counties manukau district health board hospital advisory … · presentation on the certification...

Counties Manukau District Health Board – Hospital Advisory Committee Agenda

Counties Manukau District Health Board Hospital Advisory Committee Meeting Agenda Wednesday, 7 September 2016 at 9.00am – 12.30pm, Room 107, Ko Awatea, Middlemore Hospital, Hospital Road, Otahuhu, Auckland Time Item Page No.

9.00 – 9.10am 1. Welcome

9.10 – 9.20am 2. Governance 2.1 Attendance & Apologies 2.2 Disclosure of Interests/Specific Interests 2.3 Confirmation of Public Minutes (27 July 2016) 2.4 Action Items Register Public

2

3-6 7-11

12-13 3. Resolution to Exclude the Public

14

9.20 – 9.23am 9.23 – 9.25am 9.25 – 9.35am

4. Confidential Items 4.1 Confirmation of Confidential Minutes (27 July 2016) 4.2 Action Items Register Confidential 4.3 Patient Experience & Safety Report/HQSC QSM Report

March 2016/HQSC National Patient Experience Survey May 2016/CM Health S&AE Report Full Year 2015/16 (Dr David Hughes)

15-20

21 22-57

9.35 – 9.45am

5. Safety & Quality 5.1 Inpatient Experience Survey No. 7 (Dr David Hughes)

58-61

Morning Tea Break

9.55 – 10.25am 10.25 – 11.00am 11.00 – 11.10am

6. Presentations/Reports 6.1 Certification Audit (Dr David Hughes) 6.2 Faster Cancer Treatment (Wilbur Farmilo, Anne-Marie Wilkins & Richard Small)

6.3 Q4 2015-16 Non-Financial Summary Report (Kitty Neill)

62-76 77-93

94-105

11.10– 11.25am

11.25 - 11.35am 11.35 – 11.45am 11.45 – 11.50am 11.50 – 12.00pm 12.00 – 12.10pm

12.10 – 12.20pm 12.20 – 12.25pm 12.25 – 12.35pm

7. Hospital Services Directorate Report (Phillip Balmer) 7.1 Executive Summary 7.2 Balanced Scorecard 7.3 Finance (Margaret White) 7.4 Human Resources 7.5 Responses to Action Items 7.6 Mental Health & Addictions (Tess Ahern) 7.7 Women’s Health & Kidz First (Nettie Knetsch) 7.8 Director of Midwifery (Thelma Thompson) 7.9 Surgical and Ambulatory Care (Mary Burr) 7.10 Adult Rehabilitation/Health of Older People (Dana Ralph- Smith) 7.11 Medicine, Acute Care & Clinical Support (Brad Healey) 7.12 Facilities (Phillip Balmer) 7.13 Director of Nursing (Denise Kivell)

105-108 109-112 113-117 118-119 120-129 130-134 135-140 141-142 143-146 147-150

151-156 157-158 159-162

Next Meeting: 19 October 2016

Meeting Room 107, Ko Awatea, Middlemore Hospital, Otahuhu

001

Counties Manukau District Health Board – Hospital Advisory Committee 7 September 2016

BOARD MEMBER ATTENDANCE SCHEDULE – HAC 2016

Name

Jan 10 Feb 23 Mar Apr 4 May 15 June 27 July August 7 Sept 19 Oct 30 Nov 2 Dec

Lee Mathias (Chair)

No

Mee

ting

No

Mee

ting

No

Mee

ting

No

Mee

ting

Wendy Lai

X X X

Arthur Anae

** ** ** **

Colleen Brown

Sandra Alofivae

Lyn Murphy (Committee Chair)

X

David Collings

X X

Kathy Maxwell

George Ngatai

X X X

Dianne Glenn

Reece Autagavaia

X

* Attended part meeting only ** Resigned effective 20 July 2016

002


BOARD MEMBERS’ DISCLOSURE OF INTERESTS

7 September 2016 Member Disclosure of Interest

Dr Lee Mathias • Chair Health Promotion Agency

• Chairman, Unitec • Deputy Chair, Auckland District Health Board • Acting Chair, New Zealand Health Innovation Hub • Director, healthAlliance NZ Ltd • Director, New Zealand Health Partners Ltd • External Advisor, National Health Committee • Director, Pictor Limited • Director, John Seabrook Holdings Limited • MD, Lee Mathias Limited • Trustee, Lee Mathias Family Trust • Trustee, Awamoana Family Trust • Trustee, Mathias Martin Family Trust

Wendy Lai, Deputy Chair • Partner, Deloitte • Board Member, Te Papa Tongarewa, the Museum of

New Zealand • Chair, Ziera Shoes • Board Member, Avanti Finance

Colleen Brown • Chair, Disability Connect (Auckland Metropolitan Area)

• Member of Advisory Committee for Disability Programme Manukau Institute of Technology

• Member NZ Down Syndrome Association • Husband, Determination Referee for Department of

Building and Housing • Chair IIMuch Trust • Director, Charlie Starling Production Ltd • Member, Auckland Council Disability Advisory Panel • Member, NZ Disability Strategy Reference Group

Sandra Alofivae

• Member, Fonua Ola Board • Director, Housing New Zealand • Member, Ministerial Advisory Council for Pacific

Island Affairs • Member, Social Housing Reference Group • Independent Chair, Social Investment Board

003


Dr Lyn Murphy

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

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

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

professional health studies • Member, Public Health Association of New Zealand

David Collings

• Chair, Howick Local Board of Auckland Council • Member Auckland Council Southern Initiative

Kathy Maxwell • Director, Kathy the Chemist Ltd • Regional Pharmacy Advisory Group, Propharma

(Pharmacy Retailing (NZ) Ltd) • Editorial Advisory Board, New Zealand Formulary • Member Pharmaceutical Society of NZ • Trustee, Maxwell Family Trust • Member Manukau Locality Leadership Group, CMDHB • Board Member, Pharmacy Guild of New Zealand

George Ngatai • Chair Safer Aotearoa Family Violence Prevention Network

• Director Transitioning Out Aotearoa • Director BDO Marketing • Board Member, Manurewa Marae • Conservation Volunteers New Zealand • Maori Gout Action Group • Nga Ngaru Rautahi o Aotearoa Board • Transitioning Out Aotearoa (provides services & back

office support to Huakina Development Trust and provides GP services to their people).

• Chair, Restorative Practices NZ. Dianne Glenn • Member – NZ Institute of Directors

• Member – District Licensing Committee of Auckland Council

• Life Member – Business and Professional Women Franklin

• Member – UN Women Aotearoa/NZ • President – Friends of Auckland Botanic Gardens and

Chair of the Friends Trust • Life Member – Ambury Park Centre for Riding Therapy

Inc. • Vice President, National Council of Women of New

Zealand • Member, Auckland Disabled Women’s Group • Member, Pacific Women’s Watch (NZ) • Justice of the Peace

004


Reece Autagavaia • Member, Pacific Lawyers’ Association

• Member, Labour Party • Member, Auckland Council Pacific People’s Advisory

Panel • Member, Tangata o le Moana Steering Group • Employed by Tamaki Legal • Board Member, Governance Board, Fatugatiti Aoga

Amata Preschool • Trustee of Epiphany Pacific Trust

005


HOSPITAL ADVISORY COMMITTEE MEMBERS’ REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 7 September 2016 Director having interest Interest in Particulars of interest Disclosure date Board Action Dr Lyn Murphy

AUT Midwifery Students

Currently working at AUT and the Midwifery Students come under the faculty she is working in.

27 July 2016

That Dr Murphy’s specific interest be noted. The Committee agreed that she may remain in the room and participate in any discussion but be excluded from any voting, if applicable.

006


Minutes of Counties Manukau District Health Board Hospital Advisory Committee Held on Wednesday, 27 July 2016 at 9.00 – 12.30pm, Room 107, Ko Awatea, Middlemore Hospital, Hospital Road, Otahuhu, Auckland Present: Dr Lee Mathias (Board Chair), Dr Lyn Murphy (Committee Chair), Ms Dianne Glenn,

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

In attendance: Mr Geraint Martin (Chief Executive), Ms Margaret White (Deputy Chief Financial

Officer, Hospital Services), Mr Martin Chadwick (Director Allied Health), Dr Gloria Johnson (Chief Medical Officer), Ms Denise Kivell (Director of Nursing) Mr Phillip Balmer (Director Hospital Services) and Ms Dinah Nicholas (Secretariat).

Apologies: Ms Wendy Lai and Mr George Ngatai. 1. Welcome

The Chair opened the meeting with thoughts for Peter Tod who was recently admitted to the hospital.

2. Governance

2.1 Attendance & Apologies

Noted.

2.2 Disclosure of Interest/Specific Interests

Ms Sandra Alofivae advised that she is the Independent Chair of the Social Investment Board. Dr Lyn Murphy advised to remove references to MIT. Dr Lyn Murphy declared a Specific Interest in relation to Item 7.6 on today’s agenda.

2.3 Confirmation of Public Minutes (15 June 2016) Resolution That the Public Minutes of the Counties Manukau District Health Board Hospital Advisory Committee meeting held on Wednesday 15 June 2016 were taken as read and confirmed as a true and accurate record. Moved: Dr Lee Mathias Seconded: Ms Colleen Brown Carried: Unanimously

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2.4 Action Item Register Public

Noted.

3. Resolution to Exclude the Public Individual reasons to exclude the public were noted. Resolution That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000, the public now be excluded from the meeting as detailed in the above paper. Moved: Dr Lee Mathias Seconded: Ms Dianne Glenn Carried: Unanimously

9.25am Public Excluded session. 10.22am Open meeting resumed. 4. Safety & Quality

4.1 Inpatient Experience Surveys No. 5 and 6 (Dr David Hughes)

The surveys were noted and taken as read.

4.2 Patient Communication & Coordination of Care Denise Kivell, Leanne Elder, Lara Cavit and Neshanee Naidoo took the Committee through their presentation. There is action underway in a number of areas to improve communication and coordination of care for patients, families and whaanau:

• New national system level measures – by end September/October the MoH will have a new SLM on Patient Experience.

• Use of patient experience survey in services to learn. • Patient & Whaanau Centred Care programme – overseeing a varied work

programme such as: o Expanded scope of volunteer involvement/telehealth o Leadership rounds o Health literacy awareness/AI2DET o Consumer co-design, Consumer Council o Learning environment facilities and technology

The Chair thanked the presenters for their presentation.

5. Presentation 5.1 Youth Health Presentation

Bridget Farrant and Carmel Ellis took the Committee through their presentation on health services for young people in Counties Manukau. The Chair thanked the presenters for their presentation.

008


6. Hospital Services Directorate Report

6.1 Executive Summary/Health Targets (Phillip Balmer)

The report was noted and taken as read. Mr Balmer confirmed that for the next HAC meeting (7 September) there will be a presentation on the Certification Audit and a few of the STEEP measures in the Balanced Scorecard will be pulled out for further discussion in more detail.

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

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

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

6.5 Women’s Health & Kidz First (Nettie Knetsch) In May there were 576 births at Middlemore Hospital and 61 births at the three community units, a total of 637 for the month which is 11 more than May 2015. In response to a question on whether we are prepared for an influx of women coming to Middlemore to birth from (for example) the new housing development in Pokeno, Ms Knetsch advised that she has not yet seen any increase but is keeping a close eye on this. MCIS – Dr Johnson gave a verbal update on the MCIS system which has been transferred into the Confidential Section above.

6.6 Director of Midwifery (Nettie Knetsch) Accessible, Affordable, Appropriate & Quality Maternity Care Research of Pasifika women accessing primary maternity care – in response to a question about the choice of birthing units for Pasifika women, Ms Knetsch advised that there is a lot more work needed to be undertaken on the right promotion of primary birthing units and then a decision can be made on where should they be and how many there should be. ‘Build them and they will come’ is not necessarily true for primary birthing units. The Committee asked Ms Knetsch to come back with a summary of what the next steps will be on the primary birthing units after the MQSP report is signed off by the Ministry.

6.7 Surgical & Ambulatory Care (Mary Burr)

The Surgical Assessment Unit experienced its highest utilisation month since opening in July 2015. Acute WIES were up 3.2%. Elective discharges were 27.2% over target for the month and outpatient FSA volumes 20.1% over target for the month. These results reflect the push to achieve all contracted volumes and ESPI targets by year end. Spinal activity was high in May with 26 acute spine admissions and 29 elective patients. There were 11 acute SCI patients in total, 9 of which were admitted directly to Critical

009


Care. On several days there were 19 spines across Wards 10 and 11, a heavy workload for ward staff. Emerging Issues: 1. Critical Care beds are under increasing demand. A new project is looking at ways of

improving patient flow out of Critical Care. A Spinal HDU is also being set up in Ward 11 which will enhance capacity.

2. ORL service is under pressure to meet the key performance indicators for FCT times. 3. Discharge time targets have not been met for the month. Investigation has identified

the following: a. Orthopaedics – ward staff have engaged well in sending patients to the

Discharge Lounge however, patients are being delayed awaiting clearance from the Orthopaedic team, Allied Health or Geriatrics. At times patients may also be delayed awaiting blood and tissue results or input from the Infectious Disease Team.

b. Plastics – RMO and nursing shortages are impacting on the service’s ability to discharge before 11am.

c. All SCI patients transferred to the Spinal Unit do not go through the Discharge Lounge, an ambulance collects them directly from the Ward.

The Chair acknowledged the work that Ms Gillian Cossey had done for CM Health during her time with the DHB.

6.8 Adult Rehabilitation & Health of Older People

The report was noted and taken as read.

6.9 Medicine, Acute Care & Clinical Support (Brad Healey) Gastro – hit the target in June as planned. MRI – hit the target in the last week of June. FCT – indicative performance for May is 74% (23 of 31 patients seen with 62 days). Of the breaches, three were due to patient choice, four were due to clinical considerations and one was due to capacity issues. Cardiology is exploring the opportunity to allow Nurse Practitioner-led clinics to be performed in Mangere locality. A Clinical Nurse Specialist will be appointed to assist in improving the uptake and outcomes of cardiac rehabilitation which includes running a cardiac rehabilitation community session at Pukekohe. Our nurses are very keen to become specialised and support people in the community.

6.10 Facilities The report was noted and taken as read.

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

6.12 Director of Allied Health (Martin Chadwick) The report was noted and taken as read. Mr Chadwick to update the Committee (date tbc) on the AHIED initiative (Allied Health Initiative for Education & Development). Whilst the implementation phase of AHIED has a

010


focus on the DHB, the intent has always been that it will have a wider focus to support allied health staff training in the non-hospital environment as well.

6.13 Director of Nursing The report was noted and taken a read.

Resolution That the Hospital Advisory Committee receive the Hospital Services Directorate Report for May2016. Moved: Dr Lyn Murphy Seconded: Ms Colleen Brown Carried: Unanimously The meeting closed at 12.35pm. The next meeting of the Hospital Advisory Committee will be Wednesday, 7 September 2016 at Ko Awatea, Middlemore Hospital. The Minutes of the meeting of the Counties Manukau District Health Board Hospital Advisory Committee held on Wednesday, 27 July 2016 are approved. Signed as a true and correct record on Wednesday, 7 September 2016. (Moved : /Seconded: ) Deputy Chair 7 September 2016 Dr Lyn Murphy Date

011

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


Hospital Advisory Committee Meeting – Action Items Register – 7 September 2016

DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

23.3.2016 4.10 Medicine – Intragam – Dr Johnson to talk to the regional Clinical Practice Committee about them undertaking a cost benefit analysis on the efficacy and efficiency of Intragam v what was used before.

Pending Dr Johnson 15.6.16 – Dr Johnson has discussed this with the Committee however, it may be some months before we get a response.

4.5.2016 3.2 Balanced Scorecard – report back on LOS trends by division, ethnicity and admission status.

7 September Mr Balmer Refer Item 7.5 on today’s agenda.

15.6.2016 2.4 Faster Cancer Treatment – 1-2 clinicians to attend to give the Committee a clearer understanding of where the FCT definition is going and a briefing on WOS palliative care planning for those patients who choose not to have treatment and care pathways for patients who do choose treatment.

7 September

Drs Richard Small & Wilbur Farmilo

Refer Item 6.2 on today’s agenda.

15.6.2016 3.1 Director’s Report – Dr Thornton to attend a meeting at the conclusion of winter to update on how well we went and to provide some comparisons with other DHBs across the region.

19 October (tbc)

Dr Thornton

15.6.2016 3.1 Director’s Report Report regularly against the ARI patients presenting to ED 10 or more times.

7 September

Mr Balmer


15.6.2016 3.2 Balanced Scorecard Outpatient DNA rates for Maaori & Pacific are showing as 11% and 9% respectively – advise what those % would represent in terms of numbers.

7 September

Mr Balmer


012

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


DATE ITEM ACTION DUE DATE RESPONSIBILI

TY COMMENTS/UPDATES COMPLETE

15.6.2016 3.10 ARHoP – keep a running brief each month on

national contracts and how this reorganisation/different specification is developing and any impact for CM Health.

7 September Ms Ralph-Smith


15.6.2016 3.11 Medicine – set a more ambitious target (than 5 working days) for non-gynae needle aspiration.


15.6.2016 3.14 Director of Nursing Report – Certification Audit presentation.

7 September Dr Hughes Refer Item 6.1 on today’s agenda.

27.7.2016 7.1 Director’s Report Executive Summary – pull out a few of the STEEP measures in the Balanced Scorecard for further discussion.


27.7.2016 7.6 Director of Midwifery – report back on what the next steps will be on the primary birthing units (location and number) after the MQSP report is signed off by the Ministry

30 November Ms Knetsch

27.7.2016 7.12 Director of Allied Health – report back on the AHIED initiative.

30 November Mr Chadwick

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Counties Manukau District Health Board 3.0 Resolution to Exclude the Public Resolution: That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General Subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

4.1 Minutes of HAC meeting 27 July 2016 with public excluded

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982). [NZPH&D Act 2000 Schedule 3, S32(a)]

Confirmation of Minutes For the reasons given in the previous meeting.

4.2 Action Item Register Confidential

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

Confirmation of Action Items Register For the reasons given in the previous meeting.

4.3 Patient Experience & Safety Report

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982). [NZPH&D Act 2000 Schedule 3, S32 (a)]

Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S9(2)(a)]

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Inpatient Experience – Two Years On

In July 2014 we started surveying CM Health patients on their experience. The specific aim of our Patient Experience Survey is to understand what matters most to our patients, how they rate us on what matters to them and why they give us the ratings they do.

The survey is reasonably lengthy. We make no apologies for this. CM Health are committed to improving patient experience, and to do this means we need quality information from our patients on exactly what it was that made their experience excellent, or good, or poor. We do this because evidence shows that improving patient experience is positively associated with a range of performance indicators, such as: higher levels of adherence to recommended prevention and treatment processes; better clinical outcomes; better patient safety within hospitals; less health care utilisation; and lower costs.1

We celebrated when 51 of our patients faithfully and methodically answered our questions in July 2014; we now have feedback from more than 4500 CM Health Patients and have amassed a significant amount of data thanks to the patients who have filled in our survey over the past two years. We have used their feedback to improve our performance. In the last twelve months our combined “very good” and “excellent ratings” have trended upwards, and we are now seeing steady improvements across some of our dimensions of care.

The sheer amount of data and suggestions we get does occasionally make it difficult to see where the priorities are. It is therefore helpful sometimes to step back and look at our data and to see what it is telling us about where we can make the most difference to our patients’ experiences. This is occasionally counter-intuitive. As an example, a large number of patients’ suggestions for improvement are focussed on food, amenities and noise, however the data tell us that if we only focussed on these we would be unlikely to see any difference in the way most patients rate the overall quality of their experience. In other words, food, amenities and noise control are least correlated to overall quality of experience in hospital.

The data tell us that to improve the overall quality of our patient experience then we need to get two things right. We need to ensure that our patients get consistent and coordinated care, and that every action and interaction gives them confidence in their care and treatment. Getting these two things right will improve our ratings and give us cause for celebration in another 12 months’ time.

David Hughes Deputy Chief Medical Officer

1Francis. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, Executive

Summary, 2013; p4 / Doyle, Lennox and Bell. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness, BMJ Open, 2013; 3. / Price et al. Examining the role of patient experience surveys in measuring health care quality, Medical Care Research and Review, 2014; vol 7(5)522-554. / Matthew et al. The patient experience and health outcomes, N Engl J Med, 2103: 368. / Coulter et al. Collecting data on patient experience is not enough: they must be used to improve care, BMJ, 2014; 348.

WHAT MATTERS TO OUR PATIENTS?

Counties Manukau Health Inpatient Experience Report no.7 August 2016:1

Communication is the aspect of our care most patients (57%) say makes a difference to the quality of their care and treatment.

“People introducing themselves, explaining their role and why they were involved made a difference. Some had better skills/manner at this than others.” (Rated very good)

How are we doing on communication?

10 70

Poor Moderate Very good

Being treated with compassion, dignity and respect makes a difference to the quality of care and treatment for nearly half our patients (45%).

“Doctors were very good but visiting specialists made you feel like you were taking up time.” (Rated very good)

How are we doing with dignity and respect?

6 81


Just over one-third of our patients (36%) rate having confidence in their care and treatment as one of the things that makes the most difference.

“I can honestly say it seemed to us both that people genuinely cared, were even interested in our lives.” (Rated excellent)

How are we doing with confidence?

6 80


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

058

How have we done? This month’s patient experience report tracks quarterly average ratings across a twelve-month period in order to determine whether the ratings for each dimension have improved, stalled, or slipped.

Our last annual report, in August 2015, showed a slow but steady improvement across 11 of our 12 dimensions of care. Whilst this is true of half of the dimensions in 2016, we are also seeing little or negative movement across the remaining six dimensions.

QUARTERLY AVERAGE RATINGS OF EACH DIMENSION AND CORRELATION

TO OVERALL RATINGS (JULY 2015 – JUNE 2016)

Key: ------ Improvement ----- Static ----- Slipping

CORRELATIONS TO OVERALL RATINGS

Improving our patients’ experiences means we need to focus on not only what matters to patients, but to also understand how different dimensions of care affect the quality of patient experience.

In addition to tracking ratings we have also calculated the correlations between patient ratings on each dimension, and how they rated their overall care and treatment. Hence, we can see that those patients who gave a high rating on consistent and coordinated care and confidence in their care were highly likely to rate their overall care and treatment positively.

Conversely, those who rated consistent and coordinated care and confidence in their care poorly were more likely to rate their overall care poorly. All these correlations are significant (p < .01)

When we look across each of the dimensions, we can see that of the six dimensions that have a strong or moderately strong association to positive overall ratings, four are static (within a .01 percentage point shift).

DIMENSION

JUL

SEP

2015

OCT

DEC

2015

JAN

MAR

2016

APR

JUN

2016

TREND CORRELATION

Consistent, coordinated care 8.1 7.9 7.8 8.1 STRONG

Confidence in care 8.5 8.4 8.4 8.4 STRONG

Dignity and Respect 8.4 8.7 8.3 8.5MODERATELY

STRONG

Communication 7.9 7.8 7.9 8MODERATELY

STRONG

Coordination of care 7.4 7.4 7.1 7.8MODERATELY

STRONG

Involvement in decisions 8.1 8 7.9 8MODERATELY

STRONG

Cultural needs 7.5 8.6 7.7 8.3 MODERATE

Information 7.8 7.3 8.1 8.1 MODERATE

Pain and nausea 8.1 7.9 8.4 8.3 MODERATE

Cleanliness 7.8 7.9 7.7 7.9 MODERATE

Allowing whānau support 8.3 8.5 8.2 8.1 MILD

Food and dietary needs 4 4.1 5 4.8 MILD


Rated overall care excellent

“Some staff can communicate with me in my own language, it made me feeling warm and it is easier for me to understand professional words.”

“Without exception, all of the staff .... from the cleaning lady to the Surgeon were courteous, polite and cheerful. I was very well treated by everyone with whom I came into contact... To be honest, it was far superior experience to what I expected.”

“I loved how I was treated … I was very well respected by all staff members right down to the cleaners and cooks… I will always cherish the love and care that all staff had shown to myself and my newborn baby…”

“I feel like I was at a private hospital that got very personal attention …. And I loved how I had a nurse that was there for me constantly and so considerate.”

Rated overall care very good

“The nurses were fantastic … one in particular came back when the doctors were there to reiterate my request for more consistent pain medication. Was fantastic to be backed up and have that support when I hadn't even asked for it.”

“Majority of the staff who worked with me were great. They were all kind, helped me when needed (physically and emotionally) and treated me with great respect.”

“I had some really lovely nurses- this made a huge difference to how well cared for I felt, and how valued I was as a person, and lifted my mood in the middle of an uncomfortable time.”

Rated overall care good

“The nurses were lovely, when you finally did see a dr they were very capable and informed.”

Rated overall care fair or poor

“I felt as though the decisions on my health care plan was made for me and "told" to me in a "matter of fact" kind of way and through various members of staff. There was no key person of contact that I could speak to. There was no expected time for Dr's visits/rounds and I often found out what was happening when a nurse or person drawing bloods would casually mention it … I didn't need you to hold my hand, I needed you to educate me.”

PATIENT VOICES

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IMPROVING OVERALL PATIENT EXPERIENCE Over the past few reports we have seen that, whilst our very good and excellent ratings are gradually trending upwards, so are our poor and fair ratings; primarily because less patients are choosing to rate their care as “good” and are instead choosing to rate it as poor or fair. Converting the patients who rate us “good” into “very good” and “excellent” would be key to improving our overall ratings. At the moment, however, it seems as though the main conversion is into the “poor” or “fair” categories.

WHAT SHOULD WE BE FOCUSSING ON? Paying attention to those dimensions which are most strongly correlated to overall ratings will help us improve our overall ratings. Our correlation scores show that, if we can give patients a “very good” or “excellent” experience in terms of consistent and coordinated care and confidence in their care, then we should see an associated rise in our ratings.

0

20

40

60

80

100Linear (Verygood / excellent)

Linear (Good)

Linear (Poor /Fair)


.720

CORRELATION The correlation between

consistent and coordinated care and the

overall rating is strong and significant (p<.01)

Consistent and Coordinated care Our last report on consistent and coordinated care, in March 2016, showed some significant improvements in our performance, most notably around the consistency and quality of doctor, nurse and midwife interactions.

These improvements, however, don’t appear to have shifted our overall ratings. Whilst our ratings for consistent and coordinated care are reasonably high (ranging between 7.8 and 8.1 out of 10), they have remained static.

Our patients have given us very clear messages on the things they would like to see improved. In particular, they want us to pay attention to ensuring:

Advice and care is consistent between staff and teams;

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

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

Communication is regular, consistent and informative;

Staff are consistently available and attentive and attended promptly; and

Care is coordinated and thorough e.g. planned tests are carried out.

8/10 Average rating for

consistent and coordinated care July

2015 – June 2016

.709

CORRELATION The correlation between

confidence and the overall rating is strong and significant (p<.01)

Confidence in care In April 2016 we learned that we rate well on confidence and trust. At least three-quarters of our patients tell us they are always confident they get good care and treatment and always have confidence and trust in the staff treating them. One quarter do not always feel this way.

Our performance on these measures has not changed since 2014.

Over the past two years, our patients have consistently asked us to:

Treat patients as partners in care. Listen, share information, check for understanding and talk through options;

Read clinical notes;

Value patients as people. Show compassion, empathy and kindness. Be proactive, helpful and friendly.

8/10 Average rating for

confidence in care July 2015 – June 2016

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Counties Manukau Health Inpatient Experience Report no.7 August 2016: 4

POSITIVE COMMENTS (61%)

OUR AMAZING STAFF (62%)

When asked to comment on anything that was particularly good about their hospital stay, most patients chose to comment on our staff. The words most frequently used to describe staff were “friendly”, “helpful”, “excellent”, “caring”, “kind”, “amazing”, “professional” and “honest.” These patients tell us that most staff of the staff they encountered approached their work with empathy, humour and a great deal of compassion, which does not go unnoticed or unappreciated.

“The support, compassion and understanding were exceptional in my stay … The nursing stuff in particular were all bright stars of medical intelligence and empathy and over the two weeks I stayed there, they were all so friendly and caring … Some nurses I really liked would pop in just to "chat" and see how I was going. The doctors, nurses and physios I had were all intelligent and caring. I felt not only understood but that they were on "my team". They worked well together and I felt informed and very well cared for.”

Many patients told of small acts of kindness by staff which made a huge difference as to how they felt about their stay.

“When I was told [my diagnosis], the nurses very kindly drew the curtains around for the family and I to be left in peace and also said the vacant bed in the room would stay that way, unless there was an emergency. This was very much appreciated and a kind thing to do.”

COMMUNICATION AND INFORMATION (9%)

Our patients tell us that good communication matters most to their care and treatment in hospital, and a number chose to reiterate this in their final comments. Many talked about how much they appreciated it when staff provided information, gave good explanations, listened and answered questions.

“The doctor sat and listened intently and asked questions. [The nurse] had the right balance of listening and asking relevant questions and then explaining what she was going to do etc.”

EFFICIENT, WELL ORGANISED SERVICE (7%)

Around 7% of respondents chose to comment on how impressed they were with the prompt and efficient service. Patients found it reassuring when they got a quick diagnosis and treatment.

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

“I was very impressed with the speed that the medical staff was able to access and properly diagnose my illness.”

OTHER

Other unprompted patient comments focussed on the excellent nature of some of our facilities and amenities (4%), the consistent care (2%) they received, how confident they felt in our care (2%) and that the food was nice (2%).

FOOD AND NUTRITION (29%)

Nearly one in three suggestions for improvement were focussed on food and nutrition. Most comments were about poor food quality and taste (12%), that patients were not given a menu, or they did not get what they asked for (5%), that food was served cold (2%), was not suitable for their dietary requirements (2%) or was served late (2%). Note that the numbers of patients commenting that the food needs improving has increased by 8 percentage points since the last annual report in 2015.

“After answering many times the question about allergies (egg), my daughter was still given an omelette and egg custard for lunch.”

“My mother was moved into several different wards and in doing so missed out several meals. Being a diabetic we thought this would be taken into consideration.”

CARE IN HOSPITAL (22%)

A number of comments for improvement focussed on care in hospital. These respondents felt that the service was not efficient or well organised, which many attributed to a lack of staff (7%), that staff were rushed, rude, not empathetic or uncaring (5%), that their confidence in individual members of staff who were treating them was undermined by being hurt or treated roughly (4%), or that their care was inconsistent (3%).

“I know that the nurses are really busy but sometimes it took a while before my bell was answered.”

“The night nurse was rude and rough. She was obviously tired which is acceptable but she should not take it out on the patient.”

“The doctors I had had a very condescending attitude which felt very demeaning.”

AMENITIES AND FACILITIES (10%)

One in 10 comments for improvements focussed on the amenities and facilities, in particular inefficient heating (in winter) or cooling (in summer), the inconvenience of shared bathrooms, the TV’s (too small, too old, not free, noise from other people’s), tired fixtures and fittings and the unpleasant “smokers corridor” outside the main entrance.

“Those small TV's mounted up on the wall are a joke for $5.00 a day, this is 2016 not 1985...”

“Make the wards more colourful and visually uplifting.”

NOISE AND VISITORS (10%)

Respondents ask that staff, particularly night staff, keep noise and non-work related conversations quiet (4%), and that the number of, and noise from other patient’s visitors is monitored (6%).

“…Noise did not cease until around 0300 as large number of relatives stayed over.”

OTHER

Other comments focussed on cleanliness (or lack thereof) (8%), lack of follow-up information at discharge (8%), inefficient administration (7%) or waiting too long for discharge (6%).

OVERALL COMMENTS At the end of our patient experience survey, we ask patients if there was anything they would like to comment on that was particularly good about their hospital care, or anything that they think could be improved. In total, there were 3301 patient comments. Most (61%) were positive, whilst 39 percent contained suggestions for improvement.

IMPROVEMENTS (39%)

061

Certification update 2016

Hospital Advisory Committee 7/09/16

062

2016 results

• 1 Continuous Improvement rating Tamaki Oranga – seclusion free inpatient care

• 19 Corrective Actions (as a result of partially attained

standards) 4 moderate risk 15 low risk

064

HDSS Rating system

Continuous Improvement (exceeds the standard)

Fully Attained (meets the standard)

Partially Attained (aspects meet the standard)

Unattained (substantially fails the standard)

065

High risk Requires reporting in 30 days

Moderate risk Requires reporting in 90 days

Low risk Requires reporting in 180 days

Negligible risk

066

Results in context Year

2012

2013

2014

2016

Type

Surveillance

Certification

Surveillance

Certification

No. of CI rating No. of corrective actions

0 CI rating 31 corrective actions 13 were rated moderate risk



1 CI rating 19 Corrective Actions 4 were rated moderate risk

067

The regional context at full certification

DHB Date of last full certification

CARs Moderate Low

CM Health 2016 4 15

NDHB 2013 8 14

WDHB 2013 11 19

ADHB 2014 13 15

068

The 4 Moderate risk…

1. Medication Management

- A corrective action from 2014

- Relates mostly to prescribing documentation

2. Skill mix

- Spinal patient was the subject of a patient tracer audit

- Recruitment delays

069

3. Physical environment

- Dirty / clean flow

- Infection control (reuse of single use items)

- Temperature fluctuations and facility wear and tear (Tiaho Mai)

- Cleanliness of staff areas (fridges, microwave)

4. Discharge planning

- Documentation and timeliness

070

The low risk Overdue controlled documents - This was already a corrective action and it remains open. Patient Food Fridge Temperatures - A corrective action that remains open. Temperatures not being consistently monitored, expired food, dirty fridges. Training, performance appraisals*, credentialing* - Mandatory training was already a corrective action and it remains open. *New finding

071

Complaint Management* - Lack of coordination across divisions noted, inconsistent logging practice, no corrective action follow up or database. Corrective actions - Inconsistent follow up of recommendations. This was already a corrective action and it remains open. Tiaho Mai - Locked doors - This was already a corrective action and it

remains open. *New finding

072

Tiaho Mai – *Access to courtyard - limited access to courtyard in Kuaka Tiaho Mai - *Activities - Limited activities available to patients Risk Management process - Was already a corrective action. Improvements noted – just need plan implemented Timeliness of service provision* - Delays to treatment or being seen. * New finding.

073

Care Plans - Was already a corrective action. Patient Goals - Was already a corrective action. Evaluations - fluid balance, falls, VTE. Nutrition* Right diet, right temperature etc. *New finding.

074

Documentation…..

• 5 of the 19 corrective actions relate to the adequacy of documentation, an all too common finding for DHBs:

• Completion of Assessment tools e.g. Fluid Balance Charts, Care Plans. Evaluations (Falls, Pressure Injuries, VTE etc), Medication Management, Enabler use (bed rails), discharge planning.

In 2014 the documentation issues were broader in scope, with poor documentation featuring in 11 corrective actions.

075

Faster Cancer Treatment

Counties Manukau Health September 2016

Wilbur Farmilo, Anne-Marie Wilkins, Richard Small

077

Faster Cancer Treatment (FCT) Health Target • 85% of patients graded with a high suspicion of cancer and need to be

seen within 14 days start treatment within 62 days of referral • Rising to 90% by 1 July 2017

Date of receipt of referral (for a

patient with a high suspicion of

cancer and a need to be seen within

two weeks)

Date of first cancer

treatment

62 days

Date of decision to treat (for any

patient who receives a first

cancer treatment)

Date of first cancer

treatment31 days

62 day indicator

31 day indicator

078

FCT Programme Overview

079

CM Health FCT 62-day Performance: May 2014- present

30%

40%

50%

60%

70%

80%

90%

May

June July

Augu

stSe

ptem

ber

Oct

ober

Nov

embe

rDe

cem

ber

Janu

ary

Febr

uary

Mar

chAp

rilM

ayJu

ne July

Augu

stSe

ptem

ber

Oct

ober

Nov

embe

rDe

cem

ber

Janu

ary

Febr

uary

Mar

chAp

rilM

ayJu

ne

2014 2015 2016

62-Dayperformance (%patients seenwithin 62 days)

62-Day Target

Quarterly Performance: Q3 2015 /16 71% (National avg: 74%) Q4 2015/ 16 79% (National avg: 75%)

080

Delay reasons - Patient Choice • 112 day breach – patient with gynaecological cancer went

overseas to visit sick sister • 5 day breach – patient with colorectal cancer wanted more

time to consider treatment – eventually declined treatment.

• 7 day breach – patient with lung cancer went on holiday, delaying diagnosis

• 8 day breach – patient with stomach cancer chose to defer medical oncology appointment, impacting chemotherapy start date.

• 16 day breach – patient with stomach cancer did not attend (DNA) outpatient appointment, and then went out of town for 2 weeks to attend a wedding.

081

Delay Reasons – Clinical Considerations

• Concurrent malignancies e.g lung cancer and lymphoma.

• Multiple investigations (often across more than 1 tumour stream) to determine the primary cancer in metastatic disease.

• Treatment of co-morbidities is required prior to treatment of malignancy.

• Time for wound healing prior to chemotherapy e.g where a defunctioning stoma is required.

082

50%

55%

60%

65%

70%

75%

80%

85%

90%

January February March April May June

2016

Target

62-Day performance(% patients seen within62 days)

Performance ExcludingPatient Choice

CM Health FCT 62-day Performance: Excluding Patient Choice

083

31-Day performance (% patients treated within 31 days of DTT)

60%

65%

70%

75%

80%

85%

90%

95%

May

Augu

st

Sept

embe

r

Oct

ober

Nov

embe

r

Dece

mbe

r

Janu

ary

Febr

uary

Mar

ch

April

May

June July

Augu

st

Sept

embe

r

Oct

ober

Nov

embe

r

Dece

mbe

r

Janu

ary

Febr

uary

Mar

ch

April

May

June

2014 2015 2016

31-Day performance (% patients treated within 31 days of DTT)

084

The journey…

Current State

Bridging the Gap

Future State

Understanding our systems as they

were

Redesigning our systems for the

future

Timely, quality cancer services

Utilising a collaborative quality improvement approach, supported by the Ko Awatea Service Improvement Team

085

Current State

Bridging the Gap

Future State

Underpinning principle: Improve patient experience, care quality and timely access

• Tumour stream-based continuous improvement approach • Grading KPI • HSCAN and 2-week grading flags • Timely diagnostics and pre-treatment assessment • Transition between services

086

Current State

Bridging the Gap

Future State

• A clear leadership structure • Regional collaboration and development • Regular reporting and data • Service-level leadership (SM/CL/CNC) • Future state pathway development • Micromanagement of patients through the pathway

087

Current State

Bridging the Gap

Future State

• Key developments to date: • Prospective performance monitoring and

reporting (CanTrack) • Fortnightly leadership group (executive level) • Weekly operations group (GM/SM level) • Weekly service team meetings • Twice-weekly CNC team huddles • FCT patient visibility through the pathway (eg FCT

stamp on documents) • Weekly reporting (service and programme level)

088

The Patient Story- How it was - 2014 • 55 year old female - Referred from GP • 29 days later – Attended clinic, placed on

waiting list for diagnostic test • 70 days later – diagnostic test performed • 9 days later – Saw doctor for results and to

agree treatment plan including further tests. 1st contact with Cancer Nurse Coordinator.

• 47 days later – Surgery • Total – 155 Days

089

The Patient Story- How it is improving- 2016

• 66 year old female, referral from GP • 1 day later - CNC alerted via daily referral

report, tracking commenced • 6 days later – Attended clinic, met CNC

diagnostic testing started • 14 days later – follow up with Dr for

results and agree treatment plan & further tests

• 13 days later – MDM review , refer to ACH • 26 days later – Surgery • Total – 60 days

090

Challenges…and opportunities

• Clinical and service-level engagement • Regional flexibility (inter-DHB transfers) • E-grading and internal referrals • Resource constraints:

– CT/MRI, Theatres, bronchoscopy, outpatient clinics

091

Future activity • MOH target requirements balance with clinical and

patient needs • Aligning patient needs and service design including

addressing patient equity and access • Transitioning from micromanagement to sustainable

processes – Targeted investment e.g. clinic based ultrasound scan

and biopsy and lung function testing at FSA – Whole of system approach including primary care and

screening

Let’s not hit the target…. But miss the point!

092

Where are we heading?

093

Counties Manukau District Health Board - Hospital Advisory Committee Agenda 7 September 2016

Counties Manukau District Health Board Hospital Advisory Committee

2015/16 Non-Financial Summary Quarter 4 Report

Recommendation It is recommended that the Hospital Advisory Committee: Note that this Q4 Summary Report was approved by ELT on 23 August 2016. Note the Quarter 4 progress against planned 2015/16 actions and performance expectations. Note the companion Quarterly summary report on the Northern Region Health Plan. Review the identified issues and associated actions. Prepared and submitted by Kitty Neill, Planning Advisor on behalf of Margie Apa, Director Strategic Development Purpose To provide a summary picture of how we are progressing against our planned commitments outlined in the 2015/16 CM Health Annual Plan. Significant Achievements Overall, we have performed well in meeting our commitments outlined in our Annual Plan for Quarter 4. In summary:

• Tobacco Primary – we achieved 92%, ranking 1st nationally. Over the past six months we have seen an 800% increase in referrals from primary care. This reflects increased commitment by PHOs not only to achieving the Health Target but also to achieving Smokefree 2025

• Tobacco Maternity – we achieved 100%, ranking 1st equal nationally

• CVD Health Target – we achieved an “outstanding” rating against this health target with the MOH commenting that we are “clearly leading the way in looking at the linkages between early identification, risk factor management and acute demand”. We are ranked 3rd nationally

• Immunisation – ranked fourth nationally for coverage at 8 months of age

• Long Term Conditions – we achieved an “outstanding” rating with the MOH noting our innovative work such as the Manaaki Hauora Campaign and the At Risk programme

• Diagnostic – for the first time all three colonoscopy wait time targets have been met

Key Issues Health Targets – not all targets have been met due to differing factors: • Faster Cancer Treatment Health Target remains a challenging target to meet. Close monitoring

continues through weekly tumour stream review, case review huddles, and CanTrack dashboard development. Concerns over impact of patient choice on performance is being discussed with MOH; benefit realisation of improvements currently underway will not be seen for another two months and

094


not evident in reporting due to the respective reporting. Note, end of year results for 2015/16 will be available in Quarter 1 2016/17 again due to the delayed reporting timeframe.

• Immunisation by 5 years is below the target (88% against target of 90%). However there has been a renewed focus on the five year immunisation target through B4 School Checks and primary care. This has resulted in a considerable improvement in our results over the last six months with a Q4 result of 88% achieved versus our Q2 result of 71% in December 2015. By ethnicity our results show Maaori at 82.9%, Pacific at 88.2% and Asian at 95.7%.

CM Health 2015/16 Quarter 4 Health Target Snapshot

* The national cancer target of 85% is to be achieved by Quarter 1 2016/17 due to the delay in reporting.

Secondary Primary Maternity

Quarter 1, 2015/16 95% 99% 69% 95% 95% 87% 96% 92%

Quarter 2, 2015/16 95% 103% 71% 95% 95% 88% 94% 92%

Quarter 3, 2015/16 95% 105% 70% 94% 95% 89% 100% 92%

Quarter 4, 2015/16 96% 109% 74% 95% 96% 92% 100% 92%

Achieved

National goal 95% 100% 85%* 95% 95% 90% 90% 90%

095


CM Health 2015/16 Quarter 4 Summary Progress Report – including MOH RATINGS

Dashboard Key

Yellow = Outstanding Green = Target Achieved Orange = Partially Achieved Red = Not Achieved

AP Ref.

Priority Indicator Frequency of reporting

Current Target

Performance – 2015/16 Quarter 4 Commentary / Interpretation

Total Maaori Pacific Other Asian

National Health Targets

2.1.3 Cancer Percentage of patients receiving their first cancer treatment (or other management within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks

Quarterly 85% by July 2016

74% While the target has not been met in Q4 with a final result of 74% (target based on six month retrospective data for January – June 2016), performance has improved in the three months from April-June 2016, with a result of 78% being achieved. To note is that 62-day performance data excluding patient choice achieved a result of 82%. We have completed a stock take of current activity compared with NHS best practice guidance and national DHB approaches. Overall we have implemented the majority of suggested actions. Further opportunities for development include structured escalation plans for patients that may breach, engagement with Primary Care around a whole of system approach, ongoing implementation and auditing the use of radiology imaging protocols and investigating the gap between expected and actual cancer registrations. Note that end of year results will be available in Q1 due to the three month delay in reporting.

2.1.6 CVD and Diabetes

Percentage of the eligible population who have had their cardiovascular risk assessed in the last five years

Quarterly 90% 92% 89% 93% 93%

2.1.2 Elective Surgery

Volume of elective surgery will increase by at least 4000 discharges per year

Quarterly Increase of 4,000 discharges per year

109%

2.1.1 Emergency Department Care

Percentage of patients admitted, discharged, or transferred from an ED within six hours

Quarterly 95% 96%

2.1.4 Immunisation Percentage of eight months olds who have had their primary course of immunisation on time

Quarterly 95% 95% 90% 97% 93% 99% The definition of the eight month immunisation health target requires that 95% of all eligible children aged eight months are immunised and that significant progress for the Maaori population group and, where

096


AP Ref.


Current Target



relevant, the Pacific population group has been achieved. While the 95% target was achieved for the total and Pacific populations, the coverage for Maaori was 90%. To note is that 22 Maaori children (4% of Maaori) who were not immunised on time, have now been immunised.

2.1.5 Smoking (hospital)

Percentage of hospitalised patients who smoke and were seen by a health practitioner in public hospitals and were offered brief advice and support to quit smoking

Quarterly 95% 96% 96% 96%

2.1.5 Smoking (primary)

Percentage of enrolled patients who smoke and were seen by a health practitioner in general practice and were offered brief advice and support to quit smoking

Quarterly 90% 92%

2.1.5 Smoking (maternity)

Percentage of pregnant women who identify as smokers, at the time of confirmation of pregnancy in general practice or booking with a Lead Maternity Carer, being offered advice and support to quit smoking

Quarterly 90% 100% 97.1%

MOH Quarterly Reporting Performance Indicators

2.3.7 Mental Health PP6: Improving the health status of people with severe mental illness through improved access

Quarterly

2.3.7 PP7: Improving mental health services using transition (discharge) planning and employment

Long terms clients

Quarterly These figures include those clients seen by the Consult liaison Paediatric team (CLPT) where referrals are received from within the general hospital. These clients are assessed and their care is followed up by the medical, surgical burns or other paediatric services. This team was re-configured in July to be part of the newly formed Department of psychological medicine. Though the operational management of this team now lies with the division of medicine, this team still needs to be considered as a team funded under the mental health ring-fence. The intricacies of MOH reporting are currently being looked at.

Child and Youth Quarterly 95% 84%

097


AP Ref.


Current Target



Without the inclusion of CLPT the compliance is 92.29%. Staff within the Mental Health Paediatric teams are using the agreed templates in a much more consistent manner in order to be able to conduct this audit electronically. Good progress continues to be made.

2.3.7 PP8: Shorter waits for non-urgent mental health and addiction services for 0-19 year olds - Mental Health (Provider Arm)

<3 weeks Quarterly 80% 76% The number of unique CMDHB domiciled clients aged 0-19 seen during the year ended 31 March 2016 was 6292, an increase of 6% from the 5938 unique clients seen in the corresponding period last year. This increase has meant delays for some but overall far more young people are accessing specialist mental health services and almost all are being seen within the expected timeframes. Referrals are triaged and those with the highest need are prioritized and those needing urgent intervention are seen within 48 hours. Kotahi Ra (first) appointment and universal booking system was developed and implemented in September 2014. This has successfully systemised the process for meeting demand and is assisting with maintaining responsiveness for routine (non-urgent) first appointments. The Whole of System / Integrated Locality approach including the development of School Based Mental Health services and the alignment of NGO / Primary Care at intake are amongst plans to further assist with sustainable progress against this target in 16/17.

<8 weeks Quarterly 95% 96%

2.3.7

PP8: Shorter waits for non-urgent mental health and addiction services for 0-19 year olds Addiction (NGOs)



2.3.8 Oral Health PP12: Utilisation of DHB-funded dental services by adolescents from School Year 9 up to and including age 17 years

Annual 85% 73% CM Health achieved 73.3% with 26,179 adolescents utilising dental services. Approximately 59% of utilisation was through mobile dental services on-site at secondary schools.

Growth to get closer to the target will be achieved by 2 main thrusts to improve access:

098


AP Ref.


Current Target



1. DHB submission to the remaining secondary schools to permit on-site dental e.g. Howick college(900 kids not accessing dental), plus the private schools.

2. Promoting access to adolescents outside the school system such as in alternate education, tertiary institutes, employed or unemployed.

2.3.2 Long Term Conditions

PP20: Long term conditions/DCIP

Quarterly

2.3.2 PP20: Diabetes - Improved management (HbA1c)

Quarterly

2.3.4 PP20 Acute Coronary Syndrome - Percentage of high-risk patients who receive an angiogram within 3 days of admission (‘day of admission’ being ‘Day 0’)

Quarterly 70% 80%

2.3.4 PP20 Acute Coronary Syndrome - Percentage of patients presenting with ACS who undergo coronary angiography who have completion of ANZACS QI ACS and Cath/PCI registry data collection within 30 days

Quarterly 95% 92% High acute workload may be impacting on staff ability to enter data. However, focus is being put on timely data entry.

2.3.3 PP20: Stroke - Percentage of potentially eligible stroke patients thrombolysed

Quarterly 6% 10.5%

PP20: Stroke - Percentage of stroke patients admitted to a stroke unit or organised stroke service with demonstrated stroke pathway

Quarterly 80% 81%

2.1.4 Immunisation

PP21: Percentage of two year olds who are fully immunised

Quarterly 95% 95% 92% 98% 92% 98 %

PP21: Percentage of five year olds who are fully immunised

Quarterly 90% by June 2016

88% 83% 88%

91%

96% Refer to ‘Key Issue’ section above

099


AP Ref.


Current Target



2.3 System integration

PP22: Improving system integration

Quarterly The MOH queried our mitigation strategies to address risks associated with Advanced Care Planning (ACP) conversations. A quality improvement project commenced with ED facilitated by Ko Awatea with a focus on this topic. First meeting took place in July 2016. In terms of a sector-wide ‘end to end’ focus an ACP process review project is currently being considered.

2.3.8 Health of Older People

PP23: Improving Wrap Around Services - Health of Older People

Quarterly

2.1.3 Improving wait times

PP24: Cancer Multidisciplinary Meetings Quarterly

2.2.2 Mental Health PP25: Prime Minister’s Youth Mental Health Project

Quarterly

2.3.7 PP26: The Mental Health and Addiction Service Development Plan

Quarterly

2.2.3 Child Health PP27: Delivery of the Children’s Action Plan

Quarterly

2.2.1 Rheumatic Fever

PP28: Hospitalisation rates (per 100,000 total population) for acute rheumatic

Quarterly 5.9 per 100,000 (Total)

2.3.5 Improving waiting times for diagnostic services

PP29a: Coronary angiography – within 3 months (90 days)

Monthly 95% 99%

2.3.5 PP29b: CT –within than 6 weeks (42 days)

Monthly 95% 99%

2.3.5 PP29c: MRI – within 6 weeks (42 days) Monthly 85% 67% The last week of the fourth quarter ended in achievement of the 85%. We anticipate that the July result should demonstrate achievement of this diagnostic indicator.

2.3.5 PP29d: Urgent diagnostic colonoscopy – within two weeks (14 days)

Monthly 75% 95%

2.3.5 PP29e: Diagnostic colonoscopy – within six weeks (42 days)

Monthly 65% 80%

100


AP Ref.


Current Target



2.3.5 PP29f: Surveillance colonoscopy - within twelve weeks (84 days) beyond the planned date

Monthly 65% 97%

2.1.3 Faster Cancer Treatment

PP30a: FCT - Length of time taken for patients to receive their first treatment (or other management) for cancer from date to decision-to-treat (31 day indicator)

Quarterly

PP30b: All patients ready-for-treatment, wait less than four weeks for radiotherapy or chemotherapy from decision to treat

Quarterly

2.1.2 Inpatient length of stay

OS3: Inpatient length of stay

Elective LOS Quarterly 1.59 days 1.67

3.3.3 Acute LOS Quarterly 2.63 days 2.57

7.1.2 Data Quality OS10: NHI and data submitted to National Collections

Quarterly

7.1.2 National Collections Quarterly

7.1.2 PRIMHD File Success Rate Quarterly

2.1.2 Electives SI4: Elective services standardised intervention rates (major joints, cataracts, cardiac surgery, percutaneous revascularisation & coronary angiography)

Quarterly Below expectations for angiography & angioplasty.

Screening SI6: Cervical Screening Quarterly 80% 75% 69% 82% 79% 67% An small upward trend across all ethnicities with a 3% increase in Maaori coverage.

7.1.4 Mental Health OP1: Mental health output delivery against plan

Quarterly

2.5 Patient Experience

DV4: Improving patient experience - Proportion of patients who have rated CMH overall experience of care and treatment as ‘Very Good’ or ‘Excellent’

Quarterly

2.2.8 Childhood Obesity

DV5: Childhood obesity Quarterly

101


AP Ref.


Current Target



CFA Appoint Cancer Nurse Coordinators

CFA Appoint Cancer Psychological and Social Support Workers

CFA B4 School Check Funding

CFA DSS Funding

CFA Well Child Tamariki Ora Services

CFA Green Prescription

CFA Elective Variations

CFA Rapid Response Sore Throat Primary and Community Services

102


Northern Regional Health Plan Quarter 4 Summary Report Key achievements this quarter include:

• Reasonable performance against the Minister’s health targets

• Comparison of annual mean reported pressure injury rates in age related residential care units show rate improvements of over 20% between 2014/15 and 2015/16

• The Child Health Network has completed a draft report detailing a proposed model for home injury prevention for children aged 0-5 years. This is being shared with sector partners.

• The national suite of dementia education resources (14 segments) for Primary Care is now complete

• ECG transmission by ambulance is well established and proving to be very successful • Work is well underway on the Community Cardiac Arrest project, effort is now focussed on appropriate phone

apps to enable bystanders to identify CPR and AED locations in the northern region • Diabetes Health Pathways have gone live across the region and are being used by GPs

• Major Trauma inter-hospital transfer guidelines have been finalised and formatted for implementation • The Mental Health Child and Youth service review work has been completed, with regional sign-off. • The Region has held two National Mental Health KPI Programme forums, one in Wellington and one in

Auckland, attended by around 180 participants. • Stroke services in the Northern Region have now achieved the KPI target for patients admitted to a dedicated

stroke bed for three consecutive quarters • The Youth Health Network has developed Regional Standards for Quality Care for Adolescents and Young

Adults in Secondary or Tertiary Care • The Regional Radiology IS review was completed and was endorsed by both the Radiology Network meeting in

May and the Regional Clinical Business Applications Group in June • DHB elective services have met the regional target of 65,631 elective discharges • The University of Auckland Intensive Sonography Course two year pilot ended in June 2016. The independent

evaluation report showed the pilot was very successful and achieved the pilot aims. This course is continuing via a shared funding arrangement with the DHBs and three private providers.

• Good progress is being made on the NEHR Programme • Use of the e-Referrals system continues to increase • The Northern Region has completed the first DHB- tranche of the Investor Confidence Rating assessment with

Treasury and Ministry and has been complimented on the level of engagement throughout the process.

103


The table below shows progress against the top 10 commitments

On track Some concerns regarding progress to target

Not achieved or declining performance

Commitment Status Notes

All Interventions

1 Achieve and maintain the Minister’s health targets

Reasonable progress against the health targets. The main concern for the Region is achievement of the July 1 2016 Faster Cancer Treatment target

Quality and Safety

2 Maintain falls causing major harm in the acute sector to a rate of less than or equal to 0.10 per 1000 patients days

Achieved. Rate of 0.05 at June 2016

Life and Years

3 Consistent clinical measurement tool for child health growth and obesity available across the region (establish consistent baseline measurement)

The Éclair package that includes the Sysmex solution electronic growth chart is being implemented in ADHB in August. The regional working group are working with Health Alliance to confirm the process for regional implementation.

4

95% of General Practices will be enabled to utilise the Northern Region Cognitive Impairment Pathway (baseline measurement of the % application of the pathway to be progressed alongside the roll-out)

On track, with 92 GP practices currently enabled (evaluation of tool initiated)

5 80% of patients who have a stroke are treated on a stroke unit

Achieved at 83.2%; March 2016

6 80% of patients presenting with ST elevation myocardial infarction (STEMI) referred to percutaneous coronary intervention (PCI) will be treated within 120 minutes

Achieved at 81.3%; Jun 2016

7 85% of patients receive their first treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks by July 2016 (in 2015/16 demonstrable improvement towards July 2016 target for 85%)

Consistent upward trend towards July target.

Currently at 73%; March 2015

8 Establish consistent measures and baseline for access to youth forensic services for each of the three services elements – court liaison, CYF youth justice residences and community

Reporting framework developed for Youth Forensic Services, progressing thorough final approvals and sign off.

9 37,000 patients undergo retinal screening

This is an annual target which is substantially achieved YTD. 26,002 to March 2016.

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Commitment Status Notes

The informed Patient

10 A 20% increase in the 2014/15 end of year ACP conversations documented by each of the four DHBs

Achieved

end of year target volumes

Northland target: 678 Waitemata target: 1,717

Auckland target: 5,558 Counties target: 6,112

2015/16 Conversation numbers by quarter:

Q1 Q2 Q3 Q4 Total % of annual target

NDHB 445 314 390 520 1,669 246%

WDHB 184 315 625 546 1,670 97%

ADHB 931 1,327 1,756 2,082 6,096 109%

CMDHB 1,418 2,718 1,080 1,185 6,401 105%

Total 2,978 4,674 3,851 4,333 15,836 112%

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Counties Manukau District Health Board Hospital Advisory Committee

Hospital Services Report

Recommendation It is recommended that the Hospital Advisory Committee: Receive the Hospital Services Report covering activity in July 2016.

Provide feedback on the revised format of the report, and in particular, guidance on what project-level information would be of interest to the Committee. Prepared and submitted by: Phillip Balmer, Director Hospital Services Executive Summary Month in review

Overview July was a successful month for the Hospital Services Directorate. In addition to closing out a very successful 2015/16 year, we also made significant gains in planning for the year ahead, as well as delivering to the majority of our targets for the month. The Provider Arm delivered a favourable result for the first month of the financial year, with a $23K surplus. Volumes for the month are slightly behind contract (overall (2.4)%) which reflects an uncharacteristic drop in discharges and Emergency Department presentations when compared with the previous year. Initiatives to Integrate Care: Reporting Lines and Leadership Structure Towards the end of May, the Hospital Services Directorate, in conjunction with Professional Leaders and the Primary, Community and Integrated Care Director, began consultation on restructuring the Directorate to better support the delivery of the CM Health “Healthy Together 2020” Strategic Direction. Following an iterative and comprehensive engagement process, decisions have now been made with respect the realignment of Hospital Services’ Divisions and Leadership. These decisions are expected to take effect at the end of August. In summary:

• The Medicine, Acute Care and Clinical Support division will become the Emergency Care, Medicine and Integrated Care division. Material changes include the removal of Clinical Support Services, and the addition of responsibility for leading the development and implementation of plans to progress integrated care initiatives in partnership with other Hospital services and the Primary, Community, and Integrated Care directorate.

• The Clinical Support Services removed from the current Medical, Acute Care and Clinical Support division will form a new division; Central Clinical Services. This newly formed division will also include the Food Services function currently within the Facilities division. This new division has been established to recognise the vital role these services play in determining patient outcomes and experience, and performance across the Hospital.

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• The Facilities division has also been reorganised to increase emphasis on strategic and operational support for the entire organisation’s facilities and assets; going forward this division will be known as Facilities and Asset Management. In order to reorientate the focus of this division, Non-Clinical Support Services will be shifted to Middlemore Central. In addition, the new-look Facilities and Asset Management division will assume responsibility for Procurement and Environmental Sustainability.

• With the addition of Non-Clinical Support Services (including contracted services), Middlemore Central will be expanded from an operations centre to a division of Hospital Services in its own right. Management of these services through Middlemore Central will enable effective operational 24/7 coordination in response to day-to-day changes in demand and complexity. The expanded division will also take a lead role in recognising, growing, and developing the role of volunteers across the organisation.

• Remaining Hospital Services divisions will predominantly stay the same; however, it is worth noting that management of Stroke Care will shift to Adult Rehabilitation and Health of Older People to enable the development of an integrated stroke service that will support delivery of stroke improvement goals. Additionally, the Surgical and Ambulatory Care division will be renamed to Surgical, Anaesthesia and Perioperative Services to provide clarity of function.

We recognise that these structural changes are an enabler, and in themselves will not integrate services. Therefore the Hospital will continue to emphasise the need for each service to identify and implement new models of integrated care. Integration plans will be developed by each division in conjunction with respective professional leaders and Primary, Community, and Integrated Care colleagues, and regularly monitored. Increasingly the Hospital Advisory Committee can expect to see some of these transformation initiatives highlighted through the divisions’ regular reports. Hospital Services 2016/17 Project Plan Each year, in order to remain a financially sustainable operation that continues to provide high-quality effective healthcare, Hospital Services sets an ambitious project workplan consisting of a number of service-led transformation, improvement, and revenue initiatives. A high-level overview of this workplan and the status of projects within it is provided below. Going forward, each division will include a summary update on their project portfolio within their respective reports. In order to provide perspective on the type of work being progressed, initiatives have been stratified into one of four key outcome categories:

1. Transformation: Initiatives which will enable significant business transformation, and change how we provide services to patients and carry out our operations.

2. Service Improvement: Initiatives which will enable us to put in place new processes and procedures within services, or reconfigure how we operate, to improve outcomes.

3. Business as Usual: Improving existing processes and practice to improve quality, patient safety, experience of care, and to use our resources efficiently.

4. Revenue: Opportunities to increase revenue or deliver savings through reducing costs or avoiding budgeted costs.

Category Number Examples

Transformation 31 Healthy Together Technology Projects, Manukau Wellness Park

Service Improvement 73 Production Planning initiatives, Navigation

Business As Usual 41 Optimising Patient Flow, Reducing Harm, Improve Data Quality

Revenue 33 ACC Rehab Revenue, National Procurement, Bureau Reduction

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The graph below demonstrates the number of initiatives within each division, and their current status i.e. implementation, planning, execution, close out, and benefits realisation.

Changes to the Hospital Advisory Committee Report

Over the past few reporting cycles we have made a number of incremental changes to improve the quality and presentation of the regular report to the Committee. Key points to note are:

• Performance against our National Health Targets is now presented at the top of the overarching Hospital Services Balanced Scorecard, and Volumes are now presented in the Finance section of the report. Both of these were previously reported as part of the Executive Summary in isolation from the majority of our performance indicators.

• Reorientation of the division Balanced Scorecards to include commentary for non-compliant measures. The intent is to create greater accountability and transparency for the management of areas where we are off-track. Provisional space for trend lines has also been included, however it is not possible to provide a trend line for the first month of the reporting period.

• The addition of a traffic light rating column in the division Balanced Scorecards. This enables the viewer to note performance at a glance, and to quickly drill down to areas of interest or concerns. ‘Green’ indicates the target has been met, Amber indicates a negative variance for which there is an agreed plan in place to deliver by year end, and ‘Red’ indicates areas of non-compliance with no remedial plans.

• A status update table within the divisional reports for issues previously raised under the ‘emerging issues’ section. This table ensures regular updates are provided on issues that have previously been brought to the attention of the Committee; providing reassurance that they are being appropriately managed.

0 5 10 15 20 25 30 35 40 45

Women's Health

SAC

Middlemore Central

Mental Health

Medicine

Kidz First

Information Services

Hospital Services

Healthy Together Technology

Facilities & Engineering

ARHOP

4

14

7

18

22

8

2

2

1

20

1

2

9

3

1

5

3

3

1

8

5

11

6

6

1

4

2

5

3

Current State of Hospital Services FY16/17 Workplan Initiatives by Division July 16

1. Initiation

2. Planning

3. Execution

4. Close Out

5. Benefits Realisation

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7.2 Balanced Scorecard Glossary

ESPI Elective Services Patient Flow Indicators FTE Full Time Equivalent MOH IDP Ministry of Health Indicator of DHB Performance N/A Not Applicable P&WCC Patient and Whaanau Centred Care STEMI PCI ST-elevation Myocardial Infarction Percutaneous Coronary Intervention YTD Year to Date Balanced Scorecard

Key performance indicators for July are reported in the Balanced Scorecard below. A list of definitions for the scorecard measures is available from the Director Hospital Services’ office on request. Note that the ‘Enabling High Performing People’ measures are reported one month in arrears.

Trend by monthFY16&17 Jul-16 Target Var Actual Target Var

Emergency Department - 6 hour Length of Stay target 96% 95% 1% 96% 95% 1%Faster Cancer Treatment - % high suspicion first cancer treatment within 62 days (indicative 76% 85% -15% 70% 85% -15%Elective surgery discharges 1,248 1,185 5.3% 1,248 1,185 5.3%% smokers receive smokefree advice -Total 97% 95% 2.0% 97% 95% 2.0%


Total Caseweight 7,312 7,495 -2.4% 7,312 7,495 -2.4%Acute Caseweight 5,804 5,992 -3.1% 5,806 5,992 -3.1%Elective Caseweight 1,508 1,503 0% 1,508 1,503 0%Total Discharges * 8,928 9,362 -4.6% 8,928 9,323 -4.2%Budgeted FTEs 5,875 6,035 2.7% 5,875 6,035 2.7%Operating Costs ($000) $22,227 $21,284 -4.4% 22,227 $21,284 -4.4%Personnel Costs ($000) $44,973 $47,108 4.5% 44,973 $47,108 4.5%Financial Result Total ($000) $450 $427 $23 450 $427 $23Outpatient First Specialist Assessment Volumes 4,147 4,558 -9% 4,147 4,558 -9%Outpatient Follow Up Volumes 10,115 11,305 -11% 10,115 11,305 -11%Virtual First Specialist Assessments (GP consult and nonpatient appointments) 260 321 -19% 260 321 -19%Reduce clinical outsourcing ($000) $2,174 $2,288 $114 2,174 $2,288 $114

HOSPITAL SERVICES BALANCED SCORECARD - JULY 2016

Year to date

Year to date

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Trend by monthFY16&17 Jun-16 Target Var Actual Target Var

Excess Annual Leave dollars ($000) - estimated cost for excess $3,614 $1,221 -$2,393 N/A N/A N/AAdult Rehabilitation and Health of Older People $68 $74 $6 N/A N/A N/AMedicine, Acute Care and Clinical Support $662 $372 -$290 N/A N/A N/ASurgical and Ambulatory Care $1,444 $435 -$1,009 N/A N/A N/AMental Health $303 $174 -$129 N/A N/A N/AWomen's Health and Kidz First $796 $167 -$629 N/A N/A N/A

% Staff Annual Leave >2 years 12.5% 5.0% -7.5% 12.1% 5.0% -7.1%Adult Rehabilitation and Health of Older People 4.6% 5.0% 0.4% 4.5% 5.0% 0.5%Medicine, Acute Care and Clinical Support 8.9% 5.0% -3.9% 9.4% 5.0% -4.4%Surgical and Ambulatory Care 16.6% 5.0% -12% 15.5% 5.0% -11%Mental Health 8.7% 5.0% -3.7% 8.5% 5.0% -3.5%Women's Health and Kidz First 23.9% 5.0% -19% 21.8% 5.0% -17%

% Staff Turnover (YTD no. voluntary turnovers by average headcount) 10.2% 10.0% -0.2% 9.8% 10.0% 0.2%% Sick Leave 3.7% 2.8% -0.9% 3.0% 2.8% -0.2%Workplace Injury per 1,000,000 hours 1.5 10.5 9.0 14.4 10.5 -3.9

Jul-16 Target Var Jul-15 Target VarWorkforce Population Workforce Population

Maaori 7% 16% -9% 7% 16% -9%Pacific 12% 23% -11% 12% 23% -11%Asian 29% 23% 6% 28% 23% 5%NZ European / non-specified/ other 51% 38% 14% 53% 38% 15%


% e-medication reconciliation -high risk patients within 48hrs 68% 80% -12% 68% 80% -12%% Serious Pressure Injuries rate / 100 Patients 1.9% 3.5% 1.6% 1.9% 3.5% 1.6%Falls causing major harm rate / 1,000 bed days 0.07 0.00 -0.07 0.07 0.00 -0.07Rate of adverse events / 1,000 bed days 73 N/A N/A N/A N/A N/ACentral Line Associated Bacteraemia (CLAB) rate / 1,000 line days 5.0 0.00 -5.0 5.0 0.00 -5.0Rate of S. aureus bacteraemia rate / 1,000 bed days 0.07 0.00 -0.07 0.07 0.00 -0.07

Q3 15/16 Target Var Actual Target Var% 75+ years assessed for the risk of falling # 96% 90% 6% N/A N/A N/A% 75+ years assessed for falls risk with falls intervention plans # 98% N/A N/A N/A N/A N/A

Year to date

Quarterly reporting

Year to date

Average last 12 months

Year

Workforce Diversity

Enab

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Hig

h Pe

rfor

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Firs

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% Magnetic Resonance Image (MRI) scans completed within 6 weeks from referral - MOH IDP 86% 85% 1% 86% 85% 1%% Computerised Tomography (CT) scans completed within 6 weeks from referral - MOH IDP 98% 95% 3% 98% 95% 3%% urgent diagnostic colonoscopy within 14 days - MOH IDP 100% 85% 15% 100% 85% 15%% diagnostic colonoscopy patients within 42 days - MOH IDP 75% 70% 5% 75% 70% 5%% surveillance colonoscopy patients within 84 days - MOH IDP 95% 70% 25% 95% 70% 25%% cardiac STEMI-PCI (angiography) <120mins - Northern Region 83% 80% 3% 83% 80% 3%% Coronary Angiography within 90days - MOH IDP (1mth arrears) 96% 95% 1% 96% 95% 1%ESPI 2: No. patients waiting >120 days mths for FSA - Elective ∆ 14 0 -14 14 0 -14ESPI 5: No. patients waiting >120 days treatment - Elective ∆ 1 0 -1 1 0 -1Radiology - Inpatient radiology completion times <24hrs 93% 95% -2% 93% 95% -2%Radiology- Emergency Care radiology completion times <2 hrs 95% 95% 0% 95% 95% 0%

Jul-16 Target Var Actual Target VarFaster Cancer Treatment - % high suspicion first cancer treatment within 62 days - MOH FCT 77% 85% -8% 77% 85% -8%Faster Cancer Treatment - % confirmed diagnosis first cancer treatment within 31 days 85% N/A N/A 85% N/A N/A% Radiology results reported within 24 hours 60% 75% -15% 60% 75% -15%


Average Length of Stay - Acute Inpatient - MOH IDP 2.6 3.0 0.4 2.6 3.0 0.4Average Length of Stay - Acute Arranged/ Elective - MOH IDP 2.0 1.4 -0.6 2.0 1.4 -0.6Middlemore Hospital % patients to discharge lounge or home by 1100hrs 18% 30% -12% 18% 30% -12%Acute Readmissions within 7 days - Total 2.2% 2.9% -0.7% 2.2% 2.9% -0.7%Acute Readmissions within 28 days - Total - MOH IDP (1 month in arrear) 7.1% 7.6% 0.5% 7.0% 7.6% -0.5%Acute Readmissions within 28 days - 75+ years - MOH IDP (1 month in arrear) 12% 12% 0.1% 12% 12% -0.1%Emergency Department Presentations - 75+ year olds 1,109 807 -302 1,109 807 -302% clinical summaries (meddocs) authorised <7 days of creation 75% 95% -21% 75% 95% -21%% of patient outliers - not on home ward <5% 4.3% 5.0% 0.7% 4.3% 5.4% 1.1%

% Eligible stroke patients thrombolysed - Northern Region 11% 6.0% 4.5% 8.9% 6.0% 3.0%% DHB Mental Health Services - children/ youth (0-19years) seen by 3 weeks for non-urgent 74% 80% -6% N/A N/A N/AMental Health access rate - clients seen in last 12 months as % of population (0-19 Years) 3.8% 3.2% 0.6% N/A N/A N/AMental Health access rate - clients seen in last 12 months as % of population (20-64 Years) 3.7% 3.2% 0.5% N/A N/A N/AMental Health access rate - clients seen in last 12 months as % of population (64+ Years) 2.3% 2.6% -0.3% N/A N/A N/A

Quarterly reporting

Year to date

Year to date

Year to dateQuarterly Reporting

Year to date

Tim

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Syst

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n (E

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)

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Outpatient - First Specialist : Follow-up Clinic ratio 41% 44% 3.0% 41% 44% 3.0%Outpatient - Did Not Attend rates - Maaori 21% 10% -11% 21% 10% -11%Outpatient - Did Not Attend rates - Pacific 17% 10% -7.3% 17% 10% -7.3%Theatre List Utilisation 87% 83% 3.3% 87% 83% 3.2%Day of Surgery Admissions (DOSA) 88% 90% -2.0% 88% 90% -2.0%Day Case Rate (Elective/ Arranged) 74% 65% 8.5% 74% 65% 8.5%% Medical Assessment patients with Length of Stay < 28 hours 82% 65% 17% 82% 65% 17%No. Hospital bed days occupied (against forecast open beds) 20,505 22,799 11% 20,505 22,799 11%No. Length of Stay outliers (LOS >10 days)* 290 296 2.1% 290 296 2.1%


% smokers receive smokefree advice - Maaori 97% 95% 2.0% 97% 95% 2.0%% smokers receive smokefree advice - Pacific 98% 95% 3.0% 98% 95% 3.0%% smokers receive smokefree advice - Asian 94% 95% -1.0% 94% 95% -1.0%

% Women (45-60yrs)with Breastscreen in 24months - Total 2107 2255 -148 69% 70% -1%% Women (45-60yrs)with Breastscreen in 24months - Maaori 261 269 -8 67% 70% -3%% Women (45-60yrs)with Breastscreen in 24months - Pacific 507 370 137 77% 70% 7%

Trend by month FY16&17 Jul-16 Target Var Actual Target VarPatient experience Survey data - month (n=136) and YTD (n=136) 79% 90% -11% 79% 90% -11%

NOTES* performance is against previous year's actual∆ ESPI interim results subject to change

% Screened in last 24 monthsVolumes Screened

Year to date

Year to date

Year to date

P&W

CCEq

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Effi

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7.3 Finance Glossary

DHB District Health Board FTE Full Time Equivalent ORL Otorhinolaryngology Service WIES Weighted Inlier Equivalent Separations Month in review

The Provider Arm produced a $23k surplus for July 2016. This contributes to the consolidated DHB variance of $31k favourable to budget for the month. Volumes for the month are 2% behind contract (Acute (3)%, Elective 0%) reflecting an unusual drop in discharges and Emergency Department presentations for July (compared to last year). Unfavourable revenue timing differences, including a delay in the opening of the Retail Pharmacy were mitigated by existing vacancies across the services and a high uptake of annual leave for the July school holidays. Delivery of change projects and their associated benefits within the Hospital Services Directorate will be monitored closely. The benefit target for the current financial year is $16.4M.

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Financial Results

MitigationActual Budget Variance Comparative Actual Budget Variance Forecast Budget Variance Provide

$(000) $(000) $(000)Variance to Prev Mnth $(000) $(000) $(000) $(000) $(000) $(000)

Mitigaton Stragegy where Full Year Variance is unfavourable

Income

Government Revenue 4,483 4,916 (433) U

4,483 4,916 (433) U 56,311 56,744 (433) UDelayed billings as a result of lower volumes - offset against reduced costs.

Patient/Consumer Sourced 998 1,024 (26) U 998 1,024 (26) U 12,099 12,126 (26) U

Other Income 2,077 2,912 (834) U

2,077 2,912 (834) U 30,505 31,339 (834) UDelayed opening of Retail Pharmacy, offset by drugs and personnel cost reductions.

Funder Payments 65,583 65,599 (16) U 65,583 65,599 (16) U 787,169 787,185 (16) U

Total Income 73,141 74,451 (1,309) U 73,141 74,451 (1,309) U 886,085 887,394 (1,309) U

Expenditure

Personnel 44,973 47,108 2,135 F 44,973 47,108 2,135 F 581,024 583,159 2,135 F See below

Outsourced Personnel 1,551 1,116 (435) U 1,551 1,116 (435) U 13,827 13,392 (435) U See below

Outsourced Clinical 2,174 2,288 114 F 2,174 2,288 114 F 27,778 27,892 114 F Offset by favourable personnel costs.

Outsourced Other 3,047 3,098 51 F 3,047 3,098 51 F 37,127 37,178 51 F Offset by favourable personnel costs.

Clinical Supplies (excluding Depreciation) 9,298 8,495 (804) U

9,298 8,495 (804) U 105,782 105,109 (673) U

Unexpected cost increases driven by over delivery of Surgical volumes in July - currently being investigated; unrealised planned savings, with an expectation to achieve BOY.

Other Expenses 6,157 6,288 131 F 6,157 6,288 131 F 73,037 72,988 (50) UTotal Expenditure (excl Depreciation, Interest and Capital Charge) 67,200 68,392 1,193 F 67,200 68,392 1,193 F 838,574 839,717 1,143 F

Earnings before Depreciation, Interest and Capital Charge 5,942 6,058 (117) U 5,942 6,058 (117) U 47,510 47,677 (167) U

Depreciation 2,921 2,894 (26) U 2,921 2,894 (26) U 34,759 34,733 (26) U

Interest 1,059 1,225 166 F 1,059 1,225 166 F 14,534 14,700 166 F

Capital Charge 1,512 1,512 0 F 1,512 1,512 0 F 18,149 18,149 0 FTotal Depreciation, Interest and Capital Charge 5,492 5,632 140 F 5,492 5,632 140 F 67,442 67,582 140 F

Net Surplus/(Deficit) Provider 450 427 23 F 450 427 23 F (19,932) (19,905) (27) U

Consolidated Statement of Financial PerformanceJuly 2016

Full YearMonth Year to Date

114



$(000) $(000) $(000)Variance to Prev Mnth $(000) $(000) $(000) $(000) $(000) $(000)


Medical Personnel 14,147 14,982 835 F

14,147 14,982 835 F 185,477 186,312 835 F

Reflect high vacancies, partially covered by bureau, overtime and casual staff; and high leave taken for July school holidays.

Nursing Personnel 17,362 17,789 427 F

17,362 17,789 427 F 217,705 218,131 427 FReflect high high leave taken for July school holidays, covered by bureau, overtime and casual staff.

Allied Health Personnel 6,290 6,767 477 F

6,290 6,767 477 F 83,985 84,462 477 F


Support Personnel 2,192 2,089 (104) U

2,192 2,089 (104) U 26,371 26,267 (104) UCleaners, Orderlies, Security Officers - to reduce overtime spending

Management/Administration Personnel 4,981 5,482 501 F

4,981 5,482 501 F 67,487 67,987 501 F

Reflect a level of vacancies, partially covered by overtime and casual staff; and high leave taken for July school holidays.

Total (before Outsourced Personnel) 44,973 47,108 2,135 F 44,973 47,108 2,135 F 581,024 583,159 2,135 F

Outsourced Medical 689 444 (245) U 689 444 (245) U 5,575 5,330 (245) U Offset by favourable personnel costs.

Outsourced Nursing 427 194 (233) U 427 194 (233) U 2,566 2,333 (233) U Offset by favourable personnel costs.

Outsourced Allied Health 3 11 8 F 3 11 8 F 124 133 8 F

Outsourced Support 13 1 (12) U 13 1 (12) U 24 12 (12) U

Outsourced Management/Admin 419 465 46 F 419 465 46 F 5,537 5,584 46 F

Total Outsourced Personnel 1,551 1,116 (435) U 1,551 1,116 (435) U 13,827 13,392 (435) U

Total Personnel 46,524 48,224 1,700 F 46,524 48,224 1,700 F 594,851 596,551 1,700 F

Personnel Costs By Professional GroupJuly 2016


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FTE FTE FTEVariance to Prev Mnth FTE FTE FTE FTE FTE FTE


Medical Personnel 778 825 47 F

778 825 47 F 815 823 8 F


Nursing Personnel 2,679 2,670 (9) U

2,679 2,670 (9) U 2,658 2,663 5 F

Reflect high high leave taken for July school holidays, covered by bureau, overtime and casual staff and a high level of watches for delirium, dementrue and self harm patients.

Allied Health Personnel 1,090 1,155 65 F

1,090 1,155 65 F 1,148 1,155 7 F


Support Personnel 510 505 (6) U 510 505 (6) U 504 503 (0) U

Management/Administration Personnel 817 881 63 F

817 881 63 F 866 880 13 F


Total (before Outsourced Personnel) 5,875 6,035 160 F 5,875 6,035 160 F 5,991 6,024 33 F

Outsourced Medical 25 16 (9) U 25 16 (9) U 17 16 (1) U Offset by favourable Medical FTE.

Outsourced Nursing 38 17 (21) U

38 17 (21) U 19 17 (2) U

Reflect high high leave taken for July school holidays, covered by bureau, overtime and casual staff and watches.

Outsourced Allied Health 0 1 1 F 0 1 1 F 1 1 0 F

Outsourced Support 3 0 (2) U 3 0 (2) U 0 0 (0) U

Outsourced Management/Admin 51 57 6 F 51 57 6 F 57 57 0 F

Total Outsourced Personnel 117 91 (26) U 117 91 (26) U 94 91 (2) U

Total Personnel 5,992 6,127 135 F 5,992 6,127 135 F 6,084 6,115 31 F

FTE By Professional GroupJuly 2016


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Actual Budget Variance Variance Actual Budget Variance Forecast Budget VarianceVolume Volume Volume To PM Volume Volume Volume Volume Volume Volume

M00001 - General Medicine Inpatients 1,339 1,595 (257) U 1,339 1,595 (257) U 16,992 16,992 0 FS00001 - General Surgery Inpatients 777 677 100 F 777 677 100 F 9,081 9,081 0 FS45001 - Orthopaedic Inpatients 655 666 (11) U 655 666 (11) U 8,926 8,926 0 FW10001 - Maternity Inpatients 599 537 62 F 599 537 62 F 6,442 6,442 0 FM05001 - Emergency Medical Services Inpatients 426 422 5 F 426 422 5 F 5,059 5,059 0 FS60001 - Plastic & Burns - Inpatients 383 435 (53) U 383 435 (53) U 5,832 5,832 0 FM55001 - Paediatric Medicine Inpatients 368 396 (27) U 368 396 (27) U 3,381 3,381 0 FAll Others 1,257 1,264 (7) U 1,257 1,264 (7) U 14,386 14,386 0 FTotal Acute WIES 5,804 5,992 (188) U 5,804 5,992 (188) U 70,098 70,098 0 FS45001 - Orthopaedic Inpatients 462 422 40 F 462 422 40 F 5,342 5,342 0 FS00001 - General Surgery Inpatients 374 352 22 F 374 352 22 F 4,456 4,456 0 FS60001 - Plastic & Burns - Inpatients 225 216 9 F 225 216 9 F 2,735 2,735 0 FS30001 - Gynaecology Inpatients 113 131 (18) U 113 131 (18) U 1,572 1,572 0 FS25001 - ORL Inpatients 108 117 (8) U 108 117 (8) U 1,475 1,475 0 FS40001 - Ophthalmology Inpatients 92 113 (20) U 92 113 (20) U 1,425 1,425 0 FMS02016 - Skin lesions 51 28 24 F 51 28 24 F 322 322 0 FM10001 - Cardiology - Inpatients 32 50 (18) U 32 50 (18) U 536 536 0 FAll Others 50 75 (25) U 50 75 (25) U 888 888 0 FTotal Elective WIES 1,508 1,503 5 F 1,508 1,503 5 F 18,751 18,751 0 F

Actual Last Year Variance Variance Actual Last Year Variance Forecast Budget VarianceVolume Volume Volume To PM Volume Volume Volume Volume Volume Volume

ED Attends 9,867 9,880 13 F 9,867 9,880 13 F 0 0 0 F

VolumesJuly 2016

Month Year to Date Full Year

VolumesJuly 2016

Month Year to Date Full Year

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7.4 Human Resources HR metrics are provided to outline performance for Annual Leave Balances, Sick Leave, and Turnover rates. Below are the 12 month trend graphs to June 2016.

0%1%2%3%4%5%6%

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

Sick Leave Sick Leave LY UCL Average LCL

6%7%8%9%

10%11%12%

Annualised CMDHB Voluntary Turnover Hospital Directorate Only)

Turnover Turnover LY UCL Average LCL

7%8%9%

10%11%12%13%14%15%

Percentage of CMDHB Workforce with Annual Leave Balances > 2 Years' Equivalent (Hospital Directorate Only)

> 2 Years > 2 Years LY UCL Average LCL

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0%

4%

8%

12%

16%

20%

Annual Leave Paid as Percentage of Total Paid Hours July 2015 to June 2016

AL Paid % AL Paid % LY UCL Average LCL

0 10 20 30 40 50 60 70 80

Jul'15

Aug'15

Sep'15

Oct'15

Nov'15

Dec'15

Jan'16

Feb'16

Mar'16

Apr'16

May'16

June'16

Voluntary Employee Turnover by Reason for Leaving July 2015 to June 2016

Personal To go overseas Another job in public healthResigned Left district RetiredJob in Private health Job outside of health EducationJob dissatisfaction Unpaid work

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7.5 Responses to Action Items Actions and Responses HAC Meeting 15.6.2016 –Action Item Register Keep a running brief each month on national contracts and how this reorganisation/ different specification is developing and any impact for CM Health We have reviewed the Central Region’s Technical Advisory Services Ltd 2016/17 Annual Plan, which focussed primarily on the Community Pharmacy national contract, InterRAI training and reporting contracts, and Health of Older People ‘Home Based Support Services’ and ‘Aged Residential Care’ contracts. The plan aligns with key issues facing the Health of Older People Service in Counties Manukau, and focusses on implementation of the in-between travel arrangement, future workforce, models of care development of Home Based Support Services, review of funding models, integration of Primary Care and St John contract around Residential Care Contract, and centralisation of InterRAI education and reporting resources. Further updates will be provided quarterly to HAC going forward on this item. HAC Meeting 15.6.2016 – Action Item Register Medicine – set a more ambitious target (than 5 working days) for non-gynae needle aspiration. The Medicine Balanced Scorecard has been updated to report performance against a target of 90% in three working days. HAC Meeting 15.6.2016 – Action Item Register Outpatient DNA rates for Maaori & Pacific are showing as 11% and 9% respectively – advise what those % would represent in terms of numbers. On review of Maaori and Pacific DNA rates it has been discovered that the denominator for determining performance against these targets has been incorrectly calculated, and as a result DNA rates for these two population groups are higher than what has previously been reported. This has subsequently been resolved and is reflected in the higher DNA results reported to this meeting for July. The actual number of Maaori and Pacific DNAs for the 2015/16 year are as follows:

Group Total Appointments No. Did Not Attend Percentage

Maaori Outpatients 56,518 11,538 20.41%

Pacific Outpatients 93,001 16,536 17.78% Note: ‘Pacific’ combines Samoan, Cook Island Māori, Tongan, Niuean, Tokelauan, Fijian and Other Pacific.

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HAC Meeting 15.6.2016 – Action Item Register Report regularly against the ARI patients presenting to ED 10 or more times including comparisons with other DHBs. A high-level overview of ARI Emergency Department presentations is provided below. Further analysis will be undertaken by the Health Intelligence and Informatics team to identify those attending at very high frequency, and to identify whether there are any common causes or themes which could be addressed. The graph below shows: • The volume of Emergency Department presentations by patients enrolled in the ARI programme,

by month of presentation. • The proportion of total Emergency Department presentations by ARI patients. This

demonstrates increasing Emergency Department utilisation by this group; however the number of ARI enrolments is also increasing (in order to provide a balanced view this has also been included).

• The proportion of ARI patients with an Emergency Department presentations; these remain stable at just under 4%.

As we do not have access to other district health boards’ ARI information, we are unable to provide comparisons at this stage.

HAC Meeting 27.7.2016 – Action Item Register Pull out a few of the STEEP measures in the Balanced Scorecard for further discussion. Areas of performance are highlighted on the Board agenda this afternoon. Further updates will be provided in the Quality Accounts later in the year.

42156 42186 42217 42248 42278 42309 42339 42370 42401 42430 42461 42491 42522 42552ED Presentations (ARI patients) 528 609 737 700 659 662 673 671 650 726 710 712 721 789ARI % of Total ED Presentations 5.7% 5.9% 6.9% 7.1% 7.2% 7.2% 7.2% 7.2% 6.8% 7.4% 7.8% 7.4% 7.6% 8.0%% of ARI Enrolled w/ED Present 3.8% 4.3% 4.8% 4.4% 3.9% 3.8% 3.8% 3.7% 3.6% 3.9% 3.7% 3.8% 3.6% 4.0%

0.0%

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Total ED Presentations by Month for Patients Enrolled in ARI at time of Presentation vs. (1) ARI % of Total ED Presentations by Month vs. (2) % of ARI Enrolled Patients with an ED Presentation by Month

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HAC Meeting 4.5.2016 – Action Item Register Report back on LOS trends by division, ethnicity and admission status. The following analysis has been prepared to demonstrate length of stay trends for patients treated by CM Health during the period 2011 to 2016. During this period the Average Length of Stay (ALOS) had decreased in most services. Maori and Pacific continue to have higher LOS than ‘Other’ ethnic group. The gap for Maori is particularly pronounced in the 15-65 years group. The older adult group (+65 years) shows ‘other’ ethnicity as having a longer length of stay compared to Maori and Pacific. Within this group, the older patients have the longer stays. Demographically, the oldest patients and therefore the longest stays are dominated by Europeans.

When examining ALOS by acute/elective admit type we find that elective LOS has varied only by 0.2 across the 6 years (ranging between 1.9 and 2.1 days and currently sitting at 1.9) while acute LOS has been consistent at 2.9 days for last 3 years. This information is provided from data extracted from PIMS in July 2016. 1 – Average Length of Stay by Service ALOS was decreasing in almost all services over the last six years with a slight increase in Medical Services and ARHOP during fiscal year 2016 (graph and highlighted yellow in table below).

Graph Overall ALOS

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Table Overall ALOS

The rise in ARHOP was traced to variability in the low volume area of ARHOP long stay. The bulk of ARHOP activity showed a LOS that was much lower and reducing over the time period examined.

Seventy eight percent of acute medical volumes were from General Medicine, which showed a relatively stable average length of stay. An increase in FY16 shows a small rise (0.1) returning to FY14 levels. Respiratory medicine shows an increase in FY16, however it had the largest downward ALOS trend over the last six years and the highest volume growth per year over that time.

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Average Length of Stay by Ethnicity

Average length of stay varies by age, with older adults (65+) having a significantly longer stay. Typically Maori and Pacific patients have a longer stay.

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The older adult group (+65 years) shows ‘other’ ethnicity as having a longer length of stay compared to Maori and Pacific. Within this group, the older patients have the longer stays. Demographically, the oldest patients and therefore the longest stays are dominated by Europeans.

Average Length of Stay Maori 15-65 years Patients of Maori ethnicity between the ages of 15 and 64 stay significantly longer in hospital than other ethnicities.

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On investigation we find that the rise from FY15 to FY16 was caused by a single patient discharged from ARHOP long stay, and may be considered an outlier. Removing this patient gives us a flatter graph, but the significantly higher ALOS for Maori remains.

Breaking this down by service we see several specialties that seem to reflect this pattern. General Medicine shows a widening gap in average length of stay data between ethnicities in this age group. Also note the rise in ALOS for all ethnicities between FY15 and FY16 in this specialty.

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General Surgery shows a different trend. Here ALOS is trending downwards in this age group over the time studied, except for Maori where the trend is flat.

Orthopaedic Surgery also shows a noticeable gap between Maori and ‘Other’ ethnicity. The gap has widened from 0.9 days in FY11 to 1.5 days in FY15, followed by a slight decrease in the last fiscal

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year.

Plastic Surgery shows a slightly reducing length of stay for ‘Other’ ethnicity, but a rising length of stay for Maori ethnicity.

The widest gaps are in patients at Middlemore Hospital. Satellite Hospitals do not show this pattern as strongly. Manukau Superclinic shows this pattern but as stays are already very short at

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this facility the differences are not as pronounced.

Average Length of Stay by Admit Type

Acute patients are expected to have a longer LOS than elective patients. We saw in the graph below that acute admission LOS remains stable with a slightly dipped in FY13 (average of 2.9 days). Elective admissions have been variable, showing no clear pattern over 6 years (average 2.0 days).

Graph Admit type ALOS

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7.6 Mental Health and Addictions Glossary

AoD Alcohol or Other Drug GP General Practitioner LOS Length of Stay MH&A Mental Health & Addictions NGO Non-Government Organisation PRIMHD Programme for the Integration of Mental Health Data RN Registered Nurse YTD Year to Date Highlights

Tiaho Mai - New Build Update The tender recommendation for the main contractor was endorsed by the Board on 27 July 2016, and the enabling works to Tiaho Mai have now been completed. Consultant inspections occurred on 20 July and the service accepted and took possession of the spaces. The solution for the staff service entry, link canopy, and secure entries was approved. All design peer reviews have now been resolved with the exception of fire engineering. That is expected to be resolved by August. Construction of a mock-up of the proposed staff bases is being progressed. Staff from Tiaho Mai will be involved in the design of these bases. The bases are intended to be used by staff as an alternative to being based within the clinical operations areas or “nursing stations”. The intention is to try to ensure that the bases contain the elements needed by clinical staff to undertake their tasks more efficiently while at the same time providing a safe place within the more open spaces of the ward. Decanting After much planning and preparation Tui Ward moved to Ward 22 on 10 August. The move went very well with service users from Tui Ward spending some time in the Whare until the time came for them to move to the new ward. Staff have worked very hard to ensure that the move occurred with minimal disruption for service users and the atmosphere on the day was festive. A lot of people volunteered to support the ward on this day and their contribution was very well received. The move itself was a big event for the inpatient unit and there were small gestures that went a long way to ensure the service users were included and felt safe. For example, the Occupational Therapists made each service user a “coping kit” that contained items such as stress balls, hand lotion, herbal tea etc. Service users and staff appeared to enjoy their new environment and while there were a few issues to resolve, they were minor. Simon Walker – the key liaison person between clinical services and facilities – must take most of the credit for the seamless transition to our new, temporary, facility. Nga Whetumarama blessing On 8 July Te Ohonga and CM Health kaumatua and members of the Kingiitanga led the final blessing of Nga Whetumarama. The karakia began the decant process for the whare and gave the spiritual blessing to allow the carvings, tukutuku, and tupuna photos to be taken down safety. Present and past staff attended the blessing including Ngarau Tupaea, the first Maaori Cultural Advisor for Mental Health services in the 1990’s and his wife Puhanga, who created the tukutuku and artwork for the back wall of Nga Whetumarama.

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Whole of System Integration Update Key to progressing the Mental Health and Addictions (MH&A) integration transformation agenda is engagement with stakeholders, using a process of co-design to guide and inform the design and delivery of an integrated model of care. During June there were two important events to assist us in moving forward with this agenda. In early June the Integrated MH&A Leadership Group came together with a wide range of stakeholders to reflect on where we are and share ideas. There was a great deal of energy in the room and a clear commitment to ensure that whatever we do, it is to improve the health and wellbeing of the people in our communities. It was also acknowledged that this is a challenging journey that will require us to be radical in our thinking but to not lose sight of the gains that have been achieved in many parts of the sector. The focus of the session was to discuss ideas around the creation of locality integrated care teams for MH&A and the development of a suite of community-based support services in each locality. Integrated care teams will continue to maintain the current focus on those with the most severe and enduring needs, but will develop strong working relationships with clusters of GP practices to support early intervention and help maintain our communities’ wellbeing. Each single suite of locality-based services will cover a range of functions to complement the work of the locality integrated care team. By functioning as a single suite that, together with the integrated care team, is part of the wider locality MH&A service, people will better supported by comprehensive, continuity of care. Alongside each locality’s integrated care team and single suite of services, will be access to a range of district-wide MH&A services. District-wide services are those where the size, degree of specialism, or need for service-wide consistency means that it wouldn’t be possible to provide the service at a locality level. In addition to these district-wide NGO services, there will also be a range of highly specialised District Health Board MH&A services (e.g. maternal mental health) provided through a district-wide approach but linking to locality teams. Along with this sector-wide session, there has also been dedicated work to progress thinking around how best to deliver addiction services within an integrated model of care. A joint workshop brought together representatives from both CM Health’s and Waitemata District Health Board’s MH&A services. The focus of the discussion was to reflect on the strengths, weaknesses and opportunities of current service delivery through the Community Alcohol and Drugs Service and what the options could be for service design and delivery as part of integrated care teams and locality services. The workshop attendees had a shared purpose of determining the best way to meet local need and improve health outcomes for our population, ensuring that both MH&A work together effectively to support wellbeing as part of the broader health team. Ideas were shared around potential options to be discussed in more detail at a follow-up workshop. Exemplar of practice from Clinical Nurse Director The following example of excellent clinical reasoning and client advocacy is celebrated by the service:

“A Registered Nurse (RN) at the Dual Disability (Intellectual Disability- Mental Health) Team at Matariki identified that one of her clients was presenting in a manner that was consistent with Hydrocephalus. His behaviours were being treated as behavioural only and over a period of acute ‘behavioural’ disturbance, the Registered Nurses insisted that the young man was reviewed medically. Despite facing extreme pressure to only treat as behavioural, the RN persisted, having to involve the police to ensure that the young man was transported to the

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Emergency Department at CM Health. He was then assessed as required urgent Neurological surgery with a shunt being inserted and ultimately saved his life”.

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MENTAL HEALTH SCORECARD - JULY 2016

Ensu

ring

Fina

ncia

l Su

stai

nabi

lity Trend Year to date Rating Commentary (by exception)

YTD Jul-16 Target Var Actual Target Var Overtime costs ($000) $159 $149 -$10 $159 $149 -$10 High acute demand management cost off-set by community

vacancies

Enab

ling

Hig

h Pe

rfor

min

g Pe

ople

Trend 12 month average Rating Commentary (by exception) YTD Jun-16 Target Var Actual Target Var % Staff with Annual Leave > 2 years 8.7% 5.0% -3.7% 8.5% 5% -3.5% Managers have been working with their teams to put leave

plans in place. This has seen a reduction in the % of staff with >2 years of annual leave balance in this month’s reporting.

% Staff Turnover 11.6% 10.0% -1.6% 11.3% 10.0% -1.3% % Sick Leave 4.4% 2.8% -1.6% 3.7% 2.8% -0.9% HR has been supporting Managers’ in doing more sick leave

reviews with staff wo are exhibiting high usage of sick leave. Workplace Injury Per 1,000,000 hours 0 10.5 10.5 18.7 10.5 -8.2

Firs

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Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Number of Seclusion events/100,000 5.2 5.0 -0.2 Seclusion hours/100,000 39.5 50.0 11 Number of Clients Secluded/100,000 2.9 3.0 0.1

Tim

ely

Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var

Shorter wait times for non-urgent MH&A Services (%< 3 week wait)

0-19 years 74% 80% -6.0% 20-64 years 87% 80% 7.0% 65+ years 91% 80% 11%

Shorter wait times for non-urgent MH&A Services (%< 8 week wait)

0-19 years 95% 95% 0.0% 20-64 years 96% 95% 1.3% 65+ years 97% 95% 2.0%

Syst

em In

tegr

atio

n (E

ffec

tive)

Trend Year to date Rating Commentary (by exception)

YTD Jul-16 Target Var Actual Target Var Access rate - Number of CM domiciled unique clients seen by all MH&A services ((PRIMHD reporting services include AoD and NGO services) 12 months as a % of population- Total

0-19 years 3.8% 3.2% 0.7% 20-64 years 3.7% 3.2% 0.6% 65+ years 2.3% 2.6% -0.3%

Readmissions to Tiaho Mai within 28 days – Total (June data) 19% 12% -7% 19% 12% -7%

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Effic

ient

Trend Year Rating Commentary (by exception)

YTD Jul-16 Target Var Actual Target Var Inpatient Occupancy - Tiaho Mai Acute Mental Health Unit 94.2% 85% -9.2% 94.2% 85% -9.2% Signifies over-crowding Number of Tiaho Mai Inpatient LOS >35 days 11 10 -1 11 N/A N/A

Equi

ty

Trend Year Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Access rate - Number of CM domiciled unique clients seen by MH&A services (PRIMHD) 12 months as a % of population - Maori

0-19 years 5.5% 4.5% 1.1% 20-64 years 8.4% 7.7% 0.7% 65+ years 2.6% 2.6% 0.0%

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7.7 Women’s Health and Kidz First Glossary

ALOS Average Length of Stay CLAB Central Line Associated Bacteraemia DNA Did Not Attend ED Emergency Department ESPI Elective Services Patient Flow Indicators HCA Health Care Assistant KF Kidz First LMC Lead Maternity Carer MoH Ministry of Health MQSP Maternity Quality and Safety Programme NHPPD Nursing Hours Per Patient Day SUDI Sudden Unexplained Death of Infant VIP Violence Intervention Programme YTD Year to Date Highlights

Volumes The first month of the 2016/17 year has been unusual in that Kidz First Inpatients as well as the Emergency Department saw admissions and presentations decrease in mid-July. The reduced winter activity is mirrored in other paediatric centres in Auckland. The very mild July temperatures and absence of influenza are likely to be the major contributors. There were 545 births at Middlemore Hospital and 72 at the three community units; a total of 617 births for the month which is 16 births less than July 2015. Maternity Quality and Safety Programme (MQSP) The 2015/16 MQSP Annual Report was submitted to the Ministry of Health (MoH) in July. Once the report has been approved by MoH it will be uploaded onto CM Health’s internet site and, as per last year, a formal presentation session will be held on Wednesday 12 October for all maternity providers, Board and Executive Leadership Team members, as well as maternity consumers and consumer groups. Sudden Unexplained Death of Infant (SUDI) The tremendous achievement in the implementation of the regional SUDI Safe Sleep policy and Safe Sleep projects and the reduction of Sudden Unexplained Death of Infant (SUDI) for Maaori babies in particular are described in the MQSP report as well as the Zero Patient Harm June 2016 report.

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Update on previously reported issues

Issue Date reported Update Neonatal admissions 27 July 2016 The Unit experienced 99% average occupancy during

July 2016. Overflow of low acuity neonatal had to be accommodated on the Maternity Ward. Because the Maternity Ward was also at capacity at times, the Birthing and Assessment Unit had to be used for overflow for women waiting to go to the Maternity Ward as well.

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WOMEN'S HEALTH SCORECARD – JULY 2016

Enab

ling

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Trend 12 month average Rating Commentary (by exception) YTD Jun-16 Target Var Actual Target Var % Staff with Annual Leave > 2 years - (one month in arrear) 26% 5% -21% 22% 5% -17% Work on annual leave planning is underway in

conjunction with Human Resources % Staff Turnover - (one month in arrear) 12% 10% -2% 11% 10% -1% This includes 15 planned junior medical staff rotations % Sick leave - (one month in arrears)

4.0% 2.8% -1.2% 3.5% 2.8% -0.7% This includes long term ACC leave for the 3 injured staff

(ferry incident in 15/16) Workplace injuries recorded per 1,000,000 hours - (one months in arrears) 0.0 10.5 10.5 23.0 10.5 -12.5

Jul-16 Last yr Actual

Var. Actual Last yr Actual

Var

Sick leave hrs. taken FTEs Nursing/Midwifery inc unpaid 8.1 8.4 0.3 8.1 8.4 0.3 Study leave hours taken FTEs in Nursing/Midwifery 3.3 5.4 2.1 3.3 5.4 2.1 Orientation hours taken FTEs in Nursing / Midwifery 2.1 3.4 1.3 2.1 3.4 1.3

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Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Emergency trolley checks (days checked) per month 88% 100% -12% N/A N/A N/A Monthly spot audits. No YTD figures required Hand hygiene (compliance with checks) per month 82% 80% 2% N/A N/A N/A Safe Sleep audits completed 90% 100% -10% N/A N/A N/A Occupational Health and Safety (OHS) Audit (Bi-Monthly) N/A 100% N/A N/A N/A N/A Next audit due August 2016 Violence Intervention Programme (VIP) Screening 34% 80% -46% 34% 80% -46% Developing new screening audit to improve screening

percentage Jul-16 Last yr

Actual Var. Actual Target Var

Total Caesarean Percentage 28% 29% 1% 28% 29% 1% Annual CS % is 23% but in both July 2015 and 2016, the percentage has been higher

Caesarean - elective number 72 73 1 72 73 1 Caesarean - acute number 80 90 10 80 90 10 Instrumental Deliveries 47 39 -8% 47 39 -8% No concerns at this stage

Inductions of labour % (one month in arrear) 26% 25% -1% 26% 24% -2% YTD figures are for 2015/16, monitoring trends Inductions of labour - number compared to last year (one month in arrear) 152 138 -14 1903 1713 -190 YTD figures are for 2015/16, monitoring trends

Tim

ely

Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var ED 6 hour target - National Health target (Gynae) 96% 95% 1% 96% 95% 1% ESPI 2 - No. waiting >4 months for FSA - Elective 0 0 0 0 0 0 ESPI 5 - No. waiting > 4 months for treatment - Elective 0 0 0 0 0 0

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Sy

stem

Inte

grat

ion

(Eff

ectiv

e) Trend Year to date Rating Commentary (by exception)

YTD Jul-16 Target Var Actual Target Var % transcribed clinic letters authorised <7 days created 90% 95% -5% 90% 95% -5% Monitoring leave cover Average Length of Stay Gynaecology – Middlemore Hospital 1.6 1.6 0.0 1.6 1.6 0.0 ALOS has small monthly variances. No concerns at this

stage.

Average Length of Stay Gynaecology - MSC Inpatients 0.5 0.8 0.3 0.5 0.8 0.3 Average Length of Stay Obstetric (DHB Mat) (1 month in arrear) 2.1 2.1 0.0 2.2 2.1 0.1 Average Length of Stay Obstetric (Ind. Mat) (1 month in arrear) 2.1 2.1 0.0 2.1 2.2 0.1 Average Length of Stay Vaginal Deliveries overall 2.1 2.1 0.0 2.1 2.1 0.0

Maaori - 1st time mothers 2.2 2.6 0.4 2.2 2.6 0.4 Pacific - 1st time mothers 2.6 2.7 0.1 2.6 2.7 0.1

Effic

ient

Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual 15/16 Var First Specialist Assessment/Follow-up ratio - Gynae 1:1.358 1:1.1 1:1.358 1:1.1 DNA - Midwifery Antenatal clinics – First Specialist Assessment 15% 13% -2% 15% 13% -2% Small variance in the first month DNA - Midwifery Antenatal clinic - Follow up 13% 15% 2% 13% 15% 2% DNA - Doctor Antenatal clinics- First Specialist Assessment 12% 12% 0% 12% 12% 0% DNA - Doctor Antenatal clinics - Follow up 12% 18% 6% 12% 18% 6% Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Outpatient DNA - Maaori (Gynae) 13% 13% 0% 13% 10% -3% Improving on last year's actual but awaiting

organisational initiatives for further reduction Outpatient DNA - Pacific (Gynae) 9% 11% 2% 9% 10% 1% Outpatient DNA - Maaori (Obst) 24% 26% 2% 24% 10% -14% Improving on last year's actual but awaiting

organisational initiatives for further reduction Outpatient DNA - Pacific (Obst) 16% 18% 2% 16% 10% -6%

% Resourced Occupancy (average of 9am & 9pm) Jul 16 Last Yr

Actual Var Actual 15/16 Var

Gynaecology Ward 85% 80% -5% 85% 92% 7% Occupancy percentage will have monthly variances. One month’s data only at this stage. Maternity Ward - Maternity (45 beds) (lodgers included) 83% 79% -4% 83% 79% -4%

Maternity Ward - Nursery (30 beds) (lodgers included ) 88% 90% 2% 88% 83% -5% Botany Maternity Unit (lodgers included) 90% 93% 3% 90% 85% -5% Papakura Maternity Unit (lodgers included) 79% 67% -12% 79% 77% -2% Pukekohe Maternity Unit (lodgers included) 65% 77% 12% 65% 64% -1%

% Resourced Occupancy (Middlemore Central data) Gynaecology Ward 72% 80% 8% 72% 80% 8% Maternity Ward - Maternity (45 beds) - Mothers' beds only 77% 72% -5% 77% 72% -5% Middlemore Central data does not include lodgers

Nursing Hours per Patient Day (not including HCA) at Middlemore Jul-16 Target Var. Actual Target Var. NHPPD - Maternity Ward North (including nursery PD) 5.7 6.0 0.3 5.7 6.0 0.3 NHPPD - Maternity Ward South (including nursery PD ) 5.5 5.8 0.3 5.5 5.8 0.3 Nursing Hours per Patient Day - Gynae 5.6 5.3 -0.3 5.6 5.3 -0.3 Small variance in Gynae ward

P&W

CC Trend Year to date Rating Commentary (by exception)

YTD Jul-16 Target Var Actual Target Var % transcribed clinic letters authorised <7 days created 90% 95% -5% 90% 95% -5% Monitoring leave cover

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KIDZ FIRST SCORECARD- JULY 2016

Enab

ling

Hig

h Pe

rfor

min

g Pe

ople

Trend 12 month average Rating Commentary (by exception) YTD Jun-16 Target Var Actual Target Var % Staff with Annual Leave > 2 years - (one month in arrear) 17% 5% -12% 21% 5% -16% Work on Annual Leave planning is underway in

conjunction with Human Resources % Staff Turnover - (one month in arrear) 17% 10% -7% 14% 10% -4% This includes 22 junior medical staff planned rotations % Sick leave - (one month in arrears) 4% 3% -1% 4% 3% -1% Some long term sick leave staff have now medically

retired Workplace injuries recorded per 1,000,000 hours - (one month in arrears)

0.0 N/A N/A 8.8 10.5 1.7

Jul-16 Last Yr Act

Var. Actual Last Yr Act

Var.

Nursing Sick leave hours taken in FTEs (inc unpaid sick) - onestaff 5.1 6.2 1.2 5.1 5.8 0.7 Study (both internal & external) leave taken FTE RN - onestaff 2.4 2.7 0.3 2.4 3.5 1.1

Firs

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Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Neonatal Rate of medication errors/1000 bed days per month 4.8% 3.2% -1.6% 4.8% 3.2% -1.6% Neonatal Care CLAB rate per 1000 line days per month 0.0 0.0 0.0 0.0 0.0 0.0 455 days since last CLAB CLAB insertion bundle compliance – Neonatal Unit 100% 100% 0% 100% 100% 0% CLAB prevention maintenance bundle compliance- Neonatal Unit 83% 100% -18% 83% 100% -18% Neonatal team working on documentation Emergency trolley checks (compliance with checking) 87% 100% -13% N/A N/A N/A Monthly spot audits. No YTD figures required Hand hygiene (compliance with checking) 96% 80% 16% N/A N/A N/A Monthly spot audits. No YTD figures required Safe sleep - audits completed 93% 100% -7% N/A N/A N/A Monthly spot audits. No YTD figures required Occupational Health and Safety (OHS) Audit (Bi-Monthly) N/A 100% N/A N/A N/A N/A Next audit due August 2016 Violence Intervention Programme (VIP) Screening 40% 80% -40% 40% 80% -40% Developing new screening audit to improve screening

percentage

Tim

ely

Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var ED 6 hour target (Kidz First ED) - Initial speciality 99% 95% 4% 99% 95% 4% ESPI 2 - No. waiting >4 months for FSA - Elective 0.0 0.0 0.0 0.0 0.0 0.0

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Syst

em In

tegr

atio

n (E

ffec

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Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var % transcribed clinic letters authorised >7 days of created 80% 75% 5% 80% 75% 5% Jul 16 Last Yr

Actual Var Actual 2015/16 Var

Readmission Rate (KF medical) within 7 days 7.2% 6.3% -0.8% 7.2% 5.9% -1.3% Seasonal variation Readmission Rate (KF medical) within 7 days (Maaori) 7.6% 6.8% -0.8% 7.6% 5.4% -2.3% Seasonal variation Readmission Rate (KF medical) within 7 days (Pacific) 8.9% 6.3% -2.7% 8.9% 6.2% -2.8% Seasonal variation

Readmission Rate (Level 1,2, 3) within 28 days (one month in arrear) 7.1% 7.7% 0.6% 8.4% 8.3% -0.1% Seasonal variation Readmission Rate (all Neonates) within 28 days (one month in arrear) 11.9% 3.9% -8.0% 8.1% 7.5% -0.6% 8 readmissions out of 67 discharges in June 2016 Admission Rate Babies in the first year of life (Total) 22% 22% 0.0% 22% 23% 1.0%

Admission Rate Babies in the first year of life (Maaori) 26% 27% 1.0% 26% 27% 1.0% Admission Rate Babies in the first year of life (Pacific) 31% 28% -3.0% 31% 30% -1.0% Monitoring trend for Pacific babies

ALOS (raw)- Kidz First - Surgical - Surgical Floor 2.0 2.0 -0.0 2.0 2.1 0.1 ALOS (raw)- Kidz First Medicine – Kidz First Wards 3.0 2.7 -0.3 3.0 2.7 -0.3 ALOS (raw)- Kidz First Medicine – ED Short Stay (hrs) 4.5 4.6 0.1 4.5 4.6 0.0 ALOS (raw) - Kidz First - Neonatal Unit discharge only 14.9 17.3 2.5 14.9 12.7 -2.2 Monitoring YTD trend. ALOS (raw)- Kidz First - Neonates including Women’s Health 6.5 4.8 -1.8 6.5 5.9 -0.6 Linked to Neonatal acuity and volumes

Effic

ient

Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Outpatient DNA - FSA 10% 10% 0% 10% 10% 0% Outpatient DNA - Follow up 14% 12% 2% 14% 12% 2% Monitoring trends Nurse Hours per Patient Day - KF Medical 5.4 5.8 0.4 5.4 5.8 0.4 Nurse Hours per Patient Day - KF Surgical 4.9 5.3 0.4 4.9 5.3 0.4 Nurse Hours per Patient Day- Neonatal 10.4 11.2 0.8 10.4 11.2 0.8 Jul-16 Target Var. Actual 2015/16 Var. % Resourced Occupancy - Kidz First Medical (against 2015/16) 99% 82% -17% 99% 83% -16% Reflecting daily flexing of beds and staff % Resourced Occupancy - Kidz First Surgical (against 2015/16) 86% 80% -6% 86% 79% -7% Reflecting daily flexing of beds and staff % Resourced Occupancy- Neonatal (against 2015/16) 99% 91% -8% 99% 91% -8% Reflecting increased volume and acuity

PWCC

Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Patient experience survey - month (n=5) and YTD (n=5) 80% 76% 4% 80% 76% 4% Only 4 responses out of 1323 discharges

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7.8 Director of Midwifery Glossary

LMC Lead Maternity Carer MoH Ministry of Health SUDI Sudden Unexplained Death of Infant Highlights CM Health Maternity Quality and Safety Programme The 2015-2016 Annual Report was submitted to the Ministry of Health (MoH) during July. The report encompasses not only the work guided by the National Maternity Monitoring Group and the Perinatal and Maternal Mortality Review Committee but also details other quality improvements undertaken to improve access to care or services within Counties Manukau DHB. It also reports the DHB's activity against the National Maternity Clinical Indicators and outlines what measures are being taken to address issues identified and outlines the Maternity Quality and Safety Governance Group Workplan for 2016-2017. Once it has been approved by MoH, it will be accessible online and a public launch is planned for Wednesday 12 October 2016. Community Midwifery Service Isabella Smart the Midwife Manager for the Community Midwifery Service based at Lambie Drive commenced in March 2016. Isabella alongside the team is systematically clarifying and updating processes to ensure they are working efficiently, effectively and safely in the care of women and their babies. This includes triaging the referrals, antenatal, and postnatal care as well as the specialist services which are provided. They are also investigating including the promoting and facilitating of healthy eating into the work of the community health workers in the service. LMC Liaison midwives These are two 0.5 employed midwives within the Primary and Community Directorate who also continue a Lead Maternity Carer(LMC) caseload, Heather Muriwai and Donna Ritchie. They have been working on updating the midwives directory which is available on line and hard copy for General Practitioners and LMCs to assist women in finding a LMC. One has been involved with teaching the first year midwifery students with the inclusion of cultural competence in midwifery practice. Northern Region Safe Sleep Policy This was updated and approved by the Northern Region Child Health Steering Group on 4 July 2016. Included in this policy is information on the two online Safe Sleep training modules designed for health workers. Whakawhetu online training provides a short concise update on Sudden Unexplained Death of Infant (SUDI) knowledge. MoH training is a more in depth course. Both provide consistent information and messaging about SUDI, and continuing professional development points. The Women’s Health Division enables all registered staff and health care assistants to go through this training.

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The Northern Region SUDI five-year Action Plan has two key areas of activity relating to workforce knowledge and development. The actions include:

• Health care workers have the knowledge and skills to provide consistent verbal and written advice on SUDI prevention to women and their family/whaanau and

• Consistent messages are delivered regarding safe infant sleeping, breastfeeding, smokefree and alcohol-free, and smokefree environments in all appropriate settings including healthcare facilities and the wider community.

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7.9 Surgical and Ambulatory Care Glossary

CNM Charge Nurse Manager DNA Did Not Attend ESPI Elective Services Patient Flow Indicator FSA First Specialist Assessment MMH Middlemore Hospital MSC Manukau SuperClinic SAC Surgical and Ambulatory Care YTD Year to Date Highlights

Volumes July was a busy month for the Surgical and Ambulatory Care division, with acute discharges higher than contract by 145 patients (9.90%). Elective discharges were also higher than expected by 63 patients (5.28%). Overall, patient discharges were 208 higher than contract for the month, and 14 patients ahead when compared to the previous financial year. Referral and Appointment Centre The Referral and Appointment Centre has achieved a result of 91.1% referral logging within the first 24 hours of receipt, and a further 4.7% within 48 hours for this month. The average numbers of referrals received are approximately 10,000 per month. Performance against this indicator has steadily increased through this year and is a commendable result. National Burn Centre The National Burn Centre has achieved 10 years of service and celebrated this month. Emerging Issues

Anaesthetic Technician Shortage The Anaesthetic Technician shortage continued to impact service delivery during July, with a number of theatre lists being cancelled. This issue is actively being addressed through the creation of senior roles and refreshing of the education team; this has proven attractive to Anaesthetic Technician trainees who are expressing interest in transferring to CM Health for more acute clinical experience. Update on previously reported issues

Issue Date reported Update Critical Care beds under increasing demand

27 July 2016 Currently gathering and analysing data about inpatients who could benefit from ICU admission to establish level of unmet need. IT involvement to manage data.

Demand on Ophthalmology and Otorhinolaryngology (ORL) services

27 July 2016 A number of strategies are in place to manage the volumes in both the short term and long term. There is a focus on training alternative workforce and implementing a Multi-Disciplinary Team approach across the integrated care space.

143


Issue Date reported Update Discharge time targets not met

27 July 2016 Actively monitored

144


SURGICAL AND AMBULATORY SCORECARD - JULY 2016

Ensu

ring

Fina

ncia

l Sus

tain

abili

ty Trend Year to date Rating Commentary (by exception)

YTD Jul-16 Target Var Actual Target Var Total Caseweight (Provider view) 3,206 3,118 2.8% 3,206 3,118 2.8% Elective Caseweight 1,345 1,278 5.3% 1,345 1,278 5.3% Acute Caseweight 1,860 1,839 1.1% 1,860 1,839 1.1% Acute discharges 1,609 1,464 9.9% 1,609 1,464 9.9% Elective Surgical Discharges 1,248 1,185 5.3% 1,248 1,185 5.3% Personnel Costs ($000) 12,425 12,839 3.2% 12,425 12,839 3.2% Financial Result Total ($m) 14,470 14,521 0.4% 14,470 14,521 0.4% Virtual FSAs/Follow ups -(GP consult and nonpatient appointments) 89 151 -62 89 151 -62 Working to increase virtual activity Reduce clinical outsourcing ($000) 398 302 -95 398 302 -95 Increase related to AT shortage

Enab

ling

Hig

h Pe

rfor

min

g Pe

ople

Trend 12 month average Rating Commentary (by exception) YTD Jun-16 Target Var Actual Target Var % Staff with Annual Leave > 2 years 17% 5% -12% 16% 5% -11% Individual Services working on strategies to reduced.

Annual leave plans in place for high annual leave balances

% Staff Turnover 7.7% 2.0% -5.7% 9.0% 10.0% 1.0% % Sick Leave 3.4% 2.8% -0.6% 2.8% 2.8% 0.0% Workplace Injury per 1,000,000 hours 0.0 10.5 10.5 10.3 10.5 0.2

Firs

t, D

o N

o H

arm

(Saf

ety)

Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Hand Hygiene compliance rate (based on Gold Audit) - Ward 11 76% 80% -4% 76% 80% -4% Continuing focus on improvement Pressure Injuries / 100 patients 0 0 0 0 0 0 Falls causing major harm / 1000 bed days 0 0 0 0 0 0 Severe Pressure Injury (ungradeable) per 1000 bed days 0 0 0 0 0 0 Surgical Site Surveillance for Major joints-

Antibiotics given 0-60mins before "knife to skin" 86% 95% -9% 86% 95% -9.0% Quality Manager reviewing and re-educating. All cases are reviewed and discussed at the monthly quality meeting to drive improvement.

2 grams or more Cefazolin given 93% 100% -7% 93% 100% -7.0% Appropriate skin preparation 98% 100% -2% 98% 100% -2.0%

Central Line-Associated Bacteraemia (CLAB) rate/ 1000 line days 0 0 0 0 0 0 Rate of S. aureus bacteraemia per 1000 bed days 0 0 0 0 0 0 Number of SAC re-admissions due to Venous Thromboembolism (VTE)

6 2 -6 6 0 6

Quality Manager reviewing and re-educating- An anaesthetist on the VTE committee will be reviewing all VTEs on a monthly basis to drive improvement.

Tim

ely

Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Pre-operative Length of Stay Days (from admit to surgery) 1 1 0 1 1 0 ESPI 2 No. patients waiting >120 days for FSA - Elective (Surgical Services incl Gynae)

14 0 -14 14 0 -14 ESPI compliance for early 2016/17 is at risk, particularly due to a large number of elective theatre cancellations and a shortage of Anaesthetic Technicians.

ESPI 5 No. patients waiting >120 days Treatment - Elective (Surgical Services incl Gynae) 1 0 -1 1 0 -1

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Sy

stem

Inte

grat

ion

(Eff

ectiv

e)

Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Average Length of Stay - Acute Inpatient incl Burns 3.7 3.8 0.1 3.7 3.8 0.1 Average Length of Stay - Acute Inpatient excl: Burns 3.7 3.8 0.1 3.7 3.8 0.1 Average Length of Stay - Acute Inpatient excl: Burns and Spinal Ortho 3.7 3.8 0.1 3.7 3.8 0.1 Average Length of Stay - Electives 1.4 1.5 0.1 1.4 1.5 0.1

Effic

ient

Trend Year Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Theatre list utilisation - % used MMH/MSC 87% 85% 2% 87% 85% 2% Theatre session utilisation - % used MMH/MSC 94% 95% -1% 94% 95% -1% Elective Theatre turnaround times (MSC only) 15min 15min 0min 15min 15min 0min Elective cancellations - Day of surgery as % of all Elective (all reasons)- SACS only

8% 5% -3% 8.2% 5.0% -3% Continuing to address through Theatre Project

Day of Surgery Admissions (DOSA) 88% 90% -2% 88% 90% -2% Day Case Rate (Elective/ Arranged) -Subspecialties in SACS only Adults/kids

74% 65% 9% 74% 65% 8.5%

MMH % patients discharged to discharge lounge or home by 1100hrs 21% 30% -9% 21% 30% -9% CNM Patient Flow is working through strategies and % is improving.

General Surgery 24% 30% -6% 24% 30% -6% Orthopaedics

18% 30% -12% 18% 30% -12%

CNM Patient Flow is working through strategies with this service.

Plastics 18% 30% -12% 18% 30% -12% CNM Patient Flow is working through strategies with this service.

Ratio FSA/Follow-up clinic ratio 39% 31% 8% 39% 31% 8% Outpatient DNA rates - overall- Surgical Services only 9% 10% 1% 8.8% 10% 1% Outpatient DNA rates - Maaori (FSA) - Surgical Services only 17% 10% -7% 17% 10% -7% Individual services addressing this Outpatient DNA rates - Pacific (FSA)- Surgical Services only 15% 10% -5% 15% 10% -5% Individual services addressing this

Equi

ty Trend Year Rating Commentary (by exception)

YTD Jul-16 Target Var Actual Target Var % of hospitalised smokers receiving smokefree advice & support -Total (Surgical)

94% 95% -1% 94% 95% -1%

Continuing to reinforce

P&W


YTD Jul-16 Target Var Actual Target Var Patient Experience Survey - month (n=62) and YTD (n=62) 79% 95% -16% 79% 90% -11% Organisational process

146


7.10 Adult Rehabilitation and Health of Older People Glossary

ACC Accident Compensation Corporation ARHOP Adult Rehabilitation and Health of Older People ASRU Auckland Spinal Rehabilitation Unit AT&R Assessment, Treatment and Rehabilitation Services HBSS Home Based Support Services IBC Indicative Business Case LOS Length of Stay MMH Middlemore Hospital SMO Senior Medical Officer YTD Year to Date Highlights

Auckland Spinal Rehabilitation Unit (ASRU) • Launch of the Rick Hansen Database Spinal Cord Injury Registry:

The Rick Hansen Database was successfully launched on 1 August 2016 at Middlemore Hospital with the Minister of ACC (Hon Nikki Kaye) and Mr Bill Barrable (CEO - Rick Hansen Institute, Canada) in attendance. Over 70 people attended the launch with media present from National Radio and One News. The Rick Hansen Database has assisted both Burwood and Middlemore Hospital to develop a customised registry that will be used to improve the understanding and treatment of Spinal Cord Injury. New Zealand is the first country outside of Canada to adopt the register.

• Spinal Acute Rehabilitation Senior Medical Officer Role: The new Acute Rehabilitant Senior Medical Officer (SMO) role is due to commence on 22 August 2016. This continues to support development of the spinal service at CM Health.

Strategic Assessment for Specialised Rehabilitation and Community Wellness ‘Living Well Centre’ A draft Indicative Business Case (IBC) for the above service is currently under review and will be submitted to Executive Leadership Team in August and the Board in September. The service has been named “The Living Well Centre” which is a working title to be refined through a co-design process during the Detailed Business Case stage. The centre is not just a specialist rehabilitation centre; it will have a community wellbeing focus where people from across Counties Manukau (and beyond) get well, stay well, work well and play well. It will help people recover from significant injury or illness, help those at risk of injury or illness, and help the community stay fit and well. The time frame for completion of the IBC is for this to be submitted to Treasury by September 2016 with the expectation that confirmation of a decision will be received before the end of 2016. Following this, a detailed business case is due to be developed which will require further work in the first half of 2017. Healthy Together 20/20 – Reablement Approximately ten patients were discharged to Reablement from Ward 5 during the month of July. The Geriatric Nurse Specialist has been working closely with the Reablement team to ensure a smooth patient journey. We will look to extend this from all rehabilitation wards during the following months.

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Medical Social Worker Presentation One of our Social Workers, from Respiratory Specialty in Medicine has presented posters on “Working with loss in Disaster: A social work perspective” and “Grief Experience of People Living with Chronic Obstructive Pulmonary Disease” at the 2016 Joint World Conference on Social Work, Education and Social Development, held in Seoul, Korea. She has also recently been involved with the Manaaki Hauora project “Save your Breath”. Emerging Issues

Social Workers Child Protection/Domestic Violence Cases in July were high at 253 cases. This has been the largest number of Child Protection/Domestic Violence cases the team have ever encountered (in comparison, June which was also considered a very busy month with 178 cases). The team have managed this exceptionally high caseload by doing extra hours. Recruitment Focus continues on recruitment with significant changes in staffing across Physiotherapy, Occupational Therapy and fixed term cover required for Section Head of Speech Language Therapy. Nursing staffing is becoming more stable with the additional permanent winter nursing recruitment. Update on previously reported issues An update on previously reported Emerging Issues is provided for the information of the Hospital Advisory Committee in the following table.

Issue Date reported Update

Discharge Lounge and Allied Health Decant

27 July 2016 The transition to new offices for the Allied Health team was completed mid-July as part of the Discharge Lounge rebuild. The transition went smoothly for most teams although the administration team has had to move to a temporary location for a further month to allow for building work to occur in the adjacent Discharge Lounge.

Increase in ASRU Occupancy

27 July 2016 Unchanged

148


ADULT REHABILITATION AND HEALTH OF OLDER PEOPLE SCORECARD - JULY 2016

Ensu

ring

Fina

ncia

l Su

stai

nabi

lity Trend Year to date Rating Commentary (by exception)

YTD Jul-16 Target Var Actual Target Var Spinal Inpatient ACC Revenue ('000s) 629 611 18 629 611 18 Non-acute Rehabilitation ACC Revenue ('000s) (1) 549 436 112 549 436 112

Enab

ling

Hig

h Pe

rfor

min

g Pe

ople

Trend 12 month average Rating Commentary (by exception) YTD Jun-16 Target Var Actual Target Var % Staff with Annual Leave > 2 years 4.6% 5.0% 0.4% 4.5% 5.0% 0.5% 12mth leave planning continues across the

division including minimum staffing levels % Staff Turnover 13.5% 2.0% -11.5% 10.6% 10% -0.6% The high peak coincides with the

commencement of the second semester of study, as 30% of the turnover (3/9 staff) results from returning to study.

% Sick Leave 3.5% 2.8% -0.7% 2.5% 2.8% 0.3% Reflects expected seasonal illness; annual rate remains in expected range.

Workplace Injury per 1,000,000 hours 14.0 10.5 -3.5 25.0 10.5 -14.5 One lost time injury recorded for the month of June

Firs

t, D

o N

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arm

(S

afet

y)

Trend 12 month average Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Falls - % of falls assessments done in first 6 hours 98% 100% -2% 98% 100% -2% Falls, Pressure Injuries and Medication

assessments and intervention rates continue to be monitored and incidents investigated and reviewed by senior clinical and management team.

Falls - % of Interventions completed 93% 100% -7% 93% 100% -7% Pressure Injuries - % of assessments done in first 6 hours 95% 100% -5% 95% 100% -5% Pressure Injuries - % of interventions completed 100% 100% 0% 100% 100% 0% Reduce over ride rate of Pyxis on ATR wards decrease medication errors to 15% 14% 15% -1% 14% 15% -1%

Tim

ely

Trend 12 month average Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Proportion of referrals managed via e-referrals across Services (ARHOP) 70% 50% 20% 70% 50% 20% Access to specialist services -volumes of Geriatric A&R Hotline Calls 31 36 -5.0 31 36 -5.0

Syst

em In

tegr

atio

n (E

ffec

tive)

Trend 12 month average Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Maintain number of patient 75’s or older LOS > 10 days in AT&R wards 51 55 -4.0 51 55 -4.0 Maintain direct admissions from GPs to ATR wards 21 23 -2.0 21 23 -2.0 Avoidable presentations to EC from Aged Residential Care Facilities (ARRC) 9 15 -6.0 9 15 -6.0 MMH % patients discharged to discharge lounge or home by 1100hrs 40% 33% 7% 40% 33% 7% Rehabilitation 7 day Readmissions rate 1.5% 0% 1.5% 1.5% 0% 1.5% Acute Readmission within 28 days - Total for Rehabilitation beds (8) 11% 7% 4.0% 11% 7% 4.0% SMO's review all 28 day readmissions

Effic

ient

Trend Quarterly reporting Year Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var % +65years with long term HBSS - comprehensive clinical assessment & care plan 95% 75% 20% 95% 75% 20%

149


Equi

ty Trend Year to date Rating Commentary (by exception)

YTD Jul-16 Target Var Actual Target Var Number of Spinal Rehabilitation Outreach Clinic days - (new measure 2014/15) 7 5 2 7 5 2

P&W

CC

Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Patient Experience Survey - month (n=19) and YTD (n=19) 89% 95% -6.0% 89% 90% -1.0% A meeting with the Quality Assurance

Manager and Director for Patient Safety & Quality Assurance took place this month, looking at strategies to reduce the length of inpatient in-situ survey. Agreed plan is to shorten the length of the survey in partnership with Cemplicity.

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7.11 Medicine Glossary

CT Computerised Tomography eMR eMedication Reconciliation FCT Faster Cancer Treatment FSA First Specialist Assessment FTE Full Time Equivalent GP General Practitioner MRI Magnetic Resonance Imaging SMART Safer Medical Admissions Review Team SMO Senior Medical Officer SMOOTH Safer Medicine Outcomes on Transfer Home STEMI-PCI ST-elevation Myocardial Infarction Percutaneous Coronary Intervention USA United States of America YTD Year to Date Highlights

Medicine’s focus during July was to manage the winter workload and maintain performance against the national health targets and diagnostic indicators. The division has continued to meet the ‘Shorter Stays in Emergency Departments’ national target, as well as the CT and Colonoscopy indicators, and for the first time achieved the MRI performance indicator. Whilst Emergency Department (ED) volumes were 4.9% higher than last month (1867 presentations), they were 3.7% lower than July 2015. The division has continued a number of communication strategies including providing advice to General Practitioners with clear access to telephone advice from all specialities including Emergency Medicine. The division is also in the process of implementing magnets with advice for patients on alternative after hours care and walk-in centres within their specific locality. In addition, development of a triage to community process has commenced. There has been a significant improvement in nurse facilitated discharges with over 100 in July, together with an improved performance in discharging patients before 11am. Gastroenterology The training for a Nurse Endoscopist commenced in July with Alice Washer taking up the position for CM Health. This is the first course for Nurse Endocopists in New Zealand, and Alice is one of four trainees throughout the country. Breastscreen CM Health has been successful in obtaining a ‘Support to Services’ contract for Breast and Cervical screening. This will enable the employment of additional resources to help increase coverage in both Breast and Cervical screening programmes.

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Emerging Issues

Radiology (Radiologist FTE) In July the only senior Paediatric Radiologist within Radiology returned to the USA for family reasons. Extensive international advertising is underway and this has provided three potential overseas candidates. Whilst the recruitment process continues, Paediatric Radiology is being managed by the Service’s Junior Paediatric Radiologist with assistance from Starship Hospital. In addition, a period of churn over the next 12 months is anticipated with a significant number of parental leave applications. Locums for 12 to 24 month contracts are being sought to cover future gaps. Update on previously reported issues

An update on previously reported Emerging Issues is provided for the information of the Hospital Advisory Committee in the following table.

Issue Date reported Update

Respiratory 27 July 2016 Unchanged and actively monitored

Retail Pharmacy – challenges with recruitment

27 July 2016 Unchanged – Challenge with retail pharmacy manager recruitment

Pharmacy – under performance for eMR, SMOOTH and SMART

27 July 2016 This actively being managed and there is a proposal for change in model of service delivery to increase efficiency and therefore performance. Change in model is likely to be implemented next month – change is currently under construction.

Authorisation of transcribed clinical summaries

27 July 2016 Ongoing work to manage performance against this measure is underway; see further commentary in the Balanced Scorecard.

152


MEDICINE, ACUTE CARE AND CLINICAL SUPPORT SCORECARD - JULY 2016

Ensu

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Fina

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l Sus

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Trend Year to date Rating Commentary (by exception) YTD Jul-16 Target Var Actual Target Var Total Caseweight 2,548 2,835 -10% 2,548 2,835 -10% Elective Caseweight 44 87 -49% 44 87 -49% Acute Caseweight (includes ICU) 2,504 2,748 -8.9% 2,504 2,748 -8.9% Outpatient FSA Volumes 1,334 1,514 -12% 1,334 1,514 -12% Outpatient Follow Up Volumes 3,261 3,757 -13% 3,261 3,757 -13% Virtual FSAs 130 152 -14% 130 152 -14% Budgeted FTEs 1,639 1,663 -24 1,639 1,663 -24 Total Income ($000) 1,260 1,984 -724 1,260 1,984 -724 Personnel Costs ($000) 13,984 14,253 -269 13,984 14,253 -269 Other Operating Costs ($000) 5,670 6,295 -625 5,670 6,295 -625 Financial Result Total ($000) 18,394 18,564 -170 18,394 18,564 -170

Enab

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Trend 12 month average Rating Commentary (by exception)

YTD Jun-16 Target Var Actual Target Var % Staff with Annual Leave > 2 years 8.9% 5.0% -3.9% 9.4% 5.0% -4.4% % Staff Turnover 9.1% 2.0% -7.1% 8.5% 10.0% 1.5% % Sick Leave 3.7% 2.8% -0.9% 2.9% 2.8% -0.1% Workplace Injury per 1,000,000 hours 0.0 10.5 10.5 11.1 10.5 -0.6

Safe

ty


YTD Jul-16 Target Var Actual Target Var

% electronic medication reconciliation completed for high risk patients within 48hrs

69% 80.0% -11% 69% 80.0% -11%

In July there were a total of 2955 admissions and transfers , of which 978 were consider high risk. 68% of all high risk patients had medicines reconciliation completed within 48 hours (target 80%), however it is noted that 91% of the high risk patients received medicines reconciliation during their stay. Overall 93% of high risk patients had a pharmacist initiated medicine history. 63% of all patients received medicines reconciliation during their inpatient stay. July was a busy month which higher number of admissions than usual. There was some improvement in overall productivity, albeit marginal.

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Tim

ely



% of patients admitted, discharged, transferred from ED within 6 hrs 96% 95% 1% 96% 95% 1% % MRI scans completed within 6 weeks from acceptance of referral 86% 85% 1% 86% 85% 1% % CT scans completed within 6 weeks from acceptance of referral 98% 95% 3% 98% 95% 3% Radiology - Inpatient radiology times < 24hours 93% 95% -2% 93% 95% -2%

The regional PACS upgrade occurred in July and this was followed by a number of outages which impacted on the ability of the Radiologists to report studies in a timely manner. The turnaround of Mammography exams has been impacted by the unexpected illness of the Medical Director.

Radiology ED radiology times < 2 hours 95% 95% 0% 95% 95% 0% P1 (urgent) % diagnostic colonoscopy patients receive the procedure within 14 days 100% 85% 15% 100% 85% 15%

P2 (routine)% diagnostic colonoscopy patients receive the procedure within 42 days 75% 70% 5% 75% 70% 5%

% surveillance colonoscopy patients receive their procedure within 84 days of planned date 95% 70% 25% 95% 70% 25%

% cardiac STEMI - PCI (angiography) within 120 mins - Northern Region Target 83% 80% 3% 83% 80% 3% % Coronary Angiography within 90days (1 month in arrears) 96% 95% 1% 96% 95% 1% Medical Assessment – Triage3-5 patients seen by SMO within 60 min 64min 60min -4min 64min 60min -4min Very close to target, continue to monitor. Laboratory -Test turnaround time (TAT) within 60mins

Potassium 99% 90% 9% 99% 90% 9% Haemoglobin 99% 98% 1% 99% 98% 1% PT/INR 98% 98% 0% 98% 98% 0% Troponin 1 for EC 95% 90% 5% 95% 90% 5%

Histology - All - 3 working days 88% 90% -2% 88% 90% -2% Very close to target despite large workload Breast - 3 working days

88% 100% -12% 88% 100% -12% Breast Core Biopsy target has been amended to align with Breastscreen program target

Non gynae FNAs - 3 working days 92% 90% 2% 92% 90% 2% Blood Bank - antibody screen within 4 hours 95% 90% 5% 95% 90% 5% Microbiology

Cerebrospinal Fluid cell count <30mins 95% 90% 5% 95% 90% 5% Laboratory Detection of Extended-Spectrum β-Lactamases screens <2days 95% 95% 0% 95% 95% 0% CDT (C. diff Toxin) <25hrs 89% 90% -1% 89% 90% -1% Very slightly under target but is not a test that is

required urgently UCHM (Urine Chemistry) <60mins 91% 90% 1% 91% 90% 1%

Door to Cathlab suspected Acute Coronary Syndrome < 3 days (median time) 78% 70% 8% 78% 70% 8% General Medicine - Seen By Time (minutes)

1st Time to be seen Triage 1 & 2 patients (median time) 49min <30min -19min 49min <30min -19min Performance against seen by KPI reflects the business in the hospital. Expect this to improve over summer months. Further analysis required and action plan to correct.

1st Time to be seen Triage 3 - 5 patients (median time) 90min <60min -30min 90min <60min -30min 2nd Time to be seen Triage 1 & 2 patients (median time) 74min <30min -44min 74min <30min -44min

2nd Time to be seen Triage 3-5 patients (median time) 54min <60min 6min 54min <60min 6min

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Tim

ely

(con

t.) Quarterly reporting Year

Jul-16 Target Var Actual Target Var

FCT - % high suspicion first cancer treatment within 62 days 77% 85% -8% 77% 85% -8% FCT - %confirmed diagnosis first cancer treatment within 31 days

85% N/A N/A 85% N/A N/A

% radiology results reported within 24 hours 60% 75% -15% 60% 75% -15%

Syst

em In

tegr

atio

n (E

ffec

tive)


YTD Jul-16 Target Var Actual Target Var Average Length of Stay - Acute 3.2 3.5 0.3 3.2 3.5 0.3 Acute Readmissions within 28 days - Total 11% 10% -1% 11% 10% -1% Acute Readmissions within 28 days - 75+ 12% 10% -2% 12% 10% -2% % transcribed clinical summaries (meddocs) authorised <7 days of creation

75% 95% -20% 75% 95% -20%

In preparation for the discussion at the Health Information Committee meeting about the use of the real-time report, some trial groups have been identified to trial the report. The Clinical Director of Kidz First started using this at the end of July. She is able to check at any time and this has reduced the number of letters which have exceeded the 7 day target. The Allied Health managers are early adopters for using this report as well. In the meantime, the Service Manager, Patient Information is contacting staff who have a large number of documents which have breached the target. This work will be ongoing.

% of patients on home wards in General Medicine 43.1% 75% -32% 43.1% 75% -32% % of Outliers on non-medicine wards 7.1% 0.0% 7.1% 7.1% 0.00% 7.1% Quarterly reporting Year Jul-16 Target Var Actual Target Var % eligible stroke patients thrombolysed - Northern Region Target 11% 6% 5% 9% 6% 3% Stroke patients on stroke pathway 81% 80% 1% 78% 80% -2%

Effic

ient

Trend Year Rating Commentary (by exception)

YTD Jul-16 Target Var Actual Target Var % Discharges from transit lounge or home by 1100hrs

18% 30% -12% 18% 30% -12%

APAC nurses continuing to drive the discharges from medicine to the discharge lounge. Working with Charge nurses to proactively identify discharges for the next day.

% MA short stay patients discharged home from Medical Assessment 82% 80% 2% 82% 80% 2% % Discharged from Medical Assessment Unit by 1100hrs 43% 40% 3% 43% 40% 3% % of patients < 28 hrs discharged from inpatient wards 11% <10% 1% 11% 10% 1%

Continue to monitor.

Implement Home First Renal policy - (increase CAPD & HD rate) 95% 70% 25% 95% 70% 25%

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Equi

ty

Trend Volumes Screened % Screened in last 24 mths Rating Commentary (by exception)


% Women with Breastscreen in last 24 months - total

2107 2255 -148 69% 70% -1%

Current coverage for women aged 50-69 years as at 31 July is Maaori 66.7%, Pacific 76.6% and total coverage 68.5%. The national target is 70%. Screening volumes have been lower than target this year due to MRT shortages; we have now appointed 2 new staff members and both are being trained. There is also no screening being carried out at the Mangere sub site whilst awaiting new equipment; this will be opened in September Volumes will increase when the new MRTs are trained and the Mangere sub site is operational, the site was screening 140 women per month when operating 2 days per week. It is also planned to submit a business case for an additional mammography machine and MRT for Manukau SuperClinic. This is required to meet growth due to population increases for screening and also to address increasing demands for mammography due to growth and the need to meet faster cancer treatment targets in the diagnostic service.

% Women with Breastscreen in last 24 months - Maaori

261 269 -8 67% 70% -3%

% Women with Breastscreen in last 24 months - Pacific

507 370 137 77% 70% 7%

P&W



Patient experience Survey data - month (n=22) and YTD (n=22) 77% 90% -13% 77% 90% -13%

Implementation of Advance Care Planning - number of conversations 413 262 151 4,983 3,144 1839

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7.12 Facilities Glossary

AUT Auckland University of Technology CBD Central Business District MHP Manukau Health Park MIT Manukau Institute of Technology NZHPL New Zealand Health Partnerships Ltd. Highlights

Enterprise Asset Management The Asset Management team continues to lead development this area, and are anticipating a good result in the current assessment process from Treasury. The major initiative for this year is the mobilisation of Hyperion for an organisation-wide reporting process for all assets; this project will be supported by Health Benefits Ltd Finance, Procurement and Supply Chain team. The project will initially provide the organisation with the ability to scenario-plan with a 10 year view, and to subsequently manage capital with shorter one to three year views. A presentation to the Audit, Risk and Finance Committee is planned for September when Hyperion will be advanced and an integrated view can be provided. Food Services As previously reported, rollout of the new food service across CM Health is settling. Significant improvements have been made at the patient interface with increased training of Compass Food Service Associates. The transition to ‘Steamplicity’ at the Manukau SuperClinic has been successful and has been positively received. CM Health continues to actively participate with NZ Health Partnerships Ltd (NZHPL) to extend the national contract to other District Health Boards. Hazardous Substance and Compliance The programme of work to improve the management of Hazardous Substances and Compliance across CM Health is progressing well. Current priorities include the development of a Hazardous Substance Management Plan and other key policies and procedures, verification of a recently completed chemical audit, review of Asbestos management, and collaboration with the Procurement team to positively influence the end-to-end process of hazardous substance management. Security Following a successful Proof of Concept test for baby tagging in Maternity, the Security and Asset teams are now considering how this technology can be further utilised across the hospital. The same technology has potential uses for patient tracking, and asset location and movement. A free application is being investigated to provide way-finding assistance for visitors and staff within the hospital buildings. A number of security improvements have been implemented across the Middlemore Hospital site. Of note is the completion of the security upgrade for the Western Campus Carpark building. The

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building can now only be accessed by swipe card, and cameras have been installed to detect access via the ramp and rear entrances. Emerging Issues

Non Clinical Support Major pressure on Orderly and Cleaning services across the hospital has resulted in their budgets being exceeded for the month. Going forward, the provision of unplanned and unbudgeted service will require financial sign-off from the General Manager or Service Manager of the department requiring the additional service provision. Update on previously reported issues

Issue Date reported Update Clinical Engineering workforce shortage

4 May 2016 Exacerbated by two further resignations. Regionalisation of this service is the logical solution if we are to also provide mobile servicing to smaller sites in South Auckland, Waitemata, and Northland along with centralised areas of specialties.

Kiwirail – third rail line 15 June 2016 This development will mean a considerable revamp to the Western Campus traffic flows and traffic flows to and from the train station. A timeline is yet to be determined. This needs to be in context of our Transport Plan going forward on which an initial meeting has occurred with Abley Transportation Consultants. There is a case for a bus loop linking rail, CBD, Middlemore Hospital, MIT, AUT, and MHP. Discussions to occur with Auckland Transport. This would significantly improve vehicular traffic flow in general and Middlemore in particular and could significantly mitigate the growing demand for car parking capacity.

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7.13 Director of Nursing Glossary

ACE Advanced Choice of Employment (new graduate recruitment process) AWM Assignment & Workload Manager (McKesson nursing workload management tool) CNM Charge Nurse Manager DHB District Health Board FTE Fulltime Equivalent This report provides updates on work the Director of Nursing is undertaking, and aligns this work to the organisational strategy of Healthy Together 2020. All areas are working hard to provide high quality nursing care throughout the busy winter period. The regular report will note highlights and successes from Clinical Nurse Directors of hospital services, as well as any other risks or issues within the organisation relating to nursing. Highlights

Middlemore Clinical Trials Sponsorship for Nursing or Midwifery The inaugural winner of the Middlemore Clinical Trials sponsorship for Nursing or Midwifery overseas conference attendance is Denise Beechey, Clinical Nurse Specialist in Renal Transplant. Denise will attend the ‘European Dialysis and Transplant Nursing Association/European Renal Care Association’ International Conference in Valencia, Spain in September 2016. She will present the methods and results of the Live Kidney Donation Aotearoa Project. District Commander’s Certificate of Appreciation In July, Julie Carroll - Clinical Nurse Specialist in Child Protection Service, received a District Commander’s “Certificate of Appreciation” from NZ Police. This centre of excellence supports a one-stop-shop approach for children and young people who have disclosed historical abuse. The centre focus is on supporting better outcomes by streamlining the journey a young person travels after disclosure that involves Police, Child Youth and Family and health. Child Protection facilitates a clinic from this building every week. Julie has been a part of the development of the health area in the Multi-Agency Centre in Manukau since 2013. The award recognises Julie’s contribution to collaborative work with Police and Child, Youth and Family and other agencies. Diversity Ball The Diversity Ball was a very positive event, with many teams enjoying a fun-filled evening. It was great to see that this year’s Motown theme got staff excited. The evening displayed the CM Health values - valuing everyone, excellence, kindness and togetherness and created some great memories. Healthy People, Whaanau, and Families

Patient and Whaanau Centred Care The regional working group has agreed a policy guide for metro Auckland DHBs to recognise Community Participation in consumer engagement activity. This provides consistent principles, definitions, guidance for expenses and reimbursement criteria, and contacts for Community Engagement staff at each DHB.

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A reminder was again sent to all services (Charge Nurse Managers, Social Workers) to proactively ensure that families / whanau of long-term patients and/or their partners in care, who require daily access to Middlemore Hospital and meet criteria are offered the compassionate parking allowance. Recent patient survey results suggest ongoing improvements in ratings for the food services, with surveys now seeing the highest ratings since the new contract commenced. Clinical areas also report steady improvements in responsiveness, meetings special requirements and meal temperatures. In September, Ko Awatea will host a Consumer Council meeting with participants from across New Zealand DHBs. Renee Greaves is presenting a poster on the CM Health Consumer Council at APAC conference in Sydney. Certification A final copy of the Certification 2016 report was received, with no changes made by Ministry of Health, who are yet to confirm next reporting dates. A Certification Forum with the Quality Managers reviewed the Corrective Action report and plan. Work is now underway allocating owners and leads to the correctives actions. Patient Safety The Patient Safety Leadership walk around continues to develop and expand. Recent visits include ward 32, the Critical Care Complex, and the Radiology department. Ko Awatea is assisting with formal evaluation of the model. Interviews with ward CNMs who have been visited have been videoed and shared with stakeholders. The Clinical Handover project to improve the communication during patient transfer from the Emergency Department to wards continues, with seven work streams underway. This collaborative has both clinical and quality improvement input to support change. Hand Hygiene Campaign Results of the June audit are very positive, with the overall rate for all five hand-hygiene moments in the seven gold audit areas at 82%. The Critical Care Complex, Kidz First Medical, Wards 33N and 32N (medical), and the Emergency Department all exceeded the national target (80%). Compliance by health care worker group showed Nursing at 86%, an ongoing improvement on prior audits. Medication Safety The rollout of computers for Medication Rooms to enable nurses to access medication information continues, with 51 areas completed, including 35 areas using a laptop option. Implementation of scanned medication charts versus faxing to pharmacy dispensary continues. Healthy Services

National meetings National DHB Directors’ of Nursing, Health Workforce New Zealand and Nurse Executives, and Health Roundtable meetings have had senior nurse attendance. These meetings and workshops continue to provide networking and strategic planning opportunities.

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Nurse Prescribers The NZ Nursing Council recently announced that the legislation to allow suitably qualified registered nurses, working in collaborative teams to write prescriptions for people with common and long-term conditions, comes into effect on 20 September 2016. These nurses will complete a post-graduate diploma in prescribing, including a period of supervision by an experienced prescriber. The nurse must work in a team with a medical practitioner or a nurse practitioner, from whom they can seek further advice on diagnosis or treatment. They are only able to prescribe from a restricted list of medicines. The specific conditions they will be able to prescribe for include diabetes and related conditions, hypertension, respiratory diseases, anxiety, depression, heart failure, gout, palliative care, contraception, common skin conditions and infections. People will be able to check on the Register of Nurses on the Nursing Council website to see if a nurse is authorised to prescribe. Technology developments A number of local and regional technology developments are progressing, including the continued work on completion of the McKesson upgrades, Care Compass roll-out to more areas of the hospital, and preparatory work with Orion on the regional Concerto upgrades. Ko Awatea is developing an e-portfolio platform for nursing and Allied health. The Ko Awatea Learn site will enable the concept to be taken up widely. The joint work plans to link in the undergraduate portfolios that are currently in the development phase The Director of Nursing is the project sponsor for the Clinical Documentation programme of work which includes the recording of vital signs on a mobile device (e-vitals). A visit to Waitemata DHB to observe their rollout of e-vitals impressed the clinical working group as to the potential of this tool. Further discussions with Canterbury DHB’s experience of this tool is seeing both DHBs sharing and supporting learnings. Nursing Workforce sustainability The September New Entry to Practice (new graduate nursing programme) selection process is underway in conjunction with the national Advanced Choice of Employment (ACE) programme. State examination results will be publicly available in mid-August. All candidates that were successfully matched to CM Health have been notified. There was media coverage in mid-July of an unfortunate and regrettable error with a technology glitch that saw incorrect information sent to some candidates. The national ACE service reassured stakeholders that the issue was promptly identified and rectified. Roster smoothing and support for wards introducing the Assignment and Workload Management (AWM) tool implementation continue. Validation of the AWM data is underway, in conjunction with Ko Awatea, and CM Health will work closely with Waikato DHB, New Zealand Nurses Organisation, and the Safe Staffing Healthy Workplaces Unit to validate and share information and learning. CNMs are now able to view variation reports for their wards that show allocation of workloads against model.

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Other workforce activity and highlights

Workforce metrics A number of nursing workforce metrics continues to be analysed and reported monthly including: Vacancy and Recruitment:

• At the end of July across CM Health there was a total of 164 FTE recruitable vacancies, which includes 39 Senior Nurse roles, 15 FTE Health Assistant roles, 6.1 FTE Midwifery and 104 FTE Registered Nurses. Of this total, 67 FTE are roles working in ambulatory or community/ integrated services.

Nursing leave (which is following anticipated seasonal patterns):

• As anticipated, annual leave use increased from the June rates. Services worked to enable leave for staff during the July school holidays and ensure leave use management balanced the seasonal clinical demands and winter illness for staff.

• Education leave hours were lower than recent months in all areas, reflecting prioritised staff use.

• Sick Leave continues to increase as anticipated for winter months, and affects bureau requests, along with ongoing recruitment to vacancy.

• Overtime use increased, but there is service variation within this, with more use in Mental Health, Kidz First, Acute Care and Surgical areas that broadly aligned with higher sick leave and amounts of annual leave taken in these areas.

Bureau hours and FTE used:

• As anticipated, July saw a small increase in Registered Nurse bureau use FTE (up to 53 FTE of which 8.5 was external), and more use of Health Care Assistants (126 FTE, of which 37 FTE is external). Health Care Assistant use remains largely driven by need for 1:1 patient watches in acute wards – this use again reduced slightly in July - a total of 71 FTE compared to 72 FTE in June, due to ongoing attention to improve processes. Use of watches is consistently greater on Night shifts.

Other highlights

• Surgical Service now have senior nurses in roles to support patient flow, including the acute ward focus on early discharge and Reablement referral, and an elective surgical coordinator to support improved scheduling and reduce variation.

• Kidz First continues to develop and rollout criteria-led discharge process for children admitted with Bronchiolitis. This is a joint Medical and Nursing initiative arising from a Health Round Table project.

• A 12 week pilot of an ‘acute care clinical coach’ nurse role working across Emergency, critical care and wards is showing early promise. This small team of experienced nurses are working from 1200-2000 hours are providing coaching and support for complex patient care skills and critical thinking. The working group has started formally evaluating the model and options for resourcing this.

• Adult Rehabilitation and Health of Older People now have Rainbow volunteers on wards 23 and 24 each day to support rehabilitation patients to access the portal and complete the patient experience survey.

• Critical Care Complex have completed a research project on introduction of the ‘call for concern’ system that encourages patient/families to raise concerns about changes in symptoms with staff. There is positive support to implement this concept.

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counties manukau district health board hospital advisory … · presentation on the certification...

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