a g e n d a - waitemata dhb

HOSPITAL ADVISORY COMMITTEE (HAC) MEETING

Wednesday 03rd July 2013 10.00am Note: • Public Excluded Session 10.00am to 11.00am • Open meeting from 11.00am

A G E N D A

VENUE Waitemata District Health Board Boardroom Level 1, 15 Shea Tce Takapuna

Waitemata DHB, Hospital Advisory Committee Meeting 03/07/13 i

HOSPITAL ADVISORY COMMITTEE (HAC) MEETING 03rd July 2013

Venue: Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna Time: 10.00am WDHB Board Members Gwen Tepania-Palmer – Committee Chair Lester Levy – WDHB Chair Max Abbott – WDHB Deputy Chair Pat Booth – WDHB Board Member Sandra Coney – WDHB Board Member Rob Cooper – WDHB Board Member Warren Flaunty – WDHB Board Member Wendy Lai – WDHB Board Member James Le Fevre – WDHB Board Member Christine Rankin – WDHB Board Member Allison Roe – WDHB Board Member Hasan Bhally – Co-opted Member Susanna Galea – Co-opted Member Andrew Jones – Co-opted Member

WDHB Management Dale Bramley – Chief Executive Officer Luke Bunt – Chief Financial Officer and Head of Corporate Services Andrew Brant – Chief Medical Officer Jocelyn Peach – Director of Nursing & Midwifery Debbie Holdsworth - Chief Planning and Funding Officer Phil Barnes – Director of Allied Health Mike Schubert – Interim CEO, healthAlliance Sam Bartrum – GM Human Resources Paul Garbett – Board Secretary

Apologies: Susanna Galea

AGENDA

DISCLOSURE OF INTERESTS • Does any member have an interest they have not previously disclosed? • Does any member have an interest that might give rise to a conflict of interest with a matter on the agenda?

PART I – Items to be considered in public meeting All recommendations / resolutions are subject to approval of the Board. TIME 10.00a.m (please note agenda item times are estimates only and that the public excluded session is from 10.00am-11.00am)

1. AGENDA ORDER AND TIMING

10.00am 2. RESOLUTION TO EXCLUDE THE PUBLIC .................................................................. 1

3. CONFIRMATION OF MINUTES 11.00am 3.1 Confirmation of Minutes of Hospital Advisory Committee Meeting 22/05/13 ....................... 2 4. ITEMS FOR CONSIDERATION AND RECOMMENDATION TO THE BOARD

5. PROVIDER REPORT 11.05am 5.1 Provider Arm Performance Report .........................................................................................13 6. CORPORATE REPORTS 12noon 6.1 Clinical Leaders’ Report .........................................................................................................71 12.15pm 6.2 Human Resources Report ........................................................................................................75

7. INFORMATION PAPERS 12.25pm 7.1 Elective Services Update ........................................................................................................85 12.30pm PRESENTATION : Caesarean Births (Linda Harun - General Manager Child, Women and Family

Services) Presentation deferred.

Waitemata DHB, Hospital Advisory Committee Meeting 03/07/13 ii

REGISTER OF INTERESTS

Board/Committee Member

Involvements with other organisations

Last Updated

Lester Levy Professor of Leadership – University of Auckland Business School Co-Director – New Zealand Leadership Institute Deputy Chair – Health Benefits Limited Independent Chairman – Tonkin & Taylor Chair – Auckland District Health Board Chairman – Auckland Transport

01/11/12

Max Abbott – Deputy Chair

Pro Vice-Chancellor (North Shore) and Dean – Faculty of Health and Environmental Sciences, Auckland University of Technology Patron – Raeburn House Board Member – Health Workforce New Zealand Board Member - AUT Millennium Ownership Trust Chair – Social Services Online Trust Board member – Rotary National Science and Technology Forum Trust

28/09/11

Sandra Coney Elected Member and Chair Parks Committee - Auckland Council 02/05/11 Rob Cooper Board Member – Auckland District Health Board

Chief Executive - Ngati Hine Health Trust Advisory Board Member – James Henare Research Centre, University of Auckland

26/09/12

Pat Booth Consulting Editor – Fairfax Suburban Papers in Auckland 24/06/09 Warren Flaunty Member of Henderson – Massey, Rodney and Upper Harbour Local

Boards, Auckland Council Trustee - West Auckland Hospice Trustee - Waitakere Licensing Trust Shareholder - Metlifecare Shareholder - EBOS Group Shareholder – Pharmacy Brands Ltd Shareholder – Westgate Pharmacy Ltd Chair – Three Harbours Health Foundation Director – Trusts Community Foundation Ltd

20/03/13

James Le Fevre Registrar Auckland City Hospital Auckland Helicopter Emergency Medical Service Doctor Member – Australasian Society of Emergency Medicine, Hospital Overcrowding Subcommittee

27/02/13

Wendy Lai Partner – Deloitte Board member - Museum of NZ Te Papa Tongarewa

31/10/12

Christine Rankin Member - Upper Harbour Local Board, Auckland Council Director - The Transformational Leadership Company Chief Executive – Conservative Party

17/05/13

Allison Roe Shareholder – Optimisewellbeing.com Founding member – Breast Health Foundation Director – Spiritus NZ Trustee – Allison Roe Trust Board member – North Shore Hospital Foundation Founder – Takapuna 2020 Community Group

28/03/11

Waitemata DHB, Hospital Advisory Committee Meeting 03/07/13 iii

Board/Committee Member

Involvements with other organisations

Last Updated

Gwen Tepania-Palmer

Chairperson- Ngatihine Health Trust, Bay of Islands Life Member – National Council Maori Nurses Alumni – Massey University MBA Director – Manaia Health PHO, Whangarei Board Member – Auckland District Health Board Committee Member – Lottery Northland Regional Committee

10/04/13

Co-Opted Members

Hasan Bhally Member – Association of Salaried Medical Specialists (ASMS) Recipient of funding for research and advice - Pfizer Anti-Infectives Recipient of funding for research and advice - Cubist Pharmaceuticals

08/05/12

Susanna Galea Member – New Zealand Medical Association Member – Association of Salaried Medical Specialists (ASMS) Member – Medical Protection Society

10/05/12

Andrew Jones Member – Public Services Association (PSA) Chair – Physiotherapy New Zealand Ethics Committee

08/05/12

Waitemata DHB Hospital Advisory Committee Meeting 03/07/13 iv

Waitemata District Health Board

Hospital Advisory Committee Member Attendance Schedule 2013

x Absent * Attended part of the meeting only # Absent on Board business ^ Leave of absence

NAME FEB APR MAY JULY AUG SEPT NOV DEC

Gwen Tepania – Palmer (Committee Chair)

� � �

Dr Lester Levy (Chair) � � �

Max Abbott (Deputy Chair) � � �

Pat Booth � � �

Sandra Coney � � �

Rob Cooper ^ � �

Warren Flaunty � � x

Wendy Lai � � �

James Le Fevre � x �

Christine Rankin � � �

Allison Roe � � �

Co-opted members

Hasan Bhally � � �

Susanna Galea � � �

Andrew Jones � � x

Waitemata DHB, Hospital Advisory Committee Meeting 03/07/13

2 RESOLUTION TO EXCLUDE THE PUBLIC Recommendation:

That, in accordance with the provisions of Schedule 3, Sections 32 and 33, 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

1. Confirmation of Public Excluded Minutes – Hospital Advisory Committee Meeting of 22/05/12

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)]

Confirmation of Minutes As per resolution(s) to exclude the public from the open section of the minutes of the above meeting, in terms of the NZPH&D Act.

2. Quality 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.


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)]

3. Medication 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.




4. HR Update 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.




Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.

[Official Information Act 1982 S.9 (2) (j)]

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3.1 Confirmation of Minutes of the Hospital Advisory Committee meeting held on 22nd May 2013

Recommendation: That the Minutes of the Hospital Advisory Committee meeting held on 22nd May 2013 be approved.

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Minutes of the meeting of the Waitemata District Health Board

Hospital Advisory Committee

Wednesday 22 May 2013

held at Waitemata District Health Board Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 10.10a.m

PART I – Items considered in public meeting COMMITTEE MEMBERS PRESENT: Gwen Tepania-Palmer (Committee Chair)

Lester Levy (Board Chair) Max Abbott Pat Booth Sandra Coney Rob Cooper Wendy Lai

James Le Fevre Christine Rankin

Allison Roe Hasan Bhally (Co-opted member) Susanna Galea (Co-opted member) ALSO PRESENT: Dale Bramley (Chief Executive Officer) Luke Bunt (Chief Financial Officer and Head of Corporate Services) Debbie Holdsworth (Chief Planning and Funding Officer) Jocelyn Peach (Director of Nursing and Midwifery)

Phil Barnes (Director of Allied Health) Sam Bartrum (GM Human Resources) Jenny Parr (Associate Director of Nursing) Cath Cronin (GM Surgical and Ambulatory Services) Debbie Eastwood (GM Medicine and Health of Older People Services) Gerard Lenssen (GM Service Development and Strategic Projects) John Cullen (HOD Medical, Surgical and Ambulatory Services) Penny Andrew (Clinical Lead Quality)

Tamzin Brott (HOD, Allied Health) Paul Garbett (Board Secretary) (Staff members who attended for a particular item are named at the

start of the minute for that item.) PUBLIC AND MEDIA REPRESENTATIVES:

Lynda Williams (Auckland Womens Health Council)

APOLOGIES: Apologies were received from Warren Flaunty and Andrew Jones. WELCOME: The Committee Chair welcomed those present. She expressed the

sympathy of those present for Naida Glavish and her whanau on the loss of Naida’s father at the age of 101.

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DISCLOSURE OF INTERESTS There were no additions or amendments to the Interests Register. There were no identified conflicts of interest for the open part of the agenda. 1. AGENDA ORDER AND TIMING

Items were taken in the same order as listed in the agenda, with the public excluded session being held first, from 10.15a.m until 11.59a.m.

2. RESOLUTION TO EXCLUDE THE PUBLIC (agenda page 1)

Resolution (Moved James Le Fevre/Seconded Wendy Lai)

That, in accordance with the provisions of Schedule 3, Sections 32 and 33, 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:




1. Confirmation of Public Excluded Minutes – Hospital Advisory Committee Meeting of 10/04/13

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]

Confirmation of Minutes

As per resolution(s) to exclude the public from the open section of the minutes of that meeting, in terms of the NZPH&D Act.

2. Integrated Transition of Care

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]

Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)]

3. Quality 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)]

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4. Human Resources Update 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)]

Negotiations

The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.[Official Information Act 1982 S.9 (2)(j)]

5. Medication Safety Strategy Update

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)]

Carried 10.15a.m to 11.59a.m – public excluded session 11.59a.m – the Committee resumed in open meeting. 3. COMMITTEE MINUTES

3.1 Confirmation of the Minutes of the Meeting of the Hospital Advisory Committee

held on 10 April 2013 (agenda pages 3-14) Resolution (Moved Susanna Galea/Seconded Allison Roe) That the minutes of the meeting of the Hospital Advisory Committee held on 10 April 2013 be approved. Carried Matters Arising No matters were raised.

4. DECISION ITEMS

There were no decision items.

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5. PROVIDER ARM PERFORMANCE REPORT

5.1 Provider Arm Performance Report – March 2013 (agenda pages 15-78)

Executive Summary/Overview/Scorecard The Chief Executive advised that Andrew Brant (Chief Medical Officer) was absent from the meeting because of the arrival of his new son, Jasper Brant. Dale Bramley summarised some key points from the report including:

• Good progress with health targets. • Elective surgery numbers were slightly down, impacted by three statutory

holidays. • The new table Actual versus Predicted Bed Days (page 23 of the agenda). • ESPI compliance - the existing six month target being met and close to

achieving the five month target which will apply from 1 July. A short summary of overall April 2013 results was tabled and distributed at the meeting. Luke Bunt (Chief Financial Officer and Head of Corporate Services) summarised the financial results from the report. He also noted that the possible additional costs relating to underground infrastructure had been provided for, but with the hope that they will not be incurred. He referred to the need for sustainability in savings programmes. Surgical and Ambulatory Services Cath Cronin (General Manager, Surgical and Ambulatory Services) presented this section of the report. She conveyed an apology from John Cullen, who had needed to leave for another appointment. Matters highlighted by Cath Cronin included:

• The large amount of work being done relating to the transition to the Elective Surgery Centre, and to the new ESPI targets.

• With responses to complaints, the approach being taken is to try to make a phone call to the member of the public early on, which is often helpful in resolving the complaint.

• The progress made in reducing length of stay in General Surgery (page 31 of the agenda).

• ICU doing well in terms of quality initiatives and innovation (page 31 of the agenda).

• With outpatients it was pleasing to see that while there had been an increase in the number of clinics, this had been achieved with the same number of FTEs. Probably a ceiling had been reached in that respect though. The intention is to now try and contain clinics to the current profile.

• Radiology – outsourcing of 2,000 ultrasound scans to catch up on the waiting list. It is likely that some degree of outsourcing will continue in the next year and this will be reported on further in the next couple of months.

• BreastScreen Waitemata Northland – the service is on track to achieve its target for the year.

• With DNA rates, the service has more of a problem with follow up appointments than with first specialist appointments. The introduction of “patient focused bookings” to all specialities in June should reduce the number of DNAs.

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• One area off track is the Bariatric surgery target; the Ministry’s target is being achieved, but not the Board’s own target. At the end of the year it is likely that 88 procedures will have been done compared to the Board target of 100. For the next year they would look at capacity and what the target should be compared to other clinical priorities.

Matters covered in discussion and response to questions included:

• With ultrasounds, there does seem to be a long term problem with capacity. The tendency is to out source, but the problem is never resolved. Part of the discussion that needs to take place will be on whether that budget needs to be capped. The intention is to discuss in house and develop a plan to bring back to the Board.

• ESPI compliance – there is confidence in achieving the five month targets from 1 July. Dale Bramley advised that there is a weekly report on this target to the Board Chair and himself. The most recent reports show results tracking well. The Board Chair noted that some of the financial incentives for compliance relate to the region as a whole and achieving those will be close.

• Complaints – Cath Cronin advised that they are encouraging staff to respond as soon as they receive the complaint. Good time management is important. The response time average was off track for March, but back on track for April.

Resolution (Moved Pat Booth/Seconded Rob Cooper) That the Surgical and Ambulatory Services section of the report be received. Carried Medicine and Health of Older Peoples Services Debbie Eastwood (General Manager, Medicine and Health of Older Peoples Services) and Dr Jonathan Christiansen (Head of Department – Medical, MHOPS) presented this section of the report. Matters highlighted included:

• The division is on target to meet the health targets. • The percentage of urgent diagnostic colonoscopies done within 14 days (in

the Scorecard on page 42 of the agenda) should be corrected to read “51%”, not “65%”. This is still compliant with the target. There is no simple solution to improving waiting times, as the private sector is also saturated by increased demand for colonoscopies.

• In General Medicine, the Home Based Ward approach is not making the progress hoped for. Roster redesign has been done and staffing requirements detailed. However there was an additional requirement for RMO appointments and that had been declined through the regional process. That is being appealed. Secondly there are issues relating to reconfiguration of bed stock in wards that are being worked through.

• After a long summer, there had been a stark change in admissions a week previously and there was now very considerable pressure. Winter and contingency planning will kick in.

Matters discussed included:

• The good result for the division for discharges at weekends.

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• The Board Chair commended the exceptional work done on the Winter Plan, which had been shared with Auckland DHB. He had since been pleased to see a new Winter Plan at Auckland DHB.

Debbie Eastwood and Jonathan Christiansen were thanked for the report. Resolution (Moved Max Abbott/Seconded Pat Booth) That the Medicine and Health of Older People section of the report be received. Carried Child, Women and Family Services Linda Harun (General Manager, Child, Women and Family Services) and Dr Peter van de Weijer (Acting HOD Medical CWFS) presented this section of the report. Matters highlighted included:

• Complaint response times were worse for March, but had improved in April. Complaints for this Division are often complex and emotional, particularly in areas such as maternity and women’s health and often require a meeting and conversation to resolve. They are working hard to try and have complaints resolved quickly.

• DNA rates had improved for Maori and Pacific first specialist appointments, but there are still issues with follow up appointments and they are looking at how they can better support Maori women.

• Gynaecology is on track to achieve the new ESPI five month targets from 1 July.

• Rheumatic fever – a lot of work is taking place. The swabbing programme had started and a number of children had proved positive and are being monitored through GPs.

• The Maternity Oral Health project (page 53 of the agenda) is making very positive progress and being very well received.

Peter van de Weijer commented on:

• Delays with ultrasounds are an issue with ovarian cancer. He personally graded all referrals and worked in a close relationship with referring GPs and the Radiology Department.

• There is a very strong relationship between obstetricians and gynaecologists and their counterparts at Auckland DHB. There had been a presentation to the CEOs on how they envisaged the future delivery of Women’s Health, involving a shift in model from hospital based care to primary care and tertiary care, and they had received support for that.

Matters covered in discussion and response to questions included: • Follow up information on breast screening after discharge from hospital

comes from the Well Child Provider. Data on breast feeding comes through CPHAC. Sandra Coney noted that it would be interesting to see how the drop off in breast feeding occurs and how it varies between groups.

• The issue of reducing rates of Caesarean births is being approached in collaboration with Auckland DHB and the present view is that the best approach is to reinforce primary birthing, by moving from the hospital based focus. At Linda Harun’s suggestion a presentation will be brought to HAC,

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probably in July, showing how we rate on this issue and what the trends are like.

• Some of the factors causing over expenditure in Nursing and Clinical Supplies are: the Midwifery budget being understated; a much higher level of Gestational Diabetes occurring than expected; and higher acuity of cases.

• With Dental Service Clinical Supplies the new system had incurred some unexpected costs.

Linda Harun and Peter van de Weijer were thanked for the report.

Mental Health and Addiction Services Murray Patton (Clinical Director, Mental Health) and Robert Steenhuisen (Regional Manager CADS) presented this section of the report. Murray Patton conveyed an apology from Helen Wood. Matters highlighted included:

• Performance against the shorter waits in ED target, as detailed on page 57 of the agenda.

• The very high rates of bed occupancy in Forensics and Adult Inpatient Units. • The 3.8% reduction in volume of patients for CADS for 2012 compared to

2011. Matters covered in discussion and response to questions included:

• The draft Ombudsmen’s report under the Crimes of Torture Act (page 61 of the agenda) – these types of review are required under United Nations protocols.

• The Psychosis Relapse Prevention education package (page 61 of the agenda) – it is hoped there will be substantial benefit from this. A number of elements in the package are quite generic, such as motivational interviewing, and of wider benefit than just for dealing with psychosis. Ultimately the aim is to have staff across the service very familiar with all these initiatives. Funding is totally external.

• The heading “whanau contacts” in the Scorecard on page 58 of the agenda is not Maori specific but refers to the amount of contact with family members. Murray Patton commented that this is something that they wished to improve. Engagement with families is something that had been tracked for some time and is one of the areas of focus for KPI benchmarking with NGO partners. Susanna Galea noted that “whanau” in this context does not refer just to biological family, but also to “significant others”. Social networking is very important in terms of recovery.

Resolution (Moved Susanna Galea/Seconded Wendy Lai) That the Mental Health section of the report be received. Carried

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Provider Arm Support Services Phil Barnes introduced the Hospital Operations section of the report. Matters he highlighted included:

• Asian Support Services are recognised as a very high performing group and Auckland DHB is interested in providing the same service.

• The positive results of the food audit results for the hospitals (page 71 of the agenda).

Matters covered in discussion and response to questions included:

• Information was requested for members on how the proposed national food service for hospitals would work, if it eventuated. Information will be obtained for committee members.

• Phil Barnes will check and report back with regard to progress with implementation of the recommended measures to improve accessibility for disabled users of North Shore Hospital car parking.

• There was a significant discrepancy between information that Susanna Galea had received regarding timeframes when requesting transcription services and the information Phil Barnes was receiving. This will be followed up and resolved.

• With regard to some staff members at Waitakere Hospital persistently parking in disability places, it was noted that if management persuasion had not worked, the Chief Executive was able to authorise appropriate action, which could include towing.

The Committee Chair referred to the Health Heroes award to Jan Main, Relocations Manager. Resolution (Moved Allison Roe/Seconded James Le Fevre) That the report be received. Carried

6. CORPORATE REPORTS

6.1 Clinical Leaders’ Report (agenda pages 79-81)

Phil Barnes (Director Allied Health) and Jocelyn Peach (Director Nursing and Midwifery) presented this item. Phil Barnes highlighted:

• The proposal from the suppliers of Pyxis equipment, Care Fusion, that Waitemata DHB become a “super site” for the South Pacific region (page 79 of the agenda)

• The laboratory analyser claimed to have an additional capability to provide an ultra-high sensitivity test for the rapid diagnosis of heart attacks. (Phil Barnes will send information on this to James Le Fevre).

Jocelyn Peach highlighted:

• This is the first time staff members have been selected for the Rotary Youth Leadership Awards Leadership Programme.

• With regard to the discussion earlier in the meeting on recognising long service, 96 nurses and midwives had worked more than 25 years for Waitemata DHB.

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The Committee Chair acknowledged the nursing workforce, who despite considerable pressures is still able to go the extra mile. It was really good to see the selections for the Rotary Youth Leadership Programme. She thanked Jocelyn for the great way in which she mentored. Resolution (Moved Wendy Lai/Seconded Allison Roe) That the report be received. Carried

6.2 Human Resources (agenda pages 82-85)

Sam Bartrum (GM Human Resources) advised that in the Recruitment Statistics on page 83 of the report, the number of hires should be corrected from 139 to 197. In response to a request, Sam Bartrum advised that he would include ethnicity data relating to recruitment in future reports. Resolution (Moved James Le Fevre/Seconded Rob Cooper) That the report be received. Carried

7. INFORMATION PAPERS

7.1 Elective Services Update (agenda pages 107-110) The report was taken as read and received. The Chair thanked those present. The meeting concluded at 1.15p.m.

SIGNED AS A CORRECT RECORD OF THE WAITEMATA DISTRICT HEALTH BOARD HOSPITAL ADVISORY COMMITTEE MEETING OF 22 MAY 2013

_____________________________________ CHAIR

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Actions Arising and Carried Forward from Meetings of the Hospital Advisory Committee

as at 24th June 2013

Meeting Agenda Ref

Topic Person Responsible

Expected Report Back

Comment

HAC 22/5/13

5.1 Provider Arm Performance Report:

Caesarean Births – a presentation to HAC on how WDHB rates on this issue and what the trends are.

Linda Harun

HAC 03/07/13

Proposed National Food Service for Hospitals – information to be provided to members on how this would work if it eventuated.

Phil Barnes

Refer response below.

North Shore Hospital Car Parking – update to be provided on whether recommended measures to improve accessibility for disabled users have been implemented.

Phil Barnes

HAC 03/07/13

A verbal update will be given at the meeting.

Transcription Services – discrepancy with reporting to what Susanna Galea had been advised to be reconciled and members advised.

Phil Barnes The CADS transcription service is not provided by the main transcription team. Susanna has been referred to the Service Manager, Robert Steenhuisen. Have also indicated to Robert that the main service currently has capacity to assist if required.

HAC 22/5/13

6.1 Clinical Leaders Report:

Laboratory Analyser which is claimed to have additional capacity to provide ultra-high sensitivity test for rapid diagnosis of heart attacks – information to be provided to James Le Fevre.

Phil Barnes

Actioned – information provided.

National Food Service HBL has selected Compass Ltd (a UK based multinational) as the preferred provider of the national hospital food contract. The Compass proposal is to prepare around a third of the country’s hospital food from two main centres i.e. Auckland and Christchurch. The remaining two thirds will be sourced and prepared locally in existing DHB kitchens. In order to explore the feasibility of this proposal HBL is undertaking an intensive due diligence process which involves a large team of information gatherers visiting every DHB. The visit to Waitemata DHB is scheduled for two days in early July. The team will look at every aspect of food service delivery, from production to kitchen to service, and ascertain all of the implications of the proposal for each DHB. The information gathered will be used to inform a business case scheduled to be presented to the DHBs in October/November 2013.

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Waitemata DHB Hospital Advisory Committee Meeting 03/07/13

5.1 Provider Arm Performance Report – May 2013 Recommendation That the report be received. ___________________________________________________________________________ Prepared by: Luke Bunt (Chief Financial Officer and Head of Corporate Services) and Dr Andrew Brant (Chief Medical Officer) This report summarises the Provider Arm performance for May 2013.

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Provider Arm Performance Report

Table of Contents

Glossary

Executive summary

Scorecard

Health Targets

Financial Performance

Human Resources

Divisional Reports

- Surgical and Ambulatory services

- Medicine and Health of Older People services

- Child, Women and Family services

- Mental Health and Addiction services

- Provider Arm support services

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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

NSH North Shore Hospital

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

WTH Waitakere Hospital

YTD Year To Date

Information to assist with understanding the scorecard:

For each measure the green bar reflects how well we are doing against the target for the period (ie.

May 2013), the arrow reflects progress compared to last period (ie. compared to April 2013).

Where the current month's result is still meeting target but performance has decreased compared

to last month, a dash is used.

The progress green bar is weighted for each measure based on the degree of concern of any short

fall in meeting the target. The analysts within each service have provided an initial estimate of the

weighting for each measure based on prior performance; however this element of the scorecard is

still work in progress for some of the measures. For example, this weighting is noticeable for

Elective Volumes where the scale is very sensitive so that any variance is deemed to be significant.

If performance is achieving or better than target, the bar will display as a solid green line.

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Executive Summary / Overview

Overall assessment

The overall Year to Date (YTD) consolidated result for the DHB at May is a surplus of $8.952M which

is favourable to budget by $6.720M. This is largely attributed to the Funder arm which generated a

surplus of $12.016M that was better than planned by $11.099M YTD.

The Provider arm generated a deficit of $3.088M YTD to May which was $4.404M unfavourable to

the budgeted surplus. This result reflects cost pressures experienced by the Provider arm since July

2012 to date, mainly in Surgical and Ambulatory services ($4.323M), Medicine and Health of Older

People ($5.363M) and Hospital Operations ($2.399M). These cost pressures were partially offset by

better than planned financial performance in Mental Health ($2.892M) and Corporate ($5.452M).

Key drivers for these variances are discussed in this report.

The year-end forecast result for the DHB remains a surplus of $6.8M, primarily attributed to the

Funder forecast surplus of $13.6M which will fully offset the forecast Provider arm deficit of

$6.823M.

Service Delivery

We have continued to meet the health targets for better help for smokers to quit and shorter waits

in the emergency department in May. The elective surgery target result was down from last

month’s performance at 95.7%.

16 of 87


Scorecard

Health Targets Actual Target Productivity Actual Target

Better help for smokers to quit 97.7% 1 0 95.0% � ESPI 2 - % patients waiting > 6 months for FSA 0.2% 1 0 0.0% �

Provider Arm Elective Volumes 95.7% 1 0 100.0% � ESPI 5 - % patients not treated within 6 months 0.3% 1 0 0.0% �

Shorter Waits in ED 96.7% 1 0 96.0% �� Elective Surgical Day case rate % 57.0% 1 0 60.0% �

Patient Flow

Average Length of Stay - Acutes 3.81 1 0 3.50 �

Average Length of Stay - Electives 3.65 1 0 3.82 �

Quality Actual Target Discharges before 11am* 16% 1 0 20% �

Complaint Average Response Time 23 days 0 1 14 days � Discharges during weekends 16% 1 0 20% �

Rate of falls with major harm 3.00 1 0 < 0.07 �

Pressure injuries grade 3&4 0.00 1 0 TBC �� Contracts (YTD)

Elective WIES Volumes 13,377 1 0 14,404 �

DNA Rates Number Acute WIES Volumes 47,576 1 0 46,899 �

First Specialist Assessment (FSA) DNA rate - Total 436 9.9% 1 0 10.0% �

First Specialist Assessment (FSA) DNA rate - Maori 89 18.3% 0 1 10.0% � Non-Case weighted Discharges

First Specialist Assessment (FSA) DNA rate - Pacific 74 17.3% 0 1 10.0% � First Specialist Assessment (FSA) 34,829 1 0 33,506 �

Follow up (FU) DNA rate - Total 718 8.4% 1 0 10.0% � Subsequent Attendance (FUP) 75,771 1 0 64,450 �

Follow up (FU) DNA rate - Maori 123 22.4% 0 1 10.0% � Emergency presentations (admitted) 56,836 1 0 55,267 �

Follow up (FU) DNA rate - Pacific 106 22.4% 0 1 10.0% � Emergency presentations (non-admitted) 42,220 1 0 42,801 �

Other Key Measures

Acute Readmission Rate within 28 days 11.2% 1 0 10.0% �

Staff vaccination rate 55.0% 1 0 45.0% �

HR Wellbeing Actual Target

Sick Leave Rate (days) * 8.3 days 1 0 7.5 days ��

Overtime Rate (%) * � 1.3% 1 0 1.0% ��

Annual Leave Balance > 75 days 62 1 0 36 �

Turnover Rate % * 9.6% 1 0 10.0% �

Clinical Employ (FTE) 4,390 FTE 1 0 �

* 12 month rolling average � this does not include mental health services

Financial Result YTD Actual $000s Target $000s

Revenue 662,822 k 1 0 655,421 k �

Expense 665,910 k 0 1 654,105 k �

Personnel Costs 450,098 k 1 0 446,477 k �

Outsourced Services 45,520 k 1 0 40,144 k �

Clinical Supply Costs 83,690 k 0 1 78,041 k �

Non-Clinical Supply Costs 86,602 k 1 0 89,443 k �

Contribution -3,088 k 1 0 1,316 k �

Capital Expenditure 46,139 k 0 1 72,993 k �

Indicator Title 85.0% 1 k 0 100.0% � Improvement against previous result

DHB performance achieving or above the target will display as a solid green line.

Actual TargetDHB Performance

Waitemata DHB Monthly Performance ScorecardALL Services

May 2013

Service Delivery

Human Resources

Quality

Finance

Priority One

How to read

17 of 87


Health Targets

Better Help for Smokers to Quit

Shorter Stays in Emergency Departments

18 of 87


Emergency Department Presentations

1,000

1,200

1,400

1,600

1,800

2,000

2,200

2,400

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

Pre

sen

tati

on

s

Calendar Weeks

WDHB ED Presentations

Calendar Years from 01 Jan 2008 to 08/06/2013

2008 2009 2010 2011 2012 Mean from Aug 2010 2013

Improved Access to Elective Surgery

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

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

Ele

ctiv

e S

urg

ica

l D

isch

arg

es

Week

Progress Against Elective Surgery Target - 2012/13

WDHB Provided Target Total Target Estimated WDHB Provided YTD Estimated Total YTD

19 of 87


Elective Performance: Zero Patients Waiting Over 6 Months and 5

Months

Waitemata DHB: ESPI Compliance Summary Report at 6 months and 5 monthsESPI5 Summary (1% Compliance Buffer)

Specialty Non

compliance %

6 months

Non

compliance %

5 months

Specialty Non

compliance %

6 months

Non

compliance

% 5 monthsAnaesthesiology 0.00% 0.00% Cardiology 0.00% 0.00%

Cardiology 0.00% 0.00% General Surgery 0.27% 0.56%

Dermatology 0.00% 0.00% Gynaecology 0.00% 1.12%

Diabetes 0.00% 0.00% Orthopaedic 0.61% 2.79%

Endocrinology 0.00% 0.00% Otorhinolaryngology 0.00% 2.32%

Gastro-Enterology 0.00% 0.00% Urology 0.00% 0.29%

General Medicine 0.00% 0.00% Total 0.23% 1.50%

General Surgery 0.00% 2.94%

Gynaecology 0.00% 6.09%

Haematology 0.00% 0.00%

Infectious Diseases 0.00% 0.00%

Neurology 0.00% 0.00%

Oncology 0.00% 0.00%

Orthopaedic 0.88% 6.77%

Otorhinolaryngology 0.37% 9.12%

Paediatric MED 0.00% 0.00%

Renal Medicine 0.00% 0.00%

Respiratory Medicine 0.00% 0.00%

Rheumatology 0.00% 0.00%

Urology 0.00% 0.16%

Total 0.17% 3.21%

ESPI2 Summary (0.4% Compliance Buffer)

The electives service was ESPI 2 and 5 compliant for May within an allowable Ministry of Health

buffer for patients waiting over six months. This attracts a yellow status which does not activate a

penalty countdown. The electives service is also on track to be compliant in both ESPI 2 and 5 for

the new target of no patients waiting over five months for their first specialist appointment and

surgery by 30 June 2013. Waitemata DHB is therefore likely to receive the Ministry of Health

incentive payment of approximately $500,000. There is a further incentive payment if the Northern

region meets complete ESPI compliance.

20 of 87



All Services

CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date May-13

Provider

($000’s)

Actual Budget Variance Actual Budget Variance Forecast Budget Variance

REVENUE

Government

and Crown

Agency

59,878 57,535 2,343 642,339 634,793 7,546 700,710 692,965 7,745

Other Income 1,775 1,875 (100) 20,483 20,628 (145) 22,309 22,533 (225)

Total Revenue 61,653 59,410 2,243 662,822 655,421 7,401 723,019 715,498 7,521

EXPENDITURE

Personnel

Medical 12,396 11,971 (425) 128,920 127,323 (1,597) 141,805 139,338 (2,467)

Nursing 16,410 15,443 (967) 173,694 169,603 (4,091) 190,270 185,052 (5,218)

Allied Health 8,524 8,386 (138) 87,174 88,171 997 95,437 96,380 943

Support 998 1,267 269 11,262 13,420 2,158 12,385 14,677 2,292

Management /

Administration4,653 4,273 (380) 49,048 47,960 (1,088) 53,479 52,225 (1,254)

42,980 41,340 (1,640) 450,098 446,477 (3,621) 493,375 487,672 (5,703)

Other Expenditure

Outsourced

Services4,476 3,648 (828) 45,520 40,144 (5,376) 46,745 43,792 (2,953)

Clinical Supplies 8,488 7,318 (1,170) 83,690 78,041 (5,649) 91,047 85,398 (5,649)

Infrastructure

& Non-Clinical

Supplies

7,362 8,111 749 86,602 89,443 2,841 98,674 97,636 (1,038)

20,326 19,077 (1,249) 215,812 207,628 (8,184) 236,466 226,826 (9,640)

Total Expenses 63,306 60,417 (2,889) 665,910 654,105 (11,805) 729,841 714,498 (15,343)

Contribution (1,653) (1,007) (646) (3,088) 1,316 (4,404) (6,823) 1,000 (7,823)

Allocations (0) (0) 0 (0) (0) 0 0 0 0

NET RESULT (1,653) (1,007) (646) (3,088) 1,316 (4,404) (6,823) 1,000 (7,823)

FULL YEARMONTH YEAR TO DATE


Provider

($000’s)


CONTRIBUTION

Surg & Ambulatory (70) 250 (320) 568 4,891 (4,323) 267 5,120 (4,853)

Medical & HOPS 6,252 6,321 (68) 68,216 73,579 (5,363) 73,309 79,914 (6,605)

Child Women F. 3,054 2,940 114 36,258 36,407 (149) 38,633 39,940 (1,307)

Mental Health 2,545 2,682 (137) 33,557 30,665 2,892 37,048 33,389 3,658

Provider Support (13,435) (13,200) (234) (141,687) (144,226) 2,538 (156,079) (157,363) 1,284

Total Contribution (1,653) (1,007) (646) (3,088) 1,316 (4,404) (6,823) 1,000 (7,823)

MONTH YEAR TO DATE FULL YEAR

CONSOLIDATED STATEMENT OF PERSONNEL by PROFESSIONAL GROUP Reporting Date May-13

Provider

($000’s)


FTE

Medical 653 671 18 634 649 14 651 651 0

Nursing 2,108 2,496 388 2,481 2,492 11 2,492 2,492 0

Allied health 1,406 1,577 171 1,416 1,505 89 1,508 1,508 0

Support 254 344 90 265 332 68 333 333 0

Management 735 783 48 755 781 26 781 781 0

Total FTE 5,156 5,871 715 5,550 5,758 208 5,765 5,765 0


21 of 87


Comment on Major Variances

Revenue

Provider arm revenue was $2.243M favourable to budget for the month and $7.401M favourable

YTD. For the month, additional revenue was mainly from the DHB Funder, being unbudgeted bowel

screening and Mental Health Service Level agreement funding. For the YTD, additional revenue was

realised mainly for the bowel screening project ($3.392M with matching costs), revenue to cover

cancer treatment drug costs ($1.954M), HPV ($309k), Smokefree project ($204k), over-delivery of

IDF Inflows Electives and IDF acutes for other DHBs ($1.509M), Maternity Quality and Safety

Programme ($248k), additional funding for gastro services ($188k), Cancer Care coordination and

faster cancer treatment ($320k), Gateway assessment programme ($312k), CEO funded initiatives

($773k), additional interest income ($2.977M) and small favourable positions across various

contracts and income streams. These fully offset unfavourable movements in patient sourced

income ($1.8M adverse, mainly due to a stretched target for non-residents income that has not been

achieved), ACC revenue ($1.225M adverse, with the targets set for 2012/13 budget difficult to

achieve. Investigations are underway to find ways of increasing this revenue stream) and Funder

revenue not received ($2.777M due to Provider arm under-delivery on the additional electives

contract).

Expenditure Expenditure for the Provider arm was overall unfavourable for the month ($2.889M) and YTD

($11.805M). This reflects additional costs for initiatives/contracts funded from additional revenue

discussed above and cost pressures realised in the business. Key YTD variances are summarised

below:

Adverse Personnel cost variances are as follows:

• Medical staff costs ($1.597M adverse), reflecting unbudgeted costs for funded initiatives such

as bowel screening, greater than planned allowances for SMOs including allowances for

additional clinics, job sizing, leave cover and working without registrar support, additional costs

for superannuation, ACC levies, CME/WRE costs, revaluation of staff leave balances due to

payroll errors stretching back two financial years (with offsetting funding)

• Nursing staff costs ($4.091M adverse), due to unbudgeted costs for funded initiatives, higher

than planned levels of sick leave, impact of Norovirus in several wards early in the year,

increased constant observations, high patient volumes, backfilling for maternity and other leave;

and

• Management & Admin staff costs ($1.088M adverse), mostly relates to costs for funded

programmes with offsetting revenue such as bowel screening and also unrealised savings for

transcription services.

Favourable support staff costs ($2.158M) partially offset these adverse variances. These were mainly

due to vacancies in casual cleaners and orderlies, with corresponding costs for vacancy cover in

outsourced agency staff. Allied Health staff costs were also favourable to budget by $997k, mainly

due to vacancies (with Allied Health FTEs being 89 less than budget YTD to May, mainly regional

dental staff in Child Women Services and also Mental Health Services Allied staff).

Outsourced services costs were $5.376M unfavourable. $4.691M of this variance is in outsourced

staff costs, mainly due to the Bowel Screening project (with offsetting revenue), interim care costs

and GP Lesion programmes, Emergency medical fee for service costs, NASC Respite care costs,

external bureau staff to cover vacancies. On-going initiatives implemented by the Director of Nursing

and Head of Division Nursing and working with charge nurse managers has contributed to a

reduction in the use of external bureau staff. The balance of $684k is in outsourced clinical services,

including laboratory costs and outsourced ultrasounds.

22 of 87


Clinical Supplies costs were adverse by $5.649M mainly due to volume driven cancer treatment

drugs ($1.954M adverse YTD, with offsetting revenue from the funder), prior year supplies invoices

paid this year, under-budgeting in surgical services for 2012/13 theatres related treatment

disposables / instruments / implants, greater than planned clinical depreciation due to higher items

capitalised at 2011/12 year end than planned, supplies for home based older adult services.

These adverse costs were offset by favourable movements in infrastructure costs ($2.841M) mainly

due to less than planned interest costs, a result of delays in drawing down debt for capital projects.

23 of 87


Human Resources

All Services Sick Leave

0

2

4

6

8

10

12

Ma

y-2

01

1

Au

g-2

01

1

No

v-2

01

1

Fe

b-2

01

2

Ma

y-2

01

2

Au

g-2

01

2

No

v-2

01

2

Fe

b-2

01

3

Ma

y-2

01

3

Sick Leave Rate (days per fte)

Trends

The May 2013 result shows an increase to the monthly sick leave rate, but the annual sick leave rate

has continued its gradual decline to just below 8 days. The increase in the monthly result is in line

with normal annual sick leave usage patterns and the result is in line with that for the same period in

2012.

Highlights/risks

The improvement in the year on year result for the sick leave rate in April and May is positive.

Concern remains that sick leave will be higher than normal in the coming winter given the impact of

the flu in the Northern Hemisphere winter and the anticipated continuation of the infection over the

Southern Hemisphere winter. Occupational Health and Safety have improved their vaccination rate

across the organisation year on year and it is hoped this will reduce the impact of sick leave for flu

related illness.

Planned Actions

Monitoring of sick leave usage at team level continues as winter approaches. Improved manager

access to reporting on employee sick leave usage has been implemented recently.

24 of 87


Overtime

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

Ma

y-2

01

1

Au

g-2

01

1

No

v-2

01

1

Fe

b-2

01

2

Ma

y-2

01

2

Au

g-2

01

2

No

v-2

01

2

Fe

b-2

01

3

Ma

y-2

01

3

Overtime Rate (% total hours)

Trends

The May result shows a significant decrease in the rate of overtime and we have achieved the target

of 1% for the first time. The annual result continues to reduce gradually towards the target of 1%.

The monthly usage is less than that for the same period in 2012.

Highlights/risks

There has been a significant improvement in the overtime rate over the last twelve months and the

last two months have demonstrated a significant improvement in this area. It is likely that there will

be an increase over the winter period to respond to increased levels of sick leave.

Planned Actions

Human Resources will continue to review the results going forward at service level to identify any

changes in services which are not affected by increases in the sick leave usage rate.

25 of 87


Annual Leave Management

Service Annual Leave Balance

0-24 days 25-49 days 50-74 days 75+ days

01-WIMO Medical and HOPS 1319 436 105 26

01-WSAS Surgical and Ambulatory 742 277 59 15

01-WWCW Child Women & Family 790 170 15 9

01-WMHS Mental Health Services 892 274 32 8

01-WHOG Hospital Operations 455 194 18 1

01-WACP Corporate 128 37 3 3

01-WCFA Facilities and Development 26 12 0 0

01-WPDS Decision Support 28 12 5 0

Grand Total 4,380 1,412 237 62

Trends:

The Annual Leave rate remains favourable; most staff are taking around 25 days annual leave per

year. The number of employees with an annual leave balance of over 75 days has reduced to 62.

Planned Actions:

New reporting for managers regarding annual leave balances and usage has been launched,

providing instant access to information at team level to assist with planning and preventing issues

arising.

26 of 87


Staff Retention

Staff Resignations within 6 months

Turnover

Trends

The monthly annual turnover saw an increase in May 2013 to just below 12% but the annual result is

currently within 1% of the target of 10%.

Highlights/risks

The number of leavers within six months in May (7) is within the normal range experienced over the

last 24 months and follows a smaller number in April. Each instance is reviewed at a team level.

There are no concerns about the annual or monthly turnover rate.

Planned Actions

All employees leaving within one year of service continue to be provided with an exit interview in

person, rather than via the electronic service. Any issues of concern are addressed at service and

team level as appropriate.

27 of 87


Surgical and Ambulatory Services

Service Overview

This Division provides elective and acute surgery to our community encompassing surgical specialties

such as general surgery, orthopaedics, otorhinolaryngology and urology, and includes outpatient

clinics, operating theatres and pre and post-operative wards. The service is managed by Cath

Cronin. The Head of Division Medical is John Cullen, Head of Division Nursing is Kate Gilmour and

Head of Division Allied Health is Tamzin Brott.

Scorecard

Health Targets

Better help for smokers to quit has been achieved at 98.3%.

The elective volume is meeting target at 98.9%.

Shorter waits in ED is just under target this month at 94.5%.

Radiology Waiting Times

The waiting time indicator is for 75% of accepted referrals for CT and MRI scans to receive their scan

within 6 weeks (42 days). We are currently sitting at 53% for CT and 38% for MRI.

ESPI Compliance

The work required to be completed to meet the 5 month waiting time target is being monitored

daily and is on track to achieve 100% compliance for ESPI 2 and 5 by 30 June 2013.

Quality

The service received 23 complaints in May (compared to 25 at the same time last year) and achieved

a complaint response rate of 27 days for the month which is again disappointing. The delay in the

response rate was due to seven complaints that were held up due to the complexity of issues that

required extensive consultation and time taken for review.

The service is acutely aware that this poor performance must be addressed. All complaints waiting

greater than 12 days for a response will be reviewed by the General Manager. The general

instruction is that all complaints must be addressed and finalised within the week they are received.

Human Resources

The Theatre Services consultation period for the Unit Manager position closed with the finalised

document published 30 May.


Budget variance forecast for 30 June 2013 is still targeted at $4.8M.

Additional work for clinics and theatre sessions are underway to reach ESPI compliance of five

months treatment time and there is Ministry of Health funding available for costs attributed to

meeting compliance.

28 of 87


Faster Cancer Treatment

Faster Times to Cancer Treatment - Indicator Results

For Jan-Mar 2013 Quarter

as at 18 Apr 2013

Indicator ADHB CMDHB WDHB Total

Indicator 1: Referral to First Treatment

Total cases eligible 52 52 202 306

Compliant cases 35 31 128 194

% compliant 67% 60% 63% 63%

Indicator 2: Referral Date to First Specialist Assessment



% compliant 52% 62% 51% 53%

Indicator 3: Decision-to-Treat to First Treatment



% compliant 72% 62% 82% 77%

Indicator 1: Referral to first treatment ≤ 62 days

Indicator 2: referral to FSA (≤ 14 days)

Indicator 3: Decision to treat to first treatment (≤ 31 days)

Elective Surgery Centre (ESC)

Work is well in progress to open the ESC for the first surgical patient. Collaborative programmes

between S&AS and ESC are being finalised and signed off. From an S&AS perspective we will have all

aspects of service delivery confirmed and scheduled for 15 July 2013.

Outpatients

Seven staff have graduated from the 1 year Patient Care Assistant programme with a Level 3 NZQA

qualification. An evaluation of the programme has been completed with some refinements being

made for the next programme. Feedback from the participants reflects a high level of pride in what

they have accomplished and we have a number of services who are now seeing the benefit of this

role and requesting PCA support in their clinics.

In order to support service ESPI demands, the department has provided over 25 extra clinics in the

past 2 months, mostly on a Saturday.

The development of the Outpatient Tracking Board has been delayed. We want to ensure that our

work links with the IT change management processes underway for ESC so that staff are supported

to integrate the new systems into their practice. We are anticipating our project will be at an

implementation stage in September.

Radiology

29 of 87


Increased wait times for outpatient and community referred Ultrasound, CT scanning and MR

remain an operational focus.

Outsourcing of ultrasound scans continues. Production planning in the department is underway to

ensure optimised use of available resources and the scope of request triage is being broadened to

ensure resource allocation matches clinical need.

Joint tender progress for additional MRI scanners for Waitemata and Auckland DHBs continues with

site visit planning underway. Interviews for the facility build project management are to take place

mid-June.

All Outpatient and GP referred Scans – May 2013

Ultrasound MRI CT

Total number of patients waiting for scan at end of month 2908 1436 1640

Total number scanned during the month 1602 363 935

New requests accepted during the month 1692 497 1032

Average length of time waiting for scan 116 days 114 days 98 days

% patients scanned within six weeks 44% 38% 53%

BreastScreen Waitemata Northland (BSWN)

Highlights to 30 June 2013 include BSWN achieving the 70% BreastScreen Aotearoa (BSA) coverage

target for Maori in Waitemata DHB. This is the result of a short term project (Project Ella and

Whetu) that went live at the beginning of quarter 3. Project objectives included working with

primary care to recruit and recall, screen and achieve equitable BSA coverage for Maori in the

Waitemata district. Communications are preparing an article to be included in the DHB newsletter

(June/July).

In addition, BSWN:

• Achieved the 2012/13 contracted volumes target (37,776 screens per annum)

• Achieved 70% BSA coverage in Rodney as a result of increased capacity and uptake by women to

screen using the mobile unit

• Is on track to resolve all corrective action requests (CARs) identified in the Ministry’s service

compliance audit by 24 September 2013.

DNA

Our DNA rates have maintained a status quo over the last six months despite various projects and

focus. A major opportunity presents with the opening of the ESC and the restructure of our clinic

processes and monitoring of our efficiency in outpatients. The opening of the ESC will give the

booking and scheduling team time to refocus on DNA now that we have managed ESPI compliance,

end of year performance indicators and the commissioning and opening of the ESC.

Quality Indicator – Fractured Neck of Femur (fracture hip)

We are monitoring the timeliness of transferring patients with fractured neck of femur to theatre.

There is clinically-validated evidence that the majority of patients in the group who are worked up

and receive the surgical procedure within 24 hours will have an optimised outcome and recovery.

We are tracking at 42% against a target of 85%. This will be a major project for the next six months.

We have engaged clinicians from ED, medicine, orthopaedics, nursing and allied health to work to

improve this indicator and the associated outcomes for our patients.

This is an aspirational target and we will see improvement over time as we improve our systems and

processes.

30 of 87


Scorecard

Health Targets Actual Target Productivity Number Actual Target

Better help for smokers to quit 98.3% 1 0 95.0% � Elective Surgical Day case rate % 57.0% 1 0 60.3% �

Provider Arm Elective Volumes * 98.9% 1 0 100.0% � Elective Day of Surgery Cancellations 0.6% 1 0 2.0% �

Shorter Waits in ED 94.5% 1 0 96.0% � Theatre utilisation 83.0% 1 0 85.0% �

* excludes gynae No. & % of CT scans done within 6 weeks (42 days) 346 53.0% 0 1 75.0% �

No. & % of MRI scans done within 6 weeks (42 days) 111 38.0% 0 1 75.0% �

No. & % of US scans done within 6 weeks (42 days) 609 44.0% 0 1 75.0% �

Quality Actual Target Patient Flow

Complaint Average Response Time 27 days 0 1 14 days � Day of Surgery Admission rate (DOSA) 94.0% 1 0 92.0% ��

Average Length of Stay - Acutes 6.56 0 1 4.00 �

DNA Rates Number Average Length of Stay - Electives 3.84 1 0 3.90 �

First Specialist Assessment (FSA) DNA rate - Total 165 10.2% 1 0 10.0% � Discharges at weekends 7.2% 0 1 20.0% �

First Specialist Assessment (FSA) DNA rate - Maori 27 22.5% 0 1 10.0% � Discharges before 11am 17.5% 1 0 20.0% �

First Specialist Assessment (FSA) DNA rate - Pacific 24 21.8% 0 1 10.0% �

Follow up (FU) DNA rate - Total 280 8.4% 1 0 10.0% � ESPI 2 - % patients waiting longer than 6 months for FSA

Follow up (FU) DNA rate - Maori 50 18.9% 0 1 10.0% � General Surgery 0.0% 1 0 0.0% ��

Follow up (FU) DNA rate - Pacific 26 14.5% 0 1 10.0% � ORL 0.4% 0 1 0.0% �

Orthopaedics 0.9% 0 1 0.0% �

Other Key Measures Urology 0.0% 1 0 0.0% ��

Acute Readmission Rate within 28 days 10.4% 1 0 10.0% �

% of fractured neck of femur patients to theatre within 24 hours (April 2013) 42.0% 0 1 85.0% � ESPI 5 - % of Patients not treated within 6 months

ICU - rate of CLAB per 1000 line days 1.0 1 0 < 1 � General Surgery 0.4% 1 0 0.0% �

ORL 0.0% 1 0 0.0% ��

Orthopaedics 0.8% 0 1 0.0% �

Urology 0.0% 1 0 0.0% ��

HR Wellbeing Actual Target Contracts (YTD)

Sick Leave Rate (days) * 7.4 days 1 0 7.5 days � Elective WIES Volumes

Overtime Rate (%) * 1.3% 1 0 1.0% �� Surgery (Overall) 10,867 1 0 10,990 �

Annual Leave Balance > 75 days 16 1 0 5 �� General Surgery 4,118 1 0 3,816 �

Turnover Rate % * 8.0% 1 0 10.0% � ORL 1,034 1 0 1,055 �

Clinical Employ (FTE) 774 FTE 1 0 � Orthopaedics 4,776 1 0 5,250 �

* 12 month rolling average Urology 937 1 0 871 �

Acute WIES Volumes

Surgery (Overall) 11,877 1 0 10,924 �

Financial Result YTD Actual $000s Target $000s General Surgery 6,192 1 0 5,697 �

Revenue 134,927 k 1 0 131,324 k � Orthopaedics 5,662 1 0 5,226 �

Expense 134,359 k 0 1 126,433 k �

Personnel Costs 91,750 k 1 0 88,583 k � Non-Case weighted Discharges

Outsourced Services 8,348 k 1 0 5,537 k � First Specialist Assessment (FSA) 11,607 1 0 12,634 �

Clinical Supply Costs 28,371 k 1 0 26,811 k � Subsequent Attendance (FUP) 30,145 1 0 26,660 �


Contribution 568 k 1 0 4,891 k �





Waitemata DHB Monthly Performance ScorecardSurgical and Ambulatory Service

May 2013

Service Delivery

Human Resources

Quality

Finance

Priority One

How to readHow to read

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Strategic Initiatives Deliverable /Action On Target

Elective Services Patient Indicator Flow (ESPI) compliance will be maintained each

month through:

• more consistent referral management

• a redesign of booking and scheduling processes

• outsourcing options

• improved productivity. √

Elective Surgery Centre FSA project “one stop shop” completed – improving the

quality of elective referrals from GPs

√

Continue to use the national CPAC priority scoring tool √ Formalised elective agreements will be in place with private elective providers √ Commence building of the dedicated purpose-built elective facility (Elective Surgery

Centre) on the North Shore hospital campus February 2012 to be completed by 2013.

√

Perform 100 Bariatric procedures in 2012/13 with a focus on Māori and Pacific people �

Develop and implement a training, education and resource (including a pain

education and management website) programme for patients, primary care

physicians and secondary services based on innovative, patient specific interventions

that rely on stratifying patients to individual, group based or GP partnership models

of care

√

Implement new Outpatient Service model (staffing, booking & scheduling) √ * include a � or a �

Key achievements for month:

1. ESPI 2 and 5 compliant to 6 months

2. Elective surgery productivity meeting target

3. Review of clinical supplies ongoing

4. Completed theatre schedules for NSH, WTH and ESC. Production plan underway

5. Communication plan for all activities related to the ESC rolled out to all staff

6. Project to improve timely access to acute orthopaedic theatres underway

7. Outsourcing agreed to manage ultrasound waiting list initiative

8. Service transfer from CMDHB in progress

9. WTH theatre staff outcome agreed and documented

Areas off track for month and remedial plans:

Bariatric Surgery as noted last month. We will meet the Ministry of Health target but not our

internal target. A full report will be provided in August.

Key issues/initiatives identified in coming months

• Surgical pathway analysis is underway to measure surgical demand/capacity, treat all patients

within 5 months and to sustain this in 2013/14. This work has been escalated to assist with

budget reconciliation for 2013/14 and manage referrals to resourced capacity

• Work will commence in the next few months to identify the issues associated with moving to

surgical treatment times of 4 months in December 2014

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• Daily monitoring of performance to targets and financial management continues to ensure

health targets are met and any potential risks to achieving revenue are identified and resolved.

Overspend to budget remains a risk and to limit where possible is a priority

• Clinical Supplies Project continues to improve reporting and seek timely data on expenditure for

clinical supplies, set up in-time ordering for both consumables and prosthesis, reduce the costs

of imprest held in theatre and generally contain/reduce costs. Initial trends are showing a slight

decrease in expenditure with careful monitoring and local improvements in inventory

management and approval processes

• Longer term strategies are being explored to reduce the Maori and Pacific DNA rates. A

refocused project is planned once the ESC is open.

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Financial Results


Surg & Ambulatory

($000’s)


REVENUE

Government

and Crown

Agency

13,056 11,866 1,190 134,351 130,531 3,820 146,702 142,397 4,305

Other Income 93 72 20 576 794 (217) 605 866 (261)

Total Revenue 13,149 11,939 1,210 134,927 131,324 3,603 147,306 143,263 4,044

EXPENDITURE

Personnel

Medical 4,042 3,847 (196) 42,589 41,094 (1,495) 46,735 44,955 (1,780)

Nursing 2,761 2,576 (185) 29,270 28,370 (900) 32,264 30,946 (1,318)

Allied Health 971 879 (92) 10,126 9,634 (492) 11,087 10,509 (578)

Support 156 177 21 1,606 1,818 212 1,751 1,991 240

Management /

Administration747 678 (69) 8,158 7,666 (492) 8,994 8,343 (651)

8,677 8,157 (520) 91,750 88,583 (3,167) 100,832 96,745 (4,087)

Other Expenditure

Outsourced

Services894 503 (391) 8,348 5,537 (2,811) 8,956 6,040 (2,915)

Clinical Supplies 3,073 2,528 (545) 28,371 26,811 (1,560) 30,777 29,355 (1,422)

Infrastructure

& Non-Clinical

Supplies

575 500 (75) 5,890 5,503 (388) 6,476 6,003 (473)

4,542 3,532 (1,011) 42,609 37,851 (4,758) 46,208 41,398 (4,810)

Total Expenditure 13,219 11,688 (1,531) 134,359 126,433 (7,926) 147,040 138,143 (8,897)

Contribution (70) 250 (320) 568 4,891 (4,323) 267 5,120 (4,853)

Allocations 890 890 0 9,909 9,909 0 10,787 10,787 0

NET RESULT (961) (640) (320) (9,341) (5,018) (4,323) (10,521) (5,668) (4,853)


Comment on Major Financial Variances

Contribution variance for May: U$320K, YTD: U$4.3M

Revenue Elective revenue variance F$122k: Overall elective activity for the month was higher than the DHB target by 26

WIES. YTD the revenue is 136 WIES below the target for both the Waitemata DHB population and for IDF due to

under-delivery of planned Orthopaedic elective procedures. Other unbudgeted funder revenue such as

Community Ultrasound funding along with other unbudgeted activity (such as Bowel Screening (BSP) $3,392k YTD

and Radiology revenue from Auckland DHB) generated a positive result overall YTD of F$3,603k.

Of particular note is the underfunding of acute surgery, with around $420k of unfunded General Surgery and

Orthopaedic acute surgery taking place in the month. This brings the total of this under-funded acute surgery to

around $4.2m for the year. This has been addressed by the Waitemata DHB funder for 2013/14.

On a positive note, the Breast Screening Service had a record month with 3,966 screens performed, which helped

enable them to break through the YTD target threshold of 70% coverage of the Maori population.

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Expenditure

Total expenditure was unfavourable by $1,531k for May, dominated by the $364k adverse in BSP for which

equivalent unbudgeted revenue was posted. When BSP is backed out of the result, the remaining services were

$1,167k unfavourable, split $379k in personnel and $788k in other direct costs. YTD there remains four main

areas of focus in expenditure: Medical costs, Allied Health costs, Outsourced costs and Clinical supplies surface as

recurring areas of concern.

The negative variance YTD in Medical FTE is driven by the price paid per senior FTE compared to the price

budgeted. In the base salary costs there is a payroll correction for the value of leave, at least $360k of which is

included in the YTD variance. A negative variance in payments excluding base salary of $725k stems from such

things as additional sessions, ACC levies, superannuation and WRE/CME YTD. The review of medical job-sizing and

allowances continues as a critical priority.

Allied Health Costs have a variety of drivers each making a small contribution to the unfavourable result such as

$68k from unavoidable unbudgeted cost, $162K in anaesthetic technician overtime and $84k in unbudgeted

penals in Radiology.

Variance in Outsourced costs ($1,283k YTD independent of BSP) is driven by:

• External bureau nurses used in wards and theatres ($377k YTD) - Director of Nursing has review in hand, with

recruitment of permanent staff underway where required

• Purchase of medical time from the University of Auckland and Counties Manukau DHB ($96k, $10k arising

from late invoicing for 2011/12 year)

• Interim Care and GP Skin Lesion programmes ($349k YTD) – Interim Care now put on ‘hold’; and closer

monitoring of GP Skin Lesion costs is in place

• Radiology - $193k covered under an SLA with revenue to offset.

Clinical Supplies costs once again prove to be a concern in May, despite showing an improvement in the middle of

the financial year with the YTD overspend showing as $1,339k (independent of BSP). A late start to Interventional

Radiology has generated an underspend of $540k in radiology, and along with underspends in the wards, ICU,

Surgical Specialties and Breast Screening disguise the problem in the Theatres which is $2.6M adverse, but

considering the $4.2M under-funded acute surgery, this may be understandable. Both NSH and WTH theatres

show significant overspend across a wide range of well identified account codes.

Summary

The under-funded Orthopaedic and General Surgery acute surgery ($4.2m YTD) has been difficult to absorb within

the service. Stringent cost containment measures and the constant review of processes have continued but there

remains an underlying structural deficit in the budget, exacerbated by costs rolled over from the previous

financial year. Elective events are planned to reach target (ESPI and health target) by year end. Even with the cost

control measures in place during the year, the forecast variance to budget is projected to be around $4.8m at

year end, which may closely align to the under-funded acute surgery total.

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Medicine and Health of Older Peoples Services

Service Overview

This Division is responsible for the provision of emergency care, medical services and sub-specialties (including

cardiology, dermatology, diabetes, endocrinology, gastroenterology, haematology, infectious diseases, renal,

respiratory and rheumatology), and services for older people including assessment, treatment and rehabilitation

(A, T and R), mental health services, and home based support services.

The service is managed by Debbie Eastwood with the Heads of Department Dr Jonathan Christiansen, Medical,

Shirley Ross, Nursing and Tamzin Brott, Allied Health. The Clinical Directors are Dr Hamish Hart for Medicine, Dr

John Scott for Health of Older Adults, Dr Gavin Pilkington for Psychiatry for the Older Adult, Dr Willem Landman

for Emergency Care, Dr Ali Jafer for Gastroenterology, Dr Rick Cutfield for Diabetes/Endocrinology, Dr Tony Scott

for Cardiology, Dr Hasan Bhally for Infection Diseases, Dr Janak De Zoysa for Renal, Dr Megan Cornere for

Respiratory, Dr Ross Henderson for Haematology, Dr Cathy Miller for Palliative, Dr Blair Wood for Dermatology

and Dr Michael Corkill for Rheumatology.

Scorecard

Smokefree

In May we provided documented advice and support to 98% of all identified smokers who were admitted to the

hospital. Our positive performance has supported us to maintain an aggregate of 98% across quarter 4, 2012/13.

In total we offered advice and support to 1,223 of the 1,253 identified smokers in the month.

Elective WIES Cardiology

WIES for elective cardiology procedures remains lower than contract for the reasons we have stated in previous

reports, however our performance in May has brought us to 78% against our YTD target.

We achieved 98% compliance with the elective angiography within 90 days measure, against a target of 85%.

Complaints

The number of complaints received in May reduced to 32 against an average of 35 per month from July 2012 –

May 2013. This month our turnaround time was 20 days against a target of 14. We continue to review our

processes at our Quality and Service Improvement meeting to both identify where the delays are occurring and to

discuss trends and opportunities for service improvement. We also have a 30 minute weekly meeting to identify

any areas of concern either with workload and/or complexity of the complaint.

DNAs

Our main contributor to the DNA result for Maori and to a lesser extent Pacific people is Diabetes for both First

Specialist Assessments (FSA) and Follow up appointments. The second initiative that the Diabetes DNA working

group has identified is that all Maori patients will be contacted prior to any appointments being scheduled; this

will be for both FSAs and Follow up appointments. This pilot is scheduled to run for three months and the results

will be evaluated to determine if this change in process results in a reduction in the DNA rate. We have also

commenced Saturday clinics for Maori patients who have difficulty attending appointments during the working

week. To date these clinics have had a low DNA rate. Our challenge is to engage both Maori and Pacific patients at

the very start as the DNA rate is higher for FSAs than for FU appointments.

Other Key Measures

Shorter Stay in Emergency Department (ED)

Shorter stays in ED performance for Q4 to date sits at 96.5%; the service has been under pressure due to a

combination of high patient volumes over the last four weeks as can be seen by the WDHB ED Presentations

36 of 87


graph earlier in the report and an increase in staff sickness. The Clinical Director and Operations Manager (ED) are

working closely with staff to ensure they are minimising any unnecessary delays to treatment in the ED as well as

working collaboratively with the other services to ensure optimal patient flow through the system.

General Medicine is focusing on pulling the TBS (to be seen) patients who are likely to be allocated to them from

ED to improve the timeliness of the patient transfer. The availability of inpatient beds is a challenge with most

wards operating at 97-100% occupancy for most of the month. We are starting nurse facilitated discharges from

mid-June and will also employ a discharge coordinator (nurse) on a fixed term contract for three months. The

discharge coordinator will assist with managing the >10 day inpatient LOS patients and other complex patients

who are not currently supported by the Geriatric Nurse Specialists. These are both winter initiatives.

Quality

Senior nursing has started a new forum called Frontline Focus Friday; this initiative is aimed at quality

improvement activities. The focus for May has been falls and the new improvement processes from phase 2 of

the falls project. As well as the Frontline Focus meeting the Quality Improvement specialists have been attending

Charge Nurse Manager (CNM) meetings and working with them in clinical areas to trial new monitoring and

improvement strategies. The focus for June will be on administration of opiates and the double checking process.

Human Resources

We have commenced the Charge Nurse Manager (CNM) role review with an initial launch meeting planned for

June. This is a joint initiative between Medicine & Health of Older Adult and Surgical and Ambulatory Services.

The review has a number of objectives. These include working with the CNM to clarify the service delivery

expectations of the role, as well as identifying what support the CNMs’ need to ensure they have the right skills to

perform effectively in this pivotal and challenging role. Our vision and values will underpin this work.

We have offered a contract to a psychiatrist based in England for the currently vacant position of Clinical Director

for Mental Health for the Older Adult and he has verbally accepted. His planned start date is November 2013.

Whilst sick leave in May this year was less than the same month last year, sick leave has been higher than

previous months. This has resulted in times when we are running our front line services with less nurses than our

agreed ratios. We are flexing workload and redeploying staff where possible and appropriate to maintain safe

service delivery. However much of the sick leave cover is provided by the wards’ own staff which can be less than

optimal. Based on last year - May, June and July are the months when staff experience most unplanned sick leave.

We continue to maintain a casual pool within our specialised areas such as ED, Cardiology and Renal to mitigate

some of the consequences of staff absences.

We are continuing to focus on our >75 days annual leave balance staff and this has reduced by 6 staff from

February to May. We will continue to closely manage this group of staff.

Service Delivery As noted earlier in the report, Cardiology achieved 98% compliance with the MoH target of 85% of elective

patients receiving their coronary angiogram within 90 days.

ESPI Compliance

All specialties are compliant with the 6 month target; and on track to be compliant with the 5 month target by 30

June 2013. We are continuing to work on our outpatient processes and to review all our clinic profiles to ensure

they are geared to achieve 5 month compliance by June and into next year as well as our contracted volumes.

The Medicine ALOS (average length of stay) for both acute and elective patients was up slightly compared to the

target in May at 3.70 and 3.65 days respectively. We are continuing to focus on the complex patients with >10

day LOS. As noted earlier in the report we will employ a discharge coordinator for 3 months over winter to further

improve from our current performance of 7% of inpatients in Medicine being in hospital >10 days.

Colonoscopy service delivery – the performance scorecard reports that 33% of urgent colonoscopies were

completed within 14 days; however following our usual data validation process this result will show we achieved

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the 50% target. In terms of working towards achieving the remaining 2 colonoscopy targets we are continuing to

outsource non-complex colonoscopies and are on track to open the additional endoscopy room at Waitakere

Hospital in mid July 2013.

Assessment & Diagnostic Unit (ADU) Project

We have a project coordinator working in ADU to assist with improving patient flow. Having completed a stock

take of the current issues the team have started focusing on the following:

• Review clinics and using them effectively with minimal delays for patients

• Developing and introducing checklists for certain groups of medical patients

• Effective scheduling of cardiac procedures, i.e. exercise tolerance tests for patients in ADU

38 of 87


Scorecard


Better help for smokers to quit 97.5% 1 0 95.0% � Chemotherapy waiting times - within 4 weeks 100% 1 0 100% ��

Provider Elective Volumes (Cardiology) 109.9% 1 0 100.0% � % elective coronary angiography within 90 days 98% 1 0 85% �

Shorter Waits in ED 97.4% 1 0 96.0% �� % urgent diagnostic colonoscopy done within 14 days 33% 0 1 50% �

% diagnostic colonoscopy done within 42 days 49% 1 0 50% �

% surveillance colonoscopy done within 84 days 53% 1 0 50% ��

Patient Flow

Quality Actual Target Average Length of Stay - Acutes 3.70 1 0 3.50 �

Complaint Average Response Time 20 days 1 0 14 days � Average Length of Stay - Electives 3.65 1 0 3.82 ��

Rate of falls with major harm 2.00 0 1 < 0.07 � Average Length of Stay - AT&R - to be finalised 16.00 0 1 0.00 �

Discharges at weekends 17.1% 1 0 20.0% �

DNA Rates Number Discharges before 11am 15.8% 1 0 20.0% �

First Specialist Assessment (FSA) DNA rate - Total 159 9.7% 1 0 10.0% �

First Specialist Assessment (FSA) DNA rate - Maori 31 22.8% 0 1 10.0% � ESPI 2 - % patients waiting longer than 6 months for FSA

First Specialist Assessment (FSA) DNA rate - Pacific 23 20.2% 0 1 10.0% � Cardiology 0.0% 1 0 0.0% ��

Follow up (FU) DNA rate - Total 322 7.9% 1 0 10.0% � Dermatology 0.0% 1 0 0.0% ��

Follow up (FU) DNA rate - Maori 51 18.8% 0 1 10.0% � Diabetes 0.0% 1 0 0.0% ��

Follow up (FU) DNA rate - Pacific 47 15.8% 0 1 10.0% � Endocrinology 0.0% 1 0 0.0% ��

Gastroenterology 0.0% 1 0 0.0% ��

Other Key Measures General Medicine 0.0% 1 0 0.0% ��

ADU - time to be seen from triage (Medicine) - to be finalised 0.4 0 1 0.0 � Haematology 0.0% 1 0 0.0% ��

Acute Readmission Rate within 28 days 13.7% 1 0 10.0% �� Infectious Diseases 0.0% 1 0 0.0% ��

Renal 0.0% 1 0 0.0% ��

Respiratory 0.0% 1 0 0.0% ��

Rheumatology 0.0% 1 0 0.0% ��

HR Wellbeing Actual Target ESPI 5 - % of Patients not treated within 6 months

Sick Leave Rate (days) * 8.1 days 1 0 7.5 days �� Cardiology 0.0% 1 0 0.0% ��

Overtime Rate (%) * 0.6% 1 0 1.0% �

Annual Leave Balance > 75 days 24 1 0 24 � Contracts (YTD)

Turnover Rate % * 10.7% 1 0 10.0% �� Elective WIES Volumes

Clinical Employ (FTE) 1,480 FTE 1 0 � Medical (Overall) 1,123 1 0 1,375 �

* 12 month rolling average Cardiology 898 1 0 1,168 �

Gastroenterology 225 1 0 207 �

Acute WIES Volumes

Financial Result YTD Actual $000s Target $000s Medical (Overall) 27,917 1 0 26,617 �

Revenue 247,718 k 1 0 246,099 k �

Expense 179,502 k 0 1 172,520 k � First Specialist Assessment (FSA) 12,565 1 0 11,840 �

Personnel Costs 143,040 k 1 0 139,925 k � Subsequent Attendance (FUP) 34,512 1 0 26,021 �

Outsourced Services 4,037 k 1 0 3,403 k � Emergency presentations WTK L4 (admitted) 16,044 1 0 18,188 �

Clinical Supply Costs 26,466 k 1 0 23,253 k � Emergency presentations WTK L4 (non-admitted) 22,324 1 0 22,835 �

Non-Clinical Supply Costs 5,960 k 1 0 5,938 k � Emergency presentations NSH L5 (admitted) 26,176 1 0 37,078 �

Contribution 68,216 k 1 0 73,579 k � Emergency presentations NSH L5 (non-admitted) 19,231 1 0 19,966 �

Capital Expenditure 799 k 0 1 1,539 k �



Actual TargetDHB Perfo rmance

Waitemata DHB Monthly Performance ScorecardMedical and Health of Older People

May 2013

Human Resources

Quality

Finance

Priority One Service Delivery

How to readHow to readHow to read

39 of 87


Strategic Initiatives

Deliverable /Action On Target

Complete a comprehensive review and redesign of the model of care and staffing for

General Medicine inpatient services X

Implement new model of care in General Medicine inpatients Partial

Implement rapid rounding concept to the Hospital Completed

Primary/secondary liaison role in place Completed

Implement further strategies to reduce high users of ED, A & Ms, GPs and St John

services �

To further ensure that clinical staff are strongly supported in their service, 20 hospital

services will have a ‘STEPS’ trained and supported smokefree educator within their

team. Eight services have been STEPS trained and the others will get underway when

the new Smokefree Manager starts.

�

Speech Language Therapists are implementing a new swallow screen which will reduce

the incidence of aspiration pneumonia as a complication of stroke �

Provision of specialist support to aged care residences (gerontology nurse specialist,

dietitian and clinical pharmacists) to better support patients in the community –

WDHB only

�

Continue the roll-out of the Integrated Transition of Care (previously Readmissions)

project to identify and focus on those with the highest likelihood of hospital

readmission, particularly those 65+ years.

�

InterRAI training for NASC completed by Dec 12 Completed

InterRAI benchmarking between DHBs on core quality measures is progressively

developed nationally through 2012/13 as the volumes of clients who have had an

InterRAI assessment completed increases

�

Single Point of Entry project from pilot phase to full implementation. This will provide

an integrated access point for Older Adults and Home Health Completed

Re-scope delirium work as a Rigour project – subsequent improvement work complete X

Pilot(s) for regional dementia work stream to be developed and started �

Review the memory service and work with primary care to ensure people with a

diagnosis of dementia are placed on a dementia care pathway �

Commence implementation of Dementia Day Care Services Completed

Continue to work with primary care (Waitemata PHO) to develop specialist gerontology

services. �

The SSOA work plan is delivered on time and within budget �

At least 75% of DHB Needs Assessment staff will be trained and assessing older people

in the community with InterRAI by 30 June 2013 Completed

Implementation of dementia care pathway initiated by June 2013 �

Assess and compare readmission rates for over 65s. X

An ICD service will have been established at North Shore Hospital to improve access for

our population Completed

We will have contributed to the National Review of Electrophysiology to determine the

appropriate role of cardiac electrophysiology in the diagnosis and management of

arrhythmias, and commenced implementation of any mandated recommendations

arising from this

�

We will have implemented a strategy to address the causes of ethnic inequalities in

cardiac revascularisation for patients with acute ST elevation myocardial infarction �

Reduce waiting times for diagnostic echocardiography �

Secondary services - weekly diabetes clinic at Waipareira Trust facility in west Auckland �

40 of 87


Key achievements for month

• The Operations Manager Health of Older People attended a regional rehabilitation provider

forum hosted by Counties Manukau DHB – all the four northern DHBs were there along with ABI

Cavits and Laura Fergusson Trust representatives. The attendees agreed this was an opportunity

to share useful information particularly around long term conditions work, orthopaedics

(fractured neck of femur) and stroke.

• The Clinical Nurse Specialist Rheumatology has commenced a pilot telephone clinic. The pilot

will be for 12 months and will focus on chronic patients who require follow up, but are thought

not to need to come into a clinic for this review.

• Paediatric On-call weekend service for physiotherapy has commenced. We are currently running

a joint training programme to up-skill volunteer physiotherapists from either Medicine or

Surgery and Paediatrics to fill this roster. Ideally the provision of this service will result in some

paediatric patients not needing to transfer to Starship when they require physiotherapy input

over the weekend.

Areas off track for month and remedial plans

• The Renal Service Phase 2 business case has been delayed and this has been discussed at other

meetings including Audit and Finance.


• NASC (Needs Assessment and Service Coordination) workload and waitlist – Our NASC waiting

list has steadily been increasing over the last year. However we are prioritising the urgent

and/or high risk patients and >90% are being seen within 6 weeks. It is the low risk assessments

and reviews which are delayed. The funder has initiated a project in this area.

• Allied Health has commenced a review of their community work and the first stage of data

collection has been completed. The raw data is now being analysed. This data will show the

range of complexity in the patients being seen in their homes as well as the intensity required

for this patient group. The next step will be to review the low complexity and low intensity

patients/conditions to ascertain if there are other ways to deliver the service to this particular

group, i.e. group education or centralised clinics, or alternatively ceasing to provide some

aspects of this service.

• Preparation of the options paper for the ED at Waitakere is on track. The paper is likely to

identify some process improvement opportunities along with options regarding usage of the

current space and options to extend the space available to ED.

• Work is well underway between the Renal Service and healthAlliance to extend the renal

haemodialysis contract in line with other existing contracts in the region, i.e. until 2017 which is

when the region will be aligned in terms of expiry dates.

41 of 87


Financial Results


Medical & HOPS

($000’s)


REVENUE

Government

and Crown

Agency

23,100 22,236 863 246,278 244,599 1,679 268,323 266,835 1,488

Other Income 10 136 (127) 1,441 1,500 (59) 1,701 1,636 65

Total Revenue 23,109 22,373 737 247,718 246,099 1,619 270,024 268,472 1,553

EXPENDITURE

Personnel

Medical 4,653 4,459 (194) 48,616 47,273 (1,343) 53,501 51,749 (1,752)

Nursing 6,345 6,238 (107) 70,051 68,067 (1,985) 76,844 74,309 (2,535)

Allied Health 1,522 1,567 45 15,865 16,207 342 17,321 17,727 406

Support 0 32 32 (1) 353 354 (1) 385 386

Management /

Administration784 714 (70) 8,508 8,026 (483) 9,283 8,738 (545)

13,303 13,010 (293) 143,040 139,925 (3,115) 156,948 152,908 (4,040)

Other Expenditure

Outsourced

Services382 309 (72) 4,037 3,403 (633) 4,376 3,713 (663)


Infrastructure

& Non-Clinical

Supplies

491 540 49 5,960 5,938 (21) 6,599 6,478 (122)

3,554 3,042 (512) 36,462 32,595 (3,867) 39,767 35,650 (4,117)

Total Expenditure 16,857 16,052 (805) 179,502 172,520 (6,982) 196,715 188,558 (8,157)

Contribution 6,252 6,321 (68) 68,216 73,579 (5,363) 73,309 79,914 (6,605)

Allocations 7,438 7,438 0 81,034 81,034 0 88,468 88,468 0

NET RESULT (1,186) (1,118) (68) (12,818) (7,455) (5,363) (15,159) (8,554) (6,605)

YEAR TO DATE FULL YEARMONTH


The overall result for Medicine & HOPS was unfavourable by $68k for the month and $5,363k year to

date.

Revenue There is a favourable revenue variance for the year to date of $1,619k. The main causes are

injections from the funder of $1,954k to mitigate overspends in PCT drugs and unrecovered PCT

rebates, $256k to cover higher than planned Gastroenterology volumes and $297k to reimburse the

cost of SMO leave revaluations. This gain is offset by significant unfavourable variances in ACC

revenue and Cardiology electives. ACC revenue which is under budget by $681k YTD is an area

which continues to be problematic and efforts are underway to investigate ways of increasing this

revenue stream; however there are many factors at play in this area which make this a challenging

target to achieve. Cardiology elective revenue is $1.2m unfavourable year to date due to actual

production volumes YTD being below budgeted volumes.

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Expenditure Personnel costs overall are unfavourable to budget by $3,115k YTD. Nursing staff costs are

overspent by $1,985k year to date with the main drivers being patient volume, higher than budgeted

sick leave and increased use of constant observations. The opening of the Short Stay Ward to meet

bed demand has contributed $85k to the over spend (although there has been reimbursement of

this overspend). A strict process is in now in place for replacement of unplanned leave and the use of

external bureau staff, and over summer, closing beds wherever possible. Medical over spend of

$1,343k year to date is as a result of a one off adjustment revaluing medical staff leave balances

amounting to $297k (fully reimbursed in revenue) as well as under budgeted job sizing costs in a

number of services.

Outsourced Services are $633k unfavourable YTD. External Nursing Bureau costs are $689k over

budget; this includes an estimated $169k of late billing relating to last financial year. Strict controls

around use of external bureau staff has seen these over spends reduce significantly over the two

quarters.

Clinical Supplies are unfavourable to budget $3,212k YTD. PCT drugs are over spent by $1,536k

although this cost is fully offset by the additional revenue from the Funder. Clinical depreciation is

over budget by $474k; this is expected to increase to approximately $523k by year end. Dressings

are over budget by $163k YTD with the majority of this coming from District Nursing. Ostomy and

continence products are over budget by $169k YTD with increasing patient numbers and recent price

increases contributing to this. Client related costs are over budget by $366k YTD with $175k of this

coming from recharges from ADHB for Home Haemodialysis (this is expected to continue until the

Renal Phase 2 Community facility is opened), and $223k from overspends in Mental Health Respite

care. Work within the division continues around clinical supplies, reviewing ordering and stock

levels, and key areas of overspend are being targeted.

Infrastructure and non-clinical costs are unfavourable by $21k YTD with the most significant

overspends coming from cleaning $153k, printing and stationery $82k and out of area beds for Older

Adult Mental Health patients $108k. Costs are being scrutinised, and focus put on mitigating

overspends within the existing infrastructure budget for these expenses.

Forecast Based on the May result the division should be within the forecast variance against budget of

$6,605k unfavourable.

Mitigation Strategies

• Continuing to manage annual leave for all staff

• Working with Human Resources to identify gaps in the SMO leave and expenses

reimbursement processes and to improve the processing of SMO leave

• Planning workshops in June with staff groups to identify cost reduction and/or efficiency

opportunities for the service into the future

• Continuing to proactively manage unplanned leave

• Changing the Medical Officer Roster in Emergency Department which will reduce the

demand for locum shift cover

• Offering fixed term contracts for nurses to cover winter workload

• Effectively utilising casual staff to manage peaks in workload across nursing and allied

health.

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Child, Women and Family Services

Service Overview

This Division is responsible for the provision of maternity, obstetrics, gynaecology and paediatric

medicine services for our community and the Auckland Regional Dental Service (ARDS) for metro-

Auckland. Services are provided within our hospitals, e.g. births and gynaecology surgery, and

within our community, e.g. community midwifery and mobile/transportable dental clinics. The

division is managed by Linda Harun with Dr Peter van de Weijer (acting) HOD Medical CWF, Emma

Farmer HOD Midwifery; Marianne Cameron HOD Nursing, Dr Sathananthan Kanagaratnam Clinical

Director ARDS, Dr Sue Belgrave Clinical Director Obstetrics, Dr Peter van de Weijer Clinical Director

Gynaecology and Dr Meia Schmidt-Uili Clinical Director Child Health.

Scorecard Health Targets

Gynaecology elective surgery volumes increased during May as all available theatre lists were

utilised including theatre lists of SMOs on leave. Gynaecology discharge volumes have consequently

shown an increase from 91% to 93% of target for the year to date.

ED waiting times for paediatrics is at 94.6% due to the increased volume of presentations. This is

being closely monitored by the Clinical Director and Operations Manager and addressed jointly by

paediatrics and Emergency Department staff to ensure hand over of care occurs as soon as possible.

Quality

The complaint response time for the service has improved from 24 days to 20 days, reflecting the

complexity of responses required for the complaints received over this period of time. A number of

complaints were received that required multiple sign off which delayed the response times in some

cases. Where possible minor complaints are being addressed on the day they are received.

The readmission rate for the service remains low at 6.4% and shows a small increase from 5.5%

reported previously.

Human Resources

Long term sickness and seasonal illness account for the sick leave rate of 10 days. Services closely

monitor excessive sick leave usage and initiate HR processes when appropriate.

Overtime rates within the service remain low at 0.1%.

Area of Focus – Did not attend (DNA) rates

The overall DNA rate is below target with FSA at 9.7%, while the FU rate has improved from 12.3% to

10.3%. However the rates for Maori and Pacific continue to be high despite the efforts of the

services to address this. The combined DNA numbers for Maori and Pacific equal half of the total FSA

appointments, which further highlights the urgent need for the service to address this issue in the

interests of better service to consumers as well as efficient use of consultants’ time.

Currently patient focused booking and targeted phone calls prior to appointments from Maori

Health and the Women’s Health Pacific Island Liaison Co-ordinator are in place. A survey of Maori

and Pacific consumers and a review of the GP practice referring will now be undertaken to identify

the key reasons for DNA of FSA and FU appointments and this information will be used to develop

action plans.

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Service Delivery

The theatre utilisation in gynaecology of 80% reflects the numbers of cancellations on the day of

surgery. Bookings are made to suit women, however cancellations do occur and the service is

working to ensure as many of these available times are rescheduled as is possible.

The acuity of gynaecology volumes delivered has been higher than expected and is reflected in the

WIES volumes of acute and elective gynaecology activity of 100% of targeted volumes despite the

discharged volume of 93%.

Average length of stay in all areas remains within target and discharges at weekends is better than

target at 25%.

ESPI compliance has been achieved by the service for ESPI 2 in paediatrics and gynaecology and ESPI

5 in gynaecology. Michelle Wilson, Operations Manager Women’s Health has worked extremely

hard to ensure that all gynaecology referrals are compliant within the timeframes and is to be

congratulated for this commitment.

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Scorecard


Better help for smokers to quit 100.0% 1 0 95.0% � Oral Health Arrears 17.6% 1 0 10.0% �

Provider Elective Volumes 93.3% 1 0 100.0% � Oral Health New Enrolments (Preschool) 57,567 1 0 38,478 �

Shorter Waits in ED 94.6% 1 0 96.0% � Theatre utilisation Gynaecology 80.0% 0 1 90.0% �

Exclusive breastfeeding on discharge 82.2% 1 0 75.0% �

Births 6,344 1 0 6,108 �

Patient Flow

Quality Actual Target Average Length of Stay - Maternity 2.5 1 0 2.5 �

Complaint Average Response Time 20 days 1 0 14 days � Average Length of Stay - Paediatrics 2.1 1 0 2.2 �

Average Length of Stay - SCBU 6.4 1 0 7.0 �

DNA Rates Number Discharges at weekends 25.6% 1 0 20.0% �

First Specialist Assessment (FSA) DNA rate - Total 112 9.7% 1 0 10.0% ��

First Specialist Assessment (FSA) DNA rate - Maori 31 22.0% 0 1 10.0% � ESPI 2 - % patients waiting longer than 6 months for FSA

First Specialist Assessment (FSA) DNA rate - Pacific 27 25.5% 0 1 10.0% � Gynaecology 0.0% 1 0 0.0% ��

Follow up (FU) DNA rate - Total 116 10.3% 1 0 10.0% � Paediatrics 0.0% 1 0 0.0% ��

Follow up (FU) DNA rate - Maori 22 16.1% 0 1 10.0% �

Follow up (FU) DNA rate - Pacific 33 24.4% 0 1 10.0% � ESPI 5 - % of Patients not treated within 6 months

Gynaecology 0.0% 1 0 0.0% �

Other Key Measures

Acute Readmission Rate within 28 days 6.4% 1 0 10.0% � Contracts

Elective WIES Volumes

Gynaecology 1,387 1 0 1,378 �

HR Wellbeing Actual Target Acute WIES Volumes

Sick Leave Rate (days) * 10.1 days 1 0 7.5 days �� Gynaecology 1,015 1 0 1,030 �

Overtime Rate (%) * 0.1% 1 0 1.0% � Maternity 5,350 1 0 5,563 �

Annual Leave Balance > 75 days 9 1 0 2 � Paediatrics 1,417 1 0 1,633 �

Clinical Employ (FTE) 779 FTE 1 0 � Neonatal 1,772 1 0 1,675 �

* 12 month rolling average

Other Contracted Volumes

Child Rehabilitation bed days 1,250 1 0 1,680 �

Financial Result YTD Actual $000s Target $000s Non-Case weighted Discharges (YTD)

Revenue 109,109 k 1 0 109,579 k � First Specialist Assessment (FSA) 10,073 1 0 9,806 �

Expense 72,851 k 1 0 73,173 k � Subsequent Attendance (FUP) 11,114 1 0 9,533 �





Contribution 36,258 k 1 0 36,407 k �

Capital Expenditure 343 k 0 1 588 k �




Waitemata DHB Monthly Performance ScorecardChild Women and Family Service

May 2013

Human Resources

Quality

Finance


How to read

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Deliverable /Action

On

Target

Deliver the oral health business case objectives for 2012/13 ✓

Adopt Rheumatic Fever clinical pathways and current recommendations for the school

based programme

Implement consistent evidenced-based guidelines and models of care

✓

Ongoing implementation of quality and safety standards for maternity services ✓

All parents of paediatric patients will receive advice and support to quit smoking. �

A plan is developed to ensure pregnant women are provided with advice and support to

quit by Lead Maternity Carers

✓

Support the national process for improving the numbers of newborns enrolled with

primary care by ensuring mother’s GP recorded on birth event booking form within

WDHB facilities

✓

Develop and implement a regional safe sleep strategy across primary care, pregnancy

and parenting education, and DHBs, which ensures:

• Staff who support families caring for infants receive mandatory training and updates

about prevention of SUDI and ways of communicating risks to families

• The modelling of safe sleeping practices for all infants within DHB facilities

• Safe sleeping arrangements are available for all infants after they are discharged

home

• Families are provided education and supports tailored to their level of need about

the hazards that arise in some sleeping situations

• That advice on safe strategies for night feeds and settling infants is provided

• Inclusion of Maori and Pacific cultures and values

✓

Include the management of skin infections, cellulitis and abscesses as part of the

healthcare provided in school based health services

✓


Quality and safety annual report for maternity is being completed and will be submitted to the

Ministry of Health by the end of June.

Rheumatic Fever:

• The School Based Throat Swabbing programme has commenced in both Birdwood and Ranui

Primary Schools. Public Health Nurses are going into the schools three days a week. To date,

215 children have been swabbed and 44 (20%) have been identified with a Group A Strep sore

throat. In addition, 11 children have been identified C/G sore throats – these children have also

been followed up for treatment.

• Nurses are proactively following up with families and primary care providers to ensure that

children have timely access to antibiotic treatment. To date, the majority of families have

elected to receive treatment from their General Practitioner. If this is not possible, nurses have

been providing treatment via standing orders. Active monitoring is occurring to ensure

adherence to treatment.

• Nursing staff are contact tracing where required and working closely with family members

where there are particular concerns (e.g. history of Rheumatic Fever in the family).

• The school based programme will begin in Pomaria Road Primary on June 17. Negotiations are

continuing with Nga Kakano Kura Kaupapa to identify an appropriate start date, once education

sessions are held for staff and students.

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• A Rheumatic Fever Assessment Form has been approved for piloting on Rangatira Ward. This

form is consistent with the Rheumatic Fever Guidelines and addresses the areas for

improvement identified in the audit completed earlier in the year.

Skin Infections:

• The identification and management of skin infections will be an integral component of the

Rheumatic Fever school swabbing programme

• The consent form developed includes gaining consent for Child & Family staff to visit classrooms

to check children’s skin

• The incidence of skin infections is significantly higher than anticipated

• Where skin infections are identified, the Public Health Nurse is contacting the parent or guardian

to discuss treatment that may be required.


• Implementation of the plan to provide all parents of paediatric patients with advice and support

to quit smoking has been delayed due to recording difficulties. In particular, it is not clear how

to record (and thereby monitor) what has been offered when the parent is not the patient.

Further discussions are underway with the smoking cessation team; however it appears that

recording this information will not be possible. The service can continue without recording.

• The time required to deliver the school based throat swabbing has been much greater than

anticipated. This has resulted in stress and work pressures for staff delivering the programme,

as well as the broader service. This has been compounded by staff vacancies. Recruitment is

now underway and strategies to increase support to the Waitakere team are being identified

• The standing orders for treatment for skin infections have not yet been approved by the

Pharmacy and Therapeutics Committee. The committee has requested additional information

and the orders will be considered in June.

Other Highlights

New Graduates

A further 10 new graduate midwives have been employed at NSH bringing the total to 14 new

graduates for the year. The support from the HOD Nursing for the employment of a clinical coach

has greatly assisted in the orientation and settling in of the new graduates.

Before School Checks

Child & Family are working closely with Plunket (the new provider of the developmental component

of the Before School Check programme) to build relationships and identify opportunities to improve

performance and alignment between the vision and hearing and development components of the

programme.

To date, the Vision and Hearing coverage rate has been excellent. As at the 22nd May, 79% of high

needs children and 82% of the total eligible population have had the vision and hearing screening

component of the programme completed.

The service is continuing to focus on identifying and screening those children who have had a

development check, but not a vision and hearing screen completed, to improve the DHBs overall

performance.

Transfers from Starship Hospital and Out of Area Patients in Rangatira

There has been an increase in focus on transferring Waitemata domiciled children presenting at

Starship Hospital to Rangatira Ward for their inpatient treatment. A brochure has been developed

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for Starship clinicians to give to families informing them of the ward and the services available for

children at the Waitakere Emergency Department.

There has also been agreement that there will be flexibility between the DHB boundaries and that

children living in the western areas of Auckland DHB and those with a General Practitioner within

the New Lynn cluster will be admitted to Rangatira ward.

Recently, transfers from Starship Hospital and out of area patients admitted to Rangatira are being

monitored weekly.

Co-location of Paediatric Services with Primary Care

Work is continuing on progressing the co-location and integration of child health services with the

New Lynn General Practice cluster. This work is currently focused in three areas:

1. The transition of Paediatric Outpatient clinics for children enrolled within the cluster to the

Integrated Family Centre

2. The development of shared care planning for children with chronic health conditions or who

experience multiple adversity

3. The development of the Te Aka Ora model of support for vulnerable children and families into

the locality.

Paediatric clinics will be delivered from the New Lynn Integrated Family Care Centre from the 10th

July.

Work has also begun on further increasing the number of paediatric clinics delivered from Whanau

House.


Newborn Hearing Screening programme

Deloitte have been contracted by the Ministry of Health to undertake an audit of the Newborn

Hearing Screening programme. Initial feedback has indicated a number of minor issues for attention.

The final report is expected in July.

Acute Paediatric Staffing

There are five registered nursing vacancies in Rangatira at present. Recruitment is underway, if

vacancies cannot be filled by other measures it may be necessary to close some beds and reduce

transfers from Starship as an interim measure.

A winter contingency plan has been implemented.

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Financial Results


Child Women Family

($000’s)


REVENUE

Government

and Crown

Agency

10,106 9,735 371 108,513 109,000 (487) 118,117 119,373 (1,255)

Other Income 60 53 7 595 579 16 642 632 11

Total Revenue 10,166 9,788 378 109,109 109,579 (471) 118,760 120,004 (1,244)

EXPENDITURE

Personnel

Medical 1,275 1,210 (65) 13,696 12,879 (817) 15,024 14,093 (930)

Nursing 2,041 1,969 (72) 22,334 21,516 (818) 24,545 23,487 (1,058)

Allied Health 1,929 2,052 123 19,881 20,906 1,025 21,936 22,912 976

Support 22 20 (2) 240 215 (25) 261 236 (26)

Management /

Administration318 312 (6) 3,597 3,477 (120) 3,936 3,787 (148)

5,586 5,563 (22) 59,748 58,994 (754) 65,701 64,516 (1,186)

Other Expenditure

Outsourced

Services416 368 (48) 4,165 4,048 (117) 4,498 4,416 (83)

Clinical Supplies 394 482 88 4,711 5,121 409 5,203 5,606 403

Infrastructure

& Non-Clinical

Supplies

716 434 (282) 4,227 5,011 784 4,723 5,527 803

1,526 1,285 (241) 13,103 14,179 1,076 14,425 15,548 1,123

Total Expenditure 7,112 6,848 (264) 72,851 73,173 322 80,126 80,064 (63)

Contribution 3,054 2,940 114 36,258 36,407 (149) 38,633 39,940 (1,307)

Allocations 2,929 2,929 0 31,873 31,873 0 34,801 34,801 0

NET RESULT 126 12 114 4,385 4,534 (149) 3,833 5,140 (1,307)

FULL YEARMONTH YEAR TO DATE


Contribution

May’s contribution is significantly favourable as a result of increased revenue, mostly in Womens

Health. The increase in revenue is offset partially by higher than budgeted expenses, the single

largest of these being a provision for doubtful debts of $210k affecting Infrastructure costs within

Auckland Regional Dental Service.

YTD the contribution remains unfavourable, and is expected to increase in June with quarterly ARDS

Revenue budgets coming due.

Revenue

Favourable revenue for the month is due to additional Gynaecology Elective revenue ($141k) and

higher than expected Maternity volumes ($129k), plus minor favourable items such as Colposcopy

revenue, Maternity Quality and Safety and Gateway programmes.

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This result was not sufficient to fully offset the YTD unfavourable variance due to ARDS Revenue

shortfall from ADHB and CMDHB, and it is expected that this result will worsen by circa $450k in

June for the same reason.

Expenses

May’s expenses are dominated by the Doubtful Debts provision of $210k to account for the credit

and recharge of facilities costs incurred on behalf of ADHB. These charges have been in dispute for

some 20 months, and an agreement has now been reached allowing for the collection of some of

the costs.

Variance to Forecast

CWFS was forecasting a Year End result of $1.3m unfavourable to budget, which is not borne out by

YTD results. May’s results are a total of circa $900k better than expected for this time in the month.

The reasons for the variance are:

Revenue: Revenue is currently $250k better than forecast for May year end – $141k is due to better

than expected Gynaecology Elective revenue earned in May, and $52k due to increased volumes to

the YTD average in Maternity. A further $45k relates to improved ACC revenue performance at

Wilson Centre.

Expenses: Expenses are in the region of $660k better than forecast – mostly in Personnel.

Medical costs are $75k better than expected, due to SMO Underspends from close management of

allowances and the alignment of Community Dentist roles to a Service Sizing exercise.

Nursing Expenses are $165k below expected levels, partially due to delays in recruiting into seasonal

vacancies in Child Health, and also due to high levels of Annual Leave taken in May.

Allied Health is $225k underspent compares to expected YTD levels, due to vacancies and delayed

recruitment in Dental as well as Child Health plus higher than usual leave taken – some 20 FTE were

effectively on annual leave in May.

Outsourced Services are $40k overspent to forecast, $30k of this relates to the recognition of

backdated Retinal Screening invoices due to ADHB but currently in dispute.

Clinical Supplies are $60k underspent to forecast, arising in Dental. The Forecast has assumed

continuation of YTD average spend, however the YTD result included clinic set up costs, which were

incurred only once. The actual spend is therefore significantly lower.

Infrastructure costs are $165k lower than anticipated - $150k being the difference between the

forecast doubtful debts for ADHB facilities costs and the actual $210k cost recognised.

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Mental Health and Addiction Services

Service Overview

This division provides specialist community and inpatient mental health services to Waitemata

residents. It is also provides community alcohol, drug and other addiction services, and forensic

services to the northern region. The group is managed by Helen Wood with Clinical Director Murray

Patton for Mental Health and Clinical Director Forensics, Jeremy Skipworth.

Scorecard

Health Targets

Shorter Wait times in ED: 81% - The number of ED breeches in May by Mental Health Services (MHS)

was 25, a significant decrease from 45 in April. There were 7 breeches at Waitakere and 18 at North

Shore Hospital. The reasons for breeches occurring remain similar to previous months. In the

majority of cases this is related to waiting for the person to be medically fit, waiting on the

availability of a doctor, and undertaking the Mental Health Act Process. The Chief Executive has

agreed the new target for Mental Health will be 80%, based on clinical advice from the service.

Better help for Smokers to quit: 100% - Inpatient services are performing at their peak. Community

programmes continue. Second annual art competition almost completed – this includes people’s

stories of the impact of smoking on their lives and the impact of giving up.

Quality

Complaints: 25 days - There were 16 complaints reported in May, four fewer than May 2012.

However, only four were closed in less than 15 days. The average days to close complaints for May

was 25 days. This is the highest it has been since January 2012. There are several reasons for this;

one is the complexity of two complaints which have required input from our legal team. Another is

where the complaint is awaiting the outcome of a Sentinel Event Review. Additionally one

complaint was from the Health and Disability Commission (listed as major) however it has now been

referred to advocacy services, which delays the response.

Acute readmission rate within 28 days: 16% - All resources are utilised to enable acute admission.

This includes use of both contracted and spot purchased respite beds and placing people on leave to

relatives and then back filling the beds. These coping measures are being used regularly, in particular

after hours and on the weekends and have contributed to the increased 28 day readmission rate to

16%. The readmissions have all been investigated and there are numerous other reasons for

readmission also. The readmitted people come from all 5 community services in similar numbers.

HoNOS (Health of the Nation Outcome Scales): Compliance remains an area for further attention.

HoNOS completion and utilisation will be a significant focus of the next local benchmarking

forum, 31 July. The method of reporting will be reviewed after a 6 month period to determine

whether there is a better method of portraying outcomes of treatment.

Service Delivery - Productivity

Forensic services bed occupancy remains at or near 100%. An additional 5 beds for the use of

Mason Clinic clients are now utilised. This has resulted in a reduction in the prison waiting list.

The adult unit’s high occupancy rate (98%) is reflective of high acuity and demand for acute

admission and increased length of stay (average 35 days this month). Average length of stay (LOS) is

impacted by the group of long stay patients. A discharge this month of one of these patients

increased the average length of stay.

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Scorecard


Better help for smokers to quit 100% 1 0 95% � Patient Flow

Shorter Waits in ED 81% 1 0 80% � Average Length of Stay - Adult Acute 34 0 1 15-21 �

Average Length of Stay - CADS Detox 7 1 0 6-8 ��

Bed Occupancy (midnight) - Adult Acute 98% 1 0 85% �

Bed Occupancy (midnight) - CADS Detox 101% 1 0 90% �

Bed Occupancy (midnight) - Forensics Acute&Rehab 101% 1 0 95% �

Quality Actual Target Bed Occupancy (midnight) - ID 82% 1 0 70% �

Complaint Average Response Time 25 days 0 1 14 days �

Service Access (latest available)

Seclusion MH Access Rates 0-19 years (Total) 2.63% 1 0 3.00% �

Seclusion use Forensics - hours 145 0 1 900-1100 � MH Access Rates 0-19 years (Maori) 3.46% 1 0 3.60% �

Seclusion use Forensics - episodes 4 0 1 10-14 � MH Access Rates 20-64 years (Total) 3.51% 1 0 3.50% �

Seclusion use Forensics - distinct service users 4 0 1 6-10 �� MH Access Rates 20-64 years (Maori) 7.93% 1 0 7.50% �

Seclusion use Adult - hours 18 1 0 26-30 ��

Seclusion use Adult - episodes 5 1 0 1-5 �� Waiting Times (latest available)

Seclusion use Adult - distinct service users 5 1 0 1-5 �� Youth (0-19) < 3 weeks 76% 1 0 70% �

Adult (20-64) < 3 weeks 92% 1 0 80% ��

Whanau Contacts per service user (community only) CADS (0-19) < 3 weeks 94% 1 0 80% �

Adults 70.0% 0 1 0.0% � CADS (20-64) < 3 weeks 97% 1 0 80% ��

CADS 23.0% 0 1 0.0% � Forensic (0-19) < 3 weeks 93% 0 1 0% �

Forensics 11.0% 0 1 0.0% � Forensic (20-64) < 3 weeks 89% 1 0 80% ��

Child 100.0% 0 1 0.0% ��

Youth 100.0% 0 1 0.0% �� Community Care - treatment days per service user

Adults 3.70 1 0 3-5 �

Acute Readmission Rates within 28 days Children 2.60 1 0 2-4 �

Adults 16.0% 0 1 10.0% � Youth 3.30 1 0 2-4 ��

CADS 0.0% 1 0 5.0% �� CADS 2.50 1 0 2-4 �

Forensics 1.70 1 0 2-4 �

HoNOS Change

Adult community - significant improvement 4.0% 0 1 0.0% � Community Care - Preadmission community care

Adult community - no significant change 40.0% 0 1 0.0% � Adults 74% 1 0 75% �

Adult community - significant deterioration 8.0% 0 1 0.0% ��

Adult community - non-compliant 48.0% 1 0 40.0% � Community Care - Post Discharge community care

52.0% 0 1 0.0% � Adults 78% 1 0 90% �

Adult inpatient - no significant change 31.0% 0 1 0.0% �

Adult inpatient - significant deterioration 3.0% 0 1 0.0% � Financial YTD Distinct Clients with open referral

Adult inpatient - non-compliant 10.0% 1 0 40.0% � Inpatient Adults 704 1 0 666 �

Inpatient CADS 369 1 0 355 �

Inpatient Forensics 179 1 0 163 �

Outpatient Adults 8365 1 0 8326 �

Outpatient Maori 227 1 0 235 �

HR Wellbeing Actual Target Outpatient Pacific 269 1 0 253 �

Sick Leave Rate (days) 8.8 days 1 0 7.5 days � Outpatient Youth 3238 1 0 3005 �

Overtime Rate (%) 3.1% 1 0 3.0% �� Outpatient CADS 14485 1 0 14925 �

Annual Leave Balance > 75 days 8.00 1 0 5 � Outpatient Forensics 2323 1 0 1988 �

Turnover Rate % 8.1% 1 0 10.0% �

Clinical Employ (FTE) 1,040 FTE 1 0 � New referrals during the month

* 12 month rolling average Inpatient Adults 97 1 0 72 �

Inpatient CADS 48 1 0 43 �

Inpatient Forensics 8 0 1 10 �

Outpatient Adults 904 1 0 833 �

Financial Result YTD Actual $000s Target $000s Outpatient Maori 5 0 1 9 �

Revenue 142,300 k 1 0 139,416 k � Outpatient Pacific 18 1 0 19 �

Expense 108,743 k 1 0 108,751 k � Outpatient Youth 346 1 0 249 �

Personnel Costs 98,258 k 1 0 97,569 k � Outpatient CADS 1296 1 0 1232 �

Outsourced Services 1,323 k 1 0 1,689 k � Outpatient Forensics 251 1 0 143 �



Contribution 33,557 k 1 0 30,665 k �

Capital Expenditure 122 k 0 1 343 k �




Waitemata DHB Monthly Performance ScorecardMental Health Service

May 2013

Adult inpatient - significant improvement

Human Resources

Quality

Finance


How to read

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Strategic Initiatives Deliverable /Action On Target

1. Agree multi-agency actions to improve early screening, detection and early

interventions of mental health and addiction issues

On going

√

2. Increase in Family/Whanau participation across all services /agencies and

support to them (family forums) – measured through KPI reporting and

participation in Family Forums

On going

√

3. Identify opportunities for emerging models of integrated and/or

collaborative clinical service delivery (Primary care, NGO and DHB clinical

teams) Eg primary care liaison roles

On going

√

4. Increase flexibility of rehabilitation services through shift to new model of

contracts Funder

5. Performance and productivity improvements measured through regional /

national KPI benchmarking and the Te Aranga Hou (Lean Thinking) service

improvement programme in provider arm, specifically – average length of

stay acute inpatient, 28 day readmission rate, inpatient HONOS score; and

community treatment days

On going

√

6. Develop a multi/interagency strategy for services for high risk children and

youth, to include transition, discharge and follow up protocols

On going

√

7. Implement the advanced level of the Choice and Partnership Approach

(CAPA)

√

completed

8. Child and Adolescent Mental Health Services (CAMHS) and Altered High will

engage in a collaboration project to increase referrals, access rates and co-

existing problems (CEP) competencies across both services

On going

√

9. Establish Specialist Interagency Response to Conduct Problems (SIRCP)

service (Incredible Years contract)

√

completed

10. Enhance provision of Infant Mental Health services by developing and

delivering a staff training module for infant mental health

√

completed

11. Develop and deliver basic Eating Disorder and Co-Existing Problems core

skills training for clinical teams

√

completed

12. Work with key stakeholders to perform a stocktake of self-management

tools and resources and ensure access is readily available to young people

and their families

√

completed

13. Adult mental health and addiction KPIs – child and youth, adult, forensic

established

On going

√

14. Develop measure for recording waiting times for psychological therapies –

provide quarterly report to Waitemata Stakeholder Network (WSN)

As noted

previously –

changed focus

to access

15. Development and use of WSN balanced score card to include social

inclusion measures

√

completed

16. Establish baseline and agree targets for rates of family and behaviour

assessments performed by the service per annum

√

completed

17. Increase the number and skill mix of staff trained in Infant Mental Health

module between Jan 2013-June 2013

On going

√

18. Increase the number and skill mix of staff trained in Eating Disorders and

Co-existing problems by December 2012

On going

√

19. Increase the number of families supported by service from July 2012 - June

2013 and number of programmes facilitated by service up until July 2013

On going

√ * include a �� or a ��

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Successful Collaboration between WDHB & ADHB Mental Health Services to upskill Families,

Whānau. 11 family members supporting someone with severe difficulties controlling their

emotions recently reported very positive outcomes after they attended the first Family

Connections course in Takapuna run by 2 Waitemata DHB clinicians and the Auckland DHB Family

Advisor. Measures taken before and after indicated a decrease in feelings of grief and burden and

an improvement in feelings of mastery. The international 12 week research based family

programme is based on Dialectic Behavioural Therapy (DBT) theory and skills, the evidence based

psychological treatment for those who experience this mental health problem. Families across the

two DHBs can register via Supporting Families, a family support mental health NGO. The next

course in August will be facilitated by two Auckland DHB clinicians and the Waitemata DHB Family

Advisor in an Auckland DHB locality and is already full.

Identify opportunities for emerging models of integrated and/or collaborative clinical service

delivery (Primary care, NGO and DHB clinical teams) There are currently two significant plans to

improve interaction with the primary sector. As part of the Waitemata DHB/Auckland DHB

collaboration we are meeting with representatives of the New Lynn Integrated Family Centre:

Totara House, to progress our relationship. This meeting occurred on June 13. A number of

possible ways to interact with Totara House were discussed, with these ideas being taken to a

collaborative meeting with Auckland DHB planned for the week of 17 June. Primary care liaison

Nurses in West Auckland have started spending time at West Auckland Health, which is the

medical clinic based in Whanau House, completing assessments, training staff and giving referral

advice.

Development and use of Waitemata Stakeholder Network (WSN) balanced scorecard to include

social inclusion measures (see next page for scorecard measures). The first production of the

balanced scorecard, including social indicators, is due to be presented at the provider executive

group (NGO CEOs and DHB clinical service managers). It is very exciting to see this work starting to

take shape. Further work is needed on NGO data entry. The front sheet for clinical notes has been

updated so that we get more accurate information on housing and employment status. The joint

Annual Plan 2013/14 has a focus area on assisting people returning to work in support of welfare

reforms.

Number and skill mix of staff

Increases have been achieved as follows:

• 121 staff across District MH Services and NGO have received training in Infant Mental Health

Modules (Level 1, 2 & 3)

• 240 staff across District MH Services have received training in Eating Disorders (Level 1 & 2).

Families supported by service

31 families to date have been supported by the Incredible Years Specialist Service.

55 of 87


Other Highlights

As noted under Strategic Initiative 5, performance and productivity improvements

measured through regional/national KPI benchmarking and the Te Aranga Hou (Lean

Thinking) service improvement programme in provider arm.

Waitemata Stakeholders NetworkReporting Period: Jan-Mar 2013

% service users

Service Users

5% 313

2% 122

93% 5503

5938% service

users Clients22% 129643% 256135% 2080

Unknown 0.02% 1Total 5938

20 to 45Over 45

Provider / NGO splitPercentage of service users seen by both NGO and provider:

Percentage of service users seen by NGO only:

Percentage of service users seen by provider only:

Age Profile - Currently WDHB

0 to 19 years

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Apr-

Jun12

Jul-

Sep12

Oct-

Dec12

Jan-

Mar13

Apr-

Jun13

Jul-

Sep13

Oct-

Dec13

Month

Percentage of service users registered with GP

0%10%20%30%40%50%60%70%80%90%

100%

Oct-Dec11 Jan-Mar12 Apr-Jun12 Jul-Sep12 Oct-Dec12 Jan-Mar12

Total HoHOS Score (Inpatient) - Effect Size Large

Significant improvement No significant change

Significant deteriortaion No Matched pair

0%

5%

10%

15%

20%

25%

30%

35%

Oct-Dec11 Jan-Mar12 Apr-Jun12 Jul-Sep12 Oct-Dec12 Jan-Mar12

28 day readmission rate

Target Acutal

Total HoNOS Score (Inpatient) - Effect Size Large

There are four parts to this KPI that total to 100% of HoNOS qualifying

discharges. All use the same denominator.

Numerator:

Significant improvement - The count of compliant referral closures that

have a reduction in HoNOS TS12 score from admission to discharge of six

points or more.No significant improvement - change in HoNOS TS12 score of five points

or less. This change can be an increase or decrease from admission to discharge.

Significant deterioration - increase in HoNOS TS12 score from admission

to discharge of six points or more.Non-compliant discharges - the count of referral closures that should have had their HoNOS assessment complete minus the cases that have qualify in the three categories above.

Denominator:

The count of referral closures that should have had their HoNOS

28 Day Readmission Rate

Numerator:

Total number of in-score overnight referral closures by Waiatarau or

Taharoto Unit during the reference period that are followed by a

readmission within 28 days.

Denominator:

Total number of in-scope overnight refeerral closures from Waiatarau or

Taharoto during the reference period.

Percentage of service users registered with GP

Numerator:

Total number of clients registered with a GP.

Denominator:

Total number of clients with an open referral during the reference

period.

Notes: Waitemata data - this has be to a snapshot and can not be

captured historically due to there being no recording of dates the GP

details are changed.

Issues: It is unknown how regularly this information is updated or if this is a registered PHO.

Source: Waitemata - patient management system (Pims) GPNGO - Reporting template

* Jan to March reporting period includes four NGO's.

* Includes NGO 's

January to March data includes the following NGO's:

Connect

Equip

Recovery Solutions Group

Framework

56 of 87


0.0%2.0%4.0%6.0%8.0%

10.0%12.0%14.0%16.0%18.0%20.0%

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13

Jul-13

Percentage of family and whanau contacts deliveredPercentage of family and whanau contacts delivered

Percentage of service users seen that had a contact with family or

whānau involvement in a one month period.

Numerator

Total number of service users provided with a family or whānau contact

by the mental health and addiction service within a one month

reference period. The service user may or may not be present. (Based

on national collection codes T32 – Mental health contact with

family/whānau & 36 – whānau/family face to face)

DenominatorThe total number of community care service users treated by the

mental health and addiction service organisation’s community services

in a one month reference period. The percentage of people seen that had family or whānau involvement in a contact within the month.

Source: Ministry of Health (PRIMHD Extract)Includes: Waitemata, Connect, Dayspring, Equip, Pathways, Higher

Ground

Percentage of service users in supported or home accommodation

Measure: Is client in supported, home accommodation or no regular address.

Issues: Waitemata data taken from HCC and is very incomplete.


% service users employed fulltime / employed part-time / voluntary work / education?

Source: Waitemata - Patient management system (Pims) NGO - Reporting Template

Issues: Waitemata data is not regularly updated and unable to identify full/part-time split or voluntary.


0%

20%

40%

60%

80%

100%

Apr-Jun12 Jul-Sep12 Oct-Dec12 Jan-Mar13 Apr-Jun13

Percentage of service users employed or in education programme

Employed Retired Education Unemploye d Unknown

* Includes NGO 's

0%

20%

40%

60%

80%

100%

Oct-Dec 2013 Jan-Mar 2013 Apr-Jun 2013

Percentage of Service Users by Accommodation status

Unknown Home Accommodation Supported Accommodation No regular Address

* Includes NGO 's

Youth Alcohol and Drug development presented to Parliament

On 6 June 2013 CADS Youth Psychiatrist Dr Grant Christie delivered a keynote address at a meeting

in Parliament organised by the National Committee for Addiction Treatment and hosted by Associate

Health Minister Peter Dunne. The purpose of the gathering was to promote on-going investment in

Youth AOD services amongst 80 attending politicians and senior bureaucrats. He outlined the

current evidence for effective youth AOD treatment and discussed how this might be incorporated

into a wider Youth AOD service development framework in New Zealand urban and rural settings.

This was well received and places our services in a good position to tender for some of the Prime

Minister’s Youth Mental Health Projects.

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Nurse New Graduate Programme

The first semester 2013 programme is now completed. All 16 participants have successfully

completed their level 1 competencies and are preparing for their second clinical placement. Four

participants have successfully completed the clinical component of the programme (they were mid-

year 2012 intake). No midyear new graduates were recruited via the ACE process; we have one on

the waiting list from the February 2013 intake, who we will commence in August.

Trendcare

Trendcare has been rolled out to Mason Clinic inpatient units, and went 'live' last week. Concerns

have been raised by some units that the programme does not adequately reflect their care delivery

activities. These gaps are acknowledged, and the team will work with the programme developers to

review the concerns. We may undertake a time study with Tane Whakapiripiri, which would be used

to inform the development of algorithms which reflect Maori clinical/cultural service provision.

Training with inpatient detox staff is about to commence.

Service Improvement - Productivity

Child and Youth - Service data reported by the team managers indicates significant improvements in

productivity over the past six months. Marinoto West and Marinoto North have made noteworthy

progress, particularly in the areas of referrals, admissions and client contacts. For example, from

December 2012 to May 2013 the following improvements have been achieved:

• New referrals increased by 100%

• Admissions to service increased by 125%

• Face to face contacts increased by 55%.

This bodes well for our involvement in the National KPI project. It is worth noting that the North is

experiencing higher levels of demand than the West at this time. For example, 71 referrals were

received over 6 working days in June 2013 compared with 47 referrals for the same 6 days in 2012.

Pacific Services: As part of the local KPI project the teams have been focusing on productivity and

resource management, at the same time balancing our Pacific service delivery model. With a focus

on accuracy in data capture and increasing throughput through role specialisation we have seen an

increase in community treatment days per clinical FTE in the Isalei team as depicted in the graph

below, comparing the three years. This had increased from 5 to 11 community treatment days per

clinical FTE.

58 of 87



Mason Clinic Building refurbishment programme

The steering group continues to meet to progress the remedial works required for the Mason Clinic.

Planning is at the point that we are ready to go to the market to seek expressions of interest. This

cannot occur until a final decision is made re the site of the Hostel build. The CFO and Ian

Sweetapple are progressing this.

Ombudsman’s report under the Crimes of Torture Act – Mason Clinic

The report has been received from the Chief Ombudsman from her visit to the Totara unit under the

Crimes of Torture Act 1989. The report is in general very positive and includes a number of findings

and five recommendations. The recommendations that pertain to night safety procedures –

whereby patients are only able to exit their rooms at night via use of a call button/alert to staff –

were criticised by the office. Their recommendation to ‘not lock’ patients in their room, either

during the day or overnight, raises a number of risks for the service primarily concerning

patient/staff safety and workforce/resourcing.

The service has undertaken a technical review of all units to assist an options analysis and the clinical

governance group is now considering options and implications for changes to the night safety

procedure. The options development will be further assisted via a Ministry of Health commitment

to review Night Safety Procedures in the second half of 2013. Any proposed change will need to be

fully costed and will require engagement with the Unions.

Community Acute Service

Connect (NGO) in conjunction with Waitemata DHB representatives have decided not to pursue the

placement of this service in Maire Road Orewa. They are currently looking for a new property in an

area where there is less likelihood of negative community feedback.

Contracted Respite (North Shore and Rodney)

Equip (NGO) is in the final stages of council approval for a respite facility, the fire safety plan having

been approved. They are now awaiting the Council’s Code of Compliance Certificate. Following the

issue of this certificate they will be able to apply for Ministry of Health audit of the premises and

approval to operate the 7 beds.

Taharoto Replacement Project

The Registration of interest (ROI) process has been completed for project management of the

construction. Short listing will now occur and the Request for Proposal process will be completed by

21 June. The Audit and Finance Committee agreed that the final sign off for the successful proposal

can go directly to the next full board meeting. Gender safety is now the number one priority for all

design decisions for the new unit.

59 of 87


Financial Results


Mental Health Services

($000’s)


REVENUE

Government

and Crown

Agency

13,008 12,567 441 141,100 138,241 2,859 154,071 150,808 3,263

Other Income 69 107 (38) 1,201 1,175 26 1,355 1,282 73

Total Revenue 13,077 12,674 403 142,300 139,416 2,884 155,426 152,090 3,336

EXPENDITURE

Personnel

Medical 2,010 2,044 34 20,817 21,678 861 22,680 23,731 1,050

Nursing 4,368 4,047 (321) 46,253 44,948 (1,306) 50,436 48,994 (1,442)

Allied Health 2,472 2,309 (163) 24,707 24,557 (150) 26,814 26,817 3

Support 58 55 (3) 616 581 (34) 670 636 (34)

Management /

Administration547 517 (30) 5,864 5,805 (59) 6,351 6,321 (30)

9,454 8,971 (483) 98,258 97,569 (689) 106,951 106,497 (453)

Other Expenditure

Outsourced

Services182 154 (28) 1,323 1,689 366 1,446 1,843 397

Clinical Supplies 159 123 (36) 1,397 1,301 (96) 1,558 1,424 (134)

Infrastructure

& Non-Clinical

Supplies

738 745 7 7,765 8,192 426 8,423 8,936 513

1,078 1,021 (57) 10,485 11,182 696 11,428 12,203 776

Total Expenditure 10,532 9,992 (540) 108,743 108,751 7 118,378 118,701 323

Contribution 2,545 2,682 (137) 33,557 30,665 2,892 37,048 33,389 3,658

Allocations 1,940 1,940 0 21,294 21,294 0 23,232 23,232 0

NET RESULT 605 742 (137) 12,263 9,371 2,892 13,816 10,157 3,658

YEAR TO DATE FULL YEARMONTH


Revenue

The MHSG transferred budget to the funder to commission respite beds and a community based alternative to

adult sub-acute inpatient beds which were due to commence July 2012. There has since been a delay in fully

procuring these services, hence revenue (YTD $1176k) will continue to be paid to MHSG to enable existing

arrangements to continue until the new services are operational.

Another driver of the favourable revenue result ($407k) relates to two new direct Ministry of Health contracts

associated with the drug treatment court service funding 8 additional FTE.

60 of 87


Other positive revenue variances of note are a result of unbudgeted revenue for contracts signed after the budget

was set, an SLA correction for Penina Trust $122k, revenue of $260k for the Counties Manukau DHB portion of the

Fresh Start contract for 2011/12 and cost recovery of employees working in other organisations.

Personnel Medical personnel expenditure is favourable $861k YTD due to release of a prior year accrual amounting to $432k

and volume related savings.

An overspend on nursing staff of $1,306k YTD relates partially to price, use of overtime to cover sick leave,

vacancies and acuity mainly on the inpatient units, penal rates paid to staff working particularly over the holiday

periods, unbudgeted maternity leave payments ($64k), redundancies ($32K), kiwi-saver ($158k), retirement

gratuity ($120k), new graduate exam papers ($290k) and additional costs incurred to continue staffing 4 adult

sub-acute beds at the Taharoto unit until a community alternative is commissioned later in the year. This last

issue is completely offset by additional revenue.

A YTD adverse variance of $150k is apparent in allied health of which $127k is entirely offset against the new drug

court contracts. The remainder of the variance is due to unbudgeted maternity leave payments and kiwi-saver.

Other Direct Costs

Favourable variances of $366k and $426k YTD in Outsourced Services and Infrastructure and Non-Clinical Supplies

are moderately reduced by an over spend of $96k on Clinical Supplies. The adverse variance is driven by

unbudgeted costs of $433k relating to adult respite care of $433k which is completely offset by additional

revenue. These costs are also compensated by underspends in other areas of the group such as FCT step down

beds and outsourced clinical services.

61 of 87


Provider Arm Support Services

These services include Corporate Services and Hospital Operations.

Corporate Services: Include offices of the CEO/CFO/CMO/DON/DAH, Corporate Finance, Operational

Finance, Information Systems and Management, Facilities and Development, Quality, HR & Awhina,

Maori Services and also includes outsourced healthAlliance services, HBL, other affiliation costs and

financing costs. Luke Bunt has overall financial responsibility for the Corporate Group.

Hospital Operations: Include Hospital Ops Management, Laboratories, Surgical Pathology,

Pharmacy, Nutrition and Food, Security, Traffic & Fleet, Asian/Pacific/Maori Health, Daily Operations

and Clinical Equipment Pool. Phil Barnes has overall financial responsibility for the Hospital

Operations Group.

Scorecard

HR Wellbeing Actual Target Productivity Actual Target

Sick Leave Rate (days) * 7.2 days 1 0 7.5 days �� Clinical Typing

Overtime Rate (%) * 1.3% 1 0 1.0% �� Clinical letters turnaround time - Surgical 1 days 100% 0% 2 days �

Annual Leave Balance > 75 days 5 1 0 0 � Clinical letters turnaround time - Medicine 1 days 100% 0% 2 days �

Turnover Rate % * 8.6% 1 0 10.0% �� Clinical letters turnaround time - Child, Women and Family 2 days 100% 0% 2 days �

Clinical Employ (FTE) 318 FTE 1 0 �

* 12 month rolling average

Financial Result YTD Actual $000s Target $000s

Revenue 28,768 k 1 0 29,003 k �

Expense 170,455 k 1 0 173,228 k �





Contribution -141,688 k 1 0 -144,226 k �





Waitemata DHB Monthly Performance ScorecardProvider Support Services

Corporate, Hospital Operations, Facilities, Decision Support and Provider Management

May 2013

Finance

Human Resources Service Delivery

How to read

62 of 87



Deliverable /Action On Target

North Shore Hospital Ward 5/10 refurbishment √

North Shore Hospital ESC Infrastructure √

North Shore Hospital external and internal painting X

Oral Health - 11 Community Dental Clinics, 48 Pads and 12 Transportable Dental Units √

North Shore Hospital Car Park post contract works X

North Shore Hospital Marae √

North Shore Hospital Kingsley Mortimer Unit Ward 12 upgrade √

North Shore Hospital Lift refurbishment √

North Shore Hospital Elective Surgical Centre √

We are also actively pursuing the following projects:

• North Shore Hospital Taharoto Adult Mental Health Unit redevelopment √

• Mason Clinic remedial works due to water tightness issues √

• Waitemata DHB Renal Phase II √

• North Shore Hospital MRI Phase II √

• Strategic stage business case for new ‘mini-tower’ at NSH. √

Inventory management for clinical and non-clinical supplies √

Implement Fleet Management policy for fleet vehicles √

Development of business cases for in-sourcing services (eg orderlies) complete * include a �� or a �� Key achievements for month

• Ward 5 awarded Practical Completion ahead of programme. Blessing and Opening completed,

Ward operational from 25 March 2013

• ESC infrastructure - damaged radiator due to be replaced in April, final practical completion

during commissioning of ESC project

• Post contract works relating to NSH car park are to commence in April, flood test to be arranged

for suspected seepage


• Oral Health –one lease remains outstanding with Auckland City Property

• Post contract works complete, NSH car park project main contractor in receivership, information

provided to receiver, defects being costed by alternative contractor

• A final location has not been agreed with the Maori Health team dislodged by the MRI project

• Renal project budget approved by the Board is insufficient to complete the design brief provided

to the developer by the clinical team. This is being reviewed intensely with a review of the

models of care and value-management of the design.

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Corporate Services Group Highlights / Issues

Corporate and Operational Finance

2013/14 District Annual Plan Financial Planning

Financial planning for 2013/14 is now complete and the Board approved budget has been set at a

surplus of $1M in each of 2013/14 and 2014/15 years and breakeven financial result for 2015/16.

The planned surplus is premised on the DHB achieving cost savings in excess of $16.9M. The savings

initiatives have been identified across Waitemata DHB services as well as from collaboration

activities with other DHBs and including those identified from shared services and national agency

entities (such as Health Benefits Limited and the National Health IT Board).

The Finance team is working on appropriately phasing the Board approved 2013/14 financial

budgets, savings and production plan and is also working with services to ensure that these are all

well understood by the Service and Responsibility Centre Managers. This will improve ownership of

budgets and accountability at service level and enable improved understanding and reporting of

variances to plan. Performance against the planned savings will also be reported to the DHB Board

and to the National Health Board.

The interim audit has been completed by Audit New Zealand in preparation for the full year end

audit. The Finance team is working on year end processes to ensure an efficient audit process.

Information Management

Capacity at a Glance (CAAG)

The CAAG is now operational in a pilot phase. Duty nurse managers/shift coordinators are using

CAAG to monitor ward capacity and variance. Capacity is displayed as graphical blocks of patients

and available beds by ward and specialty, with the data being fed from PiMS and Trendcare in real

time. Variance is shown in two ways; through the summary of nursing hours versus clinical hours

required, pulled from TrendCare, and the shift variance indicator forms which display a ward’s status

from “has spare capacity” to “capacity deficit” in colour. There is also a small section on ED capacity

and incoming flow of patients.

Electronic Ward Whiteboard (eWW)

The pilot of the eWW is set to commence on July 3 in Ward 2, with Anawhata and Ward 7 going live

in the subsequent weeks. The eWW, which displays information from Trendcare and other systems,

replaces the existing physical whiteboards.

Rheumatic Fever Screening

Public Health Nurses initiated a new service last month, to screen children in low decile schools for

Rheumatic Fever and skin infections. The Health Information Group has added functionality to

Soprano (accessed through Concerto) to collect the necessary information, and provide progress

against key performance indicators.

Clinical Coding

The Clinical Coding Team achieved 98.4% compliance with the MOH target of 95% for April. We are

on track to achieve greater than 95% for May. To further improve coding targets Clinical Coding and

Clinical Records have combined to trial an initiative of collecting charts and clinical notes from the

wards at North Shore Hospital.

64 of 87


Enterprise Content Management System

The regional steering group has endorsed piloting the enterprise content management system

SharePoint 2013. A vendor has been identified to scope the pilot and once this is complete, a trial

with the following capability will commence:

• Document and Records Management (at both ADHB and WDHB)

• Collaboration (proposal to pilot this in the PHO and Primary Care team).

Facilities & Development

Major Capital Projects

• Mason Clinic Remedial Works: An external contractor has been engaged to lead the

negotiations to find a suitable option for decant. The Project Plan for Tanekaha upgrade, decant

building, seismic improvements, remedial works and maintenance plan has been drafted by

Facilities & Development team in consultation with Mason Clinic team.

• Waitemata DHB Renal Phase 2: Hospital design team has been engaged to complete re-design

of building to accommodate two more stations and co-location of satellite and home therapies,

this is displacing Peritoneal Dialysis to the Community building in Albany. The Community

building project has been granted Council Resource Consent for the developer. The Building

Consent for civil works has been lodged by the developer. Waitemata DHB design team have

met the extremely tight timeframe to provide preliminary drawings for Building Consent to the

Developers’ design team. We remain on programme for design. A full review of the project

budget has been completed and a separate paper has been prepared for Board consideration at

the 3 July Meeting. Detailed design will progress after the budget is confirmed as accurate for

the pending design.

• NSH MRI: Relocation of the Maori Health team is outstanding. The temporary move of the

Chapel to level 4 of the Tower Block is acceptable with the final solution being the Level 3

Podium project. Design works for the new MRI continue to be progressed.

• NSH SSOA Decant Options: One option has been highlighted as the preferred option, further

cost estimates are being provided.

Other

• Completed works requests for preventative maintenance and reactive works at February is 90%

for NSH and 90% for WTH. This is on target with the benchmark set at 90% for both campus’.

• The existing MRI stair is non-compliant. This will need to be addressed within the project as the

building is currently not compliant. Budget uplift is required. The existing MRI Air Handling Unit

will need to be replaced as part of the project (the existing system is at end of useful life).

Budget uplift will be required.

• Lease negotiations are continuing for a ground lease at NSH Squash Club to construct a building

to accommodate a staff gym.

• The DHB Sustainability Officer is participating in the tender evaluation for HBL “Waste Disposal

and Supply of Sharps Containers”. This will ensure that we can continue with the savings

achieved by the DHB so far.

• Deferred Maintenance work has been approved by the CFO to be carried out prior to 30 June

2013 and this is underway.

• HealthWest Building at Waitakere Hospital Campus has been quantitatively reviewed by

Structural Engineers. The % of New Building Standard (%NBS) has been reviewed down. We

are reviewing the type, quantum and cost of the works required to bring this building up to

building code.

• Beca Carter Hollings & Ferner have completed their initial assessments of stairs at all owned

buildings. The remedial works are underway. A further detailed assessment of the stairs in the

65 of 87


NSH Tower Block has been completed and very few remedial works are required; these will

commence in May 2013

Hospital Operations

Asian Support Services

• Achieved Asian Outpatients Appointment DNA Target for last 12 months

• Achieved Non English Speaking Patients Appointment DNA target for last 12 months

• Queen’s Service Medal for Service Manager (Sue Lim).

Pacific Support Services

• The new Service Manager/Team Leader for the Auckland DHB/Waitemata DHB joint service

commenced on 10 June 2013 and induction is underway.

Clinical Records

• All deadlines were met for coding of in-patient episodes of care

• Staff rosters have been amended to ensure coverage of Elective Surgery Centre requirements

after July opening

• Request for Proposal (RFP) is underway (being undertaken by healthAlliance) to explore more

cost efficient off-site storage options.

Clinical Transcription

• Same day turnaround times are now being achieved for the majority of services covered by the

team

• Staff members and their Union have agreed a new KPI productivity target of 75 minutes

dictation per 8 hour day (this is an improvement on the previous target of 60 minutes dictation

per day).

Cleaning Services

• An improved process has been developed for requesting “level 1” cleaning for wards, using the

Task Manager software system to log and track jobs.

Orderly Services

• The patient identification system trial, AI2DET, commenced in May 2013. Follow up audits are

planned and a presentation to the Clinical Governance Board will be in July 2013.

Traffic & Fleet

• Parking revenue is up slightly ($6,000) compared to the same time period last year. Visitor

parking increased at NSH and decreased at WTH. Staff parking increased at both sites.

• There has been a significant decrease in staff parking non-compliance at WTH following

increased vigilance by parking staff. One vehicle was towed away in May and excellent

compliance has been in evidence since

• A paper on compassionate waiver of parking fees has been drafted for ELT – to be presented in

early June

• 11 multiple use concessionary tickets and 18 single use tickets were issued to members of the

public in May, on compassionate grounds.

Food and Nutrition Services

• The pilot for chilled meals to replace the frozen meals used in the RMO lounge has been

successfully completed. This provides higher quality food at a lower price and will also be

introduced to replace the frozen meals supplied to patients after hours.

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Laboratory Services

• This month’s Health Hero award was presented to Annette Bissett, Phlebotomy Supervisor

• New Clinical Haematologist, Anna Elinder-Camburn, started her new role and visited the

laboratory. This now releases time for Ross Henderson to fulfil his Clinical Director duties.

• Clinical Nurse Specialist recruited to monitor transfusion medicine practice to improve safety

and reduce costs

• Mahendra Naidoo, RMO for innovation, who is working with Robyn Whittaker, visited the

laboratory and was given a tour. He is keen to work on some initiatives that could reduce

wastage and unnecessary testing.

Pharmacy

• We note continued success of the e-Prescribing project and the visit of the Minister of Health

on 18 June 2013 to launch e-Prescribing as a national programme

• The wards using e-Prescribing have demonstrated reduced Pyxis override rates of <15% without

any other interventions.

Security

• Capex approved for new security server and the unit has been ordered, following concerns that

the additional load from ESC would overload the existing historic model

• This has been an average month for abuse and violence incidents.

Key issues/Risks/Initiatives Identified

Asian Support Services

• On-going issue of insufficient space and inadequate facilities in the Asian Health North Shore

Office impacts on the service’s ability to expand and take on additional work.

Transcription Services

• Contract with outsourcing agency (TranscriptionZ) expires in June and will need to be

renegotiated with improved reporting requirements and KPIs established.

Medical Records & Coding

• The recent restructure of Coding and the vacant Manager position in Records presents an

opportunity for closer collaboration between the two services and the possibility of shared

appointments.

Food and Nutrition Services

• Difficulties have been experienced in recruiting an experienced Renal Dietitian and an

experienced Paediatric Dietitian

• The Medirest Operations Manager is working off-site currently due to a lack of office space

available on a WDHB site and there is a further issue of insufficient office space at North Shore

for menu processors

• Uncertainty around HBL processes and proposals makes strategic planning for the service

difficult.

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Laboratory

• Savings targets in the face of increasing workloads are challenging within the department

• Some local initiatives are dependent on a regional review process of Auckland DHB’s

community testing service provision, which is currently underway.

Traffic/Parking

• A comprehensive review of the Waitemata DHB car fleet has been initiated in order to develop a

staff transport system of optimum cost effectiveness. Changes to the current system will need

to be aligned with a review of community services.

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Financial Results


Provider Support

($000’s)


REVENUE

Government

and Crown

Agency

607 1,129 (522) 12,097 12,422 (325) 13,496 13,552 (55)

Other Income 1,544 1,507 37 16,670 16,580 90 18,006 18,118 (112)

Total Revenue 2,152 2,637 (485) 28,768 29,003 (235) 31,502 31,669 (167)

EXPENDITURE

Personnel

Medical 417 412 (5) 3,202 4,399 1,197 3,864 4,810 945

Nursing 895 613 (282) 5,785 6,702 918 6,181 7,315 1,135

Allied Health 1,629 1,579 (51) 16,594 16,866 272 18,279 18,415 137

Support 762 983 221 8,801 10,452 1,651 9,705 11,430 1,725

Management /

Administration2,258 2,053 (205) 22,920 22,986 66 24,915 25,036 121

5,961 5,639 (322) 57,302 61,406 4,104 62,944 67,006 4,063

Other Expenditure

Outsourced

Services2,603 2,314 (289) 27,647 25,467 (2,181) 27,469 27,781 311


Infrastructure

& Non-Clinical

Supplies

4,843 5,892 1,047 62,760 64,800 2,040 72,453 70,693 (1,760)

9,626 10,198 572 113,153 111,822 (1,331) 124,638 122,026 (2,612)

Total Expenditure 15,586 15,837 250 170,455 173,228 2,773 187,582 189,032 1,451

Contribution (13,435) (13,200) (234) (141,688) (144,226) 2,538 (156,079) (157,363) 1,284

Allocations (13,198) (13,198) 0 (144,111) (144,111) 0 (157,288) (157,288) 0

NET RESULT (237) (3) (234) 2,423 (115) 2,538 1,208 (75) 1,284



The overall result for Provider Support Services was favourable to budget both for the month by

$234k and for the YTD by $2.538M.

Revenue

Revenue was unfavourable to budget for both the month ($485k) and YTD ($235k). Key revenue

variances include adverse movements in patient sourced income ($1.8M, mainly due to a very high

target set that has not been achieved), Ministry funding reduced for the revaluation impact on

capital charge ($208k) and various adverse small movements across account categories. This was

partially offset by favourable interest income ($1.977M, mainly due to high cash deposits in the HBL

sweep than planned).

Expenditure

Expenditure was favourable to budget both for the month ($250k) and YTD ($2.773M). For the YTD,

the main favourable variances are across all staff categories ($4.104M, mainly due to vacancies) and

infrastructure costs ($2.040M, mainly due to interest cost savings). These fully offset the adverse

variances in outsourced costs ($2.181M) and clinical supplies costs ($1.190M). Adverse outsourced

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costs reflect $1.824M of agency costs for casual cleaning and orderlies’ staff used to cover vacancies

(costs were budgeted in personnel, resulting in the favourable performance to budget in support

staff costs). Clinical supplies costs were adverse to budget mainly from volume related Inpatient

Pharmacy ($926k) and Lab consumables ($196k).

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6.1 Clinical Leaders Report Recommendation That the report be received. Prepared by: Dr Andrew Brant (Chief Medical Officer), Dr Jocelyn Peach (Director Nursing and Midwifery) and Phil Barnes (Director Allied Health and Acting GM for Hospital Operations) Medical staff • Dr Rob Butler has been appointed to the position of Clinical Director Psychiatry of Old Age. He is

currently in the UK and will start his new role in November 2013. He has previously worked at North Shore and Waitakere Hospitals between 2001 and 2005 when he worked as a consultant for both Liaison Psychiatry and MHSOA.

• With the appointment of Dr Anna Elinder-Camburn who has commenced as a new consultant Haematologist, the Clinical Director of Haematology, Dr Ross Henderson will be able to expand his role into providing clinical leadership over the laboratories.

• Dr Fred Sundram has commenced as a liaison psychiatrist to join Dr Louise Armstrong as the SMO team based as NSH. Dr Sundram also has a joint appointment with Auckland University as a senior lecturer where his interest is research into neuro-imaging in psychiatric conditions.

• Elective Services Centre: Most contracts have now been confirmed for the consultants working in ESC. Patients are now being booked from the commencement of ESC in July. Resuscitation protocols for in and out of hours care for the Elective Surgical entre has now been agreed and confirmed by the resuscitation committee, as well as the SMO, RMO and union groups.

• The Quality review undertaken by Ron Paterson was released to the staff and public. The quality team will be reporting on progress on the plan to the Board on a regular basis.

• Our DHB has become the first in the country to offer publicly-funded renal denervation as an alternative therapy for patients with hypertension (high blood pressure). Hypertension affects approximately a quarter of the population, and a small proportion do not respond to conventional medication regimes, severely increasing their risk of heart attacks, stroke, heart failure, kidney disease and death. Renal denervation is a major advancement in the treatment for hypertension. The procedure involves the passing of a tube into the renal artery, quietening the sympathetic nerves to the kidney by ‘zapping’ them with radiofrequency energy. Trials show it is effective in reducing blood pressure in patients with hypertension that remains poorly controlled despite medication. Patients will usually need to continue hypertension medications after the procedure, but their blood pressure is much better controlled. Sometimes the dose of medications can be reduced and in some cases, stopped altogether. It is a procedure with a low complication rate and patients can usually return home the same day. The development of the service has been led by Dr Walter van der Merwe from our renal service, and the first three patients underwent the procedure on June 18.

Allied Health, Technical and Scientific staff Dietetics • The trial programme that is monitoring enteral feeding of patients in residential care homes has

demonstrated reduced admission rates (and therefore savings) and improved quality of life for these vulnerable patients.

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• Massey University is supervising three Masters students in a multidisciplinary study of nutrition and swallowing risk for patients in residential care homes, AT & R facilities and a primary care group via Waitemata PHO.

• A “TeleHealth” trial is under development by Robyn Whittaker and allied health leaders. “Tablets” are proposed as a means of increasing the efficiency and effectiveness of community allied health teams.

• Waitemata DHB continues to lead the way in the training of Therapy Assistants – 11 students are currently progressing towards achieving the new national qualification.

• A summer school project involving a photography student from Unitec aims to develop a national photographic library of food, for use as an educational resource.

Speech Language Therapy • The Professional Leader has developed a workload management tool for use by community clinicians.

There have been concerns around high caseloads; the tool will provide a rational means of assigning work according to acuity, complexity and geography.

Physiotherapy • The Professional Leader position remains unfilled pending a review of allied health leadership roles; an

interim arrangement is under discussion, possibly involving support from ADHB. Allied Health: General The leadership team has enthusiastically embraced the IFHC concept and has put forward a number of proposals around services that could be provided in these settings, including diabetes support (dietitians), nutrition screening and social work programmes aimed at vulnerable elderly patients and children. Laboratories

• The service is collaborating with Dietitians in exploring wider use of the pre-albumin test, which is an established indicator of poor nutritional status.

• Preliminary discussions have taken place with Dr Martin Orr on the potential applications of a SNP (Single Nucleotide Polymorphism) test that can be performed on the MALDI-TOF analyser. The test is an indicator of an individual’s predisposition to dementia.

Pharmacy Recruitment is underway for an additional pharmacist to coordinate and direct an Anti-Microbial Stewardship Programme based on a proposal developed by ADHB. Benefits include:

• Cost reduction through a reduction in antimicrobial drug use. • More appropriate use of antimicrobial drugs. • Reduction in the prevalence of multi-resistant organisms. • Reduction in patient harm from anti-microbial related complications. • Improved surveillance of antimicrobial use and its effectiveness

Nursing and Midwifery Strong Leadership Leadership for patient & family-centered care, good patient experience, excellent clinical outcomes and greater employee engagement. Looking to the Future

The Executive Leadership Group for Nursing and Midwifery has been working with nurses in all senior positions to confirm expectations and establish clear leadership development plans. This work includes Charge Nurse Managers, Clinical Nurse Specialists, Nurse Educators and Heads of Division Nursing. For Charge Nurse Managers work has started seeking on-line feedback about their role and using a series of focus groups to confirm expectations and leadership development needs. The Executive Leadership Group

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for Nursing and Midwifery spent half a day recently to start a process of clarifying expectations as senior nurse leaders and what development needs are required for the expanding challenges of the role.

Expectations of professional practice have been communicated to nurses in all areas titled ‘Supporting Compassionate Care and Best Care for Everyone’. A copy has been attached.

Workforce Development A supportive work environment and workforce development environment that liberates the talents and skills of every nurse and midwife to help them be the best professional they can be. Looking to the Future. Advancing Practice excellence. Investment in staff which enables us to recruit and retain high calibre staff with the appropriate balance of knowledge, experience and caring attitude. Waitemata DHB has been successful in the Nursing Council of New Zealand audit of the Return to Practice programme offered by the Nursing Development Service annually. Interviews are underway to recruit nurses for the September new graduate programme. While the numbers will be smaller, available vacancies are being held for new graduate applicants. Nurses and Midwives have had access to a range of in-house study days over the past few months to develop their competence. Clinical training is being restricted now that the workload pressures are increasing. This is part of the seasonal planning. Quality practice for safe, effective outcomes Safer clinical quality and efficiency, a culture of excellence, through evidence-based care Jenny Parr has introduced the weekly ‘Frontline Focus Friday’ focus on clinical practice safety.

- The weekly focus on ensuring equipment is clean commenced in March 2013, with a focus on cleanliness of commodes. All commodes are inspected each week, and reported to the Associate Director of Nursing. Within 10 weeks, 99% of commodes were clean. This focus will expand to other pieces of equipment once this level is sustained.

- During May 2013, the weekly ‘Frontline Focus Friday’ discussions centred on the Falls II project. Initially Charge Nurse Managers looked at their wards to determine how well they were risk assessing patients. This was followed up with a presentation from the Quality Team regarding learning from Risk Pro incidents of patients who fell and sustained injury. The final week brought the previous discussions together and set out the approach for the Falls II approach which will involve piloting four changes on four wards:

o improvements to the risk assessment and documentation of planned care, o the investigation, management and care planned for patients who have sustained a fall, o looking at where and when falls happen using ward layout maps and o Investigating what is happening at specific times of the day where more falls happen.

During May 2013, the Senior Nurses undertook an Intravenous Line Audit on one day to establish how well we were managing IV access devices. 32 departments were audited and 390 devices were reviewed. In general the areas of observed practice (what nurses and midwives do) were better than the documentation of practice. All patients had a wristband, but 4% were not issued by the current ward e.g. still had ED on the label. Where indicated, the patient had a CLAB form in use (11 of 12). The results indicated that the next wards for the CLAB deployment need to be Ward 2 and 10 in the first instance. Documentation of insertion date (72%) and dating the dressing (75%) needs focus, although there was evidence that the access devices are generally being managed vigilantly. 10 lines should have been replaced, however had all been in situ within 4 days (as per policy). The report has been discussed at the Infection Prevention Control Executive in June 2013 and the recommendations approved. The audit will be repeated in 6 months following implementation of VIP scoring tool in all clinical areas.

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Supporting Compassionate Care and Best Care for Everyone

Our shared purpose is to do all we can to provide the best care for everyone reflecting compassionate care, excellent health and well-being outcomes

Our values and behaviours are at the heart of the vision and all we do…

Care

Everyone Matters

Compassion Communication

Connected

Courage Competence, Commitment

Better Best Brilliant

Consistent care is our core business and

the care we deliver improves individual

and community health outcomes.

A positive experience for patients /

service users, their family / whanau

matters. Care demonstrates partnership,

protection and participation.

The staff and their work experience

matters

Compassion is intelligent kindness, an

attitude and approach to the way we

interact with people, showing respect,

empathy and support for the needs of

people requiring treatment, care and

service.

Compassion is central to the care

experience every time for every person

Communication is essential to successful

caring therapeutic relationships.

Working in a connected way is the core of

effective team work, interprofessional

practice and care across the hospital –

community for all people in our district

Courage enables us to do the right thing

in our practice to provide the best care

for everyone.

A just culture supports staff to speak up

about concerns and to have the personal

strength and vision to innovate and

embrace new ways of working

Competence means having the right knowledge

and expertise to assess needs effectively, to plan

the right care required, implement and evaluate

confidently. Emphasis is on improving the care

experience, achieving the best consistently and

celebrating brilliance / excellence in practice and

the care provided

Collaboration and integration underpins these values and behaviours across the district, in public health and in social services

Nurses take the lead in these six areas

Help people to stay

independent, maximising

well being

Work with people to

provide a positive

experience of care

Deliver high quality care

and measure impact

Build and strengthen

professional leadership

Ensure we have the right

staff, with the right skills

in the right place

Support positive staff experience

• Models of care support good

assessment, care planning /

participative goal setting to

support recovery

• Practice standards ensure

essentials of care are met.

CNMs monitor through daily

rounding

• Interdisciplinary practice and

integrated care supports safe

discharge planning

• Effective practice supports

people with compromised

competence, cognitive

impairment, delirium,

dementia care

• Staff are supported by

appropriate technology and

education

Action

• Consistent care for the elderly

• Monitor Essentials of Care

standards [clinical policy]

• Monitor discharge safety

• Every time acknowledge,

introduce, duration,

explanation, thank people

[AIDET]

• DHB values consistently applied

• Feedback sought from patients/

service users / family/whanau

about care, compassion; staff /

service competence. The

patient voice is heard.

• Teams focused on needs of the

most vulnerable people,

particularly needs of the elderly

• Care is coordinated with

patient/service users involved

and informed

• Safety practices consistently

applied and profiled

• Practice is culturally sensitive

and promotes partnership,

participation and protection

Action

• Implement proactive patient

feedback mechanism and

action plans to improve

experience

• Publically report performance,

pressure injury, falls, health

care associated infections

• Patient and family focused care

models evident

• Standards of essential care are

well understood & applied

• Quality results show high

quality care: indicators, audit,

safety measures

• Leader visibility supports staff

• Issues escalated in a prompt

and confidential manner

• Practice and systems

improvements support change

to release time to care and

improvement of standards

• Safety a strong priority

• Collaborative practice culture

Action

• Develop nursing scorecard

focusing on quality metrics

• Revise audit process to make

data collection effective and

simple

• Promote safe practice priorities

• Leadership development for all

levels, includes role clarity

• Leader rounding supports

practice and values There is

presence of expert, competent,

credible, visible leadership

• Professional advice

communicates practice reality

• Workforce development

supports current and future

practice / service needs

• A culture of accountability

Action

• Undertake training needs

analysis for CNMs and develop

a leadership programme for

CNM

• Develop a leadership

programme for the Heads of

Nursing

• Staffing base, skill mix,

scheduling and service delivery

practice is evidence based.

Supported by the use of

Trendcare & CCDM tools

• Recruitment is values based

• All staff meet HPCAA and PDRP

requirements

• Workforce development

includes access to learning /

education opportunities,

developing potential succession

planning.

Action

• Utilise Trendcare and CCDM

tools to ensure adequate staffing

levels

• Utilise CCDM & Productive ward

processes to enhance efficiency

• Incorporate staffing metrics

scorecard

• Good employer practices apply

• Encouragement of professional practice

and continual growth / development

• Staff receive orientation, preceptorship,

annual appraisal, learning and

development opportunities

• Systems and processes designed to

assist staff meet service needs

• Future workforce programmes are

supported e.g. students, new graduate,

return to practice

• Shared decision making at all levels

• Recognition of the value of nursing

contribution

Action

• Monitor appraisal rate and PDRP

compliance

• Training needs analysis at all

department and team levels

• Undertake staff satisfaction survey of

each team

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6.2 Human Resources Recommendation That the report be received. Prepared by: Sam Bartrum (Director, Human Resources) Executive Summary This report identifies some key areas that are occurring in Human Resources for the month of May 2013. Corporate HR Bullying and Harassment Prevention Programme

Over the past 24 months the Human Resources team have completed a review of the organisation’s Bullying and Harassment Prevention policy, investigation process and programme. This has resulted in the development of new training provisions for staff and managers across the organisation and increased information for all parties being available on StaffNet. The DHB takes all allegations of bullying and harassment seriously and in any year will formally investigate in the region of 12 to 15 complaints. Due to the provisions of the Privacy Act the organisation is normally unable to share details of these cases, however toward the end of last year the DHB was involved in a case which was heard by the Employment Relations Authority which centred around a series of bullying and harassment complaints against a current employee. The DHB has recently been notified that the Authority found in favour of the DHB and in the determination the Authority member commended Waitemata DHB on it policy and process and further awarded costs against the employee. Further information on the case is held in the public domain and can be found here: http://dol.govt.nz/workplace/determinations/FullSummary.aspx?ID=27686750

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Recruitment May Recruitment Statistics

Actual Target Flag

Current Employ (fte) 5417 n/a � Ave number of Positions Vacant 320 n/a � No of Hires 146 n/a � % of Hires from Internal Referrals 35% 35% � Time to Hire 51 days 45 days � Cost per Hire $510 $750 �

No. Hires

(All permanent, fixed term, casual roles)

-

50

100

150

200

250

300

May-

12

Jun -1

2

Jul -

12

Aug-12

Sep-

12

Oct-1

2

Nov-12

Dec-1

2

Jan-1

3

Feb-

13

Mar-

13

Apr-13

May-

13

Cost per Hire ($)

(this includes advertising costs, relocation costs and

Monthly Recruitment Centre Running Costs)

-

200

400

600

800

1,000

May-

12

Jun -1

2

Jul -

12

Aug-12

Sep-

12

Oct

-12

Nov-12

Dec-1

2

Jan-1

3

Feb-

13

Mar-1

3

Apr-13

May-

13

Cost per Hire Cost per Hire Target ($)

Time to Hire (days)

(From candidate application to hire)

-

10

20

30

40

50

60

70

May-

12

Jun -1

2

Jul -

12

Aug-12

Sep-

12

Oct-1

2

Nov-12

Dec-1

2

Jan-1

3

Feb-

13

Mar-1

3

Apr-13

May-

13

Time to Hire (days) Time to hire Target (days)

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Ethnicity Data May 2013 - Workforce Group Ethnicity Breakdown Workforce Group

Allied Health 2 18.2% 1 9.1% 3 27.3% 2 18.2% 3 27.3% 11 100%

Care & Support 4 40.0% 6 60.0% 10 100%

Corporate & Other 3 25.0% 1 8.3% 5 41.7% 3 25.0% 12 100%

Medical 2 6.7% 1 3.3% 9 30.0% 8 26.7% 9 30.0% 1 3.3% 30 100%

Midwifery 2 11.8% 2 11.8% 2 11.8% 9 52.9% 2 11.8% 17 100%

Nursing 2 9.1% 1 4.5% 7 31.8% 6 27.3% 6 27.3% 22 100%

Technical & Scientific 1 50.0% 1 50.0% 2 100%

Waitemata DHB Total 11 10.6% 5 4.8% 27 26.0% 37 35.6% 23 22.1% 1 1.0% 104 100%

TotalMaori Pasifika Asian NZ Euro Other Not Disclosed

* The total number is larger than actual number of recruits as staff are able to identify with up to two ethnic groups and all ethnicities identified are included (94 total recruits from Leader, 104 total ethnicities identified).

New Graduate Nursing Recruitment

The shortlisting for this NEtP September 2013 intake is currently in place via the national ACE Programme.

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National Terms and Conditions for Recruitment Agencies

The 20 DHB CEs have approved the implementation of the standard Terms of Business. This is for the recruitment of clinical roles via recruitment agencies for permanent or fixed term positions (ie) employed by the DHB. It excludes locums. Implementation of the contract commenced 4 June 2013.

Social Media Policy

The Social Media Policy for Waitemata DHB has been now been published. This policy establishes the guidelines relating to social media usage within the District Health Board. Waitemata DHB uses social media for communication to the community and to engage staff. Recruitment has been using social media as part of a talent attraction strategy. This policy is to define appropriate use of these tools. The policy has been shared with Counties Manukau DHB and Auckland DHB. KiwiHealthJobs

The number of visits to KHJ continues to increase with over 35,000 visits in May. There was also a significant increase in visits from Australia and Canada during May. Long Service Recognition

The Waitemata District Health Board Long Service Recognition Guideline implementation has progressed significantly. All staff eligible for recognition since 2008 up until 31st June 2013 have been notified and invited to two events in July 2013. They will receive a card recognising their length of service and the appropriate Westfield gift voucher as per the guideline. The events are on the North Shore site on Thursday 11th July and on the Waitakere site on Tuesday 23rd July. Four hundred and eighty eight people are eligible for recognition. As of 1 July 2013 the implementation will be ongoing and on a quarterly basis staff who have reached the necessary service times will be recognised as per the guideline from within their services. Awhina

Awhina Education & Learning Awhina Education and Learning is one of the two functions in Awhina Health Campus; it has the following Learning Centres:

• Organisational Development and Leadership • Career and Talent Development • Learning Technologies (including e-Learning) • Clinical Skills and Simulation • Professional and Interprofessional Learning (medical and nursing) • Learning and Development.

This report focuses on key projects in Learning Technologies and the in-house Laparoscopic Adrenalectomy Conference which ran on 11 May.

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Learning Technologies

The Learning Technologies Centre is responsible for investigating and implementing, where appropriate, learning and educational opportunities for our staff including:

• E-Learning • AMS Leader Training records for WDHB staff (from e-Learning and face-to-face courses) • Social learning including blogs, forums and discussion groups • Mobile learning – apps, user experience and wi-fi • Scenario based learning/role-plays online • Simulations, including investigating various simulation software packages including 3D

and 4D • Provision of Netbooks for staff to access e-Learning in dedicated educational areas

(enabling flexible, online learning) • AV Co-ordination to assist medical grand rounds; AV links between Waitakere and North

Shore Hospitals for junior doctor, protected teaching time; CEO Lecture Series and Awhina Speaker Series)

• Partnerships with other educational organisations including primary healthcare, other DHBs, NGOs and hospices

• Heads of Agreement with Auckland University, Goodfellow Unit to provide selected e-Learning modules to the primary sector throughout NZ and be eligible for CPD/MOPs points for GPs and nursing portfolios – the first and only model of its kind in NZ.

E-Learning

We have a large number of e-Learning courses available that have been developed in-house by the specialist e-Learning Instructional Designers in conjunction with a wide variety of subject matter experts across Waitemata DHB. The courses currently available are:

1. Annual Updates (Fire, CPR, Occupational Health and Safety, Privacy of Health

Information, Infection Prevention and Control, ACLS Recertification Theory Test) 2. Patient Safety (SOAP – Clinical Documentation Notes, Informed Consent, Good Clinical

Research Practice, interRAI Assessment Tools, Mental Health Services Older People) 3. Safe Use of Medicines (The Adult Medication Chart, Medication History, Tramadol,

Gentamicin, Insulin, Heart Failure Medications, Medications for Older Adults, Buscopan, Metoprolol, Oxycodone, Noenatal and Paediatric Gentamicin, Pharmacological Management of Pain)

4. Diversity (CALD modules – developed by Asian Health Support Services) 5. Enteral Programme for Dietitians (Interdisciplinary Team, Dysphagia & SLT, Medications,

Nutritional Assessment, Tube Placement & Potential Issues with enteral feeding, Treatment, Monitoring, Discharge, Cultural & Ethical Safety)

6. Clinical Procedural Skills (Central Venous Catheters, Peripheral Intraveneous Cannulation, Blood Safe Programme, Stroke/Thrombolysis)

7. General (Nicotine Replacement Therapy, Smoking Cessation).

A full programme of development is scheduled for the next 12 months.

AMS Leader Training Records Project

This project commenced in October 2012 and focuses on providing one centralised training records system for Waitemata DHB and one single training record for each Waitemata DHB

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employee. These records will be accessed through Kiosk by staff and managers, by internal training providers and by Health and Disability Sector Standards Auditors.

Prior to the commencement of this project we had various databases for training records across our DHB, incomplete and out-of-date records (due to manual processes and each internal training provider keeping their own records), no ability to be able to provide HDSS auditors centralised records for mandatory training, no ability to be able to provide staff and managers quick and easy access to complete training records for staff and teams and no ability to be able to run reports to show those who have not done mandatory training or those who have out-of-date APCs. The project is being done in three phases. Phase one is complete. Achievements to date:

• Learning and Development, Mental Health, Nursing Development and Asian Health Support Services have all completed training on Leader administration and are now using AMS Leader for the training records for the courses they provide staff

• Kiosk reports are now available for all managers to see their direct reports’ training records. Individual employees can check their training records in Kiosk for those courses that have been loaded in AMS Leader

• Our model and training materials have been shared with other DHBs • Data cleansing of over 2,000 orphan records for employees within AMS Leader has

happened • Integration with e-Learning system to show all completed e-Learning records through

Kiosk has occurred.

Next steps (dependent on resourcing) are:

• Investigating how best to switch on the ‘Book Courses’ functionality and subsequent workflow

• Complete work with hA IS Computer Training team to complete training and move their courses over to Leader

• Work with Midwifery to move their courses over to Leader • Once work is finished with Mental Health, commence work with Allied Health as similar

complex model (due to diversity of disciplines) – to move their courses over to Leader • In phase three we will introduce competencies/skills profiles.

Laparoscopic Adrenalectomy Conference – held at North Shore Hospital, 11 May

On Saturday 11th May Waitemata DHB, supported by Awhina Health Campus, hosted 15 international practicing surgeons for a Retroperitoneal Laparascopic Adrenalectomy workshop organised by Dr Richard Harman and led by Dr Martin Walz. Dr Walz is Professor and Head of the Department of Surgery at the Centre of Minimally Invasive Surgery in Essen, Germany and regarded as the world’s foremost authority and most experienced surgeon in this technique. Operating took place on level 1 of North Shore Hospital with the visiting surgeons rotating through theatre with Dr Walz in groups of four. This allowed four rotations with four surgeons in the operating room with each case. Those surgeons not in the operating room remained on level 9 in the Orthopaedic Conference Room where they were able to hear commentary and see the surgery via a live audiovisual link provided by Stryker. Awhina Health Campus was engaged to help provide organisational services both in the run up to the workshop and on the day. We assisted with the production of the workshop

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information booklet that was provided to all participants, arranged for the surgeries and discussions to be filmed so that teaching resources could be produced and delivered to all registered attendees, provided full catering and organisational support throughout the day of the workshop, and collected and collated feedback data from the attendees regarding their experience on the day. We envisage there being other opportunities for in-house conferences of this nature. Awhina Research and Innovation To ensure “Best Care for Everyone”, Awhina Research and Innovation aims to facilitate and enable activity that will positively influence clinical practice, support timely clinical decisions and sustainable improvement in health outcomes for the community of Waitemata and beyond.

Each report to Clinical Governance Committee meeting will highlight, on a rotating basis, three areas of activity in Awhina Research and Innovation. This report features:

• Research and Knowledge Centre • Clinical electronic Decision Support System (CeDSS) • Library

Research & Knowledge Centre Awhina Research & Knowledge staff offer support in design, conduct and analysis of clinical trials, observational studies and audit/evaluation projects. This supportive environment enables many Waitemata DHB clinicians to deliver high quality, successful, timely and responsive project outcomes. The National Ethics Advisory Committee (NEAC) guidelines require that all research or audit related activity must be registered and approved by the host institution (locality). A total of 1258 projects have been recorded in the Awhina Research & Knowledge Centre database to date, with just under a 100 projects registered in the first quarter of 2013. On average 40% are interventional clinical trials, 24% are observational research and 36% are audit/evaluation. In July 2012 the MoH introduced new requirements placing greater responsibility for research and related activity upon the locality or host. This signalled a greater need for local and peer review which requires increased input from Awhina Research and Knowledge team to assess where a study involves more than minimal risk (that is, potential participants could reasonably be expected to regard the probability and magnitude of possible harms resulting from their participation in the study to be greater than those encountered in those aspects of their everyday life that relate to the study).

Calendar Year Number of Active

Research Projects

2007 96

2008 147

2009 230

2010 294

2011 331

2012 394

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Clinical e-Decision support platform (CeDSS)

CeDSS is a sustainable web-based tool developed to support the clinical decision making process, reduce the number of errors and enhance the quality of patient care within Waitemata DHB. CeDSS sites are recording around 11,000 views per month. Currently there are 7 services utilising this platform: Cardiology, Diabetes & Endocrinology, Paediatrics, Palliative Care, Transfusion Medicine, Pain Service and the RMO handbook. Women’s Health and Emergency Medicine are currently in discussion. The information/content owners are the clinicians. Awhina provides a coordinator to maintain and develop the sites capability to meet end use. A key development will be moving the platform to mobile devices as WiFi becomes available in the hospital and Awhina is also working toward making the service outward facing to Waitemata primary care clinicians, but this advancement is dependent on DHB and hA technology developments, and policy around quality and clinical information documents being accessible externally. Clinical Library

The Awhina library team deliver Waitemata DHB clinicians and collaborative users with multiple library services. While no individual clinical library in New Zealand can meet the needs of its users in entirety, Awhina librarians have formed excellent relationships with other library services in particular Counties Manukau, Northland and Waikato, to access material locally. As well they utilise the National Library’s interlibrary loan scheme and other national and international links and databases.

The librarians recognise the importance of emerging technologies, tools and strategies for libraries and are assessing how they will work in transforming the Awhina library service over the coming years to meet customer demand.

Workforce Elective Surgical Unit We are in the final stages of recruitment for the ESC roles and the creation of the orientation programme is in full swing. Values Implementation The last two values are being worked with to identify their behaviours – these are “Connected” and “Better, Best, Brilliant”. These are due to be completed by end of June when the full suite will be presented to ELT. We will also be presenting the ‘suggestions for improvement’ that have been provided by teams and the ‘issues’ that have been identified. Ngati Whatua o Orakei Partnership We are continuing to progress plans to offer five scholarships for Iwi members studying on health pathways, and build a support programme around these students. Recipients will be able to access support from the Education and Employment teams within Ngati Whatua as well as support offered by the Tertiary Institutions. A careers evening has been set up for June to promote careers in health, and a scholarship evening has been set up for July 2nd to introduce the scholarships to interested individuals. Allied Health Level 3 Qualification Programme continues successfully for first Cohort who will complete in December 2013.

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Occupational Health & Safety

Hyperbaric Chamber Staff The Naval Base informed the National Health Board (NHB) of its intention to cease running the Hyperbaric Unit from the 30th June 2013. The NHB has agreed to fund this service and Waitemata DHB has agreed to take it over. Funding has not been finalised and contracts for employees have been delayed until this is concluded. This is a hazardous work environment requiring extensive pre-employment screening. This involves a full diver’s medical over and above the normal health screening. To expedite the pre-employment screening process we have approached the Naval Base HR with consent forms to be completed by the candidates to allow for the release of medical information held by the Naval Base. This information, once received by OH&S, will need to be assessed to determine what further health screening is required. This is an extremely high risk environment and therefore health screening must be completed prior to commencing at Waitemata DHB. Hazard Potential Adverse Health Effect Control Measures Hyperbaric environment (staff members operating within pressurised atmosphere)

Pulmonary barotrauma (including pneumothorax, mediastinal emphysema, cerebral arterial gas embolism)

Pre-employment health screening Periodic health monitoring In-chamber and within-unit environmental monitoring Core skills training and periodic audit/retraining Equipment replacement schedule Regular equipment maintenance and repair Incident and near-miss reporting

Decompression illness Nitrogen Narcosis Aural barotrauma (middle ear and inner ear trauma) Sinus barotrauma Thermal effects (heat and cold)

Hyperbaric oxygen Oxygen toxicity (cerebral) Fire/explosion/blast Burns/multiple trauma/chest and

middle ear trauma Gases under pressure Explosion/fire Manual handling Spinal and other musculo-skeletal

injuries Sharps handling Lacerations, puncture wound Blood and body fluid

contamination/infection Slips, trips and falls Musculo-skeletal injuries Chemical exposures Respiratory/upper respiratory

irritation or allergy Skin irritation/allergy Electrical equipment Electrocution, burns Psycho-social hazards (isolation within chamber for prolonged periods; isolation of worksite from main campus)

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Flu Vaccination Update Waitemata DHB staff have put in a great effort this year to help protect themselves, their families, colleagues and patients from getting the flu. At the end of May, 55% of WDHB staff had received a flu vaccine which is a big improvement on previous years. Comparison data uptake by Occupation 2012/2013:

Uptake by Occupation

01020304050607080

Doctors

Nurses

Midw

ives

HCA's

Allied

othe

r

tota

l upta

ke

occupation

% u

pta

ke

2012

2013

2012 Number given/total in that occupation

% uptake 2013 Number given/total in that occupation

% uptake

Doctors 310 / 756 41% Doctors 428 / 731 59% Nurses 848 / 2235 38% Nurses 1236 / 2173 57% Midwives 49 / 155 32% Midwives 66 / 162 41% HCA’s 165 / 524 31% HCA’s 247 / 344 71% Allied 454 / 1220 37% Allied 763 / 1652 46% Other 630 / 1617 39% Other 691 / 1169 59% Total 38% Total 55%

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7.1 Elective Services Update Recommendation:

That the report be received.

Prepared by: Andrea Baker (Provider Arm Performance Manager) and Andrew Palmer (Senior Analyst) Endorsed by: Dr Debbie Holdsworth (Chief Planning and Funding Officer)

Glossary

DHB - District Health Board ESPI - Elective Services Performance Indicator which monitors waitlist performance ESPI 2 - This monitors the time people wait for their first specialist appointment (FSA). It should be no longer than 6 months from the date of their referral ESPI 5 - This monitors the time people wait to receive their elective surgery. It should be no longer than 6 months from their FSA FSA - First specialist appointment IDF - Inter District flows (Services provided by one DHB for another DHB’s population) MoH - Ministry of Health WIES - Weighted Inlier Equivalent Separation. This is the unit of measure applied to coding of

inpatient activity and allows the relative resource utilisation of an inpatient event to be compared across all inpatient events. This is also known as “caseweights”.

YTD - Year to date

1. Introduction

This report covers the period ending 31 May 2013.

The total value of the additional electives money (over and above baseline funding) available to Waitemata District Health Board (DHB) for 2012/13 is $32,673,964. The aim of this report is to track performance against the plan on a monthly basis to ensure the DHB is able to access the full value of this funding. It also includes reporting against the Elective Health Discharge Target and the Elective Services Performance Indicator which monitors waitlist performance (ESPI) compliance to mitigate risk of financial penalty associated with non compliance around waiting times to access elective surgery.

The additional electives plan is an organisational plan inclusive of both provider activity and Inter District flow (IDF) activity. As this report focuses specifically on the additional electives plan, there are differences in the values reported in the provider performance report earlier in the agenda. The provider arm report reports against the total electives contract the funder has with the provider arm and is inclusive of baseline and additional elective volumes.

2. Second Month of the Final Quarter 2012/13 Electives Performance

2.1 Surgical Electives Discharge Health Target Waitemata DHB’s discharge rate for May YTD (11 month’s data) was 99.7%, being 97.2% YTD for the Provider and 104.2% YTD for IDF. The Provider Arm productivity has not met the phased targets over the past four months and this, coupled with a reduction in IDF elective discharges, means it will be a moderate challenge to meet the end of year Elective Discharge target. Early forecasts of June activity at Auckland has shown a 50% reduction in activity for the month which will bring their forecast discharge activity down to almost 100% of plan. This reduction is reassuring from the perspective of Auckland implementing our agreed referral management guidelines however does mean we can no longer rely on IDFs offsetting provider under delivery as has been the case in the

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past. The provider has produced a plan to meet their year end volumes and we remain reasonably confident that collectively we will achieve the organisational elective surgical discharge target.

2.2 Caseweight delivery While the electives target is a volumes target, the actual payment from the Ministry is based on the actual caseweights or Weighted Inlier Equivalent Separation (WIES) delivered. The provider arm budgets have assumed the full value of the plan and therefore it is important that both the discharge and caseweight plan is delivered.

For May we have delivered 100% YTD of our caseweight plan (96.1% Provider Arm; 107.7% IDF) and are confident we will continue to deliver to the full plan collectively and be paid the full value of our additional electives funding. While the provider will achieve their discharge volume, they are unlikely to deliver the full value of their caseweight plan.

2.3 ESPI Compliance We were compliant within a minimal Ministry of Health (MoH) buffer with very few patients waiting beyond six months for first specialist appointment (FSA) and elective treatment. ESPI 2 was 0.2% and ESPI 5 was 0.3%. Being within the buffer does not activate a penalty countdown; however it does not mean full compliance i.e. no patients waiting over six months. Therefore Waitemata’s status colour is yellow as opposed to green. We are confident the organisation will achieve the new target of zero waiters beyond five months by 30 June 2013 with operational plans having been fully implemented and pre booking of ESPI 2 and 5 almost complete up to June 2013. The organisation is on track to receive a MoH incentive payment for achieving ESPI compliance to five months by 30 June 2013. Waitemata’s compliance share would be $554,468 plus potentially a share of the Northern region’s incentive payment of $1,779,226. Please note that to receive the incentive payment there cannot be any patients waiting over five months, therefore being within a small buffer will not comply.

2.4 Key intervention targets The MoH expectation for Waitemata surgical intervention rates for major joint production is 1,007 for 2012/13. This expectation does not have financial incentive or penalty.

The second month of the final quarter’s performance for major replacements has increased slightly to 86.8% in May YTD but is ahead of this time last year. Based on the activity to date we anticipate the provider will reach the 100% target at the end of the financial year.

Bariatric surgery, cataracts and CABG are the other key intervention targets set by the Ministry. Bariatric surgery is ahead of the MoH plan however the DHB set the target higher at 100 procedures, 53 more than the MoH plan in order to reduce inequalities for the Maori and the Pacific population as per the District Annual Plan. Bariatric surgery is performing at 82.9% YTD against the DHB internal plan and 176% YTD against the MoH contracted Bariatric volumes.

3. Electives Volumes Advice 2013-14

As previously advised, Waitemata is continuing discussions with the National Health Board regarding the inequity of additional electives funding for 13/14. These are yet to be completed however we are reasonably confident we will achieve a more favourable funding position.

4. Report Key*

Achieved Target Met Partly Achieved Within Buffer Not achieved < 98%

Of health target

* See Electives Initiative report attached for result status.

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Discharge Summary (Health Target) Elective Services Patient Indicators (ESPIs)

IDF Total 104.2% ESPI 2 (waiting time for First Specialist Assessment) 0.2%Provider Total 97.2%

General Surgery Inpatient services 96.7% ESPI 5 (waiting time for treatment) 0.3%ENT Inpatient Services 91.0%Gynaecology Inpatient Services 92.2%Orthopaedics Inpatient Services 89.3%Urology Inpatient Services 112.0%

Waitemata DHB Total Surgical Elective Discharges 99.7%Elective Surgical Purchase units, and Avastin and Skin Lesions reported to NMDS

Caseweight Delivery (CWD) Summary Surgical Procedures

IDF Total 107.7% Knee Joint Replacements 78.1%Provider Total 96.1%

Hip Joint Replacements 99.9%Waitemata DHB Total Elective CWD 100.0%Elective Surgical, Dental and Cardiology Purchase units, and Avastin and Skin Lesions reported to NMDS Total Joints 86.8%

Bariatric Procedures 82.9%

Overall

CWD Target reflects the Elective CWD purchased by the MOH. To meet the required surgical discharges target the Waitemata funder has contracted to provide additional Elective volumes on top of the MOH funded Elective CWD.

The discharge volumes YTD of 99.7% are driven by the IDF activity of 104.2%. The Provider’s discharge volume sits at 97.2% YTD. The specialties contributing to this lower rate are orthopaedics, gynaecology and ENT.

Major joint replacement volumes have increased with a YTD total against intervention requirement of 86.8%. Hip joint replacements are sitting at 99.9%.

The organisation is likely to achieve 100% of its discharge volumes against the MoH ending 30 June 2013.

Waitemata DHB attained yellow status for ESPI 2 and 5 in May 2013. This indicates the number of patients waiting over six months was within the MoH approved buffer. Yellow status does not activate any financial penalty trigger. However the Provider is well on track to reach the new ESPI compliance of five months waiting by 30 June 2013.

Elective Initiatives Report - Health Target May 2013

Surgical Elective Discharges Actual Vs Contract

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17/06/2013 Prepared by: Andrew Palmer Elective Initiatives Report 201213.xls87 of 87

a g e n d a - waitemata dhb

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