a g e n d a - waitemata district health board · 2016. 7. 8. · hospital advisory committee (hac)...

HOSPITAL ADVISORY COMMITTEE (HAC) MEETING

Wednesday 14th August 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 14/08/13 i

HOSPITAL ADVISORY COMMITTEE (HAC) MEETING 14th August 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 Robert Paine – Chief Financial Officer and Head of Corporate Services Andrew Brant – Chief Medical Officer Jocelyn Peach – Director of Nursing & Midwifery Debbie Holdsworth – Director Funding Phil Barnes – Director of Allied Health Mike Schubert – Interim Chief Executive Officer, healthAlliance Sam Bartrum – GM Human Resources Paul Garbett – Board Secretary

Apologies:

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 03/07/13 ....................... 3 4. ITEMS FOR CONSIDERATION AND RECOMMENDATION TO THE BOARD

5. PROVIDER REPORT 11.05am 5.1 Provider Arm Performance Report .........................................................................................15 6. CORPORATE REPORTS 11.55am 6.1 Clinical Leaders’ Report .........................................................................................................81 12.10pm 6.2 Human Resources Report ........................................................................................................87

7. INFORMATION PAPERS 12.20pm 7.1 Elective Services Update ........................................................................................................94 12.30pm PRESENTATION : Caesarean Births (Linda Harun - General Manager Child, Women and Family

Services)

Waitemata DHB, Hospital Advisory Committee Meeting 14/08/13 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 14/08/13 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 12/12/12 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 � � � x

Andrew Jones � � x x

Waitemata DHB, Hospital Advisory Committee Meeting 14/08/13

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 03/07/13

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 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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5. End of Life 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.


Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which is subject to an obligation of confidence. [Official Information Act 1982 S.9 (2) (ba)]

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3.1 Confirmation of Minutes of the Hospital Advisory Committee meeting held on 03rd July 2013

Recommendation: That the Minutes of the Hospital Advisory Committee meeting held on 03rd July 2013 be approved.

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Minutes of the meeting of the Waitemata District Health Board

Hospital Advisory Committee

Wednesday 3 July 2013

held at Waitemata District Health Board Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 10.11a.m

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

Lester Levy (Board Chair) Max Abbott (present until 12.15p.m) Pat Booth Sandra Coney Rob Cooper Warren Flaunty Wendy Lai

James Le Fevre Christine Rankin

Allison Roe Hasan Bhally (Co-opted member) (present until 12.30p.m) ALSO PRESENT: Andrew Brant (Acting 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) Cath Cronin (GM Surgical and Ambulatory Services) Debbie Eastwood (GM Medicine and Health of Older People Services) Jonathan Christiansen (HOD, Medical) Tamzin Brott (HOD, Allied Health) Auxilia Nyangoni (Manager, Corporate Finance and Planning) Penny Andrew (Clinical Lead Quality)

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) Jeremy Olds (New Zealand Doctor magazine)

APOLOGIES: Apologies were received from Susanna Galea, Andrew Jones and John Cullen, with apologies for early departure from Max Abbott and Hasan Bhally.

WELCOME: The Committee Chair welcomed those present and spoke of the positive

way Maori Language Week is giving exposure to the language. Following the site visit to the Elective Surgery Centre by the Board

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earlier that morning, she acknowledged the superb work of the Project Team and congratulated them on an outstanding job.

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 11.37a.m.

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

Resolution (Moved Warren Flaunty/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 22/05/13

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. 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)]

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. [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)]

Carried 10.15a.m to 11.37a.m – public excluded session 11.37a.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 22 May 2013 (agenda pages 2-12) Resolution (Moved James Le Fevre/Seconded Christine Rankin) That the minutes of the meeting of the Hospital Advisory Committee held on 22 May 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 – May 2013 (agenda pages 13-70) Executive Summary/Overview/Scorecard Andrew Brant (Acting Chief Executive) commented on:

• Achievement of the six hour target for ED is being maintained despite some challenges in the last month.

• ESPI – both targets will be met for the year and the Auckland region as a whole will also meet the targets. This is a great achievement.

11.20a.m – Sandra Coney present (she had left the meeting during the public excluded session). Luke Bunt (Chief Financial Officer and Head of Corporate Services) summarised the financial results from the report. He noted that results as at the end of May are somewhat favourable to expectations and the $6.8M favourable result for 2011/12 can be regarded as secured, with some upside to that likely. The Committee Chair congratulated management on ensuring that the end of year result is positive, which represented a great team effort. Resolution (Moved Wendy Lai/Seconded Christine Rankin) That the Executive Summary/Overview Section of the report be received. Carried Surgical and Ambulatory Services Cath Cronin (General Manager, Surgical and Ambulatory Services) presented this section of the report. Matters Cath Cronin highlighted included:

• Achievement against health targets and meeting ESPI compliance. • The complaint response time was disappointing, but reflected some extremely

complex complaints, requiring extensive consultation across staff members. • Some good results in terms of the cost control strategy, for example with

clinical supplies. • Faster cancer treatment times (page 29 of the agenda) – they had consulted

other DHBs and many had started data collection earlier, however they are probably in a better position on this than they expected to be.

• ESC will open as planned on 15 July and the Project is going well. • Breast screening – 70% had been achieved for Maori for the first time. It had

taken several years to get there and Mihi Andrews and her team had put in a major effort to reach this over the last year.

• The quality issue with treatment time for fractured neck of femur (fractured hip), as detailed on page 30 of the agenda. There will be a concerted effort to improve this over the next six months.

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Matters covered in discussion and response to questions included: • In response to a concern that highlighting one particular type of operation

may lead to preferential treatment for that, Cath Cronin advised that there is another indicator of 24 hours to theatre that applies to all acutes.

• With regard to radiology, they are trying to work out the correct percentage of work to be done in house and the correct percentage to outsource and how that can be matched to what is affordable. MRI scanning will be a concern until the additional MRI scanner is commissioned. With CT scanning there had been an increase in the number of patients waiting over 21 weeks. Information on radiology performance will be brought back to the Committee on a regular basis for review.

• The question of naming of the Elective Surgery Centre was raised and it was noted that the Chief Executive would need to be involved in any discussion or decision about that. It was also pointed out that there had been a naming and branding exercise for this. It was agreed as an action to ask for Dale Bramley’s feedback on the question.

• With regard to the Faster Cancer Treatment Indicator Results (page 29 of the agenda), Cath Cronin advised that there had not been a lot of existing information on this. It won’t be until the next reporting period that a picture will emerge of whether results are improving or not.

• With regard to DNA results, Cath Cronin commented that there is a need to re-prioritise this area and revisit it with the Maori team. They had tried various strategies, improvements had occurred, but then results had fallen away again.

• The question was asked as to what occurs with patients given a diagnosis that they should have an operation, but who decide they want to wait. Cath Cronin advised that they are given space to make that decision, but in an informed way. With cancer cases, they would certainly make sure they don’t lose track of the patient.

Cath Cronin was thanked for her report. Mental Health and Addiction Services Helen Wood (General Manager, Mental Health and Addiction Services) and Ian McKenzie (Regional Manager, Regional Forensic Services) were present for this section of the report. Helen Wood conveyed apologies from Murray Patton and Jeremy Skipworth. Matters highlighted included:

• Complaints – these are usually responded to in a reasonable time, but a few are quite complex and take longer.

• Adult Mental Health Services and Forensics Services are feeling the effects of ongoing high acute demand pressures. This has been the case for about seven months now, with no sign of easing off. It also seems that because of high occupancy rates, some patients have been discharged too early, leading to re-admissions within the 28 day period.

• Successful collaboration with Auckland DHB Mental Health Services to up skill families, Whanau (as detailed on page 55 of the agenda).

• The performance and productivity improvements measured through regional/national KPI benchmarking and Te Aranga Hou (as shown on pages 56-57 of the agenda). Ian McKenzie noted that the shift to measurement of

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outcomes is a profound shift for the Mental Health sector and that Waitemata DHB is a leader in this regard.

• Alcohol and Drug Services are hoping to obtain more funding and are presenting in Parliament on that; they are hoping to get a new contract under the Prime Minister’s initiatives.

• The improvements in productivity for Child and Youth Services and for Pacific Services (both detailed on page 58 of the agenda).

• The outcomes of the Ombudsman’s report on the Mason Clinic under the Crimes of Torture Act (page 59 of the agenda). A key issue is their recommendation to not lock patients in their rooms, which does involve a number of risks for the service. The issues raised are being worked through by the Clinical Governance Group.

12.15p.m – Max Abbott retired from the meeting. Matters covered in discussion and response to questions included:

• With regard to outpatient figures (page 53 of the agenda), they definitely wished to improve the number of Maori accessing Alcohol and Drug Services. The Maori Service is not the only way Maori access such services and in future information will be provided on numbers of Maori accessing the range of services.

• The Marinoto facility is not up to standard. There are no plans to replace it, but some upgrading is planned to address problems such as areas of dampness. Information was requested for the next meeting on what is planned for the Marinoto facility.

12.20p.m – Helen Wood retired from the meeting. In response to further questions, Ian McKenzie advised:

• With regard to the successful collaboration with Auckland DHB Mental Health Services to up skill families, whanau (page 55), he understood that strategy is being developed to have this as part of business as usual and also the beginning of something larger.

• With regard to the KPIs shown on pages 56-57 of the agenda, these are in development and bring NGOs into planning. This piece of work is taking place at a national level.

Resolution (Moved Wendy Lai/Seconded Allison Roe) That the Mental Health 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:

• Mid winter pressure, with June always being a difficult month, including change over of half the house officers and registrars and examinations in mid June.

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• ESPI targets met. • Length of stay up slightly, but within acceptable limits. • A correction was noted to the figure in the Performance Scorecard for

percentage of urgent diagnostic colonoscopies done within 14 days. This should read 50%, not 33%.

• Appointment of a new Clinical Director for Mental Health Services for the Elderly, Rob Butler.

• The Slark Hyperbaric Unit – the responsibility had been taken over from the Navy on 1 July. There are still issues being worked through.

• Current areas of divisional focus include bureau usage, annual leave (particularly those who have accrued more than 75 days), sick leave (with new processes to manage this) and tracking SMO leave.

Matters covered in discussion and response to questions included:

• With regard to increasing ACC revenue, the Division is looking at the interface with acute services and generally at maximising opportunities which are being missed.

• With regard to the issue of identifying and addressing abuse of elders, this is an area that needs development and a report will come back on that at some stage.

• In respect of reports in the media of immigrant Chinese older people being left in New Zealand by their children, who then shift to Australia themselves, Jonathan Christiansen said that anecdotally this is not a significantly more common problem with the Asian ethnic group. As an action, he would see if data is obtainable through Asian Health.

Debbie Eastwood and Jonathan Christiansen were thanked for the report. Child, Women and Family Services Linda Harun (General Manager, Child, Women and Family Services) and Dr Tim Jelleyman (Head of Division Medical, CWFS) presented this section of the report. Matters highlighted included:

• The improvement in Gynaecology elective surgery volumes. • ED waiting times for Paediatrics are being watched closely due to winter

pressures. • Response times to complaints have improved but remain above target due to

the complexity of some complaints. Penny Andrew and Linda Harun have met a number of people with complaints. This takes time but produces good results. An effort is also made to respond to straightforward complaints quickly.

• DNA rates still remain high despite all that has been done. They now wish to try talking to the people involved directly about what their reasons are for not attending appointments and they are designing a questionnaire to get consistency with that. They will bring back findings and any actions decided on. Paediatric clinics are starting shortly at the New Lynn Integrated Health Centre and it would be interesting also to know if holding gynaecology clinics off site would reduce DNAs.

• Tim Jelleyman commented that winter pressures provide a good opportunity to test collaboration with Auckland DHB in Child Health. There is a good flow of patients between the two services, although most children can be seen in their home DHB.

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• Before School Checks (page 48) – Plunket is contracted to do this work by Planning and Funding and reporting will come through to CPHAC. The Provider Arm is involved in Vision and Hearing Checks, which is why this item is reported here. Referrals on from these have not always been reported or recorded well and that reporting is being developed.

• Rheumatic fever – a key part of addressing this lies in primary care and school based clinics. The rate of Group A strep throat being found is quite high. Work is also taking place to address other issues found, like skin infections, when these tests take place. Work is also taking place to up skill GPs to make sure children get the right treatment. Although GPs are issued with guidelines, they don’t always follow those guidelines. This was taking more time than expected.

Linda Harun and Tim Jelleyman were thanked.

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

• The response to the question from the 22 May HAC meeting on the proposed National Food Service, shown on page 12 of the agenda. A due diligence visit from HBL was due to take place the following week. He had received an enquiry from HBL as to whether Waitemata DHB might be interested in being a pilot site.

• Improved access for disability users of car parking at North Shore Hospital – new parking spaces have been painted, but more work is needed with signage and the suggestion of a covered walkway still needs to be looked at.

• Sue Lim’s highly deserved Queens Service Medal award. • The decrease in staff parking non-compliance at Waitakere Hospital

following towing of a vehicle in May. • Some concern was expressed at the increased public parking charges at the

hospitals. The Board Chair noted that parking charges are a mechanism to cover the costs of future parking developments and ensure those don’t come out of health funding. Waitakere Hospital needs a major parking development; topography and geology there are not good and this will be quite expensive.

Matters covered in response to questions included:

• The non-compliance of the existing MRI stairs (page 64) had been found in a check of stairs in DHB buildings carried out recently.

• The issue with relocation of the Maori Health Team relating to North Shore Hospital MRI (page 65) – Luke Bunt advised that this was just an issue of space and the sequence in which it will be required.

Resolution (Moved Christine Rankin/Seconded James Le Fevre) That the report be received. Carried

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6. CORPORATE REPORTS

6.1 Clinical Leaders’ Report (agenda pages 71-74)

Dr Andrew Brant (Chief Medical Officer), Dr Jocelyn Peach (Director Nursing and Midwifery) and Phil Barnes (Director Allied Health) presented this item. Jocelyn Peach referred to the work being done on leadership development and focusing on quality. She highlighted the chart on page 74 of the agenda, a one page summary developed for staff members to make sure they know where we are going. Phil Barnes highlighted the summer school project, involving a photography student from Unitec, which aimed to develop a national photographic library of food, for use as an educational resource. In answer to a question, Jocelyn Peach said that she would bring back information on the Bereavement Care programme to the next meeting. The report was received.

6.2 Human Resources (agenda pages 75-84)

Sam Bartrum (GM Human Resources) was present for this item. Matters that he highlighted included:

• The data and graph included on recruits by ethnicity (page 77). This will be included in the report on a regular basis until the Committee requests that it be less often.

• The Social Media Policy is now in place. This will be shared with Auckland and Counties Manukau DHBs and the rest of the country.

• The long service recognition programme – two major events are being held to catch up on this, involving 500 staff. Following this, recognition will be handled by each of the services going forward. They will be given a list of qualifying staff for this on a monthly basis.

• Awhina – 1,250 projects have been recorded in the knowledge centre, which shows the enormous amount of research and innovation going on in the organisation.

• Influenza Vaccinations – a good result, with 55% of staff being vaccinated, compared to 38% last year.

In answer to questions, Sam Bartrum advised that the Hyperbaric Service is extremely hazardous for those working in it, which is why pre-employment screening requirements are stringent and why it is important to get the relevant information released by the Navy quickly. People currently working there would have had to meet these requirements already.

Sam Bartrum was thanked for his report. Resolution (Moved Allison Roe/Seconded Wendy Lai) That the report be received. Carried

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7. INFORMATION PAPERS

7.1 Elective Services Update (agenda pages 85-87)

The report was taken as read and received.

The Chair thanked those present.

The meeting concluded at 1.06p.m. SIGNED AS A CORRECT RECORD OF THE WAITEMATA DISTRICT HEALTH BOARD HOSPITAL ADVISORY COMMITTEE MEETING OF 3 JULY 2013

_____________________________________ CHAIR

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

as at 5th August 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 14/08/13

HAC 03/07/13

5.1 Provider Arm Performance Report:

ESC Naming – CEO to be asked about naming.

Dale Bramley

Naming and branding were determined previously.

Marinoto Facility – information to be provided on what upgrading is planned.

Helen Wood

HAC 14/08/13

Refer August Provider Arm report.

Asian Health – To see if there is any data on extent to which immigrant families leave older people in New Zealand while shifting to Australia themselves.

Jonathan Christiansen

HAC 14/08/13

Refer August Provider Arm Report.

HAC 03/07/13

6.1

Clinical Leaders’ Report: Bereavement Care Programme – update on this to be provided to August HAC Meeting.

Jocelyn Peach

HAC 14/08/13

Included in August HAC agenda – Item 7.2

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Waitemata DHB Hospital Advisory Committee Meeting 14/08/13

5.1 Provider Arm Performance Report – June 2013 Recommendation That the report be received. ___________________________________________________________________________ Prepared by: Robert Paine (Chief Financial Officer and Head of Corporate Services) and Andrew Brant (Chief Medical Officer) This report summarises the provider arm performance for the period ended 30 June 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

(i.e. June 2013), the arrow reflects progress compared to last period (i.e. compared to May 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.

17 of 96


Executive Summary / Overview

OVERALL ASSESSMENT

For the year end Waitemata DHB reached the elective health target with a result of 100.2% (IDF total

101.3% and Provider Arm total 99.6%).

For the year ended 30 June 2013, WDHB achieved a surplus of $5.995M (DHB Parent result), which

was favourable to the planned $2M surplus by $3.995M. The Funder Arm contributed to this

favourable position after generating a $13.75M surplus (against a budgeted surplus of $1M) which

fully offset the Provider arm and Governance and Funding administration adverse results. The DHB

Consolidated Group result (that is including Three Harbours Health Foundation’s $840k surplus) was

a surplus of $6.835M, which is in line with the overall year end forecast previously reported to the

Committee/Board and to the NHB.

The Provider arm generated a deficit of $7.527M for the year which was $6.527M unfavourable to

the budgeted surplus of $1M. The overall underperformance to the budget reflects budget issues,

cost pressures and unrealised savings across Provider Arm services. Underperformance to budget

was mainly in Surgical & Ambulatory services ($3.9M), Medicine & Health of Older People ($6.1M)

and Hospital Operations ($3.5M). These adverse movements were partially offset by better than

planned financial performance in Mental Health ($3.7M) and Corporate ($6.4M). Key drivers for

these variances are discussed in this report.

SERVICE DELIVERY

Did not attend rates The opening of the ESC will give the booking and scheduling team time to refocus on DNA rates for

Surgical/Ambulatory clinics. Within Medical services the greatest DNA rates are occurring for

diabetes first and follow up appointments. The clerical team in Diabetes have commenced their

initiative to contact all patients via the phone prior to any appointments being scheduled – early

results are positive. To help understand high DNA rates for children, a report is now being run

monthly, which includes the child’s NHI, clinic appointment date and telephone contact. A Pacific

and Maori staff representative is ringing each family to ascertain whether there were any significant

factors that contributed to them not attending the scheduled appointment. These factors will be

collated over time to identify strategies to improve access to appointments.

18 of 96


Scorecard

Health Targets Actual Target Productivity Actual Target

Better help for smokers to quit 96.3% 1 0 95.0% �� ESPI 2 - % patients waiting > 6 months for FSA 0.0% 1 0 0.0% �

Provider Arm Elective Volumes 99.6% 1 0 100.0% � ESPI 5 - % patients not treated within 6 months 0.0% 1 0 0.0% �

Shorter Waits in ED 96.4% 1 0 96.0% �� Elective Surgical Day case rate % 57.0% 1 0 60.0% ��

Patient Flow

Average Length of Stay - Acutes 3.46 1 0 3.50 �

Average Length of Stay - Electives 4.50 1 0 3.82 �

Quality Actual Target Discharges before 11am* 15% 1 0 20% �

Complaint Average Response Time 16 days 1 0 14 days � Discharges during weekends 22% 1 0 20% �

Rate of falls with major harm 1.00 1 0 < 0.07 �

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

Percentage of older patients assessed for the risk of falling 64% 0 1 90% Elective WIES Volumes 14,704 1 0 15,727 �

Percentage of ocasions when insertion bundle used 91% 1 0 90% Acute WIES Volumes 52,686 1 0 51,112 �

Percentage compliance with good hand hygiene practice 73% 1 0 70%

Percentage of operations where all three parts of the surgical checklist are used 80% 0 1 90% Non-Case weighted Discharges

First Specialist Assessment (FSA) 38,655 1 0 36,274 �

DNA Rates Number Subsequent Attendance (FUP) 80,573 1 0 69,622 �

First Specialist Assessment (FSA) DNA rate - Total 364 10.6% 1 0 10.0% � Emergency presentations (admitted) 61,764 1 0 60,216 �

First Specialist Assessment (FSA) DNA rate - Maori 61 17.9% 0 1 10.0% � Emergency presentations (non-admitted) 46,101 1 0 46,634 �

First Specialist Assessment (FSA) DNA rate - Pacific 47 19.6% 0 1 10.0% �

Follow up (FU) DNA rate - Total 573 8.0% 1 0 10.0% �

Follow up (FU) DNA rate - Maori 89 15.2% 0 1 10.0% �

Follow up (FU) DNA rate - Pacific 73 16.2% 0 1 10.0% �

Other Key Measures

Acute Readmission Rate within 28 days 11.5% 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 68 0 1 34 �

Turnover Rate % * 9.6% 1 0 10.0% ��

Clinical Employ (FTE) 4,395 FTE 1 0 �

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

Financial Result YTD Actual $000s Target $000s

Revenue 726,429 k 1 0 715,498 k �

Expense 733,955 k 0 1 714,498 k �

Personnel Costs 492,226 k 1 0 487,672 k �

Outsourced Services 52,956 k 0 1 43,792 k �

Clinical Supply Costs 92,695 k 0 1 85,398 k �

Non-Clinical Supply Costs 96,078 k 1 0 97,636 k �

Contribution -7,526 k 0 1 1,000 k �

Capital Expenditure 52,484 k 0 1 78,418 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 Perfo rmance

Waitemata DHB Monthly Performance ScorecardALL Services

June 2013

Service Delivery

Human Resources

Quality

Finance

Priority One

How to read

19 of 96


Health Targets

BETTER HELP FOR SMOKERS TO QUIT

SHORTER STAYS IN EMERGENCY DEPARTMENTS

20 of 96


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 06/07/2013

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 - 2012/13WDHB Provided Target Total Target Estimated WDHB Provided YTD Estimated Total YTD

21 of 96


ELECTIVE PERFORMANCE: ZERO PATIENTS WAITING OVER 5 MONTHS

Waitemata DHB: ESPI Compliance Summary Report

ESPI Number

compliant

Number

non-

compliant

Non compliance %

ESPI 2 9,091 0 0%

ESPI 5 3,082 0 0%

Specialty Number

compliant

Non

compliance

%

Specialty Number

compliant

Non

compliance

%

Anaesthesiology 122 0.0% Cardiology 164 0.0%

Cardiology 1044 0.0% General Surgery 722 0.0%

Dermatology 50 0.0% Gynaecology 452 0.0%

Diabetes 124 0.0% Orthopaedic 866 0.0%

Endocrinology 205 0.0% Otorhinolaryngology 526 0.0%

Gastro-Enterology 798 0.0% Urology 352 0.0%

General Medicine 210 0.0% Total 3082 0.0%

General Surgery 1266 0.0%

Gynaecology 811 0.0%

Haematology 74 0.0%

Infectious Diseases 20 0.0%

Neurology 38 0.0%

Oncology 39 0.0%

Orthopaedic 1030 0.0%

Otorhinolaryngology 1296 0.0%

Paediatric MED 760 0.0%

Renal Medicine 104 0.0%

Respiratory Medicine 274 0.0%

Rheumatology 220 0.0%

Urology 606 0.0%

Total 9091 0.0%

ESPI2 Summary ESPI5 Summary

Waitemata DHB achieved ESPI compliance for the year end with zero patients waiting over five

months for their First Specialist Appointment and Surgery. Waitemata will receive an incentive

payment for having achieved this milestone.

22 of 96


Financial Performance

All Services CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Jun-13

Provider

($000’s)

Actual Budget Variance Actual Budget Variance Actual Forecast Variance

REVENUE

Government

and Crown

Agency

61,674 58,172 3,502 704,013 692,965 11,048 704,013 700,710 3,303

Other Income 1,933 1,905 27 22,416 22,533 (117) 22,416 22,309 107

Total Revenue 63,607 60,077 3,530 726,429 715,498 10,931 726,429 723,019 3,410

EXPENDITURE

Personnel

Medical 14,116 12,015 (2,101) 143,035 139,338 (3,697) 143,035 141,805 (1,230)

Nursing 15,520 15,449 (71) 189,215 185,052 (4,163) 189,215 190,270 1,055

Allied Health 7,342 8,209 867 94,516 96,380 1,864 94,516 95,437 921

Support 1,034 1,257 223 12,297 14,677 2,380 12,297 12,385 89

Management /

Administration4,116 4,265 149 53,164 52,225 (939) 53,164 53,479 315

42,128 41,195 (933) 492,226 487,672 (4,554) 492,226 493,375 1,149

Other Expenditure

Outsourced

Services7,436 3,648 (3,788) 52,956 43,792 (9,164) 52,956 46,745 (6,211)

Clinical Supplies 9,005 7,357 (1,648) 92,695 85,398 (7,297) 92,695 91,047 (1,648)

Infrastructure

& Non-Clinical

Supplies

9,475 8,193 (1,282) 96,078 97,636 1,558 96,078 98,674 2,597

25,916 19,198 (6,718) 241,729 226,826 (14,903) 241,729 236,466 (5,263)

Total Expenses 68,044 60,393 (7,651) 733,955 714,498 (19,457) 733,955 729,841 (4,113)

Contribution (4,437) (316) (4,121) (7,526) 1,000 (8,526) (7,526) (6,823) (703)

Allocations 0 0 0 0 0 0 0 0 0

NET RESULT (4,437) (316) (4,121) (7,526) 1,000 (8,526) (7,526) (6,823) (703)

CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Jun-13

Provider

($000’s)


CONTRIBUTION

Surg & Ambulatory 653 229 424 1,221 5,120 (3,899) 1,221 267 954

Medical & HOPS 5,576 6,335 (759) 73,792 79,914 (6,121) 73,792 73,309 483

Child Women F. 2,528 3,534 (1,005) 38,786 39,940 (1,154) 38,786 38,633 153

Mental Health 3,499 2,724 775 37,057 33,389 3,667 37,057 37,048 9

Provider Support (16,694) (13,137) (3,557) (158,382) (157,363) (1,019) (158,382) (156,079) (2,302)

Total Contribution (4,437) (316) (4,121) (7,526) 1,000 (8,526) (7,526) (6,823) (703)

CONSOLIDATED STATEMENT OF PERSONNEL by PROFESSIONAL GROUP Jun-13


FTE

Medical 638 674 36 635 651 16 635 651 16

Nursing 2,660 2,498 (163) 2,496 2,492 (3) 2,496 2,492 (3)

Allied health 1,469 1,545 76 1,421 1,508 88 1,421 1,508 88

Support 290 343 53 267 333 66 267 333 66

Management 768 783 15 756 781 25 756 781 25

Total FTE 5,825 5,842 17 5,573 5,765 192 5,573 5,765 192

Reporting Date

Reporting Date

FULL YEARMONTH YEAR TO DATE

MONTH

Reporting Date

MONTH YEAR TO DATE FULL YEAR

YEAR TO DATE FULL YEAR

23 of 96


COMMENT ON MAJOR VARIANCES

Revenue

Provider arm revenue was $3.53M favourable to budget for the month and $10.931M favourable for

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

revenue for ESPI compliance, bowel screening and Mental Health Service Level agreement funding.

For the full year, additional revenue reflects unbudgeted funding for the bowel screening project

($3.993M with matching costs), revenue to cover cancer treatment drug costs ($2.151M), ESPI

compliance (1.108M), Mental Health funding ($1.1M), HPV ($337k), Smokefree project ($223k),

over-delivery of IDF Inflows Electives & IDF Acutes for other DHBs ($1.641M), Maternity Quality and

Safety Programme ($271k), additional funding for gastro services including transfer from Bowel

screening ($546k), Cancer Care coordination and faster cancer treatment ($361k), Gateway

assessment program ($357k), CEO funded initiatives ($800k), additional interest income ($2.25M)

and small favourable positions across various contracts and income streams.

These fully offset unfavourable movements in patient sourced income ($2.016M adverse, mainly

due to a stretched target for non-residents income that has not been achieved), ACC revenue

($1.286M adverse, with the targets set for 2012/13 budget difficult to achieve), Funder revenue not

received ($2.95M due to Provider arm under-delivery on the additional electives contract).

Expenditure

Expenditure for the Provider arm was overall unfavourable for the month ($7.651M) and YTD

($19.457M). This reflects additional costs for initiatives/contracts funded from additional revenue

discussed above and cost pressures realised in the business. The significant June month expenditure

variance also reflects the impact of year end accruals/provisions adjustments including actuarial

valuations for staff liabilities, CME provisions, bad debt write offs as well as impact of year end

capital decisions (e.g. depreciation for capitalised projects, revaluation of assets) and wash-ups with

shared agencies.

Key variances and explanations for the full year are summarised below:

Adverse Personnel cost variances are as follows:

• Medical staff costs ($3.697M adverse). This reflects unbudgeted costs that are fully offset by

funded initiatives (refer to revenue variances above), allowances for SMOs 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 ($4.163M 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 ($939k adverse), mostly relates to costs for funded

programmes with offsetting revenue such as bowel screening, unrealised savings for

transcription services and management costs charged to this staff category when the budgets

are in nursing and allied health staff categories.

Favourable support staff costs ($2.38M) 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 $1.864M, mainly

due to vacancies (with Allied Health FTEs being 88 less than budget for the year, mainly regional

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

24 of 96


Outsourced services costs were $9.164M unfavourable. $5.798M of this variance is in outsourced

staff costs, mainly due to the Bowel Screening project ($1.851M, with offsetting revenue), interim

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

costs, and 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 $3.366 is in outsourced clinical

services and mainly relates to overspends in laboratory costs, outsourced ultrasounds and

outsourced colonoscopies.

Clinical Supplies costs were adverse by $7.297M mainly due to volume driven cancer treatment

drugs ($1.693M 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 than planned and higher supplies costs than budgeted for home based older adult

services.

These adverse costs were offset by favourable movements in infrastructure costs ($1.558M) mainly

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

25 of 96


Human Resources

All Services Sick Leave

0

2

4

6

8

10

12

Jun

-20

11

Se

p-2

01

1

De

c-2

01

1

Ma

r-2

01

2

Jun

-20

12

Se

p-2

01

2

De

c-2

01

2

Ma

r-2

01

3

Jun

-20

13

Sick Leave Rate (days per fte)

Trends

The June 2013 result shows a slight increase to the monthly sick leave rate from May, with the

complete annual sick leave rate showing a seasonal fluctuation. The increase to the monthly result

compared to the annual patterns shows an improved result in the same period for June 2012 and

the previous year June 2011.

Highlights/risks

The improvement in the year on year result for the sick leave rate in June is positive. The positive

result is thought to be due to a combination of sick leave management activity and the Occupational

Health and Safety campaign to increase flu vaccinations.

Planned Actions

Monitoring of individual sick leave usage continues at team level. Improved manager access to

employee sick leave balances continues at manager and service level. Investigation into regional

reporting options to provide further information to managers on patterns and clusters of sick leave

by individual is ongoing.

26 of 96


Overtime

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

Jun

-20

11

Se

p-2

01

1

De

c-2

01

1

Ma

r-2

01

2

Jun

-20

12

Se

p-2

01

2

De

c-2

01

2

Ma

r-2

01

3

Jun

-20

13

Overtime Rate (% total hours)

Trends

The June result shows an increase in the rate of overtime (less than 1.5%) on the previous month,

the annual result continues to reduce gradually towards the target of 1%. The monthly usage is

significantly less than that for the same period in June 2012 and June 2011.

Highlights/risks

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

however the monthly usage has increased from May with a partial correlation between higher sick

leave resulting in an increased use of overtime. Other potential factors are resignations and

increased length of vacancies to reduce staff budget costs.

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.

27 of 96


Annual Leave Management

AL bal AL bal AL bal AL bal

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

01-WIMO Medical and HOPS 1275 476 113 26

01-WSAS Surgical and Ambulatory 707 265 62 19

01-WWCW Child Women & Family 769 186 19 9

01-WMHS Mental Health Services 871 299 37 9

01-WHOG Hospital Operations 454 201 17 1

01-WACP Corporate 116 39 5 3

01-WCFA Facilities and Development 22 13 0 0

01-WPDS Decision Support 27 11 6 1

Grand Total 4,241 1,490 259 68

Service

Trends

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

year. The number of employees with an annual leave balance of over 75 days remains a focus,

particularly leave planning for clinical staff.

Highlights/risks

The ongoing improvement in the annualised rate is supported by a reduction in the number of

employees with leave balances greater than 75 days. A continued focus on reducing high leave will

continue to see a reduction in the number of employees with a balance greater than 75 days.

Planned Actions

The services implemented significant annual leave plans over the summer period and monitoring of

this will continue over the winter period. There is further leave planning required to reduce leave

balances for those with an accrued balance between 50 and 75 days.

28 of 96


Staff Retention

Staff Resignations within 6 months

-

2.00

4.00

6.00

8.00

10.00

12.00

14.00

16.00

Se

p-2

01

1

De

c-2

01

1

Ma

r-2

01

2

Jun

-20

12

Se

p-2

01

2

De

c-2

01

2

Ma

r-2

01

3

Jun

-20

13

Staff Resignations within 6 mths (headcount)

Trends

The monthly annual turnover remained low in June 2013 at 2%. The monthly turnover decreased

from May with a significant six monthly and annual decrease. These results do not indicate any

significant concern and reflect the currently static external job market.

Highlights/risks

The annual trend for resignations within 6 months continues to decline overall, which has now

occurred over a sustained period of time.

Planned Actions

All employees leaving within one year of service continues 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.

29 of 96


Turnover

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

Se

p-2

01

1

De

c-2

01

1

Ma

r-2

01

2

Jun

-20

12

Se

p-2

01

2

De

c-2

01

2

Ma

r-2

01

3

Jun

-20

13

Voluntary Turnover Rate (% total employ)

Trends

The monthly turnover increased in June 2013 by 1% from May. These results do not indicate any

significant concern, although require close monitoring should the rate continue to climb.

Highlights/risks

The annual trend for resignations has increased overall, with a 1% increase on the same period June

2012.

Planned Actions

Monitor the rate of resignations going forward, analysis the reasons for resignation and propose an

action plan to reduce the rate.

30 of 96


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 Dr 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 is slightly behind target at 93.7%. The areas that have been

underperforming are being followed up.

The elective volume has been achieved for FY 2013 although noting under-delivery to target and

WIES for the orthopaedic unit.

Shorter waits in ED met the target of 96%.

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 61% for CT and 37% for MRI.

ESPI Compliance

ESPI compliance has been achieved with 100% of patients seen at clinic and/or treated within five

months.

Quality

The service received 17 complaints in June (16 received at the same time last year). The response

rate has improved within the service to 22 days for June and 14 days for July.

S&AS Complaints per Month July-June 2011-2012 & July-June 2012-2013

0

5

10

15

20

25

30

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

2011-2012

2012-2013

Overall for the year the service has reduced complaints by 19% compared to the same period in the

last financial year.

31 of 96


S&AS Compliments Received in July-June 2011-2012 & July-June 2012-2013

0

5

10

15

20

25

30

35

40

45

50

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

2011-2012

2012-2013

Overall for the year the service is receiving an increased number of compliments. There has been a

noticeable increase in compliments in care and improved patient experience which has been

pleasing to see and is a credit to Kate Gilmour and the Charge Nurse Managers of the inpatient

wards at NSH.

Human Resources

Liz Hollier has been appointed as Unit Manager, Theatre Services and Katherine Lee as the Charge

Nurse Manager of Theatre NSH.

Service Delivery

Bariatric Surgery

A total of 85 bariatric cases have been completed against a MoH target of 50 and a WDHB target of

100. Currently the wait times for the P1 cancer cases for surgery is greater than the current wait

time for bariatric surgery, for example colorectal wait time for surgery Priority 1 is 39 days. Priority 2

is 75 days in colorectal surgery compared to a Priority 2 wait time for bariatric of 49. Priority 1 is for

cancer patients only.

As we reviewed overall clinical priority and demand in all general surgery specialties in FY13 we did

not have capacity to treat 100 bariatric patients without deferring other higher priority cases. This

was discussed with the Clinical Lead of Bariatric Surgery and the Clinical Director and the view was

that a target of 80 would meet the current demand.

The table below details the number of Bariatric cases completed for the last three financial years.

The MoH target for the last two financial years was set at 47 patients with a WDHB target of 100

patients.

The low production for the 2011/12 year was due to a period of absence for one of the bariatric

surgeons.

32 of 96


To

tal

3030

61

61

8585

MoH

Target

July

Au

gu

st

Se

ptem

be

r

Octo

ber

Ma

rch

Ap

ril

Ma

y

Jun

e

No

vem

be

r

De

cem

ber

Janu

ary

Fe

brua

ry

20111 0Bariatric Bariatric 3 2 3 2 2 5 2 3 6 1

Total 3 2 3 1 2 3 6 10 2 2 52012

6 4Bariatric Bariatric 60 7 8 7 8 0 3 5 2 4 7Budget 7 5 6 8 4 4

6 44 5 4

Total 7 8 7 8 0 3 55 4

2 4 7variance 0 3 1 -2 0 -2 -1 30 4 -1

20133 11Bariatric Bariatric 100 8 8 8 3 2 9 9 5 14 5

Total 8 8 8 3 14 511 3 2 9 9 5

The table below shows the ethnicity breakdown of the patients treated for the 2012/13 financial

year. The percentage of Maori treated (as a total of all treated) is 17.6% and the percentage of

Pacific island treated is 13%.

No

vemb

er

De

cemb

er

Jan

uary

Feb

ruary

March

Ap

ril

May

June

Ethnicity Breakdown

July

Aug

ust

Se

ptemb

er

Octo

ber

To

tal

2013

0 0 0 0 0 1 0 0Bariatric Asian 0 2 0 2 5European 7 2 5 3 7 2 2

1 06 7 4 8

Maori 1 2 2 0 2 2 1 1 20 531 15

Other 0 0 0 0 0 0 00 0

0 0 0 1

Pacific Island 0 2 1 0 2 1 0 0 30 12 11

Total 8 8 8 3 11 3 14 5 852 9 9 5

Recommendations:

• Reduce the internal target for Bariatric surgery to 80 cases for FY14

• Work with the Maori and Pacific Island teams to ensure we are meeting the needs of those

communities in this programme.

WDHB Surgical Programme

A comprehensive review of the WDHB surgical programme is ongoing to identify if there are

opportunities within our current resource and funding envelope to reallocate resources to meet

WDHB population demand for timely treatment. This also gives us the opportunity to review the

specialty services that WDHB provides particularly in regards to IDF and tertiary surgical procedures.

Intensive Care/High Dependency Unit and Outreach

To enhance patient safety the CLAB (Central Line Associated Bacteraemia) initiative (which has been

a focus within the ICU/HDU for the past 12 months) is now being rolled out across the organisation

with ICU staff actively supporting the Infection, Prevention and Control team in leadership and

education.

The focus on reducing medication errors has seen five key drug policies reviewed by the

multidisciplinary team.

The Outreach team continue to report further increases in the number of patients they are

reviewing (867 patients reviewed between January-March 2013 and 1184 patients reviewed April-

June 2013). The work of the outreach team on the Waitakere site has seen 184 referrals in the last

quarter. As a direct result of the intervention of the outreach staff, eight patients were transferred

to NSH, three of who required ICU/HDU admission.

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The VQM (Visual Quality Management) programme has been completed and has been integrated

into the three monthly audit cycle.

Patient engagement and experience initiatives include the development of a new bereavement

information pamphlet for families, the upcoming participation in the patient and family quality test

trial being run by the Quality team and the commencement of a patient and whanau satisfaction

project.

Best clinical practice this quarter has seen ICU acknowledged by the Chief Investigator of an

Australasian research trial for the quality of our unit’s data collection. Two further research trials are

due to commence in August. Four ICU/HDU policies are under review and a trial of a bedside

nasojejunal insertion device has been completed which indicates a number of benefits for patients.

As a result a business case is being prepared.

Outpatients Departments

Quality boards are underway in both departments with an identified focus each month.

A small but notable event was the effort and time North Shore Hospital Outpatient staff took to

locate a patient whose wedding band was found in the department. Exhausting all other means,

creative use of local newspaper media meant that the patient and his ring were reunited, resulting in

a delighted and relieved patient and family.

Signage for the four reception areas at North Shore Hospital is being improved to ensure that all

visitors to the department can easily locate the right reception area. We will then work with staff

from the electronic patient management systems to assess how this information can be

electronically added to each patient appointment letter. This will streamline the process for patients

reporting for their appointment.

Waitakere Outpatients have completed the implementation of electronic discharge summaries for

all patients attending the medical day stay department.

Staff on both sites have contributed to over 23 clinics run on Saturdays over the past two months to

support ESPI compliance.

Radiology

Capacity shortfalls continue to impact wait times for imaging. The Ministry of Health has announced

an initiative to clear wait list backlogs to support six week wait time indicator achievement.

Additional funding will be made available August/September to either outsource MR and CT scans

waiting longer than six weeks or fund overtime in-house sessions.

The service underwent an IANZ surveillance audit in June with three corrective actions to be

followed up.

The selection process for the MRI scanner is underway, with site visits to Australia to assess three

scanners. Construction project management companies have been short listed with the final

selection to be confirmed mid-July.

Theatre NSH and WTH

The new 2013/14 schedules have been confirmed for NSH, WTH and ESC theatres. The production

plan that has been compiled to meet this year’s surgical health targets requires 98% utilisation of

available capacity for 49 weeks of the year. This will pose a considerable challenge to the S&AS and

ESC teams and require careful planning and optimal use of our current resources.

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Surgical Wards

Implementation of Partnership Care model to Wards 4, 7, 8 & 9

• The Partnership care model of nursing has been implemented into the surgical wards recently.

This model recognises the way in which a nurse works with their patient and the patient’s family

to support their involvement in decision making and self-care whilst respecting the patient’s

dignity. The partnership care model encourages a shared care/support and planning as a

partner with the patient and their family/whanau. This has enabled the surgical wards to

provide a service that ensures that each patient and family understands the care plan in place to

provide them with the best possible outcome.

• This model will also improve staff satisfaction and retention of staff, provide effective utilisation

of resources and increase CNM leadership skills to drive quality improvements. Staff are no

longer working in isolation and junior staff are supported.

• Bed side handovers have commenced on ward 8 and there is a brief coordinator to coordinator

handover prior to the bedside handover where structured essential information is shared.

• Since the implementation of this model there has been a decrease in complaints and patient

satisfaction and experience surveys are being carried out to enable us to hear from the patients

what further areas of improvement can be made to our service.

• Some surgical wards are trialling a change of shift hours which will continue to offer 24 hour

nursing cover but allow staff to finish their shifts on time, which will increase staff satisfaction.

Quality

• Quality study days continue which allow recommendations with corrective actions to be

implemented following audit.

• CLAB - The CLAB initiative is currently in wards 4 and 8 and more recently ward 7 and 9.

Maintenance compliance continues to be an area that we are striving to improve with the

support of the Infection Control team.

• Hospital Acquired Infection - As well as ongoing monthly hand hygiene audits, the wards take

part in the Hand Hygiene New Zealand Gold audits where orthopaedic SMOs’ rates have seen a

marked improvement from 18.4% to 78%, taking the orthopaedic service overall from 61.4% to

71.8%.

• Falls - There have been no falls with harm this month.

• Recruitment - A surgical clinical coach has been appointed to work alongside nurses and role

model good nursing practice and offer advice on professional nursing practice issues to enhance

practice effectiveness and safe clinical outcomes.

BreastScreen Waitemata Northland (BSWN)

BreastScreen Aotearoa (BSA) coverage by Ethnicity for the 24 months to 31 May 2013

Maori Pacific Other Total

Waitemata DHB 67.6%* 78% 67% 67.7%

Northland DHB 72% 62.8% 75% 74.3%

BSWN 70.6% 79.2% 68.9% 69.6% *Waitemata DHB achieved 70% coverage for Maori (for the first time) to 30 June 2013. Coverage statistics will be available

30 September 2013.

BSWN Annual Targets

An equity focus has been used to set coverage targets for the 2013/14 period. Our targets are:

1. Achieve 70% BSA coverage for Pacific (Northland DHB)

2. Maintain 70% BSA coverage for Maori (Waitemata DHB)

3. Achieve 70% Total BSA coverage target (BSWN)

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The focus will then shift to maintaining coverage levels for priority groups (Maori and Pacific) while

closing the gaps between Waitemata and Northland’s coverage. The reprioritisation of resource

and strategies will result in a decrease in Northland DHB’s coverage. The challenge will be brokering

agreement with Northland to support this work programme.

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.

ACC Revenue

ACC revenue for this financial year is $1.938M compared to a budget of $2.067M. While there is a

shortfall of $129k, the revenue achieved this year is higher than 2011-12 by 8.3%. ACC Elective

Surgery and ACC Radiology are $146k and $201k favourable and offset lower revenue from the

Clinical Services Contract. Clinical Services contract relate to face-to-face specialist assessment and

treatment services for ACC clients. We have an opportunity to address this with improved

administrative processes and recover that revenue.

The 2013/14 budget remains at $2.067M.

There are further opportunities to increase the ACC Elective Surgery revenue with the ESC, although

due to staffing resource this may not be possible until January when the current fellows are looking

for consultant roles.

Quality Indicator – Fractured Neck of Femur (fracture hip)

A rigour project has been endorsed by Clinical Governance Committee - ‘Managed care for patients

with fractured neck of femur to achieve best clinical outcome and decreased LOS and improved

patient experience’.

This will give a focus and profile to engage all stakeholders in one project to achieve an improved

outcome for patients with #NOF that can be sustained over time.

End of 2012/13 Financial Year

• S&AS have achieved significant outcomes in the past 12 months

• Achieved Surgical Health Targets

• Improved productivity and utilisation of theatre resources at NSH

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• Achieved budget outcome to forecast

• Redesigned nursing model of care on the surgical inpatient wards and outpatients

• Redesign of Booking and Scheduling underway and now in consultation

• Successful recruitment and development of the Operational Management Team

• Achieved performance targets and services delivery in Bowel Screening and Breast Screening

• Supported the commissioning and opening of the ESC

I would like to note thanks to all the Operations Managers and Nursing Head of Division and their

respective teams for their contribution and attention to improving service delivery to our

population. Their achievements are appreciated and contributed significantly to Waitemata DHB’s

strategic plan.

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Scorecard

Health Targets Actual Target Productivity Number Actual Target

Better help for smokers to quit 93.7% 1 0 95.0% � Elective Surgical Day case rate % 56.0% 1 0 60.3% �

Provider Arm Elective Volumes * 101.2% 1 0 100.0% � Elective Day of Surgery Cancellations 0.5% 1 0 2.0% �

Shorter Waits in ED 96.2% 1 0 96.0% � Theatre utilisation 88.0% 1 0 85.0% �

* excludes gynae No. & % of CT scans done within 6 weeks (42 days) 348 66.0% 0 1 75.0% �

No. & % of MRI scans done within 6 weeks (42 days) 89 41.0% 0 1 75.0% �

No. & % of US scans done within 6 weeks (42 days) 548 43.0% 0 1 75.0% �

Quality Actual Target Patient Flow

Complaint Average Response Time 22 days 0 1 14 days � Day of Surgery Admission rate (DOSA) 95.0% 1 0 92.0% �

Hand hygiene gold audit - ward 4 65.0% 1 0 > 70.0% � Average Length of Stay - Acutes 3.63 1 0 4.00 �

Hand hygiene gold audit - ward 9 72.0% 1 0 > 70.0% � Average Length of Stay - Electives 4.93 1 0 3.90 �

Hand hygiene gold audit - ICU 76.0% 1 0 > 70.0% � Discharges at weekends 10.7% 1 0 20.0% �

Discharges before 11am 15.8% 1 0 20.0% �

DNA Rates Number

First Specialist Assessment (FSA) DNA rate - Total 159 11.9% 1 0 10.0% � ESPI 2 - % patients waiting longer than 6 months for FSA

First Specialist Assessment (FSA) DNA rate - Maori 21 19.1% 0 1 10.0% � General Surgery 0.0% 1 0 0.0% ��

First Specialist Assessment (FSA) DNA rate - Pacific 21 25.9% 0 1 10.0% � ORL 0.0% 1 0 0.0% �

Follow up (FU) DNA rate - Total 231 7.7% 1 0 10.0% � Orthopaedics 0.0% 1 0 0.0% �

Follow up (FU) DNA rate - Maori 42 17.6% 0 1 10.0% � Urology 0.0% 1 0 0.0% ��


ESPI 5 - % of Patients not treated within 6 months

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

Acute Readmission Rate within 28 days 11.0% 1 0 10.0% � ORL 0.0% 1 0 0.0% ��

% of fractured neck of femur patients to theatre within 24 hours (April 2013) 42.0% 0 1 85.0% �� Orthopaedics 0.0% 1 0 0.0% �

ICU - rate of CLAB per 1000 line days 0.9 1 0 < 1 �� Urology 0.0% 1 0 0.0% ��

Contracts (YTD)

Elective WIES Volumes

Surgery (Overall) 11,954 1 0 12,056 �

HR Wellbeing Actual Target General Surgery 4,563 1 0 4,186 �

Sick Leave Rate (days) * 7.4 days 1 0 7.5 days �� ORL 1,130 1 0 1,156 �

Overtime Rate (%) * 1.3% 1 0 1.0% �� Orthopaedics 5,241 1 0 5,759 �

Annual Leave Balance > 75 days 19 0 1 5 � Urology 1,020 1 0 955 �

Turnover Rate % * 7.8% 1 0 10.0% �

Clinical Employ (FTE) 787 FTE 1 0 � Acute WIES Volumes

* 12 month rolling average Surgery (Overall) 12,940 1 0 11,903 �

General Surgery 6,697 1 0 6,208 �

Orthopaedics 6,229 1 0 5,694 �

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

Revenue 148,562 k 1 0 143,263 k � First Specialist Assessment (FSA) 12,726 1 0 13,678 �

Expense 147,341 k 0 1 138,143 k � Subsequent Attendance (FUP) 32,705 1 0 28,862 �





Contribution 1,221 k 1 0 5,120 k �




Actual TargetDHB Perfo rmance

Waitemata DHB Monthly Performance ScorecardSurgical and Ambulatory Service

June 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 X

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 5 months

2. Elective surgery productivity met target for FY13

3. Review of clinical supplies ongoing

4. Completed theatre schedules for NSH, WTH and ESC. Production plan for FY14 completed.

Areas off track for month and remedial plans:

Bariatric Surgery as noted last month. Report included in current HAC report.

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Key issues/initiatives identified in coming months

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

patients within 5 months and to sustain this in FY14.

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

surgical treatment time of 4 months in December 2014.

• 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.

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

clinical supplies, both consumables and prosthesis to set up in time ordering, reduce cost of

imprest held in theatre and contain/reduce costs.

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

Pringle has indicated her interest to assist both MHoPS and S&AS with this area.

• The Shorter Journey Project will be handed over from the ESC Project Team to S&AS. John

Cullen will be our clinical lead.

• S&AS are seeking funding to rollout the Enhanced Recovery After Surgery (ERAS) to orthopaedic

patients (hip/knee procedures and fractured neck of femur). Our work will be based on the

successful implantation of ERAS for Colorectal patients lead by Matthias Soop (Colorectal

Surgeon).

• Strategies are in place to contain our expenditure and to look for opportunities to contribute to

savings initiatives within the service.

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Financial Results


Surg & Ambulatory

($000’s)


REVENUE

Government

and Crown

Agency

13,590 11,866 1,724 147,941 142,397 5,544 147,941 146,702 1,239

Other Income 44 72 (28) 621 866 (245) 621 605 16

Total Revenue 13,635 11,939 1,696 148,562 143,263 5,299 148,562 147,306 1,256

EXPENDITURE

Personnel

Medical 3,877 3,861 (16) 46,466 44,955 (1,511) 46,466 46,735 269

Nursing 2,637 2,576 (61) 31,907 30,946 (961) 31,907 32,264 357

Allied Health 875 875 (0) 11,001 10,509 (492) 11,001 11,087 86

Support 164 173 9 1,770 1,991 221 1,770 1,751 (19)

Management /

Administration649 677 28 8,807 8,343 (464) 8,807 8,994 187

8,202 8,162 (40) 99,952 96,745 (3,207) 99,952 100,832 879

Other Expenditure

Outsourced

Services1,220 503 (717) 9,568 6,040 (3,528) 9,568 8,956 (612)

Clinical Supplies 2,721 2,544 (177) 31,092 29,355 (1,736) 31,092 30,777 (315)

Infrastructure

& Non-Clinical

Supplies

839 500 (339) 6,730 6,003 (727) 6,730 6,476 (254)

4,780 3,548 (1,233) 47,389 41,398 (5,991) 47,389 46,208 (1,181)

Total Expenditure 12,982 11,710 (1,272) 147,341 138,143 (9,198) 147,341 147,040 (301)

Contribution 653 229 424 1,221 5,120 (3,899) 1,221 267 954

Allocations 878 878 0 10,787 10,787 0 10,787 10,787 0

NET RESULT (226) (650) 424 (9,567) (5,668) (3,899) (9,567) (10,521) 954


Reporting Date

Comment on Major Financial Variances

Overall Overall: Contribution = $1.221m against a budget of $5.120m, resulting in a negative variance to budget of

$3.899m, compared to an originally forecasted variance of $4.8m. This difference in forecast of $954k occurred in

the most part due to an unanticipated last minute allocation of an ESPI achievement bonus of $600k, expected in

the 2013/14 FY.

Elective revenue variance

U$610k: Overall elective activity for the combined WDHB and IDF population for the year was lower than the DHB

target by 132 WIES. The main contributor to the shortfall was Orthopaedic surgery, which delivered 527 WIES less

than target ($2.44m). This was off-set by General Surgery that delivered 331 WIES above target ($1.53m). Other

unbudgeted funder revenue such an unexpected $590k ESPI compliance fund, together with Community

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Ultrasound funding and other unbudgeted activity (such as Bowel Screening (BSP) $4.0m and Radiology revenue

from ADHB) generate a positive result overall of F$5.54m.

Acute revenue variance

A material impact on SAS budget and results for the year occurred due to the higher than forecast acute surgical

demand. In total, acute volumes delivered for the year were 12,940 WIES case-weights, when only 11,967 WIES

were budgeted. The value of this activity at national price is around $4.5m (being 973 WIES @ $4,614).

Expenditure

Clinical supplies contributed $1.74m to the negative expenditure variance, the risk having been signalled from July

last year due to an understated budget, even when compared to 2011/12 actual costs (with 2011/12 planned

volumes being less than 2012/13). This may have been exaggerated by anticipated savings from

HBL/HealthAlliance procurement initiatives not eventuating.

Personnel costs were over budget by $3.2m, with $1.54m coming from SMOs alone. Further details in the SVR

below.

Summary

The higher than anticipated acute orthopaedics and general surgery demand has been difficult to absorb within

the service. Stringent cost containment measures and the constant review of processes have remained in place

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

previous financial year. Elective events reached target (ESPI & health) at year end. Even with the cost control

measures in place during the year, the actual variance was $3.9m at year end.

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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,

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 June we provided documented advice and support to 97.4% of all identified smokers who were admitted to the

hospital. Waitemata DHB has now achieved the smokefree target for the last eight consecutive quarters.

ELECTIVE WIES CARDIOLOGY

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

reports. Our performance in June has brought us to 78% against our YTD target. We achieved 100% compliance

with the elective angiography within 90 days against a target of 85%.

COMPLAINTS

The number of complaints received in June was 34 against an average of 35 per month from July –June. This

month our turnaround time was 17 days against a target of 14 days.

DNAs

The 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 clerical team in Diabetes have commenced their

initiative to contact all patients via the phone prior to any appointments being scheduled. This is for both FSA’s

and Follow up appointments. The June FSA DNA results for Maori show a solid reduction on the YTD rate;

however this is only one month of data. The pilot will run for three months initially and then we will evaluate the

results.

SHORTER STAYS IN ED

Shorter stays in ED performance for June was 97% and 96.4% so far for Quarter 1. The service has been under

pressure at both sites due to a combination of patient volumes (as can be seen by the WDHB ED Presentations

graph earlier in the report) and an increase in staff sickness. The inpatient services have been meeting weekly and

more regularly as required to identify problematic areas within the system which impact on our ability to either

see patients in the ED or have them flow through into ADU or the wards. The ADU has also been working at

capacity for much of the month and we have opened our overflow short stay ward as required to ensure patients

are safely managed.

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. This has been challenging over the last month due to high

numbers. The planned winter discharge coordinator commenced in late June and is assisting with managing the

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>10 day inpatient length of stay patients and other complex patients who are not currently supported by the

geriatric nurse specialists. The new weekend medical model for the management of post-acute patients and

responding to ward calls was implemented in June. This change means that house officers will hold a mobile

phone and be immediately contactable by the wards; the ward calls will be shared between three house officers.

Quality

The Frontline Focus Friday initiative aimed at quality improvement activities is being well attended by charge

nurse managers. The focus has been on a range of quality activities, i.e. pressure injuries, falls, infection control.

This forum is also useful in raising awareness regarding incidents in the ward and the importance of monitoring

care closely through the use of weekly audits.

The gastroenterology department is making sound progress under the Global Rating Scale (GRS) programme with

a particular emphasis on nursing processes. The appointment of a new charge nurse manager across both the

North Shore and Waitakere sites will facilitate further standardisation of processes and systems.

Maori Geriatric Nurse Specialist (GNS) Update

There are five Maori clients who reside in the same rest home and the Maori GNS has engaged in a

partnership project with the rest home manager and the community to supply culturally appropriate input.

This is an ongoing project which now includes Maori Health staff who are working with the provider arm

services to find innovative ways to support Maori clients.

The Maori GNS is also providing “cultural education in practice” to students at AUT and will be providing a session

on improving the management of Maori clients in the community from the GNS perspective to both

undergraduate and postgraduate students at UNITEC. In partnership with the Maori clinical nurse specialist

Diabetes these 2 senior nurses are working with specific Maori students to encourage and support them into a

pathway towards Maori nurse specialists in the future.

HUMAN RESOURCES

We have commenced an additional weekly session in the Cardiac Catheter Laboratory to manage both the

demand for angiography and to ensure timely access to procedures. This is particularly important over the winter

when we are experiencing high demand for acute inpatient beds and we need to minimise any unnecessary

delays.

We have successfully completed the employment of the permanent staff; technicians, senior nurse and clinical

director (senior medical officer) of the Slark Hyperbaric Unit based at Devonport. This unit will transfer from the

New Zealand Defence Force to WDHB from the 1st July 2013. This project has been successfully managed over a

90 day period due to the hard work of staff from both Waitemata and healthAlliance.

We have appointed a new charge nurse manager to Ward 10; the successful applicant is an internal appointment

from a nurse educator role. We are advertising for a charge nurse manager for Ward 5 as the current incumbent

was successful in the gastroenterology charge nurse manager role. It is pleasing to see nurses being developed

and moving into leadership roles within our own organisation.

Despite very proactive recruitment for nurses to work in the medical wards we have not had applications from

experienced nurses. The majority of nurses applying are from overseas and therefore required extended

orientation to enable them to work safety and effectively in the acute wards. We are exploring how we can use a

similar model as that which we use for new graduates for the overseas nurses.

Service Delivery As noted earlier in the report Cardiology, achieved 100% compliance with the MoH target of 85% of elective

patients receiving their coronary angiogram within 90 days.

Colonoscopy service delivery – as noted on the scorecard we achieved 56% compliance for the urgent

colonoscopy’s completed within 14 days. We are on track to open the additional endoscopy room at Waitakere

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Hospital in early August, this room will give us the additional capacity required to manage our demand within

clinically appropriate timeframes and work towards meeting all our targets.

ESPI Compliance

All specialties are compliant with the five month target this month. We are continuing to work on our outpatient

processes and to review all our clinic profiles to ensure they are maximising our productivity, this work will

continue to ensure we are consistently achieving the five month target.

Assessment & Diagnostic Unit (ADU) & ED

• ADU is making good progress with ‘bare below the elbow’ BBE. There is now a red floor marking to remind

staff to be BBE before entering a patient’s room

• ADU is also working closely with the Laboratory for near patient testing for urinalysis. This is intended to

reduce the number of specimens needing to go to the laboratory.

From the results of an audit in ED there are opportunities to improve the time taken for patients to receive

analgesia; this is the focus for June and July within the department.

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Scorecard


Better help for smokers to quit 97.4% 1 0 95.0% �� Chemotherapy waiting times - within 4 weeks 100% 1 0 100% ��

Provider Elective Volumes (Cardiology) 108.6% 1 0 100.0% �� % elective coronary angiography within 90 days 100% 1 0 85% �

Shorter Waits in ED 97.0% 1 0 96.0% �� % urgent diagnostic colonoscopy done within 14 days 57% 1 0 50% �

% diagnostic colonoscopy done within 42 days 48% 1 0 50% �

% surveillance colonoscopy done within 84 days 83% 1 0 50% �

Patient Flow

Quality Actual Target Average Length of Stay - Acutes 3.41 1 0 3.50 �

Complaint Average Response Time 17 days 1 0 14 days � Average Length of Stay - Electives 3.21 1 0 3.82 �

Rate of falls with major harm 1.00 0 1 < 0.07 � Average Length of Stay - AT&R 16.53 1 0 15.50 �

Hand hygiene gold audit - ward 10 68.0% 1 0 > 70.0% � Discharges at weekends 24.8% 1 0 20.0% �

Hand hygiene gold audit - ward 14 72.0% 1 0 > 70.0% � Discharges before 11am 14.3% 1 0 20.0% �

Hand hygiene gold audit - Anawhata 83.0% 1 0 > 70.0% �

Hand hygiene gold audit - Wainamu 76.0% 1 0 > 70.0% �� ESPI 2 - % patients waiting longer than 6 months for FSA

Cardiology 0.0% 1 0 0.0% ��

DNA Rates Number Dermatology 0.0% 1 0 0.0% ��

First Specialist Assessment (FSA) DNA rate - Total 120 9.5% 1 0 10.0% � Diabetes 0.0% 1 0 0.0% ��

First Specialist Assessment (FSA) DNA rate - Maori 19 16.4% 0 1 10.0% � Endocrinology 0.0% 1 0 0.0% ��

First Specialist Assessment (FSA) DNA rate - Pacific 14 18.2% 0 1 10.0% � Gastroenterology 0.0% 1 0 0.0% ��

Follow up (FU) DNA rate - Total 253 8.1% 1 0 10.0% �� General Medicine 0.0% 1 0 0.0% ��

Follow up (FU) DNA rate - Maori 29 14.6% 0 1 10.0% � Haematology 0.0% 1 0 0.0% ��

Follow up (FU) DNA rate - Pacific 39 18.7% 0 1 10.0% � Infectious Diseases 0.0% 1 0 0.0% ��

Renal 0.0% 1 0 0.0% ��

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

Acute Readmission Rate within 28 days 13.6% 1 0 10.0% � Rheumatology 0.0% 1 0 0.0% ��

ESPI 5 - % of Patients not treated within 6 months

Cardiology 0.0% 1 0 0.0% ��

HR Wellbeing Actual Target Contracts (YTD)

Sick Leave Rate (days) * 8.0 days 1 0 7.5 days � Elective WIES Volumes

Overtime Rate (%) * 0.6% 1 0 1.0% �� Medical (Overall) 1,221 1 0 1,489 �

Annual Leave Balance > 75 days 26 1 0 23 � Cardiology 973 1 0 1,264 �

Turnover Rate % * 10.8% 1 0 10.0% � Gastroenterology 248 1 0 224 �

Clinical Employ (FTE) 1,477 FTE 1 0 �

* 12 month rolling average Acute WIES Volumes

Medical (Overall) 30,409 1 0 29,014 �


Financial Result YTD Actual $000s Target $000s Subsequent Attendance (FUP) 37,299 1 0 28,081 �

Revenue 271,095 k 1 0 268,472 k � Emergency presentations WTK L4 (admitted) 17,463 1 0 19,817 �

Expense 197,303 k 0 1 188,558 k � Emergency presentations WTK L4 (non-admitted) 24,465 1 0 24,880 �

Personnel Costs 156,367 k 1 0 152,908 k � Emergency presentations NSH L5 (admitted) 28,638 1 0 40,399 �

Outsourced Services 4,992 k 1 0 3,713 k � Emergency presentations NSH L5 (non-admitted) 20,965 1 0 21,754 �



Contribution 73,792 k 0 1 79,914 k �

Capital Expenditure 833 k 0 1 1,599 k �



Actual TargetDHB Performance

Waitemata DHB Monthly Performance ScorecardMedical and Health of Older People

June 2013

Human Resources

Quality

Finance

Priority One Service Delivery

How to readHow to readHow to read

46 of 96


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 Completed

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. Completed

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.

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 X

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Key achievements for month

• Allied Health (Dietetics, outpatient respiratory, lymphoedema and continence physiotherapy) is

currently in the process of setting up clinics at both the New Lynn integrated family health

centre and Whanau House. The first clinics will start on at the end of July.

• The Rodney Mental Health Service for Older Adults has commenced a fortnightly clinic at Red

Beach

• E-prescribing went live at Muriwai Ward (WTK) on the 10th June

• Clinical scenario training has commenced in ED and is being well attended

• Additional Hand Hygiene auditor training is underway

• Celebrated the second anniversary of the North Shore Dialysis Centre opening

• The hypertension service continues to develop and has successfully commenced a service

providing renal denervation for refractory hypertension.

Areas off track for month and remedial plans

• Restraint minimisation committee in the process of being set up for Older Adults

• A meeting has been convened in late July with key staff from Older Adults and Allied Health to

review progress and areas for improvement for Elder Abuse programme.

• Cardiovascular risk assessment in the hospital has been impacted by the resignation of the

Waitakere assessor. Recruitment in underway for a casual person who will cover this site for

limited hours across the working week.


• NASC workload and waitlist – Our NASC waiting list has steadily being 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 (housekeeping) and reviews where we are falling

behind and this area is where the Funder has initiated a project. The number of complaints

relating to the long wait time for housekeeping is increasing

• The options paper for the ED at Waitakere is on track and will be presented to the senior

management team in late July. The paper identifies some process improvement opportunities;

however the primary focus is on the requirements of the ED in terms of clinical and patient

related space.

Asian Elderly Patients Who Have No or Limited Family Support

Recent news in the NZ Herald in May 2013, reported that nearly 3,000 people who brought their

parents into the country were no longer living here, leaving elderly migrant parents alone. Nearly a

third of the sponsors who have abandoned their parents are Chinese. This abandonment issue has

not impacted on Waitemata services hugely. We only get a few cases of elderly patients with no

family support. The general issues faced by the abandoned elderly migrants include isolation (which

could lead to depression), communication barriers and lack of transport/family support to go for

doctor/hospital appointments. Another potential issue is financial abuse, that is, the elderly migrants

are left with no asset/financial capability. The government is well aware of the elderly migrant

abandonment issues.

At WDHB, clinicians can refer non-English speaking Chinese and Korean elderly patients who require

communication and emotional support to the Asian Patient Support Service or the Asian Mental

Health Service. The Asian cultural support staff will work with the clinical teams based on the

referral needs, that is, communicate with the patients, provide cultural assessment or advice, assess

for potential abuse and also ensure safe or suitable accommodation and personal care requirements

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before discharge. The team will also ensure the elderly patient is enrolled with a GP or if needed,

accessing available culture and language specific services e.g. paid carer support, Age Concern,

Community Support Worker, rest-home care etc. An interpreting service is also available to WDHB

clinicians and primary care clinicians to assist with communication with non-English speaking Asian

elderly patients.

Author: Sue Lim, Service Manager, Asian Health Support

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Financial Results


Medical & HOPS

($000’s)


REVENUE

Government

and Crown

Agency

23,338 22,236 1,102 269,616 266,835 2,781 269,616 268,323 1,292

Other Income 39 136 (98) 1,479 1,636 (157) 1,479 1,701 (222)

Total Revenue 23,377 22,373 1,004 271,095 268,472 2,623 271,095 270,024 1,071

EXPENDITURE

Personnel

Medical 4,711 4,476 (235) 53,327 51,749 (1,578) 53,327 53,501 174

Nursing 6,473 6,242 (231) 76,524 74,309 (2,215) 76,524 76,844 319

Allied Health 1,391 1,520 129 17,256 17,727 471 17,256 17,321 65

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

Management /

Administration752 712 (40) 9,260 8,738 (523) 9,260 9,283 23

13,327 12,982 (345) 156,367 152,908 (3,459) 156,367 156,948 581

Other Expenditure

Outsourced

Services956 309 (646) 4,992 3,713 (1,280) 4,992 4,376 (617)


Infrastructure

& Non-Clinical

Supplies

601 539 (62) 6,561 6,478 (83) 6,561 6,599 39

4,474 3,056 (1,418) 40,936 35,650 (5,285) 40,936 39,767 (1,168)

Total Expenditure 17,801 16,038 (1,763) 197,303 188,558 (8,745) 197,303 196,715 (587)

Contribution 5,576 6,335 (759) 73,792 79,914 (6,121) 73,792 73,309 483

Allocations 7,434 7,434 0 88,468 88,468 0 88,468 88,468 0

NET RESULT (1,857) (1,099) (759) (14,675) (8,554) (6,121) (14,675) (15,159) 483

YEAR TO DATE FULL YEARMONTH

Reporting Date

Comment on Major Financial Variances

The overall result for Medicine & HOPS was unfavourable by $759k for the month and $6.121m for

the year.

Revenue

There is a favourable revenue variance for the year to date of $2.623m. The main causes are

revenue from the funder of $2.151m to mitigate overspends in PCT drugs and unrecovered PCT

rebates, $573k to cover additional Gastroenterology volumes and $297k reimbursing 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 $737k for the year is an area which

continues to be problematic. 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 $1.37m unfavourable year to date due to actual production

volumes for the year being below budgeted volume. ESPI incentive revenue of $382k was received

in June, which was not included in the forecast or budget.

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Expenditure

Personnel costs overall are unfavourable to budget by $3.459m YTD. Nursing staff costs are

overspent by $2.215m year to date with the main drivers being patient volume, higher than

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

meet bed demand has contributed $105k to this overspend (although there has been

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

external bureau staff, and beds were closed wherever possible. June has seen a sharp increase in

patient numbers which impacts on Ward and ED costs. Medical staff over spend of $1.578m year to

date resulted from a one off adjustment revaluing medical staff leave balances amounting to $297k

(fully reimbursed in revenue) as well as under budgeted job sizing costs and locum cover costs in a

number of services.

Other Expenditure

Outsourced Services are $1.280m unfavourable YTD. External nursing bureau costs are $706k 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. Outsourced Colonoscopy/Gastroscopy costs of $483k have been offset by additional

revenue.

Clinical Supplies are unfavourable to budget $3.9m YTD. PCT drugs are over spent by $1.693m

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

over budget by $511k. Dressings are over budget by $172k YTD with the majority of this coming

from District Nursing. Ostomy and continence products are over budget by $141k YTD with

increasing patient numbers and recent price increases contributing to this. Client related costs are

over budget by $377k YTD with $165k of this coming from recharges from ADHB for Home

Haemodialysis; this is expected to continue until the Renal Phase 2 Community facility is opened.

There is also $230k 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 $76k YTD with the most significant

overspends coming from cleaning $180k, printing and stationery $87k and out of area beds for Older

Adult Mental Health patients $125k. Costs are being scrutinised, and focus put on mitigating

overspends within the existing infrastructure budget for these expenses.

Forecast

Based on the April result a forecast variance against budget of $6.605m for the full year was

expected. The division was within this forecast with a final result of $6.091m unfavourable to

budget. The final result included $382k of additional revenue for ESPI compliance which was not

included in the forecast. Without this additional revenue, the result would have been $6.473m

unfavourable which would have been still within the forecast result.

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

• Carried out 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

• Offering fixed term contracts for nurses to cover winter workload

• Effectively utilising casual staff to manage peaks in workload across nursing/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 Tim Jelleyman 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 volumes improved in the last quarter and have reached 94.1% at year end

after focus on productivity and backfilling of theatre sessions for SMO leave

QUALITY Average complaint response time has improved to 17 days this month. The service received 14

complaints in the June month and all but one have been completed. The open complaint has an

extended response time granted by the Health and Disability Commission due to the complexity of

the case.

SCBU North Shore and Waitakere were both audited for hand hygiene in June and recorded slight

declines in performance at 81% and 79% respectively. This is still above the overall compliance rate

of 74% for the organisation and above the target of 70%. The service is working to ensure further

improvement is achieved in future audits.

QUALITY The overtime rate for the service remains low at 0.2% despite staff vacancies in some areas. The sick

leave rate is constant, although some areas have experienced high sick leave usage due to seasonal

illness.

AREA OF FOCUS – DID NOT ATTEND (DNA) RATES A process has been developed to further understand the reasons why there is a high DNA rate for

Maori and Pacific children. A report is now being run monthly, which includes the child’s NHI, clinic

appointment date and telephone contact. A Pacific and Maori staff representative is ringing each

family to ascertain whether there were any significant factors that contributed to them not

attending the scheduled appointment. These factors will be collated over time to identify strategies

to improve access to appointments.

To date, feedback from families has been:

• They forgot about the appointment

• They did not have transport to attend the appointment

• They were not able to pay for parking

• The contact details for the family were incorrect and they did not receive information about the

appointment

The overall DNA rate for the service has shown an improvement with the rates for Maori and Pacific

Follow Up appointments showing the most change.

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Service Delivery

Auckland Regional Dental Service (ARDS)

Oral Health arrears in WDHB have shown a 2.2% improvement, since January 2013. Arrears are a

measure of children not seen within their recall period.

The service is implementing the following actions to meet the Ministry of Health target of 90% of

children seen on time:

• Individualised dental care (IDC) is an assessment tool that informs the recall period. High risk

has a six month recall; medium risk a one year recall period and low risk an eighteen month

recall period. IDC is designed to spread the demand of the service by the use of recall times to

suit the risk status of the child. A higher than expected number of children are being recalled

after six months and less than expected are being recalled at eighteen months. This is

contributing to an over demand on the service. All staff have been provided further training on

individualised dental care to ensure that the risk status and recall times are used appropriately.

This will be audited regularly.

• A production plan for chair utilisation is being developed, with assistance from decision support.

This plan will be similar to that used for theatre utilisation and will be operational in Quarter 2

2013/14. This will clearly demonstrate capacity and ensure chairs are used optimally. This

planning approach has not been used before by ARDS.

• Targeted clinics will be opened for extended hours to provide more appointments and increase

accessibility. Extended hours will begin on August 15th at Edmonton clinic. Other clinics have

also been targeted to offer extended hours.

• A data quality project is being undertaken by the Team Leaders to ensure that the arrears total

accurately reflects the current state.

• The Operations Manager is monitoring the arrears situation weekly.

Women’s Health

A review of theatre utilisation has identified that gynaecology operating lists at Waitakere remain

underutilised despite a focus from the service to improve. The operating lists are being fully booked

with the number of women cancelling on the day of surgery or not attending impacting on the

utilisation rates.

Exclusive breastfeeding on discharge rates are 84.4 % overall and exceed the target of 75%. This

reflects the strong commitment of staff to supporting women in this area.

End of year birth volumes are higher than target with an additional 244 births in 2013. Along with

the increase in birth volumes both maternity facilities have seen an increase in acuity and

subsequent total WIES volumes of 577 above target at year end.

The service has recently introduced Trendcare into the maternity facilities which is demonstrating a

discrepancy between staff required based on acuity and staff available based on the staffing model.

The data will be closely monitored in coming months. The service provides care for a mother and

her baby, each with specific needs that impact on the staffing model and level of acuity.

Child Health

Child rehabilitation bed days for the year totalled 2017 which is in line with the increase of 200 bed

days from MOH. The service has successfully managed to ensure early discharge and appropriate

referrals to stay within this new funded volume.

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Scorecard


Better help for smokers to quit 95.5% 1 0 95.0% �� Oral Health Arrears 17.6% 1 0 10.0% ��

Provider Elective Volumes 94.1% 1 0 100.0% � Oral Health New Enrolments (Preschool) 63,112 1 0 42,281 �

Shorter Waits in ED 95.1% 1 0 96.0% � Theatre utilisation Gynaecology 74.0% 0 1 90.0% �

Exclusive breastfeeding on discharge 84.4% 1 0 75.0% �

Births 6,880 1 0 6,636 �

Patient Flow

Quality Actual Target Average Length of Stay - Maternity 2.6 1 0 2.5 �

Complaint Average Response Time 17 days 1 0 14 days � Average Length of Stay - Paediatrics 2.5 1 0 2.2 �

Hand hygiene gold audit - SCBU North Shore 81.3% 1 0 70.0% �� Average Length of Stay - SCBU 7.7 1 0 7.0 �

Hand hygiene gold audit - SCBU Waitakere 79.6% 1 0 70.0% �� Discharges at weekends 32.0% 1 0 20.0% �

DNA Rates Number ESPI 2 - % patients waiting longer than 6 months for FSA

First Specialist Assessment (FSA) DNA rate - Total 85 10.0% 1 0 10.0% �� Gynaecology 0.0% 1 0 0.0% ��

First Specialist Assessment (FSA) DNA rate - Maori 21 18.3% 0 1 10.0% � Paediatrics 0.0% 1 0 0.0% ��

First Specialist Assessment (FSA) DNA rate - Pacific 12 14.6% 0 1 10.0% �

Follow up (FU) DNA rate - Total 89 8.9% 1 0 10.0% � ESPI 5 - % of Patients not treated within 6 months

Follow up (FU) DNA rate - Maori 18 12.2% 1 0 10.0% � Gynaecology 0.0% 1 0 0.0% ��


Contracts

Other Key Measures Elective WIES Volumes

Acute Readmission Rate within 28 days 6.8% 1 0 10.0% � Gynaecology 1,529 1 0 1,506 �

Acute WIES Volumes

Gynaecology 1,132 1 0 1,122 �

HR Wellbeing Actual Target Maternity - acute and elective 6,633 1 0 6,056 �

Sick Leave Rate (days) * 10.0 days 1 0 7.5 days � Paediatrics 1,572 1 0 1,779 �

Overtime Rate (%) * 0.2% 1 0 1.0% �� Neonatal 1,904 1 0 1,825 �

Annual Leave Balance > 75 days 9 1 0 2 ��

Clinical Employ (FTE) 767 FTE 1 0 � Other Contracted Volumes

* 12 month rolling average Child Rehabilitation bed days 2,017 1 0 2,032 �

Non-Case weighted Discharges (YTD)


Financial Result YTD Actual $000s Target $000s Subsequent Attendance (FUP) 10,569 1 0 10,321 �

Revenue 119,312 k 1 0 120,004 k �

Expense 80,526 k 1 0 80,064 k �





Contribution 38,786 k 1 0 39,940 k �

Capital Expenditure 347 k 0 1 598 k �




Waitemata DHB Monthly Performance ScorecardChild Women and Family Service

June 2013

Human Resources

Quality

Finance


How to read

54 of 96


STRATEGIC INITIATIVES

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 √


Advice to Quit Smoking for Parents of Paediatric Patients

• Staff education sessions have commenced

Rheumatic Fever:

• The school based throat swabbing is now operating in Birdwood, Pomaria and Ranui primary

schools. Public Health Nurses are going into each school three days a week.

• To date, 728 children have been swabbed and 178 (24.5%) have been identified with a Group A

Strep throat. In addition, 32 children have been identified with a C/G sore throat – these

children have also been followed up for treatment

• Public Health Nurses are proactively following up with families and primary care providers to

ensure that children have timely access to appropriate antibiotic treatment. If this is not

possible, nurses are providing treatment to the child via standing orders. To date, the majority

of families are receiving treatment from the Child & Family Service. 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 Nga Kakano Kura Kaupapa on the 29th July

(programme has been delayed at the request of the school.

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Skin Infections:

• The identification and management of skin infections is 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 options. Where necessary, nurses have been providing treatment via

standing orders


Other Highlights

Children Frequently Presenting to the Emergency Department

Children (under 10-years) who have presented to the Emergency Department three or more time in

the last six months are being proactively identified by the Child Health Community Social Workers.

Social workers are engaging with these children’s families to identify any barriers that may be

impeding children receiving health care in the community. Solutions are also being explored and

identified, including referrals to other health providers.

Opportunistic Immunisations

The Special Care Baby Units and Rangatira ward have commenced an opportunistic immunisation

programme. The immunisation status of all children admitted into the wards is now ascertained

directly through the National Immunisation Register and immunisations are provided during

children’s inpatient stay where appropriate.

Transfers from Starship Hospital

There continues to be a focus on transferring Waitemata domiciled children presenting at Starship

Hospital to Rangatira ward for their inpatient treatment.

Co-location of Paediatric Services with Primary Care

Child Health commenced delivering services from the New Lynn Integrated Family Care Centre

(Totara Health) in July. Paediatric outpatient clinics for children enrolled within the cluster have

been transitioned to a group of paediatricians who will be delivering clinics three days per week. An

experienced Community Nurse and Social Worker are also based within the centre. The Nurse is

triaging all referrals received to the clinic and offering consultations to General Practitioners and

Practice Nurses. The Paediatrician is also providing joint consultations to families for GPs and the

opportunity for consultation and liaison.

Maternity Services

The Midwife Manager of Community services attended the TAHA conference (the inaugural Pacific

Island conference). ‘Tapuaki’, the Pacific pregnancy and parenting education curriculum was

officially launched at the conference. The curriculum was developed to better assist with

engagement of Pacific pregnant women, fathers, their families and care providers, and to improve

access to and delivery of pregnancy and parenting education. WDHB was formally acknowledged for

their support in the development of this by the gifting of a blessed copy of the curriculum.

56 of 96


The Diabetes in Pregnancy (DiP) Service Review was undertaken after the first full year of service.

Volumes of referrals are almost double those estimated, with 472 entering the service in one year

compared to the estimate of 271 in the business plan. The service plan model of partnership with

the primary Lead Maternity Carer (LMC) has proved highly successful with all LMC’s remaining in

their role and the DiP service providing the secondary service of diabetic care to women. Feedback

from the referrers (LMC’s) and the consumers was sought and this showed a high level of

satisfaction with the service. Review of maternal and neonatal outcomes for women in DiP service

aligned well with the general population, reflecting a high level of management of Diabetes in

Pregnancy. Additional staffing needs due to the higher than anticipated volumes is being reviewed

especially the Dietician and Physician resources.

Auckland Regional Dental Service (ARDS)

The 2009 Ministry of Health (MOH) report (Maternal and Child Oral Health – Systematic Review and

Analysis) identified that ‘all pregnant women should be targeted for oral health promotion, with

additional resources to develop programmes for socially disadvantaged women and those from high

risk populations’.

ARDS is successfully implementing a two year pilot, funded by MoH, to provide free oral health

services for high risk pregnant women up to nine months post-partum. The objectives of the service

are:

• To establish whether an oral health service for at-risk pregnant and post-partum women can be

run successfully in existing community-based oral health facilities

• To identify the operational factors involved in running such a service;

• To identify the cost of establishing and running the service (excluding the cost of capital-related

expenditure)

• To identify the cost-effectiveness and cost-efficiency of the service

• To identify the impact on access to service, oral health literacy and oral health-related quality of

life.

The pilot service uses the oral health community facilities. Women are seen at Westgate,

Henderson and Glenfield clinics. They are assessed by a community dentist and receive treatment

from the community dentist and the hygienist as appropriate. WDHB Maternity services are

engaged in the project and welcome the new service provision. Women are referred to this service

by independent Lead Maternity Carers, GPs and Maori and Pacific providers. Uptake of this service

has been positive. One hundred and eighty nine women have been enrolled and seen to date.


Ordering & Stocking Project

This project is a continuation to the work already achieved in ARDS in relation to ordering and Oracle

processes. Significant savings have already been made, and a pilot to standardise stock and ordering

using a card system has been completed in four clinics. Following positive evaluation the project is

being extended across the ARDS service. This project is being implemented by Prashant Gupta and

Ros Symes (Team Leader Central)

New Uniforms in ARDS

The recent $12.5m upgrade to facilities is now complete. The changes in the model of care continue

to be embedded. A number of benefits will be realised by the provision of new uniforms:

• A professional look to the children and their parents to match the upgrade of facilities

• No further use of the laundry services which means a reduction of $56,400 per annum after

initial set up

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• ARDS clinician’s uniform dress would meet the same standards as other services within WDHB.

Uniform is another alignment to connect ARDS with WDHB. As a regional service it is essential

to provide connections to the ‘family DHB’ wherever possible.

• Clinician’s morale will benefit. Uniforms have been on the agenda for a number of years; this is

the right time to action the change.

Te Aka Ora

Te Aka Ora Advisory Forum (Vulnerable Families) has undergone a formal review of the Terms of

Reference by the steering group and forum members. Development of a Te Aka Ora Maternity

Discharge Summary is almost complete and this will be recorded in Concerto and will be completed

for all women on discharge from the forum and for selected infants identified as high risk. The chair

of the forum will present an annual report to the Maternity Clinical Governance Forum.

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Financial Results


Child Women Family

($000’s)


REVENUE

Government

and Crown

Agency

10,163 10,372 (209) 118,676 119,373 (696) 118,676 118,117 559

Other Income 41 53 (12) 636 632 4 636 642 (7)

Total Revenue 10,204 10,425 (221) 119,312 120,004 (692) 119,312 118,760 552

EXPENDITURE

Personnel

Medical 1,244 1,215 (30) 14,940 14,093 (847) 14,940 15,024 84

Nursing 2,065 1,971 (94) 24,400 23,487 (912) 24,400 24,545 146

Allied Health 1,734 2,006 272 21,614 22,912 1,298 21,614 21,936 322

Support 20 20 (0) 260 236 (25) 260 261 1

Management /

Administration311 310 (1) 3,908 3,787 (121) 3,908 3,936 27

5,374 5,522 147 65,122 64,516 (607) 65,122 65,701 579

Other Expenditure

Outsourced

Services427 368 (59) 4,591 4,416 (176) 4,591 4,498 (93)

Clinical Supplies 761 485 (275) 5,472 5,606 134 5,472 5,203 (269)

Infrastructure

& Non-Clinical

Supplies

1,113 516 (597) 5,340 5,527 186 5,340 4,723 (617)

2,301 1,369 (932) 15,404 15,548 144 15,404 14,425 (979)

Total Expenditure 7,675 6,891 (784) 80,526 80,064 (463) 80,526 80,126 (400)

Contribution 2,528 3,534 (1,005) 38,786 39,940 (1,154) 38,786 38,633 153

Allocations 2,928 2,928 0 34,801 34,801 0 34,801 34,801 0

NET RESULT (399) 606 (1,005) 3,986 5,140 (1,154) 3,986 3,833 153

FULL YEARMONTH YEAR TO DATE

Reporting Date

Contribution

The contribution is unfavourable for both the month and for the full year. The result is driven by

both shortfalls in revenue and overspends in personnel and outsourced services costs.

Key items to note are the one-off $740k reclassification of prior year capital expenditure in ARDS

(November 2012), and also the credit and recharge of ARDS recharges of facilities costs to ADHB in

May/June. Motor vehicle depreciation was a total of $697k over budget for the year, due to

capitalisation of Dental TDUs and Drivable units.

Revenue

The net Revenue result for June was $221k unfavourable, bringing the total YTD result to $692k.

$2m of the unfavourable result has arisen from Dental assumptions on billings to ADHB and CMDHB

which were not realised. Child Health also returned unfavourable revenue for the year, due to ACC

shortfalls, although this was offset somewhat by Gateway revenue.

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Women’s Health made up $1.2m on the overall Revenue result, through much higher than expected

volumes. This included Gynae Electives $250k, Maternity IDFs at $265k, unbudgeted Maternity

Quality and Safety programme $242k (although there were costs associated with this), additional

Colposcopies brought in an extra $352k and Antenatal HIV testing a further $81k.

Expenses

Women’s Health also had the greatest overspend for the year, in line with the additional revenue

earned. The majority of this was through personnel costs at $1.35m overspent for the year.

Dental and Child Health were both underspent, with Dental unable to source suitable recruits to

vacancies, and lower than expected infrastructure costs for new facilities. Child Health also

struggled to recruit at times, so brought in a net underspend of $560k for the year. The late booking

of depreciation caused a large variance at year end, with a total of $697k over budget on Motor

vehicle depreciation alone for Dental TDUs and Driveables.

Variance to Forecast

Revenue: Revenue is $552k better than forecast for year end – $463k is due to better than expected

Gynae Elective revenue and Colposcopy volume increases, and $189k due to increased volumes to

the YTD average in Maternity. A further $96k relates to improved ACC revenue performance at

Wilson Centre.

Expenses: Expenses are in the region of $550k unfavourable to forecast – $579k favourable variance

in Personnel and $1.2m unfavourable variance in non-personnel costs.

Medical costs are $84k 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 $146k below expected levels, partially due to delays in recruiting into seasonal

vacancies in Child Health.

Allied Health is $322k underspent compared to expected YTD levels, due to vacancies and delayed

recruitment in Dental as well as Child Health.

Outsourced Services are $93k 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 $269k overspent to forecast, arising in Dental. $173k of this relates to

backdated depreciation from new clinical equipment purchased during the year and only capitalised

in June. The remaining $96k relates to the credit and recharge of Dental facilities costs to ADHB, as

WDHB needed to take on additional costs.

Infrastructure costs are $767k higher than anticipated - $150k being accrued to offset potential costs

of redesign of the Dental TDUs following the Labour Dept complaint, and $697k relating to

backdated Motor Vehicle depreciation once Dental Drivable and TDUs were capitalised in June.

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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 waits in ED: - 67% (72%)

There were 123 mental health ED discharges in June, 33 were breeches (Waitakere 11 & NSH 22).

Our audit of breeches during this period showed medical reasons accounted for the majority of

delays (not medically cleared) in people being discharged from the ED within 6 hours. Workload also

played a critical part, both in the acute teams (Crisis team and Psychiatric Liaison) and for on call

doctors. Seven of the delays however were unable to be accounted for, and require further analysis.

A more detailed 12 month retrospective analysis is currently underway.

Reasons for Breeches in June 2013

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Numbers

Quality

Complaint average response time 16 days

There were 11 complaints open in June across MHSG. The average days to close complaints reduced

from 25 days in May to 16 days in June. Usually delays are due to delays in the investigation process

caused through leave/sickness of key staff, administrative delays in closing the complaints off in the

system and complexity of some complaints which required extensions. The administrative delays

have been addressed and all complaints have been responded to and closed for the time period. A

review of the complaints across the Auckland Opioid and Treatment Services complaints is currently

underway, as part of service improvement activities.

Re-admission within 28 days – 9% (May data)

The re-admission rate has been fluctuating over the past nine months. It had one off peak in

March at 24% and has declined 16%, to 9%. Drivers for these changes need further

understanding. Some re-admission activity can be influenced by bed activity (too early

discharge due to pressure on beds and also conversely difficulty in getting readmission due to

beds being blocked – longer stays).

Service Delivery - Productivity Bed Occupancy: The rate of bed occupancy in adult acute units remains high (at 97%) and in

forensic services (at over 100%). For the Forensic service this is due, in part, to ongoing high

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demand for service from the prisons and courts. This month, for example, the forensic services

have been ordered by the court to accept a young man (17 years old) on trivial charges. The

order was made due to the lack of appropriate secure options for the high and complex need

patient group in the region. There appears to be an increasing trend for forensic services to be

the default secure provider for this group, which in turn creates further pressure on the prison

waiting list. The additional 5 beds in Wellington funded by MoH for Mason Clinic patients are now

full. A process and agreement for clinical oversight is being undertaken.

Access rates: Adult services continue to meet national access rate targets, however we have

not achieved the desired 3% for 0-19 years. While significant improvements in wait times have

been noted since the implementation of CAPA (Choice and Partnership Approach) it has not

had the desired effect on access rates. Analysis of activity data indicates that while the ratio of

referrals to unique clients is increasing (suggesting more referrals are coming through each

period) these referrals are not necessarily more new young people. This appears to be an

inadvertent by-product of the easy-in/easy-out aspect of CAPA whereby clients are able to

access episodic care more readily. Work will need to be undertaken to determine how to

continue to support easy access for returning clients while increasing service capacity to enable

greater access for new clients.

Waiting time targets: All services continue to perform well against national < 3 week waiting time

target for non-urgent referrals.

New referrals and YTD distinct clients: All services, with exception of CADs this month, continue to

experience increase in referrals and distinct total number of clients. This on-going increase in

pressure on services is frequently noted by our clinical staff.

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Scorecard


Better help for smokers to quit 98% 1 0 95% �� Patient Flow

Shorter Waits in ED 67% 0 1 80% � Average Length of Stay - Adult Acute 19 1 0 15-21 �

Average Length of Stay - CADS Detox 7 1 0 6-8 ��

Bed Occupancy (midnight) - Adult Acute 97% 1 0 85% �

Bed Occupancy (midnight) - CADS Detox 95% 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 16 days 1 0 14 days �

Service Access (latest available)

Seclusion MH Access Rates 0-19 years (Total) 2.62% 1 0 3.00% �

Seclusion use Forensics - hours 1387 1 0 900-1100 � MH Access Rates 0-19 years (Maori) 3.49% 1 0 3.60% �

Seclusion use Forensics - episodes 9 1 0 10-14 � MH Access Rates 20-64 years (Total) 3.51% 1 0 3.50% ��

Seclusion use Forensics - distinct service users 7 1 0 6-10 � MH Access Rates 20-64 years (Maori) 7.93% 1 0 7.50% ��

Seclusion use Adult - hours 72 0 1 26-30 �

Seclusion use Adult - episodes 4 1 0 1-5 �� Waiting Times (latest available)

Seclusion use Adult - distinct service users 4 1 0 1-5 �� Youth (0-19) < 3 weeks 76% 1 0 70% �

Adult (20-64) < 3 weeks 93% 1 0 80% �

Whanau Contacts per service user (community only) CADS (0-19) < 3 weeks 96% 1 0 80% �

Adults 72.1% 0 1 0.0% � CADS (20-64) < 3 weeks 97% 1 0 80% �

CADS 19.0% 0 1 0.0% � Forensic (20-64) < 3 weeks 89% 1 0 80% �

Forensics 10.3% 0 1 0.0% �

Child 100.0% 0 1 0.0% �� Community Care - treatment days per service user

Youth 100.0% 0 1 0.0% �� Adults 3.59 1 0 3-5 ��

Children 2.14 1 0 2-4 ��

Acute Readmission Rates within 28 days (reported one month behind) Youth 3.17 1 0 2-4 ��

Adults 9.0% 1 0 10.0% � CADS 2.30 1 0 2-4 ��

CADS 0.0% 1 0 5.0% �� Forensics 1.59 1 0 2-4 �

HoNOS Change Community Care - Preadmission community care

Adult community - significant improvement 4.4% 0 1 0.0% � Adults 79% 1 0 75% �

Adult community - no significant change 39.1% 0 1 0.0% �

Adult community - significant deterioration 7.7% 0 1 0.0% � Community Care - Post Discharge community care

Adult community - non-compliant 48.8% 1 0 40.0% � Adults 82% 1 0 90% �

44.6% 0 1 0.0% �

Adult inpatient - no significant change 27.7% 0 1 0.0% � Financial YTD Distinct Clients with open referral

Adult inpatient - significant deterioration 3.1% 0 1 0.0% � Inpatient Adults 750 1 0 707 �

Adult inpatient - non-compliant 24.6% 1 0 40.0% � Inpatient CADS 393 1 0 378 �

Inpatient Forensics 185 1 0 168 �

Outpatient Adults 8817 1 0 8742 �

Outpatient Maori 233 1 0 239 �

Outpatient Pacific 280 1 0 263 �

HR Wellbeing Actual Target Outpatient Youth 3467 1 0 3202 �

Sick Leave Rate (days) 8.8 days 1 0 7.5 days �� Outpatient CADS 15184 1 0 15685 �

Overtime Rate (%) 3.1% 1 0 3.0% �� Outpatient Forensics 2440 1 0 2080 �

Annual Leave Balance > 75 days 9.00 1 0 5 �

Turnover Rate % 7.9% 1 0 10.0% � New referrals during the month

Clinical Employ (FTE) 1,046 FTE 1 0 � Inpatient Adults 96 1 0 84 �

* 12 month rolling average Inpatient CADS 40 1 0 43 �

Inpatient Forensics 12 1 0 11 �

Outpatient Adults 850 1 0 765 �

Outpatient Maori 8 1 0 6 �

Financial Result YTD Actual $000s Target $000s Outpatient Pacific 12 1 0 12 �

Revenue 155,656 k 1 0 152,090 k � Outpatient Youth 307 1 0 211 �

Expense 118,599 k 1 0 118,701 k � Outpatient CADS 1006 1 0 1116 �

Personnel Costs 107,030 k 1 0 106,497 k � Outpatient Forensics 215 1 0 152 �




Contribution 37,057 k 1 0 33,389 k �

Capital Expenditure 155 k 0 1 353 k �




Waitemata DHB Monthly Performance ScorecardMental Health Service

June 2013

Adult inpatient - significant improvement

Human Resources

Quality

Finance


How to read

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STRATEGIC INITIATIVES


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

√

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 √

6. Develop a multi/interagency strategy for services for high risk children and

youth, to include transition, discharge and follow up protocols

√ (aug)

7. Implement the advanced level of the Choice and Partnership Approach

(CAPA)

√

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

Changed focus

to Joint Under

19 years Te

Aranga Hou

Steering Group

9. Establish Specialist Interagency Response to Conduct Problems (SIRCP)

service (Incredible Years contract)

√

10. Enhance provision of Infant Mental Health services by developing and

delivering a staff training module for infant mental health

√

11. Develop and deliver basic Eating Disorder and Co-Existing Problems core

skills training for clinical teams

√

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

√

13. Adult mental health and addiction KPIs – child and youth, adult, forensic

established √

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

√

16. Establish baseline and agree targets for rates of family and behaviour

assessments performed by the service per annum

√

17. Increase the number and skill mix of staff trained in Infant Mental Health

module between Jan 2013-June 2013 √

18. Increase the number and skill mix of staff trained in Eating Disorders and

Co-existing problems by December 2012 √

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 √

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* include a �� or a �� Key achievements for month 3. Identify opportunities for emerging models of integrated and/or collaborative clinical service delivery

(Primary care, NGO and DHB clinical teams) E.g. primary care liaison role: service representatives

continue to engage with primary care organisations and are working in collaboration with ADHB to

forward opportunities for mental health services support of the Primary Sector – particularly with New

Lynn Integrated Family Health centre (Totara House). We have booked two rooms as a starting point for

a range of our services to operate from in this centre. Discussions are in early stages with Waitemata

Health. Whitiki Maurea Service manager has met with Waitemata/Waipareira Liaison person and the

General Manager, Waipareira Health Services to plan way forward for a primary care relationship

between Whitiki Maurea and Whanau House – Both keen to access Whitiki Maureas’ Oranga (Cultural

Recovery) Programmes. Primary care nurse liaison continues to be active across all adult services.

13. Adult mental health and addiction KPIs – child and youth, adult, forensic established: Adult

services continue to actively use KPI data with another local benchmarking day with NGOs booked for 31

July. National Child and Youth process started – see later in the report: Forensic services nationally have

embarked on a process to identify suitable Key performance indicators suitable for a national

benchmarking process.

17. Increase the number and skill mix of staff trained in Infant Mental Health module between Jan 2013-

June 2013: 121 staff across Adult and Youth Mental Health Services (out of approx. 520 total staff) plus

NGOs received training in Infant Mental Health Modules (Level 1, 2 & 3).

18. Increase the number and skill mix of staff trained in Eating Disorders and Co-existing problems by

December 2012. 240 staff across Adult and Youth Mental Health Services (out of approx. 520 total staff)

received training in Eating Disorders (Level 1 & 2). At a rate of almost half the staff being trained this

exceeds expectations and is highly favourable. Champions in each team are being identified for more

advanced training which will result in each team being very capable in treating mild to moderate Eating

Disorders in the community with the specialist Regional Eating Disorders Service treating those with the

most complex and severe needs.

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. 33 families to date have been supported by the

Incredible Years Specialist Service. It was anticipated that 40 families would have been supported by

year end, but this was not quite achieved. The lead in time of service establishment took a little longer

which included considerable staff training for this specialised service.


6. Develop a multi/interagency strategy for services for high risk children and youth, to include

transition, discharge and follow up protocols: The Multi-Agency Strategy has been drafted and is out

for consultation. We are aiming for sign off by mid-August.

7. 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: The focus has shifted to the establishment of Joint Te Aranga Hou Steering Group (Lean

thinking) for WDHB services working with Under 19 year olds across CAMHS, Altered High, Tupu and Te

Atea Marino. Tupu and Te Atea Marino will join the existing project re referral and entry pathways.

OTHER HIGHLIGHTS

Multi-agency work of CADS

Provision of mental and addiction services are moving increasingly towards a multi-agency context.

CADs have for a number of years had strong connections with cross government agencies. Here are

four examples of that work:

• Working with Community Probation Services (CPS), Auckland and Waitakere Drug Courts (ADC)

and NZ Prison Service (NZPS) to improve screening for alcohol and drug problems in their

organisations. A total of 3,650 referrals were received from CPS, 135 referrals from ADC and 182

referrals from NZPS

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• Working with Child Youth and Families Services to screen for alcohol and drug problems in

young people through the Government’s “Fresh Start” initiatives. 212 referrals were received

through this programme

• Working with Primary Care Providers in transferring clients on methadone maintenance

treatment. 56% of the 1,352 clients who receive maintenance treatment were prescribed by a

General Practitioner on authorisation of CADS. This represents a modest increase on 2011/12

• CADS have also worked with a range of secondary schools to improve detection and referral of

young students with alcohol and drug problems. 619 students were referred in 12/13, an

increase of 263 in 11/12.

Positive Feedback – School Liaison

As previously reported, both the Marinoto services have allocated liaison clinicians for every high

school in the district. Below is feedback that was received from Westlake Girls High School where

we have historically had a problematic relationship:

Dear Heloise, I am writing on behalf of our Learning Enhancement Team to express our thanks and

gratitude for the time spent by Amanda and Jess in our regular Liaison meetings at our school. We

are able to get fabulous support for our students by sharing of information about our vulnerable

students and also ask general questions and seek advice and guidance. The meetings enhance our

capacity as key workers for some of our most troubled students. We see the liaison meeting as very

supportive and feel privileged that Amanda and Jess can spend time with us in this way. We do hope

that it is viewed as reciprocal in nature and we can assist them, where we can, by supplying data or

other information to enhance their work. I felt it was timely to write as this morning we had a very

good meeting and we as a team felt very supported and informed by your service. Kind regards Linda

Clouston, Head Of Learning Enhancement

Groups Work well for Pacific People

Tupu have increased their group work to cater for demand. There has been good consumer

participation in most or all of the groups, with increases ranging from 5 to up to 24 people. Groups

provided are Alo Faatasi (Waimarino), Fenoga (held at CADS South), Fale Talatala (Samoan speaking

held at the Mangere East church), and Fo’i Ma E Fa (Tongan speaking held at the Mangere East

church). These groups also enhance cultural identity for the clients as a way of recovery from their

alcohol, drug and gambling addictions. The Anger Management group continues to be offered by

Isalei Family Therapist. TUPU consumers can also access the Pacific Dialectic Behavioural Group

facilitated by Isalei clinicians.

Training in Review of Adverse Events

The Adverse Events Training is a mental health sector led initiative aiming to develop national

consistency in the implementation of the National Guidelines (HQSC, Reporting and Reviewing

Serious and Sentinel Mental Health Incidents). The principal of sharing expertise & resources across

the sector to achieve consistency is a key driver. A small group of representatives from

WDHB/ADHB, CCDHB and CDHB have developed the training on the new HQSC guidelines using the

London Protocol (Systems Analysis of Clinical Incidents).

The Adverse Event Training Pilot (one day workshop), led by WDHB and ADHB with support from

CMDHB, Waikato DHB and the HQSC, was delivered to participants from the Northern and Midlands

District Health Boards. The training package will be reviewed and further developed for another

workshop in early October in the Auckland Region, followed by the roll out into other centres across

the country.

Community Acute Service

Connect (NGO) have had to abandon their efforts to open a community acute service in the Orewa

area due to public complaint and anxiety about the services proposed location. They have now

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rented a suitable property for this service in the Silverdale area with different district council zoning.

They take possession of this property on 29 July 2013. The buildings require some alterations,

upgrading and cleaning prior to being used for a community acute service. The employment of Peer

Support workers for this service starts 29 July 2013. Connect now have large numbers of applicants

for the Registered Nursing positions in this service and have appointed a Team Leader.

Contracted Respite (North Shore and Rodney)

Equip (NGO) now have all Auckland City Council approvals for the opening for this property. They

await the results of the Ministry of Health accreditation audit. After lengthy delays it is anticipated

that this service will open in September 2013.

National Child and Youth KPI Project

The first Child and Youth Benchmarking Forum was launched on June 27th. Clinical leads and

managers from all of the 20 DHBs with their NGO partners were able to begin the process of

developing a shared understanding of performance improvement opportunities. WDHB is again a

key lead with Helen Wood (GM) a Sponsor for this process and the clinical team part of the core

group selecting initial indicators. Ten indicators have been provisionally selected for benchmarking:

• NGO Services investment - Child and Youth

• Client Index

• Access rates – PP-6

• Service User face to face contact time

• Time to first contact – PP-8 (waiting times)

• Community treatment days per service user (quarterly)

• Did not attend rates (DNA) - Further definition required

• Family Involvement - Further definition required

• Medication Usage - Further definition required

• 3 month community re-referral rates.


Peri-Natal Infant Mental Health (mums and babies)

An announcement was made by Minister Ryall at the end of May on future funding to enhance

provision of services to mothers (and fathers) and infants – $18.2M nationally over 4 years. The

total amount for this region is anticipated to be up to $3.9M over four years but half year for

2013/14. This is linked to a draft proposal sent to the Ministry of Health earlier this year based on

the planning work the Northern region finalised in January 2013. The indication of funding to the

Northern region was given in June and an initial high level plan on implementation is expected to be

submitted to the Ministry by the end of August 2013.

A Regional Planning process has been initiated by Northern Region Alliance mental health team.

Helen Wood (GM ADHB and WDHB), Dr Pete Watson (Clinical Director CMDH) and Sonia Russell

(P&F CMHD) have been nominated as leads from the regional Mental Health and Addictions regional

planning group. Representatives from regional Women’s Health network are also included in

Steering Group. The previous stakeholder reference group is being re-established.

The proposed areas for development/enhancement include:

a) Enhancing options for acute admission (4 beds) to enable mother and infant to be supported as a

dyad and with specialist input

b) Investigating the potential of another in-patient option for a less intensive acute care option

c) Enhancing community residential respite options – similar to that in CMDHB and ADHB

d) Building clinical expertise and capacity (clinical FTE) to support these new options

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e) Establishing increased options for community intensive parenting programmes

f) Post-natal unit support for extended admission.

Further strengthening of these services is noted in the Regional Health plan (Mental health section).

These focused particularly on developments that could occur without additional resource.

Contract for Intellectual Disability services

The service and Planning and Funding continue discussions with the Ministry of Health after

receiving Waitemata DHB Board support to proceed to (3 year) contract signing with the Ministry.

Issues still in discussion include the quantification of additional costs resulting from providing care

for people under 18 years old, and increments to the contract as a result of annual cost pressure.

The Ministry has also sought further clarity on the scope of the consult liaison function for this

service.

High and Complex Needs Project

The Forensic and Adult Mental Health services are contributing to an NRA (Northern Regional

Alliance) project to identify the service continuum and possible gaps in services available for people

with high and complex needs in this region. The project responds to Ministry of Health concerns

regarding Prison Waiting lists and the adequacy of a continuum of care for people with High and

Complex needs in this region.

Prime Minister’s Youth Mental Health Project

The Government is implementing a package of initiatives in four different areas – schools, online, in

families and communities and in the health system. The initiatives build on successful existing

programmes and trial promising new ones. As a component of the initiative focussing on the health

system, there will be a joint ministry (Health, Social Development and Education) review of referral

pathways into and out of Child and Adolescent Mental Health Services (CAMHS). Work has already

begun with a national stocktake of CAMHS referral information. The Werry Centre is developing a

protocol for discharge and follow-up which will be released at the next CAMHS Sector Day (16th

August) and will be trialled soon.

Facilities Update:

Taharoto Replacement Project: - Developed Design process has been completed and awaits formal

sign off by Waitemata DHB. A construction management company has been appointed and staff

from this firm will start work in late July. Their initial task will be to develop the contracting process

to engage a construction company. At this stage the construction start date is anticipated in late

September.

Mason Clinic Building refurbishment programme: - The Clinical Director and Manager attended a

meeting between the CEs and CFOs of Waitemata DHB and Unitec. The meeting confirmed the need

and willingness to progress lease negotiations. 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 for design and build options.

Marinoto North Youth Service – Pupuke building: The Pupuke Building on the North Shore Hospital

site accommodates most of the Marinoto North team and the Early Psychosis Intervention North

team. The teams were moved there in 2005. Some rooms recently have been damaged by mould

and damp. Those rooms have been waterproofed and painted. The Chief Financial Officer is

currently looking at long term options concerning the Pupuke buildings.

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Living within our Means – Summary of Progress

MHSG have a number of programmes in place to ensure that they live within their means. All have a

change team lead allocated and the majority have change teams organised with regular meetings

well underway. Liaison has occurred with PSA and process for their involvement agreed. Ten staff

briefing sessions occurred during July at worksites on the “Living within our means” projects which

included information on what has been approved by the Board to save per project. There was an

extremely good turnout with good participation.

The first approved project Consultation Document “Consolidation of Adult Community Team

Management” has been formally signed off and is currently in its consultation phase ending 6 August

2013; moving into consideration and review of feedback with final structure being agreed ending 12

August 2013; and implementation of changes commencing 16 August 2013. There are a further 7

draft Consultation Documents expected to be ready for the approval process over the next two

weeks which includes four that will require ELT sign off.

Mental Health Services Group launched the interactive staff intranet page “Living Within Our

Means” on intranet site with encouraging signs that it is being well utilised. The main aim is to

encourage staff to read the FAQ’s already on line and interact via email with further questions to be

added to the FAQs (with the target of a 24 hour response) and also to submit suggestions for

potential ideas for savings. On average we are currently fielding 2-4 emails per day. We have also

posted the very first approved Consultation Document “Consolidation of Adult Community Team

Management” that is actively seeking staff feedback.

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Financial Results


Mental Health Services

($000’s)


REVENUE

Government

and Crown

Agency

13,091 12,567 524 154,191 150,808 3,382 154,191 154,071 119

Other Income 264 107 158 1,465 1,282 183 1,465 1,355 111

Total Revenue 13,355 12,674 681 155,656 152,090 3,566 155,656 155,426 230

EXPENDITURE

Personnel

Medical 1,874 2,053 179 22,691 23,731 1,040 22,691 22,680 (11)

Nursing 4,105 4,046 (59) 50,358 48,994 (1,365) 50,358 50,436 78

Allied Health 2,221 2,259 38 26,929 26,817 (112) 26,929 26,814 (115)

Support 75 55 (20) 690 636 (54) 690 670 (21)

Management /

Administration497 516 19 6,361 6,321 (40) 6,361 6,351 (10)

8,772 8,929 157 107,030 106,497 (532) 107,030 106,951 (79)

Other Expenditure

Outsourced

Services224 153 (70) 1,547 1,843 296 1,547 1,446 (101)

Clinical Supplies 113 123 10 1,510 1,424 (86) 1,510 1,558 49

Infrastructure

& Non-Clinical

Supplies

747 745 (3) 8,513 8,936 423 8,513 8,423 (90)

1,084 1,022 (63) 11,570 12,203 634 11,570 11,428 (142)

Total Expenditure 9,856 9,950 94 118,599 118,701 102 118,599 118,378 (221)

Contribution 3,499 2,724 775 37,057 33,389 3,667 37,057 37,048 9

Allocations 1,937 1,937 0 23,232 23,232 0 23,232 23,232 0

NET RESULT 1,562 787 775 13,825 10,157 3,667 13,825 13,816 9

YEAR TO DATE FULL YEARMONTH

Reporting Date

COMMENT ON MAJOR FINANCIAL VARIANCES

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 of $1.284m per annum will continue to be paid to MHSG to enable

existing arrangements to continue until the new services are operational.

Another key driver of the favourable revenue result ($509k) relates to two new direct ministry contracts

associated with the drug treatment court service funding 8 additional FTE.

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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 $132k, 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 $1.04m for the year due to release of a prior year accrual amounting

to $432k and volume related savings. Use of locums to cover the medical vacancies has resulted in a $278k

adverse variance on outsourced medical staff.

An overspend on nursing staff of $1.365m for the year relates partially to price, use of overtime usage 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 ($189k),

retirement gratuity ($96k), 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 full year adverse variance of $112k is apparent in Allied Health. The variance is fundamentally due to

employment of eight additional FTE to support delivery of two new fully funded contracts held by CADS

associated with the drug treatment court.

Other Direct Costs

Favourable variances of $315k and $393k for the full year in Outsourced Services and Infrastructure and Non-

Clinical Supplies are moderately reduced by an over spend of $85k on Clinical Supplies. The adverse variance is

driven by unbudgeted costs of $455k relating to adult respite care which are fully compensated by revenue.

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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. Robert Paine 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) * 7.4 days 1 0 7.5 days �� Clinical Typing

Overtime Rate (%) * 1.3% 1 0 1.0% �� Clinical letters turnaround time - Surgical 0 days 100% 0% 2 days �

Annual Leave Balance > 75 days 5 1 0 0 �� Clinical letters turnaround time - Medicine 0 days 100% 0% 2 days �

Turnover Rate % * 9.3% 1 0 10.0% �� Clinical letters turnaround time - Child, Women and Family 0 days 100% 0% 2 days �

Clinical Employ (FTE) 317 FTE 1 0 �

* 12 month rolling average

Financial Result YTD Actual $000s Target $000s

Revenue 31,804 k 1 0 31,669 k �

Expense 190,185 k 1 0 189,032 k �





Contribution -158,381 k 1 0 -157,363 k �





Waitemata DHB Monthly Performance ScorecardProvider Support Services

Corporate, Hospital Operations, Facilities, Decision Support and Provider Management

June 2013

Finance

Human Resources Service Delivery

How to read

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Strategic Initiatives


North Shore Hospital Ward 5/10 refurbishment complete

North Shore Hospital ESC Infrastructure complete

North Shore Hospital external and internal painting complete

Oral Health - 11 Community Dental Clinics, 48 Pads and 12 Transportable Dental Units X

North Shore Hospital Car Park post contract works √

North Shore Hospital Marae n/a

North Shore Hospital Kingsley Mortimer Unit Ward 12 upgrade complete

North Shore Hospital Lift refurbishment complete

North Shore Hospital Elective Surgical Centre complete

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 X

• Waitemata DHB Renal Phase II X

• North Shore Hospital MRI Phase II X

• Strategic stage business case for new ‘mini-tower’ at NSH. n/a

Inventory management for clinical and non-clinical supplies X

Implement Fleet Management policy for fleet vehicles √

Development of business cases for in-sourcing services (e.g. orderlies) complete * include a �� or a �� Key achievements for month

• ESC Infrastructure project – full practical completion has been awarded as load testing of the

completed ESC building has been completed

• NSH Car Park Post Contract works – 80% completed. Flood test to SE corner complete, and

remedial works completed. Final post contract defect works underway from August 2013

• Mason Clinic – upgrade works to Tanekaha, remedial works and additional 5 pods have been

scoped, design team are being engaged through GETS procurement process

• NSH Staff Gym – the lease is executed by both parties. Consultants engaged to complete design

documentation. Resource consent has one condition that is not favourable, objection is being

lodged in July to request amendment to consent.

• A major review of fleet management is underway, led by Kieron Millar (Traffic and Fleet

Manager). The initial data analysis has indicated that a significant number of vehicles are

underutilised and that the fleet could be reduced in size without detriment to service delivery.

The next phase of the review will determine the level of efficiency to be gained by centralising

the pool of cars and through developing a centralised booking system.

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• Oral Health – one lease remains outstanding with Auckland Council. Council process has been

advised in July and will be continually followed up to suitable solution of lease being agreed

• Mason Clinic decant option remains outstanding, 2 options are considered, Unitec lease of land

or WTH Hospital Campus

• NSH MRI Phase II RFP is required to be completed to allow design works to continue.

Confirmation of the decant options for the Chapel and Maori Health Services are being worked

through

• Waitemata DHB Renal Phase II programme is behind schedule by up to three months. The

revised open date for this Service is most likely April 2014

• The North Shore Hospital marae and ‘mini tower’ projects are now not being pursued.

• Inventory management for clinical and non-clinical supplies – project currently on hold, for

review by CFO

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Corporate Services Group Highlights / Issues

Corporate and Operational Finance

2012/13 Year End Processes The preliminary unaudited result for the DHB for 2012/13 has been finalised and submitted to the

National Health Board and to the DHB’s external auditors. Various year end processes informing this

result were undertaken. These included completing asset revaluations for underground

infrastructure and dental clinics. The outcome of these revaluations was included in the preliminary

result and the net impact was an increase in the revaluation reserve of $12.4M. The year-end

external audit process is underway and the audited annual report is being prepared, to be complete

before the end of October 2013.

2012/13 Year End Processes The 2013/14 Annual Plan (DAP) has been approved by the Minister. The approved plan for 2013/14

requires the DHB to generate a surplus of $1M. The budgeting process is now complete, with all

budgets now phased over the twelve months of the year and loaded in the DHB financial systems.

Work is underway to obtain signoff of budgets at Responsibility Centre, Operational Group and

Service Group level. All Managers are required to sign off on their budgets and will be expected to

live within these budgets to enable the DHB to achieve the approved financial plan. Reporting on

financial performance to ELT will be provided at RC level and it is expected that reports will be

available widely across the DHB to provide more transparency regarding DHB financial performance

across the organisation.

Work continues on streamlining, identifying new savings and implementing identified savings. A high

level savings report is provided to the full Board.

Health Information Group

Electronic Ward Whiteboard (eWW)

The eWW is now live on Ward 2, thanks to the efforts of many - the Health Information Group,

facilities and the excellent staff of Ward 2. The ward is coping well with this new technology and the

inevitable teething problems.

Surgical Health Target and ESPIs Met

The Health Information Group has worked hard to support Surgery and Medicine to achieve the

Elective Surgery Health Target and the Elective Services Performance Indicator (ESPI) targets for the

financial year just ended.

IPANZ Public Sector Excellence Awards

Health Information Group supported John Cullen’s entry in the Public Sector Excellence Awards. The

entry, ‘A Clinician-led, Incentive-based Service Model for Hip and Knee Surgery’ in the ‘Improving

Public Value through Business Transformation’ won a highly commended certificate.

Enterprise Content Management System (ECMS)

The Health Information Group is leading the regional ECMS project. The project aims to deliver the

following capabilities which will improve business outcomes as well as compliance with legislative

requirements:

• Document and Records Management;

• Web Content Management (for DHB intranets and internets);

• Collaboration platform (for internal and external collaboration drawing on a number of tools

such as shared workspaces; Wikis and Blogs etc);

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• Electronic Workflow (for automating some processes); and

• Enterprise Search (to enable location and access to content residing on different repositories)

The ECMS Pilot scoping and re-scaling work is near completion. The Steering Group approved the

inclusion of a Web Content Management component to the pilot and it is planned that this will

include trialling the system for the WDHB intranet and external facing website for ADHB. The

project is working with healthAlliance to clarify our IS environment vis-à-vis the system

dependencies and agree a hosting arrangement for the pilot. Once this is completed indicative

timeframes for the commencement and completion of the pilot will be available.

Facilities & Development

Highlights / Issues

• Facilities Maintenance completion rates for NSH are 85% and WTH 81% of the required

maintenance schedule. The benchmark is 90%.

• Facilities & Development were able to complete additional minor operational maintenance

works of up to $900k by end of June 2013.

• Budget savings on capital projects amounting to $1.9M were returned to Corporate. This

contributed to funding available for capital for 2013/14.

• Dangerous Goods store will be audited on a monthly basis across all four campuses to ensure

compliance.

• Seismic reviews and condition assessments for all earthquake prone buildings have been

completed and the outcome of this, including options analysis will be presented to the Board by

end of September.

• The Hibiscus Coast leased premise is due for renewal in 2014. Workshops to address suitability

and location of buildings for Clinical services will be undertaken over the next 3-5 years.

Major Capital Projects

• The NSH Theatre project has been initiated again with the validation of theatres as fit for

purpose now completed. A full design team has been procured through GETS, with final

evaluations to appoint the team being undertaken in August. There is a requirement for the

building consultant team to review concept plans completed in 2010 to enable the clinical

service to complete the business case that will be presented to the Board.

• NSH Lab review has been completed. The Labs are presently non compliant for services

undertaken. The decision regarding level of compliance with Standards is being discussed with

the GM Hospital Operations. The GM will need to decide the level of compliance required.

• Remedial works to the WTH Base Load Chiller have been approved by the Board and will

progress from August 2013

Other

• The NSH, WTH and Mason Clinic external way-finding signage project has completed site master

planning. Design phases are commencing with User Groups.

• The partial upgrade of Ward 12 is expected to commence from late August, with the

requirement to decant various areas during the staged project works.

• The “Televisions Going Digital” project has engaged consultants to finalise audits and complete

roll out of systems to ensure we maintain television coverage from 1 December 2013.

• Whanau House and New Lynn Integrated Family Health Centres are completed with clinical

rooms available to take clinical services from April 2013.

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Hospital Operations

Key issues

Cleaning Services

• Increased cleaning work is being concentrated on HTO (High Touch Objects) in response to the

ongoing issue with hospital acquired infections.

• Significant support was provided for the operational commissioning ‘Go Live’ of ESC. In June, the

Theatres, CSSD and windows (inside and out) were sterilised and cleaned. This work was

completed at reduced cost to the DHB as the cleaning was completed well within the allocated

time. Clinical Engineering

The project to bring the service in-house is nearing completion. ADHB has demonstrated an

exemplary collaborative approach to ensuring that the transfer of services will proceed without risk

to patient care. WDHB will assume full responsibility for its own CE service on 5 August.

Traffic & Fleet

• Visitor parking at both North Shore Hospital and Waitakere Hospital decreased compared with

the same time last year.

• At Waitakere Hospital issues continue with non-compliance at Entrance F. One vehicle was

towed away. The formal response in writing from the GM to three of the most persistent non-

compliant drivers (staff) has had no lasting effect on two of them. Traffic has requested that this

issue be escalated in accordance with Waitemata DHB Traffic & Parking policy.

• The new Parking Policy has now been published. Laboratory Services

Transfusion Nurse Specialist commenced duties and has identified a number of opportunities for

improvements in transfusion medicine practice associated with some significant cost savings.

Pharmacy

• Minister of Health launched national ePrescribing project at North Shore Hospital in June. The

project has had very positive feedback from doctors, nurses and pharmacists. As at June 2013

218 beds were using ePrescibing. A further roll-out to medical wards at North Shore Hospital is

planned for February 2014.

• An initial assessment of the feasibility of integrating an Automated Robotic Dispensing machine

into the medicine supply chain in the dispensary at North Shore Hospital is underway.

• Two abstracts are being presented to the NZ Hospital Pharmacists Conference in November

2013.

• There has been an increase of 2.5% in the number of prescriptions dispensed from both the

Inpatient and Outpatient pharmacies compared with the same time last year.

Relocations

• Many services have taken advantage of accessing the recycled furniture and supplies and the

demand is increasing.

• ESC project team have moved from the Project Office on Shakespeare Road into the new ESC

building.

Asian Support Services

There continues to be an issue with insufficient office space for the Asian health team at North

Shore.

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Security

Ongoing issues with violence and aggression in emergency departments. Young men under the

influence of drugs have been a recurring issue this month.

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Financial Results


Provider Support

($000’s)


REVENUE

Government

and Crown

Agency

1,492 1,129 362 13,589 13,552 37 13,589 13,496 93

Other Income 1,545 1,537 7 18,215 18,118 97 18,215 18,006 209

Total Revenue 3,036 2,667 369 31,804 31,669 134 31,804 31,502 301

EXPENDITURE

Personnel

Medical 2,409 410 (1,999) 5,611 4,810 (801) 5,611 3,864 (1,746)

Nursing 240 613 373 6,025 7,315 1,291 6,025 6,181 156

Allied Health 1,121 1,549 428 17,715 18,415 700 17,715 18,279 563

Support 776 977 201 9,577 11,430 1,853 9,577 9,705 127

Management /

Administration1,907 2,050 143 24,827 25,036 209 24,827 24,915 88

6,452 5,600 (852) 63,755 67,006 3,252 63,755 62,944 (811)

Other Expenditure

Outsourced

Services4,610 2,314 (2,297) 32,258 27,781 (4,477) 32,258 27,469 (4,789)


Infrastructure

& Non-Clinical

Supplies

6,174 5,893 (281) 68,934 70,693 1,758 68,934 72,453 3,518

13,278 10,204 (3,074) 126,431 122,026 (4,405) 126,431 124,638 (1,793)

Total Expenditure 19,730 15,804 (3,926) 190,185 189,032 (1,153) 190,185 187,582 (2,604)

Contribution (16,694) (13,137) (3,557) (158,382) (157,363) (1,019) (158,382) (156,079) (2,302)

Allocations (13,177) (13,177) 0 (157,288) (157,288) 0 (157,288) (157,288) 0

NET RESULT (3,517) 39 (3,557) (1,094) (75) (1,019) (1,094) 1,208 (2,302)


Reporting Date

COMMENT ON MAJOR FINANCIAL VARIANCES

The overall result for Provider Support Services was unfavourable to budget for both the month

($3.557M) and for the year ($1.019M). The result was also below the forecast position, primarily

driven by year end provisions and adjustments taken up in Corporate in the month.

Revenue

Revenue was favourable to budget for both the month ($369k) and for the year ($134k). Favourable

interest income realised ($2.225M, mainly due to higher cash deposits in the HBL sweep than

planned) and greater than budget revenue in Facilities and Hospital Operations fully offset revenue

targets not achieved from non-resident patients ($1.891M adverse).

Expenditure

Expenditure was unfavourable to budget for both the month ($3.926M) and for the year ($1.153M).

The significant adverse variance for the month is driven by year end accruals/provisions and other

adjustments. Additional depreciation and accruals for maintenance costs for facilities were partially

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offset by interest accrual releases and less than budget interest. Greater than budget outsourced

costs were realised in the month from accruals for healthAlliance payments for capitalisation of IT/IS

assets. Actuarial valuation for staff liabilities, bad debt write offs and provisions also contributed to

the month variance.

For the year, favourable variances were across all staff categories ($3.252M, mainly due to

vacancies) and infrastructure costs ($1.758M, mainly due to interest cost savings). These partially

offset the adverse variances in outsourced costs ($4.477M) and clinical supplies costs ($1.686M).

Adverse outsourced costs reflect $2.252M 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). Also affecting the outsourced cost performance are unbudgeted

costs for healthAlliance (mainly $694k for Microsoft Licensing and $826k depreciation for capitalised

IT/IS assets) and unbudgeted HBL Finance Procurement and Supply Chain business case costs.

Clinical supplies costs were adverse to budget mainly from volume related Inpatient Pharmacy

($1.027M) and Lab consumables ($625k).

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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) Glossary CAAG - Capacity at a Glance is a database that shows minute by minute the capacity of

the hospital and the resourcing CCDM - Care Capacity Demand Management is a programme that uses a range of tools

that assist in analysing workload and available resources to forecast and monitor ability to manage capacity and demand

EN - Enrolled Nurse RM - Registered Midwife RN - Registered Nurse Trendcare - database that records the clinical needs of patients and calculates the hours of

nursing care required to meet the needs White board - White board used on each ward/unit used 24 hours a day by all clinical staff to

identify which patients are which bed and what referrals, diets, mobility and other needs the patient has or requires

Medical staff

• The Elective Surgical Centre opened successfully on July 15th with John Cullen doing the first list in the ESC, and his last personal surgical list. In the first two weeks surgical production gradually ramped up with orthopaedic, general surgery and gynaecology all contributing in the initial weeks, 94 patients over 30 sessions during the first two-week period. There has already been good feedback from patients about the care provided, and the environment. The ESC project team is gradually coming to a close, and their fantastic efforts have been acknowledged in the last couple of week.

• Richard Harman has taken over the Clinical Director position of General Surgery for the remainder of 2013, at which time a longer term appointment will be undertaken.

• I have continued to progress through the services a meeting with the doctors to discuss and progress implementation of the values, most recently radiology. I also meet with all newly employed SMOs individually and the values are discussed. These values are getting good visibility, and have been a point of discussion regarding expected behaviours of our staff, as well as a challenge to the organisation about how the DHB is living up to its values.

• A new role of Director of Infection Prevention and Control has been established. Jenny Parr has taken on this role. This also establishes a new committee which has provided a renewed organisational wide focus on IPC issues. The group has already helped develop a new strategy on hand hygiene.

• WDHB has now taken over hyperbaric medicine services from the Navy located in Devonport. • Pharmac from July 1st have taken over the role of managing the Hospital Medicines List, the

goal being to drive consistency of availability of medicines throughout DHBs. There is a mechanism for medicines outside this list to be prescribed, though a national request process. If though there is an immediate need and request, then the DHB has set up a forum to respond to requests that need an answer within three days.

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Allied Health, Technical and Scientific staff Allied health professional leadership and operational management review

A consultation document proposing some significant changes to the professional leadership and operational management of allied health staff has been presented to staff and Unions. The primary goals of the proposed changes are to:

• Establish an effective leadership framework to facilitate and accelerate DHB-wide innovation and transformational change.

• Establish a unified operational management, professional leadership and clinical governance structure for allied health staff in the adult and paediatric provider arm services.

• Provide a basis for equity of professional development for allied health staff within the adult and paediatric physical health divisions.

• Ensure the service lives within its means.

These are to be achieved through re-design of professional leadership roles and re-focussing professional leaders to provide direct clinical support and oversight to operational teams. The new framework creates a model to support much greater collaboration and cross-divisional support between allied health staff across the three physical health divisions. Laboratory services transformation

A working group comprising clinical and operational leaders has been established to progress the continuing re-design of the laboratory service to optimise efficiency and maintain the current high quality service in the face of increasing demand. The five main work streams are based on:

• The introduction of demand management tools and systems

• Repatriation of “send-away” tests where there are sound cost and/or quality indications

• Developing the optimum model for service delivery at the Waitakere site

• Reviewing skill mix and roster patterns to create the most cost efficient staffing model for each department.

• Reducing unnecessary use of blood and blood products Pharmacy

Preliminary plans have been developed to provide an outpatient pharmacy service from the main entrance foyer of Waitakere Hospital. In addition to creating a genuine service improvement for the site, a modest revenue stream is also expected. Podiatry

The DHB’s lead Podiatrist has presented a number of draft proposals detailing the potential improvements to patient care that could result from better access to podiatry for a range of vulnerable patient groups.

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Nursing and Midwifery Strong Leadership and Strategic Influence 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 the Charge Nurse Managers to review the role expectations and their preparation and support needs. As the need increases for operational efficiency and performance, the expectations of the roles have increased. This review has altered the person specifications, job description and performance management. This work will be extended to the Clinical Nurse Specialist roles. The roll-out of Trendcare has ended at the end of July 2013. The 18 month implementation to 35 wards/units has been successful due to the leadership of Heather Townend and Laurina Ferro. Trendcare was designed by nurses, for use by nurses and midwives, to

- Provide visibility of patient/service user needs and workload demand

- Provide visibility of resource utilisation / workload

- Provide information for future resource planning

Now that we have more reliable data we can provide reports for wards/units to use in planning. Analysis shows that nursing hours per patient day is lower than available resources requires generally, but when looking at ward by patient type and benchmarks with other hospitals across Australasia and Singapore they are generally consistent. There are some areas that require further analysis as they are consistently lower than patients need and we will use the tools from ‘Care Capacity Demand Management’ to understand how staff are working at different times of the day and whether skill mix is appropriate. General surgery has shown that changes can be made to the rosters and work practices to manage with existing resources.

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The Trendcare data also inputs to the new ‘Capacity at a Glance’ screen which looks at how each unit is managing the workload minute by minute and allows staff to communicate with Duty Nurse Manager if their ability to manage is compromised.

The Trendcare database is also used to produce information to the new white boards used on the three pilot wards to manage patient placement and multi-disciplinary care communication. The plan is to have all general wards with electronic white boards to standardise data presentation and allow tracking of referrals as well as duty nurse manager visibility for bed management. Workforce Development for the Future 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 Learning Programme Waitemata DHB nurses and midwives educators offer a number of learning opportunities for the 2313 nurses and midwives across the DHB to ensure clinical practice safety and essential safe skill development. In addition there are inservice options e.g. journal review, case review. 6 month offering Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13

Clinical Practice Study Days offered

39 58 43 56 42 22

Hrs of learning provided 312 464 344 448 336 176

Number attending [av 15] 585 870 645 840 630 330

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New Graduate / Entry to Practice The September 2012 general nursing new graduate programme is nearing completion and there has been good success of this group in progressing to competent practitioners within the required period. The mental health new graduate group is progressing well and completed at the end of October. It is anticipated that most of these nurses will be able to be employed. The 12 new graduate midwives have made a good transition with the support of the midwife coach. The change in the midwifery programme has produced some excellent midwives. Return to Practice programme 9 of the 10 nurses have completed the Return to Practice programme. It was a pleasure to assess their portfolios and see the successful transition back to practice after many years away. Many have shown considerable empathy and compassion. Professional Development and Recognition Programme [Nursing] and Quality & Leadership Programme [Midwifery] Waitemata DHB has a well-established professional development and recognition programme. There is 75% uptake of the programme with work underway to ensure there is 100% participation. The front-line distribution of nurses and midwives at each skill level is depicted below.

Percentage of RN,EN,RM at each Level of Practice

0

10

20

30

40

50

60

Pe

rce

nta

ge

Percentage at each level 7.3 54 34.3 4.2

L1 Entry to

PracticeL2 Competent L3 Proficient

L4 Highly

Proficient

Quality Practice and Patient Safety Safer clinical quality and efficiency, a culture of excellence, through evidence-based care Jenny Parr, Associate Director of Nursing has introduced the weekly ‘Frontline Focus Friday’ for Medicine and Health of Older People Service and Surgical and Ambulatory Service, focussing on clinical practice safety. A. Initial weekly focus was on ensuring equipment was clean, with a focus on cleanliness of

commodes. All commodes are inspected each week, and within 10 weeks 99% of commodes were clean. This focus will expand to other pieces of equipment once this level is sustained.

B. 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.

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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: [i] improvements to the risk assessment and documentation of planned care, [ii] the investigation, management and care planned for patients who have sustained a fall, [iii] looking at where and when falls happen using ward layout maps and [iv] investigating what is happening at specific times of the day where more falls happen.

Emphasis on falls prevention is one of nursing’s highest priorities. Four of the nurse

leaders have attended handovers for the past two weeks to reinforce the key expectations and also attend immediately where there is a fall with harm. There is focus on celebrating number of days where there are no falls and ensuring that staff understand that falls with harm are considered a “never event” as the cost for patients is too high.

C. 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 in 4% of cases these 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 all had 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.

Discussion has also occurred about: D. Controlled Drugs – Spot Audit E. Infection Screening and compliance F. Pressure Injury incidence G. Documentation

Monitoring of the quality of nursing practice in Child Health and Mental Health is being discussed as A,C,D and G relate to these divisions too. These services are also participating in the trigger flagging activity in the first instance.

Emergency Systems Planning Work continues with each clinical unit to ensure that they have plans in place to respond confidently in the event of an emergency. Particular work continues by Andrew Sykes with Fire response processes in areas that have alarms and fire incidents. Jackie Ferries has been working on plans relating to fuel spills, bomb threats, plans for Mason Clinic, liaising with Corrections, Police and Fire. The Waitemata DHB team is coordinating the northern health emergency group through a regional health emergency planning event with a scenario of a remote ash event. There will be a focus on impact on the health of people in Auckland and Northland, in particular respiratory, renal and neonatal needs and possible hospital evacuation. This will include CDEM, Lifelines Agencies and other emergency services.

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6.2 Human Resources Recommendation: That the report be received. Prepared by: Sam Bartrum (General Manager, Human Resources) Executive Summary

This report identifies some key areas that are occurring in Human Resources for the month of June 2013. Corporate HR

Transferring Employees

Slark Hyperbaric Unit Service Transfer The Slark Hyperbaric Unit service was successfully transferred from the New Zealand Defence Force to the DHB on the 1st July as planned. All contracts have been issued for permanent and casual staff. The Service and HR are currently working with Des Gorman to formalise his continued involvement in the Unit and we are also exploring options for additional SMO on call cover. Senior Clinical Engineering ADHB/WDHB Transfer The transfer of 2.0 FTE Clinical Engineers is in process with a completion transfer date set for 5th August. WDHB is currently preparing contracts and offers of employment will be issued in the week commencing 22nd July. The transferred engineers will form part of the new Clinical Engineering Service here at WDHB. Job Sizing Update

No of SMOs

in Specialty to Complete

Forecast Completion

Comments

Emergency Medicine FACEMs

10 14 FACEMs completed. Remaining underway and progressing.

Emergency Medicine MOs 34 Will recommence once FACEMs completed.

Geriatric Medicine 2 July / Aug

2013 9 SMOs completed. Last 2 underway.

Older Adults / Mental Health

12 End 2103 Waiting for new Clinical Director to commence before progressing forward.

Adult / Mental Health 33 Sept / Oct

2013

Service sizing completed. Individual job sizing underway.

Child & Youth Mental Health

11 Sept / Oct

2013

Service sizing completed. Individual job sizing underway.

Orthopaedics 19 July / Aug

2013 Close to completion

Surgical Pathology / Micro 7 Draft job sizes established.

Total Number of SMOs 128

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SMO Leave Project PROJECT TITLE SMO Leave & Expenses

PROJECT WORKING GROUP

Debbie Eastwood, Cath Cronin, Jonathan Christiansen, John Cullen, Alison West, Avinesh Anand/Audrey Gan, Annette Gohns, Rebecca Kopacka, Barbara Blair

The project is partnering with stakeholders to develop and implement an electronic system to reduce paper based forms submitted to Payroll and enable a timely, accurate leave recording process. The aim is to develop an electronic leave template which can be used by all services not currently using an automated system, and possibly be adapted or incorporated into current systems – currently looking at an Outlook form. SMO leave is profiled to indicate deducted hours with clear guidelines for extrapolating how leave hours are applied. Trial profiling is underway in three services in Med Hops and Surgical. A revised policy has been drafted based on the ADHB policy. Guidelines and FAQs are being developed on existing policies to assist managers and administrators to interpret the policy/MECA requirements. The electronic system will enable CME reports to access up-to-date information for the accruals and reporting. Recruitment New Graduate Nursing Recruitment We have offered 18 Graduate Nurses positions at WDHB in the NEtP September 2013 intake. Recruitment is starting now for the February 2014 intake. June Recruitment Statistics

Actual Target Flag Current Employ (fte) 5417 n/a Ave number of Positions Vacant 332 n/a

No of Hires

134 n/a % of Hires from Internal Referrals 16% 35% � Time to Hire 46 days 45 days � Cost per Hire $809 $750 �

Professional Group Count of staff Employed in June Medical 5 Nursing 58 Allied 19 Technical 6 Mental Health 13 Support 13 Total 114

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Kiwihealthjobs Highlights for June:

• The trends graph shows the considerable increase in activity on the KHJ site. Activity is up by over 50% from this time last year.

• The number of direct hires attributed to KHJ has started to increase in relation to the number of jobs advertised. Since February 2012, 180 hires have been directly attributed to KHJ.

• The number of registered subscribers to KHJ job alerts continues to increase and now sits at 4,425.

• KHJ provides information for candidates applying for first year House Officer positions via the ACE process. June saw a significant increase in activity on these pages – applications closed on 28 June.

At a glance – June 2013

Total number of visits:

31,860

Visits from: - UK - Australia - Ireland - USA - Canada

5,122 1,546

949 984 396

Number of jobs posted: - Clinical jobs - Non-clinical jobs

434 343 104

Total number of hires – Feb 12 to date from KHJ*

180

Number of Jobs advertised by month and organisation

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Awhina Medical Education and Training

Medical Council of NZ (MCNZ) Accreditation Status At their April meeting the MCNZ Education Committee considered the recent Update Report provided by Waitemata DHB. They noted the progress made to address areas requiring improvement and recommended that accreditation be granted for the balance of the accreditation period (to July 2014). This is good news and at the same time it is important to note that the next routine accreditation for resident doctors visit will occur in July 2014. Issues relating to release of house officers for protected teaching time on a Thursday, paging protocols – ensuring house officers aren’t paged back to the ward between noon and 2.30pm on Thursdays, provision of mid-run feedback by consultants and availability of a clinical skills teaching space require redress before this next visit and corrective actions are underway. Formal Teaching programme for year 1 House Officers We are now into the third quarter of the year-long teaching programme for first year house officers. This is the consolidation phase of the formal teaching programme. Key features of the consolidation phase are:

• Careers Planning – this component of the programme has included sessions during the protected teaching time on a Thursday, the Northern region Careers Fair, and one-to-one interviews with the Medical Education and Training Unit Team Leader prior to Intern Supervisor meetings

• Surgical Skills Teaching – at the Mercy Ascot Clinical Skill Centre commenced in March. House officers attend for a half-day in groups of 16-18. The final session is scheduled for 1 August. Feedback has been very positive. On the assumption that we have a clinical skills teaching space in 2014, we envisage providing this programme in-house for the next intake. Capex approval for training models has been the first step to bringing this programme in-house.

• Year 1 House Officer Case Study Presentations – have started and have been amazing. Peers are asked to review the cases on a forum page set up in ECHO (the WDHB e-Learning intranet site) and it is hoped that this process will build skills for peer review during year 2 (PGY2 year).

• Stroke rehabilitation, facilitated by the multi-disciplinary team – The following feedback on this session was received ‘Good session. (It) reinforced the importance of MDT involvement (and) good communication in the health care team.’

Dr Pat Alley and Dr Dale Sheehan presented at the recent Australian and NZ Association of Health Professionals Educations (ANZAHPE) on the integrated curriculum design that underpins this formal teaching programme.

Intern Supervisors Peter Shapkov joined the Intern Supervisors’ team recently and has just completed his first end-of-run interviewing. This gives us another surgeon in the mix and his contribution to surgical skills teaching has been greatly appreciated. House officers are now on their third, three-month run of their year 1 programme.

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Year 2 (PGY2) A monthly meeting time for PGY2s to help them navigate the Best Practice Advocacy Centre (BPac) CME requirements is being provided by the METU Team Leader, Dr Dale Sheehan. Initial support focused on the cultural competence component of the Medical Council NZ requirements using MCNZ materials. In May a video-conferenced case review session to assist PGY2 doctors enrolled with BPac was provided to support PGY2s meet their peer review requirements. This is an area for further development. Winter New Medical Registrar Workshop On June 17 the Medical Education and Training Unit hosted a midyear workshop for new medical registrars. The invitation went to registrars in the Auckland region. ADHB’s Clinical Education and Training Unit runs an event like this at the end of the year but prior to this WDHB hosted event, nothing was available for those starting in June. The June 17 event focused on tips for the new role and the chance to meet each other and the 10 consultants who presented. Smoking Cessation A Smoking Cessation session was presented to junior doctors by the Smoke Free team the day before International Smoke Free Day. This session was supported by Avril Lee (WDHB Quality Pharmacist) covering the pharmacology of Champix, including contraindications. To further reinforce this message, the smoking cessation team joined the junior doctors on a Thursday for the following two Thursdays and provided samples of gum, lozenges for house officers to see.

GROWTH – our in-house coaching programme

Our in-house coaching programme has been developed specifically for Waitemata DHB and has been running since October 2012. The GROWTH coaching programme is for our talent and high-potential staff and is developmental. It’s ‘a leadership development strategy that has the potential to improve individual and organisational performance, retain leadership talent, support succession planning, and help healthcare leaders meet professional and personal goals’1 . It can be organised quickly and put in place with relatively low levels of co-ordination and budget compared with traditional training programmes2. Several studies have shown that coaching positively influences productivity, quality, customer service and retention of best employees3. About the GROWTH coaching programme Our trained in-house coaches provide cross-Service and cross-disciplinary coaching which focuses on the development of leadership and capability, encouraging our ‘stars’ to reach their potential and impact organisational capability. GROWTH supports WDHB values, especially Connected (coaching is cross organisational and cross-Service) and Better, Best, Brilliant (it’s a reflective process facilitating continuous improvement at an individual, team and organisational level). Applicants for coaching must meet specific criteria, which include:

• Strong track record for meeting or exceeding performance expectations;

1 McNally, K. and Lukens, R. Leadership Development: An External-Internal Coaching Partnership Journal of Nursing Administration: March 2006 - Volume 36 - Issue 3 - pp 155-161 2 CIPD (2007) Coaching in organisations 3 As above.

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• Potential to develop and build leadership mindset and practices; • Positive attitude to self-development and motivated to engage in coaching – a role

model; • Committed to developing their career at Waitemata DHB.

Achievements to date

• Fifteen in-house coaches have been developed. Coaches include a General Manager, Clinical Director, Operations Managers and senior Nursing, Allied Health and non-clinical staff.

• Twenty four high-potentials have accessed GROWTH coaching. • Our coaches have said: ‘the programme has made my experience working at the

DHB richer’; ‘ assisted me to become focused on what I should be doing and has given me the motivation to strive for goals set’. One of our coaches has commented: ‘The impact of introducing coaching to WDHB… (is that) the strength of the organisation will be enhanced by improving the quality and quantity of the connections between and across services, in alignment with our new organisational valued of Connected ’.

By the end of 2013 we will have 30 in-house coaches available to more than 60 high-potentials per year.

Next steps

• Formally evaluate the benefits of the WDHB GROWTH coaching programme • Investigate where and how our in-house coaches may support service-based change

initiatives • Ongoing development of the 30 in-house coaches – to grow a coaching culture at

Waitemata DHB • Communicate the availability and benefits of the coaching programme to DHB

service and clinical leads.

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Workforce

Values Implementation We are working through the last of the values areas for focus – the items “for organisational improvement” and things that we should no do. A paper is in draft stages and once we have completed the last two areas of focus the paper will be finalised and sent to ELT for discussion. Long Service Recognition Programme Invites for the two Long Service recognition events have gone to all eligible staff. We have had a very positive response to the invitation to attend each of the events. This guideline and recognition is clearly valued by the organisation. We have had a significant number of people query their eligibility for the recognition programme and we have spent time going through each query and going back to each person individually to explain why they are not eligible at this stage. We have identified a number of people where mistakes have been made at payroll as changes of jobs have occurred which has resulted in an apparent break in continuous service. We have been able, in most instances, to fix this. Ngati Whatua o Orakei Partnership A careers evening and a scholarship evening have been held by Ngati Whatua during June. Waitemata DHB was present at the careers evening and had information on the scholarship programme at the scholarship evening. Both went well, with numerous whanau interested in careers in health. The plan is to open the Ngati Whatua scholarships up alongside the main scholarship programme in August, with scholarship recipients being announced in November.

Occupational Health & Safety

The following is submitted as a result of an action item from HAC meeting held 3rd July as below: HAC 03/07/13

Agenda Item 3.3

Human Resources Report Health and Safety – copies of the Government’s report and a report from the Institute of Directors on Board members’ responsibilities to be provided to Board members.

Sam Bartrum

Hard copies of the above two documents have been provided under separate cover with the HAC papers and a link to the full Government Task Force report has been emailed to Board members separately.

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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) both from Hospitals Group Endorsed by: Dr Debbie Holdsworth (Director, Funding)

Glossary

DAP - District Annual Plan 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 HAC - Hospital Advisory Committee 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 30 June 2013 being year end.

The total value of the additional electives money (over and above baseline funding) available to Waitemata District Health Board (DHB) for 2012/13 was $32,673,964. The aim of this report was to track performance against the plan on a monthly basis to ensure the DHB was 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. Final Month of the Final Quarter 2012/13 Electives Performance

2.1 Surgical Electives Discharge Health Target Waitemata DHB’s discharge rate for year end was 100.7%, being IDF 102.5% and the provider arm 99.7%. The Provider Arm productivity picked up in the final month of the year to contribute favourably to the final result. Auckland DHB successfully reduced their over delivery of IDF over the last four months, from as high as 111% (in August 2012). The final

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year position of 102.5% of the discharge plan was directed by the funder to ensure our surgical discharge target was not at risk.

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. At year end both discharge and caseweight plans have been met.

For year end we have delivered 101% of our caseweight plan (95% Provider Arm; 105.1% IDF) and will receive the full value of the electives funding from the MoH being $32,673,964 for the financial year.

2.3 ESPI Compliance Waitemata achieved full ESPI compliance for the year’s end with zero patients waiting over five months for their FSA and surgery. The organisation will receive a MoH incentive payment for achieving ESPI compliance. Waitemata’s compliance share will be $554k plus potentially a share of the Northern region’s incentive payment of $1.8m, being $546k making a total incentive payment of $1.1m.

2.4 Key intervention targets The MoH expectation for Waitemata surgical intervention rates for major joint production was 1,007 for 2012/13.

At year end the provider arm’s performance for major replacements was 86.6% moderately short of the intervention expectation. This expectation does not have financial incentive or penalty.

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 Island population as per the District Annual Plan (DAP). Bariatric surgery delivered 85 of the 100 procedures expected. This however is 180% achievement against the MoH allocation.

3. Electives Volumes Advice 2013-14

The elective discharge volume set by the MoH for 2013-14 is 16,701. This is an increase of 848 discharges from 2012-13. The 16,601 discharge plan attracts a maximum payment of $35,091,796 including Bariatric surgery and a surgical quality plan. The additional 848 discharges will not be fully funded but only to approximately 43%. The funder is in ongoing discussions with the MoH to increase their financial contribution to meet this gap.

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 102.5% ESPI 2 (waiting time for First Specialist Assessment) 0.0%Provider Total 99.7%

General Surgery Inpatient services 97.7% ESPI 5 (waiting time for treatment) 0.0%ENT Inpatient Services 88.7%Gynaecology Inpatient Services 92.4%Orthopaedics Inpatient Services 89.7%Urology Inpatient Services 112.3%

Waitemata DHB Total Surgical Elective Discharges 100.7%Elective Surgical Purchase units, and Avastin and Skin Lesions reported to NMDS

Caseweight Delivery (CWD) Summary Surgical Procedures

IDF Total 105.1% Knee Joint Replacements 78.0%Provider Total 95.0%

Hip Joint Replacements 99.5%Waitemata DHB Total Elective CWD 101.0%Elective Surgical, Dental and Cardiology Purchase units, and Avastin and Skin Lesions reported to NMDS Total Joints 86.6%

Bariatric Procedures 85.0%

Overall

Waitemata DHB attained the new ESPI 2 and 5 compliance target of no patients waiting over 5 months by 30 June 2013

Elective Initiatives Report - Health Target June 2013

The DHB met the year end health target discharge volume at 100.7%. IDF discharge volume was 102.5% of target. The Provider’s discharge volume was 99.7% of target.

Major joint replacement volumes were 86.6% of intervention requirements. Hip joint replacements were 99.5%.

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.

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30/07/2013 Prepared by: Andrew Palmer Elective Initiatives Report 201213.xls96 of 96