513 418 662 (244) 513Comm. Continence 154 176 (22) 181 154 176 (22) 181Community Stomal 139 132 7 109 139 132 7 109Comm. Home Help 1,487 1,848 (361) 1,652 1,487 1,848 (361) 1,652MHOP Domiciliary 632 729 (97) 684 632 729 (97) 684 *June planned figure used as DSS contract not yet finalised for 2007-2008


• Mental Health

KPI July 06

Aug 06

Sep 06

Oct 06

Nov 06

Dec 06

Jan 07

Feb 07

Mar 07

Apr 07

May 07

Jun 07

July 07

ALOS Target: 21 days 11.9 10.7 10.8 15.5 9.9 13.9 13.4 12.8 14.8 13.7 22.3 9.6 11.3 FSA within 60 days** Target: 100% 83.7% 83.9% 86.1% 82.3% 82.4% 83.7% 74.6% 75.2% 84.5% 81.5% 83.8% 85.8% 84.5%Occupancy (All wards) 88% 93% 89% 85% 92% 94% 93% 98% 100% 97% 90% 95% 100%

Incl.leave days* 107% 113% 102% 96% 108% 118% 119% 119% 130% 122% 113% 118% 130%Intensive Acute (9B/1A) Excl.leave days+ 93% 93% 87% 80% 90% 95% 99% 108% 112% 103% 92% 101% 107%

Incl.leave days* 98% 98% 96% 86% 91% 98% 100% 108% 109% 105% 92% 100% 111%Clinical Rehab (10B/C/D)

Excl.leave days+ 82% 87% 83% 77% 83% 86% 84% 96% 98% 88% 81% 88% 93%

Incl.leave days* 68% 163% 187% 253% 222% 189% 153% 93% 44% 103% 58% 23% 85% Child & Youth Inpt (1A)

Excl.leave days+ 66% 158% 185% 206% 170% 140% 140% 93% 40% 100% 39% 17% 69%

Comments : Both ‘inclusive’ and ‘exclusive’ of leave days data is provided. The inclusive data shows true workload, the exclusive data shows number of patients in hospital at only one point in time (midnight). *Target for leave inclusive days = 100%. +Target for leave exclusive days = 85% **Seen by Consultant Psychiatrist as non-acute community outpatient. Teams include: Alcohol and Drug; Clutha CMHT; Central CMHT; Waitaki CMHT; Child and Family; South CMHT; North CMHT; Youth Specialities. 3. Resource Management

Month FTE Year to date FTE Actual Budget Variance 06/07Actual Vacancies Actual Budget Variance 06/07Actual

SMO’s 23.78 30.68 6.90 22.86 4.2 23.78 30.68 6.90 22.86 RMO’s 24.61 27.96 3.35 26.69 2.6 24.61 27.96 3.35 26.69

Nursing 365.11 385.42 20.31 366.03 31.1 365.11 385.42 20.31 366.03 Allied H. 156.88 173.83 16.95 158.62 13.5 156.88 173.83 16.95 158.62

Other 69.66 69.09 (0.57) 73.30 5.7 69.66 69.09 (0.57) 73.30 Total 640.04 686.98 46.94 647.50 57.1 640.04 686.98 46.94 647.50

• At the end of July there were 57.1 FTE vacancies across the Group. This is continuing to cause significant

concern in the provision of service delivery in multiple areas across the group. • Nursing vacancies continue to increase in both the Mental Health and OPH services. This will be further impacted

upon once the new Mental Health Services are implemented. Some of these services are currently being recruited to.

• Ongoing vacancies in Allied Health continue to put pressure on services. These include Speech Language therapists, Physiotherapists and Occupational Therapists.

• The SMO for Mental Health of Older People commenced in early August and the SMO in Physical Rehabilitation is due to commence late August. The SMO positions for Child and Youth Services and Forensic Psychiatry are still being recruited to.

4. Financial Performance Net Result ($000) Month Year to date

Actual Budget Variance Actual Budget Variance Revenue 3,622 3,563 59 3,622 3,563 59 Personnel (3,542) (3,794) 252 (3,542) (3,794) 252 Expenses (667) (704) 37 (667) (704) 37 Surplus (Deficit) (587) (935) 348 (587) (935) 348 Revenue: $59K favourable for month and YTD • Other Government Revenue $49k favourable primarily due to higher bed day volumes for ACC and non-resident

OPH patients.


Personnel costs: $252K favourable for month and YTD • 46.94 FTE under budget FTE volume for July due to vacancies. • $88k favourable in Nursing due to $120k favourable Ordinary time, offset by ($56k) overtime cover for training and

vacancies. • $121k favourable for Medical Staff primarily due to vacancies $101k savings in Ordinary time and $15k course and

ct. conference/memberships savings due to phasing effe $15k favourable in Therapies also due to vacancies. •

Other costs: $37K favourable for month and YTD • $13k favourable for IT systems and telecommunications due to costs now being held by the Corporate area.

Other Operating Costs $12k favourable due to $9k corporate train• ing costs for Registrars at Ashburn Clinic not re-rinting and forms.

$10k favourable for Treatment Disposables.

Clinical Director Group Manager Nursing Director

accrued but will continue and $3k savings in p•

James Knight Elaine Chisnall Heather Casey


Women’s Health, Children’s Health & Public Health July 2007 1. Service Summary Overview • Submissions prepared for the Allied Health Review. • Elective service performance indicators continue to be compliant with Ministry of Health standards. • Work continues on drafting a physical activity and nutrition policy and guidelines for the ODHB provider arm which

will underpin our responsibility to role model Healthy Eating Healthy Actions by “walking the talk”. • Terms of reference are being developed for the new Provider Arm Information Technology and Systems Clinical

Users Reference Group. • Feedback was provided to the University of Otago’s review of the Department of Women’s and Children’s Health. • Following receipt of additional MoH Public Health Directorate funding for the Healthy Eating, Healthy Action

(HEHA) for Otago kids- getting ahead of the bulge project, the business case for the appointment of a community paediatrician has been developed. (0.5 FTE) This will be a joint clinical appointment with the Dunedin School of Medicine and will have the key role in developing this project.

• We thanked Dr Clarkson for his nine years as Clinical Director and Clinical Leader of Paediatrics. Following stepping down from these roles, Dr Clarkson continues as a Paediatrician within Children’s Health. Dr Roland Broadbent is currently the acting Clinical Leader of Paediatrics whilst continuing his Clinical Leader responsibilities in NICU.

• Feedback was provided regarding the Ministry of Health Review of Well Child Services. • The Ministry of Health gave a presentation to provider arm and planning and funding staff on the forthcoming

introduction of antenatal HIV screening. Children’s Health • Staff have expressed concern regarding the redevelopment timeline for NICU and the Children’s ward which is

now expected to be completed in mid 2009. The return of NICU occupancy to close to 100% over the last few months has again highlighted the limitations of the current NICU facility. The development of a risk minimisation contingency plan continues and a review of NICU Nursing staffing levels has been undertaken.

• Paediatric Registrar seniority has continued to result in additional work having to be undertaken by Senior Medical Staff particularly in respect to the care of chronically unwell children and neonatal retrievals. A review of Registrar staffing is being undertaken.

Public Health South – Primary Services • Leaders of the School Dental Service have continued to work with Funding and Planning to prepare the business

case as part of the Ministry of Health Community Oral Health Strategy. • The National Screening Unit has still yet to advise the new “Go Live” date for implementation of changes to the

cervical screening register. Originally the centralisation of the administration of the cervical screening register was to have commenced 1 July 2007. Despite having a definite day of commencement of the new system, to provide staff with some employment certainty we have embarked on the consultation with respect to the change management process.

Public Health South – Public Health Services • Reorientation of Public Health service delivery towards outcome focussed public health practice continues. • Staff moved into the new Public Health South office at the Remarkables Park in Frankton, Queenstown. • Six monthly monitoring reports completed for the Ministry of Health. • An outbreak of gastroenteritis at an early childhood centre highlighted the need for regional cleaning guidelines for

early childhood centres that include advice on the use of personal protective equipment. Guidelines are being developed and will be promoted by Public Health Nurses and Health Protection Officers.

• Specifications identified for the Public Health Information Management System. Women’s Health • O&G medical staff vacancies (1 consultant and 3 registrars) has stretched service delivery and planning. Three of

the four vacancies will be filled by September but significant contingency planning has been required to cover the interim period.

• The externally facilitated monthly maternity service multidisciplinary forum was held again in July. Further work has been undertaken to better define the scope of the forum and associated processes.

• Maternity service staff and access holders have expressed a desire to explore options for a primary birthing facility.

HAC report – July 2007 24/08/2007 Group Manager – Pip Stewart

• Sourcing service provision for second trimester terminations of pregnancy has continued to be difficult. With the reduction in service provision capability in Christchurch, staff have been required to spend significant amounts of time trying to arrange access for services in Wellington and Auckland.

• Changes to section 88 Primary Maternity Services Notice were implemented from 1 July 2007. It is envisaged there may be some potential impact on the handover of care from primary to secondary services. Some Lead Maternity Carers have indicated they will no longer provide epidural care which will result in the transfer of these women’s care Queen Mary staff and we are monitoring these numbers.

• Planning is underway for the implementation of the new perinatal information system. • A review of the processes used for gynae-oncology follow-ups is being planned. 2. Contractual Performance

Month Year to date


Year Actual Planned

Variance

Actual PriorYear

Gynaecology FSA1 126 134 (8) 140 126 134 (8) 140 Gynaecology FUA2 99 134 (35) 158 99 134 (35) 158 Gynae surgery c/wts3 72 83 (11) 76 72 83 (11) 76 Colposcopy 80 109 (29) 111 80 109 (29) 111 Terminations 39 43 (4) 34 39 43 (4) 34 Maternity – Births 134 145 (11) 109 134 145 (11) 109 Maternity–P/N stays 123 140 (23) 106 123 140 (23) 106 Paed FSA 114 135 (21) 114 114 135 (21) 114 Paed FUA 416 516 (100) 456 416 516 (100) 456 Paed Acute Assess 80 122 (42) 161 80 122 (42) 161 Paed medical c/wts 59 63 (4) 52 59 63 (4) 52 Paed surgery c/wts 7 14 (7) 14 7 14 (7) 14 NICU c/wts 114 95 19 99 114 95 19 99 Sexual Health FSA 160 196 (36) 183 160 196 (36) 183 Sexual Health FUA 84 137 (53) 98 84 137 (53) 98 • Contributing factors for the variance in activity are:

o Gynaecology FSA’s, FU’s and caseweights less than planned due to consultant and registrar vacancies o Paediatric acute assessments and medical caseweights below plan associated with lower acute demand o Paediatric FSA’s and FUA’s less than planned due to postponement of visiting specialist clinic and

consultant leave

• Strategies for managing the above are: o Replacement O&G registrars and consultant to commence in August and September. o Paediatric visiting specialist clinic rescheduled

3. Resource Management

Month FTE Year to date FTE Actual Budget Variance 06/07Actual Vacancies Actual Budget Variance 06/07Actual

SMO 15.39 15.25 (0.14) 13.92 1 15.39 15.25 (0.14) 13.92 RMO 19.55 22.88 3.33 21.31 3 19.55 22.88 3.33 21.31

1 FSA – First specialist appointment

o 2 FUA – Follow-up appointment

HAC report – July 2007 24/08/2007

Group Manager – Pip Stewart

Nursing 128.71 131.00 2.29 130.55 2.3 128.71 131.00 2.29 130.55 Allied Health

91.65 100.86 9.21 88.75 4.6 91.65 100.86 9.21 88.75

Support 0.87 0 (0.87) 0 0 0.87 0 (0.87) 0 Mgmt / Admin

42.73 47.10 4.37 42.63 3 42.73 47.10 4.37 42.63

Total 298.90 317.09 18.19 297.16 13.9 298.90 317.09 18.19 297.16 4. Financial Performance Net Result ($000) Month –July 2007 Year to date

Actual Budget Variance Actual Budget Variance Revenue 614 611 3 614 611 3Personnel (1,775) (1,860) 85 (1,775) (1,860) 85Expenses (424) (480) (57) (424) (480) (57)Surplus (Deficit) (1,585) (1,729) 144 (1,585) (1,729) 144 Revenue: $3k favourable variance • MoH – Personal Health $7k.

• $7k Public clinical study money not budgeted ( Alternative Pathways for Addressing Disincentives) • MoH – Public Health ($13k).

• ($10k) due to early cessation of contracts with Dunedin Combined PHO’s. • Other Government Revenue $6k.

• $6k Clinical Access for Polytechnic to Maternity ward (timing difference) • Patient/Consumer Sourced $10k.

• $7k Fertility private patients greater than budgeted

k favourable variance Personnel costs: $85• Medical: ($1

MO’s to cover Registrar vacancies

han budgeted

• $34k due to FTE being less than budgeted (mainly in Women’s Health RMO’s / SHO’s)

• Nursing 3

• nces are under budget across the WCPG Wards, partly

• $11k annual leave taken more than budgeted.

• Psychol islth Promotion / Protection Officers)

($3k) course fees and professional memberships greater than budgeted (timing difference)

• Managemendgeted. This is mainly in National Immunisation Register and Cervical

8k). • ($16k) placement fees for Paeds RMO’s • ($16k) overtime mainly in Obstetrics & Gynae S• ($28k) due to pay rates greater that budgeted • ($5k) course fees / professional memberships greater t• $9k due to annual leave taken greater than budgeted. • $7k professional fees less than budgeted( timing difference)

: $ 4k. • $11k due to FTE less than budgeted

$14k allowances less than budgeted. Allowadue to FTE being under budget

og ts, Social & Community: $40k. • $35k FTE less than budgeted (mainly Public Hea• $10k annual leave taken greater than budgeted • ($3k) long service leave greater than budgeted in Health Development Southland •

t / Admin: $29k. $15k due to • 4.4 FTE less than buScreening.


• $7k annual leave revaluations • $6k annual leave taken greater than budgeted.

ance • Treatme

patterns • $7k in Maternity ward due to occupancy

• Diagnos Srchase of FFN cassette kit (timing difference)

• Pharma uatterns

rally favourable across the group

Hotel Servicnerally favourable across the group due to occupancy

Transport: $6k. s the group

• IT Systems

$13k accounting treatment of PC leases. These are now coded to the balance sheet but have been budgeted as an expense in the cost centres.

Dr Susan Fleming/Dr John Holmes Pip Stewart Jenny Woodley

Clinical Director Group Manager Midwifery Director

Other costs: $57k favourable vari

nt Disposables: $17k. • $5k Infertility Service uneven purchasing

tic upplies: ($6k). • $6k in Maternity ward pu

ce ticals: $16k. • $7k in Infertility Service uneven purchasing p• $9k gene

• es: $6k.

• $6k ge •

• $6k generally favourable acros

& Telecommunications: $18k. •


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